Gynecology

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Materi
• Screening for Cervical Cancer • TB on pregnancy
• Cervicitis • Orchitis
• Diagnosis kehamilan
• Menstrual abnormality • TORCH
• Family planning • KB vs lipid profile
• Infertilitas • Hiperemesis gravidarum
• Kista, abses bartholini • Mola hidatidosa
• Kista Ovarium
• Demam post partus
• Thyroid and pregnancy
• Abortus • Analisa sperma
• Kehamilan ektopik • Drugs for pregnancy
• IUFD • Delirium krn organik

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Normal uterine hystology

http://instruction.cvhs.okstate.edu/histology/
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HistologyReference/HRFemaleRS.htm

http://instruction.cvhs.okstate.edu/histology/
HistologyReference/HRFemaleRS.htm

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promiscuity 3. young age of 1. Adenoacanthoma B. 45 and 56 • Malignant tumor • Sexual factor: early A. Tumor of the Uterine Cervix Risk Factors • Benign tumor • HVP infection. Adenocarcinoma partners. Sarcoma ( very rare) • Cigarette smoking • Ca. Adenosquameus carcinoma • Female factor 4. of the Cervix is the most • Socio economic status. common female malignancy in developing countries Parity. Squameus cell carcinoma (epidermoid ca. Race ©Bimbel UKDI MANTAP . multiple sexual 2.) 91 % first coitus. 18. Carcinoma of the cervix marriage. particularly Leiomyoma (myoma) type 16.

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exuberant erosion of the • Colposcopy examination cervix • at advanced as crater-shaped ulcer with high or friable warty mass • freely bleeding on examination • mobility of the cervix depend on the stage ©Bimbel UKDI MANTAP . urethral (Pap smear) • Exert pressure: obstipasi. rectal. anuria hydronephrosis --> renal failure • Visual Inspection with --> uremia Acetic acid application • Infection --> odor watery vaginal discharges Physical signs (VIA) • discover follow cytology examination • nodule. Early detection Clinical Aspects Symptoms • Cytology examination • Bleeding: vaginal. ulcer.

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©Bimbel UKDI MANTAP .

CIN III (severe).sh.jpg ©Bimbel UKDI MANTAP .lsuhsc. • Cytology low-grade SIL (squamous intraepithelial lesion) low-grade lesions high-grade SIL (HSIL) high-grade dysplasia http://www.Cervical dysplasia: • abnormal changes in the cells on the surface of the cervix that are seen underneath a microscope • Histology cervical intraepithelial neoplasia (CIN) I (mild) a benign viral infection CIN II (moderate).edu/fammed/Images/PAP-fig1.

unless they are known to be due to other cause. IIIa Tumour involves lower third of the vagina .Clinical staging of Cervical Cancer Stage 0 Carcinoma in situ. The tumor involves the lower-third or the vagina. Invasive carcinoma which can be diagnosed only by microscopy.even with superficial invasion Stage II Cervical carcinoma invades beyond the uterus. All cases with ydronephtosis or nonfunctioning kidney are included. as such. All macroscopically visible lesions. there is no cancer-free space between the tumour and the pelvic wall. Ib. or has involved (biopsy-proven) the mucosa of the bladder or rectum. with no extension to the pelvic wall IIIb Extension to the pelvic wall and / or hydronephrosis or nonfuctioning kidney Stage IVThe carcinoma has extended beyond the true pelvis. On rectal examination. cervical intraepithelial neoplasia Grade III Stage I The carcinoma is strictly confined to the cervix Ia. A bullous oedema. does not permit a case to be allotted to Stage IV IVa Spread of the growth to adjacent organs IVb Spread to distant organs ©Bimbel UKDI MANTAP . but not to the pelvic wall or to the lower third of the vagina IIa No obvious parametrial involvement IIb Obvious parametrial involvement Stage III The carcinoma has extended to the perlvic wall.

80% : benign tumor such as granulom or hamartoma 20% : malignant cancer or metastasis of malignant cancer. Solitary pulmonary nodule In radiology. ©Bimbel UKDI MANTAP . < 3 cm in diameter. SPN/ coin lession is a mass in the lung.

• Women aged 30 and over : consider a combined cervical cytology and HPV test. • Women aged 30 and over : • performed annually if conventional cervical cytology smears (Pap) are used OR • every two years with liquid based cytology tests • Women aged 30 and over who have had : • three negative smears. and • are not immunocompromised interval between tests to two . ©Bimbel UKDI MANTAP • Women who test negative by both tests should be screened every three years. but no later than age 21.three years. • no history of CIN II/III. Screening for Cervical Cancer • started three years after the onset of sexual activity. INTERVAL ACOG guideline 2008 • annual screening for women younger than 30 years of age regardless of testing method (conventional or liquid-based cytology). . • High grade cervical intraepithelial lesions (HSIL) are almost entirely related to human papillomavirus (HPV) • HSIL is a precursor to cervical cancer • Infection through genital skin to skin contact • lesions usually do not occur until three to five years after exposure to HPV.

• Screening of women with CIN II/III who undergo hysterectomy may be discontinued after three consecutive negative results have been obtained. • Not recommended in women who have had total hysterectomies for benign indications (presence of CIN II or III excludes benign categorization). DISCONTINUE • The United States Preventive Services Task Force stated screening may stop at age 65 if : • recent normal smears • not at high risk for cervical cancer.• Exceptions: Women at increased risk of CIN : • in utero DES (diethylstilbestrol) exposure. • a history of CIN II/III or • Cancer should continue to be screened at least annually. screening should be performed if the woman acquires risk factors for intraepithelial neoplasia. ACOG ©Bimbel UKDI MANTAP guideline 2008 . • immunocompromise. • The American Cancer Society guideline stated that women age 70 or older may elect to stop cervical cancer screening if : • had three consecutive satisfactory. such as new sexual partners or immunosuppression. normal/negative test results and no abnormal test results within the prior 10 years. • However.

or from reading (interpretive) errors. ©Bimbel UKDI MANTAP Emedicine . with repeated smears • False-negative Pap smears may result from inadequate sampling because of the location of the lesion (i. • Increases in estrogen stimulation result in advancement of the columnar epithelium toward the vagina (during pregnancy. • Dysplasia : loss of the normal cytoplasmic differentiation or maturation of cervical epithelium. and in newborns).e. endocervix). • Columnar epithelium extending onto the ectocervix is called ectropion • In contrast.. • Decreases in estrogen stimulation are followed by "retreat" of columnar epithelium into the endocervical canal. • The area of development of dysplasia and squamous cell cervical cancers is at the junction of the squamous and columnar epithelia (transformation zone) • This area is evidently most susceptible to viral infection. Pap Smear • to detect changes in cellular morphology (dysplasia) that are precursors to carcinoma. • Responds to changes in vaginal pH in response to fluctuating estrogen levels. • The false-negative rate of the Pap smear is at least 20%. artifacts or poor preparation of slides. in women taking oral contraceptives. • The use of serial Pap smear screening decreases the false-negative rate. it is unusual to see columnar epithelium on the ectocervix of a postmenopausal or premenarchal patient. This means that biopsy is imperative for visible cervical lesions.

Untreated inflammation can have consequences for the woman as well as her sexual partner(s). The physician's goals are to identify the cause of inflammation and to treat and resolve the condition.Unreliable Pap smear due to inflammation: If severe inflammation is present. ©Bimbel UKDI MANTAP Emedicine . its cause(s) must be investigated. if possible. Physician should repeat the test after the condition resolve to diminish the false positive result.

• The patient should avoid intercourse or intravaginal products/douches for 24-48 hours before the examination. and other supplies on hand before starting the pelvic exam. or use a saline- moistened cotton swab for pregnant women. • Rotate the Ayers spatula through a 360-degree arc over the squamocolumnar junction if visible. • Provide the cytologist with complete clinical information about the patient including age. history of radiation. Apply this to the same slide using a rolling motion as noted in step 5. spatula. If using a spray. Gently brush the spatula over the entire slide. taking care to avoid a thick smear or shearing of cells by excessive pressure. dysplasia. slide. malignancy. hormone use. ©Bimbel UKDI MANTAP Emedicine . • Use no lubricant prior to performing the Pap smear.Methods to Improve Accuracy of Pap Smears • Perform a Pap smear when the patient is in the proliferative phase (in the week following cessation of menses). • Rapidly apply fixative to the slide. • Collect the endocervical specimen using a cytobrush (about one full turn with the brush mostly inside the cervix). • Have cytobrush. hold it about 10 inches from the slide to avoid dispersing the cells. menopausal status. etc.

McCrory. MHS. Lori A. Evan R. Myers. MD . Vic Hasselblad. Jason ©BimbelD. Douglas C. MD. MPH. MD. Hickey. PhD. MD.ASC-H: atypical squamous cells cannot exclude high grade ASC-US: atypical squamous cells of undetermined significance Accuracy of the Papanicolaou Test in Screening for and Follow-up of Cervical Cytologic Abnormalities: A Systematic Review Kavita Nanda. UKDI MANTAP and David B. MPH. MD. Matchar. Bastian. MHSc.

ACOG guideline 2008 ©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

• Affordable • No need for complicated equipment • It can be done by less specialized personnel • can be implemented in a primary health-care ©Bimbel UKDI MANTAP(PHC) setting (4 ). • In developing countries. . loop excision of the transformation zone (LETZ) and cone biopsy.Visual Inspection with Acetic Acid (VIA) or PAP SMEAR ? • Pap smear has been shown to effectively lower the risk for developing invasive cervical cancer. This is because : • too few trained and skilled professionals • Healthcare resources are not available to sustain such a programme • Delays in reporting cytology results and less follow-up. • Recent studies have demonstrated that visual inspection with acetic acid (VIA) is an alternative sensitive screening method. • Cheap and non-invasive • Can be done in a lowlevel health facility like a primary health centre • Provides instant results. only 5% of eligible women undergocytology-based screening in a 5-year period. by detecting precancerous changes. • Cryotherapy as a method of treatment for precancerous lesions has some advantages : • Effective and easier to implement than loop electrosurgical excision procedure (LEEP).

©Bimbel UKDI MANTAP .VIA procedure Positive VIA test any aceto-white lesion at the squamo-columnar junction of the cervix.

