Catatan Kuliah Obgyn

Ed|led oy: WWW.red|ca|zore.
org
Korur|las Varas|sWa Kedo|lerar 3e-lrdores|a
8eru|ruWar VerjaWao Tarlargar
Forur u|ruWar Leroaga 0a|War Fa|u|las Kedo|lerar 3e-lrdores|a
0ar|: Anthon|us ud| Harjono
0|buat o|eh Hahas|swa Faku|tas Kedokteran Un|vers|tas |ndones|a

lrlrodu|s| Keseralar Reprodu|s| war|la................................................................................................... 2
Pergarlar Keperdudu|ar ..........................................................................................................................
Aralor| dar F|s|o|og|3|sler Reprodu|s| war|la ....................................................................................... 11
0arelogeres|s, Ferl|||sas| dar lrp|arlas| ................................................................................................. 1Z
P|aserla, Ta|| Pusal, 3e|apul Jar|r dar Ca|rar Arr|or............................................................................ 21
Perlurourar dar F|s|o|og| Jar|r............................................................................................................... 29
Peruoarar Aralor| dar F|s|o|og| war|la lar|| ........................................................................................ 31
Perer||saar 0oslelr| dar Asurar Arlerala| ............................................................................................ 38
Perarlauar Jar|r {Fera| Von|ror|ngj ........................................................................................................ 13
Korse||rg 0erel||a dar 0|agros|s Prerala| .............................................................................................. 15
Aralor| Rorgga Parggu| .......................................................................................................................... 1Z
luourgar arlara Felus dergar Ja|ar Lar|r.............................................................................................. 50
F|s|o|og| Proses Persa||rar Norra| ........................................................................................................... 55
Parlogral .................................................................................................................................................... 0
P|rp|rar Proses Persa||rar Norra| ......................................................................................................... 3
Vasa N|las dar La|las| (Per|ode Pasca Persa||rar) .................................................................................
Pergarlar Per|ralo|og| .............................................................................................................................. Z0
3pec|a| Aspecls ol Per|rala| Prarraco|ogy (0rug Trerapy |r Pregrarcy ard Laclal|or)......................... Z
Corger|la| Va|lorral|ors .......................................................................................................................... 81
Resus|las| dar PeraWalar lrlers|l Neoralus ............................................................................................ 89
Perya||l-perya||l yargVerpergarur| / 0|pergarur| Kerar||ar.............................................................. 9Z
l|perlers| pada Kerar||ar Pre-e||arps|a/E||arps|a .............................................................................. 98
0|aoeles Ve|||lus pada Kerar||ar............................................................................................................ 105
Ke|a|rar Jarlurg pada Kerar||ar ........................................................................................................... 110
Ke|a|rar pada Lararya Kerar||ar (Aoorlus, Prelerr, LeWal wa|lu) .................................................... 115
Perdararar da|ar Vasa Kerar||ar......................................................................................................... 125
Kerar||ar E|lop|| .................................................................................................................................... 128
0|slos|a..................................................................................................................................................... 130
Persa||rar 3urgsarg................................................................................................................................ 138
Kerar||ar Vu|l|pe| / Keroar .................................................................................................................... 111
Keluoar Pecar 0|r| dar lrle|s| lrlraparlur............................................................................................. 11Z
Perdararar Pasca Persa||rar .................................................................................................................. 119
lrdu|s| Persa||rar..................................................................................................................................... 151
Pergarlar l|ru 8edar 0oslelr|................................................................................................................. 153
Aresles|a / Ara|ges|a da|ar 0oslelr| 0|re|o|og| ..................................................................................... 11
Resus|las| Jarlurg Paru (Ap|||as| Krusus pada war|la lar||) ............................................................... 1
Varagererl ol lre lrjured Pregrarl Pal|erl ........................................................................................... 1Z2
Perer||saar urur 0|re|o|og| ............................................................................................................... 1Z8
Ed|led oy: WWW.red|ca|zore.org
|ntroduks| Kesehatan Reproduks| wan|ta
Ku||ah 0bstetr| C|neko|og|
Prof. dr. Abdu| ar| 8a|fudd|n | dr. |ran Affand| | dr. J.H. 8eno Adj|e
Tu||san tentang Penyak|t hubungan 8eksua| | Ku||ah Ku||t dan Ke|am|n
dr. 8ja|fu| Fahm| 0a|||
KE8EhATAN REPR00UK8| (Reproduct|ve hea|th}
|nternat|ona| 6onference on Popu|at|on and 0eve|opment, 6a|ro, 1994 (wh0|P} :
"Reprooucr|ve nea|rn |s a srare ol comp|ere pn,s|ca|, menra|, ano soc|a| ue||-oe|ng, ano nor mere|, rne aosence ol
o|sease or |nl|rm|r,, |n a|| marrers re|ar|ng ro rne reprooucr|ve s,srem, |rs luncr|ons ano |rs processes."
"Reprooucr|ve nea|rn rnerelore |mp||es rnar peop|e are ao|e ro nave a respons|o|e, sar|sl,|ng ano sale sex ||le ano rnar
rne, nave rne capao|||r, ro reproouce ano rne lreeoom ro oec|oe |l, unen ano nou olren ro oo so."
"lmp||c|r |n rn|s |asr cono|r|on are rne r|gnrs ol men ano uomen ro oe |nlormeo ano ro nave access ro sale, ellecr|ve,
alloroao|e ano acceprao|e mernoos ol lam||, p|ann|ng ol rne|r cno|ce, as ue|| as orner mernoos ol rne|r cno|ce lor
regu|ar|on ol lerr|||r, un|cn are nor aga|nsr rne |au, ano rne r|gnr ol access ro appropr|are nea|rn care serv|ces rnar u|||
enao|e uomen ro go sale|, rnrougn pregnanc, ano cn||oo|rrn, ano prov|oe coup|es u|rn rne oesr cnance poss|o|e ol
nav|ng a nea|rn, |nlanr."
"ln ||ne u|rn rne aoove oel|n|r|on ol reprooucr|ve nea|rn, reprooucr|ve nea|rn care |s oel|neo as rne consre||ar|on ol
mernoos, recnn|ques, ano serv|ces rnar conrr|oure ro reprooucr|ve nea|rn ano ue||-oe|ng o, prevenr|ng ano so|v|ng
reprooucr|ve nea|rn proo|ems. lr a|so |nc|uoes sexua| nea|rn, rne purpose ol un|cn |s rne ennancemenr ol rne qua||r, ol
||le ano persona| re|ar|ons, ano nor mere|, counse|||ng ano care re|areo ro reprooucr|on ano sexua||, rransm|rreo
o|seases."
what are the essent|a| e|ements of reproduct|ve hea|th, and how do these e|ements bear on every prob|ems of
fert|||ty and |nfert|||ty ?
'. Reprooucr|ve nea|rn |s rne opporrun|r,, parr|cu|ar|, lor uomen, ro regu|are ano conrro| lerr|||r,. Tn|s |nc|uoes nor on|,
lam||, p|ann|ng, our lor some coup|es, rne proper rrearmenr ol |nlerr|||r,.
2. Reprooucr|ve nea|rn snou|o a||ou a|| uomen ro nave a sale pregnanc, ano cn||oo|rrn.
J. Reprooucr|ve nea|rn |s rne srr|v|ng lor neonara| exce||ence, a||ou|ng ever, neuoorn ro nave rne oenel|rs ol a nea|rn,
|nlanc,.
4. F|na||,, reprooucr|ve nea|rn |s rne lreeoom lrom sexua||,-rransm|rreo o|seases.
KELUARCA EREN6ANA (Fam||y P|ann|ng}

|nternat|ona| 6onference on Popu|at|on and 0eve|opment, 6a|ro, 1994 (wh0|P}
"Tne a|m ol lam||, p|ann|ng programmes musr oe ro enao|e coup|es ano |no|v|oua|s ro oec|oe lree|, ano respons|o|,
rne numoer ano spac|ng ol rne|r cn||oren, ano ro nave rne |nlormar|on ano means ro oo so ano ro ensure |nlormeo
cno|ces ano make ava||ao|e a lu|| range ol sale ano ellecr|ve mernoos."
"Tne success ol popu|ar|on eoucar|on ano lam||, p|ann|ng programmes |n a var|er, ol serr|ngs oemonsrrares rnar
|nlormeo |no|v|oua|s ever,unere can ano u||| acr respons|o|, |n rne ||gnr ol rne|r oun neeos ano rnose ol rne|r lam|||es
ano commun|r|es."
"Tne pr|nc|p|e ol |nlormeo lree cno|ce |s essenr|a| ro rne |ong-rerm success ol lam||, p|an|ng programmes."
"Sovermenra| goa|s lor lam||, p|ann|ng snou|o oe oel|neo |n rermes ol unmer neeos lor |nlormar|on ano serv|ces."
"0emograpn|c goa|s, un||e |eg|r|mare|, rne suoecr ol governmenr oeve|opmenr srrareg|es, snou|o hDT oe |mposeo on
lam||, p|ann|ng prov|oers |n rne lorm ol rargers or quoras lor rne recru|rmenr ol c||enrs."
PR0CRAH "8AFE H0ThERh000" (wh0, 1988}
Ve||pul| erpal prograr / largel ulara :
1. Far||y P|arr|rg : Ke|uarga 8erercara
2. Arlerala| Care : Asurar / PeraWalar Arlerala|
3. C|ear ard 3ale 0e||very : Persa||rar yarg 8ers|r dar Arar
1. Esserl|a| 0oslelr|c Care : Pe|ayarar 0oslelr|| Esers|a|
0AUR KEh|0UPAN wAN|TA

Pra|orseps|
Ferl|||sas| dar lrp|arlas|
Eror|o 1 - 10 r|rggu |rlrauler|r
Felus 11- 10 r|rggu |rlrauler|r
KELAllRAN
Neoralus 0 - 1 ou|ar
8ay| 1 - 12 ou|ar
8al|la 1 - 3 larur
8a||la 1 - 5 larur
Ara| 5 - 12-15 larur (rerarcre)
Pu8ERTA3 (Verarcre) 12-15 larur
Reraja (Ado|eser) s/d 20 larur
Valur|las
VA3A REPR00uK3l 20-50 larur
K||ra|ler|ur (Veropause) 15-55 larur
Pasca Veropause 50-5 larur
3er|ur 5 larur |e alas

Vasa eror|o sarpa| lelus d|seoul rasa prerala| / pra|e|ar|rar.
Vasa reoralus sarpa| ara| d|seoul juga rasa prapuoerlas.
PARAHETER KE8EhATAN REPR00UK8| wAN|TA (Tantangan}

- Arg|a Keral|ar Valerra|.
- Arer|a
- Ca|upar pe|ayarar |ou rar||.
- 0|z| |urarg
- Perlo|orgar o|er leraga ler|al|r.
- Kerar||ar us|a ruda
- Ca|upar |rur|sas| lelarus lo|so|d.
- Perya||l reru|ar a||oal ruourgar se|sua|.
- T|rg|al perd|d||ar dar pergelaruar ras|r rerdar.

Hasa|ah
1. war|la dar ara| r|s||o l|rgg| o||a |erar||ar re|arpau| |urur Wa|lu reprodu|s| seral dar alau par|las l|rgg|.
2. Kerar||ar cu|up arar o||a us|a |ou arlara 20 sarpa| 35 larur.
3. Jur|ar r|Wayal persa||rar (par|las) arar sarpa| dergar 3.
1. Jara| arlar |erar||ar cu|up arar r|r|ra| 2 larur.
5. us|a / jara| d| |uar oalas arar : r|s||o |eral|ar ralerra|.
. Jur|ar ara| |eo|r dar| 3 : r|s||o |orp|||as| persa||rar.
Z. Keral|ar ralerra| : |eral|ar |ou yarg lerjad| oerruourgar dergar per|sl|Wa |erar||ar, persa||rar raupur r|las.
8. Peryeoao ulara |eral|ar ralerra| : 1) perdararar 2) |rle|s|/seps|s 3) pree||arps|a/ e||arps|a (TRlA3
peryeoao), 1) parlus |ara 5) aoorlus yarg l|da| arar ) |a|r-|a|r.
9. Tre Four Too's (1 ler|a|u) : - Too rary (ara| oarya|) - Too ear|y (rar|| us|a ruda) - Too lrequerl (jara| arlar
|erar||ar ler|a|u de|al) -Too |ale (rar|| us|a lua).
10. Tre Trree 0e|ays (3 ler|aroal) : - 0e|ay |r dec|d|rg lo see| red|ca| care - 0e|ay |r reacr|rg a red|ca| lac|||ly
W|lr adequale care - 0e|ay |r rece|v|rg qua||l|ed red|ca| care al lre lac|||ly.
11. Tola| Ferl|||ly Rale (TFR) : largel 2.2
12. Arer|a d| lrdores|a seoag|ar oesar |arera del|s|ers| Fe dar g|z| |urarg.

The 8tate of wor|d Popu|at|on 1997 documents the effects of deny|ng sexua| and reproduct|ve r|ghts |n many
countr|es :
'. 585,000 uomen-one ever, m|nure-o|e eacn ,ear lrom pregnanc,-re|areo causes, near|, a|| |n oeve|op|ng counrr|es.
Van, r|mes rn|s numoer are o|sao|eo as rne resu|r ol cn||oo|rrn. Vucn ol rn|s oearn ano suller|ng cou|o oe averreo u|rn
re|ar|ve|, |ou-cosr |mprovemenrs |n nea|rn care s,srems.
2. /oour 200,000 marerna| oearns per ,ear resu|r lrom rne |ack or la||ure ol conrracepr|ve serv|ces.
J. '20-'50 m||||on uomen uno uanr ro ||m|r or space rne|r pregnanc|es are sr||| u|rnour rne means ro oo so ellecr|ve|,.
/|rogerner J50 m||||on coup|es |ack |nlormar|on aoour ano access ro a range ol conrracepr|ve serv|ces.
4. /r |easr 75 m||||on pregnanc|es eacn ,ear {our ol aoour '75 m||||onj are unuanreo; rne, resu|r |n 45 m||||on aoorr|ons,
20 m||||on ol un|cn are unsale.
5. 70,000 uomen o|e eacn ,ear as a resu|r ol unsale aoorr|on, ano an unknoun numoer suller |nlecr|on ano orner
nea|rn consequences. Van, unsale aoorr|ons cou|o oe avo|oeo |l sale ano ellecr|ve means ol conrracepr|on uere
lree|, ava||ao|e.
6. J.' m||||on peop|e uere |nlecreo |asr ,ear o, rne numan |mmunooel|c|enc, v|rus {llvj un|cn |eaos ro /l0$; '.5
m||||on o|eo lrom llv//l0$-re|areo causes |n '996; 22.6 m||||on peop|e are ||v|ng u|rn llv//l0$.
7. ' m||||on peop|e o|e eacn ,ear lrom reprooucr|ve rracr |nlecr|ons |nc|uo|ng sexua||, rransm|rreo o|seases {$T0sj
orner rnan llv//l0$. Vore rnan na|l ol rne JJJ m||||on neu cases ol $T0s per ,ear are among reenagers.
8. '20 m||||on uomen nave unoergone some lorm ol lema|e gen|ra| mur||ar|on; anorner 2 m||||on are ar r|sk eacn ,ear.
9. Rape ano orner lorms ol sexua| v|o|ence are rampanr, rnougn man, rapes are unreporreo oecause ol rne sr|gma ano
rrauma assoc|areo u|rn rape ano rne |ack ol s,mparner|c rrearmenr lrom |ega| s,srems.
'0. /r |easr 60 m||||on g|r|s uno uou|o orneru|se oe expecreo ro oe a||ve are "m|ss|ng" lrom var|ous popu|ar|ons as a
resu|r ol sex-se|ecr|ve aoorr|ons or neg|ecr.
''. 2 m||||on g|r|s oerueen ages 5 ano '5 are |nrroouceo |nro rne commerc|a| sex marker eacn ,ear.
Tne uhFP/ reporr srresses rnar sexua| ano reprooucr|ve r|gnrs are ke, ro uomens empouermenr ano genoer
equa||r,, ano are a|so cr|r|ca| ro rne econom|c ano soc|a| ||le ol commun|r|es, nar|ons ano rne uor|o. S|ooa| ano nar|ona|
neeos co|nc|oe u|rn persona| r|gnrs ano |nreresrs. S|ven rne cno|ce, mosr uomen uou|o nave leuer cn||oren rnan rne|r
parenrs generar|on. Ensur|ng rnar uomen ano rne|r parrners nave rne r|gnr ro cnoose u||| supporr a g|ooa| rreno
rouaros sma||er lam|||es, ano ne|p counrr|es l|no a oa|ance oerueen rne|r popu|ar|ons ano resources. $uccesslu|
oeve|opmenr ellorrs u||| |n rurn or|ng sexua| ano reprooucr|ve nea|rn ro more peop|e.
PENYAK|T HENULAR 8EK8UAL (PH8} | PENYAK|T hUUNCAN 8EK8UAL (Ph8} |
8EXUALLY TRAN8H|TTE0 0|8EA8E8 (8T0}

/n, ol a o|verse group ol |nlecr|ons causeo o, o|o|og|ca||, o|ss|m||ar parnogens ano rransm|rreo o, sexua| conracr,
un|cn |nc|uoes oorn nererosexua| ano nomosexua| oenav|our; sexua| rransm|ss|on |s rne on|, |mporranr mooe ol
spreao ol some ol rne o|seases |n rne group {e.g., rne c|ass|c venerea| o|seasesj, un||e orners {e.g., nepar|r|s / llv
v|ruses, orner oacrer|a| / lunga| spec|es, ercj can a|so oe acqu|reo / rransm|rreo o, orner nonsexua| means.
{0or|anos l||usrrareo Veo|ca| 0|cr|onar,, 28rn eo., '996j
0a|ar oalasar yarg |eo|r serp|l, alau rerurul aWar, ser|rg d|gura|ar |sl||ar perya||l |e|ar|r (vererea|
d|seases).
Yarg d|ra|sud dergar perya||l |e|ar|r, j||a |sl||ar |r| yarg d|gura|ar, ada|ar perya||l yarg peru|ararrya
(lerulara) re|a|u| (ruourgar) |e|ar|r / ger|la|.

Terdapal juga pergerl|ar yarg rurg||r |e||ru d| |a|argar aWar, oarWa perya||l reru|ar se|sua| alau perya||l
|e|ar|r ada|ar perya||l yarg reryerarg orgar |e|ar|r / ger|la|. Padara|, re|a|u| rodus |orla| |e|ar|r yarg
oervar|as| (rarua| / ora| / ara|) dapal juga lerjad| geja|a perya||l pada |u||l, ru|ul, arus, dar orgar / s|sler orgar
e|slrager|la| |a|rrya.

3e|ara de|ade lera|r|r |r| |rs|ders Pl3 cepal rer|rg|al d| oeroaga| regara. Ves||pur der|||ar, dala yarg
d||apor|ar lerlu l|da| rerggaroar|ar |eadaar sesurggurrya (lerorera gururg es).

la| |r| arlara |a|r d|seoao|ar :
1. 8arya| |asus yarg l|da| d||apor|ar.
2. Ka|aupur ada |aporar, s|sler pe|aporar yarg oer|a|u oe|ur ada |eseragarar.
3. Fas|||las d|agrosl|| d| oeroaga| daerar |urarg rerdu|urg, ser|rg|a|| juga lerjad| sa|ar d|agros|s dar
perala|a|saraar.
1. 8arya| |asus yarg as|rploral|| (l|da| reroer||ar geja|a yarg |ras).
5. 8||a perder|la War|la, ser|rg larpa geja|a |ras (as|rploral||) ser|rgga rere|a rerasa l|da| per|u oerooal.
. Prograr pergorlro|ar lerradap Pl3 dar| perer|rlar / |rslars| oe|ur oerja|ar oa||.

3ecara |ese|ururar, dapal d|||ral oarWa ada oarya| la|lor yarg dapal rerpergarur| per|rg|alar lerjad|rya
|rs|ders Pl3, arlara |a|r :
1. Peruoarar derogral|| yarg |uar o|asa : pe|eda|ar jur|ar perdudu|, pergera|ar / roo|||las rasyara|al yarg
oerlaroar (ser|rg oeperg|ar |e |uar |ola urlu| pe|erjaar, ||ourar, W|sala, |orgres/ser|rar/rapal d||).
2. Kerajuar sos|a| e|oror| |rduslr|, reryeoao|ar |eo|r oarya| |eoeoasar sos|a| dar |eo|r oarya| Wa|lu yarg
ler|uarg.
3. Ke|a|a|ar s|sler regara da|ar reroer||ar perd|d||ar |eseralar ururrya dar perd|d||ar se|sua||las
|rususrya.
1. Perasaar arar pada perder|la |arera pera|a|ar ooal arl|o|ol|| dar |ovrlraseps| yarg dapal d|p|||r serd|r|, yarg
oe|ur lerlu oerar.
5. A||oal oarya| pera|a|ar arl|o|ol|| yarg l|da| sesua|, a||oalrya lerjad| res|slers| |urar lerradap arl|o|ol||
lerseoul.
. Fas|||las |eseralar |urarg rerada| lerulara las|||las |aooralor|ur dar |||r|| pergooalar.
Z. 8arya|rya |asus as|rploral||, rerasa d|r| l|da| sa||l, lelap| rerpurya| polers| urlu| reru|ar| orarg |a|r.

usara peryu|urar dar perarggu|argar rarus re||oal|ar |el|ga d|s|p||r yarg sa||rg oerruourgar :
1. seg| red||
2. seg| ep|der|o|og||
3. seg| ps||osos|a|
KE8EhATAN REPR00UK8| wAN|TA U8|A REHAJA

Latar be|akang

1. rasa reraja ada|ar rasa yarg perur d|rar||a, gejo|a| rasa |rg|r laru yarg l|rgg| da|ar oeroaga| ra|, lerrasu|
juga da|ar ra| reprodu|s| / se|sua||las.
2. suroer |rlorras| yarg oarya| dar |uas lap| oe|ur lerlu oerar, oa|| dar seral.

Hasa|ah

Vasa|ar yarg rurg||r l|rou| seoaga| a||oalrya, r|sa|rya per||a|u se|sua| yarg l|da| oa||, rerjad| peryeoao
l|rgg|rya arg|a |ejad|ar |erar||ar reraja / d| |uar r||ar, aoors|, perya||l reru|ar se|sua|, dso.
0| regara oer|eroarg, oarya| per|aW|rar yarg lerjad| pada us|a ruda. 3er|rgga yarg rerjad| rasa|ar rerdasar
seoerarrya ou|ar ruourgar se|s / |erar||ar d| |uar r||ar, lelap| perr||arar / |erar||ar pada us|a ruda (|arera
pada us|a oe|asar larur sudar rer||ar, oerruourgar se|s, rar|| dar rerpurya| ara|).

Va||r raju / ra||r rer|rg|alrya |ua||las r|dup rasyara|al d|
sualu regara, larpa|rya lrerd po|a |er|dupar reprodu|s| War|la
juga ||ul oeruoar (gral||).
1. 0ergar per|rg|alar |ua||las r|dup, g|z|, pergelaruar, dso,
dapal lerjad| rerslruas| pada ara| War|la pada us|a yarg |eo|r
aWa| (sera||r ruda).
2. 0ergar oerlaroarrya WaWasar, pergelaruar, dso, dapal
lerjad| seorarg War|la rer|||r urlu| rer||ar pada us|a yarg |eo|r
lua.
la| |r| rerjad| rasa|ar |rusus |a|r |eseralar reprodu|s| War|la
us|a reraja, |arera lerdapal ce|ar / gap yarg |uas arlara us|a rerarcre dergar us|a per|aW|rar, padara| rasa
reraja |lu ada|ar rasa yarg rerlar lerradap per||a|u se|sua| yarg |urarg oa|| (r|sa|rya oergarl|-garl| pasargar,
dso), |erurg||rar |erar||ar yarg oesar (|arera sudar rerasu|| us|a reprodu|l|l), |erurg||rar lerpapar perya||l
reru|ar se|sua|, dar seoaga|rya.
Essent|a| aspects of ado|escent (reproduct|ve} hea|th care :
'. counse||ng.
2. conrracepr|ve a|rernar|ves / cno|ces.
J. oosrerr|c care . ma|nrenance ano rerm|nar|on ol pregnanc,
4. prevenr|on ano rrearmenr ol sexua||, rransm|rreo o|seases.
Pengantar Kependudukan
Prof dr. Abdu| ar| 8a|fudd|n
Ku||ah Ep|dem|o|og| ||mu Kedokteran Komun|tas
dr. h. astaman asuk| | dra.Ambar w. Rustam
|kht|sar Ku||ah KEPEN0U0UKAN
(Prol.dr.Aodu| 8ar| 3a|ludd|r)
8ag|ar l : 0asar-dasar Keperdudu|ar
1. Pergerl|ar Perdudu|, l|ru Keperdudu|ar, 0erogral|, 3lud| Keperdudu|ar
2. Korpos|s| Perdudu|
3. Ferl|||las, C8R, A3FR, TFR
1. Vorla||las, C0R, A30R
5. V|gras|
. Arg|a Perlurourar Perdudu|
Z. Trars|s| 0erogral||
8. Korsep, u|urar
9. P|rar|da Perdudu|

8ag|ar ll : Kecerderurgar Keperdudu|ar d| lrdores|a
1. Perlurourar dar Jur|ar Perdudu|
2. Kecerderurgar T|rg|al Ferl|||las
3. Kecerderurgar T|rg|al Vorla||las

8ag|ar lll : lrp|||as| Proye|s| Perdudu| Vasa 0epar
1. Leda|ar 8ay| Kedua
2. 3la|||rg Ferl|||las
3. Perlurourar Arg|alar Kerja
1. Reraja dar Peruda
5. Perdudu| us|a Tua

8ag|ar lv : Kerurg||rar lrlervers|
1. PerdeWasaar us|a Per|aW|rar
2. Pergga|a|ar Peroer|ar A3l
3. Perarlapar Pera|a|ar Korlraseps|
1. Pergguraar Korlraseps| Ele|l|l
5. Aja|ar |epada 0ereras| Vuda
. 0u|urgar Po||l|s
Z. Keserpalar Perd|d||ar dar Keserpalar Kerja oag| war|la
8. Perd|d||ar Reprodu|s| 3eral
9. Po|a Ker|dupar Reprodu|l|l 8aru
10. Pe|eroagaar Norra Ker|dupar Ke|uarga yarg 0|rar|s
11. Kesejarleraar lou, Ara| dar Varu|a
12. lrlervers| lerradap usara Pe|eroagaar

|LHU EP|0EH|0L0C|

l|ru yarg oerruourgar dergar slud| la|lor-la|lor yarg rererlu|ar dar/alau rerpergarur| lre|uers| dar d|slr|ous|
perya||l, cedera, dar |eadaar-|eadaar |a|r yarg oerruourgar dergar |eseralar oeserla peryeoao-peryeoaorya
da|ar sualu popu|as| rarus|a, dergar lujuar reryusur prograr-prograr urlu| rercegar dar rergerda|||ar
per|uasar dar peryeoararrya.
l|ru yarg rerpe|ajar| po|a perya||l, |eseralar dar l|rg|ar |a|u rarus|a.

Pusal perral|ar : l|rg|al |esa||lar (roro|d|las) dar l|rg|al |eral|ar (rorla||las) sualu perya||l da|ar ruourgarrya
dergar la|lor-la|lor / var|aoe| |eseralar, derogral| dar sos|a| e|oror|.

Tujuan pene||t|an ep|dem|o|og|
1. rerggaroar|ar slalus |eseralar se|e|orpo| rasyara|al / popu|as| yarg rerpurya| perya||l lerlerlu dergar
cara rergr|lurg oarya|rya |ejad|ar perya||l lerseoul, rerdapal|ar l|rg|al |ejad|ar da|ar sel|ap |e|orpo| da|ar
popu|as| lerseoul, serla rerdapal|ar po|a |ecerderurgar lerlerlu yarg rerorjo|.
2. rerje|as|ar peryeoao perya||l dergar cara rererlu|ar la|lor yarg rerjad| peryeoao perya||l alau
|ecerderurgar perya||l dergar rereru|ar cara peryeoarar perya||l.
3. rerara||ar oesarrya / jur|ar |ejad|ar perya||l dar d|slr|ous|rya da|ar popu|as|
1. rergorlro| peryeoarar perya||l da|ar popu|as| dergar cara rercegar |ejad|ar-|ejad|ar oaru, reroasr|
perya||l yarg ras|r ada, rercegar |eral|ar dar rerperparjarg r|dup (res||pur rurg||r perya||l lerseoul ras|r
ada da|ar d|r| perder|la), serla rer|rg|al|ar slalus |eseralar dar |ua||las r|dup perder|la.

Kepent|ngan ep|dem|o|og|
1. Veryed|a|ar dala yarg d|per|u|ar da|ar perercaraar dar eva|uas| pe|ayarar |eseralar
2. lderl|l||as| la|lor-la|lor yarg rererlu|ar dar rerpergarur| perya||l, urlu| l|rda|ar percegarar.
3. Eva|uas| relode-relode yarg d|gura|ar da|ar pergerda||ar perya||l
1. 0es|r|ps| perja|arar a|ar| sualu perya||l
5. K|as|l||as| perya||l

Te|r||-le|r|| ep|der|o|og| se|a|r dapal d|gura|ar urlu| rere||l| perya||l, dapal juga d|ap|||as||ar pada slud|-slud|
d|slr|ous| |ara|ler|sl|| o|o|og|s, seperl| oeral oadar, go|orgar darar, le|arar darar dar ra|-ra| |a|r seoaga|rya, urlu|
rerdapal|ar seoarar |ara|lersl|| urur alau oalasar yarg rorra| da|ar popu|as|.

Hetode ep|dem|o|og|

1. 3lud| des|r|pl|l
3lud| urlu| rererlu|ar lre|uers| sualu perya||l, jer|s alau |ara|ler|sl|| orarg-orarg yarg rerder|la perya||l
lerseoul, d| sualu daerar lerlerlu da|ar jarg|a Wa|lu lerlerlu. lrlorras| d|ara||s|s urlu| rerurju||ar d|slr|ous|
alr|oul (dala |ua||lal|l/|ara|ler lelap, r|sa|rya jer|s |e|ar|r) serla d|slr|ous| var|aoe| (dala |uarl|lal|l/|ara|ler
oervar|as|, r|sa|rya urur).
3lud| des|r|pl|l rerggaroar|ar ras|| pergaralar da|ar sualu jarg|a Wa|lu lerlerlu (lrarsversa|/cross-secl|ora|).
0a|ar per|eroargarrya, ooservas| lerradap popu|as| dapal d|u|arg| dar/alau d|lerus|ar urlu| rerpero|er po|a
per|uasar dar peryeoarar (slud| |org|lud|ra|).
3urve||arce, ooservas| lerus-rererus lerradap sualu perya||l urlu| dele|s| Waoar, lerrasu| da|ar slud| |r|.

2. 3lud| ara||l|| ooservas|ora|/ ror-e|sper|rerla|
3lud| urlu| rerguj| r|poles|s lerradap el|o|og| alau la|lor-la|lor delerr|rar, d| rara seorarg dapal lerserarg sualu
perya||l lerlerlu sererlara orarg |a|r l|da|. Perguj|ar d||a|u|ar re|a|u| ooservas| lerradap ra|-ra| yarg d|cur|ga|
rerpergarur| perja|arar perya||l, re||pul| cause (peryeoao, r|sa|rya |orsurs| ra|arar lerlerlu) dar/alau slale
(|eadaar, r|sa|rya l|rgga| d| daerar d|rg|r/|eroao).
Perde|alar urlu| slud| ara||l|| ooservas|ora| re||pul| slud| case-corlro| (|e|orpo| yarg rerga|ar| |eadaar sa||l
d|oard|rg|ar dergar |e|orpo| rorra|, urlu| rerurju||ar oarWa la|lor delerr|rar d|leru|ar |eo|r oarya| pada
|e|orpo| yarg sa||l), dar slud| cororl (|e|orpo| yarg lerpapar dergar la|lor delerr|rar d|oard|rg|ar dergar
|e|orpo| yarg l|da| lerpapar, urlu| rerurju||ar oarWa |eo|r oarya| |rd|v|du dar| |e|orpo| yarg lerpapar yarg
rerjad| sa||l dar|pada dar| |e|orpo| l|da| lerpapar).

3. 3lud| ara||l|| e|sper|rerla|
3lud| urlu| rerguj| r|poles|s lerradap el|o|og| alau la|lor-la|lor delerr|rar, dergar cara e|sper|rerla|. Narur
pada pra|le|rya slud| e|sper|rerla| da|ar ep|der|o|og| rarya d|gura|ar da|ar |orle|s percegarar dar
pergooalar, r|sa|rya pada pere||l|ar va|s|r, dar l|da| d|gura|ar urlu| rere||l| el|o|og|/delerr|rar perya||l dergar
cara paparar.

3lud| des|r|pl|l reroer||ar |rlorras| rasa|ar urlu| perercaraar pe|ayarar |eseralar, serla |rlorras| ||as|l||as|
perya||l dar perja|arar a|ar|ar perya||l. lrlorras| el|o|og| / la|lor delerr|rar da|ar slud| des|r|pl|l rarya rercapa|
l|rg|al r|poles|s, yarg d|uj| |erud|ar da|ar slud| ara||l||. Pergarur |rlervers| lerradap peryeoarar dar perja|arar
perya||l, da|ar ra| |r| l|rda|ar percegarar dar pergooalar, d|pe|ajar| pada slud| ara||l|| e|sper|rerla|.
8TAT|8T|K

3ualu relode ||r|ar yarg oerlujuar rerecar|ar rasa|ar da|ar |er|dupar ryala dergar rerggura|ar leor|-leor|
prooao|||las; ururrya oerruourgar dergar pergurpu|ar, ara||s|s dar |rlerprelas| dala-dala rurer||, |rususrya
dergar relode rerar|| |rlerers| lerlarg |ara|ler|sl|| sualu popu|as| re|a|u| perer||saar lerradap sarpe| rardor.

8tat|st|k Kesehatan
3lal|sl|| rergera| dala yarg oerruourgar dergar |eseralar
0EH0CRAF|

3lud| lerlarg persoa|ar-persoa|ar dar |eadaar peruoarar-peruoarar perdudu| yarg oer|a|lar dergar |orporer-
|orporer |e|ar|rar, |eral|ar dar r|gras|.

Kepent|ngan demograf|
Veroer||ar |rlorras| lerlarg u|urar/jur|ar, peryeoarar, slru|lur, |ara|ler|sl|| |rduv|dua| perdudu| serla
peruoarar-peruoararrya.

Hetode | sumber data demograf|

1. 3ersus Perdudu|
Percacarar lerradap serua orarg da|ar sualu regara, oeserla c|r| derogral| dar c|r| sos|a| e|oror|rya.
C|r| derogral| re||pul| urur, jer|s |e|ar|r, slalus per|aW|rar, jur|ar ara| |ar|r r|dup, dar jur|ar ara| yarg ras|r
r|dup. C|r| sos|a| re||pul| perd|d||ar, lerpal l|rgga|, oarasa, agara dar |elerargar rurar largga.
C|r| e|oror| re||pul| jer|s dar |apargar pe|erjaar.
0ala sargal represerlal|l |arera rerye|urur, rarur rarya oers|lal dasar.

2. 3urve| Keperdudu|ar
0||a|u|ar secara sarp||rg lerradap se|e|orpo| perdudu| yarg d|arggap Wa||| dar| se|urur popu|as|, urlu|
rerpero|er |elerargar yarg oers|lal |rusus dar |eo|r lerper|rc|.
T|rg|al represerlal|l dala surve| re|al|l rerdar d|oard|rg|ar dala sersus, rarur |elerargar yarg d|pero|er |eo|r
lerper|rc|.

3. Reg|slras| Perdudu|
Percalalar lerus-rererus rergera| per|sl|Wa-per|sl|Wa |er|dupar (reg|slras| v|la|) sel|ap |rd|v|du da|ar popu|as|,
seperl| |e|ar|rar, |eral|ar, r|gras|/|ep|rdarar, perr||arar, percera|ar dar adops|.

Ukuran dasar demograf|
T|ngkar/Rare
u|urar lre|uers| sualu perya||l alau per|sl|Wa/|ejad|ar lerlerlu yarg lerjad| pada sualu popu|as| se|ara per|ode
Wa|lu lerlerlu, d|oard|rg|ar dergar jur|ar perdudu| yarg rerarggurg r|s||o lerseoul.
Ras|o
3ualu u|urar lre|uers| se|e|orpo| per|sl|Wa yarg rerurju||ar peroard|rgar arlara dua |ua||las, pero||arg
(rureralor) dar peryeoul (derureralor). Kedua |ua||las lerseoul l|da| rarus rerpurya| s|lal/c|r| yarg sara.
Propors|
Peroard|rgar arlara dua |ua||las d| rara pero||arg (rureralor) rerupa|ar seoag|ar dar| peryeoul (derureralor).
Rara-rara/Vean
3ualu u|urar r||a| lergar yarg d|pero|er dergar cara perjur|arar serua r||a| pergaralar yarg d|dapal, |erud|ar
d|oag| dergar oarya|rya pergaralar yarg ada.
Frekuens|
3ualu u|urar yarg reryala|ar oerapa |a|| sualu a|l|l|las alau sualu |eg|alar d||a|sara|ar pada per|ode Wa|lu
lerlerlu.
Ca|upar
3ualu u|urar urlu| rer||a| percapa|ar ras|| sualu largel |eg|alar yarg d|lerlu|ar pada per|ode Wa|lu lerlerlu.

Fungs| |nd|kator status kesehatan data demograf|

1. 3lalus Keperdudu|ar
repaoaran Penououk
Jur|ar perdudu| oeroard|rg |uas W||ayar/regara, d|ryala|ar da|ar j|Wa per |||oreler perseg|.
/ngka Perrumounan Penououk
T|rg|al perlaroarar jur|ar perdudu| sualu W||ayar/regara da|ar sualu jarg|a Wa|lu lerlerlu, d|ryala|ar da|ar
perserlase.
Persenrase Penououk Perkoraan
Jur|ar perdudu| per|olaar oeroard|rg jur|ar se|urur perdudu| regara, d|ryala|ar da|ar perserlase.

2. 3lalus v|la|
/ngka re|an|ran rasar {0ruoe 3|rrn Rarej
Jur|ar |e|ar|rar da|ar sualu W||ayar/regara se|ara 1 larur oeroard|rg jur|ar perdudu| W||ayar/regara lerseoul
pada perlergarar larur yarg sara, d|ryala|ar da|ar |e|ar|rar per 1000.
/ngka re|an|ran Venurur umur {/ge $pec|l|c Ferr|||r, Rarej
Jur|ar |e|ar|rar o|er War|la pada |e|orpo| urur lerlerlu d| sualu W||ayar/regara oeroard|rg jur|ar se|urur
perdudu| War|la |e|orpo| urur lerseoul d| W||ayar/regara lerseoul da|ar Wa|lu 1 larur, d|ryala|ar da|ar
|e|ar|rar per 1000.
/ngka remar|an rasar {0ruoe 0earn Rarej
Jur|ar |eral|ar da|ar sualu W||ayar/regara se|ara 1 larur oeroard|rg jur|ar perdudu| W||ayar/regara lerseoul
pada perlergarar larur yarg sara, d|ryala|ar da|ar |eral|ar per 1000.
/ngka remar|an Venurur umur {/ge $pec|l|c 0earn Rarej
Jur|ar |eral|ar perdudu| |e|orpo| urur lerlerlu d| sualu
W||ayar/regara oeroard|rg jur|ar se|urur perdudu| |e|orpo| urur lerseoul d| W||ayar/regara lerseoul da|ar Wa|lu
1 larur, d|ryala|ar da|ar |e|ar|rar per 1000. Ve||pul| juga arg|a |eral|ar reorala| (|e|orpo| urur |urarg dar| 28
rar|), arg|a |eral|ar oay| (|urarg dar| 1larur) dar arg|a |eral|ar ara| (|e|orpo| urur 1-1 larur).
/ngka remar|an Venurur Pen,eoao rnusus {0ause $pec|l|c Vorra||r, Rarej
Ve||pul| juga arg|a |eral|ar ralerra| (a||oal |erar||ar, persa||rar dar r|las), arg|a |eral|ar |arera perya||l
lerlerlu, dar seoaga|rya.

3. 3lalus Ca|upar Pe|ayarar Keseralar
Ras|o Puskesmas Ternaoap Penououk
Jur|ar Pus|esras d| sualu W||ayar oeroard|rg jur|ar perdudu| W||ayar lerseoul pada per|ode Wa|lu lerlerlu,
d|ryala|ar da|ar salu pus|esras per jur|ar perdudu|.
Ras|o Tenaga Puskesmas Ternaoap Penououk
Jur|ar leraga Pus|esras (|alegor| jer|s lerlerlu) d| sualu W||ayar oeroard|rg jur|ar perdudu| W||ayar lerseoul
pada per|ode Wa|lu
lerlerlu, d|ryala|ar da|ar leraga/orarg per jur|ar perdudu|.
0A8AR-0A8AR UHUH 8TU0| P0PULA8|

8tud| Popu|as| erdasarkan 0ata Pr|mer (8urve|}

3urve| ada|ar perer||saar yarg |r|l|s urlu| rerdapal|ar |rlorras| yarg lepal; ser|rg rerupa|ar sualu slud| pada
sualu daerar seruourgar dergar |ord|s| lerlerlu alau preva|ers|rya (weosler).
3urve| ada|ar sualu relode yarg oerlujuar urlu| rergurpu||ar sejur|ar oesar var|aoe| rergera| sejur|ar oesar
|rd|v|du, re|a|u| a|al pergu|ur (J.vreder 8regl).

8eoerapa lujuar urur sualu surve|, da|ar ra| |r| surve| |eseralar, d| arlararya :
1. urlu| re||ral oesarrya rasa|ar sualu perya||l da|ar rasyara|al / popu|as|, re|a|u| peroard|rgar rale dar| Wa|lu
|e Wa|lu dar dar| sualu daerar lerradap daerar |a|r.
2. urlu| re||ral peryeoarar perya||l da|ar rasyara|al / popu|as|, |ara|ler|sl|| |a|r dar| |rd|v|du yarg rerpergarur|
ada/l|da|rya perya||l, ser|rgga rale perya||l dapal d|pero|er pada |e|orpo| yarg oeroeda-oeda
3. urlu| rerpe|ajar| r|Wayal a|ar|ar perya||l dar rergera| perja|arar / slad|ur perya||l, ser|rgga dapal d|susur
perercaraar urlu| l|rda|ar percegarar dar pergooalar.
1. urlu| rererlu|ar des|r|ps| |ara|ler|sl|| orarg-orarg yarg rorra| alau l|da| sa||l, dapal rorra| secara slal|sl||,
secara |||r|s alaupur secara |dea|. Ke|orpo| |r| dapal d|pa|a| seoaga| |e|orpo| peroard|rg.
5. urlu| lorru|as| dar perguj|ar r|poles|s el|o|og|. la| |r| rerupa|ar yarg lerperl|rg dar pa||rg |orp|e|s da|ar
slud| popu|as|, |arera re||oal|ar relode ara||l|| urlu| pere||l|ar |eo|r |arjul.

Peryusurar Rercara 3urve|
1. Vererlu|ar apa yarg |rg|r d|u|ur dar |r|ler|a yarg d|gura|ar urlu| pergu|urar (slardar|sas| pergu|urar)
2. Vererlu|ar le|r||/relode yarg ooye|l|l urlu| pergu|urar serla |ord|s| d| rara le|r|| |r| dapal d|pa|a| (va||d|las,
sers|l|l|las, spes|l|s|las dar rea||o|||las pergu|urar).
3. Vererlu|ar l|rg|al |erarpuar orarg-orarg yarg a|ar re|a|sara|ar surve| dergar le|r|| lerseoul, urlu|
rergurarg| la|lor var|as| dar| p|ra| pergaral / ooserver's o|as.
1. Verguj| ras|| relode-relode dar rerguj| orarg-orarg yarg ||ul serla seoaga| ooserver.

Pe|a|saraar 3urve|
1. Pergurpu|ar dala perurjarg : |alar oe|a|arg geogral|, derogral|, popu|as|, ruourgar yarg rurg||r d|car| dso
2. Pergurpu|ar dala ulara, ra| alau oesarar yarg |rg|r d|u|ur, sesua| relode yarg d|lerlu|ar.

Pergo|arar dar lrlerprelas| 0ala 3urve|
1. Pere||l|ar |esesua|ar pero|erar dala dergar yarg d|rarap|ar.
2. Cod|rg dar laou|as|.
3. lrlerprelas| dar peryaj|ar dala da|ar oerlu| o||argar / rale / ras|o / propors|, dar seoaga|rya.

Ara||s|s 0ala 3urve|
1. uj| slal|sl|| / |era|raar da|ar rercar| ruourgar arlar la|lor.
2. Vererlu|ar pr|or|las rasa|ar dar a|lerral|l perye|esa|ar rasa|ar oerdasar|ar ras|| ara||s|s.
8tud| Popu|as| erdasarkan 0ata 8ekunder

Pada slud| popu|as| oerdasar|ar dala se|urder, |arg|ar-|arg|ar perercaraar dar pe|a|saraar pergurpu|ar dala
pr|rer le|ar d||a|u|ar o|er p|ra| |a|r. Pere||l| |argsurg dergar dala yarg d|pero|er re|a|u|ar pergo|arar,
|rlerprelas| dar ara||s|s.
3lud| popu|as| oerdasar|ar dala se|urder sargal lergarlurg lerradap s|sler reg|slras|. Kelepalar oalasar,
|e|erg|apar calalar reg|slras|, |elepalar a|o|as| lerpal dar Wa|lu, serla |elepalar perge|orpo|ar dala rerurul
|ara|ler|sl|| lerlerlu, sargal rerpergarur| ras|| a|r|r. 3|sler reg|slras| d| regara oer|eroarg ras|r rer|||||
oarya| |eleroalasar ser|rgga l|da| rerurg||r|ar d||a|u|arrya slud| popu|as| |eo|r |arjul lerradap dala yarg ada.
HA8ALAh KEPEN0U0UKAN 0| |N00NE8|A

1. Jur|ar perdudu| yarg l|rgg|.
2. Peryeoarar perdudu| / d|slr|ous| yarg l|da| rerala.
3. Korpos|s| perdudu| us|a ruda l|rgg|
1. Arus uroar|sas| l|rgg|
5. Peryeoarar suroer-suroer daya juga l|da| rerala
Anatom| dan F|s|o|og|
8|stem Reproduks| wan|ta
Ku||ar 0oslelr| 0|re|o|og|
dr. l. V. 3oepard|rar / dr. T.Z. Jacoeo / dr. l. Jur|zal
PERLU A6A 8EN0|R| JUCA ANAT0H| | h|8T0L0C| | FAAL !!

ALAT REPR00UK8| wAN|TA

Terd|r| a|al / orgar e|slerra| dar |rlerra|, seoag|ar oesar ler|ela| da|ar rorgga parggu|.
E|slerra| (sarpa| vag|ra) : lurgs| |opu|as|
lrlerra| : lurgs| ovu|as|, lerl|||sas| ovur, lrarsporlas| o|aslocysl, |rp|arlas|, perlurourar lelus, |e|ar|rar.
Furgs| s|sler reprodu|s| War|la d||erda|||ar / d|pergarur| o|er rorror-rorror gordaolrop|r / slero|d dar| poros
rorrora| lra|arus - r|polra|arus - r|pol|s|s - adrera| - ovar|ur.
3e|a|r |lu lerdapal orgar/s|sler e|slragorad/e|slrager|la| yarg juga d|pergarur| o|er s|||us reprodu|s| : payudara,
|u||l daerar lerlerlu, p|grer dar seoaga|rya.

CEN|TAL|A EK8TERNA

Vu|va
Tarpa| dar| |uar (ru|a| dar| rors puo|s sarpa| lep|
per|reur), lerd|r| dar| rors puo|s, |ao|a rayora, |ao|a
r|rora, c||lor|s, ryrer, vesl|ou|ur, or|l|c|ur urelrrae
exlerrur, |e|erjar-|e|erjar pada d|rd|rg vag|ra.

Hons pub|s | mons vener|s
Lap|sar |era| d| oag|ar arler|or syrpr|s|s os puo|s.
Pada rasa puoerlas daerar |r| ru|a| d|lurour| raroul
puo|s.

Lab|a mayora
Lap|sar |era| |arjular rors puo|s |e arar oaWar dar
oe|a|arg, oarya| rergardurg p|e|sus vera.
loro|og eror|o|og|| dergar s|rolur pada pr|a.
L|garerlur rolurdur uler| oera|r|r pada oalas alas
|ao|a rayora.
0| oag|ar oaWar per|reur, |ao|a rayora reryalu (pada
corr|sura posler|or).

Lab|a m|nora
L|palar jar|rgar l|p|s d| oa||| |ao|a rayora, l|da| rerpurya| lo|||e| raroul. 8arya| lerdapal perou|ur darar, olol
po|os dar ujurg seraoul saral.

6||tor|s
Terd|r| dar| capul/g|ars c||lor|d|s yarg ler|ela| d| oag|ar super|or vu|va, dar corpus c||lor|d|s yarg lerlarar d| da|ar
d|rd|rg arler|or vag|ra.
loro|og eror|o|og|| dergar per|s pada pr|a.
Terdapal juga reseplor ardroger pada c||lor|s. 8arya| perou|ur darar dar ujurg seraoul saral, sargal sers|l|l.

Vest|bu|um
0aerar dergar oalas alas c||lor|s, oalas oaWar lourcrel, oalas |alera| |ao|a r|rora. 8erasa| dar| s|rus uroger|la|.
Terdapal |uoarg/or|l|c|ur, ya|lu or|l|c|ur urelrrae exlerrur, |rlro|lus vag|rae, duclus g|ardu|ae 8arlro||r|| |arar-||r|
dar du|lus 3|ere |arar-||r|. Arlara lourcrel dar vag|ra lerdapal lossa rav|cu|ar|s.

|ntro|tus | or|f|c|um vag|na
Ter|ela| d| oag|ar oaWar vesl|ou|ur. Pada gad|s (v|rgo) lerlulup |ap|sar l|p|s oerru|osa ya|lu se|apul dara / hymen,
ulur larpa rooe|ar.
lyrer rorra| lerdapal |uoarg |ec|| urlu| a||rar darar rerslruas|, dapal oeroerlu| ou|ar sao|l, ou|al, ova|,
cr|o|lorr|s, seplur alau l|ror|ae. A||oal co|lus alau lraura |a|r, ryrer dapal rooe| dar oerlu| |uoarg rerjad| l|da|
oeralurar dergar rooe|ar (r|sa|rya oeroerlu| l|ror|ae). 8erlu| r|rer poslparlur d|seoul parous.
Corrurcu|ae ryrl|lorr|s ada|ar s|sa2 se|apul dara yarg rooe| yarg larpa| pada War|la perrar re|ar|r|ar / para.
lyrer yarg aororra|, r|sa|rya pr|rer l|da| oer|uoarg (ryrer |rperlorala) rerulup lola| |uoarg vag|ra, dapal
reryeoao|ar darar rerslruas| ler|urpu| d| rorgga ger|la||a |rlerra.

Vag|na
Rorgga rus|u|orerorarosa oeroerlu| laourg ru|a| dar| lep| cerv|x uler| d| oag|ar |rar|a| dorsa| sarpa| |e vu|va d|
oag|ar |auda| verlra|. 0aerar d| se||lar cerv|x d|seoul lorr|x, d|oag| da|ar 1 |uadrar : lorr|x arler|or, lorr|x posler|or,
dar lorr|x |alera| |arar dar ||r|. vag|ra rer||||| d|rd|rg verlra| dar d|rd|rg dorsa| yarg e|asl|s. 0||ap|s| ep|le|
s|uarosa oer|ap|s, oeruoar rerg||ul| s|||us ra|d.
Furgs| vag|ra : urlu| rerge|uar|ar e|s|res| ulerus pada ra|d, urlu| ja|ar |ar|r dar urlu| |opu|as| (perseluourar).
8ag|ar alas vag|ra leroerlu| dar| du|lus Vu||er|, oaWar dar| s|rus uroger|la||s. 8alas da|ar secara |||r|s ya|lu
lorr|ces arler|or, posler|or dar |alera||s d| se||lar cerv|x uler|.
T|l|| 0rayeroergr (0-spol), rerupa|ar l|l|| daerar sersor|| d| se||lar 1/3 arler|or d|rd|rg vag|ra, sargal sers|l|l
lerradap sl|ru|as| orgasrus vag|ra|.

Per|neum
0aerar arlara lep| oaWar vu|va dergar lep| depar arus. 8alas olol-olol d|alragra pe|v|s (r.|evalor ar|,
r.coccygeus) dar d|alragra uroger|la||s (r.per|rea||s lrarsversus prolurda, r.corslr|clor urelrra).
Per|rea| oody ada|ar rapre red|ar r.|evalor ar|, arlara arus dar vag|ra.
Per|reur reregarg pada persa||rar, |adarg per|u d|polorg (ep|s|olor|) urlu| rerperoesar ja|ar |ar|r dar
rercegar ruplur.
CEN|TAL|A |NTERNA

Uterus
3ualu orgar rus|u|ar oeroerlu| seperl| ouar
p|r, d||ap|s| per|loreur (serosa).
3e|ara |erar||ar oerlurgs| seoaga| lerpal
|rp|alars|, relers| dar rulr|s| |orseplus.
Pada saal persa||rar dergar adarya |orlra|s|
d|rd|rg ulerus dar perou|aar serv||s ulerus,
|s| |orseps| d||e|uar|ar.
Terd|r| dar| corpus, lurdus, corru, |slrrus dar
serv||s uler|.

$erv|ks urer|
8ag|ar leroaWar ulerus, lerd|r| dar| pars
vag|ra||s (oeroalasar / rererous d|rd|rg da|ar vag|ra) dar pars supravag|ra||s. Terd|r| dar| 3 |orporer ulara: olol
po|os, ja||rar jar|rgar ||al (|o|ager dar g|||osar|r) dar e|asl|r. 8ag|ar |uar d| da|ar rorgga vag|ra ya|lu porl|o
cerv|c|s uler| (d|rd|rg) dergar |uoarg osl|ur uler| exlerrur (|uar, arar vag|ra) d||ap|s| ep|le| s|uaro|o|urrar ru|osa
serv||s, dar osl|ur uler| |rlerrur (da|ar, arar cavur). 3eoe|ur re|ar|r|ar (ru|||para/pr|r|grav|da) |uoarg osl|ur
exlerrur ou|al |ec||, sele|ar perrar/r|Wayal re|ar|r|ar (pr|r|para/ ru|l|grav|da) oeroerlu| gar|s re||rlarg. Pos|s|
serv||s rergarar |e |auda|-posler|or, sel|rgg| sp|ra |scr|ad|ca. Ke|erjar ru|osa serv||s rergras|||ar |erd|r gelar
serv||s yarg rergardurg g|||oprole|r |aya |aroor|dral (rus|r) dar |arular oeroaga| garar, pepl|da dar a|r.
Keleoa|ar ru|osa dar v|s|os|las |erd|r serv||s d|pergarur| s|||us ra|d.

0orpus urer|
Terd|r| dar| : pa||rg |uar |ap|sar serosa/per|loreur yarg re|e|al
pada ||garerlur |alur uler| d| |rlraaodorer, lergar |ap|sar
rus|u|ar/r|orelr|ur oerupa olol po|os l|ga |ap|s (dar| |uar |e
da|ar arar seraoul olol |org|lud|ra|, aryarar dar s|r|u|ar), serla
da|ar |ap|sar erdorelr|ur yarg re|ap|s| d|rd|rg cavur uler|,
rereoa| dar rurlur sesua| s|||us ra|d a||oal pergarur rorror-
rorror ovar|ur. Pos|s| corpus |rlraaodorer rerdalar dergar
l|e|s| |e arler|or, lurdus uler| oerada d| alas ves|ca ur|rar|a.
Propors| u|urar corpus lerradap |slrrus dar serv||s ulerus
oervar|as| se|ara perlurourar dar per|eroargar War|la
(garoar).

l|gamenra pen,angga urerus
L|garerlur |alur uler|, ||garerlur rolurdur uler|, ||garerlur card|ra|e, ||garerlur ovar||, ||garerlur
sacrouler|ra prop|ur, ||garerlur |rlurd|ou|ope|v|cur, ||garerlur ves|couler|ra, ||garerlur reclouler|ra.

vasku|ar|sas| urerus
Terulara dar| arler| uler|ra caoarg arler| rypogaslr|ca/||||aca |rlerra, serla arler| ovar|ca caoarg aorla aodor|ra||s.

8a|p|ng | Tuba Fa|op||
Eror|o|og|| ulerus dar luoa oerasa| dar| duclus Vu||er|.
3epasarg luoa ||r|-|arar, parjarg 8-11 cr, oerlurgs|
seoaga| ja|ar lrarsporlas| ovur dar| ovar|ur sarpa|
cavur uler|.
0|rd|rg luoa lerd|r| l|ga |ap|sar : serosa, rus|u|ar
(|org|lud|ra| dar s|r|u|ar) serla ru|osa dergar ep|le|
oers|||a.
Terd|r| dar| pars |rlersl|l|a||s, pars |slrr|ca, pars
arpu|ar|s, serla pars |rlurd|ou|ur dergar l|ror|a,
dergar |ara|ler|sl|| s|||a dar |eleoa|ar d|rd|rg yarg
oeroeda-oeda pada sel|ap oag|arrya (garoar).

Pars |srnm|ca {proks|ma|/|srnmusj
Verupa|ar oag|ar dergar |urer lerserp|l, lerdapal
sl|rgler uleroluoa pergerda|| lrarsler garel.
Pars ampu|ar|s {meo|a|/ampu|aj
Terpal yarg ser|rg lerjad| lerl|||sas| ada|ar daerar
arpu|a / |rlurd|ou|ur, dar pada rar|| e|lop||
(palo|og||) ser|rg juga lerjad| |rp|arlas| d| d|rd|rg luoa
oag|ar |r|.
Pars |nluno|ou|um {o|sra|j
0||erg|ap| dergar l|ror|ae serla osl|ur luoae
aodor|ra|e pada ujurgrya, re|e|al dergar
perru|aar ovar|ur. F|ror|ae oerlurgs| rerarg|ap
ovur yarg |e|uar saal ovu|as| dar| perru|aar ovar|ur,
dar reroaWarya |e da|ar luoa.

Vesosa|p|ng
Jar|rgar ||al peryargga luoa (seperl| ra|rya
reserler|ur pada usus).

0var|um
0rgar erdo|r|r oeroerlu| ova|, ler|ela| d| da|ar rorgga per|loreur, sepasarg ||r|-|arar. 0||ap|s| resovar|ur,
seoaga| jar|rgar ||al dar ja|ar perou|ur darar dar saral. Terd|r| dar| |orle|s dar redu|a.
0var|ur oerlurgs| da|ar peroerlu|ar dar peralargar lo|||e| rerjad| ovur (dar| se| ep|le| gerr|ra| pr|rord|a| d|
|ap|sar ler|uar ep|la| ovar|ur d| |orle|s), ovu|as| (perge|uarar ovur), s|rles|s dar se|res| rorror-rorror slero|d
(eslroger o|er le|a |rlerra lo|||e|, progesleror o|er |orpus |uleur pascaovu|as|). 8erruourgar dergar pars
|rlurd|ou|ur luoa Fa|op|| re|a|u| per|e|alar l|ror|ae. F|ror|ae rerarg|ap ovur yarg d||epas|ar pada saal ovu|as|.
0var|ur lerl||sas| o|er ||garerlur ovar|| propr|ur, ||garerlur |rlurd|ou|ope|v|cur dar jar|rgar ||al resovar|ur.
vas|u|ar|sas| dar| caoarg aorla aodor|ra||s |rler|or lerradap arler| rera||s.

0/T/T/h .
lerak / nuoungan anarom|k anrara organ2 reproouks| {urerus, aoneksa, osoj oengan organ2 sek|rarn,a o| oa|am
rongga panggu| {rekrum, ves|ka ur|nar|a, urerra, urerer, per|roneum osoj, vasku|ar|sas| oan persaralann,a, s||akan
oaca seno|r|.
0RCAN REPR00UK8| | 0RCAN 8EK8UAL EK8TRAC0NA0AL

Payudara
3e|urur susurar |e|erjar payudara oerada d| oaWar |u||l d| daerar pe|lora|.
Terd|r| dar| rassa payudara yarg seoag|ar oesar rergardurg jar|rgar |era|,
oer|oous-|oous (20-10 |oous), l|ap |oous lerd|r| dar| 10-100 a|veo||, yarg d| oaWar
pergarur rorror pro|a|l|r rerprodu|s| a|r susu. 0ar| |oous-|oous, a|r susu
d|a||r|ar re|a|u| du|lus yarg oerruara d| daerar pap||a / pul|rg. Furgs| ulara
payudara ada|ar |a|las|, d|pergarur| rorror pro|a|l|r dar o|s|los|r
pascapersa||rar.
Ku||l daerar payudara sers|l|l lerradap rargsarg, lerrasu| seoaga| sexua||y
respors|ve orgar.

Ku||t
0| oeroaga| area lerlerlu luour, |u||l rer||||| sers|l|l|las yarg |eo|r l|rgg| dar respors|l secara se|sua|, r|sa|rya |u||l
d| daerar oo|org dar ||pal para da|ar.
Prole|r d| |u||l rergardurg prerorore (sejer|s relaoo||l slero|d dar| |eral|ros|l ep|derra| |u||l) yarg oerlurgs|
seoaga| 'parlur' daya lar|| se|sua| (ardroslero| dar ardrosleror d|oual d| |u||l, |e|erjar |er|rgal a|s||a dar |e|erjar
||ur). Prerorore d|leru|ar juga d| da|ar ur|re, p|asra, |er|rgal dar ||ur.

P0R08 h0RH0NAL 8|8TEH REPR00UK8|

adan p|nea|
3ualu |e|erjar |ec||, parjarg se||lar -8 rr, rerupa|ar sualu perorjo|ar dar| oag|ar posler|or verlr||e| lll d| gar|s
lergar. Ter|ela| d| lergar arlara 2 rer|sler ola|, d| depar sereoe|ur pada daerar poslerodorsa| d|ersela|or.
Ver||||| ruourgar dergar r|pola|arus re|a|u| sualu oalarg pergruourg yarg perde| oer|s| seraoul-seraoul saral.
Verurul |epercayaar |uro, d|percaya seoaga| lerpal ror.
lorror re|alor|r : rergalur s|r|u|l lolo-reuro-erdo|r|r reprodu|s|. Tarpa|rya re|alor|r rergraroal produ|s|
0rRl dar| r|pola|arus, ser|rgga rergraroal juga se|res| goradolrop|r dar| r|pol|s|s dar rer|cu a|l|las|
perlurourar dar se|res| rorror dar| gorad. 0|duga re|ar|sre |r| yarg rererlu|ar per|cu / orsel ru|a|rya lase
puoerlas.


h|pota|amus
Kurpu|ar ru||eus pada daerar d| dasar ola|, d| alas r|pol|s|s, d|
oaWar la|arus.
T|ap |rl| rerupa|ar salu oer|as oadar saral yarg oer|arjul |e
r|pol|s|s seoga| r|pol|s|s posler|or (reuror|pol|s|s).
Vergras|||ar rorror-rorror pe|epas : 0rRl (0oradolrop|r
Re|eas|rg lorrore), TRl (Tryrolrop|r Re|eas|rg lorrore), CRl
(Corl|colrop|r Re|eas|rg lorrore) , 0lRl (0roWlr lorrore
Re|eas|rg lorrore), PRF (Pro|acl|r Re|eas|rg Faclor).
Vergras|||ar juga rorror-rorror pergraroal : PlF (Pro|acl|r
lrr|o|l|rg Faclor).

P|tu|tar| | h|pof|s|s
Ter|ela| d| da|ar se||a lurc|ca lu|arg sprero|d.
Vergras|||ar rorror-rorror goradolrop|r yarg oe|erja pada
|e|erjar reprodu|s|, ya|lu perargsarg perlurourar dar peralargar
lo|||e| (F3l - Fo|||c|e 3l|ru|al|rg lorrore) dar rorror |ule|r (Ll -
|ule|r|z|rg rorrore).
3e|a|r rorror-rorror goradolrop|r, r|pol|s|s rergras|||ar juga
rorror-rorror relaoo||sre, perlurourar, dar |a|r-|a|r. (dela||2,
car| / oaca serd|r| yaaa.)

0var|um
8erlurgs| garelogeres|s / oogeres|s, da|ar
peralargar dar perge|uarar se| le|ur (ovur).
3e|a|r |lu juga oerlurgs| slero|dogeres|s,
rergras|||ar eslroger (dar| le|a |rlerra
lo|||e|) dar progesleror (dar| |orpus |uleur),
alas |erda|| dar| rorror-rorror
goradolrop|r.

Endometr|um
Lap|sar da|ar d|rd|rg |avur uler|, oerlurgs| seoaga| oa|a| lerpal |rp|arlas| ras|| |orseps|.
3e|ara s|||us ra|d, jar|rgar erdorelr|ur oerpro||leras|, rereoa| dar rergada|ar se|res|, |erud|ar j||a l|da| ada
perouarar / |rp|arlas|, erdorelr|ur rorlo| |eroa|| dar |e|uar oerupa darar / jar|rgar ra|d.
J||a ada perouarar / |rp|arlas|, erdorelr|ur d|perlarar|ar seoaga| lerpal |orseps|.
F|s|o|og| erdorelr|ur juga d|pergarur| o|er s|||us rorror-rorror ovar|ur.

(garoar)
l|sro|og|ca| appearance ol enoomerr|a| r|ssues our|ng rne mensrrua| c,c|e.
/. horma| pro||lerar|ve {posrmensrrua|j enoomerr|um, snou|ng sma||, ruoe-||ke parrern ol g|anos.
3. Ear|, secreror, {posrovu|aror,j enoomerr|um, u|rn prom|nenr suonuc|ear vacuo|es, a||gnmenr ol nuc|e|, ano acr|ve
secrer|ons o, rne enoomerr|a| g|anos.
0. lare secreror, {premensrrua|j enoomerr|um, u|rn preoec|oua| srroma| cnanges.
0. Vensrrua| enoomerr|um, u|rn o|s|nregrar|on ol srroma / g|anos srrucrures ano srroma| nemorrnage.
h0RH0N-h0RH0N REPR00UK8|

CnRh (Conadotroph|n Re|eas|ng hormone}
0|produ|s| d| r|pola|arus, |erud|ar d||epas|ar, oerlurgs| rersl|ru|as| r|pol|s|s arler|or urlu| rerprodu|s| dar
re|epas|ar rorror-rorror goradolrop|r (F3l / Ll ).

F8h (Fo|||c|e 8t|mu|at|ng hormone}
0|produ|s| d| se|-se| oasa| r|pol|s|s arler|or, seoaga|
respors lerradap 0rRl. 8erlurgs| rer|cu perlurourar
dar peralargar lo|||e| dar se|-se| graru|osa d| ovar|ur
War|la (pada pr|a : rer|cu peralargar sperra d| lesl|s).
Pe|epasarrya per|od|| / pu|sal|l, Wa|lu parur e||r|ras|rya
perde| (se||lar 3 jar), ser|rg l|da| d|leru|ar da|ar darar. 3e|res|rya d|raroal
o|er erz|r |rr|o|r dar| se|-se| graru|osa ovar|ur, re|a|u| re|ar|sre leedoac|
regal|l.

Lh (Lute|n|z|ng hormone} | |68h (|nterst|t|a| 6e|| 8t|mu|at|ng hormone}
0|produ|s| d| se|-se| |roroloo r|pol|s|s arler|or. 8ersara F3l, Ll oerlurgs|
rer|cu per|eroargar lo|||e| (se|-se| le|a dar se|-se| graru|osa) dar juga
rercelus|ar lerjad|rya ovu|as| d| perlergarar s|||us (Ll-surge). 3e|ara lase
|ulea| s|||us, Ll rer|rg|al|ar dar rerperlarar|ar lurgs| |orpus |uleur
pascaovu|as| da|ar rergras|||ar progesleror.
Pe|epasarrya juga per|od|| / pu|sal|l, |adarrya da|ar darar oervar|as| sel|ap lase
s|||us, Wa|lu parur e||r|ras|rya perde| (se||lar 1 jar). Kerja sargal cepal dar
s|rg|al.
(Pada pr|a : Ll rer|cu s|rles|s leslosleror d| se|-se| Leyd|g lesl|s).

Estrogen
Eslroger (a|ar|) d|produ|s| lerulara o|er se|-se| le|a |rlerra lo|||e| d| ovar|ur
secara pr|rer, dar da|ar jur|ar |eo|r sed|||l juga d|produ|s| d| |e|erjar adrera| re|a|u| |orvers| rorror ardroger.
Pada pr|a, d|produ|s| juga seoag|ar d| lesl|s.
3e|ara |erar||ar, d|produ|s| juga o|er p|aserla.
8erlurgs| sl|ru|as| perlurourar dar per|eroargar (pro||leras|) pada oeroaga| orgar reprodu|s| War|la.
Pada ulerus : reryeoao|ar pro||leras| erdorelr|ur.
Pada serv||s : reryeoao|ar pe|ura|ar serv||s dar pergerla|ar |erd|r serv||s.
Pada vag|ra : reryeoao|ar pro||leras| ep|le| vag|ra.
Pada payudara : rersl|ru|as| perlurourar payudara.
Juga rergalur d|slr|ous| |era| luour.
Pada lu|arg, eslroger juga rersl|ru|as| osleoo|as ser|rgga rer|cu perlurourar / regereras| lu|arg. Pada War|la
pascareropause, urlu| percegarar lu|arg |eropos / osleoporos|s, dapal d|oer||ar lerap| rorror eslroger (s|rlel||)
perggarl|.

Progesteron
Progesleror (a|ar|) d|produ|s| lerulara d| |orpus |uleur d| ovar|ur, seoag|ar d|produ|s| d| |e|erjar adrera|, dar
pada |erar||ar juga d|produ|s| d| p|aserla.
Progesleror reryeoao|ar lerjad|rya proses peruoarar se|relor|| (lase se|res|) pada erdorelr|ur ulerus, yarg
rerpers|ap|ar erdorelr|ur ulerus oerada pada |eadaar yarg opl|ra| j||a lerjad| |rp|arlas|.

h6C (human 6hor|on|c Conadotroph|n}
Vu|a| d|produ|s| seja| us|a |erar||ar 3-1 r|rggu o|er jar|rgar lroloo|as (p|aserla). Kadarrya ra||r rer|rg|al
sarpa| dergar |erar||ar 10-12 r|rggu (sarpa| se||lar 100.000 ru/r|), |erud|ar lurur pada lr|resler |edua
(se||lar 1000 ru/r|), |erud|ar ra|| |eroa|| sarpa| a|r|r lr|resler |el|ga (se||lar 10.000 ru/r|).
8erlurgs| rer|rg|al|ar dar rerperlarar|ar lurgs| |orpus |uleur dar produ|s| rorror-rorror slero|d lerulara
pada rasa-rasa |erar||ar aWa|. Vurg||r juga rer||||| lurgs| |ruro|og||.
0ele|s| lC0 pada darar alau ur|re dapal d|jad||ar seoaga| larda |erurg||rar adarya |erar||ar (les 0a||| Va|r|r|,
les Pac|, dso).

LTh (Lactotroph|c hormone} | Pro|act|n
0|produ|s| d| r|pol|s|s arler|or, rer||||| a|l|l|las rer|cu / rer|rg|al|ar produ|s| dar se|res| a|r susu o|er |e|erjar
payudara. 0| ovar|ur, pro|a|l|r ||ul rerpergarur| peralargar se| le|ur dar rerpergarur| lurgs| |orpus |uleur.
Pada |erar||ar, pro|a|l|r juga d|produ|s| o|er p|aserla (lPL / lurar P|acerla| Lacloger).
Furgs| |a|loger|| / |a|lolrop|| pro|a|l|r larpa| lerulara pada rasa |a|las| / pascapersa||rar.
Pro|a|l|r juga rer||||| ele| |rr|o|s| lerradap 0rRl r|pola|arus, ser|rgga j||a |adarrya oer|eo|rar
(r|perpro|a|l|rer|a) dapal lerjad| gargguar peralargar lo||||e|, gargguar ovu|as| dar gargguar ra|d oerupa
arerorrea.
$e|anurn,a .
F|s|o|og| s|k|us mensrruas| - kenam||an - persa||nan - men,usu| - aoa ku||ann,a seno|r|.
Cametogenes|s, Fert|||sas| dan |mp|antas|
dr. h. Huk| Reksoprodjo | dr. Noroyono w|bowo
Ku||ah EHR|0L0C| Anatom| Kedokteran
dr.Condo 8. Coza|| | dr. 8antoso Cunard|
CAHET0CENE8|8

3|lal |e|ar|r pr|a dar War|la d|lerlu|ar secara gerel|| o|er |oro|ras| |rorosor.
Pada pr|a : 1XY (ser|rg d|seoul juga 11XY)
Pada War|la : 1XX (ser|rg d|seoul juga 11XX)

8e|-se| gamet
3e|-se| yarg oerperar pada per|sl|Wa reprodu|s| rerjad| oa|a| |elururar se|arjulrya. 0|seoul juga se| oer|r.
Pada pr|a : se| sperra
Pada War|la : se| le|ur / ovur

Cametogenes|s
Proses peroerlu|ar, peroe|arar dar peralargar se|-se| garel sarpa| rerjad| se| garel yarg s|ap oerperar
da|ar proses reprodu|s|
Pada pr|a : sperralogeres|s - sperr|ogeres|s
Pada War|la : oogeres|s
Pembe|ahan 8e|

Tujuar peroe|arar se|-se| :
1. r|los|s : regereras|
2. r|os|s : rergurarg| |rorosor (2r0NA 1xx/xy
d|p|o|d rerjad| 1r0NA 23x/y rap|o|d), peruoarar
oerlu| se|-se| oer|r urlu| pers|apar perouarar
(sperra rergec||, ovur reroesar).
(da|ar garelogeres|s : se|-se| yarg rerga|ar|
peroe|arar ada|ar oa|a| se|-se| oer|r / garel)
H|tos|s
Krorosor re|a|u|ar rep|||as| 0NA (2r-1r)
3lad|ur : prolase - prorelalase - relalase -
aralase - le|olase, peroe|arar serlrorer. (oaca
serd|r| juga lerlarg o|o|og| se| ll)
Jur|ar a|r|r |rorosor pada peroe|arar r|los|s : |rorosor se| ara| = |rorosor se| |rdu| = 2r = 1.
H|os|s
Peroe|arar r|os|s perlara :
Rep|||as| 0NA |rorosor (2r-1r), reroerlu| pasargar roro|og, |erud|ar rergada|ar cross-over |roral|d,
per|sarar reroerlu| ||asra, lerjad| perlu|arar ger |rler|rorosor roro|og.
Jur|ar a|r|r |rorosor pada peroe|arar r|os|s perlara : |rorosor se| ara| = |rorosor se| |rdu| = 2r = 23
garda.
Peroe|arar r|os|s |edua :
Norrep|||as|, peroe|arar pada serlrorer,
Jur|ar a|r|r |rorosor pada peroe|arar r|os|s |edua : |rorosor se| ara| = |rorosor se| |rdu| = r = 23
lurgga|.

0aroar : Proses peroe|arar se|, r|los|s (||r|) dar r|os|s (|arar)
8EL-8EL EN|h PR|H0R0|AL

3e| oer|r pr|a raupur War|la rerupa|ar lururar |argsurg se|-se| oer|r pr|rord|a| (pr|rord|a| gerr ce||s) yarg
leroerlu| pada rasa eror|ora|.
3e| oer|r pr|rord|a| ru|a| larpa| d| d|rd|rg yo|| sac pada a|r|r r|rggu |e-3 perlurourar eror|o.
0a|ar per|eroargarrya se| oer|r pr|rord|a| oerp|rdar / r|gras| |e arar jar|rgar gorad, sarpa| ||ra-||ra r|rggu |e-
5.
8PERHAT0CENE8|8 - 8PERH|0CENE8|8 (PA0A PR|A}

Pada pr|a, se| oer|r pr|rord|a| lelap oerada pada slad|ur eror|ora|rya, d| da|ar jar|rgar
lesl|s, d||e||||rg| dergar se|-se| perurjarg, sarpa| saal sesudar |ar|r dar rerje|arg puoerlas.
0|lerers|as| |arjular dar| se| oer|r pr|rord|a| dar perurjargrya oaru ru|a| pada rasa
puoerlas.

Pada rasa puoerlas, se| perurjarg oer|eroarg rerjad| se|-se| suslerla|u|er 3erlo|| urlu| rulr|s| garel.

3e| oer|r pr|rord|a| oer|eroarg rerjad|
sperralogor|ur |erud|ar rerjad| sperralos|l pr|rer.

3perralos|l pr|rer |r| |erud|ar rergada|ar r|los|s
urlu| rerperoarya| d|r| lerus rererus.
Kerud|ar ras|| a|r|r peroe|arar lerseoul rerja|ar|
proses r|os|s perlara rerjad| sperralos|l se|urder.
3ele|ar |lu sperralos|l se|urder rerja|ar| proses
r|os|s |edua rerjad| sperral|d.

Per|eroargar se|arjulrya dar| sperral|d rerjad| se|
sperra deWasa d|seoul seoaga| sperr|ogeres|s.

Pada proses sperr|ogeres|s, lerjad| oeoerapa proses
perl|rg :
1. oadar dar |rl| se| sperral|d rerjad| |epa|a sperra
2. seoag|ar oesar s|lop|asra |urur dar d|aosorps|
3. lerjad| juga peroerlu|ar |erer, |erperg lergar dar
e|or
1. |epa|a sperra d|||pul| a|rosor.

las|| a|r|r proses |r| ada|ar se|-se| sperra deWasa ya|lu sperralozoa.

Karera lerjad| per|sarar pasargar |rorosor, sualu se| sperra a|ar rergardurg |rorosor separur dar|
|rdu|rya (11XY) ya|lu |erurg||rar 22X alau 22Y.

Kese|ururar proses sperralogeres|s - sperr|ogeres|s rorra| pada pr|a rerer|u|ar Wa|lu 0-Z0 rar|.

3ele|ar leroerlu| serpurra, sperralozoa rasu| |e da|ar rorgga luou|us ser|r|lerus, |erud|ar a||oal |orlra|s|
d|rd|rg luou|us sperralozoa lerdororg |e arar ep|d|d|r|s.

3uasara |ese|roargar asar-oasa dar e|e|lro||l yarg sesua| d| |rlraluou|us dar ep|d|d|r|s reroer||ar sperralozoa
|erarpuar urlu| oergera| (rol|||las sperra).

00CENE8|8 (PA0A wAN|TA}

Pada War|la, sele|ar l|oa d| gorad, se| oer|r pr|rord|a|
segera oerd|lerers|as| rerjad| oogor|ur.

0ogor|ur |erud|ar rerga|ar| oeoerapa |a|| r|los|s, dar
pada a|r|r per|eroargar eror|ora| ou|ar |el|ga sel|ap
oogor|ur d||e||||rg| o|er se|ap|s se| ep|le| yarg oerasa|
dar| perru|aar jar|rgar gorad, yarg rarl|rya rerjad| se|
lo|||u|er.

3eoag|ar oesar oogor|ur lerus rerga|ar| r|los|s,
seoag|ar |a|r oerd|lerers|as| dar lurour reroesar
rerjad| oos|l pr|rer.
0os|l pr|rer |erud|ar rergada|ar rep|||as| 0NA dar
rerasu|| proses r|os|s perlara sarpa| larap prolase.

Pada ou|ar |e-5 sarpa| |e-Z, jur|ar oogor|ur
d|per||ra|ar rercapa| 5-Z jula se|. Pada saal |lu se|-se|
ru|a| oerdegereras|, ser|rgga oarya| oogor|ur dar
oos|l pr|rer oerrerl| lurour dar rerjad| alrel||.

Telap| oos|l pr|rer yarg le|ar rerasu|| larap prolase
r|os|s perlara lelap oerlarar pada slad|urrya dergar
d||ap|s| se| lo|||u|er ep|le| geperg (se|arjulrya oos|l
pr|rer dergar se| lo|||u|er |r| d|seoul seoaga| lo|||e| pr|rord|a|).

Fo|||e| pr|rord|a| lelap pada slad|urrya (d|seoul lase |sl|raral/ lase d||l|oler / d|p|olere slage), sarpa| sesudar
|e|ar|rar dar rerje|arg puoerlas. Jur|arrya pada saal |e|ar|rar se||lar Z00 r|ou - 2 jula lo|||e|.

Pada rasa puoerlas, saro|| ru|a| leroerlu|rya s|||us rerslruas|,
lo|||e| pr|rord|a| / oos|l pr|rer ru|a| re|arjul|ar peralargarrya
dergar |ecepalar yarg oeroeda-oeda.

Pada saal ovu|as| sualu s|||us ra|d rorra|, ya|lu se||lar dua r|rggu
seoe|ur lerjad|rya perdararar ra|d oer||ulrya, rarya salu se| lo|||e|
yarg
rerga|
ar| peralargar sarpa| l|rg|al |arjul dar |e|uar
seoaga| ovur yarg s|ap d|ouar|.
Perlurourar / peralargar d|aWa|| dergar
perlaroarar u|urar oos|l pr|rer / lo|||e|
pr|rord|a| rerjad| reroesar, dar se|-se| ep|le|
se|ap|s geperg oeruoar rerjad| |uoo|d dar oer|ap|s-
|ap|s. Pada l|rg|al perlurourar |r|, oos|l pr|rer
oersara |ap|sar ep|le|rya d|seoul oereda da|ar
slad|ur lo|||e| pr|rer.

AWa|rya oos|l pr|rer oerruourgar eral dergar se| lo|||u|er |uoo|d yarg re|ap|s|rya, rarur se|arjulrya leroerlu|
sualu |ap|sar ru|opo||sa|ar|da yarg reroalas| / rer|sar|ar d| arlararya, yarg d|seoul zora pe||uc|da.

Kerud|ar leroerlu| juga sualu rorgga da|ar |ap|sar lo|||u|er (arlrur lo|||u||) yarg ra||r |ara ra||r oesar.
Telap| se|-se| lo|||u|er yarg oeroalasar dergar zora pe||uc|da oos|l pr|rer lelap ulur dar rerjad| curu|us ooprorus.
3lad|ur per|eroargar |r| d|seoul slad|ur lo|||e| se|urder.

Kerud|ar arlrur lo|||u|| sera||r reroesar, sererlara oag|ar lep| |uar |ap|sar lo|||u|er ru|a| d||ap|s| o|er dua
|ap|sar jar|rgar ||al ya|lu le|a |rlerra (|ap|sar se|u|er, seoe|ar da|ar, yarg |erud|ar rergras|||ar rorror
eslroger) dar le|a e|slerra (|ap|sar l|orosa, seoe|ar |uar).
Pada slad|ur |r|, lo|||e| d|seoul seoaga| oerada da|ar slad|ur
sudar ralarg, d|seoul seoaga| lo|||e| lers|er alau lo|||e|
de0raal.

3ele|ar lercapa| peralargar lo|||e|, oos|l pr|rer rerasu||
peroe|arar r|os|s |edua dergar rergras|||ar dua se| ara|
yarg ras|rg-ras|rg rergardurg jur|ar 0NA seoarya|
separur se| |rdu| (23 lurgga|, ).
Telap| rarya 3ATu se| ara| yarg lurour rerjad| oos|l
se|urder, sererlara se| ara| |a|rrya rarya rerjad| oadar
|uluo (po|ar oody) yarg l|da| lurour |eo|r |arjul.

Pada saal oos|l se|urder rercapa| slad|ur peroerlu|ar |urparar (co|||rg) lerjad||ar 0VULA8| d| rara oos|l
lerseoul d||epas|ar dar| lo|||e| de0raal, oersara
dergar |ap|sar curu|us ooprorus dar| se| lo|||u|ar dar
|ap|sar zora pe||uc|da.

3usurar curu|us ooprorus d| se|e||||rg zora pe||uc|da
|erud|ar rerjad| corora rad|ala.

Fo|||e| oe|as lerpal oos|l |erud|ar d| oaWar pergarur
rorror Ll r|pol|s|s a|ar rerjad| |orpus |uleur yarg
|erud|ar rergras|||ar rorror progesleror.

Kerud|ar, o|er gera|ar |orlra|s| d|rd|rg luoa dar ayurar seraoul-seraoul l|ror|ae d|rd|rg luoa, oos|l lerseoul ||ul
leroaWa |e arar ulerus. 0| da|ar luoa |r||ar lerdapal |erurg||rar lerjad|rya perouarar dergar se| sperra.

J||a lerjad| perouarar, oos|l se|urder rerye|esa||ar slad|ur peroe|arar peralargar |eduarya sarpa| rerjad|
oos|l ralarg, |erurg||rar dergar rergras|||ar salu ouar po|ar oody |ag|. 3ererlara po|ar oody ras|| peroe|arar
seoe|urrya d|per||ra|ar juga rergada|ar salu peroe|arar |ag|.

J||a lerjad| perouarar dar |erar||ar, |orpus |uleur lelap a|l|l |arera rorror progesleror yarg d|ras|||arrya
oerlurgs| rerperlarar|ar |ese|roargar rorrora| se|ara rasa-rasa aWa| |erar||ar.

J||a l|da| lerjad| perouarar, oos|l se|urder a|ar rerga|ar| degereras| da|ar Wa|lu se||lar 21-18 jar pasca
ovu|as|.

J||a l|da| lerjad| perouarar dar |erar||ar, sarpa| dergar 9-10 rar| sesudar ovu|as| |orpus |uleur a|ar
oerdegereras| dar rerga|ar| l|oros|s rerjad| |orpus a|o||ars.
A||oal degereras| |r| produ|s| progesleror juga rerurur, rerjad| sl|ru|as| urlu| lerjad|rya perdararar ra|d
oer||ulrya.

las|| a|r|r oogeres|s rorra| |erurg||rar ada|ar salu ouar oos|l ralarg dar 1-3 ouar po|ar ood|es.
Krorosor yarg d||ardurg o|er oos|l ada|ar separur dar| |rdu|rya, ya|lu 23X.
0aroar : Peroard|rgar arlara garelogeres|s pada pr|a dar War|la

0aroar : Peroard|rgar arlara garelogeres|s pada pr|a dar War|la
FERT|L|8A8| | PEHUAhAN

Pada saal |opu|as| arlara pr|a dar War|la (sarggara / co|lus), dergar eja|u|as| sperra dar| sa|urar reprodu|s| pr|a
d| da|ar vag|ra War|la, a|ar d||epas|ar ca|rar rar| oer|s| se|-se| sperra |e da|ar sa|urar reprodu|s| War|la.

J||a sarggara lerjad| da|ar se||lar rasa ovu|as| (d|seoul rasa suour War|la), ra|a ada |erurg||rar se| sperra
da|ar sa|urar reprodu|s| War|la a|ar oerleru dergar se| le|ur War|la yarg oaru d||e|uar|ar pada saal ovu|as|.
Perleruar / peryaluar se| sperra dergar se| le|ur |r||ar yarg d|seoul seoaga| perouarar alau lerl|||sas|.

0a|ar |eadaar rorra| |r v|vo, perouarar lerjad| d| daerar luoa Fa|op|| ururrya d| daerar arpu|a / |rlurd|ou|ur.
Per|eroargar le|ro|og| ||r| rerurg||r|ar perala|a|saraar |asus |rlerl|||las (l|da| o|sa rerpurya| ara|) dergar
cara rergaro|| oos|l War|la dar d|ouar| dergar sperra pr|a d| |uar luour, |erud|ar sele|ar leroerlu| eror|o,
eror|o lerseoul d|rasu||ar |eroa|| |e da|ar rar|r urlu| perlurourar se|arjulrya. Te|r|| |r| d|seoul seoaga|
perouarar |r v|lro (|r v|lro lerl|||zal|or - lvF) - da|ar |sl||ar aWar, oay| laourg.
(lvF l|da| d|oaras d| s|r|)

3perralozoa oergera| cepal dar| vag|ra |e da|ar rar|r, rasu| |e da|ar luoa. 0era|ar |r| rurg||r d|pergarur| juga
o|er perarar |orlra|s| r|orelr|ur dar d|rd|rg luoa yarg juga lerjad| saal sarggara.

Kerud|ar sperralozoa rerga|ar| per|sl|Wa :
1. rea|s| |apas|las| : se|ara oeoerapa jar, prole|r p|asra dar g|||oprole|r yarg oerada da|ar ca|rar rar|
d||urur|ar.
2. rea|s| a|rosor : sele|ar de|al dergar oos|l, se| sperra yarg le|ar rerja|ar| |apas|las| a|ar lerpergarur o|er zal-
zal dar| corora rad|ala ovur, ser|rgga |s| a|rosor dar| daerar |epa|a sperra a|ar ler|epas dar oer|orla| dergar
|ap|sar corora rad|ala. Pada saal |r| d||epas|ar r|a|uror|dase yarg dapal re|arul|ar corora rad|ala, lryps|re-|||e
agerl dar |ys|re-zore yarg dapal re|arul|ar dar reroarlu sperra re|eWal| zora pe||uc|da urlu| rercapa| ovur.

3e|a|| seouar sperralozoa reryerlur zora pe||uc|da, lerjad| per|e|alar yarg |ual dar pererousar yarg sargal
cepal.

3e|a|| le|ar lerjad| pererousar zora o|er salu sperra, lerjad| rea|s| |rusus d| zora pe||uc|da (zore-reacl|or) yarg
oerlujuar rercegar lerjad|rya pererousar |ag| o|er sperra |a|rrya.

0ergar der|||ar sargal jararg se|a|| lerjad|
pererousar zora o|er |eo|r dar| salu sperra.

3ele|ar se| sperra rercapa| oos|l, lerjad| :
1. rea|s| zora / rea|s| |orl||a| pada se|apul zora
pe||uc|da.
2. oos|l rerye|esa||ar peroe|arar r|os|s |eduarya,
rergras|||ar oos|l del|r|l|l yarg |erud|ar rerjad|
proru||eus War|la.
3. |rl| se| sperra reroesar reroerlu| proru||eus pr|a
1. e|or se| sperra ler|epas dar oerdegereras|.
5. proru||eus pr|a dar War|la, ras|rg-ras|rg rap|o|d,
oersalu dar reroerlu| z|gol yarg rer||||| jur|ar 0NA
gerap / d|p|o|d.

has|| utama pembuahan
1. perggerapar |eroa|| jur|ar |rorosor dar| perggaourgar dua parur rap|o|d dar| ayar dar dar| |ou rerjad|
sualu oa|a| |rd|v|du oaru dergar jur|ar |rorosor d|p|o|d.
2. pererluar jer|s |e|ar|r oa|a| |rd|v|du oaru, lergarlurg dar| |rorosor X alau Y yarg d||ardurg sperra yarg
rerouar| ovur lerseoul.
3. perru|aar peroe|arar dar slad|ur-slad|ur peroerlu|ar dar per|eroargar eror|o (eror|ogeres|s)
PEHELAhAN | PERKEHANCAN AwAL EHR|0

Z|gol ru|a| rerja|ar| peroe|arar aWa| r|los|s sarpa| oeoerapa |a||. 3e|-se| yarg d|ras|||ar dar| sel|ap peroe|arar
oeru|urar |eo|r |ec|| dar| u|urar |rdu|rya, d|seoul o|aslorer.

3esudar 3-1 |a|| peroe|arar : z|gol rerasu|| l|rg|al 1 se|,
d|seoul slad|ur roru|a (||ra-||ra pada rar| |e-3 sarpa| |e-1
pascalerl|||sas|).
Voru|a lerd|r| dar| |rrer ce|| rass (|urpu|ar se|-se| d| seoe|ar
da|ar, yarg a|ar lurour rerjad| jar|rgar-jar|rgar eror|o
sarpa| jar|r) dar ouler ce|| rass (|ap|sar se| d| seoe|ar |uar,
yarg a|ar lurour rerjad| lroloo|as sarpa| p|aserla).

