Manajemen Persalinan Paska Sectio Caesaria.docx

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PORTOFOLIO OBSTETRI DAN GINEKOLOGI

MANAJEMEN PERSALINAN PASKA BEDAH SECTIO CAESARIA

Oleh:

Alexander Leonard Caesar J.,dr. 018/IDI-NGW/IPRA/1/!01"

Pe#$%#$%n&:

'()(h *ar%+ano, dr. POG

NGAWI, RD DR. OROO

A*N !01



BAB I

PENDAHULUAN

e$(ah o2eras% 3aesar aa( ser%n& d%se$( 4(&a C-section aa( caesar section

adalah 2rosed(r 2e#$edahan d% #ana sa( aa( le$%h sa+aan d%$(a #elal(% 2er(

seoran& %$( 5la2aroo#%6 dan rah%# 5h%seroo#%6 (n() #elah%r)an sa( aa( le$%h $a+%.

O2eras% 3aesar #odern 2era#a )al% d%la)()an oleh Dr Ja#es 7arr+ d% Ca2e on, A9r%)a

elaan 2ada ! J(l% 18!;. 516

Ada )e)haa%ran 2($l%) dan ena&a #ed%s 2ro9es%onal enan& #en%n&)an+a

2ro2ors% )elah%ran den&an o2eras% Caesar 5!6.*al %( d%se$a$)an 2en%n&)aan 4(#lah

o2eras% 3aesar 2ada %$( ha#%l elah #en+e$a$)an 2en%n&)aan 2ro2ors% 2end(d() +an&

#e#%l%)% r%a+a 2ersal%nan 3aesar se$el(#n+a.

Ada se$(ah (n&)a2an +an& d%)aa)an Ne <or) Asso3%a%on o9 O$ser%3%ans =

G+ne3olo&%ss 2ada ah(n 1>1; ?On3e a 3esarean, ala+s a 3esarean.?5"6 A2a)ah hal

erse$( ea2 $erla)( h%n&&a saa %n% aa( %da)@ *al erse$( +an& a)an d%$ahas. Wan%a

ha#%l den&an r%a+a se)s%o 3aesar%a se$el(#n+a da2a d%aar)an ren3ana #elah%r)an

se3ara VBAC (vaginal birth after caesarean) aa( ERCS (Elective repeat caesarean

section).

D% ah(n 0-an dan aal 80-an se)s%o 3aesarea #en%n&)a 2esa. D% ah(n >0-an

d%la2or)an d% d(n%a %n% an%a #elah%r)an den&an se)s%o sesarea #en%n&)a )al%

d%$and%n&)an "0 ah(n se$el(#n+a. e$a$n+a #(l%9a)or%al, er#as() d%anaran+a

#en%n&)an+a %nd%)as% se)s%o sesarea (lan& 2ada )eha#%lan den&an 2ar( rah%#. *an+a

se$esar !B an%a d% A#er%)a 2ada ah(n 1>8 +an& )eha#%lan se$el(#n+a #en4alan%



o2eras% 3aesar #a( #ela)()an 2ersal%nan nor#al d% )eha#%lan $er%)(n+a (Vaginal Birth

After Caesarean/ VBAC). e%rn& $er4alann+a a)(, 2ersenase 7AC #en%n&)a

#en4ad% !8."B 2ada ah(n 1>>;. erda2a %nd%)as% (a#a (n() #ela)()an se)s%o

sesarea +a%( d%sos%a, &aa 4an%n, )ela%nan lea), 2ar( (er(s.

D% ah(n 80-an se)s%o sesarea aas %nd%)as% 2ar( (er(s $er)%sar !-"0B dar% an&)a

)ena%)an se)s%o 3aesarea d% A#er%)a er%)a. D% ah(n >0-an an&)a se)s%o 3aesarea aas

%nd%)as% 2ar( rah%# #en(r(n den&an d%)e#$an&)ann+a 2ersal%nan 2era&%na# 2ada

$e)as se)s%o 3aesar, Vaginal Birth After Cesarean (VBAC) aa( d%)enal 2(la se$a&a% Trial

of Labor After Cesarean (TLAC).

7AC #e#$er%)an %n&)a )e$erhas%lan se$esar 8"B #en(r( er%ll dan G%$s.5"6

Oleh )arena %(, saa %n% 7AC san&a d%)e#$an&)an (n() #en&(ran&% an&)a )ena%)an

se)s%o sesarea. 'o#2l%)as% 7AC $er(2a r(2(ra (er% #er(2a)an )o#2l%)as% (a#a

ea2% 4aran& er4ad%, han+a dar% 1000 )elah%ran. Jen%s e)s%o esarea se$el(#n+a 4(&a

#enen()an %n&)a er4ad%n+a r(2(re rah%#. J%)a se)s%o sesarea se$el(#n+a adalah 4en%s

)las%) #a)a se)%ar B a)an er4ad% r(2(ra (er%, sedan&)an loer ranserse han+a 0,B

a)an #en&ala#% r(2(re rah%#.

An&)a )e#a%an %$( $er)(ran& den&an adan+a 7AC. An&)a )e#a%an 1,; 2er

100.000 )elah%ran 4%)a 7AC, dan se$esar ,; 2er 100.000 4%)a se)s%o sesarea (lan&an.

