CASE REPORT OF OBSTETRIC & GYNECOLOGY

WAHIDIN SUDIROHUSODO HOSPITAL

January 26
th
F!"ruary #
$t
2%#&
I
OBSTETRIC
TREAT'ENT IP WP OP
1. Term Delivery, suboccipitobregmatica presentation


Normal Delivery
Early Breastfeeding Initiation
Ny atirah/ 28, g2p1a0
Ny aulia / 30 thn g3p2a0
2
2
- 2
2 etained portions of placenta I!"D # $ 1% I& '(ytocin 2) dpm
*efota(ime In+ 1 g,12 - , iv
*urretage
Keluhan berdarah sedikit sedikit
setelah partus, darah segar 2x ganti
pembalu/ hari
Post partum 14 hr yg lalu d rsb !i
sudiang "PPN# ditolong o/dokter
Post s$ tahun 2011 aioligo ga%at
&anin
'asil ()* sisa &aringan
1 - 1
.. /2011%, 22 y.o. #304 5-6-2%1.
eferred from Daya 7ospital 8it- D, /2011% term
pregnancy first stage of labor latent p-ase $ one
previous *aesarean 9ection
7istory of *-9ection on 1ugust 2%12 8it- indication of
big baby
*ontraction 4 2 ( 1%: ;2<-.%=>
"7 4 16. bpm
E"? 4 .)21 gr ;.@ ( @@=
4 2 cm
Descent 4 "loating
&9/ 4 9ingleton live pregnancy, cep-alic
presentation, placenta on corpus posterior,
1"IA ),2 cm, "etal biometry B 6%8 .d of /1,
E"? A .)@2 gr
0re-op D,4 /2011% 62 8Cs 1 day 1
st
stage of labor
latent p-ase $ one previous *aesarean
section $ *andidate for I&D 1cceptor $
0ost-op D,4 Term delivery $ one previous *aesarean
section $ I&D 1cceptor
'utcome4 , .@1% gr, <2 cm, 194 ),1%
#o8 Transverse *aesarean 9ection
Insertion of I&D
*efota(ime in+. 1g,12 -,iv
Detorolac in+. <% mg,) -,iv
anitidin in+. <% mg,) -,iv
Ny maya ,pasien dr .-asna
9* 1 di 9 sentosa BB 6%<% gr
1N* di pusCesmas
1 - 1
6. /60.1%, 6. y.o. #304 E-<-2%1.
eferred from *onsultant 8it- D, /60.1% term
pregnancy $ one previous *aesarean 9ection $
0lacenta 0revia
7istory of *-9ection on 1ugust 2%%2 8it- indication of
"etal distress
*ontraction 4 -
"7 4 16. bpm
E"? 4 .2.6 g ;.. ( @)=
&9/ 4 9ingleton live pregnancy, cep-alic
presentation, placenta on corpus posterior
8iden to t-e lo8er segment cover 'stium
&teri Internum , 1"IA@,. cm, "etal biometry B
.)8 .d of /1,E"? A .2)2 g
0re-op D,4 /60.1% term pregnancy $ one previous
#o8 Transverse *aesarean 9ection
Tubectomy of 0omeroy 3odification
*efota(ime in+. 1g,12 -,iv
Detorolac in+. <% mg,) -,iv
anitidin in+. <% mg,) -,iv
Ny 9utia- ,pasien dr .EliFabet- c +, 9p.'/
9* 1 di 9 ibsi Carena ga8at +anin
1N* di pusCesmas
1 -
*aesarean section $ 0lacenta 0revia $
"emale 9teriliFation *andidate
0ost-op D,4 Term delivery $ one previous *aesarean
section $ 0lacenta 0revia $ "emale
9teriliFation 1cceptor
'utcome4 , ..%% gr, 6) cm, 194 ),1%
<. /2011%, 2. y.o. #304 E-<-2%1.
eferred from Daya 7ospital 8it- D, /2011% term
pregnancy first stage of labor active p-ase $ one
previous *aesarean 9ection
7istory of *-9ection on "ebruary 2%12 8it- indication
of 1sma Bronc-ial
*ontraction 4 6 ( 1%: ;6%-6<=>
"7 4 16. bpm
E"? 4 .65) gr ;.5 ( @6=
4 "ully dilated
Descent 4 7odge 6
0re-T D,4 /2011% term pregnancy 2
nd
stage of
labor $ one previous *aesarean section
0ost-T D,4 Term delivery $ one previous *aesarean
section
'utcome4 , .6%% gr, <% cm, 194 ),1%
I!"D # 2) dpm
3ediolateral sinistra Episiotomy
!acuum E(traction
7ecting perineum
*efadro(yl 2 ( <%% mg
3efenamic 1cid . ( <%% mg
9" 1(1
*ontraception *ounseling 4 0lanning for
I&D Insertion
Ny fatma8ati ,pasien dr .-asna
9* 1 di 9 9ale8angan
1N* di pusCesmas
1 1
2. 0.1%, 6% y.o. 0ost 7ysterectomy 1 -our ago
