REFERAT

USG DALAM KEHAMILAN

PEMBIMBING :
Dr.DODDY RODIAT, Sp.OG
PENYUSUN :
NOR FATEHAH BT HAMDAN 030.08.292
SUBBIHAH BT KAMARALARIFIN 030.08.306
KEPANITERAAN KLINIK OBSTETRIK DAN GINEKOLOGI
RUMAH SAKIT UMUM DAERAH KARAANG
PERIODE !3 "ANUARI # 22 MARET 20!$
FAKULTAS KEDOKTERAN UNI%ERSITAS TRISAKTI
"AKARTA
DAFTAR ISI
BAB I. PENDAHULUAN ...........................................................................................3
BAB II. ULTRASONOGRAFI DALAM KEHAMILAN
i. Fisika Dasar Gelomba! S"ara##..##############...## $%&
ii.Bioe'ek Gelomba! Ul(rasoik###################.)%*
iii.Tekik Pemeriksaa USG#####################.*%+
i,.I-ikasi Pemeriksaa USG####################...%/0
,.USG Ke1amila Trimes(er I###################../0%0/
,i.Kelaia Pa-a Ke1amila Trimes(er I################0/%03
,ii.Pea2isa Kelaia Ba3aa###################..03%0*
,iii.Pemeriksaa USG Trimes(er II%III###############.#0*%3/
i4.Pee("a -a Per("mb"1a Besar 5ai##############..3/%30
4.Pemeriksaa 6aira Amio###################.30%3)
4i.Pemeriksaa Plase(a######################.3)%3+
BAB III 7 Kesim2"la
BAB I87 Da'(ar P"s(aka
2
BAB I
PENDAHULUAN
Pemeriksaa "l(rasoo!ra'i 9USG: mer"2aka s"a(" me(o-e -ia!os(ik
-e!a me!!"aka !elomba! "l(rasoik "("k mem2ela;ari mor'olo!i -a '"!si
s"a(" or!a ber-asarka !ambara eko -ari !elomba! "l(rasoik <a! -i2a("lka
ole1 or!a.
Se;ak -i2erkealka 2er(ama kali -i bi-a! obs(e(rik ole1 Ia Doal- seki(ar
&= (a1" <a! lal"> USG (ela1 me!alami 2erkemba!a <a! sa!a( 2esa(> baik
-alam 1al (ekik ma"2" k"ali(as resol"si <a! -i1asilka. Hal ii (ela1 memba3a
kema;"a <a! sa!a( -rama(is -i -alam 1al -ia!osis -a 2ea!aa ke1amila.
Mor'olo!i -a '"!si or!a ;ai -a2a( -i2ela;ari se?ara kasa( ma(a -e!a
me!!"aka USG 0%-imesi 9USG 0%D: ;eis real-time. F"!si 1emo-iamik
"(er"s%2lase(a%;ai -a2a( -i2ela;ari -e!a lebi1 m"-a1 -a ak"ra( -e!a (ekik
2emeriksaa Do22ler 9color Do22ler -a pulsed Do22ler:. Dalam -eka-e (erak1ir ii
(ela1 -ikemba!ka (ekik 2emeriksaa USG 3%-imesi 9USG 3%D:> baik ;eis 3%D
s(a(ik ma"2" 3%D real%(ime 9USG $%-imesi a(a" li,e 3%D:. Melal"i 3%D mor'olo!i>
2erilak"> -a sirk"lasi ;ai%2lase(a -a2a( -i2ela;ari -e!a lebi1 m"-a1 -a ;elas
ber-asarka as2ek 3 -imesi.
Di I-oesia 2emeriksaa USG (i-ak -iker;aka se?ara r"(i 2a-a se(ia2 ib" 1amil.
Hal ii lebi1 -isebabka ole1 bia<a 2emeriksaa USG <a! masi1 ?"k"2 ma1al -a
(i-ak (er;a!ka" ole1 seba!ia besar ib" 1amil <a! memerl"ka<a. Seba!ia besar
ib" 1amil (i-ak -ili-"!i ole1 2ro!ram as"rasi kese1a(a. 9BUKU MERAH:
Ul(rasoo!ra'i a(a" soo!ra'i 9USG: a-ala1 seb"a1 (ekik <a! mem,is"alisasika
s(r"k("r s"2er'isial a(a" -alam 2a-a ("b"1 -e!a merekam -e<"( -ari !elomba!
"l(rasoik <a! -ire'leksika -ari ;ari!a. USG -alam obs(e(rik mer"2aka
2emeriksaa "l(raso"- -alam ke1amila. Me"r"( @HO> 2emeriksaa USG "("k
ke2erl"a a(ea(al> sebaik<a -ilak"ka ses"ai "sia !es(asi> sa(" kali 2a-a (rimes(er
2er(ama> sa(" kali 2a-a (rimes(er ke-"a> -a sa(" kali 2a-a (rimes(er ke (i!a.
Selebi1<a -ilak"ka bila a-a i-ikasi se2er(i 2e?a1 ke("ba sebel"m 3ak("<a>
ke1amila le3a( 3ak(" -a seba!ai<a. 9NAD:
3
BAB II
ULTRASONOGRAFI DALAM KEHAMILAN
I. F&'&() D)')r G*+,-.)/0 S1)r)
Frek"esi !elomba! s"ara <a! -a2a( -i-e!ar ole1 (eli!a ma"sia berkisar a(ara
0&HA%0=kHA. Frek"esi !elomba! s"ara -i a(as 0=kHA -iseb"( !elomba!
"l(rasoik.
/ kiloHer(A 9kHA: B /=
3
Her(A 9HA: a(a" /=
3
!e(ar 2er -e(ik
I Me!aHer(A 9MHA: B /=
3
kHA B /=
)
HA
Semaki (i!!i 'rek"esi !elomba! s"ara> 2a;a! !elomba!<a aka
semaki 2e-ek. Semaki 2e-ek 2a;a! !elomba! s"ara <a! -i(rasmisika ke
-alam me-i"m> -a<a 2ee(rasi<a aka semaki berk"ra!. Pa-a 2emeriksaa USG>
semaki 2e-ek 2a;a! !elomba! <a! -i(rasmisika ke -alam me-i"m> -a<a
resol"si<a aka semaki baik. Da<a resol"si a-ala1 kemam2"a membe-aka 0 (i(ik
(er-eka( se?ara (er2isa1.
Frek"esi !elomba! "l(rasoik <a! -i!"aka 2a-a ala( USG -ia!os(ik
-ises"aika -e!a ke2erl"a. Pemeriksaa USG 2a-a ke1amila (rimes(er II -a III
-ilak"ka melal"i -i-i! 2er"( ib" 9(rasab-omial:. Frek"esi !elomba!
"l(rasoik <a! -i!"aka berkisar a(ara 3%& MHA> <a! mam2" memberika
ke-alama 2ee(rasi 1i!!a /&%0= ?m. Pa-a ke1amila (rimes(er I 2emeriksaa USG
2ali! baik -iker;aka melal"i ,a!ia 9(ras,a!ial:. Frek"esi !elomba! "l(rasoik
<a! -i!"aka a-ala1 *>& M1A a(a" lebi1> <a! mem2"<ai ke-alama 2ee(rasi
seki(ar &%/= ?m> (e(a2i memberika k"ali(as resol"si <a! lebi1 baik.
Pa-a 2eris(i3a 2eramba(a !elomba! s"ara> <a! -i1a(arka ole1 me-i"m
a-ala1 eer!i mekais -ari !elomba! s"ara. Ba<ak<a eer!< mekais <a!
-i1a(arka se(ia2 -e(ik melal"i s"a(" bi-a! me-i"m (e!ak l"r"s (er1a-a2 ara1
ramba( !elomba! s"ara -iseb"( i(esi(as !elomba! s"ara. Selama mele3a(i
me-i"m> i(esi(as !elomba! s"ara me!alami 2e!"ra!a <a! besar<a semaki
ber(amba1 -e!a semaki ;a"1<a ;arak <a! -i(em2"1 ole1 !elomba! s"ara.
4
Peris(i3a ii -iseb"( a(e"asi. Ter;a-i<a a(e"asi -a2a( -isebabka ole1 mekaisme
re'leksi> re'raksi> absorbsi> -a 2emba"ra 9s?a((eri!: !elomba! s"ara.
Re'leksi a-ala1 mekaisme 2ema("la i(esi(as !elomba! s"ara ole1
2erm"kaa me-i"m. Semaki besar i(esi(as !elomba! s"ara <a! -i2a("lka>
aka semaki se-iki( i(esi(as !elomba! s"ara <a! -i(rasmisika -i -alam
me-i"m. U-ara -a ("la! mer"2aka me-i"m <a! mem2"<ai -a<a re'lek(or
sa!a( k"a(> se1i!!a s"li( -ilal"i ole1 !elomba! s"ara. 6aira> -ara1 -a berba!ai
;ari!a l"ak ("b"1 memiliki -a<a re'lek(or <a! lema1> se1i!!a m"-a1 -ilal"i
ole1 !elomba! s"ara.
Bila !elomba! s"ara me?a2ai 2erm"kaa me-i"m lai <a! berbe-a si'a(
ak"s(ik<a -a -alam ara1 <a! (i-ak (e!ak l"r"s> maka i(esi(as <a!
