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DEFINISI : - PERDARAHAN > 500 cc pada

Persalinan Pervaginam

- PERDARAHAN > 1000 cc S.C

- 60 % Kematian Ibu Hamil terjadi dalam

PERIODE POST PARTUM

- 45 % Kejadiannya dalam 24 jam Pasca

Persalinan
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 PENYEBAB PERDARAHAN
POST PARTUM PRIMER
4T : - TONUS
( 75 – 90 % disebabkan ATONIA UTERI )
- TISSUE
- TRAUMA
- THROMBIN

 PENYEBAB PERDARAHAN
POST PARTUM SEKUNDER
- INFEKSI INTRA UTERI
- SISA PLASENTA
- ABNORMAL INVOLUSI PD INERSI PLACENTA
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MANAJEMEN AKTIF KALA III
☺ MASASE UTERUS
☺ PEMBERIAN UTEROTONIKA
☺ P.T.T

PENYIMPANAN UTEROTONIKA
 ERGOMETRIN
 Hindari Sinar & FREEZING
 Suhu 2 - 8 0C
 MISOPROSTOL
 Temp Kamar
 OXYTOSIN
 Suhu 15 - 30 0C
 Hindari FREEZING
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UTEROTONIKA / OXYTOCIN

☻ Diberikan “ 1 menit “ setelah bayi lahir

☻ Dosis 5 – 10 µ / I.M
☻ Reaksi 2 – 3 menit setelah Injeksi
☻ Minimal Side Efek

PTT
Jangan melakukan “ TRAKSI “ sebelum terjadi
Kontraksi Uterus

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MASASE UTERUS

☻ Masase Uterus tiap 15 menit

☻ Jika diperlukan, Masase Uterus selama
“ 2 jam Pertama “
☻ “ PASTIKAN “ Kontraksi Uterus tidak lunak /
lembek setelah kita menghentikan Masase Uterus

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Symptoms related to blood loss with postpartum hemorrhage

Blood loss Blood pressure

% ml ( mmHg ) Sign and symptoms

10 – 15 500 – 1000 normal palpitation, dizziness, tachycardia

15 – 25 1000 – 1500 slightly low weakness, sweating, tachycardia
25 – 35 1500 – 2000 70 – 80 restlessness, pallor, oliguria
35 – 45 2000 – 3000 50 – 70 collapse, air hunger, anuria

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Staging scheme for assessment of obstetric hemorrhage

Severity of shock Findings % blood loss

None None < 15 – 20 %

Mild Tachycardia ( < 100 bpm ) 20 – 25 %
Mild hypotension
peripheral vasoconstriction

Moderate Tachycardia ( 100 – 120 bpm ) 25 – 35 %

Hypotension ( systolic blood pressure 80-100 mmHg )
Restlessness
Oliguria

Severe Tachycardia ( > 120 pm ) > 35 %

Hypotension ( systolic blood pressure < 60 mmHg )
Altered consciousness
Anuria

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ANTENATAL PREVENTION
 MATERNAL AGE
 BODY MASS INDEX > 30 kg / m2
 PREVIOUS P.P.H
 ANTEPARTUM HEMORRHAGE
 Placental Abruption
 Placental Previa
 MULTIPLE PREGNANCY
 MACROSOMIC INFANT
 PREVIOUS UTERINE SURGERY
 OTHER MEDICAL CONDITION
 DM
 Coagulopathi
 PROLONGED PREGNANCY
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INTRAPARTUM PREVENTION
 PROLONGED LABOR ( > 12 Hours )
 PROLONGED THIRD STAGE ( > 30 Min )
 RETAINED PLACENTA
 FEBRILE ILLNESS
 INSTRUMENTAL DELIVERY
 CESAREAN SECTION,
ESPECIALLY EMERGENCIES IN LATE FIRST
OR SECOND STAGE OF LABOR
 AMNIOTIC FLUID EMBOLISM
 PLACENTAL ABRUPTION
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KEHAMILAN KEHAMILAN
RESIKO RESIKO
RENDAH TINGGI

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