Progress note Order for one day Order for continuation

4/9/53 4/9/53 (23.20)

G2P1 Ga 35+2 wks - NPO
with severe pre-eclamsia - 5%D/N/2 1000 ml
with preterm labor IV drip rate 120 ml/hr
ปวดศีรษะ จุกแน่นลิ ้นปี่ - CBC, UA
Urine alb 3+ - BUN, Cr, E’lyte, LFT, Uric acid
BP 200/120 mmHg - PT, PTT, INR
DTR 3+ - Blood sugar
Gross hematuria via foley - G/M PRC 2 U
cathether - NST
- Continuous fetal monitoring
- MgSO4 IV drip 1 gm/hr
- Hydralazine 5 mg IV Stat วัด BP ซ้ำ
next 15 min if ≥ 160/110 mmHg
Hydralazine 5 mg IV ซ้ำได้ q 15 min
- Record V/S q 1 hr
keep RR > 12 /min
SBP < 160 mmHg, DBP < 110
- record urine output keep > 30 ml/hr

5/9/53 5/9/53 (0.30)

ปวดศีรษะ จุกแน่นลิ ้นปี่ - G/M FFP 1000 ml
BP 170/100 mmHg - G/M Plt conc 10 U ได้ แล้ วให้ เลย
DTR 3+ - Consult Anesth for set OR C/S
NST: non reactive
FHR baseline 120 bpm 5/9/53 (1.30)
minimal variability - Consult Anesth for set OR C/S
no acceleration

Lab 5/9/53 (2.00)

Plt 43,000, Hct 30% Pre-op order for C/S
elevate liver enzyme - Set OR emergency for C/S due to
fetal distress stat
Imp: HELP syndrome - Prep skin abdomen and perineum
Plan:
- Plt conc 10 U
- Consult Anesth for set
OR C/S
Consult Anesthesia เรื่ อง set C/S
>> ให้ นำ Plt conc 10 U ไป OR พร้ อมคนไข้ + จอง ICU post-op
>> consult ICU
2.00 ได้ Plt conc >> Plt conc IV free flow
2.15 ตามหมอเด็ก
Lab 23.35 4/9/53
Chol 329 (H) TP 7.1 Alb 3.4 (L) [3.5-5] Glob 3.7 (H) [2.4-3.5] A/G ratio 0.92 (L)
TB 4.04 (H) DB 1.23 (H) AST 2186 (H) ALT 822 (H) ALP 154 (H) LDH 2725 (H) [135-225]
Lab 0.40 5/9/53
Chol 266 (H)
Total protein 7 Alb 3.5 Glob 3.5 A/G ratio 1 (L) [1.02-1.36]
Total Bilirubin 8.66 (H) [0-1.5] Direct Bilirubin 4.53 (H) [0-0.5]
AST (SGOT) 1953 (H) [0-38] ALT (SGPT) 518 (H) [10-50]
ALP 120 (H) [39-117] Glucose 361 mg/dl (H) [76-110]
BUN 14 Cr 0.8 Na 132 (L) K 4.4 Cl 100 CO2 16.5 Anion 20.4 [10-20]
CBC: WBC 13400 Hb 13.3 Hct 40.4% MCV 93.5 MCH 30.7 MCHC 32.8 RDW 14.3 % PLT 89000
PMN 91% Lymph 8% Mono 1%
PT 13.6 INR 1.21 PTT 27.9
Operative record for cesarean section
Date of operation 5/9/53 Time started 3.00 Time end 3.30
Anesthesia GA
Clinical diagnosis G2P1 GA 35+2 wks fetal distress with severe-preeclamsia
Operation LT C/S
Position supine
Incision Lower midline
Finding
Uterus abnormal มี endometrium ทาง posterior
Adnexa normal
Amniotic fluid 100 ml clear Placenta normal Umbilical cord normal
Fetus female Fetal presentation vertex Apgar 1min 0 5min 0

Procedure
Type of surgery Low transverse C/S
Fetal removal manual Placental spontaneous
Repair uterus 2-layer
Peritonization: Uterus done Abdominal wall done
Rectus sheath continuous suture
Skin staple
Estimated blood loss 400 ml
Antibiotic prophylaxis Ampicillin 2 gm IV

5/9/53 (3.30)
Post-op order for C/S 5/9/53
- NPO
- Retained foley cath
- Record V/S q 1 hr
if Diastolic BP ≥ 110 mmHg
ให้ Hydralazine 5 mg IV
- 50% MgSO4 20 gm
+ 5%D/N/2 1000 ml
IV drip rate 50 ml/hr
- 5%D/N/2 1000 ml
+ synto 20 U IV drip rate 80 ml/hr
then 5%D/N/2 IV drip rate 80 ml/hr
- CBC with plt count, LFT, BUN, Cr,
PT, PTT at ward
- Ampicillin 1 gm IV q 6 hr
- Morphine 3 mg IV q 6 hr
Lab 9.00 6/9/53
CBC: WBC 17800 Hb 11 Hct 31.4 MCV 90.8 MCH 31.9 MCHC 35.1 RDW 16% PLT 64000
 PMN 94% Lymph 4% Mono 2%
PT 11.8 INR 1.05 PTT 29.5
BUN 22 Cr 1.4 (H)
Chol 244 (H)
Total protein 5.7 Alb 2.7 (L) Glob 3 A/G ratio 0.9 (L) [1.02-1.36]
Total Bilirubin 2.39 (H) [0-1.5] Direct Bilirubin 1.07 (H) [0-0.5]
AST (SGOT) 324 (H) [0-38] ALT (SGPT) 221 (H) [10-50] ALP 108 [39-117]
Na 132 (L) K 4.2 Cl 100 CO2 21.6 Anion gap 14.6 [10-20]

Lab 21.50 6/9/53

CBC: WBC 14700 Hb 9.9 (L) Hct 29.5% (L) MCV 91.8 MCH 31 MCHC 33.7 RDW 15.1% PLT 77000
PMN 79% Lymph 15% Mono 6%
PT 11.8 INR 1.05 PTT 29.5

I/O

4/9/53

I: Parenteral 650+441 FFP 310+190 Plt 100 (10 U) MgSO 4 0+149 = 1940

O: Urine 530 Blood loss 400 = 930

5/9/30

I: Parenteral 650+627+626 MgSO4 410+393+359 = 3055

O: Urine 405+380+440 NG 50 = 1275

6/9/53

I: Parenteral 200 Oral 0+50+200 MgSO4 626+780+0 = 2400

O: Urine 900+1170+1260 = 3330

9/9/53 Stool 1

V/S before D/C

BP 150/90 mmHg RR 20/min PR 80/min Temp 36.8 o