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A B N O R M A L LA B O R
D Y S TO C IA
TUJUAN =
M ahasisw a kedokteran klinik
Mampu menginterpretasikan temuan
KASU S # 1
Ny S, 30 tahun, hamil G2 P1 A0 hamil
KASU S # 2 (cont)
Kondisi ibu baik, TD = 120/80 mmHg,
KASU S # 3 (cont)
Pemeriksaan dalam vagina
Pembukaan 5 cm.
Kulit ketuban (-)
Kepala H III
UUK kiri depan
Moulage ++
Buatlah partograf,
diagnosis klinis
dan sikap ?
KASU S # 4 (cont)
4 jam kemudian =
Gambaran apa
yang ditunjukkan
oleh partograf?
Kesimpulan apa
yang anda buat
berdasarkan
temuan partograf
tersebut ?
Dari kesimpulan
yang anda buat,
apakah persalinan
ini termasuk
normal ?
Apakah penyebab
dari kelainan ini ?
Bagaimana jika
dilakukan
augmentasi pada
kasus ini ? Apa
resikonya ?
Tindakan apa
yang paling
rasional untuk
menyelesaikan
persalinan ini ?
P ER S A LIN A N PATO LO G IS
A B N O R M A L LA B O R
D Y S TO C IA
kemajuan.
Pembukaan serviks maju tetapi tidak disertai
penurunan kepala.
Pembukaan serviks tidak maju tetapi terdapat
kemajuan dalam penurunan kepala.
Grafik garis pembukaan menyilang ke arah
kanan garis waspada.
Kontraksi tidak membaik dan diikuti dengan
tidak majunya pembukaan dan penurunan
kepala.
Progress in labor
Alarm course
P O W ER S
quantified by measurement of
intrauterine pressure (IUP).
High risk pregnancy, 2006
presentation.
Remember =ineffective labor is
generally accepted as apossible
warning sign of CPD
Amniotomy in case of intact membrane.
Oxytocin augmentation
High risk pregnancy, 2006
oxytocin augmentation.
Be careful if the lowest presenting
part of fetus still high.
augmentation.
Experience care givers.
Ready for CS immediately.
Must be prepared to manage uterine
hyperstimulation.
1 2 mU/min
Increase interval
every 30 minutes
Dosage increment
1 2 mU
Usual dose for good labor2 12 mU/min
Conversion 1 mU = 2 drops
than 3 hours
Effect on maternal :
rupture cerix, vagina, vulva or perineum
amnionic fluid embolism
PPH because hypotonic after delivery
Effect on fetus and neonate :
Hypoxia fetus
Erb or duchenne brachial palsy
William obstetrics 22 ed
PA SS A G ES
Caused by
Alarm course
G enerally assum e
Pelvic capacity is adequate if a woman
has a delivered vaginally before.
Indonesia assume that 2500 gr as a cut of
point.
High risk pregnancy, 2006
PA SS EN G ER S
Caused by
Malpresentation
Macrosomia
Shoulder dystocia
William obstetrics 24 ed
Clinicalfeature ofCPD
Excessive moulding
Failure of presenting part to engage and
descent.
High risk pregnancy 2006
oxytocin augmentation.
Arrest withCPD = CS
Remember
A lack of descent in the absence of
moulding or caput is likely due to
inadequate contractions.
by partogram.
Continuous support in labor.
Early intervention to correct inadequate
progress of labor with appropriate
intervention = such as amniotomy,
oxytocin augmentation.
M aternaleff
ects ofdystocia
Intrapartum infection
Uterine rupture
Pathological retraction ring
Fistula formation
Pelvic floor injury
Postpartum lower extremity nerve
injury
Wiiliam obstetrics 24 ed
Fetaleff
ects ofdystocia
Caput succedaneum
Fetal head molding
Asfiksia
Wiiliam obstetrics 24 ed