CASE NO.

19
IDENTITY
Name : Mrs. P
Age : 37 years
Address : Jondul Tabing
MR Number : 98 93 52
Date : September 07th, 2017
 Anamnesis (Alloanamnesis)

Chief complaint
A 37 years old patient was admitted to the
Delivery Room of Dr. M. Djamil Central General
Hospital on Sept 07th, 2017 at 12.00 pm, with
chief complain seizure at home once.
PRIMARY SURVEY
Airway : patent
Breathing : O2 5lt/minutes
Circulation : BP 200/120mmHg, HR 108x

GA Cons BP HR RR T Urin Patella Rf

Mdt somnolen 200/120 108 22 36,8 200cc/times +/+ increase

A / Antepartum eclampsia on G4P3A0L2 39-40 weeks aterm pregnancy

P/
O2 5lpm
Regimen MgSO4 initial dose maintenance dose
Antihipertension metildopa 750 mg, nipedipin 10 mg
Urine catheter
Check lab
12.05
The patien has seizure once in resuscitation emergency room about 2 minute,
after seizure the patien no conscious

Circulation : IV line inserted regiment MgSO4

Airway : non patent anesthetic consult intubation
Breating : sat 48% before intubation, 95% after intubation

GA Cons BP HR RR T Urin
Mdt Sopor 235/120 108 22 36,8 200cc/times
PRESENT ILLNESS HISTORY
Previously,the patient complain of severe headache, and then the patient had seizures at
home 1 time, about 1-2 minute, after seizure the patien concious. Patient come to RS
dr.M.Djamil and had seizure 1 time in emergency room and blood pressure was 235/120
mmHg.
Blurry vision (+), headache (+), gastric pain (+)
Feeling of pain from waist region which referred to the groin (-)
Bloody show from the vagina (-)
Fluid leakage from the vagina (-)
Massive vaginal bleeding (-)
Amenorrhea since 9 months ago
First date of LMP: dec 5th 2016,EDD: Sept 12th 2017

Prenatal care : To primary health care 4 times, at 2,3,4,5 month of pregnancy and never get
hypertension

Previous Illness History :

There wasnt previous history of heart, lung, liver, kidney, DM and hypertension.

Theres no allergic history

Family Illness History :

There wasnt history of hereditary disease, contagious and physiological illness in the
family.
 Marriage history : married twice in 2006
Educational history : senior high school graduate
Occupational history : house wife
Obstetric history :
1. 2005 / female / 3200gr / term pregnancy/
spontaneous / midwife / alive
2. 2007 / male / 3500gr / term pregnancy /
spontaneous / midwife / alive
3. 2015 / female / 3000gr / term pregnancy /
spontaneous / midwife / die
4. Present
History of family planning : (-)
Immunization : (-)
Habit : alcoholic (-),
Smoke (-), drugs(-)
PHYSICAL EXAMINATION
GA Cons BP PR RR T
Moderate Sopor 235/120 108 23 37
Urine : 200 cc at time
Prot urine : +3
Patella reflex : +/+ N
Eyes : Conjunctiva wasnt anemic, Sclera wasnt icteric, pupil
isokhor
Neck : JVP 5-2 cmH2O, tyroid gland no enlargement
Chest : Hearth normal, Lung : Rh+/+,Wh -/-
Abdoment : OR
Genitalia : OR
Extremity : Edema +/+, Physiological Reflex +/+,
Pathological Reflex -/-
BH : 158cm BW 117kg
 OBSTETRIC RECORD
Abdomen :
I : Enlarge according to aterm pregnancy, median line
hyperpigmentation, sikatrix (-)
Pa :
L1: Uterine fundal height was 3 fingers below xyphoid process.
there was nodular mass palpated.
L2 : largest resistance was palpable on left side, small parts of the fetus
was palpable on right side
L3 : a round hard mass was palpable, floating (+)
L4 : not performed
UFH : 40 cm EFW : 4180 gr His : -

Per: Tympanic
Au : Peristaltic sound was normal
Fetal Heart Rate : 170-180x/minute

Genitalia: I: V/U normal, Vaginal bleeding (-)

LABORATORY
parameter result normal
Hb 14,1 gr% 12-16,0
Leucocyte 13,660 /mm 5.00010.000
HT 41 % 37.043.0
Trombocyte 184.000 /mm3 150400
PT 9,6 second 9,2-12,4
APTT 30,2 second
28,0-37,8

Urinalisa
Protein : +++
USG

Fetal alive, singleton, head

presentation
Fetal movement was good
Biometry :
BPD : 103 mm
AC : 35 mm
FL : 72,3 mm
EFW : 3497 gr
Plasenta implanted in posterior
corpus of uterine with grade II-III
Impression :
39-40 weeks pregnancy
Fetal alive
BASELINE : 170
VARIABILITY: <5
ACCELERATION : (-)
DECCELERATION: (-)
FETAL MOVEMENT : (-)
IMPRESSION: NON REACTIVE CTG ( SECOND CATEGORY )
Ophthalmologist department
Impression : There is severe fundal eclampsia
advice:
Therapy according to OBGYN
joint treatment with ophthalmology subdivision

Cardiology department
A : eclampsia antepartum at G4P3A0L2 aterm pregnancy
P : Metildopa 3x500 mg if BP > 150 mmHg
drip fasorbid 3mg/hour
Joint treatment with cardiology subdivision
Internist department
A/ - eclampsia
- G4P3A0L2 aterm pregnancy
P/ - metyldopa 3x500 mg
Operate tolerancy
- - Pulmonary risk : severe
- - cardiovascular risk : moderate
- - metabolic risk : moderate
- - homeostasis risk : moderate
- Joint treatment with renal subdivision

Consult to High Risk consultant

Advice: stabilization termination of
pregnancy
Diagnosis :
Antepartum eclampsia in maintenance dose of MgSO 4 from on G4P3A0L2 39-40 weeks
aterm pregnancy + Acute Lung Oedem + Fetal Distress
Fetal alive singleton intrauterine

Management :
- Control GA,VS,HIS, urin,Rf Patella, fluid balance
- Informed consent
- Continue SM regiment in maintenance dose
- Antihypertension
- antibiotic (skintest)
- Consult to perinatology & anesthesiologis
- Report to OR & ICU

Planning :
Emergancy CS
At 01.00 pm :
SCTPP was performed
A male baby was born, 4600 g in weight, 51 cm height, APGAR score 4/6
Placenta was delivered with minor traction on umbilical cord, 1 piece, 16x18x3 cm in
size, 600 g in weight, umbilical cord length was 60 cm, paracentralis insertion
Pomeroy tubectomy
Blood lose during surgery : 250 cc

Diagnosis :
P4 A0 L3 post caesarean section oi eclampsia antepartum + acute lung oedem + fetal
distress + pomeroy tubectomy oi enough child
Mother-child were in care

Plan/
Monitoring post op in ICU
Continue MgSO4 maintenance dose
Antibiotic
Antihypertension
 LABORATORY POST OP
parameter Result normal
Hb 13,4 gr% 12 -15,0
Leucocyte 21.110 /mm 5.916.9
HT 39 % 37.043.0
Trombocyte 215.000/mm3 150400
PT 9,9 second 9,2-12,4
APTT 35,5 second 28,0-37,8
D-dimer 6210,06 < 500