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MFM A

dr. BRP (dr. FAM


dr. RPA dr. PPA (dr.SUL,

Ruang Nama Tgl masuk // Tgl persalinan Usia G P A Mg Hr

1 IMP H1 Tentrem/ 01907882 10/10/2019 38 2 1 0 28 1


2 IMP E2 Sulami/01906021 15/10/19 36 3 2 0 29 5

3 IMP H4 Alissa/1908437 14/10/19 18 1 0 0 33 2


Isni Nur Ahyani
4 IMP C 9/10/2019 37 3 1 1 34 2
01907859
5 IMP H3 Isnuryati/01908396 14/10/19 37 2 1 0 35 0

6 IMP F Aniq/01908639 15/10/19 32 4 1 2 37 4


7 AMARTA I Diana/1908636 15/10/19 32 3 2 1 38 5

8 BUG 2 Fitriyani/ 1905791 14/10/19 27 1 0 0 40 4


9 IMP H2 Linda / 01907048 2/10/19 // 37 2 1 0 29 4
10 IMP E1 Melinda/ 1908209 12/10/19 28 1 0 39 4
Fitri
11 BUG 2 IX5 13/10/19 24 1 1 33 3
oktaviani/1906217
Oktaviani Ratna/
12 BUG 2 VI 13/10/19 34 2 0 39 6
01908213
13 IMG G Lestari/1904667 12/10/10 31 1 0 0 29 5
Melly Ardila /
14 IMP B 15/10/19 29 4 0
01815975

15 IMP E3 Ny Vinna/ 1908423 14/10/19 30 2 0


16 ICU 16 Tri Anita / 1907167 3/10/2019 24 1 0
Rabu, 16 Oktober 2019
FM A
(dr. FAM)
(dr.SUL, dr. MAN)

AH BMI Keadaan hari ini

1 KU baik sadar TD 103/63 N 90 R 20 T 36.0 His (-). DJJ 142/152

USG Staff 11/1019: Janin ganda preskep-presbo, kesan monochorion diamnion. Air
ketuban cukup. Plasenta di corpus anterior. Janin I preskep DJJ +, BPD 6.53 AC 21.56
TBJ 931. Janin II presbo DJJ +, BPD 7.15 AC 23.88 TBJ 1262 gram

11/10/19: LE -, LE - bact 11.9 . Prot +/-. Swab vagina: tidak ditemukan bakteri

Lab 10/10/2019 : AL 14,5, Ae 3,53, Hb 10,8, Ht 32,6, AT 298


USG : janin gemeli (preskep-presbo), DJJ (+), gerak (+), AK cukup sdp 3,4 cm, kesan
monokorion, monoamnion (T Sign +), janin I BPD 6,72cm-28wod, HC 24,8-27w0d, AC
27,92 cm-27w0d, FL 5,04cm-27w0d, EFW 1043 gr, Janin II BPD 6,53 cm-27w6d, HC
24,3cm-27w4d, AC 23,2cm-27w4d, FL 5,82cm-27w0d, EFW 1103 gr

KU baik sadar TD 139/96 N 87 R 20T 36.5 His (-) . CM 1600 CK 1150 BC +450 UO:
2 24.5
0.5

Lab 15/10/19: AL 19.5 AE 4.2 Hb 12.9 AT 311 PPT/APTT 12.5/41 Alb 3.11 SGOT 24
SGPT 16 BUN 16 creat 1.39 AU 7.1 LDH 698 Na 137 K 4.1 Cl 110 URINE Prot +3

USG 15/10/19 : janin tunggal, memangjang, preskep. DJJ +, gerak +. Plasenta di


fundus grade II TBJ 760.8 gram

0 16 KU baik sadar TD 94/60 N 72 RR 20 T 36,3, His + 2x/10'/20"/S--> nife, DJJ 130


Lab 15/10/19: AL 10.5 AE 4.15 Hb 9.1 Hmt 29.3 MCV 70.6 MCH 21.9 MCHC 31.1AT
231. Ferririn 8.76 (20-250) TiBC 27 (33-102) Iron 27 (33-102) UIBC 521 (112-346) .
MDT: Micrositik hiporcromik susp defisiensi besi dan Reaksi inflamasi. Proses
hemolitik belum dapat di singkirkan.

Lab 14/10/19: AL 9.35 AE 4.2 Hb 9.3 Hmt 29.3 MCV 69.6 MCH 22,1 MCHC 31.7 AT
246. PPT/APTT 15.6/29.9 Alb 3.34 SGOT 40 SGPT 55 BUN 6.2 creat 0.63 HbsAg NR
Na 137 K 3.57 Cl 102 URINE: nit -. LE -. Bact 3.3 Prot +-

USG 14/10/19: janin tunggalmemanjang, preeskep DJJ +, gerak +. AK cukup. Plasenta


di corpus lateral TBJ 2045 gram.