A)an ea2%, 7AC #en%n&)a)an r%s%)o )e#a%an 2er%naal se$esar 11 )al% le$%h %n&&%

d%$and%n&)an den&an se)s%o sesarea (lan&an. 'e#a%an 2er%naal d%se$a$)an )arena

h!po"ic ische#ic encephalopath! dan necroti$ing enterocolitis.



BAB II

DASAR TEORI

A . Apa itu Persalia N!r"al #e$a Be%as Se%si! Sesarea atau VBAC (Vaginal

Birth After Caesarean)

Persal%nan +an& d%la)()an seoran& %$( #elal(% a&%na den&an r%a+a

#elah%r)an $a+% se$el(#n+a se3ara o2eras% se)s%o 3aesar. 'e$erhas%lan 7AC

#en%n&)a 2ada an%a den&an )elah%ran 2era&%na# se$el(#n+a, 2ersal%nan a)%9

den&an 2e#$()aan ser%)s +an& $esar, dan 2ada an%a den&an o2eras% 3aesar

se$el(#n+a aas %nd%)as% #al2resenas% 4an%n.

7e$era2a 9a)or +an& har(s d%2erha%)an 2ada )and%da an%a +an& a)an

#en4alan% 2roses 2er3o$aan 2ersal%nan. 56

1. Jen%s %ns%s% rah%# 2ada o2eras% 3aesar 2era#a se$el(#n+a

Wan%a den&an $e)as se$(ah 2ar( ranersal rendah #e#%l%)%

%n&)a )e$erhas%lan se$esar ;0B-0B 2ada 7AC dan r%s%)o erendah

(n() #en&ala#% r(2(r rah%#. R%s%)o r(2(r rah%# 2ada %ns%s% rah%#

ransersal rendah se$esar 0.B d%$and%n&)an den&an %ns%s% er%)al

rendah +a)n% se$esar !B dan %ns%s% )las%) se$esar 1.>B. Wan%a den&an

r%a+a r(2(r rah%# se$el(#n+a #e#%l%)% r%s%)o r(2(r )e#$al% se$esar

;-"!B er&an(n& lea) r(2(rn+a dan se$a%)n+a d%%n9or#as%)an (n()

#en4alan% se)s%o 3aesar%a (lan&an 5RC6.

!. O2eras% 3aesar le$%h dar% se)al% se$el(#n+a



7er%)( %n% 2resenas% +an& da2a #e#$an( (n() #en&eah(%

%n&)a )e$erhas%lan dar% 2ersal%nan 2era&%na# den&an 7e)as e)s%o

esarea :

a. 8->0B 4%)a 2ernah #elah%r)an se3ara nor#al, er(a#a 4%)a

2ersal%nan nor#al %( den&an $e)as se)s%o sesarea.

$. !-;B 4%)a 2ernah se)al% o2eras% sesarea se$el(#n+a.

3. 0-B 4%)a 2ernah d(a )al% o2eras% sesarea se$el(#n+a.

R%s%)o r(2(r rah%# #en%n&)a se%r%n& den&an 4(#lah %ns%s% rah%#

2ada o2eras% 3aesar se$el(#n+a se$esar 0.>B h%n&&a ".B.

". Ind%)as% o2eras% 3aesar se$el(#n+a

%n&)a )es()sesan dar% 7AC 4(&a $er&an(n& dar% %nd%)as%

o2eras% 3aesar se$el(#n+a. Wan%a den&an r%a+a o2eras% 3aesar

se$el(#n+a aas %nd%)as% #al2resenas% 4an%n #e#%l%)% )e$erhas%lan

7AC se$esar B d%$and%n&)an den&an d%sres 4an%n 5an&)a

)e$erhas%lan se$esar ;0B6, dan d%s2ro2ors% )e2ala-2an&&(l 5an&)a

)e$erhas%lan B.. 'eha#%lan #(l%9eal

'e$an+a)an 2enel%an #en&aa)an $aha an%a den&an

)eha#%lan #(l%2el #e#%l%)% an&)a )es()sesan 7AC +n& le$%h rendah

d%$and%n&)an den&an )eha#%lan (n&&al, ea2% r%s%)o r(2(r rah%# %da)

#en%n&)a.

B. Pre#i%t!r Kesu%sesa &BAC

1. 'ara)er%s%) #aernal

s%a %$( #en4ad% salah sa( 9a)or 2enen( )e$erhas%lan 7AC, an%a den&an

(s%a le$%h dar% 0 ah(n #e#%l%)% r%s%)o &a&al dala# 2er3o$aan 7A3 se$esar



%&a )al% l%2a d%$and%n&)an den&an an%a d% $aah 0 ah(n. ela%n %( 9a)or

en%s 4(&a #en4ad% 2red%)or )e$erhas%lan 7AC. n%s *%s2an%3, A9r%)a-

A#er%)a #e#%l%)% %n&)a )e$erhas%lan +an& rendah. 5"6

!. 7era $a+% lah%r 7era $a+% le$%h dar% "00 &ra# #e#%l%)% an&)a )e&a&alan e#2a )al% l%2a

le$%h %n&&% d%$and%n&)an $era $a+% +an& le$%h r%n&an.5"6

". R%a+a 2ersal%nan

R%a+a 2ersal%nan 2era&%na# se$el(#n+a aa( r%a+a 7AC se$el(#n+a

4(&a #en%n&)a)an an&)a )e$erhas%lan 7AC saa %n%. edan&)an r%a+a

CPD 53e2halo2el%3 d%s2ro2or%on6, %da) 2ernah 2ersal%nan 2era&%na#

se$el(#n+a #er(2a)an 2red%)or ne&a%9 (n() )es()sesan 7AC.

