FK UNS OBGIN USG 1i. Skrining Anomali Trimester Dua ISUOG Guidelines JJE 20120609

SKRINING
ANOMALI JANIN TRIMESTER KEDUA

(ISUOG Guidelines)
Judi Januadi Endjun

RSPAD GATOT SOEBROTO DITKESAD / FKUI JAKARTA DEPARTEMEN OBSTETRI GINEKOLOGI 2012
BAHAN RENUNGAN
Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan
Apakah saya sudah kompeten dan profesional?.......bukti ..? Komite Medik: KEWENANGAN KLINIS..Buku Log & Portofolio Resertifikasi 2011 Sistematikatrik-trik pemeriksaan Dokumentasi: terstandarisasi
AGENDA
Pendahuluan Program skrining Pemeriksaan berdasarkan organ Uterus dan adneksa PESAN DIBAWA PULANG Kepustakaan
PENDAHULUAN
The Interna-onal Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scien(c organiza(on that encourages sound clinical prac(ce, teaching and research for diagnos(c imaging in women's healthcare. The ISUOG Clinical Standards CommiAee (CSC) has a remit to develop Prac-ce Guidelines and Consensus Statements as educa-onal recommenda-ons that provide healthcare prac::oners with a consensus-based approach for diagnos-c imaging. They are intended to reect what is considered by ISUOG to be the best prac:ces at the -me at which they were issued.
Salomon LJ et al. Prac:ce guidelines for performance of the rou:ne mid-trimester fetal ultrasound scan, 2010 Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan
PENDAHULUAN
Although ISUOG has made every eort to ensure that guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. They are not intended to establish a legal standard of care because interpreta-on of the evidence that underpins the guidelines may be inuenced by individual circumstances and available resources. Approved guidelines can be distributed freely with the permission of ISUOG (info@isuog.org).
PENDAHULUAN
Ultrasonography is widely used for the prenatal evalua:on of growth and anatomy as well as for the management of mul-ple gesta-ons. The procedure provides diagnos-c ndings that oWen facilitate the management of problems arising in later pregnancy. For example, abnormal fetal growth is a leading cause of perinatal morbidity and mortality in both industrialized and developing countries. In 2005, the World Health Organiza-on (WHO) concluded that impaired fetal growth had many causes related to: gene-c factors, maternal characteris-cs such as nutri-on, lifestyle including smoking, age and disease; complica-ons of pregnancy; and the physical, social and economic environment1, 2.
PENDAHULUAN
A mid-trimester fetal ultrasound scan serves as an important baseline against which later scans may be compared for the evalua-on of growth and health. Ultrasonography can also be used to detect congenital anomalies36. The Eurofetus study7, a mul-center project involving 61 obstetric ultrasound units from 14 European countries, examined the accuracy of rou-ne mid-trimester ultrasonographic examina-on in unselected popula-ons. Over one half (56%) of 4615 malforma-ons were detected and 55% of major anomalies were iden-ed before 24 weeks of gesta-on.
PENDAHULUAN
Although many countries have developed local guidelines for the prac-ce of fetal ultrasonography, there are s-ll many areas of the world where they have not been implemented. Most countries oer at least one mid-trimester scan as part of standard prenatal care, although obstetric prac-ce varies widely around the world. This can be related to the availability of qualied prac((oners and equipment, local medical prac(ce and legal considera(ons; in some countries, insurance-related cost reimbursements strongly inuence how rou-ne mid-trimester scans are implemented.
PENDAHULUAN
Nonetheless, a WHO Study Group stated: Worldwide, it is likely that much of the ultrasonography currently performed is carried out by individuals with in fact liAle or no formal training.8. The intent of this document is to provide further guidance for healthcare prac--oners in the performance of the mid-trimester fetal ultrasound scan.
Salomon LJ et al. Prac:ce guidelines for performance of the rou:ne mid-trimester fetal ultrasound scan, 2010
PENDAHULUAN
SELALU ditanyakan pasien : janin saya normal ? Kenapa skrining pada 18 22 minggu Apa yg dinilai Ketepatan diagnostik : harapan vs kenyataan EBM, Cochrane, ISUOG Guideline : oke ! Standar Indonesia : jauh lebih penting Mari buat penelitian : mulai dari data dasar
PROGRAM SKRINING
Banyak pilihan : AIUM, ISUOG, ASUM Indonesia ? Perlu penyesuaian !! Penjenjangan : Level I, II, dan III Program skrining : 10 14 minggu, 18 22 minggu dan 28 32 minggu Universal vs targeted (HRP) Sistematis + peralatan USG memadai
Prenatal screening examination

