STATION 1.

ANAMNESIS: GESTATIONAL AGE & ESTIMATED DELIVERY DATE

Objectives:
1. To evaluate students ability in determining the appropriate gestational age and estimated
delivery date
2. To evaluate student communication skills in obstetrics interviewing
Instruction:
A 24 years lady, house-wife, arrives to your clinic for medical interview due to a positive urinary
pregnancy test which was performed yesterday morning
Please perform a medical interview in determining :
1. the gestational age of her pregnancy
2. the estimated date of delivery (EDD)

You have 5 minutes

Student No:

Student Name:

Check list for Station 1:

Anamnesis: Gestational Age & Estimated Date of Delivery
No

Gestational Age & Estimated Date of Delivery

1 Started with introducing her or himself to the patient

2 Asked on the last menstrual period (LMP)
- Asked the first date of the last menstrual period
- Asked the regularity of the patient menstrual cycle
3 Explored specifically on the pattern of LMP and comparing to the
previous menstrual pattern
- Total days the bleeding occurred on the mentioned LMP
- The amount of the bleeding (blood loss) on the mentioned LMP
or how many pads did the patient use during the mentioned
LMP
- Compared to the previous cycles (length and quantity)
- Confirming the actual the first date of LMP
4 Mentioning the gestational age of the conceiving patient
- On the 19th of December 2005, the gestational age is 10 weeks
5 Mentioning the estimated date of delivery
- The EDD will be on the 17th of July 2006
6 Given information to the patient for the gestational age and the
estimated date of delivery
Total Score

Max
Score
1
2
2

2
2
1
10
PASSING GRADE 7

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

FINAL MARK
Examiner:
.

Global ratings (please tick)

Failed

Pass

Comments :
.
.

SCENARIO for Station 1:

ANAMNESIS : Gestational Age & Estimated Date of Delivery
No
Question
1 Asked on the last menstrual period (LMP)
- When did the first date of the last
menstrual period
- What is regularity of the patient menstrual
cycle

Answer
The first date of the LMP was on the
9 November 2005
The type and patterns of the patient
menstrual period were regular cycle of
28-30 days, length of bleeding 5-7 days,
using 3-5 pads during the first three days
of the cycles, no pain, no blood cloths
On the 9th of November 2005 there was
only a spotting menstrual blood flow, for
three days, and only less than half-full of
blood on the sanitarian pads
On the 10th of October 2005, the pattern
of menstrual cycle was normal as the
previous experienced cycles, 7 days
bleed length in a normal amount of blood
loss by using 3-5 pads during the first 4
days
Confirmed the first date of the last
menstrual period was on the 10th of
October 2005

2 Explored specifically on the pattern of LMP

and comparing to the previous menstrual
pattern
- How many days the bleeding occurred on
the mentioned LMP
- How much the amount of the bleeding
(blood loss) on the mentioned LMP or
how many pads did the patient use during
the mentioned LMP
- Compared to the previous cycles
- If the length of the mentioned LMP similar to the normally experienced by the patient
- If the quantity of the blood loss similar to
the normally experienced by the patient
- Confirming the actual the first date of
LMP
3 Calculated the gestational age of the
On the 19th of December 2005, the
conceiving patient
gestational age is 10 weeks
4 Calculated the estimated date of delivery
The EDD will be on the 17th of July 2006
using the formula of Naegele (D+7, M-3 and
Y+1)

STATION 2: ABDOMINAL PALPATION OF PREGNANT WOMEN

Objectives:
1. to evaluate students ability to conduct abdominal examination (palpation and auscultation)
of pregnant women and interpret the result
Instruction:
A 29-year-old woman, G1 comes to your clinic to have an antenatal care.
Please perform abdominal palpation to this patient and report the examination result (fetal
lie and fetal position).
You have 5 minutes

Student No:

Student Name: ..

