Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Elevated Serum Ferritin and Interleukin-6 Level as the Risk Factor in Preterm Labor: Kadar Feritin dan Interleukin-6 Serum yang Tinggi Merupakan Faktor Risiko Terjadinya Persalinan Preterm
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Objective : To investigate the association ofserum ferritin and Interleukin-6 (IL-6) elevation as the risk factors for preterm labor.
Method : This study was a case-control study conducted at the Obstetrics and Gynecology Outpatient and Emergency Department at Sanglah General Hospital Denpasar, Bali in November 2014 until June 2015. The sample selection was done by consecutive sampling with total sample as many as 20 case samples (women with preterm labor) and 20 control samples (women with normal preterm pregnancy).
Results : Based on the analysis, there was no significant difference of patient demografic such as age, gestational age, and parity among the two groups. Chi-square analysis showed that the increased serum ferritin level had 5 fold increased risk of developing preterm labor (OR = 4.89, 95% CI = 1.20-19.94; p = 0.022), and increased serum IL-6 level had 9 fold increased risk of developing preterm labor (OR = 9.33, 95% CI = 2.18-39.96; p = 0.001) compared to normal preterm pregnancy.
Conclusion : It can be concluded that level of IL-6 and serum ferritin was the risk factor for preterm labor.
Keywords: Interleukin-6, preterm labor, serum ferritin
Abstrak
Tujuan :Untuk membuktikan hubungan kadar ferritin dan Interleukin-6 (IL-6) serum yang tinggi sebagai faktor risiko terjadinya persalinan preterm.
Metode :Penelitian ini bersifat observasional dengan studi case-control yang dilakukan di Poliklinik dan IRD Kebidanan dan Penyakit Kandungan RSUP Sanglah Denpasar, yang dilakukan mulai bulan November 2014 hingga Juni 2015. Pemilihan sampel dilakukan dengan cara berurutan dengan sampel penelitian sebanyak 20 sampel kasus (ibu dengan persalinan preterm) dan 20 sampel kontrol (ibu hamil preterm normal).
Hasil :Tidak didapatkan perbedaan bermakna dari demografik pasien yaitu usia, umur kehamilan, dan paritas pada kedua kelompok. Analisa chi-square menunjukkan peningkatan kadar ferritin serum memiliki peningkatan risiko 5 kali terjadinya persalinan preterm (OR = 4,90, IK 95% = 1,20-19,94; p = 0,022), dan peningkatan kadar IL-6 serum memiliki peningkatan risiko 9 kali terjadinya persalinan preterm (OR = 9,33, IK 95% = 2,18-39,96; p = 0,001) dibandingkan dengan kelompok ibu hamil preterm normal.
Kesimpulan : Kadar feritin dan IL-6 serum adalah faktor risiko terjadinya persalinan preterm.
Kata kunci: Interleukin-6, persalinan preterm, ferritin seru
The Role of Genital Hiatus (Gh), Perineal Body (Pb), Summation (Gh+Pb) of POP-Q Examination in Maximum Levator Hiatal Area of Women with Symptomatic Pelvic Organ Prolapse: Peran Hiatus Genitalis, Badan Perineum dan Penjumlahannya dari Pemeriksaan Pop-Q pada Luas Area Hiatus Levator Maksimal pada Perempuan dengan Prolaps Organ Panggul Simtomatik
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Objective: to provide data on the correlation of levator hiatus area measurements in symptomatic POP using 3D / 4D Ultrasound with clinical examination of Gh, Pb and summation (Gh+Pb).
Methods: Secondary data analysis of 160 POP patients examined from January 2012 to April 2017 at the Urogynecology Clinic RSCM, Jakarta. Taken data on patient characteristics, maximum 3D / 4D Ultrasound measurement of Levator Hiatus Area, and clinical measurement results using pelvic organ prolapse quantification system (POP-Q)
Results: There was a positive correlation between clinical examination and measurement of hiatal area area using ultrasound with r = 0.43 for Gh length, and the medium correlation on the sum of Gh and Pb with r = 0,51. No correlation for Pb length with r = 0.23. The optimal cut to differentiate degrees 2 by 3 is 7.5 cm / 29.7 cm2 and degree 3 by 4 is 8.3 cm / 32.1 cm2.
Conclusion: Clinical examination by summing the lengths of Gh and Pb may be consider reflects the examination of the hiatal area by using transperineal ultrasound to see the strain on levator ani called “ballooning†in an area with limited resources.
Keywords: genital hiatus, levator hiatus area, pelvic organ prolapse, perineal body.
