Sindroma Asherman

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1

SARI PUSTAKA

MANAJEMEN SINDROMA ASHERMAN

Oleh:

I. B. Praja Putra Adnyana

Pem!m!n":

Dr. An#m Suard!$a% S&O' (K)

PRO'RAM PENDIDIKAN DOKTER SPESIA*IS I

BA'IAN+SM, OBSTETRI DAN 'INEKO*O'I

,K UNUD+RSUP SAN'*AH

DENPASAR

-/0



DA,TAR ISI

BAB I PENDAHULUAN …......................................................................... 1

BAB II KAJIAN PUSTAKA......................................................................... 3

2.1.Sindroma Asherman ................................................................................ 3

2.1.1 Definisi dan Eio!o"i .................................................................... 3

2.1.2 #a$or %isi$o ................................................................................ &

2.1.3 Dia"nosis ...................................................................................... &

2.1.' Tera(i ............................................................................................ 1)

2.2 Hiseros$o(i ............................................................................................ 1)

2.3 Pen*e"ahan Adhesi Ber+!an" .................................................................. 21

2.3.1 IUD ............................................................................................... 21

2.3.2 Intrauterine Balloon Stent ............................................................. 22

2.3.3 Foley Catheter ............................................................................... 23

2.3.' Asam Hia!+rona ........................................................................... 23

BAB III SI,PULAN .................................................................................... 2-

DA#TA% PUSTAKA .................................................................................... 2



DA,TAR TABE*

Ha!aman

Ta/e! 2.1 #a$or %isi$o Sindrom Asherman ................................................. 0

Ta/e! 2.2 ea!a an" Berh+/+n"an den"an Sindrom Asherman ................ &

Ta/e! 2.3 K!asifi$asi Sindrom Asherman Berdasar$an 4a!!e dan

S*iara 15 ...................................................................................

Ta/e! 2.' K!asifi$asi European Society of Histeroscopy Classification of

Intrauterine Adhesion ................................................................... 5

Ta/e! 2.- Hasi! Poso(erai6e (ada Pasien an" ,en""+na$an Myometrial

Skoring ........................................................................................... 1&

Ta/e! 2.0 Te$ni$ 4a!!e dan S*iarra ............................................................... 1

Ta/e! 2.& Te$ni$ ,*7om/ dan 8a"ner ........................................................ 15

Ta/e! 2. Te$ni$ Broome dan 4an*ai!!ie ...................................................... 15

DA,TAR 'AMBAR

Ha!aman

am/ar 2.1 Adhesi Inra+erin ...................................................................... '

am/ar 2.2 Adhesio!isis ,en""+na$an +nin" Hiseros$o(i$ .................. 1'

am/ar 2.3 Tehni$ Insisi ,iomeri+m ......................................................... 10

am/ar 2.' Te$ni$ 4a!!e dan S*iarra............................................................ 1

am/ar 2.- Cook Balloon Uterine Stent ......................................22

BAB I

PENDAHU*UAN

Sindroma Asherman mer+(a$an s+a+ (ena$i an" diandai den"an

adana (er!e$aan di ron""a +er+s. Kondisi ini +m+mna dise/a/$an o!eh ra+ma

di endomeri+m an" eradi see!ah $+rease aa+ (as*a (ersa!inan dan da(a

mene/a/$an /er/a"ai $om(!i$asi se(eri "an""+an mensr+asi9 inferi!ias aa+

a/or+s /er+!an" :Hadisa(+ra and Hando$o9 2)13;.



Pre6a!ensi sindroma Asherman /er6ariasi< (ada ah+n 1529 Shen$er dan

,ar"a!ioh mene!ii 5) ari$e! an" /erasa! dari !a(oran $as+s sindroma

Asherman se/ana$ 251 $as+s dari /er/a"a ne"ara. ,ere$a menem+$an an"$a

$eadian erin""i erda(a di Israe! :&&) dari 251;9 =+nani :'-0 dari 251; dan

Ameri$a Se!aan :''- dari 251;. Keadian ini da(a die!as$an o!eh /e/era(a

fa$or9 a$ni> in"$a $e?as(adaan dari $!inisi9 an"$a $eadian a/or+s era(e+i$

dan i!e"a! an" eradi (ada seia( /e!ahan d+nia9 (en""+naan a!a $+rease (ada

e6a$+asi post partum aa+ post aortus9 insiden dari +/er$+!osis "enia!ia dan

infe$si (+er(+re+m an" /er/eda (ada seia( ne"ara dan $rieria an" di"+na$an

+n+$ mendia"nosa adhesi inra+erin :Bo+"ie9 et al.9 2)1-;.

Dia"nosis sindroma Asherman s+!i die"a$$an9 $arena (ada /e/era(a

$as+s adhesi inra+erin /isa eradi an(a menim/+!$an "ea!a :asim(omais;.

Pada $e/ana$an $as+s9 manifesasi $!inis an" eradi ada!ah "an""+an haid9

neri9 a/or+s /er+!an"9 aa+ inferi!ias. Ji$a did+"a adana sindroma Asherman9

histerosalpingography dan saline sonohysterography da(a di!a$+$an +n+$

men"$onfirmasi eradina sindroma Asherman.

Hiseros$o(i mer+(a$an gold standar +n+$ mendia"nosis sindroma

Asherman9 dan +"a ada /e/era(a moda!ias !ain +n+$ mendia"nosis se(eri

HS9 (emeri$saan US rans6a"ina! aa+ saline infusion sonohysterography

da(a mem/an+ menen+$an in"$a dari adhesi +er+s dan da(a me/eri$an

informasi am/ahan enan" (ro"nosa. Pada $as+s an" /era mem/++h$an !e/ih

dari sa+ moda!ias +n+$ menen+$an in"$a $e(arahan (ena$i dan (ro"nosa

+n+$ mem(er/ai$ina :,ers9 et al.! 2)12;. Bi!a di/andin"$an den"an

hiseros$o(i an" mer+(a$an gold standar 9 histerosalpingography da(a

mene"a$$an dia"nosis den"an sensii6ias dan s(esifias se/esar )@

:Hadisa(+ra and Hando$o9 2)13;.

BAB II

KAJIAN PUSTAKA

-./ S!ndr#ma A1herman

-././ De2!n!1! dan Et!#l#"!



Sindroma Asherman ada!ah "an""+an (ada +er+s dimana dida(a$an

(er!e$aan (ada +er+s. Dindin" de(an dan /e!a$an" +er+s /er!e$aan sa+ sama

!ain9 nam+n (ada /e/era(a $as+s hana se/a"ian dindin" +er+s an" /er!e$aan.

Tin"$a (er!e$aan an" eradi da(a rin"an9 sedan"9 aa+ /era< dan (er!e$aan

da(a i(is aa+ e/a!9 +"a da(a hana eradi (ada sa+ ii$9 aa+ sem+ana

/er!e$aan. Pada Sindromaa Asherman /iasana ida$ erda(a 6as$+!arisasi9 ha!

erse/+ (enin" dan mem/an+ da!am era(i. Pe!e$aan ini da(a di(isah$an

se*ara lind aa+ da!am +n+nan f!oros$o(i aa+ den"an hiseros$o( :=asmin9 et

al.. 2))&;.

Per!e$aan (ada +er+s mer+(a$an arin"an fi/roi$9 an" mer+(a$an hasi!

dari rea$sirea$si inf!amasi. Ha! ini dim+n"$in$an a$i/a eradina (er!+$aan

(ada endomeri+m9 an" dii$+i o!eh eradina fi/rosis sera rea$sirea$si an"

mene/a/$an eradina (er!e$aan :=+9 et al.. 2));

%isi$o eradina Sindroma Asherman menin"$a see!ah eradina

ra+ma (ada endomeri+m9 misa!na a$i/a $+rease aa+ (os (ar+m. Sem+a

$eadian an" mene/a/$an eadina $er+sa$an (ada endomeri+m da(a

mene/a/$an (er!e$aan. Pada +er+s an" "ra6id /erisi$o eradina *edera9

er+ama anara d+a sam(ai em(a min""+ (os(ar+m. Inf!amasi dan infe$si

mer+(a$an (redis(osisi +n+$ eradina (er!e$aan. Pada 5)@ $as+s9 (er!e$aan

inra+erin san"a dih+/+n"$an den"an $+rease (ada $om(!i$asi

$ehami!an9se(eri missed aortion aa+ a/or+s in$om(!i :Hadisa(+ra and

Hando$o9 2)13;.



