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  • ASKEP PERSALINAN NORMALJuwitasari, S.Kep. Ns

  • ESSENTIALS OF NURSING CARE: REPRODUCTIVE HEALTHNeeds of the Childbearing Family: Preconception

  • PENGERTIAN PERSALINAN NORMALAdalah proses alamiah dimana terjadi pembukaan cervik serta pengeluaran janin dan plasenta dari tubuh ibu.Suatu proses pengeluaran hasil konsepsi yang dapat hidup dari dalam uterus melalui vagina ke dunia luar (Sarwono, 1999).Persalinan yang dimulai secara spontan, beresiko rendah pada awal persalinan da tetap demikian selama proses persalinan (WHO, 1998).

  • PENGERTIAN PERSALINAN ANJURAN(INDUCTION OF LABOR)Persalinan yang hisnya/kontraksi uterusnya muncul setelah dibantu dengan cara:- Pemecahan ketuban, mengurangi ketegangan otot rahim sehingga uterus kontraksi.- Pemberian prostaglandine/mesoprostol- Pemberian oksitosin drip- Merangsang pleksus frankenhauser dengan pemasangan laminaria di kanalis servikalis.

  • PENGERTIAN PERSALINAN BUATAN(PARTUS ABNORMAL)Proses kelahiran dengan bantuan alat, misalnya:Vakum ekstraksiForcep ekstraksiDekapitasiSC

  • PERSALINAN BERDASARKAN USIA KEHAMILANPersalinan post term/post date/serotinus adalah persalinan pada usia kehamilan lebih dari 42 minggu.Persalinan aterm/matur adalah persalinan pada usia kehamilan 37-42 minggu dengan BBL > 2.500 gr.Persalinan prematur adalah persalinan pada usia kehamilan 28-37 minggu atau BBL>1.000 gr-2.499 gr.Persalinan immatur adalah persalinan pada usia kehamilan 22-28 minggu atau BBL>500gr-999 gr.Abortus adalah pengeluaran buah kehamilan
  • FAKTOR-FAKTOR YANG MEMPENGARUHI PERSALINANPowerPassage (jalan lahir)PassangerPsikologisPenolong

  • TANDA TANDA PERSALINANHis makin cepat makin sering Penipisan dan pembukaan servik sekurang-sekurangnya 3 cmKeluar lendir darah dari vagina (bloody show)/kelur air secara tiba-tiba.

  • HIS ADEKWATBersifat teratur minimal 2x tiap 10 menit lamanya 40 detik kuatKuat, mengeras saat kontraksi sehingga tak ada cekungan lagi bila ditekan dengan ujung jari.Servik membuka.

  • ADAPTASI IBU DAN JANIN SELAMA PERSALINANProses Persalinan:Kala I: Pembukaan 0-10 cmKala II: Pengeluaran janinKala III: Pengeluaran PlasentaKala IV: 2 jam post partum

  • KALA I (PEMBUKAAN CERVIK)Fase LatentFase Aktif:- fase akselerasi (2 jam pembukaan servik 3cm-4cm)- fase dilatasi maksimal (dlm 2 jam pembukaan jadi 9 cm)- fase deselerasi (dlm 2 jam pembukaan 9-10 cm/lengkap)Pada multigravida lebih 7 jam, primi gravida 14 jam.

  • COUNSELING AND PLANNING FOR PARENTHOODPreconception care focuses on risk assessment and promoting healthy behaviorsHealthy well-informed women who plan pregnancy have better outcomesContraception is important aspect in planning process

  • PRENATAL CARETo promote positive outcomes for both mother & childShould begin prior to conceptionFirst prenatal visitTypically scheduled between weeks 8-12 of gestationObtain health hx (first menarche, sexual & family hxs, Gravida/Para)Physical exam (vaginal exam, pap smearConfirm pregnancyPrenatal labs (blood type, Rh factor, rubella status, Hep B status, STD, pap smear,

  • TESTING (THE TRIPLE SCREEN)Alpha-fetoprotein testPerformed between week 16 18Indicates neural tube defects and chromosomal disordersHigh incidence of false positivesIf complication indicated amniocentesis is recommended

  • THE TRIPLE SCREEN (CONTD)Gestational Diabetes ScreeningPerformed at week 28Fasting glucose testIf failed, glucose tolerance testIf positive, dietary consult and/or diabetes educator consultInstruct on proper dietHow to monitor blood glucose levels (glucometer)If diet control unsuccessful, insulin injections may be required

  • THE TRIPLE SCREEN (CONTD)Group Beta Strep Bacteria detectionNot an uncommon findingRequires Abx upon rupture of membrane or onset of active laborRecommended that one dose of Abx be administered at least 4 hours prior to delivery to reduce risk of infant contracting group beta strepCan cause serious illness in infant but harmless to mother

  • FETAL ASSESSMENT DURING LABOR

  • ASSESSMENT FOR GENETIC DISORDERS Maternal ageEthnic backgroundFamily historyReproductive historyMaternal diseaseEnvironmental hazards Chapter 22

  • BIOPHYSICAL PROFILE (BPP)A noninvasive assessment of the fetus and its environment by U/S, noting normal and abnormal biophysical responses to stimuli.A normal BPP indicates that the CNS is functional and the fetus is not hypoxemic.A scoring system, of 5 variables, with a total score up to 10.

