Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Methylation Profile of HOXA 11 Gene in Eutopic Endometrium on Endometriosis Patient with Infertility
Get PDFObjective: To investigate the HOXA11 gene profile on endometriosispatients with infertility in Indonesia.Methods: This cross sectional study was conducted in Dr. CiptoMangunkusumo Hospital from July 2015- June 2016. The subjectswere endometriosis patients with infertility who have beenconfirmed histopathological. The control group was taken fromnon-endometriosis and fertile patients. Eutopic endometriumsamples were taken and examined for the methylation of HOXA 11gene.Results: Both groups consist of six patients. The difference ofmethylation of HOXA 11 gene between those two groups isstatistically significant (p=0.03). There was hyper methylation inendometriosis group.Conclusion: There is a hyper methylation of HOXA 11 gene ineutopic endometrium of endometriosis patients with infertility.Thus, possibly can explain the poor endometrial receptivityin endometriosis patient and give a broad research area inepigenetic therapy of endometriosis.[Indones J Obstet Gynecol 2018; 6-2: 110-113]Keywords: endometriosis, epigenetic, HOXA 11, infertility,methylatio
Rectovaginal Examination, Transvaginal Ultrasonography, and Magnetic Resonance Imaging as Diagnostic Tools for Identifying Deep Infiltrating Endometriosis Nodules: Rectovaginal Toucher, Ultrasonografi Transvaginal dan Magnetic Resonance Imaging sebagai Modalitas Penunjang Diagnosa Nodul Endometriosis Susukan Dalam
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Objective: To investigate the comparison between rectovaginal examination (RVT), transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) as diagnostic tools for identifying various Deep Infiltrating Endometriosis (DIE).
Methods: Prospective longitudinal study was done involving 31 women referred for surgical management of DIE. Calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of RVT, TVUS and MRI for DIE were recorded.
Results: The mean age was 35.1 years. DIE were present in 95.45% of women which commonly located at uterosacral ligaments (58.33%), followed by rectovaginal (16,67%), rectosigmoid- colon (16.67%) and bladder-ureter (8.3%). TVUS had the best accuracy (RVT 50.24%; TVUS 88.85%; MRI 75.77%) among other diagnostic tools for nodules located at uterosacral ligaments (RVT 52.63%; TVUS 87%; MRI 40%) and rectovaginal (RVT 76.75%; TVUS 93.34%; MRI 80%), but it poorly identified nodules located at rectosigmoid (RVT 20%; TVUS 65.56%; MRI 88.75%) and bladder-ureteral area (RVT 50.44%; TVUS 87.66%; MRI 93.55%). RVT had good PPV (88.89%) but bad NPV (32.01%) profile, made it worth to be a screening diagnostic tool.
Conclusion: RVT was a good screening diagnostic tools as it could be done easily but was weak in diagnosing anterior DIE. TVUS gave a better diagnosis rates on DIE located at sacrouterina ligaments and rectovaginal area whereas MRI did better on bowel DIE (rectosigmoid- colon area) and urological DIE (bladder-ureteral area).
Keywords: deep infiltrating endometriosis, magnetic resonance imaging, tranvaginal ultrasonograph
The Prevalence and Outcome of Teenage Pregnancies in a Tertiary Care Teaching Hospital: Prevalensi dan Luaran Kehamilan Remaja pada Rumah Sakit Pendidikan Tersier
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Objectives: To examine the prevalence as well as maternal and perinatal outcome of teenage pregnancies.
Methods: For analyzing the prevalence of the teenage mothers, we used cross-sectional study design by evaluating the medical records of all pregnant mothers who went to the obstetric clinic of Cipto Mangunkusumo Hospital, Jakarta, Indonesia, during January 2014 until December 2016. For the outcome of the teenage mothers, we used retrospective study design by analyzing medical records of teenage mothers who had delivery at the delivery ward of Cipto Mangunkusumo Hospital during January 2014 until December 2016. We compared their outcomes to outcomes of pregnant women aged 20 to 30 years old delivered at the same hospital in the same period. Maternal outcomes that were measured include preeclampsia, methods of delivery, anemia, and postpartum hemorrhage, as well as perinatal outcomes including preterm delivery, and low birthweight.
