Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Comparison of Fibrinogen Level Changes between Pregnancy with History of Abortion and Normal Pregnancy
Get PDFObjective: To know the change of fibrinogen level in pregnancy with history of abortion and normal pregnancy on 6 - 8 weeks pregnancy and 10 - 12 weeks pregnancy.
Method: This is a comparative study analytic comparative with cross sectional method on both groups, pregnancy with history of abortion and normal pregnancy. Observe the changes of fibrinogen level on 6 - 8 weeks pregnancy and then on 10 - 12 weeks pregnancy in pregnancy with history of abortion and normal pregnancy.
Result: Comparison of mean fibrinogen level between 6 - 8
weeks pregnancy and 10 - 12 weeks pregnancy, on both group showed that the fibrinogen level in the group with history of abortion increased 9.6% and in the group of normal pregnancy increased 11.4%. The raise on both group was not significant stastistically (p = 0.810). The raise fibrinogen level on normal pregnancy was significant
(p < 0.001), while on pregnancy with history of abortion is
not significant (p = 0.255). All patterns of raise and fall on fibrinogen level on both groups were not stastistically significant (p > 0.005).
Conclusion: Fibrinogen level on 10 - 12 weeks pregnancy was not lower than on 6 - 8 weeks pregnancy in pregnancy with history of abortion. There was no significant raise changes in fibrinogen level on both groups.
[Indones J Obstet Gynecol 2011; 35-2: 53-6]
Keywords: abortion, fibrinogen, haemostasis, history of abortion, normal pregnanc
The Unique Presentation of Massive Ascites Complicating Severe Preeclampsia and HELLP syndrome
Get PDFObjective: To describe a rare case of massive ascites complicating severe preeclampsia and HELLP syndrome.
Method: Reporting a case experienced and taken care in our hospital.
Result: We report a case of Mrs L, 29 years old, gravid 1, admitted at 35th week gestation, with preeclampsia, HELLP syndrome (thrombocyte 49000/ul, LDH 888 U/l), and IUFD. We found ascites pre-operatively. Cesarean section was conducted. As much as 1.5 litre of ascites was evident during CS. We put intra-abdominal drain and ascites was about 4300 ml, 3800 ml and 1200 ml on 1st, 2nd and 3th day. Patient was discharged after five days of care. One week follow up, patient came with good condition and controlled blood pressure and clinically no evident ascites.
Conclusion: Preeclampsia is one of the major causes of maternal mortality and morbidity in the world. Manifestation of preeclampsia can range from mild preeclampsia to full blown eclamptic condition. Herein we presented a case of massive ascites complicating severe preeclampsia and HELLP syndrome.
[Indones J Obstet Gynecol 2011; 35-2: 67-9]
Keywords: massive ascites, preeclampsia, HELLP syndrom
Effect of clomiphene citrate on the quality of cervical mucus in infertile women
Get PDFObjective: To describe the effect of clomiphene citrate on the
quality of cervical mucus in infertile women.
Method: This study is a non-randomized clinical trial. The study
was carried out at several education hospitals in Makassar from
March 2008 to April 2009. The subjects of the study were infertile
women who fulfilled the inclusion criteria with intervention study.
The statistical analysis was performed using Wilcoxon Sign-ed
Rank Test with α 5%.
Result: There were 36 cases found, and most were in the range
of 26 - 30 years old (38.9%), university level education (50%), civil
servant (47.2%), normal nutritionals status (55.5%), regular menstruation
cycle (94.4%), marriage length 1 - 5 years (52.8%), and previously
treated (61.1%). There was a significant difference of the
cervical mucus quality in the infertile women before and after the
administration of clomiphene citrate which tend to become worse (p
= 0.012). At previously CC-treated group, it was found that after the
administration of clomiphene citrate, the quality of cervical mucus
tend to be worse (100%).
Conclusion: The administration of clomiphene citrate tends to
have declining effect on cervical-mucus quality of infertile women.
