WEEKLY REPORT

PERIOD

Delivery room
Rooming in care unit
Operating room
Gynecological care unit
Obstetrical care unit
Oncology care unit
Family planning outpatient care unit
Obstetrical outpatient care unit
Gynecological outpatient care unit
FER outpatient care unit
Oncology outpatient care unit
Emergency care unit

Program Pendidikan Dokter Spesialis-1

Obstetri-Ginekologi
FK Unibraw / RSU Dr. Saiful Anwar
Malang
 DELIVERY ROOM
PERIOD

OPERATION Vaginal
Delivery
NO CASES
LOVSET- HYSTERO
VC. E. FORCEPS C.S
M RAPHY

Caesarean Section :
CS Ratio :
 SC x 100% = 0
 Delivery

Referred by

 Came by herself :
 Obstetrician :
 Midwife :

TOTAL :
 DELIVERY ROOM REPORT
PERIOD
DATE
NO NAME at of REFERRAL REG. PLANNING OF ACTION
HOSP.
 ROOMING IN CARE UNIT
PERIOD
DIAGNOSE NUMBER
Normal Delivery
TOTAL

ANTENATALCARE NUMBER
Primary Midwife
General Practitioner
TOTAL

LENGTH OF STAY (DAY) NUMBER

1
2
TOTAL

BREASTFEEDING (DAY) NUMBER

1
2
TOTAL

PARITY NUMBER
Prime
Multi
TOTAL

CONTRACEPTION NUMBER
IUD
IMPLANT
TOTAL
OPERATING ROOM
PERIOD

5
 GYNECOLOGICAL CARE UNIT
PERIOD
No Diagnose Number
1. AUB-L dd AUB-M
+ Anemia
+ History of CS

2. Ruptured of ectopic pregnancy

+ Anemia
+ Hypovolemic shock
+ Leukocytosis
+ History of Ectopic Pregnancy

3. Threatened abortion (6-8 weeks)

4. Menometrorhagia

Total

6
 OBSTETRICAL CARE UNIT
PERIOD
CONCLUSION

A. POST PARTUM
- VAGINAL DELIVERY
- FORCEP EXTRACTION
- VACUM EXTRACTION
- MANUAL AID
- PATHOLOGICAL VAGINAL DELIVERY

ABDOMINAL DELIVERY
- CITO DELIVERY ROOM
- CITO EMERGENCY ROOM

- ELECTIVE:

B. HIGH RISK PREGNANCY

C. MISCELLANEOUS

TOTAL

7
 ONCOLOGY CARE UNIT
PERIOD

PRO CHEMO
DIAGNOSE STAGING SITOS SURGICAL TOTAL
CURRETAGE RADIATION
Cervical
Carcinoma
Ovarial
Carcinoma
Endometrial
Carcinoma
TOTAL

8
 FAMILY PLANNING OUTPATIENT CARE UNIT
PERIOD
CONTRACEPTIVE INITIAL FOLLOW NEW NUMBER OF
METHODE VISITING UP ACCEPTOR ACCEPTOR
Oral Contraceptive
- Combined
- Progestin Only

Injection Contraceptive
- 3 Monthly Inject
- 1 Monthly Inject

Implant

IUD
- T Cu 380 A

TOTAL

REMARKS :
Implant : - Inserting :
- Removal :
- Reinserting :

IUD : - Inserting :
- Removal :
- Reinserting :

9
 OBSTETRICAL OUTPATIENT CARE UNIT
PERIOD

• Total Visit :
• High risk pregnancy :
• Low risk pregnancy :
• Hospitalization : High risk pregnancy :
Low risk pregnancy :

HIGH RISK PREGNANCY INITIAL FOLLOW UP NUMBER

Previous CS

Age ≥ 35 y.o

HbsAg (+)

Heart Disease

HIV

Ca mammae

Placenta Previa

Hypertention

Asma bronkiale

TOTAL

Hospitalized :

10
GYNECOLOGICAL OUTPATIENT CARE UNIT
PERIOD
INITIAL
CASES REVISITING NUMBER
VISIT
TUMOR
Uterine myoma
Ovarial cyst
Suspect cervical Ca
INFECTION
Vulvovaginitis nonspecific
MISCELLANEOUS
Uterine prolapsed
TOTAL

PROCEDURES NUMBER
Biopsy
VVP
TOTAL

HOSPITALIZATION NUMBER
AUB-L dd AUB-M
+ Anemia
+ History of CS
Total

DIAGNOSTIC RESULT : CLASS

INITIAL VISIT REVISITING
PROCEDURE I II III IV
Pap Smear
TOTAL

11
 FER OUTPATIENT CARE UNIT
PERIOD
INFERTILITY

PRIMARY SECONDARY
CAUSA
INITIAL REVISIT INITIAL REVISIT
A. FEMALE FACTOR
1.Cervical Factor
2.Uterine Factor
3.Tubal Factor
4.Ovarial Factor
5. Basic Examination
B. MALE FACTOR
Sperm Analysis
TOTAL

ENDOCRINOLOGY

DIAGNOSE INITIAL REVISIT TOTAL

1. Primary amenorrhea
2. Secondary amenorrhea
3. Endometrioma
TOTAL

12
 ONCOLOGY OUTPATIENT CARE UNIT
PERIOD
Post POST RESIDI POST
DIAGNOSE STG RTX SITOS P.OP TOTAL
Curettage RTX F SITOS

Cervical Ca IA
IB
IIA
IIB
IIIA
IIIB
IVA
Ovarial Ca IC
IIIA
IIIB
IIIC
IVA
Mola hidatidosa
Endometrial Ca

TOTAL

INPATIENT

PRO CHEMO
DIAGNOSE STAGING SITOS SURGICAL TOTAL
CURRETAGE RADIATION
Cervical
Carcinoma
Ovarial
Carcinoma
Endometrial
Carcinoma
TOTAL

13
 EMERGENCY CARE UNIT
PERIOD
CASES OUTPATIENT HOSPITALIZED NUMBER
OBSTETRICAL CASE :

GINECOLOGICAL CASE :

MISSCELENEOUS

TOTAL

14