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Kasus Late PPH
makmur sitepu
Divisi Feto-Maternal
Departemen Obgin FK-USU/RS. HAM
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Background
Late Post Partum Haemorrhage is defined as
abnormal or excessive bleeding from the
birth canal between 24 hours and 6 weeks
following the birth.
Late PPH occurs in 1% of postpartum
women and commonly occurs between 8
21 days postpartum.
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Causes of late postpartum
hemorrhage
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A proposed standardized system for reporting
postpartum ultrasound scan. Adapted from Neill et al.,
200224
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Normal Ultrasound Uterine postpartum
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Endometritis
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Retained Placental
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Retained Placental (echogenic mass)
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Retained Placental and post
evacuation
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The management of late postpartum
hemorrhage
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Ny. RP, usia 35 tahun. P4A0 datang bersama suami
dengan keluhan perdarahan pervaginam. Gumpalan
darah positif. Ny.RP baru melahirkan spontan 2 minggu
yang lalu
More Info I:Pemeriksaan fisik :
Vital sign : sensorium = compos mentis lemah
TD = 90/70 mmHg
Nadi = 100x/i , tekanan/volume cukup
RR = 20x/iTemperatur = afebris
Hb: 9 gr%, Leokusit: 8.000/ mm3, Thrombosit: 256.000
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Pemeriksaan obstetri :Inspekulo: vagina licin, servik licin, darah mengalir dari
ostium uteri eksterna (OUE)VT: Uterus antefleksi, ukuran 10 cm, kontraksi lemah
Adneksa dan parametrium = tidak ada kelainan
More Info II : (pada tutorial ke- 2)
USG : Uterus anteflexi, ukuran 10x8 cm. Dijumpai
bayangan hyperechoic dalam cavum uteri ukuran 3x2
cm kemungkinan berasal dari jaringan.
Adnexa : tidak ada kelainan
Kesimpulan : Sisa konsepsi
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Am J Obstet Gynecol. 1990 Sep;163(3):823-5.
Preterm delivery: a risk factor for retained placenta.
Romero R, Hsu YC,Athanassiadis AP, Hagay Z,Avila C, Nores J, Roberts A, Mazor M, Hobbins JC.
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT
06510.
Abstract
The purpose of this study was to determine whether preterm delivery, with
and without intraamniotic infection, is a risk factor for retained placenta. This
complication occurred more frequently in women with preterm vaginaldelivery than in women with term vaginal delivery (9.1% [21/231] vs 1.1%
[6/561]; p less than 0.00001; odds ratio = 9.25). There was no significant
difference in the prevalence of retained placenta between women with
preterm labor and intact membranes and those with preterm premature
rupture of membranes (8% [10/125] vs 10.4% [11/106]; p greater than or
equal to 0.05). A positive amniotic fluid culture or clinical chorioamnionitiswas not associated with a higher incidence of retained placenta. This study
indicates that preterm delivery is associated with an increased risk of
complications of the third stage of labor.
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Romero%20R%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hsu%20YC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Athanassiadis%20AP%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hagay%20Z%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Avila%20C%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nores%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20A%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mazor%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hobbins%20JC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mazor%20M%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20A%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nores%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Avila%20C%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hagay%20Z%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Athanassiadis%20AP%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hsu%20YC%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Romero%20R%22[Author]8/13/2019 Kasus Late PPH HGH
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Grading Placenta
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Analisa Kasus
Late PPH: 2 minggu
Perbaiki KU
Antibiotika 12
24 jam Uterotonika
Evakuasi dengan kuretase.
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