Resident In Charge: DAS/NIR/TOY/RAS/SAR/NAS Chief: dr. QOS Supervisor : Dr. dr. Tatit Nurseta, Sp.OG (K)

Presentasi berjudul: "Resident In Charge: DAS/NIR/TOY/RAS/SAR/NAS Chief: dr. QOS Supervisor : Dr. dr. Tatit Nurseta, Sp.OG (K)"— Transcript presentasi:

1 Resident In Charge: DAS/NIR/TOY/RAS/SAR/NAS Chief: dr. QOS Supervisor : Dr. dr. Tatit Nurseta, Sp.OG (K)

2 Emergency room: 2 Delivery room: - Physiological delivery: - Pathological delivery  Pervaginam: 1  Perabdominam: -

3 1. Ms. N / 19 y.o Incomplete Abortion (14-16 weeks) Laboratory : CBC : 11,6/10.260/33,9/469.000 FH : 11,5/18,5 UL : bakteri 43,8x1000 leuco 0,5/LPB Plano (+) EMERGENCY ROOM Planning : Propose curretage in ER operating room Premed : Inj. Cefazolin 2 gr IV Inj. Ranitidin 1 amp IV Inj. Metoclopramide 1 amp IV Informed consent, c/anastesi

4 2. Mrs. E / 22 y.o G1P0000Ab000 part 37-38 Weeks S/L + First stage active phase + History of PROM + Anemia + UTI asymptomatik Laboratory: CBC : 9,7/12.450/30,2/287.000 FH : 9,7/ 27,60 UL : Protein +1, Lekosit +1, Bakteri 712,1x1000 PTx : Spontaneous vertex delivery Outcome : On January, 7 th 2018 at 02.00 am, female baby was born, 2894 gr, 49 cm, AS 7-9 EMERGENCY ROOM

5 Laboratory: CBC : 13,9/22.720/39,8/253.000 FH : 10,9/27,6 SE : 142/3,62/104 OT/PT : 22/20 Alb : 4,45 RBS : 144 Ur/Cr : 24,5/0,86 EMERGENCY ROOM 3. Mrs. J / 42 y.o Synechia Vagina + Retentio Urine Planning : c/ urogynaecology at work hour Patient take over by urology dept Patient will be join care

6 THANK YOU

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8 Register : 11373816 Ms. N/ 19 y.o /Single/ P0000Ab000/ LC: - y.o/ Contraception: (-) / LMP : Sept 23 rd 2017 ~ 14- 16 weeks Address :Jl. Raya Dieng RT. 07/06 Sukun Malang Hospitalized on Januari 6 th 2018 at 17.00 am IDENTITY

9  Patient referred obstetrician from Panti Waluya Hospital with P0000 Ab000 GA 14 - 16 weeks Incomplete abortion + anemia + infection. SUBJECTIVE

10 December 28 th 2017 05.00 am  Patients didn’t get mestruation about 2 month  test plano by herself  result positive  Patient know about abortion drug  cytotec  consumpt 2 tab per oral and 2 tab per vaginam, during 8 hours patient consumpted the same drug and the same way. 07.00 pm Patient complained blood excess and tissue from birth canal ±3 napkins  stayed at home January 5 th 2018 01.00 pm Patient complained blood excess from birth canal ± 2 napkin / days  went to RKZ hospital  was examined by Obstetrician and diagnosed Abortus Incomplete + anemia  Suggested Transfusion 2 Kolf continue with curretage  suggested to curettage  because there is no family  referred to Saiful Anwar Hospital January 6 th 2018 06.3 0 pm Patient Arrived at ER Saiful Anwar Hospital. SUBJECTIVE

11 History of asthma (-), DM (-), Heart Disease (-) History of Menstruation : Reguler, 1x/ month, 5 – 7 days, 2 – 3 x change of napkins, pain (-) SUBJECTIVE

12 GA: Good GCS : 4 56 BP: 110/70 mmHg HR: 80 x/mnt RR: 20 x/mnt Tax : 36, 4 o C Trect: 36, 7 o C Head: An (-/-) Ict (-/-) Thorax : C/ S1-S2 single murmur (-) P/ Rh ≡│≡ Wh ≡│≡ Abd : FH~enlarged, Soefl, meteorismus (-), p Bowel sound (+)N OBJECTIVE

13 GE: Fluxus (+) minimal Insp: V/V: Fluxus (+) minimal PONP opened 1 cm, tissue was shown VT: Fluxus (+) minimal POMP opened 1 finger, tissue was palpable CUAF ~ slightly enlarge AP D/S: Mass (-) Pain (-) CD ~ wnl OBJECTIVE

