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Dr Josef Wattimury, SpOG.

Dr Josef Wattimury, SpOG.

 Kongenital  Traumatik  Infeksi  Malignansi/ Keganasan

Kongenital

Traumatik

Infeksi

Malignansi/ Keganasan

 Fibroids (myoma/leiomyoma ): These smooth, firm masses are often solitary and account for about

Fibroids (myoma/leiomyoma):

These smooth, firm masses are often solitary and account for about 3-8% of uterine

myomata.

Cervical endometriosis:

Endometriosis in the cervix is relatively

common and usually considered to be

inoffensive. This may be apparent as blue-red or blue-black lesions 1-3 mm in diameter.

 Polyps endocervical  cervical 
 Polyps endocervical  cervical 

Polyps

endocervical cervical

 Stenosis -:  Sering terjadi pasca EKSISI lesi pada serviks (paling sering menyebabkan stenosis

Stenosis -:

Sering terjadi pasca EKSISI lesi pada serviks (paling sering menyebabkan stenosis pd 1.3% kasus) Penyebab lainnya adalah pascaRADIOTERAPI, INFEKSI, dan atrofi pasca cone biopsy.

Dapat pula berhubungan dg endometriosis

Ektropion (dahulu disebut erosi serviks atau

abrasi) hal ini jika epitel di bagian sentral

meluas di sekitar ostium externum.

 Nabothian cysts (epithelial inclusion cysts/mucinous retention cysts)  Laceration :

Nabothian cysts (epithelial inclusion cysts/mucinous retention cysts) Laceration:

 Jaringan yang abnormal akan berubah menjadi putih selama 3-5 menit setelah dipulas dengan asam

Jaringan yang abnormal akan berubah menjadi putih selama 3-5 menit setelah dipulas dengan asam asetat

Mengamati perubahan warna padapermukaan

mulut rahim (serviks) dengan mata telanjang.

Menentukan apakah tes IVA pada pasien

tersebut positif atau negatif utk kemungkinan

lesi pra-kanker ataupun bahkan kanker.

.

 lendir serviks  Letak selaput lendir serviks

lendir serviks

Letak selaput lendir serviks

 Glandular epithelium  Cloumnar epithelium

Glandular epithelium

 Glandular epithelium  Cloumnar epithelium

Cloumnar epithelium

 Glandular epithelium  Cloumnar epithelium
 Tempat pemeriksaan yang tertutup  Kursi Ginekologi  Tenaga dokter pemeriksa yg profesional 

Tempat pemeriksaan yang tertutup

Kursi Ginekologi

Tenaga dokter pemeriksa yg profesional

Sumber cahaya yang memadai

vaginal speculum Sterile

Sarung tangan baru, atau HLD surgical gloves

Batang kapas besar

Cairan Asam asetat (3-5%) Asam cuka (vinegar) dan

wadah (mangkok) kecil

Wadah dg larutan chlorine 0.5%

Tempat sampah plastik dg kantong plastik di dalamnya

VIA Category Temuan Klinis Test-negative Tidak adanya lesi atau lesi asam asetat yg pucat; polyp,

VIA Category

Temuan Klinis

Test-negative

Tidak adanya lesi atau lesi asam asetat yg pucat; polyp, cervicitis, inflammation, Nabothian cysts.

Test-positive

tajam, tegas, dapat terlihat jelas,

padat (opaque/dull atau putihspt kulit kerang) area asam asetatdg atau tanpa batas yg menonjol menyentuh squamocolumnar junction (SCJ); leukoplakia dan

kutil.

Suspicious for cancer

Tukak yg nyata secara klinis, pertumbuhan spt bunga kol, tukak/ borok; perdarahan

mengalir saat disentuh.

 Daerah Asam Asetat jauh dari squamocolumnar junction (SCJ) serta tdk menyentuhnya : hasil NEGATIF.

Daerah Asam Asetat jauh dari squamocolumnar junction (SCJ) serta tdk menyentuhnya : hasil NEGATIF.

Daerah Asam Asetat menembus ke SCJ : Hasil POSITIF.

: hasil NEGATIF.  Daerah Asam Asetat menembus ke SCJ : Hasil POSITIF. Negative Photo source:

Negative

Photo source: JHPIEGO

: hasil NEGATIF.  Daerah Asam Asetat menembus ke SCJ : Hasil POSITIF. Negative Photo source:

Positive

Dugaan Kanker

Dugaan Kanker

Dugaan Kanker
 Rujuk untuk pengobatan dini.  Rujuk utk Konfirmasi diagnosis atau tes lanjutan di SpOG.

