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PENGARUH PEMBERIAN ASAM TRANEKSAMAT TERHADAP JUMLAH PERDARAHAN PASCASALIN PADA KELAHIRAN VAGINAL Chilmawati, Laili; Pradjatmo, Heru; Siswosudarmo, H.R.
JURNAL KESEHATAN REPRODUKSI Vol 1, No 2 (2014)
Publisher : IPAKESPRO

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PENGARUH PEMBERIAN ASAM TRANEKSAMAT TERHADAP JUMLAH PERDARAHAN PASCASALIN PADA KELAHIRAN VAGINALLaili Chilmawati1 , Heru Pradjatmo2, H.R. Siswosudarmo3Â ABSTRACTÂ Background: Maternal mortality is the great problem in developing countries and postpartum hemorrhage is the main cause. Obstetrics intervention and uterotonics agents have been used to control postpartum hemorrhage, but the use of hemostatic agent is still in the study.Objective: To compare the effect of tranexamic acid on postpartum hemorrhage and its potential side effects compared with placebo in vaginal deliveryMethods: A Double blindrandomized controlled Trial (RCT). We conducted a total of 198 subjects who met the inclusion criteria were recruited. The treatment group was those who got one gram tranexamic injection and the the control group those who got placebo. Independent sample t-test, chi-square and linear regression were used for statistical in treatment group analysis.Results and Discussion: A total of 198 subjects met the inclusion criteria, consisting of 99 subjects and 99 in the control group. No significant difference was found on the amount of postpartum hemorrhage (102.13Â±67.34 ml vs.110.58Â±73.57 ml;p=0.40), nor on the difference of hemoglobin level (0.99Â±1.13 g/dLvs.1.05 Â± 0.93 g/dLp=0.66), and of hematocrit level (4.06 Â± 3.73 vs.4.58Â±4.18%;p=0.36). The use of other uterotonics gave the significant difference at the decrease of hemoglobin level (p=0,02). Side effect of nausea and vomiting at tranexamic acid group didnât differ from placebo (p=1,00).Conclusion: There was no difference between the use of tranexamic acid and placebo in terms of number of bleeding the decrease of haemoglobin and hematocrit.Â Keywords: tranexamic acid; postpartum hemorrhage; hemoglobin and hematocryte level, vaginal delivery.Â ABSTRAKÂ Latar belakang: Kematian ibu merupakan masalah yang besar di negara sedang berkembang. Perdarahan pascasalin merupakan penyebab paling utama kematian ibu. Intervensi obstetrik dan obat-obat uterotonika telah digunakan secara optimal untuk mengatasi perdarahan pascasalin, tetapi obat hemostatik masih dalam kajian.Tujuan: Mengetahui pengaruh asam traneksamat terhadap jumlah perdarahan pascasalin pada persalinan vaginal dan efek samping yang mungkin terjadi.Metode Penelitian: Metode penelitian ini adalah Randomized Controlled Trial (RCT). Subyek penelitian adalah pasien dengan persalinan vaginal yang memenuhi kriteria inklusi dan eksklusi. Kelompok penelitian adalah mereka yang mendapat injeksi asam traneksamat 1 gram intravena sedang kelompok control adalah mereka yang mendapat plasebo. Independent t-test, chi-square dan regresi linier digunakan untuk analisis statistika.Hasil dan Pembahasan: Sebanyak 198 subyek memenuhi memenuhi kriteria kelayakan, terdiri atas 99 subyek masuk ke dalam kelompok perlakuan dan 99 subyek yang masuk dalam kelompok kontrol. Tidak didapatkan perbedaan secara bermakna pada jumlah perdarahan kala IV (102,13Â±67,34 ml vs 110,58Â±73,57 ml, p=0,40), penurunan kadar hemoglobin (0,99Â±1,13 g/dLvs.1,05Â±0,93 g/dL, p=0,66) dan penurunan kadar hematokrit (4,06Â±3,73 vs.4,58Â±4,18%, p=0,36). Penggunaan uterotonika lain memberikan perbedaan secara signifikan terhadap penurunan kadar hemoglobin (p=0,02). Kadar hemoglobin awal dan kadar hematokrit awal memberikan perbedaan secara signifikan terhadap penurunan kadar hematokrit (p=0,006 dan 0,01). Kejadian efek samping mual dan muntah pada pemberian asam traneksamat tidak berbeda dibandingkan dengan plasebo (p=1,00).Kesimpulan: Jumlah perdarahan kala IV, penurunan kadar hemoglobin dan penurunan kadar hematokrit tidak berbeda antara kelompok yang mendapat asam traneksamat dibanding yang mendapat placebo.Â Kata kunci: asam traneksamat, perdarahan pascasalin, kadar hemoglobin, hematokrit.Â 1 PPDS 1 Obstetri dan Ginekologi, Bagian Obstetri dan Ginekologi, Fakultas Kedokteran UGM2,3 Bagian Obstetri dan Ginekologi, Fakultas Kedokteran UGM

