ATONIA UTERI

DR DODI HENDRADI, SPOG

RS IMANUEL LAMPUNG
 MENGENALI FAKTOR RESIKO
• IBU:
– Anemia
– Partus lama
– Hiperekstensi uterus
– Induksi persalinan
– Preeklampsia
• BAYI:
– Bayi besar / gemeli
ANGGAP SEMUA PERSALINAN
BERESIKO ATONIA !!!
 LANGKAH 1: PASANG INFUS PADA
SEMUA PERSALINAN
• RL
• NaCl 0.9 %
• Jarum infus no 16 – 18
 LANGKAH 2 : UTEROTONIKA
• Ergometrin 0.2 mg (1 ampul) intravena
• Oksitosin 10 unit im atau dalam RL drip
• Oksitosin + ergometrin (dalam RL drip)
• Misoprostol 3 tab / rektal
LANGKAH 3 : PEREGANGAN TALI
PUSAT TERKENDALI
MANUAL PLASENTA
APAKAH LENGKAP ???
LANGKAH 4 : KOMPRESI UTERUS
 LANGKAH 5 : EVALUASI PENYEBAB
PERDARAHAN
• Tonus otot ?
• Robekan jalan lahir ?
• Gangguan pembekuan darah ?
• Sisa plasenta ?
 LANGKAH 6 : PERSIAPAN RUJUK
• Terpasang infus
• Ditemani bidan perujuk
• Buat sistem rujukan dengan RS terkait
• Kasus : jampersal – Jamkesda – Jamkesmas –
Pribadi (???)
PENGGUNAAN KONDOM
• Under aseptic precautions a sterile rubber catheter was inserted within the condom and tied near
the mouth of the condom by a silk thread.
• Urinary bladder was kept empty by indwelling Foley's catheter.
• After putting the patient in the lithotomy position, the condom was inserted within the uterine
cavity.
• Inner end of the catheter remained within the condom.
• Outer end of the catheter was connected with a saline set and the condom was inflated with 25-
500 mL of running normal saline.
• Bleeding was observed, and when it was reduced considerably, further inflation was stopped and
the outer end of the catheter was folded and tied with thread.
• Uterine contraction was maintained by oxytocin drip for at least 6 hours after the procedure.
• The uterine condom was kept tight in position by ribbon gauze pack or another inflated condom
placed in the vagina.
• The condom catheter was kept for 24-48 hours and then was deflated gradually over (10-15
minutes) and removed.
• Patient was kept under triple antibiotic coverage (amoxicillin [500 mg every 6 hrs] + metronidazole
[500 mg every 8 hrs] + gentamicin [80 mg every 8 hrs]) administered intravenously for 7 days.
 INVERSIO UTERI
• Definisi : keadaan dimana lapisan dalam
uterus (endometrium) turun dan keluar lewat
ostium uteri eksternum
• Bersifat komplit dan inkomplit
• Tanda : syok, perdarahan, kesakitan, tampak
endometrium (atau plasenta) terbalik
INVERSI UTERI
 PENANGANAN INVERSIO UTERI
• Reposisi segera
• Pasang tampon uterovaginal
• Uterotonika
• Rujuk
• Pasang kateter tetapi
KURETASE PASCA PERSALINAN