CR Bangsal Gin Fta 31.05.19 Rabu

Gynecology Inpatient Report
Friday, May 24th 2019 - Thursday, May 30th 2019
Dr. Fitrah Tindar Atthaariq
Supervisor:
Dr. H. Patiyus Agustiansyah, SpOG(K), MARS
Gynecological Inpatient Resident
Oncology
Dr. Idries Tirta Husada
Dr. Dwi Antono Dahlan
Urogynecology
-
FER
-
Gynecology
Dr. Riyan Wira Pratama
Dr. Andini Zuitasari
Dr. Rivai Baharuddin
Dr. Imas Kartika Dewi
Patient Recapitulation Gynecology
Inpatient Report
• Urogynecology : 2 patients
• FER - Gynecology : 7 patients
• Oncology : 17 patients
Total : 26 patients
Friday Saturday Sunday Monday Tuesday Wednesday Thursday
Total
Mei 24th Mei 25th Mei 26th Mei 27tH Mei 28th Mei 29th Mei 30th
ONCOLOGY
Total at
May 23h 38 34 30 33 34 37 36 36
Admission 0 0 3 1 3 0 0 7
Discharge 4 4 0 0 0 0 0 8
Passed away 0 0 0 0 0 1 0 1
REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY
Total at
May 23th 1 2 2 2 2 2 2 2
admission 2 2 0 1 0 2 0 7
Discharge 1 2 0 1 0 2 0 6
Passed away 0 0 0 0 0 0 0 0
Friday Saturday Sunday Monday Tuesday Wednesday Thursday
Total
Mei 24th Mei 25th Mei 26th Mei 27tH Mei 28th Mei 29th Mei 30th
UROGYNECOLOGY
Total at
May 23h 2 2 2 0 0 0 0 0
Admission 2 0 0 0 0 0 0 2
Discharge 2 0 2 0 0 0 0 4
Passed away 0 0 0 0 0 0 0 0
GYNECOLOGY
Total at
May 23h 5 3 2 0 4 4 5 5
Admission 0 0 0 4 0 1 0 5
Discharge 2 1 2 0 0 0 0 5
Passed away 0 0 0 0 0 0 0 0
TOTAL GYNECOLOGY INPATIENT
Previous week
46
(16th – 23rd May 2019)
admission 21
discharge 23
PASSED AWAY 1
Current Week
43
(24th – 30th May 2019)
WEEKLY RECAPITULATION OF GYNAECOLOGY INPATIENT DIAGNOSIS
Diagnosis Jumlah
Hydatidiform mole abortion 1
Ovarian Cancer 7
Ovarian cyst 1
Dysmenorrhea c.b Endometriosis Cyst 2
Cervical Cancer 6
GTN 2
Solid Ovarian Neoplasm 3
adenomyosis 1
Ectopic Pregnancy 1
First Trimester Pregnancy 4
Imminens Abortion 1
Uterine prolaps + Cystocele + Rectocele 2
TOTAL 31
WEEKLY RECAPITULATION OF GYNAECOLOGY PROCEDURE
PROCEDURE AMOUNT
Chemotherapy 11
Surgical staging 2
Laparotomy
Total Hysterectomy 2
HDLO 2
curettage 1
TVH 2
Admission
No. Patient’s ID ICD 10 Management ICD 9 Recent Diagnosis Condition Physician
Diagnosis
Friday, May 24th 2019
Ovarian cancer
C56.9 -PRC, TC transfusion
Mrs.YUS/61/U progressive disease 99.00 Ovarian cancer
1 D64.9 -Chemotherapy docetaxel- Stable in Ward IS
A/P2A0 + moderate anemia 99.25 progressive disease
D69.6 carboplatin 5th course
+ thrombocytopenia
Ovarian cancer
C56.9 -PRC, TC transfusion)
Mrs.PAK/51/R stage III C 99.00 Ovarian cancer
2 D64.9 -Chemotherapy docetaxel- Discharge AT
A/P3A0 +moderate anemia 99.25 stage III C
D69.6 Carboplatin 6th course
+ thrombocytopenia
GTN stage I FIGO -PRC transfusion

Mrs.LIN/32/ O01.9 99.00 GTN stage I FIGO
3 score 3 + moderate -Chemotherapy MR 6th Stable in ward IS
UA/P1A1 D64.9 99.25 score 3
anemia course
Admission
Diagnosis
Ovarian cancer -PRC transfusion

Mrs.ROZ/51/U C56.9 99.00 Ovarian cancer
4 stage III C + -Chemotherapy BEP 4th Discharge RS
A/P0A2 D64.9 99.25 stage III C
moderate anemia course
Mrs. MEL/47 Ovarian cancer Laparatomy Surgical Ovarian Cancer Stable in

5 N83.2 54.1 AT
Yo/RA inadequate staging Staging Clinically stage IV Ward
Post TVH + round

ligament fixation +
anterior and
Uterine prolaps ASH
N89.7 TVH + round ligament 68.22 posterior
Mrs.NON/69 y grade IV+ ITW
6 N85.7 fixation + anterior and 70.51 colporrhaphy discharged
o/RA/P4A0 Cystocele grade III AF
Q52.12 posterior colporrhaphy 70.52 o.i Uterine prolaps
+ Rectocele grade II RK
grade IV+
Cystocele grade III
+ Rectocele grade
II
Admission
Diagnosis

Post Anterior +
posterior
Mrs. ROM/ 69 Cystocele grade II colporaphy
ASH
+ rectocele grade III N89.7 Anterior + posterior 70.51 o.i Cystocele grade
7 yo/P4A2/ discharged ITW
+ Controlled Type 2 N85.7 colporaphy 70.52 II + rectocele grade
RA RK
Diabetes Mellitus III + Controlled
Type 2 Diabetes
Mellitus
Post Hysteroscopy
Dismenorrhea c.b diagnostic +
• Hysteroscopy
Mrs. PAR/28 endometriosis was N80.0 65.6 Laparoscopy ASH
8 diagnostic Discharge
YO / P0A0 suspected + primary N97.9 54.5 diagnostic KY
• Laparoscopy diagnostic
infertile 8 years + bilateral patent
tube
Admission
Diagnosis
Saturday, May 25th 2019
Post mole
evacuation o.i.
Mrs. ROK/ 48 Hydatidiform mole
1 O01.0 Mole Evacuation hydatidiform mole Discharge AT
YO/ RA abortion 69.0
abortion
Admission
Diagnosis
Post Laparotomy
Adhesiolysis Adhesiolisis o.i
Cyst ovarian Laparatomy hysterectomy 54.5 pseudocyst +
Mrs. SOL/40 neoplasm N83.2 totalis 68.9 internal genital Stable in
2 IS
Yo/UA malignancy was wound drain 86.04 adhesion + post ward
suspected laparotomy
hysterectomy o.i
right cyst bleeding
• Endometriosis
ASRM gr I
Dysmenorrhea e.c
(ASRM score
suspected N80
Mrs YUL/28 HDLO 2 + EFI Score
3 endometriosis + N73.6 68.12 Discharge KY
Yo/P0A0 6)
primary infertility
• Non paten tube
2 years
bilateral
Admission
Diagnosis
Sunday, May 26th 2019
Suggestive
reccurent cervical - P/ Chemotherapy Suggestive reccurent
cancer with Paclitaxel-carboplatin 1st 99.00 cervical cancer with
KAR/ 62 yo/ C53.9
1 series 99.25 Stable in ward AT
UA/ AT intahepatic and C79 intahepatic and
- P/ radiotherapy 92.23
spinal cord - Join care with neurologist spinal cord metastase
metastase
Post laparascopy
Hysterectomy per
Mrs. ARL/42 Abdominal Uterine N85.0 o.i endometrium Stable in ward
2 Laparascopy 68.12 IS
Yo/RA Pain c.b M1 hyperplasia
Adenomiosis + left
endometrial cyst dd/
Cyst ovarian
Post TAHBSO o.i
neoplasm left 65.6
Mrs. MIN/43 - TAHBSO TOA bilateral with Stable in ward
3 multiloculare N80.0 54.5 AT
Yo - Adhesiolysis adenomyom
malignancy was
suspected +
endometriosis
bilateral tube
Admission
Diagnosis
Monday, May 27th 2019
-leucogen injection
Cervical cancer 99.00 Cervical cancer
Mrs.SEV/74/U C53.9 -chemotherapy paclitaxel- Stable in Ward
1. stage 99.25 stage AT
A/P0A0 D72.819 carboplatin 4th course
III B + leucopenia 92.23 III B
-P/Radiotherapy
Cervical cancer -Admission (PRC
C53.9 transfusion) 99.00 Cervical cancer
Mrs.RUS/48/R stage Stable in Ward
2. III B + moderate D64.9 -chemotherapy Paclitaxel- 99.25 stage AT
A/P2A0
anemia D69.6 carboplatin 4th course 92.23 III B
-P/Radiotherapy
G3P1A1 13 weeks G3P1A1 13 weeks
Mrs. ULI /26 gestational age with O15.0 gestational age with
3 Cygest 400mcg/24 h PO 89.09 Stable in Ward HE
yo/ UA/ FB burst abdomen T81.31 burst abdomen SLF
SLF intrauterine intrauterine
G4P3A0 7 weeks
Mrs. YUN/ 29 Post Curretage oi
4 gestaional age with O46.02 Plan for curettage V58.83 discharged HE
yo/ UA/ HE insipien abortion
insipien abortion
Admission
Diagnosis
Tuesday, May 28th 2019
-Admission (PRC, plt

