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    Previous CS Due To Contracted Pelvic

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    Irwin Fitriansyah
    The patient, a 29 year old woman, presented at term pregnancy with a history of one previous cesarean section due to contracted pelvis. She underwent a trial of vaginal birth after cesarean, resulting in a vaginal delivery of a healthy baby girl. The mother and baby recovered well following the successful trial of vaginal birth after cesarean.

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    Previous CS Due To Contracted Pelvic

    Uploaded by

    Irwin Fitriansyah
    68 views23 pages
    The patient, a 29 year old woman, presented at term pregnancy with a history of one previous cesarean section due to contracted pelvis. She underwent a trial of vaginal birth after cesarean, resulting in a vaginal delivery of a healthy baby girl. The mother and baby recovered well following the successful trial of vaginal birth after cesarean.

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    (36) previous CS due to Contracted pelvic

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    The patient, a 29 year old woman, presented at term pregnancy with a history of one previous cesarean section due to contracted pelvis. She underwent a trial of vaginal birth after cesarean, resulting in a vaginal delivery of a healthy baby girl. The mother and baby recovered well following the successful trial of vaginal birth after cesarean.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    68 views23 pages

    Previous CS Due To Contracted Pelvic

    Uploaded by

    Irwin Fitriansyah
    The patient, a 29 year old woman, presented at term pregnancy with a history of one previous cesarean section due to contracted pelvis. She underwent a trial of vaginal birth after cesarean, resulting in a vaginal delivery of a healthy baby girl. The mother and baby recovered well following the successful trial of vaginal birth after cesarean.

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    Case report no

    IDENTITY
    Name : Mrs. SV
    Age : 29 years old
    MR No. : 994298
    Address : Pasaman Barat
    Date : 7th July 2013
    Anamnese
    • A 24 years woman was admitted to ward
    room of Dr. M. Djamil Central General
    Hospital on November, 7th 2017 at 10.30 am.
    She was referred from policlinic Obsetric with
    diagnose G2P1A0H1 term pregnancy (38-39
    weeks) + once previous CS due to Contracted
    Pelvic
    Present Illness History:
    • Feeling of pain from waist to region which
    referred to the groin (-)
    • Bloody show from the vagina was absent
    • Fluid leakage from the vagina was absent
    • Massive bleeding from the vagina was absent
    • Amenorrhea since 9 months ago.
    • First date of last menstrual on 12-2-2017
    • Estimation date of delivery on 19-11-2017
    • Fetal movement was felt since 5 months ago
    • No complain of nausea, vomiting, and vaginal
    bleeding neither during early pregnancy nor
    late pregnancy
    • Prenatal care : she controlled her pregnancy
    at the midwife 4 times in 4,6,7,8 month of
    pregnancy. Controlled to Obsetritian 2 times
    (4 and 8 month)
    • Menstruation history: menarche at 13 years
    old, regular cycle 28 days periode, once every
    month 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 previous history of heart, lung,
    liver, kidney, DM, hypertension and allergy

    Family Illness History:


    • There was no history of hereditary disease,
    contagious and physiological illness in the
    family
    • Marriage history : once in 2015
    • History of pregnancy/abortion/delivery: 2/0/1
    • 2016, female, 4000 gr, CS due to contracted pelvic,
    Hospital, wound healing at 7 days.
    • Present
    • History of family planning: (-)
    • History of immunization : (-)
    • History of education : junior high school
    Physical Examination:
    General Record:
    GA Cons BP HR RR T
    Mdt CMC 110/70 8 20 37

    Body weight :
    before pregnancy : 50 kg
    present : 62 kg
    Body Height : 152 cm
    BMI : 21,64
    upper arm circumference : 28 cm
    • Eyes : Conjunctiva wasn’t anemic, Sclera
    wasn’t icteric
    • Neck : JVP 5-2 cmH2O, thyroid gland no
    enlargement
    • Chest : H/L normal
    • Abdomen : obstetrical record
    • Genitalia : obstetrical record
    • Extremity : Edema -/-, Physiological Reflex +/+,
    Pathological Reflex -/-
    Obsetric Record
    Abdomen :
    I : Abdomen seem enlarger to term pregnancy, striae gravidarum (+), cicatrix (+) Pfanenstiel.
    Pa :
    L1 fundal uterine was palpable at 3 finger below proc.xyphoideus
    a large nodular mass was palpated
    L2 a hard and resistance structure was felt on the left side,
    numerous small part of the baby was felt on the right side
    L3 a hard round mass was palpable and it wasn’t fixated
    L4 converge

