The Effect of Analog GnRH before Laparoscopic Cystectomy to Ovarian Reserve which was Measured with anti Müllerian Hormone at Bilateral Endometriosis Cyst

Objective: To know the effect of preoperative GnRH-a treatment to preserve the ovary after laparoscopic excision of endometriomas by measuring antimüllerian hormonal before and after operation and analize the correlation with age and size of the endometrioma. Methods: Double blind randomized control trial, which is done to patients with bilateral endometriomas in Raden Saleh Clinic. Subject devided into groups GnRH-a and placebo. Patient was undergoing laparoscopic excision after four weeks of medication (GnRHa or placebo). AMH Serum levels was measured before preoperative medication and four weeks after operation. Result: There were eight bilateral endometriomas (25% patients requirement), 4 patient GnRH-a and four patients placebo, all with primary infertility. The average changes of AMH serum level before and after laparoscopy ovarian cystectomy in GnRH-a groups was 0.011 ng/ml and placebo groups was 1.502. The average changes of AMH serum level, in age strativication on both groups show the same result, GnRH-a 0.035 and placebo 1.681. In diameter cyst strativication, GnRH-a 0.011 and placebo 1.090. Conclusions: With the restrictiveness of the patient, this study find GnRH-a therapy initiated before laparoscopic cystectomy has better outcomes in ovarian reserve compared with placebo, and also the same result in age and size of cyst strativication analize. [Indones J Obstet Gynecol 2011; 35-1: 14-7] Keywords: laparoscopic cystectomy, GnRH-a, ovarian reserv

Administration of Dydrogesterone in first trimester of pregnancy will increase the level of PlGF (Placental Growth Factor)

Early placental development can be determined by measuring placental growth factor or Placental growth factor (PlGF) through the mother's blood since the first trimester of pregnancy. The purpose of this study was to determine the effect of supplementation on the development didrogesteron placenta in pregnancy by measuring the levels of PlGF. This study is a randomized double-blind clinical trial (Randomized Controlled Clinical Trial) held at the Antenatal Clinic (ANC) at the General Hospital dr. Zainoel Abidin (RSUZA), Banda Acehto women of reproductive age in the first trimester in RSUZA ANC checkup. Nonprobability sampling sampling with consecutive sampling. In this study there were two groups of women of reproductive age who are not in pairs is given didrogesteron group A while group B received placebo. Measurement of PlGF levels in both groups performed before and after treatment. PlGF levels prior to treatment in Group A 25.95 pg/ml while Group B 40.80 pg/ml. PlGF levels after the measurement results given didrogesteron in Group A for 4 weeks gainedincreasing levels of PlGF is 212.15 pg/ml, whereas in group B were given a placebo for 4 weeks was 89.60 pg/ml. Data analysis was performed using bivariate analysis between supplementation didrogesteron and PlGFlevels using SPSS 17. Analysis of data for comparative analytical numerical information unpaired two groups: Group A: the results of a PlGF levels in pregnant subjects were given didrogesteron and Group B: the results ofa PlGF levels in pregnant patients given placebo. Unpaired t-test results of the two groups showed that the group receiving didrogesteron have elevated levels of PlGF were significantly (p = 0.000 or p 0.05) compared with the placebo group were only given alone. From these results it can be concluded that the administration can trigger didrogesteron PlGF levels in women of reproductive age

The Role of Maternal Progesterone and Estradiol Levels in Predicting the Success of Induction of Labour: A Preliminary Study

