REFERAT USG DALAM KEHAMILAN

PEMBIMBING : Dr.DODDY RODIAT, Sp.OG PENYUSUN : NOR FATEHAH BT HAMDAN SUBBIHAH BT KAMARALARIFIN 030.08.292 030.08.306

KEPANITERAAN KLINIK OBSTETRIK DAN GINEKOLOGI RUMAH SAKIT UMUM DAERAH KARA ANG

PERIODE !3 "ANUARI # 22 MARET 20!$ FAKULTAS KEDOKTERAN UNI%ERSITAS TRISAKTI

"AKARTA

DAFTAR ISI

BAB I. PENDAHULUAN ...........................................................................................3 BAB II. ULTRASONOGRAFI DALAM KEHAMILAN i. Fisika Dasar Gelomba ! S"ara##..##############...## $%& ii.Bioe'ek Gelomba ! Ul(raso ik###################.)%* iii.Tek ik Pemeriksaa USG#####################.*%+ i,.I -ikasi Pemeriksaa USG####################...%/0 ,.USG Ke1amila Trimes(er I###################../0%0/ ,i.Kelai a Pa-a Ke1amila Trimes(er I################0/%03 ,ii.Pe a2isa Kelai a Ba3aa ###################..03%0* ,iii.Pemeriksaa USG Trimes(er II%III###############.#0*%3/ i4.Pe e ("a -a Per("mb"1a Besar 5a i ##############..3/%30 4.Pemeriksaa 6aira Am io ###################.30%3) 4i.Pemeriksaa Plase (a######################.3)%3+ BAB III 7 Kesim2"la BAB I87 Da'(ar P"s(aka

BAB I PENDAHULUAN Pemeriksaa "l(raso o!ra'i 9USG: mer"2aka s"a(" me(o-e -ia! os(ik

-e !a me !!" aka !elomba ! "l(raso ik " ("k mem2ela;ari mor'olo!i -a '" !si s"a(" or!a ber-asarka !ambara eko -ari !elomba ! "l(raso ik <a ! -i2a ("lka ole1 or!a . Se;ak -i2erke alka 2er(ama kali -i bi-a ! obs(e(rik ole1 Ia Do al- seki(ar &= (a1" <a ! lal"> USG (ela1 me !alami 2erkemba !a <a ! sa !a( 2esa(> baik -alam 1al (ek ik ma"2" k"ali(as resol"si <a ! -i1asilka . Hal i i (ela1 memba3a kema;"a <a ! sa !a( -rama(is -i -alam 1al -ia! osis -a 2e a !a a ke1amila . Mor'olo!i -a '" !si or!a ;a i -a2a( -i2ela;ari se?ara kasa( ma(a -e !a me !!" aka USG 0%-ime si 9USG 0%D: ;e is real-time. F" !si 1emo-i amik "(er"s%2lase (a%;a i -a2a( -i2ela;ari -e !a lebi1 m"-a1 -a ak"ra( -e !a (ek ik 2emeriksaa Do22ler 9color Do22ler -a pulsed Do22ler:. Dalam -eka-e (erak1ir i i (ela1 -ikemba !ka (ek ik 2emeriksaa USG 3%-ime si 9USG 3%D:> baik ;e is 3%D s(a(ik ma"2" 3%D real%(ime 9USG $%-ime si a(a" li,e 3%D:. Melal"i 3%D mor'olo!i> 2erilak"> -a sirk"lasi ;a i %2lase (a -a2a( -i2ela;ari -e !a lebi1 m"-a1 -a ;elas ber-asarka as2ek 3 -ime si. Di I -o esia 2emeriksaa USG (i-ak -iker;aka se?ara r"(i 2a-a se(ia2 ib" 1amil. Hal i i lebi1 -isebabka ole1 bia<a 2emeriksaa USG <a ! masi1 ?"k"2 ma1al -a (i-ak (er;a !ka" ole1 seba!ia besar ib" 1amil <a ! memerl"ka <a. Seba!ia besar ib" 1amil (i-ak -ili -" !i ole1 2ro!ram as"ra si kese1a(a . 9BUKU MERAH: Ul(raso o!ra'i a(a" so o!ra'i 9USG: a-ala1 seb"a1 (ek ik <a ! mem,is"alisasika s(r"k("r s"2er'isial a(a" -alam 2a-a ("b"1 -e !a merekam -e <"( -ari !elomba ! "l(raso ik <a ! -ire'leksika -ari ;ari !a . USG -alam obs(e(rik mer"2aka 2emeriksaa "l(raso" - -alam ke1amila . Me "r"( @HO> 2emeriksaa USG " ("k ke2erl"a a (e a(al> sebaik <a -ilak"ka ses"ai "sia !es(asi> sa(" kali 2a-a (rimes(er 2er(ama> sa(" kali 2a-a (rimes(er ke-"a> -a sa(" kali 2a-a (rimes(er ke (i!a.

Selebi1 <a -ilak"ka

bila a-a i -ikasi se2er(i 2e?a1 ke("ba

sebel"m 3ak(" <a>

ke1amila le3a( 3ak(" -a seba!ai <a. 9NAD: BAB II ULTRASONOGRAFI DALAM KEHAMILAN I. F&'&() D)')r G*+,-.)/0 S1)r) Frek"e si !elomba ! s"ara <a ! -a2a( -i-e !ar ole1 (eli !a ma "sia berkisar a (ara 0&HA%0=kHA. Frek"e si !elomba ! s"ara -i a(as 0=kHA -iseb"( !elomba ! "l(raso ik. / kiloHer(A 9kHA: B /=3 Her(A 9HA: a(a" /=3 !e(ar 2er -e(ik I Me!aHer(A 9MHA: B /=3 kHA B /=) HA Semaki (i !!i 'rek"e si !elomba ! s"ara> 2a ;a ! !elomba ! <a aka

semaki 2e -ek. Semaki 2e -ek 2a ;a ! !elomba ! s"ara <a ! -i(ra smisika ke -alam me-i"m> -a<a 2e e(rasi <a aka semaki berk"ra !. Pa-a 2emeriksaa USG> semaki 2e -ek 2a ;a ! !elomba ! <a ! -i(ra smisika ke -alam me-i"m> -a<a resol"si <a aka semaki baik. Da<a resol"si a-ala1 kemam2"a membe-aka 0 (i(ik (er-eka( se?ara (er2isa1. Frek"e si !elomba ! "l(raso ik <a ! -i!" aka 2a-a ala( USG -ia! os(ik -ises"aika -e !a ke2erl"a . Pemeriksaa USG 2a-a ke1amila (rimes(er II -a III -ilak"ka melal"i -i -i ! 2er"( ib" 9(ra sab-omi al:. Frek"e si !elomba ! berkisar a (ara 3%& MHA> <a ! mam2" memberika "l(raso ik <a ! -i!" aka

ke-alama 2e e(rasi 1i !!a /&%0= ?m. Pa-a ke1amila (rimes(er I 2emeriksaa USG 2ali ! baik -iker;aka melal"i ,a!i a 9(ra s,a!i al:. Frek"e si !elomba ! "l(raso ik <a ! -i!" aka a-ala1 *>& M1A a(a" lebi1> <a ! mem2" <ai ke-alama 2e e(rasi seki(ar &%/= ?m> (e(a2i memberika k"ali(as resol"si <a ! lebi1 baik. Pa-a 2eris(i3a 2eramba(a !elomba ! s"ara> <a ! -i1a (arka ole1 me-i"m a-ala1 e er!i meka is -ari !elomba ! s"ara. Ba <ak <a e er!< meka is <a ! -i1a (arka se(ia2 -e(ik melal"i s"a(" bi-a ! me-i"m (e!ak l"r"s (er1a-a2 ara1 ramba( !elomba ! s"ara -iseb"( i (e si(as !elomba ! s"ara. Selama mele3a(i me-i"m> i (e si(as !elomba ! s"ara me !alami 2e !"ra !a <a ! besar <a semaki

ber(amba1 -e !a

semaki

;a"1 <a ;arak <a ! -i(em2"1 ole1 !elomba ! s"ara.

