Compatibility between Menstrual Pictogram Assessment and Haemoglobin Assessment in Abnormal Uterine Bleeding: Uji Kesesuian Pemeriksaan Piktogram Menstruasi dengan Pemeriksaan Hemoglobin pada Pasien Perdarahan Uterus Abnormal

Objective: To determine the amount of wasted blood and diagnosedAUB and determine amount of decrease in haemoglobinlevels by adjusting the examination of menstrual pictogramwith haemoglobin.Methods: Diagnostic test was conducted in the DepartmentObstetrics and Gynecology Dr. Mohammad Hoesin/Faculty ofMedicine Universitas Sriwijaya Palembang, start from January 2015through January 2017. Sample was obtained from 39 patients withabnormal uterine bleeding who meet the inclusion and exclusioncriteria. Frequency and distribution of data are described in tablesand cross analyze (cut-off point) to find cut points differencemenstrual pictogram and a decrease in haemoglobin levels usingROC curve. Accuracy is measured by the value of Kappa. Dataanalysis using SPSS version 21.Results: From 39 samples that obtained, majority characteristicsage > 35 years (59%), ideal BMI (59%) and multiparous(48.7%). From statistical analysis, there was significanceassociation between haemoglobin measurement toolsand menstrual pictogram (p = 0.063). Both measuring deviceshave compatibility in predicting the type of AUB (p = 0.047),with the degree of conformity is weak (Kappa = 0.232).Conclusion: Accuracy of menstrual pictogram examination andhaemoglobin has a weak degree of conformity, so menstrualpictogram examination can’t be used to determine a decrease inhaemoglobin levels. Menstrual pictogram menstruation only usedas an evaluation of therapeutic response.[Indones J Obstet Gynecol 2018; 6-3: 172-178]Keywords: abnormal uterine bleeding, haemoglobin, menstrual pictogra

Factors Associated with Reproductive Age Couples’ Selection of Sterilization in the Era of the National Health Insurance Program

Objective:To assess factors associated withselection of contraceptive sterilization in reproductive age couples in Dr. Mohammad Hoesin Palembang hospital in the era of BPJS. Methods: This cross sectional study was conducted between January - December 2017. Study sample was reproductive age couples (RAC) who were married and came to P2 UGD, maternity room and midwifery ward of Dr. Mohammad Hoesin Palembang hospital and metour inclusion criteria. All study participants were given a questionnaire to assess factors that influence selection of contraceptive methods in women. Data were analyzed using SPSS software version 17. Results: We found a significant relationship between number of children (PR = 3,988; p = 0.016), knowledge level (PR = 3,893; p = 0,024) and husband support (PR = 5,233; p = 0.009) with sterilization contraceptive selection. In addition, there were no significant correlation between age (PR = 2,311, p = 0,210), education level (PR = 1,893, p = 0,331), woman attitude (PR = 1,567, p = 0,758), availability of contraception ( (PR = 1,969, p = 0,342), officer attitude (PR = 1,088, p = 0,000) and information given by officer (PR = 1,378; p = 0,719) 1,310; p = 0.802) with selection of sterilization. With logistic regression test, we found that husband support was the most important factor to selection of sterilization contraception (PR = 4,266, p = 0,040) followed by knowledge (PR = 3,620, p = 0,041). Conclusion:Sterilization selection in reproductive age couples at Dr. Mohammad Hoesin Palembang Hospitalis influenced by female knowledge and husband support. Keywords:sterilization, tubal ligation, vasectomy, reproductive age coupl

Serum Vitamin D Levels, Visual Analog Scale Dysmenorrhea Score, and Endometriosis ASRM Classification: a Relationship Study

