Case No

Identity
Name : Mrs B
Age : 26 yo
Date of entrance : Oct 17th 2017
Adress : Lintau
MR : 993632
Chief complaint
A female 26 yo come to emergency room M Djamil Hospital on Oct
17th 2017 at 16.30 PM sent from Batusangkar Hospital with Diagnose
G2P1A0L1 34 – 35 weeks of pregnancy + PEB on Regimen MgSO4
Maintenance dose from other hospital + ALO + IUFD
Primary Survey
• Airway : Patent
• Breathing : O2 by nasal canul 4l/mnt
• Circulation :
BP : 160/100
IVFD RL + MgSO4 Maintenance Dose
• GA : Moderate
• Cons : CMC
• BP : 160/100mmHg
• HR : 105 x /minutes
• RR : 30 x/minutes
• BH: 150 cm
• BW: 65 kg
• Before pregnant : 55kg
• BMI: 23,2 kg/m2 (normoweight)
• Upper arm circumference : 24 cm
• Urine : 200 cc  yellow cloudy
• Refleks Patella  +/+
• A/Dispneu ec susp ALO on G2P1A0L1 preterm pregnancy 34-35 weeks in
maintenance dose of MgSO4 regimen from other institution + IUFD
fetal die singelton intra uterine head presentation
• P/
• control GS,VS,FHR,Uterine contraction,fluid balance and patellar reflex
• Informed concern
• Continue maintenance dose of MgSO4 regimen
• Metildopa 500 mg (p.o)
• Complete laboratory examination
• EKG,CTG,USG
• Inj .Dexametason 8 mg (i.v)
• Consult to PEB team , perinatologist , anastesi
• Plan stabilisation
Present Illness History:
• Feeling heavy on breath happend since 5 days ago
and happend continuosly. Patient was taken to
primary healthcare and hospitalize for 2 days, feeling
well and patient repatrieted.
• 2 days then, patient feel the same things, and patient
was taken to Sayang Ibu Hospital, Patient was
hospitalized for 2 days and blood pressure was
obtained 170/100mmHg, patient get MgSO4 regiment
initial and maintenance dose, MetilDopa 500mg and
patient sent to M Djamil hospital.
• Headache (-) epigastrium paint (-) blurred vision (-)
• Pelvic pain referred to the groin was (-)
• Bloody show from the vagina was (-)
• Fluid leakage from the vagina was (-)
• Massive bleeding from the vagina was (-).
• Amenorrhea since ± 8 months ago.
• First date of last menstrual was Forgotten
• Estimation date of delivery was difficult to be
predicted
• Fetal movement was felt since 3 months ago, and the
last movement felt since 12 hours ago.
• No complain of nausea, vomitting, and vaginal
bleeding neither during early pregnancy nor late
pregnancy
• Prenatal care : control to primary center once a
month since 3 month of pregnancy,control to
obstetrician 2 times since 6 month and 7 month, she
never had high blood pressure during her pregnancy.
• Menstruation history: menarche at 12 years old,
irregular cycle, which last for 5 to 7 days each cycle
with the amount of 2-3 times pad change/day
without menstrual pain
Previous Illness History:
• There was no previous history of heart, lung, liver,
kidney, DM, hypertension and allergic

Family Illness History:

• There was no history of hereditary disease,
contagious and psychological illness in the family
 Occupation, Socioeconomics,
Psychiatry, and Habitual History:

• Marriage history: once in 2006

• History of pregnancy/abortion/delivery: 2/0/1
1. 2008,3200 gr,Boy, spontaneus delivery, midwife, Live
2. present
• History of family planning: (-)
• History of immunization: (-)
Physical Examination:
General Record:
GA Cons BP HR RR T URIN Patellar rf
Mdt CMC 160/100 105 28 36,7 ° 400cc +/+ normal

• Eyes :Conjunctiva wasn’t anemic , Sclera icteric was not icteric

• Neck : JVP 5-2 cmH2O, there was no tyroid gland enlargement
• Chest :
Heart :
I : Ictus was not visible
Pa : Ictus was not palpable
Per : Heart limit were normal
Ausk : Heart sound normal, murmur (-)
Lung :
I : symetric left = right
Pa : fremitus left = right
Perk : Sonor
Aus : Wh (-/-) Rh (+/+)

• Extremity : Edema -/-, Patela Reflex +/+, Pathological Reflex -/-

Abdoment :
I : Enlarge accordance with 8 month pregnancy, linea
mediana hyperpigmented, striae gravidarum (+), cicatrix (-)
Pa:
L1 : fundal uterine was palpated midway between
centre and Prosessus xyoideus a large, soft, noduler mass
was palpable
L2 : palpable a large resistance on the right
,palpable small part of fetus on the left
L3 : palpable round mass, hard, not fixated
L4 : didn’t performed
Uterine fundal height : 26 cm
Estimated fetal weight: 2000 gr
Uterine contraction : -
Au: Peristaltic sound was normal,
FHR : -

Genitalia : I: V/U normal, vaginal bleeding (-)

• Internist consult result :
• G2P1A0L1 34-35 weeks of pregnancy in MgSO4 regiment
maintenance dose + IUFD
• AKI Riffle F ec prerenal + low ca
• Th / drip lasix 5mg IV
• Spironolakton 1x25mg
• Ramiphil 1x30mg
• MgSO4 regiment continued
• Opthalmologist consult result :
• There was no sign fundus eclampsia
• Join treatment

• Cardiologist consult result :

