STATUS OF PATIENT
I PATIENTS IDENTITY
Name : Mrs. S
Age : 25 Years
Education : bachelor
Job : Housewife
Ethnic/Religion : Moslem
Status : Married
No. MR : 16.81.22
Age : 29 Years
Education : bachelor
Job : Employee
Ethnic/Religion : Moslem
Status : Married
1
II ANAMNESIS
Autoanamnesis has done in Room Mawar of RSUD Embung Fatimah Kota
2
Consciousness : Compos mentis Cooperative
Vital Sign
Blood Pressure : 120 / 80 mmHg
Heart Rate : 80 x / minutes, reguler
Respiration : 20 x / minutes
Temperature : 36,00C
Ears : normal
Nose : normal
Antropometri : Weight 60 kg
height 143 cm
Thorax
3
A : vesicular (+/+), rhonki (-/-), wheezing(-/-)
Obstetri Check Up
Abdomen,
palpable buttocks
L 2 : left back
L 3 : head
L 4 : Convergent
HF : 35 cm
HIS : (-)
Percussion : timpani
FHR : 140x/i
Genitalia Check Up
Internal check Up : un do
4
p/v : (-)
5
ChecGCp Result Reference Scores
Hematocrit 37 % 35 - 50 %
Basophils 0 01
Eosinophils 0 04
Neutrophil Segment 70 46 73
Limphocytes 9 17 48
6
Monocytes 6 4 10
V. WORKING DIAGNOSIS
G1P0A0 gravid 38 weeks with CPD
VI. PLAN
Mom and fetus condition observation.
Informed consent
Preparation OK and anasthesia
SC
VII. MANAGEMENT
Therapy post OP :
IVFD RL drip tramadol 100 mg 28 gtt/i
Inj Ketorolac 2x1
Metronidazole 3x1
Transamin 3x1
Vit k 3x1
Vit c 3x1
VIII. FOLLOW UP
Sens : CM
BP : 120/80 mmHg
HR : 80 x/minutes
RR : 20 x/minutes
T :36C
edema (-/-)
FHR : 130x/i
HF : 35cm
7
HIS : (-)
p/v (-)
with CPD
( 12 January up
follow 2017 06:00 WIBO: GC
S: No Complaint
: good,
(
Mawar) follow up O: GC
Sens : good,
: CM
Mawar) BP Sens : CM
: 100/70 mmHg
HR BP
: 76: x/minutes
100/60 mmHg
RR HR
: 20 :x/minutes
63 x/minutes
T RR : 20 x/minutes
:36C
EyesT :36,5C
: CA (-/-), SI (-/-)
Eyes
Extremity : :Akral
CA (-/-), SI (-/-)
warm (+),
edema
p/v (-/-)flow
(+) not
A: RL
P : IVFD P1A0H1 post SC 100
drip tramadol a/I CPD
mg
P : gtt/i
28 IVFD RL drip tramadol 100 mg
28 gtt/i2x1
Inj Ketorolac
Transamin 3x1
8
Vit k 3x1
Vit c 3x1
Metronidazole 3x1
Transamin 3x1
Vit k 3x1
Vit c 3x1
13 January 2017 06:00 WIB S: no complaint
( follow up O: GC : good,
Mawar) Sens : CM
BP : 100/60 mmHg
HR : 63 x/minutes
RR : 20 x/minutes
T :36,5C
edema (-/-)
P : aff infuse
Cefixime 3x1
Sf 1x1
Vit C 1x1
R : may return
9
Baby Status Born date : 11-1-2017 time 12;29
Weight : 3100 gr
BL : 50 cm
HC : 35 cm
CS : 35 cm
Status : alive
CHAPTER II
(coxae) bones that are formed by the fusion of ilium, ischium, and pubis.
10
The pelvis is divided into two by an imaginary plane of the regio-drawn from
pelvic arpertura (the inlet pelvis) and arpetura inferior pelvis (outlet pelvis)
(Baun, 2005).
