Case No.

57
 Name : Mrs. R
Age : 21 years old
MR No. : 9897361
Date : August 17st, 2017
Addres : Lubuk Alung
 Circulation :
2 line
HES loading 1 kolf
RL loading 1 kolf
Airway : Clear
Breathing : O2 5lt/mnt via canul nasal

GA Cons BP HR RR T

Mdrt CM 80/p 128x/i 25x/i 37OC

Diagnose
Hypovolemic Syok due to Post Partum Haemorrhage
due to uterine invertion on P1L1 post spontaneous
labor from other institution

Plan
Control GA,VS,vaginal bleeding
O2 4 lpm/nasal
Routine blood examination
Cross match PRC 4 units
Informed consent
 Chief Complaint:
A 21 years old patient was admitted to the
Emergency Room of Dr. M. Djamil Central
General Hospital on August 17st, 2017 at
08.00 am referred from midwife with
diagnosed: Post partum haemorrhage ec
uterine inversion
Present Illness History
Before the patient gave birth spontaneously in the midwife, born baby girl, weight 3500
gram, midwife say placenta attached, then do a little withdrawal and placenta released,
then blood out a lot, then look tissue like uterus, there was massive vaginal bleeding,
does not want to stop. Then patient is reffered to M. djamil central general Hospital
with
Patient getting limp and pale
epigastric pain (-)
Previous Illness History:
There was no previous history of heart, lung, liver,
kidney, DM, hypertension and allergy

Family Illness History:

There was no history of hereditary disease,
contagious and physicological illness in the family
Occupation, Socioeconomics, Psychiatry, and
Habitual History :
Marital history: once in 2016
History of pregnancy/abortion/delivery: 1/0/0
1. Present
History of family planning: (-)
History of immunization: (-)
History of education : elementary school
History of occupation : (-)
 (08.10)
GC Cons BP HR RR Temp
Mdrt CMC 90/60 114 24 36,2

Eye : Anemic conjunctiva (+), Icteric sclera (-)

Neck : JVP 5-2cmH2O
Thorax : C/P were in normal limit
Abdomen : Obstetric record
Genitalia : Obstetric record
Obstetric record
Abdomen :
Inspection : Abdomen seems not bulge
Palpation : Uterine fundal not palpated
Pressure pain (-), release pain (-), defence muscular (-)
Percussion : Tympany
Auscultation : Peristaltic sound was normal

Genitalia :
Inspection : V/U were normal, vaginal Bleeding (+)
VT : Portio can not identified, palpable mass (endometrial) in a
one third of proximal vagina
 Laboratory Finding CITO

PARAMETER RESULT NORMAL VALUE

Haemoglobin 6,5 gr/dL 9,5-15,0
Leukosit 23.260/mm3 5,9-16,9
Hematokrit 21 % 28.0-40.0
Trombosit 318.000/mm3 146.000-429.000
APTT 41,0 sec 29,2 39,4
PT 11,3 sec 10 13,6

11
 Diagnose
Hypovolemic Syok Teratasi due to Post Partum
Haemorrhage due to uterine invertion on P1L1
post spontaneous labor from other institution
 Planning

Continue Resusitation
Control GA, VS, ,vaginal bleeding , urine,
fluid balance
Antibiotic (skin test)
Consult to anestesiologyst
Uterine reposition in narcose
At 09.00 pm :
Uterine reposition was performed.
Done repositioning in narcose, uterus successfully
manually reproduced, minimal bleeding during
intervention.

Diagnose
Post uterine reposition due to post partum
haemorraghe due to uterine invertion on P1L1 post
partus spontaneous labor from other institution
Plan
Control GA, VS, vaginal bleeding, uterine
contraction, urine, fluid balance,
IUVD RL drip oksitosin : metergin
1 : 1 28 tpm
O2 2 lpm/Nasal
Ceftriaxone 2x1 gr
Metronidazol 3x1 flc
Pronalges Supp II
Check routine blood post operation
Thank You