Checklist for Station 2: ABDOMINAL PALPATION OF PREGNANT WOMAN

NO
1
2
3
4
5
6
7
8
9
10

ABDOMINAL PALPATION OF PREGNANT

WOMAN
Greet the patient and ask the patient to lie down
Wash hands with warm water and dry with towel
Take a position on the right of the patient facing right
laterally
Advise the patient that the examination will be started
Perform Leopold 1 properly
Perform Leopold 2 properly
Perform Leopold 3 properly
Perform Leopold 4 properly
Advise the patient that the procedure has been done,
remove the drape and help the patient tidy up her
clothes
Report the result (fetal lie and fetal position)
Total score

MAX
SCORE
1
1
1
1
2
2
2
2
1
2
15

PASSING GRADE 11

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

FINAL MARK

Examiner:
.
Global ratings (please tick):
Failed

Pass

Comments:
.
.

STATION 3: GYNAECOLOGICAL EXAMINATION: Bimanual Palpation

Objectives
- to evaluate students competency in performing gynecological procedure and reporting the
result
Instruction
Mrs. A, 27 years old has complained of vaginal discharge since 2 months ago. She needs to be
undergone gynecological examination. After having the patients informed consent to carry out the
examination, you ask the patient to empty the bladder and help the patient to lie on the
gynecological bed. You have already washed your hands.
Please perform bimanual palpation to this patient and report the result.
You have 5 minutes.

Student No: .

Student Name:

Checklist for Station 3: GYNAECOLOGICAL EXAMINATION

NO
1
2
3
4
5
6
7
8
9

GYNAECOLOGICAL EXAMINATION: Bimanual

palpation
Wear the hand gloves properly
Moist the antiseptic cotton and wipe the area of vulva
and perineum
Stand up position
Do the vaginal touch properly
Put the left fingertips on the suprasymphysis, and
determine and report the height of fundus uteri
With the inside hand, determine and report the size of
the uterus, its consistency and direction.
Determine and report the consistency of cervix and
condition of parametrium
Hold back the uterus at suprasymphisis region with
the left hand, and withdraw the right thumb and index
finger
Wipe at the secretion/fluids on the abdominal wall and
around the vulva/perineum
Total score

MAX
SCORE
1
1
1
2
2
2
2
1
1
13

PASSING GRADE 9

FINAL MARK
0 = inadequately or not performed
1 = some points covered
2 = satisfactory coverage of all points

Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:
.
.

STATION 4: MANAGING 2nd STAGE OF LABOUR

Objectives
- to evaluate students competency in performing assistance in second stage physiologic
delivery
Instruction
You have Mrs. B, 27 years old, G2P1, with 39 weeks gestational age, singleton baby. The mothers
and babys condition are within normal limit. Vaginal examination reveals complete cervical dilation
and the babys head is crowning. The amniotic membrane has already ruptured with clear amniotic
fluid. The mother urges to push. You have already introduced yourself, worn the apron and washed
your both hands, the patient has already been given the procedures information.
Please perform second stage delivery assistance to deliver the baby.
You have 5 minutes.

Student No: ..

Student Name: ..

Checklist for Station 4: MANAGING STAGE 2 OF LABOUR

NO
1
2
3
4
5
6
7

MANAGING STAGE 2 OF LABOUR

Put on the sterile gloves

Put on buttock sheet, leg sheet and drape for lower
abdomen
Ask the mother to take a deep breath, close the
mouth tightly, and strain the abdominal muscles to the
full power.
Deliver infants head properly
Let the infants head perform outward rotation, and if
necessary assist that rotation
Deliver infants shoulder properly
Deliver infants body properly

MAX
SCORE
1
1
1
2
1
2
2

Total score

10
PASSING GRADE 7

0 = inadequately or not performed

1 = some points covered
2 = satisfactory coverage of all points

FINAL MARK
Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:
.
.

