WEEKLY REPORT OF EMERGENCY DEPARTMENT

March 22th – 28th 2021

DELIVERY ROOM

I. OBSTETRICS CASES
BOOKED CASE

A Normal Delivery -
B Abnormal Delivery 1
NON BOOKED CASE

A Normal Delivery 5
B Abnormal Delivery 11
TOTAL

A Aterm 13
B Preterm 3
C Post term -

TOTAL 16

RESPONSE TIME:
Emergency CS: 35-40 minutes

1
II. MODE OF DELIVERY

Vertex Delivery 3

Cesarean Section 12

Spontaneous Abortion -

Spontaneous IUFD -

Spontanues Breech 1

Manual aid -

Forcep Extraction -

INDUCTION OF LABOR
Oxytocin Drip -
Misoprostol -

III. POST PARTUM STERILIZATION/ IUD

LSCS + Sterilization : 8
LSCS + IUD Insertion : 4
SuMPUC + IUD insertion : (-)
LSCS : (-)
Hysterotomy + sterilization : (-)
Caesarean Hysterectomy : (-)
Forceps Extraction + IUD : (-)

IV. MATERNAL MORTALITY :1

FETAL MORTALITY (ANTE/INTRA/POST NATAL) : -/1/-

V. CASES OF ABNORMAL DELIVERY

BC NBC TOTAL
CASES
LRP HRP IC OC

A. NEGLECTED LABOR - - - - -

B. UTERINE RUPTURE - - - - -

C. SECONDARY ARREST - - - - -

D. PROLONGED SECOND STAGE - - - - -

E. PREGNANCY INDUCED HYPERTENSION - - - - -

F. ANTEPARTUM HAEMORRHAGE - - - - -

G. PROM - - - - -

H. PPH - - - - -
 I. PRETERM - - - - -

J. HIV - - - - -

K. IUGR - - - - -

L. IUFD - - - - -

M. MALPRESENTATION - - - - -

N. MULTIPLE PREGNANCY - - - - -

O. PLACENTAL INSUFFICIENCY - - - - -

P. PREVIOUS CAESAREAN - - - - -

Q. HEART DISEASE - - - - -

R. OBESITY - - - - -

S. CONGENITAL ANOMALY FETUS - - - - -

T. OTHERS - - - - -

U. MATERNAL DEATH - - - - -

V. CONSULT - - - - -

TOTAL - - - - -

VI. GYNECOLOGY CASES:

A. TOTAL VISITORS
No. CASES ER OC SUB TOTAL

1. Ovarian Carcinoma - - -

2. Cervical Carcinoma - - -

3. Vulvar Carcinoma - - -

4. Ovarian tumor - - -

5. Mola hydatidosa - - -

6. Abortus Incomplete - - -

7. Abortus Complete - - -

8. Abortus Imminens - - -

9. Post Operation - - -

10. Uterine Myoma - - -

11. Ectopic Pregnancy - - -

12. AUB - - -

13. Endometrial carcinoma - - -

14. Uterine prolapse - - -

15. Choriocarcinoma - - -

16. Death conceptus - - -

17. Tuboovarial abscess - - -

18. Intrabdominal tumor - - -

19. Cyst Ovarian rupture - - -

TOTAL - 0 -

B.
tenderness (+). Weight: 50 kg, Height: 162 cm, BMI: 19,1; Gynecologic Status: v/v flx
(+/-) flr (-) P: smooth, slinger pain (+) CU: AF ~ as high as 5/6 weeks pregnancy, AP
D/S: Pain (+) cystic mass (-), CD: protrution (+) RT: TSA (+) N, smooth mucous;
Laboratory : Hb: 6,9; L: 21.750; Plt: 199.000; BUN/SC : 15/1,3; Alb: 3,5; OT/PT:
36/30; Na/K/Cl: 141/4,6/106; NLR : 5,5; Glucose : 124; Pregnancy Test (+); Rapid
Covid-19 : NR; Covid-19 Screening Score: 6 (live in Surabaya: 4; Pregnancy: 1; NLR >
3,5 : 1); CXR : WNL; US FAST Free fluid intra abdomen (A) Susp. Ruptured Ectopic
Pregnancy + Anemia (Hb 6,7) (P) cito Exploration Laparotomy  rupture of tuba
pregancy pars ampularis S, bleeding + 2400 cc  salphyngectomy S (66.62).

