partus spontan dan makrosomia

7/25/2019 Partus Spontan Dan Makrosomia

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2/72

Na+a -ng*a( / Ny.

BHT

J-nis *-a+in /

P-'-+(uan

U+u' / 01 tahun Su*u 2angsa / Bata*

Status (-'*a3inan /

Ka3in 4G$P"A!5

Aga+a / K'ist-n

P-*-'6aan / I2u Ru+ah

Tangga

P-nii*an / SMA

Aa+at / S-ng)n Inah

P-'u+ N). 0%B RT #7

RW #" S-ng)n Bug-,

May)ng, JEPARA

Masu* Ru+ah Sa*it /

!7 M-i "#!% (u*u

!&.07 WIB

Na+a sua+i / TU+u' / 07 TP-*-'6aan / WAa+at / S-ng)

P-'u+ N). 0%B R#" S-ng)n Bug-JEPARA.

IDENTITAS PASIEN


3/72

ANAMNESIS

Aut) ana+n-sis!% M-i "#!%, #8.0#

WIB


4/72

Ri3ayat

P-ny

a*it

S-*a'

ang

Pasi-n atang *- RSMR -ngan *-uha2agian 2a3ah t-'asa ny-'i an +-ng-n9ang s-6a* " ha'i SMRS. +-gata*an ini *-ha+ian yang *

-ngan usia *-ha+ian $# +inggu, )+-+-'i*sa*an *-ha+iannya s-tia( 22ian an *- )*t-'. S-*ita' 0 6a+(asi-n +-ng-uh (-'utnya +uai *-n9ang an +-ng-ua'*an -ni' a'ah

Pasi-n +-ngata*an ha'i (-'ta+at-'a*hi' 8 Agustus "#!7 -ngan ta*si'(-'sainan tangga !7 +-i "#!%. +-ngata*an aanya 2-ng*a* (aa *ausia *-ha+ian 1 2uan. Pasi-n+-ngata*an tia* +-'asa aanya

(using *-(aa, +ua +untah, ny-'i u+ata 2-'*unan an anan an *a2u


5/72


6/72

Hamil Ke

Usiakehamil

an

Jenispersali

nan

Penyulit

Penolong

Jeniskelami

n

BB /TB

lahir

! 01+inggu

S()ntan ; Bian P-'-+(uan

08##g'

" $

+inggu

A2)'tus ; D)*t-' ; ;

0 01+inggu

S()ntan ; Bian P-'-+(uan

$8##g'


7/72

Os tia* +-+ii*i 'i3ayat t-*a'ah tinggi, (-nya*it 6antun

*-n9ing +anis, as+a an a- Os tia* +-+ii*i 'i3ayat )(s-2-u+nya

Ri3ayat

P-nya*itDahuu

Tia* aa angg)ta *-ua'ga

+-n-'ita 'i3ayat t-*anan tinggi, (-nya*it 6antung, *-n+anis, as+a an a-'gi.

Ri3ayatP-nya*itK-ua'ga


8/72

P-+-'i*saan 1# ++Hg

Nai / 8$?>+-nit P-'na:asan / "#?>+-nit Suhu / 0%,1)= Mata / K)n6ungti@a an-+is ;>; , S*-'a i*t-'i* ;>; T-inga / tia* ta+(a* *-ainan Hiung / tia* ta+(a* *-ainan

Muut>gigi / tia* ta+(a* *-ainan -h-' / tia* ta+(a* (-+2-sa'an KGB an ti')i Jantung / BJ I;II '-gu-' +u'ni, ga)( 4;5, +u'+u' 4;5 Th)'a* / Sua'a na(as asa' @-si*u-', ')n*hi ;>;,

3h--ing ;>; A2)+-n / Ta+(a* s-suai usia *-ha+ian, 2-*as

)(-'asi a(a'at)+i 4;5, BU 45 ; ;


9/72

K--n6a' g-tah 2-ning

Su2+ani2ua / tia* it-+u*an (-+2-sa'an

Su('a*a@i*ua / tia* it-+u*an (-+2-sa'an i(at (aha / tia* it-+u*an (-+2-sa'an -h-' / tia* it-+u*an (-+2-sa'an K-tia* / tia* it-+u*an (-+2-sa'an

As(-* *-6i3aan

Ting*ah a*u / T-nang Aa+ (-'asaan / 2iasa P')s-s (i*i' / 3a6a'


10/72

PEMEIKSAAN !BSTET Ins(-*si

Wa6ah / =h)as+a g'a@ia'u+4;5

Payua'a / (-+2-sa'an (ayua'a45, hi(-'(ig+-ntasi a-')a+a++a- 45, (uting susu+-n)n6), ASI 4;5

A2)+-n/ Ins(-*si / Ta+(a* s-suai usia

*-ha+ian, in-a nig'a 45, st'i-g'a@ia'u+ 45, 2-*as )(-'asi4;5

DJJ !$# ?>+-nit, His 456a'ang, 2-u+ a-*uatP-+-'i*saan ua'

Pa(asi /T


11/72

PEMEIKSAAN !BSTETI

Pemeriksaan Hasil Satua Nilai


12/72

PEMEIKSPENUNJA

Pemeriksaan Hasil Satua

n

Nilai

NormalPemeriksaan#arah lengkap

Hemoglo$in%

!#.8 g> !!.1;!7.7

%eukosit &.0! !#0>u 0.%;!!.#

&I'' (!UNT

Eosino)l !.1# F !;0

Baso)lia #.0# F #;!

