KASUS

dr. Janne Pattiasina, Sp.OG

G3P2A0 + Hamil 39 minggu + BSC 2x + Calon Akseptor kontap
 ANAMNESIS :

IDENTITAS PASIEN Pasien masuk rumah sakit dengan pengantar dari dokter Sp.OG
dengan diagnosis G3P2A0, hamil 39 minggu,. Pasien tidak
mengeluhkan adanya nyeri perut, tidak ada pengeluaran lendir
Nama: Ny. MM dan darah dari jalan lahir. Pasien mengaku. Pasien mengeluhkan
Umur : 29 thn
Riwayat Penyakit dahulu: Hipertensi (-), DM (-), Asma (-)
Alamat : Kuda Mati
Tgl MRS : 10/11/2021 Riwayat Obstetrik:
Jam MRS : 10.30 WIT
• Anak 1 | Lahir tahun 2015 | Perempuan | SC | BB 3100 g
DPJP : dr. Janne Pattiasina, Sp.OG
• Anak 2 | Lahir tahun 2017 | Perempuan | SC | BB 3000 g

STATUS OBSTETRI

1. HPHT : 18-02-2021

2. TP : 25-11-2021

3. UK : 39 minggu
 OBJECT: Pemeriksaan luar:
• Leopold I : Bagian atas teraba bokong, TFU 3 jari dibawah
procesus xiphoideus (36 cm)
TD : 120/80 mmHg
HR : 84 x/m • Leopold II : Punggung kiri, DJJ 145 x/mnt

RR : 20 x/m • Leopold III : Teraba kepala

S : 36,5 C
• Leopold IV : Konvergen
SpO2 : 99%
• Pemeriksaan Dalam Vagina:

ANTROPOMETRI (IMT ) • Vulva/vagina : DBN

BB : 69 Kg • Portio : konsistensi kenyal
TB : 150 cm
• Tidak ada pembukaan
IMT : 30.7 (Obese II)
 PEMERIKSAAN PENUNJANG

HEMATOLOGI HASIL NILAI RUJUKAN

Hemoglobin 11.8 14,0-18,0 g/dL

Leukosit 10.52 5,0-10,0 x 103/mm3
Trombosit 327 150-400 x 103/mm3
Masa Pendarahan 1’ 1-3’
Masa Pembekuan 5’ 2-6’
Rapid Antigen Non reaktif Non reaktif
Anti HIV Non Reaktif Non Reaktif
Diagnosis Pre-OP :
• G3P2A0 + Hamil 39 minggu + Calon akseptor kontrasepsi mantap
• Janin, tunggal, hidup, intrauterine + Presentasi kepala

Tindakan :
• Sectio Caesarian Transperitoneal Profunda (SCTP)
• Tubectomy Bilateral

Hasil: Bayi lahir hidup (11/11/2021)

 Jenis kelamin : Laki-laki
 BB : 3500 gram
 PB : 50 Cm
 AS : 7/9

Diagnosis Post-OP :
- P3A0 + Akseptor Kontap
- Janin, tunggal, hidup
 Tatalaksana POST-OP

 IVFD RL : Futrolit, 2:1 + drip oksitosin 20 u/8 jam

 Inj. Ceftriaxone 1x2 gr/ IV
 Inj. Metronidazole 2x500 mg/ IV
 Inj. Ketorolac 2x30 mg/IV
 Inj. Ranitidin 2x50 mg/IV
 CESAREAN DELIVERY

 Cesarean delivery → delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the
uterine wall (hysterotomy)

 The most common indications → labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation,
multiple gestation, and suspected fetal macrosomia.

 ACOG → all eligible women with breech presentations who are near term should be offered external cephalic version
(ECV) to decrease the overall rate of cesarean delivery.

MD L. Cesarean Delivery: Overview, Preparation, Technique [Internet]. Medscape.com. Medscape; 2021 [cited 2021 Nov 11]. Available from: https://emedicine.medscape.com/article/263424-overview 12/01/2021 7
 CESAREAN DELIVERY INDICATIONS

 Maternal indications for cesarean delivery:

 Repeat cesarean delivery

 Obstructive lesions in the lower genital tract (malignancies, large vulvovaginal condylomas, obstructive vaginal septa, and leiomyomas) ~
interfere with engagement of the fetal head

 Pelvic abnormalities that preclude engagement or interfere with descent of the fetal presentation in labor

 Certain cardiac conditions that preclude normal valsalva done by patients during a vaginal delivery

 Fetal indications for cesarean delivery:

 Situations in which neonatal morbidity and mortality  prevention of trauma

 Malpresentations

 Congenital malformations or skeletal disorders

 Infection

MD L. Cesarean Delivery: Overview, Preparation, Technique [Internet]. Medscape.com. Medscape; 2021 [cited 2021 Nov 11]. Available from: https://emedicine.medscape.com/article/263424-overview 12/01/2021 8
 CESAREAN DELIVERY INDICATIONS

 Cesarean delivery that benefit the mother and the fetus:

 Abnormal placentation (eg, placenta previa, placenta accreta)

 Abnormal labor due to cephalopelvic disproportion

 Situations in which labor is contraindicated

MD L. Cesarean Delivery: Overview, Preparation, Technique [Internet]. Medscape.com. Medscape; 2021 [cited 2021 Nov 11]. Available from: https://emedicine.medscape.com/article/263424-overview 12/01/2021 9
 TUBECTOMY

 Tubectomy (tubal sterilization) → permanent method of contraception in women.

 Tubectomy → surgical process that blocks the fallopian tubes → preventing the egg released by the ovary from reaching the
uterus.

Tubectomy – What is Tubectomy, Indications, Techniques, Recovery - Apollo Cradle [Internet]. Apollo Cradle. 2019 [cited 2021 Nov 11]. Available from: https://www.apollocradle.com/tubectomy-what-is-tubectomy-indications 12/01/2021 10
 TUBECTOMY: Pomeroy Method

 The advantages to the Pomeroy method are that it is easy and quick to perform and highly effective

 Acceptance for postpartum and interval sterilization is quite high

Surgical Sterilization [Internet]. Clinical Gate. 2015 [cited 2021 Nov 11]. Available from: https://clinicalgate.com/surgical-sterilization/ 12/01/2021 11