HUBUNGAN ANTARA ENDOMETRIOSIS FERTILITY INDEX (EFI) DAN KEBERHASILAN FERTILISASI IN VITRO (FIV) Amelia, Adelina; Dasuki, Djaswadi; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 1, No 2 (2014)
Publisher : IPAKESPRO

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Adelina Amelia1, Djaswadi Dasuki2, Heru Pradjatmo3Background: Endometriosis is a gynecological disease that is found in 25-30% of infertile women. The most widely used staging system of endometriosis in IVF is the revised American Fertility Society (r-AFS) which has limited predictive ability for pregnancy after surgery. The Endometriosis Fertility Index (EFI) is used to predict fecundity after endometriosis surgery.Objective: To assess the relationship between EFI and the outcomes of IVF.Methods: The study was retrospective cohort. Subjects of study were endometriosis patients who underwent IVF in Infertility Clinic of Permata Hati, Dr. Sardjito Hospital, Yogyakarta in 2012 that met inclusion and exclusion criteria. Subjects were devided into two groups: high EFI and low EFI. ROC curve was used to obtain the cut-off point.Chi-square and logistic regression statistics analysis were used.Results and Discussion: A total of 54 cycles from 54 couples who underwent IVF were included. Cut off point for EFI is 6. There is no difference in the outcomes of IVF between high and low EFI (OR 15,135; 95% CI 0,830-276,00; p=0,067), but high EFI increased the outcome of IVF 15 times better than low EFI. The outcome of IVF was influenced by type of the embryo transfer (OR 0,126; 95% CI 0,028-0,566).Conclusion: High EFI did not affect the outcomes of IVF both rated at biochemical pregnancy, clinical pregnancy and live birth. The outcomes of IVF was influenced by type of the embryo transfer. The cause of female infertility and stage of the endometriosis increased EFI score but did not affect the outcomes of IVF.Â Keyword: endometriosis, infertility, endometriosis fertility index, in vitro fertilizationÂ ABSTRAKÂ Latar Belakang: Endometriosis adalah salah satu penyakit ginekologi yang ditemukan pada 25-50% wanita infertil. Sistim klasifikasi yang digunakan untuk menentukan derajat atau stadium endometriosis dalam FIV yaitu The revised American Fertility Society (r-AFS) yang memiliki keterbatasan dalam memprediksikan kehamilan setelah pembedahan. Endometriosis Fertility Index ( EFI) adalah sistim klasifikasi endometriosis terbaru yang dapat digunakan untuk memprediksikan kehamilan setelah pembedahan.Tujuan: Menilai hubungan antara Endometriosis Fertility Index (EFI) dan keberhasilan Fertilisasi In Vitro (FIV). Metode: Studi kohor retrospektif. Subyek penelitian adalah pasien endometriosis yang menjalani program FIV di Klinik Permata Hati RSUP Dr. Sardjito Yogyakarta pada tahun 2012 yang memenuhi kriteria inklusi dan terlepas dari kriteria ekslusi. Subyek dibagi menjadi 2, kelompok EFI tinggi dan EFI rendah. Nilai titik potong EFI didapat dari kurva ROC. Uji statistik yang digunakan adalah Chi-square dan regresi logistik.Hasil dan Pembahasan: Sebanyak 54 siklus dari 54 pasangan yang menjalani fertilisasi in vitro(FIV) disertakan dalam penelitian sesuai dengan kriteria inklusi dan eksklusi. Nilai titik potongditetapkan EFI=6. Tidak terdapat perbedaan secara statistik terhadap keberhasilan FIV antara EFI tinggi dan rendah (OR 15,135; IK 95% 0,830-276,00; p=0,067) tetapi secara klinis skor EFI tinggi meningkatkan keberhasilan FIV 15 kali dibanding skor EFI rendah. Keberhasilan FIV dipengaruhi oleh jenis embrio yang ditransfer (OR 7,020; IK 95% 1,309-37,660; p=0,023).Kesimpulan: Skor EFI tinggi tidak mempengaruhi keberhasilan dalam program FIV baik dinilai pada kehamilan biokimia, kehamilan klinik, maupun kelahiran bayi hidup. Faktor yang mempengaruhi adalah jenis embrio yang ditransfer. Faktor penyebab infertilitas wanita dan stadium endometriosis meningkatkan skor EFI tetapi tidak mempengaruhi keberhasilan FIV.Kata kunci: endometriosis, infertilitas, endometriosis fertility index,fertilisasi in vitro.Â 1,2,3 Bagian Obstetri dan Ginekologi, Fakultas Kedokteran UGM

