GROUP 13-B

NESHA PRATIWI YULIA MERITA S. P. APRILIA ADELIA P. WIRA LESTIANI ALIF SALSABILA FADEL ABDUSSABIL A HARIST TAMPUBOLON SATIA BAMA A/P KARAPPIAH 1210313018 1210311022 1210312040 1210312068 1210312093 1210312105 1210312113 1210314003

FAKULTAS KEDOKTERAN UNIVERSITAS ANDALAS

2013

Terminology
1 . Straining : efforts for stronger contractions 2 . Uterine rupture : stretching of the uterus 3 . The rest of greenery : the rest / meconium released by baby 4 . Dextrose liquid : liquid meal replacement and diuretrik 5 . Extraction Forceps : artificial delivery by using a vacuum 6 . Placenta Manual : manually removing the placenta acts 7 . Episiotomy : action incision in the perineum to facilitate the birth canal 8 . Massge uterus : a massage of the uterus so that a stronger contraction 9 . Exploration : the act of observing Rahim

STEP II
1 . Why parturition is not getting ahead ? 2 . What the doctor checks the results of data interpretation ? 3 . Why urine slightly reddish ? 4 . How pathophysiology of uterine rupture ? 5 . What antibiotics are given and how to prevent infection ? 6 . Why mothers should be referred TSB ? 7 . Any indication of an elongated second stage ? 8 . what the purpose of installing and liquid dextrose infusion ? 9 . Why do forceps deliveries and other deliveries made in what ? 10 . Why do episiotomies and how ? 11 . How do I perform uterine massage 12 . Why after suturing complications arise ? 13 . What kind of bleeding and its causes ? 14 . Why patients mengis ? 15 . What are the effects of artificial birth ? 16 . How can governance elongated second stage ? 17 . Why doctors confirmed she fully recovered emotion they will be the new home? 18 . What is the relationship of age and number of pregnancies ? 19 . How to influence labor THP urinary system and defecation ?

STEP III
1 . Is dystocia , occurs as a result of : - Abnormalities of maternal encouragement contraction - Presentation of fetal abnormalities - Abnormalities of maternal pelvic bones - Abnormalities of the soft tissues of the birth canal 2 . Interpretation of data from all normal emeriksaan 3 . Urine redness due to uterine rupture : a mother straining resulted in ureteral pressure and burst 4 . The cause of rupture of the uterus : uterine laceration / diskontinuinitas wall of uterus due to excessive tensile miomerium 5 . Antibiotics : penicillin dibeikan because there is meconium to prevent infection and sterile delivery room 6 . Reference for : uterine rupture and the fetus is still in the abdominal cavity 7 . Multiparous meningkatna risk > 1 hour second stage Nulliparous > 2 hours the second stage 8 . Because pushing up energy and cause fatigue , infusion will replace the fluids that have been lost and provide nutrients

9 . Inidikasi use - mother : eclampsia , preeklampsi and uterine rupture - fetus : stop rotation time : the second stage of labor extends 10 . Incision in the perineum to widen the birth canal there are 3 : median , lateral and lateral media . Commonly used is the median . Dilakuakan SSAT tipisdan perineum already given anesthesia 11 . Uterine Massage : rotary motion in the abdomen in order to stimulate abdominal contractions 12 . Because kontrkasi still weak namum fundus is still above 13 . a.robekan birth canal b.retensio placenta : birth canal retention c . uterine inversion - retained placenta 14 . - factor hormone oxytocin demographic factors - experience of childbirth background - psychosocial

15 . The effect : the mother : bleeding

Healing old wounds Fetus : the use of forceps extraction 16 . Governance : remove the baby quickly to prevent hypoxia and extraction using forceps 17 . - In order to prevent infection - due to uterine rupture resulting in injury to the pelvic floor muscles and result in urinary incontinence 18 . Multiparous meningkatna risk > 1 hour second stage Nulliparous > 2 hours the second stage 19 . Childbirth impact on urinary system - uterus will press on the ureter urinary system - fetus also suppress urinary system - urethral urinary retention causing edema

LO 1 Pathology of Birth
Dystocia is a delay or difficulty in the course of labor - Can be caused by abnormalities of his ( his hypotonic and hypertonic his ) , because of abnormalities of the children , the child form (hidrocefalus , conjoined twins , cord prolapse ) , the location of the child ( breech , transverse layout ) , as well as abnormalities of the birth canal

1 . DYSTOCIA BECAUSE HIS DISORDERS His abnormality can be hypotonic uterine inertia or hypertonic uterine inertia . a. Hypotonic uterine inertia His is a disorder with the power of the weak / inadequate to perform the opening of the cervix or push the child out. Hypotonic uterine inertia divided into two , namely : + Primary uterine inertia Occurs at the beginning of the latent phase . Since the beginning there has been inadequate his ( his weakness arising from the beginning of labor ) , so it is often difficult to ascertain whether the patient has entered a state of inpartu or not .

