Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Accuracy of Preoperative Endometrial Sampling for the Detection of Endometrial Pathology: a Retrospective Study
Get PDFObjective: To investigate the accuracy of endometrial sampling in
the diagnosis of endometrial pathology and the need of intraoperative
frozen section.
Methods: One hundred forty women who underwent endometrial
sampling followed by hysterectomy between 2011 and 2014 were
included in this study. Data were retrieved from patient files and
pathology archives in Department of Obstetrics and Gynecology,
Jose R. Reyes Memorial Medical Center, Manila, Philippines.
Results: There were 25 patients with malignancy but endometrial
sampling detected only 22 of them. The endometrial sampling
sensitivity and specificity for detecting cancer were 88% and 100%,
respectively with negative and positive predictive values of 97.5%
and 100%, respectively. In 3 patients, the endometrial sampling
failed to detect malignancy; 1 patient had a preoperative diagnosis
of complex hyperplasia with atypia, 1 patient had complex
hyperplasia without atypia and 1 patient had adenofibroma. A total
of eighty patients had benign findings. There were fifty-three cases
with finding of proliferative endometrium and twenty-seven were
secretory. Twenty-three (55.0%) and 11 (39.0%) cases were
confirmed by the hysterectomy specimen, respectively. The
sensitivity of endometrial sampling in detecting benign samples was
76.0% and the specificity reached up to 83.0%. The histopathology
result of the other fourteen cases were reported of having atrophy,
twelve cases were reported of having endometrial hyperplasia, four
with basal endometrium, four with endometrial polyp and one with
adenomyosis.
Conclusion: Outpatient endometrial biopsy has a high overall
accuracy in diagnosing endometrial cancer when the specimen
obtained is sufficient. A positive test result is more accurate for
ruling in disease than a negative test result is for ruling it out.
However, the diagnosis should be confirmed by frozen section in
patients with complex hyperplasia and adenofibroma.
[Indones J Obstet Gynecol 2017; 5-1: 23-29]
Keywords: abnormal uterine bleeding, endometrial hyperplasia,
endometrial sampling, frozen section, pipell
The Menopausal Symptoms of Paramedics at a Tertiary Care Center: Gejala Menopause Paramedis pada suatu Layanan Kesehatan Tersier
Get PDFObjective: To assess paramedic menopausal symptoms on theinpatient unit and outpatient unit.Methods: This was a cross sectional study. Data collect by fill thequestioner, the questioner fill by menopausal paramedic on Prof. Dr.R. D. Kandou Manado Hospital from October 2016 to January 2017.Data were analyzed using SPSS 22.0 for Windows.Results: Of 60 paramedics, 30 were divided to inpatient unit andthe other 30 were divided to outpatient unit. By the menopauserating scale, somatic and urogenital complaint in statistical testhave no significant differences. Psychology complaint with a moderatecomplaints on inpatient unit have 19 paramedic (63%) and12 paramedic (40%) on outpatient paramedic, in statistical havea significant differences (x2=9.62, p=0.022). On the total scoremenopausal complaints, the moderate complaints 18 paramedic(60%) on the inpatient unit and the minor complaints 21 paramedic(70%) on the outpatient unit, in statistical have a significantdifferences (x2=6.97, p=0.031).Conclusion: There is no significant difference in somatic andurogenital complaints on paramedic inpatient unit and outpatientunit. There is a significant difference in psychological complaintsand total score menopausal complaints on paramedic inpatientunit and outpatient unit.[Indones J Obstet Gynecol 2017; 5-4: 208-212]Keywords: menopause, menopause rating scale, paramedi
Hysterectomy to the Unicornuate Uterus Suffering of Hematometra: Histerektomi pada Unicornuate Uterus dengan Hematometra
Get PDFObjective: Unicornuate uterus with rudimentary cavity is anextremely rare Mullerian duct anomaly. It is frequently misdiagnosedor under treated, since women who suffer from thiscondition tend to be asymptomatic. We aimed to report thisinteresting case and review the available background literature.Methods: Case report.Case: A thirty two-year-old nulligravid woman was presentedwith severe abdominal pain. Laparoscopic surgery demonstratedunicornuate uterus with arudimentary cavity and hematometra.Partial hysterectomy was conducted to the right rudimentaryuterus.Conclusion: Thorough diagnosis is essential to prevent thecomplications of unicornuate uterus. Unicornuate uterus withrudimentary cavity is associated with increased rate of pregnancycomplications such as preterm labor and fetal malpresentation.Pregnancy can also occurred on the rudimentary cavity and leadsto recurrent pregnancy loss. Laparoscopy is essential for confirmatorydiagnosis. Surgical intervention should be considered asthe first line therapy to avoid associated morbidity.[Indones J Obstet Gynecol 2017; 5-4: 246-249]Keywords: hematometra, hysterectomy, unicornuate uteru
Heme Oxygenases1 (Hmox1) and Serum Ferritin Level between Preeclampsia and Normal Pregnancy
Get PDFObjective: To determine the comparison of Hmox-1 to serum
ferritin level between patients with preeclampsia and normal
pregnancy.
