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Results in Journal Indonesian Journal of Obstetrics and Gynecology: 456

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Alfian Prasetyo, Sheella Rima Bororing, Yuma Sukadarma
Indonesian Journal of Obstetrics and Gynecology pp 115-118; doi:10.32771/inajog.v9i2.1502

Abstract:
Objective: To determine the correlation between neutrophil to lymphocyte ratio and preeclampsia. To determine whether neutrophil to lymphocyte ratio can be used as a screening tool for preeclampsia.Methods: This study was conducted with a systematic review method. Articles that had been gathered and filtered were reviewed by QUADAS-2 tool. Guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) and Pedoman Nasional Pelayanan Kedokteran were used as a diagnostic criteria for determining preeclampsiaResults: Studies conducted by Kirbas et al, Cakmak et al, Wang et al and Panwar et al stated that there is a correlation between neutrophil to lymphocyte ratio to preeclampsia (p-value < 0.05). Cut-off values are diverse between 3.5 - 5.6 with different sensitivity and specificity.Conclusion: This systematic review shows that there is a relationship between neutrophil to lymphocyte ratio and preeclampsia. Neutrophil to lymphocyte ratio can be used as screening tools for preeclampsia in the first trimester.Keywords: neutrophil to lymphocyte ratio, NLR, preeclampsia. Abstrak Tujuan: Mengetahui apakah terdapat hubungan antara rasio neutrofil terhadap limfosit dengan preeklampsia. Mengetahui apakah rasio neutrofil terhadap limfosit dapat dijadikan sebagai alat bantu skrining preeklampsia.Metode: Penelitian ini dilakukan dengan metode systematic review. Artikel yang disaring akan ditentukan kualitasnya menggunakan QUADAS-2. Kriteria diagnostik preeklampsia yang digunakan adalah American College of Obstetricians and Gynecologists (ACOG) untuk penelitian luar negeri dan Pedoman Nasional Pelayanan Kedokteran untuk penelitian dalam negeri.Hasil : Penelitian yang dilakukan oleh Kirbas et al, Cakmak et al, Wang et al, dan Panwar et al menyatakan bahwa terdapat hubungan antara rasio neutrofil terhadap limfosit dengan preeklampsia ( p-value < 0.05). Nilai cutoff dari rasio neutrofil terhadap preeklampsia beragam mulai dari 3.5 - 5.6 dengan sensitivitas dan spesifisitas yang berbeda-beda.Kesimpulan : Penelitian systematic review ini menunjukan bahwa rasio neutrofil terhadap limfosit memiliki hubungan dengan penyakit preeklampsia. Rasio neutrofil terhadap limfosit dapat dijadikan sebagai alat bantu skrining untuk preeklampsia pada trimester pertama.Kata kunci: rasio neutrofil terhadap Limfosit, NLR, preeklamsia.
Dini F. Omari, Yusrawati, Satya W. Yenny
Indonesian Journal of Obstetrics and Gynecology pp 65-69; doi:10.32771/inajog.v9i2.1434

Abstract:
Objective: To analyse the association between determinants of maternal deaths and obstetric haemorrhage in Padang, Indonesia.Methods: A retrospective case-control study was conducted in Padang, Indonesia from 2015 to 2019. Maternal deaths that occurred due to obstetric hemorrhage in Padang Health Department was compared to three mothers who survived from obstetric hemorrhage (controls) in Dr. M. Djamil General Hospital, Padang, Indonesia.Results: There were 20 deaths caused by obstetric hemorrhage during 2015 to 2019. Death records could only be found in 16 cases. The most common etiology of obstetric hemorrhage was uterine atony (62.5%). Determinants associated with maternal deaths due to obstetric hemorrhage were interval between pregnancies (p=0.045; OR:10.846), history of previous labour (p=0.003; OR:8.556), and antenatal care (p=0.003; OR:21.364). Age, parity, birth attendant, and mother’s educational level were not significantly associated with maternal deaths due to obstetric hemorrhage.Conclusion: Uterine atony was the most frequent etiology of maternal deaths due to obstetric hemorrhage. There was a significant association between pregnancy intervals, history of previous labour, and antenatal care with maternal deaths due to obstetric hemorrhage.Keywords: determinant, obstetric hemorrhage, maternal death. Abstrak Tujuan: Menganalisis hubungan determinan kematian maternal akibat perdarahan obstetri di Kota Padang.Metode: Sebuah studi retrospektif case-control dilakukan di Kota Padang dari tahun 2015–2019. Setiap kasus kematian ibu akibat perdarahan obstetri dari tahun 2015–2019 yang dilaporkan oleh Dinas Kesehatan Kota Padang dibandingkan dengan tiga kasus perdarahan obstetri yang tidak berakibat kematian di RSUP Dr. M. Djamil Padang. Analisis data menggunakan uji Chi-square.Hasil: Ada 20 kasus kematian akibat perdarahan obstetri selama tahun 2015–2019. Catatan kematian hanya dapat diperoleh pada 16 kasus. Etiologi terbanyak kematian akibat perdarahan obstetri ialah atonia uteri. Determinan yang berhubungan dengan kematian akibat perdarahan obstetri ialah jarak kehamilan (p=0.045; OR:10.846), riwayat persalinan sebelumnya (p=0.003; OR:8.556), dan antenatal care (p=0.003; OR:21.364). Tidak terdapat hubungan yang signifikan antara usia, paritas, penolong persalinan, dan tingkat pendidikan ibu dengan kematian maternal akibat perdarahan obstetri.Kesimpulan: Atonia uteri merupakan etiologi tertinggi kematian maternal akibat perdarahan obstetri. Ada hubungan yang signifikan antara jarak kehamilan, riwayat persalinan sebelumnya, dan antenatal care dengan kematian maternal akibat perdarahan obstetri.Kata kunci: determinan, kematian maternal, perdarahan obstetri.
Christofer J. H. Ladja, Ims Murah Mano, Andi M. Tahir, St. Maisuri T. Chalid
Indonesian Journal of Obstetrics and Gynecology pp 90-94; doi:10.32771/inajog.v9i2.634

Abstract:
Objective: To compare the outcomes of mothers and newborns in emergency cesarean section and elective cesarean section.Methods: A prospective cohort study included 120 pregnant women consists of 60 women who performed an emergency cesarean section and 60 women who underwent elective cesarean section. Age, education level, occupation, income, history of comorbidities, history of abortion or miscarriage, antenatal care history, decision-making time until surgery is performed along with other components required, duration of operation, outcome of mother and fetal were obtained through interviews and questionnaires. Data were analyzed regarding fetal outcome and cesarean sections indications.Results: The maternal and fetal outcome between emergency and elective cesarean section were not significantly different regarding on hospital stay, dehiscence, NICU admission, Apgar score and newborn status (dead or alive). Blood transfusion is the main difference signifi cant indication for maternal outcome between emergency and elective procedure (p less than 0.05). The total duration of procedure less than 60 or more than 60 minutes and maternal-fetal outcome not signifi cantly different between two type of procedures.Conclusions: Emergency cesarean section at preterm gestational age with an operating time less than equal to 60 minutes leads to greater transfusion blood requirements compared with elective cesarean section.Keywords: emergency cesarean section, elective cesareansection, mother-infant outcome. AbstrakTujuan: Membandingkan luaran ibu dan bayi baru lahir di seksio sesarea emergensi dan elektif.Metode: Penelitian kohort prospektif melibatkan 120 perempuan hamil terdiri atas 60 perempuan yang melakukan operasi seksio sesarea emergensi dan 60 perempuan melakukan operasi elektif. Usia, tingkatpendidikan, pekerjaan, pendapatan, riwayat komorbiditas, riwayat aborsi atau keguguran, riwayat asuhan antenatal, waktu pengambilan keputusan sampai operasi dilakukan bersamaan dengan komponen lain yang diperlukan, lamanya operasi, luaran ibu dan bayi diperoleh melalui wawancara dan kuesioner. Data yang dianalisis mengenai luaran ibu dan bayinya.Hasil: Luaran ibu dan bayi antara seksio sesarea emergensi dan elektif tidak berbeda bermakna dalam hal lama rawat inap, dehisensi, admisi, skor Apgar dan status bayi baru lahir (meninggal atau hidup). Transfusi darah adalah indikasi penting utama yang berbeda untuk luaran ibu antara prosedur emergensi dan elektif (p kurang dari 0,05). Durasi total prosedur kurang dari 60 atau lebih dari 60 menit dan luaran ibu tidak berbeda secara signifikan antara kedua jenis seksio sesarea.Kesimpulan: Tindakan seksio sesarea emergensi pada usia gestasi prematur dengan waktu operasi kurang dari sama dengan 60 menit menyebabkan kebutuhan transfusi darah lebih besar dibandingkan seksio sesarea elektif.Kata kunci: luaran ibu-bayi, seksio sesarea elektif, seksio sesarea emergensi.
Rahayu Basir, Eddy Hartono, Eddy R. Moeljono, St. Nur Asni
Indonesian Journal of Obstetrics and Gynecology pp 78-81; doi:10.32771/inajog.v9i2.1153

Abstract:
Objective: To determine the correlation between spontaneous abortion and Chlamydia trachomatis infection. Methods: A cross-sectional study was conducted in women who experienced spontaneous abortion. Normal pregnancies with gestational age more than equal to 37 weeks as control. Detection of C. trachomatis in the product of conception or placenta from curettage using the PCR method. Results: Positive C. trachomatis was found 3 cases in the abortion group and 4 cases in control. In the abortion group, C. trachomatis found in 1 case with vaginal discharge history and 2 cases without this history. C. trachomatis also found in 3 cases without a history of abortion. This bacteria was not found in patients with an abortion history. In the control group, 2 cases of positive C. trachomatis were found in pregnant women with or without a history of vaginal discharge and abortion, respectively. There were no significant differences regarding the positive of C. trachomatis between the two study groups regarding history of vaginal discharge and abortion. Conclusions: Spontaneous abortion does not correlate with C. trachomatis infection. Keywords: chlamydia trachomatis, infection, spontaneous abortion. Abstrak Tujuan: Untuk mengetahui hubungan antara abortus spontan dan infeksi Chlamydia trachomatis. Metode: Penelitian potong lintang dilakukan pada perempuan yang mengalami abortus spontan. Kehamilan normal dengan usia kehamilan lebih dari sama dengan 37 minggu sebagai kontrol. Deteksi C. trachomatis pada produk konsepsi atau plasenta dari kuretase menggunakan metode PCR. Hasil: C. trachomatis positif ditemukan 3 kasus pada kelompok aborsi dan 4 kasus dalam kontrol. Pada kelompok abortus spontan, C. trachomatis ditemukan pada 1 kasus dengan riwayat keputihan dan 2 kasus tanpa riwayat keputihan. C. trachomatis juga ditemukan pada 3 kasus tanpa riwayat abortus. Bakteri ini tidak ditemukan pada pasien dengan riwayat abortus. Pada kelompok kontrol, 2 kasus positif C. trachomatis masing-masing ditemukan pada perempuan hamil dengan atau tanpa riwayat keputihan dan abortus. Tidak ada perbedaan signifikan C. trachomatis positif antara kedua kelompok penelitian berdasarkan riwayat keputihan dan abortus. Kesimpulan: Abortus spontan tidak berkorelasi dengan infeksi C. trachomatis. Kata kunci: abortus spontan, chlamydia trachomatis, infeksi.
Christy Hanudji, Eddy Suparman, Joice M. M. Sondakh
Indonesian Journal of Obstetrics and Gynecology pp 82-89; doi:10.32771/inajog.v9i2.1297

Abstract:
Objective: To find out the relationship between knowledge and attitudes of fertile aged women with IVA examination behaviour at Bitung Barat Public Health Center in Bitung City.Method: This was a cross-sectional study. Samples of 145 fertile aged women in area Bitung Barat Public Health Center Bitung city.Results: Of the 145 respondents, the highest group had sufficient and good knowledge. The highest percentage is respondents who have sufficient knowledge with a percentage of 44.14%. The attitude towards the IVA examination was assessed as good as 122 people (84.14%). The number of respondents who did not do an IVA examination is 94 people (64.83%) more than respondents who did not do an IVA examination that is 51 people (35.17%). Based on the results of statistical tests it is known that the significance value of p = 0.000. The attitude of women of childbearing age is good then the behaviour of IVA examination is also good with the results of statistical tests known that the significance value p = 0.001.Conclusions: Respondents with good IVA examination behaviour have good knowledge and attitude.Keywords: attitude, behaviour, IVA examination, knowledge. Abstrak Tujuan: Mengetahui hubungan antara pengetahuan dan sikap perempuan usia subur dengan perilaku pemeriksaan IVA di Puskesmas Bitung Barat Kota Bitung.Metode: Metode penelitian berupa analitik observasional dengan rencangan potong lintang. Sampel sebesar 145 perempuan usia subur di wilayah Puskemas Bitung Barat Kota Bitung.Hasil: Dari 145 responden, kelompok tertinggi memiliki pengetahuan yang cukup dan baik. Persentase tertinggi yaitu responden yang memiliki pengetahuan cukup dengan persentase 44,14%. Sikap terhadap pemeriksaan IVA dinilai baik yaitu sebanyak 122 orang (84,14%). Jumlah responden yang tidak melakukan pemeriksaan IVA yaitu 94 orang (64,83%) lebih banyak dari responden yang tidak melakukan pemeriksaan IVA yaitu 51 orang(35,17%). Berdasarkan hasil uji statistik diketahui bahwa nilai signifikansi p= 0,000. Sikap perempuan usia subur yang baik maka perilaku pemeriksaan IVA juga baik dengan hasil uji statistik diketahui bahwa nilai signifikansi p= 0,001.Kesimpulan: Responden dangan perilaku pemeriksaan IVA yang baik memiliki pengetahuan dan sikap yang baik.Kata kunci: pengetahuan, pemeriksaan IVA, perilaku, sikap..
Muara P. Lubis, Melvin N.G. Barus, M Rizki Yaznil, Edwin M. Asroel, Irwin L. Lumbanraja
Indonesian Journal of Obstetrics and Gynecology pp 95-101; doi:10.32771/inajog.v9i2.1493

