partus-presipitatus-gdfdon vsv

7/23/2019 Partus-Presipitatus-GdfDON vsv

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I Wayan Agung Indrawan

Divisi Obstetri Ginekologi Sosial

FKUB/RSSA alang

!artus !resi"itatus


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TERMS AND DEFINITIONS

a#Precipitate Delivery#!ersalinan yang berlangsung $e"at % & '(a)*

dan berak+ir dengan la+irnya bayi se$arae,"ulsi

b#Emergency Delivery#!ersalinan yang tidak diren$anakan-

berlangsung di te)"at tak terduga- di luarru)a+ sakit#


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DefnisiKela+iran bayi yang berlangsung kurang dari '(a) dari awal "ersalinannuli"ara ke$e"atan dilatasi $ervi, . $)/ (a)-

dan "ada )ulti"ara 0 $)/(a)

EtiologiRenda+nya resistensi bagian terenda+ dari(aringan lunak (alan la+ir

Kontraksi uterus yang a)at kuat1ilangnya sensasi nyeri


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3-3 PREDISPOSE TO A

PRE!IPITATE DE"I#ER$

a# A )ulti"ara wit+ rela,ed "elvi$ or "erineal

2oor )us$lesb# A )ulti"ara wit+ unusually strong- 3or$e3ul

$ontra$tions#

$# absen$e o3 "ain3ul sensations during labor


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!ato4siologi!R5SI!I6ASI 7Ke+a)ilan )ulti"el

Kelainan kongenitaluterus

al3or)asi "elvis

Kontraksi +i"ertonik

Oversti)ulasi

o,yto$inKe$e)asan dan

stres


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Kontraksi +i"ertonikatau tetanik

Renda+nya resistensi

(aringan lunak (alanla+ir

Dilatasi $ervi,ber(alan lebi+ $e"at

endorong (aninkeluar lebi+ $e"at

dari (alan la+ir % 8 '

(a) *

Suddent birt+


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6anda / ge(ala 7

rasa nyeri yang )elebi+i nor)al"eningkatan +eart rate- nadi dante)"eratur

"eningkatan tekanan dara+s+ort o3 breat+nesske$e)asannasal 2aring3ase relaksasi yang "endekkontraksi +i"ertonik


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3-% DAN&ER OF PRE!IPITATE

DE"I#ER$a#Maternal#%* la$erations o3 t+e $ervi,- vagina-

and/or "erineu)#

%9* Uterine atony )ay result 3ro))us$ular e,+austion a3ter unusuallystrong and ra"id labor#

%'* 6+ere )ay be in3e$tion as a resulto3 unsterile delivery#'%( A)nioti$ 2uid 5)bolis)


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3-% DAN&ER OF PRE!IPITATEDE"I#ER$

Neonatal#

%* intra$ranial +e)orr+age

%9* as"iration o3 a)nioti$ 2uid-

%'* in3e$tion as a result o3 unsterile delivery#


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)ompli*asi +anin ,an neonats

!eningkatan )ortalitas dan )orbiditas "erinatal6rau)a intra$ranial5rb:Du$+enne "alsy

Bayi )ungkin la+ir se$ara $e"at dan (atu+ kelantai se+ingga )eni)bulkan luka atau 3raktur#!ada u)u)nya bantuan resusitasi datang

terla)bat


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5)ergen$y Delivery

Initial Ste"7Obtain )aternal ;S- F1RInitiate su""ortive t,;enous a$$ess- )aternal and 3etal )onitoring

Be3ore trans3erring "t $onsider stage o3labor / "t


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5)ergen$y Delivery Sterile !elvi$ e,a) %Degree

$ervi$al

dilatation/e=a$e)ent-$rowning- > 3or 3etus inintroitus*

Deter)ine "resenting"art/"osition

!al"ate 3or skull sutures /3ontanel- butto$k- ore,tre)ity


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!ro$ess o3 ?abor and Delivery

Si, @ardinal ove)ents7# 5ngage)ent9# Fle,ion

'# Des$ent

# Internal Rotation

.# 5,tension# 5,ternal Rotation


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Delivery Ste"s:' !erineu)

stret$+ing /t+inningallow "assage o3newborn

Atte)"t to avoid5"isioto)y

': @ontrol o3 3etal +eadto "revent large"erineal tear and+ead / 3a$ial trau)ato t+e newborn

Cose/)out+su$tioning)e$oniu)

