Case No.

Patient Husband
 Name : Mrs. T  Name : Mr. A
 Age : 29 years old  Age : 32 years old
 MR No. : 01010083  Occupation : Enterpreneur
 Date : March 15th, 2018  Education : Senior High School
 Education : Senior High School
 Chief Complaint
• A 29 years old patient was admitted to the
Emergency Room of Dr. M. Djamil Central
General Hospital on March 15th, 2018 at
05:00 pm referred by Health Care Bungus at
Padang with diagnosed: G2P0A1H0 37-38 weeks
of term pregnancy + severe preeclampsia on
regimen MgSO4 maintenance dose
Present Illness History
 Patient routine control HC Bungus in Padang and found the blood
preasure 180/120 mmHg. Patient got antihypertension
(metildopa 500 mg), regiment MgSO4 initial dose, and
maintenance dose, then she was referred to RSMJ with regiment
MgSO4 and catheter urine.
 Feeling headache (-), blur vision (-), epigastric pain (-)
 Bloody show from the vagina was abcent
 There was no massive vaginal bleeding
 Amenorrhea since ± 9 months ago
 First date of last menstrual : June, 21th 2017
 Estimation date of delivery : March, 28th 2018
 Fetal movement was felt since ± 5 months ago
• No complain of nausea, vomiting, or vaginal
bleeding neither during early nor late
pregnancy
• Prenatal care to HC Bungus 3 times on 2, 5,
and 8 month of pregnancy, there was no
hypertension before
• Menstrual history : menarche at 13 years old,
irregular cycle, 5-7 days each cycle with the
amount of 2-3 times pad change/day without
any menstrual pain
Previous Illness History
• There was no previous history of heart, lung, liver, kidney
disease, DM, hypertension and allergy

Family Illness History

• There was no history of any hereditary disease, contagious
and phsycological illness in the family.
Occupation, Socioeconomics, Psychiatry, and
Habitual History :
 Marital history: once in 2013
 History of pregnancy/abortion/delivery: 2/1/0
1. 2015, abortus 8-9 weeks pregnancy, obgyn, alive.
2. Present
 History of family planning : (-)
 History of immunization : (-)
 History of occupation : (-)
Physical Examination:
General Record:

GA Cons BP HR RR T
Mdt CMC 160/110 98 22 36,7

urine : 100 cc/hour

patella reflex : +/+ normal limit
BH : 154 cm BW: 65 kg Before pregnant : 50 kg
BMI : 27,42 kg/m2 (overweight)

• Eyes : conjunctiva wasn’t anemic, sclera wasn’t icteric

• Neck : JVP 5-2 cmH2O, no enlargement of thyroid gland
• Chest : Lung: rochy +/+, wheezing -/-
heart within normal limit
 Obstetric Record
Abdomen
• Inspection : Enlarge according to term pregnancy, mid line
hyperpigmentation (+), striae gravidarum (+)
• Palpation :
L1 Uterine fundal 3 fingers below proc xyphoideus
A large, soft, nodular mass was palpated.
L2 Hard and resistance structure was palpated on the left side.
Numerous small, irregular structure were palpated on the right side
L3 A hard and round mass was palpated
L4 Convergent
UFH: 29 cm; EBW: 2700 gr ; Uterine contraction : -
• Percussion : Tympani
• Auscultation : Peristaltic sound was normal, Fetal heart sound: 130-140 x/’

Genitalia
• Inspection : V/U within normal limit
USG
• Fetal alive, singleton,intra uterine, head presentation.
• Fetal movement (+)
• Biometrics :
BPD : 91,2 mm
AC : 305 mm
FL : 72,5 mm
EFW : 2720 gr
• DSP 3cm
• Placenta was implant at uterine fundal grade II
• Impression : 37-38 weeks of term pregnancy
Fetal alive, head presentation
CTG

Baseline :130-140 bpm

Variability : 5-15 bpm
Akselerasi : (+)
Deselerasi : (-)
Contraction : (-)
Fetal movement : (+)
Impression : CTG Category I
 PARAMETER Laboratory findings Normal Value
Hemoglobin 10,8 gr/dl 9.5-15
Leukosit 12.610/mm3 5.000 – 16.000
Hematokrit 32 % 28 – 40
Trombosit 228.000 /mm3 150.000 – 400.000
APTT 30, detik 29,2 – 39,4
PT 9,9 detik 10 – 13,6
D-Dimer 2169,9 < 0,5
LDH 465 u/l 0 – 480
Random glucose 93 mg/dL 74 – 106

Protein total 6,9 mg/dL 6–7

Albumin 3,2 g/dL 3,5 – 5,2

Globulin 3,7 g/dL 1,3 – 2,7

Ureum darah 15 mg/dl 16,6 – 48,5

Creatinin darah 0,7 mg/dl 0,6 – 1,2
SGOT 21 u/l 0 – 31
SGPT 8 u/l 0 – 34
Total bilirubin 0,4 mg/dL 0,1 – 1,2
Direk 0,1 <0,20
Indirek 0,3 <0,4
Calsium 8,9 8,1 – 10,4
Natrium 129 Mmol/dL 136 – 145
Kalium 4,3 Mmol/L 3,5 – 5,1
Chlorida 99 Mmol/L 97 – 111
 URINALISA
• Protein : +++
• Glukosa : (-)
• Leukosit : 1-2/LPB
• Eritrosit : 2-3/LPB
• Silinder : (-)
• Kristal : (-)
• Epitel : (+), flat
• Bilirubin : (-)
• Urobilinogen : (-)
Cardiology
Diagnose
• Severe preeklampsia on G2A1L0 term pregnancy
Plan
• Metil dopa 3x500 mg (BP > 160)

Ophtalmologist
Diagnose
• Mild fundus eclampsia has found
Internist
Diagnose
• Severe preeclampsia on therapy

Plan
• Metildopa 3x500 mg
• Tolerance operation
– Metobolic risk : mild
– Pulmoner riak : mild
– Cardiovasculer : mild-moderate
– Hematologic : stabil
Diagnose :
• G2P0A1L0 37-38 weeks of term pregnancy +
severe preeclampsia in maintenance doses of
MgSO4 regimen from other institution
• Fetal alive, singleton, intrauterine, head
presentation H1
Management :
• Control GA, VS, Σ urine, fluid balance, patella reflec
• continue MgSO4 regimen maintenance dose
• Informed consent
• O2 4 l/’ Nasal
• Check complete blood test + urine + hepar, kidney,
haemostatic
• Antihypertention
– Metil dopa 500mg
• Antibiotics Skin test (Ceftriaxon 1gr)
• Report to PE team
• Report to operation room
• Consult to anestesiologyst
Plan :
• Emergency CS
At pm : TPPCS was performed
At pm : (17.30)
• A male baby was born by TPPCS with 2700 gram in
weight, 46 cm in height, Apgar score : 7/8.
• Placenta was born with a light traction on umbilical
cord, complete, 1 piece. Size was 15 x 14 x 2 cm, weight
 500 gram, length 50 cm.
• Bleeding during operation  200 cc

Diagnose
• P1A1L1 post TPPCS on indication of severe preeclamsia on
MgSO4 regiment maintenance dose from other
institution
• Mother in care, child good condition
Plan
• Control GA, VS, FHR, Σ urine, fluid balance,
patela reflec
• Continue MgSO4 regiment maintenance dose
• Ceftriaxone 2x1 gr i.v
• Metildopa 3x500 mg
• Ketoprofen Supp II
Thank You