Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Kadar D-dimer pada ibu hamil dengan preeklampsia berat dan normotensi di RSUP Dr. Kariadi
Get PDFTujuan: Untuk mengetahui dan menganalisis kadar D-dimer sebagai penanda terjadinya preeklampsia berat.
Bahan dan cara kerja: Dari bulan Mei - Agustus 2007 dilakukan penelitian potong lintang secara konsekutif di Poliklinik Hamil (145), Instalasi Gawat Darurat (IGD), Kamar Bersalin RSUP Dr. Kariadi/FK. UNDIP Semarang. Semua ibu hamil dengan umur kehamilan > 20 minggu dan memenuhi kriteria preeklampsia berat dan kriteria normotensi dilibatkan dalam penelitian ini setelah sesuai kriteria inklusi serta mendapatkan penjelasan dan mengikuti persetujuan ikut dalam penelitian. Materi pemeriksaan D-dimer diambil dengan cara pengambilan darah vena sebanyak 3cc yang dicampur lithium heparin. Sampel darah diperiksa kadar D-dimer dengan menggunakan alat CARDIAC Ddimer. Data dianalisis secara deskriptif, uji Mann Whitney dan uji korelasi Spearman menggunakan SPSS for Windows v. 15. Bermakna apabila
Gambaran densitas mineral tulang vertebra lumbal akseptor KB suntik DMPA
Get PDFTujuan: Dilakukan penelitian untuk menilai dampak pemakaian kontrasepsi suntik DMPA pada densitas tulang Vertebra Lumbal (VL. 1-4) pada akseptor jangka pendek pada saat sebelum suntikan ke 3-3 (minggu ke 24 atau 6 bulan) dan sebelum suntikan kelima (minggu ke 48 atau 1 tahun) dibandingkan dengan perempuan bukan akseptor sebagai kontrol dan akseptor jangka panjang (≥ 5 tahun), dengan alat Dual Energy X-Ray Absorptiometry (DEXA).
Tempat: Dilakukan di Makassar antara Januari 2006 - Maret 2007 pada 33 orang akseptor KB suntik DMPA jangka pendek (1 tahun), 31 orang akseptor suntik DMPA jangka panjang (≥ 5 tahun), dan 33 perempuan bukan akseptor KB sebagai kontrol.
Rancangan/rumusan data: Potong Lintang.
Hasil: Karakteristik sampel berdasarkan umur rerata: 22,7 ± 3,1 tahun (akseptor 1 tahun) dan 27,2 ± 4,8 tahun (kontrol), homogen secara statistik. Sebelum perlakuan, tidak ditemukan perbedaan yang bermakna
antara DMT VL. 1-4 kedua kelompok (p > 0,05). Setelah perlakuan, DMT VL. 1-4 pada akseptor 1 tahun menjadi lebih rendah dibandingkan kontrol pada semua level vertebra lumbal, dengan uji Mann Whitney menunjukkan perbedaan yang bermakna (p < 0,05). Besarnya perubahan
DMT antara akseptor dan kontrol menunjukkan perbedaan yang bermakna, di mana perubahan pada akseptor (p < 0,05) bahkan pada kontrol tidak ada perubahan (0,0). Angka kejadian pada osteopenia lebih tinggi
pada akseptor daripada akseptor 1 tahun dan akseptor 1 tahun lebih tinggi daripada kontrol pada pada semua level VL.
Kesimpulan: Kejadian osteopenia berhubungan dengan lama pemakaian KB Suntik DMPA.
[Maj Obstet Ginekol Indones 2009; 33-2: 101-7]
Kata kunci: DMT vertebra lumbal, DMP
Analisis polimorfisme gen vascular endothelial growth factor (VEGF) pada endometriosis
Get PDFTujuan: Melihat hubungan antara polimorfisme gen VEGF dengan
kejadian endometriosis pada pasien yang dilakukan operasi laparoskopi.
Tempat: RSUP Dr. Wahidin Sudirohusodo, Makassar.
Bahan dan cara kerja: Polimorfisme nukleotida tunggal pada gen
VEGF -460 pada daerah promoter dan +405 pada daerah 5’ -untranslated diuji hubungan pada penelitian potong lintang terhadap 50 perempuan dengan endometriosis dan 28 perempuan tanpa endometriosis. Setelah ekstraksi genom DNA, dilakukan pemeriksaan polymerase chain reaction (PCR) dan restriction fragment length polymorphism (RFLP) untuk analisis genotip polimorfisme VEGF. Penelitian ini dilakukan di Makassar-Indonesia sejak Januari 2007 sampai dengan Oktober 2007.