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or use female condoms to reduce the risk of cervical infection • Reasons for referral included: • suspicion of cervical cancer • the presence of a cauliflower fungating lesion • a positive VIA test. ©Bimbel UKDI MANTAP . • abstain from sexual intercourse for four weeks following cryotherapy.• Side effects of cryotherapy : cramping. spotting. –– a lesion extending onto the vaginal wall or more than 2 mm into the cervical canal • a positive VIA test 12 months after treatment with cryotherapy. vaginal discharge. or light bleeding. but ineligibility for cryotherapy –– aceto-white lesions occupying more than 75% of the cervix or extending more than 2 mm beyond the outer limit of the standard cryotherapy probe.

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Sp. Lajang Biasanya asimtomatis 3. CS dg pasangan baru dlm 3 bln terakhir UMS Penyebab: GO. umur < 21 th 2. Cervicitis *Tidak mudah membedakan servisitis dari vaginitis •Servisitis menular seksual = Servisitis •4 faktor risiko u/ prediksi servisitis: mukopurulenta 1. Retno Satiti. Non-GO (C.trachomatis) ©Bimbel UKDI MANTAP Lect.KK . By dr. CS > 1 org dlm 3 bln terakhir Datang karena mitra menderita 4.

edem. bleeding. ektopi. ektoserviks: eritem/normal .inspeculo: dd vagina eritem/tenang •PCR . endoserviks: eritem.KK . Retno Satiti. gonorrhoeae: diplokokus Gram neg •Gram: pmn > 30.vulva tenang . gonorrhoeae Diagnosis: Penyebab: N. discar mukopurulen ©Bimbel UKDI MANTAP Lect. Sp. keputihan warna kuning Px: • Kultur: Media Thayer Marthin . DGNI (+) Klinis: asimtomatis. By dr. CERVICITIS GO peradangan serviks o/k N.

ektopi.CERVISITIS NON GO Peradangan serviks bukan o/k GO Penyebab: C. Sp. keputihan kuning Px: vulva tenang inspeculo: dd vagina eritem/normal ektoserviks: eritem/normal endoserviks: eritem. Retno Satiti. Trachomatis immunofluoresence dg antibodi monoklonal ©Bimbel UKDI MANTAP Lect. discar mukopurulen C. edem. trachomatis (terbanyak) Klinis: asimtomatis. swab bleeding.KK . By dr.

edem. bau dari discar vagina •Gejala yg menyertai: gatal. sakit perut/ punggung bawah ©Bimbel UKDI MANTAP Lect. bakteri anaerob keputihan tdk selalu ditularkan secara seksual •Gejala: abnormalitas volume. By dr. warna.KK . Kandida. Retno Satiti. Vaginitis • Penyebab umumnya: Trikomonas. Sp. disuri.

Infeksi protozoa yg disebabkan oleh T. Peradangan pd dinding vagina 3.atau berbuih dan bau busuk. vaginalis Etiologi: T. Retno Satiti. Discar vagina kuning kehijauan. Sp. vaginalis inkubasi: 3-28 hr Dx: 1. TRIKOMONIASIS/Vaginitis Trikomonal Definisi: peny. strawberry cervix (+) 2. By dr. Lab: NaCl 0.KK .9% : T. vaginalis motil ©Bimbel UKDI MANTAP Lect.

©Bimbel UKDI MANTAP .

albicans Etiologi: Genus candida t/u C. Retno • Lab KOH 10% : pseudohifa Satiti. albicans (80%) kandida: kuman oportunis: di seluruh badan Predisposisi: hormonal. keputihan tak bau/masam * Dinding vagina &/vulva eritem/erosif * Discar putih kadang disertai semacam sariawan (thrush) berupa pseudomembran yg melekat pd daerah erosif • Discar putih kental spt susu/keju.KK ©Bimbel UKDI MANTAP . By dr. Sp. iritasi * keluhan gatal/panas/iritasi. KANDIDOSIS VULVOVAGINAL/ Vulvovaginitis kandidal Definisi: infeksi vagina dan/atau vulva oleh kandida khususnya C. masam • Dinding vagina dijumpai gumpalan keju * pH <= 4. antibiotik. bisa banyak. DM. imunosupresi.5 Lect.

Clue cells --> Gram - ©Bimbel UKDI MANTAP Lect. Sp.vaginalis dll Etiologi: bukan organisme tunggal perubahan situasi dlm vagina --> anaerob Inkubasi: bbrp hr-4 mgg Dx: 3 dari 4 gejala: 1. Retno Satiti.KK . Discar vagina. oleh bakteri anaerob: terutama G.5 3. Vaginosis bakterial (VB) Definisi: * gangguan pada vagina tanpa peradangan * sindroma klinik akibat perubahan lingkungan lokal * pergantian flora normal Lactobasilus sp. By dr. homogen. Discar bau spt ikan --> tes amin 4. melekat pd dinding vagina 2. PH vagina > 4. putih keabuan.

Sp.KK . By dr. Retno Satiti.DUH TUBUH VAGINA DENGAN PENDEKATAN SINDROM ©Bimbel UKDI MANTAP Lect.

Sp.DUH TUBUH VAGINA DENGAN PEMERIKSAAN INSPEKULO ©Bimbel UKDI MANTAP Lect.KK . Retno Satiti. By dr.

By dr. Sp. Retno Satiti. DUH TUBUH VAGINA DENGAN PEMERIKSAAN INSPEKULO & MIKROSKOP ©Bimbel UKDI MANTAP Lect.KK .

BILA ADA INDIKASI.Pengobatan sindrom duh tubuh vagina karena vaginitis Pengobatan untuk trikomoniasis DITAMBAH Pengobatan untuk vaginosis bakterial .KK . Sp. Pengobatan untuk kandidiasis vaginalis ©Bimbel UKDI MANTAP Lect. Retno Satiti. By dr.

By dr.Pengobatan sindrom duh tubuh vagina karena infeksi serviks Pengobatan untuk gonore tanpa komplikasi DITAMBAH Pengobatan untuk klamidiosis ©Bimbel UKDI MANTAP Lect.KK . Sp. Retno Satiti.

gonorrhea – 1/3 of cases – Chlamydia – 1/3 of cases • Clinical symptoms – Mixed infection – strep.KK .coli. Retno Satiti. – Abdominal pain anaerobes – Vaginal bleeding – Vaginal discharge • Risk factors – Urethritis – Number of sexual partners • PE – Age – Abdominal pain • 15-25 years old w/ highest frequency – Fever – Symptomatic male partner – Bimanual exam with CMT or – Previous PID adnexal tenderness – African American women – Cervical discharge ©Bimbel UKDI MANTAP Lect.Pelvic Inflammatory Disease • Acute infection of the upper genital tract structures in women. e. oviducts. Sp. klebsiella. and ovaries • Microbiology – N. involving any or all of the uterus. By dr.

suspected infection with Trichomonas.KK . Sp.• Diagnosis – Pregnancy test – Cervical sample for GC/ Chlamydia – Pelvic ultrasound • Treatment – Outpatient • Ceftriaxone 250 mg IM x 1 + doxycycline 100 mg po BID x 14 days • Add metronidazole if concern for pelvic abscess. By dr. or recent instrumentation – Inpatient • Cefoxitin 2 G IV q 6 + doxycycline 100 mg po/IV Q12 • Amp/Sulbactam 3 G IV q 6 + doxycycline po/IV • Oral administration of doxyxycline preferred due to pain associated with drug administration when infused – bioavailability of oral AND IV preparation equivalent ©Bimbel UKDI MANTAP Lect. Retno Satiti.

• Complications – Perihepatitis: Fitz-Hugh Curtis Syndrome • RUQ pain with pleuritic component – Tubo-ovarian abscess – Chronic pelvic pain –seen in 1/3 of patients – Infertility – Ectopic pregnancy ©Bimbel UKDI MANTAP Lect. By dr.KK . Sp. Retno Satiti.

2008. Diagnosis Kehamilan • Tanda Kehamilam tidak pasti (probable sign) • Tanda kehamilan pasti Obstetri Fisiologi. ©Bimbel UKDI MANTAP .

stres. . Probable sign • Amenorrhea • Quickening – Persepsi gerakan janin I – Penyebab lain : ketidakseimbangan – 18-20 mg (primigravida). obat-obatan. 16 mg ovarium hipofisis. – Kehamilan 2-3 bl << BB proliferasi asinus dan duktus – Selanjutnya >> – Pengaruh estrogen dan progesteron ©Bimbel UKDI MANTAP Obstetri Fisiologi. kencing malam >> – Desakan uterus yg membesar beta HCG. vaskularisasi>>. (multigravida) penyakit kronis – Ditemukan jg pada Pseudocyesis • Mual dan muntah • Keluhan kencing – Morning sickness >> estrogen dan – Urinasi >>. << motilitas gaster pagi hari dan tarikan ke kranial – >> dg bau menusuk. emosi tidak stabil • Konstipasi – Beri makanan ringan mudah dicerna – Efek relaksasi profesteron pd tonus otot usus • Mastodinia – Perubahan pola makan – Rasa kencang dan nyeri pada payudara • Perubahan BB – Pembesaran payudara. 2008.

7 Uterus 1 kg 16 2.4 Obstetri Fisiologi. Peningkatan BB Minggu kg • Normal: 9-14 kg 6 0.4 Darah 2 kg 18 3.7 32 8.4 34 9.5 26 6.1 36 9.5 kg 12 1.9 .1 Amnion 1 kg 14 1.1 Mammae 1 kg 20 3.7 24 5.2 28 7 30 7. ©Bimbel UKDI MANTAP 40 10.2 8 0.8 38 10. 2008.9 22 4.5 Janin 3.5 kg 10 0.8 Plasenta 0.

2008. sel eksfoliasi vagina >> – Estrogen >> – Hegar sign (+) (UK 6-8 mg) – Pembesaran uterus (stlh UK 10 mg) ©Bimbel UKDI MANTAP Obstetri Fisiologi. encer. .• >> temperatur basal > 3 mg • Warna kulit : – Kloasma. setelah 16 mg – Warna areola menggelap – Striae gravidarum – Linea nigra – Teleangiektasis – Stimulasi MSH krn estrogen yang tinggi kortikosteroid >> • Perubahan Payudara : – Tuberkel montgomery menonjol (UK 6-8 mg) – Stimulasi prolaktin dan Human Placental Lactogen – Sekresi kolostrum (UK > 16 mg) • Perubahan pelvis – Chadwick sign (+) – Serviks livid – Cairan vagina putih.