Abstract:
Objective: To evaluate sexual function and quality of life features using two validated Female Sexual Function Index (FSFI) questionnaires, and the Short-Form Health Survey (SF-36) in patients with sexually active on Placenta Accreta Spectrum (PAS) Disorder patient.Method: This research is a cross sectional analytic observational study which was conducted in Haji Adam Malik General Hospital from January 2017 - December 2019. Thirty-five study patients who have been diagnosed with PAS disorder and have been treated for at least 3 months were divided into hysterectomy and conservative groups. This study data consisted of primary data from interviews and secondary data from medical records. Independent T test is used if it is normally distributed and Mann-Whitney is used if it is not normally distributed, and it is declared significant if the P value is <0.05. Result: From 8 assessment variables in the SF-36 questionnaire by comparing the questionnaire scores of PASD patients in the hysterectomy and conservative groups by showing significant results on social function (P value 0.021). Whereas in the FSFI questionnaire, there were 6 variables to assess the sexual function of patients with pain variable showing significant results (P value 0.007).Conclusion: There were differences in quality of life (social function) and sexual function (pain) in PASD patients in the hysterectomy and conservative groups.Keywords: Female Sexual Functional Index, Placenta Accreta Spectrum, Quality of Life, Short-Form Health Survey. Abstrak Tujuan: Untuk mengevaluasi fungsi seksual dan fitur kualitas hidup dengan menggunakan dua kuesioner tervalidasi Female Sexual Function Index (FSFI), dan Short-Form Health Survey (SF-36) pada pasien dengan placenta accrete spectrum (PAS) disorder yang aktif secara seksual setelah tindakan operasi.Metode: Penelitian ini merupakan penelitian analitik observasional dengan metode potong lintang yang dilaksanakan di Rumah Sakit Umum Haji Adam Malik dari January 2017-December 2019. Tiga puluh lima pasien yang didiagnosis dengan plasenta akreta spectrum dan telah ditatalaksana minimal 3 bulan dibagi menjadi kelompok histerektomi and konservatif. Data penelitian ini terdiri atas data primer dari wawancara dan data sekunder dari rekam medis. Uji T independen digunakan jika berdistribusi normal dan Mann-Whitney digunakan jika tidak berdistribusi normal, serta dinyatakan signifikan jika nilai P <0.05.Hasil: Dari 8 variabel penilaian dalam kuesioner SF-36 dengan membandingkan skor kuesioner pasien PASD pada kelompok histerektomi dan konservatif dengan menunjukkan hasil yang signifikan pada fungsi sosial (nilai P = 0,021). Sedangkan dalam kuesioner FSFI terdapat 6 variabel untuk menilai fungsi seksual pasien dengan variabel nyeri yang menunjukkan hasil yang signifikan (nilai P = 0,007).Kesimpulan: Terdapat perbedaan dalam kualitas hidup (fungsi sosial) dan fungsi seksual (nyeri) pada pasien PASD di kelompok histerektomi dan konservatif. Kata Kunci: female sexual functional index, placenta accreta spectrum, quality of life, short-form health survey.
Dwiana Ocviyanti, Ribkhi A. Putri
Indonesian Journal of Obstetrics and Gynecology pp 107-110; doi:10.32771/inajog.v9i2.1269

Abstract:
Objectives: Diagnosis of brainstem death and the vital organ function support in the pregnant woman to prolong gestation to attain fetal viability is still controversial. The decision is influenced by ethical and legal issue in the country. Another consideration is the hospital cost and health insurance coverage. This article purpose is to report a case and discuss the biopsychosocial aspect of this issue, so the doctors know how to decide a similar case.Methods: We reported a suspected brainstem death in pregnant women and discussed the holistic approach.Case: This case is a-38-year-old women, third pregnancy, 22 weeks of gestation, referred from the secondary hospital in a comatose condition. She was diagnosed with brainstem dysfunction due to intracranial mass and cerebral oedema. She wasn't diagnosed with brainstem death due to the electrolyte imbalance that can cause this condition. We did the multidisciplinary management approach. We decided the termination of pregnancy would only be performed if the fetus reaches 28 weeks of gestational age (with survival rate on perinatology is 31%). From the husband point of view, since the attending doctors have not declared the mother to be dead, then the husband still want to keep the mother in full life support. The patient and the fetus died on the 8th day of hospitalization. The patient was fully paid for by Indonesian Health Insurance.Conclusion: Maternal brainstem dysfunction and brainstem death during pregnancy are rare. In Indonesia, ethical and legal consideration to keep both mother and fetus are appropriate with the general social, cultural, and religious values. However, we recommend managing every single case individually with an intensive multidisciplinary approach due to the possibility of the different personal value of the patient.Keywords: brainstem dysfunction, brain death, pregnancy, fetal, ethic, legal. Abstrak Tujuan: Diagnosis kematian batang otak dan dukungan fungsi organ vital pada perempuan hamil untuk melanjutkan kehamilannya sampai janin dapat hidup jika dilahirkan masih kontrovesi. Keputusan ini dipengaruhi oleh etik dan hukum di suatu negara. Pertimbangan lainnya adalah biaya perawatan rumah sakit dan cakupan asuransi kesehatan. Artikel ini bertujuan melaporkan sebuah kasus dan mendiskusikan aspek biopsikososialnya, sehingga para dokter dapat mengambil keputusan pada kasus lain yang serupa.Metode: Kami melaporkan kasus perempuan hamil dengan kecurgaan kematian batang otak dan mendiskusikan pendekatan holistiknya.Hasil: Kasus perempuan usia 38 tahun, kehamilan ketiga, 22 minggu, dirujuk dari rumah sakit sekunder dalam kondisi koma. Pasien didiagnosis dengan disfungsi batang otak akibat massa intracranial dan edema serebri. Pasien tidak didiagnosis dengan meti batang otak karena kondisi ini masih dapat dikarenakan gangguan keseimbangan elektrolit. Kami melakukan pendekatan multidisiplin. Diputuskan terminasi kehamilan akan dilakukan hanya jika janin mencapai usia kehamilan 28 minggu (dengan harapan hidup dari perinatology 31%). Dikarenakan dokter belum mengatakan pasien sudah meninggal, suami pasien menginginkan pasien dalam topangan alat. Pasien dan janinnya meninggal pada hari ke-8 perawatan. Pembiayaan pasien dengan menggunakan BPJS.Kesimpulan: Disfungsi batang otak dan kematian batang otak selama kehamilan adalah kasus yang jarang. Di Indonesia, etik dan hukum yang berlaku untuk menjaga kehidupan ibu dan janin sesuai dengan nilai sosial, budaya, dan agama. Namun demikian, kami merekomendasikan mlakukan tata laksana setiap kasus secara individu dengan pendekatan multidisiplin dikarenakan perbedaan nilai pribadi pasien dan keluarga.Kata kunci: disfungsi batang otak, etik, hukum, janin, mati batang otak, kehamilan.
Juminten Saimin, Yenti Purnamasari, Sufiah Mulyawati
Indonesian Journal of Obstetrics and Gynecology pp 74-77; doi:10.32771/inajog.v9i2.1483

Gagah B.A. Nugraha, Prakosa J. Prasetyo, Daliman
Indonesian Journal of Obstetrics and Gynecology pp 111-114; doi:10.32771/inajog.v9i2.1373

Abstract:
Objective: This case may partly explain that anaemia can be a predisposing factor for the development of many women with preeclampsia were have a low level of haemoglobin during their pregnancy.Methods: A case reportCase: We present a case 23-year-old pregnant woman who has had moderate anaemia with severe preeclampsia at 38-week pregnant. As the evidence, there were elevated blood pressure, decreasing haemoglobin obtained by routine blood analysis, and presence of urine protein by urinalysis examination.Conclusion: In terms of anaemia as one of a predisposing factor of preeclampsia it is important to care provider, pregnant women, and families to prevent anaemia in pregnancy through routine ANC.Keywords: anaemia, pregnancy, severe preeclampsia. Abstrak Tujuan: Kasus ini sebagian dapat menjelaskan bahwa anemia dapat menjadi faktor predisposisi bagi perkembangan banyak perempuan dengan preeklamsia yang memiliki kadar hemoglobin yang rendah selama masa kehamilan mereka.Metode: Laporan kasus.Kasus : Kami melaporan kasus ibu hamil berusia 23 tahun yang mengalami anemia sedang dengan preeklamsia berat di usia 38 minggu, dibuktikan dari peningkatan tekanan darah, penurunan hemoglobin, serta protein uria pada pemeriksaan urinalisis.Kesimpulan : Berkaitan antara anemia sebagai predisposisi preekalmsia, penting bagi petugas kesehatan dan ibu hamil serta keluarga untuk mencegah anemia dalam kehamilan melalui ANC yang rutin.Kata kunci : anemia, kehamilan, preeklamsia berat.
Pribakti Budinurdjaja, Ihya R. Nizomy, Hermin Sabaruddin
Indonesian Journal of Obstetrics and Gynecology pp 102-106; doi:10.32771/inajog.v9i2.1462

Abstract:
Objective: To determine the relationship between obstetric risk factors and the incidence of postpartum urinary retention in spontaneous labour at RSUD Ulin Banjarmasin.Methods: This clinical study used an analytical observational design with a cross-sectional approach. The population of this study was patients with a diagnosis of postpartum urinary retention in spontaneous labour in the delivery ward and postpartum ward of Ulin Banjarmasin Hospital between January 2018-January 2020. The sample for this study was a part of the target population selected by purposive sampling, which fulfilled the inclusion and exclusion criteria. Data were analyzed using the Chi square test and multivariate analysis using binary logistics.Results: The results showed 35 samples of patients diagnosed with postpartum urinary retention in spontaneous labour and had met the inclusion and exclusion criteria. Characteristic data of the study samples found that most of the study subjects were more than 35 years old, 27 patients (77%), 21 patients (60%) of cases with primigravida parity, 26 patients (76%) with the duration of second stage labour more than equal to 1 hour. Episiotomy was performed in 30 patients (86%), 34 patients (97%) had a newborn birthweight of less than 4000 grams. There was a significant association between the risk factors for parity in primigravida (p-value 0.02), second stage labour duration in primigravida (p-value 0.01), and episiotomy (p-value 0.01), with postpartum urinary retention in spontaneous labour. In contrast, age (p-value 0.19), and birthweight (p-value 0.10) were not significantly associated with postpartum urinary retention in spontaneous labour.Conclusions: There were significant associations between obstetric risk factors (parity, duration of second stage labour, and episiotomy) with postpartum urinary retention in spontaneous labour. Whereas age and birth weight were not significantly associated with postpartum urinary retention in spontaneous labour.Keywords: obstetric risk, postpartum retention, spontaneous delivery. Abstrak Tujuan: Mengetahui hubungan faktor risiko obstetrik dengan kejadian retensio urin postpartum pada persalinan spontan di RSUD Ulin Banjarmasin.Metode: Penelitian ini merupakan penelitian klinis dengan rancangan observasional analitik dengan pendekatan potong lintang. Populasi dari penelitian ini adalah ibu postpartum yang didiagnosis dengan retensio urin postpartum pada persalinan spontan di kamar bersalin dan di ruangan nifas RSUD Ulin Banjarmasin periode Januari 2018-Agustus 2020. Data dianalisis bivariat menggunakan uji Chi square dan analisis multivariate dengan menggunakan binary logistik.Hasil: Didapati 35 sampel yang didiagnosis retensio urin postpartum pada persalinan spontan dan memenuhi kriteria inkulusi dan eksklusi. Data karakteristik sampel penelitian ditemukan usia terbanyak subyek penelitian berusia lebih dari 35 tahun sebanyak 27 pasien (77,14%), kasus dengan paritas primigravida sebanyak 21 pasien (60%), lama kala dua primigravida lebih dari sama dengan 1 jam sebanyak 26 pasien (76%). Tindakan episiotomi sebanyak 30 pasien (86%), berat bayi lahir terbanyak pada berat kurang dari 4.000 gram yaitu sebnyak 34 pasien (97%). Terdapat hubungan yang bermakna pada faktor risiko paritas pada primigravida dengan p value 0,02, lama kala dua dengan p value 0,01, dan tindakan episotomi dengan p value 0.01 dengan kejadian retensio urin postpartum sedangkan didapatkan hasil yang tidak bermakna pada risiko obstetrik usia dengan p value 0.19 dan berat bayi lahir dengan p value 0.10 pada kejadian retensio urin postpartum.Kesimpulan: Terdapat hubungan signifikan antara faktor risiko obstetrik (paritas, lama kala dua dan tindakan episotomi) dengan retensio urin postpartum persalinan spontan. Sedangkan umur dan berat badan lahir tidak berhubungan dengan retensio urin postpartum pada persalinan spontanKata kunci: persalinan spontan, risiko obstetrik, retensio postpartum.
Hermie M. M. Tendean, Anastasia M. Lumentut, Maimun Ihsan
Indonesian Journal of Obstetrics and Gynecology pp 70-73; doi:10.32771/inajog.v9i2.1522

