JT/IUFD+ ABDOMINAL
PREGNANCY
Case Report
Identitas Nama : Ny. A
Status : Menikah
Pekerjaan : Petani-Nelayan
Alamat : Laipori
Jaminan : SKTM
Hamil anak kedua, • Perdarahan dari jalan lahir (-
tidak merasakan ), keluar cairan-cairan dari
A gerakan janin sejak jalan lahir (-), trauma (-), riw.
2 hari SMRS Infeksi selama kehamilan (-)
N
A Riwayat Menstruasi
Riwayat Kontrasepsi
M • Menarche : 15 tahun
• Tidak pernah menggunakan kontrasepsi
Pemeriksaan Khusus :
- Abdomen :
- Palpasi : TFU 25 cm, Punggung Kiri,
Presentasi Kepala, Bagian terendah
5/5
- Auskultasi : DJJ tidak ditemukan.
- Anogenital :
- Tidak dilakukan Vagina Toucher
Hb : 10.5 g/dL
Pemeriksaan Laboratorium Ht : 28.7 %
Leukosit : 10.000/µl
Trombosit : 247.000/µl
Eritrosit : 4.06 juta/µl
Non Medikamentosa
Tatalaksana • Observasi TTTV
• Rencana USG di ruangan
Follow Up
Senin, 28/5/2018
S : Keluhan (-)
O:
- TSS, CM
- TD 100/60 mmHg
- N : 82x/menit
- S : 36,5
- Hasil USG : janin T/I/IUFD, BPD 30w3d,
Spalding (+)
A : G2P1A0, Uk 30-32 minggu + T/IUFD +
Letak Lintang + susp. Kelainan kongenital + susp.
Mola partial
P:
- Pro SC 30/5/2018
- Cek PT/APTT
- KIE/SP
- Medikamentosa : Cefadroxil 2x500 mg (PO)
Hb : 11 g/dL
Hasil
Ht : 30.3 %
Laboratorium
Leukosit : 8.900/µl
Trombosit : 224.000/µl
Eritrosit : 4.37 juta/µl
Albumin : 2.5 g/dL
Jumat, 8/6/2018 Sabtu, 9/6/2018
S : nyeri post op (+) S : nyeri post op (+)
O: O:
- TSS, CM - TSS, CM
- TD 110/70 mmHg - TD 100/70 mmHg
- N : 84x/menit - N : 82x/menit
- S : 37,1 - S : 36,9
- RR: 20x/menit - RR: 20x/menit
A : Post relaparatomi aff packing abdomen e.c A : Post relaparatomi aff packing abdomen e.c
abdominal pregnancy abdominal pregnancy
P: P:
- Aff infus, stop injeksi - Boleh pulang
- Asam Mefenamat 3x500 mg (PO) - Asam Mefenamat 3x500 mg (PO)
- Asam Traneksamat 3x500 mg (PO) - Asam Traneksamat 3x500 mg (PO)
- Cefadroxil 2x500 mg (PO) - Cefadroxil 2x500 mg (PO)
- Vit. C 3x1tab (PO) - Vit. C 3x1tab (PO)
- Diet TKTP
- Rencana BLPL besok, kontrol USG 2 minggu
lagi
- Inj. MTX tunggu obat. Kontrol luka 1
minggu lagi (pasien belum mau rujuk)
Kontrol Poli Obgyn, 26/6/2018
S : kontrol luka operasi
O:
- TSS, CM
- TD 120/65 mmHg
- N : 92x/menit
- Status lokalis : luka operasi kering
- Hasil USG : VU terisi cukup, Uterus sedikit
membesar dengan plasenta diameter
7,48x11,2, cairan retrouteri (+) (cavum
douglas). Hepar/Lien dbn
A : Post laparatomi a.i abdominal pregnancy
P:
- Pro MTX TAP
- Asam Mefenamat 3x500 mg (PO)
- Metronidazole 3x500 mg (PO)
- Cefadroxil 2x500 mg (PO)
Masalah
Metotrexate tidak tersedia di RSUD
Epidemiologi2
Riwayat PID Riwayat
(Pelvic penggunaan Riwayat Operasi
Inflamatory AKDR dan KB Tuba Falopii
Disease) Hormonal
Faktor Resiko3
Riwayat Abortus Riwayat Endometriosis
Infertilitas
Case Report
Fekade Getachew Hailu, Getnet Tesfaye Yihunie, Ahmed Amdihun Essa dan Walelign kindie Tsega : Advanced
abdominal pregnancy, with live fetus and severe preeclampsia, case report4
Wanita, 26 tahun, G4,P3A0 AH2 uk ± 37 minggu 2 hari. Keluhan nyeri uluhati, nyeri kepala dan pendangan
kabur.
