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Does Misoprostol for Induction of Labor Increase the Risk of Uterine Rupture? Anggreany, Kiswa; Luthfi, Mohammmad; Siswosudarmo, Risanto
JURNAL KESEHATAN REPRODUKSI Vol 3, No 2 (2016)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: Misoprostol is a synthetic prostaglandin E1 analogue which is now commonly used for induction of labor. Hyperstimulation is a complication of misoprostol that may lead to uterine rupture.Objective: To find the association between misoprostol exposure for induction of labor with uterine rupture.Methods: Case were all women who delivered in Sardjito and affiliate Hospitals from January 2007 to November 2012 with the diagnosis of uterine rupture. Controls were taken randomly from the same hospital. Chi square test and logistic regression model were used for statistical analysis.Result and Discussion: There were 53 cases of uterine rupture and 199 controls. The incidence of uterine rupture was 53 over 64,244 deliveries or 0,08%. Risk of of uterine rupture associated with misoprostol exposure was 1, 09 (CI 95% 0,52-2,2), while that of oxytocin exposure was 0,80 (CI 95% 0,35-1,85). Logistic regression analysis showed that the highest risk factor associated with uterine rupture was fetal weight > 3500 (OR 3,46; 95% CI 1,48-8,56) followed by parity (OR 2,56;95% CI 1,019-6,465) and vacuum extraction(OR 2,45;95% CI 0,94-6,39).Conclusion: There was no association between misoprostol exposure with uterine rupture. Fetal weight> 3500 gram, Parity more than 3, and vacuum extraction increased the risk of uterine rupture associated with misoprostol use.Keywords: Misoprostol, induction of labor, uterine rupture, fetal weight, parity.

Hubungan antara Saat Penanganan Kegawatdaruratan Maternal di Luar atau Saat Jam Kerja dengan Waktu Tanggap di RSUD LA Temmamala Kabupaten Soppeng, Sulawesi Selatan Fadillah, Fadillah; Hakimi, Mohammad; Siswosudarmo, Risanto; Malinta, Umar
JURNAL KESEHATAN REPRODUKSI Vol 4, No 3 (2017)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: The national maternal mortality rate is still high at 228 per 100.000 live births. Three late allegedly related to high maternal mortality rate, are 1)too late for decision making, 2) too late for access service and 3) too late for get treatment at referral health facility. Response time for maternal emergency treatment in the hospital plays an important role, since it affects the final result.Objective: To determine the relationship between the time of obstetric emergency management and response time.Method: This study used cross sectional design with the population of study was obstetric emergency patients. One hundred and forty-five subjects were divided into two group: group treated outside of working hours as exposed groups and groups treated during working hours as control groups. Delay of response time were observed. Data was processed by statistical program using computer. Chi square test and logistic regression analysis were used to perform statistical tests.Result and Discussion: From September 1st 2015 to April 30th 2016, there were 145 cases with obstetric emergency handled. A total 82 cases among 145 (56,6%) received emergency management outside working hours. It was found that the 1st response time was delayed in handling outside work hours compared to handling during working hours (RR 2,22; 95% CI 164-3,00). The same was obtained at 2nd response time (RR 1,39; 95% CI 1,04-1,86) and 3rd response time (RR 1,65; 95% CI 1,14-2,31). Multivariate analysis was found that time of the emergency handling was the most dominant variable that affect all response time [1st response time (OR 12,61; 95% CI 4,82-32,03), 2nd response time (OR 2,17; 95% CI 1,05-4,47), 3rd response time (OR 7,70; 95% CI 1,91-31,10)]. PONEK with midwife on duty also influence 1st response time (OR 3,28; 95% CI 1,21-8,93).Conclusion: Obstetric emergency management outside of work hours increased the occurence of response time delay.Keywords: Time of management, Obstetric emergency, 1st, 2nd and 3rd response time.