'amar -./ Adhe1! Intrauter!n

:Di$+i( dari Adam ,a"os.Hseros*o(i* reamen of Asherman sndrome.%e(rod+*i6e

Bio,edi*ine n!ine.2))2.4o! ' S+((! 3.'0-1;

-./.- ,a$t#r R!1!$#

Daa men"enai (aofisio!o"i sindroma Asherman dan adhesi inra+erin

masih san"a er/aas (ada !iera+r. E6a!+asi mi$ros$o(i$ e!e$ri$ (ada se!se!

"!and+!er endomeria! (ada ?ania an" menderia Sindroma Asherman

men+n+$$an adana (er+/ahan s+/se!+!er se(eri hi!an"na ri/osom9

(em/en"$a$an (ada mio$ondria9 (en++(an (em/+!+h darah9 dan (er+/ahan

(er+/ahan an" er$ai hi(o$sia (ada se!.

Be/era(a (ene!ii e!ah memfo$+s$an (erhaianna (ada (er+/ahan (ada

6as$+!arisasi endomeri+m a$i/a adana ra+ma (ada endomeri+m. Te!ah

er/+$i adana "an""+an (ada 6as$+!arisasi dari endomeri+m dan miomeri+m

an" erdee$si me!a!+i an"io"rafi (e!6i$ (ada (asien den"an adhesi inra+erin

an" (ada.

Pada (ene!iian reros(e$if an" di!a$+$an /ar+/ar+ ini den"an

me!i/a$an ') (asien den"an sindroma Asherman9 da(a di!iha adana s+a+

resisensi (ada areri s(ira!is. Pene!ii mem(+nai hi(oesis /ah?a fenomena ini

da(a mene!as$an eradina (en+r+nan rese(i6ias dan re"enerasi (ada

endomeri+m dari ?ania erse/+. Se/a"ai am/ahan9 (ada (asien an" meres(onerhada( era(i an" di/eri$an9 "ascular endothelial gro#th factor :4E#; dan

densias mi$ro6as$+!er ernaa menin"$a se*ara si"nifi$an9 den"an demi$ian

da(a diari$ $esim(+!an /ah?a an"io"enesis dan re6as$+!arisasi $em+n"$inan

/er(eran (enin" da!am re"enerasi endomeria!. Se!ain i+ +"a erda(a d+"aan

adana $eer!i/aan dari adhesi an" /erh+/+n"an den"an sio$in (ada

(ao"enesis dari adhesi inra+erine :se(eri $firolast gro#th factor! platelet

deri"ed gro#th factor dan transforming gro#th factor tipe %;.



8a!a+(+n /e!+m da(a die!as$an9 erda(a s+a+ $em+n"$inan /ah?a

fa$or "enei$ da(a /er(eran. Ha! ini /erh+/+n"an den"an (ada (asien eren+

men+n+$$an insiden an" !e/ih serin" $eadian adhesi dan re$+rensi9 aa+

men"a(a adhesi inra+erine da(a eradi /ah$an an(a adana ra+ma o(erasi

aa+(+n (en*e+s. Di/a?ah ini disai$an da!am /en+$ a/e! fa$or risi$o an"

(a!in" serin" men"a$i/a$an sindroma Asherman< an" men+n+$$an /ah?a

$eadaan erse/+ +"a serin"$a!i /erh+/+n"an dne"an adana ra+ma iaro"eni$

erhada( endomeri+m :7onfori e a!..2)13;

Tael -./ ,a$t#r R!1!$# S!ndr#ma A1herman

#a$or %isi$o #re$+ensi %eferensi

K+rease (os a/or+s 009&@ :123&C1-0; S*hen$er dan

,ar"a!ioh9 152

K+rease (os (ar+m 219-@ :'))C1-0; S*hen$er dan



,ar"a!ioh9 152

Se$sio Sesaria 2@ :3C1-0; S*hen$er dan

,ar"a!ioh9 152

E6a$+asi +er+s (ada

(ena$i rofo/!asi$

)90@ :11C1-0; S*hen$er dan

,ar"a!ioh9 152

,a!formasi d+$+s

,+!!erian

10@ :&C'3; Si!!man and Asar$of9

15-

Infe$si :+/er$+!osis

"enia!;

' :&'C1-0; S*hen$er dan

,ar"a!ioh9 152

K+rease dia"nosi$ 190@ :3)C1-0; S*hen$er dan

,ar"a!ioh9 152,iome$omi a/domina! 193@ :2'C1-0; S*hen$er dan

,ar"a!ioh9 152

Em/o!isasi areri +erina 1' :&C-1; ,ara9 d$$9 2))&

(erasi Hiseros$o(i

- ,ero(!asi

- ,iome$omi

:mioma +n""a!;

- ,iome$omi

:m+!i(!e mioma;

- A/!asi endomeria!

0@ :1C1-;

3193@ :1)C32;

'-9-@ :5C2);

309'@ :C22;

Tas$in9 d$$9 2)))

Tas$in9 d$$9 2)))

Tas$in9 d$$9 2)))

Le+n"9 d$$9 2))3

Insersi IUD )92@ :3C1-0; S*hen$er dan

,ar"a!ioh9 152

Jahian $om(resif (ada

+er+s (ada HPP

19-@ :-C2&; I/rahim d$$9 2)13

-./.3 D!a"n#1!1

Dia"nosis Sindroma Asherman s+!i die"a$$an9 $arena (ada /e/era(a $as+sadhesi inra+erin /isa eradi an(a menim/+!$an "ea!a :asim(omais;. Pada

$e/ana$an $as+s9 manifesasi $!inis an" eradi ada!ah "an""+an haid9 neri9

a/or+s /er+!an"9 aa+ inferi!ias.

Ji$a did+"a adana Sindroma Asherman9 histerosalpingography dan saline

sonohysterography da(a di!a$+$an +n+$ men"$onfirmasi eradina Sindroma

Asherman. Hiseros$o(i mer+(a$an gold standar +n+$ mendia"nosis sindroma

Asherman9 dan +"a ada /e/era(a moda!ias !ain +n+$ mendia"nosis se(eri



HS9 (emeri$saan US rans6a"ina! aa+ saline infusion sonohysterography

da(a mem/an+ menen+$an in"$a dari adhesi +er+s dan da(a me/eri$an

informasi am/ahan enan" (ro"nosa. Pada $as+s an" /era mem/++h$an !e/ih

dari sa+ moda!ias +n+$ menen+$an in"$a $e(arahan (ena$i dan (ro"nosa

+n+$ mem(er/ai$ina :,ers9 et al.! 2)12;. Bi!a di/andin"$an den"an

hiseros$o(i an" mer+(a$an gold standar 9 histerosalpingography da(a

mene"a$$an dia"nosis den"an sensii6ias dan s(esifias se/esar )@

:Hadisa(+ra and Hando$o9 2)13;.

Tael -.- 'ejala yan" Berhuun"an den"an S!ndr#ma A1herman

:Di$+i( dari.Adam ,a"os. Hseros*o(i* reamen of Ashermans sndrome .%e(rod+*i6e

Bio,edi*ine.2))2.6o! '.S+((!.3.'0-1;

No

.

ea!a Sindroma Asherman

1. Menstrual disturance

2. Adominal pain

3. Sufertility'. Ectopic pregnancy

-. Anormal placental implantation

0. &remature deli"ery

&. Spontaneous aortion

See!ah dia"nosis dari sindroma Asherman die"a$$an9 (enin" (+!a +n+$

dien+$an in"$a aa+ deraa $e(arahan dari adhesi *a6+m +eri an" eradi

+n+$ menen+$an (ro"nosisna. Ada /e/era(a $a!sifi$asi an" e!ah di/+a9

ermas+$ dari American Fertility Society :Sad IIII; dan European Society of

'ynecology Endoscopy :rade I4;. Ada +"a $!asifi$asi an" di/+a o!eh 4a!!e

and S*iarra915 an" san"a m+dah di"+na$an9 den"an menen+$an "radin"

ai+ mild! moderate! Se"ere9 er"an+n" dari in"$a aa+ deraa adhesina

:,a"os9 2))2;.

