CHAPTER I

PREFACE

At pregnancy period, fetus will be protected by amnion fluid that use as

movement space and shield for fetus by harassment from the outside. Besides that,
amnion fluid is use to protect the fetus from infection and stabilizer temperatur
changing. Time by time based on gestation, amnion fluid index wont be same
from time by time at gestation. When pregnancy age at 25 weeks, ussually
amnion fluid index reach 239 ml, and it will be increase to 984 ml when
pregnany age at 32 weeks.

When amnion fluid more than 2000 ml, its call as polyhidramnion or
hydramnion. Hydramnion make symptoms to pregnancy woman like dispnoe
stertorous breathing), swollen on feet, big and glowing stomach. Another causes
of hydramnion is related to congenital abnormalities (anensefalus, atresia
esofagus, spina bifida, intestinal fistula), placenta abnormalities, diseases at
pregnancy period (diabetes mellitus, gemilli). So amnion fluid had important part
in progrees of pregnancy and birthcild.

1
 CHAPTER II

CASE

SMF ONSTETRY AND GYNECOLOGY

HOSPITAL OF EMBUNG FATIMAH BATAM CITY

Medical Record : 160372

I. PATIENTS IDENTITY
Name : Mrs. SP
Age : 26 years old
Gender : woman
Religion : christian
Address : mitra center a/16
Job : housewife
Marital Status : married
HPHT : 15 january 2016
Gestation : 34 weeks
Date of entry : 6 september 2016
Weight : 68 kg
Height : 160 cm

II. ANAMNESIS
Patient come to obstetrics poli with complaint like pain on her stomach and
stertorous breathing. Patient come by her own self to obstetrics poli,
hospital of embung fatimah on Tuesday, september 6th, 2016 at 10 am.

MAIN COMPLAINT
Pain on her stomac for 3 days ago dan stertorous breathing.
HISTORY OF PRESENT ILLNESS
A woman 26 years old by her own self went to obstetrics poli, hospital of
embung fatimah, batam city with complaint like pain on her stomach and
stertorous breathing since September 3rd 2016, mucous (-) blood (-).

Pregnancy history, patient born her first child: boy, weight : 2950 gr by
normal childborn at clinic on 2014.

2
 OBSTETRIC HISTORY
- Fisrt pregancy : Male. Spontaneous Delivery. 2950gr. 2014
- Second pregnancy : now

PERIODS HISTORY
Patient admited, her first period at 14 years old. Her periods cycles regular
every single month. Periods cycles 28 days, for 3-5 days. LMLP is january
15th 2016.

MARITAL HISTORY
Married just once at 2011, she were 21 years old.

ANTENATAL CARE HISTORY

Patient always her pregnancy every month to hospital.

PREVIOUS MEDICAL AND OPERATIONS HISTORY

(-)

CONTRACEPTION HISTRORY
(-)

ALERGIC HISTORY
(-)
PREVIOUS ILLNESS HISTORY
(-)

FAMILYS ILLNESS HISTORY

(-)

III. PRESENT STATUS

GENERAL STATUS
General Condition : good
Consciousness : compos mentis
Weight : 55 kg -> 68 kg
Height : 160 cm
BMI : 26.56 (overweight)
Blood Pressure : 120/70 mmHg
Heart Rate : 78x/i
Respirasi Rate : 24x/i
Temperature : 36,7 C

PHYSICAL EXAMINATION
Head : Conjungtivity : anemis (-)
sclera : ikterik (-)
Neck : Lymph gland : normal

3
 Thyroid gland : normal
Thoraks : lung : - inspection : simetris
- Palpation: fokal fremitus dekstra//sinistra
normal
- Percussion : sonor at all lungs path
- Auscultation : vesikuler (+/+), rhonki : (-/-),
wheezing (-/-)
Heart : heart sound S1-S2 regular, murmur (-) gallop (-)
Abdomen : tense looking dan glowing (+),push pain (+), bowel
sound (+), asites (+)
Ekstremity : Edema : -/-
Varises: -/-
Akral : warm (+)
IV. OBSTETRIC STATUS
Leopold Examination
Leopold I: round, firm, fundel of uterus
Leopold II : hard to palpate
Leopold III : hard to palpate
Leopold IV : the bottom part of fetus is not at pelvis entrance.

