Wrapup Sk1 Perdarahan Kehamilan Emergency A5
Transcript of Wrapup Sk1 Perdarahan Kehamilan Emergency A5
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KETUA : SITI RAFIQAH FAJRI 1102012282
SEKRETARIS : MARGIANTI 1102011154
ANGGOTA :EVA AMANDA RAHMAWATI 1102007103 ORIN ARCHI 1102010215
ANUM SASMITA 1102012025
AKBAR A!MAESA"A 1102012014
MUHAMMAD JIHAD B 1102012178
UTRI HANDA!ASAKTI 110201221#WIDIA SAT$A SUR$A 11012012305
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SKENARIOPERDARAHAN PERSALINAN
S%&'()* +(,-%) .,-( 27 /(.) (/()* % IGD RSUD %)*() %.() )%'- +(( +%'./
,%( 3 (6 ()* (. -,%'/(- %)*() %.(' ('( ('- %6(.() U,-( %(6-()
--/.)* ('- (- /%'(-' -(+(/() 34 6-)**. (,-%) 6%(.() A)/%)(/( C('% -
+.,%,6(, ,%()( 4 (- () /%'(-' &)/'& ,(/. 6-)**. ()* (. (,-%) .*(
+%'*- % +('(- () +%'-,( /%'(-' ,%%.6 % RS .)/. - .'./ S%(6( %(6-() +(,-%) 6%)*((6- %)(-() %'(/ (() 10 * () /-( (( %%6( +(( /.)*(- D('-
'-9((/ +%)(-/ %.('*( -%/(.- /-( (( '-9((/ +%)(-/ ()/.)* *-)( DM ()
-+%'/%),- ((6 %.('*()( D-(.() +%6%'-,(() ;-,- %)*() (,- +(,-%) /(6+(
,(-/ ,%()* () - (+(/() /%()() ('( 110-, /-( (( S%()./)( - (.()
+%6%'-,(() +%).)()* USG %)*() (,- %(6-() /.)**( %)*() ()-) +'%,%)/(,-
%+(( () (,- +%6%'-,(() (&'(/&'-.6 -(+(/() +'&/%-) .'-) )%*(/-; D('-
+%6%'-,(() CTG -(+(/() %,() *(9(/ ()-)
■
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Sasaran belajar
LI.1. Memahami dan menjelaskan perdarahan pada kehamilan
LI.2. Memahami dan menjelaksa tatalaksana pada kasus di
skenari
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LI.1. Memahami dan menjelaskan perdarahan padakehamilan
A. Perdarahan pada kahamilan muda
%'('(() +(( %(6-() 6.( /%'(- +(( .,-( *%,/(,- 206-)**. %)%( &)-,- -)- ((( (&'/., 6&( -(/-&,(
(/(. %(6-() %/&+- /%'*()**.
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1. A!"R#$S
De%inisi
A&'/., ((( %.(')( (,- +%6.(() ,%=('( ,+&)/() ,%%.6
6(6+. %'/(() -.+
Etil&i
T%'(- +%'('(() +(( %,-.( (,(-, ()* -,%'/(- %)*() )%'&,-,
('-)*() ,%-/(')( S%(-) -/. &>.6 /%'%+(, () ( /%',%./
6%'()*,()* &)/'(,- ./%'., ,%-)**( 6%)%(() %,+.,- ('-)*()
B%'(*(- ;(=/&' /%'-(/ ((6 +'&,%, -)- :
■ F(=/&' ;%/., : %(-)() '&6&,&6
■ F(=/&' 6(/%')( : -);%,- +%)(-/ '&)-, +%)(-/ %)&'-)?-+&/-'&- -(%/%,@ )./'-,- &(/&(/() ;(=/&' -)*.)*() ?'&&
(=&& /%6((. '(-(,- &)/'(,%+,-@ ;(=/&' -6.)&&*-,
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Jenis
abortus
Perdarahan serviks Hasil
konsepsi
Besar uterus Gejala lain
Abortus
iminens
Sedikit -
sedang
tertutup Masih di
dalam uterus
Sesuai usia
kehamilan
Kram, dan
nyeri perut
Nyeri
punggung
bawahAbortus
insipient
Sedang -
banyak
terbuka Masih di
dalam uterus
Sesuai atau
lebih keil
dari usia
kehamilan
Kram dan
nyeri perut
Abortus
inkomplit
Sedikit -
banyak
terbuka Keluar
sebagian
!ebih keil
dari usia
kehamilan
Kram dan
nyeri perut
Keluar
"aringanAbortus
komplit
Sedikit # tidak
ada
tertutup Keluar
seluruhnya
!ebih keil
dari usia
kehamilan
Nyeri dan
kram perut
tidak
dirasakan
atau hanya
sedikit bila
ada$
%terus agak
kenyal
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Dia&nsis
A)(6)%,-, : '-9((/ %(6-() () (&'/., ,%%.6)( .6( +%'('(() ('-)*() ()* %.(' '-9((/ /'(.6( ()
+%)**.)(() &(/&(/() %6%'-,(() &,/%/'-= () *-)%&&*- : 6().>%' %&+&
%)./ ()/.)* ()-) () -),+%,- &,/-.6 ,%'>-,
%6%'-,(() +%).)()* :
I D('( +%'-;%' %)*(+ : ((' H .)/. 6%)-(- ()%6-(%.&,-/ () (. %)(+ ('( .)/. (&'/., ,%+/-
II %6%'-,(() %(6-() : ((' CG (+(/ -*.)(() .)/.6%6%'-,( %(6-()
IIIU/'(,&)&*'(;- : 6%-(/ ()/.)* *%,/(,- %6'-& %)./ ()/.)* () ,%(*-)(
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#atalaksana
1 A&'/., -6-)%), < 6%)*()=(6
T-'( ('-)*
A)(*%,-= .)/. 6%'%(() )%'-
%6%'-,(() ((' CG () +'&*%,/%'&)% -(6%6.)*-)()
E>(.(,- %(6-() (+(-( +%'('(() %'(/ %)*() ()%6-(() +&>&%6-(
2 A&'/., -),-+-%)/ () (&'/., -)&6+-/
E>(.,- ,-,( (,- &),%+,- %)*() .'%/(,% /((6 (/(. (,+-'(,-
>(.6 6().( .'%/(,% (+(/ -(.() %)*() 6%)**.)(() & +('(,%'>-( ?()(*%,-@ () -);., 1020 U &,-/&,-) ((6 N(C! 0
(( +(,-%) %)*() +%'('(() ()* /-(( /%'&)/'& (,-&),%+,- ('., ,%*%'( -%>(.(,-
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3 A&'/., &6+-/
A+(-( -(*)&,-, ,.( -+(,/-() (&'/., &6+-/ /-( +%'.6%(.() /%'(+- (+(+.)
