CHAPTER I

STATUS OF PATIENT

I PATIENTS IDENTITY

Name : Mrs. S

Age : 25 Years

Education : bachelor

Job : Housewife

Ethnic/Religion : Moslem

Status : Married

Address : Tiban indah

Entry Date : 10 January 2017

No. MR : 16.81.22

Husbands name : Mr. Bima

Age : 29 Years

Education : bachelor

Job : Employee

Ethnic/Religion : Moslem

Status : Married

Address : Tiban indah

1
 II ANAMNESIS
Autoanamnesis has done in Room Mawar of RSUD Embung Fatimah Kota

Batam in 12 January 2017.

Main Complaint :
(-)
Now disease history
The patient came to the VK through poly KIA of RSUD Embung Fatimah

Kota Batam in 10 January 2017 over indication of CPD.

- Water out from vagina : (-)
- Blood out from vagina: (-)
- Not menstruation in 9 months
- HPHT : 22 April 2017 TP : 29 january 2017
- Fetus movement : felt active
- ANC history : the patient controlled her pregnancy 8 times to doctor.
- Menstruation history : Menarche : 13 years
Menstruation : regularly, 1 time each month
Cycle : 28 days
Long menstruation : 5-6 days
Painful : (-)
Old Disease History :
a Hypertension History : (-)
b Diabetes Melitus History : (-)
c Asthma History : (-)
d Heart Disease History : (-)
Family Disease History:
a Hypertension History : (-)
b Diabetes Melitus History : (-)
c Asthma History : (-)
d Heart Disease History : (-)
Marriage History:
The patient married 1 time when she was 24 years old.
Pregnancy/abortus/labour History:
1/0/0 first child pregnant now
Contraception History :
The patient is never use contraception.

III. GENERAL CHECK UP

Generalisata Check Up
General condition : Good

2
 Consciousness : Compos mentis Cooperative
Vital Sign
Blood Pressure : 120 / 80 mmHg
Heart Rate : 80 x / minutes, reguler
Respiration : 20 x / minutes
Temperature : 36,00C

Eyes : sunken (-/-), conjungtiva anemis (-/-),

Sclera ikterik (-/-)

Ears : normal

Nose : normal

Mouth : sianosis (-), lips dry (-)

Neck : enlargement lymph gland (-)

Antropometri : Weight 60 kg

height 143 cm

Thorax

Cor I : ictus cordis disappear

Pa : ictus cordis in normal limits

Pe : heart in normal limits

A : BJ I, II regular, murmur (-), gallop (-)

Pulmo I : symmetrical, retraction (-)

Pa : vocal fremitus right = left

Pe : sonor both roomy pulmonary

3
 A : vesicular (+/+), rhonki (-/-), wheezing(-/-)

Abdomen : on obstetric control

Genitalia : on obstetric control
Ekstremitas : Edema -/-, Akral warm, reflex physiology

(+/+), reflex pathology negative (-/-)

Obstetri Check Up

Face : cloasma gravidarum (-)

Abdomen,

Inspection : - look enlargement accordance with the age of pregnancy

- Striae gravidarum (-)

Palpation : L 1 : fundus uteri 4 fingers below the processus xypodeus

palpable buttocks

L 2 : left back

L 3 : head

L 4 : Convergent

HF : 35 cm

HIS : (-)

Percussion : timpani

Auscultation : bowel (+) normal

FHR : 140x/i

Genitalia Check Up

Internal check Up : un do

4
 p/v : (-)

