KONSEP PERSALINAN

Persalinan Rangkaian proses pengeluaran hasil konsepsi dari rongga uterus melalui jalan lahir UK ≤ 20 minggu atau berat janin ≤ 500 g UK ≤ 37 mg ( ≤ 295 hari ) UK >37 mg s/d ≤ 42 mg Abortus Persalinan Prematur Persalinan Aterm UK ≥ 42 mg Persalinan Postterm

Kontraksi uterus Dilatasi & effacement cevix Persalinan Stimulating Factors ?? Teori Onset Persalinan ☺ Teori Estrogen-progesteron ☺ Teori Oksitosin ☺ Teori Kontrol Endokrin Janin ☺ Teori Prostaglandin ☺ Teori Penuaan Placenta

Teori Estrogen - Progesteron Ratio E-P Memelihara kehamilan Progesteron >> Inisiasi persalinan Estrogen >> circulating Progesteron Formasi gap junction Formasi prostaglandin

Estrogen Perkembangan gap junction Sintesa lokal PGE2 Onset Persalinan Progesterone withdrawl Estrogen dominan

Teori Oksitosin Menjelang Persalinan ♪ Uterus menjadi lebih peka terhadap oksitosin ♪ Kadar oksitosin meningkat Oksitosin Bekerja langsung di myometrium Merangsang produksi PGE2 oleh desidua kontraksi directly indirectly

Teori Kontrol Endokrin Janin Pada suatu saat yang tepat pada waktu maturitas janin sudah tercapai kelenjar adrenal janin memproduksi kortikosteroid induksi persalinan Kelenjar adrenal fetal (sensitivias ) Cortisol Prostaglandin Kontraksi Adrenocorticotropic hormone

Hormonal Changes Associated with Parturition

Teori Prostaglandin Persalinan diinisiasi oleh serangkain proses : Steroid action Release precursors Release arachidonic acid Fetal membrane Prostaglandin synthesis Uterine contraction

Normal Labor Persalinan spontan belakang kepala (vertex presentation) dengan ibu dan bayi dalam kondisi baik Gravida Seorang wanita hamil yang belum masuk dalam persalinan Parturient/Para Seorang wanita hamil yang sudah mengalami persalinan

Fetal Lie

Denominator Bagian janin pada presentasi yang digunakan untuk menentukan posisi janin. Posisi Menunjukkan arah denominator janin terhadap sumbu tubuh ibu ( kiri, kanan, depan, belakang, atau sesuai dengan angka jarum jam ) Station Menunjukkan penurunan bagian terendah janin terhadap bidang panggul ( bidang Hodge )

Situs = letak janin Kedudukan sumbu janin terhadap sumbu tubuh ibu Habitus = attitude Sikap bagian-bagian janin terhadap sumbu tubuh janin → fleksi & ekstensi Presentatio Menunjukkan bagian janin yang paling rendah → kepala, bokong, bokong kaki, bahu, dll

Fetal Lie

Breech Presentations

Cephalic Presentations

Fetal Station

Stages of Labor First Stage Onset of regular contractions with cervical change to complete dilation Nulliparous hours (1.2cm/hr) Multigravida hours (1.5cm/hr) Signs of impending second stage- increased bloody show, rectal pressure, need to push

Dua perubahan cervix pada Kala I Persalinan Cervical Effacement Penipisan dan pemendekkan dari kanalis servikalis dari 2-3 cm menjadi 1 cm Cervical Dilatation Pelebaran cervical os mulai dari beberapa milimeters sampai sekitar 10 cm pada saat pembukaan lengkap

Effacement & Dilatation

Characteristics of True and False Labor Regular Contractions Orogressive cervical dilatation & effacement Discomfort starting in back and sweeping around abdomen Progressive encrease in frequency, intensity & duration Interval between contraction gradually shorten Contraction intensify by walking Discomfort ( low abdomen & groin ) No or little change in cervix Irregular interval No increase in frequency & intencity Interval between contraction remain long Walking has no intessifying effect, often give relief TrueFalse

