SKENARIO

Mrs. Retno, 30-year old woman P0A0 went to Puskesmas Semuntul due to discharge from the
vagina since 2 years ago. The discharge was excessively, smelly, itchy and disturbed her daily
activity. She also complaining that she still doesnt have baby after marriage for 1,5 years. She
hasnt been complaining about menstrual cycle and doesnt use contraception. His husband work
as a driver inter state and have sexual intercourse with other women was denial
In the examination findings :
Upon admission, she has been married for 1,5 years, P0A0, she hasnt been using any
contraception method, her LMP was 12.1.2017
Height= 153 cm; weight 58 kg; BP :120/80 mmHg; HR: 98x/min, RR: 20x/m, VAS :3
Head and neck examination within normal limit
Pretibial edema (-)
Gynaecology examination
Outer examination :
Abdomen was flat, simetrically, uterine not palpable, mass (-), pain (-), free fluid sign (-)
Inspeculo
Portio wasnt livide, closed external os, flour (+), whitehis with excessive and smelly, fluxus (-),
erotion/laseration/polyp (-), uterine sondage was AF 6 cm
Vaginal toucher:
Portio was firm, closed external os, uterine corpus within normal limit, left and right adnexal and
parametrial within normal limit, douglas pouch within normal limit
USG result:
Uterine was anteflexed, size and shape within normal limit
Both of adnexa within normal limit
C/ There is no internal genital disorder
Laboratory :
Hb 11,9g/dL, PLT: 265.000/mm3, WBC: 120.000/mm3

I. KLARIFIKASI ISTILAH
No Istilah Makna
1 Discharge Vaginal discharge, atau duh tubuh vagina adalah
cairan yang keluar dari vagina
2 Siklus menstruasi Perubahan dalam tubuh wanita, khususnya pada
bagian reproduksi yaitu ketika lapisan dinding rahim
(endometrium) yang menebal luruh karena tidak ada
pembuahan sel telur
3 Kontrasepsi Suatu cara atau metode atau alat yang digunakan
untuk mencegah pembuahan sehingga tidak terjadi
kehamilan
4 Portio livide Warna pucat kebiruan pada portio atau mulut rahim;
menandakan wanita dalam keadaan hamil
5 Os external Lubang atau pembukaan dari servix menuju vagina
6 Flour Sekret (bukan darah) yang keluar dari vagina, atau
keputihan
7 Fluxus Cairan mengalir yang keluar dari saluran reproduksi,
misalnya darah atau lendir
8 Anteflexi Letak rahim yang letaknya cenderung kedepan dan
condong kearah perut
9 Sondase uterine Cara untuk memasukkan alat melalui servix untuk
menentukan arah atau panjang kavum uteri
10 Adnexa Struktur yang mempunyai hubungan secara
structural atau fungsional dengan uterus, misalnya
tuba falopii, ovarium, dan jaringan penyokong

II. IDENTIFIKASI MASALAH

1. Mrs. Retno, 30-year old woman P0A0 went to Puskesmas Semuntul due to discharge
from the vagina since 2 years ago. The discharge was excessively, smelly, itchy and
disturbed her daily activity.
2. She also complaining that she still doesnt have baby after marriage for 1,5 years. She
hasnt been complaining about menstrual cycle and doesnt use contraception. His
husband work as a driver inter state and have sexual intercourse with other women was
denial
3. In the examination findings :
Her LMP was 12.1.2017
 Height= 153 cm; weight 58 kg; BP :120/80 mmHg; HR: 98x/min, RR: 20x/m, VAS: 3
Head and neck examination within normal limit
Pretibial edema (-)
4. Gynaecology examination
Outer examination :
Abdomen was flat, simetrically, uterine not palpable, mass (-), pain (-), free fluid sign (-)
Inspeculo
Portio wasnt livide, closed external os, flour (+), whitehis with excessive and smelly,
fluxus (-), erotion/laseration/polyp (-), uterine sondage was AF 6 cm
Vaginal toucher:
Portio was firm, closed external os, uterine corpus within normal limit, left and right
adnexal and parametrial within normal limit, douglas pouch within normal limit
5. USG result:
Uterine was anteflexed, size and shape within normal limit
Both of adnexa within normal limit
Laboratory :
Hb 11,9g/dL, PLT: 265.000/mm3, WBC: 12.000/mm3

