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A female bay was born at Moh Hoesin Hospital from 19 years old woman.

Her
mother, Mrs. Nada, was hospitalized at Moh Hoesin Hospital due to contraction. It
was her first pregnancy. She forgot when her first day of last period, but she thought
that her pregnancy was about 8 months. She said that she never had hypertension
or other illness during her pregnancy. Seven hours after admitted, she delivered her
female baby spontaneously. The labor process was 20 minutes, and ruptured of
membrane was three hour before delivery. The baby was not cried spontaneously
after birth, and resuscitation was done. APGAR score at 1 minute was 1 and 5
minute was 3, and 10 minutes was 7. One hour later the baby still grunting, and
cyanosis.
On phisycal examination:
Body weight was 1300 grams, body length was 40 cm, and head circumference was
30 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 10 minutes
of age, she still had grunting and cyanosis of the whole body. The respiratory rate
was 68 bpm, heart rate was 152 bpm, and the temperature was 36,2 oC. There was
chest indrawing. Other physical examinations were within normal.
As general practitioner please analyze the problem and the management.
Klarifiskasi Istilah
1. Contraction: Pemendekan atau penyusutan atau mendekatkan uterus
ringan, biasanya tidak nyeri dan tidak teratur selama masa kehamilan.
Intensitas dan frekuensinya meningkat secara bertahap serta bertambah
ritmis selama trimester ketiga.
2. Rupture of membrane: Pecahnya selaput korioamniotik sebelum terjadinya
persalinan
3. APGAR Score: Suatu metode untuk menilai keadaan umum bayi setelah
kelahiran yang dinilai adalah frekuensi jantung, pernapasan, tonus otot,
warna kulit, dan reaksi terhadap rangsang. Yakni dengan memasukkan
kateter ke lubang hidung sesudah jalan napas dibersihkan.
4. Grunting: Tanda adanya respiratory distress pada bayi yang baru lahir.
5. Cyanosis: Perubahan warna kulit dan membrane mukosa menjadi kebiruan.
6. Lanugo: Rambut halus pada tubuh janin.
7. Plantar Crease: Lipatan pada telapak tangan.
8. Chest indrawing: Gambaran tarikan dinding dada yang berlebihan saat
respirasi.
9. First Day of Last period: Hari pertama haid terakhir; tanggal terjadinya
haid pertama kali dalam siklus haid terakhir kali sebelu terjadi kehamilan.
Penghitungan hanya bisa dilakukan pada ibu hamil dengan siklus haid teratur
sekitar 28-30 hari.
10.
Resusitation: Memulihkan keadaan jantung dan paru setelah
keadaan henti jantung atau kematian mendadak.

Identifikasi Masalah
1. A female bay was born at Moh Hoesin Hospital from 19 years old woman. Her
mother, Mrs. Nada, was hospitalized at Moh Hoesin Hospital due to
contraction. It was her first pregnancy. She forgot when her first day of last
period, but she thought that her pregnancy was about 8 months. She said
that she never had hypertension or other illness during her pregnancy.
2. Seven hours after admitted, she delivered her female baby spontaneously.
The labor process was 20 minutes, and ruptured of membrane was three hour
before delivery.
3. The baby was not cried spontaneously after birth, and resuscitation was
done. APGAR score at 1 minute was 1 and 5 minute was 3, and 10 minutes
was 7. One hour later the baby still grunting, and cyanosis.
4. On phisycal examination:
Body weight was 1300 grams, body length was 40 cm, and head
circumference was 30 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 10 minutes of age, she still had grunting and cyanosis
of the whole body. The respiratory rate was 68 bpm, heart rate was 152 bpm,
and the temperature was 36,2oC. There was chest indrawing. Other physical
examinations were within normal.