J-( %.6 -+(,/-() (+(/ -(.() +%6%'-,(() USG.)/. &);-'6(,-
4 M-,,% (&'/.,
(( /'-6%,/%' %.( ./%'., -&,&)*() %)*() 6%/&%-(/(,- () %>(.(,- S%'>-, -+%',-(+() %)*()6%)**.)(() 6-,&+'&,/& () (/(. -(/(,- +(,-; %)*()(6-)('-( S%/%( -/. -(.() %>(.(,- ,%=('( 6%()-,
--() (-) %>(.(,- %)*() -).,- %(-'() 6%)**.)(()
GE2 +%'>(*-)(6
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5 A&'/., ,%+/-
'-),-+ /%'(+- : %>(.(,- ./%'., () ()/--&/-= +('%)/%'(?,%%.6 ,%(6( () ,%,.( +%6%',-() ('-)*() )%'&,-,
%)*() .'%/(,%@ --() ()/--&/-= :- A6+-,--) &'( 500 6*-, ('( () +'&. &),%+,- '&)/*%) (&6%)
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Pr&nsis
(( (&'/., -6-)%), ()-) -(,()( 6(,- (+(/ -,%(6(/() %'*()/.)* +(( .6( +%'('(() ()* -((6- ,()* -.
'&*)&,-, -. +(( (&'/., -6-)%), .*( (- (( (&'/%-),-+-%)/ -)&6+-/ () &6+-/ +'&*)&,-, ,()* -. (-
'mplikasi
%'('(() %(/ () +%',-,/%) ,%+,-, -);%,- ,-)%-(
-)/'(./%'-)% -);%'/--/(, +%';&'(,- -)-)* ./%'., ,%'/( =%%'(.,., () ().)* %6-
Pen(e&ahan
A).'() -. .)/. 6%(.() +%6%'-,(() (9( %(6-()
%'-).)*() /%'((+ +(+('() ((/ -6-(
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2. M"LA HIDA#"SA
De%inisi
K%(6-() ()&'6( ()* 6%6--- ('(/%' ,%+%'/- .(
()**.' ,%'/( ./%'., ()* 6%)*((6- -,/%),- B-(,()( /-((( ()-) -)/( ()* /%'%)/. S-)&)- 6 )( ((( (6-()**.' M&( -(/-&,( (+(/ &6+-/ (/(. +(',-( (( 6&(()* +(',-( %6'-& 6(,- /%'%)/.
)aktr resik
%'%6+.() .,-( 20 /(.) (/(. 40 /(.) ).-+('( ,/(/.,%&)&6- '%)( -%/ '%)( +'&/%-) (,(6 ;&(/ '%)( ()((' ('&/%) ('( '%)(
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Pat%isil&i
S(6+(- ,((/ -)- %.6 -%/(.- ,%=('( +(,/- /%'(-)( 6&(-(/-&,( A( %%'(+( /%&'- ()* 6.)=. .)/. 6%)%(,()
/%'(-)( &)-,- -)- (( /%&'- 6-,,% (&'/-&) ()-) ()*/%'%)/. 6(/- +(( 6-)**. %3 ,(6+(- 5 %(6-()A-(/)( /%'(-( *()**.() +%'%('() ('( ,%-)**(=(-'() /%'/-6.) ((6 ('-)*() 6%,%)-6 >-- T%&'-)%&+(,6( 6%)%(,() /%'(-)( ()&'6(-/(, ,% /'&;&(,
() ;.)*,-)( ,%-)**( /%'(- '%,&',- =(-'() ((6 .6( %'%-() %((6 >-- A-(/)( 6.)=. *%%6.)**%%6.)* ()* 6%)**()**. +%'%('() ('( ,%()./)(/%'(- %6(/-() ()-)
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Mani%estasi klinis
%'('(() ./%'., ()&'6( +(( /'-6%,/%' +%'/(6( ?0 +(,-%)@
M.( () 6.)/(
U.'() ./%'., %- %,(' ('-+(( .,-( *%,/(,-
%6%,('() ,(/. (/(. %.( &>('-.6 ('%)( -,( /%( ./%-)?+(( 1530 +(,-%)@
S%(*-() %=- +(,-%) 6%)*((6- +'%%(6,-( (/(.-+%'/-'&--,6%
Pemeriksaan penunjan&
%6%'-,(() ((' CG ()* 6%)-)*(/ USG : *(6(('() ,%+%'/- ((- ,(. ?,)&9;(%,@ (/(. ,('()*
%( ?&)%=&6@ /-( (()( ()/.)* *%,/(,- (/(. ;%/.,
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#atalaksana
B%*-/. /%'%/(,- 6&( -(/-&,( ('., ,%*%'( - %>(.(,---() ./(6( ((( %)*() 6%)**.)(() (,+-'(,- >(.6
,%/%( ,%(*-() %,(' 6(,,( %.(' -%'-() &,-/&,-)-)/'(>%)( -()./() ,(6+(- 24 (6 ,%/%( %>(.(,- A+(-(-+%'.() ('-)*() .)/. -,/&+(/&&*- .'%/(,% /((6 (+(/-(.() %'('(() ()* 6.)=. ('- +'&,%.' .'%/(,%6&( -(/-&,( -(,()( %'.6( ,%()*A+(-( 6&(
