Penatalaksanaan Perdarahan Uterus Abnormal

Oleh :

dr.Eva Naomi Oretla

Penatalaksanaan definitif untuk perdarahan uterus abnormal disesuaikan dengan penyebab yang mendasarinya, mulai dari perubahan gaya hidup sederhana hingga histerektomi sesuai indikasi. Terapi nonmedikamentosa, terapi medikamentosa, dan terapi operatif disesuaikan dengan usia pasien, paritas, etiologi perdarahan, morbiditas yang menyertai, fertilitas, dampak pada kualitas hidup, dan preferensi pasien.[1,6,7,19]

Terapi Inisial

Triase awal pasien dengan perdarahan uterus abnormal mencakup penilaian stabilitas hemodinamik dan status kehamilan. Pasien yang tidak stabil memerlukan rujukan ke unit gawat darurat untuk stabilisasi dan rawat inap sebelum melanjutkan dengan evaluasi tambahan. Sementara itu, pasien yang stabil dapat dievaluasi lebih lanjut dalam pengaturan rawat jalan.

Referensi

1. Munro M G, Critchley H O, Fraser I S, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018;143:393–408 DOI: 10.1002/ijgo.12666
3. Behera M A. Abnormal (Dysfunctional) Uterine Bleeding. Medscape. 2018. https://emedicine.medscape.com/article/257007-overview
5. Chodankar R, Critchley H OD. Abnormal uterine bleeding (including PALM COEIN classification). Obstetrics Gynaecology and Reproductive Medicine. 2019;0:98-104. https://www.obstetrics-gynaecology-journal.com/article/S1751-7214(19)30027-2/pdf
6. Ozge Y, Tuncay Y, Orhun CM. Overview of Abnormal Uterine Bleeding in Adolescents: Diagnosis and Management. International Journal of Women’s Health and Reproduction Sciences. 2017;5(3):158-163 DOI:10.15296/ijwhr.2017.29
7. Kaunitz A M, McCullough D C, Burnett E H. Medical management of abnormal uterine bleeding in reproductive-age women. OBG Management.2019;31(11):30-36
8. Pinto-Benetti C L, Rosa-e-silva A C J, et al. Abnormal Uterine Bleeding. Rev Bras Ginecol Obstet. 2017. 39:358–368 DOI https://doi.org/10.1055/s-0037-1603807
11. Cheong Y, Cameron I T, Critchley HO. Abnormal uterine bleeding. British Medical Bulletin. 2017;123:103–114 doi: 10.1093/bmb/ldx027
15. Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2019;99(7):435-443
18. Singh PB, Purwar R, Mall RP. Clinical spectrum and causes of abnormal uterine bleeding in reproductive age according to two FIGO systems. The New Indian Journal of OBGYN. 2021; 8(1): 105-11. DOI - 10.21276/obgyn.2021.8.1.20
19. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. 2021. https://www.nice.org.uk/guidance/ng88
27. Adawiyah R, Mulyantoro I, et al. Randomized Controlled Trial of Tranexamic Acid’s Effect on Bleeding Length: A Study on DMPA Users with Abnormal Uterine Bleeding Who Receive Low-Dose Oral Contraceptive Pill. Journal of Biomedicine and Translational Research. 2020;6(1):1-5 DOI: https://doi.org/10.14710/jbtr.v6i1.4450
28. Augusto KL, Brilhante AVM, Modesto GCD, et al. Costs and mortality rates of surgical approaches to hysterectomy in Brazil. Rev Saude Publica.2018;52(25): 1-6 DOI: https://doi.org/10.11606/S1518-8787.2018052000129
29. Ibrahem M A, Abdel-Fattah M T. Endometrial ablation for dysfunctional uterine bleeding in low-resource settings: A randomized controlled trial. Res. J. Obstet. Gynecol. 2020;13:1-7 DOI: 10.3923/rjog.2020.1.7
32. De Silva NK. Abnormal uterine bleeding in adolescents: Management. Uptodate. 2021.
33. Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG COMMITTEE OPINION, Number 785. Obstet Gynecol 2019; 134:e71.

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