Abortus Imminens

Threatened Miscarriage
dr. Hendy Buana Vijaya

Pembimbing :

dr. I Made Yudhi Sp. OG

Data Pasien
Nama

: Ny. Sr
Umur
: 37 th
RM
: 151560
Alamat
: PT. GSIP
Pekerjaan : IRT
MRS
: 07 Februari 2015

Anemnesis
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 obatobatan. 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

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

Pemeriksaan fisik
Keadaan Umum
Tampak baik
Kesadaran : CM

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

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

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

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

::-

Pemeriksaan Laboratorium
07 Februari 2015
Pemeriksaa
n

Hasil

Nilai Normal

Satuan

Hemoglobin

12,9

P : 13-18 W :
12-16

Gr/dl

Leukosit

13.300

4000-11.000

/ul

4,5 -6,5 juta

/ul

Eritrosit
Trombosit

319.000

150-450 ribu

/ul

Hematokrit

39,4

37-45

Pemeriksaa
n

Hasil

Nilai
Normal

Satuan

Basofil

0-1

Eosinofil

1-2

Stab

2-6

Segmen

70

50-70

Limfosit

25

20-40

Monosit

2-8

USG tanggal 08 Februari

2015
Abortus iminens
Usia 8 mgg

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

G3P2A1 + H 7-8 mgg + Abortus

imminens

Definition
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.

Prevalence
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 lowincome countries sometimes causes
maternal death, though this is very rare in
high-income countries

Wahabi H, Althagafi A, Elawad M. Progesteron for treating

threatened miscarriage (Review). The Chocrane Collaboration.
2008 :1-14

ETIOLOGY
of recurrent pregnant loss
Genetics
Age
Antiphospolipid syndrome
Uterine anomalies
Hormonal or metabolic
Infection
Autoimmunity
Sperms quality
Life style issues

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

Progesterone
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

Miller D. Assessment and management of miscarriage.

School of medicine. University of Otago. 2008;35:202-206

HCG concentrations in
pregnancy

Simptoms and sign

The first symptoms are usually vaginal
bleeding with or without mild
period type pain
Pelvic or backs pain
Cervical os closed

Differential diagnoses

Miller D. Assessment and management of miscarriage.

School of medicine. University of Otago. 2008;35:202-206

Diagnosis / algorithm

Miller D. Assessment and

management of miscarriage.
School of medicine.
University of Otago.
2008;35:202-206

Management
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 management
Aspiration curettage or dilatation and curettage
Medical management
Treatment with vaginal or oral prostaglandin,
usually misoprostol

Management

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

Facts of progesteron
administration

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 (OatesWhitehead 2003).
One of the included studies (Palagiano 2004) has investigated
the effect of progesterone on the relief of pain due to threatened
miscarriage and has shown significant reduction with progesterone
compare with placebo group.

Wahabi H, Althagafi A, Elawad M. Progesteron for treating

threatened miscarriage (Review). The Chocrane Collaboration.
2008 :1-14

Management

Prognosis

Discussion

Management

Follow up
Tanggal

Subjek

Objektif

Ass

Planning

07-022015

Plek (+)
Nyeri
perut (-)

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

G3P2A1
+H2
bulan +
Abortus
imminens

O2 3 lpm
IVFD RL 20 tpm
Po. Ultragestan
250mg
USG

08-022015

Plek (-)
Nyeri
perut (-)

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

G3P2A1
+H8
mgg +
Abortus
imminens

O2 3 lpm
IVFD RL 20 tpm
Po. Ultragestan
250mg