  • BIOPHYSICAL PROFILE VARIABLES Fetal breathing movementsGross body movementFetal toneAmniotic fluid volume indexNon-stress test Chapter 22

  • BPP: VARIABLES & SCORESFETAL BREATHING MOVEMENTS:>1 episode in 30 min, each > 30 seconds. (normal score = 2)Episodes absent or no episode > 30 sec in 30 min. (abnormal = 0)GROSS BODY MOVEMENTS:>3 discrete body or limb movements in 30 min. (normal = 2)< 3 episodes of body or limb movement in 30 min. (abnormal =0)

  • FETAL TONE:> episodes of active extgension with return to flexion of fetal limb(s) or trunk, opening & closing hand being considered normal tone. (normal =2)Slow extension with return to flexion, movement of limb in full extension, or fetal movement absent. (abnormal = 0)

  • REACTIVE FETAL HEART RATE:> 2 episodes of acceleration (>15 bpm) in 20 min, each lasting > 15 sec. & associated with fetal movement. (normal = 2)< 2 episodes of acdceleration or acceleration of < 15 bpm in 20 min. (abnormal = 0)

  • QUALITATIVE AMNIOTIC FLUID VOLUME:> 1 pockets of fluid measuring >1 cm in 2 perpendicular planes. (normal =2)Pockets absent or poscet < 1 cm in 2 perpendicular planes. (abnormal = 0)

  • INTERPRETATION OF BPP SCORES:Normal = 8-10 (if Amniotic fluid index is adequate)Equivocal = 6Abnormal =
  • DOCUMENTATION OF A CONTRACTION STRESS TEST Negative: No late decelerations with 3 adequate uterine contractions in a 10-minute window, normal baseline FHR and accelerations with fetal movement.

    Positive: Late decelerations occur with more than half the uterine contractions.

    Chapter 22

  • DOCUMENTATION OF A CONTRACTION STRESS TEST (CONT.)Suspicious: Late decelerations occur with less than half the uterine contractions.

    Unsatisfactory: Inadequate fetal heart rate recording or less than 3 uterine contractions in 10 minutes.

    Chapter 22

  • INDICATIONS FOR THE NST Suspected post-maturityMaternal diabetesMaternal hypertension: chronic and pregnancy-related disordersSuspected or documented IUGR History of previous stillbirthIsoimmunization

    Chapter 22

  • INDICATIONS FOR THE NST (CONT.)Older gravidaDecreasing fetal movement Sever maternal anemiaMultiple gestationHigh-risk antepartal conditions: PROM, PTL, bleedingChronic renal diseases

    Chapter 22

  • ELECTRONIC FETAL MONITORINGExternal: ultrasound transducerInternal: spiral electrode

  • ULTRASOUND TRANSDUCERHigh-frequency sound waves reflect mechanical action (fetal heart tone & valves) of the fetal heart.Noninvasive. (Does NOT require rupture of membranes or cervical dilation)Used in both antepartum and intrapartum period.Short-term variability and beat-to-beat changes in the FHR cannot be assessed accurately by this method.

  • SPIRAL ELECTRODEApplied to the fetal presenting part to assess the FHR.Converts the fetal ECG as obtained from the presenting part to the FHR via a cardiotachometer.Used ONLY when membranes are ruptured & cervix is sufficiently dilated.Short-term variability CAN be assessed using this method.

  • FHR VARIABILITYIncreased Variability: marked variability from a previous average variability.Causes: early mild hypoxia; fetal stimulation (uterine palpation, contractions, fetal activity; maternal activity; illicit drugs).Significance: unknown.Nsg.Intervention: observe for any nonreassuring patterns; if using external fetal monitoring consider an internal mode for a more accurate tracing.

  • FHR VARIABILITYDecreased Variability: marked decrease in variability from a previous average variability.Causes: hypoxia / acidosis; CNS depressants; analgesics / narcotics; barbiturates; tranquilizers, anaractics; parasympatholytics; general anesthetics; prematurity (
  • FHR VARIABILITYDecreased Variability (continued):Significance: benign when associated with fetal sleep cycles; if drugs, variability usually increases as drugs are excreted; when associated with uncorrectable late decelerations indicates presence of fetal acidosis and can result in low APGARs.Nsg.Interventions: none, if fetal sleep cycle, or CNS depressants; consider fetal scalp stimulation or apply a spiral electrode; monitor fetal oxygen saturation; prepare for birth if indicated.

  • OTHER DEFINITIONSTachycardia: a baseline FHR >160 bpm for a duration of 10 minutes or longer.Bradycardia: a baseline FHR
  • FHR CHANGESAccelerationsDecelerationsEarlyLateVariableProlonged

  • BASELINE FHRDefinition: the average rate during a 10 minute period that excludes periodic or episodic changes, periods of marked variability, and segments of the baseline that differ by more than 25 bpm.Range: 110-160 bpm.

  • ACCELERATIONSDefinition: A visually apparent abrupt increase in FHR above the baseline rate.An increase of 15 bpm and lasting 15 seconds or more, with the return to baseline less than 2 minutes from the beginning of the acceleration.Can be periodic or episodic.

  • EARLY DECELERATIONSDefinition: a transitory gradual decrease and return to baseline FHR in response to fetal head compression.Generally starts before the peak of the uterine contractions.Returns to the baseline at the