- cardiac ac-vity; - fetal number (and chorionicity if mul-ple pregnancy); - fetal age/size; - basic fetal anatomy; - placental appearance and loca-on.
KRITERIA PASIEN
Well informed, kelompok risiko tinggi Sulit : obesitas, oligohidramnion, kelainan jantung, palatoskizis Perhatikan keluhan pasien USG 3D dan 4D bukan segalanya USG 2D dengan resolusi baik : lebih penting
Fetal biometry and wellbeing
Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan
Ultrasound in Obstetrics & Gynecology Volume 37, Issue 1, pages 116-126, 7 DEC 2010 DOI: 10.1002/uog.8831 hAp://onlinelibrary.wiley.com/doi/10.1002/uog.8831/full#g1
SISTEMATIKA SKRINING
Janin : tunggal/gemelli, hidup/IUFD, presentasi, letak, posisi, dll ? Plasenta : lokasi, DM, patologi ? Amnion : ICA, kekeruhan Tali pusat : 2A-1V, SUA, Doppler Biometri : pola pertumbuhan, PJT, makrosomia ? Organ : kepala kaki, khusus : jantung Doppler Aktivitas Penilaian dan saran
KEPALA : SSP
Transversal : mulai dari puncak kepala hingga basis kranii : falks serebri, CSP, V-3, Thalamus dan ventrikel lateral serebellum, CM, NF Sagital : dari kanan ke kiri Koronal : dari anterior ke posterior
ISUOG Guidelines
Sonographic examination of the fetal central nervous system: guidelines for performing the basic examination and the fetal neurosonogram
http://www3.interscience.wiley.com/cgi-bin/fulltext/114032619/HTMLSTART (diunduh, 2 Januari 2009)
Hanya untuk Pendidikan & Kesehatan
JJE-2011/09/12
KEPALA
Sumber : ISUOG
Sumber : ISUOG
ISUOG
ISUOG
ISUOG
ISUOG
KEPALA : WAJAH & LEHER

Cari kepala dan ambil potongan transversal (seperti mencari DBP) Putar transduser 900 ke arah wajah potongan sagital wajah (tampak profil) Potar 900 geser ke bawah tampak hidung dan bibir
ISUOG
ISUOG
ISUOG
ISUOG
Case Report : Labioskizis

ISUOG
ISUOG
THORAKS
ISUOG
ISUOG
ABDOMEN : DINDING
ISUOG
ISUOG
ISUOG
ISUOG
ABDOMEN : ORGAN
ISUOG
ISUOG
ISUOG
TRAKTUS URINARIUS
ISUOG
ISUOG ISUOG
ISUOG
ISUOG
GENITALIA
BUKAN keharusan Penting pada sex linked disease dan ambigus Kesalahannya besar : 50%
VERTEBRA
ISUOG
ISUOG
EKSTREMITAS
ISUOG
ISUOG
UTERUS DAN ADNEKSA

Serviks : risiko preterm Mioma uteri Patologi bekas SC ? Massa di adneksa dan kavum Douglas/Retzii Skrining malignansi Pemantauan hasil terapi & intervensi
KETEPATAN DAN KESALAHAN DIAGNOSTIK

Kelainan minor : sulit, dapat diabaikan ? Disclaimer : penilaian sesaat, proses perubahan,
dipengaruhi banyak hal
Kelainan mayor : tergantung jenis organ
Ketepatan tidak 100%, kesalahan % Aspek medikolegal : tuntutan obstetri

80% kasus
ASPEK MEDIKO-LEGAL
Informed consent Tau keterbatasan yang ada : alat, diri, dan pasien Sediakan waktu yang cukup Sistemtis dalam pemeriksaan Manajemen sesuai SPM/SOP setempat Buat laporan tertulis dan arsipkan minimal 5 tahun CPD !!
PESAN DIBAWA PULANG

Penelusuran anomali dimulai dari struktur normal Akurasi tidak 100%, jelaskan keterbatasan USG kepada pasien (TERUTAMA PEMERIKSA) Bila ragu, rujuk ke Unit USG Level III CPD berkala + mengajar (belajarlah dengan cara mengajar)
Pelajari algoritma penapisan anomali
THE NEXT GENERATION

JJE-2012/05/01
DIVISI KEDOKTERAN FETO MATERNAL DEP. OBGIN RSPAD GATOT SOEBROTO DITKESAD FK Ui JAKARTA
Hanya untuk Pendidikan dan Kesehatan
62
Hanya untuk Pendidikan dan Kesehatan 63
JJE-2012/05/01
ONE MOMMENT IN TIME

From SOLO for the Next-G
Sumber : YOUTUBE
See U at the Next US & CTG Course
KEPUSTAKAAN
ISUOG teaching materials, 2009 at http://www.isuog.org/journal/
FMF : fetal medicine foundation
TERIMA KASIH

FK UNS OBGIN USG 1i. Skrining Anomali Trimester Dua ISUOG Guidelines JJE 20120609

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SKRINING

ANOMALI JANIN TRIMESTER KEDUA

Judi Januadi Endjun

Prenatal screening examination

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Fetal biometry and wellbeing

http://www3.interscience.wiley.com/cgi-bin/fulltext/114032619/HTMLSTART (diunduh, 2 Januari 2009)

Hanya untuk Pendidikan & Kesehatan

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

KEPALA : WAJAH & LEHER

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Case Report : Labioskizis

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan

UTERUS DAN ADNEKSA

KETEPATAN DAN KESALAHAN DIAGNOSTIK

Kelainan mayor : tergantung jenis organ

Ketepatan tidak 100%, kesalahan % Aspek medikolegal : tuntutan obstetri

PESAN DIBAWA PULANG

Pelajari algoritma penapisan anomali

THE NEXT GENERATION

Hanya untuk Pendidikan dan Kesehatan

Hanya untuk Pendidikan dan Kesehatan 63

ONE MOMMENT IN TIME

From SOLO for the Next-G

See U at the Next US & CTG Course

FMF : fetal medicine foundation

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