• Pembesaran perut (stlh UK 16 mg) • Kontraksi uterus • Balotemen – UK 16-20 mg – Dd : asites dg kista ovarium. ©Bimbel UKDI MANTAP Obstetri Fisiologi. mioma uteri. . 2008.

dst – 2 gestational sac di mg 6 gmeli • Fetal ECG : 12 mg. Tanda Kehamilan Pasti • DJJ • Laboratorium – Laenec (17-18 mg) – Doppler (12 mg) – Tes inhibisi • Palpasi 22 mg koagulasi/PP test • Rontgenografi • Inhibisi koagulasi anti HcG – Tulang tampak mg 12-14 – Jk terdapat keragu-raguan dan • Mendeteksi HcG mendesak di urin • USG • Kepekaan pada – Mg 6 : gestational sac 500-1000 mU/ml – 6-7 : polus embrional • Positif mg ke 6 – 8-9 : gerak janin – 9-10 : plasenta. dg fetalkardiografi Obstetri Fisiologi. ©Bimbel UKDI MANTAP . 2008.

Menstrual cycle Lect. OG . Sp. Hasto Wardoyo. ©Bimbel UKDI MANTAP By dr.

©Bimbel UKDI MANTAP By dr. Hasto Wardoyo. Sp. Lect. OG .

opak. Ovulasi • Terjadi 14 hari sebelum mens • >> kadar progesterone berikutnya 2ng/ml • Tanda dan tes : – Rasa sakit di perut bawah • LH surge (dg (mid cycle Radioimunoassay) pain/mittleschmerz) – Perubahan temperatur basal • USG folikel >1. jernih. menjelang ovulasi encer.7 cm efek termogenik progesteron – Perubahan lendir serviks • Uji membenang (spinnbarkeit): Fase folikular : lendir kental. mulur • Fern test : gambaran daun pakis ©Bimbel UKDI MANTAP .

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but usually does not involve passage of clots. OG . bloating and breast tenderness. ©Bimbel UKDI MANTAP By dr. although not all women experience these premenstrual symptoms. Hasto Wardoyo. Normal Menstrual Bleeding • Occurs approximately once a month (every 26 to 35 days). • Lasts a limited period of time (3 to 7 days). • May be heavy for part of the period. • Often is preceded by menstrual cramps. Sp. • Average : 35-50 cc Lect.

©Bimbel UKDI MANTAP By dr. OG . Hasto Wardoyo. Lect. Sp.

. M.G.FIGO Classification FIGO (International Federation of Gynecology and Obstetrics) classification system for causes of abnormal uterine bleeding in nongravid women of reproductive age Polyp Adenomyosis Leiomyoma Malignancy and hyperplasia Coagulopathy Ovulatory dysfunction Endometrial Iatrofenic Not yet classified ©Bimbel UKDI MANTAP Munro. 2011 .

Polyps may naturally regress in up to 25% of patients. glandular. Infertile women are more likely to be diagnosed with an endometrial polyp 4. with small polyps more likely to resolve spontaneously 5.Polyp Uterine • Usually benign but a small minority may have atypical or malignant features. and fibromuscular and connective tissue • Guidelines for Recognizing the Presence of Endometrial Polyps 1. 2012 ©Bimbel UKDI MANTAP . • These epithelial proliferations comprise a variable vascular. Medications such as tamoxifen may predispose to the formation of endometrial polyps ADVANCING MINIMALLY INVASIVE GYNECOLOGY WORLDWIDE. abnormal uterine bleeding is the most common presenting symptom 3. For women with symptoms with a polyp. Increasing age is the most common risk factor for the presentation of an endometrial polyp 2.

particularly for small polyps and if asymptomatic. Removal for histologic assessment is appropriate in postmenopausal women with symptoms 6. 2012 ©Bimbel UKDI MANTAP .GUIDELINES FOR THE MANAGEMENT OF ENDOMETRIAL POLYPS 1. Medical management of polyps cannot be recommended at this time 3. surgical removal is recommended to allow natural conception or assisted reproductive technology a greater opportunity to be successful ADVANCING MINIMALLY INVASIVE GYNECOLOGY WORLDWIDE. Conservative management is reasonable. Hysteroscopic polypectomy remains the gold standard for treatment 4. lower cost. 2. and reduced risk to the patient For the infertile patient with a polyp. Hysteroscopic removal is to be preferred to hysterectomy because of its less-invasive nature. There does not appear to be differences in clinical outcomes with different hysteroscopic polypectomy techniques 5.

ENDOMETRIOSIS Definisi Terdapatnya Jaringan endometrium diluar rahim Symptoms Pelvic Pain (acute or chronic) Dyspareunia (painful intercourse) Painful bowel movements Premenstrual staining and abnormal bleeding Difficult urination and/or blood present in the urine Infertility ©Bimbel UKDI MANTAP .

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some high androgen. Danazol. weight gain. all low estrogen Negative side effects such as accelerated bone loss. Non-Surgical Gonadotropin-releasing hormone agonists. TREATMENT 1. nausea. others high progesterone. morphine. Norethindrone. and codeine ©Bimbel UKDI MANTAP . Surgical 2. breakthrough bleeding Pain killers (aspirin. Gestrinone All acyclic.

prolonged menstrual bleeding with severe cramps. hysterectomy has been the conventional surgical treatment. hormone therapy and endometrial ablation. • Uterine artery embolisation may be an alternative option for women who do not wish to have hysterectomy and/or who wish to preserve their fertility. • It frequently occurs coincidentally with fibroids. ©Bimbel UKDI MANTAP .Adenomyosis • Benign condition • Presence of ectopic endometrial glands and stroma within the myometrium. pelvic pain and discomfort. • May cause no symptoms but some women with adenomyosis experience heavy. • Treatment for symptomatic adenomyosis includes anti-inflammatory medications. • For severe symptoms that do not respond adequately.

Myoma Uteri Benign. arises from the myometrium. uterine neoplasms. • Generally benign and found in up to 20% of women in the reproductive age group. • 30-50 years old • Classification based on anatomic location: Submucous : beneath endometrium Intramural/interstitial: within uterine wall Subserous/subperitoneal: at the serosal surface or bulge outward from myometrium ©Bimbel UKDI MANTAP . fibroids or fibromyomas. primarily composed of smooth muscle • Also called leiomyomas .

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bowel difficulty enlarged and irregular. tumor is mobile from side a pedunculated myoma to side . • Spontaneous abortion hysteroscopy. firm pregnancy if undergoing in consistency and having smooth degeneration or torsion of surface. well defined margins . premenopause Operation : myomectomy or hysterectomy ©Bimbel UKDI MANTAP . SYMPTOMS SIGN Menorrhagia and prolonged A palpable abdominal tumor : menstrual period (common) Abdominal lump – arising from • Pelvic pain : occurs in pelvis . Laparacospy • Infertility • Treatment: Observation: for small myoma. USG. hard (constipation) • Diagnosis : Bimanual exam. • Pelvic pressure:urinary • Pelvic examination:Uterus — frequency.

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• Degenerasi hyalin >> lansia. 2. berwarna putih keras • Degenerasi kistik • Sebagian mioma menjadi cair terbentuk ruangan-ruangan yang tidak teratur • berisi seperti agar-agar. Aliran darah tidak seimbang 3. Tekanan hamil ©Bimbel UKDI MANTAP . Edema sekitar tungkai 4. • Tumor kehilangan struktu aslinya menjadi homogen. • Sukar dibedakan dari kista ovarium atau suatu kehamilan. • Degenerasi merah (Caineous Degeneration) • >> Kehamilan dan nifas. • Gangguan vaskularisasi nekrosis subakut • Sarang mioma seperti daging mentah berwarna merah disebabkan oleh pigmen hemosiderin dan hemodifusi. 1. Perubahan Sekunder Myoma • Atrofi : Setelah menopause ataupunb sesudah mioma uteri menjadi kecil. Estrogen merangsang tumbuh kembang mioma. • Jaringan ikat bertambah.

Pembentukan Trombus 3. • Degenerasi Sarcomateus • Infeksi dan Suppurasi >> L. Bendungan darah dalam mioma 4. Warna merah hemosiderin/hemofuksin (Manuaba.• Degenarasi Lemak Kelanjutan degenerasi hialin. 2001) ©Bimbel UKDI MANTAP . submukosa krn ulserasi • Gangguan vaskularisasi • 1. Nekrosis 2.

sebaiknya ditinggalkan 1 atau kedua ovarium untuk menjaga jangan menopause sebelum waktunya • Sebaiknya histerektomi totalis. • Pada wanita masa reproduksi. kecuali bila keadaan tidak memungkinkan dapat dilakukan histerektomi supravaginalis lalu dilakukan rutin pap smear pada tumpul serviks ©Bimbel UKDI MANTAP .Histerektomi merupakan tindakan yang paling ideal karena mioma sering multipel dan mencegah residif.

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AUB-P : endometrial/endocervical polyp AUB-Lsm : Leiomyoma submucosal AUB-A : adenomyosis AUB-E : endometrial AUB-O : ovulatory dysfunction AUB-M : malignancy and hyperplasia ©Bimbel UKDI MANTAP .

OG . Hasto Wardoyo. • DUB anovulasi (~90% kasus) Disfungsi aksis hipothalamus-thalamus-ovarium ?anovulasi ?progesteron tidak dihasilkan ?proliferasi endometrium ?perubahan vaskular endometrium & penurunan prostaglandin ?perdarahan • DUB ovulasi Akibat dilatasi vaskular endometrium Lect. ©Bimbel UKDI MANTAP By dr. Sp. Disfungsional Uterine Bleeding • Diagnosis has to be confirmed by a process of exclusion of pathological causes.

325 mg bid-tid. Therapy should be directed at the underlying cause when possible. Ferrous gluconate. Treatment of uterine bleeding Treatment of infrequent bleeding 1. 2. ACOG 2008 ©Bimbel UKDI MANTAP . If the CBC and other initial laboratory tests are normal and the history and physical examination are normal reassurance 3.

IV vasopressin (DDAVP) should be administered. 3. Nuprin) 400 mg tid during the menstrual period. Naprosyn) 500 mg loading dose. b. • Hormonal therapy: estrogen (Premarin) 25 mg IV q6h until bleeding stops. ACOG 2008 ©Bimbel UKDI MANTAP . Mefenamic acid (Ponstel) 500 mg tid during the menstrual period. oral contraceptive pills should be administered q6h x 7 days. Ibuprofen (Motrin. then taper slowly to one pill qd. • If bleeding continues.Treatment of frequent or heavy bleeding 1. 2. a. Thereafter. Naproxen (Anaprox. NSAID • improves platelet aggregation • increases uterine vasoconstriction. c. Ferrous gluconate 325 mg tid. • NSAIDs are the first choice in the treatment of menorrhagia because they are well tolerated and do not have the hormonal effects of oral contraceptives. then 250 mg tid during the menstrual period. Patients with hypovolemia or a hemoglobin level below 7 g/dL should be hospitalized for hormonal therapy and iron replacement.

