Bagian Obstetri & Ginekologi

Fakultas Kedokteran Universitas Muslim Indonesia

CATATAN PERSALINAN
1. Tanggal : - - Penolong Persalinan :...................................................................................................................
2. Tempat Persalinan : Rumah Klinik Puskesmas Lainnya : ....................................................
3. Alamat tempat persalinan......................................................................................................................................................................

KALA I
4. Partogram melewati garis waspada
5. Lain-lain, sebutkan :...........................................................................................................................................................................
6. Penatalaksanaan yang dilakukan pada masalah tersebut:.....................................................................................................................
7. Bagaimana Hasilnya ?.............................................................................................................................................................................

Kala II
8. Lama kala II :...........Menit Episiotomi : Tidak ya, Indikasi.......................................................................................
9. Pendamping pada saat persalinan: Suami Keluarga Teman Dukun Tidak ada
10. Gawat janin : Miringkan Ibu ke sisi kiri n Minta Ibu menarik napas Episiotomi
11. Distosia Bahu: Manuver McRobert Ibu merangkak Lainnya.........................................................................................
12. Lain-lainnya, sebutkan:............................................................................................................................................................................
13. Penatalaksanaan yang dilakukan untuk masalah tsb : ...........................................................................................................................
14. Bagaimana hasilnya ?..............................................................................................................................................................................

KALA III
15. Lama kala III : ..........Menit Jumlah perdarahan :...................ml
a. Pemberian Oksitosin 10 U i.m <2 menit ? ya tidak, alasan:.....................................................................................
Pemberian ulang Oksitosin (2x)? ya, Alasan :...............................................................................................................
b. Penegangan tali pusat terkendali ? ya tidak, alasan:.....................................................................................
c. Masaase fundus uteri ? z ya tidak, alasan:.....................................................................................
16. Laserasi perineum, derajat :.................. Tindakan: Penjahitan dengan/tanpa (*) ananstesi
17. Atonia Uteri : kompresi bimanual intern metal ergometri 0,2 mg Im Oksitosin drip
18. Lain-lain, sebutkan :.................................................................................................................................................................................
19. Penatalaksanaan masalah tersebut :......................................................................................................................................................
20. Bagaimana hasilnya :...............................................................................................................................................................................

Bayi Baru Lahir

21. Berat badan .................gram, Panjang ....................cm Jenis Kelamin: L/P (*) Nilai APGAR .........................................
22. Pemberian ASI 1 jam : __ Ya __Tidak, Alasan ................................................................................................................
23. Bayi lahir pucat/biru/lemas : __Mengeringkan __Menghangatkan __Bebaskan jalan nafas
__Stimulasi Rangsang taktil __Lain-lain, sebutkan :.............................................
24. Bayi lahir pucat/biru/lemas : __Mengeringkan __Menghangatkan _ Bebaskan jalan nafas
25. __Cacat bawaan, sebutkan : ...............................................................................................................................................................
26. __lain-lain, sebutkan : ...............................................................................................................................................................
27. Penatalaksanaan yang dilakukan untuk masalah tersebu .......................................................................................................................
28. Bagaimana hasilnya ? ..............................................................................................................................................................

Pemantauan Kala IV persalinan

Jam Tekanan Temper- Kontraksi Kandung

Waktu Nadi Tinggi Fundus Uterus Perdarahan
ke darah atur Uterus Kemih
1

Masalah kala IV :...........................................................................................................................................................................................

Penatalaksanaan yang dilakukan untuk masalah tersebut :.........................................................................................................................
Bagaimana hasilnya ?...................................................................................................................................................................................