G3P2002 UK 38 minggu

Janin Tunggal Hidup

Intruterin + PEB +
Primitua Sekunder +
Lutfiah Fadlilawati

Obesitas Penguji :
dr. Hj. Erva Darmawanti, Sp.OG

KEPANITERAAN KLINIK MADYA

FAKULTAS KEDOKTERAN UNISMA
RSUD BLAMBANGAN BANYUWANGI
 Pendahuluan
Epidemiologi
● AKI meningkat (Kemenkes,
2019)
● 305 per 100.000 kelahiran
hidup
● 24.67% kejadian PE di
Indonesia

106.18 Per 100.000

kelahiran hidup

76.9
INTRODUCTION
Nama : Ny. P
Keluhan Utama
Tekanan darah tinggi
Anamnesa
Usia : 41 thn
Alamat : Watugepeng
Pekerjaan : IRT
Agama : Islam
Pendidikan terakhir : SD
MRS : 19 Mei 2021

02
 ANAMNESA
Riwayat Riwayat
Menstruasi Kontrasepsi
Pasien menggunakaan KB
Menarche saat usia 11 tahun,
Siklus menstruasi 28 hari, suntik 3 bulan, selama 10
Riwayat
Menikah 1 kali selama 27 tahun
selama 7 hari, dan kadang- tahun setelah lahir anak ke 2 pernikahan
kadang disminorhea saat
menstruasi

Riwayat Penyakit Riwayat Penyakit

Dahulu Keluarga
Riwayat Penggunaan Hipertensi : - Hipertensi : +
Diabetes mellitus : -
Obat-Obatan Diabetes mellitus : -
Obesitas : +
Pasien menyangkal penggunaan
obat-obatan
 Riwayat
Kehamilan/Persalinan
01 Usia 20 thn
Anak Perempuan
Lahir ditolong Dukun
BB : 3000 gr (pasien
lupa)
02 Usia 16 thn
Anak Perempuan
Lahir ditolong Dukun
BB : 3000 gr (pasien
lupa)
Hamil Saat
03 Ini
HPHT : 15-09-2020 (Pasien ragu)
HPL : 22-06-2021
ANC 4 kali di Bidan
 Hb 10
PITC : NR
Syiphilis : NR Albumin +1
HbSAg : NR
Gol-Da : A
 Fe, Vit C, Kalsium,
Diet rendah garam
Riwayat ANC
 Fe, Kalsium, Vit C, B6,
Aspilet 1x1
19/05/21 19/05/21
15/03/21 14/05/21
08/02/21

UK 18-19 UK 24 mgg UK 35 mgg UK 36 mgg UK 36 mgg

mgg TD 120/80 TD 140/100 TD 140/100 TD 160/100
TD 120/70 Rujuk RS Yasmin Rujuk RSBL untuk
Trimester Trimester
Trimester III program SPM
II II
Pemeriksaan
Fisik
Keadaan umum : Cukup
GCS : E4M5V6
Kesadaran : composmentis
BMI sebelum hamil : 31 kg/m2
Berat Badan : 87 kg
Pemeriksaan obstetric :
Tinggi Badan : 162 cm
Leopold I : TFU 30 cm
LILA : 32 cm
Leopold II : Punggung kiri
BMI : 33,1 kg/m2 (Obesitas grade I)
Leopold III : letak presentasi kepala
Leopold IV : 5/5 belum masuk PAP
His: (+) 1 x dlm 10’ selama 5’’
TTV: VT: pembukaan -
TD: 160/100 mmHg Pervaginam : bersih
Nadi : 88 x/menit DJJ : (+) 140x
Tax : 36,6oC
RR : 18 x/menit

Pemeriksaan head to Toe : DBN

 Penunjang
Pemeriksaan Hasil Satuan Nilai Rujukan
Hematologi
Leukosit 11.7 x 10^3 / µL 3,6-11
LYM 26.6 % 20-40
 
MIX 7.6 % 0,8-10,8
 
NEU 65.8 % 73,7-89,7
 
ALC 3.1 x 10^3 / µL 0,8-4
 
Eritrosit 4.31 x 10^6 / µL 3,8-5,2
MCV 79.1 fL 80-100
 
MCH 26.0 Pg 26-34
 
MCHC 32.8 g/dL 32-36
 
Hemoglobin 11.2 g/dL 11,5-16
Hematokrit / PCV 34.1 % 35-47
Trombosit 271 x 103 / µL 150-440
GDA 72 mg/dL 70-125
Imunologi-Serologi
  Rapid Antigen SARS Cov-2
(Rapid test)
Negative Negative

