Download - Partus-Presipitatus-GdfDON vsv
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I Wayan Agung Indrawan
Divisi Obstetri Ginekologi Sosial
FKUB/RSSA alang
!artus !resi"itatus
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TERMS AND DEFINITIONS
a#Precipitate Delivery#!ersalinan yang berlangsung $e"at % & '(a)*
dan berak+ir dengan la+irnya bayi se$arae,"ulsi
b#Emergency Delivery#!ersalinan yang tidak diren$anakan-
berlangsung di te)"at tak terduga- di luarru)a+ sakit#
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DefnisiKela+iran bayi yang berlangsung kurang dari '(a) dari awal "ersalinannuli"ara ke$e"atan dilatasi $ervi, . $)/ (a)-
dan "ada )ulti"ara 0 $)/(a)
EtiologiRenda+nya resistensi bagian terenda+ dari(aringan lunak (alan la+ir
Kontraksi uterus yang a)at kuat1ilangnya sensasi nyeri
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3-3 PREDISPOSE TO A
PRE!IPITATE DE"I#ER$
a# A )ulti"ara wit+ rela,ed "elvi$ or "erineal
2oor )us$lesb# A )ulti"ara wit+ unusually strong- 3or$e3ul
$ontra$tions#
$# absen$e o3 "ain3ul sensations during labor
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!ato4siologi!R5SI!I6ASI 7Ke+a)ilan )ulti"el
Kelainan kongenitaluterus
al3or)asi "elvis
Kontraksi +i"ertonik
Oversti)ulasi
o,yto$inKe$e)asan dan
stres
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Kontraksi +i"ertonikatau tetanik
Renda+nya resistensi
(aringan lunak (alanla+ir
Dilatasi $ervi,ber(alan lebi+ $e"at
endorong (aninkeluar lebi+ $e"at
dari (alan la+ir % 8 '
(a) *
Suddent birt+
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6anda / ge(ala 7
rasa nyeri yang )elebi+i nor)al"eningkatan +eart rate- nadi dante)"eratur
"eningkatan tekanan dara+s+ort o3 breat+nesske$e)asannasal 2aring3ase relaksasi yang "endekkontraksi +i"ertonik
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3-% DAN&ER OF PRE!IPITATE
DE"I#ER$a#Maternal#%* la$erations o3 t+e $ervi,- vagina-
and/or "erineu)#
%9* Uterine atony )ay result 3ro))us$ular e,+austion a3ter unusuallystrong and ra"id labor#
%'* 6+ere )ay be in3e$tion as a resulto3 unsterile delivery#'%( A)nioti$ 2uid 5)bolis)
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3-% DAN&ER OF PRE!IPITATEDE"I#ER$
Neonatal#
%* intra$ranial +e)orr+age
%9* as"iration o3 a)nioti$ 2uid-
%'* in3e$tion as a result o3 unsterile delivery#
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)ompli*asi +anin ,an neonats
!eningkatan )ortalitas dan )orbiditas "erinatal6rau)a intra$ranial5rb:Du$+enne "alsy
Bayi )ungkin la+ir se$ara $e"at dan (atu+ kelantai se+ingga )eni)bulkan luka atau 3raktur#!ada u)u)nya bantuan resusitasi datang
terla)bat
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5)ergen$y Delivery
Initial Ste"7Obtain )aternal ;S- F1RInitiate su""ortive t,;enous a$$ess- )aternal and 3etal )onitoring
Be3ore trans3erring "t $onsider stage o3labor / "t
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5)ergen$y Delivery Sterile !elvi$ e,a) %Degree
$ervi$al
dilatation/e=a$e)ent-$rowning- > 3or 3etus inintroitus*
Deter)ine "resenting"art/"osition
!al"ate 3or skull sutures /3ontanel- butto$k- ore,tre)ity
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!ro$ess o3 ?abor and Delivery
Si, @ardinal ove)ents7# 5ngage)ent9# Fle,ion
'# Des$ent
# Internal Rotation
.# 5,tension# 5,ternal Rotation
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Delivery Ste"s:' !erineu)
stret$+ing /t+inningallow "assage o3newborn
Atte)"t to avoid5"isioto)y
': @ontrol o3 3etal +eadto "revent large"erineal tear and+ead / 3a$ial trau)ato t+e newborn
Cose/)out+su$tioning)e$oniu)
!al"ate ne$k 3ornu$+al $ord
: Gentle tra$tion avoidbra$+ial "le,usin(uries %Co (erky or
3or$e3ul )oves*
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Delivery Ste"s
