pemaparan kasus

TUTORIAL CASE

Dr. Kalsah Nugroho Aryanto K, Sp.OG (K) Pembimbing :

Presented by :M. D wi Putra

Shinta Tantri AmandaIsnawati

Dewi Kurnia NingsihGita Amelia

Masrida Rezky

IDENTITY

Name : Nn. A Age : 18 years old Marriage Status : Not marriage RM : 35.26.xx Date of MRS : 29 mei 2012

Alloanamnesa

Chief Complaint : fever since 3 days, sharp fever and chills

Additional complaint : Dizziness Nausea, vomiting. Heartburn since 4 days 1 day before come to hospital feses are

black (1x) Bleeding gums (-), epistaxis (-), petechiae

(-)

TABEL PERJALANAN

S (subjektif) O(objektif) A(Assesment)

P(planning)

Dizziness (+), weak (+), nausea (+), heartburn (+), fever (+) since 4 days.CHAPTER black (+), bleeding gums (-), epistaxis (-), petechiae (-)

CM, Sakit sedang.BP : 110/70Temp : 37,5 CPulse : 89x/mRR: 20x/m

PF :Konjunctiva anemis (+)

Others found no abnormalities

Dengue Haemorragic fever grd I-II

Dr A (GP) -RL 8 TPM-Sanmol 3x1-Rantin inj 2x1-Vomceran 3x1

Dr. Sp.PD : th/ lanjut

Dr. B(GP) : extra novalgin 1 amp drip suhu : 40 C

29 Mei 2012

TABEL PERJALANAN

S (subjektif) O(objektif) A(Assesment)

P(planning)

Dizziness (+), weak (+). Can not defecate 2 days.

At night: OS chills 37.8 C

CMSakit sedangTemp : 36,5 C

DHF der I-II

Pkl. 11 : dr.Sp.PD-Diit Tim-RL / 6 jam-Cek urea, H2TL/12jam,UL-Koreksi Kl 25 max 2xPkl.20.45 : dr.U-Anjuran ICU karna OS sesakPkl.21.00 : dr.Sp.PD- Drip novalgin 1 amp

30 Mei 2012

TABEL PERJALANAN

S (subjektif) O(objektif) A(Assesment) P(planning)

Weakness (+), bleeding pervaginam (+).

CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C

PF:NT abd (-)NT epig (+)

Dr. U :Susp abortus septikDD: KET

-Plano test -Hb cito-IUFD Nacl loading 1 kolf-Edukasi pasien

-Konsul dr. Obgyn

31 Mei 2012 pkl. 08.30

TABEL PERJALANAN

S (subjektif) O(objektif) A(Assesment)

P(planning)

Amenorrhea (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight.

Plano test (+)Hb :6,3 gr%

Palp : TFU not palpable. Abdomen lemes, pain (-)

VT : ostium lunak, nyeri goyang (-), terbuka 2 cm, perdarahan (+), stool cell (-)

G1P0A0 + amenore 8 minggu susp KE

Susp abortus septikDD: KET

Konsul obgyn u/ persiapan USG

31 Mei 2012

TABEL PERJALANAN

S (subjektif) O(objektif) A(Assesment) P(planning)

Weakness (+), Unmenstruated (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight.

CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C

PF:NT epig (+) Plano test (+)Hb :6,3 gr%

Abortus insipien

Konsul Dr Obgyn :-Keluarga buat surat ijin ayah/wali-Perbaiki KU-Rencana tindakan R/ loading 200 cc transfusi, Sp.PD acc-Pantau TTV

31 Mei 2012

TABEL PERJALANAN

S (subjektif) O(objektif) A(Assesment) P(planning)

Abdominal pain (+), bleeding pervaginam (+)

CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C

PF:NT epig (+) Plano test (+)Hb :6,3 gr%

Abortus inkomplit

Inst dr. Obgyn :-Perbaiki KU -Inform consent kuretase

Dr. Sp.PD-Cek dengue blood (-)-H2TL/12 jam

31 Mei 2012 pkl. 10.00

TABEL PERJALANAN

S (subjektif) O(objektif) A(Assesment) P(planning)

Weakness (+), dizziness (+)

CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C

PF:NT epig (+) Plano test (+)Hb :6,3 gr%

Abortus inkomplit

dr,. Sp.PD :- Sore tetap cek H2TL dan dengue blood

31 Mei 2012 pkl. 17.30

LETS START TO DISCUSS

Medication aspect

• Abortus

• Ectopic pregnancy

Medicolegal aspect

• Policy and law

Be a family doctor

• Holistik

• Komrehensif

• Terpadu

• Berkesinambungan

• Pendekatan keluarga, proaktif, prepaid

Medical aspect

Girl, 18 yoNot marriage

Fever

Infection, neoplasma, body response, etc

Unmenstruated

Pregnancy? Or other ??

Hemorrhage

Pregnancy? Organ disorder? Fisiologic disorder?

Identity

Complaint

Problem

Complaint Fever Dizziness Nausea Vomiting Epigastric pain Black at feses

First

Weakness Bleeding pervaginam

Next

- Unmenstruated since 2 months- Coitus (+)- Abdominal pain

End

Todays topic

Pregnancy

Abortion

Ectopic pregnancy

PREGNANCY

- Amenore - Nausea - Vomitus - Poliuri (urinary tract)- Anoreksia

- Changes in breast- Skin pigmentasi- Hegar Sign- Chadwick Sign- Piscaceck Sign

- Tes Urin- Plano test- USG- DJJ (12weeks)

The termination of pregnancy, either spontaneously or intentionally, before the fetus develops sufficiently to survive. By convention, abortion is usually defined as pregnancy termination prior to 20 weeks' gestation or less than 500-g birthweight. Definitions vary, however, according to state laws for reporting abortions, fetal deaths, and neonatal deaths

(Williams obstetric 22nd edition)

Abortion

Etiologi

Zigot factor

Kromosom abnormality

Patologic ovum (ex: BO)

Sperma abnormality

Maternal factor- Chronic disease

- Infection - Hormonal disorder

- Organ disorderNutrition - Drug

- Imunology factor- Trauma

Diagnose criteria and treatments

Iminens abortion Insipien abortion Incomplete abortion

Diagnose criteria and treatments

Complete abortion Missed abortion Febris/ infection abortion

The blastocyst normally implants in the endometrial lining of the uterine cavity. Implantation anywhere else is an ectopic pregnancy

(Williams obstetric 22nd edition)

Ectopic pregnancy

Pathomechanism

Diagnosis and treatment

Medikolegal aspect for case

Definition of Women’s health

Building on the definition of health in WHO’s constitution, the platform of action adopted by the 4th world conference for women, in Beijing 1995, recognised that:

Health is a state of complete physical, mental and social-well being, and not merely the absence of disease or infirmity. Women’s health involves their emotional, social and physical well-being and is determined by the social, political, and economic context of their lives, as well as by biology.

Global Causes of Maternal Mortality

24,8

14,9

12,96,912,9

7,9

19,8

Hemorrhage 24.8%

Infection 14.9%

Eclampsia 12.9%

Obstructed Labor6.9%Unsafe Abortion12.9%Other Direct Causes7.9%Indirect Causes19.8%

Be a family doctor

References

Williams Obstetrics, twenty-second edition, 2005.

Current Diagnosis & Treatment Obstetrics & Gynecology, Tenth Edition, 2007.

Sarwono prawirohardjo, Ilmu kebidanan, 2005.

Pedoman diagnosis dan terapi obstetri dan ginekologi FK Unpad, RS. Dr. Hasan Sadikin, 2005.

Wassalamu’alaikum Wr. Wb Juni 2012

SAFE MOTHERHOOD