14  CBC: 11,6/10.260/33,9/469.000  UL: Plano (+) LABORATORY

15  Vesica Urinaria filled enough Uterus antefleksi EL didn’t linier,rest of placenta (+) Imprresion : Incomplete abortion USG

16 Incomplete Abortion ASSESSMENT

17 Planning :  Propose curretage cito in ER operating room  Preparing curretage :  Inj. Cefazolin 2 gr IV (skin test)  Inj. Ranitidin 1 amp IV  Inj. Metoclopramid 1 amp IV  Informed consent/registered OR/Insert DC PMo : Obs. vital sign, subjective, fluxus CIE c/SPV ----------------------------------- Acc Dr. dr. Tatit Nurseta, SpOG-K PLANNING

18 LAST CONDITION At Room 10 GA: Good, CM GCS: 456 BP: 120/80 mmHg HR: 88x/mnt RR: 20x/mnt GE: Fluxus (-)

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20 Register : 113738137 Mrs. J/ 41 y.o / Married 1x, 18 yr/ P2002Ab000/ LC: 11 y y.o/ Contraception: Inj. 3 months / LMP : Sept 2017 Address :Jl. Karangtengah Srikaton, Tulungagung IDENTITY

21  Patient referred obstetrician from Panti Waluya Hospital with Sinechya Vagina and Retentio Urine SUBJECTIVE

22 December 2017 05.00 am  P atients complained leukorhea, itchy (+)  Patient get traditional treatment using oil and powder that apllied to her vagina. Once a day for five days. And then the patients felt her vagina is licked January 4 th 2018 Patient complained difficult to urinate and leaked  Stayed at home January 6 th 2018 Patient complained can’t urinateand leaked urine, and abdominal pain.Patients go to Baptis Kediri Hospital and has been claimed having a vagina licked  Referral to RSSA SUBJECTIVE

23 History of asthma (-), DM (-), Heart Disease (-) History of Menstruation : irreguler because having 3 months injection familly planning SUBJECTIVE

24 GA: Moderate ill GCS : 4 56 BP: 110/70 mmHg HR: 88 x/mnt RR: 20 x/mnt Tax : 36, 4 o C Trect: 36, 7 o C Head: An (-/-) Ict (-/-) Thorax : C/ S1-S2 single murmur (-) P/ Rh ≡│≡ Wh ≡│≡ Abd : FH~enlarged, Soefl, meteorismus (-), p Bowel sound (+)N There is cyst mass  GE: Fluxus (-)  Leaked Urine (+)  Adhesion of Labia Majora  Inspekulo can’t be done OBJECTIVE

25 GE: Fluxus (-) Insp: V/V: Fluxus (+) minimal PONP opened 1 cm, tissue was shown VT: Fluxus (+) minimal POMP opened 1 finger, tissue was palpable CUAF ~ slightly enlarge AP D/S: Mass (-) Pain (-) CD ~ wnl OBJECTIVE

26  CBC: 13,9/22.720/39,8/253.000  FH: 10,9 – 23,6  Ot/Pt: 22/20  ALB: 4,45  GDS: 144  Ur/Cr: 24,5/0,86  SE : 142/3,62/104 LABORATORY

27 Hepar: Normal size, flat, normal echoparenchym homogen, portal/vasculer/bilier normal Bladder: Normal size, wall not thicken, no stone/sludge/mass, CBD not widened Pancreas : Normal size, echoparenchym homogen, no patologic lession Lien: Normal size, sharp edges, flat, echoparenchym homogen, no patologic lession, nodul and cyst not found, V. Lienalis not widened Ren D/S : Normal Size, Normal echocortex, pelvic calyceal system not widened, strict lines of cortex and medulla VU : Reguler, no patologic lession There is echo water in cavum vagina Conclusion : Like Hidrocolpos USG

28 Synechia of major labia + Urine retention ASSESSMENT

29 Planning :  C/ Urogyn atwork hours  MRS hospitalized at ward 18  Patien will be take over to Urology  Pro Cystotomy cito  Suggest estrogen gel aplication morning – afternoon  Patient wll be join care with OBG  PO:  Mefenamic acid 3x1  Rob 1x1  Vulvo hygiene  Informed consent/registered OR/Insert DC PMo : Obs. vital sign, subjective, fluxus CIE c/SPV ----------------------------------- Acc Dr. dr. Tatit Nurseta, SpOG-K PLANNING

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