-i(rasmisika aka -i"ba1 ara1<a. Per"ba1a ara1 ii aka me!ik"(i 1"k"m Sell>
-a 2eris(i3a ii -iseb"( re'raksi. Absorbsi mer"2aka mekaisme 2er"ba1a eer!i
mekais 9i(esi(as: !elomba! s"ara me;a-i eer!i 2aas. 5ari!a ("la! memiliki
-a<a absorbs <a! k"a(C se-a!ka ?airaD-ara1 -a ;ari!a l"ak mem2"<ai -a<a
absorbs <a! lema1. Mekaisme 2emba"ra (er;a-i a2abila !elomba! s"ara melal"i
2erm"kaa me-i"m <a! (i-ak ra(a> a(a" melal"i me-i"m ber"2a 2ar(ikel%2ar(ikel
kasar> maka !elomba! s"ara aka -i2a("lka ke berba!ai ara1 se?ara (i-ak
bera("ra.
Pe!ar"1 a(e"asi -alam 2emeriksaa USG a-ala1 seba!ai berik"( 7
A(e"asi aka memba(asi kemam2"a ala( USG -alam memeriksa s(r"k("r
;ari!a ("b"1 1a<a sam2ai 2a-a (i!ka( ke-alama (er(e("
A(e"asi berbe-a 2a-a berba!ai ;ari!a ("b"1 -a memberika !ambara
USG <a! berbe-a. 5ari!a ("b"1 masi!%masi! memiliki koe'isie
a(e"asi <a! berbe-a> se1i!!a 2a-a 2emeriksaa USG aka memberika
!ambara <a! berbe-a.
A(e"asi -a2a( meimb"lka !ambara ar(i'ak <a! -a2a( mem2ers"li(
2emeriksaa USG -a me<ebabka kesala1a -ia!osis.
Ala( USG (i-ak -a2a( -i!"aka "("k memeriksa s(r"k("r ;ari!a ("la!
a(a" or!a <a! berisi "-ara a(a" !as 92ar">"s"s:. Or!a ;ai (i-ak berisi !as>
se1i!!a 2emeriksaa 2ar" -a "s"s ;ai -a2a( -iker;aka -e!a USG.
5
II. B&,*2*( 0*+,-.)/0 1+3r)',/&(
Pa-a 2eris(i3a 2eramba(a !elomba! "l(rasoik> -i -alam me-i"m (er;a-i
2er"ba1a%2er"ba1a siklik ber"2a !e(ara 2ar(ikel> 2er"ba1a (ekaa> 2er"ba1a
-esi(as> -a 2er"ba1a s"1". Se?ara (eori(is> !elomba! "l(rasoi? mem2"<ai
2o(esi <a! -a2a( mer"sak s(r"k("r ;ari!a ("b"1 ;ai> (er"(ama 2a-a ke1amila
(rimes(er I -imaa 2roses or!ao!eesis se-a! (er;a-i -a mer"2aka saa( <a!
2ali! re(a "("k me!alami !a!!"a.
Ker"saka ;ari!a ("b"1 <a! (er;a-i (er"(ama akiba( 2e!ar"1 2aas 9e'ek
(ermal: -a ka,i(as 9e'ek mekais: <a! -i(imb"lka ole1 !elomba! "l(rasoi?. E'ek
(ermal <a! (er;a-i akiba( absorbsi !elomba! "l(rasoi? ole1 ;ari!a ("b"1.
Pei!ka(a s"1" <a! (er;a-i akiba( 2ema2ara !elomba! "l(rasoi? -i -alam s"a("
;ari!a -i(e("ka ole1 karak(eris(ik ak"s(ik 9i(esi(as> 'rek"esi> l"as 2erm"kaa
(ras-"ser> 'o?"s !elomba! "l(rasoi?> lama 2ema2ara> -sb: -a karak(eris(ik
;ari!a 9(a1aa ak"s(ik> absorbsi> 2er'"si ;ari!a> ko-"k(i,i(as 2aas -i -alam
;ari!a> s(r"k("r aa(omi> ke?e2a(a !elomba! "l(rasoi?> -sb:.
5ari!a ("la! 2ali! ba<ak me<era2 !elomba! "l(rasoi?> se1i!!a
2ali! ba<ak me!alami 2er"ba1a 2aas. Semaki besar i(esi(as 92o3er: -a
'rek"esi !elomba! "l(rasoi? <a! -i(asmisika ke -alam ;ari!a> maka 2aas
<a! -i(imb"lka 2a-a ;ari!a aka semaki besar. Per'"si ;ari!a -a
ko-"k(i,i(as 2aas -i -alam ;ari!a mer"2aka mekaisme <a! 2ali! -omia
-alam me!"ra!i e'ek (ermal <a! -i(imb"lka ole1 2ema2ara !elomba!
"l(rasoi?. Hi2er(ermia <a! (er;a-i 2a-a masa or!ao!eesis -a2a( meimb"lka
?a?a( 2a-a ;ai 9(era(o!eik:> 2er("mb"1a ;ai (er1amba(> -a kema(ia ;ai.
Ole1 karea e'ek (ermal ii> 2emeriksaa USG obs(e(ri? sebaik<a -i1i-ari 2a-a ib"
<a! se-a! me!alami -emam> (er"(ama 2a-a ke1amila (rimes(er I.
Ka,i(asi (er;a-i bila !elomba! "l(rasoi? -i(rasmisika ke -alam s"a("
me-i"m <a! me!a-"! i(i%i(i berisi !as 9mi?rob"bble:. Osilasi am2li("-o
(ekaa -ari !elomba! "l(rasoi? me<ebabka i(i%i(i !as me!alami 2roses
kom2resi 9-iame(er me!e?il akiba( (ekaa 2osi(i': -a -ekom2resi 9 -iame(er
membesar akiba( (ekaa e!a(i': (er"s% meer"s. A2abila am2li("-e (ekaa ?"k"2
besar> i(i%i(i !as aka me!alami ker"saka 9kola2s:. Peris(i3a ii -iseb"( ier(ial
6
?a,i(a(io 9(rasie( ?a,i(a(io a(a" ?olla2se ?a,i(a(io:. Eer!< kie(ik <a! (er;a-i
akiba( kola2s<a i(i !as aka meimb"lka reaksi 2aas -a 2er"ba1a (ekaa <a!
?"k"2 (i!!i. Pa-a bia(a! 2er?obaa> ier(ial ?a,i(a(io -ike(a1"i -a2a(
me<ebabka 2aralisis> ker"saka sel 9lisis:> -a 2embe("ka ra-ikal bebas <a!
bersi'a( (oksik -a -a2a( meimb"lka ker"saka <a! irre,ersible 2a-a kromosom
-a bebera2a s<s(em eAim.
A2abila osilasi am2li("-e (ekaa !elomba! "l(rasoi? (i-ak (erlal" besar>
-iame(er i(i%i(i !as rela(i' s(abil (i-ak me!alami kola2s. Feomea ii -iseb"(
s(able ?a,i(a(io. Osilasi <a! (er;a-i 2a-a i(i%i(i !as -a2a( meimb"lka !elomba!
mikro 9mi?ros(reami!: <a! -i2a?arka -e!a ke?e2a(a (i!!i ke me-i"m
seki(ar<a -a meimb"lka 2aas.
III. T*(/&( p*-*r&('))/ USG
Pemeriksaa USG obs(e(ri? -a2a( -iker;aka melal"i ?ara (rasab-omial
9USG%TA: a(a" (ras,a!ial 9USG%T8:.
a) Pemeriksaan USG Transabdominal
Tras-"ser 92robe: <a! -i!"aka "("k 2emeriksaa USG%TA a-ala1 ;eis
liear a(a" ko,eks. Tras-"ser ;eis ko,eks lebi1 2o2"lar -i!"aka 2a-a saa( ii
karea -a2a( meam2ilka la2a! 2a-a!a <a! lebi1 l"as -iba-i!ka ;eis
liear. Pemeriksaa USG%TA (er"(ama -iker;aka 2a-a (rimes(er II -a III.
Pa-a ke1amila (rimes(er I 2emeriksaa USG%TA sebaik<a -iker;aka
melal"i ka-"! kemi1 <a! (erisi 2e"1 9se1i!!a -iseb"( ;"!a 2emeriksaa USG
(ras,esikal:> !"a<a "("k me<i!kirka "s"s kel"ar -ari ro!!a 2el,i?> se1i!!a
(i-ak me!1ala!i 2emeriksaa !ei(alia i(era. Massa "s"s <a! berisi !as aka
me!1amba( (rasmisi !elomba! "l(rasoi?.
Sebel"m mem"lai 2emeriksaa> -i-i! ab-ome ib" 1ar"s -il"m"ri !el
"("k l"brikasi -a me!1ila!ka "-ara -ia(ara 2erm"kaa (ras-"ser -a -i-i!
ab-ome.
Pemeriksaa USG%TA mem2"<ai bebera2a ker"!ia. Ka-"! kemi1 <a!
2e"1 aka me!!a!!" ke<amaa 2asie -a 2emeriksa. Ka-"! kemi1 <a!
