crs bayu ppt
Post on 07-Jul-2018
225 Views
Preview:
TRANSCRIPT
-
8/18/2019 Crs Bayu Ppt
1/28
CASE REPORT
TOTAL PLACENTA PREVIA
Supervisor
dr. Mutawakkil JP, SpO
Prese!ted "#$
"a#u Ewa!%%a &'('))''*''+
-
8/18/2019 Crs Bayu Ppt
2/28
Introduction
ANTEPARTUM HEMORRHAGE
THE MOST COMMON IS PLACENTA PREVIA
TYPE OF PLACENTA PREVIA• Partial placenta previa
• Marginal placenta previa
• Ttal placenta previa
• L!"l#ing placenta
-
8/18/2019 Crs Bayu Ppt
3/28
Patient’s Identity
Na$e % Mr&' Y
Age % () #
Et*nic % S+n,ane&e
Natinalit# % In,ne&ian
Gra,+ate % Strata )
Occ+patin % Teac*er
-ate . A,$i&&in % Oct/er )( t*0 12)3
-
8/18/2019 Crs Bayu Ppt
4/28
Husband’s Identity
Na$e % Mr&' U
Age % (1 #
Et*nic % S+n,ane&e
Natinalit# % In,ne&ian
Gra,+ate % Strata )
Occ+patin % E$pl#e
-
8/18/2019 Crs Bayu Ppt
5/28
Chief complaint
Patient G1P)A2 c$plaint& t*at &*e get vaginal /lee,ing
-
8/18/2019 Crs Bayu Ppt
6/28
Chararacteristic of this chiefcomplaint
Since 1 *+r& /e.re t*e arrive, in
*&pital
Painle&& *e$rr*age
S+,,enl# *e$rr*age
Cntractin 456
Fetal $ve$ent 456
-
8/18/2019 Crs Bayu Ppt
7/28
History of past illness
N *i&tr# . H#perten&in
N *i&tr# . -ia/ete& Melit+&
Alerg# t egg an, &ea.,
N *i&tr# . He$atlg# -e&ea&e
N *i&tr# . 7i,ne# -i&ea&e
N *i&tr# . Tra+$a
N *i&tr# . Operatin
Fa$il# *i&tr# % ,enie,
-
8/18/2019 Crs Bayu Ppt
8/28
Menstrual history
Menarc*e % )( #
Men&tr+al c#cle % 18 ,a#&
La&t $en&tr+al peri, % Marc* )3t* 12)3
Cntraceptin *i&tr# %Cntraceptive in9ectin
-
8/18/2019 Crs Bayu Ppt
9/28
Gestational history
C-ildestatio!al
a%e &o!t-
"irt- wei%-t &/
a!d le!%t- &L 0ears La1or
A%e o23-ildre!
ears
1
ater$: % ((22 gr
L % Frget12)2 Spntane+& 3
( T*i&
pregnanc#
-
8/18/2019 Crs Bayu Ppt
10/28
Physical examination
general cn,itin % $,eratel# ill
Level . cnci+&ne&& % c$p& $enti&
Vital &ign&
/l, prea&&+re % )22;03C
?,# !eig*t % 33 @g
?,# *eig*t %)32 c$
?MI % 11 @g;$(
-
8/18/2019 Crs Bayu Ppt
11/28
General examination
E#e& % ane$ic cn9+ngtiva ";" icteric &clera ";"
M+t* % !et $+c&al $+c+&
T*ra=
*eart % *eart &+n,& I an, II0 $+r$+r "0 gallp "
l+ng % ve&ic+lar /reat* &+n,& 5;50 r*nci ";"0 !*eeing ";"
A/,$en
In&pectin % Cnve=
A+&@+ltatin % nr$al range
Palpatin % ten,erne&& 4"60 -e.ence M+&c+lar 4"6
Perc+&&in % Dull 4560 &*i.ting ,+llne&& ";"
E=tre$itie& % E,e$a ";"0 CRT B 1 &ecn,
-
8/18/2019 Crs Bayu Ppt
12/28
Obstetric examination
In&pectin% cnve=0 &triae gravi,ar+$ 456
Palpatin Lepl, I % TFU 1>c$0 /reec*
Lepl, II % .etal /ac@ i& at t*e rig*t &i,e an, .etal
e=tre$ita& i& at t*e le.t &i,e
Lepl, III % .etal *ea,
Hi& % 456 A+&@+ltatin % .etal *eart )(8=;$enit0 reg+ler
-
8/18/2019 Crs Bayu Ppt
13/28
