CASE NO.

IDENTITY
 Name : Mrs. R
 Age : 33 years old
 MR No. : 771848
 Address : Padang Besi, Indarung
 Date : May 03th, 2017
ANAMNESIS
A 33 years old patient was referred from Semen Padang General
Hopital to the Emergency Room of Dr. M. Djamil Central General
Hospital on May 03th 2017 at 12.30 pm with Diagnose G2P1A0L1
term pregnancy + IUFD suspected
• Patient felt of fetal movement decrease one day ago then consult her
pregnancy to Semen Padang General Hospital. From the examination
fetal heart rate wasn’t found. Patien refered to Dr. M. Djamil Padang
with IV line
• Patient was felt of pain from waist to region which referred to the
groin (+) since 2 hours ago
• Bloody show from the vagina since 2 hours ago
• Fluid leakage from the vagina was (-)
• No massive vaginal bleeding.
• Amenorrhea since 9 months ago.
• First date of last menstrual period was forgotten
• Leukorea (+) since 4 mouths of pregnancy
• Estimation date of delivery was hard to determine.
• 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 a private midwife every Month since and high blood pressure
wasn’t found during prenatal care.
• Menstrual History : menarche at 13 years old, irregular cycle, once in month, last
for 5 to 7 days each cycle with the amount of 2-3 times pad change/day without
menstrual pain.
Previous Illness History
• There wasn’t previous history diseases of heart, lung, liver, kidney, hipertension
and DM before pregnancy No history of alergic
Family Illness History
There wasn’t history of hereditary disease, contagious and
physiological illness in the family
• Marriage history: once at 2010
• History of pregnancy/abortion/delivery : 2/0/1
1. 2012, ♂, 2900gr, term, spontaneous, midwife, alive
2. Present pregnancy
• History of family planning :-
• History of immunization : -
GA Cons BP PR RR T
moderate CMC 130/90 90 22 37

BW BH BMI
50/62kg 150cm 22 normoweight

Eyes: conjunctiva wasn’t anemic,

sclera wasn’t icteric
Neck: JVP 5-2 cmH2O,
no enlargement of thyroid gland
Chest: Lung : Rh -/-, whee -/-
Abdomen
Inspection :
Enlarge accordance with term pregnancy, median line hyperpigmentation, striae
gravidarum (+), cicatrix (-)
Palpation :
L1: Uterine fundal was palpable 3 finger bellow Proc Xypoideus, A large nodular
mass was palpable
L2: A hard and resistance structure was felt on the right side, Numerous small and
irregular structures were felt on the left side
L3: A hard mass was palpable and fixed
L4: divergen
Uterine Fundal Height : 34 cm EBW: 3155 gr
Uterine contraction : 2-3x/20”/weak
• Percution : Tympani
• Au : normal Peristaltic sound
Fetal Heart Rate : (-)
Genitalia :
I : V/U within normal limit
VT : cervical dilatation was 1-2cm
Amnionic sac (+)
Head palpable, transversal sagitalis suture, H I-II
Pelvic inlet and pelvic outlet : no contracted pelvic
Diagnose
• G2P1A0L1 term parturient first stage laten Phase
• Fetal death singleton intrauterine head presentation,
transversal sagitalis suture H I- II
Management
• Control GA, VS,
• Informed consent
• Observe delivery process/4 hours
• Antibiotik Skin test

Plan : vaginal delivery

Laboratory Parameter Result Reference Value

SGOT 39 <32 u/l

SGPT 17 <31 u/l

Parameter Result Reference Value
Random blood 76 74-106 mg%
Hb 11,7 12 – 16 g/dL sugar

Ht 36 28 – 40 % Ureum 10 15-40 mg%

Creatinin 0,5 0.4 – 0.9 mg%

Leucocyte 86 5 - 10.103 /mm3
Kalium 3,5 3.3 – 5.1 mEq/L
Trombocyte 196 150 - 400.103 /mm3
9,4 <31.3 Chloride 107 97 – 109 mg/dl
aPTT Sec
27 < 11,5 Natrium 137 130 – 148 mEq/L
PT Sec
Calcium 9,0 8.1 – 10,4 mg/dl

Protein total 6,9 6.6 – 8.7 g/dL

Globulin 3,6 1,3-2,7

Albumin 3,3 3,8 – 5.0 g/dL

LDH 403 240 – 480 u/l

14.30
A/ : Patient was felt of pain from waist to region (+), fluid leakage from vagina (-)
GA Conc BP PR RR T
Moderate CMC 120/100 88 22 37
Abd : Uterine Contraction : 1-2 x/ 25”/weak
Genitalia :
I : V/U within normal limit
VT : cervical dilatation was 1-2cm
Amnionic sac (+)
Head palpable, Transversal sagitalis suture H I-II
Diagnose :
• G2P1A0L1 term parturient first stage laten Phase
• Fetal death singleton intrauterine head presentation, Transversal sagitalis suture
H I-II
Plan
• Observe delivery process/4 hours
• vaginal delivery
18.30
A/ : Patient was felt of pain from waist to region which referred to the groin (+)
fluid leakage from vagina (-)
GA Conc BP PR RR T
Moderate CMC 120/100 88 22 37
Abd : Uterine Contraction : 1-2 x/ 25”/weak
Genitalia :
I : V/U within normal limit
VT : cervical dilatation was 1-2cm
Amnionic sac (+)
Head palpable, Transversal sagitalis suture H I-II
Diagnose :
• G2P1A0L1 term parturient first stage laten Phase
• Fetal death singleton intrauterine head presentation, Transversal sagitalis suture
H I-II
P/
• Induction of delivery IVFD RL + oxitocyn ½ amp
• vaginal delivery
22.30
A/ : Patient was felt of pain from waist to region which referred to the groin (+)
fluid leakage from vagina (-)
GA Conc BP PR RR T
Moderate CMC 120/100 88 22 37
Abd : Uterine Contraction : 3-4 x/ 45”/strong
Genitalia :
I : V/U within normal limit
VT : cervical dilatation was 7-8cm
Amnionic sac (+)
Head palpable, left anterior occiput, H II-III
Diagnose :
• G2P1A0L1 term parturient first stage Active Phase
• Fetal death singleton intrauterine head presentation, left anterior occiput H II- III
P/
• Observe delivery process
• vaginal delivery
23.30
A/ : Feeling of pain and let to bearing down, fluid leakage spontneusly from vagina
greenish residu
GA Conc BP PR RR T
Moderate CMC 120/100 88 22 37
Abd : Uterine Contraction : 3-4 x/ 45”/strong
Genitalia :
I : V/U within normal limit
VT : cervical dilatation was complete
Amnionic sac (-) greenish residu
Head palpable, anterior occiput, H III-IV
Diagnose :
• G2P1A0L1 term parturient second stage
• Fetal die singleton intrauterine head presentation, anterior occiput H III-IV
Plan
• lead to bear down
• Vaginal delivery
At 24.15 : vaginal delivery was performed
At 24.25 :
• A male baby was born by vaginal delivery with 3300gr in weight, 50cm in
height and AS : 0/0
• Placenta was born spontaneusly, 1 piece, complete. Size was 17 x 16 x 3
cm, weight approximately 500 gr. Umbilical cord was approximately 60 cm
in length with paracentral insertion. Exploration of uterine cavity was
performed. Portio and uterine cavity were intact. Episiotomy wound was
repaired.
• Blood loss during delivery  150 cc
• Maseration first degre
D/ : P2A0L1 post vaginal delivery + fetal death
Mother were in care , baby was die
A/ : stage IV monitoring
Thank you