their pregnant patients as they may present with pain, vaginal bleeding, or more vague complaints

such as nausea and vomiting.

An ectopic pregnancy occurs when this fetal tissue implants somewhere outside of the uterus or
attaching to an abnormal or scarred portion of the uterus.
Various risk factors for ectopic pregnancy have been identified (2-5) including previous
ectopic pregnancy, previous pelvic surgery, induction of ovulation, intrauterine device usage,
history of pelvic inflammatory disease (PID), and smoking at the time of conception (2, 6-9).

Aim. To determine pregnancy and delivery outcomes among teenagers. Materials and Methods. An
8-year retrospective comparative hospital-based cohort study is analysing singleton pregnancy
comorbidities and delivery parameters of a teenage group under the age of 20 compared with a
young adult group 20–24 years of age in a university hospital. Results. Teenage is a risk factor for
preterm birth <37 weeks (1.21 [1.08–1.35]), foetal growth restriction (1.34 [1.21–1.48]), episiotomy
(1.27 [1.21–1.34]), uterine revision (1.15 [1.06–1.25]), APGAR <7 at 1 min (2.42 [1.21–1.67]),
cephalopelvic disproportion (1.26 [1.07–1.48]), and postpartum haemorrhage (1.42 [1.25–1.62]);
however, caesarean delivery occurs less frequently in teenagers than in adults (0.75 [0.70–0.80]).
The following comorbidities are risk factors for teenage pregnancy (risk ratio [CI 95%]): anaemia
(1.13 [1.10–1.17]), low urinary tract infection (1.10 [1.03–1.18]), pediculosis (2.42 [1.90–3.00]),
anogenital condyloma (1.50 [1.04–2.17]), and trichomoniasis (1.74 [1.12–2.68]). The risks for
hepatitis B and hepatitis C, premature rupture of membranes, and placenta praevia were lower
compared with those in the young adult group, respectively, 0.43 (0.26–0.71), 0.90 (0.85–0.96), and
0.29 (0.20–0.41), while the risk for gestational diabetes and preeclampsia were the same in both
groups. Conclusion. Considering the high risks for teenage pregnancy, this information should be
provided to pregnant adolescent women and their caregivers.
Cavum retzi : excavasio vesikouterina

Cavum douglass : excavasio rectouterine

Darah banyak ngumpul di cavum douglass, cek nyeri goyang vagina. Karena kehamilan ektopik (di
tuba) yang pecah dan darahnya ngisi cavum douglass.
https://www.slideshare.net/merisadewi/kehamilan-ektopik-terganggu
Teen pregnancies carry extra health risks to both the mother and the baby.
Often, teens don't get prenatal care soon enough, which can lead to problems later on. They
have a higher risk for pregnancy-related high blood pressure and
its complications. Risks for the baby include premature birth and a low birth weight.

WHO

 Adolescent mothers (ages 10–19 years) face higher risks of eclampsia,

puerperal endometritis, and systemic infections than women aged 20 to
24 years, and babies of adolescent mothers face higher risks of low
birth weight, preterm delivery and severe neonatal conditions. (4)

Purpose of review: Ectopic pregnancy continues to be an important cause of morbidity and

mortality in women. Tubal damage is the likely cause of ectopic pregnancy. Healthcare
providers who care for adolescents must screen for and treat sexually transmitted diseases
like Chlamydia in order to decrease the risk of tubal damage and ectopic pregnancy.
Smoking is a risk factor for ectopic pregnancy and teens should be encouraged to never start
smoking or to quit if they already do smoke. Though ectopic pregnancy is more likely to
occur in adults, teens are at risk as well, and early diagnosis allows for the possibility of
conservative management.

Recent findings: Any teen who presents with amenorrhea, pain, or vaginal bleeding should
be evaluated for a possible ectopic pregnancy. Adolescents are more likely to present with
pain than adults. Transvaginal ultrasound should be performed and if an intrauterine
pregnancy or ectopic pregnancy is not clearly seen, correlation with serum beta-human
chorionic gonadotropin levels is done. If the beta-human chorionic gonadotropin level is
above the 'discriminatory zone' of 1500 mIU and the transvaginal ultrasound does not show
an intrauterine pregnancy, ectopic pregnancy should be suspected.

https://pubmed.ncbi.nlm.nih.gov/18797271/

RESIKO KALAU HAMIL MUDA

1. Keguguran
2. Gangguan Kesehatan

Organ reproduksi remaja belum siap untuk mengandung bayi selama 9 bulan. Sehingga,
hamil di usia remaja bukan nggak mungkin menyebabkan robekan di vagina dengan saluran
cerna atau saluran kencing dengan vagina. Akibatnya, di kemudian hari akan menimbulkan
infeksi yang berulang dan dapat menurunkan kualitas hidup remaja tersebut.

