Umbilical Cord

Morbidity and mortality of infants at birth with umbilical cord menumbung still quite high. Perinatal mortality rate ranges from approximately 0.3-0.6%.
The incidence of labor with umbilical cord menumbung can occur at birth with latitude location, presentation buttocks legs, premature babies, and the presentation of the head. In addition to labor with head presentation, talipusat menumbung terjadikarena PAP not terisipenuh by the fetus. In labor with head presentation accompanied with talipusat menumbung, fetal death rate will increase along with the occurrence of fetal asfiksi.

With the increased morbidity and mortality in infants with birth accompanied menumbung umbilical cord, then attempted some effort to avoid the occurrence of labor with umbilical cord menumbung, one of them is by trendelenberg position.


Goal
The purpose of the handling of labor with umbilical cord menumbung among others:
1. Provide first aid in birthing mother by the umbilical cord menumbung.
2. Decrease the mortality rate in the fetus.
3. Saves fetus from asfiksi threat.

Definition
According to Prof. Dr. Roestam Mochtar, MPH, 1998. Menumbung umbilical cord is palpable when out and usually have ruptured membranes.
Menumbung umbilical cord is a condition in which the umbilical cord was in front or beside the bottom of the fetus, or the umbilical cord has been in the birth canal before the baby and the situation gets worse when the umbilical cord depressed.

Classification Menumbung Cord
Menumbung umbilical cord, fetal membrane rupture. The umbilical cord occupies one of the 3 position, namely:
1. Menumbung cord in PAP, located next to the bottom of the fetus in PAP

2. Menumbung umbilical cord into her vagina, down into the vagina

3. Menumbung cord through and out of the vaginal introitus


Etiology
1. Fetal etiology
a. Abnormal Presentation
Most of the umbilical cord presentation menumbung occur in the head but
could also be because the location of latitude and the location of the breech / posterior presentation,
especially the posterior leg.
b. Prematurity
Frequent abnormal position on premature births, one of whom
due to small babies who are not resistant to trauma and anoksia.
c. Multiple pregnancy
These factors include disorders that affect the adaptation, the frequency
larger abnormal presentation, high incidence hydramnion
rupture second child.
d. Hydramnion
When the membranes rupture, a large amount of fluid flowing out and the umbilical cord
drifting downward.

2. Etiology of Maternal
a. Pelvic disproportion head
Disproportion between the pelvis and the baby's head can not cause the fall and
rupture of the membranes can be followed menumbung umbilical cord.
b. Lower part of the high
Delays decreased head for a while to happen though pelvis
normal, especially in multiparous.

3. The etiology of umbilical cord and placenta
a. Long umbilical cord
The longer the cord the more easily menumbung
b. The placenta lies low
If the placenta near the cervix so it will block the decrease in the
lowest. In addition, insertion of the umbilical cord closer to the cervix.


Diagnosis
Diagnosis of umbilical cord menumbung made in 2 ways:
1. Seeing the umbilical cord outside of the vulva
2. Touching the umbilical cord on vaginal examination (check in)

Vaginal examination should be performed:
a. In the event of fetal distress which is not known why and trauma if the
bottom has not dropped.
b. When the membranes rupture with the lowest part is still high.
c. When all the cases at the time of membrane rupture malpresentasi
d. When clearly premature baby
e. In cases of twins

Prognosis
Menumbung cord does not endanger the mother and not complicate the delivery, but threatening to the fetus. Hope for the baby depends on the degree and duration of cord compression and the interval between diagnosis and the birth of a baby.

Factors that influence the fate of the fetus:
1. The better the state of the fetus at the time the diagnosis is made, the greater the expectation
his life. Loud pulsating umbilical cord reduce both symptoms and
otherwise weak pulsating umbilical cord is not good.
2. The sooner the baby is born after the umbilical cord drops down, the better
results. The decline more than 30 minutes enlarge fetal death 4 x.
3. The fetus of the older age pregnancy is also a greater ability to survive
of traumatic processes.
4. More and less trauma to the baby's birth, the better the prognosis for mother and
children.
5. Opening the cervix may be the most important factor. If the opening is
complete at the time the diagnosis is made it will be many babies that can
saved. The smaller the opening of the bad prognosis. Exceptions
for this is if it can be done caesarea section immediately, in terms of
where the prognosis as good or better at the opening of the cervix that are still
small.
6. Fetal death increased with increasing length of the interval between the outbreak of
membranes and the birth of a baby.

