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PROSIDENSIA UTERI

Oleh :
Hanantyo Iqbal Diandaru
30101306960
Pembimbing :
dr. H. Gunawan Kuswondo, Sp. OG
Identitas Pasien
• Nama Pasien : Ny. S
• Umur : 68 tahun
• No. CM : 132.50.49
• Agama : Islam
• Pendidikan : SD
• Pekerjaan : Ibu Rumah Tangga
• Alamat : Purworejo RT02/RW04 Sayung Demak
• Status penikahan : Menikah
• Nama suami : Tn. H
• Tanggal Masuk : 26 November 2018
• Dirawat di Bangsal : Baitun Nisa II
Anamnesis
Keluhan Utama
Benjolan yang terasa nyeri pada jalan lahir
Riwayat penyakit sekarang
Pasien datang ke poli obsgyn RSI Sultan Agung dengan keluhan keluar benjolan
dari jalan lahir sejak 2 bulan SMRS, benjolan tersebut terasa nyeri dan mengganggu
aktivitas pasien, benjolan tidak dapat masuk sendiri, namun pasien masih bisa
memasukkan benjolan tersebut apabila pasien berbaring. Pasien mengaku pernah
terjatuh 2 tahun yang lalu dengan posisi terduduk dan semenjak itu pasien
merasakan ada benjolan yang keluar dari jalan lahir namun dapat masuk sendiri bila
pasien berbaring. Saat itu pasien belum merasakan nyeri dan aktivitas pasien tidak te
rganggu sehingga pasien tidak memeriksakan diri ke dokter. Pasien mengaku susah
BAB, BAK masih normal.
Riwayat menstruasi
• Menarche umur 14 tahun
• Siklus teratur
• Lamanya haid 4 sampai 5 hari
• Pasien sudah menopause sejak 13 tahun yang lalu
• Riwayat KB IUD
Riwayat Riwayat Riwayat
Riwayat sosial
penyakit penyakit
pernikahan ekonomi
dahulu keluarga

Pasien menderita Ayah pasien menderita


Pasien menikah yang Pasien berkerja sebagai ibu rumah
hipertensi dan DM hipertensi dan DM
pertama kali dengan tangga, suami berkerja sebagai pe
suami sekarang ± 45 tani. Biaya mondok menggunakan
tahun. asuransi BPJS non PBI
Riwayat obstetri (P6A0)

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Presentation
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Pemeriksaan fisik
Status present

Keadaan Umum
01 Baik

Kesadaran
02 Compos Mentis

Vital sign
o Tensi : 170/90 mmHg
03 o Nadi : 88 x/menit
o Suhu : 36,5o C (axilla)
o RR : 20 x/menit
Status gizi
04 o BB : 49 kg
o TB : 150 cm
Status internus

o Kepala : Mesocephale, simetris. 01


o Rambut : tidak mudah rontok
o Mata : Conjungtiva anemi (-/-), sclera ikterik
o Hidung : Discharge (-), septum deviasi (-), nafas cuping hidung (-)
o Telinga : Discharge (-) 02
o Mulut : Bibir sianosis (-), kering (-), gusi berdarah (-)
o Tenggorokan: Faring hiperemis (-), pembesaran tonsil (-)
o Leher : Pembesaran tyroid (-), pembesaran limfe (-)
o Kulit : turgor baik, ptekiae (-)

4
Paru Jantung Abdomen Ekstremitas
• Inspeksi : pergerakan • Inspeksi : perut tampak
• Inspeksi : ictus cordis
kedua hemithorax datar, striae gravidarum (-),
tidak tampak
simetris linea nigra (-), bekas opera-
• Palpasi : ictus cordis
• Palpasi : stemfremitus si (-)
teraba ICS 5, 2 cm ke
dextra sinistra sama • Auskultasi : bising usus (+)
arah medial, linea
• Perkusi : sonor pada • Perkusi : tympani
midclavicularis sinistra
seluruh lapang paru • Palpasi : nyeri tekan (-)
• Perkusi : batas
• Auskultasi : suara tambah
jantung dalam batas
-an paru (-)
normal
• Auskultasi : suara tam-
bahan (-)
Status ginekologi

Inspeksi
Tampak massa uterus keluar seluruhnya dari introitus
vagina, bentuk bulat, warna merah muda dan tidak
ada darah

Palpasi
Teraba massa ukuran 10cm x 5cm x 3cm, konsistensi
kenyal, nyeri tekan (-)

Inspekulo
Tidak dilakukan

Vaginal toucher
Tidak dilakukan
Pemeriksaan penunjang
Hematologi
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Resume
Pasien datang ke poli obsgyn RSI Sultan Agung dengan keluhan keluar benjolan dari jalan lahir sejak 2 bulan
SMRS, benjolan tersebut terasa nyeri dan mengganggu aktivitas pasien, benjolan tidak dapat masuk sendiri, namun
pasien masih bisa memasukkan benjolan tersebut apabila pasien berbaring. Pasien mengaku pernah terjatuh 2 tahun
yang lalu dengan posisi terduduk dan semenjak itu pasien merasakan ada benjolan yang keluar dari jalan lahir
namun dapat masuk sendiri bila pasien berbaring. Saat itu pasien belum merasakan nyeri dan aktivitas pasien tidak
terganggu sehingga pasien tidak memeriksakan diri ke dokter. Pasien mengaku susah BAB, BAK masih normal.
Pasien memiliki riwayat hipertensi dan DM. Ayah pasien memiliki riwayat hipertensi. Pasien berobat menggu
nakan BPJS non PBI.
Status Ginekologis dari inspeksi tampak massa uterus keluar seluruhnya dari introitus vagina, bentuk bulat,
warna merah muda dan tidak ada darah, teraba massa ukuran 10 cm x 2cm x 3cm,konsistensi kenyal, nyeri tekan
(-) , inspekulo dan VT tidak dilakukan. Pemeriksaan laboratorium dalam batas normal.
Diagnosis
Prosidensia uteri
Tindakan

