Ruptur Uteri Komplit Disertai Fetal Death pada Pasien Multipara: Sebuah Laporan Kasus

Abstract

Pendahuluan : Ruptur uteri adalah suatu kondisi yang mengancam nyawa yaitu terjadi robekan pada rahim baik sebagian atau seluruhnya selama kehamilan atau persalinan.
Presentasi kasus: Wanita 43 tahun G3P2002 usia kehamilan 37 - 38 minggu datang ke RSUD Dr. TC. Hillers mengeluh nyeri perut dan perut terasa tegang sejak 4 jam yang lalu. Pemeriksaan fisik didapatkan hipotensi, takikardi, takipnea, konjungtiva anemia, ekspansi dada bilateral, distensi perut, dan nyeri tekan suprapubik. Pemeriksaan dalam belum ada pembukaan dan perdarahan aktif. DJJ tidak terdeteksi dan satu janin dapat dipalpasi. Dilakukan operasi sesar darurat, ditemukan kematian janin di rongga perut dan robekan 10 cm pada segmen bawah rahim juga anterior dinding vagina.
Diskusi: Kurangnya ANC yang adekuat, multipara, operasi sesar sebelumnya merupakan faktor risiko ruptur uteri. Ruptur uteri terjadi secara tiba-tiba dengan gejala akut yang bervariasi. Tatalaksana berupa pembedahan yaitu sterilisasi lengkap dengan histerektomi dan pilihan yang konservatif termasuk uterine sparing dengan atau tanpa ligasi tuba.
Kesimpulan: Ruptur uteri merupakan suatu kegawatdaruratan obstetri yang berpotensi menimbulkan kematian ibu dan bayi. Diagnosis yang cepat, transportasi dini, transfusi produk darah yang memadai, dan tim bedah berpengalaman sangat penting untuk penatalaksanaan ruptur uteri.

Complete Uterine Rupture with Fetal Death in a Multiparous Patient: A Case Report

Abstract
Introduction: Uterine rupture is a life-threatening condition when there is a tearing of the uterus either partially or completely during pregnancy or delivery.
Case presentation: A 43 year old pregnant woman visited RSUD Dr. T.C. Hillers with the main complains of abdominal pain and tension since 4 hours prior to the visit. physical examinations showed hypotension, tachycardia, tachypnea, anemic conjunctiva, bilateral chest expansion, abdominal distension, and suprapubic tenderness. However, the results of intravaginal examination showed no dilated cervix or active bleeding. No FHR were detected, and a single fetus can be palpated. An emergency caesarean section was performed, and fetal death was found in the abdominal cavity with 10 cm sized tear in the lower uterine segment and anterior vaginal wall.
Discussion: Poor ANC follow up, multiparous women and previous history of caesarean section are the core risk factors for uterine rupture. Uterine rupture often is sudden and may be catastrophic, and the acute signs and symptoms are variable. The treatment is often surgical and limited to two options which are either complete sterilization with hysterectomy and the more conservative option including uterine sparing option of surgical repair with or without tubal ligation.
Conclusion: Uterine rupture is an obstetric emergency which could potentially cause of maternal and perinatal mortality. Prompt diagnosis, early transport, adequate blood products transfusion, and an experience surgical team are essential for the management of uterine rupture.

Key words: Uterine rupture, fetal death, multiparous