tag:blogger.com,1999:blog-40586958851659981242024-03-08T09:49:22.607-08:00violaceoustak pernah kuberharap lebihh...karna bagiku ini sudah cukupviolaceoushttp://www.blogger.com/profile/09949245804387862932noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4058695885165998124.post-18269216252069152082011-05-05T23:59:00.000-07:002011-05-05T23:59:41.329-07:00<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac><br />
<div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">METODE PEMASANGAN KONDOM KATETER UNTUK TANGANI PERDARAHAN </span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">By, MUN AMINAH, S.SiT</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
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</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sangat menyenangkan bukan jika negara kita merupakan negara terkaya akan hasil alamnya, tetapi jika negara kita menjadi salah satu penyumbang kematian ibu terbanyak dinegara berkembang, apakah menjadi suatu kebanggaan? Tentu tidak. </span></div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sudah b</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">erbagai cara dikembangkan untuk </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">menurunkan morbiditas dan mortalitas </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">di negara kita. Dari data SDKI tahun 2007 diperoleh data untuk angka kematian ibu 228/100.000 KH. Sedangkan hasil SDKI tahun 2002/2003 yaitu sebanyak 307/100.000 KH. Jika dilihat dari perbandingan tahun 2003 dan 2007 memang mengalami penurunan, tetapi Angka ini tegolong masih tinggi jika dibandingkan dengan negara maju. Rata-rata angka kematian ibu ini disebabkan karena perdarahan saat persalinan atau setelah bersalin. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Menurunkan AKI salah satu diantaranya adalah pengelolaan perdarahan pasca salin, meliputi pengenalan faktor risiko terjadinya perdarahan pasca salin, pencegahan terjadinya perdarahan dan penanganan perdarahan pasca salin yg efektif</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">.</span></div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penyebab primer perdarahan pascasalin beberapa tahun terakhir </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">kita kenal dengan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> <b><span lang="EN-US">Empat T</span></b><span lang="EN-US">, yaitu :</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tone/ Tonus </span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">(</span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> Atonia Uteri</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">), </span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Trauma</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> (</span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">perlukaan jalan lahir, inversi uter</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">i)</span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tissue/ jaringan </span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">(</span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">retensi placenta, placenta Akreta</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">), </span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Trombin </span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">(</span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">gangguan koagulasi </span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">)</span></i></div><div class="MsoNormal" style="text-align: justify;"><span style="height: 43px; left: 0px; margin-left: 72px; margin-top: 23px; position: absolute; width: 314px; z-index: 251655680;"><img alt="Oval: Penyebab perdarahan" height="43" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif" width="314" /></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><img height="270" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image004.gif" width="452" /></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></i></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hampir </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">70% kasus paling banyak perdarahan pasca salin disebabkan atonia uteri</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Atoni</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> d</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">p</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">t terjadi setelah persalinan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">per </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">vagina</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">m</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">, persalinan operatif</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">/persalinan abdominal, disebabkan karena k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">ondisi otot polos uterus gagal berkontraksi untuk menjepit pembuluh</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">-pembuluh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> darah spiral di tempat perle</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">ka</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">tan placenta s</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">e</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">h</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">ing</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">g</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> perdarahan terjadi sangat cepat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">, dikarenakan k</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">ecepatan aliran darah pd uterus aterm diperkirakan 700 ml per menit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">, sehingga sangat memungkinkan terjadinya kematian pada ibu bersalin. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penelitian membuktikan bahwa atonia uteri lebih tinggi p</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">d</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> persalinan abdominal dibandingkan dgn vaginal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">(</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">studi kohort insiden atonia uteri </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">setelah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> SC primer 6%</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">). </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Analisis regresi menunjukkan bahwa faktor-faktor kehamilan kembar, ras tertentu, induksi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">18 jam, janin besar</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"> pemberian MgSO4 dan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">kasus </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">K</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">etuban </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">P</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">ecah </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">D</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">ini (KPD)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> merupakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">re</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">siko Atonia Uteri</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">.</span></div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jika atonia tidak segera ditangani dapat menyebabkan syok bahkan kematian. Tanda gejala syok antara lain:</span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nadi lemah dan cepat (110 kali/menit atau lebih)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tekanan darah sangat rendah : tekanan sistolik < 90 mmHg</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nafas cepat (frekuensi pernafasan) 30 kali/ menit atau lebih </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Urine kurang dari 30 cc/jam</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bingung, gelisah atau pingsan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Berkeringat atau kulit menjadi dingin dan basah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Puca</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">t</span></div><div class="MsoNormal" style="margin-left: 32.2pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-left: 35.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penatalaksanaan atonia uteri :</span></div><div class="MsoNormal" style="margin-left: 35.5pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 53.5pt; text-align: justify; text-indent: -18pt;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Langkah awal</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 53.5pt; text-align: justify;">Sering kita kenal dengan A, B, C</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 71.5pt; text-align: justify;"><br />
</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 71.5pt;"><tbody>
<tr> <td style="padding: 0cm 5.4pt; width: 182.3pt;" valign="top" width="243"><div class="MsoListParagraphCxSpMiddle" style="margin-left: 18pt; text-align: justify; text-indent: -18pt;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>A (airway)</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 34.85pt; text-align: justify; text-indent: -20.6pt;"><span style="font-family: Symbol;"><img alt="*" height="13" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Bebaskan jalan napas dengan meninggikan posisi kepala lebih ekstensi</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 34.85pt; text-align: justify; text-indent: -20.6pt;"><span style="font-family: Symbol;"><img alt="*" height="13" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Ask<span lang="EN-US"> for HELLP !!</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 32.8pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><img alt="*" height="13" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Observasi dan bicara pada pasien</span></div></td> <td style="padding: 0cm 5.4pt; width: 208.3pt;" valign="top" width="278"><div class="MsoListParagraphCxSpLast" style="margin-left: 0cm; text-align: justify;"><img height="162" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image006.gif" width="214" /></div></td> </tr>
<tr> <td colspan="2" style="padding: 0cm 5.4pt; width: 390.6pt;" valign="top" width="521"><div class="MsoListParagraphCxSpFirst" style="margin-left: 18pt; text-align: justify; text-indent: -18pt;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><b>B (</b><b><span lang="EN-US">Breathing</span>)</b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 18pt; text-align: justify;">Melakukan <span lang="EN-US">Oksigenasi </span>2 liter pada ibu dengan frekuensi pernapasan lebih dari 24 x/menit.</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 18pt; text-align: justify; text-indent: -18pt;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>C (Circulation)</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 18pt; text-align: justify;">Jika frekuensi nadi lebih dari 100x/mnt, lakukan pemasangan infus 2 jalur</div><div class="MsoListParagraphCxSpLast" style="margin-left: 0cm; text-align: justify;"><br />
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</tbody></table><div class="MsoListParagraphCxSpFirst" style="margin-left: 53.5pt; text-align: justify; text-indent: -18pt;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Penatalaksanaan Medisinalis</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 71.5pt; text-align: justify; text-indent: -18pt;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pemberian obat</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 71.5pt; text-align: justify;"><br />
