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    Laporan Kematian Cianjur April

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    Tri Utami Ningrum
    1. A 36-year-old woman (G2P1) was admitted to the hospital complaining of heavy vaginal bleeding after her water broke 12 hours prior. She was in the first stage of labor. 2. Examination found the baby in a breech position. Despite efforts to deliver vaginally, an impending uterine rupture was diagnosed and an emergency c-section was performed, during which a 10cm uterine rupture was discovered and repaired. 3. Post-operatively, the woman developed respiratory failure and hypotension. Despite resuscitation efforts, she died 4 hours later, suspected to be due to pulmonary embolism.

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    Laporan Kematian Cianjur April

    Uploaded by

    Tri Utami Ningrum
    84 views9 pages
    1. A 36-year-old woman (G2P1) was admitted to the hospital complaining of heavy vaginal bleeding after her water broke 12 hours prior. She was in the first stage of labor. 2. Examination found the baby in a breech position. Despite efforts to deliver vaginally, an impending uterine rupture was diagnosed and an emergency c-section was performed, during which a 10cm uterine rupture was discovered and repaired. 3. Post-operatively, the woman developed respiratory failure and hypotension. Despite resuscitation efforts, she died 4 hours later, suspected to be due to pulmonary embolism.

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    1. A 36-year-old woman (G2P1) was admitted to the hospital complaining of heavy vaginal bleeding after her water broke 12 hours prior. She was in the first stage of labor. 2. Examination found the baby in a breech position. Despite efforts to deliver vaginally, an impending uterine rupture was diagnosed and an emergency c-section was performed, during which a 10cm uterine rupture was discovered and repaired. 3. Post-operatively, the woman developed respiratory failure and hypotension. Despite resuscitation efforts, she died 4 hours later, suspected to be due to pulmonary embolism.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    84 views9 pages

    Laporan Kematian Cianjur April

    Uploaded by

    Tri Utami Ningrum
    1. A 36-year-old woman (G2P1) was admitted to the hospital complaining of heavy vaginal bleeding after her water broke 12 hours prior. She was in the first stage of labor. 2. Examination found the baby in a breech position. Despite efforts to deliver vaginally, an impending uterine rupture was diagnosed and an emergency c-section was performed, during which a 10cm uterine rupture was discovered and repaired. 3. Post-operatively, the woman developed respiratory failure and hypotension. Despite resuscitation efforts, she died 4 hours later, suspected to be due to pulmonary embolism.

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    of 9

    LAPORAN KEMATIAN

    Ny. S

    Residen
    dr. Ryandra Prakasa T (CR)
    dr. Harmi Harun

    Rumah Sakit Umum Daerah Kabupaten Cianjur


    Bagian Obstetri dan Ginekologi
    Kabupaten CianjurJawa Barat
    2013

    IDENTITAS

    Nama

    Ny. S

    Medrek

    573729

    Umur

    36 tahun

    Alamat

    Tegal Lega 02/04 Kec. Pagelaran Ds.Selagedang Kabupaten Cianjur

    MRS

    31-03-2013 (01.02)

    ANAMNESIS
    Keluhan Utama

    : keluar cairan banyak dari jalan lahir

    Anamnesis
    G2P1A0 merasa hamil 9 bulan datang dengan keluhan keluar cairan banyak dirasakan ibu
    sejak 12 jam SMRS. Mules-mules yang semakin sering dan bertambah kuat sejak 8 jam
    SMRS. Gerak anak dirasakan ibu.

    Riwayat obstetri
    1. Bidan, Aterm, Spontan
    2. Hamil ini
    Menikah usia 19 tahun, terakhir memakai pil KB (7 tahun)

    STATUS GENERALIS
    KU

    Compos Mentis

    TD

    120/80 mmHg

    88 x/mnt

    24 x/mnt

    37 C

    STATUS OBSTETRIK

    Pemeriksaan Luar
    TFU

    30 cm

    LA

    Sungsang, puka

    BJA

    138 x/mnt

    His

    1-2/10 menit/30 KK

    Pemeriksaan dalam
    V/v

    tak

    Pembukaan

    1-2 cm

    Ketuban

    (-)

    Bo
    kaki

    St +1, sakrum melintang; tidak teraba tali pusat di samping bokong dan

    Ket
    Hb
    Ht
    Leu
    Trom
    D/

    Nilai
    12,7 gr/dl
    35,5 %
    10.900 /mm3
    190.000 /mm3
    G2P1A0 parturien aterm kala I fase laten, ketuban pecah dini, presentasi bokong kaki

