Dhanaer

KASUS:

Seorang wanita P0A0, 19 th, datang dengan keluhan perdarahan dari jalan lahir 25hr. Metroragia (-), menoraghia (+), dismenorhea() Pemeriksaan fisik dalam batas normal. Menarke usia 12 tahun, riwayat menstruasi sebelumnya teratur.

Anovulatory or dysfunctional uterine bleeding describes the spectrum of abnormal menstrual bleeding pattern that occur in anovulatory women who have no medical ilness or pelvic pathology. (Sperrof, 2011) Menstruate more often than every 24 days or less often than every 35 days deserve evaluation as do those who consistently flow more than 7 days and women with monthly menstrual blood exeeding 80 mL

Perdarahan Uterus Abnormal >Gangguan menstruasi berupa frekwensi, Lamanya, jumlahnya pada wanita usia reproduksi >Menstruasi normal : Frekwensi : 21-35 hari Waktu : 3-7 hari Volume : 30 80 cc

Gambaran klinis : -Polymenorrhea : Frekwensi menstruasi(<24hari),

interval teratur -Menoraghia : Menstruasi dg Jumlah darah >80cc dan waktu yang lama, interval teratur -Metrorragia : Menstruasi dg Jumlah darah >80cc dan waktu yang lama, interval tdk teratur, > 7 hari. -Menometroragia : Menstruasi dg Jumlah darah >80cc dan waktu yang lama, biasanya timbul flek2 antara 2 siklus menstruasi -Hypomenorrhe : menstruasi dg jumlah yang sedikit < 30 cc -Oligomenorrhea : Frekwensi menstruasi (>35hari)

PUD

Perdarahan akut dan banyak

Perdarahan ireguler

Menorragia

Panduan tata laksana PUD, HIFERI POGI, 2007

Pola Perdarahan No
1 2

Definisi
Normal Perdarahan akut dan banyak Perdarahan ireguler

Deskripsi
Interval antara 26-35 hari, lamanya 2-7 hari. Jumlah perdarahan < 1 pembalut per 3 jam Jumlah perdarahan > I pembalut per jam atau

bila dijumpai gangguan hemodinamik

Termasuk metrorragia, menometrorragia, oligomenorrea, intermenstrual bleeding atau perdarahan tidak teratur lainnya Perdarahan banyak dan reguler (jumlahnya > 80 cc atau lebih dari 7 hari)

Menorragia

Elly JW et al. J Am Board Fam Med 2006 ; 19 : 590602

Pemeriksaan awal
Keluhan dan gejala
Nyeri pelvik Mual, peningkatan frekuensi berkemih Peningkatan berat badan, fatigue, gangguan toleransi terhadap dingin Penurunan berat badan, banyak keringat, palpitasi Riwayat konsumsi obat antikoagulan Gangguan pembekuan darah Riwayat hepatitis, ikterik Hirsutisme, akne, akantosis nigricans, obesitas Perdarahan pasca koitus Galaktorea, sakit kepala, gangguan lapang pandang

Masalah
Abortus, kehamilan ektopik Kehamilan Hipotiroid Hipertiroid Koagulopati Penyakit hati Sindrom ovarium polikistik (SOPK) Displasia serviks, polip endoserviks Tumor hipofisis

Panduan tata laksana PUD, HIFERI POGI, 2007

Intermenstrual interval (days, regularty) Volume (heavy, light, or variable) Duration (normal or prolonged, consistent or variable) Onset of abnormal menses Temporal associated (post coital, post partum) Associated symtoms Underlying systemic ilnes Medication

Sperrof, 2011

Primer

Sekunder

Tersier Prolaktin Tiroid (TSH, FT4) DHEAS, Testosteron Hemostasis (PT, aPTT, fibrinogen, Ddimer) USG transabdominal USG transvaginal SIS Doppler Mikrokuret / D&K Histeroskopi Endometrial sampling (hysteroscopy guided) Pap smear Kolposkopi

Laboratorium Pemeriksaan Penunjang

Hb Tes kehamilan urin

Darah lengkap Hemostasis (BT-CT, lainnya sesuai fasilitas)

USG

USG transabdominal USG transvaginal SIS

Penilaian endometrium

Mikrokuret D&K

Penilaian serviks (bila ada patologi)

IVA

Pap smear

Panduan tata laksana PUD, HIFERI POGI, 2007

Transvaginal Ultrasonography (TVS)

Recommendation A

First line tools for structural of reproductive tract

Disadvantages: may not always distinguish among submucosal fibroid, polyp, or adenomyosis

RCOG guidelines, 2007

Saline Infusion Sonography (SIS)

May be superior to TVS alone
(94.1% vs. 23.5% for detection of focal intrauterine pathology) SIS + biopsy: 96.2% sensitivity and 98% specificity Its not use a first line tools

(Recommendation A)

RCOG guidelines, 2007

Hysteroscopy
Hysteroscopy + biopsy = gold standard Recommendation B Diagnostic hysteroscopy easily performed in the office setting

although it requires skill

Disadvantage: complications (<1%) may include uterine

perforation, infections, excessive

bleeding, and those related to distending medium RCOG guidelines, 2007

Abnormal Uterine Bleeding, ABFM NovemberDecember 2006 Vol. 19 No. 6,

Abnormal Uterine Bleeding, ABFM NovemberDecember 2006 Vol. 19 No. 6,

Abnormal Uterine Bleeding, ABFM NovemberDecember 2006 Vol. 19 No. 6,

Abnormal Uterine Bleeding, ABFM NovemberDecember 2006 Vol. 19 No. 6,

Abnormal Uterine Bleeding, ABFM NovemberDecember 2006 Vol. 19 No. 6,

Abnormal Uterine Bleeding, ABFM NovemberDecember 2006 Vol. 19 No. 6,

Abnormal Uterine Bleeding, ABFM NovemberDecember 2006 Vol. 19 No. 6,