Professional Documents
Culture Documents
Febrilis Abortion
Supervised by :
Mutawakil J. Paransa, dr., Sp.OG
Written by :
Muhamad Dony Ardiansyah
12100116197
One of the most complications in pregnancy it was a bleeding, that could happen to any
the gestational age. Young in pregnancy, often connected with abortus, miscarriage, and loss of
early pregnancy. Abortus is defined as the threat or spending the products of conception before a
fetus can live outside the utery. Constitutes gestational age is less than 20 weeks or fetus weight
less than 500 grams. Abortus imminens is pervaginam bleeding in pregnancy before 20 weeks
without accompanied the release of the products of conception and dilatation of the uterus. The
prevalence of abortion also increases with age, whereas in 20-year-old women it is 12%, and in
women over 45 years is 50%. Eighty percent of abortions occur in the first 12 weeks of pregnancy.
One type of abortion is febrile abortion / abortion with infection. Infectious abortion is an
infected incomplete / insipiens abortion. Febrile abortion needs immediate management because
it can be a wider infection than around the genitalia also into the peritoneal cavity, even into the
whole body (sepsis) and may fall into septic shock. There are two types of abortus febrilis that is
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CHAPTER II
CASE REPORT
A. Patient’s Identity
a) Patient
Name : Mrs. C
Nationality : Indonesian
Occupation : Housewife
Religion : Islam
b) Husband
Name : Mr. U
Nationality : Indonesian
Occupation : Employe
Religion : Islam
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B. History Taking
Chief Complaint
Vaginal bleeding since 3 days ago
Familial History
History of hypertension : denied
History of kidney disease : denied
History of diabetes mellitus : denied
History of auto immune disease : denied
History of cancer : denied
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Menstruation History
Menarche : 12 years old
Menstrual cycle : regularly every 28 days, 7 days duration and
without history of pain during menstruation
Amount of menstrual blood : 2-3 normal pads / day
First day of LMP : Patient was forget
Contraception History
History of using oral contraception for 3 months
Marital History
Married three times, she has been married for 19 years
Obstetric History
No Age Gestational Labour History Sex Birth Info
Age Weight
1 2 months Aterm Spontaneous Female - Passed Away
Labor (febrile convulsion)
2 17 yo Aterm Spontaneous Female - Live
Labor
3 6 yo Aterm Spontaneous Female - Live
Labor
4 4 days Preterm Spontaneous Female - Passed Away
Labor
5 This
Pregnancy
C. Physical Examination
General condition : Moderately ill
Level of conciousness : Compos mentis
Vital signs :
Blood preassure : 110/70 mmHg
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Heart rate : 90x/ minutes
Respiration rate : 21x/ minutes
Temperature : 36,4oC (have been given fever medicine)
Weight : 45 kg
Height : 155 cm
BMI : 18 kg/m2
General Examination
Eyes : anemic conjunctiva -/-, icteric sclera -/-
Mouth : wet oral mucosa membrane
Heart : regular 1st and 2nd heart sounds, murmur -, gallop -
Lung
Inspection : symmetric chest expansion in breathing
Percussion : resonant on both lungs
Auscultation : vesicular breath sounds +/+, rhonchi -/-, wheezing -/-
Abdomen
Inspection : convex, mass (-)
Palpation :mass (-), tenderness (-), soft
Auscultation : bowel sound (+) normal
Extremities : warm, edema -/-/-/-, CRT < 2 seconds
Obstetric Examination
External Examination :
• Fundal Height : not palpable
• Waist circumference : not examined
• HIS : (-)
• FHR : (-)
Internal Examination :
• Vulva/ vagina : not found any abnomalities
• Portio : thick, soft
• Cervical dilation : 2cm
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• Fetal membrane : not examined
Support Examination
USG
Found the residual of intra uterine tissue
Laboratorium
Hb : 10,0 gr/dL
Ht : 30 %
Leukocyte : 27.200 cells
Thrombocyte : 396.000 cells
Working Diagnosis
Mrs. C, 37 years old, G5P4A0, gravida 16 weeks with febrile abortion
Management
a. IVFD Futrolit 20 gtt
b. Ceftriaxone 2x1 gram IV
c. Metronidazole 3x500 mg IV
d. Planning for curretage
Prognosis
Quo ad vitam : ad bonam
Quo ad functionam : ad bonam
Quo ad sanationam : ad bonam
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CHAPTER III
PROBLEMS
Problems:
A. How to diagnose Febrile Abortion?
History taking
To assess febrile abortion from history taking, first thing to be done is to seek for clinical
manifestation such as fever, bad smell bleeding, pain in the symphysis or lower abdomen,
abdominal distention of peritonitis.
