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8/17/2019 Aborsi Dan Hiperemesis Gravidarum
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Pendahuluan
• Berasal dari bahasa Latin aboriri -keguguran.
• Menurut New Shorter Oxford Dictionar! abortus adalah
"ersalinan kurang bulan sebelu# usia $anin ang
#e#ungkinkan untuk hidu"! dan dala# hal ini kata ini
bersinoni# dengan keguguran.
• %bortus $uga berarti induksi "enghentian keha#ilan untuk
#enghancurkan $anin.
• Biasana "ada sebelu# akhir #inggu ke &' keha#ilan
atau berat fetus ang #enca"ai ('' gra#.
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)"ide#iologi
• Dila"orkan *(-&'+ keha#ilan telah ter$adi aborsi di ,nited
States.
• Sekitar '+na ter$adi dala# tri#ester "ertta#a..
• Prealensi dunia tidak terlalu signifikan "erbedaana
dengan ang ada di ,S.
• /idak ada "redileksi ras dan hana ter$adi "ada "ere#"uan.
• 0entang usia• 1 2( tahun 3 *(+ ke$adian
• 2(-24 tahun 3 &'-&(+ ke$adian
• 5'-5& tahun 3 2(+ ke$adian
• 6 5& tahun 3 ('+ ke$adian
• f
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)tiologi
• 7enetic abnor#alities 8('-9(+:• %ne"loid risk
• Structural abnor#alities of the re"roductie tract• ;ongenital uterine defects
•
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Process
• /erbagi dala# 5 stages• /hreatened
• =neitable
• =nco#"lete
• ;o#"lete
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Stages
/hreatened
• ;onsists of an aginal
bleeding during earl
"regnanc without cerical
dilataion or change in
cerical consistenc.
• No significant "ain exist
• On exa#ination! blood orbrownish discharge #a be
"resent in the agina.
• /he cerix is not tender and
the cerical os is closed.
=neitable
• Vaginal bleeding and
dilatation of the cervix.
• More cramping ispresent
• No tissue has passed
yet
• On ultrasound, theproducts of conception
are located in the lower
uterine segment or the
cervical canal
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Stages
=nco#"lete
• >aginal bleeding! dilatation
of the cerical canal! and
"assage of "roducts of
conce"tion.
• /he cra#"s are intense and
the aginal bleeding is
hea.• ,ltrasound #a show that
so#e of the "roducts of
conce"tion are still "resent
in the uterus
;o#"lete
• Vaginal bleeding,
abdominal pain, and
passage of tissue exists.
• After the tissue passes,
the patient notes that the
pain subsides and the
vaginal bleedingsignificantly diminishes.
• The ultrasound
demonstrates an empty
uterus
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Presentation
?istor
• >aginal bleeding is usuallhea
• %bdo#inal "ain is
associated with
concurrent abortion andresoles with the
co#"letion of the abortion
Phsical
• emodynamic stability
• Abdominal and pelvic
examinations• Source of bleeding
• =ntensit of bleeding
• %n "resence or "assage of
tissue
• ;erical #otion tenderness
• ;erical os closed for co#"lete
or threatened ab"rto"#
• ,terine si@e and tenderness
• %dnexal #asses
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/reat#ent A Manage#ent
• % co#"lete abortion usuall needs no further treat#ent!
#edicall! or surgicall. /hese "atients are usuall sent
ho#e.
• /reat an re#aining ane#ia and to ealuate the blood
t"e and treat the "atient with 0ho7%M when indicated• =#"ortant to deter#ine 0h.
• %n 0h-Negatie wo#an should receie 0ho7%M within &hr of
#iscarriage or ecto"ic "regnanc to aoid the "ossibilit that the
"regnanc has ex"osed the "atient to a "ositie antigen.• /he "atientCs diet shoud be regular
• No surgical care is used
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Prognosis
• /he "rognosis for earl "regnanc loss is excellent.
• ;o#"lete abortion no increased risk exists for another
one.
