Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Modification of Immediate Postplacenta CuT-380A IUD Insertion Using Ring Forceps and Standard Inserter: Twelve Months Follow-up
Get PDFObjective: To evaluate the outcome of CuT-380A IUD postplacental
insertion in vaginal delivery using new modification insertion technique.
Method: We carried out a prospective cohort study of postplacental
IUD insertion by means of ’push and push’ technique, using ring forceps and standard inserter (inserter tube and plunger rod). We included women who underwent vaginal delivery from 1st June 2009
until 31st March 2011 and had postplacental IUD insertion. Followup
was conducted for 12 months, including history, physical examination, ultrasound and questionnaires during evaluation, through home visits and by phone. The first monitoring is before 6 weeks after delivery, the second monitoring was after 6 weeks up to 3
months, the third is after 3 months up to 6 months, the fourth is after 6 months up to 12 months, the fifth is after 12 months up to 24 months and the sixth is after 24 months up to 32 months after insertion.
Result: On the second monitoring, 2 acceptors experienced expulsion.
At the third monitoring period, one acceptor requested for IUD
removal. At 9 months up to 12 months post-insertion, one expulsion
was encountered, and one acceptor requested removal of device. At
≥12 months there was one acceptor who had IUD removal. We did
not find any report of unintended pregnancy or perforation.
Conclusion: Immediate post-placental insertion of CuT-380A IUD
after vaginal delivery using ’push and push’ technique is safe and effective.
The pregnancy rate at typical use is 0%, continuation rate is
94.1% and low expulsion rate (2.86%). Loss of follow up was 5.6%
and no perforation was reported.
Keywords: continuation rate, immediate post-placental IUD insertion,
’push and push’ technique, typical use, vaginal deliver
CD4 Percentage and Absolute CD4 Accuracy not Different in Predicting Viral Load of HIVInfected Mothers
Get PDFObjective: To determine the accuracy difference between CD4 percentage
and absolute CD4 in predicting the viral load of HIV-infected
pregnant women.
Methods: This study is a diagnostic study involving 22 HIV-infected
pregnant women who came for PMTCT at the Outpatient Clinic in
Sanglah Hospital, from September 2011 until August 2012, who
were randomly selected through consecutive sampling. Blood samples
were collected to analyze the viral load, CD4, and complete
blood count (CBC). Viral load examination was conducted using PCR
in the molecular biology laboratory in the Faculty of Medicine University
of Udayana. CD4 and CBC test was conducted in Sanglah Hospital
Laboratory. Analysis was done with 2x2 table using SPSS for
windows® version 17 to evaluate sensitivity, specificity and accuracy
rate of CD4 percentage and absolute CD4 in predicting the viral
load.
Results: Data analysis shows that CD4 percentage had 75.0% sensitivity,
88.9% specificity, and accuracy of 86.4% for predicting the viral
load in HIV-infected pregnant women. Meanwhile, absolute CD4
had 50.0% sensitivity, 77.8% specificity, and 72.7% accuracy. Chisquare
test shows that there was no significant difference in the accuracy
of CD4 percentage and absolute CD4 (p=0.457).
Conclusion: CD4 percentage and absolute CD4 had high accuracy in
predicting the viral load in HIV-infected pregnant women (86.4%
and 72.7%). There was no significant difference of accuracy between
the CD4 percentage and absolute CD4.
[Indones J Obstet Gynecol 2015; 3-4: 230-233]
Keywords: CD4, HIV-infected pregnant women, viral loa
Identifying Causes of Vaginal Discharge: The Role of Gynecologic Symptoms and Signs
Get PDFAbstract
Objective: To attain diagnostic accuracy of various gynecologic symptoms and signs in identifying causes of vaginal discharge.
Method: Eighty-two subjects were included in this cross sectional study. Gynecologic symptoms and signs were inquired from each subject and further laboratory examinations were carried out to identify the etiology. Diagnostic accuracy for each symptom and sign was compared to the laboratory examination as the standard reference. Symptoms and signs with positive predictive value (PPV) of more than 50% were considered to have good diagnostic accuracy.
Result: For bacterial vaginosis, excessive wetness in genital area; vulvar maceration; and thin, turbid, yellowish vaginal discharge had PPVs of 53%; 52%; and 52%, respectively. For candidal vaginitis, vulvar maceration; and white, curd-like vaginal discharge had PPVs of 58% and 100%, respectively. For trichomoniasis, thin, turbid, frothy, yellowish vaginal discharge; and strawberry-cervix appearance had PPVs of 60% and 100%, respectively. There were no symptoms or signs with PPV of more than 50% for chlamydial cervicitis. Diagnostic accuracy for clinical findings in gonorrheal cervicitis could not be calculated due to the small number of subjects.