Objective: To assess the correlation between vitamin D levels, dysmenorrhea intensity measured by the visual analogue scale (VAS), and the stage of endometriosis determined by the American Society of Reproductive Medicine (ASRM) grading score. Methods: A cross-sectional study was conducted involving 37 women diagnosed with suspected endometriosis who met the inclusion and exclusion criteria. The aim was to determine the correlation between vitamin D levels, dysmenorrhea VAS scores, and the ASRM endometriosis stage at RSUP Dr. Mohammad Hoesin Palembang from November 2021 to April 2022. Bivariate analysis was employed to assess correlation, utilizing Pearson's correlation test and the Spearman Rank correlation test as an alternative method. Results: There was a significant positive correlation between vitamin D levels and the VAS score for dysmenorrhea (r = 0.678; p = 0.000) and a very strong positive correlation between vitamin D levels and the degree of endometriosis (r = 0.774; p = 0.000) based on Spearman Rho's correlation test. Conclusion: There is a significant relationship between vitamin D levels with the VAS score of dysmenorrhea and the degree of endometriosis ASRM. Keywords: american society of reproductive medicine, endometriosis, visual analogue scale, vitamin

ANGKA KEJADIAN KEHAMILAN SETELAH LAPAROSKOPI OPERATIF PADA INFERTILITAS AKIBAT ENDOMETRIOSIS

Probabilitas kehamilan pada wanita infertil yang menderita endometriosis adalah sekitar dua kali lebih rendah daripada wanita dengan infertilitas idiopatik. Farmakoterapi untuk endometriosis tidak cukup efektif meningkatkan fertilitas, namun pembedahan dapat meningkatkan kesuburan. Penelitian ini bertujuan untuk mengetahui angka kejadian kehamilan setelah laparoskopi operatif pada infertilitas akibat endometriosis serta faktor yang mempengaruhinya. Penelitian dalam bentuk survival analysis dilakukan sejak bulan Januari sampai Juni 2017. Pada hasil penelitian, angka kejadian kehamilan adalah 23,4. Usia ≥30,5 tahun 6,061 kali lebih berisiko tidak bisa hamil setelah laparoskopi operatif dibandingkan usia 2,5 tahun secara signifikan lebih berisiko 18,6 kali tidak bisa hamil setelah laparoskopi operatif dibandingkan ≤ 2,5 tahun (p6 (p= 0,002). Uji multivariat didapatkan durasi infertilitas berpengaruh secara signifikan terhadap kejadian kehamilan setelah laparoskopi operatif pada pasien infertilitas akibat endometriosis (p= 0,028). Durasi infertilitas merupakan faktor risiko yang paling mempengaruhi angka kejadian kehamilan

Disorder of Sex Development, Mosaic Genetic Disorder 45x, 46xy: A Case Report

Background. Disorder of sex development (DSD) is a congenital disorder associated with interference in chromosomes, gonads, or sexes anatomically. Individual affected with DSD can be recognized since birth due to external genital ambiguity. Sexual chromosome DSD occurred because sexual chromosome numeric or structural disorder. Mosaic karyotype 45X/46XY is among the rare sexual chromosome DSD with incidence less than 1:15,000 live births. DSD individuals are susceptible to stigmatization. This can cause stress, negative emotion, and social isolation. Therefore, DSD individual management should be done as optimal as possible. Case Presentation: Twelve years old girl complaining a bump arose from anterior side of her genital resembles male genital since 4 years prior to admission without micturition and defecation complains. Patient has not experienced menarche. On external genital examination, we found the normal female external genital such as mons pubis, pubic hair, labia majora, labia minora, hymen, perineum, but without clitoris which in this case it is replaced by a glans of penis, arising from  anterior commissure of labia majora area, with an urethral estuary. Before the management is done, patient underwent multidiscipline consultations and further examinations. Subsequently, it was approved that the joint conference formation consisting obstetric and gynecology, urologist, and pediatric endocrinologist to determine the optimal management for the patient. Conclusion: In this case, diagnosis was made with history taking, clinical examination, and supporting investigation such as ultrasound imaging and could be followed by biochemistry test, voiding cystourethrography or genitogram to determine next management. Counseling should be done in detail towards the family to know what action is best for the patient. Multidiscipline team was required to get the optimum result either in medical, ethical, or religious point of view. Surgery in this case was considered followed by long term therapy afterwards

Characteristics of Endometriosis Patients in Dr. Mohammad Hoesin General Hospital on 2018 to 2020

