7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
1/35
Ferina Oktariani Tariza09/280824/KU/13100
VAGINAL BIRTH AFTR!A"RAN #VBA!$ %en&anVAKU' K"TRAK"I
Banyumas, 17 Oktober 20
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
2/35
y
I%entita( )a(ien
Na*a + N,- NK U(ia + 32 ta.n Aa*at + Aa(*aan& 3/ )ekeraan + I r*a. tan&&a "t- 'arita + 'enika. "t- O(tetri + G3)1A1
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
3/35
Ana*ne(i(
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
4/35
)e*erik(aanLaratri*
Lek(it + 13-5 6103/
Netr7i+ -41
Li*7(it + 2-33
ritr(it + 3-0 610/
H + 11-2 &/%
He*atkrit + 32-
'!V + 9:5 7L
'!H + 25:0 ;&
'!H! + 31:5 &/%
Tr*(it+ 191- 6103/
3: < 10:1 6 103/
39:3 < 3:
18:0 < 48:3
3: < 4:9 6 10/ 10:8 < 14:2 &/%
3: < 53:
81:1 < 9:0 7L
2:0 < 31:2 ;&
32 < 3 &/%
150 < 450 6 103/
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
5/35
Ana*ne(i(
Ri=a,at )en,akit >a.
A(*a: .i;erten(i: >' %an antn&%i(an&ka
Ri=a,at )en,akit Kear&aRi=a,at >': .i;erten(i: a(*a: %anantn& ;a%a kear&a %i(an&ka
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
6/35
)e*erik(aan Fi(ik
Tan&&a 21 "e;t 2014
KU+ Baik: ?*;( *enti(-
Tan%a Vita+ T> 120/80**H& RR 20 6/*enit
HR 80 ;*: re&er ". a7eri(- BB + 4 k&: kenaikan erat a%an (ea*a ke.a*ian 9k&
)6 ke;aa + Ti%ak ane*i(: ti%ak ikterik
)6 ;ar %an ek(tre*ita( + >aa* ata( nr*a
)6 a%*en + Terdapat bekas operasi SC di suprapubic tipetransversal: (;e
)a;a(i + Janin tunal, meman!an, preskep, puki,diveren, T"# $0cm
%uskultasi & 1$7'( menit )> + V/U tenan&: %in%in& @a&ina i?in: (er@ik( ti;i(: nak
%iten&a.- )e*kaan 3 ?*- "ea;t ketan #$: air ketan#$: en%ir %ara. #$- Ke;aa trn H%&e 1
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
7/35
>ia&n(i( A=a
'ti&ra@i%a: G3)1A1: .a*i 38*in&&: in;art kaa 1 7a(e aten%en&an ri=a,at "! ta.n ,an& a
'anae*en %an Tera;i
'n%k VK 'nitrin& KU/V"/>CC
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
8/35
F= ;
21/09/2014: Ca* 0-00: VK + @aa(i
Hi( + #$
>CC + 1386/*enit
)> + V/U tenan&: %in%in& @a&ina i?in:(er@ik( ti;i(: D 3?*: "eket #$: ke;aa trn
H%&e III: L> #$: AK #$
A((e(*ent + *ti&ra@i%a .a*i ater*%en&an kaaI 7a(e aten ri=- "! t. ,an& a
)an + Ren?ana VBA!
O( .i(/>CC
@aa(i ;k 10-00 ika ti%ak a%ake*aan ;er(ainan "! e*er&en?,
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
9/35
Ca* 10-00
@aa(i Hi( + #$- 36 10E/30EE/k
>CC + 1486/*enit
)> + V/U tenan&: %in%in& @a&ina i?in:(er@ik( ti;i(: nak %i%e;an: D 34?*:"eket #$: ke;aa trn H%&e II: L>#$: AK #$
A((e(*ent + *ti&ra@i%a .a*i ater* %en&ankaa I 7a(e akti7 ri=- "! t. ,an& a
)an + Ren?ana VBA!
