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8/18/2019 Lapsus KPD B
1/44
LAPORAN KASUS (MARET 2016)
KETUBAN PECAH DINIPADA KEHAMILAN
PRETERM Tri Kurniawan (C 111 11 323)P!"i!"in# $ %r& Ern' Mur' N'n#iSu*r+i,r $ %r& Ar!'n O!an- S*O. (K)
Ba#ian O"ra/ua K%,/
Ma/aar2016
8/18/2019 Lapsus KPD B
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LAPORAN KASUS
BAB I
8/18/2019 Lapsus KPD B
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I%nia Pain
Na!a $ N'
Tan##a Lair $ 245415
U!ur $ 25 Taun
RM $ 7288
HPHT $ 240542019
UK $ 2 !in##u 7 ari
TP $ 0940642016
Sau O"ri/ $ .1P0A0
MRS $ 1140342016- 1$13
8/18/2019 Lapsus KPD B
4/44
Ana!ni
Keluhan utama $ Kuar air /u"an %ari :aan air
Anamnesis terpimpin $
I"u Mau/ Ru!a Sa/i ru:u/an %ari RSUD Pan#/* %n#an
%ia#n,i .1P0A0 #ra+i% 2 !in##u 7 ari ; /u"an *
8/18/2019 Lapsus KPD B
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P!ri/aan ii/
Status Generalis$ KU "ai/- •Lin#/ar Pru $ 7
• Ta/iran Bra ?anin $ 1750 #r•Siu $ M!an:an#
•Pun##un# $ Kanan
•Ba# Tr"awa $ K*aa
•Pri!aan $ 949
•Hi$ >
•D??$ 170=4!ni
•.ra/an :anin %iraa/an i"u
•Ana/ /an un##a
8/18/2019 Lapsus KPD B
6/44
P!ri/aan ii/
Inspekulo:
Ta!*a/ *,ri, i
8/18/2019 Lapsus KPD B
7/44
P!ri/aan Pnun:an#
La",ra,riu! (1140342016)
K
Kesan : Leukositosis Ringan
Paramater Hasil Rujukan@BC 13-370 7>10 34 uL
H.B 11-3 11>16 #4%L
HCT 37- 33>70
PLT 365 190&000>790&000
CT4BT 43 >1043>
.DS 1 170 !#4%L
.OT4.PT 15417 35471 4uL
Ur4Cr 1140-62 Ur$ 10>90- Cr$ L/$1-3- Pr$ 1-1
H"A# N,n Ra/i N,n Ra/i
8/18/2019 Lapsus KPD B
8/44
P!ri/aan Pnun:an#
Ura,n,#raF Tran A"%,!ina (114342016).ra+i% un##a- i%u*
*rnai /*aa- *u/iri- *ana %i
Gravi tungghiup !" minhari
8/18/2019 Lapsus KPD B
9/44
Ru!
S,ran# wania uia 25 aun- .1P0A0- HPHT 2>5>2019- UK 2 !in##u 7 ari- TP 09>06
Ru!a Sa/i ru:u/an %ari RSUD Pan#/* %n#an %ia#n,i .1P0A0 #ra+i% 2 !in##u 7 *
Dari *!ri/aan in*/u, %i%a*a/an *r!u/aan *,ri, i
8/18/2019 Lapsus KPD B
10/44
Ru! (C,n&)
Pa%a /au ini i%a/ %ia/u/an *!ri/aan %aa!- /arna *
%aa! %a*a !nin#/a/an ri/, in/i *a%a /au /u"an *
8/18/2019 Lapsus KPD B
11/44
Dia#n,i
G#P$A$ Gravi !% minggu & ha
Ketu(an Pe)ah Dini
8/18/2019 Lapsus KPD B
12/44
Pnaaa/anaan
ID RL 25 *r !ni
Taaa/ana /,nr+ai
In:/i CaGi%i! 1 #r412:a! I
O"r+ai Hi- D??4?a! %an an%a>an%a *rainan
8/18/2019 Lapsus KPD B
13/44
,,w U*Prawaan Hari I ( Sa"u- 12 Mar 2016)
T# SOA Inru/i
12434201606&00
S$ >O$ KU$ Bai/- Sa%ar
TD$ 100460
N$ 55=4!ni
P$ 16=4!ni
S$ 36- C
P!ri/aan Luar$ TU$ 20
Hi$ >
D??$ 136=4!ni
u=u$ Dara (>)
BAK$ LanAwai KU- D??- Hi
>In:/i CaGi%i! 1 #4 12
?a!4 Inra+na
>P!aan#an Paru- In:/i
D=a!a,n 6 !#4 12 :a!4
Inra!u/uar (7=)> B% R
8/18/2019 Lapsus KPD B
14/44
,,w U*Prawaan Hari II ( Aa% 13 Mar 2016)
*gl S+A Instruksi
134342016
06&00
S: *iak aa keluhan
O$ KU$ Bai/- Sa%ar
TD$ 10040 !! H#
N$ 52=4!ni
P$ 20=4!ni
S$ 36-9 C
Pemeriksaan Luar:
TU$ 20
Hi$ (>)
D??$ 175=4!ni
u=u$ Air /u"an (>)
BAK$ Pr /ar- /unin# :rni 60ID RL 25 *r !ni
>In:/i CaGi%i! 1 #4 12
Inra+na
>In:/i D=a!a,n 6 !
