24 | Jurnal Kedokteran Mulawarman, 2018; 6(3) ISSN 2443-0439 KARAKTERISTIK PENDERITA PERDARAHAN UTERUS ABNORMAL DI RSUD ABDUL WAHAB SJAHRANIE SAMARINDA 2015-2016 Manalu Sesilia Anita Tiodora a , Novia Fransiska b , Hadi Irawiraman c a Program Studi Kedokteran, Fakultas Kedokteran Universitas Mulawarman b Bagian Obstetri dan Ginekologi RSUD Abdul Wahab Sjahranie Samarinda c Bagian Patologi Anatomi RSUD Abdul Wahab Sjahranie Samarinda Korespondensi: [email protected]Abstrak Perdarahan uterus abnormal (PUA) mengacu pada frekuensi, durasi, atau kuantitas perdarahan menstruasi yang tidak normal, yang merupakan penyebab lebih dari 70% kunjungan ke dokter ginekologi pada wanita perimenopause dan pascamenopause. Penelitian ini bertujuan mengetahui distribusi usia penderita, paritas, keluhan utama, gambaran histopatologi, dan kadar hemoglobin pada kasus PUA di RSUD Abdul Wahab Sjahranie Samarinda periode 2015-2016. Penelitian deskriptif retrospektif menggunakan data rekam medik penderita PUA. Hasil penelitian menunjukkan dari 165 kasus PUA didapatkan sebagian besar pasien berusia antara 41-50 tahun, yaitu 53,94% pasien dan paling jarang ditemukan pada usia >60 tahun, yaitu 1,82% pasien. Multipara adalah paritas mayor pada kasus PUA, yaitu 59,40% pasien dan grande multipara adalah paritas minor pada kasus PUA, yaitu 7,27% pasien. Perdarahan pervaginam adalah keluhan utama yang paling dominan, yaitu 81,21% pasien dan infertilitas merupakan keluhan utama yang paling jarang, yaitu 0,61% pasien. Hasil histopatologi yang paling umum adalah hiperplasia endometrium simpel, yaitu 49,56% pasien dan tidak ditemukan endometrium fase sekresi. Anemia berat merupakan kadar hemoglobin yang paling dominan, yaitu 51,75% pasien dan kadar hemoglobin normal paling jarang ditemukan, yaitu 11,40% pasien. Disimpulkan bahwa, penderita PUA di RSUD Abdul Wahab Sjahranie Samarinda periode 2015-2016 paling sering pada usia 41-50 tahun, multipara, keluhan utama perdarahan pervaginam, hasil histopatologi hiperplasia endometrium simpel, dan anemia berat. Kata Kunci: perdarahan uterus abnormal (PUA), paritas, gambaran histopatologi, kadar hemoglobin Abstract Abnormal uterine bleeding (AUB) refers to a frequency, duration, or quantity of abnormal menstrual bleeding, which is the cause of more than 70% of visits to gynecologist in perimenopausal and postmenopausal women. The aims of this study was to know the distribution of patient’s age, parity, major complaints, histopathological pattern, and hemoglobin levels in AUB cases at RSUD Abdul Wahab Sjahranie Samarinda in the 2015-2016 period. A retrospective descriptive study was done using medical record data of AUB patients. The results show from 165 AUB cases obtained most of the patients were between 41-50 years of age was 53.94% patients and most rarely found at the age of >60 years was 1.82% patients. Multiparous was the major parity in AUB cases was 59.40% patients and grand multiparous was the minor parity in AUB cases was 7.27% patients. Vaginal bleeding was the most dominant major complaints was 81.21% patients and infertility was the most infrequent major complaints was 0.61% patients. The commonest histopathology results was simple endometrial hyperplasia was 49.56% patients and secretory endometrium phase wasn’t found. Severe anemia was the most dominant hemoglobin levels was 51.75% patients and normal hemoglobin levels was most rarely found was 11.40% patients. It was concluded that AUB patients at RSUD Abdul Wahab Sjahranie Samarinda in the 2015-2016 period most often at the age of 41-50 years, multiparous, the major complaints was vaginal bleeding, the histopathology results was simple endometrial hyperplasia, and severe anemia.
