MORNING REPORTThursday, December 17th, 2015 at 03.30 PM –

Friday, December 18th, 2015 at 07.00 AM

Physiologic obstetrical patient : - casePathologic obstetrical patient : 3 casesGynecological patient : - casesPassed Away : - casesTotal patient : 3 cases

Obstetric ward patients : 20 patientsGynecology and Oncology ward patients : 49 patientsICU patient : 1 patientTotal Patients : 70 patients

OBSTETRICS1. 17.12.2015 Plan for vaginal delivery

Mrs.RIN/32/UA/TMS 23.49 PM D/ G2P1A0 42 weeks gestational age not inlabor SLF cephalic presentation

BS : 3US ER (FIT) :- SLF cephalic presentation- Fetal biometry : BPD : 98.2 mm FL : 76.1 mm HC : 330 mm EFW : 3620 g AC : 354 mm- Placenta at fundal of uterine- Amniotic fluid was enough, SP : 3,6 cmC/ 40 weeks gestational age SLF cephalic presentationM/ Observed vital sign, FHR, contraction IVFD RL gttt xx/m Laboratory examination Cervical ripening with misoprostol 25 ug/ 6 hours Evaluate with partograph WHO modified (active phase)P/ US Confirmation

2. 18.12.15 Spontaneous delivery

Mrs. SUL/40/UA/TMS01.15 AM

Ø 9 cmD/ G1P0A0 38 weeks gestational age inlabor active phase with history of ROM 6 hours + intrapartum infection SLF vertex presentation

Leu: 20.000 /mm3

CRP qual: (+)LEA: (-)

M/ Observed vital sign, FHR IVFD RL gtt xx/m Inj. Ampicilin 1 g/6 hours IV Laboratory examinationP/ Vaginal delivery

02.45 AMD/ G1P0A0 38 weeks gestational age inlabor 2nd stage with history of ROM 7 hours+ intrapartum infection SLF vertex presentationM/ Conduct the labor

02.55 AM Female life baby was born, BW 2600 g, BL 48 cm, AS 3/5 FT AGA

03.05 AM Placenta was delivered completely with PW 480 g, UCL 48 cm, Ø 18 x 19 cm

07.00 AM Mother were in good conditionBaby were sent to NICU

3 18.12.15 Medicinalis Mrs. DEW/19/RA/TMS

02.33 AMHb : 13,6 g/d

WBC : 28400/mm3

Plt /mm3

D/ P2A0 post spontaneous delivery 10 hours (outside) with eklampsia postpartum

STV : 15GCS: 13

M/ Observed vital sign 02 10 l/m (NRM) Stabilization 6 hours IVFD RL gtt xx/m Inj. MgSO4 20% (iv) Inj. Ceftriaxone 1gr/12 hours Metronidazole fls 500 mg Laboratory examination Consult to P1, Internal Department, Opthalmology Department, Neurology Department Consult to ICU