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Risanto Siswosudarmo
Gadjah Mada University
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PERBANDINGAN LUARAN SEKSIO SESAREA DENGAN ANESTESI UMUM DAN SPINAL: PERUBAHAN KADAR HEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYI Ifrinda Giantari; Ibnu Pranoto; Risanto Siswosudarmo
JURNAL KESEHATAN REPRODUKSI Vol 1, No 1 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.4912

Abstract

PERBANDINGAN LUARAN SEKSIO SESAREA DENGANANESTESI UMUM DAN SPINAL: PERUBAHAN KADARHEMOGLOBIN, HEMATOKRIT IBU DAN SKOR APGAR BAYIIfrinda Giantari, Ibnu Pranoto, Risanto SiswosudarmoABSTRACTBackground: Cesarean section is the most common surgical procedure in obstetrics. In 2008, nearly a third ofdeliveries was done by cesarean section. Two types of anestesi are used in cesarean section i.e., general andregional anestesi with their advantages and disadvantages. General anestesi is often used in emergency casesbut is often associated with greater risk of blood loss during surgery and depression of central nervous system ofthe newborn. Based on these facts, the decision of the type of anesthesia for cesarean section is still debated.Objective: To compare the effects between general and spinal anestesi in the alteration of maternal hemoglobinand hematocrit levels and the neonatal Apgar score.Method: This study was conducted at Setjonegoro Hospital Wonosobo, Banjarnegara, and Sardjito HospitalYogyakarta between September to December 2010. Patients undergoing cesarean section, who met inclusionand exclusion criteria were included in this study. Hemoglobin and hematocrit levels before and 6-12 hours aftersurgery were recorded, as well as the first minute Apgar score. Chi-square and t-test were used for statisticalanalysis.Results and Discussion: A total of 114 patients consisting of 59 cases for general anestesi and 55 for spinalgroups were recruited. They were comparable in terms ofmaternal age, age of gestation, parity, BMI and indicationof operation. Hemoglobin and hematocrit levels before surgery were also comparable.The decrease of hemoglobin level after operation in the group of general anesthesia was greater than in thespinal group (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d; p=0,00). The same was seen in the decrease of hematocritlevel (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). There were 28 cases of asphyxia in the group of general comparedto 22 cases in the group of spinal anestesi, but it was not statistically different (RR 1,16; 95% CI 0,81-1,65).Conclusion: The decreased level of hemoglobin and hematocrit after cesarean section in general anesthesia werehigher than spinal anesthesia group, although the difference was not clinically significant. There was no significantdifference in the incidence of asphyxia at first minute in both groups.Keywords: general anestesi, spinal anesthesia, cesarean section, hemoglobin, hematocrit, Apgar score   ABSTRAKLatar belakang: Seksio sesarea merupakan prosedur operatif obstetri yang paling sering dilakukan. Pada tahun2008, hampir sepertiga dari persalinan dilakukan dengan cara seksio sesarea. Dua jenis anestesi sering digunakanyakni anestesi umum dan spinal yang masing-masing mempunyai kelebihan dan kekurangannya. Anestesi umumsering digunakan pada kasus kedaruratan meskipun sering dikaitkan dengan risiko kehilangan darah yang lebihbesar dan penekanan pada susunan syaraf pusat bayi. Anestesi spinal sering dikaitkan dengan keadaan hipotensimaternal.Tujuan: Membandingkan penurunan kadar hemoglobin dan hematokrit ibu dan skor Apgar bayi pada seksiosesarea dengan anestesi umum dan