OBSTETRIC WARD

Wednesday, January 25 – 30th 2024

Supervisor:
Prof. Dr. dr. M. Fidel Ganis Siregar, M.Ked (OG), Sp.O.G, Subsp. F.E.R
Dr. dr. Makmur Sitepu, M.Ked(OG), Sp.O.G, Subsp. K.Fm
Dr. dr. Ichwanul Adenin, M.Ked (OG), Sp.O.G Subsp.F.E.R
Dr. dr. Muara P. Lubis , M.Ked (OG), Sp. O.G, Subsp. K.Fm
dr.Hayu L. Haryono, M.Ked(OG), Sp.O.G, Subsp. K.Fm
dr. Arvitamuriany T. Lubis, M.Ked (OG), Sp.O.G
dr. M. Iman Syahputra, M.Ked (OG), Sp.O.G
Dr. dr. Tanzil Al Hair, Sp.O.G

Residents:
dr. Tazkia Solihaty Tsabitah
dr. Muhammad Chairul Akbar Nasution
dr. Dashari Ermandi Harahap
dr. Trinidia Lubis
dr,. Atikah Zahra Mustafa Nasution
dr. Zulfindra Arifin

Obstetric and Gynecology Department

Medical Faculty of Universitas Sumatera Utara
Prof CPL USU General Hospital
2024
New Patient: 1 Patients
THANK YOU
 PATIENT 1
deby khairani
Mrs.D, 22 y.o, G2P1A0, Bataknese, Moslem, S1 , Employee, married to Mr. A, 31 y.o, Javanese, Moslem,
Senior High School, Employee. The patient was came to Emergency Room of Prof. dr. CPL USU General
Hospital on January 30th 2024 with :

Cc : Emergency C-Section
E : History of labor contraction (+). History of amniotic leakage (-). History of blood slime (-). History
of abdominal pain (-), history of vaginal bleeding (-) History of abdominal massage (-) History of post coital
bleeding (-) History of herbal consumption (-) History of fever, shortness of breath and cough (-). Defecation
and Micturition within normal limit.
History of previous illness :-
History of Medication :-
History of Surgery :-
History Of Alergy :-
LMP : 5/5/2023 (38weeks)
EDD : 12/02/2024
ANC : Obstetrician 5x

History Of Pregnancy :
1. Male, Aterm, 4.100 gram, SVD, Hospital, Obstetrican, 3y.o, Healty
2. Current Pregnancy
MEOWS

Total Score : 1
Vital Signs
Cons : CM Anemic : (-)
BP : 115/89 mmHg Icteric : (-)
Pulse : 89 bpm Cyanosis : (-)
RR : 20 rpm Dypsnoe : (-)
Temp : 36.5 ⁰C Edema : (-)

General state : Moderate BW : 65 kg

Nutritional state : Overweight BH : 156 cm
Illness State : Moderate UAC : 235 cm

Generalized Status
• Head : Inferior palpebra conj anemic (-/-), icteric (-)
• Neck : Within normal limits
• Thorax : Respiratory sound : Vesiculer (+/+)
Additional sound : wheezing(-)/(-), rhales (-)/(-)
• Extremities : oedema (-/-)
• Lymph nodes : no enlargement
Obstetric Examination
Abdomen : Asymmetrically enlarged
Fundal height : 2 fingers below processus xyphoideus (34 cm)
Tension part : Right
Lower part : Head
FM : (+)
FHR : 188x/i bpm
Uterine contraction : (-)

Vaginal Examination
VT : Cervical dilatation 2cm, Effacement 50%, Cervix sacral, Amniotic

Gloves : F/A (+), Bloodslime (-), Amniotic Fluid intake

CTG
Baseline : 140
Varability : 5-25 bpm
Acceleration : (-)
Deceleration : (-)
HIS : (-)

