Expression of Tenascin in the Uterosacral Ligament is Stronger in Women with Pelvic Organ Prolapse: Tenascin pada Ligamentum Sakrouterina Diekspresikan lebih kuat pada Perempuan dengan Prolaps Organ Panggul

Objective: This study aimed to compare the expression of tenascin uterosacral ligament in women with and without pelvic organ prolapsen (POP). Methods: The research was carried out in Dr. Wahidin Sudirohusodo Hospital and other educational hospitals of obstetrics and gynecology division UNHAS Faculty of Medicine, which began on January 1st, 2011 until April 2012. This study assessed the expression of tenascin in 35 women with POP levels III and IV, and the controls were 35 women without POP. Tenascin expression was assessed by immunohistochemical examination using tenascin antibody staining (mouse monoclonal antibody Novacastra tenascin C, code NCL-Tenas C). The research was carried out cross sectional. Sampling was done by consecutive sampling. Data processed by the chi-square. The significance level used was 0.05. Results: The results showed that the characteristics of research subjects based on age, education, parity, labor history, history of big babies, not statistically significant. This indicates that the variable does not affect the calculation of the research data. While the characteristics of menopausal status and body mass index (BMI), from the analysis of risk factors for POP is associated significantly with a higher intensity of tenascin in post-menopausal status and BMI> 25 (overweight) (p <0.05). Expression of tenascin in the sample are significantly more powerful, the weak expression (8.6%), moderate (40.0%), and strong (51.4%) than without pelvic organ prolapsed. Expression of tenascin in the control, intensity tenascin weak (77.1%), moderate (20.0%), and strong (2.9%). Conclusion: Expression of tenascin uterosacral ligament was stronger in women with POP compared with a weaker expression of tenascin in women without POP. Keywords: pelvic organ prolapse, risk factors, tenasci

Elastin Expression is the Strongest Risk Factor for Developing Pelvic Organ Prolapse

Objective: To compare elastin expression in the anterior vaginal wall of women with and with no pelvic prolapse. Methods: The research was conducted in RS Dr. Wahidin Sudirohusodo and other network hospitals of Obstetrics and Gynecology Department of Hasanuddin University, Makassar. Full-thickness specimens were obtained from the anterior vaginal wall of women having a large prolapse repaired (stage III or IV; prolapse group, 34) and the same location in patients with no prolapse having abdominal and vaginal hysterectomy (control group, 35). The expression of elastin was measured by immunohistochemistry on tissue sectioned. The examiner was unaware of sample identity and the patients’ clinical history. The result then analyzed with p<0.05 considered significant. Results: The result of this research shows that with exception of history of bearing baby > 4000 gr weight (p=0.572); age, parity, menopausal status, and body mass index were significantly different between the groups (0.001; 0.035; 0.011; 0.002; respectively). Immunohistochemical staining indicated that elastin expression in the prolapse group was lower (p=0.009). Elastin expression appeared to be stable with increasing of age, parity, menopausal status, history of bearing baby 4000 gr. weight and Body mass Index in the prolapse group. But multiple logistic regression revealed that elastin have the highest influence to prolapse among the risk factors mentioned (Exp.B =6.252). Conclusion: In this case-control study, the elastin expression were significantly lower in the vaginal wall of patients with a large prolapse. Instead of influence by other risk factors, elastin is the strongest risk factor for developing prolapse among other risk factors. This result is expected to be able to give explanation for the development of prolapse in women without risk factors such is young women and nullipara.  Keywords: elastin, prolapse, wome

Expression Collagen I and III in Anterior Vaginal Women with and without Pelvic Organ Prolapse

