kegawatdaruratan kasus obstetri
TRANSCRIPT
8/16/2019 Kegawatdaruratan Kasus Obstetri
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REFERATKEGAWATDARURATAN KASUS
OBSTETRI
Disusun Oleh :
Ferry D. M. Sihombing( 9710051)
Pembimbing :
Dr. Aloysius S, SpOG
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Gawat DaruratObstetri
Caution
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PENYEBAB KEMATIAN IBU
HIPERTENSI
PERDARAHAN INFEKSI
PIH
EMBOLI PARU
PERDARAHAN
DAHULU sekaran
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0%
10%
20%
30%
40%
50%
60%
Post Partum Hemorrhage
Abou Azar 1998
Persentase Perdarahan Postpartum
Di Negara Berkembang
P e r c e n t o f M a t e r n a l M o r t a l i t y
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Angka Kematian danKesakitan Ibu
Sepsis14.9%
Haemo!a"e24.#%
I$ie&'&a(ses
19.#%
)'!e ie&'&a(ses
*.9%U$sa+ea,o'io$
12.9%
),s'(&'e -a,o( 6.9%
Hpe'e$si/e
isoes 12.9%
Pen!e"a"Uta#a Ke#atian
I"u $
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prgilbert/mc-99
Penyebab Kematian Ibu di Negara2 Berkembang
Antepartum
Intrapartum
Postpartum
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Penangananperdarahan
DE
%&ORGANI'ATIO
N
(&RESUSCITATION
)& DEFECTI*EBLOOD
COAGULATION
+& E*ALUATIONOF RESPONSE
,& REMED- THE CAUSE
OF BLEEDING
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)ANIATI)N
Ko$s(- H(,($"i . Sp)
Siapa$ aa!
Peisa 'a$a /i'a- Ui$e )('p('As(pa$
&aia$ a$ ),a'2a$
Siapaa$ Kama )peasi
R D E R
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ESUS7ITATI)N
O2 6 -' m$'
2 I8 -i$e 16
Peisa aa! &oss ma'&! !i'($"
'om,osi' Uea -e/e- Kea'i$i$ a$
e-e'o-i'I$+(s &aia$ se"ea Na7- 09%
Ta$s+(si :::: PB7s
R D E R
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DEFEKTIVE BLOOD CAOAGULATION
1. )e &oa"(-a'io$ s&ee$ ;I$'e$a'io$a- Noma-i<e a'io
a&'i/a'e pa'ia- '!om,op-as'i$ 'ime= i+ +i,i$o"e$ '!om,i$ 'ime
,-oo +i-m a$ :ime es(-'s ae a,$oma-.
2. i/e >>P i+ &oa"(-a'io$ 'es' es(-'s ae a,$oma- a$ si'es aeoo<i$".
3. i/e &ope&ipi'a'e i+ a,$oma- &oa"(-a'io$ 'es' es(-'s ae $o'
&oe&'e ?i'! >>P a$ ,-eei$" &o$'i$(es.
4. i/e p-a'e-e' &o$&e$'a'es i+ '!e p-a'e-e' &o($' is -ess '!a$ 50 @
109 a$ ,-eei$" &o$'i$(es.
5. Use &ope&ipi'a'e a$ p-a'e-e' &o$&e$'a'es ,e+oe s("i&a-
i$'e/e$'io$.
RD E R
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E8AUATI)N )> ESP)NSE
Hi'($" 7B7 e"(-a a$ 'es
oa"(-asi ($'( me$e$'(a$
'eapi ompo$e$ aa!
R DE R
Nai 'ea$a$ aa! as aa! 78P
Hi'($" Ui$e )('p(' e$"a$ a'e'e MONITOR
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eme T!e 7a(se B-eei$"
1. A$'epa'(m : -a!ia$ ,ai a$ p-a&e$'a
2. Pos'pa'(m : )i'o&$ Pos'a"-a$i$ E"o$o/i$e
3. Esp-oasi a$ pe$"oso$"a$ &a/(m ('ei
4. Peisa se/is a$ 8a"i$a : i"asi s(m,e peaa!a$
pe,aii 'a(ma
5. i"asi s(p-ai aa! ('e(s ; a. ('ei$a a. )/ai&a a. i-ia&a
i$'eio=6. Pe'im,a$"a$ em,o-i a'ei
*. Pe'im,a$a$ His'e'omi
R D ER
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Peaa!a$ A?a- Ke!ami-a$
Abortus
Penghentian Kehamilan sebelum Janin Viable
Gawat Darurat :
• Disertai perdarahan hebat
• Abortus epti!
