• Ny.

Seorang G2P1A0, 27 tahun, usia kehamilan 34+5mgg, rujukan RS dr

Oen Solo Baru dengan keterangan PEB, pasien mengeluh sesak sejak 3
hari yll disertai batuk, demam disangkal. Pasien merasa hamil 8 bulan,
gerak janin aktif, kenceng-kenceng teratur belum dirasakan, air kawah
belym dirasakan keluar, lendir darah (-), nyeri kepala depan (+),
pandangan kabur (-) nyeri ulu hati (+), mual muntah (-).
Dari Dr Oen sudah mendapat inj. Dexametason 2 amp
Riw PEB pada kehamilan sebelumnya (-)
• Riw ANC: teratur 1x/bulan di SpOG, tensi tinggi 1 bulan yll (170/120)
• RPD: HT/DM/asma/penyakit jantung disangkal
Riwayat Kehamilan
Physical Examination
• General condition : Mild ill,
BP 170/112 HR 120x/minute
RR 28x/minute T 36.8

Eyes : Conjunctival pallor : (+/+) Scleral Icterus (-/-)

Thorax :
cor: regular heart sound 1-2, tachicardia
pulmo: Vesicular sound (+/+), Rhonchi (+/+) Wheezing (-/-)
•
Abdomen: Soft, tenderness point (-), 2 fetus palpable, contraction (-)
- Head presentation, fetal heart rate: 144x/minute
- Head presentation, fetal heart rate: 154x/minute
Genital: blood/discharge (-)
Ultrasonography
• 2 Fetus seen, both with head presentation, in utero fetal heart beat
(+/+)
• Fetal Biometry:
I II
BPD 8.44 ~ 34+0 wk 8,03 ~ 32+2 wk
HC 30,47 ~ 33+6 wk 29,35 ~ 32+2 wk
AC 27,90 ~ 32+0 wk 25,61 ~ 29+5 wk
FL 5,92 ~ 30+6 wk 5,61 ~ 29+4 wk
EFBW 1878 gram 1513 gram
• Plasental insertion grade II
• Amnionic fluid sufficient
• There is no major congenital deformity seen
Cardiotocography

Baseline 135x/minute 140x/minute

Variability 5-10 5-10
Acceleration + +
Decceleration - -
Fetal movement + +
His - -
Category I I
Resume
A G2P1A0, 27yo, gestation age: 34+5wks with normal obs and fertility
history, there are 2 palpable fetuses with 3 parts each, both with head
presentation, fetal I heart rate 144x/min and fetal II 154x/min, his (-),
blood or discharge from genital (-). Mother heart rate: 170/112, ewitz
(+) 3, with chief complain : difficulty in breathing, confirmed with
ronchi (+/+) wheezing (-/-)
Working Diagnose
• Pulmo oedem,
• impending eclamsia,
• Preterm second pregnancy
• twin fetus (both head presentation)
• Pro SCTP-em
• Protap PEB
• Metildopa 3x 250mg
• Refer to Anestesiology, Pulmonology and Cardiology
• Thorax Rontgen
• Complete blood works
• Informed Consent
• Counselling and Education
After Labour
Delivery
• 1st Baby : Male, 2100gram, AS 789
• 2nd Baby: Male 1700gram, AS 789
• No congenital defect is seen
Physical Examination
• General condition : Mild ill
BP 165/100 HR 108x/minute
RR 19x/minute T 36.8

Eyes : Conjunctival pallor : (+/+) Scleral Icterus (-/-)

Thorax :
cor: regular heart sound 1-2, tachicardia
pulmo: Vesicular sound (+/+), Rhonchi (+/+) Wheezing (-/-)
•
Abdomen: Soft, tenderness point (-), there are mark of surgical
wound(+)
Genital: blood/discharge (-)
A: post SCTP-em with indication of pulmonary oedema, impending
eclampsia, gemelli, and preterm second pregnancy and anaemia
(hb=9,7)
• RL + oxitocin drip + methylergometrin 20 dpm
• Ampicilin Sulbactam inj 1,5 gr/ 8hr
• Paracetamol 1 gr/ 8hr
• Protap PEB
• Other treatment with consultation from Anest,Pulmo, and Cardiology