VIII. VISUM ET REPERTUM: (-)

IX. CONSULT: (4)

1. Mrs. Fit/37 y.o/12.85.59.89/OC
Patient consulted from orthopedic Surgeon with GIIIP2002 17/18 weeks+Closed
Fracture Humerus S; Married: 1x  8 years; Youngest living child: 3 years;
Contraception: (-); LMP : November, 02nd 2020 (O) General Status: GCS 456
 A(-)/I(-)/C(-)/D(-); BP: 100/68, HR: 94, RR: 20; Trect: 36,5oC; SpO2 : 99%; Cor: S1S2
Murmur (-) Gallop (-); Pulmo: ves +/+, rh -/-,wh -/-; Abd: soepl. Weight: 71 kg, Height:
155 cm, BMI: 29,6; Obstetric Status: FH~ 17/18 mggu; FHR: (12-12-12); Cont: (-);
VT : Ø (-)/High presenting part; US: cephalic/S/FHR(-); Biometry ~ 17/18 weeks, EFW
190 g, Fundus placentae/gr I/AFI 13.4; Lab : Hb: 12,5; L: 17.120; PLT : 191.000; NLR :
30.4; AST/ALT : 28/27; Alb : 3,26; BUN/SC: 4/0,5; Na/K/Cl : 143/3,3/107; Glucose :
142; Rapid Covid-19 : Non Reactive, Swab Antigen Covid-19 : Non Reactive; CXR :
WNL; Screening Score: 6 (live in the red zone: 4, Pregnancy : 1, NLR > 3,5 : 1) (A)
GIIIP2002 17/18 weeks + Closed Fracture Humerus + EFW 200 g (P) Diagnostic
establishment and Optimalization Condition, obgyn join nursing.

X. DEATH CASE : (-)

1. Ms. IFA/ 25 y.o/ 12.84.34.95/OC
Patient was consulted by Internist with respiratory failure type I + Ovarian carcinoma +
meig syndrome + susp. ALO + Anemia (Hb 8,3) + AKI dd ACKD + Hypoalbuminemia
(Alb 2,6). P0000; Married: 1x  1 year; Youngest child : (-) Contraception : (-) LMP:
Dec, 3rd 2020 (O) General Status: GCS 456 A(+)/I(-)/C(-)/D(+); BP: 100/60, HR:114,
RR: 28; Trect: 36,7oC; Cor: S1S2 Murmur(-) Gallop (-); Pulmo: ves +/+, rh +/+ (basal),
wh -/-;abdomen : soepl. Weight: 75 kg, Height: 157 cm, BMI: 30,4; Gynecologic
Status: inspection : v/v : flx (+), VT : v/v/ : flx (+/-) flr (-); P : smooth; CU : hard to
evaluated; AP D/S : cystic mass size 15 cm, fixed (+); CD : wnl; RT : TSA (+) normal,
palpable lower part of tumor. US : uterus AF size 8,8x6,4 cm, ovarian mass size
7,24x8,65 cm, septa (-), papil (+) uniloculer, ascites (+). Laboratory : Hb: 8,3; L:
28.800; Plt 119.000; BUN/SC : 52/2,9; Alb: 2,61; AST/ALT: 97/23; Na/K/Cl:
137/3,5/109; CRP L 28,5; bil direct/total : 0,3/0,67; Ca : 9,1; GDA : 119; BGA :
metabolic acidosis; Ca 125 : 1013,9; Rapid Covid-19 : NR; Covid-19 Screening Score:
10 (dyspneu; live in the transimison zone: 4, malignancy : 1; plt < 180.000: 1); CXR:
bilateral effusion, metastase (-), cor wnl; US upper lower abdomen: susp. Malignant
mass ovarium, ascites, pleural effusion (A) Ovarian mass susp. malignancy + Ascites +
Post tapping ascites + Pleural Effusion Bilateral + Anemia (Hb 8,3) + Hypoalbumin
(Alb 2,6) + Metabolic acidosis + Septic Shock + AKI dd ACKD (P) Overcome
emergency in Obsgyn line, join nursing Pulmonology and Internal departement 
evacuation pleural effusion by pulmonologist + optimalization general condition
decrease of conciousness after evacuation  gasping  pro intubation  family
refused intubation, performed DNR  cause of death : septic shock

