Identity

Name : Manggala Pasca Wardhana

Place and Date of Birth : Surabaya, 20th November 1984
Institution : Junior Staff in Division of Maternal-Fetal Medicine
Department of Obstetrics and Gynecology
Medical Faculty of Airlangga University
Dr. Soetomo Hospital - Airlangga University Hospital

Practice
•  Siloam Hospitals Surabaya
•  National Hospital Surabaya
Education
Medical Doctor : Airlangga Universty School of Medicine ( 2002 – 2008)
Specialist Of Obg-Gyn : Airlangga Universty School of Medicine (2010 – 2015)
Organization
•  Surabaya Branch of Indonesia Society of Obstetrics and Gynecology (Commi^ee)
•  Surabaya Branch of Indonesia Medical Association (Commi^ee)

Wokshop / Training / Course

•  Basic Surgical Skill in Gynecologic Laparoscopy, Denpasar, 2013
•  Advanced 3D and 4D Ultrasound in Obsterics, Jakarta, 2015
•  Basic Fetal Echocardiography, The Fetal Medicine Foundation, 2015
•  Fetal Cardiac Defect, The Fetal Medicine Foundation, 2015
•  11-13 Weeks Scan, The Fetal Medicine Foundation, 2015
•  Good Clinical Practice, ICH-GCP, Surabaya, 2016
•  Obstetric Ultrasonography Course, International Society of Ultrasonography in Obstetry Gynecology, Singapore, 2016
Scientific Publication
•  Decreasing of placental PIBF and Spiral artery remodeling disturbance in mice preeclampsia model. Pregnancy
Hypertension. 2015 (Author)
•  Study Biocompability and Osteogenic Differentiation Potential of hUCMSCs with Gelatin Solvent. JBSE. 2015 (CoAuthor)
 Postterm
Pregnancy
Manggala Pasca Wardhana
Maternal Fetal Medicine, Obstetrics & Gynecology, Airlangga University
Soetomo General Hospital – Airlangga University Hospital

1st Surabaya Maternal Fetal Medicine Continuing Medical Education

Hotel Bumi Surabaya, 14th - 15th May 2016
 ACOG. Definition of Term Pregnancy. Obstet Gynecol. 2013. 122:1139

•  Kehamilan ≥ 420/7 minggu / ≥ 294 hari dari HPHT

•  ICD 10 à prolonged pregnancy
•  Prevalensi bervariasi, tergantung metode. US: 5,5%
kehamilan

Definition
ACOG Practice Bulletin No, 146, 2014
Reddy et al. 2011. Obstet Gynecol. 117:6 1st Surabaya Maternal Fetal Medicine CME
•  Mayoritas tidak diketahui
•  Salah menentukan HPHT
•  Genetik maternal – fetal
•  Gangguan produksi hormon janin:
Ø  Anensefali à estriol rendah
Ø  X-linked Ichtyosis à defisiensi sulfatase plasenta

Etiologi
 Faktor Risiko
Coughey et al. 2009. Am J Obstet Gynecol. 200:683.e1 1st Surabaya Maternal Fetal Medicine CME
 Komplikasi
Kehamilan Postterm
1st Surabaya Maternal Fetal Medicine CME
 •  Makrosomia
•  Oligohidramnion à kompresi tali pusat
•  Abnormal NST / Fetal distress à insufisiensi plasenta
dan kompresi tali pusat
•  Sindroma dismaturitas / postmaturitas à insufisiensi
plasenta / malnutrisi kronis plasenta (10-20%)
Ø  Fetal Growth Restriction
Ø  Meconeal passage
Hendricks. maturasi
àGynecol.
1964. Obstet 62:171 usus & hipoksia
Ø  Kuku panjang, kulit kering berkerut, vernix &
lanugo berkurang, meconeal stain
•  Peningkatan
Populasi Mortalitas
Swedia, seluruh Perinatal
persalinan selama 5à HIE, MAS, kejang
tahun
Ø  40(perawatan
minggu : 17NICU
/ 1000 ì)
Long
Ø • 41 term :effect:
minggu 20 / 1000 epilepsi, CP, gangguan perkembangan
Ø à 42 Komplikasi
minggu : 29 /maternal:
1000 akibat makrosomia, induksi
Ø  43 minggu : 62 / 1000
persalinan, CPD à Distosia bahu, SC, HPP, ruptur gr.4,
Komplikasi Kehamilan Postpartum
Sindroma Postmatur / Dismatur
1st Surabaya Maternal Fetal Medicine CME
 40 – 41 mgg : 0,86 – 1,08
41 – 42 mgg : 1,2 – 1,27
42 – 43 mgg : 1,3 – 1,9
> 43 mgg : 1,68 – 6,

à Per 1000 kelahiran

Kematian Perinatal
Smith, GC. 2001. BJOG. 106:861 1st Surabaya Maternal Fetal Medicine CME
1st Surabaya Maternal Fetal Medicine CME
1st Surabaya Maternal Fetal Medicine CME
 Tatalaksana
Kehamilan Postterm
1st Surabaya Maternal Fetal Medicine CME
Pastikan Usia Kehamilan

SOGC. 2008. JOGC. 30:9 1st Surabaya Maternal Fetal Medicine CME
Pastikan Usia Kehamilan

Spong CY. 2013. JAMA. 309:2445 1st Surabaya Maternal Fetal Medicine CME
Stripping of the membrane
•  Efektif mengurangi kejadian pos^erm
•  Ditawarkan dengan KIE terlebih dahulu
•  Belum ada RCT / metaanalisis: kapan dan berapa banyak?
•  Beberapa rekomendasi: 38 mgg, 39 mgg

•  742 KRR usia 41 minggu

•  Stripping of the membrane setiap 48 jam
•  40% reduksi pos^erm

Fetal Outcome
SOGC. 2008. JOGC. 30:9
Ekspektatif atau
aktif ?
1st Surabaya Maternal Fetal Medicine CME
 SC stain
Meconeal Rate fetus

1st Surabaya Maternal Fetal Medicine CME

 Perawatan Ekspektatif Heimstad, Romundstad & Salvesen.
2008. Aca Obstet Gynecol Scand. 87:2

•  Reasonable
•  Secara absolut jumlah mortalitas janin sedikit
dibandingkan jumlah induksi yang dilakukan
•  527 induksi rutin 41 minggu : 1 kematian perinatal
•  Fetal surveilance yang baik menghindari komplikasi

SOGC. 2008. JOGC. 30:9

ACOG Practice Buletin No. 146. 2014

1st Surabaya Maternal Fetal Medicine CME

•  Mulai usia kehamilan 41 minggu Bochner et al. 1988. Am J Obstet

•  Minimal 2 kali dalam seminggu Gynecol. 159:3. 550-4

à Menurunkan kematian perinatal signifikan

•  Jenis Evaluasi:
Ø  Cairan ketuban + NST atau Alfirevic, Walkinshaw. 1995. Br J Obstet
Gynecol. 102:8. 638-43
Ø  Biophysical Profile
à Tidak ada perbedaan bermakna

•  Doppler Velocimetry:
Ø  No Benefit ACOG Practice Bulletin no. 145. 2014

Ø  Hanya ditujukan jika didapatkan FGR

Evaluasi Kesejahteraan Janin

1st Surabaya Maternal Fetal Medicine CME
Postterm Pregnancy
1st Surabaya Maternal Fetal Medicine CME
Thankyou