ABORTion

Pradini Pendidikan Dokter FK UGM

07 250496 - KU - 12171

definition
Abortion is termination of
pregnancy before the fetus is
viable outside the womb, or
gestation age before 20 weeks, or
fetal weight < 500 grams
Early abortion
Late abortion

< 12 weeks
12-20 weeks

terminology
Spontaneous abortion : abortion
happens by nature, no intervention
Induced abortion : abortion made
for certain purposes
Medical or therapeutic abortion
Criminal abortion: other than
therapeutic abortion (illegal abortion)

ETIOLOGY of early abortion

Abnormal product of conception (50-64% of
first trimester abortion have abnormal
karyotype)
Infections (CMV)
Autoimmun disorders (SLE)
Endocrine abnormalities (luteal phase defect)
Uterine abnormalities (septus, arcuatus,
bicornual, didelphys, etc)
Many is still unknown

ETIOLOGY of late abortion

Infection (malaria, syphylis, typhoid)
Metabolic disorders (DM, Thyroid)
Physiologic impairment (renal, cardiac,
hepatic diseases, hypertension)
Severe dietary insufficiency: anemia,
avitaminosis
Poisoning (alcohol, drugs abuse)
Trauma to the womb
Cervical incompetence

Type of abortion

Inavitable (Insipiens) abortion

Threatened (Imminens) abortion
Incomplete abortion
Complete abortion
Missed abortion : Retention of dead conception
product in utero up to several weeks
Septic abortion : Abortion complicated by
infection of the genital tract
Habitual (recurrent) abortion : Spontaneus
abortion 3 in a row

pathophysiology

Perdarahan desidua basalis

Diikuti oleh nekrosis jaringan sekitar
Hasil konsepsi terlepas
Dianggap benda asing oleh uterus
Uterus berkontraksi untuk mengeluarkan
hasil konsepsi

UK < 8 minggu : villi khorialis

belum menembus desidua secara
dalam ; hasil konsepsi dapat
dikeluarkan seluruhnya.
UK 8-12 minggu : penembusan
sudah lebih dalam hingga plasenta
tidak dilepaskan secara sempurna
; menimbulkan banyak perdarahan
UK > 14 minggu : janin
dikeluarkan lebih dahulu daripada
plasenta

diagnosis
Anamnesis: sign and symptomps of
early pregancy, including pregnancy
test
Vaginal bleeding
Uterine cramping
Passage of tissue
Routine blood examination
Gynecologic examination

diagnosis

Insipiens abortion

Pain and bleeding are more severe

Cervix: dilated, but no tissue is passed
Amnionic membrane: bulging or ruptured
Ultrasound: fetus may be viable or not
Treatment: stimulation or curettage

For severe bleeding: cross-matched blood

Rho(D) immune globulin shoud be given before or
after evacuation in Rh negative patient

imminens abortion
Bleeding and pain: light
Abdomen is not tender, cervix is closed, but some
bleeding may come out from the external os
Ultrasound: Viable fetus
Treatment:

No specific treatment; counseling and reassuring

Bedrest is recommended, but not effective
No coitus and hard physical activity for 2 weeks
Mefenemic acid: to relieve pain
Progesteron and sedative should not be used : no
benefit in preventing abortion to occur
Vaginal infection, is treated specifically

incomplete abortion
Partial expulsion of product of conception
Pregnancy age > 6 weeks (before 6 weeks, usually
complete)
Uterine cramping and Vaginal bleeding
Cervix: dilatated, bleeding is present, sometime there is
tissue fragment
Uterus: enlarged (depends on age of gestation)
If bleeding profuse: anemia and shock
Ultrasound: retained plcental tissue fragment
Treatment: curettage and uterotonics
Rho(D) immune globulin shoud be given before or after
evacuation in Rh negative patient

complete abortion
Complete expulsion of product of conception (poc,
embryo and membranes)
Gestation age: usually less than 6 weeks
Early sign of pregnancy
Pain ceases with expulsion of poc and vaginal
bleeding continues for a few days
Cervix: closed, bleeding may be yes, may be no
Ultrasound: no tissue fragment
Treatment: no specific treatment
Tell the patient to observe: bleeding, febrile and
pain

Diagnosis & tata laksana komplikasi

CASE
Incomplete Abortion

kasus
Anamnesis:
Pasien datang dengan keluhan keluar darah
& jaringan dari jalan lahir, flek ( + ), nyeri
perut ( + ) G1P0A0, UK 9mg
Riw. KB ( - )
Riw. Asma, hipertensi, jantung, DM disangkal

kasus
Pemeriksaan fisik:
KU : baik, sadar, tidak anemis
Palpasi : NT (+) minimal
Vital Sign: TD : 100/60
N : 80 x/menit
S : Afebris (36,2)
R : 20x/menit
PD: Vulva tenang, dinding vagina licin,
teraba fragmen jaringan di oue

kasus
Dx :
Abortus incomplete
Tx :
Kuretase

additional
Septic & missed abortion

Septic abortion
Bleeding, pain or cramping is severe
High grade fever (> 380C)
Tenderness over the abdominal wall
Severe painful on pelvic
examination
The external os: dilated
Foul smelling discharge
Shock

missed abortion

Product of conception is retained 8 weeks or more

Bleeding is minimal (spotting) and dark
Pain or cramping is also minimal
The external os: closed
Pregnancy test usually negative
The size of uterus does not correspond to pregnancy
age
Hypofibrinogenemia and low platelet count
Ultrasound: image of blood clot, or network of vesicle
Treatment

Correct blood coagulation performance

D&C