CASE NO
IDENTITY
Patient Husband
Name : Mrs. H Name : Mr. R
Age : 43 years old Age : 46 years old
MR : 01 10 65 74 Education : S1
Education : S1 Occupation : Enterpreuner
Occupation : Civil cervant Address : Payakumbuh
Address : Payakumbuh
Admision date : 01/06/2021
Mrs. H, 43 years old, 01 10 65 74
Admission Origin Preparation for surgery Diagnose Plan
date
Date : Origin from : Consult to Cardiologist • G3P2A0L2 31-32 weeks of Emergency CS
01/06/2021 PONEK A/ Emergency hypertension on preterm pregnancy +
impending eclampsia on G3P2A0L2 impending eclampsia on
Referred from : 31-32 weeks of preterm pregnancy
P/ maintenance dose of
Time : Adnaan WD General Hospital MgSO4 regimen from other
04.30 Nicardipin drip start 0,5
mcg/kgBW/hour institution
Diagnose : BP target systolic < 165 or diastolic < • Fetal alive, singleton,
G3P2A0L2 31-32 weeks of 105 intra uterine, head
DPJP : preterm pregnancy + Metyldopa 3x500 mg if BP >140/90
MS presentation
impending eclampsia on
Consult to Internist
Risti : maintenance dose of MgSO4 cardiovaskuler risk : Lee Revise score
HJS regimen 0,9 %
Pulmonal risk: mild
Metabolik risk: mild-moderate
Hemostatikc function: stable
Consult to Perinatologist
Agree to accompany during delivery
Consult to Risti Consultant
Agree with the assessment
Termination perabdominam
Anamnesis PF Ultrasound
Patient came to PONEK M Djamil Hospital referred from Adnaan WD General GA Cons BP HR RR T Sat 30-31 weeks of preterm pregnancy
Hospital with G3P2A0L2 31-32 weeks of preterm pregnancy + impending Mdrt CMC 160/90 92 22 36,8 99 Fetal alive, singleton, intra uterine, head presentation
eclampsia on maintenance dose of MgSO4 regimen. Because of the limitated
facility of NICU, patient referred to M Djamil Central Hospital for further BH : 157 cm CTG: first category
management. Advice in sisrute M Djamil, patient was given MgSO4 regimen, BW before pregnancy : 70 kg
BW present pregnant : 90 kg
nifedipine 10 mg and metyldopa 500 mg while transferred and control GA, VS, BMI : 28,45 (overweight) Laboratorium
FHR, labor sign, impending sign. Upper Arm Circumference : 30 cm Hb : 14,4
- Headache (+) since 5 hours ago Ht : 41
- Blurred vision (+) since 5 hours ago Eyes :CA (-/-), SI (-/-) Leu : 16.200
- Epigastric pain (+), nausea (-), vomit (-) Abdomen: Trom : 193.000
- Pelvic pain referred to the groin (-) Diff Count : 0/0/84/11/5/-
- Bloody show from the vagina (-) Inspection : Enlarge equal to preterm pregnancy, linea mediana
hyperpigmentation (+) striae gravidarum (+) cicatrix (-) MCV/MCH/MCHC : 31/88/35
- Fluid leakage from the vagina (-) PT : 9,2
- Massive bleeding from vagina (-) Palpation APTT : 30,9
- Amenorrhea since 8 months ago Leopold I : Uterine fundal was palpable 3 fingers above umbilcal, a large soft D-Dimer :1326
- Fetal movement was felt since 4 months ago nodular was palpated Total protein : 5,9
- Menstrual history : menarche at 12 years old, regular cycle, 4-6 days each Leopold II : The largest resistance was felt on the right side. Albumin : 3,0
cycle with the amount of 2-3 times pad change/day without any menstrual Globulin : 2,9
pain. Small parts of the fetus were felt on the left side
Bilirubin total : 0,4
- History of using contraception in last 3 month : none Leopold III : A hard mass was felt, fixated Bilirubin direct : 0,2
- First date of last menstruation : 20-10-2020, Estimation date of delivery : 27- Leopold IV : convergent Bilirubin indirect : 0,2
07-2021 SGOT : 21
- History of nausea (-), vomit (-), bleeding (-) during early pregnancy SGPT :10
- Antenatal care to midwife 3 times at 1,3,5 month of pregnancy and to His : (-) FHR : 144-152 x/i
Ur :17
obstetrician 4 times at 2, 3, 6, 7 month pregnancy, patient known with UFH : 22 cm EFW : 1550 gr Cr : 0,9
hypertension when controlled at 7 months of pregnancy, and got nifedipine 10 Na : 135
mg for medication Genitalia K : 4,0
- History of nausea (-), vomit (-), bleeding (-) Cl : 109
- History of cough (-), fever (-), sorethroat (-), shortness of breathing (-) I : V/U normal, Vaginal bleeding (-)
GDR : 105
- History of contact with positive Covid-19 patient (-) VT : did not perform HBsAg : non reactive
- History of travelling out from the town (-) Anti HIV : non reactive
Urine in catheter: 500 cc/4 hours, deep yellow
History of previous Illness Protein urin : +4
There is no history of diabetes, heart disease, kidney disease
Extremity
TCM swab : negative
History of Family Disease Oedem (+/+), Refleks Patella +/+ N
