Maternal Emergency

MALVIN EMERALDI
Fatmawati RSUP

The definition of :
Bleeding from the uterus that comes with
bringing some or all of the results of the
conception before at the age of pregnancy
< 20 24 weeks and or weight < 500gr
Pathology :
On the abortion bleeding in desidua
basalis + tissue necrosis surrounding
network conception results despite
some or all (foreign objects in the uterus)
uterus contracted to remove it.

Nevertheless correlation with age

of Pregnancy
On the pregnancy < 8 mg
H do whatever ye can: I
usually conception issued
entirely, because villi desidua
koriales not penetrate it in.
On pregnancy 8-14 Mg
V illi desidua koriales
penetrate more in, so that the
placenta does not released
perfect many bleeding.
In Pregnancy > 14 mg
Y ang issued after ketuban
breaks is the fetus, followed
by placenta, if complete
bleeding not many .

Diagnosis and P enanganan

P erdarahan pervaginam, after
experiencing late menstruation on women
reproductive age.
Positive pregnancy test
The principle of managements per vaginam bleeding at the age of
pregnancy :
8. Do not directly PERFORM KURETASE !!!
9. Specify the condition of the fetus dead or alive. When possible
check with USG.
10.Beta HCG can still positive even though the fetus is dead

Nevertheless Medisinalis
indication
Health disorders that very
threatening the safety of the
Mother
Pregnancy due to rape or
incest
Uncertain occurred defect on
the weight of the fetus
( severe physical

An indication and Frequency

Nevertheless Made

Think of Abortion:
When a woman reproductive
age come with struggling
economies where cashstrapped governments as
follows:
Late menstruation
Per vaginam bleeding
Spasme or abdominal pain
bottom

The type and the degree of

Spontaneous Nevertheless

Nevertheless Iminens
Nevertheless Insipiens
Nevertheless Inkomplit
Nevertheless
selfcontained
Retention of the embryo
( Missed Abortion )

Nevertheless I mminens
Events bleeding from the uterus in pregnancy <
20 weeks , the results of the conception is still in
the uterus, without any cervical dilatation.
The symptoms
Bleeding from OUE, mules little/(-), big uterus =
age gestasi, OUI closed positive pregnancy test .
Handling of :
B edrest
USG fetus live / dead
Progesterone ??
Pro gnosa depending various & ever bleeding.
Their prognosis less good if old bleeding,
accompanied by mules and i.e. as well as the

Nevertheless I nsipien
Bleeding utereus events on pregnancy < 20
weeks , with cervical dilatation fundus increase,
the results of the conception is still in the uterus.
The symptoms :
M ules often & strong, bleeding multiply.
Handling of
Handling of : expenditures can conception results
with kuret vacuum or cunam ovum, followed by
kerokan.
In Pregnancy > 12 MG, bleeding tridak many
the danger of the great
oxytocin Infusion.
When the fetus is out, placenta left placenta

Nevertheless I
nkompletus
Part of the expenditure on conception pregnancy
< 20 ming g u , with the remnant that is left in
the uterus .
Diagnosis
K analysts servikalis open, intangible gas,
network can be intangible gas in kavum fundus/
protruding from OUE, bleeding can be many once,
will not stop before the remaining issued
shock.
The therapy

Nevertheless K ompletus
All the results of the conception had
been issued.
The symptoms
P erdarahan little, ostium fundus
eksternum terutup, uterus shrunk.
Handling of
When hemolytic s S ulfas F errosus
.

Missed A bortion
The death of the fetus < 20 mg, but not issued during
8 Mg.
The etiology ? ? , suspected H ormon progesterone
The symptoms
Begin with nevertheless imminens which then
disappears spontaneously or after therapy.
Subjective symptoms pregnancy disappeared,
mammae mengendor, uterus shrunk, test pregnancy
(-). Often accompanied by blood clotting disorders
because hipofibrinogenemia.
The therapy
T ergantung ME & the level of fibrinogens and
psychological os. If < 12 Mg DC, if > 12 Mg

Nevertheless Habitualis
Nevertheless spontaneously happens 3x in a
row (0.41%, Bishop)
The etiology of :
A bortus spontaneous, immunologic functions/
the failure of the reaction to the antigen .
Handling of :
A complete namnesa, threadlike eriksaan g ol
ongan blood husband & wife, incompatibilities
blood, threadlike eriksaan VDRL, OGTT, threadlike
Chromosomes & mikoplasma eriksaan.
On T rimester 2 cervical cerclage

Nevertheless I nfeksiosus /
Nevertheless S eptik
Nevertheless infeksiosus : nevertheless that
accompanied the infection tr aktus outer genital.
Nevertheless septic systems : nevertheless
infeksiosus weight includes the spread of germs
or toxins into the blood circulation or peritoneum.
The symptoms :
Nevertheless occurs accompanied by signs of
infection : fever , tachycardia, pervaginam
bleeding smell, uterus grows, soft, pain press,
lekositosis. If sepsis fever , tremble, T
ekanan D direction .
The handling ; infusion transfusion, antibiotics.

Try Table
Nevertheless degree
Diagnosis

Abortion
Iminens

Bleeding

Little
Being

Neverth
eless
Insipien
s

Being
Many

Neverth
eless
Inkompli
t

Little
Many

Neverth
eless
The selfcontaine
d

Little
No

Cervical
Cancer

Closed
Software

Open
Software

Open
Llunak

Large uterus

According
to the age
of
pregnancy

According
or
Smaller

Age
pregnancy

Other symptoms

Pt positive
mild Crampy
Uterus software
is Crampy/strong
Uterus software

trong Crampy
Out the network

Closed
Software

Age
pregnancy

terus software
ittle /without
crampy mass of
pregnancy (+/-)

Thank You