IDENTITY

Name
Age MR No. Date

: Mrs. F : 26 years old : 84 28 28 : Sept 22th, 2013

Anamnesis
A 26 years old patient was admitted to the Emergency Delivery Room of Dr. M. Djamil Central General Hospital on Sept 22th 2013 at 08.15 am with chief complain massive vaginal bleeding since 1 days ago.

Present Illness History

Massive vaginal bleeding since 4 hours ago, light red

colored, wetting 1 piece of pad, abdominal pain (-) Feeling of pain from waist to region which referred to the groin was negative. Fluid leakage from the vagina was absent. Amenorrhea since 9 months ago. First date of last menstrual period was Dec 16 2012 Estimation date of delivery was Sept 23 2013 Fetal movement was felt since 5 months ago.

 Early pregnancy history : nausea (-), vomiting (-), vaginal

bleeding (-) Late pregnancy history : nausea (-), vomiting (-), vaginal bleeding (+) spotted 1 piece of underwear Prenatal care to midwife regularly every month, start 2nd month of pregnancy. Menstrual History : menarche at 13 years old, regular cycle 1x 28 day for last 3 cycle, which last for 5 to 7 days each cycle with the amount of 2-3 times pad change/day without menstrual pain. Previous Illness History : There wasnt any previous history of heart, lung, liver, kidney, DM hypertension, or allergy Family Illness History : There wasnt any history of hereditary disease, contagious and psycological illness run in the family

 Marital history : once, in 2004 History of pregnancy/abortion/delivery : 2/0/1 1. 2005, male, 4200 gr, term, spontaneous delivery, midwife, alive 2. Present pregnancy History of family planning : none

History of immunization : twice time TT injection

Education : Senior high School graduated Occupation : Housewife

 Physical Examination : GA Cons BP HR RR Mdt CMC 110/60 88 20

T 36.5

BW Before/after : 54 kg/75 kg BH/BMI : 164 / 20 Kg/M2 Normoweight Eyes : Conjunctiva wasnt anemic, Sclera wasnt icteric Neck : JVP 5-2 cmH2O, no enlargement on thyroid glands Chest : heart/lungs within normal limits Abdomen : OR Genitalia : OR Extremity : Oedema -/-, Physiological Reflex +/+, Pathological Reflex -/-

OBSTETRIC RECORD
Abdomen

I
Pa

: : Enlarge according to term pregnancy, median line hyperpigmentation, striae gravidarum (+), cicatrix (-) : L1 : Uterine fundal was palpable 3 fingers below Proc. Xyphoideus A large and nodular mass was palpated L2 : A hard and resistance structure was felt on the left side Numerous small and irregular structures were felt on the right side L3 : A hard mass was palpable, floating L4 : didnt performed Uterine Fundal Height : 33 cm, Estimated fetal body weight : 3100 gr Uterine contraction : -

 Pe : Tympani Au : Peristaltic sound was normal

Fetal Heart Rate : 142 x 158x/mi Genitalia : I: V/U normal, vaginal bleeding (+) Inspeculo : Vagina: Tumor (-), Laceration (-), Fluxus (+), theres light red blood in the fornix posterior Portio : MP, size equal to an adult foot toe, tumor (-), laceration (-), fluxus (+), theres blood leakage from cervical canal, OUE closed

Laboratory Findings : Hemoglobin Leucocyte Hematocrit Trombocyte MCH MCV MCHC

: 12.9 gr% : 10.700/mm : 39 % : 160.000/mm3 : 30,4 pg : 92 um3 : 33,2 g/dL

Cardiograph
Baseline

: 140 bpm Variability : 5 10 bpm Acceleration : (-) Desceleration : (-)

Impression : reactive CTG

Ultrasound
Fetal alive, singleton, intrauterine, head presentation Fetal movement was good Biometrics :

BPD : 94,1 mm AC : 355 mm

FL : 72,8 mm EFW: 3392 gr

Placental implaned in posterior corpus extends down and

closed the OUI Impression : a term pregnancy fetal alive total placenta previa

Diagnose : G2P1A0L1 term pregnancy 39-40 weeks + HAP due to total placenta previa Fetal alive, singleton, intra uterine, head presentation, floating Management : Control general condition, vital sign, FHR, Uterine Contraction Informed consent Crossmatch, prepare blood transfusion Routine blood count Antibiotics (skin test) Consult to Anesthesiologist Report to OR Plan : Emergency CS

At 11.15 am TPPCS was performed A female baby was born with 3200 gr in weight, 50 cm in height and Apgar Score : 8/9 Placental implaned in posterior corpus extends down and closed the OUI Placenta was delivered with mild traction of umbilical cord, with size 17 x 17 x 3.5 cm and weight 550 gr. Umbilical cord was 60 cm in lenght, paracentral insertion.
Blood loss during surgery 300 cc

 D/ P2A0L2 post TPPCS on indication HAP due to

Total placenta previa both Mother and Child were in care

A/ Post surgery monitoring

THANK YOU