Referat Perdarahan Postpartum
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Perdarahan Perdarahan PostpartumPostpartum
Yenny Saputra0710006
Pembimbing : dr. Rimonta F. Gunanegara, SpOG
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P P H1
KematianMaternal
:
140.000 kematian ibu / tahun
Kematian 1 ibu / 4 menit
Pendahuluan . . .
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P P H
• jumlah ≥ 500 mL
• setelah kala III persalinan
lengkap atau dalam 24 jam
pertama setelah anak lahir.
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Klasifikasi
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1.TONUS2.TRAUMA3.TISSUE
4.THROMBOSIS5.TRACTION
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ATONIA UTERI
•Penyebab tersering dari PPH •Kontraksi uterus << / (-) → Uterus gagal kontraksi & mengecil setelah partus →
perdarahan •Terjadi pada 1 dari 20 wanita melahirkan;
75-80% kasus primary PPH
T1
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Induksi persalinan
Grande multipara
Riwayat PPH
Infeksi uterus
Anomali uterus
Faktor Risiko
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Trauma T2
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T3 Sisa plasenta
• Penyebab tersering late PPH• Penyebab :
- Kontraksi uterus kurang baik → tidak dapat mengeluarkan plasenta
- Riwayat operasi uterus sebelumnya (myomectomi)
- Invasi plasenta abnormal : akreta, inkreta, perkreta
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T4 Gangguan koagulasi
• Hipofibrinogenemia• DIC / Consumptive Coagulopathy
• Trombositopenia• Idiopathic Thrombocytopenic Purpura• HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count )
• Dilutional Coagulopathy
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T5 Inversio uteri
• Inversio uteri : bagian atas uterus memasuki kavum uteri → fundus uteri sebelah dalam
menonjol ke dalam cavum uteri• Terjadi tiba-tiba dalam kala III / segera
setelah plasenta keluar → perdarahan → syok• Terjadi spontan atau akibat tindakan• Terdiri dari inversio inkomplit & komplit
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1
2
3 4
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DIAGNOSIS
DIAGNOSIS
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Kompresi Bimanual
• Satu tangan dimasukkan ke dalam
vagina sambil membuat kepalan → ditekankan
pada fornix anterior
• Tangan yang lain diletakkan pada perut
penderita dengan memegang fundus uteri
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Tamponade
Uterus
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Uterotonica Dosis Onset Keterangan
Pitocin - 10-20 U IM- 40 U/L IV dibagi
250 cc/jam
3-5 menit
Ergotamine 0.2 mg IM / PO tiap 6-8 jam
2-5 menit KI : HT, pregnancy-induced hypertention,
hipersensitivitas
Analog Prostaglandin
0.25 mg IM, diulang tiap 15-90 menit, max 2 mg
< 5 menit ES : diare, HT, muntah, demam, flushing,
takikardi
Misoprostol 600 μg PO or PR
U t e r o t o n I c a
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Sisa PlasentaSisa Plasenta
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Tindakan Operatif
1. Laparatomi2. B-Lynch Suture
3. Ligasi arteri 4. Histerektomi
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arteri uterina arteri iliaka interna
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