Case Based Discussion

“APGAR dan RESUSITASI NEONATUS”

Februari 2019

DEPARTEMEN OBSTETRI DAN GINEKOLOGI

UNIVERSITAS NAHDLATUL ULAMA SURABAYA
RSI JEMURSARI SURABAYA

Periode 02 Desember 2019 - 21 Februari 2020

 Pembimbing :
dr. Nila, Sp.OG (K)

Dokter Muda :
 Nuris Umi Rizqi
 R. Raymond Widadiya
 Luthfi Kalindra Parahita
 Aprina Trimurtiningrum
 Nur Amiroh Aulia Sari
 LAPORAN KASUS

• DATA PASIEN
Nama ibu : Ny. B
Umur : 29 th
Agama : Islam
Pendidikan : SMP
Pekerjaan : IRT
Alamat : Surabaya
Tanggal masuk PKM : 20 Januari 2020
Tanggal keluar PKM : Rujuk

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 LAPORAN KASUS

HPHT : 13 – 04 – 2019 • Menikah : 1x Selama 10 thn

TP : 20 – 01 – 2020 • Pemeriksaan Antenatal :
Usia Kehamilan : 39/40 minggu - Kontrol bidan
• Riwayat KB : suntik 3 bulanan
Riwayat Persalinan :
• Spontan / bidan / ♂ / BBL 3800gr /
7 tahun
• Abortus / tanpa curetase / 2 tahun
yll
• hamil ini

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LAPORAN KASUS
• BUKU KIA

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 LAPORAN KASUS
• KELUHAN UTAMA
• keluar darah dari jalan lahir

• RIWAYAT PENYAKIT SEKARANG (RPS)

• Keluar darah dari jalan lahir sejak 2 jam SMRS, sebelumnya pasien
merasakan kenceng2 sejak 1 hari sebelumnya, ini merupakan
kehamilan ketiga pasien

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 LAPORAN KASUS
 Riwayat Penyakit Dahulu
Penyakit darah tinggi, asma, sakit jantung, alergi dan penyakit paru-paru
disangkal.

 Riwayat Penyakit Keluarga

Penyakit darah tinggi, asma, sakit jantung, alergi dan penyakit paru-paru dalam
keluarga pasien disangkal.

 Riwayat Menstruasi
Pasien menarche saat berusia 12 tahun. Lama haid 7 hari, siklus haid 28 hari,
ganti pembalut 2-3 kali/ hari penuh, dan tidak terdapat nyeri haid

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 LAPORAN KASUS

Pemeriksaan Fisik BB sebelum hamil : 62 kg

(Tgl. 20 – 01 – 2020) : BB saat ini : 75 kg
TB : 153 cm
Status Umum BMI :
Indeks kenaikan BB : indeks
• GCS : 456
• TD : 110/70 mmHg
• Nadi : 92 x/menit
• RR : 20 x/menit
• Temp : 36 oC

• K/L : A(-) I(-) C(-) D(-)

• Thorax : Cor : S1/S2 tunggal, reguler, murmur (-), gallop (-)
Pulmo: ves +/+ , rh -/-, wh -/-
• Abdomen :
• Ekstremitas : Edema : -/-

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 LAPORAN KASUS

Pemeriksaan Fisik Status Obstetri

(Tgl. 20 – 01 – 2020) :

TFU : 31 cm
DJJ : 138x/menit
His : 3-4x @40-50” dalam 10’

• Leopold 1: teraba bokong

• Leopold 2: punggung kanan, bagian2 kecil kiri
• Leopold 3: teraba kepala
• Leopold 4: kepala sudah masuk PAP

• VT : Ø 3 cm/ eff 50% / ketuban (+) / presentasi kepala / UUK kanan depan / H1

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 LAPORAN KASUS
Hasil Laboratorium (tgl. 28-12-2019):
Pemeriksaan Hasil Satuan Nilai Rujukan
Darah lengkap
Leukosit Ribu/uL 3,80 – 10,6
Eritrosit Juta/ uL 4,40 – 5,90
Haemoglobin 11,3 g/dL 13,2 – 17,3
Hematokrit % 40 – 52
Indeks eritrosit
MCV fL 80 – 100
MCH Pg 26,0 – 34,0
MCHC % 32 – 36
RDW-CV % 11,5 – 14,5
Trombosit Ribu/uL 150 – 440
GDA 85 PPT
HbsAg NR APTT
HIV NR LDH
Gol.Darah/Rh: A/+
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 LAPORAN KASUS

Initial Assesment :
GIII P1A1H1 39/40 minggu + Inpartu kala 1 Fase Laten + obesitas I + JTHIU +
presentasi kepala + TBJ 3100