Objective: To find out the expression of collagen [ and III in the anterior vaginal wall of women with and without pelvic organ prolapse (POP). Method: The research was a cross sect ional study, conducted in Dr. Wahidin Sudiro Husodo hospital and its networks from January 1, 2011 to April 1, 2012. The case group consisted of 35 women with POPlevel III and IV.The contro l group consisted of35 women without POP. The expression of collagen I and III were examined by immunohistochemical test with the stain ing of antibody of collagen I (mouse monoclonal collagen lab 90395 ) and the antibody collagen III (Mu167 4i).The data was then analyzed by using a computer statistic program with a significance level of 0.05. Result: It was found that in the group of women with POP, there were 28 cases of expression collagen III (84%), which is significantly higher than in women without POP, found in only 20 cases (58.8%), with p=0.02. Meanwhile, in the group of POP, 9.1% of subjects showed moderate expre ssion of collagen I, significantly less compared to the expressio n in the contro l group (35.3%), with p=0.007. For the ratio of collagen I and III, the result was weak in women with POP(58.5% ) while in the control group, the result was high (85.7%). Conclu sion: In terms of collagen I and III expression, there was no significant difference between the two groups. Keywords: collagen I, collagen III, pelvic organ prolapse, vaginal wal

Tenascin-C is Strongly Expressed in the Anterior Vaginal Walls of Women with Pelvic Organ Prolapse

Objectives: To compare the expression of tenascin in the anterior vaginal wall in women with pelvic organ prolapse and without pelvic organ prolapse (POP). Method: This study was a cross sectional study. The study was conducted in RS Dr. Wahidin Sudirohusodo and other network hospitals of Obstetrics and Gynecology Department of Hasanuddin University, Makassar, from 1st January 2011 to 1st April 2012. This study assessed the expression of tenascin in 35 women with pelvic organ prolapse grade III and IV and the controls were 35 women without pelvic organ prolapse. Tenascin expression was assessed by immunohistochemical examination using tenascin antibody staining (mouse monoclonal antibody Novacastratenascin C, code NCLTenasC). Sampling was done by consecutive sampling. Data processed by the chi-square. The significance level used was 0.05. Result: The result of this research shows that with exception of history of bearing baby > 4000 gr weight (p=0.572); age, parity, menopausal status, and body mass index were significantly different between the group. This indicates that the variable does not affect the calculation of research data. While parity, menopausal status and body mass index (BMI), from an analysis of risk factors for POP were associated with increased intensity of tenascin is significant in postmenopausal status, and BMI > 25 (overweight) (p <0.05). Expression of tenascin in a sample of moderate (+ +) as many as 18 cases (51.5%) compared with controls expression of tenascin weaker (+) 25 cases (71.5%). Conclusion: Expression of tenascin robust anterior vaginal wall in women with POP and weak women without POP. Keywords: pelvic organ prolaps, risk factors, tenascin-

Pop-Q Components Comparison among Multiparous and Nulliparous Women

Objective: To compare the measurement of POP-Q components between multiparous and nulliparous women. Method: This study is a cross-sectional research conducted in several hospitals in Makassar during the period of June to October 2012, with 270 women as the subjects. Subjects were divided into three groups: nulliparous, parity 1-2, and parity 3 (multiparous). We analyzed the mean POP-Q components results between 3 groups using t-test, analysis of prolapse based on POP-Q components measurement, and analysis of correlation between risk factors with prolapse was done using Chi-square test. Result: There is a significant difference in POP-Q components measurement between multiparous and nulliparous women, consecutively for: Aa point -2.14 and -2.97 cm, Ba point -2.11 and -2.99 cm, C point -5.69 and -6.86 cm, gh 3.33 and 2.70 cm, pb 2.60 and 3.27 cm, TVL 8.65 and 9.06 cm, Ap point -2.35 and -2.93 cm, Bp point - 2.61 and -2.96 cm, D point -6.61 and -7.42 cm. In multiparous women, points Aa, Ba, C, D, Ap and Bp became more prolapsed, gh became longer, while pb and TVL became shorter. Conclusion: The proportion of prolapse is higher in multiparous women with significant associations with age, body mass index, education level, and history of heavy physical work, delivering a large baby and use of hormonal contraceptives. Keywords: multiparous women, nulliparous women, parity, POP-

