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7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Supervisor : dr. Edihan, Sp. OG
Presented by :Sendy Perdana / 2011-061-008
ata!!ia "atu#ae! / 2011-061-1$%O!ivia &har'asanti / 2011-061-1$(
&epart'ent O) Obstetri* +nd Gyne*o!oyedi*a! a*u!ty O) +t'a aya niversity
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Patients and Patients Husband Identity
a'e : rs.
+e: %( y.o.
+ddress : uara "aru,
Penarinan, a3arta taraEthni* : "eta#i
O**upation : 4ouse#i)e
Edu*ation: E!e'entaryS*hoo!
5 : 28621
+d'itted : anuary 8th201%
a'e : r. +
+e : %8 y.o.
+ddress : uara "aru,
Penarinan, a3artatara
Ethni* : "eta#i
O**upation : 7or3ers
Edu*ation: unior 4ihS*hoo!
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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History Taking (1)hie) *o'p!ain :
4eada*he sin*e 9 days be)ore hospita! ad'ission.
4istory o) present i!!ness:
ive days be)ore ad'ission, she *o'p!ainedheada*he, and she *a'e to !o*a! hea!th *enter)or her (th prenan*y. n ea'ination, her b!oodpressure #as 160/110''4. She didn;t ta3eany 'edi*ine. then patient *a'e to the *!ini* #ith
the sa'e *o'p!ain, durin the ea'ination theb!ood pressure #as 180/110 ''4, then re)erredto the hospita! due to in*reasin b!ood pressure.She #as p!anned by the obyn do*tor/physi*ianto have *aesarean se*tion and and the patient
*hoose streri!i
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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History Taking (2)o "!urrin o) visions, o epiastri* pain, o
sei
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History taking (3)
=he patient had a history o) hypertension on the6thprenan*y.
o history o) a!!ery.
o history o) asth'a.
o history o) &iabetes.
o history o) trau'a.
o history o) operations be)ore.
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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History taking (4)
+ntenata! *are : >ve ti'es at hea!th *are *enter #ith
history o) hypertension ?patient does not re'e'ber
the ea*t nu'ber@
enar*he : 12 y.o.
enstrua! y*!e: reu!ar, %0 days interva!, ( days
duration , dys'enorrhea -
ontra*eption : ora! *ontra*eption, ear!y 2011
1stday o) !ast 'enstrua! Period : 1st #ee3 on +pri! 2012
?the patient )orot the ea*t date@
Esti'ated date o) de!ivery : 1st#ee3 anuary 201%
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Obstetrical History Gravida : G( P6 +0
arried : One ti'e )or 20 years.
Time Age ofPregnancy
LaborHistory
Sex BirthWeight
BreastMilk/substitute
1. 1$$% $ 'onths Spontaneousvaina!de!ivery
e'a!e 2$00 r "reast 'i!3
2. 1$$9 $ 'onths Spontaneousvaina!de!ivery
e'a!e %100 r "reast 'i!3
%. 1$$( $ 'onths Spontaneous
vaina!de!ivery
a!e 2(00 r "reast 'i!3
. 2002 $ 'onths Spontaneousvaina!de!ivery
a!e %000 r "reast 'i!3
9. 2006 $ 'onths Spontaneousvaina!
de!ivery
e'a!e %200 r "reast 'i!3
6. 2011 S ontaneous a!e
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Status praesens (1)
January 8th
2013 , at.2.00 pmGenera! *ondition : appear *a!'
