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PANIK VK Hep B
PANIK VK Hep B
Supervisor :
dr. Edwin Martin Asroel, M.Ked(OG), SpOG
Residents :
1. dr. Sofyan Andri
2. dr. Jonathan T L Tobing
3. dr. Willy Kurnia Almon
O Presens state
Sens : CM
BP : 110/70 mmHg
P : 82 x/min
RR : 20 x/min
T : 36,70C
Obstetrical state
Abdomen : Aymmetrically Enlarged
Fundal Height : 3 fingers below processus xyphoideus
Tension Part : Right Back
Lowest Part : Head
Fetal Movement : (+)
Uterine contraction : (-)
FHR : 128 x/ minutes, Regular
VT : Cx undilated, Blood slime (-), Amniotic fluid (-)
A Hepatitis B + PG + IUP (37-38) wga + Head Presentation + Alive Fetus
P - Oxygen 4L/i via nasal canule
- IVFD Ringer Lactate 20 dpm
Plan Reposted to Fetomaternal Supervisor dr. Edwin Martin Asroel, M.Ked(OG), SpOG
Monitoring vital sign, fetal well being with CTG
Laboratory check HbeAg
Follow Up
Time BP Pulse RR Temp HIS FHR Exp
O Presens state
Sens : CM
BP : 100/70 mmHg
P : 87 x/min
RR : 20 x/min
T : 36,60C
Obstetrical state
Abdomen : Aymmetrically Enlarged
Fundal Height : 3 fingers below xyphoid process
Tension Part : Right Back
Lowest Part : Head
Fetal Movement : (+)
Uterine contraction : (-)
FHR : 108 x/ minutes, Regular
A Fetal Bradicardia + Hep B + PG + IUP (37-38) wga + Head Presentation + Alive fetus
• The patient was laid on the operating table, with IV line and urinary
catheter inserted.
• Antiseptic and aseptic procedures were performed using povidone iodine
on the abdomen, and then draped leaving the surgical field exposed.
• Under GA-ETT anesthesia, Pfannenstiel incision was made in the
abdomen, through to the underlying layer of fascia. The fascia was incised
in the midline and extended laterally using scissor. Superior aspect of the
fascia was elevated using Kocher, and the underlying rectus muscles were
separated.
• Peritoneum was identified. The peritoneum was elevated using clamp and
entered using Metzenbaum scissor with care for the underlying organ, and
extended superiorly and anteriorly with careful visualization of the bladder.
• Seen ascites, volume ± 500 cc, yellow-ish
• The lower uterine segment was identified. A low cervical incision in the
uterus performed until subendometrium layer. Endometrium penetrated
and widened bluntly.
• By luxating head, born baby girl with BW 3200 gr, BL 48 cm, AS
0/0, anus (+). Evaluation of amniotic fluid unclear
• Seen umbilical cord loop on the neck, three times. Amniotic fluid
was green
• The umbilical cord was clamped in two places and cut in between
• The placenta was born with fundal pressure and traction on the
umbilical cord. Uterine cavity was cleaned with gauze.
• uterus was sutured by continuous interlocking stitches
• Identification of both tubal and ovarium, seen in normal condition.
• Abdominal cavity was cleaned from blood and Stoll cell.
• Peritoneum sutured continuously, muscle approximation
using simple suture and fascial closure using continous
suture.
• Subcutaneous layer was sutured with simple suture and cutis
was sutured with subcuticuler suture
• Surgical wound was closed with sofratulle, sterile gauze and
hypafix
• Mother was stable the after the operation
• Estimated blood loss : ± 500 cc
Therapy
• IVFD RL + Oxytocine 10 IU 20 dpm
• Inj. Ceftriaxone 1 gr/12 hrs
• Inj. Ketorolac 30 mg/8 hrs
• Inj Ranitidine 50 mg/12 hour
• Misoprostol per rectal 400 mcg
• Inj. Tranexamic Acid 500 mg/8 hours
• Inj Fitomenadion 4 mg/ 12 hours
Plan:
1. Observe VS, contraction, bleeding, and UOP
2. FFP Transfusion post operative 3packs @250 cc.
Follow Up
BP Pulse RR Temp Contraction Exp
Time
13.00 110/70 89 16 36.7 Adequate Vaginal Bleeding (-)
FFP wasnt ready yet
S -
O Presens state
Sens : Under narcose
BP : 80/50 mmHg
P : 109 x/min
RR : 16 x/min via ventilator
T : 36,60C
Obstetrical state
Abdomen : Distension, peristalic low
Fundal Height : 2 fingers above navel level, inadequate contraction
Vaginal Bleeding : (+), curved vaginal canal Vaginal bleeding ± 2000cc , actively
Micturition : (+) 100 cc, yellow-ish
A PPH ec Uterine atony + Hipocoagulation state + Post C-Section d/t Fetal Bradicardia + PD0
Plan:
1. Observe VS, contraction, bleeding, and UOP
2. PRC transfusion 4 packs @175 cc & FFP 4 packs @250 cc
Wednesday, September 5th 2018 at 06.00 pm
S -
O Presens state
Sens : Under narcose
BP : 75/45 mmHg
P : 109 x/min
RR : 16 x/min via ventilator
T : 36,60C
Obstetrical state
Abdomen : laxed, peristalic low
Fundal Height : 2 fingers below navel level, adequate contraction
Vaginal Bleeding : (+) didnt active
Micturition : (+) 50 cc, yellow-ish
A Post Laparotomy – B lynch suture surabaya modification d/t PPH ec Uterine Atony + Hypocoagulation
state + Hep B + Post C-Section d/t Fetal Bradycardia
P - IVFD Ringer Lactate rapid drips
- Inj Ceftriaxone 1 gr/ 12 h
- Inj Ketorolac 30 mg/ 8 h
- Inj Tranexamic Acid 500 mg/ 8 h
- PRC transfusion 4 packs @175 cc & FFP transfusion 4 packs @250 cc
Plan Laboratory check CBC, BloodGLucose adR, Blood Gas Analyse, RFT & LFT
Evaluation of vital sign, vaginal bleeding, contraction & UOP
Wednesday, September 5th 2018 at 08.00 pm
S -
O Presens state
Sens : Under narcose
BP : 115/65 mmHg
P : 89 x/min
RR : 16 x/min via ventilator
T : 36,60C
Obstetrical state
Abdomen : laxed, peristalic low
Fundal Height : 2 fingers below navel level, adequate contraction
Vaginal Bleeding : (+) didnt active
Micturition : (+) 100 cc, yellow-ish
A Post Laparotomy – B lynch suture surabaya modification d/t PPH ec Uterine Atony + Hypocoagulation
state + Hep B + Post C-Section d/t Fetal Bradycardia
P - IVFD Ringer Lactate rapid drips
- Inj Ceftriaxone 1 gr/ 12 h
- Inj Ketorolac 30 mg/ 8 h
- Inj Tranexamic Acid 500 mg/ 8 h
- PRC transfusion 4 packs @175 cc & FFP transfusion 4 packs @250 cc done
Plan Laboratory check CBC, BloodGLucose adR, Blood Gas Analyse, RFT & LFT
Evaluation of vital sign, vaginal bleeding, contraction & UOP