Distosia Bahu final
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Transcript of Distosia Bahu final
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Definisi
• Bahu depan tidak dapat lahir akibat tertahan di simfisis pubis.
• Ketidakmampuan melahirkan bahu pada persalinannormal.
Insidens
• 1 - 2 per 1000 kelahiran.
• Insiden meningkat 5-7% pada berat bayi > 4000 gr dan menigkat 8-10% pada berat bayi > 4500 gr.
DISTOSIA BAHU KEADAAN YANG TIDAK DAPAT DIDUGA SEBELUMNYA
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PRINSIP DISTOSIA BAHU
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Komplikasi Distosia bahu
• Bayi
- Kematian
- Asfiksia dan komplikasinya
- Fraktur - klavikula, humerus
- Kelumpuhan pleksus brakialis
• Ibu
- Perdarahan postpartum
- Ruptur uteri
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Faktor risiko
• Kehamilan lewat waktu
• Obesitas pada ibu
• Bayi makrosomia
• Riwayat distosia bahu sebelumnya
• Partus dengan bantuan cunam/vakum
• Persalinan lama
• Diabetes yang tidak terkontrol
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Diagnosis
• Kepala bayi melekat pada perineum sepertikepala kura-kura (‘turtle’ sign)
• Putaran paksi luar tidak terjadi
• Gagal lahir walau dengan usaha meneran optimal dan traksi yang benar
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• TIDAK DAPAT PUTAR PAKSI LUAR.
• DAGU BAYI MENEKAN PERINEUM
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Penanganan
A. Prinsip :
1. Bebaskan bahu depan dari tahanan simfisis.
2. Kecilkan diameter biakromion.
3. Perluas kapasitas panggul.
B. Hindari 4P :
1. Panic (panik).
2. Pulling (menarik-narik kepala bayi).
3. Pushing (mendorong-dorong fundus uteri).
4. Pivoting (memutar kepala secara tajam).
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Penanganan
sk for help.
ifting the legs and buttocks (Manuver McRobert).
nterior disimpaction of shoulder.
• Suprapubic pressure (Manuver Massanti).
• Rotate to oblique internal (Manuver Rubin).
otation of posterior shoulder (Manuver Wood).
anual removal of posterior arm (Manual Schwartz).
pisiotomy.
oll over (Manuver Gaskin, menungging).
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A. Ask for help
• Teriak minta tolong.
• Jangan tinggalkan pasien seorang diri.
• Aktifkan juga tim resusitasi bayi.
B. Manuver McRobert
1. Fleksi pangkal paha.
2. Lutut ibu mendekati dada ibu.
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C. Suprapubic Pressure
• Penekanan suprapubik dengan ujunggenggaman tangan pada bagian belakang bahudepan untuk membebaskan dari tahanansimfisis.
• Tidak menekan fundus uteri.
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D. Manuver Rubin
• Bahu depan didorong ke arah dada.
• Pertimbangkan tindakan episiotomi.
• Tidak menekan fundus uteri.
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E. Manuver Wood
• Bahu belakang didorong ke arah dada.
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• Bila sulit → kombinasikan dengan manuver Rubin.
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F. Manuver Schwartz
• Fleksikan tangan padasiku (menekan fosaantecubital untukmemfleksikan tangan).
• Usapkan tangansepanjang dada.
• Raih lengan depan ataujari-jari tangan dan keluarkan tangan
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F. Manuver Schwartz
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G. Episiotomi
• Dapat membantu manuver Wood dan Schwartz.
• Memberi ruang.
H. Manuver Gaskin
Menungging denganbertumpu pada telapaktangan dan lutut : memudahkan menggapaibahu belakang saat manuverSchwartz
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Setelah selesai tindakan :
• Antisipasi PPH.
• Eksplorasi laserasi dan trauma.
• Pemeriksaan fisik bayi untuk melihat adanyaperlukaan.
• Menjelaskan proses persalinan dan manuver yang dilakukan.
• Catat tindakan yang dilakukan.
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