Kehamilan Ektopik Terganggu

dr. Refinaldi, SpOG

 Kehamilan Ektopik
• Implantasi di tempat selain endometrium di kavum uteri
• 40% etiologi tidak diketahui

ACOG (USA):
• 200415% penyebab kematian maternal
• 20082% dari kehamilan trimester pertama
• 95% segmen tuba fallopiampula
• 5% ovarium, kavitas peritoneum, serviks

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California: Current Clinical Strategies
Publishing.p. 21-4.
2. Pitkin J, Peattie AB, Magowan BA. Obstetrics and Gynaecology, An Illustrated Colour Text. United Kingdom: Churchill Livingstone. p. 98-9.
3. Yates M, King J. Ectopic Pregnancy. In: Fortner KB, Szymanski LM, Fox HE, Wallach EE. The Johns Hopkins Manual of Gynecology and Obstetrics. Third Edition. Maryland:
Lippincot Williams & Wilkins.
 Epidemiologi Faktor Risiko
• UK1:200 kehamilan • Riwayat kehamilan ektopik
• Angka kematian1:1000 KE • Operasi korektif tuba
• Sterilisasi tuba
• Alat intrauterus
• Patologi dokumentasi tuba
• Infertilitas
• Assisted reproductive technology
• Infeksi genital sebelumnya
– Chlamydia
– Salfingitis
• Merokok
• Aborsi sebelumnya
• Pasangan multiseksual
• Riwayat sesar
1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California: Current Clinical Strategies
Publishing.p. 21-4.
2. Pitkin J, Peattie AB, Magowan BA. Obstetrics and Gynaecology, An Illustrated Colour Text. United Kingdom: Churchill Livingstone. p. 98-9.
 Kehamilan Tuba
• Implantasi terseringampula
• Lapisan submukosa (-)ovum
melekat di lapisan
epiteliumzigot di lapisan
muskularis
• Ismusdaerah paling
sempitruptur tuba pada
Tubal muscularis layer
trimester pertama
• Ampulaaborsi
tubahematosalpinx Chorionic villi
1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004
Edition. California: Current Clinical Strategies Publishing.p. 21-4.
2. Pitkin J, Peattie AB, Magowan BA. Obstetrics and Gynaecology, An Illustrated Colour Text. United Kingdom: Churchill
Livingstone. p. 98-9.
3. Seeber BE, Barnhart KT. Ectopic Pregnancy. In: Gibbs RS, Karlan BY, Haney AF, Nygaard. Danforth’s Obstetrics and
Gynecology. Tenth Edition. Lippincott Williams & Wilkins; 2008. p. 72-87.
 Kehamilan Abdomen
• Worley dkk, 2008:
• hasil konsepsi keluar dan menempel
pada kavitas peritoneum
• Berada di Kavum Douglas untuk
beberapa tahunmassa tidak
berkapsul
• Kalsifikasilithopedion

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California:
Current Clinical Strategies Publishing.p. 21-4.
 Tanda dan Gejala
Classic Triad
(<50% pasien):
• Amenorea
• Abdominal pain
• Vaginal bleeding
 Pemeriksaan Fisis
• Tanda vitalsyok hipovolemik
• Nyeri adneksa dan abdomen
– 45%generalis
– 35%kuadran bawah unilateral
– 25%kuadran bawah bilateral
• Massa adneksa (40%)
• Pembesaran uterus

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California:
Current Clinical Strategies Publishing.p. 21-4.
 Diagnosis
• β-hCG
Peningkatan:
• Serum Progesteron Radiologic Signs:
<50%nonviable pregnancy
>25 ng/mL
Unclotted
Empty IUP
blood(+)
<15%(Plateau)KE>aborsi
uterus spontan
• Kuldosintesis <1,500 mIU/mL+nyeri+perdarahanKE
<5ding/mL
kavitas
Cystic/solid masses 2,5x
peritoneal
nonviable
adnexal
• USGTVUS/ TAUS Dilated and Jarang dilakukan
thick-walled fallopian tubes
pregnancykuretase
70% kasuspeningkatan normal
Free echogenic fluid in pelvis
Hematosalpinx
Gold standard: Extrauterine gestational sacyolk sac

• laparoskopi

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California:
Current Clinical Strategies Publishing.p. 21-4.
Diagnosis Banding
 Tatalaksana:
Metotreksat
Antagonis Asam Folat

Inaktivasi
dihydrofolate reductase

Tetrahydrofolate↓

Sintesis DNA dan RNA↓

Inhibisi pertumbuhan sel trofoblas KE

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California:
Current Clinical Strategies Publishing.p. 21-4.
 Tatalaksana:
Surgical Management

Laparoskopi
Indikasi: Teknik:
• Hemodinamik stabil • Linear salpingostomy
• Salpingectomy
Kontraindikasi:
• Adhesi pelvis
• Hematoperitoneum
• Ukuran >4 cm
• Hemodinamik tidak stabil

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California: Current Clinical Strategies Publishing.p. 21-4.
2. Pitkin J, Peattie AB, Magowan BA. Obstetrics and Gynaecology, An Illustrated Colour Text. United Kingdom: Churchill Livingstone. p. 98-9.
3. Yates M, King J. Ectopic Pregnancy. In: Fortner KB, Szymanski LM, Fox HE, Wallach EE. The Johns Hopkins Manual of Gynecology and Obstetrics. Third Edition. Maryland: Lippincot Williams & Wilkins.
 Tatalaksana:
Surgical Management

Laparotomi
Indikasi: Teknik:
• Perdarahan↑ • Salpingectomycomplete/
• Hemodinamik tidak stabil partial
• Adhesi

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California: Current Clinical Strategies Publishing.p. 21-4.
2. Pitkin J, Peattie AB, Magowan BA. Obstetrics and Gynaecology, An Illustrated Colour Text. United Kingdom: Churchill Livingstone. p. 98-9.
3. Yates M, King J. Ectopic Pregnancy. In: Fortner KB, Szymanski LM, Fox HE, Wallach EE. The Johns Hopkins Manual of Gynecology and Obstetrics. Third Edition. Maryland: Lippincot Williams & Wilkins.
 Tatalaksana:
Surgical Management

Surgical Techniques
Salpingostomy

Kandidat idealAmpulla
Salpingectomy Membuang
End-to-end bagian tuba yang
anastomosis
Insisi tuba fallopi
ruptur stoma baru
IndikasiIsmus
Insisisecondary intention
Segmental Resection

1. Chan PD, Johnson SM. New ACOG Treatment Guidelines, Current Clinical Strategies, Gynecology and Obstetrics, 2004 Edition. California: Current Clinical Strategies
Publishing.p. 21-4.
2. Pitkin J, Peattie AB, Magowan BA. Obstetrics and Gynaecology, An Illustrated Colour Text. United Kingdom: Churchill Livingstone. p. 98-9.
3. Yates M, King J. Ectopic Pregnancy. In: Fortner KB, Szymanski LM, Fox HE, Wallach EE. The Johns Hopkins Manual of Gynecology and Obstetrics. Third Edition. Maryland:
Lippincot Williams & Wilkins.
Terima Kasih