Obstetric Chief on duty: Dr. Hendra Sugama SaputraMonday, December 1st, 2014 at 07.00 AM - Tuesday, December 2nd, 2014 at 07.00 AM

Consultant on duty: Dr. H. Iskandar Zulqarnain, SpOG(K)

1 01.12.2014 Conservative managementMrs.IND/23/UA/LAT/SAN

05.30 PM D/ G2P1A0 34 weeks gestational age not inlabor with PROM 16 hours SLF cephalic presentation + moderate anemia

Hb: 7.6 g/dlWBC : 13.500/mm3

Plt : 198.000/µLCRP (-)

US ER (IDA) :- SLF cephalic presentation- Fetal biometry :

BPD 8,49 cm FL 6,21 cm HC 29,8 cm EFW 2160 g AC 29,2 cm

- Amniotic fluid AFI 1,08 0,80 = 6,06 cm

2,12 2,06

- Placenta at anterior of uterine corpusC/ 34 weeks gestational age SLF cephalic presentation M/ Conservative management Nifedipine 10 mg tab / 6 hours Ampicillin 1 g iv (ST)/6 hours Dexamethason inj 12 mg / 24 hours (2 days) PRC transfusionP/ US confirmation

US (PM) :- SLF cephalic presentation- Fetal biometry :

BPD 8,05 cm FL 6,68 cm HC 30,58 cm EFW 2182 g AC 29,47 cm

- Amniotic fluid AFI 1,16 0,36 = 2,95 cm

0,76 0,67

- Placenta at anterior of uterine corpus- There was 2x umbilical cord strangulation- BPP : FM 2 FB 2 FT 2 ICA 0 NST 2 8- Cervical length 2,4 cm

C/ 34 weeks gestational age SLF cephalic presentation + BPP 8 + cervical length 2,4 cm + 2x umbilical cord strangulation + oligohidramnios

2.

01.12.14 Conservative management Mrs. FEN/28/RA/LAT/ASN

08.20 PM D/ G1P0A0 33 weeks gestational age not inlabor with PROM 9 hours SLF cephalic presentation

Hb: 11.4 g/dlWBC : 21.700/mm3

Plt : 343.000/µLCRP (-)

US ER (IDA) :- SLF cephalic presentation- Fetal biometry :

BPD 8,4 cm FL 6,17 cm HC 28,9 cm EFW 1840 g AC 27,5 cm

- Amniotic fluid AFI 1,12 1,03 = 5,17 cm 1,35 1,67

- Placenta at posterior of uterine corpusC/ 33 weeks gestational age SLF cephalic presentation M/ Conservative management Nifedipine 10 mg tab / 6 hours Ampicillin 1 g iv (ST)/6 hours Dexamethason inj 12 mg / 24 hours (2 days)P/ US confirmation

US US confirmation (PM):- Single life fetus cephalic presentation- Biometry : BPD : 7.72 cm AC : 24.04 cm EFW : 1408 g HC : 28.33 cm FL : 6.36 cm- Placenta at anterior of uterine corpus - Amniotic fluid was decreased, AFI : 3.16 cm- IUGR was suspected- BPP : 8C/ 31 weeks gestational age SLF cephalic presentation + IUGR was suspected + oligohydramnios + BPP 8

3.

02.12.14 LSCS due to fetal distress Mrs. ELA/18/RA/SUG/MRZ

03.30 AM D/ G1P0A0 38 weeks gestational age inlabor 1st stage active phase with history of ROM 1 day

1

FHR I : 188 x/mFHR II: 182 x/m

FHR III : 179 x/m

SLF breech presentation + fetal distress

M/ Intrauterine rescucitation: lateroposition, O2 5l/m Laboratory examination Ceftriaxone inj. 2 x 1 g iv (ST)P/ Abdominal delivery

Consult to consultant on duty agree for abdominal delivery

04.20 AM Female live baby was born, BW 3000g, BL 47cm, AS 7/9 FT AGA

04.23 AM Placenta was delivered completely, PW 520 g, umbilical cord length 48cm, Ø 19x20cm

02.12.1406:00 AM

Mother and baby were in good condition

4.

29.11.14 LSCS due to impending eclampsia Mrs.IPA/34/RA/SUG/GIN

01.00 PM GI : 6

D/ G3P2A0 31 weeks gestational age not inlabor with severe preeclampsia SLF breech presentation

Hb : 9.3 g/dlPlt : 221.000/µLSGOT : 21U/LSGPT : 13 U/LLDH : 358 U/L

M/Expectative management MgSO4 inj. protocol Nifedipine 10 mg / 8 hours Evaluation with gestosis task Consult to Internal Departement, Ophthalmology

01.12.1412.45 PM

US (PM): - SLF breech presentation- Fetal biometry :

BPD 7,74 cm FL 5,79 cm HC 27,82 cm EFW 1245 g AC 22,47 cm

- Amniotic fluid was enough- Placenta at anterior of uterine corpus- BPP : FM 2, FB 2, FT 2, ICA 2, NST 0 8

C/ 32 weeks gestational age SLF breech presentation + BPP 8 +IUGR was suspectedConsult to supervisor fetomaternalAdvice : Lung maturation 2 days Terminated the pregnancyP/ Elective cesarean section (Tuesday, 2 December 2014)

02.12.1401.00 AM

G3P2A0 31 weeks gestational age not inlabor with impending eclampsia SLF cephalic presentation

GI : 4 M/ Terminate the pregnancy (abdominal delivery)

Consult to consultant on duty : agree for abdominal delivery

10.50 AM Male live baby was born, BW 1200g, BL 37cm, AS 8/9 FT SGA

10.55 AM Placenta was delivered completely, PW 210 g, umbilical cord length 35 cm, Ø 14x15cm

02.12.14 Mother and baby were in good condition

5.

02.12.14 LSCS due to fetal distress Mrs. IIN/24/UA/SUG/MRZ

04.30 AM D/ G1P0A0 42 weeks gestational age inlabor 1st stage latent phase with PROM 2 days SLF

2

FHR I : 188 x/mFHR II: 182 x/m

FHR III : 170 x/m

cephalic presentation + fetal distress

M/ Intrauterine rescucitation: lateroposition, O2 5l/m Laboratory examination Ceftriaxone inj. 2 x 1 g iv (ST)P/ Abdominal delivery

Consult to consultant on duty agree for abdominal delivery

06.50 AM Male live baby was born, BW 3000 g, BL 49 cm, AS 8/9 FT AGA

06.55 AM Placenta was delivered completely, PW 510 g, umbilical cord length 49 cm, Ø 18x19cm

02.12.14 Mother and baby were in good condition

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