CHAPTER IV

DISCUSSION

There is pregnancy woman, 29 years old with G2P1A0H1 gravid 26-27 weeks come to
clinic hospital of embung fatimah with complain headache, feel tired, and weak. From anamnesis
we get HPHT on 0ctober 5th 2016. At USG examination at april 10th 2017, we find a fetus,
fetus heart (+), gestation age 26-27 weeks, with blood test HB 8 gr/dl and amnion fluid index
more than normal (AFI>25). Headache (+), feel tired (+) and weak . Pain on bottom stomach (-),
stertorous breathing (-), nausea (-), vomit (-).

At physcal examination we find general condition is good, consciousness compos mentis,

vital sign stable. By inspection, patient abdoments skin looks glowing, auscultation is hard to
heard, fetus heart still able to hear by doppler, palpation seems like acites (-). And obsteric
examination by leopold examination :
Leopold I: there is big part, circle, soft at fundus of uterus.
Leopold II : unpredictable
Leopold III : unpredictable
Leopold IV : the bottom part of fetus is not at pelvis entrance.

Result of laboratory is HB 8 gr/dl, USG examination looks a fetal only, fetus heart (+),
AFI more than 25 cm.
From anamnesis, physical examination, supportive examination, we can diagnose this
patient to G2P1A0H1 gravid 26-27 weeks + Anemia.
Anemia
Standing based on:
Anamnesis Theory
Pregnancy woman G2P1A0H1 gravid
26-27 weeks come with headache, feel World Health Organisation (WHO)
tired, and weak. Patient a blood test define anaemia as haemoglobin (Hb)
level <110 g/L in pregnancy and 100
and results blood 8 gr/dl. g/L postpartum. Currently, there are
no WHO recommendations on the

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 use of different haemoglobin cut-off
points for anaemia by trimester, but it
is recognised that during the second
trimester of pregnancy, haemoglobin
concentrations diminish by
approximately 5 g/L.

In view of the relative plasma

expansion being particularly marked
in the second trimester, it would
seem reasonable to define anaemia
as:
Hb <110 g/L in first
trimester
Hb <105 g/L in
second and third
trimesters
Hb <100 g/L in
postpartum period

Sign and symptom

Anamnesis Theory
Patient with complain Headache , feel There may be no symptoms,
especially in mild and moderate
tired, and weak
anemia. Patient may complain of
feelings of weakness, exhaustion
and lassitude, indigestion and loss
of appetite. Palpitation, dyspnoea,
giddiness, oedema and, rarely,
generalized anasarca and even
congestive cardiac failure can occur
in severe cases.

There may be no signs especially in

miold anemia. There may be pallor,
glossitis and stomatis. Patients may
have edema due to
hypoproteinaemia. Soft systolic
murmur can be heard in mitral area
due to hyper circulation

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 Blood test Theory
HB : 8 gr/dl The decision to transfuse should be
based on careful evaluation including
whether or not there is risk of
bleeding, cardiac compromise or
symptoms requiring urgent attention,
considering oral or IV iron therapy as
an alternative
Women receiving red cell transfusion
should be given full information
regarding the indication for
transfusion and alternatives available.
Consent should be sought and
documented in the clinical notes
Special transfusion requirements
exist in this population group and
specialist transfusion advice should
be sought.

Management Explaination
Transfusion 2 kolf PRC premed The decision to transfuse should be
ondancentron + dexamethason. based on careful evaluation including
whether or not there is risk of
bleeding, cardiac compromise or
symptoms requiring urgent attention,
considering oral or IV iron therapy as
an alternative
Women receiving red cell transfusion
should be given full information
regarding the indication for
transfusion and alternatives available.
Consent should be sought and
documented in the clinical notes
Special transfusion requirements
exist in this population group and
specialist transfusion advice should
be sought.

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 CHAPTER V

CLOSING

A. CONCLUSION
Mrs. RM 29 years old come to clinic hospital of embung fatimah on april 10th 2017 at 10
am with complain headache, feel tired, and weak.
Ay physical and supportive examination, we find abdomen skin looks strained and
glowing, hurt (-), acites (-).
Based on anamnesis, physical examination, and supportive examination, we standing
diagnose G2P1A0H1 gravid 26-27 weeks + anemia. Management for this case is to bed
rest and blood transfusion.
Generally, standing diagnose, rule of management is already suit with literatur. Prognosis
to this case based on diseases history and management is bonam.

B. SUGGESTION
To make diagnose to patient acurately, we need anamnesis, physical examination, and
supportive examination well, so that we can make suit and effective management.

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