Aeve! o) on*iousness : *ons*ious
"!ood Pressure : 1$0/110 ''4Pu!se : 11 beats/'inute
5espiration 5ate : 2 breaths/'inute
=e'perature : %6,%0
"ody #eiht : 62 3s"ody heiht : 1%,9 *'s
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Status praesens (2)4ead : nor'a! shape
Eyes : anane'i* *onuntiva , ani*teri*s*!era, pupi! B %''/%''
Ears : nor'a! shape, no se*ret
=eeth : appear nor'a!
e*3 : no !y'ph nodes en!are'ent
=horaa''ae
"oth are sy''etri* #ith hyperpi'entedareo!a
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Status praesens (3) or :C nspe*tion : api*a! i'pu!se
#as not inspe*ted
C Pa!pation : api*a! i'pu!se
pa!pab!eC Per*ussion:
pper side : S
Ae)t Side : !inea 'id*!avi*u!aris sinistra
5iht Side : !inea sterna!isdetra
C +us*u!tation: heart sound D , 'ur'ur ?-@,a!!op ?-@
Aun :
nspe*tion : sy''etryrespiratory 'ove'enton the both sides
Pa!pation : )re'itus ispresent on the bothsy''etri* areas
Per*ussion : sonor /
+us*u!tation :
breathin soundvesi*u!ar, no rhon*hiand #hee
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Status praesens (4)+bdo'en
nspe*tion : striae ravidaru' , !inea nira
Pa!pation : no painPer*ussion : ty'pani* in a!! reion
+us*u!tation : bo#e! sounds ?@
Etre'ity
Oede'a -/-Physio!oi* 5eFe
"i*eps / Pate!!a /
=ri*eps / +*hi!!es /
Patho!oi*a! 5eFe -/-
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Obstetrical Status (1)unda! heiht : %9 *'s
eta! birth #eiht predi*tion : %.(20 ra's
eta! 4eart "eats : 1 bp'4is : -
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Obstetrical Status (2)Aeopo!d ea'ination
Aeopo!d : )ee!s >r' but irreu!ar ?bottto'@
Aeopo!d : )ee!s ba*3 on the !e)t sideAeopo!d : )ee!s hard and round part ?head@
Aeopo!d : 9/9
eta! !ie : !onitudina!
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Obstetrical Status (3)aina! Ea'ination:
= #as not per)or'ed
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=G
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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CT!s "esult
eta! otion: 1 'otion in 20 'inutes
observation
on*!usion: &oubt S=
eta! 4eart "eats:"ase!ine : 160 bp'
+**e!eration -
&e*e!eration -
terus *ontra*tion:ontra*tion: -
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#ab$rat$ry %in&in's
(January 8th
2013)4b: $,8 /d!
4t : 2$ H
Aeu3o*yte: 10.900/I!
=ro'bo*yte : 168.000/I!
"!ood type : O/ 5h:
"!eedin ti'e: % 'inutes
!ottin ti'e: 9 'inutes"!ood !u*ose: (8 '/d!
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"!ood he'istry
SGO= / +S=: 2 /!
SGP= / +A=: 1$ /!E!e*tro!yte
Sodiu': 10 ''o!/A Potassiu': %,8 ''o!/A
a!siu': 1,1( ''o!/A
h!oride: 11 ''o!/A5ena! un*tion
rea: 11 '/d!reatinine: 0,6 '/d!
arbohydrate
5ando' G!u*ose test: 8 '/d!
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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o'p!ete rine Sedi'ent
G!u*ose: - Aeu3o*yte: -8/AP"Protein: =hree ?@ Eritro*yte: 2-9/AP"
"i!irubin: - Epite!: /APJ robi!inoen: nor'a! y!inder: -/APJ
Ph: (,0 rysta!: -
&ensity: 1010 "a*teria: -
O**u!t b!ood: Satu ?@ Others: -
Jetone: -
itrite: -
Aeu3o*yte: =hree ?@
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&mittin' ia'n$sisother :
G(P6+0, %( y.o., ravid %$-0 #ee3s, not in !abor,severe pre e*!a'psia #ith i'pendin e*!a'psia.
etus : intrauterine, sin!e, a!ive, headpresentation
Pronosis o) 'other : dubia ad bona'Pronosis o) )etus : dubia ad bona'
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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C$urse in The *ar&
On ad'ission:
Prepare )or Se*tio aesarea
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Operati$n rep$rt (1)Pre-operative dianosis:
G(P6+0, %( y.o., ravid %$-0 #ee3s, not in !abor,
severe pre e*!a'psia #ith i'pendin e*!a'psia.