Obstetric Risk Factors and Anal Incontinence among Women with Previous History of Vaginal Delivery

Objective: To investigate the obstetric risk factors of the anal incontinence in mothers with previous history of vaginal delivery. Methods: The was a case-control study conducted in the Obstetrics and Gynecology Department of Dr.Wahidin Sudirohusodo Hospital, Faculty of Medicine, Universitas Hasanuddin, Makassar, during the period of February 2015 through January 2016. The research instruments were used to evaluate obstetric risk factors and the anal incontinence was the self-administered questionnaire and Fecal Incontinence Severity Index. The data were analyzed statistically using the Chi-square test with the significant value of p<0.05. Results: A total of 300 subjects were recruited in this study. The research results indicated that the parity of  3, the assisted vaginal delivery history (vacuum extraction), and the prolong second stage of labor had a significant correlation with the anal incontinence with p value=0.026, OR (95% CI) = 1.8 (1.07-3.03), p=0.018 with OR (95% CI) =3.65 (1.2-10.7) and p=0.006 with OR (95% CI) = 2.9 (1.2-6.7).The history of episiotomy and the delivery of the baby  4000 gram had no correlation with the anal incontinence. Conclusion: Parity, vacuum delivery and prolong second stage of labor have an association with anal incontinence among women who has history of vaginal delivery. Keywords: anal incontinence, obstetric risk factors, vaginal deliver

Growing Teratoma Syndrome: A Rare Case Report and Review of the Literature

Growing teratoma syndrome is rare and usually it occurs in the younger aged group. The use of chemotherapy following initial surgical resection will yield the diagnosis following tumour enlargement. Complete resection is usually curative and renders better prognosis

MIOMEKTOMI SAAT SEKSIO SESAREA (Laporan Kasus)

Latar Belakang: Ahli Obstetri dan Ginekologi dahulu tidak melakukan miomektomi saat seksio sesarea karena kuatir akan terjadi perdarahan hebat akibat peningkatan&nbsp;vaskularisasi pada uterus yang hamil. Sedangkan beberapa penelitian baru yang dipublikasikan dalam beberapa literatur mendukung konsep bahwa seksio sesarea yang dikombinasikan dengan miomektomi dapat dipertimbangkan sebagai suatu prosedur operasi yang aman.&nbsp;Tujuan: Melaporkan satu kasus miomektomi saat seksio sesarea&nbsp;Metode: Laporan kasus&nbsp;Hasil: Dilaporkan satu kasus, G1P0A0 gravid 38 minggu belum inpartu, usia 27 tahun, masuk ke RS Islam Faisal dengan keluhan hamil disertai benjolan di perut. Palpasi abdomen teraba massa padat, mobile, bertepi rata pada abdomen bagian kanan atas, ukuran 15 cm x 10 cm, tinggi fundus uteri 35 cm dan DJJ 140 x/mnt. Pada pemeriksaan USG didapatkan Gravid 38 minggu 4 hari dan Mioma Uteri. Pada hari kedua perawatan, setelah dilengkapi pemeriksaan dilakukan tindakan seksio sesarea dan miomektomi. Lahir bayi perempuan, berat badan 3320 gram, panjang badan, 48 cm, nilai Skor Apgar, 8/10. Didapatkan mioma uteri multipel dengan ukuran 23 cm x 18 cm dan berat 2500 gram. Jumlah perdarahan 250 ml. Diagnosis post operatif adalah G1P0A0 gravid 38 minggu belum inpartu + mioma uteri multipel. Hasil pemeriksaan patologi anatomi adalah Leiomioma uteri. Pada intraoperasi s.d. 24 jam post operasi, pasien diberikan drips oksitosin 20 IU dalam 500 ml RL, 28 tetes per menit. Pada pemantauan 2 jam post operasi, kontraksi baik, perdarahan 50 ml/2 jam. Setelah dirawat sampai hari kelima setelah operasi, keadaan pasien baik, pasien diperbolehkan pulang.&nbsp;Kesimpulan: Miomektomi yang dilakukan pada saat seksio sesarea telah dibuktikan pada kasus ini, aman. Jumlah perdarahan tidak banyak dan kontraksi uterus baik

