partus presipitatus gdon

8/10/2019 Partus Presipitatus GDON

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I Wayan Agung Indrawan

Divisi Obstetri Ginekologi Sosial

FKUB/RSSA Malang

Partus Presipitatus


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TERMS AND DEFINITIONS

a.Precipitate Delivery.

Persalinan yang berlangsung cepat ( < 3jam) dan

berakhir dengan lahirnya bayi secara expulsi

b.Emergency Delivery.

Persalinan yang tidak direncanakan, berlangsung di

tempat tak terduga, di luar rumah sakit.


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Definisi

Kelahiran bayi yang berlangsung kurang dari 3 jam dari

awal persalinan

nulipara kecepatan dilatasi cervix 5 cm/ jam, dan pada

multipara 10 cm/jam

Etiologi

Rendahnya resistensi bagian terendah dari jaringan

lunak jalan lahir

Kontraksi uterus yang amat kuat Hilangnya sensasi nyeri


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- .DELIVERY

a. A multipara with relaxed pelvic or perineal floor

muscles b. A multipara with unusually strong, forceful

contractions.

c. absence of painful sensations during labor


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Patofisiologi

PRESIPITASI :

Kehamilan multipel

Kelainan kongenital

uterus Malformasi pelvis

Kontraksi hipertonik

Overstimulasi

oxytocin Kecemasan dan stres


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Kontraksi hipertonik atau

tetanik

Rendahnya resistensi

jaringan lunak jalan lahir

Dilatasi cervix berjalanlebih cepat

Mendorong janin keluar

lebih cepat dari jalan lahir

( 3 jam )

Suddent birth


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Tanda / gejala :

rasa nyeri yang melebihi normalpeningkatan heart rate, nadi dantemperatur

peningkatan tekanan darahshort of breathnesskecemasannasal flaring

fase relaksasi yang pendekkontraksi hipertonik


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- .DELIVERY

a.Maternal.

(1) lacerations of the cervix, vagina, and/or

perineum.

(2) Uterine atony may result from muscularexhaustion after unusually strong and rapid

labor.

(3) There may be infection as a result ofunsterile delivery.

(4)Amniotic fluid Embolism


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3-4. DANGER OF PRECIPITATE

DELIVERY

Neonatal.

(1) intracranial hemorrhage

(2) aspiration of amniotic fluid,

(3) infection as a result of unsterile delivery.


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Komplikasi janin dan neonatus

Peningkatan mortalitas dan morbiditas perinatal

Trauma intracranial

Erb-Duchenne palsy

Bayi mungkin lahir secara cepat dan jatuh ke lantaisehingga menimbulkan luka atau fraktur.

Pada umumnya bantuan resusitasi datang terlambat


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Emergency Delivery

Initial Step:Obtain maternal VS, FHR

Initiate supportive tx

Venous access, maternal and fetal monitoring

Before transferring ptconsider stage of labor / ptsparity


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Emergency Delivery Sterile Pelvic exam (Degree

cervical dilatation/effacement,

crowning, for fetus in introitus) Determine presenting

part/position

Palpate for skull sutures /

fontanel, buttock, or

extremity

P f L b d D li


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Process of Labor and Delivery

Six Cardinal Movements:1. Engagement2. Flexion

3. Descent

4. Internal Rotation

5. Extension6. External Rotation

Deli er Steps


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Delivery Steps1-3 Perineum stretching

/thinningallow

passage of newborn

Attempt to avoidEpisiotomy

3-4 Control of fetal head to

prevent large perineal

tear and head / facial

trauma to the newborn4 Nose/mouth suctioning

meconium?

4 Palpate neck for

nuchal cord

4-6 Gentle traction avoidbrachial plexus injuries(No jerky or forceful moves)


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Delivery Steps

6-7 Slippery infant

9-11 Double clampumbilical chord and

cut

12 Wrap/dry/gentle

stimulation

12 Determine APGAR at 1

/ 5 min.

12 Initiate neonatal

resuscitation if a

cyanotic / apneic

child is delivered withno response to

stimulation.


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APGAR

Good, cryingSlow,

Irregular

AbsentRespiration

R

Normal over

entire body

Normal

except for

extremities

Blue-gray,

pale all over

AppearanceA

Sneeze,cough,

pulls away

GrimaceNo responseGrimace

G

Above 100

beats/min

Below

100beats/min

AbsentPulseP

Activemovement

Arms andlegs flexed

AbsentActivityA

2 points1 point0 pointsSign


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Cutting The Umbilical Cord


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Delivery of Placenta

Occurs in 15-20m after infant is deliveredAllow spontaneous separation with gentle traction.

Aggressive traction on the cord can lead to: Uterine inversion

Cord Tearing Placenta disruptionsevere vaginal bleed


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Delivery of Placenta

Massage uterus after delivery of placenta (promotecontraction)

Oxytocin maintain uterine contraction (1020u IV in 1 L NS at250mL/h or 10u IM)

Uterine atonyexcessive vaginal bleed Oxytocin, Methylergonovine or carboprost tromethamine

Delay episiotomy or laceration repair for OBGYN to

perform.

omp ca ons o e very: or ro apse


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omp ca ons o e very: . or ro apse

In Cord Prolapse:Bimanual reveals

palpable pulsating cord

Elevate fetal partreduce cordcompression

Examiners hand

shouldRemain in Vagina

Transport

SurgeryC-sec isindicated.

