AUDIT MATERNAL

Ny. E. 38 tahun,Ibu Rumah Tangga

Dx Akhir : Syok hipovolemik irreversible,DIC,
rupture uterine posterior, Post SCTP em ai Fetal distress, presentasi muka dalam
persalinan,P3 A0, Hamil 39 minggu

4 Februari 2021
Clinical Feature
• Retroperitoneal haematomas can be potentially lifethreatening with considerable variability in morbidity
depending on the mechanism of retroperitoneal haematomas development, the speed and amount of
bleeding. . Presentation of retroperitoneal haematomas varies from acute to sub-acute and rarely insidious
onset and is often recognised from early in the pregnancy until four weeks postnatal.
1. The patient may present with signs and symptoms of shock, i.e. tachycardia, hypotension, tachypnoeic,
foetal distress, abdominal pain especially upper right or left quadrants pain, nausea, vomiting,
interscapular pain, chest pain, and right shoulder pain.
2. Often the clinical picture is sudden in onset and other common features are abdominal pain,
accompanied by signs of hypovolemic shock and reduction in haematocrit.
3. Vomiting, diarrhoea and epigastric pain may be initial symptoms in splenic artery rupture.
4. In gradually developing retroperitoneal haematoma, the early diagnosis is difficult to establish. It
manifests only after a significant amount of blood loss has occurred with resultant haemodynamic
compromise.
5. Vaginal and rectal pain with oedematous vaginal mucosa protruding through introitus may be seen in
lower pelvic haematomas
Discussion
• The prevalence of uterine rupture in developed countries in women
with previous cesarean sections has been reported to be as low as 1%.

• However, it is exceedingly rare in women without any history of

cesarean section or other gynecological surgery.
Discussion
• In patients who have an unscarred uterus, there are reported risk
factors that, though rare, can lead to possible rupture.
• These include : macrosomia, shorter interval between deliveries, post-
date pregnancies, and advanced maternal age.

• Women over 30 years of age have been reported to have two to three
times the risk of uterine rupture for women who are younger than 30
years
Discussion
• Other reported risk factors for rupture of an unscarred uterus include any
uterine anomalies, grand multiparity, cephalopelvic disproportion, and
uterine trauma, including version maneuvers and oxytocin stimulation.

• As uterine rupture is a rare complication, few large studies have examined

this disease process. However, one study examining women who gave birth
in Norway from 1967 to 2008 sought to examine specific risk factors for
uterine rupture. The researchers discovered that, among women with an
unscarred uterus, those aged over 35 years, having a parity of at least 3,
being born in a non-Western country, and having a previous miscarriage
before 12 weeks put them at a particularly high risk for rupture
Kesimpulan
Ruptur uterus pada pasien ini dengan faktor resiko :
• Usia pasien > 35 tahun.
• Multigravida
• CPD – Presentasi muka dalam persalinan
• Trauma pada uterus saat operatif
Saran
Pemantauan 2 jam post SC / partus harus lebih optimal dengan
optimalisasi EWS

Perdarahan sampai dengan syok (> 1000 cc ) biasa terjadi pada 2 jam
post partus, keterlambatan resusitasi cairan dan tranfusi darah dapat
menimbulkan komplikasi hebat (DIC,gagal ginjal,gagal nafas,sepsis) dan
kematian