5 Faktor yang mempengaruhi persalinan.ppt

7/25/2019 5 Faktor yang mempengaruhi persalinan.ppt

1/61

KONSEP PERSALINAN

DEFINISI

PROSES KELAHIRAN JANIN PADA TUA KEHAMILANSEKURANG-KURANGNYA 28 MG ATAU KALAU BY YGDILAHIRKAN BERATNYA 1000 GRAM

PERSALINAN NORMAL/BIASA

PROSES KELAHIRAN JANIN PD KEHAMILAN CUKUP BULAN(ATERM) PD JANIN LETAK MEMANJANG DAN PRESENTASIBELAKANG KEPALA YG DISUSUL PENGELUARANPLASENTA DAN SELURUH PROSES KELAHIRAN ITUBERAKHIR DLM !AKTU KURANG DARI 2" JAM TANPA

TINDAKAN PERTOLONGAN BUATAN DAN TANPAKOMPLIKASI


2/61


3/61

TANDA2 PERSALINAN

1# TANDA PERMULAAN PERSALINAN

- KEPALA TURUN MEMASUKI P A P

TERUTAMA PD PRIMI PD MULTI TDKKENTARA

- PERUT MELEBAR FUNDUS UTERI TURUN

- PERASAAN SERING BAK/SUSAH KRN

TERTEKAN BG B!H JANIN - SER$IKS JADI LEMBEK MULAI DATAR

SEKRESI BERTAMBAH BISA CAMPUR DRH


4/61

2# TANDA INPARTU

- RASA SAKIT OLEH ADANYA HIS YG

DATANG LEBIH KUAT SERING DANTERATUR

- KELUAR LENDIR CAMPUR DRH YGBANYK KRN ROBEKAN KCL PD SER$IKS

- KADANG2 KETUBAN PECAH DGNSENDIRI

-PD PEMERIKSAAN DLM SER$IKSMENDATAR DN PEMBUKAAN ADA


5/61

% F&'* +&, ..,&*3

*4&53,&,1# J&5&, 5&3* (&44&)

2# T,&& / ''&&, (6*)

7# J&,3, (&44,*)

"# P43'34 6&,3&

%# P,5,


6/61

1. Jalan lahir (Passage)

B&3&, '*&4 5&, &,5 B&3&, 5,&' 9&*3,&, :&, 53&.,

D3&;*&.& 5434 .#34>3>>>+4D3*&.& *3,3&5 *3,&5 ;&4>3&4

4*;343&5


7/61

Tulang panggul

1# O4 C?&

- 4 353. >*34& 353&>& S3,& 3# 43,&

3# 43,& 3##3 43,&3##4

- 4 34>3. =* 34>33 43,& 34>3&:3>&

- 4 =34 43.;3434 =34 &*>4 =34


8/61

2# O4 4&>*.

7# O4 >>4+34

A*3'5&43

1# S3.;3434 =34 :3:&, *.&, 4

=34

2# A*3'5&43 4&'*353&'& + .,=,'&,

44&'*. :&, 4 353.

7# A*3'5&43 4&'* ''43. +

.,=,'&, 4 4&'*. :&, ''434


9/61

U'*&, &,5

1# L&* - :34&,3& 43,&*. 2"-2@

- :34&,3& >*34&*. 28-70

- ',9&& ?*,& 18-20

- 53,'&*&, &,5 80-0

- :34&,3& =*. 10%2# D&5&.

PAP

- K,9&&


10/61

=# R&, ,& &,5

- =3:&, 5&4 17?12% - =3:&, 4.3 11%?11

- J&*&' &,&* 43,&

34>3&:3'& 11># P3, =&6& &,5

- '*&, &,* 4*3* 10-11

-'*&, .53,&, 10%

-&*'4 =34 4: 0 :*&9&


11/61

J,34 &,5

1# G3,'3: 3:&5 =5& "0

2# A,:*3: &,5 *3& 433& 1%

7# A,*3: &&' 5,9, 4*3 5* 7%

"# P5&353: .,+.3 &*& .'&

=5&'&, %


12/61

2# T,&&/K'&&, Y&, M,:*, (P6*)

