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MORNING REPORT
January, 9th 2016
Resident In Charge:
Dut/Kir/Sri/Cep/Tuk/Did/Cil
Chief : dr. Suq
Supervisor:
Dr. dr. Tatit Nurseta, SpOG-K

Emergency Room
Delivery Room
Physiological case
Pathological case :
Pervaginam
Perabdominam

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Emergency Room
1. G1P0000Ab000 gr 28-30 weeks G/L/L
+ Partus Prematurus Imminens
+ Anemia
+ Obs. Abdominal blunt trauma

DELIVERY ROOM
1. Mrs. Dewi T/21 y.o
G1P0000Ab000 part 40-41 weeks S/L
+ Second stage
+ Mild preeklampsia
Spontaneous Vertex Delivery
Outcome : January 9th 2016 at 2.55 pm
Male / 2660 gr / 47 cm / AS 7-9

2. G3P2002Ab000 gr 40-41 weeks S/L

+ Chronic Hypertension Superimposed
Preeklampsia
+ Impending Eclampsia
+ Obesity
+ Secondary Old Prime
+ age > 35 y.o
+ Fetal compromisedOn
January 9th 2016, at 9.50pm,
Male baby was borne 3224 gr/ 50 cm/ AS 6-8

Subjectives
Reg. 11271250
Mrs. U / 35 y.o / 6 yoe/ housewife
Mr. M / 46 y.o / 6 yoe/ building worker
Married 1x, 17 years
Address : KH Malik Dalam RT 4/4 Buring Malang
Admission : on 9-1-2016 at 7.10 pm

Patient was reffered by obstetrician from

Rampal Hospital with G3P2002Ab- GA 40-41
weeks with severe preeclampsia (Impending
Eclampsia)
Chief complaint : High blood pressure

SUBJECTIVES
9-1-2016
at 5.30 am
Patient felt dizzines still stayed at home
at 8.00 am
Patient felt dizzines more severe went to midwife got
examined BP 170/100 suggest reffered to obstetrician
at 11.00 am
Patient went to Rampal hospital got examined BP 200/130
given Inj. SM fulldose and Nifedipine 10 mg sublingual and
planned to CS cito because there is no ICU at Rampal
hospital suggested reffered to Saiful Anwar Hospital
family still discussed
at 5.30 pm
Patient arrived at Saiful Anwar Hospital

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Subjective
History of
high blood presure before
pregnancy (+) since 3 years ago patient
didnt routinely controll
Dizzines (+), nausea (-), vomiting (-), blurred of
vision (-), epigatric pain (-)

SUBJECTIVES
History of Pregnancy
1. Aterm/ 2600 g/ spontaneus vertex delivery/Midwife/
Male/ 16 yo/ L
2. Aterm/ 2500 g/ spontaneus vertex delivery/ Midwife/
Female/ 12 yo/ L
3. This pregnancy

ANC : Midwife 5x (last controlled 4/1/2016)

LMP : 1-4-2015 ~ 40-41 weeks
Contraception : Pill contraception was stopped 1,5
years ago

OBJECTIVES
GA
BP

: good, GCS : 456

: 170/100 mmHg
PR : 80x/mnt
RR
: 20 x/mnt
Tax : 36,5C
BH
: 149 cm BW : 85 kg
BW before pregnant : 72 kg
BMI : 33,7 kg/m2
Head : conj. an -/- ict -/Tho
: C: S1 S2 single murmur (-)
P: Rh
Wh
Abd

: FH 33 cm, longitudinal lie

, FHR 150 x/m,
EFW : 3255 gr, uterine contraction (-)

OBJECTIVES
VT (after SM injection)
1cm, eff 25%, H I, amnion (+), head
presentation, denominator difficult to evaluate,
pelvic measurement ~ wnl

LABORATORY
CBC : 13/11.190/40,4/268.000
PPT
: 9,7
APTT
: 27,3
RBS : 71
Ur/Cr
: 5,70/0,53
OT/PT
:17/7
Alb : 3,4
LDH
: 487
SE : 137/3,81/109
UL : protein +3

NST
Baseline rate
Variability
Acc
Decc
Conclusion

: 150 bpm
: < 5 bpm
: (-)
: (-)
: Patologic CTG

USG
Fetal intrauterine single life, longitudinal lie, head
below
BPD : 92,0 (37w4d)
AC
: 336 (37w3d)
FL
: 73,6 (37w5d)
EFW : 3318 gr
AFI : 15,0
Placental implantation at fundal
Maturation grade III

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Consult to cardiology department

1.HF st B dt HHD
2.Hipertension st II
3.G3P2002Ab000 gr 40-41 weeks S/L
Cardiology state : ESC intermediate risk, GCRI can not measurement
Tx :
Adalat oros 1x30 mg could be increased 2x30 mg
Methildopa 3x250 mg could be titrated 3x500 mg
ISDN 3x5 mg if BP 160 mmHg
Patient will be join care

Assessment
G3P2002Ab000 gr 40-41 weeks S/L
+ Chronic Hypertension Superimposed Preeklampsia
+ Impending Eclampsia
+ Obesity
+ Secondary Old Prime
+ age > 35 y.o
+ Fetal compromised

PLANNING
PDx :
PTx :
- Intrauterine resucitation :

O2 10 lpm (NRBM)

