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    Abortus: Levina Felicia Supervisor:Dr. Mulyanusa A. Ritonga, Spog (K) ., M.Kes

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    IMO UNPAD
    The document describes a case of a 45-year-old Indonesian woman who presented with vaginal bleeding for 6 days. Her medical history and physical examination are documented. She was diagnosed with septic abortion based on examination findings and lab results. She received IV antibiotics, uterotonics, and curettage to treat the condition and its complications of bleeding and infection. Abortions can be spontaneous or induced and have several classifications. Causes are often multifactorial relating to fetal, maternal, or external factors. Clinical manifestations and differential diagnoses are provided.

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    Abortus: Levina Felicia Supervisor:Dr. Mulyanusa A. Ritonga, Spog (K) ., M.Kes

    Uploaded by

    IMO UNPAD
    25 views27 pages
    The document describes a case of a 45-year-old Indonesian woman who presented with vaginal bleeding for 6 days. Her medical history and physical examination are documented. She was diagnosed with septic abortion based on examination findings and lab results. She received IV antibiotics, uterotonics, and curettage to treat the condition and its complications of bleeding and infection. Abortions can be spontaneous or induced and have several classifications. Causes are often multifactorial relating to fetal, maternal, or external factors. Clinical manifestations and differential diagnoses are provided.

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    CRS ABORTUS

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    The document describes a case of a 45-year-old Indonesian woman who presented with vaginal bleeding for 6 days. Her medical history and physical examination are documented. She was diagnosed with septic abortion based on examination findings and lab results. She received IV antibiotics, uterotonics, and curettage to treat the condition and its complications of bleeding and infection. Abortions can be spontaneous or induced and have several classifications. Causes are often multifactorial relating to fetal, maternal, or external factors. Clinical manifestations and differential diagnoses are provided.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    25 views27 pages

    Abortus: Levina Felicia Supervisor:Dr. Mulyanusa A. Ritonga, Spog (K) ., M.Kes

    Uploaded by

    IMO UNPAD
    The document describes a case of a 45-year-old Indonesian woman who presented with vaginal bleeding for 6 days. Her medical history and physical examination are documented. She was diagnosed with septic abortion based on examination findings and lab results. She received IV antibiotics, uterotonics, and curettage to treat the condition and its complications of bleeding and infection. Abortions can be spontaneous or induced and have several classifications. Causes are often multifactorial relating to fetal, maternal, or external factors. Clinical manifestations and differential diagnoses are provided.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    Abortus

    Levina Felicia
    Supervisor:dr. Mulyanusa A. Ritonga, SpOG (K)., M.Kes
    Identitas Pasien

    • Name : Mrs. W
    • Date of birth / Age: December, 30th 1979/ 45 years old
    • Nationality: Indonesia
    • Address : Jl. Siti Munigar No 68, Astanaanyar
    • Marital status : Married
    • Occupation : Housewife
    • Religion : Moslem
    • Date of admission : 27-9-2018
    • Date of examination : 27-9-2018
    Keluhan Utama
    • Perdarahan dari jalan lahir
    Riwayat Penyakit Sekarang
    • P0A2 datang dengan keluhan perdarahan dari jalan lahir sejak ± 6 hari SMRS.
    Perdarahan bergumpal membasahi 3-4 pembalut/hari disertai keluar jaringan seperti
    daging dirasakan sejak 6 hari SMRS. Riwayat keluar gelembung seperti telur ikan
    disangkal. Riwayat minum obat-obatan disangkal. Riwayat minum jamu-jamuan
    disangkal. Riwayat panas badan diakui ibu 1 hari SMRS. Ibu dirawat selama 2 hari di RS
    daerah, tetapi karena pasien membutuhkan ruang rawat intensif maka pasien dirujuk ke
    RSHS.
    Riwayat Pernikahan
    Marriage ♀ ♂
    1st 20/ SD, IRT 30/ SD, Wiraswasta
    2nd 30/ SD, IRT 52/ SD, wiraswasta
    Obstetrics and Gynecology History

