LAPORAN OBSTETRI PATOLOGI

1. G2P1A0 27 years old 39-40 weeks of pregnancy In ertia Uterine First Stage of Labor + Anemia + Fetal
Distress  Caesarean Section (Ny. Larenggang Silvana, MR 72.80.59)
G2P1A0 27 years old admitted on September 17 th 2020 at 13.15, was referred from Maria Walanda Maramis
Hospital diagnosed with G2P1A0 27 years old 39-40 weeks of pregnancy Inertia Uterine First Stage of Labor +
Anemia. Intrauterine fetal singleton alive cephalic presentation.

History :
 The mother feel labor pain regulary since 13 hours before admission
 There was watery discharge since 1 day before admission
 There was bloody show
 She felt the baby’s movement
 Rapid SARS COV-2 on September 16th 2020 at Maria Walanda Maramis Hospital : non reactive
 There was no history of cardiac, pulmonary, liver, renal, hypertension and diabetic disease
 LMP : December 14th 2019 EDC : September 21st 2020
 ANC : 3x at PHC, 2x at Obstetrician and Gynecologist
 Menarche : 14 years old Menstruation : 28 days, regular, 5-7 days
 Marriage : once for 5 years (2015 – now) Contraception : Injection Contraception (2018 - 2019)
 P1 : 2017 / female / spontaneous vertex delivery / 2800 grams / Teling Hospital / doctor / alive

General examinations :
General Condition : good, conscious
Blood pressure : 120/70 mmHg Pulse rate : 88 x/minutes
Respiration rate : 19 x/minutes Temperature : 36,7 °C
Conjunctive : anemic +/+ Sclera : icteric -/-
Heart and Lung : within normal limits Extremities : oedema -/-
Body height : 159 cm Body weight : 71 kg

Obstetrics examination :
Fundal height : 30 cm Fetal presentation : cephalic presentation U back on the right
FHS : 175-180 dpm Uterine contraction : -
EFW : 2945 grams (JT)

Vaginal examination :
Eff 50%, 5 - 6 cm cervical dilatation, amniotic membrane (-) meconium amniotic fluid, cephalic presentation H-I

USG :
Intrauterine fetal singleton, cephalic presentation
 FM (+), FHM (+)
 BPD : 8,38 cm, AC : 31,88 cm, FL : 7,27 cm
 EFW : 2800 - 2900 gr
 Placental implantation at fundus grade II-III
 AFL < 2 cm
Conclusions : At term Pregnancy + Cephalic Presentation + Oligohydramnios

NST
BHR : 175 – 180 bpm
Variability : 5 - 10 bpm
Acceleration : (-)
Deceleration : (+), late deceleration
Fetal Movement : < 5x/20mnt
Conclusion : Category III

Laboratory :
Hematology :
Hb : 5.8 gr/dl Leukocyte : 17.000 /mm3
Platelet : 139.000 /mm3 SGOT : ??? U/L
Ureum : 13 mg/dl SGPT : ??? U/L
Creatinin : 0.5 mg/dl

Rapid SARS COV-2 on September 16th 2020 at Maria Walanda Maramis Hospital : non reactive

ECG :
Within normal limit

Chest X-Ray :
Within normal limit

Diagnosis :
G2P1A0 27 years old 39-40 weeks of pregnancy Inertia Uterine First Stage of Labor + Anemia
Intrauterine fetal singleton alive cephalic presentation H-I + Fetal Distress

Management :
 Intrauterine resuscitation
 Emergency caesarean section
 Counseling, informed consent
 Counseling contraception  refuse IUD Post placenta
 Cross match, blood was preparation
 Observation of vital sign, UC, FHS
 Consulted to Supervisor  Advice : Intrauterine resuscitation
Emergency caesarean section
Counseling contraception  refuse IUD Post placenta

Observation :
13.30 pm – 14.00 pm UC : 4’-5’//30”-35” FHS : 175-180 bpm
14.30 pm – 15.00 pm UC : 4’-5’//30”-35” FHS : 175-180 bpm
15.00 pm – 15.30 pm UC : 4’-5’//30”-35” FHS : 175-180 bpm
15.30 pm – 16.00 pm UC : 4’-5’//30”-35” FHS : 175-180 bpm
16.00 pm – 16.30 pm UC : 4’-5’//30”-35” FHS : 175-180 bpm
16.30 pm – 17.00 pm UC : 4’-5’//30”-35” FHS : 170-175 bpm
17.00 pm – 17.30 pm UC : 4’-5’//30”-35” FHS : 170-175 bpm
17.30 pm – 18.00 pm UC : 4’-5’//30”-35” FHS : 165-170 bpm
18.00 pm – 18.30 pm UC : 4’-5’//30”-35” FHS : 165-170 bpm

At ??? : The mother was brought to the operating theatre

At ??? : Operation was begun, low segment caesarean section was performed,
At ??? : ??? baby was born, BW: ??? grams, BL: ??? cm, AS : ???
At ??? : Operation has finished

Up to now the mother and baby are in good conditions (Hb ??? g/dL), the baby at NICU 1.