Ovarian cancer transfusion, leucogen Ovarian cancer
Mrs.NUR/52/R C56.9 99.00
1 stage IV A + injection) stage IV A + mild Stable in ward AT
A/P4A0 D61.81 99.25
pancytopenia -Chemotherapy paclitaxel- anemia
carboplatin 3rd course
-Admission (Plt
transfusion)
Cervical cancer 99.00 Cervical cancer
Mrs.SUW/58/R C53.9 -Adjuvant chemotherapy
2 stage III B + 99.25 stage III B + Stable in ward RS
A/P4A D69.6 Paclitaxel-carboplatin 2nd
thrombocytopenia 92.23 thrombocytopenia
course
-P/ Radiotherapy
-Admission (PRC
Ovarian cancer
Mrs.JUM/52/R C56.9 transfusion) 99.00 Ovarian cancer
3 stage I C + mild Stable in ward IS
A/P5A0 D64.9 -Chemotherapy docetaxel- 99.25 stage I C
anemia
carboplatin 3rd course
Cervical cancer -Admission (PRC

transfusion) 99.00 Cervical cancer
Mrs.RUS/48/R stage C53.9 -chemotherapy Paclitaxel- stage
4 III B + moderate 99.25 Stable in ward AT
A/P2A0 D64.9 carboplatin 5th course III B
anemia 92.23
-P/Radiotherapy
Admission Recent
No. Patient’s ID ICD 10 Management ICD 9 Condition Physician
Diagnosis Diagnosis
G4P2A1 8 weeks P2A2 Post

Mrs. YUN/ 31
5 gestaional age with O46.02 • Curettage 69.02 Curettage o.i Discharge HE
Yo / UA
insipient abortion insipient abortion
Admission
Diagnosis
Wednesday, May 29th 2019
Post right
Ruptured ectopic D69.3 Bed rest total salphyngectomy
Mrs. WIN/ 26
1 Observation Vital Sign 99.1 Stable in Ward FB
yo/ RA/ FB pregnancy A91 o.i. fimbriae
US Confirmation
ruptured
1. Mrs.YUS/61/UA/P2A0 BACK
S/ Plan for chemotherapy

Last chemotherapy (Docetaxel-carboplatin 4th course) was in 1/5/19.
Patient have received radiotherapy (10x) in 29/1/19-12/2/19.
Surgical staging in 31/10/16,RSMH (4665/A/2016):
I.Non specific chronic cervicitis with ovula nabothy cyst
-Uterine adenomyosis
-High grade serous carcinoma in the ovarium 1
-Multiple simple cyst in the ovarium 2
-Salpingitis in both Fallopian tubes
II.Metastasis high grade serous carcinoma in the 2 of the right pelvic lymph nodes
III.Metastasis high grade serous carcinoma in the 2 of the left pelvic lymph nodes
IV.Metastasis high grade serous carcinoma in the omentum
V.Metastasis carcinoma in the intraabdominal fluid cytology
Patient was diagnosed with ovarian cancer stage III C and completed chemotherapy docetaxel-
carboplatin 6 course in 28/2/17.
Lab result (23/2/17): CA 125=44,68
Secondary debulking in 7/3/18, RSMH (1040/A/2018):
I.II.III.Metastatic carcinoma in the peritoneum, colon and ascites
Patient was diagnosed with ovarian cancer progressive disease and completed chemotheraphy
Paclitaxel-Carboplatin 6 course in 29/9/18.
CT Scan (4/12/18):
-Infiltration/metastasis in the anterior lower peritoneum, mesenterium, regional lymph nodes, minimal
ascites in the cavum pelvis, no infiltration to the urinary bladder and rectum
-No intrahepatal and spleen nodules, no hydronephrosis, normal excretion function of both kidney
O/ s : compos mentis, BP: 120/80 mmHg, P: 80 x/mins, RR: 20 times/min, T 36,6

Abdominal palpation: flat, supple, symmetrical, tenderness (-), free fluid sign (-), mass (-)
Speculum examination : vaginal vault (+) in normal limit
Vaginal toucher: vaginal vault (+) in normal limit
RT: adequate anal sphincter tone, smooth mucosa, empty ampulla of recti, intraluminar mass (-)
US result (20/2/19):
-Post radical HT SOB
-No new mass in the pelvis
-Pseudocyst ec susp adhesion
-Ascites
Lab result (30/10/18): AFP=15,67 CEA=1,4 CA 125=158,2
Lab result (8/1/19): AFP=16,6 CEA=0,9 CA 125=2.130,4
Lab result (19/2/19): CA 125=1.328,4
Lab result (20/3/19): AFP=13,54 CEA=1,3 CA 125=1.460,5
Lab result (30/4/19): CA 125=400,8
Lab result (23/5/19): Hb=8,8 WBC=4,21 Plt=26 CA 125=296,8
A/ Ovarian cancer progressive disease + moderate anemia + thrombocytopenia
P/ Admission (PRC, plt transfusion)

Chemotherapy docetaxel-carboplatin 5th course
2. Mrs.PAK/51/RA/P3A0 BACK
S/Plan for chemotherapy

Last chemotherapy (docetaxel-carboplatin 5th course) was in 26/4/19.
Surgical staging result 27/12/18,RSMH (5417/A/2018):
A.VC Tissue
-Mucinous borderline tumor in the left ovarium with focal intraepithelial carcinoma lesion
-No abnormality of left Fallopian tube
B.Remaining VC
I.-Ovula nabothy cyst of cervix
-Endometrial polyp and adnomyosis and myomatous uterus
-Follicle cyst in the right ovarium
-Simple paratubal cyst in the right Fallopian tube
II.Non specific chronic omentitis
III.Sinus histiocytes in the 5 of the right pelvic lymph nodes
IV.Sinus histiocytes in the 9 of theleft pelvic lymph nodes
V.Non specific chronic inflammation of the left paracolical
VI.Early acute appendicitis
VII.Borderline mucinous tumor in the tumor fluid cytology
O/Sens : compos mentis, BP: 110/70 mmHg, P: 84 x/mins, RR: 18 times/min, T: 36,5 oC
Speculum examination : vaginal vault (+) in normal limit
Vaginal toucher: vaginal vault (+) in normal limit
RT: sphincter ani tone was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-)
Lab result (19/9/18): AFP=1,93 CEA=1.277,8 CA 125=118,2
Lab result (23/5/19): Hb=9,0 WBC=4,77 Plt=91 Ur/Cr=15/0,7
A/Ovarian cancer stage III C + moderate anemia + thrombocytopenia
P/ Admission (PRC,plt transfusion)

Chemotherapy docetaxel-Carboplatin 6th course
3. Mrs.LINN/32/UA/P1A1 BACK
S/ Plan for chemotherapy

Last chemotherapy (MR 5th course) was in 9/5/19.
Patient underwent curettage by SpOG but no histophotologic result 2 months ago.
Patient was admitted to Emergency Unit RSMH with complaint about vaginal bleeding with 3 pads/day.
Patient then diagnosed with GTN stage I FIGO score 3 and received chemotherapy MR 1st course in
14/3/19.
O/Sens : CM , BP 120/80 mmHg, Pulse 80 bpm, RR 20 times/min, T 36.5
Abdominal palpation: flat, supple, symmetrical, fundal height unpalpable, tenderness (-), free fluid sign
(-), mass (-)
Speculum examination : not livide portio, closed OUE, fluor (-),fluxus (-), erosion/laceration/polyp (-/-/-)
Vaginal toucher: firm portio, closed OUE, CUT~normal, both of AP wasn’t tense, douglas pouch not
protrude
RT: sphincter ani tones was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-),
CUT~normal, both of AP wasn’t tense
Lab result (23/5/19): Hb=8,7 WBC=6,93 Plt=378 B-HCG=1,44
A/ GTN stage I FIGO score 3 + moderate anemia
P/ Admission (PRC transfusion)

Chemotherapy MR 6th course
3. Mrs.LINN/32/UA/P1A1 BACK
21.097 (2/3/19)
302 (20/3/19)
76,04 (5/4/19)
20,66 (23/4/19)
7,45 (8/5/19)
1,44 (23/5/19)
4. Mrs.ROZ/51/UA/P0A2 BACK
S/ plan for chemotherapy

Last chemotherapy (BEP 3rd course) was in 10/5/19.
Surgical staging in 25/2/19,RSMH (777/A/2019):
A and B.Adult granulose cell tumor in both ovarium, invading to the omentum and ascites fluid
-No sign of malignancy in both Fallopian tubes
Abdominal palpation: flat, supple, symmetrical, fundal height unpalpable, tenderness (-), free fluid sign
(-), mass (-)
Speculum examination : not livide portio, closed OUE, fluor (-),fluxus (-), erosion/laceration/polyp (-/-/-)
Vaginal toucher: firm portio, closed OUE, CUT~normal, douglas pouch not protrude
RT: sphincter ani tones was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-)
Lab result (24/5/19): Hb=9,1 WBC=6,59 Plt=131
A/ Ovarian cancer stage III C + moderate anemia

Chemotherapy BEP (bleomysin-etoposide-platosin) 4th course
Mrs. MEL/ 47 YO/ P1A0 BACK
Anamnase Physical Examination and supportive exam Diagnosis and

