PRESKAS ABORTUS TYKA

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CASE PRESENTATION « ABORTUS »

COMPILED BY: ATYKA MULYA UTAMI – 1010221068SUPERVISING: dr. PURNAWAN SENOAJI Sp.OG

KEPANITERAAN KLINIK OBSTETRI DAN GINEKOLOGIRUMAH SAKIT UMUM PUSAT PERSAHABATAN

FAKULTAS KEDOKTERAN UPN “VETERAN” JAKARTAPERIODE 13 SEPTEMBER – 20 OKTOBER 2012


BAB ICASE ILUSTRATION

A. PATIENT IDENTITY

Name : Mrs. U

Age : 23 y.o Religion : Moslem Education : High school Job : Housewife Address : Duri pulo-Gambir Medical record : 1377339 Hospital in : 05 Sept 2012


B. ANAMNESIS


….Anamnesis

A history of the disease now :The patients claims to be pregnant 5 months. HPHT 01 April 2012, ≈ UK 20 weeks. Patients a complaint out of blood from pubic since seven hours ago. Blood volume pretty much, initially red fresh watered, then the blood comes out in the form of brownish blood, like a wad. Stomachache (+), limp (+), headache (-), fever (-), whitish (+), itch (-), smell (-). Patient comes to the maternity clinic, performed ultrasound and said that the fetus is already dead, so the patients referred to RSP. smoke (-), alcoholic (-), massage (-), herbal medicine (-).


….Anamnesis

Ancient disease history :Hypertension (-), Diabetic (-), Asthma (-), Alergic (-), Heart disease (-), Lung disease (-).Family disease history :Hypertension (-), Diabetic (-), Asthma (-), Alergic (-), Heart disease (-), Lung disease (-). Menstrual history :Menarche 12 y.o, siklus 28 days, routine, long menses 5-7 days, complaining menses (-), replace pads 2x.

Obstetric history :G1 1. Hamil this time


Physically examination

General Condition : Good, Awareness CMVital Sign : BP : 110/80 mmHg, Pulse : 82x/mnt, RR : 18x/mnt, Temp : 36,7°CGeneralized Status : Head : normocephal Eye : Conjungtiva anemic -/-, sklera ikteric -/- Throat : NCH -/-, otorhea -/-, rinorhea -/- Neck : thyroid not palpable, KGB (N) Chest : symmetrical static-dinamic, retraktion (-) - Cor : BJ I&II (N) reguler, murmur (-), gallop (-) - Lung : vesikuler +/+, Rhonki -/-, wheezing -/- Abdomen : Enlarge fit pregnancy, BU (+) N Ekstremity : warm akral, CRT <2”, oedema (-), varises (-)


Physiccaly examination….

Gynaecology status :I : V/U quiet, appear to be bleeding from introitusIo : Portio slick, livide, OUE open, visible tissue at OUE, fluor (-), fluxus (+)VT : Uterus AF, CUT as big as dug eggs, portio pain shake (-/-), adneksa pain (-/-), CD not outstanding, weak parametrium, palpable tissue at OUE.


Ancillary examination

Laboratorium

DPL : 15.020/14/44/307.000

UL : protein (-), eritrosit 1-2/lpb, leukosit 5-7/lpb, bacterium (-), faint blood (++)

GDS : 102 g/dl

USG

Bigger size and shape CUT, DJJ (-), left ovarium 2x3 cm, right ovarium

2,4x3,1cm, free fluid (-), hiperekhoik visible tissue size 2,73x2,2 cm at fundus

area, impression;rest of conception.


DIAGNOSIS

THREATMENT

Inkomplit Abortus on G1 20 weeks pregnancy


Curretage report

• Pasient at litotomy position on neuroleptik analgesia;• Aseptic and anthyseptic externa genitalia and surrounded area;• make sure the bladder is empty;• put the lower and upper speculum, then put the tenaculum at outside portio 12 o’clock;• push in the sondage 7 cm, anteflexi uterus;• with abortus cunam, pull out the tissue size 3x5 cm, impressed the result of conception PA;• sistematically cleaning with sharp curretage,release the tissue about 10 cc PA;• before make sure the bleeding is stop, stop the act, wash the portio with povidon iodin;



2.1 BACKGROUND

Abortus release the result of conception before fetus can live outside the uterus.

reported the smallest fetus able alive outside the uterus 297 gram.

Indonesia’s encyclopedia end for pregnancy < 28 weeks/BL < 1000 grams.

Aida Tores and Jecqueline Sarroch Forrest study (1998)

7% medical reason 93% non medical reason

•Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 2006 : 302.•http://www.masbied.com/2011/02/08/makalah-abortus diakses tanggal 17 Agustus 2011.•http://www.klikdokter.com/kesehatankewanitaan/read/2010/07/05/4/abortus. Dikases tanggal 15 Agustus 2011.


2.2 DEFINITION

•http://www.masbied.com/2011/02/08/makalah-abortus diakses tanggal 17 Agustus 2011•Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 2008 : 460-474..


2.3 ETIOLOGI

Faktor Janin

Faktor Maternal

Faktor Paternal

50-60% karena abnormalitas kromosom (Aneuploidi/Euploidi)

- infeksi - Nutrisi- Penyakit kronis - Obat & pengaruh - Abnormalitas endokrin lingkungan

≈ abnormalitas kromosom sperma

• Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 2008 : 460-474.• Schorge. John O, Schaffer. Joseph I, Halvorson. Lisa M, Hoffman. Barbara L, Bradshaw. Karen D, Cunningham. FG. First-Trimester Abortion, Williams Gynecology,21st edition. New York : Mc Graw Hill Company, 2008 : 137-156.


