plasenta previa beneerrr
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LAPORAN KASUS
PLASENTA PREVIA
Tommy Alexander
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IDENTITAS
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ANAMNESA
KU:
Hamil 37-39
minggu dengan
keluar darah segar
dan bergumpal dari
sejak 3 hari SMRS
RPS:
Hamil 37-39 minggu
Perdarahanan dan bergumpal
dari kemaluan sejak 3 hari SMRS
Warna merah segar, mendadak
tanapa riw. trauma, flek
Nyeri (-), mules (+), lendir
berdarah (-), air (-)
Riwayat perdarahan usia hamil
30 minggu berhenti sendiri
Pasien menyangkal melakukan hubungan
suami istri sebelumyaP
RPD:
HT (-), DM (-), asma (-)
RPK
HT (-), DM (-), asma (-)
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ANAMNESA
Riwayat Menstruasi:
Menarche: Umur 11 tahun
Siklus: Teratur ± 28 hari/bulan
Lamanya : 7 hari
Banyaknya: 3x pembalut/hari
HPHT: 20-7-2012
TP: 27-4-2013
Dismenore: (-)
Riwayat
Pernikahan:
1x, usia 36
tahun
Riwayat Obstetri
1. P, 2010, 3 tahun,
spontan, bidan, 2600 g
2. Hamil ini
Riwayat Operasi
(-)
Riwayat KB :
KB suntik 3
bulan
Riwayat ANC (+)
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PF
TSS/CM
T: 120/90 mmHg
N : 84 x/menit
RR : 18 x/menit
S : 36,3 ⁰C
Kepala :normocephali,
rambut hitam, mudah dicabut
(-)
Mata :Pupil bulat isokor,
konjungtiva anemis (-/-), sklera
ikterik (-/-)
THT :Sekret (-), mukosa
hiperemis (-)
Leher :Kelenjar tiroid ttm, KGB
ttm
Status Generalis
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PF
Thoraks :Cor : S1-S2 normal reguler, murmur (-), gallop (-)
Pulmo: : Suara nafas vesikuler (+/+), ronchi (-), wheezing (-)
Abdomen: Inspeksi : Perut tampak membuncit sesuai dengan masa kehamilan
Palpasi : Supel, nyeri tekan (-) Perkusi : Timpani, nyeri ketuk (-)
Auskultasi : BU (+)
Ekstremitas: Akral hangat (+/+/+/+), oedema tungkai -/-, CRT < 2’’
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STATUS OBSTETRI
Inspeksi:
Perut membuncit sesuai
dengan masa
kehamilan, Striae
gravidarum (+)
Palpasi:
TFU teraba3 jari dibawah proc.
xyphoideus
L1 : Bokong.
L2: Punggung kiri
L3: kepala
L4 : Konvergen (belum masuk
rongga PAP)
Kontraksi : (-), gerak janin (+)
Auskultasi :
152 x/menit, teratur
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LABORATORIUM 9 April 2013, 11:27 WIB
HEMATOLOGI
Hemoglobin (g/dl) 10,4
Hematokrit (%) 29
Lekosit (/ul) 8000
Trombosit (/ul) 288.000
Gol darah O +
Proteinuri (-)
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USG 10 april2013, 10:15 WIB
Janin hidup intrauterine presentasi kepala
DJJ (+)
Punggung kiri
Ketuban cukup
Plasenta korpus depan menutup OUI
KESAN: Hamil 37 – 39 minggu, JTH, plasenta previa totalis
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Diagnosa Kerja
• Ibu : G2P1A0 hamil 37-39 minggu
dengan perdarahan pervaginam e.c
Plasenta Previa Totalis
• Anak : Janin Tunggal Hidup Intra
Uterine Presentasi Kepala
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PLANING
Rencana Diagnosis
Pro SC
Rencana Tindakan• Persiapan operasi
Lab lengkap (hematologi, hemostasis, GDS, ureum/kreatinin, SGOT/SGPT, albumin, globulin, urin lengkap)Carditocography (CTG)PuasaAntibiotik Anbacim 1g intravena
• Post operasiRawat di ruanganObservasi tanda-tanda vital, keadaan umum, perdarahan pervaginam, kontraksi uterus dan diuresis post operasiPuasa sampai peritaltik (+)Mobilisasi bertahapPeriksa H2TL post 6 jam operasi, jika Hb < 6 g/dl transfusi
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• Ad vitam : Dubia
• Ad fungsionam : Bonam
• Ad sanationam : Dubia
Prognosis
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11/04/13 Pukul 13.35 WIB
• Dilakukan SCTPP a.i G2P1A0 hamil 37-39 minggu
dengan perdarahan pervaginam e.c Plasenta
Previa Totalis
Pukul 13.40
Lahir Bayi P
BBL: 2500 gram
PBL: 47 cm
A/S: 8/9
Anus: (+)
Ketuban: Jernih
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12 april 2013 13 april 2013 14 april 2013
S : Nyeri luka op (+), BAB (-) 1 hari, kentut (+)
S : Nyeri luka bekas op (+) ↓, BAB (+), lemas (+)
S : Nyeri luka bekas op (+) ↓↓
O : TSS/ CMT : 100/70 mmHgN : 100 x/mntRR : 20 x/menitS : 36, 5⁰CConjungtiva anemis -/-
St, Purpuralis :Abd : datar, SG + LN +, Luka post op tertutup verban Darah - Pus –TFU 2 Jbp, Nt + luka postOpBU + 3-4 x / mntMamae : Retraksi +/+, ASI +/+Genital : Lokia Rubra +
O : TSS/ CMT : 120/70 mmHgN : 86 x/mntRR : 20 x/menitS : 36, 6⁰CConjungtiva anemis -/-