PENGETAHUAN DAN KETERAMPILAN BIDAN UNTUK SKRINING KANKER SERVIKS DENGAN METODE INSPEKSI VISUAL ASAM ASETAT (IVA) DI KALIMANTAN BARAT Mardiana, Mardiana; Dasuki, Djaswadi; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 2, No 1 (2015)
Publisher : IPAKESPRO

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Mardiana1, Djaswadi Dasuki2, Heru Pradjatmo2Â ABSTRACTÂ Background: Globally it is estimated that every two minutes a woman dies of cervical cancer and 500,000 women are diagnosed to have cervical cancer each year. In Indonesia, the incidence of cervical cancer is by 12.6 per 100,000 women with a mortality rate of 7 per 100,000. Screening method can reduce the incidence of cervical cancer if done cumulatively in 2012, the coverage of screening with a VIA method in Indonesia was 1.57%, whereas screening coverage with IVA in West Kalimantan Province was 1.06 %Objective: To assess midwivesâ knowledge and skills of screening practices with a VIA method in health centers Method: This was an observational study with a cross-sectional study, using quantitative and qualitative approaches. The study was conducted in health centers in the province of West Kalimantan. This study was conducted in September to October 2014. The subjects of research were midwives who served in health centers doing a VIA examination in West Kalimantan who met inclusion and exclusion criteria. The total sample of this study was 42 taken with purposive sampling. The variables of this study were the dependent variable, ie, the practice of screening skills with a VIA method, the independent variable, ie, knowledge, and the extraneous variables, ie, age, education, and years of service. Analysis of the data included univariable, bivariable, multivariable, and qualitative. The quantitative data analysis used the chi-square and logistic regression with a significance level of p <0.05 and an OR value with confidence interval (CI) of 95%.Result & Discussion: The mean value of midwivesâ knowledge was 26.0 from assessment scores of 0-30. A mean score of screening practice skills was 94.4 from 38-114. Of clinical assessment scores skill practice of competent midwives with good knowledge was higher than bad knowledge (OR= 6,98 CI 95% 1,21-40,33). After controlling education and years of service variables, good knowledge influenced screening clinical practice by 33%.Â Conclusion: Most of the midwives in West Kalimantan had good knowledge and skills to perform cervical cancer screening with a VIA method.Keywords: Knowledge, screening practice skills, VIA methodsÂ Â ABSTRAKLatar Belakang: Di seluruh dunia diperkirakan setiap dua menit seorang wanita meninggal karena kanker servik dan sekitar 500.000 wanita di diagnosis kanker seviks setiap tahun. Di Indonesia insiden kanker serviks sebesar 12,6 per 100.000 perempuan dengan angka kematian sebesar 7 per 100.000. Metode skrining dapat menurunkan kejadian kanker serviks jika dilakukan secara kumulatif. Pada tahun 2012 cakupan skrining dengan metode IVA di Indonesia sebesar 1,57%, sedangkan cakupan skrining dengan metode IVA Propinsi Kalimantan Barat sebesar 1,06%.Tujuan: Menilai pengetahuan dan keterampilan praktek skrining bidan dengan metode IVA di puskesmas Metode: Jenis penelitian observasional dengan rancangan cross-sectional study, menggunakan pendekatan kuantitatif dan kualitatif. Penelitian dilakukan di puskesmas di Provinsi Kalimantan Barat. Penelitian ini dilaksanakan bulan September sampai dengan Oktober 2014. Subjek