Abstract:
Objective: To compare maternal death in RSUD dr. Aloei Saboe Gorontalo before BPJS (in 2011-2013) and after BPJS (2014-2016)Methods: Descriptive Retrospective. Data in this study obtained from the secondary data. This data obtained by the researcher from medical records in RSUD Prof. Dr. Aloei Saboe Gorontalo.Results: In this study, the number of delivery in hospitals Prof. Dr. Aloei Saboe before BPJS (2011-2013) of 7906 deliveries of live births after 7735 and health services BPJS (years 2014-2016) of 6493 deliveries of live births BPJS 6333. Maternal mortality before and after as many as 34 cases BPJS many as 42 cases, so we get the MMR before BPJS 4.39 ‰ and 6.63 ‰ after BPJS.Conclusion: There is a significant increase in maternal mortality rate in Prof. Dr. Aloei Saboe Gorontalo (p = 0.036), after BPJS maternal mortality (years 2014-2016) was 42 cases, compared with a prior health services BPJS (2011-2013) was 34 cases. This increase occurred because of a referral system BPJS make the decreasing number of births was in the hospital decreased, and hospitals Prof. Dr. Aloei Saboe a referral centre in Gorontalo province and surrounding areas.Keywords: death, BPJS, maternal, mortality. Abstrak Tujuan: Untuk membandingkan kematian maternal di RSUD Prof. Dr. Aloei Saboe sebelum BPJS (2011-2013) dan sesudah layanan kesehatan BPJS (2014-2016).Metode: Deskriptif Retrospektif. Jenis data yang digunakan dalam penelitian ini adalah data sekunder yang diperoleh dari rekam medik di RSUD Prof. Dr. Aloei Saboe Gorontalo.Hasil: Pada penelitian ini didapatkan jumlah persalinan di RSUD Prof. Dr. Aloei Saboe sebelum BPJS (2011-2013) sebanyak 7906 persalinan dengan kelahiran hidup 7735 dan sesudah layanan kesehatan BPJS (2014-2016) sebanyak 6493 persalinan dengan kelahiran hidup 6333. Kematian maternal sebelum BPJS sebanyak 34 kasus dan sesudah BPJS sebanyak 42 kasus, sehingga didapatkan AKI sebelum BPJS 4.39 ‰ dan sesudah BPJS 6.63 ‰.Kesimpulan: Ternyata terdapat peningkatan yang bermakna (p=0,036) kematian maternal sesudah BPJS (2014-2016) sebanyak 42 kasus, bila dibandingkan dengan sebelum layanan kesehatan BPJS (2011-2013) sebanyak 34 kasus. Peningkatan ini terjadi karena sistem rujukan BPJS membuat menurunnya jumlah persalinan yang ada dirumah sakit menurun, dan RSUD Prof. Dr. Aloei Saboe merupakan pusat rujukan di propinsi Gorontalo dan sekitarnya.Kata Kunci: BPJS, kematian, maternal,mortalitas
Julianto Witjaksono, Fiastuti Witjaksono, Andhika A. Perdana
Indonesian Journal of Obstetrics and Gynecology pp 49-54; doi:10.32771/inajog.v9i1.1415

Abstract:
Objective: To investigate the effect of lifestyle modification on endometrial receptivity of obese women with polycystic ovary syndrome using ultrasonography.Methods: This observational study was conducted at Dr. Cipto Mangunkusumo General Hospital Jakarta from August 2019 to May 2020. A total of 14 subjects were participated in this study. The subjects were advised to get nutrition counseling by nutritionist and then followed up the endometrial profiles for 6 months by ultrasonography.Results: A total 19 subjects were received nutrition counseling by Clinical nutritionist, but then, only 14 subjects were evaluated the endometrial study by Ultrasonography. There were several significant result between before and after treatment some subjects such as calories, body weight, body mass index, waist circumference (p
Rajuddin Rajuddin, Fitra Rizia, Sarah I. Nainggolan
Indonesian Journal of Obstetrics and Gynecology pp 42-48; doi:10.32771/inajog.v9i1.1386

Abstract:
Objective: To assess correlation of High sensitivity C-Reactive Protein (Hs-CRP), erythrocyte sedimentation rate (ESR), progesterone and estradiol levels in the first trimester threatened abortion incidence in Dr. Zainoel Abidin Hospital, Banda Aceh.Methods: Case control design used in this study divided threatened abortion into a case group and normal pregnancy into a control group with a total of 20 subjects for each group. This research was conducted in the Emergency Room and Obstetric Ward of Dr. Zainoel Abidin hospital Banda Aceh in 2019. Eta correlation test was conducted to find out the link between variables towards threatened abortion with 95% confidence level followed by the Receiver Operating Curve (ROC) analysis to find out the cut off points.Results: Progesterone levels (14.76 ng/mL), estradiol (427.61 pg/mL), Hs-CRP (2.57 mg/L) and ESR (28.75 mm/hour) case group were lower compared to the control group. Incidence of threatened abortion correlates to progesterone and estradiol with the correlation strength respectively -0.838 and -0.416.Conclusion: Progesterone and estradiol correlate negatively with first-trimester abortion incidence. Evaluation of these two hormones levels is useful for diagnostic purposes and screening of threatened abortion with a cut point of progesterone 23.03 ng/mL and estradiol 468.8 pg/mL.Keywords: C-Reactive Protein, erythrocyte sedimentation rate, estradiol, progesterone, threatened abortion Abstrak Tujuan: Penelitian ini bertujuan untuk menilai korelasi antara kadar High sensitivity C-Reactive Protein (Hs-CRP), Laju Endap Darah (LED), progesteron dan estradiol terhadap kejadian abortus imminens pada trimester pertama di RSUD Dr. Zainoel Abidin Banda Aceh. Metode: Desain kasus kontrol digunakan dalam penelitian ini dimana kejadian abortus imminens menjadi kelompok kasus dan kehamilan normal menjadi kelompok kontrol dengan jumlah masing-masing kelompok sebanyak 20 sampel. Penelitian ini dilakukan di Instalasi Gawat Darurat dan ruang rawat Obstetri Rumah Sakit Umum Dr. Zainoel Abidin (RSUDZA) Banda Aceh pada tahun 2019. Uji korelasi Eta digunakan untuk mengetahui korelasi antar variabel terhadap abortus imminens dengan tingkat kepercayaan 95% dilanjutkan dengan analisis Receive Operating Curve (ROC) untuk menentukan titik potong. Hasil: Kadar progesteron (14,76 ng/mL), estradiol (427,61 pg/mL), Hs-CRP (2,57 mg/L) dan LED (28,75 mm/jam) kelompok kasus lebih rendah dibandingkan kelompok kontrol. Kejadian abortus imminens berkorelasi terhadap progesteron dan estradiol dengan kekuatan korelasi (R) secara berurutan -0,838 dan -0,416. Kesimpulan: Progesteron dan estradiol berkorelasi negatif terhadap kejadian abortus imminens pada trimester pertama kehamilan. Evaluasi kadar kedua hormon tersebut bermanfaat untuk kepentingan diagnostik dan penapisan abortus imminens dengan titik potong progesteron 23,03 ng/mL dan estradiol 468,8 pg/mL. Kata kunci: abortus imminent, C-Reactive Protein, estradiol, laju endap darah, progesteron
Yudianto B Saroyo
Indonesian Journal of Obstetrics and Gynecology pp 3-4; doi:10.32771/inajog.v9i1.1495

Rahmad R. B. Wicaksono, Julian Dewantiningrum, Herman Kristanto
Indonesian Journal of Obstetrics and Gynecology pp 32-37; doi:10.32771/inajog.v9i1.1429

Abstract:
Objective: To know the relationship between high-sensitivity cardiac Troponin I (hscTnI) level with left ventricular dysfunction on severe preeclampsia.Methods: An observational analytics study with a cross-sectional approach of ten pregnant women with severe preeclampsia who underwent delivery or termination pregnancy and then performed a transthoracic echocardiography examination and serum levels of hscTnI.Results: There is a significant relationship between hscTnI levels and left ventricular diastolic dysfunction (p
Juminten Saimin, Steven Ridwan, Irawaty Irawaty, Arimaswati Arimaswati, Sadly Salman, Wawan Hermawan
Indonesian Journal of Obstetrics and Gynecology pp 5-9; doi:10.32771/inajog.v9i1.1466

Abstract:
Objective: To determine the clinical profile of pregnant women with COVID-19 who hospitalized in a referral hospital.Methods: This was a descriptive study conducted on pregnant women with COVID-19 who were hospitalized at Regional Hospital of Bau-Bau and Bahteramas Hospital in Southeast Sulawesi from May to July 2020. The confirmation of COVID-19 was based on RT-PCR. Data including characteristics, clinical profile, laboratory test, imaging, management, and outcomes.Results: There were 41 pregnant women with COVID-19 and no maternal death cases. Maternal age was approximately 19 to 39 years, had middle education levels, and was a housewife. Most of them did not know their closed contacts, had no comorbidities, and referrals from other hospitals. They were 3rd-trimester and hospitalized with complaints related to pregnancy. Only 3 cases had complaints related to COVID-19, namely fever and cough. The majority of laboratory tests were leucocytosis. Chest X-ray shows bronchopneumonia, pneumonia, and normal imaging. Obstetrics management was performed according to the condition of the mother and fetus, including vaginal delivery, cesarean section, and curettage. The treatment was using broad-spectrum antibiotics and antiviral. Complications in the fetus/infant were abortion, fetal distress, LBW, and asphyxia.Conclusion: Pregnant women with COVID-19 have mild or asymptomatic symptoms, hospitalized with complaints related to their pregnancy, and treatment according to the condition of the mother and fetus. There are no complications in the mother, while complications in the baby are not clear.Keywords: COVID-19, pregnant women, referral hospital. Abstrak Tujuan: Mengetahui gambaran klinis ibu hamil dengan COVID-19 yang masuk di rumah sakit rujukan COVID-19.Metode: Penelitian ini bersifat deskriptif yang dilakukan pada ibu hamil dengan COVID-19 yang dirawat di rumah sakit rujukan di Sulawesi Tenggara, yaitu RSUD Bau-Bau dan RSU Bahteramas di Kendari, pada bulan Mei sampai Juli 2020. Konfirmasi positif COVID-19 berdasarkan hasil pemeriksaan RT-PCR. Data berupa karakteristik, gambaran klinis, pemeriksaan penunjang, penatalaksanaan, dan luaran. Hasil: Terdapat 41 ibu hamil dengan COVID-19 dan tidak ada kasus kematian ibu. Usia ibu berkisar 19-39 tahun, tingkat pendidikan menengah, dan sebagai ibu rumah tangga. Sebagian besar kasus pada trimester-3, tidak tahu memiliki kontak erat, tidak memiliki komorbid, dan rujukan dari RS lain. Sebagian besar dirawat dengan keluhan terkait kehamilannya dan hanya 3 kasus dengan keluhan terkait COVID-19, yaitu demam dan batuk. Pemeriksaan laboratorium menunjukkan lekositosis. Gambaran foto toraks menunjukkan bronkopneumonia, pneumonia, dan normal. Tindakan obstetri dilakukan atas indikasi ibu dan janin, yaitu persalinan normal, seksio sesarea, dan kuretase. Terapi yang digunakan adalah antibiotic spectrum luas dan antivirus. Komplikasi pada janin/bayi berupa abortus, gawat janin, BBLR, dan asfiksia. Kesimpulan: Ibu hamil dengan COVID-19 memiliki gejala ringan atau asimtomatik, dirawat dengan keluhan terkait kehamilannya, dan dilakukan tindakan obstetri sesuai dengan indikasi ibu dan janin. Tidak ada komplikasi pada ibu, sedangkan komplikasi pada bayi belum jelas.Kata kunci: COVID-19, ibu hamil, rumah sakit rujukan
Yakob Togar Simatupang, Yongki Wenas, Januar Simatupang
Indonesian Journal of Obstetrics and Gynecology pp 26-31; doi:10.32771/inajog.v9i1.1413

Abstract:
Objective: To predict outcome of delivery by using ultrasound measurements consisting angle of progression, and head perineum distance.Methods: Sixtytwo parturients assigned in cohort prospective study. Ultrasound examination begin with identifying the cephalic position by placement of transducer on suprapubic region. The angle of progression is obtained trans-labially, head perineum distance and cervical dilation trans-perineally. Ultrasound findings of Nuchal cord, caput, moulding, occiput posterior position then compared with conventional findings. Labour is observed, outcomes are grouped into vaginal delivery and cesarean section.Results: Thirty-six women went for vaginal delivery, 26 underwent cesarean section. Independent T-test showed significant differences of the angle of progression (121.11o vs 88.85o) and head perineum distance (5.15 cm vs 7.26 cm) between the two groups. Linear regression test found a negative correlation on how the angle of progression affecting head perineum distance p-value 101o angle of progression predicts vaginal delivery, area under curve 0.902 and positive likelihood ratio 4.4. Kappa reliability testing for nuchal cord, caput, moulding, and occiput posterior are 0.919, 0.938, 0.384, 0.681 respectively.Conclusion: Intrapartum ultrasound able to predict the outcome of delivery, digital examination of cervical dilation is the mainstay of measurement. Ultrasound able to rule out the presence of nuchal cord, caput, and occiput posterior. Keywords: angle of progression, head perineum distance, intrapartum ultrasound. Abstrak Tujuan: Mengetahui besar sudut penurunan kepala dan jarak kepala ke perineum dengan ultrasonografi intrapartum dalam memprediksi luaran persalinan. Metode: Enam puluh dua ibu bersalin dilakukan pemeriksaan ultrasonografi intrapartum. Identifikasi posisi kepala dengan meletakan transduser di suprapubik, sudut penurunan kepala secara translabial, jarak kepala ke perineum dan nilai dilatasi serviks secara transperineal. Lilitan tali pusat, kaput, molase, dan oksiput posterior pada temuan ulstrasonografi dibandingkan dengan hasil pemeriksaan konvensional. Observasi persalinan dilakukan, di kelompokan untuk persalinan pervaginam dan seksio sesarea.Hasil: Didapatkan 36 persalinan pervaginam dan 26 seksio sesarea. Uji – t secara signifikan berbeda, nilai sudut penurunan kepala (121,11o vs 88,85o), jarak kepala ke perineum (5,15 cm vs 7,26 cm) pada kedua kelompok. Uji regresi linier sudut penurunan kepala dan pengaruhnya terhadap jarak kepala ke perineum berkorelasi negatif p 101o, uji diagnostik dengan kurva Receiver Operating Characteristic didapatkan area dibawah kurva 0.902, rasio kemungkinan positif 4,4. Uji reliabilitas Kappa lilitan tali pusat, kaput ,molase, dan oksiput posterior berturut-turut (k) = 0.919, 0.938, 0.384, dan 0.681. Kesimpulan: Penggunaan ultrasonografi intrapartum dapat memprediksi luaran persalinan, pemriksaan dalam tetap menjadi pemeriksaan utama dalam menilai dilatasi serviks, ultrasnografi mampu mendeteksi lilitan tali pusat, kaput, dan posisi oksiput posterior.Kata kunci: Jarak kepala ke perineum, sudut penurunan kepala, Ultrasonografi intrapartum.
Cut M. Yeni, Mhd. Maqbul M. Lubis, Munawar, Hendra Zuffry
Indonesian Journal of Obstetrics and Gynecology pp 15-20; doi:10.32771/inajog.v9i1.1276

