refkas IUFD

7/23/2019 refkas IUFD

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REFLEKSI KASUS-IUFD-Lim Yi Wen 14155



Case

Summary

Identitas

Pasien

Anamnesis

Pemeriksaan Fisik Pemeriks

aanPenunjan

g

Diagnosisdan

Manejemen

Follow-Up



IDENTITAS PASIEN DANPENANGGUNGJAWAB

Pasien Suami

Nama Ny. KR Bp.SN

Um! "4 #a$n %1&-'-

1(()*

+' #a$n

Pe,e!aan I Rma$ Tan//a Pe0an/an/

Pen0i0i,an SD SD

Aama# K! Ja#i 12'Sampan/

K! Ja#i 12'Sampan/

T/ 3a, "5252")15 15") --

N6.7m '4-88-88 --

A/ama Iam Iam

S, Ja9a Ja9a

Ba:,



RIWAYAT PENYAKIT SEKARANG

KU Paien me!pa,an !,an 0a!i PUSKES3AS 0en/an0ia/n6a pe, IUFD.

1 ;a!i eem ma, !ma$ a,i#< paien men/e$ #i0a,me!aa,an /e!a,an ayi e,i#a! 9a,# 6!e. Ke$an pin/<

ma< nye!i pe!#< me< ,ea! en0i!2 0a!a$ 0a!i aan a$i!0ian/,. Ri9aya# a#!ama 0an in=e,i 0aam + an#e!a,$i! 0ian/,a.

;a!i ma, !ma$ a,i#< paien pe!i,a ,e PUSKES3AS<an/n/ 0i!, ,e RSUD Banyma. Saa# 0i RSUD

Bayma< paien men/a#a,an pin/< ma %>*< ,ea!en0i! 0a!i aan a$i! %>*< 0a!a$ %-*< pe!# ,en:an/-,en:an/%>* < nye!i %>* pa0a =n0 #e!i..

?S men/a#a,an ;P;T 15-1"-")14< ;PL ""-(-")15< UK "+m//



RIWAYAT PENYAKIT DA;ULU

Ama< Penya,i# Jan#n/< Penya,i#Ga< ;epa#i#i< ;ipe!#eni0ian/,a

Ri9aya# Ae!/i 6a# 0ian/,a.

RIWAYAT PENYAKIT KELUARGA

Ri9aya# Penya,i# Kea!/a Penya,i# ,!6ni 0an a9aana$i! 0ian/,a. Ri9aya# a6!# %-*



RIWAYAT ?BSTETRIK @GINEK?L?GI 3ena!,e ia15#a$n

;ai0 i, " $a!i< 0a!a$ $ai0 n6!ma< ama $ai0 ' $a!i< #i0a,a0a /an//an a,i# 9a,# $ai0

Ri9aya# pe!ni,a$an a# ,ai eama & #a$n< p6#-:6i#aee0in/%-*

Ri9aya# ?#e#!i, G+P1A1

Ri9aya# Pen//naan KB%>*< n#i $6!m6ne #iap + an ea,,ea$i!an ana, pe!#ama. Be!$en#i a9a #a$n ")14.

Pa0a "'21"2")14 %" an e#ea$ a6!#*< paienmea,,an KB n#i,an 0i P,ema.

I 5 thn PM aterm spontan !idan "# $$%%

II A!ortus&'(t$%)*+

---- ---- ----- ---- -------

III ,amil Ini

Ba:,



AN7

Paien pe!#ama ,ai mea,,an PP #e# pa0a anDe:eme! PP #e# %>*< e#ea$ i# #i0a, mea,,an AN7<#i0a, pe!na$ 0i-USG< #i0a, ,6nmi 6a#-6a#ppemen#a< pe!na$ men/aami ma mn#a$< emapa0a a9a ,e$amian.

!ee,



PE3ERIKSAAN FISIK

eneral

Kea0aan Umm e0an/< 76mp6 3en#i Tan0a Ci#a .D/ )5%#0% RR 1& 82min

;R 82min T +&.5:

An#$!6p6me#!y BB 4",/ %",/* TB 15)

Peme!i,aan Si#em

T$6!a, 0an Pa!-pa!

