Jurnal Kesehatan Reproduksi
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Perbandingan Kualitas Hidup Pasien Endometriosis Pascaoperasi sebelum Dan Sesudah Pemberian Terapi Hormonal
Get PDFLatar belakang: Endometriosis merupakan penyakit yang ditandai adanya jaringan endometrium di luar cavum uterus, yang menimbulkan reaksi peradangan kronis. Gejala endometriosis paling sering adalah nyeri pelvis dan infertilitas. Endometriosis berpengaruh terhadap kualitas hidup penderitanya, terutama karena rasa nyeri yang ditimbulkannya, bisa menghambat dalam melakukan aktivitas sehari-hari. Kombinasi dari terapi operatif dan medikamentosa efektif untuk menurunkan rekurensi, mengurangi nyeri dan meningkatkan fertilitas pada pasien dengan endometriosisTujuan: Membandingkan kualitas hidup dan skor nyeri pasien pasca operasi endometriosis sebelum dan sesudah pemberian terapi hormonalMetode: Kualitas hidup pada pasien endometriosis yang telah menjalani laparoskopi ataupun laparotomi dievaluasi dengan metode kohort prospektif menggunakan kuesioner Endometriosis Health Profile-30 (EHP-30). Kuesioner diberikan sebelum terapi hormonal dan diulang lagi setelah selesai terapi hormonal. Analisis dilakukan dengan membandingkan nilai masing-masing domain dari kuesioner inti dan kuesioner moduler sebelum dan sesudah terapi hormonal.Hasil: Total responden adalah 73 orang yang memenuhi kriteria inklusi. Terapi hormonal pada pasien endometriosis dapat memperbaiki kualitas hidup secara keseluruhan dengan rerata skor 29,89 (SD ± 17,80) menjadi 16,5 (SD ± 16,7) (p <0,001) sebelum mendapatkan terapi hormonal. Terdapat perbaikan pada semua domain kuesioner inti, dengan nilai yang bermakna secara statistik pada domain nyeri dengan rerata 41,73 (SD ± 27,08) menjadi 13,70 (SD ± 22,39) (p <0,001), domain kendali & ketidakberdayaan; rerata 34.21 (SD ± 25,63) menjadi 16,66 (SD ± 19,58) (p <0,001), domain kesehatan emosional rerata 29,84 (SD ± 21,18) menjadi 19,11 (SD ± 19,22) (p <0,001); dan domain dukungan sosial rerata 26,97 (SD ± 20,70) menjadi 20,30 (SD ± 22,37) (p=0,006), sedangkan pada domain citra diri tidak terdapat perbaikan secara signifikan. Pada kuesioner modular terdapat perbaikan signifikan pada domain pekerjaan dengan rerata 30,37 (SD ± 24,99) menjadi 13,57 (SD ± 18,62) p <0,001, domain hubungan dengan anak rerata 13,82 (SD ± 20,13) menjadi 9,58 (SD ± 17,08) dan nilai p=0,017; dan domain perasaan terhadap infertilitas rerata 45,96 (SD ± 29,80) menjadi 36,67 (SD ± 29,77) p=0,001, sedangkan pada domain hubungan seksual, hubungan dengan tenaga kesehatan dan perasaan terhadap terapi tidak terdapat perubahan yang signifikan.Kesimpulan: Kualitas hidup setelah pemberian terapi hormonal lebih baik bila dibandingkan sebelum pemberian terapi hormonal pada pasien endometriosis pascaoperas
Evaluasi KIPPas (Kartu Instrumen Prediktor Pangastuti) Jogja sebagai Instrumen Prediktor Disfungsi Dasar Panggul Pasca Persalinan Vaginal
Get PDFBackground: Postpartum pelvic floor dysfunction is pelvic floor disorder, which can be in the form of pelvic organ prolapse, urinary problem, defecation problem or sexual dysfunction. The incidence of postpartum pelvic floor dysfunction occurs in 46% of postpartum women. Until now, there is no standard instrument used to estimate the incidence of postpartum pelvic floor dysfunction. In previous studies, an instrument was obtained, namely KIPPas Jogja, to estimate the incidence of pelvic floor dysfunction after delivery, but it was still not sufficient for the number of research samples needed.Objective: To evaluate the Pangastuti Jogja Predictor Instrument Card (KIPPas Jogja) as a predictor of pelvic floor dysfunction in the form of pelvic organ prolapse after vaginal delivery.Method: This study was a prospective cohort study. Subjects who gave vaginal delivery were examined according to the KIPPas Jogja instrument and then evaluated for the diagnosis of pelvic floor dysfunction in the form of pelvic organ prolapse with POPQ examination and complaints of pelvic floor dysfunction using the PFDI and FSFI instruments at 3 months postpartum.Results and Discussion: From 133 research subjects, the results of the KIPPas Jogja assessment are high risk in 42.9% of subjects and low risk in 57.1% of subjects. The incidence of pelvic floor dysfunction in the form of pelvic organ prolapse was found in 69.17% subjects. Complaints of pelvic floor dysfunction were present in 20.31% subjects and complaints of sexual dysfunction in 11.3% subjects. The sensitivity