ante partum bleeding.ppt
TRANSCRIPT
ANTE PARTUM BLEEDINGANTE PARTUM BLEEDING
Dr.G.M PUNARBAWA, SpOG
SMF OBSTETRI-GINEKOLOGIRSUP NTB
Dr.G.M PUNARBAWA, SpOG
SMF OBSTETRI-GINEKOLOGIRSUP NTB
PENDAHULUANPENDAHULUAN
OBSTETRI ADALAH BLOODY BUSINESS OBSTETRI ADALAH BLOODY BUSINESS
KEMATIAN MATERNAL DAPAT DITURUNKAN KEMATIAN MATERNAL DAPAT DITURUNKAN
KAUSA PERDARAHAN MASIH MENONJOLKAUSA PERDARAHAN MASIH MENONJOL
A S 1979-92:4915 KEMATIAN MATERNAL NON ABORTUS30% KAUSA PERDARAHAN
A S 1979-92:4915 KEMATIAN MATERNAL NON ABORTUS30% KAUSA PERDARAHAN
PENDAHULUANLANJUTAN
PENDAHULUANLANJUTAN
KAUSA PERDARAHAN JUMLAH (%)
ABRUPTIO PLACENTAE 141 (19)LACERATION/UTERINE RUPTURE125 (16)UTERINE ATONY 115 (15)COAGULOPATHIES 108 (14)PLACENTA PREVIA 50 ( 7 )PLACENTA ADHESIVE 44 ( 6 )UTERINE BLEEDING 47 ( 6 )RETAINED PLACENTA 32 ( 4 )
KAUSA PERDARAHAN JUMLAH (%)
ABRUPTIO PLACENTAE 141 (19)LACERATION/UTERINE RUPTURE125 (16)UTERINE ATONY 115 (15)COAGULOPATHIES 108 (14)PLACENTA PREVIA 50 ( 7 )PLACENTA ADHESIVE 44 ( 6 )UTERINE BLEEDING 47 ( 6 )RETAINED PLACENTA 32 ( 4 )
CHICHACLI (1999), WILLIAM 21ST
PERDARAHAN ANTE PARTUMPERDARAHAN ANTE PARTUM
1. ABRUPTIO PLACENTAE/SOLUTIO PLACENTAE1. ABRUPTIO PLACENTAE/SOLUTIO PLACENTAE
2. PLACENTA PREVIA2. PLACENTA PREVIA
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
• PLASENTA LEPAS
• IMPLANTASI NORMAL
• SEBELUM BAYI LAHIR
• > 20 MINGGU
• PLASENTA LEPAS
• IMPLANTASI NORMAL
• SEBELUM BAYI LAHIR
• > 20 MINGGU
DEFINISIDEFINISI
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
•ACCIDENTAL HEMORRHAGE
•SOLUTIO PLACENTAE
•PREMATURE SEPARATION OF THE NORMALLY IMPLANTED PLACENTA
•ACCIDENTAL HEMORRHAGE
•SOLUTIO PLACENTAE
•PREMATURE SEPARATION OF THE NORMALLY IMPLANTED PLACENTA
TERMINATIONSTERMINATIONS
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
•EXTERNAL HEMORRHAGE
•CONCEALED HEMORRHAGE
•EXTERNAL HEMORRHAGE
•CONCEALED HEMORRHAGE
•TOTAL
•PARTIAL
•TOTAL
•PARTIAL
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
FREQUENCY AND INTENSITY
•CRITERIA DIAGNOSIS•ONSET SYMPTOMS
FREQUENCY AND INTENSITY
•CRITERIA DIAGNOSIS•ONSET SYMPTOMS
FREQUENCY: 1 PER 200 DELIVERIESFREQUENCY: 1 PER 200 DELIVERIES
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
PERINATAL MORTALITY & MORBIDITY