Neutro)liaH

1#.%# F 7#;1#

%im*osit%

!&.7# F "7;$#

Monosit %.!# F ";8

%u+ , !.!# F !;$

M(-%

1& : 8#;!##

M(H "1 Pg "%;0$

M(H( 0$ g> 0";0%

Hematokrit%

0".!# F 0%;$%

Trom$osit "!0 !#0>u !7#;$##

Eritrosit $.! !#%>u 0.8#;7."#

Pemeriksaan Hasil Sa

"olongan

&arah 5

hesus

"olongan

&arah

B

hesus P)siti:HemostasisPem$ekuan /

(T

7.## M-

Per#arahan /

BT

!.0# M-

Imunoserolog


13/72

R-su+-Wanita, 01 tahun, GICPIIAI ha+i $# +inggu, atang *-

-ngan *-uhan (-'ut 2agian 2a3ah t-'asa ny-'i +-ng-n9ang s-6a* " ha'i SMRS. Os +-ngata*an ini *-ha

*--+(at. K-ha+ian (-'ta+a ahi' s()ntan i 2ian tan+asaah. Os +-ngata*an (-'nah *-gugu'an (aa *-ha+saat usia *-ha+ian ! 2uan an ia*u*an *u'-t. K-ha+ahi' s()ntan i 2ian tan(a aanya +asaah na+un )s +2-'at ahi' ana* *-tiga $8## g'a+. K-ha+ian *--+(at si(-'i*sa s-tia( 2uan i 2ian. Os +-ngata*an aany

(aa *a*i s-6a* usia *-ha+ian 1 2uan. Ri3ayat hai +-ngata*an HPHT 8 Agustus "#!7, -ngan HP !7 M-i "#usia *-ha+ian $# +inggu. Paa (-+-'i*saan si* )2st-t'i* ia(at*an, Ins(-+-+2un9it +-+an6ang, s-suai usia *-ha+ian, st'ia- 45, in-a nig'a 45, st'ia- i@i- 4;5, st'ia- a2i9ans 4;5. Pa:unus ut-'i 07 9+, -)() I/ t-'a2a 2agian 2uat,


14/72

DIAGNOSIS


15/72

APORAN PERSAINAN

Pukul 41074 Pukul 34084 Pukul 3409:

S / (-'ut t-'asa *-n9ang S/ P-'ut t-'asa *-n9ang, 'asaingin +-ng-6an

!/KU / ta+(a* sa*it 'inganK-saa'an / 9)+()s

+-ntisTD / !"#>8#N / 8" ?>+-nitRR / "# ?>+-nitDJJ / !0% ?>+-nitHis / " ?>!# +-nit 4"7-ti*5CT /

P-+2u*aan / 8 9+KK 45, E 17 FP)'ti) / una*H)g- / IIP)int ): i'-9ti)n /UUK

! ;KU / ta+(a* sa*it 'inganK-saa'an / 9)+()s +-ntis

TD / !"#>8#N / 88 ?>+-nitRR / "# ?>+-nitDJJ / !$# ?>+-nitHis / " ?>!# +-nit 4"7 -ti*5CT /

P-+2u*aan / -ng*a(KK 4;5

P)'ti) / una*H)g- / IIIP)int ): i'-9ti)n / UUK

Pi+(in +-ng-6ansaat aa his

Pa'tus s()ntan

E(isi)t)+i+-i)at-'a

Bayi a*i;a*i, BB$87# g'a+, PB7$ 9+, A(ga's9)'- &;!#;!#

In:us D7F )*sit)sin ! a+(

P+

J

H B P

A ; GICPIIAI 01

tahun,ha+i $# +ingguAna* ! hiu(

A ; GICPIIAI 01 tahun ha+i $#

+ingguAna* ! hiu( int'aut-'in-

a()

P-'sa


16/72


17/72

'!%%!


18/72

PROGNOSIS

P)3-' / 2)na+

Passag- / 2)na+

Pass-ng-' / 2)na+


19/72

TINJAUAN PUSTAKA

Pa'tus s()n

Ma*')s)+ia


20/72

PESA%INAN N!MA%

&e)nisiP-'sainan aaah (')s-s +-+2u*a an +-ni(isnya s-'@i*s

tu'un *-aa+ 6aan ahi'.P-'sainan n)'+a aaah (')s-s (-ng-ua'an 6anin yang t-

*-ha+ian 9u*u( 2uan 401;$" +inggu5, ahi' s()ntan -ng('-s-ntasi 2-a*ang *-(aa yang 2-'angsung aa+ !8 6a+*)+(i*asi 2ai* (aa i2u +au(un (aa 6anin.