-(/-&,( ()* %,(' ? 12 6-)**. %(6-()@ -%>(.(,-%)*() (,+-'(,- >(.6 (+('(/&6- ('., -,-(+() A+(-(/%'(- +%';&'(,- (/(. +%'('(() -,/%'%/&6- -,/%'&/&6-,%'/( -*(,% ('/%'- S%/%( %>(.(,- +%6%'-,(() CG ,%'-(('., -(.() ,(6+(- ((')( /-( /%'%/%,- (*-
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*. 'EHAMILAN E'#"PI'
De%inisi
T%'(-)( -6+()/(,- &>.6 -.(' '&)**( ./%'., ,%()(
5 %(6-() %/&+- /%'(- - /.( ;(&+- ,%()*() 5,-,()( /%'-,/'-.,- - &>('-.6 ,%'>-, () '&)**(
+%'-/&)%.6
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Etil&i dan )aktr Resik
Resik tin&&i Resik sedan& Resik rendah
R-9((/ &+%'(,- /.( I);%'/--/(, R-9((/ &+%'(,- +()**. <
(&6%)
S/%'--,(,- R-9((/ -);%,- *%)-/( M%'&&
R-9((/ %(6-()
%/&+-
(,()*() ,%,.(1 K%-(,(() -(, >(*-)(
(+('() -%/- ,/-%,/'& -)
./%'&
S%--/ ,(6+(- /-( (( U,-( +%'/(6( (-
%'..)*() ,%, 18
/(.)
%)**.)(() (' T-((( T%'/./.+
A()( +(/&&*- +((
/.(
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Pat%isil&i
R.+/.'% -(,()( /%'(- ,+&)/() () (9-/() '.+/.'%-+%)*('.- &(,- -6+()/(,- A+(-( - -,6., 9(/. '.+/.'%
-(,()( +(( 6-)**. % # %(6-() ,(6+(- 8 ('%)(-(6%/%')( '%(/->% %=- I6+()/(,- - (6+.( -(,()('.+/.'% +(( 6-)**. % 8 ,(6+(- 12 %(6-() ,%()*() --)/%',/-/-.6 +(( 6-)**. % 12 ,(6+(- 1# %(6-()%'('(() +(( '.+/.'% -)/%',/-/-.6 %- 6(,,-; ('%)( %-
%(/ %)*() +%6.. ('( ./%'., () &>('-.6 S%/%('.+/.'% (,- &),%+,- (+(/ -,%'(+ (/(. /-)**( 6%)(-6(,,( +(( (&6%)
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Mani%estasi klinis
N%'- -(,()( /%'(- ('%)( '.+/.'% D(+(/ %',-;(/ -(/%'(.)-(/%'( &=( (/(.+.) 6%)%.'.
%'('(() ('- >(*-)( -(,()( %'=(%'=( ?,+&//-)*@
S-&+ 6%'.+(() /()( +%'('(() ()* %- ()./
A&6-)( () +%>-= /%)%')%,, (+(/ -;., 6(.+.)/%'&(-,(,-
%'.(() ./%'., (+(/ 6%6%,(' () 6%.)( ,%+%'/- +((%(6-()
I),/(--/(, /()( >-/(
T%'(()( 6(,,( +(( ()%,(
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Pemeriksaan penunjan&
D('( +%'-;%' %)*(+ : %6&*&-) (/(. %6(/&='-/ .)/.,'-)-)* %*(9(/('.'(/()
%6%'-,(() %(6-() : CG +&,-/-; +(( %(6-()%/&+-
%6%'-,(() .,., : USG .)/. 6%6%(() %)*()%(6-() )&'6( (&'/., () -*/% &>.6 M&-/(,
+%6%'-,(() (-))( ()/('( (-) (+('&,&+- () MRI
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#atalaksana
A( %%'(+( %)-, /(/( (,()( ()* -(.() +(( %(6-() %/&+- :
T(/( (,()( 6%-,
M%/&/'%,(/ .)/. 6%)*()=.'() /'&;&(, ()* ,%()* %'+'&-;%'(,-O(/ /%',%./ --)-(,-() +(( %(6-() %/&+- ()* /-(( '.+/.'%%=- ?()/.)* *%,/(,- 35 =6@ () (,-6/&6(/-, K&)/'( -)-(,-(+(-( /()( >-/( /-( ,/(- (( +%)(-/ *-)( +%)(-/ (/- )%'-
+()**. +%)(-/ .., +%+/-.6 () +%)(-/ +('.
T(/( (,()( %(
D-(.() (+(-( +(,-%) 6%6--- &)/'(-)-(,- /%'((+ /(/( (,()(6%-, '&,%.' &+%'(,- -(.() %)*() (+('&,&+- (/(. (+('&/&6
%'*()/.)* +(( ,/(- (/(. /-()( &)-,- +(,-%) --() /-)(()-(.() %'(,('() %/( -6+()/(,- %,(' ()/.)* *%,/(,- -)/( (/(.
