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    Case Report

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    Karina Surakusuma
    This case report describes a 35-year-old woman, G3P2A0L2, admitted at 23-24 weeks of preterm pregnancy with suspected placental abruption and heavy antepartum hemorrhage. Her condition was complicated by hypovolemic shock. Despite treatment including IV fluids and blood transfusion, her bleeding continued and induction of labor failed to progress. She ultimately underwent a hysterotomy procedure where a non-viable female fetus was delivered weighing 300g. The placenta was also manually removed. The patient received a blood transfusion during and after the procedure.

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    Case Report

    Uploaded by

    Karina Surakusuma
    37 views37 pages
    This case report describes a 35-year-old woman, G3P2A0L2, admitted at 23-24 weeks of preterm pregnancy with suspected placental abruption and heavy antepartum hemorrhage. Her condition was complicated by hypovolemic shock. Despite treatment including IV fluids and blood transfusion, her bleeding continued and induction of labor failed to progress. She ultimately underwent a hysterotomy procedure where a non-viable female fetus was delivered weighing 300g. The placenta was also manually removed. The patient received a blood transfusion during and after the procedure.

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    This case report describes a 35-year-old woman, G3P2A0L2, admitted at 23-24 weeks of preterm pregnancy with suspected placental abruption and heavy antepartum hemorrhage. Her condition was complicated by hypovolemic shock. Despite treatment including IV fluids and blood transfusion, her bleeding continued and induction of labor failed to progress. She ultimately underwent a hysterotomy procedure where a non-viable female fetus was delivered weighing 300g. The placenta was also manually removed. The patient received a blood transfusion during and after the procedure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    37 views37 pages

    Case Report

    Uploaded by

    Karina Surakusuma
    This case report describes a 35-year-old woman, G3P2A0L2, admitted at 23-24 weeks of preterm pregnancy with suspected placental abruption and heavy antepartum hemorrhage. Her condition was complicated by hypovolemic shock. Despite treatment including IV fluids and blood transfusion, her bleeding continued and induction of labor failed to progress. She ultimately underwent a hysterotomy procedure where a non-viable female fetus was delivered weighing 300g. The placenta was also manually removed. The patient received a blood transfusion during and after the procedure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    Case report

    no
    IDENTITY

     Name : Mrs. E  Name : Mr. D


     Age : 35 years old  Age : 35 years old
     MR No. : 01050929  Address : Padang
     Date : June 5 th 2019  Occupation : Entreprenur
     Address : Padang  Education : Senior High School
     Occupation : Housewife
     Education : Senior High School
    Anamnesis
    • A 35 years old patient was admitted to the Deliv
    ery Room of Dr. M. Djamil Central General Hospi
    tal on June 05th 2019 at 11.45 pm referred from
    Unand Hospital in Padang with diagnosis G3P2A
    0L2 23-24 weeks of preterm pregnancy + HAP du
    e to suspect placental abruption + once previous
    CS.
    Primary Survey (11.45 pm)
    General Record:
    GA Cons BP HR RR T Urine
    Mdt CMC 90/40 128 20 40,1 ° 20 cc on time
    –Airway : Patent
    –Breathing : O2 3 l/mnt via nasal canul
    –Circulation :
    – IV 2 line : I: IVFD RL 1000 cc loading ( total : 2000cc)
    II: IVFD HES 500 cc loading ( total : 500cc)
    Vaginal bleeding (+)
    D/ Hypovolemic shock due to HAP due to placental abruption
    on G3P2A0L2 23-24 weeks of preterm pregnancy + once
    Previous CS + obs febris
    Observation (00.15 pm)
    General Record:
    GA Cons BP HR RR T Urine
    Mdt CMC 95/50 118 24 50 cc on time
    –Airway : Patent
    –Breathing : O2 3 l/mnt via nasal canul
    –Circulation :
    – IV 2 line : I: IVFD RL 1000 cc loading
    II: IVFD HES 500 cc loading
    vaginal bleeding (+)
    D/ Hypovolemic shock due to HAP due to placental abruption
    on G3P2A0L2 23-24 weeks of preterm pregnancy + once
    Previous CS + obs febris
    Observation (00.45 pm)
    General Record:
    GA Cons BP HR RR T urine
    Mdt CMC 100/60 105 24 38,6 200 cc
    –Airway : Patent
    –Breathing : O2 3 l/mnt via nasal canul
    –Circulation :
    – IV 2 line : I: IVFD RL 40 gtt/ minute
    II: IVFD RL 40 gtt/ minute
    vaginal bleeding (+)
    D/ HAP due to placental abruption on G3P2A0L2 23-24
    weeks of preterm pregnancy + once Previous CS + obs febris
    + hypovolemic shock resolved
    Therapy
    • Control GA, VS, acute abdomen sign, vaginal
    bleeding
    • Infus Paracetamol 1 gr
    Present Illness History
    • Previously patient complaining abdominal pain since 2 h
    our before came to the hospital, then patient was exami
    ned and diagnosed with G3P2A0L2 23-24 weeks of pret
    erm pregnancy + suspect placental abruption + previous
    cs, because of no Onsite Sp.OG Doctor wasnt available,
    patient referred to the M. Djamil Padang with iv line an
    d catheter inserted.
    • Vaginal bleeding was (+) since 2 hours before came to th
    e hospital, wetting 1 pad, bright red in color
    Present illness history
    • Pelvic pain to the groin was (-)
    • Bloody show was (-)
    • Fluid leakage from the vagina (-)
    • Amenorrhea since 5,5 months ago.
    • FDLM: 12-22-2018
    • EDD: 08-28-2019
    • Fetal movement was felt since 1 months ago a
    nd movement was reduced since 1 hour befor
    e came to the hospital
    • No complain of nausea and vomiting neither duri
    ng early
    • Prenatal care : to midwife, routine every month si
    nce 3 month pregnancy (3,4,5 months of pregnan
    cy). Never control to Obstetrician.
    • Menstruation history : menarche at 13 years old,
    regular cycle, once every month, which last for 5-
    7 days each cycle, with the amount of 2-3 times p
    ad change/day, without menstrual pain
    Previous Illness History
    • There was no previous history of heart, lung, liver, kidney, hyp
    ertension and allergy.

