BAB II PEMBAHASAN Skenario Kasus Mrs.

Anita , a 39-year old woman in her first pregnancy delivered twin sons 2 h ago. There were no significant antenatal complications. She had een prescri ed ferro!s s!lphate and folic acid d!ring the pregnancy as anemia prophyla"is, and her last hemoglo in was #$,9 g%d& at 3' wee(s. The fet!ses were within normal range for growth and li)!or vol!me on serial scan estimation. A vaginal delivery was planned and she went into spontaneo!s la or at 3' wee(s and * days. The la or had een !nremar(a le and the midwife recorded oth placenta appearing complete. As this was a twin pregnancy, an intraveno!s cann!la had een inserted when la or was esta lished. The lochia has een heavy since delivery !t the woman is now leeding very heavily and passing large clot of lood. +n arrival in the room yo! find that the sheets are soa(ed with lood and there is also appro"imately ,$$ m& of lood clot in a (idney dish on the ed -o! act as the doctor in p! lic health centre and e pleased to analyse this case. The woman is conscio!s !t drowsy and pale. .eight / #,, cm, 0eight ,$1g 2n the e"amination findings3 The temperat!re is 3,,94, lood press!re #2$%5$ mm.g and heart rate ##2%min. The pheriperal e"tremities are cold. The !ter!s is palpa le to the !m ilic!s a d felt soft. The a domen is otherwise soft and non tender. +n vaginal inspection there is a second degree tear which has een s!t!red !t y! are !na le to assess f!rther d!e to the presence of prof!se leeding. The midwife sent lood tests 3$ min ago eca!se she was concerned a o!t the lood loss at the time. .aemoglo in 5,2 g%d& M46 99,$ f& 0hite cell co!nt 32$$%mm3 7latelets #3#.$$$%mm3 289 #.3 A7TT 39 s Sodi!m #3' mmol%& 7otassi!m 3., mmol%& :rea ,.2 mmol%& 4reatinine ;* !mol%&

A. Klarifikasi Istilah #. Anemia prophyla"is3 Tinda(an pencegahan terhadap anemia 2. &ochia 3 cairan secret yang erasal dari cav!m !teri dan vagina selama masa nifas 3. 7ale3 7!cat *. <rowsy3 7erasaan mengant!( yang erle ihan ,. Second- degree tear3 9o e(an yang dalam pada (!lit sehingga terlihat otot ;. 7rof!se leeding3 1ehilangan darah dalam =!mlah yang anya( 5. 289 >2nternational 8ormali?ed 9atio@3 sat!an yang la?im dig!na(an !nt!( pemanta!an pema(aian anti(ag!lan oral '. A7TT >Activated 7artial Throm oplastin Time@ 3 wa(t! trom oplastin parsial yang dia(tif(an

Identifikasi Masalah #. Mrs. Anita , a 39-year old woman in her first pregnancy delivered twin sons 2 h ago. There were no significant antenatal complications 2. She had een prescri ed ferro!s s!lphate and folic acid d!ring the pregnancy as anemia prophyla"is, and her last hemoglo in was #$,9 g%d& at 3' wee(s 3. As this was a twin pregnancy, an intraveno!s cann!la had een inserted when la or was esta lished. The lochia has een heavy since delivery !t the woman is now leeding very heavily and passing large clot of lood. *. +n arrival in the room yo! find that the sheets are soa(ed with lood and there is also appro"imately ,$$ m& of lood clot in a (idney dish on the ed ,. 7emeri(saan fisi( The woman is conscio!s !t drowsy and pale. .eight / #,, cm, 0eight ,$1g 2n the e"amination findings3 The temperat!re is 3,,94, lood press!re #2$%5$ mm.g and heart rate ##2%min. The pheriperal e"tremities are cold. The !ter!s is palpa le to the !m ilic!s a d felt soft. The a domen is otherwise soft and non tender. +n vaginal inspection there is a second degree tear which has een s!t!red !t y! are !na le to assess f!rther d!e to the presence of prof!se leeding ;. 7emeri(saan &a oratori!m The midwife sent lood tests 3$ min ago eca!se she was concerned a o!t the lood loss at the time. .aemoglo in 5,2 g%d& M46 99,$ f& 0hite cell co!nt 32$$%mm3 7latelets #3#.$$$%mm3 289 #.3 A7TT 39 s Sodi!m #3' mmol%& 7otassi!m 3., mmol%& :rea ,.2 mmol%& 4reatinin ;* !mol%&

