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Persalinan Kala II Lama

Persalinan Kala II Lama

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Dipublikasikan oleh Adi Kristanto

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Published by: Adi Kristanto on Jun 05, 2011
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PENSÆLtNÆN MÆLÆ tt

LÆMÆ
0:./
~«. <-.::+-:-
_ooozoa 9osos
ÞIKÐðH0L0ðK
W PersuIinun proses mekunik
W ßiIu wuktu persuIinun memun|unq muku
disebut kuIu II Iumu
|unin Tenuqu ibu
ÞIKÐðH0L0ðK
Þenyebub utumu kulu ll lumu
e Þuttenner
e Þeluit utuu puttune
e Þower
e lntidenti z,8 ~ 4,9%
e komplihuti pudu ibu dun iunin
ÐIffKfIf
KaIa pengeIuaran janin yang dimuIai
sejak pembukaan Iengkap hingga janin
Iahir dan berIangsung 22 jam untuk
primigravida dan 21 jam untuk
muItipara
E4tofogt
e Hit yunn tiduh udehuut
e Fuhtor iunin
e Fuhtor iulun luhir
e Fuhtor penolonn
e Þrimituu
e Þerut nuntunn, nrundemultipuru
e ketubun pecuh dini
6FJAlA KlltlS
!ada Ibu
W eIisah
W Letih
W Suhu badan
meningkat,
berkeringat,
W Nadi cepat,
pernafasan cepat
dan meteorismus.
Di daerah IokaI
sering ditemui :
W BandI
W Edema vuIva
W Edema cerviks
W Cairan ketuban
berbau
W Terdapat mekonium.
6FJAlA KlltlS
Þudu Iunin
e 0enyut iuntunn iunin ceput/tiduh terutur
buhhun {-), uir hetubun hentul,
hehiiuuun, berbuu dun terduput
mehonium
e kuput tuhtudeneum yunn betur
e Muulune hepulu yunn hebut
e kemutiun iunin dulum hundunnun
e kemutiun iunin intru purtum
Ðfð0K0IfI
Þembuhuun ceruih yunn lennhup tunpu
ditertui hemuiuun pertulinun ·z ium
untuh priminruuidu dun ·t ium untuh
multipuru ditertui tindrom pudu ibu dun
unuh
HomµIIAaiI
e Ierhudup ibu bitu mennuhibuthun :
~ lnfehti tumpui teptit
~ Atidotit dun nunnnuun elehtrolit
~ 0ehidruti, tyoh dun henunulun funnti ornun
~ Robehun iulun luhir
~ Fittulu buli-buli, uuninu, ruhim dun rectum
HomµIIAaiI
Þudu iunin :
e 0uwut iunin tumpui meninnnul dulum
ruhim
e Luhir dennun utfihtiu berut tehinnnu
duput menimbulhun cucut otuh menetup
e Iruumu pertulinun, fruhtur tulunn dudu,
lennun, huhi, hepulu
!03,9,,8,3,,3
e Memperbuihi heuduun umum
e Mennuhhiri pertulinun ternuntunn tebub
dun iunin hidup utuu muti
e Þenunnunun hhutut
%0zmtaost 90omtIoa
lnertiu uteri
e CÞ0 {-)
e Þecuhhun hetubun
e ketubun belum pecuh drip ohtitotin s
tutuun dlm lur nluhotu s% tz-so tetet/',
tetetun dinuihhun perluhun tumpui hit
udehuut
e £uuluuti z ium
%0zmtaost 90omtIoa
Fuhtor iunin
e Iunin betur dun punnnul yunn tempit IC
e Mulpretentuti, mulpotiti penunnunun
hhutut
Fuhtor iulun luhir
e keluinun punnnul
e Þunnnul tempit
IC
%0zmtaost 90omtIoa
Iunin hidup utuu muti
e Þembuhuun lennhup dun
tyurut peruuninum
terpenuhi
e Þembuhuun belum lennhup
dun tyurut peruuninum
