Ketuban Pecah

Prematur
Pembimbing :
dr. Retina Indanwati, Sp.OG

Oleh:
Zunaida Nurul Awallia
202220401011144

SMF ILMU KESEHATAN KEBIDANAN DAN KANDUNGAN

RSU HAJI SURABAYA
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG
2024
Definisi Ketuban Pecah Dini
Definisi
Ketuban pecah dini (KPD) didefinisikan sebagai pecahnya
selaput ketuban sebelum terjadinya persalinan.

Klasifikasi
Ketuban pecah dini preterm adalah pecah ketuban
yang terbukti dengan vaginal pooling, tes nitrazin dan,
tes fern atau IGFBP-1 (+) pada usia <37 minggu
sebelum onset persalinan.

Ketuban pecah dini aterm/ premature rupture of

membranes (PROM) adalah pecahnya ketuban
sebelum waktunya yang terbukti dengan vaginal
pooling, tes nitrazin dan tes
fern (+), IGFBP-1 (+) pada usia kehamilan ≥ 37 minggu.
Epidemiologi

KPD aterm
• KPD terjadi cukup besar dan cenderung
meningkat.
• Kejadian KPD aterm terjadi pada sekitar
6,46-15,6% kehamilan aterm
PPROM
• KPD preterm berhubungan dengan sekitar 18-20%
kematian perinatal di Amerika Serikat
• Sekitar 1/3 dari perempuan yang mengalami KPD
preterm akan mengalami infeksi yang berpotensi
berat
• 47,9% bayi mengalami kematian
Etiologi
Riwayat KPD

Usia <20 th &> 35 th

Perilaku Merokok

Sosial ekonomi

Inflamasi

Servik yang inkompentensik

Trauma
 PATOFISIOLOGI

Persalinan Biokimia Kolagen Kekuatan Keadaan

Dalam persalinan Pecah karena pada Perubahan struktur, Melemahnya Ketuban Pecah Dini
secara umum daerah tertentu jumlah sel, dan kekuatan selaput prematur sering
disebabkan oleh terjadi perubahan katabolisme ketuban ada terjadi pada
kontraksi urerus biokimia yang kolagen hubungannya polihidramnion,
dan peregangan menyebabkan menyebabkan dengan inkompeten serviks,
berulang selaput ketuban aktivitas kolagen pembesaran uterus, solusio plasenta
inferior rapuh berubah dan kontraksi rahim, dan
menyebabkan gerakan janin.
selaput ketuban
pecah
 Gejala Klinis

Nyeri pada uterus, DJJ

Keluarnya cairan ketuban semakin cepat, pendarahan
Janin mudah diraba Tidak ada his dalam 1 jam
merembes melalui vagina pervagina sedikit (jarang
terjadi)
 Diagnosis

Pemeriksaan Pemeriksaan
Anamnesis Fisik Penunjang

• Riwayat keluarnya • Inspekulo : adanya cairan

air ketuban 1. USG
ketuban di cavum uteri. jika
2. Tes Nitrazine
tidak ada dapat dicoba
3. IGBFBP
dengan menggerakan
4. Darah lengkap
sedikit bagian terbawah
janin atau meminta pasien
batuk atau mengedan
• Tanda infeksi: suhu >38, air
ketuban keruh dan berbau,
janin takikardi mungkin
mengalami infeksi
intrauterine
• Tes Ph : ketuban 7,1-7,3
(basa)
 Tatalaksana
Manajemen
Ekspektatif

❑Mempertahankan kehamilan adalah pilihan yang lebih baik

Ketuban Pecah Dini Usia
❑Morbiditas minor neonatus seperti hiperbilirubinemia dan takipnea transien
kehamilan <24 Minggu lebih besar apabila ibu melahirkan

Ketuban Pecah dini usia ❑Mempertahankan kehamilan akan meningkatkan resiko korioamnionitis dan
kehamilan 34-38 minggu sepsis
❑Penelitian menunjukkan bahwa mempertahankan kehamilan lebih buruk
dibanding melakukan persalinan

Ketuban Pecah dini memanjang

(Perkumpulan Obstetri dan Ginekologi Indonesia Himpunan Kedokteran Feto Maternal, 2016).
Manajemen
Aktif

❑ Kehamilan > 37 minggu, induksi dengan oksitosin. Bila gagal 🡪seksio

sesarea. Dapat pula diberikan misoprostol 25 pg - 50 pg intravaginal tiap 6
jam maksimal 4 kali.
❑ Bila ada tanda-tanda infeksi berikan antibiotik dosis tinggi dan persalinan
diakhiri.
Bila skor pelvik < 5, lakukan pematangan serviks, kemudian
induksi. Jika tidak berhasil, akhiri persalinan dengan seksio
sesarea.
Bila skor pelvik > 5, induksi persalinan
 Komplikasi

