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FK UNS OBGIN USG 1i. Skrining Anomali Trimester Dua ISUOG Guidelines JJE 20120609
FK UNS OBGIN USG 1i. Skrining Anomali Trimester Dua ISUOG Guidelines JJE 20120609
FK UNS OBGIN USG 1i. Skrining Anomali Trimester Dua ISUOG Guidelines JJE 20120609
BAHAN RENUNGAN
Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan
Apakah saya sudah kompeten dan profesional?.......bukti ..? Komite Medik: KEWENANGAN KLINIS..Buku Log & Portofolio Resertifikasi 2011 Sistematikatrik-trik pemeriksaan Dokumentasi: terstandarisasi
AGENDA
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Pendahuluan Program skrining Pemeriksaan berdasarkan organ Uterus dan adneksa PESAN DIBAWA PULANG Kepustakaan
PENDAHULUAN
The
Interna-onal
Society
of
Ultrasound
in
Obstetrics
and
Gynecology
(ISUOG)
is
a
scien(c
organiza(on
that
encourages
sound
clinical
prac(ce,
teaching
and
research
for
diagnos(c
imaging
in
women's
healthcare.
The
ISUOG
Clinical
Standards
CommiAee
(CSC)
has
a
remit
to
develop
Prac-ce
Guidelines
and
Consensus
Statements
as
educa-onal
recommenda-ons
that
provide
healthcare
prac::oners
with
a
consensus-based
approach
for
diagnos-c
imaging.
They
are
intended
to
reect
what
is
considered
by
ISUOG
to
be
the
best
prac:ces
at
the
-me
at
which
they
were
issued.
Salomon
LJ
et
al.
Prac:ce
guidelines
for
performance
of
the
rou:ne
mid-trimester
fetal
ultrasound
scan,
2010
Hanya
untuk
Pendidikan
&
JJE-2011/09/12
Kesehatan
PENDAHULUAN
Although
ISUOG
has
made
every
eort
to
ensure
that
guidelines
are
accurate
when
issued,
neither
the
Society
nor
any
of
its
employees
or
members
accepts
any
liability
for
the
consequences
of
any
inaccurate
or
misleading
data,
opinions
or
statements
issued
by
the
CSC.
They
are
not
intended
to
establish
a
legal
standard
of
care
because
interpreta-on
of
the
evidence
that
underpins
the
guidelines
may
be
inuenced
by
individual
circumstances
and
available
resources.
Approved
guidelines
can
be
distributed
freely
with
the
permission
of
ISUOG
(info@isuog.org).
Salomon
LJ
et
al.
Prac:ce
guidelines
for
performance
of
the
rou:ne
mid-trimester
fetal
ultrasound
scan,
2010
Hanya
untuk
Pendidikan
&
JJE-2011/09/12
Kesehatan
PENDAHULUAN
Ultrasonography
is
widely
used
for
the
prenatal
evalua:on
of
growth
and
anatomy
as
well
as
for
the
management
of
mul-ple
gesta-ons.
The
procedure
provides
diagnos-c
ndings
that
oWen
facilitate
the
management
of
problems
arising
in
later
pregnancy.
For
example,
abnormal
fetal
growth
is
a
leading
cause
of
perinatal
morbidity
and
mortality
in
both
industrialized
and
developing
countries.
In
2005,
the
World
Health
Organiza-on
(WHO)
concluded
that
impaired
fetal
growth
had
many
causes
related
to:
gene-c
factors,
maternal
characteris-cs
such
as
nutri-on,
lifestyle
including
smoking,
age
and
disease;
complica-ons
of
pregnancy;
and
the
physical,
social
and
economic
environment1,
2.
Salomon
LJ
et
al.
Prac:ce
guidelines
for
performance
of
the
rou:ne
mid-trimester
fetal
ultrasound
scan,
2010
Hanya
untuk
Pendidikan
&
JJE-2011/09/12
Kesehatan
PENDAHULUAN
A
mid-trimester
fetal
ultrasound
scan
serves
as
an
important
baseline
against
which
later
scans
may
be
compared
for
the
evalua-on
of
growth
and
health.