O( .i(/>CC
@aa(i ;k 14-00
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
10/35
Ca* 14-00 @aa(i
Hi( + #$- 36 10*in (ekai
>CC + 1426/*enit )> + V/U tenan&: %in%in& @a&inai?in: (er@ik( ti;i(: nak %i%e;an:D ?*: "eket #$: ke;aa trn
H%&e II: L> #$: AK #$
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
11/35
Ca* 1-00 + " + )a(ien ta*;ak &ei(a.: in&in *en&e%an-Ketan ;e?a. (;ntan-
O +
KU + Baik: (a%ar: ti%ak ane*i( V@a /ret.ra tenan&: %in%in& @a&inai?in: (er@ik( ti%akteraa: ;e*kaan en&ka;:ke;aa trn H%&e II: L> #$: (eket #$
HI" + 36/10E/40/(>CC + 1406/*enit
A + Kaa II ) + )i*;in ;er(ainan: (ia;kan re((ita(i
a,i
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
12/35
Ca* 1-30 + " + 1 a* %i;i*;in: a,i e* a.ir- Ita*;ak keea.an-
A + Kaa 2 tak *a
) + Vak* ek(tra(i
Ca* 1-50 + Ba,i a.ir (e?ara V %en&an 16 ;a(an& ?; NO-5: 26 tarikan (e%an&: eni( kea*in aki
aki: BB 300 &r: )B 50 ?*: A;&ar "?re /8 In O6,t?in 10 IU/I' 'anae*en akti7 kaa III
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
13/35
Ca* 1-55 + )a?enta a.ir (;ntan: ke(anen&ka;: e6;ra(i er(i.
Inek(i *eter&in ;i(i;erinera7i
Ca.it %aa* er Ca.it ar *atra(
A + )(t V a/i kaa 2 tak *a )2A1 Tera;i
A*6i?iin 500 *&/8./ra A( 'a7ena*at 500 *&/8./ra "F Ta/ 24./ra
)a(an& >!
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
14/35
22/09/2014 )in%a. ran&an ke )er*ata Hati ntk (er@a(iant-
>6 + )(t V a/i kaa 2 tak *a: )2A1: ri= "! ta.n ,an& a-
Tera;i ant + A*6i?iin 500*&/8a*/ ra A( 'a7ena*at 500 *&/8a*/ra "F ta/ 24 a*/ ra
Ba%%er trainin&
23/09/2014 >6 + )(t V a/i kaa 2 tak *a: )2A1: ri= "! ta.n ,an& a-
Tera;i ra ant U( BL)L
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
15/35
!ini?a Rea(nin&
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
16/35
)'BAHA"AN
>e7ini(i VBA! + )r(e( ;er(ainan ;er@a&ina* (etea.;erna. *eakkan "!-
TOLA! + Tria 7 ar a7ter ?e(arean-
)en%a;at n?e a ?ae(arean: a=a,( a?ae(arean
1988: ;enin&katan 25 ?e(arean %ei@er,rate %ari 5 ta.n 190(-
[email protected]((: %e(;ite t.e kn=n ri(k( #0-5
1 rate 7 terine r;tre$: TOLA! re*ain(an attra?ti@e ;tin 7r *an, ;atient( an%ea%( t a (??e((7 t?*e in a .i&.;r;rtin 7 ?a(e(-
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
17/35
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
18/35
A!OG Gi%eine(
On t.e a(i( 7 e@e A e@i%en?e: t.e 2010 A!OG&i%eine( *ake t.e 7=in& re?**en%atin(+
anita %en&an ri) SC sebelumnya denan insisitransversal SB* .ar( %ita=arkan TOLA!-
'en&&nakan ana(te(i ;er epidural-
Tidak menunakan misoprostol-
On t.e a(i( 7 e@e B e@i%en?e: TOLA! *a, e?n(i%ere% 7r t.e 7=in& ;atient(+
anita %en&an ri) 2' SC denan insisi transversalSB*
anita %en&an ri) 1' SC sebelumnya dapatdipertimbankan untuk persalinan denan !aninemelli-
anita %en&an ri) SC sebelumnya denan insisi tidakdiketa+ui tanpa ada tandatanda ruptur uteri-
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
19/35
A!OG Gi%eine(
Le@e B e@i%en?e =a( a( 7n%7r t.e 7=in&+ -nduksi dalam persalinan kan
*er;akan kntrain%ika(i- I %en&an ri=a,at in(i(itran(@er(a etak ren%a. %en&an ibudan !anin yan tidak berisiko %en&ananin presentasi bokon-
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
20/35
!an%i%ate( 7r TOLA!
I %en&an ri)1' atau 2' SC insisitransversal SB*-
I %en&an1' ri) SC denan tipe insisiyan tidak diketa+ui: ke?ai %en&an a%ake?ri&aan ter.a%a; in(i(i ter(et-
I %en&an ri=a,at in(i(i tran(@er(a"BR%en&an ibu dan !anin yan tidakberisiko %en&an anin presentasi bokon-
.elvis adekuat Tidak ada ri) ruptur atau skar padauterus
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
21/35
)ra(,arat VBA!