Abstract:
Objective: To determine the correlation between Glycated Albumin concentrations with the outcome of pregnant women with Type 2 Diabetes Mellitus in Zainoel Abidin Hospital, Banda Aceh. Methods: This was an observational correlational study using a cross-sectional design. Subjects include pregnant women with a history of Type 2 Diabetes Mellitus who are examined for serum GA levels using colorimetric enzymatic methods and the outcomes will be assessed during pregnancy. Data analysis was performed using the ETA test and Receiver Operating Characteristic (ROC) curve. Results: A total of 29 subjects with a mean age of 33.25 years had normal maternal outcome and those with a mean age of 34.92 years had abnormal maternal outcome. Statistically there was a significant correlation between GA levels and the maternal outcome of pregnant women with Type 2 Diabetes Mellitus (p = 0.009) with a moderate degree of negative correlation (r = 0.477). The GA cut-off for pregnancy outcome is 16.77% with a sensitivity and specificity of 76% and 75% respectively. Conclusion: Examination of GA concentration can be used as a predictor to assess maternal outcomes during pregnancy with moderate correlation and a cutoff point of 16.77%. Keywords: diabetes mellitus, glycated albumin, maternal outcome, pregnancy. Abstrak Tujuan: Untuk mengetahui korelasi kadar Glycated Albumin terhadap outcome pada ibu hamil yang menderita diabetes melitus tipe I dan untuk mengetahui berapa kadar Glycated Albumin yang dapat memberikan hasil buruk pada ibu hamil yang menderita diabetes melitus tipe II di RSUD dr. Zainoel Abidin Banda Aceh. Metode: Penelitian ini merupakan studi korelatif observasional menggunakan desain potong lintang. Perempuan hamil dengan riwayat DMT2 akan diperiksan kadar GA serum menggunakan metode enzimatik kolorimetri serta akan dinilai outcome selama kehamilan. Analisis data dilakukan menggunakan uji Eta dan kurva Receiver Operating Characteristic (ROC) dengan tingkat kepercayaan 95%. Hasil: Sebanyak 29 subjek dengan rerata usia 33,25 tahun (hasil normal) dan 34,92 tahun (hasil kelainan). Secara statistik terdapat korelasi yang bermakna antara kadar GA dan outcome ibu penderita DMT2 (p = 0,009) dengan derajat korelasi sedang (r = 0,477) dengan arah korelasi negatif. Titik potong GA terhadap outcome kehamilan adalah 16,77% dengan sensitifitas dan spesisitas secara berurutan 76% dan 75%. Kesimpulan: Pemeriksaan GA dapat dijadikan sebagai prediktor untuk menilai outcome ibu selama kehamilan dengan tingkat korelasi sedang dan titik potong 16,77%. Kata kunci: diabetes melitus, glikasi albumin, hamil, luaran ibu.
Renny Aditya, Risa Dirgagita
Indonesian Journal of Obstetrics and Gynecology pp 38-41; doi:10.32771/inajog.v9i1.1433

Abstract:
Objective: To determine the type of bacteria in post-cesarean surgical patient wounds obtained through the patient's surgical wound swab in the Ward Obstetrics and Gynecology RSUD Ulin Banjarmasin in the period August-October 2019.Methods: This study was a descriptive study with a cross-sectional approach. A total of 36 samples were taken using a purposive sampling method, but only 32 bacterial isolates were obtained. Samples in the form of clean operating wound contaminated post-cesarean patients were planted on growth media and identified microscopically to be further classified based on responses to biochemical tests.Results: Descriptive analysis shows that there are three types of bacteria, namely Staphylococcus aureus as much as 59.3%, Staphylococcus epidermidis as much as 25.0%, and Escherichia coli as much as 15.6%.Conclusion: Obtained 3 types of bacteria in the results of surgical wound swab in post-cesarean section patients who were hospitalized in the Ward and Obstetrics Hospital of Ulin Hospital Banjarmasin, namely Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli.Keywords: cesarean section, contaminant bacteria, surgery wound swab. Abstrak Tujuan: Mengetahui gambaran jenis bakteri pada luka operasi pasien pascaseksio sesarea yang didapat melalui swab luka operasi pasien di Bangsal Kandungan dan Kebidanan RSUD Ulin Banjarmasin dalam periode Agustus-Oktober 2019.Metode: Penelitian ini merupakan studi dekskriptif dengan pendekatan potong lintang. Sebanyak 36 sampel diambil menggunakan metode purposive sampling, tetapi hanya didapatkan 32 isolat bakteri. Sampel swab luka operasi bersih terkontaminasi pasien paska seksio sesarea ditanam pada media pertumbuhan dan diidentifikasi secara mikroskopis untuk selanjutnya diklasifikasikan berdasarkan respon terhadap uji biokimia.Hasil : Analisis secara deksriptif menunjukkan bahwa terdapat tiga jenis bakteri, yaitu Staphylococcus aureus sebanyak 59,3%, Staphylococcus epidermidis sebanyak 25,0%, dan Escherichia coli sebanyak 15,6%.Kesimpulan : Didapatkan 3 jenis bakteri pada hasil swab luka operasi pasien pascaseksio sesarea yang dirawat inap di Bangsal Kandungan dan Kebidanan RSUD Ulin Banjarmasin, yaitu Staphylococcus aureus, Staphylococcus epidermidis, dan Escherichia coli.Kata kunci: seksio sesarea, bakteri kontaminan, swab luka operasi.
Rismawati Tambunan, Fahriatni, Hasanuddin
Indonesian Journal of Obstetrics and Gynecology pp 59-62; doi:10.32771/inajog.v9i1.1260

Abstract:
Objective: Selective estrogen receptor modulators (SERMs) such as tamoxifen play a role in increasing the risk of developing uterine Fibroid.Methods: Case reportCase: Mrs. 47 years old, Para 6, presented with chief complaints of vaginal bleeding since a year ago. The patient was diagnosed with breast carcinoma 4 years ago and has had a right mastectomy followed by 6 cycles of chemotherapy which is then continued with tamoxifen treatment for 4 years, USG examination revealed uterine myoma to which we performed bilateral salphingoophorectomy hysterectomy, with anatomic pathology results of a uterine Fibroid and chronic endometritis.Conclusion: Selective estrogen receptor modulators (SERMs) such as tamoxifen exhibit antagonistic reactions in breast tissue which makes it appropriate to be used in the treatment of breast cancer. However, they can also be potentially agonistic on estrogen receptors in the uterus, which can cause the growth of uterine Fibroid. Nevertheless, the benefits of adjuvant tamoxifen for breast cancer outweighs its potential for developing uterine Fibroid and endometrial carcinoma, because metastatic breast cancer will always be fatal, whereas uterine myoma and endometrial cancer caused by the effects of tamoxifen can be prevented by regular evaluation and total hysterectomy.Keywords: breast cancer,tamoxifen, uterine fibroid, Abstrak Tujuan: Selektif estrogen reseptor modulator (SERMs) seperti tamoksifen berperan dalam meningkatkan risiko mengembangkan mioma uteri. Metode: Laporan KasusKasus: Ny 47 Thn Para 6, datang dengan keluhan perdarahan dari jalan lahir yang dirasakan ibu selama 1 tahun ini, pasien telah menderita kanker payudara 4 tahun yang lalu dan telah dilakukan mastektomi mammae dextra dilanjutkan kemoterapi 6 siklus kemudian dilanjutkan dengan pengobatan tamoksifen selama 4 tahun ini, dari pemeriksaan USG didapatkan adanya mioma uteri kemudian dilanjutkan dengan tindakan histerektomi salphingooforektomi bilateral, dengan hasil patologi anatomi suatu mioma uteri dan endometritis kronis.Kesimpulan: Selektif estrogen reseptor modulator (SERMs) seperti tamoksifen merupakan reaksi antagonis reseptor estrogen pada jaringan payudara yang digunakan dalam pengobatan kanker payudara, tetapi dapat berpotensi agonis pada reseptor estrogen pada uterus sehingga dapat menyebabkan pertumbuhan mioma uteri. Tetapi penggunaan tamoksifen ajuvan untuk kanker payudara lebih bermanfaat dibandingkan dengan potensinya untuk mengembangkan mioma uteri dan karsinoma endometrium, karena kanker payudara metastatik akan selalu berakibat fatal, sedangkan mioma uteri dan kanker endometrium yang ditimbulkan oleh efek tamoksifen dapat dicegah dengan evaluasi teratur dan dilakukan tindakan total histerektom.Kata kunci: kanker payudara, mioma uteri, tamoksifen
Lisnawati Yuyun, Marianna Yesy, Rinawati Rohsiswatmo
Indonesian Journal of Obstetrics and Gynecology pp 21-25; doi:10.32771/inajog.v9i1.1397

Abstract:
Objective: Increased levels of inflammatory factors in newborns are often associated with lower maternal vitamin D levels. This study aimed to find out the relationship between maternal and umbilical cord vitamin D serum levels on umbilical cord Interleukin-6 (IL-6) and serum C-Reactive Protein (CRP) levels in premature infants.Methods: The study was an observational analytic, cross-sectional design in mothers who underwent preterm birth at 28-34 weeks' gestation due to premature rupture of membranes (PROM) and their infants at Dr. Cipto Mangunkusumo General Hospital (RSCM), Jakarta and Persahabatan General Hospital, Jakarta, from January 2017 to August 2018. Levels of serum vitamin D of the maternal and umbilical cord, umbilical cord IL-6 and serum CRP in premature infants were recorded. Vitamin D level was divided into deficiency (30 ng/mL) groups. The relationship of vitamin D levels with IL-6 and CRP was carried out using Kruskal Wallis test.Results: A total of 70 subjects met the research criteria. Umbilical cord IL-6 and serum CRP levels in premature infants of vitamin D deficient mothers were higher (20.31 pg/mL and 0.50 mg/L) compared to insufficient (3.34 pg/mL and 0.45 mg/L) and normal mothers (3.29 pg/mL and 0.30 mg/L), although not statistically significant (IL-6 p = 0.665, CRP p = 0.89). Referring to the umbilical cord blood vitamin D levels, the results were different and not as expected, in which the umbilical cord IL-6 and serum CRP levels of preterm infants in the deficiency (3.76 pg/mL and 0.35 mg/L) and insufficiency (3.37 pg/mL and 0.40 mg/L) groups were lower (IL-6) and not different (CRP) than the normal group (9.41 pg/mL and 0.40 mg/L).Conclusion: There were an increasing tendency for umbilical cord IL-6 and serum CRP levels in premature infants of vitamin D deficient mothers although these were not statistically significant. Based on the levels of vitamin D umbilical cord blood, the CRP levels in the serum of premature infants were not different, while the IL-6 levels in the deficiency and insufficiency group were lower than in the normal group.Keywords: CRP, IL-6, maternal vitamin D, umbilical cord vitamin D. Abstrak Tujuan: Peningkatan kadar faktor inflamasi pada bayi baru lahir sering dikaitkan dengan rendahnya kadar vitamin D ibu. Penelitian ini bertujuan untuk mengetahui hubungan kadar serum vitamin D ibu dan tali pusat, dengan kadar IL-6 tali pusat dan serum C-Reactive Protein (CRP) bayi prematur.Metode: Studi observasional analitik dengan desain potong lintang pada subjek ibu yang mengalami kelahiran prematur di usia 28–34 minggu kehamilan disebabkan ketuban pecah dan bayi yang dilahirkannya, di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSCM) dan Rumah Sakit Umum Pusat Persahabatan, Jakarta, pada bulan Januari 2017 sampai Agustus 2018. Variabel data adalah kadar serum vitamin D ibu dan tali pusat, kadar serum IL-6 tali pusat dan kadar CRP darah bayi. Kadar vitamin D (25(OH)D) dibagi menjadi defisiensi (30 ng/mL) dan dicari hubungannya dengan kadar IL-6 tali pusat dan serum CRP bayi prematur, menggunakan uji Kruskal Wallis. Hasil: Sebanyak 70 subjek telah memenuhi kriteria penelitian. Kadar IL-6 tali pusat dan serum CRP bayi prematur dari kelompok ibu defisiensi vitamin D (20,31 pg/ml dan 0,50 mg/L) lebih tinggi dibandingkan kelompok ibu insufisiensi vitamin D (3,34 pg/mL dan 0,45 mg/L) maupun kelompok ibu normal vitamin D (3,29 pg/mL dan 0,30 mg/L) tetapi perbedaan tersebut tidak bermakna (IL-6 p=0,665 dan CRP p = 0,899). Mengacu pada kadar vitamin D darah tali pusat didapatkan hasil yang berbeda dan tidak sesuai harapan, dimana tali pusat IL-6 dan serum CRP bayi prematur mengalami defisiensi (3,76 pg / mL dan 0,35 mg / L) dan insufisiensi. (3,37 pg / mL dan 0,40 mg / L) kelompok lebih rendah (IL-6) dan tidak berbeda (CRP) dibandingkan kelompok normal (9,41 pg / mL dan 0,40 mg / L).Kesimpulan: Didapat kecenderungan peningkatan kadar IL-6 darah tali pusat dan serum CRP bayi prematur dari ibu dengan defisiensi kadar vitamin D walaupun secara statistik tidak signifikan. Berdasarkan kelompok vitamin D darah tali pusat, kadar CRP serum bayi prematur tidak berbeda, sedangkan kadar IL-6 pada kelompok defisiensi dan insufisiensi lebih rendah dibandingkan pada kelompok normal.Kata kunci: CRP, IL-6, vitamin D ibu, vitamin D tali pusat.
Fitriyadi Kusuma, Sahat B. Matondang, Laila Nuranna, Gatot Purwoto, Oni Khonsa, Purnomo Hyaswicaksono
Indonesian Journal of Obstetrics and Gynecology pp 55-58; doi:10.32771/inajog.v9i1.1438

