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DUTY REPORT

Tuesday, October 3rd 2017


Supervisor:
dr. Roy Yustin Simanjuntak, Sp.OG (K)

Residents:
1. dr. Dahler Sandana Siregar
2. dr. Donny Mega Surya
3. dr. Vivi Yovita
4. dr. Ivan C. Pasaribu
5. dr. Alyuhaz
6. dr. Effinia Kamila Hanum Siregar

Department of Obstetrics and Gynecology


Medical Faculty Universitas Sumatra Utara
Pirngadi General Hospital
2017
Total patient : 1 patient
Mrs. F, 34 y.o, G4P3A0, Javanese Moslem, senior high school, housewife,
married to Mr. H, 38 y.o, Javanese, Moslem, senior high school, employee,
was admitted to Pirngadi General Hospital on October 3rd 2017 at 02.30
am with:

CC : History of seizure
It has been experienced by the patient since today, 6 times a day. High
blood pressure (+). History of high blood pressure before pregnancy (-).
History of high blood pressure on previous pregnancy (+). History of
seizure on previous pregnancy (+). History of headacje (-), history of
blurred vision (-). History of nausea and vomitting (+). History of epigastric
pain (-). History of labor contraction (-), history of bloody show (-). History
of amniotic fluid leakage (-). Micturition and defecation shows no
abnormality. The patient was reffered from Other Hospital with diagnose:
eclampsia
Previous illness : eclampsia
Previous medication : IVFD RL + MgSO4 40% (15 cc) 14dpm
Inj. Diazepam 1 amp/ IM
Last Menstrual Periode : ?/3/2017
Estimated Due Date : ?/12/2017
ANC : 6x midwife

History of pregnancy
1. Male baby, 2100 gr, SVD, midwife, clinic, 7 y.o, healthy
2. Male baby, 2400 gr, SVD, midwife, clinic, 4 months, dead
3. Male baby, 2800 gr, C-section, hospital, obstetrician, 3 y.o, healthy
4. Current pregnancy
Vital Sign
Sensorium : Alert
BP : 200/110 mmHg
Pols : 100 times/min
RR : 24 times/min
Temp : 37C

Localized state
Head : Anemic palpebra Conjuctiva (-), icteric (-)
Neck : Lymph node enlargement (-)
Cor : S1 > S2, additional sound : (-)
Thorax : Respiratory sound : Vesicular
Additional sound : Wheezing(-)/(-), Rales (-)/(-)
Genitalia : No abnormality
Superior Ext : No abnormality
Inferior Ext : Pretibial oedem : (-)/(-)
Obstetric State
Abdomen : asymmetrically enlarge
Fundal Height : 4 fingers above navel
Tension part : right
Lower part : head
Fetal movement : (+)
Labor contraction : (-)
Fetal heart rate : 140 bpm, regular

Vaginal examination
Not performed
TAS
TAS
TAS
Singleton pregnancy, head presentation, alive fetus
BPD : 730 mm
FL : 51 mm
AC : 230 mm
EFW : 1198 gr
AFI : 8,7 cm
Placenta fundal grade II

Conclusion:
IUP (27w6d) + head presentation + alive fetus
Laboratorium findings on October 4th 2017

Hb : 13,1 N : 12-14 gr/dL


Leucocyte : 14.070 N : 4000-11000/uL
Hematocrite : 41,8 N : 36,0-42,0/%
Platelet : 302.000 N : 150.000-400.000/uL
MCV : 76,4 N : 81-99 fL
MCH : 23,9 N : 27-31 pg
MCHC : 31,3 N : 31-37 g/dl
Ad R Glucose : 88 N : < 200 mg/dl
Ureum : 36 N : 15-40 mg/dl
Creatinine : 1,13 N : 0.6-1.1 mg/dl
PT : 15,9 C : 15 seconds
APTT : 39,6 N : 32 seconds
SGOT : 54 N : 0-40 U/L
SGPT : 26 N : 0-40 U/L
Laboratorium findings on October 4th 2017

Natrium : 140 N : 136-155 mmol/L


Kalium : 3,8 N : 3,5-5,5 mmol/L
Chloride : 108 N : 95-103 mmol/L
Ureum : 36 N : 15-40 mg/dl
Creatinine : 1,13 N : 0.6-1.1 mg/dl
LDH : 1.010 N : 240-480 mg/dl
HbsAg : Non reactive N : Non reactive
HIV : Non reactive N : Non Reactive
Proteinuria : (++++) N : Negative
Decision Point
Eclampsia
Diagnosis:
Eclampsia + MG + IUP (26-28) wga + head presentation + alive fetus +
prev C-section 1x

Plan:
- Emergency C-section
- Consult to Anesthesiology Department
- Consult to Perinatology Department

Therapy:
Bolus MgSO4 40% 4 gr ( 10 cc) loading dose
IVFD RL + MgSO4 40% (30 cc) 14 dpm
Nifedipine 4x10 mg
Inj. Ceftriaxon 2gr prophylaxis (skin test)

Report to Supervisor dr. Roy Yustin Simanjuntak, Sp.OG.K Approved


THANK YOU
C-Section report d/t PE with severe feature
A male baby was delivered, BW: 910 g, BL: 35 cm, A/S: 4/6, Anal (+)

Mother was laid on the operating table, with IV line and urine catheter well instilled
Antiseptic and aseptic procedures were performed using povidone iodine and alcohol
solution (70%) on the abdomen, and then draped leaving the surgical field exposed.
Under spinal anesthesia, a pfannenstiel incision was made under prior incision, the
subcuticuler layer was sharply incisied until the fascial layer was exposed. By inserting a
surgical pinset under fascial layer and ensuring no attached muscles underneth, the fascial
layer was sharply dissected to the right and left. The muscular layer was separated exposing
the peritoneal layer.
The peritoneal layer was clamped in two places, and after confirming no intra abdominal
organs underneath, was cut in betwen and widened by sharply dissection downwards and
uppwards.
A gravid uterus was seen, the round ligaments were identified, followed by the lower
uterine segment. After separating the vesicouterine fold, a concave incision was made on
the lower uterine segment. The incison was bluntly penetrated and widend. The left
temporal of the fetus was identified by luxating the head, a female baby was delivered, BW:
910 g, BL: 35 cm, A/S: 4/6, Anal (+)
Umbilical cord was clamped in two places and cut in between. The placenta was delivered
by controlled umbilical cord traction.
The uterine cavity was cleaned.
The uterus was sutured by continuous suture using vicryl no I RB (double layer). On
Evaluating the suture no active bleeding was present.
Peritoneal, muscular, fascial, subcuticular and cuticular layers were sutured layer by layer.
Patient operative condition was stable.
Therapy :
- IVFD RL+ Oxytocin 10-10-5-5 IU 20 dpm
- IVFD RL + MgSO4 40% (30 cc) 14 dpm until 24
hours
- Ceftriaxone inj 1 gr/12 hours/iv
- Ketorolac inj 30 mg/8 hours/iv
- Ranitidine 50 mg/12 hours/iv

Observation :
- Vital sign, Uterine contraction, Fundal height, UOP,
Vaginal bleeding
- Check complete blood count 2 hours after C-section
THANK YOU