Skenario E Blok 23 Tahun 2015

Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health centre
with chief complain of vaginal bleeding. Mrs. Tari also complains abdominal cramping. She
missed her period for about 8 weeks. She also feels nauseous, sometimes has vomit and
breast tenderness. Since 1 year ago she has been complaining about vaginal discharge with
smelly odor and sometimes accompanied by vulvar itchy. She already have 2 children before
and the youngest child is 6 years old. Her husband is a truck driver.
You act as the doctor in public health centre and be pleased to analyse this case.
In the examination findings:
Height: 155 cm, weight: 50 kg,
Blood pressure: 120/80 mmHg, pulse: 80 x/m, RR: 20 x/m.
Palpebral conjunctiva: normal
Breast: hyperpigmented
Abdomen: flat and souffl, symmetric, uterine fundus is not palpable, there are no mass, no
painful tenderness and no free fluid sign.
Internal examination:
Speculum examination: portio is livide, external os opens with blood come out from external
os, there are no cervical erotion, laceration or polyp.
Bimanual examination: cervix is soft, the external os opens, no cervical motion tenderness,
uterine size is about 8 weeks gestation, both adnexa and parametrium are within normal limit.
Hb 11 g/dL; WBC 12.000/mm3; ESR 15 mm/hour Peripheral Blood Image: WNL
Urine: pregnacy test (-HCG) positive

Klarifikasi Istilah

Vaginal Bleeding

: perdarahan pada vagina baik yang berasal dari vagina itu

sendiri atau daerah lain seperti serviks atau organ lainnya pada sistem reproduksi

wanita
Abdominal cramping : kontraksi muskular spasmodik yang nyeri pada abdomen
Nauseaous
: sensasi tidak menyenangkan yang samar pada epigastrium dan

abdomen dengan kecendrungan untuk muntah

Vomit
: pengeluaran isi lambung melalui mulut
Breast tenderness
: rasa tidak nyaman atau nyeri tekan pada payudara
Vaginal discharge
: sekresi dari serviks pada vagina, fisiologis bening/putih
Hyperpigmented
: pigmentasi yang meningkat abnormal
Portio Livide
: perubahan warna portio serviks menjadi kebiru-biruan akibat

pelebaran pembuluh darah sekitarnya

Laceration
: luka robek compang camping dan rusak
Parametrium
: perluasa selubung subserosa bagia supraservikal uterus ke

lateral diantara lapisan ligamentum latum uteri

Adnexa
: tambahan atau struktur ekstra suatu organ pada uteri termasuk

tuba fallopi dan ligamentum dan ovarium

-HCG
: hormon yang dihasilkan oleh sel-sel trofoblastik dimana sel-

sel tersebut hanya ada jika terjadi proses pembuahan

Cervical motion tenderness : nyeri hebat yang dirasakan ibu ketika portio digerakkan
atau digoyangkan. Sering ditemukan pada pasien pelvic inflamantory disease, khas
pada kehamilan ektopik.

Identifikasi Masalah

1. Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health
centre with chief complain of vaginal bleeding.
2. Mrs. Tari also complains abdominal cramping. She missed her period for about 8
weeks. She also feels nauseous, sometimes has vomit and breast tenderness.
3. Since 1 year ago she has been complaining about vaginal discharge with smelly odor
and sometimes accompanied by vulvar itchy. She already have 2 children before and
the youngest child is 6 years old. Her husband is a truck driver.
4. In the examination findings:
Height: 155 cm, weight: 50 kg,
Blood pressure: 120/80 mmHg, pulse: 80 x/m, RR: 20 x/m.
Palpebral conjunctiva: normal
Breast: hyperpigmented
Abdomen: flat and souffl, symmetric, uterine fundus is not palpable, there are no
mass, no painful tenderness and no free fluid sign.
5. Internal examination:
Speculum examination: portio is livide, external os opens with blood come out from
external os, there are no cervical erotion, laceration or polyp.
Bimanual examination: cervix is soft, the external os opens, no cervical motion
tenderness, uterine size is about 8 weeks gestation, both adnexa and parametrium are
within normal limit.
6. Hb 11 g/dL; WBC 12.000/mm3; ESR 15 mm/hour Peripheral Blood Image: WNL
Urine: pregnacy test (-HCG) positive

Analisis Masalah

1. Mrs. Tari, 37 years old, from middle income family, missed her period for about 8
weeks, comes to doctor at a public health centre with chief complain of vaginal
bleeding.
a. Bagaimana hubungan usia dan sosial ekonomi menengah dengan keluhan? syeba,
albert
b. Bagaimana etiologi vaginal bleeding? (secara umum) ashny , wahyu
c. Bagaimana mekanisme vaginal bleeding? (kasus) Faqih, Thifa
d. Apa dampak yang di timbulkan apabila terjadi vaginal bleeding pada trimester
pertama? neneng, ekki
e. Apa saja faktor risiko vaginal bleeding? Alvin, ali
f. Apa saja kemungkinan penyakit (DD) dari vaginal bleeding? vivi, icha
g. Bagaimana tatalaksana awal vaginal bleeding? lidya, dida

