Tugas Dokter Muda RS Haji Surabaya

Presentasi Kehamilan Multifetal – Stase

Kehamilan
dengan BV dan
Obgyn

ISK
Oleh :
Thania Nabila 2020104011075
Winny Rizkita Dewi Ramadhani 202210401011067

Pembimbing :
dr. Retina Indanwati, Sp.OG

KSM OBSTETRI DAN GINEKOLOGI

RSUD HAJI SURABAYA
FAKULTAS KEDOKTERAN MUHAMMADIYAH
MALANG
2023
DO’A MEMULAI BELAJAR
DO’A MEMULAI BELAJAR
DO’A MEMULAI BELAJAR
Bacterial Vaginosis

Vaginosis bakterial adalah sindrom klinis akibat pergantian

Lactobacillus Spp penghasil H2O2 yang merupakan flora
normal vagina dengan bakteri anaerob dalam konsentrasi tinggi
(seperti Bacteroides Spp, Mobiluncus Spp, Gardnerela
aaginalis, dan Mycoplasma hominis)
FAKTOR RESIKO
01 02
Douching Merokok
Bilas vagina …

BV
03 04
Multiple Sex Streptococcus
Despite being red, Mars
…
is a cold place
EPIDEMIOLOGI
25%
Poisoned water
Neptune is the farthest
planet from the Sun

45%
Poisoned food
Jupiter is a gas giant and
the biggest planet

30%
Environment
Venus has a beautiful
name but it's hot
GEJALA
Asimtomatik
01 50-75% BV
asimtomatik / bergejala
ringan

Cairan Vagina
02 Berbau amis seperti ikan
atau bau seperti amonia

Homogen, tidak
menggumpal, abu-abu
03 keputihan, tipis
DIAGNOSIS
AMSEL KRITERIA : Tiga dari empat tanda-
tanda berikut.
Homogen, putih keabu-abuan, dan
01 Cairan Vagina
melekat pada dinding vagina

02 PH Vagina >= 4,5

Ditemukan clue cells meningkat >=

03 Mikroskopis 20% dari jumlah sel epitel leukosit
normal <30/lp

Serbau amis sebelum atau setelah

05 Sekret Vagina
penambahan KOH 10 % (Wbifftest)
DIAGNOSIS
Skor Nugent,
Lebih digunakan dalam
penelitian daripada praktik
klinis untuk mendiagnosis
BV
TERAPI BV PADA KEHAMILAN
KOMPLIKASI BV
Abortus Spontan BBLR
01 02
Trimester 1 & 2 Berat Bayi Lahir Rendah

Kelahiran
Prematur 06
Bacterial 03
Korioamnionitis
Vaginosis

Ruptur Membran
Infeksi
yang Prematur 05 04 Infeksi luka pasca operasi
sesar
Bacterial infection infographics
Virus vs. bacteria
Differences between two pathogens

Viruses are not living organisms Bacteria are living organisms

Viruses live inside the host cells Bacteria live in many places

Viruses are submicroscopic Bacteria are giant compared to viruses

A viral infection is systemic Bacteria affect parts of the body

Influenza, polio, COVID-19 Pneumonia, tuberculosis, tetanus

Bacterial infection infographics
01 02
Mercury Saturn
Mercury is the closest planet to Saturn is a gas giant and has
the Sun and the smallest one in several rings. It's composed of
the entire Solar System hydrogen and helium

03 04
Venus Earth
Venus has a very beautiful name Earth is the third planet from the
but is actually terribly hot, hotter Sun and the only one that
than Mercury harbors life
Bacterial infection infographics
Prodrome
Mercury is the closest
planet to the Sun
02

01 03
Incubation Illness
Jupiter is a gas giant and Venus has a beautiful
the biggest planet name but it’s hot
Bacterial infection infographics
✓ Jupiter is a gas giant and
Yes Bacteria the biggest planet
✓ Mercury is the closest
planet to the Sun

Antibiotics

✗ Neptune is the farthest

planet from the Sun
✗ Despite being red, Mars
No Viruses is a cold place
Bacterial infection infographics
The 4 stages of infection Stage 4

Stage 3

Stage 2

Stage 1

Incubation Prodrome Illness Convalescent

Mercury is the closest Despite being red, Mars Jupiter is the biggest Earth is the third planet
planet to the Sun is a cold place planet of them all from the Sun
Bacterial infection infographics