Outside Examination :
Fundus of uteruss height : 32 cm
Fetus heart : 142x/i
Contraction : (-)

Vagina Touche :
(-)

V. LABORATORIUM
Routine Blood Test
Hb : 9,3 gr/dl
Leukocytes : 12.400
Ht : 27%
Eritrocytes : 3,3 juta/ul
Trombocytes : 218 ribu/ul
Blood Group : O Rh+
HIV : negatif
HbSAg : negatif
Blood Glucose : 128 mg/dl
USG result : by used single deepest pocket methods, we got score 11.

VI. DIAGNOSE
G2P1A0H1 gravid 34 weeks + polyhydramnion

4
Follow up at ward
Date : september 6th 2016

Patient feel pain on her stomach (+)

S
Stertorous breathing (+)
General status : good
consciousness : compos mentis
blood ressure : 120/70 mmHg
heart rate: 80x/i
Respiratory rate: 23x/i
Temperatur : 36,5 C
Fetus heart : 140x/i
Infuse (+)
Eyes : ca (-) si(-)
O Thorax : DBN
Abdomen : bowel (+), asites (+), tegang (+), nyeri tekan (+)
Leopold examination:
Leopold I: there is big part, circle, soft at fundus of uterus.
Leopold II : unpredictable
Leopold III : unpredictable
Leopold IV : the bottom part of fetus is not at pelvis
entrance. (convergen)
Ekstremity : warm (+), udeme (-)
A G2P1A0H1 gravid 34 weeks + polyhydramnion
Observation condition and vital sign of patient
Suggest patient to rest
Injection theraphy:
P IVFD D5% + duvadillan 3 ampul / 25 tpm
Dexametason 2x1
Nifedipin 3x1
Prepare for amniosintesis

Date : september 7th 2016 (post amniosintesis)

S (-)
O General status : good
consciousness : compos mentis
blood ressure : 120/70 mmHg
heart rate: 80x/i
Respiratory rate: 23x/i
Temperatur : 36,5 C
Fetus heart : 140x/i
Infuse (+)

5
 Eyes : ca (-) si(-)
Thorax : DBN
Abdomen : bowel (+)
Leopold examination:
Leopold I: there is big part, circle, soft at fundus of uterus.
Leopold II : unpredictable
Leopold III : unpredictable
Leopold IV : the bottom part of fetus is not at pelvis
entrance. (convergen)
Ekstremity : warm (+), udeme (-)
A G2P1A0H1 gravid 34 weeks + polyhydramnion
P Observation condition and vital sign of patient
Suggest patient to rest
Injection theraphy:
IVFD D5% + duvadillan 3 ampul / 25 tpm
Dexametason 2x1
Nifedipin 3x1

Date : 8th september 2016

S (-)
O General status: baik
consciousness : compos mentis
blood ressure: 120/70 mmHg
heart rate : 79x/i
Respiratory rate: 20x/i
T : 36,2 C
Fetus heart : 140x/i
Infuse (+) terpasang
eyes: ca (-) si(-)
Thorax : DBN
Abdomen : bowel (+)
Leopold examination:
Leopold I: there is big part, circle, soft at fundus of uterus.
Leopold II : unpredictable
Leopold III : unpredictable
Leopold IV : the bottom part of fetus is not at pelvis
entrance. (convergen)
Ekstremity : warm (+), udeme (-)
A G2P1A0H1 gravid 34 weeks + post amniosintesis
P Observation condition and vital sign of patient
Suggest patient to rest

6
 Injection theraphy:
IVFD D5% + duvadillan 3 ampul / 25 tpm
Dexametason 2x1
Nifedipin 3x1
Patient can go home

VII. RESUME
Patient 26 years old, G2P1A0H1 gravid 34 weeks with polyhydramnion.
Patient admit she did normal child born and born a boy with weight 2950
gram in clinic at 2014, and this is her second pregnancy.

At September 6th 2016 on 10 am, patient come by her own self to

obstetrics poli, hospital of embung fatimah, batam city with pain on he
stomach dan stertorous breathing, blood (-) mucous (-). Observation result,
general condition : good, blood pressure = 120/70 mmHg, heart rate= 78x/i,
respiratory rate : 24x/i, temperatur = 36,7c, fetus heart = 142x/i.

CHAPTER III

THEORY

1. Definition

7
 Hidramion is a condition where amnion fluid index more than normal or
more than 2 liters, where amnion fluid index normal is 500-1500 ml.

2. Epidemiology

Hydramion which already indentificated to all pregnancy reach 1%. By

use index 25 cm or more, Biggio and friends (2009) at university of
alabama reported that 1% incident from 36.450 pregnany womans.