Abstrak
Tujuan: untuk memberikan data mengenai korelasi pengukuran area hiatus levator pada POP simtomatik mengunakan Ultrasonografi 3D/4D dengan pemeriksaan klinis yaitu panjang Gh, panjang Pb dan penjumlahannya.
Metode : Analisa data sekunder sebanyak 160 pasien POP yang diperiksa dari Januari 2012 hingga April 2017 di poliklinik Urogynecology RSCM, Jakarta. Diambil data karakteristik pasien, pengukuran Ultrasonografi 3D/4D maksimal Area Hiatal Levator, dan hasil pengukuran secara klinis dengan menggunakan pelvic organ prolapse quantification system (POP-Q)
Hasil : Terdapat korelasi positif antara pemeriksaan klinis dengan pengukuran luas area hiatal menggunakan USG dengan r = 0,43 untuk panjang Gh, dan korelasi pada penjumlahan Gh dan Pb dengan r=0,51 termasuk kategori sedang, sedangkan untuk panjang Pb dengan r = 0,23 tidak didapatkan adanya korelasi. Didapatkan titik potong optimal untuk membedakan derajat 2 dengan derajat 3 adalah 7,5 cm / 29,7 cm2 dan derajat 3 dan derajat 4 adalah 8,3 cm / 32,1 cm2
Kesimpulan : Pemeriksaan klinis dengan menjumlahkan panjang Gh dan panjang Pb dapat dipertimbangkan untuk mencerminkan pemeriksaan area hiatal dengan mengunakan USG 3 / 4 dimensi transperineal pada daerah dengan sarana terbatas untuk melihat regangan pada levator ani atau yang disebut sebagai “ballooning
Kata kunci : badan perineum, genital hiatus, hiatal levator ani, prolaps organ panggul
Old Perineal Rupture - From Diagnosis to Reparation: Ruptur Perineum Lama: Diagnosis sampai Perbaikan
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Objective: To describe and discuss the technique to diagnose, preparing the reparation and postoperative management in old perineal rupture case.Methods: A 28-year-old primipara woman was referred to YPK Mandiri Hospital after having incontinence to flatus, to urinate and passive soiling. Three months before admission, she had her first child through vaginal delivery.Discussion: She was diagnosed with a third-degree obstetric anal sphincter injury (OASIS). Rectal examination with digital palpation (pill-rolling motion) and ultrasound examination, revealed a distinct gap anteriorly (10 – 2 o'clock). End to end technique was preferred to repair the defect.Conclusion: A good understanding of perineal and anal sphincter anatomy is essential to diagnose OASIS. The aim of reconstructive surgery is to restore the continuity of both the external and internal anal sphincters. Ideally, the repair should be performed as soon as possible after the injury.Keywords:obstetric anal sphincter injuries, OASIS, third-degree tear, perineum, perineal trauma.
Abstrak
Tujuan:Untuk mendeskripsikan dan diskusi tentang tehnik dalam mendiagnosa, mempersiapkan operasi reparasi dan manajemen pasca operasi pada kasus rupture perineum lama.Metode:Sebuah laporan kasus yang diambil dari pasien perrempuan 28 tahun primipara yang dirujuk ke RS YPK Mandiri setelah mengeluhkan inkontinensia flatus, urin, dan keluarnya feses tanpa disadari. Tiga bulan sebelumnya, pasien melahirkan anak pertama melalui persalinan pervaginam.Diskusi: Diagnosa pasien adalah cedera sfingter ani obstetrik derajat tiga. Pemeriksaan rektal dengan palpasi digital (gerakan pill-rolling) dan pemeriksaan ultrasonografi, memperlihatkan adanya penipisan di daerah anterior (arah jam 10 – 2). Teknik end to end dipilih untuk memperbaiki defek.Kesimpulan:Pengetahuan yang baik mengenai anatomi perineum dan sfingter ani penting untuk mendiagnosis OASIS. Tujuan utama dari operasi rekonstruksi adalah untuk memperbaiki kontinuitas dari sfingter ani eksternal dan internal. Idealnya, reparasi dilakukan secepat mungkin setelah terjadinya cedera.
Kata kunci: cedera sfingter ani obstetrik, OASIS, perineum, trauma perineum, robekan derajat tig
Case Series: Cryotherapy versus Cold Coagulation as Cervical Pre-Cancer Lesion Treatment
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Objective: Elaborating the results and comparison of cryotherapy and cold coagulation for cervical pre-cancer lesion cases in West Cakung Primary Health Center, Jakarta, Indonesia.
