Click here to load reader

SLIDE PERDARAHAN POST PARTUM-TASIK.ppt

  • View
    123

  • Download
    12

Embed Size (px)

DESCRIPTION

postpartum

Text of SLIDE PERDARAHAN POST PARTUM-TASIK.ppt

  • PENATALAKSANAAN PERSALINAN KALA TIGA, KALA EMPAT DAN PERDARAHAN POST PARTUMWAWANG SETIAWAN SUKARYAFAKULTAS KEDOKTERAN UNIVERSITAS ISLAM BANDUNG

  • KEMATIAN MATERNAL53% KEMATIAN DAPAT DICEGAH

    DENGAN INTERVENSI TEKNOLOGI

    SEDERHANA

  • KEMATIAN MATERNALPENYEBAB :PERDARAHAN,SEPSISPREEKLAMPSI-EKLAMPSIPARTUS MACETUNSAFE ABORTION60 - 80% POTENSIAL DAPAT DICEGAH

  • KEMATIAN MATERNAL PENOLONG PERSALINAN YANG TERAMPILMERUPAKAN SALAH SATU INTERVENSI YANG EFEKTIF DALAM MENURUNKAN KEMATIAN MATERNAL DAN KECACATAN AKIBAT KEHAMILAN DAN PERSALINAN

  • PERSALINAN KALA TIGAPADA KEHAMILAN ATERM ALIRAN DARAH KE UTERUS 500-800 ML/MENITJIKA UTERUS TIDAK SEGERA BERKONTRAKSI, PADA BEKAS TEMPAT IMPLANTASI PLASENTA TERJADI PERDARAHAN 350-560 ML/MENIT

    PADA ATONIA UTERI DAPAT TERJADI KEHILANGAN SELURUH VOLUME DARAH DALAM 10-30 MENIT

    IBU DENGAN PERDRAHAN KARENA ATONIA DAPAT MENINGGAL < 1 JAM

  • MEKANISME LAHIRNYA PLASENTA1. FASE LATEN

    2. FASE KONTRAKSI

    3. FASE PELEPASAN PLASENTA

    4. FASE PENGELUARAN

  • KEUNTUNGAN MANAJEMEN AKTIF KALA III1. KALA III LEBIH SINGKAT

    2. PERDARAHAN BERKURANG

    3. KEJADIAN RETENSIO PLASENTA BERKURANG

  • MANAJEMEN AKTIF vs EKSPEKTAN AKTIF EKSPEKTANKEHILANGAN DARAH< 500 ML93,2%83,5%500-1000 ML5,1%13,9%> 1000 ML1,7%2,6%PLASENTA MANUAL2 %1,7%PLASENTA TERPERANGKAP1,1%0,9%LAMA KALA III8 menit15 menit

  • LANGKAH2 MANAJEMEN AKTIF KALA IIISEGERA JEPIT DAN POTONG TALIPUSAT

    BERI OKSITOSIN 10 U IM SEGERA SETELAH BAYI LAHIR

    PENEGANGAN TALIPUSAT TERKENDALI

    SETELAH PLASENTA LAHIR SEGERA MASASE FUNDUS UTERI

  • OKSITOSINPASTIKAN TIDAK ADA ANAK KEDUA (GEMELLI)DISUNTIKAN 10 UNIT OKSITOSIN (I.M) SETELAH BAHU DEPAN LAHIR ATAU SEGERA SESUDAHNYA.BILA TERPASANG INFUS DPT DITAMBAHKAN 20 UNITEFEKTIF 2 - 3 MENIT SETELAH PENYUNTIKAN

  • BERIKAN OKSITOSIN 10 IU I.M.SETELAH BAHU DEPAN BAYI LAHIRATAU SEGERA SETELAH BAYI LAHIRPASTIKAN DULU TIDAK ADA KEHAMILAN KEMBAR / GANDA

  • PENEGANGAN TALIPUSAT TERKENDALI

    JEPIT TALIPUSAT 5 CM DI DEPAN VULVA, PEGANG DENGAN TANGAN KANAN.LETAKAN TANGAN LAIN DI DEPAN KORPUS UTERI TEPAT DI ATAS SBU TEGANGKAN TALIPUSAT DGN RINGAN & HATI2, SEMENTARA TANGAN KIRI MENDORONG DORSOKRANIAL SP TANDA PLASENTA LEPAS TARIK KE BAWAH UNTUK LAHIRKAN PLASENTA