CTG 14/10/19.FHR baseline 130 variability >5 akselerasi +, decelerasi -. FM +Reaktif

KU baik sadar TD 155/100 N 89 R 18 T 36.5 CM 4150 CK 4355, BC -205 UO 1.8 His


1 39,5
(-), DJJ 159 kpm

13/10/19: Protein Esbach 0.5


Lab 12/10/19: AL 14.23 HB 12.2 AT 286 ALB 3.38 SGOT 44 SGPT 24 BUN 12.7
CREAT 0.78 GDS 76 LDH 566 NA 139 K 4.7 CL 107

CTG 10/10/19. 23.00: FHR baseline 155 variability >5 akselerasi +, decelerasi -. FM +.
KAT 1

10/11/19 USG dr WAN: janin tunggal, memanjang, preskep. DJJ +, AK cukup.plasenta


di corpus anterior. TBJ 1935 gram

LAB 9/10/2019 (16.04) : AL 9,87, Ae 4,76, Hb 12,4, Hmt 38,8, AT 279, LDH 325, Na
142, K 4,3, Cl 110, PPT 14,4/14,7, APTT 32,3/30,5, INR 1,05, ALb 3,06, SGOT 20,
SGPT 9, BUN 8,10, Cr 0,89, GDS 88, HbsAg NR, URIN : LE -, Bact 11,1, epithel 2,5,
Protein -

NST FHR baseline 135 kpm, variabilitas>5, akselerasi +, deselerasi -, gerak +, kategori
I

USG janin tunggal memanjang preskep, djj + gerak + ak cukup (AFI 10,21 cm),
plasenta di corpus lateral kanan, BPD 8,29~39w3d HC 30,20~33w4d,AC 26,48~30w4d
FL 6,06~31w3d TBJ 1836 gr
BPS : FM 2, FB 2, FT 2, AFI 2, NST 2 = 10/10

KU baik sadar TD 171/93--> nife N 75 R 20 T 36.3 CM 3300 CK 3250 BC -50 UO 1.9


1 27.27
His (-), DJJ 130 kpm

Lab 14/10/19: AL 10.46 AE 4.27 Hb 12.1 Hmt 35.3 AT 376 PPT/APTT 14.3/33.6 Alb
3.58 SGOT 14 SGPT 10 BUN 9.8 creat 0.82 GDS 83 HbsAg 83 LDH 312 Na 140 K
3.85 Cl 108 URINE: nitrit -. LE +3. bact 706.6

USG 14/10.19: janin tunggal, memanjang, preskep. DJJ +, gerak +, AK cukup plasenta
di fundus anterior . TBJ 1614gram BPS 10/10

CTG 14/10/19. 23.00: FHR baseline 150 variability >5 akselerasi +, decelerasi -. FM +.
KAT 1

KU baik sadar TD 148/82 N 90 R 18 T 36.6 CM 300 CK 850, BC -350 UO 1.6 His (-),
1 36.2
DJJ 136 kpm

15/10/19: AGD: pH 7.4 pCO2 28.3 pO2 98 Lac 1.12 HCO3 18 BE -7 (asidosis
metabolik terkompensasi). Al 10.5 AE 3.74 Hb 9.2 Hmt 28.9 MCV 77.4 MCH 24.6
MCHC 31.8 AT 246 PPT 15 APTT 28.8 LDH 282 Na 137 K 3.24 Cl 111 . URINE: Nit -
LE +2 bac 51 Keton +2 Prot +1
USG 15/10/19 : janin tunggal, memangjang, preskep. DJJ +, gerak +. Plasenta di
fkorpus posterior tidak meluas ke OUI. AK cukup. TBJ 3733gram

CTG 15/10/19FHR baseline 120 variability >5 akselerasi +, decelerasi + early. FM +.


KAT 1

2 31.2 KU baik sadar TD 126/74 N 63 R 20 T 36.0 His (-), DJJ 150 kpm

Lab AL 9.8 AE 4 Hb 8.2 Hmt 26.4 MCV 65 MCH 20 MCHC 31.1 AT 339. PPT 16.3
APTT 25.1 Alb 3.33 SGOT 15 SGPT 10 BUN 9.8 creat 0.44 GDS 79 Na 140 K 3.8 Cl
109

USG 15/10/19: janin tunggal, memanjang, preskep. DJJ +, gerak +, AK cukup. Plasenta
di corpus anterior. Lakuna + tidak meluas ke OUI. Retroplasental zone +. TBJ 3644
gram

CTG 15/10/19 FHR baseline 160 variability >5 akselerasi +, decelerasi -. FM +. KAT 1

KU baik sadar TD 120/80 N 03 R 20 T 36.6 tfu 2jbp. Lochia rubra. Cm 900 CK1026
0 26.9
BC -126 UO 0.76
Post op: 16/10/19: AL 12.96 AE 4.16 Hb 11.8 AT 178

lab 11/10/19: AL 6.99 AE 4.35 Hb 12.4 Hmt 37.5 AT 200. PPT/APTT 13.9/28.5 Alb 3.72
OT/PT 22/12 BUN 4.5 crwat 0.62 GDS 83. HbsAg NR Na 141 K 4.66 CL 111 INR 1.01
Anti ds DNA 7 ANA IF dalam konfirmasi

