Partus Presipitatus GDON
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Transcript of Partus Presipitatus GDON
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I Wayan Agung Indrawan
Divisi Obstetri Ginekologi Sosial
FKUB/RSSA Malang
Partus Presipitatus
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TERMS AND DEFINITIONS
a.Precipitate Delivery.
Persalinan yang berlangsung cepat ( < 3jam) dan
berakhir dengan lahirnya bayi secara expulsi
b.Emergency Delivery.
Persalinan yang tidak direncanakan, berlangsung di
tempat tak terduga, di luar rumah sakit.
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Definisi
Kelahiran bayi yang berlangsung kurang dari 3 jam dari
awal persalinan
nulipara kecepatan dilatasi cervix 5 cm/ jam, dan pada
multipara 10 cm/jam
Etiologi
Rendahnya resistensi bagian terendah dari jaringan
lunak jalan lahir
Kontraksi uterus yang amat kuat Hilangnya sensasi nyeri
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- .DELIVERY
a. A multipara with relaxed pelvic or perineal floor
muscles b. A multipara with unusually strong, forceful
contractions.
c. absence of painful sensations during labor
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Patofisiologi
PRESIPITASI :
Kehamilan multipel
Kelainan kongenital
uterus Malformasi pelvis
Kontraksi hipertonik
Overstimulasi
oxytocin Kecemasan dan stres
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Kontraksi hipertonik atau
tetanik
Rendahnya resistensi
jaringan lunak jalan lahir
Dilatasi cervix berjalanlebih cepat
Mendorong janin keluar
lebih cepat dari jalan lahir
( 3 jam )
Suddent birth
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Tanda / gejala :
rasa nyeri yang melebihi normalpeningkatan heart rate, nadi dantemperatur
peningkatan tekanan darahshort of breathnesskecemasannasal flaring
fase relaksasi yang pendekkontraksi hipertonik
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- .DELIVERY
a.Maternal.
(1) lacerations of the cervix, vagina, and/or
perineum.
(2) Uterine atony may result from muscularexhaustion after unusually strong and rapid
labor.
(3) There may be infection as a result ofunsterile delivery.
(4)Amniotic fluid Embolism
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3-4. DANGER OF PRECIPITATE
DELIVERY
Neonatal.
(1) intracranial hemorrhage
(2) aspiration of amniotic fluid,
(3) infection as a result of unsterile delivery.
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Komplikasi janin dan neonatus
Peningkatan mortalitas dan morbiditas perinatal
Trauma intracranial
Erb-Duchenne palsy
Bayi mungkin lahir secara cepat dan jatuh ke lantaisehingga menimbulkan luka atau fraktur.
Pada umumnya bantuan resusitasi datang terlambat
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Emergency Delivery
Initial Step:Obtain maternal VS, FHR
Initiate supportive tx
Venous access, maternal and fetal monitoring
Before transferring ptconsider stage of labor / ptsparity
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Emergency Delivery Sterile Pelvic exam (Degree
cervical dilatation/effacement,
crowning, for fetus in introitus) Determine presenting
part/position
Palpate for skull sutures /
fontanel, buttock, or
extremity
P f L b d D li
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Process of Labor and Delivery
Six Cardinal Movements:1. Engagement2. Flexion
3. Descent
4. Internal Rotation
5. Extension6. External Rotation
Deli er Steps
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Delivery Steps1-3 Perineum stretching
/thinningallow
passage of newborn
Attempt to avoidEpisiotomy
3-4 Control of fetal head to
prevent large perineal
tear and head / facial
trauma to the newborn4 Nose/mouth suctioning
meconium?
4 Palpate neck for
nuchal cord
4-6 Gentle traction avoidbrachial plexus injuries(No jerky or forceful moves)
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Delivery Steps
6-7 Slippery infant
9-11 Double clampumbilical chord and
cut
12 Wrap/dry/gentle
stimulation
12 Determine APGAR at 1
/ 5 min.
12 Initiate neonatal
resuscitation if a
cyanotic / apneic
child is delivered withno response to
stimulation.
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APGAR
Good, cryingSlow,
Irregular
AbsentRespiration
R
Normal over
entire body
Normal
except for
extremities
Blue-gray,
pale all over
AppearanceA
Sneeze,cough,
pulls away
GrimaceNo responseGrimace
G
Above 100
beats/min
Below
100beats/min
AbsentPulseP
Activemovement
Arms andlegs flexed
AbsentActivityA
2 points1 point0 pointsSign
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Cutting The Umbilical Cord
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Delivery of Placenta
Occurs in 15-20m after infant is deliveredAllow spontaneous separation with gentle traction.
Aggressive traction on the cord can lead to: Uterine inversion
Cord Tearing Placenta disruptionsevere vaginal bleed
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Delivery of Placenta
Massage uterus after delivery of placenta (promotecontraction)
Oxytocin maintain uterine contraction (1020u IV in 1 L NS at250mL/h or 10u IM)
Uterine atonyexcessive vaginal bleed Oxytocin, Methylergonovine or carboprost tromethamine
Delay episiotomy or laceration repair for OBGYN to
perform.
omp ca ons o e very: or ro apse
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omp ca ons o e very: . or ro apse
In Cord Prolapse:Bimanual reveals
palpable pulsating cord
Elevate fetal partreduce cordcompression
Examiners hand
shouldRemain in Vagina
Transport
SurgeryC-sec isindicated.
