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    The document discusses postpartum complications including postpartum hemorrhage, postpartum infection, and psychological disorders. It defines postpartum hemorrhage as blood loss of more than 500 mL within 24 hours of delivery. Risk factors for postpartum hemorrhage include uterine atony, trauma, retained placenta or clots. Postpartum infection is defined as a bacterial infection of the genital tract accompanied by fever (38°C) and is usually caused by various bacteria. Endometritis is the most common postpartum infection and presents with fever, chills, malaise and uterine tenderness. Prevention and treatment of postpartum complications are also covered.

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    The document discusses postpartum complications including postpartum hemorrhage, postpartum infection, and psychological disorders. It defines postpartum hemorrhage as blood loss of more than 500 mL within 24 hours of delivery. Risk factors for postpartum hemorrhage include uterine atony, trauma, retained placenta or clots. Postpartum infection is defined as a bacterial infection of the genital tract accompanied by fever (38°C) and is usually caused by various bacteria. Endometritis is the most common postpartum infection and presents with fever, chills, malaise and uterine tenderness. Prevention and treatment of postpartum complications are also covered.

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    29 views55 pages

    Askep Komplikasi Postpartum

    Uploaded by

    farizka
    The document discusses postpartum complications including postpartum hemorrhage, postpartum infection, and psychological disorders. It defines postpartum hemorrhage as blood loss of more than 500 mL within 24 hours of delivery. Risk factors for postpartum hemorrhage include uterine atony, trauma, retained placenta or clots. Postpartum infection is defined as a bacterial infection of the genital tract accompanied by fever (38°C) and is usually caused by various bacteria. Endometritis is the most common postpartum infection and presents with fever, chills, malaise and uterine tenderness. Prevention and treatment of postpartum complications are also covered.

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    of 55

    Komplikasi

    Postpartu
    m
    MULADEFI CHOIRIYAH
    JURUSAN KEPERAWATAN FKUB
    Learning outcome

    Perdarahan postpartum

    Infeksi post partum

    Gangguan psikologis
    By: Muladefi Choiriyah, JK-FKUB
    OVERVIEW 75% Penyebab
    kematian ibu
    Tekanan darah tinggi saat
    Perdarahan Postpartum Infeksi Postpartum kehamilan
    (preeclampsia/eclampsia)

    Partus lama/macet Aborsi yg tdk aman

    Sumber: Key facts. 2019. Maternal mortality. https://www.who.int/news-room/fact-


    sheets/detail/maternal-mortality By: Muladefi Choiriyah, JK-FKUB
    Perdarahan
    postpartum

    By: Muladefi Choiriyah, JK-FKUB


    Evensen, et al
    • The American College of
    Obstetricians and Gynecologists
    defines early postpartum
    Ward hemorrhage as at least 1,000 mL
    • Kehilangan darah > 500 cc total blood loss or loss of blood
    coinciding with signs and
    persalinan pervaginam atau >
    1000 pada SC dengan penurunan symptoms of hypovolemia within
    24 hours after delivery of the fetus
    HCT 10%
    or intrapartum loss

    Perdarahan 2012 2018

    Postpartum 2009 2017

    WHO Smith
    • Postpartum Haemorrhage (PPH) is • Kehilangan darah > 500 cc
    commonly defined as a blood loss persalinan pervaginam atau >
    of 500 ml or more within 24 hours 1000 pada SC dengan penurunan
    after birth HCT 10%

    By: Muladefi Choiriyah, JK-FKUB


    Klasifikasi PPH

    Early/primary
    • 24 jam PP

    Late/secondary
    • > 24- 6minggu PP

    By: Muladefi Choiriyah, JK-FKUB


    Mnemonic Etiology PPH

    4T

    Thrombi
    Tonus Tissue Trauma n

    By: Muladefi Choiriyah, JK-FKUB


    By: Muladefi Choiriyah, JK-FKUB
    Uterine atony and failure of
    4 T: Tonus

    contraction and retraction of
    myometrial muscle fibbers can lead to
    rapid and severe haemorrhage and
    hypovolemic shock.