H34 (',*&'43 *4)

S3;&,+& ',*&'43 43.*34 ;,:4 :.3,&, :33'3

*5&'4&43#

P: 4&& ',*&'43 *&3. .,,> =&5

,:'# K&&*& ;343' '3.3& :&, 43'34


13/61

C&&&, ,&, 34 ;*',43''&&,:*&43'*&*&,3,*


14/61

M&>&. 34

1# H34 ,:&5&, 3:&' '& :' *&*.,+=&='&, 46

2# H34 .='&&, .5&3 ='& 4&.&3 5,'&.5&3 *&* '& :&, 4&'3

7# H34 ,5&*&, 4&,& '& *&* 43.*34*'*:3,&43 :&, 5&.& ' '5&* 9&,3,'*:3,&43', *:3*&.& :, 53&.,

"# H34 5&4&, *3 ',*&'43 4:&, ' 5&4

5&4,& :&, .5&3*'&, 5&4,&

%# H34 ,3*3, ',*&'43 5.& 4:3'3 ,+*3,>35&, *&3.


15/61

7# P&44,*

a. JaninT5, ,'*&'(>*&,3.)

B& .'& :&, 5,2 :&4&* ,'*&' 4

,&4&534(5#3:,) 4 .&'435&*34(5#*&&,&&4) 4 .&,:3=5&*34 (5 *&&, =&6&)

4 +.&3'4(5 33)

B&3&, ,'*&' ;*,&534(5 :&3)&*3&534(5 =,2) .*&534(5 5334)

>>33&534(5 =5')


16/61

S*& 4&3&534(45&&,&) '*,&*3&(.&'&) 5&.:3:&(45&5&.:&)

;*,&534(45&:&3)

U=,-=,(;,&,5)UUB(F .&+*)'( .3,*)

D&*&-:&*& 43,43(:&, ')

&' ') >>3(=5')


17/61

Ukuran

1#U'*&, :3&.* >>33 ;*,&53412>. (5').,>>3317% (5 :&3) 4=>>33

=*.&3'& %>. (5=') =3&*3&5 2%>.

=3.*&5 (8>.)

2# U'*&, >3*'.;*,43& ('5353,) F*,

>>33 7" (5')., >>33&534 7%(LD)

4=>>33 =*.&3'&72(5=')

7# B& 9&*&' 12>. 53,'&*&, 7">."# B', 9&*&' *>&,* #% - 10>.


18/61

Postur

S3'&(&=34) =,&, =&3&,2 9&,3, :,

4.= 9&,3, =3&4&,+& ;5'43 '5 ,,

:&, '&'3 4*& 5,&, =*435&, :3:&:&

L&' 9&,3, 4.= 9&,3, *&:& 4.= 3=

P*4,&43 =&3&, 9&,3, +&, &:& :3=& =&6&*&3.

P4343 3,:3'&* ,' .,&', &*& =&

*=&6& &&'& 4=5& '3*3 :&, &&

=5&'&,


19/61

b. Plasenta

1# I.5&,&43 5&4,&

2# L&' 5&4,&

c. Air ketuban

1# O53 3:*&.3,

2# H+:*&.3,


20/61

MEKANISME PERSALINAN

1#TURUN

JANIN TURUN TERUS MENERUS PD HML TRIMESTER 7 PDPRIMI BEBERP MG SEBELUM MELAHIRKN DN PD MULTIHRS TERJADI PD KALA 2

2# FLEKSI PD PERMULAAN PERS KEPALA DLM SIKAP FLEKSI KRN

KEPALA TURUN TAHANAN DR DSR PANGGUL MAKIN BSRAKIBATNYA KEPALA MAKIN FLEKSI SEHINGGA DAGUMENEKAN DADA DN BGIAN BEL KEP (OKSIPUT) MENJADIBGIAN TERB!H JANIN FLEKSI MA MENGAKIBATKAN