Planning
CC : Post menopause Menstrual : Post HTSOB (2018) Diagnosis:
abdominal pain along with Marrital : Married 1x, 18 years Inadequate staging
shortness of breath Obstetric : P1A0 ovarium cancer +
cancer pain (Score
Since 1 week before Prior operation : 1)
admission, patient has been 2018 - HTSOB(Baturaya Hospital), PA 3138/III/2018 Result: low grade uterine
complaining about leiomyoma Planning :
continuous entire Physical examination : Surgical Staging
abdominal pain along with BP : 120/80 mmHg, HR :88x/m, RR: 20x/m, T: 36,5ºC Laparotomy
shortness of breath that General status : Normal
wasn’t diminished even Doctor in charge :
when patient was having Gynecologic status : AT
rest. Abdomen : Raised, tense, symmetrical, tenderness (-), free fluid sign (-), mass hard to
assess, fundal of uterine ~ post HTSOB
Mrs. MEL/ 47 YO/ P1A0
BACK

Planning
USG Confirmation :
˗Non-visualized uterus and both adnexa, appropriate with post HTSOB
˗Solid mass in the pelvic cavity with subhepatic Ri = 0.02, suspected for growth
of new malignant mass
˗Massive ascites
˗Liver and both kidney in normal condition
Conclusion: growth of new malignant mass
Laboratory examination :
Hb :12,2 WBC 9230 PLT 565.000 GDS 103.
Cr 1,37 Ur 34
PT 12.10 INR 1.10 APTT 31,7
AFP 1,34 CA 125 187,2
Mrs. MEL/47 Yo/RA/P1A0 BACK
Procedure Case Outcome

• Laparatomy Surgical Mrs. MEL/47 Yo/RA/P1A0 04.00 PM: Operation started.
Staging • Patient on supine position and on general anesthesia.
Preop diagnosis: • Aseptic and antiseptic on operating area.
ICD 10 Ovarian cancer inadequate staging • Mediana incision.
N83.2 • After peritoneum was opened,
Post op diagnosis: • There is right ovarian solid mass size 16x14 cm that adhesion with
ICD 9-CM Ovarian Cancer Clinically stage III.C omentum  Perform Adhesiolysis  Success  Perform right
54.1 Salphingooforectomy  PA
68.4 • Perform Total Hysterectomy + left salphingooforectomy  PA
65.5 • Perform Bilateral Lymfadenectomy Pelvic  PA
40.5 • Perform Total Omentectomy  PA
86.04 • Perform Stab wound drain
• Ensured there was no active bleeding, abdominal wall was closed
OP : layer by layer.
Dr. H. Patiyus • Bleeding intraoperative 1300 cc, urine 150 cc clear.
Agustiansyah, OBGYN
(C) ,MARS 06.00 PM: Operation was finished.
BACK
BACK
BACK
•1. Mrs.NON/69 yo/RA/P4A0/AF
Procedure No Case Outcome
BACK
TVH + round ligament 1 Mrs.NON/69 10.00 AM operation begin
fixation + anterior and -Incision of posterior vaginal wall, identifying sacrospinous lig,
yo/RA/P4A0
posterior colporrhaphy placing a suture with prolene 1
-Clamping the anterior and posterior introitus
Preop diagnosis: -Hydrodissection with ephedrine solution
ICD 10
Uterine prolaps grade
N89.7 -Blunt dissection to the vesicovaginal junction, separating the
IV+ Cystocele grade III
vesicouterine pouch
N85.7 + Rectocele grade II
-Clamping, cutting and suturing the sacrouterine ligaments
Q52.12 -Clamping , cutting and suturing the cardinale ligaments and
ICD 9-CM Post op diagnosis: uterine vessels
68.22 Post TVH + round -Clamping , cutting and suturing the round ligaments
70.51 ligament fixation + -Clamping cutting and suturing the tubes and ovariiproprium
anterior and ligaments
70.52
posterior - Perform colpopexi by suturing the round ligaments, tubes and
colporrhaphy ovariiproprium ligaments side by side then fixsation on a top of
Dr. H.Amir Fauzi o.i Uterine prolaps vaginal vault
OBGYN(C), PhD- dr Ratih grade IV+ Cystocele -The vaginal wall is sutured continuously
Krisna, OBGYN(C) grade III + Rectocele Perform anterior and posterior colporaphy by longitudinal incison
grade II in anterior and posterior vagina, Blunt dissection to the
vesicovaginal junction , separating the vesicouterine pouch and
cutiing the vagina perineomucocutan, vaginal mucous sutured with
matras sutured with PGA2.0
The vaginal wall is sutured continuously
10.40 AM operation finished
Identity 2. Mrs.NON/69 yo/RA/P5A0 BACK
Chief complained Vaginal lump
History About 4 years before admission, patient complained about vaginal lump that can still
put back in, vaginal lump came out if patient cough, and straining. 6 months before
admission patient complained about vaginal lump that can't put back in. Patient
denied any history of vaginal discharge. Patient had normal bowel habits but felt no
contentment on mixturition. patient then came toMyria Hospital andreffered to
RSMH.
Reproduction status Menopause 13 years
Marital status 1x 53 years, P5A0
Physical examination BP : 130/80 mmHg, HR : 88x/m, RR: 20x/m, T: 36,5ºC
Gynecologic status : Inspection: flat, supple, symmetric, uterine fundal unpalpated, mass (-), pain (-
),mobile,abdominal tenderness (-),free fluid sign (-)
Vaginal inspection exam: Vaginal lump (+), portio was not livide, OUE was closed,
fluor (-), fluxus (-), E/L/P (-) ~ POP Q
Diagnosis Uterine prolaps grade IV+ Cystocele grade III + Rectocele grade II
Planning TVH + SSF +Anterior and posterior colporrhaphy

BACK
+10 +9 +8 +7 +6 +5 +4 +3 +2 +1 0 -1 -2 -3 -4 -5 -6 -7 -8
Aa
Ba
C C
TVL
Ap
Bp
Aa Ba C
+3 +5 6
Gh Pb TVL POP Q
2 2 8
Ap Bp D
+3 +2
•2. Mrs. ROM/ 69 yo/P4A2/RA/RK
Procedure N Case Outcome
BACK
o
Anterior + posterior 2 Mrs. ROM/ 69 11.00 AM operation begin
colporaphy perform hydrodissection with ephedrine solution
yo/P4A2/RA
-sharp and blunt dissection of vaginal mucous to 2 cm
ICD 10 cephalard
-- perform aspiration with needle --> dark red blood came out
N89.7
-- perform excison with needle guiding--> dark red blood
N85.7 Preop diagnosis: came out ±300 cc
Cystocele grade II + - vaginal mucous sutured with matras sutured with PGA2.0
ICD 9-CM rectocele grade III + The vaginal wall is sutured continuously
68.22 Controlled Type 2 - perform vaginal mold to the vaginal canal
Diabetes Mellitus 12.00 AM operation finished
70.51
70.52
Post op diagnosis:
Post Anterior +
posterior
Dr. Ratih Krisna,
colporaphy
OBGYN(C)
o.i Cystocele grade
II + rectocele grade
III
Identity 1. Mrs. ROM/ 69 yo/P4A2/ RA
BACK
Chief complained Vaginal lump
History About 2 years before admission, patient complained about vaginal lump that can still
put back in. Patien denied any history of vaginal discharge. Patient had normal bowel
habits but felt no contentment on mixturition. Patient has diagnosed with type 2
Diabetes Mellitus since 2 months ago and consume antidiabetic drug regularly.
Reproduction status Menopause 19 years
Marital status 1x 51 years, P4A2
Physical examination BP : 150/80 mmHg, HR : 88x/m, RR: 20x/m, T: 36,5ºC
Gynecologic status : Inspection: flat, supple, symmetric, uterine fundal unpalpated, mass (-), pain (-
),mobile,abdominal tenderness (-),free fluid sign (-)
Vaginal inspection exam: Vaginal lump (+), portio was not livide, OUE was closed,
fluor (-), fluxus (-), E/L/P (-) ~ POP Q
Laboratory Hb 12,5 Leuko 11.440 PLt 297.000 SGOT 16 SGPT 10 BSS 150 HbA1c 9.0 Ur 28 Cr 0,9
examination Na 145 K 3,7 Ca 9,0
Diagnosis Cystocele grade II + rectocele grade III + Controlled Type 2 Diabetes Mellitus
Planning Anterior and posterior colporrhaphy

BACK
+10 +9 +8 +7 +6 +5 +4 +3 +2 +1 0 -1 -2 -3 -4 -5 -6 -7 -8
Aa
Ba
C
TVL
Ap
Bp
Aa Ba C
0 0 -3
Gh Pb TVL POP Q
4 2 7
Ap Bp D
+3 +3 -4
BACK
Mrs. PAR/ 22 YO/ P0A0 BACK
• Hysteroscopy diagnostic Mrs. PAR/22 Yo/P0A0 10.00 AM: Operation started.
• Laparoscopy • Patient on supine position and on general anesthesia.
exploration Preop diagnosis: • Aseptic and antiseptic on operating area.
Dysmenorrhea c.b endometriosis • Empty the bladder
ICD 10 was suspected + primary infertile 8 • Perform the sondage uterus Ante flexi 7 cm
N80.0 years • Install the uterus manipulator
N97.9 • Perform exploration per laparascopy and found :
Post op diagnosis: • Hysteroscopy : Cervix, endocervix and endometrial in normal limit
ICD 9-CM There is no abnormality internal Bilateral ostium Tube (+) Bubble sign (+)
65.6 genitalia + bilateral patent tube C/ paten bilateral tubes
54.5 • Laparascopy : Uterus shape and size normal
Bilateral tube and fimbrae normal
OP : Bilateral ovarian normal
DR. Dr. H. Kms Yusuf Perform chromotubation  paten bilateral tubes
Effendi, OBGYN (C) •Ensured there was no active bleeding, abdominal wall was closed
11.00 PM: Operation was finished.

