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PENGARUH PENDIDIKAN KESEHATAN TERHADAP KECEMASAN PRIMIGRAVIDA DALAM MENGHADAPI PERSALINAN Mukhoirotin, Mukhoirotin; Rahmat, Ibrahim; Siswosudarmo, Risanto
JURNAL KESEHATAN REPRODUKSI Vol 1, No 3 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

PENGARUH PENDIDIKAN KESEHATAN TERHADAP KECEMASAN PRIMIGRAVIDA DALAM MENGHADAPI PERSALINANMukhoirotin1, Ibrahim Rahmat2, Risanto Siswosudarmo3ABSTRACTBackground: During a process of labor and delivery a primigravida mother tends to have increased fear and anxiety, because of pain and discomfort. She is worry about her safety and her baby. Unless it is well managed it might cause same complication such us premature labor, prolonged labor, and fetal death. Health education is one effort that can be done by health workers to decrease anxiety and prepare mother in facing the process of labor and delivery.Objective: To find out the influence of health education to primigravida anxiety in facing the process of labor and delivery.Method: The study was a quasy experiment by pretest-postest control group design. Subjects were all primigravidas at Peterongan Public Health Centre (Puskesmas) area of Jombang Regency. A total of sixty six respondents meeting the inclusion and exclusion criteria were recruited. They were devided into two groups, the treated group received health education and booklet (n=33) and the control group received health education only (n=33). The sampling tehnique were using consecutive sampling and cluster randomized trial. The instrument used to measure anxiety was Zung Self-Rating Anxiety Scale. Data were processed using computer program. Paired and independent sample t-tests were used for statistical analysis .Results and Discussion: The anxiety scores before treatment was comparable between the two groups (p>0.05). This scores decreased significantly after treatment from 36.79 to 29.79 in the treated group, and from 36.85 to 32.03 in the control group (p<0.05). The post treatment score was significanly different between the treated and the control groups (29.79Â±4.14 vs. 32.03Â±4.01; p<0.05).Conclution: Health education with booklet was more effective to decrease anxiety in the primigravida in facing labor compared to health education only.Keywords: health education, booklet, anxiety, primigravida.Â ABSTRAKLatar Belakang: Selama proses persalinan dan melahirkan seorang ibu primigravida cenderung mengalami peningkatan ketakutan dan kecemasan, karena rasa sakit dan ketidaknyamanan. Ibu khawatir tentang keselamatan dirinya dan bayinya. Apabila hal ini tidak dikelola dengan baik dapat menyebabkan beberapa komplikasi seperti persalinan prematur, partus lama, dan kematian janin. Pendidikan kesehatan merupakan salah satu upaya yang dapat dilakukan oleh tenaga kesehatan untuk menurunkan kecemasan dan mempersiapkan ibu dalam menghadapi proses persalinan dan melahirkan.Tujuan: Untuk mengetahui pengaruh pendidikan kesehatan terhadap kecemasan primigravida dalam menghadapi persalinan.Metode: Penelitian ini adalah quasi experiment dengan pendekatan pretest-postest control group design. Subyek penelitian adalah semua primigravida di wilayah Puskesmas Peterongan kabupaten Jombang. Sebanyak 66 responden yang memenuhi kriteria inklusi dan eksklusi direkrut.Subyek penelitian dibagi menjadi dua kelompok, kelompok perlakuan yang mendapatkan pendidikan kesehatan dan booklet (n=33) dan kelompok kontrol yang mendapatkan pendidikan kesehatan (n=33). Tehnik sampling menggunakan consecutive sampling dan cluster randomized trial. Instrumen yang digunakan untuk mengukur kecemasan adalah Zung Self-Rating Anxiety Scale. Data diolah dengan menggunakan program komputer. Paired sample t-test dan independent sample t-test digunakan untuk analisis statistik.Hasil dan Pembahasan: Skor kecemasan sebelum perlakuan adalah sebanding antara kedua kelompok (p>0,05). Skor ini menurun secara signifikan setelah perlakuan dari 36,79-29,79 pada kelompok perlakuan, dan dari 36,85-32,03 pada kelompok kontrol (p<0,05). Skor setelah perlakuan terdapat perbedaan yang signifikan antara kelompok perlakuan dan kontrol (29,79Â±4,14 vs. 32,03Â±4,01, p<0,05).Kesimpulan: Pendidikan kesehatan dengan booklet lebih efektif untuk menurunkan kecemasan primigravida dalam menghadapi persalinan dibandingkan dengan pendidikan kesehatan saja.Kata Kunci: pendidikan kesehatan, booklet, kecemasan, primigravida.Â 1,2 Program Studi Magister Keperawatan, Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta3 Bagian Obstetri dan Ginekologi, Fakultas Kedokteran Universitas Gadjah Mada YogyakartaÂ