Abstract:
Objective : To determine whether there are differences in clinical response after radiotherapy and 1 year survival in patients with advanced cervical cancer with and without enlargement of PALN.Method : An observational analytic study using a retrospective cohort method was done using consecutive sampling. The subjects of this study were all women with a primary diagnosis of stages IIB to IVB cervical cancer who came to the gynecological oncology clinic of Dr. Cipto Mangunkusumo National General Hospital and underwent MRI examination before undergoing treatment in January 2016 to May 2017Results: Among 76 subjects studied, there were 4 (5.1%) subjects who had enlarged PALN. There were no significant differences between the enlargement status of PALN and age (p = 0.829), age of first sexual intercourse (p = 0.33), parity (p = 0.642), mass diameter (p = 0.777). Patients with PALN enlargement have 2.13 times risk of having negative radiotherapy outcome (p = 0.02, OR 2.13, CI95% 1.12 – 4.07). There was no difference in 1-year survival between patients with and without enlargement of PALN (median 201 vs. 293, p = 0.072).Conclusion: Patients with PALN enlargement have increased risk of having negative radiotherapy outcome (p < 0.05). There were no differences in 1 year survival between patients with advanced cervical cancer with enlargement PALN.Keywords : cervical cancer, lymph node enlargement, paraaortic, radiotherapy. Abstrak Tujuan: Mengetahui adakah perbedaan respon klinis pascaradioterapi dan kesintasan 1 tahun pada pasien kanker serviks stadium lanjut dengan pembesaran KGB paraaorta dibandingkan tanpa pembesaran KGB paraaorta.Metode: Penelitian ini merupakan penelitian analitik observasional dengan menggunakan metode kohort retrospektif. Pengambilan sampel dilakukan dengan cara pengambilan sampel berturut-turut. Subyek penelitian ini adalah semua perempuan dengan diagnosis primer kanker serviks stadium IIB hingga IVB yang datang ke poliklinik Onkologi Ginekologi RSUPN Dr. Cipto Mangunkusumo dan menjalani pemeriksaan MRI sebelum dilakukan terapi pada bulan Januari 2016 hingga Mei 2017.Hasil: Dari 76 subjek yang diteliti, didapatkan sebanyak 4 (5,1%) subyek yang mengalami pembesaran KGB paraaorta. Tidak didapatkan perbedaan yang bermakna antara status pembesaran KGB paraaorta dan usia (p = 0,829), usia hubungan seksual pertama (p = 0,333), paritas (p = 0,642), dan diameter massa (p = 0,777). Pasien dengan pembesaran KGB paraaorta memiliki risiko 2,13 kali lipat (p = 0,02, OR 2,13, IK95% 1,12-4,07) memiliki risiko respon terapi negatif. Tidak terdapat perbedaan kesintasan 1 tahun antara pembesaran KGB paraaorta dan tidak (median 201 vs. 293, p = 0,072).Kesimpulan Pasien dengan pembesaran KGB paraaorta memiliki risiko lebih tinggi mengalami respon radioterapi negatif. (p < 0,05). Tidak terdapat kesintasan 1 tahun antara pasien kanker serviks stadium lanjut dengan dan tanpa pembesaran KGB.Kata kunci: kanker serviks, paraaorta, pembesaran KGB, radioterapi.
Meice Fitrina, Sofie R. Krisnadi, Hartanto Bayuaji
Indonesian Journal of Obstetrics and Gynecology pp 10-14; doi:10.32771/inajog.v9i1.1191

Abstract:
Objective: To determine differences in serum nephrin levels in severe preeclampsia compared to normal pregnancy and also its correlation with systolic and diastolic blood pressure and proteinuria.Methods: This study is an analytical observational with cross sectional study. The observation group consisted of severe preeclampsia (n= 30) and normal pregnancy group as a control (n= 30). Both groups measured systolic and diastolic blood pressure, proteinuria and serum nephrin using the Human NPHN (Nephrin) ELISA Kit. Statistical test were performed with Mann-Whitney test and the Spearman’s rank test. A value of p
Prasila Ekaputri
Indonesian Journal of Obstetrics and Gynecology pp 81-84; doi:10.32771/inajog.v36i2.1481

Abstract:
Objectives: To determine the cut off point of cervical length usingtransvaginal ultrasonography to predict the actual occurrence ofpreterm labor in women with threatened preterm labor. Methods: A cross sectional study with consecutive random samplingmethod. We examined 80 women with singleton pregnancycomplaining of regular, painful uterine contraction and rupturedmembrane at 24-36 weeks of gestation. Women in active labor, definedby the presence of cervical dilatation less than or equal 3 cm, and having complicationwere excluded. When the patient was admitted, a transvaginalscan was performed to measure the cervical length. Parenteralmagnesium sulfate was given as the subsequent management.The primary outcome was delivery within 24 hours of presentation.Results: We found that the optimal cut off values for cervical lengthwas 2.65 cm with sensitivity 94.4 Percent, specificity 65.4Percent, positive predictivevalue 75.4 Percent and negative predictive value 81.8 Percent. In 69cases, the cervical length was more than or 2.65 cm, with 52 patients successfullycontinued their pregnancy until more than 24 hours. In the 11cases with cervical length less than or equal 2.65 cm, delivery within 24 hours occurredin 9 cases (81,8 Percent). Conclusion: The findings of this study suggest that in women withthreatened preterm labor, cervical length more than or equal 2.65 cm may help predictthe actual occurrence of preterm labor. Keywords: cervical length, threatened preterm labor, transvaginalultrasonography
Tri Loka
Indonesian Journal of Obstetrics and Gynecology pp 262-264; doi:10.32771/inajog.v8i4.1452

Maria L. N. Meo
Indonesian Journal of Obstetrics and Gynecology pp 258-261; doi:10.32771/inajog.v8i4.1156

Abstract:
Objective: To provide a summary of evidence about the benefi ts and effectiveness of perineal massage in preventing perineal rupture during labour.Methods: Evidence-based review of research articles with an evidence-based level 1a.Results: Intervention of perineal massage not only reduced the incidence of perineal rupture but also reduced the incidence of episiotomy requiring stitches, as well as reducing perineal pain after 3 months of postpartum.Conclusions: Perineal massage intervention is an intervention that is easy to do, effective, inexpensive, and has the potential to benefi t more than the potential harm in preventing perineal rupture.Keywords: intrapartum, perineal massage, perineal rupture.AbstrakTujuan: memberikan ringkasan bukti penelitian tentang manfaat dan efektifi tas dari pijat perineum dalam mencegah ruptur perineum selama persalinan.Metode: evidence-based review dengan level evidence based 1a.Hasil: Intervensi pijat perineum tidak hanya menurunkan insiden ruptur perineum tetapi juga menurunkan insiden episiotomi yang membutuhkanj jahitan, serta mengurangi nyeri perineum setelah 3 bulan postpartum.Kesimpulan: Intervensi pijat perineum merupakan intervensi yang mudah untuk dilakukan, efektif, murah, serta mempunyai potensi menguntungkan lebih banyak daripada potensi merugikan dalam mencegah ruptur perineum.Kata kunci: intrapartum, pijat perineum, ruptur perineum.
Hariyono Winarto, William Halim
Indonesian Journal of Obstetrics and Gynecology pp 244-248; doi:10.32771/inajog.v8i4.1353

Abstract:
Objective: To determine the quality of life in cancer patients who underwent chemotherapy treatment.Methods: A cross-sectional study was conducted from June to August 2019. Patients with cancer, who had undergone chemotherapy and willing to participate were included in this study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ–30) questionnaire was used as the measurement tool. The patients were grouped into three groups based on the cycles of chemotherapy.Results: Sixty three responders participated in the study. As the treatment progressed, there was a signifi cant decrease in Global Health Status (GHS) and social function. In symptom scales, there was a signifi cant increase in nausea and vomiting, pain, and insomnia.Conclusions: There was a decrease in the quality of life in patients with gynecological cancer who underwent chemotherapy in dr. Cipto Mangunkusumo National General Hospital. This result should be an evaluation for the healthcare provider to implement a holistic approach in managing cancer patients.Keywords: chemotherapy, gynaecological cancer, quality of life. Abstrak Tujuan: Untuk menilai kualitas hidup pasien kanker yang menjalani kemoterapi.Metode: Penelitian dilakukan dengan metode potong lintang, dilakukan dari Juni hingga Agustus 2019. Semua pasien dengan kanker yang menjalani kemoterapi dan bersedia mengikuti penelitian diikutsertakan dalam penelitian ini. Penilaian dilakukan menggunakan kuisioner dari The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 (EORTC QLQ- 30) digunakan. Pasien dikelompokkan menjadi 3 kelompok berdasarkan siklus kemoterapinya.Hasil: Terdapat 63 pasien yang berpartisipasi dalam penelitian ini. Seiring pengobatan, terdapat penurunan signifikan pada global health status (GHS) dan fungsi sosial. Gejala yang meningkat secara signifi kan antara lain mual dan muntah, nyeri, dan insomnia.Kesimpulan: Terdapat penurunan kualitas hidup pada pasien kanker ginekologi yang menjalani kemoterapi di Rumah Sakit Dr. Cipto Mangunkusumo. Hasil penelitian ini menjadi evaluasi untuk penyedia layanan kesehatan agar dapat menangani pasien kanker secara holistik.Kata kunci: kanker ginekologi, kemoterapi, kualitas hidup.
Herbert Situmorang, Ribkhi A. Putri, Cepi T. Pramayadi, Riyan H. Kurniawan, Muhammad D. Priangga, Eka R. Gunardi
Indonesian Journal of Obstetrics and Gynecology pp 254-257; doi:10.32771/inajog.v8i4.1268

Abstract:
Objectives: Reported a case demonstrate the double approach repair of niche treatment through the hysteroscopy and laparoscopy technique.Methods: Case report. We reported a case starting from the patient admission untill 3 months postoperative condition.Case: A 33 years old woman came with abnormal uterine bleeding, already got medication and combine oral contraception pill, but the bleeding never stopped. We found a cavity (niche) filled by menstrual blood with thin lower uterine segment (just serous layer) from transvaginal ultrasound. We did hysteroscopy and laparoscopy approach. We illuminated the niche by hysteroscopy, then resected it by laparoscopy. Patient had a day hospital admission and no symptoms anymore after the procedure.Conclusion: Many treatment methods have been described for repair of niche with varies effectivities. Double approach (hysteroscopy and laparoscopy) technique was a minimal access, but optimal approach of niche resection with up to 100% effectivity.Keywords: abnormal uterine bleeding, caesarean scar defect, hysteroscopy, istmochele laparoscopy, niche Abstrak Tujuan: Melaporkan sebuah kasus yang menggambarkan pendekatan ganda dalam memperbaiki niche dengan histeroskopi dan laparoskopi.Metode: Laporan kasus. Kami melaporkan sebuah kasus dimulai dari pasien masuk sampai dengan 3 bulan pascaoperasi.Kasus: Perempuan 33 tahun datang dengan perdarahan uterus abnormal, telah diberikan terapi obat dan pil kombinasi, namun perdarahan tidak berhenti. Dari ultrasonografi ditemukan rongga berisi darah menstrusasi dengan segmen bawah uterus yang tipis (hanya lapisan serosa). Kami melakukan pendekatan histeroskopi dan laparoskopi. Dilakukan iluminasi dengan histeroskopi, kemudian reseksi dengan laparoskopi. Perawatan pasien di rumah sakit selama satu hari, dan tidak terdapat keluhan pada pasien setelah tindakan.Kesimpulan: Terdapat banyak metode dalam tata laksana niche dengan efektivitas yang beragam. Pendekatan ganda dengan histeroskopi dan laparoskopi merupakan tehnik dengan akses minimal namun hasil optimal, dengan efektivitas hingga 100%.Kata Kunci: perdarahan uterus abnormal, defek skar sesar, histeroskopi, istmpchele, laparoskopi, niche
Suwartono Herdhana, Andrijono
Indonesian Journal of Obstetrics and Gynecology pp 249-253; doi:10.32771/inajog.v8i4.1382

Abstract:
Objective: To investigate the effectiveness TCA 85% compared to cryotherapy to treat patients with positive IVA result.Method: This is a non-inferiority randomized controlled trial study. Patients with positive VIA result referred to Jatinegara Primary Health Center were included in this study. Eligible samples were then treated with either TCA 85% or cryotherapy. The treatment was determined using a random block sampling method. Samples were then followed up 3 months after treatment in order to determine VIA result conversion.Result: Thirty-six patients were treated with TCA 85% and 36 others were treated with cryotherapy. 35 (97,2%) patients treated with TCA 85% converted to negative VIA, whereas all of the patients that were treated with cryotherapy converted to negative VIA. Bivariate analysis fisher’s exact test was then conducted with a result P-value of 1.00 (p > 0,05).Conclusion: There was no statistically significant difference of result between TCA 85% and cryotherapy for treating patients with positive VIA result.Keywords: cervical cancer, cryotherapy, TCA 85%, VIA test. Abstrak Tujuan: Mengetahui efikasi TCA 85% pada tatalaksana IVA positif dibandingkan dengan krioterapiMetode: Penelitian ini merupakan penelitian randomized control trial menggunakan metode non-inferiority study. Subyek penelitian ini merupakan pasien dengan hasil IVA positif yang dirujuk ke Puskesmas Kecamatan Jatinegara, Jakarta Timur. Tatalaksana yang diberikan ditentukan menggunakan metode random block sampling. Subyek diikuti selama 3 bulan setelah tindakan untuk menentukan hasil konversi pemeriksaan IVA.Hasil: Sbenyak 36 subjek diterapi dengan TCA 85% dan 36 lainnya diterapi dengan krioterapi. Sebanyak 35 (97,2%) pasien yang ditatalaksana dengan TCA 85% mengalami konversi menjadi IVA negatif pada follow-up bulan ke-3, sedangkan seluruh pasien yang ditatalaksana dengan krioterapi menjadi konversi menjadi IVA negatif. Dilakukan analisis bivariat fisher’s exact test dan didapatkan nilai p sebesar 1,00 (p>0,05).Kesimpulan:Tidak ada perbedaan bermakna dari efikasi penggunaan TCA 85 % dibandingkan dengan krioterapi pada terapi IVA positif.Kata kunci: kanker serviks, krioterapi, pemeriksaan IVA, TCA 85%.
Tatit Nurseta, Yahya Irwanto, Nugrahanti Prasetyorini, Bambang Rahardjo, I Wayan Subage
Indonesian Journal of Obstetrics and Gynecology pp 237-243; doi:10.32771/inajog.v8i4.1342

