Obstetric Census HRPZ II 12-18 March 2017

1. OBSTETRICS CENSUS
HRPZ II, KOTA BHARU
12th
- 18th
of MARCH 2017
Prepared by:
DR MUHAMMAD REDZWAN BIN ABDULLAH

2. 8/3
MODE OF DELIVERY NO % REMARKS
VAGINAL DELIVERIES 175 67.0
- SVD 168 96 PRIMIGRAVIDA: 58
MULTIGRAVIDA: 110
- ASSISTED VACUUM 5 2.9 PRIMIGRAVIDA: 3
MULTIGRAVIDA: 2
FORCEPS 1 0.6 PRIMIGRAVIDA: 0
MULTIGRAVIDA: 1
BREECH 1 0.6 PRIMIGRAVIDA: 1
MULTIGRAVIDA: 0
LSCS 86 33.0
- EMERGENCY 72 83.7 PRIMIGRAVIDA: 26
MULTIGRAVIDA: 46
- ELECTIVE 14 16.3 PRIMIGRAVIDA: 4
MULTIGRAVIDA: 10
TOTAL DELIVERIES 261 PRIMIGRAVIDA: 92
MULTIGRAVIDA: 169
MODE OF DELIVERY

3. 8/3
HO MO SN SP TOTAL %
PRIMIGRAVIDA 7 19 11 0 37 63.8*
MULTIGRAVIDA 1 7 5 0 13 11.8**
TOTAL 8 26 16 0 50 29.8
EPISIOTOMY
*TOTAL EPISIOTOMY PRIMIGRAVIDA
TOTAL SVD PRIMI
**TOTAL EPISIOTOMY MULTIGRAVIDA
TOTAL SVD MULTI
#EXCLUDING OPERATIVE VAGINAL DELIVERIES, BREECH AND SHOULDER DYSTOCIA

4. INDICATIONS OF EPISIOTOMY
INDICATIONS NO. OF EPISIOTOMY DONE
INSTRUMENTAL 4
SHOULDER DYSTOCIA 1
BREECH 0
OTHERS
(Fetal bradycardia, short perineal body,
prolonged 2nd
stage)
50
TOTAL 55
8/3

5. PERINEAL TEAR
PRIMIGRAVIDA MULTIGRAVIDA
SPONTANEOUS 2ND
DEGREE 0 1
3RD
DEGREE 1 0
4TH
DEGREE 0 0
IATROGENIC EPISIOTOMY 41 (including 3
vacuum, 1 shoulder
dystocia)
14 (including 1
vacuum)
3ND
DEGREE 0 0
4RD
DEGREE 0 0
CERVICAL TEAR 0 0
8/3

6. TRIAL OF LABOUR AFTER
CAESAREAN SECTION (TOLAC)
NO %
SUCCESSFUL TOLAC 2 40%
FAILED TOLAC 3 60%
TOTAL 5
8/3

7. REASONS FOR FAILED TOLAC
REASONS NO
FETAL DISTRESS 3
POOR PROGRESS 0
FAILED IOL 0
TOTAL 3
8/3

8. EXTERNAL CEPHALIC VERSION
(ECV)
TOTAL ECV DONE: 5
8/3

9. OPERATIVE VAGINAL DELIVERY
NUMBER %
VACUUM 5 83.3
FORCEPS 1 16.7
TOTAL 6 100
8/3
MATERNAL MORBIDITIES NUMBER
FAILED INSTRUMENTATION 0
3RD
OR 4TH
DEGREE TEAR 0
POSTPARTUM HEMORRHAGE 1

10. OPERATIVE VAGINAL DELIVERY
BABY OUTCOME
8/3
DISCHARGE
TO MOTHER
SCN NICU INTUBATED STILL-
BIRTH
TOTAL
NUMBER 5 1 - - - 6

11. SHOULDER DYSTOCIA
NUMBER PERCENTAGE
PRIMIGRAVIDA 1
MULTIGRAVIDA 0
TOTAL 1 100
8/3
MATERNAL MORBIDITIES NUMBER
3RD
OR 4TH
DEGREE TEAR 0
POSTPARTUM HEMORRHAGE 0

12. SHOULDER DYSTOCIA
BABY OUTCOME
8/3
DISCHARGE
TO MOTHER
SCN NICU INTUBATED STILL-
BIRTH
TOTAL
NUMBER - 1 - - - 1

13. CAESAREAN SECTIONS
NO %
ELECTIVE 72 83.7
EMERGENCY 14 16.3
TOTAL 86 33
8/3

14. INDICATIONS FOR ELECTIVE LSCS
INDICATIONS NUMBER
PREVIOUS UTERINE SURGERY/
>2 PREVIOUS SCARS
6
MALPRESENTATION:
BREECH 1
ABNORMAL LIE:
TRANSVERSE 2
MULTIPLE PREGNANCY:
NON CEPHALIC LEADING TWIN 1
MACROSOMIA 1
OTHERS:
LOWER SEGMENT UTERINE FIBROID
CHRONIC RHEUMATIC HEART DISEASE
SUBFERTILITY (PRECIOUS BABY)
1
1
1
TOTAL 14
8/3
*Based on National Obstetric Registry (NOR)

