1.

G3P1A1 19 tahun hamil 25-26 minggu dengan Ancaman Partus Prematurus

Janin intra uterin tunggal hidup letak kepala  Rawat konservatif. Nifedipine 3x 10 mg po
2. P1A1 33 tahun dengan Abortus inkomplit + bekas SC ≤ 1 tahun  Kuretase
3. G3P2A0 32 tahun hamil 33-34 minggu inpartu kala II
Janin intra uterin tunggal fetal death letak sungsang  Partus pervaginam (jam 20.04 lahir
bayi laki-laki /spt bokong/1300gr/40 cm/AS†, maserasi grade II)
4. G4P2A1 35 tahun hamil 13-14 minggu dengan hiperemesis gravidarum grade II 
Rawat Konservatif
GINEKOLOGI : 1 orang ( 1 laporan singkat)
1. P2A0 33 tahun dengan PUA-L + Anemia (Hb 7.4 g/dL)  Perbaiki KU. Transfusi PRC
sampai Hb ≥ 10 g.dL
KB : -

History :
 There was water leakage from birth canal since 1 day ago (April 3rd 2018 at 05.00 pm)
 The mother didn’t feel labor pain
 There was no bloody show
 She felt the baby’s movement
 There was histiry of leucorrhea for 2 months, not treated
 There was no history of cardiac, pulmonary, liver, renal, hypertension and diabetic disease
 ANC : 7 times at obstetrician
 LMP : June 24th 2017 EDC : March 31th 2018
 Marriage : once for 4 years Contraception : 3 mothly injection (Last used 2017)
 P1 : 2013, female, Cesarean section due to postmature, Nabire hospital, 2800 gr, alive

General Examination :
General Condition : good/Concious
Blood pressure : 110/80 mmHg Pulse rate : 82 x/minute
Respiration rate : 20 x/minute Temperature : 36.8 ° C
Conjunctive : anemic -/- Sclera : icteric -/-
Heart and lung : within normal limits Extremities : oedema -/-
Body height : 154 cm Body weight : 54 kg

Obstetrics examination :
Fundal height
EFW
Fetal presentation
FHS
Uterine contraction
: 32 cm
: 3100 gram (JT)
: Cephalic presentation U back on the right
: 135-140 times/minute
:-

Vaginal Touche :
Soft thick portio, axial position, no cervical dilation, presenting part still high, Nitrazine test (+)

USG :
Intrauterine fetal, singleton
FM (+), FHM (+)
BPD : 9,26 cm, AC : 33,15 cm, FL : 7,57 cm
EFW : 3200 – 3300 grams
Placental implantation at fundus grade III
AFL < 2 cm
Conclusions : Fullterm of pregnancy + cephalic presentation + oligohydramnios (PROM)

Laboratory:
Hb : 10.7 g/dL, WBC : 9800 /mm3, Platelets : 289.000 / mm3
ECG:
Within Normal Limits
1
 Diagnose:
G2P1A0 27 years old 40 - 41 weeks of pregnancy + 1 day of PROM + previous Cesarean section
Intrauterine fetal singleton alive cephalic presentation still high

Management:
 Antibiotic
 Emergency Caesarean Section
 Counseling informed Consent
 Counsling Contraception  refused IUD
 Observation vital signs, uterine contraction, fetal heart sound
 Consulted to supervisor  advice : Emergency Caesarean Section
Observation vital signs, uterine contraction, fetal heart sound

Observation
09.30 – 10.30 pm UC: none FHS : 145-150 bpm
10.30 – 11.30 pm UC: none FHS : 140-145 bpm
11.30 – 12.30 pm UC: none FHS : 140-145 bpm
12.30 – 01.30 pm UC: none FHS : 140-145 bpm
01.30 – 02.30 pm UC: none FHS : 140-145 bpm
01.30 – 02.30 pm UC: none FHS : 140-145 bpm

02.30 pm : The mother was brought to the operation theatre

03.05 pm : Operation was begun, low segment cesarean section was performed
03.12 am : Male baby was born, BW: 3250 grams, BL: 49 cm, AS: 6-8
04.10 am : Operation finished.

Up to now the mother and the baby is in good condition (Hb still in examination) and baby is in transition room

1.
Anamnesis :
 Nyeri perut bagian bawah ingin melahirkan (+)
 Pelepasan lendir campur darah (+)
 Pelepasan air dari jalan lahir (-)
 Pergerakan janin (+) saat MRS
 Riwayat penyakit jantung, paru-paru, ginjal, hati, kencing manis: disangkal
 PAN: 4x Puskesmas Bengkol
 HPHT : 17 Juni 2017 TTP : 24 Maret 2018
 Menikah: 1 kali selama 2 tahun KB : suntik 1 bulan ( terakhir januari 2017)
 A1: 2015, tidak dikuret

Pemeriksaan Fisik :
Keadaan umum : Cukup Kesadaran : Compos mentis
Tensi : 120/80 mmHg Nadi : 80 x/menit
Respirasi : 20 x/menit Suhu : 36,30 C
Konjungtiva : anemis (-) Sklera : ikterik (-)
C/P : dalam batas normal Ekstremitas : edema (-)
Tinggi badan : 154 cm Berat badan : 66 kg

Status Obstetrik :
TFU : 31 cm Letak janin : letak kepala U punggung kanan
BJA : 175 – 180 dpm His : 2’-3’// 50”-55”
TBBA : 3100 gram (JT)

Pemeriksaan Dalam :
pembukaan lengkap, ketuban (-) sisa mekonium, PP kepala HII-III

USG :
Janin intrauterin tunggal hidup
FM (+), FHM (+)
BPD: 9,06, AC: 32,82 cm, FL: 7,12 cm

2
EFW: 3100– 3200 gram
Plasenta implantasi di fundus grade II-III
AFL> 2 cm
Kesan : Hamil aterm + letak kepala

Laboratorium :
Hb 11,2 gr/dl, Leukosit: 20.800/mm3 Trombosit: 309.000/mm3

Diagnosis :
G2P0A1 23 tahun hamil 41-42 minggu impartu kala II lama
Janin intrauterin tunggal hidup PP kepala H II-III + gawat janin

Sikap :
 Resusitasi janin intrauterin
 Seksio Sesarea Cito
 Konseling, Informed consent
 Konseling KB  KB Suntik 3 bulan
 Sedia darah
 Observasi T, N, R, S, His, dan BJJ
 Lapor konsulen, advis : Resusitasi janin intrauterin
Seksio sesarea cito

Observasi :

Jam 00.00 – 00.30 His: 2’-3’//50”-55” BJJ: 170-175x/menit

Jam 00.30 – 00.50 His: 2’-3’//50”-55” BJJ: 160-165x/menit

Jam 00.50 : Pasien didorong ke OK cito

Jam 01.10 : Operasi dimulai dilakukan SCTP
Jam 01.15 : Lahir bayi perempuan, BBL: 3200 gram, PBL : 48 cm, AS : 6-8
Lilitan tali pusat 1x di leher
Infark plasenta 30%, Clifford Sign grade II, Ballard score 40-42 minggu
Jam 02.10 : Operasi selesai

Sampai saat ini KU ibu cukup (Hb dalam pemeriksaan). Bayi dirawat di ruang transisi