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Kasus Late PPH

makmur sitepu

Divisi Feto-Maternal

Departemen Obgin FK-USU/RS. HAM

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Background

Late Post Partum Haemorrhage is defined as

abnormal or excessive bleeding from the

birth canal between 24 hours and 6 weeks

following the birth.

Late PPH occurs in 1% of postpartum

women and commonly occurs between 8

21 days postpartum.

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Causes of late postpartum

hemorrhage

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A proposed standardized system for reporting

postpartum ultrasound scan. Adapted from Neill et al.,

200224

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Normal Ultrasound Uterine postpartum

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Endometritis

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Retained Placental

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Retained Placental (echogenic mass)

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Retained Placental and post

evacuation

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The management of late postpartum

hemorrhage

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Ny. RP, usia 35 tahun. P4A0 datang bersama suami

dengan keluhan perdarahan pervaginam. Gumpalan

darah positif. Ny.RP baru melahirkan spontan 2 minggu

yang lalu

More Info I:Pemeriksaan fisik :

Vital sign : sensorium = compos mentis lemah

TD = 90/70 mmHg

Nadi = 100x/i , tekanan/volume cukup

RR = 20x/iTemperatur = afebris

Hb: 9 gr%, Leokusit: 8.000/ mm3, Thrombosit: 256.000

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Pemeriksaan obstetri :Inspekulo: vagina licin, servik licin, darah mengalir dari

ostium uteri eksterna (OUE)VT: Uterus antefleksi, ukuran 10 cm, kontraksi lemah

Adneksa dan parametrium = tidak ada kelainan

More Info II : (pada tutorial ke- 2)

USG : Uterus anteflexi, ukuran 10x8 cm. Dijumpai

bayangan hyperechoic dalam cavum uteri ukuran 3x2

cm kemungkinan berasal dari jaringan.

Adnexa : tidak ada kelainan

Kesimpulan : Sisa konsepsi

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Am J Obstet Gynecol. 1990 Sep;163(3):823-5.

Preterm delivery: a risk factor for retained placenta.

Romero R, Hsu YC,Athanassiadis AP, Hagay Z,Avila C, Nores J, Roberts A, Mazor M, Hobbins JC.

Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT

06510.

Abstract

The purpose of this study was to determine whether preterm delivery, with

and without intraamniotic infection, is a risk factor for retained placenta. This

complication occurred more frequently in women with preterm vaginaldelivery than in women with term vaginal delivery (9.1% [21/231] vs 1.1%

[6/561]; p less than 0.00001; odds ratio = 9.25). There was no significant

difference in the prevalence of retained placenta between women with

preterm labor and intact membranes and those with preterm premature

rupture of membranes (8% [10/125] vs 10.4% [11/106]; p greater than or

equal to 0.05). A positive amniotic fluid culture or clinical chorioamnionitiswas not associated with a higher incidence of retained placenta. This study

indicates that preterm delivery is associated with an increased risk of

complications of the third stage of labor.

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Romero%20R%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hsu%20YC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Athanassiadis%20AP%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hagay%20Z%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Avila%20C%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nores%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20A%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mazor%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mazor%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20A%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nores%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Avila%20C%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hagay%20Z%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Athanassiadis%20AP%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hsu%20YC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Romero%20R%22[Author]

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Grading Placenta

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Analisa Kasus

Late PPH: 2 minggu

Perbaiki KU

Antibiotika 12

24 jam Uterotonika

Evakuasi dengan kuretase.

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