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KARAKTERISTIK PENDERITA PERDARAHAN UTERUS ABNORMAL DI RSUD ABDUL WAHAB SJAHRANIE SAMARINDA 2015-2016
Manalu Sesilia Anita Tiodoraa, Novia Fransiskab, Hadi Irawiramanc
a Program Studi Kedokteran, Fakultas Kedokteran Universitas Mulawarman b Bagian Obstetri dan Ginekologi RSUD Abdul Wahab Sjahranie Samarinda c Bagian Patologi Anatomi RSUD Abdul Wahab Sjahranie Samarinda Korespondensi: [email protected]
Abstrak Perdarahan uterus abnormal (PUA) mengacu pada frekuensi, durasi, atau kuantitas perdarahan menstruasi yang tidak normal, yang merupakan penyebab lebih dari 70% kunjungan ke dokter ginekologi pada wanita perimenopause dan pascamenopause. Penelitian ini bertujuan mengetahui distribusi usia penderita, paritas, keluhan utama, gambaran histopatologi, dan kadar hemoglobin pada kasus PUA di RSUD Abdul Wahab Sjahranie Samarinda periode 2015-2016. Penelitian deskriptif retrospektif menggunakan data rekam medik penderita PUA. Hasil penelitian menunjukkan dari 165 kasus PUA didapatkan sebagian besar pasien berusia antara 41-50 tahun, yaitu 53,94% pasien dan paling jarang ditemukan pada usia >60 tahun, yaitu 1,82% pasien. Multipara adalah paritas mayor pada kasus PUA, yaitu 59,40% pasien dan grande multipara adalah paritas minor pada kasus PUA, yaitu 7,27% pasien. Perdarahan pervaginam adalah keluhan utama yang paling dominan, yaitu 81,21% pasien dan infertilitas merupakan keluhan utama yang paling jarang, yaitu 0,61% pasien. Hasil histopatologi yang paling umum adalah hiperplasia endometrium simpel, yaitu 49,56% pasien dan tidak ditemukan endometrium fase sekresi. Anemia berat merupakan kadar hemoglobin yang paling dominan, yaitu 51,75% pasien dan kadar hemoglobin normal paling jarang ditemukan, yaitu 11,40% pasien. Disimpulkan bahwa, penderita PUA di RSUD Abdul Wahab Sjahranie Samarinda periode 2015-2016 paling sering pada usia 41-50 tahun, multipara, keluhan utama perdarahan pervaginam, hasil histopatologi hiperplasia endometrium simpel, dan anemia berat.
Kata Kunci: perdarahan uterus abnormal (PUA), paritas, gambaran histopatologi, kadar hemoglobin
Abstract Abnormal uterine bleeding (AUB) refers to a frequency, duration, or quantity of abnormal menstrual bleeding, which is the cause of more than 70% of visits to gynecologist in perimenopausal and postmenopausal women. The aims of this study was to know the distribution of patient’s age, parity, major complaints, histopathological pattern, and hemoglobin levels in AUB cases at RSUD Abdul Wahab Sjahranie Samarinda in the 2015-2016 period. A retrospective descriptive study was done using medical record data of AUB patients. The results show from 165 AUB cases obtained most of the patients were between 41-50 years of age was 53.94% patients and most rarely found at the age of >60 years was 1.82% patients. Multiparous was the major parity in AUB cases was 59.40% patients and grand multiparous was the minor parity in AUB cases was 7.27% patients. Vaginal bleeding was the most dominant major complaints was 81.21% patients and infertility was the most infrequent major complaints was 0.61% patients. The commonest histopathology results was simple endometrial hyperplasia was 49.56% patients and secretory endometrium phase wasn’t found. Severe anemia was the most dominant hemoglobin levels was 51.75% patients and normal hemoglobin levels was most rarely found was 11.40% patients. It was concluded that AUB patients at RSUD Abdul Wahab Sjahranie Samarinda in the 2015-2016 period most often at the age of 41-50 years, multiparous, the major complaints was vaginal bleeding, the histopathology results was simple endometrial hyperplasia, and severe anemia.
