FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN

KEJADIAN PROLAPSUS UTERI DI RSUP Dr. KARIADI

SEMARANG

LAPORAN HASIL
KARYA TULIS ILMIAH

Disusun untuk memenuhi sebagian persyaratan guna mencapai gelar sarjana

strata-1 pendidikan dokter

BAIQ CIPTA HARDIANTI

22010111140197

PROGRAM PENDIDIKAN SARJANA KEDOKTERAN

FAKULTAS KEDOKTERAN
UNIVERSITAS DIPONEGORO
2015

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 KATA PENGANTAR

Puji syukur saya panjatkan kehadirat Allah SWT, karena atas berkat dan
rahmat-Nya kami dapat menyelesaikan tugas Karya Tulis Ilmiah ini. Penulisan
Karya Tulis Ilmiah ini dilakukan dalam rangka memenuhi salah satu syarat untuk
mencapai gelar Sarjana Kedokteran di Fakultas Kedokteran Universitas
Diponegoro. Kami menyadari sangatlah sulit bagi kami untuk menyelesaikan
Karya Tulis Ilmiah ini tanpa bantuan dan bimbingan dari berbagai pihak sejak
penyusunan proposal sampai dengan terselesaikannya laporan hasil Karya Tulis
Ilmiah ini. Bersama ini kami menyampaikan terima kasih yang sebesar-besarnya
serta penghargaan yang setinggi-tingginya kepada:
1. Rektor Universitas Diponegoro Semarang yang telah memberi kesempatan
kepada kami untuk menimba ilmu di Universitas Diponegoro.
2. Dekan Fakultas Kedokteran UNDIP yang telah memberikan sarana dan
prasarana kepada kami sehingga kami dapat menyelesaikan tugas ini dengan
baik dan lancar.
3. dr. M. Besari Adi Pramono, Msi.Med, Sp.OG (K) selaku dosen pembimbing
yang telah menyediakan waktu, tenaga dan pikiran untuk membimbing kami
dalam penyusunan Karya Tulis Ilmiah ini.
4. Orang tua dan keluarga kami yang senantiasa memberikan semangat dan
dukungan moral maupun material.
5. Para sahabat dan teman sejawat yang selalu memberi semangat dan dukungan
dalam menyelesaikan Karya Tulis Ilmiah ini dalam suka dan duka.
6. Serta pihak lain yang tidak mungkin kami sebutkan satu-persatu atas
bantuannya secara langsung maupun tidak langsung sehingga Karya Tulis ini
dapat terselesaikan dengan baik.

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 Akhir kata, penulis berharap Allah SWT berkenan membalas segala kebaikan
semua pihak yang telah membantu. Semoga Karya Tulis Ilmiah ini dapat
bermanfaat bagi kita semua.

Semarang, 26 Juni 2015

Baiq Cipta Hardianti

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 DAFTAR ISI

HALAMAN JUDUL ............................................................................................ i

LEMBAR PENGESAHAN ................................................................................ ii

PERNYATAAN KEASLIAN PENELITIAN .................................................... iii

KATA PENGANTAR ....................................................................................... iv

DAFTAR ISI ...................................................................................................... vi

DAFTAR TABEL ............................................................................................... x

DAFTAR GAMBAR ......................................................................................... xi

DAFTAR SINGKATAN .................................................................................. xii

DAFTAR LAMPIRAN .................................................................................... xiii

ABSTRAK ...................................................................................................... xiv

ABSTRACT ..................................................................................................... xv

BAB I PENDAHULUAN ................................................................................... 1

1.1 Latar belakang ............................................................................................... 1

1.2 Masalah penelitian ........................................................................................ 3

1.3 Tujuan penelitian ........................................................................................... 3

1.3.1 Tujuan umum ........................................................................................ 3

1.3.2 Tujuan khusus ........................................................................................ 4

1.4 Manfaat penelitian ......................................................................................... 4

1.4.1 Manfaat pelayanan ................................................................................ 4

1.4.2 Manfaat keilmuan .................................................................................. 4

1.4.3 Manfaat penelitian ................................................................................. 4

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1.5 Keaslian penelitian ........................................................................................ 5