XI. DETAILS OF ABNORMAL LABOR

A. NEGLECTED LABOR: (-)
a. BC : (-)
b. NBC : (-)

B. UTERINE RUPTURE: (-)

a. BC : (-)
b. NBC : (-)

C. SECONDARY ARREST: (-)

a. BC : (-)
b. NBC : (-)
D. PROLONGED SECOND STAGE: (-)
a. BC : (-)
b. NBC : (-)

E. PREGNANCY INDUCED HYPERTENSION: (-)

a. BC: (-)
b. NBC: (-)
1. Mrs. ATA/ 14 y.o/ 12.86.42.23/ ER
(S) Patient came by herself with complaints of seizure for 3 times since 12.00 (2 hours
before), P0000; Married: 1x 1 year; Youngest living child: (-); Contraception: (-);
LMP: August 11th ,2020 ~ 33/34 wga; (O) General Status: GCS 445 A(-)/I(-)/C(-)/D(-);
BP: 165/95, HR: 118, RR: 20, Trect: 36,3oC; SpO2 : 99%; Cor: S1S2 single, Murmur (-)
Gallop (-); Pulmo: ves +/+, rh -/-,wh -/-; Leg oedema: +/+; Weight: 87 kg, Height: 160
cm, BMI: 33,9; Obsteric Status: FH : 31 cm; cephalic presentation; FHR: 11-12-12 Cont:
(-);VT : ϕ -/ High presenting part; Lab : Hb : 10,1; L: 20.840; PLT : 385.000; AST/ALT
: 51/22; Alb :2,98; BUN/SC: 4/0,9; Na/K/Cl : 141/ 3,5/ 102; NLR : 6,1; CXR : within
normal limit; IDNow swab: Negative; Covid 19 Screening Score: 6 (live in the red zone:
4, pregnancy:1, NLR > 3,5 :1) US : Cephalic/S/FHR (+); Biometry ~ 34/35 w, EFW
2230 g; Placenta posterior corpus/gr II/AFI 1,5, NST : (-); (A) GIP0000 36/37 wga +
Singleton pregnancy + Cephalic presentation + Severe Preeclampsia + Eclampsia +
Obesity Class I (BMI 33,9) + Severe oligohydramnion (AFI 1,5) + EFW 2230 g; (P) BP
reduction; Inj MgSO4 20% 4 g  MgSO4 1 g via syringe pump; Nifedipine 10mg every
8 hours if BP ≥ 160/110; Methyldopa 500mg every 8 hours; Seizure prevention;
Termination  Emergency CS (74.1) + IUD insertion; Baby born (April 4th, 2021 time
17.06) ♂/ 2400 g/ 50 cm/AS 3-5 BS: 34 week LS: p50-75, clear minimal amnion fluid,
performed intracesarean IUD insertion. Baby breathing via CPAP; At 20.30: (S) Patient
was having seizure for 30” (O) General Status: GCS 2x4 A(-)/I(-)/C(-)/D~ vent; BP:
192/116, HR: 109, RR: ~ vent, Trect: 35,9oC; SpO2 : 99%; Cor: S1S2 single, Murmur (-)
Gallop (-); Pulmo: ves +/+, rh -/-,wh -/-; Obsteric Status: FH: 3 cm below umbilicus,
Uterine cont. : adequate, v/v: flx (-); CXR: ARDS, prominent cor; CT Scan result:
Subacute to chronic ischemic cerebral infarction at cortes-subcortex left parieto-
occipital, brain edema (P) Advice from dr. Mariza, SpAn: Patient to be sedated,
MgSO4 1 gram/ hour via syringe pump; Latest condition (April 5th, 2021 06.00); (S) on
ventilator mode PSIM V PEEP 5 FiO2 40%; (O) General Status: GCS sedated, A(-)/
I(-)/ C(-)/ D(-); BP: 119/73, P: 106, RR: ~ vent, T: 36,5o C; Cor: WNL; Pulmo: WNL;
Obstetric Status: FH 8 cm below umbilicus, Uterine cont. (+), v/v: flx (-); (P) Postop
care, Recurrent seizure prevention, BP regulation; MgSO4 40% 1 gram/ hour via syringe
pump, Vit B6 10mg every 12 hours, Folic acid 1mg every 12 hours, Fluid balance
Input=Output+500cc; Mx: Symptoms/ VS/ Uterine cont./ Signs of recurrent seizure

