Duty Report

August 11-17, 2014

Consultants :
dr. St. Finekri Abidin, OBGYN (C)
dr. Bintari Puspasari, OBGYN
dr. T. Indang Dewi, OBGYN (C)

RSGS Team August 2014

Reporting
4 Caesarean sections

CAESAREAN SECTION #1

Day
11/8/1
4
DAY I
22.15

S
SCTPP

G5P2A2
Term
Mrs. Ella Sofhia, 41 yo
Pregnancy,
MR. 129632
singleton
live fetus,
CC: Referred from RS Bersalin
previous CPasutri with suspected severe
section 1x,
preeclampsia.
superimpos
ed
Patient admitted 9 month
preeclamps
pregnancy. Her LMP 4/12/13
Obstetrical Status: FH 36 ia, susp
(unsured) EDD 11/9/14~ 35-36 wga. cm, head presentation, head macrosomi
ANC regularly at OBGYN (Bogor).
4/5, FHR 152
a, not in
USG at every visit, baby in good
I: V/U wnl
labor
condition.
Io: smooth portio, closed
Contraction (-), water broke (-),
ostium, flr (-), flx (-).
bloody show (-)
Vt: portio firm, posterior, t
3cm, closed, H I
Blood pressure elevated since 2
months (140/90 mmHg), not given
CTG: Category 1
drugs.
Lab:
Frontal headache (-), nausea /
CBC (11/8/14)
vomiting (-), blurred vision (-)
9.9/31/9200/182000
Active fetal movement
SGOT 35 SGPT 20 Alb 3.6
Ur 19 Cr 0.6 RBG 115
Menarche 12 yo, reguler, GP 3x/day, Na 138 K 3.6 Cl 108
dysmenorrhea (-)
Ul protein +2
Married 1x
Obs history: G5P2A2
1.1999, boy 3800 g, spontaneous
delivery at RSPAD
2.2007, miscarriage, curettage at
RS Bogor

Physical examination
Compos mentis, BP :
170/100 mmHg, P: 86x/m,
FR 20x/m, T : 36OC
BB: 90 kg, TB 169 cm: BMI
31.5 kg/m2
Gen. state:
Pale conjungtive -/-,
abd ~ pregnancy

US exam (7/7/14)
Singleton live head
presentation, placenta
implanted at fundus, normal
implantation
BPD 9,4/HC 36 / AC 37/ FL

P
P:
Observe
hemodynamics,
contractions,
FHR
Observe
worsening of
preeclampsia
Emergency CS
MgSO4
Nifedipine 4 x
10 mg
NAC 3 x 600 mg
PO
Vit C 2 x 400 mg
IV
02.00 03.00
LUS free of
adhesion
Born baby boy,
4050 gr, 54 cm
AS 8/9
Clear amniotic
fluid
Placenta born
completely
FP : Tubectomy
Pomeroy
Hb Post op:
9.8 g/dl

CAESAREAN SECTION #2

Day
11/8/1
4
DAY I
14.00

S
SCTPP
Mrs. Dwi Novianti, 33 yo
MR. 242324
CC: irreguler contraction since 5
hours before admission
Patient admitted 9 months
pregnancy. Her LMP 12/11/13
(unsure) EDD 19/8/14~ 39 wga.
ANC regularly at KesDip
Tangerang then referred to
RSGS. USG 4x, baby in good
condition.
Contraction (-), water broke (-),
active fetal movement
Blood pressure elevated since
previous pregnancy. In RSGS
policlinic patient got Methyldopa
3x500 mg and was already
consulted to internal medicine
dept, already plan for elective csection at 18/8/2014
Frontal headache (-), nausea /
vomiting (-), blurred vision (-)
Menarche 12 yo, reguler, GP
3x/day, dysmenorrhea (-)
Married 1x
Obs history: G2P1

Physical examination
Compos mentis, BP :
160/110 mmHg, P: 84x/m,
FR 18x/m, T : 36OC
Gen. state:
Pale conjungtive -/-,
abd ~ pregnancy

G2P1 38
wga,
singleton
live fetus,
severe
preeclampsi
a, previous
CS 1x

P:
Observe
hemodynamics,
contractions, FHR
Observe worsening
of preeclampsia

Obstetrical Status : FH
30 cm, head presentation,
head 4/5, FHR 146
I: V/U wnl
Io: smooth portio, closed
ostium, flr (-), flx (-).
Vt: portio firm, posterior, t
3cm, closed, H I
CTG: Category 1
Lab:
CBC (11/8/14)
10.7/32/14000/395000
SGOT 16 SGPT 19 Alb 3.9
Ur 19 Cr 0.6 RBG 83
Na 140 K 3.9 Cl 106
Ul protein +2
US exam (7/7/14)
Singleton live head
presentation, placenta
implanted at right corpus,
normal implantation
BPD 8.8/HC 314/ AC 330/ FL
76/ AFI 3.5 SP / EFW 3000

Emergency CS
MgSO4
Nifedipine 4 x 10
mg
NAC 3 x 600 mg PO
Vit C 2 x 400 mg IV
12/8/14
14.30 15.30
Anterior part of
uterus was adhered
to omentum
Adhesiolysis
Born baby girl,
2780 gr, 49 cm AS
8/9
Clear amniotic fluid
Placenta born
completely
FP: IUD TC
Hb Post op: 11.8
g/dl
Outcome:
Now patient (BP
130/90 mmHg) and