7
(erlam2a" 2e"1 aka me-esak !ei(alia i(era ke 2os(erior> se1i!!a le(ak<a
-il"ar -a<a ;a!ka" (ras-"ser. U(er"s m"-a1 me!alami ko(raksi> se1i!!a ka("!
!es(asi -i -alam "(er"s ik"( (er(eka -a be("k<a me!alami -is(orsi. Kea-aa%
kea-aa ii aka mem2ers"li( 2emeriksaa. A-a<a m"-i!a1 -i -alam ka("!
!es(asi -a2a( l"2"( -ari 2emeriksaa.
Pemeriksaa USG%TA (a2a 2ersia2a ka-"! kemi1 2a-a (rimes(er I -a2a(
-iker;aka -e!a ?"k"2 mem"aska 2a-a 2asie <a! k"r"s> -e!a -i-i! 2er"(
<a! (i2is -a "(er"s a(e,ersi.
Pa-a ke1amila (rimes(er II -a III "(er"s (ela1 ?"k"2 besar -a le(ak<a -i
l"ar ro!!a 2el,ik. 8ol"me ?aira amio s"-a1 ?"k"2 ba<ak. Pemeriksaa USG%
TA -a2a( -iker;aka (a2a memerl"ka 2ersia2a ka-"! kemi1.
b) Pemeriksaan USG Transvaginal
Berbe-a -e!a USG%TA> 2emeriksaa USG%T8 1ar"s -ilak"ka -alam
kea-aa ka-"! kemi1 <a! koso! a!ar or!a 2el,i? bera-a -eka( -e!a
2erm"kaa (ras-"ser -a bera-a -alam area 2ee(rasi (ras-"ser. 5ika -iba-i!ka
USG%TA 9<a! 1ar"s -iker;aka -alam kea-aa ka-"! kemi1 2e"1:> 2emeriksaa
USG%T8 2a-a ke1amila (rimes(er I lebi1 -a2a( -i(erima ole1 2asie. Pemeriksaa
USG%T8 -a2a( -ilak"ka se(ia2 saa(> -a or!a 2el,i? bera-a -alam 2osisi <a!
sebear<a.
Dalam 2emeriksaa (ras-"ser (erlebi1 -"l" -iberi ;el 2a-a 2erm"kaa
eleme<a 9"("k me!1ila!ka "-ara -i 2erm"kaa (ras-"?er:> kem"-ia
-ib"!k"s -e!a ala( 2emb"!k"s k1"s"s a(a" ko-om 9ber'"!si seba!ai ala(
2eli-"!:. Sebel"m -imas"kka ke -alam ,a!ia> ";"! 2emb"!k"s (ras-"ser
-iberi ;el la!i 9ber'"!si seba!ai l"brika -a me!1ila!ka "-ara -ia(ara
2erm"kaa eleme (ras-"ser -a ser,iks "(eri:. Tras-"ser -imas"kka ke -alam
,a!ia 1i!!a me?a2ai -aera1 'oriks. Ma",er !eraka (ras-"ser -i -alam ,a!ia
mer"2aka kombiasi !eraka ma;"%m"-"r> !eraka mae",er 9ro(asi:> -a !eraka
a!"lasi ke sam2i! kiri%kaa a(a" ke a(as%ba3a1.
8
I%. INDIKASI PEMERIKSAAN USG
a) Indikasi pemeriksaan USG pada kehamilan trimester I
Pa-a 2emeriksaa USG (rimes(er 2er(ama> (er"(ama ;ika 2asie 1amil -e!a
"sia !es(asi -i ba3a1 /= mi!!"> 2e!!"aa USG (ras,a!ial a-ala1 me(o-e <a! lebi1
baik -ari2a-a me!!"aka USG (rasab-omial. Karea keak"ra(a USG (ras,a!ial
2a-a "sia ke1amila m"-a lebi1 ak"ra( -ari2a-a USG (rasab-omial. Ea! 1ar"s -iilai
ole1 2emeriksa -alam melak"ka 2emeriksaa USG (rimes(er I a-ala17
/. Pee("a a-a<a ke1amila i(ra"(erie
0. Pee("a a-a<a -e<"( ;a("! m"-i!a1 a(a" ;ai
3. Pee("a "sia ke1amila
$. Pee("a ke1amila kembar
&. Per-ara1a 2er,a!iam
). Ter-"!a ke1amila ek(o2ik
*. Ter-a2a( <eri 2el,i?
+. Ter-"!a ke1amila mola
.. Ter-"!a a-a<a ("mor 2el,i? a(a" kelaia "(er"s
/=. Memba(" (i-aka i,asi,e> se2er(i 2e!ambila sam2el ;ari!a ,ili
koriales 9?1oriai? ,ill"s sam2li!:> 2e!a!ka(a IUD
b) Indikasi pemeriksaan USG pada kehamilan trimester II dan III
Bebera2a i-ikasi 2emeriksaa USG 2a-a ke1amila (rimes(er II -a III> misal<a 7
/. Pee("a "sia ke1amila
0. E,al"asi 2er("mb"1a ;ai
9
3. Ter-"!a kema(ia ;ai
$. Ter-"!a ke1amila kembar
&. Ter-"!a kelaia ,ol"me ?aira amio
). E,al"asi kese;a1(eraa ;ai
*. Ke("ba 2e?a1 -ii a(a" 2ersalia 2re(erm
+. Pee("a 2rese(asi ;ai
.. Memba(" (i-aka ,ersi l"ar
/=. Ter-"!a ikom2e(esia ser,iks
//. Ter-"!a 2lase(a 2re,ia
/0. Ter-"!a sol"sio 2lase(a
/3. Ter-"!a ke1amila mola
/$. Ter-a2a( <eri 2el,i? a(a" <eri ab-ome
/&. Ter-"!a ke1amila ek(o2ik
/). Ke?"ri!aa a-a<a kelaia kromosomal 9"sia ib" F3& (a1"> a(a" 1asil (es
biokimia3i abormal:
/*. E,al"asi kelaia ?o!ei(al
/+. Ri3a<a( kelaia ?o!ei(al 2a-a ke1amila sebel"m<a
/.. Ter-"!a a-a<a ("mor 2el,i? a(a" kelaia "(er"s
0=. Memba(" (i-aka i,asi,e se2er(i amiose(esis> kor-ose(esis a(a"
amioi'"si.
10
11
%. U+3r)',/,0r)2& K*4)-&+)/ Tr&-*'3*r !
Kantung Gestasi
De!a USG%T8 <a! ?"k"2 baik k"ali(as<a> s(r"k("r ka("! !es(asi 9KG:
i(ra"(erie -a2a( (erli1a( m"lai ke1amila $>& mi!!" 9/* 1ari 2as?akose2si> a(a"
seki(ar /= 1ari se;ak blas(osis beri-asi ke -alam la2isa e-ome(ri"m:. Pa-a saa( i("
-iame(er<a me?a2ai 0%3 mm. S(r"k("r KG i(ra"(erie se?ara kosis(e (erli1a(
m"lai ke1amila & mi!!". Saa( -iame(er<a me?a2ai F& mm
&.
De!a USG%TA
ke1amila i(ra"(erie -a2a( (erli1a( se(ela1 -iame(er KG me?a2ai &mmC -a se?ara
kosis(e (erli1a( m"lai ke1amila ) mi!!"> saa( -iame(er KG me?a2ai F /=mm
).
Ka("! !es(asi (erli1a( seba!ai s(r"k("r kis(ik 9aekoik: berbe("k b"-ar a(a"
o,al> -e!a -i-i! <a! 1i2erekoik> -a le(ak<a ekse(rik -i -alam la2isa
e-ome(ri"m <a! meebal. S(r"k("r (erseb"( berasal -ari ka("! korio <a! berisi
?aira korio. Gambara 1i2erekoik -i-i! KG berasal -ari la2isa korio> ;ari!a
(ro'oblas> -a -esi-"a ka2s"laris. Seri!kali -i-i! KG (erli1a( seba!ai 0 la2isa
kose(rik 9-o"ble -e?i-"al sa?:> -imaa la2isa sebela1 -alam berasal -ari ?1orio
12
lea,e -a -esi-"a ka2s"laris> se-a!ka la2isa sebela1 l"ar berasal -ari -esi-"a
2arie(alis a(a" -esi-"a ,era.
S(r"k("r KG 1ar"s -ibe-aka -ari s(r"k("r aekoik lai<a -i -alam ka,"m
"(eri> se2er(i 1ema(ome(ra> 1i-rome(ra> kis(a e-ome(rial> e-ome(ri(is> a(a" ka("!
!es(asi 2als" 92se"-o%!es(a(ioal sa?: 2a-a ke1amila ek(o2ik.
Yolk sac
S"a(" ke1amila i(ra"(erie bar" -a2a( -i2as(ika se(ela1 (erli1a( s(r"k("r
<olk sa? -i -alam KG . Yolk sac berbe("k ?i?i ber-i-i! (i2is <a! le(ak<a
-i-alam r"a! korio. De!a USG%T8 <olk sa? aka kosis(e (erli1a( m"lai
ke1amila &>& mi!!"> saa( -iame(er KG F /= mmC se-a!ka -e!a USG%TA <olk
sa? aka kosis(e (erli1a( m"lai ke1amila ) mi!!" se(ela1 -iame(er KG F0=mm.