MOST 25%
KAREGARD (1986) 20%
KROHN (1987) 20/884 SOLUTIO
ANANTH (1999) 40%
PERINATAL MORTALITY & MORBIDITY
MOST 25%
KAREGARD (1986) 20%
KROHN (1987) 20/884 SOLUTIO
ANANTH (1999) 40%
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
RISK FACTOR RELATIVE RISK (%)
INCREASE AGE/PARITY NAPREECLAMPSIA 2,1-4,0CHRONIC HYPERTENTION 1,8-3,0PROM 2,4-3.0CIGARETTE SMOKING 1,4-1,9THROMBOPHILIA NACOCAINE USE NAPRIOR ABRUPTION 10-25UTERINE LEIOMYOMA NA
RISK FACTOR RELATIVE RISK (%)
INCREASE AGE/PARITY NAPREECLAMPSIA 2,1-4,0CHRONIC HYPERTENTION 1,8-3,0PROM 2,4-3.0CIGARETTE SMOKING 1,4-1,9THROMBOPHILIA NACOCAINE USE NAPRIOR ABRUPTION 10-25UTERINE LEIOMYOMA NA
ANANT AND KRAMER (WILLIAM 21ST)
ABRUPTIO PLACENTAEABRUPTIO PLACENTAEPATHOLOGY
HEMORRHAGICINTRA DECIDUA
DECIDUAL SPLITS DECIDUALHEMATOMA
•SEPARATION•COMPRESSION•DESTRUCTION
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
•CONCEALED HEMORRHAGE
•CHRONIC PLACENTAL ABRUPTION
•FETOMATERNAL HEMORRHAGE
•CONCEALED HEMORRHAGE
•CHRONIC PLACENTAL ABRUPTION
•FETOMATERNAL HEMORRHAGE
WAJIB BACA
ABRUPTIO PLACENTAEABRUPTIO PLACENTAEDIAGNOSISDIAGNOSIS
SIGN OR SYMPTOM FREQUENCY (%)
VAGINAL BEEDING 78UTERINE TENDERNESS OR BACK PAIN 66FETAL DISTRESS 60HIGH FREQUENCY CONTRACTIONS 17HYPERTONUS 17IDIOPATHIC PRETERM LABOR 22DEAD FETUS 15
SIGN OR SYMPTOM FREQUENCY (%)
VAGINAL BEEDING 78UTERINE TENDERNESS OR BACK PAIN 66FETAL DISTRESS 60HIGH FREQUENCY CONTRACTIONS 17HYPERTONUS 17IDIOPATHIC PRETERM LABOR 22DEAD FETUS 15
HURD (1983), WILLIAM 21ST
ABRUPTIO PLACENTAEABRUPTIO PLACENTAECOMPLICATIONSCOMPLICATIONS
•SHOCK ≈ ≠ BLEEDING
•CONSUMPTIVE COAGULOPATHY
•RENAL FAILURE
•COUVELAIRE UTERUS
•SHOCK ≈ ≠ BLEEDING
•CONSUMPTIVE COAGULOPATHY
•RENAL FAILURE
•COUVELAIRE UTERUS
ABRUPTIO PLACENTAEABRUPTIO PLACENTAEMANAGEMENTMANAGEMENT
STATUS OFTHE MOTHER
STATUS OFTHE FETUS
GESTATIONALAGE
PERDARAHAN ANTE PARTUMPERDARAHAN ANTE PARTUM
1. ABRUPTIO PLACENTAE/SOLUTIO PLACENTAE1. ABRUPTIO PLACENTAE/SOLUTIO PLACENTAE
2. PLACENTA PREVIA2. PLACENTA PREVIA
PLACENTA PREVIAPLACENTA PREVIA
•PATHOLOGIC IMPLANTATION
•LOW SEGMENT
•OVER OR VERY NEAR OS
•PATHOLOGIC IMPLANTATION
•LOW SEGMENT
•OVER OR VERY NEAR OS
PLACENTA PREVIAPLACENTA PREVIA
NORMAL IMPLANTATION:
•UTERINE FUNDAL
