Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Multiple Congenital Anomalies: Meningoencephalocele, Labiopalatoschisis and Clubfoot with Normal Chromosomal Analysis : Multipel Kongenital Anomali : Meningoensefalokel, Labiopalatoskhizis, dan Kaki Pengkor dengan Hasil Analisis Kromosom Normal
Full text linkObjective : To perform chromosomal microarray when similar case was found.Methods: Case reportCase : G1P0A0, 20 years-old, 23-24 weeks gestation, normal BMI, was diagnosed by ultrasonography with multiple congenital anomaly consisted by meningoencephalocele, labiopalatoschisis, and clubfoot. Amniocentesis was performed to manage karyotyping analysis and a result of 46 XY was obtained. Neonate was delivered with exact condition according to prenatal diagnosis and was demised 6 hours postnatal. Patient had no history of smoking or DM, and no familial congenital deformity. Patient was a worker in textile manufactory and inadequacy folic acid intake during pregnancy was known.Early suspicion of aneuploidy as cause of multiple congenital anomalies in this case was not proven otherwise. Serology test also found no congenital infection. Literature research indicated tendency of MTHFR polymorphisms. Genetic analysis such as chromosomal microarray to establish involvement of MTHFR polymorphism is needed.Conclusion : This case should behold as clinicians’ consideration to perform additional examination and patients counseling when similar anomaly was found during prenatal ultrasonography examination.Keyword : chromosomal microarray,karyotyping; MTHFR polymorphism, mutiple congenital anomaly.
Abstrak
Tujuan : Untuk melakukan pemeriksaan chromosomal microarray pada kasus yang sama.Metode: Laporan kasus.Kasus : G1P0A0, usia 20 tahun, hamil 23-24 minggu, didiagnosis secara ultrasonografi dengan kelainan kongenital multipel berupa meningoensefalokel, celah bibir-palatum, dan club foot. Amniosentesis dilakukan pada pasien untuk analisis kromosom dan didapatkan hasil 46 XY. Bayi lahir dengan kondisi yang sama dengan diagnosis prenatal tersebut dan meninggal 6 jam pasca salin. Dari hasil anamnesis dan pemeriksaan kami dapatkan pasien bukan perokok, tidak ada keluarga dengan cacat bawaan, indeks masa tubuh pasien normal. Pasien merupakan karyawan pabrik tekstil dan pasien tidak mengkonsumsi asam folat adekuat selama kehamilan. Dua data terakhir yang kemungkinan berkontribusi terjadinya kelainan kongenital multipel pada kasus ini, yaitu kontak dengan teratogen dan defisiensi asam folat. Dugaan awal kelainan kromosom sebagai penyebab kelainan kongenital multipel pada kasus ini tidak terbukti. Sayangnya, investigasi-investigasi lebih lanjut berupa analisis genetik, seperti pemeriksaan apakah terdapat polimorfisme MTHFR yang berhubungan dengan defisiensi asam folat pada kasus ini tidak dilakukan karena keluarga pasien menolak. Kesimpulan : Kasus ini sebaiknya menjadi bahan pertimbangan klinisi untuk melakukan pemeriksaan tambahan dan edukasi ke pasien pada saat menemukan kelainan yang sama pada pemeriksaan ultrasonografi prenatal.Keyword: chromosomal microarray; karyotyping; multipel kongenital anomali; polimorfisme MTHF
Influence of Total Hysterectomy to Sexual Function: Pengaruh Histerektomi Total dengan Fungsi Seksual
No full textObjective: To determine whether there are differences the impact of total hysterectomy on sexual function between each woman. Women who perform total hysterectomy often experience fear of the negative effects of hysterectomy on their sexual function.Methods: Randomized clinical trials have been conducted in outpatient clinic Obstetrics and Gynecological wards of Dr. Muhammad Hoesin General Hospital, Palembang from February to October 2020. There were 40 samples of women undergoing a total hysterectomy met the inclusion criteria. Sexual function before and after hysterectomy was analyzed with the Wilcoxon test. Data analysis using SPSS version 22.0.Results: This study showed decreased of desire, decreased stimuli, decreased orgasm, increased lubrication, increased sexual satisfaction, and increased dyspareunia samples after a total hysterectomy. However, with statistical analysis obtained results there were no meaningful changes in sexual function of desire (p = 0.849), stimuli (p = 0.716), lubrication (p = 0.261), orgasm (p = 0.839), sexual satisfaction (p = 0.613) and dyspareunia (p = 0.510) after total hysterectomy .Conclusion: It can be concluded that there is no significantly total hysterectomy effect on sexual function, based on FSFI (sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, and pain.Keywords: clinical trial, FSFI, hysterectomy, sexual function.
