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PERSALINAN PRETERMDAN KETUBAN PECAH DDebora Lusiana Herman

11 2014 02


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PERSALINAN PRETERM


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DE

Persa"inan #re$erm %i%e&nisi'an seba(ai #ersa"inan )an( $er*ausia 'e+ami"an ,- min((u a$au 'uran( %ari 2. +ari se*a' +ar+ai% $era'+ir /CHubinon$ 2011

Par$us #rema$urus a$au #ersa"inan #rema$ur *u(a %iar$i'an seb%imu"ain)a 'on$ra'si u$erus )an( $era$ur %iser$ai #en%a$aran %%i"a$asi ser3i's ser$a $urunn)a ba)i #a%a ani$a +ami" )an( "am

'e+ami"ann)a 'uran( %ari ,- min((u /'uran( %ari 2. +ari %a#er$ama +ai% $era'+ir /56orn 2010

Him#unan Ke%o'$eran !e$oma$erna" /P57I %i Semaran( meneba+a #ersa"inan #re$erm a%a"a+ #ersa"inan )an( $er*a%i #a%a'e+ami"an 22 8 ,- min((u


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EPIDEMI

!re'uensi %ari $er*a%in)a #ersa"inan #re$erm %i#er'ira'an s1,: %i Ameri'a Seri'a$ /AS %an 9.: %i ne(ara9ne(ara ber'e

Persa"inan #re$erm *u(a %a#a$ %iba(i menuru$ usia 'e+ami"an

se'i$ar : #ersa"inan #re$erm $er*a%i #a%a usia 'uran( %ari 2; m/extreme prematurity

se'i$ar 1: $er*a%i #a%a usia 'e+ami"an 2;9,1 min((u /severe p se'i$ar 20: #a%a usia ,29,, min((u /moderate prematurity

%an


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ETI5

=a'$or resi'o $er*a%in)a #ersa"inan #re$erm a%a"a+ abor$us )anmen(an>am =a'$or (a)a +i%u# se#er$i mero'o' #er$amba+anba%an ibu )an( $i%a' a%e'ua$ #en((unaan nar'oba

usia ibu $er"a"u mu%a a$au $er"a"u $ua $ubu+ #en%e' 'esen*ane$ni' +i#era'$i3i$as se"ama 'e+ami"an =a'$or (ene$i' #en)a'#erio%on$a" >a$a "a+ir in$er3a" an$ara 'e+ami"an sebe"umn)a

ini ser$a ria)a$ #ersa"inan #re$erm #a%a 'e+ami"an sebe"um


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Ter%a#a$ em#a$ #en)ebab u$ama un$u' 'e"a+iran 'uran( bu"an Seri'a$ )ai$u ?

Persa"inan a$as in%i'asi ibu a$au *anin se+in((a #ersa"inan %iinba)i %i"a+ir'an %en(an #ersa"inan sesar

Persa"inan 'uran( bu"an s#on$an $a' $er*e"as'an %en(an se"a#

u$u+ Ke$uban #e>a+ %ini #re$erm /PPR5M i%io#a$i'

Ke"a+iran 'embar %an mu"$i*anin )an( "ebi+ ban)a'


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PAT5!IS

Persa"inan 'uran( bu"an s#on$an


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IN!EKSI INTRAU

In=e'si #a%a =e$a" membran %isebu$ 'orioamnioni$is in=e'si #a%a $a"i #usaba'$eri )an( #a"in( ban)a' %i$emu'an a%a"a+


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DIA7

!a'$or resi'o ma)or ?

Ke+ami"an mu"$i#e"

Po"i+i%ramniom

Anoma"i u$erus

Di"a$asi ser3i's @ 2>m #a%a usia 'e+ami"an ,2min((u

Ria)a$ abor$us 2 'a"i a$au "ebi+ #a%a $rimes$er

II

Ria)a$ #ersa"inan #re$erm sebe"umn)a

Ria)a$ men*a"ani #rose%ur o#erasi #a%a ser3i's/cone biopsy, loop electrosurgical excision

procedure)

Pen((unaan >o>ain %an am#+e$amine

5#erasi besar #a%a ab%omen

!a'$or resi'o minor

a Per%ara+an #er3a


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7EALA

Usia 'e+ami"an an$ara 20 %an ,- min((u a$au 140%an 2. +ari

Kon$ra'si u$erus /+is )an( $era$ur )ai$u beru"an(-9; 'a"i a$au 29, 'a"i %a"am 10 meni$

Merasa'an (e*a"a se#er$i 'a'u %i #eru$men)eru#ai rasa 'a'u se#er$i mens$ruasi rasa$e'anan in$ra#e"3i' n)eri #un((un( baa+ /"oba>' #ain

