SEKSIO SESAREA (Sari Pustaka)
Oleh : dr. Wahyuridistia Marhenriyanto PPDS Obstetri dan Ginekologi
Pembimbing : dr. H. Ariadi, Sp.OG
PROGRAM PENDIDIKAN DOKTER SPESIALIS OBSTETRI DAN GINEKOLOGI FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS RSUP DR. M. DJAMIL PADANG 2018
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DAFTAR ISI DAFTAR ISI ............................................................................................... i DAFTAR GAMBAR GAMBAR ......................... ............ .......................... .......................... .......................... .......................... ................... ...... ii DAFTAR TABEL TABEL ........................... .............. .......................... .......................... .......................... .......................... .................... ....... iii
BAB I PENDAHULUAN PENDAHULUAN ............................................................................ 1
BAB II TINJAUAN PUSTAKA PUSTAKA .................................................................. 4 A. Definisi Operasi Seksio Sesarea Sesarea .......................... ............ ........................... .......................... ............. 4 B. Peningkatan Insidensi Insidensi Operasi Seksio Seksio Sesarea ............................. ...................... ....... 4 C. Indikasi Operasi Seksio Seksio Sesarea Sesarea dan Resiko ............... .................. .............. .... 6 D. Morbiditas dan Mortalitas Ibu .......................... ............. .......................... ........................... .................. .... 8 E. Morbiditas Neonatus .................... ...... ........................... .......................... .......................... ...................... ......... 15 F. Cesarean Delivery on Maternal Request (CDMR) Request (CDMR) ....................... ............ ........... 15 G. Persiapan Pasien ......................................................................... 17 H. Teknik Operasi Seksio Sesarea ........................... ............. ........................... ........................ ........... 21 I. Manajemen Peripartum ......................... ............ .......................... ........................... .......................... .............. 51
BAB III KESIMPULAN KESIMPULAN ........................... ............. ........................... .......................... ......................... ...................... .......... 58
DAFTAR PUSTAKA PUSTAKA ............................................................................... 59
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DAFTAR GAMBAR Gambar 1. Insisi Kulit Pfanenstiel ............................................................ 22 Gambar 2. Jenis Insisi Abdomen ............................................................. 23 Gambar 3. Pemotongan Linea Alba .......................... ............. .......................... .......................... .................. ..... 24 Gambar 4. Pemotongan Fascia ............................................................... 25 Gambar 5. Pemotongan Lapisan Vesicouterina ...................................... 27 Gambar 6. Gunting Metzenbaum .......................... ............. .......................... .......................... ...................... ......... 27 Gambar 7. Forcep atau Pinset ................................................................. 28 Gambar 8. Pelebaran Insisi Vesicouterina ......................... ............ ......................... ...................... .......... 28 Gambar 9. Diseksi Tumpul T umpul Pemisahan Vesicouterina ........................... ............. ................ .. 29 Gambar 10. Hemostat .............................................................................. 30 Gambar 11. Gunting Perban .................................................................... 30 Gambar 12. Insisi Miometrium ................................................................. 31 Gambar 13. Pelebaran Insisi Uterus ........................................................ 31 Gambar 14. Pelebaran Uterus Cephalad-Caudad .......................... ............. ...................... ......... 32 Gambar 15. Melahirkan Kepala Bayi ....................................................... 33 Gambar 16. Forcep Kepala Bayi ........................... .............. .......................... .......................... ...................... ......... 34 Gambar 17. Melahirkan Bahu Bayi .......................................................... 35 Gambar 18. Klem Pennington .......................... ............. .......................... ........................... .......................... .............. 37 Gambar 19. Ring Forcep ......................................................................... 37 Gambar 20. Pengeluaran Uterus ............................................................. 38 Gambar 21. Penjahitan Kedua Ujung Uterus ......................... ............ .......................... .................. ..... 39 Gambar 22. Penjahitan Ujung Uterus ...................................................... 40 Gambar 23. Jahitan Jelujur Uterus .......................................................... 41 Gambar 24. Jahitan 1 dan 2 Lapis Uterus ............................................... 41 Gambar 25. Penjahitan Uterus................................................................. 42 Gambar 26. Insisi Klasik .......................................................................... 46 Gambar 27. Penjahitan Insisi Klasik ........................................................ 47
