Case Report Yesi Punya Yaaaaaa

8/17/2019 Case Report Yesi Punya Yaaaaaa

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CASE REPORTSEKSIO SESAREA ATAS INDIKASI KPD + PEB + INFERTIL 9

TAHUN

Pembimbing :

dr. I G Ngr!"# S$.OG

Di%%n O&e" : 'e%i '(&!nd! P!nd!&!

))*),)9


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IDENTITAS PASIEN

N!m! : N-. 'S

U%i! : / 0!"n

Pendidi1!n : S2A

Pe1er3!!n : PNS

Ag!m! : K!0(&i1

S1 B!ng%! : Tim(r

A&!m!0 : 4&.Pe&i3!n RT 9# 45!0! L!0

2!%1 RS : ) 2!re0 /)* 3!m )., 6ITA


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ANAMNESIS

A0(!n!mne%i% di&!11!n di b!ng%!& B(gen7i&&e bed /# 0!ngg!& ) 2!re0 /

Ke&"!n 0!m! : 1e&!r !ir# &endir# d!n d!r!" d!ri 3!&!n &!"ir

Ke&"!n 0!mb!"!n : n-eri $er0 di%er0!i r!%! 1en8!ng $!d! $er0


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ANAMNESIS

Riwayat Penyakit Sekarang

P!%ien deng!n G/PA) "!mi& mingg d!0!ng menge&" %e3!1 ; 3!m %ebe&m m%!1i0


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RIWAYAT HAID

Riwayat Haid

◦H!id Per0!m! Umr : ); 0!"n

◦Sir1&!%i H!id

◦Si1&% : 0er!0r# /? "!ri

◦L!m!n-! : "!ri

◦B!n-!1n-! : >; 1!&i g!n0i $emb!&0

◦ T!1%ir!n Per%!&in!n : ;>;>/)*


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ANAMNESISRiwayat Perkawinan

2eni1!" ) 1!&i

L!m! $er1!5in!n 0er!1"ir : 9 0!"n

Riwayat Kehamilan dan Persalinan yang Lal

N(. U%i! 1e"!mi&!n 4eni% Per%!&in!n BBL Se@ U%%eng

) Ab(r0%# ?mingg

> > >

/ H!mi& %e1!r!ng


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Riwayat Penyakit Dahl

P!%ien 0id!1 memi&i1i ri5!-!0 1e&"!n -!ng %!m! %ebe&mn-! d!n 0id!1 !d! ri5$en-!1i0 3!n0ng# 0e1!n!n d!r!" 0inggi# 1en8ing m!ni%# !%m!# !&ergi (b!0


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ANAMNESIS

Riwayat Penyakit dalam Kelarga

Tid!1 !d! -!ng meng!&!mi "!& %er$!# 0id!1 0erd!$!0 ri5!-!0 d!r!" 0inggi# %!1i1en8ing m!ni%# !%m!.

Riwayat !"erasi

P!%ien meng!1 $ern!" men3!&!ni ($er!%i !$$ende10(m- d!n 8re0!%e !.i. !b(

Riwayat Met#de Kelarga $eren%ana

di%!ng1!&


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Ke$!&! :

2!0! : S1&er! i10eri1 >A># 1(n3ng0i7! !nemi% >A>

THT : d!&!m b!0!% n(rm!&

Le"er : KGB 0id!1 membe%!r# 0id!1 !d! n-eri 0e1!n

T"(r!1% :

P!-d!r! : d!&!m b!0!% n(rm!&

4!n0ng : d!&!m b!0!% n(rm!&

P!r : d!&!m b!0!% n(rm!&

E1%0remi0!%:

S$eri(r: !1r!& "!ng!0# edem! >A># %i!n(%i% >A># CRT /

InDeri(r : !1r!& "!ng!0# edem! +A+# %i!n(%i% >A># CRT /


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PEMERIKSAAN !$STETRI

◦ Pemeri1%!!n &!r :

◦ In%$e1%i : $er0 membn8i0# &ine! nigr! +# %0ri!e gr!7id!rm +

◦ P!&$!%i : / 3!ri dib!5!" Pr(8. -$"(ide%

◦ Le($(&d ): b!gi!n 0er!0!% 3!nin 0er!b! b&!0# &n!1# 0id!1 me&en0ing. Ke%!n b(1(ng

◦ Le($(&d / : 0er!b! $!n3!ng# 1er!%# 0id!1 0er$0% di %ebe&!" 1!n!n ib. Ke%!n $nggng

◦ Le($(&d : b!gi!n 0erend!" 3!nin# 0er!b! b&!0# 1er!%# me&en0ing. Ke%!n 1e$!&!.