of KIPPas Jogja is 80% and specificity is 95% with a positive predictive value of 97% and a negative predictive value of 68% to detect pelvic dysfunction in the form of pelvic organ prolapse. Meanwhile, to predict complaints of pelvic floor dysfunction, measured with PFDI-20, the sensitivity was 93% and specificity was 52%, and the positive predictive value was 33% and the negative predictive value was 96%. To predict sexual dysfunction, KIPPas obtained sensitivity of 64%, specificity of 42% with a positive predictive value of 10% and a negative predictive value of 92%.Conclusion: KIPPas Jogja can be used as a predictor of postpartum pelvic floor dysfunction. Keywords: postpartum pelvic floor dysfunction, KIPPas Jogja, POPQ, PFDI-20, FSF
Diagnosis and Treatment in patient with Herlyn-Werner-Wunderlich Syndrome: A case causing pelvic pain
Get PDFBackground: Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of Mullerian duct anomalies. The characteristic triad of this syndrome includes didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis, recently known as Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. The most common presentation is abdominal and pelvic pain, dysmenorrhea, and abdominal mass secondary to hematocolpos, hematosalping or hematometra.Objective: to determine the diagnosis and operative management of HWW syndrome case with pelvic pain as the chief complaint. Method: case examination and tracing medical records at Dr Sardjito Hospital Yogyakarta.Results and Discussion: Fourteen-year-old female, presented with pelvic pain. Physical examination revealed a cystic mass in the abdomen inferior, palpable up to 3 cm inferior to the umbilicus. From the Intravenous Pyelography (IVP) examination, it was found normal anatomy and function of the right kidney, but there was no left kidney. On a contrast-enhanced abdominal CT scan, magnetic resonance imaging (MRI) and laparoscopy showing a complete duplication of the uterus from the horn to the cervix with no connection between the two uterine cavities, both ovaries were normal, the right fallopian tube was normal, the left tube was enlarged, attached to the uterus and the left ovary, no left kidney was found. Operative management of the vaginal septectomy procedure was performed.Conclusion: MRI is most accurate for providing details regarding the altered anatomy and for identifying associated hematocolpos,hematosalping or hematometra for HWW syndrome cases. Surgical intervention by vaginal septectomy is performed to relieve symptoms, provide better reproductive and sexual functions.Keywords: Herlyn-Werner-Wunderlich syndrome; Mullerian disgenesis; pelvic pain
Early Finding of Vasa Previa: A Case Report
Get PDFVasa previa is referred to the condition of running of fetal vessels that are unprotected by placenta or umbilical cord, within the membranes over the cervix and under the presenting part of the fetus. Due to its membranous vessels, risk of being compressed or ruptures could lead to fetal demise, exsanguination or even death. Its exact etiology is still unknown but multiple risk factors are known, such as low-lying placenta, placenta previa, multiple pregnancies, multilobed placenta and velamentous umbilical cord anchorage, and assisted pregnancy like invitro fertilization.In this report we report a case of 40 years old woman, G3P1A1 at 35 weeks of gestation and history of C-section due to preeclampsia and breech presentation and curettage due to blighted ovum. Early prenatal diagnosis using ultrasonography examination could increase the survival rate of the fetus if followed by sufficient measure after diagnosed. Cesarean birth is the safest mode of delivery even before the clinical signs or onset of labor occurred
Hubungan antara Ekspresi Heat Shock Protein-70 (HSP70) dengan Skor Risk of Ovarian Cancer Relapse (ROVAR) pada Pasien Kanker Ovarium Epitelial yang Dilakukan Operasi dan Dilanjutkan dengan Kemoterapi
