gawat darurat obgyn a

8/18/2019 Gawat Darurat Obgyn A

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Gawat DaruratGawat DaruratdibidangdibidangObstetri dan GinekologiObstetri dan Ginekologi


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TUJUAN :

MEMAHAMI KEADAAN-KEADAAN YANG MERUPAKAN

KEGAWAT DARURATAN DIBIDANG OBSTETRI &

GINEKOLOGI


3/28

GAWAT DARURAT

OBSTETRI GINEKOLOGI

IBU JANIN IBU


4/28

• Disseminated Intravascular Ca!ul"at#$• %$"ertensin Emer!encies

• T#$rid and Ot#er Endcrine Emer!encies

• Dia&etic Ketacidsis In 're!nanc$

• Res"iratr$ Emer!encies Durin! 're!nanc$

• Amnitic (luids Em&lism• Neurl!ic Emer!encies Durin! 're!nanc$

• Cardiac Desease In 're!nanc$

• 'st 'artum %aemrr#a!e

• Ot#ers

EMERGENCIES IN OBSTETRICS AND GYNECOLOGY


5/28

DISSEMINATED INTRAVASCULARDISSEMINATED INTRAVASCULAR

COAGULOPATHY ( DIC )COAGULOPATHY ( DIC )

Suatu !e)ala *linis $an! &ersi+at umum $an! ditandai le#

ter)adin$a "erce"atan "em&e*uan dara# $an! ter)adi

secara sistemi* didalam "em&ulu# dara# dan disertai

den!an "emeca#an &e*uan terse&ut

CONSUMTIVE COAGULOPATHY


6/28

,- %'' $an! masive den!an "en!!antian

cairan $an! tida* ade*uat./- Slusi "lasenta

0- 'ree*lamsia Berat disertai den!an

sindrma %ELL'

PENYEBAB

SERING


7/28

• Se"sis

• Acute (att$ Liver in 're!nanc$

• Amnitic (luids Em&lism

• Adult Res"iratr$n Distress S$ndrme

• Acute %eml$tic Trans+usin Reactin

• Autimmune Desease

•1ali!nancies• 1issed A&rtin 2 IU(D

PENYEBAB

JARANG


8/28

• Kecenderun!an "erdara#an "ada &e*astusu*an )arum sunti*. lu*a "erasi dansela"ut lendir 3 GI Tract. Res"iratr$ Tract4

• %'' den!an *ntra*si uterus $an!ade*5at 3 #ati6#ati laserasi )alan la#ir 4

• S#c* $an! tida* sesuai den!an"erdara#an $an! *eluar

DIAGNOSIS

KLINIS


9/28

• Kadar (i&rin!en 666 turu

• (i&rin!en De!radatin 'rduct 666 !"#

• 'rt#rm&in Time 666 !"#• a'TT 666 !"#

• Anti T#rm&ine III 666 turu

• %&- Dan %ct 666 turu• Biliru&in 666 !"#

DIAGNOSIS

LABORATORIK


10/28

PENGELOLAANPENGELOLAAN

,- %'' 7 6 Utertni*. re"air laserasi )alan la#ir

/- Slusi 'lasenta 7 6 Amnitmi. terminasi

0- 'EB 2 %EL'' 7 6 Terminasi

8- Acute (att$ Liver 7 6 Terminasi

9- Amnitic (luids Em&lism 7 6 Krti*sterid

:- Se"sis 7 6 Anti&iti*a. *rti*sterid

;- ARDS 7 6


11/28

PENGELOLAANPENGELOLAAN

PEMBERIAN KOMPONEN DARAH

+, r.'/ 0r%1. *!'2! (P)

3, Cr4%*r."*"t!t.$5, B%%$ P!t..t'

6, PRC


12/28

PP

• ((' 3 "er unit 7 /9> ml 4

• Untu* *re*si 'T. a'TT. %i"+i&rin!en

• Dsis a5al 7 8 unit. ditam&a# &ila di"erlu*an

• Tia" unit ((' a*an menin!*at*an *adar

+i&rin!en 9 ? ,> m! 2 dl


13/28

CRYOPRECIPITATECRYOPRECIPITATE

• Cr$"reci"itate 3 "er unit 70968> ml4

• Ba#an *a$a +i&rin!en

• Di&eri*an &ila 7

,- Kadar +i&rin!en @ ,>> m!2dl

/- Kadar +i&rin!en @ ,9> m!2dl 'erdara#an

Tia" unit Cr$"r- A*an menin!*at*an *adar

+i&rin!en 9 ? ,> m!2dl-


14/28

PLATELETS ( TROMBOSIT )PLATELETS ( TROMBOSIT )

• Di&eri*an &ila 7

,- Trm&sit @ /9->>> 2 mm0

den!an atau"un tan"a "erdara#an /- Trm&sit @ 9>->>> 2 mm0 'erdara#an

• Tia" unit Trm&sit a*an menin!*at*an

)umla# trm&sit ;>>> ? ,>->>> 2 mm0


15/28

PRC ( Packed Red Cells )PRC ( Packed Red Cells )

• 1enin!*at*an $!en carr$in! ca"acit$

• 'erta#an*an %ct 3 %ematcrit 4 /9

• %ati6#ati 'RC a*an menin!*at*an

*adar Kalium dalam dara#

3 &a#a$a #i"er*alemia 666 cardiac arrest 4

Tiap pemberian 5 unit PRC, tambahkan 1 amp.

calsium bila anticoagulan yang dipakai dalam packed unit menyebabkan penurunan calsium darah


16/28

AMNIOTIC FLUIDS EMBOLISMAMNIOTIC FLUIDS EMBOLISM

( A F E )( A F E )


17/28

AMNIOTIC FLUIDS EMBOLISMAMNIOTIC FLUIDS EMBOLISM

( EMBOLI AIR ETUBAN )( EMBOLI AIR ETUBAN )

• Km"li*asi &stetri* $an! )aran!