spinal.Metode: Kohort prospektif.Penelitian dilakukan di RS Setjonegoro Wonosobo, RS Banjarnegara, dan RS Sardjitopada bulan September sampai Desember 2010. Pasien yang menjalani seksio sesarea dan memenuhi kriteriainklusi dan eksklusi dimasukkan dalam penelitian ini. Sampel penelitian diikuti sesuai dengan kelompok jenisanestesi. Kadar hemoglobin dan hematokrit sebelum operasi dan 6-12 jam sesudah operasi serta skor Apgar 1menit dicatat. X-square dan t-test dipakai untuk analisis data.Hasil dan Pembahasan: Sebanyak 114 kasus seksio sesarea memenuhi kriteria kelayakan, yang terdiri dari 59kasus kelompok anestesi umum dan 55 kasus anestesi spinal. Kedua kelompok komparabel dalam hal umur,umur kehamilan, paritas BMI dan indikasi operasi. Demikian juga kadar hemoglobin dan hematokrit sebelumoperasi, tidak menunjukkan perbedaan yang bermakna. Penurunan kadar hemoglobin setelah operasi padakelompok anestesi umum lebih besar dibanding kelompok spinal (1,75 ± 1,09 mg/dL vs 1,00 ± 0,96 mg/d;p=0,00), demikian juga penurunan kadar hematocrit (4,47 ± 2,77% vs 3,26 ± 3,04%, p=0,02). Pada penilaianmenit pertama terdapat 28 kasus asfiksia (skor Apgar < 6) pada kelompok anestesi umum dan 22 kasus padakelompok anestesi spinal (RR 1,16, 95%CI 0,81-1,65), tetapi tidak bermakna secara statistik (p=0,42).Kesimpulan: Terdapat penurunan kadar hemoglobin dan hematokrit ibu yang bermakna pada kelompok yangmenjalani seksio sesarea dengan anestesi umummeskipun secara klinis tidak bermakna. Tidak terdapat perbedaanbermakna secara statistik pada kejadian asfiksia pada menit pertama.Kata kunci: anestesi umum, anestesi spinal, seksio sesarea, hemoglobin, hematokrit, skor Apgar
DEVELOPING A NEW FORMULA FOR ESTIMATING BIRTH WEIGHT AT TERM PREGNANCY Risanto Siswosudarmo; Intan Titisari
JURNAL KESEHATAN REPRODUKSI Vol 1, No 2 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (155.104 KB) | DOI: 10.22146/jkr.5350

Abstract

DEVELOPING A NEW FORMULA FOR ESTIMATING BIRTH WEIGHT AT TERM PREGNANCY Risanto Siswosudarmo1, Intan Titisari2  ABSTRAK Latar belakang: Taksiran berat janin (TBJ) dipakai untuk panduan melakukan manajemen persalinan. Beberapa cara telah dipakai untuk mengukur taksiran berat lahir bayi misalnya dengan palpasi abdomen, pengukuran tinggi fundus uterus ibu (TFU) dan pemeriksaan ultrasonografi. Pengukuran tinggi fundus uterus ibu nampaknya merupakan cara yang paling sederhana dan murah dan dapat dikerjakan oleh semua tenaga kesehatan.Tujuan penelitian: Membuat rumus baru berdasarkan pengukuran tinggi fundus uterus ibu.Rancangan dan cara penelitian: Rancangan penelitian ini adalah studi cross sectional dengan mengukur TFU pada kehamilan 37-42 minggu di kamar bersalin RS Sardjito dan RS Jejaring. Sebanyak 655 ibu hamil yang memenuhi kriteria kelayakan dimasukkan dalam penelitian ini. Tinggi fundus diukur dengan pita non elastik flksibel dari simfisis pubis sampai puncak tinggi uterus pada saat pasien dalam persalinan kala satu. Berat lahir bayi (BLB) ditimbang dengan timbangan bayi yang sama setelah semua dikalibrasi. Analisis regresi linear digunakan untuk menghitung korelasi dan menentukan rumus TBJ berdasar TFU.Hasil: Sejumlah 655 ibu hamil yang memenuhi kriteria kelayakan dengan umur kehamilan antara 37 sampai 42 minggu masuk dalam penelitian ini. Sebagian besar mereka berumur antara 20 to 30 tahun, sedang paritasnya berimbang. Rata-rata TFU adalah 31,25 ± 2,35 cm (bervariasi dari 24 sampai 38 cm) dan rata-rata BBL adalah 3021,60 ± 341,14 gram (bervariasi dari 2050 to 4250 gram). Koefisien korelasi Pearson adalah 0.93 ( R square 0.86), yang menunjukkan adanya korelasi yang kuat antara TFU dengan BBL. Rumus TBJ berdasar TFU adalah adalah Y (BBL dalam gram) = 125 X (TFU dalam cm) – 880.Kesimpulan: Terdapat hubungan yang kuat anatara TFU dengan BBL, di mana rumus untuk mengestimasi BBL adalah BBL = 125 TFU – 880. Kata kunci: Estimasi berat lahir, Tinggi fundus uterus, Berat bay lahir, Rumus Risanto ABSTRACT Background: Estimated birth weight (EFW) is used as a guidence for management of labor. Several methods are used from abdominal palpation, measurement of fundal height and ultrasound examination. For the shake of simplicity fundal height measurement to be the simplest and cheapest way that can be done by all medical personnels.Objective of study: To develop a new formula in determining estimated birth weight based on maternal symphisis fundal height (FH).Material and method: A cross sectional study was used, consisting of 655 pregnant women from Sardjito and affiliated hospitals at 37-42 weeks of gestation. Fundal height was measured from the symphisis to the top of uterine fundus, using inverted unelastic flexible tape. Infant birth weight (IBW) was determined by the same baby scale after calibrated. Linear regression analysis was used to calculate the correlation and develop the formula.Result: A total of 655 pregnant mothers meeting the inclusion criteria from 37 to 42 weeks of gestation were recruited. Most of them were between 20 to 30 years old and their parity were almost comparable. The mean FH was 31.25 ± 2.35 cm (ranged between 24 to 38 cm) and the mean IBW was 3021.60 ± 341.14 grams (ranged between 2050 to 4250 grams). The Pearson correlation was 0.93 (R square 0.86), signifying that there was a strong correlation between FH and IBW. The formula for estimating IBW based on FH was Y (IBW in gram) = 125 X (FH in cm) – 880.Conclusion: There was a strong correlation between FH and IBW. The formula for estimating IBW was IBW = 125 FH – 880. Key words: Estimating birth weight, Fundal height, Fetal birth weight, Risanto’s formula. 1,2 Bagian Obstetri dan Ginekologi, Fakultas Kedokteran UGM
THE USE OF NEW INSERTER (R_INSERTER) FOR DELIVERING CuT-380A IUD DURING POSTPARTUM PERIOD PHASE II CLINICAL TRIAL Risanto Siswosudarmo; Kadek Kurniawan; Herdhana Suwartono; Taufik Rahman Alkaff; Maria Anggraeni
JURNAL KESEHATAN REPRODUKSI Vol 1, No 3 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (250.78 KB) | DOI: 10.22146/jkr.5750

Abstract

THE USE OF NEW INSERTER (R_INSERTER) FOR DELIVERING CuT-380A IUD DURING POSTPARTUM PERIOD PHASE II CLINICAL TRIALRisanto Siswosudarmo1, Kadek Kurniawan2, Herdhana Suwartono3, Taufik Rahman Alkaff4, and Maria Anggraeni5ABSTRAKLatar Belakang: IUD adalah salah satu alat kontrasepsi jangka panjang yang efektif, tetapi penggunaan di Indonesia masih rendah. Karena inserter IUD yang biasa di pakai terlalu pendek untuk pemasangan segera pascasalin maka bentuk inserter baru (R_inseter) telah dikembangkan.Tujuan: Untuk mengetahui apakah R_inserter dapat digunakan dengan mudah sesuai standard pemasangan IUD dan untuk mengetahui keamanannya.Metode: Uji klinis fase II, post test observation.Bahan dan cara: IUD yang dipasang adalah TCu380A dengan modifikasi pada inserternya (R_inserter) buatan PT Kimia Farma. Penelitian ini dilakukan di 3 Rumah Sakit dan 3 Puskesmas yang merupakan afiliasi rumah sakit pendidikan Dr Sardjito dari bulan Januari 2012 sampai April 2013. Semua klien yang memenuhi kriteria inklusi dan eksklusi dimasukkan dalam penelitian ini. Pemasangan dilakukan oleh Residen atau Bidan yang telah mendapatkan pelatihan. Follow up dilakukan setelah 1 minggu, 1, 3, 6, 9 dan 12 bulan pascapasang. Kemudahan, angka ekspulsi, infeksi, nyeri, perdarahan, dan angka kelangsungan