Pradini Pendidikan Dokter FK UGMABORTion

07 250496 - KU - 12171

definitionAbortion is termination of pregnancy before the fetus is viable outside the womb, or gestation age before 20 weeks, or fetal weight < 500 gramsEarly abortion< 12 weeksLate abortion12-20 weeks

terminologySpontaneous abortion : abortion happens by nature, no intervention

Induced abortion : abortion made for certain purposesMedical or therapeutic abortionCriminal abortion: other than therapeutic abortion (illegal abortion)

ETIOLOGY of early abortionAbnormal product of conception (50-64% of first trimester abortion have abnormal karyotype)Infections (CMV)Autoimmun disorders (SLE)Endocrine abnormalities (luteal phase defect)Uterine abnormalities (septus, arcuatus, bicornual, didelphys, etc)Many is still unknown

ETIOLOGY of late abortionInfection (malaria, syphylis, typhoid)Metabolic disorders (DM, Thyroid)Physiologic impairment (renal, cardiac, hepatic diseases, hypertension)Severe dietary insufficiency: anemia, avitaminosisPoisoning (alcohol, drugs abuse)Trauma to the wombCervical incompetence

Type of abortionInavitable (Insipiens) abortionThreatened (Imminens) abortionIncomplete abortionComplete abortionMissed abortion : Retention of dead conception product in utero up to several weeksSeptic abortion : Abortion complicated by infection of the genital tract Habitual (recurrent) abortion : Spontaneus abortion 3 in a row

pathophysiologyPerdarahan desidua basalisDiikuti oleh nekrosis jaringan sekitarHasil konsepsi terlepas Dianggap benda asing oleh uterusUterus berkontraksi untuk mengeluarkan hasil konsepsi

UK < 8 minggu : villi khorialis belum menembus desidua secara dalam ; hasil konsepsi dapat dikeluarkan seluruhnya.

UK 8-12 minggu : penembusan sudah lebih dalam hingga plasenta tidak dilepaskan secara sempurna ; menimbulkan banyak perdarahan

UK > 14 minggu : janin dikeluarkan lebih dahulu daripada plasenta

diagnosisAnamnesis: sign and symptomps of early pregancy, including pregnancy testVaginal bleedingUterine crampingPassage of tissueRoutine blood examination Gynecologic examination

diagnosis

Insipiens abortionPain and bleeding are more severeCervix: dilated, but no tissue is passedAmnionic membrane: bulging or rupturedUltrasound: fetus may be viable or notTreatment: stimulation or curettageFor severe bleeding: cross-matched bloodRho(D) immune globulin shoud be given before or after evacuation in Rh negative patient

imminens abortionBleeding and pain: lightAbdomen is not tender, cervix is closed, but some bleeding may come out from the external osUltrasound: Viable fetusTreatment: No specific treatment; counseling and reassuringBedrest is recommended, but not effectiveNo coitus and hard physical activity for 2 weeksMefenemic acid: to relieve painProgesteron and sedative should not be used : no benefit in preventing abortion to occurVaginal infection, is treated specifically

incomplete abortionPartial expulsion of product of conceptionPregnancy age > 6 weeks (before 6 weeks, usually complete)Uterine cramping and Vaginal bleedingCervix: dilatated, bleeding is present, sometime there is tissue fragmentUterus: enlarged (depends on age of gestation)If bleeding profuse: anemia and shockUltrasound: retained plcental tissue fragmentTreatment: curettage and uterotonicsRho(D) immune globulin shoud be given before or after evacuation in Rh negative patient

complete abortionComplete expulsion of product of conception (poc, embryo and membranes)Gestation age: usually less than 6 weeksEarly sign of pregnancyPain ceases with expulsion of poc and vaginal bleeding continues for a few daysCervix: closed, bleeding may be yes, may be noUltrasound: no tissue fragmentTreatment: no specific treatmentTell the patient to observe: bleeding, febrile and pain

Diagnosis & tata laksana komplikasi

CASEIncomplete Abortion

kasusAnamnesis:Pasien datang dengan keluhan keluar darah & jaringan dari jalan lahir, flek ( + ), nyeri perut ( + ) G1P0A0, UK 9mgRiw. KB ( - )Riw. Asma, hipertensi, jantung, DM disangkal

kasusPemeriksaan fisik:KU : baik, sadar, tidak anemisPalpasi : NT (+) minimalVital Sign: TD : 100/60 N : 80 x/menit S : Afebris (36,2) R : 20x/menitPD: Vulva tenang, dinding vagina licin, teraba fragmen jaringan di oue

kasusDx :Abortus incomplete

Tx :Kuretase

additionalSeptic & missed abortion

Septic abortionBleeding, pain or cramping is severeHigh grade fever (> 380C)Tenderness over the abdominal wallSevere painful on pelvic examinationThe external os: dilatedFoul smelling dischargeShock

missed abortionProduct of conception is retained 8 weeks or moreBleeding is minimal (spotting) and darkPain or cramping is also minimalThe external os: closedPregnancy test usually negativeThe size of uterus does not correspond to pregnancy ageHypofibrinogenemia and low platelet countUltrasound: image of blood clot, or network of vesicleTreatmentCorrect blood coagulation performanceD & C

*Hasil konsepsi keluar dalam berbagai bentuk seperti kantong kosong amnion atau benda kecil yang tak jelas bentuknya, janin lahir mati, janin masih hidup, mola kruenta, fetus kompresus, maserasi atau fetus papiraseus.

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