    Pregnancy Labor History Keterangan


    1 Abortus Tidak dikuret
    2 Abortus

    • Contraception : -
    • HPHT : lupa
    • ANC :-
    Physical Examination

    • General appearance: compos mentis, • Physiological Reflex: -/-


    moderately ill • Edema: -
    • Vital Signs • Varices: -
    • BP : 140/80 mmHg ; Temp : 36.8 ; • Thorax : symmetrical
    PR : 94x/min ; RR : 24x/min
    • Heart : S1-S2 regular
    • Height : 140cm ; Weight : 60 kg
    • Lungs : WH: -/-, RH -/-
    Obstetrics Examination
    • Abdomen :
    - Flat and soft
    - Fundal height not palpable
    - Muscular defense (-)
    - Pain on palpation (+)
    Obstetrics Examination

    • Inspeculo
    • Presence of blood coming out from OUE (+)
    • Fluxus: +, foul smelling
    • Vaginal Toucher :
    • Vulva/Vagina : no abnormalities
    • Portio: 1 cm opening, tissue palpated (+)
    pain at movement (-)
    • Adnexa : mass (-), pain on movement (-)
    • Douglas Pouch : empty, not bulging, pain (-)
    Lab Results
    • Hb : 6.1
    • Leukocyte : 12,760
    • Hematocrit : 19.4
    • Thrombocyte : 337,000
    • RBG: 169
    • Ur 47
    • Cr 1,34
    • PT 38
    Diagnosis and Management
    • Working Diagnosis : Septic Abortion
    • Management :
    • O2 nasal cannule
    • Routine lab, ECG
    • Metronidazole 3x500 mg IV
    • Ceftriaxone 2x1 gr IV
    • Paracetamol 3x500 mg
    • R/ USG fetomaternal
    • Perbaikan KU
    • Konsul TS IGD
    • Metergin 0,2 mg IM/ day
    • tendelenburg
    Discussion
    Abortus febrilis
    Abortion: definition
    • Abortion is defined as the spontaneous or induced termination of
    pregnancy before fetal viability

    WHO definition of abortion:


    • Abortion is defined as pregnancy termination before 20 weeks’ gestation
    or with fetus born weighing <500 grams.
    Abortion: Classification
    Classification by onset:
    1. Early abortion: occur in the first trimester (<12 weeks)
    2. Late abortion: occur in gestational age 12-24 weeks (T2).

    Classification by mechanism
    3. Spontaneous abortion
    4. Abortus provocatus: therapeuticus or criminalis
    Epidemiology
    • The incidence of abortion in America is approximately 10-20%.
    • In RSHS Bandung, the incidence of abortion is 18-19%
    • Most abortion happens during gestational age <12 weeks.
    • Only 4% of all abortion happens in second trimester.
    Etiology of Abortion
    The etiology of abortion is multifactorial. These are the risk factors of abortion:

