Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Level of maternal zinc serum as risk factor of preeclampsia
Full text linkObjective : To know the relationship of serum zinc levels with preeclampsia (PE)
Method: This observational research uses a type of case control research. The population of this study is all pregnant women with a single pregnancy, gestational age of 28-42 weeks who were treated at the Department of Obstetrics and Gynecology of RSUP Dr. Mohammad Hoesin Palembang from August 2020 to November 2020. The study divided into 2 group, a case group of 30 pregnant women with PE and a control group of 60 pregnant women non PE. Serum zinc level examination is performed on all samples that match the research criteria. The data is processed by using SPSS software program version 20.0 Windows.
Result: Both case and control groups had no meaningful differences to the general characteristics of the patient. There were significant differences in average zinc levels of maternal serum in both research groups (p=0.013; 43.90 plus-minus 15.79 pg/dL). The value of serum zinc levels that have the best sensitivity and specificity is at 45.5 pg/dL.
Conclusion: There is a meaningful relationship between serum zinc levels and PE events. Pregnant women with serum zinc levels greater than or equal to 45.5 pg /dL were significantly at 3.2 times more risk of PE than pregnant women with serum zinc levels less than or equal to 45.5 pg/dL. In this case it is necessary to supplement zinc earlier in pregnancy to reduce the risk of preeclampsia. Keywords: preeclampsia, zinc, case-control studie
Assosiation between Serum Cortisol Levels and Anxiety levels In Elective and Emergency Cesarean Section: Hubungan antara Kadar Kortisol Serum dan Tingkat Kecemasan Pada Operasi Caesar Elektif dan Darurat
Full text linkObjective: To detect anxiety before elective and emergency cesarean section.
Methods: This study was a cross-sectional study. The number of research samples was 42 samples consisting of 21 pregnant patients with an elective cesarean section plan and 21 pregnant patients with an emergency cesarean section at Prof. RSUP. Dr. R. D. Kandou Hospital Manado and Network Hospital in Manado from March 2021 to June 2021. Anxiety was assessed by examining serum cortisol and anxiety levels according to the Hamilton questionnaire (HAM-A). The data were then analyzed using SPSS version 23.0 software.
Results: Cortisol levels were higher in emergency cesarean section (mean 21.590±11.6392) compared to elective cesarean section (mean 10.586±4.9501). Anxiety levels according to HAM-A scores were higher in emergency cesarean section (mean 15.33±7.722) compared to elective cesarean section (mean 7.19±3.614).
Conclusion: There was a significant positive correlation between cortisol levels and anxiety levels based on HAM-A scores.
Keywords: cesarean section , cortisol, HAM-A score. anxiety,
Abstrak
Tujuan: Untuk mendeteksi kecemasan sebelum tindakan seksio sesarea elektif dan emergensi.
Metode: Penelitian ini merupakan suatu penelitian cross-sectional. Jumlah sampel penelitian 42 sampel terdiri dari 21 pasien hamil dengan rencana seksio sesarea elektif dan 21 pasien hamil dengan rencana seksio sesarea emergensi di RSUP Prof. Dr. R. D. Kandou Manado dan RS Jejaring di Kota Manado dari bulan Maret 2021 sampai bulan Juni 2021. Kecemasan dinilai melalui pemeriksaan kortisol serum dan tingkat kecemasan menurut kusioner Hamilton (HAM-A). Data kemudian dianalisis dengan menggunakan software SPSS versi 23.0.
Hasil: Kadar kortisol secara rata-rata lebih tinggi pada seksio sesarea emergensi (mean 21.590±11.6392) dibandingkan dengan seksio sesarea elektif (mean 10.586±4.9501). Tingkat kecemasan menurut skor HAM-A secara rata-rata lebih tinggi pada seksio sesarea emergensi (mean 15.33±7.722) dibandingkan dengan seksio sesarea elektif (mean 7.19±3.614).
Kesimpulan: Terdapat korelasi positif bermakna antara kadar kortisol dan tingkat kecemasan berdasarkan skor HAM-A pada semua subjek penelitian.
