7/21/2019 Case Report Dr. Dewi http://slidepdf.com/reader/full/case-report-dr-dewi 1/26 Post partum hemorrhage
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Post partum hemorrhage
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At August 25th, 10.00 am•26 years old
•Hospitalized e.c. G3P1011 39 – 40 weeks
S/ 1st sta!e o" la#or wit$ watery %a!i&al
disc$ar!e•a# 'a(!(st 2)t$ *11.33 a+,
• - 91 10e3/(
• HG 116 !/d
• P 236 10e3/(•$erapy
• 5pectati%e %a!i&al deli%ery
•
+picilli& 4 5 )00 +! po
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• "ter 7 $o(rs 30 +&t $ospitalized
patie&t &eeded to #ear dow& 2&d sta!e o" la#or
•).42 p+ #or& %i!oro(s #a#y !irl
3200 !
3rd sta!e acti%e +a&a!e+e&t
•).)0 p+ place&ta #or& co+pletely•%al(atio& o" (teri&e co&tractio&
weak
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post partum hemorrhage e.c uterine atonia
8(&dal +assa!e
-eak co&tractio&
&ter&al #i+a&(al co+pressio& -eak co&tractio&
:8; wit$ <5ytoci& 2 a+pl.
=et$yl er!o+etri&e 02 +! i.%
=isoprostol 00 +c! rectal
>teri&e co&tractio& '?,
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• t 6.30 p+ acti%e #leedi&! "ro+ <>
weak (teri&e co&tractio& wit$ s$ock 'P
0/)0 ++H! P 1105/+&t @@ 205/+&t
#l(e code
res(scitatio&
A >teri&e ato&ia co&ser%ati%e "ail(re
A "o(&d acti%e #leedi&! "ro+
%a!i&al +(cosa
total abdominal hysterectomy
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• t 11.4) p+ was do&e otal #do+i&al
Hysterecto+y• $erapy
• P@ tra&"(sio& B H#C 10 !rD
• +picilli& 351 !ra+ :• Ge&ta+yci& 250 +! :
• =etro&idazole 35)00 +! :
•ra&e5a+ic acid 351 !ra+ :
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• a# 'a(!(st 2)t$ * 22.)4p+,• - 140 10e3/(
• HG 76 !/d
• =: 940 "
• =H 29 p!
• =H 317 !/d
• P 713 10e3/(
• P elo&!ated
• aP elo&!ated
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(!(st 26t$ ' >,•>;
•03.4) a+ "ro+ i&ter&al depart+e&t*
• ;5 P2012 spo&ta&eo(s post part(+
day 0 ? post H ec HPP pri+er ec (teri&eato&ia
• Se%ere #leedi&!
• =ild &e+ia ec acti%e #leedi&!• $ro+#ocytope&ia
• oa!(lopat$y
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• a# 'a(!(st 26t$ * 09.)2p+,
• - 1)6 10e3/(
• HG 712 !/d
• =: 32 "• =H 269a p!
• =H 322 !/d
• P 37) 10e3/(
• tra&"(sio& B P E 100.000
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• a# 'a(!(st 2t$,
• - 44 10e3/(
• HG 63 !/d
• H 194 D• =: 34 "
• =H 274 p!
• =H 32 !/d
• P 310 10e3/(
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(!(st 29t$
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(!(st 30t$ Joint Conf:
•Patie&t wit$ ;
Hepari& )000 > #ol(s
Hepari& drip 1000 >/$r
He+ostasis p$ysiolo!y +o&itori&! F a+'P/P @,
•ardiolo!ist
@o $ora5 ardio+e!aly wit$ s(sp. #ilateral
ple(ral e""(sio&
a&teroseptal isc$e+ia ec s(sp +eta#olic
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Sept 1st • >;
• e+p 30 c• @@ o& %e&tilator s(pport 165/+&t
• P(lse 11)5/+&t
• ;5 P2012 post !A" #ay $th , f.up hypo%olemic shoc&,
• #'C, A(#)
•5 +picilli& 3 5 1!ra+
Ge&ta+yci& 1 5 400 +!