At another research by hill dan friends (2007) from mayo clinic, more
than 9000 prenatal patients who did USG examination regulary until third
semester. Incident (case) hydramnion show 0,9%. Mild Hydramion
defined as measure of sak with range 8-11 cm based on vertical dimension
which that 80% from cases with over fluid. Moderate Hydramion
defined as sak that contain a little bit which measure at 12-15cm that find
15% from cases. Just 5% that include to severe hydramnion which
defined with Free Floating Fetus which found to fluid sac with deepth 16
cm or more. Although 2/3 from all cases include to idiopathic, 1/3 other
cases related to abnormalities (anomali), maternal diabetes, or Meskipun
dua pertiga dari semua kasus termasuk idiopathic, multifetal gestation.
Golan and friends (2003) reportes research result is as same as to 14.000
cases.

3. Etiology
Mechanisme of hydramnion just known for less for us. Based on theory,
its happend cause:
a. Increase production of amnion fluid
Which suspect make amnion fluid is amnion epithel, but amnion fluid
can be increase because another fluid come in to amnion space,
example fetus urine or brain fluid at anencehpalus case.

b. Distraction of distribution amnion fluid

Amnion fluid is already made and streamed and be changed to the new
one. One of stream way is consume by fetus, be absorb by bowel dan
flowing to placenta and finally enter moms vasculary. This way is not

8
 effective if fetus cant swallow like esofaghus atresia cases. At
anencephalus dan bifida spinal is suspected that hydramnion happend
cause of fluid transudation from brain membraine and bone marrow
membraine. Beside that, at anencephal case, fetus cant swallow and
fluid fusion is distrubtion cause the center is not perfect until the fetus
urinate too much.

At esofaghus atresia, hydramnion happend cause fetus cant swallow.

At gemelli case is happend cause of one of fetus, its heart is more
strong than other that make urine more than normal. Its possible its
happned because of amnion is bigger at gemelli case.at hydramnion
case is often be find with big placenta.

4. Predisposition Factor
Factor that influence to hydramnion case:
a. Heart diseases
b. Nefritis
c. General Oedema (anasarka)
d. Congenital anomali (fetus), like anencephali, spinal bifida, atresia or
strictur esofhagus. In this case, its happend because :
- No stimulation from fetus dan spinal
- Exscressive Urinary Secration
- Disfunction centerl of swallow dan thirsty
- Transudation center from meningeal fluid to amnion
e. Nuchal cord
f. Diabetes mellitus
g. Gemelli uniovulair
h. Malnutrition
i. Hipofhisis gland diseases
j. At hydramnion ussualy placenta is bigger dan more heavy than
normal, its because transudation is much and become hydramnion.

5. Clasification of hydramnion
a. Acute hydramnion
Increasing amnion fluid index happend suddenly, fast and in short time
like couple days only. Ussualy its happend to early pregnancy, 5th
month and 6th month. Composition of amnion fluid at hydrmnion is
same with normal amnion fluid.
b. Chronic Hydramnion

9
 So often we meet case with increasing amnion fluid slowly in couple
weeks or months, and usually it happend to adventage pregnancy.

6. Sign and symptom

Sign :
- Uterus size is bigger than how it should be
- Identification fetus and fetus part by palpation examination is
difficult to do
- Fetus heart sound is difficult to hear
- Balotemens fetus is clear

Symptom :
- Stertorous breathing and discomfortable at abdomen because
pressure to diagfhargma.
- Disgestive disruption because of constipation or obstipation.
- Oedema because of pressure to vein cause expansion of uterus.
- Varices dan hemorrhoids
- Streched of uteruss wall make pain. This symptoms is showed to
acute hydramnion.

If polyhydramnion happend at 24-30 weeks, so that this condition often

point to acute with many symptoms acute pain in abdomen or explode
feeling wint nausea.

Abdoment skin looks glowing and oedematous with striae. Acute or

chronic polyhydramnion can cause of abortion or preterm childbirth.

