DISTOSIA BAHU

PEMBIMBING : dr. Hanudse Hartono, Sp.OG PENYAJI :

Patria Timotius Tarigan Soraya Prilia Keliat Juwita Wulansari Epifanus Arie Tanoto Tulus Laston Manurung

DEPARTEMEN OBSTETRI DAN GINEKOLOGI FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA

Pendahuluan
Angka kejadian distosia bahu menurut

American College of Obstetricians and Gynecologists (ACOG) adalah 0,6-1,4%. Angka kejadian distosia bahu juga bervariasi berdasarkan berat bayi yang dilahirkan. Distosia bahu lebih sering terjadi pada bayi yang lahir dari ibu yang diabetes dan obesitas.
Sokol RJ, Blackwell SC 2003. American College of Obstetricians and Gynecologists. Committees on Practice Bulletins-Gynecology. Shoulder dystocia. Society of Obstetricians and Gynaecologists of Canada (SOGC), 2005. Advances in Labour and Risk Management Course (ALARM) 13th edition dalam Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL

Definisi
Distosia bahu adalah persalinan yang

memerlukan tambahan manuver obstetri setelah kegagalan gentle downward traction pada kepala bayi untuk melahirkan bahu, dengan patokan waktu lahirnya kepala dengan lahirnya badan lebih dari 60 detik.

Broek, NV 2002. Life saving skills manual essential obstetric care.

Faktor Resiko
Kelainan Persalinan

Makrosomia

Faktor Resiko

Etnisitas

Presentasi Janin
Cluver CA & GJ Hofmeyr 2009. Shoulder dystocia: An update and reviewof new techniques. Cheng YW, Norwitz ER, Caughey AB 2006. The relationship of fetal position and ethnicity with shoulder dystocia and birth injury. Royal College of Obstetricians and Gynaecologists 2005. Shoulder dystocia.

Diagnosis
Kepala bayi lahir, tetapi bahu tertahan dan tidak dapat dilahirkan

Kepala bayi lahir, tetapi tetap menekan vulva dengan kencang

Dagu tertarik dan menekan perineum

Traksi pada kepala bayi tidak berhasil melahirkan bahu yang tetap berada di cranial simfisis pubis
Broek, NV 2002. Life saving skills manual essential obstetric care.

P e n a n g a n a n

Pulling

Panic

Pushing

Society of Obstetricians and Gynaecologists of Canada (SOGC), 2005. Advances in Labour and Risk Management Course (ALARM) 13th edition dalam Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL

Penanganan ALARMER
Ask for help Legs hyperflexed Anterior shoulder disimpaction

Episiotomy

Manual delivery of the posterior arm

Rotation of the posterior shoulder

Roll over onto all fours

Society of Obstetricians and Gynaecologists of Canada (SOGC), 2005. Advances in Labour and Risk Management Course (ALARM) 13th edition dalam Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL

Legs hyperflexed

Anterior shoulder disimpaction

Society of Obstetricians and Gynaecologists of Canada (SOGC), 2005. Advances in Labour and Risk Management Course (ALARM) 13th edition dalam Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL

Rotation of the posterior shoulder

Society of Obstetricians and Gynaecologists of Canada (SOGC), 2005. Advances in Labour and Risk Management Course (ALARM) 13th edition dalam Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL

Manual delivery of the posterior arm

Society of Obstetricians and Gynaecologists of Canada (SOGC), 2005. Advances in Labour and Risk Management Course (ALARM) 13th edition dalam Perinatal Outreach Program of Southwestern Ontario PERINATAL MANUAL

Bayi
Komplikasi

Ibu
Hruban L, Prochzka M, Jank P 2010. Shoulder dystocia during vaginal delivery.

Pencegahan
BBJ > 5 Kg

BBJ > 4 Kg + Kala II memanjang

SC
BBJ > 4 Kg + riw.distosia bahu sebelumnya

BBJ > 4,5 Kg + Ibu diabetes

Smeltzer, JS 2000. Shoulder dystocia, dalam Clinical maternal-fetal medicine.