    Family Illness History


    • There was no history of hereditary disease, contagious and ph
    ysiological illness in the family
    Occupation, Socioeconomics, Psychiatry
    , and Habitual History
    • Marriage history : once in 2007
    • History of pregnancy/abortion/delivery: 3/0/2
    1. 2008/Female/3500/Spontaneous/Midwife/ alive
    2. 2014/Male/4500/SC oi makrosomia/Doctor/ alive
    3. Present
    • History of family planning : (-)
    • History of immunization : (-)
    • History of education : Senior High school
    Physical Examination (00.45 am)

    GA Cons BP HR RR T urine
    Mdt CMC 100/60 105 24 38,6 200 cc
    Body weight
    before pregnancy : 50 kg
    present : 56 kg
    Body Height : 155 cm
    BMI : 20,81 ( Normo weight)
    • Eyes : Conjunctiva was anemic, Sclera
    wasn’t icteric
    • Neck : JVP 5-2 cmH2O,
    thyroid gland no enlargement
    • Chest : H/L normal
    • Abdomen : Obstetrical record
    • Genitalia : Obstetrical record
    • Extremity : Edema -/-, Physiological Reflex
    +/+, Pathological Reflex -/-
    Obstetric record

    Abdomen
    Inspection :
    Seem enlarge according to preterm pregnancy, median line
    hyperpigmentation (+), striae gravidarum (+), cicatric (+) pfanenstiel

    Palpation :
    Abdominal Tenderness (+), loose pain (-), defence muscular (-), Uterine
    fundal height hard as high as umbilical, ballotemen (+)

    Auscultation :
    FHR : (-)
    Genitalia
    Inspection : V/U normal, vaginal bleeding (+)
    • Inspeculo
    • Vagina : Chadwick sign (+), fluxus (+), there was blood
    bright red color in forniks posterior
    • Portio : MP, Size equal to an adult thumb, chadwick sign (+),
    fluxus (+) there Was blood bright red color, seems at
    fornix posterior , OUE was opened 2-3 cm medial
    Laboratory result
    11.35 pm
    USG 00.05 am
    USG (Delivery Room) 06/06/2019
    • Singleton, intrauterine, fetal dead, cephalic presentation
    • Fetal heart movement (-)
    • Biometry :
    – BPD : 39.5 mm
    – FL : 15.7 mm
    – AC : 178 mm
    – EFW : 142 gr

    • Plasenta Implanted at posterior corpus maturation grade 1, halo zone (-)


    • Spalding sign (-)