Kata kunci: kortisol, seksio sesarea, skor HAM-A. kecemasa
The Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP): Papula Urtikaria Pruritik dan Plak pada Kehamilan (PUPPP)
No full textObjective: To report a rare case of pruritic urticarial papules and plaques of pregnancy (PUPPP) in multiparous woman and its literature review.Methods: A case report with literature review.Discussion: This article reports a multigravida woman, presented with aterm pregnancy with sign and symptoms of pruritic urticarial papules and plaques since the first trimester of pregnancy. This case supports the morphological variation of skin lesions in PUPPP, as the patient had lesions other than the characteristic urticarial papules and plaques, with hyperpigmentation skin changes. The management of this case include oral and topical corticosteroids, oral antihistamines and moisturizer is used to relieve pruritus and skin lesions.Conclusion: PUPPP should be included in the differential diagnosis to differentiate this entity from other dermatoses associated with pregnancy, in order to provide appropriate treatment and reassurance.Keywords: papules, plaques, pregnancy, pruritic, urticarial.
Abstrak
Tujuan: Untuk melaporkan kasus langka mengenai papula urtikaria pruritik dan plak pada kehamilan (PUPPP) perempuan multipara, membahas literatur terkait pada PUPPP.Metode: Laporan kasus dengan telaah literatur.Diskusi : melaporkan kasus perempuan multigravida, datang dalam usia kehamilan cukup bulan dengan tanda dan gejala papula, plak, urtikaria dan pruritus sejak trimester pertama kehamilan. Kasus ini mendukung variasi morfologi lesi kulit pada PUPPP, karena pasien memiliki lesi selain papula dan plak urtikaria yang khas, dengan perubahan kulit hiperpigmentasi. Penatalaksanaan kasus ini meliputi kortikosteroid oral dan topikal, antihistamin oral dan pelembab yang digunakan untuk meredakan pruritus dan lesi kulit.Kesimpulan: PUPPP perlu dimasukkan dalam diagnosis banding untuk membedakan entitas ini dari penyakit kulit lain yang terkait dengan kehamilan, untuk memberikan pengobatan dan pelayanan yang tepat.Kata kunci: kehamilan, , papula, plak, pruritus, urtikaria
 
The Role Placental TLR-7 Expression with Cord Blood HBV DNA and Placental HBV DNA: Peran Ekspresi TLR-7 Plasenta dengan HBV DNA Tali Pusat dan HBV DNA Plasenta
Full text linkAbstract
Objective: To determine the role of TLR-7 expression on intrauterine vertical transmission in pregnancy through identification of serum hepatitis B markers in both maternal and umbilical cord blood.
Methods: Analysis of TLR expression was performed on 38 paraffin block samples of placental tissue acquired from mothers with HBV using TLR immunohistochemical staining.
Results: 16 of 38 samples were acquired from mothers aged 26-30 years-old. Most of the samples were from primiparous mothers (52.6%). This study found no significant association between TLR-7 expression and HBV DNA in the placenta and cord blood (p = 1.000). However, we found a significant association between placental TLR-7 expression and maternal HBV DNA (p = 0.034). Meanwhile, placental HBeAg and HBV DNA were not associated with placental TLR-7 expression (p = 0.082; p = 1.000).
Conclusion: There was no significant association between TLR-7 expression and HBV DNA in the placenta and cord blood, but we found a significant association between TLR-7 expression and maternal HBV DNA.
Keywords: HBV DNA, Hepatitis B, intrauterine infection, placental toll-like receptor (TLR) 7,umbilical cord.
Abstrak
Tujuan: untuk melihat peran ekspresi TLR-7 terhadap transmisi vertikal intrauterina pada kehamilan melalui identifikasi marker serum hepatitis B pada darah ibu dan talipusar.
Metode: Analisis ekspresi TLR dilakukan pada 38 sampel blok paraffin jaringan plasenta ibu yang menderita HBV dengan memakai pewarnaan imuhohistokimia TLR.
Hasil: 16 dari 38 sampel berusia 26-30 tahun. Sebagian besar sampel merupakan kelompok primipara (52.6%). Penelitian ini tidak menemukan hubungan yang signifikan antara ekspresi TLR-7 di plasenta dan HBV DNA darah tali pusat (p = 1.000). Tapi, kami menemukan hubungan yang signifikan antara ekspresi TLR-7 plasenta dan HBV DNA ibu (p = 0,034). Sedangkan HBeAg dan HBV DNA plasenta tidak berhubungan dengan ekspresi TLR-7 plasenta (p = 0,082; p = 1.000).
