Hubungan antara Preeklampsia Berat Awitan Dini dengan Pertumbuhan Janina Terhambat pada Pasien Preeklamsia Beratdi RSUP Dr. Sardjito Yogyakarta

Latar      Belakang: Pertumbuhan Janin Terhambat (PJT) merupakan salah satu komplikasi janin yang sering terjadi pada pasien Preeklamsia Berat (PEB) dan eklamsia. Angka kejadian PEB awitan dini berkisar 5-20% dari keseluruhan kasus preeklamsia yang berhubungan dengan neonatal morbiditas dan mortalitas, dimana angka kejadian PJT sendiri berkisar 3-7%, sedangkan angka kejadian PEB awitan lanjut sebesar 75-80% dari keseluruhan kasus preeklamsia yang berhubungan dengan maternal morbiditas.Tujuan: untuk mengetahui hubungan antara PEB awitan dini dan kejadian PJT di rumah sakit Sardjito Yogyakarta.Metode: rancangan penelitian adalah cross sectional study Populasi penelitian adalah pasien preeklamsia dengan janin tunggal yang lahir di RSUP DR. Sardjito Yogyakarta tahun 2013-2015. Sampel penelitian adalah pasien PEB berjumlah 135 subyek, PEB awitan dini 105 subyek, dan awitan lanjut 30 subyek. Uji chi square digunakan untuk menghitung prevalensi PJT pada PEB awitan dini dan lanjut. Stratifikasi mantel-haneszel dilakukan untuk menilai variabel perancu. Multivariat menggunakan regresi logistik.Hasil dan Pembahasan: subyek dengan PEB awitan dini adalah 51 subyek (48,57%) yang mengalami PJT sedangkan awitan lanjut adalah 7 subyek (23,33%). Subyek dengan PEB awitan dini dan preeklamsia genuine memiliki prevalensi PJT lebih tinggi RP (CI 95%)=2,453 (1,170-5,141) dan p=0,007. Prevalensi PJT pada PEB awitan dini, OR (CI95%)=3,257 (1,244-8,530) dan p=0,016; usia OR (CI 95%)=0,488 (0,202–1,178) dan p=0,111; paritas OR (CI 95%)=1,159 (0,461–2,912) dan p=0,11; jenis PE OR (CI 95%)=0,730 (0,294–1,814) dan p=0,498; dan derajat proteinuria OR (CI 95%)=0,955 (0,464–1,968) dan p=0,901. Kesimpulan: PEB awitan dini mempunyai hubungan yang signifikan dengan PJT. Kata kunci: PEB; PEB awitan dini; PEB awitan lanjut; PJT

Comparison of postthawing sperm motility recovery between cryopreserved with and without cryoprotective agent using 4 different cryopreservationmethods

Frozen-thawed human spermatozoa are routinely used for many assisted reproduction program.However, cryopreserved spermatozoa was reported to yield lower pregnancy rates compared tofresh semen in both intra uterine inseminations and in vitro fertilization/intracytoplasmic sperminjection (IVF/ICSI) due to the reduction of sperm motility and viability induced by cryopreservationprocedures. This study was aimed to evaluate the influence of cryoprotective agent (CPA) andcryopreservation methods on human sperm motility. This was a quasi experimental study. Thirtyseven normozoospermic semen samples collected in Permata Hati Infertility Clinics of Dr. SardjitoGeneral Hospital, Yogyakarta were recruited. Four different cryopreservation methods were appliedusing and without CPA (TEST-yolk buffer). In simple two steps freezing, cryostraw were graduallyfrozen from 8 to -4°C. In simple graduated freezing, cryostraus were directly frozen at -4°C. Invapor phase freezing method, the samples in cryostraw were placed 1 cm above liquid nitrogen.In the last method, the samples were directly submerged into liquid nitrogen. Thawing wasconducted by incubation at 37°C for 5 minutes. The sperm motility recovery after cryopreservationin the 4 different cryopreservation methods was evaluated and analyzed by analysis of variance(ANOVA). The fresh sperm motility before cryopreservation was 52.9 ± 4.50%. The recovery ofmotile sperms was 17.00 ± 7.83%, 20.96 ± 5.81%, 15.06 ± 8.55% and 15.68 ± 8.3%, whenusing CPA and 5.63 ± 4.63%, 5.47 ± 3.95%, 4.45 ± 4.46% and 6.08 ± 5.06% when withoutCPA following direct plunge to liquid nitrogen freezing, vapor liquid nitrogen freezing, simplegraduated freezing and simple 2-steps freezing, respectively. Among methods using CPA, thevapor phase method resulted in highest sperm motility recovery. In methods without CPA, nosignificant difference of sperm motility recovery was observed among the 4 differentcryopreservation methods. In conclusion, the use of CPA for cryopreservation improves spermmotility recovery