    Impresion :
    • 16-17 weeks of preterm pregnancy, fetal death, head presentation
    Diagnosis
    D/ HAP due to placental abruption on G3P2A0L2 23-24 weeks of preterm pregnancy +
    susp. placental abruption + once Previous CS + IUFD + hypovolemic shock resolved + ob
    s. febris

    Plan
    observation

    Action :
     Control GA, VS, UC, Sign of shock
     Informed consent
     IVFD I: RL 500 cc 20 gtt
     IVFD II: RL 500 cc 20 gtt
     Inf. Paracetamol 1000 mg
    • s/
    Follow up 6-6-19 (07.00 am)
    - Vaginal bleeding (+)
    - Abdominal pain (-)
    – Pelvic pain to the groin (-)

    GA Cons BP HR RR T
    • o/
    Mdt CMC 100/70 88 22 37,3

    Palpation :
    Abdominal Tenderness (-), loose pain (-), defence muscular (-), Uterine fundal height
    hard to palpated.
    Genitalia :

    Inspection : V/U normal, vaginal bleeding (+)


    Inspeculo
    • Vagina : Chadwick sign (+), fluxus (+), there was blood
    bright red color
    • Portio : MP, Size equal to an adult thumb, chadwick
    sign (+), fluxus (+) there Was red dark color, seems at
    fornix posterior , OUE was opened 2-3 cm medial
    LABORATORY RESULT
    06/06/2019
    06.30 am
    USG 07.00 am
    USG (Delivery Room) 06/06/2019
    • Singleton, intrauterine, fetal dead, cephalic presentation

    • Biometry :
    – BPD : 37.1 mm
    – AC : 289 mm
    – Fetal heart movement (-)
    • Spalding sign (-)
    Impresion :
    • 16-17 weeks of preterm pregnancy, fetal death, head presentation
    Diagnosis
    D/ G3P2A0L2 23-24 weeks of preterm pregnancy + HAP ec abruptio placenta + once Pr
    evious CS + IUFD + moderate anemia (7,0 gr/dL)
    Action :
     Control GA, VS, UC, vaginal bleeding, Sign of shock
     Informed consent
     crossmatch prc 4 kolf

    Consult to DPJP at 07.00am --> induction of labour

    Plan
    induction
    --> IVFD RL 500 cc + oxytocin 10 iu -> 20 gtt
    Follow up 07.45 am
    • S/ active bleeding from vagina (+)

    • o/
    GA Cons BP HR RR T
    Mdt CMC 100/60 98 24 36,8

    abd: Abdominal Tenderness (+), loose pain (-), defence


    muscular (+), Uterine fundal height hard to palpated.
    gen : vu normal, active bleeding from vagina (+)
    A/ G3P2A0L2 23-24 weeks of preterm pregnancy + HAP ec abruptio placenta
    + Previous CS + IUFD severe anemia (6,0 gr/dL) + failed of induction

    Consult to DPJP --> hysterotomy

    Action :
     Control GA, VS, vaginal bleeding, Sign of shock
     Informed consent
     crossmatch prc 4 kolf
     Ceftriaxon Injection 2x1 gr (iv)
     consult to anestesiologist
     report to operative room
    At 08.30 PM on May 06th , 2019
    Histerotomy was performed
    The baby was born, a female baby with :
    BW : 300 gr
    BH : 23 cm
    chepalo diameter : 15cm
    A/S : 0/0
    Maseration grade 1, rigor mortis (-), Livor mortis (+)
    Placenta was born with manual placenta, complete 1 piece, size ± 12x10x2 cm, ±200 gr
    in weight, umbilical cord was  35 cm in lenght and paracentral insertion.
    uterus covulare (-)
    Bleeding during operation was ± 250 cc, tranfusion during operation 3 kolf PRC

    Diagnose
    • P3A0H2 post histerotomy oi Solutio placenta + previous CS + IUFD + failed of induc
    tion + anemia on corection
    • Mother in care , baby was dead

    Action : Observe after surgery


    Plan :
    • Control GA, VS, Uterine contraction, vaginal bleeding
    • IVFD RL + 1 amp of oxytocin + 1 amp of metergin 20
    dpm
    • Ceftriaxone inj 2x1 gr
    • Misoprostol 4x400 µgr
    • Pronalgess supp II (if needed)
    • Tranfusion 1 kolf PRC post operation
    • Blood test 6 hours after surgery
    Laboratorium post op
    thank you

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