Kesimpulan: Tidak ada hubungan yang signifikan antara ekspresi TLR-7 dan DNA HBV di plasenta dan tali pusat, tetapi kami menemukan hubungan yang signifikan antara ekspresi TLR-7 dan DNA HBV ibu.
Kata kunci: HBV DNA, Hepatitis B, infeksi intrauterina, plasenta, tali pusat, toll-like receptor (TLR)
The Association betweeen Cesarean Section and Placenta Accreta: Hubungan antara Seksio Sesarea dan Plasenta Akreta
Full text linkObjective: To determine the relationship between the history of cesarean section and the incidence of placenta accreta in Dr. Zainoel Abidin Hospital Banda Aceh.
Methods: The data collection method used was secondary data collection which was assessed through retrospective medical records. Sampling in this study using total sampling method. The results of the study were processed using the chi square statistical test on 781 research samples that were collected from period April 2019 - April 2020.
Results: The results obtained were 22 respondents (2.8%) experienced placenta accreta where 18 respondents (2.30%) had placenta accreta with a history of CS and 4 respondents (0.51%) placenta accreta without a history of CS. The p value obtained was 0.000 (p value <0.05). In this study, the value of the Risk Estimate (RE) was 6.483 with a Confident Interval (CI) of 95% being (2.21-18.97).
Conclusions: There is a very significant relationship between the history of cesarean section and the incidence of placenta accreta at RSUDZA Banda Aceh and mothers with a history of CS have a 6 times greater risk of experiencing placenta accreta.
Keywords: cesarean section, placenta accrete.
Abstrak
Tujuan: Untuk mengetahui hubungan riwayat seksio sesarea dengan kejadian plasenta akreta di Rumah Sakit Umum Daerah Dr. Zainoel Abidin Banda Aceh.
Metode: Jenis penelitian ini adalah penelitian analitik dengan desain potong lintang. Metode pengambilan data yang digunakan adalah pengambilan data sekunder yang dinilai melalui rekam medik secara retrospektif. Pengambilan sampel pada penelitian ini menggunakan metode total sampling. Hasil penelitian diolah menggunakan uji statistik chi square terhadap 781 sampel penelitian yang telah dikumpulkan dari data periode April 2019 – April 2020.
Hasil: Hasil yang didapatkan sebanyak 22 responden (2,8%) mengalami plasenta akreta dimana 18 responden (2,30%) plasenta akreta dengan riwayat SC dan 4 responden (0,51%) plasenta akreta tanpa riwayat SC. Nilai p value yang didapatkan adalah 0.000 (p value <0,05). Pada penelitian ini didapatkan nilai Risk Estimate (RE) 6,483 dengan Confident Interval (CI) 95% berada (2,21- 18,97).
Kesimpulan: Hasil ini menunjukkan terdapat hubungan yang sangat signifikan antara riwayat seksio sesarea dengan kejadian plasenta akreta di RSUDZA Banda Aceh dan ibu dengan riwayat SC memiliki risiko 6 kali lebih besar untuk mengalami plasenta akreta.
Kata kunci: plasenta akreta, seksio sesarea
C-Reactive Protein and Matrix Metalloproteinase-7 in Preterm Premature Rupture of Membranes (PPROM) and Premature Rupture of Membranes (PROM): C-Reactive Protein dan Matrix Metalloproteinase-7 pada Ketuban Pecah Dini Kehamilan Preterm dan Aterm
Full text linkObjective: To determine the difference in qualitative serum CRP and MMP-7 levels between PROM and PPROM
Methods: Research with a case-control design with premature rupture of membranes in term pregnancy as a control group and preterm pregnancy as a case group conducted in the delivery room of the Regional General Hospital dr. Zainoel Abidin Banda Aceh starting from January 2020. Total number of each group as many as 30 samples that met the inclusion and exclusion criteria by taking venous blood samples to check the levels of qualitative CRP serum and levels of the Metalloproteinase-7 Matrix (MMP-7). Statistical tests for categorical - numerical data groups were tested using independent sample t-test and categorical - categorical data groups were tested using Chi-Square test.