Abstrak
Tujuan: Mengetahui adakah perbedaan dampak histerektomi total pada fungsi seksual antara setiap perempuan. Perempuan yang melakukan histerektomi total sering mengalami ketakutan akan efek negatif histerektomi pada fungsi seksualnya. Metode: Telah dilakukan uji klinis secara acak di poliklinik rawat jalan bangsal Obstetri dan Ginekologi RSUP Dr. Muhammad Hoesin Palembang dari bulan Februari sampai Oktober 2020. Sebanyak 40 sampel perempuan yang menjalani histerektomi total memenuhi kriteria inklusi. Fungsi seksual sebelum dan sesudah histerektomi dianalisis dengan uji Wilcoxon. Analisi data menggunakan SPSS versi 22.0.Hasil: Penelitian ini menunjukkan penurunan hasrat, penurunan rangsangan, penurunan orgasme, peningkatan lubrikasi, peningkatan kepuasan seksual, dan peningkatan dispareunia setelah histerektomi total. Namun dengan analistik statistik didapatkan hasil tidak ada perubahan yang bermakna pada fungsi seksual yaitu hasrat (p=0,849), rangsangan (p=0,716), lubrikasi (p= 0,716), lubrikasi (p=0,261), orgasme (p=0,839), kepuasan seksual (p= 0,613), dan dispareunia (p= 0,510) setelah histerektomi total.Kesimpulan: Dapat disimpulkan bahwa tidak ada pengaruh histerektomi total yang signifikan terhadap fungsi seksual berdasarkan FSFI (hasrat, seksual, gairah seksual, lubrikasi, orgasme, kepuasan seksual, dan nyeri.Kata kunci: fungsi seksual, FSFI, histerektomi, uji klinis
Return of Fertility After Discontinuation of Contraception According Type of Contraception, Duration of Use, Age and BMI: Kembalinya Kesuburan Pasca Penghentian Alat Kontrasepsi Berdasarkan Jenis Kontrasepsi, Lama Pemakaian, Usia dan IMT
No full textObjective : To determine the relationship between the type of contraception, duration of use, BMI, and age on the return of fertility.Methods : This was an analytic observational study with a cross-sectional design. The subjects in this study was 123 multigravida mothers who had met the inclusion criteria, namely with a history of regular intercourse and the exclusion criteria in this study were multigravida mothers with a history of abortion and failure of the family planning method. Data were collected by direct interviews and medical record data. Data were analyzed using Chi-square test and Logistic Regression test.Results: The results of the Chi-square analysis showed a relationship between the type of contraception (p=0.001;OR=1.29) and age (p=0.031;OR=4.69) with the return of fertility. However, there was no correlation between the duration of use (p=0.964;OR=0.97) and BMI (p=0.246;OR=0.50) with the return of fertility. In the logistic regression test, there was no partial effect of the type of contraception (p=0.997;OR=0.22) and age (p=0.058;OR=0.01).Conclusion : Based on the results of the analysis, it can be concluded that there is a relationship between the type of contraception and age with the return of fertility after family planning, where non-hormonal contraceptives and <30 years of age return to fertility faster, namely <1 year, but there is no relationship between duration of use and BMI with the return of fertility after family planning.Keywords: contraception, family planning, fertility.
