ABORTUS/ABORTION

GROUP 12

Members:

1. Yusuf teghar pradwi

2. Farah rullyta rizkina

3. Lailatul hidayah

4. Nur ramadhanti cindy levissa

5. Jeremy eckhart s.p

6. Ilma fi ahsani nur alaina

7. Nurhafizah rafiani

8. Muhammad bayu wirabuana

9. Muhammad syarif bustomy

10. Septian hadi setiawan

11. Alya maulida

12. Iola salsabila

13. Risa dirgagita

Tutor: Dr. dr. Oski Illiandri, M.Kes

DEFINITION

Abortion Is termination of early pregnancy with fetal weight less than 320 grams/500 grams and before
20 weeks or 22 weeks of gestation (CDC &WHO). Can also called miscarriage.

Provocatus abortion: abortion with intention

Early abortion: before 12 weeks

Late: abortion more than 12 weeks (13-28 weeks)

CLASSIFICATION

2 types based on causes

1. Spontaneous: naturally without intervention

 - Threatened/imminens: Ostium uteri is closed. Slight bleeding, there is no/slight abd pain, no
tissue expelled, uterine size consistent, preg test +. Doctors still can save the fetus

- Inevitable/insipiens: mod-severe bleeding, abd pain aggravated, tissue still not expelled,
cervix ostium open, uterine size decrease, preg test +/-. Tx: curettage

- Incomplete: a part of conception have’nt born, and left in uterus. Slight-severe bleeding,
tissue expelled partially, ou open, tissue blocked the ou, uterine size smaller, preg test +/-. TX
curettage

- Complete: all of conception products comes out from uterus. Slight/no bleeding, abd pain, ,
tissue expelled completely, cervix closed, uterine size has an enlargement, preg test +/-. No
treatment

- missed

- Septic: there is massive infection in mother

- Habitualis: more than 3 times respectively

2. Provocates: there are intervention

- Therapeutic: pregnancy should be terminate because it threaten/harm mother’s life

- Criminals : abortion with intervention but it isn’t because of medical indication

Based on pregnancy period

1. Early: 12 weeks

2. Late: 13-20 weeks

EPIDEMIOLOGY

WHO: 10-15% in Southeast asian 4million get abortus

Indonesia: 2 million (2000) in six regions in indonesia. 37 every 1000 women 30-49 years get abortion.
20-29 years old (46%)

SHS (43%)

Complete abortions: 50-60% of all conceptions

Incompete abortion: 60% of women hospitalized for bleeding

<2% of fetal losses are missed abortions

ETIOLOGY: the failure of fetal implantation in endometrium because of many factors that can influence
the fetal viability
For example: Paternal factors: sperm abnormalities, Malnutrition, Reproduction tract abnormalites

1. Fetal abnormalities: aneuploidy, or others genetic/chromosome disorder

2. Uterine/mother factors: prolaps uteri, inversion of uteri

3. Trauma in cavum uteri

4. Infection: HIV,

5. Drugs:

6. Lifestyle: cigarette smoking

7. Immunologic disorders

8. Hormonal: unbalanced endocrine

RISK FACTORS

1. Age maternal&paternal: older  higher risk of abortion 40 yo  45%, 45 yo  50%

2. History of abortion previously

3. Cigarette smoking, drugs (cocaine), excessive caffeine

4. BB: over/underweight

5. Invasive prenatal test

PATHOPHYSIOLOGY

Fetal dead  bleeding in decidua basalis  fetus released from cavum uteri  contraction of uterus &
expulsion of conception products

Medical abortion can used:

1. Mifepristone: increase uterus contraction by reversing progesteron induced inhibition

2. Misoprostol: directly stimulates myometrium

Also considered about predisposising factors

CLINICAL MANIFESTASIONS

Vaginal bleeding

Nausea vomit

Lower abd cramp

Back pain

Vulva: vaginal bleeding, bad smell

Inspekulo: bleeding of cavum uteri, there is no tissue from ostium

VT: look for pain,

- General: vaginal bleeding

- Missed abortion: decrease of uterine growth early in pregnancy, vaginal bleeding that
changes to dark brown discharge

DIAGNOSIS

1. History: Symptoms? Abd pain, amenorrhea, vaginal bleeding (amount, color, etc), cervical
opening, product of gestation expelled or not?

2. Vaginal toucher

3. Pregnancy test, estrogen and progesterone level, USG, pelvic exam, complete blood count

WHO: 3 general signs of abortion (vaginal bleeding, abd cramps, history of amenorea)

USG  to see the fetus is died/alive?

DD: Pelvic infection,

TREATMENT

1. Treat the massive bleeding:

- monitoring vital signs & bleeding rate. Administer fluids & blood as patient needed

- Oxytocin i.v for treatment of uterine atony. As an alternative, we can give intracervical
vasopressin/carboprost tromethamine and bimanual uterine massage

- If bleeding persists, screen for coagulopathy/DIC and obtain immediate gynecologic

consultation with intention of transferring the patient to operation room for repeat
curettage and if necessary, hysterectomy

2. Antibiotic

3. Tetanus toxoid i.m

4. Curettage, cervical dilatation

COMPLICATION  early and delayed

 - Severe bleeding  anemia

- Perforation of uterine walls

- Shock

- Infection

- Blood coagulation disorder

From medical intervention: such as vacuum can cause prolaps uteri

PREVENTION

Prevent the etiology from mother factors:prenatal genetic testing, treat the infection, hormonal therapy
to balance the hormon

Contraceptive counseling, youth health clinical services

Maintain physicological factors

PROGNOSIS

Dubia ad malam because the patient has massive bleeding (need prompt treatment)