K|ra-||ra pada rar| |e-5 sarpa| |e-, d| rorgga se|a-se|a |rrer ce|| rass rereroes ca|rar rererous zora pe||uc|da,
reroerlu| ruarg arlar se|. Ruarg arlar se| |r| |erud|ar oersalu dar rererur| seoag|ar oesar rassa z|gol
reroerlu| rorgga o|aslo||sla. lrrer ce|| rass lelap oer|urpu| d| sa|ar salu s|s|, lelap oeroalasar dergar |ap|sar se|
|uar.
Pada slad|ur |r| z|gol d|seoul oerada da|ar slad|ur o|aslu|a alau peroerlu|ar o|aslo||sla.

lrrer ce|| rass |erud|ar d|seoul seoaga|
eror|oo|as, dar ouler ce|| rass |erud|ar
d|seoul seoaga| lroloo|as.
|HPLANTA8|

Pada a|r|r r|rggu perlara (rar| |e-5 sarpa|
|e-Z) z|gol rercapa| cavur uler|.

Pada saal |lu ulerus sedarg oerada da|ar lase
se|res| |erd|r d| oaWar pergarur progesleror
dar| |orpus |uleur yarg ras|r a|l|l. 3er|rgga
|ap|sar erdorelr|ur d|rd|rg rar|r rerjad|
|aya perou|ur darar dar oarya| ruara
|e|erjar se|apul |erd|r rar|r yarg lerou|a dar
a|l|l.

Korla| arlara z|gol slad|ur o|aslo||sla dergar
d|rd|rg rar|r pada |eadaar lerseoul a|ar
rercelus|ar oeroaga| rea|s| se|u|er, ser|rgga
se|-se| lrolooas z|gol lerseoul dapal rererpe|
dar rergada|ar |rl||lras| pada |ap|sar ep|le|
erdorelr|ur ulerus (lerjad| |rp|arlas|).

3ele|ar |rp|arlas|, se|-se| lroloo|as yarg lerlarar d| da|ar erdorelr|ur lerus oer|eroarg , reroerlu| jar|rgar
oersara dergar s|sler perou|ur darar ralerra| urlu| rerjad| PLA3ENTA, yarg |erud|ar oerlurgs| seoaga|
suroer rulr|s| dar o|s|geras| oag| jar|rgar eror|oo|as yarg a|ar lurour rerjad| jar|r.
P|asenta, Ta|| Pusat,
8e|aput Jan|n
dan 6a|ran Amn|on
Prof.dr. Abdu| ar| 8a|fudd|n | dr. Noroyono w|bowo
Ku||ah EHR|0L0C| | Anatom| Kedokteran
dr.0ordo 3. 0oza|| / dr. 3arloso 0urard|

3ele|ar r|rggu perlara (rar| Z-8), se|-se| lroloo|as yarg ler|ela| d| alas eror|oo|as yarg oer|rp|arlas| d|
erdorelr|ur d|rd|rg ulerus, rergada|ar pro||leras| dar oerd|lerers|as| rerjad| dua |ap|s yarg oeroeda :
1. s|lolroloo|as : lerd|r| dar| se|ap|s se| |uoo|d, oalas je|as, |rl| lurgga|, d| seoe|ar da|ar (de|al eror|oo|as)
2. s|rs|l|olroloo|as : lerd|r| dar| se|ap|s se| larpa oalas je|as, d| seoe|ar |uar (oerruourgar dergar slrora
erdorelr|ur).
ur|l lroloo|as |r| a|ar oer|eroarg rerjad| PLA3ENTA

0| arlara rassa eror|oo|as dergar |ap|sar s|lolroloo|as leroerlu| sualu ce|ar yarg ra||r |ara ra||r oesar, yarg
rarl|rya a|ar rerjad| R0N00A AVNl0N

3e|-se| eror|oo|as juga oerd|lerers|as| rerjad| dua |ap|s yarg
oeroeda :
1. ep|o|as : se|ap|s se| |o|urrar l|rgg|, d| oag|ar da|ar, oeroalasar
dergar oa|a| rorgga arr|or
2. r|poo|as : se|ap|s se| |uoo|d |ec||, d| oag|ar |uar, oeroalasar
dergar rorgga o|aslo||sla (oa|a| rorgga |ur|rg le|ur)
ur|l se|-se| o|asl |r| a|ar oer|eroarg rerjad| JANlN

Pada |uluo eror|ora|, se|-se| dar| r|poo|as reroerlu| se|apul l|p|s
yarg reroalas| oag|ar da|ar s|lolroloo|as (se|apul leuser).
3e|apul |r| oersara dergar r|poo|as reroerlu| d|rd|rg oa|a| yo||
sac (|ardurg |ur|rg le|ur). Rorgga yarg lerjad| d|seoul rorgga
e|sose|or (exocoe|or|c space) alau |ardurg |ur|rg le|ur
sederrara.
0ar| slru|lur-slru|lur lerseoul |erud|ar a|ar leroerlu| KAN0uN0
KuNlN0 TELuR, LEVPEN0 K0Rl0N dar R0N00A K0Rl0N.
Pada |o|as| oe|as |rp|arlas| o|aslo||sla d| perru|aar d|rd|rg
ulerus leroerlu| |ap|sar l|or|r seoaga| oag|ar dar| proses
peryerourar |u|a.

Jar|rgar erdorelr|ur d| se||lar o|aslo||sla yarg
oer|rp|arlas| rerga|ar| rea|s| des|dua, oerupa
r|perse|res|, per|rg|alar |era| dar g|||oger, serla
edera. 3e|arjulrya erdorelr|ur yarg oeruoar d| daerar-
daerar se||lar |rp|arlas| o|aslo||sla |lu d|seoul seoaga|
des|dua. Peruoarar |r| |erud|ar re|uas |e se|urur
oag|ar erdorelr|ur da|ar |avur uler| (se|arjulrya ||ral
oag|ar se|apul jar|r)
Pada slad|ur |r|, z|gol d|seoul oerada da|ar slad|ur
o||ar|rar (ca|rar oer|ap|s dua).

PLA8ENTA

Pembentukan p|asenta

Pada rar| 8-9, per|eroargar lroloo|as sargal cepal, dar|
se|ap|s se| lurour rerjad| oer|ap|s-|ap|s.
Teroerlu| rorgga-rorgga va|uo|a yarg oarya| pada |ap|sar
s|rs|l|olroloo|as (se|arjulrya d|seoul s|rs|l|ur) yarg a|r|rrya
sa||rg oerruourgar. 3lad|ur |r| d|seoul slad|ur oerorgga
(|acurar slage).

Perlurourar s|rs|l|ur |e da|ar slrora erdorelr|ur ra||r
da|ar |erud|ar lerjad| perusa|ar erdole| |ap||er d|
se||larrya, ser|rgga rorgga-rorgga s|rs|l|ur (s|sler |a|ura)
lerseoul d|a||r| rasu| o|er darar |ou, reroerlu| s|ruso|d-
s|ruso|d. Per|sl|Wa |r| rerjad| aWa| leroerlu|rya s|sler s|r|u|as| ulerop|aserla / s|sler s|r|u|as| lelo-ralerra|.

3ererlara |lu, d| arlara |ap|sar da|ar s|lolroloo|as dergar se|ap|s se| se|apul leuser, leroerlu| se|e|orpo| se| oaru
yarg oerasa| dar| lroloo|as dar reroerlu| jar|rgar peryarourg yarg |eroul, yarg d|seoul resoderr
e|slraeror|ora|.

8ag|ar yarg oeroalasar dergar s|lolroloo|as d|seoul
resoderr e|slraeror|ora| soralop|eura|, |erud|ar a|ar
rerjad| se|apul |or|or (cror|or|c p|ale).
8ag|ar yarg oeroalasar dergar se|apul leuser dar
rerulup| oa|a| yo|| sac d|seoul resoderr
e|slraeror|ora| sp|ar|rop|eura|.
Verje|arg a|r|r r|rggu |edua (rar| 13-11), se|urur
||rg|arar o|aslo||sla le|ar leroerar da|ar ulerus dar
d|||pul| perlurourar lroloo|as yarg le|ar d|a||r| darar |ou.
Ves|| der|||ar, rarya s|sler lroloo|as d| daerar de|al
eror|oo|as saja yarg oer|eroarg |eo|r a|l|l d|oard|rg|ar
daerar |a|rrya.

0| da|ar |ap|sar resoderr e|slraeror|ora| juga
leroerlu| ce|ar-ce|ar yarg ra||r |ara ra||r oesar dar
oersalu, ser|rgga lerjad||ar rorgga yarg rer|sar|ar
|ardurg |ur|rg le|ur ra||r jaur dar| s|lolroloo|as. Rorgga
|r| d|seoul rorgga se|or e|slraeror|ora| (exlraeroryora|
coe|or|c space) alau rorgga |or|or (cror|or|c space)

0| s|s| eror|oo|as (|uluo eror|ora|), larpa| se|-se| |uoo|d
|ap|sar s|lolroloo|as rergada|ar |rvas| |e arar |ap|sar
s|rs|l|ur, reroerlu| se|e|orpo| se| yarg d||e||||rg|
s|rs|l|ur d|seoul jorjol-jorjol pr|rer (pr|rary sler v||||). Jorjol
|r| rerarjarg sarpa| oerleru dergar a||rar darar |ou.
Pada aWa| r|rggu |el|ga, resoderr e|slraeror|ora|
soralop|eura| yarg lerdapal d| oaWar jorjol-jorjol pr|rer
(oag|ar dar| se|apul |or|or d| daerar |uluo eror|ora|), ||ul rerg|rvas| |e da|ar jorjol ser|rgga reroerlu| jorjol
se|urder (secordary sler v||||) yarg lerd|r| dar| |rl| resoderr d||ap|s| se|ap|s se| s|lolroloo|as dar s|rs|l|olroloo|as.

Verje|arg a|r|r r|rggu |el|ga, dergar |ara|ler|sl|| arg|oger|| yarg d|r|||||rya, resoderr da|ar jorjol lerseoul
oerd|lerers|as| rerjad| se| darar dar perou|ur |ap||er, ser|rgga jorjol yarg lad|rya rarya se|u|ar |erud|ar rerjad|
sualu jar|rgar vas|u|ar (d|seoul jorjol lers|er / lerl|ary sler v||||) (se|arjulrya ||ral oag|ar se|apul jar|r).

3e|or e|slraeror|ora| / rorgga |or|or ra||r |ara ra||r |uas, ser|rgga jar|rgar eror|ora| ra||r lerp|sar dar|
s|lolroloo|as / se|apul |or|or, rarya d|ruourg|ar o|er sed|||l jar|rgar resoderr yarg |erud|ar rerjad| larg|a|
pergruourg (correcl|rg sla||).
Vesoderr correcl|rg sla|| yarg juga rer||||| |erarpuar arg|oger||, |erud|ar a|ar oer|eroarg rerjad|
perou|ur darar dar correcl|rg sla|| lerseoul a|ar rerjad| TALl Pu3AT.

3ele|ar |rl||lras| perou|ur darar lroloo|as |e da|ar s|r|u|as| ulerus, se|r|rg dergar per|eroargar lroloo|as rerjad|
p|aserla deWasa, leroerlu||ar |orporer s|r|u|as| ulero-p|aserla.
Ve|a|u| perou|ur darar la|| pusal, s|r|u|as| ulero-p|aserla d|ruourg|ar dergar s|r|u|as| jar|r. Ves||pur der|||ar,
darar |ou dar darar jar|r lelap l|da| oercarpur rerjad| salu (d|seoul s|sler rerocror|a|), lelap lerp|sar o|er d|rd|rg
perou|ur darar jar|r dar |ap|sar |or|or.
0ergar der|||ar, |orporer s|r|u|as| dar| |ou (ralerra|) oerruourgar dergar |orporer s|r|u|as| dar| jar|r (lela|)
re|a|u| p|aserla dar la|| pusal. 3|sler lerseoul d|rara|ar s|r|u|as| lelo-ralerra|.

P|asenta "dewasa"

Perlurourar p|aserla ra||r |ara ra||r oesar
dar |uas, ururrya rercapa| peroerlu|ar
|erg|ap pada us|a |erar||ar se||lar 1 r|rggu.
(slru|lur p|aserla deWasa : garoar)

P|aserla deWasa / |erg|ap yarg rorra| :
1. oerlu| ourdar / ova|
2. d|areler 15-25 cr, leoa| 3-5 cr.
3. oeral rala-rala 500-00 g
1. |rsers| la|| pusal (lerpal oerruourgar
dergar p|aserla) dapal d| lergar / serlra||s, d|
sarp|rg / |alera||s, alau d| ujurg lep| /
rarg|ra||s.
5. d| s|s| |ou, larpa| daerar2 yarg aga| rerorjo| (|ol||edor) yarg d|||pul| se|apul l|p|s des|dua oasa||s.
. d| s|s| jar|r, larpa| sejur|ar arler| dar vera oesar (perou|ur |or|or) reruju la|| pusal. Kor|or d|||pul| o|er arr|or.
Z. s|r|u|as| darar |ou d| p|aserla se||lar 300 cc/rer|l (20 r|rggu) rer|rg|al sarpa| 00-Z00 cc/rer|l (alerr).

CATATAN : pada |erar||ar ru|l|pe| / |eroar, dapal lerjad| var|as| jur|ar dar u|urar p|aserla dar se|apul jar|r.

Fungs| p|asenta
PRlN3lP : Furgs| p|aserla ada|ar rerjar|r |er|dupar dar perlurourar jar|r yarg oa||.
1. Nulr|s| : reroer||ar oarar ra|arar pada jar|r
2. E|s|res| : rerga||r|ar |e|uar s|sa relaoo||sre jar|r
3. Resp|ras| : reroer||ar 02 dar rerge|uar|ar C02 jar|r
1. Erdo|r|r : rergras|||ar rorror-rorror : rC0, lPL, eslroger,progesleror, dar seoaga|rya (car| / oaca serd|r|).
5. lruro|og| : rerya|ur|ar oeroaga| |orporer arl|ood| |e jar|r
. Farra|o|og| : rerya|ur|ar ooal-ooalar yarg rurg||r d|per|u|ar jar|r, yarg d|oer||ar re|a|u| |ou.
Z. Prole|s| : oarr|er lerradap |rle|s| oa|ler| dar v|rus, zal-zal lo|s|| (lelap| a|r|r2 |r| d|ragu|ar, |arera pada
|eryalaarya jar|r sargal rudar lerpapar |rle|s| / |rlo|s||as| yarg d|a|ar| |ourya).
TAL| PU8AT

Vesoderr correcl|rg sla|| yarg juga rer|||||
|erarpuar arg|oger||, |erud|ar a|ar oer|eroarg
rerjad| perou|ur darar dar correcl|rg sla|| lerseoul
a|ar rerjad| TALl Pu3AT.

Pada larap aWa| per|eroargar, rorgga perul ras|r
ler|a|u |ec|| urlu| usus yarg oer|eroarg, ser|rgga
seoag|ar usus lerdesa| |e da|ar rorgga se|or
e|slraeror|ora| pada la|| pusal. Pada se||lar a|r|r ou|ar
|el|ga, perorjo|ar |erg|urg usus (|rlesl|ora| |oop) |r|
rasu| |eroa|| |e da|ar rorgga aodorer jar|r yarg
le|ar reroesar.

Kardurg |ur|rg le|ur (yo||-sac) dar larg|a| |ardurg
|ur|rg le|ur (duclus v|le|||rus) yarg ler|ela| da|ar
rorgga |or|or, yarg juga lerca|up da|ar correcl|rg
sla||, juga lerlulup oersaraar dergar proses sera||r oersalurya arr|or dergar |or|or.

3ele|ar slru|lur |erg|urg usus, |ardurg |ur|rg le|ur dar du|lus v|le|||rus rergr||arg, la|| pusal a|r|rrya rarya
rergardurg perou|ur darar uro||||a| (2 arler| uro||||a||s dar 1 vera uro||||a||s) yarg rergruourg|ar s|r|u|as|
jar|r dergar p|aserla.
Perou|ur darar uro||||a| |r| d|||pul| o|er ru|opo||sa|ar|da yarg d|seoul wrarlor's je||y.
8ELAPUT JAN|N (AHN|0N 0AN K0R|0N}

Pada r|rggu-r|rggu perlara per|eroargar, v|||| / jorjol
re||pul| se|urur ||rg|arar perru|aar |or|or.
0ergar oer|arjulrya |erar||ar :
1. jorjol pada |uluo eror|ora| reroerlu| slru|lur |or|or |eoal
seperl| sera|-sera| (cror|or lrordosur) sererlara
2. jorjol pada |uluo aoeror|ora| rerga|ar| degereras|,
rerjad| l|p|s dar ra|us d|seoul cror|or |aeve.

3e|urur jar|rgar erdorelr|ur yarg le|ar rerga|ar| rea|s|
des|dua, juga rercerr|r|ar peroedaar pada |uluo eror|ora|
dar aoeror|ora| :
1. des|dua d| alas |or|or lrordosur rerjad| des|dua oasa||s
2. des|dua yarg re||pul| eror|oo|as / |arlorg jar|r d| alas
|or|or |aeve rerjad| des|dua |apsu|ar|s.
3. des|dua d| s|s| / oag|ar ulerus yarg aoeror|ora| rerjad| des|dua par|ela||s.

Arlara rerorar |or|or dergar rerorar arr|or lerdapal rorgga |or|or. 0ergar oer|arjulrya |erar||ar, rorgga |r|
lerlulup a||oal persaluar rerorar arr|or dar rerorar |or|or. 3e|apul jar|r se|arjulrya d|seoul seoaga| rerorar
|or|or-arr|or (arr|ocror|or|c rerorare).
Kavur uler| juga ler|s| o|er |orseps| ser|rgga lerlulup o|er persaluar cror|or |aeve dergar des|dua par|ela||s.
6A|RAN AHN|0N

Rorgga yarg d|||pul| se|apul jar|r d|seoul seoaga| R0N00A AVNl0N.
0| da|ar ruargar |r| lerdapal ca|rar arr|or (|||uor arr||).

Asa| ca|rar arr|or : d|per||ra|ar lerulara d|se|res| o|er d|rd|rg se|apul arr|or / p|aserla, |erud|ar sele|ar s|sler
ur|rar|us jar|r leroerlu|, ur|re jar|r yarg d|produ|s| juga d||e|uar|ar |e da|ar rorgga arr|or.

Furgs| ca|rar arr|or :
1. Prole|s| : re||rdurg| jar|r lerradap lraura dar| |uar
2. Voo|||sas| : rerurg||r|ar ruarg gera| oag| jar|r
3. loreoslas|s : rerjaga |ese|roargar suru dar ||rg|urgar asar-oasa (pl) da|ar rorgga arr|or, urlu| suasara
||rg|urgar yarg opl|ra| oag| jar|r.
1. Ve|ar|| : rerjaga |ese|roargar le|arar da|ar se|urur ruargar |rlrauler|r (lerulara pada persa||rar).
5. Pada persa||rar : reroers|r|ar / re||c|r|ar ja|ar |ar|r, dergar ca|rar yarg sler||, ser|rgga re||rdurg| oay| dar|
|erurg||rar |rle|s| ja|ar |ar|r.

Keadaar rorra| ca|rar arr|or :
1. pada us|a |erar||ar cu|up ou|ar, vo|ure 1000-1500 cc.
2. |eadaar jerr|r aga| |erur
3. sler||
1. oau |ras, aga| rar|s dar ar|s
5. lerd|r| dar| 98-99 a|r, 1-2 garar-garar arorgar|| dar oarar orgar|| (prole|r lerulara a|our|r), rurlurar
raroul |arugo, verr|x caseosa dar se|-se| ep|le|.
. s|r|u|as| se||lar 500 cc/jar
Ke|a|nan jum|ah ca|ran amn|on
l|oramn|on {po||n|oramn|onj
a|r |eluoar oer|eo|rar, d| alas 2000 cc. 0apal rergarar|ar |ecur|gaar adarya |e|a|rar |orger|la| susurar saral
pusal alau s|sler percerraar, alau gargguar s|r|u|as|, alau r|pera|l|l|las s|ler ur|rar|us jar|r.
D||gon|oramn|on
a|r |eluoar sed|||l, d| oaWar 500 cc. ururrya |erla|, |erur, oerWarra |ur|rg |er|jauar.
Progros|s oag| jar|r ouru|.
Pertumbuhan dan
F|s|o|og| Jan|n
Prol.dr. Aodu| 8ar| 3a|ludd|r / Prol.dr.0u|ard| l. w||rjosaslro
Ku||ar EV8Rl0L00l / Aralor| Kedo|lerar
dr.0ordo 3. 0oza|| / dr. 3arloso 0urard|
0AFTAR |8T|LAh | 0EF|N|8|

Hoore, 1973 (w||||ars 0oslelr|cs, 19lr ed., 1993)

Z,gore
Tre ce|| lral resu|ls lror lre lerl|||zal|or ol lre ovur oy a sperralozoa.
3|asromeres
V|lol|c d|v|s|or ol lre zygole g|ves r|se lo daugrler ce||s ca||ed o|asloreres
Voru|a
Tre so||d oa|| ol ce||s lorred oy 1 or so o|aslorere ce||s
3|asroc,sr
Aller lre roru|a reacres lre uler|re cav|ly, a l|u|d-l|||ed cav|ly |s lorred, corverl|rg lre roru|a lo a o|aslocysl
Emor,o
Tre eroryo-lorr|rg ce||s, Wr|cr are grouped as ar |rrer ce|| rass, g|ve r|se lo lre eroryo, Wr|cr usua||y |s
des|graled Wrer lre o||ar|rar eroryor|c d|sc lorrs.
Emor,on|c per|oo
Tre eroryor|c per|od exlerds url|| lre erd ol lre severlr Wee|, al Wr|cr l|re lre rajor slruclures are preserl.
Ferus
Aller lre eroryor|c per|od, lre deve|op|rg corceplus |s relerred lo as lre lelus
0onceprus
Tr|s lerr |s used lo reler lo ALL l|ssue producls ol corcepl|or : lre eroryo / lelus, lela| rerorares, ard p|acerla.
3pec|l|ca||y, lre corceplus |rc|udes a|| l|ssues lral deve|op lror lre zygole, oolr eroryor|c ard exlraeroryor|c.
HA8A KEh|0UPAN |NTRAUTER|N HANU8|A 8E6ARA UHUH
0|AC| HENJA0| 0UA TAhAP | PER|00E

1. masa embr|ona|
Ve||pul| rasa perlurourar |rlrauler|r sarpa| dergar us|a |erar||ar 8 r|rggu, d| rara ovur yarg d|ouar| (zygole)
rergada|ar peroe|arar dar d|lerers|as| se|-se| rerjad| orgar-orgar yarg rarp|r |erg|ap sarpa| leroerlu| slru|lur
yarg a|ar oer|eroarg rerjad| oerlu| rarus|a. Proses peroerlu|ar orgar dar| l|da| ada rerjad| ada |r|
(orgarogeres|s) pada oeoerapa s|sler orgar, r|sa|rya s|sler s|r|u|as|, oer|arjul lerus sarpa| r|rggu |e-12,
ser|rgga oeoerapa suroer rerg||as|l||as||ar perlurourar rasa eror|ora| sarpa| dergar r|rggu |e-12 (lr|resler
perlara |erar||ar).
2. masa feta|
Ve||pul| rasa perlurourar |rlrauler|r arlara us|a |erar||ar r|rggu |e 8-12 sarpa| dergar se||lar r|rggu |e-10
(pada |erar||ar rorra| / alerr), d| rara orgar|sre yarg le|ar rer||||| slru|lur |erg|ap lerseoul re|arjul|ar
perlurourar dar per|eroargar yarg pesal, sarpa| pada |eadaar yarg rerurg||r|ar urlu| r|dup dar oerlurgs|
d| dur|a |uar (e|slrauler|r).
PER|8T|wA-PER|8T|wA PENT|NC PA0A PERTUHUhAN F|8|K

Peroag|ar per|ode : Tr|resler perlara - |edua
- |el|ga

TR|HE8TER PERTAHA

H|nggu pertama
0|seoul seoaga| rasa gerr|ra|. Kara|ler|sl||
ulara rasa gerr|ra| |r| ada|ar peroe|arar
se|.
3eja| perouarar / lerl|||sas| ovur o|er sperra, z|gol yarg leroerlu| reroe|ar d|r| sarpa| lase roru|a - o|aslu|a.
Verje|arg a|r|r r|rggu perlara lerjad| |rp|arlas| d| erdorelr|ur |avur uler|.

H|nggu kedua
Terjad| d|lerers|as| rassa se|u|ar eror|o rerjad| dua
|ap|s (slad|ur o||ar|rer). Kedua |ap|sar |lu |a|ar
|erperg ep|o|as (a|ar rerjad| e|loderr) dar
r|poo|as (a|ar rerjad| erdoderr).
A|r|r slad|ur o||ar|rer d|larda| rurcu|rya a|ur
pr|r|l|l / a|ur sederrara (pr|r|l|ve slrea|).

H|nggu ket|ga
Terjad| peroerlu|ar l|ga |ap|s / |erperg ya|lu e|loderr dar
erdoderr dergar peryusupar |ap|sar resoderr d| arlararya,
d|aWa|| dar| daerar pr|r|l|ve slrea|. Eror|o d|seoul oerada
da|ar slad|ur l|ga |ap|s (slad|ur lr||ar|rer).
0ar| per|eroargar pr|r|l|ve slrea| leroerlu| |erperg saral
(reura| p|ale) dar rerjad| ||palar saral (reura| lo|d) d| oag|ar |rar|a|. 3lru|lur |r| |erud|ar oer|eroarg rerjad| a|ur
saral (reura| groove) dar rarl|rya a|ar rerjad| laourg saral (reura| luoe).

H|nggu keempat
Pada a|r|r r|rggu |e-3 / aWa| r|rggu |e-1, ru|a| leroerlu| ruas-ruas oadar (sor|l) seoaga| |ara|ler|sl||
perlurourar per|ode |r|.

8ampa| m|nggu ke-8 -12 (akh|r tr|mester pertama}
Perlurourar dar d|lerers|as| sor|l lerjad| oeg|lu cepal, sarpa| dergar a|r|r r|rggu |e-8 leroerlu| 30-35 sor|l,
d|serla| dergar per|eroargar oeroaga| |ara|ler|sl|| l|s|| |a|rrya (laoe|).
8eoerapa s|sler orgar re|arjul|ar peroerlu|ar aWa|rya sarpa| dergar a|r|r r|rggu |e-12 (lr|resler perlara).

TR|HE8TER KE0UA

H|nggu ke-12 sampa| m|nggu ke-28
Kara|ler|sl|| ulara per|eroargar
|rlrauler|r pada lr|resler |edua ada|ar
peryerpurraar slru|lur orgar urur dar
ru|a| oerlurgs|rya oeroaga| s|sler
orgar.
8|stem s|rku|as|
Jar|r ru|a| rerurju||ar adarya a|l|l|las
deryul jarlurg dar a||rar darar. 0ergar
a|al lela| e|o|ard|ogral|, deryul jarlurg dapal d|leru|ar seja| r|rggu |e-12. 0ergar slelos|op Laerrec deryul
jarlurg oaru dapal lerdergar sele|ar |erar||ar 20 r|rggu.

Ada oeoerapa slru|lur aralor|| yarg lerdapal pada rasa jar|r |erud|ar lerlulup / rerga|ar| regres| sesudar |ar|r
sarpa| deWasa, ya|lu : lorarer ova|e, du|lus arler|osus 8ola|||, arler|a dar vera uro||||a||s, dar du|lus verosus
Ararl||.

3e| darar jar|r lerulara rergardurg rerog|oo|r jer|s lela| (loF), yarg rer||||| daya ||al o|s|ger jaur |eo|r l|rgg|
d|oard|rg|ar dar|pada rerog|oo|r rarus|a deWasa (loA) pada suru dar pl yarg sara. lerog|oo|r A serd|r| oaru
d|produ|s| pada a|r|r rasa lela|, dar pada saal |ar|r, jur|arrya rercapa| rarya se||lar 30 dar| se|urur rerog|oo|r
yarg ler|ardurg da|ar reoralus. Pada |er|dupar e|slrauler|r, oerargsur-argsur produ|s| loF oer|urarg sarpa|
a|r|rrya rorra| l|da| lerdapal |ag| da|ar luour |rd|v|du.

8|stem resp|ras|
Jar|r ru|a| rerurju||ar gera| perrapasar seja| us|a se||lar 18 r|rggu. Per|eroargar slru|lur a|veo|| paru serd|r|
oaru serpurra pada us|a 21-2 r|rggu. 3urla|lar ru|a| d|produ|s| seja| r|rggu |e-20, lelap| jur|ar dar
|ors|slers|rya sargal r|r|ra| dar oaru ade|ual urlu| surv|va| e|slrauler|r pada a|r|r lr|resler |el|ga.
A||rar |e|uar-rasu| yarg lerjad| pada perrapasar jar|r |rlrauler|r ou|ar|ar a||rar udara, lelap| a||rar ca|rar arr|or.
3e|urur slru|lur sa|urar rapas jar|r sarpa| a|veo|us lererdar da|ar ca|rar arr|or lerseoul.

8|stem gastro|ntest|na|
Jar|r ru|a| rerurju||ar a|l|l|las gera|ar rere|ar seja| us|a geslas| 11 r|rggu. 0era|ar rergr|sap a|l|l larpa|
pada 2-28 r|rggu.
Ca|rar erpedu ru|a| d|produ|s| seja| a|r|r lr|resler perlara, d|||ul| dergar se|urur erz|r-erz|r percerraar
|a|rrya.
Ve|or|ur, |s| yarg lerulara pada sa|urar percerraar jar|r, larpa| ru|a| us|a 1 r|rggu. Ve|or|ur oerasa| dar| :
1) se|-se| ru|osa d|rd|rg sa|urar cerra yarg rerga|ar| des|uaras| dar rorlo|, 2) ca|rar / erz|r yarg d|se|res|
separjarg sa|urar cerra, ru|a| dar| sa||va sarpa| erz|r-erz|r percerraar, dar 3) ca|rar arr|or yarg d|r|rur
o|er jar|r, yarg |adarg-|adarg rergardurg juga |arugo (raroul-raroul ra|us dar| |u||l jar|r yarg rorlo|) dar se|-
se| dar| |u||l jar|r / rerorar arr|or yarg rorlo|.
0|s|geras| jar|r lerulara lelap oerasa| dar| s|r|u|as| ralerra|-lela|, re|a|u| p|aserla dar la|| pusal. (||ral |u||ar
p|aserla dar la|| pusal)

8|stem saraf dan neuromusku|ar
lr| rerupa|ar s|sler yarg pa||rg aWa| ru|a| rerurju||ar a|l|l|lasrya, ya|lu seja| us|a 8-12 r|rggu (a|r|r lr|resler
perlara), oerupa |orlra|s| olol yarg l|rou| j||a lerjad| sl|ru|as| |o|a|. 3eja| us|a 9 r|rggu, jar|r rarpu rergada|ar
l|e|s| a|al-a|al gera|, dergar rel|e|s-rel|e|s dasar yarg sargal sederrara (l|e|s| salu s|s| d|||ul| juga l|e|s| s|s|
|a|rrya). Terjad| juga oeroaga| gera|ar sporlar (sporlareous rovererl). Narur u|urar jar|r pada a|r|r lr|resler
perlara |r| ras|r |ec||, ser|rgga gera|ar-gera|ar jar|r oe|ur dapal d|rasa|ar o|er |ourya.
3eja| us|a 13-11 r|rggu (aWa| lr|resler |edua), gera|ar-gera|ar jar|r oaru ru|a| dapal d|rasa|ar |ourya.
Terdapal lu8uN0AN arlara |eadaar eros|ora| |ou dergar l|rg|al a|l|l|las jar|r (r|sa|rya, pada |eadaar |ou
rarar alau gero|ra, gera| jar|r |eo|r ser|rg dar |ual, seoa|||rya Wa|lu |ou sed|r alau depres| alau |ela|ular, gera|
jar|r |eo|r sed|||l dar |erar). la| |r| d|seoao|ar o|er pergarur var|as| |adar rorror adrera||r |ou yarg juga
d|lrarsler |e jar|r re|a|u| s|r|u|as| p|aserla.

8|stem saraf sensor|k khusus | |ndera
Vala yarg lerd|r| dar| |erg|urg oa|a| |ersa (|ers p|acode) dar oa|a| oo|a rala / rarg|u| opl|| (opl|c cup) pada
aWa|rya rergradap |e |alera|, |erud|ar oeruoar |ela|rya |e perru|aar verlra| Wajar. 3aral perg||ralar / rervus
opl||us rerupa|ar der|val e|loderr, rerasu|| oo|a rala dar| oag|ar posler|or.
Te||rga yarg oerasa| dar| ves||e| ol|| (ol|c ves|c|es) oergeser |e s|s| |alera| |epa|a, rererpal| lerpalrya yarg lelap.
Te||rga |uar rerpero|er |rervas| sersor|| dar| rervus lac|a||s, le||rga da|ar (orgar perdergarar dar |ese|roargar)
rerpero|er |rervas| dar| der|val e|loderr rervus vesl|ou|o|o||ear|s.
l|durg yarg oerasa| dar| oa|a| o|la|lor|| (o|laclory p|acode) rerupa|ar pereoa|ar e|loderr perru|aar d| daerar
Wajar, rerpero|er |rervas| sersor|| dar| rervus o|la|lor|us.
L|dar oerasa| dar| |erg|urg lar|rg dar| erdoderr, |erud|ar rerpero|er |rervas| sersor|| dar| caoarg rervus
lr|ger|rus dar rervus lac|a||s, serla |rervas| rolor|| dar| rervus r|pog|osus dar rervus |aryrgeus super|or.

8|stem ur|nar|us
0|oreru|us g|rja| ru|a| leroerlu| seja| urur 8 r|rggu. Pada |erar||ar 20 r|rggu jur|ar g|oreru|us d|per||ra|ar
rercapa| 300-100 r|ou.
0|rja| ru|a| oerlurgs| seja| aWa| lr|resler |edua, dar d| da|ar ves|ca ur|rar|a dapal d|leru|ar ur|re jar|r, yarg
|e|uar re|a|u| urelra dar oercarpur dergar ca|rar arr|or. Produ|s| ur|re ||ra-||ra 0.05-0.10 cc/rer|l.
0|rja| oe|ur seperurrya oerlurgs|, oa|| lurgs| l||lras| raupur e|s|res|, |arera vas|u|ar|sas| juga re|al|l ras|r sed|||l.

8|stem endokr|n
Korl||olrop|r dar l|rolrop|r ru|a| d|produ|s| d| r|pol|s|s jar|r seja| us|a 10 r|rggu, ru|a| oerlurgs| urlu| rerargsarg
per|eroargar |e|erjar suprarera| dar |e|erjar l|ro|d.
3ele|ar |e|erjar-|e|erjar lerseoul oer|eroarg, produ|s| dar se|res| rorror-rorrorrya juga ru|a| oer|argsurg.
lorror-rorror ralerra| raupur rorror-rorror p|aserla juga d|d|slr|ous||ar da|ar jur|ar oesar |e da|ar
s|r|u|as| jar|r, dar a|l|l|lasrya juga rerpergarur| perlurourar jar|r, |eo|r dar|pada rorror yarg d|produ|s| jar|r
|lu serd|r| (corlor |asus : pada jar|r arersela|us, perlurourar oadar lelap oer|argsurg dergar oa||, padara|
jar|rgar r|pol|s|s oay| lerseoul sargal |ec|| dar peroerlu|arrya serd|r| lergarggu).
Ke|erjar-|e|erjar reprodu|s| pr|a (lesl|s) juga rergras|||ar leslosleror dar ardroslered|or, rarur pada War|la
(ovar|ur) l|da| d|leru|ar se|res| eslroger dar progesleror, |erurg||rar |arera oe|ur lerjad| peralargar le|a dar
graru|osa lo|||e| |eo|r |arjul.

Perubahan set|ap bu|an
1. 8u|ar |el|ga : Wajar leroerlu| ra||r serpurra, |ela| orgar-orgar Wajar sesua| lerpalrya. A|al |e|ar|r |uar
oer|eroarg. Lerg|urg usus yarg lerdesa| |e arar la|| pusal |eroa|| lerca|up da|ar rorgga aodorer. Vu|a|
lerdele|s| gera|ar olol / rel|e|s gera| sederrara, lelap| oe|ur sarpa| rer|rou||ar sersas| pada |ou. Pada a|r|r
r|rggu |e-12, jer|s |e|ar|r lelus ururrya sudar dapal d||derl|l||as| re|a|u| perer||saar u|lrasorogral|.
2. 8u|ar |eerpal-|e||ra : luour jar|r rerarjarg dergar cepal, perlaroarar oeral rercapa| 500 g. Turour
raroul-raroul ra|us (|arugo), raroul |epa|a, a||s dar ou|u rala. 0era|ar jar|r ru|a| dapal d|rasa|ar o|er |ou.
3. 8u|ar |eerar-|elujur : oeral oadar oerlaroar oarya|, sarpa| dergar separur oeral jar|r pada |erar||ar alerr.
Ku||l |ererarar dar |er|pul |arera oe|ur leroerlu|rya jar|rgar ||al suo|ul|s. 3usurar saral pusal, |ard|ovas|u|ar
dar perrapasar oe|ur oerlurgs| serpurra dar d|arlara |el|garya oe|ur dapal oer|oord|ras| oa||, ser|rgga j||a
jar|r |ar|r pada per|ode |r| l|da| a|ar dapal oerlarar r|dup.
TR|HE8TER KET|CA

H|nggu ke-28 sampa| dengan m|nggu ke 38-42
Kara|ler|sl|| ulara per|eroargar |rlrauler|r pada lr|resler |el|ga ada|ar peryerpurraar slru|lur orgar |rusus /
dela|| dar peryerpurraar lurgs| oeroaga| s|sler orgar.

3alu |ara|ler|sl|| per|eroargar a|r|r rasa jar|r ada|ar
per|aroalar perlurourar |epa|a re|al|l lerradap perurourar
oadar.
Pada aWa| ou|ar |e-3, u|urar |epa|a rerupa|ar separur u|urar
|epa|a-oo|org (croWr-rurp |erglr / CRL), lelap| seja| aWa| ou|ar
|e-5, u|urar |epa|a re|al|l oer|urarg rerjad| seperl|ga dar| CRL,
sarpa| pada saal |ar|r u|urar |epa|a rarya sepererpal dar| CRL.
la| |r| d|seoao|ar per|rg|alar perlurourar oadar dar
e|slrer|las, oersara dergar perururar perlurourar |epa|a.

Perubahan set|ap bu|an
1. 8u|ar |elujur-|ede|apar : erdapar |era| suo|ul|s rer|rg|al, ser|rgga jar|r rerpero|er oerlu| rerou|al /
rerggeru|. Produ|s| |e|erjar |era| |u||l juga rergras|||ar |ap|sar verr|x caseosa yarg re|ap|s| |u||l jar|r. 3eja|
us|a 28 r|rggu |erg|ap, le|ar leroerlu| |oord|ras| arlara s|sler saral pusal, perrapasar dar |ard|ovas|u|ar,
res||pur ras|r sargal r|r|ra|. Jar|r yarg |ar|r pada rasa |r| dapal oerlarar r|dup, rarur d|per|u|ar lurjargar
r|dup oerupa peraWalar |rlers|l yarg sargal oa|| urlu| rercapa| ras|| opl|ra|.
2. 8u|ar |esero||ar : perlurourar |epa|a ra|s|ra|, ||rg|ar |epa|a rerjad| ||rg|ar leroesar dar|pada se|urur oag|ar
luour. Pada oay| |a||-|a||, lesl|s ru|a| lurur |e lerpalrya d| da|ar s|rolur.
3. 3aal |ar|r : lerjad| re|ar|sre adaplas| oeroaga| slru|lur jar|r. 0| arlararya, paru yarg seru|a |o|aps |arera
oe|ur ler|s| udara, seja| |ar|r rerjad| rergeroarg |arera ler|s| udara perrapasar. 8eroaga| slru|lur da|ar s|sler
|ard|ovas|u|ar rerulup. 3eja| la|| pusal d|pulus|ar, s|r|u|as| lelo-ralerra| re|a|u| p|aserla dar perou|ur uro||||a||s
lerpulus, dar oay| lerp|sar dar| s|r|u|as| |ourya.
0araran oar| /ouo .
|n| nan,a RlhSr/$/h oar| cararan ku||an ,ang aoa, o|ramoan seo|k|r gamoar2 oar| kepusrakaan.
0era|| perrumounan / perkemoangan |nrraurer|n r|oak o|muar o| s|n| se|urunn,a.
unruk na|2 oera||, reman2 o|anurkan unruk oaca uga ouku Emor|o|og| reookreran langman - |engkap run.
Perubahan Anatom| dan
F|s|o|og| wan|ta ham||
0r. h. Jun|zaf | 0r. h.H. 8oepard|man
TERJA0|NYA KEhAH|LAN

Per|sl|Wa pr|rs|p pada lerjad|rya |erar||ar :
1. Perouarar / lerl|||sas| : oerlerurya se| le|ur / ovur War|la dergar se| oer|r / sperralozoa pr|a.
2. Peroe|arar se| (z|gol).ras|| perouarar lerseoul.
3. N|das| / |rp|arlas| z|gol lerseoul pada d|rd|rg sa|urar reprodu|s| (pada |eadaar rorra| : |rp|arlas| pada |ap|sar
erdorelr|ur d|rd|rg |avur uler|).
1. Perlurourar dar per|eroargar z|gol - eror|o - jar|r rerjad| oa|a| |rd|v|du oaru.

Kerar||ar d|pergarur| oeroaga| rorror : eslroger, progesleror, rurar cror|or|c goradolrop|r, rurar
soralorarrolrop|r, pro|a|l|r dso.

lurar Cror|or|c 0oradolrop|r (rC0) ada|ar rorror a|l|l
|rusus yarg oerperar se|ara aWa| rasa |erar||ar,
oerl|u|luas| |adarrya se|ara |erar||ar.

Terjad| peruoarar juga pada aralor| dar l|s|o|og| orgar-
orgar s|sler reprodu|s|
0AN orgar-orgar s|sler luour |a|rrya, yarg d|pergarur| lerulara o|er
peruoarar |ese|roargar rorrora| lerseoul.
PERUAhAN PA0A 0RCAN-0RCAN 8|8TEH REPR00UK8|

Uterus
Turour reroesar pr|rer, raupur se|urder a||oal perlurourar |s| |orseps|
|rlrauler|r. Eslroger reryeoao|ar r|perp|as| jar|rgar, progesleror oerperar
urlu| e|asl|s|las / |e|erlurar ulerus.
Ta|s|rar |asar peroesarar ulerus pada peraoaar l|rgg| lurdus :
- l|da| rar|| / rorra| : seoesar le|ur ayar ( 30 g)
- |erar||ar 8 r|rggu : le|ur oeoe|
- |erar||ar 12 r|rggu : le|ur argsa
- |erar||ar 1 r|rggu : perlergarar s|rl|s|s-pusal
- |erar||ar 20 r|rggu : p|rgg|r oaWar pusal
- |erar||ar 21 r|rggu : p|rgg|r alas pusal
- |erar||ar 28 r|rggu : seperl|ga pusal-xypro|d
- |erar||ar 32 r|rggu : perlergarar pusal-xypro|d
- 3-12 r|rggu : 3 sarpa| 1 jar| oaWar xypro|d
lsrus uler|, oag|ar dar| serv||s, oalas aralor|| rerjad| su||l d|lerlu|ar, pada |erar||ar lr|resler l rerarjarg dar
|eo|r |ual. Pada |erar||ar 1 r|rggu rerjad| salu oag|ar dergar |orpus, dar pada |erar||ar a|r|r d| alas 32
r|rggu rerjad| segrer oaWar ulerus. vas|u|ar|sas| sed|||l, |ap|s rus|u|ar l|p|s, rudar ruplur, |orlra|s| r|r|ra| ->
oeroaraya j||a |erar, dapal ruplur, rergarcar ryaWa jar|r dar ryaWa |ou.
3erv||s uler| rerga|ar| r|pervas|u|ar|sas| a||oal sl|ru|as| eslroger dar per|ura|ar a||oal progesleror (-> larda
legar), Warra rerjad| ||v|de / |eo|ruar.
3e|res| |erd|r serv||s rer|rg|al pada |erar||ar reroer||ar geja|a |epul|rar.

Vag|na | vu|va
Terjad| r|pervas|u|ar|sas| a||oal pergarur eslroger dar progesleror, Warra rerar |eo|ruar (larda CradW|c|).

0var|um
3eja| |erar||ar 1 r|rggu, lurgs| d|aro|| a||r o|er p|aserla, lerulara lurgs| produ|s| progesleror dar eslroger.
3e|ara |erar||ar ovar|ur lerarg/oer|sl|raral. T|da| lerjad| peroerlu|ar dar peralargar lo|||e| oaru, l|da| lerjad|
ovu|as|, l|da| lerjad| s|||us rorrora| rerslruas|.

Payudara
A||oal pergarur eslroger lerjad| r|perp|as|a s|sler du|lus dar jar|rgar |rlersl|s|a| payudara. lorror |a|loger||
p|aserla (d|arlararya soralorarrolrop|r) reryeoao|ar r|perlrol| dar perlaroarar se|-se| as|rus payudara, serla
rer|rg|al|ar produ|s| zal-zal |ase|r, |a|loa|our|r, |a|log|oou||r, se|-se| |era|, |o|oslrur. Varrae reroesar dar
legarg, lerjad| r|perp|grerlas| |u||l serla r|perlrol| |e|erjar Vorlgorery, lerulara daerar areo|a dar pap|||a a||oal
pergarur re|arolor. Pul|rg susu reroesar dar rerorjo|. (oeoerapa |epusla|aar l|da| rerasu||ar payudara
da|ar s|sler reprodu|s| War|la yarg d|pe|ajar| da|ar g|re|o|og|)
PEN|NCKATAN ERAT A0AN 8ELAHA hAH|L

Norra| oeral oadar rer|rg|al se||lar -1 |g,
lerulara dar| perlurourar |s| |orseps| dar vo|ure
oeroaga| orgar / ca|rar |rlrauler|r.

8eral jar|r 2.5-3.5 |g, oeral p|aserla 0.5 |g, ca|rar
arr|or 1.0 |g, oeral ulerus 1.0 |g, peraroarar
vo|ure s|r|u|as| ralerra| 1.5 |g, perlurourar
rarrae 1 |g, perurpu|ar ca|rar |rlersl|s|a| d|
pe|v|s dar e|slrer|las 1.0-1.5 |g.
PERUAhAN PA0A 0RCAN-0RCAN 8|8TEH TUUh LA|NNYA

(oaca juga calalar |u||ar aresles|o|og| - |urayar |erg|ap lur)

8|stem resp|ras|
Keoulurar o|s|ger rer|rg|al sarpa| 20, se|a|r |lu d|alragra juga lerdororg |e |rar|a| -> lerjad| r|perverl||as|
darg|a| (20-21x/rer|l) a||oal |orp||ars| dada (cresl corp||arce) rerurur. vo|ure l|da| rer|rg|al. vo|ure res|du
paru (lurcl|ora| res|dua| capac|ly) rerurur. Kapas|las v|la| rerurur.

Eslroger dar rC0 rer|rg|al dergar ele| sarp|rg rua| dar rurlar-rurlar, se|a|r |lu lerjad| juga peruoarar
per|sla|l|| dergar geja|a ser|rg |erourg, |orsl|pas|, |eo|r ser|rg |apar / perasaar |rg|r ra|ar lerus (rerg|dar), juga
a||oal per|rg|alar asar |arourg. Pada |eadaar palo|og|| lerlerlu dapal lerjad| rurlar-rurlar oarya| sarpa| |eo|r
dar| 10 |a|| per rar| (r|pereres|s grav|darur).

8|stem s|rku|as| | kard|ovasku|ar
(oaca juga |u||ar |e|a|rar jarlurg |u||ar aresles|o|og|)
Peruoarar l|s|o|og| pada |erar||ar rorra|, yarg lerulara ada|ar peruoarar lEV00lNAVlK ralerra|, re||pul| :
- relers| ca|rar, oerlaroarrya oeoar vo|ure dar curar jarlurg
- arer|a re|al|l
- a||oal pergarur rorror, lararar per|ler vas|u|ar rerurur
- le|arar darar arler|a| rerurur
- curar jarlurg oerlaroar 30-50, ra|s|ra| a|r|r lr|resler l, rerelap sarpa| a|r|r |erar||ar
- vo|ure darar ralerra| |ese|ururar oerlaroar sarpa| 50
- vo|ure p|asra oerlaroar |eo|r cepal pada aWa| |erar||ar,
|erud|ar oerlaroar secara per|arar sarpa| a|r|r
|erar||ar
Pada lr|resler perlara, lerjad| :
- peraroarar curar jarlurg, vo|ure p|asra dar vo|ure ca|rar e|slrase|u|ar, d|serla| per|rg|alar a||rar p|asra
g|rja| dar |aju l||lras| g|oreru|us
- peraroarar / relers| a|r dar ralr|ur yarg dapal d|lu|ar d| da|ar luour, per|rg|alar T8w / lola| oody Waler
- a||oalrya lerjad| a|l|las| s|sler rer|r-arg|olers|r dar perururar aroarg osrol|| urlu| pe|epasar red|alor
vasopres|r dar sl|ru|as| daraga.
- a||oalrya pu|a lerjad| perururar |orserlras| ralr|ur da|ar p|asra dar perururar osro|a||las p|asra, ser|rgga
lerjad| edera pada 80 War|la yarg rar||.
Terjad| per|rg|alar vo|ure p|asra sarpa| 25-15, dergar jur|ar er|lros|l rer|rg|al rarya sed|||l (|adar
rerog|oo|r rerurur a||oal arer|a re|al|l). Card|ac oulpul rer|rg|al sarpa| 20-10. Res|slers| per|ler juga
rerurur, ser|rg larpa| seoaga| var|sces lurg|a|. Leu|os|l rer|rg|al sarpa| 15.000/rr3, a||oal rea|s| arl|ger-
arl||ood| l|s|o|og|| yarg lerjad| pada |erar||ar. lrle|s| d|cur|ga| o||a |eu|os|l re|eo|r| 15.000/rr3. Troroos|l
rer|rg|al sarpa| 300.000-00.000/rr3, lroroop|asl|r perl|rg urlu| reroslas|s yarg oa|| pada |erar||ar dar
persa||rar. F|or|roger juga rer|rg|al 350-Z50 rg/d| (rorra| 250-350 rg/d|). Laju erdap darar rer|rg|al. Prole|r
lola| rer|rg|al, rarur ras|o a|our|r-g|oou||r rerururr |arera lerjad| perururar a|our|r a|la-1, a|la-2 dar oela
d|||ul| per|rg|alar g|oou||r a|la-1, a|la-2 dar oela. Fa|lor-la|lor peroe|uar rer|rg|al.

Hetabo||sme
8asa| relaoo||c rale rer|rg|al sarpa| 15, lerjad| juga r|perlrol| l|ro|d. Keoulurar |aroor|dral rer|rg|al sarpa|
2300 |a|/rar| (rar||) dar 2800 |a|/rar| (reryusu|). Keoulurar prole|r 1 g/|goo/rar| urlu| rerurjarg perlurourar
jar|r. Kadar |o|eslero| p|asra rer|rg|al sarpa| 300 g/100r|. Keoulurar |a|s|ur, loslor, ragres|ur, cuprur
rer|rg|al. Ferrur d|oulur|ar sarpa| |adar 800 rg, urlu| peroerlu|ar rerog|oo|r laroarar.
(oaca juga |u||ar d|aoeles re|||lus)
Krusus urlu| relaoo||sre |aroor|dral, pada |erar||ar rorra|, lerjad| |adar g|u|osa p|asra |ou yarg |eo|r rerdar
secara oerra|ra |arera :
- aro||ar g|u|osa s|r|u|as| p|aserla rer|rg|al,
- produ|s| g|u|osa dar| ral| rerurur
- produ|s| a|ar|r (sa|ar salu pre|ursor g|u|oreogeres|s) rerurur
- a|l|l|las e|s|res| g|rja| rer|rg|al
- ele| rorror-rorror geslas|ora| (rurar p|acerla| |acloger, rorror2 p|aserla |a|rrya, rorror2 ovar|ur, r|pol|s|s,
par|reas, adrera|, groWlr laclors, dso).
3e|a|r |lu lerjad| juga peruoarar relaoo||sre |era| dar asar ar|ro. Terjad| juga per|rg|alar a|l|l|las erz|r-erz|r
relaoo||sre pada ururrya.

Traktus ur|nar|us
ureler reroesar, lorus olol-olol sa|urar |er|r rerururr a||oal pergarur eslroger dar progesleror. Kerc|rg |eo|r
ser|rg (po||ur|a), |aju l||lras| rer|rg|al sarpa| 0-150. 0|rd|rg sa|urar |er|r dapal lerle|ar o|er peroesarar
ulerus, reryeoao|ar r|droureler dar rurg||r r|drorelros|s sererlara.
Kadar |real|r|r, urea dar asar ural da|ar darar rurg||r rerurur rarur ra| |r| d|arggap rorra|.

Ku||t
Per|rg|alar a|l|l|las re|aroprore sl|ru|al|rg rorror reryeoao|ar peruoarar oerupa r|perp|grerlas| pada Wajar
(||oasra grav|darur), payudara, ||rea a|oa (-> ||rea gr|sea), slr|ae ||v|dae pada perul, dso.

Perubahan Ps|k|s
3||ap / perer|raar |ou lerradap |eadaar rar||rya, sargal rerpergarur| juga |eseralar / |eadaar urur |ou serla
|eadaar jar|r da|ar |erar||arrya.
ururrya |erar||ar yarg d||rg|r|ar a|ar d|saroul dergar s||ap gero|ra, d||r|rg| dergar po|a ra|ar, peraWalar
luour dar upaya rerer||sa|ar d|r| secara leralur dergar oa||. Kadarg l|rou| geja|a yarg |az|r d|seoul rg|dar,
ya|lu |e|rg|rar lerradap ra|-ra| lerlerlu yarg l|da| seperl| o|asarya (r|sa|rya jer|s ra|arar lerlerlu, lap| rurg||r
juga ra|-ra| |a|r)
Telap| |erar||ar yarg l|da| d||rg|r|ar, |erurg||rar a|ar d|saroul dergar s||ap yarg l|da| rerdu|urg, rapsu
ra|ar rerurur, l|da| rau rerer||sa|ar d|r| secara leralur, oar|ar |adarg juga |ou sarpa| re|a|u|ar usara-
usara urlu| rerggugur|ar |ardurgarrya.
0|ACN08T|K KEhAH|LAN

8erdasar|ar peruoarar-peruoarar aralor|| dar l|s|o|og||, dapal d||urpu||ar ra|-ra| yarg rurg||r oerra|ra pada
perer||saar l|s|s raupur perurjarg, urlu| reruju pada d|agros|s |erar||ar.

Ceja|a dan tanda yang dapat
mengarahkan d|agnos|s adanya
suatu keham||an :
1. arerorea (seoerarrya
oerra|ra j||a 3 ou|ar alau |eo|r)
2. peroesarar ulerus (larpa|
d|serla| peroesarar perul, alau
pada |erar||ar ruda d|per||sa
dergar pa|pas|)
3. adarya |orlra|s| ulerus pada
pa|pas| (8raxlor-l|c|s)
1. leraoa/lerasa gera|ar jar|r pada
pa|pas| alau larpa| pada |rag|rg.
8a||olererl (). J||a (-) cur|ga ro|a
r|dal|dosa.
5. lerdergar jarlurg jar|r (dergar
a|al Laerrec/ 0opp|er) alau v|sua|
larpa| jarlurg oerderyul pada
|rag|rg (lela| u|lrasourd
ecroscopy).
. leraoa oag|ar luour jar|r pada
pa|pas| (Leopo|d) alau larpa| pada |rag|rg (u|lrasorogral|)
Z. peruoarar serv||s ulerus (CradW|c| / legar s|gr)
8. |urva suru oadar rer|rg|al
9. les ur|re 8-rC0 (Pac|'s lesl / 0a|||Va|r|r|) pos|l|l. lal|-ral| |arera pos|l|l pa|su dapal juga lerjad| r|sa| |arera ur|re
|olor, a|al |ada|uWarsa alau cara perer||saar yarg sa|ar.
10. T|ler 8-rC0 rer|rg|al pada |erar||ar se||lar 90 rar|, |erud|ar rerurur seperl| aWa| |erar||ar, oar|ar dapal
sarpa| l|da| lerdele|s|.
11. perasaar rua| dar rurlar oeru|arg, rorr|rg s|c|ress.
12. peruoarar payudara
13. po||ur|a
Pemer|ksaan 0bstetr| dan
Asuhan Antenata|
0r.handaya | 0r.Ju||anto w|tjaksono | 0r.ambang Karsono
A8UhAN ANTENATAL (Antenata| 6are}

0ef|n|s|
Asurar arlerala| ada|ar sualu prograr yarg lerercara oerupa ooservas|, edu|as| dar perargarar red|| pada |ou
rar||, urlu| rerpero|er sualu proses |erar||ar dar persa||rar yarg arar dar reruas|ar.
(pada oeoerapa |epusla|aar d|seoul seoaga| Prerala| Care)

Pe|ayanan antenata|
Pe|ayarar arlerala| ada|ar pe|ayarar |eseralar o|er leraga proles|ora| (do|ler spes|a||s |eo|darar, do|ler urur,
o|dar, peroarlu o|dar dar peraWal o|dar) urlu| |ou se|ara rasa |erar||arrya, sesua| dergar slardard r|r|ra|
pe|ayarar arlerala| yarg re||pul| 5T ya|lu l|roarg oeral oadar, u|ur l|rgg| oadar, u|ur le|arar darar, peroer|ar
|rur|sas| TT, u|ur l|rgg| lurdus uler| dar peroer|ar lao|el oes| r|r|ra| 90 lao|el se|ara rasa |erar||ar.

Tujuan
1. rerjaga agar |ou seral se|ara rasa |erar||ar, persa||rar dar r|las serla rergusara|ar oay| yarg d||ar|r|ar
seral.
2. rerarlau |erurg||rar adarya r|s||o-r|s||o |erar||ar, dar rerercara|ar perala|a|saraar yarg opl|ra|
lerradap |erar||ar r|s||o l|rgg|.
3. rerurur|ar roro|d|las dar rorla||las |ou dar per|rala|.

Asurar arlerala| lARu3 d|ru|a| sed|r| rurg||r.

Perencanaan
JadWa| perer||saar (us|a |erar||ar dar| rar| perlara ra|d lera|r|r) :
- sarpa| 28 r|rggu : 1 r|rggu se|a||
- 28 - 3 r|rggu : 2 r|rggu se|a||
- d| alas 3 r|rggu : 1 r|rggu se|a||
KECuALl j||a d|leru|ar |e|a|rar / la|lor r|s||o yarg rerer|u|ar perala|a|saraar red|| |a|r, perer||saar rarus
|eo|r ser|rg dar |rlers|l.
KUNJUNCAN | PEHER|K8AAN PERTAHA ANTENATAL 6ARE

Tujuan
1. rererlu|ar d|agros|s ada/l|da|rya |erar||ar
2. rererlu|ar us|a |erar||ar dar per||raar persa||rar
3. rererlu|ar slalus |eseralar |ou dar jar|r
1. rererlu|ar |erar||ar rorra| alau aororra|, serla ada/ l|da|rya la|lor r|s||o |erar||ar
5. rererlu|ar rercara perer||saar/perala|a|saraar se|arjulrya

Anamnes|s

|dent|tas Pas|en
lderl|las urur, perral|ar pada us|a |ou, slalus per|aW|rar dar l|rg|al perd|d||ar. Rarge us|a reprodu|s| seral dar
arar arlara 20-30 larur. Pada |erar||ar us|a reraja, apa|ag| |erar||ar d| |uar r||ar, |erurg||rar ada ursur
pero|a|ar ps||o|og|s yarg l|rgg|. T|da| jararg pas|er rer|rla aoors|. us|a ruda juga la|lor |erar||ar r|s||o l|rgg|
urlu| |erurg||rar adarya |orp|||as| ooslelr| seperl| pree||arps|a, |eluoar pecar d|r|, persa||rar prelerr, aoorlus.

Ke|uhan utama
3adar/l|da| a|ar |erurg||rar rar||, apa|ar serala-rala |rg|r per||sa rar||, alau ada |e|urar / rasa|ar |a|r yarg
d|rasa|ar.

R|wayat keham||an sekarang | r|wayat penyak|t sekarang
Ada/l|da|rya geja|a dar larda |erar||ar.
J||a ada arerorea, |apar rar| perlara ra|d lera|r|r, s|||us ra|d o|asarya oerapa rar|. la| |r| perl|rg urlu|
rerper||ra|ar us|a |erar||ar rerslrua| dar rerper||ra|ar saal persa||rar rerggura|ar Rurus Naege|e (rZ o-
3 x 1rg) urlu| s|||us 28 x rar|.
0|larya|ar apa|ar sudar perrar per||sa |erar||ar |r| seoe|urrya alau oe|ur (j||a sudar, oerarl| |r| ou|ar
|urjurgar arlerala| perlara, rarur lelap perl|rg urlu| dala dasar |r|s|a| perer||saar ||la).
Apa|ar ada |e|urar / rasa|ar dar| s|sler orgar |a|r, oa|| yarg oerruourgar dergar peruoarar l|s|o|og|s |erar||ar
raupur l|da|.

R|wayat penyak|t dahu|u
R|Wayal perya||l s|sler|| |a|r yarg rurg||r rerpergarur| alau d|peroeral o|er |erar||ar (perya||l jarlurg, paru,
g|rja|, ral|, d|aoeles re|||lus), r|Wayal a|erg| ra|arar / ooal lerlerlu dar seoaga|rya. Ada/l|da|rya r|Wayal operas|
urur / |a|rrya raupur operas| |ardurgar (r|ore|lor|, secl|o cesarea dar seoaga|rya).

R|wayat penyak|t ke|uarga
R|Wayal perya||l s|sler||, relaoo|||, cacal oaWaar, dar seoaga|rya.

R|wayat khusus obstetr| g|neko|og|
Ada|ar r|Wayal |erar||ar / persa||rar / aoorlus seoe|urrya (d|ryala|ar dergar |ode 0xPxAx, grav|da / para /
aoorlus), oerapa jur|ar ara| r|dup.
Ada/l|da|rya rasa|ar2 pada |erar||ar / persa||rar seoe|urrya seperl| preralur|las, cacal oaWaar, |eral|ar jar|r,
perdararar dar seoaga|rya.
Pero|org persa||rar lerdaru|u, cara persa||rar, peryerourar |u|a persa||rar, |eadaar oay| saal oaru |ar|r, oeral
oadar |ar|r j||a ras|r |rgal.
R|Wayal rerarcre, s|||us ra|d, ada/l|da| ryer| ra|d alau gargguar ra|d |a|rrya, r|Wayal perya||l |ardurgar |a|rrya.
R|Wayal |orlraseps|, |ara pera|a|ar, ada rasa|ar/l|da|.

R|wayat sos|a| | ekonom|
Pe|erjaar, |eo|asaar, |er|dupar serar|-rar|.
Pemer|ksaan F|s|s

8tatus genera||s | pemer|ksaan umum

Per||a|ar |eadaar urur, |esadarar, |orur||as|/|ooperas|.
Tarda v|la| (le|arar darar, rad|, suru, perrapasar), l|rgg|/oeral oadar.
Kerurg||rar r|s||o l|rgg| pada |ou dergar l|rgg| < 115 cr, oeral oadar < 15 |g alau > Z5 |g.
8alas r|perlers| pada |erar||ar ya|lu 110/90 rrlg (r||a| d|aslo||| |eo|r oerra|ra urlu| pred||s| s|r|u|as| p|aserla).
Kepa|a ada/l|da|rya ryer| |epa|a (araer|c readacre ryer| lrorla|, ryperlers|ve / lers|or readacre ryer| suoo|s|p|la|
oerderyul).
Vala |orjurgl|va pucal / l|da|, s||era ||ler|| / l|da|.
Vu|ul / TlT ada larda radarg / l|da|, |erd|r, perdararar gus|, g|g|-ge||g|.
Paru / jarlurg / aodorer |rspe|s| pa|pas| per|us| aus|u|las| urur.
E|slrer|las d|per||sa lerradap edera, pucal, s|aros|s, var|ses, s|relr| (|ecur|gaar po||o, rurg||r lerdapal |e|a|rar
oerlu| parggu|).
J||a ada |u|a lerou|a alau lo|us |rle|s| |a|r rarus d|rasu||ar rerjad| rasa|ar dar d|rercara|ar
perala|a|saraarrya.

8tatus obstetr|cus | pemer|ksaan khusus obstetr|k

Abdomen
lnspeks| : reroesar/l|da| (pada |erar||ar ruda peroesarar aodorer rurg||r oe|ur ryala).
Pa|pas| : lerlu|ar l|rgg| lurdus uler| (pada |erar||ar ruda d||a|u|ar dergar pa|pas| o|rarua| da|ar, dapal
d|per||ra|ar u|urar ulerus - pada |erar||ar |eo|r oesar, l|rgg| lurdus dapal d|u|ur dergar p|la u|urar serl|reler,
jara| arlara lurdus uler| dergar lep| alas
s|rl|s|s os puo|s).
Perer||saar pa|pas| Leopo|d d||a|u|ar dergar
s|sleral||a :
Leopo|d l
Vererlu|ar l|rgg| lurdus dar reraoa oag|ar
jar|r yarg d| lurdus dergar |edua le|apa|
largar.
Leopo|d ll
Kedua le|apa| largar rere|ar ulerus dar| ||r|-|arar, jar| |e arar |epa|a pas|er, rercar| s|s| oag|ar oesar (o|asarya
purggurg) jar|r, alau rurg||r oag|ar |eras ou|al (|epa|a) jar|r.
Leopo|d lll
3alu largar reraoa oag|ar jar|r apa yarg ler|ela| d| oaWar (d|
alas s|rl|s|s) sererlara largar |a|rrya rerarar lurdus urlu| l||sas|.
Leopo|d lv
Kedua largar rere|ar oag|ar oaWar ulerus dar| ||r|-|arar, jar| |e arar |a|| pas|er, urlu| |orl|rras| oag|ar
leroaWar jar|r dar rererlu|ar apa|ar oag|ar lerseoul sudar rasu| / re|eWal| p|rlu alas parggu| (o|asarya
d|ryala|ar dergar saluar x/5)
J||a rerurg||r|ar da|ar pa|pas| d|per||ra|ar juga la|s|rar oeral jar|r (res||pur |erurg||rar |esa|arar juga
ras|r cu|up oesar). Pada |erar||ar alerr, per||raar oeral jar|r dapal rerggura|ar rurus cara Jorrsor-Tossec
ya|lu : l|rgg| lurdus (cr) - (12/13/11)) x 155 grar.
/usku|ras| : dergar slelos|op |ayu Laerrec alau a|al 0opp|er yarg d|lerpe||ar d| daerar purggurg jar|r, d|r|lurg
lre|uers| pada 5 del|| perlara, |el|ga dar |e||ra, |erud|ar d|jur|ar dar d||a|||ar 1 urlu| rerpero|er lre|uers|
salu rer|l. 3eoerarrya perer||saar aus|u|las| yarg |dea| ada|ar deryul jarlurg jar|r d|r|lurg se|ururrya se|ara
salu rer|l.
8alas lre|uers| deryul jarlurg jar|r rorra| ada|ar 120-10 deryul per rer|l. Ta|||ard| rerurju||ar adarya rea|s|
|orpersas| lerradap oeoar / slress pada jar|r (lela| slress), sererlara orad||ard| rerurju||ar |egaga|ar
|orpersas| oeoar / slress pada jar|r (lela| d|slress/gaWal jar|r).

Cen|ta||a eksterna
lnspeks| |uar : |eadaar vu|va / urelra, ada l|da|rya
larda radarg, |u|a / perdararar, d|scrarge, |e|a|rar
|a|rrya. Lao|a d|p|sar|ar dergar dua jar| perer||sa
urlu| |rspe|s| |eo|r je|as.
lnspeks| oa|am rerggura|ar spe|u|ur (|r specu|o) :
Lao|a d|p|sar|ar dergar dua jar| perer||sa, a|al
spe|u|ur Cusco (cocoroeoe|) d|rasu||ar |e vag|ra
dergar o||ar verl||a| |erud|ar d| da|ar ||arg vag|ra d|pular 90o ser|rgga ror|sorla|, |a|u d|ou|a. 0es|r|ps| |eadaar
pors|o serv||s (perru|aar, Warra), |eadaar osl|ur, ada/l|da|rya darar/ca|rar/ d|scrarge d| lorr||s, d|||ral |eadaar
d|rd|rg da|ar vag|ra, ada/l|da| luror, larda radarg alau |e|a|rar |a|rrya. 3pe|u|ur d|lulup ror|sorla|, d|pular
verl||a| dar d||e|uar|ar dar| vag|ra.

Cen|ta||a |nterna
Pa|pas| : co|o| vag|ra| (vag|ra| loucr) dergar dua jar| seoe|ar largar dar 8lVANuAL dergar largar |a|r rere|ar
lurdus dar| |uar aodorer. 0|lerlu|ar |ors|slers|, leoa|, arar dar ada/l|da|rya perou|aar serv||s. 0|per||sa
ada/l|da| |e|a|rar ulerus dar adre|sa yarg dapal d|leru|ar. 0|lerlu|ar oag|ar leroaWar (preserlas|) jar|r.
JAN0AN LuPA, 3ELALu PALPA3l 8lVANuAL
PA0A PEVERlK3AAN vA0lNAL llll
Pada perer||saar d| alas 31-3 r|rggu
d||a|u|ar perr|lurgar pe|v|relr| |||r|| urlu|
rerper||ra|ar ada/l|da|rya d|spropors|
lelope|v||/sela|ope|v||.
Korlra|rd||as| re|al|l co|o| vag|ra| ada|ar :
1. perdararar per vag|rar pada |erar||ar
lr|resler |el|ga, |arera |erurg||rar adarya
p|aserla prev|a, dapal rerjad| percelus
perdararar yarg |eo|r oeral (rarya oo|er
d||a|u|ar d| reja operas|, d||a|u|ar dergar cara peraoaar lorr|ces dergar sargal ral|-ral|)
2. |eluoar pecar d|r| - dapal rerjad| pred|spos|s| perja|arar |rle|s| (|or|oarr|or|l|s).
Perer||saar da|ar (vag|ra| loucr) ser|rg|a|| l|da| d||a|u|ar pada |urjurgar arlerala| perlara, |ecua|| ada
|rd||as|.
ururrya perer||saar da|ar yarg surggur oerra|ra urlu| |eperl|rgar ooslelr|| (persa||rar) ada|ar perer||saar
pada us|a |erar||ar d| alas 31-3 r|rggu, urlu| rerper||ra|ar u|urar, |ela|, preserlas| jar|r, per||a|ar serv||s
uler| dar |eadaar ja|ar |ar|r, serla pe|v|relr| |||r|| urlu| per||a|ar |erurg||rar persa||rar rorra| pervag|rar.
A|asar |a|rrya, pada us|a |erar||ar |urarg dar| 3 r|rggu, e|asl|s|las jar|rgar |ura| se||lar ja|ar |ar|r ras|r r|r|ra|,
a|ar su||l dar sa||l urlu| e|sp|oras|.

Pemer|ksaan rekta| (re|la| loucr) : d||a|u|ar alas |rd||as|.
PEHER|K8AAN LANJUTAN

Jadwa| kunjungan
ldea|rya seperl| d| alas (sarpa| 28 r|rggu 1 |a|| sel|ap ou|ar, 29-3 r|rggu sel|ap 2 r|rggu se|a|| dar d| alas 3
r|rggu sel|ap r|rggu se|a||).
Pada |urjurgar perer||saar |arjular, d|per||sa :
1. Ke|urar |ou, le|arar darar, oeral oadar, dar l|rgg| lurdus uler|.
2. Terradap jar|r d|per||sa per||raar oesar / oeral jar|r, preserlas| dar |ela| jar|r, deryul jarlurg jar|r, a|l|l|las
jar|r, per||raar vo|ure ca|rar arr|or dar |ela| p|aserla (j||a rerurg||r|ar dergar u30).

Laborator|um
J||a lerdapal |e|a|rar, d|lala|a|sara dar d|per||sa u|arg lerus sarpa| rercapa| rorra|. J||a seja| aWa| |aooralor|ur
rul|r da|ar oalas rorra|, d|u|arg |eroa|| pada |erar||ar 32-31 r|rggu.
Per||sa juga |rle|s| T0RCl (Toxop|asra, Ruoe||a, Cylorega|ov|rus, lepal|l|s / llv).
Per||sa gu|a darar pada |urjurgar perlara, o||a rorra|, per||sa u|arg pada |urjurgar r|rggu |e 2-28, urlu|
dele|s| d|r| d|aoeles re|||lus geslas|ora|.

La|n-|a|n
Pe|v|relr| rad|o|og|| (a|r|r lr|resler 3), j||a d|per|u|ar, urlu| perr|lurgar ja|ar |ar|r. Pada lr|resler 3 a|r|r,
peroerlu|ar dar peralargar orgar jar|r sudar rarp|r se|esa|, ser|rgga |erurg||rar rulas| / |ars|roger jaur
|eo|r |ec|| d|oard|rg|ar pada lr|resler perlara / |edua. Telap rarus d|gura|ar dos|s rad|as| se|ec||-|ec||rya.
u|lrasorogral| (u30) l|da| oeroaraya |arera rerggura|ar ge|oroarg suara. Fre|uers| yarg d|gura|ar dar| 3.5,
5.0, .5 alau Z.5 Vlz. Va||r l|rgg| lre|uers|, reso|us| yarg d|ras|||ar ra||r oa|| lelap| perelras| l|da| dapal da|ar,
|arera |lu rarus d|sesua||ar dergar |eoulurar.

NA8EhAT UNTUK PERAwATAN UHUH | 8EhAR|-hAR|

Akt|f|tas f|s|k
0apal seperl| o|asa (l|rg|al a|l|l|las r|rgar sarpa| sedarg), |sl|raral r|r|ra| 15 rer|l l|ap 2 jar. J||a dudu|/oeroar|rg
d|arjur|ar |a|| aga| d|l|rgg||ar. J||a l|rg|al a|l|l|las oeral, d|arjur|ar urlu| d||urarg|. lsl|raral rarus cu|up.
0|arraga dapal r|rgar sarpa| sedarg, d|perlarar|ar jargar sarpa| deryul rad| re|eo|r| 110 |a|| per rer|l.
J||a ada gargguar / |e|urar yarg rercur|ga|ar dapal reroaraya|ar (r|sa|rya, perdararar per vag|rar), a|l|l|las
l|s|| rarus d|rerl||ar.

Pekerjaan
l|rdar| pe|erjaar yarg reroaraya|ar alau ler|a|u oeral alau oerruourgar dergar rad|as| / oarar ||r|a, lerulara
pada us|a |erar||ar ruda.

|mun|sas|
Terulara lelarus lo|so|d. lrur|sas| |a|r sesua| |rd||as|.

eperg|an dengan pesawat udara
T|da| per|u |ual|r oeperg|ar dergar rerurparg pesaWal udara o|asa, |arera l|da| reroaraya|ar |erar||ar.
Te|arar udara d| da|ar |ao|r |apa| perurparg le|ar d|alur sesua| alrosler o|asa.

Hand| dan cara berpaka|an
Vard| cu|up seperl| o|asa.
Pera|a|ar saour |rusus / arl|sepl|| vag|ra l|da| d|arjur|ar |arera juslru dapal rerggarggu l|ora rorra| vag|ra.
3e|a|r |lu ap|||as| saour vag|ra| dergar a|al serprol dapal reryeoao|ar eroo|| udara alau eroo|| ca|rar yarg dapal
oeroaraya.
8erpa|a|ar seoa||rya yarg rerurg||r|ar pergera|ar, perrapasar dar persp|ras| yarg |e|uasa.

8anggama | co|tus
0apal seperl| o|asa, |ecua|| j||a lerjad| perdararar alau |e|uar ca|rar dar| |era|uar, rarus d|rerl||ar (aosl|rerl|a).
J||a ada r|Wayal aoorlus seoe|urrya, co|lus d|lurda sarpa| us|a |erar||ar d| alas 1 r|rggu, d| rara d|rarap|ar
p|aserla sudar leroerlu|, dergar |rp|arlas| dar lurgs| yarg oa||. 8eoerapa |epusla|aar rergarjur|ar agar co|lus
ru|a| d|rerl||ar pada 3-1 r|rggu lera|r|r rerje|arg per||raar largga| persa||rar. l|rdar| lraura oer|eo|rar pada
daerar serv||s / ulerus.
Pada oeoerapa |eadaar seperl| |orlra|s| / larda-larda persa||rar aWa|, |e|uar ca|rar pervag|rar, |epul|rar,
|eluoar pecar, perdararar pervag|rar, aoorlus |r|rers alau aoorlus rao|lua||s, |erar||ar |eroar, perya||l reru|ar
se|sua|, seoa||rya co|lus jargar d||a|u|ar.

Perawatan mammae dan abdomen
J||a lerjad| pap||a relra|s|, d|o|asa|ar pap||||a d|lar|| rarua| dergar pe|ar. 3lr|ae / r|perp|grerlas| dapal lerjad|, l|da|
per|u d||ual|r|ar oer|eo|rar.

hewan p|araan
leWar p|araar dapal rerjad| carr|er |rle|s| (r|sa|rya, ou|u |uc|rg / oururg, dapal rergardurg paras|l loxop|asra).
0|arjur|ar rergr|rdar| |orla|.

Herokok | m|numan keras | obat-obatan
larus d|rerl||ar se|urarg-|urargrya se|ara |erar||ar dar sarpa| persa||rar, r|las dar reryusu| se|esa|. 0oal-
ooal depresar ad||l|l (rar|ol|| dso.) rerdepres| s|r|u|as| jar|r dar rere|ar per|eroargar susurar saral pusal
pada jar|r.

C|z| | nutr|s|
Va|arar serar|-rar| d|arjur|ar yarg rererur| slardar |ecu|upar g|z| urlu| |ou rar|| (dela|| car|/oaca serd|r| ya).
urlu| percegarar arer|a del|s|ers|, d|oer| laroarar v|lar|r dar lao|el Fe.

3aca uga Voou| $/FE VDTlERlDD0 renrang /sunan /nrenara|
Pemantauan Jan|n
!"#$%& ()*+$),+*-.
dr. handaya | dr. ambang Karsono | Prof.dr. Cu|ard| h. w|knjosastro
KE8EJAhTERAAN JAN|N

Arl|rya : jar|r da|ar |eadaar r|dup, seral, l|da| sa||l, se|aral, leroeoas dar| arcarar.
Jar|r rurg||r saja oerada da|ar |eadaar r|dup seral dar l|da| sa||l, TETAPl oerada da|ar |eadaar yarg
rergarcar alau reroaraya|ar, r|sa|rya : pada |ou yarg rerga|ar| perya||l / |e|a|rar lerlerlu seperl| pre-
e||arps|a.
PEHANTAUAN JAN|N (Feta| Hon|tor|ng}

VergaWas|, rerye||d|||, rererlu|ar, apa|ar jar|r oerada da|ar |eadaar sa||l alau l|da|, serla apa|ar ada
|eadaar yarg rurg||r rerpergarur|rya.

Tujuan pemantauan jan|n
urlu| dele|s| d|r| ada/l|da|rya la|lor-la|lor r|s||o |eral|ar per|rala| lerseoul (r|po|s|a/asl||s|a, gargguar
perlurourar, cacal oaWaar, |rle|s|).

6ARA-6ARA PEHANTAUAN KE8EJAhTERAAN JAN|N

Perk|raan pertumbuhan jan|n dar| t|ngg| fundus uter| terhadap us|a keham||an
3yaral perer||saar l|rgg| lurdus : ves||a ur|rar|a dar re|lur |dea|rya da|ar |eadaar |osorg (j||a l|da|, pergarur
o|sa sarpa| 3 cr). 0|u|ur dergar pas|er |eadaar le|erlarg, pada |eadaar ulerus l|da| |orlra|s|, dar| lep| alas
s|rl|s|s sarpa| lurdus.
urlu| rerper||ra|ar ada l|da|rya gargguar perlurourar (apa|ar perlurourar jar|r lerrasu| |ec|| alau sesua|
alau oesar lerradap us|a |erar||arrya).
Corlor : |ou dergar d|aoeles re|||lus alau ooes|las, r|s||o jar|r oesar.
J||a ada gargguar perlurourar |ec||, p|||r|ar |erurg||rar r|po|s|a |ror|s ser|rgga o|s|geras| jar|r lergarggu.
J||a l|rgg| lurdus |eo|r dar|pada |a||oras| us|a |erar||ar, p|||r|ar |erurg||rar d|agros|s oard|rg : |erar||ar
ru|l|pe|, luror, r|drosela|us, oay| oesar, r|drarr|or.
J||a l|rgg| lurdus |urarg dar|pada |a||oras| us|a |erar||ar, p|||r|ar |erurg||rar d|agros|s oard|rg :
o||gor|drarr|or, perlurourar jar|r lerraroal, |eluoar pecar dar seoaga|rya.
Per||raar oeral jar|r dergar rurus Jorrsor Tossec.

Ausku|tas| denyut jantung jan|n
0ergar a|al Laerrec alau 0opp|er, alau dergar CT0/card|olo|ogral|
(e|eclror|c lela| rearl ror|lor|rg).
ldea| perr|lurgar lre|uers| jarlurg d||a|u|ar 1 rer|l perur.
J||a ada a|al CT0, o|sa d|re|ar urlu| 10 rer|l. Norra| lre|uers|
deryul 120-10 |a|| per rer|l, rer|rg|al pada saal |orlra|s|.
8alasar Wa|lu urlu| rer||a| orad||ard| : lre|uers| deryul jarlurg d|
oaWar rorra| se|ara |eo|r dar| 2 rer|l.
8alasar Wa|lu urlu| rer||a| a|se|eras| : per|rg|alar lre|uers| deryul
jarlurg d| alas 15 deryul per rer|l se|ara |urarg dar| 2 rer|l.
8alasar Wa|lu urlu| rer||a| la|||ard| : lre|uers| deryul jarlurg d| alas rorra| se|ara |eo|r dar| 2 rer|l.
Perer||saar rorra| / oa|| : Wa|lu re|a|sas| lre|uers| jarlurg rorra|, Wa|lu |orlra|s| lerjad| la|||ard|a
Tarda r|po|s|a a|ul : Wa|lu re|a|sas| dar |orlra|s| orad||ard|a
Tarda r|po|s|a |ror|| : Wa|lu re|a|sas| rorra|, Wa|lu |orlra|s| orad||ard|a
J||a ada |rle|s| |rlra parlur : lela| la|||ard|.
J||a ada gaWal jar|r : lela| orad||ard|

U|trasonograf| (U8C}
ldea| urlu| perer||saar pada lr|resler perlara sarpa| |el|ga. J||a rerurg||r|ar, |ou
rar|| sargal d|arjur|ar urlu| rerja|ar| perer||saar u30.
u30 dapal rer||a| :
1. |arlorg geslas| : jur|ar, u|urar, |o|as|, oerlu|, |eadaar
2. jar|r : r|dup / ral|, jur|ar, preserlas|, per||raar us|a geslas| re|a|u| o|orelr| jar|r
(garoar), perlurourar, |e|a|rar oaWaar, dar seoaga|rya.
Samoar . Perk|raan us|a gesras| me|a|u| pemer|ksaan o|omerr| an|n.
Paoa rr|mesrer perrama, paramerer ,ang o|paka| aoa|an arak puncak kepa|a sampa|
ookong {0Rl - croun-rump |engrnj. Paoa rr|mesrer keoua oan ker|ga, paramerer ,ang
o|paka| o| anraran,a aoa|an o|amerer o|par|era| kepa|a {3P0 - o|par|era| o|amererj, ||ngkar
perur {/0 - aooom|na| c|rcumlerence - r|oak aoa oa|am gamoarj oan panang ru|ang
lemur {Fl - lemur |engrnj.
3. la|| pusal : jur|ar perou|ur darar, s|r|u|as| (dergar 0opp|er dapal rer||a| F0JP/
Furgs| 0|rar|| Jar|r P|aserla - 30Au/ 3|r|u|as| 0arar Arler| uro||||a||s - garoar)
1. rerorar / ca|rar arr|or : |eadaar, jur|ar
5. p|aserla : |o|as|, jur|ar, u|urar, raluras|, |rsers|
. |eadaar palo|og|| : |erar||ar e|lop||, ro|a r|dal|dosa, luror, |r|orpelers|a serv||s,
dar seoaga|rya. dapal juga urlu| reroarlu l|rda|ar |rusus : arr|ocerles|s, lelos|op|,
lrarslus| |rlrauler|r, o|ops| v|||| |or|a||s

Pemantauan akt|f|tas | gerakan jan|n
0apal secara suoje|l|l (d|larya|ar |epada |ou), alau ooje|l|l (pa|pas| alau dergar u30).
Jar|r rorra|, l|da| ada r|po|s|a, a|ar a|l|l oergera|.
Norra| gera|ar jar|r d|rasa|ar o|er |ou seoarya| |eo|r dar| 10 |a|| per rar| (pada us|a d| alas 32 r|rggu).
0a|ar |er|dupar jar|r |rlrauler|r, seoag|ar oesar o|s|ger rarya d|oulur|ar o|er ola| dar jarlurg (rel|e|s
red|slr|ous|).
J||a jar|r l|da| oergera|, p|||r|ar |erurg||rar d|agros|s oard|rg : l|dur, alau r|po|s|a.

Pengamatan mekoneum dan ca|ran ketuban
Cararya dergar arr|ocerles|s alau arr|os|op|.
Pada |eadaar rorra| olol sl|rgler ar| jar|r oer|orlra|s|, re|oreur l|da| |e|uar, l|da| oercarpur dergar ca|rar
|eluoar ser|rgga ca|rar |eluoar lelap jerr|r.
Pada r|po|s|a a|ul, lerjad| r|perper|sla|l|| olol-olol luour jar|r, lelap| lerjad| juga re|a|sas| sl|rgler ar| ser|rgga
re|oreur a|ar |e|uar dar oercarpur dergar ca|rar |eluoar, reryeoao|ar Warra |er|jauar.
Pada |rle|s|, lerjad| juga |o|or| |urar da|ar se|apul dar ca|rar |eluoar (|or|oarr|or|l|s), reryeoao|ar juga Warra
|erur alau |er|jauar.
Perer||saar ras|o |ec|lr|r/spryrgorye||r (L/3 ral|o) pada ca|rar |eluoar dapal urlu| rer||a| pred||s| peralargar
paru jar|r (peroerlu|ar surla|lar).

Pengamatan hormon yang d|produks| o|eh p|asenta
Eslr|o| dar lurar P|acerla| Lacloger (lPL) ada|ar rorror p|aserla spes|l|| yarg dapal d|per||sa |adarrya pada
darar |ou, urlu| rer||a| lurgs| p|aserla.
J||a aororra|, oerarl| lerjad| gargguar lurgs| p|aserla dar oera||oal r|s||o perlurourar jar|r lerraroal sarpa|
|eral|ar jar|r.
Narur perer||saar |r| ra|ar Wa|lu |ara, o|sa ler|aroal oerl|rda| |a|au rerurggu ras||rya.

Pemer|ksaan darah dan ana||s|s gas darah jan|n
Pergaro||ar sarpe| darar o|sa dar| la|| pusal (uro|||ca| cord o|ood sarp||rg), alau dar| |u||l |epa|a jar|r (lela| sca|p
o|ood sarp||rg).
Pada jar|r dergar r|po|s|a, lerjad| as|dos|s.

Kard|otokograf| (6TC}
Verggura|ar dua e|e|lrode yarg d|pasarg pada
lurdus (urlu| rer||a| a|l|l|las ulerus) dar pada |o|as|
purclur rax|rur deryul jarlurg jar|r pada perul |ou.
0apal rer||a| a|l|l|las jarlurg jar|r pada saal r|s /
|orlra|s| raupur pada saal d| |uar r|s / |orlra|s|.
Ver||a| juga ruourgar arlara deryul jarlurg dar
le|arar |rlrauler|r.
Jar|r rorra| : pada saal |orlra|s| : j||a lre|uers| deryul
jarlurg lelap rorra| alau rer|rg|al da|ar oalas
rorra|, oerarl| cadargar o|s|ger jar|r oa|| (l|da| ada
r|po|s|a).
Pada jar|r r|po|s|a : l|da| ada a|se|eras|, pada saal
|orlra|s| juslru lerjad| dese|eras| / per|aroalar, sele|ar
|orlra|s| |erud|ar ru|a| rergr||arg (larda |rsul|s|ers|
p|aserla).
J||a ada dese|eras| d|r| : da|ar oalas rorra|, ooservas|. Kerurg||rar a||oal lururrya |epa|a, alau rel|e|s vasovaga|.
J||a ada dese|eras| |aroal : |rd||as| urlu| lerr|ras| segera.
J||a ada dese|eras| var|aoe| (seperl| dese|eras| d|r| lelap| e|slr|r), ra| |r| rerupa|ar larda |eadaar palo|og|s
r|sa|rya a||oal |orpres| pada la|| pusal (o||gor|drarr|or, ||||lar la|| pusal, dar seoaga|rya). Juga |rd||as| urlu|
lerr|ras| segera.
8alasar Wa|lu urlu| rer||a| dese|eras| : l|da| ada.
3erarusrya per||a|ar |dea| sarpa| Wa|lu 20 rer|l, lap| da|ar pra|le|, |a|au rerurggu |eo|r |ara pada |eadaar
r|po|s|a alau gaWal jar|r a|ar ra||r rerperouru| progros|s.
Ka|au gral|| deryul dalar lerus : |eadaar jar|r ror-rea|l|l.
uj| dergar oe| (||a|sor.rgoooo|), rorra| lre|uers| deryul jarlurg a|ar rer|rg|al.
CT0 o|sa d|gura|ar urlu| rer||a| lurgs| |orpersas| jarlurg jar|r lerradap slress l|s|o|og||, dergar cara : Nor
3lress Tesl (N3T), 0xylocyr Cra||erge Tesl (0CT), dar seoaga|rya.
{oera||, |a|n2, s||akan car|/oaca seno|r|j
Konse||ng Cenet|ka dan
0|agnos|s Prenata|
(d|bawakan pada Pertemuan ||m|ah Tahunan Perkumpu|an 0bstetr| C|neko|og| |ndones|a (P|T-P0C|} X|, 8emarang, 1999}
dr. Johannes 6. Hose
ag|an 0bstetr| C|neko|og| - Un|vers|tas Padjajaran - andung
HA8ALAh | TANTANCAN

Arg|a |ejad|ar cacal / |e|a|rar oaWaar per jur|ar |e|ar|rar r|dup :
2 - 3 : cacal oaWaar oeral
11-15 : cacal oaWaar r|rgar
Cacal oaWaar oerperar sarpa| 20 lerradap arg|a |eral|ar per|rala|.
Ke|a|rar |rorosor lerdapal pada se||lar Z.5 |orseps|, seoag|ar oesar (95)
oera|r|r dergar aoorlus sporlar pada lr|resler perlara.
PERKEHANCAN

3eja| larur 190ar, per|eroargar ||ru gerel||a urlu| d|agros|s r|sa|rya :
arr|ocerles|s - |derl|l||as| 8arr oody, |e|a|rar2 |rorosor, s|rdrora 0oWr, dar
seoaga|rya.
3arpa| saal |r|, 1990ar, r|sa|rya :
d|agros|s pre-|rp|arlas|, lvF - rerurg||r|ar se|e|s| |ua||las ras|| |orseps| yarg opl|ra|.
(rasa|ar : el|| ?)
U8AhA PEN6ECAhAN

Pr|rer
0ergar adu|l screer|rg, |orse||rg pra r||ar. T|rda|ar percegarar / lerap| dergar K8, adops|, sarpa| |rser|ras|
doror.
3e|urder
0ergar s|r|r|rg gerel||a, |orse||rg gerel||a dar d|agros|s prerala|. T|rda|ar percegarar / lerap| dergar lerr|ras|
/ perga|r|rar |erar||ar yarg rer||||| progros|s ouru|, alau dergar lerap| jar|r |r ulero (rasa|ar : el|| ?)
KEC|ATAN K0N8EL|NC CENET|KA

wa|lu
1. pra|orseps| : seoe|ur rer||ar, seoe|ur rar||
2. prerala| : seoe|ur |e|ar|rar
3. poslparlur : sele|ar persa||rar

Velode
1. ararres|s |erg|ap r|Wayal |e|uarga, r|Wayal perya||l, r|Wayal ooslelr| / g|re|o|og|
2. ararres|s la|lor-la|lor r|s||o
3. perje|asar cara-cara d|agros|s prerala|
1. j||a d|leru|ar |e|a|rar : perje|asar upaya pergooalar alau a|lerral|l perye|esa|ar rasa|ar, upaya-upaya suporl|l
(K8, adops|, lvF) (rasa|ar : el|| ?)
8KR|N|NC PRENATAL

8erdasar|ar : |ara|ler|sl|| derogral| / dala ep|der|o|og|, slalus carr|er, lar||y screer|rg.

