CATATAN PERSALINAN

24. Masase fundus uteri

1. Tanggal :............................................................................................................ ( ) Ya :...........................................................................................................
2. Nama Bidan :..................................................................................................... ( ) Tidak
3. Tempat Persalinan 25. Plasenta lahir lengkap (intact) : Ya / Tidak
( ) Rumah Ibu ( ) Puskesmas Jika tidak lengkap tindakan yang dilakukan :
( ) Polindes ( ) Rumah Sakit a :................................................................................................................
( ) Klinik Swasta ( ) Lainnya : ………………………………… b :................................................................................................................
4. Alamat tempat persalinan :.............................................................................. 26. Plasenta tidak lahir > 30 menit :
5. Catatan :.........................................................., Rujuk Kala I / II / III / IV ( ) Tidak
6. Alasan merujuk :............................................................................................... ( ) Ya, Tindakan : ..........................................................................................
7. Tempat rujukan :............................................................................................... ...................................................................................................................
8. Pendamping pada saat merujuk : 27. Laserasi :
Bidan : ( ) Bidan ( ) Suami ( ) Keluarga ( ) Ya, dimana : ............................................................................................
( ) Dukun ( ) Teman ( ) Tidak Ada ( ) Tidak
9. Masalah dalam kehamilan dan persalinan ini :
( ) Gawat darurat ( ) Perdarahan ( ) HDK ( ) Infeksi ( ) PMTOT 28. Jika Laserasi perinium, derajat : 1 / 2 / 3 / 4
Tindakan :
KALA I ( ) Penjahitan, dengan / tanpa anastesi
10. Partograf melewati garis waspada : Y / T ( ) Tidak di jahit, alasan :..............................................................................
11. Masalah lain,sebutkan :.................................................................................... 29. Atonia uteri :
......................................................................................................................... ( ) Ya, Tindakan :..........................................................................................
12. Penatalaksanaan masalah tersebut :............................................................... ...................................................................................................................
......................................................................................................................... ( ) Tidak
13. Hasilnya :......................................................................................................... 30. Jumlah darah yang keluar / perdarahan :....................................................
......................................................................................................................... 31. Masalah dan penatalaksanaan masalah tersebut :...................................
..................................................................................................................
KALA II Hasilnya :...................................................................................................
14. Episiotomi : ..................................................................................................................
( ) Ya. Indikasi :.................................................................................................
( ) Tidak :.......................................................................................................... KALA IV
15. Pendampin pada saat persalinan : 32. Kondisi Ibu :
( ) suami ( ) Dukun ( ) Tidak Ada KU :........... TD :................Mmhg, Nadi :........./mnt, Napas :........./mnt
( ) Keluarga ( ) Teman 33. Masalah dan penatalaksanaan masalah :
16. Gawat janin : .........................................................................................................................
( ) Ya, tindakan yang dilakukan :......................................................................... .........................................................................................................................
a :...................................................................................................................... BAYI BARU LAHIR :
b :...................................................................................................................... 34. Berat Badan :........................................gram
( ) Tidak 35. Panjang :...............................................cm
( ) Pemantauan DJJ setiap 5 - 10 mnt selama kala II, hasilnya :........................ 36. Jenis kelamin : L / P
17. Distosia bahu 37. Penilaian bayi baru lahir : baik / ada penyulit
( ) Ya, tindakan yang dilakukan :......................................................................... 38. Bayi lahir :
a :...................................................................................................................... ( ) Normal, tindakan :
b :...................................................................................................................... ( ) Mengeringkan
( ) tidak ( ) Menghangatkan
18. Masalah lain, penatalaksanaan maslah tsb dan hasilnya :............................... ( ) Rangsangan taxtil
......................................................................................................................... ( ) Memastikan IMD atau naluri menyusul segera
Asfiksia ringan/pucat/biru/lemas, tindakan :
KALA III ( ) Mengeringkan ( ) Menghangatkan
19. Inisiasi menyusui dini : ( ) Rangsangan taxti ( ) Bebaskan jalan nafas
( ) Ya ( ) Bungkus bayi dan tempatkan di sisi ibu
( ) Tidak, Alasannya :........................................................................................ ( ) Lain-lain, sebutkan :........................................
20. Lama kala III : ..........................Menit ( ) Cacat bawaan, sebutkan : ...........................................................................
21. Pemberian Oksitoksin 10 U IM ? ( Hypotermi, Tindakan : ...................................................................................
( ) Ya, waktu :............................................................menit sesudah persalinan a. ................................................................................................
( ) Tidak, Alasannya :........................................................................................ b. ..............................................................................................
Penjepitan tali pusat :.................................................menit setelah bayi lahir c. .....................................................................................................
22. Pemberian ulang Oksitoksin (2x) ?
( ) Ya, Alasan :.................................................................................................. 39. Pemberian ASI :
( ) tidak ( ) Ya, waktu :................................................... Jam setelah bayi lahir
23. Penengangan tali pusat terkendali ? ( ) Tidak, Alasan :...............................................................................................
( ) Ya. 40 Masalah lain, sebutkan :...................................................................................
( ) Tidak, alasan :........................................................................................... Hasilnya :.........................................................................................................

TABEL PEMANTAUAN PERSALINAN KALA III

Kontraksi
Jam Ke Waktu Tekanan darah Nadi Suhu Tinggi Fundus Uteri Kandung Kemih Darah yang keluar
Uterus

1 WIB MmHg x/M

WIB MmHg x/M
WIB MmHg x/M
WIB MmHg x/M
2 WIB MmHg x/M
WIB MmHg x/M
 PARTOGRAF

Fasilitas Kesehatan :.................................................................., Alamat : .....................................................................................................................................................

No. Register Nama :..................................................., Umur : ................., G :..........,P :..........., A :.............
Alamat :.................................................................................. Tanggal :..................................................., Waktu saat masuk :..........................................................
Ketuban Pecah Sejak Jam :................................................................., Mulai Mules : ...........................................................................................
200
190
180
170
160
Denyut 150
Jantung 140
Janin 130
( x/menit ) 120
110
100
90
80
Air Ketuban
Penyusupan

10
9
Bayi lahir :
8
ADA K Tanggal : …………………..Hari : ……………….
7 A SP NDA
IS W ERTI Jam : ……… Jenis Kelamin : ………….…….
6 GAR AR IS B
G
ber

tan
mb

Ser

BB : ………………………… gram
vik

m)

(x)

:
da
Pe

uk
aa

(c

5
n

PB : ………………………… Cm
4
nya

ber

tan
Tur

pal
un

da
Ke

LK : …………………………. Cm
●
a

3
LD : …………………………. Cm
2
Kel. Kongenital : …………………………………
1
……………………………………………………………….
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
waktu
(jam)

5
Kontraksi < 20 4
tiap 20 - 40 3
10 menit > 40 2
(detik) 1

Oksitoksin U/L
Tetes/menit

Obat dan
Cairan Infus
200
190
180
170
● Nadi
160
150
140
130
120
Tekanan 110
Darah 100
90
80
70
60

Temperatur ⁰C

Protein
Urine Aseton
Volume
Makan
Minum

Asuhan Persalinan Normal Penolong

(.............................................................)
........................................................................................................................