Skenario A Blok 23 Tahun 2015

A woman attends a routine antenatal appointment at 31 weeks gestation. She is

26 years old and this is her fifth preganancy. She has four children, all
spontaneous vaginal deliveries at term. Her fouth child is 18 months old and the
delivery was complicated by a postpartum haemorrhage (PPH) requiring a 4 unit
blood transfusion. She is reffered by midwife to doctor (public health centre) with
possibility of breech presentation. The mother complains of malaise and dizzy.
Due to her economic condition, she admits that during her pregnancy she only
eats some food tat can afford to buy. She feels generally tired and attributes this
to caring for her four young children. She reports good fetal movements (more
than 10 per days).
In the examination findings:
Height: 150 cm; Weight: 45 kg; Blood pressure: 126/73 mmHg; Pulse=92 x/m;
RR=22x/m
Palpebral conjunctival looked pale
Outer examination: hard parts are palpabled in te right side of mothers
abdomen.
Haemoglobin
Mean cell volume
Mean corpuscullar hemoglobin concentration
Serum iron level
Total iron binding capacity

7.8 g/dL
68 fL
28 g/dL
32ug/dL
510 mg/dL

White cell count

11.200/ L

Platelets

237.000/ L

Urinalysis: negative
Blood group: A negative
No atypical antibodies detected.
You act as the doctor in public health centre and be pleased to analysis this case.
Klarifikasi Istilah
1. Antenatal: sebelum kelahiran.
2. Gestasi: keadaan mengandung embrio atau fetus yang bertumbuh dalam
tubuh setelah penyatuan sel telur dan sel spermatozoa.
3. Post partum haemorrage: perdarahan yang terjadi segera setelah partus atau
kelahiran anak.

4. Breech presentation: kehamilan sungsang adalah posisi dimana bayi di dalam

rahim berada dengan kepala di atas sehingga saat persalinan normal, pantat
atau kaki bayi yang akan keluar terlebih dahulu.
5. Malaise: perasaan yang tidak nyaman yang samar-samar.
6. Dizzy:
7. Anemia mikrocytic hipokrom
8. Complete blood count
9. MCV:
8. MCHC:
9. Serum Iron:
10. TIBC:
Identifikasi masalah
1. She is 26 years old and this is her fifth pregnancy. She has four children, all
spontaneous vaginal deliveries at term. Her fouth child is 18 months old and the
delivery was complicated by a postpartum haemorrhage (PPH) requiring a 4 unit
blood transfusion.
a. Apa pengaruh umur ibu, umur kehamilan, dan frekuensi kehamilan dengan
keluhan yang dialami sekarang?
b. Apa pengaruh jarak antar kehamilan sebelumnya dengan keluhan?
c. Bagaimana pengaruh dari PPH terhadap kehamilan berikutnya? Kemungkinan
etiologi PPH?
d. Bagaimana tatalaksana awal PPH?
e. Bagaimana mekanisme PPH?
2. She is reffered by midwife to doctor (public health centre) with possibility of
breech presentation.
a. Apa etiologi sungsang?
HNC, suplement, gizi
G5 P4 A0
History of pph
Letak sungsang
Complaint of malaise and dizzy

Only eat some addorable to buy

Youngest child 18 months old
b. Bagaimana cara mendiagnosis sungsang?
c. Apakah ada tindakan yang bisa dilakukan untuk memperbaiki keadaan
sungsang sebelum kelahiran?
d. Apa komplikasi dari sungsang?
3. The mother complains of malaise and dizzy. She feels generally tired and
attributes this to caring for her four young children. (Chief complaint)
a. Apa etiologi dan mekanisme malaise dan dizzy pada kasus?
4. Due to her economic condition, she admits that during her pregnancy she only
eats some food tat can afford to buy.
a. Bagaimana hubungan riwayat kebiasaan terhadap kasus ini?
b. Bagaimana seharusnya nutrisi pada ibu hamil?
5. In the examination findings:
Height: 150 cm; Weight: 45 kg; Blood pressure: 126/73 mmHg; Pulse=92 x/m;
RR=22x/m
Palpebral conjunctival looked pale
Outer examination: hard parts are palpabled in te right side of mothers
abdomen.
Haemoglobin
Mean cell volume
Mean corpuscullar hemoglobin concentration
Serum iron level
Total iron binding capacity

7.8 g/dL
68 fL
28 g/dL
32ug/dL
510 mg/dL

White cell count

11.200/ L

Platelets

237.000/ L

Urinalysis: negative
Blood group: A negative
No atypical antibodies detected.
a. Bagaimana interpretasi dan mekanisme abnormalitas?

Hipotesis
Wanita mengalami kehamilan dengan presentasi sungsang disertai anemia
akibat riwayat PPH, grande multipara dan defisiensi nutrisi.
Learning Issue
1. Presentasi bokong dan ekstremitas
a. Cara penegakan diagnosis (termasuk pemeriksaan penunjang yang
dibutuhkan)
b. Diferential diagnosis
c. Working diagnosis
d. Definisi
e. Etiologi
f. Epidemiologi
g. Faktor resiko
h. Patofisiologi
i. Manifestasi klinis
j. Komplikasi
k. Tatalaksana
l. Prognosis
m. SKDI
2. Anemia dalam kehamilan
a. Cara penegakan diagnosis (termasuk pemeriksaan penunjang yang
dibutuhkan)
b. Diferential diagnosis
c. Working diagnosis
d. Definisi
e. Etiologi
f. Epidemiologi
g. Faktor resiko
h. Patofisiologi

i. Manifestasi klinis
j. Komplikasi
k. Tatalaksana
l. Prognosis
m. SKDI
3. Anatomi dan fisiologi kehamilan
4. Pemeriksaan fisik obstetri leopold, fetal heart rate, HNC
5. Status nutrisi orang hamil
6. Terminasi pregnancy
7. Perencanaaan kehamilan