Belajar Laga Vita

Pasien datang tgl 6 juni 2020 pkl 1 , awalnya rujukan PKU kotagede
riwayat stimulasi oxytocin dengan KPD, IUGR PE G3P2A0 uk 37 mingu bdp. Pasien tensi tinggi
5 IU/500ml RL 12 tpm sejak uk 10 minggu. Riwayat anak 1 dan 2 tidak pernah td tinggi.
Perniakah pertama usia ibu 36 thn.peb anak pertama.
dipertahankan botol I ai Pasien disana td 200an diberi nifedipin lalu 180an. Sejak usia 10
minggu obat yang diberikan kalk dan etabion. Datang dengan protein
IUGR, krisis HT teratasi, urin positif 3. alb 2.8 lain lain normal. Datang dengan BS awal 0. pasien
tapi sudah ada his 2x dalam 10menit. Lalu di IGD TD 180an, diberi
PEB superimposed, riw nifedipin tensi turun 170an. CTG baik, dilakukan evaluasi 8 jam kpd.
Jam 4 evaluasi his sudah 2x dalam speluh menti 25 detik sedang DJJ
KPD 13 jam, P3A0, H0, 140 kpm dengan BS 7 lalu disuulkan akselerasi dengan oksitosi..
Usuljam 4 masuk jam 8 dengan maintanance 12 tpmkrn his sudah
ibu dengan obese gr II adekuatlalu pkl 9.20 ibu ingin mengjan masuk kala II bayi lahir pkl 9.30
Jenis kelamin laki, BB 1978 as9/ de19ngan IP 1.9
PEB superimposed
 KPD

Penilaian awal dari ibu hamil

yang datang dengan keluhan
KPD aterm harus meliputi
3 hal, yaitu konfirmasi
diagnosis, konfirmasi usia
gestasi dan presentasi janin,
dan
penilaian kesejahteraan
maternal dan fetal.
 IUGR
general sequence of Doppler and biophysical change : When fetal growth is compromised,
- reduction in umbilical venous flow is the initial hemodynamic change.
Venous flow is redistributed away from the fetal liver and towards the heart. the fetal abdominal circumference
Liver size decreases, causing a lag in fetal abdominal circumference, which is
the first biometric sign of FGR.
(AC) is smaller than expected because
of depletion of abdominal adipose
●Umbilical artery Doppler index increases (diminished end-diastolic flow)
due to increased resistance in the placental vasculature.
tissue and a reduction in hepatic size
from depletion of glycogen. Most
●Middle cerebral artery (MCA) Doppler index (eg, pulsatility index) decreases
(increased end-diastolic flow), resulting in preferential perfusion of the brain
studies report that reduced AC is the
(brain-sparing effect). most sensitive single biometric
●Increasing placental vascular resistance results in absent and then reversed
indicator of FGR
end-diastolic flow in the umbilical artery.
Biometric ratios — The HC/AC and femur length (FL)/AC ratios h
been used to identify FGR and are most sensitive in asymmetric
●MCA peak systolic velocity increases secondary to an increase in the PCO2
Since FGR related to uteroplacental insufficiency is often asymm
and decrease in the PO2 in blood delivered to the fetal brain [28].
biometric ratios are generally better for predicting FGR related
uteroplacental insufficiency than for FGR from other etiologies,
●MCA pulsatility (MCAPI) index normalizes or abnormally increases as
FGR is often symmetric.
diastolic flow falls due to loss of brain-sparing hemodynamic changes.

●As cardiac performance deteriorates due to chronic hypoxia and nutritional

deprivation, absent or reversed end-diastolic flow in the ductus venosus and
pulsatile umbilical venous flow may develop.

●Lastly, tricuspid regurgitation and reversed flow at the aortic arch develop,
which can be preterminal events.
Amniotic fluid volume — Oligohydramnio
one of the sequelae of FGR. The proposed
mechanism is diminished fetal urination d
hypoxia-induced redistribution of blood fl
vital organs at the expense of less vital org
such as the kidney [

mbilical artery – When 30 percent of t

villous vasculature ceases to function,
increase in umbilical artery resistance
to reduced end-diastolic flow is consis
seen and is a weak predictor of advers
outcome in FGR. When 60 to 70 perce
villous vasculature is obliterated, umb
artery diastolic flow is absent or rever
fetal prognosis is poor. Reversed diast
is associated with poorer neonatal ou
than absent diastolic flow.
 Krisis hipertensi
• Pweningkatan TD mendadak diatas 180/120
 Pasienmasuk dari Poli tgl 4 juni rencana terminasi di
UK 37m inggu sesuai hasil konklin. Konlin di pakai
di ICU, pasang ela dengan peringan kala II. İbu PDA
TR mild pr mild ar moderate intermediate prob of
PH WHO Cr II-III, Nyha cf 1. awalnya dari cilacap
G1P0A0 (39 thn ) UK 37 minggu
jangung rujuk kesini, dari jantung sini ke poli obsgin
1 hari, ibu PDA, TR mild, MR
nikah sejak 2014 (6thn). . Tau sakit jantung sejak
Mild, PR mild, AR moderate,
usia 12 thn . Pasien diperiksa dengan BS awal 3 dan
intermediate prob of PH, WHO CR
di berik induksi misoprostol. Jam 12 malam tgl 5 ..
II-III, NYHA CF I, dengan ibu
Baru terpasang ela dan pasien ke ICU. Jam 4
infertil primer 5 tahun, riwayat
evaluasi BS masih 3, lalu evaluasi 4 jam kemudian
induksi misoprostol
(08.00) masuk miso tb III sero 2, trus bs 4, evaluasi
25mcg/4jam/po tab 4 seri 1
lagi jam 12 siang, bs4. evaluasi jam 4 BS masih 5
dngan his 3x dalam sepuluh menit sedang kuat.
Diusul kasioksi, tapi blibliau minta evaluasi 6
jamkalo ga maju pake oksitosin.evaluasi tgl 5 juni
jam 10 malam,
presbo, anhidramnion, HT kronis,
G3P1A1 hamil 37 minggu 5 hari,
pro SC scheduled emergency Sabtu 06/06/20
riwayat operasi thymoma 4 tahun
lalu
presbo, anhidramnion, HT kronis,
G3P1A1 hamil 37 minggu 5 hari,
pro SC scheduled emergency Sabtu 06/06/20
riwayat operasi thymoma 4 tahun
lalu