BAB II TINJAUAN TEORI
2.1 Pengertian Persalinan
Berdasarkan Peraturan Kementrian Kesehatan 2014 No.79 Pasal 1 Ayat 3 Persalinan adalah setiap kegiatan dan/atau serangkaian kegiatan yang ditujukan pada ibu sejak dimulainya persalinan hingga 6 (enam) jam sesudah melahirkan. Persalinan merupakan suatu proses pengeluaran hasil konsepsi yang dapat hidup dari dalam uterus melalui vagina ke dunia luar dengan umur kehamilan di atas 28 minggu. 2.1.1
Menurut WHO (World Health Organizatio O rganization) n)
Persalinan normal menurut WHO adalah persalinan yang di mulai secara spontan, beresiko rendah pada awal persalinan dan tetap demikian selama proses persalinan, bayi dilahirkan secara spontan dalam presentasi belakang kepala pada usia kehamilan antara 37- 42 minggu. Setelah persalinan ibu maupun bayi dalam kondisi baik.
2.2 Jenis Persalinan
2.2.1. Abortus pengeluaran hasil konsepsi sebelum janin dapat hidup diluar kandungan, berat janin <500 gram atau usia kehamilan kurang kurang dari 20 minggu. minggu. 2.2.2. Partus Immaturus partus dari hasil konsepsi pada kehamilan dibawah 28 minggu dengan berat janin kurang dari 1000 gram. 2.2.3. Partus Prematurus Kelahiran hidup bayi dengan berat antara 1000 gram sampai 2500 gram sebelum usia 37 minggu mi nggu.. 2.2.4. Partus Maturus atau Aterm persalinan pada kehamilan 37-42 minggu, minggu, berat janin diatas 2500 gram. 2.2.5. Partus Postmaturus atau Postterm persalinan yang terjadi 2 minggu minggu atau lebih dari hari perkiraan lahir.
5
7
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2.3 Sebab-sebab Sebab-sebab Terjadinya persalinan
Hal-hal yang menjadi penyebab mulainya persalinan belum diketahui benar, yang ada hanyalah merupakan teori-teori yang kompleks. 2.3.1 Penurunan kadar progesterone Proses penuaan plasenta terjadi mulai umur kehamilan 28 minggu, dimana terjadi
penimbunan
jaringan
ikat
sehingga
pembuluh
darah
mengalami
penyempitan dan buntu. Produksi progesterone mengalami penurunan sehingga otot rahim lebih sensitif terhadap oksitosin. Akibatnya, otot rahim mulai berkontraksi setelah mencapai tingkat penurunan progesterone progesterone tertentu. Progesteron menimbulkan relaksasi otot-otot rahim. Sebaliknya estrogen meninggikan kerentanan otot rahim. Selama kehamilan terdapat keseimbangan antara kadar progesteron dan estrogen di dalam darah, tetapi pada akhir kehamilan kadar progesteron menurun sehingga timbul his. 2.3.2 Oxytosin Oksitosin dikeluarkan oleh kelenjar hipofisis pars posterior. Perubahan keseimbangan kedua hormone estrogen dan progesterone dapat mengubah sensitivitas otot rahim sehingga sehingga sering terjadi kontraksi Braxton hicks. Menurunnya
konsentrasi
progesterone
akibat
tuanya
usia
kehamilan
menyebabkan oksitosin meningkatkan aktivitas aktivitas sehingga persalinan persa linan dimulai. 2.3.3 Teori distensi Rahim Keadaan uterus yang terus menerus membesar dan menjadi tegang mengakibatkan iskemia otot-otot uterus. Hal ini mungkin merupakan faktor yang dapat mengganggu sirkulasi uteroplasenter sehingga plasenta menjadi degenerasi. 2.3.4 Teori prostaglandin Prostaglandin yang dihasilkan oleh desidua dianggap menjadi salah satu sebab permulaan persalinan. Hasil dari percobaan menunjukkan bahwa prostaglandin yang diberikan secara intravena, intra dan extramnial menimbulkan kontraksi miometrium pada setiap umur kehamilan. 2.3.5 Lightening Terbenamnya kepala janin ke dalam rongga panggul karena berkurangnya tempat di dalam uterus dan sedikit melebarnya symphisis. Keadaan ini sering
