Obgyn Case

Case Presentation

Case PresentationCaecilia Cierra (40116002)Vinnie JulianaG1P0A0 38 39 weeks of gestation in Labor first stage laten phase, malpresentation of bottom, high blood pressure of gestation Identity Name : Mrs. S. RAge : 24 years oldAddress: CibuluhEducation: junior high schoolOccupation: housewifeMedical record : 4531**Identity (husband)Name : Mr. AAge : 28 years old Address: cibuluhEducation: Junior high schoolOccupation: laborReligion: MoslemHistory taking From autoanamnesis : Desember 16th 2013, 13.00 pm at vk RSUD ciawiPrimary subject :Patient came to the hospital, is reffered by midwife, first pregnancy, stomachache since 6 hours before came to the hospital, water came out from the vagina since 3 hours before came to the hospital, mucus (-), blood (-), nausea (-), vomit (-), headache (-), dizzines (-), epigastric pain (-), blurred vision (-), fetal movement (+)Past medical history and family story High Blood Pressure: -Diabetes Mellitus: -Asthma: -Drug allergy: -Heart disease: -History of Present PregnancyThis is the first pregnancyDate of the first day of last menstrual is march, 25th 2013EBD: January, 1st 2014

Mesntrual HistoryMenarche : 12 years oldCycle : 30 daysDuration: 6-7 daysPain: moderateMarried: woman, 22 years old, junior high school, house wife man, 26 years old, junior high school, laborContraception : -Last menstrual period : march 22th 2013EBD: january 1st 2014ANC: midwifes, 7xPhysical ExaminationGeneral condition: conscious Vital signs Blood Pressure: 150/100mmhgPulse: 82 bpmRespiratory: 24 tpmTemperature: 36,6o C

Eyes: conjuctiva anemis -/-Thoraks: cor and lungs are normalExtremities : edema (-)

External ExaminationAbdominal Fundal height : 27cmFetal presentation: bottomFetal heart rate : 130 160, regulerUterine contraction: 2x/ 10 / 20EBW: 2170 gr

Internal examinationVulva/vagina : NormalPortio: thick and softServix dilatation: 1cmFetal membrane: +Presentation: bottomMeconium: -

Laboratory FindingsHemoglobin: 12,2Hematocrite: 37Leucocyte: 9200Trombhocyte: 235000RESUMEPatient, woman 24 years old, is referred by midwife, stomachache since 6 hours before came to the hospital, water came out from the vagina since 3 hours before came to the hospital, mucus (-), blood (-), nausea (-), vomit (-), headache (-), dizzines (-), epigastric pain (-), blurred vision (-), fetal movement (+)Last menstrual period : march 25th 2013 diagnoseG1P0A0 38 39 weeks of gestation in Labor first stage laten phase, malpresentation of bottom, high blood pressure of gestation

managementIVFD RL 20gtt/ minuteNifedipine 3 x 10mgDopamed 3 x 500mgObserve the progression of the labor

PROGNOSEMother : bonamBaby : bonamFetal Malpresentation of BottomREVIEW OF THE LITERATUREDEFINITIONMalpresentations may be identified late in pregnancy or may not be discovered until intial assessment during laborType of Breech Presentation 1. Frank breech2. Complete Breech3. Footling breech4. Kneeling breech Frank BreechThe babys bottom comes first, and the legs are flexed at hip and extended at the knees ( with feet near the ears). This is the most common type of breech position.

2. Complete Breech the babys hips and knees are flexed so that the baby is sitting crosslagged, with feet beside the bottom3. Footling breech one or both feet come first with the bottom at a hinger position. This is rare at term but relatively common with premature fetusesMaternal riskProlonged labor decresed pressure exerted by the breech on the cervixTrauma to birth canal during delivery from manipulation and forceps to free the fetal headIntrapartum or postpartum hemorrhage Fetal riskCompression or prolapse of umbilical cordAspiration an asphyxia at birthBirth trauma from manipulation and forceps to free the fetal headCAUSESPrematurityMultiple pregnancyPrevious breech deliveryHydramious and oligohydramiousSpace occupying mass in the uterus that prevents the head from fitting into the lower portion such as placenta previa an fibroids COMPLICATIONSProlapse cord because the breech does not fill well enough into the pelvic brimBrith trauma : fracture of the skull clavicle, humerus, intracranial hemmorahage, rupture of abdominal organsProlonged labor because the soft buttocks do not aid in cervical dilationIntrauterine anoxiaFetal deathManagementRotate the feus from breech to cephalic presentation by external versionVaginal deliveryGESTATIONAL HYPERTENSION