/-()( %(6-() T(/( (,()( %6%'*%),-
D-(.() %/-( -(*)&,-, %(6-() %/&+- %)*() +%'('(()-/%*(() (( +(,-%) %)*() /()( >-/( ()* /-( ,/(- .*(-(.() /(/( (,()( %6%'*%),-
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!. Perdarahan pada kehamilan tua
%'('(() +(( %(6-() /.( ((( +%'('(() ()* /%'(-
+(( %(6-() 20 6-)**. %)%( &)-,- -)- ()/('( (-) :
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1. Plasenta pre+ia
De%inisi
(,%)/( ()* /%'-6+()/(,- %(/ (/(. +(( &,/-.6 ,%'>-, -)/%')( A( %%'(+( %/( +(,%)/( +'%>-( :
(,%)/( +'%>-( /&/( : &,/-.6 ,%'>-, -)/%')( /%'/./.+ ,%.'.)(( &% +(,%)/(
(,%)/( +'%>-( +(',-( : &,/-.6 ,%'>-, -)/%')( /%'/./.+ ,%(*-() &% +(,%)/(
(,%)/( +'%>-( 6('*-)(-, : ..)* +(,%)/( %'(( +(( /%+- &,/-.6 ,%'>-,-)/%')(
M%).'./ W-)&,(,/'& ?2002@ (=%)/( '%>-( ((( +(,%)/( ()* %/()(()&'6( (-/. +(( ,%*6%) (9( ./%'., ,%-)**( 6%)./.+- ,%(*-() (/(.,%.'. +%6.(() (() (-' M().(( ?18@ 6%)*%6.(() (9(
+(,%)/( +'%>-( ((( +(,%)/( %)*() -6+()/(,- - ,%-/(' ,%*6%) (9('(-6 ,%-)**( (+(/ 6%)./.+- ,%(*-() (/(. ,%.'. &,/-.6 ./%'- -)/%').6(,%)/( +'%>-( ((( +(,%)/( ()* %'-6+()/(,- +(( ,%*6%) (9( '(-6() 6%)./.+- ,%(*-() (/(. ,%.'. &,/%.6 ./%'- -)/%').6 ?S(-;.-) 2002@
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'lasi%ikasi
%6(*-() +(,%)/( +'%>-( 6%).'./ /-)*(/())( :
1 T-)(/ 1 +(,%)/( +'%>-( %/( '%)( ?+(( +%6.(() 4 =6
..)* ('- (+(/ 6%'(( /%+- +(,%)/(@
2 T-)*(/ II +,%)/( +'%>-( 6('*-)(-, /%+- +(,%)/( %'-6+-/()%)*() /%+- +%6.(() .. -*.)(() +%6.(() 4 =6
3 T-)*(/ III +(,%)/( +'%>-( +(',-(-, +(,%)/( 6%)./.+-
,%(*-() +%6.(() 4 =6
4 T-)*(/ IV +(,%)/( +'%>-( /&/(-, ,%.'. &,/-.6 ./%'--)/%').6 /%'/./.+ &% +(,%)/( +(( +%6.(() 4 =6
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M%).'./ C(- ?2002@ (,-;-(,- +(,%)/( +'%>-( -(,('()(/(, /%'(()( ('-)*() +(,%)/( 6%(.- +%6.(() (()(-' :
( (,%)/( '%>-( T&/(-, (-/. +(,%)/( ()* 6%)./.+- ,%.'.&,/-.6 ./%'- -)/%').6
(,%)/( '%>-( ('/-(-, (-/. +(,%)/( ()* 6%)./.+-,%(*-() &,/-.6 ./%'- -)/%').6
= (,%)/( '%>-( M('*-)(-, (-/. +(,%)/( ()* /%+-)( (*( (. %/()( () 6%)./.+- ,%(*-() &,/-.6 ./%'- -)/%').6
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)aktr resik
1 U,-( +%)%'-/(
U6.' 6.( ('%)( %)&6%/'-.6 6(,- %.6 ,%6+.')(
U6.' -(/(, 35 /(.) ('%)( /.6. %)&6%/'-.6 ()* .'()*,..'
2 ('-/(,
(( +('-/(, ()* /-)**- %(-() +(,%)/( +'%>-( 6(-) %,('('%)( %)&6%/'-.6 %.6 ,%6+(/ /.6.
3 E)&6%/'-.6 ()* =(=(/
B%(, +%',(-)() %'.()* %)*() ('( +%)%
B%(, &+%'(,- %(, .'%/(,% (/(. +(,%)/( 6().( %'.(() %)&6%/'-.6 +(( 6-&6( ./%'- (/(. +&-+
(( %((() 6()./'-,-
4 K%-(,(() 6%'&&
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Pat%isil&i
I6+()/(,- +(,%)/( - ,%*6%) (9( R(-6 ,%-)**(6%)./.+- ()(-, ,%'>-(-, () 6%)**()**. +'&,%, +%',(-)()
%)*() /%'(- +%'('(() I6+()/(,- +(,%)/( - ,%*6%) (9( R(-6 (+(/ -,%(() &% %)&6%/'-.6 - ;.).,./%'- %.6 ,-(+ 6%)%'-6( -6+()/(,- %)&6%/'-.6 ()* /-+-,,%-)**( -+%'.() +%'.(,() +(,%)/( .)/. 6(6+.6%6%'-() )./'-,- ()-) >-- &'%(-, +(( &'-&) %(>% ()*
+%',-,/%)
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Mani%estasi klinis
%'('(() /()+( '(,( )%'-
(,%)/( +'%>-( -(,()( %'(,&,-(,- %)*() -6+()/(,- +(,%)/(
()* ()&'6( :
1 (,%)/( ('%/( : >-->-- +(,%)/( 6%)%6+% +(( 6&6%/'-.6
2 (,%)/( -)'%/( : >-->-- +(,%)/( 6%)*-)>(,- 6-&6%/'.6
3 (,%)/( +%''%/( : >-->-- +(,%)/( 6%)%6., 6%%9(/-6&6%/'-.6
B%)/. +%'('(() (+(/ ,%--/ (/(. ()( () 6%)-6.() +%).-/ +(( ()-) 6(.+.) -. %).-/ +(( -. (+(/6%)-6.() ()%6-( ,(6+(- ,& S%()*() +(( ()-) (+(/
6%)-6.() (,;-,-( ,(6+(- %6(/-() ()-) ((6 R(-6
%(-)() %/( ()-) ((6 R(-6
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4 Pemeriksaan khusus kebidanan
%6%'-,(() +(+(,- (&6%) ?()-) %.6 =..+ .() /-)**- ;.).,./%'- ,%,.(- %)*() .,-( %(6-() K('%)( +(,%)/( - ,%*6%) (9(R(-6 6(( (+(/ -.6+(- %(-)() %/( ()-) - ((6 R(-6 ()
(*-() /%'%)( 6(,- /-)**-@
%6%'-,(() %)./ ()/.)* ()-) %'>('-(,- ('- )&'6( ,(6+(-(,;-,-( () %6(/-() ((6 R(-6
%6%'-,(() ((6 -(.() -(/(, 6%( &+%'(,- () ,-(+ .)/.