Tael -.3 Kla1!2!$a1! S!ndr#ma A1herman erda1ar$an 4alle dan S5!ara /677

:,a"os9 2))2;



:Di$+i( dari Hseros*o(i* reamen of Ashermans sndrome.Adam ,a"os.%e(rod+*i6e

Bio,edi*ine.2))2.6o! '.S+((!.3.'0-1;

Mild adhesions Filmy adhesions composed of asal

endometrium! producing partial or

complete uterine ca"ity occlusion.

Moderate adhesions Firomuscular adhesions that are

characteristically thick( still co"ered

#ith endometrium that may leed upon di"ision( partially or totally

occluding the uterine ca"ity.

Se"ere adhesions Composed of connecti"e tissue(

lacking any endometrial lining and

likely to leed upon di"ision(

partially or totally occluding the

uterine ca"ity

Tael -.8 Kla1!2!$a1! Eur#&ean S#5!ety #2 H!1ter#15#&y 9la11!2!5at!#n #2

Intrauter!ne Adhe1!#n (Pr#t#&a1a1% et al., /667)

:Di$+i( dari ,omeria! s*orin">a ne? e*hni+e for he mana"emen of se6ere

Ashermans sndrome.Ahanasios Proo(a(as.,.D.9Asher Sh+shan9,.D.9Adam

,a"os9,.%.7...9#eri!i and Seri!i.155.4o! 05.No -;

rade Keeran"an

I )hin or filmy adhesions( easily ruptured

y hysteroscope alone(

cornual areas normal

II Singular firm adhesions connecting

separate parts of the uterine

ca"ity( cannot e ruptured y



hysteroscope sheath alone(

"isuali*ation of oth tual ostia possile

IIa +ccluding adhesions only in the region

of the internal cer"ical

os( upper uterine ca"ity normal

III Multiple firm adhesions connecting

separate parts of the uterine

ca"ity( unilateral oliteration of ostial

areas of the tues

IIIa E,tensi"e scarring of the uterine ca"ity

#all( #ith amenorrhea

or pronounced hypomenorrhea

III/ Comination of III and IIIa

I4 E,tensi"e firm adhesions #ith

agglutination of uterine #alls( at least

oth tual ostial areas occluded

-./.3 Tera&!

,es$i(+n dia"nosis adhesi inra+erin ida$ s+!i +n+$ di/+a9 (enan"anan

sindroma Asherman masih a+h dari mem+as$an. Be/era(a e$ni$ e!ah

di"+na$an9 ea(i hasi!na /er6ariasi. T++an era(i (asien den"an adhesi

inra+erine ada!ah +n+$ mem(er/ai$i +$+ran dan /en+$ dari ron""a +er+s9

+n+$ mem(er/ai$i f+n"si endomeri+m menadi norma! sera +n+$ mem(er/ai$i

feri!ias9 men*e"ah eradina adhesi /er+!an". Sindroma Asherman /+$an

(ena$i an" men"an*am i?a9 dan er!e(as dari "an""+an menr+asi /iasana

mer+(a$an (ena$i an" asimomais9 sehin""a (ada ?ania an" ida$

men"in"in$an hami! dan ida$ mem(+nai "ea!a se(eri neri9 ida$!ah

mem/++h$an era(i $h+s+s dan $onse!in" mer+(a$an sa+sa+na ha! an"

di/++h$an. Nam+n9 (ada /e/era(a $as+s9 /e/era(a ?ania merasa er"an""+

$es+/+ranna dan adhesi ini (er!+ di(er/ai$i. Be/era(a era(i da(a di"+na$an

er"an+n" dari deraa $e(arahanna9 hiseros$o(i mer+(a$an s+a+ dia"nosis dan

+"a /isa menadi era(i :,a"os9 2))2;.



Pada a?a!na di!aasi dan $+rease :DF7; masih di"+na$an se*ara !+as

da!am menan"ani adhesi inra+eri. Nam+n o!eh $arena DF7 sendiri se*ara

eio!o"i di$ai$an den"an $eadian adhesi inra+eri9 inda$an ini m+!ai

diin""a!$an. 5)@ adhesi di$ore!asi$an den"an inda$an $+rease (ada $om(!i$asi

$ehami!an den"an resi$o $eadian se/esar @ :(ada inda$an $+rease (erama;

sam(ai den"an 3)@ :(ada inda$an $+rease $ei"a;. Ha! ini di(er$+a o!eh

(ene!iian an" di!a$+$an o!eh Ash!e e a!! an" menda(a$an 0 (asien an"

menda(a$an (enan"anan $+rease (os a/or+s men"a!ami adhesi inra+eri

den"an renanan ?a$+ min""+ (os inda$an9 den"an "ea!a H(oamenorea

aa+ Amenorea. :Ash!e % et all 9 2)1';

-.- H!1ter#1$#&!

Da!am (er$em/an"anna9 hiseros$o(i mem/eri$an (ende$aan minima!

in6asif da!am (enan"anan masa!ahmasa!ah di /idan" "ine$o!o!"i. Hiseros$o(i

mer+(a$an s+a+ e!es$o( an" diran*an" $h+s+s a"ar da(a diinsersi $eda!am

6a"ina dan ser6i$s +n+$ menda(a$an "am/ar 6is+a! dari $a6+m endomeri+m9

osi+m +/a /i!aera!9 $ana!is endoser6i$a!is9 ser6i$s9 sera 6a"ina.

Se/a"ian /esar enis hiseros$o(i mer+(a$an i(e rigid an" e!ah di$ena!

sea$ ah+n 15)155). Nam+n o!eh $arena +n+$ office hysteroscopy

mem/++h$an (en"a!aman !e/ih /ana$ $arena $eida$mam(+an +n+$

men"arah$an endoser6i$s dan /erh+/+n"an den"an $enamanan (asien $ei$a

me!a$+$an "era$an roasi di da!am ser6i$s +n+$ me!iha /e/era(a !esi ser6i$s.

Bi!a erda(a masa inra$a6+m an" /esar9 !e/ih s+!i +n+$ men"arah$an dan

men"enda!i$an di se$iar !esi /i!a di/andin"$an den"an fle,ile hysteroscope.

Tin"$a $es+!ian inda$an +"a a$an menin"$a (ada (asien(asien den"an

+er+s an" san"a e!as aner6ersi aa+ rero6ersi. Kom(onen dari rigid

hiseros$o(i ada!ah se/a"ai /eri$+ :Beo**hi9.2))5;-

o Sisem rod$lens den"an (andan"an mirin" 3) deraa dan diameer

!+ar -.) mm

o Terda(a d+a se!+/+n" sheath/> sa+ +n+$ iri"asi dan sa+ +n+$

suction dan $ana! o(eraif -# an" /er/en+$ o6a! sehin""a idea!

+n+$ insersi ara+mai$ $e da!am ser6i$s



o %oasi sederhana dari scope (ada $amera ada!ah 5) deraa

erhada( s+m/+ !on"i+dina! +ama scope den"an s+m/+rans6ersa! dari UI

Fle,ile hysteroscope e!ah mem/eri$an s+a+ ero/osan er/ar+ da!am

(e!a$sanaan office hysteroscopy9 Den"an /er$em/an"na enis o(i$9 light

sources9 sera men"e*i!na /en+$ dari hiseros$o(i9 mem/eri$an $e+n+n"an dan

$em+dahan da!am me!a$+$an inda$an. Pemeri$saan *a6+m +eri dan endo*er6iG.

Para histeroscopiest an" /e!+m /er(en"a!aman !e/ih men+$ai $e+n+n"an dari

fle,ile hysteroscope se/a"ai a!a !ini (erama da!am men"e6a!+asi $e!aianan

mesr+asi9 inferi!ias9 dan (erdarahan (os meno(a+se.

Pada fle,ile hysteroscope9 ++n"na an" f!e$si/e! da(a den"an m+dah

/erman+6er dinaara (er!e$aan9 o/sr+$si sera da!am men"e6a!+asi osi+m +/a.