The Accuracy of Risanto's Formula and Ultrasound Measurement in Estimating Fetal Weight

Background: Accurate estimated fetal weight (EFW) is crucial in determining delivery management. Several methods to estimate fetal weight were used such as abdominal palpation, measurement of symphisis fundal height (SFH), and ultrasound examination. Risanto’s formula based on Indonesian population had been already proven to be more accurate than Johnson’s formula. The formula was as follows: Y = 125 X - 880 where Y was EFW in grams, X was SFH in cm, and 125 was the constanta.Objective: To compare the accuracy of Risanto’s formula and ultrasound examination in estimating fetal weight.Method: A cross sectional study was carried out in Sardjito hospital, Faculty of Medicine Universitas Gadjah Mada, from March 2013 to March 2014. A total of 400 pregnant women meeting the inclusion criteria at 37 – 42 weeks of gestation were recruited. The estimated fetal weight using Risanto’s formula (R_EFW) was compared to the estimated fetal weight using ultrasound measurement (U_EFW). The U_EFW was done by obstetricians on duty or senior residents using Hadlock’s formula. Actual birth weight (ABW) was measured using the same calibrated baby scale. Accuracy was determined by comparing the mean difference between the R_EFW minus ABW (ΔR_EFW) and the U_EFW minus ABW (ΔU_EFW). Paired t-test was used for statistical analysis.Result and Discussion: The mean ABW was 3025.3 ± 414.6 gram and the mean R_EFW was 2972.7 ± 365.4 grams, while the mean U_EFW was 3058.7 ± 423.2 grams. The mean ΔR_EFW was lower than the mean ΔU_EFW (178.2 ± 147.6 grams vs 197.5 ± 155.4 grams; 95% CI 1.24 – 36.68; p = 0.04).Conclusion: Risanto’s formula was more accurate than ultrasound measurement in estimating fetal weight.Keywords: Estimated fetal weight, Risanto’s formula, Ultrasonography, Fundal heigh

Gambaran Luaran Pasien Plasenta Akreta Spektrum yang Dilakukan Manajemen Konservatif dan Manajemen Non Konservatif di RSUP Dr. Sardjito

Latar belakang: Angka kejadian plasenta akreta spektrum terus meningkat dari tahun ke tahun seiring dengan meningkatnya angka seksio sesarea. Risiko utama yang berhubungan dengan plasenta akreta spektrum adalah perdarahan banyak yang dapat menyebabkan komplikasi sekunder termasuk koagulopati, kegagalan multi sistem organ dan kematian. Manajemen optimal yang melibatkan tim multidisiplin perlu dilakukan untuk mendapatkan luaran yang baik.Tujuan: Tujuan penelitian ini adalah untuk mengetahui gambaran luaran pasien plasenta akreta spektrum yang dilakukan manajemen konservatif dan manajemen non konservatif di RSUP Dr. Sardjito.Metode: Penelitian ini merupakan penelitian deskriptif dengan menggunakan data rekam medis pasien plasenta akreta spekrum yang dilakukan tindakan di RSUP Dr. Sardjito pada tahun 2018-2020. Subjek penelitian terbagi ke dalam dua kelompok yaitu kelompok yang dilakukan manajemen konservatif dan manajemen non konservatif.Hasil: Dari 38 subjek, 22 subjek (57,89) direncanakan untuk dilakukan manajemen konservatif dan 16 subjek (42,11%) dilakukan manajemen non konservatif. Dari 22 subjek yang direncanakan untuk dilakukan manajemen konservatif, 10 subjek gagal sehingga dilakukan manajemen non konservatif. Luaran utama yang dinilai adalah jumlah perdarahan. Rata-rata jumlah perdarahan pada kelompok manajemen konservatif lebih sedikit daripada kelompok manajemen konservatif (2.179,16 ± 399,69 ml vs 5.173,07 ± 594,29 ml). Luaran lain yaitu jumlah transfusi (transfusi PRC 1.062 ± 187,50ml vs 2.048,07 ± 198,07 ml; transfusi FFP 512,50 ± 100,21 ml vs 1.117,30 ± 100,11 ml; transfusi TC 120,83 ± 29,80 ml vs 375 ± 36,92 ml) dan kematian 16,67% vs 3,85%.Kesimpulan: Luaran jumlah perdarahan dan jumlah transfusi (PRC, FFP, TC) lebih sedikit pada kelompok yang dilakukan manajemen konservatif daripada manajemen non konservatif. Angka kematian pada kelompok manajemen konservatif lebih tinggi daripada manajemen non konservatif