+ Secondary uterine inertia Occurs in the active phase of the first stage or the second stage . The beginning of his good , then the next state are distractions / abnormalities . b . Hypertonic uterine inertia His disorder with a large enough force ( sometimes to exceed normal ) but there is no coordination of the contraction of the top , middle and bottom of the uterus , so it is not efficient to open the cervix and push the baby out . Also referred to as uterine incoordinate action . Examples such as " uterine tetania " because of excessive uterotonic drugs . Patients feel pain because of his strong and lasted almost constantly . In fetal fetal hypoxia can occur due to impaired uteroplacental circulation . Factors that could cause these abnormalities include stimulation of the uterus , such as excessive oxytocin , prolonged rupture of membranes with infection , and so

2 . DYSTOCIA DISORDERS DUE TO LAY a) Location of Breech Fetal breech is located aft with head in the fundus uteri and buttocks under section uterine cavity . b ) Umbilical Cord Prolapse Namely cord lay on or passing through the lowest part of the fetus after rupture of membranes . When rupture of membranes has not called cord cutting edge . In case of cord prolapse ( umbilical cord menumbung ) incurred great danger , pinched umbilical cord at the time of passage of the fetus down in the pelvis , causing fetal asphyxia . Easy cord prolapse occurs when the rupture time leading part of the fetus is still above the PAP and not entirely shut down as was the case in labor ; hydramnios , there is no balance between the large head and pelvis , premature , the location of the abnormality .

II.DYSTOCIA ROAD BECAUSE OF BIRTH DISORDERS Dystocia due to abnormal birth canal can be caused by abnormalities in the hard tissue / pelvic bone , or soft tissue abnormalities in the pelvis .

a) dystocia due to abnormal pelvic / hard part

Can be: 1 . Pelvic deformity abnormal gynecoid , for example pelvic types Naegele , rickets , scoliosis , kyphosis , Robert and others . 2 . Abnormalities of the size of the pelvis . Narrow pelvis (pelvic contaction ) . Narrow pelvis called when size 1-2 cm less than normal size

b ) Abnormalities of the soft birth canal

Are abnormalities of the cervix uteri , vagina , hymen and other circumstances of the birth canal that blocks the smooth delivery . 1.Distosia Servic Obstruction of the progress of labor is caused by abnormalities in the cervix uteri . Although to be normal and well , sometimes - sometimes the surface of the cervix become bogged down because there are abnormalities that do not cause the cervix to open . There are 4 types of abnormalities in the cervix uteri : The cervix stiff (rigid cervix ) The cervix hanging ( hanging cervix ) Konglumer cervix ( cervical conglumer Edema cervix 2. hymen and vagina Hymen rigid , thick

LO 2 Postpartum Hemorrhage

Early
Occurs when blood loss is greater than 500 ml. in the first 24 hours after a vaginal delivery or greater than 1000 ml after a cesarean birth

*Normal blood loss is about 300 - 500 ml.)

Late
Hemorrhage that occurs after the first 24 hours

Main Causes of Early Hemorrhage are:

Uterine Atony Lacerations Retained Placental Fragments Inversion of the Uterus Placenta Accreta Hematomas

Uterine Atony
The myometrium fails to contract and **The myometrium fails to contract and theuterus uterus fills fills with with blood ofof the bloodbecause because the lack of pressure on the open the lack of pressure on the vessels of the placental site open blood
vessels of the placental site.

