No.

MR 00 03 87 86

MEDICAL FACULTY OF CHRISTIAN UNIVERSITY OF

INDONESIA GENERAL HOSPITAL
DEPARTMENT OF OBSTETRY AND GINECOLOGY
JL. Mayjen Sutoyo No. 2 Cawang, Jakarta Timur 13630
Telp.8099217 ext. 108 / 205

SURGERY REPORT
Name : Mrs. Romauli Siregar Sex : Female Age : 43 Years
Operator Prof. Dr. H.I.O Marsis, SpOG Anesthetic dr. Veronica Sp.An
Asisten Michael Mettafortuna Instrumentator Zr. Marintan
Observer Nurcahyo Tri Utomo Observer 2 -
Pre-surgical Diagnose : Missed Abortion

Post-surgical Diagnose : Post dilatation and curettage e.c. Missed Surgery Date : March 14th 2016
Abortion Duration time of surgery : 10 minute
Tehnique of operation : Type of surgery
1. Dilatation □ Emergency □ Minor
2. Suction curettage □ Poliklinik  Medium
3.  Elektif □ Mayor

Operation Procedures:
1. Patient slept supine on operation table with lithotomy position with general anaesthetic.
2. Aseptic and antiseptic at external genital region and around. Applied steril doek at both of legs
and operation field area.
3. Applied sims speculum at posterior and anterior vagina. Anterior portio clamped with kohel
tang at 12 hour direction.
4. Put off anterior sims speculum.
5. Sondasion uterus and uterine cavity obtained 9 cm, anteflexi uterus
6. Started with the Hegar dilator No. 6, the dilator was inserted into the cervix, to the dilator lip.
Proceed to the Hegar dilator No. 7, until the cervix is at least as open as the loop of the largest
curette.
7. Suction canul No.8 was put into the uterine, suction sistematically as the direction of the clock
then curretage tang no.8 was put into the uterine, curretage sistematically as the direction of the
clock.
8. Give methergin 0.2 mg IM to the patient
9. Checked if there any bleeding or not. If not, put off the kogel tang and posterior speculum sims.
10. Bleeding about ± 50cc
11. Cleaned the external genitalia with sterile kassa and betadine.
12. Extraction finished
 The condition of patient post operation:
General condition : Look mild sick
Consciouness : Compos Mentis
Blood pressure : 110/70 mmHg
Pulse rate : 80 x/minute
Respiration : 20 x/minute
Temperature : 36,5 oC

Tissue to Pathology of Anatomy :

□ Yes
No

Operator,

(Prof. dr. H.I.O Marsis, SpOG)