tag:blogger.com,1999:blog-11381868652859314922024-03-14T02:14:31.518-07:00OBSTETRI DIAN_HUSADAAnonymoushttp://www.blogger.com/profile/13798154464490898014noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-1138186865285931492.post-9444846609617636932014-03-04T17:06:00.001-08:002014-03-04T17:06:07.392-08:00SELAMAT DATANG<div style="text-align: center;">
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<br /></div>Anonymoushttp://www.blogger.com/profile/13798154464490898014noreply@blogger.com0tag:blogger.com,1999:blog-1138186865285931492.post-23620701826207138502014-02-06T19:26:00.003-08:002014-02-06T19:34:31.030-08:00VISI DAN MISI INDONESIA SEHAT 2010,,pastiiii sehat<h3 class="post-title entry-title" itemprop="name" style="font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 30px; font-weight: normal; margin: 0px; position: relative;">
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #bf9000; font-family: Arial, sans-serif; font-size: 16pt;">VISI
DAN MISI INDONESIA SEHAT 2010</span></b><span style="color: #bf9000; font-family: "Georgia","serif"; font-size: 23.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">VISI
INDONESIA SEHAT</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Untuk mewujudkan paradigma sehat tersebut
ditetapkan Visi,yaitu gambaran,prediksi atau harapan tentang keadaan
masyarakat indonesia pada masa yang akan datang,yaitu:Indonesia Sehat 2010.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Indonesia sehat 2010 adalah gambaran masyarakat
indonesia di masa depan yang penduduknya hidup dalam lingkungan dan
perilaku sehat,mampu menjangkau pelayanan kesehatan yang bermutu,adil,dan
merata,serta memiliki derajat kesehatan yang setinggi-tingginya.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Lingkungan sehat adalah lingkungan yang kondusif bagi
terwujudnya keadaan sehat yaitu lingkngan yang bebas dari polusi.tersedia air
bersih,sanitasi lingkungan yang memadai,perumahan dan pemukiman
sehat,perencanaan kawasan berwawasan kesehatan,dan kehidupan masyarakat saling
tolong menolong.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Perilaku sehat adalah perilaku proaktif untuk
memelihara dan meningkatkan kesehatan,mencegah resiko terjadinya
penyakit,melindungi diri dari ancaman penyakit,serta berperan aktif dalam
gerakan kesehatan masyarakat.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">MISI
INDONESIA SEHAT 2010</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">1.Memantapkan manajemen kesehatan yang dinamis dan
akuntabel</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Keberhasilan pembangunan berwawasan kesehatan tidak
semata-mata ditentukan oleh hasil kerja keras sektor kesehatan saja, tetapi
sangat dipengaruhi oleh hasil kerja keras serta kontribusi positif dari
berbagai sektor pembangunan lainnya. Departemen Kesehatan berperan sebagai
penggerak utama dan memfasilitasi sektor-sektor lain agar segala upaya
memberikan kontribusi yang positif terhadap perwujudan pembangunan nasional
berwawasan kesehatan.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Dengan terciptanya manajemen kesehatan yang akuntabel
di lingkungan Departemen Kesehatan, diharapkan fungsi-fungsi administrasi
kesehatan dapat terselenggara secara efektif dan efisien yang didukung oleh
sistem informasi, IPTEK serta hukum kesehatan. Melalui penyelenggaraan
manajemen kesehaaatan yang akuntabel dengan menerapkan tata penyelenggaraan
pemerintahan yang baik (<i>good governance</i>), diharapkan upaya pembangunan
kesehatan dapat dipertanggung jawabkan dan dipertanggung-gugatkan kepada semua
lapisan masyarakat, serta bebas dari korupsi, kolusi dan nepotisme (KKN).</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">2. Meningkatkan
Kinerja dan Mutu Upaya Kesehatan</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Peningkatan kinerja dan mutu upaya kesehatan dilakukan
oleh Departemen Kesehatan melalui pengembangan kebijakan pembangunan kesehatan,
yang meliputi kebijakan manajerial dan kebijakan teknis serta pengembangan standar
dan pedoman berbagai upaya kesehatan. Disamping itu Departemen Kesehatan juga
melakukan fasilitasi sumber daya kesehatan, baik tenaga , pembiayaan kesehatan,
sumber daya obat dan perbekalan kesehatan bagi para pelaku upaya/pembangunan
kesehatan. Dengan meningkatkan kinerja dan mutu upaya kesehatan, diharapkan
upaya kesehatan dapat terselenggara dengan baik, dapat dicapai (<i>accessible</i>),
dan dapat dijangkau ( <i>affordable </i>) oleh segenap kalangan
masyarakat, serta terjamin mutunya (<i>quality</i>). Upaya kesehatan tersebut
meliputi upaya kesehatan masyarakat dan upaya kesehatan perorangan.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">3.
Memberdayakan Masyarakat dan Daerah</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Peran aktif masyarakat termasuk swata, sangat penting
dan akan menentukan keberhasilan pembangunan kesehatan. Departemen Kesehatan
melaksanakan pemberdayaan masyarakat, sehingga masyarakat dapat berperan
sebagai subjek pembangunan kesehatan. Diharapkan masyarakat termasuk swasta
dapat berpartisipasi aktif dalam melayani ( <i>to serve</i>), melaksanakan
advokasi (<i>to advacate </i>), serta mengkritisi ( <i>to watch</i>)
pembangunan kesehatan baik secara individu, kelompok, maupun bersama masyarakat
luas. Potensi masyarakat termasuk swasta, baik berupa organisasi, upaya,tenaga,
dana, sarana, tekonologi, serta mekanisme pengambilan keputusan, merupakan aset
yang cukup besar yang perlu digalang.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Pelaksanaan desentralisasi dibidang kesehatan sedang
berproses. Untuk itu perlu adanya fasilitasi dari Departemen Kesehatan,
terutama kepada daerah-daerah yang sangat memerlukan. Fasilitasi lebih
diutamakan pada pengembangan kapasitas (<i>capacity building</i> ),
pelembagaan institusi disemua tataran, serta pengembangan sistem kesehatan
daerah, sehingga ada kesinambungan program kesehatan dari tingkat nasional
sampai daerah dan advokasi guna peningkatan sumber daya kesehatan diaerah.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">4.
Melaksanakan Pembangunan Kesehatan yang Berskala Nasional.</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Disamping berperan dalam pembinaan dan pengembangan
kesehatan, Departemen Kesehatan melakukan pula pelaksanaan pembangunan
kesehatan yang berskala nasional, seperti pelayanan kesehatan bagi penduduk
miskin, penanggulangan masalah kesehatan akibat bencana,
penanggulangan penyakit menular dan gangguan gizi, promosi kesehatan,
pembangunan kesehatan didaerah terpencil, tertinggal dan daerah perbatasan,
serta pendayagunaan tenaga kesehatan. Sesuai dengan Sistem Kesehatan Nasional,
Departemen Kesehatan melaksanakan penyelenggaraan upaya kesehatan Strata III
sehingga mampu melayani rujukan.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">5.Menggerakan
Pembangunan Nasional Berwawasan Kesehatan.</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Berbagai sektor pembangunan harus memasukkan
pertimbangan kesehatan dalam semua kebijakan pembangunannya. Program
pembangunan yang tidak berkontribusi positif terhadap kesehatan, apalagi yang
berdampak negatif terhadap kesehatan seyogyanya tidak diselenggarakan.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">6.
Mendorong Kemandirian Masyarakat untuk Hidup Sehat.</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Kesehatan dalah tanggung jawab bersama setiap
individu, masyarakat, pemerintah dan swasta. Apapun peran yang dimainkan
pemerintah, tanpa kesadaran individu dan masyrakat untuk secara mandiri menjaga
kesehatan mereka, hanya sedikit yang dapat dicapai.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">7.
