ADAPTASI FISIOLOGIS pada POST PARTUMpostpartum c/ puerpural sepsis, endometritis, mastitis Tekanan Darah Terjadi penurunan 20 mmHg k/ orthos hipotensi Apabila terjadi peningkatan preeklamsi

ADAPTASI FISIOLOGIS padaPOST PARTUM

Oleh

Lutfatul Latifah

Materi Kuliah Keperawatan

Universitas Jenderal Soedirman (Unsoed)

www.unsoed.ac.id

Postpartum

Postpartum = puerperium

The 6 weeks periods after childbirth

A time of rapid physiological changes within

the womens’s body as it returns to a pre

pregnant state

Adaptasi Tanda-Tanda Vital

Suhu

Maksimal 38 C k/ kerja otot meningkat, dehidrasi dan perubahan hormonal

Apabila panas lebih dari 24 jam komplikasi postpartum c/ puerpural sepsis, endometritis, mastitis

Tekanan Darah

Terjadi penurunan 20 mmHg k/ orthos hipotensi

Apabila terjadi peningkatan preeklamsi puerpuralis Peningkatan sistole 30 mmHg

Peningkatan diastole 15 mmHg

Adaptasi Kardio Vaskuler

Bradikardia 50-70x/menit (normal)

k/ toleransi dan kompensasi penurunan vaskuler resistensi

Tachikardia pd partus lama dan perdarahan

Diaphoresis (pada malam hari) dan menggigil instabilitas vasomotor ‘normal’ bila tanpa demam

Komponen darah

Hb & Ht nilainya normal meningkat bila pendarahan

Leukosit : 15.000 – 30.000

Pembekuan darah meningkat hati2 tromboemboli

Adaptasi Sistem Perkemihan

Kandung kemih edema & penurunan sensitivitas

K/ over distensi, tidak lampias dan urinary incompetence

Diuresis dalam 24 jam pertama

K/ udema pada waktu hamil

Hematuria trauma kandung kencing

Acetonuria dehidrasi dan partus lama

Proteinuria

K/ involusi uterus proses katabolisme tubuh

Adaptasi Sistem Endokrin

Setelah plasenta lahir penurunan prolaktin,

estrogen dan progesteron

Prolaktin meningkat LAKTASI sucking

Non laktasi prolaktin menurun dan estrogen

meningkat fase follicular 3 mg post partum

menstruasi 12 mg

Laktasi menstruasi pd mg 36

Perubahan Payudara

Colostrum minggu I

Warna kuning kental

Protein banyak

Tinggi fat globules

Tinggi antibodi

ASI hari ke 3

‘breast engorgement’

k/ vaskularisasi meningkat

Adaptasi Sistem Pencernaan

Minggu I

Motilitas usus menurun (pengaruh progesteron saat hamil)

Kekurangan cairan

Perineum tidak nyaman

Penurunan tonus otot abdomen

KONSTIPASI enema

Adaptasi Muskulus Skeletal

Otot abdominalis tonus <

Diastasis Rectus Abdominalis

Sensasi ekstremitas bawah

menurun k/ efek anestesi

Tromboplebitis k/ aktifitas

menurun & protrombin meningkat

Edema berkurang

Adaptasi Organ Reproduksi

Perubahan perineum

Episiotomi sakit sampai 5-6 mg postpartum

Perubahan vagina

Segera setelah melahirkan edema, luka dan biru, laserasi dan rugae tidak ada

Rugae kembali mulai 3 mg postpartum, 6 mg PP normal

Mukosa atropi kembali dengan dimulainya menstruasi

Cervical Changes

Following birth it is spongy and flabby and

formless and may appear bruised.

Original form is regained in a few hours

The shape is permanently changed by the

first childbearing.

Goes from dimple like to a lateral slit (fish

mouth)

Involusi Uterus

The rapid reduction in size of the uterus and it’s

return to a condition similar to its pre-pregnancy

state.

The uterus remains slightly larger than it was before

the first pregnancy.

Process is complete at 3 weeks except at the

placental site (6 to 7 weeks)

Subinvolution (the failure of the uterus to return to

the nonpregnant state) may be caused by an

infection or retained placenta fragments

Posisi Fundus Uterus

Waktu Posisi fundus Berat

Uterus

Lochea

1-2 jam Pertengahan umbilikus 1000 gr Rubra

12-24 jam 1 cm dibawah umbilikus 1000 gr Rubra

3 hari 3 cm dibawah umbilikus

( turun 1 cm/hari)

1000 gr serosa

9 hari Tidak teraba 500 gr alba

5-6 mg Tidak teraba 350 gr Tida ada

Lochia: Rubra, Serosa, Alba

Rubra (day 1-3): dark red in color, contains elemen

of amnion, chorion, decidua, vernix, lanugo &

meconium, should not contain clots, a few small

clots are considered normal.

Serosa (day 4-10) days: pinkish to brownish in

color, contain blood, wound exudates, erythrcytes,

leukocytes & cervical mucose.

Alba (day 10-14): creamy or yellowish in color,

contains decidual cells, mucus, bacteria, &

epithelial cells

Weight Loss

An initial weight loss of 10 to 12 lbs(5-6 kg)

occurs as a result of the birth of the infant,

placenta and amniotic fluid.

Puerperal diuresis accounts for loss of an

additional 5 lbs(2,5 kg) during the early

postpartum period.

Normally return to pre-pregnant weight by 6

weeks postpartum.

Afterpains or Afterbirth pains

Occur more commonly in multiparas than the primiparas.

Caused by intermittent contractions.

May cause severe discomfort for the first 2-3 days.

Breastfeeding may increase the severity.

Oxytocins may increase severity. (Pitocin, Methergine)

Mild analgesic may be indicated for pain relief. (Ibuprofen)