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Rini Desio Mori

406162037
Tarumanagara University
Phantom Examination - Mentor: dr. Cipta Pramana, SpOG(K)

Woman with G2P1A0, 26 years old, pregnant with 38 gestation weeks.


1 fetus alive intra uterine.
Head presentation, not engaged yet, point of direction is right occiput posterior.
Admitted to hospital with frequently contraction on Tuesday, 24th October 2017, 12.00pm.

Anamnesis:
Contraction begin since 5 hours ago, with the present of mucus, blood, but absent of amniotic
fluid.
Fetal movement is active. She was married once, 3 years ago.
The first day of last menstrual period is 31 January 2017. Estimated birth 7th November
2017. Her menarche began at 12 years old, regular cycle every 28 days, 7 days long, with
mild dismenorrhea. Her first child is a 2 years old boy, gave birth in midwife, spontaneus,
2100 gr, preterm, and now the child is healthy.
During this pregnancy, she checked her pregnancy 4 times in midwife, and the result is good,
had TT immunization twice. She never used contraception, no history of allergies, had history
of appedicitis operation when she was 5 years old.
Generalist status is normal, general condition is good, compos mentis, blood pressure 120/80
mmHg, pulse 80 t/m, RR 20x/m, T: 37c.
Obstetrics examination:
Leopold I: round, soft, not bouncy buttock
Leopold II: the fetal back feels on the motherss right
Leopold III: round, hard, bouncy head
Leopold IV: the fetal head feels convergen
Fundus uterine is 31 cm, fetal heart rate 144 t/m
Vaginal touche: 4cm dilation, 30% effacement, fetal membran (+), head in Hodge I,
point of direction is right occiput posterior, his 3 times/10/35.
Diagnose (D): G2P1A0, 26 years old, pregnant with 38 gestation weeks. 1 fetus alive intra
uterine, head presentation, not engaged yet. First stage labour, bad obstetric history.
Action (A): VT to completed the initial data.
Result (R): 4 cm dilation, 35% effacement, fetal membran (+), head in Hodge I, point of
direction is right occiput posterior. Result from pelvic examination:
Promontorium is not palpable.
Linea innominata palpable <1/3 circle
Pelvic wall symmetrical.
Spina ischiadika not protruding.
Arcus pubis >90o
Arch of the sacrum is enough.
Mobility of coccygeus is enough.
Osborn test positive <3 cm.
D: Idem, first stage labour, bad obstetric history, mild CPD.
A: Wait for 1 hour 45 minutes until 13.45 with 10 supervision.
R: At 13.45, baby is not born.

D: Idem.
A: VT to know the progress of labor.
R: 7cm dilation, 75% effacement, fetal membran (+), head in Hodge II, point of direction is
right occiput posterior.

D: Idem.
A: Wait for 45 minutes until 14.30 (Friedmans curve: 1 hour) with 10 supervision
R: At 14.30, baby is not born.

D: Idem.
A: VT to know the progress of labor.
R: 7cm dilation, 75% effacement, head in Hodge II-III, point of direction is right occiput
posterior.

D: Idem, obstructed first stage labor.


A: End the labor with abdominal delivery sectio cesarean.