Dewi Karlina Rusly
Department of Obstetrics and Gynecology, Faculty of Medicine, Indonesia University

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Laporan Kasus: Empty Follicle Syndrome pada Siklus Fertilisasi In-Vitro Rusly, Dewi Karlina; Anwar, Ruswana; Setiawan, Alvin; Nulianti, Rina; Tjandraprawira, Kevin Dominique
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 1 Maret 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i1.590

Abstract

Pendahuluan: Empty follicle syndrome (EFS) adalah suatu kondisi langka, yaitu tidak terdapatnya oosit pada folikel ovarium yang matang saat tindakan ovum pick-up (OPU). Prevalensi kasus ini berkisar 2,7%. Tujuan: Mengkaji kasus jarang yang terjadi pada siklus Fertilisasi In-Vitro (IVF) yang dilakukan stimulasi ovarium terkontrol.Metode: Laporan kasus pada program IVF siklus pertama yang diberikan stimulasi dengan menggunakan short protocol pemberian human recombinant follicle stimulating hormone (rFSH) 150 IU sejak hari ke-2 sampai dengan hari ke-12 dan cetrotide 0.25 mg pada hari ke-7 hingga hari ke-12 dilanjutkan dengan trigger menggunakan choriogonadotropin alfa 250 μg.Hasil: Perempuan berusia 30 tahun dengan infertilitas 4 tahun, mengikuti program IVF siklus I, dan diberikan stimulasi ovarium terkontrol dengan short protocol menggunakan rFSH 150 IU. Pada hari ke-12 didapatkan 10 folikel pada kedua ovarium, dengan estradiol >3000 pg/ml dan progesteron 0,94 ng/ml. Diputuskan untuk dilakukan trigger dengan choriogonadotropin alfa 250 μg. Setelah 36 jam trigger diberikan dan dilakukan OPU tidak didapatkan satu pun oosit pada cairan folikel tersebut, baik yang matur maupun yang imatur. β-hCG serum pasca-OPU adalah 2,3 mIU/ml. Pasien ditegakkan dengan diagnosis Empty Follicle Syndrome. Kesimpulan. Penegakan diagnosis Empty Follicle Syndrome masih menjadi kontroversial, salah satu etiologinya adalah kadar HCG yang rendah pasca-trigger. Pasien direncanakan untuk IVF ulang dengan batch trigger berbeda dan evaluasi serum β-hCG 36 jam pasca-trigger (sebelum OPU), dan pengulangan trigger bila serum level belum adekuat.Case Report: Empty Follicle Syndrome in an In-Vitro Fertilization CycleAbstractIntroduction: Empty follicle syndrome (EFS) is a rare condition in which no oocytes could be retrieved from mature ovarian follicles during ovum pick-up (OPU). Its prevalence ranges from 2,7%.Objective: To review a rare case of In-Vitro Fertilization (IVF) cycle undergoing controlled ovarian hyperstimulation (COH).Method: This is a case report of a first cycle IVF program that was stimulated using a short protocol of human recombinant follicle stimulating hormone (rFSH) 150 IU from day 2 to 12 and cetrotide 0.25 mg on day 7 to 12 followed by triggering using choriogonadotropin alpha 250 μg.Results: A 30-year-old female with 4 years of primary infertility, was enrolled in her first IVF cycle, and was undergoing COH with short protocol using 150 IU rFSH. On day 12, 10 follicles were found on both ovaries, with favorable oestradiol >3000 pg/ml and progesterone 0.94 ng/ml levels. A trigger of 250 micrograms of choriogonadotropin alpha was administered. During oocyte retrieval, no oocyte (mature or immature) was present in the follicular fluid. Post OPU β-hCG serum was 2.3 mIU/ml. The patient was diagnosed with EFS. Conclusion: The diagnosis of EFS is still controversial with an etiology being post-trigger low HCG level. The patient was recommended to undergo a repeat IVF cycle with a different batch of triggers and evaluation of serum β-hCG before OPU, and a repeat trigger if serum levels were not adequate.Key words: Empty follicle syndrome, β-hCG, Oocytes, Trigger, Ovum Pick-Up 
Amniotic Membrane Graft and Hysteroscopic Adhesiolysis as Treatment for Asherman Syndrome Case Rusly, Dewi Karlina; Ritonga, Mulyanusa Amarullah; Rachmawati, Anita; Rinaldi, Andi; Djuwantono, Tono
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 3 November 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i3.603

