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POST PARTUM HEMORHAGE
MANAGEMENT IN CLINICAL EMERGENCY
Sri SulistyowatiBagian Obsttri ! Gin"ologi
RS #r Mowar$i % &' UNS
Sura"arta
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Ob("ti)itas
#*inisi
E+i$,iologi
Etiologi
&a"tor risi"o
Tatala"sana
Pn-ga.an
Post +artu, .,or.ag
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#*inisi Tra$isional
'.ilangan $ara. / 011 ,L +a$a +rsalinan +r)agina,
'.ilangan $ara. / 2111 ,L +a$a s"siossara
#*inisi &ungsional
'.ilangan $ara. yang +otnsial ,nga"ibat"an
"ti$a"stabilan .,o$ina,i"
Insi$n
s"itar 03 $ari sluru. +rsalinan
Post +artu, .,or.ag
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Website: www.litbang.depkes.go.idSource: UNFPA. State of World Population, 200
451
0
!!0
!2
"0#0
671"$0
%! %#
"&0
% !1
711
211
411
2"0
611
811
911
011
MMR in t.State of World Population 2010
Esti,ats *ro, 7110
511 Sout.:Eastrn Asia Eastrn Asia
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MMR%211;111LH
"'0
"#'
""%
"0&
"00
22$
200
00
%00
A(): S*() ''+202
#00
'$'+''% ''"+''& ''$+2002 200"+200& 200$+202
R*rn- Prio$
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47;6
$ (elopok Pen-ebab (eatian SP 200/'o$ IC# 21awa:Bali 'ali,antan SulawsiIBT
00+0$ Pregnanc- wit1 abortie
outcoe
".& %.2 2.& #.! %.2 %.
0+! edea, proteinuria, and
1-pertensie disorder
?H#'@
""." "". "%.' "2.! 2#.$ "2.%
%%+%! Placenta preia, preature
separation of placenta and
Antepartu 1aeorr1age
%.% 2.& %." 2." ".! "."
"0+%", %&+
%$
t1er aternal care related
to fetus and aniotic cait-
and possible delier-
probles
".0 .& 0.0 0.$ 0. .!
!%+!!
&2
bstructed 3abour
Postpartu 1aeorr1agePPP/
0.#
!.%
.
!.$
0.0
2$.
0.!
2!."
.0
2'.$
20+2', !0+
!", !&+&,
&"+, $+
$%
t1er coplications of
pregnanc- and delier-
. !.0 2.' &.' #.' &.2
$#+'' 4oplication predoinantl-
related puerperiu and
ot1er conditions
2&.! "%." 2&. 2".' 2'.& 41;7
Total 00.0 00.0 00.0 00.0 00.0 000
0.$
71;4
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Ang"a ',atian Ibu $i In$onsia
40 +r 211;111 "la.iran .i$u+
?S#'I< 7127 @
SEBAGIAN BESARDAPATDICEGAH
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Sebab Kematian
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PENYEBAB 'EMATIAN IBU
PER#ARAHAN
+++++6 P7N879A9 UA;A
PRE:E'LAMPSIA
IN&E'SI
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Etiologi Pr$ara.an Post+artu,
Tonus : atoni utrus
Tissu%(aringan : sisa (aringan%b"uan $ara.