[Indones J Obstet Gynecol 2010; 34-2: 73-6]
Keywords: clomiphene citrate, quality of cervical mucus, infertile
wome
Patient’s assessment on quality of Obstetrics and Gynecology service at Dr. Cipto Mangunkusumo Hospital
Get PDFObjective: To evaluate patient’s assessment on service quality
of Obstetrics and Gynecology at Dr. Cipto Mangunkusumo Hospital,
the importance of each service quality dimension, and the relation
between quality assessment and several factors.
Method: The research was performed to 112 patients who were
hospitalized in the Obstetrics and Gynecology ward in August 2009.
We used a questionnaire which was developed from SERVQUAL
instrument. This questionnaire consists of 26 questions about patient
expectation and perception on the service they received. It covered
5 service quality dimensions (reliability, responsiveness, assurance,
empathy, and tangibility). Patients were asked to state the answer in
Likert scale from 1 to 7. The gap between perception and expectation
score was then calculated. If the gap was zero or positive it
means the quality was good and if negative it means the quality was
not good.
Result: Among 112 respondents, 82 respondents (73.2%) assess
that the service quality was not good, only 26.8% considered it
good. Reliability dimension had the highest expectation score followed
by assurance, responsiveness, empathy, and tangibility with
the proportion of 21%, 20%, 20%, 20%, and 19% respectively. The
sequence of the gap from the biggest to the smallest was empathy,
responsiveness, reliability, assurance, and tangibility. There was a
significant relationship between patients’ educational background
and assessment of service quality (p=0.036).
Conclusion: Obstetrics and Gynecology Deparment’s service
quality at Dr. Cipto Mangunkusumo Hospital has not fulfilled patients’
expectation. Improvements of the service quality need to be
addressed on 4 factors, which are empathy, reliability, responsiveness,
and assurance.
[Indones J Obstet Gynecol 2010; 34-2: 77-83]
Keywords: patient expectation, patient perception, Obstetrics
and Gynecology service qualit
Correlation between level of serum estrogen, c-telopeptide, and interleukin-6 in determining bone density in perimenopausal women
Get PDFObjective: To evaluate the role of estrogen as a menopausal biochemical
marker to c-telopeptide (CTx) and IL-6 as a biochemical
marker of mineral bone density in perimenopausal women.
Method: This is an observational, cross-sectional study in perimenopausal
women between 45 - 51 years old, who matched the inclusion
and exclusion criteria such as no contraception was taken
before, no specific disease that could affect the laboratory findings.
Samples were taken from outpatients clinic of Prof Dr. R.D. Kandou
hospital. The patients were gathered for blood samples collection.
Blood samples were tested in laboratory. All data were collected and
being processed statistically using Pearson correlation coefficient
(SPSS version 16).
Result: From 60 perimenopausal women (45 - 51 years old)
sample, mean age was 47.98 ± 2.26 SD. Estrogen (estradiol) level:
< 10 pg/ml, maximum 358 pg/ml, and mean 77.11 ± 86.2 SD. IL-6
level: minimum is 1.645 pg/ml, maximum 7.771 pg/ml, and mean
4.317 ± 2.112 SD. We found significant correlation between age and
estrogen level (correlation level < 0.05) and CTx level (in level <
0.01). From regression curve, age has no significant correlation with
IL-6 concentration. However, we found significant correlation between
estradiol and CTx and IL-6 with respective correlation coefficient
value of < 0.01. Likewise the correlation between CTx and IL-
6 showed significant statistically with the value of the correlation
coefficient < 0,01.
Conclusion: There is a significant correlation between estrogen,
Il-6 and CTx. These variables play an important role in the occurrence
of the physiological changes in the perimenopausal women.
This study also showed the occurrence of a bone reabsorption process
that was marked by the increase of CTx level in accordance
with the increase in the age and the increase in the level of CTx together
with the decline in the level of oestrogen. Therefore, prevention
therapy of osteoporosis should begin in earlier age, before the
further bone reabsorption take place.
