SKENARIO D BLOK 22 TAHUN 2019

A male newborn was delivered at private clinic, assisted by midwife. He was delivered from a 36 years
old woman, primigravida. Mrs. Siti, the baby’s mother had premature ruptured of membrane since 4
days ago. The liquor was thick, smelly and greenish. She had fever since one day before delivery. She
also had history of hypertension during the last trimester of pregnancy. The pregnency was full term,
39 weeks. The baby was not cried spontaneously after birth. The midwife cleared the baby’s airway
using manual suction and stimulate the baby by patting his feer. The midwife said apgar score 1 for 1st
minute and 2 for 5th minutes and 5 at 10 th minute. The baby had difficulty while breathing, and had
grunting. The midwife then referred him to Moh Hoesin Hospital.

Physical examination revealed body weight was 2300 grams. Bpdy lenght 48 cms, head circumference
34 cms. His temperature was 36oC. He looked hypoactive and tachypnoe, respiratory rate 72 breaths
perminue, there were ches indrawing, grunting could be heard using stetoscope, breathing sound was
normal, he still looked cyanotic even after been giving nasal oxygen. Sucking reflex was weak. Heart
rate was 174 beats perminute. Abdominal was tender with normal bowel sound. There were
meconeum staning at umbilical cord and skin. Other examination within normal.

KLARIFIKASI ISTILAH

No Istilah
1 cyanotic
2 Apgar score
3 Tachypnoe
4 Hipoactive
5 Sucking reflex
6 Chest indrawing
7 Premature ruptured of Keruban pecah dini, pecahnya ketuban sebelum fase aktif
membrane
8 Grunting
9 Meconeum staning at Warna kehijauan pada tali pusat dan kulit
umbilical cord and skin
Pengertian
Perubahan warna kulit dan membran mukosa menjadi kebiruan
akibat konsentrasi hemoglobin teredukasi yang berlebihan
dalam darah
Metode penilaian yang digunakan untuk mengkaji kesehatan
neonatus dalam menit pertama setelah lahir sampai 5 menit
setelah lahir dan dapat diulangi pada menit ke 10 sampai 15
Pernafasan yang sangat cepat (>55x/menit)
Penurunan abnormal aktifitas motorik dan kognitif, ditandai
dengan melambatnya pemikiran, pembicaraan, dan pergerakan.
Gerakan menghisap yang dapat dipicu dengan menyentuhkan
sebuah objek ke bibir bayi
Gerakan ke dalam dinding dada bagian bawah ketika anak
inspirasi, dan merupakan tanda gangguan pernafasan
persalinan
Bunyi pernafasan abnormal saat ekspirasi yang menandakan
bahwa glottis telah menutup aliran udara dari paru, biasanya
untuk mencegah kolaps paru
 IDENTIFIKASI MASALAH

1. A male newborn was delivered at private clinic, assisted by midwife. He was delivered from a
36 years old woman, primigravida. Mrs. Siti, the baby’s mother had premature ruptured of
membrane since 4 days ago. The liquor was thick, smelly and greenish.
2. She had fever sunce one day before delivery. She also had history of hypertension during the
last trimester of pregnancy.
3. The pregnency was full term, 39 weeks. The baby was not cried spontaneously after birth. The
midwife cleared the baby’s airway using manual suction and stimulate the baby by patting his
feer. The midwife said afgar score 1 for 1st minute and 2 for 5th minutes and 5 at 10 th minute.
The baby had difficulty while breathing, and had grunting. The midwife then referred him to
Moh Hoesin Hospital.
4. Physical examination revealed body weight was 2300 grams. Bpdy lenght 48 cms, head
circumference 34 cms. His temperature was 36oC. He looked hypoactive and tachypnoe,
respiratory rate 72 breaths perminue, there were ches indrawing, grunting could be heard
using stetoscope, breathing sound was normal, he still looked cyanotic even after been giving
nasal oxygen. Sucking reflex was weak. Heart rate was 174 beats perminute. Abdominal was
tender with normal bowel sound. There were meconeum staning at umbilical cord and skin.
Other examination within normal.

