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LAPORAN JAGA MALAM DOKTER MUDA
14 Maret 2016
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DAFTAR PASIEN MASUK
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No Identitas Diagnosis Plan/Terapi
1 Ny. ETG2P1A0, 30t01332!!1 UK" 40#3 $%
Ka&a II Feta& '()tre)) ,*et+a- e/a '(-( 1ar( a'a)e*+-'(%ra('a a$(&
ater$
O+t/$e" ay( &a*(&a*(3300 %r, AS 6!
- P($(- er)a&(-a-era%(-a$, *a&a II'(er/eat 'e-%a- a*+$e*)tra*)(
- KIE , (-r$e' /-)e-t- S(a*a- re)+)(ta)( -e-at+)- I-5 (/(&&(- 1 %r
2 Ny. LAP
G1P0A0, 22 t
01332!!!
UK" 3 $%%
IUFD *et+a- e/a'(-( 2 ar( a'a
r($(%ra('a a$(&reter$ 3 $(-%%+ '*a&a 1 a)e a*t(
O+t/$e" &a*(&a*(,2000 %r, $a)era)( 78
- La-5+t er)a&(-a-era%(-a$
-
O) 9- ea&+a)( 2 5a$- :e* &aratr(+$
3. Ny. ;
P2A0, 30t
01332!6
Rete-)( )()a &a/e-ta #&e+*)(t)()
- M-'*
- K+reta)e e&e*t(
- I-r$e' /-)e-t, KIE
- K-)+& a-e)te)(
- I- RL #
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No Identitas Diagnosis Plan/Terapi
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I'e-t(ta) Pa)(e-
Na$a " Ny. ET Ta-%%a& La(r " 21=0=19
A&a$at " Ka$+-%)e>+, S+ra*arta
Pe*er5aa- " IRT
Ta-%%a& Ma)+* " 14 Mar 2016
Ta-%%a& D(er(*)a " 14 Mar 2016
N. RM " 01332!!!
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Ke&+a- +ta$a
R+5+*a- 'ar( RSUD S+ra*arta
'e-%a- *etera-%a-)e*+-'(%ra('a a$(& ater$ *a&a IIt('a* $a5+
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R(>ayat Pe-ya*(tSe*ara-%Sera-% G2P1A0, 30 t, UK 40#3 $(-%%+
, r+5+*a- 'ar( RSUD S+ra*arta 'ata-%'e-%a- *etera-%a- )e*+-'(%ra('a.ater$ 'e-%a- *a&a II t('a* $a5+.Pa)(e- $era)a a$(& 9 +&a-. Gera*a-
5a-(- $a)( '(ra)a*a-, *e-/e-%*e-/e-%terat+r )+'a '(ra)a*a-. A(r *a>a)+'a '(ra)a*a- *e&+ar )e5a* 1r ya-%&a&+ )ee&+$ $a)+* r), &e-'(r 'ara #.Per)a&(-a- )+'a '(($(- )e&a$a 2 5a$'( RSUD )+ra*arta.
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R(>ayat Pe-ya*(t Da+&+
R(>ayat ;(erte-)( " D()a-%*a&
R(>ayat DM " D()a-%*a&R(>ayat A)$a " D()a-%*a&
R(>ayat A&er%( "
D()a-%*a&R(>ayat Ja-t+-% " D()a-%*a&
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R(>ayat O)tetr(
Me-(*a 1
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Pe$er(*)aa- F()(*
KU " ?a(*, :$) Me-t()
@(ta& S(%- " TD " 120=0 $$;%
;R " 2
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Pe$er(*)aa- F()(*
Mata" :A 7=8, SI 7=8
Thorax" /= '-
Abdomen"
S+e&, NT 78, teraa 5a-(- t+-%%a&, I-tra +ter(-, $e$a-5a-%, +*(, re)*e,*ea&a $a)+* a-%%+& 2=3 a%(a-, () 7#8 34
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Pe$er(*)aa- F()(*
UPD:
Pr$-tr(+$ t('a* teraa
L(-ea ter$(-a&() teraa 1=3 a%(a-
S(-a ()/(a'(/a t('a* teraa
Ar/+) +() 90
Ke)a-" a-%%+& %y-e/(' 7#8
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Pe$er(*)aa- Pe-+-5a-%
USG: Ta$a* 5a-(- t+-%%a& IU, +*(,re)*e, DJJ 7#8
F? ?PD 91 /$, A: 30, 9! /$, FL6,4 /$, EF?H 3012 %r
P&a/e-ta (-)er)( '( /r+) %ra'e 2, a(r
*et+a- *e)a- *+ra-% Ta* ta$a* *e&a(-a- *-%e-(ta&$ayr, *e)a- 5a-(- )aat (-( 'a&a$
*ea'aa- a(*.
