SKENARIO D BLOK 24

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 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 for 1st minute and 2 for 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 2300 gram. Body length 48 cm, head
circumference 34 cm. His temperature was 36oC. He looked hypoactive and tachypnoe, RR 73
breath perminute, there was chest indrawing, grunting could be heard using stethoscope,
breathing sound was normal, he still looked cyanotic even after been giving nasal oxyen.
Sucking reflex was weak. HR 174 beats per minute. Abdomen was tender with normal bowel
sound. There were meconeunum staining at umbilical cord and skin. Other examination within
normal.

I. Klarifikasi istilah

No. Isitilah Klarifikasi

1. Primigravida Kehamilan pertama kali
2. Premature of membrane Ketuban Pecah Dini. Pecahnya ketuban sebelum tanda-tanda
ruptured inpartu
3. Hypertension during Peningkatan tekanan darah >140/90 mmHg yang terjadi saat
pregnancy usia kehamilan lebih dari 20 minggu.
4. Apgar score Metode yang digunakan untuk menilai kondisi kesehatan bayi
pada usia 1 menit dan 5 menit setelah kelahiranya berupa
penilaian:
A: Appearance/warna kulit
P: Pulse/Denyut Jantung
G: Grimace/ Reflek gerakan
A: Activity/ aktivitas otot
R: Respiration/Pernapasan
5. Hypoactive Penurunan abnormal aktivitas motorik dan kognitif ditandai
dengan melambatnya pemikiran, pembicaraan, dan
pergerakan.
6. Tachypnoe Frekuensi pernapasan yang lebih dari 60x/menit (pada
neonates)
7. Chest indrawing Tarikan dinding dada bagian bawah ke dalam (retraksi dada)
ketika bayi bernapas dan merupakan tanda dari respiratory
distress
8. Grunting Bunyi pernapasan abnormal saat ekspirasi yang menunjukkan
bahwa glottis telah menutup aliran udara dari paru terdengar
seperti merintih.
9 Cyanotic Perubahan warna kulit dan membrane mukosa menjadi
kebiruan akibat konsentrasi hemoglobin tereduksi yang
berlebihan dalam darah
10. Meconeum Bahan berlendir yang berwarna hijau tua di dalam usus bayi
cukup bulan
11. Umbilical cord Struktur yang menghubungkan janin dan plasenta, dan berisi
pembuluh darah yang mengalirkan darah janin ke plasenta dan
sebaliknya.

II. 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 since one day before delivery. She also 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.
3. The midwife cleared the baby’s airway using manual suction and stimulate the baby by
patting his feet. The midwife said Apgar score 1 for 1st minute and 2 for 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.
4. Physical examination revealed body weight was 2300 gram. Body length 48 cm, head
circumference 34 cm. His temperature was 36oC, RR 72 breath perminute, HR 174 beats
per minute
5. He looked hypoactive and tachypnoe, there was chest indrawing, grunting could be heard
using stethoscope, breathing sound was normal, he still looked cyanotic even after been
giving nasal oxyen. Sucking reflex was weak. Abdomen was tender with normal bowel
sound. There were meconeum staining at umbilical cord and skin. Other examination
within normal.

II. 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 makna klinis dari kalimat di atas? KAK ENOT, DIBYO
b. Apa hubungan usia ibu dan primigravida dengan keluhan pada kasus? ZIANA,
RIZKA
c. Apa kemungkinan penyebab ketuban pecah dini pada kasus? RIZKA, JURGEN
 d. Apa kemungkinan penyebab cairan amnion kental, berbau, dan berwarna kehijauan?
AYU JURGEN
e. Bagaimana mekanisme Ketuban Pecah Dini? ULLY, DESTI
f. Bagaimana mekanisme cairan amnion kental, berbau, dan berwarna kehijauan? AYU,
JURGEN
g. Apa dampak KPD dan cairan amnion kental, berbau, dan berwarna kehijauan
terhadap ibu dan bayi? MEL, DESTI
h. Bagaimana tatalaksana awal ketuban pecah dini pada kasus?ZIANA ULLY

