DIAGNOSIS DERAJAT RUPTUR PERINEUM

DR. RATIH KRISNA SPOG(K)

DIVISI UROGINEKOLOGI REKONSTRUKSI
DEPARTEMEN OBSTETRI DAN GINEKOLOGI
FK UNSRI - RSMH PALEMBANG
ANATOMI SFINGTER ANI
 KLASIFIKASI ROBEKAN PERINEUM
(SULTAN 1999-RCOG-WHO)
1. Derajat I : robekan mengenai epitel vagina & kulit perineum
2. Derajat II : otot perineum tetapi tidak mengenai sfingter ani

3. Derajat III: robekan mengenai sfingter ani

 3a = robekan < 50% dari otot sfingter ani eksterna
 3b = > 50% dari otot external
 3c = otot sfingter ani eksterna juga otot sfingter ani interna

4. Derajat IV : robekan mengenai seluruh sfingter ani & mukosa

rektum
KLASIFIKASI : DERAJAT 3 DAN 4
 DIAGNOSIS

USG
Pemeriksaan Pemeriksaan
Inspeksi endoanal /
vaginal rektal
transvaginal
DIAGNOSIS

Mukosa rektum intak

Konfirmasi robekan dengan palpasi sfinter di antara ibu jari &
telunjuk pada obekan vagina (“PILL ROLLING” ACTION)
GRADE 3A
GRADE 3A TEAR (PARTIALLY TORN EXTERNAL SPHINCTER –
BLACK ARROWS
THIRD DEGREE TEAR (GRADE 3B)
GRADE 3B
ROBEKAN MUKOSA REKTUM DENGAN
SFINGTER YANG INTAK
 DIAGNOSIS
ULTRASONOGRAFI ENDOANAL

invasif dan mahal

butuhkan keahlian
khusus

overdiagnosis: USG
(+), klinis (-)

 Klinis : anamnesis +
DRE
Fourchette

Anus
Transvaginal Sonography of sphincter ani

Timor-Tritsch IE, Monteagudo A, Smilen SW et al. Simple ultrasound evaluation of the anal sphincter in female patients
using a transvaginal transducer. Ultrasound Obtet Gynecol 2005;25:177–183.
Transverse Scanning Plane
 Normal view of anal sphincter

Steensma AB. The central and posterior compartment. In: Dietz HP, Hoyte LPJ, Steensma AB. Atlas of
Pelvic Floor Ultrasound. 1st ed. London: Springer-Verlag; 2004.p.63-75.
The normal anal sphincter unit. Lower transverse section

IAS Mucosal Star

EAS
Fourth-degree sphincter tear
Pathological appearance of the mucosal star
 Fourth-degree sphincter tear.
The defect at a high transverse section.
Fourth-degree sphincter tear.
Sagittal section.
Third-degree laceration after vaginal delivery which was
repaired 3 weeks before.
Transperineal/labial Sonography
Normal view of anal sphincter

Steensma AB. The central and posterior compartment. In: Dietz HP, Hoyte LPJ, Steensma AB. Atlas of
Pelvic Floor Ultrasound. 1st ed. London: Springer-Verlag; 2004.p.63-75.
Normal sfingter ani (coronal view)
Normal sfingter ani with contraction
Normal sfingter ani (sagittal view)
Sfingter ani int et ext defect (coronal)
Sfingter ani int et ext defects (sagittal)