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REFRATKEPUTIHAN DALAM KEHAMILAN

KHARIMA SARI DELIA J510155086

KEPANITERAAN KLINIK RSUD KARANGANYARFAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH SURAKARTA

2015

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PENDAHULUAN

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Keham!a" # $%&'e' (a") me!*a+,a" *e%*a)a $e%-*aha" h&%m&"a! .

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'-m*e% ma,a"a" m,%&&%)a"'me ..a!am /a)"a

$e""),a+a" ,a.a% h&%m&" e'+%&)e" $a.aa,h%"(a me""),a+,a" %',& +e%a."(a,e$-+ha" $a+&!&)'

G!,&)e"

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R-m-'a" Ma'a!ah

e%.a'a%,a" !a+a% *e!a,a") . a+a'.%-m-',a" ma'a!ah 'e*a)a *e%,-+(a+- a$a 'aa e"' ,e$-+ha" (a")

+e%a. $a.a ,eham!a" .a" *a)ama"a$e"a")a"a""(a3

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ESTROGEN

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Ke$-+ha"De4"'

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K!a'4,a'Ke$-+ha" 4'&!&)'

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Ke$-+ha" F'&!&)'

a( *a%- !ah% -'a10 ha%  $e")a%-he'+%&)e" .a% $!a'e"+a +e%ha.a$ -+e%-' .a"/a)"a a""

7a,+- . 'e,+a% me"'+%-a'  +e%.a$a+$e")a%-h e'+%&)e"

Ha'%a+ 'e,'-a!  $e")e!-a%a" +%a"'-.a' .a%

.".") /a)"a

7a,+- .'e,+a% &/-!a'

'e,%e+ .a% ,e!e"a%'e%/,' -+e% me"a. !e*h e"e%

Ke!-a%"(a !e".% .a% /a)"a a,*a+ h&%m&" (a").$%&.-,' 'e!ama ,eham!a" (a+- e'+%&)e"

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Ke$-+ha" Pa+&!&)'"9e,'-'

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Ke$-+ha" $a+&!&)' $a.a :a"+a ham!(a") $a!") 'e%") +%a. a.a!ah "9e,'*e%-$a /a)"&'' *a,+e%a!

+%,&m&"a'' .a" ,a"..a'' ;K-!,a%"< D-%) 2005=

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Va)"&'' a,+e%a!

"9e,' )e"+a! $a!") 'e%") +e%a.O%)a"'me $e"(e*a* /a)"&'' *a,+e%a!*e%'9a+ ,&m$!e,' .a" *a'a"(a

.h-*-"),a" .e")a" "9e,' Gardnerellavaginalis, Mycoplasma hominis,Mobiluncuc sp., .a" *a,+e% a"ae%&*

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Ma"9e'+a' K!"'

50> $e".e%+a *e%'9a+ a'm+&ma+, !a *e%)ea!a*a'a"(a .+a".a .e")a" a.a"(a 'e,%e+ /a)"a(a") ,e%-h e"e% *e%:a%"a $-+h a*- a*- h"))a

,e,-""),-"")a" .e")a" *a- *-'-, a+a- am'a- *e%+am*ah 'e+e!ah me!a,-,a" h-*-")a"'e,.'-a!

e%.a'a%,a" $e"e!+a" . *e*e%a$a "e)a%a

*e%,em*a") /a)"&'' *a,+e%a! .a$a+me"m*-!,a" *e*e%a$a ,&m$!,a' $a.a ,eham!a"a"+a%a !a" ,e!ah%a" $%ema+-% ,e+-*a" $eah .",&%&am"&"+' .a" e".&me+%+' $&'+$a%+-m

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 T%,&m&"a''

Da$a+ +e%a. $a.a :a"+a ma-$-" $%a"am-" "'.e"' !e*h +")) $a.a :a"+aPe"-!a%a" -m-m"(a +e%a. me!a!- h-*-")a"'e,'-a! Nam-" $e"-!a%a" -)a *'a +e%a.me!a!- $a,aa" ha".-, a+a- *e%e"a")

Pe"(e*a* +%,&m&"a'' a.a!ah Trichomonasvaginalis $a%a'+ 4!9&%m' *e%-,-%a" 1518

m,%&" mem!, @ a)e!a .a" *e%)e%a,'e$e%+ )e!&m*a") h.-$ .a!am '-a'a"a $H5B5

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Ma"9e'+a' K!"'

