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Presented by:
I Cannu, Ma. Angelica Goldamier C.
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General Data
a GT
l 37 / Married
February 12, 1981
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a Roman Catholic
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San Pablo, Isabela
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Date of Admission: March 14, 2018 1st
s hospitalization
o Date of Discharge: March 17, 2018
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I Presented by:
a Cannu, Ma. Angelica Goldamier C.
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Chief Complaint
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I Presented by:
a Cannu, Ma. Angelica Goldamier C.
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e History2 ½of Present
months prior to
Illness
t admission,
a Advised for
l ultrasound and give
birth at a hospital
due to large fundic
M height
Dx:
l PR: 76 bpm
height, Cephalic In Labor,
fetal Macrosomia, CBC
RR: 18 cpm Elderly
Temp: 37.4C Grandmultigravida UA
M BP:120/90
BT
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Therapeutics
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PLRS 1L x 8 hours
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Ampicillin- Sulbactam 1.5G/ IV
o Q 8 ( ) ANST
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For E 1 LSCS + TAH
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Hook to baseline EFM
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FHT q 15 min
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a Presented by:
Cannu, Ma. Angelica Goldamier C.
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e ER level
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a HmG= 130 Urine color: straw
Htc=0.399 Transparency: clear
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Platelet count = 348 pH: 6.5
M WBC count = 20.19 Specific gravity=1.005
a Neutrophil=85.5 Protein: +
c Lymphocyte=9 Glucose: -
r Eosinophil=0.5 WBC: 57
o Basophil=0.1 RBC:37
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Epith cell: 17
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Hyaline cast:0
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I Bacteria:21
a Presented by:
Cannu, Ma. Angelica Goldamier C.
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e OB ward Orders
t Problem Assessment Intervention
MARCH 15 , 2018 G9 P9 (9009) Pregnancy General Liquid Diet except
a 7:10Am uterine, term, milk and carbonated drinks
then soft diet once with
Cephalic,delivered,
l PR: 87 bpm
RR: 18 cpm
Elderly Grandmultiparida flatus
Therapeutics
Temp: 37.1C D5LRS 1L x KVO
Continue Ampicillin-
M BP:100/60 Emergency Primary Low
Segment Section for Fetal Sulbactam 1.5G/ IV Q 8 for 2
a 1st Post op Day Macrosomia followed by more doses then shift to
(-)flatus Total Abdominal Ampicillin- Sulbactam
c (-)bowel movement Hysterectomy under 750mg/tab; 1 tab TID x 7 days
r Spinal Anesthesia to a live
Start 1. Mefenamic Acid
Symmetric chest baby boy
o expansion, clear breath 500mg/tab, 1 tab TID
2. Ascorbic Acid 500mg/tab 1
s sounds
Adynamic precordium
Bw: 4138g, LGA, AS;8/9;
BS-40-41 weeks; tab OD x 30 days
o normal rate and rhythm 3. Ferrous fumarate + Vitamin
Flabby, nabs, soft, non- Fetal Macrosomia B complex/tab, 1 tab Bid x 30
m tender days
Encourage ambulation
I May pull out IFCFHT q 15
a Presented by: min
Cannu, Ma. Angelica Goldamier C.
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e OB ward Orders
t Problem Assessment Intervention
a MARCH 16 , 2018 G9 P9 (9009) Pregnancy DAT
6:30Am uterine, term, For repeat CBC now
Therapeutics
l PR: 87 bpm
Cephalic,delivered,
Elderly Grandmultiparida Discontinue IVF once
RR: 18 cpm CBC is okay
Temp: 37.1C Continue oral meds
M BP:120/80 Emergency Primary Low Open wound care
Segment Section for Fetal
a 2nd Post op Day Macrosomia followed by
c (+)flatus
(+)bowel movement
Total Abdominal
Hysterectomy under
r Spinal Anesthesia to a live
Symmetric chest baby boy
o expansion, clear breath
s sounds Bw: 4138g, LGA, AS;8/9;
Adynamic precordium, BS-40-41 weeks;
o normal rate and rhythn
m Dry and well coaptated
wound
Fetal Macrosomia
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I Presented by:
A Cannu, Ma. Angelica Goldamier C.
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E Risk factors
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R Diabetes- GDM and Type II
O Race and ethnic
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O Male gender
M genetics
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A Cannu, Ma. Angelica Goldamier C.
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E Diagnosis
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O Adam 12
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Biomarkers PA-PPA
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M PP 13
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A Cannu, Ma. Angelica Goldamier C.
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Management
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A Prophylactic Labor Induction Elective Ceasarean Delivery
-in DM mothers with
L -to obviate further fetal growth macrosomic fetuses with EFW
and reduce potential delivery of >4500g
M complications -in non DM mothers with EFW
-ACOG does not support early of -5000g
A induction -decrease shoulder dystocia
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I Presented by:
A Cannu, Ma. Angelica Goldamier C.
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E Complications
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A Cesarean delivery or
L assisted delivery
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A Birth canal lacerations
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O Uterine atony
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O Prolonged 1st nd 2nd stage of
M labor
I Presented by:
A Cannu, Ma. Angelica Goldamier C.
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E Complications
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R Shoulder Brachial
O dystocia palsy
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A Cannu, Ma. Angelica Goldamier C.
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E Complications
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R Shoulder Brachial
O dystocia palsy
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A Cannu, Ma. Angelica Goldamier C.
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E Complications
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Mazzanti Mc Robert’s
C episiotomy
R manuever manuever
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A Cannu, Ma. Angelica Goldamier C.
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E Complications
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C Rubin’s Wood Corkscrew
R manuever manuever
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I Presented by:
A Cannu, Ma. Angelica Goldamier C.
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E Complications
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C cleidotomy Zavanelli symphysiotomy
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I Presented by:
A Cannu, Ma. Angelica Goldamier C.
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I Presented by:
A Cannu, Ma. Angelica Goldamier C.