Abortion

Definition

Abortion or in the world of medicine known as "abortion" is the termination of a pregnancy before the age of 20 weeks of pregnancy or baby weighs less than 500 g (when the fetus is not viable outside the womb) .1 The incidence of abortion increases with age and the presence of a history of abortion previously. Abortion process can take place:

1.       Spontaneous / natural (occurs naturally, without any action)

2.       Artificial / deliberate (intentional abortion),

3.       Therapeutic / Medical (abortions performed on medical indication for the presence of a problem or complication).

The frequency of abortion in Indonesia is very difficult to quantify accurately because of the many cases of artificial abortion / intentionally unreported. Based on estimates from BKBN, there are about 2 million cases of abortions that occur each year. In the study in the United States there are 1.2 to 1.6 million abortions are intentional in the last 10 years and is the choice of American women to unwanted pregnancies. Overall, the whole world, abortion is a major cause of death than cancer or heart disease.

Signs and Symptoms :
1. Lower abdominal pain
2. Cramps in the uterus
3. Pain in the back
4. Bleeding from the pubic
5. The opening of the cervix
6. Expenditures fetus from the womb

Investigations
Checks that need to be done is an ultrasound examination, blood tests, and examination of hormonal levels of B-hCG.

Management of post-abortion
Tests to find the cause of spontaneous abortion using ultrasound or B-hCG levels over the next 1-2 months. After experiencing abortion, mothers are encouraged not to become pregnant during the first 3 months later (if necessary use a condom or the contraceptive pill).

Reason
Abortion is a woman does become pregnant have a variety of reasons, good reasons both medical and non medical reasons. According to the study of Aida Torres and Jacqueline Sarroch Forrest (1998), states that only 1% of cases of abortion due to rape or incest (sexual intercourse one blood), 3% due to endanger the lives of expectant mothers, and 3% because the fetus will grow up with a physical disability that seriously. While 93% of cases of other abortions are due to non-medical reasons include not want to have children, citing fears interfere with your career or school, do not have enough money to care for children, and do not want to have children without fathers.

Cause
The cause of spontaneous abortion varied include infection, hormonal factors, cervical deformities, immunological factors (immune system), and diseases of the mother. The cause of abortion in general are divided over fetal factors and maternal factors.

Fetal factors
In general, spontaneous abortion that occurs due to factors caused by the presence of fetal abnormalities in fetal development [such as chromosomal abnormalities (genetic)], disorders of the placenta, and fetal injury. The frequency of chromosomal abnormalities (genetic) in the first quarter of the range of 60%.

Maternal factors
Several issues related to maternal factors that may cause spontaneous abortion is the parent of genetic factors that play a role as a carrier (carrier) in the genetic disorder; infection in pregnancy such as herpes simplex virus, cytomegalovirus, syphilis, gonorrhea; hormonal disorders such as hyperthyroidism, diabetes is Uncontrolled; cardiac abnormalities; congenital abnormalities of the uterus, such as bikornu uterus (uterine horns), uterus bersepta (a membrane barrier in it) and uterine scar due to a history of previous uterine curettage or surgery. Myoma of the uterus is also associated with the incidence of spontaneous abortion.

Risk factors associated with the occurrence of abortion is:

1. Advanced maternal age
2. History of previous pregnancies that are less well
3. History of infertility (no children)
4. Abnormalities or diseases that accompany pregnancy
5. Infections (measles, toxoplasma, etc.)
6. Exposure to a wide range of chemical substances (cigarettes, drug-obatab, alcohol, radiation)
7. Trauma to the abdomen or pelvis in the first 3 months of pregnancy
8. Abnormalities of chromosomes (genetic)

The process itself is divided on abortion:

Abortion imminens
Imminens abortion is bleeding from the uterus before the pregnancy reaches 20 weeks of age, where the fetus was still inside the womb and without the opening of the cervix. If the fetus is still alive then the pregnancy can be maintained, but if the fetus to die, they can lead to spontaneous abortion. Determination of fetal life can be done by ultrasound examination (ultrasound) to see the movement and fetal heart rate. Fetal heart rate can also be heard through the Doppler or Laennec if the fetus has reached the age of 12-16 weeks. Procedures performed included rest breaks.

Abortion insipiens
Abortion insipiens is the event of bleeding from the uterus in pregnancy before 20 weeks, with the opening of the cervix, but the fetus was still inside the womb. At this stage there is bleeding from the uterus with contractions that are increasingly stronger and more frequent, followed by the opening of the cervix.
Treatment is done is spending the rest of the products of conception (meeting the egg and sperm cells) with oxytocin infusion, and / or by curettage.
Abortion inkompletus

On abortion inkompletus, products of conception (the fetus) but the part was out there was still some left in the womb. Symptoms that occur are accompanied by cramps in the uterus uterine bleeding in large quantities, the opening occurred, and some tissue out. Handling is carried out in order to monitor the mother's condition remained stable and spending the entire network of products of conception are still left in the womb.

Abortion kompletus
Abortion kompletus characterized by a complete spending all products of conception followed by a little bleeding, and pain. Treatment is done is increase the general state of the mother.

Missed abortion
In the case of missed abortion, fetal death occurs without the expenditure of the products of conception. The reason why the fetus that died did not come out is still unclear. Usually preceded by signs and symptoms of abortion imminens who later disappeared spontaneously or disappear after treatment. A pregnancy test is negative, the signs of pregnancy does not exist, and fetal heart rate can not be detected.

Therapeutic abortion
Abortion is performed on gestational age of less than 12 weeks on the consideration of women's health, which if continued pregnancy would endanger her. For example in women with cardiac abnormalities. Can also be done on the consideration of severe fetal abnormalities.

Septic abortion
Spontaneous abortion may be followed by infectious complications. Infection can occur due to acts of abortion is not in accordance with the procedure (for instance by shamans). Infections that occur in general endometritis, which can develop into parametritis and peritonitis.

Recurrent abortion
Recurrent abortion is abortion which occurred 3 times or more in the first 3 months of pregnancy. Primary recurrent abortions occur in women who have never had a child who lived before. Secondary recurrent abortion is abortion that occurs in women who previously had never had a child born alive.

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