2. Mrs. FAI/ 27 y.o/ 12.86.41.78/ ER

(S) Patient was referred from Waluyojati Hospital, Kraksaan with GII P1001 single
intrauterine + Severe preeclampsia + Obesity Class II (BMI 37) + Suspected Gestational
DM + Heart Failure + EFW 3300 g; ANC: Midwife Azizah 4X  HRP ec. Obesity;
Krejengan Public Heath Center 1x  HRP ec. Obesity + Positive Preeclampsia
screening, Waluyojati Hospital, Kraksaan  HRP ec. Severe preeclampsia + Gestational
DM; Married: 1x 10 years; Youngest living child: 9 y.o.; Contraception: Implant,
removed since January 2020; LMP: July 13th, 2020 ~ 37/38 weeks; (O) General Status:
GCS 456 A(-)/I(-)/C(-)/D(+); BP: 163/90, HR: 110, RR: 24, Trect: 37,5oC; SpO2 :
98% (O2 mask 6lpm); Cor: S1S2 single, Murmur (-) Gallop (-); Pulmo: ves +/+, rh +/
+,wh -/-; Leg oedema: +/+; Weight: 89 kg, Height: 154 cm, BMI: 37,1; Obsteric Status:
FH : 40 cm; cephalic presentation; FHR: 12-13-12 Cont: (-); VT : ϕ 1cm/ 25%/ amnion
sac (+)/ Cephalic / Transverse SS/ H-I; Lab : Hb : 11,2; L: 10.720; PLT : 389.000;
AST/ALT : 17/11; Alb :2,7; BUN/SC: 7/ 0,5; Na/K/Cl : 140/ 3,5/ 107; NLR : 3,49;
Random blood glucose: 99; CXR : lung oedema superimposed with pneumonia,
Cardiomegaly; IDNow swab: Negative; Covid 19 Screening Score: 5 (live in the red
zone: 4, pregnancy:1); US : Cephalic/S/FHR (+); Biometry ~ 40/41 wga, EFW 4020 g;
Placenta posterior corpus/gr II-III/AFI 19,2, NST: 155/ 5-15/ reactive  Category I; (A)
GII P1001 single intrauterine + Cephalic presentation + Severe preeclampsia + Acute
lung oedema dd Pneumonia susp Covid-19 + Gestational DM + Obesity Class II (BMI
37,1) + Hypoalbuminemia (Alb 2,7) + Suspected Big baby + EFW 4000 g; (P) BP
reduction; Pending administration of MgSO4; Inj. Furosemide extra 2 amp; Nifedipine
10mg every 8 hours if BP ≥ 160/110; Methyldopa 500mg every 8 hours; Fluid restriction
input=output; Termination  Emergency CS (74.1) + IUD insertion; Baby born (April
3rd , 2021 time 19.30) ♂/ 4400 g/ 49 cm/AS 5-7 BS: 38 week LS: p>90, clear amnion
fluid, performed intracesarean IUD insertion, Baby spontaneous breathing; Latest
condition (April 4th , 2021 06.00); (S) shortness of breath (-), pain at incision site (+);
General Status: GCS sedated, A(-)/ I(-)/ C(-)/ D(-); BP: 140/70, P: 102, RR: 20, T: 36,5o
C; Cor: WNL; Pulmo: ves +/+, rh ±/±; Abdomen: Flat (+), not rigid, normal bowel
sound, dehiscience (-); Obstetric Status: FH 8 cm below umbilicus, Uterine cont. (+), v/v:
flx (-); (P) PCR swab today; Postop care, Fluid input: 700cc/ 10 hours; Output: 900cc/ 10
hours; Mx: Awaiting result for post surgery Hb