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2.3.6 Kontraksi Braxton-Hicks Kontraksi Braxton-Hicks pada saat uterus yang teregang dan mudah dirangsang itu menimbulkan distensi dinding abdomen sehingga dinding abdomen menjadi lebih tipis dan kulit menjadi lebih peka terhadap rangsangan. 2.3.7 Teori iritasi mekanik Tekanan pada ganglion servicale dan pleksus frankenhauser yang terletak di belakang serviks. Bila ganglion ini tertekan, kontraksi kontraksi uterus akan timbul. 2.3.8 Kortisol Janin Peningkatan beban / stress pada maternal maupun fetal dan peningkatan estrogen mengakibatkan peningkatan akfifitas kortisol, prostaglandin, oksitosin, menjadi pencetus rangsangan untuk proses persalinan
[14]
2.4 Mekanisme Mekanisme Persalinan
Selama proses persalinan, janin melakukan serangkaian gerakan untuk melewati panggul ( seven seven cardinal movements of labor) 2.4.1 Engagement Terjadi ketika diameter terbesar dari presentasi bagian janin (biasanya kepala) telah memasuki rongga panggul. Engagement telah telah terjadi ketika bagian terendah janin telah memasuki station station nol atau lebih rendah. Pada nulipara, engagement sering terjadi sebelum awal persalinan. Namun, pada multipara dan beberapa nulipara, engagement tidak terjadi sampai setelah persalinan dimulai. 2.4.2 Descent: Descent Descent: Descent terjadi ketika bagian terbawah janin telah melewati panggul. Descent / penurunan terjadi akibat tiga kekuatan yaitu tekanan dari cairan amnion, tekanan langsung kontraksi fundus pada janin dan kontraksi diafragma serta otototot abdomen ibu pada saat persalinan, dengan sumbu jalan lahir:
Sinklitismus yaitu ketika sutura sagitalis sejajar dengan sumbu jalan lahir
Asinklistismus anterior: Kepala janin mendekat me ndekat ke arah promontorium sehingga os parietalis lebih rendah.
Asinklistismus posterior: Kepala janin mendekat me ndekat ke arah simfisis dan tertahan oleh simfisis pubis.
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Proses Descent (Sinklitismus, Asinklitismus anterior, dan Asinklitismus posterior), Sumber: Cunningham et. al. William Obstetrics 23rd Edition
2.4.3 Fleksi ( flexion):Segera flexion ):Segera setelah bagian terbawah janin yang turun tertahan oleh serviks, dinding panggul, atau dasar panggul, dalam keadaan normal fleksi terjadi dan dagu didekatkan ke arah dada janin. Fleksi ini disebabkan oleh
Persendian leher, dapat berputar ke segala arah termasuk mengarah ke dada.
Letak leher bukan di garis tengah, tetapi ke arah tulang belakang sehingga kekuatan his dapat menimbulkan fleksi kepala.
Terjadi perubahan posisi tulang belakang janin yang lurus sehingga dagu lebih menempel pada tulang dada janin .
Kepala janin yang mencapai dasar panggul akan menerima tahanan sehingga memaksa kepala janin mengubah kedudukannya menjadi fleksi untuk mencari lingkaran kecil yang akan melalui jalan lahir (Cunningham dkk, 2013; McKinney, 2013).
2.4.4 Putaran paksi dalam (internal (internal rotation) rotation) Putaran paksi dalam dimulai pada bidang setinggi spina ischiadika. Setiap kali terjadi kontraksi, kepala janin diarahkan ke bawah lengkung pubis dan kepala berputar saat mencapai otot panggul panggul (Cunningham dkk, 2013; 2013; McKinney, 2013). 2.4.5 Ekstensi (extension (extension)) Saat kepala janin mencapai perineum, kepala akan defleksi ke arah anterior oleh perineum. Mula-mula oksiput melewati permukaan bawah simfisis pubis, kemudian kepala keluar mengikuti sumbu jalan lahir akibat ekstensi. 2.4.6 Putaran paksi luar (external ( external rotation)Putaran rotation)Putaran paksi luar terjadi ketika kepala lahir
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2.4.7 Ekspulsi Setelah bahu keluar, kepala dan bahu diangkat ke atas tulang pubis ibu dan badan bayi dikeluarkan dengan gerakan gerakan fleksi lateral ke arah simfisis pubis.
