Pemeriksaan Fisik
Didy (T2B) KU: baik, CM BB: 60 kg TB: 145 cm BMI : 34,14 kg/m2 KB : Tubektomi Pomeroy
Status Obstetri:
Dr.Sarah Ika N, TFU 32 cm, posisi kepala 5/5, His (-) DJJ 140 x/i TBJ 2945 gr
I: v/u tenang
Sp.OG,(K) Io : Portio licin, OUE tertutup, fluxus (-), fluor (-), valsava (-)
Vt : Portio posterior, Kenyal, t3 cm, ⏀tidak ada, Kepala H1
Pelvimetri Klinis :
Pelvic Inlet :Promontorium teraba, Conjunggata Vera <
Non Book Case 7,5, Linea Innominata teraba 2/3
Pasien Kiriman Pelvic Midlet : Spina Ischadica tumpul, Distansia
Sp.OG Interspinarum < 9,5, Os Sacrum konkaf
Pelvic outlet : Os cocygeus immobile, Arkus Pubis <90.
Ibu dan bayi dalam kondisi
kesan panggul sempit
baik diruangan,
Proses :
Antibiotik prfilaksis informed consent consult to
anesthesiologist dan perinatologist division Seksio
Sri Rosnidar
Kegiatan Kasus Hasil
Status Obstetrik
TFU 36 cm, punggung sebelah kiri, kepala, 5/5, TBJ 3565 gram,
HIS tidak ada, DJJ: 140x/i
I : v/u tenang
Io : portio licin, OUE tertutup, fluxus negatif, flour negatif, valsalva negatif
VT : posterior, kenyal, t 3 cm, ⌀ tidak ada, kepala Hodge I
PAI Score:
SC >2x :3
Lakuna Grade 2 :1
Tebal miomentrium 3 mm : 0,5
Plasenta Anterior :1
Fitra (T3A)/ Briging Vesel : 0,5
Total Score : 6 (kemungkinan invasi 69%)
Rachmad (T3B)
Saat ini ibu dan bayi
Dr. Sarah Ika Proses: dalam kondisi baik di
Nainggolan, Informed consent Konsul Fetomaternal (USG konfirmasi) Seksio ruangan rencana pulang
Sp.OG (K) Secarea elektif
CRANIAL
• Luka corporal dijahiit 2 lapis dengan polisorb no. 1.0 teknik jelujur, dipastikan
tidak ada perdarahan
• Pada eksplorasi, kedua tuba dan ovarium dalam batas normal, dilakukan
fimbriektomi
Nesia Saphira
Kegiatan Kasus Hasil
2. Seksio Sesarea Ny. NS, 38 thn Lahir bayi perempuan
dilanjutkan CM 1 – 20 – 81 - 02 BB 2600gr, PB 46cm,
histerektomi total AS 7/9, BS~ 36-38 minggu
G3P2A0 Hamil 37 - 38 Minggu, Janin Presentasi Kepala Air ketuban jernih
Tunggal Hidup, BSC 2x (IDT 4 tahun), perdarahan ante
partum berulang ec Plasenta Previa Totalis, Suspek Akreta
ibu dengan permasalahan High Miopia
Status Obstetri:
TFU 31 cm, punggung sebelah kiri, kepala, 5/5, HIS: 1-2x/10/20,
Maqbul (T3B)/ DJJ: 155x/i, TBJ 2790 gram
Imam (T4B) I : v/u tenang
Dr. Sarah Ika N, Io : portio licin, OUE terbuka, fluxus (+), flour (-), aktif bleeding (+)
SpOG (K) Vt : tidak dilakukan
PAI SCORE:
BSC 2x :3
Lacuna (negatif) :0
Tebal miometrium 0,25cm : 0.25
PPT anterior (positif) :1
Bridging Vessel (positif) : 0,5 Saat ini ibu dan bayi
PAI Score : 5 51% dalam kondisi baik
Proses: diruangan
informe consent konsul anestesi dan perinatologi seksio sesarea.
Cranial
Caudal
• Setelah peritoneum dibuka tampak uterus gravidus, tampak implantasi plasenta menembus
lapisan serosa corpus anterior uteri ~ Susp plasenta perkreta
• Diputuskan untuk insisi corporal
• Dengan menarik kaki Lahir bayi perempuan, BB 2600gr, PB 46cm, AS 7/9
• Plasenta dimasukan kembali ke kavum uteri , dilakukan jahitan situasional jelujur 1 lapis.