Men(e"uar'an "en%ir ber>am#ur %ara+#er3a(inam

Pemeri'saan %a"am menun*u''an ser3i's $e"a+men%a$ar 09;0: a$au $e"a+ $er*a%i #embu'aanse%i'i$n)a 2 >m

Se"a#u$ amnion serin( 'a"i $e"a+ #e>a+

Presen$asi *anin ren%a+ sam#ai men>a#ai s#inais>+ia%i'a /Cunnin(+am 2012

Kri$eria "ain )an( %iusu"'an oleh American Academy

American College of Obstreticians and Gynecolo

beri'u$ ?

Kon$ra'si )an( $er*a%i 4 'a"i %a"am 20 meni$ a$au

%an #eruba+an #ro(resi= #a%a ser3i's

Di"a$asi ser3i's "ebi+ %ari 1 >m

Pen%a$aran ser3i's sebesar ;0: a$au "ebi+


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PERUBAHAN SE


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ANITA AN7 BEMEN7ALAMI PERSALINAN PR

Estriol Saliva


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TATALAK

Tira+ barin( /Be%res$

Pemberian $o'o"i$i'

Pemberian s$eroi%

Pemberian an$ibio$i'

Emer(en>) Cer>"a(e

Peren>anaan #ersa"inan


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T5K

a"asan #emberian $o'o"i$i' #a%a #ersa"inan #re$erm

Men>e(a+ mor$a"i$as %an morbi%i$as #a%a ba)i #rema$ur

Memberi 'esem#a$an ba(i $era#i 'or$i'os$eroi% un$u' mens$imu"#aru *anin

Memberi 'esem#a$an $rasn=er in$rau$erin #a%a a=si"i$as )an( "ebi

5#$ima"isasi #ersone"


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Ni=e%i#in


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K5RTIK5ST

1 MERAN7SAN7 MATURASI PARU ANIN

2 E!EKTI! UNTUK UMUR KEHAMILAN 24 8 ,4 MIN77U

, SIN7LE C5URSE

BETAMETHAS5N ? 12 m( 1m 2 F SEHARI

DEFAMETHAS5N ? < m( I 4 F 12 AM

4 DIANURKAN UNTUK PEMAKAIAN K5MBINASI DEN7AN T5K5LISIS


17/41

ANTI

1 TIDAK MENIN7KATKAN UMUR KEHAMILAN DAN BERAT L

2 MENURUNKAN AN7KA KEADIAN IN!EKSI G SEPNE5NATUS

, TERUTAMA DIBERIKAN PADA P9 PR5M


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KETUBAN PECAH


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ANAT5MI DAN !IS


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Tabe" 1 3o"ume >airan amnion )an( "aim

Min((u (es$asi anin /( P"asen$a /( Cairan amnion /m" Per

1< 100 100 200 0

2; 1000 200 1000 4

,< 200 400 .00 24

40 ,,00 00 ;00 1-


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!un(si >airan amnion

Pro$e'si ? me"in%un(i *anin $er+a%a# $rauma %ari "uar

Mobi"isasi ? memun('inan ruan( (era' ba(i *anin

Homeos$asis ? men*a(a 'eseimban(an su+u %an "in('un(an asam

ron((a amnion un$u' suasana )an( o#$ima" ba(i *anin

Me'ani' ? men*a(a 'eseimban(an $e'anan %a"am se"uru+ ruan(an

Pa%a #ersa"inan ? membersi+'an a$au me"i>in'an *a"an "a+ir %en(an

s$eri" se+in((a me"in%un(i ba)i %ari 'emun('inan in=e'si *a"an "a+ir


24/41

DE

Ke$uban #e>a+ %ini a%a"a+ #e>a+n)a 'e$ubsebe"um in#ar$u )ai$u bi"a #embu'aan #a%'uran( %ari , %an #a%a mu"$i#ara 'uran( %a>m

'e$uban #e>a+ %ini #re$erm )a'ni 'e$uban saa$ usia 'e+ami"an be"um masa a$erm a$a'e+ami"an %ibaa+ ,; 8 42 min((u


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EPIDEMI5

Ke$uban#e>a+%ini

#rema$ur

$er*a%i#a%a1:

'e+ami"an


26/41

ETI5

Faktor predisposisi Terjadinya KPD

!a'$or se"a#u$ 'e$uban i$u sen%iri Se"a#u$ 'e$uban )an( 'e"as$is %an $i#is

A%an)a in=e'si )an( $er*a%i se>ara "an(sun( men(enai se"a#umau#un as>en%en %ari 3a(ina a$au in=e'si #a%a >airan 'e$ub