Methods: This study used analytic observational with cross
sectional design. We included 30 subjects with preeclampsia and the
other 30 people with normal pregnancy in accordance with
inclusion and exclusion criteria. Examination of Hmox-1 and ferritin
level was performed through ELISA method. The data consisted of
physical and laboratory examination and they would be continued
to the calculation in the statistical analysis.
Results: The average of Hmox-1 level in normal pregnancy and
preeclampsia was 1.2 (SD 1.6) ng/ml and 0.3 (SD 0.2) ng/ml
(
High Sensitivity CReactive Protein (hsCRP) Level on Premature Rupture of Membrane (PROM) at Term Pregnancy: Kadar High Sensitivity CReactive Protein (hsÂCRP) pada Ketuban Pecah Dini dengan Kehamilan Aterm
Get PDFObjective: To compare the level of high sensitivity C-Reactive Protein (hs-CRP) on patients with premature rupture of membranes (PROM) at term pregnancy. Methods: The study was cross-sectional design. The data collection included age, parity, gestational age, birth weight, and APGAR score on 28 pregnant women at term pregnancy consisting of 14 subjects of Premature Rupture of Membrane (PROM) less than 12 hours and the remaining one was equal or more than 12 hours. We took blood samples from the subjects for the examination of hs-CRP level. Data were analyzed using non-parametric statistical test and processed using Statistical Package for Social Sciences (SPSS) version 20. Results: The mean hs-CRP level on PROM <12-hour and 12-hour group was 12.9 and 17.8 mg/l. There was not significant difference on hs-CRP level between both of group at term pregnancy (p=0.734). Conclusion: The level of hs-CRP does not have association with the incidence of PROM. [Indones J Obstet Gynecol 2017; 5-1: 12-15] Keywords: high sensitivity C-Reactive Protein, premature ruptures of membranes, term pregnanc
Iron Deficiency Anemia, Cystitis, and Bacterial Vaginosis Increase the Risk for Developing Preterm Labor
Get PDFObjective: To prove the association of iron deficiency anemia, cystitis, and bacterial vaginosis as risk factors for preterm labor.Methods: This study was an observational case-control study conducted at the Polyclinic and IRD of Obstetrics and Gynecology Sanglah Denpasar General Hospital Center between September and December 2015. The sample selection was done by consecutive sampling with total sample as many as 35 case samples (women with preterm pregnancy) and 35 control samples (women with aterm pregnancy).Results: Pregnant mothers with iron deficiency anemia had 4 fold increased risk of developing preterm labor (OR = 4.04, 95% CI = 1.15 to 14.16, p = 0.023) compared to those without iron deficiency anemia. Pregnant mothers with cystitis had 4 fold increased risk of preterm labor (OR = 4.00, 95% CI = 1.25 to 12.80, p = 0.016) compared to those without cystitis. Pregnant mothers with bacterial vaginosis had 3 fold increased risk of preterm frequency (OR = 3.24, 95% CI = 1.22 to 8.63, p = 0.017) compared to those without bacterial vaginosis.Conclusion: Iron deficiency anemia, cystitis, and bacterial vaginosis increase the risk for developing preterm labor.[Indones J Obstet Gynecol 2017; 5-2: 73-76]Keywords: bacterial vaginosis, cystitis, iron deficiency anemia, preterm labo
Tenage Pregnancy
Get PDFSexual activity among teenagers has been increasing over the past decade, accompanied by younger age at first intercourse which is associated with inconsistent or nonuse of contraception. Problems become more complex because the onset of puberty is earlier than before and sociocultural and religious norm are less stringent, leading to greater opportunities to have pre-marital sex.1
Between 2011 and 2020, more than 140 million girls will become child brides, according to the United Nations Population Fund (UNFPA).2 If current levels of child marriages hold, 39.000 girls daily will marry too young.1 "Complication of pregnancy and childbirth are the leading cause of death in young women aged 15 - 19. Young girls who marry later and delay pregnancy beyond their adolescence have more chance to stay healthy, get higher education, and build a better life.", says Flavia Bustreo, MD, the Assistant Director-General for Family, Women and Children’s.
The prevalence of teenage pregnancy in industrialized differs in developing countries. In developed regions, teen parents tend to be unmarried, and adolescent pregnancy is seen as a social issue. By contrast, teenage parents in developing countries, such as in the WHO SEARO regions and in S.E. Asia countries, including Indonesia, are often married and their pregnancy maybe welcomed by family and society. However, in these societies, early pregnancy is usually accompanied by malnutrition and poor health care to cause medical problems.3 A report by Save the Children found that 13 million children are born to women under 20 worldwide each year, more than 90% of these births occur to women living in developing countries. The complications of pregnancy and childbirth are the leading causes of mortality among women between the age of 15 and 19.4 Resources about teenage pregnancy in Indonesia are scarce. The following data were derived from a keynote speech by the Minister of Health of the Republic of Indonesia, at the Annual Scientific Meeting of HOGSI, in Banjarmasin 2015: 38.5% and 18.4% of 22.136.584 teenage women with protein energy deficiency were pregnant and anemic, respectively. Furthermore, the pregnancy rate was 48 per 1000, the total life birth was approximately 4.809.304, and 40% of teenage mothers ended their education.