Results: Among 3.578 outpatients at Obstetric Clinic, RSUPN Cipto Mangunkusumo, we got 503 pregnant subjects, 16 (3.2%) were teenagers. Among 520 subjects who had delivery, 78 (15%) subjects were ≤ 19 years old. Teenage pregnancy was significantly associated with anemia (p < 0.05, adjusted OR = 2,08) and low birthweight (p < 0.05, adjusted OR = 1.83). Teenage pregnancy was not significantly associated with preeclampsia, methods of delivery, postpartum hemorrhage, and preterm delivery.
Conclusion: The prevalence of teenage pregnancy at Cipto Mangunkusumo Hospital is 3.2% and teenage mothers who had delivery is 15%. Teenage mothers are at increased risk of anemia and delivering low birth weight babies.
Keywords: maternal outcome, perinatal outcome, prevalence,teenage pregnancies
Abstrak
Tujuan: Penelitian ini bertujuan untuk mengetahui prevalensi kehamilan remaja serta luarannya.
Metode: Untuk menganalisis prevalensi ibu remaja, kami menggunakan desain studi potong lintang dengan mengeavaluasi rekam medis dari seluruh ibu hamil yang berobat ke klinik obstetri RSUPN Cipto Mangunkusumo pada periode Januari 2014 sampai Desember 2016. Pada luaran ibu hamil, kami menggunakan desain studi retrospektif dengan menganalisis rekam medis ibu remaja yang bersalin di RSUPN Cipto Mangunkusumo pada periode yang sama. Luaran ibu remaja dibandingkan dengan ibu yang bersalin yang berusia 20-30 tahun. Luaran ibu yang kami ukur meliputi preeklampsia, metode persalinan, anemia, perdarahan pasca persalinan, sedangkan luaran perinatal yang kami ukur meliputi kelahiran prematur dan BBLR.
Hasil: Dari seluruh 3.578 pasien di Poliklinik Obstetri RSUPN Dr. Cipto Mangunkusumo, diperoleh 503 subjek yang hamil,sebanyak 16 (3.2%) subjek adalah remaja. Dari seluruh 520 subjek yang bersalin, 78 (15%) subjek adalah remaja. Kehamilan remaja berhubungan signifikan dengan anemia (p < 0.05, adjusted OR = 2.08) dam BBLR (p < 0.05, adjusted OR = 1.83). Kehamilan remaja tidak berhubungan signifikan dengan preeklamsia, metode persalinan, perdarahan pascapersalinan, dan kelahiran prematur.
Kesimpulan: Prevalensi kehamilan remaja di RSUPN Dr. Cipto Mangunkusumo adalah 3.2% dan persalinan remaja di RSUPN Dr. Cipto Mangunkusumo adalah 15%. Ibu remaja berada pada peningkatan risiko anemia dan melahirkan bayi BBLR.
Kata kunci: kehamilan remaja, luaran ibu, luaran perinatal, prevalensi
Lselectin Levels in Patients with Endometriosis
No full textObjective: To investigate the L-selectin profile in endometrioticpatients.Methods: This was a cross-sectional study. Subjects were patientsdiagnosed endometriosis based on clinical examination, transvaginalultrasound, MRI and CT scan at the Department of Obstetricsand Gynecology of Prof. Dr. R.D. Kandou Hospital Manado, SiloamHospital and Network Hospital starting from January 2017 to May2017. The blood samples in patients prior to surgery were taken ona vein and then separated to obtain serum. Further more, serumlevels of L-selectin were measured using enzyme-linked immunosorbentassay (ELISA). Data were analyzed with SPSS version 22.0to see significance level.Results: Of the 18 samples, based on age, endometriosis highest inthe group > 26 years ie 17 patients (94.44%), followed by the agegroup of 21-25 years in 1 patient (5:56%), and none of thepatients in the age group <20 years (0%). Based on parity, themost established on a parity group 0 for 11 patients (61.11%),followed by the 1-3 parity group of 7 patients (38.99%), and nopatients in the parity > 4 (0%). Based on the highest stage is thethird stage as many as 11 people (61.11%), followed by stage 4 of7 patients (38.99%), and none of the patients in stage 1 or stage 2(0%). From a statistical test used to stage endometriosis age, theT test, p value 0.286. From a statistical test according to the levelsof L-selectin on endometriosis stadium used, the T test, p value0.090. Results of correlation tests were used, namely statingPearson test p value of 0.921.Conclusion: L-selectin levels in women with endometriosisincreased according to clinical stage, but not significant in statisticaltests. There is no significant relationship between age withstages or levels of L-selectin in women with endometriosis.Keywords: adhesion, age, endometriosis, L-selectin, stag
Malondialdehyde Levels in Preeclampsia before and after Delivery: Kadar Malondialdehid pada Penderita Preeklamsia Berat sebelum dan sesudah Persalinan
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Objective: Determine differences plasma levels MDA in preeclampsiabefore and 2 hours after delivery.