b. Tindakan</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 110.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><img alt="*" height="13" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Lakukan masase selama 15 detik</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 110.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><img alt="*" height="13" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Jika masase gagal lakukan kompresi bimanual internal (KBI)</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 110.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><img alt="*" height="13" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Jika gagal lanjutkan dengan kompresi bimanual eksternal (KBE)</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 110.2pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;"><img alt="*" height="13" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="13" /><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span>Jika masih gagal lakukan tindakan lanjut dengan modalitas yang ideal</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 117.25pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Cepat hentikan perdarahan </span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 117.25pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Mudah dilakukan </span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 117.25pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Alat dan bahan mudah disediakan </span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 117.25pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Murah </span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 117.25pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Aman </span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 53.5pt; text-indent: -18pt;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Penanganan Konservatif</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 71.5pt; text-indent: -18pt;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">N o n P e m b e d a h a n</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt; text-indent: -18pt;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Tampon Kass</span>a</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt;"><span lang="EN-US">Risiko:</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt;"><span lang="EN-US">- Perdarahan tersembunyi </span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt;"><span lang="EN-US">- Infeksi </span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt;"><span lang="EN-US">- Trauma</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt;"><span lang="EN-US">- Lebih lama</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt;"><span lang="EN-US">- Lebih sulit </span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt; text-indent: -18pt;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><span lang="EN-US">Balon intrauterin </span> (balon kateter)</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt;"><span lang="EN-US">Tindakan yang cepat dan logis bila medikamentosa gagal hentikan</span><span lang="EN-US"> </span><span lang="EN-US">perdarahan </span></div><div align="right" class="MsoListParagraphCxSpMiddle" style="margin-left: 89.5pt; text-align: right;"><span style="height: 176px; left: 0px; margin-left: 160px; margin-top: 0px; position: absolute; width: 196px; z-index: 251658752;"><img alt="Oval: - Balon kateter no.24
- Kondom dikembangkan hingga 250-500 cc
-
- Harga murah" height="176" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image007.gif" width="196" /></span><img height="158" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image009.gif" width="170" /></div><div class="MsoListParagraphCxSpLast" style="margin-left: 89.5pt;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">BALON KONDOM KATETER</span></b></div><div class="MsoListParagraphCxSpFirst" style="text-align: justify; text-indent: -18pt;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kateter dimasukan kedalam kondom dengan cara aseptik dan di ikat</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Buli-buli dipasang kateter menetap</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Dalam posisi litotomi, kateter dan kondom dimasukan ke cavum uteri</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kateter diisi cairan 250-500 cc</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Observasi perdarahan jika sudah berkurang cairan dihentikan dan kateter diikat</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Dipasang tampon vagina untuk menahan kondom</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kontraksi uterus dipertahankan dengan drip oksitosin ≥ 6jam</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Diberikan antiboitik</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;">9.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kondom dipertahankan setelah 24-48jam, dilepas gradual 10-15 menit</div><div class="MsoListParagraphCxSpLast" style="text-align: justify;"><br />
</div><div class="MsoNormal"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">KONDOM HIDROSTATIK TAMPONADE (MODIFIKASI SAYEBA)</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Perlengkapan yang diperlukan : </span></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><img height="199" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image011.gif" width="167" /><img height="200" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image013.gif" width="179" /></span><img align="left" height="178" hspace="12" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image015.gif" width="182" /><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br clear="all" /> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">PROSEDUR</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><span style="font-family: Wingdings;">ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Tidak menggunakan Kateter Folley </span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: Wingdings;">ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Set infus yang telah disambungkan dengan cairan </span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: Wingdings;">ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">ujungnya