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Persalinan Normal
Dr. Alex Lumbanraja, SpOG
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• Persalinan : suatu proses pengeluaran hasil konsepsi yang dapat hidup dari dalam uterus melalui vagina ke dunia luar
• Penyebab terjadinya inisiasi persalinan :
- faktor humoral
- pengaruh prostaglandin
- struktur dan sirkulasi uterus
- pengaruh saraf
- nutrisi2
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Tanda-tanda Persalinan
• Bloody show/lendir darah keluar
• Kontraksi uterus yang teratur
• Pecahnya selaput ketuban
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Abnormalities of Labor THE 5 “P”
• Passageway: maternal pelvis
• Powers: uterine contractions
• Passenger: fetus
• Psyche : mother’s readiness
• Penolong
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True Versus False Labor
• True labor: mulai bila kontraksi rahim terjadi dengan interval yg teratur– menyebabkan rasa sakit
• back pain increases with walking
– Disertai dengan dilatasi serviks dan lendir darah
• False labor: menyebabkan nyeri dengan interval yg tdk teratur dan tanpa dilatasi serviks
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Leopold maneuver
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4 stages of labor
• Kala I: Stage of dilation• Dimulai dari onset persalinan sampai dilatasi serviks lengkap
• Dapat disertai dengan rupturnya selaput ketuban• Kala I dibagi 2 fase: fase laten dan aktif
– Apa saja yang perlu diperiksa pada Kala I?• Monitoring tekanan darah• Denyut jantung janin• Dilatasi serviks dan penurunan kepala
– Gunakan Partogram
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Kala I
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Dilatation of the cervix
• Nullipara:Nullipara:
I - shortening I - shortening
II - dilatation of external osII - dilatation of external os
III - dilatation of internal osIII - dilatation of internal os• Multipara:Multipara:
phases I, II and III occur togetherphases I, II and III occur together
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• Beberapa hal yang harus diketahui utk mengetahui mekanisme persalinan:
1. Letak janin
2. Presentasi janin
3. Penunjuk
4. Engangement
5. Station
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Macam-macam presentasi Janin
Presentasi Kepala
Presentasi MajemukPresentasi Muka
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Macam-macam presentasi Janin
Presentasi DahiPresentasi Bokong
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Macam-macam presentasi Janin
Letak lintang
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• Station: level of presenting part (bony portion) in relation to the maternal ischial spines– Ischial spines = O station– Above spines: -5 to -1
–Below spines: +1 to +5
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Cardinal Movements of Labor
1. Engagement: descent of biparietal diameter to the level of the ischial spines (0 station)
2. Descent 3. Flexion: presenting diameters of fetal
head presenting to maternal pelvis are optimized
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4. Internal rotation: fetal occiput rotates from transverse to AP
5. Extension: head rotates under symphysis pubis
6. External rotation (restitution): occiput and spine assume same position
7. Expulsion: fetal body delivers
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Mekanisme Persalinan
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Mekanisme Persalinan
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• Kala II: Stage of expulsion– Primipara: 1-2 jam– Multipara: + ½ jam– Episiotomi
• Kala III: Kala uri– Manajemen
kala III aktif
Third stage of labor:Delivery of the placenta
Placenta
Uterus
Umbilical cord
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KALA II
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KALA III