CASE NO

IDENTITY
Patient Husband
Name : Mrs. F Name : Mr. A
Age : 32 y o Age : 36 y o
MR : 01 11 00 49 Education : senior high school
Education : Elementary School Occupation : Enterpreneur
Occupation : Housewife address : Padang
Address : Padang
Date of entry : 13/07/2020
Mr. V, 40 years, MR 01 08 97 88
TANGGAL
MASUK Referral from preparation Diagnose Management

Date : Referral from : Consult perinatology • G6P5A0L5 37-38 weeks of Forcep extraction
13/07/2021 RSUD Sei Dareh Agree to assistance
fetal aterm parturien active phase
Dharmasraya resuscitation of first stage + severe
Time : preeclampsia
05.45 WIB Diagnose : Covid 19 team consult • Fetal alive, singleton,
G6P5A0H5 of aterm ( answered after action ) intrauterine, head
DPJP : parturien active phase Patient include to suspected presentation
HY, HJS of first stage + severe Covid 19
preeclampsia Adv :Red zone in care
Swab PCR 2 x
Azitromomicin 1x500mg
Vit C 2x250mg
Zinc 2x20mg
 Clinal Data Physic examination Additional Examination

Anamnese GA Conc BP HR RR T
• Pasien referred from RS Sungai Dareh Dharmasraya with Mod CMC 130/82 93 22 36,5 Laboratory 29-9-2020
G6P5A0L5 aterm pregnancy first stage active phase + Hb: 10,8
Severe preeclampsia the patient refer to PONEK RSUP BW :  72 kg (before pregnant 58 kg) Leukosit : 16.200
Dr. M. Djamil Padang because contact with positive BH  : 155 cm Trombosit: 311.000
suspected COVID-19 and next management BMI :  24.37 (Normoweight) Ht: 31
• Pelvic pain referred to the groin since 6 hours ago UAC : 26,5cm Diff count : 0/1/76/13/10
• Bloody show from the vagina since 6 hours ago​ PT: 9,4
• Fluid leakage from the vagina since 3 hours ago Eyes : conjunctiva anemi (-) APTT: 25,1
• Vaginal bleeding massive (-) Total Protein: 5,7
• Fetal movement felt since 5 months ago Thorax : heart and lung in normal limit Albumin: 3,4
• Amenorea 9 months ago. HPHT : forget TP : unknown Globulin: 2,3
• fever (-), cough (-), dyspneu (-), history contact confirm Abdomen : Abdomen seemed enlarged in accordance to term pregnancy, striae Total Bilirubin : 0,5
positive COVID-19 (-), contact with somebody from gravidarum (+), hyperpigmentation (+), cicatrix (-)​ Direct Bilirubin : 0,2
outside Sum-bar (-). L1 =  Uterine fundal was palpable 3 fingers under proc. Xypoideus​ Indirect Bilirubin : 0,3
• History of early pregnancy : nause (+) vommit (-)       large, soft, nodular mass was palpated ​ SGOT/SGPT: 15/5
bleeding (-) L2 = a hard and resistence structure was felt on the right side, small parts of Ureum/Creatinin: 15/0,6
• History of late pregnancy : nause (-) vommit (-) bleeding the baby were felt on the left side GDS : 104
(-) L3 = a hard mass was palpated, fixated Na : 136
• ANC : regularly every month to PHC with midwife since L4 = Divergen K : 3,5
5 month pregnancy, never control to obstetrician. Contraction : 3-4x/45”/Strong FHR : 145-155x/i Cl : 108
History of pregnancy/abortion/delivery : : 5/3/1 FH: 30 cm EFW : 3100 gram Anti HIV: NR
1. 2006/male / 2900 gr/ term/ spontaneous/ HBsAg: NR
midwife/alive Gen : V/U normal , VB (-)
2. 2008/ male /2800 gr/term/ spontaneous/ VT : ∅ 8-9, amniotic sac (-) clear residue, Head presentation, right occiput Rontgen Thorax :
midwife/alive posterior, at Hodge II-III Heart lung in normal
3. 2014/male/2800gr/term/ spontaneous/ midwife/alive
4. 2018/female/2700/term/spontaneus/midwife/ alive Inner Pelvic Size: ​
5. 2019/female/2900/term/spontaneus/midwife/alive Promontorium and linea innominata are hard to to determine, straight lateral
6. present pelvic wall, sunken os sacrum, spina ischiadicha little protrude, easy to
move os coccygeus, arcus pubis >90 degrre​
Outer pelvic size:​
ITD could be entered by a fistful of adult hand, diameter 10,5 cm​
Impression : adequate pelvic​

EXtremity :
Edema -/-
 at 23.20
S:
Feeling want to bear down (+), fetal movement (+)
O:
GA Conc BP HR RR T
Mod CMC 130/82 93 22 36,5
Abdomen : contraction : 4-5x/45”/strong DJJ : 140-150x/i
Gen : V/U normal, vaginal bleeding (-)
VT : ∅ complete, amniotic sac (-) clear residue, Occiput in anterior, head on HIII-IV