    1. Fetal factors:
    1. Egg defect: blighted ovum, embryo defect, chromosome abnormalities
    2. Embryo trauma: post-chorionic villi sampling, post amniocentesis
    3. Placental development disorder: trophoblast hypoplasia
    Etiology of Abortion ~ cont.
    The etiology of abortion is multifactorial. These are the risk factors of abortion:
    2. Maternal factors:
    1. Infection in T1, T2
    2. Vascular disease (hypertension, heart disease)
    3. Immunology: HLA incompatibility, SLE
    4. Uterus disorders: hypoplasia uterus, mioma, incompetent cervix
    5. Endocrine disorders: thyroid dysfunction, insulin deficiency
    Etiology of Abortion ~ cont.
    The etiology of abortion is multifactorial. These are the risk factors of
    abortion:
    3. External factors
    1. Radiation
    2. Drugs: folic acid antagonist, anti-coagulant, etc
    3. Chemical substance: containing arsenic, benzene, etc
    4. Nutrition: severe dietary deficiency and morbid obesity
    Pathogenesis
    • Fetal death occur, soon followed by bleeding into the decidua basalis.
    • Necrotic changes in the implantation area, infiltration of acute
    inflammation cells, followed by vaginal bleeding
    • The conception products will be considered as foreign substance, uterus
    will start to contract to expel it.
    Types of Abortion.
    • Expulsion of conception is based on 4 mechanisms :
    1. Chorionic sac is expulted during very early pregnancy, leaving behind decidual residue.
    2. Amniotic sac and its content(fetus) is pushed outwards, leaving the chorion and decidue.
    3. Breakage of amnion followed by umbilical cord break off and expulsion of fetus outwards
    but the amniotic and chorionic remains inside.
    4. Whole fetus and decidue which is stuck is pushed outside while intact.
    • Most types of abortion falls in the first three types and curettage has to performed to clean
    the uterus and prevent bleeding or infection.
    Differential Diagnosis
    DD bleeding in early gestational age:
    1. Abortion
    2. Ectopic pregnancy: bleeding, abdominal pain, uterine size bigger than
    gestational age, tenderness on palpation
    3. Hydatids mole: bleeding, uterine size bigger than gestational age,
    vesicular pattern on USG, higher b-HCG level, pathology anatomy
    specimen check
    Clinical manifestations of spontaneous
    abortion
    1. Threatened abortion: bleeding (not much), ostium uteri is closed, uterus size is
    similar to gestational age, pregnancy still can be carried on; mild or no abdominal pain
    2. Inevitable abortion: abortion is happening, ostium uteri is opened, amnion is
    palpable, uterus contraction
    3. Incomplete abortion: a part of conception product is left behind, ostium uteri is
    opened, palpable tissue
    4. Complete abortion: conception product has already been expelled completely, ostium
    uteri is closed and uterus size is smaller OR ostium is closed and empty uterine cavity
    Clinical manifestations of spontaneous
    abortion
    5. Missed abortion: the conception product has been dead for 8 weeks or
    more and is retained inside the uterine.
    6. Abortus febrilis/infeksiosa: abortion with infection
    7. Abortus habitualis: abortion occurs >= 3x consequently
    Type of abortion Bleeding Cervix Conception Uterine size Other symptoms
    product
    Imminent Mild to moderate Closed Still inside Similar to Abdominal pain
    abortion
    Clinical manifestations of spontaneous
    uterine cavity gestational age and cramp, low
    back pain

    heavy abortion - Conclusions


    Inevitable Moderate to Opened Still inside Similar to/ Cramp and
    abortion uterine cavity smaller than GA abdominal pain
    Incomplete Mild to moderate Opened Some part has Smaller than GA Cramp, abdominal
    abortion already been pain, tissue expelled
    expelled
    Complete None to mild closed All part have Smaller than GA Mild/no pain, soft
    abortion been expelled uterus
    Missed abortion None Closed None (dead) Smaller than GA No signs of
    pregnancy
    Febrile abortion Ask prior abortus Opened Palpated in OUE Smaller than GA Abdominal pain,
    provokatus tenderness in
    palpation, febris,
    foul-smelling fluxus
    Complications of Abortion
    • Complications that may arise include :
    • 1. Bleeding (lacerations at birth canal, uterine atonia, residual tissue)
    • 2. Shock
    • 3. Infections
    • 4. Air Embolisms
    Management plan
    1. If the patient has shock, manage the shock first
    2. Give blood transfusion if Hb <8 g%
    3. Give uterotonic drugs (methyl ergometrin 0.2 mg IM)
    4. Give broad spectrum antibiotic (aerob and non-aerob)
    Ampicillin 3x1 gr and metronidazole 3x500 mg oral
    5. Curretage after 6 hours of antibiotics and parenteral uterotonic
    THANK YOU

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