Jurnal Anestesi Obstetri Indonesia https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri <p style="text-align: justify; margin: 12.0pt 0in 12.0pt 0in;"><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;"><img src="/ojs/public/site/images/Admin/Home_Page_JAOI2.png"></span></p> <p style="text-align: justify; margin: 12.0pt 0in 12.0pt 0in;"><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;">Indonesian Journal of Obstetric Anesthesia is a scientific journal first published on September 2018, by Collegium of Obstetric Anesthesia and Critical Care in cooperation with Indonesia Association of Anesthesiologist and Intensive Care ( INASOACC) . </span><span lang="IN" style="font-size: 10.0pt; color: black; mso-ansi-language: IN;">INA-S</span><span style="font-size: 10.0pt; color: black; mso-ansi-language: EN-US;">OACC</span><span lang="IN" style="font-size: 10.0pt; color: black; mso-ansi-language: IN;"> members are scattered throughout Indonesia, in total </span><span style="font-size: 10.0pt; color: black; mso-ansi-language: EN-US;">34</span><span lang="IN" style="font-size: 10.0pt; color: black; mso-ansi-language: IN;"> members.</span></p> <p style="text-align: justify;"><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;">The designs of cover, lay out and typography are the work of Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC).&nbsp;</span><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;">ISSN online publication of Volume 1 Number 1 September 2018 is connected with online OJS system for articles processing and all articles is accessible online since the first issue at no charge. It is published quarterly.&nbsp;</span><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;">Indonesian Journal of Obstetric Anesthesia is published by the Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC) amid the expanding scope of journal coverage in line with the organization's slogan "For Better Pregnancy-Related Outcome".</span></p> <p style="text-align: justify;"><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;">This journal is published as a vessel for various scientific articles including original articles, literature reviews, case reports. This journal is expected to provide evidence and knowledge in the field of Obstetrics and Critical Care for colleagues.&nbsp;</span><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;">We accept manuscripts in the form of Original Articles, Case Reports, Literature Reviews, both from clinical or biomolecular fields, as well as letters to editors in regards to Obstetric Anesthesia and Critical Care. Manuscripts that are considered for publication are complete manuscripts that have not been published in other national journals. Manuscripts that have been published in the proceedings of the scientific meeting can still be accepted provided they have written permission from the organizing committee.</span></p> <p style="text-align: justify; margin: 0in 0in 11.25pt 0in;"><span lang="EN-ID" style="font-size: 10.0pt; color: black; mso-themecolor: text1;">To improve the quality of journal, we appreciate your input and suggestions for any improvement.</span></p> en-US tatang.bisri@unpad.ac.id (Prof. Dr. Tatang Bisri, dr., SpAn, KNA, KAO) agnisusantijni@yahoo.co.id (Agni Susanti) Thu, 17 Sep 2020 13:08:32 +0000 OJS 3.1.2.0 http://blogs.law.harvard.edu/tech/rss 60 Perbandingan Efek Analgesi Infiltrasi Morfin 10 Mg dan Bupivakain 0,5% 2 Mg/KgBB pada Seksio Sesarea dengan Teknik Anestesi Spinal https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/45 <p><strong>Latar Belakang</strong>: Persalinan dengan seksio sesarea sangat umum dilakukan dan setiap intervensi yang dapat mengurangi rasa sakit pasca operasi layak diteliti lebih lanjut. Cara terbaik untuk mengurangi rasa sakit dengan memberikan analgesi yang langsung bekerja pada area luka. Telah diketahui morfin memiliki reseptor perifer sehingga pemberian secara subkutan dapat menjadi metode yang sangat efektif dalam manajemen nyeri pasca operasi<br><strong>Tujuan</strong>: Membandingkan efek analgesi dari infiltrasi lokal morfin 10 mg dengan bupivakain 2mg/kgBB 0,5% pada pasca seksio sesarea dengan