Manajemen Perioperatif pada Perdarahan akibat Atonia Uteri
Authors: Yulianto Sarim Budi 
Published: March 2021

Perdarahan obstetri merupakan penyebab utama kematian maternal dan perinatal. Atonia uteri merupakan penyebab tersering perdarahan postpartum. Perdarahan post partum adalah perdarahan lebih dari 500 cc setelah bayi lahir pervaginam atau lebih dari 1.000 ml setelah persalinan abdominal atau jumlah perdarahan lebih dari normal dan telah menyebabkan perubahan tanda vital. Penyebab atonia uteri adalah overdistensi uterus, kelelahan otot miometrium, plasenta letak rendah, toksin bakteri (korioamnionitis, endomiometritis, septikemia), hipoksia akibat hipoperfusi atau uterus couvelaire pada solusio plasenta dan hipotermia akibat resusitasi masif. Manajemen atonia uteri dapat berupa non farmakologi, farmakologi dan pembedahan menurut algoritma Varatharajan yaitu “HAEMOSTASIS”.Manejemen perioperatif atoni uteri terdiri dari terapi O2, monitoring noninvasif, pemasangan jalur intra vena dengan menggunakan kateter intravena yang besar dan resusitasi cairan. Tehnik anestesi tergantung keadaan klinis dan rencana tindakan berikutnya oleh dokter kandungan. Pilihan pertama transfusi darah adalah transfusi sel darah merah, platelet, fresh frozen plasma, kriopresipitat, faktor VII dan fibrinogen sintetis (RiaSTAP), Transfusi masif adalah pemberian transfusi darah sebanyak volume darah pasien dalam waktu 24 jam atau lebih dari 7 % berat badan ideal dewasa. Komplikasi yang dapat terjadi pada transfusi masif adalah hipotermi, hipokalsemia, hipomagnesemia, hiperkalemia, asidosis/ alkalosis, koagulopati dilusional, transfusion related acute lung injury (TRALI)
Perioperative Management in Bleeding cause by Uterine Atony
Abstract
Obstetric bleeding is a major cause of maternal and perinatal death. Uterine atony is the most common cause of postpartum hemorrhage. Post partum hemorrhage is bleeding more than 500 cc after the baby is vaginal labor or more than 1,000 ml after abdominal labor or the amount of bleeding is more than normal and has caused changes in vital signs. The causes of uterine atony are uterine overdistence, myometrial muscle fatigue, low lying placenta, bacterial toxin (chorioamnionitis, endomyometritis, septicemia), hypoxia due to hypoperfusion or uterine couvelaire in placental abruption and hypothermia due to massive resuscitation. Management of uterine atony can be in the form of non pharmacology, pharmacology and surgery according to the Varatharajan algorithm is "HAEMOSTASIS". Anesthesia management consists of O2 therapy, noninvasive monitoring, installation of intravenous lines using a large intravenous catheter and fluid resuscitation. Anesthesia techniques depend on clinical conditions and subsequent action plans by the obstetrician. The first choice of blood transfusion is transfusion of red blood cells, platelets, fresh frozen plasma, cryoprecipitate, factor VII and synthetic fibrinogen (RiaSTAP), massive transfusion is the administration of blood transfusion as much as the patient's blood volume within 24 hours or more than 7% of the ideal adult body weight . Complications that can occur in massive transfusions are hypothermia, hypocalcemia, hypomagnesemia, hyperkalemia, acidosis / alkalosis, dilutional coagulopathy, transfusion related acute lung injury (TRALI).