    Th/

    Infus RL
    Cefotaxim 2x1 gr IV
    Rencana partus spontan
    Observasi KU, TNSP, BJA, His

    OBSERVASI
    Jam

    His

    02.00-

    1-

    03.00

    2x/10/30KK

    03.00-

    1-

    04.00

    2x/10/30KK

    05.0006.00
    06.0007.00
    07.0008.00
    08.0009.00
    09.0010.00
    10.0011.00
    11.0012.00
    12.0013.00
    13.0014.00
    14.0015.00
    15.0016.00
    16.0016.30

    1-

    BJA

    138

    T(mm

    N(x/m

    R(x/m

    Hg)

    100/70

    80

    24
    Observasi KU

    140

    100/70

    80

    24

    142

    100/70

    80

    24

    138

    100/70

    80

    24

    142

    100/70

    84

    24

    144

    100/70

    88

    24

    136

    100/70

    80

    24

    tanda vital his


    dan BJA

    2x/10/30KK
    12x/10/30KK
    12x/10/30KK
    12x/10/30KK
    12x/10/30KK
    1-

    5 IU dlm 500
    138

    100/70

    84

    24

    136

    100/70

    88

    24

    140

    100/70

    80

    24

    142

    120/70

    84

    24

    142

    110/70

    88

    24

    132

    100/70

    94

    24

    110/70

    120

    24

    3x/10/30KK
    23x/10/30KK
    23x/10/30KK
    23x/10/30KK
    34x/10/40K
    34x/10/40K

    cc D5% 20-40
    gtt

    2x/10/30KK
    2-

    Drip oksitosin

    16.3017.00
    17.0018.00
    18.0018.15

    3-

    100/70

    122

    24

    120/70

    124

    24

    3-

    Sulit

    120/70

    122

    24

    4x/10/40K

    dinil

    4x/10/40K
    34x/10/40K

    ai

    Jam
    18.00

    Dilakukan PL
    His : 3 x / 10 menit / 30KK
    BJA : sulit dinilai
    Dilakukan PD
    v/v
    : tak
    Pembukaan : lengkap
    Ket
    : (-)
    BO St +1 sakrum kanan depan, tidak teraba tali pusat di samping bokong dan
    kaki
    D / G2P0A0 parturien aterm kala II, presentasi bokong kaki
    Pimpin ibu meneran setiap ada his
    Observasi KU, TNSP, BJA, His

    18.15

    15 menit kemudian, ibu mengeluh nyeri perut, ibu mengedan terus menerus tanpa
    dipimpin mengedan
    KU
    TD
    Nadi
    RR

    = Gelisah
    = 120/70 mmHg
    = 120 x/mnt
    = 24 x/mnt

    Dilakukan PL
    His : 3 x / 10 menit / 30KK
    BJA : sulit dinilai
    Teraba bagian bayi
    Dilakukan PD

    v/v
    : tak
    Pembukaan : lengkap
    Ket
    : (-)
    BO St +3 sakrum kanan depan, tidak teraba tali pusat di samping bokong dan
    kaki
    D / G2P1A0 parturien aterm kala II, presentasi bokong kaki; impending ruptur
    uteri
    Lahir bayi dengan manual aid
    BB: 2700 gram PB: 46 cm Tanpa tanda-tanda kehidupan. Maserasi (-)
    Disuntikan oksitosin 10 iu im, kontraksi baik
    Lahir plasenta spontan lengkap
    Dilakukan eksplorasi jalan lahir
    Teraba robekan di fornix posterior meluas ke atas sampai ke corpus posterior
    uterus
    Kesan: ruptur uteri
    D/ P2A0 partus maturus dengan manual aid; stillbirth; ruptur uteri

    19.00
    19.30
    21.00
    21.30

    Th/
    Rencana laparotomi ai ruptur uteri
    O2 5L
    Pasang IV line 2 jalur
    Guyur RL dan koloid
    Informed consent
    Lapor DPJP: advis setuju diagnosis dan tindakan
    Menghubungi OK
    Observasi KU, TNSP, perdarahan
    Ibu tiba di OK
    Dilakukan operasi
    Operasi selesai
    KU = CM
    TD = 140/90 mmHg
    Nadi = 108 x/mnt
    RR = 22 x/mnt
    SpO2 = 99%
    Abd : datar lembut
    DM (-), PS/PP (-/-) NT(-) BU(-)
    Perdarahan pervaginam (-)
    Diuresis 400cc
    Drain abdomen 50 cc, kemerahan
    D/ post HSV a.i atonia uteri e.c ruptur uteri;
    P2A0 partus maturus dengan manual aid;
    stillbirth