P-'sainan an *-ahi'an n)'+a aaah (')s-s (-ng-ua'an 6t-'6ai (aa / *-ha+ian 01;$# +inggu

ahi' s()ntan -ngan (-'s-ntasi 2-a*ang *-(aa 2-'at 2aan anin "7##;$### 'a+


21/72

Ma9a+; +a9a+ (-'sainan +-nu'ut Manua2a 4"#P-'sainan s()ntan / 2ia (-'sainan s-u'uhny

2-'angsung -ngan *-*uatan s-ni'i.P-'sainan 2uatan / 2ia (-'sainan -ngan 2

t-naga a'i ua'.P-'sainan an6u'an / 2ia *-*uatan yang i(-'

untu* (-'sainan iti+2u*an a'i ua' -ngan 6a'angsangan.

PESA%INAN N!MA%

A2 t


22/72

A2)'tus B-'a*hi+ya *-ha+ian s-2-u+ 6anin a(at hiu( i uni

u+u' *-ha+ian *u'ang a'i "# +inggu an 2-'at 6anin *ug'a+.

P-'sainan i+atu'us B-'a*hi+ya *-ha+ian s-2-u+ 6anin hiu( i unia

*-ha+ian *u'ang a'i "8 +inggu.P-'sainan ('-+atu'itas P-'sainan s-2-u+ u+u' *-ha+ian 01 +inggu an

*u'ang a'i atau sa+a -ngan "$&& g'a+.

P-'sainan at-'+ P-'sainan anta'a u+u' *-ha+ian 01 +inggu sa+(

an 2-'at 6anin -2ih a'i atau sa+a -ngan "7## g

P-'sainan s-')tinus P-'sainan +-ain(aui u+u' *-ha+ian $" +inggu a

t-'a(at tana ()st+atu'itas.

P-'sainan ('-si(itatus/ P-'sainan yang 2-'angsung 9-(at, *u'ang a'i 0 6a+.


23/72

PERSAINAN DIPENGARUHIOEH /

POWER His, t-naga +-ng-6an>+-n

PASSAGE U*u'an (anggu

PASSENGER U*u'an *-(aa, 2ayi, an ('-s-ntasi 2ayi, -ta* (as-nta.


24/72

P!.E

HIS His (-'sainan *)nt'a*si si))gis )t)t;)t)t 'ahi+. K)n

'ahi+ 2-'si:at aut)n)+, tia* i(-nga'uhi )-h *-+auana(at 6uga i(-nga'uhi )-h 'angsangan a'i ua'.

K)nt'a*si 'ahi+ 2-'si:at 2-'*aa an yang ha'us i(-'hats-2agai 2-'i*ut /a+anya *)nt'a*si / (aa (-'+uaan (-'sainan his ti+aa+ !# +-nit, (aa *aa (-ng-ua'an s-*ai aa+ " T-naga +-ng-6an > +-n-'an / 6i*a (-+2u*aan suah --:-*ti: s-3a*tu *)nt'a*si 'ahi+.


25/72

PASSA"EPANGGU

Panggu gin-*)i

Pangguant'h)()i

Panggu an')i

PangguPati(-)ia

Panggu gin-*)i


26/72

Panggu gin-*)iPaing 2anya* (aa 3anita n)'+a. $7F

3anita

Panggu ant'h)()i2-'2-ntu* )n6)ng s-(-'ti t-u'. 07 F

3anita

Panggu an')i(anggu s-(-'ti a*i;a*i. S-(-'ti s-gitiga,'uangan untu* (-nu'unan *-(aa t-'2atas.S(ina is*iai*a +-n)n6) *- aa+ 6aan

ahi' an (intu 2a3ah (anggu +-nun6u*ansuatu a'*us (u2is yang +-ny-+(it. !7F3anita.

Panggu Pati(-)ia 7F 3anita. (-+-n-*an a'i ia+-t-'

ant-'); ()st-'i)', s-2ai*nya ia+-t-'

t'ans@-'sa -2a'.


27/72

BIDANG HODGEH)g- t-ah +-n-ntu*an 2-'a

*hayaan aa+ (anggu /H I Biang yang i2-ntu*

ing*a'an PAP gn 2agian ata

H II S-6a6a' -ngan H I +-(inggi' 2a3ah sy+(hysis

H III Biang ini s-6a6a' -n

H)g- I an II, t-'-ta* s-tingis*iai*a *anan an *i'i

H IC S-6a6a' H I, II, III, t-'-s-tinggi )s 9)99ygis


28/72

PASSEN"E

Ma*')s)+ia, hi')9-(haus, *-ainan*)ng-nita,-ta* intang>sungsang, ('+u*a, an ain;ain

Aa(un (-'u2ahan yang t-'6ai (aaahi' saat (-'sainan 2-'angsung s-22-'i*ut / K-aaan s-g+-n atas an s-g+-n

'ahi+ (aa (-'sainan


29/72

TANDA PERSAINAN

Ti+2u 'asa sa*it his yang atang -2ih *uat, s-'ing, an t-'atu'.K-ua' -ni' 2-'9a+(u' a'ah 42))y sh)35 yang -2ih 2anya* *a'-na ')

s-'@i*s.