Memeliahara dan Meningkatkan pelayanan kesehatan yang bermutu, merata dan
terjangkau.</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Salah satu tanggung jawab sektor kesehatan adalah
menjamin tersedianya pelayanan kesehatan yang bermutu, merata dan terjangkau
oleh masyarakat. Penyelenggaraan pelayanan kesehatan dilakukan oleh pemerintah
dan masyarakat serta swasta.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">8. Memelihara dan meningkatkan kesehatan individu,
keluarga dan masyarakat beserta lingkungannya.</span></b><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="background-position: initial initial; background-repeat: initial initial; color: #a7674e; font-family: Arial, sans-serif; font-size: 12pt;">Tugas utama sektor kesehatan adalah memeliahara dan
meningkatkan kesehatan segenap warganya. Oleh karena itu upaya kesehatan yang
harus diutamakan adalah yang bersifat promotif-preventif yang didukung oleh
upaya kuratif-rehalibitatif. Selain itu upaya penyehatan lingkungan juga harus
diprioritaskan.</span><span style="color: #a7674e; font-family: "Arial","sans-serif"; font-size: 10.5pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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</h3>
Anonymoushttp://www.blogger.com/profile/13798154464490898014noreply@blogger.com0tag:blogger.com,1999:blog-1138186865285931492.post-62850843637553776002014-01-29T05:30:00.001-08:002014-01-29T05:30:57.098-08:00galauuu??apaan tuh,,baca yang satu ini,!!!Punya Hansaplas ga? aku kesandung nih | ada ni pake aja | kok perih bgt
sih? | ga tau ini Hansaplasnya merek lain tulisanya Salonpas | -__-<br />
___________________________________________________________________________________<br />
<br />
"AC baru rumah gue gak dingin!" | AC merek apa? | "Samsung 2 pintu" | itu kulkas bego | "gue ditipu dong" | -____-<br />
<br />
____________________________________________________________________________________<br />
<br />
Gila nih panas banget siang ini | "kan ada gue jon" | apa hubunganya ama elu? | "gue kan hot" | behhh!!!<br />
____________________________________________________________________________________<br />
<br />
*di tilang* kenapa anda menerobos lampu merah, anda ga liat lampu merah? | saya liat lampu merah. Tapi saya ga liat bapak | -__-<br />
_____________________________________________________________________________________<br />
<br />
*on the phone* sayang, kamu lagi dimana? Jadi gak? | "sudah kubilang, hapus air mataaaaa...." <a class="twitter-hashtag pretty-link js-nav" data-query-source="hashtag_click" dir="ltr" href="https://twitter.com/search?q=%23TernyataBelumDiAngkat&src=hash"><s>#</s><b>TernyataBelumDiAngkat</b></a> <a class="twitter-hashtag pretty-link js-nav" data-query-source="hashtag_click" dir="ltr" href="https://twitter.com/search?q=%23MasihRBT&src=hash"><s>#</s><b>MasihRBT</b></a><br />
_____________________________________________________________________________________<br />
<br />
*dikelas* Rara punya penggaris gak? | "gak punya pak" | Trus bapak ngukur kedalaman cinta bapak ke kamu pake apa dong? | "....." <br />
_____________________________________________________________________________________<br />
<br />
*naik ojek* "mau turun di mana neng" | di antara cinta dan dusta bang | "...."<br />
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<br />
Lo jomblo ya? | enak aje gua single tauk! | tapi sama-sama gak punya pacar kan? Hahahahaha | -__-<br />
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<br />
Eh, jahat bgt lo. Gue ulang tahun gak ngasi kado | "oh iya. Nih kado buat lo" *ngasi Tabung elpiji 3kg berpita pink* | -___-<br />
_____________________________________________________________________________________<br />
<br />
Guru Inggris: "Where is your homework?" | Murid SD: "My home is at Jalan
Kenari Nomor 12 RT 19 RW 21" | Guru: *guling2 di lantai*<br />
_____________________________________________________________________________________ <br />
<br />
Bahasa inggrisnya rindu apa? | miss | aku rindu kamu? | i Miss you | aku sangat merindukan kamu? | ngemis ngemis | -__-<br />
_____________________________________________________________________________________<br />
<br />
Mbak, balikin dong duit gue | knp emg dek? | masa beli ademsari gue minum ga ada air terjunnya kaya ditipi itu | -__-<br />
_____________________________________________________________________________________ Anonymoushttp://www.blogger.com/profile/13798154464490898014noreply@blogger.com0tag:blogger.com,1999:blog-1138186865285931492.post-43896052977440140172014-01-29T05:16:00.000-08:002014-01-29T05:16:42.690-08:00wahhh,,radang pada genetalia interna??jangan takutt,,nih ada solusinya ,,<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l14 level1 lfo7; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">CERVICITIS</span></b></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span lang="EN-SG" style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Pengertian cervicitis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<b><span lang="EN-SG" style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">
</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Cervicitis ialah radang dari selaput
lendir canalis cervicalis. Karena epitel selaput lendir cervicalis hanya
terdiri dari satu lapisan sel silindris maka mudah terkena infeksi dibandingkan
dengan selaput lendir vagina (Sarwono, 2008)</span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada seorang multipara dalam keadaan
normal canalis cervikalis bebas kuman, pada seorang multipara dengan ostium
uteri eksternum sudah lebih terbuka, batas atas dari daerah bebas kuman ostium
uteri internum.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Walaupun
begitu canalis cervicalis terlindung dari infeksi oleh adanya lendir yang
kental yang merupakan barier terhadap kuman-kuman yang ada didalam vagina.
Terjadinya cervisitis dipermudah oleh adanya robekan serviks, terutama yang
menimbulkan ectropion.(Sarwono, 2008)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Servisitis adalah peradangan dari selaput lendir dari
kanalis servikalis. karena epitel selaput lendir kanalis servikalis hanya
terdiri dari satu lapisan sel selindris sehingga lebih mudah terinfeksi
disbanding selaput lendir vagina. ( gynekologi . FK UNPAD, 1998 )Juga merupakan
:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">a. Infeksi non spesifik dari serviks</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">b.Erosi
ringan ( permukaan licin ), erosi kapiler ( permukaan kasar ), erosi folikuler
( kistik )</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">c. Biasanya terjadi pada serviks bagian posterior</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Infeksi ini terjadi pada sebagian besar wanita yang telah
melahirkan. Terdapat perlukaan ringan pada mulut rahim. Gejala infeksi ini
adalah leukorea yang kadang sedikit atau banyak, dapat terjadi perdarahan (saat
hubungan seks). Pengobatan terhadap infeksi ini dimulai dengan pemeriksaan
setelah 42 hari persalinan atau sebelum hubungan seks dimulai. Pada mulut rahim
luka lokal disembuhkan dengan cairan albutil tingtura, cairan nitrasargenti
tingtura, dibakar dengan pisau listrik, termokauter, mendinginkannya
(cryosurgery). Penyembuhan servisitis menahun sangat penting karena dapat
menghindari keganasan dan merupakan pintu masuk infeksi ke alat kelamin bagian
atas.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
</div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
</div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-SG" style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Etiologi</span></b><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt 56.7pt; text-align: justify; text-indent: -6.5pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 3;"> </span></span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Servisitis
disebabkan oleh kuman-kuman seperti : trikomonas vaginalis, kandida dan
mikoplasma atau mikroorganisme aerob dan anaerob endogen vagina seperti
streptococcus, enterococus, e.coli, dan stapilococus . Kuman-kuman ini
menyebabkan deskuamasi pada epitel gepeng dan perubahan inflamasi kromik dalam
jaringan serviks yang mengalami trauma.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -6.5pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 3;"> </span></span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Dapat juga
disebabkan oleh robekan serviks terutama yang menyebabkan ectropion, alat-alat
atau alat kontrasepsi, tindakan intrauterine seperti dilatasi, dan lain-lain.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -6.5pt;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 3;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Servicitis dapat disebabkan oleh
salah satu dari sejumlah infeksi, yang paling umum adalah :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l6 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list 70.9pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><a href="http://translate.googleusercontent.com/translate_c?hl=id&rurl=translate.google.co.id&sl=en&tl=id&twu=1&u=http://en.wikipedia.org/wiki/Chlamydia_infection&usg=ALkJrhgmx2pduF6zlif3qnlsJ1igwOJEYA" title="Infeksi Chlamydia"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">Klamidia</span></a><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> dan </span><a href="http://translate.googleusercontent.com/translate_c?hl=id&rurl=translate.google.co.id&sl=en&tl=id&twu=1&u=http://en.wikipedia.org/wiki/Gonorrhea&usg=ALkJrhhvNqH3QpVkk1HOUv7Ls3mfp2TmsA" title="Gonorea"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">gonore</span></a><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">, klamidia dengan akuntansi untuk sekitar 40% kasus</span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gonorroe, sediaan hapus dari fluor
cerviks terutama purulen.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l6 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list 70.9pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><a href="http://translate.googleusercontent.com/translate_c?hl=id&rurl=translate.google.co.id&sl=en&tl=id&twu=1&u=http://en.wikipedia.org/wiki/Trichomonas_vaginalis&usg=ALkJrhjzDLQkZK1FtiayLiiNCrcCwTzP2A" title="Trichomonas vaginalis"><i><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">Trichomonas
vaginalis</span></i></a><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
dan </span><a href="http://translate.googleusercontent.com/translate_c?hl=id&rurl=translate.google.co.id&sl=en&tl=id&twu=1&u=http://en.wikipedia.org/wiki/Herpes_simplex&usg=ALkJrhicm5INeU9CvmffcKajrlBwsYgx1w" title="Herpes simpleks"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">herpes simpleks</span></a><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> adalah penyebab yang kurang umum
dari cervicitis. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l6 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list 70.9pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peran </span><a href="http://translate.googleusercontent.com/translate_c?hl=id&rurl=translate.google.co.id&sl=en&tl=id&twu=1&u=http://en.wikipedia.org/wiki/Mycoplasma_genitalium&usg=ALkJrhgGmLZh0vo8UPGHQ4cYYcrrUSw3Lw" title="Mycoplasma genitalium"><i><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">Mycoplasma
genitalium</span></i></a><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
dan </span><a href="http://translate.googleusercontent.com/translate_c?hl=id&rurl=translate.google.co.id&sl=en&tl=id&twu=1&u=http://en.wikipedia.org/wiki/Bacterial_vaginosis&usg=ALkJrhhxvhXprzNJGSehwicQB5Wbn9iYUg" title="Bakteri vaginosis"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">vaginosis bakteri</span></a><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> dalam menyebabkan servisitis masih
dalam penyelidikan. </span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l6 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list 70.9pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sekunder terhadap kolpitis.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l6 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list 70.9pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tindakan intra dilatasi dll.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l6 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list 70.9pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Alat-alat atau obat kontrasepsi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l6 level1 lfo1; mso-margin-top-alt: auto; tab-stops: list 70.9pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Robekan serviks terutama yang
menyebabkan ectroption</span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">/ </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">extropin</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Patofisiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyakit ini dijumpai pada sebagian besar wanita yang pernah
melahirkan dengan luka-luka kecil atau besra pada cerviks karena partus atau
abortus memudahkan masuknya kuman-kuman kedalam endocerviks dan
kelenjar-kelenjarnya, lalu menyebabkan infeksi menahun. Beberapa gambaran
patologis dapat ditemukan : </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l16 level1 lfo2; mso-margin-top-alt: auto; tab-stops: list 56.7pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Cerviks
kelihatan normal, hanya pada pemeriksaan mikroskopik ditemukan infiltrasi
endokopik dalam stroma endocerviks. Cervicitis ini tidak menimbulkan gejala,
kecuali pengeluaran sekret yang agak putih kekuningan. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l16 level1 lfo2; mso-margin-top-alt: auto; tab-stops: list 56.7pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Disini
pada portio uteri sekitar ostium uteri eksternum tampak daerah kemerah-merahan
yang tidak terpisah secara jelas dan epitel portio disekitarnya, sekret
dikeluarkan terdiri atas mukus bercampur nanah. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; mso-list: l16 level1 lfo2; mso-margin-top-alt: auto; tab-stops: list 49.65pt; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sobekan pada cerviks uteri disini
lebih luas dan mucosa endocerviks lebih kelihatan dari luar (eksotropion).
Mukosa dalam keadaan demikian itu mudah kena infeksi dari vagina, karena radang
menahun, cerviks bisa menjadi hipertropis dan mengeras : sekret bertambah
banyak. </span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Klasifikasi.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l16 level2 lfo2; text-align: justify; text-indent: -14.2pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Cervicitis
Akut</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Cervicities akut dalam pengertian yang lazim ialah
infeksi yang diawali di endocerviks dan ditemukan pada gonorrhoe, dan pada
infeksi post-abortum atau post-partum yang disebabkan oleh Streptoccocus,
Stafilococcus, dan lain-lain. Dalam hal ini, serviks memerah dan bengkak dengan
mengeluarkan cairan mukopurulent. Akan tetapi, gejala-gejala pada serviks
biasanya tidak seberapa tampak di tengah gejala-gejala lain dari infeksi yang
bersangkutan. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Pengobatan dilakukan dalam rangka pengobatan infeksi
tersebut. Penyakitnya dapat sembuh tanpa bekas atau menjadi cervicitis kronis.
