Complex Obstetric Case Report: Multigravida at 36 Weeks with Imminent Premature Delivery, Hansen's disease, and Prior Cesarean Section

Arif Sangjaya, Nuswil Bernolian, Rose Mafiana


Abstract


Hansen’s disease, or leprosy, is a chronic granulomatous infection caused by the obligate intracellular bacterium Mycobacterium leprae. Pregnancy triggers leprosy in 10–25% of women because of immune disturbances, which affect the disease’s course. This study reports the case of a 26-year-old pregnant woman who presented with the chief complaint of abdominal cramps with a contraction every 10 min. The patient admitted to experience vaginal discharge since the onset of pregnancy, without itching or odor. She also revealed a history of leprosy since 2020, which manifested as lumps around the ears, face, and legs, along with numbness at the extremities. She started treatment in 2021 with multi-drug therapy (MDT) but self-discontinued at 14 weeks of pregnancy because of nausea and weakness. The management plan includes dexamethasone ( 12 mg ) intramuscularly to enhance fetal lung maturity, nifedipine ( 10 mg ) every 6 h to suppress preterm contractions, and dermatovenereological assessment to address the patient’s history of Hansen’s disease. A joint conference is planned to discuss and coordinate the management approach. This study underscores the importance of proper management with WHO-recommended multidrug therapy (MDT) comprising rifampicin, dapsone, and clofazimine. Overall, effective management strategies are crucial to prevent permanent nerve, skin, limb, and eye damage in mothers and infants affected by leprosy.

Laporan Kasus: Multigravida Hamil 36 Minggu dengan Partus Prematurus Imminens, Morbus Hansen, dan Bekas Sectio Cessaria

Abstrak
Penyakit Hansen, atau lepra, adalah infeksi granulomatosis kronis yang disebabkan oleh bakteri intraselular obligat Mycobacterium leprae. Kehamilan memicu kusta pada 10–25% wanita karena adanya gangguan imunitas yang memengaruhi perkembangan penyakit. Studi ini melaporkan kasus seorang wanita hamil berusia 26 tahun yang datang dengan keluhan utama nyeri perut dengan kontraksi setiap 10 menit. Pasien mengakui mengalami keluarnya cairan vagina yang tidak bau maupun disertai gatal sejak awal kehamilan. Pasien memilliki riwayat penyakit Hansen sejak 2020, yang ditandai dengan benjolan di sekitar telinga, wajah, dan kaki, bersama dengan mati rasa di ujung anggota tubuh. Pasien memulai pengobatan pada 2021 dengan multidrug therapy (MDT) tetapi menghentikannya sendiri pada usia kehamilan 14 minggu karena mual dan rasa lemah yang dirasakan. Rencana tatalaksana mencakup pemberian Deksametason 12 mg intramuskular untuk meningkatkan kematangan paru-paru janin, Nifedipin 10 mg setiap 6 jam untuk menekan kontraksi prematur, dan evaluasi dermatovenereologi untuk mengatasi riwayat penyakit Hansen pada pasien. Konferensi bersama direncanakan untuk membahas dan mengkoordinasikan pendekatan pengelolaan. Studi ini menekankan pentingnya pengelolaan yang tepat, dengan MDT yang direkomendasikan oleh WHO yang terdiri dari rifampisin, dapsone, dan clofazimin. Secara keseluruhan, strategi pengelolaan yang efektif sangat penting untuk mencegah kerusakan saraf, kulit, mata, dan anggota tubuh permanen baik pada ibu maupun bayi yang terkena penyakit ini.

Kata kunci: Penyakit Hansen, persalinan prematur, diagnosis.

 


Keywords


Hansen’s disease, preterm labor, diagnosis

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DOI: http://dx.doi.org/10.24198/obgynia.v7i1.614

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