penelitian bidan yang melayani pemeriksaan IVA di puskesmas di Provinsi Kalimantan Barat yang memenuhi kriteria inklusi dan eksklusi. Total sampel penelitian ini 42 sampel dengan pengambilan sampel purposive sampling. Variabel penelitian ini yaitu: variabel terikat adalah keterampilan praktek skrining metode IVA, variabel bebas: pengetahuan, dan variabel luar: usia, pendidikan, dan lama bekerja. Analisis data meliputi: univariabel, bivariabel, multivariabel, dan kualitatif. Untuk analisis data kuantitatif meng-gunakan metode chi square dan logistic regresi dengan tingkat kemaknaan p < 0,05 dan nilai OR dengan Confidence Interval (CI) 95%.Hasil & Pembahasan: Nilai mean pengetahuan bidan sebesar 26,0 dari skor penilaian 0-30. Keterampilan praktik dengan nilai mean 94,4 dari skor 38-114. Keterampilan praktik klinik yang kompeten lebih tinggi pada bidan berpengetahuan baik daripada bidan berpengetahuan kurang (OR= 6,98 CI 95% 1,21-40,33). Pengetahuan baik setelah dikontrol variabel pendidikan dan lama bekerja berpengaruh terhadap keterampilan praktik skrining sebesar 33%.Kesimpulan: Sebagian besar bidan di Kalimantan Barat memiliki pengetahuan baik dan keterampilan yang kompeten untuk skrining kanker serviks dengan metode IVA.Â Kata Kunci: Pengetahuan, keterampilan praktek skrining, metode IVAÂ 1Â Dinas Kesehatan Provinsi Kalimantan Barat2Â Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Â Â Â Yogyakarta

Status gizi sebagai faktor prognosis penderita karsinoma endometrium Pradjatmo, Heru; Pahlevi, Deyna Primavita
Jurnal Gizi Klinik Indonesia Vol 10, No 1 (2013): Juli
Publisher : Minat S2 Gizi dan Kesehatan, Prodi S2 IKM, FK-KMK UGM

Background: In Indonesia, endometrial cancer is the third gynaecologic cancer after cervical and ovarian cancers. Various factors affect the survival of the patients, however, which factors affect the survival of endometrial carcinoma patients in Dr. Sardjito Hospital remain unclear. A research is therefore needed in order to determine the survival and the prognostic factors.Objective: To investigate the prognostic factors that affect the survival of endometrial carcinoma patients who had been admitted to Dr. Sardjito Hospital.Method: The study design was retrospective cohort. The subjects were patients with endometrial carcinoma who were treated in Dr. Sardjito Hospital from 1st of January 2006 until 31st of December 2011. Kaplan-Meier analysis was performed to analyze several factors that influenced the survival of the patients. The differences of survival were analyzed with log rank test while the prognostic factors influencing the survival were analyzed using Cox regression.Results: 68 endometrial carcinoma patients were recruited as the subjects for the study. The median survival of endometrial carcinoma patients 52 months for those on early stage and 17 months on advanced stage (pâ‰¤0.01). The prognostic factors affecting survival that has been found statistically and clinically significant was the stage of the disease (p=0.002; HR=6.175; 95% CI=1.1980 to 19.25). Meanwhile, the nutritional status of patients with low, normal, and high BMIs score showed increased survival rate as indicated by the HR values of 1; 0.768; and 0.311 respectively.Conclusion: The prognostic factor that was clinically and statistically significant influenced the survival was the stage of the disease, while the nutritional status of patients was found clinically significant as the prognostic survival of the patients.

RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTOR KEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILAN LEWAT WAKTU Adintyo Rahman, Muhammad Nur; Prawitasari, Shinta; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 2, No 2 (2015)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTORKEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILANLEWAT WAKTUMuhammad Nur Adintyo Rahman1, Shinta Prawitasari2, Heru Pradjatmo3ABSTRACTBackground: Induction of labor is a common procedure performed at 15-20 % of pregnancies. The mostcommon indication was prolonged pregnancy (70 %). The past decade labor induction rate was increased2-fold as well as the risk of cesarean section. Difficulties to predict the success of induction made predictorsof success of induction widely studied. Predictors can be physical or chemical markers. One of the chemicalmarker is the ratio of estriol to estradiol levels.Objective: To determine the value of the ratio of estriol/ estradiol to predict success of induction of laborin prolonged pregnancy.Method: The design of study are Prospective Cohort. Study two hospitals (Wonosobo District Hospitaland Banjarnegara District Hospital) used in this study from September 10, 2013 until December 31,2013. Blood sampling was drown from the subject before induction to examin the levels of estriol andestradiol the induction which end in vaginal delivery were noted as succesull induction Receiver OperatingCharacteristic (ROC) method in order to determine the sensitivity, specificity, positive predictive value,negative predictive value and Area Under the Curve. Bivariate and multivariate analyzes also used todetermine the correlation between variables.Results and Discussion: This study obtained 76 samples, 69 with successful induction and 7 failed ofinduction. The research got a cut-off was point 35 the sensitivity was 71% value, specificity value of 71%,positive predictive value 49%, negative predictive value was 55.6%. Area Under the was value of 80,7%.Positive likelihood ratio 1,06 and negative likelihood ratio 0,88. Bivariate and multivariate analysis showedthat the ratio of estriol / estradiol â‰¥ 35 ng / mL significantly associated with successful induction (OR 9,598;95% CI 1,378-66,859) Bishop score was also associated with a significant induction success (OR 13,481;95% CI 1,955 -92,955)Conclusion: This study shows that the proportion ratio of estriol / estradiol in succeed induction groupwere higher (â‰¥ 35) compared with induction failure group (<35).Keywords: prolonged pregnancy, labor induction , estriol/ estradiol ratio, predictorsABSTRAKLatar Belakang: Induksi persalinan adalah prosedur umum yang dilakukan pada 15-20% kehamilan.Indikasi tersering adalah kehamilan lewat waktu (70%). Satu dekade terakhir angka induksi persalinantelah meningkat 2 kali lipat begitu juga dengan risiko seksio sesarea. Keberhasilan induksi sulit diprediksi.Prediktor keberhasilan induksi banyak diteliti baik penanda fisik maupun kimia. Salah satu penanda kimiaadalah rasio kadar estriol terhadap estradiol.Tujuan: Mengetahui nilai rasio kadar estriol estradiol untuk memprediksi keberhasilan induksi padakehamilan lewat waktuMetode: Kohort prospektif. Dua rumah sakit (RSUD Wonosobo dan RSUD Banjarnegara) dipakai dalampenelitian ini dari 10 September 2013 sampai 31 Desember 2013. Subyek yang memenuhi kriteriainklusi dan eksklusi diambil sampel darah sebanyak 5 ml sebelum Induksi untuk diperiksa kadar estrioldan estradiol kemudian dilihat keberhasilan induksinya. Analisis yang digunakan adalah metode ReceiverOperating Characteristic (ROC) untuk dapat mengetahui nilai sensitivitas, spesifitas, nilai ramal positif,nilai ramal negatif dan Area Under Curve. Analisis X2 dan Regresi logistik digunakan untuk mengetahuihubungan antar variabel.Hasil dan Pembahasan: Selama waktu penelitian didapatkan 76 sampel, 69 dengan induksi berhasil dan7 gagal induksi. Dengan cut off point 35, nilai sensitivitasnya 71%, nilai Spesifitas 71%, nilai ramal positif49%, nilai ramal negatif 55,6%. Nilai Area Under Curve sebesar 80.7%. Likelihood ratio positive 1,06 danlikelihood ratio negative 0,88. Hasil analisis multivariat menunjukkan bahwa Rasio estriol/ estradiol â‰¥ 35berhubungan dengan keberhasilan induksi secara signifikan (RO 9.598; IK 95% 1.378-66.859) Skor Bishopjuga berhubungan dengan keberhasilan induksi secara signifikan (RO 13,481; IK 95% 1.955-92.955)Kesimpulan: Kelompok yang berhasil diinduksi memiliki proporsi rasio estriol/ estradiol yang lebih tinggi(â‰¥ 35) dibandingkan dengan kelompok gagal induksiKata kunci: Kehamilan lewat waktu, induksi persalinan, rasio estriol/ estradiol, prediktor1,2,3 Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta

PRESERVASI FERTILITAS PADA PENDERITA KANKER Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 2, No 3 (2015)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

PRESERVASI FERTILITAS PADA PENDERITA KANKER*Heru Pradjatmo1ABSTRACTBackground: Young women who survive from cancer as candidates to face reproductive problemsassociated with cytotoxic cancer therapy. Side effects that alter the quality of life becomes unacceptable.Advances in reproductive medicine enables previously infertile women can obtain offspring.Objective: To recognize the effort that can be done to prevent adverse effects on fertility patients due tocancer therapyMethod: Literature studyResult and Discussion: In general, women age 40 years or less with cancer who received chemotherapy tobe likely ovarian function will cease. Studies show that many technique performed before chemotherapyallows women to have babies would be greater. Women prior to treat chemotherapy should be consultedto physicians in the field of reproductive and endocrinology for fertility preservation methods to deal withoncologist who take care the patient. All methods that can be performed should be included in counselingand all counseling and treatment including possible complications should be documented and recorded.Keywords : infertility, chemotherapy, adverse effect, preservationABSTRAKLatar Belakang: Perempuan muda yang survive dari penyakit kanker menjadi kandidat menghadapimasalah reproduksi berkaitan dengan terapi kanker yang bersifat sitotoksik. Sehingga efek samping yangmerubah kualitas kehidupan menjadi tidak dapat diterima. Kemajuan dalam kedokteran reproduksimemungkinkan wanita yang sebelumnya infertil akibat prngobatan penyakit kanker sekarang dapatmemperoleh keturunan.Tujuan: Untuk memahami upaya yang dapat dilakukan untuk mencegah terjadinya efek samping terhadapfertilitas penderita akibat terapi kanker.Metode: Studi literaturHasil dan Pembahasan: Secara umum perempuan penderita kanker sampai umur 40 tahun yangmendapat kemoterapi kemungkinan dapat berhenti fungsi ovariumnya. Studi menunjukkan bahwabeberapa teknik yang dilakukan sebelum kemoterapi memungkinkan wanita memperoleh keturunan lebihbesar. Seharusnya sebelum terapi dikonsulkan ke dokter dibidang reproduksi untuk metode preservasifertilitas dengan kesepakatan ahli onkologi yang menangani. Semua metode yang dapat dilakukan harusdimasukkan dalam konseling. Semua konseling dan pengobatan termasuk komplikasi yang mungkin terjadiseharusnya di dokumentasikan dan dicatat.Kata Kunci: infertilitas, khemoterapi, efek samping, preservasi1 Bagian Obstretika & Ginekologi Fakultas Kedokteran UGM/RSUP Dr. Sardjito Yogyakarta* Dipresentasikan pada seminar in vitro maturation (IVM) in vitro fertilization andlaparoskopic surgery, Yogyakarta, 8-9 November 2013