Get PDFBackground: Ovarian cancer is one of the leading causes of death in gynecological malignancies which occupies the third place in the world. One of largest challenge in epithelial ovarian cancer therapy is resistance to chemotherapy. Increased of Heat Shock Protein-70 (HSP70) expression associated with the progressivity of tumor cells growth through the resistance process against chemotherapy, whereas Risk Of Ovarian Cancer Relapse (ROVAR) score is a tool that used to predict the ovarian cancer recurrence risk in patient who underwent surgery followed by chemotherapy.Objective: This study is aimed to evaluate the correlation between HSP70 expression and ROVAR score in patient with epithelial ovarian cancer who underwent first line therapy. Method: This is a retrospective cohort study that involve 42 subjects with epithelial ovarian cancer who had been through surgery (optimal or suboptimal surgery) followed by chemotherapy. Immunohistochemical staining of pre chemotherapy paraffin blocks was performed using HSP70 antibody and recurrence risk was calculated using ROVAR scores after surgery followed by chemotherapy. The external variables evaluated were age, parity, Body Mass Index (BMI), menopause history, and surgical type. Data analysis used Chi Square test, spearman test, and logistic regression analysis.Result and Discussion: Of the total 42 subjects who met the inclusion criteria, most found in advanced stage with the age mean is 54,3 years old. In the ROVAR score measurement, in high risk category is found about 32(76.19%), while in the medium risk and low risk category is 10 (23.81%). On the other hand, strong HSP70 expression was found in 36(85,71%), moderate HSP70 expression in 6(14,39%), and weak HSP70 expression was not found. Based on Spearman's correlative test, there was a positive, very strong, and significant correlation between the expression of HSP70 and risk allocation according to ROVAR score (r=0.717, p=0.000). As well as in multivariate analysis, HSP70 expression had a statistically and clinically significant relationship with ROVAR score (p=0.017; RR 2.710; 95% CI 0.366-5.054) which strong HSP70 expression was 2.71 times more likely to have a high risk of recurrence according to ROVAR score.Conclusion: There is a positive, very strong, and significantly meaning between HSP70 expression and ROVAR score. Increased in HSP70 expression may lead to increased recurrence risk according to ROVAR score. Both could be used to predict recurrence in epithelial ovarian cancer post first line therapy.Keywords: Epithelial ovarian cancer, HSP70, ROVAR score, recurrence
Ketepatan Rumus Risanto untuk Memprediksi Berat Lahir Janin pada Ibu dengan Berat Badan Berlebih
Get PDFBackground: Estimated Fetal Weight (EFW) needs to be as accurate as possible to reflect the actual condition of the fetus for labor-management planning. Risanto’s formula is one of the easy to use formula to estimate fetal weight using fundal height (FH). But, oftentimes, the measurement of fundal height in overweight pregnant mothers is hard to be done precisely due to the thickness of the abdominal subcutaneous fat layer. Therefore, there is a possibility of a decrease in EFW’s accuracy in overweight mothers by using FH measurement.Objective: To determine the accuracy of Risanto’s formula in estimating fetal weight in overweight mothers.Method: It was a cross-sectional study nested within research by Aprizano in 2018. Mothers at term pregnancies with body mass index (BMI) >25 kg/m2 from Sardjito and affiliated hospitals were included in the study. The difference between the mean Risanto’s estimated fetal weight (R_EFW) and the mean actual birth weight (ABW) was analyzed using a paired t-test. Later on, the accuracy of R_EFW was analyzed based on the mean absolute percentage error and the number of cases within 75%.Results and Discussion: From the 205 research subjects, the mean R_EFW was 3050,49 ± 421,96 gram (ranged from 1995 to 4745 gram), while the mean ABW was 3129,29 ± 406,67 gram (ranged from 1800-4880 gram). Risanto’s formula tends to give a smaller estimation compared to the ABW with the mean difference (∆mean) between the two was 78,8 gram (95% CI: 50,031-107,569 and P=0,000). The mean difference was statistically significant. But, if we convert the ∆mean into a percentage, the mean difference was 2,52%. Other than that, the mean absolute percentage error was 5,8 ± 4,11 %. The number of case within the absolute percentage error of 75%. Keywords: Risanto’s formula; estimated fetal weight; overweight mothers; fetal birth weight
Malformasi Genital Perempuan: Kasus di RSUP Dr. Sardjito Yogyakarta Tahun 2019