5"6

. Ind%)as% o2eras% 3aesar se$el(#n+a

Pada se#(a 2enel%%an, %nd%)as% 3aesar se$el(#n+a )arena d%s2ro2or%onal

)e2ala-2an&&(l aa( CPD #e#%l%)% %n&)a )e$erhas%lan 7AC +an& 2al%n&

rendah 5;0-;B6. D%sress 4an%n #er(2a)an (r(an )ed(a erendah (n()

)es()sesan 7AC 5;>-"B6. edan&)an (n() %nd%)as% se2er% her2es,

2lasena 2re%a #er(2a)an 2red%)or er%n&&% )es()sesan 7AC 5-8>65"6



. Persal%nan 2era&%na# se$el(#n+a

Pas%en den&an r%a+a 2ersal%nan 2era&%na# se$el(#n+a #e#%l%)% ras%o le$%h

%n&&% (n() )es()sesan 7AC d%$and%n&)an 2as%en +an& $el(# 2ernah

#ela)()an 2ersal%nan 2era&%na# se$el(#n+a. Pas%en den&an r%a+a 1 )al%

#elah%r)an 2era&%nan #e#%l%)% )es()sesan 7AC 8>B d%$and%n&)an +an&

$el(# 2ernah +a)n% se$esar 0B. edan&)an 2as%en +an& s(dah 2ernah

#ela)()an 7AC se$el(#n+a #e#%l%)% )es()sesan >"B (n() 7AC la&%.5"6

;. Ind()s% 2ersal%nan7e$era2a 2enel%%an #en(n4())an $aha %nd()s% saa 2er3o$aan 2ersal%nan

2as)a se)s%o 3aesar #e#%l%)% r%s%)o !-" )al% l%2a )e&a&alan 7AC

d%$and%n&)an 2ersal%nan s2onan.5"6

. Pe#$()aan 3er%xPas%en den&an 2e#$()aan 3er%x +an& $esar #e#%l%)% %n&)a )es()sesan

7AC +an& le$%h $esar. Penel%%an Ela## e all, 1>> #en&e#()a)an $aha

2e#$()aan 3er%x le$%h aa( sa#a den&an 3# #e#%l%)% an&)a )e$erhas%lan

7AC 8;B.5"6

8. Jara) )eha#%lan

Pada s(a( anal%s%s, an%a den&an 4ara) )eha#%lan le$%h dar% 18 $(lan

#e#%l%)% 2el(an& )es()sesan 7AC se$esar 8;B, sedan&)an an%a den&an

4ara) )eha#%lan )(ran& dar% 18 $(lan #e#%l%)% 2el(an& )e$erhas%lan 7AC

>B.5"6

>. 'elah%ran 2re#a(r Pada 2enel%%an $esar oleh F(%nones e al )es()sesan 7AC 2ada 2re#a(r

se$esar 8!B , d%$and%n&)an den&an )elah%ran 3()(2 $(lan +a)n% se$esar B.

5"6

10. D%a$ees sela#a )eha#%lan aa( se$el(# )eha#%lan



Penel%%an #en(n4())an 2as%en den&an d%a$ees $a%) sela#a )eha#%lan aa(

se$el(# )eha#%lan #en(n4())an 2el(an& le$%h rendah (n() )es()sesan

7AC.5"6

11. s%a I$(

'e$erhas%lan 7AC #en%n&)a 4%)a (s%a %$( )(ran& dar% " ah(n.

%se# s)or%n& 5Ela## dan Ge%&er 1>>6

)or

An&)a

'e$erhas%lan 5B6

0-! !->

" >-;0

;-;

->

; 88-8>

>"8-10 >->>

C. K!trai#i%asi VBAC (Vaginal Birth After Caesarean)

No 'ara)er%s%) )or

1 s%a 0 ah(n !

! R%a+a 2ersal%nan 2era&%na#-se$el(# dan ses(dah se3%o

3aesar%a

-ses(dah se)s%o 3aesar%a !

-se$el(# se)s%o 3aesar%a 1

%da) ada 0

"Alasan la%n se)s%o 3aesar%aerdah(l( 1

Pendaaran dan 2en%2%san 3er%xsaa %$a d% r(#ah sa)% dala#

)eadaan %n2ar(

-B !

-!-B 1 -!B 0

D%laas% 3er%x 3# 1



7AC #er(2a)an )onra%nd%)as% 2ada an%a den&an : 5,;6

1. r%a+a r(2(r rah%# se$el(#n+a 5 r%s%)o r(2(r %da) d%)eah(%6!. R%a+a se$el(#n+a #en4alan% o2eras% 3aesar )las%) 5 !00->00/10.000 r%s%)o

2e3ahn+a rah%# 6". %&a aa( le$%h o2eras% se)s%o 3aesar%a se$el(#n+a. Pada )as(s-)as(s 2as%en

den&an ed()as% rendah ! )al% C so2.

