DEFENISI
Distosia adalah kelambatan atau kesulitan persalinan. Dapat disebabkan kelainan tenaga, kelainan letak, dan bentuk janin, serta kelainan jalan lahir
Pembagian Distosia Berdasarkan Penyebab
Distosia karena kelainan tenaga
Inersia uteri
Incordinate uterina action
Distosia karena kelainan letak
Presentasi belakang kepala oksiput posterior menetap
Presentasi belakang kepala oksiput melintang
Presentasi puncak kepala
Presentasi dahi
Presentasi muka
Presentasi rankap
Letak sungsang
Letak lintang
Presentasi ganda
Kehamilan ganda
Distosia karena kelainan bentuk janin
Pertumbuhan janin berlebih
Hidrosefalus dan anensefalus
Tali pusat terkemuka
Distosia karena kelainan tulang panggul
Kelainan bentuk panggul
Kelainan ukuran panggul
INERSIA UTERI
Inersia uteri adalah kelainan his yang kekuatannya tidak adekuat untuk melakukan pembukaan serviks atau mendorong janin keluar. Inersia uteri dibagi menjadi 2 :
1.inersia uteri primer : terjadi pada awal fase laten
2.inersia uteri sekunder : terjadi pada fase aktif
( Prof. Dr. Rustam mochtar, MPH, sinopsis obstetri, 305)
Etiologi
Multipara, kelainan letak janin , disproporsi sefalovelvik, kehamilan ganda, hidramnion, utrus bikornis unikolis.
Faktor predesposisi
Anemia , hidromnion, grande multipara, primipara, pasien dengan emosi kurang baik.
INCOORDINATE UTERINA ACTION
Incoordinate uterina action yaitu kelainan his pada persalinan brupa perubahan sifat his, yaitu meningkatnya tonus otot uterus, di dalam dan di luar his, serta tidak ada kordinasi antara kontraksi bagian atas, tengah, dan bawah, sehingga his tidak efisien mengadakan pembukaan serviks.( Aif mansjoer, kuspuji triyanti, rakhmi savitri, kapita selekta, edisi ketiga, hal 303 )
Etiologi
Pemberian oksitoksin yang berlebnihan atau ketuban pecah lama yang disertai infeksi.
Komplikasi
hipoksia janin karena gangguan sirkulasi uteroplasenter
Penatalaksanaan
Dilakukan pengobatan simtomatis karena belum ada obat untuk memperbaikki kordinasi fungsional antara bagian – bagian uterus.
Bila terjadi lingkaran konstriksi pada kala I , lakukan seksio sesar
PRESENTASI PUNCAK KEPALA
Presentasi puncak kepala adalah kelainan akibat defleksi ringan kepala janin ketika memasuki ruang panggul sehingga ubun – ubun besar merupakan bagian terendah.
PENATALAKSANAAN
Pasien dapat melahirkan spontan pervaginaan
PRESENTASI MUKA
Presentasi muka adalah kepala dan kedudukan defleksi maksimal sehingga oksipu tertekan pada punggun dan muka merupakan bagian terendah.
Etiologi
Keadaan yang memaksa terjadi defleksi kepala, seperti panggul sempit, tumor di leher, bagian depan atau keadaan yang menghalangi terjadinya fleksi kepala, seperti janin besar, anensefalus.
Faktor predesposisi
Multipara, perut gantung
DIAGNOSIS
Pemeriksaan luar : dada teraba seperti punggung, belakang kepala terletak berlawanan dengan letak dada, teraba bagian – bagian kecil janin dan denyut jantung janin terdengar lebih jelas pada dada.
LETAK SUNGSANG
Letak sungsang adalah janin terletak memanjang dengan kepala di fundus uteri dan bokong dibawah bagian cavum uteri
ETIOLOGI
Multiparitas , prematuritas, kehamilan ganda, hidramnion, hidrosefallus, anensefalus, plasenta previa, panggul sempit, kelainan uterus dan kelainan bentuk uterus, implantasi plasenta di kornu fundus uteri
PENATALAKSANAAN
Lakukan versi luar pada umur kehamilan 34 – 38 minggubila syarat versi luar terpenuhi. Bila pada persalinan masih letak sungsang , singkirkan indikasi seksio sesar. Lahirkan janin dengan prasat bracht
PROGNOSIS
Angka kematian bayi pada persalinan letak sungsang lebih tinggi dinamding dengan letak kepala.
Monday, May 14, 2007
Distosia
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