Selama ke1amila &%/= mi!!" -iame(er <olk sa? me?a2ai &%) mm. Se(ela1
i(" <olk sa? aka me<"s"( -a 2a-a ke1amila /0 mi!!" biasa<a (i-ak (erli1a(
la!i.
A2abila <olk sa? (i-ak -i(em"ka -i -alam ka("! !es(asi <a! -iame(er<a
G/=mm 9USG%T8: a(a" G0=mm 9USG%TA:> maka kem"!kia besar ke1amila
(i-ak aka berkemba! ormal -a aka me!alami abor("s.
Mudigah dan Janin
De!a USG%T8 s(r"k("r m"-i!a1 2er(ama kali -a2a( (erli1a( 2a-a ke1amila
&>& mi!!"> ber"2a 2eebala 2a-a seba!ia -i-i! <olk sa?. Pa;a!<a seki(ar 0%
3mm -a bel"m mem2erli1a(ka -e<"( ;a("!. Pa;a! m"-i!a1 aka ber(amba1
seki(ar /%0mm 2er 1ari. Pa;a! m"-i!a1 -i<a(aka -e!a "k"ra ;arak ke2ala%
boko! 95KB: a(a" ?ro3%r"m2 le!(1 96RL:> meski2" sebel"m ke1amila +
mi!!" ba!ia ke2ala -a ba-a masi1 bel"m -a2a( -ibe-aka. M"-i!a1 m"lai
me";"kka ak(i,i(as -e<"( ;a("! 2a-a "sia ke1amila seki(ar ) mi!!"> se(ela1
5KB me?a2ai &mm -a -iame(er KG seki(ar /+mm. Se;ak saa( i(" s(r"k("r m"-i!a1
-a ak(i,i(as -e<"( ;a("! aka kosis(e (erli1a( -e!a USG%T8. De!a USG%
TA s(r"k("r m"-i!a1 aka kosis(e (erli1a( se(ela1 -iame(er KGF0&mm.
13
Pe!"k"ra -e<"( ;a("! m"-i!a1 sebaik<a -ilak"ka melal"i ?ara M%
mo-e 9Mo(io mo-e: -a (i-ak -e!a ?ara Do22ler. Frek"esi -e<"( ;a("!9FD5:
m"-i!a1 2a-a ke1amila ) mi!!" seki(ar //= -e<"( 2er mei( 9-2m:> mei!ka(
me?a2ai /*& -2m 2a-a ke1amila . mi!!"> kem"-ia me"r" 1i!!a /)) -2m
2a-a ke1amila /0 mi!!". A2abila FD5 H+= -2m 2a-a ke1amila ) mi!!"C a(a"
H/== -2m 2a-a ke1amila F * mi!!"> "m"m<a m"-i!a1 aka ma(i -alam bebera2a
1ari kem"-ia.
Is(ila1 m"-i!a1 9embrio: -i!"aka (er1a-a2 1asil kose2si sam2ai "sia
ke1amila /= mi!!"> <ai(" selama berla!s"!<a 2roses or!ao!eesis. M"lai "sia
ke1amila // mi!!" 1asil kose2si -iseb"( ;ai9'e("s:. Masa (rasisi (er;a-i 2a-a
saa( 5KB me?a2ai 3=%3&mm.
Penentuan Usia Kehamilan
Pee("a "sia ke1amila melal"i 2emeriksaa USG 2ali! ak"ra( bila -ilak"ka
2a-a ke1amila (rimes(er I. Pa-a saa( i(" la;" 2er("mb"1a m"-i!a1 2ali! ?e2a( -a
,ariasi biolo!ik<a 2ali! ke?il. Sebel"m s(r"k("r m"-i!a1 -a2a( (erli1a(> 2ee("a
"sia ke1amila -ilak"ka melal"i 2e!"k"ra -iame(er ra(a%ra(a ka("! !es(asi
9KG:. Se(ela1 s(r"k("r m"-i!a1 (erli1a(> maka "sia ke1amila -i(e("ka melal"i
2e!"k"ra 2a;a! m"-i!a1 95KB:. M"lai (rimes(er I 2er("mb"1a ;ai s"-a1
?"k"2 besar -a ba!ia%ba!ia s2esi'ik ;ai 9se2er(i ke2ala -a eks(remi(as: s"-a1
-a2a( -ili1a( lebi1 ;elas. Se;ak saa( i(" 2e!"k"ra 5KB (i-ak ak"ra( la!i> -a
2ee("a "sia ke1amila sebaik<a -ilak"ka melal"i 2e!"k"ra ba!ia%ba!ia
s2esi'ik ;ai> se2er(i -iame(er bi2arie(al 9BPD:.
Pee("a "sia ke1amila -ilak"ka ber-asarka (abel -a(a a(a" omo!ram
<a! me!!ambarka 1"b"!a a(ara "k"ra biome(ri ;ai -a "sia ke1amila
2a-a ke1amila ormal. Aka lebi1 baik la!i bila -a(a <a! -i!"aka berasal -ari
2o2"lasi se(em2a(.
Pe!"k"ra -iame(er KG "("k mee("ka "sia ke1amila 1a<a ak"ra( bila
-i!"aka 2a-a "sia ke1amila &%)>& mi!!". Selai me!!"aka omo!ram
2erkemba!a KG> "sia ke1amila -a2a( ;"!a -i1i("! -e!a me!!"aka 'orm"la
se-er1aaC
14
Usia ke1amila 91ari: B -iame(er KG 9mm: I 3=
&
Pe!"k"ra 5KB -ilak"ka m"lai ke1amila ) mi!!"> saa( s(r"k("r m"-i!a1
se?ara kosis(e (erli1a( melal"i 2emeriksaa USG . 5arak%ke2ala%boko! mer"2aka
2arame(er <a! 2ali! baik -i!"aka "("k mee("ka "sia ke1amila> -e!a
(i!ka( kesala1a J 3%& 1ari.
!. U'&) K*4)-&+)/ $ -&/001
Gambar $7 Pa-a ke1amila $ mi!!" biasa<a 1a<a aka (erli1a( ka(o! !es(asi
ber-iame(er 0%&mm> (er(aam -alam e-ome(ri"m. Eolk Sa? biasa<a bel"m -a2a(
(eri-e(i'ikasi.
2. U'&) K*4)-&+)/ 5 -&/001
15
Gambar &7 Ka(o! !es(asi (am2ak -alam ?a,"m "(eri> -ikelili!i e-ome(ri"m> -a
berisi embrio <am! (am2ak se2er(i !aris l"r"s meem2el 2a-a <olk sa?.
Pa-a "sia ke1amila ii ka-a! s"-a1 -a2a( (erli1a( -e<"( ;a("! ;ai 92"lsasi:
3. U'&) K*4)-&+)/ 6 -&/001
Gambar )7 Be("k embrio m"lai ber"ba1 -ari l"r"s me;a-i se-iki( 'leksi. D"?("s
,i(elli"s (am2ak me!1"b"!ka embrio -e!a <olk sa?. Pa;a! embrio berkisar
$%/=mm
$. U'&) K*4)-&+)/ 8 -&/001
Gambar *7 Embrio (am2ak (er2isa1 -ari <olk sa? -a -i1"b"!ka melal"i -"?("s
,i(elli"s> berbe("k se2er(i 1"r"' K6L -e!a ba!ia ke2ala (am2ak -omia. M"lai
(erli1a( (o;ola eks(remi(as. 6RL berkisar //%/) mm. S"-a1 m"lai -a2a( -ibe-aka
s(r"k("r ke2ala -ari ba!ia ("b"1 ;ai.
16
Se(ela1 me!e(a1"i 2eris(i3a%2eris(i3a 2e(i! 2a-a ke1amila (rimes(er
2er(ama -ia(as> ki(a -a2a( me<im2"lka ka2aka1 ki(a m"lai bisa me!"k"r ka(o!
!es(asi> <ai(" 2a-a "sia ke1amila> ka2a ki(a m"lai bisa me!"k"r 6RL> -a
me!"k"r <olk sa?.
M*/01(1r K)/31/0 G*'3)'& 6G*'3)3&,/)+ S)7 8 GS9
Pee("a "sia !es(asi -e!a me!"k"r ka(o! !es(asi 1a<a -ilak"ka bila
e?1o ;ai bel"m (am2ak
Dilak"ka 2a-a "sia ke1amila $%) mi!!"
Da2a( -ili1a( se;ak ke1amila $ mi!!" ,ia (ras,a!ial -a &%) mi!!" ,ia
(rasab-omial
Terli1a( seba!ai s(r"k("r kris(ik berbe("k b"-ar a(a" o,al -e!a -i-i!
1i2erekoik> le(ak<a ekse(rik -alam la2isa e-ome(ri"m <a! meebal. S(r"k("r
(erseb"( berasal -ari ka(o! korio <a! berisi ?aira korio.
S(r"k("r ka(o! !es(asi 1ar"s -ibe-aka -e!a s(r"k("r aekoik lai<a -i
ka,"m "(eri se2er(i 1ema(ome(ra>1i-rome(ra> kis(a e-ome(rial>e-ome(ri(is> a(a"
ka(o! !es(asi 2als" 2a-a ke1amila ek(o2ik.
