Jurnal Kesehatan Reproduksi
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Perbandingan Luaran Maternal dan Perinatal Kehamilan Terkonfirmasi Covid-19 antara Gelombang Pertama dan Kedua Pandemi
Get PDFBackground : New cases of COVID-19 continued to emerge due to the new variants. Pregnant women are more susceptible to severe infections.Objective : To compare the effect of COVID-19 infection on maternal and perinatal outcomes in the first and second waves.Method : An analytical observational study with a cross-sectional design was used. Samples were selected by consecutive sampling from the medical record data of RSUP Dr. Kariadi Semarang, Indonesia, with 47 cases during the first wave (1 August 2020 to 14 May 2021) and 47 cases during the second wave (16 May to 30 September 2021). Data were analysed using univariate, chi-square, fisher’s exact, and logistic regression tests with a significant value of p <0,05.Results and Discussion : Pneumonia, ICU admission, and oxygen consumptions were higher in the second than the first wave as 87.23% VS 70.21%; p = 0.044, 36.17% VS 14.89%; p = 0.018, 65.96% VS 12.77%; p < 0.0001 respectively. The severe COVID-19 infection and maternal mortality increased in the second wave (51,06% VS 14,89%; p = 0.009; 29,79% VS 8,51%; p = <0.001). There were no differences in perinatal outcomes between the first and second waves such as fetal distress, fetal growth retardation, low birth weight, nICU admission, and mortality (0.00% VS 8.51%; p = 0.117, 0.00% VS 4.26%; p = 0.495, 12.77% VS 25.53%; p = 0.116, 12.77% VS 21.28%; p = 0.272, 4.26% VS 8.51%; p = 0.677). The incidence of COVID-19 infection in neonates remained low in both waves at 17.02% VS 12.77%; p = 0.562.Conclusion : Even though a high number of severe diseases to maternal deaths were found during the second wave, neonatal COVID-19 infections remained low.
Hubungan Seksio Sesarea Crash dengan Luaran Maternal di RSUP Dr.Sardjito
Get PDFBackground: Crash caesarean section is performed because there is a life-threatening condition to the mother or fetus. The duration between a decision is made to perform a caesarean section until delivery the baby is termed decisions to delivery interval (DDI) or response time. Response time of 30 minutes from the decision to baby delivered is considered to prevent complications and worsen maternal conditions.Objective: To assess the relationship between response time in crash caesarean section with maternal outcome at Dr. Sardjito Hospital.Method: This study was cross sectional method using secondary data from the medical record. The subjects were all pregnant women who underwent crash caesarean section and met the inclusion criteria from January 2021 to December 2022 at Dr. Sardjito Hospital.Results and Discussion: There were 38 cases that met the criteria from 114 cases of crash caesarean section during the period January 2021 to December 2022. From the data obtained, response time of £ 30 minutes was 4 (10,5%) cases and response time > 30 minutes was 34 (89,5%) %) cases. There was no significant relationship between the duration of response time and the maternal outcomes of ICU care, blood transfusion, length of hospital stay, or surgical wound infection (p>0,05). From bivariate analysis, maternal outcomes ICU care was statistically significant relationship of preoperative Hb level <8 g/dL (p=0,003; RR 2,500; 95% CI 1,613-3,875) and severe antepartum hemorrhage (p=0,000; RR 9,880; 95% CI 1,484-65,787). From bivariate analysis, severe antepartum hemorrhage was statistically significant against maternal outcomes blood transfusion (p=0,000; RR 2,600; 95% CI 1,307-5,171).Conclusion: There was no relationship between the duration of response time for crash caesarean section based on maternal indications with maternal outcomes (ICU care, blood transfusion, length of hospital stay, and surgical wound infections) at Dr. Sardjito Hospital. There is a significant relationship between severe antepartum hemorrhage with maternal outcomes of ICU care and blood transfusion. Keywords: crash caesarean section, response time, DDI, maternal outcom