dimasukkan ke dalam kondom </span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: Wingdings;">ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">kondom diikatkan pada ujung set infus. </span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: Wingdings;">ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Selanjutnya dimasukkan ke dalam kavum uteri </span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><span style="font-family: Wingdings;">ü<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US">Kondom bisa digembungkan 500 - 2.000cc</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><img height="224" src="file:///C:/Users/Customer/AppData/Local/Temp/msohtmlclip1/01/clip_image017.gif" width="239" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoListParagraphCxSpFirst"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 7.1pt;">KEUNGGULAN</div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>P<span lang="EN-US">etugas kesehatan termasuk bidan dapat lakukan </span><span lang="EN-US"> teknik ini </span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span> Aman<span lang="EN-US">, sederhana dan murah </span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Dapat<span lang="EN-US"> dijadikan penilaian apakah perlu dilakukan </span><span lang="EN-US"> </span><span lang="EN-US">pembedahan untuk hentikan perdarahan </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ingat !!!!!</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Perdarahan sedikit mungkin menimbulkan syok pd ibu yg menderita anemia berat , ibu dpt kehilangan darah 350-560 cc/menit.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Meninggal karena perdarahan postpartum dlm waktu 1 jam setelah melahirkan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Perdarahan sedikit demi sedikit dan terus-menerus atau perdarahan tiba-tiba adalah keadaan darurat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Perdarahan post partum dari episiotomi atau laserasi mungkin terjadi bersamaan dgn atoni uteri.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Syok h</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">r</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">u</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">s segera diatasi & cairan yg hilang hrs diganti.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Berikan suplementasi zat besi setelah perdarahan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Perdarahan dpt terjadi kapan saja sesudah bayi lahir.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Ruptura uteri dpt terjadi dlm persalinan tanpa tampak adanya perdarahan keluar.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">•<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jangan panik dlm menghadapi perdarahan postpartum.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="margin-left: 36pt;"><br />
</div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dengan adanya usaha setidaknya kita maju selangkah untuk mengurangi angka kematian ibu. Keselamatan ibu adalah keselamatan generasi penerus bangsa yang cerdas dan handal.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="margin-left: 117.25pt;"><b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
</span></i></b></div>violaceoushttp://www.blogger.com/profile/09949245804387862932noreply@blogger.com0tag:blogger.com,1999:blog-4058695885165998124.post-13837067923461743162011-04-27T21:38:00.000-07:002011-04-27T21:38:14.805-07:00violaceous: violaceous<a href="http://cemunviolaceous.blogspot.com/2011/04/violaceous.html?spref=bl">violaceous: violaceous</a>: "Dimanapun... sering kita meminta ap yang tak penting bagi kehidupann,,,, andai aku punya paras cantik tentu banyak pria yg kan mendekatiku....."violaceoushttp://www.blogger.com/profile/09949245804387862932noreply@blogger.com0tag:blogger.com,1999:blog-4058695885165998124.post-44442378309436483902011-04-27T21:09:00.000-07:002011-04-27T21:09:55.079-07:00violaceous<div style="color: purple; font-family: "Courier New",Courier,monospace;">Dimanapun...</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">sering kita meminta ap yang tak penting bagi kehidupann,,,,</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">andai aku punya paras cantik tentu banyak pria yg kan mendekatiku...</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">andai aku punya uang banyak...aku ingin keliling dunia,,,, </div><div style="color: purple; font-family: "Courier New",Courier,monospace;">andai aku pintar,,,pasti aku bisa memecahkan semua rumus yang tek terpecahkan oleh dunia...</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">andai...andai...dan andaiii....</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">itulah manusia yang tak pernah merasa puas dengan ap yg tlah ia dapatkann...</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">padahal banyak hal indah disekitar kita yang terkadang tak pernah terlihat oleh mata batin...</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">banyak hal yg telah kita capai..tapi..masih saja ada yaang kurang dalam diri kita </div><div style="color: purple; font-family: "Courier New",Courier,monospace;">dan aku yakin Tuhan pasti telah menyediakan semua yang kita butuhkan ,,,bahkan itu lebih....</div><div style="color: purple; font-family: "Courier New",Courier,monospace;"><br />
</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">saat berdoa, sering kali kita lupakannn...kita hanya menuruti ambisi dan kepuasan yang belum terpenuhi...Tuhan tolong kabulkan ini, kabulkan itu....</div><div style="color: purple; font-family: "Courier New",Courier,monospace;">sampai kita lupa apa yang diberikan Tuhan melebihi nikmat yang tiada tara...kita lupa meluapkan rasa Syukur yang seharusnya ada dalam hembusan nafas yang selalu mengiringi langkah kita....</div><div style="color: purple; font-family: "Courier New",Courier,monospace;"><br />
</div>violaceoushttp://www.blogger.com/profile/09949245804387862932noreply@blogger.com0