During process of the normal birth, the baby must be able to pass
through the opening both oftrue pelvic (Amatsu Therapy Association and
11
The shape of womeninlet, compared with men, tend to be more rounded
does not describe the shortest distance between the sacrum promontory and
12
Figure 1.2 An overview of three anteroposterior diameter of inlet pelvic:
of the smallest pelvic dimensions. Have a special meaning after the fetal
13
3) Pelvicoutlet(apertura pelvis inferior).
Pelvisoutlet consists of two areas which resemble a triangle. These
areas have the same basic line drawn between two ischium tuberosity. Apex
of the triangle posterior is at the tip of the sacrum and the limits of lateral is
formed by the area below the pubis arcus. Three outlet pelvic diameter is
Figure 1.4 Inlet pelvic important with diameters. Note that the
ed.
c. Pelvic forms
14
Caldwell and Moloy developed a classification of the pelvis which is still used
transverse diameter of the largest in the inlet pelvis and its partition into
anterior and posterior segment. The form of these segments to determine the
platipeloid. Posterior segment characters specify type of the pelvis, and anterior
segments and characters determine the tendencies are. Both of these are
specified as most of the pelvis is not a pure type, but rather a mix of, for
Figure 1.5 Four types of pelvis with the classification of Caldwell-Moloy. The
line crosses the widest transversal diameter split inlet into segments
15
posterior and anterior. Source: Cunningham, et al. Williams Obstetrics,
23rd ed.
the pelvis of the male pelvis. Pelvic android is more often found in women with
women who experience delays in an upright position, i.e. after the age of 14
months, while the pelvic platipeloid more commonly found in women who
have the capability of an upright position before age 14 months (Leong, 2006).
There are 6 important variables on the fetus which affects the process
of labor:
both have a high degree of error. Makrosomia fetus associated with the failure
longitudinal uterus. The location of the fetus can be variated, i.e.: longitudinal,
16
The bottom part is a presentation of the fetus which is closest to the
passage. A fetus with a longitudinal layout has the presentation of the face or
buttocks. Mixed presentation stated that there is more than one part of the
the umbilical cord, are rare.Fetus with the presentation of the head are
classified based on the part of the bone of the skull that looked i.e. oksiput
The attitude expressed the position of the head in relation to fetal spine
of the head of foetus in the mother's pelvis. If the Chin fetus experiencing
diameter that may appear on the presentation of the head. Diameter that
appear on the inlet of pelvis is increasing in line with the degree of head
extension (deflection). This can lead to the failure progress of labor. The
architecture of the pelvic wall along with the increase in uterine activity can
e. fetal position
17
Fetal position stating the relationship between a reference point on the
lower part of the fetus with the right or left side of the passage. This can be
head, the occiput became a reference for assessment. If oksiput leads directly
into the anterior position of being oksiput anterior (OA).If oksiput leads to the
right side of the mother, the position being oksiput right anterior (ROA). At
f. Station
18
Station is the measurement of the fetal part of the descent through the
between the head of the fetus and the mother's pelvis so that the fetus can not
labor occurs, when there is a mismatch between the fetus and the maternal
birth canal. 2
19
Figure 3.1 Baby,s head too large to fit through mothers pelvis
b. Etiology
ekpulsif mother.
