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Perdarahan Pasca Persalinan

Perdarahan Pasca Persalinan

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Published by: ony on Apr 18, 2011
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03/09/2013

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7/1/09
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Perdarahan Pasca Persalinan
Ali Sungkar
Divisi FetomaternalDepartemen Obstetri dan Ginekologi FKUI / RSUPN - CM
Perdarahan Obstetri
 
Respirasi
 
Sirkulasi ( Kegagalan sistem sirkulasidalam mempertahankan aliran yangadekuat pada organ-organ vital sehinggatimbul Anoxia)
 
Trauma
 
Mengancam jiwa ibu dan janin
Shock
!
The most common types of shock:
Type of shock AetiologyHypovolaemic shock Acute loss of at least 20% of the circulatingvolumeCardiogenic shock Acute disease of the heart, e.g. severemyocardial infarctionSeptic shock Septic condition caused by infectious agentsand their toxic productsNeurogenic shock Head trauma, spinal cord injuryAnaphylactic shock Repeated contact with or injection of antigenicsubstances
Shock
Hemorrhagic Shock – Pathophysiology
!
Stage 1: Compensated Stage
Mechanism: Volume depletion due to bleedingBody detects decrease in cardiac outputSympathetic Nervous System is stimulated releasing Epinephrine andNorepinehrine to stimulate Alpha and Beta ReceptorsAlpha = Vasoconstriction Beta = Bronchodilation andCardiac Stimulation
Shock
Hemorrhagic (Classic) shock – Pathophysiology
!
Stage 2: Progressive StageMechanism: Kidneys release anti-diuretic hormone which increasesvasoconstriction by closing the capillary sphincters, greatly reducingperipheral circulationIncreased hypo-perfusion causes increase in metabolic acid build up
Shock
Hemorrhagic (Classic) shock – Pathophysiology
!
Stage 3: Irreversible StageMechanism: Compensatory mechanisms failPre-capillary sphincters open releasing metabolic acids, micro-emboliand other wastes into circulationCell damage, organ failure and death occur
 
7/1/09
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Shock
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The Course of Hypovolaemic Shock in Absence of Therapy
Blood Pressure (mm Hg)Heart rate (min)Bleeding150100500Compensation Decompensation IrreversibilityShock PhasesHeart RateBlood Pressure(Time)
Shock
!
The Influence of Volume Replacement on Tissue Perfusion and Organ Function
Volume Replacement
Cerebral Function(Body Control)Pulmonary Function(O
2
Supply)LiverFunction(metabolism)Renal Function(Diuresis)HeartFunction(cardiac output)TissuePerfusion
Kegagalan Sirkulasi
Perdarahan:
 
Pada awal kehamilan (aborsi, kehamilanektopik, kehamilan mola)
 
Pada akhir kehamilan atau persalinan(plasenta previa, solusio placenta,ruptura uteri)
 
Sesudah kelahiran bayi (ruptura uteri,atonia uteri)
Tata LaksanaMengatasi Perdarahan Hebat
 
Airway
 
Breathing
 
Circulation and hemorrhage control
 
Shock position
 
Replace blood loss
 
Sto minimize the bleedin rocess
 
Posisi Syok
 ANGKATKEDUATUNGKAI300 - 500 ccdarah dari kakipindah kesirkulasi sentral
 
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 Tatalaksana :
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Nilai fundus
!
 
Simultan dengan ABC
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Atonia merupakan penyebab utama Perdarahan Post partum
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 Jika lembek
masase bimanual
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singkirkan inversio uteri
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mungkin terdapat trauma traktus bagian bawah
!
 
evakuasi bekuan darah dari vagina dan servik
!
 
membutuhkan eksplorasi manual pada saat ini
!
Tindakan simultan Pada Syok 
Perdarahan Pasca Persalinan
 
Kehilangan darah > 500 cc
 
10% dari persalinan
 
Dalam 24 jam. PP H
 
Jika 24 jam – 6 mg. 2
nd
PP H
 
Penyebab
 –
 
Atonia uteri Trauma Genital
 –
 
Retensio placentae Placenta accreta
 –
 
Iversio uterin
Tatalaksana Perdarahan pasca Persalinan
Tatalaksana bedahMethergine / MisoprostolProstaglandin / BothKompresi BimanualAtonyManualExplorationor CurettageUltrasoundSisa plasentaTatalaksana bedahImplantasiAbnormalPlacentaTatalaksanaBedahLaserasi / robekanTanda Vital & pertolonganI.V. / OxygenFoley Catheter Flow Sheet
 
Perdarahan Post Partum
Uterine Atony
 
Most common cause of pp hemorrhage
 
Contraction of uterus is 1
°
mechanism forcontrolling blood loss at delivery
 –
 
oxytocin and prostaglandins
 
Risk factors
 –
 
multiple gestation chorioamnionitis
 –
 
macrosomia precipitous labor
 –
 
polyhydramnios tocolytics
 –
 
high parity halogenated agents
 –
 
prolonged labor
Uterine Atony: Treatment
 
uterine massage
 
oxytocin:
 –
 
produced by posterior pituitary
 –
 
causes peripheral vasodilation, reflex tachycardia
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administered diluted in IV fluid, not IV push
 –
 
metabolized/excreted by liver, kidney,oxytocinase
 
ergot derivatives
 
prostaglandins
 
If drugs fail, embolization of arterial supply, ligation,or hysterectomy

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