persalinan patologis 2
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persalinan patologis 2TRANSCRIPT
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Persalinan Patologis
( Power, passage )
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Abnormalitas Power
kelainan kontraksi uterus— uterine dysfunction —
atau kekuatan ibu meneran kurang
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Abnormalities of the powers
Uterine dysfunction hypotonic primary
uterine inertia secondaryUterine
hypertonic/incoordinateDysfunction uterine hypercontractility
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Abnormalities of the powers
-----uterine inertiaEtiology of uterine inertia
Cephalopelvic disproportion atau malposisi janin Abnormal of uterine muscle (over distension : bayi
besar, gemelli, polihidramnion, mioma uteri, induksi persalinan)
faktor psikis ( cemas akan persalinan dan komplikasi)
Imbalance of endocrine system ( defisiensi oksitocin) Pemberian analgesi Lain-lain : kelelahan
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Gambaran klinik
hypotonic uterine dysfunction (coordinated): kontraksi uterus lemah, durasi pendek, intervalnya panjang, irreguler, Ibu tenang, perjalanan persalinan lama.
- primer : kontraksi lemah dari awal persalinan - sekunder : kontraksi lemah, setelah sebelumnya kontraksi uterus kuat
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hypertonic uterine inertia / Incoordinated uterine action : tidak ada sinkronisasi kontraksi bagian uterus, nyeri (+)Pembukaan cerviks berjalan lama :
- Fase laten >16 jam - Fase aktif > 8 jam , pembukaan cerviks <1.2cm/jam - Fase aktif tdk maju >2 jam - Kala II >2 jam - Persalinan > 24 jam
Gambaran klinik
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his normal Incoordinate uterin action
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Effect on maternal and fetus
maternal kelelahan (partus lama) asidosis , dehidrasi infeksi (Partus lama , KPD) postpartum hemorrhage (kontraksi uterus
lemah) laserasi jalan lahir ( Ekstraksi Forceps/vakum)
seksio sesarea
fetus distress/hipoksia (oksigenasi/blood flow ↓ ) trauma/luka pada bayi (obstructed labor , rare) prolapse tali pusat stillbirth : meninggal saat lahir
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Management
HIPOTONIC : memperkuat his, cegah HPP - Kala I : intake makanan & cairan, kosongkan vesika,
massage uterus, pecahkan ketuban Obat : Oksitocin 5 IU dlm RL/D5 500 cc mulai 8 tetes/menit Seksio sesarea : bila tdk ada kemajuan atau hipoksia janin - Kala II : EV/EF ( kepala H III-IV ) Seksio sesarea
HIPERTONIC : sinkronisasi kontraksi uterus Sedatif : morfin, Seksio sesarea
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Abnormalities of the powers-- uterine hypercontractility
Gejala Klinis dan Diagnosis : - His terlalu kuat/sering (coordinated uterine hypercontractility) - Partus presipitatus : partus yang sudah selesai < 3 jam
Komplikasi - ibu : ruptura uteri, laserasi jalan lahir/ HPP, infeksi - janin : hipoksia janin, still birth
Management : - tokolisis - seksio sesarea bila hipoksia janin, partus tidak maju
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forceps operations
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Cesarean section
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Abnormalities of passage
Kelainan panggul Kelainan jaringan lunak jalan lahir
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Contractions of the pelvic
Kelainan tulang panggul kapasitas panggul berkurang distosia
Terdiri dari : - kelainan pintu atas panggul (pelvic inlet) - kelainan tengah panggul (midpelvis) - kelainan pintu bawah panggul (pelvic
outlet0 - kombinasi
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Kelainan PAP/pelvic inlet
Flat pelvis, riwayat riketsiaGejala klinis :
- CPD, malposisi, malpresentasi - inersia uteri, partus lama - prolaps tali pusat
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Kelainan tengah panggul-Pintu bawah panggul (Midpelvic—outlet)
Funnel shaped pelvicGejala klinis :
- fetopelvic disproporsi (posisi occiput posterior persiaten, deep
transverse arrest) - distosia /inersia uteri sekunder /PK I aktif tidak maju, PK
II lama - ruptura uteri
the spines are prominent, the pelvic sidewalls converge
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Panggul Sempit
Ukuran pelvis : 2 cm kurang dari normalWanita pendek/ TB < 145Diagnosis :
- Ax : riw. Riketsia, tbc tulang, fraktur - PF : -TB, kelinan tl belakang, kaki - Pelvimetri/pemeriksaan panggul (conjugata diagonalis 12.5~13cm, diameter bi-
ischial 10cm,
arkus pubis 90 0 )
- mal presentasi, malposisi, kepala tdk masuk PAP
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Panggul Sempit
Tatalaksana : - Partus percobaan/trial of labour : pantau kemajuan
persalinan - Kelainan PAP/pelvic inlet : seksio sesarea - Kelainan panggul tengah-pintu bawah panggul : bila kepala HII-IV : pervaginam, bila kepla H III : seksio sesarea
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Kelainan Soft--tissue
Soft tissue canal : segmen uterus, cervix, vagina
segmen bawah uterus : riw seksio , mioma cerviks : riw operasi serviks :konisasi,
cauterisasi vagina : jaringan parut vagina
rigidity and dystocia .
Seksio sesarea
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Kelainan Soft--tissue
Soft tissue canal :lower part of uterus, cervix, vagina previous scar of the birth canal laceration , cervic conization and cauterization , cesarean section , rape injury in a small child , or caustic abortifacient injury to vaginal vault and cervix.
Previous scaring of the birth canal may cause tissue rigidity and dystocia .
cesarean section is generally required