Ultrasonography
can
also
be
used
to
detect
congenital
anomalies36.
The
Eurofetus
study7,
a
mul-center
project
involving
61
obstetric
ultrasound
units
from
14
European
countries,
examined
the
accuracy
of
rou-ne
mid-trimester
ultrasonographic
examina-on
in
unselected
popula-ons.
Over
one
half
(56%)
of
4615
malforma-ons
were
detected
and
55%
of
major
anomalies
were
iden-ed
before
24
weeks
of
gesta-on.
Salomon
LJ
et
al.
Prac:ce
guidelines
for
performance
of
the
rou:ne
mid-trimester
fetal
ultrasound
scan,
2010
Hanya
untuk
Pendidikan
&
JJE-2011/09/12
Kesehatan
PENDAHULUAN
Although
many
countries
have
developed
local
guidelines
for
the
prac-ce
of
fetal
ultrasonography,
there
are
s-ll
many
areas
of
the
world
where
they
have
not
been
implemented.
Most
countries
oer
at
least
one
mid-trimester
scan
as
part
of
standard
prenatal
care,
although
obstetric
prac-ce
varies
widely
around
the
world.
This
can
be
related
to
the
availability
of
qualied
prac((oners
and
equipment,
local
medical
prac(ce
and
legal
considera(ons;
in
some
countries,
insurance-related
cost
reimbursements
strongly
inuence
how
rou-ne
mid-trimester
scans
are
implemented.
Salomon
LJ
et
al.
Prac:ce
guidelines
for
performance
of
the
rou:ne
mid-trimester
fetal
ultrasound
scan,
2010
Hanya
untuk
Pendidikan
&
JJE-2011/09/12
Kesehatan
PENDAHULUAN
Hanya
untuk
Pendidikan
&
JJE-2011/09/12
Kesehatan
Nonetheless,
a
WHO
Study
Group
stated:
Worldwide,
it
is
likely
that
much
of
the
ultrasonography
currently
performed
is
carried
out
by
individuals
with
in
fact
liAle
or
no
formal
training.8.
The
intent
of
this
document
is
to
provide
further
guidance
for
healthcare
prac--oners
in
the
performance
of
the
mid-trimester
fetal
ultrasound
scan.
Salomon
LJ
et
al.
Prac:ce
guidelines
for
performance
of
the
rou:ne
mid-trimester
fetal
ultrasound
scan,
2010
PENDAHULUAN
SELALU ditanyakan pasien : janin saya normal ? Kenapa skrining pada 18 22 minggu Apa yg dinilai Ketepatan diagnostik : harapan vs kenyataan EBM, Cochrane, ISUOG Guideline : oke ! Standar Indonesia : jauh lebih penting Mari buat penelitian : mulai dari data dasar
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PROGRAM SKRINING
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Banyak pilihan : AIUM, ISUOG, ASUM Indonesia ? Perlu penyesuaian !! Penjenjangan : Level I, II, dan III Program skrining : 10 14 minggu, 18 22 minggu dan 28 32 minggu Universal vs targeted (HRP) Sistematis + peralatan USG memadai
KRITERIA PASIEN
Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan
Well informed, kelompok risiko tinggi Sulit : obesitas, oligohidramnion, kelainan jantung, palatoskizis Perhatikan keluhan pasien USG 3D dan 4D bukan segalanya USG 2D dengan resolusi baik : lebih penting
Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan
Ultrasound in Obstetrics & Gynecology Volume 37, Issue 1, pages 116-126, 7 DEC 2010 DOI: 10.1002/uog.8831 hAp://onlinelibrary.wiley.com/doi/10.1002/uog.8831/full#g1
SISTEMATIKA SKRINING
Janin : tunggal/gemelli, hidup/IUFD, presentasi, letak, posisi, dll ? Plasenta : lokasi, DM, patologi ? Amnion : ICA, kekeruhan Tali pusat : 2A-1V, SUA, Doppler Biometri : pola pertumbuhan, PJT, makrosomia ? Organ : kepala kaki, khusus : jantung Doppler Aktivitas Penilaian dan saran
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KEPALA : SSP
Transversal : mulai dari puncak kepala hingga basis kranii : falks serebri, CSP, V-3, Thalamus dan ventrikel lateral serebellum, CM, NF Sagital : dari kanan ke kiri Koronal : dari anterior ke posterior
Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan
ISUOG Guidelines
Sonographic examination of the fetal central nervous system: guidelines for performing the basic examination and the fetal neurosonogram
