trauma obstetri dan ginekologi
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TRAUMA OBSTETRI DAN GINEKOLOGI
Dr. Niken Asri Utami, SpOG
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Trauma pada perempuanSedang hamil, akan hamil“Cantik”TabuPerawanDisengajaTak disengajaAntara sengaja maupun tidakPsikologis
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TRAUMA OBSTETRI
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Trauma obstetriHamil di bawah 20 minggu
- tak disengaja trauma benturan abortus spontan
- disengaja abortus provocatus criminalis- dikerjakan oleh ahli, proses steril- dikerjakan tidak steril
Hamil di atas 20 minggu- solusio plasenta
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Trauma obstetriAncaman:
- perdarahan s.d. Syok- infeksi- gejala sisa: tidak bisa hamil lagi
(o.k. Perlengketan atau amputasi)
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AbortusTegakkan diagnosaAnamnesa:
- perdarahan per vaginam banyak/sedikit/gumpal- keluar darah setelah tindakan apa?- keputihan/lendir, bau busuk- riwayat amenore/ HPHT
Status umum: ketakutan/ HD/ temperaturPeriksa dalam/colok dubur: + informed consent
- Hymen intak/robekan- Cervix terbuka/tertutup, nyeri goyang- Teraba jaringan di oue- Tinggi fundus uteri
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Abortus - kuretaseTangani secara medis etis di sarana
kesehatan!Amankan A-B-CMedikolegal: informed consent
- tanda tangan suami/keluarga/polisi/tenaga kesehatan pengirim- minta surat nikah/KTP/kartu keluarga/tanda tangan saksi
Prosedur kuretase, antibiotika, transfusi
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Solusio plasenta
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Solusio plasentaSubjektif:
- nyeri perut hebat, kontraksi terus-menerus- keluar darah merah kehitaman dari vagina- gerak janin ada/berkurang/tidak ada- riwayat trauma
jatuh terduduk, perut terbentur
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Solusio plasentaObjektif:
- pasien sadar/shock cek HD, Hb- perut tegang, his, tetani- periksa dalam:
- ketuban menonjol- fluksus merah kehitaman, jumlah tidak
sesuai dengan gejala klinis- DJJ tachycardia/bradicardia- USG: hematom retroplasenta- dapat terjadi AKIoligouria
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Solusio plasentaManajemen
- A-B-C- Pecahkan ketuban!- Lahirkan bayi dalam 6 jam
- Pelvic score >5 induksi- Pelvic score<5 sc
- Atasi koagulopati, gangguan cairan- sedapat mungkin pertahankan uterus, bila tidak mungkin, histerektomi
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Uterus couvelaire
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Trauma ginekologi
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Anatomi
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Anatomi
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Vaskularisasi
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Trauma GinekologiTunggal/multitraumaKecelakaan – tak disengajaStraddle injuryRudapaksaPerkosaanCorpus alienumIatrogenik (episiotomy, instrumentasi)
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GambarStraddle injury Robekan hymen
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ManajemenA-B-CAntibiotika profilaksis – terapeutikMedikolegal!Direct pressure over lacerationApply cold pack to hematomeTransportRepair
- kamar ginek akut- kamar operasi- anestesia
Ekstraksi corpus alienum
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Identifikasi trauma organ ginekologiInspeksi:
- eksterior vagina s.d. Perineum- hematome perineum- hymen : dengan bantuan colok dubur, arah robekan,
robekan lama/baru- asal darah
Inspekulo Sim’s, cocor bebek, oval klem- dinding vagina- fornix anterior tembus ke vesica ?- fornix posterior- cervix
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Identifikasi trauma organ ginekologiPeriksa dalam/ palpasi bimanual/ colok dubur
- ukuran robekan dinding vagina, cervix- kedalaman robekan ke uterus/cavum douglas/ vesica urinaria/rektum- fundus uteri ; ukuran, konsistensi- adnexa parametrium: massa, nyeri- cavum douglas : menonjol?
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Hematom perineumSering:
- trauma partus- perineuraphy tidak sempurna
Manajemen:-kecil: resorpsi sendiri- besar/bertambah:
evakuasi hematom,
jahit repair
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Trauma pada anakIdentifikasi lukaIdentifikasi lebih
lanjut dan repair di kamar operasi dengan anestesia
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Corpus alienum vaginaLintah- Anamnesa : perdarahan setelah mandi di sungai
(berlangsung beberapa jam s.d. beberapa hari)- Pemeriksaan fisik: sulit (anak kecil, virgin)- Irigasi dg NS via NG Tube s.d. Keluar- Ekstraksi dg surgical forceps anestesiajangan
dipaksarahang tetap tertinggalperdarahan- Rendam air tembakau, garam, cuka, larutan
lignocaine- Antibiotika- Atasi perdarahan, transfusi
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Corpus alienum vaginaBenda asingX-ray, USG, endoskopiEkstraksi Repair per vaginam dan/atau per
abdominamAntibiotika
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Corpus alienum
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Corpus alienum
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Salus aegroti suprema lex est
Terima kasih