3. Mrs. HAM/ 29 y.o/ 12.84.59.30/IC

(S) Patient referred from Kraksaan Hospital with GII P1001 35/36 wga singleton
pregnancy + Previous CS + Severe Preeclampsia + Obs. Dyspneu. ANC: Paiton Public
Health Center 8x  HRP due to Previous CS; Kraksaan Hospital (dr. Donny, Sp.OG) 
HRP due to Previous CS; LMP: July, 24th 2020 ~ 35/36 wga; Married 1x  6 years; Last
Child : 5 y.o.; Contraception: Injection monthly, last January 2020 (O) General Status:
GCS: 456, A(-)/ I(-)/ C(-)/ D(+); BP: 170/96 mmHg P: 123, RR: 26-28, Trec: 36,5o C,
SaO2: 95-96%; Cor: S1S2 single, murmur (-), gallop (-); Pulmo: ves +/+; rh -/-, wh-/-;
extremity : Oedema -/-; Weight: 53 kg, Height : 145 cm, BMI : 25,2; Obstetric Status:
FH : 26 cm; cephalic presentation; FHR: 12-12-12 Cont: (+) 1 x 10” within 10 minutes;
VT: ϕ 3 cm/ 25%/ amnion(+)/ cephalic/ transverse SS/ HI; Lab: Hb : 9,7; WBC: 10.310;
PLT: 226.000; APTT/PTT: 49,5/9,1; AST/ALT : 29/11; Alb :2,6; BUN/SC: 5/0,5;
Na/K/Cl: 139/5/109; NLR : 6,9; Antigen Swab: Negative; IdNow Swab: Negative;
CXR: Perihillar Haziness in parahillar-paracardial left and right, DD: 1.
Interstisial Lung Oedema, 2. Interstitial Lung Pneumonia, 3. Cardiomegaly; US:
Cephalic/S/FHR (+); Biometry ~ 34/35 w, EFW 1980 g; Lateral Corpus Placenta/gr II/
Adequate amnion fluid, NST: 150/5-15/reactive  Category I (A) GII P1001 35/36 wga
+ Singleton pregnancy + Cephalic presentation + Inlabor latent phase + Severe
Preeclampsia + Lung Edema + Previous CS + Cardiomegaly + Anemia (Hb 9,7) +
Hipoalbuminemia (Alb 2,6) + Fetal Suspect IUGR + EFW 2600 g (P) Termination 
Emergency CS (74.1) + IUD Insertion (69.7) Baby born ♀ (March 3rd, 2021 00.10)/ 1800
g/ 43 cm/ AS 3-5-7; BS: 35 week LS: p<10, clear amnion fluid.

4. Mrs. SAR/ 32 y.o/ 12.26.71.12/ IC

(S) Patient referred from Obstetric Outpatient Clinic Soetomo Hospital with GIII P1011
33/34 wga singleton pregnancy + Cephalic presentation + Chronic Hypertension si
 Severe Preeclampsia + Severe Oligohidramnion + Abnormal NST + s IUGR + Treated
like Gestational DM + EFW 1900 g. ANC: Dr. dr. Poedjo H.,SpOG(K) 1x  HRP ec to
Chronic Hypertension; Obstetric Outpatient Clinic Dr. Soetomo Hospital 11x  HRP ec
to Chronic Hypertension + Treated like DM Gestational; LMP: August, 8th 2020 ~ 33/34
wga; Married 1x  7 years; Last Child : 6 y.o.; Contraception: (-) (O) General Status:
GCS: 456, A(-)/ I(-)/ C(-)/ D(-); BP: 160/100 mmHg P: 89, RR: 20, Trec: 36,9o C; Cor:
S1S2 single, murmur (-), gallop (-); Pulmo: ves +/+; rh -/-, wh-/-; extremity : Oedema -/-;
Weight: 54 kg, Height : 151 cm, BMI : 23,7; Obstetric Status: FH: 25 cm; cephalic
presentation; FHR: 12-12-12 Cont: (-); VT: (-) High presenting part; Lab: Hb : 10,6;
WBC: 8.760; PLT: 227.000; APTT/PTT: 31,3/12,8; AST/ALT: 20/12; Alb: 3,1;
BUN/SC: 8/0,5; Na/K/Cl: 140/4,3/108; Fasting Blood Glucose/2 Hour Post Prandial:
82/135; IdNow Swab: Negative; CXR: Within normal limit; US: Cephalic/S/FHR (+);
Biometry ~ 32/33 w, EFW 1940 g; Placenta / gr III/ AFI 4,5; CPR: <1; NST: 140/5-7/
suspicious NST  Category II (A) GIII P1011 33/34 wga + Singleton pregnancy +
Cephalic presentation + Severe Oligohidramnion (AFI 4,5) + Abnormal NST + Fetal
Suspect IUGR + Treated like Gestational DM + EFW 1900 g (P) Termination 
Emergency CS (74.1) + IUD Insertion (69.7) Baby born ♂ (March 3rd, 2021 18.30)/
2000/ 45 cm/ AS 7-8; BS: 35 week LS: p10-25, clear amnion fluid, baby spontaneous
breath; Patient refused IUD insertion.

