Transcript
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    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

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    ANAMNESIS

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

    WIB

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    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

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    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'

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    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

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    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 ; ;

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    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'

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    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

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    PEMEIKSAAN !BSTETI

    Pemeriksaan Hasil Satua Nilai

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    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

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    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,

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    DIAGNOSIS

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    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

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    '!%%!

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    PROGNOSIS

    P)3-' / 2)na+

    Passag- / 2)na+

    Pass-ng-' / 2)na+

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    TINJAUAN PUSTAKA

    Pa'tus s()n

    Ma*')s)+ia

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    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+

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    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

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    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+.

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    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.

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    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+.

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    PASSA"EPANGGU

    Panggu gin-*)i

    Pangguant'h)()i

    Panggu an')i

    PangguPati(-)ia

    Panggu gin-*)i

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    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'.

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    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

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    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

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    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.

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    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(

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    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

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

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    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

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    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

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    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:

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    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".

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    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.

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    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

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

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    '%EKSI

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

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    &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

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    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

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    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

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    PUTAAN PAKSI &A%AM

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    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)'.

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    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

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    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


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