I.

Skenario :
Mrs. Helen, 19-year-old pregnant woman G1P0A0 38-weeks pregnancy, was brought by
her husband to the Poliklinik RSUD Lahat to ANC. She has been complaining of
headache, epigastric pain, vomiting and visual blurring for the last 2 days. Patient also
complain of uterine contraction since 12 hours ago, also complain of bloody show, but
didnt complain of watery discharge. According to her husband, on her last ANC, 3 days
ago the midwife found that her blood pressure was high, and advice to deliver the baby
in the hospital. After that patient was delivered to emergency room for further treatment.

In the examination findings:

Upon admission,
Height = 153 cm Weight 76 kg
Sense: compos mentis, GCS: 15
BP: 180/110 mmHg, HR: 100 x/ min, RR: 21x/m.
pretibial edema
Obstetric examination:
Outer examination: fundal height 33cm, cephalic presentation, contraction 4x/10’/40’’,
FHR: 120x/min, EFW: 3100g
Vaginal toucher: portio was tender, effacement 100%, dilatation 7 cm, vertex
presentation, amniotic fluid (+), HII, transverse occiput

Lab: Hb 10.2g/dl, PLT: 180.320/mm3, WBC: 9600/mm3, and she had 4+ protein on
urine, cylinder (-), LDH: 982 gr/dL, ureum: 22 mg/dL, kreatinin: 0,51 gr/dL, SGOT
99mg/dL, SGPT: 77mg/dL, uric acid: 8,23 mg/dL

In emergency room patient was plan for stabilisation, patient was in bed rest position.
But 2 minutes after transfer to emergency room, patient having convulsion about ± 2
minutes. And after that, patient underwent decrease of consiousness with GCS 13.

Sense: decrease of consciousness, GCS: 13

BP: 180/110 mmHg, HR: 123 x/ min, RR: 28x/m, Temp: 38oC, Height: 153 cm, Weight:
76 kg
Physiological reflex: +/+, pretibial edema
Obstetric examination:
 Outer examination: fundal height 33cm, cephalic presentation, contraction 4x/10’/40’’,
FHR: 120x/min, EFW: 3100g
Vaginal toucher: portio was tender, effacement 100%, dilatation 7 cm, vertex
presentation, amniotic fluid (+), HII, transverse occiput
II. Klarifikasi Istilah
1. G1P0A0: status kehamilan dimana gestasi 1 partus 0 abortus 0 (kehamilan pertama)
2. Watery discharge: Leukorrhea adalah adanya sekret putih/kekuningan berupa mukus
yang keluar dari vagina biasanya terjadi akibat ketidakseimbangan hormon estrogen.
3. Bloody show: Lendir disertai darah dari jalan lahir.
4. Pretibial edema: Pembengkakan yang dapat diamati akibat akumulasi cairan
interstisial pada jaringan regio cruris.
5. Fundal Height: Pemeriksaan pengukuran tinggi fundus uteri yang digunakan sebagai
salah satu indikator menentukan pertumbuhan janin dan dapat dijadikan perkiraan
usia kehamilan
6. EFW : Penghitungan estimasi berat janin dengan rumus johnson toschard
7. Contraction: His adalah serangkaian kontraksi rahim karena otot-otot polos rahim
yang bekerja secara bertahap akan mendorong janin menuju serviks dan vagina
sehingga janin keluar dari rahim
8. Portio was tender
9. Vertex presentation: Presentasi fetus dimana bagian vertex/occiput merupakan bagian
yang paling dekat dengan cervix dan bagian yang pertama kali keluar saat persalinan
10. Hodge II : Sejajar dengan bidang hodge I (pinggir atas dari sympisis pubis ke
promontorium) terletak setinggi bagian bawah sympisis pubis. Bagian hodge ini
digunakan untuk mengetahui bagian terendah janin yang turun ke dalam panggul
dalam persalinan
11. Transverse occiput

III. Identifikasi Masalah:

1. Mrs. Helen, 19-year-old pregnant woman G1P0A0 38-weeks pregnancy, was brought
by her husband to the Poliklinik RSUD Lahat to ANC. She has been complaining of
headache, epigastric pain, vomiting and visual blurring for the last 2 days. Patient
also complain of uterine contraction since 12 hours ago, also complain of bloody
show, but didnt complain of watery discharge. (III)
2. According to her husband, on her last ANC, 3 days ago the midwife found that her
blood pressure was high, and advice to deliver the baby in the hospital. After that
patient was delivered to emergency room for further treatment. (I)
3. examination findings: (Informasi)
Upon admission,
Height = 153 cm Weight 76 kg
Sense: compos mentis, GCS: 15
BP: 180/110 mmHg, HR: 100 x/ min, RR: 21x/m.
pretibial edema

4. Obstetric examination: (Informasi)

Outer examination: fundal height 33cm, cephalic presentation, contraction 4x/10’/40’’,
FHR: 120x/min, EFW: 3100g
Vaginal toucher: portio was tender, effacement 100%, dilatation 7 cm, vertex
presentation, amniotic fluid (+), HII, transverse occiput

5. Laboratorium (Informasi)
Hb 10.2g/dl, PLT: 180.320/mm3, WBC: 9600/mm3, and she had 4+ protein on urine,
cylinder (-), LDH: 982 gr/dL, ureum: 22 mg/dL, kreatinin: 0,51 gr/dL, SGOT
99mg/dL, SGPT: 77mg/dL, uric acid: 8,23 mg/dL

6. In emergency room patient was plan for stabilisation, patient was in bed rest position.
But 2 minutes after transfer to emergency room, patient having convulsion about ± 2
minutes. And after that, patient underwent decrease of consiousness with GCS 13.
(II)