Methods: This was an analytic cross-sectional study. Subjectconsists of 23 pregnancies with preeclampsia, where 23 bloodsamples taken before delivery and 23 were taken 2 hours afterdelivery. This study was conducted from August 2016 untilDecember 2016 at Department of Obstetrics and GynecologyFaculty of Medicine Universitas Sam Ratulangi / Prof. Dr. R. D.Kandou Hospital Manado and satellite hospital. Samples weretaken from plasma and analysed using HPLC method at Prodiaclinical laboratory.
Results: In patients with severe preeclampsia before deliverywe found average value (1.4796  0.40819 nmol/ml), minimumvalue (1.03 nmol/ml) and maximal value (2.77 nmol/ml)and 2 hours after delivery with average value (1.2470 0.34324 nmol/ml), minimum value (0.91 nmol/ml), and maximumvalue (2.47 nmol/ml). by using Wilcoxon test, we foundthere were significant differences in plasma levels of MDA (p =0.000).
Conclusion: This significant difference suggests that decreasedplasma levels of MDA 2 hours after delivery and gives the sense thatthere is a relationship between oxidative stress of cells with severepreeclampsia before and shortly after delivery, that MDA is an indicatorof oxidative stress.
Keywords: malondialdehyde, oxidative stress, peroxidation lipid,preeclampsi
Demographic Characteristics of Mothers Who Delivered Children with Birth Defetcs: Demografi Ibu yang Melahirkan Janin dengan Kelainan
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Objective: to determine the characteristics and background of mothers who delivered neonates with birth defects.
Methods: A retrospective study was used by evaluating the medical records of patients with birth defects in Dr. Cipto Mangunkusumo Hospital during the period between September 2014 and June 2016.
Results: A total of 67 (1.85%) out of 3,619 infants who were born in Dr. Cipto Mangunkusumo Hospital during the period between September 2014 and June 2016 had birth defects. Forty-seven (70.1%) mothers of the subjects irregularly attend antenatal care. The most frequent maternal comorbid disease in this study was asthma, which was found in 4 (5.97%) mothers of the subjects. 48 (58.7%) subjects had birth weight under 2500 g.
Conclusion: In this retrospective study, the main highlight is that 70.1% of the mothers who delivered neonates with birth defects did not attend antenatal care regularly. 58.7% of the neonates with birth defects had low birth weight. This study could be used as base for further research investigating about the role of antenatal care in early detection and/or the planning of delivery for babies with birth defects. Trends in babies with birth defects suggested that fetuses diagnosed with IUGR/SGA should be given special attention, as they were at increased risk for birth defects.
Keywords: birth defect, maternal description
Abstrak
Tujuan: untuk mengetahui deskripsi/ciri-ciri dan latar belakang ibu yang melahirkan janin dengan kelainan bawaan.
Metode: Studi retrospektif digunakan dengan menggunakan data sekunder rekam medis pasien dengan kelainan bawaan di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo pada periode September 2014-Juni 2016.
Hasil: Sejumlah 67 (1.85%) dari 3,619 neonatus didapatkan dengan kelainan bawaan di RSUPN Cipto Mangunkusumo pada periode September 2014-Juni 2016 . Sejumlah 47 (70.1%) ibu dari subjek tidak teratur dalam melakukan kunjungan antenatal care. Penyakit komorbid ibu yang paling banyak ditemukan dalam studi ini adalah asma, yang ditemukan dalam 4 (5.97%) subjek. 48 (58.7%) subyek memiliki berat lahir di bawah 2500 g.
Kesimpulan: Pada studi retrospektif ini didapatkan 70.1% ibu yang melahirkan bayi dengan kelainan bawaan tidak melakukan kunjungan antenatal care. Didapatkan bahwa 58,7% bayi yang lahir dengan kelainan bawaan memiliki berat badan lahir rendah (BBLR). Studi ini dapat dijadikan sebagai landasan dilakukannya studi yang lebih besar untuk mengevaluasi peran antenatal care terhadap deteksi dini dan/atau perencanaan persalinan bayi dengan kelainan bawaan. Tren pada bayi dengan kelainan bawaan menunjukkan bahwa janin yang pada antenatal care didapatkan IUGR/SGA patut diperhatikan lebih untuk kecurigaan kemungkinan adanya kelainan bawaan.