anestesi spinal. <br><strong>Subjek dan Metode</strong>: Penelitian ini adalah uji klinis acak tersamar ganda dengan 100 sampel wanita hamil, usia 20-40 tahun, PS-ASA I-II yang akan menjalani seksio sesarea elektif dan darurat dengan anestesi spinal. Setelah dihitung secara statistik, sampel dibagi secara acak menjadi 2 kelompok. Kelompok pertama mendapat morfin 10 mg dan kelompok kedua mendapat bupivakain 0,5% 2 mg/kgBB secara infiltrasi lokal subkutan didaerah luka operasi. Skala nyeri dinilai dengan VAS. Hasilnya diuji dengan uji T-<em>independent</em>, <em>Chi-Square</em>, dengan nilai signifikan 95% (p &lt;0,05%, signifikan secara statistik). <br><strong>Hasil</strong>: Pada kelompok morfin pemberian analgesi tambahan lebih sedikit daripada kelompok bupivakain, hasilnya berbeda bermakna secara statistik (p &lt;0.05) pada setiap jam pengamatan. Efek samping tidak ditemukan pada kedua kelompok. Kelompok morfin meringankan rasa sakit lebih baik daripada kelompok bupivakain dengan skor VAS yang lebih rendah pada setiap jam pengamatan<br><strong>Simpulan</strong>: Infiltrasi lokal subkutan 10 mg morfin memberikan efek analgetik yang lebih baik pada pasien pasca seksio sesarea dengan anestesi spinal dibandingkan dengan bupivacain 0,5% 2 mg/kgBB, tanpa efek samping.</p> <p><strong>Comparison of the Analgesic Effects of 10 mg Morphine and 2mg/BW Bupivacaine 0.5% Infiltration in Cesarean Section with Spinal Anesthesia Technique</strong></p> <p><strong>Abstract</strong></p> <p><strong>Background</strong>: Nowadays, deliveries by cesarean section are more commonly done, any intervention that can make progression to reduce post-operative pain are feasible for further study. The best way to reduce pain is by administration pain relieve drug that directly act in wound. It is known that morphine has peripheral receptors, so subcutaneous administration can be a very effective method of postoperative pain management. <br><strong>Objective</strong>: To compare analgetic effect from local infiltration of 10 mg morphine with 2mg/BW bupivacaine 0.5% in post cesarean section with spinal anesthesia<br><strong>Subject and Methods</strong>: This study was done by double blinded randomized clinical trial with 100 samples of pregnant women, age 20-40 years, PS-ASA I-II that will undergo elective and emergency cesarean section with spinal anesthesia. After calculated statistically, all samples divided randomly into 2 groups. First group got morphine 10 mg and second group got bupivacaine 0.5% 2 mg/BW infiltration at the area of surgical wound. Pain scale was evaluated by VAS. The result was tested by T-independent test, Chi-Square, with significant value 95% (p&lt;0.05%, statistically significant). <br><strong>Result</strong>: In morphine group, the additional analgesia was less than bupivacaine group, the results were statistically significant (p &lt;0.05) at each hour of observation. No side effects were found in either group. The morphine group relieved pain better than the bupivacaine group with lower VAS scores at each hour of observation.<br><strong>Conclusion</strong>: Infiltration of 10 mg morphine subcutaneous compared to bupivacaine 0.5% 2mg/BW give better analgetic effect in post cesarean section patients with spinal anesthesia, without any side effects</p> Wulan Fadinie, Dadik Wahyu Wijaya, Hasanul Arifin Copyright (c) 2020 Jurnal Anestesi Obstetri Indonesia https://creativecommons.org/licenses/by-nc-sa/4.0 https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/45 Thu, 17 Sep 2020 13:01:06 +0000 Perbandingan Efektivitas Kombinasi Fentanyl–Paracetamol dan Fentanyl–Ketorolac terhadap Numerical Rating Scale (NRS) Post Operasi Seksio Sesarea https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/49 <p><strong>Latar Belakang</strong>: Nyeri post operasi seksio sesarea merupakan nyeri sedang berat dengan intensitas akut. Saat ini terdapat dua kombinasi obat anti nyeri yang umum digunakan untuk mengatasi nyeri post operasi seksio sesarea yaitu kombinasi parasetamol-fentanyl serta kombinasi ketorolac-fentanyl. Interaksi kedua obat tersebut dapat menurunkan ambang nyeri yang dapat kita periksa dengan skor <em>Numerical Rating Scale</em> (NRS). <br><strong>Tujuan</strong>: Untuk mengetahui adanya perbedaan efektivitas antara pemberian kombinasi parasetamol-fentanyl dengan ketorolac-fentanyl dalam mengatasi nyeri post operasi seksio sesarea.