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. Klasifkasi
. Etiologi
!aktor "igot #$%& 'romosom( !aktor Ibu
A b o r t u s
. menore
. Tanda2 Kehamilan
. Perdarahan
Pervaginam
. Pengeluaran jaringan
. DIAGNOSIS
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A b o r t u s
Diagnosis Perdarahan PdKehamilan Muda
Perdarahan
Serik s
!terus
Ge"ala Diagnosis
Ber/ak0ina
se1an
Tertutu2
Sesuaiusiaestasi
3 Kra# Prt "403 Uterus 5unak
A&I##ines
Tertutu2 atau Ter"uka
S1kt#e#"esar 1ari N
3Li#"un6Psn7N!eri 2rt "407N!eri !
2ortio 7Massaa1ne8a3Cairan ""sIntra"1
K E T
9 UsiaGestasi
3N!eri Prt ± : 3
3Eks2u5si 0asi5konse2si
A& Ko#25it
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A b o r t u s
Perdarahan
Serik s
!terus
Ge"ala Diagnosis
Se1an0ina
Masi;
Tertutu2
Sesuaiusiaestasi
3 Kra# Prt "403 Eks2u5si ne 3 A& Insi2ies
7N!eri 2rt "40
3Eks2u5siSe"aian
A&Inko#25it
Tertutu
2
< UsiaGestasi1anLunak
3Mua56 Munta0
3Kra# Prt B40
3Miri2Preek5a#2sia A& Mo5a
Diagnosis Perdarahan PdKehamilan Muda
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A b o r t u s
Penananan
Tergantung D/
. #onseratie $ Do Nothing
. Medi%al & Misoprostol'Prostaglandin
. Surgi%al & Pengeluaran Sisa (aringan. Anastesi !mum
. Dilatasi seriks
. Su%tion
. #urettage
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Ke!ami-a$ Ep'opi
'ehamilan diluar ca)um uteri
T(,a Amp(-a 95%
Se/is
)/ai(m
I$'a-i"ame$'e
A,ome$
*tiologi +
. Gangguan transportasi ) PID' I!D' Op pdtuba' *umor +
. Ke5ainan Hor#ona5
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TiasA#enorr0ea
B5ee1in:S2ottinA"1o#ina5 Pain
ehamilan Ekptopik
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emeriksaan fisik :
• Tanda2 syok
• Nyeri Abdomen Akut
• Pem. Ginekologis
Serviks
Korpus teri
!avum "ouglas
ehamilan Ekptopik
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Ealuasi dan Diagnosis Anamnesis dan Pem, -isik
Pemeriksaan Darah
Serial .uantitatie /$h#G)0S!+
!ltrasound
Progesterone 1eel2
#uldo%entesis
1aparas%op3
ehamilan Ekptopik
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Penanganan
• bservasi
• Laparascopy
• Laparatomy
• MTX
• Hiperosmolar
Glucose
ehamilan Ekptopik
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Solusio Plasenta
Peleasa! lase!ta rematur "a!g #mla!tas#!"a !ormal
$ % & %'( )elah#ra! %* + Kemat#a! ,a"#
D4 *5IAS
Perdarahan Uterus
Fetal Distress / Death
Uterus Hipertonus /
Hiperaktif
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Predisposisi. Pen3akit 6ipertensi
. Multi Paritas
. *rauma abdomen
. Abrupsio sebelumn3a)789+
. Peregangan !terus)Gemelli' 63dramnion+
. Insufsiensi
Plasenta
. Gi:i buruk
. Merokok
. Kokain
olusio Plasenta
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Peaa!a$ C100:200&& D 200 &&
U'e(s 'e"a$" 'e"a$" Te"a$" Fo$'asi 'e'a$i
So aa'a$a2
Pe so so
Ga$i$ Hi(p a?a' a$i$ Ma'i Ma'i
PelepasanPlasenta
C 16 ,a" 16 23 D 23
!ibrinogen Plasma D 250 m"% 120 150 m"%
G5ADE
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KOMPLIKASI
. S3ok
. Gagal Gin"al Akut
. DI#
. -etal Distress Mati
Kehilangan darah tersembunyi 2500 cc
olusio Plasenta