Pe!"k"ra -ilak"ka -ari (e2i ba!ia -alam ke (e2i ba!ia -alam
Kesala1a 2e!"k"ra seki(ar /%0 mi!!"
Ka-"! kemi1 2asie (i-ak bole1 (erlal" 2e"1 karea aka mem2e!ar"1i
be("k -a 1asil 2e!"k"ra
Ges(a(ioal Sa? masi1 rele,a D ak"ra( -i"k"r sam2ai "sia ke1amila ) mi!!"
Gambar +7 me!"k"r ka(o! !es(asioal
M*/01(1r P)/:)/0 K*p)+);B,(,/0 ")/&/ 6<r,=/ R1-p L*/034 8 <RL9
17
Da2a( -i"k"r 2a-a "sia ke1amila +%/0 mi!!"> sebel"m "sia + mi!!"
ke2ala -a ba-a (i-ak -a2a( -ibe-aka.
M"-i!a1 m"lai me";"kka ak(i,i(as -e<"( ;a("! se(ela1 "sia ke1amila
seki(ar ) mi!!".
Di"k"r 2a-a 2osisi e(ral 9me-a(ar:
Pe!"k"ra -i"k"r -ari ke2ala sam2ai boko!
5a!a sam2ai eks(remi(as -a <olk sa? ik"( (er"k"r
Ti!ka( kesala1a seki(ar &%* 1ari
Masi1 rele,a -i"k"r sam2ai "sia !es(asi /0 mi!!"
Gambar .7 me!"k"r ke2ala% boko! ;ai
M*/01(1r >&)-*3*r Y,+( S)7 6YS9
Sa(" ke1amila -a2a( -i2as(ika bila (erli1a( s(r"k("r Eolk Sa? -alam KG
Normal<a berbe("k 1am2ir b"la( se2er(i ?i?i ber-i-i! (i2is <a!
le(ak<a -i -alam r"a! korio
Diame(er seki(ar $%) mm
Da2a( -ii-e(i'ikasi 2a-a "sia !es(asi ) mi!!" se(ela1 -iame(er KG F/= mm.
Diame(er ma4imal ) mm 2a-a "sia ke1amila /= mi!!"
18
Gambar /=7 -iamae(er <olk sa?
Kehamilan Kembar
Kem"!kia s"a(" ke1amila kembar -a2a( -ike(a1"i se;ak "sia ke1amila &
mi!!"> -e!a meli1a( ;"mla1 ka("! !es(asi -i -alam ka,"m "(eri. Dia!osis
-e'ii(i' ke1amila kembar bar" bole1 -i(e!akka bila (erli1a( lebi1 -ari sa(" m"-i!a1
<a! me";"kka ak(i,i(as -e<"( ;a("!.
Ke1amila kembar bisa berasal -ari 0 b"a1 o,"m <a! -ib"a1i> -iseb"(
kembar -iAi!o(ik 9DM: a(a" (i-ak%i-e(ikC a(a" -ari seb"a1 o,"m <a! -ib"a1i -a
kem"-ia membela1 me;a-i 0 ba!ia <a! masi!%masi! berkemba! me;a-i
m"-i!a1> -iseb"( kembar mooAi!o(ik 9MM: a(a" i-e(ik. Seki(ar *=N ke1amila
kembar mer"2aka kembar DM> se-a!ka 3=N lai<a mer"2aka kembar MM.
Ber-asarka korioi(as -a amioi(as<a> kembar DM 2as(i mer"2aka kembar
-ikorioik%-iamio(ik 9DK%DA:C se-a!ka kembar MM bisa ber"2a DK%DA>
mookorioik%-iamio(ik 9MK%DA:> a(a" mookorioik%mooamio(ik 9MK%MA:.
5eis korioi(as -a amioisi(as ke1amila kembar aka sa!a( ber2e!ar"1
(er1a-a2 morbi-i(as -a mor(ali(as 1asil kose2si.
5eis korioi(as -a amioisi(as ke1amila kembar 2ali! m"-a1 -ike(a1"i
2a-a ke1amila (rimes(er I. Sam2ai ke1amila /= mi!!"> bila (erli1a( 0 ka("!
!es(asi <a! masi!%masi! berisi m"-i!a1 1i-"2> maka ke1amila kembar (erli1a(
DK%DA. Bila 1a<a (erli1a( sa(" ka("! !es(asi <a! berisi 0 m"-i!a1 1i-"2> maka
ke1amila kembar (er!olo! ke1amila MK. Bila 2a-a kembar MK (erli1a( 0 ka("!
amio <a! sali! (er2isa1 -a masi!%masi! (erisi 0 m"-i!a1 1i-"2> ke1amila
kembar (erli1a( MK%MA. Pemeriksaa <olk sa? ;"!a ber!"a "("k mee("ka
amioisi(as kembar MK. Pa-a kembar MK%DA (erli1a( 0 <olk sa? -i -alam ka("!
!es(asiC se-a!ka 2a-a kembar MK%MA 1a<a (erli1a( (erli1a( / <olk sa?.
Se-a!ka k1orioi(as -a2a( -ili1a( -ari ba(as D seka( a(ara ke-"a amio>
a2abila ba(as<a memiliki ke(ebala G0mm 9seri! -iseb"( 9lamb-a si!: maka
ke1amila (erseb"( memiliki -"a k1orio> am" ;ika k"ra! -ari 0 mm> 9seri!
-iseb"( T si!:> maka ke1amila (erseb"( memiliki sa(" k1orio.
19
Gambar / 7 Gambara USG 1amil kembar 2a-a "sia !es(asi & mi!!" -e!a -"a
ka("! !es(asi.
Gambar 07 Gambara USG 1amil kembar 2a-a "sia !es(asi & mi!!" -e!a -"a <olk
sa?.
Gambar 37 Gambara ke1amila kembar 2a-a "sia !es(asi /= mi!!". Pa-a !ambar
ii> (erli1a( ba13a ke1amila m"l(i2le <a (er-iri -ari -"a amio> -a -"a k1orio.
%I. KELAINAN PADA KEHAMILAN TRIMESTER I
!. K*4)-&+)/ /&r-1>&0)4 6.+&043*> ,?1-,)/*-.r@,/&7 pr*0/)/7@, *-p3@
)-/&,/9
20
Seri! -i;"m2ai 2a-a ke1amila (rimes(er I> akiba( ke!a!ala 2embe("ka
m"-i!a1. M"!ki (er;a-i karea 2erkamba!a m"-i!a1 (er1e(i sebel"m -a2a(
(er-e(eksi -e!a USG> a(a" m"-i!a1 ma(i -a me!alami resor2si se1i!!a (i-ak
(erli1a( -e!a USG. Seki(ar &=%.=N abor("s <a! (er;a-i 2a-a ke1amila
(rimes(er / -isebabka ole1 ke1amila irm"-i!a1 <a! seri! ber1"b"!a
-e!a kelaia kromosom. Dia!osis ke1amila irm"-i!a1 -i(e!akka bila 7
S(r"k("r m"-i!a1 (i-ak (erli1a( -alam ka(o! !es(asi 9KG: <a!
-iame(er<a G0& mm -e!a USG%(ras ab-omial
Ka(o! amiom (i-ak berisi m"-i!a1
2. P*r>)r)4)/ p)>) (*4)-&+)/ 3r&-*'3*r I
Abor("s immies 2a-a ke1amila (rimes(er / biasa<a -isebabka ole1
2e-ara1a re(rokorioik <a! le(ak<a -ibelaka! korio 'ro-os"m -a
22e-ara1a s"bkorioik <a! le(ak<a -i belaka! sela2"( korio -a me!isi
ka,"m "(eri . Per-ara1a (er;a-i karea (erle2as<a seba!ia korio 'ro-os"m
-ari -i-i! "(er"s. Pe-ara1a re(rokorioik -a s"bkorioik "m"<a (er;a-i
bersamaa. Per-ara1a <a! masi1 bar" (erli1a( 1i2erekoik (er1a-a2 korio
se-a!ka <a! s"-a1 berla!s"! /%0 mi!!" (erli1a( 1i2oekoik a(a" aekoik.
Gambara USG 2a-a abor("s isi2ies ber,ariasi (er!a("! 2a-a ;"mla1
2er-ara1a> ko-isi ka(o! !es(asi> -a -era;a( 2emb"kaa ser,iks. Seri! kali
KG be("k<a irre!"lar> le(ak<a ("r" ke ba!ia ba3a1 ka,"m "(eri> a(a"
me!isi kaalis ser,ikalis <a! (erb"ka.
Gambara abor("s ikom2le("s (i-ak s2esi'ik (er!a("! 2a-a "sia ke1amila
-a ba<ak<a sisa ;ari!a kose2si <a! (er(i!!al -i ka,"m "(eri. Ka,"m "(eri
m"!ki berisi KG <a! be("k<a (i-ak "("1 la!i. M"!ki ;"!a sisa kose2si
(erli1a( seba!ai massa eko!eik <a! (ebal irre!"lar -alam ka,"m "(eri.
