I.

OBSTETRICS INPATIENT REPORTS Sunday,August 14th, 2011until Wednesday, August 18th, 2011 Physiological patient : cases Pathological patient : cases Chief Obstetrics Inpatient: dr. Shanti Anggun D : patients dr. Sarah Rizka : patients dr. M. Fadli Rabbani : patients

Gestosis Prior CS Ante Partum Haemorrhage PROM Preterm Prolonged second stage Post Partum Haemorrhage Other TOTAL No Initial 1 2 3 4 NUR WIN ZUH ANN Age 30 25 23 20

: patients : patient : patients : patients : patient : patients : patient : patients : patients Diagnosis Treatment Forcipal Extraction Spontaneous delivery Spontaneous delivery Conservative Management LSCS Physician FIF-RYU FIF-RYU LIK-RYU FIF-RYU

Severe Preeclampsia Mild Preeclampsia Prior CS 1x + Hypertirhoid PPROM mild preeclampsia + PROM 2 hours + prior CS 1x (oi. breech presentation) threatened preterm labour + prior CS 1x + oligohidramnios + marginal placenta preave Severe Preeclampsia + Hypertiroid Prior CS Antepartum Haemorrhage Antepartum Haemorrhage Antepartum Haemorrhage

KUR

32

WEN-RYU

LIS

29

Conservative Management LSCS Spontaneous delivery LSCS LSCS LSCS

MCI-RYU

7 8 9 10 11

MAR SRI ROS HAM ELL

39 31 34 37 30

DEL LEL-GIT RNA RYU ABI

12 13 14 15 16 17 18 19 20 21 22 23

EVA SUG NUN NAN MAR ANI RIK HAD ZUR FIT RIN JUM

33 37 45 34 30 34 26 35 38 28 19 27

PROM + oligohydramnios + fetal distress PROM + transverse lie PROM + foetal distress PROM + oligohydramnios PROM Preterm Prolonged 2 stage Prolonged 2 stage Prolonged 2 stage Postpartum Haemorrhage Posterm RHD fc. NYHA III ec. MS
nd nd nd

LSCS LSCS LSCS LSCS LSCS Spontaneous delivery Vacuum extraction Forcipal extraction LSCS Brandt-Andrews manoeuvre LSCS Forcipal extraction

DEL ZAK-AM RYU FHM ABI ZAR-RYU FRN-SRK ALT-HRK ABI BRO-ATA GIT RDA-SRK

PERINATAL MORTALITY No 1 2 Initial By. KET By.HAD Age hour Diagnosis Rigor mortis Severe asphyxia Treatment Spontaneous delivery Resuscitation Physician FRN-SRK ALT-HRK

MATERNAL MORTALITY No Initial Age Diagnosis Treatment Physician -

GESTOSIS 1 30.09.11 Forcipal Extraction JUN/36/RA/LEL-DEL/ 10.30 AM D/ G3P2A0 FT pregnancy with severe preeclampsia inlabour 1st stage active phase SLF cephalic presentation GI : 5 M/ Stabilisation 3 hours MgSO4 protocol Nifedipine 3x10 mg P/ Vaginal delivery after stabilization (terminate 2nd stage with action) M/ Vaginal delivery (terminate 2nd stage with action) USG (ER): - SLF, cephalic presentation - BPD: 90 mm, FL: 71 mm, AC: 307 mm, EFW : 2630 g

- Placentae at anterior of uterine corpus - Amniotic fluid was enough, SP: 4 cm C/ Full term pregnancy SLF cephalic presentation 12.45 PM Male life baby, 2800 g, 46 cm, AS 8/9 FT AGA

30.09.11 Forcipal Extraction MAH/36/UA/LEL-DEL / 02.00 PM D/ G8P7A0FT pregnancy with severe preeclampsia + decompensated cordis NYHA III inlabour 1st stage active phase SLF cephalic presentation M/ Stabilisation 3 hours Metildopa 3 x 250 mg P/ Vaginal delivery (terminate 2nd stage with action) 07.30 PM Male life baby, 4100 g, 48 cm, AS 8/9 FT AGA 09.07.11 LSCS o.i fetal distress FAT/42/RA/DEL/ 04.00 PM D/ G4P3A0 33-34 weeks gestational age with severe preeclampsia + partial HELLP syndrome not inlabour yet SLF cephalic presentation +fetal distress GI: 5 USG ER (DDH): - SLF, cephalic presentation BS: 6 - Biometry: BPD : 86 mm FL: 63 mm EFW: 1900 g - Placenta is at fundus uterine - Amniotic fluid was enough, with SP= 4,0 cm C/ 33-34 weeks gestational age , SLF cephalic presentation M/ Stabilisation 1 hours MgSO4 Protocol Nifedipine 3x10 mg Dexamethason 2 x 10 mg for lung maturation Tubal ligation counselling Consult to Internal Department and ophthalmology department P/ abdominall termination after stabilisation 05.05 AM Female Life baby, 2000 g, 42 cm, AS 1/4/5 FT AGA