    Pasien direncanakan untuk


    pindah ke ICU ICU masih
    penuh
    Ibu dipindahkan ke ruang
    nifas
    Observasi ketat dengan
    monitor
    02 5-8L
    Terpasang IV line 2 jalur
    Transfusi PRC s/d Hb > 8
    gr/dl
    Cefotaxim 2x1 gr
    Metronidazol 3x500 mg
    Kaltrofen supp 2x1
    Dexametason 2x1
    Ranitidine 2x1

    Kalnex 3x1
    22.30

    23.30

    KU = CM
    TD = 100/80 mmHg
    Nadi = 88 x/mnt
    RR = 22 x/mnt
    SpO2 = 99%
    KU = CM
    TD = 100/70 mmHg
    Nadi = 88 x/mnt
    RR = 24 x/mnt
    SpO2 = 98%

    00.30

    KU = CM
    TD = 110/70 mmHg
    Nadi = 88 x/mnt
    RR = 24 x/mnt
    SpO2 = 94%

    01.30

    Dilaporkan keadaan menurun, pasien mengeluh


    sesak nafas, batuk (+)
    KU = Gelisah
    TD = 100/70 mmHg
    Nadi = 120 x/mnt
    RR = 30 x/mnt
    SpO2: 84 %
    Abd : datar lembut
    DM (-), PS/PP (-/-) NT(-)
    Perdarahan pervaginam (-)
    Diuresis 200cc
    Drain abdomen 50 cc, tidak produktif
    Pasien apnoe
    TD = 80/50
    Nadi = 130 lemah
    RR = 1-1
    SpO2: 75%
    KU = spoor
    TD = 80/60
    Nadi = HR = TT
    RR = 20 x/mnt ( bagging )
    KU = soporokoma
    TD = 60/40 mmHg
    Nadi = HR = 120 x/mnt
    RR = 28 x/mnt
    TD = 50/pp mmHg
    Nadi = HR = TT
    RR = Bagging
    Pupil midriasis maksimal
    TD = TT
    Nadi = HR = TT

    02.00

    02.30

    03.30

    04.00

    04.30

    O2 8 L/mnt NRM
    Tranfusi stop
    Periksa AGD
    ICU masih penuh
    Informed consent keadaan
    ibu
    Menghubungi DPJP:
    Informed consent keadaan
    ibu kepada keluarga
    O2 8 L/mnt NRM
    RJP
    Dilakukan intubasi
    Bagging
    O2 10 L/mnt NRM
    Adrenalin 1 ampul iv
    Informed consent kepada
    keluarga

    Os dinyatakan meninggal di
    hadapan keluarga, perawat

    RR = Bagging
    Pupil midriasis maksimal

    Penyebab respiratory failure


    e.c susp.emboli paru

    Laporan operasi
    Pasien terlentang di meja operasi
    A dan antiseptik daerah abdomen dan sekitarnya
    Dilakukan insisi mediana inferior
    Setelah peritoneum dibuka, tampak darah dan bekuan darah kurang lebih 500 cc
    Darah dan bekuan darah dibersihkan
    Uterus ~ gravid 14-16 minggu berwarna putih pucat, kontraksi kurang baik.
    Pada eksplorasi tampak robekan di corpus posterior sepanjang 10 cm ke lateral sebelah kiri
    meluas dari pangkal ligamentum rotundum sampai ke fornix posterior
    Kesan : rupture uteri
    Diputuskan dilakukan Histerektomi Supravaginalis
    Dilakukan reperitonealisasi
    Perdarahan dirawat.
    Rongga abdomen dicuci dengan NaCL 0,9%
    Dipasang drain abdomen
    Dinding abdomen dijahit lapis demi lapis
    Kulit dijahit subkutikuler

    Th/ post op
    Line I

    Infus Rl 30 gtt/mnt

    Line II Tranfusi PRC s/d Hb > 8 gr/dl


    Cefotaxim 2 x 1 gram
    Metronidazol 3 x 500 mg iv
    Kaltrofen 2 x 1 supp
    Ranitidine 2x1
    Dexametasone 2x1
    Kalnex 2x1
    Puasa s/d BU (+)
    Observasi KU, TNSP, Perdarahan

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