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Abstrak :
LATAR BELAKANG. Prolaps organ panggul menimbulkan keluhan kelemahan dasar panggul yang dapat mempengaruhi kualitas hidup seorang wanita. Prolaps organ urogenital dialami oleh 30-50 wanita yang berusia 20-59 tahun. Penanganan yang tepat dan dini untuk mengatasi gangguan tersebut menjadi salah satu upaya efektif. Untuk dapat melakukan penanganan dini maka diperlukan pengenalan awal terhadap penilaian prolaps organ panggul dengan keluhan minimal pada pasien. Sebelumnya studi yang dilakukan pada 296 wanita usia diatas 40 tahun, didapatkan penurunan vagina 0,5 cm di bawah himen dapat memprediksi secara akurat gejala penonjolan atau penurunan organ. Di Indonesia belum terdapat penelitian mengenai ambang batas prolaps organ panggul yang dapat memperkirakan munculnya keluhan kelemahan dasar panggul. Oleh karena itu, penelitian ini bertujuan untuk memperkirakan ambang batas timbulnya keluhan kelemahan dasar panggul, diketahuinya prevalensi kasus POP di RSCM dan diketahuinya sensitifitas dan spesifisitas kuesioner PFDI-20 dalam menilai keluhan POP. METODE. Penelitian ini merupakan suatu studi potong lintang. Data diambil dari pemeriksaan langsung POP-Q dan wawancara kuesioner PFDI-20 . Dilakukan di Poli ginekologi dan uroginekologi RSCM sejak bulan Juli 2017 hingga November 2017. HASIL. Pada penelitian ini disimpulkan bahwa dari 385 orang subyek penelitian didapat 13 mengalami prolaps organ panggul dengan proporsi masing-masing 11.2 mengalami prolaps uteri, 12.3 sistokel, dan 11.7 mengalami rektokel. Uji validitas dengan Pearson test dan reliabilitas dari kuesioner PFDI-20 menunjukan hasil valid dan reliabel. Penurunan sejauh 2.5 cm diatas himen yaitu prolapse derajat 1 sudah bisa menimbulkan keluhan penurunan organ panggul. Sedangkan untuk komponen keluhan pada kuesioner didapat PDFI-16 AUC 0.828 ndash; 0.860, IK 95 dan PFDI-19 AUC 0.831 - 0.854, IK 95 yaitu keluhan sulit menahan kemih dan sulit berkemih dianggap sebagai keluhan penurunan organ panggul yang lebih dini dirasakan oleh subyek penelitian. KESIMPULAN. Kuesioner PFDI-20 dapat digunakan sebagai skrining keluhan prolaps organ panggul. Ambang batas prolaps organ panggul yaitu jarak 2,5 cm diatas himen didalam vagina mulai menunjukkan adanya keluhan. Kata Kunci. Prolaps organ panggul, prolaps uteri, sistokel, rektokel. ......BACKGROUND. Prolaps of pelvic organs lead to complaints of pelvic floor weakness that may affect a woman 39;s quality of life. Urogenital organ prolapse is experienced by 30-50 of women aged 20-59 years. Proper treatment and early diagnosis of these disorders become one of effective efforts. To be able to perform early treatment is required early recognition of the assessment of pelvic organ prolapse with minimal complaints in patients. Previous studies conducted on 296 women over the age of 40 years, resulted a 0.5 cm vaginal protruded under the hymen can accurately predict symptoms of protrusion or prolapse of pelvic organ. In Indonesia there has been no research on pelvic organ prolapse thresholds that can estimate complaints of pelvic floor weakness. This study is aim to reveal of pelvic organ prolapse thresholds that can estimate complains of pelvic floor weakness, the prevalence of POP cases in RSCM and the sensitivity and specificity of PFDI-20 questionnare in assessing POP complaints. METHOD. This study is a cross sectional study. Data was taken from direct examination POP-Q and interview PFDI-20 questionnaire . Performed in the Gynecology and Urogynecology outpatient clinic at Cipto Mangunkusumo Hospital from July 2017 to November 2017 RESULTS. From 385 subjects, 13 had pelvic organ prolapse with proportion of 11.2 having uterine prolapse, 12.3 cystocele, and 11.7 had rectocele. Validity test with Pearson test and reliability of PFDI-20 questionnaire showed valid and reliable results. A decrease of 2.5 cm above the hymen ie 1st degree of prolapse can lead to early complaints of pelvic organ descent. As for the complaint component of the questionnaire revealed that PDFI-16 AUC 0.828 - 0.860, 95 IK and PFDI-19 AUC 0.831 - 0.854, 95 IK , that is difficult to resist urinary complaints and difficult in micturition, is considered an early complaint of pelvic organ felt by subjects. CONCLUSION. The PFDI-20 questionnaire can be used as a screening for pelvic organ prolapse complaints. The pelvic organ pelvic prolapse threshold of 2.5 cm above the hymen inside the vagina begins to show a complaint. Keywords. Pelvic organ prolapse, uterine prolapse, cystocele, rectocele

