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G1P0A0 28 years old fullterm of pregnancy 1 day premature rupture of the membrane + fetal distress Cesarean Section + IUD post placental (Mrs. Santi Pakaya MR 38.40.31) G1P0A0 28 years old admitted on September 28 th 2013 at 02.00 am, was referred from obstetrician with diagnose G1P0A0 28 years old fullterm of pregnancy premature rupture of the membrane, fetal singleton alive cephalic presentation.

History The mother didnt feel labor pain yet. 27th

There was amnion fluid leakage 17 hours before admitted to hospital since 09.00 am (September 2013) She felt the babys movement There was no history of cardiac, pulmonary, liver, renal, hypertension, and diabetic disease There was history of leukorhea last 3 months. ANC : 6 times at Obstetrician EDC : September ? 2013 Contraception : (-)

LMP : December ? 2012 Marriage : once for 2 years

General examinations : General Condition : good, conscious Blood pressure Respiration rate Conjunctive Heart and lung Body height Proteinuria : 140/90 mmHg : 24x/minute : anemic -/: within normal limits : 157 cm :+ Pulse rate Temperature Sclera Extremities Body weight : 84 x/minute : 36,6 C : icteric -/: oedema -/: 85 kg

Obstetrics examination : Fundal height back FHS : 135-144 bpm : 34 cm Fetal presentation :cephalic presentation U on the right Uterine contraction : (-)

EFW

: 3410 grams (JT)

Inspeculo : White cloudy fluid leackage from OUE, OUE closed, nitrazine test (+)

Vaginal examination : Soft thick portio axial position one finger cervix dilatation non intact membrane white cloudy cephalic presentation H I

Pelvic Examination : Inlet Promontorium : unpalpable

Linea innominata : palpable 1/3-1/3

Midpelvis Ischiadic Spine : not protruded

Side walls : straight Sacrum : concave

Outlet Arcus Pubis : > 900 : within normal limit

Conclusions

USG : Intrauterine fetal singleton cephalic presentation FM (+), FHM (+) BPD : 9,6 cm, AC : 33,97 cm, FL : 7,48 cm

Placental implantation at fundus grade III AFL < 2 cm EFW : 3400 3500 grams Conclusions : fullterm of pregnancy + cephalic presentation + oligohydramnion

NST : BHR Variability Acceleration Deceleration Fetal Movement Conclusion : 130-140 bpm : 10-15 bpm : (+) : (-) : > 5x/20mnt : reactive

Laboratorium : Hb 8,3 g% WBC 9.800 mm3 Platelets 389.000/mm3 Ht 27,2 %

Diagnosis: G1P0A0 28 years old fullterm of pregnancy 17 hours premature rupture of the membrane + preeklampsia + anemia Intrauterine fetal singleton alive cephalic presentation mild

Management: General condition recovery --> tranfusion Antibiotic Oxytocin drip Counseling Informed consent Blood smear analysis Luminal 3x30 mg

 Observation Vital Sign, UC, FHS Consulted to supervisor advice : oxytocin drip

Observation : At 02.00 - 07.00 am UC (-) FHS 140-155 bpm

At 07.00 am Vaginal examination : Soft thick portio axial position one finger cervix dilatation non intact membrane white cloudy cephalic presentation H I, Bishop Score 3 Diagnosis: G1P0A0 28 years old fullterm of pregnancy 22 hours premature rupture of the membrane + mild preeklampsia + anemia Intrauterine fetal singleton alive cephalic presentation Management: Antibiotic Oxytocin drip started (5IU oxytocin on 500cc D5%, 8 dpm increase 4 dpm/15 minutes, dpm) Observation Vital Sign, UC, FHS maximal 60

At 07.00 - 07.15 am At 07.15 - 07.30 am At 07.30 - 07.45 am At 07.45 - 08.00 am At 08.00 - 08.15 am At 08.15 - 08.30 am At 08.30 - 08.45 am At 08.45 - 09.00 am At 09.00 - 09.15 am

UC (-) UC (-) UC (-) UC (-) UC (-) UC (-) UC (-) UC (-) UC (-)

FHS 140-155 bpm FHS 145-155 bpm FHS 135-145 bpm FHS 140-150 bpm FHS 130-145 bpm FHS 130-155 bpm FHS 128-150 bpm FHS 128-140 bpm FHS 150-155 bpm

8 dpm 12 dpm 16 dpm 20 dpm 24 dpm 28 dpm 32 dpm 36 dpm 40 dpm

At 09.15 - 09.30 am At 09.30 - 09.45 am At 09.45 - 10.00 am At 10.00 - 10.15 am At 10.15 - 10.30 am At 10.30 - 10.45 am At 10.45 - 11.00 am

UC (-) UC rarely UC rarely UC rarely UC rarely UC 8-9'//10-15" UC 8-9'//10-15"

FHS 155-165 bpm FHS 165-170 bpm FHS 105-120 bpm FHS 110-120 bpm FHS 100-115 bpm FHS 90-110 bpm FHS 90-105 bpm

44 dpm 48 dpm 52 dpm 60 dpm 60 dpm 60 dpm 60 dpm

At 11.00 am Vaginal examination : Soft thick portio axial position one finger cervix dilatation non intact membrane slight cephalic presentation H I Diagnosis: G1P0A0 28 years old fullterm of pregnancy first stage of labor + mild preeklampsia + anemia Intrauterine fetal singleton alive cephalic presentation + fetal distress Management: Stop oxytocin drip Intrauterine resusitation Caesarean section Counseling Informed consent Counseling IUD post placental Blood was prepared Observation Vital Sign, UC, FHS Consulted to supervisor advice : cesarean section At 11.00 - 12.00 am At 12.00 - 01.00 pm At 01.00 - 02.00 pm UC 8-9'//10-15" UC 8-9'//10-15" UC 8-9'//10-15" FHS 110-115 bpm FHS 95-115 bpm FHS 90-110 bpm meconium

Operation delayed due to family preparation At 02.00 pm : The mother was brought to the operation theatre At 02.40 pm : Operation was begun, low segment cesarean section was performed At 02.50 pm : Male baby was born BW 3600 grams, BL 50 cm AS 5-7 Ballard score 40-42 weeks, Clifford sign grade II, placental infarc 20% Continue with IUD post placental insertion At 03.50 pm :Operation finished

Up to now the mother are in good conditions (Hb 12,9 g%), and baby still in transisition room