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DAFTAR TABEL Tabel 1. Indikasi Operasi Seksio Sesarea ......................... ............ ......................... ........................ ............ 6 Tabel 2. Indikasi Operasi Seksio Sesarea ......................... ............ ......................... ........................ ............ 7 Tabel 3. Lokasi Spesifik SSI Organ atau Rongga IIntraabdomen ntraabdomen ............. ............ . 13 Tabel 4. Skoring Perlengketan SC .......................... ............. .......................... .......................... .................... ....... 51 Tabel 5. Pemberian Analgesi Intravena Pasien Operasi SC.................... ............. ....... 53 Tabel 6. Skala REEDA.......................... ............. .......................... ........................... .......................... ........................ ............ 57
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PROGRAM PENDIDIKAN DOKTER SPESIALIS (PPDS) OBSTETRI DAN GINEKOLOGI FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS RSUP DR. M. DJAMIL PADANG
LEMBAR PENGESAHAN
Nama
: dr. Wahyuridistia Marhenriyanto Marhenriyanto
Semester
:V
Telah menyelesaikan Sari Pustaka dengan judul Seksio Sesarea
Padang, Mei 2018 Mengetahui / Menyetujui :
Peserta PPDS
Pembimbing
Obstetri & Ginekologi
(dr. H. Ariadi, Sp.OG)
(dr. Wahyuridistia Marhenriyanto) Marhenriyanto)
Diketahui : Ketua Program Studi
dr. H. Syahredi S.A., SpOG(K)
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LEMBARAN KONSULTASI KARYA ILMIAH PESERTA PPDS I OBSTETRI & GINEKOLOGI FK. UNAND/RS. M. DJAMIL PADANG NAMA
: dr. Wahyuridistia Marhenriyanto
NO. CHS
: 1550302014
SEMESTER
:V
JENIS
: LP/RF/PK/JR/Sub. Bag/Ans/PA/Sar.Pus/Prop.Pen/TA. B.I/KM/JK
No
PEMBIMBING
: dr. H. Ariadi, Sp.OG
JUDUL
: Sectio
Tanggal
Tgl
Caesaria
Koreksi
Diterima
Keterangan : R : Referat LP : Laporan Kasus PK : Presentasi Kasus JR : Journal Reading Sub. Bag : Onko, Endo,Feto, Uro, Sito, Obsos,Rep.Man Sar.Pus : Sari Pustaka Prop. Pen : Proposal Penelitian TA : Tulisan Akhir Ans : Anesthesi
Paraf
Ket
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BAB I PENDAHULUAN
Kesehatan
reproduksi
didefinisikan
dimana
manusia
mempunyai
tanggungjawab, kepuasan dan kehidupan seks yang aman dimana mereka mempunyai kemampuan reproduktif dan kebebasan untuk memilih kapan dan seberapa seringnya. Secara implisit berarti setiap orang mempunyai hak untuk mendapatkan informasi, akses yang aman, efektif, terjangkau dan metode reproduksi sesuai keinginanannya. Setiap orang juga memiliki hak untuk dapat mengakses sarana kesehatan yang dapat melayani kehamilan dan persalinan secara aman dan memberikan pasangan kemungkinan terbaik untuk memiliki keturunan yang sehat (WHO, 2015). Manusia pada dasarnya memiliki dua pilihan dalam proses persalinan yaitu secara normal (pervaginam) atau dengan operasi seksio sesarea atau biasa dikenal dengan SC. Keduanya memiliki kelebihan masing-masing, namun persalinan normal atau persalinan pervaginam memiliki kelebihan dibanding operasi SC diantaranya kecepatan penyembuhan, meminimalkan resiko ruptur uteri pada kehamilan selanjutnya, minimal resiko plasenta akreta, lebih sedikit jumlah perdarahan, perdarahan, terhidar terhidar dari cedera organ organ dalam dalam saat operasi, operasi, minimal minimal infeksi luka operasi, minimal efek anastesi, emboli dan terhindar dari resiko SC ulangan (Clinnic, 2018). Paparan terhadap mikroflora vagina pada persalinan normal berpengaruh terhadap perkembangan normal imunitas bayi (Neu and Rushing, 2011). SC sendiri mempunyai angka kematian yang lebih tinggi dibanding kelahiran normal, kemungkinan plasenta previa dan solusio plasenta dan meningkatkan kemungkinan distress pernafasan pada neonatal (Hannah, 2004).
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Primum non Nocere Nocere atau First Do No Harm yang berarti jangan merusak atau mencelakakan. Prinsip etik dasar ini juga dapat diartikan lebih baik tidak melakukan sesuatu ketimbang melakukan suatu tindakan yang akhirnya mencelakakan pasien. Prinsip ini dipakai juga dalam bidang obstetri sebagai dasar pemilihan jenis persalinan. Dengan mempertimbangkan kelebihan persalinan normal dan banyaknya resiko, komplikasi serta dampak kedepannya dari SC, maka persalinan normal selalu menjadi pilihan terbaik untuk persalinan (Harrison, 2007). Operasi SC adalah operasi untuk melahirkan bayi dengan insisi uterus. Asal muasal muasal operasi SC tidak jelas. Ada 2 tipe operasi operasi SC yaitu operasi operasi SC primer dan sekunder. Operasi SC primer merupakan operasi SC yang pertama kali dilakukan sedangkan sekunder merupakan operasi SC kedua atau lebih (Cunningham, 2014). Persalinan dengan seksio sesarea dapat dipilih jika terdapat indikasi medis yang jelas yaitu faktor ibu, faktor janin dan faktor plasenta. Cesarean delivery on maternal request (CDMR) (CDMR) adalah persalinan secara SC yang dipilih oleh seorang wanita tanpa adanya indikasi medis. CDMR dilegalkan di beberapa negara maju dengan syarat pasien telah diterangkan secara lengkap mengenai kelebihan dan kekurangan SC, perbandingannya dengan persalinan normal, komplikasi yang mungkin terjadi seperti kecacatan, cedera organ, alergi, kemungkinan angkat Rahim hingga kematian serta prognosis persalinan kedepannya. CDMR dapat dikatakan legal jika pasien telah mengerti dan tetap memutuskan memilih persalinan seksio sesarea (Cunningham, 2014). Data mengenai Cesarean mengenai Cesarean delivery on maternal request (CDMR) terbatas,
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akhir persalinan seorang wanita. Seksio sesarea merupakan pilihan persalinan saat adanya kontraindikasi untuk persalinan normal. Faktor ibu, janin dan plasenta merupakan pertimbangan dalam melakukan SC. Komplikasi seperti perdarahan, infeksi, alergi, cedera organ, pengangkatan rahim hingga kematian wajib diketahui oleh pasien sebelum menjalani SC. Banyaknya faktor yang berperan dan harus dipertimbangkan sebelumnya membuat operasi SC menarik untuk diangkat sebagai judul sari pustaka. Harapannya Harapann ya sari pustaka ini dapat berperan sebagai bahan pembelajaran dan pertimbangan persalinan secara SC.
