Wahidin Sudirohusodo
Hospital/ Dewi Novita
N No Date of Date of
PROBLEM IDENTIFICATION
admission Discharge
O
1 1. 21/ 02/ 2018
Labuang Baji Hospital
Mrs. F/33 years
P4A3
Referred By Amanat Hospital with
Hypovolemic Shock e.c Uterine Atony +
Rupture of portio + Bladder Laceration
(Post Total Hysterectomy-Left
Salpingooophorectomy + Hypogastric
Artery Ligation + bladder repair)
History of caesarean section due to
G6P3A3 42 weeks of gestational age in
latent phase 1st stage in labor + fetal
distress at Amanat Hospital
History of transfusion 2 bags PRC (post
operative) at Amanat Hospital
Post operative Hb: 6.1 gr/dL
E3M5Vx (intubated)
BP: 112/70 mmHg
HR: 149 bpm
SpO2: 99%
Laboratory results (21/4/21) after
transfusion 4 bag of PRC:
WBC:14.000 /µL
Wahidin Sudirohusodo
Hospital/ Dewi Novita
Obstetrics and Gynecology Social Division / Yuliati
February 21st – February
April 25th28
2018
th 21st – February 25th 2018
02nd 2021
– May February
Patient ID No Date of Date of
Detail of Patient Patient ID
Treatment Detail of Patient
Recommendation
Treatment Recommendation
(Age/ LMP/ RM) SITUATION ANALYSIS
admission Discharge (Age/ LMP/ RM) EFFORTS ALREADY MADE PLAN TO FOLLOW UP
1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s in c e 1 y e a r a g o . - T o t a l A b d o m in a l O b s e r v a t io n o f
-
 Critical
Mrs. K/ 65
yo/ P1A0/
A b d o m i n a l E n la r g e m e n t s i n c e 1 y e a r a g o .
emergency obstetrics
Menopause since 12 years ago.
yo/ P1A0/
- T o t a l A b since
Educate
Menopause d o m in12a l years ago. O b s e r v a t i o n o f
the
H y s te re cto m y
patient,g ehusband n e r a l c o n d it io n ,
 Family
H y s t e r e c t o m support
y patient
g e n e r a l c o n d it io n ,
MR: 830383 - B ila t e r a l v it a l s i g n
MR: 830383situation (AGDO) and- family
B il a t e r a l about: v i t a l s i g n recovery
S a l p in g o o o p h o r e c t o m y
USGSuterine
a l p in g omasso o p h: o16,54
r e c t oxm8,78
y cm W ound
 AUSGnearuterine missmass : 16,54 case x 8,78 cm  The condition of the W o u patient,
nd  Cooperate with doctors H y g ie n e a n d in
H y g ie n e a n d c o n t ro l
 Timely referral (RTW) from the plan of action,c othe n tro l
risk Labuang Baji Hospital to follow
H i s t o p a t h o lo g y
Amanat Hospital for Intensive (severe postpartum bleeding up patient’s condition fo llo w u p
H i s t o p a t h o lo g y
Care due to uterine atony, f o ll o w rupture
up  Provide good team working
M o b il iz a t i o n
 Very High risk pregnancy: of portio and bladder M o b ili z a t i o n between government, hospitals
- Postpartum hemorrhage laceration), and health care provider in
(after induction of labour  No longer have menstrual order to offering better health
by misoprostol ) period and cannot become care service and preparation
- too frequent in labour pregnant especially in high risk
 Frequent ANC at PHC 4 times  The benefits of medical pregnancy
 Low educational level interventions, and prognosis  Recommend the referral
 Low socio-economic status  Inform, educate, and counsel hospital to stay keep follow up
the husband and family about and remains concerned with
the importance psychosocial the progress of the patient's
support to the patient in recovery
order to enhance her  Recommend to the patient
recovery routine control after repair of
 the referral hospital follow Bladder to the hospital
up, helping and remains  Cooperate with BKKBN to keep
concerned with the progress doing socialization about the
of the patient's recovery importance of contraception in
all health care facility
 Wahidin Sudirohusodo Wahidin Sudirohusodo
Hospital/ Dewi Novita Hospital/ Dewi Novita
Obstetrics and Gynecology Social Division / Yuliati
February 21st – February
April 25th28
2018
th 21st – February 25th 2018
02nd 2021
– May February