Peris(i3a i i -iseb"( a(e "asi. Ter;a-i <a a(e "asi -a2a( -isebabka ole1 meka isme re'leksi> re'raksi> absorbsi> -a 2emba"ra 9s?a((eri !: !elomba ! s"ara. Re'leksi a-ala1 meka isme 2ema ("la aka semaki i (e si(as !elomba ! s"ara ole1 -i -alam

2erm"kaa me-i"m. Semaki besar i (e si(as !elomba ! s"ara <a ! -i2a ("lka > se-iki( i (e si(as !elomba ! s"ara <a ! -i(ra smisika ("la ! mer"2aka me-i"m. U-ara -a me-i"m <a ! mem2" <ai -a<a re'lek(or

sa !a( k"a(> se1i !!a s"li( -ilal"i ole1 !elomba ! s"ara. 6aira > -ara1 -a berba!ai ;ari !a l" ak ("b"1 memiliki -a<a re'lek(or <a ! lema1> se1i !!a m"-a1 -ilal"i ole1 !elomba ! s"ara. Bila !elomba ! s"ara me ?a2ai 2erm"kaa me-i"m lai <a ! berbe-a si'a( ak"s(ik <a -a -alam ara1 <a ! (i-ak (e!ak l"r"s> maka i (e si(as <a ! -i(ra smisika aka -i"ba1 ara1 <a. Per"ba1a ara1 i i aka me !ik"(i 1"k"m S ell> -a 2eris(i3a i i -iseb"( re'raksi. Absorbsi mer"2aka meka isme 2er"ba1a e er!i meka is 9i (e si(as: !elomba ! s"ara me ;a-i e er!i 2a as. 5ari !a ("la ! memiliki -a<a absorbs <a ! k"a(C se-a !ka ?aira D-ara1 -a ;ari !a l" ak mem2" <ai -a<a absorbs <a ! lema1. Meka isme 2emba"ra (er;a-i a2abila !elomba ! s"ara melal"i 2erm"kaa me-i"m <a ! (i-ak ra(a> a(a" melal"i me-i"m ber"2a 2ar(ikel%2ar(ikel kasar> maka !elomba ! s"ara aka bera("ra . Pe !ar"1 a(e "asi -alam 2emeriksaa USG a-ala1 seba!ai berik"( 7 A(e "asi aka memba(asi kemam2"a ala( USG -alam memeriksa s(r"k("r ;ari !a ("b"1 1a <a sam2ai 2a-a (i !ka( ke-alama (er(e (" A(e "asi berbe-a 2a-a berba!ai ;ari !a ("b"1 -a memberika !ambara USG <a ! berbe-a. 5ari !a !ambara <a ! berbe-a. A(e "asi -a2a( me imb"lka !ambara ar(i'ak <a ! -a2a( mem2ers"li( ("b"1 masi !%masi ! memiliki koe'isie a(e "asi <a ! berbe-a> se1i !!a 2a-a 2emeriksaa USG aka memberika -i2a ("lka ke berba!ai ara1 se?ara (i-ak

2emeriksaa USG -a me <ebabka kesala1a -ia! osis.

Ala( USG (i-ak -a2a( -i!" aka " ("k memeriksa s(r"k("r ;ari !a ("la ! a(a" or!a <a ! berisi "-ara a(a" !as 92ar">"s"s:. Or!a ;a i (i-ak berisi !as> se1i !!a 2emeriksaa 2ar" -a "s"s ;a i -a2a( -iker;aka -e !a USG.

II. B&,*2*( 0*+,-.)/0 1+3r)',/&( Pa-a 2eris(i3a 2eramba(a !elomba ! "l(raso ik> -i -alam me-i"m (er;a-i 2er"ba1a %2er"ba1a siklik ber"2a !e(ara 2ar(ikel> 2er"ba1a (eka a > 2er"ba1a -e si(as> -a 2er"ba1a s"1". Se?ara (eori(is> !elomba ! "l(raso i? mem2" <ai 2o(e si <a ! -a2a( mer"sak s(r"k("r ;ari !a ("b"1 ;a i > (er"(ama 2a-a ke1amila (rimes(er I -ima a 2roses or!a o!e esis se-a ! (er;a-i -a mer"2aka saa( <a ! 2ali ! re (a " ("k me !alami !a !!"a . Ker"saka ;ari !a ("b"1 <a ! (er;a-i (er"(ama akiba( 2e !ar"1 2a as 9e'ek (ermal: -a ka,i(as 9e'ek meka is: <a ! -i(imb"lka ole1 !elomba ! "l(raso i?. E'ek (ermal <a ! (er;a-i akiba( absorbsi !elomba ! "l(raso i? ole1 ;ari !a ("b"1. Pe i !ka(a s"1" <a ! (er;a-i akiba( 2ema2ara !elomba ! "l(raso i? -i -alam s"a(" ;ari !a -i(e ("ka ole1 karak(eris(ik ak"s(ik 9i (e si(as> 'rek"e si> l"as 2erm"kaa (ra s-"ser> 'o?"s !elomba ! "l(raso i?> lama 2ema2ara > -sb: -a ;ari !a > s(r"k("r a a(omi> ke?e2a(a !elomba ! "l(raso i?> -sb:. 5ari !a ("la ! 2ali ! ba <ak me <era2 !elomba ! "l(raso i?> se1i !!a karak(eris(ik ;ari !a 9(a1a a ak"s(ik> absorbsi> 2er'"si ;ari !a > ko -"k(i,i(as 2a as -i -alam

2ali ! ba <ak me !alami 2er"ba1a 2a as. Semaki besar i (e si(as 92o3er: -a 'rek"e si !elomba ! "l(raso i? <a ! -i(a smisika ke -alam ;ari !a > maka 2a as <a ! -i(imb"lka 2a-a ;ari !a aka semaki besar. Per'"si ;ari !a ole1 2ema2ara -a ko -"k(i,i(as 2a as -i -alam ;ari !a mer"2aka meka isme <a ! 2ali ! -omi a -alam me !"ra !i e'ek (ermal <a ! -i(imb"lka !elomba ! "l(raso i?. Hi2er(ermia <a ! (er;a-i 2a-a masa or!a o!e esis -a2a( me imb"lka ?a?a( 2a-a ;a i 9(era(o!e ik:> 2er("mb"1a ;a i (er1amba(> -a kema(ia ;a i . Ole1 kare a e'ek (ermal i i> 2emeriksaa USG obs(e(ri? sebaik <a -i1i -ari 2a-a ib" <a ! se-a ! me !alami -emam> (er"(ama 2a-a ke1amila (rimes(er I. Ka,i(asi (er;a-i bila !elomba ! "l(raso i? -i(ra smisika (eka a -ari !elomba ! "l(raso i? me <ebabka ke -alam s"a("

me-i"m <a ! me !a -" ! i (i%i (i berisi !as 9mi?rob"bble:. Osilasi am2li("-o i (i%i (i !as me !alami 2roses

kom2resi 9-iame(er me !e?il akiba( (eka a membesar akiba( (eka a

2osi(i': -a

-ekom2resi 9 -iame(er

e!a(i': (er"s% me er"s. A2abila am2li("-e (eka a ?"k"2

besar> i (i%i (i !as aka me !alami ker"saka 9kola2s:. Peris(i3a i i -iseb"( i er(ial ?a,i(a(io 9(ra sie ( ?a,i(a(io a(a" ?olla2se ?a,i(a(io :. E er!< ki e(ik <a ! (er;a-i akiba( kola2s <a i (i !as aka me imb"lka reaksi 2a as -a 2er"ba1a (eka a <a ! ?"k"2 (i !!i. Pa-a bi a(a ! 2er?obaa > i er(ial ?a,i(a(io -ike(a1"i -a2a( me <ebabka 2aralisis> ker"saka sel 9lisis:> -a 2embe ("ka ra-ikal bebas <a ! bersi'a( (oksik -a -a2a( me imb"lka ker"saka <a ! irre,ersible 2a-a kromosom -a bebera2a s<s(em e Aim. A2abila osilasi am2li("-e (eka a !elomba ! "l(raso i? (i-ak (erlal" besar> -iame(er i (i%i (i !as rela(i' s(abil (i-ak me !alami kola2s. Fe ome a i i -iseb"( s(able ?a,i(a(io . Osilasi <a ! (er;a-i 2a-a i (i%i (i !as -a2a( me imb"lka !elomba ! mikro 9mi?ros(reami !: <a ! -i2a ?arka seki(ar <a -a me imb"lka 2a as. III.T*(/&( p*-*r&('))/ USG Pemeriksaa USG obs(e(ri? -a2a( -iker;aka melal"i ?ara (ra sab-omi al -e !a ke?e2a(a (i !!i ke me-i"m

9USG%TA: a(a" (ra s,a!i al 9USG%T8:. a) Pemeriksaan USG Transabdominal Tra s-"ser 92robe: <a ! -i!" aka " ("k 2emeriksaa USG%TA a-ala1 ;e is li ear a(a" ko ,eks. Tra s-"ser ;e is ko ,eks lebi1 2o2"lar -i!" aka 2a-a saa( i i kare a -a2a( me am2ilka la2a ! 2a -a !a <a ! lebi1 l"as -iba -i !ka ;e is li ear. Pemeriksaa USG%TA (er"(ama -iker;aka 2a-a (rimes(er II -a III. Pa-a ke1amila (rimes(er I 2emeriksaa USG%TA sebaik <a -iker;aka

melal"i ka -" ! kemi1 <a ! (erisi 2e "1 9se1i !!a -iseb"( ;"!a 2emeriksaa USG (ra s,esikal:> !" a <a " ("k me <i !kirka "s"s kel"ar -ari ro !!a 2el,i?> se1i !!a (i-ak me !1ala !i 2emeriksaa !e i(alia i (er a. Massa "s"s <a ! berisi !as aka me !1amba( (ra smisi !elomba ! "l(raso i?. Sebel"m mem"lai 2emeriksaa > -i -i ! ab-ome ab-ome . ib" 1ar"s -il"m"ri !el

" ("k l"brikasi -a me !1ila !ka "-ara -ia (ara 2erm"kaa (ra s-"ser -a -i -i !

