Ekstraksi vakum dan Ekstraksi forsep

(Operative Vaginal Delivery)Susanti Apriani

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Ekstraksi vakum

Aplikasi ekstraktor vakum : outlet, rendah dan tengah seperti pada ekstraksi forsep.

prosedur rotasi tidak dilakukan

Forceps Ekstraksi

Fungsi forsep obstetrik adalah sebagai berikut :

• traksi kepala janin

• rotasi kepala janin

• fleksi kepala janin

• ekstensi kepala janin

Fungsi-fungsi ini menyebabkan kompresi kepala janin– Penggunaan yang benar meminimalkan

kompresi ini

“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

From: Assisted Vaginal Birth, ALARM International

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SYARAT

VACCUM presentasi belakang kepala, janin aterm, TBJ

>2500 g

kepala sudah masuk pintu atas panggul

panggul ibu adekuat dengan penilaian klinis

analgesia yg sesuai

pembukaan serviks lengkap dan ketuban pecah

kandung kencing ibu kosong

operator yg berpengalaman

fasilitas pendukung bila prosedur tidak berhasil

FORCEPS Kepala sudah masuk pintu atas panggul

Pembukaan serviks lengkap dan ketuban pecah

Dikenali dengan pasti posisi kepala janin

Panggul ibu adekuat

Kandung kencing ibu kosong

Analgesia yg sesuai

Operator yg berpengalaman

Fasilitas pendukung yang memadai bila tindakan gagal

From: Assisted Vaginal Birth, ALARM International

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INDICATION AND CONTRAINDICATION

No indication is absolute Prolonged 2nd stage

– Nulliparous: lack of continuous progress• >3hrs with regional anesthesia

• >2hrs w/o regional anesthesia

– Multiparous: lack of continuous progress• >2hrs with regional anesthesia

• >1hr w/o regional anesthesia

Fetal compromise

Maternal benefit to shortened 2nd stage

Contraindication-OVD Non-cephalic, face or brow presentation

Unengaged vertex

Incompletely dilated cervix

Clinical evidence of CPD

< 34 weeks gestation (vacuum)

Need for device rotation (vacuum)

Deflexed attitude of fetal head

Fetal conditions (e.g. thrombocytopenia)

Robert D. Auerbach, M.D. FACOGSenior Vice President & Chief Medical Officer CooperSurgical, Inc.Associate Clinical Professor of Obstetrics & GynecologyYale University School of Medicine

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Outlet• Scalp visible @

introitus w/o separating

labia• Fetal skull @

pelvic floor• Saggital suture

in AP plane (or ROA/LOA)

• Fetal head at or on perineum

• Rotation < 45 degrees

Low• Leading

point of fetal skull >

or = +2 station

• Rotation < 45 degrees

• Rotation > 45 degrees

Mid• Station

above +2 station but the head is

engaged

High• Not included

in classificat

ion

Robert D. Auerbach, M.D. FACOGSenior Vice President & Chief Medical Officer CooperSurgical, Inc.Associate Clinical Professor of Obstetrics & GynecologyYale University School of Medicine

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Robert D. Auerbach, M.D. FACOGSenior Vice President & Chief Medical Officer CooperSurgical, Inc.Associate Clinical Professor of Obstetrics & GynecologyYale University School of Medicine

Pelvic floor

OutletMidpelvic

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VACCUM FORCEPS

Robert D. Auerbach, M.D. FACOGSenior Vice President & Chief Medical Officer CooperSurgical, Inc. Associate Clinical Professor of Obstetrics & GynecologyYale University School of Medicine

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