STATION 5 : ACTIVE MANAGEMENT OF THE 3RD STAGE OF LABOUR

Objectives
- to evaluate students competency in performing active management of the third stage of
labour
Instruction
You have Mrs. B, 27-year-old, P2A0 who has delivered a baby boy of 3000 grams. The umbilical
cord has already been cut and clipped. Youve already worn the gloves and apron.
Please perform active third stage delivery assistance to deliver the placenta.
You have 5 minutes.

10

Student No.:

Student Name: ..

Checklist for Station 5:

ACTIVE MANAGEMENT OF THE 3RD STAGE OF LABOUR
NO
1

2
3
4
5

6
7

MANAGING THE 3RD STAGE OF LABOUR

Administer oxytocin 10 units intramuscularly (report

to the examiner, which drug that the examinee choose
and how it will be administered)
Controlled cord traction
Clamp the cord close to the perineum using sponge
forceps. Hold the clamped cord and the end of the
forceps with one hand.
Place the other hand just above the womans pubic
bone and stabilize the uterus by applying counter
traction during controlled cord traction.
Keep slight tension on the cord and await a strong
uterine contraction
When the uterus becomes rounded or the cord
lengthens, very gently pull downward on the cord to
deliver the placenta.. Continue to apply counter
traction to the uterus with the other hand
Check the placenta to be sure none of it is missing
Uterine massage
Subtotal score
Total score

MAX
SCORE
2

1
1
2
2

1
2
11
PASSING GRADE 8

FINAL MARK
0 = inadequately or not performed
1 = some points covered
2 = satisfactory coverage of all points

Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:
.
.

11

STATION 6 : GYNAECOLOGICAL EXAMINATION:

External Genitalia Inspection and Examination with Speculum
Objectives
- to evaluate students competency in performing gynecological procedure (inspection) and
reporting the result
Instruction
Mrs. A, 27 years old has complained of vaginal discharge since 2 months ago. She needs to be
undergone gynaecological examination. After having the patients informed consent to carry out the
examination, you ask the patient to empty the bladder and help the patient to lie on the
gynaecological bed. You have already washed your hands.
Please perform external genitalia examination and speculum examination to this patient and
report the result.
You have 5 minutes.

12

Student No: .

Student Name:

Checklist for Station 6: GYNAECOLOGICAL EXAMINATION

NO
1
2
3
4
5
6
7
8
9

GYNAECOLOGICAL EXAMINATION: Inspection &

Speculum Examination
Wear the hand gloves properly
Moist the antiseptic cotton and wipe the area of vulva
and perineum
Observe and report the area of vulva and perineum
Open both clefts of labium majus, observe and report
the urethral orifice and introitus
Pick up speculum with the right hand, and insert the
left index fingertip into introitus (to expose it).
Insert the speculum properly
Press the raising button so that vaginal lumen and
portio is clearly exposed
Observe and report the color of portio, vaginal walls,
and vaginal secretion or fornix
Put the speculum in the designated place
Total score

MAX
SCORE
1
1
1
1
1
1
1
1
1
9

PASSING GRADE 6

FINAL MARK
0 = inadequately or not performed
1 = satisfactory coverage of all points

Examiner:
.

Global ratings (please tick):

Failed

Pass

Comment:
..
..

13

STATION 7: PAP TEST

Objectives
- to evaluate students competency in performing PAP test

Instruction
A 25-year-old woman presents to the hospital in order to undergo annual pap smear examination.
You have already washed your hands and worn the gloves.
Please perform pap smear examination appropriately to the patient.
You have 5 minutes.

14

Student No:

Student Name: ..

Checklist for Station 7: PAP TEST

0

PAP TEST
1
2
3
4
5
6

Insert the speculum

Locate the cervix
Collect a sample of cells from the cervix. Use either
wooden spatula, cytobrush, or cervix sampler
Insert the sampling device into the ostium cervix,
either rotate 180o if using the cytobrush or rotate
360o if using the wooden spatula
Transfer the sample to the glass slide
Put in the fixative solution immediately, before
removing the speculum
Total score

Max score
1
1
2
2

2
8
PASSING GRADE 6

0 = inadequately or not performed

1 = some points covered
2 = satisfactory coverage of all points

Examiner:

FINAL MARK

Global ratings (please tick):

Failed

Pass

Comments:
.
.