HGB: 12.2 gr/dL No Date of Date of Patient ID No Date of Date of

Detail of Patient Patient ID
Treatment Detail of Patient
Recommendation
Treatment Recommendation
admission Discharge (Age/ LMP/ RM)
admission Discharge (Age/ LMP/ RM)
PLT: 62.000 /µL
1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s in c e 1 y e a r a g o . - T o t a l A b d o m in a l O b s e r v a t io n o f
GOT: 56 IU/dL 1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s i n c e 1 y e a r a g o . yo/ P1A0/
- T o t a l A b since
Menopause d o m in12a l years ago. O b s e r v a t i o n o f H y s t e re c to m y g e n e r a l c o n d it io n ,
yo/ P1A0/ Menopause since 12 years ago. H y s te re cto m y g e n e r a l c o n d it io n , - B ila t e r a l v it a l s i g n
MR: 830383
GPT: 17 IU/dL MR: 830383 - B il a t e r a l v it a l s ig n S a l p in g o o o p h o r e c t o m y
USGSuterine
a l p in g omasso o p h: o16,54
r e c t oxm8,78
y cm W ound
Albumin: 1.9 gr/dL USG uterine mass : 16,54 x 8,78 cm W ound H y g ie n e a n d
RBS: 132 mg/dL H y g ie n e a n d c o n t ro l
c o n tro l
Creatinin:1.0 mg/dL H i s t o p a t h o lo g y
H i s t o p a t h o lo g y fo llo w u p
f o ll o w u p
M o b il iz a t i o n
Treatment Diagnosis:
M o b ili z a t i o n

Post Operation (Total Hysterectomy-

Left Salpingooophorectomy +
Hypogastric Artery Ligation + bladder
repair) + Hypovolemic Shock ec Uterine
Atony + Bladder rupture + Severe
Anemia + Trombocytopenia +
Hypoalbuminemia
Treatment:
 Cefotaxime 1 gr/12 hours/ iv
 Tranexamic acid 500 mg/8 hours/ iv
 ICU admission and Endotracheal
intubation with mechanical
ventilation
 Transfusion 2 bags of PRC and 3
bags of TC
 Maintenance of catheter among 14
days post operative

2 Labuang Baji Hospital  Critical emergency obstetrics Educate the husband and family  Recommend medical provider
 Wahidin Sudirohusodo Wahidin Sudirohusodo
Hospital/ Dewi Novita Hospital/ Dewi Novita
Obstetrics and Gynecology Social Division / Yuliati
February 21st – February
April 25th28
2018
th 21st – February 25th 2018
02nd 2021
– May February

Mrs. P/35 years No Date of Date of Patient ID situation No (AGDO)Date of

Detail of Patient Date of Patient IDabout:
Treatment Detail of Patient Recommendation and stake Treatment holderRecommendation to record and
admission Discharge (Age/ LMP/ RM)
G1P0A0 admission Discharge
 A miss case
(Age/ LMP/ RM)
 The condition and cause of report pregnant women in their
1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s in c e 1 y e a r a g o . - T o t a l A b d o m in a l O b s e r v a t io n o f
Referred by St Khadijah
1. 21/ 1
02/ Hospital
2018 - withMrs. K/ 65 Timely
A b d o m i n a l Ereferral
n la r g e m e n t s i n (RTW)
c e 1 y e a r a g o from
. yo/ P1A0/
-maternal
T o t a l A b since
Menopause death
d o m in12a l years ago. O b s e r v a t i o n o f area,
H y s t e r e c t also
om y perform g e n e rhigh
a l c o n d it iorisk
n, and
yo/ P1A0/ Menopause since 12 years ago. H y s te re cto m y g e n e r a l c o n d it io n ,

MR: 830383 - B ila t e r a l v it a l s i g n
G1P0A0 37 weeks 3 days of Gestational MR: 830383 Khadijah Hospital Psychological
- B il a t e r a l support
v i t a l s i g n to the very high risk
S a l p in g o o o p h o r e c t o m y pregnancy
Age + Eclampsia Gravidarum+ Fetal  Very high risk pregnancy:
USG uterine mass : 16,54 x 8,78 cm
USGSuterine
a l p in g omass
husband and familyo o p h: o16,54
r e c t oxm8,78
y cm
W ound
screening W ound
H y g ie n e a n d
Distress - Elderly primigravida regarding the grief H y g ie nafter
c o n tro l
e and c o n t ro l