Pemeriksaa USG%TA mem2" <ai bebera2a ker"!ia . Ka -" ! kemi1 <a ! 2e "1 aka me !!a !!" ke <ama a 2asie -a 2emeriksa. Ka -" ! kemi1 <a ! (erlam2a" 2e "1 aka me -esak !e i(alia i (er a ke 2os(erior> se1i !!a le(ak <a -il"ar -a<a ;a !ka" (ra s-"ser. U(er"s m"-a1 me !alami ko (raksi> se1i !!a ka (" ! !es(asi -i -alam "(er"s ik"( (er(eka -a be ("k <a me !alami -is(orsi. Kea-aa % kea-aa i i aka mem2ers"li( 2emeriksaa . A-a <a m"-i!a1 -i -alam ka (" ! !es(asi -a2a( l"2"( -ari 2emeriksaa . Pemeriksaa USG%TA (a 2a 2ersia2a ka -" ! kemi1 2a-a (rimes(er I -a2a( -iker;aka -e !a ?"k"2 mem"aska 2a-a 2asie <a ! k"r"s> -e !a -i -i ! 2er"( <a ! (i2is -a "(er"s a (e,ersi. Pa-a ke1amila (rimes(er II -a III "(er"s (ela1 ?"k"2 besar -a le(ak <a -i l"ar ro !!a 2el,ik. 8ol"me ?aira am io s"-a1 ?"k"2 ba <ak. Pemeriksaa USG% TA -a2a( -iker;aka (a 2a memerl"ka 2ersia2a ka -" ! kemi1. b) Pemeriksaan USG Transvaginal Berbe-a -e !a kea-aa USG%TA> 2emeriksaa USG%T8 1ar"s -ilak"ka -alam

ka -" ! kemi1 <a ! koso ! a!ar or!a

2el,i? bera-a -eka( -e !a

2erm"kaa (ra s-"ser -a bera-a -alam area 2e e(rasi (ra s-"ser. 5ika -iba -i !ka USG%TA 9<a ! 1ar"s -iker;aka -alam kea-aa ka -" ! kemi1 2e "1:> 2emeriksaa USG%T8 2a-a ke1amila (rimes(er I lebi1 -a2a( -i(erima ole1 2asie . Pemeriksaa USG%T8 -a2a( -ilak"ka se(ia2 saa(> -a or!a 2el,i? bera-a -alam 2osisi <a ! sebe ar <a. Dalam 2emeriksaa eleme -ib" !k"s -e !a (ra s-"ser (erlebi1 -"l" -iberi ;el 2a-a 2erm"kaa "-ara -i 2erm"kaa (ra s-"?er:> kem"-ia

<a 9" ("k me !1ila !ka

ala( 2emb" !k"s k1"s"s a(a" ko -om 9ber'" !si seba!ai ala( -a me !1ila !ka "-ara -ia (ara

2eli -" !:. Sebel"m -imas"kka ke -alam ,a!i a> ";" ! 2emb" !k"s (ra s-"ser -iberi ;el la!i 9ber'" !si seba!ai l"brika 2erm"kaa eleme (ra s-"ser -a ser,iks "(eri:. Tra s-"ser -imas"kka ke -alam ,a!i a 1i !!a me ?a2ai -aera1 'or iks. Ma",er !eraka (ra s-"ser -i -alam ,a!i a mer"2aka kombi asi !eraka ma;"%m" -"r> !eraka ma e",er 9ro(asi:> -a !eraka a !"lasi ke sam2i ! kiri%ka a a(a" ke a(as%ba3a1.

I%. INDIKASI PEMERIKSAAN USG a) Indikasi pemeriksaan USG pada kehamilan trimester I Pa-a 2emeriksaa USG (rimes(er 2er(ama> (er"(ama ;ika 2asie 1amil -e !a "sia !es(asi -i ba3a1 /= mi !!"> 2e !!" aa USG (ra s,a!i al a-ala1 me(o-e <a ! lebi1 baik -ari2a-a me !!" aka USG (ra sab-omi al. Kare a keak"ra(a USG (ra s,a!i al 2a-a "sia ke1amila m"-a lebi1 ak"ra( -ari2a-a USG (ra sab-omi al. Ea ! 1ar"s -i ilai ole1 2emeriksa -alam melak"ka 2emeriksaa USG (rimes(er I a-ala17 /. Pe e ("a a-a <a ke1amila i (ra"(eri e 0. Pe e ("a a-a <a -e <"( ;a (" ! m"-i!a1 a(a" ;a i 3. Pe e ("a "sia ke1amila $. Pe e ("a ke1amila kembar &. Per-ara1a 2er,a!i am ). Ter-"!a ke1amila ek(o2ik *. Ter-a2a( <eri 2el,i? +. Ter-"!a ke1amila mola .. Ter-"!a a-a <a ("mor 2el,i? a(a" kelai a "(er"s /=. Memba (" (i -aka i ,asi,e> se2er(i 2e !ambila sam2el ;ari !a ,ili

koriales 9?1oria i? ,ill"s sam2li !:> 2e !a !ka(a IUD

b) Indikasi pemeriksaan USG pada kehamilan trimester II dan III Bebera2a i -ikasi 2emeriksaa USG 2a-a ke1amila (rimes(er II -a III> misal <a 7 /. Pe e ("a "sia ke1amila 0. E,al"asi 2er("mb"1a ;a i 3. Ter-"!a kema(ia ;a i $. Ter-"!a ke1amila kembar &. Ter-"!a kelai a ,ol"me ?aira am io ). E,al"asi kese;a1(eraa ;a i *. Ke("ba 2e?a1 -i i a(a" 2ersali a 2re(erm +. Pe e ("a 2rese (asi ;a i .. Memba (" (i -aka ,ersi l"ar /=. Ter-"!a i kom2e(e sia ser,iks //. Ter-"!a 2lase (a 2re,ia

10

/0. Ter-"!a sol"sio 2lase (a /3. Ter-"!a ke1amila mola /$. Ter-a2a( <eri 2el,i? a(a" <eri ab-ome /&. Ter-"!a ke1amila ek(o2ik /). Ke?"ri!aa a-a <a kelai a kromosomal 9"sia ib" F3& (a1" > a(a" 1asil (es biokimia3i ab ormal: /*. E,al"asi kelai a ?o !e i(al /+. Ri3a<a( kelai a ?o !e i(al 2a-a ke1amila sebel"m <a /.. Ter-"!a a-a <a ("mor 2el,i? a(a" kelai a "(er"s 0=. Memba (" (i -aka am ioi '"si. i ,asi,e se2er(i am iose (esis> kor-ose (esis a(a"

11

12

%. U+3r)',/,0r)2& K*4)-&+)/ Tr&-*'3*r ! De !a Kantung Gestasi USG%T8 <a ! ?"k"2 baik k"ali(as <a> s(r"k("r ka (" ! !es(asi 9KG:

i (ra"(eri e -a2a( (erli1a( m"lai ke1amila $>& mi !!" 9/* 1ari 2as?ako se2si> a(a" seki(ar /= 1ari se;ak blas(osis ber i-asi ke -alam la2isa e -ome(ri"m:. Pa-a saa( i(" -iame(er <a me ?a2ai 0%3 mm. S(r"k("r KG i (ra"(eri e se?ara ko sis(e (erli1a( m"lai ke1amila & mi !!". Saa( -iame(er <a me ?a2ai F& mm &. De !a USG%TA ke1amila i (ra"(eri e -a2a( (erli1a( se(ela1 -iame(er KG me ?a2ai &mmC -a se?ara ko sis(e (erli1a( m"lai ke1amila ) mi !!"> saa( -iame(er KG me ?a2ai F /=mm). Ka (" ! !es(asi (erli1a( seba!ai s(r"k("r kis(ik 9a ekoik: berbe ("k b"-ar a(a" o,al> -e !a -i -i ! <a ! 1i2erekoik> -a le(ak <a ekse (rik -i -alam la2isa e -ome(ri"m <a ! me ebal. S(r"k("r (erseb"( berasal -ari ka (" ! korio <a ! berisi ?aira korio . Gambara 1i2erekoik -i -i ! KG berasal -ari la2isa korio > ;ari !a (ro'oblas> -a -esi-"a ka2s"laris. Seri !kali -i -i ! KG (erli1a( seba!ai 0 la2isa ko se (rik 9-o"ble -e?i-"al sa?:> -ima a la2isa sebela1 -alam berasal -ari ?1orio