MASUK KEPALA DGN DIAMETER TERKECIL(SUB-OKSIPITOBREGMATIKA % CM KEDLM PAP DR PD DIAMETEROKSIPITO FRONTALIS 11% CM


21/61

7# PUTARAN PAKSI DALAM

MAKIN TURUN KEPALA DLM JALAN LAHIRKEPALA BERPUTAR SEHINGGA DIAMETER

TERPANJANG AKAN BERSESUAI DGN DIAMETERTERPANJANG PANGGUL ( DIAMETERANTEROPOSTERIOR KEPALA BERSESUAI DGNDIAMETER OBLIK PAP) SELANJUTNYA DGNDIAMETER ANTEROPOSTERIOR PBP KEPALAJANIN MENGALAMI GERAKAN SEPERTI SPIRALPD !AKTU TURUN DLM JLN LAHIR AKIRNYA BELKEP (OKSIPUT) BERPUTAR KEDEPAN


22/61

"# EKSTENSI (MELEPASKAN DIRI DARI

FLEKSI MAKSIMAL)

KEPALA YG FLEKSI MAKSIMAL DGN JLNGERAKAN DEFLEKSI MAKA BERTURUT2

LAHIRLAH SINSIPUT (PUNCAK KEPALA)

DAHI HIDUNG MULUT DN AKHIRNYA

DAGU# SAATINI SUMBU PANJANG BAHUBERSESUAIAN DGN DIAMETER OBLIK

PANGGUL TENGAH


23/61

%# RESTITUSI

SE!AKTU BERLANGSUNG ROTASI DLMLEHER AKAN TERPELINTIR KRN BAHUTDK SAMA2 MENGADAKAN ROTASI DLMGN KP LEBIH DULU MELAKUKAN ROTASIDLM# SAAT KEPALA LAHIR PLINTIRANLEHER AKAN TERLEPAS SEHINGGA

KEPALA JANIN AKAN BERPUTAR KEMBALISEHINGGA HUBUNGAN KEPELA JANINDGN BAHU MENJADI NORMAL SEPERTISEMULAS


24/61

@# PUTARAN LUAR

PUTARAN LUAR MENGIKUTI ROTASI DLM BAHUJANIN# SAAT BAHU MSK RONGGA PANGGUL DGN

SUMBU PANJANG BAHU BERSESUAI DIAMETEROBLIK ATAU TRAN$ERSA PD SAAT ITU KEP DIPINTU PANGGUL DGN SUMBU TERPANJANGKEPALA BERSESUAI DGN DIAMETERANTEROPOSTERIOR PBP# SAAT KEP LAHIR IA

AKAN MENGADAKAN ROTASI LUAR U/MENYESUAIKN DIRI DGN BAHU # !AKTU BAHULAHIR DGN SUMBU PNJANG BAHU BERSESUAIDIAMETER TERPANJNG PBP


25/61

P*=&&, F34353 :&,

P43'53 I= K&5& ITekanan Darah

T'&,&, D&*& K,*&'43 *4 ,&3'

1% (10-20 MMHG) &:& 43453' :3&453'%-10 MMHG

A,&*& ',*&'43 '&,&, :&*& ,*.&5

'.=&53 &:& 5


26/61

Metabolisme

M&=534. '&*=3:*& .,3,'& 4>&*&=*&,4* '&*,& >.&4 :&, &'3;3&4 4'5&5

P,3,'&&, '&.35&, :,&, &,:&-&,:&

,3,'&&, 4 ,&:3 *,&&4&, :&,>&3*&, +&, 35&,

Suhu Tubuh

K&*,& ,3,'&&, .&=534. 4.,3,'& *&.& 45&.& :&, 4*&*4&53,&, 9&,&, 5=3 10 C


27/61

Denyut Jantung

P,3,'&&, .&=534. :,+ 9&,,.,3,'& 45&.& ',*&'43

A,&*& ',*&'43 4:3'3 ,&3' :3 =&,:3,

4=5. *4&53,&,

Pernapasan

K&*,& ,3,'&&, .&=534. ,3,'&&, 5&9 ,&&4 ,*.&5


28/61

in!al P53*3 '&*,& ,3,'&&, '*9&

,3,'&&, ;35*&43 5.*54 :&,

,3,'&&, &53*&, 5&4.& 3,9&5 P*3, *3 4:3'3 =3&4& :&5&.