◦ Le($(&d ; : b!gi!n 0erend!" 3!nin %d!" m!%1 $in0 !0!% $!ngg di7ergen

◦ Per!b!!n 1e$!&! : ;,

◦ D33 : );@meni0


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Pemeri1%!!n D!&!m

◦ In%$e1&( : 0id!1 di&!11!n

◦!gin!& 0(8"er :

◦ &7!7!gin! : &endir d!n d!r!"

◦ P(r0i( : medi!&

◦ K(n%i%0en%i : &n!1

◦ Peni$i%!n : 0eb!&

◦

Pemb1!!n : ) 8m◦ Ke0b!n : 0id!1 0" 3erni"


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Pemeri1%!!n D!&!m

◦B!gi!n 0erend!" 3!nin 1e$!&!# H(dge I

◦ TB4 : )=@),,./,, gr!m


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PEMERIKSAAN LA$!RAT!RI'DAN PEN'N(AN) ** !KT!$ER *◦ Le1(%i0 : )/./&

◦ Eri0r(%i0 : ;# 30!&

◦Hem(g&(bin : )#* grd&

◦Hem!0(1ri0 : #* J

◦

Urin◦ Pr(0ein : )+


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ASSESMENT

Diagn#sis Ker.a :

Ib : G/PA) "!mi& mingg + 1$d +PEB + iner0i& 9 0!"n

4!nin : 0ngg! "id$# $re%en0!%i 1e$!&!

Pr#gn#sis

Kehamilan /d0ia ad 0#namPersalinan / d0ia ad 0#nam


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P&!nning

◦ Pr( %e80i( %e%!re!

◦ in% mgSO; ), 88


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SEKSIO SESAREA


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Deni%i

◦ Per%!&in!n b!0!n# dim!n! 3!nin di&!"ir1!n me&!&i %!0 in%i%i $!d! dindd!n dinding r!"im deng!n %-!r!0 r!"im d!&!m 1e!d!!n 0" %er0! ber!0 di!0!% , gr!m.


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4eni%

◦ Se1%i( %e%!re! 1&!%i1 : $embed!"!n %e8!r! %!nger

◦ Se1%i( %e%!re! 0r!n%$eri0(ne!& $r(nd!


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Indi1!%i 4!ninIb


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◦ P!ngg& %em$i0 !b%(&0

◦ Tm(r>0m(r 3!&!n &!"ir -!ng men-eb!b1!n (b%0r1%i

◦ S0en(%i% %er7i1%7!gin!

◦ P&!%en0! $re7i!

◦Di%$r($(r%i %e!&($e&7i1

◦R$0r 0eri memb!1!0

Indi1!Ib


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◦ Ke&!in!n &e0!1

◦G!5!0 3!nin

Indi1! 4!nin


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Se1%i( %e%!re! K&!%i1

◦De%ine1%i $!d! dinding $er0 d!n &!$!ng!n ($er!%i di$er%em$i0 deng!n "!m!

◦ P!d! dinding $er0 dib!0 in%i%i medi!n! m&!i d!ri !0!% %im%i% %e$!n3!n8m %!m$!i di b!5!" mbi&i1% &!$i% demi &!$i% %e"ingg! 1!7m $eri0(ne!

◦D!&!m r(ngg! $er0 di %e1i0!r r!"im di&ing1!ri deng!n 1!%%! &!$!r(0(mi

◦Dib!0 in%i%i %e8!r! 0!3!m deng!n $i%! $!d! %egmen !0!% r!"im# 1emd

di$er&eb!r %e8!r! %!gi0!& deng!n gn0ing.◦ Se0e&!" 1!7m 0eri 0erb1!# %e&!$0 1e0b!n di$e8!"1!n. 4!nin di&!"ir1!

me&1%ir 1e$!&! d!n mend(r(ng nd% 0eri. Se0e&!" 3!nin &!"ir %e&r"n$%!0 di3e$i0 d!n di$(0(ng di !n0!r! 1ed! $en3em$i0.


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Se1%i( %e%!re! K&!%i1

◦ P&!%en0! di&!"ir1!n %e8!r! m!n!&. Di%n0i1!n ) U (1%i0(%in 1e d!&!m r!in0r! mr!&.

◦ L1! in%i%i SAR di3!"i0 1emb!&i.

