PERSALINAN NORMAL

Dr Adi Sukrisno, SpOG, FMAS

RS PELNI PETAMBURAN
JAKARTA
2021
OBG : OBGYN

 Obstetri : Ilmu kebidanan :Ilmu yg

mempelajari org reprod wanita saat hamil,
bersalin, & nifas ( FM : Feto Maternal )

 Ginekologi : Ilmu kandungan : Ilmu yg

mempelajari org reprod wanita saat TIDAK
hamil, bersalin, & nifas ( FER / ONKO
/UROGINEKOLOGI/ SOSIAL )
S : wawancara, anamnesa
O : KU Status Generalis : K/L
tanda2 vital Th: C/ P
(T,N,RR,t) Abd
Ekstr
Status Lokalis :
Inspeksi/Palpasi/Perkusi/Auscultasi
Pemeriksaan tambahan / penunjang
A : Diagnosa / Assessment
G6 P3 A2 38-39 mgg / T / H
P : Planning ( Therapi, monitoring/follow up)
Tgl berapa Taksiran persalinan?
Bila HPHT nya tsb dibawah ini :

 20- 7 - 2008
 27- 9 - 2008
 21- 2 - 2009
 28- 1 - 2009
 23- 5 - 2009
Hasil pemeriksaan palpasi
ginekologi
 1. V/V (Vulva/vagina): Fluor? Benjolan ?
 2. P (Portio/ cervix) : Licin? Benjol? Kasar?
Besar? Tertutup? Terbuka?
 3. CU (Corpus Uteri): Ante? Retro? Besarnya?
Benjolan?
 4. AP (Adneksa Parametrium) :kanan?kiri?
 5. CD (Cavum Douglasi) : nyeri? Menonjol?
 Hasil periksa dalam di bidang obstetri
( Vaginal Toucher/VT )
 1. V/V (Vulva/vagina) : darah lendir? Darah segar?
Kehitaman?Fluor? Ketuban?
 2. Pembukaan/dilatasi Cerviks: .......cm
 3. Penipisan/pendataran/Effescement (Cerviks):0%,
25%, 50%, 75%, 100 %
 4. Ketuban : +/-, jernih ? Keruh ?
 5. presentasi : kpl? Bokong? Bahu?
 6. Denominator : bag terkecil&terendah jnn sebagai
petunjuk arah putar paksi dalam
 7. Penurunan kepala : Hodge 1?, 2? /station
INITIAL EVALUATION
INITIAL EVALUATION

 Palpation contraction
 Hiss ?
 10.3.45/K (dalam 10
mnt ada 3 kali hiss yg
masing2 hiss
berlangsung selama 45
dtk dg intensitas kuat)
LEOPOLD 1
LEOPOLD 2
LEOPOLD 3
LEOPOLD 4
EFW ( Taksiran Berat Janin ):
TFU (cm) – 11(H3)/ 12(H2)/ 13(H1)
x 145 / 155
=...........gram
FHR MONITORING
PENCEGAHAN INFEKSI UNIVERSAL
INSPECULO
CERVICAL DILATATION
 Pd letak belakang kepala : UUK = UBUN2 KECIL =
FONTANELLA MINOR = SUB OCCIPUT ( teraba seperti sudut
segitiga )

Pd letak puncak : UUB = UBUN2 BESAR = FONTANELLA MAYOR

= BREGMA =VERTEX ( teraba spt jajaran genjang )
Pd letak dahi : GLABELLA; Pd letak muka : MENTUM/dagu
Pd letak sungsang : SACRUM
PELVIC TYPES

Gynecoid
PELVIMETRY
PELVIMETRY
 PRINSIP DASAR
 Persalinan : serviks membuka dan menipis
 Kelahiran : janin + ketuban+placenta
 Normal : 37-42 mg, spontan, belakang
kepala, 18-24 jam, tanpa komplikasi pada
ibu dan bayi.
 Empat kala : I s/d IV
 Bersih dan aman, sayang ibu dan bayi

Persalinan normal JJE/UPN/RSPAD/2000

 PRINSIP DASAR
Rekomendasi :
 Asuhan sayang ibu dan bayi
 Partograf harus digunakan
 Intervensi harus atas indikasi
 Manajemen aktif kala tiga
 Tersedia obat esensial, bahan & perlengkapan
 Observasi 2 jam, kemudian 24 jam pertama
 Cegah hipotermi

Persalinan normal JJE/UPN/RSPAD/2000

 Perlengkapan
 Alat pertolongan persalinan (set partus)
 Lain-lain : partograf, klorin 0,5%
 Persedian obat-obatan untuk komplikasi :
kateter IV, metil ergometrin maleat,
oksitosin, MgSO4 40%, amok/ampisilin 500
mg
 Bahan untuk menjahit episiotomi
 Dibawa oleh ibu/keluarga