USG 14/10/19: Janin tunggal, memanjang, preskep DJJ +. AK cukup plasenta di


fundus grade III. Kelainan anatomis jantung - EFW 2605 gram

KU baik sadar TD 150/94 N 83 RR 20 T 36.2, CM 2500 CK 2560, BC -60 UO 1.3


1 31,25
cckgbb/jam

LAB post op: 14/10/19: AL 15.95 AE 3.51 Hb 11 Hmt 30 AT 117

Lab 13/10/19: AL 8.63 AE 3.87 hb 11.9 Hmt 33.1 AT 93. Alb 2.67 --> 3.23 . SGOT 52
SGPT 54 LDH 533. URINE LE +3. Bact 10780 yeast like 55.21. PROTN +3.
Lab 12/10/19: Creat urine 55.52 Prot total 366 ratio prot/creat 6592

11/10/19: USG staff: janin tunggal, memanjang, preskep. DJJ +, gerak +, AK cukup,
plasenta di corpus anterior. BPD 7.78 AC 23.46 TBJ 1358 gram

11/10/19: alb 2.4 OT/PT 77/72. KULTUR URINE: jamur +

10/10/19: AL 9.8 AE 4.25 Hb 13.1 AT 103. BUN 16.9 Crea 0.97 LDH 1141 Urine: Nitrit
+2 Leu 21 Bact 6215 Prot +3

Lab 8/10/19 BUN 48.7 Cr 1.33

LAB 6/10/2019 (14.23) : AL 13,71, Ae 4,28, Hb 13,2, Hmt 36,3, MCV 84,8, MCH 30,8,
MCHC 36,4, AT 208, Alb 3,4, SGOT 34, SGPT 34, BUN 47,2, Cr 1,77, GDS 115, LDH
931, Na 134, K 4,38, Cl 102, URIN :Protein +3
EKG 6/10/2019 : sinus rhytm 122 kpm, RAD. Kesan sinus takikadi

NST FHR baseline 140kpm, Akselerasi +, Deselerasi, Variabilitas >5, Gerak (+) kesan
reaktif

3/10/19 AL 10,73 AE 4,53 Hb 14,1 Hmt 39,7 AT 94 PPT 12,8/14,8 APTT 35,8/32,7 Alb
2,79 SGOT 59 SGPT 101 BUN 17,4 Cr 0,85 LDH 515 Na 138 K 4,17 Cl 105 GDS 115
INR 0,92 URIN LE +- Bact 91,5 prot +3

USG 2/10/19 Janin tunggal memanjang preskep DJJ(+) gerak (+) AK cukup plasenta
di fundus meluas ke corpus anterior.TBJ 1318 g

0 29.9 KU baik sadar TD 131/83 N 100 R 18 T 36.1 CM 2150 CK 2390 BC-240 UO 1.08

Lab 14/10/19 POST OP: AL 17.68 Hb 11.4 Hmt 34.4 AT 295


Lab 12/10/19: AL 9.46 AE 4.7 Hb 11.5 hmt 34.4 AT 271 PPT/APTT 13.1/32/1 Alb 2.99
SGOT 28 SGPT 31 . BUN 9.1 Creat 0.7 LDH 158 HbsAg NR URINE:LE -, nitrit 0 bact
18.6 prot +1

USG 12/10/19: janin tunggalmemanjang, preskep DJJ +, gerak +. AK cukup. Plasenta


difundus TBJ 3083 gram.

CTG 12/10/19. FHR baseline 140 variability >5 akselerasi +, decelerasi +. FM +. KAT 1

KU baik, sadar TD 120/70 N 88 RR 20 S 36,5 CM 1870 CK 2170 BC - 300 UO 1.7


1 29
TFU 2 jbp lochia rubra

14/10/19Lab post op: AL 13.61 AE 3.78 Hb 10 Hmt 29.2 AT 218

13/10/19: AL 13.92 AE 3.92 Hb 10.6 Hmt 31 MCV 79.1 MCH 27 MCHC 34.2 AT 239
GDS 112 PTT/APTT 15.8/21.1 Alb 3.7 SGOT/SGPT 14/9 BUN 4.8 creat 0.47 Na 141 K
3.5 Cl 109 INR 1.17

CTG 13/10/19. FHR baseline 150 variability >5 akselerasi +, decelerasi -. FM +. KAT 1
USG 13/10/19: USG: Janin tunggal, memanjang, presbo DJJ (+), gerak (+), plasenta di
korpus anterior, AK cukup TBJ 2547

1 30 KU baik sadar TD 130/90 N 67 R 20 T 36.5 CM 850 CK 980 BC +130 UO 0.76

13/10/19: POST OP: AL 12.28. AE 4.06 Hb 11.5 Hmt 33.4 AT 168

Lab 13/10/19: AL 11.69 AE 4.6 Hb 13.1 AT 194 PPT/APTT 13.6/39.5 Alb 3.37 OT/PT
34/60 BUN 10.1 creat 0.74 Na 133 K 3.97 Cl 100 URINE: Prot +1

USG 12/10.19: janin tunggal, memanjang, preskep. DJJ +, gerak +, AK cukup plasenta
di fundus . BPD 9.03 AC 32.28 TBJ 2802 gram

