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    Yulia AF

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    Ilmiah Program studi Obgin
    Mrs. Yulia Sulistina, 26 years old, presented with vaginal bleeding at 34 weeks of pregnancy. She had a history of two prior cesarean sections. Examination found complete placenta previa and suspected placenta accreta based on her risk factors. She was managed expectantly with monitoring, medications, and ultrasound confirmation. Due to worsening signs, she underwent an emergency cesarean section and total hysterectomy due to placenta accreta. She delivered a healthy baby boy and had an otherwise unremarkable postoperative recovery.

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    Yulia AF

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    Ilmiah Program studi Obgin
    51 views12 pages
    Mrs. Yulia Sulistina, 26 years old, presented with vaginal bleeding at 34 weeks of pregnancy. She had a history of two prior cesarean sections. Examination found complete placenta previa and suspected placenta accreta based on her risk factors. She was managed expectantly with monitoring, medications, and ultrasound confirmation. Due to worsening signs, she underwent an emergency cesarean section and total hysterectomy due to placenta accreta. She delivered a healthy baby boy and had an otherwise unremarkable postoperative recovery.

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    Mrs. Yulia Sulistina, 26 years old, presented with vaginal bleeding at 34 weeks of pregnancy. She had a history of two prior cesarean sections. Examination found complete placenta previa and suspected placenta accreta based on her risk factors. She was managed expectantly with monitoring, medications, and ultrasound confirmation. Due to worsening signs, she underwent an emergency cesarean section and total hysterectomy due to placenta accreta. She delivered a healthy baby boy and had an otherwise unremarkable postoperative recovery.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    51 views12 pages

    Yulia AF

    Uploaded by

    Ilmiah Program studi Obgin
    Mrs. Yulia Sulistina, 26 years old, presented with vaginal bleeding at 34 weeks of pregnancy. She had a history of two prior cesarean sections. Examination found complete placenta previa and suspected placenta accreta based on her risk factors. She was managed expectantly with monitoring, medications, and ultrasound confirmation. Due to worsening signs, she underwent an emergency cesarean section and total hysterectomy due to placenta accreta. She delivered a healthy baby boy and had an otherwise unremarkable postoperative recovery.

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    Identity Mrs.

    Yulia Sulistina/ 26 YO / 1326807 / OKI /GIA-DPR-DEV/ AF


    Chief complain Preterm pregnancy with vaginal bleeding
    History Patient came with vaginal bleeding since 2 hours before admission, red color, with amount
    1-2 changing pad/day. History of abdominal contraction radiates to waist (-). History of
    Admission Time
    watery discharge (-). History of leukorrhea (-). History of post coital (+) last night, history
    23.12.2022
    of trauma and massage (-). History of hypertension before pregnancy (-), history of
    08.00 AM
    hypertension in prior pregnancy (-), history of hypertension in this pregnancy (-). Patient
    admitted has preterm pregnancy with fetal movement still felt.
    Past Illnes history -
    Antenatal Care midwife every month, only 1x came to Obstetrician
    History
    Marital status Married 1x for 11 years
    Reproduction status Menarche 14 years old, regular cycle, 28 days, length: 5-6 days LMP : 08/08/2022
    Obstetric history
    1. 2013/ Male/ 3600 g/ aterm/ LSCS oi severe eclampsia/ doctor/RS Bangka/ healthy
    2. 2018/ Male/ 3100 g/ aterm/ LSCS oi previous CS 1x/ doctor/RS Bangka / healthy
    3. 2019/ Abortion / 10 weeks / didn’t curretage
    4. Current pregnancy
    Physical Examinatio BP: 121/70 mmHg, Pulse: 88 x/m, T: 36.6C, RR: 19 x/m
    n BW : 73 kg ; BH 158 cm ; BMI : 29,2 kg/m2
    Head: normocephaly, pale conjunctiva (-/-), icteric sclera (-/-)
    Neck : JVP (5-2) cmH2O, lymph nodes enlargement (-)
    Thorax:
    Cor: heart sound I-II normal, murmur (-), gallop (-)
    Lungs: normal vesicular sound (+/+), rales (-), wheezing (-/-)
    Extremities: pretibial edema (-/-)
    Obstetrical examinat External examination
    ion Abdomen : Fundal height 1 fingers above umbilical (27 cm), longitudinal lie, right fetal
    spine, cephalic presentation, U 5/5 abdominal contraction (-), FHR: 151 x/m, EFW : 2170
    gram
    Speculum examination
    Livide portio, Dilatation OUE (+), fluor (-), fluxus (+) bleeding active, E/L/P (-)
    Vaginal toucher:
    didn’t performed