T-'*aang *-tu2an (-9ah -ngan s-ni'inya. P-+-9ahan +-+2'an yang n)

*aa I (-'sainan. Ha ini t-'6ai (aa !"F 3anita, an -2ih a'i 8#F 3ani

(-'sainan s()ntan aa+ "$ 6a+.

Paa (-+-'i*saan aa+ / s-'@i*s +-nata' an (-+2u*aan t-ah aa.

Nui(a'a, s-2-u+ (-'sainan 7#;%#F (-ni(isan s-'@i*s an (-+2u*aan s

-ngan i+uainya (-'sainan (-ni(isan s-'@i*s 7#;!##F, *-+uian t-'6a

Muti(a'a tia* t-'6ai (-ni(isan s-'@i*s (aa a3a (-'sainan, t-ta(i han

9+. S-'ing*ai s-'@i*s a*an +-+2u*a *-+uian it-'us*an -ngan (-ni(isa

K)nt'a*si ut-'us +-nga*i2at*an (-'u2ahan (aa s-'@i*s 4:'-*u-nsi +ini+a

+-nit5.


30/72

MEKANISME PESA%INAN!MA%

Pa'tus i2agi +-n6ai $ *aa. Kaa I / 3a*tu untu* (-+2u*aan s-'@i*s sa+(ai

+-n6ai (-+2u*aan -ng*a( !# 9+,is-2ut *aa(-+2u*aan.

Kaa II / Kaa (-ng-ua'an 6anin, 3a*tu ut-'us -nga

*-*uatan his ita+2ah *-*uatan +-ng-an +-n)6anin *-ua' hingga ahi' Kaa III / Batasan i+uai s-t-ah ahi'nya 2ayi an

2-'a*hi' -ngan ahi'nya (as-nta. Kaa IC / " 6a+ s-t-ah (as-nta ahi' -ng*a(


31/72

KAA I

Ti+2u his an *-ua' -ni' a'ah yang 2-'asa as-*ita' *anais s-'@i*ais (-9ahPaa ('i+ig'a@ia )stiu+ ut-'i int-'nu+ a*an+-+2u*a -2ih ahuu, s-hingga s-'@i*s a*an+-nata' an +-ni(is, 2a'u *-+uian )u- +-+2u

Paa +utig'a@ia )u- an )ui suah s-i*it +-+2P-ni(isan an (-nata'an s-'@i*s t-'6ai 2-'sa+aa


32/72

P')s-s +-+2u*anya s-'@i*s i2agi " :as-.


33/72

KAA II

Kaa (-ng-ua'an 6anin, 3a*tu ut-'us -ngan *-his ita+2ah *-*uatan +-ng-an +-n)')ng 6a*-ua' hingga ahi'

His +-n6ai -2ih *uat an -2ih 9-(at, *i'a;*i'a +-nit s-*ai

His i'asa*an t-*anan (aa )t)t;)t)t asa' (angyang s-9a'a '--*t)'is +-ni+2u*an 'asa +-ng

Gtana in(a'tu *aa II / i2u ingin +-ng-6an, P-'in+-n)n6), a2ia +uai +-+2u*a, *-(aa 6anin ta

aa+ @u@a (aa 3a*tu his


34/72

KA%A III S-t-ah 2ayi ahi', ut-'us t-'a2a *-'as -ngan :unus ut-

s-i*it iatas (usat. Biasanya (as-nta -(as aa+ % !7 +-nit s-t-ah 2ayi

ahi' an *-ua' s()ntan atau -ngan t-*anan (aa :unut-'i.

Tana tana -(asnya (as-nta / P-'u2ahan u*u'an an

2-ntu* ut-'us, Tai (usat +-+an6ang, s-+2u'an a'ah ti ti2a

=atatan /Ji*a (as-nta 2-u+ ahi' aa+ !7 +-nit , a(at i2-'i*a)*sit)sin !# unit IM )sis *-ua an uangi PTTJi*a *anung *-+ih t-'a2a (-nuh, 2isa ia*u*an


35/72

KA%A I-

P-nataa*sanaaan / a*u*an +asas- :unus ut-'i E@auasi tinggi :unus 4 n)'+anya :unus ut-'i s-tinggi (

atau i2a3ahnya , +isa " 6a'i i2a3ah (usat 5 P-'i*sa (as-nta an s-a(utnya untu* +-+asti*an *-u

-ng*a( an utuh

P-'i*sa *-hiangan a'ah s-9a'a *-s-u'uhan P-'i*sa (-'in-u+ an (-'a'ahan a*ti: 4 a(a2ia aa as-

-(isi)t)+i 5 E@auasi *)nisi u+u+ i2u D)*u+-ntasi*an s-+ua t-+uan an (-nataa*saan *aa

i2-a*ang (a't)g'a:


36/72

S-a+a (')s-s (-'sainan, 6anin +-a*u*an s-'ang-'a*an untu* +--3ati (anggu ;seven cardinmovements of labor yang t-'i'i a'i /

!. Engag-+-n".


