Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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The Role of Hysteroscopy in Endometrial Hyperplasia
Get PDFObjective: To review, presented the role of hysteroscopy in endometrial hyperplasia.
Method: Literatur review.
Conclusion: The high diagnostic accuracy, associated with a minimal trauma, renders hysteroscopy the ideal procedure for both diagnosis and follow up of conservative management of endometrial hyperplasia. Hysteroscopy has made the most significant progress,
mainly because the ability to use fine diameter instruments makes it feasible to avoid both anaesthesia and cervical dilatation. The procedure may therefore be performed in an outpatient setting without the need for hospitalization. The hysteroscopic diagnosis should not
replace histological diagnosis, mostly in hysteroscopies performed after progestagen therapy, because the changes induced by drugs make more difficult the interpretation of hysteroscopy. The hysteroscopic pattern of endometrial hyperplasia appears with an over development of the endometrial mucosa with increased glandular openings, increased vascularization, cystic dilatations, polypoid aspects. Innovations in the diagnostic aspect of serious endometrial diseases through hysteroscopy is still evolving.
[Indones J Obstet Gynecol 2011; 35-2: 91-4]
Keywords: hysteroscopy, endometrial hyperplasi
Conservative Surgical Management of Postpartum Hemorrhage (PPH) Using ’Surabaya Method’ (Modified B-Lynch Compression Suture)
Get PDFObjective: To evaluate the efficacy of PPH management by conservative surgical management using B-Lynch Method and Surabaya method (Modified B-Lynch compression suture) as an alternative to hysterectomy in PPH due to uterine atony.
Method: Eighty-four cases of PPH from 2786 deliveries were
recruited in period of July 1, 2007 - August 31, 2008. The study was
perfomed in Ob/Gyn Dept. Dr. Soetomo Hospital Surabaya, Indonesia.
Its management consisted of 72 cases succeed with medical (uterotonics) and mechanical technique (tamponade technique) and
the remain of 12 failed cases was done by conservative surgical
technique that preserving uterus. The surgically therapy on these 12
cases were proceeded by B-Lynch technique on 4 cases and another
8 cases with Surabaya Method in which the technique was done by
performing brace suturing way with 3 longitudinally stitches using
chromic catgut no 2 and round needle.
Result: From 12 cases showed that all 8 cases with Surabaya
Method technique were success to stop bleeding, but 2 cases were
failed from B-Lynch Method and hysterectomy were done. Two out
of 8 cases Surabaya Method and 1 B-Lynch technique case were
ended with death which possible causes were HELLP syndrome,
DIC and multiple organ failure complication in severe preeclampsia,
although actually the bleeding had already been stopped.
Conclusion: The present study showed that Surabaya Method
was effective to stop bleeding in PPH conservative surgical management with uterus preserving. Beside simple, effective and easy to implement, the advantage of Surabaya Method was quick.
[Indones J Obstet Gynecol 2010; 34-3: 108-13]
Keywords: PPH conservative management, Surabaya Method,
B-Lynch techniqu
Report Risk of Malignancy Index of Ovarian Cancer Patients in Dr. Sardjito Hospital, Yogyakarta
Get PDFObjective: To analyse retrospectively the score of the risk of malignancy index (RMI) in determining malignancy in the patients
with ovarian mass in Dr. Sardjito Hospital Yogyakarta.
Method: Retrospective analysis.
Results: Ninety patients with complete medical record and
adnexal mass were enrolled in the study from January 2007 to
March 2009. Subjects consisted of 70 patients (77.78%) diagnosed
with malignant ovarian mass and 20 patients with benign mass
(22.22%), More than half of the malignant ovarian mass were serous
carcinomas and at advanced stages (51.43% and 51.43% subsequently). Univariate analysis presented significant difference for
ultrasound score and serum Ca-125 level in identification of ovarian
malignancy, but not with the age or the menopausal status. The performance of RMI (≥ 200 for malignancy) had a sensitivity of 70%,
a specificity of 75%, a positive predictive value of 90.74%, and
negative predictive value of 41.67%. The serum Ca-125 level had a
sensitivity of 81.43%, a specificity of 60%, a positive predictive
value of 87.69%, and a negative predictive value of 48%. The ultrasound score had a sensitivity of 65.71%, a specificity of 65%, a
positive predictive value of 86.79%, and a negative predictive value
of 35.14%.
Conclusion: Due to the nature of retrospective study, RMI is reliable
for identification of malignant and benign ovarian mass improve
the management of ovarian mass including referral system
and the decision regarding the approach used during surgery.
