case dr. edihan-pre eklampsia berat (sendy, lia & oliv).ppt

7/26/2019 Case dr. Edihan-Pre eklampsia berat (Sendy, Lia & Oliv).ppt

1/46

Supervisor : dr. Edihan, Sp. OG

Presented by :Sendy Perdana / 2011-061-008

ata!!ia "atu#ae! / 2011-061-1$%O!ivia &har'asanti / 2011-061-1$(

&epart'ent O) Obstetri* +nd Gyne*o!oyedi*a! a*u!ty O) +t'a aya niversity


2/46

Patients and Patients Husband Identity

a'e : rs.

+e: %( y.o.

+ddress : uara "aru,

Penarinan, a3arta taraEthni* : "eta#i

O**upation : 4ouse#i)e

Edu*ation: E!e'entaryS*hoo!

5 : 28621

+d'itted : anuary 8th201%

a'e : r. +

+e : %8 y.o.

+ddress : uara "aru,

Penarinan, a3artatara

Ethni* : "eta#i

O**upation : 7or3ers

Edu*ation: unior 4ihS*hoo!


3/46

History Taking (1)hie) *o'p!ain :

4eada*he sin*e 9 days be)ore hospita! ad'ission.

4istory o) present i!!ness:

ive days be)ore ad'ission, she *o'p!ainedheada*he, and she *a'e to !o*a! hea!th *enter)or her (th prenan*y. n ea'ination, her b!oodpressure #as 160/110''4. She didn;t ta3eany 'edi*ine. then patient *a'e to the *!ini* #ith

the sa'e *o'p!ain, durin the ea'ination theb!ood pressure #as 180/110 ''4, then re)erredto the hospita! due to in*reasin b!ood pressure.She #as p!anned by the obyn do*tor/physi*ianto have *aesarean se*tion and and the patient

*hoose streri!i


4/46

History Taking (2)o "!urrin o) visions, o epiastri* pain, o

sei


5/46

History taking (3)

=he patient had a history o) hypertension on the6thprenan*y.

o history o) a!!ery.

o history o) asth'a.

o history o) &iabetes.

o history o) trau'a.

o history o) operations be)ore.


6/46

History taking (4)

+ntenata! *are : >ve ti'es at hea!th *are *enter #ith

history o) hypertension ?patient does not re'e'ber

the ea*t nu'ber@

enar*he : 12 y.o.

enstrua! y*!e: reu!ar, %0 days interva!, ( days

duration , dys'enorrhea -

ontra*eption : ora! *ontra*eption, ear!y 2011

1stday o) !ast 'enstrua! Period : 1st #ee3 on +pri! 2012

?the patient )orot the ea*t date@

Esti'ated date o) de!ivery : 1st#ee3 anuary 201%


7/46

Obstetrical History Gravida : G( P6 +0

arried : One ti'e )or 20 years.

Time Age ofPregnancy

LaborHistory

Sex BirthWeight

BreastMilk/substitute

1. 1$$% $ 'onths Spontaneousvaina!de!ivery

e'a!e 2$00 r "reast 'i!3

2. 1$$9 $ 'onths Spontaneousvaina!de!ivery

e'a!e %100 r "reast 'i!3

%. 1$$( $ 'onths Spontaneous

vaina!de!ivery

a!e 2(00 r "reast 'i!3

. 2002 $ 'onths Spontaneousvaina!de!ivery

a!e %000 r "reast 'i!3

9. 2006 $ 'onths Spontaneousvaina!

de!ivery

e'a!e %200 r "reast 'i!3

6. 2011 S ontaneous a!e


8/46

Status praesens (1)

January 8th

2013 , at.2.00 pmGenera! *ondition : appear *a!'