• Ferrous gluconate 325 mg tid. as do endometrial hyperplasia and endometrial polyps.• Hysteroscopy may be necessary. Contraceptive complications and pregnancy are the most common causes of abnormal bleeding in this age group. ACOG 2008 ©Bimbel UKDI MANTAP . endometriosis. Transfusion may be indicated in severe hemorrhage. 4. Anovulation accounts for 20% of cases. and fibroids increase in frequency as a woman ages. B. and dilation and curettage is a last resort. Primary childbearing years – ages 16 to early 40s A. Pelvic inflammatory disease and endocrine dysfunction may also occur. Adenomyosis.

and/or behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and/or interference with normal activities. Sp. Hasto Wardoyo. called “premenstrual magnification”. OG ©Bimbel UKDI MANTAP ACOG 2008 . PMS the cyclic recurrence in the luteal phase of the menstrual cycle of a combination of distressing physical. PMM Many patients with psychiatric disorders also complain of worsening of their symptoms around the premenstrual phase.. By dr. Lect. psychological.

©Bimbel UKDI MANTAP ACOG 2008 .

(DSM-IV) Providers using Obstetrician/gynec Psychiatrists. Sp. 4 ed. Hasto Wardoyo. PMS PMM Diagnostic criteria Tenth Revision of Diagnostic and the International Statistical Manual Classification of of Mental th Disease (ICD-10) Disorders. primary mental health care care physicians providers Number of One 5 of 11 symptoms symptoms required Functional Not required Interference with impairment social or role functioning required Prospective Not required Prospective charting of daily charting of symptoms symptoms required for two cycles Lect. ©Bimbel UKDI MANTAP By dr. OG . other these criteria ologists.

©Bimbel UKDI MANTAP ACOG 2008 .

ACOG 2008
©Bimbel UKDI MANTAP

Dysmenorrhea
Dysmenorrhea refers to the symptom of painful menstruation. It can be divided into 2
broad categories: primary (occurring in the absence of pelvic pathology) and
secondary (resulting from identifiable organic diseases).
Primary
Usual duration of 48-72 hours (often starting several hours before or just after the
menstrual flow)
Cramping or laborlike pain
Background of constant lower abdominal pain, radiating to the back or thigh
Often unremarkable pelvic examination findings (including rectal)

Current evidence suggests that the pathogenesis of primary dysmenorrhea is due
to prostaglandin F2α (PGF2α), a potent myometrial stimulant and vasoconstrictor,
in the secretory endometrium.The response to prostaglandin inhibitors in patients
with dysmenorrhea supports the assertion that dysmenorrhea is prostaglandin-
mediated. Substantial evidence attributes dysmenorrhea to prolonged uterine
contractions and decreased blood flow to the myometrium.
©Bimbel UKDI MANTAP

Secondary
Dysmenorrhea beginning in the 20s or 30s, after previous relatively painless cycles
Heavy menstrual flow or irregular bleeding
Dysmenorrhea occurring during the first or second cycles after menarche
Pelvic abnormality with physical examination
Poor response to nonsteroidal anti-inflammatory drugs (NSAIDs) or oral
contraceptives (OCs)
Infertility
Dyspareunia
Vaginal discharge

©Bimbel UKDI MANTAP

Drug therapy:
Dysmenorrhoea can be effectively treated by drugs that inhibit
prostaglandin synthesis and hence uterine contractility.
These drugs include aspirin, mefenamic acid, naproxen or ibuprofen. As
dysmenorrhoea is often associated with vomiting, headache and
dizziness, it may be advisable to start therapy either on the day before the
period is expected, or as soon as the menstrual flow commences
Mefenamic acid is given in a dose of 250 mg 6-hourly. This drug also
reduces menstrual flow in some women with menorrhagia.

If these drugs are inadequate, suppression of ovulation with the
contraceptive pill is highly effective in reducing the severity of
dysmenorrhoea. Where it is ineffective, then careful consideration should
be given to the possibility of underlying pathology.
If all conservative medical therapy fails, then relief may sometimes be
achieved by mechanical dilatation of the cervix or by the surgical removal of
the pain fibers to the uterus in an operation known as presacral
neurectomy, but these methods of treatment should be approached with
considerable caution.
©Bimbel UKDI MANTAP

Amenorrhea ©Bimbel UKDI MANTAP .

Amenorrhea primer I. GADIS USIA 16 TH TANDA SEKS SEKUNDER (+) TETAPI BELUM MENARKE ©Bimbel UKDI MANTAP . GADIS USIA 14 TH TANDA SEKS SEKUNDER (-) & BLM MENARKE II.

©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

when affected by major hemorrhage or hypotension during the peripartum period. can result in ischemia of the affected pituitary regions leading to necrosis. ©Bimbel UKDI MANTAP .Sheehan Syndrome Hypopituitarism. the anterior pituitary is supplied by a low pressure portal venous system. •The posterior pituitary is usually not affected due to its direct arterial supply. •These vulnerabilities. caused by necrosis due to blood loss and hypovolemic shock during and after childbirth •Most common initial symptoms of Sheehan's syndrome are agalactorrhea and/or difficulties with lactation. •Many women also report amenorrhea or oligomenorrhea after delivery •Secondly.

©Bimbel UKDI MANTAP .

Menopause Climacteric : The phase in the aging process of women marking the transition from the reproductive stage of life to the non-reproductive stage The final menstrual period and occurs during the climacteric. The average age of menopause is 51. Symptoms Hot flushes (early) Insomnia Irritability Mood disturbances Physical changes Vaginal atrophy (intermediate) Stress (urinary) incontinence Skin atrophy Diseases Osteoporosis (late) Cardiovascular disease Dementia of the Alzheimer’s type Cancers ©Bimbel UKDI MANTAP .

ACOG 2008 • Menopausal transition : begins with variation in menstrual cycle length and an elevated FSH concentration and ends with the final menstrual period (12 months of amenorrhea). • Menopause is defined by 12 months of amenorrhea after the final menstrual period. • Stage -2 (early) is characterized by variable cycle length (>7 days different from normal menstrual cycle length. . • Postmenopause. • Stage +2 (late) begins five years after the final menstrual period and ends with ©Bimbel UKDI MANTAP death. • Stage +1 (early) is defined as the first five years after the final menstrual period. many women in this stage continue to have hot flashes. • It results from complete. ovarian follicular depletion and absence of ovarian estrogen secretion. • Perimenopause begins in stage -2 of the menopausal transition and ends 12 months after the last menstrual period. which is 21 to 35 days). It is characterized by further and complete decline in ovarian function and accelerated bone loss. or near complete. women at this stage often have hot flashes as well. • Stage -1 (late) is characterized by >2 skipped cycles and an interval of amenorrhea >60 days.

©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

ACOG 2008 ©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

FAMILY PLANNING ©Bimbel UKDI MANTAP .

vaginal pouch – Diafragma – spermicida • Hormonal KB – Implant – KB suntik • AKDR • Lain-lain ©Bimbel UKDI MANTAP .Metode KB • Barier KB – Coitus interuptus – Kondom.

ejakulasi dini hamil jangka pendek diafragma Mengganggu ASI (-) Sulit memasang Tdk bs memakai ISK Dipasang 6 jam pre coitus tdk Didiamkan di KB lain Alergi lateks mengganggu sex vagina . menunda Mencegah PMS. 15 menit sebelum Menyusui kapanpun hubungan (tablet.Metode Kelebihan Kekurangan Indikasi kontraindikasi Vaginal Mengganggu ASI (-) << sensasi Butuh KB Alergi lateks pouch/kondo Pengaruh sistemik (-) Not practical pendukung. KB lain High risk mother kapanpun ©Bimbel UKDI MANTAP . mudah didapat PMS. >> lubrikasi supositoria) Efektifitas 1x pakai Coitus Mengganggu ASI (-) << sensasi Tdk bs Ejakulasi dini interuptus KB pendukung Gagal >> menggunakan Ketaatan rendah Efek samping (-). gratis. mudah didapat.6 jam post Menyusui Pengaruh sistemik (-) coitus PMS Mencegah PMS >> infeksi uretra spermicida Langsung efektif (busa dan krim) Efektivitas rendah Tidak bs ISK Mengganggu ASI (-) Ketergantungan memakai KB Metode pendukung pengguna hormonal Pengaruh sistemik (-) Harus menunggu Tidak mau AKDR Mudah dipakai. m Murah.

©Bimbel UKDI MANTAP .

Pregnancy (estrogen dan reversibel hari Severe cramping. bercak perdarahan. irregular menstrual cerebro-vascular Mengganggu coitus (. Harus diminum tiap Heavy bleeding. period diseases ) nyeri kepala History of benign Breast lump or Mudah Mengganggu ASI ovarian cyst cancer Mencegah PID Mahal History of ectopic Malignant diseases Interaksi dg pregnancy of genital tract beberapa obat History of breast Abnormal vaginal Tidak melindungi diseases bleeding PMS Family history of Liver diseases and ovarian cancer benign or malignant liver tumors ©Bimbel UKDI MANTAP . Cardiovascular and progesterone) Tidak perlu px pelvis Efek samping : mual.Metode Kelebihan Kekurangan Indikasi Kontraindikasi Pil Kombinasi Sangat Efektif.

dan 7 tablet iron/plcbo . .Bifasik : 21 tablet hormon aktif dlm 2 dosis berbeda dan 7 tablet iron/plcbo .Monofasik : 21 tablet hormon aktif dlm dosis sama.Trifasik : 21 tablet hormon aktif dg 3 dosis berbeda dan 7 tablet iron/plcbo ©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

bs langsung sebelum haid berikutnya menggunakan kb pil.Waktu menggunakan Pil Special attention .7 saat ingat.Lupa 2 hari minum 2 3.Setiap saat. Pasca aborsi (segera. placebo ©Bimbel UKDI MANTAP . .Pil non hormonal diminum 7 hr suntik.kec.Hari pertama siklus haid mens setelah berhenti kb .Setelah melahirkan : 1. Setelah 3 bulan dan hari berikut minum 2 tidak ASI .Lupa minum 1 hari 2.Paket 21 pil habis tunggu 7 hari ganti .Paket 28 pil habis ganti .Pil pertama diminum hari 1 . besoknya hari post aborsi minum 2 kembali ke jadwal + kb pendukung . Setelah 6 bulan ASI eksklusif . selagi haid .

