OBSTETRICS & GYNECOLOGY DEPARTMENT

Duty Report
Tuesday, April 6th 2021
SUPERVISOR
dr. Arvitamuriany T. Lubis, M.Ked(OG), Sp.OG

RESIDENTS
1. dr. M. Agung Khoiri
2. dr. Irwin Lamtota Lumbanraja
3. dr. Asdina Ariesta
4. dr. Rizki Perdana Lubis

Department of Obstetrics and Gynecology

Medical Faculty – Universitas Sumatra Utara
2021
1. Mrs. N, 25 yo, G2P1001
Diagnosis : Prev C-Section 1 x d/t contracted pelvic + SG + IUP (38) wga + Head Presentation + Live Fetus +
In Labor
Supervisor : dr. Arvitamuriany T. Lubis, M.Ked(OG), Sp.OG
Planning : - Emergency C-Section
- Consult to Anesthesiology Department
- Consult to Perinatology Department
On April 7th 2021 at 11.40 am, by C-Section born male baby, BW 3550, BL = 52 cm, Apgar scroe 9/10, Anal (+), NBS = 38
appropriate to 38 – 40 wga
PATIENT 1
Mrs. N, 25 yo, G2P1001, Javanese, Christian, Senior high school,
Housewife. Married to Mr. D, 32 yo, Bataknese, Christian, Senior
high school, Enterpreuner. The patient came to USU General
Hospital on April 07th 2021 at 08.00 a.m with:

Cc : Labor Contraction
E : This has been experienced by patient since 6 hours ago. The
contraction felt more frequent and longer. History of blood slime (+).
History of amniotic fluid leakage (-). History of trauma (-). History of
cough (-). History of fever (-). History shortness of breath (-). History
close contact with Covid-19 patient (-). Micturition and defecation
within no abnormalities
• Previous illness :-
• Previous Medication :-
• Previous Surgery : C-Scetion (2019)
• Last Menstrual Period : 10/07/2020 (38w3d)
• EDD : 17/04/2021
• ANC : Midwife 4 times, Obstetrician 3 times

History of Pregnancy
1. Male, 3500 gr, aterm, C-Section d/t Contracted pelvic, Obstetrician,
Hospital, 1y8m, Healthy
2. Current Pregnancy
Score
0
0
0
0
0
0
0
0
0
MEOWS

Total Score 1
Vital Signs
Sens : Alert Anemic : (-)
BP : 120/70 mmHg Icteric : (-)
Pulse : 80 bpm Dyspnoe : (-)
RR : 20 rpm Cyanosis : (-)
Temp : 36.5°C Oedem : (-)

General state : Good Height : 150 cm

Illness State : Moderate Weight : 68 kg
Nutritional State : Normoweight UAC : 27.5 cm

Generalized State :
Head : Pale palpebra conjuctiva inferior (-/-), icteric sclera (-)
Neck : within no abnormalities
Cor : Within no abnormalities
Thorax : Respiratory sound : Vesicular (+/+)
Additional sound : Rales (-/-), wheezing (-/-)
Superior Ext : Within no abnormalities
Inferior Ext : Within no abnormalities
Obstetrical State
Abdomen : Asymmetrically enlarged
Fundal height : 2 fingers below proc. Xiphoideus (35 cm)
Tension part : Right
Lower part : Head (5/5)
Uterine contraction : 2 x 20”/ 10’
Fetal movement : (+)
Fetal heart rate : 143 bpm
EFW (Johnson-Taussac) : [(34 – 13) x 155] = 3410 gr
Vaginal Examination

• Vaginal Toucher : Cervix dilated 4 cm, eff. 80%, Amniotic

membrane (+), head floating, minor fontanella 2 o’clock
• Glove : Blood slime (+), amniotic fluid (-)
 Pelvic Adequacy
Promontories : Palpable (CV = 9.5; CD = 8 cm)
Innominate line : Palpable entirely
Spina Ischiatic : Protruded
Sacrum : Concave
Pubic Arch : < 90o
Coccygeus : mobile

Conclusion  Inadequate Pelvic

 TAS
(April 7th 2021)
 TAS
(April 7th 2021)
 TAS
(April 7th 2021)
 TAS
(April 7th 2021)
 TAS
(April 7th 2021)
 TAS
(April 7th 2021)
 TAS
April 7th 2021
 TAS
April 7th 2021
‐ Singleton Fetus, Head Presentation, Live Fetus
‐ Fetal movement (+), FHR : 134 bpm reg.
4 Chamber view :
‐ BPD : 94.0 mm ‐Situs solitus
‐ HC : 338.1 mm ‐Heart position was normal
‐ AC : 353.6 mm ‐Heart normal sized
‐ FL : 77.9 mm ‐Symmetrical four chamber
‐ Placenta fundal anterior grade 3 ‐Inteventricular septum normal
‐ Sagital myometrial thickness : 2.3 mm
‐ S/D Ratio : 1.82
‐ MVP : 45.9 mm
‐ TCD : 53,1 mm ( 38 wga )
‐ EFW : 3692 gr
 Laboratory Findings
April 7th 2021

