case english obgyn kelompok 11 2008 unisba
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CASE REPORT SESSION Prolaps Funiculi
Created by :Group 11
M. Rizki DwikaneM. Amri Kautsar
Erni MaryamAgli Adhitya A. PAnnisa Febrieza ZVivi Herliyanti M
Introduction
Prolaps of umbilical is one of emergency case in obstetric
prolapsus funikuli aproximately 1: 2000
of birth
Mortality occurs prolapsus fonikuli in
fetus aproximataly 11-17%
Prolapsus funikuli not influence directly
maternal condition, however very danger
to the fetus
Prolapsus funiculi is umbilical that occurs when
premature rupture of membrane and the
umbilical cord there is in lower of fetus.
CASE
IDENTITY: Date / Time entry SYAMSUDIN SH Hospital: August 22, 2013.
07:00
Name: Ny.NAge: 18 YearsEducation: junior high schoolOccupation: HousewifeReligion: IslamEthnicity: SundaAddress: Kp. Cidolag
ANAMNESA
• 9 months pregnant patient complaining of fluid from the birth canalChief
complaint
ANAMNESA
• G1P0A0 patients feel pregnant 9 months to come to the hospital with a complaint brought by midwife clear fluid output from the birth canal that quite a lot of since 23:00 last night.Another complaint is accompanied contraction in abdomen. contraction is felt more and more frequent and stronger. Fetal movement was felt.
• nothing
History family history
• nothing
History other disease
• Menarche : 13 Tahun• cycle : Teratur (28 hari)• Long menstruated : 7 hari• Dysmenorrea : Kadang-kadang• quantity : ± 2 pembalut• HPHT : 20 November
2012• Taksiran Persalinan : 27 Agustus 2013
History of menstrual
Married once with present husband
History marital
Never use contraception anything
Contrace-ption
Patient examinatioto the mide wife two times in month
ANC
Obstetric history : Now pregnant
Chronology • 22-08-2013, 04.00 o’clock
VT = Ø 4cm, amnion (-) clear, head with decreased H1 and feel umbilical cord
BP = 110/70 , HR= 80x/menit , Rr= 20x/menit, T= AffTFU = 31 cm, head presentation,FHR= 138x/menit, HIS = 3x10’-20’
Patients come to the midwife with complaints of heartburn and heartburn-clear liquid out of the birth canal since last night (23:00 hours)
- Trendelenburg position- Oksigen 5 Liter/minute
- Infuse RL
G1P0A0 parturient aterm with prolapsus funiculi, single fetal life in intrauterine
Physical Examination(in hospital)
General status:• General appearance: The patient was restless,
looking sickAwareness: Compost Mentis
• Vital sign:BP= 110/70 mmHg, HR=80x/minute, Rr= 20x/minute, T= Aff
• BW= 60 kg, BH = 159 cm
General physical exam:
• eyes:- Conjunctiva anemic + / +,- Sclera jaundice - / -,- Pupil 3mm/3mm,- The light reflex + / +Nose: Septum Deviation (-), secret (-)Mouth: moist oral mucosaEar: no justice no abnormalities
• Neck: Not palpable enlargement of the KGBThorax: cor and pulmo there is no pulmonary abnormalities
Abdomen : Inspection : Linea nigra (+), Striae Gravidarum (+), convex Palpation : Leopold I : Palpable part rather soft, round and bouncy, TFU 31 cmLeopold II: right: fetal spine (FHR: 122x/menit)left: fetal limbLeopold III: Palpable hard part, round and bouncyLeopold IV: Already entered PAP
TFU = 31 cm, Head presentation, FHR = 112x/mHIS = 3x10’-20’VT = Ø 6cm,Amniotic sac(-) , head with a palpable decline in H1 and palpable pulsating umbilical cord.
• Upper extremity: warm, CRT <2 Seconds, Edema - / - Lower extremity: cold, CRT <2 Seconds, Edema - / - Skin: pale Looks
Laboratory exam:Hb : 10.8Leukosit :13.000Trombosit :315.000Ht :31.3 %Golongan Darah : A
DIAGNOSA
G1P0A0 Parturient Aterm Kala I active phase with prolaps funiculi
Planning• Observation fetal and maternal condition• Trendelenburg position• Oksigen• Pro SC cito
DISCUSSION
1. Whether the diagnosis is correct in this case?2. Whether risk factors were found in this
patient? 3. Whether treatment was appropriate in this
case? 4. How prognosis of this case?
• Whether the diagnosis is correct in this case?
