ferina 2 vaginal birth after ceaserean (vbac)

7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)

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Ferina Oktariani Tariza09/280824/KU/13100

VAGINAL BIRTH AFTR!A"RAN #VBA!$ %en&anVAKU' K"TRAK"I

Banyumas, 17 Oktober 20


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y

I%entita( )a(ien

Na*a + N,- NK U(ia + 32 ta.n Aa*at + Aa(*aan& 3/ )ekeraan + I r*a. tan&&a "t- 'arita + 'enika. "t- O(tetri + G3)1A1


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Ana*ne(i(


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)e*erik(aanLaratri*

Lek(it + 13-5 6103/

Netr7i+ -41

Li*7(it + 2-33

ritr(it + 3-0 610/

H + 11-2 &/%

He*atkrit + 32-

'!V + 9:5 7L

'!H + 25:0 ;&

'!H! + 31:5 &/%

Tr*(it+ 191- 6103/

3: < 10:1 6 103/

39:3 < 3:

18:0 < 48:3

3: < 4:9 6 10/ 10:8 < 14:2 &/%

3: < 53:

81:1 < 9:0 7L

2:0 < 31:2 ;&

32 < 3 &/%

150 < 450 6 103/


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Ana*ne(i(

Ri=a,at )en,akit >a.

A(*a: .i;erten(i: >' %an antn&%i(an&ka

Ri=a,at )en,akit Kear&aRi=a,at >': .i;erten(i: a(*a: %anantn& ;a%a kear&a %i(an&ka


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)e*erik(aan Fi(ik

Tan&&a 21 "e;t 2014

KU+ Baik: ?*;( *enti(-

Tan%a Vita+ T> 120/80**H& RR 20 6/*enit

HR 80 ;*: re&er ". a7eri(- BB + 4 k&: kenaikan erat a%an (ea*a ke.a*ian 9k&

)6 ke;aa + Ti%ak ane*i(: ti%ak ikterik

)6 ;ar %an ek(tre*ita( + >aa* ata( nr*a

)6 a%*en + Terdapat bekas operasi SC di suprapubic tipetransversal: (;e

)a;a(i + Janin tunal, meman!an, preskep, puki,diveren, T"# $0cm

%uskultasi & 1$7'( menit )> + V/U tenan&: %in%in& @a&ina i?in: (er@ik( ti;i(: nak

%iten&a.- )e*kaan 3 ?*- "ea;t ketan #$: air ketan#$: en%ir %ara. #$- Ke;aa trn H%&e 1


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>ia&n(i( A=a

'ti&ra@i%a: G3)1A1: .a*i 38*in&&: in;art kaa 1 7a(e aten%en&an ri=a,at "! ta.n ,an& a

'anae*en %an Tera;i

'n%k VK 'nitrin& KU/V"/>CC


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F= ;

21/09/2014: Ca* 0-00: VK + @aa(i

Hi( + #$

>CC + 1386/*enit

)> + V/U tenan&: %in%in& @a&ina i?in:(er@ik( ti;i(: D 3?*: "eket #$: ke;aa trn

H%&e III: L> #$: AK #$

A((e(*ent + *ti&ra@i%a .a*i ater*%en&an kaaI 7a(e aten ri=- "! t. ,an& a

)an + Ren?ana VBA!

O( .i(/>CC

@aa(i ;k 10-00 ika ti%ak a%ake*aan ;er(ainan "! e*er&en?,


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Ca* 10-00

@aa(i Hi( + #$- 36 10E/30EE/k

>CC + 1486/*enit

)> + V/U tenan&: %in%in& @a&ina i?in:(er@ik( ti;i(: nak %i%e;an: D 34?*:"eket #$: ke;aa trn H%&e II: L>#$: AK #$

A((e(*ent + *ti&ra@i%a .a*i ater* %en&ankaa I 7a(e akti7 ri=- "! t. ,an& a

)an + Ren?ana VBA!