13

lea,e -a -esi-"a ka2s"laris> se-a !ka la2isa sebela1 l"ar berasal -ari -esi-"a 2arie(alis a(a" -esi-"a ,era. S(r"k("r KG 1ar"s -ibe-aka -ari s(r"k("r a ekoik lai !es(asi 2als" 92se"-o%!es(a(io al sa?: 2a-a ke1amila ek(o2ik. Yolk sac S"a(" ke1amila i (ra"(eri e bar" -a2a( -i2as(ika se(ela1 (erli1a( s(r"k("r <olk sa? -i -alam KG . Yolk sac berbe ("k ?i ?i ber-i -i ! (i2is <a ! le(ak <a -i-alam r"a ! korio . De !a USG%T8 <olk sa? aka ko sis(e (erli1a( m"lai ke1amila &>& mi !!"> saa( -iame(er KG F /= mmC se-a !ka -e !a USG%TA <olk sa? aka ko sis(e (erli1a( m"lai ke1amila ) mi !!" se(ela1 -iame(er KG F0=mm. Selama ke1amila &%/= mi !!" -iame(er <olk sa? me ?a2ai &%) mm. Se(ela1 i(" <olk sa? aka me <"s"( -a 2a-a ke1amila /0 mi !!" biasa <a (i-ak (erli1a( la!i. A2abila <olk sa? (i-ak -i(em"ka -i -alam ka (" ! !es(asi <a ! -iame(er <a G/=mm 9USG%T8: a(a" G0=mm 9USG%TA:> maka kem" !ki a (i-ak aka berkemba ! ormal -a aka me !alami abor("s. Mudigah dan Janin De !a USG%T8 s(r"k("r m"-i!a1 2er(ama kali -a2a( (erli1a( 2a-a ke1amila &>& mi !!"> ber"2a 2e ebala 2a-a seba!ia -i -i ! <olk sa?. Pa ;a ! <a seki(ar 0% 3mm -a bel"m mem2erli1a(ka -e <"( ;a (" !. Pa ;a ! m"-i!a1 aka ber(amba1 seki(ar /%0mm 2er 1ari. Pa ;a ! m"-i!a1 -i <a(aka -e !a "k"ra ;arak ke2ala% boko ! 95KB: a(a" ?ro3 %r"m2 le !(1 96RL:> meski2" mi !!" ba!ia ke2ala -a ba-a sebel"m ke1amila + masi1 bel"m -a2a( -ibe-aka . M"-i!a1 m"lai besar ke1amila <a -i -alam ka,"m

"(eri> se2er(i 1ema(ome(ra> 1i-rome(ra> kis(a e -ome(rial> e -ome(ri(is> a(a" ka (" !

me " ;"kka ak(i,i(as -e <"( ;a (" ! 2a-a "sia ke1amila seki(ar ) mi !!"> se(ela1 5KB me ?a2ai &mm -a -iame(er KG seki(ar /+mm. Se;ak saa( i(" s(r"k("r m"-i!a1 -a ak(i,i(as -e <"( ;a (" ! aka ko sis(e (erli1a( -e !a USG%T8. De !a USG% TA s(r"k("r m"-i!a1 aka ko sis(e (erli1a( se(ela1 -iame(er KGF0&mm.

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Pe !"k"ra -e <"( ;a (" ! m"-i!a1 sebaik <a -ilak"ka melal"i ?ara M% mo-e 9Mo(io mo-e: -a (i-ak -e !a ?ara Do22ler. Frek"e si -e <"( ;a (" !9FD5: m"-i!a1 2a-a ke1amila ) mi !!" seki(ar //= -e <"( 2er me i( 9-2m:> me i !ka( me ?a2ai /*& -2m 2a-a ke1amila . mi !!"> kem"-ia me "r" 1i !!a /)) -2m 2a-a ke1amila /0 mi !!". A2abila FD5 H+= -2m 2a-a ke1amila ) mi !!"C a(a" H/== -2m 2a-a ke1amila F * mi !!"> "m"m <a m"-i!a1 aka ma(i -alam bebera2a 1ari kem"-ia . Is(ila1 m"-i!a1 9embrio: -i!" aka (er1a-a2 1asil ko se2si sam2ai "sia

ke1amila /= mi !!"> <ai(" selama berla !s" ! <a 2roses or!a o!e esis. M"lai "sia ke1amila // mi !!" 1asil ko se2si -iseb"( ;a i 9'e("s:. Masa (ra sisi (er;a-i 2a-a saa( 5KB me ?a2ai 3=%3&mm. Penentuan Usia Kehamilan

Pe e ("a "sia ke1amila melal"i 2emeriksaa USG 2ali ! ak"ra( bila -ilak"ka 2a-a ke1amila (rimes(er I. Pa-a saa( i(" la;" 2er("mb"1a m"-i!a1 2ali ! ?e2a( -a ,ariasi biolo!ik <a 2ali ! ke?il. Sebel"m s(r"k("r m"-i!a1 -a2a( (erli1a(> 2e e ("a "sia ke1amila 2e !"k"ra -ilak"ka melal"i 2e !"k"ra -iame(er ra(a%ra(a ka (" ! !es(asi -i(e ("ka ;a i melal"i s"-a1 9KG:. Se(ela1 s(r"k("r m"-i!a1 (erli1a(> maka "sia ke1amila

2a ;a ! m"-i!a1 95KB:. M"lai (rimes(er I 2er("mb"1a

?"k"2 besar -a ba!ia %ba!ia s2esi'ik ;a i 9se2er(i ke2ala -a eks(remi(as: s"-a1 -a2a( -ili1a( lebi1 ;elas. Se;ak saa( i(" 2e !"k"ra s2esi'ik ;a i > se2er(i -iame(er bi2arie(al 9BPD:. Pe e ("a "sia ke1amila -ilak"ka ber-asarka (abel -a(a a(a" omo!ram <a ! me !!ambarka 1"b" !a a (ara "k"ra biome(ri ;a i -a "sia ke1amila 2a-a ke1amila ormal. Aka lebi1 baik la!i bila -a(a <a ! -i!" aka berasal -ari 2o2"lasi se(em2a(. Pe !"k"ra -iame(er KG " ("k me e ("ka "sia ke1amila 1a <a ak"ra( bila -i!" aka se-er1a aC 2a-a "sia ke1amila &%)>& mi !!". Selai me !!" aka omo!ram 2erkemba !a KG> "sia ke1amila -a2a( ;"!a -i1i(" ! -e !a me !!" aka 'orm"la 5KB (i-ak ak"ra( la!i> -a 2e e ("a "sia ke1amila sebaik <a -ilak"ka melal"i 2e !"k"ra ba!ia %ba!ia

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Usia ke1amila 91ari: B -iame(er KG 9mm: I 3=&

Pe !"k"ra 5KB -ilak"ka m"lai ke1amila ) mi !!"> saa( s(r"k("r m"-i!a1 se?ara ko sis(e (erli1a( melal"i 2emeriksaa USG . 5arak%ke2ala%boko ! mer"2aka 2arame(er <a ! 2ali ! baik -i!" aka " ("k me e ("ka "sia ke1amila > -e !a (i !ka( kesala1a J 3%& 1ari. !. U'&) K*4)-&+)/ $ -&/001

Gambar $7 Pa-a ke1amila $ mi !!" biasa <a 1a <a aka (erli1a( ka (o ! !es(asi ber-iame(er 0%&mm> (er(a am -alam e -ome(ri"m. Eolk Sa? biasa <a bel"m -a2a( (eri-e (i'ikasi. 2. U'&) K*4)-&+)/ 5 -&/001

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Gambar &7 Ka (o ! !es(asi (am2ak -alam ?a,"m "(eri> -ikelili !i e -ome(ri"m> -a berisi embrio <am! (am2ak se2er(i !aris l"r"s me em2el 2a-a <olk sa?. Pa-a "sia ke1amila i i ka-a ! s"-a1 -a2a( (erli1a( -e <"( ;a (" ! ;a i 92"lsasi:

3. U'&) K*4)-&+)/ 6 -&/001

Gambar )7 Be ("k embrio m"lai ber"ba1 -ari l"r"s me ;a-i se-iki( 'leksi. D"?("s ,i(elli "s (am2ak me !1"b" !ka embrio -e !a <olk sa?. Pa ;a ! embrio berkisar $%/=mm $. U'&) K*4)-&+)/ 8 -&/001

Gambar *7 Embrio (am2ak (er2isa1 -ari <olk sa? -a -i1"b" !ka melal"i -"?("s ,i(elli "s> berbe ("k se2er(i 1"r"' K6L -e !a ba!ia ke2ala (am2ak -omi a . M"lai (erli1a( (o ;ola eks(remi(as. 6RL berkisar //%/) mm. S"-a1 m"lai -a2a( -ibe-aka s(r"k("r ke2ala -ari ba!ia ("b"1 ;a i .

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Se(ela1 me !e(a1"i 2eris(i3a%2eris(i3a 2e (i ! 2a-a ke1amila !es(asi> <ai(" 2a-a "sia ke1amila > ka2a me !"k"r <olk sa?.

(rimes(er

2er(ama -ia(as> ki(a -a2a( me <im2"lka ka2a ka1 ki(a m"lai bisa me !"k"r ka (o ! ki(a m"lai bisa me !"k"r 6RL> -a

M*/01(1r K)/31/0 G*'3)'& 6G*'3)3&,/)+ S)7 8 GS9 Pe e ("a "sia !es(asi -e !a me !"k"r ka (o ! !es(asi 1a <a -ilak"ka bila e?1o ;a i bel"m (am2ak Dilak"ka 2a-a "sia ke1amila $%) mi !!" Da2a( -ili1a( se;ak ke1amila (ra sab-omi al Terli1a( seba!ai s(r"k("r kris(ik berbe ("k b" -ar a(a" o,al -e !a -i -i ! $ mi !!" ,ia (ra s,a!i al -a &%) mi !!" ,ia

1i2erekoik> le(ak <a ekse (rik -alam la2isa e -ome(ri"m <a ! me ebal. S(r"k("r (erseb"( berasal -ari ka (o ! korio <a ! berisi ?aira korio . S(r"k("r ka (o ! !es(asi 1ar"s -ibe-aka -e !a s(r"k("r a ekoik lai <a -i

ka,"m "(eri se2er(i 1ema(ome(ra>1i-rome(ra> kis(a e -ome(rial>e -ome(ri(is> a(a" ka (o ! !es(asi 2als" 2a-a ke1amila ek(o2ik. Pe !"k"ra -ilak"ka -ari (e2i ba!ia -alam ke (e2i ba!ia -alam Kesala1a 2e !"k"ra seki(ar /%0 mi !!" Ka -" ! kemi1 2asie (i-ak bole1 (erlal" 2e "1 kare a aka mem2e !ar"1i

be ("k -a 1asil 2e !"k"ra Ges(a(io al Sa? masi1 rele,a D ak"ra( -i"k"r sam2ai "sia ke1amila ) mi !!"