:a!4 Inra!u/uar
*u/u 15&00 @ITA
8/18/2019 Lapsus KPD B
15/44
Prawaan Hari III ( Snin- 17 Mar 2016)
Prawaan Hari III ( Snin- 17 Mar 2016)
,,w U*
*gl S+A Instruksi
17434201
6
06&00
S$ Kuar air /u"an
O$ KU$ Bai/- Sa%ar
TD$ 10040 !!H#
N$ 55=4!ni
P$ 16=4!ni
S$ 36- C
P!ri/aan Luar$
TU$ 20
Hi$ >
D??$ 172=4!ni
u=u$ Air Ku"an (>)
BAK$ Pr/ar
BAB$ Bu!
A$ .1P0A0 .ra+i% 2 !in##u 9 ari
; KPD PH 3
P$
>Awai KU- D??- Hi %an an%a>
an%a *r%araan
>ID RL 25 *r !ni
>In:/i CaGi%i! 1 #4 12
?a!4 Inra+na
Hai US. (174342016)$
.ra+i% un##a- i%u*- *a
8/18/2019 Lapsus KPD B
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TIN?AUAN PUSTAKAKETUBAN PECAH DINI
BAB II
8/18/2019 Lapsus KPD B
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DFnii
Ketu(an Pe)ah Dini ( amniorrhexis –
premature rupture of the membrane PROM )a%aa pe)ahn,a selaputkorioamniotik %ian%ai %n#an/uarn'a an%ain*aru)&
Soewarto S. Ketuban Pecah Dini. In: Prawirohardjo S, editor. Ilmu Kebidanan Ed IV. Jakarta: PT Bina Putaka Sarwono Prawirohardjo! "##$. %. &''
)".
8/18/2019 Lapsus KPD B
18/44
Tr!in,,#i
Premature Rupture Of The Membrane (PROM) $ P
8/18/2019 Lapsus KPD B
19/44
E*i%!i,,#i
S
8/18/2019 Lapsus KPD B
20/44
Ana,!i u Inraurin
Sa*u Ku"an a%aa a*u'an# !!"un#/u u- *a
8/18/2019 Lapsus KPD B
21/44
Ei,,#i
Ki%a/!a!*uanr+i/u4!!*raan/an /a!ian
Tr:a%i *ni*ian%an *!"u/aan
r+i/ an*a n'ri
.:aa $P*aann%ir %an %ara
In/,!*ni r+i/
.!i
Trau!a(a!ni,ini-u"&/ua- *!&Daa!)
P,ii%ra!ni,n
Ma/r,,!ia
Pnin##ian
/ananinraurin
GardvaginstrephemoTrichovaginstaph
Mn#/aa+a#in!n#*r,/,a#
Riwa'"r"ariwa'"ru/u'an#
In/i
Aunnin9ham . Preterm 8abour. In: al. Ae, editor.
8/18/2019 Lapsus KPD B
22/44
Ei,,#i
DFini+ia!in C(Aa! a/,r"a)
?u#a %a*a%iu"un#/an%n#an a/,r,i,/,n,!i
a/,rNurii
16>32+ 7
Riwa'aKPD
"u!n'a L
in
L",
Kainan
La/
Ja*aleri +. Premature u%ture o- the embrane. edca
"#/& arch /&th3!
