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OBSTETRICS INPATIENT REPORTS Sunday,August 14th, 2011until Wednesday, August 18th, 2011 Physiological patient : cases Pathological patient : cases Chief Obstetrics Inpatient: dr. Shanti Anggun D : patients dr. Sarah Rizka : patients dr. M. Fadli Rabbani : patients
Gestosis Prior CS Ante Partum Haemorrhage PROM Preterm Prolonged second stage Post Partum Haemorrhage Other TOTAL No Initial 1 2 3 4 NUR WIN ZUH ANN Age 30 25 23 20
: patients : patient : patients : patients : patient : patients : patient : patients : patients Diagnosis Treatment Forcipal Extraction Spontaneous delivery Spontaneous delivery Conservative Management LSCS Physician FIF-RYU FIF-RYU LIK-RYU FIF-RYU
Severe Preeclampsia Mild Preeclampsia Prior CS 1x + Hypertirhoid PPROM mild preeclampsia + PROM 2 hours + prior CS 1x (oi. breech presentation) threatened preterm labour + prior CS 1x + oligohidramnios + marginal placenta preave Severe Preeclampsia + Hypertiroid Prior CS Antepartum Haemorrhage Antepartum Haemorrhage Antepartum Haemorrhage
KUR
32
WEN-RYU
LIS
29
MCI-RYU
7 8 9 10 11
39 31 34 37 30
12 13 14 15 16 17 18 19 20 21 22 23
EVA SUG NUN NAN MAR ANI RIK HAD ZUR FIT RIN JUM
33 37 45 34 30 34 26 35 38 28 19 27
PROM + oligohydramnios + fetal distress PROM + transverse lie PROM + foetal distress PROM + oligohydramnios PROM Preterm Prolonged 2 stage Prolonged 2 stage Prolonged 2 stage Postpartum Haemorrhage Posterm RHD fc. NYHA III ec. MS
nd nd nd
LSCS LSCS LSCS LSCS LSCS Spontaneous delivery Vacuum extraction Forcipal extraction LSCS Brandt-Andrews manoeuvre LSCS Forcipal extraction
DEL ZAK-AM RYU FHM ABI ZAR-RYU FRN-SRK ALT-HRK ABI BRO-ATA GIT RDA-SRK
PERINATAL MORTALITY No 1 2 Initial By. KET By.HAD Age hour Diagnosis Rigor mortis Severe asphyxia Treatment Spontaneous delivery Resuscitation Physician FRN-SRK ALT-HRK
GESTOSIS 1 30.09.11 Forcipal Extraction JUN/36/RA/LEL-DEL/ 10.30 AM D/ G3P2A0 FT pregnancy with severe preeclampsia inlabour 1st stage active phase SLF cephalic presentation GI : 5 M/ Stabilisation 3 hours MgSO4 protocol Nifedipine 3x10 mg P/ Vaginal delivery after stabilization (terminate 2nd stage with action) M/ Vaginal delivery (terminate 2nd stage with action) USG (ER): - SLF, cephalic presentation - BPD: 90 mm, FL: 71 mm, AC: 307 mm, EFW : 2630 g
- Placentae at anterior of uterine corpus - Amniotic fluid was enough, SP: 4 cm C/ Full term pregnancy SLF cephalic presentation 12.45 PM Male life baby, 2800 g, 46 cm, AS 8/9 FT AGA
30.09.11 Forcipal Extraction MAH/36/UA/LEL-DEL / 02.00 PM D/ G8P7A0FT pregnancy with severe preeclampsia + decompensated cordis NYHA III inlabour 1st stage active phase SLF cephalic presentation M/ Stabilisation 3 hours Metildopa 3 x 250 mg P/ Vaginal delivery (terminate 2nd stage with action) 07.30 PM Male life baby, 4100 g, 48 cm, AS 8/9 FT AGA 09.07.11 LSCS o.i fetal distress FAT/42/RA/DEL/ 04.00 PM D/ G4P3A0 33-34 weeks gestational age with severe preeclampsia + partial HELLP syndrome not inlabour yet SLF cephalic presentation +fetal distress GI: 5 USG ER (DDH): - SLF, cephalic presentation BS: 6 - Biometry: BPD : 86 mm FL: 63 mm EFW: 1900 g - Placenta is at fundus uterine - Amniotic fluid was enough, with SP= 4,0 cm C/ 33-34 weeks gestational age , SLF cephalic presentation M/ Stabilisation 1 hours MgSO4 Protocol Nifedipine 3x10 mg Dexamethason 2 x 10 mg for lung maturation Tubal ligation counselling Consult to Internal Department and ophthalmology department P/ abdominall termination after stabilisation 05.05 AM Female Life baby, 2000 g, 42 cm, AS 1/4/5 FT AGA