15. INDICATIONS FOR EMERGENCY
LSCS
INDICATIONS NUMBER
FETAL DISTRESS 24
PREVIOUS UTERINE SURGERY (2 PREVIOUS SCARS) 7
ABNORMAL LABOUR PROGRESS (POOR PROGRESS) 5
MATERNAL REQUEST 5
SEVERE PREECLAMPSIA 3
FAILED IOL 6
MALPRESENTATION (BREECH) 5
ABNORMALL LIE
-UNSTABLE
-TRANSVERSE
-OBLIQUE
3
2
1
IUGR 2
MACROSOMIA 2
PLACENTA PREVIA MAJOR 1
OLIGOHYRAMNIOS 3
OTHERS (RVD PATIENT, ABNORMAL BABY) 2+1
TOTAL 72
8/3

16. BABY OUTCOME FOR LSCS FOR
FETAL DISTRESS
8/3
DISCHARGE
TO MOTHER
SCN NICU INTUBATED STILL-
BIRTH
TOTAL
NUMBER 12 12 - - - 24

17. CAESAREAN SECTIONS
MORBIDITIES
COMPLICATION NUMBER %
POSTPARTUM HEMORRHAGE 11 12.8
ADJASCENT ORGAN INJURY 0 0
HYSTERECTOMY 0 0
8/3

18. POSTPARTUM HEMORRHAGE
ESTIMATED BLOOD
LOSS (EBL)
500 -
999
1000 -
1499
>1500 TOTAL
SVD 3 1 0 4
VACUUM 0 1 0 1
LSCS ELECTIVE - 0 0 0
EMERGENCY - 9 2 11
TOTAL 16
8/3

19. SITI NOOR AISHAH GHANI (650317)
25 YEARS OLD, PARA 2
POST EMLSCS FOR POOR PROGRESS OF LABOUR, COMPLICATED WITH PRIMARY PPH
SECONDARY TO UTERINE ATONY.
INTRAOP: BLEEDING INTRAOP ~1.3L IN VIEW OF UTERINE ATONY AND FROM LEFT ANGLE.
BLEEDING SUTURED WITH MULTIPLE FIGURE OF 8'S, AND IV PITOCIN GIVEN STAT.
SUBSEQUENTLY UTERUS WELL CONTRACTED. ANOTHER EPISODE OF BLEEDING DUE TO
UTERINE ATONY DURING VAGINA TOILETTING. REMOVE BLOOD CLOT AROUND 1.2L. ONE
DOSE OF HEMABATE GIVEN, WELL CONTRACTED.
EBL: 1.3 INTRAOP, 1.2L POST OP. TOTAL BLOOD LOSS: 2.5L.
LIQUOR: THIN MSL
DELIVERED BABY BOY BIRTH WEIGHT 4.0kg, APGAR SCORE: 9, 10
BABY INITIALLY TRIAGED AT SCN FOR BIG BABY, THEN DISCHARGED TO MOTHER.
ON DAY 3 OF LIFE, NOTED JAUNDICE AND NEEDS FOR SINGLE PHOTOTHERAPY - TO ADMIT
HOSP TUMPAT
ANTENATALLY:
1. PROM > 12HR, ADEQUATELY COVER
2. VOLUNTARY SUBFERTILITY 5 YEARS
8/3

20. PATIENT DISCHARGED WELL FROM WARD ON DAY 3.
NO ANEMIC SYMPTOMS
COMFORTABLE.
- AMBULATING & TOLERATING ORALLY WELL
- PU/BO WELL
- NO ABDOMINAL PAIN
- NO ANEMIC SYMPTOMS
- NO EXCESSIVE PV BLEED
- AFEBRILE
- BREASTFEEDING ESTABLISHED
O/E: ALERT, CONSCIOUS, PINK. VITAL SIGNS STABLE
PA: SOFT, NON TENDER
UTERUS WELL CONTRACTED AT 18W
WI: WOUND CLEAN, DRY, NO BLEEDING, NO GAPING, NO DISCHARGE
PAD: 1/2 SOAKED
NO CALVES TENDERNESS

21. VE:
- VV:NAD
- NO ACTIVE BLEEDING
- NORMAL LOCHIA
- NO FOREIGN BODY
- NO HEMATOMA
- NO BLOOD CLOT
- INTACT PERINEUM
1. ALLOW DISCHARGE TODAY
2. TCA X 1/52 AT LC FOR MO TO REVIEW WOUND
3. TCA X 4/52 AT KK FOR PNR, PAP SMEAR AND CONTRACEPTION METHOD COUNSELLING
4. TCA STAT IF DEVELOP ABDOMINAL PAIN, INCREASE PER VAGINAL BLEEDING, FOUL
SMELLING DISCHARGE OR FEVER
5. CONT S/C HEPARIN 5000 UNIT BD TO COMPLETE FOR 10 DAYS - AT KK
---CONT TAB IBUPROFEN 400MG TDS/PRN X 5/7
---CONT TAB IBERET FOLIC 1 TAB BD X 1/12
6. ENCOURAGE ORAL INTAKE, BREATFEEDING AND AMBULATION
7. TED STOCKINGS 1/12
8. ALLOW TRIAL OF SCAR NEXT PREGNANCY