Na#(n, dala# )eadaan e)sr%# eren( 5 se2er% )e&(&(ran , )e#a%an

4an%n %nra(er%n 6 $a&% $e$era2a an%a dala# )elo#2o) d% aas, )elah%ran #elal(%

a&%na 5#es)%2(n $er%s%)o $()anlah s(a( )onra%nd%)as%6

Ada %n9or#as% +an& $el(# 3()(2 dan $erenan&an #en&ena% a2a)ah

r%s%)o r(2(r rah%# #en%n&)a 2ada an%a den&an #%o#e)o#% se$el(#n+a aa(

o2eras% rah%# se$el(#n+a +an& )o#2le)s.

e$(ah anal%s%s #(l%ar%a$el dar% s(d% NIC*D #en(n4())an $aha %da)

ada 2er$edaan +an& s%&n%9%)an dala# %n&)a r(2(r (er% d% 7AC den&an d(a aa(

le$%h )elah%ran Caesar 5>!/10.0006 se$el(#n+a d%$and%n&)an den&an r%a+a

)elah%ran 3aesar 2era#a )al% se$el(#n+a.5;8/10.0006.56 *as%l 2enel%%an %n% sa#a

den&an s(d% o$seras%onal la%nn+a +an& se3ara )esel(r(han #en(n4())an %n&)a

)es()sesan 7AC den&an d(a )elah%ran 3aesar se$el(#n+a #a(2(n sa( )al%

o2eras% 3aesar se$el(#n+a.



D. Risi%! #ari ti#a%a VBAC (Vaginal Birth After Caesarean)

1. Wan%a +an& #e#2er%#$an&)an 2%l%han (n() #elah%r)an se3ara nor#al

57AC6 seelah o2eras% 3aesar se$el(#n+a har(s d%$er%ah()an $aha 7AC

#e#%l%)% r%s%)o r(2(r rah%# se$esar !!-/10.000. 586

!. %nda)an #elah%r)an se3ara nor#al 2as)a o2eras% se3%o 3aesar%a )eha#%lan

se$el(#n+a 57AC6 #e#%l%)% res%)o 1B le$%h %n&&% (n() rans9(s% darah

510/10.000 (n() 7AC dan 100/10.000 (n() RC6 aa( endo#er%%s

5!8>/10.000 (n() 7AC dan 180/10.000 (n() RC6 d%$and%n&)an o2eras%

3aesar 5RC 6 586

". Wan%a +an& #e#%l%h #elah%r)an se3ara nor#al 2as)a )elah%ran se3%o 3aesar%a

se$el(#n+a #e#%l%)% r%s%)o a#$ahan !-"/10.000 )e#a%an 2er%naal

d%$and%n&)an den&an %nda)an ele)%9 se3%o 3aesar%a. 'e#a%an 2er%naal 2ada

7AC d%$and%n&)an RC "!/10.000 d%$and%n& 1"/10.000. 586

. 7AC #e#%l%)% r%s%)o 8/10.000 (n() #en&ala#% %s)e#% h%2o)s%a

en3e2halo2a+ 2ada $a+%, d%$and%n&)an den&an ele)%9 se3%o 3aesar%a +a%( 0. 586

. 7AC 2ada (s%a %$( le$%h dar% " ah(n #en+e$a$)an )eh%lan&an darah "0B

le$%h $an+a) d%$and%n&)an 2ada %$( (s%a )(ran& " ah(n, )arena h%so2aolo&%

#%o#er%(# s(dah $an+a) 4ar%n&an %)an+a.

E. Keutu$a &BAC (Vaginal Birth After Caesarean) #i'a#i$%a #e$a

ERCS (Elective repeat caesarean section).

1. 7AC #en&(ran&% r%s%)o 2ro$le# 2erna2asan 2ada $a+% seelah lah%r 5ra%o !-

"B 2ada 7AC +an& d%ren3ana)an, dan "-B 2ada ele)%9 se3%o 3aesar%a6. Pada

2enel%%an NIC*D d%2a2ar)an $aha N (transient tach!pne% of the ne&born)

2ada RC se$esar ".;B sedan&)an 2ada 7AC +an& d%ren3ana)an se$esar

!.;B. Le$%h 4a(h la&%, 2en&&(naan 2ro9%la)%9 sreo%d $ea#ehasone 2ada %$(



den&an (#(r )eha#%lan " #%n&&( +an& a)an d%la)()an RC #en&(ran&%

)e#a%an a)%$a &an&&(an 2erna2asan 2ada $a+% se$esar 0B. 5>6

!. R%s%)o +an& d%%#$(l)an dar% )o#2l%)as% aneses% san&a )e3%l. 7erdasar)an

2enel%%an NIC*D an%a +an& #ela)()an 3aesar 5$a%) e#er&ens% #a(2(n

ele)%96 . Dar% >"B 2rosed(r 3aesar +an& #en&&(na)an re&%onal aneses% han+a

"B +an& #en&ala#% )e&a&alan. 'e#a%an #aernal +an& d%)arena)an 2ro$le#

aneses% se$an+a) !, dar% 100.000 d%)arena)an )e&a&alan %n($as% .5106

". O2eras% RC #en%n&)a)an r%s%)o )o#2l%)as% 2ada )eha#%lan selan4(n+a.

