FORCEPS & VACUUM EXTRACTION Kanadi Sumapradja
[email protected]
FORCEP’S STRUCTURE
FORCEPS
PIPER
KIELLAND
SIMPSON
ELLIOT
FORCEP’S LOCK
FRENCH
GERMANY
SLIDING
FORCEP’S LOCK
PIVOT
ENGLISH
SEBELUM TINDAKAN
FORCEPS A
ANAESTHESIA
Adequate - epidural or pudendal Appropriate positioning and access
B
BLADDER
In/out catheterization or ensure bladder empty
C
CERVIX
Fully dilated, membranes ruptured
D
DETERMINE
Position, station and pelvic adequacy
E
EQUIPMENT
Complete and working forceps, anesthesia support
F
FORCEPS
Phantom application Left blade, left hand, maternal left side, pencil grip and vertical insertion, with right thumb directing blade right blade, right hand, maternal right side, pencil grip and vertical insertion with left thumb directing blade (PFS) lock blades and support & check application posterior fontanelle 1 cm above plane of shanks fenestration no >fingerbreadth between it and scalp sagittal suture in perpendicular to plane of shanks with occipital sutures 1cm above respective blades
G
GENTLE
Traction - applied with contraction/expulsive effort
H
HANDLE
Elevated - traction in axis of birth canal do no elevate handle too early
I
INCISION
Consider episiotomy if laceration imminent
J
JAW
Remove forceps when Jaw is reachable or delivery assured
Forceps operations are of two kinds:
Low Forceps The fetal head has reached the perineal floor and is visible at the vulva.
Mid Forceps Engagement has taken place and the leading part of the head is below the level of the ischial spines
TEHNIK EKSTRAKSI VAKUM
TEHNIK EKSTRAKSI VAKUM
Vacuum Devices
BERBAGAI ALAT EKSTRAKSI VAKUM
SYARAT PEMBUKAAN SERVIKS LENGKAP PRESENTASI KEPALA ATERM TIDAK ADA KESEMPITAN PANGGUL ANAK HIDUP PENURUNAN KEPALA STASION 0 ATAU TIDAK LEBIH DARI 2/5 • KONDISI BAIK • IBU KOOPERATIF DAN MASIH MAMPU MENGEJAN • • • • • •
KEGAGALAN EKSTRAKSI VAKUM • KEPALA TIDAK TURUN SETELAH 3 TARIKAN / TIDAK LAHIR 25 MENIT – CPD – LILITAN ERAT TALI PUSAT
• TEKANAN VAKUM BOCOR / ALAT TIDAK BERFUNGSI
INDIKASI • KALA II LAMA DENGAN PRESENTASI BELAKANG KEPALA / VERTEKS
KONTRA INDIKASI • MALPRESENTASI (DAHI, PUNCAK KEPALA, MUKA, BOKONG) • PANGGUL SEMPIT (DISPROPORSI KEPALA-PANGGUL)
