Permasalahan Perujukan Pasien dengan Malposisi yang telah Mencapai Kala II

Ayrton Fajar Muhamad, Tita Husnitawati Madjid


Abstract


Pendahuluan: Presentasi sungsang pada kehamilan prematur berhubungan dengan risiko obstetrik yang lebih tinggi dibandingkan dengan presentasi kepala. Pada kehamilan prematur, faktor predisposisi terjadinya letak sungsang adalah KPD, oligohidramnion, usia ibu lanjut, nuliparitas, riwayat operasi seksio sesarea sebelumnya, berat badan lahir janin di bawah persentil 10, dan kelainan kongenital janin. Pada persalinan prematur, presentasi sungsang merupakan keadaan berisiko tinggi. Rujukan yang tidak tepat dapat berujung timbulnya komplikasi maternal dan fetal pada presentasi sungsang prematur.
Kasus: Wanita berusia 34 tahun, G4P2A1 parturien 32 - 33 minggu rujukan dari Puskesmas datang ke Rumah Sakit Hasan Sadikin dengan keluhan mules-mules yang semakin sering dan bertambah kuat. Pasien mengetahui kehamilannya letak sungsang sejak usia kehamilan lima bulan saat memeriksakan kandungannya di SpOG.
Diskusi: Pada saat pasien rujukan datang ke RSHS, diketahui pembukaan telah lengkap dan hasil pemeriksaan dalam menunjukkan presentasi janin bokong, tidak teraba bagian-bagian kecil janin, tidak teraba tali pusat pada bagian terbawah janin. Pasien didiagnosis dengan G4P2A1 parturien 32-33 minggu kala II presentasi bokong murni, kemudian direncanakan partus pervaginam spontan dengan bracht.
Kesimpulan: Perujukan yang tepat dan cepat masih menjadi kendala. Puskesmas sebagai fasilitas primer harus mampu merujuk tepat waktu mencegah komplikasi ibu dan janin pada saat persalinan dan nifas.

Problem of Referral of Patients with Malposition who Have Reached Stage II

Abstract
Introduction: Breech presentation in preterm pregnancy is associated with higher obstetric risk compared to head presentation. In preterm pregnancy, the predisposing factors for breech presentation are KPD, oligohydramnios, advanced maternal age, nulliparity, history of previous cesarean section, fetal birth weight below 10th percentile, and fetal congenital abnormalities. In preterm labor, breech presentation is a high-risk condition. Inappropriate referral can lead to maternal and fetal complications in preterm breech presentation.
Case: A 34 year old woman, G4P2A1 parturien 32 - 33 weeks referred from Puskesmas came to Hasan Sadikin Hospital with complaints of increasingly frequent and stronger contractions. The patient knew her pregnancy was breech since five months of gestation when she was examined at an Obstetrician and Gynecology Specialist.
Discussion: When the referral patient came to RSHS, it was known that the opening was complete and the results of the internal examination showed breech fetal presentation, no palpable small parts of the fetus, no palpable umbilical cord at the bottom of the fetus. The patient was diagnosed with G4P2A1 parturien 32-33 weeks time II pure breech presentation, then planned spontaneous vaginal partus with bracht.
Conclusion: Efficient and prompt referral is still an area of concern. Primary health centers as primary facilities must be able to refer on time to prevent maternal and fetal complications during labor and postpartum.

Key words: Breech, premature, referral system

 


Keywords


Sungsang, prematur, sistem rujukan

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DOI: http://dx.doi.org/10.24198/obgynia.v7i1.638

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