COURSE IN THE HOSPITAL POST-OF ORDERS:

>Her hemoglobin and hematocrit was repeated 6 hours post BT, and give Furosemide 20mg IVTT post BT. Metrodinazole 500mg was also given every 8 hours as IV bolus. 3:30 am

11-28-12 3am >The patient was on Post-Anesthesia Care Unit (PACU) with O2 inhalation at 4LPM via nasal cannula. She undergone Low Transverse Cesarean section (LTCS) with Bilateral Tubal Ligation (BTL) under spinal anesthesia. On NPO diet, to avoid the risk for aspiration; and on tea and crackers at 12 noon to reduce vomiting. Placed flat on bed then high back rest after 6 hours. Her vital signs was monitored every 15 minutes for 2 hours; every 30 minutes for 2 hours; then every 4 hours until stable. >She was on Cefnroxime 1.5g IVTT every 8 hours for her antibiotic; Ranitidine 50mg IVTT every 8 hours for her antacid; Ketorolac 30mg IVTT every 6 hours RTC x 4 doses as her analgesic; MEM 0.2mcg IVTT every 4 hours with BP precaution as her oxyticic to reduce bleeding; Furosemide 20mg IVTT every 6 hours every post-BT as her diuretic to prevent congestion ; & biclofenac Na 75mg 1G every 12 hours x 2 doses as her analgesic. >She has indwelling indmelling catheter attached to urobag & her input & output was monitored hourly. It has to be removed at around 9 in the morning. >Her IVF should run at 30gtts/min; to be followed by DSVR 1L + 20 units oxytocin x 30gtts/min; DSVR 1L + 10 units oxytocin x same rate.

>Blood should be consumed and terminate BT line after. 11-26-12 5am >Patients lab. Results such as blood chem and urinalysis are followed-up and referred to 03-ROD. IVF on PLR 1L + 20 units oxytocin x 20 gtts/min. her CBC was repeated 6 hours after 6th unit of BT. >She was given Hydralazine 10mg IV every 6 hours and magnesium sulfate as loading close and for 24 hours due to elevated blood pressure. Antibiotics such as cefruroxine and metronidazole are continuously given every 8 hours. Ranitidine was continuously given every 8 hours; ketorolac every 6 hours and MEM was discontinued. 5:15am >Vital signs are monitored every 15 minutes for 1 hour then every 4 hours. Uterus was kept contracted, watched out for vaginal bleeding and referred urine output if it is less than or equal to 30cc/hr. Referred also if patient was hypothensive and dyspneic. 11-28-12 8pm

>Patient was on soft diet, low salt low fat once with bowel movement. With PLR 1Lx 10-15gtts/min infused well. Requested for chest x-ray and dyspneic. >Medications as continued according to their timings. Her fley catheter was retained and her input and output are still monitored hourly. 08:03am >On soft diet with banana per meal. Requested for serum sodium, potassium determination. Blood chem. Was followed up. UA and CxR pA view put on hold. >Medication are continuously given but metronidazole IV was sniffed to metronidazole p.o 500 mg TID. Other p.o meds was also prescribed such as ferrous sulfate 1tab TID, Nifedipine 10mg 1 cap TID, calcium carbonate 1 tab OD, and paracetamol 500mg 1tab every 4 hours for pain. Last dose of magnesium sulfate was given at around 2pm and FC was removed after. Bisacodyl adult suppository was also given per rectum. 11-29-12 10:00pm >On low salt, low fat. With follow up result of serum sodium, potassium. On PVR 1x KVO. Both IVTT and P.O meds was continued, but Furosemide was decreased to 20mg IV every 8 hours. She was encouraged to ambulate and to secure blood bank clearance. 11-30-12 07:30am

>On low salt low fat diet with IVF of PLR 1L x KVO rate. IVTT meds are consumed and shifted to P.O. Cefuroxime was shifted to Cefadroxil 500mg 1 cap every 8 hours as her antibiotic. Ketorolac was shifted to mafenamic acid 500mg 1 cap every 6 hours for pain. She was encouraged to do perineal hygiene daily and to ambulate. 12-01-12 >On low salt low fat diet; IVF of DSNM 1lx 20gtts/min. Should secure blood bank clearance. Continue p.o meds furosemide IVTT was shifted to furosemide 40mg/tab 1 tab BID with BP precaution. Ascorbic acid 500mg 1 cap OD was also prescribed. Vital signs monitoring was continuously done every 4 hours. 12-02-12 9am >Still on Low salt Low fat diet plus 1 banana per meal. Patient was now on MGH status once with blood bank clearance. Home meds was prescribed according to their timings. Dressing was changed prior to discharged encouraged to do BP monitoring at home and to have follow-up check up at OPD on 12-04-14. 12-03-12 Patient was discharged with home meds instructions given.

Schematic Pathophysiology of PLACENTA PREVIA TOTALIS

Precipitating Factors: *UNKNOWN

Predisposing Factors: *Age *Multiparity *Non-white ethnicity *Low socio- economic status

Patient was 31y.o, on its 8th pregnancy with no proper regular check-up due to poverty

Placenta implantation to the lower uterus

Bleeding

Uthrine Contraction

Placenta Separation Placenta Previa Totalis