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INTRODUCTION Abortion is used to indicate the release of the results of conception before the fetus can live outside

the womb. The clinic can be distinguished between threatened abortion, abortion insipien, inkompletus abortion, abortion kompletus. Abortion is estimated at an individual vaginal secretions that contain any blood or vaginal bleeding that is seen in the first half of pregnancy.Incomplete abortion is spending most of the products of conception in pregnancy before 20 weeks with still left in the uterus. Because as much as 30% of abortion remains unknown, this means that the majority of abortions occur very early. Diagnosis of suspected abortion is a woman of reproductive age complaining about experiencing vaginal bleeding after menstruation is late, there is often a sense of heartburn. Perinatal mortality rate was higher in women in the early kehamilannnya complicated by abortion.Every woman should undergo a thorough examination, because there is always the possibility that the cervix has dilated, so that abortion can not be avoided or serious complications such as extra uterine pregnancy or ovarian cyst torsion is not suspected.

Etiology
Chromosomal anomalies cause at least seperuh of this early abortion. In pregnancy, abortion is not infrequently preceded by the death of the fetus. The things that cause abortion can be divided as follows: 1. Abnormal growth of the conceptus Abnormal growth of the conceptus can cause fetal death or disability. Severe growth abnormalities are usually the cause of death of the embryo in early pregnancy. The factors that cause abnormalities in growth are: 1. Chromosomal abnormalities. Abnormalities are often found in spontaneous abortion is trisomy, polipoidi, and also the possibility of sex chromosome abnormalities. 2. Environment that is less than perfect. When the environment around the site of implantation endometrium is less than perfect so that the provision of food substances in the products of conception disturbed. 3. Outside influences. Radiation, drugs, can affect both the environment and the products of conception in the uterus. The influence of the effect generally called teratogens. 2. Placental abnormalities Infection can occur in the villi koriales and cause impaired oxygenation of the placenta, causing fetal growth retardation and death. 3. Maternal disease.

Sudden illnesses such as pneumonia, typhoid abdominalis, pyelonephritis, malaria and others can cause abortion. Toxins, bacteria, viruses, or palsmodium can enter the fetus through the placenta and cause fetal death, and then there was abortion. Severe anemia, poisoning, laparotomy, peritonitis and chronic diseases such as brusellosis, infectious mononucleosis, toxoplasmosis can also cause abortion although less frequently. 4. Genital tract abnormalities. Myoma uteri or congenital abnormalities of the uterus can cause abortion. Another cause of abortion in the second trimester is incompetent cervix that can be caused by a congenital weakness in the cervix or cervical dilatation excessive.

Pathogenesis
In early abortion hemorrhage in the basal decidua followed by necrosis of the surrounding tissue. This causes the products of conception partially or completely detached, so it is a foreign body in the uterus. This situation causes the uterus to expel its contents. At 8 weeks of pregnancy kuran gdari products of conception was usually removed completely because the villi koriales not penetrate deeply decidua. At 8-14 weeks of pregnancy, the villi koriales penetrate deeper decidua, placenta generally not released so perfect that caused a lot of bleeding. At 14 weeks gestation and above, generally issued after rupture is fetal, placental followed some time later. Bleeding is not much if the placenta immediately off completely. Products of conception may be issued in various forms, there are times when the amniotic bag is empty or look inside small objects without a clear form (blighted ovum), may also be long dead fetus (missed abortion).

SYMPTOMS
The symptoms on abortion among other inkomplitus bleeding. Bleeding in incomplete abortion can be a little to much and can persist for several days or weeks. Incomplete abortion may be followed by a mild cramp-like pain menstrual pain or lower back pain. Pain on abortion can be located on the anterior and rhythmic as labor pains on a regular. The onset of pain may be persistent lower back pain that is accompanied by a feeling of pressure in the pelvis, or the pain can be a dull pain or soreness in the midline at suprasimfisis area accompanied by uterine tenderness area. However the form of pain that occurs, continuity of pregnancy with bleeding and pain showed poor prognosis. However, the majority of women who suffer from pain and threatened by abortion, bleeding can be stopped, the pain disappeared and normal pregnancy can continue.

DIAGNOSIS

The diagnosis of incomplete abortion upheld if there is bleeding through the cervical os eksternum, accompanied by a sense of mules a little or not at all. There is a history of partial discharge of the products of conception such as blood clots, such as meat tissue. The uterus enlarges with age pregnancy, the cervix is already open and can be palpated tissue in the uterine cavity or sometimes protruding from the cervical os eksternum, coupled with a positive pregnancy test. Bleeding in incomplete abortion can be an awful lot, so it can cause shock and bleeding will not stop before the rest of the products of conception were excluded.

Investigations
Ultrasound examination is important to determine whether the fetus is alive. Invisibility of the ultrasound picture showed gestational ring with clear shapes and gives an overview of the central section of the shadow Ekho embryo means the products of conception can be said to be healthy. Ekho gestational bag without a central overview of the embryo or fetus showed the death of the conceptus. If abortion is unavoidable, gestational sac diameter is often smaller than necessary for the same gestational age. Furthermore, at the age of 6 weeks of pregnancy and thereafter, fetal heart motion will be seen clearly using ultrasound.