Pa.a ,a'-' a,-+ ma"9e'+a' *e%-$a 'e,%e+/a)"a 'e%&$-%-!e" *e%:a%"a ,e,-""),-"")a"a+a- ,eha-a" *e%*a- +.a, e"a, .a" *e%*-'a

Peme%,'aa"  D".") /a)"a +am$a,,eme%aha" .a" 'em*a* Ka.a") +e%*e"+-, a*'e',e! $a.a .".") /a)"a .a" 'e%/,' (a").,e"a! 'e*a)a strawberry appearance

 Gea!a (a") +m*-! .a$a+ .'e%+a .'$a%e-"a$e%.a%aha" $&'+&+-' .a" $e%.a%aha" .!-a%',!-' me"'+%-a'

e*e%a$a $e"e!+a" me"-"-,,a" *ah:a+%,&m&""a'' .a!am ,eham!a" .a$a+

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Ka"..a''

A"),a ,ea.a" ,a"..a'' !e*h +"))$a.a :a"+a ham! .a" ..-)a*e%h-*-")a" .e")a" $e""),a+a" ,a.a%

e'+%&)e" .a" .e$&'' )!,&)e" ./a)"a Pa.a :a"+a ham! +e%a."(a,a"..a'' 'e%") *e%'9a+ %e,-%e"

Ka"..a'' .'e*a*,a" &!eh "9e,' am-% Candida albicans Jam-% "*e%'9a+ )%am $&'+9 'a$%&4+ *e%*e"+-,*-!a+ h"))a &/a! .a" *e%,em*a") *a,

.e")a" *!a'+&$&%a

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Ma"9e'+a' K!"'  Se,%e+ /a)"a (a") me"))-m$a! .a"

*e%:a%"a $-+h ,e"+a! Gea!a !a" a.a!ah

)a+a! .e")a" "+e"'+a' 'e.a") h"))a*e%a+ .'e%+a %a'a +e%*a,a% ,eme%aha".a" *e"),a, . .ae%ah )e"+a!

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Diagnosis

Da)"&'' &-% a!*-' .+e)a,,a"*e%.a'a%,a" )am*a%a" ,!"' .a"$eme%,'aa" $e"-"a")

A"am"e''C  D+a"(a,a" me")e"a -'a me+&.e

,&"+%a'e$' (a") .$a,a &!eh a,'e$+&% K,&"+a, 'e,'-a! $%!a,- -m!ah *a- .a"

:a%"a !e-,&%ea ma'a ",-*a' $e"(a,+(a") ..e%+a $e"))-"aa" &*a+ a"+*&+,a+a- ,&%+,&'+e%&. .a" ,e!-ha",e!-ha" !a"

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Peme%,'aa" Pe"-"a")

Ha'! $e")-,-%a" $H a%a" /a)"a .a$a+ .+e"+-,a".e")a" ,e%+a' $e")-,-% $H .a" $H .a+a' @5 'e%").'e*a*,a" &!eh +%h&m&"a'' +e+a$ +.a, -,-$ '$e'4,

a%a" -)a .a$a+ .$e%,'a .e")a" me!a%-+,a" 'am$e!

.e")a" 2 +e+e' !a%-+a" "&%ma! 'a!"e 0> .a+a' &*e,)!a'' .a" 'am$e! ,e.-a .!a%-+,a" .a!am KOH 10>Pe"-+-$ &*e, )!a'' .+-+-$ .a" .$e%,'a .*a:ahm,%&',&$

 T%h&ma /a)"a!' a+a- !-e e!!' ; 'e! e$+e! .e")a" *a+a'

(a") )e!a$ &!eh *a,+e% ,e! = *a'a"(a m-.ah..e"+4,a',a" $a.a $%e$a%a+ 'a!"e (a") ma"ame%-$a,a" ,a%a,+e%'+, .a% /a)"&'' *a,+e%

Se! %a) .a% a"..a !e*h m-.ah ..a$a+,a" $a.a$%e$a%a+ KOH

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 Ta+a!a,'a"a

Re)me" (a") .%e,&me".a',a" -"+-, T%,&m&"a'' /a)"a!' .a" /a)"&''*a,+e%a! (a+-C me+%&".a&! +a*!e+ @00

500m) 2 ,a! .a!am 'eha% 'e!ama 5Bha%

Re)me" (a") .%e,&me".a',a" -"+-,,a"..a'' /a)"a!' .a$a+ .*%,a"$%e$a%a+ &%a! *e%-$a F!-&"a&!e 150m).&'' +-"))a!

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A.a$-" a%aa%a $e"e)aha" ,e$-+ha"$a.a *- ham!C  H".a% $a,aa" .a!am (a") ,e+a+ .a" +.a,

me"(e%a$ ,e%")a+  P!h!ah $a,aa" .a!am (a") +e%*-a+ .a%

,a+-"

  Pe%ha+,a" ,e*e%'ha" .ae%ah "+m

   Ja")a" .-.-, $a.a +&!e+ -m-m ,a +.a,'a")a+ +e%$a,'a

  Ga"+!ah $a,aa" .a!am 'e+a$ ha%

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 TERIMA KASIH