Académique Documents
Professionnel Documents
Culture Documents
A difficult labor
3-P
1. POWER
2. PASSAGE
3. PASSENGER
A BABY IS DELIVERED UPON A CERTAIN POWER
PHYSIOLOGIC LABOR
SPONTANEOUS LABOR
3-P
1. POWER :
Pushing power
H i s / Labor pain
PROBLEMS
lamanya 60 detik
mencapai tekanan 50 - 60
mm Hg
terjadi setiap 2 - 3 menit
menghasilkan kemajuan
persalinan yang baik
AUGMENTATION
Ginekoid :
transversa p.a.p A.P
Antropoid :
A.P p.a.p > transversa
Android
p.a.p (Narrowing to anterior)
Platipelloid
A.P < < < transversa
3. PASSENGER :
MALPOSITION
MALPRESENTATION
PHYSICAL
ABNORMALITIES
MALPOSITION :
ROT
LOT
ROP LOP
OP
MALPRESENTATION
DEFLECTION :
1. Face presentation
2. Brow presentation
BREECH PRESENTATION
TRANVERSE LIE
COMPOUND PRESENTATION
BREECH PRESENTATION
DONT PULL!
traction deflexes the
fetal head
may cause nuchal
arm
PROFILAXIS :
External version
Condition :
Dilatation < 2-3 Cm
Membrane : intact
Presenting part : above in let
Contra indication of Ext.Version :
Contracted pelvis
Hypertension
Ante partum bleeding
Uterine ( Myometrial ) scar
Constraints for External Version :
Abdominal wall hardness
Placenta lies Anteriorly
Uterine malformation
Short umbilical cord
Frank breech
Complications :
Rupture of the membrane
UTERUS ARCUATUS
TRANSVERSE LIE
MANAGEMENT :
Hand prolaps : Spontaneous /FE
Arm prolaps : Reposition/FE/CS
CORD PROLAPS
TYPES :
Occult Prolapse
True Prolapse
DIAGNOSIS :
Membrane ( - ), cord was felt
beside the presenting part.
DIAGNOSIS :
Fundal height > 42 cm
USG
COMPLICATIONS :
CPD
Shoulder Dystocia
MANAGEMENT :
Fetus alive:
Breech presentation : CS
Occiput presentation :
Spontaneous /Consider
pelvic cavity wideness
Woods manuver
FE / VE
CS
Fetus dead : Embriotomy/FE/CS
HYDROCEPHALUS
Diagnosis :
Leopold III : Large bulky head ;
undescended.
Leopold IV : Both hand //
or Diverge.
USG : Brain Ventricles >>>
Face <<< other head parts
Diagnosis : ( continued )
During delivery :
Head presentation : high
Sutures >>>
Large fontanel >>> and bulging