IV. SUPPORTING CHECK UP

Laboratorium ChecGCp on 11 January 2017

5
ChecGCp Result Reference Scores

Hemoglobin 13,2 gr/dl 11,0 - 16,5 gr/dl

Leucocytes 9500 /uL 3.500 - 10.000 /uL

Hematocrit 37 % 35 - 50 %

Trombosit 237 ribu/uL 150 - 500 ribu/uL

Erythrocytes 3,7 juta/Ul 3,6 - 5,6 juta/uL

MCV 93,9 fL 80,0 - 97,0 fL

MCH 33 g 26,5 - 33,5 g

MCHC 33,3 g/dl 31,5 - 35,0 g/dl

Basophils 0 01

Eosinophils 0 04

Neutrophil Segment 70 46 73

Limphocytes 9 17 48
6

Monocytes 6 4 10
 V. WORKING DIAGNOSIS
G1P0A0 gravid 38 weeks with CPD
VI. PLAN
Mom and fetus condition observation.
Informed consent
Preparation OK and anasthesia
SC
VII. MANAGEMENT
Therapy post OP :
IVFD RL drip tramadol 100 mg 28 gtt/i
Inj Ketorolac 2x1
Metronidazole 3x1
Transamin 3x1
Vit k 3x1
Vit c 3x1
VIII. FOLLOW UP

Day/Date Time Condition of patient

10 January 2017 10.45 WIB S: (-)

( follow up VK) O: GC : good,

Sens : CM

BP : 120/80 mmHg

HR : 80 x/minutes

RR : 20 x/minutes

T :36C

Eyes : CA (-/-), SI (-/-)

Extremity :Akral warm (+),

edema (-/-)

FHR : 130x/i

HF : 35cm

7
 HIS : (-)

p/v (-)

A: G1P0A0 gravid 38 weeks

with CPD

R : SC elective on 11 January 2017

11 January 2017 14.50 WIB S: painful post OP

( 12 January up
follow 2017 06:00 WIBO: GC
S: No Complaint
: good,

(
Mawar) follow up O: GC
Sens : good,
: CM

Mawar) BP Sens : CM
: 100/70 mmHg

HR BP
: 76: x/minutes
100/60 mmHg

RR HR
: 20 :x/minutes
63 x/minutes

T RR : 20 x/minutes
:36C

EyesT :36,5C
: CA (-/-), SI (-/-)

Eyes
Extremity : :Akral
CA (-/-), SI (-/-)
warm (+),

edema (-/-)Extremity :Akral warm (+),

edema
p/v (-/-)flow
(+) not

p/v (+) not

A: P1A0H1 flow
post SC a/I CPD

A: RL
P : IVFD P1A0H1 post SC 100
drip tramadol a/I CPD
mg

P : gtt/i
28 IVFD RL drip tramadol 100 mg

28 gtt/i2x1
Inj Ketorolac

Inj Ketorolac 2x1 3x1

Metronidazole

Transamin 3x1
8
Vit k 3x1

Vit c 3x1
 Metronidazole 3x1

Transamin 3x1

Vit k 3x1

Vit c 3x1
13 January 2017 06:00 WIB S: no complaint

( follow up O: GC : good,

Mawar) Sens : CM

BP : 100/60 mmHg

HR : 63 x/minutes

RR : 20 x/minutes

T :36,5C

Eyes : CA (-/-), SI (-/-)

Ekstremitas :Akral warm (+),

edema (-/-)

p/v (+) not flow

A: P1A0H1 post SC a/I CPD

P : aff infuse

Cefixime 3x1

Asam mefenamat 3x1

Sf 1x1

Vit C 1x1

R : may return

9
 Baby Status Born date : 11-1-2017 time 12;29

Weight : 3100 gr

BL : 50 cm

HC : 35 cm

CS : 35 cm

Status : alive

CHAPTER II

A REVIEW OF THE LITERATURE

1. Anatomy of the Pelvis

a. Pelvis Bone
The pelvis is composed of four bone: sacrum, coccyx, and two inominata

(coxae) bones that are formed by the fusion of ilium, ischium, and pubis.

Inominata bones jointed with the sacrum at sinkondrosissacroiliac and jointed

with inominatabonenext to the symphysis pubis (Cunningham, et al., 2010).

10
 The pelvis is divided into two by an imaginary plane of the regio-drawn from

the sacrum promontoryto thetop edge of the pubissymphysis, which are:

1) False Pelvic
Located above the field, serves to support the intestinum.
2) The true Pelvic
Located at the bottom of the field, had two openings: the superior

pelvic arpertura (the inlet pelvis) and arpetura inferior pelvis (outlet pelvis)

(Baun, 2005).
During process of the normal birth, the baby must be able to pass

through the opening both oftrue pelvic (Amatsu Therapy Association and

Amatsu Association of Ireland, 2006).