,%*%'( 6%)*(6- /-)(() T..() +%6%'-,(() ((6 : .)/.6%)%*(() -(*)&,-, +(,/- 6%6+%',-(+() /-)(() .)/.6%(.() &+%'(,- +%',(-)() (/(. ()( 6%6%=(() %/.() H(,-
+%6%'-,(() ((6 /%'(( +(,%)/( ,%-/(' &,/-.6 ./%'- -)/%').6
%6%'-,(() +%).)()* ?+%6%'-,(() ./'(,&)&*'(;- 6%)*.'()*-
+%6'-,(() ((6 6%)%*(() -(*)&,-,@%6%'-,(() ,/()(' (. .)/. +(,%)/( +'%>-( ((( %)*() USG
(- USG /'(),(&6-)( /'(,>(*-)( 6(.+.) /'(),+%'-)%(
USG /'(),>(*-)( () /'(),+%'-)%( (+(/ 6%6()/. -(*)&,-, +(,%)/( +'%>-( ()* %/()( +&,/%'-&'
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Dia&nsis bandin&
,ejala dan tanda )aktr predispsisi Pen-ulit lain Dia&nsis
Perdarahan tanpa n-eri/ usia
&estasi 02 min&&u
Darah se&ar
Perdarahan dapat terjadi
setelah miksi atau de%ekasi/
akti+itas %isik/ kntraksi bratn
hi(ks atau kitus
6./-+('(
6-&6( ./%'-
.,-( ()./
.'%/(,% %'.()*
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6%'&&
S&
+%'('(() ,%/%( &-/.,
T-( (( &)/'(,-
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B-,( /%'(- *(9(/ ()-)
Plasenta
pre+ia
Perdarahan den&an n-eri
intermitten atau menetap
3arna darah kehitaman dan
(air/ tapi mun&kin ada bekuan
jika slusi relati% baru
4ika stium terbuka/ terjadi
perdarahan ber5arna merah
se&ar.
Hipertensi
+ersi luar
#rauma abdmen
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&emelli
de%isiensi &i6i
S-k -an& tidak sesuai
den&an jumlah darah
7tersembun-i8
anemia berat
Melemah atau
hilan&n-a den-ut jantun&
janin
&a5at janin atau
hilan&n-a den-ut jantun&
janin
$terus te&an& dan n-eri
Slusi
plasenta
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Dia&nsis bandin&
Perdarahan intraabdminal
dan9atau +a&inal
N-eri hebat sebelum perdarahan
dan s-k/ -& kemudian hilan&
setelah terjadi re&an&an hebat
pada perut ba5ah 7kndisi ini
tidak khas8
Ri5a-at seksi
sesarea
Partus lama atau
kasep
Disprprsi
kepala 9%etpel+ik
'elainan
letak9presentasi
Persalinan
traumatik
S-k atau takikardia
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intraabdminal
Hilan&n-a &erak atau
den-ut jantun& janin
!entuk uterus abnrmal
atau knturn-a tidak jelas.
N-eri raba9tekan dindin&
perut dan ba&ian2 janin
mudah dipalpasi
Ruptur uteri
Perdarahan ber5arna merah
se&ar.
$ji pembekuan darah tidak
menunjukkan adan-a bekuan
darah setelah : menit
Rendahn-a %aktr pembekuan
darah/ %ibrin&en/ trmbsit/
%ra&mentasi sel darah
slusi plasenta
janin mati dalam
rahim
eklamsia
embli air ketuban
perdarahan &usi
&ambaran memar ba5ah
kulit
perdarahan dari tempat
suntikan jarum in%us
,an&&uan
pembekuan
darah
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#atalaksana
1 S%6.( +(,-%) %)*() %=.'-*(() +(,%)/( +'%>-( -'.. % ,+%,-(-,&,/%/'-= () *-)%&&*- .)/. -(*)&,-, ,%'/( /(/( (,()( --() /(/((,()( %'*()/.)* +(( .,-( %(6-() :
A+(-( +%'('(() /%'(- +(( 6(,( %(6-() %- (9( -(,()(-%'-() /'(),;.,% () /&&-/- ,(6+(- .,-( %(6-() 3234 6-)**.