Objective: to evaluate whether maternal progesterone and estradiol levels could be used to predictthe success ofinduction of labour (IOL) Methods:This cross-sectional study was conducted at the Women’s Health Clinic as well as delivery suite of Dr. Cipto Mangunkusumo Hospital during the period of May 2016 to April 2017. Blood samples of term pregnant women who were indicated for IOL wereobtainedbefore birth. Results:A total 44 subject were recruited in this study.Of these, 24 subjects had successful IOL while the other 20 subjects had IOL failure. There was no significant difference of progesterone among both groups (66,7% vs 75%, p=0,55). The estradiol levels in subjects who successfully performed induction had an average of 16,916.28 ± 2,574.75 pg/mL which did not differ significantly from the failed of induction group with estradiol levels of 14,832.24 ± 2374.47 pg/mL (p = 0,65). Conclusion:We found no significant association between both maternal progesterone and estradiol levels and the success rate of IOL. Further studies with larger sample sizes are required to confirm whether progesterone and estradiol play pivotal roles in the success of IOL. Keywords: progesterone, estradiol, induction of labour   Tujuan: mengevaluasi kadar progesteron dan estradiol ibu sebagai prediktor kesuksesan induksi persalinan Metode: Penelitian ini menggunakan desain potong lintang yang berlangsung pada bulan Mei 2016 hingga April 2017 di Poliklinik dan IGD Kebidanan Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo. Pasien hamil aterm yang dilakukan induksi persalinan dan memenuhi kriteria penelitian akan diambil sampel darah sebelum persalinan. Hasil: Dari 44 subjek yang mengikuti penelitian, 24 subjek berhasil dilakukan induksi persalinan dan 20 subjek gagal.Tidakterdapatperbedaanbermaknapadakadarprogesterone Antarakeduagrup(66,7% vs 75%, p=0,55). Kadar estradiol padapasien yang berhasildilakukaninduksimemiliki rata-rata 16.916,28 + 2.574,75pg/mL yang tidakberbedajauhdengankadar estradiol pasien yang gagalinduksiyaitu 14.832,24 + 2374,47pg/mL (p = 0,65). Kesimpulan: Tidakterdapat perbedaan bermakna antara kadar progesteron dan estradiol maternal terhadap keberhasilan induksi persalinan. Penelitian lebih lanjut dengan jumlah sampel yang lebih besar dibutuhkan untuk mengkonfirmasi hubungan ini dengan lebih baik. Kata kunci: progesteron, estradiol, induksi persalina

Visceral Adipose Tissue was Associated with Increased Risk of Insulin Resistance in Lean Polycystic Ovarian Syndrome, Independent with Retinol Binding Protein-4: Jaringan Adiposa Viseral berkaitan dengan Peningkatan Risiko Resistensi Insulin pada Sindrom Ovarium Polikistik dengan Indeks Masa Tubuh Normal, Independen terhadap Retinol Binding Protein-4

