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1.1 Anatomical Concepts of Physiology of the Female Reproductive System

1.1.1 Anatomy of the Physiology of the Female Reproductive System

Anatomy of the external reproductive system: Mons pubis / Mons pubis / mons veneris
Fat layer in the anterior part of the symphysis of the pubic os. At
puberty this area begins to overgrow pubic hair. Labia majora
The advanced fat layer of the mons pubis down and back, many
containing venous plexus. Embryological homologies with scrotum in
men. The uterine rotundum ligament ends at the upper limit of the labia
mayora. At the lower part of the perineum, the labia mayora converges
(in the posterior commissure). Labia minora

Thin tissue folds behind the labia mayora, not having hair follicles.
There are many blood vessels, smooth muscles and nerve endings. Clitoris
consists of head / glans clitoridis located in the superior part of the
vulva, and the corpus clitoridis which is embedded in the anterior wall
of the vagina. Embryological homologies with the penis in men.
There are also androgen receptors in the clitoris. Many blood vessels
and nerve endings, very sensitive. Vestibule
Region with upper limit of clitoris, lower fourchet border, lateral border
of the labia minora. Derived from the urogenital sinus. There are 6
holes / orificium, namely external orificium urethrae, introitus vaginae,
right-left ductus glandulae Bartholinii and right-left Skene duct.
Between the fourchet and the vagina there is the navicularis fossa. Vagina
The musculomembranous cavity is tubular in shape from the cervical
edge of the uterus in the dorsal cranial to the vulva in the caudal ventral
region. The area around the cervix is called fornix, divided into 4
quadrants: fornix anterior, posterior fornix, and left and right lateral
fornix. The vagina has an elastic ventral wall and dorsal wall. Coated
with squamous epithelium, changes following the menstrual cycle. Perineum The
area between the lower edge of the vulva and the front edge of the anus.
The boundaries of the pelvic diaphragm muscles (m.levator ani,
m.coccygeus) and urogenitalis diaphragm (transversus profinealis. M,
constrictor urethra).
The perineum stretches in labor, sometimes needing to be cut
(episiotomy) to enlarge the birth canal and prevent rupture.
Anatomy of the reproductive system in Uterus
Function: place to receive, maintain and feed the fertilized ovum.
a. Fundus: located above the mouth of the uterine tube
b. Corpus: located under the uterine tube section
c. Cervix: the lower part of the corpus that narrows Faloppi Tubes

a. Receive ovum from the ovary
b. The channel through which the spermatozoa travels to reach the ovum
c. The place of fertilization (usually occurs in ampulla)
d. Provide food for the fertilized ovum and bring it to the uterine cavity Ovary
Function Ovary:
a. Develop and expel ovum
b. Produce steroid hormones Secondary

1.2 concept of long time

1.2.1 Definition
According to WHO (2001) labor is a series of events that end with the expenditures of
infants who are sufficiently 37-42 weeks old, spontaneous birth, without
complications in both the mother and fetus, followed by removal of the placenta
and fetal membranes from the body baby.

According to Prof. Dr. Rustam Mochtar, MPH (1998), the notion of prolonged
parturition is labor that lasts more than 24 hours in primigravida and more than
18 hours in multigravida.

The old second stage is labor that lasts more than 2 hours on the primi, and more than
30 minutes to 1 hour in the multi. (Synopsis Obsestetri, 2010)stage
Secondis labor with no head reduction> 1 hour for nulliparous and multiparous.
(Sarwono, 2008)

Old labor is labor that lasts more than 12 hours, both in primiparas and multiparas. Old
labor can occur with an extension of period I and / or II. (Wiknjosastro, 2010).