• Setelah ketuban pecah biasanya segera

Persalinan disusul oleh persalinan. Periode laten
premature tergantung umur kehamilan

Risiko infeksi ibu dan anak meningkat pada Ketuban

infeksi Pecah Dini

• Dengan pecahnya ketuban terjadi oligohidramnion

Hipoksia dan yang menekan tali pusat hingga terjadi asfiksia atau
Asfiksia hipoksia

Ketuban Pecah Dini yang terjadi terlalu dini

Sindrom menyebabkan pertumbuhan janin terhambat, kelainan
derfomitas janin disebabkan kompresi muka dan anggota badan janin,
serta hipoplasi pulmonar
 Prognosis

Prognosis pada ketuban pecah dini sangat bervariatif tergantung pada

Usia kehamilan:

Adanya infeksi / sepsis, Faktor resiko / penyebab, Ketepatan Diagnosis

awal dan penatalaksanaan.
ALGORITMA
Tinjauan Kasus
 Identitas Pasien
Nama pasien : Ny. G
Usia : 27 tahun
Suku : Jawa
Agama : Islam
Pendidikan : SMA
Pekerjaan : Karyawan Swasta
Alamat : Saikhoni 90 Tambak Sumur Waru
MRS : 11 Mei 2023
Pukul : 08.21
 Anamnesis
❑ Keluhan Utama : Ketuban pecah sejak 4 hari yang lalu
❑ Riwayat Penyakit Sekarang : Pasien datang ke Ponek RS Haji Surabaya dengan keluhan keluar cairan bening dari
vagina dengan sejak sekitar 4 hari yang lalu setelah coitus. Pada saat keluar cairan yang pertama pasien periksa ke
bidan dan diberikan terapi amox, asam fenamat, dan microgest 1 x 200 mg, dan diminta kontral lagi 3 hari kemudian .
Kemudian pada saat kontrol, pasien mengatakan bahwa keluhannya tidak ada perubahan yaitu masih keluar cairan
dari jalan lahir. Sehingga bidan merujuk pasien ke RS Haji Surabaya.
❑ Riwayat Penyakit Dahulu :
• Hipertensi :-
• Diabetes mellitus :-
• Penyakit jantung :-
• Asma :-
• Pernah dirawat :-
• Pernah di operasi :-
• Jenis operasi :-
Riwayat Alergi :-
Anamnesis

❑ Riwayat Penyakit Keluarga :

Hipertensi :-
Diabetes mellitus :-
Asma :-
Penyakit Jantung :-
Riwayat sakit yang sama :-

❑ Riwayat ginekologi :-
❑ Riwayat Penyakit Sosial :
Pola makan teratur: 3 x kali sehari ❑ Skreening Gizi:
• Pasien tidak mengalami penurunan BB yang tidak
Pola minum : 1500 cc/hari direncanakan/diinginkan dalam 6 bulan terakhir
BAK : Setiap 5 • Asupan makanan pasien tidak berkurang karena
jam/hari 🡪 Bening penurunan nafsu makan/kesulitan menerima
makanan
BAB : 1x/hari 🡪
lembek ❑ Riwayat Haid :
Pola istirahat : tidur 7-8 jam Menarche : 14 th
Siklus : 28 hari, teratur
Psikologi : menerima kondisi saat
Lama : 7 hari
ini
Dismenorhea : tidak ada
Dukungan social : suami, orangtua, keluarga, HPHT : 06 Oktober 2022
Spiritual : Agama Islam TP : : 13 Juli
2023
❑ Peniaian Nyeri : UK : 30-31
Nyeri : - minggu
Sifat : -
❑ Riwayat Perkawinan :

Menikah : 1 kali menikah

Lama Menikah : 1 tahun

❑ Riwayat Kehamilan dan Persalinan: Hamil ini

❑ Riwayat ANC : Rutin bidan dan dokter kandungan

❑ Riwayat KB : Tidak ada

Pemeriksaan Umum
• Keadaan umum : Cukup
• GCS : 456
• Tinggi badan : 160 cm
• Berat badan : 56 kg
• Kesadaran : Compos Mentis
• Tekanan darah : 90/60 mmHg
• Nadi : 107 x / menit
• Suhu : 36,3 °C
• RR : 20 x / menit
• SpO2 :98%
 Pemeriksaan Fisik
A. Status Generalis