Figure 1.1 Normal pelvis anteroposterior picture of mature wo

an.Describedof Anteroposterior(AP) and Transverse (T) diameter of

pelvic inlet. Source: Cunningham, et al. Williams Obstetrics, 23rd e

b. The Diameter of Pelvis

The pelvis had four imaginary fields:
1) Pelvic Inlet (apertura pelvis superior)

11
The shape of womeninlet, compared with men, tend to be more rounded

than oval. There are four inlet diameter used:anteroposterior diameter,

transversal diameter, andobliquediameter. Anteroposterior diameter of

which is important in obstetrics is the shortest distance between the sacrum

promontorium and the symphysis pubis, known as obstetric conjugate.

Normally, obstetric conjugate size 10 cm or more in diameter, but this can

be very short on abnormal pelvic. Obstetric conjugateanteroposterior

diameter with other distinguished known as konjugatavera. Konjugatavera

does not describe the shortest distance between the sacrum promontory and

the symphysis pubis. Obstetric conjugate cannot be measured directly with

the examination of the finger. For clinical purposes, obstetric conjugate

estimated indirectly by measuring the distance of the bottom edge

promontory of the sacrum to symphysis, i.e. diagonal conjugate, and the

result is reduced 1,5-2 cm.

12
 Figure 1.2 An overview of three anteroposterior diameter of inlet pelvic:

konjugatavera, obstetric conjugate and konjugatadiagonalis measurable

clinically. Anteroposterior diameter of pelvic Central is also shown. (P =

sacrumpromontori; Symphysis pubis = SIM). Source: Cunningham, et al.

Williams Obstetrics, 23rd ed.

2) Pelvic cavity (pelvic dimensions of the smallest).

The middle of the pelvis is measured as high as ischial spines, or field

of the smallest pelvic dimensions. Have a special meaning after the fetal

head on the process of childbirth isstuck. Interspinosus diameter, 10 cm or

a little larger, usually the smallest pelvic diameter. Anteroposterior

diameter of as high as normalischia dicasized most small 11, 5 cm.

Figure 1.3 Adult female pelvis anteroposterior diameter and

depicting the transversal inlet pelvis as well as transversal diameter

(interspinosus) Central pelvis.Obstetric conjugate is normally more than

10 cm. Source: Cunningham, et al. Williams Obstetrics, 23rd ed.

13
 3) Pelvicoutlet(apertura pelvis inferior).
Pelvisoutlet consists of two areas which resemble a triangle. These

areas have the same basic line drawn between two ischium tuberosity. Apex

of the triangle posterior is at the tip of the sacrum and the limits of lateral is

the ischial sacrum ligament andischium tuberosity. The anterior triangle is

formed by the area below the pubis arcus. Three outlet pelvic diameter is

used, namely: anteroposterior, transverse and sagital posterior

.

Figure 1.4 Inlet pelvic important with diameters. Note that the

anteroposterior diameter can be divided into anterior and posterior

sagittal diameter. Source: Cunningham, et al. Williams Obstetrics, 23rd

ed.

4) Areas with the biggest pelvic dimensions (has no clinical meaning).

(Cunningham, et al., 2010)

c. Pelvic forms

14
 Caldwell and Moloy developed a classification of the pelvis which is still used

to this day. Classification of Caldwell-Molloy based on measurements of

transverse diameter of the largest in the inlet pelvis and its partition into

anterior and posterior segment. The form of these segments to determine the

classification of the pelvis into the pelvic ginekoid:, android, anthropoid, or

platipeloid. Posterior segment characters specify type of the pelvis, and anterior

segments and characters determine the tendencies are. Both of these are

specified as most of the pelvis is not a pure type, but rather a mix of, for

example, ginekoidpelvic with inclinationandroid means posteriorpelvic

ginekoid-shapedand anteriorpelvic android-shaped. (Cunningham, et al., 2010)

Figure 1.5 Four types of pelvis with the classification of Caldwell-Moloy. The

line crosses the widest transversal diameter split inlet into segments

15
 posterior and anterior. Source: Cunningham, et al. Williams Obstetrics,

23rd ed.