3. Bayi Lahir Prematur dan Berat Bayi Lahir Rendah (BBLR)

4. Anemia

"Kekurangan zat besi ketika hamil juga berhubungan dengan makanan yang dikonsumsi ibu.
Ketika tidak banyak mengonsumsi sayuran dan makanan yang mengandung zat besi, ibu
akan kekurangan zat besi dan berisiko anemia," jelas dr Uf.

5. Pendarahan

Pendarahan menjadi salah satu penyebab kematian pada ibu. Rahim perempuan yang
hamil di usia remaja masih terlalu kecil dan menyebabkan kontraksi terganggu. Akibatnya,
risiko pendarahan ketika persalinan meningkat. Pendarahan, baik berupa gumpalan yang
keluar atau tetap ada di dalam rahim bisa memicu infeksi, Bun.

6. Bayi Masuk NICU

Normalnya, bayi berada di kandungan ibu selama 37 minggu. Makanan yang dikonsumsi ibu
akan masuk ke tubuh bayi melalui plasenta. Saat hamil di usia remaja, risiko bayi lahir
prematur tinggi. Jika bayi lahir kurang dari 37 minggu, asupan oksigen ke tubuh bayi akan
menurun karena otak bayi tidak bisa berkembang dengan semestinya. Paru-paru bayi yang
lahir kurang dari 37 minggu tidak bisa berfungsi dengan sempurna. Sehingga, bayi harus
dirawat di Neonatal Intensive Care Unit (NICU) yang biayanya sangat mahal dan harapan
hidupnya juga tidak tinggi.
7. Cacat Bawaan
Kulpeng SL

RUMUS NEAGLE: hpmt + 7 hari – 3 bulan + 1 tahun

HPL: HPMT + 7 hari – 3 bulan

HPL= 40 minggu

Usia kehamilan = 40 minggu – (HPL - tgl sekarang)

Hamil ke-4, gugur 3x, usia 31 tahun. HPMT 20 mei 2020.

Kepala turun hodge 3, pembukaan 4 cm

Djj 140x/menit

39 minggu 4 hari

Multigravida nullipara, hamil aterem dalam

persalinan pembukaan 4, kala 1 fase aktif

Aterm 37 – 40 minggu 6 hari

Post date 41-42 minggu (?)

Preterm

Keluhan kenceng2

G2P1A0. Ibu 16 tahun. Umur kehamilan

HPMT 24 desember 2020

Keluar perdarrahan jalan lahir

Keluar jaringan/janin

8 minggu masih abortus

Sekundi gravida, abortus inkomplit, hamil 8 minggu

Klo abortus dikuret

Trimester 1 kontrol 1 bulan sekali sampai usia kehamilan 34 minggu.

Klo dah postdate harus diterminasi

Harus ada 10 syarat untuk dikatakan persalinan normal

Kala 1: fase laten dan aktif

Primi 13 jam. Multi 7 jam

Preterem dilakuin episiotomy karena kepala bakal leih besar dari badan. Sulit keluar. Nanti bisa
perdarahan. Maknaya episiotimi primer.

Eklamsi, jantung, harus epis primer

Sekunder: cegah melukai perineum yg sudah sangat teregang

Klo ibu2 panik primigravida perineum akan kaku.

Kalo rileks santai, perineum akan lunak elastis. Metodenya banyak.

Klo gk lahir dalam 30 menit maka akan perdarahan  retensi plasenta. Harus manual plasenta.
Hati hati syok neurogenic. Jgn ditarik, tapi diregangin

Eavaluasi 2 jam. Kandung kemih jgn sampai full (?)

Tinggi fundus uteri berkaitan dengan nifas. 2 jari di bawah pusar setelah persalinan.

Nadi 100 ada tanda2 bleeding.

KEHAMILAN EKTOPIK TERGANGGU

DEFINISI
Implantasi blastokista di tempat yang lain selain di endometrium rongga uterus.

An ectopic pregnancy occurs when fetal tissue implants outside of the uterus or attaches to an
abnormal or scarred portion of the uterus.

The embryo will then implant into endometrial tissue within the uterus. An ectopic pregnancy occurs
when this fetal tissue implants somewhere outside of the uterus or attaching to an abnormal or
scarred portion of the uterus.