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BAB II TINJAUAN PUSTAKA
A. Definisi Operasi Seksio Sesarea Operasi seksio sesarea (SC) adalah operasi untuk melahirkan bayi dengan insisi corpus uteri (Cunningham, 2014). Meskipun angka operasi SC terus meningkat 10-15 tahun terakhir, 4 indikasi klinis yang menjadi faktor penentu SC tidak berubah yaitu fetal distress distress (22%), kegagalan persalinan normal (20%), riwayat SC (14%) dan letak sungsang (11%). Saat ini ditambah faktor kelima yaitu CDMR dengan syarat terpenuhi t erpenuhi (7%) (Gian Carlo Di Renzo, 2017).
B. Peningkatan Insidensi Operasi Seksio Seksio Sesarea Sesarea Angka operasi SC saat ini terus meningkat. Alasan peningkatan ini tidak sepenuhnya dimengerti, namun beberapa penjelasan yang mungkin diantaranya (Cunningham, (Cunningham, 2014) : 1. Wanita mempunyai sedikit anak sehingga presentase kejadian melahirkan nulipara meningkat, dimana nulipara meningkatkan resiko untuk operasi SC. 2. Rata-rata Rata-rat a umur ibu meningkat, dimana wanita nulipara tua meningkatkan
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7. Operasi SC pada pasien preeklampsia preeklampsia meningkat dimana dimana persalinan dengan induksi pada pasien ini menurun. 8. Presentase Presenta se persalinan VBAC menurun dari 28% menjadi 8% tahun 2007. 9. Operasi SC elektif meningkat dengan berbagai indikasi termasuk pertimbangan cedera pada dinding pelvis terkait persalinan per vaginam, menurunkan resiko cedera janin dan permintaan ibu. 10. Kejadian malpraktek terkait cedera saat persalinan persalinan pervaginam dan tindakan operatif persalinan pervaginam (vakum & forcep) juga menjadi alasan kecenderungan memilih SC. Persalinan dengan operasi SC digunakan secara efektif sepanjang abad ke 20 dan merupakan salah satu jenis operasi yang sering dilakukan hingga saat ini. Angka operasi operas i SC di US tahun 2009 meningkat menjadi 32,9%, peningkatan sebanyak 50% selama 15 tahun. Tidak begitu jelas kenapa angka operasi SC begitu meningkat, namun diduga sebabnya bersifat multifaktorial meliputi (Callahan and Caughey, 2013) : 1. Sebab biologis seperti peningkatan kejadian kehamilan multipel, populasi usia tua dengan lebih banyak penyakit medis dan tingginya angka overweight dan overweight dan obesitas. 2. Pasien dengan kecenderungan kecenderunga n memilih SC atau Caesarean Caesarean Delivery on Maternal Request (CDMR). (CDMR). 3. Rendahnya insentif persalinan normal dibandingkan SC. Walaupun kematian terkait operasi SC rendah, sekitar 0.01-0.02%, angka ini masih lebih tinggi dibandingkan persalinan pervaginam. Lebih jauh, morbiditas dari infeksi, kejadian trombotic, wound dehiscence dehiscence dan waktu
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setelah partus pervaginam dinamakan postpartum histerektomi (Cunningham, 2014). C. Indikasi Operasi SC dan dan Resiko Resiko Indikasi tersering dari operasi SC adalah kegagalan kemajuan persalinan. Kegagalan kemajuan persalinan dapat disebabkan oleh salah satu dari 3P. Indikasi dari operasi SC dapat dilihat pada tabel dibawah ini (Callahan and Caughey, 2013). Tabel 1. Indikasi I ndikasi operasi section caesarea (Callahan and Caughey, 2013).
Indikasi Operasi Seksio Sesarea Tipe
Indikasi
Ibu/Janin
CPD Gagal Induksi
Ibu
Penyakit ibu
Riwayat SC klasik
Herpes genital aktif
Myomectomi full-thickness
HIV tidak diterapi (kenaikan Riwayat ruptur uterus viral load)
Obstruksi jalan lahir
Ca Cervix
Fibroid
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Lebih dari 85% operasi SC dilakukan atas 4 indikasi yaitu, riwayat operasi SC sebelumnya, distosia, fetal distress dan presentasi janin abnormal. Berikut adalah tabel indikasi operasi SC (Cunningham, 2014) :
Tabel 2. Indikasi operasi SC (Cunningham, 2014).
FAKTOR
INDIKASI
Maternal
Riwayat operasi SC Plasentasi abnormal Permintaan ibu Riwayat histerotomi klasik Tipe scar uterus yang tidak diketahui Dehiscence insisi uterus Riwayat full-thickness myomectomy Obstruksi massa saluran genital Ca cerviks invasif Riwayat trachelectomi
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Macrosomia Anomali kongenital Color doppler umbilicus abnormal Trombositopenia Riwayat trauma bayi saat persalinan HIV = Human immunodeficiency; HSV = herpes simplex virus.
Insidensi indikasi SC lain yang akan terus naik adalah letak sungsang karena persalinan normal terbukti meningkatkan morbiditas dan mortalitas perinatal (RCOG, 2006). Penurunan angka persalinan pervaginam letak sungsang akan menimbulkan penurunan jumlah tenaga terlatih yang dapat menolong persalinan sungsang pervaginam, hal ini berdampak balik pada meningkatnya angka SC dimana salah satu indikasi SC letak sungsang adalah tidak adanya tenaga terlatih dalam pertolongan persalinan sungsang.