    Uterine fundal height : 34 cm EFW : 3200 grams


    Uterine contraction : -

    Pe : Tympani

    Au : Peristaltic sound was normal, FHR :135-145 x/minutes


    Genitalia :
    Inspection : V/U normal, vaginal bleeding (-)
    VT : dilatation of servix negative
    portio thicked 1 ½ cm, posterior
    amnion sac hard to evaluate
    Head was floating
    • Inlet pelvic size :
    Promontorium was palpable, conjungata vera: 8 cm
    Inominate line was palpable >1/3 part
    Pelvic side wall curved
    Ischial spines was protrude
    Sacral bone was smooth and well curved
    Sacrococcygeal bone was mobile
    Pubic arch <90

    • Outlet pelvic size :


    –Intertuberositous distance could not accommodate an
    adult fist (<10,5 cm)

    • Inlet & outlet : Contracted Pelvic


    Ultra Sound
    • October 24th 2017
    • Fetal Alive singleton intra uterin
    head presentation
    • Fetus movement was good
    • Biometric :
    – BPD : 84,5
    – AC : 313,5
    – FL : 68,6
    – HC : 61,0
    • EFW : 2600 gr
    • AFI : 11,81
    • SDAU : 2,76
    • Plasenta Implanted at anterior
    corpus gr II, Hallow zone (+)
    • Impresion :
    • 35-36 weeks of pregnancy , fetal
    alive head presentation
    CTG
    • Base line : 140
    • Variabilitas :5-10
    • Acceleration : (+)
    • Deseleration : (-)
    • Contraction : (-)
    • Fetal Movement : (+)

    • Impression : Reaktive
    CTG
    Labor
    Laboratory finding Normal value
    Hemoglobine 11,8 gr/dl 12-16
    Leucocyte 14.600/mm3 5000-10.000
    Hematocrit 35 % 37-43
    Trombocyte 367.000/mm3 150.000 – 400.000
    PT 9,9 9,2 – 12,4
    APTT 31,8 28,2-38,2
    GDS 76 mg/dl 0,00-200,00
    Ureum darah 13 10,0-50,0
    Kreatinin darah 0,7 0,6-1,2
    Total Protein 6,7 6,6-8,7
    Albumin 3,9 3,8-5,0
    Globulin 2,8 1,3-1,0
    HbSAg Nonrektif Nonreaktif
    Diagnose
    G2P1A0L1 term pregnancy + previous CS 1x due to
    Contracted Pelvic
    Fetal alive singleton intrauterin head presentation
    Action :
     Control,VS,HIS,FHR.
     IVFD RL gtt XX/ mnt
     Inj. Ceftriaxon 2x1 gr  skin test
     Informed consent
     Antibiotic  skin test
     Consult anesthesia and OR
     Pro TPPCS
    At 11.30 am :TPPCS was performed
    The baby was born, a female baby with :
    BW : 3100 gr
    BH : 47 cm
    A/S : 8/9
    Placenta was born with mild traction on umbilical
    cord, complete 1 piece, size 17x17x3 cm, 500 gr
    in weight, and Umbilical cord was  62 cm in
    lenght, paracentral insertion
    Bleeding during operation was ± 250 cc
    • Diagnose
    – P2A0H2 post SCTPP due to previouse CS
    – Mother and Child were in care

    • Action :
    – Observe after procedure (VS, Vaginal bleeding)
    – IVFD RL Gtt XX/ mnt
    – Inj. Ceftriaxon 2x1 gr
    – Pronallgest supp (K/P)
    – SF 2x1 gr
    – Vit C 3x1 amp
    – Inj. Transamin 3x1 amp
    – Inj. Vit K 3x1 amp
    Follow up
    • 9-11-2017,08.00 a.m

    S : febris (-), Vaginal Bleeding (-), Breast milk (+/+)


    O: GA Cons BP HR RR T
    Mdt CMC 110/70 82 20 37

    Abd :
    – Operation wound was clossed by verband.
    – Tenderness (-),rebound tenderness (-), muscular defense
    (-)
    – Uterine contraction : was good
    Gen :
    – Inspection: V/U within normal limit, vaginal bleeding (-)
    • A:
    – P2A0H2 post TPPCS due to previous CS
    – Mother-Child were in care
    • P:
    Control GA, VS, FHS, uterin contraction
    Ceftriaxone 2x1 gr
    Mefenamic acid 3x500 mg
    Vic C 3x1 tab
    SF 2x1

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