Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Kegel’s Exercise could Reduce the Incidence of Postpartum Urinary Stress Incontinence
Get PDFObjective: To investigate the cause of postpartum urin ary incontinence in primi gravida women and to determin e the relationship between stress urinary incontinence and kegel's exercise.
Method: This was an observational study with cross sectional method , perform ed in instituti onal hospitals in Makassar. Thirty primigravida women who performed kegel's exercise were compared with 30 primi gravida women who did not perform kegel's exercise. Data were analyzed with independent-t sta tistical analysis.
Result: Urinary incontinence were significantly lower in primigravida women who performed kegel's exercise (P=O.OOO).
Conclusion: Kegel's exercise may reduce the incidence of postpartum stress urinary incontinence.
Keywords: kegel's exercise, primigravida, urinary Incontinence
The Level of 8-OHdG Serum was Higher in Women with Blighted Ovum
Get PDFObjective: To determine the difference of 8-hydroxy-2-deoxyguanocyne (8-OHdG) serum level in women experiencing blighted ovum and women with normal pregnancy.
Method: This was a cross sectional study with 82 samples, divided into two groups. Thirty two cases of blighted ovum and 51 cases of normal pregnancies, with 7-12 weeks gestational age. The examination of 8-OHdG serum level, was performed with the venous blood taken from the cubiti veins, and its 8-OHdG serum quantities were than examined at the Pathology Lab. at Sanglah General Hospital. Data was analyzed with the Shapiro Wilk Test and the t independent test with alpha 0.05.
Result: The average 8-OHdG serum level in women with blighted ovum and normal pregnancies were 0.177 (SD 0.06) ng/ml and 0.111 (SD 0.01)ng/ml, and significantly different (p<0.05). The cut off value of 8-OHdG serum level was 0.138 ng/ml with sensitivity of 96.1% and specificity of 80.6%.
Conclusion: The level of 8-OHdG serum was higher in women with blighted ovum than in women with normal pregnancies.
Keywords: 8-OHdG serum level, blighted ovum, and normal pregnancy
Primipara Undergoing Episiotomy had Lower Postpartum Sexual Function
Get PDFObjective: To compare postpartum sexual functions between primipara with episiotomy and without episiotomy.
Method: The research was conducted in public service section of Dr. Wahidin Sudiro Husodo hospital and a number of educational hospitals obstetrics and gynecology of Faculty of Medicine of Hasanuddin University, started from February to May 2012. The research evaluated the sexual function of postpartum with episiotomy in 171 primipara, and 150 primipara postpartum without episiotomy. Sexual function was measured by Female Sexual Function Index (FSFI) questionnaire which had been validated in various countries. The research was conducted with cross sectional approach. Samples were withdrawn with consecutive sampling method. The data was processed with SPSS version 17, with chi-square test, and significant level of 0.05.
Result: Indicated that either the episiotomy or non-episiotomy group has undisturbed sexual function score (>28.5), however, higher score was indicated in non-episiotomy group (65.477) compared to the episiotomy group (59.70), (p<0.05).
Conclusion: Primipara with episiotomy and breastfeeding has lower sexual functions compared to the non-breastfeeding group, however, it was statistically insignificant (p>0.05).
Keywords: episiotomy, FSFI, primipara, sexual function
Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment: Perforasi Uterus pada Mola Hidatidosa Invasif saat Tatalaksana EMACO
Get PDFObjective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole.
Method: Case report.
Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment.
Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential.
Keywords: EMACO, invasive mole, perforatio
Laparoscopic Transperitoneal Approach for Vesicovaginal Fistula Repair: the First Experience: Terapi Pembedahan Fistula Vesikovagina secara Laparoskopik Transperitoneal: Pengalaman Pertama
Get PDFObjective: To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Dr. Hasan Sadikin Hospital.
Method: A 31-year-old female presented with vesicovaginal fistula after cesarean section. Patient complained of urinary incontinence since 5 years ago. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Initially, cystoscopy was performed to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in lithotomy position and slightly Trendelenburg. Without opening the bladder, the fistula tract was excised and the bladder was separated from the anterior vaginal wall. Both the bladder and vaginal walls were then closed separately using intracorporeal suturing, interposed with the omentum.
