Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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The Effect of Vitamin D3 Supplementation on Increases of Levator Ani Contraction Strength in Women with Uterine Prolapse: Pengaruh Suplementasi Vitamin D3 terhadap Peningkatan Kekuatan Kontraksi Otot Levator Ani pada Wanita dengan Prolapsus Uteri
Get PDFObjective: 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 <0.001 and an increase in gastrocnemius soleus muscle contraction strength with a significant P value of <0.001 after vitamin D3 supplementation.Conlusions: Vitamin D3 supplementation can increase levator ani and gastrocnemius soleus muscle contraction strength in uterine prolapse patient.Keywords: gastrocnemius soleus muscle contraction strength, handheld dynamometer, vitamin D, levator ani muscle contraction strength, perineometer peritronTM, uterine prolapse.
Abstrak
Tujuan: Melihat perbedaan kekuatan kontraksi otot levator ani setelah suplementasi vitamin D3, dengan demikian diharapkan pemberian vitamin ini dapat mengurangi insidensi rekurensi prolapsus uteri pasca operasi rekonstruksi.Metode: Penelitian ini merupakan penelitian eksperimental quasi dengan rancangan sebelum dan sesudah pemberian vitamin D3 pada pasien prolapsus uteri. Subjek penelitian adalah pasien prolapsus uteri yang memenuhi kriteria inklusi penelitian (n=19). Dilakukan pemeriksaan kadar vitamin D serum, pengukuran kekuatan otot levator ani (perineometer peritronTM) dan otot lurik gastrocnemius soleus (hand held dynamometer) sebagai otot pembanding sebelum dan sesudah pemberian 3 bulan vitamin D3 1000 IU. Penelitian dilakukan di Poliklinik Ginekologi FKUP/RSHS, Poliklinik Kedokteran Fisik dan Rehabilitasi FKUP/RSHS dan Laboratorium serologi Klinik Patologi Klinik FKUP/RSHS pada bulan Januari – April 2019Hasil: Penelitian ini memperlihatkan peningkatan kekuatan kontraksi otot levator ani dengan nilai signifikan p<0,001, dan peningkatan kekuatan kontraksi otot gastrocnemius soleus dengan nilai signifikan p<0,001 setelah subjek mendapatkan suplemen vitamin D3.Kesimpulan: Penelitian ini menyimpulkan bahwa suplementasi vitamin D3 dapat meningkatkan kekuatan kontraksi otot levator ani dan otot gastrocnemius soleus pada penderita prolapsus uteri.Kata kunci: kekuatan kontraksi otot levator ani, kekuatan kontraksi otot gastrocnemius soleus, hand held dynamometer, perineometer peritronTM, prolapsus uteri , vitamin
The Suppression Effect of Kebar Extract on Endometriosis Lesion MDA and TNF -a Independent to VEGF A Study in Endometriosis Mice Mode: Efek Supresi Ekstrak Kebar terhadap Lesi Endometriosis, MDA dan TNF-a, tidak Bergantung pada VEGF: Studi pada Model Tikus Endometriosis
Get PDFBackground: The pathogenesis of endometriosis remains unclear, and involves multifactorial etiologies. The increase in oxidative stress is known to be associated with this disease. Oxidative stress increases angiogenesis and supports the proliferation of endometriosis tissue in the peritoneal cavity. Kebar grass, a medicinal plant, is expected to increase antioxidant defense resulting in decreased oxidative stress, inflammation, angiogenesis, and reduced endometrial tissue implants.
Objective: To investigate the effects of Kebar grass extract administration to MDA serum levels, TNF-a and VEGF expression, and the extension of the endometriotic lesions in mice model.
Methods: This study was experimentally designed. It was conducted in the Department of Obstetrics Gynecology, Faculty of Medicine Diponegoro, University and Faculty of Veterinary Medicine, Airlangga University. Twenty-one mice were divided into three groups: the first group is control of 7 untreated endometriosis mice model, the second group consisted of 7 mice injected with leuprolide acetate 1mg/kgBB single dose, and the last group consisted of 7 mice fed with Kebar grass extract 3mg/day for 14 days. MDA serum level was measured by spectrophotometry, TNF-a and VEGF expression by IHC using Rammele Scale Index (ImmunoReactive Score), whereas the extension of the endometriotic lesions was measured using computerize tracing.
