Preterm Rupture of Membranes with Breech Delivery

CASE REPORT
Preterm rupture of the membrane with delivery of the breech
Supervised by :
dr. Mutawakkil J Paransa, Sp.OG
Written by :
Dea Putri Ikhsani (2012.730.121)
DEPARTMENT OF OBSTETRY AND GYNECOLOGY
FACULTY OF MEDICINE MUHAMMADIYAH UNIVERSITY
RSUD R, SYAMSUDIN, SH. SUKABUMI
MARCH, 2017
1
CHAPTER I
INTRODUCTION
Spontaneous rupture of membranes (ROM) is a normal component of labor and delivery.

Premature ROM (PROM) refers to rupture of membranes prior to the onset of labor irrespective
of gestasional age. PROM can occur either at term or preterm. When PROM occurs at term,
labor typically ensues spontaneously or induced within 12 or 24 hours. Preterm PROM
(PPROM) defined as PROM prior to 37 weeks of gestation
Premature rupture of the membranes (PROM) is when the membranes rupture before the onset of
labour. In 80% of patients labour ensues within 24 hours. Once the membranes are ruptured the
barrier to ascending infection is gone and if labour does not follow within 24-48 hours, induction
of labour to prevent chorioamnionitis in the mother and systemic neonatal infection is usual.
PPROM is a major cause of perinatal mortality and morbidity. It is a associated with 20% to 30%
of all preterm births and prognosis is related primarily to the gestasional age at presentation and
delivery. A timely and accurate diagnosis of PROM is critical to optimize pregnancy outcome. A
better understanding of the diagnosis and managemet of PPROM will allow obstetric care
providers to optimize perinatal outcome and minimize neonatal morbidity.
When the buttocks of the fetus enter the pelvis before the head, the presentation is breech.
Breech presentation is more common remote from term because the bulk of each fetal pole is
more similar. Most often, however, as term approaches, the fetus turns spontaneously to a
cephalic presentation because the increasing bulk of the buttocks seeks the more spacious
fundus. Breech presentation persists in 3 to 4 percent of singleton deliveries at term.
National Institute of Child Health and Human Development-sponsored Neonatal Research

Network of 437 very-low-birthweight breech newborns. After adjusting for several variables, the
risk of intraventricular hemorrhage and death was not significantly affected by the mode of
delivery for fetuses weighing less than 1500 g.
2
CHAPTER II
CASE PRESNTATION
I. IDENTITY
A. Patients identity
Name : Mrs. Y
Age : 24 years old
Nationality : Indonesian
Ethnicity : Sundanese
Address : Jampang Tengah, Sukabumi
Education : Senior High School
Marital Status : Married
Occupation : Housewife
Religion : Moslem
Date of Admission : March 28, 2017
B. Patients Husband Identity
Name : Mr. R
Age : 26 years old
Nationality : Indonesian
Ethnicity : Sundanese
Address : Jampang Tengah, Sukabumi
Education : Senior High School
Marital Status : Married
Occupation : Worker
Religion : Islam
3
II. ANAMNESIS
Chief Complaint
Patient admitted that she felt there were gush of fluid from her vagina since 14 hours before
admission.
History of Present
Patient came to hospital 28 March 2017 because she felt there were gush of fluid from her vagina
since 14 hours before admission. The watery discharge from her vagina was clear and bloody
show (-). Patient admitted that she started to feel some contraction since 3 hours before
admission, Patient also said that there were leaking of fluid everytime she felt the fetal
movement.
History of Past Illnes
History of hypertension : denied

History of tuberculosis : denied
History of diabetes mellitus : denied
History of heart disease : denied
History of allergy : denied
History of asthma : denied
History of epilepsy : denied
History of hematologic disease : denied
History of urinary tract/kidney disease : denied
History of trauma : denied
History of surgery : denied
Family History
History of hypertension : denied

History of diabetes mellitus : denied
History of asthma : denied
History of genetic disorder : denied
4
Habitual History
History of smoking : denied

