Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Rectovaginal Fistulae in Post Repair Chronic Perineal Rupture: Fistula Rektovagina pada Pascarepair Ruptur Total Perienum Lama
Get PDFObjective: To report and discuss the causes and management of rectovaginal fistula in post repair chronic total perineal rupture.Method: A case report, a 29-year-old female patient who came to Fatmawati General Hospital with complaints of anal incontinence 9 days after repair chronic total perineal rupture. Rectovaginal examination revealed a rectovaginal fistula 2 mm in diameter at 1.5 cm proximal to the hymenal ring.Discussion: Rectovaginal fistula is one of the complications after repair of hronic total perineal rupture which disturbs the quality of life of women. The patient was diagnosed with a rectovaginal fistula in post repair chronic total perineal rupture. Conservative management with wound care and administration of honey to the patient showed improved postoperative outcome.Conclusion: Anatomical identification of the anal sphincter complex, surgical technique and postoperative care are important in preventing complications following repair of chronic total perineal rupture repair.Keywords : obstetrics sphincter anal injury, postrepair chronic, rectovaginal fistulae .
Abstrak
Tujuan : Untuk melaporkan dan mendiskusikan penyebab dan tatalaksana kasus fistula rektovagina pasca repair ruptur perineum total lama.Metode: Sebuah laporan kasus, pasien perempuan 29 tahun yang datang ke RSUP Fatmawati dengan keluhan inkontinensia anal 9 hari pascarepair ruptur perineum total lama. Pemeriksaan rectovaginal menunjukkan fistula rektovagina diameter 2 mm pada 1,5 cm proksimal hymenal ring.Diskusi : Fistula rektovagina merupakan salah satu komplikasi pascarepair ruptur perineum total yang mengganggu kualitas hidup perempuan. Pasien didiagnsos fistula rektovagina pascarepair ruptur perineum total lama. Manajemen konservatif dengan perawatan luka dan pemberian madu pada pasien menunjukkan perbaikan luaran paska operasi.Kesimpulan: Identifikasi anatomis kompleks sfingter ani, teknik operasi dan perawatan pascaoperasi penting dalam mencegah komplikasi pascarepair ruptur perineum total lama.Kata kunci: cedera sfingter ani obstetri, fistula rectovagina, repair ruptur perineum total lam
Elective versus Emergency Cesarean Sections : Mother and Fetal Outcome: Luaran Ibu dan Bayi pada Operasi Sesar Elektif dan Emergensi
Get PDFObjective: 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
Association of Obstetric Risk Factors with Postpartum Urine Retention in Spontaneous Labor: Hubungan Faktor Risiko Obstetrik dengan Retensio Urin Postpartum pada Persalinan Spontan
Get PDFObjective: 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
Role of Lifestyle Modification through Dietary Changes to Endometrial Receptivity on Infertility Women and Obesity with Polycystic Ovary Syndrome
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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<0.05) and type of the endometrial vascular zone, endometrium volume, and vascular flow index by ultrasonography (p<0.05). In this study, no significant results have been found on the correlation between dietary changes and changes in endometrial receptivity profiles.Conclusion: No significant correlation was observed between changes in anthropometrics and daily calorie intake with changes in endometrial vascular zones.Keywords: endometrial receptivity, obese, polycystic ovary syndrome, ultrasonography.