09.07.11 LSCS o.i IUGR MAR/39/RA/DEL/ 11.00 PM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 5 USG ER (DDH): - SLF, breech presentation WI: 12 - Biometry: BPD : 88 mm FL: 68 mm AC: 290mm EFW: 2346 g - Placenta is at the posterior uterine corpus - Amniotic fluid was enough, with SP= 2,8 cm C/ FT pregnancy, SLF breech presentation M/ Stabilisation 1-3 hours MgSO4 Protocol Nifedipine 3x10 mg

Tubal ligation counselling Consult to Internal Department P/ Vaginal delivery after stabilisation 10.07.11 03.45 PM D/ G1P0A0 FT pregnancy with severe preeclampsia inlabour2nd stage SLF vertex presentation GI: 4 M/ Terminated 2nd stage with forcipal extraction 04.00 Male life baby, 3500 g, 46 cm, AS 8/9 FT AGA PM

05.07.11 Spontaneous deliverySAI/39/RA/DKA-FAT/ROZ-RIA 08.00 PM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 3 hours not inlabour SLF cephalic presentation GI : 6 M/ Stabilisation 2 hours BS : 5 MgSO4 protocol Nifedipin 3x10 mg Antibiotic Tuba ligation counselling USG (ER) ATA: - Single life foetus, cephalic presentation - Biometry : BPD: 90mm, FL: 72mm AC:310 mm, EFW: 2677 gr - Placentae at anterior of corpus - Amniotic fluid enough, AFI : = 5,8 cm C/ FT pregnancy SLF cephalic presentation P/ Induction with oxytocin drip after stabilisation Vaginal delivery (terminated 2nd stage with action) 10.00 PM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 5 hours not inlabour SLF cephalic presentation GI: 4 M/ Induction with oxytocin drip P/ Vaginal delivery (terminated 2nd stage with action) 06.07.11 02.00 AM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 9 hours inlabour 1st stage latent phase SLF vertex presentation M/ Acceleration with oxytocin drip 04.00 AM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 11 hours inlabour 1st stage active phase SLF vertex presentation 08.00 AM D/ G7P6A0 FT pregnancy with chronic hypertension + history of ROM 15 hours inlabour 2nd stage SLF vertex presentation GI: 4 M/ Conduct the labour 08.05 AM Male life baby, 2800 g, 48 cm, AS 8/9 FTAGA 10.07.11 06.00AM Spontaneous deliveryMAR/46/RA/ZAR-DEL/ D/ G5P4A0 FT pregnancy with severe preeclampsia inlabour 1st stage active phase SLF vertex presentation

GI : 5

M/ Stabilisation 1-3 hours MgSO4 protocol Nifedipine 3x10 mg Counselling Tubal Ligation USG (ER) DDH: - Single life foetus, cephalic presentation - Biometry : BPD: 97mm, FL: 78mm AC: 310 mm, EFW: 3160 g - Placenta at posterior uterine corpus - Amniotic fluid enough, SP: 4,2 cm C/ FT pregnancy SLF cephalic presentation P/ Acceleration with amniotomy and oxytocin drip after stabilisation Vaginal delivery (terminated 2nd stage with action)

