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Presented by : M.

D wi Putra Shinta Tantri Amanda Isnawati Dewi Kurnia Ningsih Gita Amelia Masrida Rezky

Dr. Kalsah Nugroho Aryanto K, Sp.OG Pembimbing : (K)

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
29 Mei 2012
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 : 110/70 Temp : 37,5 C Pulse : 89x/m RR: 20x/m
PF : Konjunctiva anemis (+) Others found no

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

TABEL PERJALANAN
30 Mei 2012
S (subjektif) O(objektif) A(Assesment) P(planning)

Dizziness (+), CM weak (+). Can not Sakit sedang defecate 2 days. Temp : 36,5 C

DHF der I-II

At night: OS chills 37.8 C

Pkl. 11 : dr.Sp.PD -Diit Tim -RL / 6 jam -Cek urea, H2TL/12jam,UL -Koreksi Kl 25 max 2x Pkl.20.45 : dr.U -Anjuran ICU karna OS sesak Pkl.21.00 : dr.Sp.PD

TABEL PERJALANAN
31 Mei 2012 pkl. 08.30
S (subjektif) O(objektif) A(Assesment) P(planning)

Weakness (+), bleeding pervaginam (+).

CM BP : 80/60 Pulse : 100x/m RR : 20x/m Temp : 36,5 C


PF: NT abd (-) NT epig (+)

Dr. U : Susp abortus septik DD: KET

-Plano test -Hb cito -IUFD Nacl loading 1 kolf -Edukasi pasien
-Konsul dr. Obgyn

TABEL PERJALANAN
31 Mei 2012
S (subjektif) Amenorrhea (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight. O(objektif) Plano test (+) Hb :6,3 gr% A(Assesme nt) P(planning)

Palp : TFU not palpable. Abdomen lemes, pain (-)


VT : ostium lunak, nyeri goyang (-), terbuka 2 cm, perdarahan (+), stool cell (-)

G1P0A0 + Konsul obgyn u/ amenore 8 persiapan USG minggu susp KE Susp abortus septik DD: KET

TABEL PERJALANAN
31 Mei 2012
S (subjektif) Weakness (+), Unmenstruated (+) since 2 months, coitus with boyfriend (+), bleeding from vagina since tonight. O(objektif) CM BP : 80/60 Pulse : 100x/m RR : 20x/m Temp : 36,5 C PF: NT epig (+) Plano test (+) Hb :6,3 gr% A(Assesment) P(planning) Konsul Dr Obgyn : -Keluarga buat surat ijin ayah/wali -Perbaiki KU -Rencana tindakan R/ loading 200 cc transfusi, Sp.PD acc -Pantau TTV

Abortus insipien

TABEL PERJALANAN
31 Mei 2012 pkl. 10.00
S (subjektif) Abdominal pain (+), bleeding pervaginam (+) O(objektif) CM BP : 80/60 Pulse : 100x/m RR : 20x/m Temp : 36,5 C PF: NT epig (+) Plano test (+) Hb :6,3 gr% A(Assesment) P(planning) Inst dr. Obgyn : -Perbaiki KU -Inform consent kuretase Dr. Sp.PD -Cek dengue blood (-) -H2TL/12 jam

Abortus inkomplit

TABEL PERJALANAN
31 Mei 2012 pkl. 17.30
S (subjektif) O(objektif) A(Assesment) P(planning) Weakness (+), dizziness (+) CM BP : 80/60 Pulse : 100x/m RR : 20x/m Temp : 36,5 C PF: NT epig (+) Plano test (+) Hb :6,3 gr% dr,. Sp.PD : - Sore tetap cek H2TL dan dengue blood

Abortus inkomplit

LETS START TO DISCUSS

Medicatio n aspect

Abortus Ectopic pregnancy

Medicoleg al aspect

Policy and law

Be a family doctor

Holistik Komrehensif Terpadu Berkesinambungan Pendekatan keluarga, proaktif,

Medical aspect
Identity Complaint
Fever

Problem
Infection, neoplasma, body response, etc

Girl, 18 yo Not marriage

Unmenstruated

Pregnancy? Or other ??

Hemorrhage

Pregnancy? Organ disorder? Fisiologic disorder?

Complaint

First
Fever Dizziness Nausea Vomiting Epigastric pain Black at feses

Next
Weakness Bleeding pervaginam

End
- Unmenstruated since 2 months - Coitus (+) - Abdominal pain

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)

Abortion
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)

Kromosom abnormality

Zigot factor

Patologic ovum (ex: BO)

Sperma abnormality

Etiologi
- Chronic disease - Infection - Hormonal disorder - Organ disorder Nutrition - Drug - Imunology factor - Trauma

Maternal factor

Diagnose criteria and treatments


Iminens abortion Insipien abortion Incomplete abortion

Diagnose criteria and treatments


Complete abortion Missed abortion Febris/ infection abortion

Ectopic pregnancy
The blastocyst normally implants in the endometrial lining of the uterine cavity. Implantation anywhere else is an ectopic pregnancy
(Williams obstetric 22nd edition)

Pathomechanism

Diagnosis and treatment

Medikolegal aspect for case

Definition of Womens health

Building on the definition of health in WHOs 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. Womens 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


Hemorrhage 24.8% 19,8 7,9 Obstructed Labor 6.9% Unsafe Abortion 12.9% Other Direct Causes 7.9% Indirect Causes 19.8% Infection 14.9% 24,8 Eclampsia 12.9%

12,9 6,9 12,9

14,9

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.

SAFE MOTHERHOOD
Wassalamualaikum Wr. Wb Juni 2012