15

STATION 8: ANAMNESIS: VAGINAL DISCHARGE (STD)

Objectives:
1. To evaluate students ability in performing oriented medical interview of patient with vaginal
discharge
2. To evaluate students communication skills in medical interview.
Instruction:
Ms N, 19-year-old presents with complaint of vaginal discharge since 1 month ago.
Please perform problem oriented medical interview regarding her problem.
You have 5 minutes.

16

Student No:

Student Name: .

Checklist for Station 8: ANAMNESIS VAGINAL DISCHARGE (STD)

No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14

STD Anamnesis
Introduction to the patient
Demonstrates respect and compassion for patients
and (their families)
Asked about chief compliant and the onset
Searching the patient risk factor for STD
Asked about patient disease history
Asked about characteristic of compliant (itching,
burning sensation, pain, characteristic of fluor,
color)
Asked about patient therapeutic history (drugs,
douching, etc)
Asked about history of sexual intercourse
Asked about the sexual partner
Asked about the sexual partner compliant (Pingpong Phenomena)
Asked about contraception
Suggest to treat the sexual partner
Clarified patient statement with specific questions
Closing statement and suggestion to the patient
Total score
PASSING GRADE

0 = inadequate or not performed

1 /2 = some point covered
2/3 = satisfactory all point covered

Max Score
1
1
1
3
2
3
2
2
1
1
2
2
2
1
24
17

FINAL MARK
Examiner:
.

Global ratings (please tick)

Failed

Pass

Comments:

17

Scenario for standardized patient Station 8: STD ANAMNESIS

No.
1
2

STD Anamnesis
Asked about chief compliant and the onset
Searching the patient risk factor for STD

Asked about patient disease history

Asked about characteristic of compliant

Asked about patient therapeutic history (drugs,

douching, etc)
Asked about history of sexual intercourse
Asked about the sexual partner

6
7
8
9

Asked about the sexual partner compliant (Pingpong Phenomena)

Asked about contraception

18

Answers
Vaginal discharge
- unmarried
- multi partner
- smoking
1 month, no history of the same
disease before
(itching, burning sensation, pain,
characteristic of fluor, color)
Using vaginal douche
Yes, she has
Multi-partner, without any sexual
protection devices
There is one of her partner that
complain of itching in his penis
She always use morning-after pill

STATION 9: KONSELING KONTRASEPSI PIL

Tujuan:
1. Untuk mengevaluasi kemampuan kandidat untuk memberikan konseling mengenai
penggunaan kontrasepsi pil

Kasus
Ny. M, 26 tahun, para 1, dengan bayi berusia 8 bulan, sudah berhenti menyusui eksklusif, datang
ke klinik Anda dan menginginkan kontrasepsi pil.
Instruksi
Berikanlah konseling pada klien mengenai kontrasepsi pil, sesuai dengan yang ditanyakan oleh
klien!
Waktu Anda 5 menit.

19

Student No: ..

Student Name:

Checklist for Station 9: KONSELING KONTRASEPSI PIL

No.
1
2
3
4
5
6
7

Tanggapan kandidat atas pertanyaan klien

Menyapa pasien dan memperkenalkan diri

Menjawab cara kerja kontrasepsi pil (1 poin untuk setiap
1 jawaban benar. Skor maksimal 2)
Menjelaskan keuntungan kontrasepsi pil
(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebih
skor 3 [maksimal])
Menjelaskan keterbatasan kontrasepsi pil
(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebih
skor 3 [maksimal])
Menjelaskan kontraindikasi penggunaan kontrasepsi pil
(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebih
skor 3 [maksimal])
Menjelaskan cara penggunaan kontrasepsi pil
(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebih
skor 3 [maksimal])
Menjelaskan tindakan apa yang harus dilakukan bila lupa
minum pil
(1 poin untuk setiap 1 jawaban benar. Benar 3 atau lebih
skor 3 [maksimal])
-Skor Total
BATAS LULUS

Skor
maks.
1
2
3
3
3
3
3

18
12
NILAI AKHIR

Penguji:
.
Penilaian umum (mohon beri tanda):
Gagal

Lulus

Komentar:
.
.

