ANTE PARTUM

PARTUM BLEEDING
BLEEDING
ANTE

Dr. I Made Putra Juliawan, SpOG

SMF OBSTETRI-GINEKOLOGI
RSUP NTB

PENDAHULUAN
PENDAHULUAN
OBSTETRI ADALAH BLOODY BUSINESS

KEMATIAN MATERNAL DAPAT DITURUNK

KAUSA PERDARAHAN MASIH MENONJOL

A S 1979-92:

4915 KEMATIAN MATERNAL NON ABORT

30% KAUSA PERDARAHAN

PENDAHULUAN
PENDAHULUAN
LANJUTAN
LANJUTAN

KAUSA PERDARAHAN

JUMLAH

ABRUPTIO PLACENTAE
141 (19)
LACERATION/UTERINE RUPTURE 125 (16)
UTERINE ATONY
115 (15)
COAGULOPATHIES
108 (14)
PLACENTA PREVIA
50 ( 7 )
PLACENTA ADHESIVE
44 ( 6 )
UTERINE BLEEDING
47
RETAINED PLACENTA
32 ( 4 )
CHICHACLI (1999), WILLIAM 21ST

PERDARAHAN ANTE PARTUM

1. ABRUPTIO PLACENTAE/SOLUTIO PLACENT

2. PLACENTA PREVIA

ABRUPTIO PLACENTAE
PLACENTAE DEFINISI
ABRUPTIO

PLASENTA LEPAS

IMPLANTASI NORMA

SEBELUM BAYI LAHI

> 20 MINGGU

ABRUPTIO PLACENTAE
PLACENTAETERMINATIONS
ABRUPTIO

ACCIDENTAL HEMORRHAGE
SOLUTIO PLACENTAE

PREMATURE SEPARATION O
THE NORMALLY IMPLANTED
PLACENTA

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO

EXTERNAL HEMORRHAGE

CONCEALED HEMORRHAG

TOTAL
PARTIAL

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO

FREQUENCY AND INTENSITY

CRITERIA DIAGNOSIS
ONSET SYMPTOMS

FREQUENCY: 1 PER 200 DELIVERIE

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO
PERINATAL MORTALITY & MORBIDITY
MOST

25%

KAREGARD (1986)

20%

KROHN (1987)

20/884 SOLUTI

ANANTH (1999)

40%

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO
RISK FACTOR

RELATIVE RISK (%)

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

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

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO

HEMORRHAGIC
INTRA DECIDUA

DECIDUAL SPLITS

PATHOLOGY

SEPARATION
COMPRESSION
DESTRUCTION

DECIDUAL
HEMATOMA

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO
CONCEALED HEMORRHAGE
CHRONIC PLACENTAL ABRUPTION
FETOMATERNAL HEMORRHAGE

WAJIB BACA

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO

DIAGNOSIS

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

FREQUENC
78
66
60
17
17
22
15

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO
COMPLICATIONS

SHOCK BLEEDING
CONSUMPTIVE COAGULOPATHY
RENAL FAILURE
COUVELAIRE UTERUS

ABRUPTIO PLACENTAE
PLACENTAE
ABRUPTIO
MANAGEMENT

STATUS OF
THE MOTHER

STATUS OF
THE FETUS

GESTATIONAL
AGE

PERDARAHAN ANTE PARTUM

1. ABRUPTIO PLACENTAE/SOLUTIO PLACENT

2. PLACENTA PREVIA

PLACENTA PREVIA
PREVIA
PLACENTA

PATHOLOGIC IMPLANTATION
LOW SEGMENT
OVER OR VERY NEAR OS

PLACENTA PREVIA
PREVIA
PLACENTA

NORMAL IMPLANTATIO
UTERINE FUNDAL
UTERINE CORPORAL

PLACENTA PREVIA
PREVIA
PLACENTA

DEGREE

1. TOTAL PLACENTA PREVIA

2. PARTIAL PLACENTA PREVIA

3. MARGINAL PLACENTA PREVI

4. LOW LYING PLACENTA
5. VASA PREVIA

PLACENTA PREVIA
PREVIA
PLACENTA
IYASU (1993)

INCIDENCE

0,50%

FREDERIKSEN (1999)

0,55%

CRANE (1999)

0,33%

PARKLAND HOSPITAL 12YEARS 0,26%

WILLIAM, 21ST

PLACENTA PREVIA
PREVIA
PLACENTA

ETIOLOGY

INCREASES MATERNAL AGE

MULTIPARITY
PRIOR CESAREAN DELIVERY
SMOKING

PLACENTA PREVIA
PREVIA
PLACENTA

CLINICAL FINDIN

PAINLESS HEMORRHAGE
SECOND TRIMESTER
WITHOUT WARNING

PLACENTA PREVIA
PREVIA
PLACENTA

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

PLACENTA PREVIA
PREVIA
PLACENTA

DIAGNOSIS

CLINICAL FINDING
PAINLESS HEMORRHAGE
WITHOUT WARNING
DOUBLE SET-UP
VAGINAL EXAMINATION
SONOGRAPHY
TRANSABDOMINAL
TRANSVAGINAL

PLACENTA PREVIA
PREVIA
PLACENTA

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

PLASENTAPREVIA
PREVIA
PLASENTA
PERDARAHANSEDIKIT
SEDIKIT
PERDARAHAN
<250cc
cc))
((<250
PRETERM
PRETERM

PRETERM
PRETERM

ATERM
ATERM

SUBTOTAL
SUBTOTAL

STOP
STOP

AMNIOTOMI
AMNIOTOMI
PERDARAHAN
PERDARAHAN

ATERM
ATERM

ISTIRAHAT
ISTIRAHAT

USG
USG

ISTIRAHAT
ISTIRAHAT
TOTAL
TOTAL

PERDARAHANBANYAK
BANYAK
PERDARAHAN
500cc
cc))
((>>500

DSU
DSU

ULANG
ULANG

PARSIAL
PARSIAL

TOTAL
TOTAL

INPARTU
INPARTU
PERVAGINAM
PERVAGINAM

K SS II O
O SS EE SS A
AR
R EE A
A
SS EE K

AMNIOTOMI
AMNIOTOMI

DARAH
DARAH

INPARTU
INPARTU
PERVAGINAM
PERVAGINAM