Handling
The umbilical cord is left and labor menumbung forwarded the following circumstances:
1. When the fetus is dead
2. When the fetus is known abnormal
3. When the fetus is still very premature, so there is no hope to be able to live

Efforts to reduce cord compression and improve fetal condition is as follows:
1. Helper inserting one hand into the vagina and push the lowest to
top away from the umbilical cord. At the same time made preparations for
help delivery.
2. The patient is placed in a knee-chest position (knee CHOST) or Trendelenburg with
above your hips and head downstairs.
3. Given oxygen by mask to the mother
4. Fetal heart rate frequently checked
5. Vaginal examination to determine the presentation, the opening of the cervix,
decrease in the lowest and the state of the umbilical cord.

If the opening is complete:
1. Presentation of the head, head low in the pelvis: extraction with forceps
2. Presentation of the head, head height: Version extraction in this way contain hazards
occurrence of uterine rupture but because this is a business in a state
desperate to save the child then the risk must be taken
3. Presentation buttocks. Second leg is lowered and the baby was born as a presentation
ass feet as quickly as possible.
4. The location of latitude. Version in a presentation leg and immediately performed
extraction.

If the opening is not complete:
1. Sectio Caesaria, is the choice for a baby just month and in a state
good. The fate of infants in Caesaria section much better than the birth
other way. The danger to the mother is also very less compared to having a baby
forced the opening of the incomplete. While the preparation done
held operating businesses to reduce the compression of the umbilical cord as
mentioned above.
2. Reposition the cord to start if not feasible caesarea section.
The umbilical cord under upward into the uterus, while the lowest in the fetus
push down into the pelvis and then the resistance is sometimes repositioning the umbilical cord
successful but generally we lose much valuable time to time
do.
3. If these efforts do not succeed, keep the patient in the Trendelenburg position
in the hope that the umbilical cord was not pressured, so the baby can still live up to
opening to be wide enough to allow the birth of a baby.
4. Manual cervical dilatation, cervical incision and other ways to
impose the cervical opening will never be accepted. Little success has
whereas the risk for major capital.

KB Calendar

Definition
Periodic Abstinence or better known as the Calendar System is a way / simple contraceptive method that can be done alone by the couple by not doing sexual intercourse during fertile. This method is effective if done properly and correctly. With the use of calendar systems each pair is possible to plan every pregnancy.

Benefits

As Contraception
a. Can be used to avoid or achieve pregnancy.
b. There are no health risks associated with contraception.
c. There are no side effects.
d. Low or no cost.

As Nonkontrasepsi
a. Increasing the involvement of husbands in family planning.
b. Adding knowledge about the reproductive system in the husband and wife.
c. Allows strengthen relationships / relationship nelalui enhancing communication between husband and wife or partner.

Weaknesses and Advantages KBA Calendar System
1. Weakness
a. The length of each woman's menstrual cycle is not the same.
b. Only a few women who have regular menstrual cycles
c. Ovulation does not always occur on day 14.
d. Determination of infertility based on the ability of live sperm cells in the female reproductive tract is 5 days.
e. Bleeding that sometimes comes along with ovulation can be interpreted as menstruation. As a result, the calculation of infertility before ovulation and infertility after ovulation becomes inaccurate.
f. Determination of infertility is not based on the menstrual cycle itself.
g. Lack of understanding of the relationship between ovulation.
h. The notion that the first day of the menstrual cycle is calculated from the end of menstrual bleeding so all the calculations determining the fertile period did not automatically become wrong.
i. Husband and wife can not have sex at all times when not wanted the pregnancy. Though there is no biological necessity of time constraints. My wife actually libido increases during the fertile period. For that family planning calendar system should be combined with contraceptive use condoms. At the time of the fertile time of husband and wife can still make the marital relationship but by using condoms.

Excess
a. In terms of Economics: KB calendar done naturally and without any cost so it does not need to pay for the purchase of contraceptives.
b. In terms of Health: This calendar system is obviously far more healthy because it can avoid the harmful side effects as well as using other contraceptive devices (especially in the form of the drug).
c. From the psychological aspect: the system of this calendar does not reduce the enjoyment of the relationship itself, such as when wearing a condom for example. Although, of course, on the other side of the pair of self-control required for strict abstinence during the fertile period.