    By: Muladefi Choiriyah, JK-FKUB


    VASKULARISASI
    UTERUS

    Saat hamil

    • Aliran darah ke
    uterus 500-800
    ml/menit

    By: Muladefi Choiriyah, JK-FKUB


    Kontraksi
    otot dan
    pembuluh
    darah
    uterus

    By: Muladefi Choiriyah, JK-FKUB


    Major risk factor for Uterine Atony:

    Inhibition of
    Fatigue due to contractions by
    Overdistension of
    prolonged labor or drugs (anestesi,
    the uterus
    rapid forceful labor nsaid, mgso4,
    nifedipine)

    Bacterial toxins
    Placental
    (eg,
    implantation site in Hypoxia due to
    chorioamnionitis,
    the lower uterine abruptio placentae
    endomyometritis,
    segment,
    septicemia)

    By: Muladefi Choiriyah, JK-FKUB


    JW. Ramadhan, 2019. jurnal.fk.unand.ac.id 
    By: Muladefi Choiriyah, JK-FKUB
    By: Muladefi Choiriyah, JK-FKUB
    By: Muladefi Choiriyah, JK-FKUB
    4 T : Trauma

    Risk Factor:

    • Ruptur uterine
    • very prolonged or vigorous labor,
    • Over stimulated uterus with oxytocin or
    prostaglandins.
    • Internal version and extraction of a second twin
    • remove a retained placenta manually or with
    instrumentation
    • Cervical laceration
    • Vaginal laceration

    By: Muladefi Choiriyah, JK-FKUB


    By: Muladefi Choiriyah, JK-FKUB
    4 T: Tissue

    Retention of the
    placenta, more
    Risk factor:
    than 30 mnts
    after delivery

    Extreme
    Placenta previa preterm
    with or without gestations
    previous SC, (especially < 24
    wk)

    By: Muladefi Choiriyah, JK-FKUB


    By: Muladefi Choiriyah, JK-FKUB
    4 T : Trombine / Clotting

    Risk Factor:

    • Idiopathic thrombocytopenic purpura (ITP)


    • Acquired secondary to HELLP syndrome
    (haemolysis, elevated liver enzymes, and
    low platelet count)
    • Abruptio placentae
    • Disseminated intravascular coagulation
    (DIC)
    • Sepsis
    By: Muladefi Choiriyah, JK-FKUB
    Estimasi kehilangan
    darah

    Source: Dr Muniswaran Ganeshan (M.Med, MRCOG), Dr Harris Suharjono (FRCOG), 2012

    By: Muladefi Choiriyah, JK-FKUB


    PENILAIAN KLINIK HPP

    Tertinggal
    Atonia Robekan Retensi Inversio
    nya
    uteri jalan lahir placenta uteri
    placenta

    Placenta
    Uterus tdk
    Kontraksi Darah segar belum lahir Placenta / teraba
    uterus 30 mnt selaput tdk
    lembek lgkp

    Kontrksi Lumen
    Perdarahan
    uterus baik & vagina terisi
    segera
    keras massa

    Perdarahan Perdarahan Tmpak


    aktif Kontrksi segera
    Plasenta placenta (jika
    uterus baik &
    lengkap placenta blm
    keras
    lahir)
    By: Muladefi Choiriyah, JK-FKUB
    KOMPLIKASI HPP

    • Kehilangan 30-40% darah


    • Tanda:
    • Gelisah
    SYOK • Cemas
    HYPOVOLEM • Pucat
    IK • Berkeringat dingin
    • Nadi meningkat
    • RR meningkat
    • TD menurun

    By: Muladefi Choiriyah, JK-FKUB


    Penatalak
    sanaan

    By: Muladefi Choiriyah, JK-FKUB


    Postpartum Hemorrhage: Prevention and Treatment. 2017. http://www. aafp.org/afp. By: Muladefi Choiriyah, JK-FKUB
     KOMPRESI BIMANUAL :

    KB interna KB eksterna

    By: Muladefi Choiriyah, JK-FKUB


    Tampon Kondom kateter /
    Uterine Balloon Tamponade
    (UTB)
    (metode sayeba -2003)

