pregnant miscarriage

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Abortus Imminens Threatened Miscarriage dr. Hendy Buana Vijaya Pembimbing : dr. I Made Yudhi Sp. OG

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Page 1: Pregnant Miscarriage

Abortus ImminensThreatened Miscarriage

dr. Hendy Buana Vijaya

Pembimbing :dr. I Made Yudhi Sp. OG

Page 2: Pregnant Miscarriage

Nama : Ny. SrUmur : 37 thRM : 151560Alamat : PT. GSIPPekerjaan : IRTMRS : 07 Februari 2015

Data Pasien

Page 3: Pregnant Miscarriage

Autoanemnesis ( 07 Februari 2015)

• Pasien mengaku hamil dan mengeluh keluar darah dari jalan lahir 1 hari sebelum masuk RS (06 Februari 2015) pada petang hari. Pasien mengeluh hanya berupa gumpalan-gumpalan, sebelum maupun saat keluar darah pasien tidak ada mengeluh nyeri perut. Pasien menyangkal ada terjatuh, berhubungan/kumpul dengan suami, berpijat, maupun meminum obat-obatan. Pasien juga menyangkal adanya demam, kejang. Pasien mengaku sehari sebelum mengeleuh keluar darah sedang melakukan aktifitas berat.

• Riwayat ANC : rutin ke bidan• HPHT : 17 Desember 2014

Anemnesis

Page 4: Pregnant Miscarriage

Riwayat penyakit dahulu• Mengeluh sakit yang sama/keguguran (-)• HT (-), kejang (-)• Alergi makanan/obat (-)

Riwayat obstetri• Perempuan, 14 tahun, 2600gr, spontan,

bidan• Laki-laki, 11 tahun, 2600gr, spontan, bidan

Page 5: Pregnant Miscarriage

Keadaan Umum• Tampak baik• Kesadaran : CM

Tanda vital• Tekanan darah : 130/90 mmHg• Nadi : 84x/m• DJJ : -

Pemeriksaan fisik

Page 6: Pregnant Miscarriage

Kepala/leher• Konjungtiva anemis (-/-)• Sklera ikterik (-/-)

Thorak• Cor : irama reguler, bising (-)• Pulmo: pernafasan simetris, Rh (-), Wh

(-)

Page 7: Pregnant Miscarriage

Abdomen / Obs / Gyn• Insp : datar• Ausk : BU (+) N, Djj – (dopler)• Palp : nyeri tekan (-), uterus setinggi pusat, konsistensi

keras• Perk : timpani• Pemeriksaan dalam : VT = pembukaan (-)

Ekstremitas• Edem : -• Sianosis : -

Page 8: Pregnant Miscarriage

Pemeriksaan Hasil Nilai Normal SatuanHemoglobin 12,9 P : 13-18 W :

12-16Gr/dl

Leukosit 13.300 4000-11.000 /ulEritrosit 4,5 -6,5 juta /ul

Trombosit 319.000 150-450 ribu /ulHematokrit 39,4 37-45 %

Pemeriksaan Laboratorium07 Februari 2015

Page 9: Pregnant Miscarriage

Pemeriksaan Hasil Nilai Normal SatuanBasofil - 0-1 %

Eosinofil - 1-2 %Stab - 2-6 %

Segmen 70 50-70 %Limfosit 25 20-40 %Monosit 5 2-8 %

Page 10: Pregnant Miscarriage

Abortus iminens Usia 8 mgg

USG tanggal 08 Februari 2015

Page 11: Pregnant Miscarriage

O2 3 lpm IVFD RL 20 tpm Po. Ultragestan 1x250 mg

Terapi

Page 12: Pregnant Miscarriage

G3P2A1 + H 7-8 mgg + Abortus imminens

Page 13: Pregnant Miscarriage

Miscarriage is defined as spontaneous loss of a pregnancy before 20 weeks gestation, most miscarriages occur in the first trimester of pregnancy.

Threatenend miscarriage is miscarriage with pervaginam bleeding but conception is still intake and the cervical os (mouth of the womb) is closed.

Definition

Page 14: Pregnant Miscarriage

Misscarriage is common happening in about 15 % to 20% of pregnancies, and it can cause emotional problems in terms of deppresion, sleep disturbances, anger, etr.