Methods: Observation were conducted from cervical pre-cancer lesion cases which was found by visual inspection with acetic acid (VIA) method. Those cases were directed into cryotherapy or cold coagulation based on randomization sampling. After 6-months post therapy, the lesions were assessed. This study was administered on Cakung Barat Health Center, Jakarta, Indonesia on April-December 2018. Of 10 cases, 5 were treated using cryotherapy and the rest with cold coagulation.
Result: After 6 months follow up, 1 of 5 patients from each therapies still has VIA positive result. The side effect in form of spotting after 1 month of cryotherapy and cold coagulation were 1/5 and 3/5, respectively. There were no other side effects reported during the 6-months follow up for both treatments.
Conclusion: The result of both treatments are relatively same in converting VIA positive into negative, proved with each therapies have turned 4 for 5 patients with prior VIA positive into negative. The side effects endured by respondents were minimal in 1 month post therapy, while there were no significant side effects after 6 months post therapy.
Kata Kunci : cervix, cold coagulation, cryotherapy, pre cancer lesion
Comparison of Postpartum Urinary Retention Healing between Groups with Methods of Residual Urine Measurement Four Hours versus Six Hours Post-Delivery: Perbandingan Lama Pemulihan Retensio Urin Pascapersalinan Pervaginam antara Pengukuran Residu Urin Empat dan Enam Jam
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Objective: To know the difference of recovery time and the urinary residual volume between group of patient with different time of urinary residual collecting.
Method: A randomized controlled trial was held at Dr. Cipto Mangunkusumo central general hospital and central Karawang hospital between March and Desember 2017. Postpartum women with urinary retention risks, willing to contribute to the trial, and diagnosed as post partum urinary retention were divided into 2 groups. Urinary residual volume was measured in 4th hour and 6th hour in each group. Patient then treated according to RSCM guideline, and the time of recovery was documented.
Result: Both group have similar characteristic. The median length of recovery in the group which the urinary residual was measured in 4th hour was 30 hours, 21 hours shorter than 6th hour group, 51 hours (p< 0.001). The median of urinary residual volume of the 4th hour group was 600 ml, 400 ml lesser than the 6th hour group, 1000 ml (p< 0.001)
Conclussion: time of recovery are shorter in the 4th hour group and the urinary residual volume are less in the 4th hour group compared to the 6th hour group.
Keywords: post partum urinary retention, urine residual, urinary residual collecting time
Abstrak
Tujuan: untuk mengetahui lama pemulihan dan volume residu urin pada kelompok pasien dengan retensio urin pascapersalinan dengan beda waktu pengukuran,
Metode: Penelitian ini menggunakan desai uji klinis acak di RSUPN Dr. Cipto Mangunkusumo dan RSUD Karawang bulan Maret-Desember 2017. Perermpuan pascasalin dengan risiko retensio urin pasca persalinan, bersedia mengikuti penelitian, dan terdiagnosis retensio urin dibagi menjadi dua kelompok. Kelompok pertama diukur residu urinnya dalam 4 jam, kelompok kedua dalam 6 jam. Pasien lalu diberikan tatalaksana retensio urin sesuai protokol RSUPNCM dan dicatat waktu pulihnya.
Hasil: Karakteristik pasien pada kedua kelompok dianggap setara. Median lama pemulihan pasien retensio urin yang diukur residu urin 4 jam adalah 30 jam, berbeda 21 jam dengan pasien yang diukur resiudnya 6 jam, yaitu 51 jam (p<0.001). Median jumlah residu urin pada kelompok pengukuran residu urin 4 jam adalah 600 ml, berbeda 400 ml dengan kelompok pengukuran 6 jam, yaitu 1.000 ml (p<0.001).
Kesimpulan: Lama pemulihan lebih singkat pada kelompok pasien dengan waktu pengukuran residu urin 4 jam dibandingkan dengan 6 jam. Jumlah residu urin lebih sedikit pada pengukuran residu 4 jam dibanding 6 jam
Kata kunci: retensio urin pasca persalinan, residu urin, waktu pengukuran residu uri
Severe preeclampsia-eclampsia and their associated factors: Preeklamsia Berat-Eklamsia dan Faktor-Faktor Terkait
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Objective: To analyze factors associated with severe preeclampsia and preeclampsia at Arifin Achmad General Hospital, Pekanbaru.
Methods: This was a cross-sectional study. Data on women who were diagnosed with severe preeclampsia or eclampsia and delivered between January 2014 and December 2015 were collected. These included maternal age, educational level, gestational age, delivery method, parity and ANC provider. Data were then analyzed using chi-square test with multivariate logistic regression analysis.
