Wrapup Sk1 Perdarahan Kehamilan Emergency A5

8/19/2019 Wrapup Sk1 Perdarahan Kehamilan Emergency A5

1/57

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


2/57

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(/ ()-)

■


3/57

Sasaran belajar

LI.1. Memahami dan menjelaskan perdarahan pada kehamilan

LI.2. Memahami dan menjelaksa tatalaksana pada kasus di

skenari


4/57

LI.1. Memahami dan menjelaskan perdarahan padakehamilan

A. Perdarahan pada kahamilan muda

%'('(() +(( %(6-() 6.( /%'(- +(( .,-( *%,/(,- 206-)**. %)%( &)-,- -)- ((( (&'/., 6&( -(/-&,(

(/(. %(6-() %/&+- /%'*()**.


5/57

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.)&&*-,


6/57

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


7/57

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'-& %)./ ()/.)* () ,%(*-)(


8/57

#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

(( +(,-%) %)*() +%'('(() ()* /-(( /%'&)/'& (,-&),%+,- ('., ,%*%'( -%>(.(,-


9/57

3 A&'/., &6+-/

A+(-( -(*)&,-, ,.( -+(,/-() (&'/., &6+-/ /-( +%'.6%(.() /%'(+- (+(+.)

J-( %.6 -+(,/-() (+(/ -(.() +%6%'-,(() USG.)/. &);-'6(,-

4 M-,,% (&'/.,

(( /'-6%,/%' %.( ./%'., -&,&)*() %)*() 6%/&%-(/(,- () %>(.(,- S%'>-, -+%',-(+() %)*()6%)**.)(() 6-,&+'&,/& () (/(. -(/(,- +(,-; %)*()(6-)('-( S%/%( -/. -(.() %>(.(,- ,%=('( 6%()-,

--() (-) %>(.(,- %)*() -).,- %(-'() 6%)**.)(()

GE2 +%'>(*-)(6


10/57

5 A&'/., ,%+/-

'-),-+ /%'(+- : %>(.(,- ./%'., () ()/--&/-= +('%)/%'(?,%%.6 ,%(6( () ,%,.( +%6%',-() ('-)*() )%'&,-,

%)*() .'%/(,%@ --() ()/--&/-= :- A6+-,--) &'( 500 6*-, ('( () +'&. &),%+,- '&)/*%) (&6%)


11/57

Pr&nsis

(( (&'/., -6-)%), ()-) -(,()( 6(,- (+(/ -,%(6(/() %'*()/.)* +(( .6( +%'('(() ()* -((6- ,()* -.

'&*)&,-, -. +(( (&'/., -6-)%), .*( (- (( (&'/%-),-+-%)/ -)&6+-/ () &6+-/ +'&*)&,-, ,()* -. (-

'mplikasi

%'('(() %(/ () +%',-,/%) ,%+,-, -);%,- ,-)%-(

-)/'(./%'-)% -);%'/--/(, +%';&'(,- -)-)* ./%'., ,%'/( =%%'(.,., () ().)* %6-

Pen(e&ahan

A).'() -. .)/. 6%(.() +%6%'-,(() (9( %(6-()

%'-).)*() /%'((+ +(+('() ((/ -6-(


12/57

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 ;&(/ '%)( ()((' ('&/%) ('( '%)(


13/57

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(/-() ()-)


14/57

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@ /-( (()( ()/.)* *%,/(,- (/(. ;%/.,


15/57

#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+(- ((')( /-( /%'%/%,- (*-


16/57

*. 'EHAMILAN E'#"PI'

De%inisi

T%'(-)( -6+()/(,- &>.6 -.(' '&)**( ./%'., ,%()(

5 %(6-() %/&+- /%'(- - /.( ;(&+- ,%()*() 5,-,()( /%'-,/'-.,- - &>('-.6 ,%'>-, () '&)**(

+%'-/&)%.6


17/57

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()( +(/&&*- +((

/.(


18/57

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%)


19/57

Mani%estasi klinis

N%'- -(,()( /%'(- ('%)( '.+/.'% D(+(/ %',-;(/ -(/%'(.)-(/%'( &=( (/(.+.) 6%)%.'.

