The document discusses risk factors and management of postpartum atonia uteri (softening of the uterus). Key steps include:
1. Administering IV fluids and uterotonics like ergometrin and oxytocin to all deliveries to contract the uterus.
2. Controlled cord traction and manual removal of the placenta.
3. Compressing the uterus and evaluating for causes of bleeding like poor tone, lacerations, or retained placental tissue.
4. Preparing for referral if needed, with IV access, oxytocin drip, and contact with referral hospital.
The document discusses risk factors and management of postpartum atonia uteri (softening of the uterus). Key steps include:
1. Administering IV fluids and uterotonics like ergometrin and oxytocin to all deliveries to contract the uterus.
2. Controlled cord traction and manual removal of the placenta.
3. Compressing the uterus and evaluating for causes of bleeding like poor tone, lacerations, or retained placental tissue.
4. Preparing for referral if needed, with IV access, oxytocin drip, and contact with referral hospital.
The document discusses risk factors and management of postpartum atonia uteri (softening of the uterus). Key steps include:
1. Administering IV fluids and uterotonics like ergometrin and oxytocin to all deliveries to contract the uterus.
2. Controlled cord traction and manual removal of the placenta.
3. Compressing the uterus and evaluating for causes of bleeding like poor tone, lacerations, or retained placental tissue.
4. Preparing for referral if needed, with IV access, oxytocin drip, and contact with referral hospital.
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
Gynecology: Three Minimally Invasive Procedures You Need to Know About For: Permanent Birth Control, Heavy Menstrual Periods, Accidental Loss of Urine Plus: Modern Hormone Therapy for the Post Menopausal Women