Cervicitis akut sering terjadi dan dicirikan dengan eritema, pembengkakan,
sebukan neutrofil, dan ulserasi epitel fokal. Endocerviks lebih sering
terserang dibandingkan ektocerviks</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. </span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Cervicitis akut biasanya merupakan
infeksi yang ditularkan secara seksual, umumnya oleh Gonoccocus, Chlamydia
trachomatis, Candida albicans, Trichomonas vaginalis, dan Herpes simpleks. Agen
yang ditularkan secara non-seksual, seperti E. Coli dan Stafilococcus dapat
pula diisolasi dari cerviks yang meradang akut, tetapi perannya tidak jelas.
Cervicitis akut juga terjadi setelah melahirkan dan pembedahan.
</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Secara klinis, terdapat secret vagina purulen dan rasa
nyeri. Beratnya gejala tidak terkait erat dengan derajat peradangan.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l16 level2 lfo2; text-align: justify; text-indent: -21.3pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Cervicitis Kronis</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Penyakit ini dijumpai pada wanita yang pernah
melahirkan. Luka-luka kecil atau besar pada serviks karena partus abortus
memudahkan masuknya kuman-kuman ke dalam endocerviks dan kelenjar-kelenjarnya,
lalu menyebabkan infeksi menahun. Beberapa gambaran patologis dapat ditemukan :
</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -21.25pt;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">a. Serviks kelihatan normal; hanya
pada pemeriksaan mikroskopik ditemukan infiltrasi leukosit dalam stroma
endoserviks. Cervicitis ini tidak menimbulkan gejala, kecuali pengeluaran
secret yang agak putih-kuning.
</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -21.25pt;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">b. Disini pada portio uteri sekitar
ostium uteri eksternum tampak daerah kemerah-merahan yang tidak dipisahkan
secara jelas dari epitel portio disekitarnya, secret yang ditularkan terdiri
atas mucus bercampur nanah.
</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -21.25pt;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">c. Sobekan pada serviks uteri disini
lebih luas dan mukosa endosekviks lebih kelihatan dari luar. Mukosa dalam
keadaan demikian mudah kena infeksi dari vagina. Karena radang menahun, serviks
bisa menjadi hipertrofis dan mengeras ; secret mukopurulen bertambah pendek.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Pada proses penyembuhan, epitel tatah dari bagian
vaginal portio uteri dengan tanda-tanda metaplasia mendesak epitel torak,
tumbuh kedalam stroma dibawah epitel dan menutup saluran kelenjar-kelenjar,
sehingga terjadi kista kecil berisi cairan yang kadang-kadang keruh. Limfosit,
sel plasma, dan histiosit terdapat dalam jumlah sedang didalam serviks semua
wanita. Oleh karena itu, cervisitis kronis sulit ditentukan secara patologis
keberadaan kelainan serviks yang dapat dideteksi seperti granularitas dan
penebalan seiring dengan meningkatnya jumlah sel radang kronis didalam specimen
biopsy dianggap penting untuk memastikan diagnosis cervisitis kronis.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Cervisitis kronis paling sering terlihat pada ostium
eksternal dan canalis endoserviks. Hal tersebut dapat terkait dengan stenosis
fibrosa saluran kelenjar, yang menyebabkan kista retensi (nabothian). Bila
terdapat folikel limfoid pada pemeriksaan mikroskopik, istilah cervisitis
folikular terkadang digunakan. Secara klinis, cervisitis kronis sering kali
merupakan temuan kebetulan. Namun, cervisitis tersebut dapat menimbulkan secret
vaginal, dan beberapa kasus fibrosis yang terdapat pada canalis endoserviks
dapat menyebabkan stenosis, yang menimbulkan inferilitas.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala
Klinis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> K</span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">eputihan
hebat, biasanya kental dan biasanya berbau, sering menimbulkan erosi pada
portio yang tampak seperti daerah merah menyala.<b> </b>Pada pemeriksaan
inspekulo kadang-kadang dapat dilihat keputihan yang kental keluar dari kanalis
servikalis. Kalau portio normal tidak ada ectropion (mukosa kanalis servikalis
tampak dari luar), maka harus diingat kemungkinan gonorroe </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> </span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Gejala-gejala
non spesifik seperti nyeri punggung, dan gangguan kemih</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">, p</span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">erdarahan
saat melakukan hubungan seks</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l10 level1 lfo8; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Faktor Resiko</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Beberapa faktor yang mempengaruhi
insiden kanker serviks yaitu:</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">1. Usia.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">2. Jumlah perkawinan</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">3. Hygiene dan sirkumsisi</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">4. Status sosial ekonomi</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">5. Pola seksual </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">6. Terpajan virus terutama virus HIV</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">7. Merokok</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 39.0pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l11 level1 lfo9; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tanda
dan Gejala </span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">1.
Perdarahan</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">2. Keputihan
yang berbau dan tidak gatal</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">3. Cepat
lelah</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">4.
Kehilangan berat badan</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">5. Anemia</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l22 level1 lfo10; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Manifestasi
Klinis </span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
</span></b><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Dari anamnesis didapatkan keluhan metroragi, keputihan
warna putih atau puralen yang berbau dan tidak gatal, perdarahan pascakoitus,
perdarahan spontan, dan bau busuk yang khas. Dapat juga ditemukan keluhan cepat
lelah, kehilangan berat badan, dan anemia. Pada pemeriksaan fisik serviks dapat
teraba membesar, ireguler, terraba lunak. Bila tumor tumbuh eksofitik maka
terlihat lesi pada porsio atau sudah sampai vagina. Diagnosis harus dipastikan
dengan pemeriksaan histologi dan jaringan yang diperoleh dari biopsi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l22 level1 lfo10; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Prognosis </span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
</span></b><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Karsinoma serviks yang tidak dapat diobati atau tidak
memberikan respons terhadap pengobatan 95% akan mengalami kematian dalam 2
tahun setelah timbul gejala. Pasien yang menjalani histerektomi dan memiliki
rasio tinggi terjadinya rekurensi harus terus diawasi karena lewat deteksi dini
dapat diobati dengan radioterapi. Setelah histerektomi radikal, terjadinya 80%
rekurensi dalam 2 tahun.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l22 level1 lfo10; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Pemeriksaan
Penunjang </span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Sitologi,
dengan cara tes pap</span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;"> </span></span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">Ø</span></span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">
</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Tes Pap :
Tes ini merupakan penapisan untuk mendeteksi infeksi HPV dan prakanker serviks.
Ketepatan diagnostik sitologinya 90% pada displasia keras (karsinoma in situ)
dan 76% pada dysplasia ringan / sedang. Didapatkan hasil negatif palsu 5-50%
sebagian besar disebabkan pengambilan sediaan yang tidak adekuat. Sedangkan
hasil positif palsu sebesar 3-15%.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Kolposkopi</span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;"> </span></span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">Ø</span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Servikografi</span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;"> </span></span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">Ø</span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Pemeriksaan</span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;"> </span></span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">Ø</span></span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";"> visual
langsung</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Gineskopi</span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;"> </span></span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">Ø</span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Pap</span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;"> </span></span><span lang="EN-SG" style="font-family: Symbol; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman"; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;">Ø</span></span><span lang="EN-SG" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";"> net
(Pemeriksaan terkomputerisasi dengan hasil lebih sensitive)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l22 level1 lfo10; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">11.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pencegahan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; tab-stops: 14.2pt; text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
</span></b><span lang="EN-SG" style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: EN-SG; mso-fareast-font-family: "Times New Roman";">Pencegahan terhadap kanker serviks dapat
dilakukan dengan program skrinning dan pemberian vaksinasi. Di negara maju,
kasus kanker jenis ini sudah mulai menurun berkat adanya program deteksi dini
melalui <i>pap smear</i>. Vaksin HPV akan diberikan pada perempuan usia 10
hingga 55 tahun melalui suntikan sebanyak tiga kali, yaitu pada bulan ke nol,
satu, dan enam. Dari penelitian yang dilakukan, terbukti bahwa respon imun
bekerja dua kali lebih tinggi pada remaja putri berusia 10 hingga 14 tahun
dibanding yang berusia 15 hingga 25 tahun.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">12.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengobatan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
Luka yang terinfeksi seperti halnya luka bedah yang terinfeksi lainnya, harus
diatasi dengan pemasangan brainase. Salah satu terapi kombinasi antibiotik
berspektrum luas. Harus diberikan kepada keadaan ini. Rasa nyeri diringankan
dengan penggunaan preparat analgesik yng efektif dan bila terjadi retensi urin,
pemasangan indwelling catheter harus dilakukan.</span></div>
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<b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengertian Endometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
adalah keradangan pada dinding uterus yang umumnya disebabkan oleh partus.
Dengan kata lain endometritis didefinisikan sebagai inflamasi dari
endometrium. Derajat efeknya terhadap fertilitas bervariasi dalam hal
keparahan radang, waktu yang diperlukan untuk penyembuhan lesi endometrium, dan
tingkat perubahan permanen yang merusak fungsi dari glandula endometrium
dan/atau merubah lingkungan uterus dan/atau oviduk. Organisme nonspesifik
primer yang dikaitkan dengan patologi endometrial adalah Corynebacterium
pyogenes dan gram negatif anaerob.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
adalah infeksi pada endometrium (lapisan dalam dari rahim). Infeksi ini dapat
terjadi sebagai kelanjutan infeksi pada serviks atau infeksi tersendiri dan
terdapat benda asing dalam rahim.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Etiologi Endometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kuman-kuman
memasuki endometrium, biasanya pada luka bekas insersio plasenta, dan dalam
waktu singkat mengikutsertakan seluruh endometrium. Pada infeksi dengan
kuman yang tidak seberapa pathogen, radang terbatas pada endometrium.
