Ketuban pecah dini

PROM (Premature Rupture Of

Membran)
 DEFINISI
Ketuban pecah dini merupakan
pecahnya ketuban sebelum
terdapat tanda mulai persalinan
dan ditunggu satu jam sebelum
terjadi in partu (Manuaba, 2009).
Ketuban pecah dini adalah
pecahnya ketuban sebelum
persalinan mulai pada tahapan
kehamilan manapun (Arma, dkk
2015).Sedangkan menurut
(Sagita, 2017)
ETIOLOGI
Multipara dan Grandemultipara

Hidramnion

Kelainan letak: sungsang atau

lintang

Hidramnion

Cephalo Pelvic Disproportion

(CPD)
Kehamilan ganda
Pendular abdomen (perut
gantung)
 1. keluarnya cairan ketuban merembes
melalui vagina
2. aroma air ketuban berbau manis dan tidak
seperti
bau amoniak
3. berwarna pucat
4. cairan ini tidak akan berhenti ,atau

TANDA 5. Kering
6. kepala janin yang sudah terletak di bawah
( Mengganjal )
DAN 7. nyeri perut

GEJALA
PATOFISIOLOGI
Pecahnya selaput ketuban disebabkan oleh
hilangnya elastisitas pada daerah tepi robekan
selaput ketuban. Hilangnya elastisitas selaput
ketuban ini sangat erat kaitannya dengan
jaringan kolagen, yang dapat terjadi karena
penipisan oleh infeksi atau rendahnya kadar
kolagen. Kolagen pada selaput terdapat pada
amnion di daerah lapisan kompakta, fibroblas
serta pada korion di daerah lapisan retikuler
atau trofoblas (Mamede dkk, 2012).
Faktor yang mempengaruhi
Ketuban Pecah Dini
Usia untuk reprosuksi optimal
USIA bagi seorang ibu adalah antara
umur 20-35 tahun

Pendapatan yang meningkat

merupakan kondisi yang
Sosial menunjang bagi terlaksananya
Ekonomi status kesehatan seseorang.
Rendahnya pendapatan merupakan
rintangan yang menyebabkan
seseorang tidak mampu memenuhi
fasilitas kesehatan sesuai
kebutuhan (BPS, 2005).
 1. Primi Gravida
Paritas
2. Multi gravida
Anemia

Anemia pada kehamilan merupakan adalah anemia karena

kekurangan zat besi. Jika persendian zat besi minimal, maka
setiap kehamilan akan mengurangi persendian zat besi tubuh
dan akhirnya menimbulkan anemia. Pada kehamilan relatif
terjadi anemia karena darah ibu hamil mengalami hemodelusi
atau pengencangan dengan penigkatan volume 30% sampai
40% yang puncaknya pada kehamilan 32 sampai 34 minggu.
Dampak anemia pada janin antara lain abortus, terjadi kematian
intrauterin, prematuritas, berat badan lahir rendah, cacat bawaan dan
mudah infeksi. Pada ibu, saat kehamilan dapat mengakibatkan
abortus, persalinan prematuritas, ancaman dekompensasikordis dan
ketuban pecah dini (Manuaba, 2009).
 Perilaku
Merokok
Kebiasaan merokok atau lingkungan dengan rokok yang
intensitas tinggi dapat berpengaruh pada kondisi ibu hamil. Rokok
menggandung lebih dari 2.500 zat kimia yang teridentifikasi
termasuk karbonmonoksida, amonia, aseton, sianida hidrogen, dan
lain-lain. Merokok pada masa kehamilan dapat menyebabkan
gangguan-gangguan seperti kehamilan ektopik, ketuban pecah
dini, dan resiko lahir mati yang lebih tinggi (Sinclair, 2003).
 

Riwayat KPD
Pengalaman yang pernah dialami oleh ibu bersalin dengan
kejadian ketuban pecah dini dapat berpengaruh besar terhadap ibu
jika menghadapi kondisi kehamilan. Riwayat KPD sebelumnya
beresiko 2-4 kali mengalami ketuban pecah dini kembali.
Patogenesis terjadinya KPD secara singkat ialah akibat penurunan
kandungan kolagen dalam membran sehingga memicu terjadinya
ketuban pecah dini dan ketuban pecah preterm.
Inkompetensia serviks adalah serviks
dengan suatu kelainan anatomi yang Serviks
nyata, disebabkan laserasi sebelumnya
melalui ostium uteri atau merupakan yang
suatu kelainan kongenital pada serviks
yang memungkinkan terjadinya dilatasi Inkompetensik
berlebihan tanpa perasaan nyeri dan
mules dalam masa kehamilan trimester
kedua atau awal trimester ketiga yang
diikuti dengan penonjolan dan robekan Tekanan
selaput janin serta keluarnya hasil 1. Trauma : berupa hubungan
konsepsi. seksual, pemeriksaan dalam, Intra Uterin
amniosintesis Tekanan intra uterin
yang meninggi atau
2. Gemelli : isi rahim yang lebih meningkat secara
besar dan kantung (selaput berlebihan dapat
ketuban) relative kecil menyebabkan
sedangkan dibagian bawah terjadinya ketuban
tidak ada yang menahan pecah dini, Misalnya:
sehingga mengakibatkan
selaput ketuban tipis dan mudah
pecah (Novihandari, 2016).
KOMPLIKA
SI
Prognosis Ibu
Komplikasi yang dapat
disebabkan KPD pada ibu
yaitu infeksi intrapartal/ dalam
persalinan, infeksi puerperalis/
masa nifas, dry labour/ partus
lama, perdarahan post partum,
meningkatnya tindakan
operatif obstetric (khususnya
SC), morbiditas dan mortalitas
maternal.
Prognosis
Janin Bagi bayi terjadi :
1. Prematuritas
2. Prolaps funiculi
3. Hipoksia dan Asfiksia
4. Sindrom distress pernafasan( RSD atau Respiratory
Distress Sindrome)
5. Sindrom deformitas janin
6. Hypoplasia paru janin pada aterm
7. Morbiditas dan mortalitas perinatal
 Diagnosis
Penegakkan diagnosis KPD dapat dilakukan dengan berbagai cara yang meliputi