Simme#!i< a!a 0aa! ei,e!<W$eein/ %-*< R6n,i %-*

Jan#n/ S1S" !e/e!< iin/ %-*

A06men Inpe,i Be,a ,a %-* Linea ni/!a %-*< S#!ia ii0e0a!m%-*

Le6p60 %i*TFU $1(m< #e!aa 6,6n/< %ii*pn//n/ ,anan

%iii* #!,#! p!6minen #e!a9a$ kepala %i*0ie!/en

DJJ %--*< ;IS%>* "821)215

E,#!emi#a E0ema >2>< %pi##in/* a,!a 0in/in%-*

Peme!i,aan Daam p6!#i6 na,< pem,aan ":m< eap# ,e#an#$< en0i! %>* Ba:



PE3ERIKSAAN PENUNJANG %"5.5.")15 JA3 1&)1*

Proteinuria &2+

olongan darah/ A

Ba:,



PE3ERIKSAAN PENUNJANGUSG %"525215 J 1&+)*

esan/ Tampa, anin #n//a in#!an#e!ine

P!een#ai ,epaa

DJJ %-* /e!a, %-*

Ta, #ampa, peea!an en#!i,e a#e!a

Kean IUFD.



DIAGN?SIS

IUFD 0an P!e-E,ampia !in/an pa0a m#i/!ai0a<G+P1A1< $ami p!e#e!m< ,aa 1 =ae a,#i=

%J1')) PD pem,aan 4:m< eHa:emen# 5*

3ANAJE3EN

In. 3/S?4 4/! 6a0in/ 06e< IC pean

?,i#6in 5IU 0aam 5))m RL< #pm 20 ;IS a0e,a#

Ba:,



F?LL?W UP Tan//a "5252")15

J 1'45 3a, 3/S?4 4/! 6a0in/ 06e IC J 115 mai #imai ?,i#6in 5IU 0aam 5))m RL< #pm

J 1(+) TD 1+42'4< RR +)< S +'.1< DJJ %-*

J "145 S Paien in/in men/ean

? DJJ %-*< ;IS +821)2") TD 1+)2)

PD C2U #enan/< 0in0in/ a/ina i:in< pem,aan en/,ap< ,epaa #!n 0i ; III<

AK pe:a$

A Kaa II

P Pe!iapan 0an pimpin pe!ainan

J "15) Tea$ 0i a$i!,an ayi a,i-a,i IUFD< APGAR )2)< BBL 1'))/!< PB+':m

3amaemen A,#i= Kaa III

J "155 Paen#a a$i! p6n#an< e,p6!ai mana %-*< pe!inem !p#! %-*

A P"A1 P6# Pa!# Sp6n#an IUFD 0en/an #imai

P In :e=#!ia86ne "81 /!< In. 3e#!6ni0a6e +85))m/< Aam me=enama#e+85))m/2P?< SF 181 #a< Lyn6!a +8" #a %;1*



REFLEKSI KASUS

• TFU ":m UK >2-+"m//< TBJ "&+5/!

• 76n#!a:ep#ie 0!in/ p!e/nan:y



DEFINISI %W?RLD;EALT; ?RGANIMATI?N 1(5)*

"Fetal death" means death prior to the completeexpulsion or extraction from its mother of a product ofhuman conception , irrespective of the duration of

pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that aftersuch expulsion or extraction, the fetus does not breatheor show any other evidence of life, such as beating of theheart, pulsation of the umbilical cord, or denitemovement of voluntary muscles

. Heartbeats are to be distinguished from transientcardiac contractions; respirations are to be distinguishedfrom eeting respiratory e!orts or gasps.

Denii ain

http://en.wikipedia.org/wiki/World_Health_Organization






7LASSIFI7ATI?N

ea!y #ii!#$< 9$i:$ 6::! a# ") #6 "' 9ee, 6=/e#a#i6n<

a#e #ii!#$< 9$i:$ 6::! a# O" 9ee, 6= /e#a#i6n.