Result: Total operative time was 270 minutes. Normal diet was resumed on day 1, drain was removed on the first day after surgery, and the patient was discharged on the second day with an indwelling catheter. Surgical wound showed good cosmetic result and no leakage was identified from cystogram after 2 weeks. The catheter was removed after 2 weeks.
Conclusion: Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Dr. Hasan Sadikin Hospital with good outcome, short hospital stay, and good cosmetic result.
Keywords: laparoscopy, vesicovaginal fistul
Serum Level of Vascular Endothelial Growth Factor (VEGF) can be used to Assess Response of Radiation Therapy in Cervical Cancer
Get PDFObjective: To compare the sensitivity and specificity of Squamous Cell Carcinoma (SCC) and Vascular Endothelial Growth Factor (VEGF) levels to assess the response of radiation therapy.
Method: The study was conducted by the method of analytic observational cohort study in 24 patients with cervical cancer stage II-B and III-B in RSCM that met inclusion criteria. Examination of VEGF and SCC in serum samples was performed in the Prodia Laboratory Jakarta. The examination was conducted twice before and after radiation therapy. The subjects were treated by radiation therapy/chemoradiation according to standard procedures. After the completion of radiation was declared, the response of radiation therapy was conducted by clinical assessment.
Result: Of the 24 subjects, we obtained a mean level of SCC pre-radiation was 23.43 ± 5.84 ng/ml and post-radiation was 2.19 ± 0.68 ng/ml. The mean VEGF pre-radiation was 790.41 ± 111.06 pg/ml and post-radiation was 497.47 ± 79.26 pg/ml. ROC curves of each tumor marker obtained SCC pre-radiation AUC 40%, p 0.53 (CI 0.18-0.68) and SCC post-radiation AUC 48.1%, p 0.91 (CI 0.21-0,75) can not be used as a diagnostic and prognostic factors of response to radiation therapy. VEGF pre-radiation produced an AUC of 17.5%, p 0.04 (CI 0.00-0.36), thus cannot be used as a prognostic factor for response to radiation therapy. VEGF after radiation produced an AUC of 92.5%, p 0.01 (CI 0.81-1.00), thus can be a diagnostic factor for response to radiation therapy. VEGF post-radiation with cut-off point 614.75 pg/ml had a sensitivity 80%, specificity 75%, NDP 94.12%, NDN 42.86%; RKP 3.2; RKN 0.26 and accuracy 79.16%. There is a significant correlation between the decrease of serum VEGF level post-radiation and a positive response of radiation therapy (p 0.01, CI 1.00-3.23).
Conclusion: Examination of VEGF levels can be used to assess the response of radiation therapy with a sensitivity of 80% and specificity of 75%.
Keywords: cervical cancer, SCC, therapeutic response, VEG
Social Support and Postpartum Depression in Human Immuno Deficiency Virus (HIV) Patients: Hubungan Dukungan Sosial terhadap Depresi Pascapersalinan pada Pasien Human Immuno Deficiency Virus (HIV)
Get PDFObjective: To evaluate the relationship between social support given to HIV patients with the incidence of postpartum depression.
Method: All HIV patients who had delivery in Dr. Cipto Mangunkusumo hospital and Prof. dr. Sulianti Saroso hospital during the period of October 2012 to March 2013 were enrolled as research subjects. We performed depression screening with the Edinburgh Postnatal Depression Scale (EPDS) and to measure the social support provided by Social Support Questionnaire/Kuesioner Dukungan Sosial (KDS). Statistical analysis was done using Fisher’s exact test, Chi-square and unpaired t-test.
Result: We found a total of 34.1% of subjects who experienced postpartum depression, in which 40% did not received proper social support. Considering the demographic characteristics of the subjects who experienced depression, 70% was in age group 20-35 years, 56.7% of subjects had low education level and 70% was primiparous. Conclusion: Social support has a protective effect towards postpartum depression in HIV patients.