1.2.2 Etiology The

causes of this long labor are multicomplex and of course depend on
supervision while pregnant, good delivery help and management. The
causative factors are: Abnormalities of fetal location Pelvic abnormalities Abnormalities of his strength and
striking Wrong delivery leader Large fetus or congenital abnormalities Primi old primary and secondary Hanging stomach, grandemulti Premature rupture of membranes when the cervix is still closed,
hard and not flattened Excessive analgesia and anesthesia in the latent phase Women who are dependent, anxious and afraid of the parents
who accompany him to the hospital are candidates for prolonged

1.2.3 Signs and symptoms (clinical manifestations) Cervical opening does not pass 3 cm after 8 hours in partu The frequency and duration of contractions is less than 3
contractions per 10 minutes and less than 40 seconds Presentation abnormalities The opening of the cervix is complete, the mother wants to
strain, but there is no progress in handling I feel like I want to deal with the contraction The mother feels the pressure increases in the rectum and vagina Perinium stands out Vaginal vulva and anal sphincter appear to open Increased expenditure of blood mucus

Clinical manifestations in the mother:

Mother feels restless, tired, body temperature increases, dryness, rapid
pulse, frequent bandle circles, vulvar edema, cervical edema , the liquid
of the body smells, there is meconium.

Clinical manifestations in the fetus:

Heart rate is fast, irregular or even lost. Caput large succedaneum. Great
head Moulage. IUFD (intra uterine fetal death)
1.2.4 Pathophysiology
Second stage of labor is established by conducting an internal examination to make sure
the opening is complete or the fetal head is visible on the vulva with a diameter
of 5-6 cm. The progress of childbirth in the second stage is said to be less good
if the decrease in the fetal head is irregular on the birth canal, the failure of
expenditure in the expenditure phase. (Prawirohardjo, 2012)
Pelvic narrowing can cause prolonged labor or congestion due to an opening disorder
caused by premature rupture of membranes due to the lower part of the pelvis
over the door so that the membranes are very prominent in the vagina and after
rupture of the head the head is unable to suppress cervix because it is stuck on
the pelvic top door. Childbirth is sometimes disrupted due to soft birth defects
(genital tractus abnormalities). These disorders are in the vulva, vagina, uterine
cervix, and uterus.

His abnormality in strength or nature causes obstacles to the birth canal that are
commonly found in every birth, if it cannot be overcome it can cause labor
congestion. Whether or not he is judged by the progress of childbirth, the nature
of his own (frequency, duration, strength and relaxation) and the magnitude of
the succedaneum caput.

The birth leader who is wrong from the helper, the wrong technique, even the mother
who is tired and exhausted to deliver in the labor process can also be one of the
causes of the old second stage.
1.2.5 Pathway

1.2.6 Complications The

effects caused by prolonged labor can affect both mother and fetus.
Among them: Intrapartum
infection Infection is a serious danger that threatens the mother
and her fetus during prolonged labor, especially when
accompanied by rupture of membranes. Bacteria in the amniotic
fluid penetrate the amnion and desiccua and chorionic vessels
resulting in bacteremia, sepsis and pneumonia in the fetus due to
aspiration of infected amniotic fluid. Uterine rupture
Abnormalof the lower uterine segment poses a serious danger
during prolonged labor, especially in women with high parity
and in those with a history of cesarean section. If the
disproportion between the fetal head and the pelvis is so large
that the head is not engaged and there is no decrease, so the
lower segment of the uterus becomes very stretched which can
then cause rupture. Ring of pathological retraction
During prolonged labor constriction or local uterine ring can
occur, the most common type of band is a pathological
retraction ring. This ring is accompanied by excessive stretching
and thinning of the lower uterine segment, this ring as a
sustained abdomen and indicates a threat of rupture of the lower
uterine segment. Formation of a fistula
If the lower part of the fetus presses strongly on the pelvic top
door but does not progress for a long time, then the part of the
birth canal located between it will experience excessive
pressure. Because of circulatory disorders that can occur
necrosis that will be evident within a few days after giving birth
with the appearance of a fistula. Pelvic floor
injury Injury to the pelvic floor, innervation, or connective
fascia is an inevitable consequence of pervaginum delivery
especially if labor is difficult. Effects on the fetus in the form of kaput sucedaneum, fetal head
moulase, if continued can cause fetal distress.
1.2.7 Prognosis The
prognosis of the second stage is determined by speed in diagnosing and
treating it, the longer the parturition takes place, the greater the likelihood
of prolonged parturition and the more complications both in the mother
and in the fetus.