ETI?L?GY @ RISK FA7T?RS -ETI?L?GY ?F FETAL DE3ISE IS UNKN?WN IN "5-&) ?F ALL 7ASES

3a#e!na

•P!66n/e0 p!e/nan:y%Q4" 9,*

•Diae#e %p66!y:6n#!6e0*

•Sy#emi: pe!y#$ema#6

•An#ip$6p$6ipi0yn0!6me

•In=e:#i6n•,ypertension•Pree(lampsia•E:ampia•;em6/6in6pa#$y•A0an:e0 ma#e!naa/e

•

R$ 0ieae•U#e!ine !p#!e•3a#e!na #!ama 6!0ea#$

•In$e!i#e0#$!6m6p$iia

Fe#a

•3#ipe /e#a#i6n•In#!a#e!ine /!69#$!e#!i:#i6n

•76n/eni#aan6!mai#y

•Gene#i: an6!mai#y•In=e:#i6n %ie<pa!6i! B1(<73C< isteria*

•;y0!6p

Pla(enta

•76!0 a::i0en#•A!p#i6n•P!ema#!e !p#!e 6=mem!ane

•Caa p!eia•Fe#6ma#e!na$em6!!$a/e

•Pa:en#a in:ien:y

Ri, Fa:#6! %9ea,p!e0i:#ie ae*

•A=!i:an Ame!i:an !a:e•A0an:e0 ma#e!naa/e

•,istory o3 3etaldemise

•3a#e!na in=e!#ii#y•;i#6!y 6= ma =6!/e#a#i6na a/e in=an#

•Sma =6! /e#a#i6naa/e in=an#

•?ei#y•Paternal age



DIAGN?SA

Anamnei

Peme!i,aan

Peme!i,aana6!a#6!im

R6n#/en =6#6

a06men

• I #i0a, me!aa,an /e!a,an anin 0aam ee!apa$a!i a#a /e!a,an anin e!,!an/.

•

I me!aa,an pe!#nya e!#ama$ ,e:i.• I ea,an/an ini me!aa pe!#nya mena0i ,e!a0an me!aa,an a,i# epe!#i ma mea$i!,an.

• Inpe,i• Ti0a, #e!i$a# /e!a,an-/e!a,an anin< yan/ iaanya 0apa##e!i$a# #e!#ama pa0a i yan/ ,!.

•Pen!nan a#a #e!$en#inya penin/,a#an e!a# a0ani. Te!$en#inya pe!a$an pay0a!a.

•Kaa ,ea! ai! ,e#an a,an e!9a!na :6,a# ,eme!a$an,en#a.

•Papai• Tin//i =n0 #e!i men!n #i0a, eai 0en/an m!

,e$amian 0an #i0a, #e!aa /e!a,an-/e!a,an anin.•Den/an papai yan/ #ei#i 0apa# 0i!aa,an a0anya ,!epi#aipa0a #an/ ,epaa anin.

•A,#ai Bai, mema,ai #e#6,6p m6n6!a< 06pe! mapnUSG #i0a, a,an #e!0en/a! 0eny# an#n/ anin.

• Peme!i,aan $6!m6n ;:G0aam !ine mena0i ne/a#i=e#ea$ ee!apa $a!i,ema#ian anin.

•Peme!i,aan !a0i66/i 0apa# menim,an

maaa$ 0an #i0a, pe!. Bia 0ia,,an 5 $a!ie#ea$ ,ema#ian anin< a,an #ampa, /ama!anea/ai e!i,#.•1. Tan/ ,epaa anin #mpan/ #in0i$ a#ama ain.

•". Tan/ ea,an/ men/aami $ipe!e,i.•+. Tampa, /ama!an /a pa0a an#n/ 0anpem$ 0a!a$.

•4. E0ema 0i e,i#a! #an/ ,epaa.



3ANAGE3ENT

T$e 0ia/n6i 6= =e#a 0ea#$ i ae0 6n an ultrasounde4amination #$a# 06:men# absence of fetal cardiacactivity

Maternal la!oratory ealuation T$e 6p#imaa6!a#6!y eaa#i6n 6= 96men 9$6 $ae $a0 a=e#a 0emie2#ii!#$ i :6n#!6e!ia.