[Indones J Obstet Gynecol 2010; 34-2: 84-8]
Keywords: c-telopeptide, bone mineral density, estrogen, interleukin-
6, perimenopause wome
Comparison of administration of estradiol valerat 1 mg and 2 mg to improve squamous epithel maturation of Pap Smear preparation on postmenopausal women
Get PDFObjective: To determine the most effective dose of estradiol
valerat (daily oral administration of 1 mg or 2 mg for 14 days) to
improve squamous epithel maturation of Pap Smear on postmenopausal
women.
Method: Seventy one postmenopausal women with atrophic Pap
Smear were participated in this randomized double blind clinical
trial. 35 subjects received estradiol valerat 1 mg and the other 36
subjects received estradiol valerat 2 mg. After daily oral administration
of estradiol valerat for 14 days, second Pap Smear were performed
to evaluate epithel maturation. The side effects were also
evaluated in this study.
Result: There were 5 subjects whom lost to follow up due to refused
to perform second Pap Smear and 1 subject was drop out due
to nausea. 65 subjects were included in final analysis. Estradiol
valerat 2 mg was significantly more effective than estradiol valerat
1 mg in improving epithel maturation of Pap Smear preparation on
postmenopausal women. There were no complain about nausea and
vaginal bleeding. Leukorhea occurred more frequently in the 2 mg
group.
Conclusion: Daily oral administration of 2 mg estradiol valerat
was more effective than estradiol valerat 1 mg in improving
squamous epithel maturation of Pap Smear on postmenopausal
women with minimal side effect (leukorhea).
[Indones J Obstet Gynecol 2010; 34-2: 89-91]
Keywords: Pap Smear, postmenopausal women, estradiol valerat,
epithel maturation of Pap Smea
Subchorionic Hematoma on Threatened Abortion as Risk Factors Occurrence of Spontaneous Abortion
Get PDFObjective: To determine whether sub chorionic hematoma increases the risks of spontaneous abortion.
Method: Study using prospective cohort design, in which case group was 30 patients with threatened abortion having subchorionic hematoma during 7-20 weeks gestational age (GA), and control group was 30 patients with threatened abortion not having subchorionic
hematoma. Diagnosis was confirmed using the aid of ultrasound (USG) (Medison Sondace Live Prime 8000®). The sampling method was consecutive sampling of 7-20 weeks GA pregnancy, with minimum CRL measurements 10 mm, who came to obstetrics emergency room or outpatient clinic at Sanglah General Hospital. Patients were followed until 20 weeks GA by physical and USG examination. If the evaluation results were normal, patients were managed as a normal pregnancy. But if it had the same condition as diagnosis for threatened abortion, patients were re-managed as threatened abortion or according to current diagnosis.
Result: The average age of patient, gestational age upon examination at first visit and parity of case and control group were not statistically different (p>0.05). Percentage of spontaneous abortion within the case and control group was 40% and 13.33% respectively. The relative risks of spontaneous abortion were three times higher in the threatened group with subchorionic hematoma (RR=3;
IK 95% = 1.09-8.25; p=0.02). Median time span of the occurence of spontaneous abortion in the case and control group was 12 and 16 weeks respectively.
Conclusion: The risk of spontaneous abortion in threatened abortion with subchorionic hematoma was 3 times higher than those without subchorionic hematoma.
[Indones J Obstet Gynecol 2011; 35-4:170-2]
Key words: threatened abortion, subchorionic hematoma
Characteristics of Maternal Mortality Cases in a Tertiary Hospital
No full textObjective: To identify the characteristics of maternal mortality cases in a tertiary hospital in Jakarta, including socio-demographic characteristics, previous medical and obstetric history, and patient’s clinical condition on arrival at the hospital.
Method: This was a survey to identify the descriptive data of maternal mortality cases through medical records during study period. Manual review of 51 medical records was conducted for 2 years from January 2013 to December 2014 in Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital (RSCM).
