Crs Bayu Ppt

8/18/2019 Crs Bayu Ppt

1/28

CASE REPORT

TOTAL PLACENTA PREVIA

Supervisor

dr. Mutawakkil JP, SpO

Prese!ted "#$

"a#u Ewa!%%a &'('))''*''+


2/28

Introduction

ANTEPARTUM HEMORRHAGE

THE MOST COMMON IS PLACENTA PREVIA

TYPE OF PLACENTA PREVIA• Partial placenta previa

• Marginal placenta previa

• Ttal placenta previa

• L!"l#ing placenta


3/28

Patient’s Identity

Na$e % Mr&' Y

Age % () #

Et*nic % S+n,ane&e

Natinalit# % In,ne&ian

Gra,+ate % Strata )

Occ+patin % Teac*er

-ate . A,$i&&in % Oct/er )( t*0 12)3


4/28

Husband’s Identity

Na$e % Mr&' U

Age % (1 #

Et*nic % S+n,ane&e

Natinalit# % In,ne&ian

Gra,+ate % Strata )

Occ+patin % E$pl#e


5/28

Chief complaint

Patient G1P)A2 c$plaint& t*at &*e get vaginal /lee,ing


6/28

Chararacteristic of this chiefcomplaint

Since 1 *+r& /e.re t*e arrive, in

*&pital

Painle&& *e$rr*age

S+,,enl# *e$rr*age

Cntractin 456

Fetal $ve$ent 456


7/28

History of past illness

N *i&tr# . H#perten&in

N *i&tr# . -ia/ete& Melit+&

Alerg# t egg an, &ea.,

N *i&tr# . He$atlg# -e&ea&e

N *i&tr# . 7i,ne# -i&ea&e

N *i&tr# . Tra+$a

N *i&tr# . Operatin

Fa$il# *i&tr# % ,enie,


8/28

Menstrual history

Menarc*e % )( #

Men&tr+al c#cle % 18 ,a#&

La&t $en&tr+al peri, % Marc* )3t* 12)3

Cntraceptin *i&tr# %Cntraceptive in9ectin


9/28

Gestational history

C-ildestatio!al

a%e &o!t-

"irt- wei%-t &/

a!d le!%t- &L 0ears La1or

A%e o23-ildre!

ears

1

ater$: % ((22 gr

L % Frget12)2 Spntane+& 3

( T*i&

pregnanc#


10/28

Physical examination

general cn,itin % $,eratel# ill

Level . cnci+&ne&& % c$p& $enti&

Vital &ign&

/l, prea&&+re % )22;03C

?,# !eig*t % 33 @g

?,# *eig*t %)32 c$

?MI % 11 @g;$(


11/28

General examination

E#e& % ane$ic cn9+ngtiva ";" icteric &clera ";"

M+t* % !et $+c&al $+c+&

T*ra=

*eart % *eart &+n,& I an, II0 $+r$+r "0 gallp "

l+ng % ve&ic+lar /reat* &+n,& 5;50 r*nci ";"0 !*eeing ";"

A/,$en

In&pectin % Cnve=

A+&@+ltatin % nr$al range

Palpatin % ten,erne&& 4"60 -e.ence M+&c+lar 4"6

Perc+&&in % Dull 4560 &*i.ting ,+llne&& ";"

E=tre$itie& % E,e$a ";"0 CRT B 1 &ecn,


12/28

Obstetric examination

In&pectin% cnve=0 &triae gravi,ar+$ 456

Palpatin Lepl, I % TFU 1>c$0 /reec*

Lepl, II % .etal /ac@ i& at t*e rig*t &i,e an, .etal

e=tre$ita& i& at t*e le.t &i,e

Lepl, III % .etal *ea,

Hi& % 456 A+&@+ltatin % .etal *eart )(8=;$enit0 reg+ler


13/28

Laboratorium ndings

*e$atlg#H/ % 80) g;,L

Le+@c#te % D822 ;L

He$atcrit % 1 Eritrc#te % (01 9+ta; L

Eritrc#te in,e= MCV % .L

MCH % 13 pg

MCHC % (( g;,L

Tr$/c#te % ()