Further reports have identified that premarital sex is uncommon in India, but early marriage often occurs, which means that the rate of adolescent pregnancy is high in that country. The rate of teenage pregnancy in rural regions are higher than in urbanized areas such as South Korea and Singapore. In these areas, marriage before age 20 is rare. Although the occurrence of sexual intercourse before marriage has risen, the rate of adolescent child bearing are low, approximately 4 to 8 per 1000. In Indonesia, the rate of early marriage and pregnancy has decreased sharply; however, it remains high compared to the rest of Asia. According to the
World Health Organization, in several Asian countries including Bangladesh and Indonesia, maternal causes contributed a large proportion (26 - 37 %) of death among female adolescents.5
The Importance of Prevention
Teenage pregnancy and childbearing bring substantial social and economic burden through immediate and long term impact on teenage parents and their children.6 Pregnancy and birth are significant contributors to high school drop outs rates among girls, only about 50% of teen mothers receive a high school diploma by 22 year of age, where as approximately 90% of woman who do not give birth, during adolescent graduate from high school.
Adolescent pregnancy (i.e., in females 13 to 19 years of age) is associated with an increased risk of maternal complications during pregnancy and delivery as well as an increased risk to the fetus. Complications that are associated with adolescent pregnancy include preterm delivery, low birth weight, and infant mortality. The complications are usually are associated with behavioral, psychosocial, and economic factors. Therefore, psychosocial risk factors should be the main focus of care.7 In general, focus priorities should be given to young adolescents before the age of 15, in which relatively high proportion of young boys and girls already have sexual intercourse, and childbearing in some cases. Teenage pregnancy is one of the causes of the failure, making the goals United National Millenium Development Goals 4 and 5 failed to be accomplished.
Adolescent pregnancy is a high risk, and has considerable impact in both physical and psychosocial aspects. Youth - friendly services with sensitive counseling, high quality obstetric and antenatal care, as well as a range of safe and affordable contraceptive methods should be available
The Side Effects of Intracesarean Intrauterine Contraception: A Descriptive Study: Efek Samping Pemasangan Alat Kontrasepsi dalam Rahim (AKDR) Intrasesarea: SuatuS tudi Deskriptif
Get PDFObjective: To investigate the side effects and acceptance of intracesarean Intrauterine Device (IUD) insertion.
Methods: This was a descriptive study. Subjects were all pregnant women who had Cu T380A IUD to be placed after cesarean delivery at Prof. Dr. dr. R. D. Kandou Hospital during the period between August 2016 and September 2016.
Results: A total of 52 subjects were recruited in this study.43 (82.69%) subjects were in the age group of 20-30 years. 51 of the subjects accepted the IUD. On the 7th day, 49 (94.23%) and 51 (98.07%) subjects complained of abdominal pain and vaginal bleeding, respectively, while on the 14th day, 48 (92.3%) and 50 (96.1%) subjects had abdominal pain and vaginal bleeding, respectively. There were significant decreases in both complaints on the 14th day, compared to the 7th day. (p<0.05 and p<0.05, respectively). 51 (98.07%) subjects accepted the IUD. There were no significant difference between acceptance on day 7 and 14th (p>0.05).
Conclusion: The acceptance of side effects by the acceptor reaches 100%, with the incidence of early postpartum expulsion is 3.8%. The side effects of IUD are minimal.
[Indones J Obstet Gynecol 2017; 5-3: 139-141]
Keywords: intra-cesarean, intrauterine device, side effect
The Risk of Ovarian Malignancy Algorithm (ROMA) as a Predictor of Ovarian Tumor Malignancy: Risk of Ovarian Malignancy Algorithm (ROMA) sebagai Prediktor Keganasan Ovarium
Get PDFObject: To assess the diagnostic value of Risk of Ovarian Malignancy Algorithm (ROMA) in predicting ovarian malignancy.
Methods: Diagnostic test was performed at dr. Mohammad Hoesin Hospital Palembang during June 2016 to November 2016. Data were analized with SPSS version 21.0 and Med-calc statistic.
Results: A total of 57 subjects were recruited in this study. Subjects were divided into two groups: the premenopausal and postmenopausal group. Analysis with ROC curve was performed, the ROMA optimal cut-off of ROMA was 23.7% and 48.15% in the premenopausal and the post-menopausal group, respectively. With the optimal cut-off, the sensitivity was 79.41% and specivicity was 75%, positive predictive value wa 73.07% and negative predictive value 83.77% with accuracy 76.92% in diagnosing ovarian malignancy. Compared to RMI-3, the sensitivity was 65.5% and specivicity was 85.7% with accuracy 75.44%.
Conclusion: ROMA is not a reliable diagnostic tools of ovarian malignancy.
Keywords: CA125, HE4, ovarian cancer, risk of ovarian malignancyalgorithm/ ROMA, risk of ovarian malignancy index/RM