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Pembimbing: dr. Wahyu Jatmika, Sp.OG
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Pemerik1aan yang dian2urkan
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%O((OW 'P Tanggal : !! Januari !"; Pukul $.@ W4 S : nyeri perut (+) O : KU
: Baik
Tensi
: 110/80 mmHg
Nadi
: 80/menit
Na!as
: 18/menit
Su"u
: #$%$ 0&
'ata
: nemis (/)% ikterik (/)
T"*rak
: &*r
( S1% S tungga,% regu,er% murmur ()
-u,m*( .esiku,er% r"*nki /% "eeing / d*men
: Bising usus (+)% nyeri tekan suprapuik (+) de!ans musku,ar (+)
--2
: (+) dara"
3kstremitas
: *edem ()
: 455-50 usia 6 ta"un "ami, # minggu dengan ke"ami,an ekt*pik terganggu - : -emeriksaan dara" rutin
Tanggal : !! Januari !"; Pukul !".@" W4
P"7(e' #"7% %e r"'+ :6er"7( D(8"%%"' 8"6"r:):#( D("+':7(7 6re:6er"7(
$ Ke"#(8"' e%):6(% )er+"'++
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$
L"6"r:):#( S"86('+e%):#( %"'"' Per*"r""' !00 Tanggal : !> Januari !"; Pukul "?."" W4 S : nyeri pada ,uka p*st *perasi O:
KU
: Baik
Tensi
: 110/80 mmHg
Nadi
: 80/menit
Na!as
: 18/menit
Su"u
: #$%8 0&
'ata
: nemis (/)% ikterik (/)
T"*rak
: &*r
( S1% S tungga,% regu,er% murmur ()
-u,m*( .esiku,er% r"*nki /% "eeing / d*men
: .eran (+) remesan ()
--2
: (+) dara"
3kstremitas
: *edem ()
: p*st sa,p"ingekt*mi dekstra "ari ke1 atas indikasi ke"ami,an ekt*pik terganggu - : Tira" aring '*nit*r "em*g,*in
Tanggal : !; Januari !"; Pukul "?."" W4 S : nyeri pada ,uka p*st *perasi O:
KU
: Baik
Tensi
: 1#0/80 mmHg
Nadi
: 87/menit
Na!as
: 18/menit
Su"u
: #$%8 0&
'ata
: nemis (/)% ikterik (/)
T"*rak
: &*r
( S1% S tungga,% regu,er% murmur ()
-u,m*( .esiku,er% r"*nki /% "eeing / d*men
: .eran (+) remesan ()
--2
: (+) dara"
3kstremitas
: *edem ()
: p*st sa,p"ingekt*mi dekstra "ari ke atas indikasi ke"ami,an ekt*pik terganggu - : '*i,isasi dini
Tanggal : !@ Januari !"; Pukul "?."" W4 S : Tidak ada ke,u"an O:
KU
: Baik
Tensi
: 10/80 mmHg
Nadi
: 80/menit
Na!as
: 0/menit
Su"u
: #$% 0&
'ata
: nemis (/)% ikterik (/)
T"*rak
: &*r
( S1% S tungga,% regu,er% murmur ()
-u,m*( .esiku,er% r"*nki /% "eeing / d*men
: .eran (+) remesan ()
--2
: (+) dara"
3kstremitas
: *edem ()
: p*st sa,p"ingekt*mi dekstra "ari ke# atas indikasi ke"ami,an ekt*pik terganggu - : -u,ang
T+J&'&+ P'ST&K&
A. Definisi kehamilan ektopik terganggu