St, Purpuralis :Abd : datar, SG + LN +, Luka post op tertutup verban Darah - Pus –TFU 2 Jbp, Nt + luka postOpBU + 3-4 x / mntMamae : Retraksi +/+, ASI +/+Genital : Lokia Rubra +
O : TSS/ CMT : 120/80 mmHgN : 84 x/mntRR : 20 x/menitS : 36, 4⁰CConjungtiva anemis -/-
St, Purpuralis :Abd : datar, SG + LN +, Luka post op tertutup verban Darah - Pus –TFU 3 Jbp, Nt + luka postOpBU + 3-4 x / mntMamae : Retraksi -/-, laktasi +/+Genital : Lokia Rubra +
A: P2AO post SCTPP a.i HAP e.c PPT H+1
A: P2AO post SCTPP a.i HAP e.c PPT H+2
A: P2AO post SCTPP a.i HAP e.c PPT H+3
P :Obat Inj : ceftriaxone 1gr 2x1 Gentamycin amp 2x1 Kalnex 3x1 Alinamin F 2x1
Mobilisasi miring kanan & kiriPeriksa Hb 6 jam post transfusi
P:Obat inj:ceftriaxone 1gr 2x1 Gentamycin amp 2x1 Kalnex 3x1 Alinamin F 2x1
Mobilisasi duduk dan jalan
P : Ciprofloxacin 2x1Metilergometrin 3x1Sf 1x1Na diclofenac 2x1
GV -> jika luka bagus bleh pulangKontrol poli 1 minggu
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Perdarahan jalan lahir setelah
kehamilan 22 minggu
Perdarahan Antepartum
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DEFINISI
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FREKUENSI
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PATOFISIOLOGY
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FUNGSI PLASENTA
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RISK
FACTOR
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USG 96 %
P = plasenta ; F = janin ; AF = cairan amnion ; B = Kandung kemih ; Cx = Cervix
OVERDISTENSI BLADDER
KONTRAKSI MIOMETRIUM
FALSE +
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DIAGNOSIS
BANDING
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Klinis Ruptur Uteri Solutio Plasenta
Plasenta Previa
Terjadinya Lebih sering inpartu
Sewaktu hamil dan inpartu
Sewaktu hamil
Cara mulainya Dimulai dengan RUI
Tiba-tiba Perlahan-lahan
Perdarahan Bergantung pada pembuluh darah
yang pecah
Non-recurrent Recurrent
Warna darah Merah terang Merah kehitaman Merah terang
Preeklamsi/eklamsi
Bisa ada - -
Nyeri perut + di SBR + -
Palpasi Defans muskuler, meteorismus
Uteri in-bois, bagian-bagian
anak sulit diraba
Biasa dan floating
His Hilang Kuat Biasa
DJJ - - +
VT Robekan Ketuban tegang,
menonjol
Jaringan plasenta
Plasenta Biasa Tipis, cekung Robek di pinggir
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THERAPHY
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THERAPHY
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KONSERVATIF
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TERMINASI KEHAMILAN PP
SC
PERVAGINAM
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KOMPLIKASI
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PROGNOSA
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ANALISA KASUS
• Ibu : G2P1A0 hamil 37-38 minggu dengan
perdarahan pervaginam e.c Plasenta Previa
Totalis
• Anak : Janin Tunggal Hidup Intra Uterine
Presentasi KepalaAnamnesa:
Hamil 9 bulan
HPHT: Lupa
Perdarahan (+), flek,
mendadak, trauma (-),
nyeri (-), mules (+)
jarang2, lendir berdarah
(-), air2 (-)
Riw perdarahan 2 minggu
yll (1/2 aqua gelas)
PF:
perut membuncit, LN(
+ ) SG(+),
TFU 30 cm,
L1: Bokong,
L2 : Pu-ki,
L3 : Kepala,
L4 : Belum memasuki
PAP
Usg : Tampak janin tunggal hidup prsentasi kepala BPd 8,9; AC 29,80; TBJ: 245900 grPlasenta di korpus kanan depan sampai menutupi OUI
Kesan : Kehamilan sesuai 37-38 minggu, Plasenta Previa Totalis, Janin Presentasi Kepala Tunggal Hidup
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•Darah kehitaman•Nyeri
menetap(+)•Kontraksi menetap abdomen keras•Perburukan klinis tidak sejalan dgn
perdaran•Anemia
•Gawat janin
•Perdarahan intraabdomen•Hematuri •Nyeri hebat
•Nyeri (-)•Darah segar
•Faktor penyebab mekanik
•Perburukan klinis sejalan dengan
perdarahan•Abdomen lemas
Perdarahan
setelah ketuban
pecah
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PPT
Keluar darah dari kemaluan
Perdarahan terjadi
mendadak
Warna merah segar
Perdarahan tidak disertai
nyeri
Riwayat perdarahan 2 mgu
yll (1/2 gelas aqua)
Riwayat kontraksi (+)
jarang2
Riwayat trauma disangkal
L4:
Konvergen
Perdarahan (+)
Usg : Tampak janin tunggal hidup
prsentasi kepala
BPD 8,9; AC 29,80; TBJ 2459 gr
Plasenta di korpus kanan depan sampai
menutupi OUI
Kesan : Kehamilan sesuai 37-38
minggu dgn Plasenta Previa Totalis,
Janin Presentasi Kepala Tunggal
Hidup
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SC ???
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..Terima Kasih..