Jaringan desidua bersama-sama dengan bekuan darah menjadi nekrotis dan
mengeluarkan getah berbau dan terdiri atas keeping-keping nekrotis serta
cairan. Pada batas antara daerah yang meradang dan daerah yang sehat
terdapat lapisan yang terdiri atas leukosit-leukosit. Pada infeksi yang
lebih berat, batas endometrium dapat dilampaui dan terjadilah penjalaran.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Terjadinya
infeksi endometrium pada saat:</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Persalinan,
dimana bekas implantasi plasenta masih terbuka, terutama pada persalinan
terlantar dan persalinan dengan tindakan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 7.1pt; text-align: justify; text-indent: -18.75pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Pada
saat terjadi keguguran.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c. Saat
pemasangan alat rahim (IUD) yang kurang legeartis.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diduga
uterus dan isinya steril selama kehamilan normal dan lebih dulu melahirkan.
Kemudian waktu kelahiran atau setelah itu lumen uterus terkontaminasi
mikroorganisme dari lingkungan, mikroorganisme, kulit dan feses melalui
relaksasi peritoneum, vulva dan dilatasi cervik.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ada
berbagai macam faktor predisposisi dari endometritis. Ada sinergisme antara <i>A.
pyogenes, F. necrophorum, </i>dan<i> Prevotella melaninogenicus</i>,
menyebabkan lebih beratnya kasus endometritis. Gangguan mekanisme pertahanan
uterus seperti involusi uterus atau fungsi neutrofil akan menunda fungsi
eliminasi kontaminasi bakteri. Distosia, kelahiran kembar atau kematian janin
dan inseminasi buatan meningkatkan kesempatan untuk kontaminasi pada traktus
genital. Retensi membrane fetus adalah faktor predisposisi endometritis dan
berhubungan dengan peningkatan endometritis berat.</span></div>
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</div>
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</div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gambaran Klinik Endometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gambaran
klinik tergantung jenis dan virulensi kuman, daya tahan penderita, dan derajat
trauma pada jalan lahir. Kadang-kadang lochia tertahan oleh darah,
sisa-sisa palsenta dan selaput ketuban. Keadaan ini dinamakan lokiometra
dan dapat menyebabkan kenaikan suhu yang segera hilang setelah rintangan
diatasi. Uterus pada endometriosis agak membesar, serta nyeri pada
perabaan, dan lembek. Pada endometritis yang tidak meluas, penderita pada
hari-hari pertama merasa kurang sehat dan perut nyeri. Mulai hari ke-3
suhu meningkat, nadi menjadi cepat, akan tetapi dalam beberapa hari suhu dan
nadi menurun dan dalam kurang lebih satu minggu keadaan sudah normal
kembali. Lokia pada endometritis, biasanya bertambah dan kadang-kadang
berbau. Hal yang terakhir ini tidak boleh menimbulkan anggapan bahwa infeksinya
berat. Malahan infeksi berat kadang-kadang disertai oleh lokia yang
sedikit dan tidak berbau.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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</div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
dapat terjadi penyebaran:</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Miometritis (infeksi otot rahim)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l18 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Parametritis (infeksi sekitar rahim)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l18 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Salpingitis (infeksi saluran telur)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l18 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ooforitis (infeksi indung telur)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l18 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dapat terjadi sepsis (infeksi
menyebar)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; mso-list: l18 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pembentukan pernanahan sehingga
terjadi abses pada tuba atau indung telur.</span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Jenis-jenis Endometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 56.7pt; mso-list: l9 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 42.55pt; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
Akut</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Terutama
terjadi pada postpartum atau postabortum. Pada endometritis postpartum,
regenerasi endometrium selesai pada hari ke-9, sehingga endometritis postpartum
pada umumnya terjadi sebelum hari ke-9. Endometritis postabortum terutama
terjadi pada abortus provocatus. Endometritis juga dapat terjadi pada
masa senil.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada
endometritis akuta endometrium mengalami edema dan hiperemi, dan pada
pemeriksaan mikroskopik terdapat hiperemi, edema, dan infiltrasi leukosit
berinti polimoni yang banyak, serta perdarahan-perdarahan interstisial. Sebab
yang paling penting ialah infeksi gonorea dan infeksi pada abortus dan partus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Infeksi
gonorea mulai sebagai servisitis akuta, dan radang menjalar ke atas dan
menyebabkan endometritis akuta. Infeksi gonorea akan dibahas secara khusus, dan
oleb sebab itu tidak dibicarakan lebib lanjut di sini. Infeksi post
abortum dan post partum sering terdapat oleh karena luka-luka pada serviks
uteri, luka pada dinding uterus bekas tempat plasenta, yang merupakan porte
d’entree bagi kuman-kuman patogen. Selain in, alat-alat yang digunakan pada
abortus dan partus dan tidak sucihama dapat membawa kuman-kuman ke dalam
uterus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada
abortus septic dan sepsis puerperalis infeksi lebih cepat meluas ke miometrium
dan melalui pembuluh-pembuluh darah dan limfe dapat menjalar ke parametrium,
tuba dan ovarium serta ke peritoneum di sekitarnya. Gejala-gejala
endometritis akuta dalam hal ini diselubungi oleh gejala-gejala penyakit dalam
keseluruhannya. Penderita panas tinggi, kelihatan sakit keras, keluar
leukorea yang bernanah, dan uterus serta daerah di sekitarnya nyeri pada
perabaan.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sebab lain
endometritis akuta ialah tindakan yang dilakukan dalam uterus di luar partus
atau abortus, seperti kerokan, memasukkan radium ke dalam uterus, memasukkan
IUD (intra-uterine device) ke dalam uterus, dan sebagainya. Tergantung
dari virulensi kuman yang dimasukkan dalam uterus, apakah endometritis akuta
tetap terbatas pada endometrium, atau menjalar ke jaringan di sekitarnya.
Endometritis akuta yang disebabkan oleh kuman-kuman yang tidak seberapa
pathogen umumnya dapat diatasi atas kekuatan jaringan sendiri, dibantu dengan
pelepasan lapisan fungsional dari endometrium pada waktu haid. Dalam
pengobatan endometritis akuta yang paling penting ialah berusaha mencegah agar
infeksi tidak menjalar.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala-gejala:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Demam</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Lochia berbau, pada endometritis postabortum
kadang-kadang keluar fluor yang purulent.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c. Lochia
lama berdarah, malahan terjadi metrorrhagi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Jika radang tidak
menjalar ke parametrium atau perimetrium tidak ada nyeri.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e. Nyeri
pada palpasi abdomen (uterus) dan sekitarnya.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
Kronik</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kasusnya
jarang ditemui oleh karena infeksi yang tidak dalam masuknya pada miometrium,
tidak dapat mempertahankan diri, karena pelepasan lapisan fungsional dari
endometrium pada waktu haid. Pada pemeriksaan mikroskopik ditemukan
banyak sel-sel plasma dan limfosit. Penemuan limfosit saja tidak besar
artinya karena sel itu juga ditemukan dalam keadaan normal dalam endometrium.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala-gejala
klinis endometritis kronika ialah, leukorea dan menoragia. Pengobatannya
tergantung dari penyebabnya.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
knonika ditemukan:</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.
pada tuberkulosis;</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.
jika tertinggal sisa-sisa abortus atau partus;</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.
jika terdapat korpus alienum di kavum uteri;</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.
pada polip uterus dengan infeksi;</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.
pada tumor ganas uterus;</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.
pada salpingo-ooforitis dan sellulitis pelvik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.
Fluor albus yang keluar dari ostium</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h.
Kelainan haid seperti metrorrhagi dan menorrhagi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
kronika yang lain umumnya akibat infeksi yang terus-menerus karena adanya benda
asing atau polip/tumor dengan infeksi di dalam kavum uteri. Dahulu
diagnosis endometritis kronika lebih sering dibuat daripada sekarang.
Sejak penelitian fundamental dari Hitshcmann dan Adler tentang histology
endometrium selama siklus haid, diketahui bahwa banyak perubahan yang ditemukan
dalam endometrium dan yang dahulu dianggap patologik adalah gambaran normal
dari endometrium dalam berbagai fase siklus haid.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
tuberkulosa terdapat pada hampir setengah kasus-kasus tuberculosis
genital. Pada pemeriksaan mikrskopik ditemukan tuberkel di tengah-tengah
endometrium yang beradang menahun.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis
tuberkulosa umumnya timbul sekunder pada penderita dengan salpingitis
tuberkulosa. Pada penderita dengan tuberculosis pelvic yang asimptomatik,
endometritis tuberkulosa ditemukan bila pada seorang wanita dengan infertilitas
dilakukan biopsy endometrial dan ditemukan tuberkel dalam sediaan. Terapi
yang kausal terhadap tuberculosis biasanya dapat menyebabkan timbulnya haid
lagi.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada
abortus inkompletus dengan sisa-sisa tertinggal dalam uterus terdapat desidua
dan villi korialis di tengah-tengah radang menahun endometrium.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 14.2pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 27.0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada
partus dengan sisa plasenta masih tertinggal dalam uterus, terdapat peradangan
dan organisasi dari jaringan plasenta tersebut disertai gumpalan darah, dan
terbentuklah apa yang dinamakan polip plasenta.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l13 level1 lfo11; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diagnosa Endometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; tab-stops: 21.3pt; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Secara
klinis karakteristik endometritis dengan adanya pengeluaran mucopurulen pada
vagina, dihubungkan dengan ditundanya involusi uterus. Diagnosa endometritis
tidak didasarkan pada pemeriksaan histologis dari biopsy endometrial. Tetapi
pada kondisi lapangan pemeriksaan vagina dan palpasi traktus genital per rectum
adalah teknik yang sangat bermanfaat untuk diagnosa endometritis. Pemeriksaan
visual atau manual pada vagina untuk abnormalitas pengeluaran uterus adalah
penting untuk diagnosa endometritis, meski isi vagina tidak selalu mencerminkan
isi dari uterus. Flek dari pus pada vagina dapat berasal dari uterus, cervik
atau vagina dan mukus tipis berawan sering dianggap normal. Sejumlah sistem
penilaian telah digunakan untuk menilai tingkat involusi uterus dan cervik,
pengeluaran dari vagina alami. Sistem utama yang digunakan adalah kombinasi
dari diameter uterus dan cervik, penilaian isi dari vagina. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; tab-stops: 21.3pt; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sangat
penting untuk dilakukan diagnosa dan memberi perlakuan pada kasus endometritis
di awal periode post partum. Setiap ibu harus mengalami pemeriksaan postpartum
dengan segera pada saat laktasi sebagai bagian dari program kesehatan yang
rutin. Kejadian endometritis dapat didiagnosa dengan adanya purulen dari vagina
yang diketahui lewat palpasi rektal. Diagnosa lebih lanjut seperti pemeriksaan
vaginal dan biopsi mungkin diperlukan. Yang harus diperhatikan pada saat
palpasi dan pemeriksaan vaginal meliputi ukuran uterus, ketebalan dinding
uterus dan keberadaan cairan beserta warna, bau dan konsistensinya. Sejarah
tentang trauma kelahiran, distosia, retensi plasenta atau vagina purulenta saat
periode postpartum dapat membantu diagnosa endometritis. Pengamatan oleh
inseminator untuk memastikan adanya pus, mengindikasikan keradangan pada
uterus. Sejumlah kecil pus yang terdapat pada pipet inseminasi dan
berwarna keputihan bukanlah suatu gejala yang mangarah pada endometritis.