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Penananan O"stetrik
Terantun 1ari$
. Dera=at so5usio 25asenta
. Maturitas >anin
. Dera=at Ga4at >anin
. Perta0ankan Ke0a#i5an
. In1uksi Persa5inan
. Seksio Cesaria
Solusio Plasenta
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Plasenta Previa
I#25antasi 25asenta !an t1k nor#a5 #enutu2i se"aian:se5uru0 =5n 5a0ir
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Dianosi
s. Per1ara0an 2er?aina# - N"er#
. Perikasa Da5a# PDMO
. ULTRASONOGRAPH-
" 1# $ olusio Plasenta
S!ok >aran ter=a1i 21 Per1ara0an 2erta#a
Plasenta Preia
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. Stabilisasi Ibu
. Pemeriksaan1aboratorium
. Monitoring (anin
. Ealusi dengan!lrtasound
. Pemeriksan Spekulum
Gentle
Plasenta Preia
E?a5uasi
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FaktorPre1is2osisi
. P5asenta Pre?iase"e5u#n!a
. Mu5ti2aritas
. Ri4a!at SC / O2erasi 21 Uterus
. Ri4a!at 25asenta 2re?ia se"e5u#!a
Ko#25ik
asi • S3ok6ipoolemik • KelahiranPrematur• Plasenta akreta
Plasenta Preia
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Penananan O"stetrik
>ika Munkin Perta0ankan Ke0a#i5an@Eks2ektati;
Terantun 1ari$
. U#ur Ke0a#i5an
. Ban!akn!a 1ara0 !an ke5uar
. Kon1isi >anin
. Presentasi >anin
Plasenta Preia
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Indikasi +
Se/tio Cesaria
Plasenta Pre)ia Total ,term
Perdarahan Massi)e Preterm
Plasenta Preia
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Persa5inan Per?aina#
. Ke0a#i5an Cuku2Bu5an
. IUFD
. Dou"5e Set3u2
Marina5 : Partia5
Ta#2ona1e 1n
Ke2a5a >anin
Plasenta Preia
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Plasenta Preia ;s SolusioPlasenta
Ta$a lasenta revia Solusio Plasenta
Perdarahan VaginaMerah segar Merah Gelap
Tekanan Darah Normal Normal
Nyeri Uterus Tidak Ada Tetap
Tonus Uterus Normal
BJJ Normal Gt Janin ! "
Tes #oagulasi Normal A$normal
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Ruptur Uteri
Disru2si 1in1in uterus
Morta5itas
Ibu <$7=9
(anin <=$ =8
9
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Ciri-ciri Diagnostik
. Per1ara0an Per ?aina#
. Hi2otensi S!ok
. Ber0entin!a Persa5inan ti"a(
. Feta5 Distress
. N!eri Han!a %
. Per1ara0an Post2artun Mr2kan suatutan1a
5 u p t u r ! t e r i
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Penananan. La2arato#i SEGERA
. Per"aiki Ro"ekan Uterus
. Liasi Arteri I5ia/a interna
. Histerekto#i
5 u p t u r ! t e r i
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Pen!e"a" @ + T
≥ , //Per?aina#
Perdarahan
PostpartumPerdarahan Setelah
Kala III
7888 %% pd S#
. DINI >? "am pertama
. 1AN(!* setelah >? "am
. TONE
. TISSUE
. TRAUMA
. THROMBIN
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Perdaraha
n
E)sloras#
Ca.um Uter#
5etainedPla%enta) a%%reta 222 +
!terus0ersih4kosong
Perdarahan Postpartum
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Aton3 2222
O8ito/!n
!terus Kosong
-A TIDAK
Penanganan 20
Siapkan Operasi bila
Gagal
Periksa Vaginadan Cervix
Perdarahan Postpartum
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1asera
si
%&DAK
Jahit Luka CLUES ??????
