Skenario C Blok 23 Tahun 2014

A female baby was born at Moh. Hosin Hospital from a 19 years old woman. Her mother, Mrs. Solehah was hospitalized at Moh. Hoesin Hospital due to contraction. It was her first pregnancy. She forgot when her first day of last period, but she tought that her pregnancy was about 8 months. She said that she never had hypertension or other illness during her pregnancy. Six hours after admitted, she delivered her baby spontaneously. The labor process was 30 minutes, and rupture of membrane happened one hour before delivery. The baby didnt cry spontaneously after birth, and resuscitation was done. APGAR score at 1 minute was 1, at 5 minute was 3, and at 10 minutes was 7. One hour later the baby still had grunting and cyanosis.

On physical examination: Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm. The muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo over the body and plantar creased at 1/3 anterior. At 10 minutes of age, she still had grunting and cyanosis on the whole body. The respiratory rate was 70x/min, heart rate was 150 bpm, the temperature was 36oC. There was chest indrawing. Other physical examinations were within normal limit.

As general practitioner please analyze the problem and the management.

A. Klarifikasi Istilah 1. Contraction : Mendekatkan; pemendekkan atau penyusutan 2. Hypertension : Peningkatan tekanan darah di atas normal 3. Resuscitation : Memulihkan kembali kerja jantung dan paru setelah henti jantung atau kematian mendadak nyata yang disebabkan oleh syok listrik, tenggelam, gagal pernafasan atau penyebab lain 4. APGAR : Angka yang menunjukkan kondisi bayi, biasanya ditentukkan 60 detik setelah lahir berdasarkan frekuensi denyut jantung, upaya bernafas, tonus, otot, irritabilitas reflex, dan warna kulit 5. Cyanosis : Kulit dan membrane mukosa yang berwarna kebiruan atau pucat

6. Lanugo : Rambut halus dan tipis yang muncul pada kulit janin dan menghilang dalam beberapa waktu setelah lahir.

B. Identifikasi Masalah 1. A female baby was born at Moh. Hosin Hospital from a 19 years old woman. Her mother, Mrs. Solehah was hospitalized at Moh. Hoesin Hospital due to contraction. It was her first pregnancy. She forgot when her first day of last period, but she tought that her pregnancy was about 8 months. 2. She said that she never had hypertension or other illness during her pregnancy. 3. Six hours after admitted, she delivered her baby spontaneously. The labor process was 30 minutes, and rupture of membrane happened one hour before delivery. 4. The baby didnt cry spontaneously after birth, and resuscitation was done. APGAR score at 1 minute was 1, at 5 minute was 3, and at 10 minutes was 7. One hour later the baby still had grunting and cyanosis. 5. On physical examination: Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm. The muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo over the body and plantar creased at 1/3 anterior. At 10 minutes of age, she still had grunting and cyanosis on the whole body. The respiratory rate was 70x/min, heart rate was 150 bpm, the temperature was 36oC. There was chest indrawing. Other physical examinations were within normal limit.

C. Analisis Masalah 1. A female baby was born at Moh. Hosin Hospital from a 19 years old woman. Her mother, Mrs. Solehah was hospitalized at Moh. Hoesin Hospital due to contraction. It was her first pregnancy. She forgot when her first day of last period, but she tought that her pregnancy was about 8 months. a. Apa hubungan umur dengan riwayat kehamilan? b. Bagaimana cara menentukkan usia kehamilan berdasarkan HPHT? 2. She said that she never had hypertension or other illness during her pregnancy.

a. Apa makna klinis tidak mempunyai hipertensi atau penyakit lain selama kehamilan? 3. Six hours after admitted, she delivered her baby spontaneously. The labor process was 30 minutes, and rupture of membrane happened one hour before delivery. a. Apa hubungan proses persalinan spontan dengan rupture membrane (pecah ketuban)? b. Apa dampak rupture membrane pada ibu dan janin? c. Apa etiologi dan mekanisme rupture membrane? 4. The baby didnt cry spontaneously after birth, and resuscitation was done. APGAR score at 1 minute was 1, at 5 minute was 3, and at 10 minutes was 7. One hour later the baby still had grunting and cyanosis. a. Apa interpretasi APGAR score di atas? b. Apa etiologi tidak menangis spontan? c. Apa etiologi dan mekanisme grunting? d. Apa etiologi dan mekanisme cyanosis? 5. On physical examination: Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm. The muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo over the body and plantar creased at 1/3 anterior. At 10 minutes of age, she still had grunting and cyanosis on the whole body. The respiratory rate was 70x/min, heart rate was 150 bpm, the temperature was 36oC. There was chest indrawing. Other physical examinations were within normal limit. a. Apa interpretasi dan mekanisme abnormal dari pemeriksaan fisik : Body weight was 1400 gr, body length was 40 cm, and head circumference was 30 cm. The muscle tone decreased, she poorly flexed at the limbs, she had thin skin, more lanugo over the body and plantar creased at 1/3 anterior? b. Apa interpretasi dan mekanisme abnormal dari pemeriksaan fisik : At 10 minutes of age, she still had grunting and cyanosis on the whole body. The respiratory rate was 70x/min, heart rate was 150 bpm, the temperature was 36oC. There was chest indrawing? c. Apa dampak dari BBLR?

6. DD 7. HTD (pemeriksaan tambahan) 8. WD 9. Epidemiologi 10. Etiologi dan Faktor Resiko 11. Patogenesis 12. Penatalaksanaan 13. Komplikasi 14. Pencegahan 15. Prognosis 16. SKDI

D. Hipotesis Seorang bayi perempuan lahir pre-term, SGA, BBLSR lahir spontan dengan asfiksia dan sindrom distress pernafasan

E. Learning Issue 1. APGAR 2. BBLR 3. Neonatal Asfiksia