There is no history of hereditary, infectious and psychiatric diseases
History of pregnancy/abortion/delivery: 3/0/2
1. 2009, male, preterm, 1900 gram, vaginal delivery, obstetrician, alive
2. 2010, male, term, 3000 gram, vaginal delivery, midwife, alive
3. Present
Date Diagnosis / Action Outcome
/Operation
01/06/2021 Diagnosis Pre Action : Female baby was born at 06.05
• G3P2A0L2 31-32 weeks of preterm pregnancy + impending BW : 1185 gr,
eclampsia on maintenance dose of MgSO4 regimen from BL : 35 cm,
other institution A/S : 6/8
Acc
• Fetal alive, singleton, intra uterine, head presentation Placenta was born with mild traction size 16x14x5 cm, 200 gr
operation:
05.30 wib
Diagnose post action :
Instruction: • P3A0L3 post LSCS oi impending eclampsia on
Operation: • Control GA, VS, FHR maintenance dose of MgSO4 regimen + Post Pomeroy
06.00 wib • Informed consent tubectomy oi enough of child
• Anesthesiologist consult, internist consult, cardiologist • Mother and baby in care
consult, perinatologist consult
DPJP : • Report to OR team
Instructions :
MS • Control GA, VS, contraction, Vaginal bleeding, impending
Plan : Emergency CS sign
Risti: • IVFD RL drip MgSO4 maintenance dose 28 dpm
HJS Process : • IVFD RL drip Oxytocin 20 IU 28 dpm
G3P2A0L2 31-32 weeks of preterm pregnancy + impending • Inj. Asam tranexamat 3x500 mg
Inj. Ceftriaxone 2x1 gr
eclampsia on maintenance dose of MgSO4 regimen from other •
• Inj. Vit K 3x10 mg
institution LSCS + Pomeroy tubectomy • Methyldopa 3x500 mg
• Adalat oros 1x30 mg if SBP > 160
• Misoprostol 2 tab/6 hours
• Check lab 6 hours post op
• Admitted to HCU Obstetrics Green zone
Admission letter Reference letter
Laboratory
Swab TCM result
Ultrasound at PONEK
Ultrasound at PONEK
• Fetal alive, singleton, intra uterine, head presentation
• Fetal Biometry :
BPD : 7,91 cm FHR : 139 bpm
HC : 28,65 cm EFW : 1259 gr
AC : 26,15 cm AFI : 10,41 cm
FL : 5,95 cm SDAU : 4,07
• Placenta insertion at fundal, expanded to anterior, maturation grade II
Impression :
• 30-32 weeks of preterm pregnancy
• Fetal alive, singleton, intra uterine, head presentation
CTG
Baseline : 145
Variability : 5-20
Acceleration : (+)
Deseleration : (-)
Fetal movement : (+)
Contraction : (-)
Impression : First category
ECG
ECG : sinus rythm
QRS rate : 98 bpm
P wave : normal
PR interval : 0,16 s
QRS duration: 0,06 s
ST-T changes : (-)
LVH : (-)
RVH : (-)
Cardiologist Consult
A/ Emergency hypertension on impending eclampsia on
G3P2A0L2 31-32 weeks of preterm pregnancy
P/
Nicardipin drip start 0,5 mcg/kgBW/hour
BP target systolic < 165 or diastolic < 105
Metyldopa 3x500 mg if BP >140/90
Internist Consult
A/ G3P2A0L2 31-32 weeks of preterm pregnancy + impending
eclampsia on maintenance dose of MgSO4 regimen from other
institution
P/
cardiovaskuler risk : Lee Revise score 0,9 %
Pulmonal risk: mild
Metabolik risk: mild-moderate
Hemostatikc function: stable
Risti Consult
A/ G3P2A0L2 31-32 weeks of preterm pregnancy + impending
eclampsia on maintenance dose of MgSO4 regimen from other
institution
P/
Agree with the assessment
Termination perabdominam
Perinatology Consult
Agree to accompany during delivery
Operation report
• Patient on supine position under spinal anaesthesia
• Antiseptic and septic procedure was performed
• Pfanenstiel incission was performed
• Layer by layer was opened until peritoneal
• Gravid uterine was seen
• Low uterine incicion was performed
• By delivery head extraction a female baby was born, BW : 1185
gram, BL : 35 cm, A/S 6/8
• Placenta was born with mild traction size size 16x14x5 cm, 200
gr
• Uterine closed 2x
• Pomeroy tubectomy was performed
• Abdomen closed layer by layer
• Bleeding during operation 250 cc
DOCUMENTATION
KURVA LUBCHENCO
BALLARD SCORE (Total 20 32 weeks)
Follow Up 2 hours post op
S fever (-) P • Control GA, VS, contraction, Vaginal bleeding,
Impending sign (-) impending sign
• IVFD RL drip MgSO4 maintenance dose 28 dpm
• IVFD RL drip Oxytocin 20 IU 28 dpm
• Inj. Ceftriaxone 2x1 gr
O GA Cons BP HR RR T • Inj. Asam tranexamat 3x500 mg
Mdt CMC 160/90 96 20 36.8 C • Inj. Vit K 3x10 mg
• Methyldopa 3x500 mg
Abd : Uterine fundal palpated 2 fingers below • Adalat oros 1x30 mg if SBP > 160
umbilical, contraction (+) • Misoprostol 2 tab/6 hours
Gen : V/U normal. Vaginal bleeding (-) • Check lab 6 hours post op
Urin : 300 cc/ 2 hour, yellow
A • P3A0L3 post LSCS oi impending eclampsia on
maintenance dose of MgSO4 regimen + Post
Pomeroy tubectomy oi enough of child
• Mother and baby in care
Laboratory 6 hours post op
Thankyou