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2.5 Faktor-Faktor Faktor-Faktor yang y ang Mempengaruhi Persalinan
2.5.1
[15]
Power His (kontraksi ritmis otot polos uterus) adalah kekuatan mengejan ibu keadaan kardiovaskuler respirasi metabolik ibu. Kontraksi uterus berirama teratur dan involunter serta mengikuti pola yang berulang. Setiap kontraksi uterus memiliki tiga fase yaitu: increment (ketika intensitasnya terbentuk), acme (puncak atau maksimum), decement (ketika relaksasi). Kontraksi uterus terjadi karena adanya penimbunan dan pengikatan kalsium pada Retikulum Endoplasma (RE) yang bergantung pada Adeno Triphospat (ATP) dan sebaliknya E2 dan F2 mencegah penimbunan dan peningkatan oleh ATP pada RE, RE membebaskan kalsium ke dalam intra selular dan menyebabkan kontraksi miofibril. Setelah miofibril berkontraksi, kalsium kembali lagi ke RE sehingga kadar kalsium intraselular akan berkurang dan menyebabkan relaksasi miofibril. Peregangan serviks oleh kepala janin akhirnya menjadi cukup kuat untuk menimbulkan daya kontraksi korpus uteri dan akan mendorong janin maju sampai janin dikeluarkan. Ini sebagai umpan balik positif, kepala bayi meregang serviks, regangan serviks merangsang kontraksi fundus mendorong bayi ke bawah dan meregangkan serviks lebih lanjut, siklus ini berlangsung terus menerus. Kontraksi uterus bersifat otonom artinya tidak dapat dikendalikan oleh parturien, sedangkan saraf simpatis dan parasimpatis hanya bersifat koordinatif.
Kekuatan his kala I bersifat -
Kontraksi bersifat simetris.
-
Fundus dominan.
-
Involunter artinya tidak dapat diatur oleh parturien.
-
Kekuatan makin besar dan pada kala pengeluaran diikuti dengan reflek mengejan.
-
Diikuti retraksi artinya panjang otot rahim yang berkontraksi t idak akan kembali ke panjang semula.
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Kekuatan his kala II Kekuatan his pada akhir kala pertama atau permulaan kala dua mempunyai amplitudo 60 mmHg, interval 3-4 menit, durasi berkisar 60-90 detik. Kekuatan his menimbulkan putaran paksi dalam, penurunan kepala atau bagian terendah menekan serviks di mana terdapat fleksus frikenhauser sehingga terjadi reflek mengejan. Kekuatan his dan reflek mengejan mengakibatkan ekspulsi kepala sehingga berturut- turut lahir ubun-ubun besar, dahi, muka, kepala seluruhnya. seluruhnya.
Kekuatan his kala III Setelah istirahat sekitar 8-10 menit berkontraksi untuk melepaskan plasenta dari insersinya.
Kekuatan his kala IV Setelah plasenta lahir kontraksi rahim tetap kuat dengan amplitudo sekitar 60-80 mmHg. Kekuatan kontraksi ini tidak diikuti oleh interval pembuluh darah tertutup rapat ra pat dan terjadi kesempatan membentuk trombus. Melalui kontraksi yang kuat dan pembentukan trombus terjadi penghentian pengeluaran darah postpartum (Wiknjosastro, 2002). 2002).