Conclusion: Various gynecologic symptoms and signs were found to be accurate in diagnosing bacterial vaginosis, candidal vaginitis, and trichomoniasis. No symptoms or signs were considered accurate to aid etiological diagnosis for chlamydial and gonorrheal cervicitis.
Keywords: bacterial vaginosis, Candida sp, Chlamydia trachomatis, gynecologic symptoms and signs, Neisseria gonorrhoeae, Trichomonas vaginali
Serum Malondialdehyde Level as a Risk Factor for Threatened Abortion
Get PDFObjective: To determine the role of serum malondialdehyde level as a risk factor for threatened abortion.
Method: Our study was a caseâ€control study. We examined 60 pregnant women as our subject, 30 subjects with threatened abortion as cases and 30 subjects with normal pregnancy as control group. Serum levels of malondialdehyde of each woman was examined in the Biochemistry Laboratory Faculty of Medicine Gadjah Mada University in Yogyakarta. We tested the normality of our data using Kolmogorov†Smirnov test, and analysis was then performed using independent sample tâ€test. To determine the relationship of serum malondialdehyde with threatened abortion, Chiâ€Square test was used.
Result: From this study we found that the average serum malondialdehyde level in threatened abortion was 1.33K0.11 nmol/ml, while the average level of serum malondialdehyde in normal pregnancy was 1.03K0.10 nmol/ml. The analysis using independent tâ€test shows that the average serum malondialdehyde level on the two groups was significantly different (p=0.001). Based on the cutâ€off value of 1.12 nmol/ml, we found that the relative risk of threatened abortion is 29.57 times (95% CI=6.85â€127.64, p=0.001) in those with a high level of serum malondialdehyde.
Conclusion: The serum malondialdehyde level in threatened abortion was significantly different compared to normal pregnancy. A high level of serum malondialdehyde in pregnancy was a risk factor for threatened abortion.
Keywords: malondialdehyde, normal pregnancy, threatened abortio
Prevalence of Lower Urinary Tract Symptoms in Women Based on Bahasa Indonesia Validated ICIQ-FLUTS Long Form
Get PDFObjective: To obtain the prevalence of women with lower urinary
tract symptoms (LUTS) in Dr. Cipto Mangunkusumo National Hospital,
Indonesia.
Method: We conducted a descriptive and analytic study with questionnaire-
based data collection. All subjects were interviewed using
the conventional method and International Consultation on Incontinence
Questionnaire (ICIQ) Female LUTS long form validated in Indonesian
language in the gynecology outpatient clinic in Dr. Cipto
Mangunkusumo Hospital.
Result: Using the conventional method, proposing only one question
of urinary disturbance without asking the detailed symptoms, a
low prevalence of LUTS was obtained (17.3%). On the other hand,
with a well-structured questionnaire using ICIQ-FLUTS long form,
the prevalence of LUTS was 95.3%. This result revealed that LUTS
was a common condition among Indonesian women in the study
population with vaginal delivery as the common risk factor.
Conclusion: Screening for LUTS using a structured questionnaire
identified a significantly higher prevalence of LUTS than the conventional
method. The ICIQ-FLUTS long form validated in Indonesian
language is a robust questionnaire that can be recommended for use
in epidemiological research as well as routine clinical practice.
Keywords: ICIQ FLUTS long form, Indonesia, LUTS, prevalence,
wome
Endometrial Histology in Abnormal Uterine Bleeding with Risk Factors
Get PDFObjective: To determine the endometrial histology in abnormal
uterine bleeding (AUB) patients with risk factors.
Method: This study involved 30 patients with complaints of AUB,
aged over 35 years with associated risk factors of parity, obesity and
fasting blood glucose in the outpatient clinic at Prof. Dr. R. D. Kandou
General Hospital Manado, from July 2013 until October 2013.
Patients who agreed to be involved in this study, underwent dilatation
and curettage (D&C) to assess the endometrial histology that was
grouped as the hyperplasia and non-hyperplasia groups.
Result: From the results of the study, 7 patients were in the 35-40
years age group (23.3%) and in the 41-50 years age group were 23 patients
(76.7%). Based on parity, 11 patients (36.7%) were nulliparous
and 19 patients (63.3%) were multiparous. Based on the BMI, 16 patients
(53.5%) were obese and 14 patients (46.7%) were non-obese.
And based on the results of fasting blood sugar, similar results was
obtained in normal and abnormal fasting blood glucose with the results
of 15 patients in each groups (50%). And from all of patients
who underwent D&C, endometrial hyperplasia was shown in 21 patients
(70%) and non-hyperplasia endometrium in 9 patients (30%).
From the results of Fischer exact test, a significantly high association
was obtained between BMI and fasting blood glucose with the occurrence
of endometrial hyperplasia.
