Kasus Late PPH HGH

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    Page 1

    Kasus Late PPH

    makmur sitepu

    Divisi Feto-Maternal

    Departemen Obgin FK-USU/RS. HAM

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    Background

    Late Post Partum Haemorrhage is defined as

    abnormal or excessive bleeding from the

    birth canal between 24 hours and 6 weeks

    following the birth.

    Late PPH occurs in 1% of postpartum

    women and commonly occurs between 8

    21 days postpartum.

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    Causes of late postpartum

    hemorrhage

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    A proposed standardized system for reporting

    postpartum ultrasound scan. Adapted from Neill et al.,

    200224

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    Normal Ultrasound Uterine postpartum

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    Endometritis

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    Retained Placental

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    Retained Placental (echogenic mass)

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    Retained Placental and post

    evacuation

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    The management of late postpartum

    hemorrhage

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    Ny. RP, usia 35 tahun. P4A0 datang bersama suami

    dengan keluhan perdarahan pervaginam. Gumpalan

    darah positif. Ny.RP baru melahirkan spontan 2 minggu

    yang lalu

    More Info I:Pemeriksaan fisik :

    Vital sign : sensorium = compos mentis lemah

    TD = 90/70 mmHg

    Nadi = 100x/i , tekanan/volume cukup

    RR = 20x/iTemperatur = afebris

    Hb: 9 gr%, Leokusit: 8.000/ mm3, Thrombosit: 256.000

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    Pemeriksaan obstetri :Inspekulo: vagina licin, servik licin, darah mengalir dari

    ostium uteri eksterna (OUE)VT: Uterus antefleksi, ukuran 10 cm, kontraksi lemah

    Adneksa dan parametrium = tidak ada kelainan

    More Info II : (pada tutorial ke- 2)

    USG : Uterus anteflexi, ukuran 10x8 cm. Dijumpai

    bayangan hyperechoic dalam cavum uteri ukuran 3x2

    cm kemungkinan berasal dari jaringan.

    Adnexa : tidak ada kelainan

    Kesimpulan : Sisa konsepsi

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    Am J Obstet Gynecol. 1990 Sep;163(3):823-5.

    Preterm delivery: a risk factor for retained placenta.

    Romero R, Hsu YC,Athanassiadis AP, Hagay Z,Avila C, Nores J, Roberts A, Mazor M, Hobbins JC.

    Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT

    06510.

    Abstract

    The purpose of this study was to determine whether preterm delivery, with

    and without intraamniotic infection, is a risk factor for retained placenta. This

    complication occurred more frequently in women with preterm vaginaldelivery than in women with term vaginal delivery (9.1% [21/231] vs 1.1%

    [6/561]; p less than 0.00001; odds ratio = 9.25). There was no significant

    difference in the prevalence of retained placenta between women with

    preterm labor and intact membranes and those with preterm premature

    rupture of membranes (8% [10/125] vs 10.4% [11/106]; p greater than or

    equal to 0.05). A positive amniotic fluid culture or clinical chorioamnionitiswas not associated with a higher incidence of retained placenta. This study

    indicates that preterm delivery is associated with an increased risk of

    complications of the third stage of labor.

    http://www.ncbi.nlm.nih.gov/pubmed?term=%22Romero%20R%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hsu%20YC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Athanassiadis%20AP%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hagay%20Z%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Avila%20C%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nores%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20A%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mazor%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mazor%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20A%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nores%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Avila%20C%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hagay%20Z%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Athanassiadis%20AP%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hsu%20YC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Romero%20R%22[Author]
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    Grading Placenta

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    Analisa Kasus

    Late PPH: 2 minggu

    Perbaiki KU

    Antibiotika 12

    24 jam Uterotonika

    Evakuasi dengan kuretase.

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