Bah$an (ada (asien den"an +er+s an" san"a ane6ersi aa+ rero6ersi da(a

er!iha den"an /ai$ $arena s+d+ (andan" ) deraa9 an" da(a mem/eri$an

6is+a!isasi dan (er"era$an an" sem(+rna :Brad!e D9.2))5;. Kom(onen dari

fle,ile hysteroscope ada!ah se/a"ai /eri$+>

o Lam(+ an" erh+/+n" den"an s+m/er *ahaa /ai$ /er+(a ha!o"en

aa+ Genon

o S+d+ (andan" no! deraa

o U+n" disa! an" da(a die$+$ 1)) deraa (ada idirectional mode

dan da(a di$enda!+$an den"an se/+ah +as

o Def!e$si a$if 1)) deraa dan !a(an" (andan" 1)) hin""a 12) deraa

o Se!+/+n" sheath/ +ama hiseros$o(i erdiri dari fieroptic undles9

sa!+ran +n+$ men"o(erasi$an9 sa!+ran +n+$ men""+na$an media

an" di"+na$an +n+$ mendisensi$an dan sa!+ran *ahaa

o 7in*in (ro$sima! erdiri dari e!emen +n+$ menfo$+s$an9 +as +n+$

men""era$$an9 sisem o$+!ar (ro$sima! dan $one$si +n+$ $amera

Ke+n+n"an fle,ile hysteroscope /i!a di/andin"$an den"an rigid

hysteroscope anara !ain> Le/ih ida$ in6asif $arena ida$ memer!+$an di!aasi



ser6i$s dan ida$ (er!+ men""+na$an ena$+!+m /i!a +er+s san"a anef!eGi9 dan

!e/ih ida$ neri. Nam+n9 $er+"ian /i!a di/andin"$an den"an rigid hysteroscope

ada!ah > Har"a !e/ih maha!9 (eme!iharaan a!a memer!+$an +saha an" !e/ih

+n+$ mem/ersih$an9 disinfe$si dan ser!isasi9 "am/aran an" !e/ih $e*i! (ada

monior i$a di/andin"$an den"an hiseros$o(i sandard9 dan a!a an" !e/ih

m+dah r+sa$.

Hiseros$o(i ida$ hana di"+na$an +n+$ dia"nosis ea(i +"a se/a"ai

era(i. (erasi hiseros$o(i e!ah /er+/ah dari hana se/a"ai a!a dia"nosis

menadi era(i +n+$ adhesi inra+erin dan e!ah menadi sandar emas.

Hiseros$o(i mam(+ me!iha se*ara !an"s+n" (er!e$aan sehin""a mem/+a era(i

!e/ih aman dan e(a. Kei$a diem+$an !esi i(is9 sen+han dari hiseros$o(i dan

disensi +er+s m+n"$in s+dah *+$+( +n+$ meme*ah (er!e$aan. !eh $arena i+9

(ada $as+s$as+s an" eren+9 (er/ai$an $a6ias da(a di(ero!eh !e?a

hiseros$o(i an(a sen+h (ada (asien ra?a a!an an(a anesesi +m+m

:7onfori9 et al.. 2)13< Ts+i9 et al.. 2)1';.

Hiseros$o(i9 /i!a di/andin"$an den"an es radio!o"i9 !e/ih a$+ra +n+$

men"$onfirmasi ada aa+ ida$na adhesi dan +"a +n+$ me!iha deraa

$e(arahanna sera $+a!ias dari endomeri+m $arena *a6+m +eri da(a er!iha

se*ara !an"s+n". Hiseros$o(i da(a +"a !an"s+n" memand+ $e endo*er6i$ se*ara

6ir+a! aa+ den"an (and+an +!raso+nd sam(ai $e da!am aa+ sam(ai o/sr+$si

aa+ (er!en"$ean eridenifi$asi :,a"os9 2))2;.

Hiseros$o(i ada!ah a!a endos$o(i er/ar+ /a"i (ara "ine$o!o"is.

Hiseros$o(i ada!ah a!a e!es$o( i(is se(eri a!a fi/roo(i$ an" dimas+$$an $e

da!am 6a"ina dan ser6i$ an" da(a se*ara !an"s+n" me!iha $a6+m endomeri+m

dan osi+m +/a. Adhesi inra+erin da(a er!iha se*ara e!as dan da(a

di$!asifi$asi$an di/a?ah am(i!an !an"s+n". Un+$ ri(enin" *er6iG9 $ia /isa

men""+na$an miso(roso! :2))+"; a"ar *er6iG menadi !+na$ :=asmin9 et

al..2))&;

Nam+n9 (ada $as+s den"an adhesi an" /era9 $a6ias m+n"$in e!ah

ero$!+si aa+ er!a!+ de$a den"an em(a mas+$ a!a hiseros$o(i. Se!ain i+9

(rosed+r m+!i(!e m+n"$in di(er!+$an $arena re$+rensi (os o(erasi dari adesi.



Pada si+asi ini9 dire$omendasi$an +n+$ me!a$+$an $onse!in"

mem(erim/an"$an an"$a $es+$sesan an" rendah dan risi$o in""i eradi

$om(!i$asi :7onfori9 et al.. 2)13;.

,en+r+ /e/era(a ah!i9 (e!e(asan adhesi sehar+sna di!a$+$an dari /a"ian

/a?ah +er+s dan di!an+$an $e /a"ian aas. Be/era(a (er!e$aan senra! dan i(is

sehar+sna di!e(as er!e/ih dah+!+ s+(aa *a6+m +er+s da(a disensi se*ara

ade$+a. Per!e$aan an" (ada dan !aera! sehar+sna diera(i era$hir $arena

risi$o !e/ih in""i erhada( (erforasi +er+s dan (erdarahan. :7onfori9 et al..

2)13;.

Hiseros$o(i* adhesio!isis men""+na$an "+nin" aa+ for*e( /io(s

mem(+nai $e+n+n"an men*e"ah $om(!i$asi9 dan meminima!$an $er+sa$an

endomeri+m. (erasi an" men""+na$an s+m/er ener"i /ai$ e!e$roda aa+

6a(orisasi !aser da(a memoon" se*ara efe$if dan e(a9 ea(i se*ara eoriis

erda(a $em+n"$inan $er+sa$an endomeri+m. Electrosurgery se(eri (emoon"

mono(o!ar9 6ersa(oin /i(o!ar da(a di"+na$an +n+$ era(i adhesi inra+erin

:=+9 et al.. 2));

Pera!aan me$ani$a! dan e!e$ri$ e!ah di"+na$an se!ama adhesio!isis

hiseros$o(is. Bah$an (en""+naan ar+m aam : 0arum )ouhy; e!ah men+n+$$an

an"$a $es+$sesan an" /a"+s. Pisa+ din"in :cold knife; di"+na$an +n+$

men*e"ah $er+sa$an erma! dari sisa endomeri+m dan men"+ran"i an"$a

$eadian (erforasi :"am/ar 2;. Ke"+naan insr+men an" men""+na$an a!a

o(erasi !isri$ aa+ !aser e!ah di/+$i$an /a?ah efisien da!am adhesio!isis

hiseros$o(i. Nam+n9 $e"+naan a!a o(erasi !isri$ dih+/+n"$an den"an (oensi

$er+sa$an endomeri+m :7onfori9 et al.. 2)13;.



'amar -.- Adhe1!#l!1!1 Men""una$an 'unt!n" H!1ter#1$#&!$ (9#n2#rt!% et

al.% -/3)

(erasi /i(o!ar mem(+nai $e+n+n"an mem/+a $er+sa$an $o!aera!

an" !e/ih sedi$i di/andin"$an mono(!ar. (erasi mono(o!ar e!ah di/+$i$an

sama mem+as$an den"an /i(o!ar. A$an ea(i9 sa!ah sa+ $e+n+n"an ada!ah efe$

arin"an an" !e/ih fo$a!9 dan (en""+naan e!e$ro!i :+n+$ mem/+a disensi

+er+s; !e/ih sedi$i :Ts+i9 et al.! 2)1'< 7onfori9 et al.9 2)13;

Ji$a ener"i erma! di"+na$an +n+$ memisah$an adhesi9 di(er!+$an ener"i

seminima! m+n"$in +n+$ men*e"ah $er+sa$an arin"an endomeri+m. Ker+sa$an

erma! dari endomeri+m m+n"$in !e/ih sedi$i /i!a men""+na$an ar+m

e!e$roda di/andin"$an den"an (emoon" !oo( $arena eksposure energy.

