G1P0A0 H13

Minggu
ABORTUS
ABORTUS
Setiap perempuan hamil dapat mengalami
kehamilan terhenti, baik disengaja maupun tidak.
Berakhirnya kehamilan sebelum janin mampu
hidup, yaitu ketika usia kehamilan belum
mencapai 20 minggu atau berat janin < 500 g,
baik secara spontan maupun diinduksi
 Klasifikasi keguguran

Keguguran spontan
Keguguran spontan adalah keguguran yang terjadi tanpa disengaja, tanpa
tindakan mekanis atau medis untuk mengosongkan uterus. Beberapa faktor risiko
keguguran spontan di antaranya: anomali janin atau kelainan kromosom yang
berat, penyakit infeksi, gangguan nutrisi yang berat, penyakit menahun dan kronis,
konsumsi alkohol dan merokok, anomali uterus dan serviks, gangguan imunologis,
serta trauma fisik dan psikologis..

Keguguran diinduksi
Keguguran diinduksi adalah penghentian kehamilan yang sengaja dilakukan
sebelum janin mampu hidup, baik dengan memakai obat-obatan atau memakai
alat. Di Indonesia, keguguran diinduksi dilarang secara hukum kecuali untuk dua
kondisi, yaitu (1) indikasi kedaruratan medis dan (2) kehamilan akibat perkosaan,
dengan syarat-syarat yang telah diatur dalam UU Nomor 36 Tahun 2009 dan PP
Nomor 61 Tahun 2014. .
 01
Keguguran iminens
Keguguran iminens merupakan perdarahan dari uterus pada
kehamilan sebelum 20 minggu, Diagnosis keguguran iminens
ditentukan karena pada wanita hamil terjadi perdarahan melalui
ostium uteri eksternum, disertai sedikit nyeri abdomen atau tidak
sama sekali, uterus membesar sesuai usia kehamilan, serviks belum
membuka, dan tes kehamilan positif.

02
Keguguran insipiens
Perdarahan uterus pada kehamilan sebelum 20 minggu dengan
adanya dilatasi serviks uteri yang semakin bertambah, tetapi hasil
konsepsi masih dalam uterus. Dalam hal ini rasa perut mulas menjadi
lebih sering dan kuat serta perdarahan semakin banyak.

03
Keguguran inkomplit
Pengeluaran sebagian hasil konsepsi pada kehamilan sebelum 20
minggu dengan masih ada sisa tertinggal dalam uterus.

Keguguran komplet

Klasifikasi keguguran
secara medis
04 Perdarahan pada kehamilan muda di mana seluruh hasil konsepsi
telah keluar dari kavum uteri. Seluruh hasil kehamilan telah dilahirkan
dengan lengkap. Pada penderita ditemukan perdarahan sedikit,
ostium uteri telah menutup, dan uterus sudah banyak mengecil.
 Missed abortion

05
Missed abortion adalah kematian janin sebelum berusia 20 minggu,
tetapi janin yang mati tertahan di dalam kavum uteri tidak dikeluarkan
selama 8 minggu atau lebih. Missed abortion umumnya didahului oleh
tanda-tanda keguguran iminens yang kemudian menghilang secara
spontan atau setelah pengobatan. Gejala subjektif kehamilan
menghilang, uterus tidak membesar lagi dan cenderung mengecil,
serta tes kehamilan menjadi negatif. .

06
Keguguran habitualis
Keadaan dimana penderita mengalami keguguran berturut-turut tiga
kali atau lebih. Pada umumnya penderita tidak sulit menjadi hamil,
tetapi kehamilannya berakhir sebelum 28 minggu.

Keguguran septik dan infeksiosa

07
Keguguran septik adalah keguguran yang disertai infeksi baik pada
uterus dan organ sekitarnya, diikuti penyebaran kuman atau toksin ke
dalam peredaran darah atau peritoneum.

Umumnya pada keguguran infeksiosa, infeksi terbatas pada desidua.

Pada keguguran septik virulensi bakteri tinggi, dan infeksi menyebar
ke miometrium, tuba, parametrium, dan peritoneum. Jika infeksi
menyebar lebih jauh, terjadi peritonitis umum atau sepsis, dengan
kemungkinan diikuti oleh syok. Diagnosis keguguran infeksiosa
ditentukan dengan terdapatnya keguguran yang disertai gejala dan
tanda infeksi genitalia, seperti demam, takikardi, perdarahan
pervaginam berbau, uterus yang membesar, lembek, serta nyeri
tekan, dan leukositosis.
ANALISIS KASUS
SKENARIO
KASUS