Kepala : a/i/c/d = -/-/-/-

Leher : Pembesaran KGB (-), Deviasi trakea(-), Bendungan vena leher (-)
Thorax : Normochest, pergerakan dinding dada simetris
Pulmo : Suara nafas vesikuler, Rokhi -/- wheezing -/-
Cor : Iktus tidak kuat angkat, thrill (-) ,S1S2 tunggal, murmur (-), gallop (-)
Abdomen
I : Luka bekas operasi (-)
P : TFU : 24 cm, punggung kanan, presentasi kepala
P : Thympani
A : DJJ 140 x/menit
Ekstremitas :Tungkai (Simetris)
 B. Status Obstetri

Leopold

∙ Leopold I :TFU 24 cm

∙ Leopold II :Punggung kanan, DJJ 140 x/menit

∙ Leopold III : Presentasi Kepala

∙ Leopold IV : Konvergen, belum masuk PAP

 Pemeriksaan Genitali
Inspeksi
- Pengeluaran pervaginam : air ketuban berwarna jernih
- Lochea : tidak ada
- Volume : tidak ada
- Perineum : tidak ada
- Jahitan : tidak ada
Inspekulo vagina
- Vagina : Tidak ada kelainan
- Hymen : tidak ada data
- Portio : tidak ada data
- Cavum douglasi : tidak ada data
- VT : portio menutup
PEMERIKSAAN PENUNJANG
Darah Lengkap
• Hb : 11,3g/dl (12,8-16,8 g/dl)
• Leukosit : 32,500/ mm3
(4.500-13.5000/mm3)
• Hematokrit : 33.4 % (33-45%)
• Trombosit : 278,000 (150.000-440.000/mm3)

Kimia Klinik
• GDA : 70

Imonu-serologi
• Swab Antigen : Negatif
• Hbs Ag : Negatif

Anti HIV :
• Reagen I : Non Reaktif

USG :
● Urine Lengkap
● BJ : 1.015
● pH : 8,0
Nitrit : Negatif
Protein : 25 mg/dL (1+)
Glukosa : Normal
Keton : 15 mg/dL (2+)
Urobilin : Normal
Bilirubin : Negatif
Ery : 10-15
Leko : 40-50
Cylind : Negatif
Epithel : 2-4
Bact : Positif (+)
Cryst : Negatif
Lain-lain : Negatif

● Foto Thorax ;
● Tidak didapatkan Kelainan
Diagnosis
GIP0000 UK 30-31 minggu + THIU + Letak membujur +
Presentasi kepala+ KPP + ISK + Severe Oligohidramnion
(4,31)
Planning
Diagnosis:
- USG
- NST

Terapi:
- MRS
- Infus RL 20 tts/mnt
- Inj Ceftriaxon 2x1 gr
- Inj Dexamektason 2x 6 mg

Monitoring:
- Keluhan pasien (keluar cairan jernih dari kemaluan)
- TTV (TD, Nadi, RR, Suhu)
- DJJ
- His
Edukasi:
- Menjelaskan pada pasien dan keluarga, bahwa ketuban pasien pecah sebelum waktunya sehingga
disarankan untuk dirawat dirumah sakit dan di observasi kondisi janin dan ibunya.
- Menjelaskan rencana tindakan yang akan diberikan
- Menganjurkan ibu untuk mengurangi pergerakan dan dianjurkan untuk istirahat.
- Menjelaskan prognosis dan komplikasi dari penyakit pasien
 Kasus Teori
• Ny.G 27 Tahun ❑Penilaian awal dari ibu hamil yang datang dengan keluhan
• Keluhan utama keluar cairan bening dari KPD harus meliputi 3 hal, yaitu konfirmasi diagnosis,
jalan lahir
konfirmasi usia gestasi dan presentasi janin, dan penilaian
• HPHT : 06 Oktober 2022 kesejahteraan maternal dan fetal (Perkumpulan Obstetri dan
• UK : 30-31 Ginekologi Indonesia Himpunan Kedokteran Feto Maternal,
minggu
2016).
• Leopold :TFU 24 cm, ❑Didiagnosis secara klinis pada anamnesis pasien dan
sebelah kanan teraba bagian keras
memanjang kesan punggung, presentasi visualisasi adanya cairan amnion pada pemeriksaan fisik
kepala DJJ 140 x/menit (Perkumpulan Obstetri dan Ginekologi Indonesia Himpunan
pemeriksaan genitalia Kedokteran Feto Maternal, 2016).

