Role of Platelet-Rich Plasma Application on Mesh-Tissue Integration: Peran Aplikasi Platelet-Rich Plasma pada Integrasi Mesh dengan Jaringan

AbstractObjective: To review the advantage of PRP use on mesh-augmented surgery.Methods: Literature review of PRP application of mesh.Results: The application of PRP on mesh shows potential promising outcome.Conclusion: PRP may improve the mesh-tissue integration.Keywords: mesh-augmented surgery, pelvic organ prolapse, platelet-rich plasma, wound healing.AbstrakTujuan: Untuk menganalisa keuntungan penggunaan PRP pada pembedahan rekonstruktif dengan mesh.Metode: Kajian pustaka dari penggunaan PRP pada pembedahan rekonstruktif dengan mesh.Hasil: Aplikasi PRP pada mesh menunjukkan hasil yang positif.Kesimpulan: Aplikasi PRP dapat meningkatkan integrasi mesh dengan jaringanKata kunci: pembedahan rekonstruksi dengan mesh, penyembuhan luka, platelet-rich plasma, prolaps organ panggul

Characteristics of Patients with Obstetric and Gynecologic Fistula in Jakarta

Objective: To know the characteristics of patients with obstetrics and gynecologic fistula in Dr. Cipto Mangunkusumo Hospital, Jakarta. Method: This study was a descriptive design using secondary data from medical records and patient database during 2011-2016. Result: There were 68 subjects with fistula. From 2011-2016, there were 5 cases (7.4%), 19 cases (27.9%), 16 cases (23.5%), 11 cases (16.2%), 8 cases (11.8%), and 9 cases (13.2%) of fistula; respectively. The average age of subjects was 38 years old and only 34 subjects have complete data. Gynecologic and obstetric fistula were 17 cases each. As total 28% of fistula cases were vesicovagina fistula, 12% were rectovaginal fistula, 9% were anovagina fistula, and the other types of fistula were 2%. Among 34 subjects, there were 21% of vesicovagina fistula and 3% of rectovagina fistula, which were caused by iatrogenic. There were 7% of vesicovagina and rectovagina fistula each and 9% of anovagina fistula were caused by obstetric problems. The iatrogenic procedures found from this study were total abdominal hysterectomy (16%), vaginal hysterectomy (3%), and neovagina (3%). Conclusion: The trend of cases is decreasing during the present years (2011-2016). Gynecologic fistula cases caused by iatrogenic are the major problems, but the obstetrics fistula cases decreasing following the labor monitoring is much better nowadays. [Indones J Obstet Gynecol 2016; 4-4: 212-217] Keywords: gynecologic fistula, iatrogenic, obstetric fistul

The Outcome of Percutaneous Mitral Balloon Commissurotomy (PMBC) in Pregnant Women with Mitral Stenosis: An Evidence Based Study: Luaran Komisurotomi Balon Mitral Perkutan pada Perempuan Hamil

Abstract Objective: To review the outcome of percutaneous mitral balloon commissurotomy (PMBC) both to maternal and neonatal. Methods: The search was conducted on Pubmed®, Cochrane Library®, and Ovid® using MeSH. Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by two independent authors. Results: Several studies showed that performing the PMBC had good outcome for pregnant women functional class based on NYHA. Most of them decreased from NYHA III/IV to I/II. For delivery outcome, all studies concluded that more than 80% pregnant women with mitral stenosis undergoing PMBC delivered at term, and no congenital anomalies found. Conclusion: Percutaneous mitral balloon commissurotomy for pregnant women with severe MS is safe during pregnancy. Keywords: mitral stenosis, outcome, percutaneous mitral balloon commissurotomy,  pregnancy,   Abstrak Tujuan: Mengulas luaran komisurotomi balon mitral perkutan (KBMP) baik pada maternal maupun neonatus. Metode: Pencarian dilakukan melalui Pubmed®, Cochrane Library®, dan Ovid® menggunakan MeSH. Telaah kristis dilakukan oleh 2 penulis independen berdasarkan validitas, kepentingan, dan aplikabilitas. Hasil: Beberapa studi memperlihatkan KBMP memiliki luaran yang baik di kalangan perempuan hamil berdasarkan kelas fungsional NYHA. Kebanyakan mereka mengalami penurunan NYHA dari III/IV menjadi I/II. Untuk  luaran persalinan, seluruh studi menyimpulkan lebih dari 80% perempuan dengan mitral stenosis yang menjalani pembedahan KBMP melahirkan pada usia term dan tidak ditemukan kelainan. Kesimpulan: KBMP aman dilakukan pada perempuan hamil dengan mitral stenosis berat. Kata kunci: kehamilan, komisurotomibalon mitral perkutan, luaran, stenosis mitra