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Pe$er(*)aa- La 14 032016
;e$%&(- " 12,! %='&
;/t " 39 AL " 141 r(+=+& AT " 14! r(+=+& AE " 4,39 5t=+&
• G&. Dara " • GDS " 161
$%='&• ;)A% "
--rea/t(e
• PT " 11.9• APTT " 32.0
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Ke)($+&a-Sera-% G2P1A0 30 ta+- UK 40#3 $(-%%+,r(>ayat )tetr( 'a- ert(&(ta) a(*, teraa
5a-(- t+-%%a&, (-tra+ter(, $e$a-5a-%, +*(,re)*e, *ea&a $a)+* a-%%+& 2=3a%(a-, () 7#8 34
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D(a%-)()
Ka&a II Feta& '()tre)), *et+a- e/a'(-( 1 ar( a'a )e*+-'(%ra('a
a$(& ater$
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Tera(
1. La-5+t er)a&(-a- er a%(-a, *a&a II'(er/eat 'e-a- a*+$ e*)tra*)(
2. I-5e*)( (/(&&(- 1 %r 7I@, )*(- te)t83. KIE, (-r$e' /-)e-t
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O+t/$e
La(r ay( &a*(&a*( era%(-a$,('+, ??L 3300 %r, AS 6!, a-+)7#8
La(r &a/e-ta, &e-%*a, e-t+*/a*ra$, +*+ra- 20
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T(-5a+a- P+)ta*a
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"et#ban Pe$ahDini
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◦ Pe/a-ya *et+a- )ee&+$ >a*t+er)a&(-a- '($+&a(
Defnisi
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◦ Ha*t+ )aat e/a-ya $e$ra- )a$a(
'($+&a(-ya er)a&(-a-◦ Se$a*(- $+'a +)(a *ea$(&a- )e$a*(-
&a$a er('e &ate-
◦ Pa'a *ea$(&a- ater$ 90 a*a- $e$+&a(
er)a&(-a- 'a&a$ 24 5a$◦ Pa'a *ea$(&a- 234 $(-%%+
0 er)a&(- 'a&a$ >a*t+ 24 5a$
090 er)a&(- 'a&a$ >a*t+ 1 $(-%%+
Periode laten
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◦ I'(at(*
◦ I-e*)( 7$()" a%(-)() a*ter(a&8
◦ P&y('ra$-(-
◦ I-*$ete- )er(*
◦ A-$a&( +ter(-
◦ A*(at e$a)a-%a- /er/&a%e a'a )er(* ata+
a$-()e-te)()
◦ Tra+$a
enyebab ketuban pecah dini
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◦ R(>ayat )ee&+$-ya
◦ Pe$er(*)aa- 'e-%a- )e*+&+$ )ter(& 7(-'ar(e$er(*)aa- '(%(ta&8
/+/( a%(-a
/a(ra- ter*+$+& '( r-(* )ter(r
/a(ra- ea) 'ar( )er(*
e$er(*)aa- ; /a(ra- 7*erta) -(tra(-8 t('a*)e)(*
er-(-% %a$ara- 'a+- a*()
◦ USG-r$a& (&a 5+$&a /a(ra- /+*+
Diagnosis ketuban pecahdini
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◦ I-e*)( et+)=-e-at+)
◦ I-e*)( (+
◦ K$re)( ata+ r&a) ta&( +)at◦ Ga%a& (-'+*)( 'a- '((*+t( &e S:
omplikasi Ketuban Pecah Dini
Pada kehamilan preterm infeksi fetus dan neonatus
infeksi ibu
prolaps dan kompresi tali pusat
gagal induksi dan diikuti oleh SC
hipoplasia paru (oligohidramnion berat )
deformitas pada fetus
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◦ N(&a( *e)e5ateraa- (+ 'a- ay(
◦
Pa)t(*a- '(a%-)()◦ N(&a( *ea'aa- )er(* 'e-%a- e$er(*)aa- )e*+&+$
7)ter(&8
◦ :e%a e$er(*)aa- )er(* '(%(ta&
◦ N(&a( *-'()( ya-% $e$er&+*a- $a-a5e$e- &a-5+ta-
e.%. *e-a(*a- )++ ata+ ta*(*ar'( a'a et+) 'a- (+
◦ -(&a( a'a-ya (-'(*a)( +-t+* )e%era $e$+&a( er)a&(-a-
Manajemen Umum
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◦ ;(-'ar( e$er(*)aa- 'a&a$