'o#2l%)as% #el%2(%: 2lasena a33rea, 3edera )and(n& )e#%h, %le(s, )e$((han

(n() rans9(s% darah,*PP 5*e#ora&%) 2os 2ar(#6, h%sere)o#%. 7erdasar)an

s(d% NIC*D 2ada "0.1"! se3%o 3aesar, )as(s 2lasena a33rea se$an+a) 0.!B,

0."1B, 0.B, !.1"B, !.""B dan ;.B 2ada )eha#%lan 2era#a, )ed(a,

)e%&a, )ee#2a, )el%#a, dan )eena#. *%sere)o#% se$esar 0.;B, 0.!B,

0.>0B, !.1B, ".>B dan 8.>>B.5116

F. &BAC(Vaginal Birth After Caesarean) pa#a %asus(%)asus %)usus

1. 'elah%ran 2re#a(r 51!6

a. e$(ah s(d% )ohor reros2e)%9 #en(n4())an an%a +an& #en&ala#%

)eha#%lan 2re#a(r 5 !-"; #%n&&( )eha#%lan 6 dan a)an d%ren3ana)an

7AC #e#%l%)% %n&)a )e$erhas%lan +an& le$%h %n&&% $%la d%$and%n&)an

den&an an%a )eha#%lan 3()(2 $(lan dan a)an d%ren3ana)an 7AC 5 8! B

s B 6 dan non - s%&n%9%)an #enda2a)an r%s%)o le$%h rendah (n()

#e&ala#% r(2(r rah%#.

$. (d% 2ros2e)%9 NIC*D #en(n4())an %n&)a )e$erhas%lan 7AC

d%ren3ana)an (n() 2re#a(r dan )eha#%lan 3()(2 $(lan adalah ha#2%r sa#a



5 !,8 B s "," B 6 , ea2% %n&)a r(2(r (er(s 5"/ 10. 000 s , /10.000 6

se3ara s%&n%9%)an le$%h rendah 2ada $a+% 2re#a(r d%$and%n&)an den&an

7AC 2ada )eha#%lan 3()(2 $(lan. ro#$oe#$ol% 2en+a)% , )oa&(lo2a%

dan rans9(s% le$%h (#(# er4ad% 2ada 7AC an%a )eha#%lan 2re#a(r

d%$and%n&)an den&an +an& 3()(2 $(lan. es)% 2(n r%s%)o a$sol( &a$(n&an

)esel(r(han )(ran& dar%" B 2ada )elo#2o) 2re#a(r 7AC . *as%l 2er%naal

adalah ser(2a den&an 7AC 2re#a(r dan 2re#a(r RC. Oleh )arena %(,

an%a +an& #en4alan% 2ersal%nan 2re#a(r den&an r%a+a )elah%ran 3aesar

se$el(#n+a $%sa d%saran)an (n() #ela)()an 7AC den&an )onsel%n& +an&

e2a.!. 'eha#%lan )e#$ar, 4an%n #a)roso#%a, dan 4ara) )eha#%lan de)a 51"6

a.e$(ah 2ende)aan +an& ha%-ha% d%saran)an )e%)a #e#2er%#$an&)an

2eren3anaan 7AC 2ada an%a den&an )eha#%lan )e#$ar, 4an%n

#a)roso#%a dan 4ara) )eha#%lan 2ende), )arena ada )e%da)2as%an dala#

)ea#anan dan e9%)as% 2ada 7AC +an& d%ren3ana)an dala# s%(as% se2er%

%(. en(r( 2enel%%an NIC*D 5n H 18; )e#$ar6, 2enel%%an reros2e)%9 A

5n H " )e#$ar6 #ela2or)an an&)a )e$erhas%lan +an& sa#a 7AC 2ada

)eha#%lan )e#$ar dan )eha#%lan (n&&al 5;-8B6.

$. e$(ah %n4a(an dar% e#2a 2enel%%an reros2e)%9 dan 2enel%%an NIC*D

elah #ela2or)an 2en(r(nan se3ara s%&n%9%)an dar% )e$erhas%lan 7AC (n()

)eha#%lan den&an $a+% den&an $era 000 & aa( le$%h 5-;B6

d%$and%n&)an den&an $a+% +an& le$%h )e3%l 5-8"B6.

3.%&a s(d% o$seras%onal er$aas elah #en(n4())an r%s%)o d(a sa#2a% %&a

)al% l%2a 2en%n&)aan r(2(r rah%# (n() an%a den&an %neral )eha#%lan

2ende) 5d% $aah 1!-! $(lan6 +an& se$el(#n+a d%o2eras% 3aesar. Dala#



s(d% NIC*D, an%a +an& #en4alan% 2eren3anaan 7AC +an& se$el(#n+a

2ernah #en4alan% 3aesar ! ah(n lal( #e#%l%)% 2en%n&)aan r%s%)o (n()

)elah%ran den&an o2eras% 3aesar la&% d%$and%n&)an den&an an%a +an&

#en4alan% o2eras% 3aesar le$%h dar% ! ah(n 5"!B s !B 6.

