Ekstraksi vakum dan Ekstraksi forsep

(Operative Vaginal Delivery)

Susanti Apriani

If a person deficient in dexterity could succeed in applying the (vacuum) tractor ...it is quite probable that he would produce as much injury as benefit... Hayes, 1831

Ekstraksi vakum
Aplikasi ekstraktor vakum :

Forceps Ekstraksi
Fungsi forsep obstetrik adalah sebagai berikut : traksi kepala janin rotasi kepala janin fleksi kepala janin ekstensi kepala janin

outlet, rendah dan tengah seperti pada ekstraksi forsep.

prosedur rotasi tidak dilakukan

Fungsi-fungsi ini menyebabkan kompresi kepala janin

Penggunaan yang benar meminimalkan kompresi ini
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From: Assisted Vaginal Birth, ALARM International

SYARAT

VACCUM
presentasi belakang kepala, janin aterm, TBJ >2500 g kepala sudah masuk pintu atas panggul panggul ibu adekuat dengan penilaian klinis analgesia yg sesuai pembukaan serviks lengkap dan ketuban pecah kandung kencing ibu kosong operator yg berpengalaman fasilitas pendukung bila prosedur tidak berhasil
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FORCEPS

Kepala sudah masuk pintu atas panggul Pembukaan serviks lengkap dan ketuban pecah Dikenali dengan pasti posisi kepala janin Panggul ibu adekuat Kandung kencing ibu kosong Analgesia yg sesuai Operator yg berpengalaman Fasilitas pendukung yang memadai bila tindakan gagal

From: Assisted Vaginal Birth, ALARM International

INDICATION AND CONTRAINDICATION

No indication is absolute
Prolonged 2nd stage
Nulliparous: lack of continuous progress

Contraindication-OVD
Non-cephalic, face or brow presentation Unengaged vertex

>3hrs with regional anesthesia

>2hrs w/o regional anesthesia

Incompletely dilated cervix

Clinical evidence of CPD < 34 weeks gestation (vacuum) Need for device rotation (vacuum) Deflexed attitude of fetal head Fetal conditions (e.g. thrombocytopenia)

Multiparous: lack of continuous progress

>2hrs with regional anesthesia >1hr w/o regional anesthesia

Fetal compromise Maternal benefit to shortened 2nd stage

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Robert D. Auerbach, M.D. FACOG Senior Vice President & Chief Medical Officer CooperSurgical, Inc. Associate Clinical Professor of Obstetrics & Gynecology Yale University School of Medicine

Outlet
Scalp visible @ introitus w/o separating labia Fetal skull @ pelvic floor Saggital suture in AP plane (or ROA/LOA) Fetal head at or on perineum Rotation < 45 degrees

Low
Leading point of fetal skull > or = +2 station Rotation < 45 degrees Rotation > 45 degrees

Mid
Station above +2 station but the head is engaged

High
Not included in classification

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Robert D. Auerbach, M.D. FACOG Senior Vice President & Chief Medical Officer CooperSurgical, Inc. Associate Clinical Professor of Obstetrics & Gynecology Yale University School of Medicine

Pelvic floor

Midpelvic

Outlet

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Robert D. Auerbach, M.D. FACOG Senior Vice President & Chief Medical Officer CooperSurgical, Inc. Associate Clinical Professor of Obstetrics & Gynecology Yale University School of Medicine

VACCUM

FORCEPS

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Robert D. Auerbach, M.D. FACOG Senior Vice President & Chief Medical Officer CooperSurgical, Inc. Associate Clinical Professor of Obstetrics & GynecologyYale University School of Medicine