SKENARIO C BLOK 24 TAHUN 2018

A female was born at type C Public Hospital from a 17 years old woman. Her mother, Mrs.
Feni was hospitalized at the hospital due to hypertension (BP 180/100mmHg). It was her
second pregnancy. She forgot when her first day of last period, but she thought that her
pregnancy was about 7 months. Her other child were born preterm too, about 8 months. The
first child did not survive. He died at 1 day of age.

Four hours after admission, the doctor decided to end the pregnancy by C section. The baby
did not cry spontaneously after birth, but grunting and his whole body was cyanotic. Pediatric
resident did the first step of resuscitation to the baby, APGAR score at the first minute was 3
and fifth minute was 7. The amnion liquor was clear.

As a GP on physical examination:

Body weight 1400 grams

Body length was 42 cm

Head circumference 32 cm

The muscle tone was decreased, she was poorly flexed at the limbs, she has thin skin, more
lanugo over the body and plantar creases 1/3 anterior.

At the 15 minutes of age, she still had grunting and cyanosis of the whole body, respiratory
rate was 100 breaths per minute, there were epigastric retraction, breathing sound decreased.
Heart rate 168 beats per minute. Saturation 85% with nasal oxygen.
 I. KLARIFIKASI ISTILAH
No. Istilah
Hipertensi
1
(dalam kehamilan)
2 First day of last period
3 Born preterm
4 C section
5 Grunting
6 Sianosis
7 Resusitasi
8 APGAR score
9 Amnion liquor
8 Lanugo
9 Plantar creases
10 Epigastric retraction
Pengertian
Adanya tekanan darah ≥ 140/90 mmHg pada masa kehamilan,
dihitung minimal 2 kali dalam 24 jam.
Hari pertama dari siklus menstruasi terakhir, digunakan untuk
menghitung usia kehamilan dan taksiran tanggal persalinan.
Perubahan serviks dan disertai kontraksi uterus yang teratur
sebanyak 4 kali dalam 20 menit yang terjadi di usia
kehamilan sebelum 37 minggu.
Suatu pembedahan guna melahirkan anak lewat insisi pada
dinding abdomen dan uterus.
Terdengar suara seperti rintihan pada saat ekspirasi.
Warna kulit dan membran mukosa kebiruan karena
kandungan oksigen yang rendah dalam darah.
Tindakan untuk menghidupkan kembali atau memulihkan
kembali kesadaran seseorang yang tampaknya mati akibat
berhentinya fungsi jantung dan paru, yang berorientasi pada
otak.
Metode yang digunakan untuk menilai keadaan umum bayi
sesaat setelah kelahiran yang dinilai adalah HR, Respiratory
effort, muscle tone, warna kulit, dan reaksi terhadap
rangsangan.
Cairan jernih dengan warna sedikit kekuningan yang
menyelimuti janin di dalam rahim selama masa kehamilan,
berada di dalam kantong ketuban
Rambut halus yang tumbuh pada tubuh janin
Garis atau cekungan yang kurang lebih linear yang terdapat
pada telapak kaki.
Penarikan dinding dada bagian bawah ke arah dalam, tampak
ketika menarik napas.
 II. IDENTIFIKASI MASALAH