Trau,a : lasrasi< ru+tur< in)rsi
T.ro,bin : "oagulo+ati
Post +artu, .,or.ag
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&a"tor risi"o PPH Ant+artu,%Ha,il
Riwayat APH sblu,nya atau +lasnta ,anual
Solusio +lasnta< truta,a (i"a ti$a" tr$t"si
',atian *tus intrautrin
Plasnta +r)ia
Hi+rtnsi $ala, ".a,ilan $ngan +rotinuria
Rgangan brlbi.an +a$a utrus ? g,lliALA RASA SA'IT
HIS HILANG
PER#ARAHAN
INTRA AB#OMINAL
BIASANYA >ANIN
MATI
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RUPTURA UTERI
TERAPI
PERBAI'AN
'EA#AAN UMUM PENGANG'ATAN
>ANIN
HISTERE'TOMI%
HISTERORA&I
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INERSIO UTERI
PENYEBAB:
* DORONGAN
PADA FUNDUS
* TARIKAN PADA
TALI PUSAT
TERAPI:
* PERBAIKAN KU
* REPOSISI
UTERUS
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REPOSISI UTERUS YANG
INERSI
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REPOSISI UTERUS YANG
INERSI
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RETENSI PLASENTA
SISA PLASENTA
PER#ARAHAN 'ALA III
PER#ARAHAN BANYA'
#APAT MENINGGAL
#ALAM 7 >AM
TERAPI
PENGOSONGANUTERUS MANUAL%
'URET SISA PLASENTA
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ATONIA UTERI
UTERUS TIDAK/ KURANG
KONTRAKSIDARAH
KELUAR
BISA MENINGGAL DALAM 2
JAM
TERAPI
MASASE UTERUS
UTEROTONIKA
KOMPRESI BIMANUAL
TAMPON UTERUS
KONDOM KATETER
HISTEREKTOMI
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OPERATIE
C#!SER%
&ATI&E
RADICAL
< Bra-
sutur
< Arterial 3igation
< =-sterec+
to-
MECHANICAL
< ;asage
< 4opression
internal
external
Aorta< Ta,+ona$
ME#ICAL TJ
UTEROTONICS
< >-tocin
< 7rgoetrin
< Prostaglandin
MANAGEMENT
W= ?uidelines, 200'
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Tatala"sana : OKyto-in
0 units I bolus
71 unit +r L NaCl%RL $ri+ ttsan
-+at
21 unit intra,yo,trial $ibri"an
transab$o,inal
M$i-al Tra+i Utrotoni-
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;et1-l 7rgoetrin @ 1ati+1ati pada 1ipertensi
0.2# g ); or 0.2# g )
*osis aksiu .2# g
;isoprostol @ 1ati+1ati pada asa
%00 g 2 tablet/ oral
$00+000 g %+# tablet/ per rektal
BAN?AN P7CA?)NA;DD
M$i-al Tra+i Utrotoni-
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4 Lang"a. Uta,a Mana(,n A"ti*
'ala III Prsalinan
2; M,bri"an utrotoni"a +ili.an a$ala.
O"sitosin 21 Unit ?IM@ atau 71 U%L NaCL%RL Ittsan -+at $ala, 2 ,nit stla. bayi la.ir
7; Prgangan Tali+usat Tr"n$ali $ngan
t"anan brlawanan '(ounter%pre))ure* +a$a
utrus
4; Masas +a$a utrusstla. +lasnta la.ir;
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Non o+rati* non ,$i"a,ntosa
?,-.ani-al@
(opresi
9ianual
7ksterna
(opresi
9ianual
)nterna
fc, sengstaken+
blakeore,
rEsc1
1-drostatic,
bakri
apon rol
kasa
'BI'BEBallon
Sifat
seentara
)F* P
ekan #+&
Ta,+on 'o,+ Ao
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MANUAL
COMPRESSION
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EJTERNAL AORTIC COMPRESSION
Manual Aorti- Co,+rssion
Manu)r
Introduce :
+ ransport to 1ospital
+ Prepare protocols+
EL:MINIA AORTIC
COMPRESSION #EICE
200$ @ 200'
Success in 2!G2! cases 00H
)n conIunction wit1 regular protocols?Soltan< 7122< > Obstt Gyna-ol Rs@
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Modalitas yang paling ideal untuk penanganan perdarahan
pasca persalinan setelah medikamentosa gagal
4epat eng1entikan perdara1an.
*apat dengan uda1 dilakukan.
9a1an dan alat tersedia diana+ana.
idak a1al.
Aan.
*apat eperta1ankan fertilitas.