C Post-operative dianosis:P(+0, %( y.o., post partus 'aturus #ith *aesarean
se*tion #ith indi*ation severe pree*!a'psia #ithi'pendin e*!a'psia and post bi!atera!
>'brie3to'y. n*ised tissue: Ao#er se'ent o) uterus
Operation na'e: =ransperitonea! Pro)unda Se*tioaesaria
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Operati$n rep$rt (3)=he patient #as !aid supine and spina! anesthesi
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Operati$n rep$rt (4)=he u'bi!i*a! *ord #as *!a'ped and haned.
=he baby handed to perinato!oy.
P!a*enta #as born at 0%.% p.', *avu' uteri#as *!eaned, then the !o#er se'ent o)
uterus bein *!osed.
+)ter the ep!oration, the operator *arried
bi!atera! >'brie*to'y.=he operation #ound #as *!osed !ayer by
!ayer.
Operation done at 0.29 p.'
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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Operati$n rep$rt (+) eta! 'e'brane #eiht is 2$$0 ra's, )eta! *ord
!enth at % *'
"i!atera! i'brie*to'y #as done
Post partu' 'other *ondition : 'oderate!y i!!
Genera! *ondition : 'oderate!y i!!
"P K 160/$0 ''4, =K %6,( o, P K 100bp', 55 K 2 bp'
undus heiht 2 *' be!o# the !eve! u'bi!i*a!,'oderate uterine *ontra*tions. =ota! b!eedin L00 **
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$st Operati$n Therapy"ed 5est )or 6 hours
astin unti! bo#e! sound , then to drin3radua!!y
& 5A 1900 **/2 hours Oytosin 20 , 10 ,10 in ea*h 5A
Jetoro!a* %90 '
e)otai' 21
he*3 4" 6 hours post op
he*3 O / hr and "a!an*e /2 hr
he*3 b!ood pressure Fu*tuation
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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#ab$rat$ry %$ll$- p6 hours post operation 4e'o!obin: $,2 r/dA
nstru*tion :
Give ero)ort =ab 1 1
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DAT S ! A P "#TAL S#$%S
2nd&ay
0$/01/20
1%
S : pain around operative #ound , !atus -,
&e)e*ation-
O : +ppear *a!' unda! heiht: one >ner
be!o# the u'bi!i*us ontra*tion;s intensity: stron
"!eedin : rubra, L0 **
+ : P(+0, %( y.o., post partus'aturus #ith *aesarean se*tion#ith indi*ation severee*!a'psia #ith i'pendin
e*!a'psia and post bi!atera!>'brie*to'y.
P : 'aintenan*e SO unti! 2 hr a'i!odipine 110 '
"P : 190/$0 ''4
P : 108 beats/'in
= : %6,2 55 : 2 breaths/'in
O : 1.01 **/3/hr
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DAT S ! A P "#TAL S#$%S
%th &ay
1$/$/2012
PO&-1
S : Pain around operative #ound ,
Fatus , de)e*ation -
O: +ppear *a!' unda! heiht : one >ners be!o# the
u'bi!i*us
ontra*tion;s intensity : stron
"!eedin : rubra, L20 **
+: P(+0, %( y.o., post partus 'aturus #ith
*aesarean se*tion #ith indi*ation severee*!a'psia #ith i'pendin e*!a'psia andpost bi!atera! >'brie*to'y.
P: hane #ith ora! therapy:
+'i!odipine 2 10 ' p.o
oa'oi*!av % 629 ' p.o
e)ena'i* +*id % 900 ' p.o Gastru! % p.o
"P : 1(0/100 ''4
Pu!se : 112 beats/'in
= : %6,
55 : 22 breaths/'in
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%inal ia'n$sisP(+0, %( y.o., post partus 'aturus #ith
*aesarean se*tion #ith indi*ation severe
pree*!a'psia #ith i'pendin e*!a'psia andpost bi!atera! >'brie*to'y.