(
+aron B. J, >., Errol . Aontem%orar; Dia9noi and ana9ement Preterm Premature
u%ture o- the embrane. e4iew o- btetric and ;necolo9;. "##)!/?/@://(""
Strau SPJ. Premature u%ture o- the =etal embrane. > En9 J ed. /$$)!66)?/#@:&&6('#. Ja*aleri +. Premature u%ture o- the embrane. edca
"#/& h /&th3
http://emedicine.medscape.com/article/261137-overview#a1http://emedicine.medscape.com/article/261137-overview#a1
8/18/2019 Lapsus KPD B
23/44
Pa,Fi,,#i
Pa,Fi,,#i r:a%*
8/18/2019 Lapsus KPD B
24/44
Dia#n,i
Ana!ni
P!ri/aan ii/
P!ri/aan
Pnun:an#
Ana!ni$
Tr%a*a ri1a,at pelepasan air %ari :aan air- "r"au amis- "rwarna
jernih- %a*a keluar seikit4seikit aau men,em(ur
Pri!"an#/an
8/18/2019 Lapsus KPD B
25/44
P!ri/aan Pnun:an#US. A"%,!n
• Unu/ !ia a%a i%a/n'a,i#,'%ra!ni,n
AI ( !mniotic "luid #ndex )Mn:u!a/an /%aa!an +ri/a %ari/an,n# r"ar %i 7 /ua%ran uru&
Cara $ "a#i a"%,!n !n:a%i 7 /ua%ran- :u!a/an 7 /%aa!an +ri/an'a&
N,r!a "ia anara 9 27
$ingle Poc%et Mn#u/ur /%aa!an +ri/a 1 /an,n#a:a
N,r!a $ 2 5
• Unu/ !nnu/an uia/a!ian
• Unu/ !ia a/ :anin
• Unu/ !nnu/an "ra"a%an :anin
+aron B. J, >., Errol . Aontem%orar; Dia9noi and ana9ement Preterm Prematureu%ture o- the embrane. e4iew o- btetric and ;necolo9;. "##)!/?/@://(""
8/18/2019 Lapsus KPD B
26/44
P!ri/aan Pnun:an#• La(oratorium
• Dara Ruin (u/,i) In/i
• CRP- Pr,Ca
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Prini* Pnaaa/anaan
• Br%aar/an Uia .ai
•
A%a i%a/n'a *n'ui
27 @ 32 @ 37 @ 3 @
Pr+ia" PrTr!
K,nr+ai + A/i4In%u/i
Pr!auria
In/i
K ,r (i/,) (r,i
%
K ,n)r +a (i E
O")r +a)i
Hi)- D ? ?
An (i"i, (i/
Pr!auria
InE /
An( i"i,(
In%u/
Su%a2 ( r :a%i *!a( an#an *ar u- BB In%u/i *rainan
8/18/2019 Lapsus KPD B
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Pnaaa/anaan
gg *
>Pr,Fa/i ani"i,i<
#r,u* B
.!4 .& 3inggu >Mana:!n kon
ke)uali :i/a (ukti
suah aa (a!ni,<
%ian:u/an %n#an
>Mana:!n konser
ethametason #! m
osis aau Deksame
I/3 alam & %,i un
>Bri/an anti(ioti
unu/ !!*r*an:a
a!*iiin 2 #ra! %n#
290 !# ia* 6 :a!
*!"rian a!,/iiin
333 !# ia* 5 :a! u
!&4.# 3inggu Mana:!n konserv
Ba!a,n 12 !#
%,i aau D/a!
%aa! 7 %,i unu/ *
>Bri/an anti(ioti
unu/ !!*r*an:a
a!*iiin 2 #ra! %n#
Taaa/ana *a%a Ka!ian
Prr!
Soewarto S. Ketuban Pecah Dini. In: Prawirohardjo S, editor. Ilmu Kebidanan Ed IV. Jakarta: PTBina Putaka Sarwono Prawirohardjo! "##$. %. &''()".
Ja*aleri +. Premature u%ture o- the embrane. edca
"#/& arch /&th3!
8/18/2019 Lapsus KPD B
29/44
Pnaaa/anaan
Kurang ari !& 3inggu 4SDia/u/an /,
*ain nan#
>Da*a %ia/u/
/,nr+ai- %
*Tr!inai *r
in/i aau ,
"ar- %irai
>Ti%a/ %i
Pa%a /,n%ii Pr+ia"
htt%:55emedicine.medca%e.com5article5"&//6'(o4
http://emedicine.medscape.com/article/261137-overview#a1http://emedicine.medscape.com/article/261137-overview#a1
8/18/2019 Lapsus KPD B
30/44
Pnaaa/anaan
9sia Kehamilan < .% 3inggu49sia kehaminggu/ S
ianggap asehingga iluar kanselamat/Kehamilanini apat engan ok
gagal seksDapat pulamisoprosto?g intrava" jam makila aa tainfeksi@ (eanti(ioti) an ersa
Pa%a /,n%ii Ar!
8/18/2019 Lapsus KPD B
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Pnaaa/anaan
Pa%a /,n%ii %n#an *n'ui
9sia Kehamilan Penatalaksanaan
Uia /a!ian "ra*a*un
%n#an a/,r *n'ui
*ri $
• In/i inrauri
• S,ui, *ana
• .awa :anin
• Pr,a* ai *ua
• E+auai %a/ :anin
%n#an KT.