[Indones J Obstet Gynecol 2010; 34-3: 131-5]
Keywords: risk of malignancy index, RMI, ovarian cancer, ovarian
malignancies, ovarian carcinoma
Comparative of Pulsatile Index and Resistance Index of Vascularization Intratumoral in Operable and Non Operable Cervical Cancer (Cross Sectional Study)
Get PDFObjective: A cross sectional study from 49 cases of cervical carcinoma,
diagnosed by histopathology, early staged was done by Oncogynecologist at Gyneco-Oncology clinic of Sanglah Hospital.
Doppler ultrasonography was used to compared the different Pulsatile
Index (PI), Resistance Index (RI) from artery intratumoral with
diameter mass of the tumor, including operable and non operable.
Method: This research was cross sectional study, present 49
samples established diagnosis with cervical cancer using anatomical
patology analyzes and evaluation the staging by the supervisor in the
policlinic of Oncology in Sanglah Hospital. Examination of intratumoral
vascular cervical cancer Doppler ultrasonography was done at
policlinic of Obstetrics Graha Amerta in Sanglah Hospital using
Medison instrument, type Sonoace 8000 live prime. The data was
analyzed using Kolmogorov Smirnov test normality, then the selected
data with Independent Samples Test.
Result: Profile mean of age and parity between operable cervical
cancer and non operable was not significant (p > 0.05). The mean
Pulsatile Index (PI) in operable sample is 0.66 ± 0.9, non operable
sample is 1.11 ± 0.84, p=0.089 (p > 0.05), RI for operable sample is
0.32 ± 0.36 and non operable sample is 0.49 ± 0.28 (p > 0.05).
Conclusion: There were no significant difference of PI and Resistance
Index (RI) between operable and non operable on cervical
cancer, but they were different in velocity mean.
[Indones J Obstet Gynecol 2010; 34-3: 143-9]
Keywords: pulsatile index, resistance index, cervical cance
Laparoscopic Robotic Surgery in Gynecology
Get PDFObjective: To know the development and application of robot assisted laparoscopy in gynecology.
Method: Literature review.
Result: Laparoscopy procedure has been widely used since the last three decades where minimally invasive surgery cases and demands increase in urology, cardiac surgery, general surgery, and particularly, gynecology. To date, laparoscopy has developed into robot-assisted laparoscopy due to needs of precise dissection of delicate
structures, procedures which requires sophisticated technique, and surgeon’s fatigue through the laparoscopy procedure. There are three robotic system which are commercialized and had been approved by FDA: AESOP, ZEUS, and Da Vinci, the latest robotic system which is used worldwide nowadays. There are advantages of
robotic systems and conventional laparoscopy to open surgery laparotomy, such as diminished morbidity rate; less esthetical incisions; decreased post and intra operative blood loss, postoperative pain, use of pain medication, less cosmetic problems, and shorter length of hospital stay. Advantages of robotic surgery compared to
conventional laparoscopy and laparotomy; include improved dexterity, more precise and accurate articulation, reduced tremor and surgeon’s fatigue, and better visualization of the operating field because of 3D image. Robotic system has drawbacks such as limited area of surgery field in trocar-placing to avoid collision of the robotic arms, longer operative time, and a higher cost.
Conclusion: The major drawback of robot-assisted laparoscopy is in the term of cost; because of the high cost of robotic system; which could be overcome by a lower morbidity rate, less incisional aesthetic problem, less total intra operative blood loss, decreased demand
of analgesics post operative, and shorter length of hospitalization stay and recovery time; as compensation of the high cost of robotic system. Further researches to study about the learning curve of robotic laparoscopy to achieve a faster operative time are needed. A longer operative time in robotic system can be anticipated with accurate simulation training in robotic system. There is also a need for further researches to discuss the total peri-operative cost.
[Indones J Obstet Gynecol 2011; 35-3: 146-50]
Keywords: laparoscopy, robotic system, robot-assisted, Da
Vinci system, learning curve, gynecolog
Serum Magnesium Ion Content in 32-36 Weeks Preterm Labor Patients in Dr. Mohammad Hoesin Hospital Palembang
Get PDFObjective: To determine the average levels of serum magnesium in 32-36 weeks of preterm labor patients and to compare the average of serum level of magnesium serum in preterm delivery 32-36 weeks with an average content of magnesium ions in normal delivery.
Methods: The study is an observational descriptive cross-cut design to determine level of magnesium serum at 32-36 weeks of preterm labor.
Result: Samples of this study were patients with preterm labor who were treated at the Department of Obstetrics and Gynecology in Dr. Mohammad Hoesin Palembang from January 1st, 2009 until July 31st, 2010. The number of samples was 33 subjects. Most subjects were in the range of 20-35 years of age. The largest parity in
the preterm group was 0, namely 14 subjects (42.5%), while in the normal pregnancy group it was 1, viz. 12 subjects (36.4%).