Ke"#(8"' e%):6(% )er"*( /(8" )e8r "'+ *(/"( /er(#68"')"7( *"' )#/ *( 8"r e'*:#e)r(# %"?# )er(, Ke"#(8"' e%7)r")er(' )(*"% 7"#" *e'+"' %e"#(8"' e%):6(% %"re'" %e"#(8"' 6"*" 6"r7 (')er7)(7("8(7 )/" *"' %"'"8(7 7er?(%7 #"7( )er#"7% *"8"# )er75 )e)"6( e8"7 /er7(@") e%):6(%, Se/"+("' /e7"r %e"#(8"' e%):6(% /er8:%"7( *( )/", S"'+") "r"'+ )er"*( (#68"')"7( 6"*" :?"r(#5 r:'++" 6er)5 %"'"8(7 7er?(%"8(7 )er(5 )"'*% )er7 "'+ r*(#e')er5 *"' *(?er)(%e8 6"*" )er7, Ber*"7"r%"' (#68"')"7( "7(8 %:'7e67( 6"*" )/"5 )er*"6") %e"#(8"' 6"r7 (')er7)(7("8(7 )/"5 %e"#(8"' 6"r7 (7#(%" )/"5 %e"#(8"' 6"r7 "#68"r(7 )/"5 *"' %e"#(8"' ('@'*(/8# )/", 1 Ke"#(8"' *( 8"r )/" ("8" %e"#(8"' :?"r("85 %e"#(8"' (')r"8(+"#e')er5 %e"#(8"' 7er?(%"85 *"' %e"#(8"' "*:#('"8 "'+ /(7" 6r(#er ")" 7e%'*er, 1 Ke"#(8"' (')r")er('e *"6") *()e#%"' /er7"#""' *e'+"' %e"#(8"' e%7)r")er(', D"8"# "8 ('( *(/e*"%"' *" e'(75 "() combined ectopic pregnancy *(#"'" %e"#(8"' (')"r)er(' )er*"6") 6"*" 9"%) "'+ 7"#" *e'+"' %e"#(8"' e%7)r")er(' *"' compound ectopic pregnancy "'+ #er6"%"' %e"#(8"' (')r")er(' 6"*" 9"'()" *e'+"'
%e"#(8"' e%7)r")er(' 8e/( *"8 *e'+"' "'(' 7*" #")( *"' #e'"*( 8():6e*(:',
B.
Epidemiologi
kehamilan ektopik terganggu
Te8" )er"*( 6e'('+%")"'
'")" #8" "/7:8) *"' "'+%" %e#")("' e%):6(% *( A#er(%" Ser(%") 7e8"#" *" *e%"*e /e8"%"'+"', 4#8" 7e/e'"r'" )e8" #e'('+%") #e8"#6"( 6r:6:r7( 6er)#/"' 6e'**%, 2 I'7(*e' %e"#(8"' e%):6(%6"*" 9"'()" /%"' %8() 6)( 8e/( )('++( 6"*" 7e)("6 %")e+:r( 7(" *(/"'*('+ 6"*" 9"'()" %8() 6)(5 *"' 6er/e*""' ('( #e'('+%") 7e"8"' *e'+"' 6er)"#/""' 7(", Se"r" %e7e8r"'5 6"*" )"' 1-- 7e:r"'+ 9"'()" /%"' %8() 6)( #e#(8(%( 6e'('+%")"' re7(%: %e"#(8"' e%):6(% 7e/e7"r 15! %"8( *(/"'*('+ *e'+"' 7e:r"'+ 9"'()" %8() 6)(, G"/'+"' @"%):r r"7 *"' 6e'('+%")"' 7(" 7e%r"'+%r"'+'" #er6"%"' @"%):r )"#/""', Se/"+"( :'):5 9"'()" /%"' %8() 6)( /er7(" 3> 7"#6"( !! )"' 8(#" %"8( 8e/( #'+%(' #e'+"8"#( %e"#(8"' e%):6(% *"r(6"*" 9"'()" %8() 6)( /er7(" 1> 7"#6"( 2! )"',2 A'+%" %e"#(8"' e%):6(% 6er 1000 %e"#(8"' "'+ *(8"6:r%"' #e'('+%") e#6") %"8( 8(6") *"r( )"' 1-;0 7"#6"( 1--2, Pe'('+%")"' ('( 8e/( /e7"r 6"*" 9"'()" /%"' %8() 6)( *(/"'*('+ 6"*" 9"'()" %8() 6)( *"' ')% %e*"'"5 ('7(*e' #e'('+%") 7e(r('+ *e'+"' 6er)"#/""' 7(", De'+"' %")" 8"('5 6"*" )"' 1--2 "#6(r 2 6er7e' *"r( 7e8r %e"#(8"' "*"8" %e"#(8"' e%):6(%, Y"'+ 6e')('+5 %e"#(8"' e%):6(% /er)"'++'+ "9"/ )er"*"6 10 6er7e' *"r( 7e#" %e#")("' "'+ *(7e/"/%"' :8e %e"#(8"', 2 Peningkatan angka KET adalah di1ebabkan oleh :