F. ANTEPARTUM HAEMORRHAGE: (-)

a. BC : (-)
b. NBC : (-)
1. Mrs. LIL/ 37 y.o/ 12.84.59.30/IC
Patient came by herself with chief complaint watery vaginal discharge since 1 hour
before admitted to the hospital. ANC: Jasem Hospital 5x  HRP due to Previous CS 2x
+ Chronic Hypertension + Advanced maternal age. LMP: April, 06th 2020 ~ 36/37 wga;
Married 1x 9 years; Last Child : 8 y.o.; Contraception: COC, last 2019 (O) General
Status: GCS: 456; A(-)/ I(-)/ C(-)/ D(-); BP: 167/100 mmHg HR: 107, RR: 20, Trec:
36,5o C; Cor: S1S2 single, murmur (-), gallop (-); Pulmo: ves +/+; rh -/-, wh-/-; extremity :
Oedema -/-; Weight: 75 kg, Height : 158 cm, BMI : 30,05; Obstetric Status: FH : 28 cm;
cephalic presentation; FHR: 12-12-12 Cont: (-);VT : ϕ 1 cm/25%/amnion(-)/lithmus(+)/
cephalic/transverse SS/HI; Lab : Hb : 10,1; L: 8.280; PLT : 173.000; AST/ALT : 41/17;
Alb :2,9; BUN/SC: 8/0,5; Na/K/Cl : 138/4,7/102; NLR : 9,4; CXR : within normal limit;
Covid 19 Screening Score: 6 (live in the red zone: 4, pregnancy:1, NLR > 3,5 :1) US :
Cephalic/S/FHR (+); Biometry ~ 36/37 w, EFW 2670 g; Placenta fundus/gr II-III/AFI 7,
NST : 145/5-20/reactive  Category I (A) GIIIP2001 36/37 wga + Singleton pregnancy
+ Cephalic presentation + Chronic Hypertension SI Severe Preeclampsia + PROM < 12
Hour + Previous CS 2x + Advanced maternal Age + Obesity Class I (BMI 30,05) + EFW
2600 g (P) Termination  cito CS (74.1) + Sterilization (66.3) Baby born ♂/3200/49
cm/AS 8-9 BS: 39 week LS: p50-75, clear minimal amnion fluid, performed
fimbriectomy bilateral.

G. PROM: (1)
a. BC (-)
b. NBC : (1)
Ny. ALI/ 22 y.o/12.86.40.07
 Patient was referred from Cempaka Maternal & Pediatric hospital with GIP0000
39/40 wga singleton intrauterine + PROM + Anemia (Hb 7,1) + suspected of
Covid 19, ANC: dr. Gregorius, Sp.OG 2x  LRP, dr. Amir Fahad, Sp.OG 2x 
LRP; LMP: June 28th , 2020 ~ 39/40 wga; Married 1x 1 year; Youngest Child
(-); Contraception: (-); (O) General Status: GCS 456, A(+)/ I(-)/ C(-)/ D(-); BP:
128/72, P: 87, RR: 20, T: 36,6o C; Weight: 57 kg; Height: 157 cm; BMI: 23,1;
Cor: WNL; Pulmo: WNL; Obstetric Status: FH 33 cm, Cephalic presentation,
FHR: 144 bpm; Contractions (+); VT: ø 1 cm/ 25 %/ Amnion Sac (-) meconeal/
Head/ Transverse SS/ H-I/ Inner Pelvic Measurement~ WNL; Lab : Hb : 7,9; L:
7.900; PLT : 213.000; AST/ALT : 25/13; Alb :2,7; BUN/SC: 4/0,4; Na/K/Cl :
133/ 4,1/ 100; NLR : 9,9; CXR : within normal limit; Covid-19 Serology test from
Cempaka Putih hospital (April 2nd, 2021): IgM: reactive, IgG: reactive; IDnoe
Swab result: Negative; Covid 19 Screening Score: 6 (live in the red zone: 4,
pregnancy:1, NLR > 3,5 :1) US: H/ Singleton/ IU/ FHR(+), Biometry ~ 39/40
weeks, EFW 3341 g, Fundal placenta/ gr II/ AFI 1,2; NST : 130/2-5/ Low
variability/ Category II  intrauterine resuscitation: O2 mask, left lateral
decubitus position, Inf. RL 500cc; Evaluation NST: 120/2-5/ Low variability/
Category II (A) GIP0000 39/40 wga singleton intrauterine + Cephalic
presentation + PROM > 24 hours + Category II Abnormal NST + Anemia (Hb
7,9) + Hypoalbuminemia (Alb 2,7) + suspected of Covid 19 (reactive IgG and
IgM) + EFW 3300 g (P) Termination  Emergency CS; Baby born ♂ (April, 3 rd
2021 02.10)/ 3000 g / 48 cm / AS 7-8 BS: 40 week LS: p50; Meconeal amnion
fluid, baby spontaneous breath

