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Uli Pardede, Tiarma
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USG untuk Deteksi Plasenta Akreta -, Fauzan; Iswari, Wulan Ardhana; Uli Pardede, Tiarma; Darus, Febriansyah; Puspitasari, Bintari; Santana, Sanny; Abidin, Finekri; Endjun, Judi J
Cermin Dunia Kedokteran Vol 44, No 8 (2017): Obstetri-Ginekologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (351.255 KB) | DOI: 10.55175/cdk.v44i8.744

Abstract

Plasenta akreta merupakan implantasi abnormal plasenta pada dinding uterus, merupakan komplikasi pada sekitar 0,9% kehamilan. Diagnosis plasenta akreta dibuat berdasarkan spesimen patologis yang diperoleh setelah histerektomi. Diagnosis plasenta akreta juga dapat berdasarkan USG (ultrasonography) dan MRI (magnetic resonance imaging). Sonografi 2-dimensi konvensional adalah alat skrining yang baik untuk mendeteksi plasenta akreta. USG lebih tersedia daripada MRI, lebih murah, dan non-invasif. Oleh karena itu, USG dapat menjadi modalitas diagnostik pilihan untuk plasenta akreta. Selain itu, sensitivitas sonografi sebesar 86,4%; dibandingkan MRI sebesar 84%.Placenta accreta is an abnormal placental implantation of the uterine wall, a complication of about 0.9% of pregnancies. The diagnosis of placenta accreta is made based on pathological specimens obtained after hysterectomy. The diagnosis of placenta accreta can also be based on ultrasound (ultrasonography) and magnetic resonance imaging (MRI). Conventional 2-dimensional sonography is a good screening tool for detecting placenta accreta. Ultrasound is more available than MRI, cheaper, and non-invasive. Therefore, ultrasound may be the preferred diagnostic modality for placenta accreta. In addition, sonographic sensitivity was 86.4%; compared with MRI of 84%.
Terapi laparoskopi niche dan asimptomatik niche: laporan dua kasus Akbar, Taufik; Situmorang, Herbert; Ardhana Iswari, Wulan; Uli Pardede, Tiarma; Darus, Febriansyah; -, Bintari Puspitasari; Santana, Sanny; Abidin, Finekri; J Endjun, Judi
Cermin Dunia Kedokteran Vol 44, No 8 (2017): Obstetri-Ginekologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (613.865 KB) | DOI: 10.55175/cdk.v44i8.737

Abstract

Niche adalah gambaran hipoekoik di antara myometrium segmen bawah uterus yang menggambarkan diskontuinitas myometrium di tempat bekas operasi sesar. Angka kejadian niche meningkat seiring meningkatnya angka seksio sesarea, menimbulkan gejala ginekologi seperti perdarahan, chronic pain, dismenorea, dan disparenea. Niche dapat diterapi secara konservatif maupun operatif. Kami melaporkan dua kasus niche dengan gejala berbeda. Kasus pertama dengan gejala perdarahan pasca menstruasi selama 3 tahun dan kasus kedua terdeteksi tanpa gejala. Pada kasus pertama dilakukan perbaikan dengan laparoskopi sedangkan pada kasus kedua tidak dilakukan intervensi. Tidak semua niche harus menjalani tindakan intervensi.A niche is a hypoechoic image between the myometrium in the lower uterine segment, illustrating myometrial discontinuity after a caesarean section. Niche incidence increases along with increasing caesarean section procedure, causing gynecological symptoms such as hemorrhage, chronic pain, dysmenorrhea, and dyspareunia. Niche is treatable, conservatively or surgery. We report two niche cases with different symptoms. The first was a woman with post-menstrual bleeding for three years, the second presented without any symptoms. The first patient was treated with laparoscopic surgery whereas the second did not receive any interventions. Not all niche cases need intervention.
Diagnosis dan Tatalaksana Preeklampsia Berat Tidak Tergantung Proteinuria Sumulyo, Ganot; Ardhana Iswari, Wulan; Uli Pardede, Tiarma; Darus, Febriansyah; Puspitasari, Bintari; Santana, Sanny; Abidin, Finekri; Endjun, Judi J
Cermin Dunia Kedokteran Vol 44, No 8 (2017): Obstetri-Ginekologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (206.975 KB) | DOI: 10.55175/cdk.v44i8.742