Fetal geneti( studies- T$e!e i n6 :6nen a #6 9$en

=e#a /ene#i: #0ie a!e in0i:a#e0



D6"I7689 ISSU6S

.iming

I# 6=#en #a,e #ime #6 =y a::ep# #$e 0ea#$ 6= a ay< an0

#$e m6#$e!2pa!en# $60 n6# e !$e0 in#6 ma,in/ any 0e:ii6n a6#0eie!y 0!in/ a :$a6#i: pe!i60< in #$e aen:e 6= e!i6 ma#e!na me0i:a:6n:e!n %e/< 0iemina#e0 :6a/6pa#$y< ee!e p!ee:ampia< in=e:#i6n*..

p6n#ane6 a6! ay e/in 9i#$in 6ne #6 #96 9ee, 6= =e#a0ea#$ in #$e ma6!i#y 6= :ae.

Wai#in/ =6! p6n#ane6 a6! #6 e/in i an 6p#i6n an0 may a6i0 iea6:ia#e0 9i#$ in0:#i6n $69ee!< Wai#in/ a6 in:!eae #$e !i, 6=0ee6pin/ (oagulation a!normalities< pa!#i:a!y i= #$e =e#a 0emie i!e#aine0 =6! ee!a 9ee,. 76a/a#i6n an6!mai#ie a!e 0e #6 #$e/!a0a !eeae 6= #ie =a:#6! %a6 :ae0 #$!6m6pa#in* =!6m #$epa:en#a in#6 #$e ma#e!na :i!:a#i6n

8oute

7aginal deliery i 0ei!ae e:ae i# i /ene!ay a=e! =6! #$em6#$e! #$an :ea!ean 0eie!y< een a=#e! a p!ei6 69e! #e!inee/men# :ea!ean 0eie!y

;69ee!< 6me 96men may ini# 6n :ea!ean 0eie!y 6 #$ey :an a6i0#$e e8pe!ien:e 6= a6! an0 a/ina i!#$ 9i#$ a =e#a 0emie. T$ey $60e #$6!6/$y :6nee0 a6# #$e ene# an0 !i, 6= a/ina e!:ea!ean 0eie!y #6 en!e #$ey p!6i0e =y in=6!me0 :6nen#.



APP8'AC, .' I:DUC.I': '867ACUA.I':

third-trimester

demise

:e!i8 i=a6!ae

in0:#i6n 6=

a6!9i#$ 68y#6:in in #an0a!0

06e

:e!i8 i n=a6!ae%Bi$6p :6!e &*<06e n6# $ae a

p!ei6$y#e!6#6my :a!

mi6p!6#6 "5 #6 5) m:/a/inay ee!y =6! $6! i= "

:6n#!a:#i6n in 1) min%ma8imm & 06e *

#$e e:6n0 06e :an e06e0 #6 5) 6! 1)) m:/.%ma8imm :ma#ie 06e$60 n6# e8:ee0 &)) m:/ in"4 $6!.*

I= e8pi6n 06e n6# 6::! in #$e

!# "4 $6! 6= in0:#i6n< #$emi6p!6#6 !e/imen i !epea#e0 ae:6n0 #ime.

?8y#6:in :an e ini#ia#e0 4 $6!a=#e! a0mini#!a#i6n 6= #$ea# mi6p!6#6 06e< i= nee0e0=6! a/men#a#i6n 6= a6!.

"ate se(ond-trimester

demise %O""9ee,* *

3i6p!6#6 i #$e0!/ 6= :$6i:e =6!in0:#i6n 6= a6!

")) #6 4)) m:/ 6= mi6p!6#6a/inay ee!y + $6! % ma8imm

:ma#ie 06e 6= 14)) m:/ in "4$6!*. T$e mean e8pi6n #ime i1) #6 11 $6!.

3i6p!6#6 6ny V 3i6p!6#6 1))m:/ 6! ")) m:/ a/inay ee!y =6!$6!.

3i=ep!i#6ne-mi6p!6#6

3i=ep!i#6ne ")) m/ 6! &)) m/<=669e0 y mi6p!6#6 "4 #6 4$6! a#e!.