!nun:u//an ai #awa
:anin
>Mana:!n a/
r!inai *ra
( S/i, Bri/an ani"i,
>Bri/an /,ri/,
uia 37
i%a/n'a au
>K,nin# *a%
nan# /,n%ii
>Pria*an
inni n,nau
8/18/2019 Lapsus KPD B
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A#,ri!a
edina T, ,ill, +. Preterm Premature u%ture o- the
embrane : Dia9noi and ana9ement. +merican =amil;
Ph;ician. "##&!'6?2@:&0$(&2
8/18/2019 Lapsus KPD B
33/44
K,!*i/ai
K,!*i/ai Ini%n ()
Prainan r:a%i %aa! 1 !in##u 90>9
R*ira,r' Dir S'n%r,! 39
K,!*ri Tai Pua 32>6
K,ri,a!ni,nii 13 60
S,ui, Pa 12
K!aian :anin %aa! Rai! 1 2
edina T, ,ill, +. Preterm Premature u%ture o- the
embrane : Dia9noi and ana9ement. +merican =amil;
Ph;ician. "##&!'6?2@:&0$(&2
8/18/2019 Lapsus KPD B
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PEMBAHASAN KASUS
BAB III
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Ana!ni
*eori Kasus• Pasien merasa (asah paa
vagina/
• 3engeluarkan )airan (an,ak
ti(a 4ti(a ari jalan lahir atau
seikit4seikit/
•arna )airan iperhatikan/
• elum aa pengeluaran
lenir arah an (er(au khas
• His (elum teratur atau (elum
aa/
• Pain %aan# %n#an
/uar air %ari :aan air
• Riwa'a /uar air /u"an
air :a/ 10 :a! "u
ru!a a/i&
•Cairan 'an# /uar :rni "r"au
• Ti%a/ a%a riwa'a n'
!"u "a/an#
8/18/2019 Lapsus KPD B
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P!ri/aan ii/
T,ri Kau Tan%a>an%a in/i$
•
Suu i"u 35,
C• Na%i an%a
in/i$• Suu i"u 3-7, C
• Na%i 50 /ai 4 !ni
• D?? 190 =4!ni
T,ri Kau• P!ri/aan %n#an
*/uu! a!*a/ /uar
8/18/2019 Lapsus KPD B
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P!ri/aan ii/
T,ri KauP!ri/aan %aa!
%ia/u/an $
• S!ini!a !un#/in unu/
!n
8/18/2019 Lapsus KPD B
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P!ri/aan Pnun:an# T,ri Kau• P!ri/aan u/,i unu/ !n#aui
an%a>an%a in/i
• Kra a/!u !ra "ru"a !n:a%i
"iru
• *H air /u"an a%aa -9
• Dia/u/an *!ri/aan /uur
8/18/2019 Lapsus KPD B
39/44
Pnaaa/anaan
*eori Kasus
• P!"rian ani"i,i/ *r,Fa/i
%a*a !nurun/an in/i *a%a i"u
• La/u/an *!aan#an *aru %n#an 6
!#4 12 :a!4 i&! "an'a/ 7 /ai
*!"rian
• O"r+ai an%a>an%a *rainan
• O"r+ai a/,r *n'ui *ri
in/i (/,ri,a!ni,nii- /,!*ri ai
*ua- ,i#,i%ra!ni,n)
• Pain %i"ri/an in:/i ani"i
CaGi%i! 14#r412:4i+
• Di"ri/an *!aan#an *
%n#an %/a!a,n 6 !#4
:a! 4 i&! "an'a/ 7
*!"rian
• Dia/u/an ,"r+ai *a%a i"u
:anin ra !n#a!ai an%a>a
*rainan %n#an !n%
a/,r *n'ui *ri D??- a
+ia i"u- %an u# /,nr,
8/18/2019 Lapsus KPD B
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Ki!*uan
Ku"an *
8/18/2019 Lapsus KPD B
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Tin:auan Kau
Pa%a /au ini %ia#n,in'a a%aa G#P$A$ grav
minggu & hari (elum inpartu ' Ketu(an pini&
Segala proseur ana!ni- *!ri/aan F*!ri/aan *nun:an#- %an *naaa/anaan u%a %
sesuai engan teori 'an# a%a&
8/18/2019 Lapsus KPD B
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Pran'aan
1& Nur A!aia $ 1& Ka%aan a*a a:a 'an# "ia !n'"a"/an *,ii *au
2& a/,r ri/, KPD *a%a *ain
u%a $ 1&
8/18/2019 Lapsus KPD B
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TERIMA KASIH
QDan !ii/ Aa !i*ui raaia an#i %an "u!i %an /*a%a>N'a #aa%i/!"ai/an& Ma/a !"aa Dia %an "rawa/aa /*a%a>N'a& Dani%a/ n#a ra%a* a*a 'an# /a!u /r:a/an (&S Hu% $ 123)
8/18/2019 Lapsus KPD B
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SELAMAT BELA?AR