Ke|a|rar yarg dapal d|screer|rg prerala|, sarpa| saal |r| :
1. oeroaga| |e|a|rar rorlo|og| (dergar u|lrasorogral|)
2. |e|a|rar |rusus s|sler saral pusal (r|sa|rya, dele| laourg reura| / NT0)
3. perya||l Tay-3acrs
1. s|rdrora 0oWr
5. lra|asser|a (d||eroarg|ar |rlers|l d| |eroaga E|j|rar, FKul, Ja|arla)
. dar seoaga|rya.
|N0|KA8| 8KR|N|NC | 0|ACN08|8 PRENATAL

1. us|a |ou d| alas 35 larur.
2. adarya parerla| cosargu|r|ly.
3. |e|orpo| elr|s dergar preva|ers| l|rgg| lerradap |e|a|rar lerlerlu.
1. adarya r|Wayal |e|uarga yarg rercur|ga|ar.
5. adarya r|Wayal ooslelr|| yarg rercur|ga|ar.
. adarya r|Wayal perya||l |a|r yarg rercur|ga|ar.
Z. adarya r|Wayal pera|a|ar ooal-ooalar / paparar rad|as| / ||r|a yarg rercur|ga|ar.

HET00E 8KR|N|NC | 0|ACN08|8 PRENATAL

1. perer||saar darar / serur / ur|re |ou
2. |rspe|s| jar|r : u30, lelos|op|, arr|os|op|, dar seoaga|rya
3. perer||saar se| / jar|rgar jar|r : arr|ocerles|s, |or|or o|ops| (cror|or|c
v|||us sarp||rg / Cv3), ara||s|s darar la|| pusal (lela| o|ood sarp||rg / F83),
o|ops| |u||l jar|r
1. pada lvF d|rurg||r|ar urlu| perer||saar gerel|| pre-|rp|arlas| (pre-
|rp|arlal|or gerel|c d|agros|s)
5. ara||s|s : |rorosor, 0NA, o|o||r|a, |ruro|og|
J|ka o|remukan ke|a|nan ,ang mungk|n memoer| prognos|s ouruk oag|
kenam||an, oag| oag| an|n maupun oag| |ou, maka perr|moangan er|k / mora|
rernaoap oeroaga| a|rernar|l r|noakan penara|aksanaan ,ang akan o||akukan
mas|n menao| masa|an {apakan kenam||an akan o|nenr|kan, arau o||anurkan, arau an|n o|rerap| seak mas|n oa|am
kanoungan, osoj.
Anatom| Rongga Panggu|
Ku||ar PELvl3 Aralor| Kedo|lerar
dr. 3urja w|djaja
{,ang o|muar oa|am caku| |n| rerurama nan,a oag|an ku||an renrang oag|an ru|ang rongga panggu| uan|ra, ,ang
sek|ran,a oernuoungan oengan ||mu oosrerr|j
PELV|8 (Panggu|}

Parggu| d|oerlu| o|er 1 (erpal) ouar lu|arg
:
1. os coxae ||r| dar |arar, reroerlu|
d|rd|rg |alera| dar arler|or rorgga parggu|.
2. os coccyg|s dar os sacrur, oag|ar dar|
co|urra verleora||s, reroerlu| d|rd|rg
posler|or rorgga parggu|.
0s coxae serd|r| ras|rg-ras|rg seoerarrya
lerd|r| dar| 3 lu|arg |ec|| yarg oersalu, ya|lu
os |||ur, os |scr|ur dar os puo|s.

R0NCCA PANCCUL

Rorgga parggu| d|oag| alas dar oaWar o|er
o|darg apertura pe|v|s super|or (da|ar ooslelr| ser|rg d|seoul seoaga| p|rlu alas parggu|, PAP).
Aperlura pe|v|s super|or d|oerlu| o|er :
- prororlor|ur os sacrur d| oag|ar posler|or
- ||rea |||opecl|rea (||rea lerr|ra||s dar pecler oss|s puo|s) d|
oag|ar |alera|
- syrpr|s|s os puo|s d| oag|ar arler|or

|nk||nas| panggu|
ada|ar sudul yarg leroerlu| arlara o|darg yarg re|a|u| aperlura pe|v|s super|or dergar o|darg ror|sorla| (pada
|eadaar rorra| seoesar 0o).

8ag|ar d| alas / |rar|a| lerradap aperlura pe|v|s super|or d|seoul seoaga| pe|v|s spur|um {pe|v|s maorj, rerupa|ar
oag|ar oaWar / |auda| dar|pada rorgga aodorer.
Va|ra ooslelr||rya ada|ar urlu| rerarar a|al-a|al da|ar rorgga perul dar rerarar ulerus yarg oer|s| lelus yarg
lerus oerlaroar oesar secara oerra|ra ru|a| us|a |erar||ar ou|ar |el|ga.

8ag|ar d| oaWar / |auda| lerradap aperlura pe|v|s super|or d|seoul seoaga| pe|v|s verum (pe|v|s m|nor}, rerupa|ar
rorgga parggu| yarg sargal rererlu|ar |apas|las urlu| ja|ar |ar|r oay| pada Wa|lu persa||rar (verur=seoerarrya,
d|seoul juga lrue pe|v|s).

0|nd|ng-d|nd|ng rongga panggu|
1. d|rd|rg arler|or : perde|, d|oerlu| o|er corpus, rar| dar syrpr|s|s oss|ur puo|s
2. d|rd|rg posler|or : d|oerlu| o|er perru|aar verlra| os sacrur dar os coccyg|s serla rus|u|us pyr|lorr|s yarg
reroerlarg pada perru|aar verlra| os sacrur dar d|||pul| o|er lasc|e pe|v|s.
3. d|rd|rg |alera| : d|oerlu| o|er oag|ar os coxae d| oaWar aperlura pe|v|s super|or, rerorara ooluralor|a,
||garerlur sacroluoerosur, ||garerlur sacrosp|rosur, dar rus|u|us ooluralor |rlerrus dergar lasc|a ooluralor|a.
1. d|rd|rg |rler|or / dasar parggu| : d|oerlu| o|er d|aprragra pe|v|s (rr.|evalor ar|, rr coccyge|, lasc|a
d|aprragral|s pe|v|s, lr|gorur uroger|la|e) yarg oerlurgs| rerarar a|al-a|al rorgga parggu|. 0|aprragra pe|v|s
reroag| |ag| rorgga parggu| oag|ar oaWar rerjad| oag|ar rorgga parggu| ulara (oag|ar alas d|aprragra pe|v|s)
dar oag|ar per|reur (oag|ar oaWar d|aprragra pe|v|s).
PELV|8 VERUH

Verpurya| p|rlu rasu| ya|lu aperlura pe|v|s super|or, dar p|rlu |e|uar apertura pe|v|s |nfer|or (da|ar ooslelr|
d|seoul seoaga| p|rlu oaWar parggu|, P8P).
Aperlura pe|v|s |rler|or rerupa|ar dua seg|l|ga yarg oerse|ulu pada a|asrya (pada gar|s yarg rergruourg|ar
|edua luoer |scr|ad|ca), d|oerlu| o|er :
1. seg|l|ga oag|ar dorsa|, lr|gorur ara|e, d|oerlu| o|er |edua ||garerlur sacroluoerosur dar purca|rya ler|ela|
pada os coccyg|s.
2. seg|l|ga oag|ar verlra|, lr|gorur uroger|la|e, d|oerlu| o|er rarus |rler|or os puo|s dar rarus |rler|or os |scr|ur ||r|
dar |arar, dar purca|rya ler|ela| pada syrpr|s|s os puo|s.

6avum pe|v|s (rongga panggu|} yang mempunya| kepent|ngan obstetr|k pada proses persa||nan ada|ah rongga
yang ter|etak antara p|ntu masuk dan p|ntu ke|uar panggu| tersebut, berupa sa|uran pendek yang me|engkung
dengan bag|an cekung menghadap ke depan.
KLA8|F|KA8| PANCCUL 6AL0wELL-H0L0Y

Ada 4 t|pe panggu| dasar | karakter|st|k, menurut
k|as|f|kas| 6a|dwe||-Ho|oy :
1. l|pe g,naeco|o : oerlu| p|rlu alas parggu| seperl|
e|||ps re||rlarg ||r|-|arar, rarp|r r|r|p ||rg|arar.
0|areler lrarsversa| leroesar ler|ela| d| lergar. 0|rd|rg
sarp|rg parggu| |urus. Verupa|ar jer|s parggu| l|p||a|
War|la (lera|e lype).
2. l|pe anrnropo|o : oerlu| p|rlu alas parggu| seperl|
e|||ps reroujur arleroposler|or. 0|areler lrarsversa|
leroesar juga ler|ela| d| lergar. 0|rd|rg sarp|rg
parggu| juga |urus. Verupa|ar jer|s parggu| l|p||a|
go|orgar |era (ape lype).
3. l|pe anoro|o : oerlu| p|rlu alas parggu| seperl|
seg|l|ga. 0|areler lrarsversa| leroesar ler|ela| d| posler|or de|al sa|rur. 0|rd|rg sarp|rg parggu| reroerlu| sudul
yarg ra||r serp|l |e arar oaWar. Verupa|ar jer|s parggu| l|p||a| pr|a (ra|e lype).
1. l|pe p|ar,pe||o|o : oerlu| p|rlu alas parggu| seperl| |acarg alau g|rja|. 0|areler lrarsversa| leroesar juga
ler|ela| d| lergar. 0|rd|rg sarp|rg parggu| reroerlu| sudul yarg ra||r |eoar |e arar oaWar.

Pada oarya| |asus, oerlu| parggu| rerupa|ar l|pe carpurar.
PERE0AAN ENTUK PANCCUL wAN|TA 0AN PR|A

1. Pada War|la, d|rd|rg pe|v|s spur|ur darg|a|, 3lA3 rergradap |e verlra|. Pada pr|a, d|rd|rg pe|v|s spur|ur lajar /
curar, 3lA3 rergradap |e red|a|.
2. Pada War|la, aperlura pe|v|s super|or oeroerlu| ova|. Pada pr|a, aperlura pe|v|s super|or oeroerlu| rearl-sraped,
|erg|urg, dergar prororlor|ur os sacrur rerorjo| |e arler|or.
3. Pada War|la, pe|v|s verur rerupa|ar segrer perde| sualu |erucul parjarg. Pada pr|a, pe|v|s verur rerupa|ar
segrer parjarg sualu |erucul perde|.
1. Pada War|la, u|urar-u|urar d|areler rorgga parggu| |eo|r oesar (peroedaar sarpa| seoesar 0.5-1.5 cr)
d|oard|rg|ar u|urar-u|urar d|areler rorgga parggu| pr|a.
5. Pada War|la, aperlura pe|v|s |rler|or oeroerlu| ourdar, d|areler |eo|r oesar. Pada pr|a, aperlura pe|v|s |rler|or
oeroerlu| |orjorg dar |ec||.
. Pada War|la, argu|us suopuo|cus ada|ar sudul |eoar / oesar. Pada pr|a, argu|us suopuo|cus rerupa|ar sudul
lajar / |ec||.
EERAPA UKURAN PANCCUL wAN|TA YANC HEH|L|K| HAKNA | KEPENT|NCAN
08TETR|K

0|amerer anreroposrer|or p|nru aras panggu| {conugara |nrerna, conugara veraj
Jara| arlara prororlor|ur os sacrur sarpa| lep| alas syrpr|s|s os puo|s. T|da|
dapal d|u|ur secara |||r|| pada perer||saar l|s|s.
3ecara |||r|| dapal d|u|ur corjugala d|agora||s, jara| arlara prororlor|ur os
sacrur dergar lep| oaWar syrpr|s|s os puo|s, re|a|u| perer||saar pe|v|relr| per
vag|rar.

0|amerer oo||qua p|nru aras panggu|
Jara| dar| serd| sa|ro|||a|a salu s|s| sarpa| lorjo|ar pe|l|rea| s|s| |orlra|alera|rya
(oo|||/rery||arg).

0|amerer rransversa p|nru aras panggu|
0|areler lerparjarg ||r|-|arar dar| p|rlu alas parggu|. 8u|ar surggur d|areler |arera l|da| re|a|u| l|l|| pusal p|rlu
alas parggu|.

0|amerer / o|sranr|a |nrersp|narum paoa rongga panggu|
Jara| arlara |edua ujurg sp|ra |scr|ad|ca ||r| dar |arar.

0|amerer anreroposrer|or p|nru oauan panggu|
Jara| arlara ujurg os coccyg|s sarpa| p|rgg|r oaWar syrpr|s|s os puo|s.

0|amerer rransversa p|nru oauan panggu|
Jara| arlara oag|ar da|ar dar| |edua luoeros|las os |scr||.

0|amerer sag|ra||s posrer|or p|nru oauan panggu|
Jara| arlara oag|ar lergar d|areler lrarsversa sarpa| |e ujurg os
sacrur.
|0ANC h00CE

8|darg-o|darg separjarg surou parggu| yarg sejajar dergar p|rlu
alas parggu|, urlu| palo|ar/u|urar |erajuar persa||rar (per||a|ar
perururar preserlas| jar|r).
3|oang looge l
ada|ar o|darg p|rlu alas parggu|, dergar oalas lep| alas s|rl|s|s.
3|oang looge ll
ada|ar o|darg sejajar l-l sel|rgg| lep| oaWar s|rl|s|s
3|oang looge lll
ada|ar o|darg sejajar l-l sel|rgg| sp|ra |scr|ad|ca
3|oang looge lv
ada|ar o|darg sejajar l-l sel|rgg| ujurg oaWar os coccyg|s
PERK|RAAN UKURAN RATA-RATA PANCCUL wAN|TA N0RHAL

P|nru aras panggu| {pe|v|c |n|erj
0|areler lrarsversa (0T) 13.5 cr. Corjugala vera (Cv)
12.0 cr. Jur|ar rala-rala |edua d|areler r|r|ra| 22.0 cr.

P|nru rengan panggu| {m|o pe|v|sj
0|slars|a |rlersp|rarur (0l) 10.5 cr. 0|areler arler|or
posler|or (AP) 11.0 cr. Jur|ar rala-rala |edua d|areler
r|r|ra| 20.0 cr.

P|nru oauan panggu| {pe|v|c our|erj
0|areler arler|or posler|or (AP) Z.5 cr. 0|slars|a
|rlerluoerosur 10.5 cr. Jur|ar rala-rala |edua d|areler r|r|ra| 1.0 cr.

8||a jur|ar rala-rala u|urar p|rlu-p|rlu parggu| lerseoul |urarg, ra|a parggu| lerseoul |urarg sesua| urlu| proses
persa||rar pervag|rar sporlar.
repenr|ngan ukuran oan keaoaan panggu| uan|ra oa|am proses persa||nan . oernuoungan oengan pen||a|an lV3/hS
FETD-PElvlr oan kemauan proses persa||nan.
{|moang lero-pe|v|k - aoa pemoanasann,a seno|r|, paoa rop|k luoungan anrara Ferus oan Ja|an lan|rj

0/T/T/h . lerak / nuoungan anarom|k anrara organ2 reproouks| {urerus, aoneksa, osoj oengan organ2 sek|rarn,a o|
oa|am rongga panggu| {rekrum, ves|ka ur|nar|a, urerra, urerer, per|roneum osoj, vasku|ar|sas| oan persaralann,a,
s||akan oaca seno|r|.
hubungan antara Fetus dengan Ja|an
Lah|r
dr. h. H. 8oepard|man | dr. Last|ko rahmant|yo | dr. T. Tadju|udd|n
PR|N8|P !!

Vergradap| War|la yarg da|ar proses persa||rar (|r parlu) :
lARu3 rergelaru| |ela| dar pos|s| jar|r d| da|ar |ardurgar.
la| |r| perl|rg urlu| rererlu|ar apa|ar persa||rar dapal oer|argsurg rorra| / sporlar, alau d|per|u|ar l|rda|ar
|a|r urlu| reroarlu rerye|esa||ar proses persa||rar.
8|KAP | hA|TU8

luourgar arlara oag|ar-oag|ar oadar lelus salu sara |a|r.
8|asarya lelus oerada da|ar s||ap f|eks|, reroerlu| ovo|d rerg||ul| oerlu| |avur uler| (ruargar lurdus |eo|r |uas
dar| serv||s).
F|e|s| yarg lerjad| pada |eadaar rorra| ada|ar l|e|s| ra|s|ra| |epa|a, purggurg rerourg|u|, |edua largar
oers||arg d| depar dada dar |edua lurg|a| oers||arg d| depar perul.
Ta|| pusal ler|ela| d| arlara |edua |ergar dar lurg|a|.
{Samoar . 3eroaga| kemungk|nan s|kap an|n |nrraurer|nj
3eoe|ur |erar||ar lr|resler |el|ga (|urarg dar| 32 r|rggu), vo|ure ca|rar arr|or re|al|l |eo|r oesar dar|pada
vo|ure lelus, ser|rgga lelus oeoas oererarg-rerarg da|ar ca|rar arr|or.
3esudar rerasu|| lr|resler |el|ga (32 r|rggu alau |eo|r), vo|ure ca|rar arr|or re|al|l |eo|r |ec|| dar|pada vo|ure
lelus, ser|rgga lelus ru|a| lera|orodas| da|ar |avur uler|. 0a|ar |erar||ar rorra|, a|orodas| |r| reryeoao|ar
|ela| |epa|a lelus |eo|r rerdar dar| oadar, dergar |epa|a ler|ela| d| segrer oaWar ulerus.
Fa|lor-la|lor yarg dapal rerpergarur| s||ap jar|r, ya|lu j||a lerdapal |e|a|rar aralor|s lelus raupur |e|a|rar
aralor|s ja|ar |ar|r.
LETAK | 8|TU8

luourgar arlara surou lelus dergar surou
ja|ar |ar|r.
lerak memanang
3urou lelus searar / sejajar surou ja|ar |ar|r.
lerak me||nrang
3urou lelus lega| |urus surou ja|ar |ar|r.
lerak oo||k
3urou lelus da|ar sudul lerlerlu dergar
surou ja|ar |ar|r.
Progros|s |eoerras||ar persa||rar sporlar pervag|rar leroesar ada|ar pada jar|r |ela| rerarjarg, dar r||a|
progros|s a|ar oeroard|rg leroa||| dergar sudul arlara surou lelus dergar ja|ar |ar|r (|ela| ||rlarg rer||||| r||a|
progros|s persa||rar sporlar pervag|rar yarg ler|ec||).
PRE8ENTA8|

8ag|ar luour lelus yarg lerdapal d| oag|ar leroaWar ja|ar |ar|r.
Lela| ||rlarg alau oo||| : dapal preserlas| oaru alau purggurg.
Lela| rerarjarg : dapal preserlas| |epa|a, alau surgsarg / preserlas| oo|org.
Preserlas| |epa|a : |erurg||rar preserlas| oe|a|arg |epa|a, purca| |epa|a, dar| alau ru|a, lergarlurg |epada
s||ap |epa|a lerradap oadar jar|r.
Pada persa||rar rorra|, jar|r |ela| rerarjarg dergar preserlas| oe|a|arg |epa|a.
Presenras| ookong {gamoarj
Terdapal oeoerapa |erurg||rar :
1. Preserlas| oo|org serpurra (corp|ele
oreecr). Felus oerada da|ar pos|s| dudu|
da|ar ja|ar |ar|r lelap| oo|org ras|r
rerupa|ar preserl|rg parl. 3e|urur arggola
gera| jar|r l|e|s| serpurra (lurg|a| dar |ulul
l|e|s|).
2. Preserlas| oo|org rurr| (lrar| oreecr). 8ag|ar leroaWar (preserl|rg parl) dar| lelus ada|ar oo|org, |edua lurg|a|
da|ar l|e|s| dar sejajar lora|s (|ulul e|slers|).
3. Preserlas| |a|| (lool||r| oreecr / |rcorp|ele oreecr). 3a|ar salu alau |edua |a|| |eo|r |rler|or d|oard|rg|ar dergar
oo|org dar a|ar rerjad| oag|ar perlara yarg |ar|r.
P08|8|

luourgar arlara oag|ar lerlerlu lelus (uour-uour |ec||, dagu,
ru|ul, sa|rur, purggurg) dergar oag|ar ||r|, |arar, depar,
oe|a|arg, alau ||rlarg, lerradap ja|ar |ar|r.
uour-uour |ec|| (oe|a|arg |epa|a) oerlu| seg|l|ga. uour-uour
oesar (depar |epa|a/dar|) oerlu| seg|erpal/Waj||.

60NT0h : 0E8KR|P8| hUUNCAN FETU8 -
JALAN LAh|R

Jar|r |ela| rerarjarg, preserlas| oe|a|arg |epa|a, pos|s|
uour-uour |ec|| ||r| depar (pada persa||rar rorra|)
Jar|r |ela| rerarjarg, preserlas| |epa|a, pos|s| sulura
sag|la||s ||rlarg.
Jar|r |ela| rerarjarg, preserlas| ru|a, pos|s| dagu ||r|
depar.
Jar|r |ela| ||rlarg, purggurg d| alas (dorsosuper|or).
Jar|r |ela| rerarjarg / surgsarg, preserlas| oo|org, pos|s| sa|rur |arar oe|a|arg. (dar seoaga|rya).
ANTR0P0HETR| JAN|N

Kepa|a jan|n

Verupa|ar oag|ar luour yarg pa||rg oesar dar pa||rg |eras yarg a|ar d||ar|r|ar.
8esar dar pos|s| |epa|a jar|r a|ar sargal rererlu|ar dar rerpergarur| ja|arrya persa||rar.
Traura pada |epa|a oay| se|ara persa||rar dapal rerpergarur| |er|duparrya : r|dup serpurra, cacal, alau
rer|rgga|.
Kepa|a secara gar|s oesar dapal d|oag| rerjad| lu|arg-lu|arg lerg|ora| (|rar|ur), lu|arg-lu|arg dasar lerg|ora|
(oas|s |rar||) dar lu|arg-lu|arg ru|a.
Tu|arg lerg|ora| (|rar|ur) oay| PALlN0 rererlu|ar |eoerras||ar proses persa||rar pervag|rar, |arera daerarrya
re|al|l pa||rg |uas dar rerga|ar| |orla| |argsurg dergar ja|ar |ar|r.
(oaca serd|r| aralor| lerg|ora| - lu|arg2, sulura2, lorlare||a, rou|ase dso.)

u|urar-u|urar d|areler |epa|a oay| yarg rererlu|ar d| arlararya :
1. suoo|s|p|lo-oregral||us ( 9.50 cr) : pada persa||rar preserlas|
oe|a|arg |epa|a.
2. o|s|p|lo-lrorla||s ( 11.Z5 cr) : pada persa||rar preserlas| purca|
|epa|a
3. o|s|p|lo-rerla||s ( 13.50 cr) : pada persa||rar preserlas| dar|
1. suorerlo-oregral||us ( 9.50 cr) : pada persa||rar preserlas| ru|a
5. o|-par|ela||s (- 9.50 cr) : u|urar leroesar re||rlarg dar| |epa|a
. o|-lerpora||s ( 8.00 cr) : u|urar arlara os lerpora||s ||r| dar |arar

u|urar-u|urar s|r|urlerers|a / ||rg|ar |epa|a oay| :
1. suoo|s|p|lo-oregral||us ( 32 cr)
2. o|s|p|lo-lrorla||s ( 31 cr)
3. o|s|p|lo-rerla||s ( 35 cr)
1. suorerlo-oregral||us ( 32 cr)

ag|an tubuh jan|n yang |a|n

Per|u juga d||elaru| u|urar oag|ar oadar jar|r yarg |a|r
1. |eoar oaru (d|areler o|-acror|a||s) : 12 cr
2. ||rg|arar oaru : 31 cr
3. |eoar oo|org (d|areler |rlerlrocrarler|ca) : 12 cr
1. ||rg|arar oo|org : 2Z cr
|HANC FET0-PELV|K

Persa||nan ada|ah proses mekan|k d| mana suatu benda d|dorong me|ewat| suatu ruangan o|eh suatu tenaga.
enda yang d|dorong ada|ah bay|, ruangan yang harus d||a|u| ada|ah rongga pe|v|s, dan tenaga pendorongnya
ada|ah h|s dan kekuatan mengejan |bu.

J||a Tl0AK d|leru|ar adarya d|spropors| / |el|da|sesua|ar arlara |apas|las pe|v|s dar u|urar jar|r, ra|a persa||rar
rorra| dapal d|rarap|ar.

TETAPl JlKA A0A 0l3PR0P0R3l arlara jar|r dar pe|v|s, alau |e|a|rar |ela| (r|sa|rya ||rlarg), ra|a r|s yarg
se|ual-|ualrya dar perou|aar serv||s yarg seoesar-oesarrya se|a||pur l|da| a|ar dapal re|ar|r|ar oay| secara
l|s|o|og|s. 8ar|ar j||a d|pa|sa|ar, dapal reryeoao|ar ruplura uler| |ou, re|ros|s jar|rgar |ura| parggu| |ou,
perdararar |rlra|rar|a| oay| sarpa| |eral|ar oay| dar / alau |eral|ar |ou.

urlu| rer||a| ada / l|da|rya d|spropors| |r| d|per|u|ar perer||saar ooslelr|| yarg |erg|ap, urlu| rererlu|ar sualu
r||a| yarg d|seoul seoaga| lV8AN0 FET0 - PELvlK.
Pemer|ksaan Panggu|

lrspe|s| : ada / l|da|rya delorr|las parggu|, purggurg alau lurg|a|, |e|a|rar lu|arg parggu|
Perer||saar da|ar : rergera| oalas-oalas rorgga parggu| - prororlor|ur, ||rea |ror|rala, sp|ra |scr|ad|ca, d|rd|rg
sarp|rg, |urvalura sa|rur, ujurg sa|rur / |o|s|g|s, dar ar|us puo|s., serla rer||a| u|urar-u|urar corjugala
d|agora||s (garoar), corjugala vera, d|slarl|a |rlersp|rarur (d|areler o|sp|rosur) dar d|areler arlero-posler|or p|rlu
oaWar parggu|.
3eoa||rya pe|v|relr| |||r|| d||a|u|ar pada r|rggu |e 31-3, |arera pada saal |lu jar|rgar |ura| pe|v|s sudar cu|up
|ura| dar e|asl|s rarur oe|ur lerjad| perou|aar serv||s dar oe|ur lerjad| perururar jar|r |e da|ar rorgga
parggu|.

eberapa ukuran panggu| wan|ta yang bermakna
obstetr|k
0|amerer anreroposrer|or p|nru aras panggu| {conugara
|nrerna, conugara veraj
Jara| arlara prororlor|ur os sacrur sarpa| lep| alas
syrpr|s|s os puo|s. T|da| dapal d|u|ur secara |||r|| pada
perer||saar l|s|s. 3ecara |||r|| dapal d|u|ur corjugala
d|agora||s, jara| arlara prororlor|ur os sacrur dergar lep|
oaWar syrpr|s|s os puo|s, re|a|u| perer||saar pe|v|relr| per
vag|rar.
0|amerer oo||qua p|nru aras panggu|
Jara| dar| serd| sa|ro|||a|a salu s|s| sarpa| lorjo|ar pe|l|rea| s|s| |orlra|alera|rya (oo|||/rery||arg).
0|amerer rransversa p|nru aras panggu|
0|areler lerparjarg ||r|-|arar dar| p|rlu alas parggu|. 8u|ar surggur d|areler |arera l|da| re|a|u| l|l|| pusal p|rlu
alas parggu|.
0|amerer / o|sranr|a |nrersp|narum paoa rongga panggu|
Jara| arlara |edua ujurg sp|ra |scr|ad|ca ||r| dar |arar.
0|amerer anreroposrer|or p|nru oauan panggu|
Jara| arlara ujurg os coccyg|s sarpa| p|rgg|r oaWar syrpr|s|s os puo|s.
0|amerer rransversa p|nru oauan panggu|
Jara| arlara oag|ar da|ar dar| |edua luoeros|las os |scr||.
0|amerer sag|ra||s posrer|or p|nru oauan panggu|
Jara| arlara oag|ar lergar d|areler lrarsversa sarpa| |e ujurg os sacrur.

Perk|raan ukuran rata-rata panggu| wan|ta norma|
P|nru aras panggu| {pe|v|c |n|erj
0|areler lrarsversa (0T) 13.5 cr. Corjugala vera (Cv) 12.0 cr. Jur|ar rala-rala |edua d|areler r|r|ra| 22.0
cr.
P|nru rengan panggu| {m|o pe|v|sj
0|slars|a |rlersp|rarur (0l) 10.5 cr. 0|areler arler|or posler|or (AP) 11.0 cr. Jur|ar rala-rala |edua d|areler
r|r|ra| 20.0 cr.
P|nru oauan panggu| {pe|v|c our|erj
0|areler arler|or posler|or (AP) Z.5 cr. 0|slars|a |rlerluoerosur 10.5 cr. Jur|ar rala-rala |edua d|areler
r|r|ra| 1.0 cr.
Pemer|ksaan Jan|n

0apal d||a|u|ar pada sel|ap |urjurgar arlerala| (r|sa|rya dergar u30), rarur perer||saar yarg oerra|ra urlu|
|roarg lelo-pe|v|| ada|ar perer||saar pada saal persa||rar alau rerje|arg persa||rar.
Paoa persa||nan |erak memanang, oag|an ,ang menenrukan |moang lero-pe|v|k rerurama aoa|an kepa|a oa,|, karena
kepa|a aoa|an oag|an keras ,ang nan,a oo|en oeruoan oenruk oan menoapar rekanan oa|am oaras-oaras mou|ase
ru|ang kepa|a ,ang l|s|o|og|s {sen|ngga uga o|seour lV3/hS 0EPl/lD-PElvlrj.

{l/Tl-l/Tl . $a|an kapran rap| ser|ng o|gunakan oa|am k||n|kj
Ya|ru menenrukan perk|raan |moang lero-pe|v|k oengan oeroasarkan n||a| raks|ran oerar an|n {T3Jj, oukan
oeroasarkan ukuran o|omerr|k an|n.
0ara |n| ser|ng o|gunakan, karena memang o|amerer reroesar kepa|a an|n ,ang P/$Tl nan,a oapar o|per|ksa oengan
u$S paoana| ser|ng r|oak reroapar u$S o| k||n|k / puskesmas.

Per||a|ar |apas|las parggu| lerradap oeral jar|r |eo|r lepal d|seoul seoaga| daya akomodas| panggu|, ya|lu vo|ure
oay| leroesar yarg ras|r dapal d||ar|r|ar sporlar dar rorra| re|a|u| parggu| lerseoul, da|ar |orvers|rya lerradap
grar oeral oadar.

(||ral |u||ar 0l3T03lA)
Norra| oeral oadar oay| yarg d||ar|r|ar seorarg |ou ada|ar arlara 2500 - 1000 grar.
8ay| dergar oeral oadar |ar|r |eo|r dar| 1000 g d|seoul ra|rosor|a.
8ay| dergar oeral oadar |ar|r |urarg dar| 2500 g d|seoul oay| oeral |ar|r rerdar / 88LR.
(oeda|ar dergar preralur|las ll 88LR oe|ur lerlu preralur)

Ukuran umum | t|dak baku terhadap pembag|an berat badan bay| norma| :
- arlara 3500 - 1000 g d|go|org|ar oay| oesar,
- arlara 3000 - 3500 g lerrasu| sedarg, dar
- arlara 2500 - 3000 g lergo|org |ec||.
0ergar der|||ar (daya a|orodas|) parggu| d|seoul |uas o||a parggu| lerseoul dapal d||eWal| o|er ara| yarg oeralrya
rala-rala 3500 - 1000 g, sedarg o||a dapal d||eWal| ara| 3000 - 3500 g, serp|l o||a dapal d||eWal| ara| sarpa| 2500 -
3000 g.
Pemer|ksaan rad|o|og|k

Pe|v|relr| rad|o|og||, o|asarya d|oual 2 ouar lolo :
Foro p|nru aras panggu|
Pas|er pos|s| selergar dudu| (Trors), luoe R8 rergarar lega| |urus |e p|rlu alas parggu|. Pada lolo |r| a|ar dapal
d|||ral d|areler lrarsversa, d|slars|a |rlersp|rarur dar d|lerlu|ar jer|s pe|v|s (Ca|dWe|| - Vo|oy).
Foro |arera|
Pas|er pos|s| oerd|r| (Trors), luoe R8 d|arar|ar ror|sorla| pada lrocrarler rajor dar| sarp|rg. Pada lolo |r| a|ar
dapal d|||ral corjugala vera dar corjugala d|agora||s, d|areler arleroposler|or parggu| lergar dar p|rlu oaWar
parggu|, l|rgg| pe|v|s, d|areler sag|la||s posler|or, oerlu| sa|rur, sp|ra |scr|ad|ca dar |rc|sura |scr|ad|ca rajor.
0os|s rad|as| yarg d|gura|ar rarus dos|s arar lerradap jar|r.
KEHUNCK|NAN 0|ACN08|8 |HANC FET0-PELV|K

lmoang lero-pe|v|k {cepna|o-pe|v|kj oa|k
8erarl| parlus dapal d|rercara|ar pervag|rar.
Ves||pur der|||ar, r|s, pos|s| |epa|a dar |eadaar serv||s rarus lelap se|a|u rerdapal perral|ar se|ara parlus.

0|spropors| cepna|o-pe|v|k {0P0j
8erarl| oay| l|da| dapal d||ar|r|ar per vag|rar. J||a ara| r|dup, rarus d||a|u|ar secl|o cesarea.

remungk|nan o|spropors| cepna|o-pe|v|k {suspecreo 0P0j
Verer|u|ar perde|alar |a|r urlu| rerasl||ar r||a| |roarg, dapal dergar perer||saar rad|o|og|| alau dergar
parlus percooaar. (parlus percooaar : ||ral |u||ar d|slos|a)
F|s|o|og| Proses
Persa||nan Norma|
dr. Nugroho Kampono | dr. h. Endy H. Hoegn|
PER8AL|NAN | PARTU8

Ada|ar sualu proses perge|uarar ras|| |orseps| yarg dapal r|dup, dar| da|ar ulerus re|a|u| vag|ra alau ja|ar |a|r |e
dur|a |uar.

Partus norma| | partus b|asa
8ay| |ar|r re|a|u| vag|ra dergar |ela| oe|a|arg |epa|a / uour-uour |ec||, larpa rera|a| a|al / perlo|orgar |sl|reWa,
serla l|da| re|u|a| |ou raupur oay| (|ecua|| ep|s|olor|), oer|argsurg da|ar Wa|lu |urarg dar| 21 jar.

Partus abnorma|
8ay| |ar|r re|a|u| vag|ra dergar oarluar l|rda|ar alau a|al seperl| vers| / e|slra|s|, curar, va|ur, de|ap|las|,
eror|olor| dar seoaga|rya, alau |ar|r per aodor|rar dergar secl|o cesarea.

eberapa |st||ah
0rav|da : War|la yarg sedarg rar||
Para : War|la perrar re|ar|r|ar oay| yarg dapal r|dup (v|ao|e)
lr parlu : War|la yarg sedarg oerada da|ar proses persa||rar
8EA TERJA0|NYA PR08E8 PER8AL|NAN

1. Perururar lurgs| p|aserla : |adar progesleror dar eslroger rerurur rerdada|, rulr|s| jar|r dar| p|aserla
oer|urarg.
{paoa o|agram, oar| lancer, kok esrrogen men|ngkar ?j
2. Te|arar pada garg||or serv||a|e dar| p|e|sus Frar|errauser, rerjad| sl|ru|as| (pacera|er) oag| |orlra|s| olol
po|os ulerus.
3. ls|er|a olol-olol ulerus |arera pergarur rorrora| dar oeoar, sera||r rerargsarg lerjad|rya |orlra|s|.
1. Per|rg|alar oeoar / slress pada ralerra| raupur lela| dar per|rg|alar eslroger rerga||oal|ar per|rg|alar
a|l|l|las |orl|sor, proslag|ard|r, o|s|los|r, rerjad| percelus rargsargar urlu| proses persa||rar (0lA0RAV)

Tuo rneor|es on rne onser ol numan parrur|r|on.
/. 0orr|corrop|n-re|eas|ng normone prououceo o, rne
p|acenra |s secrereo |nro rne lera| c|rcu|ar|onano
sr|mu|ares corr|corrop|n secrer|on lrom rne anrer|or
p|ru|rar, ol rne lerus. P|acenra| 0Rl, rnrougn lera| /0Tl,
sr|mu|ares rne lera| aorena| ro proouce corr|so|, un|cn
o|nos ro rne p|acenra| g|ucocorr|co|o receprors ro o|ock
rne |nn|o|ror, ellecr ol progesrerone, lurrner sr|mu|ar|ng
0Rl prooucr|on |n sr|mu|ar|ve lasn|on.
3. Tne lera| n,porna|am|c-p|ru|rar,-aorena| ax|s |s
qu|escenr our|ng rne l|rsr na|l ol gesrar|on oecause ol |rs
suppress|on o, rne marerna| |nl|ux ol corr|so|, our our|ng
rne secono na|l ol gesrar|on, rne r|se |n oesrrogen g|ves
r|se ro rne p|acenra| enz,me ''o- n,orox,srero|o
oen,orogenase, caus|ng corr|so| ro oe converreo |nro |rs
|nacr|ve meraoo||re, corr|sone. Tne resu|r|ng negar|ve
g|ucocorr|co|o leeooack on rne lera| p|ru|rar, g|ano {|ess corr|so| passes lrom morner ro lerusj uou|o resu|r |n |ncreaseo
secrer|ons ol lera| /0Tl, corr|so| ano 0lE/ su|lare, resu|r|ng oorn |n lera| marurar|on ano sr|mu|ar|on ol parrur|r|on.

PER8AL|NAN 0|TENTUKAN 0LEh 3 FAKT0R "P" UTAHA

Pouer
l|s (|orlra|s| r|lr|s olol po|os ulerus), |e|ualar rergejar |ou, |eadaar |ard|ovas|u|ar resp|ras| relaoo||| |ou.
Passage
Keadaar ja|ar |ar|r
Passanger
Keadaar jar|r (|ela|, preserlas|, u|urar/oeral jar|r, ada/l|da| |e|a|rar aralor|| rayor)
( la|lor2 P |a|rrya : psycro|ogy, prys|c|ar, pos|l|or)
0ergar adarya |ese|roargar / |esesua|ar arlara la|lor-la|lor P lerseoul, persa||rar rorra| d|rarap|ar dapal
oer|argsurg.

PEHAC|AN FA8E | KALA PER8AL|NAN

ra|a '
Peralargar dar perou|aar serv||s sarpa| |erg|ap
(|a|a perou|aar)
ra|a 2
Perge|uarar oay| (|a|a perge|uarar)
ra|a J
Perge|uarar p|aserla (|a|a ur|)
ra|a 4
Vasa 1 jar sele|ar parlus, lerulara urlu| ooservas|

h|8

l|s ada|ar ge|oroarg |orlra|s| r|lr|s olol po|os d|rd|rg ulerus yarg d|ru|a| dar| daerar lurdus uler| d| rara luoa
la|op|| rerasu|| d|rd|rg ulerus, aWa| ge|oroarg lerseoul d|dapal dar| 'pacera|er' yarg lerdapal d| d|rd|rg ulerus
daerar lerseoul.

Resu|larle ele| gaya |orlra|s| lerseoul da|ar |eadaar rorra| rergarar |e daerar |o|us r|ror|s ya|lu daerar
|ara||s serv||a||s (ja|ar |a|r|r) yarg rerou|a, urlu| rerdororg |s| ulerus |e |uar.

Terjad|rya r|s, a||oal :
1. |erja rorror o|s|los|r
2. regargar d|rd|rg ulerus o|er |s| |orseps| 3
3. rargsargar lerradap p|e|sus saral Frar|errauser yarg lerle|ar rassa |orseps|.

l|s yarg oa|| dar |dea| re||pul| :
1. |orlra|s| s|ru|lar s|relr|s d| se|urur ulerus
2. |e|ualar leroesar (dor|ras|) d| daerar lurdus
3. lerdapal per|ode re|a|sas| d| arlara dua per|ode |orlra|s|.
1. lerdapal relra|s| olol-olol |orpus uler| sel|ap sesudar r|s
5. serv||s uler| yarg oarya| rergardurg |o|ager dar |urarg rergardurg seraoul olol,a|ar lerlar|| |e alas o|er
relra|s| olol-olol |orpus, |erud|ar lerou|a secara pas|l dar rerdalar (cerv|ca| ellacererl). 0sl|ur uler| e|slerrur
dar |rlerrur pur a|ar lerou|a.

Nyer| persa||rar pada Wa|lu r|s d|pergarur| oeroaga| la|lor :
1. |s|er|a d|rd|rg |orpus uler| yarg rerjad| sl|ru|as| seraoul saral d| p|e|sus r|pogaslr||us d|lerus|ar |e s|sler
saral pusal rerjad| sersas| ryer|.
2. peregargar vag|ra, jar|rgar |ura| da|ar rorgga parggu| dar per|loreur, rerjad| rargsarg ryer|.
3. |eadaar rerla| pas|er (pas|er oersa||r ser|rg |ela|ular, ceras/ arx|elas, alau e|s|las|).
1. proslag|ard|r rer|rg|al seoaga| respors lerradap slress

Pergu|urar |orlra|s| ulerus
1. arp||ludo : |rlers|las |orlra|s|
olol po|os : oag|ar perlara
per|rg|alar aga| cepal, oag|ar
|edua perururar aga| |aroal.
2. lre|uers| : jur|ar r|s da|ar
Wa|lu lerlerlu (o|asarya per 10
rer|l).
3. saluar r|s : ur|l Vorlev|de
(|rlers|las le|arar / rrlg
lerradap lre|uers|).

8|fat h|s pada berbaga| fase
persa||nan
ra|a ' aua| {lase |arenj
T|rou| l|ap 10 rer|l dergar
arp||ludo 10 rrlg, |ara 20-30
del||. 3erv||s lerou|a sarpa| 3 cr.
Fre|uers| dar arp||ludo lerus
rer|rg|al.
ra|a ' |anur {lase akr|lj sampa| ka|a
' akn|r
Terjad| per|rg|alar rasa ryer|,
arp||ludo ra||r |ual sarpa| 0 rrlg, lre|uers| 2-1 |a|| / 10 rer|l, |ara 0-90 del||. 3erv||s lerou|a sarpa|
|erg|ap (10cr).
ra|a 2
Arp||ludo 0 rrlg, lre|uers| 3-1 |a|| / 10 rer|l. Rel|e|s rergejar lerjad| juga a||oal sl|ru|as| dar| le|arar oag|ar
leroaWar jar|r (pada persa||rar rorra| ya|lu |epa|a) yarg rere|ar arus dar re|lur. Taroarar leraga rererar
dar| |ou, dergar |orlra|s| olol-olol d|rd|rg aodorer dar d|alragra, oerusara urlu| rerge|uar|ar oay|.
ra|a J
Arp||ludo 0-80 rrlg, lre|uers| |orlra|s| oer|urarg, a|l|l|las ulerus rerurur. P|aserla dapal |epas sporlar dar|
a|l|l|las ulerus |r|, rarur dapal juga lelap rererpe| (relers|o) dar rerer|u|ar l|rda|ar a|l|l (rarua| a|d).
PER8AL|NAN KALA 1 :
FA8E PEHATANCAN | PEHUKAAN 8ERV|K8

0lVuLAl pada Wa|lu serv||s rerou|a |arera r|s : |orlra|s| ulerus yarg leralur, ra||r |ara, ra||r |ual, ra||r
ser|rg, ra||r lerasa ryer|, d|serla| perge|uarar darar-|erd|r yarg l|da| |eo|r oarya| dar|pada darar ra|d.
8ERAKllR pada Wa|lu perou|aar serv||s le|ar |erg|ap (pada per||sa da|ar, o|o|r pors|o serv||s l|da| dapal d|raoa
|ag|). 3e|apul |eluoar o|asarya pecar sporlar pada saal a|r|r |a|a l.

Fase |aler : perou|aar sarpa| rercapa| 3 cr, oer|argsurg se||lar 8 jar.
Fase a|l|l : perou|aar dar| 3 cr sarpa| |erg|ap ( 10 cr), oer|argsurg se||lar jar. Fase a|l|l leroag| alas :
1. lase a|se|eras| (se||lar 2 jar), perou|aar 3 cr sarpa| 1 cr.
2. lase d||alas| ra|s|ra| (se||lar 2 jar), perou|aar 1 cr sarpa| 9 cr.
3. lase dese|eras| (se||lar 2 jar), perou|aar 9 cr sarpa| |erg|ap ( 10 cr).

Per|st|wa pent|ng pada persa||nan ka|a 1

1. |e|uar |erd|r / darar (o|oody sroW) a||oal ler|epasrya suroal ru|us (rucous p|ug) yarg se|ara |erar||ar
rerurpu| d| |ara||s serv||a||s, a||oal lerou|arya vas|u|ar |ap||er serv||s, dar a||oal pergeserar arlara se|apul
|eluoar dergar d|rd|rg da|ar ulerus.
2. osl|ur uler| |rlerrur dar e|slerrur lerou|a ser|rgga serv||s rer|p|s dar rerdalar.
3. se|apul |eluoar pecar sporlar (oeoerapa |epusla|aar reryeoul|ar |eluoar pecar d|r| j||a lerjad| perge|uarar
ca|rar |eluoar seoe|ur perou|aar 5 cr).

Peralargar dar perou|aar serv||s (cerv|ca| ellacererl) pada
pr|r|grav|da oeroeda dergar pada ru|l|para :
1. pada pr|r|grav|da lerjad| per|p|sar serv||s |eo|r daru|u seoe|ur
lerjad| perou|aar - pada ru|l|para serv||s le|ar |ura| a||oal persa||rar
seoe|urrya, ser|rgga |argsurg lerjad| proses per|p|sar dar
perou|aar
2. pada pr|r|grav|da, osl|ur |rlerrur rerou|a |eo|r du|u dar|pada
osl|ur e|slerrur (|rspe|u|o osl|ur larpa| oeroerlu| seperl| ||rg|arar
|ec|| d| lergar) - pada ru|l|para, osl|ur |rlerrur dar e|slerrur rerou|a oersaraar (|rspe|u|o osl|ur larpa|
oeroerlu| seperl| gar|s |eoar)
3. per|ode |a|a 1 pada pr|r|grav|da |eo|r |ara ( 20 jar) d|oard|rg|ar ru|l|para (11 jar) |arera peralargar dar
pe|ura|ar serv||s pada lase |aler pas|er pr|r|grav|da rerer|u|ar Wa|lu |eo|r |ara.
PER8AL|NAN KALA 2 :
FA8E PENCELUARAN AY|

0lVuLAl pada saal perou|aar serv||s le|ar |erg|ap.
8ERAKllR pada saal oay| le|ar |ar|r |erg|ap.
l|s rerjad| |eo|r |ual, |eo|r ser|rg, |eo|r |ara, sargal |ual.
3e|apul |eluoar rurg||r juga oaru pecar sporlar pada aWa| |a|a 2.

Per|st|wa pent|ng pada persa||nan ka|a 2

1. 8ag|ar leroaWar jar|r (pada persa||rar rorra| : |epa|a) lurur sarpa| dasar parggu|.
2. lou l|rou| perasaar / rel|e|s |rg|r rergejar yarg ra||r oeral.
3. Per|reur reregarg dar arus rerou|a (reroro|d l|s|o|og||)
1. Kepa|a d||ar|r|ar |eo|r du|u, dergar suoo|s|pul d| oaWar s|rl|s|s (s|rl|s|s puo|s seoaga| surou pular /
r|poro|||or), se|arjulrya d||ar|r|ar oadar dar arggola oadar.
5. Kerurg||rar d|per|u|ar perolorgar jar|rgar per|reur urlu| rerperoesar ja|ar |ar|r (ep|s|olor|).

Lara |a|a 2 pada pr|r|grav|da 1.5 jar, ru|l|para 0.5 jar.

Cerakan utama penge|uaran jan|n pada persa||nan
dengan |etak be|akang kepa|a

1. Kepa|a rasu| p|rlu alas parggu| : surou |epa|a
jar|r dapal lega| |urus dergar p|rlu alas parggu|
(s|r|||l|srus) alau r|r|rg / reroerlu| sudul dergar
p|rlu alas parggu| (as|r|||l|srus arler|or / posler|or).
2. Kepa|a lurur |e da|ar rorgga parggu|, a||oal : 1)
le|arar |argsurg dar| r|s dar| daerar lurdus |e arar
daerar oo|org, 2) le|arar dar| ca|rar arr|or, 3)
|orlra|s| olol d|rd|rg perul dar d|alragra (rergejar),
dar 1) oadar jar|r lerjad| e|slers| dar reregarg.
3. F|e|s| : |epa|a jar|r l|e|s|, dagu rererpe| |e lora|s,
pos|s| |epa|a oeruoar dar| d|areler o|s|p|lo-lrorla||s
(purca| |epa|a) rerjad| d|areler suoo|s|p|lo-
oregral||us (oe|a|arg |epa|a).
1. Rolas| |rlerra (pularar pa|s| da|ar) : se|a|u d|serla|
lururrya |epa|a, pularar uour-uour |ec|| |e arar depar
(|e oaWar s|rl|s|s puo|s), reroaWa |epa|a re|eWal|
d|slars|a |rlersp|rarur dergar d|areler o|par|ela||s.
5. E|slers| : sele|ar |epa|a rercapa| vu|va, lerjad|
e|slers| sele|ar o|s|pul re|eWal| oaWar s|rl|s|s puo|s
oag|ar posler|or. Lar|r oerlurul-lurul : o|s|pul, oregra,
dar|, r|durg, ru|ul, dagu.
. Rolas| e|slerra (pularar pa|s| |uar) : |epa|a oerpular
|eroa|| sesua| dergar surou rolas| luour, oaru rasu|
p|rlu alas parggu| dergar pos|s| arleroposler|or sarpa|
d| oaWar s|rl|s|s, |erud|ar d||ar|r|ar oaru depar dar
oaru oe|a|arg.
Z. E|spu|s| : sele|ar oaru |ar|r, oag|ar luour |a|rrya
a|ar d||e|uar|ar dergar rudar. 3e|arjulrya |ar|r oadar (lora|s,aodorer) dar |ergar, p|rggu| / lro|arler depar dar
oe|a|arg, lurg|a| dar |a||.
PER8AL|NAN KALA 3 :
FA8E PENCELUARAN PLA8ENTA

0lVuLAl pada saal oay| le|ar |ar|r |erg|ap.
8ERAKllR dergar |ar|rrya p|aserla.
Ke|ar|rar p|aserla : |epasrya p|aserla dar| |rsers| pada d|rd|rg ulerus, serla perge|uarar p|aserla dar| |avur uler|.
Lepasrya p|aserla dar| |rsers|rya : rurg||r dar| serlra| (3cru|lze) d|larda| dergar perdararar oaru, alau dar| lep| /
rarg|ra| (VallreWs-0urcar) j||a l|da| d|serla| perdararar, alau rurg||r juga sererpa| serlra| dar rarg|ra|.
Pe|epasar p|aserla lerjad| |arera per|e|alar p|aserla d| d|rd|rg ulerus ada|ar oers|lal adres|, ser|rgga pada saal
|orlra|s| rudar |epas dar oerdarar.
Pada |eadaar rorra|, |orlra|s| ulerus oerlaroar |eras, lurdus sel|rgg| se||lar / d| alas pusal.
P|aserla |epas sporlar 5-15 rer|l sele|ar oay| |ar|r.
(j||a |epasrya p|aserla lerjad| seoe|ur oay| |ar|r, d|seoul so|us|o/aorupl|o p|acerlae - |eadaar gaWal darural ooslelr||
ll).
KALA 4 :
08ERVA8| PA86APER8AL|NAN

3arpa| dergar 1 jar poslparlur, d||a|u|ar ooservas|.

Z po|o| perl|rg yarg rarus d|perral||ar pada |a|a 1 :
1) |orlra|s| ulerus rarus oa||,
2) l|da| ada perdararar pervag|rar alau dar| a|al ger|la| |a|r,
3) p|aserla dar se|apul |eluoar rarus sudar |ar|r |erg|ap,
1) |ardurg |erc|rg rarus |osorg,
5) |u|a-|u|a d| per|reur rarus d|raWal dar l|da| ada reralora,
) resure |eadaar urur oay|, dar
Z) resure |eadaar urur |ou.
Partograf
dr.h. |yan 8ut|a w|raatmadja
PART0CRAF

Parlogral ada|ar a|al percalalar persa||rar,
urlu| rer||a| |eadaar |ou, jar|r dar se|urur
proses persa||rar.
Parlogral d|gura|ar urlu| rerdele|s| j||a ada
pery|rpargar / rasa|ar dar| persa||rar,
ser|rgga rerjad| parlus aororra| dar
rerer|u|ar l|rda|ar oarluar |a|r urlu|
rerye|esa||ar persa||rar.

Parlogral rerupa|ar |eroarar lorr dergar
oeroaga| gral|| dar |ode yarg rerggaroar|ar
oeroaga| parareler urlu| rer||a| |erajuar
persa||rar.
0aroarar parlogral d|ryala|ar dergar gar|s
l|ap parareler (verl||a|) lerradap gar|s
perja|arar Wa|lu (ror|sorla|).
ahaya | komp||kas| persa||nan su||t |
abnorma|
1. |eral|ar |ou alau |eral|ar oay| alau
|eduarya
2. ruplura uler|
3. |rle|s| / seps|s puerpera|
1. perdararar poslparlur
5. l|sle|
PART0CRAF wh0 (oaca juga ou|u
Prol.0r.3udraj| 3urapraja)

3esua| slardar|sas| wl0 (wor|d lea|lr
0rgar|zal|or), urlu| d|gura|ar d| pe|oso|-
pe|oso| regara oer|eroarg alau r|s||r,
supaya rudar d|gura|ar o|er pe|ayar
|eseralar d| sarara leroalas.
J||a d|r||a| ada rasa|ar yarg rerer|u|ar |rlervers|, dapal segera d|usara|ar urlu| d|ruju| |e pusal |eseralar yarg
|eo|r oa||.
0ergar parlogral wl0 dapal d|r||a| |apar d|per|u|ar l|rda|ar urlu| rerye|esa||ar proses persa||rar dergar :
1) per|u/l|da|rya d|ruju|,
2) per|u/l|da|rya |rdu|s| |rlus o|s|los|r, dar
3) per|u/l|da|rya operas| secl|o cesarea.

Pere||l|ar parlogral wl0 d||a|u|ar ru|l|serlra| d| lrdores|a (1 rurarsa||l), Tra||ard (2 rurarsa||l) dar Va|ays|a (2
rurarsa||l) se|ara 15 ou|ar (Jaruar| 1990 - Varel 1991), rergras|||ar rodu| / lorr parlogral yarg se|ararg
oarya| d|pa|a| d| rara-rara.

CAR|8 wA8PA0A | T|N0AKAN
1) daerar seoe|ar ||r| gar|s Waspada rerupa|ar gar|s ooservas|
2) daerar d| arlara gar|s Waspada dar gar|s l|rda|ar rerupa|ar daerar per|u perl|roargar urlu| reruju| alau
rergaro|| l|rda|ar,
3) daerar d| seoe|ar |arar gar|s l|rda|ar ada|ar daerar rarus segera oerl|rda|.
KAPAN PART0CRAF 0||8| ?

Partograf mu|a| d||s| b||a
Vere|a yarg rasu| da|ar persa||rar :
1. lase |aler (perou|aar < 3 cr), r|s leralur, lre|uers| r|r.2x/10', |ararya<20.
2. lase a|l|l (perou|aar >3cr), r|s leralur, lre|uers| r|r.1x/10', |ararya<20.
Vasu| dergar |eluoar pecar sporlar larpa adarya r|s :
1. o||a |rlus o|s|los|r d|ru|a|
2. o||a persa||rar d|ru|a|
Vasu| urlu| |rdu|s| persa||rar :
1. perecarar |eluoar (arr|olor|) dergar alau larpa |rlus o|s|los|r
2. |rdu|s| red|s (|rlus o|s|los|r, oa|or |aleler alau peroer|ar proslag|ard|r)
3. o||a persa||rar d|ru|a| alau |rdu|s| d|ru|a| alau |eluoar pecar.

Partograf t|dak per|u d||s| b||a
1. Vasu| dergar |a|a 1 a|r|r lase a|l|l perou|aar 9 cr alau |eo|r
2. 3ecl|o cesarea e|e|l|l
3. 3ecl|o cesarea darural saal dalarg
1. us|a |erar||ar |urarg dar| 31 r|rggu
H0N|T0R PA0A PART0CRAF

Frekuens| denyut jantung jan|n
Norra| arlara 120-10 |a|| per rer|l.
Laporar dergar reroer| larda pada lorr gral||
sesua| lre|uers| jarlurg pada gar|s Wa|lu.

8e|aput | ca|ran ketuban
0|r||a| apa|ar se|apul |eluoar ras|r ulur alau
sudar pecar, j||a sudar pecar dar |e|uar d|r||a|
Warra ca|rar |eluoarrya.
Kode dergar rurul da|ar ||rg|arar.
(u) alau () : se|apul |eluoar ulur
(-) : se|apul |eluoar pecar / l|da| leraoa
warra ca|rar : jerr|r (J), r|jau (l), rerar (V)
J||a |er|rg/l|da| ada ca|rar : rurul (K).

Hou|age kepa|a jan|n
0|raoa l|sura arlara lu|arg-lu|arg |epa|a, d||apor|ar da|ar arg|a (1) sarpa| (1) rerurul derajalrya, alau o||a l|da|
ada rou|age, oer| larda (-).

Pembukaan serv|ks
Kode dergar larda s||arg (X) pada lorr gral|| sesua| perou|aar serv||s pada gar|s Wa|lu.
Fase |aler parlus |a|a 1 arlara 0 sarpa| 8 jar sarpa| dergar perou|aar 3 cr.
Fase a|l|l se||lar Z jar, dergar perr|lurgar alau rarapar rerou|a 1 cr sel|ap jar sarpa| |erg|ap.
3eoa||rya perer||saar da|ar d||a|u|ar sel|ap 1 jar pada lase |aler, dar l|ap 3 jar pada lase a|l|l. Per||raar rasu|
|a|a 2 dapal dar| ooservas| j||a ada larda-larda |||r|s |a|r.

Penurunan presentas| (pada persa||nan norma| :
kepa|a} jan|n
0apal dar| perer||saar Leopo|d saja raupur dar|
|orl|rras| perer||saar da|ar, d|r||a| da|ar oerapa
per||raar oag|ar |epa|a jar|r yarg ras|r oerada d| |uar
p|rlu alas parggu| (5/5 oe|ur rasu|, sarpa| 0/5 sudar
rasu|).
Kepa|a d|seoul ergaged o||a oag|ar leroesar |epa|a sudar rasu| p|rlu alas parggu|.

h|s
0|per||sa dergar reraoa d|rd|rg rar|r d| alas uro||||us. Fre|uers| d|r|lurg oerapa |a|| da|ar per 10 rer|l, dar
oerapa |ara |orlra|s|rya.
las||rya d|garoar|ar pada lorr gral|| r|s sesua| gar|s Wa|lu perer||saar.
0aroar |s| |ola| sesua| jur|ar / lre|uers| : |s| |ola| dergar l|l||-l|l|| urlu| |ara |urarg dar| 20 del||, dergar ars|r
gar|s urlu| |ara 20-10 del||, dar dergar o|o| urlu| |ara |eo|r dar| 10 del||.

0bat-obatan | ca|ran yang d|gunakan
0|lu||s|ar da|ar |o|or ooal / ca|rar yarg d|gura|ar sesua| gar|s Wa|lu.

Pemer|ksaan tanda v|ta| |bu
Te|arar darar (dergar parar alas oaWar urlu| s|slo||| d|aslo|||), rad| (l|l||), suru (derajal Ce|c|us), lre|uers|
perrapasar.

Ur|ne
Jur|ar (cc), prole|rur|a ( / - ), aselor.
J||a rerurg||r|ar, urlu| lujuar pra|l|s, gura|ar |erlas ce|up oeroaga| |rd||alor (slr|p-lesl) : dapal juga rerdele|s|
pl, g|u|osa, o|||ruo|r, |eu|os|l-eslerase dar seoaga|rya, da|ar salu |a|| perer||saar |erlas yarg d|ce|up|ar.
P|mp|nan Proses
Persa||nan Norma|
dr.8|rar Allard| / dr. 0W|ara 0cv|yarl| / dr.E|a Rusd|arlo 0.
TUCA8 00KTER PA0A 8AAT PER8AL|NAN

VergaWas| dar rerdarp|rg| War|la |r parlu seoa||-oa||rya, serla rer||a| apa|ar ada ra|-ra| yarg rery|rparg dar|
proses persa||rar rorra|.
J||a persa||rar rery|rparg dar| rorra|, do|ler rarus dapal rerercara|ar dar re|a|sara|ar l|rda|ar-l|rda|ar
yarg d|per|u|ar urlu| reroarlu rerye|esa||ar proses persa||rar.
Pr|ns|p !!
Aseps|s dar arl|seps|s daerar vu|va dar per|reur serla serua a|al-a|al yarg d|gura|ar, urlu| percegarar |rle|s|.

3aca uga moou| $/FE VDTlERlDD0 renrang Persa||nan /man.
P|HP|NAN PER8AL|NAN PA0A KALA 1

Kardurg |er|r dar re|lur d||osorg|ar.
Pergosorgar re|lur dapal d|oarlu dergar |||sra ca|rar g||ser|r 20-10cc alau supos|lor|a.

Perer||saar |uar, lerlu|ar |ela| dar preserlas| jar|r.
0oservas| r|s dergar reraoa ulerus daerar lurdus, ||ra-||ra d| alas uro||||us.
0oservas| oury| jarlurg jar|r dergar aus|u|las| Laerrec alau 0opp|er (j||a rerurg||r|ar, r||a| |esejarleraar jar|r
dergar e|e|lro|ard|olo|ogral|, |arera dapal d||elaru| peruoarar po|a lre|uers| deryul jarlurg jar|r pada saal r|s
dar pada saal d| |uar r|s)

Perer||saar da|ar, d|r||a| oeoerapa ra| yarg perl|rg :
1. d|rd|rg vag|ra : ada|ar oag|ar reryerp|l, rassa / |es| d| ja|ar |ar|r
2. |eadaar dar perou|aar serv||s
3. |apas|las parggu|, serla per||raar oesar |epa|a lerradap parggu| (suspe| d|spropors| sela|ope|v||)
1. l|uor a|ous, larda-larda radarg
5. |eadaar se|apul |eluoar, sudar pecar alau oe|ur
. |ela| dar preserlas| jar|r (pa||rg perl|rg)
Z. lururrya |epa|a da|ar ruarg parggu| (o|darg lodge)

P|rp|rar pada |a|a l oerlujuar :
1. rer||a| sarpa| d| rara slalus persa||rar pada saal perer||saar aWa| - apa|ar sudar rerasu|| persa||rar alau
oe|ur, o||a sudar, sarpa| d| rara parlus le|ar oer|argsurg
2. rerper||ra|ar progros|s |eoerras||ar parlus sporlar pervag|rar, alau |erurg||rar d|per|u|arrya l|rda|ar |a|r
urlu| reroarlu persa||rar.

lou d|arjur|ar oeroar|rg r|r|rg |e s|s| d| rara purggurg jar|r oerada, lujuarrya urlu| rerperrudar lururrya
|epa|a dar pularar pa|s| da|ar, serla urlu| rercegar lerle|arrya aorla aodor|ra||s o|er rassa ulerus yarg dapal
rerggarggu vas|u|ar|sas| |e ulerus dar jar|r.
lou 0lLARAN0ll rergedar / rererar.

Pero|org rerg|s| parlogral |erajuar persa||rar.
Pero|org rerpers|ap|ar a|al-a|al oarlu persa||rar.

Per||a|ar per|reur yarg reregarg dar rer|p|s, serla per||a|ar arus. J||a arus ourdar alau serupa rurul 0, larda
|epa|a sudar rerdar d| dasar parggu|.
8||a |eluoar oe|ur pecar sporlar, d|pecar|ar (arr|olor|)

lou d|p|rp|r rererar (urlu| reroual |orlra|s| d|rd|rg aodorer dar d|alragra rere|ar
ulerus)
Cara rererar : |ou pos|s| le|erlarg, dergar |edua |ergar rerarg|u| |edua ||pal para, |erer
da|ar |eadaar |eras dar |epa|a l|e|s|, rala lerou|a. 0apal juga dergar pos|s| r|r|rg |e
sarp|rg dergar s||ap yarg sara. Vererar / rergedar se|ual-|ualrya sesua| l|rou|rya
r|s, dar d|rerl||ar / |sl|raral pada saal re|a|sas| r|s.

J||a per|reur |a|u dar legarg, d||a|u|ar ep|s|olor| (|rs|s| pada per|reur dergar gurl|rg),
urlu| rerperoesar ja|ar |ar|r. lrs|s| dapal secara red|ara (pada gar|s lergar, oa||
d||a|u|ar pada ru|l|para), red|o|alera||s (pada gar|s lergar dar d|per|uas |e |alera| saal
rerde|al| arus, oa|| d||a|u|ar pada pr|r|), alau |alera||s (|argsurg r|r|rg lerradap surou
per|reur, dapal reroer||ar perou|aar yarg leroesar, |adarg d||a|u|ar pada |eadaar
d|rercara|ar e|slra|s| lorceps alau e|slra|s| va|ur).
0apal lerjad| |orp|||as| oerupa ruplura per|re| lola||s (rooe|ar per|reur lerous sarpa| r.sl|rgler ar|, oar|ar
|adarg sarpa| ru|osa re|lur).

Kerud|ar 8AYl 0lLAllRKAN dergar pegargar dar gera|ar yarg
lerarg dar rarlap, rergusara|ar lraura persa||rar ser|r|ra|
rurg||r oag| |ou raupur oay|rya.
3edapal rurg||r gera|ar pero|org rerg||ul| |rara r|s dar
|e|ualar rergedar |ou, saro|| rergerda|||ar |e|uarrya oay| serla
rerarar per|reur |ou (perasal R|lger - garoar).

3ele|ar |epa|a oay| |ar|r, oers|r|ar ja|ar rapas
dergar cara rerye|a r|durg dar ru|ul dergar
|a|r oers|r (arar goso|ar dar| alas r|durg sarpa| |e oaWar ru|ul, |erud|ar jar| yarg d||ap|s| |a|r d|rasu||ar |e
da|ar ru|ul).
Kerud|ar d||ar|r|ar oerlurul-lurul |erer, oaru dar |ergar, oadar, lurg|a| dar |a||.
3K0R AP0AR oay| d|r||a|, rercara|ar dar |a|u|ar l|rda|ar yarg rurg||r d|per|u|ar urlu| resus|las| oay| oaru |ar|r.
N||a| s|or Apgar pada rer|l perlara dar rer|l |e||ra.
Pr|ns|p perawatan segera bay| baru |ah|r (|mmed|ate care of the newborn} :
1. 0ry|rg
2. warr|rg
3. Pos|l|or|rg
1. 3ucl|or|rg
5. lderl|l|cal|or
. Propry|ax|s

Kerud|ar la|| pusal d|jep|l d| dua lerpal oerde|alar dar d|polorg d|
lergar-lergarrya (garoar). Lu|a polorgar d|raWal, d|||al dar d|lulup.

Ta|| pusal yarg rergruourg|ar uro||||us oay| dergar p|aserla, |adarg-
|adarg lerdapal ||||lar. J||a saal oaru |epa|a dar |erer yarg
d||ar|r|ar larpa| ada ||||lar, per|u d|oeoas|ar du|u seoe|ur
re|arjul|ar perge|uarar oay|. J||a ||||lar ler|a|u eral, la||pusal d|jep|l
dar d|polorg |argsurg d| de|al |erer oay| (garoar).

8eoerapa |epusla|aar rergarjur|ar perurdaar perjep|lar/
perolorgar la|| pusal se|ara oeoerapa del|| (de|ayed c|arp|rg),
alau pergalurar pos|s| |el|rgg|ar oay| lerradap |ou, alau
pergurular la|| pusal |e arar oay|.
Tujuarrya ada|ar urlu| reraroar vo|ure vas|u|ar|sas| oay| seoe|ur d||a|u|ar perolorgar, r|sa|rya pada oay|
preralur alau oeral oadar rerdar - rarur ra|-ra| |r| ras|r |orlrovers|a| (||ral rarajerer a|l|l |a|a 3).

"The act|ve management on the th|rd stage of |abour" (wh0}
/cr|ve managemenr nere |s oel|neo as a package ol |nrervenr|on, |nc|uo|ng .
'. /om|n|srrar|on ol propn,|ar|c ox,roc|c / ureroron|c |mmeo|are|, u|rn or snorr|, alrer rne o|rrn ol rne oao,.
2. Ear|, coro c|amp|ng ano curr|ng
J. 0onrro||eo coro rracr|on ro oe||ver rne p|acenra.

Ke|ar|rar p|aserla : |epasrya p|aserla dar| |rsers| pada d|rd|rg ulerus, serla perge|uarar p|aserla dar| |avur uler|.
Lepasrya p|aserla dar| |rsers|rya : rurg||r dar| serlra| (3cru|lze) d|larda| dergar perdararar oaru, alau dar| lep| /
rarg|ra| (VallreWs-0urcar) j||a l|da| d|serla| perdararar, alau rurg||r juga sererpa| serlra| dar rarg|ra|.
8eoerapa cara urlu| rer||a| p|aserla sudar / oe|ur |epas :
Kuslrer : la|| pusal d|regarg|ar dergar salu largar, daerar supras|rl|s|s d|le|ar dergar largar |a|rrya, d|r||a|
ada/l|da|rya
respor dar| regargar la|| pusal.
3lrassrar : la|| pusal d|regarg|ar dergar salu largar, daerar lurdus uler| d||elu|2 dergar largar |a|rrya, d|r||a|
ada/l|da|rya respor pada regargar la|| pusal.
K|e|r : |ou d|surur rererar, a|ar larpa| ujurg la|| pusal oergera| lurur, dar |el||a rererar d|rerl||ar, j||a ujurg
la|| pusal ra|| |eroa|| oerarl| p|aserla oe|ur |epas.

J||a |ara re|eo|r| 15 rer|l p|aserla oe|ur |e|uar, ATAu j||a lerjad| perdararar ras|l, d||a|u|ar raruver urlu|
segera rerge|uar|ar p|aserla, dapal dergar cara :
1. la|| pusal d|lar|| (lelap| oarya| |epusla|aar
Tl0AK rergarjur|ar, |arera dapal pulus d|
da|ar reryeoao|ar perdararar oeral, dar
dapal juga lerjad| |rvo|us| uler| |arera d|rd|rg
|orpus uler| ||ul lerlar|| |e |uar a||oal per|e|alar
p|aserla yarg eral)
2. cara Crede : ulerus d|p|jal pada lurdus dergar la|| pusal
d|legarg|ar
3. cara 8rardl-ArdreWs : ulerus d|le|ar d| aodorer d| daerar
lurdus, |erud|ar d| daerar supras|rl|s|s alau suouro||||a| |e arar
|rar|odorsa| (arar le|arar reroerlu| sudul |e oe|a|arg / verleora
dar |e alas / |epa|a) saro|| la|| pusal d|legarg|ar.
1. cara rarua| : salu largar reregarg|ar la|| pusal, largar |a|r
rasu| reryusur la|| pusal |e da|ar |avur uler|, rercar| |rsers|
p|aserla lerradap d|rd|rg ulerus |erud|ar d|s|s|r|ar secara rarua|
dar d||e|uar|ar |ese|ururar.

3ele|ar p|aserla |e|uar d|per||sa :
1. u|urar, oeral, oerlu|, |ors|slers|, Warra, |e|erg|apar rassa p|aserla
2. ada/l|da| |oous asesor|us, |rlar|, perdararar, luror, rodu|
3. la|| pusal : parjarg, |rsers|, jur|ar perou|ur darar, lroroos|s, ||||lar / s|rpu|, wrarlor's je||y

J||a d|cur|ga| ras|r ada s|sa da|ar |avur uler|, d||a|u|ar e|sp|oras| |ag| dergar rarua| urlu| rerge|uar|ar
s|sarya. 3|sa jar|rgar p|aserla alau se|apul |or|oarr|or da|ar |avur uler| dapal rerjad| suroer perdararar yarg
lerou|a serla dapal rerggarggu |orlra|s| ulerus yarg opl|ra|.
J||a cur|ga ada palo|og| lerlerlu pada p|aserla : per||sa palo|og| aralor| (|ao).

3arpa| dergar 1 jar poslparlur, d||a|u|ar ooservas|.

J||a lerjad| perdararar, rercara|ar dar |a|u|ar
l|rda|ar-l|rda|ar urlu| oerusara rergrerl||ar
perdararar segera :
1. |rje|s| relergorelr|r ra|eal (relerg|r) |rlrarus|u|ar
2. |orpres| ulerus o|rarua| (Easlrar)
3. e|sp|oras| s|sa p|aserla / se|apul jar|r da|ar |avur
uler|
1. e|sp|oras| |erurg||rar rooe|ar ja|ar |ar|r |a|rrya
5. |u|a ep|s|olor| alau rooe|ar ja|ar |ar|r |a|rrya d|raWal
. dapal juga d||a|u|ar perasargar larpor ulerovag|ra|
Z. j||a perdararar ras|l / l|da| ler|erda||, perl|roargar urlu| operas| r|slere|lor| (a|lerral|l TERAKllR)

PENTlN0 lll
Lu|a ep|s|olor| alau rooe|ar ja|ar |ar|r |a|rrya
d|raWal dergar oa||.
J||a lerjad| ruplura per|re| lola||s (RPT), reparas|
re|lur dar rus|u|us sl|rgler ar| d||a|u|ar |eo|r
du|u, oaru d||a|u|ar reparas| vu|va/vag|ra dar
per|reur

{gamoar . rekn|k an|ran reparas| |uka ep|s|orom|j
7 pokok pent|ng yang harus d|perhat|kan pada
ka|a 4 :
1. |orlra|s| ulerus rarus oa||,
2. l|da| ada perdararar pervag|rar alau dar| a|al
ger|la| |a|r,
3. p|aserla dar se|apul |eluoar rarus sudar |ar|r
|erg|ap,
1. |ardurg |erc|rg rarus |osorg,
5. |u|a-|u|a d| per|reur rarus d|raWal dar l|da| ada
reralora,
. resure |eadaar urur oay|
Z. resure |eadaar urur |ou.

Yarg lerperl|rg ada|ar rerjaga |ou dar oay| da|ar
|eadaar yarg oa||.

3aca uga ku||an /nesres|o|og| / Per|naro|og| renrang Resus|ras| heonarus, oan Voou| $/FE VDTlERlDD0 renrang
Persa||nan /man.
Hasa N|fas dan Laktas|
(Per|ode Pasca Persa||nan}
dr. 8|t| 0hyant| w|shnuwardhan| | dr. h. Huk| Reksoprodjo
N|FA8

Per|ode r|rggu pasca persa||rar, d|seoul juga rasa |rvo|us| (per|ode d| rara
s|sler reprodu|s| War|la poslparlur |eroa|| |epada |eadaarrya seperl| seoe|ur
rar||).
0| rasyara|al lrdores|a : per|ode 10 rar|.
PERUAhAN PA0A HA8A N|FA8 | PA86APER8AL|NAN

Uterus
Korlra|s| ulerus rer|rg|al sele|ar oay| |e|uar.
la| |r| reryeoao|ar |s|er|a pada |o|as| per|e|alar p|aserla (p|acerla| s|le)
ser|rgga jar|rgar per|e|alar arlara p|aserla dar d|rd|rg ulerus re|ros|s dar
|epas.
u|urar ulerus rergec|| |eroa|| (sele|ar 2 rar| pascapersa||rar, sel|rgg| se||lar uro||||us, sele|ar 2 r|rggu rasu|
parggu|, sele|ar 1 r|rggu |eroa|| pada u|urar seoe|ur rar||).
J||a sarpa| 2 r|rggu poslparlur ulerus oe|ur rasu| parggu|, cur|ga ada suo|rvo|us|. 3uo|rvo|us| dapal d|seoao|ar
o|er |rle|s| alau perdararar |arjul (|ale poslparlur raerorrrage).
J||a lerjad| suo|rvo|us| dergar |ecur|gaar |rle|s|, d|oer||ar arl|o|ol||a. urlu| rerperoa||| |orlra|s| ulerus dapal
d|oer||ar urlerolor||a (ergorelr|r ra|eal), rarur ergorelr|r rerpurya| ele| sarp|rg rergraroal produ|s| |a|las|
|arera rergraroal produ|s| pro|a|l|r.

$erv|ks urer|
lrvo|us| serv||s dar segrer oaWar ulerus pascapersa||rar 8ER8E0A dar l|da| |eroa|| seperl| pada |eadaar
seoe|ur rar||.
Pada ru|||para, |srus segrer oaWar ulerus rer||||| d|rd|rg sejajar (uu), |erud|ar sele|ar re|ar|r|ar (parous),
d|rd|rg rergurcup (vv).
Kara||s serv||a||s juga rerjad| |eo|r |eoar dar |orggar, ser|rgga osl|ur uler| e|slerrur larpa| l|da| |ag| oerupa l|l||
alau ||rg|arar |ec|| (seperl| pada ru|||para) lap| oerupa gar|s ror|sorla| aga| |eoar (d|seoul parous cerv|x).
vasku|ar|sas| urerus oan aoneksa yarg pada |eadaar rar|| dar persa||rar oerlaroar oarya|, |eroa|| oer|urarg
sarpa| |eadaar seperl| seoe|ur rar||.

Enoomerr|um
Erdorelr|ur rergada|ar regereras| cepal, da|ar Wa|lu 2-3 rar| s|sa |ap|sar des|dua le|ar oeregereras| (|ap|sar
s|s| d||rd|rg ulerus rerjad| jar|rgar erdorelr|ur oaru, |ap|sar s|s| |avur uler| rerjad| re|rol|| dar |e|uar seoaga|
|ocr|a). Regereras| erdorelr|ur |erg|ap |eroa|| sarpa| se||lar r|rggu |el|ga poslparlur. Kecua|| pada daerar
lerpal per|e|alar p|aserla, lerjad| lrorous ser|rgga regereras| aga| |eo|r |ara, sarpa| se||lar r|rggu.

8a|p|ng | Tuba Fa|op||
Pada persa||rar yarg l|da| oers|r, ser|rg lerjad| |rle|s| aserders dar reryeoao|ar sa|p|rg|l|s a|ul sarpa| 2 r|rggu
poslparlur. J||a lerjad|, ra| |r| sargal rergraroal proses |rvo|us|, ser|rg sarpa| rarus d||a|u|ar sa|p|rge|lor|
(d|polorg).

0arah |och|a
Locr|a ada|ar ca|rar rergardurg s|sa jar|rgar ulerus / oag|ar re|rol|| yarg |e|uar. Norra| oerlurul-lurul se|ara
rasa r|las |e|uar |ocr|a Warra rerar (ras|r oercarpur darar), |erud|ar |ur|rg, |erud|ar pul|r. Locr|a rorra|
Tl0AK oeroau. J||a oeroau d|cur|ga| ada |rle|s|.

Vag|na
Pada r|rggu |el|ga, vag|ra rergec|| dar l|rou| rugae |eroa||.

0|nd|ng abdomen
3lr|ae dar l|aooy yarg lerjad| pada |erar||ar oer|urarg.

8a|uran kenc|ng
Keroa|| rorra| da|ar Wa|lu 2 sarpa| 8 r|rggu, lergarlurg pada 1) |eadaar/ slalus seoe|ur persa||rar 2) |ararya
parlus |a|a 2 d||a|u|, 3) oesarrya le|arar |epa|a yarg rere|ar pada saal persa||rar.

La|n-|a|n
8eral oadar |ou a|ar rerurur oerlarap |arera ca|rar e|slravas|u|er yarg d|ouarg.
lou per|u l|dur 8 - 12 jar per rar|, dergar oarya| Wa|lu |sl|raral d| s|arg rar|.
V|rur seoarya| 1500 r| per rar|, dergar ra|arar laroarar r|rgga rercapa| 2100 |a|or| per rar| urlu| rercu|up|
|eoulurar se|ara reryusu|.
Arou|as| / roo|||sas| d||a|u|ar pada rar| perlara poslparlur o||a rasa peral le|ar r||arg. la| |r| a|ar rergurarg|
rasa|ar r||s| dar dele|as|.

la|-ra| |a|r / rasa|ar / |e|urar yarg ada d|perral||ar dar d|largar|.
Perer||saar rul|r re||pul| |eadaar urur dar larda v|la|, serla l|rgg| lurdus.

Pergooalar yarg per|u d|perral||ar ada|ar peroer|ar lao|el oes|, rerg|rgal 50 |ou rar|| dar oersa||r d| lrdores|a
rerga|ar| arer|a.

hat|-hat| dengan |nfeks| | demam n|fas.
|nfeks| n|fas : serua peradargar yarg d|seoao|ar o|er rasu|rya |urar |e da|ar a|al ger|la||a pada Wa|lu
persa||rar dar r|las (puerpera| |rlecl|or / puerpera| seps|s).
Febr|s puerpera||s : derar sarpa| 38oC alau |eo|r (pergu|urar suru ora|) se|ara 2 rar| da|ar 10 rar| perlara
pascapersa||rar, |ecua|| pada rar| perlara.
Arl|o|ol||a lANYA d|oer||ar o||a d|pasl||ar ada |rle|s| alau ada pred|spos|s| |rle|s| (|eluoar pecar, |rle|s|
|rlraparlur, parlus |ara, l|rda|ar operas| dar seoaga|rya).

3aca uga Voou| $/FE VDTlERlDD0 renrang Pengauasan h|las oan
Vanaemen lakras|
HENYU8U| | LAKTA8|

Payudara | Hammae
0rgar |e|erg|apar reprodu|s|. (oeoerapa |epusla|aar l|da|
rerggo|org|ar payudara da|ar s|sler reprodu|s| War|la).
Per|eroargar eror|o|og| rarrae oerasa| dar| ecloderr r|dge,
oer|eroarg rerjad| 15-25 |oous yarg lerd|r| dar| a|veo||.
La|las| se|ara |erar||ar l|da| lerjad| |arera reseplor pro|a|l|r d|dudu||
o|er eslroger yarg oerasa| dar| p|aserla.
Pascapersa||rar lerjad| perururar |adar eslroger yarg oerra|ra,
ser|rgga a|l|l|las pro|a|l|r yarg juga sedarg rer|rg|al dapal rerpergarur| |e|erjar rarrae urlu| rergras|||ar
a|r susu.

/01%* 1+&2
A|r susu |ou (A3l) - rergardurg |era|, prole|r dar |ase|r susu. Produ|s| A3l se||lar 00-Z00 r| / rar|. 3|lal |solor||
dergar p|asra. Vergardurg prole|r a|la-|a|loa|our|r dar oela-|a|log|oou||r.
6o|ostrum ada|ar a|r susu pada rasa-rasa aWa| pascapersa||rar (5 rar| sarpa| 1 r|rggu).
A3l lerd|r| dar| a|r, a|la-|a|loa|our|r, |a|losa, |ase|r, asar ar|ro, dar rergardurg arl|ood| lerradap |urar, v|rus
dar jarur. 0er|||ar juga A3l rergardurg groWlr laclor yarg oergura d| arlararya urlu| per|eroargar ru|osa
usus.
A3l a|ar re||rdurg| oay| lerradap |rle|s| dar juga rerargsarg perlurourar oay| yarg rorra|.
Arl|ood| yarg ler|ardurg da|ar a|r susu ada|ar |rurog|oou||r A (lg A), oersara dergar oeroaga| s|sler |orp|erer
yarg lerd|r| dar| ra|rolag, ||rlos|l, |a|loler|r, |a|loper|s|dase, ||soz|r, |a|log|oou||r, |rler|eu||r s|lo||r dar seoaga|rya.

F|s|o|og| proses menyusu|
0|pacu o|er rer|rg|alrya produ|s| pro|a|l|r
dar o|s|los|r seoaga| respors lerradap
sl|ru|as| r|sapar ru|ul oay| (suc||rg). 0ergar
rer|rg|alrya pro|a|l|r, lerjad| produ|s| a|r
susu, sererlara o|s|los|r reryeoao|ar
|orlra|s| rarrae yarg reroarlu
perge|uarar a|r susu. 0|s|los|r juga oerlurgs|
rer|rg|al|ar |orlra|s| ulerus ser|rgga
reroarlu |rvo|us|. 3ele|ar lercapa| l|rg|al
|orlra|s| lerlerlu, |adar pro|a|l|r dar o|s|los|r
rerurur |eroa|| (leedoac| regal|l ?), ser|rgga
produ|s| dar perge|uarar oerrerl|.
Produ|s| A3l d|rargsarg re|a|u| |el doWr
rel|ex ya|lu rargsarg pul|rg - r|pol|s|s -
pro|a|l|r - |e|erjar susu. 0er|||ar juga
o|s|los|r a|ar |e|uar seoaga| rorror yarg
rerorpa r|oep|le| du|lus rarar|a. Pada saal
reryusu| rurg||r |ou rerasa|ar rg||u / |orlra|s| d| daerar ulerus |arera pergarur o|s|los|r yarg rer|rg|al juga
lerradap ulerus.

Pent|ng d|perhat|kan
1. cara reryusu|ar yarg oerar, rercegar asp|ras| / lerseda|.
2. ooal-ooalar yarg rerpergarur| |a|las| alau yarg d|se|res| re|a|u| a|r susu
3. K8 pada rasa |a|las|

3egera sele|ar |ar|r, rerda|rya oay| d||ela||ar pada dada |ou dar ru|a| reryusu, res||pur yarg |e|uar rarya
sed|||l ca|rar |o|oslrur rarur ra| |lu sargal oerrarlaal juga urlu| rero|asa|ar oay| oe|ajar reryusu.
la| |r| ada|ar perru|aar dar| raWal gaourg, ya|lu peraWalar |ou dar oay| oersara-sara separjarg rar|. Karera
rorror pro|a|l|r yarg |orserlras|rya l|rgg| pada a|r|r |erar||ar, dar eslroger-progesleror (yarg rergraroal
produ|s| A3l) lurur oersara |ar|rrya p|aserla, ra|a A3l pur ru|a| d|produ|s|.

lou reryusu| TANPA jadWa| lerlerlu, d|sesua||ar dergar |eoulurar oay| (or derard).

Pember|an a|r susu |bu (A8|} pada bay| baru |ah|r :
1. A3l sed|r| rurg||r. J||a A3l oe|ur |e|uar, oay| l|da| usar d|oer| apa-apa, o|ar|ar oay| rerg|sap payudara |ou
seoaga| sl|ru|as| |e|uarrya A3l. Cadargar rulr|s| da|ar luour oay| cu|up ou|ar dapal sarpa| se|ara 1 rar|
pascapersa||rar.
2. l|rdar| perggarl|ar PA3l (perggarl| A3l) KECuALl ada |rd||as| red|s, r|sa|rya A3l l|da| |e|uar dar oay|
preralur dar seoaga|rya.
3. l|da| oo|er d|oer| A3l rarya pada |rd||as| red|s |elal, r|sa|rya |ou perder|la perya||l |rle|s| lerlerlu dar oay|
oe|ur lerlu|ar. Telap| j||a l|da| ada PA3l, A3l lelap d|oer||ar. Perl|roargar-perl|roargar |a|r lelap d|perral||ar.

Pember|an penggant| a|r susu |bu (PA8|} :
- PA3l : oeroaga| produ| lorru|a, urlu| adaplas| raupur lorru|a |orp||l. Korpos|s| rerde|al| A3l, |ecua|| da|ar
ra| |orpos|s| r|rera| dar |rurog|oou||r.
- us|a 0 - ou|ar : lorru|a aWa|.
- Pada d|are |ror|| / s|rdror parra|aosorps| : susu progesl|r||
- a|erg| prole|r susu sap| : rulr||or-soja (oarar susu |ede|a|)
- 30V : s||r - gu|a - r|rya| raoal|, urlu| ra|aosorps| |era|
- Erla|ac : urlu| oay| preralur. Ka|or| 81 ||a| / 100cc.
- us|a ou|ar - 1 larur : lorru|a |arjular, sudar o|sa rerer|ra susu lu||-crear yarg d|jua| oeoas.
0ura|ar 3EN00K TAKAR yarg lepal ll

J||a |ese|roargar g|z| dar ca|rar l|da| lerperur| :
- perlurourar ralura| delerse recrar|sr lergarggu
- polers| lurour |eroarg l|da| opl|ra|
PERAwATAN AY| N0RHAL PA86APER8AL|NAN

Pada parlus rorra|, oay| a|ar segera rerarg|s / oerrapas |arera pergarur r|po|ser|a l|s|o|og|s dar a|uru|as|
C02; se|a|r |lu |orpres| ja|ar |ar|r juga reroarlu |e|uarrya ca|rar dar| ja|ar rapas. 0ergar rer|r|rg|ar ru|a oay|
ra|a ca|rar a|ar dapal |e|uar serd|r|.
Peroers|rar dergar perg|sapar yarg rerggura|ar oa|or / porpa rarya d||a|u|ar o||a ca|rar oer|eo|rar. Pada
ururrya ca|rar dapal d|serap dergar serd|r|rya o|er s|r|u|as| a|veo|us dar s|sler ||rlal|| paru.

8ay| yarg seral dapal |argsurg raWal gaourg.
8ay| rorra| rurg||r rerga|ar| perururar oeral oadar pada rar|-rar| perlara sesudar |ar|r, lelap| l|da| sarpa|
re|eo|r| 10. Vurg||r juga lerjad| o|||ruo|rer|a yarg l|da| re|eo|r| 10 rg/d|.

Keoers|rar la|| pusal rarus d|perral||ar dar d|raWal.

8ay| rorra| CuKuP d|oer| A3l. 0ergar peraWalar |ou yarg oa||, secara oerlarap produ|s| A3l a|ar rer|rg|al
dergar serd|r|rya.

8ay| : ca|rar luour Z0 - Z5 oeral oadar (deWasa 0-5)
Keoulurar oa|ars, oerdasar|ar : |rla|e - oulpul, |rsers|o|e |oss, |eoulurar
lurour |eroarg.
Keoulurar |a|or| : lerulara urlu| lurour |eroarg dar relaoo||sre.
8ay| sarpa| us|a 1 larur : |eoulurar oasa| 55 ||a|/|g88/rar|.
J||a derar, l|ap |era||ar suru 1oC, |eoulurar rer|rg|al 10.
urlu| a|l|l|las l|s|| : 15 - 25 ||a|/|g88/rar|.
urlu| spec|l|c dyrar|c acl|or : Z - 8 lola|.
Jad| |eoulurar rala-rala oay| sarpa| us|a 1 larur se||lar 100 - 120
||a|/|g88/rar|.
Keoulurar |r| rerurur 10 ||a|/|g88/rar| sel|ap larur, sarpa| us|a 3 larur.
3e|arjulrya |eoulurar rala-rala 50 - 100 ||a|/|g88/rar|, sarpa| us|a puoerlas.
us|a deWasa : |eoulurar rala-rala 10 - 50 ||a|/|g88/rar|.
Pengantar Per|nato|og|
Prof.dr. Abdu| ar| 8afudd|n | Prof.dr.Cu|ard| h. w|knjosastro
Ku||ah ||mu Kesehatan Anak
Prof.dr.h.E.Hon|ntja | dr.Nartono Kadr|
PER|NAT0L0C|

l|ru yarg rerpe|ajar| |eseralar jar|r da|ar |ardurgar dar |eseralar oay| oaru |ar|r.
l|ru per|ralo|og| rerupa|ar oag|ar dar| ||ru |edo|lerar reprodu|s|.