Pelvic ginekoid considered normal female pelvis, while android is a variant of

the pelvis of the male pelvis. Pelvic android is more often found in women with

physical akitvitas weight during adolescence. Pelvic android is also found in

women who experience delays in an upright position, i.e. after the age of 14

months, while the pelvic platipeloid more commonly found in women who

have the capability of an upright position before age 14 months (Leong, 2006).

2. The condition of the Fetus inlabor

There are 6 important variables on the fetus which affects the process

of labor:

a. The size of the fetus

The size of the fetus can be determined clinically through palpation

abdomen or through the examination of ultrasonography examination, but

both have a high degree of error. Makrosomia fetus associated with the failure

of the trial of labor.

b. Location of the fetus
The location of the fetus along relative to the States along the

longitudinal uterus. The location of the fetus can be variated, i.e.: longitudinal,

transversal, or obligue. In singleton pregnancies, just a fetus with a

longitudinal layout that can be delivered through vaginal.

c. Presentation of the fetus

16
 The bottom part is a presentation of the fetus which is closest to the

passage. A fetus with a longitudinal layout has the presentation of the face or

buttocks. Mixed presentation stated that there is more than one part of the

body of the fetus on the inletof pelvis. Funik presentationstating presentation

the umbilical cord, are rare.Fetus with the presentation of the head are

classified based on the part of the bone of the skull that looked i.e. oksiput

(veteks), sinsiput, face, or forehead (Cunningham, et al., 2010).

Malpresentation refers to the presentation in addition to verteks, and

this occurs in about 5% of labor.

d. fetal posture or Attitude

The attitude expressed the position of the head in relation to fetal spine

(the degree of fetal head fleksi/extensions). Fleksi head of vital in engagement

of the head of foetus in the mother's pelvis. If the Chin fetus experiencing

optimal fleksi until it reaches chest, the diameter of the

suboccipitobregmaticus appear on the inlet of pelvis. This is the smallest

diameter that may appear on the presentation of the head. Diameter that

appear on the inlet of pelvis is increasing in line with the degree of head

extension (deflection). This can lead to the failure progress of labor. The

architecture of the pelvic wall along with the increase in uterine activity can

improve the degree of deflection at the early stages of labor.

e. fetal position

17
 Fetal position stating the relationship between a reference point on the

lower part of the fetus with the right or left side of the passage. This can be

determined through an examination of the vagina. At the presentation of the

head, the occiput became a reference for assessment. If oksiput leads directly

into the anterior position of being oksiput anterior (OA).If oksiput leads to the

right side of the mother, the position being oksiput right anterior (ROA). At

the presentation of the occiput, a variation of fetal position can be

aWeightreviated with shaping the direction of the clock as follows

(Cunningham, et al., 2010):

Figure 2.1 Layout of the elongated, the presentation of the

head.The difference in fetal posture at presentation verteks (A), (B)

sinsiput, (C), (D) the forehead. Source: Cunningham, et al. Williams

Obstetrics, 23rd ed.

f. Station

18
 Station is the measurement of the fetal part of the descent through the

passage. Classification standard is expressed in degrees-5 up to + 5. This

determination is based on quantitative measurements in centimeters on the

edge of early bone of spinaischiadica. Central point (station 1) is defined as

the field of motherspinaischiadica. Mother spinaischiadica can be palpation on

vaginal examination, approximately in line 8 or 4 hours. (Cunningham, et al,

2010; Kilpatrick & Garrison, 2007)

3. The CPD (cephalopelvik disproportion)

a. Definition

Disproporsi sefalopelvik is a State that describes the mismatch

between the head of the fetus and the mother's pelvis so that the fetus can not

come out through the vagina. Disproporsisefalopelvik caused by a narrow

pelvis, a large fetus or a combination of both.1

Cephalopelvic disproportion (CPD) or fetal pelvic disproportion in

labor occurs, when there is a mismatch between the fetus and the maternal

birth canal. 2

19
 Figure 3.1 Baby,s head too large to fit through mothers pelvis

b. Etiology

Dystocia is a difficult labor and is characterized by too slow progress

labor. Dystocia may be caused by abnormalities in the cervix, uterus, fetus,

maternal pelvic bones or other obstruction in the passage. This disorder by

ACOG is divided into three, namely:

1. Abnormalities of the strength (power) of uterine contractility and

ekpulsif mother.

