Kehamilan postmature guf

8/17/2019 Kehamilan postmature guf

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POSTTERM PREGNANCY


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Introduction

Post term pregnancy is a common situation. It

cause anxiety for both women and obstetricians

because it perceived as being a cause of increased

risk to the fetus.

Post term pregnancy per se is not a pathological

condition and should not be confused with the

post maturity syndrome described by Cliord in 19!.


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"e#nitions


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$ Post term % prolonged pregnancy & ' it is !( completed weeks or more % (9! days&.

this de#nition is accepted by both )*+ ,-I+.

$ Post maturity syndrome '

it is I/0 with associations of meconiumstained amniotic 2uid oligohydramnios fetal

distress loss of subcutaneous fat and drycracked skin re2ecting placental insu3ciency.

$ Past date ' past the calculated 4"" before !( weeks.


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Incidence '

516 7

"ating by the last menstrual period %8P&alone

has a tendency to overestimate the : .

)hile the use of early ultrasound alone tocalculate

: signi#cantly reduced the incidence of postterm

pregnancy . Ia


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Importance

:& -etal and ;eonatal risks

$ It is likely that the ma


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)hen lethal congenital abnormalities are

excluded intrapartum fetal death is ! times more

common and

neonatal death is = times more commonin infant s born after !( weeks.


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In addition meconium staining of the amniotic

2uid and the likely of intrapartum fetal hypoxia

were much more common in post term

pregnancies compared to those delivered at !6 ws.

@his result in fetal acidosis neonatal seiAures ,

perinatal death . Post term pregnancy is also a

risk factor for birth trauma and shoulder dystocia.


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B& aternal risks of post term pregnancies'

$ increased operative delivery

hemorrhage and maternal infection.

$ in addition psychological morbidity asincreased maternal anxiety .


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4tiology

;ot Clear

It is common in ' $ primigravida

$ previous post term pregnancy.=67

@he cause may be due to '

1. low cortisol levels with post term fetaldistress.

(. relative adrenocortical insu3ciency leading todelay in the onset of labor , increased risk of

intrapartum hypoxia or death.


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upport for this theory is that '

infants delivered following a post term

pregnanciesare at increased risk of '

$ sudden infant death syndrome.$ death up to ( years of age.


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-etal :ssessment


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onitoring Post term Pregnancy

@he perinatal mortality does not signi#cantly rise

until !( ws. gestation thus there is no need to oerfetal monitoring prior to this gestation if it is not

oered at term .

@here is no consensus about the appropriate

surveillance to post term pregnancy and no clear

evidence exists to support that fetal monitoring

can reduce the perinatal mortality.


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$ simple fetal monitoring is as eective as more

sophisticated monitoring of post term

pregnancies

$ @he use of "oppler analysis of various arterial

systems as uterine umbilical middle cerebraland descending aorta in uncomplicated postterm

pregnancies is not dierent from that in term

pregnancies.


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@herefore

the recommended fetal monitoring

in post term pregnancy

is


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a& :mniotic 2uid measurement

8iDuor volume fall after term thus :-I does

not improve perinatal outcomes thus the mean

pool depth %P"& is the tool of choice formonitoring

liDuor in post term pregnancy. Ib

b& C@

imple monitoring with ;@ and liDuorassessment holds an advantage over the formal

biophysical pro#le scoring.


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It is therefore vital that each woman istreated

on an individual basis and counseledregarding

the risks of post term pregnancy.


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anagement


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%1& induction of labor at !1E weeks

to reduce perinatal mortality meconiumstainingof the amniotic 2uid and small decrease in

caesarean section rate . 1a

%(& conservative management

with close fetal surveillance this can reduce excess operative delivery in women who will opt to for conservative management .


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+ther interventions'

a. nipple stimulation

but have not been shown to be ofbene#t .

b. sweeping the membranes

at or beyond !6 weeks appear tosigni#cantly

reduce the incidence of post termpregnancy

and should be oered to all women.

F i t


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Fey points'

1. the use of early ultrasound dating reduces the incidence of postterm pregnancy.

(. induction of labor after !1E weeks reduces perinatal

mortality rates without increasing C rates.

=. sweeping the membranes signi#cantly reduces the

incidence of postterm pregnancy .

!. no clear evidence that fetal monitoring can reduce the

perinatal mortality in postterm pregnancy.

. the use of ;@ and liDuor assessment in monitoring

postterm pregnancy twice weekly is recommended in women who prefer conservative management with

fetal surveillance.


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FehamilanPostterm

"epartemen +bstetri dan inekologi

-akultas Fedokteran /niversitasIndonesia 0umah akit Cipto

Fl i#k i B kti 0C+


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Klasifkasi Tingkat Kemaknaan

1EE eta5analisis berkualitas tinggi ulasan sistematik 0C@ atau0C@ dengan risiko bias sangat rendah

1E eta5analisis yang baik ulasan sistematik 0C@ atau 0C@dengan risiko bias rendah

15 eta5analisis ulasan sistematik 0C@ atau 0C@ dengan risikobias tinggi

(EE /lasan sistematik kualitas tinggi dari kasus kontrol atau studikohort atau kasus kontrol kualitas tinggi atau kohort denganrisiko confounding bias atau kebetulan yang sangat rendahserta kemungkinan hubungan kausal yang tinggi

(E tudi kasus kontrol atau kohort yang baik dengan risikoconfounding bias atau kebetulan yang rendah serta

kemungkinan hubungan kausal yang moderat(5 tudi kasus kontrol atau kohort dengan risiko confounding

bias atau kebetulan yang tinggi dengan risiko signi#kanbahwa hubungan tidak kausal

