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DISTOSIA BAHU

Deviana S. Riu
Bagian OBGIN FK UNHAS

DEFINISI

Kepala bayi telah dilahirkan tetapi bahu tertahan di panggul ibu (simfisis pubis) sehingga badan bayi tidak dapat

dilahirkan Turtle sign

Dapat terjadi baik pada persalinan spontan

ataupun dengan bantuan alat (vakum atau


forsep)
Walaupun kepala telah dilahirkan, bayi tetap

tidak dapat bernapas karena dada masih tertekan di rongga panggul ibu dan tali pusat akan tertekan oleh tubuh bayi

Bahu tertahan di simfisis pubis

FAKTOR RISIKO
Makrosomia ( > 4000 gram) Diabetes gestasi Riwayat distosia bahu sebelumnya Induksi persalinan

Partus lama
Anatomi panggul abnormal Kehamilan lewat waktu Pendek

KOMPLIKASI
BAYI Kerusakan saraf (brachial plexus injury) : !0% Pleksus brachial berfungsi untuk gerakan dan sensasi

pada lengan, jika terjadi distosia bahu dapat menyebabkan kerusakan pada saraf tersebut : paralisis, bisa berlangsung sementara ataupun menetap
Fraktur lengan atau klavikula Kerusakan otak Kematian bayi

IBU Robekan vagina (derajat III/IV) Fistula rektovaginal Perdarahan Gangguan emosional Trauma pada simfisis pubis (diatesis) dengan atau tanpa

neuropati femur
Ruptur uteri

PENANGANAN
Kasus emergensi

Tidak bisa ditangani sendiri

THE HELPERR MNEMONIC H


H : Call for help.

E : Evaluate for episiotomy.


Episiotomy should be considered throughout the management of

shoulder dystocia but is necessary only to make more room if rotation maneuvers are required. Shoulder dystocia is a bony impaction, so episiotomy alone will not release the shoulder. Because most cases of shoulder dystocia can be relieved with the

McRoberts maneuver and suprapubic pressure, many women can be spared a surgical incision

L : Legs (the McRoberts maneuver) This procedure involves flexing and abducting the maternal

hips, positioning the maternal thighs up onto the maternal abdomen. This position flattens the sacral promontory and results in cephalad rotation of the pubic symphysis. Nurses and family members present at the delivery can provide

assistance for this maneuver.

P : Suprapubic pressure

The hand of an assistant should be placed suprapubically

over the fetal anterior shoulder, applying pressure in a


cardiopulmonary resuscitation style with a downward and

lateral motion on the posterior aspect of the fetal shoulder.


This maneuver should be attempted while continuing downward traction.

E : Enter maneuvers (internal rotation)

Rubin Manoeuvre : The accoucheurs hand is inserted into the vagina and digital pressure is applied to the posterior aspect of the anterior shoulder pushing it towards the fetal chest. This rotates the shoulders forward into the

more favourable oblique diameter. Attempt delivery.

RUBIN MANUEVRE

Woods Screw Manoeuvre

While maintaining pressure as above, the accoucheur introduces their second hand and locates the anterior aspect of the posterior shoulder. Pressure is applied to rotate the posterior shoulder. Attempt delivery once the shoulders move into the oblique diameter. If this movement is unsuccessful continue rotation through 180 and attempt delivery.

Reverse Woods Screw Manoeuvre

Apply pressure to the posterior aspect of the posterior shoulder and attempt to rotate it through 180 in the opposite direction to that described in the Wood Screw manoeuvre.

R : Remove the posterior arm.

Removing the posterior arm from the birth canal also shortens the bisacromial diameter, allowing the fetus to drop into the sacral hollow, freeing the impaction. The elbow then should be flexed and the forearm delivered in a sweeping motion over the fetal anterior chest wall. Grasping and

pulling directly on the fetal arm may fracture the humerus.

R : Roll the patient.

The patient rolls from her existing position to the all-fours position. Often, the shoulder will dislodge during

the act of turning, so that this movement alone may be


sufficient to dislodge the impaction. In addition, once the position change is completed

Zavanelli maneuver
Cephalic replacement followed by cesarean delivery; involves rotating the fetal

head into a direct occiput anterior position, then flexing and pushing the vertex back into the birth canal, while holding continuous upward pressure until cesarean

delivery is accomplished. Tocolysis may be a helpful adjunct to this procedure,


although it has not been proved to enhance success over cases in which it was not

Symphysiotomy
Intentional division of the fibrous cartilage of the symphysis pubis under local

anesthesia has been used more widely in developing countries than in North America. It should be used only when all other maneuvers have failed and capability of cesarean delivery is unavailable

PENCEGAHAN

Rencanakan SC bila curiga makrosomia

Induksi persalinan sebelum postterm Mengontrol kenaikan berat badan ibu dengan

mengatur pola makan dan kadar gula darah