M U D A

BERKARAKTER
INTERPROFESIONAL EDUCATION-COLABORATION

UNISM

UNISM. AC.ID
 M U D A
UNIVERSITAS SARI MULIA BERKARAKTER
Jl. Pramuka No. 02, Banjarmasin INTERPROFESSIONAL EDUCATION-COLLABORATION

UNISM

Ganggguan Perdarahan
Winda Ayu Fazraningtyas, Ns., MSN
Department of Maternity Nursing, Faculty of Health
Sari Mulia University
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TUJUAN PEMBELAJARAN

1. Menerapkan asuhan keperawatan pada gangguan perdarahan.

2. Memahami konsep teori perdarahan awal kehamilan.
3. Memahami konsep teori perdarahan antepartum.
4. Memahami konsep teori perdarahan postpartum.
5. Memahami konsep teori gangguan pembekuan darah.

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Outline

Perdarahan Gangguan
Perdarahan Perdarahan
awal pembekuan
Antepartum Postpartum
kehamilan darah

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INTRODUCTION
• The leading cause of maternal mortality, accounting for about 35% of all
maternal deaths because of postpartum haemorrhage.
• These deaths have a major impact on the lives and health of the families
affected.
• The pregnancy-related mortality ratio in the United States was 17.3 deaths
per 100,000 live births in 2013.
• An estimated hemophilia frequency of about 1/10,000 births, both for
males and females.

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Perdarahan pada Awal Kehamilan

• Perdarahan pervaginam seringkali terjadi pada kehamilan. 
• Perdarahan awal kehamilan terjadi pada kehamilan kurang dari 22 minggu.
• Lebih dari 20% wanita hamil yang berhasil melahirkan pernah mengalami
perdarahan pervaginam selama masa antenatal.
• Kemungkinan penyebab perdarahan yang terjadi pada awal kehamilan,
yaitu abortus dan kehamilan ektopik, ataupun mola hidatidosa.

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 Abortus
• Abortus merupakan berakhirnya kehamilan sebelum janin dapat hidup
di dunia luar, tanpa mempersoalkan penyebabnya.
• Terjadi pada UK < 20 minggu atau < 22 minggu.
U
N
Faktor Maternal I
S
M
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Faktor Janin A
Etiologi C
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I
Faktor Eksternal D
 Abortus berdasarkan Gejalanya
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• Penghentian kehamilan sebelum janin mencapai viabilitas.

Abortus spontan • Ex: Ab. imminens., Ab. Insipien, Ab. Inkomplit, Ab. komplit

Abortus provokatus • Dihentikannya kehamilan untuk tujuan indikasi medis.

medisinalis
• Prosedur abortus yang dilakukan dengan prosedur dan
Abortus tidak aman oleh orang yang tidak memiliki standar medis minimal.

Abortus septik • Abortus yang mengalami komplikasi infeksi.

 Perbedaan Abortus Spontan
Diagnosa Serviks Uterus Tanda/Gejala Tindakan
Imminens Tertutup Sesuai UK • Kram perut bagian bawah • Observasi
• Uterus lunak perdarahan
• Istirahat
• Hidari koitus
Insipiens Terbuka Sesuai UK • Nyeri perut bagian bawah • Evakuasi U
• Belum ada ekspulsi hasil N
konsepsi I
Inkomplit Terbuka Sesuai UK • Nyeri perut bagian bawah • Evakuasi S
• Sebagian ekspulsi hasil M
konsepsi .
Komplit Tertutup Lebih kecil dari • Sedikit atau tanpa nyeri • Tidak perlu terapi A
UK perut bagian bawah spesifik, kecuali ada C
• Riwayat ekspulsi hasil perdarahan atau .
konsepsi infeksi. I
D
 Abortus Spontan
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Perdarahan Antepartum
• Antepartum haemorrhage (APH) is defined as bleeding from or in to the
genital tract, occurring from 24 weeks of pregnancy and prior to the birth
of the baby.
• The most important causes of APH are placenta praevia and placental
abruption, although these are not the most common.
• APH complicates 3–5% of pregnancies and is a leading cause of perinatal
and maternal mortality worldwide.
• Perdarahan yang berbahaya karena cepat dan banyak yaitu perdarahan
yang berasal dari kelainan gangguan pada plasenta. Perdarahan yang
bukan dari plasenta (misalnya serviks), relatif lebih tidak berbahaya.
• PRINSIP : pada kasus perdarahan antepartum, pikirkan kemungkinan
yang lebih bahaya lebih dahulu, yaitu perdarahan dari plasenta.
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 Kemungkinan Penyebab Perdarahan Antepartum
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perdarahan
Plasenta Solutio
yg belum jelas
Previa Plasenta
sumbernya