Kata kunci: deskripsi ibu, kelainan bawaan
Post-operative Recovery Assessment of Urinary Tract Dysfunction Following Radical Hysterectomy for Cervical Cancer Patients: Kajian Pemulihan Fungsi Berkemih pada Pasien Kanker Serviks Pascahisterektomi Radikal
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Objectives: To assess the length of recovery phase in urinary tract dysfunction following radical hysterectomy for cervical cancer patients in Ciptomangunkusumo Hospital.
Methods: This survey study was conducted in Cipto Mangunkusumo Hospital from September 2016 to May 2017. Subjects were cervical cancer patients from stage IA2 to IIA2 underwent radical hysterectomy. Suprapubic catheter (SPC) was inserted to observe the urine production after procedure. Patients were then directed for bladder training protocol involving clamping and opening SPC. Sensation of bladder fullness followed by spontaneous micturition were recorded. Measurement of post voiding residual (PVR) urine volume after spontaneous micturition until less than 100 mL was considered as resolution of urinary tract dysfunction. The average days of every achieved phase were then calculated.
Results: Twenty-nine subjects underwent radical hysterectomy during observation period. But only 21 subjects continued the bladder training protocol and recorded for the recovery phases. The average time needed to obtain sensation of bladder fullness and spontaneous micturition were 7.57 ± 4.78 days (median 5 days, minimum 3 days, maximum 22 days)and 8 ± 5.21 days (median 6 days, minimum 3 days, maximum 23 days). The objective PVR urine became less than 100mL was obtained after 21.42 ± 18 days (median 18 days, minimum 7 days, maximum 74 days).
Conslusion: Following radical hysterectomy, recording the recovery phase of urinary tract dysfuction is essential to ensure complete resolution. Complete resolution of the urinary dysfunction is achieved after 21.42±18 days in average (median 18 days, minimum 7 days, maximum 74 days).
Keywords: cervical cancer, radical hysterectomy, urinary tract dysfunction, post voiding residual volume.
Abstrak
Tujuan: Menilai masa pemulihan disfungsi saluran kemih setelah histerektomi radikal pada pasien kanker serviks di RSUPN Ciptomangunkusumo.
Metode: Studi survei dilakukan di RSUPN Cipto Mangunkusumo dari September 2016 hingga Mei 2017. Subjek penelitian terdiri dari pasien kanker serviks stadium IA2 hingga IIA2 yang menjalani histerektomi radikal. Kateter suprapubik (SPC) digunakan sebagai alat untuk memantau produksi urin pasca operasi. Pasien diinstruksikan untuk mengikuti protokol bladder training yaitu melalui prosedur menutup dan membuka kateter. Rasa sensasi ingin berkemih dan berkemih spontan. Pengukuran residu volume urin pasca berkemih dibawah 100mL dianggap merupakan indikator pemulihan disfungsi saluran kemih. Rata-rata hari dari setiap fase kemudian dihitung.
Hasil: Dua puluh sembilan subjek didapatkan selama penelitian. Namun, hanya 21 subjek yang dapat mengikuti protocol bladder traning dan dicatat perkembangan pemulihannya. Rata-rata hari yang diperlukan untuk merasakan sensasi berkemih dan berkemih spontan adalah 7,57 ± 4.78 hari (median 5 hari, minimum 3 hari, dan maksimum 22 hari) dan 8 ± 5.21 hari. (median 6 hari, minimum 3 hari dan maksimum 23 hari) Rata-rata hari untuk mencapai residu urin di bawah 100 mL adalah 21.42 ± 18 (median 18 hari, minimum 7 hari, dan maksimum 74 hari).
Kesimpulan: Setelah prosedur histerektomi radikal, pencatatan masa pemulihan penting untuk dipantau untuk memastikan pemulihan lengkap. Rata-rata hari yang diperlukan untuk pemulihan adalah 21.42 ± 18 hari (median 18 hari, minimum 7 hari, dan maksimum 74 hari).
Kata kunci: kanker serviks, histerektomi radikal, disfungsi saluran kemih, volume residu paska berkemih
The Prevalence and Risk Factors of Constipation in Pregnancy
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Objective: To estimate the prevalence of constipation inpregnancy and correlation between gestational age, dietaryfiber intake, water comsumption, and physical activity.
