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1. Mrs.Saniti /36 y.o/hospitalized october 15th 2014 /11.45 WIT

!4"2012 3#$3% Wo"& head presentation & chronichipertention s'peri(posed se)ere preecla(psia&secondary old pri(i & not in labor & *+W 3200 ,ra(

chief complain : dizzinesspatient was referred from policlinic Ulin Hospital with diagnosedG4P2012 37-3 !oP" head presentation " chronic hipertentions#perimposed se$ere preeclampsia"secondar% old primi " not

ipri(n la&or " '(! 3200 gram) patient told that she ha$edizziness since 3 ho#r admission) *a#sea +-, $omit +-, clo#d%e%esight +-, #ter#s contraction +-, water% discharge +-, &lood%show +-,

Histor% of illness: H. +", / +-, lergic +-,  Histor% of famil% illness : / +-, H. +-,  Histor% ofmarriage : 11 %ears  Histor% of contraception: inection for 3 month  Histor% of la&or : 1) 175a&ort#s512 wee6s

  2)15midwife5aterm5female53100 g5spontaneo#s  3) 20045hospital5aterm5male53300g5spontaneo#s

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tat#s Present:

G 8 : 4-9-

5;585/ +-5-5-5-,

<P : 105100 mmhg H= : 5m

== : 15menit .emp : 37 85P: $esi6#ler "5" =h -5-

tat#s >&stetri:

?; : (H 31 cm contraction : +-,

?;; : p#ngg#ng 6anan (H= @11 -11-13?;;; : leta6 6epala

?;A : &el#m mas#6 PP

A.: B +-,5 lowest part of fet#s still high5P 2

!4"2012 3#$3% Wo"& head presentation & chronic hipertention

s'peri(posed se)ere preecla(psia& secondary old pri(i & notin labor & T 3200 ,ra(

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P,

• >2 mas6er - lpm

• ;nf#s " /8

• 8omplete la&orator% chec6

• g>4 regiment

• *ifedipine 310 mg

•

etil dopa 3290 mg• *.  if the res#lt good Pro per$aginam

termination and ripening misoprostol 490 mg5ho#rs #ntil P 9

• ;f P 9 pro >/

• (l#id &alance

• >&ser$ation present stat#s 5A5(H=5impendinge6lampsia sign 5inpart# sign

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S! "oliclinic october 15th 2014

<P/: 1 cm C 3537

8: 340 C 3

H8 : 310 C 3537

Plac) 8orp#s anterior5;;;5eno#gh

'(!: 3270 gram

isite dr.enny Sp.o!"l. 12.00 WIT

d$ise:

• ;nformed consent to famil%

• Protap P'<

•  .erminasi-=epening misoprostol

• '$al#ation ho#rs

• >&ser$ation stat#s present5A5(H=5tanda2 impending5tanda2inpart#

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eamination res#lt #nit

Hemoglo&in 111 g5dl

?e#coc%te 149 ri&#5#l

'ritrosc%te 4)30 #ta5#l

Hemato6crite 34 $olD

 .rom&oc%te 339 ri&#5#l

8A 73 E

8H 29 pg

8H8 32 D

P.5P..5;*= 95272504 deti6

<* 102 g5d?

Urid acid 93 mg5dl

G>.5GP.5?/H 275195300 U5;

*a5F58l 1354151029 mmol

o(plete blood test october 15th 2014 11714

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 15$10$2014 11714

Pemeri6saan Hasil

!arna-6e6er#han F#ning m#da-ernih

< 1)000

pH 7)9

Feton *egatif  

Protein-al&#min *egatif  

Gl#6osa *egatif  

<ilir#&in *egatif  

/arah samar *egatif  

*itrit *egatif  

Uro&ilinogen 0)2

U=;*?; +'/;'*,

?e#6osit 0-2

'ritrosit 0-1elinder *egatif  

'pitel 1"

<a6teri *egatif  

Fristal *egatif  

?ain-lain *egatif  

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17)00

P 2 misoprostol 1 90mcg5$ag5 ho#rs

*et e$al#ation : 23)00

 23)00P 3 misoprostol 2 90mcg5$ag5 ho#rs

09)00P 3     misoprostol +-,

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 october 16th 20148 06.00

: +-,>: G8 49 - ;- 8- /-

<P: 19050 H=: ==: 20 .: 3)

85P: normal

.> : contraction +-, 2 20510I (H=: 12-12-11

, !4"2012 3#$3% Wo"& head presentation &

chronic hipertention s'peri(posed se)erepreecla(psia& "ri(it'a se'nder & not inlabor & T 3200 ,ra( on ter(inationripenin, (isoprostol

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11)19Patient sent to operating room

11)40

8esarian sectio was &eg#n 11)90

<a&% was &orn

Gender : female weight 2490 grlength 4 4 7 an#s +",congenital anomal% +-,

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P,

• >2 mas6er - lpm

• g>4 regiment

• *ifedipine 310 mg

• etil dopa 3290 mg

• Fons#l #lang 6ema#an persalinan

• <alans cairan

•

Pro percepat 6ala ;; &ila inpart#• o: FU5.A5/5tanda2

impending5tanda2 inpart#

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#rger% report• ;nformed consent and anti&iotic proph%lais

• Patient was lied on s#pine position #nder spinal anesthetic

• Performed disinfection of operating area J drapped operating area

• Performed incision on middle a&domen aplorating of ca$#ma&domen

1) Gra$id aterm #terine

2) *ormal P d et s

•. Performed ?8

1) Performed &ladder Eap

2) Performed low segment #terine incition +2 cm, widened to lateral&l#ntl%

3) .eared amniotic mem&rangt

4) <a&% was &orn +female5 2490 g54 cm5 4--7,

9) Placenta was &orn completel%

) Performed e$al#ation of &leeding

•. #t#re the s#rgical wo#nd la%er &% la%er

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• 13)10

Post operation

, cti$e &leeding +-, pain +-,

>, <PK 19050 H= K

==K 22 . K370

(HC #m&ilic#s

8ontraction +",

, P3013 post cesarian section

P, la&orator% chec6 post cesarian sectionif H& L tranf#tion P=8 #ntil H<M ;A(/ =/9 1000 cc524 am

o%tocin drip 2 amp 20 dpm till 24 ho#rs post op

go4 drip 40D 20 g #ntil 24 ho#rs post 8

in alinamin ( 31

in 6etorolac 31

in $it c 31

in ceftriaon 21in transamin 3900 mg

E#iid &alance

nifedipin 310 mg if <P M 14050

o&ser$ation A5E##5#ter#s contraction