Miscarriage can also be associated with excessive bleeding and shock, and in low-income countries sometimes causes maternal death, though this is very rare in high-income countries

Prevalence

Wahabi H, Althagafi A, Elawad M. Progesteron for treating threatened miscarriage (Review). The Chocrane Collaboration. 2008 :1-14

Page 15: Pregnant Miscarriage

Genetics Age Antiphospolipid syndrome Uterine anomalies Hormonal or metabolic Infection Autoimmunity Sperms quality Life style issues

ETIOLOGYof recurrent pregnant loss

Anonymous. Evaluation and treatment of recurrent pregnant loss : a committe opinion. The practice committe of the american society for reproductive medicine. 2012;98:1103-11

Page 16: Pregnant Miscarriage

Progeterone is secreted during early pregnancy from ovary by corpus luteum. Progesterone modulates the imune response of mother to prevent rejection of the embryo and it enhances uterine quiescence and supresses uterine contraction.

A progesterone level greater than 25ng/ml suggests a normal pregnancy, but a level less than 5ng/ml is associated with a poor pregnancy outcome

Progesterone

Miller D. Assessment and management of miscarriage. School of medicine. University of Otago. 2008;35:202-206

Page 17: Pregnant Miscarriage

HCG concentrations in pregnancy

Page 18: Pregnant Miscarriage

The first symptoms are usually vaginal bleeding with or without mild period type pain

Pelvic or backs pain Cervical os closed

Simptoms and sign

Page 19: Pregnant Miscarriage

Differential diagnoses

Idiopathic bleeding

Miscarriage

Ectopic pregnancy

Molar pregnancy

Cervical or vaginal abnormality

Miller D. Assessment and management of miscarriage. School of medicine. University of Otago. 2008;35:202-206

Page 20: Pregnant Miscarriage

Diagnosis / algorithm

Page 21: Pregnant Miscarriage

Miller D. Assessment and management of miscarriage. School of medicine. University of Otago. 2008;35:202-206

Page 22: Pregnant Miscarriage

The principal of management in miscariage is immediate surgical evacuation of the uterus used to be routine for all women presenting spontaneous miscariage because of concern about infection and coagulation.

Surgical managementAspiration curettage or dilatation and curettage Medical managementTreatment with vaginal or oral prostaglandin, usually misoprostol

Management

Page 23: Pregnant Miscarriage

Bed rest Abstinensia (related: oxytocin, prostaglandin E) Progesteron hCG Antibiotics Tocolysis (Buphenine hydrochloride) Immunoglobulin anti-D

Management

Page 24: Pregnant Miscarriage

Cochrane review (Dodd 2006), intramuscular progesterone was associated with a reduction in the risk of preterm birth less than 37 weeks’ gestation, and infant birthweight less than 2500 grams.

Progestogen therapy has been linked to the development of hypospadias (deformity of the penis) in the male fetus (Silver 1999); however, there is little evidence on teratogenicity (Oates-Whitehead 2003).

One of the included studies (Palagiano 2004) has investigatedthe effect of progesterone on the relief of pain due to threatenedmiscarriage and has shown significant reduction with progesterone compare with placebo group.

Facts of progesteron administration

Wahabi H, Althagafi A, Elawad M. Progesteron for treating threatened miscarriage (Review). The Chocrane Collaboration. 2008 :1-14

Page 25: Pregnant Miscarriage

Management

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Page 27: Pregnant Miscarriage
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Prognosis

Page 29: Pregnant Miscarriage

DiscussionAnemnesis

hamilPerdarahan pervaginam

Tidak nyeriUSG

Page 30: Pregnant Miscarriage

Managementcase

O2 nasal 3 lpmRinger Laktatp.O Ultragestan 250mg

Bed rest

Page 31: Pregnant Miscarriage

Follow up Tanggal Subjek Objektif Ass Planning07-02-2015

Plek (+)Nyeri perut (-)

TD 130/90Anemis (-)Nyeri tekan perut (-)DJJ (-)

G3P2A1 + H 2 bulan + Abortus imminens

O2 3 lpmIVFD RL 20 tpmPo. Ultragestan 250mgUSG

08-02- 2015

Plek (-)Nyeri perut (-)

TD 120/90Anemis (-)Nyeri tekan perut (-)DJJ (-)

G3P2A1 + H 8 mgg + Abortus imminens

O2 3 lpmIVFD RL 20 tpmPo. Ultragestan 250mg