Multigravida Post-Partum dengan Inversio Uteri Subakut Komplit yang Ditatalaksana Histerektomi Supraservikal Pervaginam

Abstract

Inversio uteri adalah salah satu komplikasi persalinan dengan risiko kematian tinggi akibat perdarahan dan syok. Laporan ini menjelaskan mengenai presentasi dan manajemen kasus inversio uteri. Seorang wanita berusia 33 tahun, P4A0 post partum spontan di bidan hari ke 5 dirujuk ke RS Mohammad Hoesin dengan riwayat uterus yang ikut keluar saat persalinan, namun uterus dapat dimasukkan kembali. Tanda-tanda vital pasien dalam batas normal. Pada pemeriksaan abdomen didapatkan tinggi fundus uteri sulit dinilai. Pada saat dilakukan inspeksi terdapat benjolan berupa keseluruhan uterus yang terbalik keluar dari serviks. Pemeriksaan laboratorium menunjukkan penurunan kadar hemoglobin (9.1 g/dL) dan peningkatan kadar leukosit (10.34x103/mm2). Pada pemeriksaan USG tidak tampak uterus pada kavum pelvis dengan kesan yang sesuai dengan gambaran inversio komplit. Pasien dipasangkan kateter lalu diputuskan untuk histerektomi supraservikal pervaginam. Kemudian pada pasien dilakukan pemasangan tampon vagina, pemberian antibiotik, antifibrinolitik serta obat simptomatik dengan stabilisasi berupa cairan dan transfusi. Setelah dua hari, tampon dilepas dan pasien membaik tanpa adanya komplikasi.

Post-Partum Multigravida with Complete Subacute Uterus Inversion Treated by Vaginal Supracervical Hysterectomy

Abstract
Uterine inversion is one of labor complications with high mortality risk caused by bleeding and shock. This paper presenting the clinical manifestation and the management of uterine inversion. A 33-year-old woman, P4A0 spontaneous postpartum at midwife day-5 was referred to Mohammad Hoesin Hospital with uterine expulsion during delivery and the uterine could be re-inserted. Vital signs within normal limits. Abdominal examination showed unmeasurable uterine fundal height. Gyneclogical examination showed an inverted uterus mass outside the cervix. There was decreased haemoglobin (9.1 g/dL) and increased leucocytes (10.34x103/mm2) level. Ultrasonography measure showed no visible uterus in pelvic cavity with impression of complete uterine inversion. The patient was catheterized and decided for vaginal supracervical hysterectomy. The patient applied with vaginal tampons and prescribed with antibiotics, antifibrinolytics and symptomatic drugs with stabilization using crystaloid fluid and blood transfusion. After two days, the tampon was removed and patient improved without any complications.

Key words: hysterectomy, uterine inversion, supracervical