Mrs. PAR/ 22 YO/ P0A0 BACK
Planning
CC: Menstrual pain and Menstrual : Menarche 13 YO, irregular cycle Diagnosis:
irregular menstrual cycle Marrital : Married 1x, 8 years Dysmenorrhea
Obstetric : P0A0 c.n suspected
Since 1 year before endometriosis +
admission, patient has been Prior operation : - primary infertility
complaining about menstrual Physical examination : 8 years
pain especially on the first BP : 110/70 mmHg, HR : 84x/m, RR: 20x/m, T: 36,5ºC VAS 4-5
three days of her cycle. General status : Normal Planning :
Patient had normal urinary HDLO
routine and bowel habits. Gynecologic status :
Patient didn’t consumpt any Abdomen : Flat, supple, symmetrical, fundal of uterine not palpable, tenderness (-), free Doctor in charge :
analgetic drugs nor fluid sign (-), mass (+) KY
experience weight lost or loss
of appetite. Patient went to Vaginal Speculum exam: Portio non livide, closed OUE, fluor (+), fluxus (-), non active
AK Ghani Hospital and bleeding, E/L/P (-)
adviced patient for a visit to
Mohammad Hoesin Hospital. Vaginal Toucher: Elastic portio, closed OUE, CUT~normal, tense right and non tense left
AP, mass (+) nodules with 6x4x4 cm in sise
Previous illness: -
Rectal touche: adequate sphincter of ani, normal mucosa, empty ampula of the recti,
MIL (-)
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Mrs. PAR/ 22 YO/ P0A0
Planning
USG Confirmation :
˗Uterus AF, shape and size 5.1 x 2.5 cm
˗Homogen myometrium, regular basal stratum
˗Endometrial line (+)
˗Portio and endocervix in normal condition
˗Both of ovarium non visual
Conclusion: No abnormalities of internal genitalia organ
Hb 14.6 WBC 7300 PLT 331.000 PT 14 INR 1.10 APTT 29.8 Fibrinogen 333.0
D-dimer 3.31 SGOT 19 SGPT 20 Alb 4.1 GDS 93 Cr 0.84 Ur 17.
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Identity Mrs. ROK/ 48 yo/ RA/ AT
Desember 07th, 2018 Early pregnancy with vaginal bleeding
at 03.33 PM
Chief complain
History 12 hours before admission, patient complained about vaginal bleeding, fresh blood, changing 2
times pad / day, history of expulsing tissue like cystic part (-). Abdominal contraction (-), nausea
(+), vomitus (-), breast tense (+). Patient came to Kayu Agung Hospital, and was referred to Moh.
Hoesin Hospital. She didn’t had menstrual cycle since 4 months. Patient admitted thar her
pregnacy is bigger than her gestational age.
Marital status 1x, 32 years
Reproduction status Menarche since 14 yo, regular 28 days cycle, for 4 days. LMP : forget
Obstetric history 1. 1992, abortion, 8 weeks, not curettage
2. 1993, abortion, 8 weeks, not curettage
3. 1994, female, 2700 g, fullterm, traditional birth attendant, healthy
6. 2008, female, 2700 g, fullterm, midwife, healthy
7. 2011, female, 2800 g, fullterm, Kayu Agung Hospital, healthy
8. Current pregnancy
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Physical examination BP : 230/140 mmHg, P: 146 x/min, T: 35.5 C, RR : 21 x/min, BW 65 kg, BH 159 cm
Obstetrical Inspection & Palpation: Flat abdominal, symmetrical, fundal height 1/2 umbilical-symphysis
examination pubic, mass (-), tenderness (-), free fluid sign (-)
Inspeculo : Portio livide, closed OUE, fluor (-), fluxus (+) bleeding not active, E/L/P (-)
VT: portio soft, closed OUE, cervical motion tenderness (-), CUT ~ 18 weeks, AP right/left not
tense, cavum douglas not protruded
US ER (DRI) - There is uterine size bigger than normal, 9,7x6,1 cm

- There is vesicular mass avascular in uterine cavity like honey comb apperance size 6,6x4,9 cm,
hydatidiform mole was suspected
- Both adnexa in normal limit
- Liver dan kidney in normal limit
C/ Hydatidiform mole was suspected

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Laboratory Hb: 13,8 g/dl, WBC 8.210/ mm3, PLT 260.000/mm3, DC 0/1/69/24/6
examination Total bilirubin 0,60; SGOT/SGPT: 15/12, Albumin 4,5; GDS 132; Ur/Cr: 15/0,73
Ca 10,0; Na 146; K 3,1
Free T3 2,68; Free T4 0,95; TSH 01,0707
Blood Beta-HCG : 38072,24
Diagnosis Hydatidiform mole was suspected + emergency hypertension
Therapy • Vital sign, bleeding observation

• Laboratory examination
• IVFD RL xx drops/m
• P/ Mole evacuation
• Assessment internal medicine departement
• Drip Nicardipine
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Internal Medicine A/
Departement - Emergency hypertension on therapy
- Euthyroid
P/
Drip Nicardipine
Operation Report Performed sondage, AF, 10 cm

25-05-2019 Performed aspiration curettage 🡪 mole tissue and blood ± 300 ml
Tissue send to PA
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Identity Mrs. SAE/54 y.o/RA- Belitang/RS

Chief complaint Abdominal enlargment
History Since 2 months before admission, patient complaint abdominal enlargment, vaginal bleeding (-), decreas of body weight
(-), decrease of appetite (-), post coital bleeding (-), dychezia (-). then patient went to Obgyn and hadbeen done
laparotomy oi uterine myoma and internal genitalia adhesion at Belitang Hospital,
Patient had been operated TAH-BSO and omentectomy at Mohammad Hoesin hospital at 11 August 2014 with PA result
no 3251/A/2014 i. Chronic cervicitis non specific, atrophy endometrial with chronic endometritis non specifis and uterus
myomatosus, luteum cyst at left ovary. II. Right ovary with albican corpur, malignant sift tissue tumor, suggestive
vascular tumour adhesion at right ovary DD/liposarcoma dedifferentiated. III. No. malignancy site at omentum
. Patient had suggested to chemoteraphy but hadnt.
Obstetric history P7A2

Gynecology Inspection : Abdomen convex,simetry, Fundal inpalpable, solid mass (+)size 15x10 cm, immobile tenderness (--), free
examination fluid sign (-), there was mediana scar with opsite (+)
VT : vaginal stump setteld, there was mass (+) with irreguler border.
US ER (DAN) • Uterus and ovary unvisual ~ TAH-BSO
• there was solid mass at abdominal pelvic cavitysize 14x8.7 cm with increase vascularization, RI : 0.52
• Paraorta and iliaca lymph node in normal limit
• liver in normal limit
• Both of kidney ~ hydronephrosis
C/ Intraabdominal pelvic tumor with primer tumor can’t be identified
Bilateral hydronephrosis
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Identity Mrs. SAE/54 y.o/RA- Belitang/RS
Laboratory Hb 10.8, Wbc 8.7, SGOT 27, SGPT 11, Ur 7, Cr 0.43, AFP 0.5, CEA 168.4, Ca 125 : 163
Examination
Diagnosis Intraabdominal pelvic tumor malignancy was suspected
dd differentiated liposarcoma + bilateral hydronephrosis
Therapy • Obs. Vital sign
• IVFD RL gtt xx/m
• plan for US confirmation
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(2) Mrs. SOL/ 39 YO/ P2A0 BACK
Planning
CC : Abdominal lump Menstrual : Menarche 14 YO, irregular cycle, first day of last period: 4/01/2019 Diagnosis:
Marrital : Married 1x, 8 years Ovarium cyst
About 1 month before Obstetric : P2A0 neoplasm
admission, patient has suspected for
been complaining about Prior operation : malignancy
abdominal accompanied by 2019 - Previous operation for adenomyosis, PA O98/HISTO/19 : Keratinizing uterine
weight lost. Patient denied myoma non specific Planning :
any history of menstrual Physical examination : Laparotomy FS
pain and post coital BP : 110/80 mmHg, HR :80x/m, RR: 18x/m, T: 36,8ºC
leeding. Patient went to General status : Normal Doctor in charge :
ObGyn specialist, got IS
diagnosed with ovarium Gynecologic status :
cyst and scheduled for an Abdomen : Raised, supple, tenderness (-), free fluid sign (-), fundal of uterine not
operation. palpable, mass (+) cystic; 13 x12 cm; upper border – 2 fingers above umbilicus; lower
border – symphisis; left border – left LMC; right border – right parailliac line; mobile.
Vaginal Speculum exam: Portio livide, closed OUE, fluor (+), fluxus (-), no protrusion of
cavum douglassi
Vaginal Toucher: Elastic portio, closed OUE, palpated cystic mass, 13 x 12 cm, no
protrusin of cavum douglassi, CUT~normal
Rectal Touche: Adequate sphincter of ani, normal mucosa, MIL (-), EFS 0%-0%
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(2) Mrs. SOL/ 39 YO/ P2A0
Planning
USG Confirmation :
˗Uterus hard to assess, appropriate with post adenomyosis resection
˗Cystic mass, 2.3 x 4.5 cm in size on one of the adnexa suspected for ovarium cyst
neoplasm
˗Right and left renal enlargement
˗Liver in normal condition
Conclusion: Bilateral ovarium cyst neoplasm, bilateral hydronephrosis
Hb 10,1 WBC 5070 PLT 200.000
Cr 0,85 Ur 21 Alb 3,5
AFP 1,34 CA 125 48,2 CEA 1,30
Mrs. SOL/40 Yo/UA/P2A0 BACK
Mrs. SOL/40 Yo/UA/P2A0 BACK