D. Morbiditas dan Mortalitas Ibu
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Wanita dengan kecenderungan memilih elektif SC diberikan konsultasi mengenai rendahnya kemungkinan terjadinya perdarahan dan korioamnionitis dibandingkan dengan persalinan pervaginam. Namun keuntungan ini diimbangi dengan kemungkinan tinggi terjadinya tromboemboli, histerektomi dan kemungkinan masuk kembali ke RS karena infeksi atau komplikasi pada luka; lamanya rawatan di rumah sakit; besarnya kemungkinan ruptur uteri dan abnormalnya abnormalnya penempelan plasenta pada kehamilan selanjutnya. Wanita W anita yang menjalani operasi SC mempunyai kemungkinan besar untuk operasi ulang pada kehamilan selanjutnya. Untuk wanita yang menjalani operasi re-SC, resiko maternal yang telah disebutkan akan jauh lebih besar. Untuk keuntungannya, ada bukti bahwa operasi SC terkait erat dengan rendahnya kemungkinan untuk terjadinya inkontinensia urin dan prolapse organ pelvis (Cunningham, 2014).
1. Jumlah Perdarahan Operasi SC 20 juta operasi SC dilakukan setiap tahunnya diseluruh dunia. Jumlah ini akan semakin meningkat kedepannya. Morbiditas yang mungkin terjadi saat SC adalah perdarahan, histerektomi, anemia, transfusi dan infeksi. Diantara morbiditas diatas, perdarahan merupakan
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monitor vital sign dan urin output, pemeriksaan hematokrit harus dilakukan selama operasi dan setelah operasi (Cunningham, 2014). Kehilangan darah pada operasi SC elektif resiko rendah dengan spinal anastesi lebih minimal dibandingkan dibandingkan anastesi umum (Aksoy et al., 2015). Pada studi yang dilakukan di Malaysia pada 400 pasien SC didapatkan kehilangan darah >500 cc selama operasi SC, BMI kg/m2, lama rawatan
30
4 hari, letak sungsang, penggunaan anastesi
spinal dan analgesia intratechal secara signifikan meningkatkan resiko SSI (Jasim et al., 2017).
2. Pemeriksaan Pemeriksa an Perdarahan SC Perdarahan dihitung berdasarkan perbandingan Hb dan Hct antara sebelum operasi dan setelah operasi. Hb dan Hct dapat mencerminkan kehilangan darah selama operasi. Hemoglobin (Hb) merupakan protein didalam sel darah merah yang bertanggung jawab untuk mengikat oksigen dan menyalurkannya ke jaringan tubuh. Untuk Untuk menjamin menjamin oksigenasi oksigenasi jaringan yang adekuat, adekuat, jumlah jumlah Hb yang cukup harus dijaga. Jumlah Hb dalam tubuh dihitung dalam satuan gram per deciliter (g/dL). Nilai normal Hb untuk laki-laki 14-18 g/dL
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3. Infeksi Luka Operasi Walaupun operasi SC dilakukan di lingkungan yang steril, resiko untuk terjadinya infeksi selalu ada. Penggunaan antibiotik profilaksis terbukti menurunkan morbiditas infeksi post SC. American College of Obstetrician and Gynecologi G ynecologist st (ACOG) (ACOG) menyarankan pemberian antibiotik profilaksis 1 jam sebelum operasi SC atau dimana keadaan tidak memungkinkan, lakukan sesegera mungkin (Gelaw et al., 2017). Biasanya luka operasi SC akan sembuh dalam rentang waktu yang kurang lebih sama. Pada sebagian kecil kasus, luka operasi akan terkontaminasi dan terjadi infeksi, hal ini dapat terjadi dimana saja termasuk di rumah sakit modern dengan protocol standar persiapan operasi dan antibiotik profilaksis yang baik (Gelaw et al., 2017). SSI menurut CDC (Centers for Disease Control and Prevention)
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d. Ditegakkannya diagnosis SSI superfisial superfisial oleh dokter
SSI insisi dalam harus memenuhi 2 kriteria wajib sebagai berikut (CDC, 2018): a. Infeksi terjadi dalam dalam rentang rentang waktu 30-90 hari hari setelah operasi operasi (hari operasi dihitung sebagai hari pertama) b. Melibatkan jaringan lunak di dalam dalam (fascia dan otot) otot)
Ditambah minimal 1 kriteria tambahan di bawah ini : a. Cairan purulen didapatkan pada insisi dalam b. Insisi dalam yang secara sengaja dibuat oleh dokter. dan dan didapatkan
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b. Ditemukan organisme dari cairan cairan atau jaringan jaringan pada pada organ dalam dalam atau rongga intraabdomen. Organisme ditemukan dari tes kultur atau non kultur mikrobiologi yang dilakukan dengan tujuan diagnosis atau terapi. c. Ditemukan abses atau bukti infeksi lain yang melibatkan organ dalam dan rongga intraabdomen yang terlihat pada anatomi secara makro atau histopatologi atau pemeriksaan radiologi yang mengarah kepada infeksi.
Ditambah minimal 1 kriteria spesifik dari infeksi organ atau rongga intraabdomen pada tabel 3 sesuai dengan Surveillance Definitions for Specific Types of Infections. Infections.