Evaluation of Pelvic Floor Muscle Strength and Anal Spinchter Defects in Women Post Repair Obstetric Anal Spinchter Injuries

Tujuan: penelitian ini bertujuan untuk mengevaluasi defek sfingter ani dan disfungsi otot dasar panggul pada perempuan pasca repair trauma sfingter ani obstetri.Metode: Analitik observasional yang dikembangkan dengan desain kohort prospektif. Perempuan yang mengalami Repair Trauma Sfingter Ani Obstetri pada Bulan Januari 2020-Juni 2021 di beberapa RS jejaring Makassar dinilai defek pasca repair dan keluhan subjektif menggunakan USG Transperineal (Alpinion cube 5 dengan probe transvaginal), Skor Wexner, Numeric Pain Rating Scale dan Perineometer (Peritron 9300 V) yang dilakukan dalam 3 kali pengukuran yaitu pada bulan 1, 3 dan 6 pasca repair. Data diuji menggunakan Mann-Whitney test, Cochrane dan Independent T test. Data diolah menggunakan SPSS 24.Hasil: Dari 51 sampel yang dilakukan pemeriksaan, didapatkan rata-rata usia 27.82±4.04 tahun dengan rerata IMT 24.52±4.31 kg/m2. Sampel didominasi oleh primipara sebanyak 41(80,4%). Rerata berat bayi 3312.75±424.24 gram. Terdapat 5 (9,8%) Pasien yang mengalami defek pasca repair, rerata skor wexner pada sampel dengan defek sfingter ani 1.60±1.14 pada bulan pertama, terdapat perbedaan yang signifikan pada dispareunia (p<0.05) dengan rerata 3.33±1.15 pada sampel dengan defek sfingter ani pada bulan keenam. Tampak peningkatan rerata skor kekuatan otot panggul pada perempuan tanpa defek sfingter ani. Kesimpulan: Gejala subjektif dapat ditemukan pada perempuan tanpa defek sfingter ani. Peningkatan kekuatan otot dasar panggul dapat terjadi seiring bertambahnya waktu pasca repair.Evaluation of Pelvic Floor Muscle Strength and Anal Sphincter Defects in Post Obstetric Anal Sphincter Injuries Repair WomenAbstractObjectives: The goal of this study was to look at anal sphincter deficiencies and pelvic floor muscle dysfunction in women who had obstetric anal sphincter injuries and had them repaired.Methods: Analytical was created as an observational study with a cohort prospective design. Women who underwent OASIS Repair in multiple Makassar hospitals between January 2020 and June 2021 were assessed subjectively using Transperineal Ultrasound (Alpinion cube 5 ultrasound with transvaginal probe), Wexner Score, Numeric Pain Rating Scale, and Perineometer (Peritron 9300 V) at 1, 3, and 6 months after repairs. The data was analyzed using the Mann-Whitney test, Cochran test, and Independent T test in SPSS 24. Result: The average age of the 51 samples that underwent the assessment was 27.82.04 years, with a mean BMI of 24.524.31 kg/m2. Up to 41 percent of the sample was dominated by primiparas (80.4 percent ). The average infant weighs 3312.75424.24 grams. There were 5 (9.8%) patients who had a defect after repair, with an average score of 1.601.14 on the first month and a significant difference in dyspareunia (p0.05) with a mean of 3.331.15 on the sixth month in the sample with anal sphincter defect. In women who do not have an anal sphincter dysfunction, there is an average increase in look strength of the pelvic muscle.Conclusion: Women without an anal sphincter abnormality had subjective complaints. With more time passed after surgery, the pelvic floor muscle may improve.Key words: pelvic floor, OASIS, Wexner score, Anal Sphincter defect, Transperineal ultrasoun