NY. N usia 23 tahun masuk ke IGD sedang mengandung anak

pertamanya dengan keluhan adanya flek dari tanggal 10-12/09/2021. di
tanggal 12 pasien mengalami flek yang agak banyak dipagi harinya
sehingga tampak seperti menstruasi. Pasien didiagnoa G1P0A0H13
minggu.
Tanda – tanda vital:
TD : 117/82 mmHg
Suhu : 36°C
Nadi : 110x/menit
Terapi yang diberikan:
Infus RL 20 tpm
Kalnex 500mg 1x sehari pukul 10.00 WIB
 Pemeriksaan fisik
Pemeriksaan Nilai normal Tanggal
13/09/2021 14/09/2021 15/09/2021
TD 120/80 mmHg 104/72 mmHg 105/82 mmHg 114/69 mmHg
Suhu 36°C 36°C 37°C 36°C
RR 12-20x/menit 20 x/menit 22 x/menit 20 x/menit
HR 60-100x/menit 88 x/menit 105 x/menit 98 x/menit
SPO2 95 – 100% 98% 98% 989/menit
Skala nyeri 1-4 2 2 2
 Data laboratorium

Tanggal Pemeriksaan Hasil Nilai rujukan

13/09/2021 Hemoglobin 13,3 g/dL 11,7 – 15,5 g/dL
Hematokrit 40,3 % 33,0 – 45,0 %
Leukosit 10,46 ribu/µl 3,60 – 11,00 ribu/µl
Trombosit 216 150 – 440 ribu/µl
GDS (H) 112 mg/dL 75 – 110 mg/dL
 Profil penggunaan obat
Nama obat Regimen dosis Rute Indikasi Tanggal
13/09/2021 14/09/2021 15/09/2021
Inf RL 20 tpm iv - √ √ √
Kalnex 500mg/5ml Iv Mencegah pendarahan √ - -
Asam folat 1 mg Oral Membantu mempercepat √ √ √
1x1 penyembuhan dan cacat
bayi
Microgest 1x200 mg Oral Penguat kandungan dan √ - -
pendarahan
Oxytoxin + RL 10unit/ml Iv Merangsang percepat - √ √
kehamilan
Bledstop 125 mg Oral Menhentikan perdarahan - - √
2x1 pasca persalinan
Bactecyn Oral Antibiotik empiris, untuk - - √
mencegah adanya infeksi
pasca bedah
Mefinal 500 mg Oral Mengatasi nyeri - - √
3x1
 ANALISIS SOAP
TANGGAL SUBJECT OBJECT ASESSMENT PLANNING
13/09/2021 Keluar darah pada jalan TD: 112/75 mmHg • Tidak ada interaksi obat • Monitoring dan
Pukul: 10.00 lahir RR: 19x/menit edukasi terapi
Hamil 12 minggu HR: 88 • monitoring
SPO2: 99% pendarahan dari jalan
Skala nyeri: 2 lahir

• Terapi yang diberikan :

Infus RL 20 tpm
Kalnex 500 mg

13/09/2021 Nyeri dibagian perut TD: 104/72 mmHg • Tidak ada interaksi obat • Monitoring dan
Pukul: 11.00 bawah RR: 20x/menit edukasi terapi
HR: 88 • Monitoring
SPO2: 98% pendarahan dari jalan
Skala nyeri: 2 lahir

• Terapi yang diberikan:

Infus RL 20 tpm
Kalnex 3 x 500 mg
As. Folat 1x1
Microgest 1x200 mg
 TANGGAL SUBJECT OBJECT ASESSMENT PLANNING
14/09/2021 Perut mulas dan masih TD: 105/73 mmHg • Tidak ada interaksi • Monitoring dan
Pukul: 07.00 keluar darah kecoklatan Suhu: 36C obat edukasi terapi
RR: 20x/menit • Monitoring
HR: 84 pendarahan dari jalan
SPO2: 99% lahir
Skala nyeri: 2

• Terapi yang diberikan :

Infus RL 20 tpm
Kalnex 3x500 mg
Asam folac 1x1
Microgest 1x200 mg
14/09/2021 Tidak ada keluhan TD: 98/90 mmHg • Tidak ada interaksi • Monitoring dan
Pukul: 14.00 Keluar darah dari jalan Suhu: 36 C obat edukasi terapi
lahir RR: 20x/menit • Monitoring
HR: 80 pendarahan dari jalan
SPO2: 99% lahir
Skala nyeri: 2

• Terapi yang diberikan :

Infus RL 20 tpm
Kalnex 3x500 mg
Asam folac 1x1
Microgest 1x200 mg
 TANGGAL SUBJECT OBJECT ASESSMENT PLANNING
14/09/2021 Masih keluar darah banyak TD: 114/69 mmHg • Tidak ada interaksi obat • Monitoring dan edukasi
Pukul: 21.00 Suhu: 36C terapi
RR: 20x/menit • Monitoring pendarahan
HR: 98 dari jalan lahir
SPO2: 99%
Skala nyeri: 2

• Terapi yang diberikan :