G. Du%u$a itrapartu" #a iter*esi pa#a &BAC +a$ #ire,aa%a

1. D%#ana dan $a&a%#ana sehar(sn+a 7AC d%la)()an@

Pere#2(an har(s d%saran)an $aha 7AC eren3ana d%la)()an 2ada

r(an&an )h(s(s +an& d%len&)a2% 2erlen&)a2an 2ersal%nan, den&an 2eraaan

$er)elan4(an %nra2ar(# dan s(#$er da+a +an& #e#ada% (n() o2eras% 3aesar

se&era sera 2erlen&)a2an res(s%as% neonaal. Ahl% )and(n&an, )e$%danan, aneses%,

)a#ar o2eras%, neonaal dan d()(n&an he#aolo&%s har(s er(s ersed%a d% sel(r(h

7AC eren3ana dan RC.516

e$(ah s(d% reros2e)%9 daa 'anada #en(n4())an $aha r%s%)o rela%9

r(2(r rah%# 2ada 7AC eren3ana den&an RC #en%n&)a d(a )al% l%2a 2ada

(n% o$ser% ol(#e rendah 5)(ran& dar% 00 )elah%ran / ah(n6 d%$and%n&)an

den&an (n% o$ser% ol(#e %n&&% 500 aa( le$%h )elah%ran / ah(n6. 516

Aneses% e2%d(ral $()an #er(2a)an )onra%nd%)as% 2ada 7AC eren3ana.

Dala# s(d% NIC*D , %n&)a )e$erhas%lan 7AC eren3ana le$%h %n&&% d% anara

2ere#2(an +an& #ener%#a e2%d(ral anal&es% dar%2ada #ere)a +an& %da) #ener%#a

anal&es% e2%d(ral 5 ", B s 0, B 6. 516



ena&a #ed%s har(s d%saran)an (n() #e#%l%)% 2e#ana(an 4an%n

ele)ron%) er(s #ener(s (n() #e#ana( )onra)s% rah%# sela#a 7AC

eren3ana.

e$(ah 3ard%oo3o&ra2h +an& a$nor#al 5CG6 adalah 2eranda +an&

2al%n& )ons%sen dala# )as(s 2ene#(an r(2(r rah%# 5-8B 6.R%s%)o rela%9 dan

a$sol( dar% e9e) sa#2%n& +an& 2arah den&an %da) adan+a 2e#ana(an 4an%n

ele)ron%) )on%n( %da) d%)eah(%. Peraaan %nra2ar(# er(s #ener(s d%2erl()an

(n() %den%9%)as% 3e2a dan #ana4e#en $e)as r(2(r rah%#.

7er%)( anda-anda +an& har(s d%3(r%&a% se$a&a% r(2(r rah%# s2onan

(spontane%s %ter%s r%pt%re): 51;6

a. Ga#$aran CG +an& %da) nor#al

$. n+er% 2er( +an& 2arah, er(a#a 4%)a ea2 ada d% anara )onra)s%3. n+er% dada aa( (4(n& $ah( sa)%, %$a-%$a #en&ala#% sesa) na2as

d. 2erdarahan a&%na a$nor#al aa( he#a(r%a

e. a)%)ard%a 2ada %$(, h%2oens% aa( s+o)

9. h%lan&n+a $a&%an 2resenas% $a+%

n() #en&an%s%2as% hal erse$(, har(s d%as2ada% &e4ala-&e4ala r(2(r

rah%# #e#$a)a 5n+er% a)( a$do#en, sensas% 2o22%n&/se2er% a)an 2e3ah, era$a

$a&%an 4an%n d% l(ar (er(s saa 2e#er%)saan leo2old, deseleras% dan $rad%)ard% 2ada

den+( 4an(n& $a+%, 2erdarahan 2era&%na#.6

!. 7a&a%#ana se$a%)n+a #en+aran)an an%a den&an r%a+a )elah%ran se3%o 3aesar

se$el(#n+a er)a% den&an hal %nd()s% 2ersal%nan.

e%a2 an%a har(s d%$er%ah( adan+a 2en%n&)aan r%s%)o d(a sa#2a%

%&a )al% er4ad%n+a r(2(r rah%# d%$and%n&)an den&an 2ersal%an nor#al. Wan%a

har(s d%$er%ah( $aha ada r%s%)o +an& le$%h %n&&% dar% 2e3ahn+a rah%# den&an

%nd()s% 2ersal%nan den&an #en&&(na)an 2rosa&land%n.



Dala# s(d% NIC*D, r%s%)o r(2(r rah%# 2er 10.000 7AC eren3ana

adalah 10!/10.000 (n() %nd()s% , 8/10.000 (n() a(&#enas% dan ";/10, 000

(n() 2ersal%nan s2onan.516

D(a 2enel%%an elah #e#a2ar)an 2er$edaan has%l +an& #er(&%)an

anara 2en&&(naan 2rosa&land%n dan non-2rosa&land%n 5se2er% %nra3er%3al

Eole+ )aeer6 Dala# 2enel%%an NIC*D %nd()s% 2rosa&land%n d%$and%n&)an

den&an %nd()s% non-2rosa&land%n %da) #en(n4())anse3ara s%&n%9%)an r%s%)o

+an& le$%h %n&&% 2ada r(2(r rah%# 510/10, 000 s 8>/10, 000, P H 0.!!6 586

edan&)an,dala# anal%s%s daa nas%onal +an& d%)(#2(l)an dar%

)oland%a, %nd()s% 2rosa&land%n d%$and%n&)an den&an non2rosa&land%n %nd()s%

d%)a%)an den&an r%s%)o r(2(r rah%# #en(n4())an se3ara s%&n%9%)an le$%h %n&&%

58/10, 000 s !>/10, 0006 dan r%s%)o )e#a%an 2er%naal +an& le$%h %n&&% a)%$a

r(2(r rah%# 511.!/10, 000 d%$and%n&)an ./10, 0006.586

es)%2(n a(&#enas% 2ersal%nan $()an #er(2a)an

)onra%nd%)as%7AC han+a har(s d%dah(l(% den&an 2en%la%an o$ser% +an& ha%-

ha%, )onsel%n& %$( oleh do)er. A(&#enas% #en&&(na)an o)s%os%n har(s d%%ras%

sede#%)%an r(2a seh%n&&a %da) #ele$%h% )onra)s% #a)s%#(# e#2a )al% dala#

10 #en%, 9re)(ens% )onra)s% +an& %deal "- )al% dala# 10 #en%.