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DISC
Ruang Disc
OREP
Infeksi lain dari saluran reproduksi wanita atau pria
EAR
Telinga, mastoid
PJI
Infeksi sendi periprostetik
EMET
Endometritis
SA
Abses spinal tanpa meningitis
ENDO
Endocarditis
SINU
Sinusitis
GIT
Saluran pencernaan
UR
Infeksi saluran pernafasan
IAB
Intraabdomen, tidak spesifik
USI
Infeksi saluran kencing
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Pada penelitian yang dilakukan di Nigeria yang melibatkan 445 rumah sakit didapatkan angka resiko SSI sebesar 9,1%. Faktor yang berpengaruh dalam kejadian SSI adalah persalinan macet, durasi operasi lama dan perdarahan banyak (Jido TA, 2012). Leukosit atau sel darah putih atau White Blood Cell (WBC) merupakan grup heterogen sel nucleus yang dapat ditemukan di sirkulasi manusia. Konsentrasi normal berkisar anatara 4.000-10.000 per microliter. Leukosit mempunyai peran penting dalam fogositosis, imunitas dan pertahanan terhadap infeksi. Leukosit dapat dinilai secara kuantitatif dan kualitatif di laboratorium. Tes sederhana leukosit adalah jumlah leukosit dan hitung jenis. Jumlah leukosit dapat dihitung manual dalam ruang Neubauer atau dihitung dengan mesin. Hitung jenis dinilai dengan cara meletakkan setetes darah pada gelas kaca, disapukan dan dihitung
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mutlak (definitif). Tes leukositosis tunggal adalah prediktor buruk adanya bakteremia dan bukan menjadi indikasi untuk melakukan kultur darah (Riley LK, 2015). Leukositosis tidak berhubungan dengan infeksi bakteri saat nifas dan tidak menjadi pertimbangan dalam pemberian antibiotik (P Dior et al., 2013).
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pengobatan/perlakuan dan prognosis pada konteks kehidupan reproduksi pada
umumnya
serta
menggunakan
pelbagai
kemajuan/kecanggihan
teknologi reproduktif apapun yang dapat menghilangkan atau menurunkan harkat dan martabat manusia. Yang dimaksud dengan reproduksi adalah terutama
tentang
awal
pumbuahan/kehamilan,
kelahiran,
sterilisasi/pencegahan sterilisasi/pencegahan kehamilan, section caesaria/SC, prokreasi (inseminasi buatan), sel punca/stem cell, cloning dan lain-lain hingga akhir kehidupan/saat
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CDMR elektif direkomendasikan pada umur kehamilan minimal 39 minggu dan tidak direkomendasikan pada wanita yang berkeinginan mempunyai banyak anak mengingat banyaknya resiko saat kehamilan selanjutnya (Practice, 2013). Resiko perlekatan plasenta yang abnormal dan sesarean histerektomi selalu meningkat setiap kali SC (Cunningham, 2014). Angka CDMR semakin meningkat tiap t iap tahunnya terutama t erutama di negara
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pengambilan keputusan tidak terkait dengan keluaran negative neonatus. Dilain pihak, saat menghadapi kejadian akut, buruknya kondisi janin, operasi SC biasanya dilakukan secepatnya, penundaan yang tidak beralasan tidak diperkenankan. Fasilitas yang memberikan pelayanan obstetric harus mempunyai kemampuan untuk melakukan operasi SC pada rentang waktu singkat (Cunningham, 2014).
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didokumentasikan didalam kamar operasi sebelum dilakukannya operasi (Cunningham, 2014) Jika rambut menghalangi daerah operasi maka harus dihilangkan pada hari operasi dengan menggunting. Ini berkaitan dengan kemungkinan infeksi pada daerah operasi dibandingkan dengan mencukur. Kateter urin menetap biasanya dipasang di rumah sakit Parkland untuk unt uk mengempeskan kandung kencing menjauhi daerah insisi histerotomi, untuk menghindari
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Tabel 5. Analgesia intravena pasien operasi SC (Cunningham, 2014).
ecovery room) Ruang pemulihan (R ecovery IV Meperidine, 25 mg setiap 5 menit hingga mencapai 100 mg atau IV Morphine, 2 mg setiap 5 menit hingga mencapai 10 mg Ruang perawatan postpartum (1x24 jam post operasi)a IM Meperidine, 50-75 mg setiap 3-4 jam jika diperlukan Atau PCA Meperidine intravena, 10 mg dengan 6 menit jeda dan dosis maksimal 200 mg dalam 4 jam jika diperlukan. Sebagai tambahan 25 mg dosis boster diperbolehkan untuk maksimum 2 kali pemberian. Atau IM Morphine, 10-15 mg setiap 3-4 jam jika diperlukan Atau PCA Morphine intravena, 1 mg dengan jeda 6 menit dan dosis maksimum 30 mg dalam 4 jam jika diperlukan. Sebagai tambahan dapat diberikan dosis boster 2 mg maksimal 2 kali pemberian. a
setiap pemberian regimen postpartum di bangsal juga diberikan
promethazine, 25 mg intravena setiap 6 jam jika diperlukan untuk mencegah mual. IM = intramuscular; IV = intravena; PCA = patient controlled analgesia. analgesia. (Yost, 2004).
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Beberapa skema cocok dipakai untuk mengontrol nyeri postoperasi. Pada percobaan di Rumah Sakit Parkland, Morphine mempunyai efek lebih superior dari Meperidine dan mempunyai hubungan signifikan dengan kenaikan angka menyusui bayi dan kelanjutan rawat bersama ibu. Menyusui dapat diinisiasi segera setelah operasi. Jika ibu memilih tidak ingin untuk menyusui, bahan pengikat payudara
tanpa
memberikan
tanda
kompresi
biasanya
dapat
meminimalkan rasa tidak nyaman (Cunningham, 2014). Setelah pasien dipindahkan ke kamarnya, pasien dipantau setiap jam minimal hingga 4 jam setelah operasi kemudian berkala setiap 4 jam sekali. Vital sign, kontraksi uterus, urin output dan perdarahan merupakan hal yang dievaluasi. Hematokrit diperiksa pada pagi hari setelah operasi. Hematokrit diperiksa lebih dini jika terjadi kehilangan darah yang tidak biasa atau jika ada hipotensi, takikardi, oliguria atau didapatkan pemeriksaan yang mengarah kepada hypovolemia. Jika hematokrit menurun signifikan dibandingkan dengan hasil preoperatif, pemeriksaan diulangi dan dicari faktor penyebab kehilangan darah selama operasi. Jika hematocrit telah stabil maka pasien diperbolehkan ambulasi dan jika tidak ada kecenderungan untuk terjadi perdarahan, maka pasien lebih disarankan untuk mandapat terapi tablet besi ketimbang tr ansfusi (Cunningham, 2014). Masa puerpurium mempunyai karakteristik ekskresi cairan yang tertahan selama kehamilan. Secara general 3 liter cairan seharusnya cukup selama 24 jam setelah operasi, namun jika urin output menurun <30mL/jam maka pasien harus dievaluasi ulang. Penyebab oliguria bisa karena kehilangan darah yang tidak disadari atau efek antidiuretic dari oxytocin (Cunningham, 2014).