◦ N(&a( a'a-ya (-e*)(
◦ Pert($a-%*a- e$er(a- a-t((t(*
(&a ter5a'( *et+a- e/a '(-( ya-%
te&a &a$a◦ Ma-a5e$e- a*t( ata+ $a-a5e$e-
e*)e*tat( ter%a-t+-% a'a *ea'aa-'a- *e(-%(-a- a)(e-
pada %ehamilan aterm &'(!mingg#)
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◦ ;(-'ar( e$er(*)aa- 'a&a$
◦ Pert($a-%*a- )ter(' a-te-ata&
◦ Pr&a*)() a-t((t(* (-traart+$
◦ Pa-ta+ ta-'ata-'a (-e*)( )e/ara *&(-() 7-a'(, )++
'a- 'e-y+t 5a-t+-% ay(8◦ Pe$er(a- a-t((t(* ya-% )e)+a( (&a ter5a'(
*r(a$-(-(t()
Pada %ehamilan preterm &(4*(!mingg#)
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◦ ;(-'ar( e$er(*)aa- 'a&a$
◦
Ster('◦ Pe$er(a- a-t((t(* a-teart+$ 'a- (-traart+$
◦ Pa-ta+ ta-'ata-'a (-e*)( )e/ara *&(-() 7$-(tr )++
'a- -a'( (+, 'e-y+t 5a-t+-% 5a-(-, 'a- $+-/+&-ya
*-tra*)( +ter+) ya-% (r(tae&8
◦ Pe$er(a- a-t((t(* ya-% )e)+a( (&a ter5a'(
*r(a$-(-(t()
◦ Pert($a-%*a- +-t+* $er+5+* *e +)at ya-% &e(
$e$a'a( (&a $+-%*(-
◦ Pera>ata- e*)e*tat(
ana+emen pada preterm &,(4 mingg#)
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A-t((t(* ya-% '(a-5+r*a-"
I+ a$(& 'e-%a- *r(a$-(-(t() $e$+t+*a- a-t((t(*
)e*tr+$ &+a)
Penicillin G 5 juta units q 4-6 h IVatau
Ampicillin 2g IV dilanjutkan 1 g q 4h
atau
Clindamyin 600 ng q 8hIV
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Feta& '()tre))
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-.TA DIST0.SS
adalah
?RADIKARDIA JANIN PERSISTEN
yang bila tidak diperbaiki
akan menimbulkan
DEKOMPES!S" #ESPO $"S"O%O&"S
dan menyebabkanKE#'S!K! PE#M!E SSP D! O#&! %!"
SE#! KEM!"!
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Et(&%( eta& '()tre)) I+
◦ e-+r+-a- *e$a$+a- $e$a>a*)(%e- (+ A-e$(a ya-% )(%-(*a-
◦ e-+r+-a- a&(ra- 'ara +ter(- )()( )+(-e ata+ (te-)( &a(-,
ree*&a$)(a
◦ *-'()( (+ ya-% *r-() (erte-)(
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Et(&%( Fa*tr Uter&a)e-ta&
◦ K-tra*)( +ter+)
(er)t($+&a)(, )&+)( &a)e-ta
◦ '()+-%)( +ter&a)e-ta& (-ar* &a)e-ta&
*r(a$-(-(t() '()+-%)( &a)e-ta& '(ta-'a( &eIUGR, &(%('ra$-(-
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Et(&%( Fa*tr Ja-(-
◦ *$re)( ta&( +)at &(%('ra$-(-
r&a) ta&( +)at +-t(ra- ta&( +)at
◦ Pe-+r+-a- *e$a$+a- 5a-(- $e$a>a*)(%e- a-e$(a erat $()a& " ()($+-()a)(, er'araa- et$ater-a&
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Sirkulasi anin
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‘FETAL DISTRESS’
bukan merupakan
sebuah kertas monitor *anin yang
+buruk,-
atau
.airan yang ter/arnai mekonium
-"ni harus disebut sebagai
+kertas pen.atat monitoring yang tidak bagus,
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KESIMPULAN
Ga>at Ja-(- $er+a*a- a& ya-%)er(+) 'a- er&+ '(*e-a&t(-'a*a-
Sea(*-ya a'a +*t( A)('e$(a 7;'ara8
Pe$a-ta+a- 'e-y+t 5a-t+-%
e-t(-% " t(a 30 $e-(t 'a&a$ *a&a 1'a- t(a 10 $e-(t 'a&a$ *a&a 2.
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