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< 7as-
41eap
J uterine cait- s1ape
7ffectie
*rainage K Ceoal : pain LL
bleeding risk L
olue : 2#0+#00cc
?ood success rate :
+2"G2" cases Sa-eba,200"/
+2G" cases Sulist-ono,200#/
Sa-eba,200" M Sulist-ono,200#/
4N*; 4A77C
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PERSIAPAN PERALATAN
(ondo
(ateter9enang pengikat
(assa ?ulung
4airan antiseptik
Spekulu Si
u ang(orentang
Set )nfus
4airan P
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(ateter diasukkan kondo, diikat 9agian uIung kateter didala kondo
Pasang cairan P dengan set infus
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Posisi litoto,i 'osong"an "an$ung "n-ing
'on$o,"attr $i,asu""an -a)u, utri
Pang"al "attr $isa,bung"an in*us st
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Pegang portio depan dg u tang
;asukkan kateter O kondo )si dengan P sapai kondo tapak
sedikit enggelebung di portio
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Stop pengisian P Pasang tapon di agina
3epas kateter dari set infus
ekuk dan ikat kateter
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#i+r"nal"an ol. Pro*; Sayba A".tr< A.li 'bi$anan $ari
Bangla$s.< 7114;
'attr &olly stril $i,asu""an " $ala, "on$o,< $ii"at
$ngan +ang"al "on$o, $ngan bnang< u(ung luar $ari
"attr $i.ubung"an $ngan in*us st yang brisi -airan
gara, *isiologis;
Stla. $i,asu""an " $ala, utrus< "on$o, $ig,bung"an
$ngan 701:7111 -- -airan gara, *isiologis ssuai "butu.an;
U(ung luar "attr $ii"at< st in*us $i"un-i bgitu +r$ara.an
br.nti;
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$etode Sa+e,a'ondo- ateter Hidro)tati. Intrauterin*
#i+r"nal"an ol. Pro*; Sayba A".tr< A.li 'bi$anan $ari
Bangla$s.< 7114;
'attr &olly stril $i,asu""an " $ala, "on$o,< $ii"at$ngan +ang"al "on$o, $ngan bnang< u(ung luar $ari
"attr $i.ubung"an $ngan in*us st yang brisi -airan
gara, *isiologis;
Stla. $i,asu""an " $ala, utrus< "on$o, $ig,bung"an$ngan 701:7111 -- -airan gara, *isiologis ssuai "butu.an;
U(ung luar "attr $ii"at< st in*us $i"un-i bgitu +r$ara.an
br.nti;
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e/a/alan pe-a)an/an ,alon ta-ponade
intrauterin
(egagalan peasangan balon, kegagalan
untuk easukkan kateter ke dala kau
uteri atau kegagalan enggebungkan
balon setela1 kateter asuk ke dala kau
uteri.
(egagalan balon taponade intrauterin
untuk eng1entikan perdara1an, setela1
terpasang dengan benar.
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Peraatan )etela .e,era)ilan pe-a)an/an
ta-ponade intrauterin
*isarankan untuk dirawat di =ig1 4are Unit atau
)ntensie 4are Unit untuk onitoring G diruIuk
Peberian infus lanIutan oksitosin dala C3 sGd 2+
2% Ia.
Peberian antibiotik spektru luas.
aponade terpasang selaa $ sGd %$ Ia,
penurunan tekanan balon dapat dilakukanberta1ap.
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I#EO
PEMASANGAN BALON 'ATETER
http://var/www/apps/conversion/tmp/scratch_7/kondom%20kateter-11.DAThttp://var/www/apps/conversion/tmp/scratch_7/kondom%20kateter-11.DAThttp://var/www/apps/conversion/tmp/scratch_7/kondom%20kateter-11.DAThttp://var/www/apps/conversion/tmp/scratch_7/kondom%20kateter-11.DAT7/24/2019 Post Partum Hemorhage Dan Management in Clinical Emergency_sragen 2014
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Tatalaksana KomprehensifKegawat Daruratan Obsgin
O ti*
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8our 3o
(opresi intraoperasi
9+l-nc1, Suare, U
3igasi a uterina, oarikacab uterina, a 1ipograstika
=isterektoi
O+rati*
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B:LYNCHFS METHO#
B:Lyn-.< 28< B>OG/
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B:LYNCHFS METHO#
6$00 cases
Success : 'H
SaroIa, 200, Arc1 ?-necol bstet
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Too ti/t : coproise t1e blood suppl-or preent spontaneous retraction
Too loo)e : inadeuate copressiono)i 2004 5#G Treloar 2007 5#G
PARTUS PERAGINAMRING'ASAN
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PARTUS PERAGINAM
Masas utrus -ari "ausa
ATONIA UTERI
'o,+rsi bi,anual % Aorta
Gagal
'ON#OM 'ATETER
Br.asil 58
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Partus
Pr)agina,
PARTUS PERAB#OMINAM
;asase uterus4ari kausa
ATONIA UTERI PLAC; BE#
Ba1it langsung
;ultiple suare
+41o
Ba1it S9CO/ Ba1it S9C+/
'on$o, "attr
5%L+n(
?agal
Histr"to,i
(ondo kateter
Mo$i*i"asi B:
Lyn-.
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ESI$PULA!
#IAGNOSIS TEPAT
PENANGANAN CEPAT
PERBAI'AN 'EA#AAN UMUMPENGHENTIAN PER#ARAHAN
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