H. POST PARTUM HAEMORRHAGE: (-)

a. BC : (-)
b. NBC : (-)

I. PRETERM: (-)
a. BC : (-)
b. NBC : (-)

J. HIV: (-)
a. BC : (-)
b. NBC : (-)

K. IUGR: (-)
a. BC : (-)
b. NBC : (-)

L. IUFD: (-)
a. BC : (-)
b. NBC : (-)

M. MALPRESENTATION: (-)
a. BC : (-)
b. NBC : (-)

N. MULTIPLE PREGNANCY: (-)

a. BC : (-)
 b. NBC : (-)

O. PLACENTAL INSUFICIENCY: (-)

a. BC : (-)
b. NBC : (-)

P. PREVIOUS CESAREAN SECTION: (-)

a. BC : (-)
b. NBC : (-)
Mrs. ITA/30 y.o/12.86.43.84/IC
Patient reffered from Obstetric Outpatient Clinic Dr. Soetomo Hospital with GIIIP2002
38/39 wga singleton intrauterine + Cephalic presentation + Previous CS 2x + Low
suspected Placenta Accreta + Abnormal NST + EFW 2800 g; ANC: Mudawamah
Midwife 1x  HRP due to previous CS 2x. Gitek Public Health Center 5x  HRP due to
previous CS 2x. Fatimah Islamic Hospital 1x  HRP due to previous CS 2x.
Blambangan Regional Hospital 1x  HRP due to previous CS 2x + susp. Placenta
Accreta. Obstetric Outpatient Clinic Dr. Soetomo Hospital 1x  HRP due to previous CS
2x + susp. Placenta Accreta; LMP : July, 11th 2020 ~ 38/39 wga; Married : 1x  6
years; Last Child : 9 m.o.; Contraception: Injection 3 monthly, last early 2020 (O)
General Status: GCS 456 A(+)/I(-)/C(-)/D(-); BP: 117/67, HR: 88, RR: 20; Trect: 36,5
oC; Cor: S1S2 Murmur(-) Gallop (-); Pulmo: ves +/+, rh -/-, wh -/-; Oedema -/-; Weight:
62 kg, Height : 156 cm, BMI : 25,4; Obstetric Status: FH: 32 cm; cephalic presentation;
FHR: 11-12-11 Cont: (-); VT: was not performed; US : cephalic/S/FHR (+), Biometry ~
37/38 w, EFW 2862 g; placenta left lateral/ gr. II – III/ Adequate Amnion Fluid/ low
suspected placenta accreta; Laboratory : Hb: 8,8; L: 9.07; Plt 272.000; BUN/SC : 3/0,4;
Alb: 3,01; OT/PT: 17/0,6; Na/K/Cl : 139/3,6/104; CXR: Pneumonia + Aortosclerosis; ID
NOW Swab result: Negative (Dr. Soetomo Hospital 05-04-2021) (A) GIIIP2002 38/39
wga singleton pregnancy + Cephalic presentation + Previous CS 2x + PPT + Low
suspected Placenta Accreta + Abnormal NST category III + Susp. Pneumonia COVID-19
+ Anemia (Hb 8,8) + EFW 2800 g (P) cito CS (74.1) + Sterilization (66.3) Baby born
♂/ 3000g/ 49 cm/AS 7-8 BS: 38 week LS p25-50, clear amnion fluid, bleeding 400 cc,
placenta accreta was not found, fimbriectomy bilateral was not performed.