History of drug consumption : denied
History of alcohol consumption : denied
Menstruation History
Menarche : 14 years old

Menstrual cycle : Regularly happens every 28 days
Menstrual duration : 7 days
Dysmenorrhea : denied
First day of last menstrual cycle : July 6, 2016
Amount of menstrual boold : 2 normal pads/ day
Contraception History
Never use any contraception
Marital History
Patient is married, already two years with her husband now
Gestational History
No Date Gestational Labor Helper Sex Birth Breast

Age History Weight Feeding
1 Now 32-33
Antenatal Care
Examination : 6 time at primary health care

History of pregnancy induced hypertension : denied
History of anemia : denied
History of sexsual transmitted disease : denied
History of tetanus toxoid immunization : TT2
5
III. PHYSICAL EXAMINATION
General condition : moderately ill
Consciousness : compos mentis (E4M65)
Blood pressure : 100/70 mmHg
Pulse : 81x /minutes
Respiratory rate : 21x/ minutes
Temperature : 36.0 C
Weight before pregenancy : 57 kg
Height : 152 cm
BMI : 24,67 kg/m2
Weight during pregnancy : 69 kg
Total weight gain : 12 kg
General Examination
Eye : palpebral edema -/- , anemic conjungtiva -/- , anicteric sclera -/-
Neck : thyroid gland enlargement (-), lymph nodes enlargement (-)
Oral : wet oral mucosa
Thorax
Cor : auscultation : regular 1st and 2nd heart sound, gallop (-), murmur (-)
Pulmo
Inspection : symmetric chest expansion in both chest field

Percussion : sonor on both lungs
Auscultation : vesicular breath sound +/+, wheezing -/-, crackles -/-
Mammae : hyperpigmentation of areola +/+, nipple retraction -/-
Abdomen
Inspection : convex, distended, striae gravidarum (-), linea nigra (-)
6
Palpation : supple in all abdomen region , tenderness (-)
Aucultation : bowel sound (+), 5-6x / minute
Extremitas : warm, edema -/-, CRT < 2s, physiological reflex ++/++/++/++,
pathological reflex -/-/-/-
Obstetric Examination
First day of last menstrual cycle : July 6, 2016
Fundus height : 28 cm
Fetal heart rate : 145x/ minute
First fetal movement : 4 month gestation
Estimated fetal weight : 2635 gram
His : 2x10/30
Leopold
Leopold I : high fundus is in the middle of center palpable processus

xyphoideus and a round, hard, bouncy head
Leopold II : the palpable on the left mother, palpable small parts of the
fetus to the right of the mother
Leopold III : palpable round, hard not bouncy, bottom
Leopold IV : divergen
Internal Examination
Vulva : not found any abnormality

Vagina : not found any abnormality
Portio : consistency thick and soft
Dilatation : 1-2 cm
Fetal membrane : amniotic is positive but there are leakage of fluid but
there are leakage of fluid, breech presentation
Non Stress Test (NST)
7
Conclusion : suspicious non stress test
IV. WORK UP EXAMINATION
Laboratory test results :
March 28, 2017
Result Normal value

HEMATOLOGY
Hemoglobin 10.6 g/dl 12-14
Leukocytes 12.000/L 4.000-10.000
Hematocrit 31% 37-47
Eritrocytes 3.5 juta/L 3.8-5.2
Eritocyte Index
MCV 89 fL 80-100
MCH 30 pg 26-34
MCHC 34 g/dl 32-36
Trombocytes 381.000/L 150.000-450.000
V. ADMITION DIAGNOSIS
G1P0A0, 24 years old, 32-33 weeks of gestation, first stage of labor (latent phase) with premature
rupture of membrane. Single, intrauterine living fetus with breech presentation.
VI. THERAPY ADMISSION
Observation of general condition and vital sign
Observation of uterus contraction (his) and fetal heart rate
Conservative management
VII. FOLLOW UP
8
March 28, 2017 ( 15.00 )
S : patient felt the contraction of her uterus
O : General condition : moderately ill
Consciousness : compos mentis
Vital sign :
Pulse : 82 x /minutes
Respiratory rate : 21 x/ minutes
Temperature : 36 C
Fundal height : 28 cm
Fetal heart rate : 145x/minute
Fetal movement : still felt by mother
Leopold
Leopold I : high fundus is in the middle of center palpable

