makalah distosia bahu asli

7/27/2019 Makalah Distosia Bahu Asli

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DISTOSIA BAHU

Disusun guna memenuhi tugas mata kuliah Asuhan Persalinan Dan Bayi Baru Lahir

Dosen : Dra. Wasnidar. .!e"

Disusun Oleh :

Desi #atalis $ahmalia %P.&'&()&())'*

aria Destri +anti %P.&'&()&()&'*

Tingkat IIA

!,,#T$IA# !,S,HATA# $,PUBLI! I#DO#,SIA

POLIT,!#I! !,S,HATA# !,,#!,S -A!A$TA I

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-U$USA# !,BIDA#A#

-alan $S. atma/ati0 1ilandak2-akarta Selatan

Tel34a5. )(&2'676786

TAHU# ()&8

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KATA PENGANTAR

Puji syukur penulis panjatkan kehadirat Tuhan Yang Maha Esa yang telah

melimpahkan rahmat dan hidayah-Nya sehingga penulis dapat menyelesaikan tugas makalahdengan judul DIT!IA "A#$%

Penulisan makalah ini &ertujuan untuk memenuhi salah satu tugas yang di&erikan 'leh

d'sen mata kuliah Asuhan Ke&idanan Persalinan dan ""(% Penulis sadar &ah)a masih

&anyak kekurangan dalam penulisan makalah ini* untuk itu penulis sangat mengharapkan

kritik dan saran yang mem&angun agar penulisan makalah &erikutnya dapat le&ih &aik%

Dengan terselesaikannya makalah ini* penulis &erharap makalah ini dapat

&erman+aat &agi penulis khususnya dan &agi pem&a,a umumnya%

akarta* ./ eptem&er .01/

Penulis

DA2TAR II

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#A(AMAN $D$( %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

KATA PENGANTAR 1

DA2TAR II%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% .

"A" I PENDA#$($AN%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /

1%1%(atar &elakang%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /

1%. Rumusan Masalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% /

1%/ Tujuan%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%3

"A" II PEM"A#AAN%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4

.%1 Pengertian Dist'sia "ahu%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%4

.%. Pat'+isi'l'gi%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%5

.%/ Eti'l'gi%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%5

.%3 Diagn'sis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%5

.%4 2akt'r Risik'%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%6

.%5%K'mplikasi%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%7

.%6 Penatalaksanaan%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%7

.%7%Pr'gn'sis%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%1.

"A" III PEN$T$P%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%1/

/%1 Kesimpulan%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%1/

/%. Kritik dan aran%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%1/

DA2TAR P$TAKA%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 13

"A" I

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PENDA#$($AN

1%1% (atar "elakang

Dist'sia adalah penyulit persalinan* sedangkan dist'sia &ahu adalah penyulit

persalinan &ahu% Angka kejadian dist'sia &ahu tergantung pada kriteria diagn'sa yang

digunakan% alah satu kriteria diagn'sa dist'sia &ahu adalah &ila dalam persalinan

per8aginam untuk melahirkan &ahu harus dilakukan maneu8er khusus seperti traksi ,uram

&a)ah dan episi't'mi% Dengan menggunakan kriteria diatas menyatakan &ah)a dari 0%9:

kejadian dist'sia &ahu yang ter,atat direkam medis* hanya 0%.: yang memenuhi kriteria

diagn'sa diatas%untuk menentukan dist'sia &ahu di gunakan ,riteria '&jekti+ yaitu inter8al

)aktu antara lahirnya kepala dengan seluruh tu&uh% Nilai n'rmal inter8al )aktu antara

persalinan kepala dengan persalinan seluruh tu&uh adalah .3 detik * pada dist'sia &ahu 69

detik% Dist'sia &ahu sering terjadi pada persalinan dengan tindakan ,unam tengah atau pada

gangguan persalinan kala I dan atau kala II yang memanjang% dist'sia &ahu yang &erulang

terjadi pada 16: pasien% Dist'sia &ahu adalah k'mplikasi ga)at yang memerlukan

penanganan yang ,epat ; tepat dan teren,ana se,ara jelas%

1%.% Rumusan Masalah

"ert'lak dari latar &elakang diatas* maka dapat di rumuskan masalahdise&ut dengan turtle sign?%