2.5.2
Passage Passage adalah keadaan jalan lahir, jalan lahir mempunyai kedudukan penting dalam proses persalinan untuk mencapai kelahiran bayi. Dengan demikian evaluasi jalan lahir merupakan salah satu faktor yang menentukan apakah persalinan dapat berlangsung pervaginam atau sectio sesaria. Pada jalan lahir tulang dengan panggul ukuran normal apapun jenis pokoknya kelahiran pervaginam janin dengan berat badan yang normal tidak akan mengalami kesukaran, akan tetapi karena pengaruh gizi, lingkungan atau hal-hal lain.
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2.5.3
Passanger Passager adalah janinnya sendiri, bagian yang paling besar dan keras pada janin adalah kepala janin, posisi dan besar kepala dapat mempengaruhi jalan persalinan, kepala janin ini pula yang paling banyak mengalami cedera pada persalinan, sehingga dapat membahayakan hidup dan kehidupan janin kelak, hidup sempurna, cacat atau akhirnya meninggal. Biasanya apabila kepala janin sudah lahir, maka bagian-bagian bagian-bagian lain dengan mudah menyusul menyusul kemudian.
2.5.4
Psikologi Respon Perasaan positif berupa kelegaan hati, seolah-olah pada saat itulah benar- benar benar terjadi realitas “kewanitaan sejati” yaitu munculnya rasa bangga biasa melahirkan atau memproduksi anaknya. a naknya. Mereka seolah-olah mendapatkan kepastian bahwa kehamilan yang semula dianggap sebagai suatu “keadaan yang belum pasti“ sekarang menjadi me njadi hal hal yang nyata. Psikologis meliputi : Melibatkan psikologis ibu, emosi dan persiapan intelektual, pengalaman bayi sebelumnya, kebiasaan adat, dukungan dari orang terdekat pada kehidupan ibu.
2.5.5
Penolong Peran dari penolong persalinan dalam hal ini adalah mengantisipasi dan menangani komplikasi yang mungkin terjadi pada ibu dan janin. Proses tergantung dari kemampuan skill dan kesiapan penolong dalam menghadapi proses persalinan.
2.6 Tahapan-tahapan Tahapan-tahapan Persalinan
2.6.1 Kala I Kala I persalinan dimulai sejak terjadinya kontraksi uterus dan pembukaan serviks hingga mencapai pembukaan lengkap (10 cm). Persalinan kala I dibagi
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2.6.1.2 Fase Aktif Persalinan[7] Frekuensi dan lama kontraksi uterus umumnya meningkat (kontraksi dianggap adekuat atau memadai jika terjadi 3x atau lebih dalam waktu 10 menit, dan berlangsung-langsung selama 40 detik atau lebih). Serviks membuka dari 4-10 cm, biasanya dengan kecepatan 1 cm atau lebih perjam hingga pembukaan lengkap. Terjadi penurunan bagian terbawah janin. Fase aktif persalinan dibagi menjadi 3.[8] 2.6.1.2.1 Fase Akselerasi Dalam waktu 3 jam pembukaan serviks dari 3 cm menjadi 4 cm. 2.6.1.2.2 Fase Dilatasi Maksimal Dalam waktu 2 jam pembukaan berlangsung sangat cepat dari 4 cm menjadi 9 cm 2.6.1.2.3 Fase Deselerasi Pembukaan menjadi lambat kembali dalam waktu 2 jam, pembukaan dari 9 cm menjadi lengkap. lengkap. Fase-fase tersebut dijumpai pada primigravida. Pada multigravida pun terjadi demikian, akan tetapi fase laten, fase aktif, dan fase deselari menjadi lebih pendek. Mekanisme mebukanya serviks berbeda antara primigravida dan multi gravida, pada yang pertama ostium uteri intemum akan membuka lebih dahulu, sehingga serviks akan mendatar dan menipis. Baru kemudian osteum uteri eksternum membuka.Pada multi gravida, ostium uteri internum sudah sedikit terbuka. Ostium uteri internum dan eksternum serta penipisan dan
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14
Asuhan persalinan yang yang di berikan oleh oleh tenaga kesehatan pada Kala I antara lain, yaitu: [9]
Beri dukungan dan dengarkan keluhan ibu
Jika ibu tampak gelisah/kesakitan:
Biarkan ia berganti posisi sesuai keinginan, tapi jika di tempat tidur sarankan untuk miring kiri.
