VI.

EMERGENCY ROOM REPORT Monday, March 4th, 2013 until Wednesday, March 6th, 2013 OBSTETRICS Physiological patient Pathological patient GYNAECOLOGY

: 1 case : 6 cases : 1 case : 8 cases

Emergency room chief dr. Yoza Firdaoz dr. Friza Novriansyah dr. Riswan Total

: : : :

2 cases 3 cases 3 cases 8 cases LAS Physician

No

Initial

Age

1.

MAR

36

2.

JUW

23

3.

ROS

30

4.

MIS

31

5.

ASM

40

6.

ANI

31

Diagnosis G2P1A0 FT pregnancy with prior CS 1x(o.i. twin pregnancy) inlabour 1st stage active phase SLF vertex presentation + threatened uterine ruptured + fetal distress P1A0 post spontaneous delivery 3 hours (outside) with postpartum eclampsia G1P0A0 FT pregnancy with PROM 1 hour inlabour 1st stage latent phase SLF vertex presentation G1P0A0 32-33 weeks pregnancy with APH cb marginal placenta praeve not inlabour SLF cephalic presentation P2A0 post spontaneous delivery 2 hours (outside) with PPH cb incarcerated placentae + unsutured episiotomy wound G3P2A0 30-31 weeks pregnancy with threatened preterm labour + prior CS 1x (oi dry labour) SLF cephalic presentation

Treatment

LSCS

YZA

Medicinal treatment Planned for vaginal delivery Expectative management Brandt Andrew manouevre + episiotomy suture Conservative management

RSW

FRZ

FRZ

RSW

YZA

GYNECOLOGY No Initial Age 1 SRI 32

Diagnosis Infected cyst was suspected

Treatment

LAS Physician RSW

Planned for laparoscopy

OBSTETRICS LAS Dr. Yoza Firdaoz LSCS o.i threatened uterine ruptured MAR/36/UA/YZA/AGU 1. 04.03.13 & fetal distress+ tubal ligation 08.30 AM D/ G2P1A0 FT pregnancy with prior CS 1x(o.i. twin pregnancy) inlabour 1st Bandle ring stage active phase SLF vertex presentation + threatened uterine ruptured was (+) suspected + fetal distress
HR I = 96 II = 94 III = 94

US ER : C/ FT pregnancy SLF cephalic presentation M/ Intra uterine resuscitation P/ Abdominal delivery Consult to ER supervisor: dr. H Amir Fauzi, SpOG(K) Agreed for abdominal delivery Intra operative : hematoma at uterine low segment (2x4cm) 09.30 AM 09.35 AM 07.03.13 Dr.Riswan 2. 04.03.13 13.00 PM
GI = 4 GCS = 15 VSS = 16 LDH:725U/l

Female live baby, 3200 g, 48 cm, AS 7/9 FT AGA Placenta was delivered completely, 500 g, 17x18 cm, umbilical cord length 45 cm Mother & baby discharged in good condition

14.00 PM 06.03.13

Medicinal treatment JUW/23/RA/LAS/UKH D/ P1A0 post spontaneous delivery 3 hours (outside) with postpartum eclampsia + partial HELLP syndrome M/ MgSO4 protocols Nifedipin 3x 10 mg Dexamethasone inj 2x10 mg iv Antibiotics Consult to Internal, Opthalmology, Neurology Departement and ICU Referred and observation in delivery room ( ICU ward was full) Discharged by request

Dr. Friza Novriansyah 3. 05.03.13 12.30 PM Planned for vaginal delivery ROS/30/UA/LAS/OKT

D/ G1P0A0 FT pregnancy with PROM 1 hour inlabour 1st stage latent phase

SLF vertex presentation US ER : C/ FT pregnancy cephalic presentation P/ Vaginal delivery 13.00 PM 06.03.13 01.00 AM 01.10 AM Performed LSCS Female live baby BW 3000g, BL 48 cm, AS 8/9 FT AGA Referred to delivery room

Dr. Friza Novriansyah 4. 05.03.13 10.30 AM Expectative management MIS/31/UA/LAS/FAR D/ G1P0A0 32-33 weeks pregnancy with APH cb marginal placenta praeve not inlabour SLF cephalic presentation M/ Expectative management Nifedipine 4x10 mg Dexamethasone inj 1x12 mg (2 days) Informed consent US confirmation (NS): C/ 32-33 weeks pregnancy SLF cephalic presentation with marginal placenta praeve Referred to delivery room Patients condition was good, bleeding (-)

Hb: 11,3 g%

USG

11.30 AM 07.03.13 Dr.Riswan 5. 06.03.13 11.35 AM

Hb: 10,4 g%

11.45 AM 07.03.13

Brandt Andrew manouevre + episiotomy suture ASM/40/UA/LAS/ARP D/ P2A0 post spontaneous delivery 2 hours (outside) with PPH cb incarcerated placentae + unsutured episiotomy wound M/ IVFD RL+oxytocin 20 iu Brandt Andrew manouevre Episiotomy suture Tubal ligation counseling Placenta was delivered completely, 460 g, 17x18 cm, umbilical cord length 46 cm Patients condition was good, but rejected tubal ligation

Dr. Yoza Firdaoz 6. 06.03.13 Conservative management ANI/31/RA/LAS/ARP

00.15 PM

TI: 5

D/ G3P2A0 30-31 weeks pregnancy with threatened preterm labour + prior CS 1x (oi dry labour) SLF cephalic presentation US ER : C/ 30-31 weeks pregnancy+cervical length 2,6 cm M/ Conservative management Nifedipine 4x10 mg Dexamethasone inj 1x12 mg (2 days) Ceftriaxone 2x1 gr P/ US confirmation Referred to delivery room Failed of conservative management Male live baby BW 1500g, BL 39cm, AS 8/9 PT AGA

13.30 PM 18.00 PM 23.20 PM

GYNAECOLOGY LAS Dr. Riswan 1. 06.03.13 10.00 AM

Leuko: 13.100/mm3 USG

Planned for laparoscopy D/ Infected cyst was suspected M/ Antibiotics inj US confirmation (NS): C/ Infected right ovarium cyst was suspected P/ Laparoscopy

SRI/32/UA/LAS/WJF