.%.% Pat'+isi'l'gi

etelah kelahiran kepala* akan terjadi putaran paksi luar yang menye&a&kan kepala

&erada pada sum&u n'rmal dengan tulang &elakang &ahu pada umumnya akan &erada pada

sum&u miring >'&li@ue? di &a)ah ramus pu&is% D'r'ngan pada saat i&u meneran akan

meye&a&kan &ahu depan >anteri'r? &erada di &a)ah pu&is* &ila &ahu gagal untuk mengadakan

putaran menyesuaikan dengan sum&u miring dan tetap &erada pada p'sisi anter'p'steri'r*

pada &ayi yang &esar akan terjadi &enturan &ahu depan terhadap sim+isis sehingga &ahu tidak

&isa lahir mengikuti kepala%

.%/% Eti'l'gi

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Dist'sia &ahu terutama dise&a&kan 'leh de+'rmitas panggul* kegagalan &ahu untuk

melipatB ke dalam panggul >misal < pada makr's'mia? dise&a&kan 'leh +ase akti+ dan

persalinan kala II yang pendek pada multipara sehingga penurunan kepala yang terlalu ,epat

menye&a&kan &ahu tidak melipat pada saat melalui jalan lahir atau kepala telah melalui pintu

tengah panggul% setelah mengalami pemanjangan kala II* se&elah &ahu &erhasil melipat

masuk ke dalam panggul%

.%3% Diagn'sis

Dist'sia &ahu dapat dikenali apa&ila didapatkan adanya Keller* dkk?

.% anin &esar >ma,r'ss'mia?* dist'sia &ahu le&ih sering terjadi pada &ayi dengan &erat

lahir yang le&ih &esar* meski demikian hampir separuh dari kelahiran d'ist'sia &ahu

memiliki &erat kurang dari 3000 g%

/% Ri)ayat '&stetriCpersalinan dengan &ayi &esar

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a% I&u dengan '&esitas* i&u mengalami '&esitas sehingga menye&a&kan ruang

gerak janin ketika mele)ati jalan lahir le&ih sempit kaena ada jaringan

&erle&ih pada jalan lahir di&andig i&u yang tidak mengalami '&esitas%

&% Multiparitas

,% Kehamilan p'sterm* dapat menye&a&kan dist'sia &ahu karena janin terus

tum&uh setelah usia 3. mingu%

d% Ri)ayat '&stetri dengan persalinan lamaCpersalinan sulit atau ri)ayat dist'sia

&ahu* terdapat kasus dist'sia &ahu rekuren pada 4 >1.:? di antara 3. )anita

>mith dkk%* 1993?

e% ephal'pel8i, dispr'p'rti'n* yaitu adanya ketidakeuaian antara kepala dan

panggul yang diaki&atkan karena "enedetti dan Ga&&e* 1967 Parks dan Fiel* 1967?%

b. Komplikasi pada Bayi

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Dist'sia &ahu dapat disertai m'r&iditas dan m'rtalitas janin yang signi+ikan%

Ke,a,atan pleksus &ra,hialis transien adalah ,edera yang paling sering* selain itu

dapat juga terjadi +raktur kla8ikula* +raktur humerus* dan kematian ne'natal

.%6% Penatalaksanaan

HELPERR - PENDEKATAN STANDAR

Dalam kasus #E(PERR >A(! .003* AA2P .003 ? panah h'ris'ntal?%

Asisten melakukan tekanan suprapu&i, se,ara &ersamaan >panah 8ertikal?% Analisa

tindakan Maneu8er M, R'&ert dengan menggunakan -ray% $kuran panggul tak

&eru&ah* namun terjadi r'tasi ,ephalad pel8i, sehingga &ahu anteri'r ter&e&as dari

sim+isis pu&is

,% Maneu8er H''ds > Wood crock screw maneuver?

Dengan melakukan r'tasi &ahu p'steri'r 1700se,aracrock screwmaka &ahu

anteri'r yang terjepit pada sim+isis pu&is akan ter&e&as% Maneu8er H''d% Tangan

kanan pen'l'ng di&elakang &ahu p'steri'r janin% "ahu kemudian diputar 170 derajat

sehingga &ahu anteri'r ter&e&as dari tepi &a)ah sim+isis pu&is

d% Melahirkan &ahu &elakang

!perat'r memasukkan tangan kedalam 8agina menyusuri humerus p'steri'r

janin dan kemudian melakukan +leksi lengan p'steri'r atas didepan dada

dengan mempertahankan p'sisi +leksi siku

Tangan janin di,ekap dan lengan diluruskan melalui )ajah janin

(engan p'steri'r dilahirkan

e% Maneu8er Ru&in * Terdiri dari . langkah

makalah distosia bahu asli

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