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346 Kepaniteraan Ilmu Kandungan dan Kebidanan RSAL Fakultas Kedokteran Trisakti
Describe a placenta that is implanted over or very near the internal cervical os
Smoked cigarettes
Maternal age
Risk Factor
Transabdominal US
Transvaginal US
Transperineal US
MRI
Conservative mx Prolongation of pregnancy by 4 wk after initial bleeding. Bethamehasone to pts < 34 wk gestation. Tocolytics prolongation of pregnancy Hospitalization until free from bleeding for 48H Outpatients management
Delivery Definite PP at 36 wk Excessive bleeding Concern about fetal condition. >2cm from cervix : Vaginal delivery <2cm from cervix : Caesarean delivery
-Blood transfusion
-Discharge after free from bleeding for 48 H Access to telephone Outpatient Responsible adult
Transportation available
Reasonable distance
Post partum hemorrhage (PPH) account for 140,000 death/year or maternal death every 4 min. Significant contributor = abnormal placentation + caesarean delivery. Profuse bleeding from LUS due to removal of placenta previa/ accreta is a challenging problem. Management : Conservative Uterotonic Uterine packing Oversewing
Uterine Atony
PPH
Prior PPH
Conservative measure
Uterotonics Intrauterine ballon tamponade
Invasive Intervation
Ligation of uterine and hypogastric a.
Uterine Packing
Oversewing
Hysterectomy
Hysterotomy Incision
24 F foley catheter inserted, distal end pass tru cervix and pull tru vagina
Postop : Oxytocin infuse for 12 H. 800mcg misoprostol rectally and 3 dose of cefazolin
Haemostasis achieved
Discussion
Uteroronics/ Uterine Massage
LUS doesnt respond due to poor contractile nature
Oversewing Tamponade
Emergency hysterectomy
Slow down the bleeding but not completly . Potential risk : injury to bladder, ureter and vasculare structure Uterine pack/ IU ballons IU pack was abandoned due to concealed hemorrhage, infection and trauma