processus xyphoideus and a round, hard, bouncy head
Leopold II : the palpable on the left mother, palpable small parts of the fetus
to the right of the mother
Dilatation : 2 cm Hodge-I
Fetal membrane : amniotic is positive but there are leakage of fluid but there are
leakage of fluid, breech presentation
His : 2x/10/20
9
A : G1P0A0, 24 years old, 32-33 weeks of gestation, first stage of labor (latent phase) with
premature rupture of membrane. Single, intrauterine living fetus with breech
presentation.
P : Observation of general condition and vital sign
Conservative management
Observation of the progress of labor
March 28, 2017 ( 21.00)
S : patient felt the contraction of her uterus and the fetal movement
Vital sign :
Temperature : 36 C
Leopold

10
Dilatation : 2 cm Hodge- II
His : 2 times in 10 minutes, duration of contraction is 30 seconds
A : G1P0A0, 24 years old, 32-33 weeks of gestation, first stage of labor (latent phase) with
premature rupture of membrane. Single, intrauterine living fetus with breech presentation.
On process of termination with oxytocin drip
March 29, 2017 ( 04.00)
S : patient felt the contraction of her uterus and the fetal movement
Vital sign :
11
Temperature : 36 C
Leopold

Portio : consistency thin and soft
Dilatation : 9 cm Hodge II
His : 4 times in 10 minutes, duration of contraction is 60 seconds
A : G1P0A0, 24 years old, 32-33 weeks gestation, first stage active phase with premature
rupture of membrane. Single, intrauterine living fetus with breech presentation.
March 29, 2017 ( 05.40)
Borned female baby with birth weight 2290 grams, height 44 cm, Apgar score 6/8 . placenta
borned spontaneously and amnionic is complete. There is no laceration of perineum and the
contraction of uterus is good.
12
S : patient felt abdominal pain
Vital sign :
Temperature : 36 C
Bleeding : about 100 cc
Contraction of uterus : firm
A : Mrs. Y,24 years old , P1A0, partus prematurus pervaginam with spontaneous brach
indication breech
P : Observation of general condition and vital sign and bleeding
March 29, 2017 ( 06.00)
S : patient felt the contraction of her uterus after delivery process
Vital sign :
Temperature : 36 C
Fundal height : 1 fingers below umbilicus
13
Post partum bleeding : rubra
indication breech
March 29, 2017 ( 12.00)
S : patient felt the contraction of her uterus after delivery process
Vital sign :
Temperature : 36.5 C
Fundal height : 2 fingers below umbilicus
Post partum bleeding : rubra
indication breech
VIII. FINAL DIAGNOSIS
Mrs.Y 24 years old P1A0, partus prematurus pervaginam with premature rupture of membrane
with spontaneous brach indication breech presentation.
14
CHAPTER III
CASE ANALYSIS AND THEORY
Comparison Case Theory Comment
Diagnosis Anamnesis : From anamnesis of The symptoms we

