Endometritis CELINE CORNELIA (405180110)

Etiology: 

• Mostly polymicrobial (2–3
ascending organisms, e.g., 
Gardnerella vaginalis, 
Staphylococcus epidermidis, group B 
Streptococcus, and/or Ureaplasma urealyticum,
all of which are usually found in the normal
vaginal flora.

Risk factors

• Cesarean delivery
• Prolonged labor
• Multiple cervical examinations
• Retained products of conception after
Chen KT. Postpartum endometritis. In: Post TW, ed.UpToDate .Waltham, delivery, miscarriage, or abortion
MA: UpToDate.2016
• Meconium in amniotic fluid
Rivlin ME. Endometritis. In: Endometritis. New York, NY:WebMD.2016
 Chen KT. Postpartum endometritis. In: Post TW, ed.UpToDate .Waltham, MA: UpToDate.2016
Rivlin ME. Endometritis. In: Endometritis. New York, NY:WebMD.2016
Prawirohardjo, Sarwono. Ilmu Kandungan, Edisi III. Jakarta : PT Bina Pustaka.
Fever

Clinical Abnormal
Diagnosis
uterine bleeding
Features Lower
abdominal
pain

Acute Dysuria

Dyspareunia

Uterine
Clinical tenderness
features
Foul-
smelling lochia

Often no Histology: 
symptomps plasma cells in chronic 
Chronic Some symptomps endometritis 
of acute
endometritis
(through milder)
 Treatment Further complications
+ Antibiotic treatment  IV clindamycin and + Surgical site infection
gentamicin
+ Peritonitis
o Ampicillin-sulbactam is a reasonable
alternative if clindamycin resistance is a + Intra-abdominal abscess
concern.
+ Asherman’s syndrome
+ Uterine curettage  to remove residual
products of conception and remaining placental
fetal tissues
+ Hysterectomy  if life threatening
complications occur or there is no response to
conservative therapeutic measures.
Antibiotic regimens for postpartum endometritis. 2015. 
Distosia Bahu CELINE CORNELIA (405180110)
Definisi
Riwayat
distosia bahu
sebelumnya

Makrosomia
> 4500 g
+ Definisi  keadaan darurat obstetrik
di mana bahu anterior janin terkena Antepartum
Faktor DM
benturan di belakang simfisis pubis ibu Predisposisi
selama persalinan pervaginam. Intrapartum
IMT > 30

Induksi
+ Epidemiologi: ∼ 0,2–3% kelahiran persalinan

Shoulder Dystocia. https://www.dynamed.com/topics/dmp~AN~T900147/Shoulder-dystocia.2016
Buku Saku Pelayanan Kesehatan Ibu di Fasilitas Kesehatan Dasar dan Rujukan.2013 
 Kala I
memanjang
Diagnosis
Kala II
Antepartum memanjang + Kesulitan melahirkan wajah dan dagu
Faktor
Predisposisi Secondary
+ Turtle sign
Intrapartum arrest
+ Kegagalan paksi luar kepala bayi
Augmentasi
oksitosin + Kegagalan turunnya bahu

Persalinan
pervaginam
yang ditolong Buku Saku Pelayanan Kesehatan Ibu di Fasilitas Kesehatan Dasar dan Rujukan.2013 
 Buku Saku Pelayanan Kesehatan Ibu di Fasilitas Kesehatan Dasar dan Rujukan.2013 
Rodis JF. Shoulder Dystocia: Intrapartum Diagnosis, Management, and Outcome. In: Post TW,
ed.UpToDate .Waltham, MA: UpToDate.. 2017.

Treatment
+ The patient should stop bearing down and lie supine with the buttocks on
the edge of the bed.
+ Perform shoulder dystocia maneuvers: 
First-line: McRoberts maneuver
Any of the internal maneuvers below may be attempted to next.
Move to another maneuver if delivery is not accomplished within 20–30
seconds.
If all above maneuvers fail  attempt the all fours position.
+ Last-resort options: 
Fracture of fetal clavicle
Zavanelli maneuver
Symphysiotomy
Komplikasi
Janin Ibu
+ Cedera pleksus brakialis (Erb palsy lebih + Laserasi perineum
sering terjadi dari pada Klumpke palsy) + Perdarahan pascapartum
+ Fraktur klavikula atau humerus
+ Hipoksia dalam waktu lama akibat
kompresi tali pusat

Rodis JF. Shoulder Dystocia: Intrapartum Diagnosis, Management, and Outcome. In: Post TW, ed.UpToDate .Waltham, MA: UpToDate.https
://www.uptodate.com/contents/shoulder-dystocia-intrapartum-diagnosis-management-and-outcome. 2017.