SKENARIO

A newborn baby was delivered at private clinic, assisted by midwife. He was delivered from a 28
years old woman, primigravida. Mrs. Siti, the babys mother had premature rupture of membrane
4 days ago. The liquor was thick, smelly and greenish. She also had fever since one day before
delivery. The pregnancy was full term. The baby was not cried spontaneously after birth. The
midwife cleared the babys airway using manual suction and stimulate the baby by patting his
feet, and then he started to cry. The midwife said Apgar score for 1st minute and 9 for 5th
minutes. After 2 hours the baby began to breath uneasily and had grunting. The baby was refered
to Moh Hoesin Hospital.

Physical examination revealed body weight was 3000 grams. Body length 50 cms, head
circumference 34 cms. He looked hypoactive and tachypnoe, respiratory rate 82 breaths
perminute, there were chest indrawing, grunting could be heard using stethoscope. Heart rate was
164 beats per minute. Abdomen was tender with normal bowel sound. There were meconium
staining at umbilical cord and skin.

Instruction :

As GP, what will you do to treat the baby?

I. KLARIFIKASI ISTILAH

No Istilah Makna
1 Primigravida Baru hamil untuk pertama kalinya
2 Dirujuk
3 Ketuban pecah dini Pecahnya selaput ketuban sebelum terjadinya proses persalinan yang
dapat terjadi pada usia kehamilan cukup waktu atau kurang waktu
4 Manual suction Alat yang digunakan dengan menggunakan tangan untuk membuang
cairan agar bayi dapat bernafas
5 Sucking reflex Reflex yang ditemukan pada bayi usia kehamilan diatas 32 minggu
berupa gerakan menghisap yang terjadi saat langit-langit mulut
disentuh oleh benda apapun
6 Grunting Suara serak rendah saat ekspirasi karena menutupnya glottis yang
menghalangi aliran udara, biasanya pada bayi yang menderita
pneumonia , pulmonary edema, ataupun distress napas
7 Apgar score Suatu metode yang digunakan untuk menilai kesehatan bayi baru
lahir secara cepat
8 Meconium staining Endapan mekonium (feses pertama yang dihasilkan bayi cukup
bulan dan terdiri dari sel epitel usus, lanugo, mucus, cairan ketuban,
empedu, dan air) berwarna hijau tua pada kulit plasenta, mukosa,
dan permukaan fetus lainnya yang mengindikasikan fetal distress

II. IDENTIFIKASI MASALAH

1. A newborn baby was delivered at private clinic, assisted by midwife. He was delivered
from a 28 years old woman, primigravida.
2. Mrs. Siti, the babys mother had premature rupture of membrane 4 days ago. The liquor
was thick, smelly and greenish. She also had fever since one day before delivery. The
pregnancy was full term.
3. The baby was not cried spontaneously after birth. The midwife cleared the babys airway
using manual suction and stimulate the baby by patting his feet, and then he started to cry.
The midwife said Apgar score 5 for 1 st minute and 9 for 5th minutes. After 2 hours the
baby began to breath uneasily and had grunting. The baby was refered to Moh Hoesin
Hospital.
4. Physical examination revealed body weight was 3000 grams. Body length 50 cms, head
circumference 34 cms. He looked hypoactive and tachypnoe, respiratory rate 82 breaths
perminute, there were chest indrawing, grunting could be heard using stethoscope. Heart
rate was 164 beats per minute. Abdomen was tender with normal bowel sound. There
were meconium staining at umbilical cord and skin.

III. ANALISIS MASALAH

1. A newborn baby was delivered at private clinic, assisted by midwife. He was delivered
from a 28 years old woman, primigravida.
a. Apa hubungan usia dan jenis kelamin bayi dengan kasus? 1 2 3
b. Apa hubungan riwayat obstetric dengan kasus? 4 5 6

2. Mrs. Siti, the babys mother had premature rupture of membrane 4 days ago. The liquor
was thick, smelly and greenish. She also had fever since one day before delivery. The
pregnancy was full term.
a. Apa hubungan riwayat gestasional dengan ketuban pecah dini? 7 8 9
 b. Apa makna klinis The liquor was thick, smelly and greenish? 10 1 2
c. Apa dampak ketuban pecah dini selama 4 hari pada kasus? 3 4 5
d. Apa hubungan demam dengan kasus? 6 7 8
e. Apa saja penyebab ketuban pecah dini? 9 10 1

3. The baby was not cried spontaneously after birth. The midwife cleared the babys airway
using manual suction and stimulate the baby by patting his feet, and then he started to cry.
The midwife said Apgar score 5 for 1 st minute and 9 for 5th minutes. After 2 hours the
baby began to breath uneasily and had grunting. The baby was refered to Moh Hoesin
Hospital.
a. Apa makna klinis dan mekanisme terjadinya gejala bayi pada kasus? 2 3 4 5
b. Apa hubungan meconium staining dengan ketuban pecah dini? 6 7 8
c. Bagaimana tatalaksana awal terkait kondisi bayi pada kasus? 9 10 1
d. Apa hubungan fetal distress dengan ketuban pecah dini? 2 3 4
e. Apa makna klinis skor Apgar pada kasus ? 5 6 7

4. Physical examination revealed body weight was 3000 grams. Body length 50 cms, head
circumference 34 cms. He looked hypoactive and tachypnoe, respiratory rate 82 breaths
perminute, there were chest indrawing, grunting could be heard using stethoscope. Heart
rate was 164 beats per minute. Abdomen was tender with normal bowel sound. There
were meconium staining at umbilical cord and skin.
a. Bagaimana interpretasi dan mekanisme abnormal hasil pemeriksaan fisik? 8 9 10
1
b. Apa pemeriksaan tambahan yang diperlukan pada kasus? 2 3 4

5. Aspek klinis
a. Diagnosis banding 5 6 7
b. Penegakan diagnosis 8 9 10
c. Diagnosis kerja 1 2 3
d. Epidemiologi 4 5 6
e. Etiologi 7 8 9
f. Faktor resiko 10 1 2
g. Pathogenesis 3 4 5
h. Patofisiologi 6 7 8 10
i. Manifestasi klinis 9 10 1
j. Pemeriksaan penunjang 2 3 4
k. Tatalaksana dan follow up 5 6 7
l. Edukasi dan pencegahan 8 9 10
m. Komplikasi 1 2 3
n. Prognosis 4 5 6
o. SKDI 7 8 9
IV. LEARNING ISSUE

1. Meconium Aspiration Syndrome 1 2 3

2. Ketuban pecah dini 4 5 6
3. Sepsis neonatorum 7 8 9 10

V. HIPOTESIS

Bayi Ibu Siti, cukup bulan, SMK, lahir spontan mengalami distress nafas et causa Meconium
Aspiration Syndrome

1pit, 2din, 3ch, 4than, 5ki, 6dyk, 7stel, 8celin, 9arm, 10ben