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LAPORAN KASUK
persalinan manual Aid dan Hpp
OlehMega Ayu Fitrian
Pembimbing :Dr. Hariadi, Sp.OG (K) OnkDr. Hariadi, Sp.OG (K) Onk
Bagian Ilmu/SMF Obstetri dan GinekologiBagian Ilmu/SMF Obstetri dan GinekologiFFK UNLAM/RSUD ULIN BanjarmasinK UNLAM/RSUD ULIN Banjarmasin
Oktober, 2013Oktober, 2013
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Pendahuluan…Pendahuluan…
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Pendahuluan…Pendahuluan…
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LAPORAN KASUSLAPORAN KASUS
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Anamnesis
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Anamnesis
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Pemeriksaan FisikPemeriksaan Fisik
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Pemeriksaan Fisik
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Pemeriksaan Laboratorium (DR)JENIS PEMERIKSAAN
09-09-13
(05.42)
09-09-13
(11.08)NILAI RUJUKAN
HEMATOLOGI
Hemoglobin (g/dl) 10,1 8,2 12,0 – 16,0
Leukosit (ribu/ul) 8,0 14,6 4,0 – 10,5
Eritrosit (juta/ul) 4,17 3,45 3,90 – 5,50
Hematokrit (vol %) 31,8 26,1 35 – 45
Trombosit (ribu/ul) 232 237 150 – 450
RDW-CV (%) 13,8 14,7 11,5 – 14,7
MCV,MCH,MCHC
MCV (fl) 76,3 75,9 80,0 – 97,0
MCH (pg) 24,2 23,7 27,0 – 32,0
MCHC (%) 31,7 31,4 32,0 – 38,0
HITUNG JENIS
Neutrofil (%) 69,6 76,5 50,0 – 70,0
Limfost (%) 22,6 10,7 25,0 – 40,0
Monosit (%) 7,8 12,8 3,0 – 9,0
MID (%) 5,6 11,20 4,0 – 11,0
Neutrofil (ribu/ul) 1,8 111,20 2,50 – 7,00
Limfosit (ribu/ul) 0,6 1,5 1,25 – 4,00
MID (ribu/ul) 2,1 1,9 –
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Diagnosis Kerja dan Penatalaksanaan
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Follow Up9/09/2013
(10.05)
Perdarahan (+)
Nyeri (-)
TD :110/80 mmHg
N : 86 x/menit
T : 36 o C
RR : 18 x/menit
TFU: setinggi pusat
Kon: (+)
Fluk: (+)
Inspekulo: perdarahan aktif
dan robekan pada cervix
P4A0 post partus
manual aid dengan
HPP et causa
lacerasi cervix
Visite dr. Bambang A, Sp. OG (K)
Dilakukan heacting portio oleh dr.
Bambang A, SpOG (K)
Dipasang tampon roll 2 buah
R/ pelepasan tampon besok pagi jam
(10.30 Wita)
Cek DR ulang
19/09/2013
(10.30)
Perdarahan (<)
Nyeri (-)
Anemia (+)
TD :120/80 mmHg
N : 86 x/menit
T : 36,3o C
RR : 20 x/menit
TFU: setinggi pusat
Kon: (+)
Fluk: (<)
Hb sahli 7,9
P4A0 post partus
manual aid + HPP et
causa lacerasi
cervix+post heacting
potrio
Cefadroxil tab 2 X 500 mg
Asam Mefenamat 3X 500 mg
B Com C 1 X ! tab
R/ pelepasan tampon besok pagi jam (10.30
Wita)
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Follow Up
Tanggal S O A P
19/09/2013
(05.45)
Perdarahan (+)
Nyeri (+)
TD :130/80 mmHg
N : 86 x/menit
T : 37o C
RR : 18 x/menit
TFU: setinggi pusat
Kon: (+)
Fluk: (,)
P4A0 post partus
manual aid
Cefadroxil tab 2 X 500 mg
Asam Mefenamat 3X 500 mg
B Com C 1 X ! tab
19/09/2013
(06.40)
Perdarahan (+)
Nyeri (<)
TD :120/80 mmHg
N : 86 x/menit
T : 36,3o C
RR : 20x/menit
TFU: setinggi pusat
Kon: (+)
Fluk: (<)
P4A0 post partus
manual aid
Cefadroxil tab 2 X 500 mg
Asam Mefenamat 3X 500 mg
B Com C 1 X ! tab
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Follow Up10/09/2013
(06.30)
Perdarahan (<)
Nyeri (-)
Anemia (+)
TD :120/80 mmHg
N : 86 x/menit
T : 36,3o C
RR : 20 x/menit
TFU: setinggi pusat
Kon: (+)
Fluk: (<)
Hb lab 8,2
P4A0 post partus
manual aid + HPP
et causa lacerasi
cervix+post
heacting potrio +
Anemia
Cefadroxil tab 2 X 500 mg
Asam Mefenamat 3X 500 mg
B Com C 1 X ! tab
Visite dr. Hariadi Sp.OG (K)
Aff tampon jam (10.00 Wita)