Laboratorium ndings
*e$atlg#H/ % 80) g;,L
Le+@c#te % D822 ;L
He$atcrit % 1 Eritrc#te % (01 9+ta; L
Eritrc#te in,e= MCV % .L
MCH % 13 pg
MCHC % (( g;,L
Tr$/c#te % ()
-
8/18/2019 Crs Bayu Ppt
14/28
upporting examination
4S RES4LT &O3to1er '5t- ()'*
Single .etal0 li.e0 *ea, pre&entatin0 gravi,
(1"(( ge&tatin !ee@&0 placenta at
p&terir crp+& cl&e all . OUI'
Ttal placenta previa
-
8/18/2019 Crs Bayu Ppt
15/28
!I"G#OI G1P)A2 gravi,a (1"(( ge&ta&inal !it*
pla&enta previa ,an ane$ia0 &ingletn
.etal0 li.e0 *ea, per&entatin'
-
8/18/2019 Crs Bayu Ppt
16/28
Management andtherapy Attac* in.+&in0 cat*eter0 r+tine /l, la/
te&t&0 prvi,e ) PRC NST
Ni.e,ipine ( = 12$g
E=pectative care
-
8/18/2019 Crs Bayu Ppt
17/28
$ollo% &p'
st
da# 2ollow up $ o3t '6
t-
()'* (
!d
da# 2ollow up$ o3t '7
t-
()'* 6
rd
da# 2ollow up $ o3t '*
t-
()'*
S% !a& < $nt*& pregnant0 vaginal /lee,ingO%7U% l@& ill /eing A!arene&&% c$p&$enti&T- )12;820 N 88=0 12= R0 S (8032CIn&pectin% /+lge0 &triae gravi,ar+$ 456palpatinLepl, I% TFU 1>c$0 palpa/le &.t part& an,
le&& r+n,Lepl, II% Palpa/le *ar, part rig*t &i,elengt*!i&eLepl, III% Palpa/le *ar, part&0 r+n, an,/+nc#I$pre&&in% t*e lcatin . t*e *ea,0 /ac@rig*tHi& 456 A+&c+ltatin% ?A )(8= ; $in0 reg+lar e=a$inatin in&pe@+l
Are nt ,nee=a$inatin In Are nt ,neE=a$inatin . H/% D'< g ; ,l A% G1P)A2 gravi,a (2"() !ee@& !it* PPTan, ane$ia% La/ I an, II0 NST0 Ni.e,ipine0 Ra!ate@&pe@tati.
S% $+le& an, e=it vaginal/lee,ing &lig*tl#O%7U% $il, pain A!arene&&% c$p&$enti&
T- )22;2C- )2= ; $in+te0 *i& 456 A% G1P)A2 gravi,a (2"()!ee@& !it* PPT an, ane$ia% .+rt*er interventin0 /&-A0 ni.e,ipine (=10 /&
general cn,itin0 vital &ign&0/e,re&t0 , v+lva *igine
S% $+le& rarel#O%7U% G, A!arene&&% c$p&$enti&T- ))2;02C-A% )1= ; $in
A% G1P)A2 gravi,a (2"()!ee@& !it* PPT an,ane$ia
P% F+rt*er interventin
-
8/18/2019 Crs Bayu Ppt
18/28
$ollo% &p cont'7
t-
da# 2ollow up $ o3t '+
t-
()'* *
t-
da# 2ollow up$ o3t '5
t-
()'* +
t-
da# 2ollow up $ o3t '8
t-
()'*
S% $+le& 456 O% 7U% G, A!arene&&% c$p&$enti& T- )22;=0 1= R0S (>2C a/,$en% TFU% 1> c$ FHR% )>= ; $in ?lee,ing 1 +n,e,erpa, A% G1P)A2 gravi,a (2"()
$ngg+ !it* PPT an,ane$ia % .+rt*er interventin0nipe,ipine (=)
O/&ervatin& in V7S% /lee,ingI a$ g, A!arene&&% c$p&$enti&T- ))2;2CHi& 4"6 TFU% 1>c$-A% )1 = ; $inLa/% H/ 8')0 le+ D8220()
-
8/18/2019 Crs Bayu Ppt
19/28
$ollo% &p cont'5
t-
da# 2ollow up $ o3t '9
t-
()'* 8
t-
da# 2ollow up$ o3t ()
t-
()'* 9
t-
da# 2ollow up $ o3t ('
st
()'*
S% patient &a# nc$plaint&O%7U% g, A!arene&&% c$p&$enti&T- ))2;2CHi& 4"6-A% )1 = ; $in A% G1P)A2 (1"(( !ee@&gravi,a !it* placenta
previa ttali& pr SC% .+rt*er interventin0cr&&$atc* 4560 ?l,PRC0 S*ave 456SC 12 Oct 12)3 at )2
