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Laporan Case III Pregnancy

Laporan Case III Pregnancy

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Published by ibaimovic

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Published by: ibaimovic on Dec 25, 2009
Copyright:Attribution Non-commercial

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11/20/2011

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Tutorial 1 Step 1:
Mrs. Partina, a 30 year old P0 A0 visited the Maternal and Neonatal Health Clinic (MNHC)in the Primary Care Health Center where you were the assistant of the doctor in charge. Shesaid that she had missed 3 periods, which normally comes on date 27
th
of the month. The firstday of her last menstrual period was on 27 July 2008 last. She has also been suffering fromnausea and vomitting. The latter had become worse that morning that she vomitted almosteverything she ate. She complained pf painless frequent-voiding, fatigue, breast discomfortand increased skin pigmentation especially on her face, nipple and abdominal skin. She wasworried about losing weight 3 kg since her last period.A.Identify the patient problem.B.Generate a list of hypoyheses for each problem.C.What further information would you like to know from Mrs. Partina?Explain your answers!
Tutorial 1 Step 2:
The doctor perform physical examination to Mrs. Partina, and the findings were as follows:
Physical examination:
Height: 160 cm tallWeight: 50 kgVital signs: within normal limitSkin turgor: normalHeart and lungs are normal.
Obstetric examination
External examination: fundal height 2 fingers above symphysisSpeculum : bluish potio, normal sizeVaginal examination : Vulva: normalVagina: normalPortio: soft, ostium is closedUterine corpus: enlarged, equals to 12 weeks pregnancyDouglas pouch: normalParametrium: normal
Laboratory results:
 
Hb: 11.5 mg%Hematocrit: 35%Platelet: 250.000/ ccLiver function test: normalKidney function test: normalUrinalysis: within normal limitUrine βhCG test: positiveD. Identify the patient problems.E. Generate a list of hypotheses for each problemF. What further information would you like to know from Mrs. Partina?Explain your answers!
Tutorial 1 Step 3The doctor
 
referred Mrs. Partina for an Ultrasonography (USG) scanning in the FetoMaternal clinic.Result of USG examination was as follow:
Uterus is enlarged filled with a singleton fetus, actively moves, HR 160 bpm, regular, CRL5.5 cm, nuchal translucency 2 mm, amniotic fluid normal, chorion frondosum at the anterior uterine wall. Both adnexa within normal limits, no abnormal mass found.G. Does the information change your hypotheses? Why?H. Identify the patient’s problem.I. Can you explain your management plans for this patient? Please describe the details.
Tutorial 2 Step 1
Mrs. Partina was sent home, given some prenatal vitamins and antiemetics. She was alsoadvised to have regular prenatal visit, scheduled once a month up to 28 weeks of pregnancyand more frequently there after.She went to a midwife for prenatal care as scheduled.
 
In the 38
th
– week of pregnancy, Mrs.Partina returned to the hospital, complaining that shehad been having regular contractions for 8 hours. She knew the baby was still moving, nowater broke.
Physical diagnosis:
Vital signs: within normal limits
Obstetric examination
Fundal height: 35 cmOn Leopold 1 a soft, soft mass was palpated in the fundus, with largest resistance on the leftside of the womb. Small fetal parts were palpable on the right during Leopold 2. On the areaabove symphisis a globular, round mass was detected by Leopold 3, it was no longer moveable. An acute angle was formed between the two examining palms.Fetal auscultation: revealed FHR 150 bpm, regular.Contraction: once in every 6 minutes, lasting 20 seconds, wea
Admission test (cardiotocography) result was consulted to feto-maternal consultant andthe result was as follow:
Baseline: 145-150 bpmVariability: 5-10 bpm, presence of 2 acceleration without deceleration during a 20minutes period.Contraction: once in every 6 minutes, amplitude : 25Conclusion: fetal in good condition
Vaginal examination
Vulva/ vagina: no abnormalitiesPortio: axial position, soft, effacement: 80%Cervical dilatation: 4-5 cmAmniotic membrane : intactPresenting part: occiput on the left anterior position, station +2Mrs. Partina was informed about her and the baby’s condition, and the doctor’s plan to havelabor augmentation. She wanted to know if she could have a spotaneous delivery and alsoabout the risks and benefit of having labor augmentation.The doctor explained everything about this plan and about the risk of having labor augmentation.After a while Mrs. Partina and her husband agreed to the doctor’s plan.

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