= tudi non analitik %laporan kasus seri kasus&

! +pini ahli

Flasi#kasi Bukti 0C+

http://../PANDUAN%20PRAKTIK%20KLINIK.pptx


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Derajat Rekomendasi

: etidaknya 1 meta5analisis ulasan sistematik atau 0C@terklasi#kasi sebagai 1EE dan dapat diaplikasikan langsung kepopulasi targetatau

/lasan sistematik dari 0C@ atau bukti5bukti mengandung studi5studi klasi#kasi 1E dapat diaplikasikan secara langsung kepopulasi target dan secara umum menun


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Penilaian Kualitas dari ukti

I Bukti diperoleh dari setidaknya satu 0C@ yangmemadai

II51 Bukti dari u


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Klasifkasi Rekomendasi

: @erdapat bukti yang baik untuk merekomendasikantindakan preventif klinis

B @erdapat bukti yang cukup untuk merekomendasikantindakan preventif klinis

C Bukti yang ada saling bertentangan dan tidakmemungkinkan untuk membuat rekomendasi untukmendukung atau menentang tindakan preventif klinismeskipun demikian faktor5faktor lain dapatmempengaruhi pengambilan keputusan

" @erdapat bukti yang cukup untuk tidakmerekomendasikan tindakan preventif klinis

4 @erdapat bukti yang baik untuk tidakmerekomendasikan tindakan preventif klinis

8 @idak terdapat cukup bukti %dalam kuantitas ataukualitas& untuk membuat rekomendasi meskipundemikian faktor5faktor lain dapat mempengaruhi

"era


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TOP!K • "e#nisi

• Penentuan usia gestasi

• Insidens dan faktor risiko

• 0isiko kehamilan postterm

• 4valuasi antenatal• ana


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Su"jek ACOG #$%%&' AA(P #$%%)' RSCM

"e#nisi Fehamilan yangmencapai ataumelebihi !( minggu

%(9! hari atautaksiran partus E 1!hari&

Fehamilan yangmencapai !(minggu

Fehamilan !( minggu lengkapatau (9! hari dari periode haidterakhir %(J6 hari dari

konsepsi&

Penentuan usiagestasi

$pengukuran C08pada trimesterpertama$pengukuran BP"atau *C dan -8 padatrimester kedua

Prenatalultrasonogra#sebelum usiagestasi (!minggu

Fetetapan usia gestasisebaiknya mengacu pada hasilultrsonogra# pada trimester 1.Fesalahan perhitungan denganrumus ;aegele dapatmencapai (67

Insidens >7 dari seluruhkehamilan

5167 dariseluruhkehamilan

$!1 minggu lengkap' (>7$!( minggu lengkap' !K

1!7$!= minggu lengkap' (K>7

-aktorrisiko

$primipara$riwayatkehamilanpostterm

http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2005%20aafp%20postterm%20management.pdf/http://rscm%20kehamilan%20postmatur.docx/http://../PANDUAN%20PRAKTIK%20KLINIK.pptxhttp://../PANDUAN%20PRAKTIK%20KLINIK.pptxhttp://rscm%20kehamilan%20postmatur.docx/http://2005%20aafp%20postterm%20management.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/


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0isikokehamilanpostterm

mortalitas perinatalmeningkat (x lipatpada gestasi !(minggu dan Lx lipat

lebih pada gestasi!= minggu ke atas

mortalitas perinatalmeningkat (x lipatpada gestasi !(minggu dan !5Lx lipat

pada gestasi !!minggu

Fametian perinatalberkaitan dengan aspirasimekonium dan as#ksia

0isikomaternal

5 "istosia5 8aserasi perineum5 C (x lebih banyak

5 C akut5 CP"5 ruptur serviks5 "istosia

5 Fematian bayiinpartu5 Bayi besar5 Perdarahanpostpartum5 Infeksi puerperium

5 "istosia

0isikoneonatal 5 -etal makrosomia5 ;ilai :pgar 5menityang rendah

5 ;ilai p* arteriumbilikal rendah

5 :s#ksia5 :spirasi5 -raktur5 Fematian perinatal5 Paralisis saraf perifer5 Pneumonia5 epsis

55 akrosomia55 sindrom aspirasimekonium

55 distress nafas55 penumonia

http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2005%20aafp%20postterm%20management.pdf/http://rscm%20kehamilan%20postmatur.docx/http://../PANDUAN%20PRAKTIK%20KLINIK.pptxhttp://rscm%20kehamilan%20postmatur.docx/http://2005%20aafp%20postterm%20management.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/http://2004%20acog%20postterm%20guidelines.pdf/


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4valuasiantenatal

4valuasi antenatalpada gestasi !65!(minggu memperbaiki

luaran perinatal

Gika dilakukanmana


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Briscoe D, Nguyen H, Mencer M, et. al. Management of pregnancy beyond 40weeks gestation. !m "am #$ysician %00&'()*)+&-4%


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0eferensi

• P +bstetri inekologi 0C (66=

• :merican College of +bstetricians and ynaecologists.anagement of postterm pregnancy. :C+ Practice

Bulletin (66!16!%=&'L=95!L• Briscoe " ;guyen * encer et. al. anagement of

pregnancy beyond !6 weeksM gestation. :m -amPhysician (66>1'19=5!(

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Kehamilan postmature guf