CTG 12/10/19 FHR 130 kpm, variabilitas>5, akselerasi +, deselerasi - gerak + his
2x/10'/110mvU kategori I
0 33.2 KU baik sadar TD 120/76 N 68 RR 20 T 36,1. CM 2530 CK 2200 BC +330 UO 0.6

13/10/19: Alb 3.19

Lab 12/10/19: AL13.24 AE 4.91 Hb 13.9 Hmt 38.5 AT 298 Alb 2.49 SGOT 29 SGPT 28
BUN 16.8 Creat 0.87 LDH 188 Na 140 K 4.36 Cl 106 GDS 100 URINE: nitrit -, LE -,
bact 760 . PROT +3

CTG 12/10/19. FHR baseline 140 variability >5 akselerasi +, decelerasi +. FM +. KAT 1

CTG 12/10/19. FHR baseline 145 variability <5 akselerasi -, decelerasi +. FM +. KAT 2

USG 12/10/19: janin tunggalmemanjang, presbo DJJ +, gerak +. AK cukup. Plasenta di


anterior. AK sedikit SDP 0.64. TBJ 697 gram. BPS 8/10
3 KU baik sadar TD 141/81 N 68 R 20 T 36.3 TFU 2 jbp/ lochia rubra +.

Lab 15/10/19: Al 13.56 AE 4.3 Hb 11.7 Hmt 34.6 AT 185 PPT/APTT 15.6/32.9 Alb 3.15
OT/PT 18/19 BUN 5.6 creat 0.5 Na 136 K 3.75 Cl 101 GDS 82

USG 15/10/19: USG: Janin tunggal, memanjang, preskep, DJJ (+), gerak (+), plasenta
di korpus posterior, AK cukupTBJ: 2729gram

CTG 15/10/19. 23.00: FHR baseline 140 variability >5 akselerasi +, decelerasi -. FM +.
KAT 1

ECHO 26/6/19: AR mild, TR mild, PR mild intermediate. Probability PH

KU baik sadar TD 107/65 N 94 R 20 T 36.0 TFU 2 jbp/ lochia rubra +. CM 3250 CK


2 24.7
2040 BC +220 UO 1.12

Lab 14/10/19: BUN 6.9 creat 0.45 HbsAg NR LDH 202 URINE: nit -. LE -. BCT 132 .
PROT +1 AL 12.3 HB 11.5 HMT 35.3
USG 14/10/19: Janin tunggal, memanjang, preskep DJJ +. AK cukup plasenta di
corpus posterior. EFW 3293

CTG 14/10/19.: FHR baseline 140 variability >5 akselerasi +, decelerasi -. FM +. KAT 1

KU GCS: E2 Vx M4 TD 130/71 N 119 kpm RR 30 T 37.4 SpO2 98% on ventilator


1 mode Spontan PEEP 5, FiO2 50 %, PPV (-) LK 101 cm. Drain minimal CM 1800 CK
833 BC -967 UO 1.38

Lab 16/10/19: JAM 03.36 pH 7.154 pCO2 29.3 pO2 149 HCO3 10.3 BE -19 lact 0.56
LAB 15/10/19: JAM 09.40 AGD pH 7.23 pCO2 15.9 pO2 123.3 HCO3 6.7 a/A.0.4 . Alb
2.57 BUN 107.4 Creat 10.48 Na 138 K 4.96 Cl 96 Na 136 K 4.96 Cl 96. JAM 22.19: pH
7.24 pCO2 20.5 pO2 172 HCO3 8.8 BE -19 lact 0.83

LAB 14/10/19: JAM 10.36 AL 29.39 AE 3.25 Hb 9.3 AT 331 PPT/APTT 19.6/41.3 Bil tot
0.84 bil dir 0.56 Alb 2.56. BUN 91.9 creat 9.39. Na 138 K 4.32 Cl 99 procal 20.66 INR
1.49 AGD: pH 7.25 . pCO2 27.2 pO2 146 lact 2.34 BE -14 HCO3 12.3
13/10/19: AGD 08.54 pH 7.34 HCO3 15.2 pCO2 28 pO2 136 Eeb -8.7 a/A 0.4 . JAM
9.04 AL 29 AE 3.22 Hb 9.3 Hmt 26.8 AT 179 Na 142 K 3.99 Cl 100. JAM 16.59 GDS
124 . JAM 20.40 GDS 126

12/10/19: CULTUR DARAH:


12/10/19 00.30: GDS 77 JAM 02.43 GDS 76. JAM 10.36 AGD pH 7.31 pCO2 41.3 pO2
191 lact 1.44 BE-5 JAM 11.02 AL 19.98 AE 3.91 Hb 11.5 Hmt 34.6 AT 123 Alb 3.01
BUN 70.4 creat 6.75 Na 141 K 3.8 Cl 99 GDS 73. JAM 13.41 AL 20.41 AE 3.49 Hb 10.2
Hmt 28.9 AT 126 PPT/APTT 20.4/46.4 Fibrinogen 378 D DIMER 371 INR 1.56 JAM
14.58 AL 19.23 AE 3.5 Hb 10.2 Hmt 30.2 AT 120 JAM 19.00 AL 22.61 AE 3.5 Hb 10.2
Hmt 29.5 AT 139 JAM 22.17 AGD: pH 7.36 pCO2 29.8 pO2 116.3 BEb -6.3 HCO3 16.9
a/A 0.4 A-aDO2 194.5 (asisdosis metabolik terkompensasi) JAM 23.52 AL 24.13 AE
3.38 Hb 9.5 Hmt 28.3 AT 149

