Abortion - keguguran
-
Upload
muhammad-nasrullah -
Category
Health & Medicine
-
view
448 -
download
2
Transcript of Abortion - keguguran
![Page 1: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/1.jpg)
KEGUGURAN‘ABORTION’
Disediakan Oleh : Nassruto
![Page 2: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/2.jpg)
Objektif
• Definisi keguguran• Senaraikan etiologi keguguran• Terangkan patofisiologi keguguran• Senaraikan manifestasi klinikal keguguran• Nyatakan Diagnosis • Terangkan pengurusan keguguran• Senaraikan komplikasi keguguran• Memberi pendidikan kesihatan
![Page 3: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/3.jpg)
Definisi
• Pengeluaran fetus sebelum ia mencapai kematangan atau ‘viability’.
• <22 minggu
• < 500 g
• <28 minggu
• <400 g
• ‘Miscarriage’WHO
Australia
![Page 4: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/4.jpg)
Epidermiologi
• 10 – 15% ibu mengandung keguguran• Umur> 30 --- 3% keguguran• >35 -------- 9% keguguran• Mengandung pertama & kedu -----6%• Mengandung kali ke 3 dan ke atas --- 16%• ‘Clinically diagnosed pregnancy’ – 65% keguguran di antara
minggu ke 6 – ke 10• Penyebab utama pendarahan vagina semasa megandung
peringakt awal
![Page 5: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/5.jpg)
ETIOLOGI
• ‘Ova-fetal’• Defective ova-fetus
• Defective implantation
• ‘Maternal’• Uterine abnormalities – developmental defect
• ‘Psychomatic’
• ‘General maternal disease’
• ‘Paternal’ – ‘chromosomes defects’
![Page 6: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/6.jpg)
Patofisiologi
• Pengasingan ova dari decidua dan villi
• Kontraksi rahim
• Membrane ruptur
• Sebelum 14 minggu, fetus dan uri masuk ke dalam vagina, lekat pada dinding rahim, membran ruptur pendarahan
![Page 7: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/7.jpg)
Jenia Keguguran
1. ‘Threatened abortion’2. ‘Inevitable abortion’3. ‘Incomplete abortion’4. ‘Complete abortion’5. ‘Septic abortion’6. ‘Recurrent abortion’7. ‘Therapeutic abortion’8. ‘Induced’ / ‘Criminal abortion’
‘Septic abortion’
![Page 8: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/8.jpg)
‘Threatened abortion’• 10% dari semua kes
mengandung• Pendarahan vagina (PV
bleeding)• Semasa minggu ke 20
pertama• Perlu beza daripada
‘implantation haemorrhage’
![Page 9: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/9.jpg)
Diagnosis
• Mengandung
• Pendarahan dari dalaman servik
• Kontraksi otot rahim
• Pemeriksaan ‘ultra sound’
![Page 10: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/10.jpg)
Rawatan
• Rehat (bed rest)
• Ubatan – sedative
• Ultrasound – echogram• Menunjuk incomplete atau missed abortion
• Dilatation & Curettage ( D & C)
![Page 11: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/11.jpg)
‘Incomplete Abortion’
• Pendarahan vagina
• Kontraksi rahim (cramp)
• Pengeluaran separuh POC - product of conception
• Jika semua POC ‘Complete Abortion’
![Page 12: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/12.jpg)
Rawatan ‘Incomplete Abortion’
• Masuk wad• Sebelum dipindah ke
hospital – hilangkan kesakitan :
Inj. Pethidine 100mg, atau inj. Morphine 15mg.
• Vaginal examination (VE), removal of POC with fingers atau sponge forceps
![Page 13: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/13.jpg)
Rawatan (continue…)
• Ubatan – inj. Ergometrine 0.25mg. IV - mengawal pendarahan. Selepas prosedur
• Jika manual removal of POC tidak berjaya• Perlu menjalani D & C di OT (operation theatre)
Bilik bedah• Standby darah.• Tisu dihantar ke makmal untuk Histologi
Patologikal Examination (HPE)• Ibu yang Rhesus negatif – perlu beri inj. Anti-D
Immunoglobulin
![Page 14: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/14.jpg)
D & C
![Page 15: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/15.jpg)
“Missed Abortion’
• Dead embryo atau placenta tidak keluar secara spontan
• Pesakit mempunyai sejarah ‘threatened abortion’ tetapi simptom mengandung hilang.
• Rahim gagal membesar
![Page 16: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/16.jpg)
“Missed Abortion’ (Continue…)
• Pregnancy test peringkat awal positif, lepas itu negatif
• Ultra sound –mengesan diagnosis awal
![Page 17: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/17.jpg)
Rawatan
• Tidak cemas dalam rawatan --- spontaneous abortion• Jika saiz kurang dari 12 minggu gestation, lakukan D & C• Standby darah.• Oxytocin infusion sebelum prosedur untuk mengurangkan
pendarahan• Jika saiz besar dari 12 minggu, berikan infusi prostaglandin F 2α
atau E 2
• Atau prostaglandin pessari 20 mg setiap 3 – 6 jam
![Page 18: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/18.jpg)
‘Inevitable Abortion’
• Tanda & simptom ‘threatened abortion’
• Kontraksi rahim bertambah, ‘colicky pain’
• Dilatasi servik, diikuti dengan pengeluaran semua POC atau ‘incomplete’
• renjatan
![Page 19: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/19.jpg)
‘Septic abortion’
• Insiden 12%• Boleh berlaku pada semu jenis ‘abortion’• Lebih pada ‘incomplete’ dan ‘induced abortion’• 80% infeksi ‘mild’. ‘localized’• Organisma terlibat – anerobic: streptococci, Staphylocci
atau E coli
![Page 20: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/20.jpg)
Septic abortion
• Deman• Discaj vagina yang berbau (pink discharge)• Leucocytosis• Takikardia• Pemeriksaan rahim – boggy dan tender• Investigasi : High vagina swab for C & S, Urine FEME,
BUSE, FBC
![Page 21: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/21.jpg)
Rawatan
• Antibiotik
• Bergantung pada keputusan C & S
• 60 – 70 % organisma adalah gram negatif
• Amoxycillin 500mg.
• Metronidazole 1g.
![Page 22: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/22.jpg)
‘Recurrent abortion’
• Ibu yang mempunyai sejarah > 3 kali ‘abortion’. 30% peluang mendapat ‘recurrent abortion’.
• Jika berjaya bersalin, peluang mendapat premature/ preterm baby.
• Penyebab-penyebab :• Penyakit sistemik – SLE• Cervical incompetence• Uterine myomata –fibroid• Endometrial infection• Chromosomal abnormalities
![Page 23: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/23.jpg)
Rawatan
• Merawat penyebab
• 50% tiada sebab, sokongan emosi
• Pendidikan kesihatan• Pemakanan
• Berhenti merokok
• Elak dari stres
• Ubat vitamin
![Page 24: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/24.jpg)
‘Therapeutic abortion’
• ‘Legal abortion’ dilakukan sebelum 28 minggu, lingkungan 20 – 24 minggu
• Indikasi :• Sosial
• Psikiatrik
• Medical
• Fetal
![Page 25: Abortion - keguguran](https://reader034.fdocuments.net/reader034/viewer/2022052219/58ee44c91a28abc4668b45bb/html5/thumbnails/25.jpg)
Komplikasi ‘abortion’
• Pendarahan vagina
• Infeksi
• Renjatan
• Kelahiran pramatang
• kesakitan