'e%)a #en&%n9or#as%)an an%a enan& %nd()s% 52rosa&land%n aa(

#eode non-2rosa&land%n6 aa (a(&#enas%, %n9or#as% +an& 4elas har(s d%$er%)an

2ada se#(a r%s%)o dan #an9aa %nda)an sera )e2((san dan $a&a%#ana hal %n%

da2a $erda#2a) 2ada )esehaan 4an&)a 2an4an&. e$a&a% 3onoh, 2ere#2(an

+an& #ere3an)an )eha#%lan $er%)(n+a da2a #ener%#a r%s%)o a#$ahan 4an&)a



2ende) er)a% den&an %nd()s% aa( a(&#enas% (n() #en&(ran&% r%s%)o

)o#2l%)as% ser%(s d% #asa de2an )eha#%lan.

H. Se%si! Caesarea Ula$a atau ERCS (Elective repeat caesarean section).

e)s%o sesarea (lan&an 2ada rah%# $e)as se)s%o sesarea #e#$er%)an an&)a

)e$erhas%lan >0B d%$and%n&)an den&an 7AC +an& han+a #e#$er%)an an&)a

)e$erhas%lan 80B. e)s%o sesarea (lan&an 4(&a #en(r(n)an an&)a )e4ad%an r(2(r

(er(s dan h%2o)s%a 4an%n.

'er(&%an se)s%o sesarea (lan&an adalah a)( 2en+e#$(han +an& le$%h

la#a d%$and%n&)an den&an 7AC dan $%a+a +an& le$%h #ahal. 'o#2l%)as% se)s%o

sesarea 4(&a #el%2(% )o#2l%)as% aneses%, 2erdarahan, )er(sa)an )and(n& )e#%h

#a(2(n or&an dala# la%nn+a, %n9e)s% 2el%s, dan 2erle)aan.

BAB III

KESIMPULAN

Wan%a +an& se$el(#n+a 2ernah r%a+a #elah%r)an den&an o2eras% 3aesar da2a

#e#%l%h #elah%r)an )eha#%lan $er%)(n+a den&an ! 3ara, +a%( #elal(% 2ersal%nan

nor#al 5VBAC/ vaginal birth after cesarean6 aa( da2a 4(&a #ela)()an o2eras% 3aesar

)e#$al% 5RC/ ele3%e re2ea 3esarean se3%on6. Ada2(n #as%n&-#as%n& )e(n(n&an

dan )er(&%an +an& d%#%l%)% oleh %a2 %nda)an $a%) 7AC #a(2(n RC.



es)%2(n se3ara &ar%s $esar 7AC #e#%l%)% r%s%)o +an& le$%h %n&&% (n()

er4ad%n+a r(2(r rah%#, rans9(s% darah, endo#er%%s, )e#a%an 2er%naal, dan %s)e#%

h%2o)s%a d%$and%n&)an RC. A)an ea2% ada 4(&a )e(n(n&an-)e(n(n&an +an&

d%#%l%)% 7AC #en&(ran&% r%s%)o N 5rans%en a3h+2ne( o9 he ne$orn6. edan&)an

RC send%r% #en%n&)a)an r%s%)o )o#2l%)as% 2ada )eha#%lan selan4(n+a. 'o#2l%)as%

#el%2(%: 2lasena a33rea, 3edera )and(n& )e#%h, %le(s, )e$((han (n() rans9(s% darah,

dan h%sere)o#%

'e2((san +an& d%2%l%h oleh seoran& 2as%en (n() #e#%l%h 7AC aa(2(n RC

$erdasar)an 9a)or )onra%nd%)as% #a(2(n 2red%)or )es()sesan 7AC. 'onra%nd%)as%

7AC #el%2(%:

16 r%a+a r(2(r rah%# se$el(#n+a 5 r%s%)o r(2(r %da) d%)eah(%6

!6 R%a+a se$el(#n+a #en4alan% o2eras% 3aesar )las%) 5 !00->00/10.000 r%s%)o

2e3ahn+a rah%# 6"6 %&a aa( le$%h o2eras% se)s%o 3aesar%a se$el(#n+a.