THE USE OF NEW INSERTER (R_INSERTER) FOR DELIVERING CuT-380A IUD DURING POSTPARTUM PERIOD PHASE II CLINICAL TRIAL Siswosudarmo, Risanto; Kurniawan, Kadek; Suwartono, Herdhana; Alkaff, Taufik Rahman; Anggraeni, Maria
JURNAL KESEHATAN REPRODUKSI Vol 1, No 3 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

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 Â± 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.Â 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 IUDâ€™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 Â± 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:Â 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

PERBANDINGAN ANTARA PEMBERIAN PROGESTERON VAGINAL DAN ALLYLESTRENOL ORAL PADA PENANGANAN ABORTUS IMINENS Dhani, Umar; Emilia, Ova; Siswosudarmo, Risanto
JURNAL KESEHATAN REPRODUKSI Vol 2, No 1 (2015)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Umar Dhani1, Ova Emilia2, Risanto Siswosudarmo3Â ABSTRACTBackground: Abortion is still the most common complication of pregnancy. Inadequate secretion of progesterone in early pregnancy has been associated with one of the cause of miscarriage. Progesterone supplementation has been used to prevent abortion but it is still debatable.Objective: To compare the success rate of vaginal progesterone vs oral allylestrenol in the treatment of threatened abortion and duration of maintaining pregnancy.Method: Randomized Clinical Trial. The study was conducted at four affiliated hospitals of Sardjito hospital Yogyakarta from November 2013 to May 2014. Subjects with the diagnosis threatened abortion meeting the following criteria were included: 8-16 weeks gestational age, hemoglobin content eH 10 g/dL, and live fetus. The following patients were excluded: there was a history of induced abortion, hormonal treatment, associated with IUD use, uterine anomaly and gynecology tumor. A total of 60 patients were recruited to obtain 0.6 times proportion difference and 80% power of study. Eligible subjects consisting of 30 and 29 were randomly allocated into vaginal progesterone and oral allylestrenol groups. Ability to maintain, duration of pregnancy and side effects were outcomes of interest. Chi-square, t-test, Fisher exact test and survival analysis were used for statistical analysis.Result & Discussion: Abortion rate in vaginal progesterone was 23.3% compared 37.9% with oral allylestrenol group (RR=0.61; 95% CI 0.27-1.36). Duration of maintaining pregnancy was 16.57 days vs 9.82 days in vaginal progesterone and oral allylestrenol respectively (mean difference 6.75 days; 95% CI 2.30-11.20). There was no difference in term of gestational age on the abortion rate (p>0.05). One case undergoing nausea was found in oral allylestrenol group.Conclusion: There was no difference between vaginal progesterone and oral allylestrenol in term of abortion rate. Vaginal progesterone could maintain pregnancy longer than oral allylestrenol.Keywords: Threatened abortion, Vaginal progesterone, Oral allylestrenol, Abortion rate, Side effect.Â ABSTRAKLatar Belakang: Abortus masih merupakan komplikasi kehamilan yang sering terjadi. Sekresi progesteron yang tidak memadai pada awal kehamilan telah dikaitkan dengan salah satu penyebab abortus. Suplementasi progesteron digunakan untuk mencegah keguguran spontan walaupun masih diperdebatkan.Tujuan: Membandingkan keberhasilan terapi progesteron vaginal vs. allylestrenol oral dalam hal kejadian abortus dan lama terjadinya abortus pada kasus abortus iminens.Metode: Randomized Clinical Trial. Penelitian dilakukan dibagian Obstetrika dan Ginekologi di RS Kabupaten yang merupakan afiliasi RS Sardjito dari bulan November 2013 sampai dengan Mei 2014. Subyek yang memenuhi kriteria berikut ini: hamil 8-16 minggu, terdiagnosis abortus iminens, kadar hemoglobin > 10 g/dL, dan janin hidup. Pasien berikut ini tidak dimasukkan dalam penelitian: riwayat abortus provokatus, riwayat penggunaan terapi hormonal, abortus imminens karena kegagalan IUD, anomali uterus dan tumor ginekologis. Sebanyak 60 pasien diikutsertakan dalam penelitian ini untuk mendapatkan beda proporsi kejadian abortus sebesar 0,6 kali dengan kekuatan penelitian sebesar 80%. Subjek dibagi menjadi dua kelompok secara random yaitu kelompok yang mendapat progesteron vaginal dan allylestrenol oral masing-masing sebanyak 30 dan 29. Keberhasilan mempertahankan kehamilan, lama hari bertahan dan efek samping adalah hasil yang dinilai. Uji Chi-square, t-test, uji Fisher dan analisis survival adalah uji statistik yang dipakai.Hasil & Pembahasan: Kejadian abortus pada kelompok progesteron vaginal adalah 23,3% dibanding, 37,9% pada kelompok allylestrenol oral (RR=0,61; 95% CI 0,27-1,36). Lama bertahan pada kelompok progesteron vaginal rata-rata 16,57 hari dibanding rata-rata 9,82 hari pada kelompok allylestrenol oral (beda rata-rata 6,75 hari; 95% CI 2,30-11,20). Tidak ada perbedaan bermakna pengaruh umur kehamilan terhadap kejadian abortus pada kedua kelompok (p>0,05). Efek samping berupa perasaan mual hanya dijumpai pada kelompok allylestrenol oral.Kesimpulan: Tidak terdapat perbedaan kejadian abortus pada kedua kelompok meskipun kemampuan bertahan lebih lama pada kelompok progesteron vaginal.Kata Kunci: Abortus iminens, progesteron vaginal, allylestrenol oral, angka abortus, efek samping.Â 1,2,3 Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada/RS SardjitoYogyakarta

