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CASE REPORT

Febrilis Abortion

Supervised by :
Mutawakil J. Paransa, dr., Sp.OG

Written by :
Muhamad Dony Ardiansyah

12100116197

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

MEDICINE FACULTY OF BANDUNG ISLAMIC UNVERSITY

RSUD R SYAMSUDIN, SH SUKABUMI


2018
CHAPTER I
INTRODUCTION

One of the most complications in pregnancy it was a bleeding, that could happen to any

the gestational age. Young in pregnancy, often connected with abortus, miscarriage, and loss of

early pregnancy. Abortus is defined as the threat or spending the products of conception before a

fetus can live outside the utery. Constitutes gestational age is less than 20 weeks or fetus weight

less than 500 grams. Abortus imminens is pervaginam bleeding in pregnancy before 20 weeks

without accompanied the release of the products of conception and dilatation of the uterus. The

prevalence of abortion also increases with age, whereas in 20-year-old women it is 12%, and in

women over 45 years is 50%. Eighty percent of abortions occur in the first 12 weeks of pregnancy.

One type of abortion is febrile abortion / abortion with infection. Infectious abortion is an

infected incomplete / insipiens abortion. Febrile abortion needs immediate management because

it can be a wider infection than around the genitalia also into the peritoneal cavity, even into the

whole body (sepsis) and may fall into septic shock. There are two types of abortus febrilis that is

without complications and that has been complicated

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CHAPTER II
CASE REPORT

A. Patient’s Identity
a) Patient

Name : Mrs. C

Date of Birth/ Age : 37 years old

Nationality : Indonesian

Address : Kp. Cijoho 10/4 Kec. Cidolog Kab. Sukabumi

Graduate from : High School

Marital Status : Married

Occupation : Housewife

Religion : Islam

Date of admission : January, 11th 2018

b) Husband

Name : Mr. U

Date of Birth/ Age : 40 years old

Nationality : Indonesian

Address : Kp. Cijoho 10/4 Kec. Cidolog Kab. Sukabumi

Graduate from : High School

Marital Status : Married

Occupation : Employe

Religion : Islam

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B. History Taking
 Chief Complaint
Vaginal bleeding since 3 days ago

 History of Present Illness


Patient came to the RSUD R. Syamsudin, SH’s obstetrician & gynecologist emergency,
with complaint with complaint vaginal bleeding since 3 days before admission. Patient was feeling
pregnant 3 months. Patient said the bleeding caused the patient fell in the bathroom. Hemorrhagic
bleeding is as big as a fist and accompanied by tissues like a meat. For 3 days the patient did not
go to the doctor only brought to traditional birth attedants. The bloods that came out had a bad
smell and the patient become had a fever at night.

 History of Past Illnesses


History of surgery : denied
History of curettage : denied
History of chronic hypertension : denied
History of kidney disease : denied
History of diabetes mellitus : denied
History of auto immune disease : denied
History of asthma : denied
History of allergy : denied
History of cancer : denied
History of TBC : denied

 Familial History
History of hypertension : denied
History of kidney disease : denied
History of diabetes mellitus : denied
History of auto immune disease : denied
History of cancer : denied

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 Menstruation History
Menarche : 12 years old
Menstrual cycle : regularly every 28 days, 7 days duration and
without history of pain during menstruation
Amount of menstrual blood : 2-3 normal pads / day
First day of LMP : Patient was forget

 Contraception History
History of using oral contraception for 3 months

 Marital History
Married three times, she has been married for 19 years

 Obstetric History
No Age Gestational Labour History Sex Birth Info
Age Weight
1 2 months Aterm Spontaneous Female - Passed Away
Labor (febrile convulsion)
2 17 yo Aterm Spontaneous Female - Live
Labor
3 6 yo Aterm Spontaneous Female - Live
Labor
4 4 days Preterm Spontaneous Female - Passed Away
Labor
5 This
Pregnancy

C. Physical Examination
General condition : Moderately ill
Level of conciousness : Compos mentis
Vital signs :
Blood preassure : 110/70 mmHg

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Heart rate : 90x/ minutes
Respiration rate : 21x/ minutes
Temperature : 36,4oC (have been given fever medicine)
Weight : 45 kg
Height : 155 cm
BMI : 18 kg/m2

 General Examination
Eyes : anemic conjunctiva -/-, icteric sclera -/-
Mouth : wet oral mucosa membrane
Heart : regular 1st and 2nd heart sounds, murmur -, gallop -
Lung
Inspection : symmetric chest expansion in breathing
Percussion : resonant on both lungs
Auscultation : vesicular breath sounds +/+, rhonchi -/-, wheezing -/-
Abdomen
Inspection : convex, mass (-)
Palpation :mass (-), tenderness (-), soft
Auscultation : bowel sound (+) normal
Extremities : warm, edema -/-/-/-, CRT < 2 seconds

 Obstetric Examination
External Examination :
• Fundal Height : not palpable
• Waist circumference : not examined
• HIS : (-)
• FHR : (-)
Internal Examination :
• Vulva/ vagina : not found any abnomalities
• Portio : thick, soft
• Cervical dilation : 2cm

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• Fetal membrane : not examined

Support Examination
USG
Found the residual of intra uterine tissue

Laboratorium
Hb : 10,0 gr/dL
Ht : 30 %
Leukocyte : 27.200 cells
Thrombocyte : 396.000 cells

Working Diagnosis
Mrs. C, 37 years old, G5P4A0, gravida 16 weeks with febrile abortion

Management
a. IVFD Futrolit 20 gtt
b. Ceftriaxone 2x1 gram IV
c. Metronidazole 3x500 mg IV
d. Planning for curretage