BAB II TINJAUAN PUSTAKA ......................................................................... 7

2.1 Prolapsus uteri ............................................................................................... 7

2.1.1 Definisi ................................................................................................... 7

2.1.2 Epidemiologi ......................................................................................... 7

2.1.3 Anatomi dan fisiologi genitalia wanita ................................................. 8

2.1.3.1 Anatomi dan fisiologi uterus ......................................................... 8

2.1.3.2 Anatomi dan fisiologi dasar panggul ........................................... 10

2.1.4 Faktor risiko ........................................................................................ 12

2.1.5 Patofisiologi ........................................................................................ 18

2.1.6 Diagnosis .............................................................................................. 20

2.1.6.1 Anamnesis ..................................................................................... 20

2.1.6.2 Pemeriksaan fisik .......................................................................... 21

2.1.6.3 Pemeriksaan penunjang ................................................................ 22

2.1.7 Klasifikasi ............................................................................................ 23

2.1.8 Penatalaksanaan ................................................................................... 25

2.1.8.1 Observasi ...................................................................................... 25

2.1.8.2 Konservatif .................................................................................. 26

2.1.8.3 Operatif ........................................................................................ 27

BAB III KERANGKA TEORI, KERANGKA KONSEP DAN HIPOTESIS ... 30

3.1 Kerangka teori ............................................................................................. 30

3.2 Kerangka konsep ......................................................................................... 31

3.2 Hipotesis ...................................................................................................... 32

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BAB IV METODE PENELITIAN ................................................................... 33

4.1 Ruang lingkup penelitian ............................................................................ 33

4.2 Tempat dan waktu penelitian ...................................................................... 33

4.2.1 Tempat penelitian ................................................................................ 33

4.2.2 Waktu penelitian .................................................................................. 33

4.3 Jenis dan rancangan penelitian .................................................................... 33

4.4 Populasi dan sampel .................................................................................... 34

4.4.1 Populasi target ...................................................................................... 34

4.4.2 Populasi terjangkau ............................................................................. 34

4.4.3 Sampel ................................................................................................. 34

4.4.3.1 Kriteria inklusi ............................................................................. 34

4.4.3.2 Kriteria eksklusi ............................................................................ 34

4.4.4 Cara sampling ........................................................................................ 34

4.4.5 Besar sampel ......................................................................................... 35

4.5 Variabel penelitian ...................................................................................... 35

4.5.1 Variabel bebas ...................................................................................... 35

4.5.2 Variabel terikat .................................................................................... 35

4.6 Definisi operasional ..................................................................................... 35

4.7 Cara pengumpulan data ............................................................................... 36

4.7.1 Bahan ................................................................................................... 36

4.7.2 Jenis data ............................................................................................. 37

4.7.3 Cara kerja ............................................................................................ 37

4.8 Alur penelitian ............................................................................................. 38

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4.9 Pengolahan dan analisis data ....................................................................... 38

4.9.1 Pengolahan data ................................................................................... 38

4.9.2 Analisa data ......................................................................................... 39

4.10 Etika penelitian .......................................................................................... 39

4.11 Jadwal penelitian ....................................................................................... 40

BAB V HASIL PENELITIAN ......................................................................... 41

5.1 Analisis sampel ........................................................................................... 41

5.2 Karakteristik pasien prolapsus uteri ............................................................ 42

5.3 Analisis uji bivariat ..................................................................................... 45

5.4 Analisis multivariat ..................................................................................... 47

BAB VI PEMBAHASAN ................................................................................. 49

6.1 Pembahasan hasil penelitian ....................................................................... 49

6.2 Keterbatasan penelitian ............................................................................... 54

BAB VII KESIMPULAN DAN SARAN ......................................................... 55

7.1 Simpulan ..................................................................................................... 55

7.2 Saran ............................................................................................................ 55

DAFTAR PUSTAKA ....................................................................................... 56

LAMPIRAN ...................................................................................................... 63

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 DAFTAR TABEL

Tabel 1. Keaslian penelitian ................................................................................... 5

Tabel 2. Faktor risiko prolapsus ........................................................................... 13

Tabel 3. Derajat prolapsus organ panggul............................................................. 24

Tabel 4. Klasifikasi prolapsus uteri ....................................................................... 25

Tabel 5. Tipe, mekanisme kerja, dan indikasi pesarium ....................................... 27

Tabel 6. Definisi operasional ................................................................................ 35

Tabel 7. Jadwal penelitian ..................................................................................... 40

Tabel 8. Karakteristik pasien prolapsus uteri ........................................................ 42

Tabel 9. Hasil analisis bivariat .............................................................................. 45

Tabel 10. Hasil analisis multivariat....................................................................... 48

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 DAFTAR GAMBAR

Gambar 1. Anatomi genitalia interna wanita .......................................................... 9

Gambar 2. Hubungan axis uterus, serviks, dan vagina ......................................... 10

Gambar 3. Tingkatan pendukung organ panggul .................................................. 12

Gambar 4. Patofisiologi prolapsus ....................................................................... 19

Gambar 5. Poin dan landmark untuk sistem POP-Q ............................................. 24

Gambar 6. Derajat prolapsus uteri ........................................................................ 25

Gambar 7. Kerangka teori ..................................................................................... 30

Gambar 8. Kerangka konsep ................................................................................. 31

Gambar 9. Alur penelitian ..................................................................................... 38

Gambar 10. Jumlah pasien prolapsus uteri .......................................................... 41

Gambar 11. Derajat prolapsus uteri ...................................................................... 44

Gambar 12. Tindakan pada pasien prolapsus uteri ............................................... 44