III. ANALISIS MASALAH

1. Mrs. Retno, 30-year old woman P0A0 went to Puskesmas Semuntul due to discharge
from the vagina since 2 years ago. The discharge was excessively, smelly, itchy and
disturbed her daily activity.
a. Apa hubungan usia dengan riwayat obstetric? (normal atau tidak riwayatnya jika
dihubungkan dengan usia) 123
b. Apa hubungan keputihan kronis dengan infertilitas pada Nyonya Retno? 456
c. Apa makna klinis discharge Nyonya Retno yang banyak, berbau, gatal dan
menggangu aktifitas sehari-hari? 789
d. Bagaimana gambaran discharge fisiologis pada wanita? 10 1 2
e. Apa saja yang menyebabkan keputihan? (fisiologis dan non) 345
2. She also complaining that she still doesnt have baby after marriage for 1,5 years. She
hasnt been complaining about menstrual cycle and doesnt use contraception. His
husband work as a driver inter state and have sexual intercourse with other women was
denial
a. Apa penyebab Nyonya Retno belum mempunyai anak setelah 1,5 tahun menikah?
678
b. Apa hubungan siklus menstruasi yang normal dan tidak menggunakan kontrasepsi
dengan infertilitas pada Nyonya Retno? 910 1
c. Apakah hubungan pekerjaan suami dengan infertilitas pada Nyonya Retno? 234

3. In the examination findings :

Her LMP was 12.1.2017
Height= 153 cm; weight 58 kg; BP :120/80 mmHg; HR: 98x/min, RR: 20x/m, VAS: 3
Head and neck examination within normal limit
Pretibial edema (-)
a. Apa interpretasi dan mekanisme abnormal dari pemeriksaan fisik? 567
b. Adakah hubungan pretibial edema (-) dengan kasus? 8910
c. Adakah hubungan hasil pemeriksaan kepala dan leher dengan kasus? 123

4. Gynaecology examination
Outer examination :
Abdomen was flat, simetrically, uterine not palpable, mass (-), pain (-), free fluid sign (-)
Inspeculo
Portio wasnt livide, closed external os, flour (+), whitehis with excessive and smelly,
fluxus (-), erotion/laseration/polyp (-), uterine sondage was AF 6 cm
Vaginal toucher:
Portio was firm, closed external os, uterine corpus within normal limit, left and right
adnexal and parametrial within normal limit, douglas pouch within normal limit
a. Bagaimana interpretasi dan mekanisme abnormal hasil pemeriksaan ginekologi?
456
 b. Bagaimana interpretasi dari morfologi discharge yang ditemukan pada Nyonya
Retno? 789

5. USG result:
Uterine was anteflexed, size and shape within normal limit
Both of adnexa within normal limit
Laboratory :
Hb 11,9g/dL, PLT: 265.000/mm3, WBC: 12.000/mm3
a. Bagaimana gambaran hasil pemeriksaan USG? 10 1 2
b. Bagaimana interpretasi dan mekanisme abnormal hasil pemeriksaan
laboratorium? 345
Aspek Klinis
a. Diagnosis banding 678
b. Algoritma penegakan diagnosis 910 1
c. Diagnosis kerja 234
d. Epidemiologi 567
e. Etiologi 8910
f. Faktor resiko 123
g. Pathogenesis 456
h. Patofisiologi 789
i. Manifestasi klinis 10 1 2
j. Pemeriksaan penunjang (pap smearnyaa) 345
k. Komplikasi 678
l. Tatalaksana dan follow up 910 1
m. Edukasi dan pencegahan 234
n. Prognosis 567
o. SKDI 8910

LEARNING ISSUE
1. Infertilitas 1-5
2. Sistem Reproduksi Wanita (anatomi dan histofisiologi) 6-10
 3. Leucorrhea -semua

HIPOTESIS
1. Nyonya Retno, 30 tahun P0A0 mengalami keputihan kronis akibat kandidiasis
2. Nyonya Retno, 30 tahun P0A0 mengalami infertilitas akibat keputihan kronis

1 pit, 2 than, 3 ch, 4 stell, 5 ki, 6 dyk, 7 arm, 8 erlin, 9 dind, 10 ben