S% /lee,ing0 n ,iine&&0 n$+le&0 .etal $ve$ent& 4560le+@rea 4"60 ?A7 ; ?A? &$t*l#0n .ever0 g, appetite0 pain 4"6O%7U% g,
A!arene&&% c$p&$enti&T- ))2;
-
8/18/2019 Crs Bayu Ppt
20/28
$ollo% &p cont'')
t-
da# 2ollow up $ o3t ((
!d
()'* ''
t-
da# 2ollow up$ o3t (6
rd
()'*
S% ten,erne&&0 ten,erne&&O% 7U% $,erate painCn&ci+&ne&&% CMT- ))2;
-
8/18/2019 Crs Bayu Ppt
21/28
Case analysis
)' H! i& t*e ,iagn&i& . t*i& patientJ
1' H! i& t*e $anage$ent . t*i& patientJ
(' :*at are t*e c$plicatin& t*at can cc+r t*i&
patientJ
-
8/18/2019 Crs Bayu Ppt
22/28
Case analysis
)' -iagn&ing placenta previaT-eor# Case
A!a!esis$/lee,ing
!it*+t painOcc+rre, a.ter t*e Mnt* <?lee,ing i& repeate, an, increa&ingl#$an#Fre&* re, /l,T*e l!e&t part . t*e c*il, i& nt a/le t
apprac* t*e inlet A/nr$alitie& la#+tHi&tr# c+rettage r cae&arean &ectin
A!a!esis $?lee,ing .r$ t*e /irt* canal
?lee,ing cc+rre, 1 *+r& SMR&'Patient& &ai, t*at n! &*e !a& < $nt*&pregnant'?lee,ing cc+r& &+,,enl# an, $an#0&+c* a& .re&* /l,'Patient& al& .eel *eart/+rn ari&ing .r$ 1
*+r& SMR&'Fetal $ve$ent i& &till perceive,
-
8/18/2019 Crs Bayu Ppt
23/28
T-eor# Case
P-#si3al e:ai!atio! $Uterine ten,erne&&0 a/,$inal ten&inan, n ten,erne&&palpa/le cntractin
T*e l!e&t part . t*e c*il, & *ig* t*at itcan nt pa&& t*e l!e&t part . t*e pelvi&
Spe3ulu e:ai!atio!$Vi&i/le /l, c$ing +t . t*e &e@&tern+$
Va%i!al e:ai!atio!$Frni&e& e=a$inatin can al& /e ,ne%Palpa/le &.t c+&*in /et!een +r .inger&an, *ea, t *ea, pre&entatin
P-#si3al e:ai!atio!$S.t +ter+&0 &t$ac* ,e& nt .eel tig*t0an, n pain
i!spekulo Are nt ,nee:ai!atio! 2or!i3es
Are nt ,ne
-
8/18/2019 Crs Bayu Ppt
24/28
T-eor# Case
"ia!ual e:ai!atio!Onl# per.r$e, in t*e perating r$rea,# .r &+rger# i$$e,iatel#':ill /e per.r$e, nl# !*en active
t*erap#
Supporti!% i!vesti%atio! $Ultra&ngrap*# 4USG6'tran&a/,$inal +ltra&+n,tran&vaginal +ltra&+n,
MRI
"ia!ual e:ai!atio! Are nt ,ne
Supporti!% i!vesti%atio!$USGLive &ingle .et+& lie& t*e *ea,0 ge&tatinalage (1"(( !ee@&0 t*e placenta cver& t*e
entire p&terir crp+& OUI' T?A% )8>gr I$pre&&in placenta previa ttali&
-
8/18/2019 Crs Bayu Ppt
25/28
(' Management
T-eor# Case
Active t*erap#0 Se@&i Cae&area - ter$inatin /# cae&arean &ectin
-
8/18/2019 Crs Bayu Ppt
26/28
)' Complication
Ane$ia an, &*c@
Placenta accreta0 increta0 per@reta
A/erratin c*il,ren
Pre$at+re /irt* an, .etal ,i&tre&&
-
8/18/2019 Crs Bayu Ppt
27/28
Conclusion
)' T*e ,iagn&i& can $a,e /# t*e *i&tr#0
p*#&ical e=a$ an, a,,itinal e=a$
1' C"&ectin !a& c*&en ,+e t ttall#
placenta previa
(' C$plicatin n t*i& patient i& ane$ia
-
8/18/2019 Crs Bayu Ppt
28/28
T;AN< 0O4
top related