Kimia Klink
Protein Urine +3 Negative
 
 19 Mei 2021
Janin Tunggal Hidup Intra
ULTRASONO Uterin
UK 38 mgg
GRAFI
EKG
 Kronologis

2005 2015 2020 2021

Pasien Pasien berhenti Pasien ANC 4 kali

menggunak menggunakan hamil di BPM
an KB KB anak ke 3 dan USG 1
suntik 3 kali
bulan

Rujuk ke RS
 Tgl 19 Mei 2021
Pukul 15.19
RSBL
TD 160/100 mmHg
Nadi 88 x/menit
Pukul 12.00 TFU 30 cm
RS Yasmin Puki, letkep, DJJ 142
TD 160/100 His + 1 x dlm 10’ selama 5’’ Pembukaan -
Pukul 08.00
Albumin +3
ANC di bidan
Anik Dx : G3P2002 UK 38 minggu Janin Dx : G3P2002 UK 38 minggu Janin Tunggal
TD 140/100 Tunggal Hidup Intra Uterin + PEB + Hidup Intra Uterin + PEB + Primitua
Primitua Sekunder + Obesitas Sekunder + Obesitas

Tx : Saran terminasi  rujuk RSBL Tx : IVFD RL 2 tpm

MgSO4 Full Dose
Inj. Dexamethasone 6 mg
Induksi persalinan :
Misoprostol 50mcq / SL/ 6 jam
Tgl 20 Mei 2021 Tgl 21 Mei 2021

RSBL pukul 19.00 RSBL pukul 10.00

TD 140/90 mmHg TD 140/90 mmHg
OK RSBL
Nadi 84 x/menit Nadi 86 x/menit
Operasi SC + MOW
TFU 30 cm TFU 30 cm
Puki, letkep, DJJ 138 Puki, letkep, DJJ 143
By.Perempuan
His 2 x dlm 10’ selama 15’’ , His 2 x dlm 10’ selama 15’’,
AS 7-8, BB 2900gr,
Pembukaan 2 cm, eff 25%, Pembukaan 2 cm, eff 25%,
PB 47cm, Ket.jernih, Anus +,
ket +, kep.Hodge 1 ket +, kep.Hodge 1
 Tatalaksa
Diagno na
IVFD RL 2 tpm
sis MgSO4 Full Dose
Inj. Dexamethasone 6 mg
G3P2002 UK 38 minggu Janin Induksi persalinan :
Tunggal Hidup Intra Uterin + Misoprostol 50mcq / SL/ 6
PEB + Primitua Sekunder + jam
Obesitas  Gagal induksi :
KIE : SC + MOW
 Faktor Resiko

Riwayat PE (↑ 7x)
Nulipara (↑ 3x)
Jarak kehamilan ≥ 10 th (↑ 3x)
Riwayat Keluarga PE (↑ 3x)
Kehamilan multiple (↑ 3x)
Obesitas (↑ 2,5x)
Usia ≥ 35 tahun (↑ 2x)
POGI,
2016
 Pusing, Rambut
rontok, haidh tidak
KB suntik 3 bulan Ny.P
teratur, keputihan,
jerawat
Obesitas Usia 41 thn G3P2002
DMPA
(Depo Medroxy
Progesteron Acetate) Hiperlipidemia Degenerasi sel ↓ ekspresi HLA-G

↓ kadar ↓ HLA-G pada

Menekan LH
hormon leptin Retensi perifer Aterosklerosis desidua plasenta
Pembuluh darah
Endometrium Mnekan sinyal
dangkal & atropi kenyang di otak Gangguan Abnormalitas invasi
Peningkatan vaskularisasi trofoblast
Menstruasi kerja jantung retroplasentar
tidak teratur ↑nafsu makan
Lumen tetap kaku &
keras
↑total massa Hipoksia &
lemak Iskemia Plasenta
A.Spiralis ANC 4 kali :
vasokonstriksi Kalsium, Fe, B6, Vit.c,
Menghasilkan Aspilet 1x1
↑ kadar LDL
ROS Kegagalan
remodelling

Merusak membrane
sel, nucleus & protein
sel endotel TFU 30 cm
Puki, letkep, DJJ 142
His + 1 x dlm 10’ selama
5’’ Pembukaan -
Disfungsi endotel
 Disfungsi endotel

Gangguan metabolism ↑ endotelin ↑ permeabilitas Perubahan sel endotel

Agregasi trombosit pada
prostaglandin ↓ NO kapiler kapiler glomerulus
sisi endotel yang rusak