Abstrak :
ABSTRAK
Prolaps uteri merupakan kondisi yang sering dialami oleh perempuan dan dapat menurunkan kualitas hidup. Penyebab prolaps uteri multifaktorial, pada umumnya berupa faktor klinis.Penelitian ini bertujuan untuk mengetahui adanya variasi gen berupa mutasi gen HOXA11 dan COL3A1 pada penderita prolaps uteri, mengetahui adanya perbedaan ekspresi protein HOXA11, COL3A1, COL1A1, MMP2, MMP9, TIMP, dan p53 pada penderita prolaps uteri dibandingkan pada perempuan tanpa prolaps uteri, serta mengetahui faktor risiko yang berhubungan dengan prolaps uteri.Studi potong lintang ini melibatkan 22 pasien prolaps uteri dan 22 tanpa prolaps uteri mulai Juni 2016 sampai Februari 2017 di RSUP dr. Kariadi Semarang. Dilakukan pencatatan data karakteristik berupa usia, paritas, IMT dan berat lahir bayi. Dilakukan pemeriksaan sekuens DNA gen HOXA11 dan Col3A1, pemeriksaan imunohistokimia pada ligamentum sakrouterina untuk menilai ekspresi protein HOXA11, COL1A1, Col3A1, MMP2, MMP9, TIMP, dan p53 pada perempuan menopause dengan prolaps uteri dan tanpa prolaps uteri.Tidak didapatkan variasi berupa mutasi gen HOXA11 pada perempuan dengan prolaps uteri sepanjang fragmen yang digunakan untuk sekuensing DNA. Didapatkan mutasi pada gen COL3A1 pada 10 pasien dengan prolaps uteri dan 6 pasien tanpa prolaps uteri p = 0,719 sepanjang fragmen yang digunakan untuk sekuensing DNA. Ekspresi protein COL1A1, MMP-9 dan p53 lebih tinggi pada kelompok prolaps p < 0,05 . Rerata usia, rerata paritas dan rerata berat lahir bayi, berbeda secara uji statistik pada kedua kelompok.Pada fragmen yang diperiksa tidak didapatkan mutasi gen HOXA11, namun didapatkan mutasi gen COL3A1 pada penderita prolaps maupun perempuan tanpa prolaps uteri. Tampak adanya faktor internal yang berperan untuk terjadinya prolaps uteri selain berbagai faktor risiko klinis. Faktor eksternal berupa usia, berat bayi lahir, dan paritas memiliki hubungan dengan prolaps uteri. Kata kunci: COL1A1, COL3A1, faktor klinis, HOXA11, menopause, MMP2, MMP9, mutasi gen, p53, prolaps uteri, TIMP.

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ABSTRACT
Uterine prolapse is a condition that decreases the quality of life of women. Multiple factors, mostly clinical, affect the course of uterine prolapse.The aims of the study were to investigate the genetic variation in the form of HOXA11 and Col3a2 gene mutations in women with uterine prolapse. This study also aimed to investigate different expression of HOXA11, COL3A1, COL1A1, MMP2, MMP9, TIMP, and p53 proteins in women with and without uterine prolapse, and to understand risk factors associated with uterine prolapse.A total of 44 women were enrolled in this cross sectional study, 22 of which with uterine prolapse and 22 others without uterine prolapse. This study was conducted between June 2016 and February 2017 in RSUP dr Kariadi, Semarang. demographic data including age, parity, BMI, and birth weight were recorded. HOXA11 and COL3A1 gene sequencing, immunohistochemistry testing of uterosacral ligament were conducted to assess HOXA11, COL1A1, COL3A1, MMP2, MMP9, TIMP, and p53 protein expressions.A mutation in COL3A1 gene along the fragment used in DNA sequencing was found among 10 women with uterine prolapse and 6 women without uterine prolapse although this did not reach statistical significance p .719 . No genetic variation in the form of HOXA11 gene mutation was found in women with uterine prolapse. Higher expression of COL1A1, MMP 9 and p53 proteins were found in prolapse group p .05 . The average of age, parity, and birth weight in two groups were statistically different.Only the COL3A1 gene mutation was detected in women with and without uterine prolapse. Beside, various clinical factors, it was confirmed that some internal factors also play important role in the course of uterine prolapse. Examples of external factors are age, birth weight, and parity. Key word COL1A1, COL3A1, clinical factors, gen mutation, HOXA11, menopause, MMP2, MMP9, p53, TIMP, uterine prolapse.