Ketuban Pecah Dini

&
Preterm
dr. Astri Diah A, SpOG (K)

Annisafitria
Raka Petra Prazasta
Ketuban Pecah
Dini
 Medical Review
ObsGyn

Pecahnya ketuban
DEFINISI

American College of
ObsGyn 2013

Pecahnya selaput
RCOG

Rupture of membrane
sebelum masuk onset ketuban secara spontan
prior to labor, occuring
persalinan diluar usia sebelum usia kehamilan
before 37 weeks
gestasi (37 minggu) 37 minggu dan onset
(PPROM) persalinan (PPROM)

Royal College of OBSGYN. Preterm Prelabour Rupture of Membrane. 2010

Cunningham, Leveno, Bloom et al. William Obs. 24 th Edition. Mc Graw Hill.

Aaron, Caughey, Julian et al. Contemporary PROM. Medical Review ObsGyn Vol I No I. 2008.
4
Epidemiologi

8-10% perempuan hamil aterm

mengalami ketuban pecah dini

Ketuban pecah dini prematur

terjadi pada 1 % kehamilan

Saifuddin AB. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010
 Faktor Risiko
5

Nihal AR, intisar, fatma el al. Extreme preterm premature rupture of membrane: risk factors and fetomaternal outcomes. Oman medical journals. March 2013
6
Faktor Risiko (2)

Faktor Ibu Faktor Bayi

Antepartum vaginal bleeding Uterus anomali
Terapi steroid kronik Dilatasi lanjut plasenta
Kelainan kolagen pembuluh darah Conisasi serviks
Trauma langsung abdomnen Pemendekan serviks trimester 2
Persalinan preterm Overdistensi uterus
Merokok Infeksi intra amnion
Penyalahgunaan obat (kokain) Multiple bimanual pemeriksaan vaginal
Anemia
BMI rendah
Defisiensi nutrisi
Sosioekonomi rendah

Aaron, Caughey, Julian et al. Contemporary PROM. Medical Review ObsGyn Vol I No I. 2008.
7
Penegakkan Diagnosis

Anamnesis Pemeriksaan Penunjang

Fisik
Keluar air-air dari Ultrasonografi
jalan lahir Pemeriksaan
Spekulum Steril

Nitrazine Test

Aaron, Caughey, Julian et al. Contemporary PROM. Medical Review ObsGyn Vol I No I. 2008.
8
Penegakkan Diagnosis

Pemeriksaan Spekulum

Gambaran cairan Didapatkan Cairan

di posterior cairan serikovaginal
forniks (pooling) servikovaginal kering
atau keluarnya pH alkali
cairan dari
ostium serviks

Aaron, Caughey, Julian et al. Contemporary PROM. Medical Review ObsGyn Vol I No I. 2008.
9
Penegakkan Diagnosis

Pemeriksaan Spekulum
The best results were obtained with the Nitrazine and ferning tests,
with a sensitivity of 90%.The false-positive rate was 17% for the Nitrazine
test, owing to contamination with urine, blood or semen, and 6% for the
ferning test, owing to contamination with cervical mucus

A similar sensitivity and false-positive rate was achieved by obtaining a

history of rapid passage of fluid from the vagina.

Ultrasound examination demonstrating oligohydramnios is also used to

help confirm the diagnosis of spontaneous rupture of the membranes.

Royal College of OBSGYN. Preterm Prelabour Rupture of Membrane. 2010

10
Penegakkan Diagnosis

The diagnosis is made by a

- history suggestive of spontaneous rupture of

membranes followed by

- A sterile speculum examination demonstrating

pooling of fluid in the posterior vaginal fornix;

Royal College of OBSGYN. Preterm Prelabour Rupture of Membrane. 2010

11
Penilaian Klinik

Tentukan
Tentukan Tentukan
Tentukan ada
Pecahnya tanda-
Usia tidaknya
Selaput tanda
Kehamilan tanda
Ketuban inpartu
infeksi

Aaron, Caughey, Julian et al. Contemporary PROM. Medical Review ObsGyn Vol I No I. 2008.
12
Pemeriksaan Penunjang

Aaron, Caughey, Julian et al. Contemporary PROM. Medical Review ObsGyn Vol I No I. 2008.
13
Tatalaksana

Konservatif

Rawat di Rumah Kortikosteroid Antibiotik

Sakit Betametason Eritromisin
2x12 mg 4x250 mg
Observasi KU, selama 10 hari
TV, dan DJJ Atau
Ampisilin 4x500
mg
Atau
Saifuddin AB. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010 Metronidazol
14
Tatalaksana

- Erythromycin should be given for 10 days following the

diagnosis of PPROM.

- Twenty-two trials involving over 6000 women with PPROM before 37

weeks of gestation were included in a meta-analysis.

- The use of antibiotics following PPROM is associated with a

statistically significant reduction in chorioamnionitis.

- There was a significant reduction in the numbers of babies born

within 48 hours and 7 days

- Neonatal infection was significantly reduced in the babies

whose mothers received antibiotics
Royal College of OBSGYN. Preterm Prelabour Rupture of Membrane. 2010
15
Tatalaksana

A meta-analysis of 15 randomised controlled trials

involving more than 1400 women with preterm
rupture of the membranes demonstrated that
antenatal corticosteroids reduce the risk of
respiratory distress syndrome; intraventricular
haemorrhage and necrotising enterocolitis

They may also reduce the risk of neonatal

death. They do not appear to increase the risk of
infection in either mother or baby.
Royal College of OBSGYN. Preterm Prelabour Rupture of Membrane. 2010
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Tatalaksana

Aktif
Kehamilan > 37 Jika gagal, dapat Skor Pelvik < 5
minggu induksi dilakukan seksio Pematangan
Oksitosin atau sesarea serviks kemudian
Misoprostol 25 induksi; jika
50 ug gagal SC.
intravaginal tiap Skor Pelvik > 5
6 jam maks 4 Induksi
kali. Jika gagal, persalinan
seksio sesarea.
Saifuddin AB. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010
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Tatalaksana

William Obstetric, 23th edition

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Korioamnionitis

Keadaan dimana Penyebaran Angka kejadian

korion, amnion, infeksi terutama 1-2%
dan cairan dari bakteri
ketuban terkena traktur
infeksi urogenitalis ibu

Saifuddin AB. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010
19
Diagnosis Korioamnionitis

Faktor Risiko Gejala Laboratorium

- Ketuban pecah - Demam - Leukositosis

onset lama - Takikardi

Tanda CTG

- Nyeri pada bagian - Takikardia janin

Rahim Uterus
lembek
- Keluar cairan
berbau dari
vagina
Saifuddin AB. Ilmu Kebidanan. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010
Preterm
Terima kasih!