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 DAFTAR SINGKATAN

BMI : Body Mass Index

IMT : Indeks Massa Tubuh

POP : Prolapsus Organ Panggul

POP-Q : Pelvic Organ Prolapse Quantification

TVL : Total Vaginal Length

WHI : Women’s Health Initiative

WHO : World Health Organization

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 DAFTAR LAMPIRAN

Lampiran 1. Ethical Clearance

Lampiran 2. Surat Ijin Penelitian

Lampiran 3. Output SPSS

Lampiran 4. Identitas Peneliti

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 ABSTRAK

Latar belakang : Prolaps uteri merupakan salah satu bentuk prolaps organ
panggul dan menempati urutan kedua tersering setelah cystourethrocele.
Prevalensi prolaps organ panggul adalah 41-50% pada wanita yang berusia di atas
40 tahun dan akan meningkat seiring dengan bertambahnya usia harapan hidup.
Walaupun prolaps uteri jarang menimbulkan mortalitas dan morbiditas yang berat,
tetapi dapat mempengaruhi kualitas hidup wanita. Etiologi prolaps belum
diketahui secara pasti, namun terdapat beberapa faktor yang dianggap sebagai
penyebab terjadinya.
Tujuan : Mengetahui angka kejadian prolaps uteri, karakteristik pasien prolaps
uteri dan faktor-faktor yang berhubungan dengan kejadian prolaps uteri di RSUP
Dr. Kariadi Semarang.
Metode : Penelitian observasional analitik dengan desain cross sectional
menggunakan data catatan medik pasien prolaps uteri di RSUP Dr. Kariadi
Semarang, selama tahun 2013 hingga 2014. Pengambilan sampel dilakukan
dengan cara consecutive sampling dan didapatkan 56 data rekam medis pasien
prolaps uteri yang memenuhi kriteria inklusi. Analisis deskriptif ditampilkan
dalam bentuk tabel distribusi frekuensi dan persen, sedangkan analisis analitik
menggunakan uji Chi-square dan uji regresi logistik.
Hasil : Terdapat 56 kasus prolaps uteri selama tahun 2013-2014. Sebagian besar
pasien prolaps uteri berusia ≥ 50 tahun (80,4%), multipara (82,1%), sudah
menopause (83,9%) dan BMI < 25 kg/m2 (51,8%). Berdasarkan uji Chi-square
didapatkan hubungan yang bermakna antara paritas, usia dan menopause dengan
kejadian prolaps uteri (p=0,000) sedangkan BMI tidak ada hubungan yang
bermakna dengan kejadian prolaps uteri (p=0,643). Hasil akhir dengan analisis
multivariat uji regresi logistik didapatkan faktor usia paling berpengaruh terhadap
kejadian prolaps uteri (p=0,000) dan OR= 102,5 (10,3 – 1020,058, IK 95%).
Simpulan : Ada hubungan antara paritas, usia dan menopause dengan kejadian
prolaps uteri dan usia adalah faktor yang paling berhubungan dengan kejadian
prolaps uteri.

Kata kunci : prolaps uteri, paritas, usia, menopause, BMI

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 ABSTRACT

Background: Uterine prolapse is a form of pelvic organ prolapse and ranks the
second most common after cystourethrocele. The prevalence of pelvic organ
prolapse is 41-50% in women aged over 40 years old and will increase in line
with life expectancy increase. Although uterine prolapse rarely cause mortality
and severe morbidity, but it can affect women’s quality of life. Prolapse etiology
has not known certainly, but there are several factors that are considered as the
cause.
Objective: To determine the incidence of uterine prolapse, uterine prolapse
patient characteristics and factors related to the incidence of uterine prolapse in
Dr. Kariadi Hospital Semarang.
Methods: An analytic observational study with cross-sectional design used
medical records of uterine prolapse patients in Dr. Kariadi Hospital, during the
years 2013 to 2014. Sampling was done by consecutive sampling and 56 medical
records of uterine prolapse patients who met the inclusion criteria were obtained.
Descriptive analysis was shown in the form of frequency and percentage
distribution table, while the analytic analysis used Chi-square test and logistic
regression.
Results: There were 56 cases of uterine prolapse during the years 2013 to 2014.
Most uterine prolapse patients aged over 50 years old (80.4%), multiparous
(82.1%), post-menopausal (83.9%) and BMI < 25 kg/m2 (51.8%). Based on Chi-
square test, there was a significant association between parity, age and
menopause with uterine prolapse incidence (p = 0.000) however there was no
significant association between BMI with uterine prolapse incidence (p = 0.643).
The final result using multivariate logistic regression analysis found that age was
the most influential factor on the incidence of uterine prolapse (p = 0.000) and
OR = 102.5 (10.3-1020.058, CI 95%).
Conclusions: There was association between parity, age and menopause with
uterine prolapse incidence and age was the factors most associated with uterine
prolapse incidence.

Key words: uterine prolapse, parity, age, menopause, BMI

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