◦ L!$i%!n I: end(me0rim ber%!m! mi(me0rim di3!"i0 %e8!r! 3e&3r deng!n ben!1"r(mi1

◦ L!$i%!n II : "!n-! mi(me0rim %!3! di3!"i0 %e8!r! %im$& deng!n catgut 1"r(

◦ L!$i%!n III : $erime0rim %!3!# di3!"i0 %e8!r! %im$& deng!n ben!ng catgut bi

◦ Se0e&!" dinding r!"im %e&e%!i di3!"i0# 1ed! !dne1%! die1%$&(r!%i

◦R(ngg! $er0 diber%i"1!n d!ri %i%!>%i%! d!r!" d!n !1"irn-! &1! dinding $di3!"i0.


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Se1%i( %e%!ri! %e8!r! 1&!%i1


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Indi1!%i Se1%i( Se%!re! K&!%

◦Bi&! 0er3!di 1e%1!r!n d!&!m memi%!"1!n 1!ndng 1en8ing n01 men8!%egmen b!5!" r!"im# mi%!&n-! !d!n-! $er&e1!0!n !1ib!0 $embed!"!n %%e%!re! -!ng &!&# !0! !d!n-! 0m(r>0m(r di d!er!" %egmen b!5!" r!

◦ 4!nin be%!r d!&!m &e0!1 &in0!ng

◦ P&!%en0! $re7i! deng!n in%er%i $&!%en0! di dinding de$!n %egmen b!5!"


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Te1ni1 %e1%i( %e%!re! 0r!n%$eri0(ne!& $r(

◦2&!>m&! di&!11!n de%ine1%i $!d! dinding $er0 d!n &!$!ng!n ($er!%idi$er%em$i0 deng!n 1!in %8i "!m!).

◦ P!d! dinding $er0 dib!0 in%i%i medi!n! m&!i d!ri !0!% %im%i% %!m$!i dmbi&i1% &!$i% demi &!$i% %e"ingg! 1!7m $eri0(nei 0erb1!).

◦D!&!m r(ngg! $er0 di %e1i0!r r!"im di&ing1!ri deng!n 1!%! &!$!r(0(mi).

◦Dib!0 bladder-fap# -!i0 deng!n menggn0ing $eri0(nem 1!ndng 1en

7e%i1(0erin!= di de$!n %egmen b!5!" r!"im


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◦Dib!0 in%i%i $!d! %egmen b!5!" r!"im ) 8m dib!5!" iri%!n $&i1! 7e%i1(0!di %e8!r! 0!3!m deng!n $i%! bed!" /8m# 1emdi!n di$er&eb!r me&in%e8!r! 0m$& deng!n 1ed! 3!ri 0e&n31 ($er!0(r). Ar!" in%i%i $!d! %egb!5!" r!"im d!$!0 me&in0!ng


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◦ Se0e&!" 1!7m 0eri 0erb1!# %e&!$0 1e0b!n di$e8!"1!n# 3!nin di&!"ir1!me&1%ir 1e$!&!n-!. B!d!n 3!nin di&!"ir1!n deng!n meng!i0 1ed! 1e0i!1$%!0 di$(0(ng# $&!%en0! di&!"ir1!n %e8!r! m!n!&. Ke d!&!m (0(0 r!"im di %n0i1!n ) U (1%i0(%in. L1! dinding r!"im di3!"i0.

◦ L!$i%!n I: di3!"i0 3e&3r# $!d! end(me0rim d!n mi(me0rim

◦ L!$i%!n II : di3!"i0 3e&3r "!n-! $!d! mi(me0rim %!3!

◦ L!$i%!n III : di3!"i0 3e&3r $!d! $&i1! 7e%i1(0erin!

◦ Se0e&!" dinding r!"im %e&e%!i di3!"i0# 1ed! !dne1%! die1%$&(r!%i.

◦R(ngg! $er0 diber%i"1!n d!ri %i%!>%i%! d!r!" d!n !1"irn-! &1! dinding $ 3!"i0.


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Se1%i( %e%!re! 0r!n%$eri0(ne!& $r(nd!deng!n iri%!n %!gi0!& d!n 0r!n%7er%!&

2emb!0 bladder-fap dmemb1! $&i1! 7e%i1(


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Se0e&!" $&i1! 7e%i1(0erin! dib1!# dib!0iri%!n me&in0!ng $!d! %egmen b!5!" r!"im

Iri%!n $!d! %egmen b!5!" r!"im%e8!r! 0m$& deng!n 1ed! 3!


