THREATENED PRETERM LABOR CASE REPORT IN RSUDZA

BANDA ACEH

ANCAMAN PARTUS PREMATURUS: SEBUAH LAPORAN KASUS DI RSUDZA

BANDA ACEH

Mohd Andalas1, Muchsal Mina2, Huzaife Hamle3, Ridwan4

1
Department of Obstetrics and Gynecology
of Faculty of Medicine Universitas Syiah Kuala
Banda Aceh
2
Medical Student
Faculty of Medicine Universitas Syiah Kuala
Banda Aceh
Abstract
Objective: To report a case of Threatened Preterm Labor.
Methode: Case Report.
Case: Woman 27 years old, parous, came to the Regional General Hospital dr. Zainoel Abidin
(RSUDZA) with pain in abdomen. The complaint has already been since 3 days before come
to Hospital. Patients also complain of water as it comes out of the vagina. On physical
examination in RSUDZA, patient was in good condition. In gynecologic examination, no mass
palpable from the adnexa, there are pain at portio movement, no bulge at Douglas cavity, and
also no mass at cervix. A laboratory examination shows normal result. We diagnose patient
with Threatened Preterm Labor. We planned maintenance of pregnancy.
Results: We didn’t find any sign of uterus perforation from the operative report. In adnexa
exploration we found an adhesion and mass at sacrouterine with suspicious ovarian pregnancy
and luteum cysts rupture.
Conclusion: Laparoscopy diagnostic procedure is the best optional method for suspicious of
uterus perforation, intra abdominal bleeding due to gynecology procedure or ectopic
pregnancy, because minimal invasive, minimal blood loss and hospital stayed shorten.
Keywords: Threatened preterm labor, preterm, and RSUDZA.

ABSTRAK
Objektif: Melaporkan kasus tentang Ancaman Partus Prematurus.
Metode: Laporan Kasus
Kasus: Wanita berusia 27 tahun, primigrapida, datang ke Rumah Sakit Umum Daerah dr.
Zainoel Abidin (RSUDZA) dengan keluhan mules-mules dibagian perut. Pasien sudah
mengeluhjan sejak 3 hari sebelum masuk rumah sakit. Pasien juga mengeluhkan keluar air-air
dari jalan lahir. Pada pemeriksaan fisik pasien di RSUDZA dalam keadaan baik. Pemeriksaan
genikologis, adneksa kiri dan kanan tidak teraba massa tetapi nyeri ketika portio digerakkan,
tidak ada bulging pada kavum Douglas dan juga tidak ada massa didaerah serviks. Pemeriksaan
laboratorium dalam batas normal. Pasien didiagnosa dengan Ancaman Partus Prematurus.
Pasien direncanakan untuk mempertahankan kehamilan
Hasil: Dari durante operasi ditemukan uterus tidak terdapat adanya kelainan. Dari eksplorasi
adneksa ditemukan perlengketan ke arah sakrouterina dengan kesimpulan kecurigaan
kehamilan ovarium kanan dan kista luteum pecah.
Kesimpulan: Tindakan laparoskopi diagnostik menjadi pilihan terbaik dalam curiga suatu
perforasi uterus, perdarahan intra abdomen atau kehamilan ektopik karena minimal invasif,
perdarahan yang minimal serta waktu rawat yang singkat dirumah sakit.
Kata kunci : Ancaman partus prematurus, Prematur dan RSUDZA

Correspondence: Mohd. Andalas, Department of Obstetrics and Gynecology Faculty of

Medicine Universitas Syiah Kuala Banda Aceh. Phone: 0811683241. Email:
andalas_m@yahoo.com

I. Introduction
Preterm labor is an obstetrics emergency and a threat to population health. 75% of infant
mortality is related to preterm labor (1, 2). Preterm labor not only inflicts financial and
emotional distress on the family, it may also lead to permanent disability (physical or neural
damages) in infants. Approximately one-third of preterm labor survivors suffer from severe
long-term neurological disabilities, such as cerebral palsy or mental retardation (3).
Furthermore, preterm infants carry increased risk of a range of neurodevelopmental
impairments and disabilities including behavioral problems, school learning difficulties,
chronic lung disease, retinopathy of prematurity, hearing impairment, and lower growth
attainment (4).
Over the last two decades, preterm birth rate has remained unchanged or even risen in
most countries, despite the increased understanding of possible risk factors and their
pathological mechanisms (5-7). Al- though neonatal mortality rate has fallen globally between
1990 and 2009 (8), the absolute number and rate of preterm births has increased during this
period. Preterm birth was the second leading cause of death in children under 5 years old (9).
In 2013, preterm birth rate in Germany, Brazilan- dUnited States were 8.7%, 10.7 and 12%,
respectively (10, 11). The vast majority (85%) of global preterm births occur in Asia and
Africa, where health systems are weak and inadequate (12, 13). In Iran incidence of preterm
labor was 7.2% in Tehran, 5.5% in Shiraz, and 8.4% in Khorramabad (14-16). Al- though in
most cases preterm births occur idiopathically, fe- tal, uterine, and placental factors as well as
maternal chronic diseases, can affect preterm birth (17). In the USA, 70% of preterm births
were idiopathic and the rest were due to pre- eclampsia (50%), fetal distress (25%) and
abruption (25%) (18). In another study, preterm multifetal pregnancies and hypertension were
introduced as the major factors affecting preterm birth (19). In order to determine the incidence
and etiologic factors of preterm labor, the present study was con- ducted on newborns at the
obstetrics emergency department of Shohadaye Tajrish Hospital with a view to identifying pre-
ventive measures.
II. Case
A 27 year old woman with parital state G1P0A0 came with chief complaint abdominal
pain. The complaints has already been since 3 days before come to hospital. The patient also
complain of water as it comes out of the vagina. The patient admited 8 months pregnancy There
is no history of asthma, allergies, hypertension, and diabetes mellitus.
From physical examination in Emergency room, patient was in good condition, blood
pressure 130/80 mmHg, heart rate 82 bpm, respiratory rate 20 per minutes, temperature 36,5°C.
On gynecological examination uterus appropiated of gestasional pragnancy, loose
parametrium, not palpable mass at adnexa, pain negatif, cervical motion was positive and
Douglas cavity is not prominent. A laboratory examination shows normal result.
Patients were diagnosed with threatened preterm labor due to 31-32 gestational age of
pregnancy. Furthermore, patients planned mantenance of pregnancy.