4%)a seoran& 2as%en #e#%l%)% )onra%nd%)as% #a)a sehar(sn+a d%la)()an %nda)an

RC. *al +an& 2erl( d%2erha%)an (n() #enen()an 2ro&nos%s 2ersal%nan 2era&%na#

den&an $e)as o2eras% 3aesar adalah se$a&a% $er%)( :

16 'ara)er%s%) #aernal

!6 7era $a+% lah%r "6 R%a+a 2ersal%nan

6 Ind%)as% o2eras% 3aesar se$el(#n+a

6 Persal%nan 2era&%na# se$el(#n+a

;6 Ind()s% 2ersal%nan6 Pe#$()aan 3er%x

86 Jara) )eha#%lan>6 'elah%ran 2re#a(r

106 D%a$ees sela#a )eha#%lan aa( se$el(# )eha#%lan



'onsel%n& an%a ha#%l den&an $e)as o2eras% 3aesar (#(#n+a adalah sa#a

se2er% )eha#%lan nor#al, han+a +an& har(s d%2erha%)an $aha )onsel%n& d%e)an)an

2ada :

• Persal%nan har(s d%la)()an d% r(#ah sa)% den&an 2eralaan +an& #e#ada%

(n() )as(s 2ersal%nan den&an 2ar( (er(s.

• 'onsel%n& #en&ena% ren3ana )el(ar&a $eren3ana (n() #e#%l%h )el(ar&a )e3%l

den&an 3ara )onrase2s% #ana2.



DAFTAR PUSTAKA

1. Cron4, *.. 5!01!6. ?Cl%n%3al O$ser%3s. A o(h A9r%3an Pers2e3%e?. 'r E ":

".

!. Parl%a#enar+ O99%3e o9 3%en3e and e3hnolo&+. Caesarean se3%ons. ostnote

!00!5186:1K .2arl%a#en.()/ 2os/2n18.2d9M.

". Ca(&he+, Aaron 7. a&%nal 7%rh A9er Cesarean del%er+. Las (2dae: ! A(&

!01". Aa%la$le 9ro#: e#ed%3%ne.#eds3a2e.3o#/ar%3le/!!18-oer%e.. 'enneh, J.Leeno. !01". W%ll%a#s an(al o9 Pre&nan3+ Co#2l%3a%ons en+

h%rd ed%%on. 3Gra-*%ll.. G(%se J, *ash%#a J, Osere%l P. %den3eK$ased a&%nal $%rh a9er Caesarean

se3%on. 7es Pra3 Res Cl%n O$se G+nae3ol.!001>:11K"0.;. (rner J. er%ne r(2(re. 7es Pra3 Res Cl%n O$se G+nae3ol. !00!1;:;>K>.

. Landon 7, 2on& C<, ho# , *a(h JC, 7loo# L, arner W,e al. R%s) o9

(er%ne r(2(re %h a r%al o9 la$or %n o#en %h #(l%2le and s%n&le 2r%or

3esarean del%er+. O$se G+ne3ol.!00;108:1!K!0.

8. Landon 7, *a(h JC, Leeno 'J, 2on& C<, Le%nde3)er ,arner W, e al.

aernal and 2er%naal o(3o#es asso3%aed %h a r%al o9 la$or a9er 2r%or

3esarean del%er+. N n&l J ed !00"1:!81K>.

>. Le%ne , Gha% , 7aron JJ, ro# C. ode o9 del%er+ and r%s) o9

res2%raor+ d%seases %n ne$orns. O$se G+ne3ol !001 >:">K!.10. Le%s G, ed%or. Wh+ ohers D%e !000K!00! he %xh Re2or o9 he

Con9%den%al n(%r%es %no aernal Deahs %n he n%ed '%n&do#. London:

RCOG Press !00

.3e#a3h.or&.()/2($l%3a%ons/WD!000!00!/3onen.h#M.

11. Ananh C, #(l%an JC, %n%leos A. he asso3%a%on o9 2la3ena 2re%a %h

h%sor+ o9 3esarean del%er+ and a$or%on: a #eaanal+s%s. A# J O$se G+ne3ol



1>>1:101K8.

1!. D(rnald CP, Ro(se DJ, Leeno 'J, 2on& C<, a3Pherson C, arner W, e

al. he aernalKEeal ed%3%ne n%s Cesarean Re&%sr+: sa9e+ and e99%3a3+ o9 a

r%al o9 la$or %n 2reer# 2re&nan3+ a9er a 2r%or 3esarean del%er+. A# J O$se

G+ne3ol !00;1>:111>K!;.

1". ;. arner W, Le%nde3)er , 2on& C<, oaad A*, *a(h JC, Landon 7, e

al. he aernalKEeal ed%3%ne n% 3esarean re&%sr+: r%al o9 la$or %h a %n

&esa%on. A# J O$se G+ne3ol !001>":1"K0.1. Wen W, R(sen ID, Wal)er , L%son R, 'ra#er , 7as)e , e al.

Co#2ar%son o9 #aernal #oral%+ and #or$%d%+ $eeen r%al o9 la$or and

ele3%e 3esarean se3%on a#on& o#en %h 2re%o(s 3esarean del%er+. A# J

O$se G+ne3ol !001>1: 1!;"K>.

1. Landon 7, Le%nde3)er , 2on& C<, *a(h JC, 7loo# , arner W, e al. he

E Cesarean Re&%sr+: 9a3ors a99e3%n& he s(33ess o9 r%al o9 la$or a9er

2re%o(s 3esarean del%er+. A# J O$se G+ne3ol !001>":101;K!".

1;. (rner J. er%ne r(2(re. 7es Pra3 Res Cl%n O$se G+nae3ol !00!1;:;>K>.17. Ro+al Colle&e o9 O$ser%3%ans and G+nae3olo&%ss. Ind(3%on o9 la$o(r.

%den3e-$ased Cl%n%3al G(%del%ne N(#$er >. London: RCOG Press !001.

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