How To Calculate The Fertile with KBA Calendar System
Before using this method, of course, married couples must know the fertile period. Cycles in each woman's fertile period is not the same. For that we need the observation of at least 6 times of the menstrual cycle. Here's how to find and calculate the fertile period:

When regular menstrual cycles (28 days):
* The first day of the menstrual cycle is calculated as the day-to-1
* The fertile is the day of the 12th until the 16th day of the menstrual cycle

example:
A wife got my period started on 2 October. October 2 is counted as day 1. So the 12th day falls on October 13th and 16th day falls on October 17th. So the fertile period is from October 12 until October 17th. On these dates may not be husband and wife have sex with wife (relations agency.) because if the wife violated the possibility of pregnancy is very big.

If an irregular menstrual cycle:
Record number of days in a menstrual cycle for 6 months (6 cycles). The menstrual cycle is calculated from the first day of menstruation at this time until the first day of next menstruation.
Shortest number of days in menstrual cycle minus 6 times 18. This count determines the first day of fertile period. The number of the longest day for 6 menstrual cycles minus 11. This count determines the last day of fertile period.

Formulas:
The first day of the fertile period = Number of days the shortest - 18
The last day of fertile period = Number of days the longest - 11
Example:
A wife got my period with the state: the shortest cycle of 26 days and the longest cycle of 32 days (beginning the first day of menstruation until the next menstruation).
The calculations are: 26-18 = 8 and 32-11 = 21. so the fertile period is to begin day-to-8 to the 21 from the first day of menstruation. At this time bersanggama.setelah spouses should not be allowed to pass from the new.

How To Calculate The Infertile with KBA Calendar System
How to calculate infertility is fairly easy. First of all, for 12 months, long menstrual cycles were recorded. Menstrual cycle is calculated starting from the first day of menstruation until the day before the first day of next menstruation. Of note will be seen whether or not regular menstrual cycles. For those who have irregular menstrual cycles, please note the number of days the shortest period and the number of days the longest period.
Then, after the menstrual cycle record is obtained, stay longer count infertility. Counting time is not fertile before ovulation by subtracting the shortest period with 21. 21 Figures derived from the sum of the egg maturation time (16 days) and the ability of live sperm cells in the uterus (5 days). For example, the shortest period is 28 days, the period is not fertile before ovulation is the first day until the seventh day (28-21). If the shortest period of 25 days, then infertility is the first day to the fourth (25-21).
Calculation of infertility after ovulation did not differ significantly. The difference is only used during menstrual periods and rate reduction. Infertility after ovulation is calculated by subtracting the longest period minus 9. Number 9 is obtained from the reduction in egg maturation shortest time (11 days) with an egg cell survival (20 days). For example, the longest period is 28 days, the period of infertility after ovulation from day 19 to the next menstruation. If the longest period of 30 days, then infertility starting day 21 until the next menstruation.

Women who Can & Should Not Use KBA Calendar System
1. Women who can
a. For contraception
All the female during reproduction, either regular menstrual cycles and irregular, not good because haik and premenopausal breast.
All women with any parity including nulliparous.
Women's skinny or fat
Women who smoke
Women with certain health reasons among others hiertensi medium, varicose veins, disminorea, moderate or severe headache, uterine myomas, endometritis, ovarii cysts, iron deficiency anemia, viral hepatitis, malaria, deep-vein thrombosis or pulmonary embolism.
Couples with religious or philosophical reasons for not menggunkaan other methods
Women who can not use other methods.
Couples who want abstinence intercourse more than a week of each menstrual cycle.
Couples who want and are motivated to observe, record, and assess signs and symptoms of fertility.
b. To conception
Couples who want mancapai pregnancy, intercourse during fertile done to achieve a pregnancy.
2. Women who should not use
Women in terms of age, parity or health problems make pregnancy a high risk of a condition.
Women before getting your period (breastfeeding, immediately after the abortion), except MOB.
Women with irregular menstrual cycles, except MOB
Women whose partners do not cooperate (abstinence) during certain times of the menstrual cycle.
Women who do not like touching daetah genetalianya.

Vasektomi

Pengertian
Vasektomi adalah istilah dalam ilmu bedah yang terbentuk dari dua kata yaitu vas dan ektomi. Vas atau vasa deferensia artinya adalah saluran benih yaitu saluran yang menyalurkan sel benih jantan (spermatozoa) keluar dari buah zakar (testis) yaitu tempat sel benih itu diproduksi menuju kantung mani (vesikulaseminalis) sebagai tempat penampungan sel benih jantan sebelum dipancarkan keluar pada saat puncak sanggama (ejakulasi). Ektomi atau ektomia artinya pemotongan sebagian.
Jadi vasektomi artinya adalah pemotongan sebagian (0.5 cm – 1 cm) saluran benih sehingga terdapat jarak diantara ujung saluran benih bagian sisi testis dan saluran benih bagian sisi lainya yang masih tersisa dan pada masing-masing kedua ujung saluran yang tersisa tersebut dilakukan pengikatan sehingga saluran menjadi buntu/tersumbat.