Aeve! o) on*iousness : *ons*ious

"!ood Pressure : 1$0/110 ''4Pu!se : 11 beats/'inute

5espiration 5ate : 2 breaths/'inute

=e'perature : %6,%0

"ody #eiht : 62 3s"ody heiht : 1%,9 *'s


9/46

Status praesens (2)4ead : nor'a! shape

Eyes : anane'i* *onuntiva , ani*teri*s*!era, pupi! B %''/%''

Ears : nor'a! shape, no se*ret

=eeth : appear nor'a!

e*3 : no !y'ph nodes en!are'ent

=horaa''ae

"oth are sy''etri* #ith hyperpi'entedareo!a


10/46

Status praesens (3) or :C nspe*tion : api*a! i'pu!se

#as not inspe*ted

C Pa!pation : api*a! i'pu!se

pa!pab!eC Per*ussion:

pper side : S

Ae)t Side : !inea 'id*!avi*u!aris sinistra

5iht Side : !inea sterna!isdetra

C +us*u!tation: heart sound D , 'ur'ur ?-@,a!!op ?-@

Aun :

nspe*tion : sy''etryrespiratory 'ove'enton the both sides

Pa!pation : )re'itus ispresent on the bothsy''etri* areas

Per*ussion : sonor /

+us*u!tation :

breathin soundvesi*u!ar, no rhon*hiand #hee


11/46

Status praesens (4)+bdo'en

nspe*tion : striae ravidaru' , !inea nira

Pa!pation : no painPer*ussion : ty'pani* in a!! reion

+us*u!tation : bo#e! sounds ?@

Etre'ity

Oede'a -/-Physio!oi* 5eFe

"i*eps / Pate!!a /

=ri*eps / +*hi!!es /

Patho!oi*a! 5eFe -/-


12/46

Obstetrical Status (1)unda! heiht : %9 *'s

eta! birth #eiht predi*tion : %.(20 ra's

eta! 4eart "eats : 1 bp'4is : -


13/46

Obstetrical Status (2)Aeopo!d ea'ination

Aeopo!d : )ee!s >r' but irreu!ar ?bottto'@

Aeopo!d : )ee!s ba*3 on the !e)t sideAeopo!d : )ee!s hard and round part ?head@

Aeopo!d : 9/9

eta! !ie : !onitudina!


14/46

Obstetrical Status (3)aina! Ea'ination:

= #as not per)or'ed


15/46

=G


16/46

CT!s "esult

eta! otion: 1 'otion in 20 'inutes

observation

on*!usion: &oubt S=

eta! 4eart "eats:"ase!ine : 160 bp'

+**e!eration -

&e*e!eration -

terus *ontra*tion:ontra*tion: -


17/46

#ab$rat$ry %in&in's

(January 8th

2013)4b: $,8 /d!

4t : 2$ H

Aeu3o*yte: 10.900/I!

=ro'bo*yte : 168.000/I!

"!ood type : O/ 5h:

"!eedin ti'e: % 'inutes

!ottin ti'e: 9 'inutes"!ood !u*ose: (8 '/d!


18/46

"!ood he'istry

SGO= / +S=: 2 /!

SGP= / +A=: 1$ /!E!e*tro!yte

Sodiu': 10 ''o!/A Potassiu': %,8 ''o!/A

a!siu': 1,1( ''o!/A

h!oride: 11 ''o!/A5ena! un*tion

rea: 11 '/d!reatinine: 0,6 '/d!

arbohydrate

5ando' G!u*ose test: 8 '/d!


19/46

o'p!ete rine Sedi'ent

G!u*ose: - Aeu3o*yte: -8/AP"Protein: =hree ?@ Eritro*yte: 2-9/AP"

"i!irubin: - Epite!: /APJ robi!inoen: nor'a! y!inder: -/APJ

Ph: (,0 rysta!: -

&ensity: 1010 "a*teria: -

O**u!t b!ood: Satu ?@ Others: -

Jetone: -

itrite: -

Aeu3o*yte: =hree ?@


20/46

&mittin' ia'n$sisother :

G(P6+0, %( y.o., ravid %$-0 #ee3s, not in !abor,severe pre e*!a'psia #ith i'pendin e*!a'psia.

etus : intrauterine, sin!e, a!ive, headpresentation

Pronosis o) 'other : dubia ad bona'Pronosis o) )etus : dubia ad bona'


21/46

C$urse in The *ar&

On ad'ission:

Prepare )or Se*tio aesarea


22/46

Operati$n rep$rt (1)Pre-operative dianosis:

G(P6+0, %( y.o., ravid %$-0 #ee3s, not in !abor,

severe pre e*!a'psia #ith i'pendin e*!a'psia.