Conclusion : CTG category I

Transabdominal Sonography
January 30th 2024
Transabdominal Sonography
January 30th 2024
Transabdominal Sonography
January 30th 2024
Transabdominal Sonography
January 30th 2024
Transabdominal Sonography
January 30th 2024
Transabdominal Sonography
January 30th 2024
 Transabdominal Sonography
January 30th 2024
- Single Fetus Intrauterine ,FM (+)
- BPD :102 mm
- HC : 355,6 mm
- AC : 329,7 mm
- FL : 75,8 mm
- MVP : 5 cm
- FHR : 170 x/i
- S/d ratio : 1,6
- EFW : 3.488gr
- Placenta Funda Posterior

Conclusion:
IUP (37-38) wga + Head Presentation + Live Fetus
 Laboratory Findings
January, 30th 2024
• Hb : 10.5 N: 12-14 gr/dL
• Leukocyte : 15.720 N: 4.000-11.000/uL
• Hematocrit : 35.7 N: 36,0-42,0/%
• Platelet : 287.000 N: 150.000-400.000/uL
• MCV : 85.6 N: 82 – 92 fL
• MCH : 27.8 N: 27 – 33.7 pg
• MCHC : 32.5 N: 32 – 36 %
• RDW-SD : 46.3 N: 11.5 – 14.5%
• Neutrophil : 74.3 N: 50.00 – 70.00%
• Lymphocyte : 15.7 N: 20.00 – 40.00%
• Monocyte : 6.8 N: 2.00 – 8.00%
• Eosinophil : 2.9 N: 1.00 – 3.00%
• Basophil : 0.3 N: 0.00 – 1.00%
• Neutrophil Abs : 6.91 N: 2,7-6,5 10^3/l
• Monocyte Abs : 0.63 N: 0,2-0,4 10^3/l
• Eosinophil Abs : 0.27 N: 0-0,1 10^3/l
• Basophil Abs : 0.03 N: 0-0.1 10^3/l
 Laboratory Findings
January, 25th 2024

Clinical Chemistry
• PT : 12.8 N: 14

• INR : 0.83 N:0.8-1.3

• APTT : 28.3 N:32.7
• Glucose : 89 N: <200
• Anti HIV (Rapid) : Non-Reactive N: Non-Reactive
• HbsAg : Non-Reactive N: Non-Reactive
Diagnosis:
SG + IUP (38)weeks + PK + AH + Fetal Distress

Therapy
IVFD RL 20 tpm
Inj cefazoline 2gr  prophylaxis

Planning:
Emergency C-Section on Tuesday, January 30th 2024
Consult to Perinatology Department
Consult to Anesthesiology Department

Reported to supervisor on duty dr. Pebri W Pulungan Sp.O.G Approved

 Emergency C-Section Report d/t Fetal distress
On January 30th 2024 at 11.37 a.m, by C-Section, born a male baby with BW 4.150 gr, BL 49 cm, Apgar Score 8/9
Anal (+) NBS 34 appropriate with 37-38 wga

• The patient was laid on the operating table. IV cath and Folley catheter was inserted
• Antiseptic and aseptic procedures were performed using povidone iodine on the abdomen, and then draped leaving the
surgical field exposed.
• Under spinal anesthesia, pfannenstil incision was performed through cutis, subcutis, until fascia. The fascia was incised
and extended laterally using scissor. 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. Lower uterine segment was identified, a transversal incision in the uterus performed until
subendometrium layer. Endometrium penetrated and widened bluntly.
• By pulling the legs born a male baby with BW 4.150 gr, BL 49 cm, Apgar Score 8/9, Anal (+)
• The umbilical cord was clamped in two places and cut in between.
• The placenta was born with traction on the umbilical cord. Uterine cavity was cleaned with gauze, evaluated there was
no active bleeding.
• Uterus was sutured double layer continuously, evaluate  Bleeding was controlled.
• Evaluating both adnexa  No abnormalities.
• Abdominal wall closed layer by layer.
• Peritoneum sutured continuously, muscle approximation using simple suture and fascial closure using continuous suture.
• Subcutaneous layer was sutured with simple suture and cutis was sutured with subcuticular suture.
• Surgical wound was closed with sofratulle, sterile gauze and hypafix.
• Patient was stable after the operation.
Surgical Findings
Diagnosis :
Post C-Section d/t Fetal Distress + PD-0