In this case, patient is woman, 37 years old, with complaint with complaint vaginal bleeding
since 3 days before admission. Patient was feeling pregnant 3 months. Patient said the bleeding
caused the patient fell in the bathroom. Hemorrhagic bleeding is as big as a fist and accompanied
by tissues like a meat. For 3 days the patient did not go to the doctor only brought to traditional
birth attedants. The bloods that came out had a bad smell and the patient become had a fever at
night. History of menstruation patient had a menarche at 12 years old, menstrual cycle regularly
every 28 days, 7 days duration and without history of pain during menstruation, amount of
menstrual blood 2-3 normal pads / day, patient was forget first day of last menstrual period. History
of using oral contraception for 3 months. Patient has been married three times for 19 years
Conclusion:
From the chief complain, patient was feeling have vaginal bleeding since 3 days before
admission. Patient was feeling pregnant 3 months. Patient said the bleeding caused the patient fell
in the bathroom. Hemorrhagic bleeding is as big as a fist and accompanied by tissues like a meat.
For 3 days the patient did not go to the doctor only brought to traditional birth attedants. The bloods
that came out had a bad smell and the patient become had a fever at night. Because of it, she was
required supporting examination, in this case to diagnose what is the real problem and patient
undergo hematologic laboratorium and usg examination.
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Physical examination
To assess febrile abortion from general examination found the temperature of body more
than 37,5oC. On Obstetric examination there are ostium uteri usually open, palpable tissue residual,
there is pain in palpation of portio and adnexa, and bad smell fluxus.
Conclusion:
In this patient found from general examination found the temperature of body febris when
the patient admitted to the hospital. On Obstetric examination there are cervical dilatation 2cm,
palpable residual tissue, there is pain in palpation of portio, and bad smell blood.
Hematologic examination
- Hb : 10,0 gr/dL
- Ht : 30 %
- Leukocyte : 27.200 cells
- Thrombocyte : 396.000 cells
Conclusion :
Leukocytosis
USG examination
Found the residual of intra uterine tissue
Conclusion :
Incomplete Abrotion
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Uterotonic Administration
Curettage
Conclusion :
In this patient, has been give IVFD Futrolit 20 gtt for fluid therapy. Antiobiotic administered
ceftriaxone 2x1 gram IV for aerob microorganism and metronidazole 3x500 mg IV for anaerob
microorganism. This patient is planned for curretage.
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CHAPTER IV
CASE ANALYSIS
Theory Case
Anamnesis Febrile Abortion Febrile Abortion
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CHAPTER V
CONCLUSION
Patient, Ny. C, a 37-year-old female, 3 months old pregnancy with a major complaint of
leukocytosis. While ultrasound examination found the remaining intra uterine tissue. From
anamnesis, physical examination and supported by support examination then the patient is
diagnosed with abortus febrilis. Management given in this case is the provision of fluid therapy
and a combination of two types of antibiotics. After a general stable, curettage is performed on the
patient to remove residual tissue. Furthermore, patients are given oral therapy in the form of
antibiotics, uterotonic, analgetic and monitored vital signs and post-curettage complaints. If the
patient's condition improves after the curretage, the patient could be discharged.
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REFERENCES
1. Hanifa W, dkk. 1999. ‘Kelainan Dalam Lamanya Kehamilan’. Ilmu Kebidanan. Edisi 2.
2. Sulaiman S, dkk. 2005. ‘Kelainan Lama Kehamilan’. Obstetri Patologi. Penerbit EGC. Jakarta.
Hal 1 – 9
3. Sarwono P. 2010. Perdarahan pada Kehamilan Muda. Ilmu Kebidanan Edisi 4. Yayasan Bina
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