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56
Name : Mrs. F
Age : 27 years old
MR No. : 97 83 07
Date : Mai 10th, 2017
Chief Complaint:
A 27 years old patient was admitted to the
Emergency Room of Dr. M. Djamil Central
General Hospital on May 10th, 2017 at 16:00
pm refered by Rasyidin hospital with
diagnosed:
GA Cons BP HR RR T
Severe GCS 11 150/120 123 32 37
Palpation :
L1 Uterine fundal was palpable 3 fingers below proc.xiphoideus,
a large nodular mass was palpable
L2 hard and resistance structure was palpated on the left side.
Numerous small, irregular structure were palpated on the right side
L3 hard mass was palpable, fixed
L4 Convergen
UFH: 34cm cm; EBW: 3410 gr ; Uterine contraction : 2-3X/35/M
Percussion : Tympani
Auscultation : Peristaltic sound was normal, Fetal heart sound: 103-112
Obstetric Record
Genitalia
Inspection : v/u within normal limits, no vaginal
bleeding
Internal examination :
: 5-6cm
Amniotic sac (-), Greenish residue
Head presentation, anterior left occiput, H II-III
USG
Fetal alive, singleton,intra uterine, head presentation.
Fetal movement (+)
Biometrics :
BPD : 94,1 mm
AC : 265 mm
FL : 70,0 mm
EFW : 3345 gr
Placenta was implanted in posterior corpus grade II
Impession : 38-39 weeks term pregnancy
Fetal alive, head presentation
Diagnose :
Decrese Of Consiusnes ec Eclampsia ante
partum in MgSO4 regimen maintenance from
other institution at G1P0A0L0 term parturient
stage I active phase + Fetal distress
Fetal alive, singleton, intrauterine, head
presentation HII-III left anterior occiput.
Management :
Control GA, VS, urine, fluid balance, patela ref
continue MgSO4 regimen maintenance dose
Informed consent
O2 5 l/ nasale
Continous MgSO4 regimen
Check complete blood test + urine + hepar, kidney, Haemostatic
Informed consent
Antihypertention
Metil dopa 500mg
Antibiotics Skin test (Ceftriaxon 1gr)
report to PE team
report to operation room
consult to anestesiologyst
Crossmatch PRC, FFP, Thrombocite
Plan :
Cyto CS
cardiology :
D/severe preeclampsia in G2P1A0L1 32 weeks
pregnancy
M/methyldopa 3 x 500 mg if blood presure
>160
oftalmologist :
D/ mild fundus eclampsia has found
M/according to Obsgyn
Neurologis
D/ Eklampsi aterpartum
M/ M/according to Obsgyn
At 13.15 pm : TPPCS was perfomed
At 22.05 pm :
A male baby was born by TPPCS with 3400 gram in
weight, 50 cm in height, Apgar score : 3/4.
Placenta was born with a light traction on umibilical
cord, complete, 1 piece. Size was 17 x 15 x 12 cm,
weight 200 gram, length 40 cm.
Bleeding during operation 250 cc
D/ P1A0L1 post TPPCS on indication of eclamtia
antepartum in MgSO4 regimen maintenance dose
+ HELLP sindrome
P/Control GA, VS, FHR, urine, fluid balance, patela ref
Intensive Care Unit
Continue MgSO4 regimen maintenance dose
Ceftriaxone 2x1 gr
Dexametason 2x2amp
Misoprostol 2tab/6hours/rectal
Metil dopa if BP 140mmhg
Transfusion PRC 2unit
Transfusion Trombosit 20 Unit
Transfusion FFP 2 unit
Pronalges supp II (K/P)
Consult Internist
Internist :
D/eclampsia post CS
pregnancy in MgSO4 regimen maintenance
Sekunder DIC
HELLP sindrome,
HP Pro 2x1
Join Treatment Whit Hematologis
Join Treatment Whit Kidney & Hipertension
Join Treatment Whit Gastroenterologis
PARAMETER Laboratory findings Normal Value
Hemoglobin 14,0 gr/dl 9.5-15
Leukosit 33.360/mm3 5.000 16.000
Hematokrit 41 % 37 43
Trombosit 54.000 /mm3 150.000 400.000
APTT 51,1 detik 29,2 39,4
PT 15,5 detik 10 13,6
Ureum darah 35 mg/dl 16,6 48,5
Creatinin darah mg/dl 0,6 1,2
LDH 5142 u/l 0 480
Direk <0,20
Indirek <0,4
A/ P1A0L1 post TPPCS on indication of eclamtia in A/ P1A0L1 post TPPCS on indication of eclamtia in
MgSO4 regimen maintenance dose + HELLP syndrome MgSO4 regimen maintenance dose + HELLP syndrome
NH1 NH2
P/ Control GA, VS, FHR, urine, fluid P/ Control GA, VS, FHR, urine, fluid
balance, patela ref balance, patela ref
Check complete blood test + urine + hepar, kidney, Continue MgSO4 regimen maintenance dose
Haemostatic Ceftriaxone 2x1 gr
Continue MgSO4 regimen maintenance dose Adalat oros 1x30 mg
Transfusion trombocite 20 unit Metil dopa 3x500 mg
Transfusion PRC 2 unit Dexametason 2x2amp
Ceftriaxone 2x1 g
Metil dopa 3x500 mg if BP 140mmHg
Dexametason 2x2amp
Thank You