Conclusion: There is a significant relationship between BMI and high
fasting blood glucose with endometrial hyperplasia.
[Indones J Obstet Gynecol 2015; 3: 146-150]
Keywords: age, AUB, BMI, endometrial hyperplasia, fasting blood
sugar, parit
Promising Male Hormonal Contraceptive are Well Established Soon a Reality
Get PDFObjective: To understand the modalities used for male hormonal
contraception.
Methods: Literature review
Conclusion: Male contraceptive methods are still limited but hormonal
contraceptive methods are being developed. The basic
mechanism of male hormonal contraception is to inhibit spermatogenesis
by suppression of the hypothalamic-pituitary-testicular axis
function. Administration of testosterone or androgen derivative that
is given in combination with progestin or GnRH antagonist shows
that male hormonal contraceptive is reversible, effective, and acceptable
as a male contraceptive method. However, no method of male
hormonal contraceptive is ready for clinical use and marketed due
to limited studies.
[Indones J Obstet Gynecol 2015; 3-4: 239-243]
Keywords: GnRH antagonist, male hormonal contraceptive, progestin,
testosteron
Difference of Vertical Transmission in HIV-Infected Women with Complete and Incomplete PMTCT
Get PDFObjective: To analyze any differences on vertical transmission in
groups with complete and incomplete program as well as the factors
influencing completion.
Method: This was a retrospective cohort study performed by data
collection from medical records and/or interviews from January
2010 to February 2012. The variables analyzed subject characteristics,
applied PMTCT program and risk factors affecting transmission.
Result: Seventy-five pregnant women who were HIV-positive were
initially recruited, but 21 subjects were excluded due to incomplete
medical records. In the first group (n=27) who received complete
PMTCT, no vertical transmission was identified, while in the second
group (n=27) with incomplete PMTCT, seven children were found to
be HIV-positive. Rupture of membrane for more than 4 hours was
the only significant risk factor for vertical transmission (p=0.001,
RR=64.5, 95% CI=6.14-677.6).
Conclusion: There was a significant difference in the occurrence of
vertical transmission between complete and incomplete PMTCT
program. Complete PMTCT program may provide protective effect
against the occurrence of vertical transmission by 25.9%.
Keywords: HIV, PMTCT, vertical transmissio
Placental Growth Factor Levels in Preeclampsia Compared to Normal Pregnancy
Get PDFObjective: To identify and analyze the differences in the levels of
PlGF in preeclampsia and normal pregnancy.
Method: This was a cross-sectional observational qualitative study
of PlGF in preeclampsia and normal pregnancy. The number of samples
in case and control group was 30 in each groups.
Result: We found that mean of maternal age in the preeclampsia
group was 28.53 years and 25.23 years in the control group. Mean
parity in preeclampsia and control group was 2.33 and 1.56, respectively.
Mean hemoglobin level in preeclampsia and control group
was 11.97 and 11.99, respectively. Mean maternal blood glucose
level was 87.0 in the preeclampsia group, and 87.9 in the control
group. In the preeclampsia group mean urea concentration was
16.45, while it was 22.78 in the control group. Mean creatinine level
was 0.92 in the preeclampsia group and 0.64 in the control group.
Mean SGPT and SGOT in the preeclampsia group was 23.36 and
21.97, while in the control group was 29.86 and 26.20. Test results
showed that PlGF levels was significantly different between the preeclampsia
and control group. Mean PlGF in the preeclampsia and control
group was 42.10 and 452.33 respectively, with
User Profile and Factors Correlating to Duration of Intrauterine Device Use
Get PDFObjective: To determine the demographic and clinical profile of intrauterine
device (IUD) users and factors correlating to duration of
IUD use.
Method: We conducted a prospective observational study of 867 patients
who underwent IUD insertion in Raden Saleh Outpatient Clinic
during the period of January - December 2011. All patients were followed
for 1 year to ascertain any complaint of discharge after insertion.
Spearman correlation test was conducted to inves- tigate the
strength of correlation and significance between age, parity, and discharge,
with duration of IUD use.
Result: During year 2011, 867 patients (median of age=34
[range=14-49]; median parity=2 [range=0-7]) underwent IUD
insertion in Raden Saleh Clinic. The majority of subjects were aged
between 31-35 years old and were willing to use IUD for 4 years.
Bivariate analysis revealed a significant correlation between age,
parity, and vaginal discharge with duration of IUD use. The strongest
correlation was identified between age and duration of use (r=0.25,
p0.002 for parity and
duration of use; r=0.05 p=0.045 for discharge and duration of use).
Conclusion: Most IUD users were aged 31-35 years, who were
willing to use IUD for 4 years. Factors that correlated with duration
of IUD use were age, parity, and vaginal discharge.
Keywords: contraceptive, duration of use, family planning, intrauterine
devic