:E Sli""ery in3ant
H: Double $la)"u)bili$al $+ordand $ut
9 Wra"/dry/gentlesti)ulation
9 Deter)ine A!GAR at / . )in#
9 Initiate neonatalresus$itation i3 a$yanoti$ / a"nei$$+ild is deliveredwit+ no res"onseto sti)ulation#
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A!GAR
Good, cryingGood, cryingSlow,Slow,
IrregularIrregularAbsentAbsentRespirationRespiration
RR
Normal overNormal over
entire bodyentire bodyNormalNormal
except forexcept for
extremitiesextremities
Bluegray,Bluegray,
pale all overpale all overAppearanceAppearanceAA
Snee!e,coug",Snee!e,coug",
pulls awaypulls away
GrimaceGrimaceNo responseNo responseGrimaceGrimace
GG
Above #$$Above #$$
beats%minbeats%minBelowBelow
#$$beats%min#$$beats%minAbsentAbsent&ulse&ulse&&
ActiveActivemovementmovement
Arms andArms andlegs flexedlegs flexed
AbsentAbsentActivityActivityAA
' points' points# point# point$ points$ pointsSignSign
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@utting 6+e U)bili$al @ord
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Delivery o3 !la$enta
O$$urs in .:90) a3ter in3ant is deliveredAllow s"ontaneous se"aration wit+ gentle
tra$tion#
Aggressive tra$tion on t+e $ord $an lead to7Uterine inversion@ord 6earing!la$enta disru"tion severe vaginal bleed
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Delivery o3 !la$enta
assage uterus a3ter delivery o3 "la$enta %"ro)ote$ontra$tion*
O,yto$in )aintain uterine $ontra$tion %090u I; in ? CS at 9.0)?/+ or 0u I*
Uterine atonye,$essive vaginal bleedO,yto$in- et+ylergonovine or $arbo"rost tro)et+a)ine
Delay e"isioto)y or la$eration re"air 3or OBGJC to"er3or)#
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@o)"li$ations o3 Delivery7 #@ord !rola"seIn @ord !rola"se7Bi)anual reveals
"al"able "ulsating$ord5levate 3etal "art
redu$e $ord$o)"ression
5,a)iners +ands+ouldRe)ain in ;agina6rans"ortSurgery @:se$ is
indi$ated#Do not atte)"t to
redu$e "rola"sed$ord
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selalu da)"ingi "asien
"asien di)inta untuk)eng+e)buskan na3as
tia" kontraksi untuk )engali+kan
keinginanuntuk )enge(an(angan )en$ega+ kela+iran bayi bila
"e)bukaan suda+ lengka"
u"ayakan lingkungan yangsteril/ase"tike"isioto)i bila di"erlukan
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3-. N/RSIN& !ARE TOPREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1a#Assess Patient 2or an Impen,ing
Precipitos Delivery Sitation#
%* !atient +as "revious obstetri$ +istory o3ra"id labor/delivery#
%9* !atient $o)"lains o3 a sudden- intenseurge to "us+#
%'* In$rease in bloody s+ow#%* Sudden bulging o3 t+e "erineu)#
%.* Sudden $rowning o3 t+e "resenting "art#
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3-. N/RSIN& !ARE TOPREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1b#!all 2or 1elp#
Do not leave t+e"atientunattended#
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3-. N/RSIN& !ARE TO
PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1$#Otain a Sterile Ostetric or
Precipitate Delivery Pac*4 i2 Availale#
%* Gloves : sterile gloves are "re3erred as t+ey+el" "ro)ote ase"sis#
%9* 6owel/$lot+%'* Bulb syringe%* 1e)ostats or $ord $la)"s:to $la)" t+e
u)bili$al $ord#
%.* S$issors:to $ut t+e e"isioto)y/$ord#%* Dry blanket/towel:to wra" t+e in3ant a3ter
delivery
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3-. N/RSIN& !ARE TO
PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1d#Provi,e t5e !leanest Environment i2
Possile%* !a"er- towel- blanket- or $oat to "la$e
under t+e "atients butto$ks#
%9* ?igating )aterial su$+ as string- yarn- ors+oela$es to tie t+e $ord#%'* A s+ar" instru)ent su$+ as s$issors- a
kni3e- or a raLor to $ut t+e $ord#
%* A dry $lot+ to wra" in3ant a3ter delivery#
