PPDS OBGIN FK UNAND/

RS.Dr.M.DJAMIL PADANG
VISI

Menjadi Institusi Pendidikan Dokter Spesialis yang Professional dan Bermartabat, yang Menghasilkan
Dokter Spesialis Obstetri dan Ginekologi yang Kompeten dan Bermoral Tinggi

MISI

1. Pengelolaan IPDS yang Taat Azas

2. Mengembangkan Staf Edukasi yang Paham, Kompeten, Berintegritas, dan Bermoral Tinggi dalam
Melaksanakan Pendidikan Dokter Spesialis Obstetri dan Ginekologi
3. Memiliki Sarana dan Prasarana yang Memadai
4. Menciptakan Atmosfir Pendidikan yang Humanis, Nalar, Kreatif, dan Kondusif
5. Menghasilkan Penelitian-Penelitian yang ikut Mewarnai Perkembangan Ilmu dan Profesi Obstetri dan
Ginekologi
6. Melaksanakan Pengabdian Masyarakat yang Bersifat Solutif Terhadap Permasalahan Obstetri dan
Ginekologi Mendasar yang Ada di Masyarakat
7. Menghasilkan Lulusan yang Menjadi Panutan Semua Pihak
CASE REPORT
N0
Identity
Name : Mrs.P
Age : 32 years old
MR No. : 97 51 23
Address : West Pasaman
Date : April 6th , 2017
History taking :
A 32 years old patient was admitted to
the Delivery Room of Dr. M. Djamil Central
General Hospital on April 6th, 2017 at 03.20 am,
was reffered from West Pasaman General
Hospital, diagnosed with G4P3A0L1 preterm
pregnancy 35-36 week + antepartum
eclampsia in MgSO4 regiment maintenance
dose
Present Illness History :
Previously before admitted to RSMJ, patient visited
primary health care to control her pregnancy, she had a
high blood pressure (180/110 mmHg) therefore she was
referred to West Pasaman Yarsi Hospital, a high blood
pressure was found (180/100 mmHg), then patient got
seizure twice, duration was 1 minute. The patient got
initial dose, maintenance dose of MgSO4 and anti
hypertension then patient was referred to Dr. M. Djamil
Central General Hospital with MgSO4 regiment without
catheter.
blurry vision (+) Feeling of headache (-),, no complain
of epigastrium pain
Feeling of pain from waist to region (-)
Bloody show from the vagina (-)
Fluid leakage from the vagina was (-)
 No massive vaginal bleeding.
Amenorrhea since 8,5 months ago.
First date of last menstrual period was forgotten
( early August 2016)
Estimation date of delivery cant be predicted
(Early May 2017)
Fetal movement was felt since 3 months ago
No complain of nausea, vomitting and vaginal
bleeding neither during early and late
pregnancy.
Prenatal care to midwife and primary health
care regulary every month since 3 month age
of pregnancy, during control blood pressure
was never high
Menstruation History : menarche at 13
years old, irregular cycle, every
month which last for about 3-7 days each
cycle with the amount of 2-3 times pad
change/day without menstrual pain
Previous Illness History :
There wasnt previous history of heart, lung, liver,
kidney, DM and hypertension and allergy

Family Illness History :

There wasnt history of hereditary disease, contagious
and psychological illness in the family.
Marriage history : once in 2007
History of pregnancy/abortion/delivery : 4/0/3
1. 2008/male/BB?/8 month/spontan/Yarsi/iufd
2. 2009/female/2500gr/term/spontan/bidan/life
3. 2016/male/6 month/spontan/dr.spog/iufd
4. present
History of family planning : (-)
History of immunization : (-)
History of education : bachelor
Hystory of occupation : teacher
Physical Examination :
GA Cons BP PR RR T urine Patella
reflex

moderate composmentis 170/120 84 20 36,5 100cc/time +/+

BW before pregnancy: 60 kg
BW during pregnancy : 90 kg
BH : 158 cm
BMI : 24 normoweight
Arm circumference : 20 cm
Patella reflex : +/+
Proteinurine ; (+++)
Urine : 100 cc/time
Eyes Conjunctiva wasnt anemic,
Sclera wasnt icteric
Neck JVP 5-2 cmH2O, tyroid gland no enlargement
Chest H/L normal
Abdoment OR
Genitalia OR
Extremity Edema -/-
Obstetric Record :
Abdoment :
I Enlarge accordance with preterm pregnancy, median
line hyperpigmentation, striae (+), cicatrix (-)
Pa :
L1: FUT was palpable between umbilical and proc xyphoideus
Round and hard mass was palpated,
L2: The hard resistence in the left side was palpated
The small part of fetus in the right side was palpated
L3 : Soft and noduler was palpated
L4 : not performed
Pe:tymphani
Au: normal peristaltic sound
FHR : 130-140x/i
Genitalia
I :V/U normal, Vaginal bleeding (-)
Ultrasonography
Ultrasonography
Fetal alive singleton intrauterine, breech
presentation
Good movement activity
Biometry :
BPD : 834 mm FL : 628 mm
AC : 336 mm
EFW : 2649 gram
Placenta was implanted at anterior fundal
Gr II-III,
Impression : preterm pregnancy
Fetal alive
 Ophtamologist
impression :
there was mild eclampsia fundus signs
th/ according obgyn departement
Cardiologist
impression : antepartum eclampsia at G4P3A0L1
th/ Metildopa 3 x 500 mg if blood pressure >160mmHg
Adalat oros 1 x 30 mg
 Neurologist
Acute Simptomatic seizure
th/ according obgyn departement
 Laboratory Finding
Laboratory finding Normal value for 2rd TM
Routine blood testing
Hemoglobine 13,5 gr/dl 9,7-14,8
Leucocyte 19.660/mm3 5.614.8
Hematocrit 40 % 30.039.0
Trombocyte 209.000/mm3 155409
MCV 81 um3 8297
MCH 27 pg 3033

