Laporan Kasus Ruptur Uteri

8/18/2019 Laporan Kasus Ruptur Uteri

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C

P2A0 POST SC IUFD + HISTEREKTOM

SUBTOTAL + SALPINGO OVEROKTOMSINISTRA A/I RUPTURE UTERI KOMPLE

Pembimbing I : dr. Apter Patai,Sp.OGPembimbing II : dr. Jasmine

Presenter : Desy Riani Hutapea,S.Ked

SMF OBSTETRI DAN GINEKOLOGIRUMAH SAKIT UMUM JAYAPURA

FAKULTAS KEDOKTERAN UNIVERSITASCENDERAWASIH

JAYAPURA2016


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Pend!"#"n

• Pen$e%% &n'&den'& (")*"( "*e(& 'e(&n+ *e(,d& e*&-#-+&n$ .e(")/n !# $n

• Pen$e%% $n+ )#&n+ 'e(&n+ &#! dn$ ri"ayat se#ti!n #aesarean )d /e!

• F/*-( )(ed&')-'&'& (&$* .n&)"#'& -)e('& *(".*&/ .&'#n$ /"(e*'e.&-.e/*-.&3

• S*&."#'& "*e("' $n+ %e(#e%&!n *" *&d/ *e)* den+n -/'&*-'&n

• P(-+n-'&' )d )'&en $n+ .en+#.& (")*"( "*e(& 'e(&n+/#& %"("/

• An+/ /e.*&n ,n&n %e(d'(/n %e(%+& '*"d& d)-(/n %e(/&'( n*( 40


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Me(")/n +n++"n d&nd&n+ (!&. )*-#-+&' )

*e(#e*/ d& 'e+.en %(-%e/n$ (!&.3

)e.&'!n #en+/) den+n *" *n) )%+&n ,n&n /e d#)e(&*-ne".

Ke%n$/n (")*"( "*e(& /'"' den+n %e/'e%e#".n$3

.e.e(#"/n )enn+nd("(* *" #)(-*-.&3


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L)-(n /'"'Identitas :

• N-3 Re/. Med&/ 9 :4 :; 42

• N. Pende(&* 9 N$3 YW

• U."( 9 2; T!"n

• A#.* 9 En*(-)

• A+. 9 K(&'*en P(-*e'*n

• Pe/e(,n 9 I%" R".! Tn++

• Pend&d&/n 9 SMA

• S"/" %n+' 9 Se("&

• Tn++# MRS 9 24 De'e.%e( 2014 J. 9 0


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Ke#"!n U*. 9 Ke#"( &(&( = ,.

R&$* Pen$/&* Se/(n+ 9 I%" .e(")/n )'&en (","/n RS S-(-n+ d*n

/e#"!n ."#e'."#e' 'e,/ 4 ,. SMRS HPHT >=2014 TP > 012016 ?UK @ :2 .&n++" ANC PKM S-(-n+ dn H.d& ?!n$ 2 dn *&d/

USG Ge(/n ,n&n d&('/n %e(/"(n+ 'e,/ < ,. SMRS Ke#"( &(&( ? = ,. SMRS Ke#"( #end&( d(! ?

? +*# ? %" ?3 N$e(& '* %"n+ &( /e8 ? .&n++" 'e%e#". .'"/ (".! '/&*3

R&$* )en$/&* 'e%e#".n$9P'&en .en+/" (&$* A'. ? H&)e(*en'& ?

Jn*"n+? DM ?


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Ri"ayat

$enstruasi• Men(8!e9 1: T!"n• S&/#"' !&d9 Te(*"( ?2< H(&• L.n$ 9 =4 !(&

• Gn*& )e.%#"* 9 2: 'e!(&• R&$* Pen++"nn

K-n*('e)'& 9 ?

Ri"ay

Pernian• Pe(n&/!n9 Tn3

• S".&9 Pe(*• U'& )e(n&/:4 *!"n


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R&$* O%'*e*(&

&! Jenis

Pers.

'sia

GestasiPenyulit

Pen!l!n

g(( JK

'

s

*. SC

C"/")

%"#nO#&+-!&d(.&-n D-/*e(

2370

0

T

.H.