Pa-a abor("s kom2le("s> sel"r"1 1asil kose2si (ela1 -ikel"arka -ari ka,"m
"(eri. Misse- abor(io mer"2aka kema(ia 1asil kose2si sebel"m ke1amila 00
mi!!" -a (er(a1a -i ka,"m "(eri selama + mi!!" a(a" lebi1.
3. K*4)-&+)/ -,+) 6M,+) H&>)3&/,')9
Mer"2aka 2e<aki( (ro'oblas !es(asioal <a! 2ali! seri! -i;"m2ai
(er"(ama 2a-a a3al -a ak1ir masa re2ro-"ksi. Bisa ber"2a kom2li(> <ai("
2roli'erasi ;ari!a (ro'oblasC ikom2li(> <ai(" 2roli'erasi (ro'oblas -iser(ai eleme
m"-i!a1. Gambara USG mola 2a-a (rimes(er I (i-ak s2esi'ik. Bisa (erli1a(
me<er"2ai ke1amila irm"-i!a1 -e!a -i-i! <a! meebal> misse-
abor(io> abor("s ikom2le("s> mioma ber-e!earasi kis(ik> a(a" 1i2er2alsi
21
e-ome(ri"m. Dalam 1al ii 2emeriksaa O%H6G ser"m sa!a( memba(" -alam
mee!akka -ia!osis.
$. K*4)-&+)/ *(3,p&(
Ke1amila ek(o2ik 9KE: a-ala1 ke1amila -imaa im2la(asi blas(osis (er;a-i
-il"ar ka,"m "(eri. Bebera2a 'ak(or <a! ber2e!ar"1 (er1a-a2 KE a-ala17
Ri3a<a( KE sebel"m<a
Ko(rase2si IUD
Ke!a!ala s(erilisasi
Per-a!a 2el,i?
Ba<i (ab"! 9'er(ilisasi i ,i(ro:
Dia!osis -e'ii(i' KE -i(e!akka bila (erli1a( KG (erisi s(r"k("r m"-i!a1
1i-"2 <a! le(ak<a -i l"ar ka,"m "(eri. Dia!osis KE s"kar -i(e!akka 2a-a 1amil
<a! masi1 m"-a se1i!!a memerl"ka 2emeriksaa serial. Gambara s2esi'ik
ke1amila ("ba ber"2a massa eko!eik berbe("k sirk"lar -e!a -iame(er /=%3= mm
<a! le(ak<a -i a-eksa. Di ba!ia (e!a1<a (erli1a( s(r"k("r aekoik <a! berasal
-ari ka(o! !es(asi> se1i!!a massa a-eksa membe("k !ambara ?i?i.
T)/>) K*0)0)+)/ K*4)-&+)/
Ta-a ke!a!ala ke1amila -a2a( ki(a ke(a1"i -e!a meli1a( berba!ai 1al seba!ai
berik"(7
Ke;a-ia 2e(i! -alam (rimes(er I (i-ak -i(em"ka
Diame(er ra(a%ra(a ka(o! !es(asi >/= mm (a2a <olk sa?
Diame(er ra(a%ra(a ka(o! !es(asi G/+ mm (a2a embrio
Pa;a! 6RL G &mm am" (ak (am2ak -e<"( ;a("!
%II. PENAPISAN KELAINAN BAAAN
Kelaia ko!ei(al> sebear<a s"-a1 -a2a( -i2erkiraka m"lai -ari 2emeriksaa
(rimes(er 2er(ama. A-a bebera2a 1al 2e(i! <a! 2erl" -ike(a1"i -alam me-ia!osis
a-a<a kelaia ko!ei(al ma<or 2a-a ;ai7
22
/. N"?1al Trasl"sesi
0. Nasal Boe
3. Fok"s e?1o!eik i(rakar-ia?
$. E?1o!eik bo3els
Em2a( (a-a -i a(as s"-a1 -a2a( -i(e("ka 2a-a 2ea2isa (rimes(er 2er(ama. De!a
me;"m2ai sala1 sa(" -ari em2a( (a-a -i a(as> kem"!kia besar ;ai (erseb"( aka
me!alami kelaia ?o!ei(al 2a-a saa( la1ir<a.
!.N174)+ Tr)/'+1'*/'&
/. Pe!"k"ra ke(ebala ;ari!a -i -aera1 (e!k"k
0. Seba!ai -e(eksi -ii kelaia kromosom 9si-roma -o3:
3. Usia !es(asi /=%/$ mi!!"
$. Pe!"k"ra -ilak"ka (e!ak l"r"s (er1a-a2 k"li( (e!k"k ke ara1 l"ar sam2ai
-aera1 se2er(i 2i(a (i2is -i a(as k"li(
&. Bila NTG3mm > maka ki(a ?"ri!a si-roma -o3
Gambar //a7me";"kka "?1al (rasl"sesi <a! masi1 -alam ba(as ormal.

Gambar // b7me";"kka 2eebala "?1al <a! me?a2ai +.3?m> Hal ii
mer"2aka (a-a ba13a a-a<a kelaia kromosom 2a-a ;ai ii.
23
2.N)')+ B,/*
/. Dilak"ka 2a-a ke1amila //%/$ mi!!" -a 2a;a! 6RL $&%+$mm
0. Tam2ila !ambar -i2erbesar 7 (am2ak sel"r"1 ke2ala -a ba!ia a(as (1oraks
3. Po(o!a mi- sa!i(al
$. Pa-a -aera1 1i-"! 1ar"s (am2ak (i!a b"a1 !aris 1i2erek1oik> !aris ba!ia
a(as a-ala1 k"li( 1i-"!> -i ba3a1<a !aris ("la! 1i-"!> -a <a! ke(i!a
a-ala1 kela;"(a -ari 1i-"! <a! bera-a -i a(as !aris 1i-"!> le(ak<a 1ar"s
lebi1 (i!!i
Gambar /0 a7Gambara 1i-"! ;ai ormal> -i -aera1 1i-"! (am2ak (i!a b"a1
!aris 1i2erek1oik> !aris ba!ia a(as a-ala1 k"li( 1i-"!> -iba3a1<a !aris ("la!
1i-"!> -a <a! ke(i!a a-ala1 kela;"(a -ari 1i-"! <a! bera-a -ia(as !aris
1i-"!> <a! le(ak<a lebi1 (i!!i.
24
Gambar /0 b7 Gambara ;ai <a! (i-ak memiliki ("la! 1i-"!> -imaa 1a<a
(erli1a( -"a 1i2erek1oik sa;a.
3.F,(1' *74,0*/&( &/3r)()r>&)7
/. Tam2ak seba!ai s"a(" s(r"k("r <a! ber3ara 2"(i1 (era!
0. Terle(ak 2a-a ,e(rikel kiri
3. Dilak"ka 2a-a "sia !es(asi /=%/$ mi!!"
$. Per(a-a kelaia kromosom
Gambar /37 Pa-a !ambara 2o(o!a meli(a! ;a("! 9'o"r ?1amber ,ie3: -i a(as>
Nam2ak a-a<a s"a(" s(r"k("r <a! 1i2erek1oik 2a-a r"a! ;a("!> me";"kka
a-a<a kelaia 2a-a ;ai ii.
$.E74,0*/&( .,=*+
/. Tam2ak seba!ai massa "s"s <a! (am2ak lebi1 2a-a( -a ek1o!eik 92"(i1
(era!:.
0. Per(a-a kelaia kromosom
Gambar /$7 (am2ak massa 2a-a(.
25
%III. PEMERIKSAAN USG TRIMESTER II DAN III
Pa-a 2emeriksaa 2a-a (rimes(er ke-"a -a ke(i!a berbe-a -e!a 2emeriksaa
(rimes(er 2er(ama> 2a-a 2emeriksaa ii> ;ai s"-a1 (erbe("k> -i maa 1al%1al <a!
1ar"s -i2er1a(ika 2a-a (rimes(er II -a III a-ala17
/. Kea-aa ;ai
0. Usia !es(asi
3. 6aira ke("ba
$. Plase(a
!.K*)>))/ :)/&/
;ai 1i-"2 a(a" ma(i> -e!a ?ara ki(a me?ari 2"lsasi ;a("! ;ai
;"mla1 ;ai> ki(a 2er1a(ika a2aka1 ("!!alDm"l(i2el> ;ika lebi1 -ari / ;ai>
1ar"s -i(e("ka k1orioi(as -a amioi(as
kelaia ko!ei(al ma<or
2rese(as" -a le(ak ;ai> ;ika "sia !es(asi s"-a1 memas"ki (rimes(er III>
1ar"s -i2er1a(ika le(ak ;ai> a2aka1 mema;a!Dmeli(a!> obliP"e> -a
2rese(asiDba!ia (erba3a1<a> a2aka1 2rese(asi ke2ala> a(a" 2rese(asi
boko!