Results: Both Kebar grass extract and leuprolide acetate administration significantly decrease MDA serum levels in endometriosis mice model, compare with the control group, (0.09±0.02 nmol, 0.11±0.07 nmol, and 0.30±0.06 nmol, respectively; p=0.001). TNF-α expression of the group treated with Kebar grass extract was lower than leuprolide acetate and control group (2.43±1.521 %, 4.86±0.458 %, and 7.26±2.898 %, respectively; p=0.002). However, there was no significant difference in VEGF expression among study groups (4.34±2.40 %, 5.11±1.95 %, and 7.40±3.49 % respectively; p=0.116). Finally, the extension of the endometriotic lesions of the mouse models administered with Kebar grass extract and leuprolide acetate was smaller than the control group (0 mm2, 4.54±7.75 mm2, and 34.80±13.09 mm2 respectively; p=0.005).
Conclusion: Kebar grass extract has the effect of decreasing MDA serum levels and reducing TNF-α expression, resulted in smaller endometriotic lesions in mice, even though it does not affect VEGF expression.
Keywords: malondialdehyde, tumour necrosis factor alpha, vascular endothelial growth factor, endometriotic lesion, kebar grass extract, endometriosis mous
Effectiveness, Safety and Obedience of Dienogest and Leuprolide Acetate in Postlaparoscopic Endometriosis Patients: Efektivitas, Keamanan dan Kepatuhan terhadap Dienoges dan Leuprolide Asetat pada Pasien Endometriosis Pascalaparoskopi
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Objective: Comparing therapeutic effectiveness, safety profile, and adherence between Dienogest and postoperative Leuprolide Acetate in women with endometriosis who underwent laparoscopy.
Methods: This study was a randomized clinical trial comparing the open label study to compare the effectiveness of therapy, safety profile, and obedience between postoperative dienogest and leuprolide acetate in women with endometriosis who underwent laparoscopy.
Result: From the statistical test it was found that there was effectiveness of dienogest after 4 weeks of therapy (p = 0.004), after 8 weeks of therapy (p = 0.004) and after 12 weeks of therapy (p = 0.004). In the leuprolide acetate group it was also found that there was effectiveness of administration after 4 weeks of therapy (p = 0.004), after 8 weeks of therapy (p = 0.004) and after 12 weeks of therapy (p = 0.003). There was no difference in systolic blood pressure (p = 0.481), diastolic blood pressure (p = 1,000) and pulse frequency (p = 0.125) breath frequency (p = 1,000) and temperature (p = 0.236) between patients who received dienogest and leuprolide acetate. From the statistical analysis it was found that there were no differences in side effects in patients who received dienogest and leuprolide acetate (p = 0.238).
Conclusion: There was no difference in therapeutic effectiveness, and the safety profile assessed by side effects as well as obedience of postoperative Dienogest and Leuprolide Acetate in endometriosis women undergoing Laparoscopy because in both groups there was a decrease in VAS scores from week to week.
Key Word: Dienogest, Leuprolide Acetate, Endometriosis, Post-Laparoscopy, Therapy
Abstrak
Tujuan: Membandingkan efektivitas terapi, profil keamanan, dan kepatuhan antara Dienogest dengan Leuprolid Asetat pascaoperatif pada wanita endometriosis yang menjalani Lapararoskopi.
Metode: Penelitian ini merupakan uji klinik acak berpembanding dengan open label study untuk membandingkan efektivitas terapi, profil keamanan, dan kepatuhan antara dienogest dan leuprolid asetat pascaoperatif pada wanita endometriosis yang menjalani lapararoskopi.