Be/era(a (ene!eian me!a(or$an $e/erhasi!an dari adhesio!isis men""+na$an

electrosurgery. Electrosurgery memi!i$i hemosasis an" !e/ih /a"+s

di/andin"$an den"an (en""+na$an "+nin" :=+9 et al.9 2));

Tera(i den"an 6a(orisasi !aser men""+na$an !aser Nd=A :neodmi+m

do(ed ri+m a!+mini+m "arne; and KTP :Poassi+mian!(hos(hae; e!ah

di"+na$an da!am era(i sindroma Asherman. Tehni$ ini di"+na$an +n+$

me!isis$an adhesi den"an (en"!ihaan !an"s+n"9 den"an $e+n+n"an (emoon"an



an" (resisi dan hemosasis an" /ai$. A$an ea(i9 ha! ini mem(+nai $er+"ian

ai+ adana (oensi $er+sa$an or"an 6is*era! i$a eradi (erforasi +er+s9 on"$os

in""i9 dan ida$ ada $e+n+n"an !e/ih di/andin"$an a!a e!e$ri$ :7onfori9 et al..

2)13;. Pem/edahan men""+na$an laser "apori*ation9 ermas+$ Nd=A !aser

dan KTP !aser9 e!ah di!a(or$an o!eh Ne?on e a! dan 7ha(man and 7ha(man9

men"hasi!$an ne$rosis arin"an san"a minima!9 ai+ se$iar 1 2 mm :=+9 et al .

2));

,* 7om/ dan 8a"ner (ada ah+n 155& menera(i 0 $as+s den"an adhesi

inra+erin /era den"an !a(aros$o(i> e$ni$ an" di!a$+$an ada!ah se(arasi

dindin" +er+s menadi d+a hemi*a6ias den"an memas+$$an 13 #ren*h Pra

di!aor ser6iG. Kem+dian9 sisa fi/rosis se(+m di(oon" $e arah f+nd+s den"an

"+nin" hiseros$o(i. Hasi!na sem+a ?ania da(a mensr+asi se*ara re"+!ar9 '

dianarana me!ahir$an /ai. Perforasi +er+s eradi (ada 3 $as+s9 ea(i hana

sa+ saa an" mem/++h$an hiseros$o(i adhesio!isis. :7onfori9 et al.. 2)13;

Myometrial scoring 9 mer+(a$an se/+ah e$ni$ hiseros$o(i +n+$

(enan"anan sindroma Asherman an" era dih+/+n"$an den"an $ee/a!an dari

adhesi inra+erine dan +n+$ me!iha /era(a (en+r+nan +$+ran dari *a6+m +eri.

Te$ni$ ini /er++an +n+$ mem(er/ai$i +$+ran +er+s $em/a!i norma! dan

$em/a!i $e /en+$ sem+!a dan mem(er/ai$i f+n"si dari endomeri+m9 e$ni$ ini

e!ah di*o/a (ada & (asien an" se/e!+mna e!ah men""+na$an hiseros$o(i

$on6ensiona! dan ida$ /erhasi! :Proo(asas9et al..155;.

Tehni$ myometrial scoring ini erdiri dari (emoon"an enam sam(ai

de!a(an insisi se(anan" ' mm dari f+nd+s +er+s men++ ism+s men""+na$an

(isa+ e!e$roda :Collins knife electrode/ den"an ++an mem/esar$an $a6ias

+er+s dan se*ara (oensia! mer+sa$ f+n"si endomeri+m. Dianara ++h ?ania

an" diera(i den"an ehni$ ini9 !ima dianarana memi!i$i (o!a mensr+asi

norma! dan i"a menadi hami!. Se!ain i+9 (en"+ran"an si"nifi$an dari neri e!ah

er*a(ai :7onfori9 et al.. 2)13;. Proo(a(as e a! mene!as$an e$ni$ hiseros$o(i

er/ar+ +n+$ sindroma Asherman an" /era dimana & (asien den"an inferi!e

se$+nder den"an amenorrhea aa+ o!i"omenorrhea e!ah diera(i dimana den"an

men""+na$an 0 sam(ai insisi !on"i+dina! dari miomeri+m dari f+nd+s sam(ai



$e ishm+s den"an men""+na$an 7o!!in $nife e!e$roda. Hasi!na9 (er/ai$an

si$!+s mensr+asi9 neri (an""+! an" rin"an dan 3 ?ania hami!. ,ere$a

menim(+!$an inisisi (ada miomeri+m mem(er!+as ron""a +er+s9 menin"$a$an

f+n"si mensr+asi dan f+n"si re(rod+$si :Proo(a(as9 et al.. 155;.

'amar -.3 Tehn!$ In1!1! M!#metr!um

:Di$+i( dari ,omeria! s*orin">a ne? e*hni+e for he mana"emen of se6ere

Ashermans sndrome.Ahanasios Proo(a(as.,.D.9Asher Sh+shan9,.D.9Adam

,a"os9,.%.7...9#eri!i and Seri!i.155.4o! 05.No - /



Tael -.0 Ha1!l P#1t#&erat!e &ada Pa1!en yan" Men""una$an Myometrial

Skoring (Pr#t#&a1a1%et al../667)

:Di$+i( dari ,omeria! s*orin"> a ne? e*hni+e for he mana"emen of se6ere Ashermans

sndrome.Ahanasios Proo(a(as.,.D.9Asher Sh+shan9,.D.9Adam ,a"os9,.%.7...9#eri!i

and Seri!i.155.4o! 05.No - /

4a!!e dan S*iarra me!a(or$an 1& (asien die6a!+asi dan diera(i se!ama 1)

ah+n. Pasien erse/+ ses+ai den"an (aofisio!o"i Sindroma Asherman9 den"anham(ir 5@ mem(+nai ri?aa $+rease9 !e/ih dari -) @ ?ania di$!asifi$asi$an

se/a"ai moderae adhesi dan 5)9' @ amenorrhea9o!i"omenorrhea dan

hi(omenorrhea. Te$ni$ an" di"+na$an /er/eda dari S+"imoo $arena mere$a

men""+na$an "+nin" hiseros$o(i +n+$ adhesio!isis. ,ere$a men""+na$an

!a(aros$o(i +n+$ men"onro! (em/edahan inra+erine dan men*e"ah eradina

(erforasi +er+s dan a"ar da(a a$ses +n+$ me!iha (e!6is a(a/i!a (ada HS

dida(a$an o$!+si +/a. ,ere$a men""+na$an mei!en /!+e +n+$ menandai

endomeri+m dan +n+$ memisah$an dari arin"an s*ar. See!ah (em/edahan9

ham(ir 5)@ ?ania $em/a!i f+n"si mensr+asina959'@ hami! dimana 0)9'@

?ania men"a!ami inferi!ias se/e!+mna :Proo(a(as9 et al.. 155;.



'amar -.8 Te$n!$ 4alle dan S5!arra(/677) (Ma"#1% --)

:Di$+i( dari Adam ,a"os.Hseros*o(i* reamen of Asherman

sndrome.%e(rod+*i6e Bio,edi*ine n!ine.2))2.4o! ' S+((! 3.'0-1;

Tael -.; Te$n!$ 4alle dan S5!arra(/677) (Ma"#1% --)



Pada $as+s ?ania den"an oa! (er!e$aan (ada *a6+m +eri9 e$ni$ an"

di!a$+$an o!eh ,*7om/ dan 8a"ner da(a di$era$an9 mes$i(+n /erisi$o in""i

+n+$ eradina (erforasi +eri. ,ere$a mene!as$an (ada 0 ?ania9dimana -

erda(a (er!e$aan $a6+m +eri an" /era. ,ere$a mer+/ah *a6+m an" me!e$a

erse/+ menadi se(+m9se/e!+ di(oon" den"an men""+na$an "+nin"

hiseros$o(i sam(ai $e f+nd+s. ,es$i(+n an"$a $eadian $om(!i$asi /er+(a

(erforasi +eri an" in""i9 $om/inasi den"an men""+na$an !a(aros$o(i den"an

"+nin" hiseros$o(i dari(ada men""+na$an e!e$ro aa+ !aser /erari risi$o



eradina ra+ma e$sra+erine da(a diminima!isir :,a"os9 2))2< Lin9 et al..