Gangguan mens. hirsutisme ©Bimbel UKDI MANTAP . masalah barbiturat HIV pembekuan darah Riw. Pil Progestin (Mini Pill) Kelebihan Kekurangan Indikasi Kontraindikasi .Jerawat.Tdk mengganggu .Mens tdk teratus . . Kanker payudara .Gemuk .Dosis rendah . mual Mioma uteri .Tdk mencegah PMS. .Wanita menyusui Hamil ASI amenorrhea .Tdk memberi efek .Perubahan mood Riw. stroke .Mahal 180/110) atau TB. fenitoin.Perokok segala Pedarahan per .Spotting usia vaginam .KB darurat .Nyeri kepala.TD tinggi (< Menggunakan obat samping estrogen .

KB sebelumnya KB suntik minipil diberi di .Muntah 2 jam setelah minum dan tidak haid minum pil lagi.Lupa minum 1 hari hari berikut minum 2 . pakai kondom .Lupa 2 hari minum 2 jadwal selanjutnya saat ingat.Mulai hari 1-5 mens Menyusui 6 mg. besoknya minum 2 kembali ke .Bl > 6 mg menyusui.Waktu menggunakan Pil Special attention .KB lain dpt lgsg ganti jadwal + kb pendukung ©Bimbel UKDI MANTAP .KB sebelumnya hormonal bs lgsg diganti minipil .Lupa minum 3 jam lgsg mens minum saat ingat pakai . . kondom saat coitus dlm 48 jam . minipil dimulai hr 1 . saat coitus dlm 48 jam haid.6 bulan.

rifampisin Sickle cell anemia Pil tdk boleh digunakan Efek samping penanganan Amenorrhea PP test tdk hamil lanjutkan KB dg dosis estrogen 50 mcg atau turunkan dosis progesteron. akan berhenti sendiri > 3 bulan naikkan dosis estrogen (50 mcg) perdarahan ©Bimbel UKDI MANTAP stop kembali dosis awal. pusing. . px ginekologi vaginam/ spotting Biasa pada 3 bulan pertama. px ginekologi tdk hamil minum pil saat muntah makan malam/sebelum tidur Perdarahan per Pp tes. Hamil stop pil Mual. PIL KOMBINASI DAN PROGESTIN Keadaan Saran DM Tanpa komplikasi Pil dapat diberikan Migrain Tanpa defisit neurologi fokal Pil dapat diberikan Menggunakan fenitoin. Dosis etinilestridiol 50 mcg barbiturat. Tes kehamilan.

Dpt .Menghambat gerakan tuba . Migrain berat PMS . Fertilitas dapat . Gangguan . Hamil Kombinasi .Punya anak cukup Progestin .Depo Noretisteron Enantat 200 mg. Tidak mengganggu infeksi . Ikterik dan Injeksi .Takut sterilisasi . Invasif . Dapat digunakan tertunda jangka panajang .Mengentalkan lendir serviks . Tumor payudara coitus .Tidak mau minum pil tromboemboli ASI menyebabkan tiap hari . Gangguan hepar usia > 35 .25 mg Depo Medroksiprogesterone Asetat (Depo provera) + 5 mg Estradiol Sipionat (1 .Menekan Ovulasi bulan sekali .50 mg Noretindron Enantat + 5 mg Estradiol . DUB . HT > 180/110 atau st II dg banyak komplikasi . tiap 2 ©Bimbel UKDI MANTAP bln (4 injeksi ) tiap 3 bln .Menyusui . Efek samping estrogen (kombinasi) Jenis suntikan : .Atrofi endometrium Valerat (sebulan sekali) mengganggu implantasi . DM dg komplikasi. Tidak mencegah .Menunda hamil . Metode Keuntungan Kerugian Indikasi Kontraindikasi Injeksi .Depoprovera (150 mg DMPA) tiap 3 bln . Efektif . Tidak mengganggu . Mens lebih .

tidak ASI tdk anemia boleh suntik Amenorrhea Singkirkan kehamilan.Boleh mundur 2 mg dari jadwal asal tdk dalam 2-3 bl. haid ** Sickle cell Tidak boleh diberikan .Post partus 3 minggus. hamil pakai KB pendukung 7 hr ©Bimbel UKDI MANTAP .Ganti dari KB non hormonal ** Mual. akan hilang .Boleh maju 2 mg dari jadwal Spotting Bl tidak hamil.Post partus > 6 bl. KB . tdk haid. pusing.Post partus 6 bulan. Keadaan Penanganan Waktu injeksi Td tinggi < 180/110 dpt diberikan dg pengawasan -hari 1 mens** DM Dapat diberikan jk tanpa .Post aborsi ** dapat dilanjutkan . defisit neurologis dan nyeri ASI asal tdk hamil kepala Obat TB dan Ditambah pil etinilestradiol epilepsi 50 mcg / ganti KB .Setelah hari 7 mens dg KB kompikasi pendukung 7 hari** Migrain Dpt diberikan jk tdk ada . akan hilang Ganti dari KB hormonal sesuai jadwal muntah dalam 2-3 bulan . Jk tidak hamil. ASI.

Jadena dan Indoplant : 2 batang.Implanon : 1 batang. first year Does not protect against Wants to have longterm Pregnancy preg. active liver women Has got enough children disesaes or tumors Requires minor surgical Rapidly effective. up to estrogen bleeding Client can not discontinue five years Does not accept sterilization Breast lump or cancer on her own Immediate return of fertility Is breastfeeding Diabetes mellitus and after removal Implant may be visible hypertension Inexpensive and convenient under the skin Severe migrain headache Menstrual problems may Depression happen Other side effects are similar to injectables . IMPLANT Keuntungan Kerugian Indikasi Kontraindikasi Highly effective. 75 mg levonogestrel. HIV. 3 tahun ©Bimbel UKDI MANTAP . HBV birth spacing Jaundice.2-0.Norplant : 6 batang.5/100 STDs. 3 tahun . 68 mg 3-keto-desogestrel. 5 tahun . 36 mg levonogestrel. rate 0. less than Does not want to take dailly Active thromboembolic procedur for insertion and pills disorder 24 hours removal Has contraindication to Undiagnosed vaginal Longterm protection.

tumor jinak atau ganas pada hati jangan menggunakan implant ©Bimbel UKDI MANTAP .Gangguan hati. stroke. penyakit jantung. terapi TB dan epilepsi.

Siklu haid terganggu dlm 3 bulan pertama . not user May spontaneously expel STDs dependent Requires checking the string Has sucessfully used an IUD in the past Efek Samping : .Haid >> . recent or recurrent years for the Tcu 380A) and subsequent infertility sterilization PID Immediate return to Requires minor surgical Has one or more children Acute purulent discharge fertility upon removal prosedure either on Is breastfeeding from the cervical canal No hormonal side efeects insertion or removal Does want to take (gonorrheal or chlamydial (local only) May increase menstrual hormonal contraception cervicitis) Cost effective bleeding and cramping because of side effects or Undiagnosed vaginal Suitable for lactating No protection against STDs. AKDR (ALAT KONTRASEPSI DALAM RAHIM) Keuntungan Kerugian Indikasi Kontraindikasi Immediate. contraindications bleeding women HIV or HBV Is at low risk of contracting High risk for GTIs or STDs Practical. highly effective Requires pelvic examination Prefers a longterm and Pregnancy and longterm (up to 8 May increase risk of PID effective method but no Current.Spotting antar siklus ©Bimbel UKDI MANTAP .

MLCu 375. Nova T inactivating them and the Medusa Pessar Less likely a local inflamation may prevent •Steroid medicated IUDs such as implantation of the fertilized egg ProgestasertR. plastic (Lippes Loop) or Mevhanism of action : Preventing fertilization. uterine abormality and cervical stenosis ©Bimbel UKDI MANTAP . by blocking the stainless steel (the chiness ring) migration of the sperms to the ovum. and LevoNovaR Relative Contraindication Leukemia.Available mainly in three types •Innert IUDs. •Coper bearing IUDs which include the TCu decreasing the number of sperm and 200. diabetes and immunocompromised women Severe anemia Rheumatic or Valvular heart disease Severe painful menstrual period (dismenorrhea) History of an ectopic pregnancy Uterine fibromyomas. MLCu 250. TCu 380A.

©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

kombinasikan dengan metode kontrasepsi lain setelah bayi berusia 6 bulan TIDAK DILANJUTKAN JIKA Setelah beberapa bulan amenorea. Metode Laktasi Amenore • MLA merupakan metode kontrasepsi Wanita yang: alamiah yang mengandalkan pemberian ASI pada bayinya Menyusukan bayinya secara eksklusif • Akan tetap mempunyai efek (memberikan ASI secara penuh tanpa kontrasepstif apabila • Menyusukan secara penuh suplementasi lainnya) (eksklusif) Belum mendapat haid sejak • Belum haid melahirkan bayinya • Usia bayi kurang dari 6 Menyusukan secara eksklusif sejak bulan • Efektif hingga 6 bulan bayi lahir hingga bayi berusia 6 bulan 1 • Bila ingin tetap belum ingin hamil. klien mulai mendapat haid Tidak menyusukan secara eksklusif Bayi telah berusia diatas 6 bulan Ibu bekerja dan terpisah dari bayinya lebih dari 6 jam dalam sehari ©Bimbel UKDI MANTAP .

Metode KBA Metode Kalendar Suhu Tubuh Basal (STB) Metoda Mukosa Servik (Billings) Simptotermal (STB + Mukosa Servik) ©Bimbel UKDI MANTAP .

KBA: Pemanfaatan Untuk Kontrasepsi: Menghindari sanggama dalam periode subur dalam siklus menstruasi untuk menghindarkan terjadinya kehamilan Untuk Kehamilan: Melakukan sanggama dalam periode subur (disekitar pertengahan siklus menstruasi) dimana peluang terjadinya kehamilan cukup besar. ©Bimbel UKDI MANTAP .

Grafik menstruasi ©Bimbel UKDI MANTAP .

JENIS TUBEKTOMI • Pascapersalinan –Minilaparotomi Subumbilikus • Interval –Minilaparotomi Suprapubik –Laparoskopi ©Bimbel UKDI MANTAP .

