CASE REPORT

BREECH PRESENTATION

ULAN NOPUTRI, S.KED

TUTOR :DR. YUDHO DARUNO, SP.OG (K)DEPARTMENT OF OBSTETRY AND GYNEKOLOGY MEDICAL FACULTY BENGKULU OF UNIVERSITY DR. M.YUNUS HOSPITAL BENGKULU, `2015

MEDICAL RECORDS

1. IDENTITY NAME : MS. GR MR NUMBER: 678292 AGE: 21 RELIGION: ISLAM ETHNIC : INDONESIAN LAST EDUCATION : SMP OCCUPATION : HOUSEWIFE ADDRESS : TANJUNG HARAPAN, BENGKULU HOSPITALIZED : 04 FEBRUARY 2015, 01.00 AM

2. MARRIED HISTORY FIRST MARRIED, LASTED 1 YEARS 3 MONTHS3. MENSTRUAL HISTORYMENARCHE: 15 YEARSMENSTRUAL CYCLE: 28 DAY, REGULARMENSTRUAL PERIOD: 6 DAYLAST MENSTRUAL PERIOD: 06 MAY 2014 ESTIMATES OF LABOR: 13 FEBRUARY 2015CONTRACEPTION: NO4. GESTATION / LABOR HISTORY 1. THIS GESTATION

5. ANTENATAL CARE HISTORY MIDWIFE FIVE TIMES, OBSTETRICIANS TWO TIMES6. SOCIOECONOMIC HISTORY MEDIUM7. PAST MEDICAL HISTORYHYPERTENTION: (-)ASTHMA: (-) DIABETES : (-)HEART DISEASE : (-)SURGICAL HISTORY: (-)

8. ANAMNESAMC : WILL BIRTH WITH BREECH PRESENTATIONHISTORY OF PRESENT ILLNESS :+ 6 HOURS BEFORE HOSPITALIZED, PATIENTS COMPLAIN OF ABDOMINAL CONSTRACTION THAT EXTENDS TO THE WAIST INTERMITTENT, WHICH IS MORE FREQUENT AND STRONGER. OUT OF AMNIOTIC FLUID (-), VAGINAL BLEEDING AND VAGINAL DISCHARGE (+). THEN PATIENT GO TO MIDWIFE, AND MIDWIFE REFERRED TO M. YUNUS HOSPITAL. PATIENT CLAIMED FULL TERM PREGNANT WITH THE FETUS MOVEMENT WAS PERCEIVED.

PHYSICAL EXAMINATION1. PRESENT STATUS GENERAL APPEARANCESENSES: COMPOS MENTISHABITUS : ATLETICUS WEIGHT: 55 KGHEIGHT: 150 CMBLOOD PRESSURE: 120/80 MMHGPULSE RATE: 86X/MINUTERESPIRATION RATE: 20X/MINUTETEMPERATURE: 37C

SPECIFIC APPEARANCE HEAD: ANEMIC CONJUNCTIVAL -/-, ICTERUS SCLERA -/-NECK: JUGULARE VEIN PRESSURE NOT INCREASED, MASS (-)THORAXCARDIAC: HEART SOUND (+) NORMAL, MURMUR (-), GALLOP (-)PULMO: BREATH SOUND (+) VESICULAR, RONCHI (-), WHEEZING (-)PAPILA MAMMAE : BULGE OF NIPPLE, CLEAN, BREAST MILK (-)ABDOMEN: MASS(-), TENDERNESS (-), BOWEL SOUND (+) NORMALSURGICAL SCAR (-), HEPAR NOT PALPABLE, SPLEEN NOT PALPABLEEXTREMITY: OEDEMA OF PRETIBIA -/-

OBSTETRIC EXAMINATIONOBSTETRIC EXAMINATION ON DATE OF 04 FEBRUARY 2015 AT 01.00 AM OBTAINED :EXTERNAL EXAMINATION : FUNDAL HEIGHT 31 CM, LONGITUDINAL FOETUS, BACK IN THE RIGHT SIDE, BREECH PRESENTATION, HIS 3X/10/35, FHR 146X/MINUTE,REGULAR AND EFW 2790 GRAMS.INTERNAL EXAMINATION :VAGINAL TOUCHER : SOFT PORTIO IN PALPABLE , ANTERIOR, EFFISEMENT 100%, DILATATION OF PORTIO 4 CM, BREECH, HODGE II, AMNIOTIK MEMBRAN (+), FRONT RIGHT SACRUM

ZATUCHNI ANDROS SCORE< 4 : sectio Caesar4 : reevaluation> 4 : pervaginam

In these patient obtained Zatuchni Andros score is 6, which means pervaginam parturition.

