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ENDOMETRIOSIS

WHAT IS THE GENERAL


PRACTICE APPROACH?

STUDI KASUS
Ibu S, 25 th
Bersalin 3 hr yll Dukun
Anak meninggal wktu lahir
Melahirkan 2 hari 1 mlm,
ketuban pecah

STUDI KASUS 3 hari ini


Panas & menggigil
Perdarahan pervaginam
dokter pkm:
Pucat , S: 39 c, TD : 120/70
N:120/mnt
Uterus setinggi pusat
Nyeri perut bawah
Lokia merah

pertanyaan
1. Dx ? DD ?
2. 3 langkah pertama yang di buat?
Langkah selanjutnya?
3. Gx & tanda syok, tx nya?
4. Perbaikan & stabilisasi, asuhan yg
di perlukan?

Dx & DD
Dx Susp. Endometriosis

FIRST A FEW
QUESTIONS!
IS TREATMENT ALWAYS REQUIRED?
WHO NEEDS TREATMENT?
DOES ANY TREATMENT REALLY
WORK?
DOES TREATMENT IN YOUNG
WOMEN PREVENT INFERTILITY AND
PROGRESSION?

I DONT HAVE THE


ANSWERS
ENDOMETRIOSIS PROGRESSES IN
MOST CASES OF MODERATE AND
SEVERE DISEASE
SPON REGRESSION CAN OCCUR IN
UP TO 58% OF MILDER CASES
NATURAL HISTORY IS STILL
UNCHARTED TO A LARGE EXTENT

HOWEVER---MEDICAL TREATMENTS AND SURGERY


FAIL TO ARREST DISEASE IN UP TO A
THIRD
COMBINATIONS OF TREATMENTS HAVE
ALSO FAILED TO CONTROL DISEASE FOR
INDEFINITE PERIODS WHEN FOLLOWED
UP
PREGNANCY HAS A VARIABLE EFFECT
ON ENDOMETRIOSISPERSISTENCE,
REGRESSION AND PROGRESSION

AND ALSO--------ENDOMETRIOSIS MAY OCCUR IN THE


EARLY MENOPAUSE, USUALLY IN
ASSOCIATION WITH HRT
LAPAROSCOPIC ABLATION OF VISIBLE
ENDO IN INFERTILE WOMEN IS ASSOC
WITH SIGNIFICANTLY INCREASED
FERTILITY RATES
THERE IS NO DATA REGARDING EARLY
INTERVENTION WRT PREVENTION

PREVALENCE
NOT PRECISELY KNOWN2-5%
20-40% OF WOMEN IN INFERTILE
COUPLE RELATIONSHIPS VS 5% OF
FERTILE WOMEN
BUT ALSO FOUND IN 6-43% OF WOMEN
UNDERGOING LAPAROSCOPIC
STERILIZATION
52% OF TEENAGES WITH CPP
SYNDROME

Familial association
Relative Risk to siblings 2.3 overall
Relative Risk to sibs if severe endo
15

Risk factors
Single/nulliparous
Early menarche
Non oral contraception
Non smoker shorter cycle/longer
duration of flow
Dysplastic naevus syndrome,
melanoma

symptoms
90%
70%
75%
55%

severe dysmenorrohoea
chronic pelvic pain
dyspareunia
infertility

Infertility mechanisms
Adhesion Increased Cell
Defective
s
PGs
mediated folliculog
distorsion
gamete
enisis
inj
Chronic
Activated Increased LUFFS
salpingiti macroph prev. ABs
s
ag
Altered
Cytokines Fertilizati hyperprol
tubal
on failure actinaemi
motil
a
Impaired Sperm
Early
Luteal

Treatment of pain
NSAIDS: all significantly better
than placebo, studies vary which
one is best
Naproxen >mefanemic
acid>aspirin
Naproxen=ibuprofen
Naproxen only drug with significant
SEs

treatment of menstrual
pain
Treatment
evidence
Simple analgesics
Herbal remedies

level of
1
1

alcohol
2
Antidepressants/anxiolytics
2
OCPs
1
NSAIDS
3

ENDOMETRIOSIS PAIN
PSYCO-PHYSICAL TREATMENTSACCUPUNCTURE, MESSAGE,
RELAXATION, TENS
EXERCISE
ANTI-OESTROGEN DRUGS
LAPAROSCOPY/ OPEN SURGERY

LIMITATIONS OF DRUG
THERAPY
ONLY SHRINKS SOME TYPES OF
ENDOMETRIOSIS WHICH ARE
OESTROGEN SENSITIVE IE RED AND
BLISTER APPEARANCE NOT BROWN,
BLACK AND WHITE
SHRINKAGE NOT COMPLETE- USUALY
LEAVES MICRO DISEASE
RESULTS FOR INFERTILITY TREATMENT
NO BETTER THAN NO TREATMENT
DOES NOT DEAL WITH ADHESIONS

META-ANALYSIS MIN/MILD
ENDOMETRIOSIS
NO
TREAT
DRUG
THERAPY
SURGERY
IVF

PREG
RATE
44%

235

41%

418

1- 5

65%

912

1-6

20

257

FOLLOWUP
0.5-3