Hasil: Distribusi genotip polimorfisme -460T>C pada perempuan
dengan endometriosis berbeda bermakna dibandingkan dengan perempuan tanpa endometriosis (pG pada perempuan dengan endometriosis berbeda tidak bermakna dibandingkan dengan perempuan tanpa endometriosis (p>0,05).
Kesimpulan: Data ini menunjukkan bahwa polimorfisme nukleotida
tunggal pada gen VEGF -460T>C pada daerah promoter gen VEGF bisa berhubungan dengan kejadian endometriosis pada populasi di Makassar- Indonesia.
[Maj Obstet Ginekol Indones 2009; 33-2: 108-17]
Kata kunci: endometriosis, polimorfisme, VEG
Manajemen risiko dalam pelayanan pasien preeklampsia berat (PEB)/ eklampsia di Instalasi Gawat Darurat RSUPNCM
Get PDFTujuan: Mendapatkan gambaran mengenai pelaksanaan manajemen
risiko dalam pelayanan pasien PEB/eklampsia di IGD lantai 3 RSCM.
Bahan dan cara kerja: Penelitian ini dilakukan di IGD lantai 3
RSCM menggunakan pendekatan kualitatif dengan melakukan wawancara terhadap 15 orang pasien yang datang dan dirawat karena PEB/Eklampsia dan pihak manajemen yang terdiri dari Direktur Pelayanan Medis RSCM, Dokter konsultan IGD lantai 3 RSCM, dan Kepala Ruangan IGD RSCM.
Hasil: Sebagai tolok ukur keluaran, angka kematian ibu menurun sebesar 0,14%; lama rawat menjadi 1 hari di IGD; dan kepuasan pasien sebesar 53,3%. Dalam hal identifikasi risiko diketahui bahwa belum ada SOP yang khusus dibuat RSCM untuk penanganan PEB/Eklampsia dan walaupun sudah ada prosedur pelaporan dan pencatatan insiden klinis, namun belum ada formulir pelaporan selain rekam medis dan belum terstruktur dengan baik. Kinerja perawat masih dianggap kurang dan belum ada sistem manajemen risiko formal yang diterapkan. Analisa risiko sudah berjalan dengan baik. Terdapat upaya penurunan risiko seperti pelatihan tenaga medis, pemenuhan fasilitas, supervisi dan forum komunikasi.
Namun sistem prioritas masih perlu dikembangkan. Pendanaan
risiko dialokasikan untuk perlindungan terhadap tenaga medis jika terjadi tuntutan di mana kasus diproses sesuai dengan prosedur hukum yang berlaku dan untuk pemenuhan fasilitas terutama bagi pasien tidak mampu. Sudah terdapat upaya peninjauan sebagai evaluasi risiko.
Kesimpulan: Langkah-langkah manajemen risiko dalam penanganan
pasien PEB/Eklampsia di IGD lantai 3 RSUPNCM sudah membaik
walaupun belum dilaksanakan secara optimal, terlihat dari pencapaian
tolok ukur keluaran dari angka kematian ibu, lama rawat, dan kepuasan pasien sampai bulan Agustus 2008 memberikan hasil yang baik dan menurunkan terjadinya risiko yang tidak diinginkan. Faktor-faktor yang mendukung baiknya keluaran adalah tenaga kerja yang terlatih terutama dokter, fasilitas pelayanan yang lengkap, serta pengawasan yang baik dan terstruktur.
[Maj Obstet Ginekol Indones 2009; 33-3: 135-42]
Kata kunci: PEB, eklampsia, manajemen risiko, IGD, RSC
Relation between CYP17 Polymorphism and Hyperandrogenemia in Polycystic Ovarian Syndrome
Get PDFObjectives: To find 5-untranslated region polymorphism of
CYP17 gene and its connection with hyperandrogenemia in polycystic ovarian syndrome.
Methods: A cross sectional descriptive study with consecutive random sampling method. Body mass index, ovarian morphology by ultrasonography, fasting insulin level, fasting blood glucose level, 17-hydroxyprogesterone level, total testosterone level, serum hormone binding globulin level, and CYP17 gene polymorphism in 45 subject with PCOs and 45 control subject who attend Yasmin clinic
of Cipto Mangunkusumo General Hospital with menstruation problems were measured. CYP17 gene polymorphism was evaluated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method with MspA1 restriction enzyme.