Hasil: Dari uji statistik didapatkan hasil terdapat efektivitas pemberian dienogest setelah 4 minggu terapi (p = 0,004), setelah 8 minggu terapi (p = 0,004) dan setelah 12 minggu terapi (p = 0,004). Pada kelompok leuprolid asetat juga didapatkan hasil terdapat efektivitas pemberian setelah 4 minggu terapi (p = 0,004), setelah 8 minggu terapi (p = 0,004) dan setelah 12 minggu terapi (p = 0,003). Tidak terdapat perbedaan tekanan darah sistolik (p = 0,481), tekanan darah diastolik (p = 1,000) dan frekuensi nadi (p = 0,125) frekuensi napas (p = 1,000) dan suhu (p = 0,236) antara pasien yang mendapatkan dienogest dan leuprolid asetat. Dari analisa statistik didapatkan hasil tidak terdapat perbedaan efek samping pada pasien yang mendapatkan dienogest dan leuprolid asetat (p = 0,238).
Kesimpulan: Tidak terdapat perbedaan efektivitas terapi, dan profil keamanan yang dinilai dari efek samping serta kepatuhan Dienogest dan Leuprolid Asetat pascaoperatif pada wanita endometriosis yang menjalani Lapararoskopi karena pada kedua kelompok terdapat penurunan VAS skor dari minggu ke minggu.
 
Pelvic Floor Muscle Strength Stress Urinary Incontinence: Kekuatan Otot Dasar Panggul dan Stres Inkontinensia Urin
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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, US
Visceral Adipose Tissue was Associated with Increased Risk of Insulin Resistance in Lean Polycystic Ovarian Syndrome, Independent with Retinol Binding Protein-4: Jaringan Adiposa Viseral berkaitan dengan Peningkatan Risiko Resistensi Insulin pada Sindrom Ovarium Polikistik dengan Indeks Masa Tubuh Normal, Independen terhadap Retinol Binding Protein-4
Get PDFObjective: 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, SOP
Effect of Vitamin D3 Supplementation on Levator Ani Muscle Strength in Primipara Pregnancy with Post-partum Vitamin D3 Deficiency : Efek Suplementasi Vitamin D pada Kekuatan Otot Levator Ani pada Kehamilan Primipara dengan Defi siensi Vitamin D3 Pascapersalinan
Get PDFObjective: 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 <0.001. However, the maximum strength of levator ani muscle contraction did not increase (P-value <0.829).Conclusions: Vitamin D3 supplementation increases basal tone strength.Keywords: basal tone, maximum levator ani muscle contraction, perimetry, primiparous vitamin D3 defi ciency, vitamin D.
Abstrak
Tujuan: Untuk mengetahui manfaat pemberian suplementasi vitamin D pascasalin terhadap kekuatan otot lurik.Metode: Tipe penelitian ini adalah penelitian eksperimental quasi dengan rancangan sebelum dan sesudah pemberian vitamin D3 pada ibu primipara pascasalin yang mengalami defisiensi vitamin D3, dengan mengukur kekuatan otot dasar panggul sebelum dan sesudah pemberian 3 bulan vitamin D3. Subjek penelitian adalah primipara pasca persalinan spontan yang memenuhi kriteria inklusi penelitian (n=33). Dilakukan pemeriksaan kadar vitamin D serum dan pengukuran tonus basal dan kontraksi maksimal levator ani dengan menggunakan perimetri sebelum dan sesudah pemberian suplementasi vitamin D3. Penelitian dilakukan di Poliklinik obstetri FKUP/RSHS dan Laboratorium serologi Klinik Patologi Klinik FKUP/RSHS pada bulan 1 Maret- 31 Mei 2018.Hasil: Hasil penelitian ini dengan menggunakan uji wilcoxon didapatkan peningkatan kadar serum vitamin D3 dan peningkatan kekuatan tonus basal setelah pemberian suplementasi vitamin D3 dengan nilai P<0,001. Sedangkan kekuatan kontraksi otot maksimal levator ani tidak mengalami peningkatan dengan nilai P<0,829.Kesimpulan: Suplementasi vitamin D3 meningkatkan kekuatan tonus basalKata kunci: kontraksi maksimal levator ani, perimetri, primipara defi sisensi vitamin D3, tonus basal, vitamin D.
 
The Role of Giving High Dose Calcium for Preventing Preeclampsia: Peran Pemberian Kalsium Dosis Tinggi untuk MencegahTerjadinya Preeklamsia
Get PDFAbstractObjective: 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
Transvaginal Ultrasound Assessment of Cervical Length in Threatened Preterm Labor
Get PDFObjectives: 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, transvaginalultrasonograph