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Gambar +7 me !"k"r ka (o ! !es(asio al M*/01(1r P)/:)/0 K*p)+);B,(,/0 ")/&/ 6<r,=/ R1-p L*/034 8 <RL9 Da2a( -i"k"r 2a-a "sia ke1amila +%/0 mi !!"> sebel"m "sia + mi !!"

ke2ala -a ba-a (i-ak -a2a( -ibe-aka . M"-i!a1 m"lai me " ;"kka ak(i,i(as -e <"( ;a (" ! se(ela1 "sia ke1amila seki(ar ) mi !!". Di"k"r 2a-a 2osisi e(ral 9me -a(ar: Pe !"k"ra -i"k"r -ari ke2ala sam2ai boko ! 5a !a sam2ai eks(remi(as -a <olk sa? ik"( (er"k"r Ti !ka( kesala1a seki(ar &%* 1ari Masi1 rele,a -i"k"r sam2ai "sia !es(asi /0 mi !!"

Gambar .7 me !"k"r ke2ala% boko ! ;a i

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M*/01(1r >&)-*3*r Y,+( S)7 6YS9 Sa(" ke1amila -a2a( -i2as(ika bila (erli1a( s(r"k("r Eolk Sa? -alam KG Normal <a berbe ("k 1am2ir b"la( se2er(i ?i ?i le(ak <a -i -alam r"a ! korio Diame(er seki(ar $%) mm Da2a( -ii-e (i'ikasi 2a-a "sia !es(asi ) mi !!" se(ela1 -iame(er KG F/= mm. Diame(er ma4imal ) mm 2a-a "sia ke1amila /= mi !!" ber-i -i ! (i2is <a !

Gambar /=7 -iamae(er <olk sa? Kehamilan Kembar Kem" !ki a s"a(" ke1amila kembar -a2a( -ike(a1"i se;ak "sia ke1amila & mi !!"> -e !a meli1a( ;"mla1 ka (" ! !es(asi -i -alam ka,"m "(eri. Dia! osis -e'i i(i' ke1amila kembar bar" bole1 -i(e!akka bila (erli1a( lebi1 -ari sa(" m"-i!a1 <a ! me " ;"kka ak(i,i(as -e <"( ;a (" !. Ke1amila kembar bisa berasal -ari 0 b"a1 o,"m <a ! -ib"a1i> -iseb"(

kembar -iAi!o(ik 9DM: a(a" (i-ak%i-e (ikC a(a" -ari seb"a1 o,"m <a ! -ib"a1i -a kem"-ia membela1 me ;a-i 0 ba!ia <a ! masi !%masi ! berkemba ! me ;a-i m"-i!a1> -iseb"( kembar mo oAi!o(ik 9MM: a(a" i-e (ik. Seki(ar *=N ke1amila kembar mer"2aka kembar DM> se-a !ka 3=N lai Ber-asarka korio i(as -a -ikorio ik%-iam io(ik 9DK%DA:C se-a !ka <a mer"2aka kembar MM. kembar am io i(as <a> kembar DM 2as(i mer"2aka

kembar MM bisa ber"2a DK%DA>

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mo okorio ik%-iam io(ik 9MK%DA:> a(a" mo okorio ik%mo oam io(ik 9MK%MA:. 5e is korio i(as -a am io isi(as ke1amila kembar aka sa !a( ber2e !ar"1 (er1a-a2 morbi-i(as -a mor(ali(as 1asil ko se2si. 5e is korio i(as -a am io isi(as ke1amila kembar 2ali ! m"-a1 -ike(a1"i 2a-a ke1amila (rimes(er I. Sam2ai ke1amila /= mi !!"> bila (erli1a( 0 ka (" ! !es(asi <a ! masi !%masi ! berisi m"-i!a1 1i-"2> maka ke1amila kembar (erli1a( DK%DA. Bila 1a <a (erli1a( sa(" ka (" ! !es(asi <a ! berisi 0 m"-i!a1 1i-"2> maka ke1amila kembar (er!olo ! ke1amila MK. Bila 2a-a kembar MK (erli1a( 0 ka (" ! am io <a ! sali ! (er2isa1 -a masi !%masi ! (erisi 0 m"-i!a1 1i-"2> ke1amila kembar (erli1a( MK%MA. Pemeriksaa <olk sa? ;"!a ber!" a " ("k me e ("ka am io isi(as kembar MK. Pa-a kembar MK%DA (erli1a( 0 <olk sa? -i -alam ka (" ! !es(asiC se-a !ka 2a-a kembar MK%MA 1a <a (erli1a( (erli1a( / <olk sa?. Se-a !ka k1orio i(as -a2a( -ili1a( -ari ba(as D seka( a (ara ke-"a am io > a2abila ba(as <a memiliki ke(ebala G0mm 9seri ! -iseb"( 9lamb-a si! : maka ke1amila (erseb"( memiliki -"a k1orio > am" ;ika k"ra ! -ari 0 mm> 9seri ! -iseb"( T si! :> maka ke1amila (erseb"( memiliki sa(" k1orio .

Gambar / 7 Gambara USG 1amil kembar 2a-a "sia !es(asi & mi !!" -e !a -"a ka (" ! !es(asi.

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Gambar 07 Gambara USG 1amil kembar 2a-a "sia !es(asi & mi !!" -e !a -"a <olk sa?.

Gambar 37 Gambara ke1amila kembar 2a-a "sia !es(asi /= mi !!". Pa-a !ambar i i> (erli1a( ba13a ke1amila m"l(i2le <a (er-iri -ari -"a am io > -a -"a k1orio .

%I. KELAINAN PADA KEHAMILAN TRIMESTER I !. K*4)-&+)/ /&r-1>&0)4 6.+&043*> ,?1-,)/*-.r@,/&7 pr*0/)/7@, *-p3@ )-/&,/9 Seri ! -i;"m2ai 2a-a ke1amila (rimes(er I> akiba( ke!a!ala 2embe ("ka m"-i!a1. M" !ki (er;a-i kare a 2erkamba !a m"-i!a1 (er1e (i sebel"m -a2a( (er-e(eksi -e !a USG> a(a" m"-i!a1 ma(i -a me !alami resor2si se1i !!a (i-ak (erli1a( -e !a USG. Seki(ar &=%.=N abor("s <a ! (er;a-i 2a-a ke1amila ole1 ke1amila irm"-i!a1 <a ! seri ! ber1"b" !a irm"-i!a1 -i(e!akka bila 7 (rimes(er / -isebabka

-e !a kelai a kromosom. Dia! osis ke1amila

S(r"k("r m"-i!a1 (i-ak (erli1a( -alam ka (o ! !es(asi 9KG: <a ! -iame(er <a G0& mm -e !a USG%(ra s ab-omi al

Ka (o ! am iom (i-ak berisi m"-i!a1

2. P*r>)r)4)/ p)>) (*4)-&+)/ 3r&-*'3*r I Abor("s immi e s 2a-a ke1amila 2e -ara1a (rimes(er / biasa <a -isebabka ole1

re(rokorio ik <a ! le(ak <a -ibelaka ! korio

'ro -os"m -a

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22e -ara1a s"bkorio ik <a ! le(ak <a -i belaka ! sela2"( korio -a me !isi ka,"m "(eri . Per-ara1a (er;a-i kare a (erle2as <a seba!ia korio 'ro -os"m -ari -i -i ! "(er"s. Pe -ara1a re(rokorio ik -a s"bkorio ik "m" <a (er;a-i bersamaa . Per-ara1a <a ! masi1 bar" (erli1a( 1i2erekoik (er1a-a2 korio se-a !ka <a ! s"-a1 berla !s" ! /%0 mi !!" (erli1a( 1i2oekoik a(a" a ekoik. Gambara USG 2a-a abor("s i si2ie s ber,ariasi (er!a (" ! 2a-a ;"mla1 ke ba!ia ba3a1 ka,"m "(eri> a(a"

2er-ara1a > ko -isi ka (o ! !es(asi> -a -era;a( 2emb"kaa ser,iks. Seri ! kali KG be ("k <a irre!"lar> le(ak <a ("r" me !isi ka alis ser,ikalis <a ! (erb"ka. Gambara abor("s i kom2le("s (i-ak s2esi'ik (er!a (" ! 2a-a "sia ke1amila -a ba <ak <a sisa ;ari !a ko se2si <a ! (er(i !!al -i ka,"m "(eri. Ka,"m "(eri m" !ki berisi KG <a ! be ("k <a (i-ak "("1 la!i. M" !ki ;"!a sisa ko se2si (erli1a( seba!ai massa eko!e ik <a ! (ebal irre!"lar -alam ka,"m "(eri. Pa-a abor("s kom2le("s> sel"r"1 1asil ko se2si (ela1 -ikel"arka -ari ka,"m "(eri. Misse- abor(io mer"2aka kema(ia 1asil ko se2si sebel"m ke1amila 00 mi !!" -a (er(a1a -i ka,"m "(eri selama + mi !!" a(a" lebi1.