Ruptur sinus Plasenta letak

Vasa Previa
marginalis rendah
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Predisposisi

Cacat Rahim
(riw.
Riw. Plasenta
Grande Kuretase, op. Kelainan
Primipara tua previa
multipara mioma, Uterus
sebelumnya
manual
plasenta)
 Perdarahan Postpartum
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• Perdarahan postpartum didefinisikan sebagai kehilangan 500 ml atau

lebih darah setelah persalinan pervaginam atau 1000 ml atau lebih
setelah seksio sesaria.

Perdarahan Perdarahan
postpartum postpartum Klasifikasi
primer sekunder
 Etiology

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N
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Laserasi Retensio S
Atonia uteri Koagulopati M
jalan lahir plasenta
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A
C
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D
 Gambaran Klinis Perdarahan Obstetri
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 Gangguan Pembekuan Darah
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• Gangguan pada faktor pembekuan darah (trombosit) adalah perdarahan

yang terjadi karena adanya kelainan pada proses pembekuan darah ibu,
sehingga darah tetap mengalir.
• Pada periode post partum awal, kelainan sistem koagulasi dan platelet
biasanya tidakmenyebabkan perdarahan yang banyak, hal ini bergantung
pada kontraksi uterus untukmencegah perdarahan. Deposit fibrin pada
tempat perlekatan plasenta dan penggumpalan darah memiliki peran
penting beberapa jam hingga beberapa hari setelah persalinan.
 MUDA
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Deep Vein Thrombosis

• Deep vein thrombosis, or DVT, is the development of a blood clot in a deep
vein.
• During pregnancy, up to 80 percent of DVTs occur in the left leg.
• If left untreated, a clot can break off and travel through the circulatory
system to the lungs (called a pulmonary embolism, or PE), which can be
life-threatening.
• DVT carried out in pregnancy because of the level of blood-clotting
proteins increases while anti-clotting protein levels get lower. Other factors
that can contribute are the enlarged uterus, which increases pressure on
the veins that return the blood to the heart from the lower body.

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 Symptoms of DVT
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• A heavy or painful feeling in the leg (a

lot of people say that it feels like a
really bad pulled muscle that doesn’t
go away)
• Tenderness and/or warmth in the calf
or thigh
• Slight to severe swelling
 Risk Factors of DVT
• Have a family or personal history of VTE
• Are 35 years or older
• Are overweight or obese
U
• Smoke N
I
• Have preeclampsia or certain chronic illnesses including hypertension, inflammatory
S
bowel disease or other vascular diseases M
• Are on strict bed rest .
A
• Have severe varicose veins C
• Delivered by cesarean section .
I
• Have a postpartum hemorrhage or need a blood transfusion D
• Are taking birth control pills (progestin-only pills, however, do not increase DVT risk,
nor do the IUD and implant)
 Disseminated Intravascular Coagulation
• Uncontrolled peripartum bleeding, resulting in disseminated intravascular
coagulation (DIC), is one of the leading causes for maternal mortality
worldwide
• This is in spite of an adaptive physiologic mechanism that generates a
U
physiologic prothrombotic state during gestation. N
• Disseminated intravascular coagulation (DIC) represents a life threatening I
S
condition which is the endpoint of uncontrolled systemic activation of the M
hemostatic system, leading to a simultaneous widespread microvascular .
thrombosis, that can compromise the blood supply to different organs, and A
C
may lead to organ failure .
• This process is associated with increased degradation of coagulation factors I
D
as well as anticoagulation proteins, and followed by their impaired
synthesis, leading to uncontrolled bleeding.
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Disseminated Intravascular Coagulation

• Obstetrical DIC has been associated with a series of pregnancy complications
including the following:
 Acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations,
and uterine rupture);
 Placental abruption;
 Preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet
count syndrome;
 Retained stillbirth;
 Septic abortion and intrauterine infection;
 Amniotic fluid embolism; and
 Acute fatty liver of pregnancy. 
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