2)13;

Tael -.< Te$n!$ M59#m dan =a"ner(/66<) (Ma"#1% --)



Te$ni$ !ain an" di!a$+$an ada!ah e$ni$ o!eh Broome dan 4an*ai!!ie.

,ere$a me!a$+$an era(i (ada -- ?ania den"an (er!e$aan an" $om(!i

den"an men""+na$an $om/inasi +!rasono"rafi9 "+nin"9 dan f!oros$o(i.

Endomeri+m diidenifi$asi den"an men""+na$an US9 hiseros$o(i dimas+$$an

$e *a6+m +eri !a!+ dis+ni$$an *airan +n+$ menandai endomeri+m +n+$

men*e"ah eradina (erforasi +er+s. Pem/edahan ini di!a$+$an /er+!an" sam(ai

- $a!i (ada seia( (asien.Sem+a ?ania $em/a!i f+n"si mensr+asina dan ida$

ada $om(!i$asi an" seri+s :,a"os9 2))2;.

Tael -.7 Te$n!$ Br##me dan 4an5a!ll!e(/666) (Ma"#1% --)



%eseos*o(i ranser6i$a! see!ah di!aasi ser6i$ den"an !aminaria +"a

disaran$an (ada era(i sindroma Asherman /era. Laminaria di/+a dari an"$ai

$erin" a!"a an" /ernama !aminaria di"iaa. Kei$a dimas+$$an $e da!am



ser6i$9 se*ara (er!ahan!ahan ser6i$ menadi di!aasi. Lan"$ah (erama ada!ah

memas+$$an sa+ aa+ d+a !aminaria $e da!am ser6i$. Sea!ah 2' am di da!am

ser6i$9 !aminaria erse/+ di!e(as dan di"ani den"an i"a aa+ em(a /aan"

dimas+$$an $e da!am f+nd+s se!ama 2' am $em+dian. A$hirna9 hiseros$o(i

rese$si dari adhesi di!a$+$an da!am (en"a?asan !a(aros$o(i. Ani/ioi$a

(rofi!a$sis di/eri$an se!ama dan see!ah o(erasi. Intrauuterine de"ice :IUD; +"a

di(asan" di da!am +er+s dan di/eri$an era(i hormona! $on+"asi esro"en dan

medroG(ro"eserone asea. Sem+a (asien men*a(ai mensr+asi norma! dan i"a

menadi hami! :d+a me!ahir$an /ai dan sa+ $e"+"+ran;. :7onfori9 et al.. 2)13;.

(erasi hiseros$o(i (ada (asien ra?a a!an9 men""+na$an 72 +n+$

disensi +er+s. Tea(i meode ini memi!i$i $eer/aasan hana (ada (asien de"an

adhesi inra+erine an" i(is. Pada aman se$aran"9 meode ini san"a aran"

di"+na$an +n+$ hiseros$o(i adhesio!isis. :=+9 et al.. 2));

Tera(i hiseros$o(i (ada sindroma Asherman mem(+nai hasi! an" /a"+s

dan men"hi!an"$an "an""+an mensr+asi. Per/ai$an feri!ias see!ah era(i

hiseros$o(i da(a di(en"ar+hi o!eh /e/era(a fa$or se(eri si$!+s mensr+asi

se/e!+m dan see!ah o(erasi9 $e(arahan dari adhesi9 dan re$+rensi adhesi see!ah

era(i :7onfori9 et al.. 2)13< =asmin9 et al.. 2))&;.

Esro"en serin" di"+na$an +n+$ mend+$+n" (ro!iferasi endomeri+m dan

$esem/+han see!ah o(erasi. #arhi e a! mem/+$i$an (enin"$aan si"nifi$an (ada

$ee/a!an endomeri+m dan 6o!+me see!ah (em/erian esro"en. Pem/erian

esro"en (reo(erasi +"a disaran$an $arena mem(+nai $e+n+n"an ai+

menin"$a$an $ee/a!an endomeri+m se/e!+m di!a$+$an iner6ensi o(erasi.

Ta$asa$i e a! me!a(or$an (em/erian si!denafi! *irae :1))m"Chari9 se*ara

inra6a"ina!;9 ;. LAr"inine :0 "Chari; aa+ 6iamin E :0)) m"Chari; menin"$a$an

$ee/a!an endomeri+m dan (er/ai$an (ada inde$s resisensi areri. A$an ea(i9

Ts+i e a! ida$ di/eri$an era(i ini $arena masih har+s di!a$+$an (ene!iian !e/ih

!an+ +n+$ men"eah+i efe$ sam(in" an" da(a eradi. :Ts+i9 et al.. 2)1';.

-.3 Pen5e"ahan Adhe1! Berulan"



Adhesi /er+!an" (as*a (em/edahan ada!ah sa!ah sa+ fa$or (enin" an"

da(a men"ha!an"i f+n"si re(rod+$si $em/a!i norma! (ada (as*a era(i adhesi

inra+erine. Keadian adhesi /er+!an" san"a in""i (ada /e/era(a $as+s (ada

(asien den"an sindroma Asherman an" /era9 /e/era(a meode +n+$ men*e"ah

eradina adhesi /er+!an" see!ah (em/edahan e!ah di!a$+$an.,es$i(+n

demi$ian /e/era(a s+di $om(araif e!ah di!a$+$an :7onfori9 et al.. 2)13<

Senda"9 et al.. 2)13;

-.3./ IUD

Keadian adhesi /er+!an" (as*a (em/edahan ermas+$ in""i:391@ sam(ai

239-@;. Per!e$aan ini /iasana *ender+n" i(is. Pen""+naan IUD (ada

(en*e"ahan (er!e$aan /er+!an" ada!ah sa!ah sa+ (er*o/aan (erama an"

di!a$+$an dan dido$+menasi$an :7onfori9 et al.. 2)13< Senda"9 et al.. 2)13;.

Ha! ini /ersifa s(e$+!aif /ah?a IUD da(a mem/+a re"enerasi

endomeri+m se*ara fisio!o"is den"an *ara memisah$an dindin" anerior dan

(oserior +er+s.,es$i(+n /ana$ (ene!ii me!a(or$an /ah?a hasi! erse/+

*+$+( /a"+s9 ea(i masih erda(a $onf!i$ daa9 dan masih erda(a (er/edaan

men"enai +$+ran dan enis IUD na" di"+na$an. 4es*e e a! men""+na$an IUD

*o((er den"an hasi! an" mem+as$an (ada ' ?ania den"an amenorhhea. Pada

fo!!o? +( an" di!a$+$an se*ara se$i!as see!ah insersi IUD9 erda(a an"$a an"

/erma$na (ada ?ania an" f+n"si mensr+asina $em/a!i norma!. ,es$i(+n

demi$ian9/e/era(a (ene!ii (er*aa /ah?a fa$orfa$or inf!amasi an"

di!e(as$an (ada saa IUD dimas+$$an mem(er/+r+$ eradina !+$a (ada

endomeri+m. To+"+* e a! menem+$an ida$ ada (er/edaan da!am $eadian

adhesi /er+!an" (ada ?ania an" di/eri$an IUD se*ara a*a$9 era(i esero"en

aa+ ida$ di/eri$an era(i see!ah rese$si se(+m (ada hiseros$o(i.

1e"onogestrel$releasing IUD ida$ /o!eh di"+na$an $arena efe$ s+(resi dari

endomeri+m. )$shaped IUD am(a$na san"a $e*i! +n+$ /isa memisah$an

dindin" dianara $a6+m +eri. 1ippes loop mer+(a$an IUD an" *+$+( ade$+a

+n+$ men*e"ah eradina adhesi /er+!an" mes$i(+n IUD enis ini s+dah m+!ai

aran" diem+$an :7onfori9 et al.. 2)13< =+9 et al.. 2))< Senda"9 et al.. 2)13;.