11/10/19: 19.17 AGD: pH 7.46 pCO2 26.8 pO2 231 lac 1.47BE -4. 11/10.19: AGD pH
7.46 pCO2 26.8 pO2 231 lact 1.47 (alkalosis respiratorik) . 19.22 : AL 17.21 AE 4.36 Hb
12.7 Hmt 35.5 AT 126 Alb 4.06 BUN 48.8 creat 4.39 GDS 34 Na 141 K 3.2 Cl 95 cal
2.69 11/10/19: AGD 9.37 pH 7.41 pCO2. 28 pO2 184 Lac 1.83 BE -7 HCO3 17.8
(asidosis metabolik terkompensasi). LAB 9.53 AL 15.25 AE 2.99 Hb 8.6 Hmt 24.6 AT
91 alb 2.64 BUN 98. creat 8.6 Na 142 K 4.24 Cl 97 Cal 1.78 GDS 83 INR 1.38
PPT/APTT 35.6/31.4.

Lab 10/10/19
AL 12.9 AE 2.89 Hb 8.3 Hmt 23.7 AT 62 Lab pkl 11.48 Hb 8.4 AL 11.8 AT 53 Hmt 24.4
Ppt 18/14.4 Aptt 34.7/30.2 Fibrinogen 266 D-Dimer 453 AGD pH 7.43
PCO2 22.2 PO2 131 HCO3 14.8 BE -7.9 Bil 2.37 Alb 2.9 SGOT 63 SGPT 204 Na 141
K 4.21 Cl 98 Ca 1.74 Procal 16.35 Gds 112 Inr 1.36 Bun 79.5 Cr 7.66 Lab 10/10/19
(04.00) pH 7.22 PC02 50.8 PO2 240 Hc03 20.9 BE -7 Lact 1.73
10/10/19: RO THORAX ::
- Pneumonia lobaris dextra
- Pleural reaction pulmo dextra
- Oedema pulmonum
- Cardiomegaly, LVH
- Terpasang HD cath dengan insersi melalui vena jugularis eksterna dextra dan ujung
distalnya mengarah ke caudal di linea paravertebralis dextra setinggi corpus V.Th 6-7

Lab 10/10/19 (02.16) Hb 5,6, AL 11,02, AT 44, Hmt 17, PPT 21,3/14,7, APTT 40,8/30,5,
INR 1,64, Alb 2,58, OT 57, BUN 72,4, Cre 7,18, Na 142, K 4,33, Cl 99, Ca 1,71,
(02.13), PH 7,33, PCO2 36,1, HCO3 19,1, PO2 47,2, SO2 80,5, TCO2 20,2, BE -5,6

(02.09) PH 7,262, PCO2 46,2, HCO3 20,9, PO2 230, Lac 1,65, SO2 100, TCO2 22, BE
-6

LAB 9/10/2019 (21.15) : AL 11,04, Ae 2,47, Hb 6,9, Hmt 20,7, MCV 83,9,MCH 27,9,
MCHC 33,3, AT 51, PPT 21,7/14,7, APTT 41,9/30,5, SGOT 68, SGPT 311, BUN 75,1,
Cr 7,02, GDS 106, Na 144, K 3,72, CL 1,9, Ca 1,9, INR 1,67, AGD : pH 7,25, PCO2
42,8, PO2 178, HCO3 19,2, BE -8, Lac 1,94, GDS 139, LAB 9/10/2019 (09.31) : AL
11,7, Ae 2,94, Hb 8,1, Hmt 23,7, MCV 80,6, MCH 27,6, MCHC 34,2, AT 52, PPT 20,2/
14,7, APTT 35,6/30,5, INR 1,55, Fibrinogen 320, D-Dimer 461, Bil total 2,27, Bil direct
2,15, bil indirect 0,12, Alb 2,12,SGOT 173, SGPT 858, BUN 71, Cr 7,48, GDS 121, Na
141, K 3,84, Cl 102, Mg 2,24, Ca 2,03, Procalsitonin 19,91, AGD pH 7,4, PCO2 27,2,
PO2 141, HCO3 17,6, BE -7, Lac 2,56
8/10/19: HASIL CULTUR URINE: BACTERIA TIDAK DI TEMUKAN