37/72


38/72

EN"A"EMEN

Suatu *-aaan i+ana ia+-t-' 2i(a'i-ta su+--3ati (intu atas (anggu.Paa 1#F *asus, *-(aa +asu* (intu atas (ani2u (aa (anggu 6-nis gin-*)i -ngan )*s+-intang 4t'an@-'sa5

P')s-s -ngag-+-n *-aa+ (intu atas (ana(at +-aui (')s-s normal sinklitismusasinklitismus anterior dan asinklitismus posterior.


39/72

ASINKLITISMUS ANTERIOR

Sutu'a sagitais -2ih -*at *-a'ah sa9'u+. Asin*itis+u-'a6at s-ang (asti t-'6ai (aa (-'sainan n)'+a, na+6i*a -'a6at 2-'at, g-'a*an ini a(at +-ni+2u*an is(')s-:a) (-@i* (aa (anggu yang 2-'u*u'an n)'+a s-*a


40/72

ASINKLITISMUS POSTERIORSutu'a sagitais -2ih -*at *-a'ah si+s(u2is (parietal one presentasion! posisi "erla$anan den#an asinklitismus anterior


41/72

'%EKSI

G-'a*an -*si t-'6ai a*i2at aanya tahanan sining (anggu an )t)t asa' (anggu.


42/72

&ESENSUS < PENUUNAKEPA%A =

Paa nui(a'a, -ngag-+-n t-'6ai s-2-u+ intia* 2-'an6ut sa+(ai a3a *aa IIL (aa -s-nsus 2-'angsung 2-'sa+aan -ngan iatas

P-ny-2a2 t-'6ainya -s-nsus /!.T-*anan 9ai'an a+ni)n".T-*anan angsung )-h :unus ut-'i (aa 2)*)n0. Usaha +-n-'an i2u$. G-'a*an -*st-nsi tu2uh 6anin 4tu2uh 6anin +-n6


43/72


44/72


45/72

PUTA PAKSI &A%AM2INTENA% !TATI!NB-'sa+a -ngan g-'a*an -s-nsus, 2agiat-'-nah 6anin +-ngaa+i (uta' (a*si aa(aa -@- s-tinggi s(ina is9hiai9a 42iant-ngah (anggu5.

K-(aa 2-'(uta' a'i ()sisi t'an@-'sa +-n()sisi ant-'i)' 4*aang;*aang *-a'ah()st-'i)'5.

PUTA PAKSI &A%AM


46/72

Paa ('-s-ntasi 2-a*ang *-(aa, 2agian yang t-'-nah a

u2un;u2un *-9i an 2agian iniah yang a*an +-+uta' *

2a3ah si+sis. Puta'an (a*si aa+ +uta* i(-'u*an un

*-(aa, *a'-na (uta'an (a*si +-'u(a*an suatu u

+-ny-suai*an ()sisi *-(aa -ngan 2-ntu* 6aan ahi', *hus

2iang t-ngah an (intu 2a3ah (anggu0 Puta'an (a*si t-'6ai t-'s-ni'i, t-ta(i s-au 2-'sa+aan -ngan +a6unya

tia* t-'6ai s-2-u+ *-(aa sa+(ai *- H)g- III *aang;

t-'6ai s-t-ah *-(aa sa+(ai i asa' (anggu

Puta' (a*si 2iasanya 2-'a*hi' s-t-ah *-(aa +-n9a(ai asa'

PUTA PAKSI &A%AM2INTENA% !TATI!N


47/72

PUTAAN PAKSI &A%AM


48/72

PUTAAN PAKSI &A%AMSEBABS-2a2;s-2a2 (uta'an (a*si aa+ ya*ni/Paa -ta* -*si, 2agian 2-a*ang *-(aa +2agian t-'-nah a'i*-(aa.Bagian t-'-nah *-(aa ini +-n9a'i tahanan yas-i*it, yaitu is-2-ah -(an atas t-+(at t-'hiatus g-nitais anta'a anta'a +us9uus-@at)an *anan.U*u'an t-'2-sa' a'i 2iang t-ngah (anggia+-t-' ant-')()st-'i)'.


49/72

EKSTENSI

Puta'an (a*si s--sai *-(aa sa+(ai i asat-'6aiah -*st-nsi atau --*si *-(aa, s-2a2 /su+2u 6aan ahi' (aa (intu 2a3ah (anggu +--(an an *- atas s-hingga *-(aa ha'us +-*st-nsi untu* +-auinya. Kaau tia* t-'6ai -*st-

a*an t-'t-*an (aa (-'in-u+ an +-n-+2usnya. Pa2-*-'6a ua *-*uatan yang satu +-n-sa*nya *- 2yang satunya is-2a2*an )-h tahanan asa' (an+-n)a*nya *- atas. *-*uatan *- a'ah -(an atas