09.00 AM D/ G5P4A0 FT pregnancy with severe preeclampsia inlabour 1st stage active phase SLF vertex presentation GI: 2 M/ Acceleration with amniotomy and oxytocin drip 10.30 AM D/ G5P4A0 FT pregnancy with severe preeclampsia inlabour 2nd stage SLF vertex presentation GI: 2 M/ Conduct the labour 10.40 AM Male life baby, 3000 g ,48 cm, AS 8/9 FTAGA 7 09.07.11 LSCS o.i IUGR MAR/39/RA/DEL/ 11.00 PM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 5 USG ER (DDH): - SLF, breech presentation WI: 12 - Biometry: BPD : 88 mm FL: 68 mm AC: 290mm EFW: 2346 g - Placenta is at the posterior uterine corpus - Amniotic fluid was enough, with SP= 2,8 cm C/ FT pregnancy, SLF breech presentation M/ Stabilisation 1-3 hours MgSO4 Protocol Nifedipine 3x10 mg Tubal ligation counselling Consult to Internal Department P/ Vaginal delivery after stabilisation 10.07.11 02.00 AM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 3 P/ Vaginal Delivery 07.30 AM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 3 P/ Wait for Internal department assesment for delivery

11.30 AM Consult result from Internal Departement : C/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid on therapy not inlabour SLF breech presentation +IUGR was suspected Advice : - PTU 1 x 100 mg - Check for Free T4 & TSH - Join care with Internal Departement 11.35 AM Consult to consultant on duty : Advice : Consult to Fetomaternal Subdivison 11.40 AM Consult to Fetomaternal Subdivision Advice : Terminate with abdominal delivery 04.40 PM Female Life baby, 1850 g, 46 cm, AS 8/9 FT SGA PRIOR CS 1 14.08.11 01.00 AM VBAC: 5 LCSS o.i ARI/28/UA/LEL-DEL/ D/ G2P1A0 36-37 weeks gestational age with prior CS 1x (o.i anhydramnion) and Hypertiroid inlabour 1st stage latent phase SLF cephalic presentation P/ Vaginal delivery Consult to Internal department Result : Lung and Heart function compensated Hypertiroid Therapy : PTU Joint Care with Internal Endocrine division USG (ER): - SLF, cephalic presentation - BPD 89 mm, FL 71 mm, AC 300 mm, EFW 3252 g - Placentae at posterior corpus - Amniotic fluid was enough, SP = 3,8 cm C/ 36-37 weeks gestational age SLF cephalic presentation Male life baby, 3700 g 48 cm AS 8/9 FT AGA

parto

09.30 AM

ANTEPARTUM HAEMORRHAGE 1 05.07.11 LSCS o.i Recurrent bleeding ROS/34/RA/RNA/WEN-RIA 08.00 D/ G3P2A0 33-34 weeks gestational age with APH c.b placenta praeve was PM suspected not inlabour SLF cephalic presentation M/ Expectative management Tocolytic with Nifedipine 4x10 mg Dexamethasone inj 2x6 mg (2 days) Antibiotic USG Confirmation (HT):

06.07.11

09.00 AM usg

07.07.11 09.00 AM 02.35 PM 2 06.07.11 01.00 AM

- Single life foetus, cephalic presentation - Biometry : BPD: 88 mm, FL: 68 mm AC: 308mm, EFW: 2472 gr ~ 34-35 weeks gestational age - Placentae at posterior uterine corpus covered all internal os - Amniotic fluid enough, SP: 3,8 cm - BPP: FM: 2, FT: 2, FB: 2, NST: 2, ICA: 2 10 C/ 34-35 weeks gestational age with total placental praeve SLF cephalic presentation BPP 10 D/ G3P2A0 33-34 weeks gestational age with total placenta praeve with recurrent bleeding not inlabour yet SLF cephalic presentation M/ Abdominal delivery Male life baby, 2450 g 45 cm AS 8/9 PT AGA

LSCS oi total placenta praeve HAM/37/UA/RYU/WEN-FAT D/ G1P0A0FT pregnancy with APH c.b total placenta praeve was suspected inlabour SLF cephalic presentation USG (ER) ATA: - Single life foetus, cephalic presentation - Biometry : BPD: 94mm, FL: 74mm AC: 328mm, EFW: 3224 g - Placentae at posterior uterine corpus covered all internal os - Amniotic fluid enough, SP: 3,2 cm C/ FT pregnancy with total placental praeve SLF cephalic presentation M/ Abdominal delivery 02.30 AM Male, 3300 g, 49 cm, AS 8/9 FTAGA 06.07.11 LSCS oi transverse lie + total placenta praeve ELL/30/RA/ABI/WEN-RIA 11.00 PM D/ G2P1A0 FT Pregnancy with APH cb placenta praeve was suspected inlabour SLF transverse lie USG ER (HRK): - SLF, tranverse lie - Biometry: BPD 93mm FL 72 mm AC 315 mm EFW 2650 gr - Placenta at posterior uterine corpus covered all internal os - Amniotic fluid was enough, SP 4,3 cm C/ FT pregnancy, SLF transverse lie + total placenta praeve M/ Abdominal delivery 07.07.11 Female life baby, 2700 gr, 47 cm AS 7/9 FTAGA 01.50 AM

