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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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A proposed standardized system for reporting postpartum ultrasound scan. Adapted from Neill et al.,
200224
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Endometritis
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Retained Placental
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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/i Temperatur = 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 vaginal delivery 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 chorioamnionitis was 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.
Grading Placenta
Analisa Kasus
Late PPH: 2 minggu Perbaiki KU Antibiotika 12 24 jam Uterotonika Evakuasi dengan kuretase.
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