*4&53,&,


29/61

Perubahan astro "ntestinal M353&4 5&.=, :&, &=4=43 .&'&,&,

&:& '*&,

G& 5&.=, =*'*&, '&*,& '&3;3&4,>*,&&, =*,3 :&, *9&:3

,4,&, 5&.=, +&, 5&.=&

M&5 .,& =3&4& 4&.&3 454&3 4&5&4&


30/61

#ematologi

HB .,3,'& 12 M / 100>> :&, '.=&5&34*3 4.5& 45& 1 &*3 *4&53,&, '>&53

&:& ,:&*&&, 4&*.

Uterus

K,*&'43 *4 :&*3 ,:4 ':&, '=&6&

&=:.,

P&53, '& :3 ,:4

K,*&'43 *4 :&, *5&'4&43 43,& '&5&9&,3, .&4' *,& 53' .,+=&='&, 4*3'

334 :&, ..='&


31/61

Ser$iks

L.= 334 :&, ..='& E., (,334&,) '.&9&,

.,:'&, :&, ,334&, 4*. &:& &'3* '&.35&,

.,9&:3 ==*&& .. S*


32/61

Perbe%aan Penipisan Antara &uli %an Multi

N53&*&1# S=5. *4&53,&, .,334 %0 @0

.='&&, 1>.

2# M5&3 *4&53,&, ,334&, %0 100

.5&3 .='&&,

=# M53&*&

1# S=5. *4&53,&, 4*3, 3:&' .,334

='& 1 2>.2# B3&4&,+& .5&3 *4&53,&, 4*


33/61

Mana!emen 'ala "

S'&*&, M,'&93 *36&+& '4&&, D5

K5&*&

P.*3'4&&, ;343'

P.*3'4&&, 9&,3, P&5&43 &4'5&43

M,35&3:&& ..=& :3&,4&

M,35&3 '.&9&, *4&53,&, &**&;

M.=& *,>&,& &4&,


34/61

Mengurangi asa &yeri Menurut arneis

Mi%*i+ery

1# A:&,+& 44*&, +&, :&& .,:',

*4&53,&,

2# P,&*&, 4343

7# R5&'4&43 :&, 5&3&, *,&&4&,

"# I43*&& :&, *3


35/61

Teknik Untuk Mengurangi asa &yeri

1# K&:3*&, ,:&.3, *4 .,*44,&, +&, ,+&.&, :&, :*,&, :&*3

*&, +&, .,:',

2# P*=&&, 4343 :&, **&'&,

7# S,&, :&, 39&&,

"# C,**4* ,' .,*&,3

&,&, &:& 53&., 4&>*353&'&

%# P39&&, &,:& &:& 3,5


36/61

@# P,'&,&, &:& 5

# K.*4 &,& :&, '.*4 :3,3,8# B*,:&.

# P,5&*&, 4&*&

10# $34534&43 :&, .4&&, *&3&,11# M43'


37/61

F34353 :&, 43'53 '&.35&,

(&4'= 1)

1# M ' "/ =5, ' 1I= *5&.=& .,4*&43 &+ :&*& ,+*3 :&,

=4&* '55&&, + .,& ('*,34) .,&,' 4*3,',>3,4&.&3 7 =5, HCG &:& :5. *3, :&, 4*. *45& ',443 .&5 && &,& .,& *:'43 &3* 53*+ =*5=3&, *&4& *3 :35&.=, ,>*,&&,'.=, =&, &,3, .,3:&. :&, ..=,>3.&'&,&, &+:&*& *&4&&, , =*& ,+*3 :4,&, '4.&, &*35& 4'3&* 3, 5& '5