Do not attempt toreduce prolapsed cord
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selalu dampingi pasien
pasien diminta untuk menghembuskan nafastiap kontraksi untuk mengalihkan keinginanuntuk mengejan
jangan mencegah kelahiran bayi bilapembukaan sudah lengkap
upayakan lingkungan yang steril/aseptikepisiotomi bila diperlukan
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FOR ANTICIPATED PRECIPITATE
BIRTH
a.Assess Patient for an Impending
Precipitous Delivery Situation.
(1) Patient has previous obstetric history of rapidlabor/delivery.
(2) Patient complains of a sudden, intense urge to
push.
(3) Increase in bloody show. (4) Sudden bulging of the perineum.
(5) Sudden crowning of the presenting part.
3 5 NURSING CARE TO PREPARE
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3-5. NURSING CARE TO PREPAREFOR ANTICIPATED PRECIPITATE
BIRTH
b.Call for Help. Do
not leave the patientunattended.
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FOR ANTICIPATED PRECIPITATE
BIRTH
c.Obtain a Sterile Obstetric or PrecipitateDelivery Pack, if Available.
(1) Gloves - sterile gloves are preferred as they
help promote asepsis.
(2) Towel/cloth
(3) Bulb syringe
(4) Hemostats or cord clamps-to clamp the
umbilical cord. (5) Scissors-to cut the episiotomy/cord.
(6) Dry blanket/towel-to wrap the infant after
delivery
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.FOR ANTICIPATED PRECIPITATE
BIRTH
d.Provide the Cleanest Environment ifPossible
(1) Paper, towel, blanket, or coat to place under the
patient's buttocks.
(2) Ligating material such as string, yarn, orshoelaces to tie the cord.
(3) A sharp instrument such as scissors, a knife, or
a razor to cut the cord.
(4) A dry cloth to wrap infant after delivery.
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.FOR ANTICIPATED PRECIPITATE
BIRTH
e.Provide for Asepsis to the Greatest ExtentPossible.
(1) Pour Betadineover the patient's perineum if
time does not permit for perineal prep.
(2) Wash your hands and glove, if possible.
FOR ANTICIPATED PRECIPITATE
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FOR ANTICIPATED PRECIPITATE
BIRTH
f.Support the Patient.
(1) Keep the patient informed of plans for delivery.
(2) Speak in a calm tone and provide direction to
available assistants (e.g., significant other).
(3) Encourage the patient to pant or blow through
contractions to slow the delivery process and to
decrease the force of expulsion.
(4) Provide for privacy, but do not leave thepatient alone
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- .MANAGEMENT OF PRECIPITATE
DELIVERY
a.Check for Presence of an Intact Amniotic Sac.
(1) If the membranes do not break spontaneously,
they should be ruptured just prior to or with thedelivery of the head.
(2) Caution must be taken to prevent the membranes
from covering the infant's mouth as the first breath is
taken, otherwise aspiration of amniotic fluid canoccur.
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- .MANAGEMENT OF PRECIPITATE
DELIVERY
Support the Perineum and Infant's Head. (1) Apply support to the perineum with your
dominant hand (usually right hand) using a towel
or cloth.
(2) Apply support to the fetal head with your
nondominant hand.
(3) Increase the pressure of the dominant hand in
a downward motion against the perineum as thefetal head extends.. ( digeser ke bawah)
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- .MANAGEMENT OF PRECIPITATE
DELIVERY
Support the Perineum and Infant's Head(4) Provide mild downward pressure with the
nondominant hand against the fetal head as the
fetal head extends. ( cegah extensi)
(5). Neverattempt to delay delivery by applying
pressure on the fetal head.
(6) Combine efforts of the right and left hand. This
will result in a slow, controlled extension of thefetal head.
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- .MANAGEMENT OF PRECIPITATE
DELIVERY
c.Assist With the Actual Delivery of the Head. d.Coach the Patient to Pant/Blow.
3 6 NURSING CARE FOR MANAGEMENT
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3-6. NURSING CARE FOR MANAGEMENT
OF PRECIPITATE DELIVERY
e.Bulb Suction Amniotic Fluid from theInfant's Mouth. Or wiped by clean towel.
f.Allow Rotation.Allow the infant to
spontaneously accomplish external rotation.
g.Check for a Nuchal Umbilical Cord.
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- .MANAGEMENT OF PRECIPITATE
DELIVERY
h.Allow Infant to Complete External Rotation. i.Coach the Patient to Push and to Pant/Blow.
(1) The nurse applies gentle downward pressure on
the head until the anterior shoulder delivers from
under the pubic arch and becomes visible.
(2) Support the infant's head and neck.
J. Assist With Delivery of the Posterior
Shoulder
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3-6. NURSING CARE FOR
MANAGEMENT OF PRECIPITATE
DELIVERY
.Assist with Delivery of the Placenta.
Active management of 3rdphase
Fundal massage
Oxytocin injection
Cord traction
3 7 NURSING CARE AFTER A
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3-7. NURSING CARE AFTER A
PRECIPITATE DELIVERY
a. Assist the mother into a comfortable positionwith her legs extended.
b. Provide a clean surface under the patient's
buttocks. c. Check uterine fundus every 10 to 15 minutes
during the first hour to assure contraction ofmyometrium and normal lochial flow.
(1) Gently massage the uterus if the fundus is softor boggy.
(2) Avoid overstimulation as myometrium will fatigueand result in severe atony.
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