eferred from *a-aya 3ediCa 7ospital 8it- D, 0ost
-ypovolemic s-ocC e.c 0ost-0artum Bleeding e.c.
1tonia &teri $ *ardiac arrest $ 0ost -ysterectomy $
1rtery 7ypogastrica #igation
7istory of !aginal Delivery 2 -ours ago,
7istory of "luid escucitation 4
-Transfusion of 2 Bag "res- "roFen 0lasma
- Transfusion of 2 Bag ?B*
- Transfusion of 2 ?ida-es
/eneral 9tatus 4 Intubated
Blood 0ressure 4 Difficult To assess
7 4 Difficult To assess
Breat- 4 Difficult To assess
0re-T D,4 0.1% 0ost-partum $ 0ost Total
-ysterectomy e.c. 1tonia &teri $ 0ost 7ypovolemic
9-ocC $ *ardiac 1rrest
) minutes later G
1nast-esia 4
3onitor 9et 1sistole, 9a'2 4 <2 H
1< 3inutes later 4
B0 4 <2, .2
D, espiratory "ailure 0ost *ardiac arrest
1% minutes later 4
B0 4 52,.% 7 4 1sistole
2 minutes later 4
B0 4 52,62 7 4 56, 9a'2 4 56 H
. minutes later 4
B0 4 112,2< 7 4 <), 9a'2 4 52 H
2 minutes later 4
B0 4 111,)% 7 4 112, 9a'2 4 @< H
. minutes later 4
B0 4 65,.% 7 4 111, 9a'2 4 @@ H
5 minutes later 4
*!* Insertion, *!0 4 .,2
6% minutes later 4
B0 4 162,11%,7 4 15),416 ;ventilator =, 9a%2 51H
1dvice from t-e 9upervisor 4
Informed *onsent to t-e "amily regarding
t-e condition of t-e patient
*onsult to 1net-esiologist for T-e Intensive
*are &nit
u+uCan dari dr. 1. "atima- 9p.'/
I* to t-e family ,
*ardiopulmoner escucitation 2 cyclus
Epinefrin 2 ampul
Epinefrin 6 1mpul in 1%% cc Na*l
Epinefrin 2 ampul
9ulfas 1tropin 2 1mpul
Epinefrin 2 1mpul, 9ulfas 1tropin 2 1mpul
9ynus r-ytm G !ascon 1% cc
/elofusin <%% cc t-roug- I! line
/elofusin <%% cc ;flus-=
1 -
< minutes later 4
B0 4 )5,.2 , 7 4 26, 9a%2 6@H
5 minutes later 4
B0 4 1.6,51, 7 4 1<., 9a%24 ))H
2 minutes later 4
B0 4 1)@,5@, 7 4 12., 9a%24 )2H
. minutes later 4
B0 4 1)@,5@, 7 4 12., 9a%24 )2H
6 minutes later 4
B0 4 E, 7 4 %, 9a%24 -
D, 3ultiple organ failure e.c.*irculational failure e. c.
-ypovolemic s-ocC
Dopamin 1%mcg , CgBB,minute
*0, 9ulfas 1tropin 2 1mpul , Dopamin1<
mcg , CgBB, minute,
Epinefrin 2 1mpul
Epinefrin 2 1mpul
Epinefrin 2 1mpul
0atient stated to be deat- in front of t-e
family by t-e 1nest-esiologist
II GYNECOLOGY 4 No *ase
III FA'ILY PLANNING 4 No *ase
I( CONSULT 4 1 case
( 'ATERNAL DEATH 4 1 case
(I NON 'ATERNAL DEATH 4 No *ase
(II NEW CONTRACEPTI(E ACCEPTOR 4
'ral contraception 4 - In+ection 4 - Implant 4 -
*ondom 4 - I&D 4 1 Tubectomi 4 1
T-ese cases 8ere -ad been discussed at ?a-idin 9udiro-usodo 7ospital on 3onday, "ebruary 1
st
, 2%16
by 44
1. dr. 1de Ira8an ;'= 1.
2. dr. 1le(ander 3arvin 9usatya ;'= 2.
.. dr. Deddy aFaC ;'= ..
6. dr. De8i ECa 9atriani ;'= 6.
<. dr. "inianty aynelda 3angelle ;'= <.
2. dr. "irman I-ram T-amrin ;'= 2.
5. dr. #ucia #eonie #evita ;'= 5.
). dr. 3argaret Diana ;'= ).
@. dr. 3uFdatul D-airia- ;'= @.
1%. dr. Natami De8i ati- ;'= 1%.
11. dr. ?i8i Ira8an ;'= 11.
12. dr. IulfaeCasari Nasruddin 12.
1.. dr. 1FiFa- Nurdin 1..
16. dr. 3erdyana DarCut-ni 16.
1<. dr. a-ma8ati ;DB= 1<.
12. dr. 9ari Ifdiana Jalal 12.
15. dr. Inggrid *laudia 3a-ama 15.
1). dr. D8i 1ndina "arFani ;DB= 1).
1@. dr. Edi 9abara ;DB= 1@.
2%. dr. 3agfira 9t.9ara- ;'bginsos= 2%.
21. dr. onaldo 1.ambulangi ;'bginsos= 21.
22. dr. 1c-older 9irait ;'bginsos= 22.
2.. dr. 1nd-inna K 2..
26. dr. 7artono 3adong ;*-ief= 26.
2<. dr. 9ri Tarti 3anoppo ;*-ief= 2<.
22. dr. ita "irdiyanti ;*-ief= 22.
3engeta-ui,
Donsulen uma- 9aCit
dr. 7asna8aty, 9p. '/.