Objective: To determine whether visceral adipose tissue or serum RBP-4 were related with the risk increment of insulin resistance in normal BMI PCOS patients. Methods: This was a cross-sectional study conducted in normal body mass index PCOS patients at Yasmin Clinic, RSCM, Jakarta from July 2014 until March 2015. Diagnosis of PCOS was established using Rotterrdam (2003) criteria. Insulin resistance was confirmed by using ratio of HOMA-IR >1.4. Results: Among 40 subjects, 20 subjects (50%) belong insulin resistance group. Serum RBP-4 level was higher in insulin resistance group (p=0.06). After ROC analysis was conducted, area under curve for of serum RBP-4 was 69.9% (CI 95% -3754.77 - (186.60-7696.14, p=0.061)). Cut-off level of serum RBP-4 was 23814.5 ng/mL yielded sensitivity and specificity to a level of 60% and 60%, respectively. After logistic regression were analyzed, visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients. Conclusions: Visceral adipose tissue demonstrated substantial association with the risk increment of insulin resistance in normal BMI PCOS patients, independent with serum RBP-4 levels. Key words: body mass index, diagnosis, insulin resistance, PCOS, retinol binding protein-4   Abstrak Tujuan: Untuk menentukan apakah jaringan adiposa viseral atau serum RBP-4 berhubungan dengan peningkatan risiko resistensi insulin pada Sindrom Ovarium Polikistik dengan indeks masa tubuh normal. Metode: Studi potong lintang dilakukan pada subjek SOPK dengan IMT normal di Klinik Yasmin, RSCM, Jakarta sejak Juli 2014 sampai dengan Maret 2015. Penegakan diagnosis SOPK dilakukan dengan kriteria Rotterdam (2003). Resistensi insulin dikonfirmasi dengan pemeriksaan rasio HOMA-IR > 1.4 Hasil: Diantara 40 subjek, sebanyak 20 subjek (50%) mengalami resistensi insulin. Kadar serum RBP-4 lebih tinggi pada kelompok resistensi insulin (p=0.06). Setelah dilakukan analisis Receiver Operating Curve (ROC), serum RBP-4 memiliki Area Under the Curve  (AUC) sebesar 69.9% (IK 95% -3754.77 - (186.60-7696.14, p=0,061)). Titik potong kadar serum RBP-4 adalah 23814.5 ng/mL dengan sensitivitas dan spesifisitas masing-masing 60% dan 60%. Setelah dilakukan analisis regresi logistik, jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada pasien SOPK dengan IMT normal. Kesimpulan: Jaringan adiposa viseral menunjukan asosiasi yang kuat dengan terjadinya resistensi insulin pada SOPK dengan IMT normal, independen terhadap kadar serum RBP-4. Kata kunci: diagnosis, indeks masa tubuh, resistensi insulin, retinol binding protein-4, SOP

Administration of Dydrogesterone in First Trimester of Pregnancy Will Increase the Level of PlGF (Placental Growth Factor)

Early placental development can be determined by measuring placental growth factor or Placental growth factor (PlGF) through the mother's blood since the first trimester of pregnancy. The purpose of this study was to determine the effect of supplementation on the development didrogesteron placenta in pregnancy by measuring the levels of PlGF. This study is a randomized double-blind clinical trial (Randomized Controlled Clinical Trial) held at the Antenatal Clinic (ANC) at the General Hospital dr. Zainoel Abidin (RSUZA), Banda Acehto women of reproductive age in the first trimester in RSUZA ANC checkup. Nonprobability sampling sampling with consecutive sampling. In this study there were two groups of women of reproductive age who are not in pairs is given didrogesteron group A while group B received placebo. Measurement of PlGF levels in both groups performed before and after treatment. PlGF levels prior to treatment in Group A 25.95 pg/ml while Group B 40.80 pg/ml. PlGF levels after the measurement results given didrogesteron in Group A for 4 weeks gainedincreasing levels of PlGF is 212.15 pg/ml, whereas in group B were given a placebo for 4 weeks was 89.60 pg/ml. Data analysis was performed using bivariate analysis between supplementation didrogesteron and PlGFlevels using SPSS 17. Analysis of data for comparative analytical numerical information unpaired two groups: Group A: the results of a PlGF levels in pregnant subjects were given didrogesteron and Group B: the results ofa PlGF levels in pregnant patients given placebo. Unpaired t-test results of the two groups showed that the group receiving didrogesteron have elevated levels of PlGF were significantly (p = 0.000 or p < 0.05) compared with the placebo group were only given alone. From these results it can be concluded that the administration can trigger didrogesteron PlGF levels in women of reproductive age

Correlation of anti-Müllerian hormone levels with metabolic syndrome events in polycystic ovary syndrome: A cross-sectional study