ANALISIS MASALAH

1. A male newborn was delivered at private clinic, assisted by midwife. He was delivered from a 36
years old woman, primigravida. Mrs. Siti, the baby’s mother had premature ruptured of
membrane since 4 days ago. The liquor was thick, smelly and greenish.
a. Apa hubungan usia ibu dan status obstetrik terhadap ketuban pecah dini? ulfi jason
b. Apa kemungkinan penyebab ketuban pecah dini pada kasus? Nendy sisi
c. Apa dampak dari ketuban pecah dini bagi ibu dan bayi serta dampak jika tidak ditangani secara
cepat? Miranti, jason
d. Apa makna klinis dari kalimat “The liquor was thick, smelly and greenish”? miranti, jason
e. Bagaimana karakteristik cairan ketuban yang normal? (termasuk waktu normal pecahnya
ketuban saat persalinan) sisi
f. Bagaimana mekanisme ketuban pecah dini pada kasus? miranti, nendy
g. Bagaimana tatalaksana awal terhadap kasus ketuban pecah dini? Jason, miranti
h. Bagaimana klasifikasi ketuban pecah dini? Ulfi, nendy

2. She had fever since one day before delivery. She also had history of hypertension during the last
trimester of pregnancy.
a. Apa makna klinis dari “She had fever since one day before delivery”? nendy dyah
b. Apa dampak demam yang dialami ibu terhadap janin? Miranti sisi
c. Apa dampak hipertensi yang dialami ibu terhadap janin di trimester ke-III? Jason aul
d. Apa hubungan hipertensi dengan ketuban pecah dini pada kasus? Nendy ulfi

3. The pregnency was full term, 39 weeks. The baby was not cried spontaneously after birth. The
midwife cleared the baby’s airway using manual suction and stimulate the baby by patting his feer.
The midwife said apgar score 1 for 1st minute and 2 for 5th minutes and 5 at 10 th minute. The baby
had difficulty while breathing, and had grunting. The midwife then referred him to Moh Hoesin
Hospital.
 a. Apa makna klinis dari kalimat “The baby was not cried spontaneously after birth”? dyah
clarisya
b. Bagaimana kriteria penilaian Apgar score? Iqbal dyah
c. Apa makna klinis dari nilai Apgar 1/2/5 pada kasus? Clarisya iqbal
d. Bagaimana penanganan pertama terhadap bayi yang tidak menangis secara spontan? rere
clarisya
e. Apa kemungkinan penyebab bayi sulit bernafas dan merintih? Rere aul
f. Bagaimana hubungan ketuban pecah dini dengan bayi yang tidak menangis spontan, sulit
bernafas dan merintih? Rere aul
g. Bagaimana screening pada bayi baru lahir? clarisya vezi
h. Bagaimana mekanisme merujuk neonatus pada kasus? Iqbal dyah

4. Physical examination revealed body weight was 2300 grams. Bpdy lenght 48 cms, head
circumference 34 cms. His temperature was 36oC. He looked hypoactive and tachypnoe,
respiratory rate 72 breaths perminue, there were ches indrawing, grunting could be heard using
stetoscope, breathing sound was normal, he still looked cyanotic even after been giving nasal
oxygen. Sucking reflex was weak. Heart rate was 174 beats perminute. Abdominal was tender with
normal bowel sound. There were meconeum staning at umbilical cord and skin. Other
examination within normal.
a. Bagaimana interpretasi hasil pemeriksaan diatas? Rere vezi
b. Bagaimana mekanisme terjadinya abnormalitas dari hasil pemeriksaan diatas? Aul vezi
c. Bagaimana klasifikasi berat badan bayi pada kasus? Sisi ulfi
d. Bagaimana gambaran hasil pemeriksaan fisik diatas? (chest indrawing, cyanotic, meconeum
staning) rere aul
e. Apa kemungkinan penyebab meconeum staning? Dyah iqbal
f. Bagaimana mekanisme terjadinya meconeum staning pada kasus? Vezi clarisya
g. Apa makna klinis dari kalimat “Other examination within normal”? iqbal vezi

LEARNING ISSUE

1. BBLR (sisi, ulfi)

2. Asfiksia (apgar score) (dyah, clarisya, iqbal)
3. ARDS (Respiratory distress : bronkopneumonia dibahas secukupnya) (rere, aulia, vezi)
4. Infeksi neonatal khususnya dengan faktor risiko KPD (aspirasi meconeum) (miranti, jason,
nendy)

HIPOTESIS

Bayi laki-laki baru lahir diduga mengalami ARDS suspek et causa bronkopnemonia dengan riwayat
aspirasi meconeum.