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TAHUN 2013
PENYEBAB KEMATIAN IBU DI RSUD DR SOETOMO TAHUN 2014
JANTUNG PE HPP LUPUS GINJAL
DM TUMOR SEPSIS HIV RUPTURA UTERI
CEDERA OTAK KANKER SUFOKASI LIVER PARU
11
10
5 5
2 2 2 2 2
1 1 1 1 1
PENYEBAB KEMATIAN IBU di SURABAYA
Periode tahun 2012 - 2015
AKI PE HPP
2012 60 18 14
2013 49 14 14
2014 39 11 11
2015 38 8 15
KEMATIAN MATERNAL
DI SURABAYA 2015
Jumlah kematian : 38
Causa mortis :
HPP = 15
5 Plasenta akreta
Preeklamsia = 8
PLACENTA ACCRETA
INCIDENCE
maternal
age &
multiparity
myometr • previous
ial tissue myomectomy
damage • curettage
1. Cesarean Delivery
2. Cesarean Section
3. Operasi Sesar
4. Bedah Sesar
5. Partus Perabdominam
6. Abdominal Episiotomy
7. Others…..
INCIDENCE CESAREAN SECTION
China 2010
50%
India 18%
• Caesarean rate in
US, 2012 : 32,8 % 38 %
34 %
(Births: Final Data for 2012)
30 %
• Caesarean rate at 27 %
referral hospital /
Teaching hospital :
20%
(Indonesian Ministry of
health)
Caesarean Delivery Characteristic – Dr. Soetomo Hospita;l Manggala PW., dr.- Ernawati, dr., SpOG
DIAGNOSIS
Cesarean Scar GS at Cesarean Scar
TRIMESTER II
Greyscale ultrasound : 95% sensitivity
and 82% positive predictive value.
Look for…
Loss of the retroplacental echolucent
zone (Plac-Myometrial interface)
An irregular retroplacental echolucent
zone
Thinning or disruption of the hyperechoic
serosa/bladder zone
Exophytic masses invading bladder
Abnormal placental lacunae
TRIMESTER
LANJUT
RETROPLAC SPACE (-) UTERINE-BLADDER INTERFACE
UTERINE-BLADDER INTERFACE MYOMETRIAL THICKNESS
PLAC LACUNAR SPACES BRIDGING VEINS
PLACENTA
ACCRETA INDEX
Placenta Accreta Index (PAI)
Sensitivity, specificity, and positive and
negative predictive values at each PAI score
lacuna
5 3 BSC 3
4 bridging vessel
5
myometrial
8 4 thickness
plasenta anterior
AKRETA TIDAK
MANAGEMENT
Surgical Conservative
COUNSELING :
- risks of profuse hemorrhage
- need for hysterectomy
- possible maternal death
TAKE HOME MESSAGE
Literature review
Average blood loss 3,000 – 5,000 mL at the time of
delivery
Most common surgical complication cystotomy
(often intentional)
Ureteral injury in 10 – 15% of cases
Less common injuries to bowel, pelvic nerves and
large vessels and vesico-vaginal fistulas
RISK FACTORS :
Post CS
PACENTA PREVIA
Hudon L et al: Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv 1998
MANAGEMENT ???
RUJUK SAJA……….
AMAAAAAAN………
Wkwkwk……
Gambaran Umum Penanganan Perdarahan Postpartum
Primer Sekunder Tersier
Pemeriksaan Antenatal
Pemeriksaan Antenatal
Skrining risiko perdarahan
Skrining risiko
postpartum pada semua pasien
perdarahan postpartum
pada semua pasien
BSC + plasenta previa
Curiga Plasenta Akreta
Intrapartum
•Manajemen aktif kala 3 Perdarahan Postpartum
•Evaluasi perdarahan •Atasi sesuai penyebabnya
postpartum (Mat/underpad)
Tidak
Perdarahan Postpartum teratas Tidak teratasi
• Atasi sesuai penyebabnya i •Stabilisasi
MATUR
NUWUN