Tujuan ||mu kedokteran reproduks|
lrlacl surv|va| : |ese|aralar yarg ulur.
Jad| proses reprodu|s| ou|ar rarya lerd|r| dar| proses perouarar, |erar||ar, |e|ar|rar dar r|dup saja, lelap| juga
usara urlu| rerjar|r lurour |eroarg yarg seulurrya.
0A8AR PERKEHANCAN |LHU PER|NAT0L0C|

1. arg|a |eral|ar per|rala| / reorala| yarg l|rgg|
2. arg|a relardas| rerla| yarg lerjad| seja| proses |erar||ar / |e|ar|rar l|rgg|.
3. dala surve| ep|der|o|og|
1. pere||l|ar |eseralar reprodu|s|, l|s|o|og| jar|r dar reoralus
5. |e|argsurgar r|dup oay| 88LR (oay| oeral |ar|r rerdar) dar preralur.
. |e|uarga oerercara
0aftar |st||ah dan 0ef|n|s|

Hasa keham||an | masa gestas|
Vasa seja| lerjad|rya |orseps| sarpa| dergar saal |e|ar|rar, d|r|lurg dar| rar| perlara ra|d lera|r|r (rerslrua| age
ol pregrarcy).
Kerar||ar cu|up ou|ar (lerr / alerr) : rasa geslas| 3Z-12 r|rggu (259 - 291 rar|) |erg|ap.
Kerar||ar |urarg ou|ar (prelerr) : rasa geslas| |urarg dar| 3Z r|rggu (259 rar|).
Kerar||ar |eWal Wa|lu (posllerr) : rasa geslas| |eo|r dar| 12 r|rggu (291 rar|).
8ay| cu|up ou|ar (lerr |rlarl) : oay| dergar us|a geslas| 3Z - 12 r|rggu.
8ay| |urarg ou|ar (prelerr |rlarl) : oay| dergar us|a geslas| |urarg dar| 3Z r|rggu.

Hasa per|nata|
Vasa seja| lerjad|rya |orseps| sarpa| dergar 1 r|rggu (28 rar|) sesudar |e|ar|rar.
u|urar slal|sl|| : rasa seja| |erar||ar 28 r|rggu sarpa| dergar 28 rar| sesudar |ar|r (oalasar |ara). 3e|ararg
rerjad| rasa seja| |erar||ar 22 r|rggu, |arera v|ao|||las dar rarapar r|dup jar|r yarg ra||r oesar pada us|a
|erar||ar yarg |eo|r ruda (rerurul lC0-10 wl0).
u|urar o|o|og|s : rasa seja| lerjad|rya |orseps| sarpa| salu ou|ar sesudar |ar|r, d|r|lurg seja| rar| perlara ra|d
lera|r|r.

Hasa neonata|
Vasa seja| |ar|r sarpa| dergar 1 r|rggu (28 rar|) sesudar |e|ar|rar.

Neonatus
8ay| oerurur 0 (oaru |ar|r) sarpa| dergar us|a 1 ou|ar sesudar |ar|r.
Neoralus d|r| : us|a 0 - Z rar|
Neoralus |arjul : us|a Z - 28 rar|.

erat badan |ah|r (b|rthwe|ght}
8eral oadar reoralus pada saal |e|ar|rar, d|l|roarg da|ar Wa|lu salu jar sesudar |ar|r.
8ay| oeral |ar|r cu|up : oay| dergar oeral |ar|r > 2500 g.
8ay| oeral |ar|r rerdar (88LR) / LoW o|rlrWe|grl |rlarl : oay| dergar oeral oadar |ar|r |urarg dar| 1500 - 2500 g.
8ay| oeral |ar|r sargal rerdar (88L3R) / very |oW o|rlrWe|grl |rlarl : oay| dergar oeral oadar |ar|r 1000 - 1500 g.
8ay| oeral |ar|r aral sargal rerdar (88LA3R) / Exlrere|y very |oW o|rlrWe|grl |rlarl : oay| |ar|r r|dup dergar oeral
oadar |ar|r |urarg dar| 1000 g.

Abortus : oay| |ar|r dergar oeral oadar |urarg dar| 500 g, dar / alau us|a geslas| |urarg dar| 20 r|rggu. Arg|a
rarapar r|dup aral sargal |ec||, |urarg dar| 1.

Lah|r h|dup (||ve b|rth}
Perge|uarar |erg|ap sualu ras|| |orseps| (oay|), larpa rerardarg rasa |erar||arrya, d| rara, sele|ar lerp|sar
dar| |ourya, oay| lerseoul rerurju||ar larda-larda |er|dupar seperl| gera|ar rapas, pu|sas| jarlurg, pu|sas| la||
pusal, alau pergera|ar olol, larpa reroeda|ar |eadaar la|| pusal sudar d|polorg alau oe|ur alaupur ras|r
lerruourg dergar p|aserla.

Kemat|an jan|n
Keral|ar seoe|ur lerjad|rya perge|uarar yarg |erg|ap ras|| |orseps| dar| |ourya, larpa rerardarg rasa
|erar||ar. Keral|ar d|larda| dergar l|da| adarya usara perrapasar alau larda-larda |er|dupar yarg |a|r seperl|
pu|sas| jarlurg, pu|sas| la|| pusal alau pergera|ar olol-olol.

Lah|r mat| (st|||b|rth}
Ke|ar|rar ras|| |orseps| da|ar |eadaar ral|, yarg le|ar rercapa| urur |erar||ar 28 r|rggu alau oeral |ar|r
se|urarg-|urargrya 1000 g.

Kemat|an per|nata|
Keral|ar pada rasa |erar||ar 28 r|rggu sarpa| dergar Z rar| sesudar |ar|r.
Arg|a |eral|ar per|rala| (per|rala| rorla||ly rale) : jur|ar |eral|ar per|rala| d||a|| 1000 |a|u d|oag| dergar jur|ar
oay| |ar|r r|dup dar |ar|r ral|.
Keral|ar reorala| d|r| (ear|y reorala| dealr)
Keral|ar oay| pada Z rar| perlara sesudar |ar|r.
(j||a |urarg dar| salu rar|, gura|ar r|lurgar yarg sesua| - jar alau rer|l).
Keral|ar reorala| |arjul (|ale reorala| dealr)
Keral|ar oay| pada rar| |e Z - 28 sesudar |ar|r.
A0APTA8| NE0NATAL

Pergerl|ar : proses peryesua|ar lurgs|ora| reoralus dar| |er|dupar d| da|ar ulerus |e |er|dupar d| |uar ulerus.
Kerarpuar adaplas| l|s|o|og|s |r| d|seoul juga roreoslas|s.
8||a lerdapal gargguar adaplas| : oay| a|ar sa||l.

homeostas|s

1. |erarpuar rerperlarar|ar lurgs|-lurgs| v|la|
2. oers|lal d|rar|s
3. d|pergarur| larap lurour |eroarg, lerrasu| rasa perlurourar dar per|eroargar |rlrauler|r.
Pada oay| |urarg ou|ar, lerdapal oeroaga| gargguar re|ar|sre adaplas|.

Adaplas| segera : lurgs|-lurgs| v|la| (s|r|u|as|, resp|ras|, susurar saral pusal, percerraar dar relaoo||sre).

loreoslas|s reoralus d|lerlu|ar o|er |ese|roargar arlara ralur|las dar slalus g|z|.

Kerarpuar roreoslas|s pada reoralus oerdasar|ar us|a |erar||ar :
1. cu|up ou|ar : rerada|
2. |urarg ou|ar : lergarlurg rasa geslas|. Valr||s ola| oe|ur serpurra, rudar lerjad| perdararar |rlra|rar|a|.
Arg|a |ejad|ar s|rdror gaWal rapas reoralus dar r|pero|||ruo|rer|a l|rgg|.
3. |eWal Wa|lu : lerjad| raroalar perlurourar jar|r |rlrauler|r a||oal perururar lurgs| p|aserla, lerjad| r|po|s|a
jar|r.

Hasa neonatus |eb|h tepat j|ka d|pandang sebaga| masa adaptas| dar| keh|dupan |ntrauter|n menuju
keh|dupan ekstrauter|n dar| berbaga| s|stem.
EVALUA8| NE0NATU8

1. rer||a| larap perlurourar dar per|eroargar jar|r, |esesua|ar us|a |erar||ar
2. rer||a| adaplas| reorala| (s|or Apgar, rel|e|s)
3. rer||a| l|s|| reorala| secara s|sleral|| (ada/l|da| |e|a|rar rorlo|og|/l|s|o|og|)
1. reroer| |derl|l||as| : jer|s |e|ar|r, oeral oadar, parjarg oadar
5. rererlu|ar perargarar yarg d|per|u|ar

K|as|f|kas| neonatus menurut masa gestas|
1. |urarg ou|ar (prelerr |rlarl) : |urarg 259 rar| (3Z r|rggu)
2. cu|up ou|ar (lerr |rlarl) : 259 sarpa| 291 rar| (3Z-12 r|rggu)
3. |eo|r ou|ar (posllerr |rlarl) : |eo|r dar| 291 rar| (12 r|rggu) alau |eo|r.

K|as|f|kas| neonatus menurut berat |ah|r
1. oeral |ar|r rerdar : |urarg dar| 2500 g
2. oeral |ar|r cu|up : arlara 2500 sarpa| 1000 g
3. oeral |ar|r |eo|r : |eo|r dar| 1000 g

K|as|f|kas| menurut berat |ah|r terhadap masa gestas|
d|des|r|ps||ar rasa geslas| dar u|urar oeral |ar|r yarg sesua|
urlu| rasa |erar||arrya :
1. reoralus cu|up/|urarg/|eo|r ou|ar (NC8/NK8/NL8)
2. sesua|/|ec||/oesar urlu| rasa |erar||ar (3VK/KVK/8VK)
Pemer|ksaan f|s|k bay| baru |ah|r : kr|ter|a 0ubow|tz | a||ard |
attag||a | Lubchenco (deta||nya car| | baca send|r|}

Per||raar us|a geslas| rerurul Luocrerco : ||ral |u||ar |e|a|rar pada
|ararya |erar||ar / persa||rar prelerr.

Kr|ter|a f|s|k neonatus norma|
- cu|up ou|ar : us|a |erar||ar 3Z - 12 r|rggu
- oeral oadar |ar|r : 2500 - 1000 g (sesua| rasa |erar||ar)
- parjarg oadar : 11 - 53 cr
- ||rg|ar |epa|a (re|a|u| d|areler o|par|ela|) : 31 - 3 cr
- s|or Apgar Z - 10
- larpa |e|a|rar |orger|la| alau lraura persa||rar

Kr|ter|a neuro|og|k neonatus norma|
- lrog pos|l|or (l|e|s| e|slrer|las alas dar oaWar)
- Rel|e|s Voro / |ejular (), rarus s|relr|s
- rel|e|s r|sap () pada serlurar pa|alur ro||e
- rel|e|s rerggerggar ()
- rel|e|s rool|rg ()

Tao|e . Exrerna| pn,s|ca| cnaracrer|sr|cs {ropj ano neuro|og|ca|
{oorromj exam|nar|on cnarr lor esr|mar|on ol rne
gesrar|ona| age ol rne neuoorn {3a||aro, er a|.,
'976j

N||a| |aborator|um darah neonatus norma|
- lo : 11 - 22 g/d|
(|adar lo-F l|rgg|, rerurur dergar
perlaroarar us|a)
- ll : 13 - 3
- Er|lros|l : 1.2 - jula /rr3
- Rel||u|os|l : 3 - Z
- Leu|os|l : 5000 - 30000 /rr3 J||a ada |rle|s|
< 5000/rr3.
- Troroos|l : 150000 - 350000 /rr3
- vo|ure darar : 85 cc/|g88

N||a| |aborator|um ca|ran otak neonatus norma|
- Warra : 90 - 91 xarlocrrore (|e|ur|rg2ar jerr|r)
- Norre / Pardy () Pada us|a d| alas 3 ou|ar rarus sudar
regal|l.
- Prole|r : 200-220 rg/d|
- 0|u|osa : Z0-80 rg/d|
- Er|lros|l : 1000 - 2000 / LP8
- Leu|os|l 10 - 20 / LP8
rerurju||ar lurgs| 888 (o|ood-ora|r oarr|er) ras|r oe|ur serpurra.
PERAwATAN 8ECERA AY| ARU LAh|R
(|HHE0|ATE 6ARE 0F ThE NEw0RN}

1. rerpe|ajar| ararres|s : r|Wayal rar||, r|Wayal
persa||rar, r|Wayal |e|uarga
2. rer||a| s|or Apgar
3. re|a|u|ar resus|las| reoralus
1. peraWalar la|| pusal : perolorgar jargar ler|a|u perde|. Lu|a d|oer| |arular arl|sepl|| dar d|lulup. larus d|aWas|
dar peroar d|garl| l|ap rar|.
5. |derl|l||as| : oer| |arlu oerlu||sar rara |ou, d|||al d| perge|argar largar alau |a||
. perer||saar l|s||, ooservas| larda v|la|
Z. |ela||ar oay| da|ar |arar lrars|s| (j||a |eadaar urur oa||), alau da|ar |r|uoalor j||a ada |rd||as|.
8. lerlu|ar lerpal peraWalar : raWal gaourg alau raWal |rusus alau raWal |rlers|l.
9. prosedur ruju|ar o||a per|u

J||a ada perya||l yarg d|lurur|ar dar| |ou, r|sa|rya perya||l repal|l|s 8 a|l|l, |argsurg d|oer||ar va|s|ras| (g|oou||r).

8tab|||sas| sesudah |ah|r
- rasa geslas| cu|up : oay| ralur
- pers|apar |e|ar|rar jar|r dar| |ou
- sesudar |ar|r, perrapasar perlara : rargsarg ||r|a, relaoo||| dar lerr||
- dapal r|dup d| |uar ulerus
- adaplas| s|sler2 |a|r

8yarat perawatan gabung (neonatus d|rawat bersama |bunya}
- r||a| Apgar |eo|r dar| Z
- oeral |ar|r |eo|r dar| 2000 g
- rasa geslas| |eo|r dar| 35 r|rggu
- lre|uers| rapas 10 - 0 |a|| per rer|l
- lre|uers| deryul jarlurg 100 - 110 |a|| per rer|l
- suru arlara 3.5 - 3Z.5 oC
- rel|e|s oa||
- l|da| ada |e|a|rar |orger|la| rayor
KE8E|HANCAN KAL0R| 0AN 6A|RAN PA0A NE0NATU8

ay| : ca|ran tubuh 70 - 757 berat badan (dewasa 0-57}
Keoulurar oa|ars, oerdasar|ar : |rla|e - oulpul, |rsers|o|e |oss, |eoulurar
lurour |eroarg.

Kebutuhan ka|or| : terutama untuk tumbuh kembang dan metabo||sme.
8ay| sarpa| us|a 1 larur : |eoulurar oasa| 55 ||a|/|g88/rar|.
J||a derar, l|ap |era||ar suru 1oC, |eoulurar rer|rg|al 10.
urlu| a|l|l|las l|s|| : 15 - 25 ||a|/|g88/rar|.
urlu| spec|l|c dyrar|c acl|or : Z - 8 lola|.
Jad| |eoulurar rala-rala oay| sarpa| us|a 1 larur se||lar 100 - 120
||a|/|g88/rar|.
Keoulurar |r| rerurur 10 ||a|/|g88/rar| sel|ap larur, sarpa| us|a 3 larur.
3e|arjulrya |eoulurar rala-rala 50 - 100 ||a|/|g88/rar|, sarpa| us|a puoerlas.
us|a deWasa : |eoulurar rala-rala 10 - 50 ||a|/|g88/rar|.

Pember|an a|r susu |bu (A8|} pada bay| baru |ah|r :
- A3l sed|r| rurg||r. J||a A3l oe|ur |e|uar, oay| l|da| usar d|oer| apa-apa, o|ar|ar oay| rerg|sap payudara |ou
seoaga| sl|ru|as| |e|uarrya A3l. Cadargar rulr|s| da|ar luour oay| cu|up ou|ar dapal sarpa| se|ara 1 rar|
pascapersa||rar.
- l|rdar| perggarl|ar PA3l (perggarl| A3l) KECuALl ada |rd||as| red|s, r|sa|rya A3l l|da| |e|uar dar oay| preralur
dar seoaga|rya
- l|da| oo|er d|oer| A3l rarya pada |rd||as| red|s |elal, r|sa|rya |ou perder|la perya||l |rle|s| lerlerlu dar oay|
oe|ur lerlu|ar. Telap| j||a l|da| ada PA3l, A3l lelap d|oer||ar. Perl|roargar-perl|roargar |a|r lelap d|perral||ar.

Pember|an penggant| a|r susu |bu (PA8|} :
- PA3l : oeroaga| produ| lorru|a, urlu| adaplas| raupur
lorru|a |orp||l. Korpos|s| rerde|al| A3l, |ecua||
da|ar ra| |orpos|s| r|rera| dar |rurog|oou||r.
- us|a 0 - ou|ar : lorru|a aWa|.
- Pada d|are |ror|| / s|rdror parra|aosorps| : susu progesl|r||
- a|erg| prole|r susu sap| : rulr||or-soja (oarar susu |ede|a|)
- 30V : s||r - gu|a - r|rya| raoal|, urlu| ra|aosorps| |era|
- Erla|ac : urlu| oay| preralur. Ka|or| 81 ||a| / 100cc.
- us|a ou|ar - 1 larur : lorru|a |arjular, sudar o|sa rerer|ra
susu lu||-crear yarg d|jua| oeoas.
0ura|ar 3EN00K TAKAR yarg lepal ll

J||a |ese|roargar g|z| dar ca|rar l|da| lerperur| :
- perlurourar ralura| delerse recrar|sr lergarggu
- polers| lurour |eroarg l|da| opl|ra|
8|8TEH RUJUKAN PERAwATAN NE0NATU8

Perl|roargar oerdasar|ar |eadaar oay| :
1. oay| rorra| : ruarg lrars|s| - raWal gaourg / radya / |rlers|l
2. oay| oeral oadar |ar|r rerdar alau oay| |urarg ou|ar : raWal radya / |rlers|l
3. oay| dergar lurjargar verl||as| / resp|ras| / s|r|u|as| : raWal |rlers|l
1. oay| dergar lurjargar relaoo||| / rulr|s| parerlera| : raWal radya / |rlers|l
5. oay| dergar perarlauar |elal resp|ras| dar s|r|u|as| : raWal radya / |rlers|l
HA8ALAh UHUH PA0A AY| ARU LAh|R

1. Preralur|las
NC8 (reoralus cu|up ou|ar) : 3Z - 12 r|rggu.
Pr|rs|p : 8ay| preralur = NK8 (reoralus |urarg ou|ar) ll
JAN0AN d|sara|ar oeg|lu saja 88LR ll Karera rurg||r
saja 88LR sudar cu|up ou|ar dar raluras| sudar
|erg|ap.
2. 3|rdror gaWal rapas reoralus (NR03 - Neorala| Resp|ralory 0|slress 3yrdroore) / asl||s|a reoralorur
3. l|pero|||ruo|rer|a (reorala| jaurd|ce)
1. lrle|s| per|rala|
5. Ke|a|rar / cacal oaWaar
. 0argguar / perya||l a||oal lraura persa||rar

unruk na|2 oera||n,a, s||akan car| / oaca seno|r|.

8pec|a| Aspects of
Per|nata| Pharmaco|ogy
(0rug Therapy |n Pregnancy and Lactat|on}
C|deon Koren, H0 & Hart|n 8.6ohen, H0
0ept. of Ped|atr|c Pharmaco|ogy
Facu|ty of Hed|c|ne, Un|vers|ty of Toronto, 6anada
(Teks dar| Katzung C, as|c & 6||n|ca| Pharmaco|ogy, thed, 1995}
Tre ellecls ol drugs or lre lelus ard reWoorr |rlarl are oased or lre gerera| pr|rc|p|es. loWever, lre prys|o|og|c
corlexl |r Wr|cr lrese prarraco|og|c |aWs operale, are 0lFFERENT |r pregrarl Worer ard |r rap|d|y ralur|rg
|rlarls.

Al preserl, lre spec|a| prarraco||rel|c laclors operal|ve |r lrese pal|erls are oeg|rr|rg lo oe urderslood, Wrereas
|rlorral|or regard|rg prarracodyrar|c d|llererces (eg, receplor craracler|sl|cs ard resporse) |s sl||| qu|le
pre||r|rary. Tr|s crapler preserls oas|c pr|rc|p|es ol prarraco|ogy |r lre spec|a| corlexl ol per|rala| ard ped|alr|c
lrerapeul|cs.
0RUC ThERAPY |N PRECNAN6Y
Pharmacok|net|cs

Vosl drugs la|er oy pregrarl Worer CAN cross lre p|acerla ard expose lre deve|op|rg eroryo ard lelus lo lre|r
prarroco|og|c ard leraloger|c ellecls.

6r|t|ca| factors affect|ng p|acenta| drug transfer and drug effects on the fetus |nc|ude the fo||ow|ng :
1. Tre prys|ocrer|ca| properl|es ol lre drug
2. Tre rale al Wr|cr lre drug crosses lre p|acerla ard lre arourl sure lo lre drug
3. Tre dural|or ol exposure lo lre drug
1. 0|slr|oul|or craracler|sl|cs |r d|llererl lela| l|ssues
5. Tre slage ol p|acerla| ard lela| deve|oprerl al lre l|re ol exposure lo lre drug
. Tre ellecls ol drugs used |r coro|ral|or

A. L|p|d 8o|ub|||ty
As |s lrue a|so ol olrer o|o|og|c rerorares, drug passage across lre p|acerla |s deperderl or ||p|d so|uo|||ly ard lre
degree ol drug |or|zal|or. L|popr|||c drugs lerd lo d|lluse read||y across lre p|acerla ard erler lre lela| c|rcu|al|or. For
exarp|e, lr|operla|, a drug corror|y used lor cesarear secl|ors, crosses lre p|acerla a|rosl |rred|ale|y ard car
produce sedal|or or aprea |r lre reWoorr |rlarl. l|gr|y |or|zed drugs sucr as succ|ry|cro||re ard luoocurar|re, a|so
used lor cesarear secl|or, cross lre p|acerla s|oW|y ard acr|eve very |oW corcerlral|ors |r lre lelus. lrperreao|||ly
ol lre p|acerla lo po|ar corpourds |s re|al|ve ralrer lrar aoso|ule. ll r|gr erougr ralerra|-lela| corcerlral|or
grad|erls are acr|eved, po|ar corpourds cross lre p|acerla |r reasurao|e arourls. 3a||cy|ale, Wr|cr |s a|rosl
corp|ele|y |or|zed al prys|o|og|c pl, crosses lre p|acerla rap|d|y. Tr|s occurs oecause lre sra|| arourl ol sa||cy|ale
lral |s rol |or|zed |s r|gr|y ||p|d-so|uo|e.

. Ho|ecu|ar 8|ze
Tre ro|ecu|ar We|grl ol lre drug a|so |rl|uerces lre rale ol lrarsler ard lre arourl ol drug lrarslerred across lre
p|acerla. 0rugs W|lr ro|ecu|ar We|grls ol 250-500 car cross lre p|acerla eas||y, deperd|rg upor lre|r ||p|d so|uo|||ly
ard degree ol |or|zal|or; lrose W|lr ro|ecu|ar We|grls ol 500-1000 cross lre p|acerla W|lr rore d|ll|cu|ly; ard lrose
W|lr ro|ecu|ar We|grls grealer lrar 1000 cross very poor|y. Ar |rporlarl c||r|ca| app||cal|or ol lr|s properly |s lre
cro|ce ol repar|r as ar arl|coagu|arl |r pregrarl Worer. 8ecause |l |s a very |arge (ard po|ar) ro|ecu|e, repar|r |s
urao|e lo cross lre p|acerla. ur|||e Warlar|r, Wr|cr |s leraloger|c ard srou|d oe avo|ded dur|rg lre l|rsl lr|resler,
repar|r ray oe sale|y g|ver lo pregrarl Worer Wro reed arl|coagu|al|or. Apparerl excepl|ors lo lre s|ze ru|e are
ralerra| arl|oody g|oou||rs ard cerla|r po|ypepl|des lral cross lre p|acerla oy sore se|ecl|ve recrar|srs lral ras
rol yel oeer |derl|l|ed.

6. Prote|n |nd|ng
Tre degree lo Wr|cr a drug |s oourd lo p|asra prole|rs (parl|cu|ar|y a|our|r) ray a|so allecl lre rale ol lrarsler ard
lre arourl ol drugs lrarslerred. loWever, |l a corpourd |s very ||p|d-so|uo|e (eg, sore areslrel|c gases), |l W||| rol
oe allecled greal|y oy prole|r o|rd|rg. Trarsler ol lrese rore ||p|d-so|uo|e drugs ard lre|r overa|| rales ol equ|||oral|or
are rore deperderl or (ard proporl|orale lo) p|acerla| o|ood l|oW. Tr|s |s oecause very ||p|d-so|uo|e drugs d|lluse
across p|acerla| rerorares so rap|d|y lral lre|r overa|| rales ol equ|||oral|or do rol deperd or lre lree drug
corcerlral|ors oecor|rg equa| or oolr s|des. ll a drug |s poor|y ||p|d-so|uo|e ard |s |or|zed, |ls lrarsler |s s|oW ard W|||
prooao|y oe |rpeded oy |ls o|rd|rg lo ralerra| p|asra prole|rs. 0|llererl|a| prole|r o|rd|rg |s a|so |rporlarl, s|rce
sore drugs exr|o|l grealer prole|r o|rd|rg |r ralerra| p|asra lrar |r lela| p|asra oecause ol a |oWered o|rd|rg
all|r|ly ol lela| prole|rs. Tr|s ras oeer sroWr lor su|lorar|des, oaro|lurales, prerylo|r, ard |oca| areslrel|c agerls.

0. P|acenta| and Feta| 0rug Hetabo||sm
TWo recrar|srs re|p lo
prolecl lre lelus lror drugs
|r lre ralerra| c|rcu|al|or :
(1) Tre p|acerla |lse|l p|ays a
ro|e oolr as a
ser|perreao|e oarr|er ard
as a s|le ol relaoo||sr ol
sore drugs pass|rg lrrougr
|l. 3evera| d|llererl lypes ol
aroral|c ox|dal|or reacl|ors
(eg, rydroxy|al|or, N-
dea||y|al|or, derelry|al|or)
rave oeer sroWr lo occur |r
p|acerla| l|ssue. Elraro| ard
prerooaro|la| are ox|d|zed |r
lr|s Way. Corverse|y, |l |s
poss|o|e lral lre relaoo||c
capac|ly ol lre p|acerla ray
|ead lo creal|or ol lox|c
relaoo||les, ard lre p|acerla
ray lrerelore augrerl
lox|c|ly (eg, elraro|,
oerzypyreres). (2) 0rugs
lral rave crossed lre
p|acerla erler lre lela|
c|rcu|al|or v|a lre uro|||ca|
ve|r. Aooul 10-0 ol
uro|||ca| verous o|ood l|oW
erlers lre lela| ||ver; lre
rera||rder oypasses lre ||ver
ard erlers lre gerera| lela|
c|rcu|al|or. A drug lral erlers
lre ||ver ray oe parl|y
relaoo||zed lrere oelore |l
erlers lre lela| c|rcu|al|or. lr
add|l|or, a |arge proporl|or ol
drug preserl |r lre uro|||ca|
arlery (relurr|rg lo lre
p|acerla) ray oe srurled
lrrougr lre p|acerla oac| lo
lre uro|||ca| ve|r ard |rlo
lre ||ver aga|r. ll srou|d oe roled lral relaoo||les ol sore drugs ray oe rore acl|ve lrar lre parerl corpourd ard
ray allecl lre lelus adverse|y.
Pharmacodynam|cs

A. Haterna| 0rug Act|ons
Tre ellecls ol drug or lre reproducl|ve l|ssues (oreasl, ulerus, elc) ol lre pregrarl Worar are sorel|res a|lered oy
lre erdocr|re erv|rorrerl appropr|ale lor lre slages ol pregrarcy. 0rug ellecls or olrer ralerra| l|ssues (rearl,
|urgs, ||dreys, cerlra| rervous sysler, elc), are N0T crarged s|gr|l|carl|y oy pregrarcy, lrougr lre prys|o|og|ca|
corlexl (card|ac oulpul, rera| o|ood l|oW, elc) ray oe a|lered ard ray requ|re lre use ol drugs lral are rol reeded |r
lre sare Worar Wrer sre |s rol pregrarl. For exarp|e, card|ac g|ycos|des ard d|urel|cs ray oe reeded lor
corgesl|ve rearl la||ure prec|p|laled oy lre |rcreased card|ac Wor||oad ol pregrarcy, or |rsu||r ray oe requ|red lor
corlro| ol o|ood g|ucose |r pregrarcy-|rduced d|aoeles.

. Therapeut|c 0rug Act|ons |n the Fetus
Fela| lrerapeul|cs |s ar ererg|rg area |r per|rala| prarraco|ogy. Tr|s |rvo|ves drug adr|r|slral|or lo lre pregrarl
Worar W|lr lre lelus as lre largel ol lre drug. Al preserl, corl|coslero|ds are used lo sl|ru|ale lela| |urg ralural|or
Wrer preralure o|rlr |s expecled. Prerooaro|la|, Wrer g|ver lo pregrarl Worer rear lerr, car |rduce lela| repal|c
erzyres respors|o|e lor lre g|ucoror|dal|or ol o|||ruo|r, ard lre |rc|derce ol jaurd|ce |s |oWer |r reWoorrs Wrer
rolrers are g|ver prerooaro|la| lrar Wrer prerooaro|la| |s rol used. Recerl|y, adr|r|slral|or ol prerooaro|la| lo lre
rolrer ras oeer sroWr lo decrease lre r|s| ol |rlracrar|a| o|eed|rg |r prelerr |rlarls. Arl|arrylrr|c drugs rave a|so
oeer g|ver lo rolrers lor lrealrerl ol lela| card|ac arrrylr|as.

6. Pred|ctab|e Tox|c 0rug Act|ons |n the Fetus
Crror|c use ol op|o|ds oy lre rolrer ray produce deperderce |r lre lelus ard reWoorr. Tr|s deperderce ray oe
rar|lesled aller de||very as a reorala| W|lrdraWa| syrdrore. A |ess We|| urderslood lela| drug lox|c|ly |s caused oy
lre use ol arg|olers|r-corverl|rg erzyre |rr|o|lors dur|rg pregrarcy. Trese drugs car resu|l |r s|gr|l|carl ard
|rrevers|o|e rera| darage |r lre lelus ard are lrerelore corlra|rd|caled |r pregrarl Worer. Adverse ellecls ray a|so
oe de|ayed, as |r lre case ol lera|e leluses exposed lo d|elry|sl||oeslro| (0E3), Wro ray oe al |rcreased r|s| lor
aderocarc|rora ol lre vag|ra aller puoerly.

0. Teratogen|c 0rug Act|ons
A s|rg|e |rlrauler|re exposure lo a drug car allecl lre lela| slruclures urdergo|rg rap|d deve|oprerl al lre l|re ol
exposure. Tra||dor|de |s ar exarp|e ol a drug lral ray prolourd|y allecl lre deve|oprerl ol lre ||ros aller or|y or|el
exposure. Tr|s exposure, roWever, rusl oe al a cr|l|ca| l|re |r lre deve|oprerl ol lre ||ros. Tre lra||dor|de
procore||a r|s|| occurs dur|rg lre lourlr lrrougr lre severlr Wee|s ol geslal|or oecause |l |s dur|rg lr|s l|re lral lre
arrs ard |egs deve|op.
Tre recrar|srs oy Wr|cr d|llererl drugs produce leraloger|c ellecls are poor|y urderslood ard are prooao|y
ru|l|laclor|a|. For exarp|e, drugs ray rave a d|recl ellecl or ralerra| l|ssues W|lr secordary or |rd|recl ellecls or
lela| l|ssues. 0rugs ray |rlerlere W|lr lre passage ol oxyger or rulr|erls lrrougr lre p|acerla ard lrerelore rave
ellecls or lre rosl rap|d|y relaoo||z|rg l|ssues ol lre lelus. F|ra||y, drugs ray rave |rporlarl d|recl acl|ors or lre
processes ol d|lererl|al|or |r deve|op|rg l|ssues. For exarp|e, v|lar|r A (rel|ro|) ras oeer sroWr lo rave |rporlarl
d|llererl|al|or-d|recl|rg acl|ors |r rorra| l|ssues. 3evera| v|lar|r A ara|ogues (|solrel|ro|r, elrel|rale) are poWerlu|
leralogers, suggesl|rg lral lrey a|ler lre rorra| processes ol d|llererl|al|or. F|ra||y, del|c|ercy ol a cr|l|ca| suoslarce
appears lo p|ay a ro|e |r sore lypes ol aororra||l|es. For exarp|e, lo||c ac|d supp|ererlal|or dur|rg pregrarcy
appears lo reduce lre |rc|derce ol reura| luoe delecls, eg, sp|ra o|l|da.
Corl|rued exposure lo a leraloger ray produce curu|al|ve ellecls or ray allecl severa| orgars go|rg lrrougr vary|rg
slages ol deve|oprerl. Crror|c corsurpl|or ol r|gr doses ol elraro| dur|rg pregrarcy, parl|cu|ar|y dur|rg lre l|rsl
ard secord lr|reslers, ray resu|l |r lre lela| a|coro| syrdrore. lr lr|s syrdrore, lre cerlra| rervous sysler, groWlr,
ard lac|a| deve|oprerl ray oe allecled.

To be cons|dered as teratogen|c, a cand|date substance or process shou|d :
(1) resu|l |r a craracler|sl|c sel ol ra|lorral|ors, |rd|cal|rg a se|ecl|v|ly lor cerla|r largel orgars;
(2) exerl |ls ellecls al a parl|cu|ar slage ol lela| deve|oprerl, |e, dur|rg lre ||r|led l|re per|od ol orgarogeres|s ol lre
largel orgars;
(3) sroW a dose-deperderl |rc|derce. 3ore drugs W|lr |roWr leraloger|c or olrer adverse ellecls |r pregrarcy are
||sled |r lre lao|e.

0RUC U8E 0UR|NC LA6TAT|0N

0rugs srou|d oe used corserval|ve|y dur|rg |aclal|or, ard lre prys|c|ar rusl |roW Wr|cr drugs are polerl|a||y
dargerous lo rurs|rg |rlarls (see lao|e).

Vosl drugs adr|r|slered lo |aclal|rg Worer ARE deleclao|e |r oreasl r|||. Forlurale|y, lre corcerlral|or ol drugs
acr|eved |r oreasl r||| |s usua||y |oW.

Trerelore, lre lola| arourl lre |rlarl Wou|d rece|ve |r a day |s suoslarl|a||y |ess lrar Wral Wou|d oe cors|dered a
lrerapeul|c dose. ll lre rurs|rg rolrer rusl la|e red|cal|ors ard lre drug |s a re|al|ve|y sale ore, sre srou|d
opl|ra||y la|e |l 30-0 r|rules aller rurs|rg ard 3-1 rours oelore lre rexl leed|rg. Tr|s a||oWs l|re lor rary drugs lo
oe c|eared lror lre rolrer's o|ood, ard lre corcerlral|ors |r oreasl r||| W||| oe re|al|ve|y |oW. 0rugs lor Wr|cr ro dala
are ava||ao|e or salely dur|rg |aclal|or srou|d oe avo|ded, or lre oreaslleed|rg d|scorl|rued Wr||e lrey are oe|rg
g|ver.
Vosl arl|o|ol|cs la|er oy rurs|rg
rolrers car oe delecled |r oreasl r|||.
Telracyc||re corcerlral|ors |r oreasl
r||| are approx|rale|y Z0 ol ralerra|
serur corcerlral|ors ard preserl a r|s|
ol perrarerl loolr sla|r|rg |r lre |rlarl.
Cr|orarprer|co| corcerlral|ors |r
oreasl r||| are rol sull|c|erl lo cause
lre gray oaoy syrdrore, oul lrere |s a
rerole poss|o|||ly ol caus|rg oore
rarroW suppres|or, ard
cr|orarprer|co| srou|d oe avo|ded
dur|rg |aclal|or. lsor|az|d reacres a
rap|d equ|||or|ur oelWeer oreasl r|||
ard ralerra| o|ood. Tre corcerlral|ors
acr|eved |r oreasl r||| are r|gr erougr
so lral pyr|dox|re del|c|ercy ray occur
|r lre |rlarl |l lre rolrer |s rol g|ver
pyr|dox|re supp|ererls.

Vosl sedal|ves ard ryprol|cs acr|eve
corcerlral|ors |r oreasl r||| sull|c|erl
lo produce a prarraco|og|c ellecl |r
sore |rlarls. 8aro|lurales la|er |r
ryprol|c doses oy lre rolrer car
produce |elrargy, sedal|or, ard poor
suc||rg rel|exes |r lre |rlarl.
Cr|ora|rydrale car produce sedal|or |l
lre |rlarl |s led al pea| r|||
corcerlral|or. 0|azepar car rave a
sedal|ve ellecl or lre rurs|rg |rlarl, oul
rosl |rporlarl|y, |ls |org ra|l ||le car
resu|l |r s|gr|l|carl drug accuru|al|or.
0p|o|ds sucr as rero|r, relradore,
ard rorpr|re erler oreasl r||| |r
quarl|l|es polerl|a||y sull|c|erl lo
pro|org lre slale ol reorala| rarcol|c
deperderce |l lre drug Was la|er
crror|ca||y oy lre rolrer dur||rg pregrarcy. ll cord|l|ors are We|| corlro||ed ard lrere |s a good re|al|orsr|p oelWeer
lre rolrer ard lre prys|c|ar, ar |rlarl cou|d oe oreasl-led Wr||e lre rolrer |s la||rg relradore. 3re srou|d rol,
roWever, slop la||rg lre drug aorupl|y; lre |rlarl car oe lapered oll lre relradore as lre rolrer's dose |s lapered.
Tre |rlarl srou|d oe Walcred lor s|grs ol rarcol|c W|lrdraWa|.

V|r|ra| use ol a|coro| oy lre rolrer ras rol oeer reporled lo rarr rurs|rg |rlarls. Excess|ve arourls ol a|coro|,
roWever, car produce a|coro| ellecls |r lre |rlarl. N|col|re corcerlral|ors |r lre oreasl r||| ol sro||rg rolrers are
|oW ard do rol produce ellecls |r lre |rlarl. very sra|| arourls ol calle|re are excreled |r lre oreasl r||| ol collee-
dr|r||rg rolrers.

L|lr|ur erlers oreasl r||| |r corcerlral|ors equa| lo lrose |r ralerra| serur. C|eararce ol lr|s drug |s a|rosl
corp|ele|y deperderl upor rera| e||r|ral|or, ard Worer Wro are rece|v|rg ||lr|ur ray expose lre oaoy lo re|al|ve|y
|arge arourls ol lre drug.

0rugs sucr as propy|lr|ourac|| ard lo|oular|de erler oreasl r||| |r quarl|l|es sull|c|erl lo allecl erdocr|re lurcl|or |r
lre |rlarl. Trey srou|d oe avo|ded |l poss|o|e or oreaslleed|rg d|scorl|rued.

Rad|oacl|ve suoslarces sucr as |od|raled l-125 a|our|r ard rad|o|od|re car cause lryro|d suppress|or |r |rlarls ard
ray |rcrease lre r|s| ol suosequerl lryro|d carcer as rocr as lerlo|d. 8reaslleed|rg |s corlra|rd|caled aller |arge
doses ard srou|d oe W|lrre|d lor days lo Wee|s aller sra|| doses.
3|r||ar|y, oreaslleed|rg srou|d oe avo|ded |r rolrers rece|v|rg carcer crerolrerapy or oe|rg lrealed W|lr s|r||ar
agerls lor co||ager d|seases sucr as |upus erylreralosus or posl-lrarsp|arl.
Teks as|| oar| rarzung 3S {eoj, 3as|c & 0||n|ca| Pnarmaco|og,, 6rn eo.
lonoon. Prenr|ce-la|| lnrernar|ona| lro., '995,
o|ker|k u|ang nan,a unruk kepenr|ngan oe|aar ko-as.
6ongen|ta| Ha|format|ons
T.w.3ad|er, Pr.0
0epl.ol Ce|| 8|o|ogy ard Aralory
ur|vers|ly ol Norlr Caro||ra, Crape| l|||, Norlr Caro||ra, u3A
(le|s dar| 3ad|er Tw, Largrar's Ved|ca| Eroryo|ogy, Zlred., 1995)
|NTR00U6T|0N

6ongen|ta| ma|format|ons, congen|ta| d|sorders, congen|ta| anoma||es ard b|rth defects are syroryrous lerrs
used lo descr|oe structura|, behav|ora|, funct|ona| and metabo||c d|sorders present at b|rth.

The sc|ence that stud|es the causes and mechan|sms of these d|sorders |s terato|ogy (Cr.teratos, monster}.

Vajor slruclura| arora||es occur |r 2-3 ol ||veoorr |rlarls, ard ar add|l|ora| 2-3 are recogr|zed |r cr||drer oy age
5 years, lor a lola| 1-. 8|rlr delecls are lre |ead|rg cause ol |rlarl rorla||ly, accourl|rg lor approx|rale|y 21 ol a||
|rlarl dealrs. Trey are lre 5lr |ead|rg cause ol years ol polerl|a| ||le |osl pr|or lo age 5, ard a rajor corlr|oulor lo
rary d|sao|||l|es. Trey are a|so rord|scr|r|ralory, sucr lral rorla||ly rales produced oy o|rlr delecls are lre sare lor
a|| rurar races.

lr 10-0 ol a|| o|rlr delecls, lre causes are ur|roWr. 0erel|c laclors, sucr as crrorosore aororra||l|es ard
rularl geres, accourl lor approx|rale|y 15; erv|rorrerla| laclors produced approx|rale|y 10; a coro|ral|or ol
gerel|c ard erv|rorrerla| |rl|uerces (ru|l|laclor|a| |rrer|larce) produce 20-25; ard lW|rr|rg causes 0.5-1.

V|ror arora||es occur |r approx|rale|y 15 ol reWoorrs. Trese slruclura| aororra||l|es, sucr as r|crol|a (sra||
ears), p|grerled spols, srorl pa|peora| l|ssures, elc, are rol delr|rerla| lo lre rea|lr ol lre |rd|v|dua| oul |r sore
cases are assoc|aled W|lr rajor delecls. For exarp|e, |rlarls W|lr ore r|ror arora|y rave a 3 crarce ol rav|rg a
rajor ra|lorral|or; lrose W|lr lWo r|ror arora||es rave a 10 crarce; ard lrose W|lr lrree or rore rave 20.
Trerelore, r|ror arora||es serve as c|ues lor d|agros|rg rore ser|ous urder|y|rg delecls poss|o|y ex|sl.

There are severa| types of anoma||es :

1. Ha|format|ons occur dur|ng format|on of structures, e.g. dur|rg orgarogeres|s. Trey ray resu|l |r corp|ele or
parl|a| aoserce ol a slruclure or |r a|leral|ors ol |ls rorra| corl|gural|ors. Va|lorral|ors are caused oy erv|rorrerla|
ard/or gerel|c laclors acl|rg |rdeperderl|y or |r corcerl. Vosl ra|lorral|ors rave lre|r or|g|r dur|rg lre lr|rd lo lre
e|grl Wee|s ol geslal|or.

2. 0|srupt|ons resu|t |n morpho|og|ca| a|terat|ons of structures after the|r format|on and are due to destruct|ve
processes. vascu|ar acc|derls |ead|rg lo ooWe| alres|as ard delecls produced oy arr|ol|c oards are exarp|es ol
deslrucl|ve laclors lral produce d|srupl|ors.

3. 0eformat|ons are due to mechan|ca| forces that mo|d over a part of the fetus over a pro|onged per|od of
t|me. C|uoleel, due lo corpress|or |r lre arr|or|c cav|ly, are ar exarp|e. 0elorral|ors oller |rvo|ve lre
ruscu|os|e|ela| sysler ard ray oe revers|o|e poslrala||y.

4. 8yndromes refers to a group of anoma||es occur|ng together that have a spec|f|c, common et|o|ogy. Tr|s
lerr |rd|cales lral a d|agros|s ras oeer rade ard lral lre r|s| ol recurrerce |s |roWr. lr corlrasl, assoc|al|or relers
lo lre rorrardor appeararce ol lWo or rore arora||es lral occur logelrer rore lrequerl|y lrar oy crarce a|ore, oul
lor Wr|cr lre el|o|ogy ras rol oeer delerr|red. Exarp|es ol assoc|al|or |rc|ude ClAR0E (co|oooras, rearl delecls,
alres|a ol lre croarae, relarded groWlr, ger|la| arora||es ard ear aororra||l|es) ard vACTERL (verleora|, ara|,
card|ac, lracrea|, esopragea|, rera| ard ||ro arora||es). Assoc|al|ors are a|so |rporlarl, oecause, a|lrougr lrey do
rol corsl|lule a d|agros|s, recogr|l|or ol ore or rore ol lre corporerls proroles lre searcr lor olrers |r lre group.
PR|N6|PLE8 0F TERAT0L0CY

As a resu|l ol |aooralory slud|es ard ooserval|ors oy c||r|ca| sc|erl|sls, laclors delerr|r|rg lre capac|ly ol ar agerl lo
produce o|rlr delecls rave oeer del|red.

These pr|nc|p|es of terato|ogy were f|rst formu|ated by w||son |n 1959, and have stood the test of t|me. They
|nc|ude :

1. 3uscepl|o|||ly lo leralogeres|s deperds or lre gerolype ol lre corceplus ard lre rarrer |r Wr|cr lr|s gerel|c
corpos|l|or |rleracls W|lr lre erv|rorrerl. Tre ralerra| gerore |s a|so |rporlarl W|lr respecl lo drug relaoo||sr,
res|slarce lo |rlecl|or, ard olrer o|ocrer|ca| ard ro|ecu|ar processes lral W||| |rpacl or lre corceplus.

2. 3uscepl|o|||ly lo leralogers var|es W|lr lre deve|oprerla| slage al lre l|re ol exposure. Tre rosl sers|l|ve per|od
lor |rduc|rg o|rlr delecls |s lre 3rd lo 8lr Wee|s ol geslal|or, lre per|od ol eroryogeres|s. Eacr orgar sysler ray
rave ore or rore slages ol suscepl|o|||ly. Furlrerrore, Wr||e rosl aororra||l|es are produced dur|rg lre per|od ol
eroryogeres|s, delecls ray a|so oe |rduced pr|or lo or aller lr|s per|od, sucr lral ro slage ol deve|oprerl |s
corp|ele|y sale.

3. Var|leslal|ors ol aororra| deve|oprerl deperd or dose ard dural|or ol exposure lo a leraloger.

1. Teralogers acl |r spec|l|c Ways (recrar|srs) or deve|op|rg ce||s ard l|ssues lo |r|l|ale aororra| eroryogeres|s
(palrogeres|s).

5. Tre rar|leslal|ors ol aororra| deve|oprerl are dealr, ra|lorral|ors, groWlr relardal|or, ard lurcl|ora| d|sorders.
ENV|R0NHENTAL FA6T0R8

url|| lre ear|y 1910's, |l Was assured lral corger|la| delecls Were caused pr|rar||y oy rered|lary laclors. w|lr lre
d|scovery oy 0regg lral 0errar reas|es allecl|rg a rolrer dur|rg ear|y pregrarcy caused aororra||l|es |r lre
eroryo, |l sudder|y oecare ev|derl lral corger|la| ra|lorral|ors |r rurars cou|d a|so oe caused oy erv|rorrerla|
laclors.

0oserval|ors oy Lerz, ||r||rg ||ro delecls lo lre sedal|ve lra||dor|de |r 191, rade |l c|ear lral drugs cou|d cross lre
p|acerla ard produce lela| delecls. 3|rce lral l|re, rary agerls rave oeer |derl|l|ed as leralogers (laclors lral
cause arora||es).
|nfect|ous agents

Rube||a (Cerman meas|es}
Al preserl, |l |s We|| eslao||sred lral ruoe||a v|rus |rlecl|or |r pregrarcy car cause ra|lorral|ors ol lre eye (calaracl
ard r|croprlra|r|a); |rlerra| ear (corger|la| dealress due lo deslrucl|or ol Corl| orgar); rearl (pers|slerl duclus
arler|osus, alr|a| / verlr|cu|ar sepla| delecls); ard, occas|ora||y, leelr (erare| |ayer aororra||ly). Tre v|rus ray a|so
respors|o|e lor sore cases ol ora|r aororra||l|es ard rerla| relardal|or. Vore recerl|y, |l ras oecore ev|derl lral
lre v|rus a|so causes |rlrauler|re groWlr relardal|or, ryocard|a| darage ard vascu|ar aororra||l|es.
Calaracls resu|l lror |rlecl|or dur|rg lre lr Wee| ol pregrarcy; dealress lror |rlecl|or dur|rg lre 9lr Wee|; card|ac
delecls lo||oW |rlecl|or |r lre 5lr lo 10lr Wee|s, ard derla| delorr|l|es lo||oW |rlecl|or oelWeer lr ard 9lr Wee|s.
Aororra||l|es ol lre cerlra| rervous sysler lo||oW |rlecl|or |r lre 2rd lr|resler.
0errar reas|es rar|leslal|ors or lre rolrer ray oe r||d ard goes urrecogr|zed, ra||rg lre o|rlr delecls rol
suspecled Wrer lre cr||d |s oorr, ard lourd aller lre cr||d |s rear|y 2-1 years ol age. 0r lre olrer rard, s||r rasres
caused oy arolrer agerls ray oe |rcorrecl|y allr|ouled lo ruoe||a.
3ave ard ellecl|ve vacc|res lor ruoe||a are recerl|y oe|rg deve|oped ard adr|r|slered.

6ytomega|ov|rus (6HV}
CVv ras oeer pos|l|ve|y |derl|l|ed as caus|rg ra|lorral|ors ard crror|c lela| |rlecl|ors, Wr|cr pers|sls aller o|rlr.
Pr|rc|pa| l|rd|rgs ol lre |rlecl|or are r|crocepra|y, cereora| ca|c|l|cal|ors, o||rdress ard cror|orel|r|l|s, ard
repalosp|erorega|y. 3ore |rlarls rave |err|clerus ard ru|l|p|e pelecr|ae ol lre s||r. Tre d|sease |s oller lala|
Wrer allecl|rg lre eroryo or lelus, oul |r case ol surv|va|, rer|rgoercepra||l|s ray cause rerla| relardal|or.
3|rce lre d|sease |s rard|y recogr|zed |r pregrarl Worer, |l |s rol |roWr Wral lre d|llererce |s oelWeer ar ear|y ard
a |ale |rlecl|or dur|rg deve|oprerl. ll |s |||e|y lral Wrer lre eroryo |s |rlecled al ar ear|y slage, lre darage |s so
severe lral |l |s urao|e lo surv|ve. Trose cases lral core lo our allerl|or are prooao|y leluses lral rave oeer |rlecled
or|y |ale |r pregrarcy.

herpes 8|mp|ex V|rus (h8V}
Trere are a leW reporls |r lre ||leralure lral sroW
lral |rlrauler|re |rlecl|or ol lre lelus W|lr l3v
occas|ora||y occurs. usua||y, lre |rlecl|or |s
lrarsr|lled c|ose lo lre l|re ol de||very, ard lre
aororra||l|es reporled are r|crocepra|y,
r|croprlra|r|a, rel|ra| dysp|as|a,
repalosp|erorega|y, ard rerla| relardal|or. lr
rosl cases, roWever, lre cr||d acqu|res lre |rlecl|or
lror lre rolrer al o|rlr as a vererea| d|sease, ard
syrplors ol lre d|sease lrer deve|op or lre oaoy
dur|rg lre l|rsl 3 Wee|s ol age. Trese syrplors are
craracler|zed oy |rl|arralory reacl|ors.

Var|ce||a (6h|ckenpox}
Trere |s approx|rale|y a 20 crarce ol corger|la|
arora||es occur|rg lo||oW|rg ralerra| var|ce||a
|rlecl|or |r lre 1sl lr|resler. 0elecls |rc|ude ||ro
rypop|as|a, rerla| relardal|or, ard rusc|e alropry.

human |mmunodef|c|ency V|rus (h|V}
Tr|s v|rus causes acqu|red |rrurodel|c|ercy
d|sease (Al03) ard ray oe lrarsr|lled lo lre lelus.
Tre v|rus does rol appear lo oe a rajor leraloger,
a|lrougr r|crocepra|y, groWlr relardal|or, ard
aororra| lac|es rave oeer allr|ouled lo |ls ellecls.

0ther v|ra| |nfect|ons and hypertherm|a
Va|lorral|ors lo||oW|rg ralerra| |rlecl|ors W|lr
reas|es, rurps, repal|l|s, po||orye||l|s, ECl0
v|rus, Coxsac||e v|rus, ard |rl|uerza v|rus rave
oeer descr|oed. Prospecl|ve slud|es |rd|cale,
roWever, lral lre ra|lorral|or rale lo||oW|rg
exposure lo lrese agerls |s |oW |l rol rorex|slerl.
A corp||cal|rg laclor |rlroduced oy lrese ard olrer
|rlecl|ous agerls |s lral rosl are pyroger|c ard |rcreased oody lerperalure (ryperlrerr|a) |s leraloger|c. lr ore
reporl, Z ol 3 (11) arercepra||c |rlarls Were oorr lo rolrers W|lr a r|slory ol ryperlrerr|a al lre l|re lral, |r lre
eroryo, lre reura| lo|ds are c|os|rg. lrleresl|rg|y, |r lWo ol lrese cases lre ep|sode ol ryperlrerr|a appeared lo oe
re|aled lo saura oalr|rg ard rol lo ary |rlecl|or.

Toxop|asma gond|| (Toxop|asmos|s}
Valerra| |rlecl|or W|lr lre prolozoar paras|le, acqu|red lror poor|y coo|ed real, doresl|c ar|ra|s (espec|a||y cals),
or so|| corlar|raled W|lr laeces, ras oeer sroWr lo produce corger|la| ra|lorral|ors. Tre allecled cr||d ray rave
cereora| ca|c|l|cal|or, rydrocepra|us, or rerla| relardal|or. Cror|orel|r|l|s, r|croprlra|r|a, ard olrer ocu|ar delecls
rave a|so oeer reporled. ll |s |rposs|o|e lo g|ve prec|se l|gures or lre |rc|derce ol ra|lorral|ors caused oy
loxop|asros|s, s|rce, as |r lre case ol CVv, lre d|sease |s usua||y urrecogr|zed |r pregrarl Worer.

8yph|||s
3ypr|||s |s |rcreas|rg |r |rc|derce ard ray |ead lo corger|la| dealress ard rerla| relardal|or |r lre ollspr|rg. lr
add|l|or, rary olrer orgars, sucr as lre |urgs ard ||ver, are craracler|zed oy d|lluse l|oros|s.
Rad|at|on exposure

Tre leraloger|c ellecl ol |or|z|rg rad|al|or ras oeer |roWr lor rary years, ard |l |s We|| recogr|zed lral r|crocepra|y,
s|u|| delecls, sp|ra o|l|da, o||rdress, c|ell pa|ale, ard delecls ol lre exlrer|l|es ray resu|l lror lreal|rg pregrarl
Worer W|lr |arge doses ol x-rays or rad|ur. A|lrougr lre rax|rur sale dose lor lre rurar lelus |s rol |roWr, |r
r|ce lre lelus car oe daraged W|lr a dose as sra|| as 5 rad.
ll rusl oe rea||zed lral lre ralure ol lre ra|lorral|or deperds or lre dose ol lre rad|al|or ard lre slage ol
deve|oprerl al Wr|cr lre rad|al|or |s g|ver.
lr add|l|or lo lre ellecl ol d|recl rad|al|or or lre eroryo, |rd|recl ellecls or gerr ce||s rusl oe cors|dered. lrdeed,
re|al|ve|y sra|| doses ol rad|al|or |r r|ce rave oeer sroWr lo cause rulal|ors lral suosequerl|y |ed lo lre
occurrerce ol corger|la| ra|lorral|ors |r succeed|rg gereral|ors.
6hem|ca| agents and pharmaceut|ca| drugs

Tre ro|e ol crer|ca| agerls ard prarraceul|ca| drugs |r lre producl|or ol aororra||l|es |r rurars |s d|ll|cu|l lo
access lor lWo reasors : (a) rosl slud|es are relrospecl|ve, re|y|rg or lre rolrer's rerory lor a r|slory ol exposure,
ard (o) lrere |s sucr a |arge ruroer ol prarraceul|ca| drugs erp|oyed oy pregrarl Worer. 0r|y 20 ol pregrarl
Worer used ro drugs al a|| dur|rg lre|r pregrarcy.

Re|al|ve|y leW ol lre rary drugs used dur|rg pregrarcy rave oeer pos|l|ve|y |derl|l|ed as oe|rg leraloger|c. 0re
exarp|e |s tha||dom|de, ar arl|rausearl ard s|eep|rg p|||, lral rad oeer assoc|aled W|lr are||a ard rerore||a (lola|
or parl|a| aoserce ol lre exlrer|l|es). 0elecls produced oy lra||dor|de are aoserce or gross delorr|l|es ol lre |org
oores, |rlesl|ra| alres|a ard card|ac aororra||l|es. Tre drug Was lrer |rred|ale|y reroved lror lre rar|el.
Arolrer dargerous drug |s am|nopter|n, a lo||c-ac|d arlagor|sl arl|relaoo||le, lral ras oeer used as ar
arl|reop|asl|c agerl. 0elecls produced |rc|ude arercepra|y, rer|rgoce|e, rydrocepra|us, ard c|ell ||p ard pa|ale.
3|rce rary arl|reop|asl|c agerls |rr|o|l r|los|s, |l |s rol surpr|s|rg lral lrey are polerl leralogers.
0lrer drugs a|so rave leraloger|c polerl|a|, |rc|ud|rg lre arl|corvu|sarl d|pheny|hydanto|n (prerylo|r), va|pro|c
ac|d ard tr|methad|one, Wr|cr are used oy ep||epl|c Worer. Tre ra|lorral|ors produced |rc|ude rearl
aororra||l|es, crar|olac|a| delecls, ard r|crocepra|y. Prerylo|r a|so produces ra|| ard d|g|la| rypop|as|a, groWlr
aororra||l|es ard rerla| del|c|ercy. Trese delecls corsl|lule a d|sl|rcl pallerr ol dysrorprogeres|s |roWr as lre
lela| rydarlo|r syrdrore. va|pro|c ac|d a|so produces reura| luoe delecls ard ||ro arora||es. Tr|relrad|ore a|so
produces a craracler|sl|c pallerr |roWr as lre lr|relrad|ore syrdrore |rc|ud|rg ra|lorred ears, c|ell pa|ale,
card|ac delecls, uroger|la| ard s|e|ela| arora||es.
Arl|psycrol|c ard arl|arx|ely agerls (major and m|nor tranqu|||zers, respecl|ve|y : prerolr|az|re, ||lr|ur,
reprooarale, cr|ord|azepox|de ard d|azepar) are suspecled produces ol corger|la| ra|lorral|ors. lr ary case, |l
ras oeer slrorg|y suggesled lral use ol lrese agerls dur|rg pregrarcy carr|es a r|gr r|s|.
Tre arl|coagu|arl warfar|n |s leraloger|c, Wrereas hepar|n does rol appear lo oe. warlar|r cause rypop|as|a ol lre
rasa| carl||age, crordrodysp|as|a, cerlra| rervous sysler delecls, |rc|ud|rg rerla| relardal|or, ard alropry ol lre
opl|c rerves.
Arl|ryperlers|ve agerls lral |rr|o|l lre arg|olers|r-corverl|rg-erzyre (A6E-|nh|b|tors) produce groWlr relardal|or,
rera| dyslurcl|or, lela| dealr, ard o||gorydrarr|ors.

lr add|l|or lo lre drugs d|scussed |r sore dela||, caul|ors ras oeer expressed regard|rg a ruroer ol olrer
corpourds lral r|grl oe darag|rg lo lre eroryo or lelus. Tre rosl perr|rerl arorg lrese are propy|th|ourac||
(PTu) ard potass|um |od|de (cause corger|la| go|ler ard rerla| relardal|or), streptomyc|n (dealress),
su|fonam|des (|err|clerus), lre arl|depressarl |m|pram|ne (||ro delorr|l|es), tetracyc||nes (oore ard loolr
arora||es), amphetam|nes (ora| c|ells ard card|ovascu|ar aororra||l|es), ard qu|n|ne (dealress). F|ra||y, lrere |s
|rcreas|rg ev|derce lral sa||cy|ates | asp|r|n, lre rosl corror|y |rgesled drug dur|rg pregrarcy, |s polerl|a||y
rarrlu| lo lre deve|op|rg ollspr|rg Wrer used |r |arge doses.

0re ol lre |rcreas|rg proo|ers |r loday's soc|ely |s lre ellecl ol soc|a| drugs sucr as L80 (|yserg|c ac|d
d|elry|ar|de), P6P (prercyc||d|re, arge| dusl), rar|juara, a|coro|, ard coca|re. L30 seers lo oe assoc|aled W|lr
sore ||ro aororra||l|es ard ra|lorral|ors ol lre cerlra| rervous sysler. PCP ard rar|juaras are pred|cled lo oe
assoc|aled W|lr sore ra|lorral|ors ard |aler oerav|ora| aororra||l|es. 6oca|ne ras oeer reporled lo cause
sporlareus aoorl|or, groWlr relardal|or, r|crocepra|y, reurooerav|ora| proo|ers, uroger|la| arora||es, ard
gaslroscr|s|s. Vary aororra||l|es produced oy coca|re ray oe due lo |ls acl|or as a vasocorslr|clor lral causes
rypox|a. A|coho| are slrorg|y assoc|aled W|lr corger|la| aororra||l|es sucr as crar|olac|a| aororra||l|es, ||ro
delorr|l|es ard card|ovascu|ar delecls, ard logelrer W|lr rerla| relardal|or ard groWlr del|c|ercy lrey ra|e up lre
lela| a|coro| syrdrore.
6|garette sro||rg ras rol oeer ||r|ed lo rajor o|rlr delecls. 3ro||rg does corlr|oule lo |rlrauler|re groWlr
relardal|or ard prelerr o|rlr, roWever.

Recerl|y, |sotret|no|n (a v|lar|r-A ara|og) used lo lreal acre ard olrer derraloses, ras oeer sroWr lo cause a
craracler|sl|c pallerr ol ra|lorral|ors |l used dur|rg pregrarcy, lre pallerr |roWr as |solrel|ro|r / v|lar|r-A
eroryopalry. Assoc|aled lealures ol lre eroryopalry |rc|ude reduced ard aororra| ear deve|oprerl, l|al rasa|
or|dge, rard|ou|ar rypop|as|a, c|ell pa|ale, rydrocepra|y, reura| luoe delecls, ard rearl arora||es.
hormones

Androgen|c agents
3yrlrel|c progesl|rs Were lrequerl|y used dur|rg pregrarcy lo preverl aoorl|or. Tre progesl|rs elr|slerore ard
rorelr|slerore rave cors|derao|e ardroger|c acl|v|ly, ard rary cases ol rascu||r|zal|or ol lre ger|la||a |r lera|e
eroryos rave oeer reporled. Tre aororra||l|es cors|sled ol er|arged c||lor|s assoc|aled W|lr vary|rg degrees ol
lus|or ol lre |ao|oscrola| lo|ds.

0|ethy|st||bestro| (0E8}
0E3, a syrlrel|c eslroger, Was corror|y used |r lre 1910's ard 1950's lo preverl aoorl|or. Tr|s pracl|ce Was
corlra|rd|caled |r 19Z1 Wrer |l Was delerr|red lral yourg Worer aged 1-22 years rad ar |rcreased |rc|derce ol
carc|roras ol lre vag|ra ard cerv|x lo||oW|rg exposure lo lre drug |r ulero.
Furlrerrore, a r|gr percerlage ol lrese exposed Worer sullered lror reproducl|ve dyslurcl|or lral appears lo oe
due, |r parl, lo corger|la| ra|lorral|ors ol lre ulerus, uler|re luoes, ard upper vag|ra. Va|e eroryos exposed |r
ulero car a|so oe allecled, as ev|derced oy ar |rcrease |r ra|lorral|ors ol lre lesles ard aororra| sperr ara|yses
arorg lrese |rd|v|dua|s. lr corlrasl lo lre lera|es, roWever, ra|es do rol derorslrale ar |rcreased r|s| ol
deve|op|rg carc|roras ol lre ger|la| syslers.

0ra| contracept|ves
8|rlr corlro| p|||s, corla|r|rg eslrogers ard progeslerores, appear lo rave a |oW leraloger|c polerl|a|. loWever, use ol
ora| corlracepl|ves srou|d oe d|scorl|rued |l pregrarcy |s suspecled.

6ort|sone
Exper|rerla| Wor| ras repealed|y sroWr lral corl|sore |rjecled |rlo r|ce ard raoo|ls al cerla|r slages ol pregrarcy
causes a r|gr percerlage ol c|ell pa|ales |r lre ollspr|rg. loWever, |l ras oeer |rposs|o|e lo |rp||cale corl|sore as ar
erv|rorrerla| laclor caus|rg c|ell pa|ale |r rurars.
Haterna| d|sease

0|abetes me|||tus
0|sluroarces |r caroorydrale relaoo||sr dur|rg pregrarcy |r d|aoel|c rolrers cause a r|gr |rc|derce ol sl|||o|rlrs,
reorala| dealrs, aororra||y |arge |rlarls, ard corger|la| ra|lorral|ors. Tre r|s| ol corger|la| arora||es |r cr||drer
ol d|aoel|c rolrers |s 3-1 l|res lral lor lre ollspr|rg ol rord|aoel|c rolrers ard ras oeer reporled lo oe as r|gr as
80 |r lre ollspr|rg lror d|aoel|cs W|lr |org-slard|rg d|sease. A var|ely ol ra|lorral|ors rave oeer ooserved,
|rc|ud|rg card|ac, s|e|ela|, ard cerlra| rervous sysler arora||es.
Faclors respors|o|e lor lrese delorr|l|es rave rol oeer de||realed, a|lrougr ev|derce suggesls lral a|lered g|ucose
|eve|s p|ay a ro|e ard lral |rsu||r |s rol leraloger|c. lr lr|s respecl, a s|gr|l|carl corre|al|or ex|sls oelWeer lre sever|ly
ard dural|or ol lre rolrer's d|sease ard lre |rc|derce ol ra|lorral|ors. A|so, slr|cl corlro| ol ralerra| relaoo||sr
W|lr agress|ve |rsu||r lrerapy reduces lre occurrerce ol ra|lorral|ors. 3ucr lrerapy, roWever, |rcreases lre
lrequercy ard sever|ly ol rypog|ycer|c ep|sodes.
0ur|rg gaslru|al|or ard reuru|al|or slages, lre rarra||ar eroryos are r|gr|y deperderl or g|ucose as ar erergy
source, sucr lral ever or|el ep|sodes ol |oWered o|ood g|ucose car oe r|gr|y leraloger|c. Trerelore, caul|or rusl oe
erpras|zed |r rarag|rg lre pregrarl d|aoel|c Worar, ard lrerapy srou|d oe |r|l|aled ever pr|or lo corcepl|or.
lr lre case ol ror-|rsu||r-deperderl d|aoeles re|||lus, ora| rypog|ycer|c agerls ray oe erp|oyed. Trese agerls
|rc|ude lre su|lory|ureas ard o|guar|des. 8olr c|asses ol agerls rave a|so oeer |rp||caled as leralogers, sucrr lral
lrey rusl oe erp|oyed W|lr caul|or.

Pheny|ketonur|a (PKU}
Volrers W|lr PKu, |r Wr|cr lre erzyre prery|a|ar|re rydroxy|ase |s del|c|erl, resu|l|rg |r |rcreased serur
corcerlral|or ol prery|a|ar|re, are al r|s| lor rav|rg |rlarls W|lr rerla| relardal|or, r|crocepra|y ard card|ac delecls.
worer W|lr lrese d|sease Wro ra|rla|r lre|r |oW prery|a|ar|re d|el pr|or lo corcepl|or reduce lre r|s| lo lre |rlarls
lo oac|grourd rales.
Nutr|t|ona| def|c|enc|es

A|lrougr rary rulr|l|ora| del|c|erc|es, parl|cu|ar|y v|lar|r del|c|erc|es, rave oeer prover lo oe leraloger|c |r
exper|rerla| Wor|, lrere |s ro del|r|le ev|derce lral lrey are leraloger|c |r rurars. Trus, W|lr lre excepl|or ol
erder|c crel|r|sr, Wr|cr |s re|aled lo ralerra| |od|re del|c|ercy, ro ara|og|es lo ar|ra| exper|rerls rave oeer lourd
|r rurars.
hypox|a

lypox|a |rduces corger|la| ra|lorral|ors |r a greal var|ely ol exper|rerla| ar|ra|s. wrelrer lre sare |s va||d lor
rurars rera|rs lo oe seer. A|lrougr cr||drer oorr al re|al|ve|y r|gr a|l|ludes are usua||y ||grler |r We|grl ard sra||er
lrar lrose oorr rear or al sea |eve|, ar |rcrease |r lre |rc|derce ol corger|la| ra|lorral|ors ras rol oeer roled. lr
add|l|or, Worer W|lr cyarol|c card|ovascu|ar d|sease oller g|ve o|rlr lo sra|| |rlarls, oul usua||y W|lroul ary gross or
s|gr|l|carl corger|la| ra|lorral|ors.
Env|ronmenta| chem|ca|s

A leW years ago, |l Was roled |r Japar lral a ruroer ol rolrers W|lr d|els cors|sl|rg ra|r|y ol l|sr rad g|ver o|rlr lo
cr||drer W|lr ru|l|p|e reuro|og|ca| syrlors resero||rg cereora| pa|sy. Furlrer exar|ral|or revea|ed lral lre l|sr
corla|red ar aororra||y r|gr |eve| ol orgar|c rercury, Wr|cr Was speWed |rlo V|rarala 8ay ard olrer coasla| Walers
ol Japar oy |arge |rduslr|es. Vary ol lre rolrers d|d rol sroW ary syrplors lrerse|ves, |rd|cal|rg lral lre lelus
Was rore sers|l|ve lo rercury lrar lre rolrer.
Lead ras oeer assoc|aled W|lr |rcreased aoorl|ors, groWlr relardal|or, ard reuro|og|ca| d|sorders.
Arorg lre pesl|c|des, lre delo||arl 2,1,5-T (Agerl 0rarge) ras oeer |rp||caled as leraloger |r rarra|s. loWever,
ro ev|derce cou|d oe lourd lral lre rero|c|de Was leraloger|c |r rurars.
6hR0H080HAL AN0 CENET|6 FA6T0R8

Crrorosora| aororra||l|es ray oe rurer|ca| or slruclura| ard are |rporlarl causes ol corger|la| ra|lorral|ors ard
sporlareous aoorl|ors. ll |s esl|raled lral 50 ol a|| corcepl|ors erd |r sporlareous aoorl|or ard lral 50 ol lrese
aoorluses rave rajor crrorosora| aororra||l|es. Trus, approx|rale|y 25 ol a|| corcepluses rave a rajor
crrorosore delecl.
Tre rosl corror crrorosore aororra||l|es |r aoorluses are 15X (Turrer syrdrore), lr|p|o|dy, ard lr|sory 1.
Crrorosore aororra||l|es a|so courl lor Z ol rajor o|rlr delecls, Wr||e gere rulal|ors accourl lor ar add|l|ora|
Z.
Numer|ca| abnorma||t|es

Tre rorra| rurar soral|c ce|| corla|rs 1 crrorosores; lre rorra|
garele corla|rs 23 crrorosores. Norra| soral|c ce||s are d|p|o|d or 2r;
rorra| gareles are rap|o|d or r.
Eup|o|d relers lo ary exacl ru|l|p|e ol r, e.g. d|p|o|d or lr|p|o|d. Areup|o|d
relers lo ary crrorosore ruroer lral |s roreup|o|d ard |s usua||y app||ed
Wrer ar exlra crrorosore |s preserl (lr|sory) or Wrer ore |s r|ss|rg
(rorosory). Areup|o|dy resu|ls lror rord|sjurcl|or dur|rg re|os|s or
r|los|s ard ray |rvo|ve lre aulosores or lre sex crrorosores.

Tr|somy 21 (0own syndrome}
0oWr syrdrore |s caused oy lre preserce ol ar exlra copy ol crrorosore
21 (lr|sory 21). C||r|ca||y, lealurse ol cr||drer W|lr 0oWr syrdrore |rc|ude
groWlr relardal|or; vary|rg degrees
ol rerla| relardal|or; crar|olac|a| aororra||l|es, |rc|ud|rg upWard s|arl|rg
eyes, ep|carlra| lo|ds, l|allered lac|es, ard sra|| ears; card|ac delecls;
|rlesl|ra| sleros|s; uro|||ca| rerr|a; ard rypolor|a.
lr 95 ol cases, lre syrdrore |s caused oy lr|sory 21 due lo re|ol|c
rord|sjurcl|or, ard |r Z5 ol lrese |rslarces, rord|sjurcl|or occurs dur|rg
oocyle lorral|or. Furrlerrore, Worer over 35 years rave a grealer r|s|
ol rav|rg ar allecled cr||d. lr approx|rale|y 1 ol cases, lrere |s ar
uroa|arced lrars|ocal|or oelWeer crrorosore 21 ard e|lrer ol
crrorosores 13, 11 or 15. Tre l|ra| 1 are due lo rosa|c|sr resu|l|rg
lror r|lol|c rord|sjurcl|or. Trese |rd|v|dua|s rave sore ce||s W|lr a
rorra| crrorosore ruroer ard sore lral are areup|o|d. Trey ray
exr|o|l leW or rary ol lre
craracler|sl|cs ol 0oWr syrdrore,
deperd|rg or lre ruroers ol
aororra| ce||s ard lre|r |ocal|or.

Tr|somy 18 (Edwards 8yndrome}
Pal|erls W|lr lr|s crrorosora| arrargererls sroW lre lo||oW|rg lealures :
rerla| relardal|or, corger|la| rearl delecls, pror|rerl occ|pul, |oW-sel ears,
ard l|ex|or ol l|rgers ard rards. lr add|l|or, pal|erls lrequerl|y sroWs
r|crogralr|a, rera| arora||es, syrdacly|y, ard ra|lorral|ors ol lre s|e|ela|
sysler. Tre |rc|derce ol lr|s cord|l|or |s aooul 1 |r 5,000 lo 8,000
reWoorrs. Tre |rlarls usua||y d|e oy age 2 rorlrs.

Tr|somy 13 (Patau 8yndrome}
Tre ra|r aororra||l|es ol lr|s syrdrore are rerla| relardal|or, ro|oprosercepra|y / r|crocepra|y, corger|la| rearl
ard rera| delecls, dealress, c|ell ||p ard pa|ale, eye delecls sucr as r|croprla|r|a, aroprla|r|a, ard co|ooora, ard
uro|||ca| rerr|a. Tre |rc|derce ol lr|s aororra||ly |s aooul 1 |r ,000 lo 50,000 ||ve o|rlrs. Vosl ol lre |rlarls d|e oy
age 3 rorlrs.

Turner syndrome
Turrer syrdrore, lourd |r Worer W|lr ar urr|sla|ao|y lera|e appeararce, |s craracler|zed oy lre aoserce ol
ovar|es (gorada| dysgeres|s) ard srorl slalure. 0lrer aororra||l|es lrequerl|y lourd are Weooed rec|, p|grerled
rev|, coarclal|or ol aorla, |yrpredera ol lre exlrer|l|es, s|e|ela| delorr|l|es, ard a oroad cresl W|lr W|de|y spaced
r|pp|es.
Approx|rale|y 55 ol allecled |rd|v|dua|s W||| oe rorosor|c lor lre X ard crroral|r regal|ve due lo rord|sjurcl|or.
lr Z5 ol lrese cases, rord|sjurcl|or |r lre ra|e garele |s lre cause. lr lre rera|rder ol lre cases, roWever,
slruclura| aororra||l|es ol lre X crrorosore (15) or rosa|c|sr (30) cause lre syrdrore.

K||nefe|ter syndrome
Tre c||r|ca| lealures ol K||rele|ler syrdrore, lourd or|y |r ra|es ard usua||y
delecled al puoerly, are sler|||ly, lesl|cu|ar alropry, rya||r|zal|or ol lre
ser|r|lerous luou|es, ard |r rosl cases, gyrecorasl|a. Tre ce||s rave 1Z
crrorosores W|lr a sex crrorosora| corp|ererl ol lre XXY lype, ard a
sex crroral|r oody |s lourd |r 80 ol cases. Tre |rc|derce |s aooul 1 |r 500
ra|es. Nord|sjurcl|or ol lre XX roro|ogues |s lre rosl corror causal|ve
everl. 0ccas|ora||y, pal|erls W|lr K||rele|ler syrdrore rave 18
crrorosores, |.e., 11 aulosores ard 1 sex crrorosores (XXXY). A|lrougr
rerla| relardal|or |s rol gerera||y parl ol lre syrdrore, lre rore X
crrorosores lrere are, lre rore |||e|y lrere W||| oe sore degree ol rerla|
|rpa|rrerl.

Tr|p|e X syndrome
Pal|erls W|lr lr|p|e X syrdrore are |rlarl||e, W|lr scarly rerses ard sore
degree ol rerla| relardal|or. Trey rave lWo sex crroral|r ood|es |r lre|r
ce||s.
8tructura| abnorma||t|es

3lruclura| crrorosore aororra||l|es |rvo|ve ore or rore crrorosores ard usua||y resu|ls lror crrorosore
orea|age. 8rea|s are caused oy erv|rorrerla| laclors sucr as v|ruses, rad|al|or ard drugs. Tre resu|l ol orea|age
deperds or Wral rappers lo lre oro|er p|eces. lr sore cases, lre oro|er p|ece ol a crrorosore |s |osl, ard lre
|rlarl W|lr parl|a| de|el|or ol a crrorosore |s aororra|. A We||-|roWr syrdrore caused oy parl|a| de|el|or ol lre
srorl arr ol crrorosore 5 |s lre cr|-du-cral syrdrore. Tre cr||drer rave a cal-|||e cry, r|crocepra|y, rerla|
relardal|or, ard corger|la| rearl d|sease. Vary olrer re|al|ve|y rare syrdrores are |roWr lo resu|l lror a parl|a|
crrorosore |oss.

H|crode|et|ons, sparr|rg or|y a leW corl|guous geres, a|so occur. 3|les Wrere lrese de|el|ors occur are ca||ed
corl|guous geres corp|exes ard car oe |derl|l|ed oy r|gr-reso|ul|or crrorosore oard|rg lecrr|ques. Ar exarp|e ol
a r|crode|el|or |rvo|ves lre |org arr ol crrorosore 15 (15q11-15q13). lrrer|l|rg lre
de|el|or or lre ralerra| crrorosore resu|ls |r| Arge|rar syrdrore, ard lre cr||drer are rerla||y relarded, carrol
spea|, exr|o|l poor rolor deve|oprerl, ard are prore lo urprovo|ed ard pro|orged per|ods ol |augrler. ll lre delecl |s
|rrer|led or lre palerra| crrorosore, lre Prader-w|||| syrdrore |s produced, craracler|zed oy rypolor|a, ooes|ly,
rerla| relardal|or, rypogorad|sr ard cryplrorcrr|d|sr. Cases lral exr|o|l d|llererl|a| express|or, deperd|rg or
Wrelrer lre gerel|c raler|a| |s |rrer|led lror lre rolrer or lre lalrer, represerl gerel|c |rpr|rl|rg.

Frag||e s|tes are reg|ors ol crrorosores lral derorslrale a propers|ly lo separale or orea| urder cerla|r ce||
rar|pu|al|ors. For exarp|e, lrag||e s|les car oe errarced oy cu|lur|rg |yrprocyles |r lo|ale-del|c|erl red|ur.
A|lrougr rurerous lrag||e s|les rave oeer del|red, or|y lre s|le |ocaled or lre |org arr ol lre X crrorosore (Xq2Z)
ras oeer corre|aled W|lr ar a|lered prerolype ard |s ca||ed lre lrag||e X syrdrore. Tre syrdrore |s craracler|zed oy
rerla| relardal|or, |arge ears, pror|rerl jaW, ard pa|e o|ue |r|des. Va|es are allecled rore oller lrar lera|es (1/2000
vs 1/2000), Wr|cr ray accourl lor lre preporderarce ol ra|es arorg lre rerla||y relarded. Tre syrdrore |s secord
or|y lo 0oWr syrdrore as a cause ol crrorosora||y der|ved rerla| relardal|or.

Hutant genes
Vary corger|la| ra|lorral|ors |r rurars are |rrer|led, ard sore sroW a c|ear rerde||ar pallerr ol |rrer|larce. lr
rary cases, lre aororra||ly |s d|recl|y allr|oulao|e lo a crarge |r lre slruclure or lurcl|or ol a s|rg|e gere, rerce lre
rare s|rg|e gere rulal|or. ll |s esl|raled lral lr|s lype ol delecl ra|es up approx|rale|y 8 ol a|| rurar
ra|lorral|ors.
w|lr excepl|ors ol lre X ard Y crrorosores |r lre ra|e, geres ex|sl as pa|rs or a||e|es, sucr lral lrere are lWo
doses lor eacr gerel|c delerr|rarl, ore lror lre rolrer ard ore lror lre lalrer. ll a rularl gere produces ar
aororra||ly |r a s|rg|e dose, desp|le lre preserce ol a rorra| a||e|e, |l |s a dor|rarl rulal|or. ll oolr a||e|es rusl oe
aororra| (douo|e dosage) or |l lre rulal|or lral occurs |s X-||r|ed |r lre ra|e, |l |s a recess|ve rulal|or. 0radal|ors |r
lre ellecls ol rularl geres ray occur due lo rod|ly|rg laclors.
lr add|l|or lo caus|rg corger|la| ra|lorral|ors, delecl|ve gere acl|or causes a |arge ruroer ol |roorr errors ol
relaoo||sr. Trese d|sease, arorg Wr|cr prery||elorur|a, rorocysl|rur|a, ard ga|acloser|a are lre oesl |roWr, are
lrequerl|y accorpar|ed oy or cause var|ous degrees ol rerla| relardal|or.

As rapp|rg ol lre rurar gerore corl|rues, lre assoc|al|or ol spec|l|c geres W|lr lre|r rorra| lurcl|ors ard lre
aororra||l|es lrey cause W||| oecore rore prec|se. A|ready, reW ro|ecu|ar lecrr|ques sucr as l|ourescerce |r s|lu
ryor|d|zal|or (Fl3l), Wr|cr uses spec|l|c 0NA prooes lor |derl|ly|rg de|el|ors ol gerel|c raler|a|, rave |rproved our
ao|||ly lo delecl gere ard crrorosore aororra||l|es.
60N6LU8|0N8

Vary laclors ray |rleracl W|lr lre d|llererl|al|rg ard groW|rg eroryo.
Tre resu|l, roWever, |s rol recessar||y a gross ra|lorral|or.
lr sore |rslarces, lre leraloger|c agerl ray oe so lox|c or ray allecl a v|la| orgar sysler ol lre eroryo or lelus so
severe|y lral dealr resu|ls. lr olrer cases, lre erv|rorrerla| |rl|uerce ray oe so r||d lral lre eroryo or lelus |s ao|e
lo surv|ve oul sore ol |ls orgar syslers are allecled. Tr|s ray resu|l |r parl|a| or lola| groWlr relardal|or or a
lurcl|ora| |rpa|rrerl sucr as rerla| relardal|or.
A var|ely ol agerls are |roWr lo produce corger|la| ra|lorral|ors |r approx|rale|y 2-3 ol a|| ||veoorr |rlarls. Trese
agerls |rc|ude v|ruses, sucr as ruoe||a ard cylorega|ov|rus; rad|al|ors; drugs, sucr as lra||dor|de, ar|ropler|r,
arl|corvu|sarls, arl|psycrol|cs, ard arl|arx|ely corpourds; soc|a| drugs, sucr as PCP, c|garelles, coca|re, ard
a|coro|; rorrores, sucr as d|elry|sl||oeslro|; ralerra| d|aoeles; ard crrorosora| aororra||l|es, sucr as lr|sory 21
(0oWr syrdrore).
Ellecls ol leralogers are deperderl or lre ralerra| ard lela| gerolype, lre slage ol deve|oprerl Wrer exposure
occurs, ard lre dose ard dural|or ol exposure ol lre agerl. Vosl rajor ra|lorral|ors are produced dur|rg lre per|od
ol eroryogeres|s (leraloger|c per|od), oul |r slages pr|or lo ard aller lr|s l|re lre lelus |s a|so suscepl|o|e, sucr lral
ro per|od ol geslal|or |s corp|ele|y lree ol r|s|.
Preverl|or ol rary o|rlr delecls |s poss|o|e oul |s deperderl or ar aWareress oy prys|c|ars ard oy Worer ol
cr||doear|rg age ol lre r|s|s |rvo|ved.
Teks as|| oar| $ao|er Tw, langman's Veo|ca| Emor,o|og,, 7rn eo., lonoon . w||||ams & w||k|ns, '995,
o|ker|k u|ang nan,a unruk kepenr|ngan oe|aar ko-as.

Samoar ||usrras| ramoanan oar| 0orran R$, rumar v, Rooo|ns $l {eosj, Rooo|ns Parno|og|c 3as|s ol 0|sease, 5rn eo.,
Pn||aoe|pn|a . w3 $aunoers 0o., '994.
Resus|tas| dan Perawatan |ntens|f
Neonatus
Ku||ah Anestes|o|og|
dr. 8unatr|o | dr. Adj| 8untoro
Ku||ah ||mu Kesehatan Anak
Prof.dr. h..E. Hon|ntja | dr. Nartono Kadr|
NE0NATU8

Neoralus ada|ar orgar|sre yarg sedarg oerada pada per|ode adaplas| |er|dupar |rlrauler|r |e |er|dupar
e|slrauler|r.

Tne neuoorn per|oo |s oel|neo as rne l|rsr 28 oa,s ol ||le.
Vasa reorala| ada|ar per|ode se|ara salu ou|ar (|eo|r lepal : 1 r|rggu = 28 rar|) sele|ar |ar|r.

Vasa adaplas| sele|ar |ar|r |lu rerupa|ar juga
sualu rasa yarg sargal |r|l|s dar rererlu|ar
urlu| |er|dupar |rd|v|du se|arjulrya.
Va|a rasa|ar-rasa|ar yarg lerjad| pada rasa |lu
dapal se|a|| rergarcar ryaWa |rd|v|du yarg
ras|r sargal |erar |lu.
Alau, searda|rya ryaWa dapal lerse|aral|ar,
rasa|ar lerseoul rurg||r dapal juga
rerpergarur| |ua||las r|dup |rd|v|du lerseoul
se|arjulrya.

0a|ar ||ru per|ralo|og| / peraWalar |rlers|l,
|egaWalar yarg lerjad| pada rasa lerseoul d|seoul
|egaWaldaruralar per|rala|.
RE8U8|TA8| NE0NATU8 Pendahu|uan
Resus|las| d|per|u|ar o|er reoralus yarg da|ar
oeoerapa rer|l perlara |er|duparrya l|da| dapal
rergada|ar verl||as| ele|l|l dar perlus| ade|ual
urlu| rererur| |eoulurar o|s|geras| dar
e||r|ras| |aroord|o|s|da, alau o||a s|sler |ard|ovas|u|ar l|da| cu|up dapal reroer| perlus| secara ele|l|l |epada
susurar saral pusal, jarlurg dar orgar v|la| |a|r. (Cregory, 1975}

Peryeoao lerjad|rya o|s|geras| yarg l|da| ele|l|l
dar perlus| yarg l|da| ade|ual pada reoralus
dapal oer|argsurg seja| saal seoe|ur persa||rar
r|rgga rasa persa||rar.

Kond|s| yang memer|ukan resus|tas| neonatus
m|sa|nya :
1. suroalar ja|ar rapas : a||oal |erd|r / darar /
re|or|ur, alau a||oal ||dar yarg jalur |e posler|or.
2. |ord|s| depres| perrapasar a||oal ooal-ooalar
yarg d|oer||ar |epada |ou r|sa|rya ooal areslel||,
ara|gel|| |o|a|, rar|ol||, d|azepar, ragres|ur
su|lal, dar seoaga|rya
3. |erusa|ar reuro|og|s
1. |e|a|rar / |erusa|ar sa|urar rapas alau
|ard|ovas|u|ar alau susurar saral pusal, dar / alau
|e|a|rar-|e|a|rar |orger|la| yarg dapal
reryeoao|ar gargguar perrapasar / s|r|u|as|
5. syo| r|povo|er|| r|sa|rya a||oal |orpres| la||
pusal alau perdararar

Resus|las| |eo|r perl|rg d|per|u|ar pada rer|l-
rer|l perlara |er|dupar. J||a ler|aroal, o|sa
oerpergarur ouru| oag| |ua||las r|dup |rd|v|du
se|arjulrya.

Pent|ng untuk resus|tas| yang efekt|f :
1. leraga yarg lerarp||, l|r |erja yarg oa||
2. perararar lerlarg l|s|o|og| dasar perrapasar,
|ard|ovas|u|ar, serla proses asl||s|a yarg progres|l
3. |erarpuar / a|al pergalurar sur|, verl||as|,
ror|lor|rg
1. ooal-ooalar dar ca|rar yarg d|per|u|ar

PR|N8|P !!
Penyebab kemat|an yang pa||ng cepat ada|ah asf|ks|a dan perdarahan.

Asf|ks|a per|nata| rerupa|ar peryeoao rorla||las dar roro|d|las yarg perl|rg. A||oal jarg|a parjarg asl||s|a
per|rala| |r| dapal d|peroa||| secara oerra|ra o||a ra| |r| d||elaru| 3E8ELuV |e|ar|rar (r|sa|rya pada |eadaar
gaWal jar|r), ser|rgga dapal d|usara|ar rerperoa||| s|r|u|as| / o|s|geras| jar|r |rlrauler|r alau segera re|ar|r|ar
jar|r urlu| rerpers|rg|al rasa r|po|ser|a jar|r yarg lerjad|.

3ETlAP oay| yarg d||ar|r|ar d| |uar |arar oersa||r yarg rer||||| pera|alar |erg|ap rerda|rya d|arggap rer|||||
la|lor r|s||o laroarar.
Proses yang terjad| pada asf|ks|a per|nata|

Proses yarg lerjad| pada asl||s|a per|rala| dapal d|rara||ar res||pur peryeoaorya oe|ur d||elaru|.
Ke|urargar o|s|ger pada jar|r ser|rg d|serla| r|per|apr|a dar as|dos|s carpurar relaoo|||-resp|ralor||.

Pada |eadaar asl||s|a / r|po|ser|a yarg lerjad| / d|leru|ar seoe|ur |e|ar|rar, geja|a yarg dapal d|dele|s| dar| |uar
ururrya oerupa lela| orad||ard|a (ser|rg d|seoul dergar |sl||ar urur / gerera||sas| oerupa gaWal jar|r). J||a
d||arjul|ar dergar perer||saar darar r|sa|rya |eWal darar la|| pusal, dapal d|leru|ar as|dos|s.