&n&


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P-$-RIKSAA& ISIK Status Generalis

• Kedn U.". 9 T.)/ '/&* 'edn+

• Ke'd(n 9 C-.)-' Men*&'

• T&n++& Bdn 9 141 8. Be(* Bdn 9


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S**"' O%'*e*(&• Pemeriks! L"r 9 TFU9 27 8. DJJ 9 ;0 d).

• Le-)-#d 1 9 %+&n *' ,n&n %+&n #"n//e('

• Le-)-#d 2 9 P"/

• Le-)-#d : 9 Ke)#

• Le-)-#d = 9 Pen"("nn %+&n *e(end! ,n&n =4

• I!s#ek"$% 9 VU 9 *enn+ )-(*&- #&8&n #&&de OUE *e(%""-( ? ""' ? #' ?

• Pemeriks! D$m 9 )-(*&- /en$# )-'*e(&-( *e%#)e.%"/n 1 8. /e*"%n ? /e)# !-d+e I


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Pe.e(&/'n )en"n,n+

USG9 Jn&n P(e'en*'& B-/-n+ T"n++# H&d") )#8en*+(de 0 #e*/ (end!3

U'& /e!.n :2:: .&n++"

CTG 9 K*e+-(& III

(PD / 01 A2 / 3.4 -5 / *67

grH2 / 87.0 FL 6


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Pe.e(&/'n Pen"n,n+ ?#%-(*-(&".Dara% 9engap pre !perasi; p!st !perasi;

Hem!gl!bin 1:30 +d# 1:= +d#

Hemat!rit :


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R-S'$-

• I%" d*n+ den+n /e#"!n )e("* ."#e'."#e' 'e,/ 4 ,. SMRS3 H TP >012016 ?UK @ :2 .&n++"3 2 /-n*(-# /e!.n d& PKM S-(-n+

USG ? OS .en+/" +e(/ ,n&n %e(/"(n+ 'e,/ < ,. 'e%e#". '/&*/e#"( &(&( ? = ,. SMRS #end&( d(! ? /e)"*&!n ? ?3 N$e(& '* %"n+ &( /e8 ? 'e,/ @ 1 .&n++" 'e%e#". .'"/R&$* )e('#&nn )e(*. %$& #/&#/& #!&( den+n SC BB %$& ?&nd&/'& -#&+-!&d(.&-n3

• Pe.e(&/'n '&/ 9 Kedn U.". 9 *.)/ '/&* 'edn+3 Ke'dMen*&'3 Tnd*nd &*# 9 TD 9 1:0


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DIAG&OSIS K-RJA

G* ,n&n )d G2P1 !. :2:: .&n++" JPKT

< J. BSC 1 ?&d* : *!"n O#&+-!&d(.&-n ?ICBe#". In)(*"3


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Ren#ana


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24122014 ?010

2010 TP 9 >7201 +e(/ ,n&n %e(/"(n+'e,/ < ,. SMRS /e#"( &(&( ? 'e,/ < ,. '.(' de.. ? 'e,/ *d .#. (&$*

%'8 1 ?: *!n $n+ ##"n$e(& '* BAB ?'e,/ 1 .&n++" '.(' /e)"*&!n ? dn +*#

(&$* '. ?

TFU9 27 8.

Bnd#e (&n+ ?

DJJ 9 ;0 d).

H&' 9

TD 9 1:0


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6>*>7*1 7=.46;,R. ?K

S: Perdara%anper@aginam ;, nyeri

tean pada perut, tampa

sangat gelisa%, pusing,eringat dingin dan ingin

munta%. N$e(& !.)&( d&'e#"("! #)n+ )e("* ?3

O: Ku : tampa saitberat, es : 2$

;

Stts !bs : ?)' tenang,perdara%an

per@aginam ;

A: Ga"at Canin suspe#t s!lupla#enta pada GP* %amil 8>minggu, KPD 3 Cam, (S2 * B,Olig!%idrami!n, (elum InpartP:> Guyur R9 !lf > O nasal 3 lpm

> P!sisi sy!