20

Skenario untuk konseling kontrasepsi pil (Station 9)

No.
1
2

Klien (resident)

Dokter (kandidat)
Selamat pagi, Ibu M. Saya dr. (menyebut namanya)
Selamat pagi, Dok!
(berjabat tangan)
Bagaimana sih Dok
Cara kerja pil kontrasepsi:
sebenarnya cara kerja pil
1. menekan ovulasi (pelepasan sel telur)
kontrasepsi itu?
2. mengentalkan lendir leher rahim sehingga sulit
dilalui oleh sperma
Oh, begitu. Lalu, apakah
Oh, keuntungannya banyak, di antaranya adalah:
keuntungannya bila saya
1. efektivitasnya tinggi bila digunakan secara tepat
menggunakan kontrasepsi pil?
risiko kegagalan kecil (1 kehamilan/1000
wanita dalam tahun pertama penggunaan)
2. risiko terhadap kesehatan kecil
3. tidak mengganggu hubungan seksual
4. siklus haid menjadi teratur, darah haid berkurang
5. mudah dihentikan setiap saat
6. kesuburan segera kembali setelah penggunaan
pil dihentikan
Wah, banyak sekali
Oh, tentu saja setiap metoda ada kelebihan dan
manfaatnya ya, Dok. Kalau
kekurangannya. Kekurangannya di antara lain seperti:
saya boleh tahu, adakah
1. harus teratur penggunaannya, jangan sampai
kerugiannya bila saya
lupa
menggunakan pil?
2. mungkin dapat membosankan karena harus
diminum setiap hari
3. dapat terjadi mual, terutama pada 3 bulan
pertama
4. ada efek samping seperti pusing, nyeri
payudara, kenaikan berat badan sedikit (namun
efek samping tersebut tidak selalu ada, jadi
bersifat individual)
5. sebaiknya tidak digunakan pada wanita yang
masih menyusui (dapat mengurangi ASI)
6. tidak dapat mencegah penyakit menular seksual,
hepatitis B, infeksi HIV
Wah, saya masih menyusui,
Yang tidak dapat menggunakan pil adalah yang:
Dok. Tapi sudah tidak eksklusif.
1. masih menyusui eksklusif
Apakah saya boleh
2. hamil atau dicurigai hamil
menggunakan pil?
3. ada perdarahan per vagina yang belum diketahui
sebabnya
4. perokok berusia > 35 tahun
5. riwayat darah tinggi, penakit jantung
6. punya penyakit hati akut (hepatitis)
7. kepatuhannya diragukan/sering lupa
8. kanker payudara atau yang dicurigai kanker

21

Baiklah Dok. Setelah

mempertimbangkan masakmasak dan juga saya telah
berdiskusi dengan suami, saya
memilih menggunakan pil.
Bagaimanakah cara yang
terbaik untuk
menggunakannya?

Bagaimana bila saya lupa

minum pil satu hari, Dok? Atau
lupa 2 hari atau lebih?
Berbahayakah?

payudara
Bagus. (sambil menerangkan, dokter menunjukkan
panah-panah pada kemasan)
1. Pil sebaiknya diminum pada saat yang sama
setiap hari, misalnya setiap pagi atau setiap
malam (waktunya sama)
2. Jangan sampai lupa / terlewat
3. Dianjurkan diminum saat hari pertama haid
4. Bila paket berisi 28 pil, minum sampai habis dan
mulai lagi dengan kemasan baru
5. Bila paket berisi 21 pil, setelah paket habis,
tunggu satu minggu, kemudian baru minum pil
dari paket yang baru.