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Tujuan : Untuk mengetahui pengaruh modifikasi gaya hidup pada reseptivitas endometrium perempuan obesitas dengan sindrom ovarium polikistik menggunakan ultrasonografi.Metode: Penelitian observasional ini dilakukan di Rumah Sakit Umum Cipto Mangunkusumo Jakarta dari Agustus 2019 hingga Mei 2020. Sebanyak 14 subjek berpartisipasi dalam penelitian ini. Semua subyek disarankan untuk mendapatkan konseling gizi oleh ahli gizi dan dilakukan observasi profil endometrium selama 6 bulan dengan ultrasonografi.Hasil: Sebanyak 19 subjek menerima konseling gizi oleh ahli gizi klinis, tetapi kemudian, hanya 14 subjek yang dievaluasi profil endometrium dengan Ultrasonografi. Ada beberapa hasil yang signifikan antara sebelum dan sesudah perawatan beberapa subjek seperti kalori, berat badan, indeks massa tubuh, lingkar pinggang (p<0,05) dan tipe zona vaskular endometrium, volume endometrium, dan indeks aliran vaskular dengan ultrasonografi (p <0,05). Dalam penelitian ini, tidak ditemukan hasil yang signifikan pada korelasi antara perubahan pola makan dan perubahan dalam profil reseptivitas endometrium.Kesimpulan: Tidak ada korelasi yang signifikan antara perubahan antropometrik dan asupan kalori harian dengan perubahan zona vaskular endometrium.Kata kunci: endometrium, obesitas, reseptivitas, sindrom ovarium polikistik, ultrasonograf
Role of Ambulatory Laparoscopy in Diagnosis of Ascites with Unknown Etiology
Get PDFBackground: Ascites could be caused by many underlying diseases, mainly portal hypertension, malignancy, and heart failure. Other etiologies include tuberculosis and pancreatitis. Difficulties in confirming the cause of ascites have been seen in many clinical settings. Ambulatory laparoscopy is one of powerful tools to rule out many etiologies of ascites despite being invasive in its nature. This case report would like to show one case of peritoneal TB presenting with ascites. Patient has undergone many laboratory workups in search of ascites origin. Literature study is done to look for evidence about timing and role of laparoscopy in ascites work-up.
Case illustration: A-26-year-old P2 woman came to hospital with a history of vaginal delivery 22 days before admission presenting with massive ascites. No obstetric complication was found. Transvaginal ultrasound revealed normal postpartum uterus and ovaries, surrounded with ascites. Both the liver and kidneys were found normal on ultrasound. Abdominal CT scan with contrast showed massive ascites with thickened omentum. ADA was 36 IU/L. We decided to perform diagnostic laparoscopy and biopsy for histopathology. We found massive yellowish ascites and hyperaemic tubal enlargement with thickening of the peritoneum. Pathology examination proved the appearance of chronic salpingitis and granulomatous peritonitis consistent with tuberculosis peritonitis.
Conclusion: Laparoscopy as a minimal invasive tool can diagnose ascites with unknown etiology patients after failure to prove diagnosis from clinical laboratory and radiological examination. It is one best alternative to diagnose peritoneal TB presenting with ascites with its superiority in visualizing abdominal cavity and obtaining specimens for histology with lower risk of morbidity
Clinical Profile of Pregnant Women with COVID-19 Hospitalized in Regional Referral Hospital : Profil Ibu Hamil dengan COVID-19 yang Dirawat di Rumah Sakit Rujukan
Get PDFObjective: 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.
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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 rujuka
Does Knowledge Affect the Attitude of Fertile Aged Women in Visual Inspection with Acetic Acid Examination? A cross-sectional study: Apakah Pengetahuan Mempengaruhi Perilaku Wanita Berusia Subur pada Pemeriksaan Inspeksi Visual Asetat? Sebuah Studi Potong Lintang
Get PDFObjective: 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.
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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.