7. Pathogenesis
At early pregnancy, amniont space is fill by fluid with compotition
so similar with extracell fluid. For first trimester pregnancy, movement of
water and its molecule is not only by amnion, but penetrate to fetuss skin.
For second trimester, fetus start to micturition, swallow amnion fluid.
Almost all this process is for manage amnion fluid index, at normal
condition fetus swallow amnion fluid, as predicted this mechanisme one
way to manage amnion fluid index. This theory is admited by fact that
almost hydramnion is always be happend when fetus cant swallow, like
atresia esofhagus case. For sure swallow process is not the only one

10
 mechanisme to prevent hydramnion. Pritchard and Abramovich measure
this point and find at many heavy hydramnion case, fetus swallow amnion
fluid in much amount. At anensefalus and spinal bifida, this etiology factor
is increase transudation fluid from meningen to amnion space. Another
explanation that possible post anensefalus, when there is not swallow
disruption, is increasing micturition as result center stimulation at
cerebrospinal that unprotected or decreasing antidiuretic effect as result
disruption of arginin vasopressin secretion. The opposite is clearly
admitted that fetus abnormality that cause anuria always make
oligohydramnion.
At hydramnion that happend to twin pregnancy monozygot,
showed hypothesis that bone fetus take the most circulation and get heart
hypertrophy, iys cause increasing micturition at early neonatal, that cue
that hydramnion is cause by increasing production fetus urine.
Hydramnion case that often happend to diabetes at third semester still
unexplainable. One of this explaination is that fetus with hyperglicemic
that cause osmotic diuresis. Bar hava and friends (1994) proved that
amnion fluid volume at third semester from 399 diabetes gestasional
reflect last glicemic status. Yasuhi and friends (1994) reported increasing
production fetus urine at diabetic woman in fasting is compare to non-
diabetic in control. The most exciting, fetus urine production is increasing
nondiabetic woman after eat, but it not happend to diabetic woman.

8. Diagnose
a. Anamnesis
- Abdoment is bigger and heavier than normal
- At light case, subjective complain is not much
- At acute case and expansion uterus, there is some complain that
cause of pressure to organs especially diafhragma, like stertorous
breathing (dispnoe), epigastric pain, and sianosis
- Abdoment pain because of uterus strained, nausea, and vomit
- Oedema at extremity, vulva, abdoment
- At acute process and abdoment look so big, shock, stertorous
breathing
b. Physcal Examination

11
 1. Inspection
- Abdomen looks big and strained, glowing, striae, skin so clear
and flat umbilicus sometimes.
- If acute, moms looks stertorous breathing (dispnoe) and
sianosis, hard to hold her abdoment.

2. Palpation
- Strain abdomen and pain, oedeme at vulva and extremity
- Fundus uterus is higher from real pregnancy age
- Fetus part is difficult to predict cause too much amnion fluid
- Too much fluid show like acites
- At head part, fetus head still predictable, balotement will be
clear
- Because free fetus floating, so that its possible to make wrong
prediction of fetus position
3. Auscultation
Fetus heart sometimes cant be hear or if its could, its so soft.
4. Vaginae touche
Amnion membraine is palpable and project even out of contraction.
c. Supportive Examination
1. X-ray
- Show blur shadow because too much fluid, sometimes fetus
shadow is unclear.
- X-ray at hydramnion case is usefull to make diagnose and to
define etology like anomali congenital (anensefali or gemelli).

2. USG
- Many expert make definiton hydramnion if amniotic fluid
index (AFI) more than 24-25 cm.
- Many technique to measuse amnion fluid, but as standard we
used technique based on Phelan with this criteria :
1. We can measure in after more than 30 weeks
2. Position when we are gonna measure it:
a) Patient lay down with fowler position or supine
b) Divine abdomen to 4 kuadrans with umbilicus as center
point
Above umbilicus become 2 kuadrans above/bottom
Nigra linea divine to left or right
3. Technique measuring amnion fluid :
Put probe verticaly on abdomens kuadran
Its have to perpendicular

12
 Find the biggest amnion fluid sak at that kuadran,
and measure it in milimeter (mm).
Gather all result from 4 kuadrans in centimeter
(cm).
Total 4 kuadrans at amnion fluid normal is 12 (less
than 4,6cm).
4. Range for result:
Less than 5 cm is oligohydranmion
More than 25 cm is hydranmion
5. Notes :
Measuring at pregnancy less than 20 weeks by divide
abdomen into 2 parts, is left and right. Result of measuring
by Moore and Cayle is only measure free anmion fluid if
we meet length between 1-2 cm.

- By USG examination, category of hydranmion is:

Mild Hydramnion , is sak of anmion reach 8-11 cm in
vertical dimension. The biggest incident 80% from all
case.
Moderate Hydramion , if deepth of anmion fluids sak
reach 12-15 cm. The biggest incident is 15%.
Severe Hydramion, if we can find free fetus floating in
amnions sak that reach 16 cm or more. The biggest
incident is 15%.