b. Fungsi kandung kencing dan usus Kateter urin dapat dilepas segera setelah pasien dapat bergerak seperti semula dan minimal 12 jam setelah operasi atau untuk alasan kenyamanan pada pagi hari setelah operasi (NICE, 2011). Prevalensi terjadinya retensio urin setelah operasi sebesar 3-7%. Anastesia
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setelah
operasi
(Cunningham,
2014).
Insidensi
terjadinya
inkontinensia urin pada persalinan normal (7,3%) lebih tinggi dibandingkan SC elektif (4,5%). Insidensi terjadinya cedera kandung kencing lebih tinggi saat operasi SC (0,1%) dibandingkan persalinan normal (0,003%) (NICE, 2011) Setelah operasi SC, sering terjadi berhentinya aktifitas usus selama beberapa jam hingga hari yang biasanya akan pulih dengan sendirinya. Hal ini terkadang memberikan rasa tidak nyaman pada beberapa pasien seperti rasa penuh di perut, nyeri, perut membesar akibat gas dan kotoran yang tidak dapat keluar, mual, muntah hingga penurunan nafsu makan. Terkadang pasien membutuhkan membutuhkan obat untuk menyelesaikan permasalahan ini dan mengakibatkan penundaan pemulangan
pasien.
Walaupun
pemberian
makan
dini
dapat
merangsang peristaltic usus, namun juga dapat mengakibatkan pasien muntah, oleh karena itu banyak juga dokter yang tetap menunggu pemberian makan hingga peristaltic usus kembali. Cara lain yang dapat dilakukan adalah mengunyah permen karet dalam 24 jam setelah operasi. Cara ini terbukti efektif, murah, aman dan dapat dilakukan dimanapun (Pereira Gomes Morais E, 2016). Pemberian makanan dan minuman sejak awal setelah operasi (early oral feeding) terbukti mempersingkat waktu pulihnya peristaltik usus dan mempersingkat waktu rawat di rumah sakit. Tidak ada perbedaan signifikan munculnya gejala mual, muntah, distensi perut, ileus paralitik dan jumlah analgetik antara grup early oral feeding (EOF) dengan grup delayed oral feeding 12-24 12-24 jam (NICE, 2011). Pada kasus tanpa komplikasi, makanan biasa bisa diberikan 8 jam setelah operasi. operasi. Walaupun beberapa kasus kasus ileus adinamik terjadi terjadi setelah operasi namun angkanya sangat kecil dan bisa diabaikan. Gejalanya seperti distensi abdomen, perut tidak nyaman/nyeri, tidak dapat flatus atau buang air besar. Patofisiologi dari ileus postoperatif kompleks dan melibatkan faktor inflamasi dan neural yang hingga saat ini belum dimengerti sepenuhnya. Jika terdapat demam yang tidak dapat dijelaskan sebabnya, maka cedera usus yang luput disadari
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kasusnya berat maka dapat dilakukan dekompresi dengan nasogastric tube (NGT) (Cunningham, 2014).
c. Ambulasi dan Perawatan Luka SC
meningkatkan
resiko
untuk
terjadinya
tromboemboli
dibandingkan dengan persalinan normal. Tambahan resiko jika pasien berumur >35 tahun, obesitas, paritas >3, SC emergensi, SCean histerektomi, infeksi, penyakit berat, preeklampsia, deep vein thrombosis, trombofilia dan kelumpuhan. Ambulasi dini menurunkan resiko untuk terjadinya tromboemboli vena. Pada kebanyakan instansi, keesokan hari setelah operasi, pasien sudah harus bangun dari tempat tidurnya dan dibantu berjalan minimal 2 kali. Pada hari kedua, pasien sudah harus bisa berjalan tanpa dibantu (Cunningham, 2014). Pasien
dimotivasi
untuk
meminum
obat
analgetik,
menyelesaikan obat antibiotik, memakai pakaian longgar yang berbahan katun dan mandi setiap harinya (NICE, 2011). Luka operasi dilihat setiap harinya, jahitan dan klip biasanya dapat dilepas 4 hari setelah operasi. Jika terdapat keraguan terhadap jahitan misalnya pada pasien obesitas, jahitan atau klip dapat dipertahankan hingga 7-10 hari setelah operasi. Pasien dapat mandi 3 hari
setelah
operasi
dan
tidak
berbahaya
untuk
jahitannya
(Cunningham, 2014). Pada penelitian RCT yang dilakukan pada 320 pasien SC dengan penutupan luka menggunakan staples, didapatkan tidak adanya perbedaan perawatan luka dan lepas perban awal (6 jam setelah operasi) dengan 24 jam setelah operasi terhadap lama penyembuhan luka. Pasien yang dibuka perban lebih awal merasa lebih puas karena dapat membersihkan diri lebih awal (Peleg D, 2016).
d. Penyembuhan luka Penyembuhan
luka
setelah
operasi
SC
dapat
dinilai
menggunakan skala REEDA. Penyembuhan luka dinilai secara berkala dalam
selang
waktu
berbeda-beda
untuk
melihat
proses
penyembuhannya. Skala REEDA awalnya dipakai untuk menilai
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Redness, Edema, Echymosis, Discharge dan Appoximation (Alvarenga et al., 2015).