  • JANGAN TARIK TALI PUSAT TANPA MENDORONG DORSOKRANIAL DENGAN TANGAN KIRI/KANAN

  • PERSALINAN KALA IV, TINDAKAN YANG BAIKIKAT TALI PUSATPEMERIKSAAN FUNDUS DAN MASASENUTRISI DAN HIDRASIBERSIHKAN IBUISTIRAHATMEMULAI MENYUSUIMENOLONG IBU KE KAMAR MANDIMENGAJARI IBU DAN KELUARGA

  • PERSALINAN KALA IV, TINDAKAN YANG TIDAK BAIKTAMPON VAGINA

    GURITA DAN SEJENISNYA

    MEMISAHKAN IBU DAN BAYI

  • MANAJEMEN ATONIA UTERI UNTUK MENCEGAH HPPIDENTIFIKASI RISIKO TINGGI

    ADA PENOLONG TERLATIH SAAT PERSALINANUTEROTONIKACAIRAN INFUSTRANSPORTASI SETIAP SAAT

    MEMBERDAYAKAN DAN MELATIH PENOLONG PERSALINAN PROAKTIF MENGAMBIL TINDAKAN SEDINI MUNGKIN

  • MENCEGAH PERDARAHAN POST PARTUM AKIBAT ATONIA UTERIMENGIDENTIFIKASI IBU DGN RISIKO TINGGI UNTUK MELAHIRKAN DI RS.

    GRANDEMULTIPARA PARTUS LAMA KEHAMILAN GANDA IBU TUA

  • MISOPROSTOL EFEK UTEROTONIKA KUAT

    TIDAK MENINGKATKAN TEKANAN DARAH

    CEPAT DISERAP

    TIDAK PERLU PENYIMPANAN KHUSUS

  • SEGERA MASASE FUNDUS UTERISESUDAH PLASENTA LAHIR(MAKSIMAL 15 DETIK)UTERUS KONTRAKSI ?TIDAKEVALUASI / BERSIHKAN BEKUAN DARAH / SELAPUT KETUBANKOMPRESI BIMANUAL INTERNA (KBI) MAKS. 5 MENITUTERUS KONTRAKSI ?AJAR KELUARGA MELAKUKAN KOMPRESI BIMANUAL EKSTERNA (KBE)KELUARKAN TANGAN (KBI) SECARA HATI2 SUNTIK METHYL ERGOMETRIN 0,2 MG I.MPASANG INFUS RL + 20 IU OKSITOSIN, GUYURLAKUKAN LAGI KBI

    PERTAHANKAN KBI SELAMA 1-2 MENITKELUARKAN TANGAN SECARA HATI-HATILAKUKAN PENGAWASAN KALA IVEVALUASI RUTINYAYATIDAK

  • UTERUS KONTRAKSI ?LIGASI ARTERI UTERINA DAN / ATAU HIPOGASTRIKAB-LYNCH METHODRUJUK SIAPKAN LAPAROTOMILANJUTKAN PEMBERIAN INFUS + 20 IU OKSITOSIN MINIMAL 500 CC/JAM HINGGA MENCAPAI TEMPAT RUJUKANSELAMA PERJALANAN DAPAT DILAKUKAN KOMPRESI AORTA ABDOMINALIS/KBEHISTEREKTOMIPERDARAHAN BERLANJUTTIDAKPENGAWASAN KALA IVYAPERTAHANKAN UTERUSPERDARAHAN BERHENTI

  • KOMPRESI BIMANUAL INTERNAL

  • KOMPRESI BIMANUAL EKSTERNAL

  • KOMPRESI AORTA ABDOMINALIS

  • SISA PLASENTA SISA PLASENTA DAPAT NYEBABKAN PERDARAHAN POST PARTUM AWAL (EARLY)/LAMBAT (DELAYED). LAKUKAN PENGAMBILAN SECARA MANUAL DGN ANESTESI UMUM (VOLATILE,1.5 2 MERUPAKAN KONSENTRASI ALVEOLAR MINIMAL YG MGK PERLU UNTUK RELAKSASI UTERUS)KADANG2 WAKTU SISA PLASENTA DIKELUARKAN SECARA MANUAL, TERJADI PERDARAHAN HEBAT KARENA PLASENTA AKRETA YG TIDAK TERDIAGNOSA (JARANG)

  • MANUAL REMOVAL Of THE PLACEMTA Preparation of patientExplain the intervention to the woman and reassure her Take blood for typing and cross-matching and for haemoglobin level if it has not already been done Start IV infusion,if not already established, and infuse either Ringers lactate or normal saline. Run it fast if hypovolaemia has not yet been corrected. Blood transfusion may be needed if haemorrhage is severe. Give one dose of prophylactic antibiotics: Ampicillin 2 g IV, and -metronidazole 500 mg IV, or -cefazolin 1 g IV, plus metronidazole 500 mg IV.