• Laparatomy FS Mrs. SOL/40 Yo/UA/P2A0 03.00 PM: Operation started.
• Patient on supine position and on general anesthesia.
ICD 10 Preop diagnosis: • Aseptic and antiseptic on operating area.
N83.2 Cyst ovarian neoplasm malignancy • Mediana incision.
was suspected • Do the exploration and found a tissue above peritoneum and fluid
ICD 9-CM  performed PAB cytology
54.1 Post op diagnosis: • Do the exploration after peritoneum was opened  found adhesion
68.4 Post Laparotomy Adhesiolisis o.i between ……. And pelvic cavity  adhesiolysis  succeed 
65.5 pseudo cyst + internal genital bleeding cyst in the right ovarian  cystectomy found tissue intra
40.5 adhesion + post laparotomy peritoneum  all tissues  PA
86.04 hysterectomy o.i right cyst bleeding • Install the stab wound drain
• Ensured there was no active bleeding, abdominal wall was closed
OP : layer by layer.
Dr. H. Irawan • Bleeding intraoperative 700 cc,urine 150 cc clear,transfusion 200 cc
Sastradinata, OBGYN (C)
,MARS 05.00 PM: Operation was finished.
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Mrs. YUL/ 28 YO/ P0A0 BACK
Planning
CC: Lower abdominal pain Menstrual : Menarche 13 YO, regular cycle Diagnosis:
Marrital : Married 1x, 2 years Dysmenorrhea
Patient has been complaining Obstetric : P0A0 c.n suspected
about intermittent lower endometriosis +
abdominal pain that started Prior operation : - primary infertility
since 1 year ago that Physical examination : 2 years
sometimes disrupted her BP : 120/80 mmHg, HR : 80x/m, RR: 20x/m, T: 36,5ºC
daily activities and General status : Normal Planning :
diminished with resting. HDLO
Patient denied any history of Gynecologic status :
vaginal bleeding or any Abdomen : Flat, supple, symmetrical, fundal of uterine not palpable, tenderness (-), free Doctor in charge :
palpated mass. Patient didn’t fluid sign (-) KY
experience weight lost and
loss of appetite. Vaginal Speculum exam: Portio non livide, closed OUE, fluor (+), fluxus (-), non active
bleeding, E/L/P (-)
Previous illness: -
Vaginal Toucher: Elastic portio, closed OUE, CUT~normal, tense right and left AP, no
protrusion of cavum douglassi
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(1) Mrs. YUL/ 28 YO/ P0A0
Planning
USG Confirmation :
˗Uterus AF, normal shape and size
˗Endometrial line (+)
˗Right ovarium in normal condition
˗Left adnexa: hypoechoic mass, 1.2 x 1.2 cm in size, adhesive to surrounding tissue,
suspected for pseudocyst
˗Liver and both kidney in normal condition
Conclusion: No organic abnormalities of uterus and ovarium, left adnexa adhesion

appropriate with pseudocyst
Hb 13.7 WBC 8110 PLT 243.000 PT 14.3 INR 1.12 APTT 32.0 Febrinogen 297.0 D-
dimer 0.24 SGOT 13 SGPT 9 Cr 0.75 Ur 17 Na 144 K 3.9
Mrs YUL/28 Yo/P0A0 BACK

• HDLO Mrs YUL/28 Yo/P0A0 12.30 PM: Operation started.
• Patient on supine position and on general anesthesia.
ICD 10 Preop diagnosis: • Aseptic and antiseptic on operating area.
N80 Dysmenorrhea e.c suspected • Empty the bladder
N73.6 endometriosis + primary infertility 2 • Perform the sondage uterus retro flexi 6 cm
years • Install the uterus manipulator
ICD 9-CM • Perform exploration per laparascopy and found :
68.12 Post op diagnosis: • Hysteroscopy : found hyper vascularization on uterine wall
Endometriosis ASRM gr I (ASRM Bubble sign (-) right and left tubes
OP : score 2 + EFI Score 6) C/ non paten bilateral tubes
DR. Dr. H. Kms Yusuf Non paten tube bilateral • Laparascopy : Normal genital
Effendi, OBGYN (C) Seems endometriosis spotting on posterior 
ablation
Perform chromotubation non paten bilateral tubes
•Ensured there was no active bleeding, abdominal wall was closed
01.30 PM: Operation was finished.

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Sunday, May 26th 2019
Identity KAR/ 62 yo/ UA/ AT Hospitalized : 21/05/19 09.00 PM
Chief complaint Fatigue
History Petient is consult from neurologi department with diagnose spinal leptomeningeal metastase + cancer pain with history
of cervical cancer. in January 2014 os has been diagnosed with cervical cancer stage IIIB and has been done for
chemotherapy 6 series, external radiation 25x, internal radiation 3x, finished in April 2018. in 11-05-2019 os has been
done pap smear with result LGSIL smear and CT scan (10-05-2019) with result solid mass with nacrotic component size
8.66 x 5.71 x 5 cm in right paraaorta and 8.88 x 7.32 x 7.5 cm in left paraaorta (suggestive metastase DD/ primary lesion
with intrahepatal metastase
Marital status 1X 39 years

Reproduction status Menopause since 15 years ago.
Obstetric history P3A0

Past iIlness history Chemoterapy 6 series
External radiation 5x
Internal radiation 3x
Vital Sign BP 110/80 Pulse : 86x/m T: 36.7 RR: 20x/m
Obstetrical examination Palpation:
flat, supple symmetric, fundal height not palpable, mass(-), free fluid(-),
Insp:
portio bumps, closed OUE, exophytic mass that infiltrated to proximal third of vagina, fluor -,fluxus - fragile and easy to
bleed E/L/P -
VT: vaginas was atrophyRT
TSA good,slick mucosa,mass-, both A/P not tense,right CFS 75 %,left CFS 75 %
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Identity KAR/ 62 yo/ UA/ AT
US confirmation • There was uterus small size 4.7 x 1.89 cm ~ post chemotherapy and radiation
• Myometrium homogen, regularly stratum basalis, endomettrial line (-)
• Potio and endocervix in normal limit
• Both of ovarium cant assess
• No enlargement paraaorta and parailiaca lymph gland
• There was full blast with stricture of urethra
• hepar and kidney in normal limit
C/ no internal genitalia abnormalities ~ post chemotherapy and radiation
stricture of urethra
Laboratorium Hb 6,3 Leu 15100 Plt 292000 Albumin 1,6 U/C = 193/2,63 SGOT/SGPT = 16/15
Diagnose Cervical cancer Stage IIIB Complete therapy+ LGSIL
Management • USG confirmation

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Mrs. ARL/ 42 YO/ P2A0 BACK
Hysterectomy per Mrs. ARL/ 42 YO/ P2A0 11.50 AM: Operation started.
Laparascopy • Patient on lithotomy position and on general anesthesia.
Preop diagnosis: • Aseptic and antiseptic on operating area.
ICD 10 Abdominal Uterine Pain c.b M1 • Operation area was narrowed by sterile dock
N83.2 • Performed sondage and found uterus ante-flexi 10 cm
Post op diagnosis: • Installing the uterus manipulator
ICD 9-CM Post laparascopy hysterectomy o.i • Performed laparoscopy, installing the trocar in 4 points
54.1 hyperplasia endometrium • Found uterus shape and size are normal, found bleeding
68.4 intraabdominal
65.5 •Performed hysterectomy per laparoscopy
40.5 •Installing the stab wound drain
86.04 • The tissue is examine to the pathology laboratory
• Ensured there was no active bleeding
OP : • Bleeding intraoperative 200 cc
Dr. H. Irawan
Sastradinata, OBGYN (C) 2.20 PM: Operation was finished.
,MARS
Mrs. ARL/ 42 YO/ P2A0 BACK
(1) Mrs. ARL/ 42 YO/ P2A0 BACK
Planning
CC: Vaginal bleeding Menstrual : Menarche 13 YO, regular cycle. Diagnosis:
1. 5/4/19 until now (21/5/19) Abnormal
Since 1 month before 2. Month 2 and 3 normal bleeding of the
3. 5/1/19 to 12/1/19
admission, patient has been 4. 4/12/19 to 12/12/19
uterus c.b M1
complaining about excessive Obstetric : P2A0
menstrual bleeding for 2 Planning :
months length in 1 month with Prior operation : Laparoscopy HT
the amount of 1x change of 9/2018 – Curetage procedure, PA 1883/DAT/2018: functional endometrial polyp
diapers/ day. Patient denied Physical examination : Doctor in charge :
any history irregular menstrual BP : 120/80 mmHg, HR : 74x/m, RR: 18x/m, T: 36,5ºC IS
General status : Normal
cycle, dysmenorrhea and
vaginal discharge but agreed Gynecologic status :
for having post coital bleeding. Abdomen : Flat, supple, symmetrical, fundal of uterine not palpable, tenderness (-), free fluid sign
Patient had the same (-), mass (-)
complained about 8 months
ago, got herself a curetage Vaginal Speculum exam: Portio non livide, closed OUE, fluor (-), fluxus (-), E/L/P (-), Sondase 8 cm
procedure at Baturaja Hospital
Vaginal Toucher: Elastic portio, posterior, closed OUE, CUT~normal, no protrusion of cavum
with PA result: functional douglassi, tense right and left AP
endometrial polyp. Patient
then referred to Mohammad Rectal Touche: Adequate sphincter of ani, normal mucosa, empty ampula of the recty, MIL (-), no
Hoesin Hospital for another protrusion of cavum douglassi
round of operation.
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(1) Mrs. ARL/ 42 YO/ P2A0
Planning
USG Confirmation :
˗Uterus AF, normal shape and size, 7.5 x 4.5 cm
˗Thickened endometrial line (+), 1.1 cm
˗Regular basal stratum, homogen myometrium
˗Both ovarium in normal condition, 2.0 x 1.5 cm in size (right) and 2.0 x 1.9 cm in size (left)
Conclusion: Thickened endometrium suspected endometrial hyperplasia
Hb 12,4 WBC 8450 HT37 % Plt 269.000 PT 13 INR 1,01 APTT 89
Ur 24 Cr 0,69
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(2) Mrs. MIN/ 42 YO/ P1A1 BACK