Results: There were 3294 deliveries happened between January and December 2015. Prevalence of severe preeclampsia during the study period was 14.54% and that of eclampsia was 3.28%. Mothers aged >35 have more than twice the risk of developing severe preeclampsia and eclampsia (95% CI 1.1- 4.6, p = 0.0001). Gestational age has the strongest association with eclampsia (Adjusted OR 2.4, p = 0.002, 95% CI 1.3-4.2). Severe preeclamptic-eclamptic mothers were at least five times as likely as the non-preeclamptic/eclamptic to have Cesarean Section or operative vaginal delivery (p = 0.0001).
Conclusions: Prevalence of severe preeclampsia was 14.54% and that of eclampsia was 3.28% in the period between January 2014 and December 2015. Mothers aged >35 were three times as likely as those age ≤35 to develop severe preeclampsia – eclampsia, Term pregnancy had higher risk of severe preeclampsia – eclampsia compared with preterm pregnancy; however, preterm pregnancy has 2.4 times as likely as term pregnancy to develop a worsening severe preeclampsia/eclampsia. Finally, mothers with severe preeclampsia or eclampsia have a five times greater risk of having delivered via Cesarean Section or operative vaginal delivery compared to the non-preeclamptic – non-eclamptic ones.
Keywords: eclampsia ,educational level, gestational age, parity, severe preeclampsia.
Abstrak
Tujuan: Untuk menganalisa faktor-faktor yang berhubungan dengan preeklamsia berat dan eklampsia di RSUD Arifin Achmad Pekanbaru.
Metode: Penelitian ini merupakan penelitian potong lintang. Data yang diambil yaitu perempuan yang didiagnosis dengan preeklamsia atau eklampsia dan melahirkan pada Januari 2014hingga Desember 2015. Usia ibu, tingkat pendidikan, usia kehamilan, metode persalinan, paritas dan pemberi layanan ANC juga disertakan. Data kemudian dianalisis menggunakan uji chi-squaredengan analisis regresi logistik multivariate.
Hasil: Terdapat 3.294 kelahiran padaJanuari 2014 hingga Desember 2015. Prevalensi preeklamsia berat selama penelitian ini yaitu 14.54% dan eklampsia sebesar 3.28%. Usia ibu>35tahun memiliki risiko dua kali lebih besar untuk terjadinya preeklamsia berat dan eklampsia (95% CI 1.1- 4.6, p = 0.0001). Usia kehamilan memiliki hubungan yang paling kuat dengan eklampsia (Adjusted OR 2.4, p = 0.002, 95% CI 1.3-4.2). Ibu dengan preeklamsia-eklampsia lima kali lebih besar untuk dilakukan seksio Cesarean ataupersalinan pervaginam dengan bantuan alat dibandingkan dengan pasien tanpa preeklamsia/eklampsia. (p = 0.0001).
Kesimpulan: Prevalensi preeklamsia berat adalah 14.54% dan eklampsia 3.28% pada periode Januari 2014 sampai Desember 2015. Usia ibu >35 tahun memiliki tiga kali lebih besar risiko untuk terjadinya preeklampsoa-eklampsia. Kehamilan cukup bulan memiliki risiko lebih tinggi untuk terjadinya preeklamsia-eklampsia dibandingkan dengan kehamilan preterm; namun, kehamilan preterm memiliki risiko 2.4 kali lebih besar untuk mengalami perburukan preeklamsia/eklampsia dibandingkan pada kehamilan cukup bulan. Ibu dengan preeklamsia atau eklampsia memiliki risiko lima kali lebih besar untuk melahirkan dengan seksio Cesarean atau pervaginam dengan bantuan alat dibandingkan dengan pasien tanpa preeklamsia atau eklampsia.
Kata kunci : eklamsia, paritas, preeklamsia berat, tingkat pendidikan, usia kehamilan
 
Perineal Body Length and Pelvic Organ Prolapse in Menopausal Women: Panjang Perineal Body dan Prolaps Organ Panggul pada Wanita Menopause
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Objective: To determine the correlation between the perineal body length and the pelvic organ prolapse (POP) in menopausal women.
Methods: The total vaginal length (TVL), genital hiatus (GH), and perineal body (PB) length as the POP-Q component were measured at 60 menopausal women enrolled in a cross-sectional study.
Results: Menopausal women with POP have the shorter perineal body (63.3%; <3 cm) compared with menopausal women without POP (36.7%; ≥3 cm). The mean length of the perineal body in menopausal women who suffer POP 2.81 ± 0.26 cm while in women without POP is 3.23±0.17 cm. POP risk was 25 times in menopausal women with a perineal body length <3 cm compared with longer perineal body (p = 0.01; OR = 25.4; 95% CI 3.1-209.1).Conclusion: Perineal body length is a risk factor for pelvic organ prolapse in menopausal women.Keywords: perineal body, prolapse, pelvic organ prolapsed
Abstrak
Tujuan: Menentukan korelasi panjang perineal body dengan kejadian prolaps organ panggul (POP) pada perempuan menopause.