Do not attempt toreduce prolapsed cord


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selalu dampingi pasien

pasien diminta untuk menghembuskan nafastiap kontraksi untuk mengalihkan keinginanuntuk mengejan

jangan mencegah kelahiran bayi bilapembukaan sudah lengkap

upayakan lingkungan yang steril/aseptikepisiotomi bila diperlukan


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FOR ANTICIPATED PRECIPITATE

BIRTH

a.Assess Patient for an Impending

Precipitous Delivery Situation.

(1) Patient has previous obstetric history of rapidlabor/delivery.

(2) Patient complains of a sudden, intense urge to

push.

(3) Increase in bloody show. (4) Sudden bulging of the perineum.

(5) Sudden crowning of the presenting part.

3 5 NURSING CARE TO PREPARE


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3-5. NURSING CARE TO PREPAREFOR ANTICIPATED PRECIPITATE

BIRTH

b.Call for Help. Do

not leave the patientunattended.


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BIRTH

c.Obtain a Sterile Obstetric or PrecipitateDelivery Pack, if Available.

(1) Gloves - sterile gloves are preferred as they

help promote asepsis.

(2) Towel/cloth

(3) Bulb syringe

(4) Hemostats or cord clamps-to clamp the

umbilical cord. (5) Scissors-to cut the episiotomy/cord.

(6) Dry blanket/towel-to wrap the infant after

delivery


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.FOR ANTICIPATED PRECIPITATE

BIRTH

d.Provide the Cleanest Environment ifPossible

(1) Paper, towel, blanket, or coat to place under the

patient's buttocks.

(2) Ligating material such as string, yarn, orshoelaces to tie the cord.

(3) A sharp instrument such as scissors, a knife, or

a razor to cut the cord.

(4) A dry cloth to wrap infant after delivery.


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.FOR ANTICIPATED PRECIPITATE

BIRTH

e.Provide for Asepsis to the Greatest ExtentPossible.

(1) Pour Betadineover the patient's perineum if

time does not permit for perineal prep.

(2) Wash your hands and glove, if possible.



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BIRTH

f.Support the Patient.

(1) Keep the patient informed of plans for delivery.

(2) Speak in a calm tone and provide direction to

available assistants (e.g., significant other).

(3) Encourage the patient to pant or blow through

contractions to slow the delivery process and to

decrease the force of expulsion.

(4) Provide for privacy, but do not leave thepatient alone

-


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- .MANAGEMENT OF PRECIPITATE

DELIVERY

a.Check for Presence of an Intact Amniotic Sac.

(1) If the membranes do not break spontaneously,

they should be ruptured just prior to or with thedelivery of the head.

(2) Caution must be taken to prevent the membranes

from covering the infant's mouth as the first breath is

taken, otherwise aspiration of amniotic fluid canoccur.

-


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DELIVERY

Support the Perineum and Infant's Head. (1) Apply support to the perineum with your

dominant hand (usually right hand) using a towel

or cloth.

(2) Apply support to the fetal head with your

nondominant hand.

(3) Increase the pressure of the dominant hand in

a downward motion against the perineum as thefetal head extends.. ( digeser ke bawah)

-


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DELIVERY

Support the Perineum and Infant's Head(4) Provide mild downward pressure with the

nondominant hand against the fetal head as the

fetal head extends. ( cegah extensi)

(5). Neverattempt to delay delivery by applying

pressure on the fetal head.

(6) Combine efforts of the right and left hand. This

will result in a slow, controlled extension of thefetal head.

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DELIVERY

c.Assist With the Actual Delivery of the Head. d.Coach the Patient to Pant/Blow.

3 6 NURSING CARE FOR MANAGEMENT


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3-6. NURSING CARE FOR MANAGEMENT

OF PRECIPITATE DELIVERY

e.Bulb Suction Amniotic Fluid from theInfant's Mouth. Or wiped by clean towel.

f.Allow Rotation.Allow the infant to

spontaneously accomplish external rotation.

g.Check for a Nuchal Umbilical Cord.

-


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DELIVERY

h.Allow Infant to Complete External Rotation. i.Coach the Patient to Push and to Pant/Blow.

(1) The nurse applies gentle downward pressure on

the head until the anterior shoulder delivers from

under the pubic arch and becomes visible.

(2) Support the infant's head and neck.

J. Assist With Delivery of the Posterior

Shoulder


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3-6. NURSING CARE FOR

MANAGEMENT OF PRECIPITATE

DELIVERY

.Assist with Delivery of the Placenta.

Active management of 3rdphase

Fundal massage

Oxytocin injection

Cord traction

3 7 NURSING CARE AFTER A


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3-7. NURSING CARE AFTER A

PRECIPITATE DELIVERY

a. Assist the mother into a comfortable positionwith her legs extended.

b. Provide a clean surface under the patient's

buttocks. c. Check uterine fundus every 10 to 15 minutes

during the first hour to assure contraction ofmyometrium and normal lochial flow.

(1) Gently massage the uterus if the fundus is softor boggy.

(2) Avoid overstimulation as myometrium will fatigueand result in severe atony.
http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/images/500_CC_640.jpghttp://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/images/500_CC_640.jpg


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