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Perbandingan Skala Nyeri Pasien Kista Endometriosis Dan Adenomiosis Sebelum Operasi, Setelah Operasi Dan Setelah Pemberian GNRH Analog Wahyuridistia Marhenriyanto; Dedy Hendry
Andalas Obstetrics And Gynecology Journal Vol 4, No 1 (2020)
Publisher : Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/aoj.4.1.35-47.2020

Background: Endometriosis is the growth of the epithelium and endometrial glands outside the uterine cavity. In endometriosis there is a process of neurogenesis and angiogenesis. The degree of endometriosis pain depends on the depth of endometrial implant infiltration in nerve fibers and / or neurogenesis. Operative action and postoperative hormone therapy are the main choices for preventing recurrence and reducing pain complaints.Purpose: to determine the comparison of pain scales of patients with endometriosis before surgery, after surgery and after administration of GnRH analogues.Method: This study was an observational analytic with a retrospective cohort design in the Obstetrics and Gynecology Clinic of RSUP Dr. M. Djamil Padang in June 2017 to January 2018. The sample size were of 35 people with inclusion and exclusion criteria. The inclusion criteria were the diagnosis of endometriosis (endometriosis cysts and adenomyosis) from ultrasonography and anatomical pathology, had surgery and received analogue GnRH injection three times. Exclusion criteria were not proven endometriosis, hysterectomy surgery, using analgesics and not following analogue GnRH injection procedures. The pain scale is assessed by the Wong-Baker Faces Pain Rating Scale. The pain scale is assessed during menstruation before surgery, first menstruation after surgery and first menstruation after three analogues of GnRH injections. Data analysis using SPSS version 22, where univariate analysis is used to see the characteristics of respondents and bivariate analysis using Wilcoxon Test. Statistical test results were significant if p <0.05.Result: Based on the Wilcoxon statistical test results obtained p value = 0.0001 (p value <0.05) which can be concluded that there is a significant reduction in the pain of endometriosis of patients after surgery compared to before surgery.Conclusion: There was a significant decrease in pain in endometriosis patients before surgery.Keywords: Endometriosis, Adenomyosis, Pain Scale, GnRH anaologist

KORELASI EKSPRESI IMMUNOSITOKIMIA VASCULAR ENDOTHELIAL GROWTH FACTOR A (VEGF A) DENGAN PROTEIN GENE PRODUCT 9,5 (PGP 9,5) DARAH HAID PADA PATOFISIOLOGI ENDOMETRIOSIS Dedy Hendry; Tita Husnitawati Madjid; Ruswana Anwar; Anita Rachmawati
Andalas Obstetrics And Gynecology Journal Vol 1, No 1 (2017)
Publisher : Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/aoj.1.1.38-46.2017

There are changes of eutopic endometrium molecular fenotipe in endometriosis such as changes in gene expression, steroid hormone response, increase of inflammation marker and cellular adhesion molecule, decrease of apoptotic index and decidualization capacity, increase of oxidative stress marker, increase activity of angiogenesis and neurogenesis. This study was conducted to analyze the differences in the expression of angiogenic factors (VEGF A) and neurogenesis factors (PGP 9.5) eutopic endometrium of menstrual bleeding among patients with endometriosis and non endometriosis and then the correlation of the two factors. This study is a cross sectional that examines the relationship between the incidence of endometriosis with risk factors such as VEGF expression and PGP 9.5 in menstrual blood. There were significant differences in the expression of VEGF A eutopic endometrium menstrual blood between endometriosis and non endometriosis group (p=0.002). There are significant differences expression of VEGF A and PGP 9.5 eutopic endometrial of menstrual blood between endometriosis and non endometriosis groups. There is a positive correlation between the expression of VEGF A with PGP 9.5 eutopic endometrial of menstrual blood on endometriosis patients.Keywords: eutopic endometrium, menstrual blood, VEGF A expression, PGP 9.5 expression, immunocytochemistry

KARAKTERISTIK PENDERITA ENDOMETRIOSIS DAN ADENOMIOSIS DI RSUP DR. M. DJAMIL PADANG PERIODE JANUARI 2017 – OKTOBER 2018 Arde Hidayat; Dedy Hendry
Andalas Obstetrics And Gynecology Journal Vol 3, No 1 (2019)
Publisher : Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/aoj.3.1.1-8.2019

Background : Endometriosis is a benign gynecological disorder characterized by the presence of endometrial glands and stroma outside the normal location. Endometriosis is a chronic disorder which is a major cause of infertility, dysmenorrhea, dyspareunia and chronic pelvic pain with varying degrees of pain. Management of endometriosis can be in the form of medical therapy and/ or surgical therapy. Surgical therapy can be conservative and definitive.Objective : This study aims to obtain the characteristics of patients with endometriosis and adenomiosis who are operated at Dr. M. Djamil Padang for the period of January 2017 - October 2018.Method : This was descriptive retrospective study, using medical records data of endometriosis patient at Dr. RSUP M. Djamil Padang.Result : The results of the study obtained 160 cases of endometriosis patients who were operated during that period but only 154 patients had complete data in the medical record. Endometriosis cases were common among age of 36-45 years old (42.2%), married (87.7%), nullipara (61.7%), ovarian endometrioma (44.8%),laparotomy method (54.6%), type of surgery was cystectomy (44.8%), and pain reduced post operation (62.7%).Conclusion : Most frequent characteristics of endometriosis patient were operated in the 36-45 year age group, married, nullipara, ovarian endometrioma, laparotomy method, type of surgery was cystectomy and pain reduced post operationKeywords: endometriosis, adenomiosis, dysmenorrhea