Vaginal pH of Menopausal Women is Related to the Duration of Menopause: Keasaman Vagina Perempuan Menopause Berhubungan dengan Lamanya Menopause
Get PDFRole of Maternal Factors in Low Birth Weight: Peran Faktor Ibu dalam Kejadian Berat Bayi Lahir Rendah
Get PDFObjective : To determine the correlation between body mass index, age, parity, gestational weight gain and low birth weight at Atma Jaya Hospital in 2016-2019.Methods : This was a cross-sectional study of 111 sample medical records of pregnant women who gave birth at Atma Jaya Hospital in 2016-2019 and met the inclusion and exclusion criteria. Data management was performed using the Chi-square test and multivariate logistic regression test.Results: Most of the mothers were in the group with normal BMI (60.4%), the G1 age group (21-29 years old) (45.9%), the low multiparity group (parity 1-3 times) (57.7%). The analysis showed that there was a significant relationship between parity group grand multipara (p=0.028; OR=5.206; 95% CI=1.195-22.686) with the incidence of LBW. There was no significant relationship between BMI group lean (p=0.303; OR=1.646; 95% CI=0.638-4.246), group normal (p=0.532), group fat (p=0.440; OR=1.957; 95% CI=0.357-10.737), maternal age group G1 (p=0.141), group G2 (p=0.587; OR=1.327; 95% CI=0.478-3.687), group G3 (p=0.111; OR=0.262; 95% CI=0.050-1.360), parity group nulliparity (p=0.494; OR=0.669; 95% CI=0.212-2.117), group low multiparity (p=0.051), and gestational weight gain group low (p=0.955; OR=1.028; 95% CI=0.396-2.667), group normal (p=0.986), group high (p=0.897; OR=0.917; 95% CI=0.245-3.424) with the incidence of LBW.Conclusion : There is a significant relationship between parity with the incidence of low birth weight. There is no relationship between body mass index, age, and gestational weight gain with the incidence of low birth weight.Keywords: age, BMI, gestational weight gain, LBW, parity.
Abstrak
Tujuan: Mengetahui apakah terdapat hubungan antara indeks massa tubuh, usia, paritas, dan pertambahan berat badan ibu hamil terhadap kejadian berat bayi rendah di Rumah Sakit Atma Jaya tahun 2016-2019.Metode: Penelitian ini merupakan penelitian analitik potong lintang dengan menggunakan rekam medis sebanyak 111 sampel ibu hamil yang melangsungkan persalinan di RS Atma Jaya pada tahun 2016-2019 dan memenuhi kriteria inklusi dan eksklusi. Pengelolaan data dilakukan dengan menggunakan uji Chi-square dan uji regresi logistik multivariat.Hasil : Didapatkan sebagian besar ibu berada pada kelompok dengan indeks massa tubuh normal (60,4%), kelompok usia G1 (21-29 tahun) (45,9%), kelompok paritas low multiparity (paritas 1-3 kali) (57,7%), dan kelompok pertambahan berat badan normal (47,7%). Hasil analisis menunjukkan terdapat hubungan antara paritas kelompok grand multipara (p=0,028; OR=5,206; 95% CI=1,195-22,686) terhadap kejadian BBLR. Tidak terdapat hubungan signifikan antara indeks massa tubuh kelompok kurus (p=0,303; OR=1,646; 95% CI=0,638-4,246), kelompok normal (p=0,532), kelompok gemuk (p=0, 440; OR=1, 957; 95% CI=0, 357-10.737), usia ibu hamil kelompok G1 (p=0,141), kelompok G2 (p=0,587; OR=1,327; 95% CI=0,478-3,687), usia kelompok G3 (p=0,111; OR=0,262; 95% CI=0, 050-1,360), paritas kelompok nulliparity (p=0,494; OR=0,669; 95% CI=0,212-2,117), kelompok low multiparity (p=0.051), pertambahan berat badan ibu hamil kelompok kurang (p=0.955; OR=1.028; 95% CI=0.396-2.667), kelompok sesuai (p=0.986), dan kelompok lebih (p=0.897; OR=0.917; 95% CI=0.245-3.424) dengan kejadian BBLR.Kesimpulan : Terdapat hubungan yang signifikan antara paritas dengan kejadian berat bayi lahir rendah. Tidak terdapat hubungan antara indeks massa tubuh, usia, dan pertambahan berat badan ibu hamil dengan kejadian berat bayi lahir rendah.Kata kunci: BBLR, IMT, paritas, pertambahan berat badan, usia