1. Bila lupa minum1 pil, sebaiknya minum segera

setelah ingat, dan minum sekaligus 2 pada hari
yang sama.
2. Bila lupa 2 pil atau lebih, minum 2 pil setiap hari
sampai sesuai jadualnya kembali, dan sebaiknya
gunakan metoda kontrasepsi lain (misalnya
kondom) atau tidak melakukan hubungan
seksual sampai haid kembali.
3. Bila tidak haid, segera ke klinik untuk uji
kehamilan
Baiklah, terima kasih Dok. Saya Terima kasih kembali
permisi.

22

STATION 10: PRE-IUCD INSERTION COUNSELING

Objectives:
1. To evaluate students ability in conducting specific method (IUCD) and pre-insertion
counseling
Instruction:
A woman of 28 years old comes to your clinic in order to get more information about IUCD. She is
P2A0 with children of 3 years old girl and 1 month-old baby boy. She and her husband have
already decided to use IUCD contraceptive method to limit the number of their children. Theyve
already sought the information from their relatives and internet.
Please give information about IUCD insertion procedure to the patient
You have 5 minutes.

23

Student No: ..

Student Name:

Checklist for Station 10: PRE-IUCD INSERTION COUNSELING

NO
1
2
3
4
5
6

PRE-IUCD INSERTION COUNSELING

Greet the client warmly and introduce her/himself

Show the IUCD and explain the mechanism of IUCD
and its effectiveness
Explain the possible side effects and other problems
that may be encountered
Show the site and explain the process of IUCD
insertion and what the patient may feel during and
after the insertion
Explain examinations, which are needed prior the
IUCD insertion to determine whether the IUCD
insertion procedure could be done or not.
Ask if she needs more information before IUCD
insertion procedure executed
Total score

MAX
SCORE
1
2
2
2
2
1
10

PASSING GRADE : 7

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

FINAL MARK
Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:
.
.

24

STATION 11: OPERATIVE VAGINAL DELIVERY FORCEPS

Mrs. A, 27 years old, Gravida 1 at 41 weeks of gestational age. Uncomplicated pregnancy.

Spontaneous labor onset 16 hours ago, 4 cm to fully dilated in 6 hours. She had spontaneous
rupture of membrane 5 hours ago. From obstetrical examination: estimated fetal weight 3000
grams, normal average pelvic. Contraction 3 times in 10 minutes, 40, average with good
relaxation. FHR 80 bpm during and after contraction.
On inspection, there was greenish amniotic fluid came from vagina.
What would you do now?

You have 5 minutes

25

Student No: .

Student Name:

Checklist for Station 11: OPERATIVE VAGINAL DELIVERY: FORCEPS

If the candidate choose forceps assisted delivery, tell him/her to perform it on the phantom, and
discuss the process as they go.
0

Max
Score
2

Anesthesia

- give local anesthetic (infiltration) to the perineum

Bladder

- in/out catheterization or ensure empty bladder

Cervix

- fully dilated

Determine position, station and pelvic adequacy

(examinee determines position on the model)
- occiput anterior
- membrane has ruptured
- head on Hodge IV
Equipment
Forceps

- check and articulate forceps

- lubricate
- phantom application, consider left forcep first
- left blade, left hand, maternal left side, pencil grip
and vertical insertion, with thumb directiong the blade
- right blade, right hand, maternal right side, pencil
grip and vertical insertion with left thumb directing the
blade
- lock blades and support
- check application:
posterior fontanelle 1 cm above plane of
shanks
fenestration not > fingerbreadth between it
and scalp
sagital suture in perpendicular to plane of
shanks with occipital sutures 1 cm above
respective blades

26

1
1
1
1
1
1
2
2

1
1
1
1

Max
score
2

Gentle
traction

- applied gently with contraction/expulsive effort

(forearm bent)

Handle
elevated

- traction in axis of birth canal

- do not elevate handle too early, wait for occiput
under pubic arch

1
1

Incision

- consider episiotomy if laceration imminent a perineum

distends

Jaw

- remove forceps when jaw is reachable or delivery

assured
Total score
PASSING GRADE

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

25
17

FINAL MARK
Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:
.
.