Transfusi PRC 2 kolf
11/09/2013
(06.30)
Perdarahan (<)
Nyeri (-)
Anemia (+)
TD :120/80 mmHg
N : 86 x/menit
T : 36,3o C
RR : 20 x/menit
TFU: setinggi pusat
Kon: (+)
Fluk: (<)
P4A0 post partus
manual aid + HPP et
causa lacerasi
cervix+ post
heacting potrio +
Anemia terkoreksi
Cefadroxil tab 2 X 500 mg
Asam Mefenamat 3X 500 mg
B Com C 1 X ! tab
SF 1X1 tab
Post transfuse 2 kolf
BLPL
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Laporan Sungsang (05.45 Wita)
Laporan partus letak sungsang (9-9-2013, 05.45 Wita).
1. Pembukaan lengkap, bokong kaki berada di depan vulva.
2. Dilakukan episiotomi mediolateral dan bokong kaki ditunggu sampai lahir-
lahir berturut-turut sampai perut, dada, dan bahu dilahirkan dengan cara
Lovset dan kepala dilahirkan dengan perasat Mariausceau
3. Lahir bayi perempuan, BB: 3400 gram, PB: 59 cm, AS: 6-7-9 pada tanggal 9
September 2013 jam 05.45 Wita, Anus (+), dan kelainan kongenitasl (-)
4. Dilakuakn klem 2 posisi pada tali pusat, tali pusat di potong. Dilakukan
penyuntikan oksitosin 10 IU secara IM pada regio femurl lateral dan
dilakukan peregangan tali pusat terkendalai.
5. Lahir plasenta lengkap denga insertio
6. Infark (-), Klasifikasi (-), Hematom (-)
7. Dilakukan penjahitan luka episiostomi
8. Dilakukan observasi kala IV
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Terapi Post Partus1. Cefadroxil tab 3X500 mg2. Asam Mefenamat tab 3X500 mg3. B Com C tab 1X1
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Pembahasan Pembahasan
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Diagnosis berdasarkan PenunjangUSG (letak plasenta atau cacat bawaan)MRIRoetgen (posisi tungkai, fleksi kepala, cacata
bawaan)
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MRI Sungsang
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Kasus Vs Teori (KPD)
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Penatalaksanaan Sungsang
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Per Vaginam
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Per vaginam Manual Aid
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Pengeluaran Bahu ……
Cara Klasik
Cara Mueller
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Pengeluaran Bahu …. (lanjutan)
Cara Loevset
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Pengeluaran Kepala ……
Cara Mauriceau
Cara Prague Terbalik
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Pengeluaran Kepala …… (Lanjutan)
Cara Cunam Piper
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Pertimbangan Melahirkan Per Vaginam Pada Kasus
Skor 0 1 2
Paritas Primigravida Multigravida
Usia Kehamilan 39 minggu 38 minggu 37 minggu
Taksiran TBJ 3630 gram 3176-3629 gram < 3176 gram
Riwayat Sungsang Tidak pernah 1 kali 2 kali
Dilatasi Serviks < 2 cm 3 cm > 4 cm
Station -3 -2 -1 atau lebih rendah
Skor Zatuchni Andros
Kasus Skor: 6 (dapat dilakukan persalinan per vaginam
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Hemorraghe Post Partum (HPP) Hemorraghe Post Partum (HPP)
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Faktor Predisposisi KPD
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Langkah-Langkah Diagnosis HPP
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Kasus Vs Teori (HPP)
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Penatalaksanaan HPP
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Kasus Vs Teori (Pentalaksanaan HPP)
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Teknik Penjahitan Portio
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Terima KasihTerima Kasih