Abstrak
Tujuan: Mengetahui hubungan jenis kontrasepsi, lama pemakaian, IMT, dan usia terhadap kembalinya kesuburan.Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain potong lintang. Subjek penelitian ini adalah ibu multigravida yang telah memenuhi kriteria inklusi yaitu dengan riwayat senggama teratur dan bersedia menjadi responden serta kriteria ekslusi dalam penelitian ini adalah ibu multigravida dengan riwayat abortus dan kegagalan metode KB. Besar subjek dalam penelitian ini sebanyak 123 orang. Pengambilan data dilakukan dengan wawancara langsung dan melihat data rekam medis. Analisis data dilakukan uji statistik Chi-square dan uji Regresi Logistik.Hasil : Hasil analisis dengan Chi-square, menunjukan adanya hubungan jenis kontrasepsi (p = 0,001; OR = 1,29) dan usia (p=0,031; OR = 4,69) dengan kembalinya kesuburan. Namun, tidak terdapat hubungan lama pemakaian (p= 0,964; OR =0,97) dan IMT (p= 0,246; OR =0,50) dengan kembalinya kesuburan. Pada uji regresi logistik tidak terdapat pengaruh parsial dari jenis kontrasepsi (p=0,997; OR =0,22) dan usia (p=0,058; OR=0,01).Kesimpulan : Berdasarkan hasil analisis yang dilakukan dapat disimpulkan terdapat hubungan jenis kontrasepsi dan usia dengan kembalinya kesuburan pasca KB, dimana pada jenis kontrasepsi non hormonal dan usia < 30 tahun lebih cepat kembali subur yaitu < 1 tahun, namun tidak terdapat hubungan lama pemakaian dan dengan kembalinya kesuburan pasca KB.Kata kunci: keluarga berencana, kesuburan kontrasepsi
Estradiol on Day Seven is a Good Predictor for Oocyte Maturation Rate in In Vitro Fertilization Program: Kadar estradiol hari ketujuh sebagai prediktor tingkat kematangan oosit pada program Fertilisasi In Vitro
Full text linkAbstract
Objective: to determine which factors influence the rate of oocyte maturation in In Vitro Fertilization (IVF) program.
Methods: A retrospective cohort study was conducted using secondary data from IVF participants at the Yasmin Fertility Clinic, Dr. RSUP. Cipto Mangunkusumo, Jakarta, Indonesia during the period January 2019 to December 2020, as recorded in the InaRepromed archive. The variables analyzed were age, body mass index, and hormone levels on day 1, day 7, and day hCG, with oocyte maturation rate as the main outcome. Correlation test was performed between several variables and the level of oocyte maturation rate and followed by multivariate analysis to assess the factors that were closely related to oocyte maturation rate.
Results: Data from 52 subjects were collected for the study. Positive correlation was observed between oocyte maturation rate and estradiol on day 7 (r = 0.229), while negative correlation was observed between oocyte maturation rate and progesterone/estradiol ratio on day 7 (r = -0.289) and luteinizing hormone on day 1 (r = -0.265). Multivariate analysis revealed that higher estradiol on day-7 was associated with better oocyte maturation rate (p = 0.047).
Conclusion: Higher estradiol level on day 7 was associated with better oocyte maturation rate in IVF.
Keywords: Assisted reproductive technology (ART), estradiol, in vitro fertilization (IVF), progesterone.
Abstrak
Tujuan: untuk menentukan faktor-faktor yang mempengaruhi tingkat pematangan oosit dalam program Fertilisasi InVitro (FIV).
Metode: Desain penelitian adalah kohort retrospektif, menggunakan data sekunder peserta bayi tabung Klinik Fertilitas Yasmin, RSUP Dr. Cipto Mangunkusumo, Jakarta, Indonesia selama periode Januari 2019 hingga Desember 2020, yang tercatat di dalam arsip InaRepromed. Variabel yang dianalisis adalah umur, indeks massa tubuh, dan kadar hormon pada hari ke-1, hari ke-7, dan hari ke-hCG, dengan tingkat maturasi oosit sebagai luaran utama. Dilakukan analisis korelasi antara beberapa variabel dengan tingkat maturasi oosit, dan dilanjutkan dengan analisis multivariat untuk menilai faktor-faktor yang berhubungan kuat dengan tingkat maturasi oosit.
Hasil: Data dari 52 subjek dikumpulkan untuk penelitian ini. Dijumpai korelasi positif antara tingkat maturasi oosit dan estradiol pada hari ke 7 (r = 0,229), sedangkan korelasi negatif diamati pula antara tingkat maturasi oosit dan rasio progesteron/estradiol pada hari ke 7 (r = -0,289) dan hormon luteinisasi pada hari 1 (r = -0,265). Analisis multivariat mengungkapkan bahwa estradiol yang lebih tinggi pada hari ke-7 dikaitkan dengan tingkat maturasi oosit yang lebih baik (p = 0,047).