2.U'&) 0*'3)'&
Mee("ka "sia !es(asi 2a-a (rimes(er II -a III berbe-a -e!a (rimes(er I>
bebera2a 1al <a! 2erl" -i2er1a(ika a-ala17
Diame(er bi2arie(al 9Bi2arie(al Diame(erDBPD:
Diame(er Oksi2i(o Fro(alis 9O??i2i(o Fro(al Diame(erDOFD:
Li!kar ke2ala 9Hea- 6ir?"m'ere?eDH6:
Pa;a! 1"mer"s 9H"mer"s Le!(1DHL:
Li!kar Per"( 9Ab-omial 6ir?"m'ere?eDA6:
26
Pa;a! Fem"r 9Fem"r Le!(1DFL:
Ba<ak sekali ?ara mee("ka "sia !es(asi 2a-a (rimes(er II -a III> am" <a!
essesial D 3a;ib -alam 2emeriksaa a-ala17
2..!. D&)-*3*r B&p)r&*3)+ 6B&p)r&*3)+ D&)-*3*r8 BPD9
Sebel"m me!"k"r -iame(er bi2arie(al> ki(a 1ar"s me-a2a(ka !ambara 2o(o!a
meli(a! ke2ala> a-a2" s<ara(%s<ara(<a a-ala17
/. Gambara se2er(i bola r"!b<
0. E?1o !aris (e!a1 (erle(ak sime(ris -ari a(erior ke 2os(erior ke2ala -a
ber;ala se2a;a! ke2ala
3. Ka,"m se2("m 2el"si-"m membela1 e?1o !aris (e!a1 2a-a se2er(i!a a(erior
ke2ala
$. Diame(er bi2arie(al -i"k"r -ari 2arie(al <! sa(" ke 2arie(al <! lai> -ari o"(er%
ier> a(a" o"(er%o"(
2.2. L&/0()r K*p)+) 64*)> 7&r71-2*r*/7*8 H<9
Dalam me!"k"r li!kar ke2ala> ?ara meam2ilka ke2ala sama -e!a ?ara
meam2ilka ke2ala "("k me!"k"r BPD. Li!kar ke2ala -i"k"r 2a-a sisi l"ar
("la! ke2ala 9o"(er%o"(er:
2.3. D&)-*3*r A/3*r,;P,'3*r&,r 6)/3*r,;p,'3*r&,r >&)-*3*r9
Dalam me!"k"r -iame(er a(ero%2os(erior> ?ara meam2ilka ke2ala sama -e!a
?ara meam2ilka ke2ala "("k me!"k"r BPD. Diame(er a(ero%2os(erior -i"k"r
-e!a ?ara me!"k"r ;arak -ari os o??i2i(al ke os 'ro(al> -i"k"r o"(er%o"(er.
27
Gambar /&7 Tam2ila 2o(o!a meli(a! ke2ala <a! baik "("k me!"k"r
BPD> H6 -a APD. Ke2ala berbe("k se2er(i bola r"!b<> (erli1a( e?1o !aris
(e!a1 -a se2("m 2el"si-"m <a! memo(o! -i se2er(i!a> -a (erli1a(
(1alam"s.
2.$. M*/01(1r +&/0()r p*r13 6A.>,-&/)+ <&r71-2*r*/7* 8 A<9
Sebel"m me!"k"r li!kar 2er"(> ki(a 1ar"s bisa -"l" meam2ilka 2o(o!a
meli(a! 2er"( <a! bear> ?ara<a a-ala17
/. Ambil 2o(o!a lo!i("-ial ("b"1 ;ai se1i!!a (am2ak !ambara
,er(ebra> -a ;a("!
0. Se(ela1 (am2ak ;a("!> 2"(ar (ras-"?er .= -era;a( 1i!!a (am2ak
!ambara (ras,ersal ;a("!>
3. Lal" !erakka (ras-"?er bebera2a milime(er ke i'erior 1i!!a (am2ak
!ambara ,er(ebra> !as(er> -a ,ea "mbilikal -alam sa(" bi-a! 2o(o!.
$. Se(ela1 me-a2a(ka 2o(o!a meli(a! ab-ome <a! baik> maka -a2a(
-i"k"r -iame(er ab-ome> <a! -i"k"r -ari sisi l"ar k"li(.
28
Gambar /)7Gambar -ia(as a-ala1 !ambara 2o(o!a meli(a! ab-ome
<a! baik> -imaa (erli1a( ,er(ebrae> !as(er -a ,ea "mbili?al
2.5. M*/01(1r P)/:)/0 F*-1r 62*-1r +*/034 8 FL9
Per(ama (e("ka le(ak ke2ala.
/. Lak"ka ro(asi sam2ai (am2ak ,er(ebra sam2ai -aera1 l"mbal a(a" sa?r"m.
0. Lak"ka ro(asi $& -era;a( ke kiri a(a" ke kaa "("k me?ari !ambara
'em"r <a! baik.
3. U("k me-a2a(ka 'em"r <! baik> (ras-"ser 1ar"s se;a;ar -e!a 'em"r.
$. Pa;a! 'em"r -i"k"r -ari ";"! ke ";"!
29
Gambar /*7Gambara -ia(as a-ala1 ?o(o1 !ambara 'em"r <a! baik>
2a;a! 'em"r -i"k"r -ari ";"!%";"!.
IA. PENENTUAN PERTUMBUHAN DAN BESAR "ANIN
Pa-a 2emeriksaa USG> 2eilaia 2er("mb"1a ;ai (er"(ama -i-asarka a(as
2eilaia "k"ra aa(omi -a 2er"ba1a '"!sioal ;ai selama masa ke1amila.
Pe<im2a!a 2a-a 2rose 2er("mb"1a ;ai bisa -ke(a1"i lebi1 m"-a1 -e!a
"k"ra aa(omi ;ai.
/. Per("mb"1a ;ai (er1amba(
Per("mb"1a ;ai (er1amba( 9P5T: -a2a( (erba!i ke2a-a sime(rik -a
asime(rik. P5T sime(rik (er;a-i -isebabka ole1 'ak(or i(risi? 9kelaia
!ee(i?D: -a eks(risik <ai(" ba1a (era(o!eik> i'eksi i(ra"(erie> mal"(risi
bera(> -a seba!ai<a <a! (er;a-i se;ak ke1amila m"-a. P5T asime(rik
2e<ebab<a a-ala1 'ak(or eks(risik> (er"(ama is"'isiesi 2lase(a> <a!
"m"<a (er;a-i 2a-a ke1amila (rimes(er III. Gambara s2esi'ik P5T asime(rik
(erli1a( 2a-a besar a(a" bera( ;ai berk"ra! se-a!ka 2a;a! ;ai 1a<a
se-iki( ber2e!ar"1. Be("k ("b"1 (i-ak 2ro2orsioal 7li!kar ab-ome <a!
ke?il -e!a li!kar ke2ala. 8ol"me ?aira amio berk"ra! karea 2ro-"ksi
"ri berk"ra!. Uk"ra 2alse(a me!e?il. P5T asime(rik ;ara! -iser(ai
kelaia ko!ei(al.
30
Pa-a P5T sime(rik> !a!!"a 2er("mb"1a (erli1a( 2a-a bera( -a
2a;a! ;ai <a! berk"ra!. Uk"ra ke2ala lebi1 ke?il -ari ormal>
mikrose'al"s. Kelaia ko!ei(al seri! -i(em"ka - biasa<a m"l(i2le -a
me<ebabka kelaia -ari ,ol"me ?aira amio 9oli!o1i-ramio a(a"
2oli1i-ramio:.
0. Ke1amila kembar
Ke1amila kembar 2a-a (rimes(er I 1ar"s selal" -ie,al"asi "("k me!e(a1"i
kem"!kia (er;a-i<a re-"ksi s2o(a 9,ais1i! (3i: a(a" !a!!"a lai
semasa ke1amila. Pa-a ke1amila (rimes(er II korioisi(as ke1amila kembar
-a2a( -ike(a1"i -e!a memeriksa ;eis kelami ke-"a ;ai> ;"mla1 2lase(a
-a seka( 2emisa1 ke-"a ;ai. Pa-a -ikorio> seka( 2emisa1 (erli1a( (ebal
9(er-iri -ari2a-a 0 la2isa amio -a 0 la2isa korio: se-a!ka 2a-a
kembar mookorio -iamio seri!kali sa!a( (i2is se1i!!a s"li(
-ii-e(i'ikasi.
3. Kelaia ko!ei(al ;ai
Seba!ia besar kelaia ko!ei(al ;ai -a2a( -ike(a1"i sebel"m "sia
ke1amila 0= mi!!" <ai(" sebel"m memas"ki 2eria(al. Bebera2a 2e(a-a
kelaia ko!ei(al <a! -i;"m2ai -i USG a-ala17
8ol"me ?aira amio <a! abormal
Per("mb"1a ;ai (er1amba( (er"(ama sebel"m "sia ke1amila 0=
mi!!"
Kelaia mor'olo!i be("k ("b"1 -a s(r"k("r or!a ;ai
Uk"ra biome(ri ;ai <a! abormal
Uk"ra 2lase(a <a! abormal
Ar(eri "mbili?al ("!!al
Ak(i,i(a bio'isik ;ai <a! berk"ra!