• Hb : 11 N: 12-14 gr/dL
• Leukosit : 10.720 N: 4.000-11.000/uL
• Hematokrit : 35 N: 36,0-42,0/%
• Platelet : 417.000 N: 150.000-400.000/u
• MCV : 77.80 N: 82-92 fL
• MCH : 24.40 N: 27-31 pg
• MCHC : 31.40 N: 32-36 g%
• NLR : 2.78
• PT : 11.90 C: 11.7 – 15.1
• INR : 0.83
• APTT : 28.00 C: 28.2 – 42.2
• Ad Random Glucose : 91 N: 0.00-140 mg/dl
• Ureum : 16 N: <50
• Creatinin : 0.66 N: 0.6-1.3 mg/dl
• Natrium : 137 N: 136-155 mmol/dl
• Kalium : 4.79 N: 3.5-5.5 mmol/dl
• Chlorida : 101 N: 95-103 mmol/dl
• HBsAg : Non Reactive N: Non Reactive
• Anti-HIV : Non Reactive N: Non Reactive
• VDRL/ TPHA : Non Reactive N : Non Reactive
• RT PCR SARS-CoV-2 : Negatif N : Negatif
Diagnosis :
Prev C-Section 1x d/t Contracted Pelvic + SG + IUP (38) wga + Head Presentation + Live
Fetus + In Labor

Therapy:
- IVFD RL 20dpm
- Inj. Cefazoline 2gr/IV  prophylaxis (Skin test)

Plan :
- Emergency C-Section
- Consult to Anesthesiology Department
- Consult to Perinatology Department

Reported to Supervisor dr. Arvitamuriany T. Lubis, M.Ked(OG), Sp.OG  Approved

THANK YOU
 Anesthesiology Department
• A : Prev C-Section 1x + SG + IUP (38) wga + Head
Presentation+ Live fetus + Inpartu
• P : ACC to helps for anesthesia the patient
 Perinatology Department
• A : Prev C-Section 1x + SG + IUP (38) wga + Head
Presentation+ Live fetus + Inpartu

• P : Approve to help the baby after delivery

 C-Section d/t Prev C-Section 1x d/t Contracted labor + Head Presentation + Live Fetus
On April 7th 2021 at 11.40 a.m by C-Section born baby girl, BW : 3550 gr, BL 52 cm, Apgar Score 9/10,
Anal (+), NBS = 38 appropriate to 38 - 40 wga

• The patient was laid on the operating table, with IV line and urinary catheter inserted.
• Antiseptic and aseptic procedures were performed using povidone iodine on the
abdomen, and then draped leaving the surgical field exposed.
• Under Spinal anesthesia, pfanensteil incision was performed in previous scar. Fascia
was incised in and extended laterally using scissor. Superior aspect of the fascia was
elevated using Kocher, and the underlying rectus muscles were separated.
• Peritoneum was identified. The peritoneum was elevated using clamp and entered
using Metzenbaum scissor with care for the underlying organ, and extended superiorly
and anteriorly with careful visualization of the bladder. Seen uterus appropriate to
gestational age. The lower uterine segment was identified. A low cervical incision in
the uterus performed until subendometrium layer. Endometrium penetrated and
widened bluntly.
• By luxating the head, born female baby, BW : 3550 gr, BL 52 cm, Apgar Score 9/10,
Anal (+)
• The placenta was born with fundal pressure and traction on the umbilical cord.
Uterine cavity was cleaned with gauze.
• Uterus was sutured continuously, evaluate  Bleeding was controlled
• Evaluating both adnexae  No abnormalities
• Abdominal wall closed layer by layer
• Peritoneum sutured continuously, muscle approximation using simple suture and
fascial closure using continous suture
• Subcutaneous layer was sutured with simple suture and cutis was sutured with
subcuticuler suture
• Surgical wound was closed with sofratulle, sterile gauze and hypafix
• Mother was stable the after the operation
 Laboratory Findings Post C-Section
April 7th 2021
• Hb : 11.2 N: 12-14 gr/dL
• Leukosit : 15.360 N: 4.000-11.000/uL
• Hematokrit : 35.20 N: 36,0-42,0/%
• Platelet : 415.000 N: 150.000-400.000/u
• MCV : 77.20 N: 82-92 fL
• MCH : 24.60 N: 27-31 pg
• MCHC : 31.80 N: 32-36 g%
THANK YOU