Comparison Study of Urinary Retention Incidence in Assisted Vaginal Delivery Case with and without 24-Hour Catheterization

Background: Urinary retention is a condition commonly seen after vaginal delivery, especially in the highrisk cases, such as assisted vaginal delivery, grade 3-4 th perineal rupture, or another high risk. Urinary retention caused by unsynchronized between the contraction of the bladder detrusor. Urinary catheterization is one of the preventions of urinary retention. It gives a time for perineal trauma to relieve and no longer edema, so that urethra can be fully relaxed. Therefore, 24-hour catheterization expected to prevent bladder overdistention. It also prevents the bladder from becoming atonia. Objective: This research aims to study the incidence of urinary retention in assisted vaginal delivery with and without 24-hour catheterization. Method: This study used randomized control trials that compared two groups with 24hour catheterization and without 24-hour catheterization. This study was conducted on 40 women in each group who experienced assisted vaginal birth at Dr Soetomo Hospital, Indonesia. Result: Six women (15%) experienced urinary retention with 24-hour catheterization and six women (15%) had urinary retention without catheterization. There was no significant difference in the incidence of urinary retention with 24-hour catheterization and without 24-hour catheterization (p-value = 1.00). Also, there was no significant interference of urinary retention in the normal and prolonged second stage of labor (p-value = 0.736), and there was no significant risk factor contributing to urinary retention. Conclusion: No significant difference in urinary retention occurred in assisted vaginal delivery with and without 24-hour catheterization

Postoperative Catheterization after Total Vaginal Hysterectomy: Six versus Twenty Four Hours. A Randomized Controlled Trial: Kateterisasi Pascaoperasi Total Vaginal Histerektomi: Enam Jam versus Dua Puluh Empat Jam. Sebuah Penelitian Randomisasi Terkontrol

Abstracts Objective: To find out whether urinary bladder catheterization after total vaginal hysterectomy is more advantageous.Methods: Forty-six subjects were included. Subjects were divided into two groups. In one group (n = 24), a transurethral catheter was removed after six hours post-surgery. In the other group (n = 24), the catheter was removed after twenty-four hours. A few hours after removal of the catheter, patients were asked to urinate. Then residual volumes were measured by measuring cylinder, using 12F catheter. Pain was measured using visual analogue scale (VAS) score. Patients’ length of stay was also compared. Data were analyzed using Student T-test if distributed normally or Mann-Whitney Rank if data was abnormal.Results: Mean age for each group was 63,21 ± 8,73 and 62,38 ± 7,52 (6 hours, 24 hours respectively). Median score for 6 hours group was 50,00 (range 5 - 80) and for 24 hours was 100 (range 30 - 250) (P = 0,000). Pain perception and hospital stay were not statistically different in both group (P = 0,134 and P = 0,377)Conclusion:In this study, difference in postoperative catheterization time is associated with residual volume. Keywords: bladder catheterization, postoperative catheterization, residual volume, total vaginal hysterectomy.   Abstrak Tujuan: Untuk membandingkan lama waktu pemasangan kateter paskaoperasi total vaginal histerektomi yang lebih menguntungkan.Metode: Empat puluh enam pasien ikut serta dalam penelitian. Secara acak dibagi menjadi 2 kelompok. Pada grup I (n = 24), pelepasan kateter dilakukan setelah enam jam pascaoperasi. Pada grup II (n = 24), kateter dilepas setelah dua puluh empat jam. Beberapa jam setelah pelepasan kateter, pasien diminta untuk buang air kecil. Lalu residu urin diukur setelahnya menggunakan gelas ukur, memakai kateter no. 12 F. Skor nyeri menggunakan skor Visual Analogue Scale (VAS). Lama rawat inap juga dibandingkan. Analisis data menggunakan student's T-test. Jika terdistribusi tidak normal, analisis memakai Mann-Whitney Rank.Hasil: Rerata usia untuk tiap grup adalah 63,21 ± 8,73 dan 62,38 ± 7,52 (6 jam, 24 jam, secara berurutan). Skor median untuk grup 6 jam adalah 50,00 (range 5 – 80) dan grup 24 jam adalah 100 (range 30 – 250) (P = 0,000). Tidak ada perbedaan signifikan secara statistic pada rasa skor nyeri dan lama rawat inap (P = 0,134 dan P = 0,377).Kesimpulan: Pada penelitian ini, perbedaan waktu pemasangan kateter pascaoperasi memiliki hubungan dengan volume sisa urine.Kata kunci: kateterisasi urine, kateterisasi pascaoperasi, volume sisa urine, total vaginal histerektomi

