Kegawatdaruratan Maternal Neonatal

Dan Basic Life Sopport

DISTOSIA
BAHU
Kelompok 3
 Amalia Rahmah
 Fatma Rizki Wijanarko
 Mia Tri Rahmaniatri
 Nurima risky putri m
 Pokok Bahasan

Penyebab Patofisiologis Diiagnosis

Vision
01 03 05
Start 07
Distosia 02 04 06

bahu
Penaganan

Definisi Tanda dan gejala komplikasi

 Definisi

Distosia bahu adalah suatu keadaan diperlukannya tambahan manuver obstetrik oleh karena
dengan tarikan biasa ke arah belakang pada kepala bayi tidak berhasil untuk melahirkan
kepala bayi. Pada persalinan dengan presentasi kepala, setelah kepala lahir bahu tidak dapat
dilahirkan dengan cara pertolongan biasa dan tidak didapatkan sebab lain dari kesulitan
tersebut. (Prawirohardjo.2018)
 1. Persalinan disfungsional akibat kontraksi uterus yang tidak efektif
atau akibat upaya mengedan ibu (kekuatan atau powers ).

2. Perubahan struktur pelvis (jalan lahir atau passage ). Walau pun

kekuatan gaya ekspulsifnya mungkin normal, memiliki kelainan struktur
atau karakter jalan lahir yang menimbulkan hambatan mekanis terhadap
turunnya bagian terbawah janin yang tidak teratasi

3. Sebab-sebab pada janin, meliputi kelainan presentasi atau kelainan posisi,

bayi besar, dan jumlah bayi (penumpang atau passengers )

4. Posisi ibu selama persalinan dan melahirkan

5. Respon psikologis ibu terhadap persalinan yang berhubungan dengan

pengalaman, persiapan, budaya dan warisannya, serta sistem pendukung.

E T I O L O G I
Distosia bahu
Tanda dan gejala
Pada proses persalinan normal kepala lahir melalui gerakan ekstensi.
Namun, pada distosia bahu kepala akan tertarik kedalam dan tidak
dapat mengalami putar paksi luar yang normal.

Ukuran kepala dan bentuk pipi menunjukkan bahwa bayi gemuk dan
besar. Begitu juga dengan postur tubuh parturien yang biasanya juga
mengalami obesitas.

Usaha untuk melakukan putar paksi luar, fleksi lateral dan traksi tidak
berhasil melahirkan bahu.

Kepala janin telah lahir namun masih erat berada di vulva

Dagu tertarik dan menekan perineum

Tanda kepala kura-kura yaitu penarikan kembali kepala terhadap

perineum sehingga tampak masuk kembali ke dalam vagina.
Setelah kelahiran kepala, akan terjadi
putaran paksi luar yang menyebabkan
kepala berada pada sumbu normal
dengan tulang belakang bahu pada
umumnya akan berada pada sumbu
miring (oblique) di bawah ramus pubis.
Dorongan pada saat ibu meneran akan
meyebabkan bahu depan (anterior)
berada di bawah pubis, bila bahu gagal
untuk mengadakan putaran
menyesuaikan dengan sumbu miring dan
tetap berada pada posisi anteroposterior,
pada bayi yang besar akan terjadi
benturan bahu depan terhadap simfisis
sehingga bahu tidak bisa lahir mengikuti
kepala.

PATOFISIOLOGIS
Distosia bahu
 KOMPLIKASI
K
O
M • Distosia bahu dapat menyebabkan perdarahan
P postpartum. Perdarahan tersebut biasanya disebabkan oleh
L atonia uteri, rupture uteri, atau karena laserasi vagina dan
servik yang merupakan risiko utama kematian ibu.
I
K • Partus lama yang sering kali disertai pecahnya ketuban
A pada pembukaan kecil, dapat menimbulkan dehirasi serta
S asidosis dan infeksi intrapartum.
I
• Dengan his yang kuat, sedang janin dalam jalan lahir tertahan,
Pada dapat menimbulkan regangan segmen bawah uterus dan
pembentukan lingkaran retraksi patologis (Bandl).