Persalinan normal JJE/UPN/RSPAD/2000

PARTOGRAF
 Pemantauan
kemajuan persalinan
 Dibuat sejak inpartu
 Garis waspada dan
garis bertindak

Partus Normal JJE/UPN/RSPAD/2000

PARTOGRAPH
PARTOGRAPH
 KALA PERSALINAN

Kala Satu
Kala Dua
Kala Tiga
Kala Empat

Partus Normal
JJE/UPN/RSPAD/2000
 KALA SATU
 Pembukaan 1-10 cm, lamanya 18-24 jam
 Fase laten dan Fase aktif
 Bebas melakukan aktivitas, kecuali ada
penyulit
 Mengurangi nyeri : posisi tertentu, obat,
anestesi epidural, entonox, TENS dan ILA
 Pahami teknik pernafasan yang baik

Partus Normal JJE/UPN/RSPAD/2000

 KALA DUA
 Pengeluaran bayi
 Paling berat
 Lamanya 1-2 jam
 Posisi duduk tegak atau
setengah duduk
 Teknik pernafasan pada
kala dua
 Episiotomi ?
JJE/UPN/RSPAD/2000
Partus Normal
Paracervical Block
Pudendal Block
Pudendal Block
 GERAKAN UTAMA
DALAM PERSALINAN
 Engagement
 Penurunan kepala
 Fleksi
 Putaran paksi dalam
 Ekstensi
 Putaran paksi luar
(restitusi)
 Ekspulsi
JJE/UPN/RSPAD/2000
Partus Normal
Sebelum Kepala Masuk PAP
Engagement
Fleksi
Putaran Paksi Dalam
Kepala mulai keluar
Ekstensi
Putaran Paksi Luar
Bahu depan lahir
lahirBahu belakang
EKSPULSI
PENJEPITAN UMBILIKUS
Kala Tiga
 Pengeluaran Uri
 Lamanya 30 menit
 Manajemen aktif
 Bahaya perdarahan

Partus Normal JJE/UPN/RSPAD/2000

Kala Empat
 Dua jam setelah bayi
dan uri dilahirkan
 Penjahitan luka
 Pengawasan ketat
 Keluarga dilibatkan
 Rawat Gabung 
sayang bayi dan ibu

Partus Normal JJE/UPN/RSPAD/2000

 Inappropriate Practices

 Restriction of food and fluids during labor

 Routine intravenous infusion in labor
 Repeated or frequent vaginal examinations, especially by
more than one caregiver
 Routinely moving laboring woman to a different room at
onset of second stage
 Encouraging woman to push when full dilation or nearly
full dilation of cervix has been diagnosed, before woman
feels urge to bear down

Nielson 1998;
Ludka and Roberts 1993.
Practices Used for Specific
Clinical Indications
 Bladder catheterization
 Operative delivery
 Oxytocin augmentation
 Pain control with systemic agents
 Pain control with epidural analgesia
 Continuous electronic fetal monitoring
Normal Labor and Childbirth:
Conclusion
 Have a skilled attendant present
 Use partograph
 Use specific criteria to diagnose active labor
 Restrict use of unnecessary interventions
 Use active management of third stage of labor
 Support woman’s choice for position during labor and
childbirth
 Provide continuous emotional and physical support to
woman throughout labor
PENCEGAHAN INFEKSI UNIVERSAL
References
Carroli G and J Belizan. 2000. Episiotomy for vaginal birth (Cochrane Review), in The Cochrane
Library. Issue 2. Update Software: Oxford.
Eason E et al. 2000. Preventing perineal trauma during childbirth: A systematic review.
Obstet Gynecol 95: 464–471.
Gupta JK and VC Nikodem. 2000. Woman’s position during second stage of labour (Cochrane
Review), in The Cochrane Library. Issue 4. Update Software: Oxford.
Lauzon L and E Hodnett. 2000. Caregivers' use of strict criteria for diagnosing active labour in
term pregnancy (Cochrane Review), in The Cochrane Library. Update Software: Oxford.
Ludka LM and CC Roberts. 1993. Eating and drinking in labor: A literature review. J Nurse-
Midwifery 38(4): 199–207.
Madi BC et al. 1999. Effects of female relative support in labor: A randomized control trial.
Birth 26:4–10.
Neilson JP. 1998. Evidence-based intrapartum care: evidence from the Cochrane Library. Int J
Gynecol Obstet 63 (Suppl 1): S97–S102.
World Health Organization Safe Maternal Health and Safe Motherhood Programme. 1994.
World Health Organization partograph in management of labour. Lancet 343 (8910):1399–
1404.
World Health Organization (WHO). 1999. Care in Normal Birth: A Practical Guide. Report of a
Technical Working Group. WHO: Geneva.