PERDARAHAN

PASCA SALIN
Rizki Amalia
PERDARAHAN PASCA SALIN
• Definisi: Perdarahan post partum
adalah perdarahan melebihi 500 ml
yang terjadi setelah bayi lahir.
• Perdarahan yang lebih dari normal
yang telah menyebabkan perubahan
tanda vital (ibu mengeluh lemah,
limbung, berkeringat dingin, menggigil,
hiperpnea, tekanan sistolik < 90 mmHg,
nadi > 100/menit, Hb < 8 g%)
 MASALAH
• Perdarahan post partum dini yaitu perdarahan
setelah bayi lahir dalam 24 jam pertama persalinan
dan perdarahan post partum lanjut yaitu perdarahan
setelah 24 jam persalinan.
• Perdarahan post partum dapat disebabkan oleh
atonia uteri, robekan jalan lahir, retensio plasenta,
sisa plasenta dan kelainan pembekuan darah.
 PENGELOLAAN UMUM
• PENGELOLAAN SYOK
• Selalu siapkan tindakan gawat darurat
• Tata laksana persalinan kala III secara aktif
• Minta pertolongan pada petugas lain untuk
membantu bila dimungkinkan
• Lakukan penilaian cepat keadaan umum ibu meliputi
kesadaran nadi, tekanan darah, pernafasan dan suhu
• Jika terdapat syok lakukan segera penanganan
• Periksa kandung kemih, bila penuh kosongkan
• Cari penyebab perdarahan dan lakukan pemeriksaan
untuk menentukan penyebab perdarahan
 DIAGNOSIS
GEJALA & TANDA TANDA & GEJALA LAIN
KERJA
 Uterus tidak  Syok
berkontraksi dan  Bekuan darah pada
lembek serviks / posisi terlen-
 Perdarahan segera tang akan
Atonia uteri
sete-lah anak lahir menghambat aliran
darah keluar
 Darah segar yang  Pucat
meng-alir segera  Lemah
setelah bayi lahir  Menggigil Robekan
 Uterus kontraksi dan jalan lahir
keras
 Plasenta lengkap
 Plasenta belum lahir  Tali pusat putus akibat
setelah 30 menit traksi berlebihan
 Perdarahan segera (P3)  Inversio uteri akibat
Retensio
 Uterus berkontraksi tarikan plasenta
dan keras  Perdarahan lanjutan
 TANDA & GEJALA
GEJALA & TANDA DIAGNOSIS KERJA
LAIN
 Plasenta / sebagian  Uterus berkontraksi
selaput (mengan- tetapi tinggi fundus Tertinggalnya
dung pembuluh da- tidak berkurang
rah) tidak lengkap
sebagian plasenta
 Perdarahan segera atau ketuban
(P3)
 Uterus tidak teraba  Neurogenik syok
 Lumen vagina terisi  Pucat dan limbung
masa
 Tampak tali pusat Inversio uteri
(bila plasenta
belum lahir)
 Sub-involusi uterus  Anemia
 Nyeri tekan perut  Demam Endometritis atau sisa
fragmen plasenta
bawah dan uterus
Late postpartum
 Perdarahan
hemorrhage
 Lokhia
Perdarahan
mukopurulen dan postpartum sekunder
Condom Tamponade
A condom is inflated with
isotonic saline/air through a
catheter, and is used to
create tamponade within
the uterus for stoppage of
massive PPH, when other
conservative methods failed.
 Logistics Needed

Instruments and logistics needed for condom

catheter application by Sayeba’s method- all FDA
approved
 Procedure

Condom tied over catheter

by thread or clip
 Procedure

Cervical lips are hold by sponge forceps

 Procedure

Fitted condom is inserted into uterus

Procedure

The mouth of cervix and

vagina is then packed by
ribbon gauge pack or
sterile sanitary pads or a
second condom inflatted
within vagina to prevent
slippage of condom from
the uterine cavity
 Procedure

The distal end of the catheter is connected

with saline set
 Procedure

The regulator is opened up fully for rapid flow of saline

into the condom to inflate it within uterine cavity by 250-
500 ml of saline. In severe atony even 1500ml of saline
may be needed and can be introduced without any harm.
 Procedure

Inflation of condom is shown

 Procedure

Inflated condom producing distention of

the uterus and thereby compresses sinuses
 Procedure
When saline stops
going, the saline bag is
compressed.
When resistance can be
felt it indicates
tamponade has
produced.
 Procedure

When Tamponade formed, catheter folded & strapped

 Procedure

Vulval pad is applied tightly

 Procedure
• When bleeding stops, it indicates haemostasis has
achieved ie. ‘tamponade test’ is positive.
• The regulator of saline set is closed and bleeding is
observed.
• In most of the cases bleeding stops within 0-15
minutes.
 Procedure
• The vital signs and per vaginal bleeding need to be
monitored continuously.
• I/V saline with 20 units of oxytocin has to be
continued for at least 6 hours to maintain the
uterine contraction.
• The condom catheter is kept for 24 hours. If still,
bleeding is observed, catheter can be kept for 48
hours.
• Parentral antibiotic to be given at least for 72 hours
 Procedure

If no more bleeding, the suture is cut

and catheter is deflated by draining
the saline. Deflation should be done
gradually and stepwise
Procedure

The pack and condom catheter is removed

and vital signs and per vaginal bleeding is
continuously monitored
SURGERY
TERIMA KASIH