DEPARTEMEN OBSTETRI DAN

GINEKOLOGI
FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN

REFARAT
MARET 2016

ABORTUS

Ruwaeda Nasruddin (C11111320)

Pembimbing: dr. Valentina Anita Andriani
Supervisor: dr. Ellen Th Wewengkang, Sp.OG. M.Kes

PENDAHULUAN
Menurut WHO tahun 2012, 208 juta wanita
didunia diestimasikan hamil setiap tahunnya.
Menurut Elisabeth (2013) estimasi insidens
keguguran dini (<12 minggu) 15% dan keguguran
lambat (12-22) 4%.
Riskesdas 2010, angka kejadian keguguran 4%.
Dari semua keguguran di Indonesia, 6,54%
mengaku ada upaya untuk mengakhiri
kehamilanya.
World Health Organization.Safe Abortion: technical dan policy guidance for health system, 2nd ed. WHO Library Cataloguing-inPublication Data.2012
Larsen CL et al. New Insight into mechanism behind miscarriage. Biomedcentra Medicine. 2013, 11:154 (1-10)
Pranata S, Sadewo Sri FX. Kejadian Keguguran, Kehamilan Tidak Direncanakan dan Pengguguran di Indonesia. Buletin Penelitian Sistem
Kesehatan. 2012; 15(2) : 180-192

DEFINISI
Abortus didefinisikan sebagai ancaman
pengeluaran hasil konsepsi secara spontan
maupun diinduksi sebelum fetus tersebut dapat
hidup diluar kandungan dengan batasan usia
kehamilan kurang dari 20 minggu dan berat fetus
kurang dari 500 gram

Wiknjosastro H. Ilmu Kandungan. Edisi 2. Jakarta : Penerbit Bina Pustaka Sarwono Prawirohardjo; 2012
Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

ETIOLOGI

Larsen CL et al. New Insight into mechanism behind miscarriage. Biomedcentra Medicine. 2013, 11:154 (1-10)
Decherney H, Alan et al. Current Diagnosis & Treatment Obstetrics & Gynecology 11th ed. The McGraw-Hill Companies.2013
Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

Patomekanisme

Wiknjosastro H. Ilmu Kandungan. Edisi 2. Jakarta : Penerbit Bina Pustaka Sarwono Prawirohardjo; 2012
Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

KLASIFIKASI
Abortus

Abortus
Septik

Wiknjosastro H. Ilmu Kandungan. Edisi 2. Jakarta : Penerbit Bina Pustaka Sarwono Prawirohardjo; 2012
Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

DIAGNOSIS
Anamnesis

Jenis
Abortus

Perdarah Servik
an
s

Hasil
Konsepsi

Besar
Uterus

KLASIFIKASI ABORTUS
Abortus
Sedikit
tertutu Masih
Sesuai
SPONTAN
iminens
-sedang
p
didalam
usia
uterus

Gejala lain

Kram dan nyeri

perut
kehamilan Nyeri perut
bagian bawah

Abortus
insipiens

Sedangbanyak

terbuka Masih dalam Sesuai/leb Kram dan nyeri

uterus
ih kecil
perut
dari usia
kehamilan

Abortus
inkomplit

Sedikitbanyak

terbuka Keluar
sebagian

Lebih
Kram dan nyeri
kecil dari perut, keluar
usia
jaringan
kehamilan

Abortus
komplit

Sedikittidak ada

tertutu
p

Keluar
seluruhnya

Lebih
kecil dari
usia
kehamilan

Nyeri dan kram

perut tidak
dirasakan /hanya
sedikit bila ada,
uterus agak
kenyal

Missed
Abortion

Tidak ada

tertutu
p

Tidak ada
(mati)

Lebih
kecil dari
usia

Tanda-tanda
kehamilan
menghilang

Laboratorium
Darah Rutin
Kadar -hCG

World Health Organization.Safe Abortion: technical dan policy guidance for health system, 2nd ed. WHO Library Cataloguing-inPublication Data.2012

USG

Decherney H, Alan et al. Current Diagnosis & Treatment Obstetrics & Gynecology 11th ed. The McGraw-Hill Companies.2013

Cont..

Bickhauss Jennifer et al. Re-examining Sonographic Cut-off Values for Diagnosing Early Pregnancy Loss. National Institute Public Acces
2013;3(1):1-10

PENATALAKSANAAN
Expectant Management

Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014
Committe of practice bulletin. Early Pregnancy Loss. The American College of Obstetricians and Gynecologist. 2015(150):1-10
Allison L Jana et al. Management of First Trimester Pregnancy Loss Can Be Safely Moved Into the Office. Reviews in Obstetrics
Gynecology. 2011; 4(1): 5-14

Expectant Management
Efektif pada pasien dengan :
Abortus Inkomplit
Usia Kehamilan < 8 minggu

Terapi Farmakologi

Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

Terapi Operatif
ASPIRASI VAKUM

Allison L Jana et al. Management of First Trimester Pregnancy Loss Can Be Safely Moved Into the Office. Reviews in Obstetrics
Gynecology. 2011; 4(1): 5-14
Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

Persiapan
Dilatasi Serviks

Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

Dilatasi dan Kuretase

Cunningham,FG et al. Williams Obstetrics 24th ed. The McGraw-Hill Companies. 2014

Dilatasi dan Evakuasi

Dilatasi dan Ekstraksi

DIFFERENTIAL DIAGNOSIS

Wiknjosastro H. Ilmu Kandungan. Edisi 2. Jakarta : Penerbit Bina Pustaka Sarwono Prawirohardjo; 2012

KOMPLIKASI

World Health Organization.Clinical Decherney H, Alan et al. Current Diagnosis & Treatment Obstetrics & Gynecology 11 th
ed. The McGraw-Hill Companies.2013
practice handbook for Safe Abortion. WHO Library Cataloguing-in-Publication Data.2012
Mellerup Natja et al. Management of abortion complications at a rural hospital in Uganda : a quality assessment by a partially completed
criterion-based audit. BioMed Central Womens Health. 2015;15(76): 1-8

POST ABORTION CARE

POST ABORTION CARE

Dufresne Danielle, Robert K Person. Do ypu need to follow hCG (Human chorionic gonadotropin) levels to zero for everyone who has had a
spontaneous abortion. Evidence-Based Medicine. 2015
World Health Organization.Clinical practice handbook for Safe Abortion. WHO Library Cataloguing-in-Publication Data.2012
Allison L Jana et al. Management of First Trimester Pregnancy Loss Can Be Safely Moved Into the Office. Reviews in Obstetrics Gynecology.
2011; 4(1): 5-14

TERIMA
KASIH