Sitti Musdhalifah AM.

C11111331

PEMBIMBING RESIDEN PEMBIMBING KONSULEN

dr. Bayu P. Putra dr. Ajardiana Idrus, Sp.OG (K)

BAGIAN OBSTETRI & GINEKOLOGI FAKULTAS

KEDOKTERAN UNIVERSITAS HASANUDDIN
MAKASSAR
2017
 DEFINISI

Alat yang diletakkan didalam vagina berfungsi menopang organ prolaps

agar tetap berada pada tempatnya dan menghilangkan gejala akibat prolaps
selama alat tersebut dipakai.

Magali Robert, MD, Calgary AB Et Al. Technical Update On Pessary Use. J Obstet Gynaecol Can 2013;35 (7 Esuppl) : S1–S11
 TIPE PESSARIUM
• Support pessaries
• Space filling pessaries

Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence Foundation Australian.
University Of South Australia. Icahe. Juli 2012
 TIPE PESARIUM
• Support pessaries
- Ring
- Gehrung
- Shaatz
- Lever

Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence Foundation Australian.
University Of South Australia. Icahe. Juli 2012
 TIPE PESARIUM

Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence Foundation Australian.
University Of South Australia. Icahe. Juli 2012
 SUPPORT PESSARIES
• A. Ring Pessary
- Ring - Ring with support

- Incontinence ring - Incontinence ring with support

MILEX®Pessary In-Service Training. 2014 CooperSurgical.

• B. Gehrung

• C. Shaatz

MILEX®Pessary In-Service Training. 2014 CooperSurgical.

• D. Lever (Hodge, Smith, Risser)

MILEX®Pessary In-Service Training. 2014 CooperSurgical.

 TIPE PESSARIUM

Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence Foundation Australian.
Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse.
University Continence
Of South Foundation
Australia. Australian.
Icahe. Juli 2012
University Of South Australia. Icahe. Juli 2012
 SPACE FILLING PESSARIES
• A. Gelhorn C. Cube

• B. Donut D. Inflatoball

MILEX®Pessary In-Service Training. 2014 CooperSurgical.

UKURAN PESSARIUM
 INDIKASI PESARIUM

Prolaps Organ Panggul

Inkontinensia urin

Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence Foundation Australian.
University Of South Australia. Icahe. Juli 2012
 Perdarahan vagina
yang tidak
Riwayat Penyakit terdiagnosis
radang panggul
Latex sensitivity
atau alergi
Infeksi vagina
yang aktif

Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ
Prolapse. Continence Foundation Australian. University Of South Australia. Icahe.
 LANGKAH INSERSI PESSARIUM
• Diskusikan penggunaan pessarium dengan pasien

• Pemeriksaan vagina untuk menentukan derajat prolaps & estimasi ukuran

pesarium

• Lubrikasi ujung pessarium dan introitus vagina

• Masukkan pesarium secara perlahan dengan cara menjauhi urethra

• Memeriksa ekspulsi pessarium dengan meminta pasien untuk mengedan

atau batuk

• Apabila tidak terjadi ekspulsi, selipkan jari diantara pessarium dan dinding
vagina untuk memastikan pemasangan tidak terlalu ketat

Vierhout ME. The use of pessaries in vaginal prolapse. European Journal of Obstetrics and Gynecology. Nov 10 2004;117(1):4-9.
 • Minta pasien untuk berjalan selama beberapa menit
• Apabila tidak ada keluhan, minta pasien datang kontrol 2 mgg
kemudian.
• Apabila pasien mampu mengurus dirinya sendiri berikan
instruksi yang jelas dan minta pasien untuk kembali bila
mengalami rasa nyeri, kesulitan berkemih, atau kesulitan BAB
• Periksa kembali setelah 1 bulan apakah terpasang dengan baik
• Apabila pasien tidak mampu mengurus dirinya sendiri →
kontrol 3-6 bulan
• Kemudian periksa setiap tahun.

Vierhout ME. The use of pessaries in vaginal prolapse. European Journal of Obstetrics and Gynecology. Nov 10 2004;117(1):4-9.
 INSERSI & REMOVAL
RING PESSARIES

• VIDEO INSERSI & RE MOVAL RING PESSARIES

 INSERSI & REMOVAL
GELHORN PESSARIES

• VIDEO INSERSI & REMOVAL GELHORN PESSARIES

 ANALISIS DATA

K Mild vaginal discharge

o
m Konstipasi

l
Erosi
i
k Perdarahan vagina
a
s Perburukan inkointinensia urin
i

Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence Foundation Australian.
University Of South Australia. Icahe. Juli 2012
 FOLLOW UP PESSARIUM
• Tanyakan tentang keluhan

• Periksa posisi pessarium, lalu keluarkan dan cuci dengan sabun dan air

• Pemeriksaan spekulum → lecet atau erosi

• Lecet atau erosi → lepas pessarium + lokal estrogen.

• Tidak ditemukan lecet atau erosi dan pesarium intak → cuci dibawah air mengalir
dengan sabun, dikeringkan dan dimasukkan kembali.

• Pessarium yang modern umumnya terbuat dari silikon, yang membuat pesarium
tersebut tidak menimbulkan alergi dan dapat di autoklaf.

• Keputihan yang ringan dan berbau dapat diobati dengan vaginal acidifiers.

• Jika didapatkan adanya kontraindikasi estrogen, maka gel berbahan dasar air dapat
digunakan.
Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence Foundation Australian.
University Of South Australia. Icahe. Juli 2012
 REFERENSI
1. Tsikouras P, Dafopoulos A, Vrachnis N, Et Al. Uterine Prolapse In Pregnancy: Risk Factors,
Complications And Management. Journal Of Maternal-Fetal And Neonatal Medicine. Jul 09 2013:1-6.
2. Panduan Penatalaksanaan Prolaps Organ Panggul. Himpunan Uroginekologi – POGI. 2013
3. Magali Robert, MD, Calgary AB Et Al. Technical Update On Pessary Use. J Obstet Gynaecol Can 2013;35
(7 Esuppl) : S1–S11
4. Guidelines For The Use Of Support Pessaries In The Management Of Pelvic Organ Prolapse. Continence
Foundation Australian. University Of South Australia. Icahe. Juli 2012.
5. Anthony J. Viera, LT, MC, USNR. Practical Use of the Pessary. Am Fam
Physician. 2000 May 1;61(9):2719-2726.
6. Sheetle M Shah Æ Abdul H Sultan Æ Ranee Thakar. The history and evolution of pessaries for pelvic organ
prolapse. Int Urogynecol J (2006) 17: 170–175.
7. Prawirohardjo, Sarwonon. 2011. Ilmu Kandungan Edisi Ketiga. Jakarta : PT Bina Pustaka.
8. Catherine S. Bradley, M.D., M.S.C.E., Cystocele. National Kidney and Urologic Diseases Information
Clearinghouse. www.urologic.niddk.nih.gov.
9. Continence Pessaries for Urinary Incontinence. The Canadian Continence Foundation
10. MILEX®Pessary In-Service Training. 2014 CooperSurgical.
11. Guidelines for the Use of Support Pessaries in the Management of Pelvic Organ
Prolapse.http://w3.unisa.edu.au/cahe/Resources/GuidelinesiCAHE/iCAHE Guidelines. asp or www.
continence.org.au