case letak kepala

8/18/2019 Case Letak kepala

1/60

SECTIO CAESAREA IN INDICATCHIN POSTERIOR FACE

PRESENTATION AND GESTATIOHYPERTENSIONHUSNA

1102011120

PRECEPTOR:

Dr. H. Dada S!"ad#$ S%OG


2/60

IDENTITYW#&'

• Na(' : Mr". A#• A)' : 33 *'ar" O+d• Addr'"" : C#,#!-• Ed!a/# : !#r H#)

S+• O!%a/# : H!"'#&'• M'd#a+ R'rd: 3241• Da/' & H"%#/a+#5'd : 24/ a 2016

• T#(' & H"%#/a+#5'd: 10.77a(

H!",ad

• Na(' : Mr. E• A)' : 33 *'a• Addr'"" : C#,#!• Ed!a/# : E+'(

S+• O!%a/# : Sa


3/60

REFERENCE

T#"

%a/#'/a" r'&'r''

"


4/60

MAIN COMPLAINT

F+!#d !/ & /'8a)#a


5/60

ANAMNESIS

G9P3A3 # (/" %r')a/$ ('" #/ /a/ ;!#d !/ & /' 8a)#a "#' 6 !r" a)/ra"+!'/ +#" a )r''#" +#


6/60

ANAMNESIS

T'r'>" a+" a ,r#" ,+d* (!!"$ ,!/ +#//+'. Pa/#'/ a" ,'' &''+#) /' &'/a+ (8'('(/" a)$ !/#+ . Pa/#'/ d'#'d /' (a* 'ar/,!r$ "'8'r' 'ada'$ ad ,+!rr'Pa/#'/ a" #"/r* & #) ,+d %r'""!r' d!r#) /' %r')a*.


7/60

O@STETRIC HISTORYPREGNAN

CY PLACE DELIVER

AGE OF

PREGNANC

Y

HOW TO

DELIVER

BABY’S

WEIGHTSEX A

I A,r/# # 2 (/ %r')a/

II H(' M#d#&' Pr'(a/!r'S%/a'

!"100)r

d

IIIH"%#/a

+D/r Ma/!r'

S%/a'

!"3300)r

*'

IV A,r/# # 3 (/ %r')a/

V H(' Para?# Ma/!r'S%/a'

!"4000)r ♀

*'

VI A,r/# # 3 (/ %r')a/

VII CURRENT PREGNANCY


8/60

INFORMATION

Mar#/a+ S/a/!"

• F#r"/ Marr#a)'• B 20 *'ar" +d$ HS$

H!"'#&'• 27 *'ar" +d$

E+'('/ar* "+$"a+'"(a

M'"/r!a/#• T' r"/ da* & /' +a"/

('"/r!a+ %'r#d: 23rd A%r#+ 2017

• E"/#(a/'d D'+#8'r*: 30/ a!ar* 2016

• R')!+ar C*+'• A(!/ & ,+d: r(a+• N %a#• L')/: 9 da*"• M'ar': 14 *'ar" +d

C/ra'

• La"/ /I?'/#$'8'r* #?'

• Fr( 200

• S' "/%#?'/# #++#) a


9/60

ADDITIONAL INFORMATIO

Pr'a/a+ Car'• M#d#&'•

/#('"'=a(#a/#• La"/ '=a( a,!/ 1

''- a)

C(%+a#D!r#)

Pr')a*• T'r'>"

(%+a# d!r#)/' %r')a*

Pa"/ M'H#"/

•N #"/r*


10/60

PRESENT STATUS

• 36$9 0C• 20 =(#!/'

• =(#!/'• 190110 ((H)

@+dPr'""!r

'

P!+"'Ra/'

T'(%'ra/!r'

R'"%#ra/# Ra/'