Planning
CC : Abdominal lump Menstrual : Menarche 15 YO, regular cycle, first day of last period 23/3/19 Diagnosis:
Marrital : Married 2x 1997-2001 (4 years) and 2010-now Adenomyosis + left
Patient has been Obstetric : P1A1 endometriosis cyst
complaining about DD/ left
enlarging abdominal lump Prior operation : multifollicular
for the last 10 years. Physical examination : ovarium cyst
Patient had normal urinary BP : 120/80 mmHg, HR :88x/m, RR: 20x/m, T: 36,5ºC neoplasm
routine and bowel habits. General status : Normal suspected for
Patient denied any vaginal malignancy +
bleeding and dyspareunia Gynecologic status : bilateral
but agreed for having post Abdomen : Raised, supple, fundal of uterine hard to assess, tenderness (-), mass (_) 12 endometriosis
coital bleeding. Patient cm in diameter; upper border – 2 fingers below umbilicus; lower border – symphisis;
didn’t experience weight right border – 3 fingers of right LMC; left border – left LMC, free fluid sign (-) Planning :
lost and loss of appetite. Laparotomy FS
Doctor in charge :
AT
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(2) Mrs. MIN/ 42 YO/ P1A1
Planning
USG Confirmation :
˗Enlarge uterus, globuler shaped, 12.88 x 5.67 cm
˗Homogen myometrium, irregular basal stratum, endometrial line (-), 5.97 mm
˗Posterior corpus: uncircumscribed hyperechoic mass, 6.57 x 3.18 cm in size suspected for
adenomyosis
˗Right ovarium in normal condition
˗Left ovarium: cystic mass with clear septum and internal echo, 11.28 x 7.57 cm in size suspected for
left endometriosis cyst, contained active vascularisation, RI 0.39 DD/ left multicystic ovarium cyst
neoplasm suspected for malignancy
˗Both adnexa: elongated tubular cystic mass with incomplete septum and internal echo, right and
left, 21.17 x 5.55 cm and 11.52 x 2.45 cm respectively, suspected for bilateral tubal endometriosis
˗Liver in normal condition
˗Ascites (-)
Conclusion: Adenomyosis, left endoemtriosis cyst DD/ malignant left multicystic ovarium cyst
neoplasm, bilateral tubal endometriosis
Hb 7,9 WBC 13280, PLT 647.000 BSS 103
Cr 0,61 Ur 13 Alb 3,3
AFP 1,34 CA 125 187,2
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Monday, May 27th 2019
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1. Mrs.SEV/74/UA/P0A0
S/ Scheduled for chemotherapy
Last chemotherapy (paclitaxel-carboplatin 3rd course) was in 3/5/19.
Cervical biopsy in 4/2/19,RS Charitas (PA/2019/00295):
-H SIL (CIN III/CA insitu) + focal microinvasive squamous cell carcinoma
-Possibility of cervical cancer with invasion can not be ruled out yet
Ro thorax (22/3/19):
-Cardiomegaly
-Dextroscoliosis of the thoracal vertebrae, epx Th6-7
US result (26/3/19):
-Malignant cervical mass invading to both parametrium, pelvic wall, urinary bladder, and proximal rectum
-Cystic ovarian neoplasm
-Cholelithiasis

Abdominal palpation: flat, supple, symmetrical, tenderness (-), fundal height unpalpable, free fluid sign (-), mass (-)
Speculum examination: portio become a mass, fragile, easy to bleed, exophytic mass with size of 2x2 cm
Vaginal Toucher: portio become a mass, fragile, easy to bleed, exophytic mass with size of 2x2x2 cm, CUT~normal,
both AP was tense, douglas pouch not protrude
RT: sphincter ani tone was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-), CUT~normal,
CFS 25%-25%
A/ Cervical cancer stage III B + leucopenia
P/ Admission (leucogen injection)

Adjuvant Chemotherapy paclitaxel-carboplatin 4th course
Radiotherapy
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2. Mrs.RUS/48/RA/P2A0
S/Scheduled for chemotherapy
Last chemotherapy (Paclitaxel-carboplatin 3rd course) was in 6/4/19.
Cervical biopsy in14/12/18,RSUD Ibnu Suwoto Baturaja (3654/MI/2018):
-Moderately differentiated non keratinizing squamous cell carcinoma
BNO-IVP result (14/2/19):
-Non visualized left kidney
-Right hydronephrosis grade 2 and and hydroureter
US TUG result (14/2/19):
-Left hydronephosis-hydroureter
-Mild right elvoectasis, possible physiologic variation
-Susp left and right PNC
Ro Thorax (12/2/19):
-Dilated aorta
-No metastasis in the lung
Abdominal palpation: flat, supple, symmetrical, tenderness (-), fundal height unpalpable, free fluid sign (-), mass (-)
Speculum examination: portio become a mass, fragile, easy to bleed, exophytic mass with size of 6x5 cm infiltrating to
1/3 proximal of vagina
Vaginal toucher: portio become a mass, fragile, easy to bleed, exophytic mass with size of 6x5x5 cm infiltrating to 1/3
proximal of vagina, CUT~normal, both of AP was tense, douglas pouch not protrude
RT: sphincter ani tones was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-), CFS 50%-50%
A/Cervical cancer stage III B + moderate anemia

Adjuvant chemotherapy Paclitaxel-carboplatin 4th course
Radiotherapy (scheduled in 13/6/19)
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Identity Mrs. ULI /26 yo/ UA/ FB
27-5-2019 at 11.30 PM Early pregnancy with abdominal burst
Chief complaint
History Patient was consulted from Surgery Department. 10 days ago, patient had operated at Hermina Hospital o.i accute
appendicitis. Patient complained abdominal contraction (-), trauma (-), post coital (-), leuchorhea (-). Patient admitted that
she has early pregnancy and amenorhea for 3 months.

Reproduction status Menarche 10 yo, regular cycles 28 days, for 7 days, LMP : forgot
Obstetric history 1. 2014, 3 months, abortion, curettage, Bari Hospital

2. 2015, male, 3500 g, Moh. Hoesin Hospital, spontaneous delivery, healhty
3. This pregnancy.
Physical examination BP : 110/70 mmHg, P : 84x/min, T : 36.5 C, RR : 20 x/min
Gynecology examination Inspection & Palpation :
Abdomen flat,symmetric, no tense, uterine fundal palpated at symphisis, mass (-), tenderness (-), free fluid sign (-).
Inspeculo and VT : didn’t did perform
US ER - SLF intrauterine
- CRL 6.67 cm, FHR (+)
- Pulsation (+)
C/ 13 weeks gestational age SLF intrauterine
Diagnosis G3P1A1 13 weeks gestational age with abdominal burst SLF intrauterine
Therapy - There was no special management in Obgyn Department
- Cygest 400 ug PR
- Plan for rehecting as Surgery Department
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Identity Mrs. YUN/ 29 yo/ UA/ HE BACK
18-2-2017 at 05.00 PM Vaginal spotting
Chief complaint
History 3 hours before admission, patient complained about vaginal spotting 1x change pad, history tissue discharge s (-), history tissue
discharge such as fish eye (-), abdominal contraction (-), nausea vomitting (-), history breast tense (+), history of trauma (-), post
coital (-).