Lab 8/10/19 j09.38 AL 12.93 AE 3.19 Hb 8.9 Hmt 25 AT 59 PPT 20.7 APTT 36.2 Alb
2.65 BUN 88.1 Cr 0.03 Na 148 K 3.82 Cl 89 Mg 1.85 Cal 1.9 GDS 134 Ph 7.4 Pco2
28.2 p02 84 Lac 3.37 SO2 96 BE -7 j13.54 AL 13.63 AE 4.5 Hb 12.1 Hmt 36.1 AT 66
BUN 48.4 Cr 5.3 Na 138 K 3.18 Cl 98 Mg 2.5 Cal 2.46 j19.23 AL 9.97 AE 2.82 Hb 7.8
Hmt 22 AT 66 Alb 2.19 BUN 60.5 Cr 6.97 Na 140 K 3.6 Cl 100 GDS 158

7/10/19: RO thorax: Oedema pulmonum


- Cardiomegaly, LVH
- Terpasang HD cath dengan insersi melalui vena jugularis eksterna dextra dan ujung
distalnya mengarah ke caudal di linea paravertebralis dextra setinggi corpus V.Th 6-7

Dibandingkan dengan foto thorax sebelumnta tanggal 07/10/2019 jam 13.46 secara
radiologis gambaran oedema pulmonum berkurang
lab 7/10 (10,19) ph) 7,301 pco2 38,2 pO2 83 HCO3 18,9 (09.49) al 11,45 ae 3,65 hb
10,1 hmt 29,2 at 41 ppt 24,3 aptt 47,8/29,4 bilirubin total 2,96 alb 2,91 sgot 1523 sgpt
2148 bun 74 cr 7,31 gds 82 na 144 k 4,05 cl 102 mg 1,69 ca 1,83 NT pro BNP 25942
procal 27,81 inr 1,91 (08,22) al 10,99 ae 2,89 hb 8 hmt 23 at 53

LAB 6/10/2019 (14.26) : GDS 74, (13.47) : 20, (11.15) : AL 13,11, Ae 3,72, Hb 10,4,
Hmt 30,3, MCV 81,5, MCH 28, MCHC 34,3, AT 50, PPT 26,2/14,4, APTT 38,1/30,3,
INR 2,08, Fibrinogen 253, D-DImer 1154, ALb 3,47, BUN 66,8, Cr 6,19, GDS 38, Na
140, K 4,10, Cl 104, Ca 1,95 , AGD : PH 7,30, PCO2 37,6, PO2 111, HCO3 18,9, BE -7,
Lac 5,34
LAB 5/10/2019 (21.00) : AL 6,27, Ae 2,84, Hb 7,8, Hmt 23, MCV 81, MCH 27,5, MCHC
33,9, AT 39, PPT 29,2/14,4, APTT39,6/30,3, INR 2,35, BUN 57, Cr 5,43, GDS 78, Na
144, K 3,63, Cl 100, AGD (14.00) : pH 7,37, PCO2 37,4, PO2 234, HCO3 22, BE -3, ,
Lac 3,01 LAB
5/10/2019 (08.00) : Al 8,12, Ae 2,7, Hb 7,4, Hmt 21,5, MCV 79,6, MCH 27,4, MCHC
34,4, AT 40, PPT 31,6/13,8, APTT 36/30,9, INR 2,57, ALb 3,32, BUN 47,40, Cr 4,63,
GDS 60, Na 145, K 3,56, Cl 98, Ca 1,85 , AGD : pH 7,36, PCO2 40,3, PO2 107, HCO3
22,8, PH 7,39, Lac 2,53,

LAB 5/10/2019 (00.15): AL 9,10, Ae 2,63, Hb


7,2, Hmt 21, AT 41, PPT 27,3, APTT 35,6, INR 2,18 Fibrinogen 243, D-Dimer 1395, Na
141, K 3,31, Cl 102, Ca 1,81, GDS 94 AGD (00.13) : pH 7,3, PCO2 44,4,, PO2 203,
HCO3 25,2, BE 0, Lac 2,46
AGD PKL 18.00, PH 7.413, PO2 208, PCO2 39.4, HCO3 25.2, BE 1, TCO2 26,
LACTAT 2.5, GDS 98, AL 9.8, AE 3, HB 8.3, HMT 24, AT 53
Lab pkl 14.00 Ppt 30.9/14.4, Aptt 55.3/30.3, INR 2.51, Fibrinogen 222, AL 10.42, AE
2.6, HB 7.1, HMT 20.6, AT 65
Lab 09.16, pH 7.535 PCO2 28.5, PO2 195, Lac 5.14, BE 1, HCO3 24, AL 3.76, AE
2.11, AT 23, Hmt 16.8, Hb 5.8, Alb 3.32, Bun 24.3 Cr 2.91, Gds 119 , Na 146 , K 4.13,
Cl 107, Lab 4/10/19 (02.41), AL 8.52, AE 2.68, Hb 7.5, Hmt 22, AT 78, PPT 24.5/14.2,
APTT 39.8/30.8, Alb 3.07, Na 145, K 3.46, Cl 103, INR 1.93, AGD pH 7.306, pCO2
34.4, pO2 313, Lac 9.96, BE-9