Biarkan
ia
berjalan
atau
beraktivitas
ringan
sesuai
kesanggupannya
Anjurkan suami atau keluarga memjiat punggung atau membasuh muka ibu
Ajari teknik bernapas
Jaga privasi ibu. Gunakan tirai penutup dan tidak menghadirkan orang lain tanpa seizin ibu. Izinkan ibu untuk mandi atau membasuh kemaluannya setelah buang air kecil/besar.
Jaga kondisi ruangan sejuk. Untuk mencegah kehilangan panas pada bayi ba yi baru lahir, suhu ruangan minimal 250C dan semua pintu serta jendela harus tertutup.
Beri minum yang cukup untuk menghindari dehidrasi.
Sarankan ibu berkemih sesering mungkin.
Pantau parameter berikut secara rutin dengan menggunakan partograf.
Pasang infus intravena untuk pasien dengan:
Kehamilan lebih dari 5
Hemoglobin ≤9 g/dl atau hematokrit ≤27%
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15
Tabel penilaian dan intervensi Kala I
Selain kondisi di atas, ada beberapa tindakan yang sering dilakukan namun sebenarnya tidak banyak membawa manfaat bahkan justru merugikan, sehingga tidak dianjurkan melakukan hal-hal berikut: Kateterisasi kandung kemih rutin
Dapat meningkatkan risiko infeksi saluran kemih. Lakukan hanya jika ada indikasi. Posisi terlentang
Dapat mengurangi detak jantung dan penurunan aliran darah uterus sehingga kontraksi melemah Mendorong abdomen
Menyakitkan bagi ibu dan meningkatkan risiko ruptura uteri Mengedan sebelum pembukaan serviks lengkap
Dapat menyebabkan edema dan laserasi serviks
[8]
2.6.2 Kala II
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16
Tanda dan gejala Kala II
Dorongan meneran
Tekanan anus
Perineum menonjol
Vulva membuka Asuhan yang diberikan oleh tenaga kesehatan pada ibu saat Kala II antara
lain, yaitu[9] :
Mengenali tanda dan gejala Kala II 1.
Memeriksa tanda berikut: -
Ibu mempunyai keinginan untuk meneran.
-
Ibu merasa tekanan yang semakin meningkat pada rektum dan/atau vaginanya.
-
Perineum menonjol dan menipis.
-
Vulva-vagina dan sfingter ani membuka.
Menyiapkan pertolongan persalinan 2.
Pastikan kelengkapan peralatan, bahan dan obat-obatan esensial. -
Klem, gunting, benang tali pusat, penghisap lendir steril/DTT
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17
4.
Lepas semua perhiasan pada lengan dan tangan lalu cuci kedua tangan dengan sabun dan air bersih kemudian keringkan dengan handuk atau tisu bersih.
5.
Pakai sarung tangan steril/DTT untuk pemeriksaan dalam.
6.
Ambil spuit dengan tangan yang bersarung tangan, isi dengan oksitosin 10 unit dan letakkan kembali spuit tersebut di partus set/wadah DTT atau steril tanpa mengontaminasi spuit.
Memastikan pembukaan lengkap dan keadaan Janin baik 7.
Bersihkan vulva dan perineum, dari depan ke belakang dengan kapas atau kasa yang dibasahi air DTT.
8.
Lakukan pemeriksaan dalam untuk memastikan bahwa pembukaan serviks sudah lengkap. Lakukan amniotomi bila selaput ketuban belum pecah, dengan syarat: kepala sudah masuk ke dalam panggul dan tali pusat tidak teraba.
9.
Dekontaminasi sarung tangan dengan mencelupkan tangan yang masih memakai sarung tangan ke dalam larutan klorin 0,5%, kemudian lepaskan sarung tangan dalam keadaan terbalik dan rendam dalam larutan klorin 0,5% selama 10 menit. Cuci kedua tangan setelahnya.
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18
Gambar posisi persalinan setengah duduk -
Anjurkan ibu untuk cukup minum.
