Tabel 2- Perkiraan Kehilangan Cairan dan Darah, Berdasarkan Presentasi Penderita Semula

KELAS I Kehilangan Darah (mL) Kehilangan Darah (% volume darah) Denyut Nadi Tekanan Darah Tekanan nadi (mm Hg) Frekuensi Pernafasan Produksi Urin >30 (mL/jam) CNS/ Status Mental Penggantian Cairan Kristaloid (Hukum 3:1) Sedikit cemas

Kelas II

Kelas III

Kelas IV

Sampai 750

750-1500

1500-2000

>2000

Sampai 15%

15%-30%

30%-40%

>40%

<100 Normal Normal atau Naik 14-20

>100 Normal

>120 Menurun

>140 Menurun

Menurun

Menurun

Menurun

20-30

30-40

>35

20-30

5-15

Tidak berarti

Agak cemas

Cemas, bingung Kristaloid dan darah

Bingung,lesu (lethargic) Kristaloid dan darah

Kristaloid

pregnancy at risk for serious complications is considered to be a high risk pregnancy. A high risk pregnancy may be identified by using a scoring system such as the system developed by Hobel et al . [1] Risk factors are assigned a score corresponding to the degree of risk. A score of 10 or more indicates a high risk pregnancy that should receive more than routine prenatal care. The table below is a modification of Hobel et al's scoring system.

PREGNANCY RISK ASSESSMENT [1]

OB History Risk Factor Previous stillbirth Previous neonatal death Previous premature infant Post-term > 42 weeks Fetal blood transfusion for hemolytic disease Repeated miscarriages Previous infant > 10 pounds Six or more completed pregnancies History of eclampsia Previous cesarean section History of preeclampsia History of fetus with anomalies Medical History Risk Factor Abnormal PAP test Chronic hypertension Heart disease NYHA Class II-IV (symptomatic) Insulin dependent diabetes (> A2) Moderate to severe renal disease Previous endocrine ablation Sickle cell disease Epilepsy Heart disease NYHA Class I (no symptoms) History of TB or PPD >= 10 mm Positive serology (for syphilis) Points 10 10 10 10 10 5 5 5 5 5 1 1 Points 10 10 10 10 10 10 10 5 5 5 5

Pulmonary disease Thyroid disease Family History Family history of diabetes Physical Risk Factor Risk Factor Incompetent cervix Uterine malformations Maternal age 35 and over or 15 and under Maternal weight < 100 pounds or > 200 pounds Small pelvis Current Pregnancy Risk Factor Abnormal fetal position Moderate to severe preeclampsia Multiple pregnancy Placenta abruptio Placenta previa Polyhydramnios or oligohydramnios Excessive use of drugs/alcohol Gestational diabetes (A1) Kidney infection Mild preeclampsia Rh sensitization only Severe anemia < 9 g/dL hemoglobin Severe flu syndrome or viral disease Vaginal spotting Bladder infection Emotional problems Mild anemia 9 g/dL hemoglobin Moderate alcohol use Smoking >= 1 pack per day

5 5 Points 1 Points 10 10 5 5 5 Points 10 10 10 10 10 10 5 5 5 5 5 5 5 5 1 1 1 1 1

REFERENCE 1. Hobel CJ, Hyvarinen MA et al. Prenatal and intrapartum high-risk screening. Am J Obstet Gynecol. 1973; 117: 1-9. PMID: 4722373