Perbandingan Kejadian Missing String IUD CUT 380A Pascasalin antara yang Dipasang Menggunakan R_Inserter dengan yang Dipasang Menggunakan Klem Cincin (Evaluasi 13-24 Bulan) Dewi, Silvy Kusuma; Siswosudarmo, Risanto; Lutfi, Muhammad
JURNAL KESEHATAN REPRODUKSI Vol 4, No 3 (2017)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: One of the main complaint of IUD client was missing string. The main cause of missing string was folded string into the cervical canal. The incidence of translocation in case of missing string was 0 â€“ 5%.Objective: To compare the incidence of missing strings IUD CuT 380A inserted by R_inserter compared to ring forceps during postpartum period in addition to compare incidence of malposition, cumulative expulsion, the continuation of IUD, pregnancy and menstrual complaintsMethod: The study was conducted in Sardjito Hospital Yogyakarta. The subjects were divided into two groups, of exposed group (inserted postpartum IUD using R_inserter) and control group (inserted postpartum IUD by using ring forceps). Follow-up was performed in the period of 13-24 months postpartum. Data was analized with Chi-square test and relative risk for comparing two proportions.Result and Discussion: A total of 178 study subjects consisted of 91 subjects inserted with R_inserter and 87 subjects with a ring forceps. The incidence of missing strings in R_inserter was lower than ring forceps group, 1.2% vs. 3.6% (RR 0.33; 95% CI 0.36-3.18). There was only one subject IUD malposition from ring forceps group. The incidence of expulsion cumulative in the R_inserter was higher than ring forceps, 6.0% vs 4.1% (RR 1.47; 95% CI 0.43-5.05). The continuation rate of IUD in R_inserter and ring forceps groups was 83% and 85.7% (RR 0.97; 95% CI 0.86-1.09) and no incidence of pregnancy. Number of menstrual complaints on R_inserter were lower than the ring forcep 2.4% vs. 3.6% (RR 0.66%; 95% CI 0.11-3.83).Conclusions: There was no difference in the incidence of missing strings, malposition, expulsion, continuity and menstrual complaints between IUD CuT 380A inserted by R_inserter and ring forceps during the postpartum period.Keywords: postpartum IUD, R_inserter, ring forceps, missing strings, malposition.

The Accuracy of Risanto's Formula and Ultrasound Measurement in Estimating Fetal Weight Pietersz, Elsina Krisnawati; Rachman, Irwan Taufiqur; Siswosudarmo, Risanto
JURNAL KESEHATAN REPRODUKSI Vol 5, No 1 (2018)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: Accurate estimated fetal weight (EFW) is crucial in determining delivery management. Several methods to estimate fetal weight were used such as abdominal palpation, measurement of symphisis fundal height (SFH), and ultrasound examination. Risantoâ€™s formula based on Indonesian population had been already proven to be more accurate than Johnsonâ€™s formula. The formula was as follows: Y = 125 X - 880 where Y was EFW in grams, X was SFH in cm, and 125 was the constanta.Objective: To compare the accuracy of Risantoâ€™s formula and ultrasound examination in estimating fetal weight.Method: A cross sectional study was carried out in Sardjito hospital, Faculty of Medicine Universitas Gadjah Mada, from March 2013 to March 2014. A total of 400 pregnant women meeting the inclusion criteria at 37 â€“ 42 weeks of gestation were recruited. The estimated fetal weight using Risantoâ€™s formula (R_EFW) was compared to the estimated fetal weight using ultrasound measurement (U_EFW). The U_EFW was done by obstetricians on duty or senior residents using Hadlockâ€™s formula. Actual birth weight (ABW) was measured using the same calibrated baby scale. Accuracy was determined by comparing the mean difference between the R_EFW minus ABW (Î”R_EFW) and the U_EFW minus ABW (Î”U_EFW). Paired t-test was used for statistical analysis.Result and Discussion: The mean ABW was 3025.3 Â± 414.6 gram and the mean R_EFW was 2972.7 Â± 365.4 grams, while the mean U_EFW was 3058.7 Â± 423.2 grams. The mean Î”R_EFW was lower than the mean Î”U_EFW (178.2 Â± 147.6 grams vs 197.5 Â± 155.4 grams; 95% CI 1.24 â€“ 36.68; p = 0.04).Conclusion: Risantoâ€™s formula was more accurate than ultrasound measurement in estimating fetal weight.Keywords: Estimated fetal weight, Risantoâ€™s formula, Ultrasonography, Fundal height