Poin
Redness
Edema
Ecchymosis Ecchymosis
Discharge
Approximation
0
-
-
-
-
Dekat
1
<0,25 cm
<1
Serum
Kulit terpisah
dari insisi
dari insisi
cm
bilateral
<0,25
cm
bilateral <0,5
atau
3
mm
cm
unilateral 2
<0,5
cm
dari insisi
1-2
cm
dari insisi
bilateral
0,25-1
cm
Serosa-
Kulit dan jaringan
atau
gulnous
subcutis terpisah
>1 cm bilateral
Darah-
Kulit, subcutis dan
atau
purulen
fascia terpisah
bilateral 0,5-2
cm
unilateral 3
>0,5
cm
dari insisi
>2
cm
dari insisi
bilateral
>2
cm
unilateral
Skor Total
Tabel 6. Skala REEDA (Alvarenga et al., 2015).
Sedangkan bekas luka atau skar dapat dinilai menggunakan skala
skar
Vancouver
yang
meliputi
pigmentasi,
ketinggian,
kelembutan/konsistensi kelembutan/konsistensi dan vaskularisasi (Samadi S, 2010).
e. Fisioterapi Fisioterapi pernafasan setelah operasi SC dengan anastesi umum tidak terbukti bermanfaat mengurangi batuk dan dahak (NICE, 2011).
f.
Kepulangan pasien Pasien dapat dipulangkan pada hari ketiga atau keempat post operasi jika tidak ada komplikasi. Pasien dapat pulang lebih cepat jika pasien mempunyai cukup motivasi. Rataan hari rawat pasien SC elektif adalah 4 hari (NICE, 2011). Aktivitas pada minggu pertama terbatas pada perawatan diri dan perawatan bayi dengan bantuan. Mengend arai mobil dapat dilakukan jika nyeri tidak menghambat gerakan untuk
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namun banyak wanita menggunakan cuti 12 minggu untuk memulihkan diri sebelum mulai bekerja (Cunningham, 2014).
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BAB III KESIMPULAN
1. Persalinan pervaginam spontan merupakan yang terbaik. 2. Metode persalinan pada wanita adalah persalinan normal (pervaginam) dan operasi SC. 3. Persalinan pervaginam direkomendasikan sebagai pilihan pertama dan SC sebagai pilihan terakhir jika terdapat indikasi maternal, fetal atau plasenta. 4. CDMR merupakan pilihan wanita untuk melakukan SC tanpa indikasi dan harus mendapatkan informed consent yang baik sebelumnya. 5. Persiapan sebelum SC dan tatalaksana setelah operasi memiliki peran penting dalam meminimalkan morbiditas dan mortalitas ibu dan bayi. 6. Perdarahan, infeksi dan perlengketan merupakan morbiditas yang sering terjadi pada SC. 7. Teknik operasi SC bermacam-macam bermacam-m acam dan dapat digunakan bergantung kondisi klinis pasien, kompetensi dan pertimbangan klinis. 8. Persiapan sebelum operasi yang baik, teknik operasi yang tepat dan perawatan pasca operasi yang benar menentukan outcome SC.
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DAFTAR PUSTAKA
AKSOY, H., AKSOY, Ü., YÜCEL, B., ÖZYURT, S. S., AÇMAZ, G., BABAYIĞIT, M. A., GÖKAHMETOĞLU, GÖKAHMETOĞLU, G. & AYDIN, T. 2015. Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomized prospective study. Journal of the Turkish Turkish German German Gynecological Association, 16 158-163. ALVARENGA, M. B., FRANCISCO, FRANCISCO, A. A., OLIVEIRA, S. M. J. V. D., SILVA, F. M. B. D., SHIMODA, G. T. & DAMIANI, L. P. 2015. Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability. 23 162-168. ASHLEY, S., MUSCAT, JOLENE, CALIXTE, ROSE, HAN, TINA, VINTZILEOS & ANTHONY 2016. Factors Influencing Adhesion Formation After Primary Cesarean Delivery. Obstetrics & Gynecology, 26 279. AWONUGA, A. O., FLETCHER, FLETCHER, N. M., SAED, G. M. & DIAMOND, D IAMOND, M. P. 2011. Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations: A Review. Reproductive Sciences, 18 1166-1185. BILLETT 1990. Hemoglobin and Hematocrit. Clinical Methods, 3rd edition Chapter 151. BLUMENREICH BLUMENREICH 1990. The White Blood Cell and Differential Count. Clinical Methods: The History, Physical, and Laboratory Examinations, Examinations, 153. CALLAHAN, T. L. & CAUGHEY, A. B. 2013. 2 013. Obstetrics and Gynecology. Sixth Edition Chap.2 13-14. CARRI R. WARSHAK, A. V. 2017. Maternal and surgical factors associated with surgical site infections after cesarean delivery in obese women with intact membranes. American Journal Journal of Obstetrics & Gynecology . CDC 2018. Surgical Site Infection (SSI) Event. Procedure-associated Procedure-associated Module, 9 132. CHENG, H., CHEN, B. P. H., SOLEAS, I. M., FERKO, N. C., CAMERON, C. G. & HINOUL, P. 2017. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Systematic Review. Surg Infect (Larchmt), 18 722-35. ,
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Jodi S. Dashe, Barbara L. Hoffman, Brian M. Casey, Jeanne S. Sheffield. 24th edition. DIMITROV A, S. G., KRŬSTEVA K 1999. The overall and step -by-step duration of cesarean section. Akush Ginekol Ginekol (Sofiia), 3 7-10. DUPERRON, L. 2011. Should patients be entitled to cesarean section on demand?: YES. Canadian Family Physician, 57 1246-1248. GELAW, K. A., AWEKE, A. M., ASTAWESEGN, F. H., DEMISSIE, B. W. & ZELEKE, L. B. 2017. Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia. Patient Saf Surg, 11. GIAN CARLO DI RENZO, A. M. 2017. Cesarean Delivery. 1 1-2. GU GU LMEZOGLU L̈ MEZOGLU AM, S. L., BETRAN AP, VILLAR J, PIAGGIO G 2004. WHO systematic review of maternal mortality and morbidity: methodological issues and challenges. BMC Med Res Methodol, 4 16. GUISE, DENMAN, EMEIS, MARSHALL, WALKER, R, F., R, J., P, N., KB, E. & M, M. 2010. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol, 115 1267-1278. HAAS DM, M. S., CONTRERAS K 2014. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev, 12. HAELLE, T. 2017. Antibiotics After Cesarean Curb Infection in Obese Women. ,
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Society for Maternal-Fetal Medicine (SMFM) 2017 Annual Pregnancy Meeting.
