Case 0

• Nama : NY. M
• Umur : 34
• MR : 980214
• Alamat : Lubuk Kilangan
• A 34 years old patient was referred to M.Djamil General hospital on
June 1st 2017 at 14.00 from Midwifery Practitional with diagnose
Placental retensio
• 14.05 Blood preasue 80/ airways : paten
Consius breathing : O2 10L NRM
Pulse hard to difine Circulation : IV 2 line
monitor was apply Resisitaion
Hr : 112 BP : 100/7O
D/ Syok hypovolemic due to Post Partum Haemorage due to retensio
plasenta
• 14.30 BP: 100/70 airways : clear
Consius breathing : O2 4L via nasal canul
Pulse:112x/menit Circulation : 2 Line IV line IVFD RL
saturation : 99%

D/ resolved Syok hypovolemic due Post Partum Haemorage

previously patient was labour at midwife 3 hours ago, spotaneus
labour, whit wheigt 3500 gr , Body Lenght 51 cm, A/s 8/9.
but after baby born, placental was’t spontan born, pasien was refferd
to Private Hospital , Cause massive bleding pastinet referred to
M.Djamil General Hospital.
This is second labour, fist son was normal labour 3 years ago.
Previous Illness History
• There wasn’t previous history diseases of heart, lung, liver, kidney,
and DM before pregnancy No history of alergic

Family Illness History

There wasn’t history of hereditary disease, contagious and
physiological illness in the family
• Marriage history: once at 2013
• History of pregnancy/abortion/delivery : 1/0/0
1. 2014,3100gr,Male,Spontan,Midwife,Life
2. Present
• History of family planning :-
• History of immunization : -
GA Cons BP PR RR T
Moderate CMC 100/70 112 24 37

BW BH BMI Patella rf Σ urine

60/72kg 158 cm 24 normoweight +/+ N 50cc at the
time

Eyes: conjunctiva anemic,

sclera wasn’t icteric
Neck: JVP 5-2 cmH2O,
no enlargement of thyroid gland
Chest: heart within normal limit
lung : rhonci -/-, wheezing -/-
• Au : Normal Peristaltic sound

Genitalia :
I : V/U within normal limit
Umbilical Cord was looked at vulva
Abdomen
Inspection :
There was little bulging observed in lower of abdominal region
Palpation :
Uterine Fundal was palple 2 finger above umbilical,
Uterine contraction was good
Diagnose
• Resolved Hypovolemic Shock due to Post Partum
Haeorage due to Placental retensio on P2A0L2 Post
Spotaneus Labour from other institision
Management
• Control GA, VS, FHR, liquid balance, urine volume
• Informed consent
• O2 14lt/mnt via nasal canul
• Routine blood test

Plan :
Manual Placental
Laboratory
Parameter Result Reference Value
Hb 7,2 12 – 15 g/dL
Ht 23 40 – 48 %
Leucocyte 14,300 5,9 - 16,9.103 /mm3
Trombocyte 244.000 146 - 429.103 /mm3
aPTT 33,4 22.6 – 35.0 Sec
PT 11,0 9.6 – 12.9 Sec
Manual Placenta was perform
Placenta was born with manual placenta with size 17 x 15 x 2,5 cm and
weight  525 gr. Umbilical cord Insetion P/C.
Perineal laseration hectinged and treated
Diagnose :
P2A0L2 Post Manual Placenta oi Placenta Retensio from other
institution + Mild Anemia
Management
• Control GA, VS, liquid balance, urine volume
• IVFD RL ( 2amp Ocytosin + 1amp Methergine) 8hours/kolf
• Inj Cefrtiaxone 1gr
• Mefemanic Acid 3x500mg
• SF 2x300mg tab
• Vit C 2x50mg tab
• 3 unit PRC transfusion
• 02-06-2017 08.00 am
A/: Fever -, vaginal bleeding -
PF/: GA COns BP HR RR T Urine

Moderate CM 100/80 88 x/m 24 x/m afebris 100cc /

mmHg 1 jam
Abdomen : FUT 3 fingers under umbilical
contraction was good,
Genital : Inspection: Vulva and urethra were normal
D/: P2A0L2 Post Manual Placenta oi Placenta Retensio from other institution
+ Mild Anemia
Plan :
• Control GA, VS, liquid balance, urine volume
• IVFD RL
• Cefixime 2x200mg
• Mefemanic Acid 3x500mg
• SF 2x1
• Vit C 2x1
• 2 unit PRC transfusion
THANKS