Vous êtes sur la page 1sur 6


Ariel Timy1, Dwiana Ocviyanti2

Faculty of Medicine Universitas Indonesia, Obstetric and Gynecology Department
Cipto Mangunkusumo National Referral Hospital

Adolescent pregnancy is a pregnancy with a female age of less than 19 years. In this
pregnancy very much affects various biopsychosocial aspects. According to United
Nations Development Economic and Social Affairs (UNDESA, 2010), Indonesia is
among the 37 countries with a high percentage of young marriages and is the second
highest in ASEAN after Cambodia.1
Marriage at a young age is risky because of insufficient readiness from aspects of health,
mental and emotional, education, socio-economic and reproduction. In adolescent
pregnancy, especially a pregnancy that is not expected, it could increase the incidence of
the act of abortion or abortus provocatus, which is still included in criminal cases.2
Objective: to carry out a holistic approach from the biological, psychological and social
aspects of patients with abortus provocatus in G1, 18 weeks pregnant, IUFD fetus, and
unwanted pregnancy.
Case Illustration : A 17-year-old woman came to Cipto Mangunkusumo Hospital with
complaints of late menstruation since 4 months ago, the patient did not know that she was
pregnant, then an examination was obtained from a test pack, and the result was positive.
the patient then went to Jakarta to avoid family and neighbors in Makassar, and came to
Cipto Mangunkusumo Hospital. She was then diagnosed with a single IUFD fetus. From
information which is obtained from the family, the patient's mother felt angry and
disappointed with her, from the patient's statement showed that the pregnancy was not
expected. The patient denies any abortion.
Discussion: Adolescent pregnancy can bring biopsychological and social effects to the
patient’s life. Unknown and unplanned pregnancies can result in a criminal act, namely
an illegal abortion.
Keywords: adolescent pregnancy, abortus provocatus

Case Illustration
A G1P0 woman, is 17-year-old tribe of was referred to Cipto Mangunkusumo
Bugis, Muslim and currently unmarried. hospital.
The patient is currently a 3rd grade high Patient came with 110/70 mmHg of
school student in the city of Makassar. blood pressure, pulse : 84 beats per
The patient lived with her parents, and is minute, breathing : 20 breaths per minute.
the last child of 3 siblings. Her father's On physical examination, no
job is an entrepreneur and he has a abnormalities were found. On obstetric
printing business in the Soppeng area of examination, inspection: the vulva and
Makassar, while the patient's mother is a urethra were smooth, negative active
housewife. The patient came to the bleeding. Speculum examination:
maternity room at Cipto Mangun slippery portio, OUE opening was 2 cm,
Kusumo Hospital with complaints of late visible tissue in portio, fluor negative,
menstruation since 4 months ago, with fluxsus positive. On vaginal toucher
the results of a positive test pack test, the examination : soft portio, axial, 2 cm
first day of the last menstrual period was thick, 2 cm opening, palpable tissue in
on September 3rd, 2018. Patient claimed portio.
not to be pregnant, and never get tested Based on USG result, it was found that
with the test pack. The patient claimed to there was an intrauterine single fetus,
have had sex with her partner as much as negative FHR, CRL were difficult to
twice without using a condom. Patient assess, negative spalding sign, amniotic
claimed to take menstrual smoothing fluid ran out. Patient were diagnosed
medication 1 month ago and herbal with incipient abortion in G1, 18 weeks
medicine as many as 2 pills, but she did pregnant, IUFD fetus, adolescent
not know the name of the herbal pregnancy, and unwanted pregnancy.
medicine. Patient got information about Management of this patient was with
the herbal medicine from her friends. induction of 200 mcg of vaginal
There were complaints of water broke misoprostol every 6 hours, injection of
and blood spots last week which were ampicillin sulbactam 4x1,5gr
accompanied by nauseous. Then, the intravenously, psychiatric and medico-
patient went to Jakarta (there was a legal forensics consultation. The result
family of an obstetrician) and was said to of discussions with MOD, patient whose
be pregnant, the fetus died and then she age was less than 18 years, was
suspected trials of abortion, according to The patient said that she felt scared when
the medico-legal forensic counseling she found out that she was pregnant. The
procedure. Based on the results of the patient and her parents want the baby to
psychiatry consultation, the patient be expelled from her belly immediately.