A:
G6P5A0L5 38-39 weeks of term parturien of second stage + suspected COVID-19

P:
monitor GA, VS,
Assist delivery
Plain
Assist second stage  forceps extraction
 DATE OF DIAGNOSE ACTION
ACTION
Date : Diagnosis Pre Tindakan Baby was born, boy, at 05.55
13/07/2021 • G6P5A0L5 aterm pregnancy first stage active BBW: 2.940 gram
phase + Severe preeclampsia HW : 48 cm
Action : • Fetal alive, singleton, intrauterine, head A/S : 6/8
05.45 WIB presentation Plasenta born by manual placenta, complete, 1 piece, parasentralis insertion
size 15x13x2 cm and weight 550 gr
DPJP : Rencana Tindakan
HY, HJS Second stage by assisted  Extraction forcep Diagnose Post op/action :
P6A0L6 post forcep extraction oi severe preeclampsia

Process Instruct
G6P5A0L5 aterm pregnancy first stage active • Control GA, VS, contraction, VB
phase + Severe preeclampsia • IVFD RL drip Oksitosin 10 IU + metergin 0,2 28 tpm
 second stage  forceps extraction • Cefixime 2x200 mg po
• Paracetamol 3x500 mg po
• SF 2 x 180 mg po
• Vit C 3 x 50 mg po
• Foley cateter 12 hours post forceps
• Check lab 6 hours post forceps
• Admitted to yellow zone
• Swab PCR 2 x
Admission letter Referral Letter
Laboratory
Rontgen Thorax
Consult Pulmonology
• Patient suspected COVID-19
• yellow zone  Swab PCR 2x

• P/
• Azitromicin 1x500 mg
• Vitamin C 2x 250 mg
• Zinc 2x20 mg
Consult perinatology
• Agree to assist the labor progress
according to conditions at birth
 13/07/2021 pukul 23.30 wib
S/ Baby was born at 05.55
BW : 3.060 gram
HW : 49 cm
AS : 8/9
Placenta born by manual placenta, complete, 1 piece, 500 gram weight, paracentral insertion
16x13x3 cm, 500 gram weight
Laseration of perineum grade I

O/ GA Conc PO HR RR T
Mdrt CMC 104/68 98 20 36,7
Abdomen : 2 finger below umbilicus. Contraction (+) good
Gen : V/U normal. VB (-)

A/ P4A1H4 post forcep extraction + suspected COVID-19

P/ Monitor four stage
 Fourth stage
Hours time BP HR T Fundal height contraction Urine Bleeding
output
1 23.30 100/60 98x 36,5 2 finger below Normal - -
umbilicus

  23.45 100/60 88x   2 finger below Normal -

umbilicus

  00.00 100/70 80x   2 finger below Normal -

umbilicus

00.15 100/70 84x 2 finger below Normal -

umbilicus

2 00.45 100/70 80x 36,8 2 finger below Normal 100 cc -

umbilicus

  01.15 110/70 88x   2 finger below Normal -

umbilicus
 30/09/2020 at 07.00
S/ fever (-)
bleeding (-)
Pain in perineal wound (-)

O/ GA Con BP HR RR T
Mode CMC 110/70 74 20 36,7
Abdomen : FUT 2 jari bawah pusat. Contraction (+) baik
Gen : V/U normal. VB (-)

A/ P4A1H4 post forcep ekstraksi ai suspek COVID-19 NH 1

P/ • control GC, VS, Contraction, VB
• IVFD RL drip Oksitosin 10 IU + Metergin 0,2 28 tpm
• Cefixime 2x200mg
• Parasetamol 3 x 500 mg
• SF 2 x 180 mg
• Vit C 3 x 50 mg
• Swab PCR 2 x
Laboratory post delivery
Forceps Extraction Report​
• PAddress the woman (explain the procedure and ask for consent)​

• Bladder empty need to be catheterised​

• Examine the woman to assessment if cervix fully dilated​

• Determine the position of the fetal head​

• Equipment ready​, Forceps applied​

• Articulate the forceps and hold them in position ​

• Disarticulate, place left blade in the left-hand ​

• Apply to the left side of the mother’s pelvis ​

• Cephalic curve towards vulva ​, Shank vertical at start ​

• Posterior fontanelle midway between shanks, 1 cm above plane of shanks ​

• Fenestrations admit no more than one fingertip. ​

• Sutures posteriorly fontanelle above and equidistant from, upper surface of each blade, sagittal suture is within the midline​

• Gentle traction in a downward and outward direction using a J shaped curve ​

• This may be performed during or after contractions​

• Handles drawn up in a J shaped curve​

• Incision or episiotomy needs to be considered when the fetal head is being delivered​

• Forceps are removed in the opposite order they were placed in. When the Jaw is visible​

• Apply to the left side of fetal head​

• Right-hand protects maternal tissue, applies force ​

• Repeat for right-sided ​

• Articulate handles and lock (handles should lock together easily)​

• Baby was born BW : 3.060 gr LB 49 cm A/S 8/9

• Placenta completes 1 500 gram, insertion paracentral

• Explore wound, blodd loss ± 150 cc

Lubchenko Curve
Thank You