I= #e:$ni:a e8pe!#ie i aaiae<0ia#a#i6n an0 ea:a#i6n i a!ea6nae a#e!na#ie#6 mi6p!6#6

6arly to mid-se(ond

trimester

a :ini:ian 9i#$app!6p!ia#e#e:$ni:a

e8pe!#ie iaaiae

Dia#i6n an0ea:a#i6n i

p!6ay #$ee# 6p#i6n%69e! !i, 6=in=e:#i6n*

#e:$ni:ae8pe!#ie i n6#

aaiae

mi6p!6#6 i e0=6! in0:#i6n. T$ein0:#i6n !e/imeni #$e ame a inp!e/nan:ien0e!/6in/ me0i:a#e!mina#i6n 9i#$6#a =e#a 0emie



?YT?7IN STANDARD D?SES

"a!or Indu(tion

).5-1 mUni#2min IC< #i#!a#e 1-" mUni#2min X15-&)min n#i:6n#!a:#i6n pa##e!n !ea:$e0 #$a# i imiia! #6 n6!ma a6!%ay & mUni#2min* may 0e:!eae 06e a=#e! 0ei!e0

=!eXen:y 6= :6n#!a:#i6n !ea:$e0 an0 a6! $a p!6/!ee0 #6 5-&

:m 0ia#i6n

Di#e #6 1) mU2mL y a00in/ 1) U %1 mL* #6 1))) mL 6= D5W<LR< 6! NS

Postpartum <leeding

1) #6 4) ni# IC in=i6n in 1))) mL a# a !a#e :ien# #6 :6n#!6ee0in/.1) ni# I3 a=#e! 0eie!y 6= pa:en#a.



6S.IMA.I: .IM6 'F D6A., T$e =669in/ /!6 n0in/ appea! #6 e /660 p!e0i:#6!

6= #$e #ime 6= =e#a 0ea#$

/e#a#i6na a/e %/e#a#i6na a/e e #$an "5 9ee, 69#$e 0ee6pmen# 6= p6#m6!#em :$an/e*

• //e# #$e =e# $a een 0ea0 a# ea# i8$6!

B!69n 6! !e00i:66!a#i6n 6= #$emii:a :6!0 6!0eXama#i6n O1 :m

• //e# #$e =e# $a een 0ea0 a# ea# 1"$6!

DeXama#i6n 6= #$e=a:e< a:,< a06men

• //e# #$e =e# $a een 0ea0 a# ea# 1$6! %60y 6ne Z :ap< =a:e< ne:,< :$e#<a:,< a!m< $an0< e/< =66#< :!6#m*

DeXama#i6n O5pe!:en# 6= #$e 60y 6! O"60y 6ne

• suggests the 3etus has !een dead at least$* hours

Skin (olor that is!rown or tan

• //e# #$e =e# $a een 0ea0 a# ea# #969ee,

3mmi:a#i6n %ie<!e0:e0 6=# #ie6me< ea#$e!y ,in<0eepy !69n-#aine0#ie*





EDUKASI PLANNING FUTUREPREGENAN7Y• T$e!e i n6 :6nin:in/ ei0en:e 6n #$e 6p#imm in#e!p!e/nan:y in#e!a a=#e! a #ii!#$.

• I# i !ea6nae #6 a0ie 96men #6 0eay :6n:ep#i6n n#i #$ey =ee #$ey $ae a:$iee0py:$66/i:a :6!e 6= #$e p!ei6 p!e/nan:y 6< 9$i:$ #ypi:ay #a,e a# ea# & #6 1"m6n#$

• ?e!a#i6na e!ie //e# #$a# 96men a!e m6!e ne!ae #6 p6##!ama#i: #!e in#$e p!e/nan:y eXen# #6 #ii!#$ 9$en :6n:ep#i6n 6::! 66n a=#e! #$e 6 an0#$a# m6#$e! 9$6 0eie! #$ei! ne8# ay a!6n0 #$e annie!a!y 6= #$ei! !# ay[

0ea#$ a!e pa!#i:a!y ne!ae

• An a00i#i6na :6ni0e!a#i6n i #$a# #$e !i, 6= a0e!e p!e/nan:y 6#:6me appea! #6 e69e! 9$en #$e in#e!p!e/nan:y in#e!a i m6!e #$an i8 m6n#$