• An!*a *e)adian ,7 />->>>

• Kematian i&u :> 6=>• Ge)ala *linis menn)l 7

,- %$"*sia

/- %emd$namic clla"s 0- DIC


18/28

SUSPECTED AFESUSPECTED AFE• Durin! la&r. CS. Dilatatin and Evacuatin

• Acute #i"ia 3d$s"neu. c$ansis. res"- arrest-4

• Severe #aemrr#a!e 5it# n sur!ical caused

• Acute %$"tensin 2 Cardiac arrest

• Cnsum"tive Ca!ul"at#$ 3DIC4


19/28

GE!ALA LINISGE!ALA LINIS

• SIGN SF1'TO1S N

%$"tensin 80 ,>>

(etal d$stress 0> ,>>

ARDS 3 'ulmnar$ Oedema4 /= 0

Cardi"ulmnar$ arrest 8> =;

C$ansis 0= =0 Ca!ul"at#$ 0= =0

D$s"neu // 8

SeiHure // 8=

Atn$ ,, /0

Brnc#s"asm ; ,9

Transient #$"ertensin 9 ,,

Cu!# 0 ;

%eadac#e 0 ;

C#est "ain , /


20/28

Diagnosa BandingDiagnosa Banding

• Se"sis

• Acute 1$card In+arctin

• As"ratin 'neumnia• 'ulmnar$ t#rm&em&lism

• Slusi 'lasenta

• Km"li*asi Anest#esia


21/28

EVALUATION OF SUSPECTED AFEEVALUATION OF SUSPECTED AFE

Arterial Bld Gas

CBC 'latelets

'T 'TT(i&rin!en (D'

Crssmatc# Bld t$"e

C#est 6Ra$,/ Lead Electrcardi!ram


22/28

1aternal Nenatal Outcme1aternal Nenatal Outcme

• Overall 1aternal 1rtalit$ 7 :> ? => ,9 Survivrs 666 Neurl!icall$ Intact

• Nenatal Survival Rate 7 => 9> Survivrs 666 %$"ic Brain In)ur$

3Res"iratr$ Acidemia 4

• Cardiac arrest cases 666 = Neur intact


23/28

NEONATAL OUTCOME IN CARDIAC ARREST CASES

INTERVAL (MNT) SURVIVAL NEURO INTACT

CARDIAC ARREST TO DELIVERY (7) (7)

8 9 + ;<

9 = +9 + ;<

+; = 39 6 6

3; = 59


24/28

PATOFISIOLOGI AFEPATOFISIOLOGI AFE

H4*.rt%" Ut, C%tr!t,

Itr!-ut, Pr.''ur. "r.!'.

C%2*.t. .''!t"% %0

Ut, B%%$ %>

.t! t% M!t.r! T"''u.Tr!'0.r

S.*t" '/%#

A!*/4!t" '/%#

Pu2%!r4 E2?%"'2.

ANAPHYLACTOIDSYNDROME OF

PREGNANCY


25/28

%E1ODFNA1IC%E1ODFNA1IC

RES'IRATORFRES'IRATORF

ALTERATION ALTERATION'r+und %$"ia

S$stemic 'ulmnar$


26/28

Ca!ul"at#$ In A(ECa!ul"at#$ In A(E

• S#rten Clttin! Time

• T#rm&"lastin Li*e E++ect• Induce 'latelets A!!re!atin

• Release 'latelets (actr III

• Activatin Cm"lement Cascade


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DIAGNOSISDIAGNOSIS

• +, KLINIS

• 3, LABORATORIK

• 5, DIAGNOSIS PASTI :

D"t.2u#! .t! D.?r"' $"$!!2 *.2?uu/ $!r!/ *u2%.r

C!t/, Pu2, : 9 7 Ot%*'" :


28/28

MANAGEMENT OF AFEMANAGEMENT OF AFE

S/%#

H4*%t.'"% H4*%.2"! D I C

1nitr CO B' Adeuate O/ Treat Ca!ul"at#$

C'R as Indicated (etal 1nitrin! La&- Evaluatin

V%, E*!'"% :

Cr4't!%"$ C%%"$

B%%$ C%2*%.

Pr.''%r [email protected] :

D%*!2".

N%r.*".*/r".E*/.$r".

I%tr%*" [email protected] :

D"@"t!"'

Ir.!'. O3

K..* 2!t.r! PO3

; 22/@

!. 2!'# F CPAP

Itu?!t"%

M./, V.t"!t"%Pu2%!r4 O.$.2! :

ur%'.2"$. 2%r*/"

B%%$ C%2*%.

T/.r!*4 :

'RBCs

'latelets

(('

Cr$"reci"itate

Pu2%!r4 Art, C!t/,

!' I$"!t.$

CORTICOSTEROIDS

( C%tr%.r'"!)

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