13
 Weeks Amnionic Fluid
Fetus (gr) Placenta (gr) Fluid
Gestation (ml)
16 100 100 200 50
28 1000 200 1000 45
36 2500 400 900 24
40 3300 500 800 17

- Single Deepest Pocket : USG may be used to obtain a qualitative

measure of the amount of amniotic fluid present visible assesing
the AF is to measure the depth of the largest visible pocket of fluid
surrounding the fetus. The normal range for the deepest vertical
pocket ( or maximum vertical pocket ) is 2 cm to 8 cm in singleton
gestations. The normal range for the single deepest pocket in twin
gestation appears to 2,2 cm to 7,5 cm.

Depth of Largest Visible Pocket Qualitative Description

< 1 cm Severe oligohydramnions
1 and 2 cm Mild oligohydramnions
> 2 and < 8 cm Normal
8 and < 12 cm Polyhydramnions
12 cm and < 16 Moderate polyhydramnions
16 cm Severe [olihydramnions

9. Management
There is 3 fases for management of hydramnion :
a. Pregnancy
At mild hydranmion case is rarely bring clinis therapies, just
observation and symptomatic therapy.
At severe hydranmion with some complains, its should take
care at hospital for bed rest. bring less salt diet. We can use
drug like sedative and duretic. If dispnoe with sianosis, do
abdominal function on bottom of umbilicus. Incition
500cc/hour per day. If we incition anmion fluid, we afraid will

14
 be contraction and solutio placenta, if fetus is not viabel yet.
Complication of incition is:
contraction
Trauma of fetus
Damage of abdomens part by incition
Infection and shock
If there is blood or fetus hit placenta when we do aspiration, we
have to stop incition.

b. Childbirth
If there is no emergency situation, so just wait.
If there is complain like dispnoe and sianosis, we can do
incition transvaginal by servix if entrace is open. By use needle
incition, stick to some place, so that amnion fluid will out
slowly.
If amnion membraine break when we do vaginae touche, to
hold it we can use our fistful as tampone for some times and
prevent lost anmion fluid. All this is to prevent solutio placenta
or bleeding post childbirth cause of antonia uteri.

c. Post childbirth
We have to be aware about bleeding post childbirth, its better
we do blood criteria examination, blood transfusin and prepare
uteronica drug.
Set infuse for help bleeding post childbirth
If bleeding post childbirth and mom be weak, to prevent
infection we can give antibiotic with methods:
Amniosintesis
Its purpose is for make mom feel better, its effective enough.
But amnionsintesis can trigger contraction even just incition
little fluid.

Other management for hydranmion is indomethasin. Indomethasin

(1,5mg/kgBB/hari) reduce production of anmion fluid , increase absorb ,
reduce production lungs fluid and fetus urine. But this methods have
potential to close ductus arteriosus fetalis earlier.

15
10. Different Diagnose
Gemelli (twins)
Acites (serosa fluid in abdoment space)
Ovarian cysts
Pregnancy with tumor
Mola hidatidosa
Full bladder

11. Complication
Premature
Oblique position
Nuchal cord is come out first than fetus at childbirth process
Bleeding when childbirth process
solutio plasenta before childbirth because of uterus size is wane so
drastic as time as reduce of anmion fluid
bladder infection because of increasing pressure to bladder
hypertension gestasional
fetal death (stillbirth)

12. Prognosis
For fetus , its prognosisnya little bad (mortality 50%) especially because
of:
a. Anomali congenital
b. Premature
c. Complication because of fetus position, oblique position
d. Eritroblastosis
e. Diabetes mellitus
f. Solutio plasenta if amnion membraine break suddenly

For mom:
a. Solutio plasenta
b. Atonia uteri
c. bleeding postpartum
d. Retencio plasenta
e. Shock

16
 CHAPTER IV

DISCUSSION

There is pregnancy woman, 26 years old with G2P1A0H1 gravid 34 weeks

come to clinic hospital of embung fatimah with complain pain on her stomach for
3 days. From anamnesis we get HPHT on january 15th 2016. At USG examination
at september 6th 2016, we find a fetus, fetus heart (+), gestation age 33-34 weeks,
with amnion fluid index more than normal (AFI>25). Headache (-), pain on
bottom stomach (+), stertorous breathing (+), nausea (-), vomit (-).