Approach - Patient comes with the premature rupture of found in this patient are
symptoms that she felt membrane, we can ask matched with the
there were gush of fluid the patient about : theory, which is there
from her vagina timing of watery are leaking of clear fluid
- Patient admitted that discharge of her vagina, from vagina in preterm
the watery discharge how much the watery gestasional age (< 37
from her vagina was discharge from her weeks of gestation)
clear and bloody show vagina, whether the
(-) cause of membrane
- Patient said that her rupture are spontaneous
pregnancy are 9 month or traumatic, gestasional
of gestation and she age and date delivery
still felt the fetal prediction, history of
movement premature rupture of
membrane in previous
pregnancy
Obstetric The membranes From this case, we
Examination : surrounding the fetus found that the
- First day of last rupture at least 1 hour gestational age are
menstruration : July 6, prior to the onset of about 32-33 weeks
2016 labor, this is called gestation, so this is a
- Fundus hveight : premature rupture of preterm, premature
28 cm membranes (PROM). rupture of membrane
- His : 2x10/20 PROM is often (PPROM).
- Internal Examination confused with PPROM, The contraction of
Vulva : not found any which is preterm, uterus are not adequate
abnormality premature rupture of and from CTG we also
Vagina : not found any membranes, with found contraction of
abnormality preterm being before 37 uterus, so maybe this is
Portio :consistency weeks the premature
thick and soft gestation.Diagnosis contraction.
Dilatation : 1-2 cm rupture of membranes From internal
15
- amniotic is positive but (ROM) is suspected examination and
there are leakage of with history of a gush or leopold we found the
fluid, breech leaking of fluid from the breech presentation
presentation vagina. Diagnosis can
be cofrimed by the pool,
nitrazine and fern test
Therapy Earlier the therapy is Study found that in we found that the
conservative management preterm premature gestational age are 32-
because of 32- 33 weeks of rupture of membrane 33 weeks, so it best to
gestational age. that happened in > 28 evaluate the option to
The palnning of therapy is weeks of gestation, it is terminate or doing the
termination of pregnancy best to discussed the expectative
option of therapy to the management and it will
patient family, be best if there are
especially about the coallaboration with
fetal and maternal risk, neonantalogist
whether the patient want
to choose the
termination or
expectative
management
Leopold examination: In pregnancy to less From internal

I : Fetal than 32 week, the examination and
head amount of amniotic leopold we found the
II : Fetal fluid is relatively more, breech presentation, this
back is at the thus allowing fetus is final diagnosis
left side, and moves freely. Thus the because the fetal can't
fetal extremities fetus can put in cephalic doing some movement
is at the right presentation, breech, or inside uterus
side transverse layout.
III :
Buttocks
IV :
Divergent
16
Problems :
1. What is PPROM? ? theory and pathophysiology
2. How is the diagnosis of this patient ?
3. How is the management of this patient ?
4. How is the follow up of this patient ?
5. What are the complications that can occur in this case ?
6. What is breech presentation ?
7. what what are classification breech presentation ?
8. what are the risk factors of breech presentations ?
9. How Terms of vaginal breech deliveries?
Answers :
1. PPROM or preterm premature rupture of membranes defines spontaneous rupture of fetal

membranes before 37 completed weeks and before labor onset ( American College of
Obstetricians and Gynecologists). Intrauterine infection is believed to be a major predisposing
event. Risk factos for PPROM include women with prior PPROM, low socioeconomic status,
body mass index 19,8, nutrional deficiency and cigarette smoking. Despite these risk factors,
none is identified in most cases of preterm rupture.
Amnionic epithelium is functioned as a major site of transfer between amnionic fluid and
amnion. This epithelium is metabolically active and its cells synthesize tissue inhibithor of
MMP-1, prostaglandin E2 (PGE2) and fetal fibronectin (fFN). In term pregnancies, amionic
expression of prostaglandin endoperoxide H synthase correlates with elevated fFN promote
synthesis of MMPs that break down the strength-bearing collangens and increases prostaglandin
synthesis to prompt uterine contractions and cervical ripening. This pathway is upregulated in
premature rupture membrane induced by infection
Preterm membrane rupture pathogenesis may be related to increased apoptosis of

membrane cellular components and to increased level of specific protease in membrane and
amnionic fluid. Matrix metaloproteinase (MMP) family is involved with normal tissue
remodeling and particularly with collagen degradation. The MMP-1, MMP-2,MMP-3 and MMP-
9 are found in higher concentrations in amnionic fluid from pregnancies with preterm
prematurely rupture of membranes. MMPs activity is in part regulated by tissue inhibitors of
matrix metalloproteinase-TIMPs. Several of these inhibitors are found in lower contractions in
17
amnionic fluid from women with ruptured membranes. Elevated MMP levels found at a time
when protease inhibitor expression decreases supports further that their expression alters
amniotic tensile strength. Increased MMPs allow collagen breakdown in fetal membranes
resulting in premature rupture
2. The diagnosis of this patient are : G1P0A0, 24 years old, 32-33 weeks of gestation, first stage of
labor (latent phase) with premature rupture of membrane. Single, intrauterine living fetus with
breech presentation.
Discussion :
Diagnosis of rupture of membranes (ROM) is suspected with a history of vaginal leakage of