• W$en #$e :ae 6= #$e p!i6! #ii!#$ i n,n69n< #$e!e i n6 ei0en:e #$a# in#eniem6ni#6!in/ in =#!e p!e/nan:ie 9i ma,e a i/ni:an# 0iHe!en:e in p!een#in/ #ii!#$.Nee!#$ee< pa#ien# an8ie#y ee may e 0e:!eae0 9i#$ m6!e =!eXen# p!ena#aii# an0 =!eXen# #e#in/< :$ a n6n#!e #e# an0 #!a6n0 e8amina#i6n. Deie!y

e=6!e 4) 9ee, i 6=#en pe!=6!me0 #6 p!6i0e #$e m6#$e! 9i#$ 6me py:$66/i:a!ea!an:e an0 a mea!e 6= :6n#!6 6e! #$e p!e/nan:y. 7ini:ian 9i nee0 #6 0e:i0e6n #$e #imin/ 6= panne0 ea!y 0eie!y 6n a :ae-y-:ae ai



S.8A.6I6S F'8 P8676:.I':'F S.I""<I8.,

Pe!i:6n:ep#i6na =6i: a:i0 =6!#i:a#i6n

P!een#i6n 6= maa!ia

Syp$ii 0e#e:#i6n an0 #!ea#men#

;ype!#enie 0i6!0e! 6= p!e/nan:y 0e#e:#i6n an0 mana/emen#

Diae#e 6= p!e/nan:y 0e#e:#i6n an0 mana/emen# Fe#a /!69#$ !e#!i:#i6n 0e#e:#i6n an0 mana/emen#

P6##e!m p!e/nan:y %O41 9ee, 6= /e#a#i6n* i0en#i:a#i6n an0in0:#i6n

S,ie0 i!#$ a##en0an# a# i!#$

Aaiaii#y 6= ai: eme!/en:y 6#e#!i: :a!e Aaiaii#y 6= :6mp!e$enie eme!/en:y 6#e#!i: :a!e

http://www.uptodate.com.ezproxy.ugm.ac.id/contents/folic-acid-drug-information?source=see_link

http://www.uptodate.com.ezproxy.ugm.ac.id/contents/folic-acid-drug-information?source=see_link



7?NTRA7EPTICE CS IUFD



TERI3A KASI;



3IS7ELLANE?US



KB INJEKSI

A=#e! a mi:a!!ia/e 6! a6!#i6n Y6 :an $ae #$e ine:#i6n imme0ia#ey a=#e! a

mi:a!!ia/e 6! a6!#i6n< an0 y6 9i ep!6#e:#e0 a/ain# p!e/nan:y #!ai/$# a9ay. I=y6 $ae #$e ine:#i6n m6!e #$an e 0aya=#e! a mi:a!!ia/e 6! a6!#i6n< y6[ nee0 #6e a00i#i6na :6n#!a:ep#i6n =6! een 0ay.

A=#e! /iin/ i!#$

Y6 :an $ae #$e :6n#!a:ep#ie ine:#i6n a#any #ime a=#e! y6 $ae /ien i!#$< i= y6 a!en6# !ea#=ee0in/. I= y6 a!e !ea#=ee0in/<#$e ine:#i6n 9i ay e /ien a=#e! i89ee,< a#$6/$ i# may e /ien ea!ie! i=ne:ea!y.

I= y6 #a!# ine:#i6n 6n 6! e=6!e 0ay "1 a=#e!/iin/ i!#$< y6 9i e imme0ia#ey p!6#e:#e0a/ain# e:6min/ p!e/nan#.

I= y6 #a!# ine:#i6n a=#e! 0ay "1< y6 9inee0 #6 e a00i#i6na :6n#!a:ep#i6n =6! #$e=669in/ een 0ay.

T$e :6n#in6 !eeae 6=p!6/e#6/en

#6p a 96man !eeain/ ane// ee!y m6n#$ %6a#i6n*

#$i:,en #$e m: =!6m #$e

:e!i8 %ne:, 6= #$e 96m*<ma,in/ i# 0i:# =6! pe!m #6pa #$!6/$ #6 #$e 96m an0!ea:$ an n=e!#iie0 e//

ma,e #$e inin/ 6= #$e 96m#$inne!< 6 #$a# i# i nae #6

pp6!# a =e!#iie0 e//



LYN?RAL =hat is "ynoral>Lyn6!a :6n#ainin/ #$e a:#ie in/!e0ien#e#$inye#!a0i6 i a yn#$e#i: e!i6n 6= #$e =emaee8 $6!m6ne 6e#!6/en. T$e me0i:a#i6n 96!, y

