Retensio Yaitu plasenta belum lahir 30 menit

Plasenta setelah anak lahir

KSM/Dep. Obstetri & Ginekologi RSUP Dr.Hasan Sadikin Bandung Fakultas Kedokteran Universitas Padjadjaran. Panduan Praktik Klinik Obstetri & Ginekologi. 2018
Penyebab

Fungsional:
● His kurang kuat (penyebab terpenting) .
● Plasenta sukar terlepas karena tempatnya (insersi di sudut tuba) ; bentuknya
(plasenta membranasea, plasenta anularis) ; dan ukurannya (plasenta yang
sangat kecil) / plasenta adhesiva

Patologi-anatomi:
● Plasenta akreta : vili korialis menanamkan diri lebih dalam ke dinding rahim.
Plasenta normal menanamkan diri sampai ke batas atas lapisan otot rahim.
● Plasenta inkreta : Vili korialis yang sampai masuk ke dalam lapisan otot rahim
● Plasenta perkreta : vili korialis yang menembus lapisan otot dan mencapai
serosa atau menembusnya

Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Padjajaran Bandung. Obstetri Patologi. Bandung: Elstar Offset. 2014
Gejala

● Perdarahan pervaginam sedikit sampai banyak

● Tinggi fundus uteri sepusat
● Biasanya tampak tali pusat
 Tatalaksana

Dilakukan pelepasan plasenta secara manual. Jika plasenta sulit dilepaskan, pikirkan kemungkinan
plasenta akreta. Terapi terbaik pada plasenta akreta komplit adalah histerektomi

KSM/Dep. Obstetri & Ginekologi RSUP Dr.Hasan Sadikin Bandung Fakultas Kedokteran Universitas Padjadjaran. Panduan Praktik Klinik Obstetri & Ginekologi. 2018
World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. World Health Organization, 2012.
 Pelepasan Plasenta Secara Manual
● Give one dose of prophylactic antibiotics:
- ampicillin 2 g IV, and
- metronidazole 500 mg IV, or
- cefazolin 1 g IV, plus metronidazole 500 mg IV.

● Use an analgesic such as pethidine 25 mg IV, and a sedative such as diazepam 10 mg IV

● If she is unable to void urine, catheterize and empty the bladder. A full bladder can prevent the
delivery of the placenta.

World Health Organization. Managing postpartum haemorrhage. World Health Organization, 2008.
World Health Organization. Managing postpartum haemorrhage. World Health Organization,
2008.
 Pelepasan Plasenta Secara Manual
● Continue to provide counter-traction to the uterus with the other hand to prevent uterine inversion.
● Insert your hand again to palpate the uterine cavity for any remaining placental tissue.
● Add oxytocin 20 IU to 1 litre of IV fluid (either Ringer’s lactate or normal saline) and give by
intravenous infusion. Give rapidly if bleeding.
● Have an assistant massage the uterus to encourage contraction.
● If there is continued heavy bleeding, give ergometrine 0.2 mg IM to help the uterus contract, or
prostaglandins depending on national policy (prostaglandins should not be given intravenously as
this may be fatal).
● Examine the removed placenta and check for completeness
● Check for tears in the birth canal and repair, as required

World Health Organization. Managing postpartum haemorrhage. World Health Organization, 2008.
Terimakas
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