Results: In PCOs group, the genotype distribution were; 11.1% subject with genotype CC, 71.1% subject with genotype TC and 17.8% subject was wild type TT. In non PCOs group, the genotype distribution for CC, TC and TT respectively were 13.3%, 46.7% and 40%. There was significant difference between both group in distribution
of TC and TT genotype, with p value 0.013. Frequencies of
allele c and allele t in PCOs group were 47% and 53%. In non PCOs group, frequency of allele c and t were 37% and 63%. There were tendency for higher frequency of allele c in the PCOs group but the difference was not statistically significant. Median FAI value for genotype CC homozygote, TC heterozygote and TT homozygote in PCOs group respectively were; 6.82 (6.07 - 8.23); 5.59 (0.25 -21.45) and 4.74 (3.48 - 8.88). There was tendency for increase FAI value in PCOs group corresponds to variant allele, but the result was not statistically different.
Conclusion: There were higher proportion of CC homozygote and TC heterozygote genotype in PCOs patient with tendency of increasing FAI value.
[Indones J Obstet Gynecol 2011; 35-1: 3-7]
Keyword: polycystic ovarian syndrome, free androgen index, CYP17 polymorphis
Profile of Policystic Ovarian Syndrome Patients in Dr. Cipto Mangunkusumo General Hospital Jakarta March 2009 - March 2010
Get PDFObjective: To study phenotype profile and correlation between fasting blood glucose-fasting insulin ratio and luteinizing hormonefollicle stimulating hormone ratio with free androgen index in polycycstic ovarian syndrome in Dr. Cipto Mangunkusumo Hospital Jakarta.
Method: A descriptive cross-sectional study was carried out at Dr. Cipto Mangunkusumo General Hospital Jakarta in March 2009 - March 2010, using secondary data, were involved 105 reproductive age women who has been diagnosed as PCOs with Rotterdam criteria. History of the subjects was taken from medical record that consist of interview result about menstrual history and clinical
manifestations of hyperandrogenemia and clinical, biochemical, and ovarian ultrasound assessment.
Result: From 105 women were identified, 100 women with
oligo/amenorrhea (94.2%) and 34 women with hirsutism (32.4%). Further evaluation of the 105 cases, it was identified 80% subjects with polycystic ovaries morphology, 34.3% with hyperandrogenemia, 71.4% with insulin resistant, and 66.7% with increasing LH and FSH ratio. While, the most symptom and sign combination is
oligo/amenorrhea and polycystic ovaries morphology, that is 44.8%. With Spearman non parametric correlation test, there were a significant correlation between fasting blood glucose-fasting insulin ratio and free androgen index (FAI) with coefficient of correlation -0.342 and and between LH/FSH and FAI with coefficient of correlation
0.386.
Conclusion: The most common symptom and sign of PCOs patients in this study were oligo/amenorrhea and polycystic ovaries and insulin resistant. There were significant correlations between fasting blood glucose-fasting insulin ratio and LH/FSH with FAI.
[Indones J Obstet Gynecol 2011; 35-1: 8-13]
Keywords: polycystic ovarian syndrome, insulin resistance, luteinizing hormone hypersecretion, hyperandrogenemi
Pregnancy Exercise Reduce Oxidative Damage in Pregnant Women
Get PDFObjective: To determine the effect of exercise during pregnancy in reducing oxidative damage marked by decrease of malondialdehyde (MDA) and 8-hydroxy-2-deoxy-guanosine (8-OHdG) levels.
Method: A number of 66 pregnant women were recruited in this study and grouped to two groups, i.e. 30 of them as control group and the rest as treatment group. Pregnancy exercise was performed to all 36 pregnant women from 20 weeks gestation on treatment
group. The exercise was performed in the morning for about 30 minutes, twice a week until fullterm. Blood sample was taken for MDA and 8 OHdG level at the beginning of research, at 20 weeks of gestation, and at intial delivery or fullterm. Student’s t-test was applied
to compared the difference between treatment and control group with 5% significant value.
Result: This study reveals that there were significant decrease of MDA and 8-OHdG level amongs treatment and control groups (p < 0.05).
Conclusion: Light exercise started from pregnancy age 20
weeks will decrease MDA and raised 8-OHdG levels compared to control group without exercise.
[Indones J Obstet Gynecol 2011; 35-2: 57-60]
Keywords: oxidative stress, malondialdehyde, 8-hidroxy-2-
deoxy-guanosin
Ovarian reserve
Get PDFObjective: To asses ovarian reserve (OR) is important in infertility
management that will undergo Assisted Reproductive Technology
(ART) programs. using some methods, eg. physical measurements:
ovarian volume, Antral follicle Count (AFC); Biomarker assay,
indirect and direct methods, Day 3 FSH, Anti-Mullerian Hormone
(AMH), Inhibin B.
