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Case Report
Hanisah Idris
Norfarah Izzati Azman
Identity
Name : Mrs Y
Sex :
Age : 34 y.o
Religion : Islam
Race : Jawa
Address : Teluk Jambe
Anamnesis (18th of January 2014, 0650hrs)
RPS
Menstrual History
First day of LMP :-
Estimated Due Date : 22-01-2014 (ANC)
Past Medical History
Gestational Age : 40 wks HTN (-) , DM(-), asthma
Menarche : 15 thn (-), Heart Failure (-)
Menstrual Cycle : regular
Duration : 4 days Family History
Volume : 2 pads/day HTN (-) , DM(-), asthma
Dismenore : (-) (-), Heart Failure (-)
Marital Status
Married once at 14 y.o
Thorax
Mammae : Simetris, hiperpigmentasi pada kedua areola, retraksi putting -/-
Cor : Bunyi jantung I-II regular, murmur -, gallop
Pulmo : Suara nafas vesikuler, rhonki -/-, wheezing -/-
Abdomen : membesar sesuai usia kehamilan, striae gravidarum (+)
1. Examination of uterine
fundus
Symphysio- fundal
height(35cm)
2. Fetal back (right side)
3. Presenting part : vertex
4. Engagement of presenting
part (4/5)
Hodge : I-II
GDS : 100
mg/dl JPKTH, plasenta di
fundus
Resume
Wanita, 29 tahun, G2P1A0 hamil 39-40 minggu,HPHT : 09-
04-2013, TP: 16-01-2014 dirujuk bidan dengan keluhan
ketuban pecah sejak 1 hari SMRS, mengaku hamil 9 bulan,
keluhan keluar air-air sejak 18 jam SMRS. berwarna bening,
amis, banyak, tidak disertai lendir bercampur darah. keluar
tiba-tiba saat pasien bangun dari tempat tidur untuk kekamar
mandi. Keputihan sejak 3 hari SMRS.tidak banyak, putih,
gatal. mules-mules hilang timbul sejak 18 SMRS. tidak
bertambah kuat. Pasien masih merasakan gerakan janin.
Riwayat terbentur/ trauma, demam dan nyeri saat BAK
disangkal. Pasien berobat ke bidan terdekat dikatakan oleh
bidan ketuban pasien sudah pecah. Kemudian pasien di
rujuk ke RSUD Karawang.
Diagnosis
PK1 aktif pada G3P2A0 hamil 38-39minggu, JPKTH
Therapy
Observasi tanda tanda vital, HIS, DJJ dan kemajuan
persalinan.
Terapi medikamentosa ;
Ceftriaxone 2 x 1 gram IV bolus
Rencana Persalinan Per Vaginam
Prognosis
Postpartum hemorrhage28%)
heart diseases
pregnancy-induced hypertension
(or Amniotic fluid embolism )
infection
Definition of PPH
PPH is defined as blood loss of more than 500 mL following vaginal
delivery or more than 1000 mL following cesarean delivery. A loss of
these amounts within 24 hours of delivery is termed early or primary
PPH, whereas such losses are termed late or secondary PPH if they
occur 24 hours after delivery.
Major causes
Uterine atony (90%)
lacerations of the genital tract(6%)
retained placenta(3%-4%)
coagulation defects (blood dyscrasia)
Oxytocin agents
Methergine
Prostaglandin
Mechanical stimulation of uterine contraction:
intrauterine packing
Surgical methods
If massage and agents are unsuccessful:
Ligation of the uterine arteries
ligation of the hypogastric arteries
selective arterial embolization
hysterectomy
taking into account the degree of hemorrhage,the overall
status of patient,her future childbearing desires
2. Lacerations of the genital tract
(Trauma)
Causes:
Instrumented delivery (forceps)
manipulative delivery(breech
extraction,precipitous labor, macrosomia)
Types:
perineum laceration
vaginal laceration
cervical laceration
Perineum and Vaginal laceration
repair:
cervical laceration >2cm in length and be actively bleeding
laceration of vaginal and perineum
3. Retained placenta (Tissue)