CASE NO

Identity
Patient Husband
Name : Mrs. V Name : Mr. S
Age : 26 years old Age : 30 years old
MR No : 01 10 58 40 Education : S1
Education : Senior high school Occupation : Civil servant
Occupation : enterpreneur Address : Padang
Address : Padang
Admission Date : 24/05/2021
Mrs. V, 26 years old, MR 01 10 58 40

Admission Origin Preparation Diagnosis Plan

date
Date : Origin : Pulmonologist Consultation • G2P1A0L1 39-40 weeks of term General
24/05/2021 Rasidin General A/ Confirmed Covid-19 parturient latent phase of first condition
Hospital G2P1A0L1 39-40 weeks of term parturient stage + moderate anemia improvement
Time : latent phase of first stage + moderate anemia • Fetal alive singletone  Elcective CS
10.40 Diagnose : P/ intrauterine head presentation
G2P1A0L1 39-40 weeks Azitromisin 1x500mg,, Zinc 2x20mg, Vit C
DPJP : of term parturient 2x250mg, Vit D 1x1000 IU
RZ latent phase of first Lab test + inflammation marker
stage + fetal tachycardia Rontgen thorax
+ COVID-19 confirmed
positive Anesthesiology Consult
Agree for operation
ASA 2
Perinatologist Consult
Agree to assistance fetal resuscitation
HOM consult
Advice :
Operative can held if HB ≥ 10 g/dl
Canceled Anticoagulan
 Anamnese Examination ADDITIONAL EXAMINATION

Anamnese GA Cons BP HR RR T SpO2 USG:

The patient was come from Rasidin Genral Hospital with G2P1A0L1 39-40 weeks of term Mdt CM 120/70 100 20 36,8 99% • 39-40 weeks of term pregnancy
parturient latent phase of first stage + fetal tachycardia + COVID-19 confirmed positive according to fetal biometry
• Previously, the patient came to PHC for pregnancy check up and COVID 19 screening for Body height : 155 cm
Body weight : 46 kg ( before 56 kg) • Fetal alive, singleton, intra uterine,
labor preparation, 3 days later PCR result was positive and than patien refered to Rasidin BMI : 19.14kg/m2 (normalweight) head presentation.
General Hospital, pastien complaint was felt Uterine contraction, Because of lack of
facilities, patient was referred to M. Djamil General Hospital with infused inserted Eye : Conjunctival was not anemic, sclera wasn’t icteric Laboratory :
• Pelvic pain from waist to the groin (+) since 3 hour ago Thorax : cor and pulmo is normal Hb : : 9.5
• Bloody show from the vagina since 3 hour ago Abdomen Leuko : 77430
• Fluid leakage from the vagina (-) Inspection : HT : 29
• No massive vaginal bleeding Abdomen seems enlarge accordance to term pregnancy. Trombo : 281.000
Hyperpigmentation (+), striae gravidarum (+), cicatrix (+)
• Amenorrhea since 9 months ago pfanensteil Dc : 0/0/85/9/6
• Fetal movement was felt since 5 months ago Palpation : PT : 10.1
• First date of last menstruation : 16/08/2020 Leopold APTT : 265
• Estimation date of delivery : 23/05/2021 L1: Uterine fundal palpated 3 fingers below proc D dimer : 1139
• History of nausea (+), vomit (-), bleeding (-) during early pregnancy xyphoideus. A big soft nodular mass was palpated Total protein : 6.4
• Antenatal care by midwife 4 times at 2,3,8,9 month pregnancy, and obstetrician 2 times L2: Large and resistance structure was palpated on the right Albumin : 3.3
at 6,7 month pregnancy side. Numerous small structure were palpated on the left Globulin : 3.1
• Menstrual history : menarche at 12 years old, regular cycle, 4-6 days each cycle with the side. Bil total : 0.3
amount of 2-3 times pad change/day without any menstrual pain L3: A round hard mass was palpated, fixated Bil direk : 0,1
L4: convergen
• History of cough (-), fever (-), sorethroat (-), shortness of breathing(-) Bil indirek : 0,2
• History of contact with positive Covid-19 patient (-) UFH : 33 cm ; UC : 1-2x/20”/mild SGOT/SGPT : 12/6
• History of travelling out from the town (-) EFW: 3100 gr Kalsium : 8.3
• Marriage history : Once on 2017 Auscultation : FHR : 150-156 x/I Ureum :9
History of Previous Illness Creatinin : 0.5
• There is no history of hypertension, diabetes, heart, pulmonary, liver, and kidney disease Vagina: Ins : V/U normal, vaginal bleeding (+), not active GDS : 106
History of Family Disease VT : dilatation (-), portio thick soft, effacement 10%, Na/K/Cl : 138/3.6/107
• There is no history of hereditary, infectious, and psychiatric diseases posterior, amnion sac and the lowest part hard to identified HBsAg : Non reactive
History of Pregnancy/Abortion/Delivery : 2/0/1 Anti HIV : Non reactive
1. 2018/3000gr/term/vaginal delivery/doctor/alive Ekstremity: warm, oedema dorsum pedis and pretibial (-) Procalcitonin : <0.05
2. Present PCR swab : positive
 Diagnose Outcome