Metode: Pengukuran komponen POP-Q meliputi total vaginal length (TVL), genital hiatus (GH), dan panjang perineal body (PB) dilakukan pada 60 perempuan menopause yang dilibatkan dalam penelitian potong lintang.
Hasil: Perempuan menopause dengan POP memiliki perineal body yang lebih pendek (63,3%; <3 cm) dibandingkan dengan perempuan menopause tanpa POP (36,7%; ≥3 cm). Panjang rata-rata perineal body pada perempuan menopasue yang menderita POP 2,81 ± 0,26 cm sedangkan pada perempuan tanpa POP adalah 3,23 ± 0,17 cm. Risiko POP 25 kali pada perempuan menopause dengan panjang perineal body <3 cm dibandingkan dengan tubuh perineum yang lebih panjang (p = 0,01; OR = 25,4; 95% CI 3,1-209,1).
Kesimpulan: Panjang perineal body merupakan faktor risiko prolaps organ panggul pada perempuan menopause.
Kata kunci : perineal body, prolapsed, prolaps organ panggu
Postoperative Pain Survival and Correlating Factors in Endometriosis Patients: Kesintasan Keluhan Nyeri Pasca Pembedahan pada Pasien Endometriosis serta Faktor-Faktor yang Mempengaruhi
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Objective: To determine the survival of pain complaints at 3, 6, 9 and 12 months and the correlation between age at diagnosis, age of menarche, parity, stage of disease and post-operative medication in endometriosis patient at RSUPN Dr. Cipto Mangunkusumo.
Methods: This was a prospective cohort study with survival analysis method of 139 women of productive age with endometriosis who came to Gynecology Outpatient Clinic in Dr. Cipto Mangunkusumo Hospital from January 2015 to January 2017. The patients were observed at 3 months, 6 months, 9 months and 12 months after the surgery.
Results: Survival of pain complaints at 3, 6, 9 and 12 months after endometriosis operation was 99.2%, 96.6%, 93% and 88.4% respectively. There was no significant correlation between post-operative pain survival and age of diagnosis (p=0.138), age of menarche (p=0.492), parity (p=0.110) and stage of disease (p=0.908). There was a significant correlation between post-operative medical therapy and pain complaints survival. Subjects who were given medication had a risk of 0.26 times (CI 95% 0.081-0.857) pain recurrence compared to those who were not.
Conclusion: Pain complaints survival were significantly associated with post-operative medical therapy, but not associated with age, age of menarche, parity and stage of disease.
Keywords: endometriosis, postoperative medical therapy, postoperative pain, survival
Abstrak
Tujuan: Mengetahui kesintasan keluhan nyeri pada 3, 6, 9 dan 12 bulan dan hubungan antara usia saat diagnosis, usia menarke, paritas, stadium penyakit dan terapi medisinalis pasca pembedahan pada pasien endometriosis di RSUPN Dr. Cipto Mangunkusumo.
Metode: Penelitian kohort prospektif pada 139 wanita usia produktif dengan metode analisis kesintasan pada pasien endometriosis yang datang ke Poliklinik Ginekologi RSUPN Cipto Mangunkusumo pada bulan Januari 2015 hingga Januari 2017. Pasien kemudian diobservasi pada bulan ke 3, 6, 9 dan 12 setelah operasi.
Hasil : Kesintasan keluhan nyeri pada bulan ke 3, 6, 9 dan 12 berturut-turut adalah 99,2%, 96,6%, 93% dan 88,4%. Tidak ada hubungan yang bermakna antara kesintasan nyeri pasca pembedahan dengan usia saat diagnosis (p=0,138), usia saat menarke (p=0,492), paritas (p=0,110) dan stadium penyakit (p=0,908). Terdapat hubungan yang bermakna antara terapi medisinalis pasca pembedahan dan kesintasan keluhan nyeri. Subyek yang mendapatkan terapi medisinalis pasca pembedahan memiliki risiko 0,26 kali mengalami kekambuhan nyeri dibandingkan dengan yang tidak.
Kesimpulan : Kesintasan keluhan nyeri memilki hubungan yang bermakna dengan terapi medisinalis pasca pembedahan namun tidak memiliki hubungan dengan usia saat diagnosis, usia menarke, paritas dan stadium penyakit.
Kata kunci: endometriosis, kesintasan, nyeri pasca pembedahan, terapi medisinalis pasca pembedaha