Prognosis
Quo ad vitam : ad bonam
Quo ad functionam : ad bonam
Quo ad sanationam : ad bonam

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CHAPTER III
PROBLEMS
Problems:
A. How to diagnose Febrile Abortion?
 History taking
To assess febrile abortion from history taking, first thing to be done is to seek for clinical
manifestation such as fever, bad smell bleeding, pain in the symphysis or lower abdomen,
abdominal distention of peritonitis.
In this case, patient is woman, 37 years old, with complaint with complaint vaginal bleeding
since 3 days before admission. Patient was feeling pregnant 3 months. Patient said the bleeding
caused the patient fell in the bathroom. Hemorrhagic bleeding is as big as a fist and accompanied
by tissues like a meat. For 3 days the patient did not go to the doctor only brought to traditional
birth attedants. The bloods that came out had a bad smell and the patient become had a fever at
night. History of menstruation patient had a menarche at 12 years old, menstrual cycle regularly
every 28 days, 7 days duration and without history of pain during menstruation, amount of
menstrual blood 2-3 normal pads / day, patient was forget first day of last menstrual period. History
of using oral contraception for 3 months. Patient has been married three times for 19 years

Conclusion:
From the chief complain, patient was feeling have vaginal bleeding since 3 days before
admission. Patient was feeling pregnant 3 months. Patient said the bleeding caused the patient fell
in the bathroom. Hemorrhagic bleeding is as big as a fist and accompanied by tissues like a meat.
For 3 days the patient did not go to the doctor only brought to traditional birth attedants. The bloods
that came out had a bad smell and the patient become had a fever at night. Because of it, she was
required supporting examination, in this case to diagnose what is the real problem and patient
undergo hematologic laboratorium and usg examination.

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 Physical examination
To assess febrile abortion from general examination found the temperature of body more
than 37,5oC. On Obstetric examination there are ostium uteri usually open, palpable tissue residual,
there is pain in palpation of portio and adnexa, and bad smell fluxus.

Conclusion:
In this patient found from general examination found the temperature of body febris when
the patient admitted to the hospital. On Obstetric examination there are cervical dilatation 2cm,
palpable residual tissue, there is pain in palpation of portio, and bad smell blood.

 Hematologic examination
- Hb : 10,0 gr/dL
- Ht : 30 %
- Leukocyte : 27.200 cells
- Thrombocyte : 396.000 cells

Conclusion :
Leukocytosis

 USG examination
Found the residual of intra uterine tissue
Conclusion :

Incomplete Abrotion

B. What is Management for Febrile Abortion


Management of Febrile abortion falls into two general categories: observation and
treatment.

 Stabilization Of Vital Signs


 Administration Of Aerobic And Anaerobic Antibiotics

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 Uterotonic Administration
 Curettage

Conclusion :
In this patient, has been give IVFD Futrolit 20 gtt for fluid therapy. Antiobiotic administered
ceftriaxone 2x1 gram IV for aerob microorganism and metronidazole 3x500 mg IV for anaerob
microorganism. This patient is planned for curretage.

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CHAPTER IV
CASE ANALYSIS
Theory Case
Anamnesis Febrile Abortion Febrile Abortion

Clinical manifestation Clinical manifestation


 Fever  Pastient had Fever
 Vaginal bleeding  Patient had vaginal bleeding
 Bad smell bleeding 3 days ago
 Pain in the symphysis or  Bad smell bleeding
lower abdomen
 Abdominal distention of
peritonitis

Physical General examination found General examination found


examination the temperature of body the temperature of body
more than 37,5oC. On febris when the patient
Obstetric examination
admitted to the hospital. On
there are ostium uteri
usually open, palpable Obstetric examination there
tissue residual, there is are cervical dilatation 2cm,
pain in palpation of portio palpable residual tissue,
and adnexa, and bad smell there is pain in palpation of
fluxus. portio, and bad smell blood.

Supporting  Hematologic  Hematologic


examination
examination examination
Leukocytosis Leukocytosis

 USG examination  USG examination


Found the residual of intra Found the residual of intra
uterine tissue uterine tissue
-

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CHAPTER V
CONCLUSION

Patient, Ny. C, a 37-year-old female, 3 months old pregnancy with a major complaint of

vaginal bleeding accompanied by signs of infection. From laboratory investigation found

leukocytosis. While ultrasound examination found the remaining intra uterine tissue. From

anamnesis, physical examination and supported by support examination then the patient is

diagnosed with abortus febrilis. Management given in this case is the provision of fluid therapy

and a combination of two types of antibiotics. After a general stable, curettage is performed on the

patient to remove residual tissue. Furthermore, patients are given oral therapy in the form of

antibiotics, uterotonic, analgetic and monitored vital signs and post-curettage complaints. If the

patient's condition improves after the curretage, the patient could be discharged.

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REFERENCES

1. Hanifa W, dkk. 1999. ‘Kelainan Dalam Lamanya Kehamilan’. Ilmu Kebidanan. Edisi 2.

Yayasan Bina Pustaka Sarwono Prawirohardjo. Jakarta. Hal : 302 – 12

2. Sulaiman S, dkk. 2005. ‘Kelainan Lama Kehamilan’. Obstetri Patologi. Penerbit EGC. Jakarta.

Hal 1 – 9

3. Sarwono P. 2010. Perdarahan pada Kehamilan Muda. Ilmu Kebidanan Edisi 4. Yayasan Bina

Pustaka Sarwono Prawirohardjo. Jakarta. Hal: 473

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