fluid, either as a contionus stream or as a gush. The woman should be instructed during
antepartum period to be aware of this condition and to report such an event promptly Diagnosis
can be confirmed by the pool, nitrazine and fern tests.
Using a sterile speculum, rupture membrane are diagnosed if amnionic pools in the
posterior fornix or clear fluid flows from the cervical canal. This can be augmented by
asking the patient to cough or bear down, potentially allowing one to observe fluid
escaping from the cervix
If the diagnosis remain uncertain, we can use pH of vaginal fluid. Vaginal secretions are
normally acidic (4.5 to 5.5), whereas amniotic fluid is alkaline (7.0-7.5). Thus, when the
fluid is placed on nitrazine paper, the paper should immediately turn blue. A pH above
6.5 is consistent with ruptured membranes. Flase positive test results may occur with
coexistent blood, semen or bacterial vaginosis, whereas flase negative test may result
with scant fluid.
The estrogens in the amnionic fluid cause crystallization of the salts in the amnionic fluid
when it dries. Under low microscopic power, the crystals resemble the blades of a fern,
giving the test its name
Confirmation of rupture membranes is usually accompanied by sonographic previously

determined, to estimate gestasional age. If fluid volume was previously normal and there is no
other reason to suspect low fluid, oligohidramnions is indicative of ROM.
In situations when accurate diagnosis is necessary (e.g., PPROM where antibiotic

prophylaxis would be indicated), amniocentesis may be used to inject dilute indigo carmine dye
into the amniotic sac to look for leakage of fluid from the cervik onto a tampon ( the amnio dye
test or tampon test)
For the diagnosis of premature contraction in this case, it is best to evaluate the characteristic
of contraction in this patient. In early pregnancy, the uterus undergoes irregular contractions that
are normally painless. During the three trimester, there are contractions that appear
18
unpredictably, irregular and usually nonrythmic, these contractions called Barxton Hicks
contractions or usually known as false labor.
Meanwhile, for the diagnosis of breech presentation, that is a final diagnosis,because in

gestational age 32-33 weeks, the fetal can't doing the movement inside the uterus and the fetal
enganged or fixed to pelvic inlet
Conclusion : G1P0A0, 24 years old, 32-33 weeks of gestation, first stage of labor (latent phase)
with premature rupture of membrane. Single, intrauterine living fetus with breech presentation.
3. The earlier management of this patient is the conservative management because of there is the
uncertainty in the gestational age. But, after the fundal height examination and HPHT estimation
was done, the gestational age of this patient is 32-33 weeks. After the gestational age is certain,
there is a change in the planning of therapy. The planning of therapy in patient is to do the
termination of pregnancy with consent from patient and patients family.
Discussions :
Recommended management of preterm premature rupture of membranes according to American

College of Obstetricians and Gynecologists (2013) are :
Gestational Age Management

