pph pit pogi xix herman kristanto
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Perdarahan Postpartum
Epidemiologi Etiologi Faktor Risiko Herman Kristanto Himpunan Kedokteran Fetomaternal
Courtesy of Sara Paterson-Brown
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Perdarahan Postpartum
Definisi Perdarahan berlebih yang menyebabkan keluhan
pada pasien (semisal pusing, vertigo, sinkop)
dengan atau tanpa tanda-tanda hipovolemia
(hipotensi, takikardia atau oliguria)
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Perdarahan Postpartum
Definisi • Perdarahan ≥ 500 ml setelah bayi lahir
pada persalinan pervaginam
• Perdarahan ≥ 1000 ml pada bedah caesar
• Penurunan hematokrit ≥ 10%
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Perdarahan Postpartum
Definisi • Perdarahan ≥ 500 ml setelah bayi lahir
pada persalinan pervaginam
• Berat (severe) bila ≥ 1000 ml
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Perdarahan Postpartum
Definisi • Dini / Primer Terjadi dalam waktu 24 jam postpartum
• Lanjut / sekunder Terjadi setelah 24 jam sampai 6 minggu postpartum
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Perdarahan Postpartum
Epidemiologi • Definisi berbeda-beda
• Estimasi visual sering tidak akurat
• Kecenderungan insidens makin meningkat baik di negara maju maupun berkembang
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http://www.biomedcentral.com/1417-2393/9/55
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Perdarahan Postpartum
Epidemiologi
Faktor penyebab meningkatnya insiden :
• Bedah caesar
• Induksi persalinan
• Augmentasi persalinan
• Kehamilan ganda
• Kehamilan pada usia ekstrim
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Perdarahan Postpartum
Epidemiologi
• Komplikasi yang paling sering terjadi dalam kehamilan dan persalinan
• Berhubungan dengan mortalitas dan morbiditas maternal
• Salah satu penyebab tersering perawatan intensive peripartum
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Perdarahan Postpartum
Epidemiologi Morbiditas maternal yang potensial terjadi :
• Acute renal failure
• Acute respiratory failure
• Sepsis
• Coagulopathy
• Hysterectomy
• Prolonged mechanical ventilation (≥ 96 hours)
• Length of hospitalization > 7 days
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Anesth Analg 2010 (110) : 1368-73
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4 T
ETIOLOGI
• Tone 70%
• Trauma 20%
• Tissue 10%
• Thrombin 1%
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Perdarahan Postpartum
Faktor risiko (antepartum) • Riwayat perdarahan postpartum
• Solusio plasentae
• Plasenta previa
• IUFD
• Preeklampsia
• Overdistensi uterus
• Kelainan darah
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Faktor risiko (intrapartum) • Persalinan dgn tindakan
• Partus lama
• Partus presipitatus
• Persalinan dgn induksi
• Infeksi
• Distosia bahu
• Kelainan darah yang didapat
Perdarahan Postpartum
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Faktor risiko (postpartum)
• Laserasi atau episiotomi
• Plasenta restan
• Ruptura uteri
• Inversio uteri
• Kelainan darah yang didapat
Perdarahan Postpartum
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Penyebab tersering perdarahan postpartum
Faktor risiko :
• Overdistensi uterus (hidramnion, kehamilan ganda, makrosomia)
• Kelelahan miometrium (partus lama, paritas tinggi)
• Infeksi intraamnion
• Kelainan fungsional / anatomis uterus (anomali uterus, plasenta previa)
Perdarahan Postpartum (tone)
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Anesth Analg 2010 (110) : 1368-73
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Penyebab tersering setelah atonia uteri
Faktor risiko :
• Laserasi serviks atau vagina (partus presipitatus, persalinan dgn tindakan)
• Hematoma
• Ruptura uteri (spontan, trauma, bekas bedah caesar)
• Perluasan irisan bedah caesar (malposisi, deep engagement)
Perdarahan Postpartum (trauma)
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Faktor risiko :
• Retained blood clots (atonic uterus)
• Retained products (abnormalitas plasenta, riwayat pembedahan uterus, paritas tinggi)
Perdarahan Postpartum (tissue)
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Faktor risiko :
• Pre-existing states (hemophilia, Von Willebrand’s)
• Terapi antikoagulan
• Didapat selama kehamilan (ITP, preeklampsia, DIC)
Perdarahan Postpartum (thrombin)
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Courtesy of Sara Paterson-Brown
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