Coccus
bacteria

01 02
Monococcus Diplococcus
Jupiter is a gas giant and Venus has a beautiful
the biggest planet name but it's hot
Bacterial infection infographics
Things with
bacteria

Money Phones
Mercury is the closest Jupiter is the biggest
planet to the Sun planet of them all

Door handles
Despite being red, Mars
is a cold place
Bacterial infection infographics
Bacteria cell

Organic
90%

Water Dry solids Inorganic

10%

80% 20%
Bacterial infection infographics
01 02
Jupiter Neptune
Jupiter is a gas giant and Neptune is the farthest
the biggest planet planet from the Sun

03 04
Mercury Mars
Mercury is the closest Despite being red, Mars
planet to the Sun is a cold place

05 06
Venus Pluto
Venus has a beautiful Pluto is considered a
name but it's hot dwarf planet
Bacterial infection infographics
Parts of the bacteria Chromosome Flagellum
Mercury is the closest planet to the Sun and the
smallest one in the entire Solar System Cytoplasm

Cell wall

Endospore
80%
Most of a bacterial cell is water Pilus
Bacterial infection infographics
Some places where bacteria live

01 02 03

Desktop Books Elevator button

Mercury is the closest Jupiter is a gas giant and Venus has a beautiful
planet to the Sun the biggest planet name but it's hot
Bacterial infection infographics
01 02
Staphylococcus Diplococcus
Jupiter is a gas giant and Neptune is the farthest
the biggest planet planet from the Sun

Main types
of bacteria

03 04
Bacillus Streptococcus
Mercury is the closest Despite being red, Mars
planet to the Sun is a cold place
Bacterial infection infographics
Mercury is the closest
Good Bifidobacteria planet to the Sun

Jupiter is a gas giant and

Escherichia the biggest planet

Venus has a beautiful

Lactobacillus name but it's hot

Campylobact Neptune is the farthest

Bad er planet from the Sun

Despite being red, Mars

Enterococcus is a cold place

Pluto is considered a
Clostridium dwarf planet
Bacterial infection infographics
Bacterial infection symptoms
General
Fever Jupiter is a gas giant and the biggest planet of them all

Chills Neptune is the farthest planet from the Sun

Fatigue Mercury is the closest planet to the Sun and the smallest one

Localized
Swelling Despite being red, Mars is a cold place full of iron oxide dust

Pain Venus has a very beautiful name but is actually a hot planet

Redness Ceres is located in the main asteroid belt

Bacterial infection infographics
Treatment

01 02 03

Antibiotics Supportive care Drainage

Mercury is the closest Jupiter is a gas giant and Venus has a beautiful
planet to the Sun the biggest planet name but it's hot
Bacterial infection infographics

Penicillin
01 Neptune is the farthest 25%
planet from the Sun

Tetracyclines
02 Despite being red, Mars 75%
is a cold place
Bacterial infection infographics
Mercury is the closest
Meningitis planet to the Sun
Neisseria meningitidis

Jupiter is a gas giant and Streptococcus

Ear infection the biggest planet pneumoniae

Venus has a beautiful Haemophilus

Pneumonia name but it's hot influenzae

Skin Neptune is the farthest

Staphylococcus aureus
infections planet from the Sun
Bacterial infection infographics
Bacterial infections
overview
01 02
Eye infections Blood infections
Jupiter is a gas giant and Mercury is the closest
the biggest planet planet to the Sun

03 04 05
Pneumonia Gastritis Skin infections
Venus has a beautiful Neptune is the farthest Despite being red, Mars
name but it's hot planet from the Sun is a cold planet
Bacterial infection infographics
● Streptococcus pneumoniae
● Neisseria meningitidis
● Haemophilus influenzae Bacterial meningitis
● Streptococcus agalactiae
● Listeria monocytogenes
● Streptococcus pneumoniae
● Staphylococcus aureus
Pneumonia ● Haemophilus influenzae
● Mycoplasma pneumoniae
● Mycobacterium tuberculosis
● Chlamydia trachomatis
● Neisseria gonorrhoeae
● Treponema pallidum Sexually transmitted diseases
● Ureaplasma urealyticum
● Haemophilus ducreyi
Bacterial infection infographics
Environment mVOCs
● Plants
● Soil