34 weeks or more Proceed to delivery, usually by induction of
labor.
Grup B streptococcal prophylaxis is
recommended
32 weeks to 33 completed weeks Expectant management unless feltal pulmonary
maurrity is decommend
Grup B streptoccal prophylaxis is
recommended
Corticocosteroids- no consensus, but non
experts recommended
Antimicrobial to prolong latency if no
Contraindication
24 weeks to 31 completed weeks Expectant management :
Grup B streptococcal streptoccal prophylaxis is
recommended
Single- course corticosteroid us is
recommended
Tocolytics no consessus
Antimicrobials to prolong latency if no
19
contraindication
Before 24 weeks ( the combinations of birth Patient conselling
weight, gestational age and sex provides the Expectant managemt or inductions of labor
best etimates chances of survival and should be Grup B streptoccal prophylaxis is
considered in individual cases recommended
Corticocosteroids are not recommended
consensus, but non experts recommended
Antimicrobials- there are incomplete data on
use in prolonging latency
20
21
Once the membrane rupture, delivery is recommended when the risk of ascending infection to
maternal outweighs the risk of prematurity
Conculsion : the final management of this case is to the termination of pregnancy or induction of
labor before viability is considered because the risk of ascending infection to maternal outweight
the risk of prematurity
4. PPROM has been known as the main cause of preterm delivery and associated with increased
rates of neonatal and maternal morbidity and mortality. Although it has different cause, collagen
metabolism is considered as the main factor in premature rupture of membranes. Vitamin C
usage during pregnancy can modulated the collagen metabolism and cause the strength of
aminochorion membranes. Vitamin C is an antioxidant that blocks the damaging effects of
oxidative stress in vitro. Therefore, vitamin C can prevent premature rupture of membranes
through its role as an antioxidant or in collagen synthesis and maintenance. Vitamin C
supplement is recommended to be administered for pregnant women with the history of PPROM
during pregnancy to prevent PPROM.
5. The fetal membranes serve as a barrier to ascending infection. Once the membrane rupture,
both the mother and fetus are at risk of infection and of other complications.
Neonatal complications :
Neonatal complications relate to the gestasional age at rupture of membranes. PPROM is

associated with a 4- fold increase in perinatal mortality and a 3- fold increase in neonatal
morbidity, including respiratory distress syndrome, polimicrobial intraamnionitic infection and
intraventricular hemorrhage. Other neonatal complications include fetal pulmonary hypoplasia,
skeletal deformities, cord prolapse especially in pregnancy with non- vertex presentation, and
increased casarean delivery for malpresentation . severe oligohydramnions in the setting of
PPROM results in an increased incidence of cord compression and fetal distress in labor, leading
to a further increase in the risk of caserean delivery. Infection, cord accident and other factor
contribute to the 1% to 2% risk of intrauterine fetal demise ( stillbirth) after PPROM .
Maternal complications :
Maternal complications include choriamnionitis. Choriamnionitis is seen more commonly in

women with prolonged preterm PPROM, severe olighydramnions, multiple vaginal discharge
and fetal tachycardia indicate clinical chorioamnionitis.Additionally, because more fetuses with
PPROM present with malpresentation ( eg. Breech), the risk of casarean delivery with its
attendant surgical risk to the parturient is higher in PPROM as compared with term deliveries.
6. Breech presentation is more common remote from term. Most often, however, before the onset
of labor the fetus turns spontaneously to a cephalic presentation, so that breech presentation
22
persists in only about 3 to 4 percent of singleton deliveries. Specifically, the annual rate of
breech presentation at delivery in nearly 150,000 infants delivered at Parkland Hospital in the
10-year period ending in 2002 was 3.6 percent.
As term approaches, the uterine cavity usually accommodates the fetus in a longitudinal lie with
the vertex presenting. Factors other than gestational age that appear to predispose to breech
presentation include hydramnios, uterine relaxation associated with great parity, multiple fetuses,
oligohydramnios, hydrocephaly, anencephaly, previous breech delivery, uterine anomalies, and
pelvic tumors. Fianu and Vaclavinkova (1978) provided sonographic evidence of a much higher
prevalence of placental implantation in the cornual-fundal region for breech presentation (73
percent) than for vertex presentations (5 percent). The frequency of breech presentation also is
increased with placenta previa, but only a small minority of breech presentations are
associated with a previa. No strong correlation has been shown between breech presentation and
a contracted pelvis.
7. The varying relations between the lower extremities and buttocks of breech presentations
form the categories of frank, complete, and incomplete breech presentations. With a frank breech
presentation, the lower extremities are flexed at the hips and extended at the knees, and thus the
feet lie in close proximity to the head (Fig. 28-2). A complete breech presentation differs in that
one or both knees are flexed (Fig. 28-3). With incomplete breech presentation, one or both hips
are not flexed and one or both feet or knees lie below the breech, such that a foot or knee is
lowermost in the birth canal (Fig. 28-4). Footling breech is an incomplete breech with one or
both feet below the breech.
23
8. Understanding the clinical settings that predispose to breech presentations can aid early
recognition. Other than early gestational age, risk factors include abnormal amnionic fluid
volume, multifetal gestation, hydrocephaly, anencephaly, uterine anomalies, plasenta previa,
fundal placental implantation, pelvic tumors, high parity with uterine relaxtion, and prior breech
delivery.
9. A score of 6 clinical variables were made at the time of admission to hospital for predicting
the success of vaginal breech deliveries
Zachtuchni Andros Score
Parameter Value
0 1 2
Primi Multi -
Breech presentation No One time Twice
Estimated fetal weight >3650 g 3649-3176 g < 3176 g
Gestation >39 weeks 38 weeks < 37 weeks
Station <-3 -2 -1 atau >
cervical dilation 2 cm 3 cm 4 cm
- If score : 4 sectio caesarea