JJE-2011/09/12
Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan
Ultrasound in Obstetrics & Gynecology Volume 37, Issue 1, pages 116-126, 7 DEC 2010 DOI: 10.1002/uog.8831 hAp://onlinelibrary.wiley.com/doi/10.1002/uog.8831/full#g2
KEPALA
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Sumber : ISUOG
Sumber : ISUOG
ISUOG
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ISUOG
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ISUOG
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ISUOG
Cari kepala dan ambil potongan transversal (seperti mencari DBP) Putar transduser 900 ke arah wajah potongan sagital wajah (tampak profil) Potar 900 geser ke bawah tampak hidung dan bibir
Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan
Ultrasound in Obstetrics & Gynecology Volume 37, Issue 1, pages 116-126, 7 DEC 2010 DOI: 10.1002/uog.8831 hAp://onlinelibrary.wiley.com/doi/10.1002/uog.8831/full#g3
ISUOG
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ISUOG
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ISUOG
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ISUOG
ISUOG
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ISUOG
THORAKS
ISUOG
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Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan
Ultrasound in Obstetrics & Gynecology Volume 37, Issue 1, pages 116-126, 7 DEC 2010 DOI: 10.1002/uog.8831 hAp://onlinelibrary.wiley.com/doi/10.1002/uog.8831/full#g4
ISUOG
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ABDOMEN : DINDING
Hanya untuk Pendidikan & JJE-2011/09/12 Kesehatan
ISUOG
Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan
Ultrasound in Obstetrics & Gynecology Volume 37, Issue 1, pages 116-126, 7 DEC 2010 DOI: 10.1002/uog.8831 hAp://onlinelibrary.wiley.com/doi/10.1002/uog.8831/full#g5
ISUOG
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ISUOG
ISUOG
ABDOMEN : ORGAN
ISUOG
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ISUOG
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ISUOG
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TRAKTUS URINARIUS
ISUOG
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ISUOG ISUOG
ISUOG
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ISUOG
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GENITALIA
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BUKAN keharusan Penting pada sex linked disease dan ambigus Kesalahannya besar : 50%
VERTEBRA
ISUOG
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ISUOG
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EKSTREMITAS
ISUOG
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Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan
Ultrasound in Obstetrics & Gynecology Volume 37, Issue 1, pages 116-126, 7 DEC 2010 DOI: 10.1002/uog.8831 hAp://onlinelibrary.wiley.com/doi/10.1002/uog.8831/full#g6
ISUOG
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Serviks : risiko preterm Mioma uteri Patologi bekas SC ? Massa di adneksa dan kavum Douglas/Retzii Skrining malignansi Pemantauan hasil terapi & intervensi
ASPEK MEDIKO-LEGAL
Informed consent Tau keterbatasan yang ada : alat, diri, dan pasien Sediakan waktu yang cukup Sistemtis dalam pemeriksaan Manajemen sesuai SPM/SOP setempat Buat laporan tertulis dan arsipkan minimal 5 tahun CPD !!
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DIVISI KEDOKTERAN FETO MATERNAL DEP. OBGIN RSPAD GATOT SOEBROTO DITKESAD FK Ui JAKARTA
62
JJE-2012/05/01
Sumber : YOUTUBE
KEPUSTAKAAN
ISUOG teaching materials, 2009 at http://www.isuog.org/journal/
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TERIMA
KASIH
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