7. Sense: decrease of consciousness, GCS: 13 (Informasi)

BP: 180/110 mmHg, HR: 123 x/ min, RR: 28x/m, Temp: 38oC, Height: 153 cm,
Weight: 76 kg
Physiological reflex: +/+, pretibial edema

8. Obstetric examination: (Informasi)

Outer examination: fundal height 33cm, cephalic presentation, contraction
4x/10’/40’’, FHR: 115x/min, EFW: 3100g
 Vaginal toucher: portio was tender, effacement 100%, dilatation 7 cm, vertex
presentation, amniotic fluid (+), HII, transverse occiput

IV. Analisis Masalah

1. Mrs. Helen, 19-year-old pregnant woman G1P0A0 38-weeks pregnancy, was brought
by her husband to the Poliklinik RSUD Lahat to ANC. She has been complaining of
headache, epigastric pain, vomiting and visual blurring for the last 2 days. Patient
also complain of uterine contraction since 12 hours ago, also complain of bloody
show, but didnt complain of watery discharge.
a. Bagaimana hubungan usia ibu, status kehamilan, dan usia kehamilan terhadap
keluhan pada kasus?
b. Berapa kali minimal dilakukan ANC dan apa saja yang harus dinilai?
c. Apakah etiologi dan bagaimana mekanisme dari headache?
d. Apakah etiologi dan bagaimana mekanisme dari epigastric pain?
e. Apakah etiologi dan bagaimana mekanisme dari vomiting?
f. Apakah etiologi dan bagaimana mekanisme dari visual blurring?
g. Bagaimana fisiologi persalinan?

2. According to her husband, on her last ANC, 3 days ago the midwife found that her
blood pressure was high, and advice to deliver the baby in the hospital. After that
patient was delivered to emergency room for further treatment.
a. Apa dampak dari tekanan darah tinggi terhadap ibu dan janin pada kasus ini?
b. Berapa tekanan darah normal pada ibu hamil trimester 3?
c. Bagaimana tatalaksana awal pada saat diketahui pertama kali ibu menderita
hipertensi kehamilan?
d. Apa faktor predisposisi terjadinya hipertensi dalam kehamilan?
e. Apakah tekanan darah ibu diperburuk oleh kehamilannya?
f. Apa saja faktor kehamilan resiko tinggi?
3. examination findings:
Upon admission,
Height = 153 cm Weight 76 kg
Sense: compos mentis, GCS: 15
BP: 180/110 mmHg, HR: 100 x/ min, RR: 21x/m.
pretibial edema
 a. Apa interpretasi dan bagaimana mekanisme abnormalitas pada pemeriksaan fisik?
b. Berapa kenaikan berat badan normal saat hamil?

4. Obstetric examination:
Outer examination: fundal height 33cm, cephalic presentation, contraction 4x/10’/40’’,
FHR: 120x/min, EFW: 3100g
Vaginal toucher: portio was tender, effacement 100%, dilatation 7 cm, vertex
presentation, amniotic fluid (+), HII, transverse occiput
a. Apa interpretasi dan bagaimana mekanisme abnormalitas pada pemeriksaan
obstretrik?
b. Apa saja rumus untuk menghitung estimasi berat janin (EFW)?
c. Apa saja tanda tanda inpartu?
d. Apa saja klasifikasi hodge? (sertakan gambar!)
5. Laboratorium
Hb 10.2g/dl, PLT: 180.320/mm3, WBC: 9600/mm3, and she had 4+ protein on urine,
cylinder (-), LDH: 982 gr/dL, ureum: 22 mg/dL, kreatinin: 0,51 gr/dL, SGOT
99mg/dL, SGPT: 77mg/dL, uric acid: 8,23 mg/dL
a. Apa interpretasi dan bagaimana mekanisme abnormalitas pada pemeriksaan
laboratorium?
6. In emergency room patient was plan for stabilisation, patient was in bed rest position.
But 2 minutes after transfer to emergency room, patient having convulsion about ± 2
minutes. And after that, patient underwent decrease of consiousness with GCS 13.
a. Bagaimana hubungan usia ibu, status kehamilan dan usia kehamilan dengan kejang
yang dialami?
b. Apa saja tipe-tipe kejang pada ibu hamil? Pada kasus ini terjadi kejang apa?
c. Apa etiologi dan bagaimana mekanisme kejang pada kasus?
d. Apa etiologi dan bagaimana mekanisme penurunan kesadaran pada kasus?
e. Apa tatalaksana awal kejang pada kasus?
f. Apa dampak kejang terhadap ibu dan janin?
7. Sense: decrease of consciousness, GCS: 13
BP: 170/110 mmHg, HR: 123 x/ min, RR: 28x/m
a. Apa makna klinis penurunan tekanan darah sebelum di tata laksana?
b. Apa makna klinis peningkatan denyut nadi dan bagaimana mekanisme
kompensasi tubuh?
 8. Obstetric examination:
Outer examination: fundal height 33cm, cephalic presentation, contraction
4x/10’/40’’, FHR: 115x/min, EFW: 3100g
Vaginal toucher: portio was tender, effacement 100%, dilatation 7 cm, vertex
presentation, amniotic fluid (+), HII, transverse occiput
a. Apa makna klinis FHR turun?
b. Apa kriteria gawat janin?

Hipotesis: Mrs. Helen 19 tahun G1P0A0 usia kehamilan 38 minggu menderita eklampsi et
causa hipertensi pada kehamilan

Template:
a) DD
b) WD
c) How to diagnose
d) Definisi
e) Epidemiologi
f) Etiologi
g) Faktor resiko
h) Patofisiologi dan patogenesis
i) Manifestasi klinis
j) Pemeriksaan penunjang
k) Tatalaksana
l) KIE
m) Komplikasi
n) Prognosis
o) SKDI