    Laboratory examinat Hb 11,1 g/dL; WBC 9.95x103/mm3; Ht 32%; PLT 337x103 /uL; MCV 82,8; MCH 29;
    ion MCHC 35; RBC 3,89x103 mm; OT/PT 21/20 U/L ; HBsAg non reactive; TPHA non
    reactive; VDRL non reactive; Anti HIV non reactive; Urinalysis = protein (-) ; leukocyte 0-
    09.04.23
    1 ; LEA (-) ; bacteria (+2)
    US Examination  Single life fetus cephalic presentation
    Fetal Biometry
     BPD: 8,96 AC: 30.14 EFW: 2455 g
     HC: 32,03 Fl : 6,64 cm
     TCD : 4,35 cm ~ 34w1d
    Amniotic fluid sufficient, AFI = 11,57 CM
    Placenta at corpus uteri anterior expanding to OUI ~ Complete Placenta Previa

    PAI Score : Prior CS 2x = 3 ; Lacuna grade 2 = 1 ; Complete Placenta Previa = 1,


    myometrial thickness <1mm = 1 ; Bridging vessel (+) = 0,5
    Total score : 6,5 ~ 83%

    C/
     34 weeks gestational age single life fetus cephalic presentation
     Complete Placenta Previa
     PASD (PAI Score 6,5 ~ Probability 83%) was suspected
    CTG (09.04.23)
    Baseline
    130x/minute
    Variability : Normal
    variability (6-25
    x/m)
    Deceleration (-)
    Acceleration (-)
    Contraction (-)
    Category 1
    Diagnosis  G3P2A0 34 weeks gestational age not in labor (Z34.30)
     Antepartum Haemorrhage cb Complete Placenta Previa (O46.9)
     Prior CS 2x o.i eclampsia (O34.21)
     PASD (PAI Score 6,5 ~ Probability 83%) was suspected (O43.13)
     SLF cephalic presentation (O32.2)
    Management  Observation of vital sign, contraction and FHR
     Laboratory examination
     Tranexamic acid 500 mg/8h
     Tocolytic
     US Confirmation
     Expectative management
    US Confirmation  Single life fetus cephalic presentation
    (10.04.2023)  Fetal Biometry
    dr. Abarham  BPD : 8.71cm FL : 6,02 cm
    Martadiansyah, Sp.OG,  HC : 31.62 cm AC : 28,91 cm
    Subsp. KFm  EFW : 2317 gram
     Amniotic fluid sufficient
     Cervical Length 2.32 cm ~ cervical shortening
     placental bulge (+)
     PAI Score
     prior CS 2x : 3
     complete placenta previa : 1
     grade II lacunae : 1
     clear zone + : 1
     bridging vessel : 0.5
     PAI scrore 6.5 ( probability 83%)
    C/
     34 weeks single life fetus cephalic presentation
     complete placenta previa, PASD was suspected, PAI score 6.5 ~ probability 83%,
    urinanry bladder invasion was suspected
     cervical shortening
    Operative Report 16.30 PM Operation started
    11.04.2023 - Patient on supine position under spinal anesthesia .
    - Aseptic and antiseptic procedure on surgical site and its surrounding area was
    performed.
    - Corporal incision was performed above old wound. Abdominal wall was incised
    further until the peritoneal cavity were exposed.
    - LSCS was performed  semilunar incision on lower uterine segment was
    performed. Amniotic fluid (+), clear colour, smell (-)
    - The baby was delivered by foot extraction
     
    16.40 PM Life neonates was born, male, weight 3500 gram, length 50 cm, HC 35 cm, A/S
    8/9 FT AGA
    - Total hysterectomy was performed

      
    18.30 PM Operation completed
    Lubchenco
    Ballard score

    Recent Diagnosis • P3A1 post LSCS + total hysterectomy oi PASD + complete placenta previa + prior
    CS 2x + cervical shortening
    Recent Condition Stable in ward

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