<br><strong>Subjek dan Metode</strong>: Penelitian eksperimental dengan pendekatan uji klinis menggunakan 30 subjek pasien hamil dengan umur 20-40 tahun dengan status fisik ASA I-II yang akan menjalani operasi seksio sesarea dengan spinal anestesi lidocain 5% hiperbarik. Grup pertama diberikan 1000mg paracetamol dan 0,3mcg/kg/jam fentanyl intravena sebagai analgesik. Grup ke 2 diberikan ketorolac 30mg dan fentanyl o,3mcg/kg/jamPada penelitian ini dilakukan analisis univariat dan bivariat. <br><strong>Hasil</strong>: Hasil uji beda terhadap karakteristik subyek penelitian didapatkan pada kelompok parasetamol dan fentanyl terdapat perbedaan yang signifikan pada post operasi dengan nilai p=0,005 (p&lt;0,05), pada ketorolac dan fentanyl terdapat perbedaan yang signifikan post operasi dengan nilai p=0,023 (p&lt;0,05) d<br><strong>Simpulan</strong>: Kombinasi parasetamol fentanyl lebih efektif dibandingkan dengan ketorolac fentanyl.</p> <p>&nbsp;</p> <p><strong>The Comparison of the Effectiveness of Combination Fentanyl-Paracetamol with Fentanyl–Ketorolac on Numerical Rating Scale (NRS) Post Caesarean Section</strong></p> <p><strong>Abstract</strong></p> <p><strong>Background</strong>: Postoperative cesarean section pain is moderate-to-severe pain with acute intensity. There are two common anti-pain drug combinations used to treat post-cesarean section pain, namely the parasetamol-fentanyl combination and the ketorolac-fentanyl combination. The interaction of the two drugs can lower the pain threshold which we can check with the Numerical Rating Scale (NRS) score.<br><strong>Objective</strong>: To determine the difference in effectiveness between the combination of parasetamol-fentanyl and ketorolac-fentanyl in dealing with post-cesarean section surgery pain.<br><strong>Subject and Method</strong>: This study is an experimental study with a clinical trial approach using 30 subjects of pregnant patients aged 20-40 years with ASA I-II physical status who will undergo cesarean section surgery with hyperbaric 5% lidocaine spinal anesthesia. The first group were given 1000 mg parasetamol and 0.3 mcg/kg/h fentanyl intravenous as analgesics. The second group were given ketorolac 30 mg and fentanyl 0.3 mcg/kg/h intravenously. In this study, univariate and bivariate analyzes were performed. <br><strong>Results</strong>: The results of different tests on the characteristics of research subjects were found in the paracetamol and fentanyl groups, there was a significant difference in the post-operation with a value of p = 0.005 (p &lt;0.05), in ketorolac and fentanyl there was a significant difference post-surgery with a value of p = 0.023 (p &lt;0.05) where the paracetamol and fentanyl groups with NRS scores tended to fall, and the ketorolac and fentanyl groups with NRS scores tended to increase.<br><strong>Conclusion</strong>: The combination of parasetamol and fentanyl was more effective than ketorolac and fentanyl.</p> Andy H, Sugeng Budi Santoso, RTH Supraptomo Copyright (c) https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/49 Thu, 17 Sep 2020 12:56:33 +0000 Perioperatif Anestesia pada Pasien Seksio Sesarea dengan Skizofrenia https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/46 <p>Pasien hamil dengan gangguan kejiwaan menjadi kasus yang menantang bagi ahli anestesi obstetri. Seorang ahli anestesi obstetri harus menyadari aspek hukum, etika, dan medis dari kondisi tersebut dan menyelesaikan setiap masalah secara individual. Penilaian pra operasi dan persiapan harus disesuaikan dengan jenis gangguan pasien. Pilihan teknik anestesi tergantung pada status mental pasien, dan perawatan pasca operasi (pemberian obat anti nyeri dan kelanjutan terapi medis penyakit kejiwaan) harus dikelola dengan baik. Seorang wanita 37 tahun, G2P1A0 hamil 40 minggu dengan skizofrenia dilakukan tindakan seksio sesarea, pasien rutin mengkonsumsi obat antipsikotik. Pasien sempat mengalami penundaan operasi karena tidak kooperatif sehingga dikonsulkan ulang ke psikiater. Teknik pembiusan dengan spinal anestesi menggunakan <em>bupivacaine heavy</em> 10mg. Selama operasi berlangsung hemodinamik stabil, tekanan darah sistolik 100–130 mmHg, diastolik 60–90 mmHg, nadi 80–95x/menit, laju nafas 16–20x/menit dengan saturasi oksigen 100%. Bayi lahir 2 menit setelah insisi dengan Apgar score 8/10. Penanganan pasien skizofrenia yang akan dilakukan tindakan seksio sesarea membutuhkan pemahaman yang baik agar tidak terjadi morbiditas maupun mortalitas, mengingat gangguan kejiwaan adalah hal yang cukup lazim terjadi.