Pre Op Diagnosis Plan

• G2P1A0L1 39-40 weeks of term parturient latent phase of • Elective CS, May 25th 2021
first stage + moderate anemia • PRC Crossmatch 3 unit  pre operation PRC
• Fetal alive singletone intrauterine head presentation transfusion 1 unit
• Anesthesia, perinatology, pulmonology consult
Addmision Letter Referral Letter
Ultrasound
 Ultrasound Interpretation
Fetal alive singleton intra uterine, head presentation
Fetal movement and activity was good
BPD : 9,43 cm
AC : 35,28 cm
HC : 33,88 cm
FL : 7,78 cm
EFW : 3711gr
FHR : 153 bpm
AFI: 9,8 cm
Placenta Implantated on fundus expanded to anterior corpus, maturation grade II-III
Impression :
• 39-40 weeks of aterm pregnancy according to biometry
• Fetal alive singleton intra uterine, head presentation
Laboratory Result
Swab PCR
Swab PCR: Positive
Pulmonologist Consultation
A/
• Confirmed Covid-19
• G2P1A0L1 39-40 weeks of term parturient
latent phase of first stage
P/
Azitromisin 1x500mg, Zinc 2x20mg, Vit C
2x250mg, Vit D 1x1000 IU
Lab test + inflammation marker
Rontgen thorax
Swab PCR
PERINATOLOGY CONSULT
• Agree to assistance fetal resuscitation
HOM Consult
A/
G2P1A0L1 39-40 weeks of term parturient latent phase of
first stage
Confirmed Covid-19

P/
Cardiovascular risk : low risk
Respiratoric risk : moderate
Metabolic risk : mild
Haemostasis risk : stable
Advice :
Operative can held if HB ≥ 10 g/dl
Canceled Anticoagulan
 May 24 th 2021 20.00 May 25 th 2021 08.00

S/ • Vaginal bleeding (-) • Vaginal bleeding (-)

• Fetal movement (+) • Fetal movement (+)

O/ GA          Cons      BP          HR        RR        T​ GA          Cons      BP          HR        RR        T​

Mdrt     CMC     110/70     80        20       36​,4 Mdrt     CMC     120/70     80        20       36​,4

Abd : contraction (-) FHR : 152-158x/i Abd : contraction (-) FHR : 148-154x/i
Genitalia : V/U normal, VB (-) Genitalia : V/U normal, VB (-)

A/ • G2P1A0L1 39-40 weeks of term parturient latent phase of first stage + • G2P1A0L1 39-40 weeks of term parturient latent phase of first stage +
moderate anemia moderate anemia
• Fetal alive singletone intrauterine head presentation • Fetal alive singletone intrauterine head presentation

