KASUS NO

IDENTITY
Identity Husband Identity

Name : Mrs. T Name : Mr. F

MR : 01147379 Education : Senior High School
Age : 18 Years old Age : 21 Years old
Address : Panpangan Address : Panpangan
Ocupation : Housewife Ocupation : Enterpreneur
Education : Elementary School
Admission date : August 30th, 2022
Primary Survey
GC Cognition BP HR RR SpO2 T Urine

Severe Somnolen 180/110 108 24 98 % O2 10 L/l 36.8 Urine 300 cc/8
GCS 9 NRM hours, dark
E2M4V3 yellow

Airway : Patent
Breathing : Spontan, RR 24x/min , SpO2: 98% with O2 10 L/I NRM
Circulation : BP: 180/110 mmHg, HR 98x/min  IVFD RL + maintenance dose of MgSO4 regimen 1 gr/hour
Thorax : Cor : S1 S2 normal, pulmo : Lung sound vesicular, Rh -/-, Wh -/-
Abdominal : HIS (-), FHR 134- 146x/min
Genitalia : V/U within normal limits, Vaginal bleeding (-)
Extremity : Physiologist Reflex +/+, pathologist reflex -/-, patellar reflex +/+

A/ Eclampsia antepartum with maintenance dose of MgSO4 regimen on G1P0A0L0 31-32 weeks of preterm pregnancy

Th/ Control GA, VS, FHR

O2 10 L NRM
IVFD RL + maintenance dose of MgSO4 regimen 1 gr/hour
Nicardipine drip 5cc/hour
Inj Dexamethasone 2 amp

R/ Internist consultation
Cardiologist consultation
Neurologist consultation
Pediatrics consultation
 CLINICAL DATA
Anamnese 30-08-2022 02.40 P.M Previous illness history :
• Patient came referred from PONEK RST Padang with diagnosed Eclampsia • There is no history of hypertension, DM, heart, renal,
antepartum with maintenance dose of MgSO4 regimen on G1P0A0L0 31- lung disease
32 weeks of preterm pregnancy . Previously the patient complained of
seizure 1x at home at 06.00 for 2-3 minutes, the patient conscious before and Family illness history :
• There were no history of congenital, psychiatric and
after seizure. Then patient came to midwife, from the midwife the patient was contagious disease
advised to go directly to the hospital, but the patient went home, after 2
hours her family took the patient to PONEK RST Padang and then History of marriage : 1x, 2022
seizure 1x at PONEK RST Padang the patient was in somnolen state History of pregnancy/abortion/delivery : 1/0/0
after the seizure and then given maintenance dose of MgSO4 regimen. Due 1. Current pregnancy
to limited facilities, the patient was referred to Dr. M. Djamil Hospital with NRM,
infusion and catheter attached.
• Headache (+), blurry vision (-), epigastric pain (-)
• Pelvic pain referred to the groin (-)
• Fluid leakage from the vagina (-)​
• Bloody show from the vagina (-)​
• Massive bleeding from vagina (-)​
• LMP : forgot      EDD : hard to determine
• Menstrual history : menarche at 11 years old, regular cycle 28 days, 7-9 days
each cycle with the amount of  3-4 times pad change/day, menstrual pain​(+)
• ANC : Control to midwife 3x at 5th,6th,7th month of pregnancy and never came to
obstritician. There is not found history of hypertension during pregnancy.
• History early pregnancy : nausea (-), vomit (-), fluor albus (-)​
• Cough (-) flu (-) fever (-) traveling (-) and history of contact with confirmed
COVID-19 about 2 weeks ago was denied​
• Travel history out of town (-), contact history with COVID-19 patient (-)​
 PHYSICAL EXAMINATION
Physical Examination Genitalia : V/U normal, bleeding (-)
GA Cons BP HR RR T VT : Not performed
Severe Somnolen 180/110 108 24 36.8
Body Height : 152 cm Extremity :
Body Weight before pregnancy : 45 kg Physiologist Reflex +/+, pathologist
Body weight now : 49 kg
BMI : 19.5 (normoweight)
Eyes : Conjunctiva wasn’t anemic, Sclera Icteric (-/-)
Abdomen :
Ins : Enlarge equal to preterm pregnancy. Median line hyperpigmentation (+), striae gravidarum (+), cicatrix (-)
Palpate :
L1 : Uterine fundal palpated between proc. xyphoideus and umbilicus. A big nodular, round, soft mass was
palpable
L2 : Resistance was palpated on left side, fetal small parts was palpated on the right side
L3 : Hard, round mass was palpable, unfixated
L4 : Not performed

UFH : 27cm
UC : (-) FHR : 134- 146x/min
 SUPPORTIVE EXAMINATION
PONEK Ultrasound: Aug 30th 2022  02.30 p.m  Emergency CS
• Gravid 31-32 weeks of preterm pregnancy according to biometry A female baby was born at ​02.35 p.m
• Fetal, alive singleton, intrauterine, head presentation BW : 2100 gram​
BL : 41 cm
Laboratory, Aug 30th 2022 A/S : ​7/8
Hb/Ht/Leu/Tro : 10.5/34/21.790/308.000 Total protein/GDS: 5.5/77 Placenta was born complete with mild traction, size 13x10x4 cm,
B/E/N/L/M : 0/0/92/6/2 SGOT/SGPT : 29/12 weight 300 grams
PT/APTT: 8.9/25.2 Alb/Glo : 2.7/2.8 Bleeding during operation 250 cc​
Bil tot/direct/indirect : 0.4/0.3/0.1 Ddimer : 2828
Protein urin : +2 Diagnose Post Op :
• P1A0H1 post LSCS oi Eclampsia antepartum with maintenance dose
Diagnose Pre Op : of MgSO4 regimen
• Eclampsia antepartum with maintenance dose of MgSO4 regimen on • Mother and baby in care​
G1P0A0L0 31-32 weeks of preterm pregnancy
• Fetal, alive singleton, intrauterine, head presentation Process :
• Eclampsia antepartum with maintenance dose of MgSO4
Plan : regimen on G1P0A0L0 31-32 weeks of preterm
• Stabilization → Emergency CS pregnancyStabilization LSCS