09.07.11 LSCS o.i IUGR MAR/39/RA/DEL/ 11.00 PM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 5 USG ER (DDH): - SLF, breech presentation WI: 12 - Biometry: BPD : 88 mm FL: 68 mm AC: 290mm EFW: 2346 g - Placenta is at the posterior uterine corpus - Amniotic fluid was enough, with SP= 2,8 cm C/ FT pregnancy, SLF breech presentation M/ Stabilisation 1-3 hours MgSO4 Protocol Nifedipine 3x10 mg
Tubal ligation counselling Consult to Internal Department P/ Vaginal delivery after stabilisation 10.07.11 03.45 PM D/ G1P0A0 FT pregnancy with severe preeclampsia inlabour2nd stage SLF vertex presentation GI: 4 M/ Terminated 2nd stage with forcipal extraction 04.00 Male life baby, 3500 g, 46 cm, AS 8/9 FT AGA PM
05.07.11 Spontaneous deliverySAI/39/RA/DKA-FAT/ROZ-RIA 08.00 PM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 3 hours not inlabour SLF cephalic presentation GI : 6 M/ Stabilisation 2 hours BS : 5 MgSO4 protocol Nifedipin 3x10 mg Antibiotic Tuba ligation counselling USG (ER) ATA: - Single life foetus, cephalic presentation - Biometry : BPD: 90mm, FL: 72mm AC:310 mm, EFW: 2677 gr - Placentae at anterior of corpus - Amniotic fluid enough, AFI : = 5,8 cm C/ FT pregnancy SLF cephalic presentation P/ Induction with oxytocin drip after stabilisation Vaginal delivery (terminated 2nd stage with action) 10.00 PM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 5 hours not inlabour SLF cephalic presentation GI: 4 M/ Induction with oxytocin drip P/ Vaginal delivery (terminated 2nd stage with action) 06.07.11 02.00 AM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 9 hours inlabour 1st stage latent phase SLF vertex presentation M/ Acceleration with oxytocin drip 04.00 AM D/ G7P6A0 FT pregnancy with chronic hypertension + PROM 11 hours inlabour 1st stage active phase SLF vertex presentation 08.00 AM D/ G7P6A0 FT pregnancy with chronic hypertension + history of ROM 15 hours inlabour 2nd stage SLF vertex presentation GI: 4 M/ Conduct the labour 08.05 AM Male life baby, 2800 g, 48 cm, AS 8/9 FTAGA 10.07.11 06.00AM Spontaneous deliveryMAR/46/RA/ZAR-DEL/ D/ G5P4A0 FT pregnancy with severe preeclampsia inlabour 1st stage active phase SLF vertex presentation
GI : 5
M/ Stabilisation 1-3 hours MgSO4 protocol Nifedipine 3x10 mg Counselling Tubal Ligation USG (ER) DDH: - Single life foetus, cephalic presentation - Biometry : BPD: 97mm, FL: 78mm AC: 310 mm, EFW: 3160 g - Placenta at posterior uterine corpus - Amniotic fluid enough, SP: 4,2 cm C/ FT pregnancy SLF cephalic presentation P/ Acceleration with amniotomy and oxytocin drip after stabilisation Vaginal delivery (terminated 2nd stage with action)