• Echo : EF 20%
global hipokinetik
efusi pericard minimal
katub –katub baik
• PPCM
• G2P1A0L1 34-35 weeks pregnancy + PEB + IUFD
• Th/
• Inj lasix 40mg  drip 5mg / jam
• Ramiphil 2,5 1x1
• Spironolakon 1x25 ( morning )
• EKG
• Termination of pregnancy
 Diagnose
• Dispneu ec PPCM on G2P1A0L1 33-34 weeks preterm of pregnancy+ PEB in
maintenance dose MgSO4 regimen from other institution + IUFD
• Fetal die singeltoon head presentation
Management
• Control GA,VS,FHR,uterine contraction,urine output and patellar reflex
• Continue maintenance dose of MgS04 regimen
• Metildopa 500 mg
• Complete laboratory examination,EKG
• Consult to preeklamsia team ( ophthalmologist,internist,cardiologis)
• Consult to perinatologist
• Plan SC
• 20.00 acc Anastesi

• 20.30 acc OK

• 21.00 Patient arrives in room OK

At 23.15 PM : CCS was performe
A female baby was born with
2000 gr in weight,
40 cm in height
A/S : 0/0
Maseration gr. 1
Placenta was delivered by mild traction on the umbilical cord, complete,1
pieces, 12x 10 x 2,5 cm size, approximately 300 gr weight. The Umbilical
length cord length was approximately 30 cm,para central insertion.
Tubektomy pomeroy on both fallopian tube was performed.
Blood loss during operation  250 cc

D/ : P2A0L1 post CCS oi. PEB in maintenance dose of MgSO4 regimen from
other institition + susp. ALO + IUFD + TP oi medicinalis
mother on ICU – Child were Die
 Laboratory Finding

Laboratory finding Normal value for 3rd TM

Routine blood testing
Hemoglobine 12,3gr/dl 9,5-15,0
Leucocyte 27.320 /mm3 5.9–16.9
Hematocrit 37 28.0–40.0
Trombocyte 232.000/mm3 146–429
Laboratory Finding result

Laboratory finding Normal value for 3rd TM

Routine blood testing
PT 9,3 10,0-13,6
APTT 28,9 29,2-39,4
D-Dimer 1681 <0,5
SGOT 30 U/L 0,00-31,00
SGPT 20U/L 0,00-34,00
 PARAMETER RESULT REFERENCE VALUE
Calcium 7,2mg/dl 8,6-10,3

Potassium 4,2 mmol/L 3,5-5,1

Sodium 137 mmol/L 139-145

Chlorida 106 mmol/L 97-111

Random blood glucose 132 mg/dl <200,00
Total protein 5,7g/dl 5,6 – 6,7
Albumin 3,0 g/dl 2,3 – 4,2
Globulin 2,7 g/dl 2,5-3,3
LDH 650 u/l < 480
Ureum 11mg/dl 16,6 – 48,5
Creatinin 0,5 mg/dl 0,6 – 1,2
URINALISIS RESULT REFERENCE VALUE

Protein ++++ -

Glucose - -

Leucocyte 5-6 0-5

Eritrocyte 2-3 0-1

Cylinder - -

Crystal - -

Epitel + flat Flat Epithel

Bilirubin - -

Urobilinogen + +
Post Surgery Laboratory Finding
No. Parameter Results Normal range

1 Haemaglobin 10,9 11.-14

2 Haematokrit 31 37-43

3. Leucocyte 12.131mm3 5000-10.000

4. Trombocyte 197,350Mm3 150-400

Follow up 18/10/17
S/ patient got ICU treatment
O/
GA CONS BP HR RESP T
Worst On medical 120/70 80 18 36,7
effect

Abdomen : wound were closed by verban

Genitalia : V/U normal
A/
P2A0L1 post CCS oi. PEB in maintenance dose of MgSO4 regimen from other
institition +PPCM + susp. ALO + IUFD + TP oi medicinalis ND 1
mother on ICU – Child were Die
Th/
drip oksi 2 amp --> 20 tpm
Ceftriaxon 2x1
As. Traneksamat 3x1
Vit K 3x1
Omeprazol 2x40
Furosemid 3x1
Metildopa 3 x500
Fentanyl : sedacum 2cc/jam
Follow up 19/10/17
S/ patient got ICU treatment, fever(-)
O/
GA CONS BP HR RESP T
Worst On medical 130/70 80 18 36,7
effect

Abdomen : wound were closed by verban

Genitalia : V/U normal
A/
P2A0L1 post CCS oi. PEB in maintenance dose of MgSO4 regimen from other
institition + PPCM + susp. ALO + IUFD + TP oi medicinalis ND2
mother on ICU – Child were Die
Th/
drip oksi 2 amp --> 20 tpm
Ceftriaxon 2x1
As. Traneksamat 3x1
Vit K 3x1
Omeprazol 2x40
Furosemid 3x1
Metildopa 3 x500
Fentanyl : sedacum 2cc/jam
No. Parameter Results Normal range

1 Haemaglobin 12,0 11.-14

2 Haematokrit 36 37-43

3. Leucocyte 11500mm3 5000-10.000

4. Trombocyte 127,000Mm3 150-400

 PARAMETER RESULT REFERENCE VALUE
Calcium 8,1 mg/dl 8,6-10,3

Potassium 3,4 mmol/L 3,5-5,1

Sodium 138 mmol/L 139-145

Chlorida 98 mmol/L 97-111

Random blood glucose 138 mg/dl <200,00
Total protein 5,7g/dl 5,6 – 6,7
Albumin 2,8 g/dl 2,3 – 4,2
Globulin 2,7 g/dl 2,5-3,3
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