</p> <p><strong>Perioperative Anesthesia in Cesarean Section Patients with Schizophrenia</strong></p> <p><strong>Abstract</strong></p> <p>Pregnant patients with psychiatric disorders present as challenging cases for obstetric anesthetists. An obstetric anesthetist should be aware of legal, ethical, and medical aspects of the conditions and solve each problem on a individual basis. Preoperative assessment and the preparation should be adjusted according to the type of patient’s disorder. Choice of anesthetic technique should actively be dependent on the mental status of the patient, and postoperative care should be attentively managed regarding pain relief and continuation of medical therapy for the psychiatric disease. A 37-year-old woman, G2P1A0, 40 weeks pregnant with schizophrenia, was performed a cesarean section, patient taking antipsychotic drugs. Anesthetic technique with spinal anesthesia uses Bupivacaine heavy 10mg. During the operation hemodynamically stable, systolic blood pressure 100-130 mmHg, diastolic 60-90 mmHg, pulse 80-95x/min, breathing rate 16-20x/min with 100% oxygen saturation. The baby is born 2 minutes after incision with an Apgar score 8/10. Management of schizophrenia patients who will undergo cesarean section requires a good understanding to prevent morbidity and mortality, considering psychiatric disorders are quite common.</p> Ayu Rosema Sari, Dewi Yulianti Bisri, Yusmein Uyun Copyright (c) 2020 Jurnal Anestesi Obstetri Indonesia https://creativecommons.org/licenses/by-nc-sa/4.0 https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/46 Thu, 17 Sep 2020 13:00:15 +0000 Anestesia untuk Seksio Sesarea pada Pasien dengan Korioamnionitis dan Trombositopenia https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/50 <p>Infeksi maternal adalah salah satu komplikasi perinatal yang paling umum terjadi. Kejadian kehamilan dengan korioamnionitis merupakan 1% dari kasus di Amerika atau di negara maju sedangkan di negara berkembang kasus ini lebih tinggi. Pasien G3P1A1 31 minggu, umur 23 tahun. Pada pemeriksaan didapatkan hemodinamik stabil dengan tekanan darah:110/70 mmHg, laju nadi: 76x/menit, laju nafas:18 x/menit, suhu 38<sup>o</sup>C, kesadaran compos mentis, kontak baik. Pada pemeriksaan jantung dan paru dalam batas normal. Pemeriksaan laboratorium didapatkan Hb: 7,2 g/dl, trombosit: 12.000 /ul, lekosit: 27,5/ul, SGOT: 210/ul, SGPT: 141/ul. Pasien diputuskan untuk dilakukan seksio sesarea emergensi. Persiapan operasi yang sebelumnya dilakukan transfusi dengan trombosit konsentrat 3 kolf. Pada saat induksi hemodinamik stabil dilakukan induksi di ruang operasi dengan fentanyl 50 ug, propofol 2 mg/kg BB, rokuronium 0,6 mg/kgBB, dan pemeliharaan anestesi dengan sevofluran, N<sub>2</sub>O/O<sub>2</sub>. Selama operasi hemodinamik pasien stabil, saturasi oksigen [SpO<sub>2</sub>] 99 %, operasi dilakukan selama 1 jam, lahir bayi dengan berat badan 1200 gram, dan dirawat di bangsal bayi resiko tinggi. Pasca bedah pasien sadar penuh dilakukan ekstubasi dan diberikan masker oksigen 6 lt/ mnt dan pasien dirawat di ICU. Pada pemeriksan didapatkan hasil analisa gas darah normal dan kenaikan trombosit yang bertahap. Pada hari ke 3 mencapai 40/ul disertai dengan menurunnya jumlah lekosit dan suhu pasien normal. Pasien diputuskan pindah bangsal dengan rawat bersama dengan penyakit dalam.