Mother left lateral recumbent

- IVFD RD5% 20 tpm
- SM full dose (has been treated at Rampal Hospital): MgSO4 20 % 4 gr
IV slow bolus and MgSO4 40% 10 gr drip in RD5 500 cc until 6 hours
continued with SM maintenance 40% 10 gr in 500 ml RD5 /12 hours
until 24 hours post partum if contraindication (-)
- Proposed to termination with CS cito + tubectomy pomeroy
- Insert DC
- Premed : Inj. Cefazoline 1 gr iv (skin test)
Inj. Ranitidine 1 Amp iv
Inj. Metochlopramide 1 Amp iv
- Registered OR/informed consent/blood preparation
Pmo : VS,subjective, FHR, uterine contraction, SM contraindication
CIE
c/spv --------------------------------------------Acc Dr.dr. Tatit Nurseta, SpOG-K

OUTCOME
On January 9th 2016, at 9.50pm,
Male baby was born
3224 gr/ 50 cm/ AS 6-8

Last Condition mother and Baby

MOTHER
RR
GA : Good, CM
BP : 150/84 mmHg
HR : 96 bpm
RR : 20 bpm
Urine prod : 70cc/hour

BABY

Fetal movement : Good

No Oxygen
No Infusion
Baby box

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Subjectives
Reg. 11095083
Mrs. D/ 21 y.o / 9 yoe/ housewife
Mr. D / 22 y.o / 9 yoe/ Food seller
Married 1x, 1 years
Address : Jl. KH Hasim V/46, RT 08/03 Kedung
kandang Malang
Admission : on 10-1-2016 at 5.50 am

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Patient was consulted by surgery department

with obs. Abdomen Blunt Trauma + gravida 26
weeks

SUBJECTIVES
9-1-2016
At 4.30 pm
Patient fall in the bathroom with prone position felt uterine
contraction went to ER RSSA
Patient know that her pregnancy was gemelli when she had
ANC to obstetrician
Patient has history of gemelli from her husband
History of lekorhea (-), dysuria was denied
History of coitus (-)

SUBJECTIVES
History of Pregnancy
1. This pregnancy

ANC : Obstetrician 2x (last controlled 20/12/2015)

Midwife 2x
LMP : 26-6-2015 ~ 28-30 weeks
Contraception : -

OBJECTIVES
GA
BP
RR
BH

: Good, GCS : 456

: 110/70 mmHg
PR : 80x/mnt
: 20 x/mnt
Tax : 36,5C
: 150 cm
BW : 60 kg

Head : conj. an -/- ict -/Tho

: C: S1 S2 single murmur (-)
P: Rh
Wh
Abd

: FH 25 cm, longitudinal lie , FHR 141/152 x/m

EFW : 1180/1180 gr, uterine contraction (+)
rarely

OBJECTIVES
VT
2cm, eff 75%, H I, amnion (+), head
presentation, denominator difficult to evaluate,
pelvic measurement ~ wnl

LABORATORY
CBC : 9,3/14.540/29,10/261.000
PPT
: 9,2
APTT
: 25,2
RBS : 79
Ur/Cr
: 10,10/0,48
OT/PT
:15/9
SE : 133/3,61/110
BGA : 7,45/25,7/85,9 /17,9/-6,4/97,1

NST
Baby I :
Baseline rate
Variability
Acc
Decc
Conclusion

: 135 bpm
: 5-15 bpm
: (+)
: (-)
: Normal CTG

Baby II:
Baseline rate
Variability
Acc
Decc
Conclusion

: 130 bpm
: 5 20 bpm
: (+)
: (-)
: Normal CTG

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Ultrasonografi
Baby intrauterine G/L/L longitudinal lie head below head below
Baby I : BPD : 68,5 (27w4d)
AC : 230 (27w3d)
FL : 47,6 (25w6d)
EFW : 1014 gr
AFI : enough
Baby II : BPD : 66,7 (26w6d)
AC : 234 (27w5d)
FL : 48,7 (26w3d)
EFW : 1053 gr
AFI : enough
Placenta implantation at fundal, maturation grade II
Dividing membrane (+), RPH (-)

USG abd FAST

baby gemelli intrauterine longitudinal, head below, HR baby I : 153
bpm, HR baby II : 145 bpm , BPD I : 6,76 (26w2d) FTA1:
41,08(27w2d) FL1: 4,65 (26w3d) ; EFW1: 1096 gr and BPD2:
7,01(27w1d), FTA2: 41,16 (27w2d), FL2:4,93 (27w5d), EFW2: 1092
gr
Placenta impantation at fundal until corpus posterior with mild
indentation and parenchymal micro calcification. Free fluid at fossa
hepatorenal, splenorenal, subdiafragma D/S
and peri vesica is not visible.
conclusion
1.Free fluid at cavum abdominal not visible
2.Solid abdominal organ was intact
3.Gemelli gravida life intrauterine with GA 26-27 weeks
4.Maternal functional right mild hydronephrosis

Assessment
G1P0000Ab000 gr 28-30 weeks G/L/L
+ Partus Prematurus Imminens
+ Anemia
+ Obs. Abdominal blunt trauma

PLANNING
PDx : USG FM at work hour, cultur urine/cervix at ward
PTx :
- Conservative treatment
- Tocolytic : Kaltrofen supp II
- Lung maturation induction with Inj. Dexamethason 2x16 mg IV
- Inj. Cefazolin 3x1 gr IV (skin test)
- Tx oral : Isoxuprine 3x1 tab
Mefenamic acid 3x 500 mg
SF 1x1 tab
- If conservative treatment failed pro expectatif pervaginam
Pmo : VS,subjective, FHR, uterine contraction, sign of inpartu
CIE
c/spv -----------------------------------Acc Dr.dr. Tatit Nurseta, SpOG-K

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