The Effectiveness of Misoprostol Single Dose Oral for Evacuation of Incomplete Abortion

This study is aimed to find out the effectiveness of oral 600 mcg single dose misoprostol for the evacuation of conception remnant in cases of incomplete abortion. This research is done by quasi experimental method with one group pretest – posttest design. The population of the study is all women who were diagnosed with incomplete abortion in less than 12 weeks of gestation in Cipto Mangunkusumo National general Hospital and affiliations hospital from June 2018 to June 2019. Women who met the study criteria, was treated with oral misoprostol 600 mcg single dose and then undergo conception evacuation evaluation and side effects evaluation. Effectiveness evaluation was seen after 7 days of single dose 600 mcg of misoprostol by measuring <15 mm endometrial thickness on transvaginal ultrasound. The effectiveness of using single dose oral misoprostol 600 mcg in the study participants was 93.55%, which were 29 out of a total of 31 participants. The side effects experienced after being given misoprostol were bleeding with less than the same amount as menstruation (71.0% and 9.0%), diarrhea (6.5%), and shivering (67.7%), and not found side effects of vomiting. Based on data analysis using paired T test before and 24 hours after administration of misoprostol, there was a significant difference between endometrial thickness (p value <0.001). Misoprostol 600 mcg per oral dose is effective for the evacuation of retained conception tissue of incomplete abortion at less than 12 weeks gestation, so that it can be an alternative non-operative method of evacuating retained conception tissue in incomplete abortion cases other than the operative method. Side effects found were bleeding, diarrhea, and chills. Side effects of vomiting were not found in this study

Male Contraceptives

Background: The world’s population has been growing exponentially, however, currently the choices for male contraception are limited. This review explores ongoing researches on male contraceptives

Postpartum Contraceptive Use Among HIV Positive Women in Cipto Mangunkusumo Hospital Jakarta, Indonesia: A Cross Sectional Study

Background: Prevention of unintended pregnancy among HIV positive women is the second element of prevention of mother to child transmission of HIV. Contraceptive use in Indonesia remains low, despite the potential contribution of family planning (FP) to the prevention of HIV infection and unintended pregnancy. It is anticipated that this research will update existing knowledge, inform policy makers and programmers to support safer and healthier reproductive options among HIV positive women in the study area.Methods: The study was conducted in Cipto Mangunkusumo Hospital Jakarta, Indonesia, since January 1st 2013 until December 31st 2014. Of the original cohort of 5499 women delivered in 2013-2014, 65 were HIV positive. The 58 subjects in this study were selected from each group of HIV positive women and HIV negative who had delivery in this hospital either by emergency admission or elective caesarean section. Results: There were a total of 5449 deliveries, during the study period, out of which 65 were HIV positive women (1,2%). From 58 randomly selected patients, the mean age of HIV positive mothers was 27,74 ± 4,73 years. Their parity ranged from zero to five. With significantly uses of long acting contraception as IUD and sterilization on HIV-positive women as well as booked cased patients.Conclusions: The high rates of unintended pregnancies in the sample of HIV positive women suggest that the WHO’s strategy of preventing unintended pregnancies amongst HIV positive women to minimise vertical transmission of HIV must be reinforced. Long acting and permanent methods could fill an important gap in family planning services in Indonesia given women’s stated fertility preferences indicating a strong desire to either not have a future pregnancy or to wait several years before the birth of their next child

KNOWLEDGE, ATTITUDE, AND BEHAVIOR ABOUT ABORTION AMONG ADULT WOMEN AT PEUNAYONG DISTRICT, BANDA ACEH, INDONESIA

Objective: Every year approximately 13% (78,000) of maternal death caused by unsafe abortion. Indonesia Family Planning Association predicts 2.5 million abortions per year and 1.5 million of them committed by teenagers. Adolescent reproductive health problems are more alarming year by year. Sexual behavior tends to be permissive and bold with limited knowledge of reproductive health has increased the risk of abortion. This study is to assess the knowledge, attitudes, and behavior regarding abortion in young adults. Methods: This is a descriptive cross-sectional study. The subjects were young women aged 18–24 years old who were fulfilled by inclusion and exclusion criteria. The knowledge, attitudes, and behavior were assessed using questionnaire. The results were analyzed using statistical program. Results: The total subjects recruited in this study were 55 subjects. Twenty-eight (50.9%) of subjects has a good knowledge and 27 (49.1%) of subjects had a moderate knowledge. Twenty-nine (52.7%) subjects had moderate attitudes and 36.4% of subjects had good attitude. Thirty (54.5%) of subjects had a good behavior regarding abortion. Conclusion: Most of the subjects had good level of knowledge and moderate attitude toward abortion

National health coverage programs and quality of referral obstetrics and gynaecology clinic in Dr Cipto Mangunkusumo Hospital Jakarta