3. K*4)-&+)/ -,+) 6M,+) H&>)3&/,')9 Mer"2aka 2e <aki( (ro'oblas !es(asio al <a ! 2ali ! seri ! -i;"m2ai ak1ir masa re2ro-"ksi. Bisa ber"2a kom2li(> <ai("

(er"(ama 2a-a a3al -a m"-i!a1. Gambara

2roli'erasi ;ari !a (ro'oblasC i kom2li(> <ai(" 2roli'erasi (ro'oblas -iser(ai eleme USG mola 2a-a (rimes(er I (i-ak s2esi'ik. Bisa (erli1a( irm"-i!a1 -e !a -i -i ! <a ! me ebal> misseme <er"2ai ke1amila

abor(io > abor("s i kom2le("s> mioma ber-e!e arasi kis(ik> a(a" 1i2er2alsi e -ome(ri"m. Dalam 1al i i 2emeriksaa O%H6G ser"m sa !a( memba (" -alam me e!akka -ia! osis.

$. K*4)-&+)/ *(3,p&(

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Ke1amila ek(o2ik 9KE: a-ala1 ke1amila -ima a im2la (asi blas(osis (er;a-i -il"ar ka,"m "(eri. Bebera2a 'ak(or <a ! ber2e !ar"1 (er1a-a2 KE a-ala17 Ri3a<a( KE sebel"m <a Ko (rase2si IUD Ke!a!ala s(erilisasi Per-a !a 2el,i? Ba<i (ab" ! 9'er(ilisasi i ,i(ro:

Dia! osis -e'i i(i' KE -i(e!akka bila (erli1a( KG (erisi s(r"k("r m"-i!a1 1i-"2 <a ! le(ak <a -i l"ar ka,"m "(eri. Dia! osis KE s"kar -i(e!akka 2a-a 1amil <a ! masi1 m"-a se1i !!a memerl"ka 2emeriksaa serial. Gambara s2esi'ik ke1amila ("ba ber"2a massa eko!e ik berbe ("k sirk"lar -e !a -iame(er /=%3= mm <a ! le(ak <a -i a- eksa. Di ba!ia (e !a1 <a (erli1a( s(r"k("r a ekoik <a ! berasal -ari ka (o ! !es(asi> se1i !!a massa a- eksa membe ("k !ambara ?i ?i .

T)/>) K*0)0)+)/ K*4)-&+)/ Ta -a ke!a!ala ke1amila -a2a( ki(a ke(a1"i -e !a meli1a( berba!ai 1al seba!ai berik"(7 %II. Ke;a-ia 2e (i ! -alam (rimes(er I (i-ak -i(em"ka Diame(er ra(a%ra(a ka (o ! !es(asi >/= mm (a 2a <olk sa? Diame(er ra(a%ra(a ka (o ! !es(asi G/+ mm (a 2a embrio Pa ;a ! 6RL G &mm am" (ak (am2ak -e <"( ;a (" ! PENAPISAN KELAINAN BA AAN

24

Kelai a ko !e i(al> sebe ar <a s"-a1 -a2a( -i2erkiraka m"lai -ari 2emeriksaa (rimes(er 2er(ama. A-a bebera2a 1al 2e (i ! <a ! 2erl" -ike(a1"i -alam me -ia! osis a-a <a kelai a ko !e i(al ma<or 2a-a ;a i 7 /. N"?1al Tra sl"se si 0. Nasal Bo e 3. Fok"s e?1o!e ik i (rakar-ia? $. E?1o!e ik bo3els Em2a( (a -a -i a(as s"-a1 -a2a( -i(e ("ka 2a-a 2e a2isa (rimes(er 2er(ama. De !a me ;"m2ai sala1 sa(" -ari em2a( (a -a -i a(as> kem" !ki a besar ;a i (erseb"( aka me !alami kelai a ?o !e i(al 2a-a saa( la1ir <a. !.N174)+ Tr)/'+1'*/'& /. Pe !"k"ra ke(ebala ;ari !a -i -aera1 (e !k"k 0. Seba!ai -e(eksi -i i kelai a kromosom 9si -roma -o3 : 3. Usia !es(asi /=%/$ mi !!" $. Pe !"k"ra -ilak"ka (e!ak l"r"s (er1a-a2 k"li( (e !k"k ke ara1 l"ar sam2ai -aera1 se2er(i 2i(a (i2is -i a(as k"li( &. Bila NTG3mm > maka ki(a ?"ri!a si -roma -o3

Gambar //a7me " ;"kka

"?1al (ra sl"se si <a ! masi1 -alam ba(as ormal.

25

Gambar // b7me " ;"kka

2e ebala

"?1al <a ! me ?a2ai +.3?m> Hal i i

mer"2aka (a -a ba13a a-a <a kelai a kromosom 2a-a ;a i i i.

2.N)')+ B,/* /. Dilak"ka 2a-a ke1amila //%/$ mi !!" -a 2a ;a ! 6RL $&%+$mm 0. Tam2ila !ambar -i2erbesar 7 (am2ak sel"r"1 ke2ala -a ba!ia a(as (1oraks

3. Po(o !a mi- sa!i(al $. Pa-a -aera1 1i-" ! 1ar"s (am2ak (i!a b"a1 !aris 1i2erek1oik> !aris ba!ia a(as a-ala1 k"li( 1i-" !> -i ba3a1 <a !aris ("la ! 1i-" !> -a <a ! ke(i!a a-ala1 kela ;"(a -ari 1i-" ! <a ! bera-a -i a(as !aris 1i-" !> le(ak <a 1ar"s lebi1 (i !!i

Gambar /0 a7Gambara 1i-" ! ;a i

ormal> -i -aera1 1i-" ! (am2ak (i!a b"a1

!aris 1i2erek1oik> !aris ba!ia a(as a-ala1 k"li( 1i-" !> -iba3a1 <a !aris ("la !

26

1i-" !> -a

<a ! ke(i!a a-ala1 kela ;"(a

-ari 1i-" ! <a ! bera-a -ia(as !aris

1i-" !> <a ! le(ak <a lebi1 (i !!i.

Gambar /0 b7 Gambara ;a i <a ! (i-ak memiliki ("la ! 1i-" !> -ima a 1a <a (erli1a( -"a 1i2erek1oik sa;a. 3.F,(1' *74,0*/&( &/3r)()r>&)7 /. Tam2ak seba!ai s"a(" s(r"k("r <a ! ber3ar a 2"(i1 (era ! 0. Terle(ak 2a-a ,e (rikel kiri 3. Dilak"ka 2a-a "sia !es(asi /=%/$ mi !!" $. Per(a -a kelai a kromosom

Gambar /37 Pa-a !ambara 2o(o !a meli (a ! ;a (" ! 9'o"r ?1amber ,ie3: -i a(as> Nam2ak a-a <a s"a(" s(r"k("r <a ! 1i2erek1oik 2a-a r"a ! ;a (" !> me " ;"kka a-a <a kelai a 2a-a ;a i i i. $.E74,0*/&( .,=*+

27

/. Tam2ak seba!ai massa "s"s <a ! (am2ak lebi1 2a-a( -a ek1o!e ik 92"(i1 (era !:. 0. Per(a -a kelai a kromosom

Gambar /$7 (am2ak massa 2a-a(.

%III. PEMERIKSAAN USG TRIMESTER II DAN III Pa-a 2emeriksaa 2a-a (rimes(er ke-"a -a ke(i!a berbe-a -e !a 2emeriksaa (rimes(er 2er(ama> 2a-a 2emeriksaa i i> ;a i s"-a1 (erbe ("k> -i ma a 1al%1al <a ! 1ar"s -i2er1a(ika 2a-a (rimes(er II -a III a-ala17 /. Kea-aa ;a i 0. Usia !es(asi 3. 6aira ke("ba $. Plase (a !.K*)>))/ :)/&/

28

;a i 1i-"2 a(a" ma(i> -e !a ?ara ki(a me ?ari 2"lsasi ;a (" ! ;a i ;"mla1 ;a i > ki(a 2er1a(ika a2aka1 (" !!alDm"l(i2el> ;ika lebi1 -ari / ;a i > 1ar"s -i(e ("ka k1orio i(as -a am io i(as

kelai a ko !e i(al ma<or 2rese (as" -a le(ak ;a i > ;ika "sia !es(asi s"-a1 memas"ki (rimes(er III> 1ar"s -i2er1a(ika 2rese (asiDba!ia boko ! le(ak ;a i > a2aka1 mema ;a !Dmeli (a !> obliP"e> -a (erba3a1 <a> a2aka1 2rese (asi ke2ala> a(a" 2rese (asi

2.U'&) 0*'3)'& Me e ("ka "sia !es(asi 2a-a (rimes(er II -a III berbe-a -e !a (rimes(er I>

bebera2a 1al <a ! 2erl" -i2er1a(ika a-ala17 Diame(er bi2arie(al 9Bi2arie(al Diame(erDBPD: Diame(er Oksi2i(o Fro (alis 9O??i2i(o Fro (al Diame(erDOFD: Li !kar ke2ala 9Hea- 6ir?"m'ere ?eDH6: Pa ;a ! 1"mer"s 9H"mer"s Le !(1DHL: Li !kar Per"( 9Ab-omi al 6ir?"m'ere ?eDA6: Pa ;a ! Fem"r 9Fem"r Le !(1DFL:

Ba <ak sekali ?ara me e ("ka "sia !es(asi 2a-a (rimes(er II -a III> am" <a ! esse sial D 3a;ib -alam 2emeriksaa a-ala17 2..!. D&)-*3*r B&p)r&*3)+ 6B&p)r&*3)+ D&)-*3*r8 BPD9 Sebel"m me !"k"r -iame(er bi2arie(al> ki(a 1ar"s me -a2a(ka !ambara meli (a ! ke2ala> a-a2" s<ara(%s<ara( <a a-ala17 /. Gambara se2er(i bola r"!b< 2o(o !a

29

0. E?1o !aris (e !a1 (erle(ak sime(ris -ari a (erior ke 2os(erior ke2ala -a ber;ala se2a ;a ! ke2ala 3. Ka,"m se2("m 2el"si-"m membela1 e?1o !aris (e !a1 2a-a se2er(i!a a (erior ke2ala $. Diame(er bi2arie(al -i"k"r -ari 2arie(al <! sa(" ke 2arie(al <! lai > -ari o"(er% i er> a(a" o"(er%o"( 2.2. L&/0()r K*p)+) 64*)> 7&r71-2*r*/7*8 H<9 Dalam me !"k"r li !kar ke2ala> ?ara me am2ilka ("la ! ke2ala 9o"(er%o"(er: 2.3. D&)-*3*r A/3*r,;P,'3*r&,r 6)/3*r,;p,'3*r&,r >&)-*3*r9 Dalam me !"k"r -iame(er a (ero%2os(erior> ?ara me am2ilka ke2ala sama -e !a ?ara me am2ilka ke2ala " ("k me !"k"r BPD. Diame(er a (ero%2os(erior -i"k"r -e !a ?ara me !"k"r ;arak -ari os o??i2i(al ke os 'ro (al> -i"k"r o"(er%o"(er. ke2ala sama -e !a ?ara

me am2ilka ke2ala " ("k me !"k"r BPD. Li !kar ke2ala -i"k"r 2a-a sisi l"ar

Gambar /&7 Tam2ila 2o(o !a meli (a ! ke2ala <a ! baik " ("k me !"k"r BPD> H6 -a APD. Ke2ala berbe ("k se2er(i bola r"!b<> (erli1a( e?1o !aris

30

(e !a1 -a (1alam"s.

se2("m 2el"si-"m <a ! memo(o ! -i se2er(i!a> -a

(erli1a(

2.$. M*/01(1r +&/0()r p*r13 6A.>,-&/)+ <&r71-2*r*/7* 8 A<9 Sebel"m me !"k"r li !kar 2er"(> ki(a 1ar"s bisa -"l" me am2ilka 2o(o !a meli (a ! 2er"( <a ! be ar> ?ara <a a-ala17 /. Ambil 2o(o !a lo !i("-i al ("b"1 ;a i se1i !!a (am2ak !ambara

,er(ebra> -a ;a (" ! 0. Se(ela1 (am2ak ;a (" !> 2"(ar (ra s-"?er .= -era;a( 1i !!a (am2ak !ambara (ra s,ersal ;a (" !> 3. Lal" !erakka (ra s-"?er bebera2a milime(er ke i 'erior 1i !!a (am2ak !ambara ,er(ebra> !as(er> -a ,e a "mbilikal -alam sa(" bi-a ! 2o(o !. $. Se(ela1 me -a2a(ka 2o(o !a meli (a ! ab-ome <a ! baik> maka -a2a( -i"k"r -iame(er ab-ome > <a ! -i"k"r -ari sisi l"ar k"li(.

31

Gambar /)7Gambar -ia(as a-ala1 !ambara

2o(o !a

meli (a ! ab-ome

<a ! baik> -ima a (erli1a( ,er(ebrae> !as(er -a ,e a "mbili?al 2.5. M*/01(1r P)/:)/0 F*-1r 62*-1r +*/034 8 FL9 Per(ama (e ("ka le(ak ke2ala. /. Lak"ka ro(asi sam2ai (am2ak ,er(ebra sam2ai -aera1 l"mbal a(a" sa?r"m. 0. Lak"ka ro(asi $& -era;a( ke kiri a(a" ke ka a " ("k me ?ari !ambara 'em"r <a ! baik. 3. U ("k me -a2a(ka 'em"r <! baik> (ra s-"ser 1ar"s se;a;ar -e !a 'em"r. $. Pa ;a ! 'em"r -i"k"r -ari ";" ! ke ";" !

Gambar /*7Gambara

-ia(as a-ala1 ?o (o1 !ambara

'em"r <a ! baik>

2a ;a ! 'em"r -i"k"r -ari ";" !%";" !. IA. PENENTUAN PERTUMBUHAN DAN BESAR "ANIN Pa-a 2emeriksaa Pe <im2a !a USG> 2e ilaia 2er("mb"1a ;a i ;a i (er"(ama -i-asarka a(as

2e ilaia "k"ra a a(omi -a 2er"ba1a '" !sio al ;a i selama masa ke1amila . 2a-a 2rose 2er("mb"1a bisa -ke(a1"i lebi1 m"-a1 -e !a "k"ra a a(omi ;a i .

32

/. Per("mb"1a ;a i (er1amba( Per("mb"1a ;a i (er1amba( 9P5T: -a2a( (erba!i ke2a-a sime(rik -a asime(rik. P5T sime(rik (er;a-i -isebabka bera(> -a ole1 'ak(or i (ri si? 9kelai a m"-a. P5T asime(rik !e e(i?D: -a eks(ri sik <ai(" ba1a (era(o!e ik> i 'eksi i (ra"(eri e> mal "(risi seba!ai <a <a ! (er;a-i se;ak ke1amila 2e <ebab <a a-ala1 'ak(or eks(ri sik> (er"(ama i s"'isie si 2lase (a> <a ! "m" <a (er;a-i 2a-a ke1amila (rimes(er III. Gambara s2esi'ik P5T asime(rik (erli1a( 2a-a besar a(a" bera( ;a i berk"ra ! se-a !ka 2a ;a ! ;a i 1a <a se-iki( ber2e !ar"1. Be ("k ("b"1 (i-ak 2ro2orsio al 7li !kar ab-ome <a ! ke?il -e !a 2ro-"ksi "ri li !kar ke2ala. 8ol"me ?aira berk"ra !. Uk"ra am io berk"ra ! kare a 2alse (a me !e?il. P5T asime(rik ;ara !

-iser(ai kelai a ko !e i(al. Pa-a P5T sime(rik> !a !!"a 2a ;a ! ;a i me <ebabka 2er("mb"1a (erli1a( 2a-a bera( -a ormal> a(a"

<a ! berk"ra !. Uk"ra kelai a -ari ,ol"me ?aira

ke2ala lebi1 ke?il -ari am io 9oli!o1i-ram io

mikrose'al"s. Kelai a ko !e i(al seri ! -i(em"ka - biasa <a m"l(i2le -a 2oli1i-ram io :.

0. Ke1amila kembar Ke1amila kembar 2a-a (rimes(er I 1ar"s selal" -ie,al"asi " ("k me !e(a1"i kem" !ki a (er;a-i <a re-"ksi s2o (a 9,a is1i ! (3i : a(a" !a !!"a lai semasa ke1amila . Pa-a ke1amila (rimes(er II korio isi(as ke1amila kembar -a2a( -ike(a1"i -e !a memeriksa ;e is kelami ke-"a ;a i > ;"mla1 2lase (a -a seka( 2emisa1 ke-"a ;a i . Pa-a -ikorio > seka( 2emisa1 (erli1a( (ebal 9(er-iri -ari2a-a 0 la2isa am io -a 0 la2isa korio : se-a !ka kembar mo okorio -ii-e (i'ikasi. -iam io 2a-a seri !kali sa !a( (i2is se1i !!a s"li(

3. Kelai a ko !e i(al ;a i

33

Seba!ia

besar kelai a

ko !e i(al ;a i

-a2a( -ike(a1"i sebel"m "sia

ke1amila 0= mi !!" <ai(" sebel"m memas"ki 2eri a(al. Bebera2a 2e(a -a kelai a ko !e i(al <a ! -i;"m2ai -i USG a-ala17 8ol"me ?aira am io <a ! ab ormal Per("mb"1a mi !!" Kelai a mor'olo!i be ("k ("b"1 -a s(r"k("r or!a ;a i Uk"ra biome(ri ;a i <a ! ab ormal Uk"ra 2lase (a <a ! ab ormal Ar(eri "mbili?al (" !!al Ak(i,i(a bio'isik ;a i <a ! berk"ra ! ;a i (er1amba( (er"(ama sebel"m "sia ke1amila 0=

A. PEMERIKSAAN <AIRAN AMNION Pe !"k"ra ,ol"me ?aira am io (ela1 me ;a-i s"a(" kom2o e i (e!ral -ari 2emeriksaa ke1amila " ("k meli1a( a-a <a resiko kema(ia ;a i . Hal i i -i-asarka ba13a 2e "r" a 2er'"si "(ero2lase (a -a2a( me !akiba(ka !a !!"a alira -ara1 !i ;al -ari ;a i > me "r" ka ,ol"me miksi -a me <ebabka (er;a-i <a oli!o1i-roam io . Kelai a ;"mla1 am io -a2a( me imb"lka !a !!"a 2a-a ;a i se2er(i 1i2ol2lasia 2ar"> -e'ormi(as ;a i > kom2resi (ali 2"sa(> P5T> 2rema("ri(as> kelai a le(ak -a kema(ia ;a i . Pemeriksaa metode ?aira am io -a2a( -ilak"ka -e !a (i!a ?ara> <ai("7 2emeriksaa se?ara s"b;ek(i'> 2emeriksaa -e !a vertical deep single pocke(> -a -i2erke alka ole1 P1ela . Secara Subjektif -e !a !I " mniotic !luid Indeks : <a !