Asf|ks|a yang terdeteks| sesudah |ah|r, prosesnya berja|an da|am beberapa fase | tahapan (0awes}. :
1. jar|r oerrapas regap-regap (gasp|rg), d|||ul| dergar
2. rasa rerl| rapas (lase rerl| rapas pr|rer).
3. J||a asl||s|a oer|arjul lerus, l|rou| ser| perrapasar regap-regap yarg |edua se|ara 1-5 rer|l (lase gasp|rg
|edua), d|||ul| |ag| dergar
1. rasa rerl| rapas |edua (rerl| rapas
se|urder)

8ay| yarg oerada da|ar |eadaar rerl| rapas
pr|rer, o|asarya p|elor|| (Wa|aupur oarya| yarg
s|arol||). 8ay| da|ar rerl| rapas se|urder,
oerWarra o|ru sarpa| urgu dar pucal.
8ay| yarg d||ar|r|ar da|ar |eadaar rerl| rapas
pr|rer, ser|rg dapal ru|a| oerrapas sporlar
sele|ar sl|ru|as| sersor|| (r|sa|rya le|apa| |a||
d|lepo|, alau purggurg d|usap-usap dergar
aga| cepal dar |eras).
8ay| yarg oerada da|ar |eadaar rerl| rapas
se|urder, l|da| a|ar dapal ru|a| oerrapas
sporlar, dar rarus d|oarlu dergar verl||as|
le|arar pos|l|l dar o|s|ger (resus|las|
perrapasar arl|l|s|a| / re|ar||).
Va||r |ara se|arg Wa|lu dar| saal ru|a| rerl|
rapas se|urder sarpa| d|ru|a|rya resus|las|
verl||as| le|arar pos|l|l, ra||r |ara pu|a Wa|lu
yarg d|per|u|ar oay| urlu| ru|a| oerrapas
sporlar yarg ade|ual, progros|s ra||r ouru|.

3e|ara asl||s|a, curar jarlurg dar le|arar
darar rerurur.
Terjad| red|slr|ous| curar jarlurg urlu|
rerperlarar|ar a||rar darar |e ola|, jarlurg
dar adrera|.
Pada asl||s|a yarg lerus oer|arjul, curar jarlurg ra||r rerurur dar a||rar darar |e orgar-orgar v|la| l|da|
rercu|up| |ag|.

Pada oay| dergar asl||s|a, secara |asar lerdapal |ore|as| arlara lre|uers| jarlurg dergar curar jarlurg. Karera |lu
perarlauar lre|uers| jarlurg (r|sa|rya dergar slelos|op, alau peraoaar rad| la|| pusal) rerupa|ar cara yarrg oa||
urlu| rerarlau ele|l|l|las upaya resus|las|.

Per|engkapan dan obat-obatan resus|tas| (tabe|}

Resus|las| reorala| yarg ele|l|l rerer|u|ar leraga yarg ler|al|r dar per|erg|apar yarg lepal (||ral laoe|).
lerda|rya d|sed|a|ar r|r|rur 2 sel per|erg|apar resus|las| (urlu| rergradap| |erurg||rar persa||rar |eroar)
dar 1 ur|l resus|las| roo|| urlu| |eper|uar lrarsporl.

Pr|ns|p-pr|ns|p umum prosedur resus|tas| neonatus

Pr|ns|p resus|tas| neonatus :
T (temperature}, baru kemud|an A--6-0

Pengaturan suhu
3erua reoralus da|ar |eadaar apapur rerpurya| |esu|arar
urlu| oeradaplas| pada suru ||rg|urgar yarg d|rg|r.
Neoralus yarg rerga|ar| asl||s|a |rususrya, rerpurya| s|sler
pergalurar suru yarg |eo|r l|da| slao||, dar r|polerr|a |r| dapal
rerperoeral / rerper|aroal peru||rar |eadaar as|dos|s yarg
lerjad|.
3egera sesudar |ar|r, oadar dar |epa|a reoralus rerda|rya
d||er|rg|ar se|ururrya dergar |a|r |er|rg dar rargal, dar
d||ela||ar le|arjarg d| oaWar a|al / |arpu peraras rad|as|, alau
pada luour |ourya, urlu| rercegar |er||argar paras. 8||a
d||ela||ar de|al |ourya, oay| dar |ou rerda|rya
d|se||rul| dergar oa||.
Narur rarus d|perral||ar pu|a agar l|da| lerjad|
perarasar yarg oer|eo|rar pada luour oay|.

T|rda|ar resus|las| pada oay| seoa||rya d||a|u|ar pada
sualu reja yarg le|ar d||erg|ap| dergar pera|alar
resus|las|.

Pen||a|an status k||n|k
0|gura|ar per||a|ar Apgar urlu| rererlu|ar |eadaar oay| pada rer|l |e 1 dar |e 5 sesudar |ar|r.
N||a| pada rer|l perlara : urlu| rererlu|ar seoerapa jaur d|per|u|ar l|rda|ar resus|las|. N||a| |r| oer|a|lar dergar
|eadaar as|dos|s dar |e|argsurgar r|dup.
N||a| pada rer|l |e||ra : urlu| rer||a| progros|s reuro|og||.

Ada peroalasar da|ar per||a|ar Apgar |r|, ya|lu :
1. Resus|las| 3E0ERA d|ru|a| o||a d|per|u|ar, dar l|da| rerurggu sarpa| ada per||a|ar pada rer|l perlara.
2. Kepulusar per|u-l|da|rya resus|las| raupur per||a|ar respors resus|las| dapal cu|up dergar rerggura|ar
eva|uas| lre|uers| jarlurg, a|l|l|las resp|ras| dar lorus reurorus|u|ar, dar|pada dergar r||a| Apgar lola|. la| |r| urlu|
rergreral Wa|lu.

Perencanaan berdasarkan perh|tungan n||a| Apgar
1. N||a| Apgar rer|l perlara Z - 10 : o|asarya oay| rarya rerer|u|ar l|rda|ar perlo|orgar oerupa pergr|sapar
|erd|r / ca|rar dar| orolar|rg dergar rerggura|ar ou|o syr|rge alau sucl|or ur|l le|arar rerdar. lal|-ral|,
perg|sapar yarg ler|a|u |ual / lraural|| dapal
reryeoao|ar sl|ru|as| vaga| dar orad||ard|a sarpa|
rerl| jarlurg.
2. N||a| Apgar rer|l perlara 1 - : rerda|rya orolar|rg
cepal d||sap dar d|oer||ar 02 100. 0||a|u|ar sl|ru|as|
sersor|| dergar lepo|ar alau serl||ar pada le|apa| |a||
dar goso|ar se||rul |er|rg pada purggurg. Fre|uers|
jarlurg dar resp|ras| lerus d|parlau |elal. 8||a lre|uers|
jarlurg rerurur alau verl||as| l|da| ade|ual, rarus d|oer||ar verl||as| le|arar
pos|l|l dergar |arlorg resus|las| dar surg|up ru|a. J||a l|da| ada a|al oarlu
verl||as|, gura|ar le|r|| perrapasar oualar dar| ru|ul |e r|durg-ru|ul.
3. N||a| Apgar rer|l perlara 3 alau |urarg : oay| rerga|ar| depres| perrapasar yarg oeral dar orolar|rg rarus
cepal d||sap. verl||as| dergar le|arar pos|l|l dergar 02 100 seoarya| 10-50 |a|| per rer|l rarus segera d||a|u|ar.
Kecu|upar verl||as| d|r||a| dergar rerperral||ar gera|ar d|rd|rg dada dar aus|u|las| oury| rapas. J||a lre|uers|
jarlurg l|da| rer|rg|al sesudar 5-10 |a|| rapas, |orpres| jarlurg rarus d|ru|a|. Fre|uers| : 100 sarpa| 120 |a|| per
rer|l, dergar 1 |a|| verl||as| sel|ap 5 |a|| |orpres| (5:1).

JlKA lre|uers| jarlurg lelap d| oaWar 100 |a|| per rer|l sele|ar 2-3
rer|l, usara|ar re|a|u|ar |rluoas| erdolra|ea.

0ura|ar |ar|rgos|op dergar daur |urus (Vag|||). 0ura|ar sl||el urlu|
rerurlur ja|ar p|pa.
3l||el jargar sarpa| |e|uar dar| ujurg p|pa. Pos|s| p|pa d|per||sa
dergar aus|u|las|.

Ka|au lre|uers| jarlurg lelap |urarg dar| 100 sele|ar |rluoas|, oer||ar
0.5 - 1 r| adrera||r (1:10.000). 0apal juga secara |rlra|ard|a| alau
|rlralra|ea|, lap| |eo|r d|arjur|ar secara |rlravera.

J||a l|da| ada ar|| yarg oerperga|arar
urlu| rerasarg |rlus pada vera per|ler
oay|, |a|u|ar |aleler|sas| vera alau arler|
uro||||a||s pada la|| pusal, dergar |aleler
uro||||a||s. 3eoe|ur peryurl||ar ooal,
rarus d|pasl||ar ada a||rar darar yarg
oeoas raroalar. 0ergar der|||ar
perou|ur la|| pusal d|oual rerjad|
drug/l|u|d lrarsporl ||re.

JAN0AN rerasu||ar |arular r|perlor|| seperl| g|u|osa 50 alau ralr|ur o||arooral yarg l|da| d|ercer|ar re|a|u|
vera uro||||a||s, |arera dapal rerusa| parer||r ral|.

8ay| dergar asl||s|a oeral yarg l|da| respors|l lerradap lerap| alau rerpurya| lre|uers| jarlurg yarg ade|ual lelap|
perlus|rya ouru|, rerda|rya d|oer||ar ca|rar e|spars| vo|ure darar (p|asra vo|ure exparder) : 10 r|/|g88
P|asrarale alau a|our|r 5 secara |rlus se|ara 10 rer|l.

Ka|au d|duga oarya| lerjad| perdararar, oer||ar lrarslus| 10 r|/|g88 darar |erg|ap (Wro|eo|ood).
8||a orad||ard|a rerelap : u|arg| dos|s adrera||r.
0apal juga d|oer||ar |a|s|ur g|u|oral 10 urlu| ele| |rolrop|| 50-100 rg/|g88 |rlravera per|arar-|arar, alau su|las
alrop|r urlu| arl||o||rerg|| / lerap| orad||ard|a 0.01 rg/|g88.

As|dos|s resp|ralor|| : d||ore|s| dergar rerperoa||| verl||as|
As|dos|s relaoo||| : d||ore|s| dergar |rlus ralr|ur o||arooral dar ca|rar e|spars| vo|ure darar.

Ada 3 rasa|ar perl|rg oer|a|lar dergar peroer|ar ralr|ur o||arooral pada oay| :
1. zal |r| sargal r|perlor||. 8||a d|oer||ar dergar cepal dar da|ar jur|ar oesar a|ar rerge|spars| vo|ure
|rlravas|u|ar.
2. j||a d|oer||ar da|ar |eadaar verl||as| l|da| ade|ual, PaC02 a|ar rer|rg|al ryala, pl a|ar lurur, as|dos|s ra||r
oeral dar dapal lerjad| |eral|ar. lerda|rya ralr|ur o||arooral lANYA d|oer||ar j||a verl||as| ade|ual, alau le|ar
lerpasarg verl||as| re|ar|| yarg oa||.
3. Peroer|ar o||arooral dapal pu|a reryeoao|ar r|polers|.

urlu| ror|lor|rg : per||sa darar arler| uro||||a||s urlu| ara||s|s gas darar. 8||a per|u |a|u|ar |aru|as| vera serlra|
urlu| reroarlu rererlu|ar oa|ars ca|rar.
Penyu||t yang mungk|n terjad| se|ama resus|tas|

h|poterm|a
0apal rerperoeral |eadaar as|dos|s relaoo|||, s|aros|s, gaWal rapas, depres| susurar saral pusal, r|pog|||er|a.
Pneumotoraks
Peroer|ar verl||as| le|arar pos|l|l dergar |rl|as| yarg ler|a|u cepal dar le|arar yarg ler|a|u oesar dapal
reryeoao|ar |orp|||as| |r|.
J||a oay| rerga|ar| |e|a|rar rerorar r|a||r alau asp|ras| re|or|ur, r|s||o preurolora|s |eo|r oesar |arera
|orp||ars jar|rgar paru |eo|r |erar.
Trombos|s vena
Perasargar |rlus / |aleler |rlravera dapal rer|rou||ar |es| lraura pada d|rd|rg perou|ur darar, polers|a|
reroerlu| lrorous. 3e|a|r |lu, |rlus |arular r|perlor|| re|a|u| perou|ur darar la|| pusal juga dapal rerga||oal|ar
re|ros|s ral| dar lroroos|s vera.
|NTR00UK8| TENTANC PERAwATAN |NTEN8|F NE0NATU8
(NE0NATAL |NTEN8|VE 6ARE}
Transfer ke un|t perawatan |ntens|f
neonatus

Trarsler |e ur|l peraWalar |rlers|l reoralus (NlCu -
reorala| |rlers|ve care ur|l) d|perl|roarg|ar pada
|eadaar / |asus :
1. 0aWal rapas (s|aros|s, la||prea, relra|s| d|rd|rg
dada, perrapasar cup|rg r|durg, alau rerl| rapas)
yarg rerer|u|ar 02 10 alau |eo|r urlu| rercegar
s|aros|s serlra|
2. 8ay| preralur |urarg dar| 2000 grar alau us|a
geslas| (j||a d||elaru|) |urarg dar| 3Z r|rggu
3. 8ay| yarg sedarg rerga|ar| peru||rar dar| upaya
resus|las| oesar
1. 8ay| yarg sargal rurg||r rerer|u|ar oarluar
resp|ras| alau oarluar red|s oesar |a|rrya.

Neoralus r|s||o l|rgg|, lerulara oay| preralur, rerer|u|ar sualu LlN0KuN0AN Klu3u3, dergar |oro|ras|
|rusus ca|rar dar rulr|s|, serla sarara-sarara perdu|urg |a|rrya urlu| rerperlarar|ar |er|duparrya.

Hasa|ah pada neonatus r|s|ko t|ngg|
1. |rusus pada oay| preralur : r|pero|||ruo|rer|a a||oal orgar ral| oe|ur ralarg, vo|ure darar rerdar, r|pog|||er|a,
del|s|ers| la|lor-la|lor |ruro|og||, del|s|ers| surla|lar.
2. pada reoralus r|s||o l|rgg| ururrya : rerlar lerradap |rle|s|.
ha| yang d|perhat|kan pada perawatan |ntens|f neonatus

Pengenda||an |nfeks|
lrle|s| roso|or|a| rerupa|ar peryeoao |rle|s| yarg ser|rg reryerarg reoralus da|ar peraWalar. Peru|arar dapal
re|a|u| pelugas red|s raupur pera|alar yarg d|gura|ar.
Keadaar reoralus r|s||o l|rgg| sargal |erar, dapal segera rerouru| j||a lerserarg |rle|s|, |eo|r cepal dar |eo|r
oeral d|oard|rg|ar oay| rorra| |a|rrya.
3ler|||sas| dar |eoers|rar rerupa|ar syaral ulara sualu ur|l peraWalar |rlers|l pada ururrya, lerrasu| pada ur|l
peraWalar |rlers|l reoralus.

wA8PA0A : geja|a-geja|a mencur|gakan seps|s neonatorum :
1. geja|a urur : oay| l|da| |e||ralar seral, l|da| rau r|rur, suru oadar ra|| (leor|s) alau lurur (r|polerr|a) padara|
oerada da|ar |orlro| suru ruargar yarg oerar.
2. geja|a gaslro|rlesl|ra| : rurlar, d|are, repalorega||, perul |erourg, Warra |ererarar
3. geja|a resp|ralor|| : d|spreu, la||preu, s|aros|s
1. geja|a |ard|ovas|u|ar : la|||ard|a, edera, der|dras|, produ|s| ur|re |urarg
5. geja|a susurar saral pusal : |elarg|, |r|laoe|, |ejarg, l|da| sadar
. geja|a reralo|og|| : ||lerus, sp|erorega||, pele||ae, perdararar |a|r, r|lurg |eu|os|l dar/alau lroroos|l rerurur.

Pengenda||an suhu
Neoralus Tl0AK rarpu rerperlarar|ar suru luourrya da|ar ||rg|urgar yarg ler|a|u paras alau d|rg|r. la| |r|
|arera |uas perru|aar luourrya re|al|l oesar peroard|rgarrya lerradap oeral oadar, ser|rgga real |oss |eo|r l|rgg|.
J||a lerdapal |eadaar r|po|s|a dar slao|||las |ard|ovas|u|ar yarg rerdar, daya larar lerradap suru ||rg|urgar a|ar
sera||r rerurur.
3e|edar sualu pergalurar suru ruargar yarg sesua| saja le|ar lerou|l| oerras|| rerurur|ar rorla||las per|rala|
secara oerra|ra.

Hon|tor|ng
Keadaar urur, larda v|la|, geja|a-geja|a palo|og||, per|rg|alar / perururar oeral oadar, oa|ars ca|rar, |adar
e|e|lro||l dar osro|a||las serur, perer||saar ur|re, d||a|u|ar rul|r.
J||a rerurg||r|ar, seoa||rya d|gura|ar pera|alar ror|lor|rg e|e|lror|| / d|g|la| yarg |erg|ap dergar |erarpuar
lurgs| rere|ar ser|rgga dapal d||a|u|ar ara||s|s yarg |orl|ryu.

6a|ran, e|ektro||t dan nutr|s|
3erua reoralus da|ar ur|l peraWalar |rlers|l lARu3 rerer|ra ca|rar / rulr|s| / ooal re|a|u| |rlus |rlravera.
Jur|ar ca|rar lergarlurg pada us|a geslas|, us|a pasca|e|ar|rar, u|urar / oeral oadar, slalus |||r|s dar l|s|o|og|s,
serla |eadaar palo|og|| yarg rurg||r reryerla| (r|sa|rya d|are, ||lerus, arer|a, dar seoaga|rya).
Keoulurar ca|rar oasa| ururrya 50-100 cc/|goo pada rar| perlara, |erud|ar lurur sarpa| 0-Z0 cc/|goo pada rar|
|el|ga. J||a oay| rer||||| oeral oadar |eo|r rerdar alau us|a geslas| |eo|r preralur, |eoulurar ca|rar rerjad| |eo|r
l|rgg|.
lrlus ca|rar d|ror|lor sel|ap -8 jar, dergar |rpul / oulpul oa|ars yarg |elal. T|ap 21 jar d|oual re|ap|lu|as| re||pul|
|ese|roargar ca|rar dar e|e|lro||l, |rpul/oulpul lerrasu| |rsers|o|e Waler |oss, lurgs| |rja|, dar perer||saar e|e|lro||l
serur.
E|e|lro||l Na d|oer||ar 3 rEq/d| ca|rar, dar K 2 rEq/d|.
Nulr|s| ra|s|rur d|oer||ar Z5 |a|or| per 100 cc ca|rar, da|ar oerlu| asar ar|ro dar |arular g|u|osa, re|a|u| |rlus
|rlravera.
JlKA 8AYl 0APAT VlNuV 0AN l8u 0APAT VEN0ELuARKAN A3l, 8AYl lARu3 0l8ERlKAN A3l.

0bat-obatan
urlu| as|dos|s, d|gura|ar ralr|ur o||arooral.
urlu| sl|ru|as| |ard|ovas|u|ar dar vasopresor, d|gura|ar ep|relr|r.
Ka|s|ur g|u|oras rer|rg|al|ar |orlra|l|||las r|o|ard|ur, ral|2, peroer|ar ler|a|u cepal dapal reryeoao|ar ar|lr|a.
0|u|osa urlu| suroer ererg|. lal|-ral| da|ar perr|lurgar, dapal lerjad| r|po/r|perg|||er|a alau r|per/r|poosro|a||las.
A|our|r d|pa|a| seoaga| p|asra vo|ure exparder j||a ada r|povo|er|a, lerulara j||a l|da| ada lrarslus| darar.
Na|oxor dapal d|gura|ar j||a lerjad| depres| |ard|ovas|u|ar dar/alau perrapasar a||oal arasles|a alau ara|ges|a
yarg d|oer||ar pada |ou seoe|ur persa||rar.
Furoser|de dapal d|pa|a| j||a d|cur|ga| ada edera paru alau gaga| jarlurg a||oal over|oad ca|rar.
Arl|o|ol|| urur d|pa|a| go|orgar per|c||||r alau ar|rog|||os|d, d|p|||r yarg oerspe|lrur |uas, dapal rererous saWar
darar ola|, l|da| lo|s||, dapal d|oer||ar secara parerlera|.
PRlN3lP : dos|s dar |rlerva| peroer|ar d|sesua||ar pada |eadaar ras|rg-ras|rg |asus (la||ored / l|lral|or dose).

Transfus| darah
8ay| preralur ser|rg rerga|ar| arer|a. Arer|a pada reoralus JAN0AN rarya oerdasar|ar perer||saar |adar
rerog|oo|r alau reralo|r|l, |arera r||a| |lu l|da| represerlal|l lerradap slalus o|s|geras| jar|rgar o|er se|-se| darar
rerar.
Arer|a pada reoralus serarusrya rerperl|roarg|ar :
1. jur|ar aoso|ul rerog|oo|r da|ar s|r|u|as| yarg rererlu|ar lrarsporl o|s|ger d| da|ar darar.
2. lurgs| yarg rererlu|ar |erarpuar re|epas|ar o|s|ger |e da|ar jar|rgar
3er|rgga pada reoralus, rassa er|lros|l|ar yarg rerjad| var|aoe| yarg rererlu|ar |apas|las arg|ul o|s|ger da|ar
s|r|u|as|, ou|ar r||a| lo alau ll.
Per|u d|perl|roarg|ar oarWa da|ar rasa-rasa reorala| aWa| lerjad| perururar rassa er|lros|l yarg oerra|ra,
se|a|r |lu lerjad| |orvers| dar| rerog|oo|r lela| (loF) rerjad| rerog|oo|r deWasa (loA) yarg rer||||| |ara|ler|sl||
al|r|las lerradap o|s|ger dar d|sos|as| lo-o|s|ger yarg oeroeda. 0ergar |ala |a|r, s|sler reropo|el|| reoralus
rerarg sedarg oerada da|ar rasa adaplas| dar| l|pe lela| |e l|pe deWasa.
8erdasar|ar pr|rs|p |lu, |arera rasa|ar ulara ada|ar o|s|geras| jar|rgar dar ou|ar serala-rala r||a| lo alau ll,
ra|a lerap| dergar o|s|geras| |eo|r oarya| d|oer||ar pada reoralus d|oard|rg|ar lrarslus| darar.
ururrya lrarslus| darar JARAN0 d|oer||ar pada reoralus |ecua|| lerjad| r|povo|er|a yarg oerra|ra.

Vent||as| mekan|k
Pada oay| dergar lurgs| resp|ralor|| yarg l|da| ade|ual, a|al oarlu perrapasar (verl||as| re|ar||) reregarg
perarar yarg sargal perl|rg.
verl||as| d|alur dergar a|al oerle|arar pos|l|l, dergar oeoerapa cara yarg rurg||r r|sa|rya le|arar pos|l|l |orl|ryu
(CPPv - corl|ruous pos|l|ve pressure verl||al|or), le|arar pos|l|l |rlerr|ler (lPPv / lVv - |rlerr|llerl pos|l|ve pressure
verl||al|or / |rlerr|llerl rardalory verl||al|or) dar seoaga|rya.
0a|ar pergguraar verl||as| re|ar|| d| rara lre|uers| perrapasar d|alur o|er a|al, d|per|u|ar re|a|sas| olol pas|er
yarg oa||, serla depres| perrapasar sporlar pas|er, |arera j||a lerjad| po|a perrapasar sporlar pas|er yarg l|da|
sesua| dergar po|a yarg d|alur o|er a|al, dapal lerjad| preurolora|s sarpa| perdararar |rlra|rar|a|. urlu| |eper|uar
|r| dapal d|gura|ar r|sa|rya pe|urpur olol parcuror|ur, alau ooal go|orgar rorl|r alau oaro|lural yarg juga
rer||||| ele| sedas|.
Perl|rg juga d|perral||ar suru, |e|eroaoar, le|arar dar vo|ure a||rar o|s|ger yarg d|gura|ar.
ra|o rerrar|k, oera||2 renrang oos|s, cara pemoer|an, |nrerva|, srrareg| penanganan |nrens|l paoa kasus per kasus, oso,
s||akan car| / oaca seno|r|.
Aspek sos|o-ekonom| perawatan |ntens|f neonatus
PeraWalar |rlers|l reoralus d| salu p|ra| ada|ar sarara yarg rerer|u|ar oarya| pera|alar, prosedur dar leraga
red|s yarg se|a|u s|ap rerargar| oeroaga| rasa|ar yarg lerjad|. la| |r| a|ar reryeoao|ar o|aya peraWalar dar
ooal-ooalar rerjad| sargal rara|.

0| |a|r p|ra|, pas|er serd|r| rerupa|ar seorarg reoralus dergar r|s||o l|rgg| yarg sargal |erar |eadaarrya,
ser|rgga pe|uarg urlu| lelap r|dup dergar |ua||las yarg oa|| lerlu juga sargal leroalas.
la| |r| PERLu d|je|as|ar |epada orarglua pas|er, |arera orarglua lerlu sargal rergrarap|ar ras|| peraWalar yarg
seoa||-oa||rya dergar o|aya yarg rara| lerseoul, sererlara pada |eryalaarrya oulpul yarg ra|s|ra| rerupa|ar
sualu ra| yarg cu|up su||l d|pero|er. Apa|ag| j||a |e|uarga pas|er oerasa| dar| go|orgar e|oror| |erar / |urarg
rarpu. 3e|a|r |lu juga, rurg||r |ou pas|er ras|r juga oerada da|ar peraWalar pascapersa||rar d| rurarsa||l
lerseoul, ser|rgga rerjad| laroarar oeoar o|aya oag| |e|uarga pas|er.

J||a rerurg||r|ar, seoa||rya d|usara|ar suos|d| dara rurarsa||l seoaga| suroer yarg polers|a| urlu|
pergeroargar dar pere||raraar ur|l peraWalar |rlers|l reoralus, ser|rgga pe|ayarar pada ur|l peraWalar |rlers|l
reoralus |r| dapal lelap ra|s|ra| dar l|da| serala-rala oergarlurg rarya |epada peroayarar pas|er.
Penyak|t-penyak|t yang Hempengaruh| |
0|pengaruh| Keham||an
Ku||ah 0bstetr| C|neko|og| (Pengantar | T|njauan Umum}
dr. med. H. Josopraw|ro
0araran ku||an |n| nan,a penganrar saa. 0era||2 aoa o| oa|am cararan rop|k mas|ng-mas|ng
{ramoanan ku||an ||mu pen,ak|r oa|am, anesres|, emor|o|og| osoj
3aca seno|r| uga oar| ouku2 |a|n |noooo |||
PENYAK|T |U 0ALAH KEhAH|LAN
0apal lerjad| sa||rg rerpergarur| arlara |erar||ar dergar perya||l yarg rurg||r sedarg d|der|la |ou.
Arl|rya :
1. Perya||l lerseoul dapal rerpergarur| |erar||ar : reryeoao|ar ele| lerlerlu pada jar|r, rerggarggu ja|arrya
|erar||ar, reroaraya|ar |erar||ar dar persa||rar, sarpa| rergarcar ryaWa |ou dar / alau jar|r.
2. Perya||l lerseoul dapal d|pergarur| o|er |erar||ar : |arera peruoarar l|s|o|og| ralerra| se|ara |erar||ar,
perya||l lerseoul dapal d|pergarur| rerjad| |eo|r r|rgar alau |eo|r oeral.
Pent|ng :
1. pererluar rercara perala|a|saraar perya||l (red|ca| lrealrerl)
2. pererluar rercara perala|a|saraar |erar||ar / persa||rar (ooslelr|c lrealrerl).

PENT|NC 0|KETAhU|

1. Peruoarar aralor| / l|s|o|og| se|ara |erar||ar
2. luourgar sa||rg rerpergarur| yarg lerjad| arlara perya||l lerseoul dergar |erar||ar
3. A|lerral|l pergooalar perya||l lerseoul yarg arar oag| |erar||arrya.

Pada peroer|ar ooal-ooalar, rarus d|arggap oarWa 3EVuA ooal yarg d|oer||ar |epada |ou dapal re||rlas|
p|aserla dar dapal reroer||ar ele| lerlerlu |epada jar|r
{oaca uga renrang larmako|og| per|nara|, - paoa caku| |n|, reks saouran oar| Farmako|og| rarzungj.
0/T/T/h
or.Joso uga memoanas secara s|ngkar oeoerapa pen,ak|r ,ang mempengarun| / o|pengarun| kenam||an {n|perrens|, o|aoeres, pen,ak|r anrung, osoj.
$eoag|an oanan renrang n|perrens| paoa kenam||an o| caku| |n| uga oerasa| oar| cararan ku||an or.Joso.
Tenrang o|aoeres me|||rus oan pen,ak|r anrung paoa kenam||an, oanan o|amo|| oar| maka|an l|mu Pen,ak|r 0a|am {or. $aruono waspao| / Prol.or.Jana
r|sanro - PlT-lP0 '997j.
Tenrang perr|moangan operas| paoa kasus2 oeoan non-oosrerr|k ,ang rerao| paoa masa kenam||an, pemoanasan reroapar paoa cararan anesres|o|og|.
re|a|nan kongen|ra| an|n ak|oar pengarun oeroaga| lakror, rermasuk pen,ak|r marerna|, pemoanasan reroapar o| oag|an emor|o|og| {congen|ra| ma|lormar|ons -
reks saouran oar| ouku langmanj
Pen,ak|r2 |a|n r|oak o|oanas o| s|n|, s||akan car| / oaca seno|r|.
h|pertens| pada Keham||an Pre-
ek|amps|a|Ek|amps|a
Ku||ar 0oslelr| / 0|re|o|og|
dr.red. V.JosopraW|ro / dr. lardaya / Prol.dr. 0u|ard| l. w||rjosaslro /
dr.3|l| 0ryarl| w|srruWardrar| / dr.Noroyoro w|ooWo
Terdapat t|ga kategor| besar ke|a|nan h|pertens| yang d|sebabkan o|eh keham||an !3,#-*%*456+*704#7
853#,$#*9+)*..

EP|0EH|0L0C| h|PERTEN8| 0ALAH KEhAH|LAN

Pene||t|an berbaga| faktor r|s|ko terhadap h|pertens| pada keham||an | pre-ek|amps|a | ek|amps|a :

Us|a
lrs|ders l|rgg| pada pr|r|grav|da ruda, rer|rg|al pada pr|r|grav|da lua. Pada War|la rar|| oerus|a |urarg dar| 25
larur |rs|ders > 3 |a|| ||pal
Pada War|la rar|| oerus|a |eo|r dar| 35 larur, dapal lerjad| r|perlers| |aler

Par|tas
- arg|a |ejad|ar l|rgg| pada pr|r|grav|da, ruda raupur lua
- pr|r|grav|da lua r|s||o |eo|r l|rgg| urlu| pre-e||arps|a oeral

Ras | go|ongan etn|k
- o|as (rurg||r ada peroedaar per|a|uar / a|ses lerradap oeroaga| elr||d| oarya| regara)

Faktor keturunan
J||a ada r|Wayal pre-e||arps|a/e||arps|a pada |ou/rere| perder|la, la|lor r|s||o rer|rg|al sarpa| 25

Faktor gen
0|duga adarya sualu s|lal reses|l (recess|ve lra|l), yarg d|lerlu|ar gerol|p |ou dar jar|r

0|et | g|z|
T|da| ada ruourgar oerra|ra arlara reru / po|a d|el lerlerlu (wl0). Pere||l|ar |a|r : |e|urargar |a|s|ur
oerruourgar dergar arg|a |ejad|ar yarg l|rgg|. Arg|a |ejad|ar juga |eo|r l|rgg| pada |ou rar|| yarg ooese /
overWe|grl

|k||m | mus|m
0| daerar lrop|s |rs|ders |eo|r l|rgg|

T|ngkah |aku | sos|oekonom|
Keo|asaar rero|o| : |rs|ders pada |ou pero|o| |eo|r rerdar, rarur rero|o| se|ara rar|| rer||||| r|s||o |eral|ar
jar|r dar perlurourar jar|r lerraroal yarg jaur |eo|r l|rgg|.
A|l|l|las l|s|| se|ara rar|| : |sl|raral oar|rg yarg cu|up se|ara rar|| rergurarg| |erurg||rar / |rs|ders r|perlers|
da|ar |erar||ar.

h|perp|asentos|s
Prole|rur|a dar r|perlers| grav|darur |eo|r l|rgg| pada |erar||ar |eroar, d|z|gol|| |eo|r l|rgg| dar|pada roroz|gol||.
l|drops lela||s : oerruourgar, rercapa| se||lar 50 |asus
0|aoeles re|||lus : arg|a |ejad|ar yarg ada |erurg||rar palol|s|o|og|rya ou|ar pre-e||arps|a rurr|, re|a|r|ar
d|serla| |e|a|rar g|rja| / vas|u|ar pr|rer a||oal d|aoelesrya.
Vo|a r|dal|dosa : d|duga degereras| lroloo|as oer|eo|rar oerperar reryeoao|ar pre-e||arps|a. Pada |asus ro|a,
r|perlers| dar prole|rur|a lerjad| |eo|r d|r| / pada us|a |erar||ar ruda, dar lerryala ras|| perer||saar palo|og| g|rja|
juga sesua| dergar pada pre-e||arps|a.

PAT0F|8|0L0C| PRE-
EKLAHP8|A

3arpa| se|ararg el|o|og| pre-e||arps|a
oe|ur d||elaru|. Vero|cara|ar
palol|s|o|og|rya l|da| |eo|r dar|
rergurpu||ar leruar-leruar
lerorera yarg oeragar. Narur
pergelaruar lerlarg leruar yarg
oeragar |r||ar |urc| ulara su|sesrya
perargaar pre-e||arps|a.
3er|rgga pre-e||arps|a / e||arps|a
d|seoul seoaga| "rne o|sease ol man,
rneor|es |n oosrerr|cs."

/ "proposeo" sequence ol evenrs |n rne
parnogenes|s ol roxem|a ol pregnanc,.
Tne ma|n learures are . 'j oecreaseo
urerop|acenra| perlus|on, 2j |ncreaseo
vasoconsrr|crors ano oecreaseo
vasoo||arors, resu|r|ng |n |oca| {p|acenra|j
ano s,srem|c vasoconsrr|cr|on, ano Jj
o|ssem|nareo |nrravascu|ar coagu|ar|on
{0l0j.
Tne pr|mar, cause{sj ol pre-ec|amps|a /
ec|amps|a sr||| unknoun.

Perubahan kard|ovasku|ar
Tururrya le|arar darar pada |erar||ar
rorra| : |arera vasod||alas| per|ler.
vasod||alas| per|ler d|seoao|ar
perururar lorus olol po|os arler|o|, a||oal :
1. rer|rg|alrya |adar progesleror da|ar s|r|u|as|
2. rerururrya |adar vaso|orslr||lor (adrera||r/roradrera||r/ arg|olers|r ll)
3. rerururrya respors d|rd|rg vas|u|ar lerradap vaso|orslr||lor a||oal produ|s| vasod||alor / proslaro|d yarg juga
l|rgg| (P0E2 / P0l2)
1. rerururrya a|l|l|lassusurar saral s|rpal|s vasorolor
Pada lr|resler |el|ga a|ar lerjad| per|rg|alar le|arar darar yarg rorra| |e le|arar darar seoe|ur rar||.
1/3 pas|er pre-e||arps|a : lerjad| peroa|||ar r|lre d|urra|, le|arar darar ra|| pada ra|ar rar|. Juga lerdapal
peruoarar |ara s|||us d|urra| rerjad| 20 jar per rar|, dergar perururar se|ara l|dur, yarg rurg||r d|seoao|ar
peruoarar d| pusal pergalur le|arar darar alau pada rel|e|s oaroreseplor.

Regu|as| vo|ume darah
Pergerda||ar garar dar roreoslas|s juga rer|rg|al pada pre-e||arps|a.
Kerarpuar rerge|uar|ar ralr|ur lergarggu, lap| derajalrya oervar|as|. Pada |eadaar oeral rurg||r juga l|da|
d|leru|ar edera (sualu pre-e||arps|a |er|rg).
J||a ada edera |rlersl|s|a|, vo|ure p|asra |eo|r rerdar d|oard|rg|ar War|la rar|| rorra|, dar dergar der|||ar
lerjad| rero|orserlras|. Pors| card|ac oulpul urlu| perlus| per|ler re|al|l lurur.
Perlus| p|aserla re|a|u|ar adaplas| lerradap peruoarar2 |r|, ra|a pera|a|ar d|urel|| ada|ar Tl0AK sesua| |arera
juslru a|ar rerperouru| r|povo|er|a. P|aserla juga rergras|||ar rer|r, d|duga oerlurgs| cadargar urlu| rergalur
lorus dar perreao|||las vas|u|ar |o|a| der| rerperlarar|ar s|r|u|as| leloralerra|.
Peruoarar relaoo||sre slero|d l|da| je|as. Kadar a|dosleror lurur, |adar progesleror l|da| oeruoar.
Ke|a|rar lurgs| peroe|uar darar d|lurju||ar dergar perururar AT lll.
Rala-rala vo|ure darar pada perder|la pre-e||arps|a |eo|r rerdar sarpa| 500 r| d|oard|rg War|la rar|| rorra|.

Fungs| organ-organ |a|n
Drak
Pada rar|| rorra|, perlus| sereora| l|da| oeruoar, rarur pada pre-e||arps|a lerjad| spasre perou|ur darar ola|,
perururar perlus| dar sup|a| o|s|ger ola| sarpa| 20. 3pasre reryeoao|ar r|perlers| sereora|, la|lor perl|rg
lerjad|rya perdararar ola| dar |ejarg / e||arps|a.
lar|
Terjad| per|rg|alar a|l|l|las erz|r-erz|r ral| pada pre-e||arps|a, yarg oerruourgar dergar oeralrya perya||l.
S|na|
Pada pre-e||arps|a, arus darar ele|l|l g|rja| oer|urarg 20, l||lras| g|oreru|us oer|urarg 30. Pada |asus oeral
lerjad| o||gour|a, urer|a, sarpa| re|ros|s luou|ar a|ul dar re|ros|s |orle|s rera||s. ureur-|real|r|r rer|rg|al jaur d|
alas rorra|. Terjad| juga per|rg|alar perge|uarar prole|r (s|rdrora relrol|| pada |erar||ar).

8|rku|as| uterus, kor|odes|dua dan p|asenta
Peruoarar arus darar d| ulerus, |or|odes|dua
dar p|aserla ada|ar palol|s|o|og| yarg
TERPENTlN0 pada pre-e||arps|a, dar
rerupa|ar la|lor yarg rererlu|ar ras|| a|r|r
|erar||ar.
1. Terjad| |s|er|a ulerop|aserler, reryeoao|ar
|el|da|se|roargar arlara rassa p|aserla yarg
rer|rg|al dergar a||rar perlus| darar s|r|u|as|
yarg oer|urarg.
2. r|poperlus| ulerus rerjad| rargsargar
produ|s| rer|r d| ulerop|aserla, yarg
rerga||oal|ar vaso|orslr||s| vas|u|ar daerar
|lu. Rer|r juga rer|rg|al|ar |epe|aar vas|u|ar
lerradap zal-zal vaso|orslr||lor |a|r
(arg|olers|r, a|dosleror) ser|rgga lerjad| lorus
perou|ur darar yarg |eo|r l|rgg|.
3. |arera gargguar s|r|u|as| ulerop|aserler |r|, lerjad| perururar sup|a| o|s|ger dar rulr|s| |e jar|r. A||oalrya
oervar|as| dar| gargguar perlurourar jar|r sarpa| r|po|s|a dar |eral|ar jar|r.

P|crure . l|sroparno|og|ca| appearance ol urer|ne vesse|s |n pre-ec|amps|a. hore rne c|orr|ng |ns|oe rne vesse|s oue ro
acure arneros|s, l|or|no|o necros|s ol rne vesse| ua||s, suoenoorne||a| macropnages {arrousj, ano per|vascu|ar / srroma|
|,mpnoc,r|c |nl||rrare {oark oorsj.

{Peruoanan oeroaga| s|srem enz|mar|k ruoun |a|nn,a . oaca seno|r| ,aaa.. $usan oener eeuu||. g||eeeee..j
0|ACN08|8 PRE-EKLAHP8|A

0|agnos|s pre-ek|amps|a d|tegakkan berdasarkan :
1. per|rg|alar le|arar darar yarg |eo|r oesar alau sara dergar 110/90 rrlg
2. alau per|rg|alar le|arar s|slo||| > 30 rrlg alau d|aslo||| > 15 rrlg
3. alau per|rg|alar rear arler|a| pressure >20 rrlg, alau VAP > 105 rrlg
1. prole|rur|a s|gr|l||ar, 300 rg/21 jar alau > 1 g/r|
5. d|u|ur pada dua |a|| perer||saar dergar jara| Wa|lu jar
. edera urur alau per|rg|alar oeral oadar oer|eo|rar

Te|arar darar d|u|ur sele|ar pas|er |sl|raral 30 rer|l (|dea|). Te|arar darar s|slo||| ada|ar saal lerdergar oury|
Korol|oll l, le|arar darar d|aslo||| pada Korol|oll lv.

8||a le|arar darar rercapa| alau |eo|r dar| 10/110 rrlg, ra|a pre-e||arps|a d|seoul oeral. Ves||pur le|arar
darar oe|ur rercapa| 10/110 rrlg, pre-e||arps|a lerrasu| |r|ler|a oeral j||a lerdapal geja|a |a|r seperl|
d|seoul|ar da|ar laoe|.

Kr|ter|a 0|agnost|k Preek|amps|a erat
1. Te|arar darar s|slo||| > 10 rrlg alau d|aslo||| > 110 rrlg.
2. Prole|rur|a = 5 alau (3) pada les ce|up slr|p.
3. 0||gur|a, d|ures|s < 100 r| da|ar 21 jar
1. 3a||l |epa|a reoal dar gargguar perg||ralar
5. Nyer| ep|gaslr|ur alau |uadrar |arar alas aodorer alau ada ||lerus
. Edera paru alau s|aros|s
Z. Troroos|loper|a
8. Perlurourar jar|r yarg lerraroal

Pre-e||arps|a dapal lerjad| pada us|a |erar||ar sele|ar 20 r|rggu, alau oar|ar sele|ar 21 jar posl parlur.

8||a d|leru|ar le|arar darar l|rgg| pada us|a |erar||ar oe|ur 20 r|rggu, |eadaar |r| d|arggap seoaga| h|pertens|
kron|k.

Pre-ek|amps|a dapat ber|anjut ke keadaan yang |eb|h berat, ya|tu ek|amps|a.
Ek|amps|a ada|ah keadaan pre-ek|amps|a yang d|serta| kejang.

0eja|a |||r|| pre-e||arps|a dapal oervar|as| seoaga| a||oal palo|og| |eoocorar |ap||er dar vasospasre yarg rurg||r
l|da| d|serla| dergar le|arar darar yarg ler|a|u l|rgg|.
V|sa|rya, dapal d|jurpa| asc|les, per|rg|alar erz|r ral|, |oagu|as| |rlravas|u|ar, s|ndroma hELLP (rero|ys|s,
e|evaled ||ver erzyre, |oW p|ale|els), perlurourar jar|r lerraroal, dar seoaga|rya.

8||a da|ar asurar arlerala| d|pero|er le|arar darar d|aslo||| |eo|r dar| 85 rrlg, per|u d|p|||r|ar |erurg||rar
adarya pre-e||arps|a reroa|al.
Apa|ag| o||a |ou rar|| rerupa|ar |e|orpo| r|s||o lerradap pre-e||arps|a.

3e|a|r ararres|s dar perer||saar l|s||, pada |ecur|gaar pre-e||arps|a seoa||rya d|per||sa juga :
1. perer||saar darar rul|r serla ||r|a darar : ureur-|real|r|r, 300T, L0, o|||ruo|r
2. perer||saar ur|re : prole|r, redu|s|, o|||ruo|r, sed|rer
3. |erurg||rar adarya perlurourar jar|r lerraroal, |orl|rras| u30 o||a ada.
1. r||a| |esejarleraar jar|r (|ard|olo|ogral|).

Komp||kas| pre-ek|amps|a berat | ek|amps|a
- ao|al|o rel|rae
- 0lC
- gaga| g|rja|
- perdararar ola|
- gaga| jarlurg
- edera paru

|mpend|ng ec|amps|a
Pre-e||arps|a oeral d|serla| salu alau |eo|r geja|a : ryer| |epa|a reoal, gargguar v|sus, rurlar-rurlar, ryer|
ep|gaslr|ur, |era||ar le|arar darar progres|l. 0|largar| seoaga| |asus e||arps|a.
PENATALAK8ANAAN PRE-EKLAHP8|A

Pr|ns|p penata|aksanaan pre-ek|amps|a
1. re||rdurg| |ou dar| ele| per|rg|alar le|arar darar
2. rercegar progres|l|las perya||l rerjad| e||arps|a
3. rergalas| alau rerurur|ar r|s||o jar|r (so|us|o p|aserla, perlurourar jar|r lerraroal, r|po|s|a sarpa| |eral|ar
jar|r)
1. re|ar|r|ar jar|r dergar cara yarg pa||rg arar dar cepal sesegera rurg||r sele|ar ralur, alau |ralur j||a
d||elaru| oarWa r|s||o jar|r alau |ou a|ar |eo|r oeral j||a persa||rar d|lurda |eo|r |ara.
Penata|aksanaan pre-ek|amps|a r|ngan

1. dapal d||ala|ar l|da| rerpurya| r|s||o oag| |ou raupur jar|r
2. l|da| per|u segera d|oer||ar ooal arl|r|perlers| alau ooal |a|rrya, l|da| per|u d|raWal |ecua|| le|arar darar
rer|rg|al lerus (oalas arar 110-150/90-100 rrlg).
3. |sl|raral yarg cu|up (oeroar|rg / l|durar r|r|ra| 1 jar pada s|arg rar| dar r|r|ra| 8 jar pada ra|ar rar|)
1. peroer|ar |ur|ra| 1-2 x 30 rg/rar| o||a l|da| o|sa l|dur
5. peroer|ar asar asel||sa||s||al (asp|r|r) 1 x 80 rg/rar|.
. o||a le|arar darar l|da| lurur, d|arjur|ar d|raWal dar d|oer| ooal arl|r|perlers| : rel||dopa 3 x 125 rg/rar|
(rax.1500 rg/rar|), alau r|led|p|r 3-8 x 5-10 rg/rar|, alau r|led|p|r relard 2-3 x 20 rg/rar|, alau p|rdo|o| 1-3 x 5
rg/rar| (rax.30 rg/rar|).
Z. d|el rerdar garar dar d|urel|| Tl0AK PERLu
8. j||a ralur|las jar|r ras|r |ara, |arjul|ar |erar||ar, per||sa l|ap 1 r|rggu
9. |rd||as| raWal : j||a ada perouru|ar, le|arar darar l|da| lurur sele|ar 2 r|rggu raWal ja|ar, per|rg|alar oeral
oadar re|eo|r| 1 |g/r|rggu 2 |a|| oerlurul-lurul, alau pas|er rerurju||ar larda-larda pre-e||arps|a oeral. 8er||ar
juga ooal arl|r|perlers|.
10. j||a da|ar peraWalar l|da| ada peroa||ar, lala|a|sara seoaga| pre-e||arps|a oeral. J||a peroa||ar, |arjul|ar
raWal ja|ar
11. perga|r|rar |erar||ar : d|lurggu sarpa| us|a 10 r|rggu, |ecua|| d|leru|ar perlurourar jar|r lerraroal, gaWal
jar|r, so|us|o p|aserla, e||arps|a, alau |rd||as| lerr|ras| |a|rrya. V|r|ra| us|a 38 r|rggu, jar|r sudar d|ryala|ar
ralur.
12. persa||rar pada pre-e||arps|a r|rgar dapal d||a|u|ar sporlar, alau dergar oarluar e|slra|s| urlu|
rerpercepal |a|a ll.
Penata|aksanaan pre-ek|amps|a berat

0apal d|largar| secara a|l|l alau |orserval|l.
A|l|l oerarl| : |erar||ar d|a|r|r| / d|lerr|ras| oersara dergar pergooalar red|s|ra|.
Korserval|l oerarl| : |erar||ar d|perlarar|ar oersara dergar pergooalar red|s|ra|.
Pr|rs|p : Telap PEVANTAuAN JANlN dergar |||r|s, u30, |ard|olo|ogral| lll

1. Penanganan akt|f.
Perder|la rarus segera d|raWal, seoa||rya d|raWal d| ruarg |rusus d| daerar |arar oersa||r. T|da| rarus ruargar
ge|ap.
Perder|la d|largar| a|l|l o||a ada salu alau |eo|r |r|ler|a |r| :
- ada larda-larda |rperd|rg e||arps|a
- ada lELLP syrdrore
- ada |egaga|ar perargarar |orserval|l
- ada larda-larda gaWal jar|r alau lu0R
- us|a |erar||ar 35 r|rggu alau |eo|r
(Prol.0u| : 31 r|rggu oerar| lerr|ras|. Perrar ada |asus 31 r|rggu, oerras||, |erjasara dergar per|ralo|og|, oay|
rasu| |r|uoalor dar NlCu)
JAN0AN LuPA : 0K3l0EN 0EN0AN NA3AL KANuL, 1- L / VENlT ll
Pergooalar red|s|ra| : d|oer||ar ooal arl| |ejarg Vg301 da|ar |rlus dexlrose 5 seoarya| 500 cc l|ap jar. Cara
peroer|ar Vg301 : dos|s aWa| 2 grar |rlravera d|oer||ar da|ar 10 rer|l, d||arjul|ar dergar dos|s pere||raraar
seoarya| 2 grar per jar dr|p |rlus (80 r|/jar alau 15-20 leles/rer|l).
3yaral peroer|ar Vg301 : - lre|uers| rapas |eo|r dar| 1 |a|| perrer|l - l|da| ada larda-larda gaWal rapas - d|ures|s
|eo|r dar| 100 r| da|ar 1 jar seoe|urrya - rel|e|s pale||a pos|l|l.
Vg301 d|rerl||ar o||a : - ada larda-larda |rlo|s||as| - alau sele|ar 21 jar pasca persa||rar - alau o||a oaru jar
pasca persa||rar sudar lerdapal peroa||ar yarg ryala.
3|ap|ar arl|dolur Vg301 ya|lu Ca-g|u|oras 10 (1 grar da|ar 10 cc NaC| 0.9, d|oer||ar |rlravera da|ar 3
rer|l).
0oal arl| r|perlers| d|oer||ar o||a le|arar darar s|slo||| |eo|r dar| 10 rrlg alau le|arar darar d|aslo||| |eo|r dar|
110 rrlg. 0oal yarg d|pa|a| ururrya r|led|p|r dergar dos|s 3-1 |a|| 10 rg ora|. 8||a da|ar 2 jar oe|ur lurur
dapal d|oer| laroarar 10 rg |ag|.
Terr|ras| |erar||ar : o||a perder|la oe|ur |r parlu, d||a|u|ar |rdu|s| persa||rar dergar arr|olor|, o|s|los|r dr|p,
|aleler Fo||ey, alau proslag|ard|r E2. 3ecl|o cesarea d||a|u|ar o||a syaral |rdu|s| l|da| lerperur| alau ada
|orlra|rd||as| parlus pervag|rar. Pada persa||rar pervag|rar |a|a 2, o||a per|u d|oarlu e|slra|s| va|ur alau curar.

2. Penanganan konservat|f
Pada |erar||ar |urarg dar| 35 r|rggu larpa d|serla| larda-larda |rperd|rg ec|arps|a dergar |eadaar jar|r oa||,
d||a|u|ar perargarar |orserval|l.
Ved|s|ra| : sara dergar pada perargarar a|l|l. Vg301 d|rerl||ar o||a |ou sudar rercapa| larda-larda pre-
e||arps|a r|rgar, se|aroalrya da|ar Wa|lu 21 jar. 8||a sesudar 21 jar l|da| ada peroa||ar ra|a |eadaar |r|
d|arggap seoaga| |egaga|ar pergooalar dar rarus segera d||a|u|ar lerr|ras|.
0oslelr|| : perarlauar |elal |eadaar |ou dar jar|r. 8||a ada |rd||as|, |argsurg lerr|ras|.
Penata|aksanaan ek|amps|a

Ek|amps|a ada|ah ke|a|nan akut pada wan|ta ham||, da|am persa||nan atau n|fas, yang d|tanda| dengan
t|mbu|nya kejang dan | atau koma.

3eoe|urrya War|la rar|| |lu rerurju||ar geja|a-geja|a pre-e||arps|a (|ejarg-|ejarg d|pasl||ar 8uKAN l|rou|
a||oal |e|a|rar reuro|og|| |a|r).
0|agros|s d|lega||ar oerdasar|ar geja|a-geja|a pre-e||arps|a d|serla| |ejarg dar alau |ora.

Tujuar pergooalar : rergrerl||ar / rercegar |ejarg, rerperlarar|ar lurgs| orgar v|la|, |ore|s| r|po|s|a /
as|dos|s, |erda|||ar le|arar darar sarpa| oalas arar, perga|r|rar |erar||ar, serla rercegar / rergalas|
peryu||l, |rususrya |r|s|s r|perlers|, seoaga| perurjarg urlu| rercapa| slao|||sas| |eadaar |ou seopl|ra| rurg||r.

3||ap ooslelr|| : rerga|r|r| |erar||ar dergar lraura ser|r|ra| rurg||r urlu| |ou.
Pergooalar red|s|ra| : sara seperl| pada pre-e||arps|a oeral. 0os|s Vg301 dapal d|laroar 2 g |rlravera o||a
l|rou| |ejarg |ag|, d|oer||ar se|urarg-|urargrya 20 rer|l sele|ar peroer|ar lera|r|r. 0os|s laroarar |r| rarya
d|oer||ar salu |a|| saja.
J||a ras|r |ejarg, d|oer||ar arooaro|la| 3-5 rg/|g88 |rlravera per|arar-|arar.
PeraWalar pada serargar |ejarg : d|raWal d| |arar |so|as| dergar pererargar cu|up, rasu||ar sud|p ||dar |e
da|ar ru|ul perder|la, daerar orolar|rg d|r|sap. F||sas| oadar pada lerpal l|dur secu|uprya.

8|kap dasar
serua |erar||ar dergar e||arps|a lARu3 d|a|r|r| larpa rerardarg urur |erar||ar dar |eadaar jar|r.
Perl|roargarrya ada|ar |ese|aralar |ou.
Kerar||ar d|a|r|r| o||a sudar lerjad| slao|||sas| rerod|rar||a dar relaoo||sre |ou, pa||rg |ara 1-8 jar seja|
d|agros|s d|lega||ar. Yarg perl|rg ada|ar |ore|s| as|dos|s dar le|arar darar.
Cara lerr|ras| juga dergar pr|rs|p lraura |ou ser|r|ra| rurg||r.
8ay| d|raWal da|ar ur|l peraWalar |rlers|l reoralus (NlCu).

Pada |asus pre-e||arps|a / e||arps|a, j||a d|pulus|ar urlu| secl|o cesarea, seoa||rya d|pa|a| ANE3TE3lA uVuV.
Karera |a|au rerggura|ar aresles|a sp|ra|, a|ar lerjad| vasod||alas| per|ler yarg |uas, reryeoao|ar le|arar darar
lurur. J||a d|guyur ca|rar (urlu| rerperlarar|ar le|arar darar) o|sa lerjad| edera paru, r|s||o l|rgg| urlu| |eral|ar
|ou.
Pasca persa||rar : ra|rlerarce |a|or| 1500 ||a| / 21 jar, o||a per|u dergar se|arg rasogaslr|| alau parerlera|,
|arera pas|er oe|ur lerlu dapal ra|ar dergar oa||. Vg301 d|perlarar|ar sarpa| 21 jar poslparlur, alau sarpa|
le|arar darar ler|erda||.

Resus|tas| jan|n : pent|ng d|kuasa| !!

0araran . o| lnoones|a
rasus pre-ek|amps|a r|ngan sampa| oerar o| oaeran, |ka mungk|n, o|perranankan se|ama mungk|n samo|| o|ruuk.
rarena resus|ras| / perauaran |nrens|l neonarus o| oaeran sangar su||r o||akukan. recua|| |ka kasus rerao| o|
rumansak|r oengan las|||ras |engkap, oapar |angsung rerm|nas|.
Tap| seoag|an oesar kasus mas|n o|rangan| konservar|l samo|| o|ruuk. /k|oarn,a, pera|anan pen,ak|r mak|n oerar,
prognos|s mak|n ouruk, angka kemar|an marerna| / per|nara| mak|n r|ngg| {pre-ek|amps|a / ek|amps|a merupakan sa|an
saru lakror penenru angka kemar|an marerna| / per|nara| ,ang rerurama o| lnoones|aj.
h|PERTEN8| KR0N|K 0ENCAN KEhAH|LAN

l|perlers| |ror|| rurg||r sudar lerdapal
seoe|ur |erar||ar, rurg||r re||pul| 3-20 dar|
se|urur r|perlers| da|ar |erar||ar.
3eoao yarg urur : r|perlers| esers|a|, |e|a|rar
g|rja|, perya||l vas|u|ar, erdo|r|r, perya||l
|o|ager.

K||r|s |e|orpo| r|s||o l|rgg| ada|ar :
- us|a pas|er d| alas 10 larur
- ada r|Wayal r|perlers| d| |uar |erar||ar
- le|arar darar d| alas 10/100 rrlg
- ada r|Wayal d|aoeles re|||lus, perya||l g|rja|,
|ard|or|opal|, perya||l |o|ager / vas|u|er

La|u|ar perer||saar les lo|erars| g|u|osa ora|,
|arera |adarg lerjad| oersara dergar d|aoeles
re|||lus.

l|perlers| |ror|| dapal rerga|ar| super|rposed pre-ec|arps|a, arl|rya pre-e||arps|a yarg reryerla| perya||l |lu.

Pr|rs|p : pergerda||ar le|arar darar, dapal dergar ooal-ooalar seperl| pada pre-e||arps|a. J||a ada |rd||as|
lerradap palo|og| |a|r, r|sa|rya ureur-|real|r|r l|rgg|, ra|a per|u d||a|u|ar rerod|a||s|s dar lerr|ras|.
0|abetes He|||tus pada Keham||an
Ku||ah ||mu Penyak|t 0a|am
dr. 8arwono waspadj|
(d|bawakan pada Pertemuan ||m|ah Tahunan ||mu Penyak|t 0a|am, Jakarta, 1997}
PEN0AhULUAN

0|aoeles re|||lus (0V) pada |erar||ar l|da| jararg d|leru|ar.
Preva|ers| 1-3.
0V prageslas|ora| 0.1-0.5. 0V geslas|ora| 0.1-12.
(lergarlurg pada lerpal dar |r|ler|a d|agrosl|| yarg d|gura|ar).

0| lrdores|a : preva|ers| 0V geslas|ora| 1.9 - 3. pada |erar||ar ururrya.
Pada |ou rar|| dergar r|Wayal |e|uarga 0V : preva|ers| 5.1.

Per|u d|perral||ar : r|s||o roro|d|las dar rorla||las ralerra| dar per|rala| l|rgg|.
0ergar perge|o|aar seoa||-oa||rya, ras|| a|r|r lelap dapal opl|ra|.
PEHAC|AN 0|AETE8 HELL|TU8 PA0A KEhAH|LAN

1. 0H yang memang sudah d|ketahu| sebe|umnya dan kemud|an menjad| ham|| (0H ham|| = 0Hh = 0H
pragestas|ona|}. 8ebag|an besar termasuk go|ongan |00H (|nsu||n 0ependent 0H}.

2. 0H yang baru saja d|temukan pada saat keham||an (0H Cestas|ona| = 0HC}. Umumnya termasuk go|ongan
N|00H (Non |nsu||n 0ependent 0H}

0HC send|r| d|bag| dua sub ke|ompok
1. seoerarrya sudar rerg|dap 0V seoe|urrya, lap| oaru d||elaru| saal rar|| (sara dergar 0Vl).
2. seoe|urrya oe|ur rerg|dap 0V, oaru rerg|dap 0V da|ar rasa |erar||ar (Pregrarcy-lrduced 0|aoeles
Ve|||lus, 0V0 sesurggurrya, sesua| dergar del|r|s| |ara wl0 1980).

Kedua suo |e|orpo| |r| 8ARu dapal d|oeda|ar sele|ar d||a|u|ar les lo|erars| g|u|osa ora| (TT00) u|argar pasca
persa||rar. urlu| suo |e|orpo| 0Vl, ras|| TT00 pascapersa||rar ras|r a|ar lelap aororra|, sererlara urlu|
0V0 ras|| |eroa|| rorra|.

K|as|f|kas| wh0
3uo |e|orpo| 0V0 sesurggurrya rasu| |e|orpo|
To|erars| 0|u|osa Perrar Aororra|.

Pada |ou rar|| dergar 0V0, |erurg||rar lerjad| Nl000V
rerelap 10-15 larur |erud|ar jaur |eo|r oesar dar|pada |ou
rar|| rorra|.

K|as|f|kas| wh|te (195}
T|da| oarya| d|gura|ar, |arera ||as|l||as| |r| ururrya
urlu| |asus-|asus l00V yarg rerelap dar |erud|ar rar||.
8a|| urlu| rererlu|ar |orp|||as| perya||l d|aoeles |lu
serd|r| dar urlu| rerper||ra|ar progros|s oay|, lelap| l|da|
dapal rerggo|org|ar 0V0 secara lepal d| da|arrya.

K|as|f|kas| Pyke (19??}
1. 0V0 yarg a|ar |eroa|| rorra| lo|erars| g|u|osarya
sele|ar persa||rar
2. Pregeslas|ora| 0V yarg 0V-rya sudar ada seoe|urrya
alau |erud|ar rerelap sele|ar persa||rar
3. Pregeslas|ora| 0V dergar |orp|||as|
HETA0L|8HE KAR0h|0RAT PA0A KEhAH|LAN N0RHAL

Pada War|la rar|| rorra| lerjad| oarya| se|a|| peruoarar rorrora| dar relaoo||| urlu| perlurourar dar
per|eroargar lelus yarg opl|ra|.
Yarg oerruourgar dergar palo|og| d|aoeles re|||lus ada|ar peruoarar relaoo||sre |aroor|dral.

Pada |erar||ar rorra|, lerjad| |adar g|u|osa p|asra |ou yarg |eo|r rerdar secara oerra|ra |arera :
1. aro||ar g|u|osa s|r|u|as| p|aserla rer|rg|al
2. produ|s| g|u|osa dar| ral| rerurur
3. produ|s| a|ar|r (sa|ar salu pre|ursor g|u|oreogeres|s) rerurur
1. a|l|l|las e|s|res| g|rja| rer|rg|al
5. ele| rorror-rorror geslas|ora| (rurar p|acerla| |acloger, rorror2 p|aserla |a|rrya, rorror2 ovar|ur, r|pol|s|s,
par|reas, adrera|, groWlr laclors, dso).
3e|a|r |lu lerjad| juga peruoarar relaoo||sre |era| dar asar ar|ro.
PAT0F|8|0L0C| 0|AETE8
HELL|TU8 PA0A
KEhAH|LAN

Pada 0V0, se|a|r peruoarar2
l|s|o|og|s lerseoul, lerjad| juga
|eadaar jur|ar / lurgs| |rsu||r
yarg l|da| opl|ra|. Terjad| juga
peruoarar ||rel||a |rsu||r dar
res|slers| lerradap ele| |rsu||r.
A||oalrya : |orpos|s| suroer
ererg| da|ar p|asra |ou oeruoar
(|adar gu|a darar l|rgg|, |adar
|rsu||r lelap l|rgg|).

Ve|a|u| d|lus| lerlas|||las| da|ar
rerorar p|aserla, pada s|r|u|as|
jar|r juga ||ul lerjad| |orpos|s|
suroer ererg| yarg aororra|
(reryeoao|ar |erurg||rar lerjad|
oeroaga| |orp|||as|). 3e|a|r |lu
lerjad| juga r|per|rsu||rer|a, ser|rgga jar|r rerga|ar| juga gargguar relaoo||| (r|pog|||er|a, r|poragreser|a,
r|po|a|ser|a, r|pero|||ruo|rer|a dso).
H0R|0|TA8 0AN H0RTAL|TA8 |U 0AN JAN|N PA0A 0HC

Komp||kas| materna|
|rle|s| sa|urar |er|r, r|drarr|or, r|perlers| (|ror|| / pree||arps|a / e||arps|a)

Komp||kas| feta| |ntrauter|n
r|s||o aoorlus sporlar, |e|a|rar |orger|la| (lerulara perlurourar s|sler saral pusal), |rlsul|s|ers| p|aserla
(rerga||oal|ar r|p|ser|a |ror||), |eral|ar |rlrauler|r, ra|rosor|a, orgarorega||,

Komp||kas| neonatus pascapersa||nan
preralur|las, |eral|ar per|rala| / reorala|, lraura |ar|r, gargguar relaoo||| (r|pog|||er|a, r|poragreser|a, r|po-
|a|ser|a, r|pero|||ruo|rer|a), s|rdror gaWal rapas reoralus, po||s|ler|a, lroroos|s vera rera||s, dso.

Komp||kas| pada us|a anak | dewasa
gargguar lurour |eroarg, |rle|e|lua|, ooes|las, sarpa| d|aoeles re|||lus |lu serd|r|.
FAKT0R R|8|K0 0HC

R|wayat obstetr| mencur|gakan
- r|Wayal aoorlus oeru|arg
- r|Wayal re|ar|r|ar oay| ral| larpa seoao yarg je|as
- r|Wayal re|ar|r|ar oay| dergar cacal oaWaar
- r|Wayal re|ar|r|ar oay| dergar oeral |ar|r d| alas 1000 g
- r|Wayal pree||arps|a / e||arps|a
- po||r|drarr|or
R|wayat med|s mencur|gakan | hat|-hat|
- us|a |ou saal rar|| d| alas 30 larur
- r|Wayal 0V |ou rar||, alau r|Wayal 0V da|ar |e|uargarya
- r|Wayal 0V0 / T0T pada |erar||ar seoe|urrya
- r|Wayal |rle|s| sa|urar |er|r oeru|arg se|ara rar||
- |ou ooes|las
- r|Wayal oeral oadar |ar|r |ou d| alas 1000-1500 g
8KR|N|NC, PEHER|K8AAN 0AN KR|TER|A 0|ACN08|8

usara s|r|r|rg
0|rarap|ar dapal rerjar|rg 0V0 seja| perleruar arlerala| PERTAVA.
Tap| dar| sudul ele|l|l|las, ras|| pos|l|l lerl|rgg| a|ar d|pero|er pada us|a |erar||ar 2-28 r|rggu.

Konsensus PERKEN|, 1997
d|arjur|ar urlu| re|a|u|ar perer||saar peryar|rg pada perleruar arlerala| perlara, j||a pos|l|l d|lala|a|sara
seoaga| 0V0, j||a regal|l perer||saar d|u|arg |ag| pada us|a |erar||ar 2-28 r|rggu.
Cara perer||saar :
Perer||saar d||a|u|ar pada |eadaar puasa. 0|oer||ar oeoar g|u|osa seoesar Z5 grar. Kadar g|u|osa darar
d|per||sa rarya pada 2 jar pasca oeoar g|u|osa lerseoul (2 jar poslprard|a|).

Kr|ler|a d|agros|s 0'3u|||var - Varar (191)
0|per||sa |adar g|u|osa darar puasa dar |adar g|u|osa darar 1 jar, 2 jar dar 3 jar pasca oeoar g|u|osa 100 g.
0|agros|s 0V0 d|lega||ar o||a lerdapal 0uA alau |eo|r ras|| aororra|. 8alas r||a| rorra| : puasa < 90 rg/d|, 1 jar
pp < 15 rg/d|, 2 jar pp < 115 rg/d|, 3 jar pp < 125 rg/d|.

Kr|ter|a d|agnos|s wh0 (1980, 1985} - sama dengan kr|ter|a d|agnos|s 0H pada keadaan t|dak ham||.

Kr|ter|a d|agnos|s mod|f|kas| wh0 - PERKEN| (1997}
0|per||sa rarya |adar g|u|osa p|asra 2 jar pp.
N||a| > 200 rg/d| : d|aoeles re|||lus (j||a oaru d||elaru| saal rar||, 0V0).
N||a| 110 - 200 rg/d| : lo|erars| g|u|osa lergarggu (T0T)
N||a| < 110 rg/d| : rorra|
3esua| arjurar wl0, pada leruar T0T (gu|a darar 2 jar pp 110 - 200 rg/d|) d|largar| juga seoaga| |asus 0V0,
ser|rgga pas|er dergar |adar gu|a yarg |eo|r rerdar (da|ar |r|ler|a 0'3u|||var) juga lerrasu| da|ar yarg d|largar|.
PENCEL0LAAN 0|AETE8 HELL|TU8 CE8TA8|0NAL

1. Penge|o|aan med|s

3esua| dergar perge|o|aar red|s 0V pada
ururrya, perge|o|aar 0V0 juga lerulara
d|dasar| alas perge|o|aar 0lZl / 0lET dar
pergerda||ar oeral oadar |ou.

Perr|lurgar reru se|roarg sara dergar
perr|lurgar pada |asus 0V ururrya, dergar
d|laroar|ar sejur|ar 300 - 500 |a|or| per rar|
urlu| lurour |eroarg jar|r se|ara rasa
|erar||ar, sarpa| se|esa| rasa reryusu|.

Perge|o|aar 0V da|ar |erar||ar oerlujuar
urlu| :
- rerperlarar|ar |adar g|u|osa darar puasa < 105 rg/d|
- rerperlarar|ar |adar g|u|osa darar 2 jar pp < 120
rg/d|
- rerperlarar|ar |adar lo g|||os||al (lo A1c) < -
- rercegar ep|sode r|pog|||er|a
- rercegar |elorur|a / |eloas|dos|s d|aoel||
- rergusara|ar lurour |eroarg jar|r opl|ra| dar
rorra|

0|arjur|ar perarlauar gu|a darar leralur r|r|ra| 2 |a|| ser|rggu (|dea| : sel|ap rar|, j||a rurg||r dergar a|al
per||sa serd|r| d| rurar).

0|arjur|ar |orlro| sesua| jadua| perer||saar arlerala|, ra||r de|al per||raar persa||rar |orlro| ra||r ser|rg. lo
g|||os||al d|per||sa |dea| l|ap - 8 r|rggu.

Kera||ar oeral oadar |ou d|arjur|ar 1-2.5 |g pada lr|resler perlara, se|arjulrya rala-rala 0.5 sel|ap r|rggu. 3arpa|
a|r|r |erar||ar, |era||ar oeral oadar yarg d|arjur|ar lergarlurg slalus g|z| aWa| |ou (|ou 88 |urarg 11-20 |g, |ou
88 rorra| 12.5-1Z.5 |g, |ou 88 |eo|r / ooes|las Z.5-12.5 |g).

JlKA perge|o|aar d|el saja l|da| oerras||, LAN03uN0 d|gura|ar |nsu||n. lARu3 preparal |rsu||r rarus|a (rurar
|rsu||r). lrsu||r ror rurar dapal reryeoao|ar lerjad|rya arl|ood| lerradap |rsu||r erdoger, arl|ood| |r| dapal
rererous p|acerla| o|ood oarr|er dar oerpergarur pada jar|r.
Pada 0V0 : |rsu||r yarg d|pa|a| ada|ar dos|s rerdar, |erja |rlerred|ale, 1-2 |a|| serar|.
Pada 0Vl : peroer|ar rurg||r per|u |eo|r ser|rg, alau |oro|ras| arlara srorl acl|rg dar |rlerred|ale, urlu|
rercapa| |adar g|u|osa yarg d|rarap|ar.
0oal r|pog|||er|| ora| Tl0AK d|gura|ar da|ar 0V0, rerg|rgal ele| leraloger|lasrya yarg l|rgg|, serla d|e|s|res|
da|ar jur|ar oesar re|a|u| A3l.

2. Penge|o|aan obstetr|k

Perer||saar arlerala| : perarlauar |||r|s |ou
dar jar|r, lerulara le|arar darar, peroesarar
/ l|rgg| lurdus uler|, deryul jarlurg jar|r, |adar
gu|a darar |ou, perer||saar u30,
|ard|olo|ogral| (j||a rerurg||r|ar).
Pa||rg |dea| : per||a|ar jar|r dergar s|or lurgs|
d|rar|| jar|r-p|aserla (F0JP).
J||a ada ra|rosor|a, perlurourar jar|r
lerraroal, gaWal jar|r - perl|roarg|ar secl|o
cesarea.
J||a seruarya oa||, l|da| ada rasa|ar oa|| dar|
aspe| 0V raupur dar| aspe| ooslelr|| |a|rrya,
dapal d|rarap|ar persa||rar sporlar
pervag|rar o|asa.

3. Penge|o|aan bay|

Pers|apar resus|las| reoralus yarg oa||.
Perer||saar darar la|| pusal urlu| rergu|ur |adar g|u|osa dar reralo|r|l oay|.

Vasa|ar yarg rurg||r l|rou| : peruoarar rorlo|og| / l|s|o|og| a||oal gargguar perlurourar |rlrauler|r, ra|rosor|a,
cacal oaWaar, gargguar relaoo||| r|pog|||er|a / r|po|a|ser|a / r|poragreser|a / r|pero|||ruo|rer|a, gargguar
reralo|og|| po||s|ler|a / r|perv|s|os|las, gargguar perrapasar dar |e|a|rar jarlurg oaWaar.
KE8|HPULAN

Perge|o|aar d|aoeles re|||lus da|ar |erar||ar rerer|u|ar perde|alar dar |erja sara l|r yarg seoa||-oa||rya.
0ergar perge|o|aar red|s, ooslelr|| raupur ped|alr|| yarg oa||, d|rarap|ar a|ar d|pero|er ras|| a|r|r yarg
ra|s|ra|, sara alau rerde|al| ras|| a|r|r pada |erar||ar rorra|.
Ke|a|nan Jantung
pada Keham||an
Ku||ah ||mu Penyak|t 0a|am
Prof.dr.Jahja K|sjanto
(d|bawakan pada Pertemuan ||m|ah Tahunan ||mu Penyak|t 0a|am, Jakarta, 1997}
PR|N8|P

1. war|la dergar |e|a|rar jarlurg, rurg||r 8ARu d||elaru| perya||lrya pada Wa|lu sedarg rar||.
2. 3eoa|||rya, peruoarar l|s|o|og|s |erar||ar yarg rorra| 0APAT reroer||ar |e|urar dar geja|a yarg serupa
seperl| seorarg pas|er perya||l jarlurg.
0|er |arera |lu ||la rarus rergera| |eo|r du|u peruoarar alau gargguar |ard|ovas|u|ar yarg dapal lerjad| pada
War|la rar||.
EAN JANTUNC PA0A HA8A KEhAH|LAN

Peruoarar l|s|o|og| pada |erar||ar rorra| : lerulara perubahan hEH00|NAH|K materna|, re||pul| :
1. relers| ca|rar, oerlaroarrya oeoar vo|ure dar curar jarlurg
2. arer|a re|al|l
3. a||oal pergarur rorror, lararar per|ler vas|u|ar rerurur
1. le|arar darar arler|a| rerurur
5. curar jarlurg oerlaroar 30-50, ra|s|ra| pada a|r|r lr|resler perlara, rerelap sarpa| a|r|r |erar||ar
. vo|ure darar ralerra| |ese|ururar oerlaroar sarpa| 50
Z. vo|ure p|asra oerlaroar |eo|r cepal pada aWa| |erar||ar, |erud|ar oerlaroar secara per|arar sarpa| a|r|r
|erar||ar

Pada lr|resler perlara, lerjad| :
1. peraroarar curar jarlurg, vo|ure p|asra dar vo|ure ca|rar e|slrase|u|ar, d|serla| per|rg|alar a||rar p|asra
g|rja| dar |aju l||lras| g|oreru|us
2. peraroarar / relers| a|r dar ralr|ur yarg dapal d|lu|ar d| da|ar luour, per|rg|alar T8w / lola| oody Waler
3. a||oalrya lerjad| a|l|las| s|sler rer|r-arg|olers|r dar perururar aroarg osrol|| urlu| pe|epasar red|alor
vasopres|r dar sl|ru|as| daraga.
1. a||oalrya pu|a lerjad| perururar |orserlras| ralr|ur da|ar p|asra dar perururar osro|a||las p|asra, ser|rgga
lerjad| edera pada 80 War|la yarg rar||.
h|P0TE8|8 HEKAN|8HE PERUAhAN KAR0|0VA8KULAR PA0A HA8A KEhAH|LAN

h|potes|s "overf|||"
Kerar||ar ada|ar sualu |eadaar oeoar vo|ure e|slra yarg d|leru|ar dergar adarya per|rg|alar p|asra dar
vo|ure e|slrase|u|ar, |aju l||lras| g|oreru|us dar a||rar p|asra g|rja|.
0|arggap oarWa r|perse|res| pr|rer a|dosleror rer|rou||ar relers| ralr|ur dar a|r.

h|potes|s "underf|||"
Kerar||ar ada|ar sualu |eadaar oer|urargrya vo|ure darar yarg ele|l|l, yarg d|serla| dergar r|perse|res|
a|dosleror se|urder.
Verurul r|poles|s |r|, vasod||alas| arler|a| ada|ar peryeoao peruoarar s|r|u|as| ulara yarg reryeoao|ar
urderl||||rg s|r|u|as|, rerururrya le|arar darar, oerlaroarrya curar jarlurg se|uder lerradap oer|urargrya
aller|oad, sl|ru|as| poros rer|r-arg|olers|r-a|dosleror, serla d||epas|arrya vasopres|r.
Terjad| relers| ralr|ur dar a|r da|ar g|rja|, reryeoao|ar perlaroarar vo|ure ca|rar e|slrase|u|er dar p|asra.

Peryeoao peruoarar lararar vas|u|ar pada |erar||ar : oe|ur je|as.

Eslroger : ele| l|da| |ors|sler lerradap le|arar darar, lelap| rerarg rer|rg|al|ar curar jarlurg re|a|u|
peraroarar slro|e vo|ure dar vo|ure p|asra.
Progesleror : rer|rg|al|ar deryul jarlurg, lelap| rarya oerperar sed|||l pada le|arar darar alau curar jarlurg.
Proslas||||r dar r|lr|l o|s|da : vasod||alor yarg d|ras|||ar erdole| da|ar jur|ar yarg rer|rg|al pada |erar||ar, lap|
|orlr|ous|rya pada vasod||alas| ras|r d|le||l|.
KELUhAN | CEJALA KAR0|0VA8KULAR YANC HENYERUPA| TAN0A-TAN0A PENYAK|T
JANTUNC PA0A KEhAH|LAN

Ke|uhan pas|en yang dapat d|jumpa| pada keham||an norma|
1. Rasa sesa| rapas (d|sprea) oerlaroar pada lr|resler perlara, purca|rya pada r|rggu |e 28-31, dapal
reryerupa| |e|urar pada perya||l jarlurg.
2. Ke|urar rudar rerasa |el|r, rerururrya lo|erars| lerradap excerc|se ser|rg d|leru|ar.
3. 3|r|op dar pus|rg pada a|r|r |erar||ar, rurg||r a||oal |orpres| vera cava |rler|or o|er ulerus yarg reroesar,
reryeoao|ar oer|urargrya arus oa||| vera ser|rgga lerjad| perururar curar jarlurg.
1. Perrapasar aga| cepal (overorealr|rg) ser|rg d|leru|ar |arera |orpres| paru oag|ar oasa| o|er ulerus yarg
reroesar.

Ceja|a ak|bat perubahan kard|ovasku|ar f|s|o|og|s yang dapat d|jumpa| pada keham||an norma|
1. Te|arar vera jugu|ar|s yarg rer|rgg|.
2. Peraroarar vo|ure darar reryeoao|ar |e|eo|rar oeoar jarlurg, garoararrya reryerupa| regurg|las| r|lra|.
3. Fre|uers| rad| |eo|r cepal, ler|s| perur alau |o|aps.
1. Ar|l|ra, dapal supraverlr||u|ar alau verlr||u|ar. J||a jararg lerjad|, d|arggap rorra|. Per|u d|perral||ar adarya
ar|lr|a yarg polers|a| oeroaraya (ra||grarl).
5. 8ury| jarlurg |e-3 d| ape|s o|er |arera perg|s|ar verlr||e| yarg cepal, dapal d|leru|ar pada 90 War|la rar||.
. 8|s|rg s|slo||| (l|oW rurrur) pada daerar aorla alau pu|rora| juga dapal d|leru|ar pada 90 War|la rar||.
Z. 8|s|rg |orl|ryu o|er |arera verous rur dapal d|leru|ar pada lossa supra||av||u|ar|s alau se|a |ga |e-2
paraslerra| |arar / ||r|, yarg rergr||arg dergar sed|||l pere|arar pada slelos|op.
8. Edera lurg|a|.

PEHER|K8AAN KhU8U8 UNTUK JANTUNC

1. E|ektrokard|ograf| (EKC}
dapal lerjad| garoarar peruoarar pos|s| jarlurg |e ||r|, d|serla| adarya ge|oroarg 0 yarg |ec|| dar ge|oroarg T
yarg leroa||| pada sadapar lll o|er |arera rolas| lerseoul. 0R3-rale dapal rer|rg|al 10-15. Ta|||ard|a
supraverlr||u|ar re-erlrarl dapal d|arggap ar|lr|a yarg l|da| oeroaraya pada |erar||ar. 3eoa|||rya j||a ada
la|||ard|a s|rus pers|sler, l|uller alr|ur, l|or||as| alr|ur alau la|||ard|a verlr||e|, per|u d|per||sa |eo|r |arjul urlu|
rerasl||ar ada l|da|rya |e|a|rar jarlurg.

2. Ekokard|ograf|
o|asarya d|per|u|ar, o||a d|leru|ar o|s|rg yarg re|eo|r| rurrur derajal l. Per|u urlu| rergelaru| adarya |e|a|rar
|alup, |e|a|rar jarlurg oaWaar, |ard|or|opal|, per||a|ar lurgs| verlr||e| dar |alup oualar.

3. Foto toraks
dapal d||erja|ar, lARu3 dergar prole|s| rad|as| yarg oa||. 0||a|u|ar o||a lerdapal d|spreu yarg oaru l|rou| pada
rasa |erar||ar.
0AT-0ATAN YANC 0|ER|KAN PA0A KEhAH|LAN

PR|N8|P !!
0oal yarg re|a|u| a||rar darar |ou lARu3 d|arggap dapal re|a|u| p|aserla dar sarpa| |e s|r|u|as| jar|r, |ecua|| j||a
ada ou|l| / |elerargar l|da| der|||ar.

Perubahan f|s|o|og| materna| pada keham||an akan mengubah farmakok|net|k obat-obatan yang d|ber|kan.
1. vo|ure d|slr|ous| oeoerapa ooal oerlaroar se|ara |erar||ar, |arera adarya peraroarar lola| oody Waler da|ar
oadar dar jar|rgar |era|, arlara r|rggu |e-10 sarpa| 30.
2. 8erlaroarrya |aju l||lras| g|oreru|us pada |erar||ar juga reraroar |ecepalar e||r|ras| ooal yarg d||e|uar|ar
re|a|u| g|rja|.
3. A|l|l|las erz|r ral| oer|urarg, juga rerpergarur|. Vol|||las dar pergosorgar |arourg yarg |eo|r |aroal pada
|erar||ar dapal rerguoar l|rg|al aosorps| ooal ora| da|ar lra|lus gaslro|rlesl|ra||s.

Per||raar peruoarar dos|s ooal yarg d|oulur|ar pada |erar||ar ada|ar 3uKAR, o|er |arera |lu do|ler rarus
dergar le||l|| rerl|lras| dos|s ooal sesua| respors larra|o|og|s |ou. Kadarg oar|ar per|u d|per||sa |adar ooal da|ar
serur.

3esudar |rp|arlas|, |eoarya|ar ooal 0APAT rercapa| eror|o secara oeoas da|ar |orserlras| yarg o|asarya |eo|r
rerdar dar| |ourya.
Karera saWar darar-ola| jar|r oe|ur leroerlu| serpurra sarpa| pada lr|resler |edua |erar||ar, ra|a susurar
saral pusal jar|r dapal dergar rudar lerpergarur o|er ooal yarg d|oer||ar pada |ourya.
8eroaga| ooal dapal reryeoao|ar raroalar perlurourar jar|r, |e|a|rar oerlu| dar gargguar lurgs| orgar, del|s|l
lurgs|ora| sarpa| dergar |eral|ar jar|r.
(car|/oaca serd|r| yaaa.)
KELA|NAN JANTUNC PA0A KEhAH|LAN

Perya||l jarlurg rerupa|ar peryeoao urular |e-3 |eral|ar |ou rar||.

Ke|a|rar jarlurg yarg ser|rg d| lrdores|a : perya||l jarlurg reral||, |e|a|rar jarlurg oaWaar dar |ard|or|opal|.
Perya||l jarlurg |ororer dar r|perlers| pr|rer da|ar |erar||ar jararg d|jurpa| (oeda|ar r|perlers| pr|rer dergar
r|perlers| pada pre-e||arps|a ll)

Pada |ou rar|| dergar |e|a|rar jarlurg, cadargar jarlurg (card|ac reserve) oer|urarg, |arera oesarrya oeoar
rerod|rar|| dar| |erar||ar dar dar| perya||l jarlurgrya.
Fa|lor-la|lor yarg dapal rerperouru| |eadaar jarlurg |ou : ars|elas, a|l|l|las oer|eo|rar, suru paras, |e|eroaoar.
3edapal rurg||r rarus d|r|rdar|. Keo|asaar rero|o| / |orsurs| a||oro| |a|au ada rarus d|rerl||ar.

0a|ar rerargar| |ou rar|| dergar |e|a|rar jarlurg :
perer||saar prerala| |eo|r spes|l||, lerrasu| da|ar :
- ||as|l||as| derajal |e|a|rar jarlurg, |e|as oerapa (NYlA)
- lurgs| verlr||e|
- le|arar arler| pu|rora||s
- e|e|lro|ard|ogral|, e|o|ard|ogral|
- |oord|ras| ar|| |eo|darar dergar ar|| |ard|o|og|

Kerar||ar dergar |alegor| NYlA |e|as l alau ll dapal
d|lerus|ar, lelap dergar perarlauar yarg oa||.

Ke|a|rar dergar |alegor| NYlA |e|as lll dar lv seoa||rya
0lANJuRKAN Tl0AK lAVlL. R|s||o |eral|ar d| alas 50.
V|sa|rya : r|perlers| pu|rora| pr|rer, s|rdror E|serrerger,
|e|a|rar ooslru|s| s|rploral||, sleros|s aorla, sleros|s
pu|rora|, coarclal|o aorlae, s|rdror Varlar, dar gargguar
lurgs| verlr||e|.

JlKA |e|a|rar lerseoul d|leru|ar pada |erar||ar, d|per|u|ar perargarar lerserd|r| dergar |oord|ras| |ard|o|og|,
|eo|darar, aresles|o|og| dar reoralo|og|. Telap rarus d|perl|roarg|ar |erurg||rar per|urya lerr|ras| /
perga|r|rar |erar||ar der| |ese|aralar |ou.
PENYAK|T JANTUNC REHAT|K (PJR}

Peryeoao leroarya| |e|a|rar |alup jarlurg yarg d|dapal. Perarggu|argar |erar||ar dergar PJR ururrya dergar
reslr||s| a|l|l|las l|s|| pada pas|er yarg s|rploral||, serla peroer|ar arl|o|ol|| percegarar d|lerus|ar.

Arl|o|ol|| prol||a|s|s lerradap erdo|ard|l|s d|arjur|ar d|oer||ar juga seWa|lu persa||rar.

Perarlauar rerod|rar|| d|arjur|ar juga seja| aWa| geja|a persa||rar, d|lerus|ar sarpa| 21 jar pasca persa||rar,
pada pas|er dergar dergar r|Wayal gaga| jarlurg, serla pada pas|er dergar |e|a|rar |alup cu|up oeral, d|slurgs|
verlr||e| ||r| dar r|perlers| pu|rora|.

8eoerapa |e|a|rar |alup yarg ser|rg d|jurpa| :

8tenos|s m|tra| (H8}
Verupa|ar |e|a|rar leroarya| pada |erar||ar dergar PJR.
3e||s|r le|arar (pressure grad|erl) pada |alup r|lra| yarg reryerp|l oerlaroar oesar dergar rer|rg|alrya deryul
jarlurg dar vo|ure darar pada |erar||ar. Per|rg|alar le|arar alr|ur ||r| dapal reryeoao|ar l|rou|rya alr|a| l|uller
/ l|or||as| alr|ur, yarg rerpercepal deryul verlr||e| ser|rgga |eo|r rer|rg|al|ar le|arar alr|ur ||r|. 3e|a|r |lu,
oer|urargrya le|arar osrol|| |o|o|d serur pada |erar||ar dar peroer|ar ca|rar |rlravera yarg rurg||r
oer|eo|rar pada per|parlur dapal reryeoao|ar l|rou|rya edera paru.
Tujuar lerap| pada V3 yarg cu|up oeral ada|ar urlu| 1) rerper|aroal deryul jarlurg dar 2) rergurarg| oeoar
vo|ure jarlurg. la| |r| dapal lercapa| dergar reslr||s| a|l|l|las l|s|| dar peroer|ar preparal oela-o|oc|er. Pada pas|er
dergar AF, peroer|ar d|go|s|r dapal rergorlro| deryul jarlurg. vo|ure p|asra dapal d||ururg| dergar reslr||s|
ca|rar / garar dar peroer|ar d|urel|| ora|. Pera|a|ar d|urel|| agres|l Tl0AK d|arjur|ar |arera dapal reryeoao|ar
r|povo|er|a dar perururar perlus| ulerop|aserla|.
Parlus pervag|rar ururrya 0APAT d||a|u|ar pada V3. Pada V3 derajal sedarg sarpa| oeral (<1.5 cr2)
perarlauar rerod|rar|| d|arjur|ar pada Wa|lu |r parlu dar re|ar|r|ar. Pada Wa|lu re|ar|r|ar, lerjad|
pergurargar ooslru|s| vera |ava |rler|or o|er ulerus, ser|rgga lerjad| per|rg|alar arus oa||| vera (verous oac|l|oW)
yarg dapal reryeoao|ar per|rg|alar oerra|ra dar| (PAwP) pu|rorary arlery Wedge pressure. Karerarya,
perarlauar rerod|rar|| d||arjul|ar sarpa| 21 jar pasca persa||rar.
J||a d|per|u|ar, d|arjur|ar aresles| ep|dura| pada parlus pervag|rar alau peraodor|rar.

Regurg|tas| m|tra| (HR}
Ke|a|rar |r| o|asarya dapal d|alas| pada |erar||ar, |erurg||rar |arera adarya pergosorgar verlr||e| ||r| secara
se|urder o|er perururar lararar vas|u|ar s|sler|| secara l|s|o|og|s.
Pada pas|er yarg s|rploral||, peroer|ar d|urel||a dar d|go|s|r dapal rergalas| oer|urargrya lurgs| s|slo|||
verlr||e| ||r|. l|dra|az|r yarg d|arggap arar urlu| |erar||ar, dapal d|oer||ar urlu| rergurarg| aller|oad verlr||e|
||r|.

8tenos|s aorta (A8}
Pada A3 derajal oeral dergar |uas |alup <1.0 cr2 dapal l|rou| |e|urar dysproe d'ellorl, s|r|op, dar sesa| a||oal
edera paru.
J||a l|da| dapal d|alas| dergar pergooalar, ra|a d||a|u|ar perculareous oa||oor va|vu|op|asly alau j||a jar|r sudar
dapal r|dup d| |uar rar|r, d||a|u|ar lerr|ras| dergar secl|o cesarea.
T|rda|ar oedar jarlurg lerou|a (oper rearl surgery) ada|ar oer|s||o 3AN0AT TlN00l urlu| jar|r.