Pengaruh Konseling Antenatal terhadap Penerimaan AKDR pascasalin sebuah uji klinis non randomisasi Faris, Abdul; Soetrisno, Soetrisno; Siswosudarmo, Risanto; Malinta, Umar
JURNAL KESEHATAN REPRODUKSI Vol 5, No 2 (2018)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: During postpartum period women have a high motivation to start using contraception and postpartum IUD is an ideal method to offer. The rate of IUD use is still low, 14.06% of all postpartum contraceptive use. This might be attributed to lack of information and counseling from health providers.Objective: To compare the number of postpartum IUD used among groups of clients who were counseled during ANC and re-counseled during latent phase (exposed group), and group counseled during latent phase only (control group).Method: This study was a prospective quasi-experimental or randomised clinical trial. The first group was those counseled during ANCÂ and latent phase, and the second was those counseled at latent phase only. Chi square and relative risk were used for statistical test two proportions.Result and Discussion: A total of 342 subjects who met Â inclusion and exclusion criteria were recruited. They consisted of the 210 subjects (61,4%) for the first group and 132 subjects (38,6%) for the second.The rate of IUD used in the first group was 82 of 210 (39%) and 30 of 132 (22.7%) in the second, RR 1,72Â (95% CI 1.20 â€“ 2.46), p 0,002. The rate of IUD used was also significantly influenced by a history of IUD acceptor RR 2,90 with 95% CI 2.23 â€“ 3.77), a history of contraceptive used (RR 1,79 with95% CI 1,18 â€“ 2,71) and a history of contraceptive counselling (RR 1,50 with 95% CI 1,03 â€“ 2,19).Conclusion: Clients who were counseled twice (during ANC and repeated at latent phase) had higher rate of postpartum IUD used significantly than those who were counseled at latent phase only. Other factors that significantly affected the rate of postpartum IUD used were history of IUD acceptor, history of contraceptive used.Keywords: Postpartum IUD; counseling; rate of postpartum IUD use; antenatal care

Hubungan antara Program Ekspanding Maternal and Neonatal Survival (EMAS) dengan Peningkatan Pengetahuan, Sikap dan Perilaku Bidan dalam Pengelolaan Kasus Kegawatdaruratan Obstetrik Pra Rujukan Widyaningsih, Wiwik; Siswosudarmo, Risanto; Hadijono, Soerjo
JURNAL KESEHATAN REPRODUKSI Vol 5, No 3 (2018)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Latar Belakang:Â Angka kematian ibu di Kabupaten Kebumen tahun 2014 adalah 12 yang sebagian besar disebabkan oleh perdarahan pascasalin dan preeklampsia berat (PEB). Dalam program EMAS salah satu kegiatan adalah peningkatan pengetahuan dan ketrampilan untuk penatalaksanaan perdarahan pascasalin dan preeklampsia berat (PEB).Tujuan:Â Untuk mengetahui hubungan paparan program EMAS dalam hal pengetahuan, sikap dan perilaku bidan saat mengelola kasus kegawatdaruratan obstetrik pra rujukan.Metode:Â Penelitian ini menggunakan desain cross sectional, dilaksanakan terhadap bidan yang merujuk kasus perdarahan postpartum dan pre eklampsia berat di IGD RSU PKU Muhammadiyah Gombong dari tahun 2014-2015. Kuesioner yang digunakan dinilai dengan skala Likert, menilai pengetahuan dengan kuesioner benar salah, sedangkan ketrampilan dengan daftar tilik keterampilan nilai dari 10 sampai 100 kalau menjalankan prosedur sesuai harapan.Hasil dan Pembahasan:Â Sebanyak 104 responden (bidan), yang terdiri dari 52 bidan yang terpapar program EKSPANDING MATERNAl AND NEONATAL SURVIVAL (EMAS) dan 52 lainnya adalah responden tang tidak terkena program EMAS (kontrol). Mereka sebanding dalam usia, tahun pelayanan (pengalaman kerja), dan nilai pelatihan PPGDON. Analisis bivariat menunjukkan bahwa paparan program EMAS berhubungan secara signifikan dengan peningkatan pengetahuan, sikap dan perilaku bidan di bidang kegawatdaruratan kebidanan. Hasil analisis regresi logistik menunjukkan bahwa program EMAS berhubungan dengan hasil peningkatan pengetahuan managemen aktif kala III (OR: 6,41; 95% CI 2,32-17,72); pengetahuan PEB (OR: 11,72; 95% CI 4,19-32,78); sikap managemen aktif kala III (OR: 2,97; 95%CI 1,11-7,91); sikap PEB (OR 25,87; 95% CI 8,17-81,90). Hubungan dengan keterampilan managemen aktif kala III (OR: 7,37; 95% CI 2,10-25,85) dan keterampilan PEB (OR: 26,64; 95% CI 7,98-88,96).Kesimpulan:Â Terdapat hubungan antara Program Expanding Maternal and Neonatal Survival dengan peningkatan kemampuan, sikap dan perilaku bidan di bidang pengelolaan prarujukan kasus kegawatdaruratan obstetrik.Kata kunci: Expanding Maternal and Neonatal Survival (EMAS);Â pengetahunan; sikap; perilaku; penanganan prarujukan kegawatdaruratan obstetrik;