C Post-operative dianosis:P(+0, %( y.o., post partus 'aturus #ith *aesarean

se*tion #ith indi*ation severe pree*!a'psia #ithi'pendin e*!a'psia and post bi!atera!

>'brie3to'y. n*ised tissue: Ao#er se'ent o) uterus

Operation na'e: =ransperitonea! Pro)unda Se*tioaesaria


23/46


24/46

Operati$n rep$rt (3)=he patient #as !aid supine and spina! anesthesi


25/46

Operati$n rep$rt (4)=he u'bi!i*a! *ord #as *!a'ped and haned.

=he baby handed to perinato!oy.

P!a*enta #as born at 0%.% p.', *avu' uteri#as *!eaned, then the !o#er se'ent o)

uterus bein *!osed.

+)ter the ep!oration, the operator *arried

bi!atera! >'brie*to'y.=he operation #ound #as *!osed !ayer by

!ayer.

Operation done at 0.29 p.'


26/46

Operati$n rep$rt (+) eta! 'e'brane #eiht is 2$$0 ra's, )eta! *ord

!enth at % *'

"i!atera! i'brie*to'y #as done

Post partu' 'other *ondition : 'oderate!y i!!

Genera! *ondition : 'oderate!y i!!

"P K 160/$0 ''4, =K %6,( o, P K 100bp', 55 K 2 bp'

undus heiht 2 *' be!o# the !eve! u'bi!i*a!,'oderate uterine *ontra*tions. =ota! b!eedin L00 **


27/46

$st Operati$n Therapy"ed 5est )or 6 hours

astin unti! bo#e! sound , then to drin3radua!!y

& 5A 1900 **/2 hours Oytosin 20 , 10 ,10 in ea*h 5A

Jetoro!a* %90 '

e)otai' 21

he*3 4" 6 hours post op

he*3 O / hr and "a!an*e /2 hr

he*3 b!ood pressure Fu*tuation


28/46

#ab$rat$ry %$ll$- p6 hours post operation 4e'o!obin: $,2 r/dA

nstru*tion :

Give ero)ort =ab 1 1


29/46

DAT S ! A P "#TAL S#$%S

2nd&ay

0$/01/20

1%

S : pain around operative #ound , !atus -,

&e)e*ation-

O : +ppear *a!' unda! heiht: one >ner

be!o# the u'bi!i*us ontra*tion;s intensity: stron

"!eedin : rubra, L0 **

+ : P(+0, %( y.o., post partus'aturus #ith *aesarean se*tion#ith indi*ation severee*!a'psia #ith i'pendin

e*!a'psia and post bi!atera!>'brie*to'y.

P : 'aintenan*e SO unti! 2 hr a'i!odipine 110 '

"P : 190/$0 ''4

P : 108 beats/'in

= : %6,2 55 : 2 breaths/'in

O : 1.01 **/3/hr


30/46

DAT S ! A P "#TAL S#$%S

%th &ay

1$/$/2012

PO&-1

S : Pain around operative #ound ,

Fatus , de)e*ation -

O: +ppear *a!' unda! heiht : one >ners be!o# the

u'bi!i*us

ontra*tion;s intensity : stron

"!eedin : rubra, L20 **

+: P(+0, %( y.o., post partus 'aturus #ith

*aesarean se*tion #ith indi*ation severee*!a'psia #ith i'pendin e*!a'psia andpost bi!atera! >'brie*to'y.

P: hane #ith ora! therapy:

+'i!odipine 2 10 ' p.o

oa'oi*!av % 629 ' p.o

e)ena'i* +*id % 900 ' p.o Gastru! % p.o

"P : 1(0/100 ''4

Pu!se : 112 beats/'in

= : %6,

55 : 22 breaths/'in


31/46

%inal ia'n$sisP(+0, %( y.o., post partus 'aturus #ith

*aesarean se*tion #ith indi*ation severe

pree*!a'psia #ith i'pendin e*!a'psia andpost bi!atera! >'brie*to'y.