PROM 1 30.09.11 11.00 PM BS : 2

LSCS o.i. tranverse lie HAS/27/UA/DEL/ D/ G2P0A1 FT pregnancy with PPROM 1 hours inlabour SLF tranverse lie M/ Antibiotic P/ Abdominal delivery

10.15 PM

01.40 PM 15.08.11
01.00AM ZA : 3

USG (ER) LIK : - SLF, tranverse lie - BPD 90 mm, AC 336 mm, FL 72 mm, EFW 3000 g - Placentae at the anterior of uterine corpus - Amniotic fluid was enough, AFI : 2,0 1,3 = 6,1 2,1 0,7 C/ FT Pregnancy SLF tranverse lie Female life baby, 2700 gr, 47 cm AS 8/9 FTAGA LSCS o.i. anhydramnios SUM/36/UA/FLADWI/ D/ G1P0A0 FT Pregnancy with PROM 7 hours inlabour 1st stage latent phase SLF breech presentation + anhidramnios + FPD M/ Antibiotic P/ Abdominal delivery USG ER : - SLF, cephalic presentation - BPD 97 mm, FL 76 mm, AC 320 mm, EFW 3248 g - Placentae at anterior of uterine corpus - Amniotic fluid was minimal with AFI 0,2 0,2 = 2,9 1,2 1,3 C/ 40 weeks gestational age SLF cephalic presentation presentation Male life baby, 2700 g 48 cm, AS 7/9 FT AGA

06.15 AM

01.15 PM

05.07.11 LSCS oi foetal distress + Tuba ligation NUN/45/RA/RYU/WEN-FAT 09.30 PM D/ G7P5A1 FT pregnancy with PROM 14 hours not inlabour SLF cephalic presentation with foetal distress M/ Intra uterine resuscitation Antibiotic Tuba ligation counselling P/ Abdominal delivery 10.25 PM Female, 3300 g, 51 cm, AS 5/9 FTAGA 05.07.11 LSCS oi dried labour NAN/28/RA/FHM/RNL-RIA 12.00 PM D/ G2P0A1 FT pregnancy with PROM 2 days not inlabour yet SLF cephalic presentation BS: 2 M/ Antibiotic USG (ER) ATA : - Single life foetus, cephalic presentation - Biometry : BPD: 94 mm, FL: 75mm AC: 320 mm, EFW: 3079 g - Placenta at anterior of corpus - Amniotic fluid is minimal, AFI 1,4 0,2 = 4,5 cm 1,6 1,3 C/ FT pregnancy SLF cephalic presentation with oligohydramnios

P/ Abdominal delivery 06.07.11 06.20 AM Male, 2850 g, 47 cm, AS 8/9 FTAGA 5 06.07.11 LSCS oi failed of induction MAR/30/UA/ABI/RNL-FAT 06.30 AM D/ G1P0A0 FT pregnancy with PROM 7 hours not inlabour SLF cephalic presentation. 10.00 AM USG (HT): - SLF, cephalic presentation with normal activity - Biometry: BPD 8,7 cm FL 7,7 cm AC 29,9 cm EFW 2575 gr - Placenta at the posterior uterine corpus BS: 2 - Amniotic fluid was enough with AFI 14,7 cm C/ 36-37 gestational age, SLF cephalic presentation M/ Antibiotic P/ Vaginal delivery 11.30 AM D/ G1P0A0 FT pregnancy with PROM 12 hours not inlabour SLF cephalic presentation. BS: 2 M/ induction with oxytocin drip 07.30 PM D/ G1P0A0 FT pregnancy with PROM 20 hours not inlabour + failed of induction SLF cephalic presentation. M/ Abdominal delivery 09.10 PM Female life baby, 3200 gr, 49 cm AS 7/9 FTAGA