Kesimpulan: Kadar estradiol yang lebih tinggi pada hari ke 7 dikaitkan dengan tingkat pematangan oosit yang lebih baik pada program FIV.
Kata kunci : Teknologi reproduksi berbantu (TRB), estradiol, fertilisasi in vitro (IVF), progesteron
Clinical Pregnancy Rate in in-Vitro Fertilization (IVF) among Endometrioma Patients Underwent Cystectomy Laparoscopy : Kejadian Kehamilan Klinis setelah Fertilisasi In Vitro pada Pasien Endometrioma Postsistektomi Laparoskopi
Full text linkAbstract
Objective: to discuss the clinical pregnancy rate and factors influencing fecundity among endometriosis women having cystectomy laparoscopically who underwent IVF.
Methods: The search was conducted on Pubmed®, EBSCOhost®, and Proquest®, Cochrane Library®, ClinicalKey® using MeSH.
Case : A 38-years woman, P0A0 come to the gynecology clinic with a chief complaint of primary infertility for eight years. The patient had undergone a bilateral endometrial cyst resected with laparoscopy and failed for two cycles of IVF. What is the clinical pregnancy rate of women that undergo IVF with a history of ovarian endometrioma cystectomy?
Results:, There were six articles appropriate to the inclusion criteria and further appraised using the Centre for Evidence-Based Medicine, University of Oxford appraisal tools. The studies consisted of five prognostic studies and one meta-analysis. The studies were appraised for their validity, Importance, and Applicability.
Conclusion: The pregnancy rate in patients undergoing IVF after ovarian cystectomy ranges from 14%-45.2%. A prudent consideration and carefulness during cystectomy surgery are essential for patients that wish to be fertile.
Keywords: clinical pregnancy rate, endometrioma, in vitro fertilization, laparoscopy, ovarian cystectomy
Abstrak
Tujuan: Untuk menelaah tentang kemungkinan terjadinya kehamilan secara klinis pada perempuan yang menjalani IVF dengan riwayat laparoskopi sistektomi dan faktor-faktor yang mempengaruhi kesuburannya.
Metode: Pencarian jurnal dilakukan dengan menggunakan search engine Pubmed®, EBSCOhost®, dan Proquest®, Cochrane Library®, ClinicalKey® menggunakan MeSH.
Kasus: Perempuan P0A0 berusia 38 tahun datang ke poliklinik dengan keluhan utama infertilitas selama delapan tahun. Pasien memiliki riwayat kista endometrioma bilateral yang sudah di kistektomi dengan laparoskopi dan dua kali gagal menjalani siklus IVF. Berapa kemungkinan terjadinya kehamilan secara klinis pada perempuan yang menjalani IVF dengan riwayat kistektomi endometrioma?
Hasil: Dari hasil pencarian didapatkan enam artikel jurnal yang sesuai dengan kriteria inklusi dan dianalisis lebih lanjut menggunakan telaah kritis Evideence-Based Medicine, University of Oxford. .Terdapat lima jurnal studi prognostic dan satu meta-analisis. Studi-studi tersebut akan ditelaah kritis lebih lanjut berdasarkan validitas, kepentingan, dan aplikabilitasnya
Kesimpulan: Kemungkinan terjadinya kehamilan secara klinis pada pasien yang menjalani IVF setelah kistektomi endometrioma ovarium adalah 14%-45,2%. Pertimbangan yang bijaksana dan hati-hati diperlukan untuk melakukan operasi kistektomi pada pasien yang mengalami endometrioma dan ingin tetap subur.
Kata kunci: endometrioma, fertilisasi in vitro, kehamilan klinis, kistektomi ovarium, laparoskop
Assessment serum zinc levels in pregnancy with COVID-19 compared with normal pregnancy: Penilaian kadar seng serum pada kehamilan dengan COVID-19 dibandingkan dengan kehamilan normal
Full text linkAbstract
Objective: The objective of this study was to assess serum zinc levels in pregnancy with COVID-19 compared with normal pregnancy.