Successful Conservative Treatment of Cesarean Scar Pregnancy with Systemic Methotrexate Injection: A Case Report
Get PDFCesarean scar pregnancy (CSP) is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty one-year old third gravida presented at five weeks of gestation with complaints of vaginal spotting. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography. Conservative management of CSP was done successfully with the injection of systemic methotrexate. CSP pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. The optimal management of caesarean section pregnancy should be individualized depending upon the hemodynamic status depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, and patient’s preference
Faktor-Faktor yang Mempengaruhi Cakupan Skrining Kanker Serviks dan Loss to Follow Up pada Wanita dengan IVA Positif yang Menjalani Krioterapi di Negara Berkembang: Scoping Review
Get PDFBackground: Cervical cancer is one of the main health problems in developing country and the second most common cancer in Indonesian women. For a better outcome, it is necessary to pay attention for discovery of the disease at an early stage. Single visit approach with visual inspection of acetic acid (VIA) followed by cryotherapy considered efficient and cost effective. However, low uptake of screening and loss to follow up after cryotherapy remain the biggest challenge.Objective: We aimed to identify factors affecting low uptake of cervical cancer screening and loss to follow up women with VIA positive undergone cryotherapy in developing countries.Method: This study is a literature review with scoping review design. Systematic search were conducted from databases PubMed, ScienceDirect, SAGE journals, Scopus and Google Scholar. Total 42 articles were selected for analysis, 35 articles discussed factors affecting cervical cancer screening uptake in developing countries and 7 articles discussed loss to follow-up women with VIA positive undergone cryotherapy.Results and Discussion: Factors identified affecting cervical cancer screening uptake and loss to follow up from demand side included lack of knowledge, perception and awareness, access constrain, fear or shame feeling and cost related problem. From supply side or healthcare system, these factors included lack of trained providers, lack of infrastructure, lack of information, coordination and communication, as well as ineffective administrative processes.Conclusion: Problems of cervical cancer screening uptake and loss to follow up after cryotherapy were identified from demand side and health service provider side. Recommendation of service improvement must consider influencing factors and limitations encountered on the field. Keywords: cervical cancer, screening, visual inspection of acetic acid, loss to follow-up, cryotherap
Analisis Presumed Consent pada Penanganan Kasus Kegawatdaruratan Obstetri dari Persepsi Dokter dan Pasien
Get PDFLatar Belakang: Kondisi kegawatdaruratan obstetri, etika kedokteran dan hukum kesehatan memberikan tantangan tersendiri dalam pengambilan keputusan dokter. Pengambilan keputusan dalam kondisi kegawatdaruratan obstetri bervariasi tergantung kondisi medis pasien, dilema etik yang muncul ataupun aliran berpikir bioetika. Tujuan: Menganalisis presumed consent pada penanganan kasus kegawatdaruratan obstetri dari persepsi dokter dan pasien melalui aspek Kaidah Dasar Bioetika, Etika Klinik dan aliran berpikir bioetika.Metode: Metode kualitatif dengan pendekatan case study. Penelitian ini menggunakan desain holistic single case study design melalui wawancara mendalam kepada informan dokter dan pasien.Hasil dan Pembahasan: Dalam menyelesaikan suatu dilema etik, analisis prima facie menjadi solusi dalam pengambilan keputusan terhadap dilema etik bagi dokter dengan cara memilih prinsip yang lebih diprioritaskan berdasarkan kaidah dasar bioetika, etika klinik dan aliran berpikir bioetika.Kesimpulan: Implementasi metode presumed consent menjadi pilihan yang tepat dalam penanganan kondisi kegawatdaruratan obstetri berdasarkan aspek kaidah dasar bioetika, etika klinik dan aliran berpikir bioetika. Kata kunci: presumed consent; kegawatdaruratan obstetri; aliran berpikir bioetika; kaidah dasar bioetika; etika klini