)an%an %ari A*eri?an !e&e 7O(tretri?ian( an% G,ne?&i(tta.n 1999 %an 2004 +
VBA! *e*erkan ke.a%iran (eran&%kter a.i kei%anan: (eran& a.iana(te(i: %an (ta7 ,an& *e*;n,aikea.ian %aa* .a ;er(ainan "!e*er&en(i-
Ka*ar ;erati7 %an (ta7 %i(ia&akan:%ara. ,an& tea. %i?r((*at?. %an aat*nitr >CC .ar( ter(e%ia-
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
22/35
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
23/35
Ot?*e( 7 Intere(t
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
24/35
An&ka keer.a(ian VBA!*enrt Fa**Untk *enentkan keer.a(ian ;er(ainan ;er@a&ina* (etea. (ek(i(e(aria #VBA!+Va&ina Birt. A7ter !ae(arean$: %aa* (at ;eneitian(er@a(ina ,an& *eiatkan 5022 ;a(ien: Br?e L- Fa**: '> %anAnn '- Gei&er: ).> *e*atAdmission Scoring System(ea&ai erikt+
/o arakteristik Skor
1 U(ia J40 ta.n 2
2 Ri=a,at ;er(ainan ;er@a&ina +"ee* %an (e(%a. "!)er(ainan ;er@a&ina (e(%a. "!)er(ainan ;er@a&ina (ee* "!Ti%ak a%a
4210
3 Aa(an ain (eain ;art( tak *a ntk "!ter%a.
1
4 )en%ataran %an ;eni;i(an (er@ik( (aat tia%i R" %aa* kea%aan in;art +525 < 5J 25
210
5 >iata(i (er@ik( 4 ?* 1
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
25/35
An&ka keer.a(ian VBA!*enrt Fa**-
)a(ien ini An&kakeer.a(ian
a%aa. 4
Skor %nka keber+asilan3
02 4249
3 590
4 4
5 9
8889
93
810 9599
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
26/35
Selected Clinical "actors %ssociated )it+ Trialo 5abor %ter .revious Cesarean 6elivery Success
-ncreased .robability o Success Stronpredictors3 *i)ayat .artus Spontan Sebelumnya.artus Spontan
6ecreased .robability o Success Ot+erpredictors3 -ndikasi berulan SC #sia ibu
tnis non )+ite #sia estasi 840 minu Obesitas .reeclampsia
Jarak antar ke+amilan yan renda+ Bayi besar 40004900r3
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
27/35
VBA! (??e(( rate ;rir?e(arrean %ei@er,
-ndication o previous SC :B%C success rate
>i(;r;r(i ke;aa
;an&&
05
Feta %i(tre(( 93
Bree?. ;re(entatin 89
)a?enta ;re@ia 89
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
28/35
Bene7it(
'en&.in%ari "! eran&
'en&ran&i a*an,a *a(a %i R"
akt ;e*i.an ei. ?e;at-
Interak(i ianak ei. ?e;atterain
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
29/35
Ri(k(
Feta Ri(k La.ir *ati Hi;k(ia I(ke*ia n?e;a;ati Ke*atian ;erinata
'aterna Ri(k Tran(7(i In7ek(i
Hi(terekt*i R;tr teri !.rina*niniti(
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
30/35
A(te Kntrain%ika(iVBA! Feta >i(tre((
Letak Lintan&
)a?enta ;re@ia
I %en&an ri=a,at R;tr Uteri
Ri= in(i(i teri ,an& tera ;anan/10000 ri(k 7 terine r;tre$
36 ata ei. ri= "!-
R,a !e&e 7 OG Greent; Gi%eine
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
31/35
)re%i?tr( 7 teriner;tre
-ncreased *ate o #terine*upture
6ecreased *ate o #terine*upture
Ka(ik .i(terekt*i )er(ainan (;ntan
)er(ainan "! 26 ataei. Ri= ;er(ainan ;er @a&ina(ee*n,a
In%k(i )er(ainan )er(ainan ;reter*
)en&&naan ;r(ta&an%in
Carak antar ke.a*ian
,an& ;en%ek
In7ek(i ;a%a ri= "!(ee*n,a
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
32/35
Reati@e Kntrain%ika(iVBA! Bree?. ;re(entatin 'ti;e &e(tatin
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
33/35
!*;i?atin(
Uterine %e.i(?en?e Uterine r;tre i7et.reatenin&
"i&n( an% (,*;t*( A?te n(et 7eta ra%,?ar%ia #0$
A%*ina ;ain #10$
Va&ina ee%in& #5$
He*%,na*i? in(taiit, #510$
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
34/35
!ini?a ?n(i%eratin
Rek*en%a(i *nitr anineran&-
)er.atikan kr@a ;er(ainan- )er(ia;an ntk "! e*er&en(i ikaa%a tan%a a.a,a-
7/24/2019 Ferina 2 Vaginal Birth After Ceaserean (Vbac)
35/35
T.ank M