Aspilet 1x1 Albumin +3

↓ prostasiklin ↑Tromboksan ↓ tekanan onkotik Proteinuria

Vasokonstriksi Perpindahan cairan Hipoalbuminemia

intravascular ke
interstisium
TD 160/100
mmHg
Kegagalan Spasme arteri Turbulensi Hepar
Hipertensi
autoregulasi retina pada iskemia Edema
otak Edem retina pembuluh
darah kapiler Tekanan di
Peregangan selaput Vasospasme hepar naik
meningen Iskemia
Edema otak Gangguan Kapiler pecah
penglihatan OT/PT naik
Sakit kepala
Koagulasi
Kejang konsumtif
Sel-sel hepar
membesar
Trombositopenia
Kapsula glison Induksi persalinan: Misoprostol
MgSO4 full dose: 50mcq/SL/6jam
Inj. teregang
Injeksi 4gr IV (MgSO4 20%) 20cc
Injeksi 6gr IV (syiring pump) MgSO4 40% Dexamethasone
Mengurangi konsumsi garam 6mg Nyeri epigastrium SC+MOW
AWESOM
E
WORDS
 Pasien dirujuk ke
RSBL karena
ingin
Pasien periksa ke bidan
menggunakan
Anik dengan TD 140/100
asuransi SPM.
19/05/21
dan dirujuk untuk periksa 19/05/21 Pukul 15.19
ke RS 19/05/21 Pukul 15.00
19/05/21 Pukul 12.00
Pukul 08.00 Pasien datang ke
IGD RSBL. TD :
Pasien periksa di RS 160/100
Pasien hamil anak ke 3 Yasmin TD 160/100.
dengan usia kehamilan USG oleh
35-36 mgg (HPHT) 38 dr.Haris,Sp.OG dan
mgg (USG) disarankan MRS
Kronologis

MERCURY VENUS MARS

Venus has a beautiful Despite being red, Mars is
name, but it’s terribly hot actually a cold place

JUPITER SATURN NEPTUNE

It’s the biggest planet in Saturn is the ringed one Neptune is the farthest
our Solar System and a gas giant planet from the Sun
A PICTURE IS
WORTH A
THOUSAND
WORDS
 FACTORS TO
1-3 4-6 CONSIDER
7-9
MONTHS MONTHS MONTHS

Mercury is the closest Venus is the second Neptune is the farthest

planet to the Sun planet from the Sun planet from the Sun
CLINICAL
TRIAL
PRECLIN PHASE 1 PHASE 2 PHASE 3
ICAL
Lab studies Human safety Expanded Efficacy &
safety safety

Tens Hundreds Thousands

Low dose Medium dose Medium dose,

with placebos randomized
 CLINICAL TIMELINE
CONCLUSIO
NS
PRECLINI Neptune is the farthest
planet from the Sun
CAL
Earth is the planet we
live on 05
04
03 RESUL
01 02 TS
Mercury is the closest
EXPERIMENT
planet to the Sun
ATION
RESEA Despite being red, Mars
is actually a cold place
RCH
Venus has a beautiful
name, but it’s quite hot
A PICTURE
ALWAYS
REINFORCES
THE
Images reveal large amounts
CONCEPT
of data, so remember: use an
image instead of long texts.
Your audience will
appreciate that!
 TENDENCY
Mercury is the closest planet to
the Sun and the smallest one in
our Solar System—it’s only a bit
larger than our Moon

MERCU
RY
MARS

VENUS

If you want to modify this graph, click on it, follow the link, change the data and replace it here
RESULTS
EXPERIMENT A EXPERIMENT B

OUTCOME OUTCOME
TREATME Test 1 Test 2 Test 3 Test 1 Test 2 Test 3
NT
Group 1 315 285 600 345 123 568

Group 2 210 390 600 235 234 689

Group 3 240 165 580 324 365 867

 RESULTS ANALYSIS
NEPTUNE SATURN

60%
Mercury

30% 10% 80% 90% 35%

Mars Venus Mercury Mars Venus
SUCCESS RATE

PATIENT

90% S
CURED

WITHOUT
70% SECONDARY
EFFECTS
 CONCLUSIONS

JUPITER
It’s the biggest planet
in our Solar System

01 03
02
MERCURY VENUS
Mercury is the closest NEPTUNE Venus has a beautiful
planet to the Sun name, but it’s terribly hot
Neptune is the farthest
planet from the Sun
SNEAK PEEK
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KS
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●Hand drawn family in different life stages

PHOTOS
●Beautiful pregnant woman meditating
●Medium shot pregnant woman posing in underwear
 Riwayat Penyakit
Pasien dirujuk ke
Sekarang
RSBL karena
ingin
Pasien periksa ke bidan
menggunakan
Anik dengan TD 140/100
asuransi SPM.
19/05/21
dan dirujuk untuk periksa 19/05/21 Pukul 15.19
ke RS 19/05/21 Pukul 15.00
19/05/21 Pukul 12.00
Pukul 08.00 Pasien datang ke
IGD RSBL. TD :
Pasien periksa di RS 160/100
Pasien hamil anak ke 3 Yasmin TD 160/100.
dengan usia kehamilan USG oleh
35-36 mgg (HPHT) 38 dr.Haris,Sp.OG dan
mgg (USG) disarankan MRS
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