Therapy :
- IVFD RL 500 ml + Oxytocin 10 IU 20 dpm
- Inj. Ceftriaxone 1 gr / 12 hours
- Inj. Ketorolac 30 mg / 8 hours
- Inj. Ranitidine 50 mg / 12 hours

Plan :
• Monitoring Vital Sign, Vaginal Bleeding, Urine Output, Uterine contraction
• Check CBC 2 hours post Operation

Reported to supervisor on duty dr. Pebri W Pulungan Sp.O.G Approved Approved

 Laboratory findings
January 30th 2023 (Post Op)
• Hb : 10.1 N: 12-14 gr/dL
• Leukocyte : 19.130 N: 4.000-11.000/uL
• Hematocrite : 32.8 N: 36,0-42,0/%
• Platelet : 369.000 N: 150.000-400.000/uL
• MCV : 81.2 N: 82 – 92 fL
• MCH : 25.7 N: 27 – 33.7 pg
• MCHC : 31.7 N: 32 – 36 %
• RDW-SD : 39.2 N: 11.5 – 14.5%
• Neutrophil : 74.3 N: 50.00 – 70.00%
• Lymphocyte : 15.7 N: 20.00 – 40.00%
• Monocyte : 6.8 N: 2.00 – 8.00%
• Eosinophil : 2.9 N: 1.00 – 3.00%
• Basophil : 0.3 N: 0.00 – 1.00%
• Neutrophil Abs : 6.91 N: 2,7-6,5 10^3/l
• Monocyte Abs : 0.63 N: 0,2-0,4 10^3/l
• Eosinophil Abs : 0.27 N: 0-0,1 10^3/l
• Basophil Abs : 0.03 N: 0-0.1 10^3/l
Follow Up
January 31th 2024 (08.00 am)
S Pain on Surgical wound
O Sens : CM
BP : 126/82 mmHg
HR : 70 bpm
RR : 20 rpm
T : 36.5
SpO2 : 99% Via RA

Localized State:
Abdomen : Laxed, Peristaltic (+)
Operation wound : Covered by Gauzed, seems dry
Vaginal Bleeding : (-) , Lochia rubra (+)
Micturition : On catheter 50cc/hrs, Yellow fish
Defecation : (-) Flatus (+)

A Post C-Section d/t Fetal Distress + PD-1

P IVFD RL + Oksitosin 20 IU 28 gtt/i sampai 15 jam post partum
Inj. Ceftriaxone 1gr/12jam
Inj. Ranitidine 50mg/12jam
Inj. Ketorolac 30mg/8 jam

I Catheter removal
Mobilization
Follow Up
January 31th 2024 (08.00 am)
S Pain on Surgical wound
O Sens : CM
BP : 126/82 mmHg
HR : 70 bpm
RR : 20 rpm
T : 36.5
SpO2 : 99% Via RA

Localized State:
Abdomen : Laxed, Peristaltic (+)
Operation wound : Covered by Gauzed, seems dry
Vaginal Bleeding : (-) , Lochia rubra (+)
Micturition : spontaneous
Defecation : (-) Flatus (+)

A Post C-Section d/t Fetal Distress + PD-2

P Cefadroxil 2 x 500 mg
Mefenamic acid 3x500 mg
B comp 2x1
Sulfat Ferrosus 2x1

I IV Line removal
Oral therapy
Follow Up
February 1st 2024 (08.00 am)
S Pain on Surgical wound
O Sens : CM
BP : 126/82 mmHg
HR : 70 bpm
RR : 20 rpm
T : 36.5
SpO2 : 99% Via RA

Localized State:
Abdomen : Laxed, Peristaltic (+)
Operation wound : Covered by Gauzed, seems dry
Vaginal Bleeding : (-) , Lochia rubra (+)
Micturition : spontaneous
Defecation : (-) Flatus (+)

A Post C-Section d/t Fetal Distress + PD-3

P Cefadroxil 2 x 500 mg
Mefenamic acid 3x500 mg
B comp 2x1
Sulfat Ferrosus 2x1

I Change Gazue
Ambulatory today
THANK YOU