Manajemen Retensio Urin Pasca Persalinan Pervaginam

  Retensio urin pascapersalinan (RUPP) adalah ketidakmampuan berkemih spontan atau dapat berkemih spontan 6 jam setelah persalinan dengan residu urin >200 mL. RUPP menimbulkan peregangan kandung kemih berlebihan sehingga mengganggu persarafan dan atonia otot detrusor. Faktor risiko RUPP adalah primipara, persalinan dengan alat, persalinan kala II lama, dan ruptur perineum luas. Gejala klinis berupa buang air kecil (BAK) sedikit atau tidak dapat BAK. Manajemen RUPP dengan residu urin 200-500 mL dilakukan kateterisasi intermiten tiap 6 jam sampai residu urin <200 mL. Jika residu urin 500-1.000 mL dilakukan dauer kateter 1x24 jam dan 6 jam kemudian pasien diminta berkemih spontan, 5 menit kemudian diukur residu urin. Jika residu urin 1.000-2.000 mL, dipasang dauer kateter selama 2x24 jam dan buka tutup kateter/4-6 jam selama 24 jam. Jika residu urin >2.000 mL, dauer kateter 3x24 jam dan bladder training selama 24 jam. Enam jam kemudian diukur volume residu urin dan bila residu urin <200 mL maka volume residu urin dikatakan normal. Pascapersalinan, tatalaksana dilakukan secara simultan dengan pemasangan kateter diikuti pemberian prostaglandin, antibiotik, dan edukasi minum air 2-3 liter perhari. Perlu pemeriksaan klinis yang baik pada pengawasan lama kala II, pengosongan kandung kemih dan tatalaksana robekan jalan lahir.   Post-Partum Urinary Retention Management  Postpartum urinary retention (PPUR) is defined as inability to pass urine spontaneously or able to pass urine spontaneously in 6 hours following delivery with residual urine volume of >200 ml. PPUR is causing overdistention of bladder resulted in neurologic dysfunction and detrusor muscle atonia. Risk factor for PPUR including primipara, assisted vaginal delivery, prolonged second stage of labor and extensive perineal rupture. Clinical symptoms related to PPUR are decreasing urine volume or unable to urinate spontanously. Management in PPUR with residual urine 200-500 ml is by intermitten catether every 6 hours continued with spontaneously urinate and residual urine will be measured after 5 minutes. PPUR management with residual urine 500-1000 ml is by applied dauer catheter 1x24 hours continued with spontaneously urinate after 6 hours and residual urine also will be measured after 5 minutes. PPUR management with residual urine 1000-2000 ml is by applied dauer catheter 2x24 hours, continued with opening and closing catheter every 4-6 hours for 24 hours. If residual urine >2000 ml, dauer cathetetr will be applied for 3x24 hours, continued with bladder training for 24 hours. Residual urine will be measured after 6 hours. The result is normal if residual urine <200 ml. PPUR management is done simultaneously with catheter application, prostaglandin, antibiotics and hydration 2-3 L/day. Good clinical examination and management during prolonged second stage of labor, bladder emptying and perineal ruptur management are needed in preventing post partum urinary retention.  &nbsp

Management of Aplastic Anemia in Pregnancy: A Case Report: Manajemen Anemia Aplastic Pada Kehamilan: Laporan Kasus