11/60

PRESENT STATUS

H

' a d a d N ' . -

C?!/#8aad S+'ra #r(a+"#/!a/#

T*r#d ad

L*(% Nd'"ar' r(a+

C 0 r a d P ! + (

0

Cr 1

"/

ad2d "!dr')!+ar$ Ga++%" adM!r(!r

V'"#!+ar@r'a/#)S!dS*(('/r#a+

T'Ra#%a#A"

N'#

'=/'d'VarV'#

Pa/


12/60

O@STETRIC STATETERNAL EAMINATION

H#)&

F!d!" U/'r#

34(

A,d(#a+#r!(&'r''

7

(

F'/a+Pr'"'/a/#

H'adR#)/@a-47

La,r

12 =10(#!/'"

1020"'d"

F'/a+ H'ar/Ra/'

136

=(#!/'$R')!+ar

E"/#(a/'dF'/a+W'#)/


13/60

O@STETRIC STATUS

I"%'/#

• N#/ra5#' T'"/ J

Fr#'"

Pa+%a/#•

Pa+%a,+' ard


14/60

O@STETRIC STATUS

INTERNAL EAMINATIO

Na,r(a+#/#

'"

V!+8a

Na,r(a+#/#

'"Va)#a

Id

Pr/#

I" /d'

D#+a/#C'r8#=

I" /d'

A(#F+!#d

Id

T'L'"/

Par/


15/60

EARLY DIAGNOSIS

G9P3A3 G'"/a/# 340

W''-" #/ Pr'(a/!r'R!%/!r' & /' M'(,ra'"

ad S!"%'/ S'8'r'Pr''+a(%"#a

GO,"'r8a/# G''ra+ S/a/'$


16/60

GMANAGE

MENTP+a#) (aa)'('/

O,"'r8a/# G''ra+ S/a/'$V#/a+ S#)"$ La,r$ F'/a+

H'ar/ Ra/'$ D'+#8'r*Pr)r'""

I&r('d C"'/

I&!"# R#)'r>" La/a/'700 20 )//(#!/'

C'- H'(a/+)* adUr#' R!/#'

D%a('/ 3 = 700 () PO

N#&'d#%#' 3 = 10 () PO

G


17/60

GMANAGE

MENTP+a#) (aa)'('/

I? C'&/a=#(' 2 = 1VI

M)SO4 +ad#) d"'4 )ra(" # 100

R#)'r La/a/' !/ #(#!/'"

M)SO4 (a#/'a

d"' & 10 )ra(" # R#)'rK" +a/a/'$ )//(#

C/ra'%/#: Pa/#'

a)r''d a,!/ IUD

24/


18/60

LA@ORATORY EAMINATION24/ a

2012

H'(a/+)*

• H'()+,#: 11$ )dL• H'(a/r#/ : 37• L'!-*/' : 240((3

• P+a/'+'/" : 191.000((3

• Er*/r*/' : 4$12(#++#((3

Ur#'• D'"#/* Ur#' : 1.017

• @+d Ur#' : POS • L'-"#/ E"/ra"' : N')a/#8'• %H Ur#' : $0• N#/r#/ Ur#' : N')a/#8'• Protein Urine : Ne!ti"e• G+!-"a Ur#' : N')a/#8'• '/ Ur#' : N')a/#8'• Ur,#+#)' Ur#' : Nr(• @#+#r!,# Ur#' : N')a/#8'


19/60

OF [email protected]:

D%a('/ J$N#&'d#%# J$ I?

C'&/a=#(' 1 )r IV.

F'/a+ H'ar/ Ra/':136=(#!/'

12.00

M)SO4 +ad#) d"'& 4 )ra(" # 100 R#)'r La/a/' !/ #

17 (#!/'"

12.17:

Pr/# /'d'r /#-$ 'r8#=d#+a/# 23 ($%r'"'/a"# J

M)SO4 (a#/'a'

d"' & 10 )ra(" # 700 R#)'r La/a/' 20

12.47:

F'/a+ 'ar/ ra/' 14=(#!/'

13.47:

F'/a+ 'ar/ ra/' 133=(#!/'

14.47:

F'/a+ 'ar/ ra/' 134=(#!/'

17.