Keradangan pada cervix (cervisitis) dan vagina (vaginitis) juga mempunyai
abnormalitas seperti itu. Bila terdapat sedikit cairan pada saat palpasi
uterus, penting untuk melakukan pemeriksaan selanjutnya yaitu dengan
menggunakan spekulum. Untuk beberapa kasus endometritis klinis atau
subklinis, diagnosa diperkuat dengan biopsy uterin. Pemeriksaan mikroskopis
dari jaringan biopsy akan tampak adanya peradangan akut atau kronik pada
dinding uterus. Pemeriksaan biopsi uterin dapat untuk memastikan terjadinya
endometritis dan adanya organisme di dalam uterus. Tampak daerah keradangan
menunjukkan terutama neutrofil granulocyte dan dikelilingi jaringan nekrosis
dengan koloni coccus.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 21.3pt; margin-right: 0in; margin-top: 0in; tab-stops: 21.3pt; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Cara
sederhana juga adalah dengan melakukan pemeriksaan manual pada vagina dan
mengambil mukus untuk di inspeksi. Keuntungan teknik ini adalah murah, cepat,
menyediakan informasi sensory tambahan seperti deteksi laserasi vagina dan
deteksi bau dari mukus pada vagina. Satu prosedur adalah pembersihan vulva
menggunakan paper towel kering dan bersih, sarung tangan berlubrican melalui
vulva ke dalam vagina. Pinggir, atas dan bawah dinding vagina dan os cervik
eksterna dipalpasi dan isi mukus vagina diambil untuk diperiksa. Tangan
biasanya tetap di vagina untuk sekurangnya 30 detik. Pemeriksaan vagina manual
telah sah dan tidak menyebabkan kontaminasi bakteri uterus, menimbulkan phase
respon protein akut atau menunda involusi uterus. Tetapi operator sadar bahwa
vaginitis dan cervicitis mungkin memberikan hasil yang salah. Vaginoscopy dapat
dilakukan dengan menggunakan autoclavable plastik, metal atau disposable foil-
lined cardboard vaginoscope, yang diperoleh adalah inspeksi dari isi vagina.
Tetapi mungkin ada beberapa resistensi menggunakan vaginoscop karena dirasa
tidak mudah, potensial untuk transmisi penyakit dan harganya. Alat baru untuk pemeriksaan
mukus vagina terdiri dari batang stainless steel dengan hemisphere karet yang
digunakan untuk mengeluarkan isi vagina.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l13 level1 lfo11; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penanganan Endometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l0 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 49.65pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis Akut</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">Terapi:</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Pemberian
uterotonika</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.
Istirahat, posisi/letak Fowler</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.
Pemberian antibiotika</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d. Endometritis
senilis, perlu dikuret untuk mengesampingkan diagnosa corpus carcinoma.
Dapat diberi estrogen.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-left: 49.65pt; mso-add-space: auto; mso-list: l0 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 49.65pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Endometritis Kronik</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">Terapi:</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
<span style="mso-tab-count: 1;"> </span>Perlu dilakukan kuretase untuk
diferensial diagnosa dengan carcinoma corpus uteri, polyp atau myoma
submucosa. Kadang-kadang dengan kuretase ditemukan emndometritis
tuberkulosa. Kuretase juga bersifat terapeutik.</span></div>
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</div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Myometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l15 level1 lfo12; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengertian
Myometritis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
Miometritis / Metritis adalah radang miometrium. Metritis adalah infeksi uterus
setelah persalinan yang merupakan salah satu penyebab terbesar kematian ibu.
Penyakit ini tidak berdiri sendiri tetapi merupakan lanjutan dari endometritis,
sehingga gejala dan terapinya seperti endometritis.</span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Klasifikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 78.0pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Metritis
akuta</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Metritis Akuta biasanya terdapat
pada abortus septic atau infeksi postpartum. Penyakit ini tidak berdiri
sendiri, akan tetapi merupakan bagian dari infeksi yang lebih luas. Kerokan
pada wanita dengan endometrium yang meradang (endometritis) dapat menimbulkan
metritis akut. Pada penyakit ini miometrium menunjukkan reaksi radang berupa
pembengkakan dan infiltrasi sel-sel radang. Perluasan dapat terjadi lewat jalan
limfe atau lewat trombofeblitis dan kadang-kadang dapat terjadi abses.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 70.9pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Metritis
Kronik</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Metritis kronik adalah diagnosis
yang dahulu banyak dibuat atas dasar menometroragia dengan uterus lebih besar
dari biasa, sakit pinggang dan leukorea. Akan tetapi pembesaran uterus pada
seorang multipara umumnya disebabkan oleh pertambahan jaringan ikat akibat
kelamin. Bila pengobatan terlambat atau kurang adekuat dapat menjadi :</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1)
Abses pelvik </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 92.15pt; margin-right: 0in; margin-top: 0in; tab-stops: 78.0pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2)
Peritonitis</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 92.15pt; margin-right: 0in; margin-top: 0in; tab-stops: 78.0pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3)
Syok septic</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 92.15pt; margin-right: 0in; margin-top: 0in; tab-stops: 78.0pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4)
Dispareunia </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 92.15pt; margin-right: 0in; margin-top: 0in; tab-stops: 78.0pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5)
Trombosis vena yang dalam</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6)
Emboli pulmonal</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 92.15pt; margin-right: 0in; margin-top: 0in; tab-stops: 78.0pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7)
Infeksi pelvik yang menahun </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 92.15pt; margin-right: 0in; margin-top: 0in; tab-stops: 78.0pt; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">8)
Penyumbatan tuba dan infertilitas</span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Faktor
Predisposisi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Infeksi abortus
dan partus</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Penggunaan alat
kontrasepsi dalam rahim</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c. Infeksi post
curettage</span></div>
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</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l15 level1 lfo12; tab-stops: 56.7pt; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala – gejala</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Demam </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Keluar lochea berbau
/ purulent, keputihan yang berbau</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c. Sakit pinggang</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d. Nyeri abdomen </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e. Nyeri saat
berhubungan seksual</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f. Nyeri di daerah
pelvic</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g. Nyeri di punggung
kaki (betis)</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h. Gangguan kesuburan</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i. Gangguan
buang air besar (sembelit atau kembung)</span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Komplikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Dapat
terjadi penyebaran ke jaringan sekitarnya seperti:</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.
Parametritis (infeksi sekitar rahim)</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.
Salpingitis (infeksi saluran otot)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 78.0pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.
Ooforitis (infeksi indung telur)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 78.0pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d. Pembentukan
pernanahan sehingga terjadi abses pada tuba atau indung telur. </span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penatalaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
Terapi miometritis :</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Antibiotika
spektrum luas</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
Ampisilin 2 g iv / 6 jam</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
Gentamisin 5 mg kgbb</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
Metronidasol 500 mg iv / 8 jam</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Profilaksi
antitetanus</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l15 level1 lfo12; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Manajemen</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
-Antibiotik kombinasi</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">
-Transfusi jika diperlukan</span></div>
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</div>
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</div>
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</div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Parametritis</span></b></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Definisi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Parametritis
adalah radang dari jaringan longgar di dalam lig.latum. Radang ini biasanya
unilatelar. Parametritis adalah infeksi jaringan pelvis yang dapat terjadi
beberapa jalan: </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Secara
rinci penyebaran infeksi sampai ke parametrium memalui 3 cara yaitu:</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.
Penyebaran melalui limfe dari luka serviks yang terinfeksi atau dari
endometritis</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Penyebaran langsung dari luka serviks yang meluas sampai ke dasar
ligamentum</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Penenyebaran
sekunder dari tromboflebitis pelvika. Proses ini dapat tinggal terbatas pada
dasar ligamentum latum atau menyebar ekstraperitoneal ke semua jurusan. Jika
menjalar ke atas , dapat diraba pada dinding perut sebelah lateral di atas
ligamentum inguinalis, atau pada fossa iliaka. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Radang
paling banyak berlokasi di parametrium bagian lateral akan tetapi bisa juga ke
depan dan ke belakang, radang bisa juga menjahi abses. Apabila terjadi abses,
dan proses berkembang terus, maka abses akan mencari jalan keluar yaitu di atas
ligamentum pouparty, ke daerah ginjal, melalui foramina obturatorium ke
paha bagian dalam, dan sebagianya. Parametritis dapat juga menahun dan di
tempat radang terjadi fibrosis. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kalau
terjadi infeksi parametrium, maka timbulah pembengkakan yang mula-mula
lunak tetapi kemudian menjadi keras sekali. Infiltrasi ini dapat terjadi hanya
pada dasar lig. Latum tetapi dapat juga bersifat luas misalnya dapat menempati
seluruh parametrium sampai ke dinding panggul dan dinding perut depan di atas
lig. Inguinale.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kalau
filtrat menjalar ke belakang dapat menimbulkan pembengkakan di belakang cervix.
Eksudat ini lambat laun direasorpsi atau menjadi abses. Abses dapat memecah di
daerah lipat paha di atas lig. Inguinale atau ke dalam cavum douglas.
Parametritis biasanya unilateral dan karena biasanya sebagai akibat luka
cervix, lebih sering terdapat pada primipara daripada multipara. </span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Etiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Parametritis dapat terjadi:</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1)
Dari endometritis dengan 3 cara : </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Per
continuitatum : endometritis → metritis → parametitis.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Lymphogen.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.