     Kondom diikat dg kateter


     Cek sdh tdk bocor
     250-500 cc NS
     Selama 24-48 jm/ rujuk

    By: Muladefi Choiriyah, JK-FKUB


    EBP

    By: Muladefi Choiriyah, JK-FKUB


    Infeksi
    postpartum

    By: Muladefi Choiriyah, JK-FKUB


    Infeksi bakteri pada tractus genetalia yang
    Definisi diikuti oleh demam (38°C).

    infeksi
    postpartu
    m

    By: Muladefi Choiriyah, JK-FKUB


    Penyebab infeksi

    Bakteri Staphylococc
    Streptokokus
    anaerobik us aureus

    Gonokokus clostridia

    By: Muladefi Choiriyah, JK-FKUB


    FAKTOR RESIKO

    Higiene
    Malnutrisi Anemia
    buruk

    Proses
    persalinan
    Kelelahan
    bermasala
    h
    By: Muladefi Choiriyah, JK-FKUB
    Endometritis

    INFEKSI YG Thrombophlebitis
    UMUM
    Infeksi Luka
    TERJADI operasi/laserasi
    Mastitis*

    By: Muladefi Choiriyah, JK-FKUB


    ENDOMETRIT
    IS
     adalah inflamasi dan infeksi
    dinding uterus
     Onset : 2-4 hari postpartum

    By: Muladefi Choiriyah, JK-FKUB


    Tanda endometritis

    Demam >
    Menggigil Malaise Anoreksia
    38°C

    Uterus Lochea : Peningkatan


    Nyeri/kram
    besar + kecoklatan, nadi,
    uterus
    lunak bau busuk leukosit
    By: Muladefi Choiriyah, JK-FKUB
    Faktor resiko

    Pemeriksaa
    Persalinan Prolonge n vagina
    SC PROM terlalu
    sering

    Perineal
    Internal FHR Nutrisi
    care yang
    monitor buruk
    buruk
    By: Muladefi Choiriyah, JK-FKUB
    Antibiotik
    Isitrahat
    Antipiretik

    Penatalaksanaan Peningkatan intake cairan


    Diet tinggi protein dan vit C
    Perineal hygiene
    Jelaskan treatment pada ibu/keluarga

    By: Muladefi Choiriyah, JK-FKUB


    TROMBOPHLEBI
    TIS DAN
    TROMBOSIS

    Adalah inflamasi pada


    sirkulasi vena dan
    penggumpalan darah,
    biasanya muncul pada
    ekstrimitas bawah
     DVT (Deep Vena
    Thrombosis)
     Insiden 0,5-3% dari
    1000 ibu

    By: Muladefi Choiriyah, JK-FKUB


    • Grande multipara
    Fakt • Usia > 35 thn
    or •
    •
    Imobilisasi
    Riwayat DVT
    resik sebelumnya
    o • Persalinan SC
    • Varises vena

    By: Muladefi Choiriyah, JK-FKUB


    Tanda gejala

    nyeri kaki- bengkak homan’s


    Demam menggigil
    paha unilateral sign (+)

    Panas
    Leukositosi Perubahan
    Kemerahan terlokalisas
    s warna kulit
    i

    By: Muladefi Choiriyah, JK-FKUB


    By: Muladefi Choiriyah, JK-FKUB
    Analgesik

    Istirahat dengan kaki dinaikkan

    Peningkatan intake cairan

    Pelembab kaki
    Penanganan
    Kompres hangat

    Terapi LMWH heparin berat molekul rendah


    (anticoagulant)
    Monitor perdarahan sbg efek terapi heparin

    By: Muladefi Choiriyah, JK-FKUB


    MASTITIS

     Unilateral
     Penyebab : S. Aureus
     Onset: 3-4 minggu PP
     Berasal dari mulut bayi 
    masuk ke luka puting

    By: Muladefi Choiriyah, JK-FKUB


    menggigil

    demam

    malaise
    Tanda dan
    gejala nyeri payudara

    pembesaran nodus limfa ketiak

    pembesaran payudara tapi terjadi obstruksi


    ASI

    By: Muladefi Choiriyah, JK-FKUB


    • Statis ASI
    Fakt • Tersumbatnya
    ductus ASI
    or • Jarang menyusui
    resik • Primipara
    o • Luka pada puting
    susu