!al"ate ne$k 3ornu$+al $ord

: Gentle tra$tion avoidbra$+ial "le,usin(uries %Co (erky or

3or$e3ul )oves*


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Delivery Ste"s

:E Sli""ery in3ant

H: Double $la)"u)bili$al $+ordand $ut

9 Wra"/dry/gentlesti)ulation

9 Deter)ine A!GAR at / . )in#

9 Initiate neonatalresus$itation i3 a$yanoti$ / a"nei$$+ild is deliveredwit+ no res"onseto sti)ulation#


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A!GAR

Good, cryingGood, cryingSlow,Slow,

IrregularIrregularAbsentAbsentRespirationRespiration

RR

Normal overNormal over

entire bodyentire bodyNormalNormal

except forexcept for

extremitiesextremities

Bluegray,Bluegray,

pale all overpale all overAppearanceAppearanceAA

Snee!e,coug",Snee!e,coug",

pulls awaypulls away

GrimaceGrimaceNo responseNo responseGrimaceGrimace

GG

Above #$$Above #$$

beats%minbeats%minBelowBelow

#$$beats%min#$$beats%minAbsentAbsent&ulse&ulse&&

ActiveActivemovementmovement

Arms andArms andlegs flexedlegs flexed

AbsentAbsentActivityActivityAA

' points' points# point# point$ points$ pointsSignSign


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@utting 6+e U)bili$al @ord


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Delivery o3 !la$enta

O$$urs in .:90) a3ter in3ant is deliveredAllow s"ontaneous se"aration wit+ gentle

tra$tion#

Aggressive tra$tion on t+e $ord $an lead to7Uterine inversion@ord 6earing!la$enta disru"tion severe vaginal bleed


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Delivery o3 !la$enta

assage uterus a3ter delivery o3 "la$enta %"ro)ote$ontra$tion*

O,yto$in )aintain uterine $ontra$tion %090u I; in ? CS at 9.0)?/+ or 0u I*

Uterine atonye,$essive vaginal bleedO,yto$in- et+ylergonovine or $arbo"rost tro)et+a)ine

Delay e"isioto)y or la$eration re"air 3or OBGJC to"er3or)#


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@o)"li$ations o3 Delivery7 #@ord !rola"seIn @ord !rola"se7Bi)anual reveals

"al"able "ulsating$ord5levate 3etal "art

redu$e $ord$o)"ression

5,a)iners +ands+ouldRe)ain in ;agina6rans"ortSurgery @:se$ is

indi$ated#Do not atte)"t to

redu$e "rola"sed$ord


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selalu da)"ingi "asien

"asien di)inta untuk)eng+e)buskan na3as

tia" kontraksi untuk )engali+kan

keinginanuntuk )enge(an(angan )en$ega+ kela+iran bayi bila

"e)bukaan suda+ lengka"

u"ayakan lingkungan yangsteril/ase"tike"isioto)i bila di"erlukan


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3-. N/RSIN& !ARE TOPREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1a#Assess Patient 2or an Impen,ing

Precipitos Delivery Sitation#

%* !atient +as "revious obstetri$ +istory o3ra"id labor/delivery#

%9* !atient $o)"lains o3 a sudden- intenseurge to "us+#

%'* In$rease in bloody s+ow#%* Sudden bulging o3 t+e "erineu)#

%.* Sudden $rowning o3 t+e "resenting "art#


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3-. N/RSIN& !ARE TOPREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1b#!all 2or 1elp#

Do not leave t+e"atientunattended#


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3-. N/RSIN& !ARE TO

PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1$#Otain a Sterile Ostetric or

Precipitate Delivery Pac*4 i2 Availale#

%* Gloves : sterile gloves are "re3erred as t+ey+el" "ro)ote ase"sis#

%9* 6owel/$lot+%'* Bulb syringe%* 1e)ostats or $ord $la)"s:to $la)" t+e

u)bili$al $ord#

%.* S$issors:to $ut t+e e"isioto)y/$ord#%* Dry blanket/towel:to wra" t+e in3ant a3ter

delivery


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3-. N/RSIN& !ARE TO

PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1d#Provi,e t5e !leanest Environment i2