'*3,& .,,95 '=3*&, :3=6 *.'&&, '53'3'& :* '&+ :&*& .,3,' .:& *43,,

*=, 4&4&, & &3 :' *&43,&5 >& .,&,34*&4&&, 6&4-6&4 &' .=3*& *3&,


38/61

2# M ' %- 8 /=5, ' 2

M&5 :&, .,&/.*,3, 43',44 4&.&3 43& 12 . *4=,' &* 9: 5=5&* &,:& &* .,>5 4*&:63' *4 ,&3' :3&&4 43.3434 =34',*&'43 =*&?,

3>'4 .5&3 :&, *4 45&.& .5 ,43 / 3,;'43 4&5 '.345&.& .5 ',&3'&, BB 4'3&* 1 4&.&3 2' 5&4,&

=*;,43 / *:'43 *., .,3,' 45*& .&'&, *&4&&,,&, + =&* 4.=53 .,3:&. :&, ..=,>3 .&'&,&,


39/61

"# . ' 1"-1/ =5, ' "

F,:4 :3,& &,&*& 43.3434 :&, 4& == ,&3' 0" 4&.&3 0% ' *.45&.& 434& '&.35&, 5=3 =,+' ,*3 :3&.* =3&*3&5 : :3'* :,4 4'*43 3, =*'*&,

,*&,&, .&5 ,+*3 5 &3 4.=&&, 3:, ':,2 .3.34&, 53,&4*3 *4.= 43 =*:* '3'& 43'& 33 =,'&' *3,, : '&'3 :, ,9& 6&9& &.:& 5& 453 ..4&', *&3&, 4*3, .,9&', =,:&

%# . ' 18-22/=5, ' %

F,:4 .,>&&3 4 &+:&*& .,4'*43 '54*. >&3*&, '=&, "00>>

*&4& &'&, 3,4&, :&, 43, =35& 4343 =*=& .,:&:&' & 5=3 453 && 5=3 .:&*&4.4 .= *&4&&, .,+&:&*3 '&.35&, =*5&,9 '3',&,


40/61

@# . ' 27-2/=5, ' @

;,:4 :3&&4 4& 4&'3 ,, :&, '*&.

&:& '&'3 &:& 4*3 *&


41/61

# . ' 28-71/=5, '

;,:4 =*&:& :3*,&&, &,&*& 4& :&, ?33:4 &:&.*3: *,&&4&, :&:& .,&,3 ,&&4 * &*34 =,' 9&,3,: :3&5&43 55& .,9&5&,3 .5 3,3, 4'&53 9: 3= *&4& &,&4 :5.

* *&4& '3&&, 9&,3, 5=3 '& 453 3:* '54*. =34&:3*&4 ',*&'43 =34& :5. 1 .,3 .,3,' '.=3*&&, .,3,''*&&, 9: 3= .,3,' 5&.,&, :, '&+&5&, ,, =+ .,3,''=4&,&, :, '55&&, : '&.35&,

8# . ' 72-7%/=5, ' 8

F,:4 .,>&&3 *444 ?33: &+:&*& , :&, ,+*3 '&,

4*3, ',>3, '&'3 =,'&' :&, :+4,&'3&&, 9&,3, + *&* .,3,' .=3*& '*, '&.35, &', =*&'3* '*&&, ,, '4 =+:, *4 *&4& *'&, :, 4&'3 : &,5 '.=3*&&, =*4&.&&,:, '>.&4&, '*, 6&' &' 5&.& 5&3 .,3,' ''&'&, :,',*&'43


42/61

# . ' 7@-"0/=5, '

P,*,&, =+ :5. 5.&4 '*&&,:&, 3', :' 4&=&* :, 534&.3.3 :, =*'&+&5,&, =+


43/61

P*=&&, ;34353 6&,3& &.35

1# *=&&, *4

'*&, : >' =5, 70?2%?20 >. :,

'&&43&4 "000 >> == 70 * 9&:3 1000* : &'3*'&.35&,

D&*3 =,' '& : "=5, =,' =5& &'3* .5

=9* 5* :' .5 4=4&* 5* &+&. .5 2 =5,

4=4&* 5* ==' 7 =5, 5* &,4 M 13**3 &,9&, :&, 5,&' (&*) :3,:3,

*&3. 334


44/61

P4343 &, && **;5'43 "=5, .4 :5. *,&5


45/61

S343. 43*'5&43

$5. :* ,&3' 4& .5&3 *3.4* *&.& '3*&2 2% *4, :,>&',+& 72 . :33'3 >*& 9&,, + .,3,'& 70 *4, &'3=&.:543 : . ' 1@ 4&& >' =5, ',&3'&, 5&4.& .,>&&3 "0