Abstract:
Objective: Comparing scoring with RMI3 and RMI4 in establishing the diagnosis of adnexal tumour in RSUD Dr. Saiful Anwar Malang.Methods: Prospective cohort study with samples of all patients suspected of having an adnexal tumour diagnosed in gynecology policlinic using gynecological oncology policlinic medical records at RSUD Dr. Saiful Anwar in the form of age, demographics, menopause status, Ca125, ultrasound results.Results: Between the RMI3 results and the results of histopathology, a contingency coeffi cient of 0.596 was obtained with a p-value of 0.000015 (p
Fernandi Moegni, Nadir Chan, Budi I. Santoso, Raymond Surya, Leonardo Tanamas
Indonesian Journal of Obstetrics and Gynecology pp 228-230; doi:10.32771/inajog.v8i4.763

Abstract:
Objective: To evaluate the role of fractioned CO2 laser intravaginal as a non-invasive treatment for relieving stress urinary incontinence (SUI) symptoms.Methods: This was a prospective, quasi-experimental study in patients with SUI. The patients were treated through three different sessions in a month apart by the fractioned CO2 laser Femilift©, produced by Alma Lasers. The patients fi lled and completed questionnaires about continence assessment, quality of life, and sexuality before and after therapy based on PISQ-12 and ICIQ-UI questionnaire. Perineometry was performed to prove the outcome.Results: Twenty women were enrolled. At 4 weeks following the third treatment, there was a signifi cant improvement for continence assessment (7.70 ± 4.38 to 4.50 ± 2.88; p < 0.001), quality of life and sexuality (28.13 ± 7.06 to 33.13 ±7.80; p < 0.001), and vaginal perineometer results (37.20 ± 17.24 to 48.80 ± 16.72; p = 0.009).Conclusions: Fractioned CO2 intravaginal laser has a role in improving SUI symptoms.Keywords: fractioned CO2 laser, stress urinary incontinence, vaginal rejuvenation. AbstrakTujuan: Untuk mengetahui efektivitas terapi laser CO2 terfraksi intravaginal sebagai terapi non-invasif untuk mengurangi gejala inkontinensia urine (IU) tipe tekanan.Metode: Penelitian ini merupakan studi prospektif, quasieksperimental pada pasien dengan inkontinensia urin (IU) tipe tekanan yang mengikuti terapi laser CO2 terfraksi intravaginal tiga sesi berbeda, dengan jarak satu bulan menggunakan laser CO2 terfraksi Femilift© dari Alma Lasers. Subjek mengisi kuesioner mengenai penilaian kontinensia, kualitas hidup dan kehidupan seksual sebelum dan sesudah terapi (kuesioner PISQ-12 dan ICIQ-UI). Selain kuesioner, pemeriksaan perineometri juga dilakukan pada beberapa subjek penelitian untuk membuktikan efektivitas terapi.Hasil: Dua puluh subjek ikut dalam penelitian ini. Penilaian pada minggu keempat setelah sesi terapi ketiga, menunjukkan peningkatan yang signifi kan pada penilaian kontinensia (7.70 ± 4.38 ke 4.50 ± 2.88; p < 0.001), pada kualitas hidup dan kehidupan seksual (28.13 ± 7.06 ke 33.13 ±7.80; p < 0.001), dan pada hasil perineometri (37.20 ± 17.24 ke 48.80 ± 16.72; p = 0.009).Kesimpulan: Terapi laser CO2 terfraksi intravaginal menunjukkan kecenderungan untuk mengurangi gejalainkontinensia urine (IU) tipe tekanan.Kata kunci: inkontinensia urin tipe tekanan, terapi laser CO2 terfraksi intravaginal, vaginal rejuvenation.
Laila Nuranna
Indonesian Journal of Obstetrics and Gynecology pp 201-202; doi:10.32771/inajog.v8i4.1447

Rizkar A. Sukarsa, Devi N. Anti, Benny H. Purwara, R.M Sonny Sasotya
Indonesian Journal of Obstetrics and Gynecology pp 231-236; doi:10.32771/inajog.v8i4.1063

Abstract:
Objective: To determine the benefi ts of post-partum vitamin D supplementation on striated muscle strength. Methods: This is a pre-post quasi-experimental study on postpartum vitamin D3 supplement provision in primiparous women with vitamin D3 defi ciency. The effect of vitamin D3 supplement was assessed through the measurement of pelvic floor muscle strength before and after 3 months of vitamin D3 supplementation. Thirty-three primiparous postpartum women with spontaneous vaginal delivery who met inclusion criteria participated in this study. Serum vitamin D3 level, basal tone, and maximum levator ani contraction were measured by perimetry prior to and after vitamin D3 supplementation. This study was conducted in the Obstetric Clinic and Clinical Serology Laboratory of Clinical Pathology Department, Dr. Hasan Sadikin General Hospital/ Faculty of Medicine, Universitas Padjadjaran from March 1 to May 31, 2018.Results: Data analysis using the Wilcoxon test showed an increase in serum vitamin D3 level and a basal tone strength after vitamin D3 supplementation with a P-value of
Andon Hestiantoro, Danang T. Pamungkas
Indonesian Journal of Obstetrics and Gynecology pp 222-227; doi:10.32771/inajog.v8i4.1338

Abstract:
Objectives: To investigate health information quality about PCOS on the internet in Indonesian language.Methods: Top website from two separate search engines (Google and Bing) was collected using the keyword of “sindrom ovarium polikistik” (polycystic ovarian syndrome). Analysis of health information quality on those websites was performed.Results: Sixty-nine websites were included for analysis. The majority of those websites have good information quality in terms of content accuracy and website credibility. There was no difference in quality between the two search engines. The website was found at the top two pages in each search engine to have better quality than the later pages (p=0.02). The educational website had better quality (p=0.05). The website made by healthcare organizations had better quality (p=0.04). The non-commercial website had better information quality (p=0.01).Conclusion: Criteria affecting health information quality on the internet were as follows: found at the top two pages on a search engine; educational website; made by healthcare organization; and non-commercial purpose.Keywords: health information quality, Indonesian language, internet-based, polycystic ovarian syndrome Abstrak Tujuan: Untuk melakukan kajian kualitas informasi kesehatan tentang PCOS di internet dalam Bahasa Indonesia.Metode: Situs web teratas dari dua mesin pencari terpisah (Google dan Bing) dikumpulkan dengan menggunakan kata kunci “sindrom ovarium polikistik”. Analisis kualitas informasi kesehatan pada situs-situs tersebut telah dilakukan.Hasil: Enam puluh sembilan situs web dimasukkan untuk analisis. Mayoritas situs web tersebut memiliki kualitas informasi yang baik dalam hal akurasi konten dan kredibilitas situs web. Tidak ada perbedaan kualitas antara kedua mesin pencari tersebut. Situs web ini ditemukan pada dua halaman teratas di setiap mesin pencari memiliki kualitas yang lebih baik daripada halaman-halaman selanjutnya (p = 0,02). Kualitas situs web berbasis pendidikan menunjukkan hasil lebih baik (p = 0,05). Kualitas website yang dibuat oleh organisasi kesehatan menunjukkan hasil lebih baik (p = 0,04). Situs web non-komersial memiliki kualitas informasi yang lebih baik (p = 0,01).Kesimpulan: Kriteria yang mempengaruhi kualitas informasi kesehatan di internet adalah sebagai berikut: ditemukan pada dua halaman teratas pada mesin pencari; situs web berbasis pendidikan; dibuat oleh organisasi kesehatan; dan tujuan non-komersial.Kata kunci : bahasa indonesia, berbasis internet, kualitas informasi kesehatan, sindrom ovarium polikistik.
Cut M. Yeni, Rismawati Tambunan, Hasanuddin
Indonesian Journal of Obstetrics and Gynecology pp 216-222; doi:10.32771/inajog.v8i4.1299

Abstract:
Objective: The research was aimed to show about characteristics of subject, fetal fibronectin, vaginal pH, cervical length of women with threatened preterm labor, and which are become preterm labor? Preterm labor is occurs most often in 20 weeks gestation to less than 37 weeks gestation. This condition is concerned about Obstetric problem and associated with significant neonatal morbidity and mortality.Methods: This study used the design of case control where preterm pregnant women who become research subjects divided into two groups with threat and without the threat of pre-term labor. Fetal fibronectin , vaginal pHand cervical length than in both groups were evaluated as a risk factor for preterm labor. Mann-Whitney test , Wilcoxon test and Chi-squared test were used as statistical tests with a confidence level of 95%.Results: A total of 86 preterm pregnant women involved in this study with an average age 30 , 5 ± 6.25 (group threat) 32.16 ± 5.25 (non-threatening). Comparison of fetal fibronectin (p = 0.005), vaginal PH(p
Juminten Saimin, Indria Hafizah, Nina Indriyani, Ashaeryanto, Satrio Wicaksono
Indonesian Journal of Obstetrics and Gynecology pp 203-206; doi:10.32771/inajog.v8i4.1349

Abstract:
Objective: To assess the characteristics of postmenopausal women in the coastal areas that experience uterine prolapse.Methods: This was a retrospective descriptive study conducted at Alpha Gynecology Clinic in Kendari. Samplesare cases of uterine prolapse from coastal areas that visited in January to December 2017. Samples were taken by consecutive sampling. The diagnosis of uterine prolapse is based on the Pelvic Organ Prolapse Quantification system. Data is presented with tables and narration.Results: There were 21 respondents who experienced uterine prolapse. Most respondents were aged 61-70 years (42.8%), work as housewives (71.4%), parity more than 4 (85.7%), and duration of menopause >5 years (100.0%). The most common complaint at the fi rst time was a feeling of a lump in the vagina (81.0%), in the third degree of uterine prolapse (57.1%), and accompanied by comorbidities (66.7%). Conclusions: Uterine prolapse in postmenopausal women in the coastal areas was found in housewives, aged 61-70 years, grande-multiparous, and duration of menopause >5 years. The main complaint was felt a lump in the vagina, in the third degree and accompanied by comorbidities. Counselling, information and education regarding symptoms and management of uterine prolapse need to be done.Keywords: coastal areas, postmenopausal women, uterine prolapse.AbstrakTujuan: Mengetahui karakteristik perempuan postmenopause di daerah pesisir yang mengalami prolapsus uteri.Metode: Penelitian ini bersifat deskriptif retrospektif yang dilakukan di Klinik Ginekologi Alfa di Kendari. Sampel adalah kasus prolapse uteri yang berasal dari daerah pesisir yang berkunjung pada bulan Januari sampai Desember 2017. Sampel diambil secara consecutive sampling. Diagnosis prolapsus uteri berdasarkan sistem Pelvic Organ Prolapse Quantification. Data disajikan dalam bentuk tabel dan narasinya.Hasil: Hasil penelitian menunjukkan terdapat 21 responden yang mengalami prolapsus uteri. Responden terbanyak berusia 61-70 tahun (42,8%), pekerjaan sebagai ibu rumah tangga (71,4%), paritas lebih dari 4 (85,7%), dengan lama menopause lebih dari 5 tahun (100,0%). Keluhan yang paling sering dialami pada saat pertama datang adalah terasa ada yang mengganjal di jalan lahir (81,0%), dengan diagnosis prolapsus uteri derajat 3 (57,1%), dan disertai penyakit penyerta (66,7%).Kesimpulan: Prolapsus uteri pada perempuan postmenopause di daerah pesisir ditemukan pada ibu rumah tangga, usia 61-70 tahun, grande multipara, menopause >5 tahun. Keluhan utama terasa ada yang mengganjal di jalan lahir disertai penyakit penyerta, dengan diagnosis prolapse uteri derajat 3. Perlu dilakukan penyuluhan, konseling dan edukasi mengenai gejala dan penatalaksanaan prolapsus uteri.Kata kunci: daerah pesisir, prolaps uteri, perempuan postmenopause.
Arief K. Prasojo, Peby M. Lestari, Hatta Ansyori, Theodorus
Indonesian Journal of Obstetrics and Gynecology pp 207-2015; doi:10.32771/inajog.v8i4.1112