Regurg|tas| aorta (AR}
3ara ra|rya dergar VR, ra|a AR dapal d|alas| pada |erar||ar. Kerurg||rar d|seoao|ar o|er oer|urargrya
lararar vas|u|ar s|sler|| dar per|rg|alar deryul jarlurg, ser|rgga lerjad| pererde|ar lase d|aslo|e.
Pada pas|er s|rploral||, peroer|ar d|urel||a, d|go|s|r dar r|dra|az|r urlu| rergurarg| aller|oad dapal d|oer||ar
se|ara |erar||ar dar persa||rar.

Pro|aps katup m|tra| (HVP}
VvP ada|ar prolrus| aororra| dar| salu alau dua daur |alup r|lra| |e da|ar alr|ur pada lase s|slo|||, dapal dergar
alau larpa d|serla| regurg|las|.
Keoarya|ar d|leru|ar pada War|la us|a ruda, dergar preva|ers| oerdasar|ar e|o|ard|ogral| rercapa| 1Z. J||a
oerdasar|ar |e|urar alau geja|a, preva|ers| |eo|r |ec||.
Ke|urar dapal oerupa oerdeoar a||oal ar|lr|a, alau d|seoao|ar o|er regurg|las| r|lra|. 0eja|a yarg d|leru|ar ada|ar
syslo||c c||c| dergar alau larpa d|serla| |ale syslo||c rurrur. EK0 o|asarya rorra| dergar |erurg||rar d|leru|ar
peruoarar 3T dar T regal|l pada |ead |rler|or dar |alera|. E|o|ard|ogral| a|ar rerega||ar d|agros|s.
VvP Tl0AK rerggarggu |erar||ar. Telap| VvP yarg d|serla| VR, res||pur rudar d|alas|, per|u percegarar
lerradap erdo|ard|l|s. J||a lerjad| ar|lr|a, per|u d|oer||ar go|orgar oela-o|oc|er. J||a ada r|Wayal lrars|erl |screr|c
allac| per|u rerdapal asar asel|| sa||s||al / asp|r|r.
KAR0|0H|0PAT|

Yarg ser|rg d|leru|ar ada|ar |ard|or|opal| per|parlur, dapal l|rou| dar| 1 ou|ar seoe|ur parlus sarpa| dergar
ou|ar sesudar parlus. Verupa|ar 5 peryeoao |eral|ar a||oal |e|a|rar jarlurg pada |erar||ar.
Peryeoao l|da| d||elaru|. Kerurg||rar oesar dasarrya ada|ar |ruro|og|s.

0a|ar |||r|| d|leru|ar d|slurgs| verlr||e| ||r| sarpa| dergar gaga| jarlurg.
0|agrosl|| oerdasar|ar adarya oury| jarlurg |el|ga d| ape|s, |adarg d|serla| o|s|rg s|slo||| yarg l|da| ada
seoe|urrya. Pada EK0 d|leru|ar oeroaga| oerlu| ar|lr|a, yarg o|asarya oerupa la|||ard|a s|rus. 0apal l|rou|
peruoarar EK0 yarg reryerupa| |rlar| r|o|ard.

Karera r|orelr|ur ulerus juga rerpurya| V8-|soerzyre dar| creal|r|r prospo||rase (CK-V8), ra|a o|asarya
lerjad| per|rg|alar CK-V8 juga pada parlus War|la yarg rorra|. urlu| rerasl||ar ada l|da|rya |rlar| r|o|ard,
per|u juga perer||saar lropor|r-T, alau |a|au per|u |aleler|sas|.

0|agnos|s band|ng da|am k||n|k termasuk : kard|om|opat| d||atas| yang sudah ada sebe|umnya, |nfark m|okard
per|partum, embo|| pu|monum, transfus| ber|eb|han, dan edema paru m|sa|nya o|eh karena pember|an r|trod|n.
Pas|er dergar gaga| jarlurg d|oer||ar d|urel||, d|go|s|r, ACE-|rr|o|lor (poslparlur) dar Warlar|r. J||a lerjad| ar|lr|a,
dapal d|oer| ar|odaror. Pada |asus oeral, lerulara j||a pada o|ops| d|leru|ar larda r|o|ard|l|s, d||a|u|ar
peroer|ar |rurosupres|l dergar predr|so|or 1.5 rg/|g/rar| d|laroar azal|opr|r 1 rg/|g/rar|.
Pergooalar d|lerus|ar sarpa| ada peroa||ar, lerulara oerdasar|ar o|ops| ser|a|.
Peroer|ar ACE |rr|o|lor poslparlur d|lerus|ar se|ara lurgs| verlr||e| ||r| aororra|, yarg dapal d|||ral dar| ser|a|
e|o|ard|ogral|, alau d|rerl||ar j||a lerjad| |erar||ar |ag|. J||a lurgs| verlr||e| ||r| lelap ouru|, d|arjur|ar pas|er l|da|
rar|| |ag|.
KELA|NAN JANTUNC AwAAN

3ecara urur |e|a|rar jarlurg oaWaar (6h0 - congen|ta| heart d|sease} d||e|orpo||ar da|ar |e|a|rar jarlurg
oaWaar yarg as|arol|| dar s|arol||.
Ke|a|nan jantung bawaan as|anot|k

J||a d|leru|ar da|ar |erar||ar, o|asarya dapal d|alas| dergar oa||.
Ke|orpo| r|s||o rerdar :
0ele| seplur alr|ur, dele| seplur verlr||e|, du|lus arler|osus paler, arora|| Eosle|r, sleros|s pu|rora|, sleros|s
aorla r|rgar sarpa| sedarg, dar |e|a|rar jarlurg lrarspos|s| yarg sudar d||ore|s|.
Ke|orpo| r|s||o sedarg :
Coarclal|o aorlae, sleros|s pu|rora| dergar srurl |arar |e ||r|, r|perlers| pu|rora| pada du|lus arler|osus paler,
dele| aorla-pu|rora||s, alau dele| seplur verlr||e|.
Ke|orpo| r|s||o l|rgg| :
3leros|s aorla oeral. (juga oer|s||o l|rgg| oag| jar|r).
Ke|a|nan jantung bawaan s|anot|k

J||a s|aros|s reryerla| |e|a|rar jarlurg oaWaar, o|asarya ra| lerseoul rerupa|ar |e|a|rar yarg |orp|e|s.
R|s||o pada |ou |a|ar |arera rer|rg|alrya adres| lroroos|l dar oer|urargrya l|or|ro||s|s, ser|rgga r|s||o lroroos|s
oerlaroar. J||a lerjad| lrorool|eo|l|s alau lroroos|s vera da|ar, ra|a l|da| rarya reraroar r|s||o lerjad|rya
eroo|| pu|rora|, lelap| juga eroo|| parado|sa|.
3esudar lr|resler |el|ga, dapal d|oer||ar asp|r|r dos|s rerdar. Peroer|ar repar|r prol||a|s|s dapal d|perl|roarg|ar,
dergar perarlauar yarg oa||.
R|s||o urlu| jar|r TlN00l, dapal oerupa oeral oadar |ar|r rerdar, preralur|las, sarpa| |eral|ar jar|r. J||a lo |eo|r
dar| 18 g o|asarya l|da| ada jar|r yarg r|dup, |eoarya|ar jar|r rer|rgga| pada lr|resler perlara.

8eoerapa |e|a|rar jarlurg oaWaar s|arol|| yarg dapal d|jurpa| pada |erar||ar :

Tetra|og| Fa||ot (TF}
Pas|er dergar TF yarg r|rgar dapal rercapa| us|a deWasa larpa ada |e|urar oerarl|. Telap| pada |erar||ar,
|arera adarya perururar lararar vas|u|ar per|ler, dapal lerjad| per|rg|alar srurl |arar |e ||r|, ser|rgga geja|a
s|aros|s oerlaroar dar l|rou| perouru|ar. Persa||rar a|ar reroaraya|ar |ourya, |arera dergar lerjad|rya
perdararar a|ar rer|rou||ar r|polers| yarg rerperoeral srurl |arar |e ||r|.
0aga| jarlurg |arar dar ||r| dapal lerjad| pada |erar||ar, lerulara j||a d|serla| regurg|las| aorla (AR). AR |r|
o|asarya a|ar l|rou| secara progres|l pada TF yarg l|da| d||ore|s|, o|er |arera daur |alup aorla l|da| lerlarar dar
pro|aps. 3e|a|r |lu, |orp|||as| ar|lr|a alr|ur o|asarya a|ar l|rou|. R|s||o a|ar lerjad|rya |e|a|rar jarlurg oaWaar
pada jar|r oer||sar arlara 2.5 - 8.3.
Pada TF yarg sudar d||ore|s| seoe|urrya, progros|srya |eo|r oa||.

8|ndrom E|senmenger
3|rdror E|serrerger o|asarya d|serla| l|rgg|rya lararar vas|u|ar pu|rora| serla srurl yarg leroa||| alau dua arar
pada daerar alr|ur, verlr||e| alau aorlo-pu|rora|.
Pas|er dapal r|dup sarpa| rasa us|a reprodu|l|l, lap| o|asarya |e|urar oerlaroar pada us|a 30ar.
Keadaar |r| rerouru| pada |erar||ar, |arera adarya raroalar pada oulpul verlr||e| |arar. vasod||alas| s|sler||
pada |erar||ar a|ar reraroar srurl |arar |e ||r|, rerperoeral s|aros|s. 3er|rgga j||a lerjad| perururar le|arar
darar sed|||l saja, seperl| pada s|r|op vasovaga| alau perdararar r|rgar, dapal rer|rou||ar |eral|ar rerdada|.
Arg|a |eral|ar pas|er s|rdror E|serrerger |arera |erar||ar rercapa| 52.
3eoa||rya pas|er s|rdror |r| Tl0AK d|arjur|ar rar||. J||a s|rdror |r| d|leru|ar pada |erar||ar, d|arjur|ar
lerr|ras| red|| pada lr|resler perlara.
J||a d||elaru| pada |erar||ar dar pas|er lN0lN re|arjul|ar |erar||arrya, rarus d|oer|laru|ar r|s||orya. Per|u
|oord|ras| dar perarlauar |elal |ard|o|og| dar ooslelr| urlu| rerdele|s| perouru|ar rerod|rar||. Pada lr|resler
|el|ga pas|er rarus lola| oed resl dergar pos|s| |alera|. Pada persa||rar per|u d|aWas| ar|| aresles|o|og|.
J||a lerjad| gaga| jarlurg d|oer||ar d|go|s|r. Peroer|ar d|urel|| rarus ral|-ral| urlu| rercegar rero|orserlras|.
Peroer|ar repar|r prol||a|s|s pada lr|resler |el|ga ras|r |orlrovers|a|, lelap| o|asarya repar|r oaru d|oer||ar
seoe|ur parlus dergar secl|o cesarea da|ar aresles| urur, |erud|ar d|lerus|ar dergar |urar|r poslparlur.
Persa||rar d||a|u|ar d| lCu yarg oerde|alar dergar |arar oedar, serla pas|er d|raWal r|r|ra| sarpa| 11 rar|
poslparlur urlu| rercegar r|s||o |eral|ar rerdada|.
0araran . gamoar / a|gor|rma / pene|asan renrang mas|ng-mas|ng ke|a|nan anrung, oera||2 parol|s|o|og| / o|agnos|s /
penara|aksanaan oso, s||akan car| / oaca seno|r|.
Ke|a|nan pada Lamanya Keham||an
(Abortus, Preterm, Lewat waktu}
Prof.dr. Cu|ard| h. w|knjosastro | dr. Noroyono w|bowo
HA8A KEhAH|LAN | HA8A CE8TA8|

Vasa seja| lerjad|rya |orseps| sarpa| dergar saal |e|ar|rar, d|r|lurg dar| rar| perlara ra|d lera|r|r (rerslrua| age
ol pregrarcy).

Kerar||ar cu|up ou|ar (lerr / alerr) : rasa geslas| 3Z-12 r|rggu (259 - 291 rar|) |erg|ap
Kerar||ar |urarg ou|ar (prelerr) : rasa geslas| |urarg dar| 3Z r|rggu (259 rar|).
Kerar||ar |eWal Wa|lu (posllerr) : rasa geslas| |eo|r dar| 12 r|rggu (291 rar|).

Aoorlus : oay| |ar|r dergar oeral oadar |urarg dar| 500 g, dar / alau parjarg oadar |urarg dar| 25 cr, dar / alau
us|a geslas| |urarg dar| 20 r|rggu. Arg|a rarapar r|dup aral sargal |ec||, |urarg dar| 1.
(8arya| |epusla|aar rerelap|ar oalasar oeroeda lerlarg aoorlus dar| seg| us|a |erar||ar, arlara 18-21 r|rggu.)
(wl0 : 22 r|rggu)
A0RTU8
lsl||ar aoorlus d|pa|a| urlu| rerurju||ar perge|uarar
ras|| |orseps| seoe|ur jar|r dapal r|dup d| |uar
|ardurgar.

8erdasar|ar var|as| oeroaga| oalasar yarg ada lerlarg
us|a / oeral |ar|r jar|r v|ao|e (yarg rarpu r|dup d| |uar
|ardurgar), a|r|rrya d|lerlu|ar sualu oalasar aoorlus
seoaga| perga|r|rar |erar||ar seoe|ur jar|r rercapa|
oeral 500 g alau us|a |erar||ar 20 r|rggu. (lera|r|r,
wl0/Fl00 1998 : 22 r|rggu)

Proses aoorlus dapal oer|argsurg spontan (sualu
per|sl|Wa palo|og|s), alau art|f|s|a| | terapeut|k (sualu
per|sl|Wa urlu| perala|a|saraar rasa|ar / |orp|||as|).

Aoorlus sporlar d|duga d|seoao|ar o|er :
- |e|a|rar |rorosor (seoag|ar oesar |asus)
- |rle|s| (cr|aryd|a, rycop|asra dso)
- gargguar erdo|r|r (r|pol|ro|d|sre, d|aoeles re|||lus)
- o|s|dar (ro|o|, a||oro|, rad|as| dar lo|s|r)

Proses abortus d|bag| 4 tahap : abortus |mm|nens,
abortus |ns|p|ens, abortus |nkomp|et dan abortus
komp|et.
Abortus |mm|nens

Aoorlus |rr|rers ada|ar per|sl|Wa lerjad|rya perdararar dar| ulerus pada |erar||ar seoe|ur 20 r|rggu, d| rara
ras|| |orseps| ras|r da|ar ulerus, dar larpa adarya d||alas| serv||s.
C|r| : perdararar pervag|rar, dergar alau larpa d|serla| |orlra|s|, serv||s ras|r lerlulup.
J||a jar|r ras|r r|dup, ururrya dapal oerlarar oar|ar sarpa| |erar||ar alerr dar |ar|r rorra|.
J||a lerjad| |eral|ar jar|r, da|ar Wa|lu s|rg|al dapal lerjad| aoorlus sporlar.
Pererluar |er|dupar jar|r d||a|u|ar |dea| dergar u|lrasorogral|, d|||ral gera|ar deryul jarlurg jar|r dar gera|ar
jar|r. J||a sarara leroalas, pada us|a d| alas 12-1 r|rggu deryul jarlurg jar|r d|cooa d|dergar|ar dergar a|al
0opp|er alau Laerrec.
Keadaar jar|r seoa||rya segera d|lerlu|ar, |arera rerpergarur| rercara perala|a|saraar / l|rda|ar.
Perargarar : |sl|raral oar|rg, pererluar |eadaar jar|r, oeoerapa suroer rergarjur|ar peroer|ar progesleror
(ras|r |orlrovers|).

0/T/T/h . reroapar peroeoaan oel|n|s| aoorrus |mm|nens oengan kamus keookreran 0or|ano oa|am na| o||aras| serv|ks, seoaga| oer|kur .
|mm|nenr a., |mpeno|ng aoorr|on |n un|cn rne o|eeo|ng |s proluse, rne cerv|x solreneo ano o||areo, ano rne urer|ne conrracr|ons approacn rne cnaracrer ol |aoor
pa|ns.
0or|anos l||usrrareo Veo|ca| 0|cr|onar,, 28rneo., '994.
0|skus| oengan or.horo,ono w|oouo .
seoenarn,a pasr| /0/ o||aras| serv|ks mesk|pun seo|k|r {ser|oakn,a paoa osr|um |nrernumj, ,ang o|per|ukan menao| a|an ke|uar oaran ke vag|na. Tap|
pr|ns|pn,a aoa|an, seaun mana o||aras| rerseour o|anggap oermakna / paro|og|k. la| |n| akan menao| sa|an saru oasar perr|moangan penara|aksanaan .
apakan kenam||an akan rerus o|perranankan arau r|oak.
0asar perr|moangan |a|n ,ang |eo|n penr|ng, rer|epas oar| o||aras| serv|ks {unruk prognos|s oan penara|aksanaanj ,a|ru . apakan oaran ,ang ke|uar |ru oerasa|
oar| ar|ngan lera| arau ar|ngan marerna| ?
J|ka oaran oerasa| oar| ar|ngan lera|, oerarr| prognos|s unruk ke|anuran kenam||an ouruk. hamun unruk pemer|ksaan ke aran |n|, sangar su||r oan prakr|s
namp|r r|oak mungk|n o||akukan o| k||n|k. $en|ngga oa|am prakrek ser|ng o|amo|| |angkan konservar|l, kenam||an rerap o|usanakan unruk o|perranankan.
Perran,aan |a|n |ag| . oaga|mana oengan kua||ras n|oup konseps| ,ang re|an
menga|am| "ceoera" ak|oar peroaranan paoa us|a kenam||an muoa rerseour ?
Abortus |ns|p|ens

Aoorlus |rs|p|ers ada|ar per|sl|Wa lerjad|rya perdararar dar|
ulerus pada |erar||ar seoe|ur 20 r|rggu, dergar adarya
d||alas| serv||s uler| yarg rer|rg|al, lelap| ras|| |orseps|
ras|r oerada d| da|ar ulerus.
C|r| : perdararar pervag|rar, dergar |orlra|s| ra||r |ara
ra||r |ual ra||r ser|rg, serv||s lerou|a.
Perargarar : sl|ru|as| perge|uarar s|sa |orseps| dergar
o|s|los|r |rlus, dar / alau dergar |urelase (ral|2 oaraya
perloras|).
Abortus |nkomp|etus

Aoorlus |r|orp|elus ada|ar per|sl|Wa perge|uarar seoag|ar
ras|| |orseps| pada |erar||ar seoe|ur 20 r|rggu, dergar
ras|r ada s|sa lerl|rgga| da|ar ulerus.
C|r| : perdararar yarg oarya|, d|serla| |orlra|s|, serv||s
lerou|a, seoag|ar jar|rgar |e|uar.
Perargarar : opl|ra||sas| |eadaar urur dar larda v|la| |ou
(perdararar oarya| dapal reryeoao|ar syo|), perge|uarar
se|urur jar|rgar |orseps| dergar e|sp|oras| d|g|la| dar o||a
per|u d||a|u|ar |urelase da|ar aresles|a (|elar|r) dar
ara|ges|a reuro|epl (pel|d|r, d|azepar).
Abortus komp|etus

Aoorlus |orp|elus ada|ar lerjad|rya perge|uarar |erg|ap
se|urur jar|rgar |orseps| seoe|ur us|a |erar||ar 20
r|rggu.
C|r| : perdararar pervag|rar, |orlra|s| ulerus, osl|ur
serv||s sudar rerulup, ada |e|uar jar|rgar, l|da| ada s|sa
da|ar ulerus.
0|agros|s |orp|el d|lega||ar o||a jar|rgar yarg |e|uar juga
d|per||sa |e|erg|aparrya.
Perargarar : opl|ra||sas| |eadaar urur dar larda v|la|
|ou.
Abortus hab|tua||s

Kejad|ar aoorlus oeru|arg, ururrya d|seoao|ar |arera
|e|a|rar aralor|| ulerus (r|ora, seplur, serv||s
|r|orpeler dso), alau |e|a|rar la|lor-la|lor |ruro|og|.
ldea| d||a|u|ar perer||saar u30 urlu| re||ral ada/l|da|rya
|e|a|rar aralor|. J||a |e|a|rar aralor| d|s|rg||r|ar, |a|u|ar
rarg|a|ar perer||saar la|lor-la|lor rorrora| / |ruro|og| /
|rorosor.
H|ssed abort|on

Keral|ar jar|r dar re|ros|s jar|rgar |orseps| larpa ada
perge|uarar se|ara |eo|r dar| 1 r|rggu alau |eo|r (oeoerapa
ou|u : 8 r|rggu ?).
8|asarya d|daru|u| larda dar geja|a aoorlus |rr|rers yarg
|erud|ar rergr||arg sporlar alau rergr||arg sele|ar
pergooalar.
Perargarar dergar rerge|uar|ar jar|rgar |orseps|,
d|arjur|ar rerggura|ar d||alas| du|u dergar |ar|rar|a, dar
sl|ru|as| |orlra|s| ulerus dergar o|s|los|r. J||a d|pulus|ar
re|a|u|ar l|rda|ar |urel, rarus sargal oerral|-ral| |arera
jar|rgar le|ar rergeras, dar dapal lerjad| gargguar
peroe|uar darar a||oal |orp|||as| |e|a|rar |oagu|as|
(r|pol|or|rogerer|a).
Abortus terapeut|k

0||a|u|ar pada us|a |erar||ar |urarg dar| 12 r|rggu, alas
perl|roargar / |rd||as| |eseralar War|la d| rara o||a
|erar||ar |lu d||arjul|ar a|ar reroaraya|ar d|r|rya,
r|sa|rya pada War|la dergar perya||l jarlurg, r|perlers|,
perya||l g|rja|, |oroar per|osaar (rasa|ar ps|||s). 0apal
juga alas perl|roargar / |rd||as| |e|a|rar jar|r yarg oeral.
Abortus sept|k

3eps|s a||oal l|rda|ar aoorlus yarg ler|rle|s| (r|sa|rya d||a|u|ar o|er du|ur alau aWar). 8araya leroesar ada|ar
|eral|ar |ou.
T|rda|ar :
- resus|las| dar peroa||ar |eadaar urur |ou
- peroer|ar arl|o|ol|| spe|lrur |uas dos|s l|rgg|
- perge|uarar s|sa |orseps| da|ar jar
PR|N8|P !!
Perdararar pervag|rar pada |erar||ar |urarg dar| 12 r|rggu
1. JAN0AN LAN03uN0 0lLAKuKAN KuRETA3E lll
2. lerlu|ar du|u, jar|r ral| alau r|dup. J||a rerurg||r|ar, per||sa dergar u30
3. jargar lerpergarur rarya perer||saar 8-lC0 yarg
pos|l|l, |arera res||pur jar|r sudar ral|, 8-lC0 rurg||r
ras|r l|rgg|, o|sa oerlarar sarpa| 2 ou|ar sele|ar |eral|ar
jar|r.
0|agnost|k

1. ararres|s : perdararar, ra|d lera|r|r, po|a s|||us ra|d, ada l|da| geja|a / |e|urar |a|r, car| la|lor r|s||o /
pred|spos|s|. R|Wayal perya||l urur dar r|Wayal ooslelr| / g|re|o|og|.
2. pr|rs|p : War|la us|a reprodu|l|l dergar perdararar per vag|rar aororra| lARu3 se|a|u d|perl|roarg|ar
|erurg||rar adarya |erar||ar.
3. perer||saar l|s|s urur : |eadaar urur, larda v|la|, s|sleral||. JlKA |eadaar urur ouru| |a|u|ar resus|las| dar
slao|||sas| segera l
1. perer||saar g|re|o|og| : ada l|da|rya larda a|ul aodorer. J||a rerurg||r|ar, car| suroer perdararar : apa|ar
dar| d|rd|rg vag|ra, alau dar| jar|rgar serv||s, alau darar rerga||r |e|uar dar| osl|ur ?
5. j||a d|per|u|ar, aro|| darar / ca|rar / jar|rgar urlu| perer||saar perurjarg (aro|| sed|aar 3E8ELuV
perer||saar vag|ra| loucre)
. perer||saar vag|ra| loucre : ral|-ral|. 8|rarua| lerlu|ar oesar dar |ela| ulerus. Terlu|ar juga apa|ar salu jar|
perer||sa dapal d|rasu||ar |e da|ar osl|ur dergar Vu0Al / |ura|, alau l|da| (re||ral ada l|da|rya d||alas|
serv||s). Jargar d|pa|sa. Adre|sa dar pararelr|ur d|per||sa, ada l|da|rya rassa alau larda a|ul |a|rrya.
Tekn|k penge|uaran s|sa abortus

Perge|uarar jar|rgar pada aoorlus
:
sele|ar serv||s lerou|a (pr|rer
raupur dergar d||alas|), jar|rgar
|orseps| dapal d||e|uar|ar secara
rarua|, d||arjul|ar dergar
|urelase.
1. 3ordage, rererlu|ar pos|s| dar
u|urar ulerus.
2. Vasu||ar larg aoorlus
separjarg oesar ulerus, ou|a dar pular 90o urlu| re|epas|ar jar|rgar, |erud|ar lulup dar |e|uar|ar jar|rgar
lerseoul.
3. 3|sa aoorlus d||e|uar|ar dergar |urel lurpu|, gura|ar serdo| leroesar yarg o|sa rasu|.
1. Pasl||ar s|sa |orseps| le|ar |e|uar serua, dergar e|sp|oras| jar| raupur |urel.
Pert|mbangan

Kerar||ar us|a |eo|r dar| 12 r|rggu seoa||rya d|se|esa||ar dergar proslag|ard|r (r|soproslo| |rlravag|ra|) alau |rlus
o|s|los|r dos|s l|rgg| (20-50 u/dr|p).
K|r| dergar a|al r|sap dar |aru| p|asl|| dapal d||e|uar|ar jar|rgar |orseps| dergar lraura r|r|ra|, lerulara
r|sa|rya pada |asus aoorlus ro|a.
Jar|rgar |orseps| d|||r|r urlu| perer||saar palo|og| aralor|, agar dapal d||derl|l||as| |e|a|rar v||||. 8araya /
|orp|||as| yarg dapal lerjad| pasca ro|a ada|ar |egarasar (perya||l lroloo|asl|| geslas|ora| garas / PT0).
Faktor r|s|ko | pred|spos|s| yang (d|duga} berhubungan dengan terjad|nya abortus

1. us|a |ou yarg |arjul
2. r|Wayal ooslelr| / g|re|o|og| yarg |urarg oa||
3. r|Wayal |rlerl|||las
1. adarya |e|a|rar / perya||l yarg reryerla| |erar||ar (r|sa|rya d|aoeles, perya||l |ruro|og| s|sler|| dso).
5. oeroaga| racar |rle|s| (var|o|a, CVv, loxop|asra, dso)
. paparar dergar oeroaga| racar zal ||r|a (ro|o|, ooal2ar, a||oro|, rad|as|, dso)
Z. lraura aodorer / pe|v|s pada lr|resler perlara
8. |e|a|rar |rorosor (lr|sor| / rorosor|)
0ar| aspe| o|o|og| ro|e|u|ar, |e|a|rar |rorosor lerryala pa||rg ser|rg dar pa||rg je|as oerruourgar dergar
lerjad|rya aoorlus.
Penata|aksanaan pasca abortus

Perer||saar |arjul urlu| rercar| peryeoao aoorlus. Perral||ar juga |rvo|us| ulerus dar |adar 8-rC0 1-2 ou|ar
|erud|ar.
Pas|er d|arjur|ar jargar rar|| du|u se|ara 3 ou|ar |erud|ar (j||a per|u, arjur|ar pera|a|ar |orlraseps| |ordor
alau p||).
Apakah keham||an akan d||anjutkan atau t|dak ?

Pr|rs|p perl|roargar urlu| p|||rar perala|a|saraar :
1. apa|ar |erar||ar ras|r rurg||r d||arjul|ar (j||a aoorlus ras|r |rr|rers) ?
2. o||a ras|r rurg||r d||arjul|ar, apa|ar |ua||las |orseps| lelap dapal ra|s|ra| ?

Aspek et|k abors| :
oaca juga ca|u| ser|rar el|| (ra|a|ar Prol.dr.Ralra 3uprapl| 3ar||, PlT-P00l 1999 dar Fl00 0u|de||res 1998).

PER8AL|NAN PRETERH

wor|d hea|th 0rgan|zat|on :
L|veoorr |rlarls de||vered oelore 3Z Wee|s lror lre l|rsl day ol lre |asl rerslrua| per|od are lerred preralure.

|st||ah

Vu|a-ru|a, |sl||ar preralur d|oer||ar urlu| oay| dergar oeral |ar|r 2500 g alau |urarg.
Telap| se|ararg oay| der|||ar d|seoul seoaga| oay| dergar oeral oadar |ar|r rerdar (|oW o|rlrWe|grl |rlarls / L8w).
J||a d|serla| dergar rasa geslas| yarg |urarg dar| 3Z r|rggu, oaru oay| lerseoul d|seoul seoaga| preralur.
J||a d|serla| dergar |el|da|sesua|ar oeral oadar lerradap us|a geslas|rya, r|sa|rya a||oal raroalar perlurourar
|rlrauler|r (|rlrauler|re groWlr relardal|or / lu0R), oay| lerseoul d|seoul seoaga| |ec|| urlu| rasa |erar||arrya
(sra|| lor geslal|ora| age / 30A).

Preralur|las dar lu0R oerruourgar dergar rorla||las dar roro|d|las per|rala| yarg |eo|r l|rgg|.

El|o|og| PA3Tl dar| persa||rar prelerr ser|rg|a||
l|da| d||elaru|.
Yarg d||elaru| / d|leru|ar ada|ar |ord|s|-|ord|s|
yarg reryeoao|ar lerpa|sa d||a|u|ar l|rda|ar
ser|rgga lerjad| persa||rar prelerr.

Fakror r|s|ko gangguan perrumounan |nrraurer|n oan
persa||nan prererm {raoe|j

Perkembangan terakh|r
d|leru|ar ruourgar arlara |adar CRl (corl|colrop|r re|eas|rg rorrore) yarg l|rgg| pada rasa |erar||ar dergar
lerjad|rya persa||rar prelerr.
3edarg d|le||l| |erurg||rar urlu| rerdele|s| d|r| |erurg||rar |ararya |erar||ar oerdasar|ar pereruar |r|.
l|poles|s :
1. |adar CRl d| alas rorra| : |erar||ar a|ar oera|r|r prelerr.
2. |adar CRl da|ar oalas rorra| : |erar||ar a|ar oera|r|r pada us|a alerr.
3. |adar CRl d| oaWar rorra| : |erar||ar a|ar oer|argsurg |eo|r |ara dar oera|r|r |eWal Wa|lu / posllerr.
Pencegahan

Pr|rs|p usara percegarar parlus preralurus (= usara rerperlarar|ar |erar||ar sedapal rurg||r sarpa| us|a
|erar||ar alerr) :
1. edu|as| pas|er urlu| perer||saar dar peraWalar arlerala| yarg oa|| dar leralur
2. rerje|as|ar la|lor-la|lor r|s||o |erar||ar dar persa||rar
3. rerje|as|ar larda / geja|a yarg rerupa|ar perlarda oaraya yarg lARu3 d||elaru| pas|er, supaya pas|er dapal
|argsurg rercar| perlo|orgar |e rurar sa||l (|orlra|s| / ru|es, |e|uar ca|rar / |erd|r / darar, derar, pus|rg, dar
seoaga|rya)
1. 8lLA lerjad| larda-larda lerseoul, d||a|u|ar perala|a|sa-raar red|| urlu| oerusara rerperlarar|ar |erar||ar
sedapal rurg||r
5. 8lLA d|leru|ar larda yarg l|da| rerurg||r|ar urlu| rerperlarar|ar |erar||ar |eo|r |ara (r|sa|rya,
perou|aar serv||s, |eluoar pecar, gaWal jar|r, |rle|s|) d|usara|ar urlu| rerc|pla|ar |ord|s| yarg seopl|ra|
rurg||r oag| |ou dar jar|r, |erud|ar d||a|u|ar lerr|ras| |erar||ar.
Penata|aksanaan

Perala|a|saraar red|| |asus yarg lerjad| pada us|a |erar||ar oe|ur cu|up, dergar adarya r|s||o persa||rar
prelerr:
1. lrle|s| : d|lala|a|sara dergar arl|o|ol||a spe|lrur |uas dos|s l|rgg| (||ral |u||ar |rle|s| |rlraparlur). 0erar /
r|perp|re|s|a |ou yarg rurg||r lerjad| juga rarus d|ooal|, |arera |eadaar r|perp|re|s|a dapal oera||oal ouru| pada
s|r|u|as| jar|r.
2. Korlra|s| : |orlra|s| yarg oer|s||o l|rgg| ada|ar |orlra|s| dergar lre|uers| |eo|r dar| 3-1 |a|| per jar. 0a|ar 18 jar
rerje|arg parlus, |orlra|s| a|ar rer|rg|al (r|s) sarpa| 2-1 |a|| sel|ap 10 rer|l dergar |rlers|las yarg ra||r |ual,
ra||r |ara dar ra||r ser|rg. Pada |asus dergar |orlra|s|, d||a|u|ar lerap| lo|o||s|s, dergar ooal-ooalar oela-
agor|s (r|sa|rya sa|oularo|, leroula||r), saro|| lerus rergaWas| |eadaar |ou dar |eadaar jar|r. Pergooalar
d|oer||ar dergar |rlus, |erud|ar dapal d||arjul|ar dergar ooal ora| o||a pas|er d|pu|arg|ar. 8||a |orlra|s| r||arg,
peroer|ar lo|o||s|s dapal d|rerl||ar.
3. Per|cu peralargar paru jar|r : urlu| a|se|eras| peralargar paru jar|r, d|oer||ar preparal |orl||oslero|d
(r|sa|rya de|sarelasor, oelarelasor) yarg a|ar rersl|ru|as| produ|s| dar se|res| surla|lar d| paru jar|r. ldea|
d|oer||ar r|r|ra| se|ara 2 x 21 jar.

Prys|ca| Craracler|sl|cs Exar|ral|or Crarl Forr lor Esl|ral|or ol 0eslal|ora| Age ol lre NeWoorr (Luocrerco, 19Z1)
Pert|mbangan penata|aksanaan obstetr| | per|nato|og|

J||a usara rerperlarar|ar |erar||ar larpa|rya l|da| rurg||r, dar lerpa|sa d|p|||r ja|ar lerr|ras| |erar||ar, ada
oeoerapa perlaryaar yarg dapal rerjad| perl|roargar :
1. 8erapa oesar |erarpuar |||r|| urlu| rerjaga |er|dupar oay| prelerr ?
2. 8erapa oesar pe|uarg / |erurg||rar r|dup oay| dergar oeral |ar|r dar us|a geslas| lerseoul ?
3. 8aga|rara persa||rar a|ar d||a|u|ar ? Pervag|rar alau peraodor|rar (secl|o cesarea) ?
1. Korp|||as| apa yarg rurg||r l|rou| ? Apa|ar a|al / sarara / |erarpuar yarg ada rerada| ?
5. 8aga|rara perl|roargar dar| p|ra| pas|er / |e|uarga, lerlarg |erurg||rar |eadaar oay| yarg |urarg oa||,
|orse|uers| peraWalar oay| preralur yarg |ara dar oeral, dar seoaga|rya ?
Penanganan obstetr| | per|nato|og|

R|s||o |orp|||as| lraura persa||rar leroesar pada oay| preralur ada|ar lerjad|rya perdararar per|verlr||u|ar, yarg
dapal reryeoao|ar |eral|ar.
Perl|roargar (FKul) : per||raar oeral jar|r 1500-2000 g preserlas| |epa|a d||ar|r|ar dergar secl|o cesarea. urlu|
|ela| surgsarg, sarpa| dergar per||raar oeral 2500 g d||ar|r|ar dergar secl|o cesarea.
Resus|las| dar peraWalar |rlers|l urlu| reoralus rarus d|pers|ap|ar.

3ele|ar |ar|r, perer||saar urlu| per||a|ar per||raar us|a geslas| oay| segera d||a|u|ar (ada oeroaga| cara / |r|ler|a :
0uooW|lz, 8allag||a, Luocrerco - garoar)

oaca uga ku||an .
- |nleks| |nrraparrum oan keruoan pecan o|n|
- per|naro|og|
- resus|ras| oan perauaran |nrens|l neonarus
KEhAH|LAN LEwAT wAKTU (P08TTERH}

Keham||an yang ber|angsung |eb|h dar| 294 har| atau 42 m|nggu |engkap sejak har| pertama ha|d terakh|r |bu,
d|sebut sebaga| postterm atau keham||an |ewat waktu.
Hasa|ah

1. pererluar us|a |erar||ar oerdasar|ar rar| perlara ra|d lera|r|r ser|rg|a|| l|da| rudar, |arera |ou l|da| |rgal
|apar largga| rar| perlara ra|d lera|r|rrya yarg pasl|.
2. 3e|a|r |lu, pererluar saal ovu|as| yarg pasl| juga l|da| rudar.
3. Fa|lor-la|lor yarg rerpergarur| perr|lurgar : var|as| s|||us ra|d, |esa|arar perr|lurgar o|er |ou, dar
seoaga|rya.

Rurus Naege|e ras|r urur d|pa|a|, lelap| rarus lelap d||rgal oeroaga| la|lor d| alas yarg dapal rerpergarur| /
reryeoao|ar lerjad|rya |esa|arar perr|lurgar.

0ergar adarya perer||saar u|lrasorogral| (u30) : us|a |erar||ar dapal d|lerlu|ar |eo|r lepal, dergar
pery|rpargar rarya |eo|r alau |urarg salu r|rggu.
Tap| ras|r juga rerupa|ar rasa|ar pada |erar||ar ru|l|pe| / |eroar, |arera ras|rg-ras|rg jar|r a|ar oeru|urar
|eo|r |ec|| dar|pada pada |erar||ar lurgga| yarg rorra|.
Et|o|og| | Patof|s|o|og|

0|duga adarya |adar |orl|so| yarg rerdar pada darar jar|r. 3e|a|r |lu, |urargrya a|r |eluoar dar |rsul|s|ers|
p|aserla juga d|duga oerruourgar dergar |erar||ar |eWal Wa|lu.

Furgs| p|aserla rerurca| pada us|a |erar||ar 38-12 r|rggu, |erud|ar VENuRuN sele|ar 12 r|rggu, ler||ral dar|
rerururrya |adar eslroger dar |a|loger p|aserla. Terjad| juga spasre arler| sp|ra||s p|aserla.
A||oalrya dapal lerjad| gargguar sup|a| o|s|ger dar rulr|s| urlu| r|dup dar lurour |eroarg jar|r |rlrauler|r.
3|r|u|as| ulerop|aserla oer|urarg sarpa| 50 (ll).
vo|ure a|r |eluoar juga oer|urarg |arera ru|a| lerjad| aosorps|.

Keadaar-|eadaar |r| rerupa|ar |ord|s| yarg l|da| oa|| urlu| jar|r.
R|s||o |eral|ar per|rala| pada oay| poslralur cu|up l|rgg| : 30 preparlur, 55 |rlraparlur, 15 poslparlur.
0|agnos|s keham||an |ewat waktu pada pemer|ksaan antenata|

1. perr|lurgar us|a |erar||ar (rurus Naege|e) : jargar |upa perl|roarg|ar la|lor-la|lor d| alas.
2. perer||saar ser|a| l|rgg| lurdus uler| rerurju||ar perururar, |arera jar|r yarg l|da| lurour |eo|r oesar |ag|
sererlara a|r |eluoar ru|a| oer|urarg.
3. adarya perasaar |ou oarWa gera|ar jar|r oer|urarg lre|uers| dar |rlers|lasrya.

Perl|rg : perarlauar jar|r urlu| rererlu|ar |eadaar jar|r.
J||a pada perr|lurgar posllerr, lap| pada perer||saar lerryala |eadaar jar|r ras|r oa||, rurg||r ada sa|ar
perr|lurgar alau ada la|lor |a|r yarg oerpergarur pada |eadaar |r|.
Pert|mbangan penata|aksanaan

1. |erar||ar dapal d|perlarar|ar / persa||rar d|lurda 1 r|rggu |ag|, dergar lerus ooservas| gera|ar jar|r dar
perer||saar deryul jarlurg jar|r 3 rar| |ag| (|dea|rya d||a|u|ar juga les larpa le|arar / rorslress lesl), ATAu
2. l|da| rerperlarar|ar |erar||ar |eo|r |ara |ag|, |argsurg d||arjul|ar dergar |rdu|s| persa||rar, dergar
perl|roargar |ord|s| jar|r yarg cu|up oa|| / opl|ra|.
(oaca juga |u||ar |rdu|s| persa||rar)
0|agnos|s bay| postmatur pascapersa||nan

0|agros|s oay| poslralur pascapersa||rar, dergar rerperral||ar larda-larda poslralur|las yarg dapal d|oag|
da|ar 3 slad|ur :
1. slad|ur l : |u||l larpa| |er|rg, rapur dar rudar rerge|upas (raseras|), verr||s |aseosa sargal sed|||l sarpa|
l|da| ada.
2. slad|ur ll : |eadaar |u||l seperl| slad|ur l d|serla| dergar peWarraar |u||l yarg |er|jauar o|er re|oreur yarg
oercarpur a|r |eluoar.
3. slad|ur lll : lerdapal peWarraar |e|ur|rgar pada |u|u dar |u||l jar|r serla pada jar|rgar la|| pusal.

Pada saal persa||rar, PENTlN0 d|r||a| |eadaar ca|rar |eluoar. J||a le|ar lerjad| peWarraar re|or|ur (|er|jauar)
alau oar|ar pergerla|ar dergar Warra r|jau |er|larar, oeg|lu oay| |ar|r rarus segera d||a|u|ar resus|las| a|l|l.
ldea|rya |argsurg d||a|u|ar |rluoas| dar pero||asar lra|rea.
Kemungk|nan komp||kas| pada bay| postmatur

r|po|s|a, r|povo|er|a, as|dos|s, s|rdror gaWal rapas, r|pog|||er|a, r|polurgs| adrera|.

Perdarahan da|am Hasa Keham||an
dr. handaya | dr. Noroyono w|bowo | Prof.dr.Cu|ard| h. w|knjosastro
0/T/T/h . karena peroaranan paoa us|a kenam||an muoa {oo/ aoorrus, kenam||an ekrop|k rerganggu, mo|aj aoa ku||ann,a mas|ng2, maka paoa uou| |n|
,ang |eo|n oan,ak o|oanas aoa|an PER0/R/l/h /hTEP/RTuV {oo/p|asenra prev|a, so|us|o p|asenra, peroaranan oar| sumoer |a|nj.
Yarg d|ra|sud / yarg d|oaras seoaga| perdararar da|ar rasa |erar||ar ada|ar PER0ARAlAN VELALul vA0lNA
yarg lerjad| pada rasa |erar||ar (vag|ra| o|eed|rg |r pregrarcy).
8uKAN perdararar dar| orgar / s|sler orgar |a|rrya.

Perdararar per vag|rar rerupa|ar |e|urar urur yarg oarya| d|jurpa|, dar rerupa|ar peryeoao cu|up l|rgg|
seorarg War|la dalarg |e rurar sa||l, TERuTAVA j||a d||elaru| alau d|sarg|a ada |erar||ar.

Kerar||ar yarg d|serla| perdararar yarg oer|argsurg 3 rar| alau |eo|r cerderurg oera|r|r dergar aoors| /
|egugurar.

8alas leor|l|s arlara |erar||ar ruda dar |erar||ar lua ada|ar us|a |erar||ar 22 r|rggu, rerg|rgal |erurg||rar
r|dup jar|r d| |uar ulerus. (dr.lardaya : 28 r|rggu)
PER0ARAhAN PA0A U8|A KEhAH|LAN HU0A

0|agros|s oard|rg :
1. oerracar-racar jer|s aoorlus
2. |erar||ar ro|a r|dal|dosa
3. |erar||ar e|lop|| luoa yarg ruplur.
1. perdararar a||oal seoao |a|r (lraura, eros|, |egarasar, dso)

PR|N8|P !!
PER0ARAlAN PERvA0lNAV PA0A KElAVlLAN Vu0A
1. JAN0AN LAN03uN0 0lLAKuKAN KuRETA3E ll
2. lerlu|ar du|u, jar|r ral| alau r|dup. J||a rerurg||r|ar, per||sa dergar u30
3. jargar lerpergarur perer||saar 8-lC0 yarg pos|l|l, |arera res||pur jar|r sudar ral|, 8-lC0 rurg||r ras|r
l|rgg|, o|sa oerlarar sarpa| 2 ou|ar sele|ar |eral|ar jar|r.

/oorrus, mo|a n|oar|oosa, kenam||an ekrop|k . aoa ku||an mas|ng2.
PER0ARAhAN ANTEPARTUH

Perdararar arleparlur d|oalas| pada perdararar
dar| ja|ar |ar|r sele|ar us|a |erar||ar 22 r|rggu
(res||pur palo|og| yarg sara dapal juga lerjad|
pada |erar||ar seoe|ur 22 r|rggu).
8alasar Wa|lu rerurul |epusla|aar |a|r :
oervar|as|, ada juga yarg 21, 28 r|rggu (lr|resler
|el|ga).

Perdararar yarg oeroaraya |arera cepal dar
oarya| ya|lu perdararar yarg oerasa| dar| |e|a|rar
/ gargguar pada p|aserla. Perdararar yarg ou|ar dar| p|aserla (r|sa|rya serv||s), re|al|l |eo|r l|da| oeroaraya.

PRlN3lP : pada |asus perdararar arleparlur, p|||r|ar |erurg||rar yarg |eo|r oaraya |eo|r daru|u, ya|lu
perdararar dar| p|aserla.

0|agros|s oard|rg : perdararar |arera seoao ooslelr|| alau ou|ar |arera seoao ooslelr|| (laoe|)
P|asenta prev|a

P|aserla prev|a ada|ar |eadaar |ela| p|aserla yarg aororra|, ya|lu pada segrer oaWar ulerus, ser|rgga dapal
rerulup| seoag|ar alau se|urur ja|ar |ar|r (pada |eadaar rorra|, p|aserla ler|ela| d| oag|ar lurdus alau segrer
alas ulerus).

0|sebut sebaga|
1. P|aserla prev|a lola||s : j||a se|urur
perou|aar ja|ar |ar|r lerlulup jar|rgar
p|aserla.
2. P|aserla prev|a pars|a||s : j||a seoag|ar
perou|aar ja|ar |ar|r lerlulup jar|rgar
p|aserla.
3. P|aserla prev|a rarg|ra||s : j||a lep| p|aserla oerada lepal pada lep| perou|aar ja|ar |ar|r.
1. P|aserla |ela| rerdar : j||a p|aserla ler|ela| pada segrer oaWar ulerus, lelap| l|da| sarpa| rerulup| perou|aar
ja|ar |ar|r.

Et|o|og|
El|o|og| : l|da| je|as.
0|per||ra|ar |arera adarya gargguar d|slr|ous| vas|u|ar|sas| ulerus alau alrol| des|dua r|sa|rya a||oal perdararar
persa||rar seoe|urrya.
J||a ada rassa luror d| |orpus / segrer alas ulerus (r|sa|rya, r|ora), |erurg||rar p|aserla juga a|ar
oer|rp|arlas| d| oaWar, lelap| oe|ur je|as ruourgarrya.

Ceja|a | tanda
1. perdararar per vag|rar, Warra rerar segar.
2. oag|ar leroaWar jar|r oe|ur rasu| parggu|.
3. alau ada |e|a|rar |ela| jar|r.
1. l|da| d|serla| geja|a ryer| (larda |ras p|aserla prev|a).
5. pada perer||saar ja|ar |ar|r leraoa jar|rgar p|aserla (|ura|).
. dapal d|serla| gaWal jar|r sarpa| |eral|ar jar|r, lergarlurg oeralrya.

0|agnos|s
Ararres|s : r|Wayal perdararar, l|da| ryer|, darar rerar segar.
Perer||saar l|s|s urur : |eadaar urur / larda v|la| |ou rurg||r dapal oa|| sarpa| ouru|, lergarlurg oeralrya
perdararar.
Perer||saar ooslelr|| : oag|ar leroaWar jar|r o|asarya oe|ur rasu| p|rlu alas parggu|. lrspe|u|o larpa| darar dar|
osl|ur.
Perer||saar perurjarg : |orl|rras| u30 j||a rurg||r.
Calalar : pada |ecur|gaar p|aserla prev|a, perer||saar vag|ra| loucr rarus lATl-lATl, |a|u|ar peraoaar lorr|ses,
d| |uar / lep| pors|o serv||s, dar jargar rerasu||ar jar| |e da|ar |ara||s serv||a||s. Pada peraoaar pors|o dapal
d|leru|ar oag|ar / area yarg |ura| (des|r|ps| pos|s| daerar |ura| dergar jar oerapa).
ldea|rya perer||saar |r| d||a|u|ar da|ar |eadaar 3lAP operas|. 0a|ar |eadaar s|ap operas|, urlu| rerasl||ar
d|agros|s, jar| dapal d|rasu||ar |e da|ar |ara||s, dar j||a leraoa jar|rgar |ura| / |ol||edor p|aserla, perer||saar
d|rerl||ar dar largar d||e|uar|ar, |arera lraura perer||saar lerradap jar|rgar p|aserla dapal rer|rou||ar
perdararar sargal oarya| dar cepal.

Penata|aksanaan
1. Perala|a|saraar pas|l (Jorrsor-Vacalee, 1915) : pada perdararar PERTAVA, pr|rs|prya, j||a us|a |erar||ar
oe|ur opl|ra|, |erar||ar ras|r dapal d|perlarar|ar, |arera perdararar perlara ururrya l|da| oeral dar dapal
oerrerl| dergar serd|r|rya. Pas|er rarus d|raWal dergar |sl|raral oar|rg lola| d| rurar sa||l, dergar pers|apar
lrarslus| darar dar operas| seWa|lu-Wa|lu. TETAPl j||a pada perdararar perlara |lu le|ar d||a|u|ar perer||saar
da|ar / vag|ra| loucr, |erurg||rar oesar a|ar lerjad| perdararar yarg |eo|r oeral ser|rgga rarus d|lerr|ras|.
2. P|||rar persa||rar : lergarlurg dar| |ela| / derajal p|aserla prev|a, |eadaar urur |ou, |eadaar jar|r. Pada
p|aserla prev|a lola||s / pars|a||s, seoa||rya d||a|u|ar secl|o cesarea. Pada perdararar yarg oeral dergar |eadaar
|ou dar/alau jar|r yarg ouru|, rarus juga d||a|u|ar secl|o cesarea segera.
3. J||a persa||rar yarg d|p|||r ada|ar per vag|rar, r|sa|rya pada |asus p|aserla prev|a rarg|ra||s alau p|aserla |ela|
rerdar, d||a|u|ar perecarar se|apul |eluoar (arr|olor|). 0|rarap|ar perururar jar|r a|ar dapal rere|ar
p|aserla dar rergrerl||ar perdararar. TETAPl pere|arar lerradap p|aserla juga oerarl| supres| lerradap s|r|u|as|
lelo-ralerra|, yarg j||a oer|argsurg |ara dapal reryeoao|ar |eral|ar jar|r. Tarpa|rya secl|o cesarea lelap
rerjad| a|lerral|l leroa||. Persa||rar per vag|rar rarya d||a|u|ar pada |eadaar d| rara secl|o cesarea l|da|
rurg||r d||a|u|ar, lelap dergar perararar oarWa progros|s |ese|aralar jar|r pada persa||rar per vag|rar
ada|ar ouru|.
8o|us|o p|asenta

3o|us|o p|aserla ada|ar |epasrya p|aserla (p|acerla| aorupl|or) dar| lerpal |rp|arlas|rya pada |orpus uler| seoe|ur
oay| |ar|r.
0apal lerjad| pada sel|ap saal da|ar |erar||ar.

Ter|epasrya p|aserla dapal seoag|ar (pars|a||s) alau se|ururrya (lola||s), alau rarya ruplur pada lep|rya (ruplura
s|rus rarg|ra||s).

Ceja|a | tanda
1. Perdararar per vag|rar, Warra rerar
|er|larar
2. VuN0KlN Ju0A l|da| larpa| perdararar,
|arera darar l|da| |e|uar re|a|u| osl|ur lelap|
rerurpu| d| relrop|aserla - ral|-ral| (garoar
||r|). 3e|a|r |lu, j||a ada perdararar yarg |e|uar,
jur|ar perdararar yarg larpa| ou|ar
rerupa|ar garoarar sesurggurrya jur|ar
perdararar yarg lerjad| (garoar |arar).
3. Rasa ryer| / ru|es yarg lerus-rererus,
|arera ulerus oer|orlra|s| dar legarg.
1. 0apal d|serla| gaWal jar|r sarpa| |eral|ar jar|r.

0|agnos|s
1. ararres|s : r|Wayal perdararar per vag|rar (l|da| rerggaroar|ar oeralrya so|us|o ll ral|-ral|, rurg||r juga
l|da| ada larda perdararar ll), ryer| dar ru|es lerus-rererus (rerjad| larda / |ecur|gaar uTAVA), gera|ar jar|r
d|rasa|ar oer|urarg alau rergr||arg.
2. perer||saar l|s|s : |eadaar urur dapal oa|| sarpa| ouru| (syo|), ulerus legarg lerus rererus, ryer| le|ar pada
ulerus, deryul jarlurg jar|r orad||ard|a alau rergr||arg.
3. J||a rerurg||r|ar, per||sa |orl|rras| u30 : perral||ar perdararar relrop|aserla.

Penata|aksanaan
PRlN3lP : 1) rercegar |eral|ar |ou, 2) rergrerl||ar suroer perdararar, 3) j||a jar|r ras|r r|dup,
rerperlarar|ar dar rergusara|ar jar|r |ar|r r|dup.
1. opl|ra||sas| |eadaar urur |ou : lrarslus| darar, |rlus
2. lerr|ras| |erar||ar : persa||rar segera, pervag|rar alau o||a per|u peraodor|rar (secl|o cesarea). 0|rarap|ar
dapal rerye|aral|ar ryaWa jar|r, dar, dergar |ar|rrya p|aserla, d|rarap|ar dapal rergrerl||ar perdararar.
Narur j||a d|pulus|ar secl|o cesarea, l|da| per|u rerurggu sarpa| darar lersed|a, |arera l|rda|ar leroa||
sesurggurrya ada|ar rergrerl||ar perdararar.
3. urlu| rergurarg| le|arar |rlrauler|r yarg dapal reryeoao|ar re|ros|s g|rja| (rel|e|s ulero-rera|), se|apul
|eluoar segera d|pecar|ar, res||pur oe|ur lerlu persa||rar a|ar d||a|u|ar pervag|rar.

Prognos|s
Progros|s |ou : lergarlurg dar| :
1. |uas daerar p|aserla yarg rerga|ar| so|us|o
2. jur|ar perdararar
3. derajal gargguar reroslas|s yarg lerjad|
1. ada-l|da|rya la|lor peroeral |a|r (pre-e||arps|a, |rle|s|, dar seoaga|rya), serla, lerulara,
5. Wa|lu arlara lerjad|rya so|us|o dergar perge|uarar |s| ulerus.
Progros|s oay| : lergarlurg dar| :
1. |eadaar pada saal d|lega||ar d|agros|s so|us|o : seoag|ar oesar jar|r rer|rgga| da|ar Wa|lu yarg sargal cepal.
2. j||a jar|r ras|r r|dup, lergarlurg Wa|lu arlara lerjad|rya so|us|o dergar perge|uarar / persa||rar.
3. ada l|da|rya las|||las / |erarpuar resus|las| dar peraWalar |rlers|l yarg oa|| pascapersa||rar.
Perdarahan ak|bat sebab |a|n

PRlN3lP : res||pur ada r|Wayal yarg rergarar|ar |ecur|gaar |epada |erurg||rar seoao |a|r, r|sa|rya lraura,
eros|, |egarasar, dso, lelap lARu3 d|p|||r|ar |erurg||rar adarya |e|a|rar / gargguar dar| p|aserla, |arera
rerupa|ar |erurg||rar dergar progros|s yarg lerouru| / leroeral, dar rerer|u|ar perala|a|saraar gaWaldarural
segera.

0|agros|s oard|rg : s||a|ar car| / oaca serd|r|.
Jararg d|oaras d| |u||ar.
Keham||an Ektop|k
dr. Eka Rusd|anto C.| dr. Noroyono w|bowo
0EF|N|8|

Keham||an ektop|k ada|ah keham||an yang terjad| d| |uar kavum uter|.

3er|rg d|seoul juga |erar||ar e|slrauler|r. Kurarg lepal, |arera |erar||ar pada corru uler| alau serv||s uler|
(|rlrauler|r) juga ras|r lerrasu| seoaga| |erar||ar e|lop||.
PAT0F|8|0L0C|

0vum yang te|ah d|buah| ber|mp|antas| d| tempat |a|n se|a|n d| endometr|um kavum uter|.
Pr|rs|p palol|s|o|og| : gargguar / |rlerlerers| re|ar|| lerradap ovur yarg le|ar d|ouar| da|ar perja|ararrya reruju
|avur uler|.

Kemungk|nan |mp|antas|
d| luoa Fa|op|| (pa||rg ser|rg, 90-95, dergar
Z0-80 d| arpu||a), serv||s, ovar|ur, aodorer,
dso.

lrp|arlas| palo|og|| d| d|rd|rg |urer luoa pa||rg
ser|rg, |arera luoa rerupa|ar ja|ur ulara
perja|arar ovur.
3er|rg lerjad| pada :
1. |e|a|rar luoa alau adarya r|Wayal perya||l
luoa (r|sa|rya sa|p|rg|l|s), reryeoao|ar o||us|
alau |erusa|ar s|||a luoa.
2. r|Wayal operas| luoa, sler|||sas| dso
3. r|Wayal perya||l radarg parggu| |a|rrya.
1. pergguraar lu0 yarg rercegar lerjad|rya
|rp|arlas| |rlrauler|r.
5. ovu|as| yarg ru|l|pe| a||oal |rdu|s| ooal-ooalar, usara lerl|||sas| |r v|lro, dso.

ls| |orseps| yarg oer|rp|arlas| re|a|u|ar perelras| lerradap |ar|ra propr|a dar pars rus|u|ar|s d|rd|rg luoa.
Kerusa|ar luoa |eo|r |arjul d|seoao|ar o|er perlurourar |rvas|l jar|rgar lroloo|as. Karera lroloo|as rerg|rvas|
perou|ur darar d|rd|rg luoa, lerjad| ruourgar s|r|u|as| yarg rerurg||r|ar jar|rgar |orseps| oerlurour.

Pada sualu saal, |eoulurar eror|o d| da|ar luoa l|da| dapal lerperur| |ag| o|er sup|a| darar dar| vas|u|ar|sas| luoa
|lu.
Ada oeoerapa |erurg||rar a||oal ra| |r| :
1. |erurg||rar leroerlu|rya jar|rgar ro|a oer|s| darar d| da|ar luoa, |arera a||rar darar d| se||lar cror|or
rerurpu|, reryeoao|ar d|slers| luoa, dar rerga||oal|ar ruplur |rlra|urer |arlurg geslas| d| da|ar |urer luoa.
2. |erurg||rar luoa| aoorl|or, |epas dar |e|uarrya darar dar jar|rgar |e ujurg d|sla| (l|ror|a) dar |e rorgga
aodorer.
3. |erurg||rar reaosorps| jar|rgar |orseps| o|er d|rd|rg luoa seoaga| a||oal pe|epasar dar| sup|a| darar luoa.
1. |erurg||rar ruplur d|rd|rg luoa |e da|ar rorgga per|loreur, seoaga| a||oal eros| v|||| cror|a||s alau d|slers|
oer|eo|rar luoa - |eadaar |r| yarg urur d|seoul |erar||ar e|lop|| lergarggu / |erar||ar e|lop|| dergar ruplur
luoa.
"KEhAH|LAN EKT0P|K TERCANCCU"
(Keham||an ektop|k tuba yang ruptur}

Ceja|a | tanda
1. Ada r|Wayal ler|aroal ra|d dar geja|a |erar||ar ruda.
2. A|ul aodorer, lerulara ryer| perul |arar / ||r| oaWar.
3. Perdararar per vag|rar (dapal juga l|da| ada).
1. Keadaar urur |ou dapal oa|| sarpa| ouru| / syo|, lergarlurg oeralrya perdararar yarg lerjad|.
5. Kadarg d|serla| leor|s.

0|agnos|s
1. Ararres|s : r|Wayal ler|aroal ra|d / arerorrrea, geja|a dar larda |erar||ar ruda, dapal ada alau l|da| ada
perdararar per vag|rar, ada ryer| perul |arar / ||r| oaWar.
2. Perer||saar l|s|s : |eadaar urur dar larda v|la| dapal oa|| sarpa| ouru|, ada larda a|ul aodorer. 3aal
perer||saar adre|sa dergar vag|ra| loucr, ada ryer| o||a pors|o d|gera||ar (ryer| goyarg pors|o).
3. Perer||saar perurjarg d|agrosl|| : ur|re 8-rC0 (), |u|doserles|s (d|leru|ar darar d| |avur 0oug|as|), u30.
1. 0|agros|s pasl| rarya d|lega||ar dergar |aparolor|.

0|agnos|s band|ng
lal|-ral| dergar d|agros|s oard|rg, r|sa|rya apperd|s|l|s
pada us|a |erar||ar ruda : rurg||r ada larda |erar||ar,
rurg||r juga ada larda a|ul aodorer - seoa|||rya
|erar||ar e|lop|| lergarggu oe|ur lerlu pu|a d|serla| geja|a perdararar.

Penata|aksanaan keham||an ektop|k dengan ruptur tuba
1. 0pl|ra||sas| |eadaar urur |ou, dergar lrarslus|, |rlus, o|s|ger, alau
|a|au d|cur|ga| ada |rle|s|, d|oer||ar juga arl|o|ol||a.
2. Perala|a|saraar yarg |dea| ada|ar rergrerl||ar suroer perdararar
segera dergar |aparolor| dar sa|p|rge|lor| (rerolorg oag|ar luoa
yarg lergarggu).

Prognos|s bag| keham||an ber|kutnya
ururrya peryeoao |erar||ar e|lop|| (r|sa|rya peryerp|lar luoa alau
pasca perya||l radarg parggu|) oers|lal o||alera|. 3er|rgga sele|ar
perrar rerga|ar| |erar||ar e|lop|| pada luoa salu s|s|, |erurg||rar pas|er a|ar rerga|ar| |erar||ar e|lop|| |ag|
pada luoa s|s| yarg |a|r.

KEhAH|LAN 8ERV|KAL

Kerar||ar serv||a| jararg lerjad|. Pada |rp|arlas| d| serv||s, dapal lerjad| perdararar larpa d|serla| ryer|, dar
|erurg||rar lerjad|rya aoorlus sporlar sargal oesar. J||a |erar||ar lurour sarpa| oesar, perdararar / ruplur
yarg lerjad| sargal oeral, ser|rgga ser|rg d|per|u|ar l|rda|ar r|slere|lor| lola|.

Kr|ter|a Rub|n (1911} urlu| |erar||ar serv||a| :
1. |e|erjar serv||s rarus d|leru|ar d| seoerarg lerpal |rp|arlas| p|aserla
2. lerpal |rp|arlas| p|aserla rarus oerada d| oaWar arler| uler|ra alau per|loreur v|sera|e ulerus
3. jar|r l|da| oo|er lerdapal d| daerar |orpus ulerus
1. |rp|arlas| p|aserla d| serv||s rarus |ual
Kr|ler|a Ruo|r su||l d|lerap|ar secara |||r|s |arera rerer|u|ar r|slere|lor| lola| urlu| rerasl||arrya.

Kr|ter|a k||n|s dar| Paa|man & HcE||n (1959} urlu| |erar||ar serv||a|, |eo|r dapal d|lerap|ar secara |||r|s :
1. osl|ur uler| |rlerrur lerlulup
2. osl|ur uler| e|slerrur lerou|a seoag|ar
3. ras|| |orseps| ler|ela| d| da|ar erdoserv||s
1. perdararar ulerus sele|ar lase arerorrea, larpa d|serla| ryer|
5. serv||s |ura|, reroesar, dapal |eo|r oesar dar|pada lurdus (rour-g|ass ulerus).
KEhAH|LAN 0VAR|AL

Kerar||ar ovar|a| d|lega||ar alas dasar kr|ter|a 8p|ege|berg :
1. luoa pada s|s| |erar||ar rarus rorra|
2. |arlurg jar|r rarus ler|ela| da|ar ovar|ur
3. |arlurg jar|r d|ruourg|ar dergar ulerus o|er ||garerlur ovar|| propr|ur
1. jar|rgar ovar|ur yarg ryala rarus d|leru|ar da|ar d|rd|rg |arlurg jar|r

Pada |eryalaarrya |r|ler|a |r| su||l d|perur|, |arera ururrya le|ar lerjad| |erusa|ar jar|rgar ovar|ur, perlurourar
lroloo|as yarg |uas, dar perdararar reryeoao|ar lopogral| |aour, ser|rgga pergera|ar |rp|arlas| perru|aar ovur
su|ar d|lerlu|ar secara pasl|.
KEhAH|LAN EKT0P|K 0| TEHPAT LA|N

Kerar||ar |rlra||garerler, |erar||ar aodor|ra|, dso, j||a lerlar||, |rg|r laru dela||, rarap car| / oaca serd|r|.
Jararg d|oaras d| |u||ar....
0|stos|a
dr. h. Yun|zaf | dr. handaya
PEN0AhULUAN

Persa||nan norma|
3ualu |eadaar l|s|o|og|s, rorra| dapal oer|argsurg serd|r| larpa |rlervers| pero|org.

Ke|ancaran persa||nan tergantung 3 faktor P utama
Ke|ualar |ou (poWer), |eadaar ja|ar |ar|r (passage) dar |eadaar jar|r (passarger).
( la|lor2 P |a|rrya : psycro|ogy, prys|c|ar, pos|l|or)
0ergar adarya |ese|roargar / |esesua|ar arlara la|lor-la|lor P lerseoul, persa||rar rorra| d|rarap|ar dapal
oer|argsurg.
8||a ada gargguar pada salu alau |eo|r la|lor P |r|, dapal lerjad| |e|aroalar alau gargguar pada ja|arrya
persa||rar.

Ke|aroalar alau |esu||lar persa||rar |r| d|seoul 0|8T08|A.

0|slos|a oerpergarur ouru| oag| |ou raupur jar|r.
Pergera|ar d|r| dar perargarar lepal a|ar rererlu|ar progros|s |ou dar jar|r.
0|8T08|A AK|AT KELA|NAN KEKUATAN |U (KELA|NAN h|8}

Tarda r|s rorra| :
- lurda| dor|rar
- s|relr|s
- ra||r |ara, ra||r |ual, ra||r
ser|rg
- re|a|sas| oa||.

8||a salu alau |eo|r larda lerseoul
l|da| d|jurpa| alau l|da| sesua|,
|eadaar lerseoul d|seoul gargguar
/ |e|a|rar r|s alau |rers|a uler|.

Samoar . akr|l|ras urerus norma|
paoa kenam||an, persa||nan {n|sj oan
n|las.

Ke|a|rar r|s dapal oerupa |rers|a
uler| r|polor|| alau |rers|a uler|
r|perlor||.
|ners|a uter| h|poton|k

Ada|ar |e|a|rar r|s dergar
|e|ualar yarg |erar / l|da| ade|ual urlu| re|a|u|ar perou|aar serv||s alau rerdororg ara| |e|uar.

0| s|r| |e|ualar r|s |erar dar lre|uers|rya jararg.
3er|rg d|jurpa| pada perder|la dergar |eadaar urur |urarg oa|| seperl| arer|a, ulerus yarg ler|a|u leregarg
r|sa|rya a||oal r|drarr|or alau |erar||ar |eroar alau ra|rosor|a, grarderu|l|para alau pr|r|para, serla pada
perder|la dergar |eadaar eros| |urarg oa||.

0apal lerjad| pada |a|a perou|aar serv||s, lase |al|r alau lase a|l|l, raupur pada |a|a perge|uarar.

|ners|a uter| pr|mer : lerjad| pada perru|aar lase |aler. 3eja| aWa| le|ar lerjad| r|s yarg l|da| ade|ual, ser|rgga
ser|rg su||l urlu| rerasl||ar apa|ar perder|la le|ar rerasu|| |eadaar |r parlu alau oe|ur.

|ners|a uter| sekunder : lerjad| pada lase a|l|l |a|a l alau |a|a ll. Perru|aar r|s oa||, |erud|ar pada |eadaar
se|arjulrya lerdapal gargguar / |e|a|rar.

Penanganan :
1. Keadaar urur perder|la rarus d|peroa|||. 0|z| se|ara |erar||ar rarus d|perral||ar.
2. Perder|la d|pers|ap|ar rergradap| persa||rar, dar d|je|as|ar lerlarg |erurg||rar-|erurg||rar yarg ada.
3. Pada |rers|a pr|rer, sele|ar d|pasl||ar perder|la rasu| da|ar persa||rar, eva|uas| |erajuar persa||rar 12 jar
|erud|ar dergar per||sa da|ar. J||a perou|aar |urarg dar| 3 cr, pors|o leoa| |eo|r dar| 1 cr, perder|la
d||sl|raral|ar, d|oer||ar sedal|va ser|rgga dapal l|dur. Vurg||r ras|r da|ar la|se |aoor. J||a sele|ar 12 jar
oer||ulrya lelap ada r|s larpa ada |erajuar persa||rar, |eluoar d|pecar|ar dar r|s d|peroa||| dergar |rlus p|los|r.
Per|u d||rgal oarWa persa||rar rarus d|se|esa||ar da|ar Wa|lu 21 jar sele|ar |eluoar pecar, agar progros|s jar|r
lelap oa||.
1. Pada |rers|a uler| se|urder, da|ar lase a|l|l, rarus segera d||a|u|ar :
a. per||a|ar cerral apa|ar ada d|spropors| sela|ope|v|| dergar pe|v|relr| |||r|| alau rad|o|og|. 8||a ada CP0 ra|a
persa||rar segera d|a|r|r| dergar secl|o cesarea.
o. o||a l|da| ada CP0, |eluoar d|pecar|ar dar d|oer| p|loc|r |rlus.
c. r||a| |erajuar persa||rar |eroa|| 2 jar sele|ar r|s oa||. 8||a l|da| ada |erajuar, persa||rar d|a|r|r| dergar secl|o
cesarea.
d. pada a|r|r |a|a l alau pada |a|a ll o||a syaral e|slra|s| va|ur alau curar d|perur|, ra|a persa||rar dapal segera
d|a|r|r| dergar oarluar a|al lerseoul.

Per|u d||rgal oarWa rarp|r 50 |e|a|rar r|s pada lase a|l|l d|seoao|ar alau d|ruourg|ar dergar adarya CP0,
s|sarya oaru d|seoao|ar la|lor |a|r seperl| a||oal |e|a|rar pos|s| jar|r, peroer|ar ooal sedal|va alau re|a|sar
lerradap olol ulerus, dar seoaga|rya.
|ners|a uter| h|perton|k

Ada|ar |e|a|rar r|s dergar |e|ualar cu|up oesar (|adarg sarpa| re|eo|r| rorra|) rarur l|da| ada |oord|ras|
|orlra|s| dar| oag|ar alas, lergar dar oaWar ulerus, ser|rgga l|da| el|s|er urlu| rerou|a serv||s dar rerdororg
oay| |e|uar. 0|seoul juga seoaga| |rcoord|rale uler|re acl|or. Corlor r|sa|rya lelar|a uler| |arera ooal ulerolor||a
yarg oer|eo|rar.

Pas|er rerasa |esa||lar |arera r|s yarg |ual dar oer|argsurg rarp|r lerus-rererus. Pada jar|r dapal lerjad|
r|po|s|a jar|r |arera gargguar s|r|u|as| ulerop|aserler.

Fa|lor yarg dapal reryeoao|ar |e|a|rar |r| arlara |a|r ada|ar rargsargar pada ulerus, r|sa|rya peroer|ar
o|s|los|r yarg oer|eo|rar, |eluoar pecar |ara dergar d|serla| |rle|s|, dar seoaga|rya.

Penanganan : peroer|ar sedal|va dar ooal yarg oers|lal lo|o||l|| (rere|ar |orlra|s| ulerus) agar |orlra|s| ulerus
lerseoul r||arg dar d|rarap|ar |erud|ar l|rou| r|s rorra|. 0eryul jarlurg jar|r lARu3 lerus d|eva|uas|.

8||a dergar cara lerseoul l|da| oerras||, persa||rar rarus d|a|r|r| dergar secl|o cesarea.
0|8T08|A AK|AT KELA|NAN JALAN LAh|R

0|slos|a |arera |e|a|rar ja|ar |ar|r dapal d|seoao|ar adarya |e|a|rar pada jar|rgar |eras / lu|arg parggu|, alau
|e|a|rar pada jar|rgar |ura| parggu|.
Ke|a|nan tu|ang panggu|

0apat berupa :
1. Ke|a|nan bentuk panggu| yarg l|da| rorra| gyreco|d, r|sa|rya parggu| jer|s Naege|e, Racr|l|s, 3co||os|s,
Kypros|s, Rooerl dar |a|r-|a|r.
2. Ke|a|nan ukuran panggu|. 8erlu| parggu| War|la yarg pa||rg |dea| urlu| persa||rar ada|ar oerlu| gyreco|d
(||as|l||as| Ca|dWe|| - Vo|oy). var|as| oerlu| |a|r ya|lu oerlu| ardro|d, arlropo|d, p|al|pe|o|d (||ral juga |u||ar parggu|).

Ukuran rata-rata panggu|
wan|ta norma|
P|rlu alas parggu| (pe|v|c
|r|el) :
0|areler lrarsversa (0T)
13.5 cr. Corjugala vera
(Cv) 12.0 cr. Jur|ar
rala-rala |edua d|areler
r|r|ra| 22.0 cr.
P|rlu lergar parggu| (r|d
pe|v|s) :
0|slars|a |rlersp|rarur (0l) 10.5 cr. 0|areler arler|or posler|or (AP) 11.0 cr. Jur|ar rala-rala |edua d|areler
r|r|ra| 20.0 cr.
P|rlu oaWar parggu| (pe|v|c oul|el) :
0|areler arler|or posler|or (AP) Z.5 cr. 0|slars|a |rlerluoerosur 10.5 cr. Jur|ar rala-rala |edua d|areler
r|r|ra| 1.0 cr.


Kemacetan persa||nan pa||rg ser|rg lerjad| pada p|rlu alas parggu| (l-
l) alau p|rlu lergar parggu| (sarpa| l-lll).

Ke|a|rar oerlu| alau u|urar parggu| dapal d||elaru| dar| ararres|s
dar perer||saar yarg oa||.
Ararres|s per|u d|larya|ar r|Wayal perya||l daru|u, ada/l|da| perya||l
racr|l|s, palar lu|arg parggu|, cox|l|s dar seoaga|rya. Pe|v|relr| |||r||
alau rad|o|og|| rarus dapal rererlu|ar per||raar oerlu| dar u|urar
parggu| dergar oa||.
Pada |eadaar parggu| palo|og||, ara| dergar oeral jar|r d| alas 2500
grar a|ar su||l d||ar|r|ar. urlu| |lu d|perl|roarg|ar secl|o cesarea.

Norra| oeral ara| yarg d||ar|r|ar seorarg |ou ada|ar arlara 2500 - 1000 grar.
8ay| dergar oeral oadar |ar|r |eo|r dar| 1000 g d|seoul ra|rosor|a.
8ay| dergar oeral oadar |ar|r |urarg dar| 2500 g d|seoul oay| oeral |ar|r rerdar
(oeda|ar dergar preralur|las ll 88LR oe|ur lerlu preralur)

Ukuran umum | t|dak baku terhadap pembag|an berat badan bay| norma| :
arlara 3500 - 1000 g d|go|org|ar oay| oesar, arlara 3000 - 3500 g lerrasu| sedarg dar arlara 2500 - 3000 g
lergo|org |ec||. 0ergar der|||ar parggu| d|seoul |uas o||a parggu| lerseoul dapal d||eWal| o|er ara| yarg oeralrya
rala-rala 3500 - 1000 g, sedarg o||a dapal d||eWal| ara| 3000 - 3500 g, serp|l o||a dapal d||eWal| ara| sarpa| 2500 -
3000 g.

(hAT|-hAT| : 8a|ah kaprah tap| ser|ng d|gunakan da|am k||n|k !!}
Ya|lu rererlu|ar per||raar |roarg lelo-pe|v|| dergar oerdasar|ar r||a| la|s|rar oeral jar|r (T8J).
Cara |r| ser|rg d|gura|ar, |arera rerarg d|areler leroesar
|epa|a jar|r yarg PA3Tl rarya dapal d|per||sa dergar u30
padara| ser|rg l|da| lerdapal u30 d| |||r|| / pus|esras.

Kapas|tas p|ntu atas panggu| (pe|v|c |n|et capac|ty, |6} dan p|ntu tengah panggu| (m|dpe|v|c capac|ty, H6}
dapat d|h|tung dengan rumus :
V|sa|rya sele|ar d|per||sa dar d|r|lurg dergar rurus, X = 95 dar Y = 80. lrlerprelas|rya ada|ar |apas|las |r|el
parggu| d|r|lurg da|ar grar ada|ar 95 x 1000 g = 3800 g, dar |apas|las r|dpe|v|s ada|ar 80 x 1000 g = 3200 g.
Va|a |apas|las ler|ec|| parggu| |lu ada|ar 3200 g, |arera j||a |eo|r dar| |lu oay| l|da| a|ar dapal re|eWal| r|dpe|v|s.
N||a| |r| d|seoul seoaga| 0AYA AK0H00A8| PANCCUL (0AP}.

0aya akomodas| panggu|
Kerarpuar sualu parggu| urlu| dapal d||eWal| o|er ara| leroesar, r||a|rya sara dergar |apas|las ler|ec|| o|darg
parggu| lerseoul.

8erlu| dar u|urar parggu| pada War|la deWasa ururrya lelap seurur r|dup, |ecua|| j||a ada pergarur lraura,
|rle|s| parggu|, alau luror. 8eg|lu pu|a daya a|orodas| parggu| War|la lerseoul a|ar lelap. 3er|rgga j||a ada
r|Wayal perer||saar parggu| dergar rad|o|og| (Roerlger, CT scar alau u|lrasorogral|), j||a l|da| ada |ecur|gaar
yarg rerurg||r|ar lerjad| peruoarar lerseoul, perer||saar l|da| per|u d|u|arg| |ag|.

Ke|a|rar oerlu| parggu| (parggu| aororra| / palo|og||) : |argsurg secl|o cesarea ll
Ke|a|rar u|urar parggu| dergar oerlu| rorra| : parlus percooaar.
Pada sel|ap |erar||ar alau persa||rar yarg d|a|ar| seorarg War|la, yarg dapal oeruoar ada|ar oeral oadar jar|r.
8esar alau oeral jar|r |r| dapal d|lerlu|ar dergar pergaralar oerdasar|ar perga|arar alau dergar a|al
u|lrasorogral|. Kesa|arar perals|rar oeral ara| yarg pa||rg oesar seoa||rya l|da| re|eo|r| 10 oeral ara| yarg
sesurggurrya.
Pada |ecur|gaar / suspe| CP0, dapal d||a|u|ar parlus percooaar pervag|rar, dergar calalar |es|apar sarara
urlu| secl|o cesarea c|lo rarus ada.
Partus percobaan

Ada|ar sualu parlus l|s|o|og|s yarg d||a|u|ar pada |erar||ar alerr, ara| preserlas| oe|a|arg |epa|a dergar suspe|
d|spropors| sela|ope|v|| (CP0).

Tujuan l|rda|ar parlus percooaar ada|ar rerasl||ar ada l|da|rya CP0.

0|ru|a| saal perder|la d|ryala|ar |r parlu, dergar per||a|ar |erajuar persa||rar d|ru|a| sele|ar persa||rar rasu|
lase a|l|l. Per||a|ar d||a|u|ar sel|ap 2 jar.

Yang d|n||a| da|am partus percobaan :
- |erajuar perou|aar serv||s
- lururrya |epa|a
- pularar pa|s| da|ar (rerularrya uour-uour |ec|| |e depar)

8||a pada sel|ap per||a|ar per 2 jar lerseoul lerdapal peruoarar yarg oerra|ra |orporer yarg d|r||a| |lu, ra|a
parlus percooaar d||ala|ar ada |erajuar dar d|lerus|ar.
8||a dar| 3 |orporer lerseoul l|da| ada |erajuar yarg oerra|ra, ra|a parlus percooaar d||ala|ar gaga|,
d|pasl||ar ada CP0 dar persa||rar d|a|r|r| dergar secl|o cesarea.

Partus percobaan harus d|hent|kan dan d||anjutkan dengan sect|o cesarea segera j|ka :
- ada larda-larda r|po|s|a / asl||s|a jar|r
- ada larda-larda ruplura uler| reroa|al

Partus percobaan d|katakan berhas|| j|ka ukuran terbesar kepa|a jan|n te|ah me|ewat| b|dang panggu| yang
d|n||a| | d|cur|ga|, m|sa|nya :
1. |||r|s d|per||ra|ar |epa|a le|ar re|eWal| p|rlu alas parggu|, j||a oag|ar lererdar lu|arg |epa|a (ou|ar rou|age
alau |apul oesar) le|ar re|eWal| o|darg lodge lll (l-lll).
2. |||r|s d|per||ra|ar |epa|a le|ar re|eWal| p|rlu lergar parggu|, j||a oag|ar lererdar lu|arg |epa|a (ou|ar rou|age
alau |apul oesar) le|ar re|eWal| lodge lv (l-lv).

3esudar parlus percooaar d|ryala|ar oerras||, persa||rar dapal d|se|esa||ar sporlar alau dergar a|al oarlu curar
alau va|ur.

PR|N8|P !!
Tl0AK A0A |rd||as| parlus percooaar pada preserlas| |a|r se|a|r preserlas| oe|a|arg |epa|a. J||a ada suspe| CP0
pada preserlas| |a|r, persa||rar d|a|r|r| dergar secl|o cesarea.
{or.lanoa,a . nar|-nar|, ,ang oeru| parrus percooaan, oukan cooa-cooa parrus ||j
Ke|a|nan jar|ngan |unak urogen|ta|

T|da| jararg d|slos|a d|seoao|ar adarya |e|a|rar dar| jar|rgar |ura| uroger|la|. Keadaar yarg ser|rg d|jurpa| ada|ar
d|slos|a yarg d|seoao|ar o|er luror ovar|ur yarg rerg|s| ja|ar |ar|r. 3e|a|r d|slos|a, j||a persa||rar d|pa|sa|ar
pervag|rar |erurg||rar juga lerjad| pecarrya luror lerseoul.
Keadaar |a|r yarg juga dapal reryeoao|ar d|slos|a ada|ar |e|a|rar ulerus, |e|a|rar serv||s, seplur vag|ra dar
adarya edera vu|va.
Per||a|ar orgar-orgar |r| da|ar persa||rar rerda|rya d||a|u|ar dergar se|sara, ser|rgga |eadaar |erurg||rar
adarya d|slos|a a||oal |e|a|rar orgar |r| dapal segera d|alas|.
ururrya pada d|slos|a a||oal |e|a|rar jar|rgar |ura|, ara| d||ar|r|ar dergar secl|o cesarea.
0|8T08|A KARENA KELA|NAN ENTUK, UKURAN, LETAK | PRE8ENTA8| JAN|N

T|da| lerjad| pularar pa|s| da|ar

0a|ar persa||rar rorra|, |epa|a rerasu|| p|rlu alas parggu| dergar sulura sag|la||s da|ar |eadaar re||rlarg alau
oo|||, ser|rgga uour-uour |ec|| oerada d| |arar alau d| ||r| ||rlarg, alau d| |arar alau ||r| oe|a|arg. 3ele|ar |epa|a
rerasu|| o|darg lergar parggu| (lodge lll), |epa|a a|ar rerular |e depar a||oal leroerlur sp|ra |s||ad||a
ser|rgga uour-uour |ec|| oerada d| depar (pularar pa|s| da|ar).

Telap| |adarg l|da| lerjad| pularar, ser|rgga uour-uour |ec|| lelap oerada d| oe|a|arg alau re||rlarg. Keadaar |r|
d|seoul deep transverse arrest, occ|put transverse pers|stent alau occ|put poster|or pers|sten. Kedua |eadaar
|r| a|ar rerper|aroal alau dapal rerpersu||l ja|arrya persa||rar.
0eep transverse arrest
Peryeoao |edua |eadaar lerseoul ser|rg d|ruourg|ar dergar adarya ke|a|nan da|am bentuk dan ukuran panggu|
seperl| pada parggu| arlropo|d d| rara d|areler arler|or-posler|or |eo|r parjarg dar| d|areler lrarsversa. Parggu|
ardro|d dergar oerlu| aga| |orverger dar| d|rd|rg sarp|rg dar sa|rur yarg |or|al rerupa|ar pred|spos|s|
lerjad|rya o|s|pul posler|or pers|slers. 8eg|lu pu|a pada parggu| p|al|pe|o|d dergar sa|rur yarg |or|al.

Cara rererlu|ar o|s|pul re||rlarg ada|ar dergar perer||saar da|ar, d| rara d|raoa sulura sag|la||s re||rlarg
dergar uour-uour |ec|| d| ||r| alau |arar. Pada o|s|pul posler|or, leraoa uour-uour |ec|| d| ||r| alau |arar oe|a|arg.
Pada |eadaar |r| 3uLlT d|rara||ar |eoerras||ar ja|arrya persa||rar. Kerurg||rar |esu||lar se|a|u ada. 3||ap
rerurggu ada|ar yarg pa||rg o|ja|sara.

Jones 199 : pada 5 |asus lerjad| persa||rar sporlar dergar uour-uour |ec|| rerular |e depar |eo|r daru|u.
3edarg|ar 8 parlus sporlar pervag|rar dapal lerjad| dergar uour-uour |ec|| lelap d| oe|a|arg, sererlara
s|ssarya d||ar|r|ar dergar e|slra|s| lorcep, e|slra|s| va|ur alau secl|o cesarea.

Ke|a|rar preserlas| |a|r yarg dapal reryeoao|ar
d|slos|a : presentas| muka dan dah|.

Penyebab ke|a|nan pos|s| kepa|a jan|n da|am ja|an
|ah|r :
- CP0 - grarde ru|l|para
- r|drarr|or - oay| |ec|| pada parggu| |uas
- ||||lar la|| pusal pada |erer - arersela||
- p|acerla prev|a
Presentas| muka dan presentas| dah|
0|agnos|s presentas| muka : perer||saar da|ar leraoa rala, r|durg, ru|ul dar dagu.
0|agnos|s presentas| dah| : leraoa uour-uour oesar, dar|, rala, |adarg r|durg.
Presentas| dah|
Turggu, |arera 2/3 a|ar oeruoar rerjad| preserlas| ru|a alau o|s|pul. J||a jar|r oesar alau l|da| ada peruoarar
preserlas|, |epulusar leroa|| ada|ar secl|o cesarea.
Tl0AK d|arjur|ar usara rerguoar pos|s| |epa|a, |arera r|s||o lerjad| pro|aps la|| pusal.

Presentas| muka
8||a dagu oerada d| depar, persa||rar pervag|rar sporlar progros|s |eo|r oesar. 8||a dagu oerada d| oe|a|arg, s||ap
rerurggu dagu oerpular |e depar. 8||a dagu lelap d| oe|a|arg dar l|da| ada perpularar, persa||rar pervag|rar
l|da| rurg||r |arera lerjad| del|e|s| |epa|a yarg ra|s|ra|, rarus d||a|u|ar secl|o cesarea.
J||a lururrya oag|ar lererdar |epa|a |urarg |arcar, alau |erajuar perou|aar serv||s |aroal, secl|o cesarea juga
rarus d||a|u|ar.
0|stos|a bahu

Kadarg-|adarg pada persa||rar dergar uour-uour |ec|| d| depar, lerjad| |esu||lar re|ar|r|ar oaru jar|r. 3er|rg
lerjad| juga pada oay| yarg oesar (|eo|r dar| 1000 g).
T|rda|ar : wood-screW raruever, o||a l|da| oerras|| d||a|u|ar peralarar ||av||u|a jar|r.
Arjurar : j||a pada perer||saar ada |ecur|gaar jar|r oesar, perl|roargar secl|o cesarea a|ar |eo|r oa||.
Letak ||ntang

Lela| ||rlarg ada|ar preserlas| jar|r yarg l|da| oa|| sara se|a||.
Persa||rar pervag|rar Tl0AK VuN0KlN, |ecua|| pada |eadaar jar|r
sargal |ec||, alau le|ar ral| cu|up |ara.

Peryeoao |ela| ||rlarg :
- p|aserla prev|a - |erar||ar ru|l|pe|
- preralur|las - parggu| serp|l
- perdu|ur d|rd|rg aodorer - r|drarr|or
- ru|l|par|las -|e|a|rar ulerus alau jar|r |a|rrya

0|agros|s :
1. perer||saar |uar (pa|pas| Leopo|d) d|raoa |epa|a d| |arar alau d| ||r|
perul |ou
2. oury| jarlurg oerada d| se||lar pusar
3. lurdus uler| lerradap us|a geslas| |eo|r rerdar dar|pada |ela| rerarjarg
1. perer||saar da|ar rurg||r dapal d|raoa |ergar, oaru alau |ga jar|r
5. lerlu|ar oerdasar|ar |ela| purggurg : dorsosuper|or alau dorso|rler|or, dorsoarler|or alau dorsoposler|or.

8||a jar|r da|ar |eadaar r|dup, segera d||a|u|ar perga|r|rar persa||rar dergar secl|o cesarea.
8||a jar|r le|ar ral| dar syaral-syaral eror|olor| lerperur|, |a|u|ar eror|olor|. J||a eror|olor| l|da| rurg||r
d||erja|ar, |a|u|ar secl|o cesarea.

Kore|s| |ela| ||rlarg rerjad| rerarjarg dergar vers| |uar ras|r dapal d|cooa d||a|u|ar o||a :
- persa||rar ras|r da|ar lase |aler
- se|apul |eluoar ras|r ulur
- oag|ar leroaWar jar|r oe|ur rasu| p|rlu alas parggu|
- ara| da|ar |eadaar oa||
- |ou da|ar |eadaar oa||

T|rda|ar vers| e|slra|s| pada |ela| ||rlarg rarya oo|er d||a|u|ar :
- ara| |edua |erar||ar |eroar
- se|apul |eluoar oaru pecar alau
d|pecar|ar
Letak sungsang

Lela| surgsarg ser|rg d|leru|ar da|ar
persa||rar.
Peryeoao :
- preralur|las
- p|aserla prev|a
- r|drarr|or
- r|ora uler|
- |erar||ar ru|l|pe|
- r|drosela|us / arersela|us
0|agros|s |ela| surgsarg :
1. perer||saar |uar, jar|r |ela| rerarjarg, |epa|a d| daerar lurdus uler|
2. perer||saar da|ar, leraoa oo|org saja, alau oo|org dergar salu alau dua |a||.

Lela| surgsarg ser|rg d||ar|r|ar dergar cara :
- p|rp|rar rererar dergar oarluar alau rarua| a|d
- e|slra|s|

3yaral parlus pervag|rar pada |ela| surgsarg :
- jar|r l|da| ler|a|u oesar
- l|da| ada suspe| CP0
- l|da| ada |e|a|rar ja|ar |ar|r
J||a oeral jar|r 3500 g alau |eo|r, lerulara pada pr|r|grav|da alau ru|l|para dergar r|Wayal re|ar|r|ar |urarg dar|
3500 g, secl|o cesarea |eo|r d|arjur|ar.

3yaral p|rp|rar rererar |a|a ll pada |ela| surgsarg :
1. perou|aar |erg|ap
2. oo|org ler|ela| d| lodge lll alau |eo|r
3. |eluoar d|lurggu pecar serd|r|, alau d|pecar|ar o||a perou|aar |erg|ap
1. ral|-ral| pro|aps la|| pusal
5. ral|-ral| allercor|rg read.
Varua| a|d d||a|u|ar pada saal oadar ara| le|ar |e|uar dar |ou yarg sedarg d|p|rp|r rererar, d| rara d|oulur|ar
oarluar urlu| rerpercepal dar rerperrudar lase perge|uarar oay|. Vas|r d|arggap oarluar l|s|o|og|s, ror-
|rvas|l, ser|rgga pergarurrya lerradap |eseralar jar|r l|da| oerra|ra, o||a d||erja|ar dergar cerral.

