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DISTOSIA BAHU

PELATIHAN OBSTETRI EMERGENSI DASAR (POED) KEPANITERAAN KLINIK


DISIPLIN ILMU OBGIN FK UMI / UNISMUH 2015

DEFINISI

Kepala bayi telah dilahirkan tetapi

bahu

tertahan di panggul ibu (simfisis pubis)

sehingga badan bayi tidak dapat


dilahirkan Turtle sign

Dapat terjadi baik pada persalinan spontan

ataupun dengan bantuan alat (vakum atau


forsep)
Walaupun kepala telah dilahirkan, bayi tetap

tidak dapat bernapas karena dada masih

tertekan di rongga panggul ibu dan tali


pusat akan tertekan oleh tubuh bayi

Bahu tertahan di simfisis pubis

FAKTOR RISIKO
Makrosomia ( > 4000 gram)

Diabetes gestasi
Riwayat distosia bahu sebelumnya

Induksi persalinan
Partus lama

Anatomi panggul abnormal


Kehamilan lewat waktu

Pendek

KOMPLIKASI
BAYI
Kerusakan saraf (brachial plexus injury) : !0%

Pleksus brachial berfungsi untuk gerakan dan sensasi pada

lengan, jika terjadi distosia bahu dapat menyebabkan


kerusakan pada saraf tersebut : paralisis, bisa berlangsung
sementara ataupun menetap
Fraktur lengan atau klavikula

Kerusakan otak
Kematian bayi

IBU
Robekan vagina (derajat III/IV)
Fistula rektovaginal
Perdarahan
Gangguan emosional
Trauma pada simfisis pubis (diatesis) dengan atau tanpa

neuropati femur
Ruptur uteri

PENANGANAN
Kasus emergensi
Tidak bisa ditangani sendiri

THE HELPERR MNEMONIC H


H : Call for help.
E : Evaluate for episiotomy.
Episiotomy should be considered throughout the management of

shoulder dystocia but is necessary only to make more room if rotation


maneuvers are required. Shoulder dystocia is a bony impaction, so

episiotomy alone will not release the shoulder. Because most cases of
shoulder dystocia can be relieved with the McRoberts maneuver and

suprapubic pressure, many women can be spared a surgical incision

L : Legs (the McRoberts maneuver)


This procedure involves flexing and abducting the maternal hips,

positioning the maternal thighs up onto the maternal abdomen.


This position flattens the sacral promontory and results in
cephalad rotation of the pubic symphysis. Nurses and family
members present at the delivery can provide assistance for this
maneuver.

P : Suprapubic pressure

The hand of an assistant should be placed suprapubically over the


fetal anterior shoulder, applying pressure in a cardiopulmonary
resuscitation style with a downward and lateral motion on the
posterior aspect of the fetal shoulder. This maneuver should be
attempted while continuing downward traction.

Animasi Perasat Massanti & Rubin

E : Enter maneuvers (internal rotation)

Rubin Manoeuvre : The accoucheurs hand is inserted

into the vagina and digital pressure is applied to the posterior


aspect of the anterior shoulder pushing it towards the fetal chest.

This rotates the shoulders forward into the more favourable


oblique diameter. Attempt delivery.

MANUVER RUBIN
Mengecilkan diameter antero posterior

bahu (bagian posterior bahu atas


didorong ke arah dada sambil ditekan
ke bawah/inferior,)
Episiotomi
Tahan (bukan mendorong) fundus uteri
agar bayi tidak terdorong ke arah
fundus

RUBIN MANUEVRE

Woods Screw Manoeuvre

While maintaining pressure as above, the accoucheur


introduces their second hand and locates the anterior aspect
of the posterior shoulder. Pressure is applied to rotate the
posterior shoulder. Attempt delivery once the shoulders move
into the oblique diameter. If this movement is unsuccessful
continue rotation through 180 and attempt delivery.

WOODS CORKSCREW
MANEUVER

Reverse Woods Screw Manoeuvre

Apply pressure to the posterior aspect of the


posterior shoulder and attempt to rotate it through 180 in
the opposite direction to that described in the Wood Screw
manoeuvre.

R : Remove the posterior arm.

Removing the posterior arm from the birth canal also


shortens the bisacromial diameter, allowing the fetus to drop into
the sacral hollow, freeing the impaction. The elbow then should be
flexed and the forearm delivered in a sweeping motion over the
fetal anterior chest wall. Grasping and pulling directly on the fetal
arm may fracture the humerus.

R : Roll the patient.

The patient rolls from her existing position to the all-

fours position. Often, the shoulder will dislodge during the act
of turning, so that this movement alone may be sufficient to

dislodge the impaction. In addition, once the position change is


completed

Zavanelli maneuver
Cephalic replacement followed by cesarean delivery; involves rotating the fetal head into a

direct occiput anterior position, then flexing and pushing the vertex back into the birth

canal, while holding continuous upward pressure until cesarean delivery is accomplished.
Tocolysis may be a helpful adjunct to this procedure, although it has not been proved to
enhance success over cases in which it was not

Symphysiotomy
Intentional division of the fibrous cartilage of the symphysis pubis under local anesthesia

has been used more widely in developing countries than in North America. It should be
used only when all other maneuvers have failed and capability of cesarean delivery is
unavailable

PENCEGAHAN

Rencanakan SC bila curiga makrosomia

Induksi persalinan sebelum postterm

Mengontrol kenaikan berat badan ibu dengan mengatur

pola makan dan kadar gula darah