- Obesity in pregnancy patient’s and baby’s patient  Recommend andHf o i lsperform

t o p a t h o lo g y
Loss of consciousness (+) H i s t o p a t h o lo g y lo w u p
(weight gain 20 kilograms demise. Family understand f o ll o w u p counselling (teamwork with
History of convulsion (+) 3 times, once M o b il iz a t i o n
among pregnancy) and accept the condition. government, hospital, and
at home and twice St. Khadijah 1 M o b ili z a t i o n
- Seizures 3 times in health care provider) to
Hospital
pregnancy community about high risk and
History of headache (+) epigastric pain
 Frequent ANC at PHC 4 times, very high risk pregnancy
(+) blurry vision (+)
Once in Obstetrician
 Low educational level
History with stabilization of patient,
 Low socio-economic status
MgSO4 treatment, and intubation
support in Khadijah Hospital before
referred to Labuang Baji Hospital

ICU, Monday (26/4/21) Labuang Baji

Hospital
22.30

GCS : E1M1Vx (intubated)

BP: 216/132 mmHg

HR: 165 bpm
RR: 25 bpm
SpO2: 68 %
Ronkhi +/+ (diffuse)
 Wahidin Sudirohusodo Wahidin Sudirohusodo
Hospital/ Dewi Novita Hospital/ Dewi Novita
Obstetrics and Gynecology Social Division / Yuliati
February 21st – February
April 25th28
2018
th 21st – February 25th 2018
02nd 2021
– May February

HIS: (-) No Date of Date of Patient ID No Date of Date of

Detail of Patient Patient ID
Treatment Detail of Patient
Recommendation
Treatment Recommendation
admission Discharge (Age/ LMP/ RM)
admission Discharge (Age/ LMP/ RM)
FHR: 125 bpm, irregular
1. 21/ 02/ 2018 - Mrs. K/ 65
1. 21/ 02/ 2018 -
A b d o m i n a l E n la r g e m e n t s i n c e 1 y e a r a g o .
Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s in c e 1 y e a r a g o .
- T o t a l A b since
d o m in12a l years ago. O b s e r v a t i o n o f
- T o t a l A b d o m in a l O b s e r v a t io n o f
yo/ P1A0/ Menopause H y s t e re c to m y g e n e r a l c o n d it io n ,
yo/ P1A0/ Menopause since 12 years ago. H y s te re cto m y g e n e r a l c o n d it io n , - B ila t e r a l v it a l s i g n
MR: 830383
Laboratory results from St. Khadijah 1 MR: 830383 - B il a t e r a l v it a l s ig n S a l p in g o o o p h o r e c t o m y
USGSuterine
a l p in g omasso o p h: o16,54
r e c t oxm8,78
y cm W ound
Hospital (28/4/21) USG uterine mass : 16,54 x 8,78 cm W ound H y g ie n e a n d
H y g ie n e a n d c o n t ro l
HGB: 12.1 gr/dL c o n tro l
H i s t o p a t h o lo g y
WBC : 15.100/uL fo llo w u p
H i s t o p a t h o lo g y
PLT : 281.000 /uL f o ll o w u p
M o b il iz a t i o n
Neutrophile: 84.8 % M o b ili z a t i o n
Lymphocite: 6.9 %

Pre Operative Diagnosis:

G1P0A0 37weeks of Gestational Age +
Loss of cons consciousness ec Eclampsia
Gravidarum + Acute Pulmonary Edema
+ Emergency Hypertension + Fetal
Distress

01.30 (ICU, Tuesday (27/4/21)

S:
GCS: E1M1Vx(intubated)
BP: 65/42 mmHg
HR: 55 bpm
SpO2: Not measurable in monitor
Ronkhi: +/+ (diffuse)

HIS: (-)
FHR (-)
A: G1P0A0 37 weeks of Gestational Age
 Wahidin Sudirohusodo Wahidin Sudirohusodo
Hospital/ Dewi Novita Hospital/ Dewi Novita
Obstetrics and Gynecology Social Division / Yuliati
February 21st – February
April 25th28
2018
th 21st – February 25th 2018
02nd 2021
– May February