consumed herbal medicine 1 week ago The patient's parents said that they felt
with the intention of wanting to abort it. sad and disappointed that their only
The victim admitted to being in sexual daughter had to experience this. The
contact with her partner around patient's parents want her to finish high
September / October (forgetting exactly school and succeed, not like them who
when it was), forced without safety, only graduated from junior high school.
having sex twice. No history of threats, On physical examination, the mental
physical violence, or providing food / status is obtained, appearance:
drink. From the forensic department, adolescent girl according to age, attitude:
patient with incipient abortion in G1, 18 less cooperative, resistant, psychomotor
weeks pregnant, was suspected to be an behavior : calm but seeming to be on
abortus provocatus. Medical guard or alert, speech: less spontaneous,
management according to the midwifery enough volume, clear articulation, many
department, which is recommendations answering "don't know", "Do not
to report to the police department. From remember or forget", mood: dysphoric
the results of the psychiatric consultation, mood, affect: limited, harmonious,
on history taking, the patient was coherent thought process, content
relieved and glad that the baby had come thought: fear of angry mother, enough
out of her belly. The patient said that she ideas, perceptions: good. Management
did not know that she was pregnant. The of psychiatry: supportive psychotherapy
patient only found out she was pregnant (empathy validation, reassurance).
after being told by her mother 4 days ago. Discussions
The patient said she had sex with her Adolescent pregnancy is often
partner twice. Her partner is 2 years older associated with unwanted pregnancy,
and is a senior, he has graduated from and can also increase the lifting of crime
high school but has not worked. The such as the act of abortion or abortus
patient feels sad and disappointed with provocatus illegally.2,3 Pregnancy in
her partner and intends to forget him. adolescence is much influenced by
several factors such as weak supervision Psychological aspects
from parents or family, disappointment There are several psychological aspects
with family, bad environmental factors that cause adolescent pregnancy such
and advances in communication as4: 1. The lack of the role of parents in
technology that can easily access the family. Attention and the role of
pornography.2,4 The biopsychosocial parents greatly influence the mental and
concept is a medical approach from psychological development of the
various perspectives such as behavioral, children. Children who do not feel peace
cognitive, psychological health and in their families will tend to seek peace
social health. outside in various ways, there are times
Biological aspects when they do things that many of them
Adolescent pregnancy has a higher tend to do negative things as a form of
number of complications in both the their regret towards the parents. 2. Lack
mother and fetus, in this case the of Sex Education from Parents and
complications that occur are more Families to Adolescents. Information is
towards the psychological and social provided that around 65% of information
aspects of the patient by acting abortus about sex comes from friends, 35% from
provocatus illegally because patient and pornographic films, and only 5%
families feel ashamed of the surrounding information about sex are from parents.
community. 3. Development of science and
Psychologically, adolescents with technology which is not based on strong
premarital pregnancies will feel mental development.
depressed, scared, confused, and The more advanced science and
embarrassed, as a result, they tend to technology makes it easier for teenagers
have an abortion. Worse, women who do to get information about sex.
not want a pregnancy generally have an Adolescents who are pregnant outside of
abortion clandestinely and through marriage face a variety of psychological
unsafe abortion, which is an abortion problems, namely fear, disappointment,
performed by an incompetent person regret, and low self-esteem towards their
such as a “dukun”, so that it can cause pregnancy, resulting in efforts to
cases such as bleeding, infection and eliminate them by way of abortion.
other abnormalities, even death.5 Doing abortion has the smallest loss
compared to continuing the pregnancy, impact on education dropping because
where the situation will become more they have to care for their children or are
complicated if the young man or the man ashamed to be seen by their friends.6 so
who impregnate woman is not that it can cause a criminal effect.
