I.

Skenario D blok 22

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 aso had history of hypertension during the
last trimester of pregnancy. The pregnancy 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 feet. The midwife said Apgar score 1 of 1 st
minute and 2 of 5th minutes and 5 at 10th 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 2.300 grams. Body length 48 cms, head
circumference 34 cms. His temperature was 360C. He looked hypoactive and tachypnoe,
respiratory rate 72 breaths perminute, there were chest indrawing, grunting could be heard
using stethoscope, breathing sound was normal, he still looked cyanotic even after been
giving nasal oxygen. Sucking reflex was weak. Heart rate was 174 beats per minute.
Abdomen was tender with normal bowel sound. There were meconenum staining at
umbilical cord and skin. Other examination within normal.

II. Klarifikasi istilah

1. Apgar score : Test yang dilakukan pada bayi baru lahir menit
pertama dan menit kelima untuk menentukan
kondisi bayi. Normal >7. ( medline )

2. Chest indrawing : Pergerakan masuk dari dinding dada bagian

bawah ketika anak menarik napas dan merupakan
tanda dari respiratory distress. (ncbi.nlm.nih.gov )

3. Manual suction : Digunakan untuk membersihkan endapan atau

sekresi berlebihan pada saluran respirasi bawah
pada pasien yang tidak bisa secara efektif
melakukan dengan sendiri. ( www.gosh.nhs.uk)
4. Meconenum : Deposisi dari meconium pada kulit, plasenta,
staining permukaan bayi yang lain yang disebabkan oleh
fetal distress. ( medical dictionary )

5. Grunting : Suara abnormal pendek, dalam, hoarse pada

ekshalasi yang sering disertai dengan nyeri dada
yang berat ( mosby medical dictionary )

III. Identifikasi Masalah

NO Topik Kesesuaian Konsen
1 He was delivered from a 36 years old Tidak Sesuai **
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 aso had history of
hypertension during the last trimester of
pregnancy. The pregnancy was full term, 39
weeks.
2. The baby was not cried spontaneously after Tidak Sesuai ***
birth. The midwife cleared the baby’s airway
using manual suction and stimulate the baby
by patting his feet. The midwife said Apgar
score 1 of 1st minute and 2 of 5th minutes and
5 at 10th minute. The baby had difficulty
while breathing, and had grunting.
3. Physical examination revealed body weight Tidak sesuai *
was 2.300 grams. Body length 48 cms, head
circumference 34 cms. His temperature was
360C. He looked hypoactive and tachypnoe,
respiratory rate 72 breaths perminute, there
were chest indrawing, grunting could be
heard using stethoscope, breathing sound

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 was normal, he still looked cyanotic even
after been giving nasal oxygen. Sucking
reflex was weak. Heart rate was 174 beats
per minute. Abdomen was tender with
normal bowel sound. There were
meconenum staining at umbilical cord and
skin. Other examination within normal.

IV. Analisis Masalah

1. 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 feet. The midwife
said Apgar score 1 of 1st minute and 2 of 5th minutes and 5 at 10th minute. The baby
had difficulty while breathing, and had grunting.

a. Apa makna klinis dari bayi tidak menangis spontan, kesulitan bernafas, dan
grunting saat lahir ? ., nada

Makna klinis bayi tidak menangis spontan adalah adanya kegagalan nafas
secara spontan dan teratur. Kesulitan bernafas dan merintih saat lahir
menunjukkan bahwa bayi mengalami respiratory distress.

b. bagaimana cara penilaian APGAR score ? anggun, ress

c. Apa interpretasi dari APGAR score pada kasus ? anggun, ress
d. Apa dampak dari bayi yang lahir tidak menangis spontan ? ., nada
e. Apa saja tanda bayi lahir sehat ? aap, .
f. Apa saja pemeriksaan yang harus dilakukan pada bayi baru lahir ? aap, nada
g. Apa tindakan yang harus dilakukan apabila bayi tidak menangis spontan
setelah lahir ? ., nada
h. Bagaimana mekanisme penggunaan manual suction ? oca, sartika
i. Apa indikasi dan tujuan dilakukannya patting pada kaki bayi ? oca, sartika
j. Apa tatalaksana bayi pada kasus ? anggun, ress, ., nada

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2. 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 aso had history
of hypertension during the last trimester of pregnancy. The pregnancy was full term,
39 weeks.
a. Bagaimana hubungan primigravida 36 tahun pada kasus ? oey, tasya
b. Apa makna klinis dari cairan ketuban kental, berbau, dan kehijauan ? ginting,
oey
c. Bagaimana tanda cairan ketuban normal ?sartika, ginting
d. Apa dampak dari pecah ketuban dini dari 4 hari yang lalu terhadap ibu dan
janin ? tasya, ginting
e. Bagaimana mekanisme demam pada kasus dan hubungannya terhadap KPD 4
hari yang lalu ? tasya, leo
f. Bagaimana mekanisme hipertensi ibu pada trimester terakhir pada kasus ? leo,
ginting
g. Apa klasifikasi hipertensi pada ibu pada kasus ? leo, oey
h. Apa hubungan hipertensi pada trimester terakhir terhadap pecah ketuban dini ?
leo, oey
i. Apa saja faktor risiko dari KPD ? sartika
j. Apa etiologi dari KPD ? tasya
k. Apa tatalaksana awal dari KPD ? oey, ginting
l. Apa saja tanda - tanda dari KPD ? tasya

3. Physical examination revealed body weight was 2.300 grams. Body length 48 cms,
head circumference 34 cms. His temperature was 360C. He looked hypoactive and
tachypnoe, respiratory rate 72 breaths perminute, there were chest indrawing, grunting
could be heard using stethoscope, breathing sound was normal, he still looked
cyanotic even after been giving nasal oxygen. Sucking reflex was weak. Heart rate
was 174 beats per minute. Abdomen was tender with normal bowel sound. There
were meconenum staining at umbilical cord and skin. Other examination within
normal.
a. Apa interpretasi dari pemeriksaan fisik pada kasus ? oca, sartika, leo, citra
b. Apa mekanisme abnormalitas dari pemeriksaan fisik pada kasus ? oca, sartika,
leo, citra

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 c. Apa saja pemeriksan penunjang yang diperlukan pada kasus ? oca, sartika, leo,
citra
d. Apa dampak dari meconinum staining pada bayi baru lahir ?aap, ress
e. Apa saja etiologi dari meconinum staining ?aap, anggun

V. Hipotesis

Bayi baru lahir dengan BBLR dan SGA mengalami RDS dan MAS e.c hipertensi dan
KPD

Learning Issues

1. Berat bayi lahir rendah ( template ) 1,10,11,12

2. Small gestational age ( template ) 2,4,7,9
3. Meconinum aspiration syndrome ( template ) 3,6,8,11
4. Ketuban pecah dini ( template ) 4,5,7,9
5. Respiratory Distress Syndrome ( template )1,2,10,12
6. Pemeriksaan fisik dan penunjang 3,5,6,8