Abstract

Preeklampsia merupakan salah satu penyebab morbiditas dan mortalitas maternal dan perinatal terbesar, yang terjadi pada 2-3% kehamilan. Preeklampsia didefinisikan sebagai suatu sindrom yang berhubungan dengan vasospasme, peningkatan resistensi pembuluh darah perifer, dan penurunan perfusi organ yang ditandai adanya hipertensi, edema dan proteinuria yang timbul karena kehamilan. Mengingat pentingnya penanganan dini, diagnosis dan penentuan beratnya preeklampsia tidak lagi bergantung kepada adanya proteinuria. Tatalaksana terminasi pada preeklampsia tanpa perburukan disarankan saat usia kehamilan mencapai 37 minggu.Preeclampsia is one of the largest causes of maternal mortality and morbidity, occurring in approximately 2-3% of pregnancies. It is defined as a range of symptoms related to vasospasm, an increase in peripheral vascular resistance, and a decrease in organ perfusion, as evidenced by hypertension, edema, and proteinuria, related to pregnancy. Considering the significance of early management, an absence of proteinuria in new onset hypertension no longer rules out the diagnosis of preeclampsia. Termination in stable preeclampsia is recommended only at a gestational age of 37 weeks or older.
Akurasi Pemeriksaan Ultrasonografi oleh Residen Obstetri dan Ginekologi pada Kasus Seksio Sesarea Emergensi di RSPAD Gatot Soebroto April-Oktober 2016 Kapnosa Hasani, Rachmat Dediat; Arief Rahman, Ichnandy; Ardhana Iswari, Wulan; Uli Pardede, Tiarma; Darus, Febriansyah; Puspitasari, Bintari; Santana, Sanny; Abidin, Finekri; Endjun, Judi J
Cermin Dunia Kedokteran Vol 44, No 8 (2017): Obstetri-Ginekologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (113.419 KB) | DOI: 10.55175/cdk.v44i8.734

Abstract

Pendahuluan: Pemeriksaan taksiran berat janin menggunakan ultrasonografi (USG) saat ini rutin pada keadaan emergensi untuk membantu keputusan managemen pasien di kamar bersalin. Pada penelitian ini dilakukan penilaian akurasi taksiran berat janin menggunakan ultrasonografi oleh residen obstetri dan ginekologi pada kasus seksio sesarea emergensi. Desain: Studi retrospektif terhadap 63 kasus kehamilan yang menjalani seksio sesarea emergensi di RSPAD Gatot Soebroto April-Oktober 2016. Taksiran berat janin (TBJ) dikalkulasi dan dibandingkan dengan berat lahir (BL) Dilakukan analisis ketepatan diagnosis makrosomia, berat lahir rendah dan faktor-faktor yang berperan dalam akurasi pemeriksaan USG.Hasil: Rerata selisih absolut antara TBJ dan BL 222 ± 198 g (172-272). Rerata persentase selisih absolut antara TBJ dan BL 8,0 ± 5,9 % (6,2-9,7%). Selisih absolut antara TBJ dan BL didapatkan < 10 % pada 71 % kasus. Pada uji korelasi didapatkan korelasi yang baik antara TBJ dan BL (r=0,91, p=0,001). Kemampuan memprediksi makrosomia memiliki sensitifitas 67 % dan spesifisitas 98 %. Kemampuan memprediksi berat lahir rendah memiliki sensitifitas 80 % dan spesifisitas 95 %. BMI ≥ 35 kg/m2 memiliki rerata kesalahan pengukuran lebih besar (359 g vs 208 g, p=0,001). Keadaan oligohidramnion dan inpartu tidak didapatkan mempengaruhi akurasi taksiran berat janin. Simpulan: Pemeriksaan taksiran berat janin oleh residen memiliki akurasi cukup baik. Diagnosis makrosmia memiliki sensitifitas rendah. BMI pasien ≥ 35 kg/m2 merupakan salah satu faktor yang mempengaruhi akurasi pemeriksaan USG oleh residen. Background: Ultrasonography-based estimated fetal weight is currently a routine workup for emergency cases in the delivery room. This study explores the accuracy of estimated fetal weight using ultrasonography conducted by obstetrics and gynecology residents during emergency caesarean sections. Design: This is a retrospective study conducted on 63 pregnancies terminated with emergency caesarean section in RSPAD Gatot Soebroto on April to October 2016. Estimated fetal weight (EFW) was calculated and compared to birth weight, analyzed for accuracy for diagnosis of macrosomia, low birth weight, and factors that influence the accuracy of an ultrasonography imaging. Results: Absolute means difference between EFW and BW was 222 ± 198 g (172-272). Absolute means difference percentage between EFW and BW was 8,0 ± 5,9 % (6,2-9,7%). Absolute difference between EFW and BW was found to be <10% in 71% of cases. Correlation tests showed a good correlation between EFW and BW (r=0,91, p=0,001). Sensitivity of macrosomia diagnosis was 67% with a specificity of 98%, while low birth weight predictions had 80% sensitivity and 95% specificity. EFW miscalculation is higher in women with BMI ≥ 35 kg/m2 (359 gr vs 208 gr, p=0,001); oligohydramnion and delivery were not found to influence EFW accuracy. Conclusion: Fetal weight estimation obstetrics and gynecology residents was found to have adequate accuracy. The diagnosis of macrosomia, however, was found to have low sensitivity, and maternal obesity (≥ 35 kg/m2) influenced the accuracy of ultrasonographic diagnosis.
Co-Authors -, Bintari Puspitasari Abidin, Finekri Ardhana Iswari, Wulan Arief Rahman, Ichnandy Darus, Febriansyah Endjun, Judi J Fauzan - Herbert Situmorang Herbert Situmorang J Endjun, Judi Kapnosa Hasani, Rachmat Dediat Puspitasari, Bintari Santana, Sanny Sumulyo, Ganot Taufik Akbar Wulan Ardhana Iswari, Wulan Ardhana