PUTA PAKSI %UA


50/72

PUTA PAKSI %UA2E>TENA% !TATI!N

S-t-ah *-(aa ahi', t-'6ai (uta' (a*si ua' 4'-st+-ny-2a2*an ()sisi *-(aa *-+2ai (aa ()sisi saat t-'6ai aa+ 6aan ahi'. B-a*ang *-(aa ana* +-+uta'a'ah (unggung ana* untu* +-nghiang*an t)'si (aa t-'6ai *a'-na (uta'an (a*si aa+ (uta'an '-stitu

2aasan / (uta'an (a*siua'5.S-an6utnya (uta'an ian6ut*an hingga 2-a*ang *-(aa -ngan tu2-' is9hiai9u+ s-sisi (uta'an (a*si s-2-na'nya an is-2a2*an *a'-na u*u'an 2ahu +-n-+aa+ ia+-t-' ant-')()st-'i)' (intu 2a3ah (anggu.


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EKSPU%SI

S-t-ah (uta'an (a*si ua', 2ahu -(an s2a3ah si+sis an +-n6ai hi()+)*i)*-ahi'an 2ahu 2-a*ang. K-+uian 2ah+-nyusu an s-an6utnya s-u'uh 2a

ahi' s-a'ah -ngan (a*si 6aan ahi'.Bahu ant-'i)' a*an +-ngaa+i (uta' (a*s-6auh $7# +-nu6u a'9us (u2is s-2-u+ ai2a3ah si+sis.


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EPISIOTOMID-nisi /

Suatu tina*an insisi (aa (-'in-u+ yang +-ny-2t-'()t)ngnya s-a(ut -ni' @agina, 9in9in s-a(ut a'a, 6a(aa s-(tu+ '-*t)@agina, )t)t;)t)t an :as-a (-'in-u+ as-2-ah -(an (-'in-u+


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EPISIOTOMI

Ini*asi 6anin /

; S-3a*tu +-ahi'*an 6anin ('-+atu' ;9-gah t-'6at'au+a yang 2-'-2ihan (aa *-(aa 6anin

; -ta* sungsang, +-ahi'*an 6anin -ngan 9una+, -*s@a*u+ 6anin 2-sa'

Ini*asi i2u

P-'-gangan (-'in-u+ yang 2-'-2ihan s-hingga ita*utt-'6ai ')2-*an (-'in-u+ atau 'u(tu' (-'in-u+.


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EPISIOTOMI MEDIAISPaa t-*ni* ini insisi i+uai a'i u6ung t-'2a3ah int')itus @agina sa+(ai 2atas atas

)t)t sngt-' aniK-untungan /

P-'a'ahan -2ih s-i*it s*t PD

(-n6ahitan *-+2ai -2ih +uah (-ny-+2uhan -2ih +-+uas*an.

Tia* a*an +-+(-nga'uhi *-s-i+2angan )t)t i*anan *i'i asa' (-@is

Muah s-+2uh, *'n 2-*as insisi +uah i'a(at*an

Tia* 2-gitu sa*it (aa +asa ni:as Dis(a'-uni 6a'ang t-'6ai

K-'ugian /

P-'uasan as-'asi *- sngt-' ani atau as-'asi +-n6ang*au hingga '-*tu+ 4as-'asi

'-*tu+5

EPISIOTOMI MEDIOATERA


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EPISIOTOMI MEDIOATERA

Sayatan yang i 2uat a'i ga'ist-ngah *-sa+(ing +-n6auhianus , i+uai a'i u6ungt-'2a3ah int')itus @agina+-nu6u *- 2-a*ang sa+(ing*i'i atau *anan it-ngah anta'a

s(ina is9hiai9a anusK-untungan / -2ih *-9i*-+ung*inannya +-n9a(ai )t)tsngt-' ani an '-*tu+

K-'ugian /

; P-'a'ahan u*a -2ih 2anya* PD

; Ot)t;)t)t (-'in-u+ t-'()t)ng ; (-n6ahitan u*a -2ih

an a+a

; Insisi at-'a a*an +-ny-2a2*an ist)'si 4(

*-s-i+2angan asa' (-@is.

; Ot)t )t)tnya aga* -2ih suit untu* isatu*an

4a()sisinya suit5, s-hingga t-'2-ntu* 6a'ingan (a'ut

2ai*

; Rasa ny-'i (aa s-(-'tiga *asus s-a+a 2-2-'a(a ha'

*aang ii*uti is(a'-uni 4ny-'i saat 2-'hu2ungan5

EPISIOTOMIATERAIS


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ATERAIS

Paa t-*ni* ini insisi ia*u*an *- a'ah at-'a +uai a'i *i(aa 6a+ 0 atau & +-nu'ut a'ah 6a'u+ 6a+

u*a insisi ini a(at +--2a' *- a'ah i+ana t-'a(at (-+a'ah (un-na int-'na, s-hingga a(at +-ni+(-'a'ahan yang 2anya*. S-ain itu (a'ut yang t-'6ai +-ni+2u*an 'asa ny-'i yang +-ngganggu (-n-'ita


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MAKROSOMIA

Bia 2-'at 2aan 2ayi +--2ihi $### g'a+ atau -2ih tan(a+-+anang usia *-ha+ian.