Possile%* !a"er- towel- blanket- or $oat to "la$e

under t+e "atients butto$ks#

%9* ?igating )aterial su$+ as string- yarn- ors+oela$es to tie t+e $ord#%'* A s+ar" instru)ent su$+ as s$issors- a

kni3e- or a raLor to $ut t+e $ord#

%* A dry $lot+ to wra" in3ant a3ter delivery#


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3-. N/RSIN& !ARE TO

PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT1

e#Provi,e 2or Asepsis to t5e &reatestE6tent Possile#

%* !our BetadineMover t+e "atients"erineu) i3 ti)e does not "er)it 3or

"erineal "re"#%9* Was+ your +ands and glove- i3 "ossible#


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3-. N/RSIN& !ARE TO

PREPARE FOR ANTI!IPATEDPRE!IPITATE 0IRT13#Spport t5e Patient#%* Kee" t+e "atient in3or)ed o3 "lans 3or

delivery#

%9* S"eak in a $al) tone and "rovide dire$tion

to available assistants %e#g#- signi4$ant ot+er*#%'* 5n$ourage t+e "atient to "ant or blow

t+roug+ $ontra$tions to slow t+e delivery"ro$ess and to de$rease t+e 3or$e o3

e,"ulsion#%* !rovide 3or "riva$y- but do not leave t+e

"atient alone


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3-7 N/RSIN& !ARE FORMANA&EMENT OF PRE!IPITATE

DE"I#ER$a#!5ec* 2or Presence o2 an Intact

Amniotic Sac#

%* I3 t+e )e)branes do not breaks"ontaneously- t+ey s+ould be ru"tured (ust"rior to or wit+ t+e delivery o3 t+e +ead#

%9* @aution )ust be taken to "revent t+e

)e)branes 3ro) $overing t+e in3ants )out+as t+e 4rst breat+ is taken- ot+erwiseas"iration o3 a)nioti$ 2uid $an o$$ur#


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DE"I#ER$Spport t5e Perinem an, In2ant8s1ea,#

%* A""ly su""ort to t+e "erineu) wit+ yourdo)inant +and %usually rig+t +and* using a

towel or $lot+#%9* A""ly su""ort to t+e 3etal +ead wit+ your

nondo)inant +and#

%'* In$rease t+e "ressure o3 t+e do)inant+and in a downward )otion against t+e"erineu) as t+e 3etal +ead e,tends##% digeser ke bawa+*


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DE"I#ER$Spport t5e Perinem an, In2ant8s1ea,

%* !rovide )ild downward "ressure wit+ t+enondo)inant +and against t+e 3etal +ead

as t+e 3etal +ead e,tends# % $ega+ e,tensi*

%.*# Neveratte)"t to delay delivery bya""lying "ressure on t+e 3etal +ead#

%* @o)bine e=orts o3 t+e rig+t and le3t+and# 6+is will result in a slow- $ontrollede,tension o3 t+e 3etal +ead#


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DE"I#ER$$#Assist 9it5 t5e Actal Delivery o2t5e 1ea,#

d#!oac5 t5e Patient to Pant:0lo;#


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DE"I#ER$e#0l Sction Amniotic Fli, 2rom t5eIn2ant8s Mot5# Or wi"ed by $lean towel#

3#Allo; Rotation Allow t+e in3ant tos"ontaneously a$$o)"lis+ e,ternal

rotation#g#!5ec* 2or a Nc5al /milical !or,#


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DE"I#ER$+#Allo; In2ant to !omplete E6ternalRotation#

i#!oac5 t5e Patient to Ps5 an, toPant:0lo;%* 6+e nurse a""lies gentle downward

"ressure on t+e +ead until t+e anteriors+oulder delivers 3ro) under t+e "ubi$ ar$+and be$o)es visible#

%9* Su""ort t+e in3ants +ead and ne$k#


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3-7 N/RSIN& !ARE FORMANA&EMENT OF

PRE!IPITATE DE"I#ER$

#Assist ;it5 Delivery o2 t5e Placenta#A$tive )anage)ent o3 'rd"+aseFundal )assageO,yto$in in(e$tion@ord tra$tion


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3-= N/RSIN& !ARE AFTER A

PRE!IPITATE DE"I#ER$a# Assist t+e )ot+er into a $o)3ortable "osition

wit+ +er legs e,tended#b# !rovide a $lean sur3a$e under t+e "atients

butto$ks#$# @+e$k uterine 3undus every 0 to . )inutes

during t+e 4rst +our to assure $ontra$tion o3)yo)etriu) and nor)al lo$+ial 2ow#%* Gently )assage t+e uterus i3 t+e 3undus is

so3t or boggy#%9* Avoid oversti)ulation as )yo)etriu) will

3atigue and result in severe atony#


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