- If score : 5 pervaginam delivery
- If Estimated fetal weight 3500 gram, sectio caesarea
- If Estimated fetal weight > 1800 (preterm)
24

Preterm Rupture of Membranes with Breech Delivery

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Preterm Rupture of Membranes with Breech Delivery

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CASE REPORT

Preterm rupture of the membrane with delivery of the breech

dr. Mutawakkil J Paransa, Sp.OG

Dea Putri Ikhsani (2012.730.121)

DEPARTMENT OF OBSTETRY AND GYNECOLOGY

FACULTY OF MEDICINE MUHAMMADIYAH UNIVERSITY

RSUD R, SYAMSUDIN, SH. SUKABUMI

Spontaneous rupture of membranes (ROM) is a normal component of labor and delivery.

National Institute of Child Health and Human Development-sponsored Neonatal Research

Age : 24 years old

Address : Jampang Tengah, Sukabumi

Education : Senior High School

Marital Status : Married

Date of Admission : March 28, 2017

B. Patients Husband Identity

Age : 26 years old

Address : Jampang Tengah, Sukabumi

Education : Senior High School

Marital Status : Married

History of Past Illnes

History of hypertension : denied

History of hypertension : denied

History of smoking : denied

Menarche : 14 years old

Never use any contraception

Patient is married, already two years with her husband now

No Date Gestational Labor Helper Sex Birth Breast

Examination : 6 time at primary health care

General condition : moderately ill

Consciousness : compos mentis (E4M65)

Blood pressure : 100/70 mmHg

Pulse : 81x /minutes

Respiratory rate : 21x/ minutes

Weight before pregenancy : 57 kg

BMI : 24,67 kg/m2

Weight during pregnancy : 69 kg

Total weight gain : 12 kg

Neck : thyroid gland enlargement (-), lymph nodes enlargement (-)

Oral : wet oral mucosa

Inspection : symmetric chest expansion in both chest field

Mammae : hyperpigmentation of areola +/+, nipple retraction -/-

Inspection : convex, distended, striae gravidarum (-), linea nigra (-)

First day of last menstrual cycle : July 6, 2016

Fetal heart rate : 145x/ minute

First fetal movement : 4 month gestation

Estimated fetal weight : 2635 gram

Leopold I : high fundus is in the middle of center palpable processus

Vulva : not found any abnormality

Non Stress Test (NST)

IV. WORK UP EXAMINATION

Laboratory test results :

March 28, 2017

Result Normal value

VI. THERAPY ADMISSION

Observation of general condition and vital sign

Observation of uterus contraction (his) and fetal heart rate

S : patient felt the contraction of her uterus

O : General condition : moderately ill

Consciousness : compos mentis

Blood pressure : 100/70 mmHg

Respiratory rate : 21 x/ minutes

Fetal heart rate : 145x/minute