Lo. 5 ruptur perinei dan retensio plasenta

Ruptur perineum

• Is a ruptur obstetric that occurs in the perineum as a result of the inability of the pelvic muscles and soft tissues to accommodate the birth of a fetus.

• can be avoided by keeping the pelvic floor should not be passed by the head of the fetus rapidly

• Generally occur in the midline and can be extensive if: - Fetal head is born too soon - Pubic arch angle is smaller than usual so that the fetal head was forced backwards born more than usual - Fetal head through PBP with a larger size than sirkumferensia suboksipito-bregmatika - Children born with vaginal surgery

Stadium of ruptur perineum

• Stadium 1 : only the perineal skin and vaginal mucosa is lacerated

• Stadium 2: rear wall of the vagina and the connective tissue that connects the muscles of the diaphragm urogenitalis at the midline is injured

• Stadium 3 : muscular sphincter ani eksternum come off and sometimes the front wall of the rectum also participate torn

Retensio placenta• The placenta is not yet born within ½ hour after the baby is born• Etiology:1. placenta has not separated from the uterine wall, Because:

- less-powerful uterine contractions to release the placenta,- placenta is firmly attached to the uterine wall because korialis villi penetrate the decidua to the myometrium-up under the peritoneum (placenta accreta-perkreta)

2. Had the placenta separated, but not yet born, Because:- no attempt to give birth,- incorrect handling of third stage, resulting in constriction ring at the bottom of the uterus that prevent the placenta (placenta inkarserasio)- vesica urinaria or rectum is full

Retensio placenta

• Adhesiva placenta: placenta attached to the decidual endometrium deeper

• Placenta accreta: villi khorialis grow deeper and penetrate the decidual endometrium up to the upper limit of the myometrium

• Inkreta placenta: villi khorialis grow penetrate into the myometrium

• Perkreta placenta: villi khorialis grow to reach or penetrate the serosa