Lapjag 11-17 FAD

Duty ReportAugust 11-17, 2014Consultants :dr. St. Finekri Abidin, OBGYN (C)dr. Bintari Puspasari, OBGYNdr. T. Indang Dewi, OBGYN (C)

RSGS Team August 2014

Reporting4 Caesarean sections

CAESAREAN SECTION #1

Day S OAP11/8/14DAY I22.15SCTPP

Mrs. Ella Sofhia, 41 yoMR. 129632

CC: Referred from RS Bersalin Pasutri with suspected severe preeclampsia.

Patient admitted 9 month pregnancy. Her LMP 4/12/13 (unsured) EDD 11/9/14~ 35-36 wga. ANC regularly at OBGYN (Bogor). USG at every visit, baby in good condition.Contraction (-), water broke (-), bloody show (-)

Blood pressure elevated since 2 months (140/90 mmHg), not given drugs.Frontal headache (-), nausea / vomiting (-), blurred vision (-)Active fetal movement

Menarche 12 yo, reguler, GP 3x/day, dysmenorrhea (-)

Married 1xObs history: G5P2A21999, boy 3800 g, spontaneous delivery at RSPAD2007, miscarriage, curettage at RS Bogor2009, girl 3000 g, SC at RSPAD due to cord entanglement2011, miscarriage, curettage at RS BogorThis pregnancyPhysical examinationCompos mentis, BP : 170/100 mmHg, P: 86x/m, FR 20x/m, T : 36OCBB: 90 kg, TB 169 cm: BMI 31.5 kg/m2Gen. state: Pale conjungtive -/-, abd ~ pregnancy

Obstetrical Status: FH 36 cm, head presentation, head 4/5, FHR 152I: V/U wnl Io: smooth portio, closed ostium, flr (-), flx (-).Vt: portio firm, posterior, t 3cm, closed, H I

CTG: Category 1Lab:CBC (11/8/14)9.9/31/9200/182000SGOT 35 SGPT 20 Alb 3.6Ur 19 Cr 0.6 RBG 115Na 138 K 3.6 Cl 108Ul protein +2

US exam (7/7/14)Singleton live head presentation, placenta implanted at fundus, normal implantationBPD 9,4/HC 36 / AC 37/ FL 7.4/ AFI normal/ EFW 4075G5P2A2 Term Pregnancy, singleton live fetus, previous C-section 1x, superimposed preeclampsia, susp macrosomia, not in labor

P: Observe hemodynamics, contractions, FHRObserve worsening of preeclampsia

Emergency CSMgSO4Nifedipine 4 x 10 mgNAC 3 x 600 mg POVit C 2 x 400 mg IV

02.00 03.00LUS free of adhesionBorn baby boy, 4050 gr, 54 cm AS 8/9Clear amniotic fluidPlacenta born completely

FP : Tubectomy Pomeroy

Hb Post op: 9.8 g/dl

Outcome:Now patient (130/90 mmHg) and baby are in good condition, already discharged


Mrs. Dwi Novianti, 33 yoMR. 242324

CC: irreguler contraction since 5 hours before admission

Patient admitted 9 months pregnancy. Her LMP 12/11/13 (unsure) EDD 19/8/14~ 39 wga. ANC regularly at KesDip Tangerang then referred to RSGS. USG 4x, baby in good condition.Contraction (-), water broke (-), active fetal movement

Blood pressure elevated since previous pregnancy. In RSGS policlinic patient got Methyldopa 3x500 mg and was already consulted to internal medicine dept, already plan for elective c-section at 18/8/2014

Frontal headache (-), nausea / vomiting (-), blurred vision (-)


Married 1xObs history: G2P12005, SC at RSPAD due to breech presentation, girl 2500 g.This pregnancyPhysical examinationCompos mentis, BP : 160/110 mmHg, P: 84x/m, FR 18x/m, T : 36OCGen. state: Pale conjungtive -/-, abd ~ pregnancy

Obstetrical Status : FH 30 cm, head presentation, head 4/5, FHR 146I: V/U wnl Io: smooth portio, closed ostium, flr (-), flx (-).Vt: portio firm, posterior, t 3cm, closed, H I

CTG: Category 1Lab:CBC (11/8/14)10.7/32/14000/395000SGOT 16 SGPT 19 Alb 3.9Ur 19 Cr 0.6 RBG 83Na 140 K 3.9 Cl 106Ul protein +2

US exam (7/7/14)Singleton live head presentation, placenta implanted at right corpus, normal implantationBPD 8.8/HC 314/ AC 330/ FL 76/ AFI 3.5 SP / EFW 3000G2P1 38 wga, singleton live fetus, severe preeclampsia, previous CS 1x

P: Observe hemodynamics, contractions, FHRObserve worsening of preeclampsia

Emergency CSMgSO4 Nifedipine 4 x 10 mgNAC 3 x 600 mg POVit C 2 x 400 mg IV

12/8/1414.30 15.30Anterior part of uterus was adhered to omentum AdhesiolysisBorn baby girl, 2780 gr, 49 cm AS 8/9Clear amniotic fluidPlacenta born completely

FP: IUD TC


Outcome:Now patient (BP 130/90 mmHg) and baby are in good condition, ready for rooming in