Perbandingan Skala Nyeri pada Kuretase antara Pemberian Lidokain Paraservikal dan Intraservikal Ksyatria, Yudhistya Ngudi Insan; Pradjatmo, Heru; Emilia, Ova
JURNAL KESEHATAN REPRODUKSI Vol 3, No 1 (2016)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: Curettage is a gynecological diagnostic and therapeutic procedures. Curettage actions causing sensation of pain although the pain threshold is different for each person. Local anesthesia is an effective choice for various minor gynecological procedures. One of them is paracervical block. Paracervical block reduces pain by blocking nerve impulses across the uterovaginal plexus. Another method is the injection of local anesthetic trough intracervical who works as an anesthetic infiltrating agent, distending the tissue, causing mechanical disruption of nerve impulses. Theoritically, intracervical lidocaine injection will require a lower level of precision than the blockade of peripheral nerves directly, more reliable and reproducible. We measured patientâ€™s pain during curettage usingthe Visual Analogue Scale (VAS).Â Method: RCTÂ Location of study: Bantul District Hospital, Wonosari District Hospital, and Banjarnegara Distric Hospital.Â Result and Discussion: The study included 60 patients who got curettage within inclusion criteria. Every time patients came, we performed randomization and divided the patients into two groups, the control group (paracervical) and intervention group (intracervical), 30 subjects each. VAS was measured 5 minute after curettage was started. Characteristics of subjects in curettage frequency, curettage indication, parity and educational level for both groups are equal, did not differ statistically. The results of the mean pain scale (VAS). In the control group was 42,33Â±16,583 and 34,33Â±18,880 on the treatment group. Mean difference was 8 mm, with 95% CI -1.124 to 17.124 and p=0.408. The difference was not significant statistically. The intracervical group has mild pain scale (VAS<44 mm) in 27 of 30 patient, compared to 15 of 30 patients in paracervical group. It result in Relative Risk (RR) of 1,532.Â Conclusion: Intracervical lidocaine injection can be considered as an alternative local anesthetic on curettage. The average pain scale did not differ significantly with paracervical block. And both of it located in VAS < 44mm (mild pain). Intracervical lidocaine injection even have RR= 1,532 compared with paracervical block to produce mild pain scale (VAS < 44 mm).Â Keywords: curettage; paracervical;intracervical ;VASÂ

Peran Penambahan Misoprostol pada Penatalaksanaan Aktif Kala Tiga dalam Menurunkan Perdarahan Pasca Persalinan Geni, Puti Lenggo; Rachman, Irwan Taufiqur; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 4, No 3 (2017)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: Postpartum haemorrhage is the leading cause of maternal mortality in both developed and developing countries, which is almost 80 % due to the failure of the uterus to contract. Misoprostol is a powerful uterotonic agent used as an alternative in preventing postpartum haemorrhage.Objective: The purpose of this study was to determine whether administration of misoprostol adjunctive therapy in active management of the third stage of labor influenced postpartum blood loss.Method: This study was a non-blinding randomized controlled trial that divided subjects into two groups. The treatment group was the group who received misoprostol 600 mcg orally for adjunctive treatment in active management of the third stage of labor and the control group did not receive misoprostol, each group also got routine oxytocin 10 IU intramuscularly. Both group were assessed of the number of blood loss in the fourth stage of labor, decreased levels of hemoglobin and hematocrit within 24 hours after delivery. Chi square test was conducted to determine the strength of the relationship between the two groups.Result and Discussion: The study recruited 104 subjects, there were significant difference for the mean number of blood loss in the fourth stage of labor and the decrease in hemoglobin levels within 24 hours of postpartum between treatment and control group (OR 2.45; 95% CI 1.05-5.71, p=0.04), (OR 2.99; 95% CI 1.26-7.11, p=0.01). The mean of the decreasing hematocrit levels was statistically not significant between the two groups (OR 0.87; 95% CI 0.38-1.99, p=0.75).Conclusion: The addition of misoprostol to the routine active management of the third stage of labor was statistically significant to decrease amount of postpartum blood loss.Keywords: misoprostol, active management of the third stage of labor, postpartum blood loss, postpartum hemorrhage.

