DISTOSIA BAHU

Oleh:
Z U R I A H M E I Z A R A H S YA M

Pembimbing:
d r. M o h . K h a e r u m a y a n s y a h

Supervisor:
Dr.dr.Deviana Soraya Riu, Sp.OG(K)
PENDAHULUAN

• Persalinan  sebuah proses fisiologis

DISTOSIA

 kontraksi uterus dan berakhir saat lahirnya

bayi dan ekspulsi plasenta.

Karaçam Z, Walsh D, Bugg GJ. Evolving understanding and treatment of labour dystocia. European Journal of Obstetrics & Gynecology and Reproductive Biology.
2014;182(Supplement C):123-7.
KALA PERSALINAN
DISTOSIA
• Secara istilah distosia diartikan sebagai persalinan yang
sulit dan ditandai oleh waktu persalinan yang lama

• Distosia dapat muncul pada saat kala satu maupun kala

dua persalinan.

Lowe NK. A Review of Factors Associated With Dystocia and Cesarean Section in Nulliparous Women. Journal of Midwifery & Women's Health. 2007;52(3):216-28.
FAKTOR RESIKO DISTOSIA:

Faktor Fetal-Maternal Faktor Intrapartum

• R. distosia sebelumnya • Prolonged 1st stage of
• Makrosomia labour
• Prolonged 2nd stage of
• DM
labour
• IMT 30kg/m2 • Augmentasi Oksitosin
• Induksi saat proses persalinan • Assisted vaginal delivery

Lowe NK. A Review of Factors Associated With Dystocia and Cesarean Section in Nulliparous Women. Journal of Midwifery & Women's Health. 2007;52(3):216-28.
Bean C. Abnormal Labor. In: Evans AT, DeFranco E, editors. Manual of Obstetrics. 8 th ed. Philadelphia: Wolters Kluwer; 2015. p. 163-73.
 Distosia dibagi menjadiDISTOSIA
3k

POWER PASSENGER PASSAGE

Williams Obstetrics. 24 ed. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al., editors. New York: McGraw-Hill Education; 2014.
 DISTOSIA BAHU
• Distosia bahu adalah keadaan dimana perlu adanya tambahan manuver obstetrik
oleh karena tersangkutnya bahu janin dan tidak dapat dilahirkan setelah kepala
janin dilahirkan.
• Distosia bahu dapat dikenali apabila didapatkan adanya:
1. Kepala bayi sudah lahir, tetapi bahu tertahan dan tidak dapat dilahirkan
2. Kepala bayi sudah lahir, tetapi bahu menekan vulva dengan kencang
3. Dagu tertarik dan menekan perineum
4. Traksi pada kepala tidak berhasil melahirkan bahu yang tetap tertahan di kranial
simfisis pubis
Prawirohardjo Sarwono. Persalinan Lama. Ilmu Kebidanan. Edisi ke-4 Cetakan ke-3. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010.
Stitely ML, Gherman RB. Shoulder dystocia: Management and documentation. Seminars in Perinatology. 2014;38(4):194-200.
 FAKTOR-FAKTOR RISIKO DISTOSIA BAHU
-Riwayat distosia bahu pada persalinan sebelumnya
-Diabetes Melitus dan Diabetes Gestasional
-Obesitas, persalinan posterm
-Multiparitas
-Berat lahir yang besar
-Kelainan panggul

Norwitz ER, Schorge JO. Obstetrics and Gynecology at a Glance. 4th ed: John Wiley & Sons, Ltd; 2013.
Stitely ML, Gherman RB. Shoulder dystocia: Management and documentation. Seminars in Perinatology. 2014;38(4):194-200.
 PENANGANGAN DISTOSIA BAHU
1.HINDARI 4P: Panic, Pull Of the Head, Push of
the uterine fundal, Pivoting (sharply
angulating the head, using the coccyx as a
fulcrum)

2.A L A R M E R
Stitely ML, Gherman RB. Shoulder dystocia: Management and documentation. Seminars in Perinatology. 2014;38(4):194-200.
 PENANGANAN DISTOSIA BAHU