Background: Various endocrine disorders have been reported in women of reproductive age, 10% of which is affected by polycystic ovary syndrome (PCOS). Objective: This study aimed to evaluate the correlation of anti-Müllerian hormone (AMH) levels with the metabolic syndrome in patients with PCOS. Materials and Methods: This cross-sectional study employed a consecutive sampling method using medical records from January 2013 to December 2017 at Dr. Cipto Mangunkusumo General Hospital polyclinic and Yasmin in vitro fertilization Clinic (Kencana), Jakarta, Indonesia. The primary outcome of the study was the AMH levels as independent variable correlated with metabolic syndrome. The secondary outcome was also the AMH levels correlated with each PCOS phenotype. The tertiary outcome was each PCOS phenotype as independent variable correlated with metabolic syndrome. Results: Women with phenotype 1 of PCOS had a median AMH level of 13.92 (range: 3.88-34.06) ng/ml. 21% patients had metabolic syndrome, with a median AMH level 7.65 (3.77-20.20) ng/ml, higher than the women without metabolic syndrome (p = 0.38). The most frequent phenotype in women with PCOS was phenotype 4, oligo- or anovulation and polycystic ovary morphology (OA/PCOM) in 41.3%. The most frequent phenotype in women with metabolic syndrome was phenotype 1, OA + PCOM + hyperandrogenism in 56.5%. Conclusion: All PCOS phenotypes exhibited significant correlations with the AMH level. Phenotype 1 (OA + PCOM + hyperandrogenism) was associated with the highest AMH level and was significantly associated with metabolic syndrome. Key words: Anti-Müllerian hormone, Metabolic syndrome, Polycystic ovary syndrome

The Outcome on Conservative Surgical Treatment of Adenomyosis

Objective: To understand the outcome on conservative surgical treatment of adenomyosis. Methods: A retrospective cohort study followed for 2 years from 2010 to 2012 of women with adenomyosis were diagnosed by transvaginal sonography and confirmed histologically. Subjects divided into women who were treated by adenomyosis resection (with/without Osada’s technique) and who were underwent hysterectomy. Results: After the surgery, as many as 40 patients (81.63%) did not feel any pain (VAS 0), and 9 patients (18.37%) still felt pain. For the fertility outcome, we had 8 patients (20.51%) getting pregnant naturally without any fertility intervention. Two patients (5.13%) had successfully conceived by IVF. According to the type of surgery, from 8 natural pregnancy, 7 patients (87.50%) was underwent conventional resection of adenomyosis and 1 patients (12.50%) underwent Osada’s procedures. Two patients who were conceived by IVF, both of them were underwent Osada’s resection. Conclusion: Adenomyosis resection both conservative or Osada’s procedures actually has a better outcome for relieving pain; therefore, some patients can still have a child. Keywords: adenomyosis resection, conventional resection, infertility, Osada’s procedur

The Effectiveness of Phalleria Macrocarpa Bioactive Fraction in Alleviating Endometriosis And/or Adenomyosis Related Pain

The overexpression of estrogen receptor-beta (ER-&szlig;) and the cyclooxygenase-2 (COX-2) enzyme coupled with the absence of expression of progesterone receptors (PR) is critical to thepathogenesis of endometriosis and adenomyosis associated pain.&nbsp; DLBS1442, a novel bioactiveextract of Phaleria macrocarpa, exerts its action by downregulating the overexpressed ER-&szlig; andCOX-2 products and up-regulating PR gene expression. This pilot study was conducted to evaluatethe effectiveness of DLBS1442 treatment in alleviating endometriosis- and/or adenomyosis-relatedpain. Ten endometriosis and/or adenomyosis patients were recruited consecutively at YasminClinic Dr. Cipto Mangunkusumo General Hospital in January - March 2013. Pain associated withmenses, including pre-menstrual pain, dysmenorrhea, dyschezia and dysuria, was measuredusing the visual analog scale (VAS) at each of the next three menstrual cycles. Patients reportingone or more pain symptoms with a VAS score = 4 were given 100 mg of DLBS1442 three timesdaily for 12 weeks. VAS score reduction was noted in the first post-treatment menstrual cycle(approximately 5.3 weeks after treatment initiation) and VAS scores continued to decline overthe final two cycles. DLBS1442 was effective in alleviating endometriosis- and/ or adenomyosisrelatedpain, as demonstrated by early pain reduction as evaluated using the VAS