34

 Memb"("1ka 2e !alama <a ! ?"k"2 Se?ara s"b;ek(i' -ika(aka ormal bila7 (am2ak seba!ia ("b"1 ;a i seba!ia la!i (i-ak me em2el

meleka( 2a-a -i -i ! "(er"s> -a

>-ia (ara ("b"1 ;a i -a -i -i ! "(er"s masi1 (er-a2a( ?aira am io Secara Single Pocket Ber-asarka sa(" k"a-ra sa;a Diambil ka (o ! (erbesar <a ! (erle(ak a (ara -i -i ! "(er"s -a ("b"1 ;a i Ti-ak bole1 a-a ba!ia ;a i <a ! (erle(ak -i -alam area 2e !"k"ra (erseb"(

Gambar /+7Gambar -i a(as a-ala1 ?o (o1 2e !"k"ra se?ara si !le 2o?ke(> -ima a <a ! -i"k"r a-ala1 ;arak ,er(i?al (er;a"1 a (ara ba!ia ;a i -a -i -i ! "(er"s> -a (i-ak a-a ba!ia ;a i <a ! (erle(ak -alam area 2e !"k"ra (erseb"(.

I (er2re(asi 2e !"k"ra ?aira am io ber-asarka si !le 2o?ke(.

35

H)'&+ P*/01(1r)/ G0?m > H+?m G+?m +%/0?m /0%/)?m G/)?m G/?m > H0?m H/ ?m

I/3*rpr*3)'& 8ol"me ?aira am io Poli1i-ram io Poli1i-ram io ri !a Poli1i-ram io se-a ! Poli1!i-ram io bera( Bor-erli e> e,al"asi "la ! Oli!o1i-ram io ormal

Pengukuran Amnion dengan metode Phelan (4 kuadran A!"# Ab-ome -iba!i a(as $ k"a-ra Se(ia2 k"a-ra -i"k"r i -eks ?aira am io <a

Pe !"k"ra 1ar"s (e!ak l"r"s -e !a bi-a ! 1oriAo (al -a (i-ak a-a bole1 a-a ba!ia ;a i -ia (ara <a

Gambar /.7 Pemeriksaa

?aira

am io

me "r"( P1ela > ab-ome <a

-iba!i a(as $

k"a-ra > -a se(ia2 k"a-ra -i"k"r i -eks ?aira am io

36

Gambar 0=7 -i a(as me " ;"kka 2asie .

?ara mele(akka

2robe <a ! be ar 2a-a 2er"(

I (er2re(asi Pe !"k"ra ?aira am io -e !a me(o-e AFI H)'&+ P*/01(1r)/ G0?m > H+?m G+?m +%/0?m /0%/)?m G/)?m G/?m > H0?m H/ ?m I/3*rpr*3)'& 8ol"me ?aira am io Poli1i-ram io Poli1i-ram io ri !a Poli1i-ram io se-a ! Poli1!i-ram io bera( Bor-erli e> e,al"asi "la ! Oli!o1i-ram io ormal

AI. PEMERIKSAN PLASENTA

37

a. Me e ("ka le(ak 2lase (a 7 " ("k me e ("ka a2aka1 le(ak 2lase (a ormal 9-i '" -"s D ?or2"s "(eri> a(a" ab ormal 92lase (a 2re,iaD 2lase (a mar!i alD 2lase (a le(ak re -a1: b. Me e ("ka !ra-e ma("rasi 2lase (a 7 " ("k me e ("ka a2aka1 ke1amila (erseb"( ?"k"2 b"la 9a(erm: a(a" (i-ak. ?. Kelai a be ("k 2lase (a Be ("k ormal me <er"2ai ?akram. Dalam 2erkemba !a <a> 2lase (a -a2a(

me !alami berba!ai ,ariasi kelai a be ("k. Kelai a <a ! -a2a( -ike(a1"i melal"i 2emeriksaa USG a-ala1 2lase (a membra esa> 2lase (a s"kse ("ria> 2lase (a biloba(a -a 2lase (a sirk"m,ala(a. -. Me e ("ka kelai a Sam2ai ke1amila "k"ra 2lase (a. 0= mi !!"> (ebal 2lase (a (i-ak lebi1 -ari 0%3 ?m. < me ?a2ai $%& ?m.

me ;ela ! a(erm ke(ebala

e. Perleka(a ab ormal 2lase (a Dalam 2erkemba !a <a> 2lase (a meleka( 2a-a -i -i ! "(er"s melal"i

-esi-"a basalis. Ka-a !%ka-a ! -esi-"a basalis (i-ak (erbe ("k sem2"r a se1i !!a ,ili korio ik meleka( la !s" ! 2a-a miome(ri"m 92lase (a akre(a:> me !i ,asi la2isa miome(ri"m 92lase (a i kre(a:> ba1ka me emb"s la2isa miome(ri"m -a seros"m "(er"s 92lase (a 2a kre(a:. Dia! osis 2lase (a akre(a melal"i USG me ;a-i lebi1 m"-a1 bila im2la (asi 2lase (a bera-a -i se!me ba3a1 "(er"s ba!ia -e2a . '. Kalsi'ikasi 2lase (a Kalsi'ikasi 2lase (a mer"2aka 2roses 'isiolo!is -alam ke1amila akiba(

-e2osisi kalsi"m 2a-a 2lase (a. M"lai (erli1a( 2a-a ake1amila 0. mi !!" -a semaki me i !ka( -e !a ber(amba1 <a "sia ke1amila . Pa-a USG> -e2osisi kalsi"m (erli1a( seba!ai ber?ak%ber?ak eko!e ik <a ! (i-ak memberika ba<a !a ak"s(ik. De2osisi kalsi"m (er"(ama <a -i ba!ia basal -a se2(a 2lase (a se1i !!a !ambara kalsi'ikasi (erli1a( lebi1 kasar. Proses klasi'ikasi

38

2lase (a seri !kali (er;a-i lebi1 -i i 2a-a 2ree?lam2sia -a P5T. Kalsi'ikasi lebi1 lamba( 2a-a ib" DM -a i kom2a(ibili(as r1es"s. !. Sol"(io 2lase (a A-ala1 2eris(i3a (erle2as <a 2lase (a <a ! le(ak <a -aera1 mar!i al. Perle2asa s2iralisC se-a !ka ormal -ari -i -i !

"(er"s sebel"m 3ak(" <a. Lokasi (erseri ! a-ala1 -i -aera1 re(ro2lase (a a(a" -i re(ro2lase (a (er;a-i kare a r"2("re ar(eri -i mar!i al kare a r"2("re ,e a mar!i alis. Nam" >

sol"sio 2lase (a seri !kali (i-ak (er-ia! osis melal"i 2emeriksaa USG. 1. T"mor 2lase (a T"mor <a ! seri ! (er-a2a( 2a-a 2lase (a a-ala1 korio !ioma. Pa-a USG> korioa !ioma (erli1a( seba!ai massa 2a-a( 1i2erekoik (erle(ak -i -aera1 s"bkorio ik -a seri ! me o ;ol -ari 2erm"kaa 'e(al 2lase (a.

Gambar 0/7 a-ala1 (i !ka( !ra-asi 2lase (a beser(a ?iri%?iri <a.

39

DAFTAR PUSTAKA /. Pra3iro1ar-;o S. B"k" ilm" kebi-a a > Sar3o o Pra3iro1ar-;o. Pe erbi( Pra3iro1ar-;o> 5akar(a> 0==.. Ms 0$*%0). 0. E -;" > 5"-i 5a "a-i. 90==*:. Ul(raso o!ra'i Dasar Obs(e(ri -a Gi ekolo!i. 5akar(a 7 Fak"l(as Ke-ok(era U i,ersi(as I -o esia 3. Karso o B.Ul(raso o!ra'i Obs(e(ri 9S(a -ar- -a Ba!ia i -ikasi 2emeriksaa :.

Obs(e(ri -a Gi ekolo!i FKUIDRSUPN Dr. 6i2(o Ma !" k"s"mo>

5akar(a. 0==3&. @i;a<a e!ara H> @irak"s"ma1 FF> Mose 56> S"kar<a @S. $. K"rs"s Dasar Ul(raso o!ra'i -a Kar-io(oko!ra'i. Ba!ia DSMF Obs(e(ri -a Gi ekolo!i FK U i,ersi(as Pa-;a-;ara RSUP -r.Hasa Sa-iki > Ba -" !> 0===

40