O( .i(/>CC

@aa(i ;k 14-00


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Ca* 14-00 @aa(i

Hi( + #$- 36 10*in (ekai

>CC + 1426/*enit )> + V/U tenan&: %in%in& @a&inai?in: (er@ik( ti;i(: nak %i%e;an:D ?*: "eket #$: ke;aa trn

H%&e II: L> #$: AK #$


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Ca* 1-00 + " + )a(ien ta*;ak &ei(a.: in&in *en&e%an-Ketan ;e?a. (;ntan-

O +

KU + Baik: (a%ar: ti%ak ane*i( V@a /ret.ra tenan&: %in%in& @a&inai?in: (er@ik( ti%akteraa: ;e*kaan en&ka;:ke;aa trn H%&e II: L> #$: (eket #$

HI" + 36/10E/40/(>CC + 1406/*enit

A + Kaa II ) + )i*;in ;er(ainan: (ia;kan re((ita(i

a,i


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Ca* 1-30 + " + 1 a* %i;i*;in: a,i e* a.ir- Ita*;ak keea.an-

A + Kaa 2 tak *a

) + Vak* ek(tra(i

Ca* 1-50 + Ba,i a.ir (e?ara V %en&an 16 ;a(an& ?; NO-5: 26 tarikan (e%an&: eni( kea*in aki

aki: BB 300 &r: )B 50 ?*: A;&ar "?re /8 In O6,t?in 10 IU/I' 'anae*en akti7 kaa III


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Ca* 1-55 + )a?enta a.ir (;ntan: ke(anen&ka;: e6;ra(i er(i.

Inek(i *eter&in ;i(i;erinera7i

Ca.it %aa* er Ca.it ar *atra(

A + )(t V a/i kaa 2 tak *a )2A1 Tera;i

A*6i?iin 500 *&/8./ra A( 'a7ena*at 500 *&/8./ra "F Ta/ 24./ra

)a(an& >!


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22/09/2014 )in%a. ran&an ke )er*ata Hati ntk (er@a(iant-

>6 + )(t V a/i kaa 2 tak *a: )2A1: ri= "! ta.n ,an& a-

Tera;i ant + A*6i?iin 500*&/8a*/ ra A( 'a7ena*at 500 *&/8a*/ra "F ta/ 24 a*/ ra

Ba%%er trainin&

23/09/2014 >6 + )(t V a/i kaa 2 tak *a: )2A1: ri= "! ta.n ,an& a-

Tera;i ra ant U( BL)L


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!ini?a Rea(nin&


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)'BAHA"AN

>e7ini(i VBA! + )r(e( ;er(ainan ;er@a&ina* (etea.;erna. *eakkan "!-

TOLA! + Tria 7 ar a7ter ?e(arean-

)en%a;at n?e a ?ae(arean: a=a,( a?ae(arean

1988: ;enin&katan 25 ?e(arean %ei@er,rate %ari 5 ta.n 190(-

[email protected]((: %e(;ite t.e kn=n ri(k( #0-5

1 rate 7 terine r;tre$: TOLA! re*ain(an attra?ti@e ;tin 7r *an, ;atient( an%ea%( t a (??e((7 t?*e in a .i&.;r;rtin 7 ?a(e(-


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A!OG Gi%eine(

On t.e a(i( 7 e@e A e@i%en?e: t.e 2010 A!OG&i%eine( *ake t.e 7=in& re?**en%atin(+

anita %en&an ri) SC sebelumnya denan insisitransversal SB* .ar( %ita=arkan TOLA!-

'en&&nakan ana(te(i ;er epidural-

Tidak menunakan misoprostol-

On t.e a(i( 7 e@e B e@i%en?e: TOLA! *a, e?n(i%ere% 7r t.e 7=in& ;atient(+

anita %en&an ri) 2' SC denan insisi transversalSB*

anita %en&an ri) 1' SC sebelumnya dapatdipertimbankan untuk persalinan denan !aninemelli-

anita %en&an ri) SC sebelumnya denan insisi tidakdiketa+ui tanpa ada tandatanda ruptur uteri-


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A!OG Gi%eine(

Le@e B e@i%en?e =a( a( 7n%7r t.e 7=in&+ -nduksi dalam persalinan kan

*er;akan kntrain%ika(i- I %en&an ri=a,at in(i(itran(@er(a etak ren%a. %en&an ibudan !anin yan tidak berisiko %en&ananin presentasi bokon-


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!an%i%ate( 7r TOLA!

I %en&an ri)1' atau 2' SC insisitransversal SB*-

I %en&an1' ri) SC denan tipe insisiyan tidak diketa+ui: ke?ai %en&an a%ake?ri&aan ter.a%a; in(i(i ter(et-

I %en&an ri=a,at in(i(i tran(@er(a"BR%en&an ibu dan !anin yan tidakberisiko %en&an anin presentasi bokon-

.elvis adekuat Tidak ada ri) ruptur atau skar padauterus


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)ra(,arat VBA!