Stages of Labor Second Stage Begins with complete dilation Ends with entire birth of the infant Nulliparous- 30 minutes to 3 hours Multiparous- 5 to 30 minutes

Mechanism of Labor Positional movements the fetus undergoes to accommodate itself through the maternal pelvis Engagement Descent Flexion Internal rotation Extension Restitution External rotation Birth of the shoulders

Stages of Labor Third Stage Begins with the complete birth of the baby Ends with complete delivery of the placenta Usually 5-30 minutes Clinical signs of placental separation- lengthening of the cord, gush of blood from the vagina, rising of the uterine fundus Expulsion of the placenta- Schultz or Duncan Examination of the placenta

Manajemen Aktif Kala III segera memberikan oksitosin 10 U im atau ergometrine 0,2 mg im dalam 2 menit setelah bayi lahir Peregangan Tali Pusat Terkendali Masase uterus segera setelah plasenta lahir 5 U oxytocin & 0,5 mg ergometrine dan → mengurangi lamanya kala III

First stage of labor: Cervical dilation Second stage of labor: Delivery of the baby Third stage of labor: Delivery of the placenta Partially dilated cervix Placenta Uterus Umbilical cord

Stages of Labor Fourth Stage Begins with birth of the placenta and ends one hour later Highest risk to maternal well-being Observations- examine uterus for firmness, inspect cervix, vagina, perineum for lacerations and repair, evaluate maternal vital signs, examine the baby

Kekuatan Persalinan Kontraksi Rahim increment acme decrement Intensitas kontraksi meningkat Kontraksi mencapai puncak Intensitas kontraksi menurun Kontraksi rahim dinyatakan dalam : frekuensinya dalam 10 menit : lama (detik ) rata-rata kontraksi : intensitas rata-rata kontraksi : L/S/K

Maternal Pushing Ketika pembukaan cervix sudah lengkap,dan bagian terendah janin sudah di dasar pelvis, ibu akan terdorong untuk mengejan Meneran hanya dilakukan saat kontraksi, didahului dengan menarik napas panjang dan menghembuskannya dengan dorongan ke arah vagina Pastikan ibu mendapat cukup minum untuk menghindari dehidrasi

Respon Maternal terhadap Kehamilan dan Persalinan Respon Fisiologis ► Cardiovascular ► Respiratory ► Urinary

Cardiac Output meningkat 40 % - 50 % Tekanan sistolik meningkat 10 mmHg saat kontraksi pada kala I persalinan dan 30 mmHg pada kala II Tekanan diastolik meningkat 5 – 10 mmHg saat kontraksi pada kala I persalinan dan 25 mmHg pada kala II Cardiovascular

Cardiac output during three stages of gestation, labor, and immediately postpartum compared with values of nonpregnant women. All values were determined with women in the lateral recumbent position.

TABLE 8-4. Ventilatory Function in Pregnant Women Compared with the Postpartum Period During Pregnancy Factor 10 Weeks 24 Weeks 36 Weeks Postpartu m 6-10 Weeks Respiratory rate Tidal volume (mL) a Minute ventilation (L) —— a Vital capacity (L) Inspiratory capacity (L) Expiratory reserve volume (L) Residual volume (L) a a Significant increase or decrease compared with pregnant women.

Psychology of Pregnancy Psychosocial tasks Rubin Leaderman’s tasks Fathers Stress and Depression

Developmental Tasks of Pregnancy (Rubin, 1984) Seeking safe passage for herself and her child through pregnancy, labor, and delivery. Ensuring the acceptance by significant persons in her family of the child she bears. Binding-in to her unknown baby. Learning to give of herself.

Maternal Focus Trimester 1 I’ m pregnant! 2 There’s a BABY ….. 3 I’m going to be a MOM

Lederman, RP. Psychosocial Adaptation in Pregnancy, 2nd Ed Developmental Tasks of Pregnancy acceptance of pregnancy identification with motherhood role relationship to the mother relationship to the husband/partner preparation for labor processing fear of loss of control & loss of self esteem in labor