Delivery Suite Report

Thursday, April 20th 2017

Consultant :
dr. Arietta Pusponegoro, OBGYN (C)
dr. Rima Irwinda, OBGYN (C)

Residents
ER Team April 2017
 Reporting
2 Procedures :
2 Cesarean Sections
 Procedure No Case Outcome
Caesarean 1 PPROM, oligohydramnios, post lung Boy, 1915 gram, 44 cm, AS 9/10
section maturation
Triawa HC/AC
BS ~ 32 wga
ICD 10 Mrs. TR, 39 yo Scanty amniotic fluid
O12 MR 421-00-45 Placenta born completely
O42.0
Z37.0
Z3A.31 PPROM 4 hours on G1 31-32 wga, FP : IUD TC
singleton live head presentation,
ICD 9-CM diminished amniotic fluid (AFI 6),
69.7 contraction TS 4, asymtomatic UTI
74.1 Chronic hypertension
88.78
75.34 Process:
PPROM, TS 4, normal CTG, no signs of Risk of PPROM :
infection antibiotic, tocolytic and lung • Urinary tract Infection
Melsa T2A maturation after 2 days US exam
Independent Oligohydramnios (AFI 1)  Emergency C-
section

NBC Now mother is in good condition with

Reffered Permata Ibu Hospital due to controlled BP 130/90 mmHg with
preeclampsia and no available NICU nifedipin SR 1 x 30 mg,and baby is in
good condition in the ward, rooming in.
 Procedure No Case Outcome
Caesarean 2 Diaphragmatic hernia Girl, 3570 g, 51 cm, AS 8/9
section

ICD 10
Mrs. SMU, 39 yo
MR. 410-31-13
Triawa HC 340 mm, AC 300 mm
BS ~ 40 wga
Abundant amniotic fluid
Q79.0 Placenta born completely
Z3A.37
Z37.0 G4P2A1 37 wga, singleton live head
Q33.6 presentation, fetal with diaphragmatic hernia FP : Plan for implant
and pulmonary hypoplasia.
Now mother is in good condition in the ward
and baby is in NICU with HFO 60%, pulse 142
ICD 9-CM Process : x/m, SaO2 96%.
75.34 • April 10th 2017, Fetomaternal US exam BGA: (14.20)
88.78 said fetal with right diaphragmatic hernia 7,350/57.1/47.9/80.9/6/31.8/33.6
74.1 and lung hypoplasia Plan for septic work up, baby gram, and
• April 17th 2017, Join conference  evaluated by pediatric surgeon
prognosis dubia, c-section for maximal
Ares T2B treatment , plan for perform at ER 4th
Independent floor due to easily ventilator mobilisation
and near to the NICU

NBC
Patient was reffered from Santo Yusuf hospital
with polyhydroamnion and Macrosomia
 Warm, clear airway, dry,
was done in 1 minutes”
Reassessment : grunting , , FHR <100x/mnt 
tonus (+), inadequat, rednessskin
baby
2 minute: since beginning diagnosed with
lung hypoplasi
Baby covered with sheet , performed
intubation NTT no 4, depthness 11 cm
 5 Minutes: intubate, performed VTP 5/21 10 Minutes: Sat 97%, T 36,5  FiO2 ↓ 50%
with FiO2 100%, FHR >100x/mnt, Sat 92%, T Injc vit K, eye zalft
36,7c, performed RBG 78 mg/dL  FiO2 ↓ STABLE CONDITION
56% Move NICU
continue VTP
 March 30th, 2017
RSCM Kencana

Dr.med. Damar Prasmusinto, OBGYN

(C)

The heart seems pushed to the right

side the morphology of heart is
normal
Left lung is normal, right lung was
pushed.

There is a part of intestinal part with

the size 6.2 x 4.5 cm move to lung
cavity. Left Diaphragm part was
seen, the right part is difficult to
identify. Abdomen structure looks
wider. Urinary tract is normal and
both extremities are normal.

Prognosis: dubia ad bonam

Suggestion : referred to the hospital

with NICU and pediatric surgeon.
 April 10th, 2017

FM US examination by Dr. dr. Yuditiya

Purwosunu, OBGYN (C):

• Almost of fetal intestines fills the

whole part of right lung cavity.
Therefore, the right lung can be seen
• The heart of fetus is pushed to the left
side and the shape of both lungs is
small, There is fetal with
diaphragmatica hernia.
• normal activity of fetus.
• EFW is 3100 gram, AFI 18.3 cm
• No sign of hypoperfusion