1.2.8 Medical Confection

Management of old parturition includes: Prevention
a. Infant birth preparation and good prenatal care will reduce the
incidence of prolonged labor.
b. Childbirth should not be forced if the cervix is immature. Mature
cervix is a cervix that is less than 1.27 cm (0.5 inches) long, has
experienced flattening, is open so that at least one finger can be
entered and soft and can be widened. Supportive action
a. During labor, the patient's enthusiasm must be supported. We must
encourage him by avoiding words that can cause concern in the
b. Liquid intake at least 2500 ml per day. At all long periods, this
amount of fluid intake is maintained by administering an infusion
of glucose solution. Dehydration, with signs of acetone in the
urine, must be prevented
c. Emptying of the bladder and intestine must be adequate. Bladder
and rectum that are full not only cause feelings of injury more
easily than when they are empty.
d. Although women who are in labor, must be rested with sedatives
and the pain is relieved by analgesics, but all these preparations
must be used wisely. Excessive amounts of narcosis can interfere
with contractions and endanger the baby.
e. Rectal or vaginal examination should be done with the smallest
possible frequency. This examination hurts the patient and
increases the risk of infection. Every inspection must be carried out
with a clear intention. Preliminary care

Management of patients with prolonged labor is as follows:
a. Injections of Cortone acetate 100-200 mg intramuscular
b. Procaine penicillin: 1 million intramuscular IU
c. Intramuscular Streptomycin 1 g
d. Infusion of fluids:
1) Physiological saline solution
2) Glucose solution 5-100% in the first fetus: 1 liter / hour
e. Rest for 1 hour for observation, except when circumstances require
to act immediately Relief
Can be done spontaneously, vacuum extraction, forceps extraction,
manual aid in breech location, embryotomy if the fetus dies, and
cesarean section.

1.3 Client care plan with a long time II

1.3.1 Assessment Identity History of disease now, past and family Physical examination: Head To toe Investigation of
1.3.2 nursing diagnoses that may arise
Diagnosis 1: Acute pain Definition
Sensory and emotional experiences that are unpleasant due to
actual or potential tissue damage. Limitation of characteristics
a. Communicate the pain
b. Grinning
c. Limited attention span
d. Pale Related factors Agents that
cause injury (biological, chemical, physical and psychological)

Diagnosis 2: Anxiety Definition
Feelings of discomfort or anxiety that are vague accompanied by
an autonomic response, feeling of fear caused by anticipation of
danger. Defining characteristics
a. Restlessness
b. Expressing concern
c. Fears
d. Increased sweating
e. face tense Factors related
a. crisis situations
b. Stress
c. Threats Death
d. Threats to the self concept
e. unfulfilled Needs

Planning 1.3.3
Diagnosis 1: Acute Pain
Criteria Objectives and results(outcomescriteria):based on the
NOC (see reference list)
a. Shows effective individual relaxation techniques
b. Maintain pain levels Nursing and rational interventions: based on the NIC (see
reference list)
a. Giving analgesics: using pharmacological agents
b. Pain management: Reduces or maintains pain to a level of

Diagnosis 2: Anxiety Outcome objectives and criteria (outcomes criteria): based on the
NOC (see reference list)
a. Anxiety decreases
b. Demonstrate self-control of anxiety Nursing and rational interventions: based on the NIC (see
reference list)
Extension of effective ways of straining
a. Explain the benefits of effective push
b. Teach your mother how to push effectively

1.4. Bibliography
Amalia, LN (2014). Midwifery Care In Mrs. "M" With the Actions of the
Section of the Section for the Indications of Old Time in the Vk Room, Irs
Rsup Ntb. Available in: www.academia .edu> case_kala_II_lama.

Diyah, et al (2010) Midwifery Care on Maternity Mothers With Old Partus

Against Ny. "S" at Rsud Banyudono. Available in: www.>
preliminary report_kala_2_lama.

Manuaba, IBG, 1998, Midwifery, Gynecology and Family Planning for

Midwife Education, EGC, Jakarta.

Mochtar, R., 1998, Synopsis of Obstetrics: Obstetrics Physiology, Pathological

Obstetrics Volume I, EGC, Jakarta

Prawirohadjo, S., 2002, Maternal and Neonatal Health Services Edition I, Bina
Pustaka Foundation, Jakarta.

Banjarmasin, May 2017

Academic receptors, Clinical prescribers,

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