Inspeksi → Air ketuban ❑Tentukan pecahnya selaput ketuban, dengan adanya cairan
ketuban di vagina. Jika tidak ada dapat dicoba dengan
menggerakkan sedikit bagian terbawah janin atau meminta
pasien batuk atau mengedan (Perkumpulan Obstetri dan
Ginekologi Indonesia Himpunan Kedokteran Feto Maternal,
2016).
 • Pada usia kehamilan lebih dari 34
minggu,mempertahankan kehamilan akan
• Terapi: meningkatkan resiko korioamnionitis dan sepsis
- MRS (level of evidence Ib).Tidak ada perbedaan
signifikan terhadap kejadian respiratory distress
- Infus RL + Drip Bicasma 2 amp, syndrome. Pada saat ini, penelitian
20 tts/mnt menunjukkan bahwa mempertahankan
- Inj Ceftriaxon 2x1 gr kehamilan lebih buruk dibanding melakukan
- Inj Dexamektason 2x 6 mg persalinan
(Perkumpulan Obstetri dan Ginekologi
Indonesia Himpunan Kedokteran Feto Maternal,
2016).

Jika usia kehmailan 32-37 minggu, belum

inpartu, tidak ada infeksi, tes busa negatif, beri
deksamethason, observasi tanda infeksi dan
kesejahteraan janin (Sarwono Ilmu kebidanan
2014)
Daftar pustaka

• Perkumpulan Obstetri dan Ginekologi Indonesia Himpunan Kedokteran Feto Maternal,

2016. Pedoman Nasional Pelayanan Kedokteran Ketuban Pecah Dini. Jakarta: POGI.
• ACOG (The American College of Obstetricians and Gynecologists. Premature Rupture
of Membranes). 2020. Clinical Management Guidelines for Obstetrician-Gynecologists
– Practice Bulletin
• Saifuddin, A. B., Rchimhadhi, T. & Wiknjosastro, G. H., 2010. Ilmu Kebidanan Sarwono
Prawirohardjo. 4 ed. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo .
• Cunningham, F. G. et al., 2018. Williams Obstetrics. 25 ed. United States of America:
McGraw-Hill Education.
Tinjauan Islam
Q.S Al-Mursalat (77) ayat 21-22
Syukran Katsiran
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 Table of contents

01 02 03
Introduction Resume Cover letter

04 05 06
My work Previous projects Other
Contents of a
portfolio
● A portfolio is composed of three main elements:
● Content - this includes the actual work you want to
showcase and can be anything from writing samples to
photographs or videos
● Design - the design should reflect your personality and
style while remaining professional. It should also make it
easy to navigate the portfolio
● Summary - a brief summary at the beginning of the
portfolio will help provide an introduction to your work
and give visitors a better understanding of yourself and
what you have created
 You should include in your portfolio…

Work samples
Work samples can be anything from
graphics to writing, videos or
websites that showcase your design,
development or the writing skills
you have
Skills
Skills and qualifications are the
credentials you have that show
employers your experience and
abilities in various areas that are
related to your field
Professional
narrative
An overview of past project
successes or other accomplishments
as well as a summary of relevant
knowledge and skills gained over
the course of your career
02
Resume
 “I always strive for excellence. I believe in the power of
Jane Doe collaboration, and i love to build meaningful relationships
with clients throughout the creative process”
+34 654 321 432 Experien
jane@freepik.com ce
Educatio
2014-2016 Marketing technician Marketing agency
n
● Tracking and analyzing data to optimize campaigns
2010- 2014 ● Communication ● Coordinating promotional activities
● Writing
Marketing degree ● Leadership 2016-2021 Content creator Creation studio

● Creating videos, podcasts, graphics and infographics

● Developing unique and engaging content
2016- 2017 ● Graphic Design
● Creativity 2021-now Team leader Creation studio
Graphic design master ● Curiosity
● Motivating and leading team members in tasks
● Setting clear objectives and goals for the team
2017- 2019 ● Creativity
● Adaptability
Content creation master ● Management
 Previous projects
Marketing
“I was responsible for managing campaigns across
all major social media platforms; creating, curating
and optimizing content for maximum engagement;
analyzing data to gain insights into customer
behavior and maintaining a strong relationship with
customers”
Content creation projects
“I have participated throughout my career in crafting
SEO-friendly copy, creating promotional videos,
designing newsletters and brochures and more. My
work has been well received with several pieces
being featured in prominent and important
publications”
 Freepik
Cover letter +91 620 421 838
jane@freepik.com

Welcome to my portfolio!