1, Me'('+%")'" 6re?"8e'7( ('@e%7( )/" "%(/") 6e'8"r"' 7e%7"8 2, D("+':7(7 8e/( *('( *e'+"' 6e#er(%7""' +:'"*:)r:6(' %:r(:'(% "'+ 7e'7()(@ *"' 8)r"7:':+r"@( )r"'7?"+('"8 6"*" /e/er"6" %"77 )er"*( re7:r67( 7e/e8# *(8"%%"' *("+':7(7 6"*" #"7" 8"8, 3, P:68"r()"7 %:')r"7e67( "'+ #e'e+" %e"#(8"' (')r")er('e )e)"6( )(*"% ')% %e"#(8"' e%7)r")er('e, !, S)er(8(7"7( )/" "'+ +"+"8 >, I'*%7( "/:r7( "'+ *((%)( *e'+"' ('@e%7( ., Me'('+%")'" 6e'++'""' )e%'(% re6r:*%7( *e'+"' /"')"', ;, Be*" )/"5 )er#"7% r(9"") 7"86('+:):#( 7er)" )/:68"7)( ')% %e"#(8"' )/" C. Etiologi kehamilan ektopik terganggu
Se/"+("' /e7"r 6e'e/"/ %e"#(8"' e%):6(% )(*"% *(%e)"(, T("6 %e"#(8"' *(#8"( *e'+"' 6e#/""' )e8r *( /"+("' "#68" )/"5 *"' *"8"# 6er"8"'"' %e )er7 )e8r #e'+"8"#( "#/")"' 7e('++" 6"*" 7"") '(*"7( #"7( *( )/"5 ")" '(*"7('" *( )/" *(6er#*", 1. F"%):r – @"%):r "'+ #e#e+"'+ 6er"'"' *"8"# "8 ('( ("8" 7e/"+"(
/er(%) $ 1, F"%):r *"8"# 8#e' )/" 23 $
e'*:7"86('+()(7 *"6") #e'e/"/%"' 6er8e'+%e)"' e'*:7"86('+5 7e('++" 8#e' )/" #e'e#6() ")" #e#/e')% %"'):'+ /')
6"*" (6:68"7(" )er( 8#e' )/" 7e#6() *"' /er8e%% – 8e%% *"' "8 ('( 7er('+ *(7er)"( +"'++"' @'+7( 7(8(" e'*:7"86('+
:6er"7( 68"7)(% )/" *"' 7)er(8(7"7( "'+ )"% 7e#6r'" *"6") #e'"*( 7e/"/ 8#e' )/" #e'e#6()
2, F"%):r 6"*" *('*('+ )/" 23 $
e'*:#e)r(:7(7 )/" *"6") #e#*"%"' (#68"')"7( )e8r "'+ *(/"( *"8"# )/"
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3, F"%):r *( 8"r *('*('+ )/" 23
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6e#"%"( IUD *( #"'" 6r:7e7 6er"*"'+"' "'+ *"6") )(#/8 6"*" e'*:#e)r(# *"' e'*:7"86('+ *"6") #e'e/"/%"' )er"*('" %e"#(8"' e%):6(%, F"%):r ## 6e'*er()" "'+ 7*" #e'" *"' @"%):r 6er:%:% +" 7er('+ *(/'+%"' *e'+"' )er"*('" %e"#(8"' e%):6(%,
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D. Patofisiologi kehamilan ektopik terganggu
1, Ke"#(8"' T/" Fer)(8(7"7( *"6") )er"*( *( /"+("' #"'" 7"" *( )/" @"8:6(5 7e%()"r >> )er"*( *( "#68"5 2> *( (7#75 1; *( @(#/r(",O8e %"re'" 8"6(7"' 7/#%:7" *( )/" @"8:6(( )(6(75 #e#'+%('%"' :?# "'+ )e8" *(/"( *"6") 7e+er" #e'e#/7 7"#6"( %e e6()e85 J(+:) "%"' 7e+er" )er)"'"# *( 8"6(7"' #7%8er, Tr:@:/8"7 /er6r:8(@er"7( *e'+"' e6") *"' #e'+('?"7( *"er" 7e%()"r'", Se"r" /er7"#""'5 6e#/8 *"r" (/ )er/%" #e'e/"/%"' )er"*( 6er*"r""' *( r"'+ "')"r" )r:@:/8"75 ")" "')"r" )r:@:/8"7 *"' "r('+"' *( /"9"'", D('*('+ )/" "'+ #e'"*( )e#6") (#68"')"7( J(+:) #e#6'"( %e)""'"' "'+ re'*" )er"*"6 ('?"7( )r:@:/8"7, E#/r(: ")" "'(' 6"*" %e"#(8"' e%):6(% 7er('+%"8( )(*"% *()e#%"' ")" )(*"% /er%e#/"'+,1.