2. Mrs. Tari also complains abdominal cramping. She also feels nauseous, sometimes
has vomit and breast tenderness.
a. Bagaimana mekanisme keluhan? ali, lidya,
b. Adakah hubungan abdoinal cramping dengan vaginal bleeding? Faqih, ashny
c. Apa saja tanda-tanda kehamilan? (tanda pasti, mungkin, dugaan) wahyu, syeba
3. Since 1 year ago she has been complaining about vaginal discharge with smelly odor
and sometimes accompanied by vulvar itchy.
a. Bagaimana etiologi vaginal discharge dengan bau dan vulva yang gatal? Icha, ekki
b. Bagaimana mekanisme vaginal discharge dengan bau dan vulva yang gatal?
Neneng, vivi
c. Bagaimana komplikasi kehamilan pada smelly vaginal discharge? dida, alvin
d. Adakah hubungan vaginal bleeding dengan vaginal discharge? Thifa, albert

4. She already have 2 children before and the youngest child is 6 years old. Her husband
is a truck driver.
a. Bagaimana hubungan pekerjaan suami dengan keluhan adanya vaginal discharge?
ashny, albert
b. Bagaimana pengaruh jarak kehamilan yang jauh terhadap kehamilan sekarang?
Faqih, syeba
c. Mengapa jarak kehamilan cukup jauh? Thifa, wahyu
d. Berapa jarak kehamilan ideal? neneng, ekki
5. In the examination findings:
Height: 155 cm, weight: 50 kg,
Blood pressure: 120/80 mmHg, pulse: 80 x/m, RR: 20 x/m.

Palpebral conjunctiva: normal

Breast: hyperpigmented
Abdomen: flat and souffl, symmetric, uterine fundus is not palpable, there are no
mass, no painful tenderness and no free fluid sign.
a. Bagaimana interpretasi dan mekanisme abnormalitas pemeriksaan fisik?
(ali, lidya, dida, alvin)
6. Internal examination:
Speculum examination: portio is livide, external os opens with blood come out from
external os, there are no cervical erotion, laceration or polyp.
Bimanual examination: cervix is soft, the external os opens, no cervical motion
tenderness, uterine size is about 8 weeks gestation, both adnexa and parametrium are
within normal limit.
a. Bagaimana interpretasi dan mekanisme abnormalitas pemeriksaan dalam? Faqih,
Thifa, wahyu
b. Bagaimana cara mengukur usia kehamilan? ashny, syeba, albert
c. Bagaimana cara pemeriksaan dalam? (speculum dan bimanual) vivi, icha
d. Apa saja yang dapat menyebabkan pembukaan serviks pada kehamilan trimester
pertama? ali, lidya
e. Bagaimana dampak pembukaan serviks pada usia kehamilan trimester pertama
terhadap kehamilan? (sertakan gambar kalo bisa) dida, alvin
f. Bagaimana klasifikasi abortus? ( dan tipe kasus) neneng, ekki

7. Hb 11 g/dL; WBC 12.000/mm3; ESR 15 mm/hour Peripheral Blood Image: WNL

Urine: pregnacy test (-HCG) positive
a. Bagaimana interpretasi dan mekanisme abnormalitas pemeriksaan lab? Vivi ekki

b. Apa pemeriksaan penujang lain yang dapat dilakukan? icha,neneng

c. Bagaimana interpretasi -HCG positif (selain kehamilan)? vivi, icha,neneng, ekki

Hipotesis : Mrs. Tari, 37 tahun, P2A1 mengalami abortus insipien et causa infeksi dan
kehamilan usia tua ( Faqih, Thifa, ashny , wahyu, syeba, albert)
a.
b.
c.
d.
e.
f.
g.

DD
WD dan penegakan diagnosis
Definisi
Epidemiologi
Etiologi
Faktor risiko
Patofisiologi

h.
i.
j.
k.
l.
m.

Manifestasi klinis
Tatalaksana ( medis dan non-medis) dan pencegahan
Pemeriksaan penunjang
Komplikasi
Prognosis
SKDI

Learning Issues
1. Anatomi dan fisiologi kehamilan trimester pertama (ali, lidya, dida, alvin)
2. Abortus ( Faqih, Thifa, ashny , wahyu, syeba, albert)
3. Tatalaksana kasus (vivi, neneng, ekki, icha)

Maaf kalo pembagian nya ada yg ngerasa ga adil atau

ga sesuai sama LI yaa,, biar semua belajar juga
Seperti biasa TNR 12, Justify, spasi 1,5 yaaa

DAFTAR PUSTAKA

TOLOOOONG BANGET

YAAA.....!!
yang kutipan-kutipan.... Inget, tutor kita siapa, kita
mau kumpulin laporan sementara juga,, jadi saling
bantu yaa teman
Kumpul paling lambat besok,

Selasa 17 Februari 2015, jam 8 malam.