Vacar-racar le|r|| rarua| a|d (8ACA 3EN0lRl) : cara 8racrl, cara 8urrs-Varsra||, cara Vue||er, cara Loevsel,
cara Vaur|ceau.
Ta|| pusat pendek atau me||||t d| |eher jan|n

Pada perururar oay| yarg l|da| raju sarase|a|| cu|up |ara, per|u
d|cur|ga| la|| pusal perde| alau adarya ||||lar la|| pusal. J||a ada,
|orl|rras| u30.
Jargar d|pa|sa|ar persa||rar pervag|rar. Perl|roarg|ar secl|o
cesarea.
J||a ||||lar la|| pusal oaru d|leru|ar sele|ar |epa|a oay| |ar|r,
d||epas|ar du|u dergar d||erdor|ar, alau |a|au ||||lar eral, dergar ral|-ral| d|jep|l dar d|polorg de|al |erer oay|, oaru
|erud|ar persa||rar oay| d||arjul|ar.
Pos|s| mengunc| (|ock|ng} pada persa||nan bay|
kembar

0apal lerjad| o||a oay| perlara |ela| surgsarg dar oay| |edua |ela|
|epa|a. Verupa|ar |eadaar gaWal darural yarg dapal
reryeoao|ar |eral|ar jar|r.
0|usara|ar urlu| rerdororg |epa|a oay| |edua urlu| reroer|
ja|ar pada oay| perlara. Narur r|s||o lraura persa||rar pada
|eadaar |r| sargal l|rgg|.
3er|rgga, j||a d|pero|er d|agros|s aWa| |erar||ar |eroar dergar
oay| perlara |ela| surgsarg, d|arjur|ar perl|roargar urlu| secl|o
cesarea pr|rer.
Ke|a|nan anatom|k jan|n

Terulara ser|rg d|seoao|ar o|er h|drosefa|us.
Ke|a|rar jar|r |a|rrya yarg rurg||r reryeoao|ar d|slos|a :
1. tumor abdomen
2. asc|tes

0|agros|s r|drosela|us :
1. perer||saar |uar, |epa|a leraoa d| alas s|rl|s|s, |eo|r rerorjo| |arera u|urar |epa|a |eo|r oesar dar|pada rorra|,
ser|rgga |epa|a l|da| o|sa rasu| |e p|rlu alas parggu|.
2. perer||saar da|ar, |epa|a ras|r d| alas p|rlu alas parggu|, sulura-sulura re|eoar.
3. d|agros|s pasl| u30 alau Roerlger.

Perge|uarar jar|r r|drosela|us :
1. pa||rg |dea| dergar secl|o cesarea
2. j||a surv|va| progros|s jar|r sargal |ec||, alau jar|r sudar ral|, d|cooa urlu| rergurarg| vo|ure |epa|a dergar
pur|s| dar asp|ras| ca|rar |||uor sereorosp|ra||s re|a|u| sulura alau lorlare|.

3ele|ar ara| |ar|r r|dup, pada us|a oeoerapa rar| dapal d||a|u|ar operas| srurl verlr||u|o-per|lorea| alau verlr||u|o-
jugu|ar (vP srurl). 0|oual sa|urar arlara verlr||e| ola| dar vera jugu|ar|s, alau arlara verlr||e| ola| dar rorgga
per|loreur, ser|rgga ca|rar sereora| yarg oer|eo|rar rer||||| dra|rase laroarar dar l|da| rere|ar jar|rgar ola|.

Pada luror aodorer alau asc|les, pa||rg |dea| seoa||rya persa||rar d|se|esa||ar dergar secl|o cesarea.
Persa||nan 8ungsang
dr. Nugroho Kampono | dr. 0mo A. Hadj|d
CAHARAN UHUH

Pada |erar||ar sele|ar 3Z r|rggu, d|dapal|ar 5-Z |ela| surgsarg / preserlas| oo|org.
Pada |erar||ar lr|resler |e 2 (21-21 r|rggu) 33
Pada aWa| lr|resler |e 3 (29-32 r|rggu) 11
Vorla||las per|rala| : |eral|ar per|rala| 13 |a|| |eo|r l|rgg| dar|pada |eral|ar per|rala| pada preserlas| |epa|a.
Voro|d|las per|rala| : 5-Z |a|| |eo|r l|rgg| dar|pada preserlas| |epa|a.
0aroarar |r| d|pergarur| us|a |erar||ar, oeral jar|r dar jer|s preserlas| oo|org.

3eoao ulara |eral|ar per|rala| pada preserlas| oo|org : r|po|s|a, lraura persa||rar, preralur|las dar |e|a|rar
|orger|la|.
Ke|a|rar |orger|la| lerdapal -18 pada preserlas| oo|org, d|oard|rg|ar 2-3 pada preserlas| |epa|a.
ET|0L0C|

Valerra| : |e|a|rar ulerus (seplur, ulerus ur||orr|s), luror g|re|o|og|| (r|ora uler|, luror adre|sa)
Fela| : |e|a|rar ca|rar |eluoar (po||/o||gor|drarr|or), |e|a|rar lelus (arersela|us, r|drosela|us, |e|a|rar
reurorus|u|ar seperl| d|slrol|a r|olor||)
Vers| spontan
Preserlas| oo|org yarg d|jurpa| pada 29-32 r|rggu, Z5 rerga|ar| vers| sporlar pada |erar||ar 38 r|rggu.
Pada |ear||ar 3Z r|rggu, vers| sporlar seoesar 18.
Pos|s| |ree-cresl |ou se|ara 15 rer|l l|ap 2 jar se|ara 5 rar| oerlurul-lurul, d|rarap|ar dapal rerperoesar
|erurg||rar lerjad|rya vers| sporlar pada lr|resler 3 a|r|r.
JEN|8 PRE8ENTA8| 0K0NC

1. Presentas| bokong sempurna
(comp|ete breech}. Felus oerada da|ar
pos|s| dudu| da|ar ja|ar |ar|r lelap|
oo|org ras|r rerupa|ar preserl|rg
parl. 3e|urur arggola gera| jar|r l|e|s|
serpurra (lurg|a| dar |ulul l|e|s|).
2. Presentas| bokong murn| (frank
breech}. 8ag|ar leroaWar (preserl|rg parl) dar| lelus ada|ar oo|org, |edua lurg|a| da|ar l|e|s| dar sejajar lora|s
(|ulul e|slers|).
3. Presentas| kak| (foot||nk breech | |ncomp|ete breech}. 3a|ar salu alau |edua |a|| |eo|r |rler|or d|oard|rg|ar
dergar oo|org dar a|ar rerjad| oag|ar perlara yarg |ar|r.
JEN|8 P|HP|NAN PER8AL|NAN 8UNC8ANC

P|||han pertama : persa||nan pervag|nam

a. Persa||nan spontan. Jar|r d||ar|r|ar dergar |e|ualar dar leraga |ou serd|r|. Cara |r| |az|r d|seoul cara 8racrl.
b. Hanua| a|d atau ekstraks| bokong pars|a|. 3ele|ar oo|org |ar|r sporlar seoalas uro||||us, |ergar dar |epa|a
d|rar|pu|as| urlu| re|ar|r|ar oay|. Pergguraar curar urlu| re|ar|r|ar |epa|a lerrasu| |r|ler|a |r|.
c. Ekstraks| bokong. Jar|r d||ar|r|ar seulurrya dergar rera|a| leraga pero|org.

R|s|ko : kepa|a terjebak (head entrapment} pada aftercom|ng head a||oal l|da| lerjad|rya rou|age |epa|a, alau
perou|aar serv||s yarg l|da| |erg|ap. Per|sl|Wa |r| lerjad| pada 88/1000 persa||rar. R|s||o |r| dapal d||urarg|
dergar rerperlarar|ar l|e|s| dergar rere|ar suprapuo|| e|slerra| dar l|da| re|a|u|ar e|slra|s|.

Peryeoao ulara |eral|ar per|rala| larpa |e|a|rar |orger|la| : rooe|ar lerlor|ur cereoe||| a||oal lra|s| pada
r|pere|slers| |epa|a, lraura pada redu||a sp|ra||s. l|pere|slers| |epa|a pada persa||rar preserlas| oo|org,
reryeoao|ar sudul arlara gerarar dar verleora |eo|r dar| 105 derajal. Pro|apsus la|| pusal juga lerjad| pada 0.5
persa||rar dergar preserlas| oo|org rurr|; oo|org serpurra 1-5; |a|| 10.

l|slerosloralor| alau |rs|s| 0urresser : o||a |epa|a lerjeoa| a||oal perou|aar serv||s uler| yag l|da| |erg|ap.
0||a|u|ar |rs|s| pada daerar serv||s jar 2, jar dar jar 10. 8araya |rs|s| |r| ada|ar perdararar dar pe|eoarar
rooe|ar |e segrer oaWar ulerus.

3|r|urlerers|a aodorer dar s|r|urlerers|a |epa|a jar|r re|al|l se|roarg pada |erar||ar seoe|ur 3 r|rggu. 0|
alas 3 r|rggu, s|r|urlerers|a |epa|a |eo|r oesar dar| aodorer alau lora|s.

Perala|a|saraaar persa||rar pervag|rar : 90 persa||rar preserlas| oo|org d| Arer||a 3er||al d||a|u|ar dergar
secl|o cesarea.
3eoerarrya, secl|o cesarea juga rerupa|ar r|s||o roro|d|las dar rorla||las |ou yarg |eo|r l|rgg| dar|pada persa||rar
pervag|rar.

Pertanyaan : Apakah persa||nan pervag|nam |eb|h berbahaya bag| bay| dar|pada sect|o cesarea ?

Terdapat beberapa faktor yang mempengaruh| :
1. us|a |erar||ar : oay| preralur oerr|s||o |eo|r l|rgg| urlu| persa||rar pervag|rar, |arera ras|o ||rg|ar |epa|a /
||rg|ar aodorer |eo|r oesar pada aWa| lr|resler |e 3 ser|rgga |erurg||rar lerjad|rya |epa|a lerjeoa| |eo|r oesar.
0|sarar|ar urlu| secl|o cesarea pada |erar||ar |urarg dar| 31 r|rggu.
2. preserlas| oo|org rurr| : pa||rg ca|ap urlu| persa||rar pervag|rar, |arera pro|apsus la||pusal |eo|r |ec||
dar|pada oo|org serpurra alau |a||.
3. la|s|rar oeral jar|r : dar| slud| se|ara |r|, oeral jar|r se||lar 2500-3500 g rerpurya| arg|a roro|d|las yarg pa||rg
rerdar pada oay|.
1. r|Wayal persa||rar : ras|r ada |orlrovers| persa||rar pada pr|r|para. 3eoag|ar cerler reryarar|ar secl|o
cesarea, Wa|aupur a|asar yarg rerurjarg l|da| je|as.
5. pe|v|relr| rad|o|og|| : perer||saar |r| rerasl||ar u|urar parggu|, ser|rgga dapal rererlu|ar |roargar
lelope|v|| |eo|r oa||. CT-scar rer||||| dos|s rad|as| 1/3 |a|| |eo|r rerdar d|oard|rg|ar lolo Rorlger |orvers|ora|.
. r|pere|slers| |epa|a : dergar l|e|s| |epa|a |e oe|a|arg |erer, r|s||o |epa|a lerjeoa| dar lraura sp|ra| rer|rg|al.
0|agros|s dapal d|oual dergar perer||saar rad|o|og|| alau u|lrasorogral|.
Z. perer||saar da|ar (pe|v|s) : ra||r lurur preserlas| oo|org dar ra||r |eoar perou|aar serv||s pada aWa|
persa||rar, progros|s ra||r oa||.
8. |erajuar persa||rar : o||a |erajuar persa||rar oa|| (perou|aar serv||s dar lururrya preserl|rg parl |arcar),
persa||rar pervag|rar rer||||| progros|s ra||r oa||.

Persa||rar pervag|rar d|arggap arar : us|a |erar||ar alerr, r|s sporlar, perou|aar |arcar dar u|urar oay|
sedarg (2000-3500g).
Vers| |uar

Ve|a|u|ar pularar pada lelus dar| d|rd|rg
aodorer ser|rgga rerjad| preserlas| |epa|a.
8araya : perdararar leloralerra|, separas|
p|aserla, |egaga|ar vers|.
Kegaga|ar vers| : |eroa||rya jar|r pada pos|s|
seru|a sele|ar vers|.
Per|u a|al u|lrasorogral| urlu| perardu repos|s| jar|r, dar seoe|ur dar sesudar vers| |uar per|u d|oer| lo|o||s|s.
AwA3l peruoarar lre|uers| deryul jarlurg jar|r, |erurg||rar lerjad| gaWal jar|r pada l|rda|ar vers| a||oal
lergarggurya s|r|u|as| jar|r dar| rar|pu|as| yarg rurg||r lerjad| pada jar|r / p|aserla / la||pusal
Petunjuk | rekomendas| pada persa||nan pervag|nam

1. Perer||saar u|lrasorogral| urlu| re||ral ada/l|da|rya |e|a|rar oaWaar, |o|as| p|aserla, r|pere|slers| |epa|a,
la|s|rar oeral jar|r |||r|| raupur u|lrasorogral||
2. Jar|r lurgga|, lerulara preserlas| oo|org rurr|, la|s|rar oeral jar|r 2500-3500 g.
3. Pe|v|relr| ade|ual (rad|o|og||) : p|rlu alas parggu|, d|areler lrarsversa > 11.5 cr dar d|areler arleroposler|or >
10 cr, sedarg|ar p|rlu lergar parggu| d|slars|a |rlersp|rarur > 10 cr dar d|areler arleroposler|or > 11.5 cr.
1. Adarya pero|org yarg lrarp||, dar las|||las |arar operas| darural urlu| secl|o cesarea.
5. T|da| ada |rd||as| ooslelr|| raupur gerera||s urlu| secl|o cesarea oa|| oag| |ou raupur jar|r.
P|||han kedua : sect|o cesarea

Persa||rar dergar secl|o cesarea l|da| sara ararrya dergar parlus pervag|rar preserlas| |epa|a.

Terjad|rya r|pere|slers| |epa|a dar |esu||lar re|ar|r|ar |epa|a pada sayalar ulerus yarg |ec|| ser|rg lerjad| dar
rer|rou||ar roro|d|las oay| yarg rer|rg|al.

(secl|o cesarea l|da| d|oaras d| s|r| - ||ral |u||ar oedar ooslelr|)


PR08E0UR PERT0L0NCAN PER8AL|NAN PERVAC|NAH
PA0A PRE8ENTA8| 0K0NC
PERT0L0NCAN PER8AL|NAN 8P0NTAN (RA6hT}

1. Tarap perlara : |ar|rrya oo|org sarpa| uro||||us, sporlar.
2. Tarap |edua : lase cepal, |ar|rrya uro||||us sarpa| ru|ul, lase d| rara oay| rarus
d||ar|r|ar cepal |arera la||pusal lerjep|l o|er |epa|a oay| d| p|rlu alas parggu| (oalas
Wa|lu 8 rer|l).
3. Tarap |el|ga : lase |aroal, |ar|rrya ru|ul sarpa| se|urur |epa|a. Kepa|a rarus
d||ar|r|ar |aroal urlu| rergr|rdar| lerjad|rya perdararar |rlra|rar|a| (ruplura
lerlor|ur cereoe|||) a||oal de|orpres| yarg rerdada|.
Te|r|| : r|per|ordos|s oadar oay|

Keurlurgar :
1. largar pero|org l|da| rasu| ja|ar |ar|r, ser|rgga rergurarg| r|s||o |rle|s|.
2. rerde|al| persa||rar l|s|o|og||, rergurarg| lraura pada jar|r.
Kerug|ar :
1. 5-10 rerga|ar| |egaga|ar.
2. l|da| d||a|u|ar pada parggu| serp|l, jar|r oesar, ja|ar |ar|r |a|u (pr|r|para), rucra| arr (|ergar rerjurg||l).
PR08E0UR HANUAL A|0 (PART|AL REE6h EXTRA6T|0N}

lrd||as| :
1. o||a perlo|orgar secara 8racrl gaga|.
2. e|e|l|l, |arera seja| seru|a d|rercara|ar perlo|orgar dergar rarua| a|d.
Tarapar :
1. Tarap perlara : |ar|rrya oo|org sarpa| uro||||us, sporlar.
2. Tarap |edua : |ar|rrya oaru dar |ergar rera|a| leraga pero|org secara ||as|| (0everler), Vue||er alau Lovsel.
3. Tarap |el|ga : |ar|rrya |epa|a, dergar cara Vaur|ceau-ve|l-3re|||e, Najou|, w|gard Varl|r-w|rc|e|, Prague
leroa|||, alau dergar curar P|per
Tahap pertama : |ah|rnya bokong sampa|
umb|||kus, spontan.
Tahap kedua : He|ah|rkan bahu dan |engan

Tekn|k cara k|as|k
Ve|ar|r|ar oaru dar |ergar secara ||as||
ada|ar re|ar|r|ar oaru dar |ergar oe|a|arg
|eo|r daru|u, |arera |ergar oe|a|arg oerada d| ruargar yarg |eo|r |uas (sa|rur), oaru |erud|ar re|ar|r|ar |ergar
depar yarg oerada d| oaWar s|rl|s|s. 8||a |ergar depar su|ar, ra|a |ergar depar d|pular rerjad| |ergar oe|a|arg,
ya|lu dergar rerular ge|arg oaru |e arar oe|a|arg dar |erud|ar |ergar oe|a|arg |r| d||ar|r|ar.

Tekn|k cara Hue||er
Ve|ar|r|ar oaru dar |ergar cara Vue||er
ada|ar re|ar|r|ar oaru dar |ergar depar |eo|r
daru|u dergar e|slra|s|, oaru |erud|ar
re|ar|r|ar oaru dar |ergar oe|a|arg.

Tekn|k cara Lovset
Pr|rs|p persa||rar cara Lovsel ada|ar rerular
oadar jar|r da|ar selergar ||rg|arar oo|a|-
oa||| saro|| d||a|u|ar lra|s| curar |e oaWar
ser|rgga oaru yarg seoe|urrya oerada d|
oe|a|arg a|r|rrya |ar|r d| oaWar s|rl|s|s.
Keurlurgar :
1. sederrara dar |egaga|ar jararg
2. largar pero|org l|da| rasu| |e da|ar ja|ar
|ar|r, ser|rgga r|s||o |rle|s| r|r|ra|.

Nucha| arm (|engan menjungk|t}
Vero|org persa||rar |ela| oo|org dergar lar||ar r|rgar sarpa| s|apu|a |ar|r. 3arpa| oalas |r| |r| luour oay| d|pular
ser|rgga d|areler o|a|ror|a||s da|ar pos|s| arleroposler|or. 3eoalas a|s|||a oaru s|ap d||ar|r|ar. Tra|s| oer|eo|rar
urlu| re|ar|r|ar oaru reryeoao|ar |ergar lerl|rgga| d| alas |epa|a dar lersarg|ul |ergarrya d| |erer (rucra| arr).
urlu| |lu pero|org re|ela||ar dua jar| separjarg rurerus dar rergusap|ar |e ru|a dar dada oay| sarpa| |ar|r
|ergar lerseoul saro|| d|dororg |e alas. lurerus oay| rarus d|sp||rl dergar jar| pero|org dar ou|ar d|gael. Nucra|
arr |adarg-|adarg dapal d|oeoas|ar dergar rerular oadar oay| searar dergar jar| oay| rerurju|, ser|rgga
largar yarg rerjurg||l dapal leroeoas re|eWal| ru|a oay|.
Tahap ket|ga : me|ah|rkan kepa|a yang menyusu| (aftercom|ng head}

6ara Haur|ceau-Ve|t-8me|||e
Targar pero|org d|rasu||ar da|ar ja|ar |ar|r, jar| lergar
d|rasu||ar da|ar ru|ul, jar| le|urju| dar jar| rar|s rerce|ar
lossa |ar|ra, sedarg|ar jar| |a|r rerce|ar |erer. 8adar oay|
d||ela||ar d| alas |ergar ooaWar pero|org, seperl| rerurggarg
|uda. Jar| le|urju| dar jar| lergar pero|org dar| |ergar yarg |a|r
rerce|ar |erer oay| dar| arar purggurg, rerperlarar|ar pos|s|
|erer dar rercegar lerjad|rya del|e|s| alau r|pere|slers| |epa|a.
Kedua largar pero|org rerar|| |epa|a jar|r curar |e arar oaWar
dar peroarlu pero|org re|a|u|ar e|spres| Kr|sle||er. 8||a
suoo|s|pul larpa| d| oaWar s|rl|s|s, |epa|a d|e|evas| |e arar alas
dergar suoo|s|pul seoaga| surou (r|poro|||or), ser|rgga |ar|r |epa|a se|ururrya.

6ara Najouk
Kedua largar pero|org rerce|ar |erer oay| dar| arar depar dar oe|a|arg. Kedua
largar pero|org rerar|| oaru curar |e oaWar, dar as|sler reroarlu rerdororg
|epa|a oay| |e arar oaWar, dar| le|arar supras|rl|s|s.

6ara Prague terba||k
Cara |r| d|pa|a| o||a o|s|pul dergar uour-uour |ec|| oerada d| oe|a|arg de|al sa|rur
dar ru|a oay| rergradap s|rl|s|s.
3alu largar pero|org rerce|ar |erer dar| arar oaWar dar purggurg oay| d||ela||ar
pada le|apa| largar pero|org. Targar pero|org |a|r reregarg |edua perge|argar |a||. Ka|| d|lar|| |e alas
oersaraar dergar lar||ar pada oaru oay|, ser|rgga perul oay| rerde|al| perul |ou. 0ergar |ar|rg seoaga| surou
(r|poro|||or), |epa|a oay| dapal d||ar|r|ar.

6unam P|per
Curar P|per rer||||| |erg|urg |epa|a dar |erg|urg parggu| yarg
parjarg, dapal d|pergura|ar urlu| re|ar|r|ar |epa|a yarg
reryusu|, d|lar|| |e oaWar.
lrd||as| curar |r| selara dergar perlo|orgar perge|uarar |epa|a
cara Vaur|ceau.

Ekstraks| pada presentas| bokong

Tekn|k ekstraks| kak| (P|nard}
1. Targar pero|org rasu| rercar| oo|org, parg|a| para sarpa|u |ulul, rergaodu|s|
dar l|e|s| pada para jar|r ser|rgga |a|| oaWar rerjad| l|e|s|. Targar yarg d| |uar
rere|ar lurdus |e arar oaWar. 3ele|ar |a|| oaWar l|e|s|, perge|argar |a|| d|pegarg
dar d|lurlur |e|uar dar| vag|ra sarpa| oalas |ulul.
2. Kedua largar pero|org reregarg oel|s, |a|| d|lar|| curar |e oaWar sarpa| parg|a|
para |ar|r.
3. Parg|a| para d|lar|| curar |e arar oaWar sarpa| lrocrarler depar |ar|r, d|susu|
lrocrarler oe|a|arg dar oo|org |ar|r.
1. urlu| re|ar|r|ar oay| selerusrya, largar pero|org reregarg leruro-pe|v|| dar
d|lar|| curar |e oaWar sarpa| uro||||us |ar|r. urlu| re|ar|r|ar oaru, |ergar dar
|epa|a d||a|u|ar perlo|orgar secara rarua| a|d.

Tekn|k ekstraks| bokong
1. 0||a|u|ar pada preserlas| oo|org rurr| (lrar| oreecr) dar oo|org sudar oerada d| dasar parggu|. Jar| le|urju|
pero|org yarg searar dergar oag|ar |ec|| jar|r d|rasu||ar |e da|ar ja|ar |ar|r dar d||ela||ar pada ||pal para. L|pal
para d|lar|| curar |e oaWar.
2. 3ele|ar lrocrarler depar d||ar|r|ar, ra|a jar| le|urju| yarg |a|r segera rerga|l ||pal para oe|a|arg, dar d|lar||
curar |e oaWar sarpa| oo|org |ar|r.
3. Targar pero|org reregarg leruro-pe|v|| oay| dar re|ar|r|ar oay| dergar cara rarua| a|d.
8YARAT PARTU8 PERVAC|NAH PA0A LETAK 8UNC8ANC

- jar|r l|da| ler|a|u oesar
- l|da| ada suspe| CP0
- l|da| ada |e|a|rar ja|ar |ar|r
J||a oeral jar|r 3500 g alau |eo|r, lerulara pada pr|r|grav|da alau ru|l|para dergar r|Wayal re|ar|r|ar |urarg dar|
3500 g, secl|o cesarea |eo|r d|arjur|ar.
8YARAT P|HP|NAN HENERAN KALA || PA0A PER8AL|NAN LETAK 8UNC8ANC

1. perou|aar |erg|ap
2. oo|org ler|ela| d| lodge lll alau |eo|r
3. |eluoar d|lurggu pecar serd|r|, alau d|pecar|ar o||a perou|aar |erg|ap
1. ral|-ral| pro|aps la|| pusal
5. ral|-ral| allercor|rg read.

PENYUL|T | K0HPL|KA8| YANC HUNCK|N TERJA0|

1. 3ulo|as| : asp|ras| darar, |erd|r, re|or|ur, a|r |eluoar lerr|sap |e ja|ar rapas
2. Pro|aps la|| pusal
3. Asl||s|a
1. Kerusa|ar jar|rgar ola|
5. Fra|lur pada lu|arg-lu|arg oay| : rurerus, ||av||u|a, lerur, d|s|o|as| oaru, lu|arg |epa|a
. Cedera p|e|sus ora||a||s, reralora olol-olol.
Keham||an Hu|t|pe| | Kembar
Prof.dr. Cu|ard| h. w|knjosastro | dr. Last|ko ramantyo
0EF|N|8|

Keham||an mu|t|pe| (mu|t|p|e pregnancy} ada|ar sualu |erar||ar dergar dua jar|r alau |eo|r.

3er|rg d|seoul juga seoaga| keham||an kembar (tw|n pregnancy} - seoerarrya |sl||ar |r| |eo|r lepal urlu| |erar||ar
dergar 0uA jar|r.

lsl||ar :
dua jar|r - gere||| / |eroar / lW|r
l|ga jar|r - lr|p|el / |eroar l|ga
erpal jar|r - quadrup|el / |eroar erpal
||ra jar|r - qu|rl|p|el / |eroar ||ra, dar selerusrya.

hukum he|||n
peroard|rgar arlara |erar||ar |eroar dar lurgga| ada|ar 1 :
89 dar |arjular |uadralrya.
(|eroar l|ga = 1 : 89 parg|al 2, |eroar erpal = 1 : 89
parg|al 3, dar selerusrya).

Kembar s|am | kembar dempet (pagus}
Ada|ar |erar||ar ru|l|pe| (ururrya dua jar|r) d| rara ada
oag|ar luour salu jar|r yarg ras|r rererpe| / oersalu dergar oag|ar luour jar|r |a|rrya.
0|seoao|ar per|sarar eror|o / segrerlas| yarg lerraroal dar l|da| serpurra.
JEN|8 KEhAH|LAN KEHAR

Keham||an kembar d|z|got|k | mu|t|z|got|k
Terjad| dar| dua le|ur (d|) alau |eo|r (ru|l|) yarg d|ouar|, |erud|ar
ras|rg-ras|rg lurour rerjad| jar|r |erg|ap.
lrs|ders (|erar||ar dar| dua le|ur) se||lar 0 dar| se|urur |erar||ar
|eroar. 0|seoul juga |eroar lralerra|, |eroar o|rovu|ar / ru|l|ovu|ar,
|eroar relero|og.
Ara|-ara| jer|s |e|ar|rrya dapal sara alau oeroeda, |ara|ler|sl||
l|s|| ururrya oeroeda.
P|aserla dar se|apul jar|r : ras|rg-ras|rg ara| rer||||| |or|or dar
arr|orrya serd|r|, rarur p|aserla rurg||r lerp|sar ras|rg-ras|rg
alau lurour rerjad| salu (2 arr|or, 2 |or|or, 2 alau 1 p|aserla)

Keham||an kembar monoz|got|k
Terjad| dar| salu le|ur. 0|seoul juga |eroar |derl||, |eroar ur|ovu|ar,
|eroar roro|og.
lrs|ders se||lar 30 dar| se|urur |erar||ar |eroar.
Kedua ara| jer|s |e|ar|r sara, u|urar arlropo|og||rya sara, ruparya r|r|p, dapal sara pers|s alau oayargar
cerr|r, s|d|| jar| dar le|apa| largar sara. Vurg||r sa|ar salu ||da| |arera area dor|rar |orle|s sereor|rya
oer|aWarar dar| saudararya.
P|aserla dar se|apul jar|r : lergarlurg pada us|a saal
lerjad|rya segrerlas|
FAKT0R PRE0|8P08|8| | ET|0L0C|

Fa|lor d|slr|ous| (oargsa, rered|las, urur, par|las)
rarya oerpergarur sed|||l, rarp|r l|da| oeroeda
oerra|ra d| arlara popu|as|.

Keham||an berasa| dar| |eb|h dar| satu te|ur
(umumnya dua te|ur} dapat terjad| pada :
1. pera|a|ar ooal-ooalar |rdu|s| ovu|as| (c|or|prer,
rorror goradolrop|r) reryeoao|ar lerjad| peralargar
|eo|r dar| salu lo|||e| da|ar sel|ap s|||us.
2. prosedur lerl|||sas| |r v|lro, d| rara oeoerapa eror|o
yarg d|ouar| d||rp|arlas||ar da|ar ulerus, j||a serua
oer|eroarg dergar oa|| ra|a lerjad| perlurourar
|eo|r dar| salu.

Keham||an berasa| dar| satu te|ur terjad| :
A||oal adarya |erja la|lor pergraroal (|rr|o|l|rg laclor)
pada rasa aWa| perlurourar eror|o |rlrauler|r,
rerpergarur| segrerlas| se|arjulrya pada oeroaga|
l|rg|alar.

PERTUHUhAN JAN|N

8eral oadar ras|rg-ras|rg jar|r |eo|r r|rgar dar|pada jar|r pada |erar||ar lurgga| pada urur |erar||ar yarg
sara (ru|a| lerl|rgga| seja| us|a d| alas 30 r|rggu, peroedaar oeral pada persa||rar dapal sarpa| 1000-1500 g).
Peryeoaorya d|per||ra|ar ada|ar regargar oer|eo|rar ulerus ser|rgga s|r|u|as| p|aserla rerurur.
0|slr|ous| rulr|s| / s|r|u|as| arlara |edua jar|r juga |erurg||rar l|da| sara, lergarlurg pada daerar |rp|arlas|
p|aserla pada d|rd|rg ulerus, perlurourar p|aserla, peroag|ar daerar pada |edua p|aserla, dar |a|r-|a|r. J||a
|el|da|se|roargar |r| sargal oeral, dapal lerjad| |e|a|rar oaWaar sarpa| |eral|ar pada salu jar|r yarg |urarg
rerdapal s|r|u|as| oa||.
HA8ALAh PA0A KEhAH|LAN KEHAR

1. r|s||o pre-e||arps|a / e||arps|a, parlus preralurus, arer|a
2. r|s||o alor|a uler|, r|drarr|or
3. r|s||o p|aserla prev|a, so|us|o p|aserlae, |eluoar pecar d|r|
1. r|s||o |e|a|rar oaWaar, gargguar perlurourar sarpa| |eral|ar jar|r
5. r|s||o ra|preserlas|, pro|aps la|| pusal, d|slos|a
. r|s||o perdararar pasca persa||rar
Kes|rpu|ar : rorla||las / r|s||o ralerra| raupur per|rala| rer|rg|al

PENANCANAN 8ELAHA KEhAH|LAN

1. peroesarar perul dapal d|larar dergar rera|a| |orsel, lelap|
jargar ler|a|u |ercarg sarpa| reryu||l|ar |ou oerrapas.
2. perja|arar jaur dar |o|lus d|r|rdar|, dapal rerjad| pred|spos|s|
parlus prelerr
3. |ore|s| arer|a |ou dergar ooal reral|r|| dar rulr|s| l|rgg|
prole|r / r|rera|, |arera arer|a |ou oerpergarur ouru| pada
o|s|geras| jar|r, ler|eo|r pada |erar||ar |eroar

PENANCANAN 8ELAHA PER8AL|NAN

1. pers|apar resus|las| dar peraWalar |rlers|l reoralus, |arera
oay| yarg a|ar |ar|r rer||||| oeral oadar |ar|r rerdar dar
|erurg||rar juga preralur
2. pers|apar lrarslus| |ou
3. PENTlN0 : per||a|ar |ela| / |rlerpos|s| arlara |edua ara|
|rlrauler|r, urlu| rererlu|ar rercara persa||rar dar progros|s.

Samoar . kemungk|nan |erak / |nrerpos|s| keoua an|n |nrraurer|n
paoa kenam||an kemoar

J||a ara| perlara |ela| rerarjarg, persa||rar pervag|rar o|asa.
3ele|ar ara| perlara |ar|r, d||a|u|ar per||a|ar u|arg (perer||saaar aodorer raupur vag|ra|) urlu| rer||a| |ela|
dar |eadaar ara| |edua.

ATA8 waktu ke|ah|ran anak kedua antara 5 - 15 men|t sesudah anak pertama. J||a ler|a|u cepal, lraura
persa||rar pada ara| |edua |eo|r oesar (sele|ar ||ul slress pada Wa|lu ara| perlara |ar|r, rarus rerga|ar| |ag|
slress pada persa||rarrya serd|r|). J||a ler|a|u |ara, dapal lerjad| r|po|s|a.

8eoerapa |epusla|aar rergarjur|ar perurdaar perolorgar la|| pusal {oe|a,eo c|amp|ngj sele|ar |ar|r ara|
perlara, alau darar dar| polorgar la|| pusal ara| perlara d|urul |eroa|| |e arar p|aserla, urlu| reroer| laroarar
pada ara| |edua yarg ras|r oerada d| da|ar. Narur rarlaal ra|-ra| |r| ras|r |orlrovers|a|.

J||a jar|r |edua ||rlarg, u|urar jar|r yarg |eo|r |ec|| rerurg||r|ar urlu| vers| alau e|slra|s| ser|rgga lelap dapal
|ar|r pervag|rar.
HA8ALAh YANC HUNCK|N TERJA0| PA0A 8AAT
PER8AL|NAN AY| KEHAR

1. rurg||r ara| perlara ||rlarg alau surgsarg dar ara| |edua
rerarjarg (lerjad| pos|s| sa||rg rergurc| / |rler|oc||rg)

2. rurg||r lerjad| pro|aps la|| pusal (r|s||o l|rgg| |arera oay| |ec||)
3. rurg||r ada p|aserla prev|a
1. pada |eroar roroarr|ol||, dapal lerjad| sa||rg re||||l / |usul
pada la|| pusal jar|r (dapal ler||||l / ler|a|l dergar e|slrer|lasrya
serd|r| alau saudararya, alau dergar la|| pusal saudararya).

Vasa|ar-rasa|ar lerseoul rerupa|ar |rd||as| secl|o cesarea.
Ketuban Pecah 0|n| dan
|nfeks| |ntrapartum
dr. Endy H. Hoegn| | dr. 0w|ana 0cv|yant| | dr. Noroyono w|bowo
KETUAN PE6Ah 0|N|

Ketuban pecah d|n| ("ear|y rupture of the membrane"} : ada oerracar-racar oalasar / leor| / del|r|s|.

Ada leor| yarg rergr|lurg oerapa jar seoe|ur |r parlu, r|sa|rya 2 alau 1 alau jar seoe|ur |r parlu.
Ada juga yarg reryala|ar da|ar u|urar perou|aar serv||s pada |a|a l, r|sa|rya |eluoar yarg pecar seoe|ur
perou|aar serv||s 3 cr alau 5 cr, dar seoaga|rya.

Pr|rs|prya ada|ar |eluoar yarg pecar seoe|ur Wa|lurya.

Hasa|ahnya : Kapan se|aput ketuban pecah (spontan} pada persa||nan norma| ?

Norra| se|apul |eluoar pecar pada a|r|r |a|a l alau aWa| |a|a ll persa||rar. 8|sa juga oe|ur pecar sarpa| saal
rergedar, ser|rgga |adarg per|u d|pecar|ar (arr|olor|).

KETUAN PE6Ah 0|N| ERhUUNCAN ERAT 0ENCAN
PER8AL|NAN PRETERH 0AN |NFEK8| |NTRAPARTUH
Patof|s|o|og|

8arya| leor|, ru|a| dar| dele| |rorosor, |e|a|rar |o|ager, sarpa| |rle|s|.
Pada seoag|ar oesar |asus lerryala oerruourgar dergar |rle|s| (sarpa| 5).
l|gr v|ru|erce : oaclero|des. LoW v|ru|erce : |aclooac|||us.

Ko|ager lerdapal pada |ap|sar |orpa|la arr|or, l|oroo|as, jar|rgar rel||u|er |or|or dar lroloo|as.
3|rles|s raupur degradas| jar|rgar |o|ager d||orlro| o|er s|sler a|l|l|las dar |rr|o|s| |rler|eu||r-1 (lL-1) dar
proslag|ard|r.
J||a ada |rle|s| dar |rl|aras|, lerjad| per|rg|alar a|l|l|las lL-1 dar proslag|ard|r, rergras|||ar |o|agerase jar|rgar,
ser|rgga lerjad| depo||rer|sas| |o|ager pada se|apul |or|or / arr|or, reryeoao|ar se|apul |eluoar l|p|s, |erar dar
rudar pecar sporlar.
Faktor r|s|ko | pred|spos|s| ketuban pecah d|n| | persa||nan preterm

1. |erar||ar ru|l|pe| : |eroar dua (50), |eroar l|ga (90)
2. r|Wayal persa||rar prelerr seoe|urrya : r|s||o 2 - 1x
3. l|rda|ar sarggara : Tl0AK oerpergarur |epada r|s||o, KECuALl j||a r|g|ere ouru|, pred|spos|s| lerradap |rle|s|
1. perdararar pervag|rar : lr|resler perlara (r|s||o 2x), lr|resler |edua/|el|ga (20x)
5. oa|ler|ur|a : r|s||o 2x (preva|ers| Z)
. pl vag|ra d| alas 1.5 : r|s||o 32 (vs. 1)
Z. serv|x l|p|s / |urarg dar| 39 rr : r|s||o 25 (vs. Z)
8. l|ora vag|ra aororra| : r|s||o 2-3x
9. l|ororecl|r > 50 rg/r| : r|s||o 83 (vs. 19)
10. |adar CRl (corl|colrop|r re|eas|rg rorrore) ralerra| l|rgg| r|sa|rya pada slress ps||o|og|s, dso, dapal rerjad|
sl|ru|as| persa||rar prelerr
8trateg| pada perawatan antenata|

- dele|s| la|lor r|s||o
- dele|s| |rle|s| secara d|r|
- u30 : o|orelr| dar lure||sas|
Tr|resler perlara : dele|s| la|lor r|s||o, a|l|l|las se|sua|, pl vag|ra, u30, perer||saar 0rar, darar rul|r, ur|re.
Tr|resler |edua dar |el|ga : ral|-ral| o||a ada |e|urar ryer| aodorer, purggurg, |rar d| daerar pe|v|s seperl|
sedarg ra|d, perdararar per vag|rar, |erd|r rerar ruda, d|scrarge vag|ra, po||ur|a, d|are, rasa rere|ar d| pe|v|s.
J|ka ketuban pecah : jangan ser|ng per|ksa da|am !! Awas| tanda-tanda komp||kas|.
Komp||kas| ketuban pecah d|n|

1. |rle|s| |rlra parlur (|or|oarr|or|l|s) ascerders dar| vag|ra |e |rlrauler|r.
2. persa||rar prelerr, j||a lerjad| pada us|a |erar||ar prelerr.
3. pro|aps la|| pusal, o|sa sarpa| gaWal jar|r dar |eral|ar jar|r a||oal r|po|s|a (ser|rg lerjad| pada preserlas|
oo|org alau |ela| ||rlarg).
1. o||gor|drarr|or, oar|ar ser|rg parlus |er|rg (dry |aoor) |arera a|r |eluoar rao|s.
Keadaan | faktor-faktor yang d|hubungkan dengan partus preterm

1. |alroger|| : ryg|ere |urarg (lerulara), l|rda|ar lraural||
2. ralerra| : perya||l s|sler||, palo|og| orgar reprodu|s| alau pe|v|s, pre-e||arps|a, lraura, |orsurs| a||oro| alau
ooal2 ler|ararg, |rle|s| |rlraarr|or suo|||r||, |or|oarr|or|l|s |||r||, |r|orpelers|a serv||s, serv|s|l|s/vag|r|l|s a|ul,
KETu8AN PECAl pada us|a |erar||ar prelerr.
3. lela| : ra|lorras| jar|r, |erar||ar ru|l|pe|, r|drops lela||s, perlurourar jar|r lerraroal, gaWal jar|r, |eral|ar
jar|r.
1. ca|rar arr|or : o||gor|drarr|or dergar se|apul |eluoar ulur, |eluoar pecar pada prelerr, |rle|s| |rlraarr|or,
|or|oarr|or|l|s |||r||.
5. p|acerla : so|ul|o p|acerla, p|acerla praev|a (|erar||ar 35 r|rggu alau |eo|r), s|rus rag|ra||s, cror|oarg|ora,
vasa praev|a.
. ulerus : ra|lorras| ulerus, overd|slers| a|ul, r|ora oesar, des|duos|l|s, a|l|l|las ulerus |d|opal||.

Persa||nan preterm (partus prematurus} : persa||nan yang terjad| pada us|a keham||an antara 20-37 m|nggu.
Tarda : |orlra|s| dergar |rlerva| |urarg dar| 5-8', d|serla| dergar peruoarar serv||s progres|l, d||alas| serv||s ryala 2
cr alau |eo|r, serla per|p|sar serv||s oer|arjul sarpa| |eo|r dar| 80.
lrs|ders rala-rala d| rurarsa||l2 oesar d| lrdores|a : 13.3 (10-15)
{persa||nan prererm - aoa ku||ann,a seno|r|j
|NFEK8| |NTRAPARTUH

lrle|s| |rlraparlur ada|ar |rle|s| yarg lerjad| da|ar rasa persa||rar / |r parlu.

0|seoul juga kor|oamn|on|t|s, |arera |rle|s| |r| re||oal|ar se|apul jar|r.

Pada |eluoar pecar jar, r|s||o |rle|s| rer|rg|al 1 |a||. Keluoar pecar 21 jar, r|s||o |rle|s| rer|rg|al sarpa| 2
|a|| ||pal.

Protoko| : pa||ng |ama 2 x 24 jam sete|ah ketuban pecah, harus sudah partus.
Patof|s|o|og|

1. ascerd|rg |rlecl|or, pecarrya |eluoar reryeoao|ar ada ruourgar |argsurg arlara ruarg |rlraarr|or dergar
dur|a |uar.
2. |rle|s| |rlraarr|or o|sa lerjad| |argsurg pada ruarg arr|or, alau dergar perja|arar |rle|s| re|a|u| d|rd|rg ulerus,
se|apul jar|r, |erud|ar |e ruarg |rlraarr|or.
3. rurg||r juga j||a |ou rerga|ar| |rle|s| s|sler||, |rle|s| |rlrauler|r rerja|ar re|a|u| p|aserla (s|r|u|as|
leloralerra|).
1. l|rda|ar |alroger|| lraural|| alau r|g|ere ouru|, r|sa|rya perer||saar da|ar yarg ler|a|u ser|rg, dar seoaga|rya,
pred|spos|s| |rle|s|.

Kurar yarg ser|rg d|leru|ar : 3lreplococcus, 3lapry|ococcus (grar pos|l|l), E.co|| (grar regal|l), 8aclero|des,
Peplococcus (araeroo).
0|agnos|s |nfeks| |ntrapartum

1. leor|s d| alas 38oC (|epusla|aar |a|r 3Z.8oC)
2. |ou la|||ard|a (>100 deryul per rer|l)
3. lela| la|||ard|a (>10 deryul per rer|l)
1. ryer| aodorer, ryer| le|ar ulerus
5. ca|rar arr|or oerWarra |erur alau r|jau dar oeroau
. |eu|os|los|s pada perer||saar darar lep| (>15000-20000/rr3)
Z. perer||saar perurjarg |a|r : |eu|os|l eslerase () (ras|| degradas| |eu|os|l, rorra| regal|l), perer||saar 0rar,
|u|lur darar.
Komp||kas| |nfeks| |ntrapartum

1. |orp|||as| |ou : erdorelr|l|s, perururar a|l|l|las r|orelr|ur (d|slor|a, alor|a), seps|s CEPAT (|arera daerar
ulerus dar |rlrarr|or rer||||| vas|u|ar|sas| sargal oarya|), dapal lerjad| syo| sepl|| sarpa| |eral|ar |ou.
2. |orp|||as| jar|r : asl||s|a jar|r, seps|s per|rala| sarpa| |eral|ar jar|r.
Pr|ns|p penata|aksanaan

1. pada |eluoar pecar, lerr|ras| |erar||ar, oalas Wa|lu 2 x 21 jar
2. j||a ada larda |rle|s| |rlraparlur, lerr|ras| |erar||ar / persa||rar oalas Wa|lu 2 jar.
3. JAN0AN TERLALu 3ERlN0 PERlK3A 0ALAV
1. o||a per|u, |rdu|s| persa||rar
5. ooservas| dar opl|ra||sas| |eadaar |ou : o|s|ger ll
. arl|o|ol||a spe|lrur |uas : gerlar|c|r |v 2 x 80 rg, arp|c||||r |v 1 x 1 rg, arox|c||||r |v 3 x 1 rg, per|c||||r |v 3 x 1.2
jula lu, relror|dazo| dr|p.
Z. ulerolor||a : relrerg|r 3 x 1 arpu| dr|p
8. peroer|ar |orl||oslero|d : |orlrovers|. 0| salu p|ra| dapal rerperouru| |eadaar |ou |arera rerurur|ar |rur|las,
d| |a|r p|ra| dapal rersl|ru|as| peralargar paru jar|r (surla|lar). 0| R3CV d|oer||ar, oersara dergar arl|o|ol||a
spe|lrur |uas. las|| cu|up oa||.
Perdarahan Pasca Persa||nan
Prof.dr. Cu|ard| h. w|knjosastro | dr. handaya
PER0ARAhAN PA86A PER8AL|NAN (hEH0RAC|A P08TPARTUH - hPP}

Ada|ar perdararar |eo|r dar| 500 cc yarg lerjad| sele|ar ara| |ar|r.

Perdararar pr|rer : lerjad| da|ar Wa|lu 21 jar pascapersa||rar.
Perdararar se|urder : lerjad| da|ar Wa|lu sesudar 21 jar perlara pascapersa||rar |lu.

Hasa|ah d| |ndones|a
3eoag|ar oesar persa||rar lerjad| l|da| d| rurar sa||l, ser|rgga ser|rg pas|er yarg oersa||r d| |uar |erud|ar lerjad|
lPP ler|aroal dalarg d| rurar sa||l, Wa|lu l|oa |eadaar urur / rerod|rar||rya sudar rerouru|.
A||oalrya rorla||las l|rgg|.
KEHUNCK|NAN PENYEA

1. alor|a uler|
2. per|u|aar ja|ar |ar|r
3. pe|epasar p|aserla dar| ulerus
1. lerl|rgga|rya seoag|ar p|aserla da|ar ulerus (relers|o, a|rela, su|serlur|ala..)
5. |e|a|rar proses peroe|uar darar a||oal r|pol|or|rogerer|a
. |alroger|| - l|rda|ar yarg sa|ar urlu| rerpercepal |a|a 3 : perar||ar la|| pusal, pere|arar ulerus |e arar oaWar
urlu| rerge|uar|ar p|aserla dergar cepal, dar seoaga|rya.
0|ACN08|8

Pr|ns|p :
1. o||a seorarg |ou oersa||r rerga|ar| perdararar sele|ar ara| |ar|r, perlara-lara d|p|||r|ar oarWa perdararar
lerseoul oerasa| dar| relers|o p|aserla alau p|aserla |ar|r l|da| |erg|ap.
2. 8||a p|aserla le|ar |ar|r |erg|ap dar |orlra|s| ulerus oa||, dapal d|pasl||ar oarWa perdararar lerseoul oerasa| dar|
per|u|aar pada ja|ar |ar|r.

J||a perdararar ras|l, d|agros|s re|al|l |eo|r rudar.
lATl-lATl pada perdararar |aroal, sed|||l-sed|||l lap| lerus-rererus, dapal l|da| lerdele|s| / lerd|agros|s.
3er|rgga pada peraWalar pascapersa||rar per|u ooservas| |||r|s dar |aooralor|ur ser|a|.

PR|N8|P !!
Perdararar rarya|ar 0EJALA ll larus d||elaru| dar d|lala|a|sara peryeoaorya lll
8u|ar se|edar rerperoa||| lo ll
(r|sa|rya dergar lrarslus|, ooal2ar reral|r||, oeg|lu..)

8eda|ar :
Perdararar |arera per|u|aar ja|ar |ar|r, |orlra|s| ulerus oa||.
Perdararar |arera alor|a uler| alau s|sa p|aserla, |orlra|s| ulerus |urarg oa||.
PENATALAK8ANAAN

Terap| leroa|| ada|ar PENCE0AlAN seja| rasa arlerala|. Tala|a|sara arer|a dergar rulr|s| / g|z| dar ooal
reral|r||, v|lar|r, r|rera|. J||a ada la|lor r|s||o, dapal d||a|u|ar aulolrarslus| / lrarslus| roro|ogus (pas|er
reraourg dararrya serd|r| urlu| d|gura|ar Wa|lu persa||rar).

Pada Wa|lu persa||rar, s|ap|ar |eper|uar urlu| resus|las| dar lrarslus|.

3egera sesudar oay| |ar|r, |rje|s| |rlrarus|u|ar ergorelr|r dar / alau o|s|los|r urlu| rer|rg|al|ar |orlra|s| ulerus
(d||a|u|ar juga pada persa||rar rorra| o|asa)

lATl-lATl pada |erar||ar gere||| / |eroar yarg l|da| d||elaru| seoe|urrya, peroer|ar ulerolor|| sele|ar oay| |ar|r
dapal reryeoao|ar lerjep|l / lerperarg|aprya oay| |edua yarg ras|r oerada d| da|ar.
URUTAN | 8|8TEHAT|KA T|N0AKAN PA0A KA8U8
PER0ARAhAN PA86APER8AL|NAN

1. segera sesudar oay| |ar|r, |rje|s| |rlrarus|u|ar ergorelr|r dar / alau o|s|los|r urlu| rer|rg|al|ar |orlra|s| ulerus
(d||a|u|ar juga pada persa||rar rorra| o|asa)
2. j||a lerjad| perdararar, sererlara p|aserla oe|ur |ar|r (pa||rg |ara 30 rer|l sesudar oay| |ar|r), |a|u|ar raruver
a|l|l urlu| rerge|uar|ar p|aserla (d|arjur|ar cara 8rardl-ArdreWs alau rarua| - ||ral |u||ar p|rp|rar persa||rar
rorra|)

3. j||a lerdapal s|sa p|aserla yarg su||l d||e|uar|ar (relers|o / |r|rela / a|rela / per|rela dso), sererlara perdararar
oerja|ar lerus, ru|a| d|p|||r|ar perl|roargar urlu| |aparolor| / r|slere|lor|.

1. usara urlu| rergrerl||ar perdararar sererlara,
dapal dergar |orpres| o|rarua| dar rassage
(Easlrar / 0|c||rsor).

5. 0apal juga d||a|u|ar perasargar larpor
ulerovag|ra|, dergar |asa gu|urg parjarg yarg
d|pasarg padal rererur| ulerus sarpa| vag|ra,
d|perlarar|ar se|ara 12-21 jar.

. j||a a|r|rrya d|pulus|ar l|rda|ar |aparolor|, |a|u|ar ||alar arler|| r|pogaslr||a |arar dar ||r|, serla, a|lerral|l
lera|r|r, r|slere|lor|

urlu| r|slere|lor|, lARu3 d|ya||r| oerar oarWa perdararar oerasa| dar| s|sa |rp|arlas| p|aserla alau dar| d|rd|rg
ulerus, ou|ar dar| rooe|ar / per|u|aar ja|ar |ar|r |a|rrya alau dar| gargguar reralo|og| |a|rrya.
|nduks| Persa||nan
Prof.dr. Cu|ard| h. w|knjosastro | dr. handaya
|N0UK8| PER8AL|NAN

|nduks| persa||nan ada|ar sualu upaya sl|ru|as| ru|a|rya proses persa||rar.
(dar| l|da| ada larda-larda persa||rar, d|sl|ru|as| rerjad| ada)

8eda|ar dergar akse|eras| persa||nan, sualu upaya rerpercepal proses persa||rar.
(sudar ada larda-larda persa||rar, rarur |erajuarrya |aroal, ser|rgga d|a|se|eras| rerjad| cepal)
TAN0A-TAN0A PER8AL|NAN N0RHAL

Pas|er o|asarya re|apor|ar rasa ru|es / sa||l perul r||arg-l|rou|, a||oal r|s, yarg ra||r |ara, ra||r |ual dar ra||r
ser|rg.
8|sa dergar alau larpa d|serla| |e|uar darar |erd|r alau ca|rar |eluoar.
|N0|KA8| P0K0K UNTUK |N0UK8| PER8AL|NAN

1. urlu| jar|r yarg ras|r da|ar |ardurgar, perl|roargarrya ada|ar |ord|s| e|slrauler|r a|ar |eo|r oa|| dar|pada
|rlrauler|r, alau |ord|s| |rlrauler|r |eo|r l|da| oa|| alau rurg||r reroaraya|ar.
2. urlu| |ou, perl|roargarrya ada|ar rergr|rdar| / rercegar / rergalas| rasa sa||l alau rasa|ar2 |a|r yarg dapal
reroaraya|ar ryaWa |ou.

lrd||as| jar|r, r|sa|rya : |erar||ar |eWal Wa|lu (poslralur|las), |r|orpal|o|||las Rr
Pada us|a |erar||ar poslralur, d| alas 10 rar| |eo|r dar| saal per||raar parlus, lerjad| perururar lurgs| p|aserla yarg
oerra|ra, yarg dapal reroaraya|ar |er|dupar jar|r (gargguar s|r|u|as| ulerop|aserla, gargguar o|s|geras| jar|r)
lrd||as| |ou, r|sa|rya : |eral|ar jar|r |rlrauler|r
lrd||as| jar|r dar |ou, r|sa|rya : pre-e||arps|a oeral

HET00E |N0UK8| PER8AL|NAN
8urg|ka|

0ergar cara :
1. re|epas|ar / rer|sar|ar se|apul |arlorg |eluoar dar| segrer
oaWar ulerus (slr|pp|rg), alau
2. rerecar|ar se|apul |arlorg |eluoar (arr|olor|)

3lr|pp|rg, dapal dergar cara :
1. rarua| (dergar jar| lergar / le|urju| d|rasu||ar da|ar |ara||s serv||a||s)
2. dergar oa|or |aleler Fo|ey yarg d|pasarg d| da|ar segrer
oaWar ulerus re|a|u| |ara||s serv||a||s, d||s| ca|rar (dapal sarpa|
100 cc pada Fo|ey ro.21), d|rarap|ar a|ar rerdororg se|apul
|eluoar d| daerar segrer oaWar ulerus sarpa| ler|epas (8uKAN
urlu| d||alas| serv||s).
Arr|olor|, se|apul |eluoar d||u|a| / d|rooe| dergar rerggura|ar
separur ||er Kocrer (ujurg yarg oerg|g| lajar), sler||, d|rasu||ar
|e |ara||s serv||a||s dergar per||rdurgar jar|-jar| largar.
Hed|s|na|

0ergar rerggura|ar ooal-ooal urlu| sl|ru|as| a|l|l|las ulerus, r|sa|rya sparle|r su|lal, proslag|ard|r (r|soproslo|-
der|val proslag|ard|r) alau o|s|los|r.
3edarg da|ar pere||l|ar : pergguraar prepraral proslag|ard|r lao|el r|soproslo| |rlravag|ra| (d|pasarg d| ruarg
lorr|x).
Pada oeoerapa |epusla|aar, |rdu|s| proslag|ard|r |rlravag|ra| d|seoul|ar dapal d||a|u|ar oersaraar dergar
pera|a|ar oa|or |aleler Fo|ey (garoar).

0| FKul/R3CV : d|gura|ar juga o|s|los|r.
0a|ar |o|l 500 cc dexlrose 5, d|carpur|ar 5 lu o|s|los|r s|rlel||. Ca|rar o|s|los|r d|a||r|ar re|a|u| |rlus dergar
dos|s 0.5 rlu sarpa| 1.0 rlu per rer|l, sarpa| d|pero|er respors oerupa a|l|l|las |orlra|s| dar re|a|sas| ulerus
yarg cu|up oa||.
lal|-ral|, Korlra|s| ulerus yarg ler|a|u |ual dar re|a|sas| yarg |urarg a|ar dapal oera||oal ouru| lerradap jar|r
|arera gargguar s|r|u|as| ulerop|aserla|.
Eva|uas| :
dapal d|u|arg sarpa| dergar 3 |a||. J||a persa||rar
oe|ur raju, d|ryala|ar relra|ler / |rdu|s| gaga|.

J||a sudar lerdapal a|l|l|las |orlra|s| ulerus
seoe|urrya lelap| l|da| oa|| (r|sa|rya pada
|rcoord|raled uler|re acl|or), a|l|l|las lerseoul
d|e||r|ras| |eo|r daru|u r|sa|rya dergar pelr|d|re 50 rg, oaru d||a|u|ar |rdu|s|.
TAN0A-TAN0A |N0UK8| A|K

1. respors ulerus oerupa a|l|l|las |orlra|s| r|orelr|ur oa||
2. |orlra|s| s|relr|s, dor|ras| lurdus, re|a|sas| oa|| (sesua| dergar larda-larda r|s yarg oa|| / ade|ual)
3. r||a| pe|v|| rerurul 8|srop (laoe|)
PR|N8|P !!

1. perl|rg : ror|lor |eadaar oay|, |eadaar |ou, aWas| larda-larda ruplura uler|
2. perl|rg : rarus rerarar| larra|o||rel||, larra|od|rar||, dos|s dar cara peroer|ar ooal yarg d|gura|ar urlu|
sl|ru|as| ulerus.
K0NTRA|N0|KA8| |N0UK8| PER8AL|NAN

1. |orlra|rd||as| / la|lor peryu||l urlu| parlus pervag|rar pada ururrya : adarya d|spropors| sela|ope|v||, p|aserla
prev|a, |e|a|rar |ela| / preserlas| jar|r.
2. r|Wayal secl|o cesarea (r|s||o ruplura uler| |eo|r l|rgg|)
3. ada ra|2 |a|r yarg dapal rerperoesar r|s||o j||a lelap d||a|u|ar parlus pervag|rar, alau j||a secl|o cesarea e|e|l|l
rerupa|ar p|||rar yarg leroa||.
Pengantar
||mu edah 0bstetr|
dr. handaya | dr. h. H. 8oepard|man | dr. 0mo A. Hadj|d
|LHU E0Ah 08TETR|

edah obstetr| ada|ar l|rda|ar oedar yarg d||a|u|ar urlu| reroarlu / rergalas| rasa|ar-rasa|ar yarg lerjad|
se|ara proses persa||rar.

Urutan |nd|kas| t|ndakan bedah berdasarkan pr|or|tas :
1. lo save ||le
2. lo re|ease suller|rg
3. lo correcl delorr|ly

Pr|ns|p :
1. T|ap l|rda|ar peroedarar rarus d|dasar|ar alas |rd||as| yarg lepal
2. Per|u d|p|||r l|rda|ar yarg pa||rg arar oag| |ou dar jar|r, rerg|rgal |ord|s| rere|a dar ||rg|urgarrya
3. T|rda|ar rarus d|se|erggara|ar seder|||ar rupa ser|rgga sedapal rurg||r l|da| l|rou| |orp|||as| pada |ou dar
oay|.

8yarat yang per|u d|perhat|kan da|am t|ndakan pembedahan :
1. Pers|apar preoperal|l yarg oa||
2. Aseps|s dar arl|seps|s yarg oa||
3. Aresles| / ara|ges|a yarg oa||
1. T|rda|ar / prosedur yarg oa||
5. Eva|uas| / perala|a|saraar posloperal|l yarg oa||
{unruk pers|apan preoperar|l oan anesres|a, ||nar uga ku||an anesres|o|og|j
EP|8|0T0H|

Ep|s|olor| ada|ar sualu l|rda|ar oarluar persa||rar oerupa |rs|s| pada per|reur yarg reryeoao|ar lerpolorgrya
|ap|sar se|apul |erd|r vag|ra, c|rc|r se|apul dara, jar|rgar pada seplur re|lovag|ra|, olol-olol dar lasc|a per|reur,
serla |u||l seoe|ar depar per|reur.

|nd|kas| :
Pr|rs|p : urlu| rercegar lraura persa||rar pervag|rar yarg ler|a|u oeral, oag| jar|r raupur oag| |ou.
1. lrd||as| jar|r : jar|r preralur, jar|r |ela| surgsarg, jar|r yarg a|ar d||ar|r|ar dergar e|slra|s| curar / va|ur,
dar jar|r oesar. 0apal juga d||a|u|ar pada jar|r alerr rorra| yarg d|rercara|ar |ar|r pervag|rar sporlar (oerarl|
perl|roargar oerdasar|ar |rd||as| |ou).
2. lrd||as| |ou : rercegar rooe|ar per|reur yarg oeral a||oal peregargar per|reur yarg oer|eo|rar pada saal
persa||rar pervag|rar sporlar raupur dergar l|rda|ar e|slra|s|. ururrya pada pr|r|para, |arera e|asl|s|las
jar|rgar dasar parggu| ras|r |urarg, l|rda|ar ep|s|olor| rarp|r se|a|u d|per|u|ar.

Tekn|k : oerdasar|ar arar gar|s |rs|s| : ep|s|olor| red|a|, |alera| alau red|o|alera|.
EK8TRAK8| 6UNAH | F0R6EP8

E|slra|s| curar ada|ar sualu l|rda|ar oarluar persa||rar d| rara jar|r d||ar|r|ar dergar sualu lar||ar curar /
lorceps yarg d|pasarg pada |epa|arya.

Forceps | cunam :
Forceps / curar ada|ar a|al oarlu persa||rar,
leroual dar| |ogar, lerd|r| dar| sepasarg (2
ouar) serdo| ya|lu serdo| curar ||r| dar
serdo| curar |arar.

3eoerapa en|s lorceps {gamoar k|r| ke kananj .
haege|e, re||ano, lock|ng, $|mpson-3raun,
P|per, 3oerma, Tarn|er. {cararan . propors|
ukuran oa|am gamoar r|oak sesua|j.

Vas|rg-ras|rg serdo| curar rer||||| :
1. larg|a| peregarg / rard|e : urlu| d|pegarg o|er pero|org persa||rar
2. |urc| curar / |oc| : urlu| rergurc| pada pers||argar curar
|arar dergar curar ||r|.
3. larg|a| curar : oag|ar arlara |urc| curar dergar o||ar / daur
curar.
1. o||ar / daur curar : oag|ar yarg a|ar rerce|ar |epa|a jar|r.

3eoerapa mooe| kunc| cunam .
a. lnggr|s {$me||ej. o. Peranc|s. c. Jerman. o. horueg|a {gamoarj

0aur curar ururrya rer||||| dua |erg|urgar :
1. |erg|urg |epa|a (cepra||c curve), d|sesua||ar dergar |urva |epa|a jar|r
2. |erg|urg parggu| (pe|v|c curve), d|sesua||ar dergar |urva rorgga parggu| |ou.

erdasarkan kemajuan persa||nan | penurunan kepa|a d| da|am rongga panggu|, pemaka|an cunam d|bag|
menjad| :
1. cunam t|ngg| (h|gh forceps} : e|slra|s| curar pada |eadaar |epa|a ras|r oerada d| alas p|rlu alas parggu|.
3aal |r| l|da| d|pa|a| |ag| |arera lraura yarg lerjad| sargal oeral. Perlo|orgar persa||rar urlu| |eadaar |r|
d|garl||ar dergar secl|o cesarea.
2. cunam tengah (m|d forceps} : e|slra|s| curar pada |eadaar |epa|a sudar ca|ap / ergaged lelap| oe|ur
rererur| syaral urlu| curar rerdar. 3aal |r| juga sudar jararg d|pa|a|, perlo|orgar persa||rar urlu| |eadaar |r|
d|garl||ar dergar e|slra|s| va|ur alau secl|o cesarea.
3. cunam rendah (out|et | |ow forceps} : e|slra|s| curar pada |eadaar |epa|a sudar rercapa| p|rlu oaWar
parggu| dar sulura sag|la||s jar|r sudar oerada da|ar |eadaar arleroposler|or. Pera|a|ar curar urlu| |eadaar |r|
yarg pa||rg ser|rg d|gura|ar.

|nd|kas| :
Pr|rs|p : |eadaar yarg rerer|u|ar perlo|orgar persa||rar |a|a dua yarg d|percepal, |arera j||a ler|aroal dapal
reroaraya|ar |eadaar |ou dar / alau jar|r.
1. lrd||as| |ou : pree||arps|a / e||arps|a, ruplura uler| reroa|al, perya||l jarlurg, asra, dar |a|r-|a|r.
2. lrd||as| jar|r : gaWal jar|r.

Kontra|nd|kas| :
1. 8ay| preralur (|arera |orpres| pada lu|arg |epa|a yarg oe|ur ralarg / oe|ur rer||||| |erarpuar rou|age
yarg oa|| dapal reryeoao|ar lerjad| perdararar per|verlr||u|ar.
2. 0|spropors| sela|ope|v||.

8yarat :
1. Jar|r alerr.
2. Jar|r rarus dapal |ar|r pervag|rar (l|da| ada d|spropors|)
3. Perou|aar serv||s sudar |erg|ap.
1. Kepa|a jar|r sudar ergaged.
5. 3e|apul |eluoar sudar pecar, alau j||a oe|ur, d|pecar|ar.

Proceoures lor lorceps exrracr|on . '.
Pre||m|nar, app||car|on mooe. 2. lnserr|ng rne
|elr o|aoe us|ng rne |elr nano, |nro rne morners
|elr sacra| cav|r,, ro grao rne |elr par|era| oone ol
rne cn||o {Duarrer ru|e ol 0ennenj. J. lnserr|ng
rne r|gnr o|aoe us|ng rne r|gnr nano, |nro rne
morners r|gnr sacra| cav|r,, ro grao rne r|gnr
par|era| oone ol rne cn||o {Duarrer ru|e ol
0ennenj. 4. 0|os|ng ano |ock|ng rne lorceps
o|aoes. 5. 0|g|ra| cneck|ng lor correcr
pos|r|on|ng, lo||oueo o, a l|rsr rr|a| rracr|on.
0orrecr pos|r|on|ng |l necessar,. 6. lo|o|ng rne
lorceps |n pos|r|on lor oel|n|r|ve rracr|on. 7.
3|par|era| pos|r|on ol rne lorceps on rne cn||os
neao. 8, 9. /lrer pre||m|nar, ep|s|orom,, ano
u|rn gooo conrracr|ons, rne lorceps are pu||eo
sreep|, ooun unr|| rne neck na|r||ne appears,
rnen s|ou|, upuaros ro comp|ere oe||ver, ol rne
neao {see arrousj. Tne cn||o |s oe||vereo
manua||, alreruaros.

J||a rerurg||r|ar, lar||ar curar d||a|u|ar dergar oarluar leraga |ou (pada saal r|s / gera|ar rergejar). Narur
j||a |eadaar l|da| rerurg||r|ar alau oer|s||o l|rgg| oag| |ou urlu| rergejar, lar||ar dapal lelap d||a|u|ar larpa
lergarlurg leraga |ou.

Ekstraks| cunam pada keadaan khusus (baca send|r|} :
1. 3ulura sag|la||s ||rlarg : gera| rolas| cara Large
2. 0|s|pul posler|or pers|slers : gera| rolas| cara 3carzor|

Kemungk|nan kegaga|an | error source :
1. Kesa|arar rererlu|ar pos|s| |epa|a jar|r
2. Ada d|spropors| sela|ope|v|| yarg l|da| d|leru|ar seoe|urrya.
3. Ada jar|rgar |ou yarg lerjep|l / ler|u|a.

R|s|ko komp||kas| :
1. R|s||o |orp|||as| pada |ou : perdararar, rooe|ar ja|ar |ar|r, l|slu|a, lra|lur lu|arg parggu|, |rle|s|.
2. R|s||o |orp|||as| pada oay| : rerar jejas lorceps pada |epa|a, lra|lur lu|arg lerg|ora|, perdararar |rlra|rar|a|,
para||s|s rervus las|a|, asl||s|a / lerce|||, sarpa| |eral|ar jar|r.
EK8TRAK8| VAKUH

E|slra|s| va|ur ada|ar sualu l|rda|ar oarluar persa||rar d| rara jar|r d||ar|r|ar dergar e|slra|s| rerggura|ar
le|arar regal|l dergar a|al va|ur (regal|ve-pressure vacuur exlraclor) yarg d|pasarg d| |epa|arya.

Pada e|slra|s| va|ur, |eadaar l|s|o|og|s yarg d|rarap|ar ada|ar leroerlu|rya |apul su|sadereur pada |epa|a jar|r
seoaga| |orpersas| a||oal pergr|sapar / le|arar regal|l.

Kerud|ar sele|ar |epa|a rererpe| pada rarg|u| va|ur, lar||ar d||a|u|ar dergar oarluar leraga dar| |ou
(oersaraar dergar saal r|s / gera|ar rergejar) rergarda||ar pererpe|ar |apul lerseoul pada rarg|u| va|ur.

A|at ekstraktor vakum terd|r| dar| beberapa bag|an :
1. Porpa / res|r pergr|sap dergar le|arar regal|l.
2. 8olo| / laourg udara d||erg|ap| dergar raroreler urlu| reroual dar rergalur le|arar udara regal|l.
3. P|pa / se|arg pergruourg arlara res|r / oolo| dergar rarg|u| e|slra|lor va|ur.
1. Rarla| / gagarg perar|| yarg lerpasarg pada rarg|u| e|slra|lor va|ur.
5. Varg|u| e|slra|lor va|ur yarg lerpasarg pada |epa|a oay|.

|nd|kas| :
Pr|rs|p : |eadaar yarg rerer|u|ar perlo|orgar persa||rar |a|a dua yarg d|percepal, |arera j||a ler|aroal dapal
reroaraya|ar |eadaar |ou dar / alau jar|r.

Kontra|nd|kas| :
1. 0|spropors| sela|ope|l||.
2. Ruplura uler| reroa|al.
3. Keadaar |ou d| rara |ou l|da| oo|er rergejar, r|sa|rya perya||l jarlurg oeral, pree||arps|a oeral, asra oeral
dar seoaga|rya.

8yarat : (umumnya serupa dengan syarat ekstraks| cunam}
1. Jar|r alerr.
2. Jar|r rarus dapal |ar|r pervag|rar (l|da| ada d|spropors|)
3. Perou|aar serv||s sudar |erg|ap (pada ru|l|grav|da, dapal pada
perou|aar r|r|ra| Z cr).
1. Kepa|a jar|r sudar ergaged.
5. 3e|apul |eluoar sudar pecar, alau j||a oe|ur, d|pecar|ar.
. laroarar, lARu3 ada |orlra|s| ulerus (r|s) dar leraga
rergejar |ou.

0e||ver, u|rn vacuum exrracr|on . alrer rne cup |s arracneo ro rne
oao,s verrex {or n|p / ourrock |n oreecn presenrar|onj, rne negar|ve
pressure |s |ncreaseo, rnen rne exrracror |s pu||eo accoro|ng ro rne
rn,rnm ol rne morners conrracr|ons. Pr|or ep|s|orom, m|gnr oe
requ|reo. Tne o|recr|on ol rracr|on, as |n norma| vag|na| or lorceps
oe||ver,, |s l|rsr s||gnr|, oounuaro, rnen loruaro ano rnen s|ou|,
upuaro, lo||ou|ng rne curvarure ol rne pe|v|s. wnen one nano |s
pu|||ng, rne orner nano snou|o ne|p ro suspeno rne morners per|nea| reg|on ro prevenr lurrner per|nea| ruprure.

Tanda prosedur ekstraks| vakum gaga| :
1. Varg|u| va|ur ler|epas, rurg||r a||oal le|arar regal|l yarg |urarg, alau per|rg|alar le|arar regal|l yarg
ler|a|u cepal ser|rgga peroerlu|ar |apul su|sadereur l|da| serpurra, alau ada oag|ar jar|rgar |ou yarg lerjep|l,
alau ada |eoocorar pada a|al, alau |erurg||rar adarya d|spropors| sela|ope|v|| yarg l|da| lerdele|s| seoe|urrya.
2. 3ele|ar selergar jar d|usara|ar d||a|u|ar lra|s|, oay| oe|ur |ar|r, e|slra|s| va|ur d|ryala|ar gaga|.

R|s|ko komp||kas| :
1. R|s||o |orp|||as| |ou : perdararar, rooe|ar / lraura ja|ar |ar|r, l|slu|a, |rle|s|.
2. R|s||o |orp|||as| jar|r : e|s|or|as| |u||l |epa|a, sela|reralora / suoga|ea| reralora, re|ros|s |u||l |epa|a
PER8AL|NAN PER A00H|NAH (8E6T|0 6E8AREA}

3ecl|o cesarea ada|ar sualu l|rda|ar oarluar persa||rar d| rara jar|r d||ar|r|ar re|a|u| sualu |rs|s| pada d|rd|rg
perul dar d|rd|rg ulerus.

8yarat :
1. ulerus da|ar |eadaar ulur (|arera pada secl|o cesarea, ulerus a|ar d||rs|s|). J||a lerjad| ruplura uler|, ra|a
operas| yarg d||a|u|ar ada|ar |aparolor|, dar l|da| d|seoul seoaga| secl|o cesarea, res||pur perge|uarar jar|r juga
d||a|u|ar per aodor|rar.
2. 8eral jar|r d| alas 500 grar.

|nd|kas| :
Pr|rs|p : 1) |eadaar yarg l|da| rerurg||r|ar
jar|r d||ar|r|ar per vag|rar, dar/alau 2)
|eadaar gaWal darural yarg rerer|u|ar
perga|r|rar |erar||ar / persa||rar segera, yarg
l|da| rurg||r rerurggu |erajuar persa||rar
per vag|rar secara l|s|o|og|s.
1. lrd||as| |ou : parggu| serp|l aoso|ul, luror-
luror ja|ar |ar|r yarg rer|rou||ar ooslru|s|,
sleros|s serv||s / vag|ra, p|aserla prev|a,
d|spropors| sela|ope|v||, ruplura uler| reroa|al.
2. lrd||as| jar|r : |e|a|rar |ela|, pro|aps
la||pusal, gaWal jar|r.

ururrya secl|o cesarea l|da| d||a|u|ar pada
|eadaar jar|r ral|, |ou syo| / arer|a oeral yarg
oe|ur leralas|, alau pada jar|r dergar |e|a|rar
|orger|la| rayor yarg oeral.

erdasarkan |ns|s| | tekn|k yang d||akukan,
terdapat beberapa jen|s sect|o cesarea :
1. sect|o cesar|a k|as|k : |rs|s| aodorer verl||a|
d| gar|s red|ar, |erud|ar |rs|s| ulerus juga
verl||a| d| gar|s red|ar. 0||a|u|ar pada |eadaar
yarg l|da| rerurg||r|ar |rs|s| d| segrer
oaWar ulerus r|sa|rya a||oal per|e|alar pasca
operas| seoe|urrya alau pasca |rle|s|, alau ada
luror d| segrer oaWar ulerus, alau jar|r oesar
da|ar |ela| ||rlarg, alau p|aserla prev|a dergar
|rsers| d| d|rd|rg depar segrer oaWar ulerus.
Korp|||as|rya ada|ar perdararar yarg lerjad|
a|ar sargal oarya| |arera jar|rgar segrer
alas |orpus uler| sargal vas|u|ar.
2. sect|o cesarea transper|tonea||s profunda :
|rs|s| aodorer verl||a| d| gar|s red|ar (alau
dapal juga ror|sorla| rerg||ul| gar|s |orlur |u||l
d| daerar suprapuo||), |erud|ar p||ca
ves|couler|ra d|gurl|rg dar d|s|s|r|ar, |erud|ar
d|oual |rs|s| pada segrer oaWar ulerus d| oaWar |r|sar p||ca yarg |erud|ar d||eoar|ar secara lurpu| dergar arar
ror|sorla|. 3egrer oaWar ulerus re|al|l |urarg vas|u|ar d|oard|rg|ar |orpus uler|, ser|rgga d|rarap|ar perdararar
yarg lerjad| l|da| seoeral d|oard|rg|ar pada secl|o cesarea cara ||as|| - 0AV8AR -
3. sect|o cesarea yang d||anjutkan dengan h|sterektom| (cesarean hysterectomy}.
4. sect|o cesarea transvag|na|.

R|s|ko komp||kas| :
1. Korp|||as| |ou : perdararar oarya|, |rle|s|, per|e|alar orgar-orgar pe|v|s pascaoperas|.
2. Korp|||as| jar|r : depres| susurar saral pusal jar|r a||oal pergguraar ooal-ooalar aresles|a (lela| rarcos|s).

Senera| proceoures ol a oeep-rransper|ronea| cesarean-secr|on oe||ver, . /. verr|ca| m|o||ne |nc|s|on ol rne sk|n
oerueen rne umo|||cus ano rne puo|c s,mpn|s|s, lo||oueo u|rn |a,er-o,-|a,er separar|on ol rne suocuraneous lar,
musc|e, lasc|a ano per|roneum ol rne aooom|na| ua||. 3. /lrer rne grav|o urerus |s exposeo, rne per|ronea| sneer
oerueen rne anrer|or ua|| ol rne urerus ano rne upper / posrer|or ua|| ol rne ur|nar, o|aooer |s |oenr|l|eo ano cur, ano
rnen separareo. Tne |ouer m|o||ne reg|on ol rne anrer|or urer|ne ua|| |s rnen cur u|rn a sma|| snarp |nc|s|on. 0. Tnrougn
rne sma|| |nc|s|on, rne urer|ne ua|| |s o|v|oeo lurrner |arera||, us|ng rne operarors l|ngers. Tne amn|or|c memorane |s
rnen cur ro ga|n access ro rne urer|ne cav|r,. 0. 0e||ver, ol rne oao, ano rne p|acenra. E & F. 0|os|ng repa|r ol rne
urer|ne ua||, us|ng oouo|e / ruo-|a,er surures recommenoeo. Tne o|eeo|ng |n rne urer|ne cav|r, musr oe conrro||eo l|rsr
oelore rnese repa|rs. S. 0|os|ng repa|r ol rne per|roneum, lo||oueo u|rn |a,er-o,-|a,er c|osure ol rne aooom|na| ua||.
EHR|0T0H|

Eror|olor| ada|ar sualu l|rda|ar oarluar persa||rar dergar cara rerusa| alau rerolorg oag|ar-oag|ar luour
jar|r agar dapal |ar|r pervag|rar, larpa re|u|a| |ou.

Terdapat beberapa jen|s t|ndakan embr|otom| :
Kran|otom|
rerper|ec|| u|urar |epa|a jar|r dergar cara re|uoarg| lerg|ora| |epa|a jar|r dar rerge|uar|ar |s|rya, ser|rgga
jar|r dapal dergar rudar |ar|r pervag|rar.
0ekap|tas|
rer|sar|ar |epa|a jar|r dar| luour secara rerolorg |erer jar|r
K|e|dotom|
reralar|ar salu alau dua lu|arg ||av||u|a jar|r urlu| rerper|ec|| ||rg|arar oaru.
Ev|seras| | eksenteras|
rerusa| d|rd|rg aodorer / lora|s jar|r dar rerge|uar|ar orgar-orgar v|scera.
8pond||otom|
rerolorg ruas-ruas lu|arg oe|a|arg jar|r.
Punks|
rerge|uar|ar ca|rar dar| luour jar|r.

|nd|kas| embr|otom|
Pr|ns|p utama : jan|n mat|
1. Jar|r ral| dergar |eadaar gaWaldarural / oaraya pada |ou, ser|rgga per|u segera d||e|uar|ar larpa
rerurg||r|ar rerurggu |erajuar proses persa||rar secara l|s|o|og|s.
2. Jar|r ral| yarg l|da| rurg||r |ar|r sporlar pervag|rar.
Pengecua||an : jan|n h|dup, pada keadaan :
1. l|drosela|us, r|drops lela||s, j||a |rg|r d||a|u|ar pur|s|.
2. J||a |rg|r d||a|u|ar ||e|dolor|, dapal juga pada jar|r r|dup.

K0NTRA|N0|KA8| : JAN|N h|0UP
(|ecua|| pada |ord|s| pergecua||ar lerseoul d| alas)

8yarat :
1. Korjugala vera parggu| |ou |eo|r oesar dar| cr.
2. Perou|aar serv||s |eo|r dar| Z cr (seoa||rya |erg|ap.
3. 3e|apul |eluoar sudar pecar alau d|pecar|ar.
1. T|da| ada luror / ooslru|s| ja|ar |ar|r.
5. (pada jar|r ral|) : Keadaar jar|r ral| rarus d|pasl||ar.

0/T/T/h .
Proseour / gamoar-gamoar emor|orom| r|oak |kur o|muar, karena seoeru|n,a oera|| rekn|k emor|orom| r|oak rermasuk oanan ,ang o|aarkan kepaoa ko-as.
ra|au mau ranu / ||nar2, s||akan oaca ouku aar l|mu reo|oanan, l|mu 3eoan reo|oanan arau w||||ams Dosrerr|cs.
PENATALAK8ANAAN PER0ARAhAN PA86APER8AL|NAN

Pr|ns|p :
1. o||a seorarg |ou oersa||r rerga|ar| perdararar sele|ar ara| |ar|r, perlara-lara d|p|||r|ar oarWa perdararar
lerseoul oerasa| dar| relers|o p|aserla alau p|aserla |ar|r l|da| |erg|ap.
2. 8||a p|aserla le|ar |ar|r |erg|ap dar |orlra|s| ulerus oa||, dapal d|pasl||ar oarWa perdararar lerseoul oerasa| dar|
per|u|aar pada ja|ar |ar|r.
3. Kore|s| yarg oerar ada|ar VEN0lENTlKAN 3uV8ER PER0ARAlAN. usara aWa| urlu| rerperlarar|ar
rerod|rar|| dapal dergar cara lrarslus|, lap| suroer perdararar rarus d|car|, d|leru|ar dar d|largar|, urlu|
rergrerl||ar perdararar.

Tenrang peroaranan pasca persa||nan . aoa ku||ann,a seno|r|
P|asenra manua|, 3ranor-/noreus, kompres| o|manua|, pemasangan
rampon urerovag|na|, n|srerekrom|, oaca seno|r| ,aa.
LUKA | R0EKAN JALAN LAh|R
Robekan vag|na | vu|va | per|neum

Kerurg||rar el|o|og| r|sa|rya :
1. |epa|a jar|r ler|a|u cepal |ar|r.
2. p|rp|rar persa||rar l|da| seoaga|rara resl|rya.
3. seoe|urrya lerdapal oarya| jar|rgar parul pada
per|reur.
1. persa||rar dergar d|slos|a oaru.
5. |rs|s| ep|s|olor| yarg ler|a|u jaur, alau seoa|||rya,
ler|a|u |ec||.

Jen|s robekan per|neum berdasarkan |uasnya :
1. rooe|ar per|reur l|rg|al l : rooe|ar rarya lerjad|
pada ru|osa vag|ra, dergar alau larpa rerooe|
|u||l per|reur / vu|va oag|ar depar.
2. rooe|ar per|reur l|rg|al ll : rooe|ar lerjad| pada
ru|osa vag|ra (dergar / larpa rerooe| |u||l
per|reur / vu|va oag|ar depar) dar r.per|re|
lrarsversa||s, larpa rerooe| r.sl|rgler ar|.
3. rooe|ar per|reur l|rg|al lll - lv : rooe|ar lerjad|
pada se|urur per|reur sarpa| rergera| olol-olol
sl|rgler ar| dar rurg||r juga seoag|ar oesar d|rd|rg re|lur d|sla| (d|seoul juga ruplura per|re| lola||s).
(ruplura per|re| lola||s d| oeoerapa |epusla|aar yarg oeroeda d|seoul seoaga| lerrasu| da|ar rooe|ar derajal lll,
alau lv).

Pr|ns|p reparas| robekan per|neum :
1. reparas| ru|a-ru|a dar| l|l|| parg|a| rooe|ar d|
seoe|ar da|ar / pro|s|ra|, |e arar |uar / d|sla|.
2. jar|lar |ap|s der| |ap|s, |ap|s da|ar |erud|ar
|ap|s |uar.

R|s||o |orp|||as| : perdararar, |rle|s|, reralora, l|slu|a.
Robekan serv|ks

Rooe|ar serv||s dapal lerjad| pada :
1. parlus pres|p|lalus (persa||rar ler|a|u cepal).
2. lraura |arera a|al-a|al oarlu persa||rar
3. pada Wa|lu persa||rar |a|a ll, perou|aar oe|ur |erg|ap.
1. parlus |ara d|serla| edera serv||s, ser|rgga serv||s rapur dar rudar rooe|.

R|s||o |orp|||as| :
1. |orp|||as| segera : perdararar, dapal reryeoao|ar syo| sarpa| |eral|ar.
2. |orp|||as| jarg|a parjarg : lerjad| |r|orpelers| serv||s, dapal reryeoao|ar juga |rlerl|||las se|urder.

Pr|ns|p penjah|tan robekan serv|ks :
1. reparas| ru|a-ru|a dar| l|l|| parg|a| rooe|ar d| seoe|ar da|ar / pro|s|ra|, |e arar |uar / d|sla|.
2. jar|lar dapal se|ap|s, lap| j||a da|ar, d||a|u|ar |ap|s der| |ap|s, |ap|s da|ar |erud|ar |ap|s |uar.
Robekan vag|na bag|an da|am | robekan forn|ks (ko|poreks|s}

Ko|pore|s|s ada|ar sualu |eadaar d| rara lerjad| rooe|ar pada oag|ar alas / da|ar vag|ra (reg|o lorr|ces) ser|rgga
seoag|ar serv||s uler| dar rurg||r seoag|ar ulerus ler|epas dar| vag|ra.
Rooe|ar yarg lerjad| dapal rerarjarg alau re||rlarg.

Et|o|og| :
1. parlus dergar d|spropors| sela|ope|v||
2. parlus ler|a|u cepal
3. lraura Wa|lu rar|pu|as| / e|sp|oras| ja|ar |ar|r (r|sa|rya Wa|lu rerge|uar|ar p|aserla secara rarua|)
1. ruourgar se|sua| / co|lus yarg |asar d|serla| dergar |e|erasar alau rerggura|ar oerda-oerda lajar.

Perala|a|saraar : e|sp|oras| dar reparas| segera dergar cara |aparolor|.
Ruptura uter|

Ruplura uler| ada|ar |ejad|ar rooe|rya d|rd|rg ulerus.

Jer|s ruplura uler| oerdasar|ar |erurg||rar el|o|og| :
1. ruplura uler| sporlar : lerjad| sporlar pada |eadaar d| rara lerdapal peryu||l pada persa||rar, r|sa|rya |e|a|rar
|ela| / preserlas| jar|r, d|spropors| sela|ope|v||, |orlra|s| ulerus oer|eo|rar r|sa|rya a||oal |rdu|s| / sl|ru|as|
ulerolor||, dso
2. ruplura uler| lraural|| : lerjad| a||oal lraura l|s|| pada ulerus, r|sa|rya |arera dororgar / le|arar pada ulerus
saal persa||rar, pergguraar a|al-a|al oedar ooslelr| yarg lraural||, p|aserla rarua|, |ece|a|aar (lraura lurpu|
alau lraura lerous aodorer), dso.
3. ruplura uler| |arera |o|us r|ror|s : lerjad| |arera adarya |o|us r|ror|s pada ulerus, r|sa|rya ada jar|rgar parul
oe|as operas| seoe|urrya, r|ora uler|, dso.

Jer|s ruplura uler| oerdasar|ar rooe|ar |ap|sar ulerus :
1. ruplura uler| |r|orp||l : rarya d|rd|rg ulerus yarg rooe|, sedarg|ar |ap|sar serosa / per|loreur |orpus uler| lelap
ulur, ser|rgga |s| |orseps| ras|r lerdapal d| da|ar ulerus. 0apal oer|arjul rerjad| ruplura |orp||l.
2. ruplura uler| |orp||l : rooe|ar lerjad| pada d|rd|rg ulerus sarpa| per|loreur, ser|rgga |s| |orseps| dapal |e|uar |e
da|ar rorgga perul.

Ceja|a :
1. geja|a aWa| / reroa|al : r|s |ual lerus-rererus, rasa ryer| reoal d| aodorer oaWar, ryer| Wa|lu d|serlur /
d|le|ar, ge||sar, le|arar darar, rad| dar perrapasar rer|rg|al.
2. segera sele|ar lerjad| ruplur, dapal d|jurpa| geja|a-geja|a a|ul aodorer, |eadaar urur rerouru| dapal sarpa|
syo|, dar pada ruplur lola| dapal d|raoa oag|ar luour jar|r yarg |e|uar dar| |avur uler| |e da|ar rorgga aodorer.
3. j||a ruplur le|ar oer|argsurg |ara, rurg||r lerjad| releor|srus dar delars rus|u|ar aodorer, ser|rgga oag|ar
luour jar|r su||l d|raoa.

Penata|aksanaan :
Laparolor| segera, d|serla| dergar peroer|ar o|s|ger, |rlus dar/alau lrarslus| darar. Tujuarrya ada|ar
rerye|aral|ar ryaWa |ou (lerulara, |arera |erurg||rar oesar jar|r segera rer|rgga|) dar j||a jar|r ras|r r|dup,
urlu| rerye|aral|ar ryaWa jar|r.

0/T/T/h .
ru||an |n| nan,a penganrar / |nrroouks|.
/oa oan,ak aspek2 oeoan oosrerr| |a|nn,a ,ang r|oak o|oanas o| s|n|, m|sa|n,a persa||nan sungsang {aoa ku||ann,a
seno|r|j, p|asenra manua|, n|srerekrom|, oso oso oso - ka|o rerrar|k, s||akan car| / oaca seno|r|.

3aca uga moou| "$/FE VDTlERlDD0" oag|an Perro|ongan Dosrerr|k Esens|a| romprenens|l
Anestes|a | Ana|ges|a
da|am 0bstetr| C|neko|og|
Ku||ah ANE8TE8|0L0C|
dr. Adj| 8untoro | dr. Cunawarman asuk|
PER8|APAN PRE0PERA8| | PREANE8TE8| (PRE-0P V|8|T}

Tujuan
1. rergera| pas|er, rergelaru| rasa|ar saal |r|, rergelaru| r|Wayal perya||l daru|u serla |eadaar / rasa|ar yarg
rurg||r reryerla| pada saal |r|.
2. rerc|pla|ar ruourgar do|ler-pas|er
3. reryusur rercara perala|a|saraar seoe|ur, se|ara dar sesudar aresles| / operas|
1. |rlorred corserl

Pen||a|an catatan med|k (chart rev|ew}
1. Veroeda|ar rasa|ar ooslelr| / g|re|o|og| dergar rasa|ar ror-ooslelr| yarg lerjad| pada |erar||ar.
2. Jer|s operas| yarg d|rercara|ar
3. |rd||as| / |orlra|rd||as|
1. ada/l|da| |erurg||rar lerjad|rya |orp|||as|, la|lor peryu||l
5. ooal-ooalar yarg perrar / sedarg / a|ar d|oer||ar urlu| rasa|ar saal |r| yarg |erurg||rar dapal oer|rlera|s|
dergar ooal / prosedur aresles|
. ras||-ras|| perer||saar perurjarg / |aooralor|ur yarg d|per|u|ar

Pemer|ksaan pas|en
Ararres|s : perl|rg rergurpu||ar dala laroarar lerlarg r|Wayal perya||l yarg dapal rerjad| peryu||l / la|lor
r|s||o l|rda|ar aresles| (asra, r|perlers|, perya||l jarlurg, perya||l g|rja|, gargguar peroe|uar darar, dso), r|Wayal
operas| / aresles| seoe|urrya, r|Wayal a|erg|, r|Wayal pergooalar, |eo|asaar rero|o| / a||oro| / ooal-ooalar.
Perer||saar l|s|| : l|rgg| / oeral oadar, larda v|la| |erg|ap, |epa|a / |erer (perral|ar Klu3u3 pada ru|ul / g|g| / TlT
/ sa|urar rapas alas, urlu| a|rWay ra|rlerarce se|ara aresles| / operas|), jarlurg / paru / aodorer / e|slrer|las.
Pada |asus ooslelr| / |asus ror-ooslelr| da|ar |erar||ar, perl|rg d||a|u|ar : perer||saar ooslelr| (ururrya le|ar
d||a|u|ar o|er do|ler ooslelr|), perarlauar |esejarleraar jar|r (dergar lela| ror|lor|rg).