*4,P*3, :* *365&, 1 .,*, :&, .,3,'& : &'3* '&.35&,

H.&'*3 .,*, '*, ',&3', 5&4.& :* 9.5& *3*43.,3,'&/ &*,* 02 # K,4,*&43 = .,*, 5'43 .,3,'10#000>> =3, *.=43

TD .,*, : *3.4* 2 '.:3&, ,*.&5 5&3 ,&:3 ,&3'

*&&2 8" ? *.,J&,, .& 9&,, ,&3' '3*&2 70 *4, : '.5, 7 =5, :&,

.,*, 5&3 .2 *&'3*


46/61

T5&, :&, 33

B35& '&543. >' 33 :' &'&,

''*&,&, '&543. *4,:3&, &,55,&* '&543.: 5, &,9&, =*'*&,

K5,9&* ,:'*3,

K5 +*3: ..=4&*

K5 +34 ..=4&* : 5=4 &,*3*


47/61

M&=534.

K&.35&, ..,+&3 ;' : .&=534. '&*,& 3 *4 >' .&'&,+ =*33

BMR .,3,'& 1% -20 *4, : *3.4* &'3*

K43.=&,, &4&. &5'&53 =*= D3=', *3, + =&,+&'

!&,3& .5 4*3, &4 '*, ,&* 3:*&, &*&, + =*5=3&,.&'& 4*3, *9: D. '&.35&,

K&:&* '54*5 .,3,' ,' &+ :&*& =&:&, * && :,

5,&, K&543. :3=', 1% * ** *&.& :5. *3.4* &'3* 70-"0 *;4;* 2* ** & =43 70-%0 * **

C,*, *9&:3 *,43 &3*


48/61

BB ,&3' @%-1@#% ' :34=&=', 9&,3, *3 >&3*&,

'=&, *4 &+:&*&


49/61

M,,'&, 43& '&.35&,

P,'*&, 3,3 ;,:4 *3 :,&, 3& ,'*

22-28 . 2"-2% >. :3&&4 43.3434

28 . 2@ >.

70 . 2#%-70>.

72 . 3:.

7" . 71>.

7@. 72 >.

78 . 77 >.

"0 . 7 >.

M,'* :3.5&3 :* 43.3434 4&.&3 ;,:4 J&*&' ;,:4 :&, 4+.3434 :&5&. >. :3=&3 7% .*&'&, &,+&

'&.35&, :5. =5,


50/61

U43& '&.35&, :33, :&*3

1# &*3 *&.& &3: *&'3*

2#5&.&,+& &.,* 7# :&*3 3,3 ;,:4 *3

"# 4&& .5&3 *&4& **&'&, &,&'

%# 4&& .5&3 *:,&* :99 @# :, .*3'4&&, &.,343,434

# :&*3 =4* &,&' && '&5& :, USG


51/61

T&,+& '&.35&, =*:&4&*'&, ;

A'3* =5, ' III (12.) 1-2 9&*3 &/ 43.3434

A'3* =5, ' I$ (1@.) *,&, 4 4+.3434

A'3* =5, ' $ (20.) 79* =6 4

A'3* =5, ' $I (2".) 43,3 4&

A'3* =5, ' $II (28.) 7 9* &/4

A'3* =5, ' $III (72.) *,, 4 *444 ?+3:4

A'3* =5, ' I (7@.) 7 9&*3 =6 P

A'3* =5, ' ("0.) *,, 4 /?


52/61

M,,'&, *3: '&.35&,

P*3: '&.35&, :3.5&3 49&' ',443 4&.&3 :, =&+3 5&3*

1# 0-8 . *3: .=*3

. 1-7 *3: * .=*3 .5&3 :* ',443 4&.&3 9: *=&&, 9: .=*3

. "-8 *3: .=*3 *.=&, :&, .=,'&, *&,

2# M ' - 11 :34= ;4 .=,'&, *&,2 &.3* 454&3

7# 12-2 . :34= ;&5/ 9&,3, .=,'&, *&, 454&3 :35&,9', :,*'.=&,&, :, ,+.*,&&, 4*& *.=&,

"# 28-1 =5&, 5&3* :34= *3,&&5

T*3.4* 1 43& '&.35&, 0-12 .