V. Discussion
In this case, the patient complaints with contraction 3 days before came to hospital
increasing heavy. Patients also complain out the liquare from the birth canal, blood out denied.
Patients pregnant for 8 months with first day of Last Mensturation Period 21-06-2017, Estimate
due date 28-03-2018 ̴ 31-32 weeks. ANC patients routinely in 2 times midwife, at Spesialist
obstetri and Gynecology 1 time. In the last ultrasound the fetus to be in good condition. She
also complain white discharge , white milk sometimes itchy and odorless. Fever during
pregnancy negative, feces and urine in normal range. Patients had appendectomy surgery in
2015, had been treated 2 times in Maternal and Childhood hospital with vomiting and diarrhea
complaints ± 6 months ago. The history of asthma, allergies, hypertension, and diabetes
mellitus is denied by the patient. In family history patient's mother has hypertension and the
patient's husband has a history of epilepsy. The patient works as a housewife and husband
works as a trader. First menstrual patient age 16 years, 6-15 days, 2-3 x GP, dysmenorhea (-).
The patient was married one time at the age of 22 years. Pregnant patients 1 time that is
pregnant at this time. patients never use family planing.
Preterm labor is one of the major causes of perinatal mortality and morbidity
worldwide. Preterm delivery causes 70% prenatal or neonatal mortality, and causes long-term
morbidity. Another suggestion is that preterm delivery is a labor that takes place at 20-37 weeks
'gestation calculated from the first day of the last menstrual period in accordance with this
patient with 31-32 weeks' gestation including preterm pregnancy.
The diagnosis of preterm labor is made if a patient with gestational age of less than 37
weeks with regular contractions, once every 10 minutes or 2 times in 20 minutes, which may
be associated with dilatation and / or thinning of the cervix. In this patient there was 2x / 10 '/
25' 'TFU 25 cm, TBJ: 1860gram, inspection vulva and urethra in normal line, At inspeculo,
portio smooth, open OUE, negative flucsus, white discharge negative (smelled fishy) ,
Negative Valsava, nitrazin test negative,negative shake pain, cavum douglas not protruding,
adnexa no mass, flexible parametrium. So on this patient can be established with the threat of
premature partus
The first thing to think about the management of preterm labor is whether it is preterm
labor. Next seek for the cause and assess the clinical, laboratory, or ultrasonographic well-
being of the fetus, including fetal growth, weight, number and condition of amniotic fluid,
percentage and fetal state, congenital anomalies. In these patients were found to be the first
pregnant 31-32 weeks, the live fetal head presentation, the premature partus threat (tocolytic
score 3). then in this patient a diagnosis of preterm premature detection but no a sign of inpartu
is given by a tocolysis agent that aims to prevent premature infant mortality and morbidity,
providing opportunities for corticosteroid therapy to stimulate fetal lung surfactant, allowing
intrauterine transfer in more complete facilities and optimization of personnel with titration
nifedipin 10 mg until the loss of his maximum 120 mg and give maintance adalat oros 1x30mg.
and administer corticosteroids for lung maturation with dexamethasone 6mg / 12 hours for 2
days, and antibiotics to prevent infection clindamycin 3x300 mg and metronidazole 3x500 mg
and bedrest education and motivation of breast feeding use of contraceptives or family planing

Reference
1. Kliegman RM, Behrman R, Jenson H. Stanton B. Nel- son textbook of pediatrics. Germany:

Elsevier Health Sci- ences; 2007. 


2. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D. Spong CY Williams Obstetrics.

USA: The McGraw-Hill Companies, Inc. Medical Publishing Division; 2010. 


3. Lawn JE, Cousens S, Zupan J, Team LNSS. 4 mil- lion neonatal deaths: when Where Why

The Lancet. 2005;365(9462):891-900. 


4. SaigalS,DoyleLW.Anoverviewofmortalityandsequelae of preterm birth from infancy to

adulthood. The Lancet. 2008;371(9608):261-9. 


5. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, et al. National,
regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends
since 1990 for selected coun- tries: a systematic analysis and implications. The Lancet.

2012;379(9832):2162-72. 


6. Langhoff-Roos J, Kesmodel U, Jacobsson B, Rasmussen S, Vogel I. Spontaneous preterm

delivery in primiparous women at low risk in Denmark: population based study. Bmj.

2006;332(7547):937-9. 


7. Norman JE, Morris C, Chalmers J. The effect of chang- ing patterns of obstetric care in
Scotland (1980-2004) on rates of preterm birth and its neonatal consequences: perinatal

database study. PLoS medicine. 2009;6(9):1009. 


8. Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, et al. Neonatal
mortality levels for 193 countries in 2009 with trends since 1990: a system- atic analysis of
progress, projections, and priorities. PLoS Med. 2011;8(8):e1001080.