CASE PRESENTATION ABORTUS

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

KEPANITERAAN KLINIK OBSTETRI DAN GINEKOLOGI RUMAH SAKIT UMUM PUSAT PERSAHABATAN FAKULTAS KEDOKTERAN VETERAN JAKARTA PowerpointUPN Templates PERIODE 13 SEPTEMBER 20 OKTOBER 2012

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BAB I CASE ILUSTRATION

A. PATIENT IDENTITY

Name Age Religion Education Job Address Medical record Hospital in

: Mrs. U : 23 y.o : Moslem : High school : Housewife : Duri pulo-Gambir : 1377339 : 05 Sept 2012

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B. ANAMNESIS

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.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 (-).

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.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

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Physically examination
General Condition Vital Sign : Good, Awareness CM : BP : 110/80 mmHg, Pulse : 82x/mnt, RR : 18x/mnt, Temp : 36,7C Generalized 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 (-)

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Physiccaly examination.
Gynaecology status : I : V/U quiet, appear to be bleeding from introitus Io : 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.

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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.

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DIAGNOSIS
Inkomplit Abortus on G1 20 weeks pregnancy

THREATMENT
R dx/ Vital sign observation and bleeding R th/ The rest of evacuation plan conception by curetage

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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 oclock; 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;

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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. Indonesias encyclopedia end for pregnancy < 28 weeks/BL < 1000 grams.
Aida Tores and Jecqueline Sarroch Forrest study (1998)

7% medical reason
1% rapping/incest 3% dangerously for mother 3% malformation

93% non medical reason

scared for carrier have no money unmarried partner

Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 2006 : 302. Powerpoint Templates 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.

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2.2 DEFINITION

Is a frightening or release of conception result before fetus can live outside the uterus. Limitation < 20 mgg, BL < 500 grams. Derek & Jones (2002) out of fetus before viable, < 22mgg & BL < 500 grams.

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

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

Faktor Janin Faktor Maternal

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

Faktor Paternal
abnormalitas kromosom sperma Powerpoint Templates

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,21 st edition. New York : Mc Graw Hill Company, 2008 : 137-156.

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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 vili korialis yet passed deeper easy to release UK 8-14 weeks vili korialis already passed deeper hard to release bleeding >>
Prawirohardjo, Sarwono. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 1999 : 570.

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2.6 DIAGNOSIS
Type of Abortus Symptoms Signs

Iminens

Bleeding <<

-blood from vagina<< -Uterus pregnancy -OUE closed -blood from vagina >> -contraction >> -OUE opened -Uterus pregnancy

Insipiens

-Bleeding >> -Pain >>

Incomplete

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

Complete

-bleeding << -OUE closed - Decrease uterus

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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 Symptoms and signs genitalia infection -Fever - increase of uterus, soft -Tachycardi -pain -Smelly bleeding - Leukositosis -increase uterus - Feel palpable above OUE Powerpoint Templates Page 18

Septic

cervicalis

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

..2.6 DIAGNOSIS
Supported examination

Lab USG

Complete blood examination

Pregnant signal

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

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.2.6 DIAGNOSIS
USG

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2.7 ABORTUS THREATMENT

Threatment at firstTrimester
Termination : - Suction - Medikamentosa

Threatment at second Trimester

Surgery Method
Medikamentosa method Extra Amniotik abortion
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Hart. Mark David, Norman. Jane. Gynaecology Illustrated, 5th edition. London : Churchill Livingstone, 2000 : 340-348.

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2.7 Medication
Medication generally procedure abortus:
First score - Recognize vital sign, shock/infection sign

Dispensing techniques rest of conception

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.

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

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2.8 COMPLICATION
Bleeding
Perforation Infektion Shock

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BAB III Discussion

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

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BAB III discussion 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 !!!

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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, 5th 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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