Insi-n ia2-t-s (aa i2u +-ning*at s-i'ing -ngan+-ning*atnya 2-'at 2aan ahi' +--2ihi $### g'a+.

Dianta'a 6anin +a*')s)+i* a'i 3anita (-ngia( ia2-t-s,

t-'a(at (-ning*atan ing*a' 2ahu yang *)ns-*u-nsinya a(-ning*atan '-si*) ist)sia 2ahu (aa (-ahi'an (-'@agina+


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DIAGNOSIS

tia* a(at it-ga**an hingga 2ayi iahi'*an an iti+2ang2aannya.

s2+ 2ayi ahi', a(at ia*u*an (-'*i'aan untu* +-ngantiat-'6ainya ist)sia 2ahu, :'a*tu' *a@i*ua, atau 9--'a (-*s2'a*iais.

B-'at 6anin

-ngan +-niai +-niai :a*t)' '-si*) i2u,(-+-'i*saan *inis, atau (-+-'i*saan USG 'u+us 6)hns)n


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ETIOOGI G-n-ti*, )2-sitas an )@-'3-ight yang iaa+i ayah i2u a(at +-nu

2ayi. P-'ta+2ahan 2-'at 2aan i2u yang 2-'-2ihan s-a+a *-ha+ian, ()

yang i*)nsu+si i2u ha+i a*an 2-'(-nga'uh (aa 2-'at 2aan i2u.

yang 2-'-2ih 2isa +-nga*i2at*an 2ayi ahi' -ngan 2-'at iatas 'at

I2u -ngan ia2-t-s +-itus, tingginya gua a'ah i2u 2isa 2-'(-nga

2-'at 2aan 2ayi. Ji*a :ungsi (as-nta an tai (usat 2ai*, +a*a 6anin

tu+2uh +a*in su2u'. I2u ha+i -ngan 'i3ayat +-ahi'*an 2ayi +a*')s)+ia, i2u yang s-2

(-'nah +-ahi'*an 2ayi +a*')s)+ia 2-'-si*) 7;!# *ai -2ih tinggi u

+-ahi'*an 2ayi +a*')s)+ia i2aning*an i2u yang 2-u+ (-'nah +

2ayi +a*')s)+ia.

Mutig'a@ia, aa *-9-n-'ungan 2-'at 2aan ahi' ana* *-ua an


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PENANGANAN

Bia t-'a(at s-:a)(-@i* is()'()'si, ian6u'*an s-9ti) 9a-sa'ia.

Bia suit +-ahi'*an 2ahu an 6anin hiu( ia*u*-(isi)t)+i yang 9u*u( untu* -2a' an 6aniniusaha*an ahi', atau 2ahu i(-'*-9i -ngan

+-a*u*an *-i)t)+i uniat-'a atau 2iat-'a. S-iahi'*an i6ahit *-+2ai -ngan 2ai* an untu*9--'a ()st*-i)t)+i i*)nsu*an *- 2agian 2-

A(a2ia 6anin +-ningga, ia*u*an -+2'i)t)+i.


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KOMPIKASI

Pa#a I$u I2u +-ngaa+i ')2-*an

(-'in-u+ P-'sainan -ngan

)(-'asi 9a-sa'ia

K-hiangan a'ah aa+6u+ah 2anya* saat(-'sainan

Ru(tu' ut-'i an s-'@i*s

Pa#a Bayi

Bayi a*an ahi' -ngan

na:as an *aang*aa

-ngan t'au+a tuang 2ahu.

Dist)sia atau +a9-t (a

Hi()gi*-+ia

Hi()gi*-+ia iguna*a

gua a'ah 2ayi i2a3a

'ata;'ata. Di*ata*an hi

a(a2ia *aa' gu*)sa

a'i 0# +g> (aa s-+

n-)natus tan(a +-nia

g-stasi atau aa tia*n


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PEN=EGAHAN

P-ni+2angan 2-'at 2aan i2u s-9a'a t-'atu' an AN= yI2u ha'us s-au +-n6aga 2-'at 2aannya aga' t-ta(

ha+i, s-2ai*nya +-a*u*an (-ngatu'an ()a +a*-2utuhan *a)'i. Ma*anan 'ingan i(-'2)-h*an hina'i 9-+ian +anis

Oah'aga 'ingan. M-nu'ut (-n-itian yang ia*u*an )

a'i N)'3-gia +-ny-2ut*an, '-si*) 2ayi ahi' -ngan u2isa 2-'*u'ang hingga "8F 2ia i +asa *-ha+ia2-')ah'aga s-9a'a t-'atu' (aa t'i+-st-' ua an tiga

I2u ha+i h-na*nya +-+-'i*sa*an *aa' gua+-s*i(un s-2-u+nya tia* aa ia2-t-s +-itus.


