Manajemen Ekspektatif pada Kehamilan Preterm Gemeli Satu Hidup Satu Meninggal

Rimbun Wahyu Gumilar, Yusrawati Yusrawati

Abstract


Latar Belakang: Sindrom transfusi janin kembar/twin to twin transfusion syndrome (TTTS) merupakan komplikasi dari kehamilan multipel monokorion (15%–20 %) dengan risiko morbiditas dan mortalitas tinggi.
Tujuan: Melaporkan kasus TTTS.
Rancangan dan Metode: Merupakan laporan kasus seorang wanita berusia 30 tahun yang dirawat di bangsal obstetri dan ginekologi RSUP  Dr. M. Djamil Padang periode 9–13 November 2018 dengan diagnosis awal G2P1A0H1 gravid preterm 27–28 minggu dengan TTTS.
Hasil: Diagnosis TTTS ditegakkan berdasarkan temuan ultrasonografi;  kehamilan monochorionic diamniotic (MCDA) dan polihidramnion pada salah satu kantung (single deepest pocket: 22,64 cm). Dilakukan amnioreduksi dua kali atas indikasi subyektif (sesak); pasien dipulangkan 1 hari kemudian. Pada kontrol pertama (7 hari setelah pasien dipulangkan), salah satu janin diketahui mengalami intrauterine fetal death (IUFD). Kehamilan dipertahankan hingga aterm dengan pemantauan kadar fibrinogen pasien. Kehamilan diterminasi pada usia kehamilan 37 - 38 minggu secara section caesarea transperitoneal (SCTP) atas indikasi letak lintang. Bayi pertama berjenis kelamin perempuan, berat 1.800 gram, panjang badan 41 cm, appearance, pulse, grimace, activity, respiration (APGAR) score  7/8. Bayi kedua berjenis kelamin perempuan, berat 500 gram, panjang badan 35 cm, derajat maserasi grade III. Penyebab intrauterine growth restriction (IUGR) dan IUFD pada kasus ini diduga karena TTTS.
Simpulan: Diperlukan pemantauan kadar fibrinogen hingga kehamilan aterm pada TTTS. Bayi yang lahir hidup memerlukan pemeriksaan lanjutan untuk memantau komplikasi TTTS.


Kata kunci: monochorionic diamniotic, sindrom tranfusi janin kembar, ultrasonografi


Abstract
Background: Twin to twin transfusion syndrome (TTTS) syndrome is a complication of multiple monocorionic pregnancies (15% - 20%) with a high risk of morbidity and mortality.
Objectives: To report a case of TTTS.
Design and Methods: A case report of a woman, 30 years old, was diagnosed as G2P1A0L1 preterm pregnancy 27 - 28 weeks with TTTS. Patient was treated in obstetrics and gynecology ward of Central Public Hospital Dr. M. Djamil Padang since November 9th  2018 until December 13rd 2018.
Results: Twin to twin transfusion syndrome was diagnosed by ultrasound findings; the presence of a monochorionic diamniotic (MCDA) pregnancy and the presence of polyhydramnios in the other sac (single deepest pocket: 22.64 cm). Amnioreduction was performed twice for patient’s subjective indication (dyspnea); Patient was discharged one day after second amnioreduction. At first control (7 days after discharged), one of fetal twins was known to intrauterine fetal death (IUFD). Pregnancy was maintained till term by monitoring fibrinogen level. The patient was terminated in pregnancy 37 - 38 weeks by section caesarea transperitoneal (SCTP) for indications of transverse lie position. First baby is female, weight 1.800 gr, length: 41 cm, appearance, pulse, grimace, activity, respiration (APGAR) score 7/8. Second baby is female, weight 500 gr, length 35 cm, maceration level grade III. Twin to twin transfusion syndrome was suspected as cause of intrauterine growth restriction (IUGR) and IUFD in this case.
Conclusion: Monitoring of fibrinogen levels is required until aterm pregnancy in  TTTS. Live born baby needs a follow up examination to monitor complications of TTTS.

Key words: monochorionic diamniotic, twin to twin transfusion syndrome, ultrasonography


Keywords


twin to twin transfusion syndrome; monochorionic diamniotic; ultrasonography

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DOI: http://dx.doi.org/10.24198/obgynia.v2n2s.124

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