Keywords: Edinburgh postnatal depression scale, HIV, (kuesioner dukungan sosial), postpartum depression, social suppor
Effect of Delay in Postpartum Hemorrhage Management on the Rate of Near-Miss and Maternal Death Cases: Pengaruh Keterlambatan Penanganan Perdarahan Pascapersalinan terhadap Kejadian Hampir Mati dan Kematian Ibu
Get PDFObjective: To recognize the effect of delay in the management of postpartum bleeding to the occurrence of near-miss and maternal death cases. Method: Prospective cohort. The study population was patients with postpartum hemorrhage. All PPH cases from thirteen hospitals (Sardjito and 12 affiliated hospitals) were recorded. The study was carried out from January 1st to June 30th 2009. The study group was those who experienced delay and the control group was those without delay. The outcome was measured as the number of near-miss and death cases. Near-miss was defined as those who experienced severe shock, demonstrated by systolic blood pressure 90 mmHg or less. Chi square test, t-test and logistic regressions were used to analyze our data.Result: From January 1st to June 30th 2009 we identified 139 cases of PPH from 8,924 deliveries (1.6%). From the 80 referred cases, as much as 22 cases (27.5%) were delayed, and 12 from 139 (8.6%) experienced delay in the hospital. A total of 30 cases among 139 (21.6%) experienced delay both outside and in the hospital. There were 74 near-miss cases, 9 of which ended in death of the patient. This means the real occurrence of near-miss cases is 65 from 139 cases or 46.8% while the occurrence of maternal death was 9 out of 139, or 6.47%. Case fatality rate was 9 from 139 or 6.47%; maternal near-miss ratio was 6.22; mortality index was 13.84% and maternal mortality ratio is estimated as 103/100.000 live births. Multivariate analysis showed delay in referral increased the risk of near-miss cases as much as 8.37 folds, while bleeding >1500 ml increased risk of near-miss by 12.12 folds. Delay in both referral and management in the hospital increased the risk of maternal death rate as much as 25.34 folds, hemoglobin <6 g/dl and unavailability of blood increase maternal death by 31.58 folds and 13.39 folds, respectively.Conclusion: Delay in referral and delay of in-hospital management ncreased the occurrence of near-miss and maternal mortality cases significantly. Multivariate analysis showed that the amount of bleeding, hemoglobin level and lack of blood availability influenced the occurrence of near-miss and maternal death more than the delay itself.Keywords: delay, maternal death, maternal near-miss, PP
Higher Preoperative Endometrial Cancer Risk Showed More Advanced Stage
Get PDFObjective: To evaluate the pr eoperative endo metria l cancer risk as a guida nce to choose th e typ e of surg ical approach based on European Society for Medical Oncology guideline (200 9).
Method: Cross-sectional study involved 73 endometrial cancer patients of Dr. Cipto Mangunkusumo Hospital, from january 200 6 to December 2012 whi ch obt ain ed from medical record. The inclusion criteria wer e endometr ial cancer pati ents with compl ete D&C, ultr asonographic, and postoperative histopathological rep orts. Endometrial cancer risk of recurren ce was classified acco rding to ESMO 2009 and final diagno sis and stage based on FIGO.
Result: From 40 5 patients, only 73 patients had compl ete reports. Most of the them were postmenopaus al (54.8 %), non-nulliparity (79 .9%), and obese (49.5%) women.According to risk of recurren cestratification, low, intermediate and high risk were found in 12 patients, 27 patients, and 34 pati ents. Based on FIGO, there were 60.2% early and 39.8% advanced sta ge. In high risk gro up, rates of advan ced stage wer e prominent compar ed to othe r gro ups. There were 38.3% patients with postoper ativ e positive lymph nod es metastases.
Conclusion: Most of th e endometrial cancer patients we re pr eoperatively diagnosed as high risk. The commones t stage after surgical examination were me. High risk of recurrence showed more positive lymph node compared to low or intermediat e risk. Result of preoperative histopathological and myometrial invasion compared to postoper ative results wer e showed to be inconsistent Pat ients with =1/2 myometrial invasion had more positive lymph nodes metastases. Endometrial cancer risks compared to FIGO stage showed the higher the risk, th e more advanced the stage were.
Keywords: endometrial cancer, FIGO stage, high risk, histol ogical type, intermediate risk , low risk, lymph node