20
4. Abnormalities involving the fetus (passenger), for example the
1. Maternal Factors
It is said that the Central narrow pelvis if; the number of the
2. Fetal Factors
b) Hidrocephalus
21
c)Abnormalities location of the fetal. 7.8
c. Epidemilogi
in the 2005 World Health Report of the World Health Organisation (WHO).9
Data from the Reproductive Health Library States there is 180 to 200
million pregnancies each year. These 585,000 going from maternal deaths due
Constriction of pelvic cavity that can occur include narrowing of the pelvic
22
it brings about rough assessment of obstetric conjugate that usually has a
narrowing the pelvis inlet is often defined as the diagonal of less than
conjugate size 11.5 cm. For the sake of biparietal diameter then labor fetus
that resides within the normal range 9.5-9.8 cm, therefore labor will be
difficult if the fetus must pass through the room veraconjugate less than 10
cm
2) The narrowing pelvis cavity (midpelvis)
The central door of the pelvis is considered narrowing in the amount
cavity.2
3) The constriction ofpelvis outlet
Narrowing down the definition of the pelvis is
pubis ramus, anterior triangle peak limit and is bounded by the inferior part
pubis narrows (< 90o) so that the anterior triangle of the narrows. Based on
this narrowing, in order for of the fetal head can be born larger room is
23
required at the back pelvis outlet so that the head is forced towards the
posterior.
e. Clinical manifestations
(primipara), 38 mg (multipara) 7
f. Inspection
possible have a capacity of a narrow pelvis, but that does not mean a
woman with normal height can have a narrow pelvis. From previous
previous labor goes well with normal weight baby, the chances of a
outlet. As for the pelvimetri the outside does not have much meaning
24
(a)
(b)
(c)
25
Pelvimetri radiological
Can give a clear picture and have a level of precision that is not
are prohibitive. From pelvimetri with imaging of the pelvic type can
be determined, the actual pelvic size, vast areas of the pelvis, hip,
Significant associations have been found between the risk for dystocia
26
head volume and maternal pelvic dimensios. Unfortunately, the
considered to be inadequate, i.e. the values of the area under the curve
27
Figure 3.4 MR. pelvimetry images with measurements; b. the Transverse
g. Enforcement Of Diagnosis. 12
a primigravida in late pregnancy head child has not entered p.a. p and error
1) Anamnesis
The head does not enter P.A. P and there is a history of errors layout
(LLi, layout of the buttocks), long ago labor, birth or death of the
operation.
2) Inspection
kifosis, etc. Outer pelvic abnormalities (rachitis, etc) if the head has
not entered P.A. P looks the contours as the head protrudes above
the symphysis.
3) The Palpation
The head does not enter p.a. p or is still rocking, and there are signs
ofOsborn, namely the head pushed towards p.a. p with one hand
28
abovesimphysis pubis are another measure of perpendicular hand
General examination
(primipara), 38 mg (multipara)
transversal< 12 cm
9.5 cm
h. Management. 7,13
29
do simfisiofomia and kraniotomia, but simfisiotomia rarely done in Indonesia,
1) Sectio Caesaria
Sectiocaesaria can be done on an elective or primary, i.e. before
under the terms for labor troughvaginal not or has not been
fulfilled.
2) Labor Trial
between fetal head and pelvis, and having reached the conclusion
that there is hope that the labor can take place safely, trought
30
We stop labor experiment if:
quite good and done with good labor leader, the head of the
and right hip bones at the symphysis of the pelvis cavity that
i. Prognosis. 7
When labor with pelvic heads disproportion left lasting taking itself
without appropriate action, arising out of danger to the mother and fetus are:
inrapartum infections.
With his strong advances in the way fetuses being born is stuck can
31
and when it is not immediately taken action will happen rupture
atony.
With labor not progressing because of the diproporsi head of the
hips, the way the old born undergo pressure between the head of
the fetus and pelvic bone. Things that cause interference with the
can cause a need on the network above the bones of the head of the
32
CHAPTER III
CASE THEORY
In these patients with On the theory to the case of CPD (cephalopelvic
have height 143cm. message was pregnant with height less than 145cm
in these patients with gestational age On theories with CPD (cephalopelvic disproportion)
38 weeks with inspection results in her to diagnose the case one of the criteria is the fetus has
Leopold4 State convergen by means of not entered a PAP at 36 weeks gestational age
pregnant patients
In these patients with pregnancy On the theory to the case of CPD one ofmanagement
recommend to SC and have set on an elective or primary, i.e. before labor begins or
the schedule SC on date at the beginning of labor, and secondarily, that is after
33