+ Loss of cons consciousness

No Date of ecDate of Patient ID No Date of Date of
Detail of Patient Patient ID
Treatment Detail of Patient
Recommendation
Treatment Recommendation
admission Discharge (Age/ LMP/ RM)
admission
Eclampsia Gravidarum + AcuteDischarge (Age/ LMP/ RM)
1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s in c e 1 y e a r a g o . - T o t a l A b d o m in a l O b s e r v a t io n o f
Pulmonary Edema + Emergency
1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s i n c e 1 y e a r a g o . yo/ P1A0/
- T o t a l A b since
Menopause d o m in12a l years ago. O b s e r v a t i o n o f H y s t e re c to m y g e n e r a l c o n d it io n ,
yo/ P1A0/ Menopause since 12 years ago. H y s te re cto m y g e n e r a l c o n d it io n , - B ila t e r a l v it a l s i g n
MR: 830383
Hypertension + Fetal Distress + IUFD MR: 830383 - B il a t e r a l v it a l s ig n S a l p in g o o o p h o r e c t o m y
USGSuterine
a l p in g omasso o p h: o16,54
r e c t oxm8,78
y cm W ound
USG uterine mass : 16,54 x 8,78 cm W ound H y g ie n e a n d
01.45 H y g ie n e a n d c o n t ro l
S: (-) c o n tro l
H i s t o p a t h o lo g y
GCS: E1M1Vx(intubated) H i s t o p a t h o lo g y fo llo w u p
f o ll o w u p
BP: Not measurable M o b il iz a t i o n

HR: Not palpated M o b ili z a t i o n

Light Reflex: dilated pupil

Cornea Reflex: negative

Post Operative Diagnosis:

G1P0A0 37 weeks of Gestational Age
+ Cardiac Arrest + Respiratory Failure
ec Diffuse Acute Pulmonary Edema

Treatment :
 ICU admission for ventilator
support by anesthesiologist
 MgSO4 40% 6 gr in Ringer Lactate
500 cc 28 dpm
 Planning for emergency lower
segment transverse caesarean
section
 Cardiopulmonary resuscitation

3 Labuang Baji Hospital  Potential of Emergency  Collaborates with the  Recommend to Women’s
Ms. Q /11 years Obstetrics (APGO) Women’s Empowerment Empowerment and Child
G1P0A0  Unwanted pregnancy and Child Protection Protection Departments