Haematogen : phlebitis → periphlebitis → parametritis </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2)
Dari robekan serviks </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3)
Perforasi uterus oleh alat-alat ( sonde, kuret, IUD) </span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Patofisiologi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .5in;">
<span lang="ES" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; letter-spacing: .05pt; line-height: 150%; mso-ansi-language: ES; mso-fareast-font-family: "Times New Roman";">Endometritis </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">→ </span><span lang="ES" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; letter-spacing: .05pt; line-height: 150%; mso-ansi-language: ES; mso-fareast-font-family: "Times New Roman";">Infeksi meluas </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">→<span style="letter-spacing: .05pt;"> </span></span><span lang="ES" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; letter-spacing: .05pt; line-height: 150%; mso-ansi-language: ES; mso-fareast-font-family: "Times New Roman";">Lewat jalan limfe
atau tromboflebitis </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">→
</span><span lang="ES" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; letter-spacing: .05pt; line-height: 150%; mso-ansi-language: ES; mso-fareast-font-family: "Times New Roman";">Infeksi menyebar ke miometrium </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">→ </span><span lang="ES" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; letter-spacing: .05pt; line-height: 150%; mso-ansi-language: ES; mso-fareast-font-family: "Times New Roman";">Miometritis </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">→ Infeksi meluas lewat jalan
limfe/tromboflebitis → Parametritis</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Terjadi
reaksi :</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.
Kalor</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Dolor</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.
Nyeri hebat</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.
Nafsu makan berkurang</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.
Asam lambung meningkat</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.
Reaksi mual</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.
Vasodilatasi</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">8.
syok septic/ infertilitas/ infeksi meluas</span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tanda
dan gejala</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -21.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Suhu
tinggi dengan demam tinggi </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Parametritis
ringan dapat menyebabkan suhu yang meninggi dalam nifas. Bila suhu tinggi menetap
lebih dari seminggu disertai rasa nyeri di kiri atau kanan ada nyeri sebelah
atau kedua belah di perut bagian bawah, sering memancar pada kaki.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 29.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada
perkembangan proses peradangan lebih lanjut gejala-gejala parametritis menjadi
lebih jelas. Pada pemeriksaan dalam dapat diraba tahanan padat dan nyeri di
sebelah uterus dan tahanan ini yang berhubungan erat dengan tulang panggul,
dapat meluas ke berbagai jurusan. Di tengah-tengah jaringan yang meradang itu
bisa tumbuh abses. Dalam hal ini, suhu yang mula-mula tinggi secara menetap
menjadi naik turun disertai dengan menggigil.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Penderita tampak sakit, nadi cepat, dan perut nyeri.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Nyeri unilateral tanpa gejala
rangsangan peritoneum, seperti muntah</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l4 level1 lfo14; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diagnosis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dalam
minggu pertama biasanya gejala-gejala setempat belum menunjukkan dengan nyata
adanya perluasan infeksi ; yang lebih penting ialah gejala umum. Seorang
penderita dengan infeksi yang meluas diluar porte d’entrée tampaknya sakit,
suhu meningkat dengan kadang-kadang disertai menggigil, nadi cepat, keluhannya
juga lebih banyak.</span></div>
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</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l4 level1 lfo14; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Prognosis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 28.35pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 28.35pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Yang
paling dapat dipercayai untuk membuat prognosa ialah nadi ; jika nadi tetap di
bawah 100 maka prognosa baik, sebaliknya kalau nadi di atas 130, apalagi kalau
tidak ikut turun dengan turunnya suhu prognosanya kurang baik.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 28.35pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 28.35pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Demam yang
continou adalah lebih buruk prognosanya dari demam yang remittens. Demam
menggigil berulang-ulang, insomnia dan icterus, merupakan tanda-tanda yang
kurang baik.Kadar Hb yang rendah dan jumlah leucocyt yang rendah atau sangat
tinggi memburukkan prognosa.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Juga kuman
penyebab yang ditentukan dengan pembiakan menentukan prognosa. Menurut
derajatnya septicemia merupakan infeksi yang paling berat dengan mortalitas
tinggi, dan yang segera diikuti oleh peritonitis umum. Pada Pelvioperitonitis
dan Sellulitis pelvis bahaya kematian dapat diatasi dengan pengobatan yang
sesuai. Abses memerlukan tindakan untuk mengeluarkan nanahnya.</span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penatalaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1) Pencegahan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Selama kehamilan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Oleh
karena anemia merupakan predisposisi untuk infeksi nifas, harus diusahakan
untuk memperbaikinya. Keadaan gizi juga merupakan factor penting, karenanya
diet yang baik harusdiperhatikan. Coitus pada hamil tua sebaiknya dilarang
karena dapat mengakibatkan pecahnya ketuban dan terjadinya infeksi.</span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Selama persalinan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 28.35pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Usaha-usaha
pencegahan terdiri dari membatasi sebanyak mungkin kuman-kuman dalam jalan
lahir, menjaga supaya persalinan tidak berlarut-larut, menyelesaikan persalinan
dengan trauma sedikit mungkin, dan mencegah terjadinya perdarahan banyak. Semua
petugas dalam kamar bersalin harus menutup hidung dan mulut dengan masker,
alat-alat, kain-kain yang dipakai dalam persalinan harus suci hama. Pemeriksaan
dalam hanya boleh dilakukan jika perlu, terjadinya perdarahan harus dicegah
sedapat mungkin dan transfusi darah harus diberikan menurut keperluan.</span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Selama nifas</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sesudah
partus terdapat luka-luka dibeberapa tempat pada jalan lahir. Pada hari pertama
postpartum harus dijaga agar luka-luka ini tidak dimasuki kuman-kuman dari
luar. Tiap penderita dengan tanda-tanda infeksi nifas jangan dirawat bersama
dengan wanita-wanita dalam nifas sehat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: 21.3pt;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> <b>Pengobatan</b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Antibiotika
memegang peranan yang sangat penting dalam pengobatan infeksi nifas. Karena
pemeriksaan-pemeriksaan ini memerlukan waktu, maka pengobatan perlu dimulai
tanpa menunggu hasilnya. Terapi pada parametritis yaitu dengan memberika
antibiotika berspektrum luas. Dalam hal ini dapat diberikan penicillin dalam
dosis tinggi atau antibiotika dengan spectrum luas, seperti ampicillin dan
lain-lain.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Disamping
pengobatan dengan antibiotika, tindakan-tindakan untuk mempertinggi daya tahan
badan tetap perlu dilakukan. Perawatan baik sangat penting, makanan yang
mengandung zat-zat yang diperlukan hendaknya diberikan dengan cara yang cocok
dengan keadaan penderita, dan bila perlu transfusi darah dilakukan.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Jika
keadaan sudah tenang dapat diberi terapi diatermi dalam beberapa seri dan
penderita dinasehatkan agar jangan melakukan pekerjaan yang berat- berat.
Dengan terapi ini biar pun sisa- sisa peradangan masih ada, keluahan- keluhan
penderita sering kali hilang atau sangat berkurang. Pada sellulitis
pelvika dan pelvioperitonitis perlu diamat-amati dengan seksama apakah terjadi
abses atau tidak. Jika terjadi abses, abses harus dibuka dengan menjaga supaya
nanah tidak masuk kedalam rongga peritoneum dan pembuluh darah yang agak besar
tidak sampai dilukai. Jika ditemukan abses, di tempat itu perlu diadakan
pembukaan tumor dan drainase karena selalu ada bahaya bahwa abses mencari jalan
ke jaringan tubuh yang lain. Kalau ada fluktasi perlu dilakukan insici. Tempat
insici ialah di atas lipat paha atau pada cavum douglas. </span></div>
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</div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> <b>Penanganan
</b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Beri
antibiotik seperti benzilpenisilin ditambah gentamisin dan metronidazol.<br />
Jika perlu, berikan obat pereda nyeri seperti pethidine 50-100 mg 1M setiap 6
jam.<br />
Jika ibu tidak membaik dalam 2 atau 3 hari, ibu harus segera di bawa ke rumah
sakit daerah.</span></div>
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</div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l3 level1 lfo13; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Adnexitis</span></b></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l4 level2 lfo14; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengertian </span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Adnexitis
adalah infeksi atau radang pada adnexa rahim. Adnexa adalah jaringan yang
berada di sekitar rahim, termasuk tuba fallopi dan ovarium.Istilah lain dari
adnexitis antara lain: pelvic inflammatory disease, salpingitis, parametritis,
salpingo-oophoritis.</span></div>
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</div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l20 level1 lfo15; tab-stops: list 56.7pt; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala:</span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Kram atau nyeri perut bagian bawah yang tidak berhubungan dengan haid(bukan pre
menstrual syndrome)</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Menorrhagia</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Keluar cairan kental berwarna kekuningan dari vagina</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Nyeri saat berhubungan intim</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Demam</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Nyeri punggung</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Keluhan saat buang air kecil</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l20 level1 lfo15; tab-stops: list 56.7pt; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyebab</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Radang
atau infeksi ini biasanya akibat infeksi yang menjalar ke atas dari uterus,
tetapi juga bisa datang dari tempat ekstra vaginal lewat jalan darah, atau
menjalar dari jaringan-jaringan di sekitarnya. Diantara sebab yang paling
banyak adalah infeksi gonorrhea(kencing nanah) dan Chlamidia, serta infeksi
setelah aborsi dan masa nifas. Selain itu juga sebagai akibat dari beberapa
tindakan, seperti kerokan, laparotomi, pemasangan IUD dan perluasan radang dari
alat yang letaknya tidak jauh seperti appendiks.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peradangan
biasanya disebabkan oleh infeksi bakteri, dimana bakteri masuk melalui vagina
dan bergerak ke rahim lalu ke tuba falopii. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">90-95%
kasus PID disebabkan oleh bakteri yang juga menyebabkan terjadinya penyakit
menular seksual (misalnya klamidia, gonore, mikoplasma, stafilokokus,
streptokokus). </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Infeksi
ini jarang terjadi sebelum siklus menstruasi pertama, setelah menopause maupun
selama kehamilan. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penularan
yang utama terjadi melalui hubungan seksual, tetapi bakteri juga bisa masuk ke
dalam tubuh setelah prosedur kebidanan/kandungan (misalnya pemasangan IUD,
persalinan, keguguran, aborsi dan biopsi endometrium). </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyebab
lainnya yang lebih jarang terjadi adalah: </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Aktinomikosis
(infeksi bakteri) </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Skistosomiasis
(infeksi parasit) </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Tuberkulosis. </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 35.45pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Penyuntikan zat warna pada pemeriksaan rontgen khusus. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span></span></div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l20 level1 lfo15; tab-stops: list 42.55pt; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Faktor
resiko terjadinya PID: </span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; tab-stops: 42.55pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Aktivitas
seksual pada masa remaja </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; tab-stops: 42.55pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Berganti-ganti
pasangan seksual </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; tab-stops: 42.55pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Pernah
menderita PID </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; tab-stops: 42.55pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Pernah
menderita penyakit menular seksual </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; tab-stops: 42.55pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Pemakaian alat kontrasepsi yang bukan penghalang.</span></div>
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</div>
<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l20 level1 lfo15; tab-stops: list .5in; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Terapi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyakit
ini dapat diterapi dengan pemberian antibiotika. Tergantung dari derajat
penyakitnya, biasanya diberikan suntikan antibiotik kemudian diikuti dengan
pemberian obat oral selama 10-14 hari. Beberapa kasus memerlukan operasi untuk
menghilangkan organ sumber infeksi, ini dilakukan jika terapi secara
konvensional (pemberian antibiotik) tidak berhasil. Jika terinfeksi penyakit
ini melalui hubungan seksual, maka pasangannya juga harus mendapat terapi
pengobatan, sehingga tidak terinfeksi terus menerus. Pembedahan perlu dilakuan
jika :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Jika terjadi ruptur atau abses ovarium</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Jika terjadi gejala-gejala ileus karena perlekatan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: .5in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Jika terjadi kesukaran untuk membedakan antara apendiksitis akuta dan
adneksitis akuta</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; tab-stops: 35.45pt; text-align: justify; text-indent: .5in;">
</div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; mso-add-space: auto; mso-list: l3 level1 lfo13; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">F.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">PERITONITIS</span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l20 level2 lfo15; tab-stops: list 31.5pt; text-align: justify; text-indent: -14.2pt;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Definisi</span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify; text-indent: .25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peritonitis adalah peradangan dinding kavum abdomen atau
peritoneum.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify; text-indent: .25in;">
</div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 35.45pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Etiologi</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Secara
umum peritonitis biasanya disebabkan oleh :</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.