Effect of Delay in Postpartum Hemorrhage Management on the Rate of Near-Miss and Maternal Death Cases Siswosudarmo, Risanto
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To recognize the effect of delay in the management of postpartum bleeding to the occurrence of near-miss and maternal death cases. Method: Prospective cohort. The study population was patients with postpartum hemorrhage. All PPH cases from thirteen hospitals (Sardjito and 12 affiliated hospitals) were recorded. The study was carried out from January 1st to June 30th 2009. The study group was those who experienced delay and the control group was those withoutdelay. The outcome was measured as the number of near-miss and death cases. Near-miss was defined as those who experienced severe shock, demonstrated by systolic blood pressure 90 mmHg or less. Chi square test, t-test and logistic regressions were used to analyze our data.Result: From January 1st to June 30th 2009 we identified 139 cases of PPH from 8,924 deliveries (1.6%). From the 80 referred cases, as much as 22 cases (27.5%) were delayed, and 12 from 139 (8.6%) experienced delay in the hospital. A total of 30 cases among 139 (21.6%) experienced delay both outside and in the hospital. There were 74 near-miss cases, 9 of which ended in death of the patient. This means the real occurrence of near-miss cases is 65 from 139 cases or 46.8% while the occurrence of maternal death was 9 out of 139, or 6.47%. Case fatality rate was 9 from 139 or 6.47%; maternal near-miss ratio was 6.22; mortality index was 13.84% and maternal mortality ratio is estimated as 103/100.000 live births. Multivariate analysis showed delay in referral increased the risk of near-miss cases as much as 8.37 folds, while bleeding >1500 ml increased risk of near-miss by 12.12 folds. Delay in both referral and management in the hospital increased the risk of maternal death rate as much as 25.34 folds, hemoglobin <6 g/dl and unavailability of blood increase maternal death by 31.58 folds and 13.39 folds, respectively.Conclusion: Delay in referral and delay of in-hospital management ncreased the occurrence of near-miss and maternal mortality cases significantly. Multivariate analysis showed that the amount of bleeding, hemoglobin level and lack of blood availability influenced the occurrence of near-miss and maternal death more than the delay itself.Keywords: delay, maternal death, maternal near-miss, PPH