Reproduction status Menarche 13 yo, regular cycles 28 days, for 5 days, LMP : 7-1-2019
Obstetric history 1. 2010, Abortus, Curratage

2. 2011, female, 3000 g, spontaneus delivery, healthy.
4. This pregnancy.
Physical examination BP : 130/70 mmHg, P : 88 x/min, T : 36.0 C, RR : 20 x/min, Weight 55 kg, Height 155 cm
Abdomen flat,symmetric, no tense, Fundal height unpalpable, mass (-), tenderness (-), free fluid sign (-).
Inspeculo : Livide portio, OUE closed, fluor (-), fluxus (-), E/L/P (-)
VT : Soft portio, OUE closed, CUT  normal, right & left AP no tense, no protution of cavum Douglas
US ER (ITW) GS (+)  8 weeks
Yolk sac (+)
C/ 6 weeks gestational age intrauterine
Diagnosis G3P2A0 7 weeks gestaional age with Insipiens abortion
Therapy Obs Vital sign & bleeding
P/ Curretage
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Identity Mrs. ERN/ 44 yo/ UA/ IS
Chief complain Abominal Enalrgement and Dypsneu
History Since 1 weeks before admission patient complained abdominal enlargement, abdominal pain, spread to waist (+), vaginal
bleeding (-), abdominal massage (-), fever (-), mausea (-), vomitting (-), decrease of body weight (-), decrease of appetite (-),
with malaise then patient went to Banyuasin Hospital then referred to Mohammad Hoesin Hospital
Then patient went to obgyn, diagnosed with ovarian cyst malignancy was suspected
Marital status Not married
Reproduction status Menarche 13 yo, cycle irreguler, 5 days, LMP : forgot
Obstetric history -
Physical examination BP : 120/70 mmHg, P : 88 x/min, T : 36.3 C, RR : 20x/min, Weight 157 cm, Height 45 cm
Conj. Anemis(-)
Obstetrical examination Palpation : Abdominal flat, symmetric, tendernes (+), fundal height was not palpable, free fluiid sign (-), mass (-), free fuid
sign (-)
Iinspeculo and VT : not assisted
RT: TSA was good, smooth mocouse, ampoule was normal, left and right AP wasn’t tense
Lab examination Hb: 10.5 g/dl, wbc 14.290/ mm3, trombosit 631.000/mm3
27-05-19 Ur/cr 212/11.23, CEA 1.20, Na 142, K 4.7, Ca 9.0
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Identity Mrs. ERN/ 44 yo/ UA/ IS
US ER (ITW) - uterus AF size and shape within normal limit, 3.94 x 1,1 cm
- homogenous myometrium, irregular stratum basalis, endometrial line +, 0.3 cm thickness
- portio and endocervix within normal limit
- right adnexa: solid mass 11.71 x 8.91 cm, right solid ovarian neoplasm was suspected
- left adenxa within normal limit
-Both of renal, liver, lien within normal limit
-Ascites (+)
C/ Right solid ovarian neoplasm
Ascites
Diagnosis Right solid ovarian neoplasm malignancy was suspected +
ascites
Therapy • Observed vital sign
• IVFD RL xx drops/min
• P/ US confirmation
• P/ Lab examination (tumor marker)
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1. Mrs.NUR/52/RA/P4A0
S/ Continue the chemotherapy
Surgical staging (13/3/19) at Moh.Hoesin Hospital with PA’s result (1020/A/2019):
I-IV.High grade serous carcinoma, possible source from ovary, invading to the myometrium,
omentum, tunica muscularis of colon, 1 lymph nodes, and ascites fluid.
Last chemotherapy (paclitaxel-carbopaltin 2nd course) was in 8/5/19.
Speculum examination: vaginal stump in normal limit
Vaginal Toucher: vaginal stump in normal limit
RT: TSA was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-)
Lab result (27/5/19): Hb=8,4 WBC=2,75 Plt=29 AST/ALT=32/25 Ur/Cr=39/1,33
A/ Ovarian cancer stage IV A + pancytopenia
P/ Admission (PRC, plt transfusion, leucogen injection)

Chemotherapy paclitaxel-carboplatin 3rd course
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2. Mrs.SUW/58/RA/P4A0
Cervical biopsy in 4/4/19,Moh.Hoesin Hospital (1334/A/2019):
-Moderately differentiated squamous cell carcinoma of cervix
US result (4/4/19):
-Malignant cervical mass invading to the myometrium was suspected
-Enlargement of the right parailiacal lymph nodes
-No mass infiltration in the urinary bladder
-No hydroureter-hydronephrosis
BNO IVP result (4/5/19):
-Normal excretion and secretion function of both kidney
-Susp luscent stone in the left kidney DD/ artefact
-No sign of obstruction in bilateral urinary tract
Clinical staging : Cervical cancer stage III B
Last chemotherapy (paclitaxel-carboplatin 1st course) was in 8/5/19.
Abdominal palpation: flat abdomen, supple, symmetrical, fundal height unpalpable, tenderness (-), free fluid sign (-), mass (-)
Speculum examination: portio was bumpy, not fragile, not easy to bleed, exophytic mass with size of 2x2 cm, infiltrating to the 1/3
proximal of vagina
Vaginal Toucher: portio was bumpy, not fragile, not easy to bleed, exophytic mass with size of 2x2x2 cm, infiltrating to the 1/3 proximal of
vagina, CUT~normal, Douglas pouch not protrude, both AP was tense, CFS 25%-25%
RT: sphincter ani tone was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-), CFS 25%-25%
Lab result (27/5/19): Hb=10,6 WBC=5,78 Plt=66
A/ Cervical cancer stage III B + thrombocytopenia
P/ Admission (Plt transfusion)

Adjuvant chemotherapy paclitaxel-carboplatin 2nd course
Radiotherapy
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BACK
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3. Mrs.JUM/52/RA/P5A0
Surgical staging (22/3/19) at Moh.Hoesin with PA’s result (1179/A/2019):
I.-Endometrial atrophic
-Simple cyst in the left ovary
II.No sign of malignancy in the omentum
III.-Mucinous carcinoma in the right ovary
-Right non specific chronic salpingitis
IV.Sinus histiocytes in the 8 of the right pelvic lymph nodes.
V.Sinus histiocytes in the 3 of the left pelvic lymph nodes
VI.Focal mucinous mass in the peritoneal fluid cytology
Last chemotherapy (docetaxel-carboplatin 2nd course) was in 6/5/19.
Abdominal palpation: flat , supple, symmetric, tenderness (-), free fluid sign (-), mass (-)
Speculum examination: vaginal stump in normal limit
Vaginal Toucher: vaginal stump in normal limit
RT: TSA was good, smooth mucosa, empty ampulla of recti, intraluminar mass (-)
Lab result (27/5/19): Hb=9,4 WBC=5,26 Plt=198 AFP=3,33 CEA=11,6 CA 125=7,5
A/ Ovarian cancer stage I C + mild anemia

Chemotherapy docetaxel-carboplatin 3rd course
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4. Mrs.RUS/48/RA/P2A0
Cervical biopsy (14/12/18) at Ibnu Sutowo Baturaja hospital with PA’s result 3654/MI/2018:
-Moderately differentiated non keratinizing squamous cell carcinoma
BNO-IVP result (14/2/19):
-Non visualized left kidney
-Right hydronephrosis grade 2 and and hydroureter
-Left hydronephosis-hydroureter
-Mild right elvoectasis, possible physiologic variation
-Susp left and right PNC
Thorax radiograph (12/2/19):
-Dilated aorta
-No metastasis in the lung
Clinical staging: cervical cancer stage IIIB
Last chemotherapy (Paclitaxel-carboplatin 4th course) was in 9/5/19.
Abdominal palpation: flat , supple, symmetric, tenderness (-), fundal height unpalpable, free fluid sign (-), mass (-)
Speculum examination: portio was bumpy, not fragile, not easy to bleed, exophytic mass, size 6x5cm, infiltrating to 1/3
proximal of vagina
Vaginal toucher: portio was bumpy, not fragile, not easy to bleed, exophytic mass, size 6x5x5cm, infiltrating to 1/3
proximal of vagina, CFS: 25%-25%
RT: TSA was good, smooth mucous, empty ampulla of recti, intraluminar mass (-), CFS 25%-25%
A/Cervical cancer stage IIIB + moderate anemia

P/ Hospitalized – Blood transfusion)
Chemotherapy Paclitaxel-carboplatin 5th course
Radiotherapy (scheduled in 13/6/19)
Identity Mrs. YUN/ 29 yo/ UA/ HE BACK
18-2-2017 at 05.00 PM Vaginal spotting
Chief complaint
History 3 hours before admission, patient complained about vaginal spotting 1x change pad, history tissue discharge s (-), history tissue
discharge such as fish eye (-), abdominal contraction (-), nausea vomitting (-), history breast tense (+), history of trauma (-), post
coital (-).

Reproduction status Menarche 13 yo, regular cycles 28 days, for 5 days, LMP : 7-1-2019
Obstetric history 1. 2010, Abortus, Curratage

4. This pregnancy.
Physical examination BP : 130/70 mmHg, P : 88 x/min, T : 36.0 C, RR : 20 x/min, Weight 55 kg, Height 155 cm
Abdomen flat,symmetric, no tense, Fundal height unpalpable, mass (-), tenderness (-), free fluid sign (-).
Inspeculo : Livide portio, OUE closed, fluor (-), fluxus (-), E/L/P (-)
VT : Soft portio, OUE closed, CUT  normal, right & left AP no tense, no protution of cavum Douglas
US ER (ITW) GS (+)
CRL 1.79  8 weeks
Yolk sac (+)
C/ 8 weeks gestational age intrauterine
Diagnosis G4P2A1 8 weeks gestaional age with Insipient abortion
Therapy Obs Vital sign & bleeding
P/ Curretage
BACK
Mrs. YUN/ 29 yo/ UA/ HE
Curettage Mrs. YUN/ 29 yo/ UA/ HE 09.30 AM: Operation started.
•Patient on supine position and on TIVA
ICD 10 Preop diagnosis: •Aseptic and antiseptic on operating area.
O46.02 G4P2A1 7 weeks gestational age with
insipient abortion •Portio was seen avoely
•Sondage of uterus ante flexi 10 cm
ICD 9-CM Post op diagnosis: •Performed curettage in uterine cavity. Amount of blood and tissue + 100 cc
69.02 P2A2 Post curettage o.i insipient •Tissue would be examined in pathology laboratory
abortion
OP : 10.10 AM: Operation was finished.