2. his Disorder: inertia uteri/weakness of his

3. powerof pushing less for instance in hernia or shortness of breath.

20
4. Abnormalities involving the fetus (passenger), for example the

location latitude, the position of the forehead, hydrocephalus.

5. Abnormalities at birth (passage), for example, narrow pelvic tumor

that narrow down the passage.

Factors of occurrence of CPD:

1. Maternal Factors

a. the presence of pelvic abnormalities

b. changing shape due to disease of the spine

c. changing shape due to illness

d. existence of the narrowness of the pelvis

i) Narrowness of the pelvis inlet are narrow if

veraconjungate 10 cm or less in diameter tranvera less

than 12 cm is usually present on pelvic abnormalities

ii) The narrowness of the pelvic cavity

It is said that the Central narrow pelvis if; the number of the

diameter of the spina less than 9 cm, the narrowness of

outlet of belly. Said to be narrower if the distance

between tuberosis 15 cm or less, if the pelvic outletais

narrow usually pelvic cavity) is also narrow.

2. Fetal Factors

a) Fetus that is too large

b) Hidrocephalus

21
 c)Abnormalities location of the fetal. 7.8

c. Epidemilogi

Obstructed labour, the direct clinical consequence of CPD, is

responsible for 8% of maternal deaths worldwide, according to figures quoted

in the 2005 World Health Report of the World Health Organisation (WHO).9

Data from the Reproductive Health Library States there is 180 to 200

million pregnancies each year. These 585,000 going from maternal deaths due

to complications from pregnancy and childbirth. The cause of death was

bleeding 24,8%, infection and sepsis 14.9%, hypertension and

preeklampsi/eklampsi 12.9%, labor (dystocia) bogged down 6.9%, 12.9%, and

abort because other direct7.9%. 8

d. Classification and pathophysiology. 1,7

Constriction of pelvic cavity can cause dystocia birth moment.

Constriction of pelvic cavity that can occur include narrowing of the pelvic

inlet, cavity pelvis(midpelvis), and narrowing thepelvic outlet, as well as a

combination of the three.

1) Narrowing the pelvic inlet

The pelvis inlet is considered narrow in veraconjugate (anteroposterior

diameter) less than 10 cm and a diameter of less than 12 cm transversal.

Vera conjugate checked with conjugate how to measure diagonally so that

22
 it brings about rough assessment of obstetric conjugate that usually has a

diameter of 1.5 cm smaller than the diagonal conjugate. Therefore

narrowing the pelvis inlet is often defined as the diagonal of less than

conjugate size 11.5 cm. For the sake of biparietal diameter then labor fetus

that resides within the normal range 9.5-9.8 cm, therefore labor will be

difficult if the fetus must pass through the room veraconjugate less than 10

cm
2) The narrowing pelvis cavity (midpelvis)
The central door of the pelvis is considered narrowing in the amount

of distansiainterspinarum and posterior sagital13.5 cm. If

distansiainterspinarum less than 8 cm and it is considered the central pelvis

narrows, whereas when distansiainterspinarum less than 10 cm then there is

reason for us to be aware of the possibility of narrowing of thepelvis

cavity.2
3) The constriction ofpelvis outlet
Narrowing down the definition of the pelvis is

distansiaintertuberousischii 8 cm. Pelvis outletformed by two triangles

with intertuberousischii as based.

