Motto :

Jalani hidup ini dengan sabar, jujur dan ikhlas,

Mau mengerti dan melaksanakan tatacara (adab) yang
benar, dan
Mempunyai kemauan untuk selalu berbuat baik
memperbaiki diri dan lingkungan, serta membuat orang lain
lebih baik
 KEUTAMAAN ILMU

Barang siapa mengamalkan apa-apa yang ia ketahui, maka Allah SWT akan mewariskan
kepadanya ilmu yang belum diketahuinya, dan Allah SWT akan menolong dia dalam amalannya
sehingga ia mendapatkan surga. Dan barang siapa yang tidak mengamalkan ilmunya, maka ia
tersesat oleh ilmunya itu, dan Allah SWT tidak menolong dia dalam amalannya sehingga ia akan
mendapatkan neraka (sabda Rasulullah Muhammad SAW)

Ilmu lebih utama dari harta, ilmu adalah pusaka para Nabi, sedangkan harta adalah pusaka
Karun atau Firaun.

Ilmu lebih utama dari harta, karena ilmu akan menjagamu sementara harta malah engkau yang
harus menjaganya.

Ilmu lebih utama dari harta karena di akherat nanti pemilik harta akan dihisab, sedangkan
orang berilmu akan memperoleh syafaat.

Ilmu lebih utama dari harta karena pemilik harta bisa mengaku menjadi Tuhan akibat harta
yang dimilikinya, sedangkan orang berilmu justru mengaku sebagai hamba Tuhan karena
ilmunya.
Harta itu jika engkau berikan menjadi berkurang, sebaliknya ilmu jika engkau berikan malahan
semakin bertambah.

Pemilik harta disebut dengan nama kikir dan buruk, tetapi pemilik ilmu disebut dengan nama
keagungan dan kemuliaan.

Pemilik harta itu musuhnya banyak, sedangkan pemilik ilmu temannya banyak.
Harta akan hancur berantakan karena lama ditimbun zaman, tetapi ilmu tidak akan rusak dan
musnah walau ditimbun zaman.

Harta membuat hati seseorang menjadi keras, sedangkan ilmu malah membuat hati menjadi
bercahaya.
(hamba Allah)
 Pendahuluan
Hamil normal Trimester 1
KEHAMILAN EKTOPIK
Prosedur diagnostik
Penatalaksanaan
Simpulan
Kepustakaan
 93% terletak di tuba falloppii

UK : 4.9% (1970) 9.6% (1992) (RCOG, 2000)

Nyeri perut, disertai / tanpa perdarahan

Risiko tinggi: riwayat kelainan/operasi tuba, pemakaian

IUD
 Anamnesis

Pemeriksaan Fisik

Pemeriksaan Penunjang
Non invasif
Infasif
 Haid : HTA, siklus, keteraturan, nyeri
Faktor PREDISPOSISI: Riwayat operasi di
regio abdomen, IUD, PMS
Tes hamil (+)
Disertai nyeri dan atau perdarahan
pervaginam?
Infertilitas
 Status Generalis: tanda vital, akut
abdomen, pucat
Status Obstetri:
Tanda hamil
Ketidaksesuaian besar uterus dengan usia
gestasi
Disertai / tanpa nyeri atau perdarahan per
vaginam
 Uji kehamilan: urin, darah
USG : sangat bermanfaat
Von Slanny : Hb dan Ht berkala
Punksi Kavum Doglas
Laparotomi Percobaan
LD dengan persiapan LO
1. The uterus and adnexa should be evaluated for the
presence of a gestational sac (GS). If GS is seen, its
location should be documented. The presence or
absence of an embryo should be noted and CRL
recorded
2. Presence or absence of cardiac activity should be
reported
3. Fetal number should be documented
4. Evaluation of the uterus, adnexal structures, and cul-
de-sac should be performed
1. Hormone 8 Pregnancies of
measurement : hCG unknown location
2. Miscarriage and 9 Twins pregnancy
IUFD 10 Trophoblastic disease
3. Ectopic pregnancy 11 Ovarian problems
4. Cervical pregnancy 12 Uterine fibroids
5. Ovarian pregnancy 13 Pregnancy and IUD
6. Abdominal 14 Screening fetal
pregnancy anomaly
7. Heterotopic 15 Organization of early
pregnancy pregnancy unit

Trish Chudleigh, 2004

 hCG > 25 IU/L = day 24 25 of a regular 28-day
cycle
Double approximately every 2 days
EP is suspected if hCG does not double in 2 3
days or cut-off 1000 IU/L can not be seen GS in
TVS
Expectant management of EP if hCG < 1000 IU/L
Trish Chudleigh, 2004
http://www.orion-group.net/journals/Journals/Vol6_May2000/images/164.jpg
http://www.obgyn.net/hysteroscopy/articles/dx-lap-FIG12.jpg
 Clinical conditions which increase risk of EP include
the presence of a scarred tube from salpingitis/PID
and/or previous tubal surgery
TVS : no GS within uterus. Uterus size is normal or
slightly enlarged . 85% in initial US scan (Chudleigh T, 2004)