testosteron), tetapi sebagian besar akan dikonversi
oleh enzim aromatase di sel-sel granulosa menjadi
estrogen. Korpus luteum berdiameter 1,5 cm,
dicapai dalam 7-8 hari setelah ovulasi. Korpus
luteum mulai berinvolusi dan akhirnya kehilangan
fungsi sekresi juga sifat warna kekuningan lipidnya
dalam 12 hari setelah ovulasi, menjadi korpus
albikans, beberapa minggu berikutnya, korpus
albikans akan digantikan oleh jaringan ikat dan
dalam beberapa bulan akan diserap.40 Perdarahan
pada fase sekresi disebabkan oleh karena
perdarahan uterus disfungsional siklus ovulasi dan
defek utama pada kontrol proses regulasi volume
darah yang hilang selama gangguan menstruasi
endometrium.36
Kasus Perdarahan Uterus Abnormal menurut
Kadar Hemoglobin
Kadar hemoglobin yang paling banyak
ditemukan pada penderita PUA di RSUD Abdul
Wahab Sjahranie Samarinda Periode 2015-2016
adalah kurang dari 8,0 gr/dl (anemia berat), yaitu
sebanyak 59 kasus (51,75%). Hasil penelitian ini
serupa dengan penelitian yang dilakukan oleh
Roopina & Madhurima (2017) di Henry Ford
Hospital, Detroit, Michigan, United States of
America yang menyatakan bahwa kadar
hemoglobin penderita PUA yang paling banyak
ditemukan adalah kurang dari 8,0 gr/dl (anemia
berat), yaitu sebesar 90%.41 Sedangkan penelitian
yang dilakukan oleh Nebgen, Rhodes, Hartman,
Munsell, & Lu (2016) di Department of Gynecologic
Oncology and Reproductive Medicine, The
University of Texas MD Anderson Cancer Center
Institutional, Houston, Texas, United States of
America menunjukkan hasil kadar hemoglobin
penderita PUA yang paling banyak ditemukan
adalah 8,0-10,9 gr/dl (anemia sedang), yaitu
sebesar 42,10%.42
Banyak penderita PUA mengalami anemia
defisiensi besi karena kehilangan darah akut atau
kronis akibat perdarahan pervaginam yang
merupakan keluhan utama yang paling sering
ditemukan pada penderita PUA. PUA menyebabkan
anemia defisiensi besi dan membatasi aktivitas
normal pada dua per tiga wanita yang kehilangan
lebih dari 80 ml darah per siklus menstruasi.
Meskipun tujuan utama pengobatan penderita PUA
adalah untuk mengobati patologi yang mendasari
yang menyebabkan kehilangan darah yang
berlebihan. Tetapi, pengobatan anemia defisiensi
besi harus dilakukan secara bersamaan dengan
pengobatan patologi yang mendasarinya untuk
meningkatkan status kinerja keseluruhan dan
untuk meningkatkan persediaan zat besi dalam
tubuh.8
SIMPULAN
Berdasarkan hasil penelitian dapat
disimpulkan bahwa dari 165 kasus PUA di RSUD
Abdul Wahab Sjahranie Samarinda periode 2015-
2016 paling sering ditemukan pada kelompok usia
41-50 tahun, paritas 2-4 (multipara), keluhan
utama perdarahan pervaginam, histopatologi
hiperplasia endometrium simpel, dan kadar
hemoglobin <8,0 gr/dl (anemia berat).
UCAPAN TERIMA KASIH
Terima kasih kepada seluruh dosen pengajar,
staf akademik, kemahasiswaan, tata usaha, dan
seluruh staf Fakultas Kedokteran Universitas
Mulawarman, seluruh pihak RSUD Abdul Wahab
Sjahranie Samarinda, serta seluruh pihak yang
Jurnal Kedokteran Mulawarman, 2018; 6(3) | 33
telah membantu pelaksanaan penelitian ini atas
segala bantuan, kerja sama, pengertian, dan
kemudahan yang diberikan.
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