Antley-Bixler Syndrome: A Case Report and Literature Review

Sindroma Antley-Bixler pertama kali dikemukakan oleh Ray Antley dan David Bixler tahun 1975. Sindroma ini jarang dan berhubungan dengan kelainan perkembangan tulang dan kartilago sehingga sering disebut multisynostotic osteodysgenesis syndrome. Craniosynostosis dan synostosis radiohumeral merupakan temuan yang paling konsisten. Penyebab sindroma ini belum jelas, diduga karena adanya mutasi genetik.Laporan kasus:Seorang ibu 22 tahun G2P1A0 dirujuk ke poliklinik obstetri dan ginekologi RSUP dr.Sardjito pada usia kehamilan 32-33 minggu untuk pemeriksaan antenatal dengan kecurigaan fetal craniosynostosis dan ventriculomegaly. Pada usia kehamilan 38 minggu, bayi lahir dengan craniosynostosis, ocular hypertelorism, disertai syndactily digiti II-IV pedis dextra et sinistra dengan diagnosis sementara sindroma Apert. Pemeriksaan penunjang yakni MSCT scan kranial dan foto rontgen regio artikulatio cubiti anteroposterior dan lateral menunjukan adanya craniosynostosis dan synostosis radioulna dan radiohumeral bilateral mengarahkan diagnosis sindroma Antley-Bixler. Bayi dipulangkan setelah 24 hari perawatan. Saat ini bayi masih menjalani perawatan berkala di instalasi rawat jalan ilmu kesehatan mata dan bedah saraf RSUP Dr. Sardjito  Kesimpulan: Laporan kasus ini bertujuan untuk membahas penegakan diagnosis, tatalaksana yang telah dilakukan dan rencana tatalaksana yang akan datang.  Kata kunci : Sindroma Antley-Bixler, craniosynostosis, synostosis radiohumeralAntley-Bixler Syndrome: A Case Report and Literature Review AbstractAntley-Bixler syndrome (ABS) was first described by Ray Antley and David Bixler in 1975. The syndrome is rare and characterized by abnormalities of bone and cartilage development (“syndrome of multisynostotic osteogenesis”). Craniosynostosis and radiohumeral synostosis are the most consistent findings. The cause of this syndrome is unclear, but genetic mutations are suspected.Case report: A 22-year-old female G2P1A0 was referred to the obstetrics and gynecology outpatient clinic at RSUP Dr. Sardjito at 32-33 weeks of gestation for antenatal care and further evaluation due to suspected fetal craniosynostosis and ventriculomegaly. At 38 weeks’ gestation, the baby was born with craniosynostosis, ocular hypertelorism, and syndactily digiti II-IV pedis dextra and sinistra, suspected Apert syndrome. Further investigation by using radiologic examination (cranial MSCT scan and X-ray at anteroposterior and lateral articulation cubital) revealed craniosynostosis, bilateral radioulna and radiohumeral synostosis, directed the diagnosis to Antley-Bixler syndrome. The baby was discharged after 24 days of hospitalization. Currently, the baby is still undergoing regular evaluation and treatment at the Ophthalmology and Neurosurgery outpatient departments at RSUP Dr. SardjitoConclusion: The aim of this case report is to discuss how to diagnose this syndrome and the management that had been done and further plans

Pengetahuan dan Sikap Residen Obstetri dan Ginekologi tentang Keselamatan Pasien di Kamar Bersalin RSUP Dr. Sardjito Yogyakarta