Perbandingan Karakteristik dan Luaran Maternal pada Unexpected Spektrum Placenta Akreta saat Pandemi Covid -19
Get PDFLatar belakang: Pandemi COVID-19 mempengaruhi sistem pelayanan kesehatan di dunia. Kegawatan maternal yang diakibatkan oleh Spektrum Placenta Akreta (SPA) menjadi tantangan di bidang obstetri, khususnya dalam kinerja multidisplin tim dan dukungan sumber daya fasilitas kesehatan.Tujuan: Membandingkan karakteristik dan luaran dari pasien dengan unexpected dan expected SPA saat pandemi COVID-19.Metode: Desain penelitian secara cross-sectional. Pengambilan sampel kasus SPA secara consecutive sampling dari data rekam medis RSUP Dr. Kariadi, Semarang, pada periode 2020 – 2021.Hasil dan Pembahasan: Limapuluh tiga dari 154 kasus (34,42%) merupakan unexpected SPA. Tidak terdapat perbedaan karakteristik yang meliputi umur, indeks massa tubuh, jumlah riwayat sectio cesarea, jumlah riwayat placenta previa, cara persalinan dan kerjasama tim. Jumlah perdarahan dan kebutuhan transfusi darah yang diberikan tidak terdapat perbedaan pada kedua kelompok. Terdapat risiko untuk Cesarean histerektomi pada unexpected SPA (adjusted OR 4,13 (1,31-55,02)). Case Fatality Rate (CFR) pada unexpeted 5,67%, sedangkan pada expected 0,9%. Pada kasus unexpexted SPA didapatkan 3 kasus dengan terkonfirmasi COVID-19 dan meninggal.Kesimpulan: Tata kelola spektrum placenta akreta di RSUP Dr. Kariadi selama pandemi COVID-19 tidak terdapat perbedaan luaran maternal pada kasus unxpected dan expected dan didapatkan kualitas pelayanan optimal dengan CFR yang rendah.Kata kunci: Spektrum Placenta Akreta (SPA), unxpected dan expected, pandemi COVID-19, luaran materna
Evaluation of the Application of Modified Early Obstetric Warning Score in Maternal Patients at Sardjito General Hospital in 2019-2020
Get PDFBackground: Modified Early Obstetric Warning Score (MEOWS) is used to identify obstetric patients at risk of deterioration. MEOWS has long been used in the maternal ward of Dr. Sardjito Central General Hospital. Research in other countries found that MEOWS cards were not filled in completely and some MEOWS cards were not followed up.Objective: to determine the completeness of the MEOWS card and the suitability of the interventions carried out with the MEOWS card instructions.Methods: This study is a mixed method study (quantitative descriptive and qualitative phenomenology).Results: Out of 1285 study subjects, the proportion of complete MEOWS cards was 84.67%. The proportion of appropriate interventions was 95.05%. Appropriate intervention was associated with length of hospitalization ≥ 7 days, p value 0.043, prevalence ratio 0.456 (95% confidence interval 0.242-0.858). Reasons for staff not completing MEOWS cards and not performing appropriate interventions were management factors, lack of knowledge, compliance, vigilance, training and medical records.Conclusion: Most MEOWS cards were completed and appropriate interventions were performed. Appropriateness of MEOWS interventions is likely to reduce the prevalence of length of stay ≥ 7 days. MEOWS completion and interventions are influenced by staff management, knowledge, vigilance and compliance, which can be improved by training and practical use of medical records
Gangguan Stres Pasca Trauma pada Kasus Pelecehan Seksual: Case Report