Extrauterine extraovarian adnexal mass,

pseudogestational sac (10 29% of EP : Chudleigh T, 2004),
and hemoperitoneum
The EP is usually on the side of the CL : 78% (Chudleigh
T, 2004)
Living embryo outside of the uterus

Arthur C. Fleischer, 2004

 Janin hidup, di tuba kanan

http://www.advancedfertility.com/ectopic.htm
 EP may also contain a rim of increased vascularity,
although this is variable, depending on the extent of
trophoblastic invasion into the tubal wall

TV-CDS can distinguish distended paraovarian/uterine

veins from the vascular rim of an EP

EP have variable wall vascularity and pain

A ruptured EP can be implied if there is a complex
solid tubal mass, hematosalpinx, or hemoperitoneum

Fluid in the pouch of Douglas : 20 25% (Chudleigh T, 2004)

(Arthur C. Fleischer, 2004)
 Clinical diagnosis Ultrasound sign

Indications for workup Extra uterine findings

Transvaginal ultrasound Indetermined sonograms

Serum hCG and the EP vascular flow patterns

discriminatory zone
Sonographic assistance in
Delayed or missed therapeutic management
diagnosis is seen as
failure of care and can Clinical interpretation of
result in litigation sonographic findings
MASS DI ADNEKSA ! !
KE di Tuba Kanan
Jaringan KET pasca operasi

http://www.pathguy.com/lectures/ectopic.jpg

 Cornual EP : can occur within one uterine cornua, it can
enlarge because it is surrounded by myometrium. If it
ruptures, catastrophic bleeding can occur

Abdominal EP : can be diagnosed by the presence of

fetus, choriodecidua, or placenta separate from uterus

Cervical EP : GS inside the cervical area

Ovarian EP : virtually impossible to distinguish from CL

if the embryo is not seen
(Arthur C. Fleischer, 2004)
http://www.obgyn.net/us/_uploads/CORNUP2.jpg
 Interstitial portion of the fallopian tube
1.1 6.3% of all EP
IVF and previous salphingectomy
Upper lateral aspect of the uterus, outside the
uterine cavity & partially surrounded by
myometrium
The proximal interstitial segment of the tube
joining the uterus
Severe hemorrhage and hysterectomy
MTX is effective for the treatment of early
interstitial pregnancy
Trish Chudleigh, 2004
http://radpod.org/wp-content/uploads/2006/11/interstitial_ectopic_brighter.jpg
http://www.obgyn.net/us/cotm/1003/moroder_interstitial1.jpg
 Implanted below the IO
1:2400 to 1:50,000 pregnancies
0.15% of all EP
US Criteria :
1. No evidence of an IUP
2. An hourglass uterine shape with ballooning of the
cervical canal
3. The presence of a GS or placental tissue within the
cervical canal, especially if cardiac activity is present
4. A closed internal os

MTX : local injection or systemic or potassium chloride local injection

Trish Chudleigh, 2004
http://www.scielo.br/img/revistas/clin/v61n4/30696f1.jpg

http://www.data-integrator.com/site_40/articole/ar%2010/clip_image019.jpg
 1:4000 to 1:7000 deliveries

US Criteria :
Ipsilateral tube must be intact
GS must be within the ovary
The ovary must be connected to the uterus by the ovarian ligament
Ovarian tissue must be within the sac wall
GS cannot be separated from the ovary

DD : corpus luteum, fixing fallopian tube to the ovary due

to pelvic adhesion

Local excision by Laparoscopically

Trish Chudleigh, 2004

1:3400 to 1:8000 deliveries

Intraperitoneal implantation
(exlusive of intratubal, ovarian,
or intraligamentous sites of
nidation

GS or fetal parts are usually
seen behind the uterus in the
pouch of Douglas or laterally
within the broad ligament

Trish Chudleigh, 2004



KE LANJUT

http://www.uphs.upenn.edu/path/web_docs/p200/GYN200/GYN0211.jpeg

 IUP + EP

1:6000 pregnancies

High risk : ART

 KEHAMILAN HETEROTOPIK
http://www.mayoclinicproceedings.com/images/7601/7601cr4-fig1.jpg
http://www.obgyn.net/us/gallery/OB_1_Abnormal_3D_Heterotopic_Pregnancy.jpg

ttp://www.webmm.ahrq.gov/media/cases/images/case43_fig1.jpg
 8 31% diagnosis cannot be made by
US at the initial visit

Serum hCG and progesterone

 RUJUK KE DOKTER / RS

Kenali faktor risiko

Curiga KE / KET ..segera RUJUK

Pasang infus, surat pengantar, ditemani

perawat/Bidan
 Medikamentosa
MTX

Operatif
LO
Laparotomi
Salpingostomi atau salpingektomi
Injeksi MTX
 KE / KET merupakan keadaan yang dapat
membahayakan jiwa pasien
Punya potensi medikolegal
Anamnesis dan pemeriksaan yang teliti sangat
berperan penting dalam tatalaksana pasien
Curiga KE / KET , segera rujuk ke dokter/RS
Informed consent
Arthur C. Fleischer, 2004
 judijanuadi@hotmail.com
judijanuadi@gmail.com
ISUOG, Singapore, 2008 http://www.scribd.com
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