Background. Endometriosis is defined as the presence of endometrial-like tissue outside the uterus. The prevalence of endometriosis is not known with certainty because it is necessary to perform a laparoscopy to confirm the diagnosis of endometriosis and is usually found during examination for other indications. This study aims to explore the characteristics of endometriosis patients at Dr. Mohammad Hoesin General Hospital Palembang. Methods. This research is descriptive observational research. The research data were obtained from the medical records of endometriosis patients treated at Dr. Mohammad Hoesin General Hospital Palembang from 2018 to 2020. Results. Of the 105 sample data studied, the most distribution of endometriosis patients was in the reproductive age group (15-49 years) (99%), menarche 12-14 years (67.6%), the location of endometriosis in the ovaries (58.1%), status indoor workers (99%), marital status (85.7%), fertile (43.8%), and infertile patients (41.9%), the chief complaint of dysmenorrhea (66.7%), stage IV disease (63, 8%), nullipara (60%), surgical management (79%). Conclusion. Most of the characteristics of endometriosis patients were in the reproductive age group (15 – 49 years), menarche 12-14 years, endometriosis location in the ovary, indoor worker status, marital status, infertility, the main complaint of dysmenorrhea, stage IV disease, nullipara, surgical treatment

Cortisol Level Related to Depression in Women with Endometriosis

Background: Several main symptoms of endometriosis can lead to physical and psychological stress and also hormonal disturbances as the result of prolonged stress. Cortisol was associated with the onset of depression. This study aimed to determine the relationship between cortisol levels and depression in women with endometriosis at the Department of Obstetrics and Gynecology at Dr. Mohammad Hoesin General Hospital (RSMH) Palembang. Methods: A cross-sectional study was performed at the Reproductive Endocrinology and Infertility outpatient clinic and inpatient ward, Department of Obstetrics and Gynecology at Dr. Mohammad Hoesin General Hospital Palembang, from January to November 2020. There were 74 samples of endometriosis patients who met the inclusion criteria. The blood cortisol level was examined using the ELISA method. The determination of depression level was performed by filling out the Beck Depression Inventory questionnaire. Data were analyzed using SPSS version 22.0. Results: Seventy-four samples met the inclusion criteria. As many as 44 patients (59.5%) without depression, 20 patients (27%) with mild depression, 8 patients (10.8%) with moderate depression, and only 2 patients (2.7%) with severe depression. There were no differences in age, marital status, parity, menstrual cycle, and duration of treatment between endometriosis patients with and without depression (p > 0.05). There was a significant difference in cortisol levels between endometriosis patients with and without depression (p = 0.017). Endometriosis patients with cortisol levels ≤ 7.4 mg/dl were three times more at risk of depression than endometriosis patients with cortisol levels > 7.4 mg/dl. In addition, there was a significant relationship between cortisol level and depression status (OR = 3.023 (95% CI 1.153–7.942; p = 0.041). This study also found a significantly low negative correlation between cortisol levels and BDI scores (r = -0.249; p = 0.032). Conclusion: There was a significant relationship between serum cortisol levels and depression in women with endometriosis. Endometriosis patients with depression had significantly lower cortisol levels than endometriosis patients without depression

Abnormal Uterine Bleeding in Adolescent

Abnormal uterine bleeding (AUB) is defined as the abnormal bleeding from the uterine corpus in term of duration, volume, frequency and/or regularity. This condition occurs in 37% of adolescents and may affect the quality of life and increased hospitalization. Etiology is divided into structural and non-structural causes, known as PALM-COEIN. The most common etiology in adolescents is anovulatory menstruation due to immature hypothalamus-hypophysis axis. Diagnostic evaluation should include investigation in the etiology of AUB, anemia signs, and hemodynamic status. Treatment of AUB consists of hormonal and non-hormonal therapy. Therapy in adolescent is given based on the severity of bleeding, grading of anemia, and hemodynamic stability. Follow-up is required after therapy. Understanding AUB in adolescents can help clinicians deliver appropriate and comprehensive treatment. This review was aimed to explain about definition, epidemiology, etiology, pathophysiology, diagnosis, and treatment of abnormal uterine bleeding in adolescent