A. PEMERIKSAAN <AIRAN AMNION
Pe!"k"ra ,ol"me ?aira amio (ela1 me;a-i s"a(" kom2oe i(e!ral -ari
2emeriksaa ke1amila "("k meli1a( a-a<a resiko kema(ia ;ai. Hal ii
-i-asarka ba13a 2e"r"a 2er'"si "(ero2lase(a -a2a( me!akiba(ka !a!!"a
31
alira -ara1 !i;al -ari ;ai> me"r"ka ,ol"me miksi -a me<ebabka (er;a-i<a
oli!o1i-roamio. Kelaia ;"mla1 amio -a2a( meimb"lka !a!!"a 2a-a ;ai
se2er(i 1i2ol2lasia 2ar"> -e'ormi(as ;ai> kom2resi (ali 2"sa(> P5T> 2rema("ri(as>
kelaia le(ak -a kema(ia ;ai. Pemeriksaa ?aira amio -a2a( -ilak"ka
-e!a (i!a ?ara> <ai("7 2emeriksaa se?ara s"b;ek(i'> 2emeriksaa -e!a vertical
deep single pocke(> -a -e!a metode !I "mniotic !luid Indeks: <a!
-i2erkealka ole1 P1ela.
Secara Subjektif
Memb"("1ka 2e!alama <a! ?"k"2
Se?ara s"b;ek(i' -ika(aka ormal bila7 (am2ak seba!ia ("b"1 ;ai
meleka( 2a-a -i-i! "(er"s> -a seba!ia la!i (i-ak meem2el
>-ia(ara ("b"1 ;ai -a -i-i! "(er"s masi1 (er-a2a( ?aira amio
Secara Single Pocket
Ber-asarka sa(" k"a-ra sa;a
Diambil ka(o! (erbesar <a! (erle(ak a(ara -i-i! "(er"s -a
("b"1 ;ai
Ti-ak bole1 a-a ba!ia ;ai <a! (erle(ak -i -alam area 2e!"k"ra
(erseb"(
32
Gambar /+7Gambar -i a(as a-ala1 ?o(o1 2e!"k"ra se?ara si!le 2o?ke(> -imaa
<a! -i"k"r a-ala1 ;arak ,er(i?al (er;a"1 a(ara ba!ia ;ai -a -i-i! "(er"s> -a
(i-ak a-a ba!ia ;ai <a! (erle(ak -alam area 2e!"k"ra (erseb"(.
I(er2re(asi 2e!"k"ra ?aira amio ber-asarka si!le 2o?ke(.
H)'&+ P*/01(1r)/ I/3*rpr*3)'&
G0?m > H+?m 8ol"me ?aira amio ormal
G+?m Poli1i-ramio
+%/0?m Poli1i-ramio ri!a
/0%/)?m Poli1i-ramio se-a!
G/)?m Poli1!i-ramio bera(
G/?m > H0?m Bor-erlie> e,al"asi "la!
H/ ?m Oli!o1i-ramio
Pengukuran Amnion dengan metode Phelan (4 kuadran A!"#
Ab-ome -iba!i a(as $ k"a-ra
Se(ia2 k"a-ra -i"k"r i-eks ?aira amio<a
Pe!"k"ra 1ar"s (e!ak l"r"s -e!a bi-a! 1oriAo(al -a (i-ak a-a
bole1 a-a ba!ia ;ai -ia(ara<a
33
Gambar /.7 Pemeriksaa ?aira amio me"r"( P1ela> ab-ome -iba!i a(as $
k"a-ra> -a se(ia2 k"a-ra -i"k"r i-eks ?aira amio<a
Gambar 0=7 -i a(as me";"kka ?ara mele(akka 2robe <a! bear 2a-a 2er"(
2asie.
I(er2re(asi Pe!"k"ra ?aira amio -e!a me(o-e AFI
H)'&+ P*/01(1r)/ I/3*rpr*3)'&
G0?m > H+?m 8ol"me ?aira amio ormal
G+?m Poli1i-ramio
+%/0?m Poli1i-ramio ri!a
/0%/)?m Poli1i-ramio se-a!
G/)?m Poli1!i-ramio bera(
G/?m > H0?m Bor-erlie> e,al"asi "la!
H/ ?m Oli!o1i-ramio
34
AI. PEMERIKSAN PLASENTA
a. Mee("ka le(ak 2lase(a 7 "("k mee("ka a2aka1 le(ak 2lase(a ormal
9-i '"-"s D ?or2"s "(eri> a(a" abormal 92lase(a 2re,iaD 2lase(a mar!ialD
2lase(a le(ak re-a1:
b. Mee("ka !ra-e ma("rasi 2lase(a 7 "("k mee("ka a2aka1 ke1amila
(erseb"( ?"k"2 b"la 9a(erm: a(a" (i-ak.
?. Kelaia be("k 2lase(a
Be("k ormal me<er"2ai ?akram. Dalam 2erkemba!a<a> 2lase(a -a2a(
me!alami berba!ai ,ariasi kelaia be("k. Kelaia <a! -a2a( -ike(a1"i
melal"i 2emeriksaa USG a-ala1 2lase(a membraesa> 2lase(a s"kse("ria>
2lase(a biloba(a -a 2lase(a sirk"m,ala(a.
-. Mee("ka kelaia "k"ra 2lase(a.
Sam2ai ke1amila 0= mi!!"> (ebal 2lase(a (i-ak lebi1 -ari 0%3 ?m.
me;ela! a(erm ke(ebala< me?a2ai $%& ?m.
e. Perleka(a abormal 2lase(a
Dalam 2erkemba!a<a> 2lase(a meleka( 2a-a -i-i! "(er"s melal"i
-esi-"a basalis. Ka-a!%ka-a! -esi-"a basalis (i-ak (erbe("k sem2"ra
se1i!!a ,ili korioik meleka( la!s"! 2a-a miome(ri"m 92lase(a akre(a:>
me!i,asi la2isa miome(ri"m 92lase(a ikre(a:> ba1ka meemb"s la2isa
miome(ri"m -a seros"m "(er"s 92lase(a 2akre(a:. Dia!osis 2lase(a akre(a
melal"i USG me;a-i lebi1 m"-a1 bila im2la(asi 2lase(a bera-a -i se!me
ba3a1 "(er"s ba!ia -e2a.
'. Kalsi'ikasi 2lase(a
Kalsi'ikasi 2lase(a mer"2aka 2roses 'isiolo!is -alam ke1amila akiba(
-e2osisi kalsi"m 2a-a 2lase(a. M"lai (erli1a( 2a-a ake1amila 0. mi!!" -a
semaki mei!ka( -e!a ber(amba1<a "sia ke1amila. Pa-a USG> -e2osisi
kalsi"m (erli1a( seba!ai ber?ak%ber?ak eko!eik <a! (i-ak memberika
ba<a!a ak"s(ik. De2osisi kalsi"m (er"(ama<a -i ba!ia basal -a se2(a
2lase(a se1i!!a !ambara kalsi'ikasi (erli1a( lebi1 kasar. Proses klasi'ikasi
2lase(a seri!kali (er;a-i lebi1 -ii 2a-a 2ree?lam2sia -a P5T. Kalsi'ikasi
lebi1 lamba( 2a-a ib" DM -a ikom2a(ibili(as r1es"s.
!. Sol"(io 2lase(a
A-ala1 2eris(i3a (erle2as<a 2lase(a <a! le(ak<a ormal -ari -i-i!
"(er"s sebel"m 3ak("<a. Lokasi (erseri! a-ala1 -i -aera1 re(ro2lase(a a(a"
-aera1 mar!ial. Perle2asa -i re(ro2lase(a (er;a-i karea r"2("re ar(eri
35
s2iralisC se-a!ka -i mar!ial karea r"2("re ,ea mar!ialis. Nam">
sol"sio 2lase(a seri!kali (i-ak (er-ia!osis melal"i 2emeriksaa USG.
1. T"mor 2lase(a
T"mor <a! seri! (er-a2a( 2a-a 2lase(a a-ala1 korio!ioma. Pa-a USG>
korioa!ioma (erli1a( seba!ai massa 2a-a( 1i2erekoik (erle(ak -i -aera1
s"bkorioik -a seri! meo;ol -ari 2erm"kaa 'e(al 2lase(a.
Gambar 0/7 a-ala1 (i!ka( !ra-asi 2lase(a beser(a ?iri%?iri<a.
36
DAFTAR PUSTAKA
/. Pra3iro1ar-;o S. B"k" ilm" kebi-aa> Sar3oo Pra3iro1ar-;o. Peerbi(
Pra3iro1ar-;o> 5akar(a> 0==.. Ms 0$*%0).
0. E-;"> 5"-i 5a"a-i. 90==*:. Ul(rasoo!ra'i Dasar Obs(e(ri -a Giekolo!i.
5akar(a 7 Fak"l(as Ke-ok(era Ui,ersi(as I-oesia
3. Karsoo B.Ul(rasoo!ra'i Obs(e(ri 9S(a-ar- -a i-ikasi 2emeriksaa:.
Ba!ia Obs(e(ri -aGiekolo!i FKUIDRSUPN Dr. 6i2(o Ma!"k"s"mo>
5akar(a. 0==3&. @i;a<ae!ara H> @irak"s"ma1 FF> Mose 56> S"kar<a @S.
$. K"rs"s Dasar Ul(rasoo!ra'i -a Kar-io(oko!ra'i. Ba!iaDSMF Obs(e(ri -a
Giekolo!i FK Ui,ersi(as Pa-;a-;ara RSUP -r.Hasa Sa-iki> Ba-"!>
0===
37