Kehamilan Post Date

KASUS
Identitas Pasien :
Nama
: Ny. A
Usia
: 26 th
Alamat
: Pengaron, Mojowarno
Tgl. Masuk : 18 September 2015

ANAMNESA
Pasien kiriman dari pkm mojowarno dengan G2 P1001 UK
42-43 minggu, mengeluh kenceng-kenceng tadi pagi
jam 01.00 s/d jam 04.00, darah lendir (-), ketuban (-).
RPD : hipertensi (-), DM (-)
Riwayat Menikah 1x selama 6 tahun
Riwayat Obstetri :
I: 9bln/3000gram/laki-laki/Spt B/RS/4,5th
II:hamil ini
Riwayat ANC: Bidan 5x, USG dokter 1x
HPHT : 3-12-2014
HPL : 10-9-2015
UK : 41/42minggu

Pemeriksaan Fisik
KU: baik, sadar, tidak anemis.
Vital sign :
TD :110/80 mmHg
N : 88x/mnt
R : 20x/mnt
t
: 36
Palpasi : janin tunggal memanjang
LI : teraba bokong, TFU : 30 cm
LII : puka, DJJ 153X/menit
LIII : teraba kepala, sudah masuk panggul
LIV : kepala teraba 4/5 bagian
TBJ : 3500 gram
DJJ (+)
HIS (-)
VT: 1cm/25%/letkep/SS mel/H-I/UPD~N/ket(+)

Diagnosis :
GII p1001 uk 41/42 THIU + letkep + tak inpartu
+ post date + tbj 2790 gr

Terapi :
NST, bila NST baik dan ketuban cukup, pro
terminasi~PS
Bila inpartu Pro spt B
Misoprostole 4x50mg/Vag/6jam s/d PS5
Bila PS 5, pro OD
Mx:kel/VS/his/DJJ/UC

Evidence Based
Management for Post Date
Pregnancy
1. First trimester ultrasound
should be offered, ideally

between 11 and 14 weeks, to all women, as it is a more

accurate assessment of gestational age than last menstrual
period with fewer pregnancies prolonged past 41+0 weeks.
2. If there is a difference of greater than 5 days between
gestational age dated using the last menstrual period and
first trimester ultrasound, the estimated date of delivery
should be adjusted as per the first trimester ultrasound.
3. If there is a difference of greater than 10 days between
gestational age dated using the last menstrual period and
second trimester ultrasound, the estimated date of delivery
should be adjusted as per the second trimester ultrasound.
4. When there has been both a first and second trimester
ultrasound, gestational age should be determined by the
earliest ultrasound.

 5. Women should be offered the option of membrane

sweeping commencing at 38 to 41 weeks, following a
discussion of risks and benefits.
6. Women should be offered induction at 41+0 to 42+0
weeks, as the present evidence reveals a decrease in
perinatal mortality without increased risk of Caesarean
section.
7. Antenatal testing used in the monitoring of the 41- to
42-week pregnancy should include at least a non-stress
test and an assessment of amniotic fluid volume.
8. Each obstetrical department should establish
guidelines dependent on local resources for scheduling
of labour induction.
J Obstet Gynaecol Can 2008;30(9):800810

Definisi Post date

pregnancy
Postterm pregnancy is defined as pregnancy that
has extended to or beyond 42 weeks of gestation
(294 days), or estimated date of delivery (edd) +14
days (ACOG, 2004). The terms prolonged
pregnancy,
postdates
and
postdatism
are
synonymously used to describe the same condition.
The terms postdate and prolonged pregnancy are
ill-defined and best avoided (ACOG, 2004).

Etiologi
The most common cause of
prolonged pregnancies is inaccurate
dating (Neilson, 2000; Crowley,
2004).

Postterm pregnancy is associated with significant

risks to the mother. There is an increased risk of:
1) labour dystocia (9-12% versus 2-7% at term);
2) severe perineal lacerations (3rd & 4th degree tears),
related to macrosomia (3.3% versus 2.6% at term);
3) operative vaginal delivery; and 4) doubling in caesarean
section (CS) rates (14% versus 7% at term) (Rand et al.,
2000; Campbell et al., 1997; Alexander et al., 2000; Treger
et al., 2002).
Caesarean delivery is associated with higher incidence of
endometritis, haemorrhage, and thromboembolic disease
(Alexander et al., 2001; Eden et al., 1987).