Instruction : Instruction :
• Control GA, VS, FHR • Control GA, VS, Vaginal bleeding
• O2 10 L NRM • IVFD RL + 20 IU Oxytocin  20 dpm​​
• IVFD RL 20 dpm + maintenance dose of MgSO4 regimen 1 gr/hour • IVFD RL + MgSO4 maintenance dose 1gr/ hours ​
• Nicardipine drip 5cc/hour • Inj. Ceftriaxone 2 x 1 gram IV​
• Inj Dexamethasone 2amp • Nicardipine drip 5cc/hour if BP > 150mmhg
• Pronalges supp II if needed​
• Laboratory check 6 hours post CS​
• Care in ICU
Admission Letter Referal Letter
Laboratorium
PONEK Ultrasound
USG
Fetal, alive singleton, intrauterine, head presentation
Fetal movement was good

Biometry :
• BPD : 8.19 cm
• AC : 27.24 cm
• FL : 6.16 cm
• EFW : 1820 gr
• AFI : 5.35 cm
• FHR : 112 x/min
Placenta was implanted at fundus extend to corpus posterior, maturation grade II

Impression :
Gravid 31-32 weeks of pregnancy according to biometry
Fetal, alive singleton, intrauterine, head presentation
Internist Consultation
A/
• Eclampsia antepartum with maintenance dose of
MgSO4 regimen on G1P0A0L0 31-32 weeks of
preterm pregnancy
P/
• Currently to do the operation in general
anesthesia with the risk of surgery;
Cardiovascular: Lee Revised Score 0.4% very low
risk. Pulmonary: mild-moderate risk. Metabolic:
can’t identify. Hemostasis: can’t identify.
• Check PT/APTT, Alb/Glb, Ur/Cr, Na/K/Cl, GDS,
SGOT/SGPT
• Metildopa 3x500 mg
Cardiologist Consultation
A/
• G1P0A0L0 31-32 weeks of preterm
pregnancy + eclampsia + HT emergency

P/
• Metildopa 3x500 mg
• Adalat oros 1x30 mg
• Drip nicardipine start from 5 mg/jam
(uptitrasi), target SBP < 160 mmHg and DBP
110 mmHg
• Based on Lee revised score cardiovascular
mayor perioperative risk 0.9% (mild)
Neurologist Consultation
A/
Eclampsia antepartum
P/
• Observation of seizure
Pediatrics Consultation
P/
• The baby born has a risk of respiratory
distress and hypothermia. We will
accompany the delivery and rescucitation of
baby born according the risk the baby's
needs
Operation Report
• Patient on supine position under general
anaesthesia​
• Antiseptic and septic procedure was performed​
• Pfanennstiel  incision was performed​until
peritoneal​
• Low uterine incision was performed​
• A female baby was born ​with head extraction
• BW : 2100 grams, BL : 41 cm, A/S: 7/8
• Placenta was born with mild traction,
size 13x10x4cm and weight 300 gr
• Uterine sutured 2 layer, plica sutured 1 layer​
• Abdomen was closed layer by layer​
• Skin closed by subcuticular closure​
• Bleeding during operation approximately 250 cc​
Documentation
Lubchenko Curve
Ballard Score
20→ 32 weeks
 Follow Up 2 Hours Post Op

S Post operative pain (+)​ P • Control GA, VS, Vaginal bleeding

• IVFD RL + 20 IU Oxytocin  20 dpm​​
• IVFD RL + MgSO4 maintenance dose 1gr/ hours ​
• Inj. Ceftriaxone 2 x 1 gram IV​
• Nicardipine drip 5cc/hour if BP >150mmhg
• Pronalges supp II if needed​
O GA       Cons       BP         HR          RR       T        Urine​ • Laboratory check 6 hours post CS​
Svr      DPO      145/80      88     20    36.9   250 cc/2hrs​ • Care in ICU
​
Abd : Operation wound closed by verband.  Uterine  fundal palpated  2
fingers below umbilical, Contraction (+)​
Genitalia : V/U normal. Vaginal bleeding (-)​

A • P1A0H1 post LSCS oi Eclampsia antepartum with maintenance dose

of MgSO4 regimen, Puerperium day 0
• Mother and baby in care​
 Follow Up 26/08/2022 (08.00)

S Post operative pain (+)​ P • Control GA, VS, Vaginal bleeding

• IVFD RL + 20 IU Oxytocin  20 dpm​​
• IVFD RL + MgSO4 maintenance dose 1gr/ hours ​
• Inj. Ceftriaxone 2 x 1 gram IV
• metildopa 3x500mg
O GA       Cons       BP         HR          RR       T        Urine​ • adalat oros 1x30mg if BP > 150mmhg
Mdt      CM      134/85      90     18    36.8   250 cc/2hrs​ • Pronalges supp II if needed​
​
Abd : Operation wound closed by verband.  Uterine  fundal palpated  2
fingers below umbilical, Contraction (+)​
Genitalia : V/U normal. Vaginal bleeding (-)​

A • P1A0H1 post LSCS oi Eclampsia antepartum with maintenance dose

of MgSO4 regimen, Puerperium day 1
• Mother and baby in care​
6 Hours Post Operative Laboratory
6 Hours Post Operative Laboratory
Thank You