case report dr. dewi

7/21/2019 Case Report Dr. Dewi

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Post partum hemorrhage



At August 25th, 10.00 am•26 years old

•Hospitalized e.c. G3P1011 39 – 40 weeks

S/ 1st sta!e o" la#or wit$ watery %a!i&al

disc$ar!e•a# 'a(!(st 2)t$ *11.33 a+,

• - 91 10e3/(

• HG 116 !/d

• P 236 10e3/(•$erapy

• 5pectati%e %a!i&al deli%ery

•

+picilli& 4 5 )00 +! po



• "ter 7 $o(rs 30 +&t $ospitalized

patie&t &eeded to #ear dow& 2&d sta!e o" la#or

•).42 p+ #or& %i!oro(s #a#y !irl

3200 !

3rd sta!e acti%e +a&a!e+e&t

•).)0 p+ place&ta #or& co+pletely•%al(atio& o" (teri&e co&tractio&

weak



post partum hemorrhage e.c uterine atonia

8(&dal +assa!e

-eak co&tractio&

&ter&al #i+a&(al co+pressio& -eak co&tractio&

:8; wit$ <5ytoci& 2 a+pl.

=et$yl er!o+etri&e 02 +! i.%

=isoprostol 00 +c! rectal

>teri&e co&tractio& '?,



• t 6.30 p+ acti%e #leedi&! "ro+ <>

weak (teri&e co&tractio& wit$ s$ock 'P

0/)0 ++H! P 1105/+&t @@ 205/+&t

#l(e code

res(scitatio&

A >teri&e ato&ia co&ser%ati%e "ail(re

A "o(&d acti%e #leedi&! "ro+

%a!i&al +(cosa

total abdominal hysterectomy



• t 11.4) p+ was do&e otal #do+i&al

Hysterecto+y• $erapy

• P@ tra&"(sio& B H#C 10 !rD

• +picilli& 351 !ra+ :• Ge&ta+yci& 250 +! :

• =etro&idazole 35)00 +! :

•ra&e5a+ic acid 351 !ra+ :



• a# 'a(!(st 2)t$ * 22.)4p+,• - 140 10e3/(

• HG 76 !/d

• =: 940 "

• =H 29 p!

• =H 317 !/d

• P 713 10e3/(

• P elo&!ated

• aP elo&!ated



(!(st 26t$ ' >,•>;

•03.4) a+ "ro+ i&ter&al depart+e&t*

• ;5 P2012 spo&ta&eo(s post part(+

day 0 ? post H ec HPP pri+er ec (teri&eato&ia

• Se%ere #leedi&!

• =ild &e+ia ec acti%e #leedi&!• $ro+#ocytope&ia

• oa!(lopat$y



• a# 'a(!(st 26t$ * 09.)2p+,

• - 1)6 10e3/(

• HG 712 !/d

• =: 32 "• =H 269a p!

• =H 322 !/d

• P 37) 10e3/(

• tra&"(sio& B P E 100.000



• a# 'a(!(st 2t$,

• - 44 10e3/(

• HG 63 !/d

• H 194 D• =: 34 "

• =H 274 p!

• =H 32 !/d

• P 310 10e3/(



(!(st 29t$



(!(st 30t$ Joint Conf:

•Patie&t wit$ ;

Hepari& )000 > #ol(s

Hepari& drip 1000 >/$r

He+ostasis p$ysiolo!y +o&itori&! F a+'P/P @,

•ardiolo!ist

@o $ora5 ardio+e!aly wit$ s(sp. #ilateral

ple(ral e""(sio&

a&teroseptal isc$e+ia ec s(sp +eta#olic



Sept 1st • >;

• e+p 30 c• @@ o& %e&tilator s(pport 165/+&t

• P(lse 11)5/+&t

• ;5 P2012 post !A" #ay $th , f.up hypo%olemic shoc&,

• #'C, A(#)

•5 +picilli& 3 5 1!ra+

Ge&ta+yci& 1 5 400 +!

=etro&idazole 3 5 )00 +!

ra&e5a+ic acid 3 5 1 !ra+

Paraceta+ol 3 5 1 !ra+

=idazola+ 10 +!/$r

8e&ta&yl )00 +!/day



Sept 3rd

•@ee%al(atio& "ro+ cardiolo!y dept.

•@< $ora5 P&e(+o&ia dd/ l(&! ede+a

e"t ple(ral e""(sio&

•;I ; ? @;S? l(&! ede+a

•$ 'Bse&siti%ity test,• e#(lizer %e&toli& 3 5 2) +!

• o%e&o5 2 5 04 +!

• cetazola+ide 1 5 1

• e"tria5o&e 2 5 2 !ra+

• e%o"lo5aci& 1 5 7)0+!

• =etro&idazole 3 5 )00 +!

• Paraceta+ol 3 5 1 !ra+

• 8(rose+ide 10 +!/$r



Sept )t$

• lood !as a&alysis

• or+al• 8

• @o $ora5

Sept 9t$

•Stop %e&tilator s(pport



Sept 2)t$

• Patie&t disc$ar!ed "ro+ Sa&!la$ Hospital



Ha&!i&! iss(e

• -$y did ato&ia $appe& despite $a%i&! &o predispositio&

"actorJ

• -$y total a#do+i&al $ysterecto+yJ-$at a#o(t K y&c$ li!atio& o" (teri&e artery or

s(pra%a!i&al $ysterecto+yJ

• ; ca& it #e pre%e&tedJ

• -$at ca(se @;S a&d l(&! ede+aJ %e& w$e& t$e

patie&ts $a%e #ee& treated i& >J



Thankyou……



. . . .

(11.42) (06.56)

, , , , , , .

, , , , , , .

HCT 38,7 24,3 31,5 23,9 22,1 25,2 19.4

PLT 236 71,3 216 60 37,5 43 31.0

Tidakterbacaalat (memanjang) .

.

#PTT Tidakterbacaalat (memanjang) 44.0

#on$%o

PTT

11.3

on$%o

'PTT

.

PH 6.09 7.27 7.20 7.27 7.41

PC2 49 45 42 40 39

2 61 190 283 114 146

a

. . . . .

. . . . .

TC2 10.9 22.1 17.1 19.6 25.9

B* -23.4 -6.1 -11.1 -8.0 0.1

+o2 67 100 100 98 99

G u 120

%, . .

%,u .

'+T 156 81

' 3.19 3.38

B-! 19.6 28.5

% no,n 9.8

,% .

a

# 3.1



Sept 4t$

• ;I ; ? @;S? l(&! ede+a ? :P

• $ 'Bse&siti%ity test,• e#(lizer %e&toli& 3 5 2) +!

• o%e&o5 2 5 04 +!

• cetazola+ide 1 5 1

• e"tria5o&e 2 5 2 !ra+

• e%o"lo5aci& 1 5 7)0+!



• 8(rose+ide 10 +!/$r



Sept 7t$

• $ora5 P• or Size S$ape B &or+al

• Po B p&e(+o&ia dd/ l(&! ede+a

B le"t ple(ral e""(sio&



Sept 9t$

• ; ? "e%er ? @;S? (&! ede+a ? :P

• $ '#ased o& se&siti%ity test,• e#(lizer %e&toli& 3 5 2) +!

• +ipe&e+ 3 5 1 !ra+

• e"tria5o&e 2 5 2 !ra+

• e%o"lo5aci& 1 5 7)0+!



• <&da&setro& 3 5 +!• <+eprazole 1 5 40 +!

case report dr. dewi

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