The anterior part of the lateral side of the triangle is bounded by the

pubis ramus, anterior triangle peak limit and is bounded by the inferior part

of thepubissymphysis. The apex of the posterior triangle is bounded by the

end of the vertebrae S3. Decreased distansiaintertuberous resulted in arkus

pubis narrows (< 90o) so that the anterior triangle of the narrows. Based on

this narrowing, in order for of the fetal head can be born larger room is

23
 required at the back pelvis outlet so that the head is forced towards the

posterior.

e. Clinical manifestations

The clinical symptoms of the CPD itself include:

Labor longer than usual

The fetus has not entered a PAP at 36 weeks gestational age

(primipara), 38 mg (multipara) 7
f. Inspection

On The Approximate Capacity Of The Narrow Pelvis

Narrow pelvis estimates can be obtained from regular checkup

and anamnesa. For example on the vertebrae tuberculosis,

poliomyelitis, kifosis. In women with a height less than normal it is

possible have a capacity of a narrow pelvis, but that does not mean a

woman with normal height can have a narrow pelvis. From previous

labor anamnesa can also be estimated capacity of the pelvis. If at

previous labor goes well with normal weight baby, the chances of a

narrow pelvis is small.

Measurement of the pelvis (pelvimetri)

Is one way to obtain information about the pelvis. Through

pelvimetri fields by hand can be a rough measure of the inlet, middle,

and outlet of pelvis as well as giving a clear picture of the pelvis

outlet. As for the pelvimetri the outside does not have much meaning

24
 (a)

(b)

(c)

Figure 3.2 (a, b, c) Physical Examination of pelvimetri

25
Pelvimetri radiological

Can give a clear picture and have a level of precision that is not

achievable clinically. This inspection can give you the exact

measurements of the critical diameter of two impossible with clinical

examination that is the diameter of the inlet and transversal diameters

between spinaischiadica. But this examination has the danger of

radiation exposure to the fetus especially so rarely done.

Pelvimetri with CT scan and MRI

Can reduce radiation exposure, the degree of accuracy of better

than radiological, easier, but the cost is prohibitive.

It also can be done with MRI examinations with an advantage among

other things there is no radiation, pelvic measurements accurately, fetal

Imaging is complete. This inspection is rarely done because the costs

are prohibitive. From pelvimetri with imaging of the pelvic type can

be determined, the actual pelvic size, vast areas of the pelvis, hip,

capacity and power of accommodation namely volume of the biggest

baby can still be born spontaneously.

The combination of the fetal head volume measurement with

the pelvic capacity measurements have also been a topic of interest.

Significant associations have been found between the risk for dystocia

caused by CS and the combination of the measurements of the fetal

26
 head volume and maternal pelvic dimensios. Unfortunately, the

accuracy of this technique to identify those women requiring CS was

considered to be inadequate, i.e. the values of the area under the curve

(AUC) in receiver operating curves last (ROC) being 0.4-0.8 at best.11

Figure 3.3 MR. pelvimetry images with measurements; a. Anteroposterior

conjugate of the inlet(conjucatavera) and outlet.

27
 Figure 3.4 MR. pelvimetry images with measurements; b. the Transverse

diameter of the inlet (diametertransversa); c. Transverse conjugate of the

outlet (interspina in diameter)

g. Enforcement Of Diagnosis. 12

We always think about the possibility of a narrow pelvis, when there is

a primigravida in late pregnancy head child has not entered p.a. p and error

location of the fetus. The diagnosis can be when we are with:

1) Anamnesis

The head does not enter P.A. P and there is a history of errors layout

(LLi, layout of the buttocks), long ago labor, birth or death of the

child is aided with tools (vacuum extraction or forsep) and

operation.

2) Inspection

The mother seemed shorter sections of the bones or have scoliosis,

kifosis, etc. Outer pelvic abnormalities (rachitis, etc) if the head has

not entered P.A. P looks the contours as the head protrudes above

the symphysis.

3) The Palpation

The head does not enter p.a. p or is still rocking, and there are signs

ofOsborn, namely the head pushed towards p.a. p with one hand

28
 abovesimphysis pubis are another measure of perpendicular hand

on headthat stands out.

General examination

Need to narrow/abnormalpelvic suspiciously when:

The existence of disease of bones and joints

The shape of the body is not normal (kyphosis, scoliosis)

Short women (TB < 145 cm)

Anamnesa on the first labor

The fetus has not entered a PAP at 36 weeks gestational age

(primipara), 38 mg (multipara)

Pelvimetri (clinical and radiologik)

Narrowness of PAP when Vera c. <10 cm and diameter

transversal< 12 cm

Narrowness of pelvic cavity when interspinarum diameter <

9.5 cm

Narrowness of PBP when Arcus Pubis < 90 cm

h. Management. 7,13

SectioCaesaria and labor experiment is the primary action to deal with

labor at disproporsisefalopelvik. In addition, sometimes there are indication to

29
do simfisiofomia and kraniotomia, but simfisiotomia rarely done in Indonesia,

while the kraniotomia is only done on the fetus died.

