Professional Documents
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Pleno Sken 24 C
Pleno Sken 24 C
Kelompok A2
Anggota
• Reza Nurdesni 04011381419148
• Wulan Purnama Sari 04011381419160
• Fidella Ayu Aldora 04011381419163
• Muhammad Alif Prizarky 04011381419173
• Ulfa Mutia 04011381419177
• Ahmad Reiman 04011381419179
• N.P. Ayu Oka Shinta 04011381419188
• Ridho Surya Putra 04011381419199
• Angelina Hendesa 04011381419200
• Masayu Shavira R.S. 04011381419213
• Vejitha Raja Kumar 04011381419222
• Pavitra Subramaniam 04011381419225
Outline
1. Skenario
2. Klarifikasi Istilah
3. Identifikasi Masalah
4. Analisis Masalah
5. Learning Issues
6. Kerangka Konsep
7. Kesimpulan
Skenario
Mrs Sukinem, 38 years old women in her fifth pregnancy delivered her son
spontaneously 4 hours ago. She was helped by birth attendant in her village,
about 1,5 hours away from referral hospital. She lived with her husband who
is a farmer and her mother in law who is a birth attendant. She gave birth a
male baby, weighed 4000grams. The placenta was delivered by birth
attendant, she claimed it was delivered completely. Suddenly after placenta
was delivered, massive blood came out from the vagina. The birth attendant
called midwife and according to midwife, uterine contraction was poor and
uterine fundal could not be palpated at that time. She gave the mother
intramuscular oxytocin injection 10 IU and referred her to primary health
service (Puskesmas) which already got PONED certification. Her antenatal
care history was 2 times with midwife in this public health and already
diagnosed with mild anemia due to Fe serum deficiency (her last month Hb
count was 9g/dl)
On arrival, as general practitioner public health service, you find the patient is
consciousness but drowsy and pale. You also find approximately 1000ml of
blood clots in her pants.
In the examination findings:
Height 155cm, weight 50kg, Blood pressure 60/40mmHg, heart rate 140x/min,
respiratory rate 36x/min, temperature 35 C. The peripheral extremities are cold. The
abdomen is otherwise soft and non tender . The uterus fundal can not be palpated, no
uterine contraction. On vaginal inspection there is blood clot in vagina and no portio
laceration or vaginal/perineal laceration are identified.
You do resuscitation on her, made her to become in Trendelenburg position, gave her
oxygen 6-8L/min , insert 2 venous line and folley catheter, do blood examination
including routine blood analysis, hemostatic analysis and serum blood analysis. You
gave 2000ml crystalloid fluid and 300 cc pack red cells, also oxytocin 20 IU in 500 ml
crystalloid fluid.
After 30 min, she became consciousness and not drowsy anymore. Blood pressure
become 100/70mmHg, pulse 92x/min, respiratory rate 22x/min, temperature 35,8 C,
urine output 100cc. You re-examine the patient again, uterine fundal still cannot be
palpated, uterine contraction is poor, and vaginal bleeding is still coming out. You do
bimanual interna compression but still no uterine contraction. You gave her
misoprostol 600ug vaginally and do abdominal aorta compression but uterine
contraction wont get better. You insert uterine tamponade using Sayeba condom
method and plan to refer her to RSMH, hospital nearby.
The laboratory result:
Hb: 4,2g/dl
WBC: 3,200/mm
Platelet: 115 000/mm
INR: 1,3
APTT: 39’
You finally refer this patient after 1 hour treatment in you public health
service to RSMH.
Klarifikasi Istilah
• Tredelenburg: posisi berbaring pada tempat yang datar dimana
kepala berada lebih rendah daripada pelvis.
• PONED certification: pelayanan obstetrik neonatus esensial dasar
untuk puskesmas yang mempunyai fasilitas/kemampuan utk
penanganan kegawat daruratan obstetrik dan neonatus dasar
• Placenta: organ yang tumbuh dalam rahim selama kehamilan yang
memiliki fungsi untuk menghubungkan calon bayi denganibu utk
transfer oksigen dan nutrisi
• Resuccitation: proses pertolongan pembaikan kelainan fisiologis
pada pasien akut
• Foley catheter: tabung kecil steril yang dimasukkan ke kantung
kemih untuk drainase urin
• Bimanual interna compression: dilakukan pada kasus perdarahan
primer posrtpartum dilakukan ketika semua usaha sudah gagal
untuk menyelamatkan hidup dari ibu.
Klarifikasi Istilah
• Misoprostol: obat yg digunakan utk mencegah dan mengobati
tukak lambung.
• Oxytocin: hormon hipatalamus yg tersimpan di hipofisis posterior,
memiliki aktivitas untuk kontraksi uterus dan mengeluarkan air
susu.
• INR: international normalise ratio. Pengukuran labratorium utk
mengetahui berapa lama darah membentuk clot. Normalnya 0,9-
1,3.
• APTT: activated parsial thromboplastin time adalah pemeriksaan
untuk mengetahui pembekuan darah.
• Uterine tamponade: adalah tampon berbentuk balon yang diinsersi
ke uterus dan dikembangkan dengan tujuan untuk meghentikan
perdarahan.
• Abdominal aorta compression: adalah manuver emergensi yang
digunakan untuk menghentikan dan megontrol perdarahan
postpartum dan memungkinkan resusitasi.
Identifikasi Masalah
No Identifikasi masalah Problem Concern
Uterus berkontraksi
• Anjurkan keluarga untuk membantu melakukan KBE
• Keluarkan tangan secara perlahan
• Suntikkan metilergometrin 0,2 mg IM
• Ulangi KBI
Histerektomi
Komplikasi
• Syok hipovolemik
• Anemia
• Syndrome sheehan
SKDI
Kerangka Konsep
Kesimpulan
Mrs. Sukinem, 38 tahun P5 mengalami
perdarahan postpartum primer et causa atonia
uteri dan rupture uteri