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PROGNOSIS

Paa (anggu n)'+a 6anin -ngan 2-'at 2aan$###;$7## g'a+ u+u+nya tia* +-ni+2u*an*-suitan aa+ (-'sainan. Dist)sia a*an i(-')2ia 6anin -2ih 2-sa' a'i(aa $7##;7### g'a+ (aa *-(aa yang suah *-'as 4()st+atu'itas5

(aa 2ahu yang -2a'. A(a2ia is()'()'sis-:a)(-@i* i2ia'*an a*an t-'6ai *-suitan 2ai*(aa i2u +au(un (aa 6anin.

MANUA PASENTA


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MANUA PASENTA


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O(-'at)' 2-'i'i atau uu* ihaa(an @u@a -ngan saah satu tan

*i'i5 +-'-gang tai (usat, tangan yang ain 4tangan *anan5 -ngan 6

i* * 2 * *


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i*un9u(*an +-+2-ntu* *-'u9ut.

D-ngan u6ung 6a'i +-n-usu'i tai (usat sa+(ai (as-nta 2ia t-'

'ing, +-ng-+2ang*an s-9a'a (-'ahan;ahan 6a'i tangan yang +-+

tai.

tangan *i'i i-ta**an i atas :unus ut-'i a'i ua' ining (-'ut i2

+-nahan atau +-n)')ng :unus itu *- 2a3ah.

Tangan yang i aa+ sa+(ai *- (as-nta, t-usu'iah (-'+u*aan :-

(inggi' (as-nta. Paa (-'a'ahan *aa tiga, 2agian (inggi' (as-nt

M-aui 9-ah t-'s-2ut, s-i(*an 2agian una' a'i tangan yang 2-'a

anta'a ining ut-'us -ngan 2agian (as-nta yang t-ah t-'-(as i D-ngan g-'a*an tangan s-(-'ti +-ngi*is ai', (as-nta a(at i-(a

4*aau +ung*in5, s-+-nta'a tangan yang i ua' t-ta( +-nahan :un

su(aya 6angan i*ut t-')')ng *- atas.

D-ngan -+i*ian, *-6aian ')2-*an ut-'us 4(-':)'asi5 a(at ihina

Pas-nta 2-'hasi i*-ua'*an -*s()'asi 4aanya 2agian ining

s)2-* atau 2agian (as-nta yang t-'sisa5

KOMPIKASI


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KOMPIKASI

Muti(- )'gan :aiu'- yang 2-'hu2ungan -nga*)a(s si'*uasi an (-nu'unan (-':usi )'gan s-(sis (as-nta a*'-ta hist-'-*t)+i +-ngang*at sisa (as-nta aa+ ut-'us.

ROBEKAN PERINEUM


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ROBEKAN PERINEUM

Eti))gi /

R)2-*an (aa (-'in-u+ u+u+nya t-'6ai (aa(-'sainan i+ana /

!. K-(aa 6anin t-'au 9-(at ahi'

". P-'sainan tia* i(i+(in s-2agai+ana +-stin0. S-2-u+nya (aa (-'in-u+ t-'a(at 2anya*

6a'ingan (a'ut

$. Paa (-'sainan -ngan ist)sia 2ahu

JENIS > TINGKAT


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JROBEKAN

R)2-*an (-'in-u+ a(at i2agi +-n6ai $ ting*at

!.Ting*at ! / R)2-*an hanya t-'6ai (aa s-a(ut @agina -ngan atau tan(a +-ng-nai *uit (-'inu9utgut, s-9a'a 6-u6u' gn gu'- ): -ight

".Ting*at " / R)2-*an yang t-'6ai -2ih aa+ yai+-ng-nai s-a(ut -ni' @agina 6uga +-ng-nai +

(-'in-i t'ans@-'sais, ta(i tia* +-ng-nai sngt-'ata*an (inggi' yang 2-'g-'igi, 9utgut s-9a'a

6-u6u'>t-'(utus;(utus.0.Ting*at 0 / R)2-*an yang t-'6ai +-ng-nai s-u'

(-'in-u+ sa+(ai +-ng-nai )t)t )t)t sngt-' a


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KESIMPUAN


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KESIMPUANP-'sainan n)'+a aaah (')s-s (-ng-ua'an 2uah *-ha

2uan yang +-n9a*u( (-ng-ua'an 2ayi, (as-nta *-tu2an, -ngan ('-s-ntasi *-(aa a'i 'ahi+ i2u +-a-ngan t-naga i2u s-ni'i.

Kaa I (-'sainan i+uainya (')s-s (-'sainan yang itaaanya *)nt'a*si yang t-'atu', a-*uat an +(-'u2ahan (aa s-'@i*s hingga +-n9a(ai (-+2u*aan -ng

Kaa II (-'sainan i+uai *-ti*a (-'u2ahan s-'@i*s suah 2-'a*hi' -ngan ahi'nya 2ayi. Kaa ua 6uga i*-na (-ng-ua'an

Kaa II (-'sainan i+uai s-t-ah ahi'nya 2ayi an -ngan ahi'nya (as-nta an s-a(ut *-tu2an

*aa IC (-'sainan i+uai s-t-ah ahi'nya (as-nta an

partus spontan dan makrosomia

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