09.00 AM D/ G5P4A0 FT pregnancy with severe preeclampsia inlabour 1st stage active phase SLF vertex presentation GI: 2 M/ Acceleration with amniotomy and oxytocin drip 10.30 AM D/ G5P4A0 FT pregnancy with severe preeclampsia inlabour 2nd stage SLF vertex presentation GI: 2 M/ Conduct the labour 10.40 AM Male life baby, 3000 g ,48 cm, AS 8/9 FTAGA 7 09.07.11 LSCS o.i IUGR MAR/39/RA/DEL/ 11.00 PM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 5 USG ER (DDH): - SLF, breech presentation WI: 12 - Biometry: BPD : 88 mm FL: 68 mm AC: 290mm EFW: 2346 g - Placenta is at the posterior uterine corpus - Amniotic fluid was enough, with SP= 2,8 cm C/ FT pregnancy, SLF breech presentation M/ Stabilisation 1-3 hours MgSO4 Protocol Nifedipine 3x10 mg Tubal ligation counselling Consult to Internal Department P/ Vaginal delivery after stabilisation 10.07.11 02.00 AM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 3 P/ Vaginal Delivery 07.30 AM D/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid not inlabour SLF breech presentation +IUGR was suspected GI: 3 P/ Wait for Internal department assesment for delivery
11.30 AM Consult result from Internal Departement : C/ G3P2A0 FT pregnancy with severe preeclampsia + Hypertiroid on therapy not inlabour SLF breech presentation +IUGR was suspected Advice : - PTU 1 x 100 mg - Check for Free T4 & TSH - Join care with Internal Departement 11.35 AM Consult to consultant on duty : Advice : Consult to Fetomaternal Subdivison 11.40 AM Consult to Fetomaternal Subdivision Advice : Terminate with abdominal delivery 04.40 PM Female Life baby, 1850 g, 46 cm, AS 8/9 FT SGA PRIOR CS 1 14.08.11 01.00 AM VBAC: 5 LCSS o.i ARI/28/UA/LEL-DEL/ D/ G2P1A0 36-37 weeks gestational age with prior CS 1x (o.i anhydramnion) and Hypertiroid inlabour 1st stage latent phase SLF cephalic presentation P/ Vaginal delivery Consult to Internal department Result : Lung and Heart function compensated Hypertiroid Therapy : PTU Joint Care with Internal Endocrine division USG (ER): - SLF, cephalic presentation - BPD 89 mm, FL 71 mm, AC 300 mm, EFW 3252 g - Placentae at posterior corpus - Amniotic fluid was enough, SP = 3,8 cm C/ 36-37 weeks gestational age SLF cephalic presentation Male life baby, 3700 g 48 cm AS 8/9 FT AGA
parto
09.30 AM
ANTEPARTUM HAEMORRHAGE 1 05.07.11 LSCS o.i Recurrent bleeding ROS/34/RA/RNA/WEN-RIA 08.00 D/ G3P2A0 33-34 weeks gestational age with APH c.b placenta praeve was PM suspected not inlabour SLF cephalic presentation M/ Expectative management Tocolytic with Nifedipine 4x10 mg Dexamethasone inj 2x6 mg (2 days) Antibiotic USG Confirmation (HT):
06.07.11
09.00 AM usg
- Single life foetus, cephalic presentation - Biometry : BPD: 88 mm, FL: 68 mm AC: 308mm, EFW: 2472 gr ~ 34-35 weeks gestational age - Placentae at posterior uterine corpus covered all internal os - Amniotic fluid enough, SP: 3,8 cm - BPP: FM: 2, FT: 2, FB: 2, NST: 2, ICA: 2 10 C/ 34-35 weeks gestational age with total placental praeve SLF cephalic presentation BPP 10 D/ G3P2A0 33-34 weeks gestational age with total placenta praeve with recurrent bleeding not inlabour yet SLF cephalic presentation M/ Abdominal delivery Male life baby, 2450 g 45 cm AS 8/9 PT AGA