32/46


33/46

ase +na!ysisFrom History Taking and Pysical !"amination# $e

can conclude%

Te &atient $as &regnant'estational age 34* $eeks

+e $as in ,irst stage o, labor on admission

+e as risk ,actor o, se-ere eclam&sia $it im&ending

.o istory o, &re-iously sectio caesarea


34/46

ase +na!ysis=he patient #as prenant

eta! heart beat positive #ith base!ine 1 bp'

Positive dianosti* sin :

Fetal eart tones can be detected as early as to 1*

$eeks ,rom te last menstrual &eriod (/0P) by

o&&ler tecnology


35/46

ase +na!ysis'estational age 34* $eeks/ast menstrual &eriod % +pri! 2012 ?the patient )orot the

ea*t date@ -M %$-0 #ee3s

Fundal eigt 3 cm


36/46

=G=G ea'ination :

eta! 4eart "eats:

"ase!ine : 160 bp'

+**e!eration -

&e*e!eration -

terus*ontra*tion:

ontra*tion: -

eta! otion: 1 'otion in 20 'inutes

observation

on*!usion: &oubt S=


37/46

+na!ysis )or =Griteria )or &oubt S=eta! 'ove'ent N 2 ti'es in 20 'inutesea'ination or a**e!aration N 10 bp'

or'a! "ase!ine

riteria )or nor'a! base!ine

reuen*y 120-160 bp'


38/46

ase +na!ysisn ana'nesa #e )ound :4eada*he sin*e 9 days be)ore hospita! ad'ission

4istory o) hypertension on the 6thprenan*y

n physi*a! ea'ination #e )ound :"!ood Pressure : 1$0/110 ''4

o epiastri* pain

Oede'a -/-n !aboratory >ndins,#e )ound :

Proteinuria


39/46

ase +na!ysisriteria )or Severe Pre-e*!a'psia:yanosis

i*roaniopathy he'o!ysis

riteria )or 'pendin:

b!urry visionEpiastri* pain

4eada*he


40/46

&+=O SE=O

+ES+5E+ aterna! 5epeat *esarean de!ivery

Obstru*tive !esions in the !o#er enita! tra*t,

in*!udin 'a!inan*ies, !are vu!vovaina!*ondy!o'as, obstru*tive vaina! septa, and!eio'yo'as o) the !o#er uterine se'ent thatinter)ere #ith enae'ent o) the )eta! head

arro# pe!vi* abso!ute and abnor'a!ities

?stenosis@ that pre*!ude enae'ent or inter)ere#ith des*ent o) the )eta! presentation in !abor

P!a*enta previa

&isporpotion o) *epha!ope!vi*

5upture uteri


41/46

&+=O SE=O

+ES+5E+eta!"ree*h

&ysto*ia

eta! distress


42/46

Se*tio aesarean )or

Pree*!a'psiandi*ation :Gestation N % #ee3s

un)avourab!e *ervi,

previous esarean se*tion,

bad obstetri* history,

)eta! distress,

)ai!ed indu*tion o) !aborintra-uterine ro#th restri*tion?Obinna +u


43/46

anae'ent o) sei


44/46

) no a**ess, ad'inister SO throuhdeep route:

Aoadin dose : SO 9r ?10'!@ in ea*hbutto*3 ?10r tota!@ r over 10-19'inutes

aintenan*e : SO 9r every hour Etre'e!y pain)u!, ris3 o) !utea! abs*ess

+ddition o) 1 '! o) 1H y!o*aine to the so!ution 'ayhe!p to redu*e the pain at the ine*tion site


45/46

onitorin #hen on

SO4our!y 'onitorinPate!!ar 5eFees shou!d be present

Ear!iest sin i) toi*ity deve!ops

5espiratory 5ate M 12-16 bp'

rine Output M %0 '!/hour ?100 '! / hour@ Ensure SO is e*reted throuh the 3idneys

SO does not *ause rena! i'pair'ent / )ai!ure

O2 saturation


46/46

THA%& '!

case dr. edihan-pre eklampsia berat (sendy, lia & oliv).ppt

Documents