)an%an %ari A*eri?an !e&e 7O(tretri?ian( an% G,ne?&i(tta.n 1999 %an 2004 +

VBA! *e*erkan ke.a%iran (eran&%kter a.i kei%anan: (eran& a.iana(te(i: %an (ta7 ,an& *e*;n,aikea.ian %aa* .a ;er(ainan "!e*er&en(i-

Ka*ar ;erati7 %an (ta7 %i(ia&akan:%ara. ,an& tea. %i?r((*at?. %an aat*nitr >CC .ar( ter(e%ia-


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Ot?*e( 7 Intere(t


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An&ka keer.a(ian VBA!*enrt Fa**Untk *enentkan keer.a(ian ;er(ainan ;er@a&ina* (etea. (ek(i(e(aria #VBA!+Va&ina Birt. A7ter !ae(arean$: %aa* (at ;eneitian(er@a(ina ,an& *eiatkan 5022 ;a(ien: Br?e L- Fa**: '> %anAnn '- Gei&er: ).> *e*atAdmission Scoring System(ea&ai erikt+

/o arakteristik Skor

1 U(ia J40 ta.n 2

2 Ri=a,at ;er(ainan ;er@a&ina +"ee* %an (e(%a. "!)er(ainan ;er@a&ina (e(%a. "!)er(ainan ;er@a&ina (ee* "!Ti%ak a%a

4210

3 Aa(an ain (eain ;art( tak *a ntk "!ter%a.

1

4 )en%ataran %an ;eni;i(an (er@ik( (aat tia%i R" %aa* kea%aan in;art +525 < 5J 25

210

5 >iata(i (er@ik( 4 ?* 1


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An&ka keer.a(ian VBA!*enrt Fa**-

)a(ien ini An&kakeer.a(ian

a%aa. 4

Skor %nka keber+asilan3

02 4249

3 590

4 4

5 9

8889

93

810 9599


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Selected Clinical "actors %ssociated )it+ Trialo 5abor %ter .revious Cesarean 6elivery Success

-ncreased .robability o Success Stronpredictors3 *i)ayat .artus Spontan Sebelumnya.artus Spontan

6ecreased .robability o Success Ot+erpredictors3 -ndikasi berulan SC #sia ibu

tnis non )+ite #sia estasi 840 minu Obesitas .reeclampsia

Jarak antar ke+amilan yan renda+ Bayi besar 40004900r3


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VBA! (??e(( rate ;rir?e(arrean %ei@er,

-ndication o previous SC :B%C success rate

>i(;r;r(i ke;aa

;an&&

05

Feta %i(tre(( 93

Bree?. ;re(entatin 89

)a?enta ;re@ia 89


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Bene7it(

'en&.in%ari "! eran&

'en&ran&i a*an,a *a(a %i R"

akt ;e*i.an ei. ?e;at-

Interak(i ianak ei. ?e;atterain


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Ri(k(

Feta Ri(k La.ir *ati Hi;k(ia I(ke*ia n?e;a;ati Ke*atian ;erinata

'aterna Ri(k Tran(7(i In7ek(i

Hi(terekt*i R;tr teri !.rina*niniti(


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A(te Kntrain%ika(iVBA! Feta >i(tre((

Letak Lintan&

)a?enta ;re@ia

I %en&an ri=a,at R;tr Uteri

Ri= in(i(i teri ,an& tera ;anan/10000 ri(k 7 terine r;tre$

36 ata ei. ri= "!-

R,a !e&e 7 OG Greent; Gi%eine


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)re%i?tr( 7 teriner;tre

-ncreased *ate o #terine*upture

6ecreased *ate o #terine*upture

Ka(ik .i(terekt*i )er(ainan (;ntan

)er(ainan "! 26 ataei. Ri= ;er(ainan ;er @a&ina(ee*n,a

In%k(i )er(ainan )er(ainan ;reter*

)en&&naan ;r(ta&an%in

Carak antar ke.a*ian

,an& ;en%ek

In7ek(i ;a%a ri= "!(ee*n,a


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Reati@e Kntrain%ika(iVBA! Bree?. ;re(entatin 'ti;e &e(tatin


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!*;i?atin(

Uterine %e.i(?en?e Uterine r;tre i7et.reatenin&

"i&n( an% (,*;t*( A?te n(et 7eta ra%,?ar%ia #0$

A%*ina ;ain #10$

Va&ina ee%in& #5$

He*%,na*i? in(taiit, #510$


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!ini?a ?n(i%eratin

Rek*en%a(i *nitr anineran&-

)er.atikan kr@a ;er(ainan- )er(ia;an ntk "! e*er&en(i ikaa%a tan%a a.a,a-


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T.ank M

ferina 2 vaginal birth after ceaserean (vbac)

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