14/28

upporting examination

4S RES4LT &O3to1er '5t- ()'*

Single .etal0 li.e0 *ea, pre&entatin0 gravi,

(1"(( ge&tatin !ee@&0 placenta at

p&terir crp+& cl&e all . OUI'

Ttal placenta previa


15/28

!I"G#OI G1P)A2 gravi,a (1"(( ge&ta&inal !it*

pla&enta previa ,an ane$ia0 &ingletn

.etal0 li.e0 *ea, per&entatin'


16/28

Management andtherapy Attac* in.+&in0 cat*eter0 r+tine /l, la/

te&t&0 prvi,e ) PRC NST

Ni.e,ipine ( = 12$g

E=pectative care


17/28

$ollo% &p'

st

da# 2ollow up $ o3t '6

t-

()'* (

!d

da# 2ollow up$ o3t '7

t-

()'* 6

rd

da# 2ollow up $ o3t '*

t-

()'*

S% !a& < $nt*& pregnant0 vaginal /lee,ingO%7U% l@& ill /eing A!arene&&% c$p&$enti&T- )12;820 N 88=0 12= R0 S (8032CIn&pectin% /+lge0 &triae gravi,ar+$ 456palpatinLepl, I% TFU 1>c$0 palpa/le &.t part& an,

le&& r+n,Lepl, II% Palpa/le *ar, part rig*t &i,elengt*!i&eLepl, III% Palpa/le *ar, part&0 r+n, an,/+nc#I$pre&&in% t*e lcatin . t*e *ea,0 /ac@rig*tHi& 456 A+&c+ltatin% ?A )(8= ; $in0 reg+lar e=a$inatin in&pe@+l

Are nt ,nee=a$inatin In Are nt ,neE=a$inatin . H/% D'< g ; ,l A% G1P)A2 gravi,a (2"() !ee@& !it* PPTan, ane$ia% La/ I an, II0 NST0 Ni.e,ipine0 Ra!ate@&pe@tati.

S% $+le& an, e=it vaginal/lee,ing &lig*tl#O%7U% $il, pain A!arene&&% c$p&$enti&

T- )22;2C- )2= ; $in+te0 *i& 456 A% G1P)A2 gravi,a (2"()!ee@& !it* PPT an, ane$ia% .+rt*er interventin0 /&-A0 ni.e,ipine (=10 /&

general cn,itin0 vital &ign&0/e,re&t0 , v+lva *igine

S% $+le& rarel#O%7U% G, A!arene&&% c$p&$enti&T- ))2;02C-A% )1= ; $in

A% G1P)A2 gravi,a (2"()!ee@& !it* PPT an,ane$ia

P% F+rt*er interventin


18/28

$ollo% &p cont'7

t-

da# 2ollow up $ o3t '+

t-

()'* *

t-

da# 2ollow up$ o3t '5

t-

()'* +

t-


t-

()'*

S% $+le& 456 O% 7U% G, A!arene&&% c$p&$enti& T- )22;=0 1= R0S (>2C a/,$en% TFU% 1> c$ FHR% )>= ; $in ?lee,ing 1 +n,e,erpa, A% G1P)A2 gravi,a (2"()

$ngg+ !it* PPT an,ane$ia % .+rt*er interventin0nipe,ipine (=)

O/&ervatin& in V7S% /lee,ingI a$ g, A!arene&&% c$p&$enti&T- ))2;2CHi& 4"6 TFU% 1>c$-A% )1 = ; $inLa/% H/ 8')0 le+ D8220()


19/28

$ollo% &p cont'5

t-


t-

()'* 8

t-

da# 2ollow up$ o3t ()

t-

()'* 9

t-

da# 2ollow up $ o3t ('

st

()'*

S% patient &a# nc$plaint&O%7U% g, A!arene&&% c$p&$enti&T- ))2;2CHi& 4"6-A% )1 = ; $in A% G1P)A2 (1"(( !ee@&gravi,a !it* placenta

previa ttali& pr SC% .+rt*er interventin0cr&&$atc* 4560 ?l,PRC0 S*ave 456SC 12 Oct 12)3 at )2