Methods: The sampling method used was consecutive sampling. All subjects enrolled must meet eligibility inclusion and exclusion criteria with signed informed consent. The study was conducted from March 2021 to June 2021 in Manado. Pregnant women with COVID-19 and normal pregnant women serum zinc levels were measured.
Results:Sixteen pregnant patients with COVID-19 and 16 normal pregnant patients’ serum zinc levels were measured.All pregnant women with COVID-19 have low serum zinc levels (100%), whereas in the normal pregnancy group only 8 subjects (50%) have low serum zinc levels and 8 subjects (50%) have normal serum zinc levels. In the pregnancy with COVID-19 group, the mean±SD value was 40.75±10.440, whereas in the normal pregnancy group the mean±SD value was 60.25±17.407. The analysis using an independent T-test shows a significant difference in serum zinc levels between pregnancies with COVID-19 and normal pregnancies (p=0.001).
Conclusion: There is a significant difference in serum zinc levels in pregnancies with COVID-19 and normal pregnancies.
Keywords: COVID-19,pregnancy with COVID-19, zinc in pregnancy.
Abstrak
Tujuan: Untuk mengetahui kadar zinc pada kehamilan dengan COVID-19 dibandingkan pada kehamilan normal.
Metode: Pengambilan sampel metode consecutive sampling setiap subjek yang sesuai dengan kriteria inklusi dan eksklusi penelitian dan telah menandatangani surat persetujuan. Penelitiandilakukan bulan Maret 2021 sampai Juni 2021 di Manado. Dilakukan pemeriksaan kadar zinc dalam serum pasien hamil dengan COVID-19 dan pasien hamil normal.
Hasil:Enam belas pasien hamil dengan COVID-19 dan 16 pasien hamil normal dilakukan pemeriksaan kadar zinc. Kelompok kehamilan dengan COVID-19, semuanya memiliki kadar zinc rendah (100%). Sedangkan pada kehamilan normal kelompok kadar zinc rendah sebanyak 8 orang (50%) dan kadar zinc normal sebanyak 8 orang (50%). Pada kelompok kehamilan dengan COVID-19 didapatkan nilai mean±SD sebesar 40,75±10,440, sedangkan pada kelompok kehamilan normal nilai mean±SD sebesar 60,25±17,407. Pada analisis uji beda independen menunjukkan bahwa terdapat perbedaan bermakna kadar zinc pada kehamilan dengan COVID-19 dan kehamilan normal (p=0.001).
Kesimpulan: Terdapat perbedaan bermakna kadar zinc pada kehamilan dengan COVID-19 dan kehamilan normal
Kata kunci : COVID-19,kehamilan dengan COVID-19,zinc pada kehamilan,
 
EMA and EMACO Chemotherapy in High Risk Gestational Trophoblast Disease, which Better? Kemoterapi EMA dan EMACO dalam Risiko Tinggi Penyakit Trofoblas Gestasional, Mana yang Lebih Baik?
Full text linkAbstract
Objective: Determine the best effectiveness and efficacy between EMA and EMACO for patients with high-risk GTN.
Results: GTN patients who received EMA showed remissions as high as 74.4% - 96.6% of cases. The side effects of anemia in EMA were less toxic than EMACO, but it wasn’t the case in neutropenia. Two studies showed that 57,1% and 87% patients relapse within 2 years, while none in 5 years and 7 years follow-ups.
Discussion: With EMACO use, it has been observed to result in increased morbidity and increased health care costs and when patients experience complications while staying overnight in the hospital, they are not monitored by a good specialist team. Patients treated with EMACO had more peripheral neuropathy as result of vincristine than EMA. The use of EMA certainly requires further evaluation.
Conclusion: Patients with High-risk GTN who treated first-line with EMA or EMACO have an excellent prognosis. Both regiments are equally effective. There were differences in treatment scheduling, hospitalization requirements, and toxicity between regimens.
Keywords: EMA, EMACO, gestational trophoblastic neoplasia
Abstrak:
Tujuan: Mengetahui efektivitas dan efikasi terbaik diantara EMA dan EMACO untuk pasien dengan NTG berisiko tinggi.
Hasil: Pasien dengan NTG yang menerima EMA menunjukkan remisi setinggi 74.4%-96.6% dari kasus. Efek samping anemia dari EMA lebih tidak toksik dibandingkan EMACO, namun tidak dengan neutropenia. Dua studi menunjukkan bahwa 57.1% dan 87% pasien mengalami kekambuhan dalam 2 tahun, namun tidak ada dalam follow up 5 tahun dan 7 tahun.