1 2 3 4 5

Rawat inap Pengawasan Pro kolporaphy Terapi Cek Hb post operasi


Keadaan umum posterior dan medikamentosa
Tanda vital perinioraphy Premedikasi :
Ceftriaxone 1 gr IV
Post operasi :
Infus RL 20 tpm
Ceftriaxone 2 x 1 gr
Kalnex 3 x 1 tab
Fermia 1 x 1 tab
Tampon vagina dengan
betadine
Edukasi

Rawat luka
01

Personal hygiene
02

Jangan pijat perut


03

Konsumsi makanan mengandung serat


04
Follow up

28/11/18 29/11/18

Tidak ada
Nyeri keluhan

KU : baik KU : baik

TD : 154/57 TD : 130/80

HR : 80 HR : 80

RR : 20 RR : 20

S: 36 S : 36,3
Tinjauan Pustaka
Definisi
Prolaps uteri adalah turunnya uterus kedalam introitus vagina yang diakibatkan oleh
kegagalan atau kelemahan dari ligamentum dan jaringan penyokong (fasia).
Klasifikasi Friedman dan Little ( 1961 )

01 Prolapsus uteri tingkat I, dimana serviks uteri turun


sampai introitus vagina

Prolapsus uteri tingkat II, dimana serviks menonjol


02 keluar dari introitus vagina

Prolapsus uteri tingkat III, seluruh uterus keluar dari


03 vagina; prolapsus ini juga disebut prosidensia uteri.
Faktor risiko

1 2 3 4 5

Multiparitas Usia Penyakit jaringan ikat Ras Peningkatan tekanan


Persalinan pervaginam adalah yang Peningkatan insiden mungkin Sepertiga dari wanita deng Meskipun perbedaan kan intraabdomen
paling sering dikutip sebagai faktor akibat dari penuaan fisiologis an sindrom Marfan dan tig dungan kolagen telah dib
risiko untuk prolaps uteri. dan proses degeneratif serta a perempat dari wanita de Kondisi ini dapat sebabk
uktikan antara ras, perbe
hipoestrogenisme.
ngan sindrom Ehlers-Danl an oleh obesitas, sembeli
daan ras di tulang pangg
os melaporkan riwayat prol t kronis, batuk kronis, da
ul juga mungkin memain
aps organ pevis. n angkat berat berulang-
kan peran.
ulang.
Patofisiologi
Uterine Prolaps terjadi ketika otot-otot dasar panggul dan ligamen
meregang menjadi rusak dan lemah, sehingga mereka tidak lagi
dapat mendukung organ-organ panggul, memungkinkan uterus jatu
h ke dalam vagina. Penyokong utama viseral panggul terdiri atas
kompleks otot levator ani dan jaringan ikat pelekat organ-organ
panggul (fasia endopelvic). Kerusakan atau disfungsi dari satu atau
kedua komponen ini dapat menyebabkan terjadinya prolaps.
Anamnesis
• Rasa berat pada atau rasa tertekan pada pelvis.
• Pada saat duduk pasien meraskan ada benjolan seperti ada bola
atau kadang-kadang keluar dari vagina.
• Nyeri pada pelvis, abdomen, atau pinggang.
• Nyeri pada saat berhubungan.
Pemeriksaan fisik
Pemeriksaan ginekologi biasanya mudah dilakukan,
Friedman dan Little menganjurkan sebagai berikut; Penderita
dalam posisi jongkok disuruh mengejan dan ditentukan dengan
pemeriksaan dengan jari, apakah portio uteri pada posisi normal a
tau portio telah sampai introitus vagina, atau apakah serviks uteri
sudah keluar dari vagina.
Pemeriksaan penunjang
• Pemeriksaan laboraturium
• Pemeriksaan USG
Penatalaksanaan
• Observasi
• Konservatif
• Latihan otot dasar panggul
• Pemasangan pessarium
• Bedah
• Ventrofiksasi
• Operasi manchester
• Histerektomi vagina
• Kolporafi
• Kolpokleisis
Komplikasi
• Kreatinisasi mukosa vagina dan portio uteri.
Prosidensia uteri disertai dengan keluarnya dinding vagina (inversio); karena itu mukosa v
agina dan serviks uteri menjadi tebal serta berkerut, dan berwarna keputih-putihan.
• Dekubitus.
Jika serviks uteri terus keluar dari vagina, ujungnya bergeser dengan paha dan pakaian d
alam; hal itu dapat menyebabkan luka dan radang, dan lambat laun timbul ulkus dekubitus
. Dalam keadaan demikian, perlu dipikirkan kemungkinan karsinoma, lebih-lebih pada pen
derita berusia lanjur.
• Hipertrofi serviks uteri dan elangasio kolli.
Jika serviks uteri turun ke dalam vagina sedangkan jaringan penahan dan penyokong uter
us masih kuat, karena tarikan ke bawah di bagian uterus yang turun serta pembendungan
pembuluh darah, serviks uteri mengalami hipertrofi dan menjadi panjang pula. Hal yang te
rakhir ini dinamakan elongasio kolli.
• Kemandulan.
Karena serviks uteri turun sampai dekat pada introitus vaginae atau sama sekali keluar da
ri vagina, tidak mudah terjadi kehamilan.
Terima kasih
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