F'/a+ 'ar/=(#

Pr/# /''r8#= d#+a/

A(# ;!P"/'r#

Pr'"'/a/>+

Ad8#' &Da*

S'/# C


20/60

ADVANCED DIAGNOSIS

G9P3A3 Par/!r#'/ 340W''-" r"/ "/a)' & +a,r

a/#8' %a"' #/ C#P"/'r#r Fa' Pr'"'/a/#

Pr'(a/!r' R!%/!r' & /'M'(,ra'" ad G'"/a/#a+

H*%'r/'"#

OPERATION REPORT


21/60

OPERATION REPORTTi#e St!rt:$%&'' WIB

Ti#e En):$%&*' WIB

D+r!tion:*' ,enit

.*

O3er!tor:)r& D!nn1 Pri#!4 S3&OG

A""#"/a/ 1:A?a/

I"/r!('/:D'"#

A'"/'"#+)#"/:dr. Dad#$ S%.A

A'"/'"#a A""#"/a/:

Fa!5#

T*S%#

Pre S+rer1 Di!no5i5:G%P6A6 P!rt+rient 678*' Wee95 r5t 5t!e o; it Se-tio C!e5!re! in in)i-!tion Cin

Po5terior F!-e Pre5ent!tion !n) Ge5t!tion!< H13erten5ion

T*SCT

OPERATION REPORT


22/60

OPERATION REPORTA ,a,* a" ,r #/ SC a/ 19.10 >

G'd'r: Ma+'

W'#)/: 3100 )ra("

L')/: 4 (

APGAR Sr' 1>: 7 7>: 9

Aa+ J

D#"rd'r": J


23/60

FINAL DIAGNOSIS

P4A3 Ma/!r' D'+#8'r* #/

S'/# Ca'"ar'a ##d#a/# C# P"/'r#r

Fa' Pr'"'/a/# adG'"/a/#a+ H*%'r/'"#


24/60

FOLLOW UP

ARE ATTACHE


25/60

DISCUSSION FACE

PRESENTATIO


26/60

FACE PRESENTATION

F'/a+ %r'"'/a/# !r" ' /' &'/a+ 'a*%'r'=/'d'd "! /a/ /' &'/a+ &a'$ ,'/''# ad r,#/"$ #" /' %r'"'/#) %ar/. T' ##d'

a,!/ 1 # 700 d'+#8'r#'".

/' #%!/ a//a'd#/ /' ,a- & /'&'/!" " /' +'"/%ar/ & /' &'/!" #"# r ('/!(

S*(%*"#" P!,#

ETIOLOGY RIS FACTO


27/60

ETIOLOGY RIS FACTO

T' '/#+)* & &a'

%r'"'/a/# #""('a/'#)(a/#. D!r#)

r(a+ 8'r/'=d'+#8'r*$ /' &'/a+

'ad #" (ar-'d+*;'='d$ #/ /' &'/a+#%!/ a" /'+'ad#) %ar/.

Pr'(a/!r#/*

Narr

P'+8#

@@

C

)/A('

A''%a+#

a

C#+/'

!(,#+#a+rd

# /''-

M!+/#

%ar#/#'"


28/60

DIAGNOSIS

T' d#a)"#" & &a' %r'!"!a++* (ad' a/ /' /#(''=a(#a/# d!r#) +a,

"&/ /#""!'" & /' &'/a+ ("' ar' /'d ad?a'/ /

,'" ad r,#/a+ r#

Fa' %r'"'/a/# #" /'

")ra%* r ,* rad#@'a!"' a''%a+#a!#&r(+* %r'"'/ &a

a''%a+* "!+d ,' r!/' &a' %r'"'/a/# #"


29/60

HOW TO DIAGNOSE

Va)#a+

E=a(

A,d(#a+Pa+%a/#

W'd'+#8'r /'