• Dengan persalinan yang tidak maju, jalan lahir pada suatu

I tempat mengalami tekanan yang lama antara kepala janin dan
B tulang panggul.
u

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KOMPLIKASI
Komplikasi pada bayi :

 Partus lama dapat meningkatkan kematian perinatal apalagi jika ditambah

dengan infeksi intrapartum.
 Propalus funikuli, apabila terjadi mengandung bahaya yang sangat besar
bagi janin dan memerlukan kelahirannya dengan segala apabila ia masih
hidup.
 Dengan adanya disproporsi sefalopelvik kepala melewati rintangan pada
panggul dengan mengadakan moulge.
 Selanjutnya tekanan oleh promontarium atau kadang-kadang oleh simfisis
pada panggul picak menyebabkan perlukaan pada jaringan diatas tulang
kepala janin, malahan dapat pula menimbulkan fraktur pada os parietalis.
 FAKTOR RESIKO
Bayi cukup bulan pada umumya memiliki ukuran bahu yang lebih lebar dari
kepalanya, sehingga mempunyai resiko terjadinya distosia bahu. Resiko
akan meningkat dengan bertambahnya perbedaan antara ukuran badan dan
bahunya dengan ukuran kepalanya. Pada bayi makrosomia, perbedaan
ukuran tersebut lebih besar dibandingkan bayi tanpa makrosomia, sehingga
bayi makrosomia lebih beresiko. Dengan demikian, kewaspadaan terjadinya
distosia bahu diperlukan pada setiap pertolongan persalinan dan semakin
penting bila terdapat faktor-faktor yang meningkatkan resiko makrosomia.
Adanya DOPE (diabetes, obesity, prolonged pregnancy, excessive fetal size
or maternal weight gain) akan meningkatkan resiko kejadian. Keadaan
intrapartum yang banyak dilaporkan berhubungan dengan kejadian distosia
bahu adalah Kala I lama, partus macet, Kala II lama, stimulasi oksitosin, dan
persalinan vaginal dengan tindakan. Meskipun demikian, perlu disadari
bahwa sebagian besar kasus distosia bahu tidak dapat diprediksi dengan
tepat sebelumnya.
DIAGNOSIS
 Kepala bayi sudah lahir, tetapi bahu
tertahan dan tidak dapat dihindarkan.

 Kepala bayi sudah lahir, tetapi tetap

menekan vulva dengan kencang

 Dagu tertarik dan menekan perinium

 Traksi pada kepala tidak berhasil

melahirkan bahu yang tetap tertahan di
kranial simpisis pubis.

 Begitu distosia bahu dikenali, maka

prosedur tindakan untuk menolongnya
darus segera dilakukan.
PENANGANAN
DISTOSIA BAHU
PENTING !!!!!
Prinsip

1. Bebaskan bahu depan dari tahanan

simpisis
2. Kecilkan diameter biakromion
3. Perluas kapasitas panggul

Hindari 4p

1. Panic
2. Pulling (menarik-narik kepala bayi)
3. Pushing (mendorong-dorong fundus uteri)
4. Pivoting (memutar kepala secara tajam)
 “A L A R M”
MENCARI Manuver mcRobert o Manuver Massanti
PERTOLONGAN o Manuver Rubin Manuver wood Manuver Schwartz

2 4 5

Ask for help Lifting the ligs and Anterior disimpaction Rotation of Manual removal
buttocks
of shoulder posterior shoulder of posterior arm
Cari pertolongan,
jangan tinggalkan Mengangkat
o Suprapubic pressure
pasien seorang kaki dan bokong (Manuver massanti)
diri, dan siapkan Rotasi bahu Penanganan lengan
o Rotate to oblique internal
tim resusitasi (Manuver Rubin) posterior posterior manual
Pada distosia bahu dapat dilakukan beberapa
pertolongan yaitu :

Manuver Mc. Robert Maneuver Wood

Cork Screw
Manuver Massanti
Manuver Shwartz
Manuver Rubin

Portfolio Presentation
1. Manuver Mc.
Robert

Maneuver Mc.robert dimulai dengan

memposisikan ibu dalam posisi Mcrobert,
yaitu ibu telentang, memfleksikan kedua paha
sehingga lutut menjadi sedekat mungkin
kedada dan rotasikan kedua kaki kearah luar
(aduksi). Lakukan episiotomy yang cukup
lebar. Gabungan episiotomy dan posisi
McRobert akan mempermudah bahu
posterior melewati promontorium dan masuk
ke dalam panggul.
 2. Manuver Massanti