• Pada eksplorasi kedua tuba dan ovarium dalam batas normal
Cranial
Caudal
Caudal
Obstetric state:
FH : 34 cm, back on the left side,head, 5/5 FHR : 155 bpm, contraction :
negative, EFW :3255 gr
Dr. dr. I : V/U wnl
Hasanuddin, Io : portio livide, OUE was closed, fluxus negative, fluor negative,
OBGYN(C) vasalva test negative
PAI Score
Previous C-Section > 2x :3
Lacuna grade 3 : 3,5
Non Book Case Bridging vessel : 0,5 Mother is in good
Placenta corpus anterior : 1,0 condition in ward, Baby
Reffered by obgyn Myometrium thickness 0,29 cm : 0,5
due to previous C- Total is in NICU level 2A with
8,75 96 %
Section 3 time Labiopalatoschisis
Process : Th/-OGT
CTG category 1 consult to dpjp consult to anesthesiology and - IVFD dex 10% 8cc/hour
perinatology division c- section
• Lower segment of uterus is sharply sliced, bluntly penetrated, and sharply dilated to lateral side,
penetrated the placentae
• By luxating the head Born male baby, 3100 gr, 47 cm, AS 8/9
• Clear amniotic fluid
• With gently traction of the umbilical cord, placenta was delivered with not complete cotyledon,
there was massive bleeding
• Uterine lower segment was sutured 1 layer with no. 1 Polysorb.
• Decided to perfomed ligation of hypogastric artery, continued with total hysterectomy
• Both of round ligaments were clamped, cut, and sutured with PGA. No.1
• Vesico-uterine plica was incised and pushed downward, We performed bladder flap
• We performed windowing, broad ligament was incised through ip ligament and ureter was
identified. IP ligaments was clamped, cut, and sutured with PGA No.1
• Both of uterine vessels was clamped, cut and sutured cardinal ligaments was clamped, cut, and
sutured Both of Sacro uterine ligaments was clamped, cut, and sutured with PGA No.1
• Vagina was cut immediately beneath the cervix
• Uterus was taken out and sent to PA. vaginal stump was sutured with continuous interlocking
technique using PGA no 1.0 and reperitonealization with PGA no.2-0
• The abdominal was closed layer by layer. Peritoneum sutured continuous with no.2/0 chromic cat
gut. Muscle sutured interuptus with no. 2/o chromic cat gut. Fascia sutured continuous with No. 1
polysorb. Subcuntaneous layer sutured with no. 2/0 chromic cat gut. Skin was sutured
subcuticular with no. 3.0 Prolene
• Operation was done. Bleeding during operation 4300 cc. urine 150 cc.
Nurlina
Procedure Case Outcome
2. Seksio Ny. N, 42 tahun Lahir bayi laki-laki,BB 4000
sesarea CM 0-91-23-90 gram, PB 48 cm, AS 6/7
dilanjutkan G6P5 hamil 37-38 minggu, janin presentasi kepala tunggal ,BS~ 36-38 minggu
dengan total hidup, BSC 3x, plasenta previa totalis, susp Plasenta akreta, Air ketuban jernih
histerektomi Makrosomia Plasenta implantasi di
korpus anterior meluas
Seksio sesarea a i BSC 3x, plasenta previa totalis, susp menutupi OUI dengan
Plasenta akreta, Makrosomia plasenta kesan akreta
Status Obstetrikus
TFU 40 cm, punggung kanan, presentasi kepala, 5/5, HIS negatif, FP: -
Razi (T3A)/ DJJ 150 x/i, TBJ : 4185 gram
Nisa (T2B)/ I: V/U Tenang
Dr.dr. Io: Porsio licin, OUE tertutup, fluxus negatif, fluor negatif
VT : tidak dilakukan
Hasanuddin,
Sp.OG (K) CTG kategori I
Ibu saat ini rawat di ICU 2
PAI score
Previous c-section 2 times: 3
dengan Ventilator mode
Non Book Case SCMV, PEEP 5cmH2O,
Lacunae grade 3: 3,5
Kiriman SpOG Miometrial thicknes 1,2 cm: 0,5 FiO2 25%, KGDS bayi post
dengan BSC 3X Bridging vessel positif : 0,5
SC 28mg/dL, bayi rawat
Placenta previa anterior: 1
Total : 8,5 ~ 96% NICU Lv 2B dengan dx/
NCB makrosomia, RDS,
Process : Hipoglikemia, dengan
Tocolysis Rencana Terminasi kehamilan Informed consent CPAP Peep 7cmH20, Fi O2
konsul anesthesiologi dan perinatologi --> Seksio Caesarea Elektif 40%, IV Dex 10% 10cc/j
SC dilanjutkan dengan total histerektomi