No full textAbstrakLatar belakang: Tindakan kekerasan atau pelecehan seksual semakin banyak dilaporkan pada beberapa tahun belakangan ini, terutama pada perempuan. Bukan saja pada tingkat global, tetapi juga nasional maupun lokal. Tindakan kekerasan atau pelecehan seksual berpotensi menimbulkan trauma yang mendalam bagi korban, depresi maupun gangguan kejiwaan yang lain.Metode: Studi kasus tentang pelecehan seksual yang menimbulkan gangguan stress pasca trauma.Hasil dan Pembahasan: Seorang perempuan 18 tahun, masih sekolah ditingkat SMA mengeluh ketakutan setelah mengalami beberapa kali kekerasan atau pelecehan seksual baik oleh orang terdekat maupun orang yang tidak dikenal. Dengan pendekatan multiaksial korban diagnosis dengan Gangguan Stress Pasca-Trauma. Terkonfirmasi korban mengalami Depresi berat menggunakan Hamilton Depression Rating Scale dan Depresi ekstrim dengan menggunakan Beck Depression Inventory. Teridentifikasi beberapa faktor seperti: Adanya konflik dan kekerasan dalam keluarga, pernah menjadi korban atau perbuatan seksual sebelumnya, lingkungan keluarga yang tidak mendukung secara emosional, hubungan orang tua-anak yang buruk, dan kemiskinan. Dilakukan tatalaksana secara komprehensif menggunakan pendekatan multidisilin. Secara Farmakologi diberikan Risperidon 1 miligram tablet tiap 24 jam per-oral pagi, dan Sertraline 25 miligram tablet tiap 24 jam per-oral malam. Korban juga mendapatkan psikoterapi, edukasi, dan dukungan sosial. Selanjutnya terhadap korban dilakukan pemantauan secara berkala.Kesimpulan: Kekerasan atau pelecehan seksual rentan menimbulkan Gangguan Stress Pasca-Trauma sehingga memerlukan pendekatan multidisiplin dan tatalaksana komprehensif. Mulai dari melakukan anamnesis untuk konfirmasi diagnosis, tatalaksana dan pemantauan.Kata kunci: pelecehan seksual pada perempuan, Gangguan stress Pasca-Trauma, Depresi.
Dukungan Sosial Suami Terhadap Pemberian ASI Eksklusif di Wilayah Puskesmas Sinorang Kabupaten Banggai
Get PDFBackground: Exclusive breastfeeding is one of the world's efforts to prepare healthy future generations from an early age.Objective: This research is to determine the relationship between husband's social support and exclusive breastfeeding for breastfeeding mothers at the Sinorang Community Health Center, Banggai Regency.Method: This research is quantitative research with a cross-sectional approach. Data analysis used in this research used the chi square test.Results and Discussion: There is a significant relationship (p value = 0.000) of husband's informative support with exclusive breastfeeding; there is a significant relationship (p value = 0.047) of husband's emotional support with exclusive breastfeeding; there is a significant relationship (p value = 0.000) of husband's instrumental support with exclusive breastfeeding; There is a significant relationship (p value = 0.024) of husband's appraisal support with exclusive breastfeeding.Conclusion: There is a relationship between social support consisting of informative support, emotional support, instrumental support, appraisal support and exclusive breastfeeding
Stres, Kecemasan dan Kadar Kortisol Serum Wanita dengan Sindrom Ovarium Polikistik (SOPK)
Get PDFLatar Belakang: SOPK dikaitkan dengan risiko kesehatan mental jangka panjang seperti disfungsi seksual, gangguan kesehatan, gangguan mood, kecemasan, dan depresi. Kadar kortisol mempengaruhi fungsi endokrin lain dalam tubuh dan dapat mempengaruhi resistensi insulin dan anovulasi.Tujuan: Mengetahui tingkat stress, tingkat kecemasan dan kadar kortisol serum wanita dengan sindrom ovarium polikistik (SOPK)Metode: Penelitian deskriptif, metode sampel pusposive sampling dengan jumlah responden 30 wanita dengan sindrom ovarium polikistik di Yogyakarta. Instrumentasi menggunakan Kuesioner State Anxiety dan Trait Anxiety (STAI), Perceived Stress Scale-10 (PSS-10), dan Kadar kortisol serum dengan ELISA di LPPT UGM.Hasil dan Pembahasan: Seluruh responden mengalami kecemasan, sebesar 53% responden mengalami kecemasan berat, dan seluruh responden mengalami tingkat stress berat. Rerata kadar kortisol serum 124.98 mcg/dl.Kesimpulan: Faktor psikologis sebagai indikator psikologis yang perlu dicegah atau dikelola saat merawat SOPK. Kombinasi terapi fisik dan psikoterapi atau mindfulness diperlukan untuk efektivitas terapi yang optimal