Mrs. Arum A, 31 yoMR. 419713

CC: irreguler contractions and bloody show since 1 day before admission

Patient admitted 9 months pregnancy. Her LMP 10/11/13 EDD 17/8/14~ 39 wga. ANC regularly at RSGS. USG 3x, baby in good condition. Planned for elective CS on 19/8/2014 due to HbsAg(+)Water broke (-), active fetal movement

Menarche 13 yo, reguler, GP 2-3x/day, dysmenorrhea (-)

Married 1xObs history: G3P1A12008, miscarriage2011, girl 2600 g, spontaneous delivery at RSAL.This pregnancyPhysical examinationCompos mentis, BP : 100/70 mmHg, P: 92x/m, FR 18x/m, T : 36OCGen. state: Pale conjungtive -/-, abd ~ pregnancy

Obstetrical Status : FH 32 cm, head presentation, head 4/5, FHR 146, his 1-2 x/10/40I: V/U wnl Io: smooth portio, closed ostium, flr (-), flx (+).Vt: portio firm, axial, t 2 cm, 2 cm dilatation, head H I-II

CTG: Category 1Lab:CBC (7/8/14)10.6/31/11830/221000SGOT 20 SGPT 19 Ur 14 Cr 0.6 RBG 79Ul wnl

US exam (7/7/14)Singleton live head presentation, placenta implanted at leftcorpus, normal implantationBPD 90/HC 311/ AC 344/ FL 71/ AFI 12 / EFW 3159Latent phase of labor in G3P1A1 38 wga, singleton live fetus, HbsAg reactive

P: Observe hemodynamics, contractions, FHR

Emergency CSConsult to perinatology for HepB Ig

12/8/1420.00 21.00Born baby boy, 3100 gr, 50 cm AS 8/9Clear amniotic fluidPlacenta born completely


Outcome:Now patient and baby are in good condition, already discharged

The mechanism of MTCT remains unclear. Most MTCTs likely occur perinatally by microperfusion of maternal blood to the fetal circulation during the uterine contractions and tearing of the placenta at birth. Other possible modes of infection include swallowing amniotic fluid, vaginal secretions, or exposure to maternal blood during VD.


Mrs. Grace A, 26 yoMR. 440720

CC: Referred from Tebet PHC due to prolonged active phase of labor

Patient admitted 9 months pregnancy. Her LMP 29/10/13 EDD 5/8/14~ 41 wga. ANC regularly at PHC. Contraction (+) since 10 hours, water broke (+) 18 hours. Active fetal movement

Patient was given oxytocin drip 24 drip/minute for 12 hours at PHC. Dilatation 4 cm 6 cm 7 cm 7 cm (every 4 hours)


Married 1xObs history: G1This pregnancyPhysical examinationCompos mentis, BP : 110/50 mmHg, P: 90x/m, FR 18x/m, T : 36.5OCGen. state: Pale conjungtive -/-, abd ~ pregnancy

Obstetrical Status : FH 33 cm, head presentation, head 2/5, FHR 156, his 1-2x/10/45I: V/U wnl Vt: portio thin, 7 cm dilatation, head H II-III, small fontanel left-transverse

CTG: Category 1Lab:CBC (13/8/14)12.6/36/24000/226000SGOT 3 SGPT 20 Ur 15 Cr 0.6 RBG 108Ul protein wnl

US exam (7/7/14)Singleton live head presentation, placenta implanted at anterior corpus, normal implantationBPD 91/HC 314/ AC 310/ FL 79/ AFI 4.1 / EFW 3100Inertia of active phase of labor in G1 40-41 wga, singleton live fetus

P: Observe hemodynamics, contractions, FHRObserve signs of intrauterine infection and cord compression

Initial plan: vaginal deliveryAcceleration with Oxytocin 5 IU/500 cc RL, start at 8 tpm, escalated 4 tpm/30 mins until adequate contractions or max 40 tpm.

Ceftriaxone 1 x 2 g IV

Day S OAP13/8/14DAY I21.00

13/8/14DAY I22.00

13/8/14DAY I24.00

14/8/1402.00

Oxytocin drip is administered (8 tpm)

Frequent contractions, active fetal movement



His 3-4 x /10 / 45FHR 142 dpm

Physical examinationCompos mentis, BP : 110/70 mmHg, P: 86x/m, FR 18x/m, T : 36.5OCGen. state: wnlObstetrical Status : FHR 150, his 4x/10/45I: V/U wnl Vt: complete cm dilatation, head H III, small fontanel left-transverse

Physical examinationCompos mentis, BP : 120/80 mmHg, P: 90x/m, FR 18x/m, T : 36.5OCGen. state: wnlObstetrical Status : FHR 150, his 4x/10/45I: V/U wnl Vt: complete cm dilatation, head H III, caput H III+, small fontanel posterior

Adequate contractions on active phase of labor in G1 40-41 wga, singleton live fetus

Second stage of labor in G1 40-41 wga, singleton live fetus

Distosia of second stage of labor in G1 40-41 wga, singleton live fetus

Sustain oxytocin drip, evaluate after 3 hours

Observe hemodynamics, contractions, FHR

Management of second stage

Emergency CS

03:00Born baby girl, 3150 gr, 50 cm AS 8/9Nil amniotic fluidPlacenta born completely

Now patient and baby are in good condition already discharged

Partograph from PHC Tebet

CTG Category 1

THANK YOU

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Lapjag 11-17 FAD