,a,*

W(

r,(a* ,'%a+%a,+',!+)' &

&'/a+ 'ad'ar /'

,a- & /'

&'/!" /' 'dd#a)

(

%

PR


30/60

DIAGNOSISPR

Fa'Pr'"'/a/#

C# a/'r#r

S%/a'!"d'+#8'r*

Fr'%"E=/ra/#

C# P"/'r#r

C# r/a/' //' a/'r#r

S%/a'!"d'+#8'r*

Fr'%"'=/ra/#

C# r/a/' //' %"/'r#r

SC

La,r "/a)' II


31/60

MECHANISM OF LA@OR17

('

/!(/ra"8'r"'

27('/!(%"/'r#r

60 ('/!(a/'r#r

T' ('a#"( & +a,r &a' %r'"'/a/# #" "#(#+a

/' 8'r/'= %r'"'/a/# #/' +)'"/ d#a('/'r ('/ ,rJ '/'r" /' %'+8

/ra"8'r"'+*.


32/60

MECHANISM OF LA@OR

E=/'ra+R/a/#

Add#/#a+(8'('

/'=/'"#

J

F+'=#I/'ra+r/a/#

E)a)'('/


33/60

MECHANISM OF LA@ORFa'

d'"'d"/ /'

(#d%+a'

#/'ra+r/a/#

!r" #/

/' 8'r/#a+a=#"

/' ('/!( r/a/'"a/'r#r+* !d'r /'

"*(%*"#" %!,#"

8a)#a+d'+#8'r*

"!+d ,'

'=%'/'d

Fr'%"$ ,!/ 8a!!

(

#& /'('/!(r/a/'"

%"/'r#r+*

/


34/60

DISCUSSION II:

PREMATURERUPTURE OF TH

MEM@RANES


35/60

PREMATURE RUPTURE O THE MEM@RANES

Pr'(a/!r' r!%/!r' & /' ('(,ra'" PROMJ #" d''a(#rr'=#" "%/a'!" r!%/!r' & ('(,ra'" a" %%a(#/(*J ,'&r' /' "'/ & +a,r a/ a* "/a)' & )'

PPROM "!+d ,' !"'d /% d'' /"' %a/#'/" ar' %rr!%/!r'" ('(,ra'"$ '/'r r / /'* a8' /ra

ETIOLOG


36/60

ETIOLOGY AND

RISFACTOR

Va)#a+

I&'/#"

N!/r#/#a+

d'#'#'"

C'r8#a+

I&'/#"

I(%'/'/'r8#

A,r(a+

('(,ra'%*"#+)*

DIAGNOSIS


37/60

DIAGNOSISH#"/r* & 8a)#a+ +""& ;!#d

Cr(a/# &a(#/# ;!#d # /'

8a)#a

S%'!+!( 8a)#a /r( d#a)"#"$ /

a""'"" 'r8#a+d#+a/# ad +')/

S%'!+!( 8a)#a &r%r'/'r( / ,/a#'r8#a+ !+/!r' ad

a(# ;!#d "a(%+'"&r %!+(ar*

(a/!ra/# /'"/".

P+#) & a(#/#;!#d # &r#=

%"/'r#r.

A Va+"a8a (a'!8'rr "+#)/ &!da+

%r'""!r' '=%'+ ;!#d&r( /' 'r8#a+ "$# #" d#a)"/# &

PROM.

CONFIRM THE DIAGNOSIS


38/60

CONFIRM THE DIAGNOSIS

T'"/#) /' ;!#d #/N#/ra5#' %a%'r #++ /!r,+!' # /' %r'"'' & /'

a+-a+#' a(#/# ;!#d

P+a#) a "a(%+' a(#r"%# "+#d'$ a#r

dr*#)$ ad '=a(##)&r &'r#).