  • EQUIPMENT & SUPPLIES NEEDED: antiseptic solution sterile glovesone long sterile glovesterile swabs sterile vulval pad clamp, e.g. sponge-holding forceps receiver for placentadrugs: -analgesia -ergometrine -oxytocin -antibiotics syringes and needles.

  • ANALGESIAUse an analgesic such as pethidine 25 mg IV, and a sedative such as diazepam 10 mg IV. If the pethidine and diazepam are not available, use another appropriate analgesic, if available, and continue gently with the manual removal of the placenta as it is a life saving procedure.

  • Procedure1Provide emotional support to the woman throughout. 2.Help the woman lie on her back with knees bent. If she is unable to void urine, catheterize and empty the bladder. A full bladder can prevent the delivery of the placenta. 3.Administer analgesic. 4.Wash and scrub your hands and arms well. 5.Clean around the vagina and the perineal area with an antiseptic solution. 6.Put on short sterile gloves first. Part the labia and clean the vestibule, i.e. the area inside the labia minora. Then, on the hand that will be inserted into the vagina, put on a long sterile glove on top of the short one. This will prevent the introduction of bacteria from the arm. (If no long glove is available, use a second short glove, cut off the part for the fingers and use the rest to lengthen the first glove) 7.Hold the umbilical cord with a clamp and pull cord gently until it is taut and parallel with the floor. 8.Introduce the other, long-gloved hand into the vagina with the fingers and thumb straight but close together and follow the cord, using a gentle rotation movement to go through the cervical os into the uterine cavity (Figure 9.1). Follow the cord until you find the placenta. (Once you have put your hand into the uterus, do not bring your hand out until you have separated the placenta and are bringing it out of the uterus. Do not go in and out of the uterus as this increases the risk of infection). 9.Let go of the cord with your external hand and grasp the fundus of the uterus through the abdomen. This supports the uterus and provides counter traction during the manual removal to prevent inversion of the uterus. (Figure 9.2). 10. Reach the placenta and find its edge. Slip the fingers of your hand between the edge of the placenta and the uterine wall. With your palm facing the placenta and fingers held tightly together, use a sideways slicing movement to gently detach the placenta. Go all around the placental bed until all the placenta is detached from the uterine wall. 11. When all of the placenta is separated and in the palm of your hand, (Figure 9.3) gently withdraw the placenta from the uterus. Do not pull on just a piece of placenta for it may tear from the rest of the placenta. The membranes will follow the delivered placenta. Pull them out slowly and carefully as they might tear off and be left in the uterus giving rise to haemorrhage or infection. 12. Continue to provide counter-traction to the uterus with the other hand to prevent uterine inversion. 13. Insert your hand again to palpate the uterine cavity for any remaining placental tissue. 14. Add oxytocin 20 IU to 1 litre of IV fluid (either Ringers lactate or normal saline) and give by intravenous infusion. Give rapidly if bleeding. 15. Have an assistant massage the uterus to encourage contraction. 16. If there is continued heavy bleeding, give ergometrine 0.2 mg IM to help the uterus contract, or prostaglandins depending on national policy (prostaglandins should not be given intravenously as this may be fatal). 17. Examine the removed placenta and check for completeness (Figure 9.4). 18. Check for tears in the birth canal and repair, as required. Problems in the removal of the placenta. If the placenta does not separate from the uterine wall by gentle lateral movements of the finger tips at the line of cleavage, suspect placenta accreta and refer the woman to a higher level health facility for laparotomy and possible sub-total hysterectomy. No bleeding will occur from the uterine wall if the placenta is attached, only from areas where the placenta has separated If the placenta is retained due to a constriction ring, or if hours or days have passed since the birth of the baby, it may not be possible to get the whole hand into the uterus. Remove the placenta in fragments using two fingers, ovum forceps or a wide, blunt curette. Referral for exploration of the uterus under anaesthetic may be requi