27

STATION 12: KOMPRESI UTERUS BIMANUAL INTERNA

Anda baru saja melakukan persalinan per vaginam anak pertama pada seorang nyonya, 20
tahun, berat badan lahir 3500 gram. Setelah plasenta dilahirkan lengkap dan Anda pastikan
tidak ada laserasi jalan lahir, Anda mendapatkan uterus tidak berkontraksi, perdarahan per
vaginam masih berlangsung.
Tindakan apa yang akan Anda lakukan sekarang?
Waktu Anda 5 menit.

28

Student No: .

Student Name:

Checklist for Station 12: KOMPRESI UTERUS BIMANUAL INTERNA

Jika kandidat memilih kompresi uterus bimanual interna, perintahkan ia untuk memperagakannya
pada fantom, dan diskusikan proses ini ketika berlangsung.
0
Persiapan

Evaluasi

Pastikan kandung kemih telah kosong / kosongkan

kandung kemih dengan kateter
- penolong berdiri di depan vulva dan memberitahukan
pada pasien apa yang akan dilakukan (memasukkan
tangan ke dalam vaginanya)
- penolong mengenakan sarung tangan dan
mengoleskan larutan antiseptik pada sarung tangan
kanan
- Dengan ibu jari dan telunjuk tangan non dominan
menyisihkan kedua labia minora ke lateral dan tangan
dominan secara obstetrik dimasukkan melalui introitus
vagina
- Kepalkan tangan dominan dan letakkan dataran
punggung jari telunjuk hingga kelingking pada forniks
anterior, dorong uterus ke arah kranio-anterior
- Tapak tangan non dominan menekan bagian belakang
korpus uteri

Skor
Maks.
2
2

- Lakukan kompresi dengan jalan mendekatkan telapak

tangan kiri dengan kepalan tangan kanan pada forniks
anterior

- Perhatikan perdarahan yang terjadi. Bila perdarahan

berhenti, pertahankan posisi demikian hingga kontraksi
uterus membaik.

Pasca
tindakan

- Keluarkan tangan kanan, bersihkan sarung tangan dan

rendam dalam larutan klorin 0,5%
- Cuci tangan dan lengan, keringkan dengan handuk.
Total skor
PASSING GRADE

29

2
2
20
14

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

FINAL MARK
Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:
.
.

30

STATION 13: KURETASE PADA ABORTUS INKOMPLIT

Tujuan:
1. Kandidat dapat melakukan kuretase tajam pada kasus abortus inkomplit
Kasus:
Ny. S, 19 tahun, mengalami perdarahan per vaginam saat usia kehamilan 8 minggu. Dari hasil
pemeriksaan, Anda mendiagnosisnya sebagai abortus inkomplit dan Anda merenanakan kuretase
tajam. Pasien telah menandatangani informed consent dan telah mendapatkan anestesi
neuroleptik. Anda siap melakukan tindakan kuretase.
Waktu Anda 5 menit.

31

Student No: .

Student Name:

Checklist for Station 13:

MELAKUKAN KURETASE TAJAM PADA ABORTUS INKOMPLIT
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Tindakan
Pastikan kandung kemih telah kosong / kosongkan kandung
kemih dengan kateter
Kandidat melakukan pemeriksaan dalam ulang dalam narkosis
untuk memastikan besar dan arah uterus
Kandidat melepaskan sarung tangan dan menggantinya dengan
yang baru dan steril
Kandidat melakukan a- dan antisepsis genitalia eksterna dan
sekitarnya
Kandidat memasang spekulum Sims (dengan bantuan asisten)
dan menampakkan porsio, kemudian porsio dibersihkan dengan
larutan antiseptik
Kandidat memasang tenakulum pada bibir atas serviks,
melepaskan spekulum anterior dan memegang tenakulum
dengan tangan non-dominan
Kandidat melakukan sondase dan menyebutkan panjang dan
arahnya
Kandidat memasukkan sondase ke dalam wadah berisi klorin
0,5%
Kandidat mengambil jaringan sisa konsepsi dengan tang abortus
Kandidat melakukan kuretase secara sistematik sampai kavum
uteri diyakini bersih
Kandidat mengevaluasi apakah masih terdapat perdarahan dari
kanalis servikalis
Kandidat melepaskan tenakulum dan meyakinkan tidak ada
perdarahan dari lubang bekas tusukan tenakulum
Kandidat membersihkan porsio dengan antiseptik
Kandidat melepaskan spekulum dan meletakkan semua alat ke
dalam ember berisi larutan klorin 0,5%
Kandidat mencuci tangan dan lengan, mengeringkannya dengan
handuk.
Total score
PASSING GRADE

32

Skor
Maks.

1
2
1
1
2

2
1
1
2
1
1
1
2
1
20
14

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

FINAL MARK
Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:
.
.

33

STATION 14. PEMASANGAN AKDR

Tujuan
1. Mengevaluasi kemampuan kandidat untuk melakukan pemasangan AKDR (alat
kontrasepsi dalam rahim)
Instruksi
Lakukanlah pemasangan AKDR Copper-T 380 A pada klien ini. Klien sudah mendapatkan
konseling dan sudah dalam posisi litotomi.
Waktu Anda 5 menit

34

Student No: .

Student Name:

Checklist for Station 14:

MELAKUKAN PEMASANGAN AKDR PADA KLIEN
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
14.
15.

Tindakan
Pastikan kandung kemih telah kosong / kosongkan kandung
kemih dengan kateter
Kandidat memasukkan lengan AKDR Cu T 380A di dalam
kemasan sterilnya
Kandidat memakai sarung tangan baru
Kandidat melakukan a- dan antisepsis genitalia eksterna dan
sekitarnya
Kandidat memasang spekulum cocor bebek dan menampakkan
porsio
Kandidat mengusap vagina dan serviks dengan larutan antiseptik
Kandidat memasang tenakulum pada bibir atas serviks,
melepaskan spekulum anterior dan memegang tenakulum
dengan tangan non-dominan
Kandidat melakukan sondase dan menyebutkan panjang dan
arahnya (teknik tidak menyentuh [no touch technique])
Kandidat menggeser biru pada tabung inserter sesuai dengan
dalam uterus, kemudian ia membuka seluruh plastik penutup
kemasan
Kandidat memasang AKDR dengan teknik withdrawal
Kandidat menggunting benang AKDR, melepaskan dan
mengeluarkan tenakulum dan spekulum
Kandidat memasukkan semua alat setelah digunakan ke dalam
ember berisi larutan klorin 0,5%
Kandidat mencuci tangan dan lengan, mengeringkannya dengan
handuk.
Total score
PASSING GRADE

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

Skor
Maks.

1
2
1
1
1
1
2

2
2

2
2
2
1
20
14
FINAL MARK

Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:

35

STATION 15: VAGINAL DELIVERY OF BREECH PRESENTATION

Objective
1. to perform vaginal delivery of breech presentation
Instruction:
.
..

36

Student No: ..

Student Name: ..

Checklist for Station 15:

MELAKUKAN PERSALINAN PER VAGINAM PADA SUNGSANG
No.
1.
2.
3.
4.
5.

Tindakan
Pastikan kandung kemih telah kosong / kosongkan kandung
kemih dengan kateter

Skor
Maks.

1
2
1
1
1
1
2
2
2

6.
7.
8.
9.
10.
14.
15.

2
2
2
1

Kandidat mencuci tangan dan lengan, mengeringkannya dengan

handuk.
Total score
PASSING GRADE

0 = inadequate or not performed

1 = some points covered
2 = satisfactory coverage of all points

FINAL MARK
Examiner:
.

Global ratings (please tick):

Failed

Pass

Comments:

.
..

37