2. She had fever since one day before delivery. She also 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.
a. Apa makna klinis dari kalimat di atas? DESI, DESTI
b. Apa kemungkinan penyebab bayi tidak menangis secara spontan setelah dilahirkan?
ZIANA, RIZKA
c. Apa hubungan hipertensi dengan keluhan pada kasus? RIZKA, AYU
d. Bagaimana karakteristik bayi lahir normal dan sehat? MEL DESI
e. Bagaimana mekanisme bayi tidak menangis spontan saat dilahirkan pada kasus?
KAK ENOT, DIBYO
f. Apa dampak bayi tidak menangis spontan saat dilahirkan? DIBYO DESI

3. The midwife cleared the baby’s airway using manual suction and stimulate the baby by
patting his feet. The midwife said Apgar score 1 for 1st minute and 2 for 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.
a. Apa makna klinis dari kalimat di atas? MEL ULLY
b. Apa indikasi dan kontraindikasi dilakukannya manual suction and patting baby’s
feet? DESTI ULLY
c. Bagaimana cara melakukan manual suction and patting baby’s feet? KAK ENOT,
DIBYO
d. Apa saja kriteria Apgar score, nilai normalnya, dan bagaimana cara menghitungnya?
DESI, AYU
e. Kapan dilakukannya penilaian Apgar score? MEL DESTI
f. Bagaimana mekanisme kesulitan bernapas dan grunting pada kasus? ZIANA, RIZKA
g. Bagaimana tatalaksana awal untuk bayi pada kasus oleh dokter umum? RESUSITASI
NEONATUS ULLY, MEL

4. Physical examination revealed body weight was 2300 gram. Body length 48 cm, head
circumference 34 cm. His temperature was 36oC, RR 72 breath per minute, HR 174 beats
per minute
 a. Bagaimana interpretasi dari hasil pemeriksaan fisik umum di atas? DESI, AYU
b. Bagaimana mekanisme abnormal dari hasil pemeriksaan fisik umum di atas? MEL
DIBYO
c. Bagaimana klasifikasi berat bayi terhadap usia kehamilan? DESTI

5. He looked hypoactive and tachypnoe, there was 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. Abdomen was tender with normal bowel
sound. There were meconeum staining at umbilical cord and skin. Other examination
within normal.
a. Bagaimana interpretasi dari hasil pemeriksaan fisik spesifik di atas? ULLY DESI
b. Bagaimana mekanisme abnormal dari hasil pemeriksaan fisik spesifik di atas? KAK
ENOT, RIZKA
c. Apa makna ditemukan meconeum pada kasus? AYU, KAK MEL
d. Apa dampak ditemukan meconeum pada bayi? DIBYO, JURGEN

III. Hipotesis

Bayi laki-laki baru lahir diduga mengalami Respiratory Distress Syndrome et causa
Bronchopneumonia.

DD: aspirasi meconeum

Pem. Penunjang: rontgen, CBC, IT ratio, bilirubin, CRP, LED, Pro-calcitonin, Kimia darah: Gula
darah, analisis gas darah (gangguan asam basa?), Lumbal pungsi, Mikroblogi: kultur bakteri dari
darah bayi

Tatalaksana:

 Diinkubator (rentan hipotensi)

 Vitamin K
 Oksigen
 Harus puasa  infuse (tidak boleh menyusui)
 Antibiotik empiris (cari kemungkinan bakteri penyebab sesak)

Komplikasi:

Prognosis: imunitas rendah!!!!

SKDI: 3B

Learning Issue:
1. Anatomi dan Fisiologi Sistem respirasi pada neonates DESI, RIZKA, MEL

2. Respiratory Distress Syndrome ATAU ASFIKSIA PERINATAL (CARILAH SESUAI

KASUS) KARENO DAK YAKIN!!!!

a. Pemeriksaan Penunjang DESI, AYU, DIBYO, DESTI

b. Diagnosis Banding
c. Algoritma Penegakan Diagnosis
d. Diagnosis kerja
e. Definisi
f. Epidemiologi
g. Etiologi ZIANA, RIZKA, JURGEN
h. Faktor Risiko
i. Patogenesis
j. Patofisiologi
k. Klasifikasi
l. Manifestasi klinis KAK ENOT, ULLY, KAK MEL
m. Tatalaksana
n. Komplikasi
o. Prognosis
p. Edukasi dan Pencegahan
q. SKDI

3. Ketuban Pecah Dini ZIANA, ULLY, DESTI

4. BBLR KAK ENOT, DIBYO

5. Infeksi pada Neonatus AYU, JURGEN

a.