Rujuk untuk pengobatan dini.

Rujuk utk Konfirmasi diagnosis atau tes

lanjutan di SpOG.

 IVA adalah pemeriksaan yang cukup memberi harapan bagi deteksi dini yang mudah dan murah.

IVA adalah pemeriksaan yang cukup memberi harapan bagi deteksi dini yang mudah dan murah.

Perubahan warna pada permukaan selaput lendir

serviks (mulut Rahim) saat dipolesdengan asam asetat menunjukkan tanda awal perubahan ke arah keganasan.

Jenis sel pada masing2 lapisan selaput lendir

mulut rahim memberikan gambaran gradasi warna yang berbeda2.

Perubahan usia dan hormonal dapat mengubah

letak lapisan sel pd zona transisional

 ACCP. Visual screening approaches: Promising alternative screening strategies . Cervical Cancer Prevention Fact

ACCP. Visual screening approaches: Promising alternative screening

strategies. Cervical Cancer Prevention Fact Sheet. (October 2002).

ACCP & World Health Organization. Cervical cancer prevention in developing countries: A review of screening and programmatic strategies. (Forthcoming, November 2003).

Gaffikin L, Lauterbach M, Blumenthal PD. “Performance of visual

inspection with acetic acid for cervical cancer screening: A qualitative summary of evidence to date,” Obstetrical and Gynaecological Review

58(8):543-550. (August 2003).

McIntosh N, Blumenthal PD, Blouse A, eds. Cervical cancer prevention guidelines for low-resource settings. Baltimore, MD:JHPEIGO. (2001).

Riegelman RK and Hirsch RP. Studying a study and testing a test: How to read the medical Literature (2 nd Edition). Boston, MA:Little, Brown and Company. (1989).

 Pada beberapa wanita, lendir srviks berfungsi menghambat pergerakan sperma ke dalam rongga uterus. Hal

Pada beberapa wanita, lendir srviks berfungsi menghambat pergerakan sperma ke dalam

rongga uterus. Hal itu terjadi krn :

Jumlahnya terlalu sedikit utk memungkinkan sperma bergerak bebas

Lendir terlalu kental dan lengket Lendir tidak cocok dengan jenis sperma suami.

 Moderate specificity results in resources being spent on unnecessary treatment of women who are

Moderate specificity results in resources being spent on unnecessary treatment of women who are free of precancerous lesions in a single-visit approach.

No conclusive evidence regarding the health or cost implications of over-treatment, particularly in areas with high HIV prevalence.

There is a need for developing standard training methods and quality assurance measures.

Likely to be less accurate among post-menopausal women.

Rater dependent.

 Visual inspection with acetic acid (VIA) can be done with the naked eye (also

Visual inspection with acetic acid (VIA) can be

done with the naked eye (also called cervicoscopy

or direct visual inspection [DVI]), or with low magnification (also called gynoscopy, aided VI, or

VIAM).

Visual inspection with Lugol’s iodine (VILI), also known as Schiller’s test, uses Lugol’s iodine instead of acetic acid.

 Failure of fusion of the Müllerian ducts  Congenital absence or hypoplasia of the

Failure of fusion of the Müllerian ducts

Congenital absence or hypoplasia of the

cervix

In utero exposure to non-steroidal oestrogens (such as diethylstilbestrol) and other non-

steroidal oestrogens

  Sensitivity Specificity Minimum 65% 64% Maximum 96% 98% Median* 84% 82% Mean*
 

Sensitivity

Specificity

Minimum

65%

64%

Maximum

96%

98%

Median*

84%

82%

Mean*

81%

83%

* Weighted median and mean based on study sample size

Source: Adapted from Gaffikin, 2003

 Simple, easy-to-learn approach that is minimally reliant upon infrastructure.  Low start-up and sustaining

Simple, easy-to-learn approach that is minimally

reliant upon infrastructure.

Low start-up and sustaining costs.

Many types of health care providers can perform

the procedure.

Test results are available immediately.

Requires only one visit.

May be possible to integrate VIA screening into primary health care services.

 Sensitivity: The proportion of all those with disease that the test correctly identifies as

Sensitivity: The proportion of all those with

disease that the test correctly identifies as

positive.

Specificity: The proportion of all those

without disease (normal) that the test

correctly identifies as negative.