HE/DRM/VAI/WAH/
ZAN
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Mrs. WIN/ 26 yo/ RA/ FB 03.00 AM
Chief complain Early pregnancy with vaginal bleeding
About 1 month ago patient complained about vaginal bleeding, 1x change pads/ day. reddish. Blood Cloth
(+).Abdominal contraction (+), nausea (+), vomit (-), Fish eye appearence (-), of abdominal massage (-), post coital
History (-), leucorrhea (-), trauma, toothache (-), taking herbal medicine (-), history of breast tense (+), history of amenorea
4 weeks (+).And then 2 days before admitted to hospital patient complained about Vaginal bleeding.
Marital Status 1x, 4 years

Reproduction Menarche, 13 yo, iregular cycle , LMP forgot
1. This pregnancy, PT (+)
Obstetric History
General Exam BP: 120/70 mmHg, P: 84 x/min, T: 36.5C, RR: 20 x/min,

Inspection: abdomen was flat, symmetrical, uterine fundal height was not palpable, mass (-), free fluid sign (-),
Gynecological Examination pain (-)
Inspeculo: portio was livide, OUE was closed, flour (-), fluxus (+), blood not active, E/L/P (-)
VT: soft portio, posterior, closed OUE, CUT ~ 8 weeks, AP right & left were not tense, CD not protrude,
US ER (DRI) • Uterine shape and size in normal limit size 6,5 cm x4,44 cm
• Reguler stratum basalis,homogen myometrium,endometrial line +
• In right adnexa there was inhomogen complex mass size 2,5 x 3,2 cm ectopic pregnancy was suspected dd
hematocelle
• Left ovarium in normal limit size 2,1 cm x2,3 cm
• Hepar and bilateral renal in normal limit
• C/ Ectopic pregnancy was suspected
Dd/Hematocelle
Hb I 9.6, WBC: 18.960, PLT: 310.000. Bhcg : 6.745
Laboratory Exam HB II 9,3
HB III 8,9
Diagnosis Threatened Abortion Dd/Ectopic Pregnancy
• Total Bedrest
• Vital sign observation, contraction, bleeding
Therapy • IVFD RL drops XX / minute
• Fonslani Test Evaluation
S : abdominal discomfort
O : Sens : CM, BP 110/80 Pulse 88 bpm RR 22 x/m Temp : 36.70C HB II 9,3
pain (+/-)
04.00 AM A : Threatened Abortion Dd/Ectopic pregnancy
P : Observation vital sign, blood evaluation
• IVFD RL gtt XX/m
S : abdominal discomfort
O : Sens : CM, BP 100/60 Pulse 101 bpm RR 26 x/m Temp : 36.70C HB III 8,9
Inspection: Abdomen was flat, symmetric, uterine fundal height was not palpable, mass (-), free fluid sign (+), pain (+)
A : Threatened Abortion Dd/Ectopic pregnancy
P : Observation vital sign, blood evaluation
06.00 AM
• IVFD RL gtt XX/m
• Consult to DPJP
• P/US Confirmation
• 08.00 AM  Has been done for US Confirmation C/Disturbanced ectopic pregnancy
• Exploration Laparatomy Cito  rupture right fimbriae ( blood and clot +/- 200cc ) right salphingectomy
Mrs. MUR/ 19 yo/ RA/ FB
Chief complain vaginal bleeding
Patient came to RSMH with referral from OBGYN with diagnosis susp. GTN,About 2 months ago patient
complained about vaginal bleeding, 2x change pads/ day. reddish. Abdominal contraction (+), nausea (+), vomit (-
), Fish eye appearence (-), of abdominal massage (-), post coital (-), leucorrhea (-), trauma, toothache (-), taking
History
herbal medicine (-), history of breast tense (-)
Marital Status 1x, 6 bln
Reproduction Menarche, 12 yo, regular cycle , LMP forgot
1. P0A1
Obstetric History
General Exam BP: 120/70 mmHg, P: 84 x/min, T: 36.5C, RR: 20 x/min,
pain (-)
Gynecological Examination Inspeculo: portio was livide, OUE was closed, flour (-), fluxus (+), blood not active, E/L/P (-)
VT: soft portio, posterior, closed OUE, CUT ~ was normal, AP right & left were not tense, CD not protrude
Mrs. MUR/ 19 yo/ RA/ FB
US ER (DRI) • Uterus AF, size and shape within normal, size 6,5 cm x 5,0 cm
• Myometrium homogen, stratum basal regular, endometrial line (+).
• Portio and endocervix within normal limit
• There was a Vesicular mass with active vascularization  GTN was suspected
• left ovarium size enlarged size 3.73 x 1,90 functional cyst was suspected
• Right ovarium was normal
• Liver and both kidneys within normal limit
• C/ GTN was suspected
Laboratory Exam Hb 12.2, WBC: 7120., PLT: 403.000. SGOT 21 SGPT 15 abumin 4.5
Diagnosis GTN was suspected
• Total Bedrest
• Vital sign observation, contraction, bleeding
Therapy
• IVFD RL drops XX / minute
Follow Up Patient was Stable in Ward

Mrs. YES/ 31 yo/ UA/ FB
Chief Complain Early pregnancy with SLE
Since 2 days before admitted to the hospital patient complained about gingival bleeding,bleeding when patient
woke up from sleep and brushing teeth,epistaxis (-),ptechiae and hematome in skin (-), defecation and micturition
History was normal,patient now in pregnancy (12 weeks), vaginal bleeding (-)nausea (-) vomitting (-), post coital
bleeding(-), tense breast (+). History of late menstruation (+) since 12 weeks ago.
Patient had SLE since 7 year ago
Marital status 1x,7 months
Reproduction Menarche, 13 yo, regular cycle,7 days, LMP March 21th 2019
Obstetric history 1. This pregnancy
General Exam BP: 110/70 mmHg, P: 88 x/min, T: 36.5C, RR: 20 x/min, BW: 47 kg, BH:155 cm
Inspection: abdomen was flat, symmetrical, uterine fundal height 2 finger above symphisis, mass (-), free fluid
Gynecological Examination sign (-),
Speculum Examination and Vaginal toucher was not performed
• SLF intrauterine
• BPD 2.27 cm, HC : 8.43 cm AC: 6,8 cm, FL: 1.03 cm,EFW 72.71 g
US ER (DRI) • Placenta on Fundus of uterine
•Amniotic Fluid was sufficient
• C/ 13 weeks gestational age SLF intrauterine
Diagnosis G1P0A0 13 weeks gestational age with SLE SLF intrauterine
137
• Vital sign observation
• Lab Examination
Therapy
• Plan for US Confirmation
• There is no specific treatment from OBGYN at this moment
Follow Up Patient was stable in ward
138
Thank You

CR Bangsal Gin Fta 31.05.19 Rabu

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Gynecology Inpatient Report

Friday, May 24th 2019 - Thursday, May 30th 2019

Dr. Fitrah Tindar Atthaariq

REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY

Friday, May 24th 2019

GTN stage I FIGO -PRC transfusion

Friday, May 24th 2019

Ovarian cancer -PRC transfusion

Mrs. MEL/47 Ovarian cancer Laparatomy Surgical Ovarian Cancer Stable in

Post TVH + round

Friday, May 24th 2019

Saturday, May 25th 2019

Saturday, May 25th 2019

Tuesday, May 28th 2019

-Admission (PRC, plt

Cervical cancer -Admission (PRC

Tuesday, May 28th 2019

G4P2A1 8 weeks P2A2 Post

Wednesday, May 29th 2019

S/ Plan for chemotherapy

O/ s : compos mentis, BP: 120/80 mmHg, P: 80 x/mins, RR: 20 times/min, T 36,6

A/ Ovarian cancer progressive disease + moderate anemia + thrombocytopenia

P/ Admission (PRC, plt transfusion)

S/Plan for chemotherapy

A/Ovarian cancer stage III C + moderate anemia + thrombocytopenia

P/ Admission (PRC,plt transfusion)

S/ Plan for chemotherapy

A/ GTN stage I FIGO score 3 + moderate anemia

P/ Admission (PRC transfusion)

S/ plan for chemotherapy

A/ Ovarian cancer stage III C + moderate anemia

P/ Admission (PRC transfusion)

Anamnase Physical Examination and supportive exam Diagnosis and

Anamnase Physical Examination and supportive exam Diagnosis and

Conclusion: growth of new malignant mass

Procedure Case Outcome

Planning TVH + SSF +Anterior and posterior colporrhaphy

Planning Anterior and posterior colporrhaphy

11.00 PM: Operation was finished.

Conclusion: No abnormalities of internal genitalia organ

Mrs. PAR/ 22 YO/ P0A0

Mrs. PAR/ 22 YO/ P0A0

US ER (DRI) - There is uterine size bigger than normal, 9,7x6,1 cm

C/ Hydatidiform mole was suspected

Diagnosis Hydatidiform mole was suspected + emergency hypertension

Therapy • Vital sign, bleeding observation

Operation Report Performed sondage, AF, 10 cm

Identity Mrs. SAE/54 y.o/RA- Belitang/RS

Obstetric history P7A2

Conclusion: Bilateral ovarium cyst neoplasm, bilateral hydronephrosis

Procedure Case Outcome

(2) Mrs. SOL/ 39 YO/ P2A0

(2) Mrs. SOL/ 39 YO/ P2A0

Conclusion: No organic abnormalities of uterus and ovarium, left adnexa adhesion

Procedure Case Outcome

01.30 PM: Operation was finished.

(1) Mrs. YUL/ 28 YO/ P0A0

(1) Mrs. YUL/ 28 YO/ P0A0

Marital status 1X 39 years

Obstetric history P3A0

Diagnose Cervical cancer Stage IIIB Complete therapy+ LGSIL

Management • USG confirmation

Conclusion: Thickened endometrium suspected endometrial hyperplasia