Analisis Masalah 1. Mrs. Anita , a 39- ear ! old "o#an in her first $re%nan& deli'ered t"in sons ( h a%o. )here "ere no si%nifi&ant antenatal &o#$li&ations a. Aagaimana h! !ngan !sia 39 tah!n, (ehamilan pertama, dan (em ar dengan (el!han !tama perdarahan pada (as!sB >#@ . Aagaimana etiologi dan me(anisme ter=adinya (ehamilan (em arB >2@ c. Apa risi(o dari (ehamilan dan persalinan ana( (em ar pada i ! dan ana(B >3@ (. She had *een $res&ri*ed ferrous sul$hate and foli& a&id durin% the $re%nan& as ane#ia $ro$h la+is, and her last he#o%lo*in "as 1,,9 %-d. at 3/ "eeks a. Apa indi(asi pem erian profila(sis anemia pada (ehamilanB>*@ . Aagaimana me(anisme (er=a asam folat dan ferro!s s!lfatB >,@ c. Aagaiamana prevalensi anemia pada (ehamilan (em arB >;@ d. Aagaimana opsi persalinan yang se ai(nya dipilih pada (as!s erdasar(an data . #$,9 g%d& pada mingg! (e 3'B >5@ e. Apa(ah pada (as!s ini diinddi(asi(an !nt!( dila(!(an transf!si darah, dan apa pilihan transf!si darahB >'@ 3. As this "as a t"in $re%nan& , an intra'enous &annula had *een inserted "hen la*or "as esta*lished. )he lo&hia has *een hea' sin&e deli'er *ut the "o#an is no" *leedin% 'er hea'il and $assin% lar%e &lot of *lood. a. Aagaimana etiologi dan me(anisme perdarahan he at pada (as!sB >9@ . Apa ma(na (linis (el!arnya lochia erat pada (as!sB>#$@ c. Apa indi(asi dan t!=!an dila(!(an pemasangan 26 can!la pada persaliananB >##@ 0. 1n arri'al in the roo# ou find that the sheets are soaked "ith *lood and there is also a$$ro+i#atel 2,, #. of *lood &lot in a kidne dish on the *ed. a. Apa ma(na (linis ditme!(an ,$$m& g!mpalan darah pada eng(o(B >#2@ . Apa dampa( dari perdarahan ,$$m& pada (as!s terhadap i !B >#3@ 2. Pe#eriksaan fisik )he "o#an is &ons&ious *ut dro"s and $ale. Hei%ht 3 122 &#, 4ei%ht 2,K% In the e+a#ination findin%s5 )he te#$erature is 32,96, *lood $ressure 1(,-7, ##H% and heart rate 11(-#in. )he $heri$eral e+tre#ities are &old. )he uterus is $al$a*le to the u#*ili&us a*d felt soft. )he a*do#en is other"ise soft and non ! tender. 1n 'a%inal ins$e&tion there is a se&ond ! de%ree tear "hi&h has *een sutured *ut ou are una*le to assess further due to the $resen&e of $rofuse *leedin%

a. Aagaimana interpretasi dari pemeri(saan fisi( pada (as!sB >#*@ . Aagaimana me(anisme a normalitas dari pemeri(saan fisi( ada (as!sB >#,@ c. Aagaimana dera=at (lasifi(asi ro e(an =alan lahirB >#;@ 8. Pe#eriksaan .a* )he #id"ife sent *lood tests 3, #in a%o *e&ause she "as &on&erned a*out the *lood loss at the ti#e. Hae#o%lo*in 7,( %-d. M69 99,, f. 4hite &ell &ount 3(,,-##3 Platelets 131.,,,-##3 IN: 1.3 AP)) 39 s Sodiu# 13/ ##ol-. Potassiu# 3.2 ##ol-. ;rea 2.( ##ol-. 6reatinin 80 u#ol-. a. Aagaimana interpretasi dari pemeri(saan la oratori!m pada (as!sB >#5@ . Aagaimana me(anisme a normalitas dari pemeri(saan la oratori!m ada (as!sB >#'@ 5. Apa <iagnosis Aanding pada (as!sB >#9@ '. Aagaimana cara menega((an diagnosis pada (as!sB >2$@ 9. Apa 7emeri(saan pen!n=ang yang diperl!(an pada (as!sB >2#@ #$. Apa <iagnosis 1er=a pada (as!sB >22@ ##. Aagaimana Cpidemologi (as!sB >23@ #2. Apa Da(tor 9isi(o pada (as!sB >2*@ #3. Aagaimana 7atogenesis pada (as!sB >2,@ #*. Apa 7enatala(sanaan pada (as!sB >perdaharan, ro e(an@ >2;@ #,. Aagaimana 1ompli(asi pada (as!sB >25@ #;. Aagaimana 7encegahan pada (as!sB>2'@ #5. Aagaiamana 7rognosis pada (as!sB >29@ #'. Aagaimana S1<2 pada (as!sB >3$@ .ipotesis3 8y. Anita, 39 tah!n, dengan riwayat anemia, E#7#A$, ayi (em ar, did!ga menderita pendarahan post part!m e.c. ro e(an =alan lahir dera=at 22. &earning 2ss!es3 #@ 7endarahan 7ost 7art!m 2@ 1ehamilan (em ar

Na#a M!tiara (halida 9enal y!s!f 8!r s!ci Arisma p!tra -!da l!tfiadi <wi =!wanita F!lianda 9if(y Faneva 1ristian Aiman Siva 2) al

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