USG: / r!+' !/ &'/a+a(a+#'" ad /

a""'"" )'"/a/#a+ a)'ad a(#/# ;!#d

8+!('


39/60

PROM

PROM

A(#/# F+!#d Id'=Q 7 (

O+#)#dra(# PROM a/ +'"" /a 24''-"> )'"/a/#

D'8'+%('/ &%!+(ar**%%+a"#a PROM !r" a/ 3

''-"> r +a/'r ad#/# & /''r8#= #" &a8ra,+'

+a,r "!+d ,'#d!'" a&/'r 6 /

!r" #& "%/a'!"

/ra/#" !

CONSERVATIVE


40/60

CONSERVATIVEMANAGEMENT

PPROMC/#!' /' %r')a* !/#+ /' +!)

%r+' #" (a/!r'

T r')#5' r#a(##/#" H#) (a/'ra+/'(%'ra/!r' ad a /'d'r 3$0CJ$ "('/#('"#rr#/a,+'$ !/'r!"$ &'/a+ /a*ard#a$ +'!*/"#"

I a"'" & "!,+##a+ #&'/# d#a)"#" ad /r'a/('/ (a* ,' d'+a*'d

A(%##++# r 'r*/r(*# %r+) /'#/'r8a+ / d'+#8'r* # %a/#'/" #/ PPROM


41/60

@ECA

Gr'a/'rr#"-

Da(a)'/'

%r'/'r(,a,*>",ra#

C'r',ra+ Pa+"*

MANAGEMENT OF


42/60

MANAGEMENT OFCHORIOAMNIONITIS

Cr#a(##/#

"

C(,#a/#a/#,#/#

A(%##++#ad

G'/a(*#

C'%a+"%r#La,r

"!+d ,'#d!'d

I& 'r8#= #"!&a8ra,+'

MANAGEMENTPa/#'/

+#)#dra(#


43/60

MANAGEMENT

O,"'r8a/# 2 / 3da*" #/!/ a*

'8#d'' & #&'/#"

C"#d'r / !/%a/#'/(aa)'('/

T' %a/#'/ "!+d r'+#a,+'$ &!++* #&r(

r')ard#) /' r#"-#8+8'd$ ad%r'%ar'd /

%ar/##%a/' # 'r ar'

R'"/r#/'d %*"#a+a/#8#/*$ #/a+a/#8#/*$ (#/r /'

/'(%'ra/!r' a/ +'a"/ 4/#('" %'r da*.

F'/a+ #- C!/

I 1 !r 3 /#('"

I& +* 1 -#-

M#/r # 12 !r

I& 10 /#(' )

I& Q 10 G /"%#/a+ a" " a

%""#,+'

+#)#dra(#ad#da/' &r

(aa)'(


44/60

LA@OR AND DELIVERY

PROMO+#)#dra(#

D'r'a"'

A(#/# F+!#d

@/ 8'r/'= r,r''

%r'"'/a/#"

C"#d'rC'"ar'aDE+#8'r*


45/60

DISCUSSION III

HYPERTENSIONDISORDER IN

PREGNANCY

J


46/60

HYPERTENSIONIN PREGNANCY

@EFOREPREGNANT

40 WEES20 WEES

PROTEIN URINE J

PROTEIN URINE J

PROTEIN URINE J

PROTEIN URINE J

RED : SUPERIMPOSED PREECDAR @LUE: GESTATIONAL HYP

YELLOW: PREECLAMPSLIGHT @LUE: CHRONIC HYPER


47/60

ETIOLOGY AND RIS FACT

F#r"/ Pr')a*

H*%'r%+a'/"#"

A)' & (/'r

Fa(#+* #"/r*

H*%'r/'"# ad R'a+ D#"rd'r H#"/r*

THEORY OF A,r(a+#/* &P+a'/aVa"!+ar#5a/#


48/60

HYPERTENSIONVa"!+ar#5a/#

I"'(# &P+a'/a$

S/r'""O=#da/#8'$

Ed/'+#a+D#"&!/#

I((!+)#I/+'ra'

Card#8a"!+arada%/a/#

G''/#

I;a((a/#"/#(!+!"


