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Maisuri T.

Chalid

Fetomaternal Division
Department of Obstetrics and Gynecology
Faculty of Medicine Hasanuddin University

2016
1. Fetal life, number, presentation, and activity should be documented

2. An estimate of amniotic fluid volume (increased, decreased, normal) should be


reported

3. The placental location, appearance, and its relationship to the internal cervical os
should be recorded. The umbilical cord should be imaged

4. Assessment of gestational age should be accomplished at the time of the initial scan
using a combination of cranial measurement such as BPD or HC, and limb
measurement such as FL

5. Fetal weight should be estimated in the late 2nd and in the 3rd trimesters and
requires the measurement of AD or AC

6. Evaluation of the uterus (including the cervix) and adnexal structures should be
performed

7. The study should include, but not necessarily be limited to, assessment of the fetal
anatomy
Abnormal heart rate and / or rhythm
should be reported

Multiple pregnancies : number of GS,


number of placenta, presence or absence
of a dividing membrane, fetal genitalia (if
visible), comparison of fetal sizes, and
comparison of amniotic fluid volume on
each side of the membrane
Diagnosa : B-mode atau doppler
Tidak tampak pulsasi jantung atau tali pusat
Bila ragu, ulangi USG 1 minggu
Cari kausa : perdarahan, anomali uterus,
kelainan yolk sac, anomali janin, dll
Beri informed consent dengan baik, hati-hati
pasien rujukan konsultasi USG
Gambaran TVUS M-mode yg merekam denyut jantung
janin yg telah (-) pertanda IUFD
Gambar 1 dan 2. Spalding sign
Trimester II
Jenis kelamin mungkin berbeda pada dizigot &
sama pada monozigot
2 plasenta : kadang-kadang sulit :
Plasenta fusi
Plasenta berdekatan

Membran yang tebal diantara kedua amnion


Subjektif
Hampir semua menipis pada trimester III
> 2 : dikorionik
twin peak atau Lambda sign
Jaringan korion yang mendesak masuk diantara
membran pada plasenta
Membentuk echogenic triangle

Bila twin peak tidak ditemukan :


T sign
Tidak menyingkirkan dikorionik
Physiologic variation with
stage of pregnancy should be
considered in assessing the
appropriateness of AF
volume
36 42
weeks
Placental position early in
pregnancy may not correlate well
with its location at the time of
delivery.

Over distended bladder or lower


uterine contraction can give the
examiner a false impression of
placenta previa.

Abdominal, transperineal, or
vaginal views may be helpful in
visualizing the internal cervical os
Correlation between the margin
of the placenta and internal
cervical os (OUI)

Placenta previa in the 2nd


trimester (5%) and only < 1% at
term (placental migration).

Repeat scan at 36 W must


confirm the diagnosis of
placenta previa
The placenta is in front of or previous
to the fetus relative to the birth canal

It remains the primary cause of 3rd


trimester bleeding and eminently
detectable with US (translabial or
transvaginal).

No contraindication

Term : 0.5 1% all pregnancies.


(older, multiparas, prior CS, and
prior abortions)
Low lying placenta : the placental edge is < 5
cm of the internal cervical os but not
covering any significant portion of it.

No artifact caused by over distention of the


bladder or uterine contractions causing a
false positive diagnosis of a previa
(Transvaginal or Translabial).

Translabial : sensitivity of 100% and a specify


of 70% if a distance of less than 2 cm was
recorded for the placenta-internal os
distance.
Plasenta previa total

A B

Plasenta previa marginal TVUS (A) dan TAUS(B)


Pseudoprevia akibat overdistended buli-buli (A)
Setelah pengosongan buli-buli, ternyata plasenta tdk memanjang
sampai ke serviks. Gbran seperti serviks ternyata merupakan ddg
anterior dan posterior segmen bawah uterus yg tertekan buli-buli
Bayangan plasenta previa Setelah kepala janin
marginal yg terhalang oleh berpindah
acoustic shadow kepala janin
plesenta previa
dimana tepi plasenta
Mencapai OUI

plasenta previa
dimana plasenta menutup
ostium uteri internum
Abrupsi / Solusio placenta :

Abrupsi placenta adalah pelepasan plasenta sebelum


janin dilahirkan
Perdarahan antepartum yg biasanya disertai rasa
nyeri yg sangat. (Perdarahan placenta previa tidak
disertai rasa nyeri)
Secara sonografik mungkin bisa terdiagnosis. Namun
banyak kasus abrupsi yg tidak terlihat.
Bila terlihat, gambaran sonografiknya
dpt berubah-ubah tergantung lamanya
hematoma yg terjadi.
Hasil ultrasound yg negatif belum
tentu menyingkirkan adanya abrupsi
placenta, shg penatalaksanaan klinis
hrs didasarkan pd kondisi pasien.
Pelepasan prematur
sebagian atau seluruh
plasenta dari ddg uterus
sebelum kelahiran janin
Ultrasound tidak
mendeteksi pemisahan
plasenta dari dinding,
tetapi mengidentifikasi
adanya hematoma
retroplasental
Daerah hematoma (HE) yg hipoechoic
terangkatnya tepi plasenta dan membran
Placenta
Abruptio
n

Fetal Head

Abrupsi
Placenta