Masalah Konsen
Mrs. Feni, 17 yo, pregnant woman was hospitalized at the hospital due to
hypertension (BP 180/100mmHg). Four hours after admission, the doctor III
decided to end the pregnancy by C section.
The female baby did not cry spontaneously after birth, but grunting and his
I
whole body was cyanotic.
It was her second pregnancy. She forgot when her first day of last period,
but she thought that her pregnancy was about 7 months. Her other child
IV
were born preterm too, about 8 months. The first child did not survive. He
died at 1 day of age.
Pediatric resident did the first step of resuscitation to the baby, APGAR
score at the first minute was 3 and fifth minute was 7. The amnion liquor II
was clear.
As a GP on physical examination:
Body weight 1400 grams
Body length was 42 cm
Head circumference 32 cm
The muscle tone was decreased, he was poorly flexed at the limbs, he has
V
thin skin, more lanugo over the body and plantar creases 1/3 anterior.
At the 15 minutes of age, he still had grunting and cyanosis of the whole
body, respiratory rate was 100 breaths per minute, there were epigastric
retraction, breathing sound decreased. Heart rate 168 beats per minute.
Saturation 85% with nasal oxygen.
III. ANALISIS MASALAH
1. Mrs. Feni, 17 yearso, pregnant woman was hospitalized at the C Public hospital due
to hypertension (BP 180/100mmHg). Four hours after admission, the doctor decided
to end the pregnancy by C section.
a. Bagaimana hubungan usia ibu dengan hipertensi yang dialami Mrs. Feni?
b. Bagaimana hubungan usia ibu, hipertensi, dengan keadaan bayi?
c. Apa indikasi persalinan C section?
2. The female baby did not cry spontaneously after birth, but grunting and his whole
body was cyanotic.
a. Apa makna klinis dari keadaan bayi?
b. Apa etiologi dan mekanisme dari bayi tidak menangis spontan setelah dilahirkan?
c. Bagaimana APGAR score pada bayi baru lahir terkait skenario?
d. Apa etiologi dan mekanisme dari merintih?
e. Apa etiologi dan mekanisme dari sianosis pada bayi?
f. Apa hubungan jenis kelamin bayi dengan keadaan yang dialaminya?
g. Bagaimana tatalaksana awal dari keadaan bayi di atas?
3. It was her second pregnancy. She forgot when her first day of last period, but she
thought that her pregnancy was about 7 months. Her other child were born preterm
too, about 8 months. The first child did not survive. He died at 1 day of age.
a. Bagaimana cara menghitung usia gestasi?
b. Bagaimana klasifikasi usia gestasi dan berat badan lahir pada bayi dan interpretasi
pada kasus?
c. Apa makna klinis dari anak sebelumnya lahir preterm dan hanya bertahan hidup 1
hari?
d. Apa dampak kelahiran premature terhadap bayi?
4. Pediatric resident did the first step of resuscitation to the baby, APGAR score at the
first minute was 3 and fifth minute was 7. The amnion liquor was clear.
a. Bagimana cara menilai APGAR score dan interpretasi pada kasus?
b. Bagaimana cara resusitasi pada kasus?
c. Apa makna klinis dari cairan amnion yang jernih?
5. As a GP on physical examination:

Body weight 1400 grams

 Body length was 42 cm

Head circumference 32 cm

The muscle tone was decreased, she was poorly flexed at the limbs, she has thin skin,
more lanugo over the body and plantar creases 1/3 anterior.

At the 15 minutes of age, she still had grunting and cyanosis of the whole body,
respiratory rate was 100 breaths per minute, there were epigastric retraction, breathing
sound decreased. Heart rate 168 beats per minute. Saturation 85% with nasal oxygen.

a. Apa interpretasi dari hasil pemeriksaan fisik?

b. Bagaimana klasifikasi berat badan bayi baru lahir dan interpretasi pada kasus?
c. Apa makna klinis dari body length was 42 cm, head circumference 32 cm, muscle
tone was decreased, she was poorly flexed at the limbs, thin skin, more lanugo
over the body and plantar creases 1/3 anterior?
d. Bagaimana mekanisme abnormalitas dari grunting and cyanosis of the whole
body, respiratory rate was 100 breaths per minute, there were epigastric retraction,
breathing sound decreased. Heart rate 168 beats per minute?

Hipotesis:

Seorang bayi perempuan Ny. Feni, lahir preterm secara c section , BBLSR dan respiratory
distress.

IV. ASPEK KLINIS

1. DD
2. How to diagnose
3. WD
4. Etiologi
5. Epidemiologi
6. Faktor Risiko
7. Pathogenesis dan patofisiologi
8. Manifestasi
9. Pemeriksaan penunjang
10. Tatalaksana
11. Komplikasi
12. Edukasi dan pencegahan
13. Prognosis
Quo ad vitam :
Quo ad functionam :
Quo ad sanationam :
14. SKDI
V. LEARNING ISSUES
1. BBLR
2. Respiratory distress syndrome
3. Asfiksia Neonatorum

VI. KERANGKA KONSEP

VII. KESIMPULAN

DAFTAR PUSTAKA