Diskusi: Dengan penggunaan EMACO, dapat diobservasi bahwa terdapat peningkatan morbiditas dan peningkatan biaya pelayanan kesehatan, dan ketika pasien mengalami komplikasi pada saat rawat inap di rumah sakit, mereka tidak dimonitor oleh tim spesialis yang baik. Pasien yang diterapi dengan EMACO memiliki efek samping neuropati perifer lebih tinggi yang disebabkan oleh vinkristin, dibandingkan EMA. Penggunaan EMA membutuhkan evaluasi lebih lanjut.
Kesimpulan: Pasien dengan NTG berisiko tinggi yang diterapi dengan lini pertama EMA atau EMACO mempunya prognosis yang baik. Kedua regimen tersebut efektif. Ada perbedaan dalam penjadwalan terapi, kebutuhan rawat inap dan toksisitas antara regimen,
Kata kunci: EMA, EMACO, neoplasia trofoblastik gestasional
 
Sociodemographic Factors of Elective and Emergency Cesarean Delivery in the Referal Hospital: A cross-sectional study: Faktor Sosiodemografi pada persalinan seksio sesarea elektif dan emergensi di Rumah Sakit Rujukan: sebuah penelitian potong lintang
Full text linkObjectives: To analyze the correlation between sociodemographic factors and cesarean section delivery at Referral Hospital in Kendari.
Method: This was a cross-sectional study conducted at dr. Ismoyo Hospital in Kendari. Data were obtained from medical records of cesarean section delivery from January to December 2019. Sampling used simple random sampling techniques. Data were analyzed using the Chi-square test.
Result: There were 50.5% emergency cesarean and 49.5% elective cesarean. The maternal age was 18-44 years. Most cases are aged 20-35 years (78.5%), have a higher education level (65.1%), employees (53.2%), and multipara (56.5%). There was a correlation between age and cesarean section (p = 0.027). There was no correlation between education level (p = 0.618), occupation (p = 0.563), and parity (p = 0.365) with cesarean section.
Conclusion: There is a correlation between maternal age and cesarean section. Education, counseling, and antenatal care should be done for early detection.
Keywords: age, cesarean section, education level, occupation, parit
The mIRNA519a-3p and NKG2D in endometriosis.
No full textBackground: Natural killer (NK) cells play a role in pathogenesis of endometriosis. Lower expressions of NK cells receptor group 2D (NKG2D) ligands inhibits cytotoxic activity of NK cells; a common immunity avoidance mechanism in neoplasms. Literatures have proven miRNAs regulatory effect on NKG2D expression. There has been no specific biomarker for diagnosing endometriosis. Non-invasive means of diagnosing endometriosis may reduce well-known risks of invasive method of diagnosis and yield better results.
Purpose: To investigate the correlation between miRNA-519a-3p expression with NKG2D ligands (MICA, MICB, ULBP 1-6) on endometriosis and non-endometriosis patients.
Methods: This was a cross-sectional study held in five centers: dr. Cipto Mangunkusumo General Hospital, Pelni Hospital, Bunda Hospital, YPK Mandiri Hospital, and Primaya Evasari Hospital from October 2020 to July 2021. miRNA and NKG2DL analysis were done in Human Reproduction, Infertility and Family Planning (HRIFP) cluster at IMERI FKUI.
Results: We obtained 19 patients in each study groups. NKG2D ligands and miRNA519a-3p relative expressions were not significantly different (p > 0.05). Increased miRNA519a-3p expression negatively affected NKG2D ligands expression. A decrease in ULBP1 and an increase in ULBP2 increased the probability for endometriosis. NKG2D ligands expression may be influenced by infection, pro-inflammatory cytokine production, dan polymorphism. NKG2D ligands expression level can be different depending on the origin of the sample. Lower expression of miRNA519a-3p indirectly inhibits tumor apoptosis by lowering NKG2D ligands, caspase, or mRNA.
Conclussion: We did not manage to establish a correlation between NKG2D ligands with miRNA519a-3p in endometriosis and non-endometriosis patients