(( .,-( 34 6-)**. -+%'/-6()*() ()/('( '%,-& +%'('(() ((66(/.'(,- ().)*()
W(/. %(-'() -(,()( -/%)/.() /-)*(/ %6(/()*() +('. ()-)M(/.'(,- +('. -(.() %)*() +%6%'-() %,(6%/(,&) 212 6* IM((6 ('( 24 (6 (/(. %,(6%/(,&) 4# 6* +%' &'( ,%(6( 2 ('-
Pilihan (ara kelahiran :
S%,-& ,%,('%( 6%'.+(() =('( %(-'() /%'+-- +(( (,., +(,%)/( +'%>-(
K%(-'() +%' >(*-)(6 (+(/ -(.() +(( (,., +(,%)/( +'%>-(6('*-)(-, %)*() +'%,%)/(,- %+(( (( =('( -)- ,%(+./ %/.()
-(,()( -+%=(() /%'%- (.. .)/. 6%'()*,()* %(-'()
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#indakan +(( +(,%)/( +'%>-( :
( T-)(() (,(' .6.6 M%6()/(. /%()() ('( )(- ()%6&*&-) 6%6%'- &,-*%) 6%6(,()* -);.,% 6%6%'
%,+()%' +(,6( (/(. ,%'.6 ()* -(9%/() U,((() +%6%'-() ('( %)*(+ ()* /%( -(9%/() ((6 .6(6%)=..+-
(( +%'('(() ()* 6%)*()=(6 )(9( ,%,-& ,%,('%(,%*%'( -(.() ,%/%( +%)*&(/() ,& -6.(-
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= (( +%'('(() ()* /%/(+ %(/ (/(. 6%)-)*(/ ('%)( +(,%)/( +'%>-( /&/(-, (/(. +(',-(-, ,%*%'( (.() ,%,-&,%,('-( ('%)( +(,%)/( %/( '%)( ?+(,%)/( /-( /%'-(/ -(%(' 6../ ,%'>-, ,%-/(' 45 =6@ +%=(() ,%(+./ %/.()() %'-() -);.,% &,-/&,-) -( +%'('(() /-( %'%)/-(.() +%',(-)() +%'>(*-)( %)*() ;&',%+ (/(. %,/'(,->(.6 -( +%'('(() /-( %'%)/- (.() ,%,-& ,%,('-(
T-)(() ,%/%( 6%(-'()
1@ C%*( ,& ?,& %6&'(*-@
2@ ()/(. .'-) %)*() (/%/%' 6%)%/(+
3@ ()/(. ,-,/%6 &(*.(,- ?&(*.&+(/-@
4@ (( (- +()/(. %6&*&-) -/.)* %'-/'&,-/ () %6(/&'-/
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#erapi
T%'(+- (/(. /-)(() /%'((+ *()**.() -)- -(.() - /%6+(/ +'(/-
(( (,., +%'('(() ()* ()( +%)*&(/() ,& ((( %)*() -);.,%M(='&%L %'-,/&) H(%6(==% (,6(*% (,6(;.-) (( (,., +(,-%)*%-,( -%'-() 10 6* >(-.6 ?-(%+(6@ IM (/(. IV ,%=('( +%'(()
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'mplikasi
M(/%')( : +%'('(() ,& %6(/-() -);%,- %6&- ,&.,-& +(,%)/(
F%/., : +'%6(/.'% %6(/-() +%'('(() ()-)
K&6+-(,- ()* (+(/ /%'(- +(( -. (6- %)*() +(,%)/( +'%>-(((( :
( %'('(() () ,&
I);%,-
= !(,%'(,- ,%'>-, '%6(/.'-/(, (/(. (-' 6(/-
Pr&nsis
'&*)&,-, 6(/%')( -(,()( (- '&*)&,-, (& %'*()/.)* +(( .,-(%(6-() (( (,., +'%6(/.'% +(,%)/( +'%>-( 6%)(- +%)%( ./(6(%6(/-() +%'-)(/(
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2. S"L$SI" PLASEN#A
De%inisi
T%'%+(,)( +(,%)/( ,%%.6 9(/.)( %)*() -6+()/(,- )&'6( +((
%(6-() /'-6%,/%' %/-*( T%'%+(,)( +(,%)/( ,%%.6 9(/.)(6%)%(() (.6.(,- ('( ()/('( +(,%)/( () -)-)* R(-6 ()*(+(/ 6%)-6.() *()**.()*()**.() +%).-/ /%'((+ -. 6(.+.)
()-)
'lasi%ikasi
D%'((/ ,&.,-& +(,%)/( :
1 D(+(/ 6%)*%.('() ('( ('- &,/-.6 ./%'- %(6-()
2 T%'/./.+ ('%)( +%'('(() ()( +(( '%/'&+(,%)/('
3 G(.)*() ,%(*-() +%'('(() (() N(6+( () ,%(*-() '%/'&+(,%)/('
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)aktr resik
R-9((/ ,&.,-& +(,%)/( ,%%.6)(
H-+%'/%),- +(( %(6-()
U,-( -. ()* /.( () 6./-+('-/(,
D-,/%),- ./%'., ?*%,/(,- 6./-+% -'(6)-&)@
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M%'&& &),.6,- (=&& () +%)**.)((() &(-)
B%',(6(() %)*() +'%%(6,-( () %(6,-(
T%()() >%)( =(>( -);%'-&' ()* /-)**-
K%.'()*() (,(6 ;&(/
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Etil&i
1 T'(.6( ()*,.)* /%'((+ ./%'., (6-
T%'(/. /%'./(6( /%.)*.+
T%)()*() ()( ()* ,%()* -*%)&)*
2 T'(.6( %-()() ('/-)( ,&.,-& +(,%)/( /%'(- ('%)( /-)(()%-()() ()* -(.() :
S%/%( >%',- .('
S%/%( 6%6%=(() %/.() %',(-)() ()( %.( (6- %6('
3 D(+(/ /%'(- +(( %(6-() %)*() /(- +.,(/ () +%)%
P t %i i l i
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Pat%isil&i
■ M%()-,6% +%'/(6( ((( %(, +(( +%6.. ('( ()* 6%)%(()'.+/.'% +%6.. ('( %,-.( (,(-, H%6(/&6( 6%)%(() '&%()
+(( +%6.. ('( ,%-/(')( ,%-)**( 6%6+%'()( +%'('(() ()
