TUTORIAL A1Larasjati Tartiko Harjo (1010211058)Reynita Setia Dewi(1010211059)Amanda Friska (1010211152)Rizki Rahmiana Harahap(1010211078)Mutia Rachmi (1010211179)Gina Novita Sari (1010211107)Dodi Saputra(1010211103)Chaerunisa Utami(0910211146)Nita Juliana Anggraini(1010211097)Levi Aulia Rachman(1010211054)Novianto Adi(1010211065)Anna Andany Lestari(1010211056)Fakultas KedokteranUniversitas Pembangunan Nasional “ Veteran “ JakartaTahun Ajaran 2011/2012Page 1Mrs. Dani, a 26 year-old G1P0 woman at 35 weeks’ gestation is admitted to the hospital because of mild discomfort at the upper left abdominal part. She also complains a bit tense on her lower tummy. There is no water broke, nor bloody or slimy discharge from her vagina. She admits that the baby is still moving now.Physical examination :Blood pressure: 110/70 mmHgHeart rate: 80 bpmObstetric examination :Uterine fundus is 30 cm above symphysis.Leopold 1: A globular round hard mass is occupying the uterine fundus.Leopold 2: Small fetal parts detected on the left abdominal wall, on theright side a long- flat area of mass with higher resistance is detected on theright side.Leopold 3: Some soft mass is palpable above symphysis.Leopold 4: ConvergentContraction: Once in every 10 minutes, weak.Auscultation (Laennec stethoscope)•Fetal heartbeat could be easily and more clearly heard just above the umbilicus•Fetal Heart Rate: 144-152 beat per minuteSpeculum examination: no abnormalitiesVaginal examination: Vulva/ vagina: no abnormalitiesCervical dilatation: nonePelvic examination: normal1.What are Mrs. Dani’s problem?2.Explain the significance of the above physical and laboratory findings!3.What further investigation, if any should be taken into account and would be appropriate at this point? Explain your reasons!Page 2She was referred to the feto maternal clinic at the nearest district hospital. She came back, bringing the result of USG as follows:A singleton fetus, male, in breech presentation, the back is on the right. Biometrical measurements are in accordance with a 35 week’s pregnancy. Heart rate is normal. Estimated fetal weight is 2200 ± 300 grams. No major congenital anomalies detected. The placenta lies in the anterior body of the uterus not occupying the internal uterine ostium. Amniotic fluid index 12 cm.ConclusionG1P0, 35 week’s pregnancy, breech presentation.The doctor prescribed oral tocolysis and explained the alarming signs as when the patient should return prior to the schedule follow up visit.
1.What do you think would be the decision for referral made by the doctorin the MCH clinic? Explain your answer!2.Explain you should tocolysis be given the patient!3.What do they mean by ‘alarming sign’ in the case?Page 3Mrs. Dani returned three weekd later to the MCH clinic, complaining that she hasbeen having regular contraction for 8 hours. She noted to have uterine contractions every 7 to 8 minutes. She knows the baby is still moving, no water broke.Physical examination :Vital signs : within normal limitsObstetric examination :Leopold 1: A globular round hard mass is occupying the uterine fundus.Leopold 2: Small fetal parts detected on the left abdominal wall, on theright side a long- flat area of mass with higher resistance is detected on theright side.Leopold 3: Some soft mass is palpable above symphysis, and have somehow entered the pelvic inlet.Estimated fetal weight 2700 gramsContraction: once every 3 minutes, lasting 50 seconds, strong.Fetal Heart Rate: 152-160 beat per minuteVaginal examination :Vulva/ vagina: no abnormalitiesPortio: axial position, soft, effacement 80%Cervical dilatation: 9-10 cmAmniotic membrane: intactPresenting part: breech, sacrum on the right, station +2, no feet palpableAdmission test result with cardiotocography : fetal in good conditionAn hour later full dilatation is reached and as the baby’s buttock is bulging in the perineum.She was lead to bear down. There was no difficulty while delivering the shoulderwith lovset maneuver.A baby boy is born, weighing 2750 grams, 50 cm in length.1.How this delivery differs from normal delivery of occiput presentation?2.Explain the use partogram!3.What are the problems during labor!4.Explain your answer!5.What would be your management plan for this patient?EpilogueThe baby is sent to the perinatology unit.Both the baby and Mrs. Dani are dismissed in good condition.
LEARNING PROGRESS REPORTHari/tanggal: Rabu, 20 April 2011Nama tutor: dr. MariaKasus: Persalinan AbnormalGroup: A1TerminologiProblemHipotesisMekanismeMore infoI dont knowLearning issuesMrs. Dani, 26 tahun, G1P0 dengan usia kehamilan 35 mingguKU : - tidak nyaman di bagian perut kiri atas, his palsu, tidak ada ketuban pecah.KT : bayinya masih bergerak1.Apa yang menyebabkan adanya his palsu?2.Kenapa ada rasa nyeri di bagian perut kiri atas?3.Mengapa pada usia kehamilan 35 minggu belum ada presentasi kepala?4.a. Leopold I : massa bulat yang kerasb. Leopold II :kiri : ekstremitas janin, kanan : punggung janinc. Leoplod III : massa yang lembut/ lunakd. Leopold IV : convergent5. mengapa kontraksi yang dialami Mrs. Dani lemah?G1P0, H: 35 minggu dengan malpresentasi bokong dan kontraksi dini1.Observasi dalam 2 minggu :Tinggi fundus uteri, Leopold, USG, CTG, Vital sign.2.Versi luar.3.ANC pada trimester 3 dipantau tekanan darah.Persalinan Abnormal
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