Sunday, October 12th 2014

I. HISTORY TAKING

Name
: Mrs. H
Age
: 31 yo
Address
:
Occupation
: Housewife
Date of Admission
: October 12th 2014
Date of Examination : October 12th 2014
MR Number
:
First day of Last Periode
: Januari 20th 2014
Due Date
: Oktober 27th 2014

Patient G2P1A0, 31 years old, 40+1 weeks

gestational age, referred from midwife with
G2P1A0 40 weeks gestational age, history
of SC 7 years ago with indication CPD.
Patient feel pregnant more than 9 months.
Fetal movement still can be feel. Frequently
contraction have been felt. Amniotic Fluid
have not been felt yet. Bloody show (+)

History
History
History
History
History

of
of
of
of
of

DM
: denied
hypertension
: denied
asthma
: denied
heart disease
: denied
allergy
: denied

Good

Frequently, at midwife since 3 months pregnancy

H. History of Menstruation
Menarche

: 13 y.o

Length of periode

: 6-7 days

Menstruation cycle

: 28 days

Frequency of marriage
Length of marriage

: 1 time
: 8 years

Contraception (+): injection

II. PHYSICAL EXAMINATION

General Appeareance
Compos mentis
Vital Sign
Blood Pressure
Respiration Rate
Heart Rate
Temperature

:
:
:
:

120/80 mmHg
20 bpm
88 bpm
36,50 C

Cor: Heart Sound I-II, Reguler,

Murmur (-)
Pulmo: Vesicular Sound (+/
+), Add. Sound (-/-)
Abdomen :
Supel, Pain Pressure (-),
palpated single fetus, vertical
elongated IU, head
presentation, right back,
contraction (+)
2x/10/30/mild, Fetal Heart
Rate (+) 12-11-12 reguler,
head has entered pelvic,
Fundal
height 30 cm, EFWB
Genital:
2900
gramnormal, vaginal wall
VT: v/u
normal, portio soft flat, opening
3 cm,
eff : 30%, head
presentation, head down at H I,
Skin Amnion and sign cant
assessed, Amniotic Fluid (-),
bloody show (+)

Pale conjungtiva(-/-)
Icteric sclera(-/-)

USG :
Appear single fetus, IU vertical elongated, right
back, head presentation, Fetal Heart Rate (+)
BPD 9.28 cm / AC 35.62 cm / FL 6.02 / EFBW
2900 gram
Plasenta insersion in fundus grade II
Amniotic fluid enough (AFI 9.96)
No major congenital
Appeareance : Fetus in a good condition

Seorang G3P2A0, 27 tahun, UK 37+4 minggu. Pasien datang

sendiri dengan keluhan merembes dengan riwayat obstetri dan
fertilitas baik. Pasien merasa hamil 8 bulan.

Dari pemeriksaan fisik: Supel, NT (-), teraba janin tunggal IU

memanjang, preskep, puka, HIS , HIS (+) 2x/10/30/sedang,
DJJ (+) 12-11-12 reguler, kepala janin masuk panggul <1/3,
TFU 30 cm, TBJ 2945 gram

VT: v/u tenang, dinding vagina dbn, porsio lunak mendatar,

pembukaan 3 cm, eff : 25%, preskep, kepala turun di H II, KK
dan penunjuk belum dapat dinilai, AK (+) jernih tidak berbau,
STLD (+)

Pemeriksaan USG Tampak janin tunggal, IU memanjang, puka,

preskep, EFBW 3196 gram, Kesan: Saat ini janin dalam kondisi
baik

CPD (Cephalo Pelvico Disproportion)

second gravid, fullterm, inlabor,
stage I laten phase

Management

Propose re SCTP em
Inform consent
Consult anestesion
Inj ceftriaxon 1 amp/24hour
skin test

CPD is an obstetric condition in which a baby's

head is too large or a mother's birth canal too
small to permit normal labor or birth.
In relative CPD, the size of the baby's head is
within normal limits but larger than average or
the size of the mother's birth canal is within
normal limits but smaller than average, or
both; relative CPD is often overcome by
molding of the head, the forces of labor, or the
use of forceps to effect delivery.
In absolute CPD, the baby's head is markedly
or abnormally enlarged or the mother's birth
canal is markedly or abnormally contracted,
making vaginal delivery impossible

Increased Fetal Weight:

Very large baby due to hereditary reasons - a baby whose

weight is estimated to be above 5 Kgs or 10 pounds .

Postmature baby - when the pregnancy goes above 42
weeks.
Babies of women with diabetes usually tend to be big.
Babies of mothers who have had a number of children each succeeding baby tends to be larger and heavier.

Abnormal Fetal Position:

Occipito-posterior position - In this position the fetus

faces the mothers abdomen instead of her back.

Brow presentation
Face presentation.

Problems with the Pelvis:

Small pelvis.
Abnormal shape of the pelvis due to diseases like
rickets, osteomalacia or tuberculosis.
Abnormal shape due to previous accidents.
Tumors of the bones.
Childhood poliomyelitis affecting the shape of the hips.
Congenital dislocation of the hips.
Congenital deformity of the sacrum or coccyx.

Problems with the Genital tract:

Tumors like fibroids obstructing the birth passage.
Congenital rigidity of the cervix.
Scarring of the cervix due to previous operations like
conisation.
Congenital vaginal septum.