Curriculum Vitae

Name : dr. Alfa Putri Meu5a, Sp. OG, Subsp. Urogin RE

Educa5on :
• 2007 Faculty of Medicine Universitas Indonesia
• 2013 OBGYN Faculty of Medicine Universitas Indonesia
• 2016 Urogyne Consultant Faculty of Medicine Universitas Indonesia
• 2018 Fellowship on Advanced Pelvic Organ Prolapse Surgeries
(Laparoscopy and transvaginal mesh), Kameda Medical Center, Japan
Current posi5on:
• Terminology and StandardizaTon CommiUee- InternaTonal Urogynecological
AssociaTon
• Training commiUee-Kolegium Obstetri Ginekologi Indonesia
• Treasurer P2KS JNPK-KR
• Medical staff Department of Obstetrics and Gynecology FKUI-RSCM
Organiza5on: IUGA, PERKINA, HUGI, POGI, IDI
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Prolaps Organ Panggul (POP)
Pasca Persalinan
Alfa Putri Meutia

Divisi Uroginekologi Rekonstruksi dan Este5k

Departemen Obstetri Ginekologi FKUI-RSCM
 Outline
Pendahuluan
Persalinan sebagai faktor risiko POP
Diagnosis POP
Tatalaksana POP
Kapan harus dirujuk?
Tips Pencegahan POP
Take Home Messages
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 Apakah ini normal?
Terasa seperT ada yang turun/tertarik kebawah

Tidak nyaman saat duduk, terasa ada yang mengganjal

Teraba benjolan saat cebok

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 Pendahuluan

It is recognised that many women These symptoms are oaen

develop symptoms of pelvic floor perceived by women as a normal
dysfuncTon during or aaer consequence of childbirth and
pregnancy and childbirth. they may not seek help.
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Patofisiologi POP pada Kehamilan dan Persalinan
Studi oleh Rahn et al:
Perubahan fisiologis terjadi pada
otot dasar panggul dan jaringan dinding vagina pada wanita
ikat selama kehamilan. hamil lebih mudah untuk
distensi dan fleksibel
dibandingkan wanita yang Tdak
hamil.

Progesteron dalam jumlah Sintesis abnormal atau

besar mempengaruhi dasar degradasi serat kolagen dan
panggul dengan menyebabkan elasTn dinding vagina
relaksasi otot polos dan sebagai berkontribusi pada patofisiologi
antagonis efek estrogen. prolaps.

Razzak L. Pathophysiology of pelvic organ prolapse. Pelvic Floor Disorders. 2018;

 hOps://riskcalc.org/UR_CHOICE/

Wilson D, Dornan J, Milsom I, Freeman R. Ur-choice: Can we provide mothers-to-be with informaTon about the risk of
future pelvic floor dysfuncTon? InternaTonal Urogynecology Journal. 2014;25(11):1449–52.
 Event case study for Pelvic Organ Prolapse (POP)
OBS = N paTents in each study, CI Confidence Interval and Forest plot

Data yang diperoleh dalam systema'c review ini menunjukkan prevalensi POP sebesar
14,2% pada wanita post partum. Pelaporan POP terhitung kompleks karena diagnosis POP
memerlukan pemeriksaan dalam vagina.

Persalinan pervaginam meningkatkan prevalensi gangguan dasar panggul sebesar 2 kali lipat
dibandingkan secTo cesarea, secara khusus risiko POP meningkat 3 kali lipat. Namun
demikian dampak prevenTf SC terhadap POP hanya bersifat sementara.

Barca JA, Bravo C, Pintado-Recarte MP, Asúnsolo Á, Cueto-Hernández I, Ruiz-Labarta J, et al. Pelvic floor morbidity following vaginal
delivery versus cesarean delivery: SystemaTc review and meta-analysis. Journal of Clinical Medicine. 2021;10(8):1652.
Rørtveit G, Hannestad YS. Sammenheng Mellom forløsningsmetode og Bekkenbunnssvikt. Tidsskria for Den norske
legeforening. 2014;134(19):1848–52.
 Koc O, Duran B. Role of elecTve cesarean secTon in
prevenTon of Pelvic Floor Disorders. Current Opinion in
Obstetrics & Gynecology. 2012;24(5):318–23.
Gejala Klinis
 Visual,
Pelvic floor
speculum, POP-Q
ultrasound
bimanual

Metode
Uroflowmetry Urodynamics Cystoscopy
DiagnosTk
CT scan
Defecography Pelvic MRI abdomen &
pelvis
 Sistem Klasifikasi

● Saat ini klasifikasi dinilai dengan Pelvic Organ Prolapse-Quan'fica'on (POP-Q)

● TiTk acuan adalah hymen
● Posisi di atas hymen ditulis dengan angka negaTf cm dan di bawah hymen dengan angka posiTf cm.
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Supported by:
 Pelvic Floor Strength

POP
Vaginal Laxity
Vaginismus
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26
Pelvic Floor Ultrasound

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26
Care pathway for the management and referral of pelvic organ prolapse (pop) [Internet]. Care Pathway for the Management and Referral of Pelvic Organ Prolapse (POP)
| Australian Commission on Safety and Quality in Health Care. [cited 2022Oct29]. Available from: hUps://www.safetyandquality.gov.au/publicaTons-and-resources/
resource-library/care-pathway-management-and-referral-pelvic-organ-prolapse-pop
 Pelvic Floor
Muscle Training
• Kegel exercises – terdiri dari
serangkaian kontraksi volunter dari
dasar panggul.
• Beberapa ahli merekomendasikan
untuk melakukan laThan Kegel 3
kali sehari dalam 10 hingga 15
repeTsi.

Wallace S, Miller L, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in
Obstetrics & Gynecology. 2019;31(6):485-493.
hUps://www.uptodate.com/contents/vaginal-pessaries-indicaTons- Pesarium
devices-and-approach-to-selecTon?
topicRef=8072&source=see_link#H2158876212
Pesarium
Vaginal

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 Cara memilih pesarium yg tepat

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Femicushion

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 Indikasi Rujukan ke SpOG
• POP simptomaTk:
– Disfungsi seksual
– Kesulitan berkemih
– InkonTnensia urgensi dan frekuensi
– Dispareunia
– KonsTpasi dan inkonTnensia alvi
– Hidronefrosis
– NefropaT obstrukTf
• Pasien menginginkan intervensi pembedahan
 •Persalinan pervaginam berkaitan erat
dengan patofisiologi POP

Take Home
•Diagnosis dan penanganan awal POP
Messages dapat dilakukan pada layanan primer

•Skrining dan pencegahan POP dapat

diterapkan melalui edukasi secara
komprehensif
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