%'('(() ('- >(*-)( -(,()( %'=(%'=( ?,+&//-)*@

S-&+ 6%'.+(() /()( +%'('(() ()* %- ()./

A&6-)( () +%>-= /%)%')%,, (+(/ -;., 6(.+.)/%'&(-,(,-

%'.(() ./%'., (+(/ 6%6%,(' () 6%.)( ,%+%'/- +((%(6-()

I),/(--/(, /()( >-/(

T%'(()( 6(,,( +(( ()%,(


20/57

Pemeriksaan penunjan&

D('( +%'-;%' %)*(+ : %6&*&-) (/(. %6(/&='-/ .)/.,'-)-)* %*(9(/('.'(/()

%6%'-,(() %(6-() : CG +&,-/-; +(( %(6-()%/&+-

%6%'-,(() .,., : USG .)/. 6%6%(() %)*()%(6-() )&'6( (&'/., () -*/% &>.6 M&-/(,

+%6%'-,(() (-))( ()/('( (-) (+('&,&+- () MRI


21/57

#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%'*%),-


22/57

!. Perdarahan pada kehamilan tua

%'('(() +(( %(6-() /.( ((( +%'('(() ()* /%'(-

+(( %(6-() 20 6-)**. %)%( &)-,- -)- ()/('( (-) :


23/57

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@


24/57

'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


25/57

M%).'./ C(- ?2002@ (,-;-(,- +(,%)/( +'%>-( -(,('()(/(, /%'(()( ('-)*() +(,%)/( 6%(.- +%6.(() (()(-' :

( (,%)/( '%>-( T&/(-, (-/. +(,%)/( ()* 6%)./.+- ,%.'.&,/-.6 ./%'- -)/%').6

(,%)/( '%>-( ('/-(-, (-/. +(,%)/( ()* 6%)./.+-,%(*-() &,/-.6 ./%'- -)/%').6

= (,%)/( '%>-( M('*-)(-, (-/. +(,%)/( ()* /%+-)( (*( (. %/()( () 6%)./.+- ,%(*-() &,/-.6 ./%'- -)/%').6


26/57


27/57

)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%'&&


28/57

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%'-() )./'-,- ()-) >-- &'%(-, +(( &'-&) %(>% ()*

+%',-,/%)


29/57

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


30/57


31/57

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()/. -(*)&,-, +(,%)/( +'%>-( ()* %/()( +&,/%'-&'


32/57

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( ./%'-

.,-( ()./

.'%/(,% %'.()*

%(, SC

6%'&&

S&

+%'('(() ,%/%( &-/.,

T-( (( &)/'(,-

./%'.,

B(*-() /%'%)( ()-)

/-( 6(,. A

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

Plihidramnin

&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


33/57

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

Adan-a (airan bebas

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

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36/57

#indakan +(( +(,%)/( +'%>-( :

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= (( +%'('(() ()* /%/(+ %(/ (/(. 6%)-)*(/ ('%)( +(,%)/( +'%>-( /&/(-, (/(. +(',-(-, ,%*%'( (.() ,%,-&,%,('-( ('%)( +(,%)/( %/( '%)( ?+(,%)/( /-( /%'-(/ -(%(' 6../ ,%'>-, ,%-/(' 45 =6@ +%=(() ,%(+./ %/.()() %'-() -);.,% &,-/&,-) -( +%'('(() /-( %'%)/-(.() +%',(-)() +%'>(*-)( %)*() ;&',%+ (/(. %,/'(,->(.6 -( +%'('(() /-( %'%)/- (.() ,%,-& ,%,('-(

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38/57

#erapi

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'mplikasi

M(/%')( : +%'('(() ,& %6(/-() -);%,- %6&- ,&.,-& +(,%)/(

F%/., : +'%6(/.'% %6(/-() +%'('(() ()-)

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2. S"L$SI" PLASEN#A

De%inisi

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'lasi%ikasi

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)aktr resik

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42/57

Etil&i

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P t %i i l i


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Pat%isil&i

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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%'%+(,)( +(,%)/( .'()* ('- .(,)(

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2 S&.,-& +(,%)/( sedan&

T%'%+(,)( +(,%)/( %- ('- /%/(+- %.6 6%)=(+(- 2


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3 S&.,-& +(,%)/( berat

!%+(,)( +(,%)/( %- ('- 2%(-'% ./%'., /%'(- *()**.() &)/'(,-() (/&)-( ./%'-

Di i


47/57

Dia&nsis

1 Anamnesis : /%'(+(/ +%'('(() -,%'/(- '(,( )%'- /%'(- ,+&)/() (/(.('%)( /'(.6( +%'./ /%'(,( )%'- --./- +%).'.)() ,(6+(- /%'%)/-)(*%'(() ()-) ((6 R(-6 %'('(() +%'>(*-)(6 &)/'(,- ./%'., ()