Effect of Delay in Postpartum Hemorrhage Management on the Rate of Near-Miss and Maternal Death Cases Siswosudarmo, Risanto
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To recognize the effect of delay in the management of postpartum bleeding to the occurrence of near-miss and maternal death cases. Method: Prospective cohort. The study population was patients with postpartum hemorrhage. All PPH cases from thirteen hospitals (Sardjito and 12 affiliated hospitals) were recorded. The study was carried out from January 1st to June 30th 2009. The study group was those who experienced delay and the control group was those withoutdelay. The outcome was measured as the number of near-miss and death cases. Near-miss was defined as those who experienced severe shock, demonstrated by systolic blood pressure 90 mmHg or less. Chi square test, t-test and logistic regressions were used to analyze our data.Result: From January 1st to June 30th 2009 we identified 139 cases of PPH from 8,924 deliveries (1.6%). From the 80 referred cases, as much as 22 cases (27.5%) were delayed, and 12 from 139 (8.6%) experienced delay in the hospital. A total of 30 cases among 139 (21.6%) experienced delay both outside and in the hospital. There were 74 near-miss cases, 9 of which ended in death of the patient. This means the real occurrence of near-miss cases is 65 from 139 cases or 46.8% while the occurrence of maternal death was 9 out of 139, or 6.47%. Case fatality rate was 9 from 139 or 6.47%; maternal near-miss ratio was 6.22; mortality index was 13.84% and maternal mortality ratio is estimated as 103/100.000 live births. Multivariate analysis showed delay in referral increased the risk of near-miss cases as much as 8.37 folds, while bleeding >1500 ml increased risk of near-miss by 12.12 folds. Delay in both referral and management in the hospital increased the risk of maternal death rate as much as 25.34 folds, hemoglobin <6 g/dl and unavailability of blood increase maternal death by 31.58 folds and 13.39 folds, respectively.Conclusion: Delay in referral and delay of in-hospital management ncreased the occurrence of near-miss and maternal mortality cases significantly. Multivariate analysis showed that the amount of bleeding, hemoglobin level and lack of blood availability influenced the occurrence of near-miss and maternal death more than the delay itself.Keywords: delay, maternal death, maternal near-miss, PPH

Risanto’s Formulas is more Accurate in Determining Estimated Fetal Weight Based on Maternal Fundal Height Titisar, Hanifah I; Siswosudarmo, Risanto
Indonesian Journal of Obstetrics and Gynecology Volume. 1, No. 3, July 2013
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objectives: To compare the accuracy of Johnson’s and Risanto’s formulas in determining estimated fetal weight based on maternal fundal height (FH). Methods: This was a cross sectional study, consisting of 655 pregnant women from Dr. Sardjito Hospital and affiliated hospital sat 37-42 weeks of gestation. Fundal height was measured from the symphisis to the top of uterine fundus, using inverted unelastic flexible tape. EFW based on Johnson’s and Risanto’s formulas were compared with the actualbirth weight. Wilcox on analysis was used for statistical analysis. Results: Mean EFW of Johnson’s formula was 3136 ± 392.2 grams and EFW of Risanto’s formula was 3056 ± 322.5 grams and mean actual birth weight was 3021 ± 341.1 grams. The mean difference between EFW of Johnson’s formula and the actual birth weight was 156.1 ± 107.3 grams, and mean difference between EFW of Risanto’s formula and the actual birth weight was 100.8 ± 86.1 grams. Those two differences was statistically significant (p=0.001). Conclusion: This study showed that Risanto’s formula was more accurate than Johnson’s in predicting birth weight based on the maternal’s fundal height. [Indones J Obstet Gynecol 2013; 1-3: 149-51] Keywords: actual birth weight, fundal height, Johnson’s formula, Risanto’s formula

DEVELOPING A NEW FORMULA FOR ESTIMATING BIRTH WEIGHT AT TERM PREGNANCY Siswosudarmo, Risanto; Titisari, Intan
JURNAL KESEHATAN REPRODUKSI Vol 1, No 2 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

DEVELOPING A NEW FORMULA FOR ESTIMATING BIRTH WEIGHT AT TERM PREGNANCYÂ Risanto Siswosudarmo1, Intan Titisari2Â Â ABSTRAKÂ 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 Â± 2,35 cm (bervariasi dari 24 sampai 38 cm) dan rata-rata BBL adalah 3021,60 Â± 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) â€“ 880.Kesimpulan: Terdapat hubungan yang kuat anatara TFU dengan BBL, di mana rumus untuk mengestimasi BBL adalah BBL = 125 TFU â€“ 880.Â Kata kunci: Estimasi berat lahir, Tinggi fundus uterus, Berat bay lahir, Rumus RisantoÂ ABSTRACTÂ 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 Â± 2.35 cm (ranged between 24 to 38 cm) and the mean IBW was 3021.60 Â± 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) â€“ 880.Conclusion: There was a strong correlation between FH and IBW. The formula for estimating IBW was IBW = 125 FH â€“ 880.Â Key words: Estimating birth weight, Fundal height, Fetal birth weight, Risantoâ€™s formula.Â 1,2 Bagian Obstetri dan Ginekologi, Fakultas Kedokteran UGM

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