Penyebaran infeksi dari organ perut yang terinfeksi.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify; text-indent: .25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Yang sering menyebabkan peritonitis adalah perforasi
lambung, usus, kandung empedu, appendiks, buli-buli dan pankreas. Sebenarnya
peritoneum sangat kebal terhadap infeksi, jika pemaparan tidak berlangsung
terus-menerus, tidak akan terjadi peritonitis dan peritoneum cenderung
mengalami penyembuhan jika diobati.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Luka tusuk karena bakteri dari pisau atau benda tajam yang masuk ke rongga
abdomen.<br />
3. Kelainan hati atau gagal jantung, dimana cairan bisa terkumpul di perut (asites)
dan mengalami infeksi.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.
Penyebabnya biasanya adalah infeksi pada pipa saluran yang ditempatkan di dalam
perut</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.
Iritasi tanpa infeksi</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 42.55pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Misalnya
peradangan pankreas (pankreatitis akut) atau bubuk bedak pada sarung tangan
dokter bedah juga dapat menyebabkan peritonitis tanpa infeksi. <br />
6. Infeksi dari rahim dan saluran telur yang mungkin disebabkan oleh beberapa
jenis kuman (termasuk yang menyebabkan gonorrhoe dan infeksi chlamidia).<br />
<b style="mso-bidi-font-weight: normal;"><br />
3. Patofisiologi </b></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify; text-indent: 28.35pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peradangan menimbulkan akumulasi
cairan karena kapiler dan membran mengalami kebocoran. Respon umum terhadap
kehilangan cairan intravaskular ini digariskan dalam gambar l. Jika defisit
cairan tidak dikoreksi secara cepat dan agresif, maka dapat menimbulkan
kematian sel. Pelepasan berbagai mediator seperti interleukin, dapat memulai
kaskade respons hiperinflamatoris, sehingga membawa perkembangan selanjutnya
dari kegagalan banyak organ. Karena tubuh mencoba mengkompensasi dengan cara
retensi cairan dan elektrolit oleh ginjal, produk buangan juga ikut menumpuk.
Takikardia awalnya meningkatkan curah jantung, tetapi ini segera gagal begitu
terjadi hipovolemia. Terjebaknya cairan di dalam cavum peritonealis dan lumen,
lebih lanjut meningkatkan tekanan intra abdomen, membuat usaha pernafasan penuh
menjadi sulit dan menimbulkan penurunan perfusi splanik.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify; text-indent: 28.35pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala sisa metabolik mencakup
katabolisme otot untuk menyediakan asam amino skeleton untuk sintesis energi
dan protein fase akut. Cadangan glikogen hati dengan cepat berkurang secara
dini dalam perjalanan peritonitis, dan terjadi resistensi insulin relatif.
Bahkan dengan pemberian protein dan kalori dari luar (eksogen), lingkungan
hormonal dapat mencegah penggunaan penuhnya untuk mendukung hospes.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">KLASIFIKASI<br />
A. Peritonitis Primer</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peritonitis
yang disebabkan oleh penyebaran infeksi dari darah dan limfe ke peritoneum.<br />
Pembagian peritonitis berdasarkan kuman penyebab:</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.
Peritonitis Streptococcus</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyebabnya adalah Streptococcus ß haemolitikus, penderita
terbanyak berusia ± 4 tahun akibat infeksi saluran pernafasan, seperti
tonsilitis atau faringitis.</span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peritonitis
pneumococcus</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyebabnya
adalah pneumococcus, penderita terbanyak adalah anak perempuan berusia 3-10 tahun,
akibat vaginitis dan salphingitis. Selain itu dapat disebabkan oleh pneumonia
dan infeksi telinga tengah.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.
Peritonitis gonococcus</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sering
terjadi pada wanita dewasa karena salphingitis.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peritonitis
tuberculosis</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyebabnya
adalah Mycobacterium tuberculosa dan dapat terjadi pada semua golongan umur.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">B. Peritonitis Sekunder</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peritonitis
yang disebabkan oleh masuknya bakteri atau enzim ke peritoneum, biasanya :</span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Infeksi
peritoneum akut bisa disebabkan oleh perforasi gastrointestinal atau nekrosis pankreas.</span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sering
disebabkan oleh organisme aerob dan anaerob. Organisme yang paling sering
adalah E. coli dan Bacteroides fragilis.</span></div>
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</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pemasangan
benda asing ke dalam rongga peritoneum pada :<br />
1) Kateter Ventrikulo - Peritoneal yang dipasang pada pengobatan hidrosefalus<br />
2) Kateter Peritoneo - Jugular untuk mengurangi asites</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3)
Continous Ambulatory Peritoneal Dialisis.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Tanda Dan Gejala Klinik</span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gambaran
klinis bervariasi sesuai dengan jenis dan luasnya agen penyebab, kondisi umum
penderita dan respon tubuh penderita terhadap inflamasi dan infeksi.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.
Nyeri abdomen, nyeri abdominal akut merupakan gejala khas, nyeri ini terjadi
tiba-tiba, hebat, dapat terlokalisir ataupun difus</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Muntah, pada awalnya merupakan refleks visceral. Muntah kemudian menetap
sebagai tanda peritonitis dan ileus.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.
Peningkatan denyut nadi, temperatur, dan frekuensi pernafasan. </span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.
Iritasi diafragma sehingga pernafasan menjadi cepat dan dangkal.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.
Nyeri tekan abdomen dan spasme otot. Nyeri lepas mungkin ditandai dengan tidak
adanya nyeri tekan.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.
Bising. usus menghilang dan ini merupakan tanda yang paling penting dari
peritonitis.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.
Distensi abdomen dalam berbagai tingkatan.</span></div>
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</div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tes Laboratorium</span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.
Leukositosis, hematokrit yang meningkat (hemokonsentrasi) dan metabolik
asdosis, pada peritonistis yang tidak di terapi, dapat terjadi
kegagalan-kegagalan ; pernapasan, hepatik dan renal</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.
Gambaran radiologik menunjukkan adanya distensi abdomen yang difus dari ileus
paralitik. Lingkaran batas cairan dan gas tersebar pada Gambaran usus halus dan
usus besar, berdilatasi, udara bebas dapat terlihat pada kasus – kasus
perforasi.<br style="mso-special-character: line-break;" />
<br style="mso-special-character: line-break;" />
</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6. Diagnosa</span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diagnosa
peritonitis akut, baik yang disebabkan oleh bakterial maupun kimiawi,</span></div>
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<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">S</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ecara
umum ditegakkan berdasarkan : </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">THERAPI<br />
Terapi pada peritonitis primer adalah dengan pemberian antibiotika bila
diagnosa telah ditegakkan. Sedangkan untuk peritonitis sekunder, terapi
bergantung pada penyakit dasarnya memerlukan tindakan bedah.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Langkah - langkah penatalaksanaan
peritonitis :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Mengistirahatkan traktus gastrointestinal
dengan puasa dan pemasangan selang nasogastrik yang bertujuan untuk
pengontrolan dekompresi terhadap distensi usus akibat ileus paralitik.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Atasi syok dan koreksi cairan dan
elektrolit. <br />
Resusitasi hebat dengan larutan salin isotonik adalah penting. Pengembalian
volume intravaskular memperbaiki perfusi jaringan dan pengantaran oksigen,
nutrisi, dan mekanisme pertahanan. Defisit kalium bertanggung jawab terhadap
inhibisi ileus setelah peritonitis sembuh. Pengeluaran urin dan tekanan
pengisian jantung harus dipantau.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Antibiotika berspektrum luas
diberikan secara empirik dan kemudian diubah jenisnya setelah hasil pembiakan
laboratorik keluar. Pilihan antibiotika didasarkan pada organisme mana yang
dicurigai menjadi penyebab. Antibiotika ini merupakan tambahan bagi drainase
bedah, walaupun drainase sendiri tidak mutlak harus dilakukan. Harus tersedia
dosis yang cukup pada saat pembedahan karena bakteremia akan berkembang selama
operasi.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Oksigen dan dukungan ventilasi.
