HUBUNGAN ANTARA INFEKSI BAKTERIAL VAGINOSIS DENGAN KEJADIAN ABORTUS - Copy

HUBUNGAN ANTARA INFEKSI
BAKTERIAL VAGINOSIS DENGAN
KEJADIAN ABORTUS
Tigor Peniel Simanjuntak
Departemen Obstetri dan Ginekologi FK. UKI
SMF. Obstetri dan Ginekologi RSU. UKI
Jakarta
Bacterial Vaginosis (BV)
Infeksi vagina disebabkan oleh tergantinya flora
normal vagina (Lactobacillus spp) dengan
mikroorganisme anaerob dan mikroorganisme
fakultatif, seperti:
- Gardnerella vaginalis,
- Prevotella, Atopobium vaginae,
- Peptostreptococcus
- Bacteroides spp, Mobiluncus spp,
- Mycoplasma hominis,
- Ureaplasma urealyticum.
Fisiologis Lingkungan Mukosa Vagina
 PH : 3,5 – 4,5
 Mengandung mikro-organisme :
Lactobacillus spp, Atopobium vaginae,
Leptotrichia , dan Megasphaera
- Mensintesis asam laktat, Hidrogen
peroksida, antibiotic toxic hydroxyl
radicals, Bakteriosin, Probiotik.
Faktor yg Mempengaruhi Ekosistim Vagina
 Fluktuasi Hormon
Menstruasi
 Pembersih Vagina
Personal Hygiene
 Perilaku Seksual
 Hamil dan Menyusui
:
Sevi Giakoumelou1, Nick Wheelhouse2, Kate Cuschieri3, Gary
Entrican2,4, Sarah E.M. Howie5, and Andrew W. Horne1,*
The role of infection in miscarriage
Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, UK 2 Moredun Research Institute,
Pentlands Science Park, Bush Loan, Edinburgh EH26 0PZ, UK 3 Scottish HPV Reference Lab, Division of Lab Medicine,
Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK 4 The Roslin Institute and Royal (Dick) School of Veterinary
Studies, University of Edinburgh, Easter Bush, Midlothian EH25 9RG, UK 5 Centre for Inflammation Research, University
of Edinburgh, Edinburgh EH16 4TJ, UK
Human Reproduction Update. 2016; 22 (1): 116 – 33.
vaginal infection with bacterial vaginosis,
with increased risk of miscarriage has been
demonstrated.
BV Menyebabkan Abortus
Influence of bacterial vaginosis on conception and miscarriage in the first trimester:
cohort study S G Ralph, A J Rutherford, J D Wilson . BMJ VOLUME 319 24 JULY 1999
www.bmj.com
Abstract
Objectives To assess whether bacterial vaginosis affects the rates of conception and
miscarriage in the first trimester.
Results 190 of 771 (24.6%) women had bacterial vaginosis. No difference in
conception rate was found between those women with bacterial vaginosis and those
with normal vaginal flora: 61 women (32.1%) and 146 of 493 women (29.6%)
respectively (relative risk 1.08, 95% confidence interval 0.85 to 1.39; odds ratio 1.12,
0.77 to 1.64). However, 22 women (31.6%) with bacterial vaginosis who conceived
had a significantly increased risk of miscarriage in the first trimester compared with
27 women (18.5%) with normal vaginal flora (crude relative risk 1.95, 1.11 to 3.42;
crude odds ratio 2.49, 1.21 to 5.12). This increased risk remained significant after
adjustment for factors known to increase the rate of miscarriage: increasing
maternal age, smoking, history of three or more miscarriages, no previous live birth,
and polycystic ovaries (adjusted relative risk 2.03, 1.09 to 3.78; adjusted odds ratio
2.67, 1.26 to 5.63).
Patomekasime (1)
infeksi
IL- 6
PGF-2α – PGE-2
Kontraksi Uterus
Abortus
Patomekasime (2)
infeksi
CD4+CD25+FOXp3 Sel T Regulator
Th-1
TNF-α – IFN-ɣ
Trombosis,
Nekrosis
Abortus
Diagnosis :
1. Anamnesis :
2. PX. Obsteri :
3. PX. Sekret vagina:
- Metode Amsel
- Metode Nugent
- Kultur.
4. PX. Bio-molekular
Diagnosis : Metode Amsel
1. Peningkatan sekret vagina (bersifat
homogen)
2. PH Vagina : > 4,5
3. Whift test : Positif (Bau amis/ Fishy
odour)
4. Px mikroskopis : Clue cell positif
BV positif : Minimal 3 ditemukan
Diagnosis : Metode Nugent
Pewarnaan gram: Menghitung jumlah
kuman/ Lapangan pandang.
1. Lactobacillus
2. Gardnerella vaginalis
3. Mobiluncus
Diagnosis : Metode Nugent
Skor Gardnerella vaginalis : (Skor 0-4)
0 : Tidak ditemukan kuman/ lap pandang
1 : 1 kuman/ lap pandang
2 : 2 – 5 kuman/ lap pandang
3 : 6 – 30 kuman/ lap pandang
4 : > 30 kuman/ lap pandang
Diagnosis : Metode Nugent
Skor Lactobacillus spp : (Skor 0-4)
4 : Tidak ditemukan kuman/ lap pandang
3 : 1 kuman/ lap pandang
2 : 2 – 5 kuman/ lap pandang
1 : 6 – 30 kuman/ lap pandang
0 : > 30 kuman/ lap pandang
Diagnosis : Metode Nugent
Skor Mobiluncus spp : (Skor 0-4)
0 : Tidak ditemukan kuman/ lap pandang
1 : 1 - 4 kuman/ lap pandang
2 : ≥ 5 kuman/ lap pandang
Diagnosis : Metode Nugent
Rumus : Skor Gadnella + [4 - (Skor
Lactoballus)] + [ (Skor Mobiluncus/2)]
Hasil :
- Skor ≥ 6 : BV
- Skor 4 - 6 : Intermediate
- Skor 0 - 3 : Normal
Terapi:
Trimester I :
Clindamysin 2 x 300 mg = 7 hari
Trimester II dan III :
- Clindamysin 2 x 300 mg = 7 hari
- Metronidazol 2 x 500 mg = 7 hari
Take Home Message
BV pada kehamilan merupakan infeksi yang
sering bersifat asimtomatik.
Dagnosis BV berdasarkan kriteria Amsel
merupakan gold standard dari pemeriksaan BV,
dan pewarnaan gram dengan kriteria Nugent.
Terdeteksinya infeksi BV secara dini, dan
pengobatan secara tepat dapat menurunkan
risiko terjadinya abortus.
Take Home Message
Pengobatan
pada
trimester
I
dapat
menggunakan Clindamycin 300 mg 2 kali sehari
selama 7 hari.
Pengobatan pada trimester II dan III dapat
diberikan Metronidazole 500 mg oral 2 kali
sehari selama 7 hari, Metronidazole 250 mg
oral 3 kali sehari selama 7 hari, dan
Clindamycin 300 mg oral 2 kali sehari selama 7
hari.
Mauliate Godang...... Horas