Infus RL 20 tpm
Kalnex 3x500 mg
Asam folac 1x1
Microgest stop
• Jika belum pembukaan
misoprostol 2 tablet
• Jika sudah pembukaan RL +
oxytoxin 1 amp
• Tindakan curratge
15/09/2021 11.30

15/09/2021 Perut mulas, cemas TD: 97/66 mmHg • Tidak ada interaksi obat • Monitoring dan edukasi
Pukul: 07.00 Suhu: 37 C terapi
RR: 20x/menit • Monitoring pendarahan
HR: 89 dari jalan lahir
SPO2: 98%
Skala nyeri: 3

• Terapi yang diberikan :

Infus RL + oxytoxin 1 amp
 TANGGAL SUBJECT OBJECT ASESSMENT PLANNING
15/09/2021 Lemes dan pusing TD: 105/82 mmHg • Tidak ada interaksi obat • Monitoring dan edukasi
Pukul: 12.00 Suhu: 37 C terapi
RR: 22x/menit • Monitoring pendarahan
HR: 105 dari jalan lahir
SPO2: 99%
Skala nyeri: 2

• Terapi yang diberikan :

Infus RL + oxytoxin 1 amp
Bledstop
Mefinal
Bacytecin

15/09/2021 lemas TD: 97/66 mmHg • Tidak ada interaksi obat • Monitoring dan edukasi
Pukul: 21.00 Suhu: 37 C terapi
RR: 20x/menit • Monitoring pendarahan
HR: 87 dari jalan lahir
SPO2: 98%
Skala nyeri: 3

• Terapi yang diberikan :

Infus RL + oxytoxin 1 amp
Bledstop
Mefinal
Bacytracin
 Nama obat Tepat pasien Tepat obat Tepat Tepat dosis Tepat rute Efek
indikasi pemberian samping
Asam tranexamat Sudah tepat Sudah tepat Sudsh tepat Sudah tepat Sudah tepat Mual,muntah,pusing,
500mg/ml Pasien mengalami Asam tranexamat Menghambat 500mg/5ml Diberikan secara diare, anemia,
pendarahan dapat digunakan fibrinolysis dengan intravena migrain
untuk menghentikan menggantikan
pendarahan plasminogen dari
fibrin

Asam folac Sudah tepat Sudah tepat Sudah tepat Sudah tepat Sudah tepat Mual, perubahan
Pasien mengalami Asam folac dapat Merangsang produksi 1x seahri 1 mg (1 Obat diberikan peroal mood, kembung,
lemas digunakan untuk trombosit pada tablet) nafsa makan
anemia anemia defisiensi bekurang
folat

Microgestin Sudah tepat Sudah tepat Sudah tepat Sudah tepat Sudah tepat Sakit kepala,
Karena microgestin Menghambat sekresi 1 mg/5mcg Diberikan secara oral anorexia, mual
dapat mengatasi gonadotropin dari
pendarahan dan hipofisis, mencegah
penguat kandungan pematangan folikel
serta dan ovulasi

Mefinal Sudah tepat Sudah tepat Sudah tepat Sudah tepat Sudah tepat Konstipasi, sakit
Pasien mengalami Asam mefenamat Asam mefenamat 3xsehari 1 tablet Diberikan secara perut, anorexia,
nyeri dapat mengatasi dapat menghambat 500 mg peroral diare, gastritis
nyeri sintesis prostaglandin
COX-1 dan COX-2
 Nama obat Tepat pasien Tepat obat Tepat Tepat dosis Tepat rute Efek
indikasi pemberian samping
Bleedstop Sudah tepat Sudah tepat Sudah tepat Sudah tepat Sudah tepat Mual, muntah,
Pasien methyergotamine 125 mg Secara peroral halusinasi, diare,
mengalami dapat hidung tersumbat
pendarahan menghentikan
pascapersalinan pendarahan
postpartum
Bactecyn Sudah tepat Sudah tepat Sudah tepat Sudah tepat Sudah tepat Mual, muntah,
Pasien Bactecyn dapat Menganggu Dosis yang Secara peroral peradangan
melakukan digunakan sintesis dinding diberikan 375 mg pembuluh darah,
Tindakan sebagai antibiotic sel bakteri selama nyeri
pembedhan empiris pasca replikasi aktiof,
berupa curratge pembedahan menyebabkan
aktivitas
bakterisid
terhadap
organisme yang
rentan
Oxytoxin Sudah tepat Sudah tepat Sudah tepat Sudah tepat Sudah tepat Kontraksi Rahim
Pasien Oxytoxin dapat Dapat 10 unit/ml Secara IV yang berlebihan,
mengalami merangsang merangsang mual
abortus percepatan dalam prostaglandin muntah,perdarah
persalinan lokal sehingga an pada Rahim,
merangsang takikardia
kontraksi uterus
 Konseling, Informasi dan Edukasi

1. Farmakologi
2. Non farmakologi

• Memonitoring efek samping obat

THANK YOU
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