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ase +na!ysisFrom History Taking and Pysical !"amination# $e
can conclude%
Te &atient $as ®nant'estational age 34* $eeks
+e $as in ,irst stage o, labor on admission
+e as risk ,actor o, se-ere eclam&sia $it im&ending
.o istory o, &re-iously sectio caesarea
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ase +na!ysis=he patient #as prenant
eta! heart beat positive #ith base!ine 1 bp'
Positive dianosti* sin :
Fetal eart tones can be detected as early as to 1*
$eeks ,rom te last menstrual &eriod (/0P) by
o&&ler tecnology
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ase +na!ysis'estational age 34* $eeks/ast menstrual &eriod % +pri! 2012 ?the patient )orot the
ea*t date@ -M %$-0 #ee3s
Fundal eigt 3 cm
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=G=G ea'ination :
eta! 4eart "eats:
"ase!ine : 160 bp'
+**e!eration -
&e*e!eration -
terus*ontra*tion:
ontra*tion: -
eta! otion: 1 'otion in 20 'inutes
observation
on*!usion: &oubt S=
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+na!ysis )or =Griteria )or &oubt S=eta! 'ove'ent N 2 ti'es in 20 'inutesea'ination or a**e!aration N 10 bp'
or'a! "ase!ine
riteria )or nor'a! base!ine
reuen*y 120-160 bp'
7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt
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ase +na!ysisn ana'nesa #e )ound :4eada*he sin*e 9 days be)ore hospita! ad'ission
4istory o) hypertension on the 6thprenan*y
n physi*a! ea'ination #e )ound :"!ood Pressure : 1$0/110 ''4
o epiastri* pain
Oede'a -/-n !aboratory >ndins,#e )ound :
Proteinuria
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ase +na!ysisriteria )or Severe Pre-e*!a'psia:yanosis
i*roaniopathy he'o!ysis
riteria )or 'pendin:
b!urry visionEpiastri* pain
4eada*he
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&+=O SE=O
+ES+5E+ aterna! 5epeat *esarean de!ivery
Obstru*tive !esions in the !o#er enita! tra*t,
in*!udin 'a!inan*ies, !are vu!vovaina!*ondy!o'as, obstru*tive vaina! septa, and!eio'yo'as o) the !o#er uterine se'ent thatinter)ere #ith enae'ent o) the )eta! head
arro# pe!vi* abso!ute and abnor'a!ities
?stenosis@ that pre*!ude enae'ent or inter)ere#ith des*ent o) the )eta! presentation in !abor
P!a*enta previa
&isporpotion o) *epha!ope!vi*
5upture uteri
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&+=O SE=O
+ES+5E+eta!"ree*h
&ysto*ia
eta! distress
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Se*tio aesarean )or
Pree*!a'psiandi*ation :Gestation N % #ee3s
un)avourab!e *ervi,
previous esarean se*tion,
bad obstetri* history,
)eta! distress,
)ai!ed indu*tion o) !aborintra-uterine ro#th restri*tion?Obinna +u
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anae'ent o) sei
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) no a**ess, ad'inister SO throuhdeep route:
Aoadin dose : SO 9r ?10'!@ in ea*hbutto*3 ?10r tota!@ r over 10-19'inutes
aintenan*e : SO 9r every hour Etre'e!y pain)u!, ris3 o) !utea! abs*ess
+ddition o) 1 '! o) 1H y!o*aine to the so!ution 'ayhe!p to redu*e the pain at the ine*tion site
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onitorin #hen on
SO4our!y 'onitorinPate!!ar 5eFees shou!d be present
Ear!iest sin i) toi*ity deve!ops
5espiratory 5ate M 12-16 bp'
rine Output M %0 '!/hour ?100 '! / hour@ Ensure SO is e*reted throuh the 3idneys
SO does not *ause rena! i'pair'ent / )ai!ure
O2 saturation
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THA%& '!