merupakan hasil utama yang diobservasi. Hasil dan Pembahasan: Selama kurun waktu tersebut telah direkrut sebanyak 142 klien yang memenuhi kriteria kelayakan. Lama pemasangan rata-rata adalah 3,89 ± 2,08 menit dengan minimum 2 menit dan maksimum 10 menit. Tidak ada kesulitan yang dirasakan. Secara kumulatif kejadian dalam 1, 3, 6, 9 dan 12 bulan untuk ekspulsi masing-masing adalah 9,9%, 9,9%, 10,6%, 10,6% dan 10%. Angka ekspulsi jika IUD dipasang dalam 10 menit pertama setelah plasenta lahir adalah 6,2% dibanding 24,1% bila pemasangan dilakukan setelah 10 menit (RR 3,90; 95%CI 1,37-11,2). Kejadian seperti infeksi, nyeri dan perdarahan relatif kecil dan dapat diatasi. Angka kelangsungan selama 1, 3, 6, 9 dan 12 bulan berturut turut adalah 89,4%, 89,4%, 86,6% 86,6% dan 85,9%. Tidak dijumpai kehamilan pada penelitian ini.Kesimpulan: R_inserter dapat dipakai untuk memasang IUD CuT-380A dengan mudah dan aman. Angka kejadian ekspulsi tertinggi terjadi dalam satu bulan pertama pascapasang dan berhubungan dengan saat pemasangan.Kata kunci: R_inserter, IUD pascasalin, ekspulsi, infeksi, angka kelangsungan. ABSTRACT Background: IUD is one of the most effective and long acting contraception, but the rate of its use in Indonesia is still low. As conventional IUD inserter is too short to deliver it during immediate postpartum (postplacental) period, then the new inserter, R_inserter, is developped.Objective:To find out whether the R_inserter can be used easily to deliver CuT-380A IUD during postpartum period in a standard procedure and to find out its safety.Method: Phase II clinical trial, post-test observation.Materials and Method: The IUD’s used were the conventional CuT-380A with a modification on its inserter namely 9 cm longer, produced by PT Kimia Farma Indonesia. The study was carried out in three hospitals and three community health centers (Puskemas) which were the network of Sardjito teaching hospital, from January 2012 to April 2013. All eligible women needing IUD as their contraception were recruited. IUD insertion was carried out by trained obstetric and gynecology resident or midwives. Follow up was done after 1 week, then 1, 3, 6, 9 and 12months after insertion.The ease of insertion, rate of the following events namely expulsion, infection, pain, bleeding, and continuation were main outcomes of interest.Results and Discussion: During the study period, a total 142 participants were recruited. The mean duration of insertion was 3.89 ± 2.08 minutes (ranged 2 to 10 minutes). No subjective difficulties were perceived by the providers. The cumulative expulsion rate for 1, 3, 6, 9 and 12 months were 9.9%, 9.9%, 10.6%, 10.6% and 10.% consecutively. The rate of expulsion if the IUD was inserted during 10 minutes after placental delivery was 6.2% compared to 24.1% if it was inserted after 10 minutes (RR 3.90; 95% CI 1.37-11.2). Infection, pain, and bleeding were relatively small and could be appropriately managed. The continuation rate for 1, 3, 6, 9 and 12 months were 89.4%, 89.4%, 86.6%, 86.6% and 85.9% consecutively. No pregnancy was found during the study period.Conclussion: The R_inserter could be easily used to deliver a CuT-380A IUD. The rate of expulsion was highest during the first month of insertion and was related to the time of insertion.Keywords:  R_ inserter, postpartum IUD, expulsion, infection, continuation rate.1,2,3,4 Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Gadjah Mada/ Sardjito Hospital Yogyakarta5 National Family Planning Board, Jakarta
Co-Authors Herdhana Suwartono Ibnu Pranoto Ifrinda Giantari Intan Titisari Kadek Kurniawan Maria Anggraeni Taufik Rahman Alkaff