d8-2
DESCRIPTION
skenario 2TRANSCRIPT
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Perdarahan Pasca Persalinan et causa
Atonia Uteri
D8
Kelly 102012078
Timoty Mario 102012161
Theresia 102012165
Dian Nurul 102012292
Feyan 102012!5!
"ndre# Danny 102012$60
%anty &racella 'amandasa 102012$56
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Jam 15.30 Seorang perempuan berusia 28tahun melahirkan seorang bayi laki-lakiyaitu anaknya yang ketiga. Persalinannyaberjalan lancar. Jam 1.10 ketika pera!atmemeriksanya pasien bera"a "alamkea"aan kurang sa"ar "an pucat.
Skenario
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Identifkasi Istilah
-
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Rumusan Masalah Seorang perempuan berusia 28 tahun
melahirkan seorang bayi laki-laki yaituanaknya yang ketiga kurang sa"ar "anmuka pucat setelah berjalannya #0 menitpersalinan
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Analisis Masalah
$%
&namnesis Pemerik
saan
'i(erential
'iagnosis
)orking'iagnosi
s
*tiologi*pi"emi
ologi
Pato+sio
logi
,ejala
linisPenatalaks
anaan
Prognosi
s
Pencegahan
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Hipotesis Seorang perempuan berusia 28 tahun
"i"uga terkena Postpartum emorrhage
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Early◦ Occurs when blood loss is greater than
500 ml. in the first 24 hours after a vaginal delivery
or greater than 1000 ml after a cesarean birth
*Normal blood loss is about 300 - 500 ml.)
10%
Late◦
Hemorrhage that occurs after the first 24 hours
PostpartumHemorrhage
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eluhan utama $i!ayat persalinan ter"ahulu
◦ Penyakit
◦ 'engan tin"akan
$i!ayat penyakit ter"ahulu◦ 'arah tinggi
◦ '%
$i!ayat konsumsi obat◦ aspirin
$i!ayat trauma
Anamnesis
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/ujuan umum /ujuan khusus Palpasi
nspekulo
Pemeriksaan fsik
tan"a-tan"a ital /ekanan "arah 4060mmg Suhu 367 9rekuensi na"i
100:menit 9rekuensi napas 20:menit
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b◦ /rimester 1 "an 3 ; 11g"l
◦ /rimester 2 ; 10<5 g"l
t 36 = #3 > aP// P/
Pemeriksaan penunjang
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Uterine Atony (Working Diagnosis)
Lacerations
Retained Placental Fragments
Clotting
Main Causes o EarlyHemorrhage are:
&?&
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laerations nspeksi&nestesi lokal
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P$*'SP@SA, 9&/@$S1. Spontaneous or Precipitous "eliery
2. SiBe< Presentation< an" Position oC baby
3. %anipulatiC partus#. Dular< cerical< perineal< uretheral area an"
aginal arices
Post Partum Hemorrhage
!"aerations!
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RE#E$#I% P"ACE$#A
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$i!ayat PP /en"ensi per"arahan Epenjahitan<
hematomaF
P//< P/< /rombostitopenia
9aktor pre"isposisi◦ Solusio plasenta< stillbirth< P'< eklampsia< sepsis
/erapi
Clotting
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**The myometrium fails to contract and
the uterus fills with blood because of
the lack of pressure on the open
vessels of the placental site
&terine Atony
The myometrium fails to contract and
the uterus fills with blood because of
the lack of pressure on the open blood
vessels of the placental site.
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Maniestasi klinis
SyokPer"arahan hebat<gra"ual< tak "apat
"ikontrol
Penurunan tekanan "arahPeningkatan "enyut na"i
Pembengkakan nyeri"aerah agina
'arah keluar "isertaigumpalan
9un"us uteri naik
Per"arahan banyak "anti"ak merembesour glass shape
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etiologypathophysiology
Uterine
Muscle fatigue
Overdistention
of the
Uterus
chorioamnionitis
Excessive use of
Analgesia Anesthesia
Uterinedistortion
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tindakanPosisi tren"elenburg
%asase Cun"us uteri< puttingsusu
@ksitosin%isoprostol 800-1000
mikrogramompresi bimanual
ompresi aorta ab"ominalis /ampon kon"omlaparotomi
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#indakan 'edah
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Gpaya pencegahan
oksitosin
Persalinan perlahan-lahan sesuai kontraksi
lem tali pusat se"ekat mungkin "engan ula< "an 10 cm "ari bayi
Hran"t an"re! teknik
/an"a plasenta lepas< 'uncan-SchultBe<bentuk uterus membulat<tangan kiri sim+sis< menghemat !aktu kelahiran plasenta
Sikap ekspektatiC su"ah "itinggalkan
*aluasi Perlukaan
#atalaksana akti kala iiipersalinan
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&nemia %orbi"itas terkait transCusi Postpartum hipotensi I nekrosis sebagaian
atau seluruh kelenjar hipo+sis anterior ipotensi I gagal ginjal akut "an ci"erasistem organ
isterektomi I sterilitas
komplikasi
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&merika Serikat 6-10100.000 Aegara berkembang 1000100.000
epidemiologi
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Huruk Per"arahan pasca persalinan "apat
menyebabkan kematian ibu #5> terja"ipa"a 2# jam pertama setelah bayi lahir< 8-63> "alam satu minggu setelah bayi lahir<"an 82-88> "alam "ua minggu setelah bayilahir.
prognosis
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Per"arahan postpartum a"alah hilangnya"arah lebih "ari 500 ml "alam 2# jam pertamasetelah lahirnya bayi. Aormalnya< per"arahan"ari tempat plasenta terutama "ikontrol oleh
kontraksi "an retraksi anyaman serat-seratotot serta agregasi trombosit "an trombus+brin "i "alam pembuluh "arah "esi"ua.
omplikasi kasus ini bermacam = macam
namun hal terburuk yang "apat terja"i a"alahkematian. %aka itu perlu pencegahan "inisupaya ti"ak terja"i hal serupa.
kesimpulan