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Se0e&!" 1!7m 0eri 0erb1!# d!n %e&!$0 di$e8 3!nin di&!"ir1!n deng!n me&1%ir 1e$!&!n-


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Iri%!n %egmen b!5!" r!"im di3!"i0 P&i1! 7e%i1(0erin! di3!"i0 %e


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KETUBAN PECAHDINI


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Se&!$0 1e0b!n

◦2eng"!%i&1!n !ir 1e0b!n d!n me&indngi 3!nin 0er"!d!$ ine1%i

◦ Se&!$0 1e0b!n $e8!" d!&!m $r(%e% $er%!&in!n


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Deni%i

Ke!d!!n $e8!"n-! %e&!$0 1e0b!n %ebe&m$er%!&in!n


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2e1!ni%me Ke0b!n Pe8!" D

K(n0r!1%i0er%

Pereg!ng!n0er%

Perb!"!nbi(1imi!

1e0


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F!10(r re%i1(

◦Ber1r!ngn-! !%!m !%1(rbi1 %eb!g!i 1(m$(nen 1(&!gen

◦ Ke1r!ng!n 0emb!g! d!n !%!m !%1(rbi1 -!ng ber!1ib!0 $er0mb"!n %0!bn(rm!&.


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K(m$&i1!%i

◦Ine1%i m!0ern!& !0! ne(n!0!&

◦ Per%!&in!n $rem!0r

◦Hi$(1%i! 1(m$re%i 0!&i $%!0

◦De(rmi0!% 3!nin

◦2ening1!0n-! in%iden %e1%i( %e%!re!

◦G!g!&n-! $er%!&in!n n(rm!&


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Di!gn(%i%

◦

2enen01!n $e8!"n-! %e&!$r 1e0b!n

Ad!n-! 8!ir!n 1e0b!n di 7!gin◦2engger!11!n %edi1i0 b!gi!n 0erb!5!" 3!nin memin0! $!%ien n01 b!0

menged!n.

◦Nitrazin test

◦ !d!0id!1n-! ine1%i %" ?M8 %er0! !ir 1e0b!n 1er" !0! berb!. Ld!r!" ),.mm# 3!nin 0!1i1!rdi! ine1%i in0r!0erin

◦

Ten01!n 0!nd!>0!nd! $er%!&in!n d!n %1(ring $e&7i1◦Ad! 0id!1n-! 1(n0r!1%i -!ng 0er!0r

◦ Peri1%! d!&!m $en!ng!n!n !10i


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Pen!ng!n!n

◦

K(n%er7!0i◦ R!5!0 di rm!" %!1i0

◦ An0ibi(0i1

◦ />; mingg dir!5!0 %e&!m! !ir 1e0b!n m!%i" 1e&!r !0! %!m$!i 0id!1 1e&

◦ /> mingg# be&m in$!r0# 0id!1 !d! ine1%i# 0e% b%! neg!0i de@!me0"!%(b%er7!%i 0!nd!>0!nd! ine1%i# d!n 1e%e3!"0er!!n 3!nin.

◦ mingg 0ermin!%i


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Pen!ng!n!n

◦

K(n%er7!0i◦ /> mingg# %d!" in$!r0i# 0id!1 !d! ine1%i 0(1(&i0i1# de@!me0"!%(n# d!n

%e0e&!" /; 3!m.

◦ /> mingg# !d! ine1%i !n0ibi(0i1 d!n ind1%i# ni&!i 0!nd!>0!nd! ine1%i


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Pen!ng!n!n

◦

A10i◦ mingg ind1%i deng!n (@-0(8in

◦ Bi&! g!g!&

◦ 2i%($r(%0(& /,>, in0r!7!gin!& 0i!$ * 3!m m!1%im!& ; 1!&i

◦ Bi&! %1(r $e&7i1 ,# &!11!n $em!0!ng!n %er7i1%# 1emdi!n ind1%i. 4i1! 0id!1 ber"!%i $er%!&in!n deng!n %e1%i( %e%!re!

◦ Bi&! %1(r $e&7i1 ,# ind1%i $er%!&in!n


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PEB


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Pree1&!m$%i!

◦

Hi$er0en%i -!ng 0imb& %e0e&!" / mingg 1e"!mi&!n di%er0!i deng!n $r(


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Hi$er0en%i

◦

Te1!n!n d!r!" %i%0(&i1 d!n di!%0(&i1 );9 mmHg. Peng1r!n 0e1!n!ndi&!11!n / 1!&i %e&!ng ; 3!m


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Edem!

◦

Edem! gener!&i%!0!

did!$!01!n edem! gener!&i%!0!# !0! 1en!i1!n ber!0 b!d!n#, 1gmin


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Pen8eg!"!n $ree1&!m$%i!