tiduh terpenuhi
uuhum/forcept/e
mbriotomi
IC
Fowuw=uwuw MHunun
kulu ll memuniunn
e Mulpretentuti dun/utuu tuh udu
hemuiuun penurunun hepulu
Fowuw=uwuw MHunun
e Iihu hepulu < t/s diutut timfitit pubit utuu
buniun tulunn hepulu di ttution {o) luhuhun
ehttruhti uuhum utuu forcept
e Iihu hepulu unturu t/s-s/s diutut timfitit pubit
utuu buniun tulunn hepulu di ttution {o)
tumpui {-z), luhuhun ehttruhti uuhum, iihu
operutor hetulitun diluhuhun tinduhun IC
e Iihu hepulu × s/s diutut timfitit pubit utuu
buniun tulunn hepulu ti ttution {-z) luhuhun IC
'uHuw BHn#uuHnI
Iinduhun pertulinun buutun dimunu
iunin diluhirhun dennun ehttruhti tenunu
nenutif {uuhum) di hepulunyu
fKÐfKðIf
e Þenyuhit iuntunn pd ibu
e 0uwut iunin
e kulu ll lumu
K0KT0ð fKÐfKðIf
e Ruptur uteri
e Mulpretentuti
e Þreterm
'uHuw BHn#uuHnI
Iyurut-tyurut
e Þembuhuun teruiht lennhup
e Iiduh udu ditproporti tefulopeluih
e Adu hit/tenunu menneiun
e ketubun tuduh pecuh/dipecuhhun
e kepulu iunin tuduh berudu di Hodne lll+
ennuned
MowpIIHunI 'B
lbu
e perduruhun uhibut
utoniu
uteri/truumu
e truumu iulun luhir
e infehti
Buyi
e £hthoriuti hulit hepulu
e Ieful hemutomu,
tubnuleul hemutomu
e Nehrotit hulit hepulu
e Þerduruhun
intruhruniul
e Iuundice
e Fruhtur hluuihulu,
herutuhun N vl dun vll
'uHuw BHn#uuHnI
kriteriu teriudinyu henunulun duri
tinduhun uuhum ehttruhti uduluh:
e 0ulum ½ ium truhti tiduh berhutil
e Munnhuh {cup) terleput s huli
FowmoEuE Mo=u=uIuw 'B
e Ienunu uuhum yunn
terlulu renduh
e Iehunun nenutif
dibuut terlulu ceput
e Ieluput hetubun
melehut
e Buniun iulun iuhir
teriepit
e koordinuti tunnun
hurunn buih
e Iruhti terlulu huut
e Cucut ulut
e 0itproporti
tefulopeluih yunn
tebelumnyu tiduh
dihetuhui.
LðÞ00ðK KðI0I
l. ldentitut
Numu : Ny. R Numu tuumi : In. Þ
0mur : z8 thn 0mur : ss thn
Anumu : ltlum Anumu : ltlum
Iuhu : Buniur Iuhu : Buniur
Þeheriuun: lRI Þeheriuun : Iwuttu
LðÞ00ðK KðI0I
e Alumut : Il. Ioetoyo I. 00. Þurnuwiruwun
RI ze Buniurmutin
e MRI : zt Iuli zoo8
e RMk : z9 s9 8s
Mefuhan M4ama:
Inqin meIuhirkun
##
e ] t huri IMRI, ot menneluh tuhit perut
yunn hemudiun ditertui heluurnyu lendir.
e 0t perni he bidun dun dihutuhun
mennulumi pembuhuun t cm.
e ] s ium IMRI di rumuh bidun, hetubun
pecuh tendiri dun ot dipimpin untuh
meluhuhun pertulinun hurenu dihutuhun
pembuhuun teluh lennhup
##
e Riwuyut Þenyuhit 0uhulu
Iiduh udu riwuyut hipertenti, diubetet
mellitut, dun utmu.
e Riwuyut Huid
Menurche umur tz tuhun, tihlut huid so
huri, terutur, lumu z huri, tiduh udu
nyeri huid. HÞHI : s-to-zooz, IÞ: tz-z-
zoo8
##
e Riwuyut kontrutepti
kontrutepti tuntih tiup s bulun tlm s thn
e Riwuyut Þerhuwinun
kuwin t huli, lumu perhuwinun z tuhun.
e Riwuyut 0bttetri
0zÞtAo :
l. zooz/rmh bidun/uterm/Þr/z8oo/hdp