6%6+%'.(, ('%( ()* /%'+-,(
■ M%()-,6% ,%()./)( ((( /%()() >%)( ()* 6%)-)*(/ %)*() =%+(/-/%'.,() % '.()* -)/%'>-- ,%-)**( /%'(- +%%('() +(( >%)(>%)( ()/%'(-( +%6-,(() +(,%)/(
■ M%()-,6% (-))( ((( ;(=/&' 6%()- ,%+%'/- /'(.6( (/(. /'(,- /(- +.,(/ ()* +%)%
Pen-ulit terhadap ibu Pen-ulit terhadap janin
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Pen-ulit terhadap ibu Pen-ulit terhadap janin
1. !erkuran&n-a darah dalam sirkulasi darah
umum
2. #erjadi penurunan tekanan darah/
penin&katan nadi dan pernapasan
*. Ibu tampak anemis
;. Dapat timbul &an&&uan pembekuan darah/
karena terjadi pembekuan intra+askuler
diikuti heml-sis darah sehin&&a %ibrin&en
makin berkuran& dan memudahkan
terjadin-a perdarahan 7hip%ibrin&enemia8
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Mani%estasi klinik
1 S&.,-& +(,%)/( rin&an
T%'%+(,)( +(,%)/( .'()* ('- .(,)(
T-( 6%6%'-() *%(( -)- () -/%6.() ,%/%( +%',(-)() K%((() .6.6 -. () ()-) /-( 6%)*((6- *()**.()
%',(-)() %'(() %)*() ()=%' +%' >(*-)(
2 S&.,-& +(,%)/( sedan&
T%'%+(,)( +(,%)/( %- ('- /%/(+- %.6 6%)=(+(- 2
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3 S&.,-& +(,%)/( berat
!%+(,)( +(,%)/( %- ('- 2%(-'% ./%'., /%'(- *()**.() &)/'(,-() (/&)-( ./%'-
Di i
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Dia&nsis
1 Anamnesis : /%'(+(/ +%'('(() -,%'/(- '(,( )%'- /%'(- ,+&)/() (/(.('%)( /'(.6( +%'./ /%'(,( )%'- --./- +%).'.)() ,(6+(- /%'%)/-)(*%'(() ()-) ((6 R(-6 %'('(() +%'>(*-)(6 &)/'(,- ./%'., ()
)%'- (&6%)
2 Pemeriksaan :
%6%'-,(() %isik umum : %((() .6.6 +%)%'-/( /-( ,%,.(- %)*() .6( +%'('(() /%()() ('( 6%).'.) )(- () +%')(+(,()6%)-)*(/ +%)%'-/( /(6+( ()%6-,
%6%'-,(() khusus : +(+(,- (&6%) ?+%'./ /%*()* /%'.,6%)%'., /%',()%'- ,((/ -+(+(,- (*-() ()-) ,.(' -/%)/.()@ (.,./(,- ?%)./
()/.)* ()-) ,()*(/ %'>('-(,- ('- (,;-,-( '-)*() ,(6+(- %'(/@ +%6%'-,(() ((6 ?/%'(+(/ +%6%.() %/.() /%*()* () 6%)&)&@
3 %6%'-,(() penunjan& : %)*() ./'(,&)&*'(;- -.6+(- +%'('(()()/('( +(,%)/( () -)-)* (&6%)
Dia&nsis bandin&
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Dia&nsis bandin&
Slusi plasenta Plasenta pre+ia
'ejadian H(6- /.( -) +('/. H(6- /.(
Anamnesis M%)((
T%'(+(/ /'(.6(
%'('(() %)*() )%'-
%'(() /()+( -,(('-
T()+( /'(.6(
%'('(() /()+( )%'-
'eadaan umum T-( ,%,.(- %)*() +%'('(()
A)%6-, /%()() ('( )(-
+%')(+(,() /-( ,%,.(- %)*()
+%'('(()
D(+(/ -,%'/(- +'%
%(6,-(
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#atalaksana
1 S&.,-& +(,%)/( rin&an
D%)*() /()( +%'./ /%*()* ,%--/ +%'('(() /-( /%'(. ()( %((() ()-) 6(,- (- (+(/ -(.() penan&anan se(ara knser+ati% B-( +%'('(() %'()*,.)* /%'., %/%*()*() 6(-) 6%)-)*(/ %)*() ()-)()* 6(,- (- -(.() seksi sesaria %)()*()() +%'('(() ()*
%'%)/- () %((() ()* (- +(( %(6-() +'%6(/.'% -(.()-'.6( ,(-/
2 S&.,-& +(,%)/( sedan& dan berat
Penan&anann-a dilakukan dirumah sakit ('%)( (+(/ 6%6(((() -9( +%)%'-/( T(/((,()()( ((( pemasan&an in%us dan trans%usedarah/ meme(ahkan ketuban/ induksi persalinan atau seksi sesarea O% ('%)( -/. +%)()*()() ,&.,-& +(,%)/( ,%()* () %'(/ ('.,-(.() - '.6( ,(-/ %)*() ;(,--/(, ()* 6%)=..+-
'mplikasi
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'mplikasi
K&(*.(,- &),.6/-;
N%'&,-, /..., () &'/%, *-)(
A/&)-( ./%'., ()* 6%)%(() +%'('(() +&,/+('/.6%).-/ ,&.,-& +(,%)/( (+(/ /%'(- +(( -. () ()-)
1 %).-/ pada ibu
%'('(() (+(/ 6%)-6.() :
( V('-(,- /.'.))( /%()() ('( ,(6+(- ,&
%'('(() /-( ,%,.(- %)*() %((() +%)%'-/( ()%6-, ,(6+(- ,&
= K%,(('() %'>('-(,- ('- (- ,(6+(- &6(
G()**.() +%6%.() ('(
2 %).-/ pada janin
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2 %).-/ pada janin