◦

Pen8eg!"!n n(nmedi1!&◦ Pen8eg!"!n deng!n medi1!&


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Pree1&!m$%i! ber!0

◦

Pree1&!m$%i! deng!n 0e1!n!n d!r!" %i%0(&i1 )* mmHg d!n 0e1!n!n d!di!%0(&i1 ))mmHg di%er0!i $r(0einri! &ebi" , g/; 3!m


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Di!gn(%i%

◦

Te1!n!n d!r!" )*))mmHg d!n 0id!1 menrn me%1i$n ib "!mi& %dir!5!0 dirm!" %!1i0 d!n %d!" men3!&!ni 0ir!" b!ring.

◦ Pr(0einri! &ebi" , g/; 3!m !0! ;+ d!&!m $emeri1%!!n 1!&i0!0i

◦O&igri! !d!&!" $r(d1%i rin ,88/; 3!m

◦ Per0mb"!n 3!nin in0r!0erin -!ng 0er"!mb!0

◦ Tr(mb(%i0($eni! ber!0 : ). mm !0! $enrn!n 0r(mb(%i0 deng!


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Peng(b!0!n

◦

2!gne%im %&!0 regimen◦ L(!ding d(%e : ; gr!m 2gSO; i.7. , gr!m i.m. Segr!m i.m. ;>*3!m

◦An0i"i$er0en%i &ini $er0!m!

◦ Niedi$in )>/mg $er (r!& di&!ngi meni0# m!@ )/ mgd!&!m /; 3!m

◦An0i"i$er0en%i &ini 1ed!

◦ Di!(1%ide >* mgi.7.,meni0


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INFERTILITAS


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F!10(r Pen-eb!b Iner0i&i0!%

N(n Org!ni1 Org!ni1


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N(n (rg!ni1

◦U%i! :

◦ 9; J $erem$!n %br di %i! , 0!"n !0! J $erem$!n %br di %i! ? meng!&!mi 1e"!mi&!n d!&!m 1rn 5!10 0!"n &!m! $erni1!"!n.

◦ Ke0i1! %i! ; 0!"n 1e%em$!0!n n01 "!mi& "!n-! ,J $er b&!n ,/J=


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N(n (rg!ni1

◦ Fre1en%i %engg!m!

◦ Ang1! 1e3!di!n 1e"!mi&!n men8!$!i $n8!1n-! 1e0i1! $!%!ng!n %!mi i%0ri me"bng!n %!mi i%0ri deng!n re1en%i /> 1!&i d!&!m %emingg.


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N(n (rg!ni1

◦ P(&! "id$

◦ A&1("(&

◦ 2er(1(1

◦ Ber!0 b!d!n


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Org!ni1

◦2!%!&!" 7!gin!

◦ Di%$!reni : r!%! 0id!1 n-!m!n %!!0 me&!11!n %engg!m!. A1ib!0 d!ri !10(r in

◦ !gini%m% : r!%! n-eri %!!0 $eni% !1!n me&!11!n $ene0r!%i 1e 7!gin!

◦ !gini0i% : Ine1%i 1m!n 1&!midi 0r!1(m!0i%# Ni%eri! g(n(re.


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Org!ni1

◦2!%!&!" 0er%

◦ F!10(r %er7i1% : %er7i%i0i%# 0r!m! $!d! %er7i1%

◦ F!10(r 1!7m 0eri : 1e&!in!n !n!0(mi 1!7m 0eri# !10(r end(me0ri(%i%

◦ F!10(r 2i(me0rim : Aden(mi(%i% < 1e&!in!n!n mi(me0rim ber$! %%$!n 3!rid!n 1e&en3!r -!ng %!ng!0 men-er$!i end(me0rim.


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◦2!%!&!" 0b! : %mb!0!n 0b! b!i1 $!d! $!ng1! 0eng!"# m!$n 3ng

◦2!%!&!" (7!rim : 0er1!i0 deng!n ng%i (7&!%i


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Pemeri1%!!n d!%!r iner0i&i0!

◦An!mne%i%

◦ Kebi!%!!n mer(1(1 # !&1("(&

◦ Si1&% "!id

◦ Fre1en%i %engg!m!

◦ Ter!$i 1"%% : An0i "i$er0en%i# 1(r0i1(%0er(id# %i0(%0!0i1!


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◦ Pemeri1%!!n %i1

◦ Peng1r!n 0inggi b!d!n# &ing1!r $ingg!ng# ber!0 b!d!n.

◦ Ad!n-! $er0mb"!n r!mb0 -!ng !bn(rm!&


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◦ Pemeri1%!!n $enn3!ng

◦ Peni&!i!n 1!d!r $r(ge%0er(n $!d! !%e &0e!& m!di!


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Pemeri1%!!n !n!&i%i% %$erm!

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