<![CDATA[A 38-year-old patient with G6P5A0, 39 weeks pregnant, presented to the Emergency Room of RSBAH Bandar Lampung with complaints of abdominal cramps since 2:15 PM. The abdomen felt tense, and contractions became more frequent with longer durations. The patient reported leaking fluids from the vagina (+) and bloody mucus (+) since the previous night, as well as intermittent pain. The patient has a history of one previous cesarean section (C/S) for her 5th child. The vital signs were as follows: Blood Pressure 114/72 mmHg, Pulse Rate 82 bpm, Respiratory Rate 21 breaths/min, Temperature 36.7°C, Oxygen Saturation 98%. On hematological examination, a decrease in hemoglobin (8.9 g/dL), hematocrit (28%), erythrocyte count (3.4 x10^6/µL), MCH (27 pg), MCHC (31 g/dL), and Hct were noted, along with a decrease in the percentage of eosinophils (0%) and lymphocytes (12%), and an increase in neutrophils (85%). On abdominal examination, there was a scar from a previous C-section. On the anogenital examination, 20 cc of clear amniotic fluid was noted, and vaginal touch revealed a thin cervix, 1 cm dilation, cephalic presentation, low station, and spontaneous rupture of membranes with 50 cc of fluid. The pre-labor diagnosis for this case was G6P5A0, 39 weeks gestation with Premature Rupture of Membranes and a history of Cesarean Section. The post-labor diagnosis was P6A0, spontaneous vaginal delivery with VBAC. Pre-labor management included monitoring vital signs and GCS, observation of DJJ, IVFD RL 20 drops per minute, Cefadroxil 2x1, Mefenamic acid 3x1, Inbion 2x1, Misoprostol 2 tablets per rectal. Post-labor management included monitoring vital signs, general condition, and bleeding, IVFD RL with oxytocin infusion 1 amp, Cefadroxil 2x1 tablets, Mefenamic acid 3x1 tablets, Inbion 2x1 tablets. The prognosis in this patient is dubia ad bonam. Keywords: Pregnancy; Premature Rupture of Membranes; VBAC. Pasien usia 38 tahun dengan G6P5A0 hamil 39 minggu datang ke IGD RSBAH Bandar Lampung dengan keluhan perut terasa mulas sejak siang pukul 14.15. Perut terasa kencang dan semakin sering dengan durasi semakin lama. Pasien merasa keluar air-air dari jalan lahir (+), lendir darah (+) sejak semalam, serta nyeri yang hilang timbul. Pasien terdapat riwayat SC 1 kali pada anak ke 5. Tekanan Darah 114/72 mmHg, Denyut Nadi 82 x/menit, Laju Pernapasan 21 x/menit, Suhu 36,7°C, Saturasi Oksigen 98%. Pada pemeriksaan penunjang hematologi didapatkan penurunan hemoglobin (8,9 gr/dl), penurunan hematokrit (28%), penurunan eritrosit (3,4 10^6/µL), penurunan MCH (27pg), penurunan MCHC (31 g/dl), penurunan Hit. Jenis Leukosit Eosinofil (0%), penurunan Hit. Jenis Leukosit limfosit (12%), dan peningkatan pada Hit. Jenis Leukosit Neutrofil (85%). Pada pemeriksaan luar abdomen terdapat luka bekas operasi (riwayat SC). Pada anogenital di Pengeluaran pervaginam terdapat air ketuban yang tidak berbau dengan volume 20 cc. Pada vaginal touch porsio teraba tipis, pembukaan 1 cm dengan presentasi kepala, penurunan HI, dan ketuban pecah spontan dengan volume 50 cc. Diagnosis pre persalinan pada kasus ini yaitu G6P5A0 Hamil 39 Minggu dengan KPD dan Riwayat SC Jth Preskep, dan diagnosis post persalinan pada kasus ini yaitu P6A0 PP Spontan dengan VBAC. Tatalaksana pre persalinan yang didapat oleh pasien yaitu Observasi TTV dan GCS, Observasi DJJ, IVFD RL 20 tpm, Cefadroxil 2x 1, Asam mefenamat 3 x 1, Inbion 2x 1, Misoprostol 2 tab per rectal. Tatalaksana post persalinan yaitu monitoring TTV, keadaan umum, dan perdarahan, IVFD RL+ 1 amp oxytocin gtt xx tpm, Cefadroxil 2x1 tab, Asam mefenamat 3x1 tab, Inbion 2x1 tab. Prognosis pada pasien ini yaitu dubia ad bonam.]]>