-.3.- Intrauterine Balloon Stent



Inrauterine stent mer+(a$an s+a+ meode me$ani$ an" di"+na$an +n+$

men*e"ah eradina adhesi /er+!an". Ter/+a dari si!i*on9 /er/en+$ se"ii"a

mener+(ai /en+$ $a6+m +er+s. Pada /e/era(a $as+s era(i adhesi inra+erin

(rosed+r (enaa!a$sanaanna ermas+$ mem/eri$an inra+erine /a!!oon sen

se"era see!ah (rosed+r9 den"an *ara ini dida(a$an hasi! an" mem+as$an.Se*ara

s(esifi$9(ara (ene!ii me!a(or$an se$iar 12') (asien an" menda(a era(i

inra+erine sen9 an"$a reraa $ehami!an 0190 @ dan an"$a a/or+s s(onanna

1-90 @. Tida$ ada daa an" di!a(or$an men"enai $eadian adhesi /er+!an". Para

(ene!ii mere$omendasi$an (em/erian ani/ioi* /roads(e$r+m (ada (rosed+r

(emasan"an intrauterine alloon stent :7onfori9 et al.. 2)13< =+9 et al.. 2))<

Senda"9 et al.. 2)13;.

Pada (ene!iian $ohor (ada 1)& (asien den"an sindroma Asherman9

(en""+naan inra+erine /a!!oon sen9 di/andin"$an den"an IUD dan asam

hia!+rona9 men"hasi!$an hasi! an" mem+as$an den"an rendahna an"$a

$eadian adhesi /er+!an" :7onfori9 et al.. 2)13< =+9 et al.. 2));.

'amar -.0 Cook Balloon Uterine Stent (Mar5h% 9. M.. -//)

:di$+i( dari 7har!es , ,ar*h.,ana"emen of Asherman Sndrome.%e(rod+*i6e

Biomedi*ine n!ine.2)11.23.03&0;

-.3.3 Foley Catheter



Foley Catheter mer+(a$an a!a me$anis an" (erama di"+na$an +n+$

memisah$an dindin" +er+s +n+$ men*e"ah eradina adhesi /er+!an". Pada

s+di den"an 2- $as+s den"an moderae dan se6ere adhesi9 amnion "raf den"an

fo!e *aheer dimas+$$an $e da!am +er+s se!ama 2 min""+ see!ah (em/edahan

hiseros$o(i. ,es$i(+n erda(a $eadian (erforasi +er+s (ada d+a $as+s9 hasi!

an" si"nifi$an dida(a$an ai+ den"an ida$ adana (er!e$aan /er+!an" (ada

(asien den"an moderae adhesi :7onfori9 et al.. 2)13< Senda"9 et al.. 2)13;.

Pen""+naan foley catheter +"a di/andin"$an den"an IUD. Kei$a IUD

di!e(as$an see!ah erda(a (erdarahan (er6a"inam9 $aeer erse/+ ea(

di(erahan$an sam(ai 1) hari. ro+( an" diera(i den"an foley catheter

men+n+$$an reraa $ehami!an an" in""i di/andin"$an den"an "ro+( IUD

:3395@ di/andin" 229- @;. Dari sem+a "ro+(9 se$iar 1 @ ?ania $em/a!i f+n"si

mensr+asina. =an" (er!+ di(erhai$an dari meode ini ada!ah $eadian (erforasi

+er+s9 ascending infe$si dari 6a"ina dan rasa $eida$namanan :7onfori9 et al..

2)13< Ts+i ! et al.. 2)1';.

-.3.8 A1am H!alur#nat

Asam Hia!+rona ada!ah sa!ah sa+ $om(onen arin"an man+sia an"

/ana$ dan ermas+$ da!am men"a+r f+n"si /io!o"is man+sia se(eri mi"rasi

se!9(ro!iferasi. Pada de*ade a$hir9 Prod+$ mener+(ai asam hia!+rona e!ah

diado(si (ada (em/edahan "ine$o!o"i +n+$ men*e"ah eradina adhesi

inra(erionea! dan inra+erine. ,e$anisme $erana sam(ai saa ini /e!+m da(a

dimen"eri. Asam Hia!+rona men"hasi!$an /arrier semenara anara or"an an"

se*ara me$anis men"ham/a eradina adhesi.Se/a"ai am/ahan9 a ini

menin"$a$an (er/ai$an arin"an (erione+m den"an menin"$a$an (ro!iferasi se!

mesoe!:7onfori9 et al.. 2)13< Ts+i ! et al.. 2)1';.

Autocross$linked asam ha!+roni ada!ah ani adhesi an" er/ar+ an"

da(a men*e"ah eradina adhesi see!ah (em/edahan "ine$o!o"i. a ini da(a

men*e"ah eradina adhesi inra(erionea! see!ah !a(aros$o(i miome$omi dan

adhesi /er+!an" see!ah (em/edahan hiseros$o(i. Ani adhesi !ain an"

di"+na$an ada!ah sodi+m hia!+rona dan *ar/oGmeh!*e!!+!ose an" di"+na$an

+n+$ men*e"ah eradina adhesi inra+erine. Pada s+di a*a$9 1-) (asien an"



menda(a $+rease $arena a/or+s9 (ada "ro+( an" di/eri$an era(i ani adhesi

men+n+$$an $eadian adhesi an" !e/ih rendah dari(ada an" ida$ di/eri$an9

mes$i(+n /e!+m *+$+( daa an" men+n+$$an $arena (er!+ di fo!!o? +( !e/ih

!ama dan +"a har+s di!iha men"enai feri!iasna :*onfori9 et al.. 2)13;.

BAB III

KESIMPU*AN

Sindroma Asherman mer+(a$an s+a+ (ena$i an" ida$ s+!i +n+$

didia"nosis9 nam+n (enan"anan sindroma Asherman masih a+h dari mem+as$an.

Be/era(a e$ni$ e!ah di"+na$an9 ea(i hasi!na /er6ariasi. T++an era(i (asien

den"an adhesi inra+erine ada!ah +n+$ mem(er/ai$i +$+ran dan /en+$ dari

ron""a +er+s9 +n+$ mem(er/ai$i f+n"si endomeri+m menadi norma! sera

+n+$ mem(er/ai$i feri!ias.

Sindroma Asherman /+$an (ena$i an" men"an*am i?a9 dan er!e(as

dari "an""+an menr+asi /iasana mer+(a$an (ena$i an" asimomais9

sehin""a (ada ?ania an" ida$ men"in"in$an hami! dan ida$ mem(+nai

"ea!a se(eri neri9 ida$!ah mem/++h$an era(i $h+s+s dan $onse!in"

mer+(a$an sa+sa+na ha! an" di/++h$an. Nam+n9 (ada /e/era(a $as+s9

/e/era(a ?ania merasa er"an""+ $es+/+ranna dan adhesi ini (er!+ di(er/ai$i.

Be/era(a era(i da(a di"+na$an er"an+n" dari deraa $e(arahanna9

hiseros$o(i mer+(a$an s+a+ dia"nosis dan +"a /isa menadi era(i :,a"os9

2))2;.

Hiseros$o(i mem/eri$an (ende$aan minima! in6asif da!am (enan"anan

masa!ahmasa!ah di /idan" "ine$o!o!"i. Hiseros$o(i mer+(a$an s+a+ e!es$o(

an" diran*an" $h+s+s a"ar da(a diinsersi $eda!am 6a"ina dan ser6i$s +n+$

menda(a$an "am/ar 6is+a! dari $a6+m endomeri+m9 osi+m +/a /i!aera!9

$ana!is endoser6i$a!is9 ser6i$s9 sera 6a"ina.

Ber/a"ai enis e$ni$ hiseros$o(i e!ah di$em/an"$an "+na menan"ani

adhesi +er+s9 $e+n+n"an dan $er+"ian san"a /er"an+n" (ada $eah!ian sera am

er/an" o(eraor da!am men"o(erasi$an a!a hiseros$o(i. Se/a"ian /esar enis

hiseros$o(i mer+(a$an i(e rigid an" e!ah di$ena! sea$ ah+n 15)155).



Nam+n o!eh $arena +n+$ office hysteroscopy mem/++h$an (en"a!aman !e/ih

/ana$ $arena $eida$mam(+an +n+$ men"arah$an endoser6i$s dan

/erh+/+n"an den"an $enamanan (asien $ei$a me!a$+$an "era$an roasi di

da!am ser6i$s +n+$ me!iha /e/era(a !esi ser6i$s. Bi!a erda(a masa inra$a6+m

an" /esar9 !e/ih s+!i +n+$ men"arah$an dan men"enda!i$an di se$iar !esi /i!a

di/andin"$an den"an fle,ile hysteroscope. Tin"$a $es+!ian inda$an +"a a$an

menin"$a (ada (asien(asien den"an +er+s an" san"a e!as aner6ersi aa+

rero6ersi :Brad!e D9.2))5;.