Uterine Atony Predisposing Factors

Prolonged labor Overdistention of the Uterus

Trauma due to Obstetrical Procedures Grandmultiparity

Intrapartum Stimulation with Pitocin

Excessive use of Analgesia / Anesthesia

Post Partum Hemorrhage Lacerations

PREDISPOSING

FACTORS

1. Spontaneous or Precipitous delivery 2. Size, Presentation, and Position of baby 3. Contracted Pelvis 4. Vulvar, cervical, perineal, uretheral area and vaginal varices

Signs

and Symptoms

1. Bright red bleeding where there is a steady trickle of blood and the uterus remains firm. 2. Hypovolemia

Inversion of the Uterus

The

uterus inverts or turns inside out after delivery. Complete inversion - a large red rounded mass
protrudes from the vagina

Incomplete
but felt

inversion - uterus can not be seen,

Predisposing
**Dont

Factors:

Traction applied on the cord before the placenta has separated.

pull on the cord unless the placenta has separated. use the fundus to push the placenta

Incorrect traction and pressure applied to the fundus, especially when the uterus is flaccid
**Dont

out

Placenta Accreta

Signs:
During the third stage of labor, the placenta does not want to separate. Attempts to remove the placenta in the usual manner are unsuccessful, and lacerations or perforation of the uterus may occur

LO 3 Treatments
1. Dystocia a. His Disorders - Do symptomatic treatment to reduce muscle tone , pain , reduce fear . Fetal heart rate should continue to be evaluated . If this way does not work, labor must end with a cesarean sectio . - General state of the patient must be repaired . Nutrition during pregnancy should be note . b. Dystocia Disorders Due To Lay - If fetal weight 3500 g or more , particularly in primigravid or multiparous with a history of giving birth less than 3500 g , cesarean sectio preferable .

2. Dystocia Road Because Of Birth Disorders

- excision hymen ( hymen ) Vaginal Septa Circular Anteris - posterior handling : - Do excision wherever possible so that delivery runsmooth - If tough and too wide , it is recommended to perform sectio Cesaria

LO 4 Postpartum Psychiatric Disorders

Mental Health problems can complicate the puerperium. There are days when each new mother may feel inadequate, but the mother who has a constant feeling of inadequacy needs professional counseling.

Pregnancy alone is not a cause of a psychiatric Illness; however, the psychological and physiological stressors relating to pregnancy may bring on an emotional crisis

Mood Disorders
The

Most common Mood Disorders are:

Baby Blues

Postpartum Depression Bipolar Disorder

Baby blues
50-80% of moms are affected Self-limiting (up to 10 days) Cause

Seems to be related to changes in progesterone, estrogen, and prolactin levels

Symptoms
Tearful yet happy overwhelmed

Treatment

Postpartum Major Mood Disorder Postpartum Depression

Risk

factors:

Primiparity History of postpartum depression Lack of social and relational support

Clinical

therapies

Counseling and support groups Medication (usually SSRIs) Childcare assistance

Postpartum Psychosis
Predisposing

factors

Similar to those of postpartum depression

Assessments

Grandiosity Decreased need for sleep (insomnia) Flight of ideas Psychomotor agitation/hyperactivity Rejection of infant

Treatment for mood disorders

Drug therapy Psychotherapy Explain the importance of good nutrition and rest Reintroduce the mother to the baby at the mothers own pace

LO 5 Uterine Rupture
Rare: 0.04% of deliveries. Risk factors include: Prior C/S: up to 1.7% of these deliveries. Prior uterine surgery. Hyperstimulation with oxytocin. Trauma. Parity > 4.

Uterine Rupture
Risk factors include: Epidural. Placental abruption. Forceps delivery (especially mid forceps). Breech version or extraction.

Uterine Rupture
Sometimes found incidentally. During routine exam of uterus. Small dehiscence, less than 2cm. Not bleeding. Not painful. Can be followed expectantly.

Uterine Rupture before delivery

Vaginal bleeding. Abdominal tenderness. Maternal tachycardia. Abnormal fetal heart rate tracing. Cessation of uterine contractions.

Uterine Rupture after delivery

May be found on routine exam. Hypotension more than expected with apparent blood loss. Increased abdominal girth.

Uterine Rupture
When recognized, get help. ABCs. IV fluids. Surgical correction.

LO 6 Retained Placental Fragments

This occurs when there is incomplete separation of the placenta and fragments of placental tissue retained.

Signs

Boggy , relaxed uterus Dark red bleeding D&C Administration of Oxytocins Administration of Prophylactic antibiotics

Treatment