Analisis Masalah
1. A female bay was born at Moh Hoesin Hospital from 19 years old woman. Her
mother, Mrs. Nada, was hospitalized at Moh Hoesin Hospital due to
contraction. It was her first pregnancy. She forgot when her first day of last
period, but she thought that her pregnancy was about 8 months. She said
that she never had hypertension or other illness during her pregnancy.
a. Hubungan usia dan kehamilan? 1, 8, 5
b. Bagaimana mekanisme kontraksi pada kehamilan? 2, 9, 6
c. Bagaimana cara menghitung usia gestasi pada ibu Nadia (selain HPHT)? 3,
10, 7
d. Apa saja risiko kehamilan pada usia muda? 4, 1, 8
e. Apa saja faktor risiko kehamilan preterm? 5, 2, 9
f. Apa saja komplikasi dari kelahiran premature? 6, 3, 10

2. Seven hours after admitted, she delivered her female baby spontaneously.
The labor process was 20 minutes, and ruptured of membrane was three hour
before delivery.

a. Apa makna kelinis dari persalinan 20 menit setelah 7 jam dan pecahnya
ketuban 3 jam sebelum persalinan? 7, 4, 11
b. Apa etiologi ruptured of membrane? 8, 5, 1
c. Bagaimana mekanisme terjadinya ruptured of membrane? 9, 6, 2
d. Apa komplikasi dari ruptured of membrane terhadap ibu dan janin? 10, 7,
3
3. The baby was not cried spontaneously after birth, and resuscitation was
done. APGAR score at 1 minute was 1 and 5 minute was 3, and 10 minutes
was 7. One hour later the baby still grunting, and cyanosis.
a. Apa makna klinis bayi tidak menangis setelah lahir? 11, 8, 4
b. Apa interpretasi dari APGAR score pada kasus ini? 1, 9, 5
c. Apa etiologi dari cyanosis? 2, 10, 6
d. Apa makna klinis dari merintih dan cyanosis pada kasus? 3, 11, 7
e. Apa indikasi tindakan resusitasi pada bayi baru lahir? 4, 1, 8
4. Physical examination:
Body weight was 1300 grams, body length was 40 cm, and head
circumference was 30 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 10 minutes of age, she still had grunting and cyanosis
of the whole body. The respiratory rate was 68 bpm, heart rate was 152 bpm,
and the temperature was 36,2oC. There was chest indrawing. Other physical
examinations were within normal.
a. Apa interpretasi dan mekanisme abnormal?
- BW, BL, HC: 5, 2, 9
- Muscle tone: 6, 3, 10
- Poorly flexed at the limbs: 7, 4, 11
- Thin skin: 8, 5, 1
- More lanugo over the body: 9, 6, 2
- Plantar creases 1/3 anterior: 10, 7, 3
- At 10 minutes of age still grunting: 11, 8, 4
- At 10 minutes of age still cyanosis of whole body: 1, 9, 5
- RR: 2, 10, 6
- HR: 3, 11, 7
- Temperature: 4, 1, 8
- Chest indrawing: 5, 2, 9
b. Bagaimana ciri-ciri bayi prematur? 6, 3, 10
Hipotesis
Mrs. Nadia, G1P1A0, melahirkan bayi spontan preterm yang mengalami
respiratory distress dan asfiksia.
Template
1. How to diagnose 7, 4, 1
2. DD 8, 5, 2

3.
4.
5.
6.
7.
8.

Pemeriksaan Penunjang 9, 6, 3
WD 10, 7, 4
Etiologi 11, 8, 5
Epidemiologi 1, 9, 6
Patofisiologi 2, 10, 7
Tatalaksana (Ibu dan Bayi) --- bayi yang sekarang dan edukasi ibu untuk
kehamilan berikutnya karena ada kecenderungan berulang 3, 11, 8
9. Preventif dan Edukasi 4, 1, 9
10.Komplikasi 5, 2, 10
11.Prognosis 6, 3, 11
12.SKDI 7, 4, 1
LI
1.
2.
3.
4.

Respiratory distress 1, 5, 9, 11, 6


BBLR 2, 6, 10, 3, 7
Asfiksia 3, 7, 11, 4, 8
Penyakit Membran Hyalin 4, 8, 1, 5, 9

1. Abdil
2. Izza
3. Aas
4. Indri
5. Wawan
6. Gufron
7. Owen
8. Yopi
9. Rozak
10. Fakhri
11. Shulaksana

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