TD : 150/100 mmHg, N : 112x/menit, RR : 22x/menit, S : 36.8, DJJ : 132x/menit, presentasi kepala
USG : janin tunggal intrauterin, taksiran usia kehamilan 30 minggu, ratio FL : AC 24.2, plasenta pada anterior
uterus, tampak gambaran uterus bikornu.
Sectio Cesarean cito tampak janin pada rongga abdomen dalam kantung amnion yang masih intak lahir
neonatus laki-laki BL 1800gr AS 7-8. Plasenta berimplantasi pada Broad Ligament kanan. Tidak ada usus atau
pembuluh darah besar yang melekat plasenta dilepaskan.
Case Report
PayneshaM. Anderson, Erin K. Opfer, Jeanne M. Busch, and Everett F.Magann : An Early AbdominalWall Ectopic
Pregnancy Successfully Treated with Ultrasound Guided Intralesional Methotrexate: A Case Report5
Wanita, 26 tahun, G4,P1A2. Keluhan bercak-bercak darah dan nyeri perut. Usia kehamilan 3 minggu 2 hari
berdasarkan HPHT. Riw. Penggunaan AKDR, sudah dilepas 2 hari sebelum menstruasi terakhir.
1. Prawirohardjo S. Kehamilan Ektopik dalam Ilmu Kebidanan. Jakarta :
Yayasan Bina Pustaka ; 2011.
2. Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic
pregnancy: a 10 year population-based study of 1800 cases. Human
reproduction. 2002 Dec 1;17(12):3224-30.
3. Fylstra D.L., Ectopic Pregnancy not within the ( distal) Fallopian Tube: etiology,
diagnosis, and treatment. American Journal of Obstertics & Gynaecology.
April 2012, 289-299.
4. Hailu FG, Yihunie GT, Essa AA, kindie Tsega W. Advanced abdominal
pregnancy, with live fetus and severe preeclampsia, case report. BMC
pregnancy and childbirth. 2017 Dec;17(1):243.
Dafpus :
1. Full-term extrauterine abdominal pregnancy: a case report : Dahab AA, Aburass R, Shawkat W, Babgi R,
Essa O, Mujallid RH. Full-term extrauterine abdominal pregnancy: a case report. Journal of medical case
reports. 2011 Dec;5(1):531.
2. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location :
Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of
pregnancy of unknown location. Human reproduction update. 2013 Oct 6;20(2):250-61
3. Ectopic pregnancy: history, incidence, epidemiology, and risk factors : Marion LL, Meeks GR. Ectopic
pregnancy: history, incidence, epidemiology, and risk factors. Clinical obstetrics and gynecology. 2012 Jun
1;55(2):376-86.
4. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review : Panelli DM,
Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a
review. Fertility research and practice. 2015 Dec;1(1):15.
5. The Role of Serum Beta hcg in Early Diagnosis and Management Strategy of Ectopic Pregnancy : Surampudi
K, Gundabattula SR. The role of serum beta hcg in early diagnosis and management strategy of ectopic
pregnancy. Journal of clinical and diagnostic research: JCDR. 2016 Jul;10(7):QC08.
6. Advanced abdominal pregnancy, with live fetus and severe preeclampsia, case report : Hailu FG, Yihunie
GT, Essa AA, kindie Tsega W. Advanced abdominal pregnancy, with live fetus and severe preeclampsia,
case report. BMC pregnancy and childbirth. 2017 Dec;17(1):243.