● Oral microbiome
Hardware ● Lung microbiome
Disease
● Urogenital microbiome
● Buildings ● Skin microbiome detection
● Air-conditioner ● Gut microbiome

Diet
● Meat
● Cheese Diagnosis
Bacterial infection infographics
Avoid bacterial infections

Wash your hands Wash your food Heat your food

2 60°
minute

Water only
s

Before, during and after Eliminate

Every food
you handle food microorganisms
Bacterial infection infographics
25%
Poisoned water
Neptune is the farthest
planet from the Sun

45%
Poisoned food
Jupiter is a gas giant and
the biggest planet

30%
Environment
Venus has a beautiful
name but it's hot
Bacterial infection infographics
Common types of
bacterial infection
Mercury is the closest planet to
the Sun and the smallest one in
the entire Solar System

● Oral microbiome
● Lung microbiome
● Urogenital microbiome
● Skin microbiome
60% 70% 90% 80% 60% ● Gut microbiome

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
Bacterial infection infographics
01 02
Jupiter Neptune
Jupiter is a gas giant and Neptune is the farthest
the biggest planet planet from the Sun

03 04
Mercury Mars
Mercury is the closest Despite being red, Mars
planet to the Sun is a cold place

05 06
Venus Pluto
Venus has a beautiful Pluto is considered a
name but it's hot dwarf planet

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
Bacterial infection infographics

Bacteria Both Virus

Strep throat Bronchitis Common cold
Tuberculosis Ear infection Flu
Whooping cough Sinus infection Sore throat

Antibiotics? Antibiotics? Antibiotics?

Yes Maybe No
Bacterial infection infographics
Bifidobacteria Escherichia
Jupiter is a gas giant and 01 02 Neptune is the farthest
the biggest planet planet from the Sun

Lactobacillus
06
Bacterial 03
Campylobacter
Mercury is the closest Despite being red, Mars
planet to the Sun infections is a cold place

Enterococcus Clostridium
Venus has a beautiful 05 04 Pluto is considered a
name but it's hot dwarf planet
Bacterial infection infographics
Evolution of
bacterial
infections
Mercury is the closest planet
to the Sun and the smallest
one

Mercury + 20%
Neptune + 30%
Saturn + 40%

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
Bacterial infection infographics
Bacterial vaginosis
Itchiness or redness
White or yellow discharge
Fishy smell
Vaginal bleeding after sex
Possible causes
✓ Unprotected sex
✓ Multiple sex partners
✓ New sex partners
✓ Shared sex toys
✓ Douching
✓ Smoking
✓ Intrauterine devices
Bacterial infection infographics
30% Blood infection 10%
Sepsis Osteomyelitis
Mercury is the closest Despite being red, Mars
planet to the Sun is a cold place

20% 40%
Candida Bacteraemia
Earth is the third planet Saturn is a gas giant
from the Sun with several rings
Infeksi Saluran Kemih
 DEFINISI
Infeksi tersering yang dialami
wanita (50-60%) yang

Infeksi Saluran disebabkan oleh perubahan

fungsi atau struktur saluran

Kemih / ISK kemih yang dapat

menyebabkan komplikasi
(Kelahiran Prematur dan
BBLR) dan penularan vertikal
dari ibu ke janin

DefinisiBono MJ, Reygaert WC. Urinary Tract Infection. [Updated 2021 Jun
23]. In: StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2021
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470195/
 1. Bakteri gram positif (E. coli)
2. Bakteri gram negatif (K.
pneumoniae, Proteus mirabilis)

ETIOLOGI 3. Streptococcus B
4. Chlamydia, Candida albicans

Bono MJ, Reygaert WC. Urinary Tract Infection. [Updated 2021 Jun 23]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470195
Perubahan Fungsi Saluran Kemih
pada Saat Kehamilan
 KLASIFIKASI

-Paling sering terjadi

-Bakteriuria (>100.000/mL) tanpa adanya
gejala infeksi saluran kemih akut

-Gejala ISK
- Identifikasi sedikitnya 100.000
-Bakteriuria bermakna terkait invasi
bakteri/mL
mukosa kandung kemih
-Inflamasi parenkim renal, kaliks,
dan pelvis
 Gejala Klinis ISK

Bono MJ, Reygaert WC. Urinary Tract Infection. [Updated 2021 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470195/
PENEGAK
Anamnesis
AN - Frequency, dysuria, pyrexia