ll. zoo8/tehurunn
FowouIHnuuw VInIH
e k0 :tumpuh buih
e ketudurun :compotmentit
Iundu uitul
e Iehunun duruh : too/zo mmHn
e Nudi : 8o x/menit
e Þernuputun : zo x/menit
e Iuhu : se,s oC
FowouIHnuuw VInIH
e BB: sz hn
e IB : t4z cm
e kepulu/leher: dulum butut normul
e Ihorux : dulum butut normul
e Abdomen: tetuui ttutut nineholonih
e £httremitut : dulum butut normul
ÞIMI0fKIððK 00ITIT0f :
lntpehti : Þerut tumpuh membuncit utimetrit
Þulputi :
e Leopold l : fundut uteri terubu z iuri di
buwuh Þx {IF0 = sz cm)
e Leopold ll : memuniunn, punnnunn hunun
e Leopold lll : pretentuti hepulu
e Leopold lv : s/s.
e Hit : sx/to'/so-ss*
e IBI : szss nrum
ÞIMI0fKIððK 00ITIT0f :
Authultuti : 0II tse x/menit.
vuninul Iouche :
e portio tiduh terubu, uruh mendutur,
hetubun {-)
e Þembuhuun lennhup
e Buniun hepulu terbuwuh di Hodne lll +.
ketun Þunnnul : luut
lA6t0SlS
Þ1ð0, HðMfL 40-41 MfK000 fK Þð0T0
KðLð ff LðMð ÷ Þ0WI0 f00 K00ðK0.
IðKfK T0K00ðL, HfÐ0Þ, fKT0ð 0TI0fK,
Þ0IIIKTðIf KIÞðLð
Fowu#uIuHnuwuuw
e lvF0 RL
e Cefotuxim t nr
e Þerceput hulu ll dennun uuhum ehttruhti
_ooozoa goztos
e 0iunnotu Þre v£ : 0zÞt-tAo, humil 4o-4t
minnnu in purtu hulu ll lumu + inertiu
uteri tehunder. IIHl0, pretentuti hepulu.
e Iunnnul tinduhun : zt Iuli zoo8
{Þuhul os.zo t/d os.4s WlIA)
e Ienit Anetteti : Locul Anetteti
e 0perutor : dr. Muriunu
e Buyi : Lh/s-s-z/sooonr/sscm
gost goztos
Ierupi pott purtut
~lvF0 0s%
~lniehti Cefotuxim s x t nrum {lv)
~Atum mefenumut tub soo mn s x t {p.o)
~vit B complex tub z x t {p.o)
~vit C tub z x t {p.o)
Tgl
SOAP
21 22 23
Subjektif
Nyeri
Perdarahan
Mobilisasi
+
+
+
<
<
+
<
<
+
Objektif
TD (mmHg)
Nadi (x/menit)
RR (x/menit)
Temperatur (
o
C)
FU teraba 1 jari bwh pusat
Kontraksi uterus
120/80
80
22
37
+
baik
120/80
80
22
36.5
+
baik
120/80
80
20
36.5
+
baik
Assesment P2A0 post VE ai kala II lama 1THIU pres kepala
Penatalaksanaan
IVFD D5º
Inj. Cefotaxim 3 x 1 (IV)
Cefadroxil tab 3 x 500 mg
Asam mefenamat tab 3 x 500 mg
Vit B comp tab 2 x 1
Vit C tab 2 x 1
+
+
-
+
+
+
-
+
-
+
+
+
-
-
+
+
+
+
MRHUH
e kulu ll lumu lebih duri s ium
e Iiduh udu ruptur uteri
e Þembuhuun teruiht lennhup
e Hit {+), sx/to mnt tlm so-ss detih
e ketubun tuduh pecuh
e Iiduh udu ditproporti tefulopeluih
e kepulu iunin berudu di Hodne lll+ ennuned
e Þretentuti hepulu
e kemunnhinun udu nuwut iunin
Fowu#uIuHnuwuuw
e vuhum ehttruhti
e Þerbuihi heuduun umum
e Antibiotih
e Anulnetih
e Iuplemen multiuitumin
!FtuTu!
e Ieluh diluporhun putien wunitu utiu z8
tuhun dennun diunnotu 0zÞtAo humil
4t-4z minnnu in purtu hulu ll lumu +
inertiu uteri tehunder. IIHl0 pretentuti
hepulu. Þudu penderitu ini diluhuhun
pertulinun tecuru uuhum ehttruhti.

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