Sepsis yang sedang berlangsung membawa ke hipoksemia yang disebabkan oleh
pintas dan splinting dinding dada. Penghantaran oksigen yang cukup adalah
penting. </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Obat - obat yang menstimulasi
aktivitas usus tidak boleh diberikan.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6. Penyakit yang berhubungan dan
akibat umum peritonitis harus diobati<br />
7. Pembedahan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Koreksi penyakit dasar.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 56.7pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hal ini menjadi peraturan
penatalaksanaan peritonitis yang fundamental. Penyingkiran atau penutupan
sumber kontaminasi peritoneal harus dilakukan segera. Segala usaha harus
dilakukan untuk membuang semaksimal mungkin benda asing dan material - material
infeksius.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l16 level2 lfo2; text-align: justify; text-indent: -.25in;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Cairan
peritoneal diaspirasi dan dibilas dengan larutan salin. Pembilasan dengan
antibiotika dan antiseptika masih diperdebatkan sampai sekarang.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l16 level2 lfo2; text-align: justify; text-indent: -.25in;">
<span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Drainase
(pengaliran) pada peritonitis umum tidak dianjurkan karena pipa itu dengan
segera ( dalam waktu hanya beberapa jam) menjadi terisolasi atau terpisah dari
ruangan yang dimaksudkan semula, mempengaruhi pertahanan peritoneum dan dapat
mengganggu organ dalam. Indikasi drainase adalah :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Pengumpulan pus yang terlokalisir.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 1.0in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•Suatu
daerah dari jaringan mati yang tidak dapat<br />
dibuang.<br />
• Penutupan organ berongga yang tidak aman.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 70.9pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">•
Kebocoran cairan tubuh seperti empedu, cairan pankreas, urin, cairan usus,
darah yang tidak dapat dihentikan dengan operasi.<br />
Kontaminasi retroperitoneal dengan faeces, pus, dan darah.</span><span style="font-family: Symbol; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-symbol-font-family: Symbol;"><span style="mso-char-type: symbol; mso-symbol-font-family: Symbol;"> </span></span><span lang="IN" style="mso-ansi-language: IN;"></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 70.9pt; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-list: l4 level1 lfo14; text-align: justify; text-indent: -.25in;">
<b style="mso-bidi-font-weight: normal;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perawatan pasca bedah harus sangat
seksama pada penderita yang keadaannya gawat. Antibiotika harus diberikan dan
bila perlu diganti. Ahli bedah harus waspada terhadap pembentukan abses. Posisi
setengah duduk (semi - Fowler) dapat mengumpulkan pus yang terbentuk pada
rongga pelvik, tetapi kegunaan posisi ini tidak sebesar yang dibayangkan.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 52.9pt; margin-right: 0in; margin-top: 0in; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
KOMPLIKASI <br />
a. Hipovolemia pada penderita peritonitis kimiawi.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: 3.25pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.Sepsis
pada penderita peritonitis bakterial.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 70.9pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -.25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.Kegagalan
organ - organ tubuh (pulmoner, kardial, hepatik, renal),</span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mendahului kematian beberapa hari
sebelumnya.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 63.8pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: -10.9pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.Abses
abdominal dan perlengketan yang dapat menyebabkan obstruksi abdominal di
kemudian hari.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: 49.65pt; margin-right: 0in; margin-top: 0in; text-align: justify; text-indent: .25in;">
<span style="font-family: "Times New Roman","serif"; font-size: 13.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
PROGNOSA<br />
Prognosa peritonitis tergantung kepada usia penderita, penyakit yang
berhubungan, penyebab peritonitis, serta daya guna dan kesigapan tindakan bedah
itu sendiri</span></div>
Anonymoushttp://www.blogger.com/profile/13798154464490898014noreply@blogger.com0tag:blogger.com,1999:blog-1138186865285931492.post-68580578559872698802014-01-29T05:04:00.001-08:002014-01-29T05:04:26.790-08:00cara tepat dan paling jitu dalam menolong persalinan<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L39"></a></h3>
Segera setelah plasenta dan selaput ketuban lahir, lakukan masase
uterus, letakkan telapak tangan di fundus dan lakukan masase dengan
gerakan melingkar secara lembut hingga uterus berkontraksi (fundus
teraba keras)<br />
<ul>
<li>Lakukan tindakan yang diperlukan jika uterus tidak berkontraksi setelah 15 detik melakukan rangsangan taktil/ masase. <br />
</li>
</ul>
<h2>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="BIX">IX. Menilai Perdarahan</a> </h2>
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L40">Langkah 40</a></h3>
Periksa kedua sisi plasenta baik bagian ibu maupun bayi dan pastikan
selaput ketuban lengkap dan utuh. Masukkah plasenta ke dalam kantung
plastik atau tempat khusus. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L41"">Langkah 41</a></h3>
Evaluasi kemungkinan laserasi pada vagina dan perineum. Lakukan penjahitan bila laserasi menyebabkan perdarahan. <br />
<h2>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="BX">X. Melakukan Asuhan Pasca Persalinan</a> </h2>
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L42">Langkah 42</a></h3>
Pastikan uterus berkontraksi dengan baik dan tidak terjadi perdarahan pervaginam. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L43">Langkah 43</a></h3>
Beri cukup waktu untuk melakukan kontak kulit ibu – bayi (di dada ibu paling sedikit 1 jam)<br />
<ul>
<li>Sebagian besar bayi akan berhasil melakukan inisiasi menyusu dini
dalam waktu 30-60 menit. Menyusu pertama biasanya berlangsung sekitar
10-15 menit. Bayi cukup menyusu dari satu payudara<br />
</li>
<li>Biarkan bayi berada di dada ibu selama 1 jam walaupun bayi sudah berhasil menyusu. </li>
</ul>
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L44">Langkah 44</a></h3>
Lakukan penimbangan/ pengukuran bayi, beri tetes mata antibiotik
profilaksis, dan vitamin K1 1mg intramuskular di paha kiri anterolateral
setelah satu jam kontak kulit ibu – bayi. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L45">Langkah 45</a></h3>
Berikan suntikan imunisasi Hepatitis B (setelah satu jam pemberian Vitamin K1) di paha kanan anterolateral.<br />
<ul>
<li>Letakkan bayi di dalam jangkauan ibu agar sewaktu-waktu bisa disusukan<br />
</li>
<li>Letakkan kembali bayi pada dada ibu bila bayi belum berhasil menyusu
di dalam satu jam pertama dan biarkan sampai bayi berhasil menyusu.</li>
</ul>
<em><strong><br />
</strong></em><br />
<em><strong>Evaluasi</strong></em> <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L46">Langkah 46</a></h3>
Lanjutkan permantauan kontraksi dan mencegah perdarahan per vaginam<br />
<ul>
<li>2-3 kali dalam 15 menit pertama pasca persalinan<br />
</li>
<li>Setiap 15 menit pada 1 jam pertama pasca persalinan<br />
</li>
<li>Setiap 20-30 menit pada jam kedua pasca persalinan<br />
</li>
<li>Jika uterus tidak berkontraksi dengan baik, melakukan asuhan yang sesuai untuk menatalaksana atonia uteri. </li>
</ul>
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L47">Langkah 47</a></h3>
Ajarkan ibu/ keluarga cara melakukan masase uterus dan menilai kontraksi.<br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L48">Langkah 48</a></h3>
Evaluasi dan estimasi jumlah kehilangann darah. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L49">Langkah 49</a></h3>
Periksa nadi ibu dan keadaan kandung kemih setiap 15 menit selama 1 jam
pertama pasca persalinan dan setiap 30 menit selama 2 jam pertama
persalinan<br />
<ul>
<li>Periksa temperatur ibu sekali setiap jam selama 2 jam pertama pasca persalinan<br />
</li>
<li>Melakukan tindakan yang sesuai untuk temuan yang tidak normal.</li>
</ul>
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L50">Langkah 50</a></h3>
Periksa kembali kondisi bayi untuk memastikan bahwa bayi bernapas dengan
baik (40-60 kali/ menit) serta suhu tubuh normal (36,5 – 37,5). <br />
<br />
<strong><em><br />
</em></strong><br />
<strong><em>Kebersihan dan keamanan </em></strong><br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L51">Langkah 51</a></h3>
Tempatkan semua peralatan bekas pakai dalam larutan klorin 0,5% untuk
dekontaminasi (10 menit). Cuci dan bilas peralatan setelah
didekontaminasi. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L52">Langkah 52</a></h3>
Buang bahan-bahan yang terkontaminasi ke tempat sampah yang sesuai. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L53">Langkah 53</a></h3>
Bersihkan badan ibu menggunakan air DTT. Bersihkan sisa cairan ketuban,
lendir dan darah. Bantu ibu memakai pakaian yang bersih dan kering. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L54">Langkah 54</a></h3>
Pastikan ibu merasa nyaman, Bantu ibu memerikan ASI. Anjurkan keluarga
untuk memberi ibu minuman dan makanan yang diinginkannya. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L55">Langkah 55</a></h3>
Dekontaminasi tempat bersalin dengan larutan klorin 0,5%. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L56">Langkah 56</a></h3>
Celupkan sarung tangan kotor ke dalam larutan klorin 0,5%, balikkan
bagian dalam keluar dan rendam dalam larutan klorin 0,5% selama 10
menit. <br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L57">Langkah 57</a></h3>
Cuci kedua tangan dengan sabun dan air bersih mengalir kemudian keringkan dengan tissue atau handuk yang kering dan bersih. <br />
<br />
<strong><em><br />
</em></strong><br />
<strong><em>Dokumentasi </em></strong><br />
<h3>
<a href="http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html" name="L58">Langkah 58</a></h3>
Lengkapi partograf (halaman depan dan belakang), periksa tanda vital dan asuhan kala IV.
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sumber : http://www.nengbidan.com/2012/04/58-langkah-asuhan-persalinan-normal-apn.html<br /><div class="post-footer-line post-footer-line-3">
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Anonymoushttp://www.blogger.com/profile/13798154464490898014noreply@blogger.com0tag:blogger.com,1999:blog-1138186865285931492.post-86387600554816629422014-01-29T01:04:00.001-08:002014-01-29T01:04:45.144-08:00wahh,,gangguan stress hilang sekejap dengan ,elihat yang satu ini nihhh,,!!!<div class="separator" style="clear: both; text-align: center;">
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