DIAGNOSI
S Pemeriksaan Fisik

Nyeri flank, nyeri tekan, dan nyeri

tekan costovertebral
PENEGAK Pemeriksaan Penunjang

AN
DIAGNOSI ● Kultur Urin
● Pemeriksaan DL → Tanda

S infeksi (leukositosis)
● Dipsticktest → untuk
deteksi nitrit, leukosit,
protein, dan darah di dalam
urin.
 ISK
ISK Bawah
Bakteri Asimptomatis : 10^5
(sistitis akut)
CFU/mL
ISK Atas
(pyelonefritis)

Pireksia, nyeri daerah Frekuensi, Disuria,

pinggang, Banyak nyeri suprapubic,
leukosit dan bakteri. kultur : Hematuria
Tanda syok septik: mikroskopikdan gross
takikardi dan hipotensi,
hematuria bila sistitis
kultur: banyak leukosit
dan bakteri hemoragik
Terapi Spesifik Bakteriuria Asimptomatik
E. Coli
● Fosfomycin trometamol (3g
dosis tunggal)
● Nitrofurantoin 100 mg 2x1 7
hari
● Amoksiklav 625 mg 3x1 5 hari
(<20 minggu kehamilan)
● Trimetropin 300 mg 5 hari
(hindari pada trimester 1 dan
defisiensi folat)
Gram Negatif
● Norfloxacin 400 mg 2x1
5 hari
● Ulangi pemeriksaan
midstream urin 48 jam
setelah terapi komplit
PNPK Infeksi saluran kemih pada
kehamilan, 2015
Strep group B
● Penisilin V 500 mg 2x1 5
hari
● Benzylpenisilin IV 3 gram
(profilaksis saat inpartu)
● Linomycin 600 mg IV
setiap 8 jam
● Azithromycin 500 IV
(alergi penisilin)
 Terapi Sistitis Akut
- Analgetik ringan
Menurunkan gejala nyeri
- Antibiotik

•Fosfomycin trometamol (3g dosis tunggal)

•Cefalexin 500 mg 2x1, 7 hari
•Nitrofurantoin 50 mg oral 4x1 7 hari atau 100 mg 2x1, 7 hari
•Amoksiklav 625 mg 3x1, 5-7 hari (kehamilan <20 minggu)
PNPK Infeksi saluran kemih pada kehamilan, 2015
 Terapi Pielonefritis

● MRS
● Rawat jalan dan anti mikroba oral hanya untuk gejala minimal
● Antibiotik : Ceftriaxone 1 g IV 1x1 2 hari tidak demam à Cefalexin 500 mg 4x1 10 hari
● Hipotensi à (+) Gentamicin 5 mg/kgBB 1x1 3 hari iv
● Trimester 2/3 à Ceftriaxone 2 g IV, Clindamycin 900 mg 3x1 IV ATAU Vancomycin 1 g
2x1 IV DAN Gentamicin 5mg/kgBB 1x1 iv

Clinical Practice Guideline Management of Urinary Tract Infections in Pregnancy. (2015). Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and the
Clinical Strategy and Programmes Division, Health Service Executive
KOMPLIKASI :

1. ARDS
2. KONTRAKSI UTERUS
3. SEPSIS
BV DAN ISK DALAM KEISLAMAN
 Syariat Islam mengajarkan prinsip-prinsip kesehatan, kebersihan dan
kesucian lahir batin. Sebagai contohnya, sistem kesehatan dalam Islam
tercermin dalam ajaran syariat yang mewajibkan para pemeluknya untuk
senantiasa membersihkandirinya dari berbagai kotoran (najis) serta
ketidaksucian (hadas), dengan sebuah paket ibadah seperti wudhu, mandi,
shalat danlain sebagainya
"Dari Rasulullah Shallallahu 'alaihi wa sallam: Sesungguhnya Allah SWT itu suci yang
menyukai hal-hal yang suci, Dia Maha Bersih yang menyukai kebersihan, Dia Maha Mulia
yang menyukai kemuliaan, Dia Maha Indah yang menyukai keindahan, karena itu
bersihkanlah tempat-tempatmu." (HR. Tirmizi).

"Bersuci (thaharah) itu setengah daripada iman." (HR. Ahmad, Muslim, dan Tirmidzi)
Terimakasih