MORNING REPORT November 13th 2012

RESIDENT IN CHARGE : Bom/Lum/Rut/Hay/Tir/Ron/Dan CHIEF : dr. Ton

SUPERVISOR : dr. Bambang Rahardjo, SpOG dr. Sutrisno, SpOG-K dr. Samodra Soeparman, SpOG

EMERGENCY ROOM : 3 DELIVERY ROOM Physiological Delivery : 3 Pathological Delivery

Perabdominam : 1

IDENTITY
Register : 1232787 Mrs. F / 43 y.o./ 6 y.o.e / housewife Mr. K / 42 y.o./ 6 y.o.e / farmer Married 1x, 25 years Address : Ds. Wringin Anom Rt.28 Rw.06 Poncokusumo Admission : November 13th, 2012 at 09.30 pm

SUBJECTIVE
Patient was referred by the name of a general practitioner PHC Tumpang with G3P2002 GA 36-37 weeks with suspect transverse lie + severe preeclampsia

13-11-2012 At 05.00 am patient felt uterine contraction still stayed at home At 03.00 pm patient felt uterine contractions more frequent went to Tumpang PHC, examined with BP=180/... + suspect transverse lie patient was suggested referred to RSSA patient and family still discussed At 05.00 pm patient felt fluid excess from birth canal still looking for vehicle At 08.00 pm went to RSSA

SUBJECTIVE

History of hypertension before pregnant (+) since 3 years ago, patient never took any medication History of nause (-), vomitting (-), epigastric pain (-), blurred vision (-), headache (-)

Patient never knew before that her pregnancy was in transverse lie.

SUBJECTIVE
History of previous delivery:
1. At/3300/SptB/Midwife/M/24 y.o/L 2. At/2800/SptB/Midwife/F/18 y.o/L 3. This pregnancy
ANC : midwife 2x, last control October 13th 2012 LMP 23-2-2012 ~ 37-38 weeks Contraception: injection every 3 month, stop 1 year ago

OBJECTIVE
GA : Good, CM BH : 160 cm BW : 67 kg BP : 170/100 HR : 88 x/m RR : 20 x/m Tax : 36,5 C , Trec : 36,7 C H/N: an -/- ict -/Th : c/ S1S2 single, murmur(-) p/ rh / wh / Abd: FH 27 cm, 102 cm, transverse lie, FHR : 130 x/m (doppler), EFW: 2754 gr, Uterine contraction 10.3.30/ms

OBJECTIVE

VT (after SM inj)
4 cm, eff 100 %, HI, amniotic membrane (-) clear Presentation small part of the baby Denominator difficult to evaluated Pelvic measurement : wnl

USG
Fetus intrauterine single life, transverse lie right head dorso superior BPD : 92,7 (37w 5d) AC : 296 (33w 4d) FL : 73.2 (37w 3d) EFW : 2732 gram AFI : 7,2 Placenta implanted at cornual fundal dextra, maturation gr III

CTG
Normal
Baseline rate Variability Acc. Dec. : 130 bpm : 5-15 bpm : (+) : (-)

LABORATORY
CBC RBS Alb LDH SGOT/SGPT Ur/Cr Na/K/Cl PPT APTT Urinalysis : 14.420/ 13,8/ 39,4/ 274.000 : 73 : 3,52 : 586 : 20/20 : 16/0,55 : 135/4,13/114 : 9,6 (10,9) : 27,4 (26,2) : protein trace

ASSESSMENT
G3 P2002 Ab000 part 37-38 weeks S/L
+ First stage active phase + Transverse lie right head dorso superior + Chronic hypertension SIPE + Secondary old prime + Age > 35 y.o

PLANNING
PDx: consult cardio and ophtalmology departement PTx: Proposed to terminate by cesarean section cito + Tubectomy Pomeroy Inj SM Full dose, SM 20% bolus iv slowly, SM 40% 10 gram im right-left buttock continued with SM 40% 5 gram drip in RD5% every 6 hours if contraindication (-) Preparation for operation: Prepare blood/ c. Anestesi/ register OR IVFD RL 1000 cc Inj ampicillin 1 gram iv (skin test) Inj metoclopramid 1 amp Inj ranitidine 1 amp Tocolitic : kaltrofen supp II perrectal Informed consent PMo: VS, complain, uterine contraction, FHR, urine production, patellar reflex, fluid balance/ 6 hours, sign of impending eclampsia CIE c/ SPV ________________________ Acc dr. BAR, SpOG

OUTCOME

On November 14th, 2012 at 01.15 am Female baby born BW 2690 gr/ 46 cm / AS 7-9

TERIMA KASIH

IDENTITY

Register : 11074766 Mrs. W / 22 y.o./ 9 y.o.e / housewife Mr. A / 22 y.o./ 9 y.o.e / factory labour Married 1x, 5 bulan Address : Ds. Pakis Kembar RT 1 / 2 Pakis Malang Admission : November 2nd, 2012 at 04.00 am

SUBJECTIVE
Patient was referred by a midwife with G1P0Ab0 GA 24-28 wks susp premature fluxus active
1-11-2012 At 11.00 pm patient felt uterine contraction still stayed at home 2-11-2012 At 01.00 am patient felt uterine contraction more frequent accompanied with blood excess from birth canal 3 female napkins went to midwife reffered to Saiful Anwar Hospital History of trauma (-), massage (-), coitus (+)

SUBJECTIVE
History of previous delivery:
1. This pregnancy
ANC : midwife 2x

LMP 9-5-2012 ~ 26-28 weeks

Contraception: (-)

OBJECTIVE
GA : good, CM BP : 100/70 HR : 100 x/m RR : 20 x/m Tax: 36,0 C , Trec : 36,1 C H/N: an -/- ict -/Th : c/ S1S2 single, murmur(-) p/ rh / wh / Abd : FH 19 cm, longitudinal bujur U , EFW : 930 gr, FHR : 160 x/m (doppler), uterine contraction (+) rarely

OBJECTIVE
GE : flux (-), fluor (-)
Insp: Fluxus (+), clot (+) Fluxus coming out from OUE OUE opened 2 cm, tissue (+) Laseration (-), varises (-)
VT : didnt performed

USG
Fetus intrauterine single life, longitudinal lie head below BPD : 64,5 (26w1d) AC : 202 (24w2d) FL : 44.7 (24w5d) EFW : 802 gram AFI : 2,1 Placenta implanted at corpus anterior spreading covering OUI, maturation gr I

Lab Result
CBC PPT APTT : 20.470/10,4/29,3/249.000 : 10,3 (11,0) : 27,7 (25,4)

ASSESSMENT
G1 P0000 Ab000 gr 26-28 weeks S/L + Mid trimester bleeding + Fluxus active

PLANNING
PDx: PTx: Pro termination with hysterotomi cito Preparation for operation: Prepare blood/ c. Anestesi/ register OR IVFD double line Insert DC Inj Gentamycin 80 mg iv Inj metoclopramid 1 amp Inj ranitidine 1 amp Tocolitic : Kaltrofen supp II per rectal Informed consent PMo: VS, complain, uterine contraction, FHR, flux CIE c/ SPV Acc dr. BAR, SpOG

OUTCOME

On November 2, 2012 at 05.35 am male baby born BW gr/ cm /

Terimakasih