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Deviana S. Riu
Bagian OBGIN FK UNHAS
DEFINISI
Kepala bayi telah dilahirkan tetapi bahu tertahan di panggul ibu (simfisis pubis) sehingga badan bayi tidak dapat
tidak dapat bernapas karena dada masih tertekan di rongga panggul ibu dan tali pusat akan tertekan oleh tubuh bayi
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
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
P : Suprapubic pressure
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
RUBIN MANUEVRE
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.
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.
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
The patient rolls from her existing position to the all-fours position. Often, the shoulder will dislodge during
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
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
Induksi persalinan sebelum postterm Mengontrol kenaikan berat badan ibu dengan