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Kelompok 28 D

Rizki Erizka (0910312105) Rizka Aganda Fajrum (0910312084)

Rizqa Fiorendita Hadi (0910312088)

Mega Redha Putri (0910312038)

Ami Tri Nursasmi (0910312126)

Pramesty Yunita Putri (0910313220)

M Ridho Azhari (0910313227)

Tristika Aulia S (0910313264)

Prem Nath Morhan (0810314265)


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LEARNING OBJECTIVE

1. Mahasiswa mampu menjelaskan keadaanpatologis selama persalinan, tindakan, sertapenanganannya.

2. Mahasiswa mampu menjelaskan FetalDistress.3. Mahasiswa mampu menjelaskan keadaan

patologis selama masa nifas, tindakan, serta

penanganannya.4. Mahasiswa mampu menjelaskan perubahan

psikologis setelah persalinan dan pada masanifas.


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PATHOLOGICAL CONDITIONS

DURING CHILDBIRTH

Dystocia

Rupture perinei

Premature rupture of membranes Umbilical cord prolapse

Uterine rupture


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DYSTOCIA

Dystocia is the difficulty in the course of labor. Dystociadue to disorders of (his) is not normal, either thestrength or nature, thus inhibiting the smooth delivery.

His normal:1. Uterine muscle tone is not how high his outside, and

then improve on his time. At the opening of the cervixwhen there are 2 phases: latent and active phases.

2. Uteris contraction begins in one uterine horn, the rightor left, and then spread throughout the muscles of theuterus.


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3. Fundus uteri first contract (fundal dominance) andlonger than other parts. The center of the contract alittle slower, shorter and not as strong as the lower

uterine fundus contraction (bottom segment of theuterus) and cervix remain passive or only very weakcontractions.


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FETOPELVIC

DISPROPORTIONContracted Pelvic Inlet. The pelvic inlet usually is considered to be

contracted if its shortest anteroposteriordiameter is less than 10 cm or if thegreatest transverse diameter is less than12 cm.


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Contracted Midpelvis.

It frequently causes transverse arrest ofthe fetal head, which potentially can leadto a difficult midforceps operation or tocesarean delivery.

There is reason to suspect midpelviccontraction whenever the interischialspinous diameter is less than 10 cm.

When it measures less than 8 cm, themidpelvis is contracted.


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Contracted Pelvic Outlet.

This finding usually is defined as aninterischial tuberous diameter of 8 cm orless. The pelvic outlet may be roughly

likened to two triangles, with theinterischial tuberous diameter constitutingthe base of both.


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Forceps Delivery and Vacuum

ExtractionFORCEPS. consist of two crossing branches. Each

branch has 4 components: blade, shank,

lock, and handle. Each blade has twocurves. The cephalic curve conforms to the shape

of the fetalhead, and thepelvic curvecorresponds more or less to the axis of thebirth canal Some varieties are fenestratedorpseudofenestratedto permit a firmer

hold on the fetal head.


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INDICATIONS FOR FORCEPS

Generally, the indications andprerequisites for the use of the forcepsdelivery for delivery are the same as

vacuum extractor Some maternal indications include heart

disease, pulmonary injury or compromise,

intrapartum infection, certain neurologicalconditions, exhaustion, or prolongedsecond-stage labor


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more than 3 hours with, and more than 2

hours without, regional analgesia in thenulliparous woman. In the parous woman,a prolonged second stage is defined asmore than 2 hours with, and more than 1

hour without, regional analgesia.

Fetal indications: prolapse of the umbilical

cord, premature,separation of theplacenta; or a nonreassuring fetal heartrate pattern.


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Prerequisites for Forceps

Application.

1. The head must be engaged.

2. The fetus must present as a vertex or bythe face with the chin anterior.

3. The position of the fetal head must beprecisely known.

4. The cervix must be completely dilated.

5. The membranes must be ruptured.6. There should be no suspected cephalic-

pelvic disproportion.


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VACUUM EXTRACTION

The advantages of the vacuum extractorover forceps include:

1. the avoidance of insertion of space-

occupying steel blades within the vaginaand of the requirement for precisepositioning overthe fetal head;

2. the ability to rotate the fetal head withoutimpinging on maternal soft tissues;

3. the decreased intracranial pressure duringtraction.


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Cesarean Delivery

defined as the birth of a fetusthrough incisions in the

abdominal wall (laparotomy)and the uterine wall(hysterotomy).


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INDICATIONS

Dystocia

Fetal distress


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TECHNIQUE FOR CESAREAN

DELIVERY Abdominal Incisions

Vertical Incision

Transverse Incisions

Uterine Incisions


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PREMATURE RUPTURE OF

MEMBRANES Premature rupture of membranes is the rupture of the

membranes at any time before the onset of labor regardlessof whether rupture of membranes occurred at 24 weeksgestation or 44 weeks

Management of premature rupture of membranes:

1. Conservatives: Outpatienthospital with bed rest, There areno signs of infection and fetal distress,Approximately 37 weeks of gestation,Antibiotic prophylaxis with amoxicillin 3 500 mg for 5 days,Giving tokolitik if any contraction of the

uterus and give kortikosteroid to finalize fetal lung function, Donot do vaginal examination, Perform termination of pregnancy if there are any signs of infection or fetal distress,When the 3 x 24 hours there was no release of water and

no contraction uteru then do a gradual mobilization. If the ongoing release of water, do termination of pregnancy.