Tubektomi: Mekanisme Kerja Mencegah pertemuan sperma dengan sel telur (fertilisasi) dengan jalan menutup atau oklusi saluran telur (tuba fallopii) ©Bimbel UKDI MANTAP .

©Bimbel cincin titanium UKDI MANTAP . Kontrasepsi Metode Operatif Oklusi Tuba secara Laparoskopik – teknik (1): • Pengangkatan dinding abdomen dengan insuflasi CO2 menyediakan ruang untuk memposisikan Elektrokoagulasi atau aplikasi instrumen bedah.

Kontrasepsi Metode Operatif

Oklusi Tuba secara Laparoskopik – teknik (2):

menyediakan ruang untuk memposisikan Elektrokoagulasi atau aplikasi
instrumen bedah. cincin titanium
©Bimbel UKDI MANTAP

Tubektomi: Petunjuk Untuk Klien

• Jaga luka insisi bersih dan kering selama 2 hari.
Lakukan kegiatan harian secara bertahap.
• Sebaiknya hindari sanggama selama 1 minggu atau
klien siap untuk itu
• Jangan melakukan kerja berat/mengangkat benda
berat selama 1 minggu.
• Untuk nyeri pasca-tubektomi gunakan 1 - 2 tablet
analgesik setiap 4 sampai 6 jam.
• Jadwalkan kunjungan ulangan antara hari ke 7–14.
• Pesankan untuk kembali setelah 1 minggu jika
menggunakan benang jahit yang tidak dapat diserap
(non-adsorbable)
©Bimbel UKDI MANTAP

MOP

©Bimbel UKDI MANTAP

Jenis Vasektomi

• Vasektomi Tanpa Pisau
(VTP atau No-scalpel
Vasectomy) lebih
disukai
• Vasektomi dengan insisi
skrotum (tradisional)

©Bimbel UKDI MANTAP

Vasektomi dengan Insisi • 1 atau 2 insisi pada skrotum • 99% prosedur vasektomi dilakukan dengan anestesia lokal • Jenis oklusi yang umum dipakai: • Ligasi • Kauterisasi • Gabungan (kombinasi) ©Bimbel UKDI MANTAP .

Vasektomi Tanpa Pisau • Dikembangkan di Cina oleh Profesor Lee dan mulai diperkenalkan di Amerika Serikat pada tahun 1988 • Menggunakan anestesia lokal • Petugas memfiksasi vasa diferensia di bawah skrotum dan raphe mediana • Kemudian vasa diambil dengan klem diseksi dan dioklusi. baik yang kiri maupun yang kanan (hanya melalui satu lubang) • Luka diseksi tidak perlu dijahit. cukup ditutup plester ©Bimbel UKDI MANTAP .

Kontrasepsi Metode Operatif ©Bimbel UKDI MANTAP .

Vasektomi: Mekanisme Kerja Oklusi vasa deferensia membuat sperma tidak dapat mencapai vesikula seminalis sehingga tidak ada di dalam cairan ejakulat saat terjadi emisi ke dalam vagina ©Bimbel UKDI MANTAP .

klien boleh membersihkan luka dengan sabun dan air bersih • Gunakan penyangga skrotum. Vasektomi: Petunjuk Untuk Klien • Pastikan area luka diseksi/insisi tetap bersih. ©Bimbel UKDI MANTAP . kering dan terbalut selama 3 hari. • Jangan mengorek atau menggaruk luka insisi atau diseksi sebelum sembuh. • Klien boleh mandi setelah 24 jam tetapi luka harus tetap kering. jaga agar area operasi tetap kering dan istirahatlah selama 2 hari. Setelah 3 hari.

klien diminta kembalilah setelah 1 minggu vasektomi • Untuk memastikan tidak ada sperma dalam cairan mani.3 hari atau hingga klien terasa nyaman atau siap untuk itu. Vasektomi: Petunjuk Untuk Klien • Untuk mengatasi nyeri. ©Bimbel UKDI MANTAP . • Bila menggunakan benang jahit yang tidak diserap. – Untuk mengosongkan depot sperma dalam vesikula seminalis.6 jam dan pakai kompres es (jangan basah) • Jangan mengangkat benda berat atau bekerja keras selama 3 hari. minum 2 . • Hindari sanggama selama 2 .3 tablet analgesik setiap 4 . gunakan kondom/kontrasepsi lain hingga 20 kali ejakulasi. lakukan uji air mani setelah 3 bulan operasi.

Vasektomi: Barier Medik dalam Pelayanan • Menerapkan batasan usia (muda dan tua) dan paritas (kurang dari dua anak yang lahir hidup. tidak ada anak laki-laki) • Status perkawinan/persetujuan dari pasangan • Kurangnya tingkat pemahaman klinik dan program dari pemberi layanan • Penerapan kriteria atau aturan ketat • Ketentuan ketat tentang pemberi pelayanan: – Dokter Spesialis – Dokter terlatih ©Bimbel UKDI MANTAP .

uk ©Bimbel UKDI MANTAP . gagal KB • Morning after pill – Progestin only – Mekanisme : mukosa cerviks lebih kental. menunda ovulasi – Levonogestrel 1.5 mg single dose atau 0. dalam 5 hari dari unprotected coitus • Copre bearing IUD (>> efektif) – Hanya dipasang pada yang sudah menikah www.nhs. Emergency post coital contraception • Digunakan setelah unprotected coitus.75 mg tiap 12 jam (satu hari) .

©Bimbel UKDI MANTAP .

FAQ.ACOG. 2013 ©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP . Orkhitis. kelainan kongenital (Hipospadia. prostatitis. tidak hamil 40% faktor istri 40% faktor suami 20% pada keduanya wanita: 35-60% faktor tuba & peritonium 10-25% kasus: Unexplained infertility Faktor Suami a. Gangguan transfortasi: Varikokel. agenesis vas deferens. kelainan hipotalamus-hipofisa -c. tanpa kontrasepsi. Epididimitis. Autoimunitas. Myotonic distrophy). 2-3 x hub sex/minggu. klinefelters syndrome. Infertilitas Selama 1 tahun. Impotensi dan yang tak diketahui sebabnya. 35% : faktor sperma -b.

©Bimbel UKDI MANTAP .

• Faktor Istri : – Infeksi – Gangguan ovulasi – Gangguan anatomi Gangguan Ovulasi •Penuaan (usia) •POF •Polikistik Ovarii (PCOS) •Kelainan pada hipotalamus-hipofisis •Hiperprolaktin •Kelainan kongenital ©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

jerawat dan alopesia ©Bimbel UKDI MANTAP . Sindroma Ovarium Polikistik Kelainan endokrin wanita usia reproduktif Definisi klinis Terdapatnya hiperandrogenemia yang berhubungan dengan anovulasi kronik pada wanita tanpa adanya kelainan dasar spesifik pada adrenal atau kelenjar hipofisa •Gejala : Siklus menstruasi yang iregular: oligomenore dan amenore Hiperandrogen: hirsutisme.

Obesitas > 65% wanita SOPK IMT > 27 Distribusi lemak = kelainan metabolik ( hipertensi. resistensi insulin / intoleransi glukosa ) Mulai belasan tahun BB resistensi insulin. penyembuhan siklus menstruasi pengurangan 10-15 % BB 75% konsepsi spontan Akantosis nigrikan Stimulasi insulin lapisan basal epidermis Ovarium polikistik Terdapat pada 16-25% wanita normal & wanita amenora etiologi lain Kista folikular kecil multipel (< 10mm). mengelilingi stroma. agen sensisitasi insulin. dislipidemia. 80% wanita hiperandrogenemia mempunyai ovarium polikistik (tidak pada wanita yang menggunakan OC. atau bentuk lain supresi ovarium) ©Bimbel UKDI MANTAP .

14.11.15 IVF dari siklus menstruasi • FSH murni (Metrodin) 75 IU cara pemberian sama dengan hMG ©Bimbel UKDI MANTAP . 8.8.7.6.12.10.Px penunjang infertilitas Fisik diagnostik-ginekologik Foto HSG Suhu badan basal (ovulasi) Penunjang USG-TV Analisa sperma Penunjang hormonal (bila diperlulkan) Laparoskopi-histeroskopi Terapi Induksi Ovulasi Senggama Terencana • Clomiphene Citrate (CC) 50-150 mg IUI diberikan pada hari ke 5. 7.9.13. 6. 9 Induksi Ovulasi dari siklus menstruasi Laparoskopi operatif • hMG 2-3 Ampl/hari diberikan pada Drilling hari ke 5.

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Kista dan Abses Bartholini • Umum pada wanita umur reproduksi • Lokasi pada labia mayora • Abses 3 kali lebih umum dari pada kista • Obstruksi pada distal duktus dapat karena retensi sekret dan pembentukan kista ©Bimbel UKDI MANTAP .

fragilis Clostridium perfringens dispareunia. Patologi • Abses Bartholini Isolates from Bartholin's Gland Abscesses merupakan Aerobic organisms polymikrobal infeksi Neisseria gonorrhoeae • Neisseria gonorrhoeaea Staphylococcus aureus Streptococcus faecalis yang paling umum Escherichia coli • Jika tidak inflamasi Pseudomonas aeruginos Chlamydia trachomatis asimtomatik Anaerobic organisms Bacteroides • Simtom: nyeri vulva. kesulitan Peptostreptococcus species berjalan/olah raga Fusobacterium species ©Bimbel UKDI MANTAP .

Penatalaksanaan • Asimtomatik tidak perlu terapi • Incisi dan drainase tx cepat & mudah kemungkinan rekuren • WORD CATHETER • MARSUPIALIZATION • INCISI & DRAINASE ©Bimbel UKDI MANTAP .

WORD CATHETER • Pembuatan 5 mm incisi pada kista atau abses • Masukkan kateter Word dan dikembangkan dengan 2-3 ml saline selama 3-4 minggu • Jika tidak ada bukti infeksi tidak perlu antibiotik ©Bimbel UKDI MANTAP .

Marsupialisasi • Membuka rongga tertutup mjd kantong terbuka. • Untuk cegah kista berulang • Dengan lokal anestesi • Pembuatan insisi vertikal elips 1.5-3 cm (sesuai garis Langer) • Cukup dalam sampai kulit vestibular dinding kista • Pengeluaran isi kista dg sendok kuret kecil sampai bersih • Dinding kista dijahit ke kulit vertibular dengan jahitan interupted .