</p> <p><strong>Anaesthetic for Caesarean Section in Patient with Chorioamnionitis and Thrombositopenia</strong></p> <p><strong>Abstract</strong></p> <p>Maternal infection is one of the most common perinatal complications. The incidence of pregnancy with chorioamnionitis constitutes 1% of cases in the United States or in developed countries whereas in developing countries this case is higher. G3P1A1 patient 31 weeks, age 23 years. on examination, hemodynamically stable blood pressure: 110/70 mmHg, pulse rate: 76x / min, respiratory rate: 18 x / min, temperature 38 <sup>o</sup>C, composmentis awareness, good contact, on heart and lung examination are within normal limits. Laboratory examination obtained Hb: 7.2 g / dl, platelets: 12,000 / ul, leukocytes: 27.5 / ul, SGOT: 210 / ul, SGPT: 141 / ul. The patient was decided to do cesarean section. Preparation of surgery was done before transfusion with platelet concentrate 3 colf. At the time of stable hemodynamic induction, then induction was carried out in the operating room with 50 ug fentanyl, propofol 2 mg / kg BW, rocuronium 0.6 mg / kgBW and maintenance of anesthesia with sevoflurane, N<sub>2</sub>O / O<sub>2</sub>. During hemodynamic surgery the patient is stable, SpO<sub>2</sub> is 99%, surgery is carried out for 1 hour, a baby is born weighing 1200 grams and is treated in a high-risk infant ward. After surgery the patient was fully conscious, extubated, and the patient was treated in the ICU. In the examination, the result of normal blood gas analysis and increased a platelets accompanied by a decrease in the number of leukocytes and normal temperature. The patient was decided to move the ward with care together with internal medicine.</p> Dina Paramita, Ery Laksana Copyright (c) 2020 Jurnal Anestesi Obstetri Indonesia https://creativecommons.org/licenses/by-nc-sa/4.0 https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/50 Thu, 17 Sep 2020 00:00:00 +0000 Trombositopenia Berat pada Ibu Hamil dengan Sistemik Lupus Erythematosus yang Dilakukan Seksio Sesarea https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/48 <p>Trombositopenia adalah hal yang umum muncul pada kehamilan normal, disebut trombositopenia berat bila jumlah trombosit &lt;50.000 /µL. Komplikasi kehamilan oleh penyakit Lupus Eritematosus Sistemik (<em>Systemic Lupus Erythematosus</em> = SLE) dapat menimbulkan trombositopenia berat patologis. Karena peran penting trombosit dalam pembekuan darah, dilain pihak proses persalinan akan menimbulkan perdarahan, maka dibutuhkan jumlah dan fungsi trombosit yang cukup. Trombositopenia-SLE berderajat berat perlu mendapat terapi untuk meningkatkan jumlah dan fungsi trombosit sebelum menjalani persalinan. Upaya peningkatan jumlah trombosit pada trombositopenia-SLE diawali dengan kortikosteroid sebagai terapi awal, dengan terapi alternatif lanjutan imunosupresif, splenektomi, plasmaferesis, trombopoetic, dan konsentrat trombosit. Pada kasus ini trombositopenia tidak dapat teratasi, sehingga pemeriksaan fungsional pembekuan darah bleeding time dan clotting time digunakan untuk membantu memperkirakan kemungkinan terjadi perdarahan berkelanjutan. Perhatian utama pada pemilihan tehnik anestesi kasus ini adalah kemungkinan terjadi perdarahan berkelanjutan, dalam hal ini dipilih yang dipertimbangkan berisiko terkecil yaitu <em>total intravenous anesthesia</em> (TIVA) dengan ketamin. Perawatan pasca operasi dilaksanakan juga dengan tetap mewaspadai kemungkinan terjadi perdarahan berkelanjutan.</p> <p>&nbsp;</p> <p><strong>Severe Trombositopenia in Pregnant Woman with Sistemic Lupus Erythematosus Ongoing Caesarean Section</strong></p> <p><strong>Abstract</strong></p> <p>Thrombocytopenia is a common occurrence in normal pregnancy, will classified as severe thrombocytopenia if platelet count &lt;50.000/ µL. Pregnancy complicated by Systemic Lupus Erythematosus (SLE) can lead to pathological severe thrombocytopenia. As thrombocytes has a main role in haemostasis, and delivery process will always caused bleeding, thrombocytes needed in proper amount and function. Severe SLE-Thrombocytopenia has to treat aiming higher total thrombocytes and function before delivery. Effort in raising thrombocytes count on SLE-thrombocytopenia patients recommended starting from corticosteroid as first line treatment, followed by any alternatif therapy if thrombocytes count did not responds to corticosteroid therapy, such