13. Melakukan pimpinan meneran saat ibu mempunyai dorongan yang kuat untuk meneran. -
Perbaiki cara meneran apabila caranya tidak sesuai.
- Nilai DJJ setiap kontraksi uterus selesai. 14. Anjurkan ibu untuk berjalan, berjongkok atau mengambil posisi yang nyaman, jika ibu belum merasa ada dorongan untuk meneran dalam 60 menit. Segera hubungi dokter spesialis obstetri dan ginekologi jika bayi belum atau tidak akan segera lahir setelah 120 menit (2 jam) meneran (untuk primigravida) atau 60 menit (1 jam) meneran
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19
sementara tangan yang lain menahan kepala bayi untuk menahan posisi defleksi dan membantu lahirnya lahirnya kepala. -
Anjurkan ibu meneran sambil bernapas cepat dan dangkal.
20. Periksa lilitan tali pusat dan lakukan tindakan yang sesuai jika hal itu terjadi. -
Jika lilitan tali pusat di leher bayi masih longgar, selipkan tali pusat lewat kepala bayi.
Memeriksa tali pusat -
Jika lilitan tali pusat terlalu ketat, klem tali pusat di dua titik lalu gunting di antaranya. Jangan lupa untuk tetap lindungi leher bayi.
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20
Melahirkan bahu depan -
Gerakkan arah atas dan distal untuk melahirkan bahu belakang seperti gambar berikut :
Melahirkan bahu belakang
Membantu lahirnya badan dan Tungkai 23. Setelah kedua bahu lahir, geser tangan yang berada di bawah ke arah perineum ibu untuk menyangga kepala, lengan dan siku
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21
Bila ada jawaban “Tida “Tidak”, bayi mungkin mengalami asfiksia. Segera lakukan resusitasi bayi baru lahir (lihat bab 3.3) sambil menghubungi dokter spesialis anak. Bila dokter spesialis anak tidak ada, segera persiapkan rujukan. Pengisapan lendir jalan napas pada bayi tidak dilakukan secara rutin 26. Bila tidak ada tanda asfiksia, lanjutkan manajemen bayi baru lahir normal. Keringkan dan posisikan tubuh bayi di atas perut ibu -
Keringkan bayi mulai dari muka, kepala, dan bagian tubuh lainnya kecuali bagian tangan tanpa membersihkan verniks.
-
Ganti handuk basah dengan handuk yang kering
-
Pastikan bayi dalam kondisi mantap di atas dada atau perut
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22
kehilangan darah. Sebagian besar kesakitan dan kematian ibu di indonesia disebabkan oleh perdarahan pasca persalinan, dimana sebagian besar disebabkan oleh atonia uteri dan retentio plasenta yang sebenarnya dapat dicegah dengan menejemen kala tiga. Manajemen aktif kala tiga terdiri dari 3 langkah utama :
Pemberian suntikan oksitosin
Melakukan penegangan tali pusat terkeldali
Massage Fundus uteri
2.6.3.2 Asuhan pada Kala III Asuhan yang di berikan oleh tenaga kesehatan pada ibu bersalin saat kala III yaitu, antara lain[9]: 28. Beritahukan kepada ibu bahwa penolong akan menyuntikkan oksitosin untuk membantu uterus berkontraksi baik.
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23
Ikat tali pusat dengan benang DTT/steril pada satu sisi kemudian lingkarkan kembali benang ke sisi berlawanan dan lakukan ikatan kedua menggunakan simpul kunci.
Lepaskan klem dan masukkan dalam larutan la rutan klorin 0,5%.