p!een#in/ 6a#i6n< #$i:,enin/ #$e m: in #$e:e!i8 an0 :$an/in/ #$e inin/ 6= #$e #e!. I# :an ee0 =6! #$e mana/emen# 6= men6paa ymp#6m%$6!m6ne !epa:emen# #$e!apy* :$ a p6#men6paa 6#e6p6!6i< !ea# :an:e!<0ymen6!!$ea< 0y=n:#i6na #e!ine ee0in/ an0=emae $yp6/6na0im. S6me 96men may a6 #a,e i#a6n/ 9i#$ 6#$e! me0i:a#i6n a an 6!a :6n#!a:ep#ie6! i!#$ :6n#!6 pi an0 #6 !e/a#e #$e men#!a

:y:e.

.

Aderse e?e(tsPa#ien# in/ Lyn6!a may en:6n#e! n9an#e0 i0eeHe:# :$ a

;ea0a:$e

De:!eae0 e8 0!ie

Naea

Diine

C6mi#in/

;ype!#eni6n



EFFA7E3ENT AND DILATATI?N



BIS;?P S7?RE



DEFINISI LAIN Kema#ian anin 0aam !a$im %IUFD* a0aa$ ,ema#ian anin setelah $% minggu

kehamilan #e#api eem pe!maan pe!ainan. Ini menyea,an ,6mpi,aipa0a e,i#a! 1 ,e$amian. Den/an mn:nya :a!a 0ia/n6#i, 0an #e!ape#i,yan/ ei$ a! pa0a " 0aa9a!a yan/ a< penan/anan IUFD #ea$ e!ai$ 0a!i

peman#aan e!pen/$a!apan ,e :amp! #an/an yan/ ei$ a,#i=. %;a:,e!< "))1*

Kema#ian anin 0aam !a$im iaa$ ,ema#ian anin 0aam #e! yan/ e!a#nya 5))/!am a#a ei$< ia ,e$amian #ea$ men:apai ") min// a#a ei$. %Pen/!Bea! Pe!,mpan ?#e#!i 0an Gine,66/i In06neia< 1((1*

IUFD a0aa$ ,ea0aan #i0a, a0anya #an0a-#an0a ,e$i0pan anin 0aam ,an0n/anai, pa0a ,e$amian yan/ ea! 0a!i ") min// a#a ,!an/ 0a!i ")min//. Kema#ian anin 0aam ,e$amian a0aa$ ,ema#ian anin 0aam ,e$amianeem p!6e pe!ainan e!an/n/pa0a ia ,e$amian " min// ,e a#aa#a e!a# anin 1))) /!am ,e a#a. %R#am 3:$#a!< 1((*

IUFD a0aa$ ,ema#ian $ai ,6nepi eem 0i,ea!,an 0en/an emp!na 0a!i

!a$im inya #anpa meman0an/ #anya ,e$amian. %Sa!96n6< "))5*

Kema#ian anin 0i0enii,an ea/ai ,ema#ian in#!a#e!ine eem e!$p!60, ,6nepi mania 0i,ea!,an. Ini #i0a, 0ia,ia#,an 6e$ a6!i #e!ape#i,a#a ee,#i=. Kema#ian anin ini yan/ 0ie# ,ema#ian in#!a#e!ine 0anmen/a,ia#,an a$i! ma#i. %B6a,< "))4*

a:,



PREEKLA3PSIA

#ree$lampsia %erat

Te,anan 0a!a$ Q1&)211) mm;/ pa0a ia ,e$amian Q") min//

Te :ep !in menn,,an p!6#ein!ia O"> a#a peme!i,aan p!6#ein,an#i#a#i= menn,,an $ai Q5 /2"4 am

A#a 0ie!#ai ,e#e!ia#an 6!/an ain

\ T!6m6i#6penia %1)).))) e2L*< $em6ii mi,!6an/i6pa#i

\ Penin/,a#an SG?T2SGPT< nye!i a06men ,a0!an ,anan a#a

\ Sa,i# ,epaa < ,6#6ma pen/i$a#an

\ Pe!#m$an anin #e!$ama#< 6i/6$i0!amni6n

E0ema pa! 0an2a#a /a/a an#n/ ,6n/e#i= \ ?i/!ia % 5))m2"4am*< ,!ea#inin Q 1<" m/20

refkas IUFD

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