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Abstrak :
Latar Belakang. Laparoskopi ginekologi memiliki insidens yang cukup tinggi dalam menyebabkan mual dan muntah paska operasi yaitu sekitar 50% dan belum ada obat-obatan yang terbukti efektif mencegah hal ini. Pemberian anti muntah tunggal disebutkan kurang efektif, sehingga dibutuhkan lebih dari satu macam obat, oleh karena itu dilakukan penelitian ini dengan membandingkan pemberian deksametason, ondansetron, serta deksametason dan ondansetron dalam mencegah mual dan muntah paska laparoskopi ginekologi. Metode. Merupakan penelitian eksperimental dengan rancangan randomized clinical trial (RCT). Subyek penelitian dibagi menjadi 3 kelompok, yaitu deksametason+plasebo, ondansetron+plasebo, dan deksametason+ondansetron yang diberikan 1 jam sebelum induksi. Hasil. Didapatkan 57 wanita yang memenuhi kriteria inklusi dan mengikuti penelitian, menjalani laparoskopi ginekologi. Hasil analisis statistik tidak didapatkan perbedaan bermakna rerata skoring mual dan muntah baik pada 6 jam (p=0,418) maupun 12 jam paska operasi pada ketiga kelompok perlakuan (p=0,588), namun demikian kombinasi deksametason dan ondansetron menghasilkan rerata skoring mual dan muntah yang lebih rendah daripada pemberian deksametason atau ondansetron saja. Kesimpulan. Pemberian deksametason, ondansetron dan kombinasi deksametason + ondansetron tidak menurunkan secara bermakna skoring mual dan muntah paska operasi pada wanita yang menjalani laparoskopi ginekologi. ...... Background. Gynecological laparoscopy has a fairly high incidence in causing postoperative nausea and vomiting which is about 50 % and there are no drugs that are proven to prevent this effecetively. A single antiemetic less effective to prevent post operative nausea and vomiting, so it takes more than one drug. This study was conducted to compare the administration of dexamethasone, ondansetron, and dexamethasone plus ondansetron in preventing nausea and vomiting after gynecological laparoscopy. Methods. This study was an experimental study with randomized clinical trials (RCTs) design. The study subjects were divided into 3 groups, dexamethasone + placebo, ondansetron + placebo and dexamethasone + ondansetron that was given 1 hour before induction. Results. A total of 57 women who fullfill the inclusion criteria and follow the study, undergoing gynecological laparoscopy. The Statistical analysis found no significant differences in mean scoring both nausea and vomiting at 6 hours (p=0.418) and 12 hours post operative in all three treatment groups (p=0.588), but the combination of dexamethasone and ondansetron can reduce post operative nausea and vomiting mean scoring than dexamethasone or ondansetron alone. Conclusion. Dexamethasone,ondansetron and dexamethasone + ondansetron combination does not reduce postoperative nausea and vomiting scoring significantly in women undergoing gynecological laparoscopy.

Abstrak :
[Tesis ini bertujuan mendapatkan akurasi diagnostik dari gejala dan tanda ginekologi sebagai upaya diagnosis penyebab keputihan. Menurut kepustakaan, penyebab keputihan yang paling sering adalah bakterial vaginosis, Candida sp, T.vaginalis, C.trachomatis, dan N.gonorrhoeae. Gejala yang diteliti adalah bau tidak sedap, gatal, rasa basah berlebih, nyeri vulva, nyeri sanggama, perdarahan diluar siklus haid, perdarahan pasca sanggama, dan nyeri buang air kecil.Tanda yang diteliti adalah maserasi pada vulva, vagina kemerahan, fluor keruh kekuningan encer, fluor putih bergumpal, fluor keruh kekuningan encer berbuih, serviks dengan bercak bercak merah (strawberry cervix), serviks dengan ektopi dan fluksus berbentuk pus. Dari 188 subyek yang dilakukan dengan consecutive sampling, didapat 82 subyek yang memenuhi kriteria inklusi dan eksklusi. Pada seluruh subyek dilakukan pemeriksaan gejala dan tanda ginekologis, serta dilakukan pemeriksaan laboratorium yaitu pewarnaan Gram untuk bakterial vaginosis, sediaan basah untuk T.vaginalis dan Candida sp, PCR untuk N.gonorrhoeae dan C.trachomatis. Maserasi vulva, rasa basah berlebih, dan fluor keruh kekuningan encer memiliki akurasi diagnostik yang baik untuk bakterial vaginosis. Maserasi vulva dan fluor putih bergumpal memiliki akurasi diagnostik yang baik untuk Candida sp. Fluor keruh encer kekuningan berbuih, dan bercak merah pada serviks memiliki akurasi diagnostik yang baik untuk T.vaginalis. Untuk C.trachomatis dan N.gonorrhoeae tidak ditemukan gejala dan tanda yang memiliki akurasi diagnostik baik.;Objective: This study aims to gather diagnostic accuracy of various gynecologic symptoms and signs in identifying causes of vaginal discharge. Methods: 82 subjects were included in this cross sectional study. Gynecologic symptoms and signs were examined from each subject and further laboratory examinations were employed to identify the etiology. Diagnostic accuracy for each symptom and sign was calculated using result from the laboratory examination as the standard reference. Symptoms and signs with positive predictive value (PPV) of more than 50% were considered to have good diagnostic accuracy. Results: For bacterial vaginosis, excessive wetness in genital area; vulvar maceration; and thin, turbid, yellowish vaginal discharge had PPVs of 53%; 52%; and 52%, respectively. For candidal vaginitis, vulvar maceration; and white, curd-like vaginal discharge had PPVs of 58% and 100%, respectively. For trichomoniasis, thin, turbid, frothy, yellowish vaginal discharge; and strawberry-cervix appearance had PPVs of 60% and 100%, respectively. There were no symptoms or signs with PPV of more than 50% for chlamydial cervicitis. Diagnostic accuracy for clinical findings in gonorrheal cervicitis could not be calculated due to small number of subjects. Conclusion: Various gynecologic symptoms and signs were found to be accurate in diagnosing bacterial vaginosis, candidal vaginitis, and trichomoniasis. No symptoms or signs were considered accurate to aid etiological diagnosis for chlamydial cervicitis and gonorrheal cervicitis., Objective: This study aims to gather diagnostic accuracy of various gynecologic symptoms and signs in identifying causes of vaginal discharge. Methods: 82 subjects were included in this cross sectional study. Gynecologic symptoms and signs were examined from each subject and further laboratory examinations were employed to identify the etiology. Diagnostic accuracy for each symptom and sign was calculated using result from the laboratory examination as the standard reference. Symptoms and signs with positive predictive value (PPV) of more than 50% were considered to have good diagnostic accuracy. Results: For bacterial vaginosis, excessive wetness in genital area; vulvar maceration; and thin, turbid, yellowish vaginal discharge had PPVs of 53%; 52%; and 52%, respectively. For candidal vaginitis, vulvar maceration; and white, curd-like vaginal discharge had PPVs of 58% and 100%, respectively. For trichomoniasis, thin, turbid, frothy, yellowish vaginal discharge; and strawberry-cervix appearance had PPVs of 60% and 100%, respectively. There were no symptoms or signs with PPV of more than 50% for chlamydial cervicitis. Diagnostic accuracy for clinical findings in gonorrheal cervicitis could not be calculated due to small number of subjects. Conclusion: Various gynecologic symptoms and signs were found to be accurate in diagnosing bacterial vaginosis, candidal vaginitis, and trichomoniasis. No symptoms or signs were considered accurate to aid etiological diagnosis for chlamydial cervicitis and gonorrheal cervicitis.]