responsible so that the suffering is only Abortus provocatus criminalis; is
borne alone with the family. The family abortion that is intentionally carried out
faces difficult problems in the which violates or contravenes various
community as if they are unable to legal provisions in force in Indonesia.
provide moral education to their Intentional abortion with various other
daughters, so often the woman takes reasons, such as embarrassment to
steps to take an abortion, which leads to neighbors, economically unprepared and
criminal acts. so on.)8
There is also a new problem that is after Abortion in Indonesia has a law
a woman has committed an act of stipulated in the Criminal Code,
abortion, the woman will have feelings according to Article KUHP Bab XIX
of guilt that can endanger her life, if not pasal 346 which forbids abortion, “ A
immediately helped, she will experience woman who on purpose perform
major depression, frustration and abortion or perform an action that makes
emptiness or will experience "Post the baby die in her womb or ask other to
abortion syndrome", namely, loss of perform the procedure, threatened with
self-esteem, multiple nightmares about the longest imprisonment 4 years.”10,11
babies, unable to enjoy sexual relations, Strategies to address social problems
hysterics, trying drugs, and wanting to associated with adolescent pregnancy
commit suicide.6,7 need to involve joint interventions,
Social aspects including education, skills development,
There are a number of social effects clinical and social support for adolescent
related to adolescent pregnancy, one of mothers, so as not to have a negative
which is criminal acts such as illegal impact on crime.8
abortion because a woman and her Conclusions
family are embarrassed to accept the In adolescent pregnancy, it has complex
current situation. In other respects biopsychosocial problems, especially if
adolescent pregnancy can also have an the patient does not want her pregnancy,
and will have an impact on crime such as of pregnant and parenting
adolescents. Pediatrics.
an illegal abortion.
In this patient there is also an action of 7. Patch LK. Adolescent pregnancy:
psychosocial issues. Indiana
abortus provocatus which is not safe,
medicine : the journal of the Indiana
even can be fatal which can lead to death State Medical Association.
of the mother.
8. Suryono Ekotama dkk, 2001,
Therefore, supervision in adolescent Abortus Provokatus bagi korban
pemerkosaan perspektif viktimologi,
pregnancy is very important. In addition
kriminologi, dan hukum pidana,
to health and medical aspects, UAJY, Yogyakarta
9. Cook SMC, Cameron ST. Social
supervision also includes social and
issues of teenage pregnancy.
psychological support to make Obstetrics, Gynaecology &
Reproductive Medicine.
pregnancy in adolescence possible under
optimal conditions. 10. Hamzah, Andi, Dr.SH., 1984, Kitab
Undang-undang Hukum Pidana,
Ghalia Indonesia, Jakarta.
References : 11. Hanafiah, M. Yusuf., Prof.Dr.SPOG
& Amri Amir, Dr.SpF., 1999, Etika
1. Ri PDdIKK. Situasi Kesehatan
Kedokteran & Hukum Kesehatan,
Reproduksi Remaja.
Penerbit Buku Kedokteran EGC,
2. Shaw M, Lawlor DA, Najman JM.
Teenage children of teenage
mothers: Psychological, behavioural
and health outcomes from an
Australian prospective longitudinal
study. Soc Sci Med 2006;62:2526–
3. Azevedo WF, Diniz MB, Fonseca ES,
Azevedo LM, Evangelista CB.
Complications in adolescent
pregnancy: systematic review of the
literature. Einstein (Sao Paulo,
Brazil). 2015;13(4):618-26.
4. Organization WH. Adolescents:
health risks and solutions. 13
December 2018.
5. Cameron S, Glasier A, Lohr PA,
Moreau C, Munk-Olsen T, Induced
abortion, ESHRE Capri Workshop
Group, Human reproduction, Vol 32,
No.6, pp 1160-1169, 2017
6. Hodgkinson S, Beers L,
Southammakosane C, Lewin A.
Addressing the mental health needs