Incisi dan drainase • Dilakukan pada pasien yang tidak respon pada terapi konservatif tidak ada infeksi aktif Kekambuhan • Pemasangan balon kateter Word (Kambuh 3-17%) • Marsupialisasi (Kambuh 10-24%) • Eksisi risiko perdarahan ©Bimbel UKDI MANTAP .

Patofisiologi • GO cepat menjadi abses keluar lewat duktus tersumbat: abses membesar • Radang bisa berulang (68-75%) • Jika menahun terbentuk kista ©Bimbel UKDI MANTAP .

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dikelilingi lapisan sel granulosa. seorus sanguine. clear straw colour fluid • Terjadi karena >> beta HCG (mola. multiple pregnancy) ©Bimbel UKDI MANTAP . berisi cairan. berisi cairan jernih • Jika ovulasi tdk terjadi folikel graafian tidak ruptur tumbuh menjadi kista • Kista teka lutein: • Kista ovarium fungsional bilateral. • Cairan : serous.• Kista folikel : • Kista fungsional ovarium • Tipe kista ovarium tersering • Dinding kista tipis.

• Pertumbuhan jaringan mengeblok kripta cervix trapping cervival mucus inside crypts ©Bimbel UKDI MANTAP . intestinal.• Kista coklat : • Disebabkan oleh endometriosis • Dibentuk ketika jaringan endometrium mengelupas tumbuh dan membesar di dalam ovarium • Jaringan endometrium berdarah seiring waktu menjadi coklat • Ruptur materi kista keluar ke permukaan uterus. menorrhagia. dyspareunia • Kista nabothian: kista di cervix • Kista berisi mukus • >> di permukaan cervix • Terjadi krn metaplasi epitel squamous stratifikatum ektoserviks menjadi epitel columnar seperti di endoserviks. dan rongga di antaranya. vesica. • Gejala : Heavy bleeding.

tumbuh dari sisa duktus mesonefrikus/ Gartner’s duct. ©Bimbel UKDI MANTAP .• Kista Gartner / vaginal inclusion cyst : – Lesi kistik vagina jinak. – Asimtomatik – >> di dinding lateral vagina – Kejadian ureter ektopik dan hipoplasia renal ipsilateral sering menyertai kisa Gartner.

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Demam postpartus ©Bimbel UKDI MANTAP .

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UK < 22 mg atau berat < 500 gr Early abortion < 12 weeks Late abortion 12-20 weeks • Abortus imminens • Spontaneous abortion: abortion happens by nature. Abortus • Perdarahan + hasil konsepsi. no • Abortus Insipiens intervention • Abortus Inkomplit • Induced abortion (artificial • Abortus Komplit abortion): abortion made for certain purposes • Missed Abortion – Medical or therapeutic abortion • Septic abortion – Criminal abortion: other than • Habitual abortion therapeutic abortion (illegal abortion) ©Bimbel UKDI MANTAP .

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arcuatus. ETIOLOGY EARLY ABORTION LATE ABORTION • Abnormal product of • Infection (malaria. • Autoimmun disorders (SLE) Thyroid) • Endocrine abnormalities • Physiologic impairment (renal. avitaminosis didelphys etc) • Isoimmunisation • Many is still unknown • Poisoning (lead. drugs abuse) • Trauma to the womb • Cervical incompetence ©Bimbel UKDI MANTAP . anemia. hypertension) • Uterine abnormalities • Severe dietary insufficiency: (septus. (luteal phase defect) cardiac. syphylis. conception typhoid) • Circumvallate placenta • Infections (CMV) • Metabolic disorders (DM. hepatic diseases. bicornual.

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Cochrane Database of Systematic Reviews 2007. Ab imminens • Penanganan : – Bedrest total – Hindari aktivitas fisik berlebihan dan hub seksual – Antibiotik mencegah infeksi – tokolitik • Progesterone VS placebo – Wahabi HA. ©Bimbel UKDI MANTAP . Issue 3. inkomplit. – Jika perdarahan : • Berhenti lakukan ANC seperti biasa • Berlanjut Pptes. atau komplit. USG • Rawat inap : – Untuk menunjang bedrest – Observasi jika berlanjut menjadi Ab insipiens. Progestogen for treating threatened miscarriage. Abed Althagafi NF. Elawad M.

berikan oksitosin 20U dalam 500cc RL 40 tpm untuk mempercepat ekspulsi ©Bimbel UKDI MANTAP .2 mg IM (dpt diulang tiap 15 menit jk perlu) – Atau misoprostol 400 mcg per oral (dapat diulang tiap 4 jam jk perlu) – Lanjutkan dg kuretase • UK > 16 mg : – Tunggu ekspulsi spontan evakuasi sisa konsepsi – Jk perlu. Abortus insipiens • UK < 16 mg : – Evakuasi konsepsi dg aspirasi vakum manual – Jk tdk bisa : ergometrin 0.

2 mg IM atau misoprostol 400 mcg PO • UK < 16 mg. ©Bimbel UKDI MANTAP . drip 40 tpm sampai tjd ekspulsi – Jk perlu : misoprostol 200 mcg pervag tiap 4 jam smp ekspulsi (maks 800 mcg) – Jk perlu : kuretase untuk membersihkan sisa jaringan di uterus. terus menerus – Aspirasi vakum manual untuk evakuasi jaringan – Jk tidak ada : kuretase dg sendok kuret tajam – Jk perlu ergometrin 0.2 mgIM (dpt diulang stlh 15 menit) atau misoprostol 400 mcg PO (dpt diulang setelah 4 jam) • UK > 16 mg : – Oksitosin 20 U dlm 500 cc RL. Abortus inkomplit • UK < 16 mg – Evakuasi jaringan secara digital – Perdarahan berhenti ergometrin 0. perdarahan banyak.

dan perdarahan • Cek Hb post abortus anemia ringan SF 600 mg/hari 2 mingggu • Jk anemia berat (<7 gr/dl) transfusi darah sampai Hb mencapai 10 mg/dl ©Bimbel UKDI MANTAP . Abortus Komplit • Tidak perlu evakuasi jaringan • Observasi KU. VS.

Abortus rekuren/habituasi • Abortus spontan berturut-turut selama tiga kali atau lebih • Penyebab : >> anomali kromosom ©Bimbel UKDI MANTAP .

parametritis. hingga peritonitis • Penyebab : bakteri anaerob (>>). H. tangani syok jk terjadi ©Bimbel UKDI MANTAP . Campylobacter jejuni. spektrum luas parenteral. streptokokus grup A • Terapi : evakuasi segera produk konsepsi. – Sekret vagina berbau – AL > 11 rb atau < 4 rb – Dapat terjadi syok septik • metritis. Abortus septik • >> komplikasi pada abortus kriminalis • Tanda dan gejala : – demam. influenzae.

• Nyeri perut << • OUE menutup • PPTest (-) • Ukuran uterus < UK • USG : blood clot dalam uterus • Tx : dilatasi dan kuretase ©Bimbel UKDI MANTAP . Missed abortion • perdarahan dari jalan lahir ≥ 8 mg • Perdarahan sedikit. hitam.

©Bimbel UKDI MANTAP . dysphoria. Complication • Hemorrhage • Infection • Choriocarcinoma • Infertility • Rh senstization: avoided by Rh immune globulin • Psychological effect: grief. anxiety. depression etc.

Kontrasepsi Post Abortus Metode Waktu aplikasi Keterangan Kondom Segera Membantu mencegah PMS Pil hormonal Segera Butuh ketaatan tinggi Suntikan Segera Implan Segera Jk sudah punya anak 1 atau lebih dan ingin KB jangka panjang AKDR Segera atau setelah pasien Tunda insersi jk Hb < 7 pulih gr/dl atau curiga infeksi Tubektomi Segera Tunda jk curiga infeksi dan Hb < 7 gr/dl ©Bimbel UKDI MANTAP .

http://www.com/physical.Safe pregnancy after medical abortion • Don’t have sex until 2-4 weeks after abortion. • Patient can get pregnant as soon as two weeks after an abortion. • Menstrual cycle will go back to it’s regular cycle and ovulation at 2 weeks post abortion.afterabortion.html ©Bimbel UKDI MANTAP .

Kehamilan Ektopik Definisi Kehamilan yang implantasi blastosisnya terjadi di luar mukosa endometrium ©Bimbel UKDI MANTAP .

– USA-5 kali lipat – UK-2 kali lipat – France 15/1000 kehamilan – India-1 dalam 100 kehamilan • Recurrence rate . 25% sesudah kejadian ke-2 ©Bimbel UKDI MANTAP .15% sesudah kejadian ke-1. INSIDENSI >1 dalam 100 kehamilan. • Bukti terakhir menunjukkan kehamilan ektopik meningkat di beberapa negara.

©Bimbel UKDI MANTAP . ETIOLOGI • Beberapa faktor yang menyebabkan terhambatnya transport zygote dari tuba ke uterus • Keadaan tuba sendiri yang menyokong terjadinya implantasi di mukosanya sendiri • Kongenital atau Acquired.

Tubal Hypoplasia . Partial stenosis • ACQUIRED - – Inflamasi: PID. ETIOLOGI • KONGENITAL . tumor ovarium – Kasus Miscellaneous : IUD . Puerperal Sepsis. Septic Abortion. Congenital diverticuli . ART (IVF & & GIFT ©Bimbel UKDI MANTAP . Tortuosity . Recanalisasi tuba – Neoplastic: mioma intraligamenter. Endometriosis. adhesi intraluminal – Pembedahan: Pembedahan rekonstruksi tuba. Accessory ostia .

Tempat-tempat kehamilan ektopik Abdomen (< 2%) Ampulla (>85%) Isthmus (8%) Cornual (< 2%) Ovary (< 2%) Cervix (< 2%) 1)Fimbria 2)Ampulla 3)Isthemus 4)Interstitial 5)Ovarium 6)Cervic 7)Cornual 8) Secondary abdominal 9) ligamentum latum 10)Primary abdominal ©Bimbel UKDI MANTAP .

Gambaran Klinis • Kehamilan ektopik ada yang asimptomatik hingga ruptur • Ada dalam 2 variasi: akut dan kronik • Gejala-gejala: – Amenorrhea – Nyeri abdomen – Syncope – Perdarahan pervaginam – Massa pelvis ©Bimbel UKDI MANTAP .

paling awal 4. dan sebelum adanya gejala-gejala • Pengukuran hCG kehamilan normal meningkat 2 kali lipat tiap 2 hari pada minggu 4-8. DIAGNOSIS DINI • Dapat didiagnosis sebelum umur kehamilan 6 minggu.5 minggu. hCG 2000 IU/L • Laparoskopi gold standard ©Bimbel UKDI MANTAP . KE tidak ada peningkatan • Kadar progesteron serum (8-10 minggu) • USG transvaginal: 4-5 mg.