Pengaruh Konseling Antenatal terhadap Tingkat Penerimaan IUD Pasca Salin:Non RCT Kurniawan, Andrianto; Siswosudarmo, Risanto
JURNAL KESEHATAN REPRODUKSI Vol 6, No 1 (2019)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Background: Postpartum period is a period where a woman has a great motivation to use a contraceptive. The present data showed that the use of IUD was only about 7,75% of all mixed contraceptive use. Counseling carried out during the antenatal care period continued during early labor is believed be able to increase its acceptance.â€¨Objective: To compare the effect of antenatal counseling continued during the early labor versus counseling in the early labor only on the acceptance of postpartum IUD use.Method: The study was carried out in Sardjito Hospital and several Puskesmas in the province of Yogyakarta during six months period from January to June 2015. A non-randomized controlled trial (quasi experimental design) was used. Pregnant women meeting the inclusion and exclusion criteria that are counseled during their antenatal visit continued during their early labor were assigned as the exposed group. Those who are counseled during the early labor only were assigned to the control group. Counseling was done using a specific designed card introduced by BKKBN. The main outcome of interest is the real insertion of postpartum IUD. Chi square test, relative risk and logistic regression were used for statistical analysis.Result and Discussion: A total of 144 subjects were recruited consisting of 72 subjects as the exposed group and 72 as the control. Both groups were comparable in terms of age, parity, education, mode of delivery, and history of previous IUD use. The rate of IUD insertion on the exposed group was 52.8% compared to 26.4% in the control (RR 2.00; 95% CI 1.28-3.12). Other factors contributing to the acceptance of postpartum IUD were mode of delivery and previous IUD use. Logistic regression showed that the most dominant factor contributing to the acceptance of postpartum IUD was history of previous IUD use, (OR 8,42; 95% CI 1,68â€“42,27) followed by mode of delivery (OR 4.96; 95% CI 1.86â€“13.26), while timing of counseling was the third (RR 2.93; 95% CI 1.36â€“6.32).Conclusion: Counseling carried out during ANC continued in the period of early labor increased significantly the acceptance of postpartum IUD. Other factors contributing to the acceptance of IUD use were history of previous IUD use and mode of delivery.Key words: Postpartum IUD; Time of Counseling; Antenatal Care; Rate of Acceptance; IUD pasca salin; waktu konselingÂ

Kualitas Rujukan Bidan Delima di RSU A.W. Sjahranie, Samarinda Ginting, Erwin; Soejoenoes, Ariawan; Siswosudarmo, Risanto; Malinta, Umar
JURNAL KESEHATAN REPRODUKSI Vol 6, No 2 (2019)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Latar Belakang:Â Angka kematian ibu merupakan indikator tingkat kesehatan, di mana di Indonesia angka ini masih tinggi. Bidan Delima adalah salah satu program nasional dalam upaya menurunkan angka kemaitian ibu ini.Tujuan:Â Membandingkan ketepatan rujukan pasien Bidan Delima dengan Bidan Non-Delima serta luaran meternal dan neonatalnya.Metode: Penelitian ini dilaksanakan di Rumah Sakit Umum Abdul Wahab Sjahranie Samarinda. Pasien yang dirujuk oleh Bidan Delima digunakan sebagai kelompok kasus sedangkan pasien yang dirujuk oleh bidan Non-Delima digunakan sebagai kontrol. Penelitian ini menggunakan studi Cross Sectional. Ukuran sampel dihitung untuk mendapatkan tipe satu 0,05, kekuatan 0,80 dan perbedaan proporsi sekitar 30%. Pengolahan data menggunakan alat pengolah data di komputer. Chi-Square dan regresi logistik digunakan untuk analisa statistik.Hasil dan Pembahasan:Â Sebanyak 189 pasien yang memenuhi syarat yang terdiri dari 66 pasien Bidan Delima dan 123 pasien Bidan Non-Delima digunakan. Pasien tepat waktu yang dirujuk oleh Bidan Delima adalah 63,6% dibandingkan dengan 72,4% oleh Bidan Non-Delima, memberikan RP 0,88 (95% CI 0,71-1,09). Angka kelahiran vaginal masing-masing adalah 54,5% dan 66,7% pada Bidan Delima dan Non-Delima masing-masing (RP 0,82; 95% CI 0,64-1,05). Tingkat bayi bugar masing-masingÂ adalah 78,8% dan 86,2% pada Bidan Delima dan Non-Delima (RP 0,91; 95%Â CI 0,79-1,05).Simpulan:Â Tidak ada perbedaan ketepatan rujukan, luaran maternal dan neonatal antara Bidan Delima dan Bidan Non-Delima.Kata Kunci: Bidan Delima; Non-Delima; Ketepatan RujukanÂ Â

