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Patient Husband
Name : Mrs. T Name : Mr. A
Age : 29 years old Age : 32 years old
MR No. : 01010083 Occupation : Enterpreneur
Date : March 15th, 2018 Education : Senior High School
Education : Senior High School
Chief Complaint
• A 29 years old patient was admitted to the
Emergency Room of Dr. M. Djamil Central
General Hospital on March 15th, 2018 at
05:00 pm referred by Health Care Bungus at
Padang with diagnosed: G2P0A1H0 37-38 weeks
of term pregnancy + severe preeclampsia on
regimen MgSO4 maintenance dose
Present Illness History
Patient routine control HC Bungus in Padang and found the blood
preasure 180/120 mmHg. Patient got antihypertension
(metildopa 500 mg), regiment MgSO4 initial dose, and
maintenance dose, then she was referred to RSMJ with regiment
MgSO4 and catheter urine.
Feeling headache (-), blur vision (-), epigastric pain (-)
Bloody show from the vagina was abcent
There was no massive vaginal bleeding
Amenorrhea since ± 9 months ago
First date of last menstrual : June, 21th 2017
Estimation date of delivery : March, 28th 2018
Fetal movement was felt since ± 5 months ago
• No complain of nausea, vomiting, or vaginal
bleeding neither during early nor late
pregnancy
• Prenatal care to HC Bungus 3 times on 2, 5,
and 8 month of pregnancy, there was no
hypertension before
• Menstrual history : menarche at 13 years old,
irregular cycle, 5-7 days each cycle with the
amount of 2-3 times pad change/day without
any menstrual pain
Previous Illness History
• There was no previous history of heart, lung, liver, kidney
disease, DM, hypertension and allergy
GA Cons BP HR RR T
Mdt CMC 160/110 98 22 36,7
Genitalia
• Inspection : V/U within normal limit
USG
• Fetal alive, singleton,intra uterine, head presentation.
• Fetal movement (+)
• Biometrics :
BPD : 91,2 mm
AC : 305 mm
FL : 72,5 mm
EFW : 2720 gr
• DSP 3cm
• Placenta was implant at uterine fundal grade II
• Impression : 37-38 weeks of term pregnancy
Fetal alive, head presentation
CTG
Ophtalmologist
Diagnose
• Mild fundus eclampsia has found
Internist
Diagnose
• Severe preeclampsia on therapy
Plan
• Metildopa 3x500 mg
• Tolerance operation
– Metobolic risk : mild
– Pulmoner riak : mild
– Cardiovasculer : mild-moderate
– Hematologic : stabil
Diagnose :
• G2P0A1L0 37-38 weeks of term pregnancy +
severe preeclampsia in maintenance doses of
MgSO4 regimen from other institution
• Fetal alive, singleton, intrauterine, head
presentation H1
Management :
• Control GA, VS, Σ urine, fluid balance, patella reflec
• continue MgSO4 regimen maintenance dose
• Informed consent
• O2 4 l/’ Nasal
• Check complete blood test + urine + hepar, kidney,
haemostatic
• Antihypertention
– Metil dopa 500mg
• Antibiotics Skin test (Ceftriaxon 1gr)
• Report to PE team
• Report to operation room
• Consult to anestesiologyst
Plan :
• Emergency CS
At pm : TPPCS was performed
At pm : (17.30)
• A male baby was born by TPPCS with 2700 gram in
weight, 46 cm in height, Apgar score : 7/8.
• Placenta was born with a light traction on umbilical
cord, complete, 1 piece. Size was 15 x 14 x 2 cm, weight
500 gram, length 50 cm.
• Bleeding during operation 200 cc
Diagnose
• P1A1L1 post TPPCS on indication of severe preeclamsia on
MgSO4 regiment maintenance dose from other
institution
• Mother in care, child good condition
Plan
• Control GA, VS, FHR, Σ urine, fluid balance,
patela reflec
• Continue MgSO4 regiment maintenance dose
• Ceftriaxone 2x1 gr i.v
• Metildopa 3x500 mg
• Ketoprofen Supp II
Thank You