Results: A total of 60 samples with 30 PPROM and 30 PROM mothers. There was no statistically significant difference in the qualitative CRP serum result in PROM patients with term and preterm pregnancies. On MMP-7 examination, the mean MMP-7 level of preterm PROM mothers was higher than at term PROM, which was 5.28 mg / L and there was a significant relationship between MMP-7 and qualitative CRP in PROM patients with term pregnancy (p <0.05).
Conclusion: There is no significant difference in the value of qualitative CRP and MMP-7 between PPROM and PROM. However, there was a significant association between qualitative serum CRP and plasma MMP-7 in PROM.
Keywords: c-reactive protein, matrix metalloproteinase-7,rupture of membranes.
Abstrak
Tujuan: Untuk mengetahui perbedaan gambaran serum CRP kualitatif dan kadar MMP-7 antara kehamilan preterm dan aterm dengan ketuban pecah dini di RSUD Dr. Zainoel Abidin Banda Aceh.
Metode: Penelitian dengan desain kasus kontrol dengan ketuban pecah dini kehamilan aterm sebagai kelompok kontrol dan kehamilan preterm sebagai kelompok kasus. yang dilakukan di Kamar Bersalin Rumah Sakit Umum Daerah dr. Zainoel Abidin Banda Aceh pada Januari 2020. Dengan jumlah masing-masing kelompok sebanyak 30 sampel yang memenuhi kriteria inklusi dan eklusi dengan pengambilan sampel darah vena untuk dilakukan pemeriksaan kadar serum CRP kualitatif dan kadar Matrix Metalloproteinase-7 (MMP-7). Uji statistik untuk kelompok data yang bersifat kategorik - numerik diuji menggunakan uji T tidak berpasangan dan pasangan kelompok data yang bersifat kategorik - katergorik akan diuji menggunakan uji Chi-Square.
Hasil: Sebanyak 60 penderita KPD dengan 30 Ibu KPD Preterm dan 30 KPD aterm. Tidak dijumpai perbedaan yang bermakna secara statistik gambaran serum CRP kualitatif pada penderita KPD dengan kehamilan aterm dan preterm. Pada pemeriksaan MMP-7 rerata kadar MMP-7 ibu KPD preterm lebih tinggi dibandingkan KPD aterm yakni senilai 5,28 mg/L dan terdapat hubungan bermakna antara MMP-7 dan CRP kualitatif pada penderita KPD dengan kehamilan aterm (p < 0,05).
Kesimpulan: Tidak terdapat perbedaan gambaran signifikan nilai CRP kualitatif dan MMP-7 antara KPD preterm dan aterm. Namun, terdapat hubungan yang signifikan antara serum CRP kualitatif dan MMP-7 plasma pada penderita ketuban pecah dini dengan kehamilan aterm.
Kata kunci: c-reactive protein, matrix metalloproteinase-7, ketuban pecah dini
Cesarean delivery Characteristics during JKN Implementation : Karakteristik persalinan sesar selama Implementasi JKN
Full text linkObjective: To compare the characteristics of cesarean before and during JKN, also analyzes the factors that influence these differences.
Methods: This was a quantitative study with a longitudinal retrospective design and qualitative research used design case studies. The population were delivery women at the Banyuwangi referral hospital before and during JKN. The quantitative data were analyzed firstly by univariable and then bivariable. The bivariable analysis was performed by comparing the prevalence ratio (PR) between two variables.
Results: The proportion of cesarean delivery had increased significantly during the implementation of JKN. 50% of maternal deaths before JKN gave birth using cesarean delivery, this proportion increased significantly to 60% during JKN. Indications of fraud committed by health workers to be a factor in increasing the proportion of cesarean delivery. Other contributing factors were repeated cesarean delivery, delayed referral, and the number of obstetric complications.
Conclusion: There was an increase in the proportion of cesarean deliveries during the implementation of JKN. BPJS Kesehatan needed to re-evaluate the system they had created so far. The quality of service must be emphasized so that the negative impact on women could be minimized.
Keywords: cesarean section, health insurance, maternal mortality.
Abstrak
Tujuan: Membandingkan karakteristik persalinan sesar sebelum dan selama implementasi JKN, selain itu juga menganalisis faktor-faktor yang berpengaruh.
