Anestesi pada

Obstetri

Ardi Pramono

Case

Seorang ibu hamil 39 minggu, mulai merasakan

kenceng-kenceng teratur. Diperiksa oleh dokter
kandungan dinyatakan sudah mulai buka 2 cm.
Karena takut nyeri sewaktu melahirkan, maka dokter
menyarankan pemasangan LEA (labour epidural
analgesia). Tetapi dalam proses melahirkan, ternyata
harus di lakukan cesar.

Imajinasikan kondisi berikut

Jika datang pasien ibu hamil, apakah yang anda

pikirkan?
Apakah ibu hamil = ibu yang sakit?
Kegawatan apakah yang mungkin muncul pada
ibu hamil?
Apakah yang anda sarankan jika ibu hamil ingin
melahirkan tanpa rasa nyeri?
Apakah komplikasi penanganan ibu hamil dengan
LEA, ILA, SC?

Stage of labor

1st stage: regular contraction and dilatation

pain is carried by visceral aff. fibers (T10-L1).
2nd stage: full dilatation, ends w. delivery of
the infant pain from stretching birth canal,
vulva, perineum (S2-S4)
3rd stage: delivery placenta

Stage proses kelahiran jenin

Physiological changes

Increased:
Hematological: vol. (40-50%), total blood vol. (2540%), dilutional anemia (hmt 31.9-36.5%)
Cardiovascular: CO (30-50%), decreased SVR
(35%), HR (15-20 bpm)
Pulmonary: minute vent.(50%), decreased. FRC
(20%), airway edema, dec PaCO2 and PaO2
Gastrointestinal: prolonged emptying, dec. lower
esophageal spinc. Tone
Altered drug responsed: decreased requirement
inhaled and local anesthetic

Fetal heart monitoring

Beat to beat variability: normal 110-160 bpm

be careful for fetal distress (due to arterial
hypoxemia, acidosis
Early decelerations: begin onset urine
contractions head contraction
Late decelerations: after uterine contraction
uteroplasental insuff.
Variable decelerations: caused by umbilical
cord compression

Aortocaval compression syndrome

Caused by impaired venous return

Symptoms: nausea, vomiting, hypotension,
tachycardia, sweating
Prevented by laterally position

Medications used during labor

Vasopressors: ephedrin, phenylephrine

Oxytocin
Tocolytics: terbutalin
MgSO4

Anesthesia for labor and delivery

Common pain medication: meperidine (25-50 mg iv),

mo (2-5 iv), fentanyl (25-50 ug iv).
Lumbar epidural blockade:
Epidurals (in active labor 5-6 cm in nullipara; 3-4
cm in multipara)
Intrathecal opioid in significant pain: use fentanyl,
meperidine, sufentanyl
Spinal anesthesia (saddle block) for forceps delivery
and repair traumatic laceration of vagina and rectum


Combined spinal and epidural labor
Paracervical block at fornix of vagina
Pudendal block
General anesthesia (rare)

Ibu hamil perlu ketenangan menghadapi pemberian analgesi epidural

Salah satu posisi pemberian analgesi lumbal

Anesthesia for cesarean

General anesthesia
Regional anesthesia (spinal or epidural)

Anesthesia for curretage

Case:

Ab. Inkompletus
Molla hidatidosa
Blighted ovum
PUD (perdarahan uterus disfungsional)

Prinsip: Sedasi dan anlegetik ketamin,

petidin, midazolam

Ibu hamil memerlukan ketenangan seperti air yang jernih

Alhamdulillah..

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