2.4 ABORTUS PATHOLOGIC

Start happened abortus desidua basalis bleeding

nekrotic tissue

release part of/ all result of conception

corpus alienum inside uterus

uterus contraction UK < 8 weeks UK 8-14 weeks

vili korialis yet passed deeper vili korialis already passed easy to release deeper hard to release

bleeding >>

•Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 1999 : 570.



2.6 DIAGNOSIS

Type of Abortus Symptoms Signs

Iminens Bleeding << -blood from vagina<<-Uterus ≈pregnancy-OUE closed

Insipiens -Bleeding >>-Pain >>

-blood from vagina >>-contraction >>-OUE opened-Uterus ≈pregnancy

Incomplete -Pervaginam bleeding-Shock/anemic-OUE opened-Tissue palpable-decrease Uterus

Complete -bleeding <<-OUE closed- Decrease uterus


2.6 DIAGNOSIS

Type of Abortus Symptoms Sign

Delayed -pregnant sujective symptom(-)

-decrease mamae-decrease uterus-pregnant test(-)-DJJ (-)

Habitualis -cervix opened at trimester II pregnancy without contraction

Septic Symptoms and signs genitalia infection-Fever - increase of uterus, soft-Tachycardi -pain -Smelly bleeding - Leukositosis

cervicalis -increase uterus- Feel palpable above OUE

•Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 2002 : 480.


…..2.6 DIAGNOSIS

Supported examination

•http://reproduksiumj.blogspot.com/2009/09/abortus. Diakses tanggal 27 Juli 2011.. Diakses tanggal 27 Juli 2011.


….2.6 DIAGNOSIS

USG


2.7 ABORTUS THREATMENT

Threatment at firstTrimester

Termination : - Suction

- Medikamentosa

Threatment at second Trimester

Surgery Method

Medikamentosa method

Extra Amniotik abortion

•Hart. Mark David, Norman. Jane. Gynaecology Illustrated, 5 th edition. London : Churchill Livingstone, 2000 : 340-348.


…2.7 Medication

Medication generally procedure abortus:

First score

Dispensing techniques rest of conception

- Recognize vital sign, shock/infection sign

•Hart. Mark David, Norman. Jane. Gynaecology Illustrated, 5th edition. London : Churchill Livingstone, 2000 : 340-348.•Marjono, Anthonius Budi. Cakul OBGYN Plus. Mahasiswa Fakultas Kedokteran Universitas Indonesia. Diunduh dari www.medicalzone.org. Diakses tanggal 12 Agustus 2011.


2.7 MEDICATION

Curretage

A series of releasing tissue process that attaches to the

wall cavity prolapse with invasion and manipulation of

instruments into the cavity prolapse.

Indication

Inkomplit Abortus

Septic Abortus

•Saifuddin, Abdul Bari. Buku Acuan Pelayanan Kesehatan dan Neonatal. Jakarta : Yayasan Bina Pustaka Sarwono Prawirohardjo, 2006.


2.8 COMPLICATION

Bleeding

Perforation

Infektion

Shock


• Mrs. 23 y.o, G1P0A0 referred with vaginal bleeding since 7 hours

ago

SMRS. Based on last menstrual period ≈ 20 weeks

• PF : Ginaecologic stat impressed rest of conception at OUE with

open OUE.

• Ancillary examination USG : Impressed rest of conception at

fundus area.

Diagnosis : Inkomplit abortus

Medication : Evacuate rest of conception with curretage

BAB IIIDiscussion


Inkomplit abortus

Spending some results on < 20 weeks pregnancy conception with

there is still time left in the conception of the uterus.

Etiologi : - Fetus factor

- Maternal factor

- Paternal factor

Diagnosis : - Bleeding through OUE with abdominal pain

- Open OUE feels tissue

Medicatin : curetage complication !!!

BAB IIIdiscussion


DAFTAR PUSTAKA

1. Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono

Prawirohardjo, 2006 : 302.2. http://www.masbied.com/2011/02/08/makalah-abortus diakses tanggal 17 Agustus 2011.3. http://www.klikdokter.com/kesehatankewanitaan/read/2010/07/05/4/abortus. Dikases tanggal 15

Agustus 2011.4. Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono

Prawirohardjo, 2008 : 460-474.5. Schorge. John O, Schaffer. Joseph I, Halvorson. Lisa M, Hoffman. Barbara L, Bradshaw. Karen

D, Cunningham. FG. First-Trimester Abortion, 21st edition. New York : Mc Graw Hill Company, 2008 : 137-156.

6. http://reproduksiumj.blogspot.com/2009/09/abortus. Diakses tanggal 27 Juli 2011.7. Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono

Prawirohardjo, 1999 : 570.8. Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono

Prawirohardjo, 2002 : 480.9. Hart. Mark David, Norman. Jane. Gynaecology Illustrated, 5 th edition. London : Churchill

Livingstone, 2000 : 340-348.10. Marjono, Anthonius Budi. Cakul OBGYN Plus. Mahasiswa Fakultas Kedokteran Universitas

Indonesia. Diunduh dari www.medicalzone.org. Diakses tanggal 12 Agustus 2011.11. Saifuddin, Abdul Bari. Buku Acuan Pelayanan Kesehatan dan Neonatal. Jakarta : Yayasan Bina

Pustaka Sarwono Prawirohardjo, 2006.


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PRESKAS ABORTUS TYKA