Mintalah assisten menekan suprasimfisis kearah posterior menggunakan pangkal tanggannya untuk
menekan bahu anterior agar mau masuk di bawah simfisis. Sementara itu lakukan tarikan pada kepala
janin kearah posterokaudal dengan mantap.
Lakukan tersebut akan melahirkan bahu anterior. Hindari tarikan yang berlebihan karena akan
mencederai pleksus brachialis. Setelah bahu anterior dilahirkan, langkah selanjutnya sama dengan
pertolongan persalinan persentasi kepala. Maneuver ini cukup sederhana, aman, dan dapat mengatasi
sebagian besar distosia bahu derajat ringan sampai sedang.
3. Manuver Rubin

Dimulai dengan masukkan tangan kejalan

lahir hingga mencapai bahu depan bayi,
lakukan penekanan pada bagian
belakang bahu sehingga bahu terdorong
kedepan kearah dada (vaginal approach)
, Ketika dilakukan penekanan
PowerPoint PowerPoint
suprapubik Presentation
pada posisi punggung janin
Presentation
anterior akan membuat bahu lebih
abduksi, sehingga diameternya
mengencil. Dengan bantuan tekan
suprasimfisis ke arah posterior, lakukan
tarikan kepala ke arah posterokaudal
dengan mantap untuk melahirkan bahu
anterior.
4. Manuver Wood Cork Screw
Manuver Wood dilakukan dengan
menggunakan dua jari dari tangan
yang berseberangan dengan
punggung bayi (pumggung kanan
berarti tangan kanan, punggung
kiri berarti tangan kiri) yang
diletakkan di bagian depan bahu
posterior. Bahu posterior dirotasi
180 derajat. Dengan demikian,
bahu posterior menjadi bahu
anterior dan posisinya berada di
bawah arkus pubis, sedangkan
bahu anterior memasuki pintu atas
panggul dan berubah menjadi
bahu posterior. Dalam posisi
seperti itu, bahu anterior akan
dengan mudah dapat dilahirkan.
5. Manuver Shwartz

•Masukkan tangan kedalam vagina

menyusuri humerus posterior janin dan
kemudian melakukan fleksi lengan
posterior atas didepan dada dengan
mempertahankan posisi fleksi siku

•Tangan janin dicekap dan lengan

diluruskan melalui wajah janin

•Lengan posterior dilahirkan

 Kesimpulan
Distosia bahu adalah peristiwa dimana tersangkutnya bahu janin dan tidak dapat
dilahirkan setelah kepala janin dilahirkan. Tanda dan gejala distosia bahu adalah pada
proses persalinan normal kepala lahir melalui gerakan ekstensi. Pada distosia bahu
kepala akan tertarik ke dalam dan tidak dapat mengalami putaran paksi luar yang
normal. Disebabkan oleh karena faktor-faktor komplikasi pada maternal atau
neonatal. Untuk penatalaksanaan nya dilakukan episiotomy secukupnya dan
dilakukannya Manuver Mc.Robert,karena manuver ini cukup sederhana, aman, dan
dapat mengatasi sebagian besar distosia bahu derajat ringan sampai sedang.
TERIMA KASIH
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unique zing and appeal to your Presentations. Get a modern PowerPoint
Presentation that is beautifully designed.

Get a modern PowerPoint Presentation that is beautifully

designed. Easy to change colors, photos and Text.

You can simply impress your audience and add a unique zing and appeal to
your Presentations. I hope and I believe that this Template will your Time,
Money and Reputation. You can simply impress your audience and add a
unique zing and appeal to your Presentations. Get a modern PowerPoint
Presentation that is beautifully designed.
Thank You
Insert the Sub Title of Your Presentation
Fully Editable Shapes
Fully Editable Shapes
PNG IMAGES
 Fully Editable Icon Sets: A
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

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 Fully Editable Icon Sets: B
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
 Fully Editable Icon Sets: C
You can Resize without
losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com