ABORTUS SPONTAN

ABORTUS

Miscarriage adalah terminologi non-ilmiah untuk abortus yang artinya adalah berakhirnya kehamilan secara alamiah suatu kehamilan pada stadium dimana embrio atau fetus masih belum dapat hidup mandiri dan pada umumnya , batasan untuk manusia adalah sebelum gestasi berusia 20 minggu.

Abortus adalah komplikasi kehamilan dini yang sering terjadi [1][2] .

TERMINOLOGI

Abortus spontan yang terjadi sebelum kehamilan minggu ke 6 sering disebut sebagai “early pregnancy loss” [3]  atau “chemical pregnancy[4] . Abortus yang terjadi setelah kehamilan 6 minggu disebut abortus spontan klinis [3]

Abortus spontan komplet pada minggu ke 6 (8 minggu dihitung dari HPHT)

KLASIFIKASI

Gambaran klinik dari abortus iminen adalah perdarahan pervaginam dalam kehamilan sebelum usia kehamilan yang viabel dan memerlukan penilaian lanjut. Pada pemeriksaan terlihat janin masih hidup dan kehamilan masih dapat diharapkan berlanjut sampai aterm tanpa masalah.

Klasifikasi lain yang disimpulkan tidak dapat dilanjutkan adalah :

  • Blihghted Ovum : kantung kehamilan tumbuh  normal namun bagian embrio dari konsepsi tidak terbentuk atau berhenti berkembang (kehamilan anembrionik)
  • Abortus insipien : perdarahan disertai dengan servik yang sudah terbuka[10] , dan konsepsi sedang dalam proses pengeluaran dan umumnya akan berlanjut ke abortus kompletus.  Detak jantung janin mungkin sudah negatif atau masih positif, dan hal ini termasuk pertimbangan kriteria.
  • Abortus Kompletus : bila hasil konsepsi (trofoblas, vili chorialisi, kantung gestasi, yolk sac, dan bagian janin (embrio); pada kehamilan yang lebih lanjut fetus, talipusat, plasenta, cairan amnion, dan selaput ketuban.) sudah keluar semua.
  • Abortus inkompletus : Bila jaringan sudah keluar sebagian, dan sisanya masih berada in utero.[11]
  • “Missed Abortion” : bila embrio sudah mati namun peristiwa abortus belum terjadi dalam waktu tertentu

Klasifikasi berikut merupakan komplikasi lanjut atau dampak dari peristiwa abortus:

  • septic abortion : terjadi bila jaringan yang berasal dari abortus inkompletus atau “missed abortion” mengalami infeksi sekunder. Infeksi uterus akan dapat meluas dan menyebabkan septicaemia
  • Recurrent pregnancy loss: disebut pula sebagai Habitual abortion atau terjadinya peristiwa abortus sebanyak 3 kali berturut-turut.   

Keluhan fisik abortus spontan beragam dan tergantung pada usia kehamilan: .[13]

  • Pada kehamilan 6 minggu, hanya ada sedikit gumpalan darah disertai nyeri periodik dan “cramping pain”
  • Pada kehamilan 6 – 13 minggu, gumpalan darah keluar bersama janin dan plasenta sebelum proses berakhir. Proses akan memakan waktu beberapa jam dan berakhir dalam beberapa hari.
  • Pada kehamilan > 13 minggu, proses akan diawali dengan keluarnya janin dan plasenta dapat keluar seluruhnya atau sebagian sehinga terjadi abortus inkompletus Gambaran klinik berupa perdarahan, nyeri dan “cramping” serupa dengan stadium awal abortus atau kadang lebih hebat dan menyerupai “miniatur  persalinan”.

GEJALA DAN TANDA

Gejala utama abortus adalah perdarahan;[14]  perdarahan pada kehamilan awal disebut sebagai abortus iminen. Setengah pasien akan mengalami abortus.[15]

Abortus spontan dapat terdeteksi melalui pemeriksaan USG atau melalui pemeriksaan serial hCG – human chorionic gonadotropin .

ETIOLOGI

  • Genetik
  • Kelainan uterus
  • Kelainan hormonal
  • Infeksi sistem reproduksi
  • Rejeksi jaringan

TRIMESTER PERTAMA

  1. Secara klinis sebagian besar berupa abortus spontan pada trimester pertama.[19][20]
  2. Abnormalitas kromosomal ditemukan pada 50% embrio yang mengalami abortus pada 13 minggu kehamilan pertama. Embrio dengan masalah genetik, 95% akan mengalami abortus.
  3. Defisiensi Progesterone pada paruh kedua siklus haid (luteal phase) memerlukan suplemen progesteron pada kehamilan trimester pertama..[21]

TRIMESTER KEDUA

15% kegagalan kehamilan pada trimester kedua disebabkan oleh :

  1. Kelainan anatomis uterus,
  2. Pertumbuhan dalam uterus (mioma uteri, polip endometrium), atau
  3. Kelainan pada servik.[21]
  4. Kondisi diatas juga dapat menyebabkan  persalinan preterm.[19]
  5. 19% disebabkan oleh kelainan pada talipusat
  6. Kelainan placenta[25]

FAKTOR RESIKO

Rujukan

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About Bambang Widjanarko

Obstetrician and Gynecologist ; Staf pengajar di Fakultas Kedokteran & Kesehatan UMJ ; Kepala Departemen Obstetri Ginekologi FKK UMJ ; Ahli Kebidanan & Ilmu Penyakit Kandungan di RS Islam Jakarta Utara.

Posted on 29/04/2012, in Uncategorized. Bookmark the permalink. Leave a comment.

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