Abstract:
Objective: Knowing the effectiveness of high doses of calcium in preventing preeclampsia.Methods: Experimental analytical study with Randomized Controlled design Single-blind trial in the form of survival analysis (survival analysis) in the period June 2018 - May 2019 in fetomaternal outpatients clinic in Mohammad Hoesin Hospital, PalembangResults: The mean hemoglobin level at the last visit found that the average hemoglobin level between the two groups was 12.81 in the high calcium group and 12.61 in the low calcium group, while the mean hematocrit level between the two groups was 35.17 in the high calcium group and 34.84 in the low calcium group and the respective calcium levels each group is 10.1. In this study, after high calcium intervention, no pregnant women with preeclampsia were found, whereas in the low-dose calcium intervention group it was found that 3 of 17 patients (17.7%) had preeclampsia. With the McNemar test it was found that there was no difference in the incidence of preeclampsia both after highdose calcium and low-dose calcium interventions (p = 0.250).Conclusions: High-dose calcium (1.5g - 2g) is effective in preventing preeclampsia and there was no difference in effectiveness between administration of high-dose calcium with low-dose calcium administration to the incidence of preeclampsia.Keywords: high dose calcium, preeclampsia, randomized control trial. AbstrakTujuan: Mengetahui efektivitas pemberian kalsium dosis tinggi dalam mencegah preeklamsia.Metode: Penelitian analitik eksperimental dengan desain randomized controlled trial single blind dalam bentuk ujian alias kesintasan (survival analysis) dalam kurun waktu Juni 2018 – Mei 2019 di Poliklinik Fetomaternal Rumah Sakit Umum Pendidikan Mohammad Hoesin, PalembangHasil: Rerata kadar hemoglobin pada kunjungan terakhir didapatkan rerata kadar hemoglobin antara kedua kelompok adalah 12,81 pada kelompok kalsium tinggi dan 12,61 pada kelompok kalsium rendah, sedangkan rerata kadar hematokrit antara kedua kelompok adalah 35,17 pada kelompok kalsium tinggi dan 34,84 pada kelompok kalsium rendah dan rerata kadar kalsium masing-masing kelompok adalah 10,1. Pada penelitian ini setelah intervensi kalsium tinggi tidak ditemukan ibu hamil yang mengalami preeklamsia, sedangkan pada kelompok intervensi kalsium dosis rendah ditemukan 3 dari 17 pasien (17,7%) menderita preeklamsia. Dengan uji Mc Nemar didapatkan hasil tidak terdapat perbedaan kejadian preeklamsia baik setelah intervensi kalsium dosis tinggi maupun kalsium dosis rendah (p = 0,250). Hal ini berarti kalsium dosis tinggi dan rendahefektif untuk mencegah preeklamsia.Kesimpulan: Kalsium dosis tinggi (1,5g – 2g) efektif dalam mencegah preeklamsia dan tidak ditemukan perbedaan efektivitas antara pemberian kalsium dosis tinggi dengan pemberian kalsium dosis rendah terhadap kejadian preeklamsia.Kata kunci: kalsium dosis tinggi, preeklamsia, randomized control trial.
Vita Silvana, Andon Hestiantoro, Muharam Natadisastra, Kanadi Sumapraja, Budi Wiweko
Indonesian Journal of Obstetrics and Gynecology pp 168-173; doi:10.32771/inajog.v8i3.1417

Abstract:
Objective: To determine whether visceral adipose tissue or serum RBP-4 were related with the risk increment of insulin resistance in normal BMI PCOS patients. Methods: This was a cross-sectional study conducted in normal body mass index PCOS patients at Yasmin Clinic, RSCM, Jakarta from July 2014 until March 2015. Diagnosis of PCOS was established using Rotterrdam (2003) criteria. Insulin resistance was confirmed by using ratio of HOMA-IR >1.4. Results: Among 40 subjects, 20 subjects (50%) belong insulin resistance group. Serum RBP-4 level was higher in insulin resistance group (p=0.06). After ROC analysis was conducted, area under curve for of serum RBP-4 was 69.9% (CI 95% -3754.77 - (186.60-7696.14, p=0.061)). Cut-off level of serum RBP-4 was 23814.5 ng/mL yielded sensitivity and specificity to a level of 60% and 60%, respectively. After logistic regression were analyzed, visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients. Conclusions: Visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients, independent with serum RBP-4 levels. Key words: body mass index, diagnosis, insulin resistance, PCOS, retinol binding protein-4 Abstrak Tujuan: Untuk menentukan apakah jaringan adiposa viseral atau serum RBP-4 berhubungan dengan peningkatan risiko resistensi insulin pada Sindrom Ovarium Polikistik dengan indeks masa tubuh normal. Metode: Studi potong lintang dilakukan pada subjek SOPK dengan IMT normal di Klinik Yasmin, RSCM, Jakarta sejak Juli 2014 sampai dengan Maret 2015. Penegakan diagnosis SOPK dilakukan dengan kriteria Rotterdam (2003). Resistensi insulin dikonfirmasi dengan pemeriksaan rasio HOMA-IR > 1.4 Hasil: Diantara 40 subjek, sebanyak 20 subjek (50%) mengalami resistensi insulin. Kadar serum RBP-4 lebih tinggi pada kelompok resistensi insulin (p=0.06). Setelah dilakukan analisis Receiver Operating Curve (ROC), serum RBP-4 memiliki Area Under the Curve (AUC) sebesar 69.9% (IK 95% -3754.77 - (186.60-7696.14, p=0,061)). Titik potong kadar serum RBP-4 adalah 23814.5 ng/mL dengan sensitivitas dan spesifisitas masing-masing 60% dan 60%. Setelah dilakukan analisis regresi logistik, jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada pasien SOPK dengan IMT normal. Kesimpulan: Jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada SOPK dengan IMT normal, independen terhadap kadar serum RBP-4. Kata kunci: diagnosis, indeks masa tubuh, resistensi insulin, retinol binding protein-4, SOPK
Asih Anggraeni, Surahman Hakim, Budi I. Santoso, Tyas Priyatini, Fernandi Moegni
Indonesian Journal of Obstetrics and Gynecology pp 179-185; doi:10.32771/inajog.v8i3.1270

Abstract:
Objective: To examine the relationship between muscle strength and muscle thickness of levator ani with stress urinary incontinence (SUI) in women.Methods: This study uses a comparative cross-sectional study design. We collected 82 women who visiting the Obstetrics and Gynecology clinic of RSUPN Dr. Cipto Mangunkusumo with the study group were subjects with positive cough tests while the control group were subjects with negative cough tests. The data obtained in the form of history taking, Questionnaire for Urinary Incontinence Diagnosis (QUID), physical examination (POPQ), cough test. perineometer, and ultrasound.Results: We found no significant difference between the levator ani muscle thickness to the incidence of SUI with the median levator ani muscle thickness 0.63 cm (range 0.31-1.02 and p = 0.897). While levator ani muscle strength against SUI has a median of 19.5 (range 4.6-88.6 and p = 0.001). In multivariate analysis it was found that purely SUI, prolapse and age had no significant effect on the strength of levator ani muscles with a p-value of 0.243; 0.844; 0.903.Conclusions: There is no significant difference in levator ani muscle thickness between women who experience SUI compared to those who do not. Women with SUI have weaker levator ani muscle strength than those who do not experience but are not statistically significant. And there is no correlation between muscle strength and levator ani muscle thickness in women with SUI.Keywords: muscle strength, muscle thickness, perineometer, stress urinary incontinence, ultrasound. Abstrak Tujuan : Untuk mengkaji hubungan antara kekuatan otot dan ketebalan otot levator ani dengan keluhan IU-T pada perempuan.Metode : Penelitian ini menggunakan desain perbandingan potong lintang dengan melibatkan 82 wanita yang berkunjung di poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo dengan kelompok studi adalah subyek dengan tes batuk positif sedangkan kelompok kontrol adalah subyek dengan tes batuk negative. Data yang diperoleh berupa hasil anamnesis, Questionnaire for Urinary Incontinence Diagnosis (QUID), pemeriksaan fisik (POPQ), tes batuk. perineometer , dan USG.Hasil: Hasil penelitian ini didapatkan tidak ada perbedaan bermakna antara ketebalan otot levator ani terhadap kejadian IUT dengan median ketebalan otot levator ani 0,63 cm (jarak 0,31-1,02 dan p=0,897). Sedangkan kekuatan otot levator ani terhadap IUT memiliki median 19,5 (jarak 4,6-88,6 dan p=0,001). Pada analisis multivariat didapatkan bukti bahwa secara murni IUT, prolap dan usia tidak mempunyai pengaruh bermakna terhadap kekuatan otot levator ani dengan nilai p masing-masing 0,243; 0,844; 0,903.Kesimpulan : Tidak terdapat perbedaan yang bermakna pada ketebalan otot levator ani antara perempuan yang mengalami IU-T dibanding yang tidak mengalami. Perempuan IU-T mempunyai kekuatan otot levator ani yang lebih lemah dibanding yang tidak mengalami, namun tidak bermakna secara statistik. Tidak terdapat hubungan korelasi antara kekuatan otot dan ketebalan otot levator ani pada perempuan yang mengalami IU-T. Kata kunci : inkontinensia urin jenis tekanan, ketebalan otot, kekuatan otot, perineometer, USG
Taufik S. Ismail, Andy P. Meliala, Kulsum B. Syarifudin
Indonesian Journal of Obstetrics and Gynecology pp 192-196; doi:10.32771/inajog.v8i3.1151

Abstract:
Objective: To investigate more regarding the ethical dilemma resolution and medico-legal aspect of medical pregnancy termination due to preexisting Rheumatic Heart Disease (RHD).Methods: a Case report, presented a case of heart failure due to RHD in pregnancy, a 33-year-old patient in her third pregnancy with multiple valve disease including severe mitral stenosis, moderate mitral regurgitation, and mild tricuspid regurgitation. The patient came to the emergency ward due to shortness of breath worsening when she started becoming pregnant. The medical decision taken is very dilemma between continuing the pregnancy with the risk of endangering the mother's life or terminating the pregnancy with the risk of the mother losing her fetus. Results: After a joined conference that involved some medical, ethical, medicolegal and spiritual expertise discussing the best therapeutic options for patients, it was decided that the patient's condition was very high risk if the pregnancy was continued, using the minus malum principle, which is to take an actions with minimal risk, hence termination pregnancy is worse than the patient's death. Another ethical principle is beneficence which is for the good of the patient. The clinical ethics considered are medical indication and quality of life.Conclusion: The ethical concept should guide the obstetrician to reach ethically justified judgment regarding the balance between autonomy-based and beneficence-based obligation to the pregnant mother and the fetus. Women with RHD of reproductive age must receive early preconception evaluation and advice regarding the potential impact of pregnancy on their cardiovascular function.Keywords: ethical dilemma, medico-legal, pregnancy, rheumatic heart disease AbstrakTujuan: Menyelidiki lebih lanjut tentang penyelesaian dilemma etika dan tinjauana spekmedikolegal terhadap terminasi kehamilan medis karena Penyakit Jantung Rheumatik (PJR) yang sudah ada sebelumnya.Metode: Laporan kasus, disajikan sebuah kasus gagal jantung karena PJR pada kehamilan, seorang pasien berusia 33 tahun pada kehamilan ketiga dengan penyakit katup ganda termasuk stenosis mitral berat, regurgitasi mitral sedang, dan regurgitasi trikuspidringan. Pasien dating keruang gawat darurat karena napasnya yang pendek memburuk ketika mulai hamil. Keputusan medis yang diambil sangat dilematis antara meneruskan kehamilan dengan risiko membahayakan jiwa buat auterminasi kehamilan dengan risiko si ibu kehilangan janinnya.Hasil: Setelah dilakukan join conference yang melibatkan beberapa keahlian baik medik, etik, medikolegal maupun spiritual membicarakan pilihan terapi terbaik buat pasien maka diputuskan bahwa kondisi pasien sangat berisiko tinggi apabila kehamilan diteruskan, dengan menggunakan prinsip etika minus mallum yaitu mengambil tindakan yang lebih kecil keburukannya, maka terminasi kehamilan lebih kecil keburukannya dibandingkan kematian pasien. Prinsip etika yang lain adalah beneficence yaitu demi kebaikan pasien. Etika klinik yang dipertimbangkan adalah indikasi medis dan kualitas hidup.Kesimpulan: Konsepetis harus memandu ahli obstetrik untuk mencapai penilaian etis yang dibenarkan tentang keseimbangan antara kewajiban berbasis otonomi dan berbasis beneficence kepada ibu hamil dan janin. Perempuan dengan RHD usia reproduksi harus menerima evaluasi prakonsepsi dini dan saran mengenai dampak potensial kehamilan pada fungsi kardiovaskular mereka.Kata kunci: Dilemaetik, kehamilan, medikolegal, penyakit jantung rheumatik
Rachmad Rachmad, Mohd Andalas, Cut M. Yeni, Nurhayani D. Susanti, Reno K. Kamarlis
Indonesian Journal of Obstetrics and Gynecology pp 186-191; doi:10.32771/inajog.v8i3.1189

Abstract:
Objective: To obtain whether there was a correlation between the Sassone morphological index and CA 125 tumour markers for suspecting epithelial ovarian cancer with serous types.Methods: This research was analysis correlation and diagnostic test using cross-sectional design. This study was conducted in Dr. Zainoel Abidin Hospital, from November 2018 until April 2019. Results: There were 30 samples of patients with suspected malignant ovarian tumours. The Mann-Whitney test has been performed and the results show no relationship between the Sassone morphological index and epithelial ovarian cancer with serous type (p-value 0.627) and there was no correlation between CA 125 tumour marker and epithelial ovarian cancer with serous types (p-value 0.251). The diagnostic test was performed to examine the sensitivity and specificity for the Sassone morphological index in epithelial ovarian cancer with serous type, resulting in 60% and 28%, respectively. In this study, the sensitivity and specificity for CA 125 tumour marker in epithelial ovarian cancer with serous type were 80% and 40%, respectively. Conclusion: There was no correlation between the Sassone morphological index and CA 125 tumour marker for suspecting epithelial ovarian cancer with serous types. Keywords: CA 125 tumour marker, 0 epithelial ovarian cancer with serous types, morphological index of Sassone. Abstrak Tujuan: Untuk mengetahui adakah korelasi antara indeks morfologi Sassone dan penanda tumor CA 125 dalam memprediksi kanker ovarium epitelial tipe serous. Metode: Penelitian ini menggunakan rancangan potong lintang dengan melakukan uji korelasi dan diagnostik.Penelitian dilakukandi RSUD Dr. Zainoel abidin, dalam kurun waktu November 2018 sampai dengan April 2019.Hasil : Selama penelitian didapatkan 30 sampel penderita tumor ovarium suspek ganas. Dilakukan analisis dengan uji Mann-Whitney, didapatkan tidak terdapat hubungan antara indeks morfologi Sassone terhadap kanker ovarium epitelial tipe serous (p-value 0,627) dan tidak terdapat hubungan antara penanda tumor CA 125 terhadap kanker ovarium epitelial tipe serous (p-value 0,251). Kemudian dilakukan uji diagnostik dimana didapatkan nilai sensitivitas, spesifisitas dari indeks morfologi Sassone pada kanker ovarium epitelial tipe serous adalah 60% dan 28%. Sedangkan nilai sensitivitas dan spesifisitas penada tumor CA 125 pada kanker ovarium epitelial tipe serous pada penelitian ini didapatkan 80% dan 40%.Kesimpulan: Tidak ada hubungan antara indeks morfologi Sassone dan penanda tumor CA 125 dalam memprediksi kanker ovarium epitelial tipe serous.Kata kunci: indeks morfologi Sassone, kanker ovarium epitelial tipe serous, penanda tumor CA 125
Ali Sungkar, Raymond Surya
Indonesian Journal of Obstetrics and Gynecology pp 197-200; doi:10.32771/inajog.v8i3.1376