012ParityPrimigravidaMultigravida-Gestation 39 weeks38 weeks 37 weeksEstimated Fetal Weight 3130 gram3629-3176 gram 3175 gramHistory of breech presentastion-1x2xStation-3-2-1or less4 cm

LABORATORY EXAMINATIONROUTINE BLOOD (04-02-2015)HB: 11G/DL(12 18 G/DL)LEUKOCYTE: 13.000/MM3(5000 10.000 MM3)THROMBOCYTE: 210.000 SEL/MM3(200.000 500.000/MM3)HEMATOCRYTE: 33 %(38-44%)

PARTOGRAF

DIAGNOSE G1P0A0 FULL-TERM PREGNANT INPARTU ACTIVE PHASE OF THE FIRST STAGE OF LIFE SINGLE FETUS BREECH PRSENTATION.PROGNOSISMOTHER: BONAMFOETUS: DUBIA AT BONAMTHERAPYOBSERVATION OF VITAL SIGNS MOTHER, HIS, FETAL HEART RATEIVFD RL GTT XX /MINUTEROUTINE BLOOD TESTS, CROSSMACTHPARTOGRAPH EVALUATION ACCORDING TO WHO MODIFICATIONPLANNING OF PERVAGINAM PARTURITION

FOLLOW UP

04.02.201505.00 AM 7 centimeter.His 4x/10/4004.02.201508.10 AM complete. Led patient to perfom labor. Bracht spontaneous labor action.Neonates born alive, male, weight 3000 grams, body length 49 cm, head circumference of 30 cm, chest circumference 31 cm, Apgar Score 5/6 FTAGA

05.02.201508.00 AMS : urinate (+), nausea and vomit (-). Present stateGeneral state : wellSense : compos mentis BP : 110/70mmHgPulse : 88x/mtRR : 20x/mtT : 37,2 0 CExternal Examination :Flat of abdomen, supple, uterine fundal at palpable 2 fingers below the umbilicus, good uterine contractions, active bleeding (-), Lhokia rubra (+), episiotomy wound is good.A : P1A0 Post Spontaneus parturition, day two with Breech persentation, alive neonates, male, weight 3000 grams, body length 49 cm, head circumference of 30 cm, chest circumference 31 cm, Apgar Score 5/6 FTAGA T/- Observation mothers vital sign - Mefenamic acid 3 x 500 mg- Amoxicillin 3x500 mg

DISCUSSIONBREECH IS A CONDITION IN WHICH THE FETUS IS LOCATED AFT WITH HEAD IN FUNDUS AND BUTTOCKS ARE AT THE BOTTOM OF THE UTERINE CAVITY, OR THE FETUS IS LOCATED ON THE LONGITUDINAL AXIS OF THE HEAD POSITION IN THE FUNDUS. ANAMNESA FROM PATIENT OBTAINED THE MOTHERS PREGNANCY IS THE FIRST PREGNANCY. ACCORDING TO THE FIRST DAY OF THE LAST MENSTRUAL PERIOD, IS CURRENTLY 39 WEEKS PREGNANT AND WHEN IT COMES, THE MOTHER IN A STATE OF FULL-TERM PREGNANT, INPARTU THE ACTIVE PHASE OF THE FIRST STAGE. EXAMINATION OF THE PATIENT ON ABDOMINAL PALPATION USING THE LEOPOLD MANEUVER FOUND THE HEAD LIES IN THE FUNDUS OF UTERINE, THE MAXIMUM PUNCTUM FOETUS HEART RATE IS ABOVE FROM THE UMBILICAL SO IT CAN BE CONSIDERED A FETUS IS BREECH PRESENTATION. ULTRASOUND EXAMINATION ALSO BEEN DONE BEFORE AND FOUND THE LOWEST PART FROM FETUS IS BREECH.

SO, THAT THE PATIENT IS DIAGNOSED WITH G1P0A0 FULL-TERM PREGNANT INPARTU THE ACTIVE PHASE OF THE FIRST STAGE OF LIFE SINGLE FETUS BREECH PRSENTATION.CONSERVATIVE MEASURES IN THESE PATIENTS HAS BEEN DONE WELL. IN THESE PATIENTS IS NOT DONE SECTIO CAESAR, BUT SPONTANEUS LABOR ACTION BY WAY OF BRACHT. BECAUSE, WHEN VIEWED FROM A SCORE OF ZATUCHNI-ANDROS IN PATIENTS OBTAINED A SCORE OF MORE THAN 4, SO THAT LABOR PREGNANCY CAN BE PERVAGINAM.

THANKYOU

QUESTION?HOW LONG TIMES BREECH PRESENTATION, WE NEED FOR LABOR DELIVERY? IS IT SAME LIKE HEAD PRESENTATION? ANSWER : WE JUST 8 MINUTES, TO SAVE THE BABY. BECAUSE IF OVER THE TIME, WILL HAPPEN HYPOXIA IN THE FETAL. THATS SO BAD FOR BABY.2. IN THE CASE , THE LABOR IS SPONTANTLY BRACHT, WHEN WE DO THAT? WHAT THE CONDITIONS? ANSWER : 3.WHEN THE GESTATIONAL WEEK WILL HAPPEN BREECH PRESENTATION? HOW THE MECHANISM THAT?ANSWER : BELOW 34 WEEKS OF GESTATIONAL, THE BABY CAN AROUND IN THE CAVUM UTERY.