%'('(() ()* /%'/-6.) - %(()* +(,%)/( 6%)**()**. ,-'.(,- ())./'-,- % ('( ()-) ,%-)**( (+(/ 6%)-6.() as%iksia rin&an sampaiberat dan kematian dalam Rahim
'mplikasi -an& dapat terjadi pada Ibu:
( S& +%'('(()
G(*( *-)(
= K%-()() +%6%.() ('(
* >ASA PRE>IA
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*. >ASA PRE>IA
De%inisi
V(,( +'(%>-( ((( &6+-(,- &,/%/'- -6()( +%6.. ('( ()-)
6%-)/(,- (/(. %'(( - %(/ &,/-.6 ./%'- -)/%').6 ?=%'>-=( &,@ %6.. ('( /%',%./ %'(( -((6 ,%(+./ %/.() ? /-( /%'-).)*%)*() /(-+.,(/ (/(. ('-)*() +(,%)/(@ ,%-)**( (() +%=( -( ,%(+./%/.() +%=(
Etil&i
I),%',- >%(6%)/&,( -)- -(,()( /%'(- +(( kehamilan &anda9 &emeli('%)( +(( %(6-() *()( ,.6%' 6(()() ()* (( +(( +(,%)/((() 6%)(- '%./() &% ()-) ,%-)**( %)*() (()( '%./()/%',%./ (() 6%6+%)*('.- %+%)()(6() /(- +.,(/< -),%',-
Pat%isil&i
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Pat%isil&i
%'('(() /%'(- +(( ,((/ +%6.(() ,%'>-, +(( ,((/ -)- ,%(+./%/.() +%=( ,%-)**( +%6.. ('( ()-) -./ /%'+./., ,%-)**( /%'(-
+%'('(() B-(,()( >(,( +'%>-( -6.)*-)() +(( .( ,-/.(,- ? insertin
+elamentsa dan plasenta suksenteriata
Mani%estasi klinis
T()( () *%(()( %.6 -%/(.- ,%=('( +(,/- +%'('(() +(( -),%',->%(6%)/&,( -)- /%'-(/ -( /%( /%'(- >(,( +'%>-( (-/. +%'('(() ,%*%'(,%/%( %/.() +%=( () ('%)( +%'('(() -)- %'(,( ('- ()( %)*()
=%+(/ .)- ()/.)* ()( 6%)(- .'. B-,( .*( 6%)%(() (- -/.6%)-)**(
Dia&nsis
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Dia&nsis
(( +%6%'-,(() -*-/( (() /%'(( +%6.. ('( ()-) J-( +%6..('( -)- -/%() 6(( (() /%'(- '(-('-( +(( ()-) S%(-) -/. (+(/-*.)(() +%6%'-,(() USG D&++%' /'(),>(*-)( .)/. 6%6(,/-()
-(*)&,-,
J('()* /%'-(*)&,( ,%%.6 +%',(-)() )(6.) (+(/ -.*( -( .,*()/%)(/( %)*() C&&&' D&++%' 6%6+%'-(/() (()( +%6.. ('(
+(( ,%(+./ %/.() -%+() &,/-.6 ./%'- -)/%').6
T%, A+/ : .- +%('./() (,( %6&*&-) D-/%/%,() 2 3 /%/%, ('./() (,(
%((6 1 6! ('( E'-/'&,-/ ()-) /(() /%'((+ +%=( ,%-)**(=(6+.'() (() /%/(+ %'9(')( 6%'( J-( ('( /%',%./ %'(,( ('- -.%'-/'&,-/ (() ,%*%'( +%=( () =(6+.'() %'.( 9(')( 6%)(- =&(/
D-(*)&,( -+(,/-() +(,=( ,(-) %)*() +%6%'-,(() ,%(+./ %/.() () +(,%)/(
S%'-)*(- ()-) ,.( 6%)-)**( ,((/ -(*)&,( -/%*(() 6%)*-)*(/ (9( ,%--/ +%'('(() ()* /%'(- ,.( %'(6+( ;(/( (*- ()-)
#atalaksana
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#atalaksana
%)%'-/( %)*() %=.'-*(() >(,( +'%>-( -'.. % ,+%,-(-, &,/%/'-= ()*-)%&&*- K%(-'() +(( (,., >(,( +'%>-( -(.() %)*() ,%,-&,%,('-(
H()( 6%(.() -(*)&,( () -( -=.'-*(- (9( -. (6- 6%)*((6-%(6-() *()( ,%*%'( (.() USG D() (+(-( 6%)*%/(.- -. +&,-/-;6%)*((6- -),%',-& >%(6%)/&,( (.() '..() +(( R.6( S(-/?S%,-& S%,('%(@
LI 2 1 Memahami dan mejelaskan tatalaksana perdarahan
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LI.2.1 Memahami dan mejelaskan tatalaksana perdarahan
pada kasus di skenari
!()*( +%'/(6( 6%)*((+- +(,-%) %)*() +%)('(() ((( se&eraperiksan perna%asann-a () memberikan in%us laruta rin&er@laktat (/(.
('./() ;-,-&&*- () %=%+(/())( -,%,.(-() %)*() %./.() ,%/-(+(,., ,%'/( memberika H! dan &ln&an &ln&an darah T'(),.;-('( -( ((' H 10 *'(6 .*( - +()/(. ('- 9(/. % 9(/. /()(/()( >-/( -. (6- () +%6()/.() %,%(/%'(() ()-) -().'()6%6+%'*.)(() KTG *.)( %- (.'(/ 6%6()/(. %((() ()-) $ntuk
&a5at janin ()*,.)* +%',-(+() tindakan (aesar se(tin
DA)#AR P$S#A'A
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DA)#AR P$S#A'A
A. I B(*., I %/ ( 2012 I6. %-()() %)(-/ K().)*() D() KBE 2 J(('/( : EGC 2010
C'-, T F'(), ! %/ ( 2014 K(+-/( ,%%/( %&/%'() E 4 J(('/( : M%-(A%,=.(+-.,
S(-;.-) A B R(=-6(- T 9-)&,(,/'& G H 2013I6.%-()()(('/(/ -)( +.,/(( ,('9&)& +'(9-'&('&