Longcase kpd

file:///C:/Users/user/Downloads/kupdf.net_pnpk-kpd-2016.pdf

Ketuban pecah dini (KPD) didefinisikan sebagai pecahnya selaput ketuban sebelum terjadinya
persalinan. Ketuban pecah dini dapat terjadi pada atau setelah usia gestasi 37 minggu dan disebut KPD
aterm atau premature rupture of membranes (PROM) dan sebelum usia gestasi 37 minggu atau KPD
preterm atau preterm premature rupture of membranes (PPROM).

Klasifikasi, diagnosis,

https://media.neliti.com/media/publications/144057-EN-risk-factors-of-premature-rupture-of-mem.pdf

Age of mothers < 20 years belongs to the too young age with less mature condition of uterus for giving
birth, so risky of suffering from premature rupture of membrane. Meanwhile, age > 35 years belongs to
the too old age for giving birth, especially among old mothers and at high risk of suffering from
premature rupture of membrane.10 Age > 35 years also makes condition and function of uterus
decreasing. One of causes is uterus tissue which is no longer fertile, meanwhile uterus wall is the place
where placenta attached to. Moreover, tissue of pelvic cavity and the muscles are weakening as in line
with the age getting older. This makes the pelvic cavity no longer easy to face and solve heavy
complications such as bleeding. In certain condition, its hormonal condition is not as optimum as the age
before. That is why the risk of miscarriage, amniotic fluid leak, fetal death and other complications also
increasing. This is line with theory stating that women who experience pregnancy more than twice need
to be more careful of because getting pregnant too often results the weak uterine condition as it is often
in tense due to pregnancy, Multiparity is one of predisposing factors of premature rupture of membrane
incidence because among multiparous women, incompetent cervix is often found, so there is no
resistance on amniotic membrane. Parity (multi/grande multiparity) is the general cause of premature
rupture of membrane incidence.13 Parity is one of factors causing premature rupture of membrane
because the increase of parity which enables cervix damage during delivery before. The too many
number of child is medical factor that becomes a background of maternal and perinatal mortality. The
more number of born child is, it may decrease reproductive health with risks including abortus,
preeclampsia, premature rupture of membrane and low birthweight. Multigravida mothers have risk of
suffering from premature rupture of membrane. Multiple preganancy may raise excessive tension of
uterus and at the end, it may raise contraction. If contraction is excessive while labor signs such as cervix
opening is not yet maximum, thus premature rupture of membrane incidence may arise. . In
malposition, the lowest position of fetus does not cover the birth canal, so there is no resistance on
amniotic membrane that causes the easy leak of amniotic membrane

https://rcpi-live-cdn.s3.amazonaws.com/wp-content/uploads/2016/05/19.-Preterm-Prelabour-Rupture-
of-Membranes.pdf

What antenatal tests should be performed? Women should be observed for signs of clinical
chorioamnionitis at least every four to six hours. A weekly high vaginal swab and at least a weekly
maternal full blood count should be considered. Fetal monitoring using cardiotocography should be
considered where regular fetal surveillance is required. Women with clinical signs of chorioamnionitis
should be commenced on broad spectrum antibiotics and delivery should be undertaken. CLINICAL
PRACTICE GUIDELINE PRETERM PRELABOUR RUPTURE OF THE MEMBRANES 7 The criteria for the
diagnosis of clinical chorioamnionitis include maternal pyrexia, tachycardia, leucocytosis, uterine
tenderness, offensive vaginal discharge and fetal tachycardia. During observation the woman should be
regularly examined for such signs of intrauterine infection and an abnormal parameter or a combination
of them may indicate intrauterine infection. The frequency of maternal temperature, pulse and fetal
heart rate auscultation should be between every four to six hours (Ismail, 1985; Romem and Artal, 1984;
Carlan, 1993). Women with clinical signs of chorioamnionitis should be commenced on broad spectrum
antibiotics and delivery should be undertaken. The recently developed Irish Maternity Early Warning
System (I-MEWS) should be used to record the vital signs.

https://www.gfmer.ch/SRH-Course-2010/national-guidelines/pdf/Management-PROM-SLCOG.pdf

https://pdfs.semanticscholar.org/4a12/b83e05774a5d332d4db0a0c0271a3f2bbed1.pdf

https://www.nice.org.uk/guidance/ng25/evidence/full-guideline-2176838029

Stripping of the membranes

Stripping of the membranes
dapat meningkatkan aktivitas fosfolipase A2 dan
prostaglandin F2
α
(PGF2
α
) dan menyebabkan dilatasi
serviks secara mekanis
yang melepaskan prostaglandin.
Stripping
pada selaput ketuban dilakukan
dengan memasukkan jari melalui ostium uteri internum dan menggerakkannya
pada arah sirkuler untuk melepaskan
kutub inferior selaput ketuban dari
segmen bawah rahim.
9,22
(Evidence level C). Risiko dari teknik ini meliputi
infeksi, perdarahan, dan pecah ketuban spontan serta ketidaknyamanan pasien.
Telaah Cochrane menyimpulkan bahwa
stripping of the membrane
saja tidak
menghasilkan manfaat klinis yang pen
ting, tapi apabila digunakan sebagai
pelengkap, tampaknya berhubungan dengan
kebutuhan dosis oksitosin rata-
rata yang lebih rendah dan peningkatan rasio persalinan normal pervaginam.
23
(Evidence level A, RCT).
2. Amniotomi
Diduga bahwa amniotomi meningka
tkan produksi atau menyebabkan
pelepasan prostaglandin secara lokal. Risiko yang berhubungan dengan
prosedur ini meliputi tali pusat menum
bung atau kompresi tali pusat, infeksi
maternal atau neonatus, deselerasi
denyut jantung janin,
perdarahan dari
plasenta previa atau plasenta letak
rendah dan kemungkinan luka pada janin.
Teknik amniotomi adalah sebagai berikut :
9,22
a.
Dilakukan pemeriksaan pelvis untuk mengevaluasi serviks dan posisi
bagian terbawah janin.
b.
Denyut jantung janin diperiksa (direk
am) sebelum dan setelah prosedur
tindakan dilakukan
c.
Bagian terbawah harus sudah masuk panggul
12
d.
Membran yang menutupi kepala janin
dilepaskan dengan jari pemeriksa
e.
Alat setengah kocher (
cervical hook
) dimasukkan melalui muara serviks
dengan cara meluncur melalui tangan
dan jari (sisi pengait mengarah ke
tangan pemeriksa
f.
Selaput ketuban digores atau
dikait untuk memecahkan ketuban
g.
Keadaan cairan amnion diperiksa (jer
nih, berdarah, tebal atau tipis,
mekonium)
Menurut telaah Cochrane, hanya ada
dua uji terkontrol yang baik yang
mempelajari penggunaan amniotomi saja, dan buktinya tidak mendukung
penggunaannya untuk induksi persalinan.
23
(Evidence level A, telaah
sistematis RCT)
https://docplayer.info/34967552-Metode-metode-pematangan-serviks-dan-induksi-persalinan.html