Scribd Logo
Upload

Welcome to Scribd!

  • 15 views

    Diskusi Placenta Akreta

    Uploaded by

    tenri ola

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Diskusi Placenta Akreta

    Uploaded by

    tenri ola
    15 views3 pages

    Original Title

    diskusi placenta akreta

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    15 views3 pages

    Diskusi Placenta Akreta

    Uploaded by

    tenri ola

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Perempuan Gravida 4 Para 2 Abortus 1 dengan usia kehamilan 34 minggu datang ke rs.

    Wahidin sudirohusodo dengan rujukan dari rs Lamadukelleng Sengkang untuk elektif operasi
    Caesar. Pasien didiagnosis dengan presentasi kaki dan riwayat post section caesarea 2 kali
    atas indikasi sc pertama dengan letak sungsang dan post section caesarea kedua atas
    indikasi post section caesarea 1 kali, placenta previa dan placenta perkreta. These findings
    were based on serial ultrasound reports.
    In the preoperative area, patient’s haemoglobin and hematocrite were 9,5 g/dl and 28,8%, the
    platelet count was 371x103/L. Peripheral intravenous catethers were inserted, a complete
    blood cell count and a type and cross match for 1000cc PRC were completed. Findings of the
    last US examination, a grey scale ultrasound with Doppler study showed placenta on the
    anterior corpus, closed the internal ostium uteri, lacuna (+), there’s no clear zone ~ percreta
    placenta, closed but not involvement the urinary vesica. Had been consult to the
    anesthesiologist.

    Patient with stable haemodynamic, accepted to do the operation with spinal anesthesia and if
    during the operation find difficulties can consult to the urology. Kami memberikan informed
    consent kepada pasien dan keluarga tentang tindakan yang akan dilakukan yakni operasi
    sectio caesarea dengan dilakukan pengangkatan placenta,will did active management with
    hysterectomy.
    On the day of the operation, after made pfannesteil incision, buka facia secara medial tampak
    peritoneum, uterus tampak gravid, it was many
    varises, with the incision at the lower segment
    through the placenta dengan placenta tampak
    menembus lapisan serosa di daerah anterior hingga
    segmen bawah rahim dan neovaskularisasi ke lapisan
    serosa vesika urinaria. Insisi corpus anterior secara
    transversal lebih kurang 6cm dan perdalam secara
    tajam. , delivered baby secara berturut turut kaki,
    bada, bahu dan kepala dengan berat lahir 2520 g, panjang badan 50cm, nilai apgar 8/10
    without difficulties, patients still on the stable haemodynamics.

    The time from uterine incision to delivery the baby was 5 minutes. Immediately on delivery,
    an infusion of oxytocin, 20 U/L, was initiated. Dilakukan Ligasi pembuluh darah dan
    neovaskularisasi. Lakukan reseksi uterus pada tempat invasi placenta. Evakuasi placenta
    kemudian jahit uterus dimulai dengan aproksimasi bagian tengah uterus dan dilanjutkan
    dengan jahitan kontiniu. Subsequently delivery of the placenta and then we successed tried to
    removal of the placenta completely manually, then performed hemostated on the placental
    bed, after that closed the lower segment continuously with PGA no. 1. Good contraction,
    performed bilateral tubectomy. Explore there’s no bleeding, no vaginal bleeding, stable
    haemodynamics closed the abdomen layer by layer. For the finishing, the gauze was taken
    through the vaginal and then observed for the vaginal bleeding. After 15 minutes observation,
    there was no vaginal bleeding.

    Estimated total blood loss during durante operation was 2500 mL.the operation was
    performed as long as 1 hour 30 minutes. Before patient was transferred to the postanesthesia
    recovery unit, she was alert and her blood pressure this time was 110/70 mmHg, her heart
    rate was 80x/min. After 2 hours observation in the recovery room with stable
    haemodynamics, patient reffered to the high care unit. Patient was transfusion with 1000 cc
    PRC, 2 hours after the last transfusion, the haemoglobin level was checked, the haemoglobin
    level 10 g/dL, and her condition still on stable haemodynamics and no vaginal bleeding. The
    patient was transferred to the post partum unit and dipasangkan kateter tetap selama 7 hari
    dengan antibiotic dan antinyeri oral.

    You might also like