ALARMEkstraksi vakum adalah suatu forseps obstetrik
Penerapan outlet, rendah dan tengah seperti pada prosedur rotasi forseps tidak dilakukan
“If a person deficient in dexterity could succeed in applying the (vacuum) tractor ...it is quite probable that he would produce as much injury as benefit...”
Hayes, 1831
Assisted Vaginal Birth
Ibu
kondisi yang memerlukan kala dua diperpendek
Kelelahan ibu
MATERNAL-maternal condiitons such as cardiovascular, neurological, cerebrovascular + pulmonary.
Assisted Vaginal Birth
Kepala belum masuk pintu atas panggul
dilatasi cervix tidak lengkap
bukti klinis adanya CPD
Define engaged = where biparietal diameter is at or below pelvic inlet
Assisted Vaginal Birth
letak di panggul tengah
sikap bayi yang sulit
Previous fetal scalp sampling is not a contraindication
Low BW or prematureneonates have an increased incidence of retinal hemmorrhages
Assisted Vaginal Birth
kepala sudah masuk pintu atas panggul
panggul ibu adekuat dengan penilaian klinis
analgesia yg sesuai
kandung kencing ibu kosong
Assisted Vaginal Birth
Penempatan anatomi yg sesuai
sudut traksi yang benar.
Hindari tenaga/manuver yang berlebihan
Awasi penurunan /pengeluaran.
[Confirm indications and conditions for use]
and document in chart
[Ensure proper anatomical placement]
[Avoid entrapment of maternal soft tissue]
via finger sweep
pelvic curve
emphasize be sure prepared to deal with procedure failure + potential complications arising
Assisted Vaginal Birth
Assisted Vaginal Birth
Poros Jalan Lahir
Shows direction of pelvic curve + direction of traction with instrument delivery
6.unknown
3 tarikan, pada 3 kontraksi, tidak ada kemajuan
3 kali lepas: setelah satu kjali gagal, nilai ulang dengan hati-hati sebelum memasang kembali
Setelah 30 menit pemasanan tanpa kemajuan
[3 pulls, over 3 contractions, no progress]
No progress or decent of baby
[ 30 minutes elapsed time]
30 min of use of device with no ensuing delivery
Assisted Vaginal Birth
Tenaga traksi yang terlalu kuat
tak dikenali adanya CPD
aplikasi pada panggul tengah
Terkenanya jaringan lunak ibu pada introitus
Assisted Vaginal Birth
traksi kepala bayi
rotasi kepala bayi
fleksi kepala bayi
ekstensi kepala bayi
Penggunaan yang benar meminimalkan tenaga kompresi ini
Unlike vacuum where cannot rotate
Assisted Vaginal Birth
Ibu
Kondisi yang membutuhkan kala dua diperpendek
Kelelahan ibu
Assisted Vaginal Birth
panggul ibu adekuat
tersedianya pendukung dan fasilitas yang adekuat
Forceps must never be before full dilatation or with an unengaged vertex
Assisted Vaginal Birth
Kepala bayi telah berada di dasar panggul
Sutura segitalis berada pada:
Kapala bayi berada pada atau di atas perineum
ACOG: "Committee in Obstetrics, Maternal and Fetal Medicine"
Application of forceps is defined by the station
Outlet
low
mid
This slide + the next define these 3 stations for the purpose of forcep application.
Assisted Vaginal Birth
dua jenis :
ACOG: "Committee in Obstetrics, Maternal and Fetal Medicine"
There is no role for forcep application at any station above plus two.
Assisted Vaginal Birth
Bagian terendah kepala di atas station +1
Plihan lain untuk forseps tengah adalah seksio sesarea – akses untuk melakukan seksio sesarea sangat penting saat melakukan persalinan dengan forseps
Assisted Vaginal Birth
Saat diameter biparietal kepala masuk pintu atas panggul
Saat bagian terendah kepala berada di atau di bawah spina ishiadika (station 0)
Assisted Vaginal Birth
9.unknown
Memeriksa Pemasangan – “Posisi untuk Keamanan”
Ubun-ubun kecil di tengah antara batang forseps dan satu jari di atas bidang datar dari tangkai forseps dengan sutura lambdoid satu jari di atas tiap tangkai
Masuknya tangkai harus nyaris tak terasa dan tidak lebih dari seujung jari dapat diselipkan antara tangkai forseps dengan kepala bayi
Sutura sagitalis tegak lurus terhadap bidang datar dari tangkai forseps
Assisted Vaginal Birth
Side view of correct positioning
5.unknown
Correct traction direction
Traksi
1. Direction - depends on station; based on axis of parturition
2. Amount - use force of forearm only (elbow bent) combine with maternal expulsive effort.
12.unknown
Assisted Vaginal Birth
From: Human Labour & Birth, Harry Oxorn
Rotation should be completed by moving the handle in a wide circle so the toe remains fixed for rotation, otherwise one is carving vaginal sidewalls.
14.unknown
13.unknown
Assisted Vaginal Birth
8 percobaan acak prospektif
persalinan sesar
diperlukannya analgesia untuk ibu
morbiditas ibu dan neonatus
8 trials looked at outcomes such as delivery by intended method, etc.
Assisted Vaginal Birth
Cochran data:
to the left of the zero line is forceps less (i.e. vacuum more)
to the right of the zero line is vacuum less (i.e. forceps more)
Example: Less likely to fail forceps c-section is less with vacuum because if you fail vacuum you could use forceps but unlikely vice versa
Assisted Vaginal Birth
Lebih sedikit membutuhkan anestasi regional/umum
Lebih sedikit trauma terhadap vagina/perineum ibu
[Bullet 1]
Pasien harus dibuat waspada terhadap resiko-resiko ini
Cephalohematoma occurs in 1-15% of vaginal deliveries. Is a collection of blood between the periostea + cranial bones hence limited by suture lines
Subgaleal hemorrhage occurs in 46/1000 vacuum deliveries. Bleeding occurs between the skull periosteum + galea aponeurotica. This is not limited by suture lines + can cover whole calvarium with several hundred ml blood
Neonatal retinal hemorrhages are most common in SGA + sequential vacuum then forceps
No significant long term sequelae have been documented with neonatal retinal hemmorhages
Assisted Vaginal Birth
Dokumentasi ini harus memiliki penjelasan terhadap intervensi operasi yang telah dilakukan
Termasuk gambaran tentang cara pelaksanaan tehnik operasi dan indikasi-indikasinya
Kebutuhan untuk Intervensi harus:
convincing, compelling, consented to, charted
Emphasize need for adequate documentation of what you did, why you did it, + how you did it with any complications noted.
Assisted Vaginal Birth