Fle,ile hysteroscope e!ah mem/eri$an s+a+ ero/osan er/ar+ da!am

(e!a$sanaan office hysteroscopy9 Den"an /er$em/an"na enis o(i$9 light

sources9 sera men"e*i!na /en+$ dari hiseros$o(i9 mem/eri$an $e+n+n"an dan

$em+dahan da!am me!a$+$an inda$an. Pemeri$saan *a6+m +eri dan endo*er6iG.

Para histeroscopiest an" /e!+m /er(en"a!aman !e/ih men+$ai $e+n+n"an dari

fle,ile hysteroscope se/a"ai a!a !ini (erama da!am men"e6a!+asi $e!aianan

mesr+asi9 inferi!ias9 dan (erdarahan (os meno(a+se.

Myometrial scoring 9 mer+(a$an se/+ah e$ni$ hiseros$o(i +n+$

(enan"anan sindroma Asherman. Tehni$ myometrial scoring ini erdiri dari

(emoon"an enam sam(ai de!a(an insisi se(anan" ' mm dari f+nd+s +er+s

men++ ism+s men""+na$an (isa+ e!e$roda :Collins knife electrode/ den"an

++an mem/esar$an $a6ias +er+s dan se*ara (oensia! mer+sa$ f+n"si

endomeri+m. :Proo(asas9et al..155;.

Da!am men*e"ah eradina adhesi /er+!an" (as*a inda$an hiseros$o(i9

ada /e/era(a moda!ias an" da(a di(erim/an"$an. Pen""+naan Intrauterine

Balloon Stent da(a di(erim/an"$an dimana (ada (ene!iian $ohor (ada 1)&

(asien den"an sindroma Asherman9 (en""+naan inra+erine /a!!oon sen9

di/andin"$an den"an IUD dan asam hia!+rona9 men"hasi!$an hasi! an"

mem+as$an den"an rendahna an"$a $eadian adhesi /er+!an" :7onfori9 et al..

2)13< =+9 et al.. 2));.

Autocross$linked asam ha!+rona ada!ah ani adhesi an" er/ar+ an"

da(a men*e"ah eradina adhesi see!ah (em/edahan "ine$o!o"i. a ini da(a

men*e"ah eradina adhesi inra(erionea! see!ah !a(aros$o(i miome$omi dan



adhesi /er+!an" see!ah (em/edahan hiseros$o(i. Ani adhesi !ain an"

di"+na$an ada!ah sodi+m hia!+rona dan caro,ymethylcellulose an" di"+na$an

+n+$ men*e"ah eradina adhesi inra+erin. Pada s+di a*a$9 1-) (asien an"

menda(a $+rease $arena a/or+s9 (ada "ro+( an" di/eri$an era(i ani adhesi

men+n+$$an $eadian adhesi an" !e/ih rendah dari(ada an" ida$ di/eri$an9

mes$i(+n /e!+m *+$+( daa an" men+n+$$an $arena (er!+ di fo!!o? +( !e/ih

!ama dan +"a har+s di!iha men"enai feri!iasna :*onfori9 et al.. 2)13;.



27

DA,TAR PUSTAKA

Anonim. 2)1)9 Pra*i*e +ide!ines for ,ana"emen of Inra+erine Sne*hiae9

AA'12! )he 0ournal of Minimally In"asi"e 'ynecology. 4o!. 1&9 No 1.

Beo**hi9 S. 2))59 Insr+menaion in ffi*e Hseros*o(> %i"id

Hseros*o(9 Hseros*o( ffi*e E6a!+aion an d ,ana"emen of he

Uerine 7a6i9 *ha(er 1.

Bo+"ie. 2)1-9 Treamen of Ashermans Sndrome in an +(aien

Hseros*o( Sein"9 3M'9 6o!. 229 No. 3.

Brad!e9 D. 2))59 Insr+menaion in ffi*e Hseros*o(> #!eGi/!e

Hseros*o(9 Hseros*o( ffi*e E6a!+aion an d ,ana"emen of he

Uerine 7a6i9 *ha(er 2.

Broome9J.D.9 4an*ai!!ie9 T.. 15559 #!+oros*o(i*a!! "+ded hseros*o(i*

di6ision of adhesion in se6ere Asherman Sndrome9 Else"ier Science9 6o!.

53. No 0.

7onfori9 A.9 A!6i""i9 7.9 ,a"os9 A. 2)139 The mana"emen of Asherman

Sndrome >a re6ie? o !iera+re9 4eproducti"e Biology and

Endocrinology! 6o!. 11> 11.

7onfori9 A.9 A!6i""i9 7.9 ,o!!o. A.9 P!a*ido De. .9 ,a"os. A. 2)139 The

,ana"emen of Asherman Sndrome> a %e6ie? Liera+re9 4eproducti"e

Biology and Endocrinology 0ournal .

Hadisa(+ra and Hando$o. 2)139 The mana"emen of Asherman Sndrome in

"ne*o!o"9 Med 3 Indonesia9 6o!. 229 ((. 1210.

Lin9 M.9 8ei9 ,.9 Li9 T.7.9 H+an"9 .9 H+an"9 D.9 ho+9 #.9 han"9 S. 2)139 A

*om(arison of inra+erine /a!!oon9inra+erine *onra*e(i6e de6i*e and

ha!+roni* a*id "e! in he (re6enion of adhesion reformaion fo!!o?in"

hseros*o(i* s+r"er for Asherman Sndrome>a *ohor s+d9 European

3ournal of +stetric and 'ynecology and 4eproducti"e Biology9 6o!. 1&)9

((. -12-10.

,a"os9 A. 2))29 Hseros*o(i* reamen of Asherman sndrome.%e(rod+*i6e9

Bio Medicine +nline9 6o!. ' S+((! 3.'0-1.



28

,ar*h9 7.,. 2)119 ,ana"emen of Asherman Sndrome9 4eproducti"e

Biomedicine +nline9 6o!. 23. (( 03&0

,ers9 E. ,.9 H+rs9 B. S. 2)12. 7om(rehensi6e mana"emen of se6ere

Asherman sndrome and amenorrhea9 Fertility and Sterility9 6o!. 5&9 No 1.

Proo(a(as9 A.9 S+shan9 A.9 ,a"os9 A. 1559 ,omeria! s*orin">a ne?

e*hni+e for he mana"emen of se6ere Ashermans sndrome9 Fertility

and Sterility9 6o!. 059 no. -.

Senda"9 A. 2)139 Hseros*o(i* mana"emen of inra+erine adhesion9 3ournal

of )urkey Society of +stetric and 'ynecology9 6o!. 1)9 (( 21-.

Thomson9 ,.B.9 A//o9 J.A.9 Kin"son9 A.9 Lenar9 ,.9 4an*ai!ie9 T.. 2007,

‘#!+oros*o(i*a!! "+ided sne*hio!sis for (aiens ?ih Ashermans

Sndrome>mensr+a! and feri!i o+*ome9 Fertility and Sterility9 6o!.

&.no 2.

Ts+i9 K.H.9 Lin9 L.T.9 7hen"9 J.T.9 Ten"9 S.8.9 8an"9 P.H. 2)1'9 7om(rehensi6e

reamen for inferi!e ?omen ?ih se6ere Asherman Sndrome9

)ai#anese 3ournal of +stetrics and 'ynecology9 6o!. -39 ((. 3&23&-.

=asmin9 H.9 Nasir9 A.9 Noorani9 K.J. 2))&9 Hsros*o(i* mana"emen of

Ashermans Sndrome9 3&MA9 6o!. -&>--3.

=+9 D.9 Li9 T.7.9 Mia9 E.9 H+an"9 M.9 Li+9 =.9 Pen"9 M. 2))9 #a*or affe*in"

re(rod+*i6e o+*ome of hseros*o(i* adhesio!sis for Ashermans

sndrome9 Fertility and Sterility9 6o!. 59 no 3.

=+9 D.9 8on"9 =.,.9 7heon"9 =.9 Mia9 E.9 Li9 T.7. 2))9 Asherman Sndromeone

*en+r !aer9 Fertility and Sterility9 6o!. 59 no '.

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Sindroma Asherman