Name Age MR No.

Date

: Silvia netty : 37 years old : 75 25 42 nd : NOvember 2 , 2011

Anamnesis : A 37 years old patient was admitted to the Ward Room of Dr. M. Djamil Central General nd Hospital on November 2 , 2011 at 11.00 am sent by Poliklinic with D/ G3P1A1L1 term pregnancy 37-38 weeks previous CS on indivation contracted pelvic pro elective CS Present Illness History : Feeling of pain from waist to region which referred to the groin was absent. Bloody show from the vagina was absent. Fluid leakage from the vagina was absent. No massive vaginal bleeding. Amenorrhea since 9 months ago. First date of last menstrual period forget Estimation date of delivery cannot be dievaluated Fetal movement was felt since 5 months ago. No complain of nausea, vomitting and vaginal bleeding neither during early pregnancy nor late pregnancy. Prenatal care to Poliklinik Dr.M.Djamil Hospital regularly. Menstruation History : menarche at 13 years old, regular cycle, once in 30 days which last for 5 to 6 days each cycle with the amount of 2-3 times pad change/day without menstrual pain. Previous Illness History : There wasnt previous history of heart, lung, liver, kidney, DM and hypertension. Family Illness History : There wasnt history of hereditary disease, contagious and physicological illness in the family. Marriage history : once in 2000 History of pregnancy/abortion/delivery : 3/1/1 I. 2000, Abortus,curetage,3 months, privat hospital,obstetriciant II. 2002,female,3400gr, term pregnancy, CS on indication of contrated pelvic,Dr. M jamil hospital, alive, the wound heal in 7 days History of family planning : (-) History of immunization : (-) Physical Examination : GA Cons BP PR RR T Body Weight Body Height Mdt CMC 120/70 80 20 af 67 kg 143 cm Eyes : Conjunctiva wasnt anemic, Sclera wasnt icteric Neck : JVP 5-2 cmH2O, tyroid gland no enlargement Chest : H/L normal Abdoment : OR Genitalia : OR Extremity : Edema -/-, Physiological Reflex +/+, Pathological Reflex -/Obstetric Record : Face : Chloasma gravidarum was positive Breast : Both enlarge, areola/nipple hyperpigmentation, colostrum (+) Abdoment : I : Enlarge according to term pregnancy, median line hyperpigmentation, striae gravidarum (+), cicatrix (+) linea mediana previous CS

Pa : L1 : Uterine fundal was palpable 3 finger below xyphoideus cartilage A large nodular mass was palpated L2 : A hard and resistance structure was felt on the right side Numerous small, irregular were felt on the left side L3 : A hard mass was palpable and floating L4 : not doing Uterine Fundal Height : 31 cm Estimated fetal body weight : 2790 gr Uterine contraction : (-) Pe : Tympani Au : Peristaltic sound was normal Fetal Heart Sound :148x/minute Genitalia :I VT V/U normal none Portio was thick 1,5cm, post, moderate Amniotic sac cannot be evaluated Head palpable was floating.

Pelvic Inlet

Pelvic Outlet Impression

: Promontory can be reached Inominate line palpable -3/4 Sacrum bone : concave Pelvic side wall : straight Ischiadic spine : protruded Coccygeus bone : moveable Arc of pubic : < 90 : Inter tuberous distance cannot be passed through by normal adult fist (<10,5 cm) : contracted pelvic primary CS

Diagnose : G2P1A0L1 gravid aterm (37 38 weeks) + previous CS +contracted pelvic primery CS Fetal alive, singleton, intra uterine, head presentation floting Management : Control GA, VS, FHS, Uterine Contraction Check routine blood labor Prepare for blood transfution Informed consent Plan : Elective CS Laboratory : Hb : 10.9 gr% Leucocyte : 7,900/mm Hematocrit : 31,8% 3 Trombocyte : 187,000/mm USG : Fetal alive singleton intrauterine head presentation Fetal movement activity good BPD : 91HL : 63 FL : 74 AC : 326 TBA : 2900 3000gr Implantation of Placenta at rightanterior corpus grade II-III AFI : 8,9 Lower unterin segment : 3 mm Impression : Gravid aterm Fetal alive

CTG : Baseline Variability Akseleration Deseleration Fetal Movement Contracted Impresstion : reactive
th

: 140 dpm : 5-15 dpm : +/positif : -/negatif : +/positif : -/negatif

November, 3 2011 At 10.05am : TPPCS was perfomed At 11.05 am : finished TPPCS At 10.10 am :Afemale baby was born by TPPCS with 2778 gram in weight, 49 cm in height, Apgar score : 8/9. Placenta was born with a little pull on umibilical cord, complete, 1 piece. Size was 17 x 16 x 3 cm, weight 500 gram Umbilical cord was approximately 50 cm in length with paracentral insertion. Bleeding during operation 250 cc D/ P2A1L2 post TPPCS on indication of contracted pelvic primary CS Mother Child were in care management/ : Observe after operation