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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(

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T()+( /'(.6(

%'('(() /()+( )%'-

'eadaan umum T-( ,%,.(- %)*() +%'('(()

A)%6-, /%()() ('( )(-

+%')(+(,() /-( ,%,.(- %)*()

+%'('(()

D(+(/ -,%'/(- +'%

%(6,-(


49/57

#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


50/57

'mplikasi

K&(*.(,- &),.6/-;

N%'&,-, /..., () &'/%, *-)(

A/&)-( ./%'., ()* 6%)%(() +%'('(() +&,/+('/.6%).-/ ,&.,-& +(,%)/( (+(/ /%'(- +(( -. () ()-)

1 %).-/ pada ibu

%'('(() (+(/ 6%)-6.() :

( V('-(,- /.'.))( /%()() ('( ,(6+(- ,&

%'('(() /-( ,%,.(- %)*() %((() +%)%'-/( ()%6-, ,(6+(- ,&

= K%,(('() %'>('-(,- ('- (- ,(6+(- &6(

G()**.() +%6%.() ('(

2 %).-/ pada janin


51/57

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


52/57

*. >ASA PRE>IA

De%inisi

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Etil&i

I),%',- >%(6%)/&,( -)- -(,()( /%'(- +(( kehamilan &anda9 &emeli('%)( +(( %(6-() *()( ,.6%' 6(()() ()* (( +(( +(,%)/((() 6%)(- '%./() &% ()-) ,%-)**( %)*() (()( '%./()/%',%./ (() 6%6+%)*('.- %+%)()(6() /(- +.,(/< -),%',-

Pat%isil&i


53/57

Pat%isil&i

%'('(() /%'(- +(( ,((/ +%6.(() ,%'>-, +(( ,((/ -)- ,%(+./%/.() +%=( ,%-)**( +%6.. ('( ()-) -./ /%'+./., ,%-)**( /%'(-

+%'('(() B-(,()( >(,( +'%>-( -6.)*-)() +(( .( ,-/.(,- ? insertin

+elamentsa dan plasenta suksenteriata

Mani%estasi klinis

T()( () *%(()( %.6 -%/(.- ,%=('( +(,/- +%'('(() +(( -),%',->%(6%)/&,( -)- /%'-(/ -( /%( /%'(- >(,( +'%>-( (-/. +%'('(() ,%*%'(,%/%( %/.() +%=( () ('%)( +%'('(() -)- %'(,( ('- ()( %)*()

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Dia&nsis


54/57

Dia&nsis

(( +%6%'-,(() -*-/( (() /%'(( +%6.. ('( ()-) J-( +%6..('( -)- -/%() 6(( (() /%'(- '(-('-( +(( ()-) S%(-) -/. (+(/-*.)(() +%6%'-,(() USG D&++%' /'(),>(*-)( .)/. 6%6(,/-()

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J('()* /%'-(*)&,( ,%%.6 +%',(-)() )(6.) (+(/ -.*( -( .,*()/%)(/( %)*() C&&&' D&++%' 6%6+%'-(/() (()( +%6.. ('(

+(( ,%(+./ %/.() -%+() &,/-.6 ./%'- -)/%').6

T%, A+/ : .- +%('./() (,( %6&*&-) D-/%/%,() 2 3 /%/%, ('./() (,(

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#atalaksana


55/57

#atalaksana

%)%'-/( %)*() %=.'-*(() >(,( +'%>-( -'.. % ,+%,-(-, &,/%/'-= ()*-)%&&*- K%(-'() +(( (,., >(,( +'%>-( -(.() %)*() ,%,-&,%,('-(

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LI 2 1 Memahami dan mejelaskan tatalaksana perdarahan


56/57

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


57/57

DA)#AR P$S#A'A

A. I B(*., I %/ ( 2012 I6. %-()() %)(-/ K().)*() D() KBE 2 J(('/( : EGC 2010

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S(-;.-) A B R(=-6(- T 9-)&,(,/'& G H 2013I6.%-()()(('/(/ -)( +.,/(( ,('9&)& +'(9-'&('&

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