as immunosuppresif drugs, splenectomy, plasmapharesis, thrombopoetic drugs, and trombocyte concentrate. In this case, severe thrombocytopenia couldn’t be resolved, so then the bleeding time and clotting time taken as tools to estimate blood’s ability to coagulate. The main consideration on choosing anesthesia’s plan in this case is possibility condition to held uncontrolled bleeding. Therefore, the procedure with the lowest risk for maternal and fetal, total intravenous anesthesia with ketamin, had chosen. Caring for post operative SLE-thrombocytopenia patient should never ignoring vigilance for sustainable bleeding.</p> Mariza Fitriati, Ratih Kumala Fajar Apsari, Sri Rahardjo Copyright (c) 2020 Jurnal Anestesi Obstetri Indonesia https://creativecommons.org/licenses/by-nc-sa/4.0 https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/48 Thu, 17 Sep 2020 12:58:47 +0000 Penggunaan Skor Indeks Plasenta Akreta (IPA) sebagai Prediktor Manajemen Perioperatif Seksio Sesarea Pasien dengan Plasenta Previa Totalis Suspek Akreta https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/47 <p>Plasenta akreta adalah suatu kondisi kehamilan yang serius yang disebabkan oleh kelainan perlekatan plasenta yang membutuhkan perhatian khusus secara perioperatif. Kasus ini menggambarkan manajemen anestesi yang sesuai untuk seksio sesarea dan total abdominal histerektomi karena &nbsp;plasenta previa totalis dugaan akreta. Seorang wanita berusia 33 tahun dipersiapkan untuk menjalani seksio sesarea elektif dan histerektomi total akibat plasenta previa totalis dengan kecurigaan tinggi terhadap akreta berdasarkan Indeks Skor Plasenta Akreta (IPA). Pemeriksaan penunjang dilakukan oleh dokter kandungan untuk mengkonfirmasi diagnosis. Pada pasien ini dilakukan tindakan anestesi umum untuk prosedur operasinya. Kadar hemoglobin pasien sebelum operasi adalah 9,1 g / dl. Dengan total perdarahan selama operasi adalah 2000 mL. Estimasi kehilangan darah yang ditolerir untuk pasien ini adalah 633 ml. Pasien menerima transfusi 2(dua) kantong darah PRC dan 1(satu) kantong darah WB. Kadar hemoglobin setelah transfusi adalah 8,9 g / dL Pasien dipulangkan dari rumah sakit dalam kondisi stabil setelah dirawat selama 3 hari diruangan. Sebagai kesimpulan, evaluasi dan persiapan perioperatif dan kolaborasi multidisiplin adalah kunci keberhasilan manajemen pasien dengan plasenta previa suspek akreta.</p> <p>&nbsp;</p> <p><strong><em>The Use of Placenta Acreta Index (PAI) Score as </em></strong><strong><em>Perioperative Management Predictor of Sectio Caesarean Patient with </em></strong></p> <p><strong><em>Total Placenta Previa Suspected Acreta</em></strong></p> <p class="Dodd" style="line-height: normal;"><span style="font-size: 11.0pt;">Placenta accreta is a serious pregnancy condition caused by disorder of placenta attachment that needs a special consideration perioperatively. This case was described the propriate anesthesia management for Cesarean Section and Total Abdominal Hysterectomy due to Total Placenta Previa suspected Accreta. A 33 years old woman considered for elective cesarean section and hysterectomy due to Total Placenta Previa with high suspicion of Accreta <span style="color: red;">according to Placenta Accreta Index (PAI) Score</span>. Supportive examination was done by the obstetrician to confirm the diagnosis. She underwent general anesthesia for the surgery. Patient’s hemoglobin level before surgery was 9.1 g/dL. With total bleeding during the surgery is 2000 mL. The allowable blood loss for the patient is 633 mL. Patient was transfused with 2 bags of PRC and 1 bag of Whole Blood. The hemoglobin level after transfusion was 8.9 g/dL She was discharged from the hospital in stable condition after being treated for 3 days at normal ward. As conclusion, perioperative evaluation and preparations and multidiscipline collaboration are the key for successful management for patient with Placenta previa/accreta</span></p> <p>&nbsp;</p> Dadik Wahyu Wijaya, Yusmein Uyun, Sri Rahardjo Copyright (c) 2020 Jurnal Anestesi Obstetri Indonesia https://creativecommons.org/licenses/by-nc-sa/4.0 https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/47 