PENATALAKSANAAN • Tergantung stage penyakit dan kondisi pasien • Pilihan terapi: – Ekspektatif – Medikamentosa – Pembedahan • Pilihan terapi berdasarkan penilaian luaran jangka pendek (menurunnya hCG. trofoblast persisten. keutuhan tuba) dan luaran jangka panjang (patensi tuba dan fertilitas berikutnya) ©Bimbel UKDI MANTAP .

PENATALAKSANAAN • Ekspektatif: – Bila titer ßhCG < 2000 IU/L. tidak ditemukan bagian janin – Hemoperitoneum < 50 ml – Tidak ada gejala-gejala klinis yang semakin memburuk • Efikasi jelek. rawat inap lama. mengalami penurunan progresif – USG: ukuran massa < 2 cm. evaluasi lama ©Bimbel UKDI MANTAP .

Yang paling banyak digunakan MTX – Singgle dose 50 mg/m3 • Syarat: – Titer ßhCG < 2000 IU/L – Ukuran massa KE < 3. prostaglandin. PENATALAKSANAAN • Medikamentosa – Sistemik atau lokal – Agen: MTX.5 cm ©Bimbel UKDI MANTAP . glukosa hiperosmolar.

LAPAROSCOPY? SALPINGECTOMY? VS SALPINGOSTOMY / SALPINGOTOMY? Tergantung stabilitas hemodinamik. ukuran dan lokasi KE. keahlian ©Bimbel UKDI MANTAP . Pembedahan Perdebatan: LAPAROTOMY? VS.

7%) ©Bimbel UKDI MANTAP .2%) vs Laparotomi (1.6%) •Angka trofoblas persisten: Laparoskopi (12.•Kecenderungan Laparoskopi: •Perdarahan sedikit •Kebutuhan analgesi •Lama rawat inap •Cepatnya penyembuhan •Biaya •Terjadinya kehamilan intrauterin berikutnya: Laparoskopi (70%) vs Laparotomi (55%) •Terjadinya kehamilan ektopik rekuren: Laparoskopi (5%) vs Laparotomi (16.

8-11%. SALPINGECTOMY VS SALPINGOSTOMY / SALPINGOTOMY Kehamilan ektopik rekuren: Salpingostomi lebih tinggi (15%) dibandingkan salpingektomi (10%) Kegagalan pengambilan produk kehamilan secara komplit: Salpingostomi 4. salpingektomi hampir tidak ada Salpingektomi lebih dipilih bila tuba kontralateral masih baik ©Bimbel UKDI MANTAP .

©Bimbel UKDI MANTAP .

management ≥6 : Induksi dg oksitosin Terminasi kehamilan < 5 : matangkan serviks dg prostaglandin dan kateter Foley ©Bimbel UKDI MANTAP .

BBLR INH . Neurotoksik pd n 8 Semua jenis OAT aman untuk ibu menyusui ©Bimbel UKDI MANTAP .Persalinan Preterm . OTOTOKSIK pd janin . Nefrotoksik Efek teratogenik tidak terbukti . TB on pregnancy and lactation Efek pada kehamilan : .>> kematian perinatal Ethambutol KONTRA INDIKASI : STREPTOMYCIN .Gangguan pertumbuhan janin Rifampicin .

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The majority of cases of mumps orchitis occur in prepubertal (less than 10 years old) males. or in men older than 50 years of age with benign prostatic hypertrophy. while most cases of bacterial orchitis occur in sexually active men. Orchitis caused by a bacterial infection most commonly develops from the progression of epididymitis. generally caused by a viral or bacterial infection. Most cases of orchitis are caused by infection with the mumps virus. This is called epididymo-orchitis. ORCHITIS Orchitis is an inflammatory condition of one or both testicles in males. ©Bimbel UKDI MANTAP . an infection of the tube that carries semen out of the testicles.

any of which may require surgery. Testosterone levels are not affected in other cases. death of a testicle. ©Bimbel UKDI MANTAP . or continuous draining through the skin.The symptoms associated with orchitis may range from mild to severe. and the inflammation may involve one or both testicles. Patients may experience the rapid onset of pain and swelling. Symptoms of orchitis may include the following: • Testicular swelling • Testicular redness • Testicular pain and tenderness • Fever and chills • Nausea • Malaise and fatigue • Headache • Body aches • Pain with urination Tuberculous epididymitis and mumps orchitis can cause testicular atrophy (shrinkage). Severe cases may lead to an abscess (collection of pus). or the symptoms may appear more gradually. which may reduce testosterone production in the affected testicle.

Longer courses may be required if the prostate gland is also involved. Antibiotic therapy is necessary to cure the infection. the patient may require admission to a hospital for IV antibiotics. sexually active men need to make sure that all of their sexual partners are treated if the cause is determined to be a STD. Young. Mumps orchitis will generally improve over a 1-2 week period. Antibiotics commonly used may include ceftriaxone (Rocephin). If a patient has high fever. or if he develops serious complications. ©Bimbel UKDI MANTAP . azithromycin (Zithromax) or ciprofloxacin (Cipro). Patients should treat symptoms with the home care treatments outlined above.People with bacterial orchitis or bacterial epididymo-orchitis require antibiotic treatment. Doryx). is vomiting. Most men can be treated with antibiotics at home for 10-14 days. They should either use condoms or abstain from sexual relations until all partners have completed their full course of antibiotics and are symptom-free. If the cause of orchitis is determined to be viral in origin. if he is very ill. doxycycline (Vibramycin. Antibiotics prescribed will depend on the patient age and underlying cause of the bacterial infection. antibiotics will not be prescribed.

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Rubella ©Bimbel UKDI MANTAP .

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CMV ©Bimbel UKDI MANTAP .

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TOXOPLASMOSIS ©Bimbel UKDI MANTAP .

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www.com/component/k2/item/d ©Bimbel UKDI MANTAP ownload/1281 . • Newer progestogens do not seem to change fasting or nonfasting insulin or glucose levels over the long term.nutrition411. • Older generations of hormonal contraceptives increase insulin secretion and the insulin resistance of cells • Serum glucose levels are likely to increase in users of these hormonal contraceptives. • Excessive cortisol is linked to weight gain in some women. Hormonal Contraception and Lipid Metabolism • Hormonal contraceptives produce >> cortisol • Cortisol increase the mobilization of free fatty acids from adipose. generally by 10 milligrams (mg)/deciliter (dL).

This increases the risk of thrombosis of all types.nutrition411. • Coagulation proteins. www. are produced by the liver at a greater rate in women who are taking hormonal contraceptives. including fibrinogen. while HDL cholesterol is decreased.com/component/k2/item/d ©Bimbel UKDI MANTAP ownload/1281 .• Older generation forms of hormonal contraceptives (>> estrogen ) increase total cholesterol and LDL cholesterol. • Newer forms increasing HDL and keeping LDL steady.

Hiperemesis Gravidarum ©Bimbel UKDI MANTAP .

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MOLA HIDATIDOSA • Kelainan vili korionik : – gangguan proliferasi trofoblas dg derajat bervariasi – edema stroma vilus • Letak : rongga uterus (>>). tuba falopii. ovarium ©Bimbel UKDI MANTAP .

XX atau 46. Gambaran Mola Parsial Mola komplit Kariotipe Umumnya 69.Proliferasi ringan-sedang berat Honey comb appearance trofoblas Gambaran Klinis : . fokal Difus . XXX atau 69.Penyulit medis Jarang Sering . RBC Sering dijumpai Tidak ada janin Bervariasi.Amnion.Diagnosis Missed abortion Gestasi mola . ringn- . Bervariasi. fokal.USG Honey comb Snow storm/ appearance granular appearance .Ukuran uterus Kecil untuk masa 50% besar untuk kehamilan masa kehamilan . 46.Janin Sering dijumpai Tidak ada .Kista teka Snow storm appearance lutein >> << ©Bimbel UKDI MANTAP . XXY XY Patologi : .Penyakit pascamola < 5-10% 20% .Edema vilus Bervariasi.

Lugol 10 >< di resseptor tiroid tetes/8jam • Embolisasi akibat deportasi • Pada kasus berat: PTU vs metimazol trofoblas ke venula • Krisis tiroid: sol.k estrogen dan gonadotropin korionik yg • PTU 3x 100mg/hari.• Perdarahan uterus • Evakuasi jaringan mola segera • Ukuran uterus berubah – Aspirasi vakum. histerektomi • Hipertensi. dilatasi tidak sesuai UK (oksitosin. tjd < 24 mg – menghilangkan hipertiroidisme kehamilan – menyebabkan kegawatan • Hiperemesis hipertiroid (krisis tiroid atau gagal jantung tiroid) • Tirotoksikosis • Deteksi dini koriokarsinoma – >> kadar tiroksin plasma (deteksi hCG) o. DJJ (-) kuret tajam. prostaglandin) dan • Aktivitas janin (-). Lugol + PTU + propanolol ©Bimbel UKDI MANTAP . menjelang susunannya mirip tirotropin kuretase + Sol.

• Cegah kehamilan min 1 tahun • Ukur kadar hCG tiap 2 minggu • Tunda terapi selama kadar hCG berkurang • Setelah kadar normal cek hCG tiap bulan selama 6 bulan tiap 2 bulan selama 1 tahun ©Bimbel UKDI MANTAP .

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THYROID DISORDER AND PREGNANCY ©Bimbel UKDI MANTAP .

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ANALISA SPERMA

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Drugs for pregnancy
Chloramphenicol

Ciprofloxacin

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Gentamycin Ceftriaxon ©Bimbel UKDI MANTAP .

gejala memburuk di malam hari • Gangguan emosional : depresi. Gangguan mental Organik. halusinasi (visual)). anxietas/takut. apatis. hendaya daya ingat segera dan pendek • Gangguan psikomotor : hipo/hiperaktivitas • Gangguan siklus tidur-bangun : insomnia. 3P terganggu • Gangguan kognitif secara umum : distorsi persepsi (ilusi. hilang timbul sepanjang hari kurang dari 6 bulan ©Bimbel UKDI MANTAP .Delirium • Gangguan kesadaran dan perhatian : kesadaran berkabut-koma. mudah marah. kehilangan akal Onset cepat. disorientasi.

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