LSCS oi total placenta praeve HAM/37/UA/RYU/WEN-FAT D/ G1P0A0FT pregnancy with APH c.b total placenta praeve was suspected inlabour SLF cephalic presentation USG (ER) ATA: - Single life foetus, cephalic presentation - Biometry : BPD: 94mm, FL: 74mm AC: 328mm, EFW: 3224 g - Placentae at posterior uterine corpus covered all internal os - Amniotic fluid enough, SP: 3,2 cm C/ FT pregnancy with total placental praeve SLF cephalic presentation M/ Abdominal delivery 02.30 AM Male, 3300 g, 49 cm, AS 8/9 FTAGA 06.07.11 LSCS oi transverse lie + total placenta praeve ELL/30/RA/ABI/WEN-RIA 11.00 PM D/ G2P1A0 FT Pregnancy with APH cb placenta praeve was suspected inlabour SLF transverse lie USG ER (HRK): - SLF, tranverse lie - Biometry: BPD 93mm FL 72 mm AC 315 mm EFW 2650 gr - Placenta at posterior uterine corpus covered all internal os - Amniotic fluid was enough, SP 4,3 cm C/ FT pregnancy, SLF transverse lie + total placenta praeve M/ Abdominal delivery 07.07.11 Female life baby, 2700 gr, 47 cm AS 7/9 FTAGA 01.50 AM
LSCS o.i. tranverse lie HAS/27/UA/DEL/ D/ G2P0A1 FT pregnancy with PPROM 1 hours inlabour SLF tranverse lie M/ Antibiotic P/ Abdominal delivery
10.15 PM
01.40 PM 15.08.11
01.00AM ZA : 3
USG (ER) LIK : - SLF, tranverse lie - BPD 90 mm, AC 336 mm, FL 72 mm, EFW 3000 g - Placentae at the anterior of uterine corpus - Amniotic fluid was enough, AFI : 2,0 1,3 = 6,1 2,1 0,7 C/ FT Pregnancy SLF tranverse lie Female life baby, 2700 gr, 47 cm AS 8/9 FTAGA LSCS o.i. anhydramnios SUM/36/UA/FLADWI/ D/ G1P0A0 FT Pregnancy with PROM 7 hours inlabour 1st stage latent phase SLF breech presentation + anhidramnios + FPD M/ Antibiotic P/ Abdominal delivery USG ER : - SLF, cephalic presentation - BPD 97 mm, FL 76 mm, AC 320 mm, EFW 3248 g - Placentae at anterior of uterine corpus - Amniotic fluid was minimal with AFI 0,2 0,2 = 2,9 1,2 1,3 C/ 40 weeks gestational age SLF cephalic presentation presentation Male life baby, 2700 g 48 cm, AS 7/9 FT AGA
06.15 AM
01.15 PM
05.07.11 LSCS oi foetal distress + Tuba ligation NUN/45/RA/RYU/WEN-FAT 09.30 PM D/ G7P5A1 FT pregnancy with PROM 14 hours not inlabour SLF cephalic presentation with foetal distress M/ Intra uterine resuscitation Antibiotic Tuba ligation counselling P/ Abdominal delivery 10.25 PM Female, 3300 g, 51 cm, AS 5/9 FTAGA 05.07.11 LSCS oi dried labour NAN/28/RA/FHM/RNL-RIA 12.00 PM D/ G2P0A1 FT pregnancy with PROM 2 days not inlabour yet SLF cephalic presentation BS: 2 M/ Antibiotic USG (ER) ATA : - Single life foetus, cephalic presentation - Biometry : BPD: 94 mm, FL: 75mm AC: 320 mm, EFW: 3079 g - Placenta at anterior of corpus - Amniotic fluid is minimal, AFI 1,4 0,2 = 4,5 cm 1,6 1,3 C/ FT pregnancy SLF cephalic presentation with oligohydramnios
P/ Abdominal delivery 06.07.11 06.20 AM Male, 2850 g, 47 cm, AS 8/9 FTAGA 5 06.07.11 LSCS oi failed of induction MAR/30/UA/ABI/RNL-FAT 06.30 AM D/ G1P0A0 FT pregnancy with PROM 7 hours not inlabour SLF cephalic presentation. 10.00 AM USG (HT): - SLF, cephalic presentation with normal activity - Biometry: BPD 8,7 cm FL 7,7 cm AC 29,9 cm EFW 2575 gr - Placenta at the posterior uterine corpus BS: 2 - Amniotic fluid was enough with AFI 14,7 cm C/ 36-37 gestational age, SLF cephalic presentation M/ Antibiotic P/ Vaginal delivery 11.30 AM D/ G1P0A0 FT pregnancy with PROM 12 hours not inlabour SLF cephalic presentation. BS: 2 M/ induction with oxytocin drip 07.30 PM D/ G1P0A0 FT pregnancy with PROM 20 hours not inlabour + failed of induction SLF cephalic presentation. M/ Abdominal delivery 09.10 PM Female life baby, 3200 gr, 49 cm AS 7/9 FTAGA
