Diagnosis kehamilan dan abortus
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Transcript of Diagnosis kehamilan dan abortus
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DIAGNOSIS KEHAMILAN
Dr Wisnu Prabowo SpOG
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LAMA KEHAMILAN
• 280 hari/ 40 minggu/ 10 bulan (lunar month)• Trimester I : 0 – 12 minggu• Trimester II : 13-28 minggu• Trimester III : 29-40 minggu
• ATERM ( 37 - 40 MINGGU)• IMATURE ( 20 - 28 MINGGU)• PRETERM ( 28 - 36 MINGGU )• POSTERM ( > 40 MINGGU )
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TANDA & GEJALA KEHAMILAN
• TANDA TIDAK PASTI– Amenore– Mual-muntah– Mengidam– Pingsan– Anoreksia– Payudara membesar– Gangguan BAK-BAB– Pigmentasi kulit– Varises– Epulis
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• Tanda Pasti– Gerakan janin (perabaan)– Denyut jantung janin (fetoskop, dopler, USG)– Tulang janin (Rontgen)
• Diagnosis Banding Kehamilan– Pseudocyesis– Mioma Uteri– Kista Ovarii– Retensi Urin– Hematometra
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PERDARAHAN ANTEPARTUM
TRIMESTER I
ABORTUSHAMIL EKTOPIK
MOLA HIDATIDOSA
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ABORTUS/ MISCARRIAGE
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Pengeluaran hasil konsepsi < 500 mg ( 20 minggu)
• Spontan• Tindakan:
•kriminalis•teraupetis/ medicinalis
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Etiologi
• kelainan pertumbuhan hasil konsepsi:– kelainan kromosom– lingkungan – pengaruh luar
• kelainan placenta• penyakit ibu• kelainan traktus genitalis
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Diagnosa
• Perdarahan pada kehamilan muda Pikirkan:– abortus– KET– Mola hidatidosa– Hamil dengan kelainan kelainan serviks
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Anamnesa
• perdarahan: jumlah/ jenis• nyeri• last menstrual period/ HPHT• tanda-tanda kehamilan berkurang ??• Riwayat obstetri• Riwayat ginekologi, infeksi serviks, operasi• Riwayat KB
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DERAJAD ABORTUS :
Diagnosa Perdarahan Serviks Besar Uterus Gejala lain
Ab Iminens Sedikit - sedang
Tertutup Sesuai dengan usia kehamilan
- uji hamil (+)- Kram- Uterus lunak
Ab Insipiens Sedang – banyak
Terbuka Sesuai atau lebih kecil - Kram- Uterus lunak
Ab Inkomplet Sedikit – banyak
Terbuka Lebih kecil dari usia kehamilan
- Kram- Keluar jaringan- Uterus lunak
Ab Komplet Sedikit at tidak ada
Lunak (terbuka – tertutup)
Lebih kecil dari usia kehamilan
- Sedikit at tidak ada kram- Keluar massa kehamilan- Uterus kenyal
Missed Abortion
Sedikit, warna kehitaman
Agak kenyal dan tertutup
Lebih kecil dari usia kehamilan
- Menghilang sebagian gejala kehamilan- Uterus tidak membesar- Embrio mati
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Immines (Threatened/
ancaman)
• perdarahan segar• besar uterus sesuai umur kehamilan• Ostium uteri eksternum tertutup• USG: tanda-tanda kehidupan FHM, FM
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Insipiens (Inevitable, berlangsung)
• Nyeri/ mules• Bekuan darah• Ostium uteri eksternum membuka
– (ketuban +)
• USG: hasil konsepsi dalam uterus
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Kompletus
• besar uterus < normal• OUE menutup• Perdarahan sedikit• USG: hasil konsepsi (-)
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Inkompletus
• Perdarahan + bekuan• OUE terbuka• Teraba jaringan dalam canalis
servikalis
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Missed abortion
• Tanda dan gejala kehamilan menghilang
• Perdarahan sedikit• USG: tanda kehidupan janin (-)
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abortus septik
• semua yang disebut disertai infeksi
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Pemeriksaan
• inspekulo• pemeriksaan dalam• USG
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Penanganan
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Imminens
• bed rest• progesteron ??
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Insipiens/ Inkompletus/
kompletus/ missed, prinsipnya
• menghentikan perdarahan/ evakuasi
• mengembalikan fungsi hemodinamika
• mencegah infeksi
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Komplikasi
• perdarahan• perforasi• syok• infeksi
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Abortus habitualis
3 x abortus spontan berturut-turut
• causa ??
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•immunologi (Tlx ??)•antikardiopilin antigen•ABO inkompability•GTT•VDRL/ TPHA•Kelainan kromosom ??•Infeksi mikoplasma•Serviks inkompeten
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Therapi
• Spesifik tidak adaInkompeten serviks:
ShirodkarMac Donald
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