HANNAH, M. E. 2004. 2004 . Planned elective cesarean section: A reasonable choice for some women? CMAJ : Canadian Medical Association Journal, 170 813814. HARRISON, C. 2007. Primum non nocere is only the beginning. Paediatrics & Child Health, 12 379-380. JASIM, H. H., SULAIMAN, S. A. S., KHAN, A. H., DAWOOD, O. T., ABDULAMEER, A. H. & USHA, R. 2017. Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section. Clinical Medicine Insights: Therapeutics, 9 1179559X17725273. JIDO TA, G. I. 2012. Surgical-site Infec on Following Cesarean Sec on in Kano, Nigeria. Annals of Medical Medical and Health Health Sciences Research, Research, 2 33-36. ,
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NICE 2011. Cesarean section. Clinical Guidelines, 2 166. OPOIEN HK, V. A., GRINDE-ANDERSEN A, ET AL. 2007. Post-cesarean surgical site infections according to CDC standards: Rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Gynecol Scand 1097-1102. P DIOR, U., KOGAN, L., ELCHALAL, U., GOLDSCHMIDT, N., BURGER, A., NIR-PAZ, R. & EZRA, Y. 2013. Leukocyte Blood Count during Early Puerperium and its relation to puerperal infection. PELEG D, E. E., WARSOF SL, COHEN N, BEN SHACHAR I 2016. Early wound dressing removal after scheduled cesarean delivery: a randomized controlled trial. Am J Obstet Obstet Gynecol, 215 e1-5. PEREIRA GOMES MORAIS E, R. R., PORFÍRIO GJM, MACEDO CR, SARMENTO VASCONCELOS V, DE SOUZA PEDROSA A, TORLONI MR. 2016. Chewing gum for enhancing early recovery of bowel function after caesarean section. Cochrane Database of Systematic Reviews. POGI 2009. Undang-Undang Republik Indonesia Nomor 36. 29. 29 . PRACTICE, C. O. O. 2013. Cesarean Delivery on Maternal Request. American College of Obstetricians and Gynecologists, 559. PURWADIANTO, A., SOETEDJO, GUNAWAN, S., BUDININGSIH, Y., PRAWIROHARJO, PRAWIROHARJO, P. & FIRMANSYAH, A. 2012. Kode Etik Kedokteran Indonesia. 1 37-39. RCOG 2004. Cesarean Section. 10. RCOG 2006. THE MANAGEMENT OF BREECH PRESENTATION. Guidelines, 20b. RILEY LK, R. J. 2015. Evaluation of Patients with Leukocytosis. 92, 11 1004-1011. SAMADI S, K. T., EMAMI A, MOOSAVI NS, TAFAGHODI M, BEHNAM HR 2010. The effect of Hypericum perforatum on the wound healing and scar of Complement Med. , 16 113-117. cesarean. J Altern Complement SEROV, NIKOLAEVICH, V., ADAMYAN, VLADIMIROVNA, L., FILIPPOV, SEMENOVICH, O., ARTYMUK, VLADIMIROVNA, N., BELOKRINITSKAYA BELOKRINITSKAYA & EVGENEVNA, T. 2014. Caesarean section: indications, methods of anesthesia, surgical technique, antibiotic prophylaxis, management of the postoperative period. 10. SEYAM, E., IBRAHIM, E. M., YOUSEFF, A. M., KHALIFA, E. M. & HEFZY, E. 2018. Laparoscopic Management of Adhesions Developed after Peritoneal Nonclosure in Primary Cesarean Section Delivery. Obstetrics and ,
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TULANDI, B, A.-S., G, A., C, Z. & L., M. 2011. Prospective study of intraabdominal adhesions among women of different races with or without keloids. Am J Obstet Gynecol, 204 132. TULANDI, T. & LYELL, D. J. 2013. Classification of intra-abdominal adhesions after cesarean delivery. Gynecological Gynecological Surgery, 10 25-29. VOGEL, J. P., BETRÁN, A. P., VINDEVOGHEL, VINDEVOGHEL, N., SOUZA, J. P., TORLONI, M. R., ZHANG, J., TUNÇALP, Ö., MORI, R., MORISAKI, N., ORTIZ-PANOZO, E., HERNANDEZ, B., PÉREZ-CUEVAS, R., QURESHI, Z., GÜLMEZOGLU, A. M. & TEMMERMAN, M. 2015. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. The Lancet Global Health, 3 e260-e270. WHO. 2015. Reproductive health [Online]. Available: http://www.who.int/topics/reproductive_health/en/.. http://www.who.int/topics/reproductive_health/en/ ,
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