=etro&idazole 3 5 )00 +!
ra&e5a+ic acid 3 5 1 !ra+
Paraceta+ol 3 5 1 !ra+
=idazola+ 10 +!/$r
8e&ta&yl )00 +!/day
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Sept 3rd
•@ee%al(atio& "ro+ cardiolo!y dept.
•@< $ora5 P&e(+o&ia dd/ l(&! ede+a
e"t ple(ral e""(sio&
•;I ; ? @;S? l(&! ede+a
•$ 'Bse&siti%ity test,• e#(lizer %e&toli& 3 5 2) +!
• o%e&o5 2 5 04 +!
• cetazola+ide 1 5 1
• e"tria5o&e 2 5 2 !ra+
• e%o"lo5aci& 1 5 7)0+!
• =etro&idazole 3 5 )00 +!
• Paraceta+ol 3 5 1 !ra+
• 8(rose+ide 10 +!/$r
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Sept )t$
• lood !as a&alysis
• or+al• 8
• @o $ora5
Sept 9t$
•Stop %e&tilator s(pport
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Sept 2)t$
• Patie&t disc$ar!ed "ro+ Sa&!la$ Hospital
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Ha&!i&! iss(e
• -$y did ato&ia $appe& despite $a%i&! &o predispositio&
"actorJ
• -$y total a#do+i&al $ysterecto+yJ-$at a#o(t K y&c$ li!atio& o" (teri&e artery or
s(pra%a!i&al $ysterecto+yJ
• ; ca& it #e pre%e&tedJ
• -$at ca(se @;S a&d l(&! ede+aJ %e& w$e& t$e
patie&ts $a%e #ee& treated i& >J
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Thankyou……
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. . . .
(11.42) (06.56)
, , , , , , .
, , , , , , .
HCT 38,7 24,3 31,5 23,9 22,1 25,2 19.4
PLT 236 71,3 216 60 37,5 43 31.0
Tidakterbacaalat (memanjang) .
.
#PTT Tidakterbacaalat (memanjang) 44.0
#on$%o
PTT
11.3
on$%o
'PTT
.
PH 6.09 7.27 7.20 7.27 7.41
PC2 49 45 42 40 39
2 61 190 283 114 146
a
. . . . .
. . . . .
TC2 10.9 22.1 17.1 19.6 25.9
B* -23.4 -6.1 -11.1 -8.0 0.1
+o2 67 100 100 98 99
G u 120
%, . .
%,u .
'+T 156 81
' 3.19 3.38
B-! 19.6 28.5
% no,n 9.8
,% .
a
# 3.1
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Sept 4t$
• ;I ; ? @;S? l(&! ede+a ? :P
• $ 'Bse&siti%ity test,• e#(lizer %e&toli& 3 5 2) +!
• o%e&o5 2 5 04 +!
• cetazola+ide 1 5 1
• e"tria5o&e 2 5 2 !ra+
• e%o"lo5aci& 1 5 7)0+!
• =etro&idazole 3 5 )00 +!
• Paraceta+ol 3 5 1 !ra+
• 8(rose+ide 10 +!/$r
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Sept 7t$
• $ora5 P• or Size S$ape B &or+al
• Po B p&e(+o&ia dd/ l(&! ede+a
B le"t ple(ral e""(sio&
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Sept 9t$
• ; ? "e%er ? @;S? (&! ede+a ? :P
• $ '#ased o& se&siti%ity test,• e#(lizer %e&toli& 3 5 2) +!
• +ipe&e+ 3 5 1 !ra+
• e"tria5o&e 2 5 2 !ra+
• e%o"lo5aci& 1 5 7)0+!
• =etro&idazole 3 5 )00 +!
• Paraceta+ol 3 5 1 !ra+
• <&da&setro& 3 5 +!• <+eprazole 1 5 40 +!
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