Get PDFBackgroundReproductive tract malformations are rare in general population but are commonly encountered in women with infertility and recurrent pregnancy loss. Their true prevalence in the general population is not absolutely known mainly owing to methodological bias. Common uterine anomalies are important owing to their impact on fertility, and certain Mullerian malformations are particularly important because they cause serious clinical symptoms and affect woman’s quality of life. Identification of symptoms and timely diagnosis are an important key to the management of these defects. Although MRI being gold standard in delineating uterine anatomy, recent advances in imaging technology, specifically 3-dimensional ultrasound, achieve accurate diagnosis. Surgical management depend on the type of anomaly and its complexity and also involves multiple specialties; thus, patients should be referred to centres with experience in the treatment of complex genital malformationsObjectiveDetermined the description of cases of female genital malformation at Dr. Sardjito Hospital in 2019.MethodThis is descriptive study. The subject in this study were all new patient with female genital malformation at Obgyn Polyclinic Dr. Sardjito Hospital January-December 2019. Obtained 30 cases of female genital malformation.ResultThere is 30 cases of genital malformation in 2019. They were 4-44 years with mode at group 16-20 years. They consist of vaginal and cervicovaginal agenesis 14 cases, Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrom 6 cases, hematometra of hemiuterine 4 cases, Herlyn-Werner-Wunderlich (HWW) syndrome 3 cases, imperforate hymen, didelphys uterus and genital ambiguous each 1 case. Five cases of cervicovaginal agenesis have been done sigmoid vaginoplasty, all of them have good sexual function after procedure. One case MRKH syndrome has been done sigmoid vaginoplasty with good sexual function after that. Two cases HWW syndrome have been surgical treatment that are vaginal septectomy and vaginal septectomy with laparascopic cystectomy.ConclusionThe correct knowledge of embryology of the genitourinary is essential for the understanding, study, diagnosis and management of genital malformations, especially complex ones and those that lead to reproductive problems. Surgical techniques for correcting genital malformations depend on the type of anomaly and complexity
Perilaku Seksual Berisiko serta Kaitannya dengan Keyakinan Diri Remaja untuk Mencegah: Studi Deskriptif
Get PDFBackground: The misuse of media or technology (smartphones, internet) to access various information including pornographic sites can increase adolescents to engage in sexual activity because adolescents continue to feel challenged to do so in real life.Objective: Describe risky sexual behavior and its relation to adolescent self-efficacy to prevent itMethod: The method used in this research is descriptive analytic conducted online by distributing questionnaire links to prospective respondents. The data analysis process used the Pearson testResults and Discussion: There is an increase in the number of incidents of risky sexual behavior, 39% of adolescents are not at risk, 8.1% are low risk, 27.7% are at moderate risk and 25.2% are at high risk. The majority of adolescents have the confidence to prevent risky sexual behavior by 64.8%. Furthermore, the results found that there was a significant relationship between risky sexual behavior and adolescent self- efficacy with a p value of 0.005.Conclusion: The increasing number of cases of risky sexual behavior can be of particular concern for all of us, especially health workers, to be able to develop educational program methods for adolescents, considering that this age is the nation's successor. Keywords: adolescent; risky sexual behavior; self- efficac
Pengaruh Perawatan Kehamilan dan Persalinan dengan Kejadian Kematian Neonatal
Get PDFAbstractBackground: Maternal care interventions (ANC) can reduce perinatal mortality by up to 75%. Neonatal mortality is closely related to the first 100 days of life starting from conception, the intra-uterine period, or in the womb for 230 days. Neonatal mortality can also be caused by various factors based on the cause, namely: Direct causes related to complications during the newborn and indirect causes related to the mother are hypertension, anemia in pregnancy, quality of care during pregnancy and/or delivery, and maternal mortality. Maternal mortality has some characteristics, such as Condition 4 is categorized as too much (namely too young; too old; too close range; and too much), while Condition 3 is categorized as delay, (being late to recognize the danger signs of childbirth; being late in making decisions; being late in handling by health workers in health facilities). Neonatal mortality refers to death in the 1st 28 days of life. Neonatal deaths are divided into two types, such as early neonatal