Conclusion: Based on the results of studies, the magnesium levels of 32-36 weeks preterm labor group was lower than the normal delivery group. The average of magnesium level in preterm labor group was 1.57 ± 0.18, while in the normal delivery group, it was 1.88 ± 0.23. There was a statistically significant difference found on
magnesium levels in both groups (
The Effect of Polymorphisms of Estrogen Receptor βRS1271572 to the Incidence of Epithelial Ovarian Carcinoma
Get PDFObjective: To determine the effect of polymorphism of estrogen receptor β to the risk of epithelial ovarian carcinoma at Dr. Mohammad Hoesin Hospital Palembang
Methods: This population-based case control study included 40 women with epithelial ovarian carcinoma and 40 controls, from January 2010 until December 2011. Data analysis was performed by Chi Square test.
Results: Distribution of estrogen receptor beta genotypes, both GT and TT (wild type-mutant and mutant), among case subjects was significantly higher than control (24 subjects {60%} vs. 5 subjects {12.5%}). The genotype effect was statistically significant for rs1271572 (OR=2.636; p=0.039) with Chi Square analysis. Whereas
the allotype effect was also statistically significant (OR=1.949; p= 0.047).
Conclusion: Polymorphism of estrogen receptor β may play a role in the risk of epithelial ovarian carcinoma at Dr. Mohammad Hoesin Hospital Palembang.
[Indones J Obstet Gynecol 2012; 36-1:32-6]
Keywords: epithelial ovarian carcinoma, polymorphism of estrogen receptor β, risk factor of ovarian carcinom
The Correlation between Psychosocial Stress and Prematurity
Get PDFObjective: This study was aimed to analyze the relationship between the level of psychosocial stress on preterm birth and term birth. Methods: This was a cross-sectional study, with 45 patients experiencing preterm birth and at term birth, who met the inclusion and exclusion criterias in Obstetrics and Gynecology Department of Dr. Hasan Sadikin Hospital and other hospital nearby. Result: The level of psychosocial stress on preterm birth was severe 64.4 %, moderate 14% and mild 2%. The comparison between the group resulted in p < 0.001 using chi-square test with confidence interval 95% and correlation coefficient was phi = 0.811. The specific psychosocial stressor were problem with in laws (p=0.001), problem with husband (p=0.003), foreclosure on a mortgage or loan (p=0.001), change in residence (p=0.001), major change in living conditions (building a new home, remodeling) (p=0.001), no monetary possession (p=0.001), major change in financial state (p=0.004), environment vulnerability (p=0.035), and being dismissal from work (p=0.014). Conclusion: The relationship between psychosocial stress and preterm birth was significant. The stressor included problem with in laws foreclosure on a mortgage or loan, change in residence, major change in living conditions (building a new home, remodeling, no monetary possesion, major change in financial state, environment vulnerability, and dismissal from work. [Indones J Obstet Gynecol 2012; 36-2: 55-60] Keywords: preterm birth, psychosocial stre
Factors Influencing Maternal Mortality from Severe Preeclampsia and Eclampsia
Get PDFObjective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/μl, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsi
Evaluation of Obstetric Emergency Referral Cases at Dr. Cipto Mangunkusumo Hospital January - December 2008
Get PDFObjective: To have description and evaluation about obstetric
emergency referral cases at obstetric emergency room of Dr. Cipto
Mangunkusumo Hospital (RSCM) from January until December
2008.
Method: This is a cross-sectional descriptive-analytic study
with 458 secondary data samples from simple random sampling
performed to all obstetric referral cases at obstetric emergency
room of RSCM from January until December 2008. The data were
pro-cessed for frequencies and bivariate analysis, and then further
analyzed with multivariate analysis.
Results: Patients’ age varied between 16 to 47 years old (27.78
± 6.51). Grandemultiparous women had 51.9% morbidity/mortality
(p = 0.024). Midwives were the majority of referee (73.1%), but
71.1% main obstetric emergency cases were referred by Ob/Gyn.
There were 260 cases corresponded to main obstetric emergency
with 88 cases diagnosed as hypertension. Most of the cases were
referred due to threatened preterm labor (22.5%), with 74.7% reasons for referral were ’lack of facility’. Most of the cases had no
complete referral record (91% cases had no referral time and 12.4%
cases had no initial assessment). Our hospital’s mean response time
was 8 minutes. From multivariate analysis, referee (OR for doctors
and Obstetricians 2.751; 95% CI 1.475 - 5.129) and delivery
method (OR for spontaneous delivery 0.412; 95% CI 0.227 - 0.750)
were two most influent variables for obstetric emergency referral
cases outcome. The MMR for this study was 253.2/100.000.
Conclusion: Our referral system is still not efficient. It needs
improvement and continuous input and facility fulfillment.
[Indones J Obstet Gynecol 2010; 34-4: 164-9]
Keywords: referral system, maternal mortality ratio, referral time,
response tim