Duty Report

Saturday, August 29th 2015

Supervisor on duty:
Dr. dr. Sarma N. Lumbanraja, M.Ked(OG), SpOG.K

Duty Team:

1. Dr. Juhriani Malahayati

2. Dr. Irliansyah Putra
3. Dr. Isnayu
4. Dr. Irfan Hamidi
5. Dr. Ria Suci
6. Dr. Ryan Andrian
7. Dr. Dwi Fenny Amir

Obstetric dan Gynecology Department

Medical Faculty of USU/ RSUP HAM
2015

1.

Mrs. R, 29 years old, G1P0A0

Dx : Solutio Placenta + IUFD + PG + IUP (22-24) WGA + Breech
Presentation
Planning :
- Immediately hysterotomy

PATIENT 1

1.

Mrs. R, 29 years old, G1P0A0, bataknese, moslem, senior high school,

housewife wife of Mr. E ,40 yo,, bataknese, moslem, senior high school,
enterpreneur admitted at Adam Malik Hospital at August 29th 2015, 04.00 p.m.
With
CC: Vaginal bleeding
E

: Experienced by the patient since this morning, volume :2x changes

clothes. The bloods colour is bright red. History of abdominal pain (+).
History of prior trauma (-). History of massage on the abdomen (-). History
of herbal drink consumption (-). The patient has never felt this before.
Defecation and micturition normal. referred by obstetrician from another
hospital, with diagnosed suspect solutio palcenta + IUFD + IUP (23-25)
WGA + Breech Presentation

Previous ilness: appendicitis perforation ?

Previous medical hist: Laparatomy 2 months ago at RSHAM d/t appendicitis
perforation ?
Previous operation:
1.

17-04-2015

: Laparatomy d/t Appendic perforation, in other hospital

2.

24-04-2015

: Primary suture d/t Wound dehischen , in HAM hospital

3.

30-04-2015

: Relaparatomy + yeyunostomy, in HAM hospital

4.

19-05-2015

: Ileostomy closure, in HAM hospital

HPHT : ? 02 - 2015
TTP: ? 11 2015
Previous pregnancy :
5.

This pregnancy

Vital Sign
Cons
: CM
Anemic
:
BP : 110/70 mmHg
Icteric
:
Pulse
: 70x/i
Cyanosis
:
RR : 20 x/i
Dypsnoe
: (-)
Temp : 36,0C
Edema
:

(+)
(-)
(-)
(-)

Localized State :
Head

: Conj Palpebra inferior anemic (+)/(+), icteric (-)/(-)

Neck

: in normal limit

Thorax : Respiratory sound

Additional sound

: Vesiculer
: Wheezing(-)/(-), Rhonki (-)/(-)

Obstetrical state :
Abdomen
: symetricaly enlarged
Fundal Height : at the level of umbilicus
Streched part :
Lower part
:
Fetal Movement : Uterine contraction : FHR
:Inspeculo : visible blood in the vagina, cleaned, looks
placenta

TAS

TAS
Single fetus, dead fetus
FM (-), FHR (-)
BPD 5,73 cm
FL 3,73 cm
AC 19,19 cm
HC 22,14 cm
Placenta corpus posterior
Seen hyperechoic shadow, size : 9,56 x 9,18 cm, localized under placenta
Conclusion : IUFD + IUP (23-24) GWA + Solutio placenta

LABORATORY FINDINGS on 29/08/2015

Hb
: 8.9 gr/dl N: 12-14/gr/dl
Leukocyte
: 8,51 /mm3 N: 4000-11000/uL
Hematocrit
: 27,3 % N: 36,0-42,0/%
Platelet
: 113 /mm3 N:150.000-400.000/u
Ad Random Glucose : 75,3 mg/dl N: < 200 mg/dl

APTT
: 68,7
C= 33,5 S

PT
: 27,3
C= 14 S

TT
: 21,5
C = 17,8 S

D-dimer
: >5000 ng/mL N = <500

Ureum
: 12,8
N : 10-50 mg/dl

Creatinin
: 0,44
N : 0,6-1,2 mg/dl

LABORATORY FINDINGS on 29/08/2015

Natrium
Kalium
Klorida
Albumin

: 137
mg/dl N : 135-155 mg/dl
: 3,7 mg/dl N : 3,6- 5,5 mg/dl
: 109
mg/dl N : 96-106 mg/dl
: 2,7g/dl N : 3,5-5 g/dl

Dx : Solutio Placenta + IUFD + PG + IUP (22-24) WGA + Breech

Presentation

Planning:
- Immediately hysterotomy
Report to supervisor Dr. dr. Sarma N. Lumbanraja, M.Ked(OG),
SpOG.K Approved

Post Sub Total Abdominal Histerectomy

d/t uterine atony
Mother was laid in operation table, with double iv line and urine catheter
installed well
Antiseptic and aseptic procedure was performed, with betadine and alcohol
solution (70%), and covered by sterile fabric except operation field
Under spinal anesthetic, midline incision was made until fascia revealed
Fascia was cut from middle to left and right
Muscle was opened bluntly
Visceral peritoneum was elevated with clamp, and was cut from right to the
left, and separated bluntly.

 Seen covulaire uterusand we dicided to do histerotomy

By pulling the legs, The baby girl born with 645 gr of weight and 23 cm of
height, apgar score was 0 , anus (+) it has extensive skin peeling on the
body, impressed maseration grade 1.
Umbilical cord was pale, placenta was taken out completely
Uterine cavity was cleane, Uterine cavity and internal uterine ostium was
cleaned using sterile gauze.
We found bad and weak uterus contraction we gave the uterotonica but not
giving any efect, the bleeding was uncontrolled, about 700 cc
We decided to do Subtotal histerectomy
The abdominal cavity was cleaned using NaCl solution.
Peritoneum, muscle, fascia, subcutis and cutis was sewed consecutively
The mother condition after c-section : stable