**.77 *8.77, R. OK Pasien menCalani terminasi perabd!minam


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9ap!ran Operasi :

• P'&en *e(#en*n+ den+n ne'*e'& +ene(#

• A dn n*&'e)'&' de(! -)e('& dn 'e/&*(n$

• In'&'& )nnen'*&e# )d de(! %e/' -)e('&3 D&nd&n+ %d-.en d&'$*#)&' de.& #)&'3 Pe(&*-ne". d&%"/ *.)/ "*e("' +(&d"'3 P#&/e'&/-"*e(&n d&'$* 'e."n(3 SBU d&'$* 'e."n( d&*e."%"' 'e8*".)"# de%(/n 'e8( *,.3

• Pe(&*-ne". d&%"/ *.)/ /e#"( d(! @ 1000 88 ##" d/"/n e/')d&d)*/n (")*"(e "*e(& /-.)#e* ?n*e(&-( 8-()"' )-'*e(&-( d&d)%$& IUFD :000 +(.

• D&)"*"'/n "n*"/ !&'*e(e/*-.& '"%*-*# '#)&n+- -e(-/*-.& '&n&'*(

, C p


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• L&+.en*". (-*"nd '")en'-(&". -(& /nn dn /&(& d&,e)&* )-*-n+

• Dn,"*/n ' "*e("' d&/#e. )-*-n+ dn d&&/*

• Dn,"*/n "*e("' d&)e+n+'e*&nn+& &'*!."'

• Dn,"*/n *"% /nn d&/#e. d&)-*-n+ dn d&&/*

• D&)'*&/n *&d/ d )e(d(!n

• D/"/n (e)en*-n''&

• A%d-.en d&,!&* #)&' de.& #)&'

• O)e('& 'e#e'& )e(d(!n @ 200 88100088 > "(&ne @ =00 883


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• Te()& )-'* -)e('& 9

• Ce*(&-ne 2 +(2= ,.

• Me*(-n&d-#e :4 .+

• K#ne :100 .+

• RL 9 D4 291

• T(n'"'& WB !&n++ H% Q 10

• B#n8e 8&(n

• A#en.&n F :1.)"#

• T(e.d-# :1 .)"# ?&

• V&*.&n C :1 .)"# ?&

D&+n-' P-'* O)e(*& 9P2A0 #%s& SC IUFD + His&erek&%mS$#i!(% %)er%k&%mi si!is&r /i k%m#$e& .

6 * 7*6 *1:87 5I


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6>*>7*6 *1:87 5IKreatinin,SGO


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PEMBAHASAN

•

$engapa pasien ini didiagn!sa dengan ruptur ute


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$engapa pasien ini didiagn!sa dengan ruptur ute


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KAS'SKe$"r! ir8ir se.k < .m se'e$"m

ms"k r"m- ski& + #e!i!(k&! s"-"'*! 7


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p y g y C y pasus ini

• P'&en $n+ %e(&'&/- *&n++& n*( #&n )e('#&n.en+#.& d&'*-'& +(nde ."#*&)( )en++"nn -*" )(-'*+#nd&n "n*"/ .e.)e(8e)* )e('#&nn!. $n+ )e(n! .e#!&(/n 'e%e#".n$ .e##"'e'( *" -)e('& #&n )d (!&.n$ )e(n! !&'*)e#/'nn *(&# - #%-( *e("*. )d )'&en %e/

'e'(e3

2edera atau An!mali 'terus yang


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Sebelum Ke%amilan Searang Ke%amilan Se

13 Pe.%ed!n $n+ .e#&%*/n .&-.e*(&". Sesi! sesarea atau %isteret!mi R&$* (e)('& (")*"( "*e(& 'e%e#".n$ In'&'& .&-.e/*-.& .e##"& *" '.)&end-.e*(&".

Re'e/'& /-(n" d#. *"% #-)&& &n*e('*&'&# Me*(-)#'*&23 T(". "*e("' $n+ *e(,d& *n) d&'en+, A%-(*"' den+n &n'*(".en*'& ?/"(e* '-nd'e T(". *,. *" *".)"# ?/e8e#/n )&'")e#"(" R")*"( '&.*-.*&/ ?'en* (")*"( )d/e!.n 'e%e#".n$

13 Se%e#". )e('#&nn K-n*(/'& )e('&'*en &n*en' ') S*&."#'& )e('#&nn ?-/'&*-'&n)(-'*+#nd&n In'*'& &n*(.n&-n ?'#&ne

Pe(-('& -#e! /*e*e( )en+"/&n*e(n# T(". e/'*e(n# ?*,. *" Ve('& #"( Oe(d&'*en'& "*e("' ?!&d(.n23 Se#. )e('#&nn Ve('& &n*e(n Pe#!&(n den+n %-/-n+ $n

