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abortus
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TUTORIAL CASE
Dr. Kalsah Nugroho Aryanto K, Sp.OG (K) Pembimbing :
Presented by :M. D wi Putra
Shinta Tantri AmandaIsnawati
Dewi Kurnia NingsihGita Amelia
Masrida Rezky
IDENTITY
Name : Nn. A Age : 18 years old Marriage Status : Not marriage RM : 35.26.xx Date of MRS : 29 mei 2012
Alloanamnesa
Chief Complaint : fever since 3 days, sharp fever and chills
Additional complaint : Dizziness Nausea, vomiting. Heartburn since 4 days 1 day before come to hospital feses are
black (1x) Bleeding gums (-), epistaxis (-), petechiae
(-)
TABEL PERJALANAN
S (subjektif) O(objektif) A(Assesment)
P(planning)
Dizziness (+), weak (+), nausea (+), heartburn (+), fever (+) since 4 days.CHAPTER black (+), bleeding gums (-), epistaxis (-), petechiae (-)
CM, Sakit sedang.BP : 110/70Temp : 37,5 CPulse : 89x/mRR: 20x/m
PF :Konjunctiva anemis (+)
Others found no abnormalities
Dengue Haemorragic fever grd I-II
Dr A (GP) -RL 8 TPM-Sanmol 3x1-Rantin inj 2x1-Vomceran 3x1
Dr. Sp.PD : th/ lanjut
Dr. B(GP) : extra novalgin 1 amp drip suhu : 40 C
29 Mei 2012
TABEL PERJALANAN
S (subjektif) O(objektif) A(Assesment)
P(planning)
Dizziness (+), weak (+). Can not defecate 2 days.
At night: OS chills 37.8 C
CMSakit sedangTemp : 36,5 C
DHF der I-II
Pkl. 11 : dr.Sp.PD-Diit Tim-RL / 6 jam-Cek urea, H2TL/12jam,UL-Koreksi Kl 25 max 2xPkl.20.45 : dr.U-Anjuran ICU karna OS sesakPkl.21.00 : dr.Sp.PD- Drip novalgin 1 amp
30 Mei 2012
TABEL PERJALANAN
S (subjektif) O(objektif) A(Assesment) P(planning)
Weakness (+), bleeding pervaginam (+).
CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C
PF:NT abd (-)NT epig (+)
Dr. U :Susp abortus septikDD: KET
-Plano test -Hb cito-IUFD Nacl loading 1 kolf-Edukasi pasien
-Konsul dr. Obgyn
31 Mei 2012 pkl. 08.30
TABEL PERJALANAN
S (subjektif) O(objektif) A(Assesment)
P(planning)
Amenorrhea (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight.
Plano test (+)Hb :6,3 gr%
Palp : TFU not palpable. Abdomen lemes, pain (-)
VT : ostium lunak, nyeri goyang (-), terbuka 2 cm, perdarahan (+), stool cell (-)
G1P0A0 + amenore 8 minggu susp KE
Susp abortus septikDD: KET
Konsul obgyn u/ persiapan USG
31 Mei 2012
TABEL PERJALANAN
S (subjektif) O(objektif) A(Assesment) P(planning)
Weakness (+), Unmenstruated (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight.
CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C
PF:NT epig (+) Plano test (+)Hb :6,3 gr%
Abortus insipien
Konsul Dr Obgyn :-Keluarga buat surat ijin ayah/wali-Perbaiki KU-Rencana tindakan R/ loading 200 cc transfusi, Sp.PD acc-Pantau TTV
31 Mei 2012
TABEL PERJALANAN
S (subjektif) O(objektif) A(Assesment) P(planning)
Abdominal pain (+), bleeding pervaginam (+)
CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C
PF:NT epig (+) Plano test (+)Hb :6,3 gr%
Abortus inkomplit
Inst dr. Obgyn :-Perbaiki KU -Inform consent kuretase
Dr. Sp.PD-Cek dengue blood (-)-H2TL/12 jam
31 Mei 2012 pkl. 10.00
TABEL PERJALANAN
S (subjektif) O(objektif) A(Assesment) P(planning)
Weakness (+), dizziness (+)
CMBP : 80/60Pulse : 100x/mRR : 20x/mTemp : 36,5 C
PF:NT epig (+) Plano test (+)Hb :6,3 gr%
Abortus inkomplit
dr,. Sp.PD :- Sore tetap cek H2TL dan dengue blood
31 Mei 2012 pkl. 17.30
LETS START TO DISCUSS
Medication aspect
• Abortus
• Ectopic pregnancy
Medicolegal aspect
• Policy and law
Be a family doctor
• Holistik
• Komrehensif
• Terpadu
• Berkesinambungan
• Pendekatan keluarga, proaktif, prepaid
Medical aspect
Girl, 18 yoNot marriage
Fever
Infection, neoplasma, body response, etc
Unmenstruated
Pregnancy? Or other ??
Hemorrhage
Pregnancy? Organ disorder? Fisiologic disorder?
Identity
Complaint
Problem
Complaint Fever Dizziness Nausea Vomiting Epigastric pain Black at feses
First
Weakness Bleeding pervaginam
Next
- Unmenstruated since 2 months- Coitus (+)- Abdominal pain
End
Todays topic
Pregnancy
Abortion
Ectopic pregnancy
PREGNANCY
- Amenore - Nausea - Vomitus - Poliuri (urinary tract)- Anoreksia
- Changes in breast- Skin pigmentasi- Hegar Sign- Chadwick Sign- Piscaceck Sign
- Tes Urin- Plano test- USG- DJJ (12weeks)
The termination of pregnancy, either spontaneously or intentionally, before the fetus develops sufficiently to survive. By convention, abortion is usually defined as pregnancy termination prior to 20 weeks' gestation or less than 500-g birthweight. Definitions vary, however, according to state laws for reporting abortions, fetal deaths, and neonatal deaths
(Williams obstetric 22nd edition)
Abortion
Etiologi
Zigot factor
Kromosom abnormality
Patologic ovum (ex: BO)
Sperma abnormality
Maternal factor- Chronic disease
- Infection - Hormonal disorder
- Organ disorderNutrition - Drug
- Imunology factor- Trauma
Diagnose criteria and treatments
Iminens abortion Insipien abortion Incomplete abortion
Diagnose criteria and treatments
Complete abortion Missed abortion Febris/ infection abortion
The blastocyst normally implants in the endometrial lining of the uterine cavity. Implantation anywhere else is an ectopic pregnancy
(Williams obstetric 22nd edition)
Ectopic pregnancy
Pathomechanism
Diagnosis and treatment
Medikolegal aspect for case
Definition of Women’s health
Building on the definition of health in WHO’s constitution, the platform of action adopted by the 4th world conference for women, in Beijing 1995, recognised that:
Health is a state of complete physical, mental and social-well being, and not merely the absence of disease or infirmity. Women’s health involves their emotional, social and physical well-being and is determined by the social, political, and economic context of their lives, as well as by biology.
Global Causes of Maternal Mortality
24,8
14,9
12,96,912,9
7,9
19,8
Hemorrhage 24.8%
Infection 14.9%
Eclampsia 12.9%
Obstructed Labor6.9%Unsafe Abortion12.9%Other Direct Causes7.9%Indirect Causes19.8%
Be a family doctor
References
Williams Obstetrics, twenty-second edition, 2005.
Current Diagnosis & Treatment Obstetrics & Gynecology, Tenth Edition, 2007.
Sarwono prawirohardjo, Ilmu kebidanan, 2005.
Pedoman diagnosis dan terapi obstetri dan ginekologi FK Unpad, RS. Dr. Hasan Sadikin, 2005.
Wassalamu’alaikum Wr. Wb Juni 2012
SAFE MOTHERHOOD