Professional Documents
Culture Documents
PPCM
PPCM
Nadiya Afifah
12100117126
Preceptor:
dr. H. Dadan Susandi, Sp.OG
▷ Date of Admission :
November 1st, 2018
▷ Time of Admission:
4.30 PM
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CHIEF COMPLAIN
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History of Present Illness
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OB History
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Additional Information
▷ Marital History ▷ Menstrual History
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Review of Systems
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General Examination
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Physical Examination
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Physical Examination
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Obstetrics Examination
▷ FHt = 34 cm / 99 cm
▷ Fetal Presentation = head, right-fetal back, 2/5
▷ Fetal Weight = 3.105 gram
▷ Uterine contractions = 2 contractions in 10 minutes,
for 35 seconds
▷ FHB = 148x/ min., regular
▷ Internal Exam:
○ Vulva: Normal
○ Vagina: Normal
○ Cervix: thick, soft, medial, 4-5 cm dilated,
○ Amniotic membrane: not intact, clear amniotic fluid
○ Lowest part: cephalic, station +1
○ Smallest crown: right anterior 15
V
V
V
V
V
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Laboratory Examination
▷ Hematology: ▷ Immunoserology
▷ Hemoglobin :12,3g/dl ▷ HIV : Non Reaktif
▷ Hematokrit : 35% ▷ HBsAg: Non Reaktif
▷ Leukosit : 8,330 /mm3 ▷ Kimia Klinik
▷ Trombosit : 327,000 /mm3 ○ AST (SGOT): 20 U/L
○ ALT (SGPT): 9 U/L
▷ Eritrosit : 3.88 juta/mm3
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Diagnosis
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Management Plan
▷ R/ vaginal delivery
▷ Oxytocin drip: 5 IU in 500c D5% 20
dpm for the first 15 min., increased 5
drops every 15 minutes (max. 60 dpm)
▷ Observe general condition, vital sign,
fetal heart rate, uterine contraction, and
progress of labor.
▷ Family planning motivation.
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Follow up
Tanggal Catatan
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Prognosis
▷ quo ad vitam
○ Mother: ad bonam
○ Child: dubia ad malam
▷ quo ad functionam
○ Mother: ad bonam (no risk of reproductive organ
damage unless there’s another underlying
reproductive organs’ disease/trauma)
○ Child: dubia (high risk of recurrency in next
pregnancies)
▷ quo ad sanantionam : dubia ad bonam
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Premature Rupture of
Membrane (PROM)
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Fetal membranes consist of 2 layers:
1. Chorion (outer).
2. Amnion (inner).
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Types of PROM
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Etiology of PROM
▷ In majority, causes not known.
▷ Possible causes:
○ increases friability of the membranes.
○ Decreased tensile strength of membranes.
○ Cute inflammation of placenta
○ Polyhydramnios.
○ Cervical incompetence.
○ Multiple pregnancies.
○ Infections: e.g. chorioamnionitis, UTI and lower genital
tract infections.
■ sub clinical infection: maybe one reason for prom ,
the relatinship between bacterial vaginosis and pre
term labor or pprom show this fact
○ Cervical length <2.5 cm.
○ Prior preterm labour.
○ Low BMI (<19 kg/m2). 27
Risk Factors of PROM
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Patho-
genesis
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Diagnosis of PROM
▷ History.
○ Patient complains of discharge of clear fluid
(liquor) vaginally.
▷ Examination:
○ Speculum: shows liquor draining through
cervical os.
○ Examination of collected fluid from posterior
fornix:
■ Fern test, crystallization of liquor when
dried on a slide.
■ Litmus test or Nitrazine paper test for
detection of pH (6 to 6.2) 30
Differential Diagnosis
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Complications of PROM
▷ Maternal hazards:
○ Preterm labor.
○ Increased risk of infection.
▷ Fetal:
○ Cord prolapse.
○ Intrauterine infection.
○ Fetal pulmonary hypoplasia.
○ Neonatal sepsis.
○ Respiratory distress syndrome.
○ Intraventricular hemorrhage.
○ Necrotizing enterocolitis. (NEC).
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Management of PROM
▷ Depends on:
1. Gestational age of the fetus.
2. whether the patient is in labour or not.
3. Any evidence of sepsis.
4. Prospect of fetal survival in that institution, if delivery
occurs.
▷ If there is: amnionitis, placental abruption, fetal
death or distress, labour process then a prompt
effective delivery should be done with broad
spectrum intrapartum antibiotics and admit the
baby to the nursery intensive care unit if needed.
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Management
Term (37 weeks or Preterm (32 to 33 completed
more) or Near term (34 weeks) :
weeks to 36 completed ▷ Expectant management, unless
weeks) : fetal pulmonary maturity is
documented. Management aims
▷ Wait for spontaneous to continue for fetal maturity so
onset of labor for 24- transfer the patient with the
48h. fetus in utero to a center
equipped with NICU.
▷ If fails then induction
▷ Group B streptococcal
of labor with oxytocin prophylaxis recommended
or C/S (for obstetric ▷ Corticosteroids—no consensus,
reasons). but some experts recommend
▷ Group B streptococcal ▷ Antibiotics recommended to
prophylaxis prolong latency if there are no
contraindications
recommended. 34
Preterm (24 weeks to 31 Less than 24 weeks:
completed weeks) :
▷ Expectant Management
▷ Expectant management or induction of labor
▷ Group B streptococcal
▷ Group B streptococcal
prophylaxis recommended
prophylaxis is not
▷ Single-course recommended
corticosteroid use
recommended ▷ Corticosteroids are not
recommended
▷ Tocolytics—no consensus
▷ Antibiotics recommended ▷ Antibiotics—there are
to prolong latency if there incomplete data on use
are no contraindications in prolonging latency
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