Prawirohardjo Sarwono. Persalinan Lama. Ilmu Kebidanan. Edisi ke-4 Cetakan ke-3. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010.
DUTTA D. Prolonged Labor, Obstructed Labor, Dystocia Caused by Fetal Anomalies. In: KONAR H, editor. DC DUTTA’s TEXTBOOK OF OBSTETRICS. 7 th ed. New Delhi • London • Philadelphia • Panama: Jaypee Brothers Medical Publishers (P) Ltd; 2013. p. 401-9.
Stitely ML, Gherman RB. Shoulder dystocia: Management and documentation. Seminars in Perinatology. 2014;38(4):194-200.
 Ask for help
} your side
• get the mother on
• partner, coach
• nursing
Lift or hyperfleks legs McRobert’s maneuver
Anterior disimpaction of shoulder
- suprapubic pressure (Massanti)
- rotate to oblique (Rubin)

Prawirohardjo Sarwono. Persalinan Lama. Ilmu Kebidanan. Edisi ke-4 Cetakan ke-3. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010.
DUTTA D. Prolonged Labor, Obstructed Labor, Dystocia Caused by Fetal Anomalies. In: KONAR H, editor. DC DUTTA’s TEXTBOOK OF OBSTETRICS. 7 th ed. New Delhi • London • Philadelphia • Panama: Jaypee Brothers Medical Publishers (P) Ltd; 2013. p.
401-9.
Stitely ML, Gherman RB. Shoulder dystocia: Management and documentation. Seminars in Perinatology. 2014;38(4):194-200.
MC ROBBERT
MANUVER MASSANTI
RUBIN MANEUVER
 R otation of the posterior shoulder
•Woods’ maneuver
•Rubin+Wood Cockscrew
M anual removal of posterior arm (Schwartz)
E pisiotomy  consider
R oll over  onto 2-4 or knee chest (Gaskin)

Prawirohardjo Sarwono. Persalinan Lama. Ilmu Kebidanan. Edisi ke-4 Cetakan ke-3. Jakarta: PT Bina Pustaka Sarwono Prawirohardjo. 2010.
DUTTA D. Prolonged Labor, Obstructed Labor, Dystocia Caused by Fetal Anomalies. In: KONAR H, editor. DC DUTTA’s TEXTBOOK OF OBSTETRICS. 7 th ed. New Delhi • London • Philadelphia • Panama: Jaypee Brothers Medical
Publishers (P) Ltd; 2013. p. 401-9.
Stitely ML, Gherman RB. Shoulder dystocia: Management and documentation. Seminars in Perinatology. 2014;38(4):194-200.
WOODSCREW
REMOVE POSTERIOR ARM
GASKIN MANEUVER
GASKIN MANEUVER
 CONCLUTION
•Anticipate and be prepared
(most are unpredictable)
•Remember the mnemonic
“ ”
•Stay calm, don’t anic, ull,
ush, ivot.
TERIMA KASIH
 DAFTAR PUSTAKA
1. Karaçam Z, Walsh D, Bugg GJ. Evolving understanding and treatment of labour dystocia. European Journal of Obstetrics & Gynecology and Reproductive
Biology. 2014;182(Supplement C):123-7.
2. Lowe NK. A Review of Factors Associated With Dystocia and Cesarean Section in Nulliparous Women. Journal of Midwifery & Women's Health.
2007;52(3):216-28.
3. Bean C. Abnormal Labor. In: Evans AT, DeFranco E, editors. Manual of Obstetrics. 8 th ed. Philadelphia: Wolters Kluwer; 2015. p. 163-73.
4. Williams Obstetrics. 24 ed. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al., editors. New York: McGraw-Hill Education;
2014.
5. Beckmann CRB, Ling FW, Barzansky BM, Herbert WNP, Laube DW, Smith RP. Obstetrics and Gynecology. 6 th ed. Bevis KS, Jr JRB, Blanchard MH, Bourne
R, Buck J, Busher M, et al., editors. Baltimore: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2010. 497 p.
6. Prawirohardjo S. ILMU Kebidanan 4th ed. Jakarta: PT Bina Pustaka; 2010.
7. Evans AT, DeFranco E. MANUAL OF OBSTETRICS: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2015.
8. DUTTA D. Prolonged Labor, Obstructed Labor, Dystocia Caused by Fetal Anomalies. In: KONAR H, editor. DC DUTTA’s TEXTBOOK OF OBSTETRICS. 7 th ed.
New Delhi • London • Philadelphia • Panama: Jaypee Brothers Medical Publishers (P) Ltd; 2013. p. 401-9.
9. Norwitz ER, Schorge JO. Obstetrics and Gynecology at a Glance. 4th ed: John Wiley & Sons, Ltd; 2013.
10. Stitely ML, Gherman RB. Shoulder dystocia: Management and documentation. Seminars in Perinatology. 2014;38(4):194-200.