Thu, 17 Sep 2020 12:59:35 +0000 Diagnosis dan Tatalaksana Emboli Air Ketuban https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/38 <p>Emboli air ketuban merupakan sindrom katastrofik yang terjadi selama kehamilan dan persalinan atau segera setelah melahirkan. Emboli air ketuban adalah peristiwa masuknya air ketuban yang mengandung sel-sel janin dan material debris lainnya ke dalam sirkulasi maternal yang menyebabkan kolaps kardiorespirasi. Patofisiologinya sampai saat ini belum jelas. Ada tiga faktor utama yang menyebabkan masuknya air ketuban kedalam sirkulasi ibu yaitu robekan amnion dan korion, terbukanya vena ibu baik melalui vena-vena endoserviks, sinus venosus subplasenta atau akibat laserasi segmen bawah rahim serta adanya tekanan yang mendesak masuknya air ketuban kedalam sirkulasi ibu. Gambaran klinisnya sesak yang tiba-tiba, gagal nafas dan hipotensi yang diikuti oleh kolaps kardiovaskuler, DIC dan kematian. Emboli air ketuban mempunyai angka morbiditas dan mortalitas yang tinggi. Pengenalan dini dan diagnosis emboli air ketuban sangat penting untuk meningkatkan angka harapan hidup maternal maupun janin. Penatalaksanaan emboli air ketuban bersifat non spesifik dan suportif, yaitu meningkatkan oksigenasi, memperbaiki sirkulasi, dan memperbaiki koagulopati diikuti dengan prinsip-prinsip <em>basic life support</em> dan <em>advanced life support</em>, dengan fokus utama yaitu stabilisasi kardiopulmonal maternal secara cepat. Tujuan utama yang paling penting adalah mencegah bertambah beratnya hipoksia dan gagal organ yang lebih lanjut. Resusitasi cepat sangat diperlukan tergantung pada keadaan klinis pasien. Pasien dengan emboli air ketuban mempunyai prognosis yang sangat jelek. Sampai saat ini, sindroma ini tidak dapat diprediksikan atau dicegah. Dengan diagnosis awal yang baik, resusitasi cepat dan pendekatan multidisiplin yang baik akan meningkatkan prognosis, memperbaiki mortalitas dan morbiditas maternal maupun fetal.</p> <p><strong>Diagnostic and Management of Amniotic Fluid Embolism</strong></p> <p><strong>Abstract</strong></p> <p>Amniotic fluid embolism (AFE) is a catastrophic syndrome that occurs during pregnancy and childbirth or immediately after delivery. Amniotic fluid embolism is an event when amniotic fluid containing fetal cells and other debris enter the maternal circulation, which causes cardiorespiratory collapse. The pathophysiology is not yet clear. There are three main factors that cause the entry of amniotic fluid into the mother's circulation, i.e. tearing of the amnion and chorion, an opening of the maternal veins either through the endocervical veins, subplacental venous sinuses or due to laceration of the lower uterine segment and the pressure that forces the entry of amniotic water into the mother's circulation. The clinical features are sudden onset of breathlessness, respiratory failure and hypotension followed by cardiovascular collapse, DIC and death. Amniotic fluid embolism has high morbidity and mortality rates. Early recognition and diagnosis of amniotic embolism are very important to increase the life expectancy of both the maternal and the fetus. Management of amniotic fluid embolism is non-specific and supportive, namely increasing oxygenation, improving circulation, and improving coagulopathy followed by the principles of basic life support and advanced life support, with the main focus of rapid maternal cardiopulmonary stabilization. The main and most important goal is to prevent further progression of hypoxia and organ failure. Rapid resuscitation is necessary, depending on the clinical condition of the patient. Patients with amniotic fluid embolism have a very poor prognosis. Until recently, this syndrome could not be predicted or prevented. With a good initial diagnosis, rapid resuscitation and a good multidisciplinary approach will improve prognosis, improve maternal and fetal mortality and morbidity.</p> Dwiana Sulistyanti, Yusmein Uyun Copyright (c) 2020 Jurnal Anestesi Obstetri Indonesia https://creativecommons.org/licenses/by-nc-sa/4.0 https://jurnalanestesiobstetri-indonesia.id/ojs/index.php/Obstetri/article/view/38 Thu, 17 Sep 2020 13:01:50 +0000