•
Morbidi would be increased if ane#ia or infectiondeelo"s.
;o#"lication
• *2+ increased risk of subseuent #ocardial infarction.• =nfection or accu#ulation of clot in the uterine cait
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Patient )ducation
• %dise the "atient to return to the e#ergenc de"art#ent
if an of the following s#"to#s occur • Profuse aginal bleeding
• Seere "elic "ain
• /e#"erature greater than *'' <
• /he "atient needs to hear that one #isscarriage does not
"ut her at increased risk for another #iscarriage.
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?=P)0)M=S 70%>=D%0,M
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Definisi
• ?i"ere#is graidaru# adalah suatu keadaan di#ana
"enderita #engala#i #ual-#untah ang berlebihan!
sede#ikian ru"a sehingga #engganggu aktiitas dan
kesehatan "enderita secara keseluruhan.
• Eeadaan #ual dan #untah ang berat dan berlebihan
sela#a keha#ilan! ang #engakibatkan
ketidaksei#bangan elektrolit! #etabolik! dan nutrisi tan"a
#asalah-#asaalh #edis lainna.
• %#erican Pregnanc %ssociation! adalah kondisi angditandai dengan #ual "arah! #untah! "enurunan berat
badan! dan gangguan elektrolit.
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)"ide#iologi
• /er$adi dala# ('-4'+ keha#ilan.
• Pada *-*'+ keha#ilan! ge$ala da"at berlan$ut #elewati
&'-&& #inggu 8biasana berakhir *&-*5 #inggu:.
• /er$adi keha#ilan se$u#lah *-2+ di =ndonesia! '!2+ di
Swedia! '!(+ di california! '!+ di ;anada! *'!+ di
;hina! '!4+ di Norwegia! &!&+ di Pakistan dan *!4+ di
/urki.
• Sehingga "realensina '!(-&+ atau 53*''' keha#ilan
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)tiologi
• Penebab "asti belu# diketahui! teta"i ada bebera"a
faktor "redis"osisi sebagai berikut•
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7e$ala Elinik• /erbagi dala# 2 tingkatan! aitu 3
!. Ting"at # Muntah terus #enerus
Makan berkurang! berat badan #enurun
Eulit dehidrasi! tonus le#ah! #ata ta#"ak cekung! lidah kering
Neri di daerah e"igastriu#
/ekanan darah #enurun dan denut nadi #eningkat
$. Ting"at ## Penderita ta#"ak lebih le#ah
7e$ala dehidrasi #akin ta#"ak! urin berkurang! turgor kulit #akin
kurang! lidah kering dan kotor
/ekanan darah #enurun dan nadi #eningkat
BB #enurun
7e$ala he#okonsentrasi #akin ta#"ak
7angguan B%B
Mulai ta#"ak ge$ala gangguan kesadaran #en$adi a"atis
Nafas berbau aseton
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Pe#eriksaan Diagnostik
• Laboratoriu# ,rinalsis
o Eetonuria ang berasal dari oksidasi le#ak ang tidak se#"urna.
o Peningkatan #assa $enis urin karena adana "roteinuria
Eultur bakterio 8FG-: Helicobacter pylori
Pe#eriksaan darah lengka"o %kan ter$adi "eningkatan leukosit a"abila terda"at infeksi
)lektorlit! B,N! kreatinino Penurunan kadar Na dan ;l darah karena dehidrasi seluler dan "las#a.
o Penurunan E karena adana #untah dan dehidrasi.
o Da"at #enebabkan asidosis
)n@i# he"ar o Biasana akan #engala#i "eningkatan 8ta"i #asih kurang dari 2'':
/S? dan /5o Eadar ?;7 ang tinggi da"at #erangsang rese"tor /S? sehingga #enebabkan transient
h"erthroidis#. /er$adi "enurunan kadar /S?
• =#aging ,S7
o 8FG-: keha#ilan ganda atau #ola hidatidosa
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Penatalaksanaan
Non