A 31-year-old woman, Mrs. L, was admitted to the delivery room with intermittent waist pain for 2 hours. She had a history of 3 previous C-sections. On examination, she was term pregnant with a singleton fetus in head-down position. Ultrasound confirmed a term pregnancy and reactive fetal heart rate monitoring. Given her history of 3 C-sections, her management was a planned C-section under spinal anesthesia. A female baby was delivered weighing 2.7kg with good APGAR scores. The mother's post-operative bleeding was 250cc and both mother and baby were in stable condition.
A 31-year-old woman, Mrs. L, was admitted to the delivery room with intermittent waist pain for 2 hours. She had a history of 3 previous C-sections. On examination, she was term pregnant with a singleton fetus in head-down position. Ultrasound confirmed a term pregnancy and reactive fetal heart rate monitoring. Given her history of 3 C-sections, her management was a planned C-section under spinal anesthesia. A female baby was delivered weighing 2.7kg with good APGAR scores. The mother's post-operative bleeding was 250cc and both mother and baby were in stable condition.
A 31-year-old woman, Mrs. L, was admitted to the delivery room with intermittent waist pain for 2 hours. She had a history of 3 previous C-sections. On examination, she was term pregnant with a singleton fetus in head-down position. Ultrasound confirmed a term pregnancy and reactive fetal heart rate monitoring. Given her history of 3 C-sections, her management was a planned C-section under spinal anesthesia. A female baby was delivered weighing 2.7kg with good APGAR scores. The mother's post-operative bleeding was 250cc and both mother and baby were in stable condition.
A 31-year-old woman, Mrs. L, was admitted to the delivery room with intermittent waist pain for 2 hours. She had a history of 3 previous C-sections. On examination, she was term pregnant with a singleton fetus in head-down position. Ultrasound confirmed a term pregnancy and reactive fetal heart rate monitoring. Given her history of 3 C-sections, her management was a planned C-section under spinal anesthesia. A female baby was delivered weighing 2.7kg with good APGAR scores. The mother's post-operative bleeding was 250cc and both mother and baby were in stable condition.
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Three times previous CS
Case 93
Patients ID Name Age Address MR Date of admission 2013
: : : : :
Mrs. L 31 years old Bariang Indah 18 12 55 August 23rd,
Anamnesis A 31 years old patient was admitted to the Delivery Room of Dr. M. Djamil Central General Hospital on August 23rd, 2013 at 09.00 pm with chief complain feeling of pain from waist region intermittent was felt since 2 hours ago.
Present Illness History
Feeling of pain from waist region intermittent was felt since 2 hours ago. Bloody show from the vagina was absent. Fluid leakage from the vagina was absent. There is no massive vaginal bleeding. Amenorrhea since 9 months ago. First date of last menstrual period was forgotten. Estimation date of delivery cant be estimated. Fetal movement was felt since 5 months ago. No complain of nausea, vomitting, and vaginal bleeding neither during early pregnancy nor late pregnancy. Prenatal care to Rasyidin District Hospital, regular once a month since 2 month of pregnancy age. Menstruation history : menarche at 12 years old, irregular cycle, once in 25-35 days which last for 5 to 7 days each cycle with the amount of 2-3 times pad change/day without menstrual pain.
Previous Illness History
There was no history of cardiac disease, lung disease, liver disease, renal disease, diabetes mellitus, hypertension. Allergic history was denied
Familial Illness History
There was no history of any hereditary, contagious, or psychiatric disorder.
Marriage history: married once in 1999
Obstetric history : Pregnancy/Abortion/Delivery: 3/0/2 1. In 2000, female, 2800 gr, term, spontaneusly, hospital, alive 2. In 2003, female, 2800 gr, term, CS oi no dilatation, Private Hospital, wound healed in 7 days, alive 3. In 2005, male, 2800 gr, term, CS oi previous SC, District Hospital, wound healed in 7 days, alive 4. In 2006, male, 2800 gr, term, CS oi previous SC, District Hospital, wound healed in 7 days, died at age 2 days 5. present Educational history : Senior High School Occupational history : housewife History of family planning : contraception injection every three month Immunization : TT 1x (7th month)
PHYSICAL EXAMINATION GA Cons BP PR RR T Mdt CMC 120/70 82x 20x 37 Body Height : 150 cm Present Body weght : 45 kg Before Pregnancy Body Weight : 50 kg BMI : 22.3 kg/m2 Upper Arm Circumferrence : 23 cm
Inspection : enlarged due to a term pregnancy, median line
hyperpigmentation, cicatrix (+) previous CS with median line incision Palpation : L1 : uterine fundal was palpated 3 fingers below proccesus xyphoideus, a soft, large noduler mass was palpated L2 : hard and resistance structure was felt on the left side, numerous small and irregular structures were felt in the right side L3 : a round hard mass was palpated, not fixated L4 : didnt performed Uterine fundal height : 31 cm, EBW : 2790 g, uterine contraction : (+)/S/W
Percussion Auscultation
: tympani : normal peristaltic sound, FHR : 142-154 bpm
Genitalia : I : V/U normal, Vaginal bleeding (-)
Vaginal examination : 1 finger Portio 1,5 cm in thickness, posterior, moderate Amniotic sac (+) Head was palpated at HI Impression Internal and External pelvimetry : adequate pelvic
ULTRASOUND
ULTRASOUND Fetal alive, singleton, intrauterine, head presentation Fetal movement was good Biometrics : BPD : 90,2 mm AC
: 310 mm
FL
: 71,4 mm
EFW : 2757 gr Placenta was implanted in posterior corpus, grade IIIII Impression : term pregnancy fetal alive, head presentation
CTG
CARDIOGRAPH Interpretation : Baseline
: 140 bpm
Variability
: 5-15 bpm
Acceleration
: (+)
Deseleration
: (-)
Contraction
: (+)
Fetal Movement : (+)
Impression : Reactive CTG
Laboratory Finding Laboratory finding
Normal value for 3rd TM
Routine blood testing
Hemoglobine
11,9 gr/dl
9,5-15,0
Leucocyte
14.800/mm3
5.916.9
Hematocrit
35 %
28.040.0
Trombocyte
210.000/mm3
146429
MCV
89 um3
8199
MCH
30,1 pg
2932
33,6 g/dl
32-36
MCHC
Diagnosis G5P4A0L3 term pregnancy phase + 3 times previous CS + contraction Fetal alive, singleton, intra uterine, head presentation at HI
Management : Control general condition, vital sign, FHR, uterine contraction Routine blood test Antibiotics (Skin test) Informed Consent Consult to OR and anesthesiologist
Planning : Caesarean section
At 09.45 PM CCS was performed A female baby was born with : 2700 gr in weight, 47 cm in height, APGAR score 8/9 Placenta was born with a slight pull on the umbilical cord, complete, 1 piece, with size of 17x16x3 cm, 550 g in weight, the umbilical cord length was 60 cm, with paracentral insertion. Pomeroy Tubectomy was performed. Bleeding during surgery was 250 cc Diagnosis : P5A0L4 post CCS due to 3 times previous CS + PT o.i enough child Mother child were in care