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2. Active severe infection If found then give high dosesof antibiotics. When inpartu signsfound, infection and fetal distress then dothe termination of pregnancy:induction or acceleration of labor,Do seksiosesaria if labor induction or accelerationfailed, Perform cesarean hysterectomy when signsof severe uterineinfection was found.


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Fetal DistressIn medicine (obstetrics), the term fetal distress refers to

the presence of signs in a pregnant woman before orduring childbirththat suggest that the fetus may not bewell. Because of its lack of precision, the term iseschewed in modern obstetrics.

There are many causes of "fetal distress" including:Breathing problems, Abnormal position andpresentation of the fetus, Multiple births, Shoulderdystocia, Umbilical cord prolapse, Nuchal cord,Placental abruption, Premature closure of the fetalductus arteriosus, Uterine rupture

Treatment: Instead of referring to "fetal distress" current

recommendations hold to look for more specific signsand symptoms, assess them, and take the appropriatesteps to remedy the situation. Traditionally the diagnosisof "fetal distress" lead the obstetrician to recommendurgently delivery by instrumental delivery or caesarean

section if vaginal delivery is possible rapidly.


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PATHOLOGICAL CONDITIONS

DURING CHILDBIRTH

bleeding infection


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Puerperal infection is a bacterial infection of thegenital tract, occurs after delivery, marked increasein temperature to 38 degrees Celsius or more for 2days in the first 10 days postpartum, excluding thefirst 24 hours.Etiology : The organism that attacks the formerimplantation of the placenta or laceration due to

childbirth is a normal inhabitant of the cervix andbirth canal, perhaps also from outside. Usuallymore than one species. Are anaerobic grampositive coccus (peptostreptokok, peptokok,bakteriodes and clostridium). Germs are a varietyof aerobic gram-positive and E. coli. Mycoplasmain the final report may play a role in the etiology ofpuerperal infection.


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Infection of the perineum, vulva, vagina, andcervix:

Symptoms include pain and heat at site of infection, sometimes painful while urinating. If the gum inflammation can get out, usuallythe situation is not severe, the temperaturearound 38degrees Celsius and pulse rate below 100 perminute. When an infected wound closedstitching and gum inflammation cannot get out,

the fever may rise to 39-40 degrees Celsius,sometimes accompanied by chills.


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Endometritis:

Sometimes lokia stuck in uterus by blood, retainedplacenta and membranes amniotic called lokiometraand can cause an increase in temperature.

Uterus slightly enlarged pain in touching and flabby.

Septicemia:

Since the beginning, the patient is already sick andweak.

Up to 3 days post partum Quickly rising temperatures,usually accompanied

shivering.

The temperature around 39-40 degrees Celsius,general condition quickly deteriorated, rapid pulse

(140-160 times per minute or more).


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Piemia:

Not long after the birth, the patient already feel

pain, abdominal pain and temperatureslightly increased.

Symptoms of general infection with high

temperature and shivering occur after the germwith emboli entering the general bloodcirculation.

distinctive feature is repeated with thetemperature rising rapidly shivering followed bya decrease in temperature.

Gradually the symptoms of lung abscess,

pnneumonia and pleuritis.


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Peritonitis:

In common peritonotis Increase in body

temperature, rapid pulse and a small, stomachbloating and pain, and no defense musculaire.

Advance the original reddish become pale, sunkeneyes, skin face cold; there hippocratica facies.

on a limited peritonitis pelvic area, the symptomsare not as heavy as peritonitis general.

peritonitis is limited: the patient got fever, lower

abdominal pain but the circumstances generallynot good.

Can there abscess formation.


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Pelvic cellulitis: When the high temperature settled more than one

weeks with pain in the left or right side and painon examination in, is suspect of cellulitis pelvika.

Symptoms will be more and more obvious in itsdevelopment.

At the examination in solid detainee and palpablepain in the uterus. In the middle of the inflamed tissue that arise could

abscess where temperatures early

high first settled, to be up and down accompaniedby chills. The patient looked ill, rapid pulse, and stomach

pain


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PSYCHOLOGICAL CHANGES AFTER

CHILDBIRTH AND DURING CHILDBIRTH

Causes of depresion

a. Constitutional factors. Postpartum disorders associated with parity status is a history of obstetric patients, including historyof pregnancy until delivery and if there arecomplications from pregnancy and childbirth occur earlier and more in primiparous women.

Women generally suffer more primiparous postpartum blues because of primiparous women are in the process

of adaptation, if used to think only about themselves so thebaby is born if the mother does not understand his role he willbecome confused while the baby should remain hospitalized.?


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b. Physical factors.Physical changes after delivery and mounting ofmental disorders during the first 2 weeks showed that physicalfactors associated with first birth is an important factor.Hormonalchanges drastically after birth and during the two day latencyperiod betweenbirth and emergence of symptoms. This changewas highly influential in thebalance.Sometimes progesterone rises and estrogen decreased rapidly after birth is a factor that's for sure.

c. Psychological factors. Rapid transition from a state of "two inone" at the end of pregnancy to two individuals of themother and child depend on individualpsychological adjustment. Klaus and Kennel (Regina etal, 2001), indicating the importance of love in overcoming the

transitional period is to start a good relationshipbetween mother and child.

d. Social factors. Paykel (Regina et al, 2001) argues thatthe settlement inadequate more often cause depression inwomen - mothers, in addition to lack of support in marriage.

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