•UTERINE CORPORAL
NORMAL IMPLANTATION:
•UTERINE FUNDAL
•UTERINE CORPORAL
PLACENTA PREVIAPLACENTA PREVIA DEGREE
1. TOTAL PLACENTA PREVIA
2. PARTIAL PLACENTA PREVIA
3. MARGINAL PLACENTA PREVIA
4. LOW LYING PLACENTA
5. VASA PREVIA
1. TOTAL PLACENTA PREVIA
2. PARTIAL PLACENTA PREVIA
3. MARGINAL PLACENTA PREVIA
4. LOW LYING PLACENTA
5. VASA PREVIA
PLACENTA PREVIAPLACENTA PREVIA INCIDENCEINCIDENCE
IYASU (1993) 0,50%
FREDERIKSEN (1999) 0,55%
CRANE (1999) 0,33%
PARKLAND HOSPITAL 12YEARS 0,26%
IYASU (1993) 0,50%
FREDERIKSEN (1999) 0,55%
CRANE (1999) 0,33%
PARKLAND HOSPITAL 12YEARS 0,26%
WILLIAM, 21ST
PLACENTA PREVIAPLACENTA PREVIA ETIOLOGYETIOLOGY
•INCREASES MATERNAL AGE
•MULTIPARITY
•PRIOR CESAREAN DELIVERY
•SMOKING
•INCREASES MATERNAL AGE
•MULTIPARITY
•PRIOR CESAREAN DELIVERY
•SMOKING
PLACENTA PREVIAPLACENTA PREVIA CLINICAL FINDINGCLINICAL FINDING
•PAINLESS HEMORRHAGE
•SECOND TRIMESTER
•WITHOUT WARNING
•PAINLESS HEMORRHAGE
•SECOND TRIMESTER
•WITHOUT WARNING
PLACENTA PREVIAPLACENTA PREVIA
THE CAUSE OF SPONTANEOUSHEMORRHAGE IS RELATED TODEVELOPMENT OF THE LOWERUTERINE SEGMENT
THE CAUSE OF SPONTANEOUSHEMORRHAGE IS RELATED TODEVELOPMENT OF THE LOWERUTERINE SEGMENT
PLACENTA PREVIAPLACENTA PREVIA DIAGNOSISDIAGNOSIS
CLINICAL FINDINGPAINLESS HEMORRHAGEWITHOUT WARNING
DOUBLE SET-UPVAGINAL EXAMINATION
SONOGRAPHYTRANSABDOMINALTRANSVAGINAL
CLINICAL FINDINGPAINLESS HEMORRHAGEWITHOUT WARNING
DOUBLE SET-UPVAGINAL EXAMINATION
SONOGRAPHYTRANSABDOMINALTRANSVAGINAL
PLACENTA PREVIAPLACENTA PREVIA
MANAGEMENT:
1. FETUS IS PRETERM?
2. FETUS MATURE TO DELIVERY?
3. THOSE IN LABOR?
4. SEVERE HEMORRHAGE?
MANAGEMENT:
1. FETUS IS PRETERM?
2. FETUS MATURE TO DELIVERY?
3. THOSE IN LABOR?
4. SEVERE HEMORRHAGE?
PLASENTA PREVIAPLASENTA PREVIA
PERDARAHAN SEDIKIT( <250 cc )
PERDARAHAN SEDIKIT( <250 cc )
PERDARAHAN BANYAK( > 500 cc )
PERDARAHAN BANYAK( > 500 cc )
PRETERMPRETERM ATERM ATERM
ISTIRAHATISTIRAHATUSGUSG
TOTALTOTAL SUBTOTALSUBTOTAL
AMNIOTOMIAMNIOTOMI
PERDARAHANPERDARAHAN INPARTUINPARTU
PERVAGINAMPERVAGINAM
S E K S I O S E S A R E AS E K S I O S E S A R E A
PRETERMPRETERM ATERMATERM
ISTIRAHATISTIRAHAT
STOPSTOP ULANGULANG
DSUDSU
TOTALTOTAL
PARSIALPARSIAL
AMNIOTOMIAMNIOTOMI
DARAHDARAH INPARTUINPARTU
PERVAGINAMPERVAGINAM