T*3.4* 2 43& '.5, 17-28 .

T*3.4* 7 43& '&.35&, 2-"2 .

0-20 . &=*421-2 . 3.&*4

28-7@ . *.&*

7-"2 . &*.

"7. 4 *. && 4*3,4


53/61

A'3* 1 =5,

B&:&, =+ .5,', ,9, %-10 .. '&5& 4*3& :* 45*.:3& 4&5*&, + &'&, 9&:3 9&,, *=,' :&, 4:& =*:,+

A'3* 2 =5, .'& 95&4 =*=,' .&,43& 4: ,+& ,'&3 , :&,

'&'3 &5& '5&.3, 4: &.&' &3 =5. 95&4 =,',+& A'3* 7 =5,

P,9, - >. 4: &:& 4 *5&,, :&, '' 9,34 '5&.3, 4: ::3,',

A'3* " =5,

P,9, 10-1 >. =*& 100 * **&', 9&,3, 4: : :3*&4&'&, A'3* % =5,

P,9, 18-22>. == 700* =,+3 9,, 4: : :3:,&*


54/61

P*.=&, :&, *'.=&,&,

.=*3 M3, '3& 45&


55/61

M '.&

K&,, '*3,3' =*:3&.* 2-7 >. ,9, .=*3 "-%>. 9&,,.,,95 '*,

D35&&43 *&,2 9&,,

B&'&5 5,&, :&, ,'&3 .5&3 *53& &.,3, .5&3 ..=,'4 54

M ',&. ,9, .=*3 22-2" .. :&, '&5& >' =4* :3=,:, =:, 9&*3, :&, '&'3 .5&3 &:& :&, 53,& 5&* ..=,' ,95&, :34343 '&5&

A'3* *3: .=*3 :&, .5&3 *3: 9&,3, :3.5&3 8 . 45&;*3534&43 &,9&, .=*3 ">. *:3*3 :&*3 *.=&, :&,

.&&,&, 4*'*2 + *=,' 45&.& .=*3,&5


56/61

A'3* @ =5,

P,9, 28-7" >. == @00*

K53 *


57/61

A'3* =5,

P,9, "@ >. == 2%00 * '*, '53 4: *343 :, 5.&'

A'3* =5, ' 10

J&,3, 4: >' =5, (.&*) ,9, %0 >. == 7000 *

K53 &54 5&'32 5=3 =*& :* 6&,3& &' &:& 5&3 *&.=5&, .&43 &:&


58/61

S3*'5&43 &53 4&

;,43 :&, 43*'5&43 &53 4&

& 4*'*

1# 5&'

*: &,&*& 4& 9&,3, :&, *.'&&, ;&5 5&4,&

=# =,'

,9, 5=3 '*&, %%>.(70-100>.) :&, &*34 ,& 1-1% >. 6&*,& 3 :&,:' 5*4 (=*353,) '*, .= :* 5=3 ,9, :* 5 4 43,& =*'5'2 3.=5,95&, : *.'&&, :34= 43.5 &54 :3533 5 &.,3, + 4&,& *&.5'& .,&,:, 2 &**3 .=353'4 :&, 4&


59/61

F,43 &53 4

S=&&3 4&5*&, =&3 9&,3, /

1# M,:', ,*343 2# 4=&&3 4&5*&, :5. ,5&*, '*&,

7# 4=&3 4&5 + ..=*3 45&+ '43, =&3

9&,3, K:& &**3 :,


60/61

S3*'5&43 &53 4&

D&*& +, .,&,:, '43, :&, ,*343

:&*3 5&4,& .&4' = 9&,3, .5&53


61/61

S3*'5&43 :* 9&,3,

D&*& 3= + '&+& 0'43, :&, ,*343 :&*3 5&4,& .&4''= 9&,3, .5&53

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