CAESAREAN SECTION #3

Day
13/8/1
4
DAY I
15.00

S
SCTPP
Mrs. Arum A, 31 yo
MR. 419713
CC: irreguler contractions and
bloody show since 1 day before
admission
Patient admitted 9 months
pregnancy. Her LMP 10/11/13
EDD 17/8/14~ 39 wga. ANC
regularly at RSGS. USG 3x, baby
in good condition. Planned for
elective CS on 19/8/2014 due to
HbsAg(+)
Water broke (-), active fetal
movement
Menarche 13 yo, reguler, GP 23x/day, dysmenorrhea (-)
Married 1x
Obs history: G3P1A1
1.2008, miscarriage
2.2011, girl 2600 g,
spontaneous delivery at RSAL.
3.This pregnancy

O
Physical examination
Compos mentis, BP :
100/70 mmHg, P: 92x/m,
FR 18x/m, T : 36OC
Gen. state:
Pale conjungtive -/-,
abd ~ pregnancy
Obstetrical Status : FH
32 cm, head presentation,
head 4/5, FHR 146, his 1-2
x/10/40
I: V/U wnl
Io: smooth portio, closed
ostium, flr (-), flx (+).
Vt: portio firm, axial, t 2
cm, 2 cm dilatation, head H
I-II
CTG: Category 1
Lab:
CBC (7/8/14)
10.6/31/11830/221000
SGOT 20 SGPT 19
Ur 14 Cr 0.6 RBG 79
Ul wnl
US exam (7/7/14)
Singleton live head
presentation, placenta
implanted at leftcorpus,
normal implantation
BPD 90/HC 311/ AC 344/ FL
71/ AFI 12 / EFW 3159

A
Latent
phase of
labor in
G3P1A1 38
wga,
singleton
live fetus,
HbsAg
reactive

P
P:
Observe
hemodynamics,
contractions, FHR
Emergency CS
Consult to
perinatology for
HepB Ig
12/8/14
20.00 21.00
Born baby boy,
3100 gr, 50 cm AS
8/9
Clear amniotic fluid
Placenta born
completely
Hb Post op: 10.4
g/dl
Outcome:
Now patient and
baby are in good
condition, already
discharged

CAESAREAN SECTION #4

Day
13/8/1
4
DAY I
20.30

S
SCTPP

Physical examination
Compos mentis, BP :
Mrs. Grace A, 26 yo
110/50 mmHg, P: 90x/m,
MR. 440720
FR 18x/m, T : 36.5OC
Gen. state:
CC: Referred from Tebet PHC due Pale conjungtive -/-,
to prolonged active phase of
abd ~ pregnancy
labor
Obstetrical Status : FH
Patient admitted 9 months
33 cm, head presentation,
pregnancy. Her LMP 29/10/13
head 2/5, FHR 156, his 1EDD 5/8/14~ 41 wga. ANC
2x/10/45
regularly at PHC.
I: V/U wnl
Contraction (+) since 10 hours,
Vt: portio thin, 7 cm
water broke (+) 18 hours. Active dilatation, head H II-III,
fetal movement
small fontanel lefttransverse
Patient was given oxytocin drip
24 drip/minute for 12 hours at
CTG: Category 1
PHC. Dilatation 4 cm 6 cm
Lab:
CBC (13/8/14)
7 cm 7 cm (every 4 hours)
12.6/36/24000/226000
SGOT 3 SGPT 20
Menarche 12 yo, reguler, GP
Ur 15 Cr 0.6 RBG 108
3x/day, dysmenorrhea (-)
Ul protein wnl
Married 1x
US exam (7/7/14)
Obs history: G1
Singleton live head
1.This pregnancy
presentation, placenta
implanted at anterior
corpus, normal
implantation
BPD 91/HC 314/ AC 310/ FL
79/ AFI 4.1 / EFW 3100

A
Inertia of
active
phase of
labor in G1
40-41 wga,
singleton
live fetus

P
P:
Observe
hemodynamics,
contractions, FHR
Observe signs of
intrauterine
infection and cord
compression
Initial plan: vaginal
delivery
Acceleration with
Oxytocin 5 IU/500
cc RL, start at 8
tpm, escalated 4
tpm/30 mins until
adequate
contractions or max
40 tpm.
Ceftriaxone 1 x 2 g
IV

Day
13/8/1
4
DAY I
21.00
13/8/1
4
DAY I
22.00
13/8/1
4
DAY I
24.00

Oxytocin drip is administered (8

tpm)

Frequent contractions, active

fetal movement

Frequent contractions, active

fetal movement

Frequent contractions, active

fetal movement
14/8/1
4
02.00

His 3-4 x /10 / 45

FHR 142 dpm

Physical
examination
Compos mentis, BP :
110/70 mmHg, P:
86x/m, FR 18x/m, T :
36.5OC
Gen. state: wnl
Obstetrical
Status : FHR 150,
his 4x/10/45
I: V/U wnl
Vt: complete cm
dilatation, head H III,
small fontanel lefttransverse
Physical
examination
Compos mentis, BP :
120/80 mmHg, P:
90x/m, FR 18x/m, T :
36.5OC
Gen. state: wnl
Obstetrical
Status : FHR 150,

Adequate
contractions on
active phase of
labor in G1 40-41
wga, singleton live
fetus
Second stage of
labor in G1 40-41
wga, singleton live
fetus

Sustain oxytocin
drip, evaluate after
3 hours

Observe
hemodynamics,
contractions, FHR
Management of
second stage

Emergency CS
Distosia of second
stage of labor in G1
40-41 wga,
singleton live fetus

03:00
Born baby girl,
3150 gr, 50 cm AS
8/9
Nil amniotic fluid
Placenta born
completely
Now patient and

THANK YOU