C+orioamnioni$is P+)e"one=ri$is

Sis$i$is

Cer3isi$is

a(ini$is


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Ke"ainan 'e+ami"an ? >er3i6 in>om#e$en men)ebab'an %in%in( 'e$uban #a"in( baa+

$e'anan #a"in( $in((i

cephalo-pelvic disproportion

Peduncular abdomen/#eru$ (an$un(

'e"ainan "e$a' *anin /"e$a' sun(san( se+in((a $i%a' a%a ba(ian )an( menu$u#i #in$u a$as #an((u" /PAP )an( %a#a$ men(+a"an(

$er+a%a# membran ba(ian baa+

+i%ramnion 'e+ami"an (an%a


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53er%is$ensi u$erus men(a'iba$'an se"a#u$ 'e$uban men*a%i "eb

Trauma %an $e'anan in$ra ab%omina"

!a'$or "ain

Umur usia ibu )an( "ebi+ $ua mun('in men)ebab'an 'e$uban 'uran( 'uamu%a

Pari$as /mu"$i#ara (ran%emu"$i#ara Pa%a 'e+ami"an )an( $er"a"u serin( a

mem#en(aru+i #roses embr)o(enesis se+in((a se"a#u$ 'e$uban )an( $er"ebi+ $i#is )an( a'an men)ebab'an se"a#u$ 'e$uban #e>a+ sebe"um $an%ain#ar$u

Mero'o' se"ama 'e+ami"an

De&siensi (ii %ari $emba(a %an 3i$amin C

Ria)a$ KPD sebe"umn)a


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PAT5!IS

Ter%a#a$ 'eseimban(an an$ara sin$esis %an %e(enerasi e's$rase"ue"r ma$rPeruba+an s$ru'$ur *um"a+ se" %an 'a$abo"isme 'o"a(ena'$i3asi 'o"a(en beruba+se"a#u$ 'e$uban in=erior ra#u+'on$ra'si u$erus %an #ere(an(an beru"an(Se"a#u$ 'e$uban #e>a+


30/41

DIA7

Anamnesis Ins#e'si Pemeri'sa

Pena$a"a'Pemeri'saanPenun*an(


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ANAM

Pen%eri$a merasa basa+ #a%a 3a(ina a$au men(e"uar'an >airan )an( banCairan berbau '+as %an #er"u *u(a %i#er+a$i'an arna 'e"uan)a >airan $e'e"u+an %emam $in((i n)eri ab%omen %an 'e"uar >airan #er3a(inam berb


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PEMERIKSAAN

Meru#a'an "an('a+ #er$ama un$u' men%ia(nosis KP#emeri'saan %a"am se#er$i vaginal toucher%a#a$ mresi'o in=e'siIns#e'u"o

Mi'ros'o#is

/$es #a'is


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PEMERIKSAAN 5BST

Memeri'sa a%an)a >airan )an( 'e"uar #er3a(inam )an( me>onium 3erni' 'aseosa rambu$ "anu(o %an $i%a' ber

Den(an ins#e'u"o "i+a$ %an #er+a$i'an a#a'a+ air 'e$uban meman( 'e"uar %ari 'an

ser3i'a"is %an a#a'a+ a%a ba(ian )an( #e>a+

Kea%aan umum %ari ser3i's *u(a %ini"ai %i"a$asi %an #en%a$aran a%an)a #ro"a#se $a"i #usa$ a$au $i%a' e's$remi$as ba)i

Poo"in( #a%a >airan amnion %ari =orni's #os$erior


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PEMERIKSAAN PENU

Tes La'mus


35/41

US7


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PENATALAKSA

Konser3a$i=AK$i=


37/41

TERAPI K5NSER


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TERAPI


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K5MP

Persa"inan


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PR57

Pro(nosis #a%a 'e$uban #e>a+ %ini san(a$ ber3aria$i= $er(an$un(

Usia 'e+ami"an

A%an)a in=e'si se#sis

!a>$or resi'o #en)ebab

Ke$e#a$an Dia(nosis aa" %an #ena$a"a'sanaan

Pro(nosis %ari KPD $er(an$un( #a%a a'$u $er*a%in)a "ebi+ >e#a'e+ami"an "ebi+ se%i'i$ ba)i )an( %a#a$ ber$a+an Ba(aimanaumumn)a ba)i )an( "a+ir an$ara ,4 %an ,- min((u mem#un)a'om#"i'asi )an( $i%a' serius %ari 'e"a+iran #rema$ure


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