Modul distosia (reproduksi)
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KELOMPOK 5SKENARIO 2
MODUL DISTOSIA
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SKENARIO
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Wanita, 35 tahun, hamil anak ketiga dan persalinan tidak maju. Pada pemeriksaan fisik didapatkan bahwa tanda vital dalam batas normal, tinggi fundus 3 jari dibawah proc.xyphoideus, punggung di kanan ibu, bagian terendah kepala, perlimaan 2/5. jarak antara symfisis pubis-tinggi fundus uteri 37 cm, lingkar perut ibu 95 cm. denyut jantung janin 130 x/menit. His 2x dalam 10 menit dengan durasi 30-35 detik. Pembukaan serviks 4 cm, ketuban utuh, penurunan sesuai bidang Hodge 2 dengan kondisi panggul dalam cukup.
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Wanita 35 tahun
Persalinan tidak maju
G3P2A0
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INTERPRETASI HASIL PEMERIKSAAN
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Berdasarkan pemeriksaan Leopold
LEOPOLD 1• TFU 3 jari dibawah proc.xyphoideus
LEOPOLD 2• Punggung janin dikanan ibu
LEOPOLD 3• Bagian terendah janin kepala
LEOPOLD 4• Perlimaan 2/5
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Menentukan usia kehamilan
• Rumus Naegele’sHPHT=(Tanggal+7) (bulan-3) (tahun+1)
Anamnesis tambahan• Pengukuran TFU
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Menentukan berat janin
• Rumus Johnson’s – TBJ = (TFU– N) x155
• Rumus McDonald:– TBJ : TFU x LP
37 x 95 3515 gram
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Pemeriksaan obstetri lain …
DJJ 130 x/menit(N : 120-
160x/mnt)
His 2x dalam 10
menit
Pembukaan 4 cm (kala I fase aktif)
Durasi his 30-35 dtk
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Pemeriksaan ginekologik
Ketuban utuh
Kondisi panggul dalam cukup
Bidang hodge 2
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PARTOGRAF
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Pertanyaan
• Anatomi jalan lahir?• Mekanisme persalinan normal?• Tahap persalinan normal?• Faktor yang berperan dalam persalinan?• Tanda-tanda inpartu?• Tanda-tanda persalinan macet?• Definisi dan penyebab persalinan tidak maju?• Komplikasi persalinan macet pada ibu dan janin?• Penanganan pada persalinan macet?
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TANDA-TANDA PERSALINAN
MACET?
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ANATOMI JALAN LAHIR
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Jalan lahir
Bagian lunak
Bagain tulang
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TEORI-TEORI PERSALINAN
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TEORI PERSALINAN
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MEKANISME PERSALINAN NORMAL
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VIDEO
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TAHAP PERSALINAN NORMAL
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KALA PERSALINAN
KALA PERSALINAN
KALA 1 (kala pembukaan)
KALA 2 (kala pengeluaran)KALA 3 (kala uri)
KALA 4 (observasi pasca salin)
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•=pematangan dan pembukaan serviks sampai lengkap•Terdiri dari 2 fase (fase laten dan fase aktif)•Fase laten : pembukaan sampai 4cm, ± 8 jam•Fase aktif : pembukaan 4cm – 10 cm, ± 6 jam
Kala 1(kala
pembukaan)
•=mulai dari pembukaan serviks lengkap sampai bayi keluar•Multigravida : ± 30 menit•Primigravida : ± 1,5 jam
Kala 2 (kala pengeluaran
)
•=pengeluaran plasenta•6-15 menit setelah bayi lahir
Kala 3 (kala uri)
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•Diamati sampai 2 jam setelah partus•Ada 7 hal yang harus diperhatikan !!
Kala 4(observasi pascasalin
)
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FAKTOR YANG BERPERAN DALAM PERSALINAN
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Power Passage Passanger
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TANDA-TANDA INPARTU
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Tanda-tanda persalinan normal
• Rasa sakit akibat adanya HIS yang lebih kuat, sering, dan teratur
• Keluar lendir bercampur darah (show) yang lebih banyak karena robekan kecil pada serviks
• Terkadang ketuban pecah dengan sendirinya• Serviks mulai membuka (dilatasi) dan
mendatar
Mochtar 2002
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DEFINISI DAN PENYEBAB DISTOSIA
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• =persalinan lama atau disebut juga distosia , didefinisikan sebagai persalinan yang abnormal/sulit
sumber : ilmu kebidanan hal.562 ,Jakarta;2010
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Penyebab
Passanger
Passage
Power
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Kelainan HIS
Inersia uteri
His terlalu kuat
Incoordinate
uterine action
Kelainan jalan lahir
Kelainan janin
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Kelainan his
• Inersia uteri- Fundus berkontraksi
lebih kuat dan lebih dahulu daripada bagian-bagian yang lain.
- Paling sering pada multigravida
• Incoordinate uterine action
- Sifat his berubah- Tidak ada sinkronisasi
kontraksi bagian-bagian uterus.
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Kelainan jalan lahir
• Bentuk panggul• Ukuran panggul
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Kelainan janin
• Malpresentasi• Malposisi • Ukuran janin
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KOMPLIKASI DISTOSIA BAGI IBU DAN JANIN
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Bagi ibu
• Infeksi intrapartum• Ruptura uteri• Cincin retraksi patologis• Pembentukan fistula• Cedera otot-otot dasar
panggul
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Bagi janin
• Kaput suksedaneum• Molase kepala janin
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Penanganan dystocia
Inersia uteri• Oxytocin • Sectio cesarea
Incoordinate uterine action• Analgetic• Persalinan cunam(jika
memenuhi syarat)• Sectio cesarea
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TERIMA KASIH