Abstract

Introduction: Secondary amenorrhea which caused by intrauterine adhesions is called Asherman’s syndrome. This occurs when the uterine cavity becomes partially or completely blocked, which can damage the basal layer of the endometrium and cause the formation of adhesive cicatricial tissue. The prevalence or incidence of Asherman Syndrome ranges from 2.84-5.5% in women. Case Report: A woman 33 years old had a history of amenorrhea for 2 years and three times curettage due to miscariage. Ultrasound findings showed 1.35 cm long cicatrix in the uterine cavity, and probe had only entered 3 cm. The patient underwent hysteroscopy adhesiolysis and grafting of intrauterine amniotic membrane. The intrauterine catheter was monitored for 1 month. Postoperatively the patient also received estradiol valerate therapy 3 x 2 mg for three months. Management of Asherman syndrome with hysteroscopy adhesiolysis with direct observation accompanied by grafting of amniotic membrane using intrauterine catheter tube is one of the techniques to overcome recurrent intrauterine adhesion. Conclusion:  Secondary amenorrhea in Asherman syndrome is better treated operatively with direct observation of the hysteroscopy and adhesiolysis. The using of amniotic membrane graft and supportive therapy are very helpful for the success of endometrial growth and preventing recurrent adhesions, increase the menstrual volume and chances of pregnancy.Pencangkokan Selaput Ketuban dan Histeroskopi Adhesiolisis sebagai Penatalaksanaan untuk Kasus Sindrom AshermanAbstrakPendahuluan: Amenorea sekunder yang disebabkan oleh perlengketan intrauterin disebut sindrom Asherman dengan prevalensi berkisar antara 2,84 - 5,5%.Laporan Kasus: Seorang wanita berusia 33 tahun mempunyai riwayat amenore 2 tahun dan kuretase sebanyak 3 kali akibat abortus. Temuan USG menunjukkan cicatrix sepanjang 1,35 cm di rongga rahim, sondage hanya masuk 3cm. Pasien menjalani histeroskopi adhesiolisis dan pemasangan cangkok selaput ketuban intrauterin. Kateter intrauterin dipantau selama 1 bulan. Pascaoperasi pasien juga mendapat terapi estradiol valerat 3 x 2mg selama tiga bulan. Penatalaksanaan sindrom Asherman dengan histeroskopi adhesiolisis dengan observasi langsung disertai pemasangan cangkok selaput ketuban menggunakan selang kateter intrauterin merupakan salah satu teknik yang efekstif untuk mengatasi adhesiolisis intrauterin berulang.Kesimpulan: Amenore sekunder pada sindrom Asherman lebih baik ditangani secara operatif dengan observasi langsung berupa histeroskopi dan adhesiolisis. Pemasangan cangkok selaput ketuban dan terapi suportif sangat membantu keberhasilan pertumbuhan endometrium dan mencegah perlengketan berulang, meningkatkan volume darah saat menstruasi dan peluang terjadinya pembuahan.Kata kunci: Adhesi intrauterin, Histeroskopi, Pencangkokan selaput ketuban, Rekonstruksi endometrium, Sindrom Asherman.
AST to Platelet Ratio Index (APRI), Fib-4 Score, and Pregnancy Outcome of Pregnant Women with Hepatitis B Maghfirah, Desi; Yusuf, Fauzi; Abubakar, Azzaki; Rusly, Dewi Karlina; Darnifayanti, Darnifayanti
Majalah Kedokteran Bandung Vol 55, No 3 (2023)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v55n3.3066

Abstract

Hepatitis B virus infection in pregnancy has become a major concern in many developing countries,. The relationship between hepatitis B virus infection and pregnancy is complex and puzzling. This study aimed to investigate the relationship between hepatitis B virus infection and pregnancy outcomes with the insights into the AST to Platelet Ratio Index (APRI) and Fib-4 score. This was a cross-sectional study on pregnant women with hepatitis B virus infections who underwent labor at dr. Zainal Abidin Hospital General Hospital, Aceh, Indonesia. Data were collected from the obstetric ward patient medical records from 2017 to 2019 and 77 pregnant women was identified to be infected with hepatitis B virus, of which 44 had complete medical record data and were included in the analysis. The median APRI in this study was 0.30 (0.1-1.2) while the median FIB-4 score was 0.74 (0.3-1.9). Delivery with live births was identified in 42 (95.5%) women. Term pregnancy and vaginal delivery were observed in 39 (88.6%) and 10 (22.7%) women, respectively, Complicated pregnancy was seen in 14 (31.8%) of pregnancies that included complications such as oligohydramnios, HELLP, severe preeclampsia, placenta previa, and premature rupture of membranes. APRI was higher in the stillbirth group (0.5 [0.2-0.8] p = 0.682) and preterm birth group (0.4 [0.2-0.6], p = 0.502). FIB-4 scores were higher in the stillbirth group (1.2 [0.5-1.8], p = 0.517) and preterm birth group (0.9 [0.4-1.9], p = 0.529). Hence, pregnancy does not always worsen liver function and is not related to the natural course of hepatitis B infection. Pregnancy with hepatitis B without fibrosis is not associated with poor pregnancy outcomes. Routine liver function examination is needed in pregnant mothers with hepatitis B virus infections.