Perbandingan Cadangan Ovarium Sebelum Dan Setelah Tindakan Laparoskopi Kistektomi “Fertility Sparing” Pada Penderita Kista Endometriosis Dwinda Rizary; Dedy Hendry
Andalas Obstetrics And Gynecology Journal Vol 4, No 1 (2020)
Publisher : Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/aoj.4.1.95-109.2020

Laparoscopy Cystectomy still remains the first line as the treatment of endometriosis cyst. A “fertility sparing” laparoscopy is a procedure that preserve uterus and ovaries of endometrioma patient. Objective: was to compare the ovarian reserve before and after laparoscopic cystectomy “fertility sparing” using three marker of ovarian reserve which are AMH, FSH and Estradiol on 2nd or 3rd day of menstrual period and counting the AFC by Transvaginal Ultrasound.Methods: This study is an experimental study on 25 endometrioma patient. Ovarian reserve values was taken before and after laparoscopy using three markers which are AMH, FSH and Estradiol and AFC. All patient included to group performed laparoscopy cyctectomy with several techniques which are no or less use of electrocoagulation, using vassopresin injected to the cyst wall, using stripping of the membrane technique on cyst, without suturing, using compression to control bleeding, avoiding hillus cut. Statistical Analysis was using paired t test method.Result: There was average differences on AMH value before 1,77 ± 0,39 ng/ml and after laparoscopy 1,54 ± 0,38 ng/ml. FSH value before was 6,91 ± 4,59 mlU/ml and after was 10,13 ± 6,51 mlU/ml, for estradiol before was 99,65 ± 77,18 mlU/ml and after was 63,67 ± 35,22 mlU/ml. There were 15 samples before laparoscopy has AFC <4, 10 samples has AFC 4-6, after laparoscopiy there was 8 samples has 8 AFC, 8 samples has 4-6 AFC, and 9 samples has 7-10 AFC. There was a statistical significance on the reduce of ovarian reserve before and after laparoscopic cystectomy “fertility sparing” (p=0,001).Conclusion: There was the affect of laparoscopy cystectomy to the decrease of ovarian reserve which sre 13% decreaed of AMH (p+0,001), 31,6% increased of FSH (p=0,001), estradiol was 47,8% decreaed (p=0,001) and AFC has increased 47.9% (p=0,003). Keywords: Laparoscopic Cystectomy, Endometriosis, Anti Mullerian Hormone, Antral Follicle

Uterus Didelphys dengan Agenesis Servik Bilateral Dwinda Rizary; Dedy Hendry
Andalas Obstetrics And Gynecology Journal Vol 4, No 1 (2020)
Publisher : Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/aoj.4.1.133-138.2020

Background : The mullerian duct anomaly is a congenital abnormality of the female reproductive system caused by abnormal embryological development during pregnancy. If accompanied by cervical agenesis and infertility, intervention must be taken. Accurate diagnosis and proper treatment are very crucial to the future of reproduction and treatment of infertility in patients.Objective: Reporting the handling of cases of uterine didelphys accompanied by bilateral cervical agenesis.Method : Case reportCase: Reported cases of women aged 34 years with primary amenorrhea and 9 years primary infertility, not typical cyclic pain, normal secondary sex development and from gynecological examination obtained cervical agenesis. Transvaginal ultrasound examination found a mass with the appearance of adenomyosis. Laparoscopic performed show 2 masses, 1 mass resembling adenomyosis with a size of 9x6x5cm located lateral to the left pelvis and another mass in the form of a hypoplastic uterus with a size of 2x2x1cm visible 2 tubes with 2 ovaries within normal limits. Uterine mass resembling adenomyosis with a location far from the vagina making it difficult to do anastomoses while other uterus hypoplasia and non-functional. Hysterectomies were performed on the mass of adenomyosis with the results of PA was adenomyosis.Conclusion: The uterus didelphys with bilateral cervical agenesis with 1 uterine adenomyosis and located in the pelvic lateral it was difficult to do uterovaginal anastomose so that hysterectomy was performed. Second uterine was hypoplasia and non-functional so that no action was taken. Need to think about "future fertility" in these patients and various options for having children. Keywords: Primary Amenorrhea, Uterine Didelphys, Cervical Agenesis, Adenomyosis

Agenesis Serviks Meiza Martadinata; Dedy Hendry
Andalas Obstetrics And Gynecology Journal Vol 3, No 1 (2019)
Publisher : Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/aoj.3.1.70-75.2019