MCHC 34 g/dl 32-36

 Laboratory Finding
Laboratory finding Normal value for 2rd TM

PT 8,8 9,5-13,4
APTT 31,1 22,9-38,1
INR <1,2
D-Dimer 2705,75 <500
SGOT 45 U/L 2,00-33,00
SGPT 19 U/L 3,00-33,00
 PARAMETER RESULT REFERENCE VALUE
Calcium 8,5 mg/dl 8,2-9,0
Kalium 3,4mmol/L 3,5-5,1
Natrium 142mmol/L 136-145
Chlorida 111 mmol/L 97-109
Random blood glucose 83 mg/dl <200,00
Total protein 6,6 g/dl 5,7 6,9
Albumin 3,1 g/dl 2,6 4,5
Globulin 3,5 g/dl 2,5-3,3
LDH 678 u/l 80-447
Bilirubin Total 0,4 mg/dl 0,1-1,2
Ureum 12 mg/dl 16,6 48,5
Creatinin 0,6 mg/dl 0,6 1,1

URINE = +++
 Internist
impression : Antepartum eclampsia in SM regiment
maintenance dose from other institutions at G4P3A0L1
preterm pregnancy
Operation toleration
Cardiovascular risk : mild-moderate
Endocrine metabolic risk : unmeasured
Pulmonal risk : mild
Haemostasis risk : stabil
th/
consult anestesiologist
metildopa 3x 500 mg
advis/
joint treatment with kidney hypertention department
Diagnose :
G4P3A0L1 preterm pregnancy 35-36 week + antepartum
eclampsia in MgSO4 regiment maintenance dose from other
institution
Fetal alive, singleton, intrauterine, breech presentation
Management :
Control GA, VS, Uterine Contraction, FHR, fluid balance,
patella reflex,
Informed consent
Continue MgSO4 regiment maintenance dose
Antihypertension
Informed consent
Consult to ophtamology, cardiologiy, neurology, internae
departement
Consult to perinatology
Consult to Operation Room and anaesthesiology
Planning :

Planning :
CS
At 10.30 pm
TPPCS was performed
At 10.45 am
A female baby was born with 2500 gram in weight,
43 cm in height, Apgar score : 7/8
Placenta was born with a little pull on umibilical cord,
complete, 1 piece.
Size was 17 x 18 x 2,5 cm, weight 500 gram, length 60
cm with paracental Implantation,
Bleeding during operation 250 cc

Diagnose
P4 A0 L2 post TPPCS on indication antepartum
eclampsia in MgSO4 regiment maintenance dose
mother-Child were in care
 Laboratory Finding post op
Laboratory finding Normal value for 2rd TM
Routine blood testing
Hemoglobine 11,0 gr/dl 9,7-14,8
Leucocyte 23.930 /mm3 5.614.8
Hematocrit 33 % 30.039.0
Trombocyte 324.000/mm3 155409
PT 8,7 9,5-13,4
APTT 32,9 22,9-38,1

D-- dimer Empty reagen

 FOLLOW UP
April, 7TH 2017
S : febris (-) vaginal bleeding (-) urine (+)
Feeling of headache (-), blurry vision (-),
epigastrium pain (-)
O:
GA Cons BP PR RR T Urine Patella
reflex
moderate composmentis 140/80 84 18 37 100cc/ +/+
hour
Eye : conjuntiva anemic -/-
Abdomen : wound post operation : good
Fundal uterine palpable 3 fingers
below umbilical
contraction : good
 FOLLOW UP
April, 7TH 2017
Genitalia : I : vulva-urethra normal
vaginal bleeding (-)
A : P4A0 L2 post TPPCS on indication antepartum eclampsia day 1
P:
Control GA, VS, contraction, vaginal bleeding
Cefoperazone 2 x1 gr iv
Metronidazole 3 x500mg IV
Asam mefenamat 3 x 500mg
Methyl dopa 3 x 500mg
Adalat Oros 1 x 30mg
Sulfas ferrous 1 x1
Vitamin C 3 x 1