Abstract:
Objective: To discuss about blood loss in an obstetric setting, the role of blood transfusion, and patient blood management.Methods: Literature review.Results: Severe anaemia with hemoglobin level less than 7 g/dL or late gestation (more than 34 weeks) and/ or significant symptoms of anaemia, the recommendation is giving only single unit transfusion followed by clinical reassessment for further transfusion. In postpartum hemorrhage (PPH), massive transfusion protocols are commonly used description as large volume of blood products over a brief period to a patient with uncontrolled or severe hemorrhage, transfusion more than 10 RBC units within 24 hours, transfusion more than 4 RBC units in 1 hour with anticipation of continued need for blood, replacement of more than 50% of total blood volume by blood products within 3 hours. All obstetric units have a clear-cut massive transfusion protocol for the initial management of life-threatening PPH, considering early transfusion therapy with RBCs and FFP.Conclusion: Patient blood management aims to maintain hemoglobin concentration, optimize haemostasis, and minimize blood loss in effort to improve patient outcomes. Massive transfusion protocol in management of life-threatening should depend on each obstetric unit.Keywords: blood transfusion, obstetric cases, patient blood management. Abstrak Tujuan: Untuk mendiskusikan tentang hilang darah dalam obstetric, peran transfusi darah, dan patient blood management.Metode: Kajian pustaka.Hasil: Anemia berat dengan nilai hemoglobin kurang dari 7 g/dL atau kehamilan lanjut (lebih dari 34 minggu) dan/ atau gejala nyata anemia, rekomendasi ialah memberikan satu unit transfusi diikuti dengan penilainan klinis untuk transfusi lebih lanjut. Pada perdarahan postpartum, protokol transfusi massif umum digambarkan sebagai volume darah yang dibutuhkan jumlah banyak dalam periode singkat, transfusi lebih dari 10 sel darah merah dalam 24 jam atau lebih dari 1 jam, penggantian lebih dari 50% total volume darah dalam 3 jam. Seluruh unit obstetric memiliki protokol transfusi massif yang jelas untuk taalaksana awal perdarahan postpartum dengan mempertimbangkan transfusi awal untuk komponen sel darah merah dan FFP.Kesimpulan: Patient blood management bertujuan untuk menjaga konsentrasi hemoglobin, optimalisasi hemostasis, dan minimalisasi hilang darah untuk meningkatkan luaran pasien. Protokol transfusi masfi dalam tatalaksana yang mengancam nyawa sangat bergantung pada setiap unit obstetrik.Kata kunci: kasus obstetri, patient blood management, transfusi darah
Septian Sima, Nusratuddin Abdullah, Sharvianty Arifuddin, Trika Irinta, Telly Tessy
Indonesian Journal of Obstetrics and Gynecology pp 142-150; doi:10.32771/inajog.v8i3.1136

Abstract:
Objective: To determine the relationship of Chlamydia trachomatis infection in patient with ruptured ectopic pregnancy through examination of endocervical swabs, tubal tissue using Polymerase chain reaction (PCR) and Enzyme linked immunoabsorb and assay (ELISA) serum IgG antibodies Specific to Chlamydia trachomatis.Method: This study was an observational analytic study with a cross sectional study design. In this study, there were 50 participants consisting of 25 ruptured ectopic pregnancy patients and 25 non-ruptured ectopic pregnancy patients who underwent treatment at Dr.Wahidin Sudirohusodo Hospital as well as networking hospitals at the Universitas Hasanuddin in Makassar City.Results: The results showed that Chlamydia trachomatis infection in patients with ruptured ectopic pregnancies was found to be 84% positive in tubal tissue, 72% with endocervical swabs and 64% with serum examination. There was a significant relationship between chlamydial tracheal infection obtained through examination of tubal tissue, endocervical swab and specific serum IgG in patients with ruptured ectopic pregnancy (p
Eka R. Gunardi, Arresta Suastika
Indonesian Journal of Obstetrics and Gynecology pp 161-167; doi:10.32771/inajog.v8i3.1254

Abstract:
Objective: To understand the pattern of referral cases (accuracy of referral diagnosis, the accuracy of referral health facility and consistency of referral diagnosis) in obstetrics and gynaecology outpatient clinic before and after the implementation of JKN.Methods: This is an observational cross-sectional study using medical records of patients who were referred to obstetrics and gynaecology outpatient clinic in Dr. Cipto Mangunkusumo General Hospital in 2013 and 2014. Data were analyzed with bivariate analysis with chi-square, consisting of the accuracy of referral cases, accuracy of referral health facility, and consistency of referral cases before and after implementation of JKN.Results: There is a growing number of patients in obstetrics and gynaecology outpatient clinic after the implementation of JKN in 2014, which is 4.311 patients. Subjects were 222 cases, 104 cases from 2013 and 118 cases from 2014. From the analyzed data, the accuracy of referral diagnosis before JKN is 81.7% and after JKN 72.9%. (p=0.118), the accuracy of referral health facility before JKN is 63.5% and after JKN 71.2% (p=0.220), and the consistency of referral diagnosis before JKN is 89.4% and after JKN 84.7% (p=0.302).Conclusion: There is no statistically significant difference between the accuracy of referral diagnosis, the accuracy of referral health facility, and consistency of referral diagnosis before and after the implementation of JKN.Keywords: national health coverage program, obstetrics and gynaecology, outpatient clinic, referral AbstrakTujuan: Untuk memahami pola kasus rujukan (ketepatan diagnosis rujukan, ketepatan asal fasyankes perujuk, dan kesesuaian diagnosis rujukan) di Poliklinik Obstetri dan Ginekologi sebelum dan setelah pelaksanaan JKN.Metode: Penelitian ini adalah observasional potong lintang dengan menggunakan data rekam medis pasien yang dirujuk ke Poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo selama tahun 2013 dan 2014. Analisis dilakukan dengan analisis bivariat dengan chi square untuk membedakan ketepatan diagnosis rujukan, ketepatan asal fasyankes perujuk, dan kesesuaian diagnosis rujukan sebelum dan setelah pelaksanaan JKN.Hasil: Terdapat peningkatan jumlah kunjungan Poliklinik Obstetri dan Ginekologi sejak dilaksanakannya program JKN pada tahun 2014, yaitu sebanyak 4.311 pasien. Jumlah subjek adalah sebanyak 222 subjek, terdiri dari 104 subjek pada tahun 2013 dan 118 subjek pada tahun 2014. Dari analisis data, didapatkan tingkat ketepatan diagnosis sebelum JKN adalah 81,7% dan setelah JKN 72,9% (p=0,118), tingkat ketepatan fasyankes perujuk sebelum JKN adalah 63,5% dan setelah JKN 71,2% (p=0,220), serta tingkat kesesuaian diagnosis sebelum JKN adalah 89,4% dan setelah JKN 84,7% (p=0,302).Kesimpulan: Tidak ada perbedaan yang bermakna secara statistik antara ketepatan diagnosis rujukan, ketepatan fasyankes perujuk, dan kesesuaian diagnosis fasyankes rujukan sebelum dan sesudah pelaksanaan JKN.Kata kunci: jaminan kesehatan nasional, obstetri dan ginekologi, poliklinik, rujukan
Satrio B. Purnomo, Bobby I. Utama, Yusrawati, Ori John, Muhammad Iqbal
Indonesian Journal of Obstetrics and Gynecology pp 151-155; doi:10.32771/inajog.v8i3.1157

Abstract:
Objective: To know the correlation of insulin resistance with body mass index in obesity women infertility.Method: This research used a cross-sectional study design. This study was conducted on February 2017 until January 2019 at Obstetric and Gynecology Division of RSUP Dr. M. Djamil and Ibnu Sina Hospital in Padang. The population of the study were all patients were obese in women of reproductive age with infertility complaints with a total sample of 27 people. The sampling technique was consecutive sampling. Data analysis was done by univariate and bivariate using Pearson correlation test.Results: We found that less than half of the respondents experienced insulin resistance with HOMA-IR values > 2,5 (22.2%) and more than half of respondents did not experience insulin resistance with HOMA-IR values < 2,5 (77.8%). There was a correlation of insulin resistance with body mass index in obese female infertility (p 2,5 (22,2%) dan lebih dari separuh responden tidak mengalami resistensi insulin dengan nilai HOMA-IR < 2,5 (77,8%). Terdapat korelasi resistensi insulin dengan indeks massa tubuh pada infertilitas perempuan obesitas (p
Muhammad F. C. Husna, Peby M. Lestari, Ahmad K. Syamsuri, Theodorus
Indonesian Journal of Obstetrics and Gynecology pp 137-141; doi:10.32771/inajog.v8i3.1113

Abstract:
Objective: To compare the sensitivity and specificity of the diagnosis of chorioamnionitis in preterm labor using serum vitamin D and calcium in Dr.Mohammad Hoesin Hospital Palembang.Method: This diagnostic test was carried out in the Obstetrics and Gynecology Department of Dr. Mohammad Hoesin Hospital Palembang from October 2018 to April 2019. Research subjects were women in preterm labor with chorioamnionitis. We collected 39 samples and 36 of them met the inclusion criteria.Results: Eighteen patients with hypovitaminosis vitamin D had chorioamnionitis with a sensitivity value of 94.74%, specificity 5, 88%, positive predictive value (PPV) 52.9% and negative predictive value (NPV) 50%. Two of the 4 patients with hypocalcemia had chorioamnionitis with sensitivity of 10.53%, specificity 88. 24%, positive predictive value (PPV) 50% and negative predictive value (NPV) 46. 9%.Conclusion: Reliability of diagnosis accuracy of serum vitamin and calcium levels against chorioamnionitis is poor.Keywords: accuracy tests, calcium, chorioamnionitis, vitamin D Abstrak Tujuan: Membandingkan sensitivitas dan spesifisitas diagnosis korioamnionitis pada partus prematurus antara serum vitamin D dan kalsium di Rumah Sakit Dr. Mohammad Hoesin Palembang.Metode: Uji diagnostik dilakukan di Departemen Obstetrik dan Ginekologi RSUP Dr. Mohammad Hoesin Palembang. Penelitian dilaksanakan sejak Oktober 2018 hingga April 2019. Subjek penelitian adalah wanita hamil prematur yang didiagnosa korioamnionitis. Terdapat 39 sampel dimana 36 sampel termasuk kriteria inklusi.Hasil: Terdapat 18 pasien dengan hipovitaminosis vitamin D memiliki luaran koriaoamnionitis memiliki nilai sensitivitas 94,74%, spesifisitas 5, 88%, positive predictive value (PPV) 52, 9% dan negative predictive value (NPV) 50%. 2 dari 4 pasien dengan hipokalsemia memiliki luaran korioamnionitis memiliki sensitivitas 10, 53%, spesifisitas 88, 24%, positive predictive value (PPV) 50% dan negative predictive value (NPV) 46, 9%.Kesimpulan: Akurasi diagnosis kadar serum vitamin dan kalsium terhadap luaran korioamnionitis memiliki derajat kesesuaian (realiabilitas) kurang baik.Kata kunci: kalsium, korioamnionitis, uji kesesuaian, vitamin D
Aria Wibawa, Iqra Anugerah
Indonesian Journal of Obstetrics and Gynecology pp 156-160; doi:10.32771/inajog.v8i3.1285

Abstract:
Objective: To determine the relationship between obstetric history and maternal nutrition factors to the incidence of crime in children.Methods: This study was an observational analytic study using a case-control method. The subject of this research is the mother of a child criminal offender in Tangerang Juvenile Detention Center who was recruited using a consecutive sampling method. Sampling was conducted in January 2016 to March 2019. Nutrition history data were obtained using an Indonesian version of the Food Frequency Questionnaire.Result : There were 56 mothers of child offenders who met the study inclusion criteria and 38 subjects as controls. A significant obstetric history of violent crime in children is parity (p = 0.006), place of pregnancy control (p
Nenny Yoanitha, Benny H. Purwara, Irma Ruslina, Sonny Sasotya
Indonesian Journal of Obstetrics and Gynecology pp 174-178; doi:10.32771/inajog.v8i3.1184

Abstract:
Objective: To investigate the differences of levator muscle contraction strength after vitamin D3 supplementation, thus it is expected that the administration of vitamin D3 can reduce the incidence of uterine prolapse recurrence after reconstructive surgery.Methods: This study is a quasi-experimental study with pre-and-post vitamin D3 supplementation on uterine prolapse patient. Participants in this study were patient with uterine prolapse and fulfilled inclusion criteria (n=19). Serum vitamin D3 levels, levator ani muscle contraction strength (perineometer peritron TM), gastrocnemius soleus muscle contraction strength (hand held dynamometer) were measured prior to and after vitamin D3 1000 IU supplementation. This study was conducted in Gynecology Clinic, Physical Medicine and Rehabilitation Clinic, and The Department of Clinical Pathology Dr. Hasan Sadikin General Hospital/ Faculty of Medicine Universitas Padjadjaran on January-April 2019Results: This study showed an increase in levator ani muscle contraction strength with a significant P value of
Budi I Santoso
Indonesian Journal of Obstetrics and Gynecology pp 135-136; doi:10.32771/inajog.v8i3.1396

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