1) Sectio Caesaria
Sectiocaesaria can be done on an elective or primary, i.e. before

labor begins or at the beginning of labor, and secondarily, that is

after the labor goes on for some time.

a. Sectio caesaria elective planned ahead and done on pregnancy

quite a month because the pelvis is fairly heavy chance, or

because there was a real sefalopelvik disproporsi.

b. secondary Sectio done because labor experiment deemed failed,

or because an indication arises to resolve labor selekas may,

under the terms for labor troughvaginal not or has not been

fulfilled.

2) Labor Trial

Based on careful examination on appraisal of old pregnant

shape and pelvic measurements in all areas andthe relationship

between fetal head and pelvis, and having reached the conclusion

that there is hope that the labor can take place safely, trought

vaginal can be taken the decision to hold the trial of labor.

30
 We stop labor experiment if:

Opening not or less once his progress.

Form of the mother or the child becomes less good.
The presence of a pathological retraction circle.
After complete opening and amniotic rupture despite his

quite good and done with good labor leader, the head of the

largest diameter in 1 hour remains unwilling to pass through

the top of the pelvis.

Forseps or vacuum failed.
3) Simfisiotomi
Simfisiotomi is the Act of the pelvic bones to separate the left

and right hip bones at the symphysis of the pelvis cavity that

becomes more widespread.

4) Kraniotomi

On labor issues dragged on and with the fetushad died in

childbirth, should be solved by kraniotomi.

i. Prognosis. 7

When labor with pelvic heads disproportion left lasting taking itself

without appropriate action, arising out of danger to the mother and fetus are:

1. Danger on the mother:

Laboris long that often accompanied the amniotic rupture at the

opening of a small can cause dehydration and acidosis and

inrapartum infections.
With his strong advances in the way fetuses being born is stuck can

arise the lower uterine segment strain (rupture atony threatened)

31
 and when it is not immediately taken action will happen rupture

atony.
With labor not progressing because of the diproporsi head of the

hips, the way the old born undergo pressure between the head of

the fetus and pelvic bone. Things that cause interference with the

circulation due to the occurrence of ischemia and subsequently

necrosis on the venue.

a few days post, will occur vesikoservikalis fistula or fistula

vesikovaginalis or rektovaginalis fistula.

2. Danger on the fetus:

long Partus perinatal deaths can increase especially when coupled

with intrapartum infection

disprpoportion with the head of the fetal head pelvis can pass

through obstacles in the pelvis with moulage. Moulage may be

experienced by the head of a fetus without an bad result to a

certain boundaries, but if those limits exceeded rupture would

occur on intracranial hemorrhage and tentorium serebelli.

Further pressure by the promontory or sometimes by a symphysis

can cause a need on the network above the bones of the head of the

fetus and may also cause fracture of the on osparietal.

32
 CHAPTER III

ANALYSIS OF THE CASE

CASE THEORY
In these patients with On the theory to the case of CPD (cephalopelvic

pregnancyG1P0A0H0gravid38 weeks disproportion) to diagnose the case one of the

have height 143cm. message was pregnant with height less than 145cm

in these patients with gestational age On theories with CPD (cephalopelvic disproportion)

38 weeks with inspection results in her to diagnose the case one of the criteria is the fetus has

Leopold4 State convergen by means of not entered a PAP at 36 weeks gestational age

the lower part of the fetus has not (primipara), 38 mg (multipara)

entering PAP, then the first child of

pregnant patients
In these patients with pregnancy On the theory to the case of CPD one ofmanagement

G1P0A0H0 gravid 38 weeks is a section of caesaria. Sectio caesaria can be done

recommend to SC and have set on an elective or primary, i.e. before labor begins or

the schedule SC on date at the beginning of labor, and secondarily, that is after

January 11, 2017 the labor goes on for some time.

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