Lab 3/10/2019 (20.35) : AL 11,7, Ae 1,21, Hb 3,4, Hmt 10,3, MCV 85,1, MCH 28,1,
MCHC 33,0, AT 56, PPT 56,4/14,2, APTT 88,4/30,8, Alb 1,31, BUN 12,0, Cr 1,87, Na
147, K 4,26, CL 95, Mg 1,6, Ca 1,82, INR 4,97, AGD (19.20) : pH 7,036, PCO2 46,2,
PO2 23, HCO3 12,4, Lac 12,38

Lab 3/10/2019 (17.22) : AL 14,6, Ae 2,49, Hb 7, Hmt 21,3, MCV 85,5, MCH 28,1,
MCHC 32,9, AT 29, GDS 100, AGD 3/10/2019 (16.59) : pH 7,17, PCO2 30,1, PO2
238, HCO3 11,1, lac 10,98

Lab 3/10/2019 (15.23) : Al 26,65, Ae 3,30, Hb 9,5, Hmt 28,9, MCV 87,6, MCH 28,8,
MCHC 32,9, AT 54, PPT 60,4/14,2, APTT 119,2/30,8, Fibrinogen <6, D-Dimer >20000,
Bil total 1,13, Bil direct 0,90, Alb 1,58, SGOT 401, SGPT 293, BUN 11, Cr 1,63, HbSAg
NR, Na 139, K 5,17, CL 107, Mg 1,7, Ca 1,83, GDS 101, INR 6,69, AGD (15.13) : PH
7,08, PCO2 29,2, PCO2 225, HCO3 8,8, BE -21, Lac 13,67
019
MFM B
dr. DEN (dr. NAW)
dr. SME (dr. KHA)

Diagnosis/ assesment

PPROM 6 hari, gemeli (preskep-presbo)


monochorion diamnion, G2P1A0 , hamil 28
minggu 1 hari bdp
Krisis hipertensi teratasi, PEB, Partial HELLP
syndrom, IUFD, anhidramnion, G3P2A0 hamil 29
minggu 5 hari dalam induksi misoprostol
25mcg/6jam/vag tab II seri I

PPROM 2 hari G1P0A0 hamil 33 minggu 2 hari,


bdp. Ibu anemia dan underweight
TS UPD: Anemia micrositik hipokromik

PEB, IUGR, G3P1A1 uk 34 minggu 2 hari dalam


induksi misoprostol 25mcg/6jam/vag tab III seri I
Krisis hipertensi teratasi PEB superimpose,
G2P1A0 hamil 35 minggu bpd riwayat SC 8
tahun yang lalu

GH. G4P1A2 hamil 37 minggu 4 hari bdp. Obs


dyspnea susp dyspepsia syndrome. Anemia susp
deficiensy besi
G3P2A0 hamil 38 minggu 5 hari bdp. Riwayat SC
2x dengan Anemia riwayat transfusi. Ibu asma
tidak dalam serangan

Konsul UPD imunologi

Post SC ai janin suspek total AV blok P1A0 H1


Post sc emergency+sterilisasi pomeroy ai. Fetal
compromised, preterm, letak lintang, Krisis HT
teratasi, Parsial HELLP Syndrome PEB, AKI
membaik, ISK,P2A1 cukup anak H2

nefro : Post SC emergency ai fetal


compromised, krisis ht, peb, partial HELLP
syndrome, aki membaik, ISK jamur dan bakteri.

Cardio : HT emergensi, PEB, partial HELLP


syndrome
Post SC emergency ai. Stimulasi gagal. Riwayat
induksi oxytocin 5IU/500cc RL bottle I hasbis
dilanjutkan stiumulasi oxytocin 5IU/500cc RL 28
tpm dipertahankan bottle II habis. PEB P1A1. H2
Post SC emergency+repair buli ai. Presbo, dp.
Preterm, rupitur buli iatrogenic P1A0 H3

TS UROLOGI
Post SC emergency ai. Prolong latent phase
riwayat SC 7 tahun yang lalu. Ibu pre eclampsia
P2A0. Riwayat asma tidak dalam serangan H3
Post partum spontan bracht ai prespo, preterm,
PEB, IUGR, ologohidramnion, hipoalbuminemia
teratasi , ibu obese grade I. Infertil primer 7
tahun. Riwayat induksi misoprostol 25mcg/6jam
tablet IV seri I. H1
Post partum spontan P4A0 , Ibu riwayat PDA
post closure. 1 tahun yang lalu WHO CR I CF I.
H1

TS CARDIOLOGI: PDA post closure

Post partum spontan, PEB. Riwayat stimulasi


oxytocin 5IU/500cc RL 32 tpm dipertahankan
botol I ai. Partus tak maju P2A0. H0
Penumonia susp. Hospital Aquired Pneumonia,
edema pulmo akut. Post relaparotomi eksplorasi,
ligasi a.uterina sinistra, a.vaginalis sinistra,
a.vesicalis sinistra ai perdarahan tunggul vagina
lateral kiri H5, post SC ai. Kala II tak maju, syarat
VE tak terpenuhi dilanjutkan relaparotomi B
Lynch suture dilanjutkan relaparotomi
TAH+SOS ai perdarahan post partum dini, atonia
uteri,ruptur serviks, P1A0 H11, AKI, DIC. Sepsis
UPD nefro: Syok hemorrhagic, DIC, post SC TAH
ai. Atonia uteria. Post relaparotmi AKI dengan
problem oveload cairan
Anestesi : Post relaparotomi eksplorasi
emergensi ai syok hemoragik gr IV post,
laparotomi TAH ec atonia uteri, H8, anemia, AKI,
DIC

DIC Score: Platlets: 0 INR: 1 D-Dimer: 0.