mortality refers to death before 7 days or 0-6 days, and late neonatal mortality to death on days 7-28. The highest rate of neonatal deaths is perinatal mortality, where intrauterine fetal death occurs from 28 weeks of gestation to the 1st 7 days of life.Objective: This study was to determine the risk of neonatal death associated with prenatal care and delivery, as well as other factors.Research Methods: This type of observational research with a quantitative approach is a case-control research design. In this study, the case was neonatal mortality and the exposure was pregnancy care and delivery care. Calculation of the case-control sample size without matching by considering previous studies with a minimal sample studied for 1:1 control cases. Thus, the total number of samples is 86 people. By taking non-probability sampling, it is determined by quota sample.Results and Discussion: There is a relationship between Neonatal mortality with a P-value of 0.3150, which means being late in recognizing danger signs has a risk of 3.150 times The Asymptotic Significance (2-sided) value shows a P-value = 0.011 which means that 35 years has a risk of 3.496 times that of the age with no risk category 25-35 years. The Asymptotic Significance (2-sided) value shows a P-value = 0.006 which means that <0.05, the OR value is declared significant or significant. While the 95% CI showed a value of 1.438-8.498. There is a relationship between danger signs and Neonatal Mortality, the Odds value of the Haenszel Coat Ratio is indicated by the Estimate value, which is 3.150, which means that the variable late recognizes danger signs has a risk of 3.150 times that of not recognizing danger signs late. The Asymptotic Significance (2-sided) value shows a P-value = 0.011, which means that <0.05, the OR value is declared significant or significant. While 95% CI showed a value of 1.306-7.600.Conclusion: Pregnancy care and other factors, such as age and danger signs, have a risk of neonatal death compared to delivery care. Pregnant women of reproductive age have a higher risk than the group of live neonates. In the stillbirth group, pregnant women who were late in recognizing danger signs were higher than in the live neonates group. Keywords: Neonatal Death; Pregnancy and Delivery Care; RSUD dr. Haulussy Ambon.
Hubungan antara Stres dan Pola Menstruasi pada Remaja Perempuan Sekolah Menengah Atas Negeri di Kota Yogyakarta
Get PDFLatar Belakang: Perubahan pada siklus menstruasi dapat disebabkan oleh kelainan primer maupun sekunder pada organ reproduksi. Stres merupakan salah satu penyebab gangguan sekunder pada sistem reproduksi yang dapat menyebabkan functional hypothalamic amenorrhea (FHA), premature ovarian failure (POF), atau perubahan pada karakteristik siklus menstruasi melalui penekanan pada aksis hipotalamus-pituitari-gonad. Beberapa penelitian mendukung pernyataan ini, namun masih terdapat variasi untuk mengidentifikasi ambang batas dimana tingkat stres dapat mengganggu siklus menstruasi.Tujuan: Mengetahui bagaimana hubungan antara stres dengan gangguan menstruasi pada remaja perempuan Sekolah Menengah Atas (SMA) Negeri di kota Yogyakarta.Metode: Metode penelitian ini adalah Cross-sectional. Subyek penelitian terdiri dari remaja perempuan kelas X dan XI SMA Negeri di kota Yogyakarta yang berusia 15-18 tahun dan data-data diperoleh melalui pengisian kuesioner online. Gangguan menstruasi ditentukan berdasarkan kriteria The International Federation of Gynecology and Obstetrics (FIGO) abnormal uterine bleeding (AUB) system-1 tahun 2018 yang direvisi. Tingkat stres diukur melalui skor Perceived Stress Scale (PSS) dan variabel luar yang dievaluasi adalah indeks massa tubuh dan aktivitas fisik dengan intensitas sedang. Analisis data menggunakan uji Chi Square dan analisis regresi logistik.Hasil: Dari total 596 responder yang memenuhi kriteria inklusi, prevalensi tingkat stres tinggi sebesar 70,47% dan gangguan menstruasi sebesar 43,29%. Analisis bivariat menunjukkan tidak terdapat hubungan yang bermakna antara tingkat stres tinggi (p= 0,830; RP 1,022), indeks massa tubuh (p= 0,542; RP 1,094), maupun aktivitas fisik intensitas sedang (p= 0,717; RP 1,045) terhadap gangguan menstruasi. Hasil yang sama ditunjukkan melalui analisis multivariat.Kesimpulan: Tingkat stres tinggi ditemukan pada sebagian besar remaja perempuan di kota Yogyakarta, namun tidak terdapat hubungan antara tingkat stres terhadap gangguan menstruasi.Kata kunci: gangguan menstruasi, stres, remaja perempua