PRETERM LABOUR 1 30.08.11 Conservative management WID/25/UA/LEL-DEL/ 07.30 PM D/ G2P1A0 31-32 weeks gestational age with threatened preterm labour SLF IT : 1 cephalic presentation USG (ER) : - Single life foetus, cephalic presentation - Biometry : BPD : 82 mm FL : 58 mm AC : 271 mm EFW : 1845 g - Placenta is at right uterine corpus - HR increasing irreguler - Amniotic fluid is enough, SP: 3,2 cm C/ 31-32 weeks gestational age SLF cephalic presentation M/ Conservative managemenet Bedrest Tocolitik with nifedipine 4x10mg Dexamethasone 2 x 6 mg (2 days) P/ USG confirmation 30.08.11 Conservative management LIN/26/UA/FIF-DWI/ 07.30 PM D/ G2P0A1 33-34 weeks gestational age with threatened preterm labour SLF IT : 2 cephalic presentation

USG (ER) : - Single life foetus, cephalic presentation - Biometry : BPD : 83 mm FL : 67 mm AC : 247 mm EFW : 2176 g - Placenta is at uterine corpus - Amniotic fluid is enough, SP: 5,4 cm C/ 33-34 weeks gestational age SLF cephalic presentation M/ Conservative managemenet Bedrest Tocolitik with nifedipine 4x10mg Dexamethasone 2 x 6 mg (2 days) P/ USG confirmation 31.08.11 Conservative management HEN/21/UA/FIF-DWI/ 11.10 PM D/ G1P0A0 31-32 weeks gestational age with threatened preterm labour SLF IT : 3 cephalic presentation

USG (ER) : - Single life foetus, cephalic presentation - Biometry : BPD : 78 mm FL : 29 mm AC : 275 mm EFW : 1750 g - Placenta is at uterine corpus - Amniotic fluid is enough, SP: 3,5 cm C/ 31-32 weeks gestational age SLF cephalic presentation M/ Conservative managemenet Bedrest Tocolitik with nifedipine 4x10mg Dexamethasone 2 x 6 mg (2 days) PROLONGED SECOND STAGE 1 31.09.11 Spontaneous delivery WIN/20/UAFLA-DWI/ 08.00AM D/ G1P0A0FT pregnancy inlabour with prolonged 2nd stage (outside)SLF vertex presentation M/ Terminate the 2nd stage with forcipal extraction 08.05 AM Female life baby, 2800g , 46 cm AS 8/9 FTAGA

16.08.11 Forcipal extraction HER/32/UA/LEL-EMR/ 04.30 PM D/ G1P0A0 FT pregnancy inlabour prolonged 2nd stage (out side) SLF vertex presentation M/ Terminate the second stage with forcipal extraction 06.00 PM Male life baby, 3200 g, 48 cm AS 8/9 FTAGA 07.07.11 LSCS oi Malposition ZUR/38/UA/ABI/RNL-RIA 04.30 AM D/ G3P2A0 FT pregnancy inlabour prolonged 2nd stage (out side) SLF vertex

presentation. M/ Abdominal delivery Tuba ligation counselling 06.40 AM Female life baby, 3900 g, 51cm AS 8/9 FTAGA POSTPARTUM HAEMORRHAGE 1 06.07.11 Brandt-Andrews manoeuvre FIT/30/UA/BRO-ATA/MFU-RNA 04.45 AM D/ P2A0 post spontaneous delivery 2 hours (outside) with early PPH c.b retention of placenta M/ Brandt-Andrews manoeuvre 05.15 AM Placenta was born, 450 g, 50 cm 17x18 cm

OTHERS 1 31.09.11 09.00 PM 03.07.11 2

Spontaneous delivery SUM/35/UA/FLA-DWI/ nd D/G1P0A0 FT Pregnancy inlabour 2 stage, SLF breech presentation P/ Vaginal delivery Female life baby, 2700 g, 49 cm A/S 8/9 FT AGA

31.09.11 Spontaneous delivery MAR/29/RA/FIF-DWI/ 09.00 AM D/ G4P3A0 FT pregnancy inlabour 1st stage active phase footing presentation with congenital defect was suspected USG(ER) EDO: - Single life foetus, breech presentation - Hypoechoic lobus with many layer at the intestinal of the baby - Biometry : BPD : 92mm, AC : 356 mm - Placenta at posterior uterine corpus - Amniotic fluid enough Sp:5,6 cm C/ FT pregnancy SLF breech presentation with congenital defect was suspected M/ antibiotic P/ Vaginal delivery 11.40 AM Female life baby, 2600 g, 50 cm A/S 8/9 FT AGA