    By: Muladefi Choiriyah, JK-FKUB


    Penanganan
    • Antibiotik
    • Tetap menyusui/diperah
    • Istirahat
    • Intake cairan banyak
    • Kompres hangat
    • Antipiretik
    • Diet tinggi protein dan vit C
    • Kaji mulut bayi adanya infeksi
    seperti jamur/candida
    By: Muladefi Choiriyah, JK-FKUB
    Lesi puting susu

    MA
    STI Sist. Ductus terinfeksi
    TIS

    Edema, bengkak, sumbatan mamae

    ABSES MAMAE
    (hentikan menyusui 
    diperah)
    By: Muladefi Choiriyah, JK-FKUB
    Gangguan
    psikologis

    By: Muladefi Choiriyah, JK-FKUB


    Gangguan psikologis

    Baby Depresi Psikosis


    blues PP PP

    By: Muladefi Choiriyah, JK-FKUB


    By: Muladefi Choiriyah, JK-FKUB
    ASUHAN
    KEPERAWATAN
    KOMPLIKASI
    POSTPARTUM

    By: Muladefi Choiriyah, JK-FKUB


     Setiap mahasiswa mengisi class coment
    dengan membuat diagnosa keperawatan
    utama dan intervensinya dari kasus dibawah
    ini.

    By: Muladefi Choiriyah, JK-FKUB


    Kasus
     Ny. ERN seorang pasien perempuan, usia 25 tahun, pekerjaan ibu
    rumah tangga datang ke Rumah Sakit bersama seorang bidan dengan
    keluhan perdarahan pervaginam sejak 11 jam yang lalu setelah pasien
    melahirkan dan ditolong oleh bidan.
     Bayi lahir spontan, langsung menangis kuat, jenis kelamin perempuan,
    hidup, cukup bulan, BB 3.800 gram, diikuti lahirnya plasenta, tetapi
    disertai dengan perdarahan pervaginam terus menerus sebanyak 8
    kali ganti pembalut pasca melahirkan. Terdapat robekan placenta,
    manual placenta + namun perdarahan belum berhenti.
     Riwayat demam -, riwayat penyakit gangguan pembekuan darah -.
    Selain itu pasien juga mengeluh lemas dan menggigil.
     Pasien mempunyai 2 anak, anak pertama berusia 2 tahun dengan
    riwayat kelahiran spontan, cukup bulan, BB 3.700 gram, dan lahir
    ditolong oleh bidan, anak kedua lahir 11 jam sebelum masuk rumah
    sakit, lahir spontan, cukup bulan, BB 3.800 gram, ditolong oleh bidan.
    By: Muladefi Choiriyah, JK-FKUB
    Kasus
     Pada pemeriksaan fisik didapatkan keadaan umum lemah, kesadaran
    CM, TD110/70 mmHg, nadi 120 x/menit, RR 24 x/menit, suhu 36,6 o C.
     Pemeriksaan fisik didapatkan konjungtiva anemis dan akral dingin. Pada
    pemeriksaan luar obstetri ditemukan tinggu fundus uteri (TFU) setinggi
    umbilikus, kontraksi sedang, tidak terdapat nyeri tekan. Pemeriksaan
    dalam ditemukan portio cervix: lividae (kebiruan), ostium uteri
    eksternum terbuka, perdarahan aktif, laserasi +, hecting +.
     Pemeriksaan penunjang Hb yaitu 6,2 gr/dl, leukosit 13.800/ul, trombosit
    177.000/mm3 , hematokrit 19%, Clotting Time (CT) 12 menit dan
    Bleeding Time (BT) 4 menit.
     Diagnosis medis pada pasien ini adalah P2A0 postpartum spontan
    dengan HPP dini ec sisa plasenta + anemia berat.
     Pada pasien ini dilakukan tatalaksana aktif berupa kuretase, disertai
    dengan pemberian IVFD RL 2 jalur guyur dan salah satu flabot didrip
    oksitosin 2x10 IU , transfusi Whole Blood (WB) yang dilanjutkan dengan
    Packed Red Cell (PRC), dan pemberian antibiotik amoksisillin. By: Muladefi Choiriyah, JK-FKUB
    TERIMA KASIH

    By: Muladefi Choiriyah, JK-FKUB

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