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MATERNAL MORTALITY REPORT

Mrs. Deti Suhartini


MR 847647
September 7th 2018
At 04.45 am At 05.35 am

P: P: Ranitidine 2x1 amp IV


S: Vomit and nausea, active fetal Cr…3x4g IV
movement
O: dyspnea, CM (GCS E4V5M6)
BP 110/90 mmHg, HR 96x/mnt,
RR24x/mnt, Temp 36,5oC
Obstetric status:
TFU 30 cm, left back, cephalic
presentation
Lab results:
Diff count: 0/0/77/16/7
UV/CV: 14/1.1
A: Observation dispneu
30 weeks gestation, cephalic
presentation
Tumor mammae bilateral
P: Ranitidine 2x1 amp IV
Cr…3x4g IV
September 7th 2018
At 01.30 am At 08.00 am

S: Asphyxia, nausea, vomit, heartburn,


blood mucus (-), water break (-), fetal S: Asphyxia improved, heartburn
movement (+) improved, fetal movement (+)
O: General (+), CM (GCS E4V5M6) O: BP 110/70 mmHg, HR 96x/mnt,
BP 130/90 mmHg, N 90, Temp 36.5, RR 24x/mnt, Temp 36,5oC, pain scale 0
pain scale 2 General status WNL
General status WNL Obstetric status:
Obstetric status: TFU 30 cm, left back, cephalic
TFU 30 cm, left back, cephalic presentation 5/5
presentation 5/5 FHR (+) 146 DPM
FHR (+) 155 TPM Intravena: RL 500 mL 20 npm
UL: Prof T2, LEA +++
A: G3P2A0 H3og, epigastric pain, dispneu A: (foto blur)
Tumor mammae bilateral
P: Hemodynamic stabile, FHR TTV
contraction observation
Consult to Internal medicine and CV
Blood examination (-)
September 7th 2018
At 03.15 pm At 03.30 pm

A: G3P2A0 H3og, epigastric pain, ec


dispneu, ec dispepsia S: Asphyxia improved, Vomit and nausea
Tumor mammae bilateral improved, fetal movement (+)
O: General (+), CM (GCS E4V5M6)
P: Hemodynamic stabile, FHR TTV BP 110/70 mmHg, HR 96x/mnt,
contraction observation RR 24x/mnt, Temp 36,5oC, pain scale 0
Consult to Internal medicine and CV General status WNL
Blood examination (-) Obstetric status:
TFU 30 cm, left back, cephalic FHR (+)
September 7th 2018
At 03.30 pm At 05.00 pm

S: Asphyxia, headache (-), heartburn,


blurred vision, active fetal movement,
S: Asphyxia improved, Vomit and nausea
water breaks
improved, fetal movement (+)
O: Asphyxia, CM (GCS E4V5M6)
O: General (+), CM (GCS E4V5M6)
BP 140/90 mmHg, HR 101 x/mnt,
BP 110/70 mmHg, HR 96x/mnt,
RR 22x/mnt, Temp 37,2oC, SaO2 99%
RR 24x/mnt, Temp 36,5oC, pain scale 0
General status: WNL
General status WNL
Obstetric status: FHR 155 TPM
Obstetric status:
Inspection: Bright vulva urethra
TFU 30 cm, left back, cephalic FHR (+)
A: G3P2A0,30 weeks gestation, cephalic
presentation
Preeclampsia with severe feature
Observe dyspnea ec pleural effusion
dd/ odem porv
P:
1. Stabile hemodynamic, observe TTV,
contraction, and DJJ
2. Examine lab
September 7th 2018
At 06.00 pm (OBGYN) At 09.16 pm (OBGYN)

S: Vomit and nausea, active fetal


movement
O: CM (GCS E4V5M6)
O: Lab result OT/PT 198/44  Partial
BP 110/90 mmHg, HR 96x/mnt,
HELLP Syndrome
RR28x/mnt, Temp 36,5oC
P: Sectio caesaria CITO
Obstetric status: FHR 140 TPM
Report to dr. Farida Sp.OG & dr. Yeni
Lab results:
Sp.A
Diff count: 0/0/77/16/7
UV/CV: 14/1.1
A: Observation dispneu
30 weeks gestation, cephalic
presentation
Tumor mammae bilateral
P: ….
Report to dr. V… SpOG (K),
coordinate with perinatology on the
Availability of NICU tomorrow
September 7th 2018
01.20 am 20.30 pm

Patient came to ER with nausea Worsening dyspnea (+)


CM (GCS E4V5M6) Check BGA, electrolyte
BP 130/90 mmHg, HR 131 x/mnt,

01.20 am 23.30 pm

Patient came to ER with nausea Seizure, hysteria


CM (GCS E4V5M6) HR 42 x/mnt  Inj. SA 2 ampuls
BP 130/90 mmHg, HR 131 x/mnt, Ultrasound at ER: fetus intrauterine (+) 
consult OBGYN

00.00 am (OBGYN)

Decrease of consciousness VT : Firm portio, posterior, thick 2 cm,


BP 160/100 mmHg, HR 103 x/mnt, opened 1 cm, head on Hodge I-II
RR 36x/mnt, T 36.7’C, SaO2 96% US : Singleton IUFD, Placenta at posterior
Obstetric state  FH 2 fingers above corpus, retroplacental hematoma (-), FHR
navel, irregular contraction, FHR (-) (-), Biometry can not be done by US at ER
September 7th 2018
At 06.00 pm At 09.30 pm (OBGYN)

S: Asphyxia, nausea, vomit, heartburn,


blurred vision (-), active fetal
movement (+)
O: General (+), CM (GCS E4V5M6)
BP 131/78 mmHg, HR 124x/mnt,
RR 24x/mnt, SaO2 99%
General Status: WNL
Obstetric status:
FHR 144 TPM, irregular contraction
vulva uretra tenang
A: G3P2A0,30 weeks gestation, cephalic
presentation
Preeclampsia with severe feature
Observe dyspnea ec pleural effusion P:
P: Stabile hemodynamic, measure TTV,
Treat cause  MENY therapy, Asphyxia
recovered  correspond to doctor’s
therapy
Blood Gas Analysis
16/9/2018 16/9/2018
Test 17/9/2018 Normal Limit
14:44 (regist) 18:35 (regist)
Artery Artery Artery Artery

pH 7.512 7.426 7.358 7.35-7.45

pCO2 19.6 24.9 35.7 35-45

pO2 127.3 108.6 100.8 75-100

SaO2 99.3 97.4 97.7 95-98

BE -4.4 -14.2 -8.8 -2.5-2.5

HCO3 15.9 10.9 14.6 21-25

Lactate 6.9
14/9/2018
Test Normal Limit
20.52
Hemoglobin
Hematocrit
Leukocyte
Thrombocyte
MCV/MCH/MC
HC
PT / APTT

RBG
Na/K/Cl

ALT/AST

Ur/Cr

Albumin
D dimer
Lactate
Urynalisis

Mg/Ca

Pct
Anti-HIV
HbsAg
COD

• HELLP Syndrome dd/ AFLP