Q. HEART DISEASE: (-)

a. BC : (-)
b. NBC : (-)

R. OBESITY: (-)
a. BC : (-)
b. NBC : (-)

S. CONGENITAL ANOMALY FETUS: (-)

a. BC : (-)
b. NBC : (-)

T. OTHERS : (1)
a. BC : (-)
b. NBC : (1)
1.Mrs. PUT/33 y.o/12.85.61.40/IC
 Patient referred from PHC Hospital with GIII P1011 36/37 wga + HT Chronic
Superimposed Severe PreEclampsia + Placenta Previa Totalis susp. Accreta. + History of
surgery + Previous section caesarean. ANC: PHC Hospital 8x  HRP ec Previous
section caesarean; LMP: June, 20 th 2020 ~ 36/37 wga; Married 1x  10 years; Last
Child : 2 y.o. Contraception: OC last 2018 (O) General Status: GCS: 456; A(-)/ I(-)/
C(-)/ D(-); BP: 150/100 HR: 89, RR: 20, Trec: 36,6o C; Cor: S1S2 single, murmur (-),
gallop (-); Pulmo: ves +/+; rh -/-, wh-/-; extremity : Oedema +/+; Weight: 98 kg, Height :
160 cm, BMI : 38,3; Obstetric Status: FH: 38 cm; cephalic presentation; FHR: 13-13-13
Cont: (-); VT: (-) US Fetomaternal: Cephalic/S/FHR (+); Biometry ~ 36/37/w, EFW
3000 g, anterior corpus placentae expanding and covering OUI, Low suspicious of OUI/
plac gr III/AFI 4,6; Lab : Hb : 10,2; L: 18.620; PLT : 294.000; NLR : 2,7; AST/ALT :
30/6; Alb : 2,8; BUN/SC: 12/0,9; Na/K/Cl : 139/4,3/109; Urine Protein +2; Rapid Covid-
12 : Non Reactive, swab IDI now Covid-12 : Non Reactive; CXR : WNL; Screening
Score: 5 (live in the red zone: 4, Pregnant : 1) (A) GIII P1011 36/37 wga + HT Chronic
Superimposed Severe PreEclampsia + Placenta Previa Totalis susp. Accreta + History of
surgery + Previous section caesarean.+ Severe Oligohydramnion (AFI 4,6) + Obesity
Class III (BMI 38,3) + Hypoalbuminemia (Alb 2,89) + EFW 3000 g + (P) Cito CS (74.1)
+ IUD (69.7)  Baby born ♂/3000/50 cm/AS 7-8 BS: 36 week LS: p75 durante op : no
finding placenta invasion.

U. MATERNAL DEATH: (2)

a. BC : (-)
b. NBC : (2)
1. Mrs. WAR/ 28 thn/12.85.55.22 /ER
Patient reffered from Mitra Husada Sidoarjo Hospital with P2003 Post SC 1 hours (ec.
Post date ) + Early HPP ec Atonia Uteri. P2002; Married: 1x 11 years; Youngest living
child: 0 days.; Contraception: Injection 3 monthly, last 2017; (O) General Status: GCS
111 A(+)/I(-)/C(-)/D(-); BP: 50/palpation, HR: 65, RR: 12 via intubation jackson rees
mask 10 lpm; Trect: 36,5oC; SpO2 : 99%; Cor: S1S2 Murmur (-) Gallop (-); Pulmo: ves
+/+, rh -/-,wh -/-; Abd: soepl, pain (+). Weight: 65 kg, Height: 152 cm, BMI: 28,1;
Gynecologic Status:V/v flx (+) flr (-) P: smooth, CU: as high as umbilicus, contraction :
(+), AP D/S: pain (-) mass (-), CD: protrution (+) RT: TSA (+) N , smooth
mucous;Laboratory : Hb: 3,3; L: 31.390; Plt: 179.500; BUN/SC :5 /1,8; Alb: 1,2; OT/PT:
25/13; Na/K/Cl: 146/4,8/111; Glucose : 209; Rapid Covid-19 : Non Reactive; Covid-19
Screening Score: 5 (live in red zone: 4; pregnancy: 1); CXR : WNL (A) P2002 post SC
D-0 (ec post date) + HPP ec Atonia uteri + Hipovolemia Shock + Anemia (Hb 3,1) +
Lost of consiosness (P) Resusitaion in RES room on March 01st, 2021 at 21.00 GCS
111, BP : not measured, HR : not palpable  cardiac arrest  ROSC (-) cornea reflex -/-
 patient confirmed dead in front of doctor, paramedic, and family; Suspected cause of
death: Hipovolemic shock ec HPP ec Atonia Uteri.