failure of descent

7/27/2019 Failure of Descent

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Case report


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IDENTITY Name : Mrs Elvi Nila S (27 years old)

MR No. : 83 0p0 87

Date : May 29th

, 2013Adress : Parak Buruk Street, Padang City


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History taking:

A 27 years old patient was admitted to the Delivery

Room of Dr. M. Djamil Central General Hospital onMay 29th, 2013 at 05.00 am with a chief complain ofwater leakage from the vagina since 2 hours ago.


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Present Illness History :

Fluid leakage from the vagina since 7 hours ago

soaking a piece of sarong, with clear color and putridsmell

Pelvic pain radiating to the groin (-)

Bloody show (-)

Massive vaginal bleeding (-)

Amenorrhea since 9 months ago.

First date of last menstrual period was forgotten

Estimation date of delivery cant be predicted

Fetal movement was felt since 4 months ago.


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No complain of nausea, vomiting and vaginal bleedingneither during early pregnancy nor late pregnancy.

Prenatal care to midwife every month since the age ofpregnancy was 3 months, fetal and mother in a good

condition. Menstruation History : menarche at 13 years old, irregular

cycle, once a month which last for 4 to 6 days each cyclewith the amount of 2-3 times pad change/day without

menstrual pain.


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Previous Illness History :There wasnt previous history of heart, lung, liver, kidney,DM, hypertension and drugs allergic.

Family Illness History :

There wasnt history of hereditary disease, contagious andpsychological illness in the family.


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Marriage history : Once in 2012History of pregnancy/abortion/delivery : 1/0/0

1. Present

History of family planning : (-)History of immunization : (-)

History of formal education: Senior High School

graduated

History of Habitually : Cigarrete (-), alcohol(-), drugs(-)


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Physical Examination :

GA : Moderate

Consciousness : CMC Blood Pressure : 120/80 mmHg

Pulse rate : 82x /

Respiratory Rate : 20x/

Temperature : 36,7 C

BWbefore pregnant: 49 Kg

Body Weight : 60 Kg

Body Height : 153 cm

Upper arm circumference : 25 cm

BMI : 20,94 kg/m2

Nutrition state : Normoweight


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Eyes : Conjunctiva wasnt anemic, Sclerawasnt icteric

Neck : JVP 5-2 cmH2O, thyroid gland noenlargement

Chest : H/L normal

Abdomen : OR

Genitalia : OR

Extremity : Edema -/-, Physiological Reflex +/+,Pathological Reflex -/-


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Obstetric Record :

Abdomen : I : Enlargement in accordance with term

pregnancy, median line hyperpigmentation, striaegravidarum (+), cicatrix (-)

Palpation :

L1: Uterine fundal height was palpable 2fingers below xiphoideus processus. A large,

soft, nodular mass was palpable, not fixed L2: Greatest resistance was palpable on the

left side. Numerous small, irregular structurewere felt on the right side


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L3 : A hard mass was palpable, fixed

L4 : ConvergenUterine Fundal Height : 30 cm

Estimated fetal body weight : 2635 gr

Uterine contraction : -

Pe : Tympani

Au : Peristaltic sound was normal

FHR : 130-140x/1


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Genitalia

Inspection : normal V/U, vaginal bleeding -

Inspeculo : Vagina : tumor (-),laceration (-), fluxus (+), there was clear

fluid pooling at posterior fornix, litmus test (+)

Portio : NP, size of adult thumb. Tumor (-), laceration (-),fluxus (+), there was clear fluid passing from cervical canal,

external cervical ostium was closed.

VT : no

Portio thickness 1.5cm, posterior position, moderate consistency

Amnion (-), clear residu Head presentation H I-II


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Internal pelvic measurement: Promontory was not reached

Innominate line was 1/3-1/3 palpable Concave sacrum os Straight pelvic side wall Ischiadic spines did not protrude excessively coccygeus os was flexible Pubic arch > 90

Pelvic Outlet examination : Intertuberous distance could accomodate an adult fist (>

10.5 cm)

Impression : there is no contracted pelvic


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Laboratory Finding

Parameter Result Unit

Haemoglobin 10.3 g/dl

Leukocyte 9.8 103/mm3

Thrombocyte 222 103/mm3

Hematocrit 30 %

Eritrocyte 3.5 103/mm3


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Diagnose :

G1P0A0 L0 term pregnancy + PROM 2 hours ago

Fetal alive, singleton, intra uterine, head presentationat HI-II


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Management :

Control GA, VS, FHS, Uterine Contraction

Informed consent Check routine blood

Plan :

Pervaginam delivery


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09.00 amA/ Feeling of pain from waist region which referred

to the groin (+)

Fetal movement (+)

PE/ GC Con BP PR RR Temp

Mod CMC 120/80 80 20 37

Abd : his 2-3x/40/moderate, FHR (140-145 x/i)


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Genitalia: I : V/U normal

Vaginal toucher: 2-3 cmAmniotic sac (-), clear residue Head was palpated sagittal suture transvers HI-II

D/ G1P0A0 L0Parturient term pregnancy stage I latent phase

+ PROM 2 hours agoFetal alive, singleton, intra uterine, head presentation at HI-II


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Management :


Control 4 hours again

Plan : Pervaginam delivery


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01.00 pmA/ Feeling of pain from waist region which referred

to the groin (+)

Fetal movement (+)


Mod CMC 110/70 80 20 37

Abd : his 2-3x/45/strong, FHR (135-142 x/i)


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Vaginal toucher: 5-6 cmAmniotic sac (-), clear residue Head was palpated occiput transvers HI-II

D/ G1P0A0 L0Parturient term pregnancy stage I active phase



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Management :





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02.00 pmA/ Feeling of pain from waist region which referred

to the groin (+)

Fetal movement (+)


Mod CMC 120/80 80 20 37



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Vaginal toucher: 8-9 cmAmniotic sac (-), clear residue Head was palpated left occiput transvers HI-II

D/ G1P0A0 L0Parturient term pregnancy stage I active phase



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Management :





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03.15 pmA/ Patient feels pain and desires to want to surrender

Fetal movement (+)


Mod CMC 120/80 80 20 37



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Management :




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04.15 pmA/Patient feels pain and desires to want to surrender

Fetal movement (+)


Mod CMC 110/70 82 20 37



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Vaginal toucher: completeAmniotic sac (-), clear residue Head was palpated left occiput transvers HI-II

D/ G1P0A0 L0Parturient term pregnancy stage I I + PROM 2

hours ago + failure of descentFetal alive, singleton, intra uterine, head presentation at HI-II


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Management :

Control GA, VS, FHS, Uterine Contraction Informed Consent

Report to operating room Consult to perinathology Prepare blood transfution (crossmatch)

Plan : Cyto CS


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At 11.00 : TPPCS was performed

A male baby was born by TPPCS with 3100 gram in weight, 52cm in height, Apgar score : 8/9.

Placenta was born with a light traction on umbilical cord,complete, 1 piece. It was 17 x 16 x 3 cm in size, and 500 gramin weight, umbilical cord 60 in length. Paracentralis

insertion.IUD was put in the uterine cavum

Bleeding during operation 250 cc

D/ P1A0L1 post TPPCS on indication failure of descent ec

malpresentation + IUD acceptorMother Child were in care

S/ Observe after operation

Rooming in


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failure of descent

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