49/60

HYPERTENSIONIN PREGNANCY

DIAGNOSISE+'8a/#

E+'8a/'d


50/60

DIAGNOSIS @+d

Pr'""!r'

"'r!(

'5*('

+'8'+ S'r!(Ur#A#d ↑

W'#)/)a#ad'd'(a

Pr/'#!r#a

V#"!

a+d#"/!r,a'"

PYLa,'/a++

D#r'/8a"d#+a/


51/60

PY

M'd#a/#

IV H*dra+a5#'@1 ad A1

"'+'/#8,+-'r

Sd#!(#/r%r!""#d'

Pr8#d#)(#!/'/

(#!/' /& ,+d%r'""!r'

M)SO4 20 r

40

Lad#) d"'

4 )ra( # 10 R#)'r

La/a/' # 1(#!/'"

Ma#/'a'd"'

10 )ra( # 7 R#)'r

La/a/'$ 2)//(#!/'

Ora+

N#&'d#%#' Ca+#!(Ca'+ @+

M'/#+d%a


52/60

IDENTIFICATIOCASE


53/60

HOW TODIAGNOSE TH

PATIENT

T#" #" 'r 9/ Pr')a* a" "!'r'd (#"arr#a)' 3


54/60

T#" #" 'r 9 Pr')a*$ a" "!'r'd (#"arr#a)' 3/#('"$ a" d'+#8'r* 3 ,a,#'" G9P3A3

Pa/#'/ &''+" /#" #" 'r # (/" %r')a/$ a&''+#) /' &'/a+ (8'('/ "#' 7 (/" a)r"/ da* & /' +a"/ ('"/r!a+ %'r#d: 23rd A%r#+

H#) F!d!" 34 ( G'"/a/# 340 ''

Aa('"#": /' +a,r a" a%%'ar'd "#' 4 !r" #r'a"#)+* "/r)'r ad (r' &r'

d#+a/# 34 ($ &'/a+ %r'"'/a/# # %"/'%r'"'/a/# r"/ "/a)' & +a,r a/#8' %a"'

P"/'r#r Fa' Pr'"'/a/#

Aa('"#": /a/ ;!#d !/ & /' 8a)#a "#' 6 !r" a).C+r'd /ra"+!'/ +#


55/60

C+r'd /ra"+!'/ +#

Pr'(a/!r' R!%/!r' & /' M'(,ra'"

Aa('"#": Pa/#'/ d'#'d /' (%+a#/" & a* 'ar/"'8'r' 'ada'$ ad ,+!rr'd 8#"# ad a" #"/r#) ,+d %r'""!r' ,'&r' r d!r#) /' %r')a*$ ,%r'""!r' 190110 ((H)$ Pr/'# !r#' J G'"/a/#

H*%'r/'"#

G9P3A3 Par/!r#'/ 340 W''-" r"/ "/a)'

a/#8' %a"' #/ C# P"/'r#r Fa' Pr' Pr'(a/!r' R!%/!r' & /' M'(,ra

G'"/a/#a+ H*%'r/'"#

HAS THE


56/60

HAS THE

MANAGEMENT@EEN

APPROPRIATE

C# P"/'r#r Fa'Pr'"'/a/#

S'/


57/60

Maa)'('/

Pr'"'/a/#

Pr'(a/!r' R!%/!r'& /' M'(,ra'"

I? C'

G'"/a/#a+H*%'r/'"#

M)SO

(a#

D%a

N#&'d#


58/60

HAS A@OUT THPROGNOSIS


59/60

! ad &!/#a(

R'%rd!/#8' &!/#: ad ,a(! ad &!/#a(

S'=!a+ &!/#: Ad ,a(! ad 8#/a(: ad ,a(


60/60

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