P/ • Control GA, VS, VB, UC, FHR, Labor • Control GA, VS, VB, UC, FHR, Labor
IVFD RL 20 tpm IVFD RL 20 tpm

Plan : Plan :
• Elective CS, April 26th 2021 • Crossmatch PRC 3 unit  PRC transfusion 1 unit  done
• Crossmatch PRC 3 unit  PRC transfusion 1 unit • Consul to Anaesthesiology, Perinatology, pulmonology
• Consul to Anaesthesiology, Perinatology, Pulmonology • Prepare to redzone OR
 DATE DIAGNOSIS OUTCOME

25/05/2021 Preoperative Diagnosis : At 11.10 LSCS was performed

11.00 • G2P1A0L1 39-40 weeks of term parturient latent phase Female baby was born by head
of first stage + moderate anemia BW : 3250 gram
• Fetal alive singletone intrauterine head presentation BL : 50 cm
A/S : 8/9
Placenta was delivered with light traction, complete, 1 piece, umbilical cord’s
DPJP : Plan length 50 cm, placenta size 17 x 14 x 3 cm, weight 500 gram
RZ Elective CS Bleeding during operation approximately 250 cc

Instruction Postoperative Diagnosis

Control VS, UC, FHR, vaginal bleeding P2A0L2 post LSCS oi + Covid-19 confirmed positive + moderate
Informed consent anemia
Consult to pulmonologist, perinatologist, anesthesia Plan
Crossmatch 3 unit PCR  post PRC transfusion 1 Post operative treatment
unit
Report to OR team Instructions
•Control GA, VS, contraction, vaginal bleeding
•IVFD RL + oxytocin + metergin 1:1
Process •Inj. Ceftriaxone 2 x1 gram
G2P1A0L1 39-40 weeks of term parturient latent phase of •Pronalges supp (if needed)
first stage + moderate anemia  General condition •Azitromisin 1x500mg,
•Zinc 2x20mg,
improvement LSCS •Vit C 2x250mg,
•Vit D 1x1000 IU
•Ro Thorax PA
•Care in redzone HCU
•Check labor 6 hours post op
 Operation Report
• Patient on supine position under spinal anaesthesia
• Antiseptic and septic procedure was performed
• Used sterille duk
• Pfanensteil incision in abdominal wall was performed layer by layer
until peritoneal.
• A gravid uterus was appeared
• Classic insicion was performed on uterin corpus
• Male baby was born by foot extraction, BW : 3250 gram, BL : 50
cm, A/S : 8/9
• Placenta was delivered with light traction, complete, 1 piece,
umbilical cord’s length 50 cm, placenta size 17 x 14 x 3 cm, weight
500 gram
• Double layer closure then performed
• Abdomen was closed layer by layer
• Skin closed by subcuticular closure
• Bleeding during operation approximately 250 cc
Baby
Kurva Lubchenco
BALLARD SCORE : 40  40

√
 

√
 

√
 

√
 

√
 

√
 

√
 

√ √
   

√
 

√
 

√
 
 26-05-2021 17.00 WIB
S Post operative pain (+) Fever (-) Vaginal P •Control GA, VS, contraction, vaginal bleeding
bleeding (-) •Post operative treatment
•IVFD RL drip oxytocin + metergin (1:1) 28 tpm
O Gen Cons BP HR RR T •Inj. Ceftriaxone 2 x1 gram
Mdt CMC 110/70 84 20 36.4 C •Pronalges supp (if needed)
•Azitromisin 1x500mg,
Abdominal : Fundal uterine palpated 2 fingers •Zinc 2x20mg,
below umbilical. Contraction (+) •Vit C 2x250mg,
Genitalia : V/U normal. Vaginal bleeding (-) •Vit D 1x1000 IU
•Check labor 6 hours post op

A P2A0L2 post LSCS oi + Covid-19 confirmed

positive + moderate anemia
Mother and baby was in care
Post op laboratory
Thankyou