No Date of
admission
Pre Treatment Diagnosis :
G1P0A0 34 - 36 weeks of02/Gestational
1. 21/ 2018
Age in active phase 1st of labor
Post Treatment Diagnosis :
Preterm delivery + 2nd degree perineal
laceration
Outcome :
Male, BW : 2600 gr, BL : 48 cm, AS : 7/9
NBS : 30 (36 weeks)
Treatment :
- Spontaneous vertex delivery
- Repair of perineal laceration
- Contraceptive oral combination 1
tablet/12 hours/oral
Wahidin Sudirohusodo Wahidin Sudirohusodo
Hospital/ Dewi Novita Hospital/ Dewi Novita
Obstetrics and Gynecology Social Division / Yuliati
February 21st – February
April 25th28
2018
th 21st – February 25th 2018
02nd 2021
– May February
Date of 
Patient ID Pregnancy No Date due
admission
of to incest
Detail of Patient Date of with Patient ID Departments Treatment Detail for mental
of Patient
Recommendation
collaborate
Treatment with Social
Recommendation
Discharge (Age/ LMP/ RM)
Discharge (Age/ LMP/ RM)
her stepfather and pregnancy supports and psychological Department for continue
1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s in c e 1 y e a r a g o . - T o t a l A b d o m in a l O b s e r v a t io n o f
- Mrs. K/ 65 result
A b d o m i n a lfrom
E n la r g e m minor
e n t s i n c e 1 sexual
y e a r a g o . abuse
yo/ P1A0/
-assistance
T o t a l A b since
Menopause services
d o m in12a l years ago. O b s e r v a t i o n o f H y mental
s t e r e c t o m y supports g e n e rand
a l c o n d it io n ,
yo/ P1A0/ Menopause since 12 years ago. H y s te re cto m y g e n e r a l c o n d it io n , - B ila t e r a l v it a l s i g n
MR: 830383 (rape victim) MR: 830383
- B il a t e r a l v it a l s ig n psychological
S a l p in g o o o p h o r e c t o m y
assistance
 Frequent ANC at Labuang Baji 
USG uterine mass : 16,54 x 8,78 cm
USGSuterine
a l p in g omasso o p h: o16,54
Provide legal justice r e c t oxm8,78
y cm
W ound
services W ound
H y g ie n e a n d
Hospital 2 times assistance from Women’s H y g ie n e a n d  Recommend too n Social c t ro l
c o n tro l
(Accompanied by Women’s Empowerment and Child department toH ifollow s t o p a t h o lo g y up
H i s t o p a t h o lo g y fo llo w u p
Empowerment and Child Protection Departments
f o ll o w u p
about progress of patient’s
M o b il iz a t i o n
Protection Provincial collaborate with Social school and social protection
M o b ili z a t i o n
Departments) Department (report to the  Recommend to stake holder
 High risk pregnancy : young police about the sexual (government) to improve
primigravida abuse) counseling in community
 Low educational level  Family psychosocial support about prevent sexual abuse
(dropout from Primary as well as empathic and
School) supportive attitude to help
 Low socio-economic status the recovery process for
patient
 Suggest and support the
patient and family about
how importance to
continue patient’s school
and strengthen faith in god
 Support the patient’s
decision to permit her child
to be adopted by another
family
 Wahidin Sudirohusodo Wahidin Sudirohusodo
Hospital/ Dewi Novita Hospital/ Dewi Novita
Obstetrics and Gynecology Social Division / Yuliati
February 21st – February
April 25th28
2018
th 21st – February 25th 2018
02nd 2021
– May February

RECAPITULATION OF NoREFERRED
Date of Date CASE
of Patient ID No Date of Detail of Patient Date of Patient ID
Treatment Detail of Patient
Recommendation
Treatment Recommendation
admission Discharge (Age/ LMP/ RM)
CASE admission Discharge TOTAL CASE
(Age/ LMP/ RM) HOSPITAL
1. 21/ 02/ 2018 - Mrs. K/ 65 A b d o m i n a l E n la r g e m e n t s in c e 1 y e a r a g o . - T o t a l A b d o m in a l O b s e r v a t io n o f
Referred 1. 21/ 02/ 2018 - Mrs. K/ 65 2 A b d o m i n a l E n la r g e m e n t s i n c e 1 y e a r a g o . yo/ P1A0/
d o m in12a l years ago.Labuang
- T o t a l A b since
Menopause O b s e r v a t i o n oBaji
f Hospital,
H y s t e r e Maternal
cto m y Fetal
g e n e r a Division
l c o n d it io n ,
H y s te re cto m y g e n e r a l c o n d it io n ,
Non-referred yo/ P1A0/
MR: 830383
1 Menopause since 12 years ago. MR: 830383
- B il a t e r a l Labuang
v it a l s ig n Baji Hospital, Maternal
- B ila t e r a l
S a l p in g o o o p h o r e c t o m y
Fetal Division
v it a l s i g n

USGSuterine
a l p in g omass
o o p h: o16,54
r e c t oxm8,78
y cm W ound
USG uterine mass : 16,54 x 8,78 cm W ound H y g ie n e a n d
RECAPITULATION OF COVID-19 CASE H y g ie n e a n d c o n t ro l

CASE TOTAL CASE HOSPITAL

c o n tro l
H i s t o p a t h o lo g y
fo llo w u p
Covid-19 - H i s t o p a t h o lo g y
f o ll o w u p
Non-Covid-19 3 Maternal Fetal Division, Labuang Baji Hospital
M o b il iz a t i o n
M o b ili z a t i o n

RECAPITULATION OF NEAR MISS AND MISS

CASE HOSPITAL
TOTAL CASE
Near miss 1 Labuang Baji Hospital
Miss 1 Labuang Baji Hospital

Makassar, May 2nd 2021

Acknowledge By
Supervisor

Dr. dr. Hj. A. Mardiah Tahir, Sp.OG (K)