Method: Literature review in published studies which assessment
the Ovarian Reserve.
Conclusions: Assessment of ovarian reserve (OR) is very important
to predict the outcome of ART programs. There were several
methods to assessing the OR, but none as a single predictor. The
best candidate for a single biomarker is AMH.
[Indones J Obstet Gynecol 2010; 34-1:43-6]
Keywords: predictor of ovarium reserve, assisted reproductive
technolog
Gonadotoxic Effect of Combined Chemotherapy on Anti Müllerian Hormone (AMH) Level in non-Gynecologic Cancer Patients in Reproductive Age
Get PDFObjective: To assess the effect of combined chemotherapy on
levels of Anti-Müllerian Hormone (AMH).
Method: This is a prospective cohort study on 12 non-gynecologic
cancer women aged 20 - 40 years who received combined
chemotherapy treatment. AMH levels and menstrual pattern before
and after three months of chemotherapy were examined. The relationships between age, chemotherapy regimens and the cumulative doses on the change of AMH were also analyzed.
Result: The median age of subjects was 37 years (range 20 - 40
years). Pre chemotherapy AMH analysis revealed an inverse correlation between age and AMH levels (r = -0.715; p = 0.009). AMH
levels after 3 months of combined chemotherapy drastically declined
to 84.6% (p = 0.002). Multivariate analysis indicated that age
and total cumulative dose were the main factors contributing to the
AMH levels reduction (r = -0.679; p = 0.002 and r = 0.405; p =
0.027). Ten of 12 subjects (83.3%) experienced amenorrhea after
3 months of chemotherapy and had lower level of pre and postchemotherapy AMH compared to those who still maintained normal periods (p = 0.03 and 0.02).
Conclusion: AMH levels in non-gynecological cancer women
who received combined chemotherapy decreased dramatically after
3 months of chemotherapy. Main factors that contribute to this were
the cumulative dose and age. Most of these subjects experienced
amenorrhea after 3 months of chemotherapy.
[Indones J Obstet Gynecol 2010; 34-3: 119-24]
Keywords: ovarian reserve, chemotherapy, Anti Müllerian Hormone
(AMH), ovarian function, gonadotoxi
Expression of p16INK4a Biomarker has a Diagnostic Value in Predicting the Progressivity of Precancerous Cervical Lesion
Get PDFObjective: To evaluate clinical value of p16INK4a biomarker
level, by doing p16INK4a immunocytochemistry staining, as a predictor of progressivity of precancerous cervical lesion.
Method: Design of this research is case-control study which will
be stratified. Research was conducted in Cytology Laboratorium,
Gynecology Specialistic Division, Department of Obstetrics and
Gynecology, Dr. Cipto Mangunkusumo Hospital from August 2007
to September 2008. Immunocytochemistry examination was conducted in Anatomic Pathology Department, Dr. Hasan Sadikin Hospital. We divided the sample into two categories; patients with and
without cervical intraepithelial neoplasia (CIN). This research will
evaluate HPV infection and p16INK4a biomarker by doing p16INK4a
immunocytochemistry (ICC) staining.
Results: We have done immunocytochemistry examination in
130 patients, 26 without CIN and 104 with CIN. Immunocytochemistry cut-off point level is 50, which means value < 50 means low (L) p16INK4a expression and in reverse, value ≥ 50 means high (H) p16INK4a expression. The bivariate analysis of our study were p16INK4a (H) expression has the risk of CIN 1 with OR 8.4, for CIN 2 with OR 13 and for CIN 3 with OR 21, greater than p16INK4a (L) with all p values are significant. ICC p16INK4a (H) expression, age, number of sexual partners, and education are contributory to the risk of progressivity in CIN. The multivariate analysis demonstrates, ICC expression of p16INK4a (H) has a risk (OR) of CIN 1 17.19 times greater than p16INK4a (L); p16INK4a (H) expression’s OR for CIN 2 is 25.56; and for OR CIN 3 is 37.32. The expression of p16INK4a has a significant p value and high OR, thus ICC expression of p16INK4a is suggested to be included in the algorithm of precancerous cervical lesion guidelines and scoring of probability of CIN as an alternative to HPV DNA considering less cost of the test. In this research, we found a scoring model to determine probability of progressivity in precancerous cervical lesion.
Conclusion: The expression of p16INK4a has a diagnostic value
in predicting the progressivity of precancerous cervical lesion.
[Indones J Obstet Gynecol 2010; 34-3: 125-30]
Keywords: p16INK4a expression, immunocytochemistry, predictor
of progressivity, precancerous cervical lesio