Purpose: Implementation of national health coverage contributes to the increasing number of outpatient visits in Obstetrics and Gynecology Department, Dr. Cipto Mangunkusumo Hospital. It may be caused by improper referral system or number of government insurance patients called as BPJS patients. Therefore, this study aims to analyse the pattern and quality of referral system in the implementation of national health coverage.Method: The quasi experimental study was conducted using pre and post analysis of the cases pattern and referral quality. It included accuracy of referred case diagnosis, accuracy of referring health facility, and consistency of referred case diagnosis.Results: There was an increasing number of referral visits in the early implementation of  national health program; however, it declined overtime. There was reduction of general obstetrics and gynaecology cases and increase of sub-specialistic cases. It was in appropriate to the role of centre referral hospital in Indonesia. Around 98% referral diagnosis was correct to be referred, 82% cases came from correct health facility, and 98% referral diagnosis was consistent to Dr. Cipto Mangunkusumo hospital.Conclusion: The quality referral cases improves with the implementation of national health coverage program

Menstrual Pattern and Characteristics of One-Rod and Two-Rod Levonorgestrel Implant Users

Introduction. The maternal mortality ratio (MMR) in Indonesia reaches 359 per 100,000 live births. The long-acting reversible contraceptive (LARC) method is an effective contraceptive choice for reducing MMR. The contraceptive implant is one of the LARCs that has low usage due to lack of education about the side effects. This study aims to compare the menstrual pattern and characteristics between one-rod and two-rod levonorgestrel implant users. Methods. A prospective cohort study was performed in patients at Cipto Mangunkusumo Hospital (RSCM) from March 2016 to May 2018. Subject recruitment was done by consecutive sampling. This study was conducted from March 2016 until May 2019. Statistical analysis was performed on the data using the chi-square test to determine the relationship between menstrual pattern and characteristics, and the use of one-rod or two-rod levonorgestrel implants. Results. A total of 140 subjects participated in the study, comprising 70 (50%) one-rod users and 70 (50%) two-rod users. In the first month, 32.9% one-rod users experienced amenorrhea, 22.9% experienced shortened menstrual period, 30% experienced normal menstrual period, and 14,2 % experienced lengthened menstrual period. In comparison, in the first month, 41.4% two-rod users experienced amenorrhea, 15.7% experienced shortened menstrual period, 32.9% experienced normal menstrual period, and 10% experienced lengthened menstrual period. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Conclusion. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Implications. Menstrual patterns and characteristics from levonorgestrel implants user can help clinicians to reduce discontinuation rate from the acceptors. Further research should be conducted to know other side effects aside from menstrual bleeding patterns

Successful procedure in conservative management of interstitial (cornual) ectopic pregnancy

A 35-year-old woman presented with spotting and lower abdominal pain. Follow-up sonography was suggestive of interstitial ectopic pregnancy. Laparoscopic cornuostomy was carried out. Before incision, diluted vasopressin was injected around the site of interstitial pregnancy. Removal of the conceptual tissues was conducted smoothly through a 1.5 cm incision. The overall blood loss was 50 mL. The operative time was 50 min, and there were no intraoperative complications. We successfully performed laparoscopic cornuostomy, which was followed by an unremarkable postoperative course. Laparoscopic surgery is a safe and effective minimally invasive surgical intervention for interstitial ectopic pregnancy if performed by the experienced surgeon. Local vasopressin injection is a good alternative for bleeding control in conservative laparoscopic surgery

Buku panduan praktis pelayanan kontrasepsi

xxviii, 300 hl

Buku panduan praktis pelayanan kontrasepsi

xxviii, 300 hal; 24 c

Antenatal Contraceptive Counselling and Postpartum IUD Use: Evaluation of Contraceptive Service in Tertiary Hospital in Indonesia

Background: Effective contraceptive use is one of a measure of decreasing maternal mortality rate. The low contraceptive prevalence rate of the IUD as a LARC is partly caused by a lack of knowledge regarding the method. Antenatal contraceptive counselling is considered a potential factor in increasing the use of postpartum IUD. Though it has been a part of routine service, the effectiveness of antenatal contraceptive counselling in our center was seldom studied. Methods: Seventy women who underwent antenatal care in the third trimester in our center were enrolled in the study. Contraceptive counselling was given integrated with antenatal care visits. A questionnaire for measuring knowledge, attitude, and contraceptive choice was given before and after contraceptive counselling. Postpartum contraceptive method usage was evaluated after birth. Results: Fifty eight women were enrolled and included in the final analysis. Before counselling, only 39.7 percent of subjects had a good level of knowledge, and 36.2 percent subjects had a good level of attitude. While after counselling 75.9 percent of subjects had a good level of knowledge and 72.4 percent subjects had a good level of attitude. Before counselling, IUD uptake was only 15.5 percent, while post-counselling, 77.6 percent of subjects chose and used IUD as their post-partum contraceptive method. Conclusion: Contraceptive counselling given antenatal can increase postpartum IUD use