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3-. N/RSIN& !ARE TO
PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1
e#Provi,e 2or Asepsis to t5e &reatestE6tent Possile#
%* !our BetadineMover t+e "atients"erineu) i3 ti)e does not "er)it 3or
"erineal "re"#%9* Was+ your +ands and glove- i3 "ossible#
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3-. N/RSIN& !ARE TO
PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT13#Spport t5e Patient#%* Kee" t+e "atient in3or)ed o3 "lans 3or
delivery#
%9* S"eak in a $al) tone and "rovide dire$tion
to available assistants %e#g#- signi4$ant ot+er*#%'* 5n$ourage t+e "atient to "ant or blow
t+roug+ $ontra$tions to slow t+e delivery"ro$ess and to de$rease t+e 3or$e o3
e,"ulsion#%* !rovide 3or "riva$y- but do not leave t+e
"atient alone
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3-7 N/RSIN& !ARE FORMANA&EMENT OF PRE!IPITATE
DE"I#ER$a#!5ec* 2or Presence o2 an Intact
Amniotic Sac#
%* I3 t+e )e)branes do not breaks"ontaneously- t+ey s+ould be ru"tured (ust"rior to or wit+ t+e delivery o3 t+e +ead#
%9* @aution )ust be taken to "revent t+e
)e)branes 3ro) $overing t+e in3ants )out+as t+e 4rst breat+ is taken- ot+erwiseas"iration o3 a)nioti$ 2uid $an o$$ur#
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3-7 N/RSIN& !ARE FORMANA&EMENT OF PRE!IPITATE
DE"I#ER$Spport t5e Perinem an, In2ant8s1ea,#
%* A""ly su""ort to t+e "erineu) wit+ yourdo)inant +and %usually rig+t +and* using a
towel or $lot+#%9* A""ly su""ort to t+e 3etal +ead wit+ your
nondo)inant +and#
%'* In$rease t+e "ressure o3 t+e do)inant+and in a downward )otion against t+e"erineu) as t+e 3etal +ead e,tends##% digeser ke bawa+*
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3-7 N/RSIN& !ARE FORMANA&EMENT OF PRE!IPITATE
DE"I#ER$Spport t5e Perinem an, In2ant8s1ea,
%* !rovide )ild downward "ressure wit+ t+enondo)inant +and against t+e 3etal +ead
as t+e 3etal +ead e,tends# % $ega+ e,tensi*
%.*# Neveratte)"t to delay delivery bya""lying "ressure on t+e 3etal +ead#
%* @o)bine e=orts o3 t+e rig+t and le3t+and# 6+is will result in a slow- $ontrollede,tension o3 t+e 3etal +ead#
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3-7 N/RSIN& !ARE FORMANA&EMENT OF PRE!IPITATE
DE"I#ER$$#Assist 9it5 t5e Actal Delivery o2t5e 1ea,#
d#!oac5 t5e Patient to Pant:0lo;#
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3-7 N/RSIN& !ARE FORMANA&EMENT OF PRE!IPITATE
DE"I#ER$e#0l Sction Amniotic Fli, 2rom t5eIn2ant8s Mot5# Or wi"ed by $lean towel#
3#Allo; Rotation Allow t+e in3ant tos"ontaneously a$$o)"lis+ e,ternal
rotation#g#!5ec* 2or a Nc5al /milical !or,#
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3-7 N/RSIN& !ARE FORMANA&EMENT OF PRE!IPITATE
DE"I#ER$+#Allo; In2ant to !omplete E6ternalRotation#
i#!oac5 t5e Patient to Ps5 an, toPant:0lo;%* 6+e nurse a""lies gentle downward
"ressure on t+e +ead until t+e anteriors+oulder delivers 3ro) under t+e "ubi$ ar$+and be$o)es visible#
%9* Su""ort t+e in3ants +ead and ne$k#
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3-7 N/RSIN& !ARE FORMANA&EMENT OF
PRE!IPITATE DE"I#ER$
#Assist ;it5 Delivery o2 t5e Placenta#A$tive )anage)ent o3 'rd"+aseFundal )assageO,yto$in in(e$tion@ord tra$tion
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3-= N/RSIN& !ARE AFTER A
PRE!IPITATE DE"I#ER$a# Assist t+e )ot+er into a $o)3ortable "osition
wit+ +er legs e,tended#b# !rovide a $lean sur3a$e under t+e "atients
butto$ks#$# @+e$k uterine 3undus every 0 to . )inutes
during t+e 4rst +our to assure $ontra$tion o3)yo)etriu) and nor)al lo$+ial 2ow#%* Gently )assage t+e uterus i3 t+e 3undus is
so3t or boggy#%9* Avoid oversti)ulation as )yo)etriu) will
3atigue and result in severe atony#
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