Jangan membungkus puntung tali pusat atau mengoleskan cairan/bahan apapun ke puntung tali pusat 32. Tempatkan bayi untuk melakukan kontak kulit ibu ke kulit bayi. Letakkan bayi dengan posisi tengkurap di dada ibu. Luruskan bahu bayi sehingga bayi menempel dengan baik di dinding dada-perut ibu. Usahakan kepala bayi berada di antara payudara ibu dengan posisi lebih rendah dari puting payudara payudara ibu. 33. Selimuti ibu dan bayi dengan kain hangat dan kering dan pasang
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24
Jika plasenta tidak lahir setelah 30-40 detik, hentikan penegangan tali pusat dan tunggu hingga timbul kontraksi berikutnya dan ulangi prosedur di atas. 37. Lakukan penegangan dan dorongan dorso-kranial hingga plasenta terlepas, lalu minta ibu meneran sambil menarik tali pusat dengan arah sejajar lantai dan kemudian ke arah atas, mengikuti poros jalan lahir dengan tetap melakukan tekanan dorso-kranial, seperti gambar berikut.
Jika tali pusat bertambah panjang, pindahkan klem hingga berjarak sekitar 5-10 cm dari vulva dan lahirkan plasenta
Jika plasenta tidak lepas setelah 15 menit menegangkan tali pusat:
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25
40. Periksa kedua sisi plasenta baik yang menempel ke ibu maupun janin dan pastikan bahwa selaputnya selaputnya lengkap dan utuh. 41. Evaluasi adanya laserasi pada vagina dan perineum dan lakukan penjahitan bila laserasi menyebabkan perdarahan aktif.
8
2.6.4 Kala IV
Kala IV dimulai saat plasenta lahir sampai 2 jam pertama postpartum. Pada Kala ini ibu baru saja mengalami perubahan fisik yang luar biasa. Petugas/bdan harus tinggal bersama ibu dan bayi untuk memastikan bahwa keduanya dalam kondisi stabil dan mengambil tindakan yang tepat untuk melakukan stabilisasi. Pada saat plasenta telah lahir segera lakukan pemeriksaan pada kedua sisi plasenta baik yang menempel pada ibu maupun janin dan pastikan bahwa
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26
Sebagian besar bayi akan berhasil melakukan inisiasi menyusu dini dalam waktu 60-90 menit. Menyusu pertama biasanya berlangsung pada menit ke-45-60, dan berlangsung selama 10-20 menit. Bayi cukup menyusu dari satu payudara.
Tunda semua asuhan bayi baru lahir normal lainnya dan biarkan bayi berada di dada ibu selama 1 jam walaupun bayi bayi sudah berhasil menyusu.
Bila bayi harus dipindah dari kamar bersalin sebelum 1 jam atau
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27
Berikan gelang pengenal pada bayi yang berisi informasi nama ayah, ibu, waktu lahir, jenis kelamin, dan tanda lahir jika ada.
Lakukan pemeriksaan untuk melihat adanya cacat bawaan (bibir sumbing/langitan sumbing, atresia ani, defek dinding perut) dan tandatanda bahaya pada bayi.
Bila menemukan tanda bahaya, hubungi dokter spesialis anak. Bila dokter spesialis anak tidak ada, segera persiapkan rujukan
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28
51. Tempatkan semua peralatan bekas pakai dalam larutan klorin 0,5% untuk dekontaminasi (10 menit). Cuci dan bilas peralatan setelah didekontaminasi. 52. Buang bahan-bahan yang terkontaminasi ke tempat sampah yang sesuai. 53. Bersihkan badan ibu menggunakan air DTT. Bersihkan sisa cairan ketuban, lendir dan darah. Bantu ibu memakai pakaian yang bersih dan kering. 54. Pastikan ibu merasa nyaman.
Bantu ibu memberikan ASI.
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29
K lasi lasi fi kasi D er aj at Ro R obek an/L n/L aser ser asi P er i neum neum menur nurut ut buk buku u saku saku mater maternal nal[7] Derajat
Penjelasan
1
Laserasi epitel vagina atau laserasi pada kulit perineum saja
2
Melibatkan kerusakan pada otot-otot perineum, tetapi tidak melibatkan kerusakan sfringter ani
3
Kerusakan pada otot sfringter ani
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2.8.2 Continue
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Indikasi
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presipitatus antara lain terjadinya robekan perineum bahkan robekan
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2.9.1.7 Kesempitan pintu bawah panggul
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2.9.2.3 Presentasi bokong
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