Henetapkan rencana anestes|
1. Korsu|las| dergar do|ler yarg a|ar re|a|u|ar l|rda|ar ooslelr||.
2. Perje|asar |epada pas|er : relode, |erurg||rar r|s||o, cara, pers|apar (d|el, puasa, prered||as|), peru||rar,
dso.

PEhTlhS 0lrET/lul . F/RV/rDlDSl D3/T-D3/T
{ureroron|k / roko||r|k, vasopresor / vasoo||aror, , anesres|, ana|ges|, musc|ere|axanr, osoj
unruk oera|| n,a, oaca seno|r| ,aaaaa |||.
ANE8TE8|A | ANALCE8|A UNTUK KA8U8 08TETR|
Pert|mbangan : F|s|o|og| Keham||an | Persa||nan (Haterna| Phys|o|ogy}

8|stem pernapasan
Peruoarar pada lurgs| pu|rora|, verl||as| dar perlu|arar gas. Furcl|ora| res|dua| capac|ly rerurur sarpa| 15-20,
cadargar o|s|ger juga oer|urarg. Pada saal persa||rar, |eoulurar o|s|ger (oxyger derard) rer|rg|al sarpa|
100.
Verje|arg / da|ar persa||rar dapal lerjad| gargguar / suroalar ja|ar rapas pada 30 |asus, reryeoao|ar
perururar Pa02 yarg cepal pada Wa|lu d||a|u|ar |rdu|s| aresles|, res|upur dergar d|serla| der|lrogeras|.
verl||as| per rer|l rer|rg|al sarpa| 50, rerurg||r|ar d||a|u|arrya |rdu|s| aresles| yarg cepal pada War|la
rar||.

8|stem kard|ovasku|ar
Per|rg|alar |s| se|urcup / slro|e vo|ure sarpa| 30, per|rg|alar lre|uers| deryul jarlurg sarpa| 15,
per|rg|alar curar jarlurg sarpa| 10. vo|ure p|asra rer|rg|al sarpa| 15 sererlara jur|ar er|lros|l rer|rg|al
rarya sarpa| 25, reryeoao|ar lerjad|rya d||ul|ora| arer|a ol pregrarcy.
Ves||pur lerjad| per|rg|alar |s| dar a|l|l|las s|r|u|as|, pere|arar / |orpres| vera cava |rler|or dar aorla o|er rassa
ulerus grav|d dapal reryeoao|ar lerjad|rya sup|re ryperlers|or syrdrore. J||a l|da| segera d|dele|s| dar d||ore|s|,
dapal lerjad| perururar vas|u|ar|sas| ulerus sarpa| asl||s|a jar|r.
Pada persa||rar, |orlra|s| ulerus / r|s reryeoao|ar lerjad|rya aulolrarslus| dar| p|aserla seoesar 300-500 cc
se|ara |orlra|s|. 8eoar jarlurg rer|rg|al, curar jarlurg rer|rg|al, sarpa| 80.
Perdararar yarg lerjad| pada parlus pervag|rar rorra| oervar|as|, dapal sarpa| 100-00 cc. Pada secl|o cesarea,
dapal lerjad| perdararar sarpa| 1000 cc. Ves||pur der|||ar jararg d|per|u|ar lrarslus|. la| |lu |arera se|ara
|erar||ar rorra| lerjad| juga per|rg|alar la|lor peroe|uar vll, vlll, X, Xll dar l|or|roger ser|rgga darar oerada
da|ar rypercoagu|ao|e slale.

C|nja|
A||rar darar g|rja| dar |aju l||lras| g|oreru|us rer|rg|al sarpa| 150 pada lr|resler perlara, rarur rerurur
sarpa| 0 d| alas rorpregrarl slale pada saal |erar||ar alerr. la| |r| |erurg||rar d|seoao|ar o|er a|l|l|las
rorror progesleror.
Kadar |real|r|r, urea dar asar ural da|ar darar rurg||r rerurur rarur ra| |r| d|arggap rorra|.
Pas|er dergar pree||arps|a rurg||r oerada da|ar proses reruju |egaga|ar lurgs| g|rja| res||pur perer||saar
|aooralor|ur rurg||r rerurju||ar r||a| rorra|.

ulerus grav|d reryeoao|ar per|rg|alar le|arar |rlragaslr|| dar peruoarar sudul gaslroesopragea| jurcl|or,
ser|rgga rer|rg|al|ar |erurg||rar lerjad|rya regurg|las| dar asp|ras| pu|rora| |s| |arourg. 3ererlara |lu lerjad|
juga per|rg|alar se|res| asar |arourg, perururar lorus sl|rgler esopragus oaWar serla per|aroalar pergosorgar
|arourg. Erz|r-erz|r ral| pada |erar||ar rorra| sed|||l rer|rg|al.
Kadar |o||reslerase p|asra rerurur sarpa| se||lar 28, rurg||r a||oal rerod||us| dar perururar s|rles|s. Pada
peroer|ar su|s|r|||o||r dapal lerjad| o|o|ade reurorus|u|ar urlu| Wa|lu yarg |eo|r |ara.
Larourg lARu3 se|a|u d|cur|ga| perur oer|s| oarar yarg oeroaraya (asar |arourg, ra|arar) larpa rerardarg
|apar Wa|lu ra|ar lera|r|r.

8|stem saraf pusat
A||oal per|rg|alar erdorpr|r dar progesleror pada War|la rar||, |orserlras| ooal |rra|as| yarg |eo|r rerdar cu|up
urlu| rercapa| aresles|a; |eoulurar ra|olar rerurur sarpa| 25, |sol|urar 10, relo|s|l|urar 32. Pada
aresles| ep|dura| alau |rlrale|a| (sp|ra|), |orserlras| areslel|| |o|a| yarg d|per|u|ar urlu| rercapa| aresles| juga
|eo|r rerdar. la| |r| |arera pe|eoarar vera-vera ep|dura| pada |erar||ar reryeoao|ar ruarg suoara|rro|d dar
ruarg ep|dura| rerjad| |eo|r serp|l.
Fa|lor yarg rererlu|ar ya|lu per|rg|alar sers|l|l|las seraoul saral a||oal rer|rg|alrya |erarpuar d|lus| zal-zal
areslel|| |o|a| pada |o|as| rerorar reseplor (errarced d|llus|or).

Transfer obat dar| |bu ke jan|n me|a|u| s|rku|as| p|asenta
Juga rerjad| perl|roargar, |arera ooal-ooalar aresles|a yarg ururrya rerupa|ar depresar, dapal juga
reryeoao|ar depres| pada jar|r. larus d|arggap oarWa 3EVuA ooal dapal re||rlas| p|aserla dar rercapa|
s|r|u|as| jar|r. (oaca juga calalar spec|a| aspecls ol per|rala| prarraco|ogy)
T|ndakan Anestes| | Ana|ges| Reg|ona|

Ana|ges| | b|ok ep|dura| (|umba|} : ser|rg d|gura|ar urlu| persa||rar per vag|rar.
Anestes| ep|dura| atau sp|na| : ser|rg d|gura|ar urlu| persa||rar per aodor|rar / secl|o cesarea.

Keuntungan :
1. Vergurarg| pera|a|ar rar|ol|| s|sler|| ser|rgga |ejad|ar depres| jar|r dapal d|cegar / d||urarg|.
2. lou lelap da|ar |eadaar sadar dar dapal oerparl|s|pas| a|l|l da|ar persa||rar.
3. R|s||o asp|ras| pu|rora| r|r|ra| (d|oard|rg|ar pada l|rda|ar aresles| urur)
1. J||a da|ar perja|ararrya d|per|u|ar secl|o cesarea, ja|ur ooal aresles|a reg|ora| sudar s|ap.

Kerug|an :
1. l|polers| a||oal vasod||alas| (o|o| s|rpal|s)
2. wa|lu ru|a |erja (l|re ol orsel) |eo|r |ara
3. Kerurg||rar lerjad| sa||l |epa|a pasca pur|s|.
1. urlu| persa||rar per vag|rar, sl|ru|us ryer| dar |orlra|s| dapal rerurur, ser|rgga |erajuar persa||rar dapal
rerjad| |eo|r |aroal.

Kontra|nd|kas| :
1. Pas|er rero|a| 5. 3eps|s
2. lrsul|s|ers| ulero-p|aserla . 0argguar peroe|uar
3. 3yo| r|povo|er|| Z. Ke|a|rar 33P lerlerlu
1. lrle|s| / |rl|aras| / luror pada |o|as| |rje|s|

Tekn|k :
1. Pasarg ||re |rlus dergar d|areler oesar, oer||ar 500-1000 cc ca|rar |r|sla|o|d
(R|rgerLa|lal).
2. 15-30 rer|l seoe|ur aresles|, oer||ar arlas|da
3. 0oservas| larda v|la|
1. Ep|dura| : pos|s| pas|er |alera| de|uo|lus alau
dudu| rerourg|u|, d||a|u|ar pur|s| arlara
verleora L2-L5 (ururrya L3-L1) dergar jarur
/ lro|ard. Ruarg ep|dura| d|capa| dergar
perasaar r||argrya lararar pada saal jarur
rererous ||garerlur l|avur.
5. 8p|na| | subarakno|d : pos|s| |alera|
de|uo|lus alau dudu|, d||a|u|ar pur|s| arlara
L3-L1 (d| daerar cauda equ|ra redu||a sp|ra||s), dergar jarur / lro|ard. 3ele|ar rererous ||garerlur l|avur
(r||arg lararar), lusu|ar d|lerus|ar sarpa| rererous se|apul duraraler, rercapa| ruargar suoara|ro|d.
lderl|l||as| ada|ar dergar |e|uarrya ca|rar cereorosp|ra|, j||a sly|el d|lar|| per|arar-|arar.
. Kerud|ar ooal areslel|| d||rje|s||ar |e da|ar ruarg ep|dura| / suoara|ro|d.
Z. Keoerras||ar aresles| d|uj| dergar les sersor|| pada daerar operas|, rerggura|ar jarur ra|us alau |apas.
8. J||a d|pa|a| |aleler urlu| aresles|, d||a|u|ar l||sas|. 0aerar pur|s| d|lulup dergar |asa dar p|esler.
9. Kerud|ar pos|s| pas|er d|alur pada pos|s| operas| / l|rda|ar se|arjulrya.

0bat anestet|k yang d|gunakan : ||doca|r 1-5, cr|orproca|r 2-3 alau oup|vaca|r 0.25-0.Z5. 0os|s yarg d|pa|a|
urlu| aresles| ep|dura| |eo|r l|rgg| dar|pada urlu| aresles| sp|ra|.

Komp||kas| yang mungk|n terjad| :
1. J||a lerjad| |rje|s| suoara|rro|d yarg l|da| d||elaru| pada rercara aresles| ep|dura|, dapal lerjad| lola| sp|ra|
areslres|a, |arera dos|s yarg d|pa|a| |eo|r l|rgg|. 0eja|a oerupa rausea, r|polers| dar |er||argar |esadarar, dapal
sarpa| d|serla| rerl| rapas dar rerl| jarlurg. Pas|er rarus d|alur da|ar pos|s| le|erlarg / sup|re, dergar ulerus
d|geser |e ||r|, d||a|u|ar verl||as| 02 100 dergar ras| d|serla| pere|arar lu|arg cr|co|d, |erud|ar d||a|u|ar
|rluoas|. l|polers| d|largar| dergar reroer||ar ca|rar |rlravera dar epredr|re.
2. lrje|s| |rlravas|u|ar d|larda| dergar gargguar perg||ralar, l|r|lus, dar |er||argar |esadarar. Kadarg lerjad| juga
serargar |ejarg. larus d||a|u|ar |rluoas| pada pas|er, rerggura|ar 1.0 - 1.5 rg/|g88 su|s|r|||o||r, dar d||a|u|ar
r|perverl||as| urlu| rergalas| as|dos|s relaoo|||.
3. Korp|||as| reuro|og|| yarg ser|rg ada|ar rasa sa||l |epa|a sele|ar pur|s| dura. Terap| dergar |sl|raral oar|rg lola|,
r|dras| (>3 L/rar|), ara|ges||, dar perg||al / |orsel perul (aodor|ra| o|rder).
T|ndakan Anestes| Umum

T|rda|ar aresles| urur d|gura|ar urlu| persa||rar per aodor|rar / secl|o cesarea.

|nd|kas| :
1. 0aWal jar|r.
2. Ada |orlra|rd||as| alau |eoeralar lerradap aresles|a reg|ora|.
3. 0|per|u|ar |eadaar re|a|sas| ulerus.

Keuntungan :
1. lrdu|s| cepal.
2. Pergerda||ar ja|ar rapas dar perrapasar opl|ra|.
3. R|s||o r|polers| dar |rslao|||las |ard|ovas|u|ar |eo|r rerdar.

Kerug|an :
1. R|s||o asp|ras| pada |ou |eo|r oesar.
2. 0apal lerjad| depres| jar|r a||oal pergarur ooal.
3. l|perverl||as| pada |ou dapal reryeoao|ar lerjad|rya r|po|ser|a dar as|dos|s pada jar|r.
1. Kesu||lar re|a|u|ar |rluoas| lelap rerupa|ar peryeoao ulara rorla||las dar roro|d|las ralerra|.

Tekn|k :
1. Pasarg ||re |rlus dergar d|areler oesar, arlas|da d|oer||ar 15-30 rer|l seoe|ur operas|, ooservas| larda v|la|,
pas|er d|pos|s||ar dergar ulerus d|geser / d|r|r|rg|ar |e ||r|.
2. 0||a|u|ar preo|s|geras| dergar 02 100 se|ara 3 rer|l, alau pas|er d|r|rla re|a|u|ar perrapasar da|ar
seoarya| 5 sarpa| 10 |a||.
3. 3ele|ar reg|o aodorer d|oers|r|ar dar d|pers|ap|ar, dar operalor s|ap, d||a|u|ar |rdu|s| dergar 1 rg/|g88
l|operla| dar 1.5 rg/|g88 su|s|r|||o||r.
1. 0||a|u|ar pere|arar |r||o|d, d||a|u|ar |rluoas|, dar oa|or p|pa erdolra|ea| d||eroarg|ar. 0|a||r|ar verl||as|
dergar le|arar pos|l|l.
5. 02-N20 50-50 d|oer||ar re|a|u| |rra|as|, dar su|s|r|||o||r d||rje|s||ar re|a|u| |rlus. 0apal juga d|laroar|ar
|rra|as| 1.0 erl|urar, 0.Z5 |sol|urar, alau 0.5 ra|olar, sarpa| jar|r d||ar|r|ar, urlu| rercegar |ou oargur.
. 0oal |rra|as| d|rerl||ar sele|ar la|| pusal d|jep|l, |arera ooal-ooal lerseoul dapal reryeoao|ar alor|a uler|.
Z. 3ele|ar |lu, urlu| ra|rlerarce aresles| d|gura|ar le|r|| oa|ars (N20/rar|ol||/re|a|sar), alau j||a ada r|perlers|,
areslel|| |rra|as| yarg |ual juga dapal d|gura|ar dergar |orserlras| rerdar.
8. E|sluoas| d||a|u|ar sele|ar pas|er sadar.
9. (calalar) J||a lerjad| r|perlorus ulerus, sererlara d|per|u|ar re|a|sas| ulerus yarg opl|ra|, ra| |r| rerjad| |rd||as|
urlu| |rdu|s| cepal dar pergguraar areslel|| |rra|as|.
0/T/T/h .
Paoa kasus-kasus oosrerr| paro|og| ,ang memer|ukan ooar-ooaran / penanganan meo|k se|a|n anesres|, o|oer|kan seoaga|mana senarusn,a.
0onron .
'. paoa pre-ek|amps|a, o|oer|kan uga vasoo||aror, magnes|umsu|lar.
2. paoa |nleks| arau kemungk|nan |nleks|, o|oer|kan anr|o|or|ka.
J. paoa keaoaan umum / ranoa v|ra| ,ang ouruk, m|sa|n,a s,ok, n|poks|a, o|rara|aksana oengan oks|gen, ca|ran, ooar2an, oan seoaga|n,a.
ANE8TE8|A | ANALCE8|A UNTUK 0PERA8| N0N-08TETR|
PA0A HA8A KEhAH|LAN (N0N-08TETR|6AL 8URCERY 0UR|NC PRECNAN6Y}

3e||lar 1-5 War|la rar|| rerga|ar| rasa|ar yarg l|da| oerruourgar secara |argsurg dergar |erar||arrya, yarg
rerer|u|ar l|rda|ar operas| (r|sa|rya : lraura, apperd||s|l|s, dso dso).

Vorla||las / roro|d|las ralerra| : l|da| oeroeda s|gr|l||ar dergar l|rda|ar aresles| / operas| pada War|la yarg l|da|
rar||.
Vorla||las / roro|d|las per|rala| : LE8ll TlN00l s|gr|l||ar, arlara 5-35.

Pada |asus gaWal darural, rorla||las ralerra| dar per|rala| 3AN0AT TlN00l (||ral calalar raragererl ol |rjured
pregrarl pal|erl).

Pert|mbangan t|ndakan anestes| untuk bedah non-obstetr| pada masa keham||an :
1. Kese|aralar |ou (pr|or|las ulara)
2. usara rerperlarar|ar |erar||ar
3. usara rerperlarar|ar l|s|o|og| s|r|u|as| ulero-p|aserla yarg opl|ra|
1. Percegarar sedapal rurg||r, pera|a|ar ooal-ooalar yarg rer||||| ele| depres|, ele| raroalar perlurourar
alau ele| leraloger lerradap jar|r.

Anjuran | pert|mbangan :
1. 0peras| e|e|l|l seoa||rya d|lurda sedapal rurg||r sarpa| r|rggu pascapersa||rar (sele|ar rasa r|las, d| rara
serua peruoarar l|s|o|og|s a||oal |erar||ar d|rarap|ar le|ar |eroa|| pada |eadaar rorra|).
2. 0peras| ser|-urgerl seoa||rya d|lurda sarpa| lr|resler |edua alau |el|ga.
3. Te|r|| aresles|a reg|ora| (lerulara sp|ra|) |eo|r d|arjur|ar, |arera paparar / exposure ooal-ooalar lerradap jar|r
re|al|l pa||rg r|r|ra|.
1. Prered||as| r|r|ra| : oaro|ral |eo|r d|arjur|ar d|oard|rg|ar oerzod|azep|r; rar|ol|| dapal d|gura|ar urlu|
ara|ges|a.
5. urlu| pas|er yarg d|rercara|ar aresles|a dergar N20, oer||ar sup|ererlas| asar lo|al (N20 dapal rergraroal
s|rles|s dar relaoo||sre asar lo|al).
. J||a operas| d||a|u|ar da|ar rasa |erar||ar, |arjul|ar perer||saar arlerala| dergar perral|ar |rusus pada lela|
rearl ror|lor|rg dar per||a|ar a|l|l|las ulerus, urlu| dele|s| |erurg||rar persa||rar prelerr pascaoperas|.
ANE8TE8|A | ANALCE8|A UNTUK KA8U8 C|NEK0L0C|

Kuretase

urlu| l|rda|ar |urelase, d|gura|ar :
1. ara|gel||a (pelr|d|r 1-2 rg/|goo, dar/alau reuro|epl||a |elar|r lC| 0.5 rg/|goo, dar/alau lrarado| 1-2 rg/|goo)
2. sedal|va (d|azepar 10 rg)
3. alrop|r su|lal (0.25-0.5 rg/r|)
d|oer||ar re|a|u| |rlus |rlravera.
urlu| rer|rg|al|ar |orlra|s| ulerus d|gura|ar ergorelr|r ra|eal.
{oaca uga moou| "$ale Vornernooo" renrang Penunrun 3e|aar rurerase {PDErjj
Laparotom| operas| g|neko|og|

urlu| operas| g|re|o|og| dergar |aparolor|, d|gura|ar aresles|a urur.
Laparoskop|

urlu| l|rda|ar |aparos|op|, d|per|u|ar |eadaar |rusus :
1. Perg|s|ar rorgga aodorer dergar udara (preuroper|loreur)
2. Kadarg d|per|u|ar pos|s| Trerde|erourg e|slr|r.
3. Kadarg d|gura|ar e|e|lro|oagu|as|.

Tujuar aresles| pada |aparos|op| ada|ar :
1. rercegar per|rg|alar le|arar pars|a| C02 da|ar darar (PaC02) pada |rsul|as| aodorer dergar gas C02.
2. rergurarg| polers|a| |ejad|ar ar|l|r|a a||oal r|per|aro|a dar as|dos|s.
3. rerperlarar|ar slao|||las |ard|ovas|u|ar pada |eadaar per|rg|alar le|arar |rlraaodor|ra| yarg oesar a||oal
|rsul|as| C02 (ururrya le|arar ra|| sarpa| 20-25 crl20, dapal sarpa| 30-10 cr l20).
1. rerc|pla|ar re|a|sas| olol yarg ade|ual urlu| reroarlu l|rda|ar operas|

Perg|s|ar rorgga per|loreur dergar C02 dapal reryeoao|ar per|rg|alar PaC02 j||a perrapasar l|da|
d||erda|||ar. Ke|eo|rar C02 dapal d|alas| dergar |erda|| lre|uers| perrapasar 1.5 |a|| d| alas lre|uers| oasa|.
Per|rg|alar le|arar |rlraaodor|ra| a||oal |rsul|as| gas dapal reryeoao|ar rurlar dar asp|ras|, serla per|rg|alar
le|arar vera serlra| dar curar jarlurg se|urder a||oal red|slr|ous| serlra| vo|ure darar. Te|arar |rlraaodor|ra|
sarpa| 30-10 cr l20 seoa|||rya dapal reryeoao|ar perururar le|arar vera serlra| dar curar jarlurg dergar
cara rerurur|ar perg|s|ar jarlurg |arar.

Velode yarg d|arjur|ar ada|ar aresles| dergar N20-02 peroard|rgar Z5-25 |rra|as|, dergar areslel|| rar|ol||
dar rusc|ere|axarl. 0apal juga d|gura|ar laroarar aresles| |rra|as| da|ar |orserlras| rerdar, seperl| 0.5-1.0
|sol|urar alau erl|urar. J||a d|per|u|ar, aresles|a |o|a| o|o| reg|o per|uro||||a| dapal d||a|u|ar dergar 10-15 cc
oup|vaca|r 0.5. 3edas| r|rgar dapal d|oer||ar.
Fert|||sas| |n v|tro

urlu| asp|ras| oos|l secara |aparos|op|, d|gura|ar aresles| yarg sesua|.
urlu| asp|ras| oos|l dergar parduar u|lrasorogral|, dapal d|gura|ar aresles| |o|a| reg|o suprapuo|| dergar
oup|vaca|r 0.5 10 - 15 cc, d|serla| laroarar ara|ges| dar sedas| dergar oerzod|azep|r |oro|ras| oersara
lerlar||, reper|d|r alau rorl|r dos|s rerdar.
Resus|tas| Jantung Paru
(Ap||kas| Khusus pada wan|ta ham||}
Ku||ah ANE8TE8|0L0C|
dr. 8unatr|o | dr. |ndro Hu|jono | dr. Huhammad As'at
PENCANTAR RE8U8|TA8|

Resusc|tat|on
Tre resloral|or lo ||le or corsc|ousress ol ore apparerl|y dead ; |l |rc|udes sucr reasures as arl|l|c|a| resp|ral|or ard
card|ac rassage.

6ard|opu|monary Resusc|tat|on (6PR}
Tre arl|l|c|a| suosl|lul|or ol rearl ard |urg acl|or as |rd|caled lor card|ac arresl or apparerl sudder dealr resu|l|rg
lror e|eclr|c sroc|, droWr|rg, resp|ralory arresl, ard olrer causes.
Tre lWo rajor corporerls ol CPR are arl|l|c|a| verl||al|or ard c|osed cresl card|ac rassage.

{0or|anos l||usrrareo Veo|ca| 0|cr|onar,, 28rn eo, '994j
HENChA0AP| PA8|EN T|0AK 8A0AR

Pada pas|er l|da| sadar, ada |erurg||rar lurgs| v|la| |ard|ovas|u|ar / resp|ras| oa|| alau da|ar oalas rorra|, lelap|
lurgs| |esadarar lergarggu. Corlor ya|lu orarg l|dur alau da|ar pergarur ooal.
Kerurg||rar |a|r ada|ar lergarggurya lurgs| v|la| |ard|ovas|u|ar / resp|ras| sarpa| l|rg|al yarg cu|up oerra|ra
yarg dapal reryeoao|ar perururar |esadarar. Jad| |esadarar rerurur a||oal lergarggurya (alau lerlENTlrya
lurgs| v|la|). la| |r| rergarcar ryaWa dar dapal reryeoao|ar |eral|ar segera j||a l|da| d||a|u|ar resus|las|.

Vergradap| pas|er l|da| sadar yarg rercur|ga|ar :
per||sa respors, ade|ual alau l|da|, perral||ar
gera| rapas, raoa deryul rad|. Perer||saar larda
v|la| |r| d|seoul pr|rary survey. l|ul| juga urular
A8C0.

Lakukan resus|tas| segera.

PENT|NC d|ketahu| berbaga| def|n|s| | batasan mat| !!
Pererluar |eral|ar yarg lepal a|ar rercegar d||a|u|arrya resus|las| yarg l|da| per|u. Telap| pererluar |eral|ar
yarg sa|ar a|ar reryeoao|ar seorarg yarg rurg||r ras|r dapal d|lo|org juslru l|da| lerlo|org, |arera l|da|
d||a|u|ar resus|las|.
FA8E-FA8E RE8U8|TA8|

Pr|ns|p | kata kunc| : oks|genas| se| sampa| ke
per|fer !!

1. oas|c ||le supporl : A (a|rWay), 8 (orealr|rg), C
(c|rcu|al|or)

2. advarced ||le supporl : 0 (drugs/l|u|d), E
(e|eclrocard|ograpry), F (l|or|||al|or)

3. pro|orged ||le supporl : 0 (gaug|rg), l (rurar
rerlal|or), l (|rlers|ve care)

urlu| |eve| |o-as FKul, perl|rg rerguasa| r|r|ra|
sarpa| advarced ||le supporl.
Tap| lelap per|u rergelaru| / oaca serd|r| lerlarg
pro|orged ||le supporl sarpa| lCu.

PR|N8|P !!
PENYEA KEHAT|AN TER6EPAT A0ALAh
A8F|K8|A 0AN KECACALAN 8|RKULA8|

A. A|RwAY

Pada pas|er l|da| sadar :
||dar jalur |e oe|a|arg (orolar|rg), rerulup ja|ar rapas. A||oalrya |rla|e o|s|ger lergarggu, reryeoao|ar r|po|s|a
|arera asl||s|a.
0argguar ja|ar rapas ra||r d|peroeral dergar |el|da|rarpuar se|l-delerse recrar|sr urlu| rerge|uar|ar |erd|r
re|a|u| rel|e|s oalu| (rel|e|s-rel|e|s rerurur pada |eadaar r|po|s|a oeral).
Tarda-larda : suara rergoro| dar suara |erd|r, ras|r ada gera|ar dar raWa perrapasar (j||a ras|r ada
perrapasar), alau l|da| ada gera|ar rapas raupur raWa perrapasar (j||a perrapasar sudar oerrerl|).

La|u|ar pembebasan ja|an napas dergar Tr|p|e Varuever : r|pere|slers| |epa|a, ou|a ru|ul, arg|al dagu.
L|dar a|ar lerarg|al dar| ja|ar rapas.
Tarda-larda : suara rergoro| r||arg.
8ers|r|ar ja|ar rapas dar| ca|rar |erd|r / darar rerggura|ar a|al r|sap sucl|or (|a|au ada), alau r|r|rg|ar pos|s|
|epa|a dar oadar supaya ca|rar |erd|r / darar rerga||r |e|uar.
J||a ada, gura|ar juga a|al oarlu r|sa|rya p|pa erdolra|ea|, p|pa orolar|rg / 0uede| dar seoaga|rya, urlu|
rerperlarar|ar ja|ar rapas.

lal|-ral| pada pas|er lraura |epa|a dar |erer, JAN0AN |a|u|ar r|pere|slers| |epa|a ll
. REATh|NC

lurgs| perrapasar lergarggu, oar|ar rurg||r oerrerl|. A||oalrya juga |rla|e o|s|ger lergarggu, reryeoao|ar
r|po|s|a |arera asl||s|a.
Tarda-larda : l|da| ada gera|ar raupur raWa perrapasar

La|u|ar pernapasan buatan (art|f|c|a| breath|ng} segera.

Cara : pernapasan mu|ut-ke-mu|ut (roulr-lo-roulr orealr|rg, pada pas|er deWasa alau ara| oesar) alau
pernapasan mu|ut-ke-h|dung-mu|ut (roulr-lo-roulr/rose orealr|rg, pada pas|er oay| alau ara| |ec||).
J||a ada a|al oarlu p|pa, d||a|u|ar perrapasar ru|ul-|e-p|pa (roulr-lo-luoe orealr|rg) alau rerggura|ar a|al oarlu
oa|or resus|las| (oagg|rg). J||a ada oa|or resus|las| dar laourg o|s|ger, dapal d|ruourg|ar, supaya udara yarg
d|ler|ra perder|la |eo|r |aya o|s|ger d|oard|rg|ar udara e|sp|ras| pero|org yarg |aya |aroord|o|s|da.

Fre|uers| rapas oualar :
1. 2 |a|| rapas d| arlara 15 |a|| |orpres| jarlurg |uar (j||a pero|org 1 orarg), alau
2. 1 |a|| rapas d| arlara 5 |a|| |orpres| jarlurg |uar (j||a pero|org 2 orarg).
larus d|capa| lre|uers| rapas 10-11 |a|| per rer|l dar lre|uers| |orpres| 0-100 |a|| per rer|l, |arera lujuar
resus|las| ada|ar rerggarl||ar lurgs| resp|ras| dar s|r|u|as| l|s|o|og|s.
6. 6|R6ULAT|0N

|erurg||rar lerdapal gargguar lurgs| |ard|ovas|u|er yarg reryeoao|ar gargguar vas|u|ar|sas| |e susurar saral
pusal (ola|), a||oalrya |esadarar rerurur.
Tarda-larda : deryul rad| l|da| leraoa (arler| carol|s / lerora||s |eo|r rudar), deryul jarlurg l|da| lerdergar.

La|u|ar kompres| jantung |uar segera.
Kedua largar pero|org dergar jar|-jar| d|s||arg|ar, d||ela||ar d| alas 1/3 oaWar slerrur, |erud|ar dergar oeral
oadar pero|org, d||a|u|ar |orpres| arar verl||a| lega| |urus urlu| rerorpa jarlurg dar| |uar. larus d| alas a|as
yarg |eras dar rala.

Fre|uers| |orpres| rarus rercapa| 0-100 |a|| per rer|l. Fre|uers| rapas oualar :
1. 2 |a|| rapas d| arlara 15 |a|| |orpres| jarlurg |uar (j||a pero|org 1 orarg), alau
2. 1 |a|| rapas d| arlara 5 |a|| |orpres| jarlurg |uar (j||a pero|org 2 orarg).
larus d|capa| lre|uers| rapas 10-11 |a|| per rer|l dar lre|uers| |orpres| 0-100 |a|| per rer|l, |arera lujuar
resus|las| ada|ar rerggarl||ar lurgs| resp|ras| dar s|r|u|as| l|s|o|og|s.
TAN0A-TAN0A RE8U8|TA8| JANTUNC PARU 0|LAKUKAN A0EKUAT

1. gera| ra||-lurur dada pada saal rapas oualar ade|ual, l|da| lerdergar oury| udara oocor
2. leraoa deryul jarlurg |arol|s oersaraar dergar le|arar |orpres|
3. o||a lerpasarg EK0, larpa| ge|oroarg 0R3 pada saal |orpres|

PR|N8|P !!
ThE 8AVACE 0F L|FE PRE6E0E8 ThE 8AVACE 0F L|H8
V|sa|rya saal |orpres|, jargar |ual|r lerjad| lra|lur |ga ser|rgga le|arar |orpres| d||urarg|/d|per|erar |arera ragu-
ragu. Karera j||a |orpres| |urarg ade|ual, lujuar resus|las| l|da| lercapa| dar pas|er l|da| lerlo|org. 3ererlara,
|a|au |orpres| ler|a|u |ual dar lerjad| lra|lur |ga : lelap |arjul|ar lerus |orpres|.
Korp|||as| lra|lur |ga r|sa|rya j||a lerjad| reralo/preurolrora|s, dapal d|largar| sesudar resus|las|.
(ada |erurg||rar pas|er lelap r|dup res||pur lerjad| lra|lur |ga, dar|pada j||a resus|las| d|rerl||ar, pas|er ral|).
PEN|LA|AN RE8U8|TA8| AwAL

KEHUNCK|NAN hA8|L RE8U8|TA8| AwAL
(A6}

1. las|| e|slr|r : pas|er sadar |eroa||, alau
pas|er d|ryala|ar ral|
2. las|| d| arlararya : pas|er oe|ur sadar lelap|
oe|ur d|ryala|ar ral|
8e|ur d|ryala|ar ral|, deryul sporlar l|da| ada :
|arjul|ar 0EF
8e|ur d|ryala|ar ral|, deryul sporlar ada :
|arjul|ar raWal |rlers|l (lCu).
0. 0RUC8 AN0 FLU|08

3ed|a|ar ve|r access 2 ouar, s|ap |erurg||rar per|u
d||a|u|ar rap|d |rlus|or alau |rlraverous drugs
adr|r|slral|or.
1. oer||ar adrera||r 0.5 - 1.0 rg (deWasa), alau 10
rcg/|g88 |rlravera. F|usr/o||as dergar NaC| 0.9 10
cc, urlu| rercegar ooal lerl|rgga| d| per|vera.
2. adrera||r dapal juga d||oer||ar |rlralra|ea (adrera||r
1o 1 cc 9 cc l20)
3. u|arg| peroer|ar adrera||r l|ap 3 - 5 rer|l sarpa|
deryul jarlurg () alau sarpa| pas|er d|ryala|ar ral|
jarlurg (deryul l|da| ada, EK0 l|al).
1. oer||ar NalC03 |rlravera 1 rEq/|g88, u|arg| l|ap
10 rer|l 0.5 rEq/|g88 (o||a lerjad| card|ac arresl,
pergu|argar l|ap 2 rer|l). Tujuar ada|ar |ore|s|
as|dos|s relaoo||| secara o||rd. J||a ada las|||las
perer||saar ara||s|s gas darar c|lo, |ore|s| as|dos|s
dergar rurus 1/ x oase del|c|l x 88.

Adrera||re : c|ass l drug (del|r|le|y re|plu|)
3od|ur o|caroorale : del|r|le|y re|plu| |l lrere |s a relaoo||c ac|dos|s or ryper|a|er|a.
Recorrerded dose ard adr|r|slral|or ol adrera||re :
1. 1 rg |rlraverous pusr every 3 - 5 r|rs.
2. |rlerred|ale dose : 2 - 5 rg |rlraverous pusr every 3 - 5 r|rs.
3. esca|d|rg dose : 1 rg - 3 rg - 5 rg |rlraverous
pusr every 3 r|rs.
1. r|gr dose : 0.1 rg/|g8w |rlraverous pusr
every 3 - 5 r|rs.
E. ELE6TR06AR0|0CRAPhY

0aroarar e|e|lro|ard|ogral| yarg rerer|u|ar
|rlervers| :
- asyslo|e
- verlr|cu|ar lacrycard|a
- verlr|cu|ar l|or|||al|or
- e|eclrorecrar|c d|ssos|al|or

Asyslo|e :
1. u|arg| (0)
2. laroar|ar Ca-g|u|oras 10 1000 rg dar CaC|2 10 500 rg/Z0|g88,
3. u|arg l|ap 10 rer|l.
1. |a|r-|a|r : vasopresor

3u|las alrop|r, d|oer||ar dergar dos|s :
- as|slo|e 1 rg
- s|rus orad||ard|a 0.5 rg
- u|arg 5 rer|l |erud|ar (dos|s rax. 2 rg).
F. F|R|LLAT|0N TREATHENT
Ta|||ard| / l|or||as| verlr||e| : def|br||as| (a|al del|or|||alor)
1. e|e|lrode 1 d| ||r| pull|rg susu ||r|, e|e|lrode 2 d| |arar slerrur alas.
2. arus ||slr|| searar (0C)
3. crarge : deWasa 200-30 J, ara| 100-200 J, oay| 50-100 J.
1. u|arg| o||a per|u, |arjul|ar dergar |orpres| jarlurg |uar |ag|
5. oer||ar ooal ||groca|re 1-2 rg/|g88 oo|us |rlravera, dar 1-1 rg/rer|l dr|p.
KAPAN RE8U8|TA8| 0|hENT|KAN ?

- s|r|u|as| dar verl||as| sporlar
- ada pero|org |a|r yarg |eo|r rarpu
- pero|org sudar |el|r
- pas|er d|ryala|ar ral|
- sesudar - 1 jar rarp|r pasl| lurgs| ola| l|da| a|ar pu||r (||ral rel|e|s pup||)
6AR0|0 PULH0NARY RE8U86|TAT|0N 0F ThE PRECNANT w0HAN
Phys|o|og|ca| changes |n |ate pregnancy re|evant to 6PR

Resp|ratory system :
- |rcreased verl||al|or
- |rcreased oxyger derard
- reduced cresl corp||arce
- reduced lurcl|ora| res|dua| capac|ly

6ard|ovascu|ar system :
- |rcreased card|ac oulpul up lo 50
- |rcreased p|asra vo|ure up lo 50
- reduced v|scos|ly ol lre vascu|ar corlerls
- reduced vascu|ar res|slarce (|urgs / sysler|c)
- reduced |rlravascu|ar orcol|c pressure
- reduced verous relurr due lo |rler|or vera cava
corpress|or

Castro|ntest|na| system :
- |rcorpelerl gaslroesopragea| (card|ac)
spr|rcler
- |rcreased |rlragaslr|c pressure
- |rcreased r|s| ol regurg|lal|or

wan|ta ham|| :
perubahan f|s|o|og| - kard|ovasku|ar|resp|ras| - terjad| h|poks|a re|at|f

0|ff|cu|t resusc|tat|on of the pregnant woman (see p|cture} :
A. 0|ll|cu|l a|rWay raragererl ard |rluoal|or, due lo : 1) lu|| derl|l|or ard gur edera, 2) srorl ard ooese rec|, 3)
er|arged oreasl.
8. 0|ll|cu|l verl||al|or ard exlerra| cresl corpress|or, due lo : 1) sp|ayed / l|ared r|o cage, 5) ra|sed d|aprragr..
C. Reduced verous relurr, due lo : ) |rler|or vera cava corpress|or oy lre er|arged ulerus.

lar|| :
1. ulerus reroesar o|er rassa jar|r (lerulara) dar |s| |orseps| |a|rrya.
2. rere|ar vera cava |rler|or : verous relurr rerurur, dapal r|polers| sarpa| syo|.
3. rere|ar aorla aodor|ra||s : |eserular e|slrer|las oaWar, gargguar lurgs| g|rja|

3eoa||rya perder|la d|oar|rg|ar dergar pos|s| r|r|rg |e ||r|, ulerus d|dororg |e ||r|, oo|org |arar d|garja|.

Faktor pencetus kegawatan pada wan|ta ham|| :
- lraura
- perdararar
- eroo|| pu|rora|
- perya||l jarlurg (lerulara) alau perya||l s|sler|| |a|rrya
- |orp|||as| lerap| lo|o||l||
- pre-e||arps|a / e||arps|a

Resus|tas| jantung paru :
- le|r|| sara saja, l|da| ada rod|l||as|
- perl|roargar 0C (?)
- slardar lerap| / slardar prosedur d|perral||ar

PR|N8|P :
"Resusc|tat|ng the mother |s the best resusc|tat|on for the baby."

J|ka jan|n h|dup :
1. lerus|ar RJP
2. pers|ap|ar secl|o cesarea segera
3. secl|o cesarea rarus d||a|u|ar da|ar 1-5 rer|l
1. surv|va| pr|or|ly : lerulara |ese|aralar |ou, oaru |ese|aralar oay|rya.

Pert|mbangan-pert|mbangan |a|n untuk term|nas| :
- us|a |erar||ar
- per||raar v|ao|||las jar|r
- |es|apar persor|| pero|org
- |eadaar jar|r
- Wa|lu
0/T/T/h .
3aca uga ru||san ramoanan Vanagemenr ol rne lnureo Pregnanr Par|enr

Hanagement of the
|njured Pregnant Pat|ent
Ceorges 0esjard|ns, H.0. FR6P6
0|v|s|on of Trauma Anesthes|a and 6r|t|ca| 6are
Ryder Trauma 6enter - Un|vers|ty of H|am| | Jackson Hemor|a| Hed|ca| 6enter

(Teks as|| dar| webs|te |nternet - http:||www.obgyn.net}
|NTR00U6T|0N

Traura ras oecore lre rosl lrequerl cause ol ralerra| dealr |r lre ur|led 3lales ol Arer|ca. A|lrougr ralerra|
rorla||ly due lo olrer causes sucr as |rlecl|or, rerorrrage, ryperlers|or, ard lrrorooeroo||sr, ras dec||red over
lre years, lre ruroer ol ralerra| dealrs due lo perelral|rg lraura, su|c|de, ror|c|de ard rolor ver|c|e acc|derls
ras r|ser slead||y.
Acc|derla| |rjur|es occur |r lo Z ol a|| pregrarl pal|erls. Perelral|rg lraura accourls lor as rary as 3 ol
ralerra| dealrs. lr lre case ol gursrol Wourds lo lre pregrarl aodorer, overa|| ralerra| rorla||ly |s |oW ( 3.9 ).
Fela| rorla||ly, or lre olrer rard, |s r|gr, rarg|rg oelWeer 10 ard Z0 .

A|though the |n|t|a| assessment and management pr|or|t|es for resusc|tat|on of the |njured pregnant pat|ent
are the same as those for other traumat|zed pat|ents, the spec|f|c anatom|c and phys|o|og|c changes that
occur dur|ng pregnancy may a|ter the response to |njury and hence necess|tate a mod|f|ed approach to the
resusc|tat|on process.

The ma|n pr|nc|p|e gu|d|ng therapy must be that resusc|tat|ng the mother w||| resusc|tate the fetus.
FETAL PhY8|0L0CY

The effect of trauma on pregnancy depends on the gestat|ona| age of the fetus, the type and sever|ty of the
trauma, and the extent of d|srupt|on of norma| uter|ne and feta| phys|o|ogy.

The surv|va| of the fetus depends on adequate uter|ne perfus|on and de||very of oxygen.

Tre uler|re c|rcu|al|or ras ro auloregu|al|or Wr|cr |rp||es lral uler|re o|ood l|oW |s re|aled d|recl|y lo ralerra|
sysler|c o|ood pressure, al |easl url|| lre rolrer approacres rypovo|er|c sroc|. Al lral po|rl, per|prera|
vasocorslr|cl|or W||| lurlrer corpror|se uler|re perlus|or. 0rce oov|ous sroc| deve|ops |r lre rolrer, lre crarces ol
sav|rg lre lelus are aooul 20 .

ll lela| oxygeral|or or perlus|or are corpror|sed oy lraura, lre resporse ol lre lelus ray |rc|ude oradycard|a or
lacrycard|a, a decrease |r lre oase||re var|ao|||ly ol lre rearl rale, lre aoserce ol rorra| acce|eral|ors |r lre rearl
rale, or recurrerl dece|eral|ors. ll srou|d oe roled lral ar aororra| lela| rearl rale ray oe lre l|rsl |rd|cal|or ol ar
|rporlarl d|srupl|or |r lela| roreoslas|s. 0ur|rg lraura resusc|lal|or, eva|uat|on of the fetus shou|d beg|n w|th
auscu|tat|on of heart tones and cont|nuous record|ng of the heart rate.

Traura lo lre ulerus (d|recl or |rd|recl) car a|so |rjure lre ryorelr|ur ard deslao|||ze dec|dua| |ysosores, re|eas|rg
aracr|dor|c ac|d lral car cause uler|re corlracl|ors, ard perraps |rduc|rg preralure |aoor.
HATERNAL PhY8|0L0CY

|ncreases |n card|ac output and b|ood vo|ume beg|n ear|y |n the f|rst tr|mester and are 30-407 above the
nonpregnant state by 28 weeks. Th|s re|at|ve hypervo|em|c state and hemod||ut|on |s protect|ve for the mother
because fewer red b|ood ce||s are |ost dur|ng hemorrhage. Tre rypervo|er|a prepares lre rolrer lor lre o|ood
|oss lral accorpar|es vag|ra| de||very (500 r|) or cesarear secl|or (1000 r|). loWever, a|rosl 10 ol ralerra|
o|ood vo|ure ray oe |osl pr|or lo lre rar|leslal|or ol s|grs ol ralerra| sroc|.

0esp|le lre |rcrease |r o|ood vo|ure ard card|ac oulpul, lre parlur|erl |s suscepl|o|e lo rypolers|or lror aorlocava|
corpress|or |r lre sup|re pos|l|or. 0r|y aooul 10 ol pregrarl pal|erls al lerr deve|op syrplors ol sroc| |r lre
sup|re pos|l|or, oul lela| corpror|se car oe occurr|rg ever |r lre asyrploral|c rolrer. Lell uler|re d|sp|acererl
|rcreases card|ac oulpul oy 30 ard reslores c|rcu|al|or. uler|re d|sp|acererl rusl oe ra|rla|red al a|| l|res dur|rg
resusc|lal|or, lrarsporl ard per|operal|ve|y lor rorooslelr|ca| surgery.

As lre ulerus er|arges, lre d|aprragr r|ses aooul 1 cr ard lre d|areler ol lre cresl er|arges oy 2 cr, |rcreas|rg lre
suoslerra| arg|e oy 50. Care srou|d oe la|er lo cors|der lrese aralor|c crarges Wrer lrorac|c procedures sucr
as lroracoslor|es are oe|rg perlorred.

The most |mportant resp|ratory change dur|ng pregnancy |s the decrease |n funct|ona| res|dua| capac|ty
(FR6}. 8eg|rr|rg |r lre secord lr|resler, lrere |s a 20 decrease |r FRC coup|ed W|lr a 20 |rcrease |r oxyger
corsurpl|or. lr add|l|or, 30 ol parlur|erls rave a|rWay c|osure dur|rg rorra| l|da| verl||al|or |r lre sup|re pos|l|or.

A|| lrese crarges pred|spose lo rap|d la||s |r Pa02 dur|rg per|ods ol aprea or a|rWay ooslrucl|or. lerce,
supp|ererla| oxyger |s a|Ways |rd|caled lor lrese pal|erls |r lre resusc|lal|or roor. V|rule verl||al|or |rcreases al
lerr oy 50 due lo ar |rcrease |r l|da| vo|ure, so rorra| PaC02 la||s lo 30-32 rrlg W|lr a s||grl corpersalory
decrease |r p|asra o|caroorale |eve|s.

|ncreased |eve|s of progesterone and estrogen |nh|b|t gastro|ntest|na| mot|||ty. lr add|l|or, lrere |s a decrease
corpelercy ol lre gaslroesopragea| spr|rcler, Wr|cr |rcreases lre polerl|a| lor asp|ral|or. As lre ulerus er|arges, |l
d|sp|aces lre |rlesl|res upWard ard |alera||y, slrelcr|rg lre per|loreur ard ra||rg lre aodor|ra| prys|ca|
exar|ral|or urre||ao|e.

To accorrodale oolr ralerra| ard lela| relaoo||c ard c|rcu|alory requ|rererls, rena| b|ood f|ow |ncreases by 25
to 507 dur|ng gestat|on. 8|ood urea r|lroger (8uN) ard serur creal|r|re are reduced. A|so, lre ||dreys er|arge oy
ryperlropry ard ryperer|a as ear|y as lre 10lr Wee| ol geslal|or secordary lo rorrora| ard recrar|ca| laclors.

The neuro|og|c changes of pregnancy |nc|ude a 25 to 407 decrease |n anesthet|c requ|rements. Tr|s rears
lral |oss ol corsc|ousress car occur ever al sedal|ve doses.
CENERAL APPR0A6h T0 ThE TRAUHA PAT|ENT

The pr|mary |n|t|a| goa| |n treat|ng a pregnant trauma v|ct|m |s to stab|||ze the mother's cond|t|on.
Tre pr|or|l|es lor lrealrerl ol ar |rjured pregrarl pal|erl rera|r lre sare as lrose lor lre rorpregrarl pal|erl.
PR|HARY 8URVEY

As W|lr ary olrer |rjured pal|erl, lre pr|rary survey ol lre |rjured pregrarl pal|erl addresses lre a|rWay/cerv|ca| sp|re
corlro|, orealr|rg ard c|rcu|al|or (A8C; vo|ure rep|acererl/rerorrrage corlro|), W|lr the mother rece|v|ng
treatment pr|or|ty.

8upp|ementa| oxygen |s essent|a| lo preverl ralerra| ard lela| rypox|a. 3evere lraura sl|ru|ales ralerra|
calecro|ar|re re|ease, Wr|cr causes ulerop|acerla| vasocorslr|cl|or ard corpror|sed lela| c|rcu|al|or. Preverl|or ol
aorlocava| corpress|or |s a|so esserl|a| lo opl|r|ze ralerra| ard lela| rerodyrar|cs. Pregrarl pal|erls oeyord 20
Wee|s' geslal|or srou|d rol oe |ell sup|re dur|rg lre |r|l|a| assessrerl. Lell uler|re d|sp|acererl srou|d oe used oy
l||l|rg lre oac|ooard lo lre |ell or as a l|ra| reasure, lre ulerus car oe rarua||y d|sp|aced.

hypovo|em|a shou|d be suspected oelore |l oecores apparerl oecause ol lre re|al|ve pregrarcy |rduced
rypervo|er|a ard rerod||ul|or lral ray ras| s|gr|l|carl o|ood |osses. Aggress|ve vo|ure resusc|lal|or |s ercouraged
ever lor rorrolers|ve pal|erls. Tre preural|c arl|sroc| garrerl (PA30) ray oe used lo slao|||ze |oWer exlrer|ly
lraclures ard perraps corlro| rerorrrage. lr lre pregrarl pal|erl, |rl|al|or ol lre aodor|ra| corparlrerl ol lre
PA30 srou|d oe avo|ded oecause |l corpror|ses ulerop|acerla| o|ood l|oW.
8E60N0ARY 8URVEY

The secondary survey cons|sts of obta|n|ng a comp|ete h|story, |nc|ud|ng an obstetr|ca| h|story, perform|ng a
phys|ca| exam|nat|on, and eva|uat|ng and mon|tor|ng the fetus.

Tre ooslelr|ca| r|slory |s |rporlarl oecause lre |derl|l|cal|or ol cororo|d laclors ray a|ler raragererl dec|s|ors. A
r|slory ol prelerr |aoor or p|acerla| aorupl|or puls lre pal|erl al |rcreased r|s| lor lre recurrerce ol lre cord|l|or. Tre
ooslelr|ca| r|slory srou|d |rc|ude lre dale ol lre |asl rerslrual|or, expecled dale ol de||very ard ary proo|ers or
corp||cal|ors ol lre currerl ard prev|ous pregrarc|es. 0elerr|ral|or ol lre uler|re s|ze prov|des ar approx|ral|or ol
geslal|ora| age, |.e. reasurererl ol lurda| re|grl |s a rap|d relrod lor esl|ral|rg lela| age.

0eterm|nat|on of feta| age and hence of feta| matur|ty |s an |mportant factor |r lre dec|s|or approacr regard|rg
ear|y de||very.

Tre lelus |s usua||y cors|dered v|ao|e Wrer |l ras a 50 crarce ol exlrauler|re surv|va|. ll reorala| lac|||l|es are
ava||ao|e, lr|s usua||y rears al 25 lo 2 Wee|s' geslal|or or ar esl|raled We|grl ol Z50 g. Vore aggress|ve |rsl|lul|ors
use 21 Wee|s' geslal|or or ar esl|raled We|grl ol 500 lo 00 g as lre cul-oll po|rl, a|lrougr crarces ol surv|va| are
lrer reduced lo 20 lo 30. ll srou|d oe roled lral, ever W|lr lre oesl ol u|lrasourd dal|rg cr|ler|a, ur|ess lre l|re ol
corcepl|or |s |roWr exacl|y, lre ass|grrerl ol geslal|ora| age |s suojecl lo 1 lo 2 Wee|s ol urcerla|rly. 0ec|s|ors or
lela| v|ao|||ly are rade or lre oas|s ol lre oesl geslal|ora| age ava||ao|e. wrer esl|ral|rg lre lela| age |r lre
resusc|lal|or area, a rougr gu|de r|grl oe lral Wrer lre lurdus ol lre ulerus exlerds oeyord lre uro|||cus, lre lelus
|s polerl|a||y v|ao|e.

Pe|v|c and recta| exam|nat|ons shou|d be performed. As|de lror lre usua| secordary survey, assessrerl ol lre
|rjured pregrarl pal|erl srou|d ru|e oul vag|ra| o|eed|rg, ruplured rerorares, a ou|g|rg per|reur, lre preserce ol
corlracl|ors, ard ar aororra| lela| rearl rale ard rrylrr.

Fetomaterna| hemorrhage (FHh}, the transp|acenta| hemorrhage of feta| b|ood |nto the norma||y separate
materna| c|rcu|at|on, |s a un|que comp||cat|on of trauma dur|ng pregnancy.
Tre reporled |rc|derce ol FVl aller lraura |s 8 lo 30. Trere |s ro rea| corre|al|or oelWeer sever|ly ol lraura,
geslal|ora| age ard lrequercy ard vo|ure ol FVl. Corp||cal|ors ol FVl |rc|ude Rr sers|l|zal|or |r lre rolrer, lela|
arer|a, lela| paroxysl|c alr|a| lacrycard|a or lela| dealr lror exsargu|ral|or. lr lreory, FVl |s poss|o|e oy lre 1lr
Wee| ol geslal|or; sore say lral FVl oecores a corcerr aller 12 Wee|s geslal|or Wrer lre ulerus r|ses aoove lre
pe|v|s ard oecores ar orgar suscepl|o|e lo d|recl lraura. FVl |s delecled oy lre K|e|rauer-8el|e (K8) ac|d e|ul|or
lecrr|que or ralerra| o|ood. upor exar|ral|or, adu|l ce||s rera|r co|or|ess Wr||e lela| red ce||s lurr or|grl purp|e-
p|r|. Tre ral|o ol lela| ce||s lo ralerra| ce||s |s recorded, erao||rg ca|cu|al|or ol lre vo|ure ol lela| o|ood |ea|ed |rlo
lre ralerra| c|rcu|al|or:

Vosl c||r|ca| |aooralor|es W||| screer 1000 red o|ood ce||s la|er lror lre rolrer. A ralerra| o|ood vo|ure ol 5 ||lers |s
corror|y assured |r |aooralory lorru|as so lral ore lela| ce|| per 1000 ce||s courled correspords lo a FVl ol 5 r|.
urlorlurale|y, lre arourl ol FVl sull|c|erl lo sers|l|ze rosl Rr-regal|ve Worer |s We|| oe|oW lre 5-r| sers|l|v|ly
|eve| ol lre lyp|ca| |aooralory's K8 lesl. As ||ll|e as 1 r| ol Rr-pos|l|ve o|ood car sers|l|ze Z0 ol Rr-regal|ve Worer.
Currerl|y, severa| correrc|a| ||ls exped|le ard s|rp||ly lre lesl process. urlorlurale|y, lre sers|l|v|ly ol a|| lre K8 lesl
|s re|al|ve|y |oW.
Trerelore, a|| Rr-regal|ve rolrers Wro preserl W|lr a r|slory ol aodor|ra| lraura srou|d rece|ve ore 300-ug
propry|acl|c dose ol Rr |rrure g|oou||r (arl|-0 |rrurog|oou||r; Rrogar) W|lr|r Z2 rours ol lre lraural|c everl.
A|lrougr corlrovers|a|, We oe||eve lral lre K8 lesl srou|d oe reserved lor Rr-regal|ve Worer Wro are al r|s| lor
rass|ve FVl lral W||| exceed lre ell|cacy ol ore dose ol |rrure g|oou||r, |.e. rore lrar 30 r|. Accord|rg lo sore
slud|es, leWer lrar 1 ol a|| lraura cases ard or|y 3.1 ol rajor lraura cases exceed lre coverage ol ore 300-ug
Rr |rrure g|oou||r dose. As a gerera| ru|e, 300 ug ol Rr |rrure g|oou||r srou|d oe g|ver lor every 30 r| ol lela|
o|ood lourd |r lre ralerra| c|rcu|al|or. Tre K8 lesl |s prooao|y urrecessary oelore 1 Wee|s' geslal|or oecause lre
lela| o|ood vo|ure |s oe|oW 30 r| oelore lr|s geslal|ora| age. For cases ol docurerled FVl, sore slud|es
recorrerd repeal|rg lre K8 lesl |r 21 rours lo crec| lor |rcreased o|eed|rg.

FETAL A88E88HENT

Feta| eva|uat|on beg|ns w|th check|ng feta| heart rate and not|ng feta| movement.

Fela| rearl lores car oe delecled oy auscu|lal|or or dopp|er prooe. Tr|s srou|d oe dore ear|y |r lre secordary survey
ard repealed lrequerl|y. Tre rorra| rarge lor lre lela| rearl rale |s 120 lo 10 oeals/r|rule.

Corl|ruous e|eclror|c lela| rearl-rale ror|lor|rg (EFV) rera|rs lre rosl W|de|y used roda||ly lor eva|ual|or ol lre
lelus, ard |s ar adjurcl lo lre ror|lor|rg ol lre ralerra| cord|l|or. Tre use ol EFV perr|ls prorpl |derl|l|cal|or ol lre
lelus al greal r|s| lor aspryx|a ard lela| dealr. Ary v|ao|e lelus ol 21 or rore Wee|s' geslal|or requ|res ror|lor|rg
aller a lraura everl. Tr|s |rc|udes pal|erls W|lr ro oov|ous s|grs ol aodor|ra| |rjury oecause d|recl |rpacl |s rol
recessary lor lelop|acerla| palro|ogy lo oe preserl.

Corlroversy ex|sls corcerr|rg lre dural|or ol lela| ror|lor|rg lo||oW|rg a lraural|c everl lo |derl|ly polerl|a| lraura-
re|aled lela| proo|ers. Tre oojecl|ve ol lre ror|lor|rg per|od |s lo |derl|ly preralure |aoor, aorupl|o p|acerla ard lela|
d|slress. Tre coro|ral|or ol r|gr-reso|ul|or rea|-l|re u|lrasorograpry ard card|olocograpr|c ror|lor|rg seers lo
rave lre r|gresl
sers|l|v|ly ard spec|l|c|ly. Trey srou|d oolr oe |rsl|luled as soor as leas|o|e W|lroul |rlerler|rg W|lr ralerra|
resusc|lal|ve ellorls.

The most common obstetr|c prob|em caused by trauma |s uter|ne contract|ons. Vyorelr|a| ard dec|dua| ce||s,
daraged oy corlus|or or p|acerla| separal|or, re|ease proslag|ard|rs lral sl|ru|ale uler|re corlracl|ors. Progress|or
lo |aoor deperds upor lre s|ze ol uler|re darage, lre arourl ol proslag|ard|rs re|eased, ard lre geslal|ora| age ol
lre pregrarcy. 3ore slud|es quesl|or lre roul|re use ol loco|yl|cs lor preralure |aoor aller lraura oecause lre
rajor|ly (90) ol corlracl|ors slop sporlareous|y ard lrose corlracl|ors lral are rol se|l-||r|led are oller
palro|og|ca| |r or|g|r, lrus, corlra|rd|cal|ors lo loco|yl|c lrerapy.

P|acenta| abrupt|on aller lraura occurs |r 2 lo 1 ol r|ror acc|derls ard |r up lo 50 ol rajor |rjur|es. 3eparal|or
resu|ls as lre |re|asl|c p|acerla srears aWay lror lre e|asl|c ulerus dur|rg sudder delorral|or ol lre ulerus.
Aorupl|or car occur W|lr ||ll|e or ro exlerra| s|grs ol |rjury lo lre aodor|ra| Wa||. Valerra| rorla||ly lror aorupl|or |s
|ess lrar 1, oul lela| dealr rarges lror 20 lo 35. C||r|ca| l|rd|rgs lral |rd|cale aorupl|or |rc|ude vag|ra| o|eed|rg,
aodor|ra| crarps, uler|re lerderress, arr|ol|c l|u|d |ea|age, ralerra| rypovo|er|a, a ulerus |arger lrar rorra| lor
lre geslal|ora| age, or a crarge |r lre lela| rearl rale. wrer preserl aller lraura, vag|ra| o|eed|rg |s a or|rous s|gr
oller |rd|cal|ve ol p|acerla| separal|or. Tre l|rsl-||re lesl lo lry lo corl|rr lre preserce ol aorupl|or |s lre
lrarsaodor|ra| u|lrasourd. urlorlurale|y, |l |s |ess lrar 50 accurale. lr gerera|, card|olocograpr|c ror|lor|rg |s
rore sers|l|ve |r p|c||rg up p|acerla| aorupl|or oy lela| d|slress lrar u|lrasourd |s oy v|sua||zal|or. Vosl cases ol
aorupl|or oecore ev|derl W|lr|r severa| rours aller lraura.

6ard|otocograph|c mon|tor|ng shou|d be started |n the resusc|tat|on room and cont|nued for a m|n|mum of 4
hours.
A r|r|rur ol 21 rours ol card|olocograpr|c ror|lor|rg |s recorrerded lor pal|erls W|lr lrequerl uler|re acl|v|ly (
rore lrar corlracl|ors per rour ), aodor|ra| or uler|re lerderress, ruplured rerorares, vag|ra| o|eed|rg, or
rypolers|or. For pal|erls W|lroul ary ol lrese s|grs or syrplors, rorra| l|rd|rgs or lre card|olocograpr|c ror|lor lor
al |easl 1 rours dural|or ard a rorra| u|lrasourd, d|scrarge ray oe cors|dered. Fela| d|slress |s assoc|aled W|lr
p|acerla| aorupl|or 0 ol lre l|re ard |rred|ale |rlerverl|or |s requ|red.

lr lre lraura sell|rg, u|lrasourd ray re|p |derl|ly olrer proo|ers re|aled lo lre ralerra| everl oes|des p|acerla|
aorupl|or sucr as cord pro|apse ard p|acerla prev|a. ll |s a|so roul|re lo eva|uale lre lelus lor geslal|ora| age, card|ac
acl|v|ly ard rovererl. ll l|re perr|ls, a corp|ele o|oprys|ca| prol||e ray oe perlorred.
0|ACN08T|6 H00AL|T|E8 | RA0|AT|0N EXP08URE

Fo||oW|rg ralerra| slao|||zal|or ard assessrerl, ard lela| eva|ual|or, lre exlerl ol ralerra| ard lela| |rjury |s
delerr|red W|lr lre re|p ol spec|l|c d|agrosl|c roda||l|es.

8ens|t|v|ty to rad|at|on |s greater dur|ng |ntrauter|ne deve|opment than at any other t|me of ||fe. A|lrougr lrere
|s rucr corcerr aooul rad|al|or exposure, a d|agrosl|c roda||ly deered recessary lor ralerra| eva|ual|or srou|d rol
oe W|lrre|d or lre oas|s ol |ls polerl|a| razard lo lre lelus.

Tre lela| dose ol rad|al|or rece|ved |r |rd|v|dua| cases ray vary oy a laclor ol 50 or rore, deperd|rg or lre
equ|prerl used, lecrr|que used, ruroer ol rad|ograprs dore |r a corp|ele sludy, ralerra| s|ze, ard lela|/uler|re
s|ze. lr gerera|, x-ray oears a|red rore lrar 10 cr aWay lror lre lelus are rol dargerous.
Tre rajor ellecls ol exposure lo lre lelus |rc|ude corger|la| ra|lorral|ors, groWlr relardal|or, poslrala| reop|as|a,
ard dealr. lr lre l|rsl Wee| ol ||le, oelore |rp|arlal|or, lre eroryo |s very sers|l|ve lo |elra| ellecls ol rad|al|or oul ras
a |oW prooao|||ly ol susla|r|rg leraloger|c or groWlr-relard|rg ellecls |l |l |s ao|e lo |rp|arl ard groW. 0ur|rg rajor
orgarogeres|s ol lre 2rd lo Zlr Wee|s, lre eroryo |s sers|l|ve lo lre leraloger|c, groWlr-relard|rg, |elra|, ard
poslrala| reop|asl|c ellecls ol rad|al|or. 0rgars are |ess sers|l|ve lo rad|al|or leralogeres|s |r lre 8lr lo 10lr Wee|s,
oul groWlr relardal|or, cerlra| rervous sysler dyslurcl|or, ard poslrala| reop|asl|c ellecls ray occur. 3lud|es sroW
lral exposure ol lre lelus lo |ess lrar 5 lo 10 rad (5000 lo 10000 rrad) causes ro s|gr|l|carl |rcrease |r lre r|s| ol
corger|la| ra|lorral|ors, |rlrauler|re groWlr relardal|or, or r|scarr|age. A|lrougr lr|s does rol rear lral lrere are
del|r|le|y ro r|s|s |r exposures |ess lrar 5 rad, |l does rear lral lr|s |eve| ol rad|al|or carr|es ||ll|e r|s| lor lre lelus
Wrer corpared lo sporlareous r|s|s. Al a rad|al|or dose ol 15 rad, lrere |s approx|rale|y a crarce lral lre cr||d
cou|d deve|op severe rerla| relardal|or, a |ess lrar 3 crarce ol deve|op|rg cr||drood carcer, ard a 15 crarce ol
rav|rg a sra|| read s|ze.

when perform|ng rad|ograph|c eva|uat|on of the mother, feta| |rrad|at|on shou|d be m|n|m|zed by sh|e|d|ng the
abdomen when feas|b|e w|th a |ead apron. wrer rary rad|ograprs are requ|red over a |org per|od, a
lrerro|ur|rescerl dos|reler ray oe allacred lo lre pal|erl lo serve as a gu|de lo lre dosage ol rad|al|or de||vered.
As a gu|de lo prys|c|ars, reporls lror sore slud|es |rd|cale lral lre rad|al|or dose lror a p|a|r AP cresl x-ray |s |r
gerera| oe|oW 0.005 rad, a pe|v|c l||r oe|oW 0.1 rad, CT-scar ol lre read (1-cr s||ces) 0.05 rad, CT-scar ol lre upper
aodorer (20 1-cr s||ces) oe|oW 3.0 rad ard CT-scar ol lre |oWer aodorer (10 1-cr s||ces) 3.0 lo 9.0 rad.
LUNT A00H|NAL TRAUHA

Trere are severa| |rporlarl cors|deral|ors Wrer address|rg o|url lroracoaodor|ra| lraura |r lre pregrarl pal|erl.
Tre prys|ca| exar|ral|or ray oe urre||ao|e oecause lre er|arged ulerus d|sp|aces lre aodor|ra| corlerl ard
slrelcres lre per|loreur lrus perraps d|r|r|sr|rg lre resporse lo per|lorea| |rr|lal|or. Tre eva|ual|or ol poss|o|e
|rjury lo lre aodorer |s d|llererl oecause ol lre preserce ol lre grav|d ulerus. Tre prelerred d|agrosl|c roda||l|es lor
eva|ual|or dur|rg lre l|rsl lr|resler ol pregrarcy are u|lrasourd, d|agrosl|c per|lorea| |avage (0PL), ard CT-scar, |r
lral order. 8ecause lre l|rsl lr|resler |s lre per|od ol orgarogeres|s, u|lrasourd |s prelerao|e lor lre delecl|or ol
reroper|loreur. 8ecause ol |ls sers|l|v|ly, 0PL car oe used lo eva|uale lre aodorer us|rg lre suprauro|||ca|, oper
lecrr|que lo avo|d |rjury lo lre grav|d ulerus. Tre rajor d|sadvarlage ol 0PL W|lr respecl lo lre pregrarl pal|erl |s |ls
|rvas|veress. ll CT-scar |s recessary, oolr ora| ard |rlraverous corlrasl red|a srou|d oe adr|r|slered. 0ur|rg lre
secord lr|resler, u|lrasourd or CT-scar ray oe used lo eva|uale lre aodorer. 0PL ray oe d|ll|cu|l lo perlorr
oecause lre er|arged ulerus ray |rlerlere W|lr lre deperderl calreler pos|l|or ard relurr ol l|u|d. 0r lre olrer rard,
severa| slud|es rave sroWr |ls salely ard uselu|ress. 0ur|rg lre lr|rd lr|resler, lre |rjured pregrarl pal|erl car oesl
oe assessed oy u|lrasourd or CT-scar.

A|lrougr rolor ver|c|e acc|derls are lre rosl corror cause ol ser|ous o|url lraura |r pregrarcy, assau|ls, aouse
ard la||s are lrequerl. lr add|l|or lo ralerra| rorla||ly lror o|url lraura, Wr|cr |s esl|raled lo oe aooul Z, lre lelus
|s al s|gr|l|carl r|s|, espec|a||y |l p|acerla| aorupl|or, p|acerla prev|a, or uler|re ruplure occur.
PENETRAT|NC Th0RA60A00H|NAL TRAUHA

As rerl|ored oelore, as pregrarcy progresses, |rlra-aodor|ra| orgars crarge pos|l|or, W|lr |rporlarl |rp||cal|ors.
8ecause lre ooWe| |s pusred upWard oy lre er|arged ulerus, perelral|rg |rjury lo lre upper parl ol lre aodorer |s
rore |||e|y lo oe assoc|aled W|lr ru|l|p|e gaslro|rlesl|ra| |rjur|es. 0rgars |rvo|ved |r decreas|rg lrequercy are lre
sra|| ooWe|, ||ver, co|or, ard sloracr. 0ur|rg lre lr|rd lr|resler, |rjur|es lo lre |oWer quadrarls ol lre aodorer
a|rosl exc|us|ve|y |rvo|ve lre ulerus. Tr|s ray oe advarlageous lo lre rolrer oecause lre ulerus ard arr|ol|c l|u|d
aosoro rosl ol lre erergy ol lre r|ss||e, resu|l|rg |r |ess deslrucl|or lo olrer orgars. ll lre ulerus |s |rvo|ved |r
perelral|rg lraura, lela| |rjury ray occur |r 0 lo 90 ol cases. 0ursrol Wourds lo lre ulerus carry a ralerra|
rorla||ly ol Z lo 9 ard a lela| rorla||ly ol arourd Z0. Fela| rorla||ly |s r|grer |l |rjury |s caused oelore 3Z Wee|s ol
geslal|or.

wrer eva|ual|rg lre palrWay ol a ou||el, rad|ograprs (arleroposler|or ard |alera| v|eWs) ol lre cresl ard aodorer,
W|lr lre erlrarce ard lre ex|l Wourds rar|ed W|lr paper c||ps ray re|p lre prys|c|ars. 3ore corlroversy ex|ls oul
lre preva|||rg op|r|or al lr|s l|re |s lral pregrarl Worer W|lr gursrol Wourds lo lre aodorer srou|d gerera||y
urdergo rardalory ce||olory. 3lao Wourds lo lre aodorer are raraged s|r||ar|y |r pregrarl ard rorpregrarl
pal|erls |l s|grs ol oov|ous |rlra-aodor|ra| |rjury are preserl (sroc|, per|lorea| s|grs, ev|sceral|or) or pos|l|ve
|rvesl|gal|or.

A r|d||re ce||olory srou|d oe perlorred, W|lr exp|oral|or as |r lre rorpregrarl slale. ll exlrauler|re |rlra-aodor|ra|
|rjur|es are |derl|l|ed, orgars are repa|red or resecled |r lre usua| rarrer. wrerever lre er|arged ulerus |rlerleres
W|lr adequale exar|ral|or or repa|r, cesarear secl|or |s requ|red. Ce||olory a|ore does rol jusl|ly cesarear secl|or
oecause |l pro|orgs lre operal|or ard |rcreases o|ood |oss oy al |easl 1000 r|. 3pec|l|c |rd|cal|ors lor cesarear
secl|or dur|rg ce||olory |rc|ude ralerra| sroc| ard pregrarcy rear lerr, lrreal lo ||le lror exsargu|ral|or lror ary
cause, recrar|ca| ||r|lal|or lor ralerra| repa|r, |rreparao|e uler|re |rjury, |rslao|||ly |r a polerl|a||y v|ao|e lelus,
urslao|e lroraco|uroar sp|re |rjury, ard ralerra| dealr.
URN |NJURY

Trealrerl pr|or|l|es are lre sare Wrer rarag|rg pregrarl ard rorpregrarl ourr v|cl|rs. Va|rlerarce ol a rorra|
|rlravascu|ar vo|ure, avo|darce ol rypox|a, ard preverl|or ol |rlecl|or are |rporlarl. 8urred areas ol l|ssue srou|d
oe deor|ded ard c|eared. 3||ver su|lad|az|re crear srou|d oe used spar|rg|y oecause ol lre r|s| ol |err|clerus
assoc|aled W|lr su|lorar|de aosorpl|or.

lr cases ol e|eclr|ca| ourrs, lela| rorla||ly |s r|gr al Z3 ever W|lr a ralrer |oW e|eclr|ca| currerl oecause ol lre lelus'
|ac| ol res|slarce lo e|eclr|ca| sroc|. Tr|s |s prooao|y re|aled lo lre lacl lral lre lelus |s l|oal|rg |r arr|ol|c l|u|d W|lr a
|oW res|slarce lo currerl. No raller roW lr|v|a| lre|r |rjury ray seer, lela| ror|lor|rg ard u|lrasourd assessrerl are
|rd|caled lor a|| pregrarl v|cl|rs ol e|eclr|ca| sroc|.
PER|H0RTEH 6E8AREAN 0EL|VERY

0ur|ng materna| resusc|tat|on, adequate oxygenat|on, f|u|d |oad|ng, and |eft |atera| decub|tus shou|d be tr|ed
to see |f materna| c|rcu|at|on can be |mproved.

Haterna| surv|va| after de||very of the fetus dur|ng unsuccessfu| card|opu|monary resusc|tat|on (6PR} has
been reported. ll lrere |s ro resporse lo advarced card|ac ||le supporl W|lr|r a leW r|rules (2 lo 3 r|rules), ralerra|
card|opu|rorary resusc|lal|or rusl oe corl|rued, arler|or lroracolory W|lr oper-cresl card|ac rassage (0CV) oul
W|lroul aorl|c cross-c|arp|rg srou|d oe cors|dered, ard erergercy cesarear secl|or lor a v|ao|e lelus srou|d oe
perlorred.

3lud|es rave sroWr lral corverl|ora| exlerra| card|ac rassage (ECV) oecores |ess ellecl|ve as lre pal|erl
approacres lerr oecause ol recrar|ca| laclors. Tre or|y relrod ol assess|rg adequacy ol lela| oxygeral|or dur|rg
CPR |s lo ror|lor lela| rearl rale (FlR). Carol|d pu|se ard erd-l|da| C02 ror|lor|rg srou|d oe used lo ror|lor
adequacy ol ralerra| v|la| orgar perlus|or dur|rg CPR.

wrer lre geslal|ora| age |s |ess lrar 21 Wee|s, erergercy cesarear de||very |s usua||y rol perlorred oecause lre
lelus |s loo sra|| lo surv|ve ard lre o|rlr |s ur|||e|y lo rave rucr ellecl or ralerra| rerodyrar|cs.
loWever, Wrer geslal|ora| age |s grealer lrar 21-25 Wee|s, erergercy cesarear o|rlr prooao|y W||| lavorao|y allecl
ralerra| or lela| oulcore.

Al a geslal|ora| age ol 2 lo 32 Wee|s, Wrer exlerra| card|ac rassage |s rol ellecl|ve, as |rd|caled oy la||ure lo
gererale a carol|d pu|se, |radequale erd-l|da| C02 |eve|s, or lela| oradycard|a, 0CV srou|d oe ser|ous|y cors|dered
oelore ar erergercy cesarear secl|or |s perlorred. ll 0CV prove successlu|, lre de||very ray oe de|ayed so lral
crarces ol poslrala| surv|va| |rprove.

Even s||ght pro|ongat|on of feta| |ntrauter|ne ||fe w||| probab|y |mprove the chances of feta| surv|va|, espec|a||y
when gestat|ona| age |s |ess than 28 weeks. ll, roWever, 0CV proves lo oe |rellecl|ve, lre lelus rusl oe de||vered
|rred|ale|y. Aller 32 Wee|s geslal|or, Wrer ECV |s rol ellecl|ve, ar erergercy cesarear secl|or rusl oe perlorred
|rred|ale|y. 0e||ver|rg lre |rlarl |rproves ralerra| card|ac l||||rg, lrereoy |rprov|rg lre success ol CPR.

The |onger the de|ay between the onset of card|ac arrest and de||very, the |ess are the chances of feta| and
materna| surv|va|.

ll, roWever, lre ECV appears lo oe ellecl|ve, ECV ray oe corl|rued lor 5 r|rules. ll a sporlareous c|rcu|al|or |s rol
reslored W|lr|r 5 r|rules, ar erergercy cesarear de||very rusl oe perlorred. ll lr|s la||s lo rev|ve lre rolrer, 0CV
ray oe cors|dered. ldea||y, persorre| lra|red |r reorala| resusc|lal|or srou|d oe ava||ao|e lo allerd lre |rlarl.
60N6LU8|0N

Traura ras oecore lre rosl lrequerl cause ol ralerra| dealr |r lre ur|led 3lales ol Arer|ca. Tre ra|r pr|rc|p|e
gu|d|rg lrerapy rusl oe lral resusc|lal|rg lre rolrer W||| resusc|lale lre lelus.
Pemer|ksaan Umum
C|neko|og|
Ku||ah 0bstetr| | C|neko|og|
dr. 0w|ana 0cv|yant| | dr. Ju||anto w|tjaksono
PR|N8|P !!

1. Pas|er War|la us|a reprodu|s| |asus apapur lARu3 d|p|||r|ar |erurg||rar adarya |erar||ar ll
2. Perer||saar g|re|o|og| : sargal sers|l|l, d|per|u|ar |epercayaar dar |ooperas| pas|er yarg oa||. J||a pas|er
ara|-ara|, aja| juga orarglua / pergasurrya urlu| rererar| se|ara perer||saar.
3. Perer||saar da|ar rarus rerperral||ar aseps|s / arl|seps|s yarg oa||.
KELUhAN UHUH PA8|EN C|NEK0L0C|

1. Perdararar per vag|rar
2. 0argguar ra|d
3. Kepul|rar / d|scrarge
1. Vassa / oerjo|ar
5. Nyer|
. 3u||l rerdapal ara| (|rlerl|||las)
Per|u d|p|||r|ar 3EVuA |erurg||rar yarg rurg||r dapal reryeoao|ar / rerpergarur|.
0|ACN08|8 | HA8ALAh UHUH KA8U8 C|NEK0L0C|

1. Kepul|rar / |rle|s|
2. 0argguar ra|d
3. Ke|a|rar oaWaar
1. Erdorelr|os|s
5. Turor j|ra| / garas
. 0argguar a||oal rasa|ar ps|||s : vag|r|srus, lr|g|d|las, dso

ANAHNE8|8

1. Ada l|da|rya geja|a / larda / |ecur|gaar |erar||ar, ra|d lera|r|r.
2. R|Wayal ruourgar se|sua| yarg d|cur|ga| seoaga| peryeoao (co|lus suspeclus) pada perya||l |rle|s|.
3. R|Wayal ooslelr| / g|re|o|og|, r|Wayal |orlraseps|, r|Wayal perya||l daru|u
V|los : perya||l ruourgar se|sua| rarya reru|ar re|a|u| sarggara - 3ALAl - o|sa juga reru|ar |eWal |orla|
rarua| / ora| / a|al / |a|rrya.
PEHER|K8AAN F|8|8
8tatus genera||s | pemer|ksaan umum

Perer||saar o|asa secara reg|ora| / per orgar s|sler : |eadaar urur, larda v|la|, dar selerusrya.
3erarusrya ada sa|s| / orarg |a|r yarg rerdarp|rg| perer||saar, seoa||rya War|la (r|sa|rya peraWal alau o|dar).
Pemer|ksaan payudara

Perer||saar payudara :
lrspe|s| : da|ar |eadaar slal|s (d|ar) dar d|rar|s (oergera| / |orlra|s| olol pe|lora||s)
Pa|pas| : ada/l|da|rya rassa / oerjo|ar aororra|, larda-larda radarg, dar seoaga|rya.
0||a|u|ar juga pa|pas| |e|erjar gelar oer|rg a|s|||a.
(Pada oeoerapa |epusla|aar, payudara lerrasu| juga da|ar s|sler reprodu|s| War|la yarg juga d|pe|ajar| secara
|rusus da|ar ||ru g|re|o|og|, lerrasu| juga perya||l / |e|a|rar2 pada payudara.)

Exam|nar|on ol rne lema|e oreasr.
/. lnspecr|on . '. w|rn arms ro rne s|oe; ooservar|on ol rne s|ze ol
rne oreasrs, rne|r s,mmerr,, ano an, sk|n cnanges or orner
aonorma||r|es. 2. Exam|nar|on u|rn arms ra|seo aoove rne neao;
rn|s a||ous one ro see an, rerner|ng ol rne sk|n or l|xar|on ol an,
rumour ro rne unoer|,|ng musc|e or lasc|a. J. w|rn arms presseo
|nro rne n|ps; rn|s pos|r|on renses rne musc|es |n rne reg|on ol rne
ax|||a
3. 3reasr pa|par|on . 0an oe oone u|rn rne par|enr |n rne s|rr|ng, |,|ng or srano|ng pos|r|ons. Exam|ne rne cons|srenc, ol rne oreasrs. $earcn lor an, masses
ano rne|r moo|||r,. Exam|ne |l rnere |s an, parno|og|ca| secrer|on lrom rne n|pp|e.
0. /x|||ar pa|par|on . Exam|nar|on ol ax|||ar, |,mpn nooes; alrer rnar, pa|par|on ol rne suprac|av|cu|ar nooes; oerecr|on ol en|argeo |,mpn nooes, ano, |l rne, are
presenr, reporr rne|r numoer, cons|srenc,, ano moo|||r,.
8tatus khusus g|neko|og|

|nspeks| dan pa|pas| |uar : Vu|va | uretra
0es|r|ps| |rspe|s| dar pa|pas| (des|r|ps| lerarg ada|ar j||a l|da| ada larda radarg, perdararar alau d|scrarge,
ou|ar lerarg oa||-oa|| saja oerada d| lerpalrya). lrspe|s|, apa|ar lerdapal |ord||ora, oarlo||r|l|s, vu|vovag|r|l|s,
l|uor / darar, perlurourar jarur, ||sla 3|ere / 0ardrer / 8arlo||r, ves||e| rerpes, dar seoaga|rya. Pa|pas| apa|ar
ada ryer|, des|r|ps| |ors|slers| rassa, dso.
Lapor|ar |eadaar r|rer (j||a lersarg|a ras|r gad|s, per||sa dergar jar| re|a|u| recla| loucr, rerdororg r|rer |e
arar |uar). 8eda|ar slru|lur aru|ar|s / rugae pr|rer yarg rarp|r serupa dergar rooe|ar se|urder.

|nspeks| da|am (|n speku|o}
3pe|u|ur lerlulup, rasu||ar da|ar vag|ra dergar o||ar verl||a|, |erud|ar d| da|ar vag|ra d|pular 90o sarpa| o||ar
ror|sorla|, ou|a urlu| rerarpa||ar pors|o serv||s, lorr|ces dar d|rd|rg vag|ra.
0|rd|rg vag|ra / lorr||s : Warra, perru|aar, des|r|ps|.
J||a ada l|uor, des|r|ps| Warrarya (pul|r rurg||r Card|da, |ur|rg lua oerousa rurg||r Tr|crororas, oarya| jerr|r
rurg||r Cr|aryd|a). Aro|| dergar sWao d| daerar lorr|x posler|or, per||sa r||ros|op|| dergar Nac| / K0l (urlu|
jarur) alau grar.
Porl|o : Warra, perru|aar, des|r|ps|. Apa|ar ada eclop|o / eros|, perlurourar, l|uxus (darar dar| osl|ur).
Terdapal racar-racar jer|s spe|u|ur : Cusco, Pedersor, lullrar, 0raves, 3|rs, dar seoaga|rya.
Yarg urur d|gura|ar ada|ar spe|u|ur Cusco/Pedersor/0raves (oerlu| cocor oeoe|) alau spe|u|ur relra|lor 3|rs
(oerlu| u) - (||ral garoar).

Pa|pas| da|am (pemer|ksaan vag|na| | vag|na| touch}
Vasu||ar jar| lergar dergar pe|ar re|a|u| corr|sura posler|or. J||a d||a|u|ar dergar oerar, d|rd|rg vu|va/vag|ra
a|ar re|a|sas|, rarur j||a ler|a|u |asar juslru a|ar |orlra|s|. 3ele|ar jar| lergar dapal rasu|, d|||ul| jar| le|urju|.
JAN0AN LuPA largar |a|rrya rerarar lurdus ulerus (8lVANuAL ll).
Pa|pas| jar| da|ar d| pors|o dar largar |uar d| lurdus, rer||a| u|urar, oerlu|, arar |orpus uler| (CuT).
Pa|pas| jar| da|ar d| lorr||s |alera||s dar largar |uar d| ||r|-|arar lurdus, rer||a| adre|sa / pararelr|ur.
Pararelr|ur (||garerlur |ard|ra|e, ||garerlur rolurdur, ousr l|ssue) rorra| |ura|, l|da| leraoa rassa, l|da| ada
ryer| le|ar.
Adre|sa (orgar |alera| ulerus, luoa-ovar|ur) rorra| l|da| reroesar / l|da| leraoa rassa, l|da| ada ryer| le|ar.
JlKA lerdapal |eadaar aororra| / |e|a|rar : des|r|ps| dergar 0AV8AR / s|elsa s|eral|s, |ela| lerradap ulerus /
adre|sa.

Pemer|ksaan rekta| (co|ok rekta| | rekta| touch}
0||a|u|ar alas |rd||as|.
Pada v|rgo, perer||saar loucr vag|ra| l|da| d||a|u|ar, perer||saar da|ar d||a|u|ar re|a|u| re|la|.

Tab|e : F|nd|ngs at gyneco|og|ca| exam|nat|ons



PEHER|K8AAN PENUNJANC

1. les |erar||ar (8-lC0) : ur|re slr|p lesl
2. darar per|ler |erg|ap
3. les spes|l|| lerradap |e|a|rar (grar, K0l, |o|pos|op| dso)
1. rad|o|og| (u30, l30, Clscar, VRl, dso)
5. Pap srear (s|lo|og| e|slo||as|) dar seoaga|rya, d||a|u|ar alas |rd||as|
Perer||saar perurjarg d|agrosl|| s|sler reprodu|s| War|la -
ada |u||arrya serd|r|.
PEHER|K8AAN C|NEK0L0C| PA0A PA8|EN ANAK-ANAK

3ecara pr|rs|p / le|r|s l|da| oeroeda dergar
perer||saar pada pas|er deWasa.

larya, pada pas|er ara|-ara|, d|per|u|ar
pers|apar dar perde|alar yarg |eo|r |rlers|l
|arera ser|rg|a|| ada perasaar la|ul alau
ra|u (|arera a|ar d|per||sa ger|la||a).
la| |r| dapal reryeoao|ar pas|er oers||ap
l|da| |ooperal|l da|ar perer||saar.

Pent|ng d|ketahu|
1. slad|ur per|eroargar / raluras| dar| us|a
oay|, |ara|-|ara| sarpa| puoerlas
(deve|oprerla| gyreco|og|c aralory ard
sexua| ralural|or)
2. peroedaar arlara |eadaar rorra|, var|as|
rorra| alau |eadaar aororra|.
3. |eadaar |ao|| secara ps|||s / eros|ora| pada oeroaga| l|rg|alar us|a ara|-ara| sarpa| puoerlas

Pemer|ksaan
1. Perde|alar ps||o|og|s : rererarg|ar dar reya||r|ar pas|er. Pada pas|er reraja, rurg||r ada per|sl|Wa /
per||a|u se|sua| yarg pr|oad| dar l|da| |rg|r d|cer|la|ar. lal|-ral| da|ar rergga|| / rergurpu||ar dala. Juga ral|-
ral| pada |oroar |e|erasar alau per|osaar. J||a pas|er ara|/reraja yarg cu|up |orur||al|l l|da| rergrerda||
pergarlar / orarglua oerada d| de|alrya, d|usara|ar |erjasara dergar orarglua / pergarlarrya. Ada|ar juga lAK
PA3lEN urlu| raras|arya d|rorral| lerrasu| lerradap orarglua / pergarlarrya.
2. Kerjasara dergar orarg lua / pergarlar pas|er. Pada pas|er oay| alau ara|-ara| |ec||, orarglua alau pergarlar
per|u reroarlu reregarg pas|er d| |urs| alau lerpal l|dur.
3. J||a pas|er per|u d|pegarg|, seoa||rya o|er
orarg yarg d||era| alau d|percaya o|errya.
J||a l|da| ada, oaru lerpa|sa pas|er d|pegarg|
o|er peraWal / pelugas. Pada pas|er ara|
reraja, d|r|rla urlu| |ooperal|l dar dudu| d|
|urs| g|re|o|og|| dergar pos|s| dorsa| ||lolor|.
1. Perer||saar |rspe|s| vu|va / vag|ra :
|a|u|ar lra|s| |ao|a rajora ||r| dar |arar
5. Kerurg||rar r|rer ras|r ulur : jargar
|a|u|ar co|o| vag|ra|. La|u|ar perer||saar
co|o| duour (recla| loucrer) |erud|ar lar|| |e
arar depar-oaWar, urlu| rerarpa||ar vu|va
/ vag|ra |eo|r je|as.
. J||a d||a|u|ar perer||saar vag|ra| loucre /
pa|pas| o|rarua| gura|ar salu jar| saja da|ar
vag|ra. La|u|ar 3E8ELuV perer||saar
spe|u|ur, urlu| reraoa jara|, leoa| dar arar
serv||s, |eadaar d|rd|rg vag|ra, se|a||gus
rerper||ra|ar u|urar spe|u|ur yarg a|ar
d|gura|ar. Per||sa adre|sa / pararelr|ur
(sara).
Z. Perer||saar spe|u|ur : gura|ar u|urar
yarg sesua|.
8. Pada pas|er oay| ser|rg cu|up d||a|u|ar lra|s| |ao|a |e ||r|-|arar urlu| rerarpa||ar ||arg vag|ra, l|da| per|u
perer||saar spe|u|ur raupur loucr.
9. J||a per|u, j||a pas|er sargal l|da| |ooperal|l, s|ap|ar sedas| alau aresles|a urlu| rererarg|ar pas|er.
Pr|ns|p pemer|ksaan g|neko|og| pas|en anak-anak

J||a d|lerlu|ar adarya |rd||as| perer||saar g|re|o|og| pada pas|er ara|-ara|, JAN0AN sarpa| l|da| dapal
ler|a|sara |arera |eleroalasar la|lor-la|lor lerseoul.
J||a l|da| rarpu, ruju| segera

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