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D wi Putra Shinta Tantri Amanda Isnawati Dewi Kurnia Ningsih Gita Amelia Masrida Rezky
IDENTITY
Name : Nn. A Age : 18 years old Marriage Status : Not marriage RM : 35.26.xx Date of MRS : 29 mei 2012
Alloanamnesa
Chief Complaint : fever since 3 days, sharp fever and chills Additional complaint :
Dizziness
Nausea,
vomiting. Heartburn since 4 days 1 day before come to hospital feses are black (1x) Bleeding gums (-), epistaxis (-), petechiae (-)
TABEL PERJALANAN
29 Mei 2012
S (subjektif) O(objektif) A(Assesment) P(planning)
Dizziness (+), weak (+), nausea (+), heartburn (+), fever (+) since 4 days. CHAPTER black (+), bleeding gums (-), epistaxis (-), petechiae (-)
CM, Sakit sedang. BP : 110/70 Temp : 37,5 C Pulse : 89x/m RR: 20x/m
PF : Konjunctiva anemis (+) Others found no
Dr A (GP) -RL 8 TPM -Sanmol 3x1 -Rantin inj 2x1 -Vomceran 3x1
Dr. Sp.PD : th/ lanjut Dr. B(GP) : extra novalgin 1 amp drip suhu : 40 C
TABEL PERJALANAN
30 Mei 2012
S (subjektif) O(objektif) A(Assesment) P(planning)
Dizziness (+), CM weak (+). Can not Sakit sedang defecate 2 days. Temp : 36,5 C
Pkl. 11 : dr.Sp.PD -Diit Tim -RL / 6 jam -Cek urea, H2TL/12jam,UL -Koreksi Kl 25 max 2x Pkl.20.45 : dr.U -Anjuran ICU karna OS sesak Pkl.21.00 : dr.Sp.PD
TABEL PERJALANAN
31 Mei 2012 pkl. 08.30
S (subjektif) O(objektif) A(Assesment) P(planning)
-Plano test -Hb cito -IUFD Nacl loading 1 kolf -Edukasi pasien
-Konsul dr. Obgyn
TABEL PERJALANAN
31 Mei 2012
S (subjektif) Amenorrhea (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight. O(objektif) Plano test (+) Hb :6,3 gr% A(Assesme nt) P(planning)
G1P0A0 + Konsul obgyn u/ amenore 8 persiapan USG minggu susp KE Susp abortus septik DD: KET
TABEL PERJALANAN
31 Mei 2012
S (subjektif) Weakness (+), Unmenstruated (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight. O(objektif) CM BP : 80/60 Pulse : 100x/m RR : 20x/m Temp : 36,5 C PF: NT epig (+) Plano test (+) Hb :6,3 gr% A(Assesment) P(planning) Konsul Dr Obgyn : -Keluarga buat surat ijin ayah/wali -Perbaiki KU -Rencana tindakan R/ loading 200 cc transfusi, Sp.PD acc -Pantau TTV
Abortus insipien
TABEL PERJALANAN
31 Mei 2012 pkl. 10.00
S (subjektif) Abdominal pain (+), bleeding pervaginam (+) O(objektif) CM BP : 80/60 Pulse : 100x/m RR : 20x/m Temp : 36,5 C PF: NT epig (+) Plano test (+) Hb :6,3 gr% A(Assesment) P(planning) Inst dr. Obgyn : -Perbaiki KU -Inform consent kuretase Dr. Sp.PD -Cek dengue blood (-) -H2TL/12 jam
Abortus inkomplit
TABEL PERJALANAN
31 Mei 2012 pkl. 17.30
S (subjektif) O(objektif) A(Assesment) P(planning) Weakness (+), dizziness (+) CM BP : 80/60 Pulse : 100x/m RR : 20x/m Temp : 36,5 C PF: NT epig (+) Plano test (+) Hb :6,3 gr% dr,. Sp.PD : - Sore tetap cek H2TL dan dengue blood
Abortus inkomplit
Medicatio n aspect
Medicoleg al aspect
Be a family doctor
Medical aspect
Identity Complaint
Fever
Problem
Infection, neoplasma, body response, etc
Unmenstruated
Pregnancy? Or other ??
Hemorrhage
Complaint
First
Fever Dizziness Nausea Vomiting Epigastric pain Black at feses
Next
Weakness Bleeding pervaginam
End
- Unmenstruated since 2 months - Coitus (+) - Abdominal pain
Todays topic
Pregnancy
Abortion
Ectopic pregnancy
PREGNANCY
- Changes in breast - Skin pigmentasi - Hegar Sign - Chadwick Sign - Piscaceck Sign
Abortion
The termination of pregnancy, either spontaneously or intentionally, before the fetus develops sufficiently to survive. By convention, abortion is usually defined as pregnancy termination prior to 20 weeks' gestation or less than 500-g birthweight. Definitions vary, however, according to state laws for reporting abortions, fetal deaths, and neonatal deaths
(Williams obstetric 22nd edition)
Kromosom abnormality
Zigot factor
Sperma abnormality
Etiologi
- Chronic disease - Infection - Hormonal disorder - Organ disorder Nutrition - Drug - Imunology factor - Trauma
Maternal factor
Ectopic pregnancy
The blastocyst normally implants in the endometrial lining of the uterine cavity. Implantation anywhere else is an ectopic pregnancy
(Williams obstetric 22nd edition)
Pathomechanism
Building on the definition of health in WHOs constitution, the platform of action adopted by the 4th world conference for women, in Beijing 1995, recognised that:
Health is a state of complete physical, mental and social-well being, and not merely the absence of disease or infirmity. Womens health involves their emotional, social and physical well-being and is determined by the social, political, and economic context of their lives, as well as by biology.
14,9
Be a family doctor
References
Williams Obstetrics, twenty-second edition, 2005. Current Diagnosis & Treatment Obstetrics & Gynecology, Tenth Edition, 2007. Sarwono prawirohardjo, Ilmu kebidanan, 2005. Pedoman diagnosis dan terapi obstetri dan ginekologi FK Unpad, RS. Dr. Hasan Sadikin, 2005.
SAFE MOTHERHOOD
Wassalamualaikum Wr. Wb Juni 2012