Background : Cervical agenesis is an extremely rare congenital anomaly of female reproductive system with manifestation on the absence of uterine cervix with normal development of uterine and secondary sex signs. According to the American Fertility Society, cervical agenesis is classified as type IB Müllerian anomaly. Symptoms are include primary amenorrhea, cyclic abdominal lower pain and infertility.Objective : To report the treatment of cervical agenesis.Case Report : Reportedly, a woman, 28 years old, came with complaints of primary amenorrhea, cyclic abdominal lower pain and 3 years of primary infertility. From speculum and transvaginal ultrasonography examination, the uterine was slightly smaller than normal, without cervical uterine, found adhesion, both ovarian were normal. Laparoscopic utero-vaginal anastomosis was performed and catheter condom was maintained in the cervical canal for 3 months. Two weeks after catheter was removed, a hysteroscopy was performed, but the canal was found closed.Conclusion : In this case, after the laparoscopic utero-vaginal anastomosis was performed, the cervical canal which has been made, is found closed. So, a further evaluation is needed to get more effective results.Keywords: Type IB Müllerian anomaly, cervical agenesis, primary amenorrhea, infertility, laparoscopic utero-vaginal anastomosis

Correlation Between Levels of Interleukin-6 in Peritoneal Fluid With Degree of Pain, Adhesion, and Endometriosis Fertility Index Score in Endometriosis Angga Trifianda Prima; Dedy Hendry; Hafni Bachtiar
Andalas Obstetrics And Gynecology Journal Vol 5, No 2 (2021)
Publisher : Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/aoj.5.2.193-205.2021

Introduction : Endometriosis is a benign gynecological disorder characterized by the presence of endometrial tissue and stroma outside the uterine cavity. Several theories have been proposed to explain the occurrence of endometriosis, one of which is the theory of inflammation. Endometriosis lesions can produce inflammatory cytokines, resulting in their increased levels in the peritoneal fluid. This process causes disruption in pelvic anatomy, ovarian function, prostaglandin production and growth factor production that causes pain, adhesions and infertility. Interleukin-6 (IL-6) is an important and potential inflammatory cytokine in assisting the diagnosis of endometriosis. These cytokines act as activating macrophages that can stimulate endometrial cell proliferation and modulate the secretion of other cytokines such as IL-10, IL-13 and TNF-α which augments the inflammatory process. High levels of IL-6 in the peritoneum are relatedto advanced endometriosis associated with pain, severe pelvic adhesions and embryotoxic effects leading to infertility. The effect of IL-6, both local and systemic, on the growth of endometriosis lesions and its associated symptoms is great that this cytokine is considered an important marker.Objective : This study aims to determine the relationship between local inflammatory factors (IL-6 in peritoneal fluid) obtained during laparoscopy with the degree of pain, the degree of adhesions and the correlation with the Endometriosis Fertility Index (EFI) score in endometriosis patients.Material and methods : This is a quantitative analytic research with a cross sectional study design which was conducted on 22 patients with endometriosis. Prior to the laparoscopy, historical factor (EFI score) was recorded and an assessment of the pain scale was performed by filling out a questionnaire. Intraoperatively, the peritoneal fluid was obtained. If the peritoneal fluid was found, it was taken directly with a volume of 3-5 cc using 10 cc syringe. If no fluid was found, peritoneal rinsing was performed using 0.9% NaCl fluid, then 3-5 cc fluid was aspirated using a 10 cc syringe. Subsequently, an examination was carried out using the RayBio Human IL-6 ELISA Kit. During the laparoscopy procedure, the degree of adhesion of the pelvic organs was assessed by looking at the shape and how the adhesions can be separated. Surgical factor (EFI score) was assessed intraoperatively to obtain data for the least function score, AFS endometriosis score and AFS total score. Statistical analysis was performed using paired t test and correlation test.Results : The mean age of the respondents was 34.86 ± 6.11 years, 81.8% were nulliparous, 100% were married, 100% experienced both primary and secondary infertility and 81.8% had no prior pregnancy history. In the study, it was found that IL-6 levels of peritoneal fluid were higher in patients with the degree of severe pain (P <0.05) compared to moderate with the results of 32.58 ± 7.31 pg/ml and 25.39 ± 2.70 pg/ml. IL-6 levels were found to be higher in grade three adhesions than grade two (P <0.05) with results of 32.78 ± 6.65 pg/ml and 23.86 ± 2.18 pg/ml. The mean peritoneal fluid IL-6 levels were 30.75 ± 7.01 pg/ml and the mean EFI score was 4.09 ± 2.09. The correlation of IL-6 levels in peritoneal fluid with EFI score showed a value of r = -0.448 which had moderate strength and a negative pattern, indicating that the higher the IL-6 level of peritoneal fluid, the lower the EFI score (P <0.05).Conclusion : There is a relationship between IL-6 levels of peritoneal fluid in endometriosis with the degree of pain and the degree of adhesion, where IL-6 levels were found to be higher in the degree of severe than moderate pain (P <0.05), higher in third degree adhesions than second degree ( P <0.05). There was a correlation between IL-6 levels of peritoneal fluid with EFI score (P <0.05) with a negative pattern of moderate strength analysis results (r = -0.448).Keywords: Endometriosis, Interleukin-6, Degree of Pain, Degree of Adhesion, Endometriosis Fertility Index Score

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