Aplastic anemia was first recognized by Ehrlich in 1888, although the pathogenesis of aplastic anemia has remained elusive. Aplastic anemia is a subtype of anemia characterized by pancytopenia and a hypocellular bone marrow which are the risk factor can be due to chemicals, drugs, infections, irradiation, leukemia, and inherited disorders. There is universal agreement that pregnancy complicated by aplastic anemia is a serious condition. The risk to the mother is mainly in the form of hemorrhage meanwhile the fetus may suffer from growth restriction and even intrauterine death. Most of the fetal complications are due to maternal anemia. We here present one cases of pregnancy complicated by aplastic anemia, which were seen within 3 months at our hospital. This high incidence is because the hospital is a top national care referral unit with good hematology and blood bank support. Keyword: aplastic anemia, pregnancy, pancytopenia Abstrak Anemia aplastik pertama kali dikenali oleh Ehrlich pada tahun 1888, walaupun patogenesis anemia aplastik masih sulit dipahami. Anemia aplastik adalah subtipe anemia yang ditandai dengan pansitopenia dan hiposeluler sumsum tulang yang merupakan faktor risiko yang dapat disebabkan oleh bahan kimia, obat-obatan, infeksi, iradiasi, leukemia, dan kelainan bawaan. Terdapat kesepakatan universal bahwa komplikasi kehamilan berupa anemia aplastik merupakan kondisi serius. Risiko kepada ibu hamil terutama dalam bentuk perdarahan sementara janin dapat mengalami hambatan dalam pertumbuhan dan bahkan kematian dalam kandungan. Sebagian besar komplikasi janin disebabkan oleh anemia pada maternal. Kami di sini menyajikan satu kasus komplikasi kehamilan berupa anemia aplastik, yang ditemukan dalam waktu 3 bulan di rumah sakit kami. Kejadian yang tinggi ini karena rumah sakit adalah unit rujukan perawatan nasional teratas dengan hematologi yang baik dan dukungan bank darah

The Use of Vaginal Pessary for Pelvic Organ Prolapse’s Treatment

Pelvic organ prolapse (POP) is the descent of the anterior and/or posterior vaginal wall or vagina apex (uterus or vaginal apex after a hysterectomy) and has negative effects on woman’s daily activities and reduces her quality of life. One of the treatments of POP is pessary that has limited evidence but still commonly used for treatment of genital prolapse and considered as the first line treatment by the American Urogynecologic Society (AUGS). This evidence-based case report (EBCR) is made to critically analyze from the current studies whether the use of pessary improves the symptoms of pelvic organ prolapse or not. A search of literature was performed in two databases, MEDLINE and Cochrane. Eligible articles were observational studies, clinical trials, systematic reviews, or meta-analyses that published within the last 5 years. All studies showed symptoms improvement with four studies using Pelvic Organ Prolapse Distress Inventory (POPDI) score and one study using International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS). Keywords: pelvic organ prolapse, pessary, treatment. Penggunaan Pesarium Vagina untuk Penatalaksanaan Prolaps Organ Pelvik Abstrak Prolaps organ pelvik (POP) adalah penurunan dinding anterior dan atau posterior vagina atau apeks vagina (uterus atau apeks vagina setelah histerektomi) yang memiliki dampak negatif terhadap aktivitas sehari-hari dan menurunkan kualitas hidup. Salah satu tata laksana POP adalah pesarium yang memiliki bukti ilmiah terbatas tetapi masih digunakan untuk tata laksana prolaps genitalia dan dipertimbangkan sebagai terapi utama menurut American Urogynecologic Society (AUGS). Evidence-based case report (EBCR) dibuat untuk menganalisis secara kritis dari studi yang sudah ada apakah penggunaan pesarium dapat memperbaiki gejala dari prolaps organ pelvik atau tidak. EBCR ini dilakukan dalam dua databases, MEDLINE dan Cochrane. Artikel yang memenuhi syarat merupakan studi observasional, percobaan klinis, ulasan sistematis, atau meta-analisis yang telah dipublikasi pada 5 tahun terakhir. Semua studi menunjukan bahwa terdapat perbaikan dari gejala (POP) dengan empat studi menggunakan pelvic organ prolapse distress inventory (POPDI) score dan satu studi lainnya menggunakan International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS). Kata kunci: prolapse organ pelvik, pesarium, penatalaksanaan