22. MISS FONH (650726)
8/3
27 YEAR-OLD, PARA 1
POST EMLSCS FOR FAILED TRIAL OF SCAR
-DIFFICULTIES: DENSE ADHESION, ADHESIOLYSIS WAS DONE
-LIQUOR: CLEAR
-EBL: 1600CC
DELIVERED BABY GIRL, BW: 3.0kg, APGAR SCORE: 9 IN 1 MINUTE, 10 IN 5 MINUTES.
BABY DISCHARGED TO MOTHER.
ANTENATALLY:
1) PROM > 24H, ADEQUATE COVER WITH IV BENZYLPENICILLIN
2) 1 PREVIOUS SCAR IN 2012 FOR TWIN PREGNANCY
UPON DISCHARGE, DAY 2 POST OP,
- COMFORTABLE
- AMBULATING & TOLERATING ORALLY WELL
- PU WELL/PASS FLATUS
- NO ABDOMINAL PAIN, NO ANEMIC SYMPTOMS, NO EXCESSIVE PV BLEED
- AFEBRILE

23. O/E: CONSCIOUS, ALERT, PINK, VITAL SIGN STABLE.
PA: SOFT, NON TENDER, UTERUS WELL CONTRACTED AT 18 WEEK SIZE
PAD: 1/4 PAD SOAKED
WOUND CLEAN, NO GAPPING, NO DISCHARGE, NO SKIN INDURATION, NO BRUISES.
NO CALVES TENDERNESS
VE:
- VV:NAD
- NO ACTIVE BLEEDING, NO FOREIGN BODY, NO HEMATOMA, NO BLOOD CLOT
- NORMAL LOCHIA
- INTACT PERINEUM
PLAN:
1. ALLOW DISCHARGE
2. TCA 1/52 LC TO REVIEW WOUND
3. TCA LC 4/52 AT LOCAL CLINIC FOR PNR, CONTRACEPTION AND PAP SMEAR
4. TCA STAT IF DEVELOP ABDOMINAL PAIN, INCREASE PER VAGINAL BLEEDING, FOUL
SMELLING LOCHIA OR FEVER
5. ENCOURAGE BREAST FEEDING EXCLUSIVELY FOR 6 MONTH, AMBULATING, AND ORALLY
6. FOR S/C HEPARIN 5000 UNIT BD - TO COMPLETE 10 DAYS
7. TAB BRUFEN 400MG TDS
8. TAB IBERET FOLIC 1 TAB OD
9. FOR LSCS + BTL NEXT PREGNANCY

24. SITI FAEZAH MAT ROMI (651190)
26 YEARS OLD PARA 1
1. POST SVD WITH 3RD DEGREE TEAR AND PRIMARY PPH SECONDARY TO UTERINE ATONY
2. POST EUA AND VAGINAL WALL REPAIR
-DELIVERED BABY GIRL, BW2,8 KG, AS 9 IN 1 MINUTE , 10 IN 5 MINUTES
-EBL: 1500 CC
ANTENATALLY:
1) PROM >12HOURS
- ADEQUATE COVER WITH IV BENZYLPENICILLIN
DISCHARGED WELL FROM POST NATAL WARD ON DAY 3 POST SVD.
AFEBRILE
NO ANEMIC SYMPTOMS
NO SOB,NO CHEST PAIN
NO INCREASE PV BLEEDING
TOLERATING ORALLY WELL
AMBULATING WELL
PU WELL/PASSING FLATUS
8/3

25. O/E:ALERT, CONSCIOUS, NOT PALE. V/S STABLE.
P/A: SOFT NON TENDER
UTERUS CONTRACTED AT 18 WEEK SIZE
PAD: STAINING, NORMAL LOCHIA
NO CALVES TENDERNESS
VE:
SUTURE INTACT
NORMAL LOCHIA
NO HEMATOMAA,NO ACTIVE BLEEDING
NO BLOOD CLOT EVACUATED
NO FOREIGN BODY
PR :
NO SUTURE FELT
ANAL SPHINTER GOOD

26. PLAN:
1) ALLOW DISCHARGE
2) TCA 4/52 AT LC FOR PNR, CONTRACEPTION AND PAP SMEAR
3) TCA STAT IF FEVERISH, ABDOMINAL PAIN, INCREASE PV BLEED AND FOUL SMELLING
DISCHARGE
4) ENCOURAGE ORALLY, AMBULATING AND BREAST FEEDING
5) TCA UROGYNAE x2/52
6) DISCHARGED WITH:
-TAB IBERET FOLIC 1 TAB OD
-ACRIFLAVIN PRN X6/52
-ALCOHOL 70% X 1/52

27. 8/3
THANK
YOU
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