MANAGEMENT

If the bleeding is not a lot and less than 16 weeks gestation, spending the products of conception can be done digitally or with pliers to remove the products of conception ova that exit through the cervix. If the bleeding stops, give ergometrin 0.2 mg IM or misoprosotol 400mcg orally.

If much bleeding or bleeding continues and gestational age less than 16 weeks, the evacuation of waste products of conception with:

- Manual Vacuum Aspiration (MVA) is a method selected. Evacuation with a sharp curette should only be done if the manual vacuum aspiration is not available. - If evacuation can not be done, give ergometrin 0.2 mg IM (repeated after 15 minutes if necessary) or misoprosotol 400mcg orally (may be repeated after 4 hours if necessary)

If the pregnancy is over 16 weeks:

- Infuse oxytocin 20 units in 500ml of IV fluids (saline or Ringer's lactate fisologik) with a rate of 40 drops / min until the expulsion of the conceptus occurs - If you need to give misoprosotol 200 mcg vaginally every 4 hours until the expulsion of the conceptus occurs (maximum 800mcg) - Evacuation of waste products of conception are left behind in the uterus

When accompanied by shock due to bleeding

Soon to be given intravenous fluids or Ringer physiological saline followed by transfusion. After the shock resolved, do scrapings. After action ergometrin injected IM to maintain muscle contractions of the uterus.

CASE ILLUSTRATION
A female patient, aged 34 years admitted to hospital obstetrics dibangsal Pariaman from the date 6-42005 with: The main complaint: a little bit of blood out of the pubic since 11 days ago Disease History Now: - Bleeding from the genitals a little since 11 days ago 1 dark red strands moistened towels, sometimes accompanied by pain. - History jaringa out like no meat - History of blood clots out there - No history of fever - No history of trauma - No menstruation since 2 months ago - This is the third pregnant, the youngest child aged 7 years - HPHT 18 January 2005 - RHM: nausea (+), vomiting (-), bleeding (-) - RHT: - PNC: regular kebidan - R menstruation: menarche age of 13 regular, 1 x 28 days, 5-7 days old, 2-3 x daily change duk. Past medical history: - Have never miscarried before - No history of heart disease, lung, liver, kidney, diabetes, hypertension. Family history of disease: no family member suffering from a contagious disease, heredity, or psychosis. History marriage: 1 x 1990 History of pregnancy / abortion / delivery: 3/0/2 1. 1992 men, 3500, at term, spontaneous, midwife, living. 2. In 1997, a woman, 3300, at term, spontaneous, midwife, living. 3. now History KB: injectable R immunization: (-)

PHYSICAL EXAMINATION

General condition: Good Awareness: composmentis cooperative


Blood pressure: 120/80 mmHg Nadi: 84x/menit Breath: 22x/menit Temperature: 37 C STATUS internus Eyes: not anemic conjunctiva, sclera jaundice is not ENT: no abnormalities Neck: JVP 5-2 cmH 2 O, the thyroid is not enlarged Thorax: heart and lung DBN Abdomen: status obstetrikus Genitalia: status obstetrikus Ekstermitas: edema (-), R.Fisiologis + / +, R. Pathologic - / STATUS OBSTETRIKUS Advance: chloasma gravidarum (+) Mammary: enlarged, A / P hyperpigmentation Abdomen:

inspection: looks a little bulge, L / M hyperpigmentation, sikatrik (-) palpation: FUT palpable three fingers below the center, ballotement (+) percussion: timpani Auscultation: BU (+) N, BJA (-) Inspection: vulva and urethra calm Inspekulo:

Genitalia:

Vaginal tumors (-), fluksus (+), lacerations (-). Looks difornik posterior blood accumulate. portio: MP, soft, tumor (-), fluksus (+), lacerations (-), OUE slightly open, looking a little blood cervical dikanalis. Additional examination: plano test (+) Diagnosis of work: 8-10 weeks + G3P2A0H2 gravid abortion inkompletus Attitude: KU control, VS, PPV Recommendation: Ultrasound Plan: curettage.

DISCUSSION
The patient was a 34-year-old multiparous, obstetrics hospitals treated dibangsal Pariaman from the date of 6-4-2005. in time the patient was diagnosed with gravid G3P2A0H2 8-10 weeks +

incomplete abortion. The diagnosis is made based on the patient's anamnesis which is not menstruating since 2 months ago, a history of positive young pregnant, bleeding from the pubic since 11 days ago, dark red, slightly, never stops, sometimes accompanied by pain. History came out like a lump of tissue. From the examination of blood visible inspekulo fornik accumulate in the posterior, and the cervix was slightly open. Additional checks obtained from the positive pregnancy test. Then the patient is planned for curettage.
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