E/'*(/'& %-/-n+ An-.#& ,n&n $n+ .e(e+n+ Pene/n $n+ %e(#e%&!n )d)e('#&nn Pen+e#"(n )#'en* 'e8( :3 D&d)* P#'en* /(e* *" )e(/(e* Ne-)#'& *(--%#'*&/ +e'*'&

S/"#'& "*e("' (e*(-e('& $n

(agaimana meanisme terCadinya ruptu uteri


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g C y p


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engapa a u an se s ! sesar a%i t t i bt t l d l i


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engapa a u an se s ! sesar a%isteret!mi subt!tal, dan salping!@!ret!mi sinistra

Pe(*-#-n+n $n+ *e)* (")*"( "*e(& #)(*-.&?Se8*&- Ce'(en Se%e#".n$ )ende(&* d&%e(&

-/'&+en *(n'"'e d(! +"$"(n 2 #&ne &n"'8&(n +(. '&-#-+&/(&n+e( #/** "n*"/

.en8e+!.en+*'& *e(,d&n$ '$-/ !&)--#e.&/3

Pen,!&*n #"/ (-%e/n !n$ d/"/n /'"' )&n++&( (-%e/n .'&! 'e+( d

(*'e(* *&d/ *e(#&!* dn$ *nd*&ne/'& dn *&d/ *e(d)* ,(&n+n $n+ (

dn ne/(-'&'3

P* s& %#ersi *i*#&k! r%'ek! "&eri k%m#$e& #%r#"s !&eri%r *! #%s&eri%r ser& i*er #* %r!"

"&eri!e !( me!*ek&i &"' si!is&r *! A,"&eri!e !me!(ki'&k! "&er"s &i*k *#& *i#er&-!k!3 -$ imer"#k! i!*iksi *i$k"k!! -is&erek&%mi s"' &%&

*! s$#i!(% %)%rek&%mi si!is&r3


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H&'*e(&-( *"%e/*-.&? P-.e(-$ &%"$+ )"n$ 8"/") n/3 &%" $n+ %e#".

.e.)"n$& n/%e#". .e(' #en+/)

/e#"(+n$

)e('#&nn %e(&/"*n$d/"/n e#e8*&e 'e8*&-n 'e'(&

i i i


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pasien ini • D+n *e(,d&n$ (")*"(e e/')"#'& ,n&n /e /". %d-.en )e#"n+ /e#n+

!&d") ,n&n 'n+* %"("/3

• n+/ .-(*#&*' $n+ d)-(/n %e(/&'( d(& 405 !&n++ 74 5

• K-nd&'& ,n&n *e(+n*"n+ )d de(,* &.)#n*'& )#'en* $n+ *e*) &n*/

• S* (")*"( '*"'*"n$ )e#"n+ /e#n+'"n+n !&d") ,n&n d#! )e#!&(n /#" *&d/ /n *e(,d& !&)-/'& /(en )e.&'!n )#'en* dn !$)--#e.&

• (")*"( d&&/"*& den+n )e.&'!n )#'en* *-*# 'e+e( ./ 'n+* 'ed&/&* ,$n+ d)* d&'e#.*/n den+n 'e+e(3

• P(-+n-'&' ,n&n 9 .#.

• P(-+n-'&' &%"

- Ad &*. 9 d"%& d %-n.

- Ad 'n'&-n. 9d"%& d .#.

- Ad 'n'&-n. 9 d"%& d %-n.


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Ke'&.)"#n

Pd /'"' &n& )'&en.en+#.& (")*"(e "*e(&/-.)#e* IUFD dn-#&+-!&d(.&-n )d "'&/e!.n :2:: .&n++"d&/&%*/n /(endn$ %e/' 'e8*&- )d'e+.en %! (!&. d(&/e!.n 'e%e#".n$den+n &nd&/'&-#&+-!&d(.&-n3

T*#/'n den&*&$n+ d/"/n &#!

.en+*'& '$-/!&)--#e.&/ $n+d&#.& )'&en dn

.e#/"/n *&nd/n'e8*&- 8e'(&n

d("(*3

Pen8e+d/"/

&#! .eANC den

.en8e'e#.

.e#/"/)e('#&n

"n*"*e(,d&

d


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