Planning Terapi : Spontan Pervaginam

Planning Monitoring : CHPB, TTV ibu

Planning Edukasi : -

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 LAPORAN KASUS
Evaluasi pasien :

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 LAPORAN KASUS
Evaluasi pasien :

ibu memasuki kala 1 fase aktif 30 menit kemudian memasuki kala 2 ,

10 menit kemudian memasuki kala 3 setelah palsenta lahir ibu
mengalami pendarahan kurang lebih 750 cc
Kencenng-kenceng
20 menit
SMRS Setelah MRS

2 jam Status obstetrikus

SMRS
• TFU : 1 jari dibawah pusat,
kontraksi lemah
Keluar darah dan
Lendir • V/U : kosong, perdarahan
aktif (+)
• VT : portio ~ post partum,
dilakukan eksplorasi intrakavum
 ada sisa darah  evakuasi
manual

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DIAGNOSIS AKHIR
Perdarahan Post Partum ec atonia uterus

PROGNOSIS
• Ad vitam : Dubia ad bonam
• Ad fungsionam : Ad bonam
• Ad sanationam : Dubia ad bonam
Tatalaksana
Rencana Terapi :
• Double IVFD RL 1000cc/12 jam
• Ceftriaxone 1x2gr
• Asam tranexamat 3x500mg
• Rencana transfusi bila Hb < 8 gr/dl

Rencana monitoring :
• Observasi tanda vital, kontraksi, perdarahan
 Follow up

30/12/2019 (Ruangan mawar 108.1, Pukul 09.00 WIB)

Nyeri (+) sedikit, lemas (+), pusing (-), sesak (-) perdarahan (+) GP 2x tidak
S
penuh, ASI (+), mobilisasi (+) BAK (+) BAB (-)
Keadaan umum: Baik, tampak sakit sedang
Kesadaran: compos mentis
Tanda vital
TD: 96/63 mmHg/ Nadi: 88x/menit/Suhu: 370 C/RR: 20x/menit
Status Generalisata: dalam batas normal
O
Status Obstetri
TFU : 2 jari dibawah pusat, kontraksi baik
Inspeksi : v/u tenang, perdarahan aktif (-)
Pemeriksaan Laboratorium :
Hb: 8.1g/dl Leu : 30.280
Follow up
A Anemia ec perdrahan post partum

Observasi KU, TTV, kontraksi, perdarahan

- atasi anemia : Transfusi PRC 1 kolf (250cc) dengan target Hb ≥8g/dL
Hemobion 1x360mg PO
P - cegah nyeri : Asam mefenamat 3x500mg PO
- cegah infeksi : Ceftriaxone 1x2gr IV
- IVFD →RL 500 cc/12 jam
Tinjauan pustaka
APGAR SCORE ???

a simple method of quickly

assessing the health and vital
signs of a newborn baby. It
was created by Dr. Virginia
Apgar in 1952.
 APGAR sCORE
Kategori Penilaian :
•A – Appearance (skin color)

•P – Pulse (heart rate)

•G – Grimace (reflex irritability/response)

•A – Activity (muscle tone)

•R – Respiration (breathing ability)

 When is Apgar testing done?
• Apgar testing is typically done at one and five minutes after a
baby is born, and it may be repeated at 10, 15, and 20 minutes
if the score is low. The five criteria are each scored as 0, 1, or 2
(two being the best), and the total score is calculated by then
adding the five values obtained (1).
What do Apgar scores mean?
• Apgar scores of 0-3 are critically low, especially in term and
late-preterm infants
• Apgar scores of 4-6 are below normal, and indicate that the
baby likely requires medical intervention
• Apgar scores of 7+ are considered normal (1, 3)
 What can cause low Apgar scores?
• A wide range of pregnancy and birth-related complications can result in low Apgar scores. Importantly,
babies who have been deprived of oxygen often perform poorly on the Apgar test (although higher scores
do not necessarily indicate a lack of oxygen-deprivation). Listed below are just a few of the complications
that can cause a baby to become oxygen-deprived, and may manifest in low Apgar scores:
• C-Section errors and delays
• Fetal monitoring errors
• Infections
• Maternal medical conditions
• Placental Abruption
• Preterm birth
• Prolonged and arrested labor
• Umbilical cord problems
• Uterine hyperstimulation/tachysystole (this can be caused by the delivery drugs Pitocin and Cytotec)
• Uterine rupture
• When a child has a brain injury such as HIE or cerebral palsy, it is imperative that experts rely on objective
scientific methods and direct observation to determine if the child was exposed to damaging
hypoxia/asphyxia around the time of birth. Clinical markers should be examined and all possibilities of
causes explored so that the cause and timing of the brain injury can be pinpointed.