PRETERM LABOUR 1 30.08.11 Conservative management WID/25/UA/LEL-DEL/ 07.30 PM D/ G2P1A0 31-32 weeks gestational age with threatened preterm labour SLF IT : 1 cephalic presentation USG (ER) : - Single life foetus, cephalic presentation - Biometry : BPD : 82 mm FL : 58 mm AC : 271 mm EFW : 1845 g - Placenta is at right uterine corpus - HR increasing irreguler - Amniotic fluid is enough, SP: 3,2 cm C/ 31-32 weeks gestational age SLF cephalic presentation M/ Conservative managemenet Bedrest Tocolitik with nifedipine 4x10mg Dexamethasone 2 x 6 mg (2 days) P/ USG confirmation 30.08.11 Conservative management LIN/26/UA/FIF-DWI/ 07.30 PM D/ G2P0A1 33-34 weeks gestational age with threatened preterm labour SLF IT : 2 cephalic presentation
USG (ER) : - Single life foetus, cephalic presentation - Biometry : BPD : 83 mm FL : 67 mm AC : 247 mm EFW : 2176 g - Placenta is at uterine corpus - Amniotic fluid is enough, SP: 5,4 cm C/ 33-34 weeks gestational age SLF cephalic presentation M/ Conservative managemenet Bedrest Tocolitik with nifedipine 4x10mg Dexamethasone 2 x 6 mg (2 days) P/ USG confirmation 31.08.11 Conservative management HEN/21/UA/FIF-DWI/ 11.10 PM D/ G1P0A0 31-32 weeks gestational age with threatened preterm labour SLF IT : 3 cephalic presentation
USG (ER) : - Single life foetus, cephalic presentation - Biometry : BPD : 78 mm FL : 29 mm AC : 275 mm EFW : 1750 g - Placenta is at uterine corpus - Amniotic fluid is enough, SP: 3,5 cm C/ 31-32 weeks gestational age SLF cephalic presentation M/ Conservative managemenet Bedrest Tocolitik with nifedipine 4x10mg Dexamethasone 2 x 6 mg (2 days) PROLONGED SECOND STAGE 1 31.09.11 Spontaneous delivery WIN/20/UAFLA-DWI/ 08.00AM D/ G1P0A0FT pregnancy inlabour with prolonged 2nd stage (outside)SLF vertex presentation M/ Terminate the 2nd stage with forcipal extraction 08.05 AM Female life baby, 2800g , 46 cm AS 8/9 FTAGA
16.08.11 Forcipal extraction HER/32/UA/LEL-EMR/ 04.30 PM D/ G1P0A0 FT pregnancy inlabour prolonged 2nd stage (out side) SLF vertex presentation M/ Terminate the second stage with forcipal extraction 06.00 PM Male life baby, 3200 g, 48 cm AS 8/9 FTAGA 07.07.11 LSCS oi Malposition ZUR/38/UA/ABI/RNL-RIA 04.30 AM D/ G3P2A0 FT pregnancy inlabour prolonged 2nd stage (out side) SLF vertex
presentation. M/ Abdominal delivery Tuba ligation counselling 06.40 AM Female life baby, 3900 g, 51cm AS 8/9 FTAGA POSTPARTUM HAEMORRHAGE 1 06.07.11 Brandt-Andrews manoeuvre FIT/30/UA/BRO-ATA/MFU-RNA 04.45 AM D/ P2A0 post spontaneous delivery 2 hours (outside) with early PPH c.b retention of placenta M/ Brandt-Andrews manoeuvre 05.15 AM Placenta was born, 450 g, 50 cm 17x18 cm
Spontaneous delivery SUM/35/UA/FLA-DWI/ nd D/G1P0A0 FT Pregnancy inlabour 2 stage, SLF breech presentation P/ Vaginal delivery Female life baby, 2700 g, 49 cm A/S 8/9 FT AGA
31.09.11 Spontaneous delivery MAR/29/RA/FIF-DWI/ 09.00 AM D/ G4P3A0 FT pregnancy inlabour 1st stage active phase footing presentation with congenital defect was suspected USG(ER) EDO: - Single life foetus, breech presentation - Hypoechoic lobus with many layer at the intestinal of the baby - Biometry : BPD : 92mm, AC : 356 mm - Placenta at posterior uterine corpus - Amniotic fluid enough Sp:5,6 cm C/ FT pregnancy SLF breech presentation with congenital defect was suspected M/ antibiotic P/ Vaginal delivery 11.40 AM Female life baby, 2600 g, 50 cm A/S 8/9 FT AGA