ANTE PARTUM BLEEDING

Dr.G.M PUNARBAWA, SpOG

SMF OBSTETRI-GINEKOLOGI RSUP NTB

PENDAHULUAN

OBSTETRI ADALAH BLOODY BUSINESS

KEMATIAN MATERNAL DAPAT DITURUNKAN

KAUSA PERDARAHAN MASIH MENONJOL

A S 1979-92:
4915 KEMATIAN MATERNAL NON ABORTUS 30% KAUSA PERDARAHAN

PENDAHULUAN
LANJUTAN

KAUSA PERDARAHAN ABRUPTIO PLACENTAE LACERATION/UTERINE RUPTURE UTERINE ATONY COAGULOPATHIES PLACENTA PREVIA PLACENTA ADHESIVE UTERINE BLEEDING RETAINED PLACENTA
CHICHACLI (1999), WILLIAM 21ST

JUMLAH (%) 141 (19) 125 (16) 115 (15) 108 (14) 50 ( 7 ) 44 ( 6 ) 47 ( 6 ) 32 ( 4 )

PERDARAHAN ANTE PARTUM

1. ABRUPTIO PLACENTAE/SOLUTIO PLACENTAE

2. PLACENTA PREVIA

ABRUPTIO PLACENTAE DEFINISI

PLASENTA LEPAS
IMPLANTASI NORMAL SEBELUM BAYI LAHIR > 20 MINGGU

ABRUPTIO PLACENTAE

TERMINATIONS

ACCIDENTAL HEMORRHAGE SOLUTIO PLACENTAE PREMATURE SEPARATION OF THE NORMALLY IMPLANTED PLACENTA

ABRUPTIO PLACENTAE

EXTERNAL HEMORRHAGE

CONCEALED HEMORRHAGE

TOTAL PARTIAL

ABRUPTIO PLACENTAE

FREQUENCY AND INTENSITY CRITERIA DIAGNOSIS ONSET SYMPTOMS FREQUENCY: 1 PER 200 DELIVERIES

ABRUPTIO PLACENTAE
PERINATAL MORTALITY & MORBIDITY MOST KAREGARD (1986) KROHN (1987) ANANTH (1999) 25% 20% 20/884 SOLUTIO 40%

ABRUPTIO PLACENTAE
RISK FACTOR
INCREASE AGE/PARITY PREECLAMPSIA CHRONIC HYPERTENTION PROM CIGARETTE SMOKING THROMBOPHILIA COCAINE USE PRIOR ABRUPTION UTERINE LEIOMYOMA
ANANT AND KRAMER (WILLIAM 21ST)

RELATIVE RISK (%)

NA 2,1-4,0 1,8-3,0 2,4-3.0 1,4-1,9 NA NA 10-25 NA

ABRUPTIO PLACENTAE

PATHOLOGY

HEMORRHAGIC INTRA DECIDUA

SEPARATION COMPRESSION DESTRUCTION

DECIDUAL SPLITS

DECIDUAL HEMATOMA

ABRUPTIO PLACENTAE
CONCEALED HEMORRHAGE
CHRONIC PLACENTAL ABRUPTION FETOMATERNAL HEMORRHAGE

WAJIB BACA

ABRUPTIO PLACENTAE
DIAGNOSIS SIGN OR SYMPTOM FREQUENCY (%)
78 66 60 17 17 22 15

VAGINAL BEEDING UTERINE TENDERNESS OR BACK PAIN FETAL DISTRESS HIGH FREQUENCY CONTRACTIONS HYPERTONUS IDIOPATHIC PRETERM LABOR DEAD FETUS
HURD (1983), WILLIAM 21ST

ABRUPTIO PLACENTAE
COMPLICATIONS

SHOCK

BLEEDING

CONSUMPTIVE COAGULOPATHY RENAL FAILURE COUVELAIRE UTERUS

ABRUPTIO PLACENTAE
MANAGEMENT

STATUS OF THE MOTHER

STATUS OF THE FETUS

GESTATIONAL AGE

PERDARAHAN ANTE PARTUM

1. ABRUPTIO PLACENTAE/SOLUTIO PLACENTAE

2. PLACENTA PREVIA

PLACENTA PREVIA

PATHOLOGIC IMPLANTATION

LOW SEGMENT
OVER OR VERY NEAR OS

PLACENTA PREVIA

NORMAL IMPLANTATION: UTERINE FUNDAL

UTERINE CORPORAL

PLACENTA PREVIA

DEGREE

1. TOTAL PLACENTA PREVIA

2. PARTIAL PLACENTA PREVIA

3. MARGINAL PLACENTA PREVIA 4. LOW LYING PLACENTA 5. VASA PREVIA

PLACENTA PREVIA
IYASU (1993) FREDERIKSEN (1999) CRANE (1999)

INCIDENCE

0,50% 0,55% 0,33%

PARKLAND HOSPITAL 12YEARS

WILLIAM, 21ST

0,26%

PLACENTA PREVIA

ETIOLOGY

INCREASES MATERNAL AGE MULTIPARITY PRIOR CESAREAN DELIVERY SMOKING

PLACENTA PREVIA

CLINICAL FINDING

PAINLESS HEMORRHAGE SECOND TRIMESTER

WITHOUT WARNING

PLACENTA PREVIA

THE CAUSE OF SPONTANEOUS HEMORRHAGE IS RELATED TO DEVELOPMENT OF THE LOWER UTERINE SEGMENT

PLACENTA PREVIA

DIAGNOSIS

CLINICAL FINDING PAINLESS HEMORRHAGE WITHOUT WARNING

DOUBLE SET-UP VAGINAL EXAMINATION

SONOGRAPHY TRANSABDOMINAL TRANSVAGINAL

PLACENTA PREVIA
MANAGEMENT:

1. FETUS IS PRETERM?
2. FETUS MATURE TO DELIVERY? 3. THOSE IN LABOR? 4. SEVERE HEMORRHAGE?

PLASENTA PREVIA
PERDARAHAN SEDIKIT ( <250 cc ) PRETERM ATERM PERDARAHAN BANYAK ( > 500 cc ) PRETERM ISTIRAHAT ISTIRAHAT USG DSU STOP ULANG TOTAL AMNIOTOMI PERDARAHAN INPARTU PERVAGINAM

ATERM

TOTAL

SUBTOTAL

PARSIAL AMNIOTOMI INPARTU PERVAGINAM

DARAH

SEKSIO SESAREA