Efektivitas
Efektifitas : 99% lebih

Cara Kerja
Saluran vas deferens yang berfungsi mengangkut sperma dipotong dan diikat, sehingga aliran sperma dihambat tanpa mempengaruhi jumlah cairan semen. Jumlah sperma hanya 5% dari cairan ejakulasi. Cairan semen diproduksi dalam vesika seminalis dan prostat sehingga tidak akan terganggu oleh vasektomi.

Keuntungan dan Kerugian
1. Keuntungan
a. Tidak akan mengganggu ereksi, potensi seksual, produksi hormon.
b. Perlindungan terhadap terjadinya kehamilan sangat tinggi. Dapat digunakan seumur hidup.
c. Tidak menggangugu kehidupan seksual suami istri.
d. Tidak mengganggu produksi ASI (untuk kontap wanita).
e. Lebih aman (keluhan lebih sedikit)
f. Lebih praktis (hanya memerlukan satu kali tindakan)
g. Lebih efektif (tingkat kegagalannya sangat kecil)
h. Lebih ekonomis (hanya memerlukan biaya untuk sekali tindakan)
i. Tidak ada mortalitas/kematian.
j. Pasien tidak perlu dirawat di rumah sakit.
k. Tidak ada resiko kesehatan.
l. Tidak harus diingat-ingat, tidak harus selalu ada persediaan.
m. Sifatnya permanen.

Kerugian
a. Memerlukan operasi bedah
b. Prosedur ini hanya untuk pasangan yang sudah memutuskan untuk tidak akan punya anak lagi.
c. Harus dengan tindakan pembedahan.
d. Harus memakai kontrasepsi lain (kondom) selama beberapa hari atau minggu sampai sel mani menjadi negatif.
e. Tidak dapat dilakukan dengan orang yang masih ingin mempunyai anak lagi

Kegagalan
Walaupun vaektomi dinilai paling efektif untuk mengontrol kesuburan pria, namun masih mungkin dijumpai suatu kegagalan.
Vasektomi dikatakan gagal bila :
a. Terjadi rekanalisasi spontan
b. Istri (pasangan) hamil
c. Pada analisis sperma setelah 3 bulan pasca vasektomi atau setelah 15 – 20 kali ejakulasi masih dijumpai spermatozoa.
d. Dijumpai spermatozoa setelah sebelumnya azoosperma.
e. Gagal mengenal dan memotong saluran vas deferens
f. Adanya anomali anatomi, mis ; ada 2 saluran vas deferens di kiri atau di kanan
a. Hubungan badan di lakukan sebelum kantong seminal benar- benar kosong

Efek Samping & Komplikasi
1. Efek Samping
a. Timbul rasa nyeri.
b. Abses pada bekas luka.
c. Hematoma
Biasanya terjadi bila daerah skrotum diberi beban yang berlebihan, missal naik sepeda, duduk terlalu lama dalam kendaraan dalam jalanan yang rusak dan sebagainya.

Komplikasi
a. Pendarahan
b. Peradangan bila sterilisasi/ alat proses kurang


Indikasi & Kontraindikasi
1. Indikasi
a. Menunda kehamilan
b. Pria yang ingin mengakhiri kesuburan
c. Pria yang ingin membatasi kehamilan
d. Setiap pria, suami dari suatu pasangan usia subur yang telah memiliki jumlah anak cukup dan tidak ingin menambah anak.

2. Kontraindikasi
a. Peradangan kulit atau jamur pada kemaluan.
b. Peradangan pada alat kelamin pria.
c. Penyakit kencing manis.
d. Kelainan mekanisme pembekuan darah.
e. Infeksi didaerah testis (buah zakar) dan penis
f. Hernia (turun bero)
g. Varikokel (varises pada pembuluh darah balik buah zakar)
h. Buah zakar membesar karena tumor
i. Hidrokel (penumpukan cairan pada kantong zakar)
j. Buah zakar tidak turun (kriptokismus)
k. Penyakit kelainan pembuluh darah


Tempat Pelayanan
Rumah Sakit, Puskesmas, Klinik KB yang mempunyai tenaga terlatih untuk melakukan vasektomi, Dokter, Bidan Swasta.