Pert#m,a!g)a! :
• DIC
• Kela#!a! Fa)tor Pem,e)ua!
• /urtur Uter#
AA
Perdarahan Postpartum
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Klasifkasi @
1. Hi2ertensi estasiona5(& Preek5a#2sia
)& Ek5a#2sia
4. Superimposed preeclampsia/ eclampsia
,& Hi2ertensi kronis
6ipertensi
Pen!e"a" ke#atian
P k5 i
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Preek5#a2sia
7, 6ipertensi stlh >8 mggkehamilan
>, Proteinuria
<, Oedem
?, Ge"ala Sub"ekti
. Preeklamsi 5ingan
. Preeklamsi 0erat
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Preek5a#2sia Rinan
% &ipertensi
% Proteinuria ' ()) mg ! *+ ,am
% -edema ringan . peningkatan BB /
% Urine -utput ' 0)) 11 ! *+ ,am
TD S!s ≥ %+ ##H : ) ##H ↑ N
TD Dias ≥ ##H : %, ##H ↑ N
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Preek5a#2sia
Berat. Hi2ertensi
TD S!s ≥ % ##H
TD Dias ≥ %% ##H
. Proteinuria < , : (+ =a# @ + )6 + +
. O5iuria 3 9 + // : (+ =a#
. Oe1e# #assi?e
. Tan1a( I#2en1in ek5a#2si
. E1e#a 2aru 1an Sianosis
. IUGR
. HELLP S!n1ro#e
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Eklampsia
Preek5a#2sia
Ke=an
-
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Hi t i D l K h il
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PENA*A1AKSANAA
N Hal-hal yang harus kita pantau antara lain :
. Tekanan 1ara0
. Funsi in=a5 @ Ureu# 1an kretinin
. Asa# urat
. Funsi 0e2ar @ seru# a5"u#in 1antrasa#inase
. H"6 Ht6 Leukosit 1n tro#"osit
Penilaian u/ kesejahteraan janin meliputi :
. USG se=ak ke0a#i5an usia #u1a
. Pe#eriksaan Do25er arteri u#"i5ika5is
Hipertensi Dalam Kehamilan
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Indikasi (anin untukperawatan di 5S
. Hasi5 USG #e#2er5i0atkan a#"aran
!an statis atau #ena5a#i 2enurunan. O5io0i1ra#nion @ /airan a#nion 9 , /#
. Non reakti; non stress test
. Biosi/a5 2ro5 skor kuran 1ari
Hipertensi Dalam Kehamilan
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#ndikasi $anin untuk terminasi
ke%amilan
. Ke#atanan =anin
. Non Reakti; NST1enan 1ese5arasi
. Biosika5 2ro5 skor 9 +1a5a# ( ka5i
2e#eriksaan 1nse5an 4aktu + =a#&
Hipertensi Dalam Kehamilan
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Prinsi2Penananan
. *erminasi Kehamilan
. Istirahat
. Diet
. Obat$obatanantihipertensi
. Penanganan lain
Hipertensi Dalam Kehamilan
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O"at3o"atan. Manesiu# su5;at untuk #enatasi ke=an6
1a2at 1i"erikan intra?ena6 #au2un 1i"erikanse/ara 2erio1i/ #e5a5ui intra#usku5er&
. Hi1ra5ain untuk #enurunkan tekanan 1ara0"i5a tekanan 1iasto5i/ 5e"i0 1ari %% ##H&
. Men0in1ari at3at !an "ersi;at 1iureti/1an 0i2ersos#otik
. Me#"atasi asu2an /airan intra?ena
. Proses 2ersa5inan
Hipertensi Dalam Kehamilan
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GOO O S # G # S
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GOOD O0S*E*5I#A1 EME5GEN#IES#A5E
./afe Motherhood