P"*" "'+ 6er)"#" )e8r /er(#68"')"7( 6"*" 7(7( ")" '+ :':) e'*:7"86('+, Per%e#/"'+"' )e8r 7e8"')'" *(/")"7( :8e %r"'+'" ?"7%8"r(7"7( *"' /("7"'" )e8r #")( 7e"r" *('( %e#*("' *(re7:r/7(, P"*" '(*"7( 7e"r" (')er%:8#'er )e8r /er'(*"7( "')"r" 2 :':) e'*:7"86('+, Se)e8" )e#6") '(*"7( )er))65 #"%" )e8r *(6(7"%"' *"r( 8#e' )/" :8e 8"6(7"' "r('+"' "'+ #e'er6"( *e7(*" *"' *('"#"%"' 67e*:%"678"r(7, K"re'" 6e#/e')%"' *e7(*" *( )/" )(*"% 7e#6r'" #"8""' %"*"'+ %"*"'+ )(*"% )"#6"%5 *e'+"' #*" ?(8( %:r("8(7 #e'e#/7 e'*:7"86('+ *"' #"7% %e *"8"# 8"6(7"' :):) – :):) )/" *e'+"' #er7"% "r('+"' *"' 6e#/8 *"r", Per%e#/"'+"' "'(' 7e8"')'" /er+"')'+ 6"*" /e/er"6" @"%):r5 7e6er)( )e#6") (#68"')"7(5 )e/"8'" *('*('+ )/"5 *"' /"'"%'" 6er*"r""' "'+ )er"*( :8e ('?"7( )r:@:/8"7, 1. D( /"9" 6e'+"r :r#:' e7)r:+e' *"' 6r:+e7)er:' *"r( %:r67 8)e# +r"?(*()")(7 *"' )r:@:/8"75 )er7 #e'"*( /e7"r *"' 8e#/e% e'*:#e)r(# *"6") /er/" 68" #e'"*( *e7(*", D"6") *()e#%"' 68" 6er/""' – 6er/""' 6"*" e'*:#e)r(# "'+ *(7e/) @e':#e'" Ar("7 – S)e88", Se8 e6()e8 #e#/e7"r *e'+"' (')('" (6er)r:@(%5 (6er%r:#")(%5 8:/8er *"' /er/e')% )"% )er")r, S():68"7#" 7e8 *"6") /er8/"'+ – 8/"'+ ")" /er/7"5 *"' %"*"'+ – %"*"'+ *()e#%"' #():7(7, Per/""' )er7e/) "'" *()e#%"' 6"*" 7e/"+("' %e"#(8"' e%):6(%, 1. 2, A/:r)7 T/" Ter"*('" "/:r)7 )/" /er+"')'+ 6"*" 8:%"7( (#68"')"7(, U##'" )er"*( /(8" (#68"')"7( *( "#688"5 7e/"8(%'" r6)r )/" )er)"#" /(8" (#68"')"7( *( *"er" (7#7, A*"'" 6er*"r""' #e'e/"/%"' 68"7e')" *"' #e#/r"' )er8e6"7 *"r( *('*('+
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4eberapa 2eni1 kehamilan lain:
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H. Komplikasi kehamilan ektopik terganggu
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