7d persalinan sungsang
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Transcript of 7d persalinan sungsang
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Persalinan Sungsang
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Tujuan– Insidens dan
Kemaknaan– Seleksi– Tatalaksana
– Intrapartum– Persalinan
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• Definisi– letak longitudinal atau memanjang– terbawah bokong atau kaki – kepala di bagian fundus
• Jenis– murni - fleksi lipat paha, lutut ekstensi– komplit - fleksi lipat paha dan lutut – kaki - satu atau dua kaki terbawah
dan lipat paha ekstensi
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Jenis Presentasi Bokong
Komplit Kaki Murni
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Insidens
– 3 to 4% dari total kehamilan– Meningkat dengan makin
mudanya usia gestasi– 7 to 10% ( 32 weeks)– 25 to 35% (< 28 weeks)
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Etiologi Presentasi Bokong
– idiopathic– prematuritas (head to
trunk size)– abnormalitas struktur
uterus/pelvik – fibroma uterus– anomali fetus– polihidramnion– hamil kembar
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Diagnosis – Gerakan kaki yang
dirasakan ibu– Pemeriksaan Leopold– DJJ diatas umbilikus– Periksa Dalam– USG– Rontgen
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Rekomendasi Persalinan Bokong– Partus percobaan bila usia gestasi 36 mg
atau BB 2500-4000 gram– Tawarkan partus percobaan bila usia
gestasi 31 - 35 atau BB 1500-2500 gram– Tawarkan SC bila 30 mg atau BB < 1500
gram– Tak cukup bukti untuk menawarkan
berbagai cara konservatif bila BB > 4000 grams*
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Kriteria Seleksi Partus Percobaan
– Bokong Murni atau Komplit– Kepala tidak hiperekstensi– Taksiran BB 2500 - 4000g
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Konfirmasi USG
– pastikan letak dan jenis presentasi
bokong– nilai posisi kepala– tentukan taksiran BB bayi– nilai IUGR dan kelainan kongenital– ukur volume cairan ketuban– konfirmasi lokasi implantasi plasenta
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Kontraindikasi Partus Percobaan– Kondisi ibu dan bayi yang tak
memungkinkan
– Presentasi kaki
– Hiperekstensi kepala
– Tidak ada PTM (Informed Consent)
– Tidak tersedia tenaga kompeten untuk melakukan pertolongan
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Persiapan
– Rencanakan melahirkan di rumah sakit– MRS bila ada tanda partus prematur
imminens atau KPD– Surveilens memedai untuk bayi– Epidural & ARM bila ada indikasi– Singkirkan adanya prolapsus tali pusat
bila ketuban pecah– Prognosis baik bila dilatasi 0.5 cm/jam
setelah pembukaan 4 cm– Induksi dan Augmentasi (bila ada
indikasi)
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Penatalaksanaan persalinan
– Siapkan resusitator berpengalaman– Kosongkan kandung kemih– Penolong didampingi asisten yang
berpengalaman– Siapkan forceps bila diperlukan
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Bokong melewati PAP
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Penurunan Bokong
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Ekspulsi Spontan
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
• ekspulsi spontan hingga umbilikus
• sakrum difasilitasi untuk mengarah ke anterior
• ekstraksi aktif merupakan kontraindikasi
• SC bila penurunan bokong atau proses ekspulsi gagal
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• Sigap & Tunggu
– JANGAN TARIK!–Traksi membuat kepala ekstensi
–Tangan menjungkit
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Lahirkan kaki dengan merotasikan paha ke lateral dan fleksi lutut – pertahankan posisi sakrum anterior
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Melahirkan Lengan– ibu meneran baik– lahirkan bila terlihat
sayap skalpula– rotasikan lengan ke
anterior– lewatkan humerus di
depan dada dan lahirkan
– Lakukan hal yang sama pada lengan lainnya
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Hindarkan ekstensi berlebihan
Obstetrics - Normal and Problem Pregnancies,2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Lahirkan kepala
Manuver Mauriceau - Smellie - Veit
Topang tubuh bayi pada lengan penolong dengan posisi horisontal
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Melahirkan Kepala
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Melahirkan Kepala– Forceps– Asisten
mengangkat bayi– Pasang langsung
dan lahirkan kepala
Obstetrics - Normal and Problem Pregnancies, 2nd EditionEdited by SG Gabbe, JR Niebyl, JL Simpson. (1991)
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Mencegah Presentasi Bokong– Versi luar pada usia gestasi 36
weeks – Keberhasilan 30 - 70%
tergantung keahlian penolong
– Menurunkan insidens SC
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Kesimpulan
– seleksi pasien secara baik– beri penjelasan dan informed
consent– prognosis baik bila dilatasi 0.5
cm/jam setelah pembukaan 4 cm– induksi dan augmentasi (bila perlu)– penolong terampil– pantau bayi secara baik– dibantu bukan berarti ditarik