Result: Of 51 cases of maternal deaths, 46 subjects (90.19%) had nine years of minimum education background. There were two subjects less than 21 years old and another was 42 years old. None of these subjects were using intrauterine device (IUD) or implant as the contraceptive methods where 66.6% subjects with underlying disease never used contraception. Ninety-two percent of subjects did antenatal care (ANC) regularly and 80.4% (41 subjects) of them was done in midwives. There were 14 subjects (29.78%) who had ANC in the first trimester of pregnancy. Severe preeclampsia is the most prevalent complication in pregnancy (26 subjects, 65%), which all (100%) patients arrived at RSCM with HELLP Syndrome. Therefore, preeclampsia was the leading cause of death in RSCM.
Conclusion: The characteristics of maternal death in RSCM are prevalent in the group of 25-34 years old with the high school as the educational background. Most of them are multiparity and do not use the long-term contraceptive methods. Preeclampsia is the major cause of maternal death in RSCM.
Keywords: maternal mortality, risk factors, tertiary hospita
Heme Oxygenase1 Level in Normotensive Pregnancy and Preeclampsia with Severe Features
Get PDFObjective: To understand the relationship of heme oxygenase-1
(HO-1) level between normotensive pregnancy and preeclampsia
with severe features.
Method: The cross sectional study was conducted in the Department
of Obstetrics and Gynecology, Faculty of Medicine, Universitas
Sam Ratulangi/Prof. Dr. R. D. Kandou General Hospital Manado. The
subjects consisted of 26 pregnant women with normal blood pressure
and 26 women with severe features of preeclampsia. We took
the patients’ history, general physical examination, and laboratory
assessment. The blood samples were taken from normotensive women
more than 20 weeks of pregnancy and preeclamptic women
with severe features more than 20 weeks of pregnancy. The data obtained
was processed using SPSS 20.0 software. We did the nonparametric
Mann-Whitney test to analyze the relationship between
heme oxygenase-1 (HO-1) level in normotensive pregnancy and
preeclampsia with severe features.
Result: The level of heme oxygenase-1 (HO-1) in normotensive
pregnant women was at 3.24 (SD 0.58) ng/ml (95% CI 3.00-3.47),
and the level of heme oxygenase-1 (HO-1) of preeclamptic women
with severe features was 3.92 (SD 0.73) ng/ml (95% CI 3.62-4.21).
The result of Mann-Whitney test showed p value of 0.001 which
meant that there was significant difference in the level of heme oxygenase-
1 (HO-1) between normotensive women and pre-eclamptic
women with severe features.
Conclusion: There was the relationship between the level of heme
oxygenase-1 (HO-1) and the incidence of preeclampsia with severe
features.
Keywords: heme oxygenase-1 (HO-1), normotensive pregnancy, preeclampsia with severe feature
Incidence of PostOperative Urinary Retention after Pelvic Organ Prolapse Reconstruction
Get PDFAbstract
Objective: To determine the incidence of post-operative urinary retention
after pelvic organ prolapse reconstruction and associated
factors.
Method: This was a prospective cohort study conducted in Dr. Cipto
Mangunkusumo and another associate hospital. We recruited women
planned for pelvic organ prolapse reconstruction from April
2013 to April 2015. Inclusion and exclusion criteria were women
with pelvic organ prolapse (2nd, 3rd and 4th degree) without prior
urinary retention, drugs affecting bladder function, and history of
bladder injury. After surgery, urinary catheter was applied for 24
hours. Six hours apart from urinary catheter released, residual urine
was measured. Urinary retention was defined as residual urine more
than 100 ml.
Result: Of 200 subjects, 59 of them (29.5%) classified as having urinary
retention. No association found between age, body mass index
(BMI), degree of prolapse, degree of cystocele and urinary tract infection
toward urinary retention. Total vagina hysterectomy + anterior
colporaphy + colpoperineoraphy + sacrospinous fixation and reconstruction
duration more than 130 minutes were associated with
urinary retention (relative risk (RR) 3.66; 95% CI 2.91-4.60;