S% /lee,ing0 n ,iine&&0 n$+le&0 .etal $ve$ent& 4560le+@rea 4"60 ?A7 ; ?A? &$t*l#0n .ever0 g, appetite0 pain 4"6O%7U% g,

A!arene&&% c$p&$enti&T- ))2;


20/28

$ollo% &p cont'')

t-

da# 2ollow up $ o3t ((

!d

()'* ''

t-

da# 2ollow up$ o3t (6

rd

()'*

S% ten,erne&&0 ten,erne&&O% 7U% $,erate painCn&ci+&ne&&% CMT- ))2;


21/28

Case analysis

)' H! i& t*e ,iagn&i& . t*i& patientJ

1' H! i& t*e $anage$ent . t*i& patientJ

(' :*at are t*e c$plicatin& t*at can cc+r t*i&

patientJ


22/28

Case analysis

)' -iagn&ing placenta previaT-eor# Case

A!a!esis$/lee,ing

!it*+t painOcc+rre, a.ter t*e Mnt* <?lee,ing i& repeate, an, increa&ingl#$an#Fre&* re, /l,T*e l!e&t part . t*e c*il, i& nt a/le t

apprac* t*e inlet A/nr$alitie& la#+tHi&tr# c+rettage r cae&arean &ectin

A!a!esis $?lee,ing .r$ t*e /irt* canal

?lee,ing cc+rre, 1 *+r& SMR&'Patient& &ai, t*at n! &*e !a& < $nt*&pregnant'?lee,ing cc+r& &+,,enl# an, $an#0&+c* a& .re&* /l,'Patient& al& .eel *eart/+rn ari&ing .r$ 1

*+r& SMR&'Fetal $ve$ent i& &till perceive,


23/28

T-eor# Case

P-#si3al e:ai!atio! $Uterine ten,erne&&0 a/,$inal ten&inan, n ten,erne&&palpa/le cntractin

T*e l!e&t part . t*e c*il, & *ig* t*at itcan nt pa&& t*e l!e&t part . t*e pelvi&

Spe3ulu e:ai!atio!$Vi&i/le /l, c$ing +t . t*e &e@&tern+$

Va%i!al e:ai!atio!$Frni&e& e=a$inatin can al& /e ,ne%Palpa/le &.t c+&*in /et!een +r .inger&an, *ea, t *ea, pre&entatin

P-#si3al e:ai!atio!$S.t +ter+&0 &t$ac* ,e& nt .eel tig*t0an, n pain

i!spekulo Are nt ,nee:ai!atio! 2or!i3es

Are nt ,ne


24/28

T-eor# Case

"ia!ual e:ai!atio!Onl# per.r$e, in t*e perating r$rea,# .r &+rger# i$$e,iatel#':ill /e per.r$e, nl# !*en active

t*erap#

Supporti!% i!vesti%atio! $Ultra&ngrap*# 4USG6'tran&a/,$inal +ltra&+n,tran&vaginal +ltra&+n,

MRI

"ia!ual e:ai!atio! Are nt ,ne

Supporti!% i!vesti%atio!$USGLive &ingle .et+& lie& t*e *ea,0 ge&tatinalage (1"(( !ee@&0 t*e placenta cver& t*e

entire p&terir crp+& OUI' T?A% )8>gr I$pre&&in placenta previa ttali&


25/28

(' Management

T-eor# Case

Active t*erap#0 Se@&i Cae&area - ter$inatin /# cae&arean &ectin


26/28

)' Complication

Ane$ia an, &*c@

Placenta accreta0 increta0 per@reta

A/erratin c*il,ren

Pre$at+re /irt* an, .etal ,i&tre&&


27/28

Conclusion

)' T*e ,iagn&i& can $a,e /# t*e *i&tr#0

p*#&ical e=a$ an, a,,itinal e=a$

1' C"&ectin !a& c*&en ,+e t ttall#

placenta previa

(' C$plicatin n t*i& patient i& ane$ia


28/28

T;AN< 0O4

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