01 02 03 04 05

Keluar menggunakan
Dari
nya Air Memeriksa adanya Test USG
pemeriksaan
ketuba cairan yang berisi nitrazin/lakmus
inspekulo
n dari mekonium, vernik
terlihat keluar menentukan usia kehamilan,
Vagina kaseosa, rambut
cairan ketuban letak janin, berat janin, letak
lanugo dan
dari cairan kertas lakmus plasenta serta jumlah air
kadang-kadang
servikalis merah berubah ketuban. Pemeriksaan air
bau kalau ada
menjadi biru ketuban dengan tes leukosit
infeksi.
(basa) bila esterase, bila leukosit darah
ketuban sudah lebih dari 15.000/mm3 ,
pecah kemungkinan adanya infeksi
 Pemeriksaan penunjang
1.
Pemeriksaan
laboratorium
2.
Pemeriksaan
USG

Mikroskopik (tes
pakis), dengan Pemeriksaan ini
meneteskan air dimaksudkan untuk
ketuban pada gelas melihat jumlah
objek dan dibiarkan cairan ketuban
Tes lakmus (tes nitrazin), jika kering, pemeriksaan dalam kavum uteri.
kertas lakmus merah berubah mikroskopik Pada kasus KPD
menjadi biru ,menunjukkan menunjukkan terlihat jumlah
adanya air ketuban (alkalis) gambaran daun cairan ketuban
pakis yang sedikit
Penatalaksanaan
karena mempertahankannya memerlukan waktu lama.
Apabila sudah mencapai berat 2000 gram dapat
1.kehamilan dipertimbangkan untuk diinduksi. Apabila terjadi
dibawah 26 kegagalan dalam induksi makan akan disetai infeksi yang
minggu diikuti histerektomi

Pemberian kortikosteroid dengan pertimbangan

akan menambah reseptor pematangan paru,
menambah pematangan paru janin

Pemberian batametason 12 mg dengan interval 24 jam, 12

mg tambahan, maksimum dosis 24 mg, dan masa kerjanya
2-3 hari, pemberian betakortison dapat diulang apabila
setelah satu minggu janin belum lahir.

Pemberian tokolitik untuk mengurangi kontraksi uterus

dapat diberikan apabila sudah dapat dipastikan tidak
terjadi infeksi korioamninitis
 Apabila janin hidup serta terdapat prolaps tali pusat, pasien dirujuk
dengan posisi panggul lebih tinggi dari badannya, bila mungkin
2. pada ibu
dengan posisi sujudDorong kepala janin keatas degan 2 jari agar tali
hamil aterm
pusat tidak tertekan kepala janin.Tali pusat di vulva dibungkus kain
atau preterm
hangat yang dilapisi plastik
harus dirujuk ke
rumah sakit.
Apabila terdapat demam atau dikhawatirkan terjadinya infeksi saat
rujukan atau ketuban pecah lebih dari 6 jam, makan berikan antibiotik
penisilin prokain 1,2 juta UI intramuskular dan ampisislin 1 g peroral.

yaitu tidah baring, diberikan sedatif berupa fenobarbital 3 x 30 mg

3. Pada kehamilan Berikan antibiotik selama 5 hari dan glukokortikosteroid, seperti

kurang 32 minggu deksametason 3 x 5 mg selama 2 hari. Berikan pula tokolisis, apanila
dilakukan
Contentstindakan
04 terjadi infeksi maka akhiri kehamilan
konservatif

Pada kehamilan 33-35 miggu, lakukan terapi konservatif selama 24 jam

kemudian induksi persalinan.
 ada his maka pimpin meneran dan apabila tidak ada his maka
4. Pada lakukan induksi persalinan
kehamilan lebih
dari 36 minggu
Apabila ketuban pecah kurang dari 6 jam dan pembukaan kurang
dari 5 cm atau ketuban pecah lebih dari 5 jam pembukaan kurang
dari 5 cm (Sukarni, 2013).

5. Sedangkan induksi dengan oksitosin, apabila gagal lakukan seksio

untuk penanganan sesarea.
aktif yaitu untuk
kehamilan > 37
Dapat diberikan misoprostol 25µg – 50µg intravaginal tiap 6 jam
minggu
maksimal 4 kali
SEKIAN
TERIMAKAS
IH
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your Presentations. Easy to change colors, photos and Text.
You can simply impress your audience and add a unique zing and appeal to your Presentations.
I hope and I believe that this Template will your Time, Money and Reputation. Get a modern
PowerPoint Presentation that is beautifully designed. Easy to change colors, photos and Text. I
hope and I believe that this Template will your Time, Money and Reputation. You can simply
impress your audience and add a unique zing and appeal to your Presentations. You can simply
impress your audience and add a unique zing and appeal to your Presentations. I hope and I
believe that this Template will your Time, Money and Reputation.

You can simply impress your audience and add a unique zing and appeal to your Presentations.
I hope and I believe that this Template will your Time, Money and Reputation.
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Fully Editable Shapes
Fully Editable Shapes
 Fully Editable Icon Sets: A

You can Resize without

losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
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 Fully Editable Icon Sets: B

You can Resize without

losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
 Fully Editable Icon Sets: C

You can Resize without

losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com