Anamnesa :complaining of fluid from the birth canal
Obstetric exam :TFU = 31 cm, Head presentation, FHR = 112x/m,HIS = 3x10’-20’,VT = Ø 6cm, Amniotic sac(-) , head with a palpable decline in H1 and palpable pulsating umbilical cord.
vaginal toucher visible or palpable cord in the vagina that sometimes it is sticking up out of the vulva as in this case and palpable pulsating umbilical cord indicating that the fetus is alive
• Prolaps fulikuli : if a palpable cord out / be in the side and passes the lowest part of the
fetus in the birth canal, the umbilical cord can prolapse into the vagina or even outside the
vagina after rupture
Leading cord
Occult prolapsed
• Investigations CTG bradycardia • Examination of the fetal heart rate, decreased
heart rate obtained
CLINICAL SYMPTOMS
• There are two main problems occur: 1. Umbilical cord wedge between the lowest part of the fetus in the mother's pelvis. 2. umbilical cord vessel spasm due to central chilled temperatures outside the mother's body.
• Gejala : -Bradikardia/Takikardi- Irreguler- VT : Palpable funiculi prolaps- CTG = Deselerasi Variabel
Whether risk factors were found in this patient?
Fetal Factor
• Abnormal Presentation
• Prematuritas• Gemelli• Hydramnion
Maternal History
• CPD• The lowest
part of the high
In this case found that the risk factors in patients are:
1. Rupture of membranes before time 2. The lowest part of the fetus is still high 3. Long umbilical cord (known after childbirth) 4. CPD?
Whether treatment was appropriate in this case?
MidwifeTrendelenburg
position
Hospital- Trendelenberg
position- Infus
- Report for Obgyn dept
Emergency Treatment(SC cito)
General treatment
– In the case of prolapse required immediate management– Informed Consent carried on the family – Definitive therapy is the delivery of a fetus with immediate– Vaginal delivery is possible only when the complete
opening, the lowest part of the fetus has entered the pelvis, and there is no CPD
– Danger to the mother and fetus will be reduced – if the SC Pending the preparation of SC mother remained
Trendelenburg position – O2 provide 5-8 liters / minute – Giving fluids through the infusion– DJJ observation
Prolaps Funiculi
On the location of the head :a. If the opening is small / incomplete done cesarean section, unless the heart sounds is a very bad boy. During the wait for surgery preparation, intrauterine resuscitation attempted. Also try pressure on the cord so avoided or reduced, for example by placing the mother in Trendelenburg position. Before performing cesarean sections examined fetal heart sounds again.
If the opening is complete : - Perform cesarean section if the head is still high, head rocking version and extraction or cesarean section. -With vacuum extraction or forceps if the head of the largest size has passed the pelvic brim. - In small children (children gemeli II) can be arranged in advance fundus expression and if the requirements are extraction with forceps. Do not waste time try repositioning the umbilical cord
How prognosis of this case?- Anemia
- Fever
Maternal Prognosis
- Fetal distress
- Death
Fetal Prognosis
• In this case not obtained a poor prognosis because appropriate treatment and managed to prevent fetal distress leading to death. Baby is born, female sex weighing 3150 g, Apgar score 7-9, congenital abnormalities (-), clear amniotic fluid. Circumstances both mother and baby
• Baby is born, female sex weighing 3150 g, Apgar score 7-9, congenital abnormalities (-), clear amniotic fluid. Circumstances both mother and baby.
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Kesehatan Reproduksi. Jakarta : ECG. 2005. 37-8,155-7.
2. Cunningham G.F, Gant N.F, dkk. Penyakit dan Kelainan Plasenta. Obstetri Williams. Edisi 2. Volume 2. Jakarta : ECG. 2006 : 926.
3. Liewellyn D, Jones. Prolaps Tali Pusat. Dasar-dasar Obstetri dan Ginekologi. Edisi 6. Jakarta : ECG. 2002:162.
4. Wikipedia, the Free Encyclopedia. Umbilical Cord Prolapse. Available fromhttp://www.en.wikipedia.org/wiki/cordProlapsed. Accessed : 28/08/2013.
5. Benson Ralph C. Complication of Labor and Delivery. Current Obstetric, Gynecologic, Diagnosis, Treatment. Lange Medical Publication. California. 2004: 617-18.
6. Boyle JJ. Prolapsed Cord. Available from :http://www.merck.com/mmpe/topic/prolapsedcord.htm. Accessed : 28/08/2013
7. Cleaveland Clinic. Umbilical Cord Proplase. Available from: http://www.cleavelandclinic.org/healt/health-info.Umbilicalcord-asp. Accessed:28/08/2013