1. Ny.

Vanessa, seorang wanita berusia 30 tahun, mengklaim bahwa dia

dalam kondisi awal kehamilan, datang ke UGD RSMP pada tanggal
12 Maret 2019 dengan seorang kepala mengeluh darah menetes dari
alat kelaminnya sejak 2 hari yang lalu. Ny. Vanessa mengklaim
bahwa darah itu dalam bentuk bercak merah gelap. Nyonya vanessa
juga mengeluh kram perut.
2. Mrs. vanessa belum melakukan pemeriksaan kehamilan. riwayat
trauma dan pijat di daerah perut menurun, tetapi dia mengklaim
bahwa dia memiliki riwayat keputihan yang sering.
3. Ny. Vanessa mengalami menstruasi pertamanya pada usia dua belas
tahun, periode haidnya teratur (28 hari), nyeri saat menstruasi
menurun. hari pertamanya dari periode menstruasi terakhir adalah
pada 25 Desember 2018.
4. Sekarang dia hamil anak keempat, anak pertamanya yang sekarang
berusia 5 tahun, dan dilahirkan dengan bantuan bidan melalui proses
persalinan normal. dia melakukan aborsi pada awal kehamilan kedua
dan ketiga.
1b. What is the meaning Mrs. vanessa chief complained of blood dripping
from her genital since 2 days ago?
Answer: the meaning of bleeding can be considered as an endanger of the
mother and child, causing death. Ovum implantation, cervical carcinoma,
abortion, hydatidiform mole, ectopic pregnancy, menstruation, normal
pregnancy, local vaginal/cervical abnormalities such as varicose veins, injury,
erosion and polyps.

For the past 2 days, the phase of the disease is acute.

1e. What is the meaning Mrs. vanessa also complaining an abdominal

cramps?
Answer: The meaning abdominal cramps can be caused by infection after
childbirth, miscarriage, or abortion

Abortion

Pain is usually preceded by vaginal bleeding

Pain over the symphysis and intermittent

Disturbed ectopic pregnancy

Abdominal pain may occur before any vaginal bleeding

Bleeding is usually dark brown, not fresh blood, small amounts (Krisnadi,
2016: 660).

2c. what is the kind of pregnancy examination?

Answer: Pregnancy Examination (Antenatal Care = ANC) is the examination
of pregnant women who are both physical and mental mother and child in the
assessment, childbirth and postpartum period that can support childbirth,
when parturition, breastfeeding and return associated with health problems
(Wiknjosastro, 2005). ; Manuaba, 2008).
Weight Check
the womb or even a midwife during pregnancy, the first time it is done is by
checking this weight (weigh). The purpose of the pregnancy checkup is to
determine the increase in body weight of pregnant women in each month. If
her body weight rises normally and there is no increase in excessive body
weight, it is one indication of a healthy pregnancy as well.

Stomach examination
This pregnancy checkup is always done every time you control and check the
pregnant woman. The purpose of the stomach examination in pregnancy is to
see the position of the uterus, measure fetal growth, and know the position of
the fetus. Because the position of the fetus also changes according to the age
of pregnancy.

Fetal Heart Rate Check

This examination is done by an obstetrician or midwife in a way called a
doopler technique. Or it could also be a pregnancy ultrasound. Knowing the
fetal heart rate also functions and is useful to find out whether the fetus is in
a healthy condition or not. Then when this pregnancy examination is carried
out and carried out. Pregnancy examinations can be carried out by competent
health personnel, for example through an obstetrician or midwife with a
minimum of 3 examinations during pregnancy, namely in the first trimester,
second trimester and third trimester of pregnancy, even if the pregnancy is
normal. But it's good to have a pregnancy examination once a month until the
age of 6 months, twice a month at 7-8 months and once a week when the
womb reaches 9 months.

This pregnancy examination is also if in rural communities known as ANC

(Ante Natal Care) The definition of antenatal care is a visit of pregnant
women with health workers to get ANC services according to the standards
set. The term visit here does not only mean that pregnant women who visit a
service facility, but that every contact of health workers, both diposyandu,
village maternity halls, home visits with pregnant women not providing ANC
services in accordance with the standards can be considered a visit of pregnant
women.

2f. What are the impact of frequent vaginal discharge?

Answer: Leucorrhoea is a symptom of discharge from the vagina other than
blood menstruation.
A. Normal (physiological) vaginal discharge
Physiological vaginal discharge usually occurs and occurs during
menstruation, getting sexual stimulation, overcoming severe stress, being
pregnant or struggling.

b. Abnormal vaginal discharge (pathological)

Pathological leucorrhoea is called leucorrhoea with distinctive
characteristics, warns it of white like stale milk, yellow or greenish,
recovering with an itchy and painful taste, trying to break rotten or fishy.
Leucorrhoea is one of the signs or symptoms of abnormalities in the female
reproductive organs. These disorders can include infections, cervical polyps,
malignancies (tumors and cancer), and the presence of foreign objects.
However, not all infections in the reproductive tract provide symptoms of
vaginal discharge.

4d. What are the impact of abortion?

The terrible impact of illegal abortion according to Adi Utarini is:
1. If done using nonstandard and sharp tools such as sticks, babbling trees, or
others, then the risk of uterine rupture or a huge wound.
2. The uterus that is more than 3 times in the tumor is at risk, infection, or
even growth conversion
3. Illegal abortions carried out by people who are not experts, can cause the
curettage process to be unclean until it becomes heavy bleeding.
4. Equipment that cannot be sterile will stop infection in the female
reproductive organs, even to the intestine.
5. For anxiety, a sense of guilt that arises from abortion can cause them to
suffer from depression, change in personality to be introverted, and often
cannot enjoy sexy relationships if they are married
6. If you support abortion, returning to the desired pregnancy, then an
assessment of pregnancy will challenge, or overcome problems in the brain,
brain or digestive devices (Adi Utarini. 2005).

(Adi Utarini. 2005. Kesehatan Wanita Sebuah Perspektif Global.

Yogyakarta: Universitas Gajah Mada.)

Prognose
Imminens : Ibu (bonam), Bayi (dubia ad bonam)
Inspiens : Ibu (bonam), Bayi (malam)

1g. How the pathophysiology in this case?

Answer : Infection of the genitals → microorganisms enter the vaginal canal
→ servical canal → multiply in the uterus → damaged attachments →
necrotic changes in the implantation area → infiltration of acute
inflammatory cells → vaginal bleeding.

5b. How is the abnormal mechanism in this case?

Answer:
Infection of the genitals → vaginal canal microorganisms → cervical duct →
proliferate in the uterus → damaged attachment → necrotic changes in the
area of implantation → damage to the decidua basalis which causes tissue
necrosis above it → vaginal bleeding.

BHAY