Conclusion : 36 wga and fetus with

diaphragmatica hernia ( right part), and
pulmonary hypoplasia

Prognosis: dubia

Suggestion: this born baby need back up

exit precodure, adequate neonatal
resusitation, pediatric surgeon.
 TIMELINE

April 10th, 2017

The result consultation of The result consultation of

perinatology :
Re-consult if patient is planned
for elective Cesarean section
and will be confirmed about the
available place on NICU with
ventilator.
pediatric surgeon:
The diaphragmatic hernia will
be done through elective
surgery after baby is born and
within good condition.
 TIMELINE

April 14th, 2017 April 17th, 2017

Patient control to outpatient clinic

with :
G4P2A1 37 wga, singleton live head
presentation, fetal with diaphragmatic
hernia and pulmonary hypoplasia.
P/
• Elective C-section Friday 21/4/17
• Join confrence with perinatology
and pediatric surgery
• Preoperative :
• Anasteshiology
• Perinatology
• Optimal setting for Operathing
theater
Join Conference
• Bad prognosis  survival rate 1 0f
5 pregnancy with C-section  0%
• Plan for C-section 20/4/17 at ER
• If there are Prom/in labor before
20-4-17, plan for vaginal delivery /
C-section due to obstetrical
indication
• Plan for Fetomaternal Ultrasound
before C-section
 April 18th, 2017

Dr. dr. Yuditiya Purwosunu, OBGYN (C):

Active movement and normal breathing.

The intestine fills almost right lung cavity
until pushing the right lung.
The heart was pushed to left and makes
both sizes of lung smaller
BPD 90/ HC 335/ AC 358/ FL 67. EFW 3380
gestational age 37 wga
Placenta on porterior part. SDAU 2.2 ICA
20

Conclusion : 37 wga and normal activity

fetus. Fetus with diaphragmatica hernia
(left). With the sequencing pulmonary
hypoplasia. There is not sign of
hypoperfusion
 Baby delivering from operating theater
with ventilator FiO2 50%, PEEP 25, RR
60x/ m, StO2 79-80%.

The born baby arrives at the NICU room.

Assessment (I): The baby weight is 3750 gr.

Cold extremities. Baby is fighting with the
mode of ventilator.

The mode changes to HFO FiO2 50%, Amp

25, freg 10, PaO2 12 StO2 unstable on 75-
80%.

Assessment (II) : cold extremities, T

35.6C  give the loading RL 35 ml
 PEDIATRIC SURGERY
If there herniation and pulmonary
hypoplasia

Assessment of the babygram

Ipsilateral contralateral

If there is any
No need immediate worsening of If laboratory result is
repair laboratory result normal

Optimalizating the Immediate procedure

general condition (repair of the hernia)
Baby in NICU with HFO
 Procedure No Case Outcome

Caesarean 2 Hernia diaphragmatica Girl, 3570 gram,51 cm, AS 8/9

section Triawa
Mrs. SMU, 39 yo
BS ~ wga
Diminished amniotic fluid
ICD 10 MR. 410-31-13 Placenta born completely
Q79.0
Z3A.37 G4P2A1 37 wga, singleton live head FP : refused IUD
Z37.0 presentation, fetal with diaphragmatic
Q33.6 hernia and pulmonary hypoplasia. Analysis for congenital anomalies :
Mother : Maternal age
ICD 9-CM Prosces : Placenta : no anomalies
75.34 CHD 35 wga,  ANC at RSCM  Joint fetal : OMIM (DIH1) maps to
88.78 conference (EXIT procedure)  SC at 38 chromosome 15q26; DIH2 (222400)
74.1 wga(20/4/2017) maps to chromosome 8p23; and DIH3
(610187) is associated with mutation in
Ares T2B the ZFPM2 gene (603693).
Independent

NBC
Patient was referred from Santo Yusuf
hospital with polyhydroamnion and
Macrosomia. ( March 24th, 2017)
Now mother in good condition in the
ward and baby are in NICU for work fo
stabilitation resusitation.Baby with HFO
60%, pulse 142 x/m, StO2 96%.
BGA: (14.20)
7,350/57.1/47.9/80.9/6/31.8/33.6
Plan for septic work up, baby gram, and
for consult to pediatric surgeon for
work up from pediatric surgeon
If there herniation and pulmonary
hypoplasia

Assessment of the babygram

Ipsilateral contralateral

If there is any
No need immediate worsening of If laboratory result is
repair laboratory result normal

Optimalizating the Immediate procedure

general condition (repair of the hernia)
work up from pediatric surgeon
If there herniation and pulmonary
hypoplasia

Assessment of the babygram

Ipsilateral contralateral

If there is any
No need immediate worsening of If laboratory result is
repair laboratory result normal

Optimalizating the Immediate procedure

general condition (repair of the hernia)
THANK YOU