Metode: Studi kuantitatif dengan desain longitudinal retrospective dan studi kualitatif dengan desain case studies. Populasi adalah ibu bersalin di rumah sakit rujukan Kabupaten Banyuwangi sebelum dan selama JKN. Data kuantitatif dianalisis secara univariabel dan bivariabel. Analisis bivariabel dengan membandingkan prevalensi rasio (PR) diantara dua variabel.
Hasil: Proporsi persalinan sesar meningkat secara signifikan selama implementasi JKN. 50% ibu yang meninggal bersalin dengan metode sesar, proporsi ini meningkat selama JKN menjadi 60%. Indikasi kecurangan oleh tenaga kesehatan menjadi salah satu faktor yang menyebabkan peningkatan ini. Faktor lain yang berkontribusi adalah persalinan sesar yang berulang, keterlambatan rujukan dan banyakanya komplikasi obstetrik.
Kesimpulan: Terdapat peningkatan proporsi persalinan sesar selama implementasi JKN. BPJS Kesehatan perlu mengkaji ulang sistem yang dibuat selama ini. Kualitas pelayanan harus tetap dipertahankan, agar tidak berdampak pada kesehatan ibu.
Kata kunci: jaminan kesehatan, kematian ibu, persalinan sesar
How the Type of Surgery and Adherence to the Clinical Pathway Correlate with Quality Control and Cost Control in Endometriosis Surgery: Bagaimana Jenis Pembedahan dan Kepatuhan pada Clinical Pathway Berhubungan dengan Kontrol Kualitas dan Kontrol Biaya pada Operasi Endometriosis
Full text linkObjective: This study examined the correlation of the type of surgery and adherence to the clinical pathway corresponding to the national guidelines in terms of quality and cost control.
Methods : Quantitative economic evaluation was conducted to assess the type of surgery and adherence to clinical pathways in terms of quality and cost control. The data were analyzed using the chi-square or Mann–Whitney test.
Results : Of the sample of 82 patients who had undergone laparoscopy or laparotomy, 54.9% had a laparoscopic procedure, while 45.1% had undergone laparotomy ; only 25.6% of the case procedures adhered to the clinical pathway. In general, it can be interpreted that, in a laparoscopy procedure, the potential risk that a mismatch will occur in quality control is up to 32 times that of a laparotomy procedure. Moreover, good adherence to the clinical pathway does not correlate with good cost control. Overall, of the 82 cases, only three (3.7%) showed a good fit for both quality control and cost control.
Conclusions : The type of surgery correlates with quality and cost control, whereas adherence to the clinical pathway does not correlate with either quality or cost control.
Keywords: Laparotomy, Laparoscopy, surgery, endometriosis, national health insurance
Abstrak
Tujuan: Studi ini menguji korelasi jenis operasi dan kepatuhan terhadap jalur klinis yang sesuai dengan pedoman nasional dalam hal kontrol kualitas dan biaya.
Metode: Evaluasi ekonomi kuantitatif dilakukan untuk menilai jenis operasi dan kepatuhan terhadap jalur klinis dalam hal kualitas dan pengendalian biaya. Data dianalisis menggunakan uji chi-square atau Mann-Whitney.
Hasil: Dari sampel 82 pasien yang pernah menjalani laparoskopi atau laparotomi, 54,9% menjalani prosedur laparoskopi, sedangkan 45,1% pernah menjalani laparotomi ; hanya 25,6% dari prosedur kasus yang mengikuti jalur klinis. Secara umum dapat diartikan bahwa, dalam prosedur laparoskopi, potensi risiko terjadinya ketidaksesuaian dalam kontrol kualitas adalah hingga 32 kali lipat dari prosedur laparotomi. Selain itu, kepatuhan yang baik terhadap jalur klinis tidak berkorelasi dengan pengendalian biaya yang baik. Secara keseluruhan, dari 82 kasus, hanya tiga (3,7%) yang menunjukkan kesesuaian yang baik untuk pengendalian kualitas dan pengendalian biaya.
Kesimpulan: Jenis pembedahan berkorelasi dengan kualitas dan pengendalian biaya, sedangkan kepatuhan terhadap jalur klinis tidak berkorelasi dengan kualitas atau pengendalian biaya.
Kata kunci: Laparotomi, Laparoskopi, pembedahan, endometriosis, jaminan kesehatan nasiona