Background: The traditional medical Oath of ‘first do no harm’ is something that is very rarely breached either intentionally by a doctor, nurse or other health practitioner. Resident is health workers who perform services directly to patients that’s why their knowledge and attitudes towards patient safety are very usefulObjective: To determine the relationship of the level of knowledge with the attitudes about patient safety in obstetrics and gynecology resident while services in delivery room at Dr DR Sardjito hospital.Method: Descriptive methods with cross sectional approach, accompanied by a qualitative research The study involved 90 residents of Obstetrics and Gynecology at Sardjito Hospital Yogyakarta , by filling out a questionnaire. Knowledge assessed based on the number of correct answers and categorized into good and bad. Attitudes toward patient safety was assessed using a Safety Attitude Questionnaire (SAQ) labor and delivery version. Reliability was measured using Cronbach’s alpha. The qualitative data collection (interviews) conducted to support the descriptive data.Result and Discussion: Cronbach’s Alpha value for SAQ= 0.862, and the question of knowledge = 0.702. Between 77 responden who had good level of knowlage, only 53,2% had a good level of attitudes, and between 13 who has bad level of knowlage, there were 10 responden with good level of attitudes (76,9%) (RP 0,69;95%CI 0,44-1,04; p= 0,11). Elements of stress recognition on the attitude were getting the lowest average value (3.50 ± 0.56). From the qualitative data were known that the resident had desire for a reduction in working hours as well as improved communication and collaboration between teams. Althogh most of resident had a good level of knowledge and attitudes about patient safety, there were no meaning because of p value was >0,05 (OR 2,69;95%CI 0,66-10,9; p= 0,17).Conclusion: Clinically, a good level of knowledge about patien safety improving a good level of attitude towards patient safety.Keywords: Knowledge- attitude- patient safety- resident obstetric

Peran Penambahan Misoprostol pada Penatalaksanaan Aktif Kala Tiga dalam Menurunkan Perdarahan Pasca Persalinan

Background: Postpartum haemorrhage is the leading cause of maternal mortality in both developed and developing countries, which is almost 80 % due to the failure of the uterus to contract. Misoprostol is a powerful uterotonic agent used as an alternative in preventing postpartum haemorrhage.Objective: The purpose of this study was to determine whether administration of misoprostol adjunctive therapy in active management of the third stage of labor influenced postpartum blood loss.Method: This study was a non-blinding randomized controlled trial that divided subjects into two groups. The treatment group was the group who received misoprostol 600 mcg orally for adjunctive treatment in active management of the third stage of labor and the control group did not receive misoprostol, each group also got routine oxytocin 10 IU intramuscularly. Both group were assessed of the number of blood loss in the fourth stage of labor, decreased levels of hemoglobin and hematocrit within 24 hours after delivery. Chi square test was conducted to determine the strength of the relationship between the two groups.Result and Discussion: The study recruited 104 subjects, there were significant difference for the mean number of blood loss in the fourth stage of labor and the decrease in hemoglobin levels within 24 hours of postpartum between treatment and control group (OR 2.45; 95% CI 1.05-5.71, p=0.04), (OR 2.99; 95% CI 1.26-7.11, p=0.01). The mean of the decreasing hematocrit levels was statistically not significant between the two groups (OR 0.87; 95% CI 0.38-1.99, p=0.75).Conclusion: The addition of misoprostol to the routine active management of the third stage of labor was statistically significant to decrease amount of postpartum blood loss.Keywords: misoprostol, active management of the third stage of labor, postpartum blood loss, postpartum hemorrhage

PENGARUH PENDIDIKAN SEKSUAL TERHADAP PERILAKU PEMENUHAN KEBUTUHAN SEKSUAL PASANGAN MASA KEHAMILAN DI PUSKESMAS KASIHAN II BANTUL

Background: Both physical and psychological changes during pregnancy could influence sexualit

A Rare Case of Conjoined Pygopagus Twins: Case Report

Introduction and importance: Conjoined twins are a complication of monozygotic pregnancies with an incidence of 1:50,000-200,000 of life births. Pygopagus is found around 17% of all types of conjoined twins and has a mortality rate of 23%. Proper diagnosis and management in this case is important.   Presentation of case:   A 25-year-old primigravida woman presented at 22 weeks of gestation with a Pygopagus ultrasound result at 17 weeks of gestation. MRI was performed at 25 weeks of gestation, showed conjoined pygopagus twins with lumbosacral spina bifida, without visualized bone union, separated bladder, rectum and anus were difficult to evaluate. Caesarean section (CS) is planned at 36 weeks of gestation and postpartum MRI will be performed in preparation for the separation surgery. The patient was admitted to the hospital at 35 weeks of gestation in the active phase of the first stage of labor, then an urgent caesarean section was performed. Both babies were born with an APGAR score of 2/4/7. The second baby died a few hours after delivery. The separation surgery was performed as an emergency, but the first baby died during the procedure. Conclusions:  Pygopagus requires holistic management, starting from diagnosis, preparation for delivery, to postpartum complications. The proper holistic management is expected to reduce infant and maternal morbidity and mortality