Fibrinogen : 0 SCORE: 1.
UPD Nefro : post SC dan TAH ai atonia uteri,
syok hemoragik teratasi, DIC, AKI

Anestesi : Syok hemoragik, post relaparotomi


TAH ai atonia uteri, post SC emergency ai kala II
tak maju H1 asidosis metabolik berat,
hpoalbuminemia, anemia gravis, DIC
Post Transfusi
4/10/2019 (PRC 9, TC 18, FFP 5) 5/10/2019
(PRC 1, TC - , FFP 5) 6/10/2019 (PRC 1,
TC 5, FFP 5) TOTAL : 11 PRC, 23 TC, 15
FFP
MFM B
dr. DEN (dr. NAW)
dr. SME (dr. KHA)

Planning TBJ/BBL AS

Manajemen konservatif, Inj. Dexamethason 1 seri (selesai 07.00


11/10/19) amoxcicilin 3x500mg, nifedipin 10mg/8j/po extra (bila ada 931/1262//
his). Vit C 1x1. USUL cek lab ulang darah dan urine hari ini
MgsSO4 1g./jam mulai jam 18.00 15/10/19. nifedipin 3x10mg.
760:08:00
Methyldopa 3x500mg. Evaluasi jam 06.00 pagi ini

Management konservatif. Dexamethason 2x1A. eritromisin


2045/
4x250mg.
Lacak feses rutin dan reticulosit

Manajemen PEB, inj. MgSO4 1 gr/jam/iv (selesai 18.00 10/10/19),


nifedipin 10 mg/8j/po, Inj. Dexamethason 1 Amp/12j/iv (1 seri) 1935/
selesai jam 06.00 11/9/19). Evaluasi jam 08.00
Management konservatif. MgSO4 1g/jam sudah selesai. Nifedipin
3x10mg. Methyldopa 3x500mg. Miniaspi 1x80mg. SF 1x1.
1614/
dexamethason 1g/12jam 1 seri selesai jam 07.30 16/10/19. PRO RE
SC HARI INI

Omeprazole 1x1A. Antasida 3x1. bila masuk dalam persalinan, SC


MFM/DJ
emergency

Lacak konsul UPD


transfusi sesuai UPD, pro SC dan MOW setelah perbaikan KU MFM/DJ

Ketorolac 3x30mg. USUL ganti oral 2605/


Ketorolac 3x30mg. USUL ganti oral 1358 /1110 5/7

Cefotaxim 1g/8jam selama 3 hari jika BLPL ganti cefixime 2x200mg

adalat oros 30mg/24j/po lepas raber


Paracetamol. Nifedipin 3x10mg. 3083/2574 8/9
Inj cefriaxone 2x1g. Ketorolac 3x30mg. 2547/2170 6/9

Pertahankan cateter tinggal 14 hari


Asam mefenamat 3x1. SF 1x1. Nifedipin 10mg K/P. Amoxicicilin
2802/2700 7/8
3x500mg
MgSO4 1g/jam selesai jam 13.00 13/10/19. Inj dexa 2x1A selesai
23.00 13/10/19. nifedipin 3x10mg. Methyldopa 3x500mg. Amoxicilin 697/
3x500ng . SF 1x1. Kalk 3x500mg. Bromocriptin 2x2.5mg
Asam mefenamat 3x1. USUL BLPL 2729/2940 8/9

Pseudonafil 1x20 mg , masuk saat BLPL

Amoxcilicin 3x500mg. Pct 3x500mg. Kalk 3x500mg. Methyldopa


3293/3460 8/9
3x250mg
Perbaikan KU, terapi lain sesuai TS anestesi dan upd nefro. Lepas
tampon 12/10/19
Total HD 2x (terakhir 11/10/19) transfusi 2 kolf surante HD
Fentanyl 3ml/jam, Cefriaxon 1g/12jam/iv, Gentamisin 80mg/12jam/iv,
Metronidazol 500mg/8jam/iv, Paracetamol 1g/8jam/iv, Omeprazol
40mg/24jam/iv, Vit K 1A/8jam/iv, Furosemid 10mg/jam
MUO/24j, cairan 1500-200 cc/ 24 j bisa tranfusi prc/wb tanpa HD,
evaluasi BUN/Cr, Transfusi alb > 3, Pro HD hari ini 11/10/19
dr. Koord. TIM

MFM/ DN A
MFM/DN A

MFM/DN A
MFM/ DN A
MFM/DN A

A
B

MFM/DN A
MFM/DN A
OBS/DN A
MFM/DN B
OBS/NUR A
MFM/DN A
MFM/DN A

MFM/DN A
MFM/ RK B