I'm [name], a highly creative and motivated individual, with a

passion for [field of expertise]. My portfolio is filled with unique
and inspiring content, which showcases my skills in the field

Here you will find everything ranging from writing samples,

photographs, videos and more. I strive for excellence in all that I do,
and this portfolio serves as a testament to my capabilities and
accomplishments.

Have a look around, get to know me better, and don't hesitate to

reach out if you have any questions or would like to collaborate!

Sincerely,
Jane Doe
+91 620 421 838 | jane@freepik.com
 Photo showcase
This photo showcase is a collection of stunning
images, each capturing a unique moment in time. Let
them inspire you!
My best work
“As an artist, it's my job to capture the beauty, joy and
emotion of the world around me. I strive to create
something unique in each piece, combining technique
and detail”
"Creativity is the key to
unlocking your true
potential."
 What people say about me
Employer 1
“I have been impressed by the quality,
attention to detail and creative approach
brought to every project made”
Employer 3
“This person has a strong technical
understanding in order to develop successful
strategies. Highly recommended for any kind
of project or task”
Employer 2
“Projects and campaigns are always taken to
another level with ideas that come from this
person. Digital marketing and content
creation experience is quite evident”
Employer 4
“Content creation is top-notch, with engaging
yet professional writing style tailored to
different audiences while keeping a steady
brand message”
 My skills and qualifications
Leadership
“I possess leadership abilities that
have been sharpened through past
roles where I was responsible for
the teams”
Organization
“My proactivity allows me to plan
ahead and prioritize tasks
according to objectives and
different deadlines”
Problem-solving
“My problem-solving capabilities
have enabled me to solve difficult
issues in the past, using creative and
innovative solutions”
Technical skill
“I am knowledgeable in several
technical areas such as
programming languages that
support my ambition in my field”
Communications
“With excellent verbal and written
skills, I can effectively convey
complex messages to a variety of
audiences”
Interpersonal
skill
“Teamwork is one of the essential
part of my daily job, and I am
sensitive towards different
cultures”
 200
The number of projects I have been working on
 A chart of the areas I work in
Social media
Instagram, Twitter

Marketing
Promotion

Graphic design
Illustrations, vectors

Copywriting
SEO copywriting

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 Table
Categor
Project title Skills Date Ref y
Project 1 Graphic design Jan 2022 [Link or reference] Print

Project 2 Copywriting Feb 2022 [Link or reference] Content

Project 3 Video production Mar 2022 [Link or reference] Motion

Project 4 3D modeling Apr 2022 [Link or reference] 3D

Project 5 UI/UX design May 2022 [Link or reference] Web

Project 6 HTML/CSS Jun 2022 [Link or reference] Web

How did I achieve success?
Step 1 Step 8
Identifying objectives Focusing on the future

Step 2 Step 7
Research and preparation Analyzing outcomes

Step 3 Step 6
Developing strategies Continuous improvement

Step 4 Step 5
Plans of action Measuring progress
 Roadmap of my future projects
Ma
Initiative Objective Jan Feb Mar Apr
y
Jun Jul Aug Sep Oct Nov Dec
Developing a digital Reach potential customers through
marketing strategy well-crafted campaigns

Creating engaging Craft content that engages and

content inspires the target audience

Optimizing search Optimize for better and more

rankings visibility with SEO

Leveraging social Connect with customers and boost

media platforms brand awareness

Gather user data to optimize design

Analyzing user habits
for more engagement

Executing email Send emails to subscribers to convert

campaigns leads into sales
 Thanks!
Do you have any questions?
youremail@freepik.com | +34 654 321 432 | yourwebsite.com

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Create your Story with our illustrated concepts. Choose the style you like the most, edit its colors, pick
the background and layers you want to show and bring them to life with the animator panel! It will
boost your presentation. Check out how it works.

Pana Amico Bro Rafiki Cuate

 Use our editable graphic resources...
You can easily resize these resources without losing quality. To change the color, just ungroup the resource and click
on the object you want to change. Then, click on the paint bucket and select the color you want. Group the resource
again when you’re done. You can also look for more infographics on Slidesgo.
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JANUARY FEBRUARY MARCH APRIL

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 ...and our sets of editable icons
You can resize these icons without losing quality.
You can change the stroke and fill color; just select the icon and click on the paint bucket/pen.
In Google Slides, you can also use Flaticon’s extension, allowing you to customize and add even more icons.
Educational Icons Medical Icons
Business Icons Teamwork Icons
Help & Support Icons Avatar Icons
Creative Process Icons Performing Arts Icons
Nature Icons
SEO & Marketing Icons