Perbandingan Kejadian Retensi Urin antara Persalinan dengan Vakum Ekstraksi dan Persalinan Normal Petrana, Nurul Hikmah; Emilia, Ova; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 3, No 3 (2016)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: Urinary retention after vaginal delivery is a common problem with incidence 1.7% - 17.9%. Assissted vaginal delivery is one risk factor for the occurence of urinary retention.Objective: to compare urinary retention between normal vaginal delivery and assissted vaginal delivery using extraction vacum, and evaluate factors related to urinary retention.Method: The study was prospective cohort design, conducted in 3 hospitals and 2 primary health centres during 6 month period since September 2013- February 2014. Subjects were divided into two groups i.e. normal delivery and assissted delivery using extraction vacum, each 118 subjects. Events of urinary retention was assessed and also related factors were identified. Analysis used Chi-Square test, Fisher test and also logistic regression analysis.Result and Discussion: In total 236 subjects were involved, there was no difference in age and parity among the subjects. Incidence of urinary retention among extraction vacum delivery group was higher (32.2%) compare to normal delivery (11.9%). Multivariate analysis using logistic regression showed that extraction vacum (p=0.074; OR 2.71; 95% CI 1.55-4.73), baby weight (p= 0.230; OR 1.95; 95% CI 0.655.84) and perineal injury (p= 0.614; OR 1.35; 95% CI 0.41-4.36) were not significant risk factors for urinary retention. Length of labour (p=0.003; OR 3.71; 95% CI 1.55-8.86) and parity (p= 0.023; OR 2.29; 95% CI 1.2-4.66) were significant risk factors for urinary retention.Conclusion: Urinary retention is higher among vaginal delivery with extraction vacum compare to normal delivery. Length of labour and parity are external factors related to urinary retention.Keywords: Assissted vaginal delivery, extraction vacum, normal delivery, urinary retention, postpartum

Hubungan Response Time Seksio Sesarea Emergensi Kategori 1 dengan Luaran Perinatal di RSUP Dr.Sardjito Gunawan, Tri; Attamimi, Ahsanudin; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 5, No 1 (2018)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: Caesarean section is often applied as a preventif efoort against the continued effects of perinatal asphyxia. The cesarean section (SC) in pregnant woman can be performed in a planned manner with various indications or performed by emergency (emergency) on maternal or fetal indications and or both.Objective: To study the association of response time in category I emergency caesarean section with perinatal outcomes in Dr. Sardjito hospital and the average response time of category 1 emergency cesarean section in Dr. Sardjito hospital.Method: This study uses retrospective cohort. Category 1 CS with an indication of fetal accordance with the inclusion criteria was recorded from 1st January 2012 until 31th July 2016, then we find the response time mean as the cut off point of this study to compare with their perinatal outcomes.Result and Discussion: There were 155 cases out of 386 of emergency CS category 1 met the inclusion criteria during the period 1st January 2012 to 31th July 2016. From the data obtained, the average response time of category 1 emergency CS was 115Â±52 minutes (35 - 360 minutes). We found no significant differences in perinatal outcomes in the groupâ€™s response time â‰¥115 minutes with a value of p>0.05 on the Apgar score, CPAP, infant mortality, ventilator, NICU care, MAS and HIE than those category 1 emergency CS with a response time <115 minutes. From multivariate analysis, general anaesthesia was statistically significant against perinatal outcomes Apgar score <7 at 5 minutes with (p=0.044). Prematurity in the multivariate analysis was statistically significant against perinatal outcomes Apgar score â‰¤3 at 1 minute with (p=0.040), Apgar score <7 at 5 minutes with (p=0.025) and the use of CPAP with (p=0.009).Conclusions: Response time category 1 emergency cesarean section in this study did not affect perinatal outcomes. General anesthesia effect on perinatal outcomes Apgar score <7 at 5 minutes, whereas the prematurity effect on perinatal outcomes Apgar score â‰¤3 at 1 minute, Apgar score <7 at 5 minutes and the use of CPAP.Keywords: category 1 emergency caesarean section, response time, fetal distress

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