Methods: This study used cross-sectional design with samples of174 healthy pregnant women undergoing antenatal care atObstetrics and Gynecology Outpatient Clinic RSCM during August -October 2016. Data were collected using questionnaire. Diagnosisof constipation was based on ROME III criteria, dietary fiber ismeasured using Food Frequency Questionnaire (FFQ), and physicalactivity was measured using International Physical Activity Questionnaire(IPAQ). Chi-square and Fisher’s exact test were conducted toevaluate the association between variables.
Results: The prevalence of constipation in pregnant womenobserved in this study was 13.2% (95% CI 8.3-18.1). The mostfrequent complaints included straining, incomplete evacuation,and anorectal obstruction. Dietary fiber intake was low in 81.03%subject. with average dietary fiber intake of 18.97 gram/day.There was no significant association between constipation andgestational age (OR 4.36, 95%CI 0.51-37.48 for second trimesterand OR 2.04, 95%CI 0.25-16.7 for third trimester), dietaryfiber intake (OR 0.82, 95%CI 0.28-2.39), water consumption(OR 1.38, 95%CI 0.56-3.41), and physical activity (OR 1.167,95%CI 0.28-4.87).
Conclusion: Prevalence of constipation in pregnant women is13.2%. There is no significant correlation between gestational age,dietary fiber intake, water consumption, and physical activity.
Keywords: constipation, pregnant woman, ROME II
Effect of Postpartum Pelvic Floor Muscles Training in Pelvic Floor Muscles Strength on Postpartum Women with Stress Urinary Incontinence
Get PDFObjective: To evaluate the effect of pelvic floor training (Kegelexercise) on pelvic floor muscle strength in postpartum womenwith SUI.Methods: Thirty-five birth vaginally postpartum women with SUIwere experimentally enrolled. After four weeks of postpartumobservation, the diagnosis of SUI confirmed, and all of these womenwere asked to complete the International Consultation onIncontinence Questionnaire-Sort Form (ICIQ-SF) questionnaire.The strength of the pelvic floor muscle measured with perineometerevery once in 3 weeks for 12 weeks of Kegel exercise. SUI severityassessed with ICIQ-SF after completing the Kegel exercise. A pairedt-test was used to compare measurement results between ICIQ-SFquestionnaire and perineometer and multiple linear regressionmodels was used for multivariate analysis. A p value of less than 0.05was taken to be statistically significant.Results: Findings show a significant difference between clinicalvariables (parity, neonates birth weight, perineal tear grade, BMI)and the improvement of pelvic floor muscles before and afterperformed the Kegel exercise (all p<0.05). The pelvic floormuscles strength significantly improved (p=0.000) after Kegelexercise both in ICIQ-SF questionnaire and perineometermeasurement.Conclusion: Pelvic muscles floor training or Kegel exercise improvepelvic muscles floor strength in postpartum women with SUI.[Indones J Obstet Gynecol 2018; 6-2: 114-118]Keywords: pelvic muscles floor training, postpartum, stress urinaryincontinenc
The Prevalence of Occult Omental Metastases in Patients with Epithelial Ovarian Cancer
Get PDFObjective: Studies regarding omentectomy on epithelialovarian cancer are scarce with conflicting results; this study isaimed to investigate the prevalence of occult metastases inpatients with epithelial ovarian cancer of the omentum.Methods: A cross-sectional study design was used by evaluating themedical records of surgically staged ovarian cancer patients in Dr.Cipto Mangunkusumo Hospital, Jakarta, Indonesia during the periodof January 2009 to December 2015.Results: A total of 51 subjects were involved in this study. One(2%) of 51 subjects was found to have occult metastases in theomentum. The prevalence of metastases of early stage epithelialovarian cancer in 2009-2015 is 33.3% (17 out of 51 subjects),whereas the omental involvement is found only in 2% subjects(1 out of 51).Conclusion: The prevalence of occult metastases of early stageepithelial ovarian cancer in Dr. Cipto Mangunkusumo Hospital,Jakarta, Indonesia, from 2009-2015 in 2% (1/51 subjects).[Indones J Obstet Gynecol 2018; 6-2: 119-122]Keywords: cancer, epithelial, metastases, omentum, ovarian cancer,ovary, prevalenc