At physcal examination we find general condition is good, consciousness

compos mentis, vital sign stable. By inspection, patient abdoments skin looks
glowing, auscultation is hard to heard, fetus heart still able to hear by doppler,
palpation seems like acites (+). And obsteric examination by leopold
examination :
Leopold I: there is big part, circle, soft at fundus of uterus.
Leopold II : unpredictable
Leopold III : unpredictable
Leopold IV : the bottom part of fetus is not at pelvis entrance.

Result of laboratory is normal, USG examination looks a fetal only, fetus

heart (+), AFI more than 25 cm.
From anamnesis, physical examination, supportive examination, we can
diagnose this patient to G2P1A0H1 gravid 34 weeks + polihydramnion.

Polihydranmion
Standing based on:
Anamnesis Theory
Pregnancy woman G2P1A0H1 gravid Symptos :

17
34 weeks come with pain on stomach - Stertorous breathing and
and stertorous breathing for 3 days. uncomfortable feeling on
stomach because pressure on
diagfragma.
- Digestive disruption because of
constipation or obstipation.
- Oedema because of pressure to
vein cause expansion of uterus
- Varices dan hemorrhoids
- Streched of uteruss wall
make pain.
This symptoms is showed to
acute hydramnion.

Physcal Examination Theory

- Abdomen : looks strained, glowing Inspection :
- Abdomen looks big and
(+),hurt (+), bowel (+), acites (+)
- leopold examination : strained, glowing, striae, skin
Leopold I: there is big part, circle,
so clear and flat umbilicus
soft at fundus of
sometimes.
uterus. - If acute, moms looks stertorous
Leopold II : unpredictable
breathing (dispnoe) and
Leopold III : unpredictable
Leopold IV : the bottom part of sianosis, hard to hold her
fetus is not at pelvis abdoment.
Palpation
entrance.
- Strain abdomen and pain,
oedeme at vulva and extremity
- Fundus uterus is higher from
real pregnancy age
- Fetus part is difficult to
predict cause too much
amnion fluid
- Too much fluid show like
acites
- At head part, fetus head still
predictable, balotement will be

18
 clear
- Because free fetus floating, so
that its possible to make wrong
prediction of fetus position
Auscultation
Fetus heart sometimes cant be
hear or if its could, its so soft.

Supportive Examination Theory

USG Nilai AFI >25 CM based on USG

Management Explaination
Amniosintesis If dispnoe with sianosis, do abdominal
function on bottom of umbilicus.
Incition 500cc/hour per day. If we
incition anmion fluid, we afraid will be
contraction and solutio placenta.
IVFD RL IVFD D5% + duvadillan 3 Group vasodilator and consist active
ampul / 25 tpm ingrediant Isoxsuprine, relaxing muscle
uterus.
Dexamethason 2x1 Kortikosteroid use to maturation fetuss
lungs.
Nifedipin 3x1 Anti hypertension drug group Ca-
clocker use to reduce tension and heart
rate, enlarge and relaxing vascular, and
increase blood flow to extremity.

19
 BAB V

CLOSING

A. CONCLUSION

Mrs. SP 26 years old come to clinic hospital of embung fatimah on

september 6th 2016 at 10 am with complain pain on her stomach for 3
days.

20
 Ay physical and supportive examination, we find abdomen skin looks
strained and glowing, hurt (+), acites (+), and AFI >25 cm based on USG.

Based on anamnesis, physical examination, and supportive examination,

we standing diagnose G2P1A0H1 gravid 33-34 weeks + polihidromion.
Management for this case is to reduce stertorous breathing and pain by bed
rest and amnionsintesis.

Generally, standing diagnose, rule of management is already suit with

literatur. Prognosis to this case based on diseases history and management
is bonam.

B. SUGGESTION
To make diagnose to patient acurately, we need anamnesis, physical
examination, and supportive examination well, so that we can make suit
and effective management.

BIBLIOGRAPHY

Prawirohardjo, S. Ilmu Kebidanan. Edisi 4. Jakarta: PT Bina Pustaka

Sarwono Prawirohardjo. 2010

Cunningham. Et all. William Obstetric (23nd ed). United States Of America :

the McGraw-Hill Companies. 2010

21
 Amriewibowo.2010. Kelainan Air Ketuban Poihidromion Komplikasi Dan
Penyulit Dalam Kehamilan. Pengantar Kuliah Obstetri Dan Ginekologi

Mochtar R. Sinopsis Obstetry Jilid 2. Jakarta:EGC;2010

Manuaba IBG, Chandranita IA, Fajar IBG. Pengantar Kuliah Obstetry.

Jakarta;EGC;2007

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