KEGAWATDARURATAN OBSTETRI

DAN KELAINAN GINEKOLOGI

PRODI SARJANA KEBIDANAN
FAKULTAS KESEHATAN
UNIVERSITAS SARI MULIA
 DETEKSI DINI DAN
PENANGANAN AWAL GADAR
KALA I PERSALINAN

By. Sismeri Dona, M.Keb

VISI MISI
UNIVERISTAS SARI MULIA

VISI MISI FAKULTAS KESEHATAN

VISI MISI
PRODI SARJANA KEBIDANAN

D
D D
D
D
 01 DARING

ACTIVITY 02 PROBLEM BASED

LEARNING

05 TASK
Tujuan Pembelajaran

Memahami deteksi dini dan penanganan

awal gadar pada Kala I persalinan
1. Prolonged labour
2. Malposition & malpresentasi
3. Premature Rupture of membran
 POWERS
His
Kekuatan Ibu

KRITIKAL
PERSALINAN PASSAGE
Jalan Lahir / panggul ibu

PASSENGER
The fetus (malposition / malpresentation)

Psikologi ibu, Penolong

KALA I PERSALINAN
Duration
Primip. 6-18
Multip. 2-10
 DISTOCIA - PASSAGE

Friedman also described four abnormal patterns of labor:

(1) Prolonged latent phase.

(2) Protraction disorders (protracted active phase dilatation and

protracted descent).

3) Arrest disorders (prolonged deceleration phase, secondary arrest

of dilatation, arrest of descent, and failure of descent).

(4) Precipitate labor disorders.

KELAINAN PADA LAMA KALA I
Primipara Multipara
Prolonged latent phase (Normal mean = 6.4 h) (Normal mean = 4.8 h)

>20 h >14 h

Protracted dilatation <1.2 cm/h <1.5 cm/h

Protracted descent <1 cm/h <2 cm/h
Protracted 2nd stage (Normal mean = 50 min)
>2 h (+1 h)
(Normal mean = 20 min)
>1 h (+1 h)

Arrest of dilatation >2 h >2 h

Arrest of descent >1 h >1 h
Precipitate labor <3 h from onset of
contractions
 DISTOCIA - PASSAGE

Inlet

Mid-pelvis

Outlet
Current Diagnosis & Treatment Obstetrics & Gynecology - 10th Ed. (2007)
 DISTOCIA - PASSAGE
¨ Bony pelvis
- Gynecoid (50%)
- Android (33% white, 15% black)
- Anthropoid (50% black, 20% white)
-Platypelloid (<3%)
 DISTOCIA - PASSAGE
Classification:
• Contraction of the pelvic inlet
• Contraction of the mid-pelvis and pelvic outlet
• General contraction of the pelvis traumatic fracture, rickets,
chondrodystrophic dwarfism,
• Pelvic deformities kyphosis & scoliosis,
exostosis, bone neoplasia
DISTOCIA - PASSAGE
¨ Conjugate
- diagonal (<11.5) Pelvimetry
- obstetric (<10 cm) ✔ X-ray
- true
✔ US
¨ Transverse diameter (<12 cm)
✔ MRI
¨ Interspinous diameter (<8 cm)
✔ Clinical pelvimetry

¨ Intertuberous diameter (<8 cm)

DISTOCIA - PASSAGE
• Jaringan lunak jalan lahir (uterine or vaginal congenital
anomalies, bekas luka pada jalan lhir )

• Massa pada opanggul/ neoplasia

• Letak Placental (plasenta letak rendah / previa)

DISTOCIA - PASSAGE

• Bandl’s retraction ring & Uterine rupture

• Fistula Vescicovaginal & rectovaginal

• Cedera pada dasar panggul

 DISTOCIA - POWER
• Normal contractions
- Kontrasksi dominasi di Fundal, Intensity >24 mmHg (40-60 mmHg) Frequency
3-5/10 min, teratur semakin lama semakin sering

• Hypotonic (sering terjadi pada Primipara)

(causes: sedative yang berlebihan, over distensi uterus spt pada kehamilan
kembar, polihidramion à pemberian oksitoksin)

• Hypertonic dan un Uncoordinate dysfunction

sering terjadi bersamaan ditandai dengan fundus tetap tinggi, dan kontraksi
seing serta intens.
(causes: abruption, oxytocin, CPD, fetal malpresentation, latent phase of labor)
Jika terjadi pada fase laten à sedative à Kala II à Vacum
DISTOCIA - POWER
 Dystocia
Precipitate labor
• <3 h from onset of contraction

Primipara Multipara
• Precipitate dilatation >5 cm/h 10 cm/h

• Causes:
Extremely strong contractions
low birth canal resistance
Oxytocin (+ associate with placental abruption)

• Treatment:
Stop oxytocin
beta mimetics (terbutaline / ritodrine)
No-risk childbirth?
What happens to maternity
care when we attempt to
eliminate all risks?
 REFERENSI
1. https://www.obgproject.com/2017/12/29/acog-guidance-update-
diagnosis-management-prom-prelabor-rupture-membranes/
2. Sanjay Singh*, Uttara Aiyer Kohli, Shakti Vardhan I Management of
prolonged second stage of labor nternational Journal of Reproduction,
Contraception, Obstetrics and Gynecology Singh S et al. Int J Reprod
Contracept Obstet Gynecol. 2018 Jul;7(7):2527-2531 www.ijrcog.org .
DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182855
3. https://www.sciencedirect.com/science/article/pii/S1751721412000425
THANK YOU
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