Hubungan antara Ekspresi P53 Mutan terhadap Operabilitas Kanker Serviks Stadium IIB Pasca Kemoterapi Neoajuvan Arsyad, Nur Rohmah; Siswosudarmo, Risanto; Kusumanto, Ardhanu
JURNAL KESEHATAN REPRODUKSI Vol 7, No 1 (2020)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.53838

Background: The therapy for stage IIB cervical cancer according to FIGO is concurrent chemoradiation. The neoadjuvant chemotherapy followed by radical hysterectomy is an alternative therapy to improve the survival rate of cancer patients. Cervical cancer is mainly caused by the infection of Human Papilloma Virus (HPV), which contains protein E6 and E7 that downregulate the apoptotic function of p53. The absent of p53 wild-type and the present of p53 mutation play roles on the cervical cancer pathogenesis.Objective: To analyze the association between the expression of mutant p53 to the stage IIB cervical cancer operability after neoadjuvant chemotherapyMethod: This study was a prospective cohort, using 40 of 67 patient who met eligibility criteria. The parafin block from cervical tissue were processed for immunohistochemical staining of p53 using Anti-mutant p53 antibody [Y5] ab32049, Abcam, USA. Two study groups were assessed as: 1) weak and 2) strong expression of mutant p53 expression after neoadjuvant chemotherapy based on H-score. Both group (weak and strong) were comparable in term of mutant p53 expression. In this study, the evaluation of operability was performed clinically. Age, BMI, histopathology, grade of differentiation, and regiment were also evaluated as the external variables. Chi square test, and logistic regression analysis were used for statistical analysis.Results and Discussion: The rate of cervical cancer operability after chemotherapy was 19 out of 40 (47.5%). The strong expression of mutant p53 was observed in 6 subjects (15%). There was no significant association between weak vs strong expression of mutant p53 to the operability of the cancer (RR 1.5, CI 95% 0.46-4.88, p 0.45). Multivariate analysis showed that combination (50 mg/m2 dan 5 fluorourasil 450 mg/m2) was significantly correlated the operability (OR 7.02, CI 95% 1.27-40.07,Â p 0.03).Â Conclusion: The expression of mutant p53 not correlate with operability after neoadjuvant chemotherapy, but combinationÂ regiment was.Keywords: expression of mutant p53, stage IIB of cervical cancer, neoadjuvant chemotherapy, operability

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

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

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

PENGARUH PENDIDIKAN KESEHATAN TERHADAP KECEMASAN PRIMIGRAVIDA DALAM MENGHADAPI PERSALINAN Mukhoirotin Mukhoirotin; Ibrahim Rahmat; Risanto Siswosudarmo
JURNAL KESEHATAN REPRODUKSI Vol 1, No 3 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

PENGARUH PENDIDIKAN KESEHATAN TERHADAP KECEMASAN PRIMIGRAVIDA DALAM MENGHADAPI PERSALINANMukhoirotin1, Ibrahim Rahmat2, Risanto Siswosudarmo3ABSTRACTBackground: During a process of labor and delivery a primigravida mother tends to have increased fear and anxiety, because of pain and discomfort. She is worry about her safety and her baby. Unless it is well managed it might cause same complication such us premature labor, prolonged labor, and fetal death. Health education is one effort that can be done by health workers to decrease anxiety and prepare mother in facing the process of labor and delivery.Objective: To find out the influence of health education to primigravida anxiety in facing the process of labor and delivery.Method: The study was a quasy experiment by pretest-postest control group design. Subjects were all primigravidas at Peterongan Public Health Centre (Puskesmas) area of Jombang Regency. A total of sixty six respondents meeting the inclusion and exclusion criteria were recruited. They were devided into two groups, the treated group received health education and booklet (n=33) and the control group received health education only (n=33). The sampling tehnique were using consecutive sampling and cluster randomized trial. The instrument used to measure anxiety was Zung Self-Rating Anxiety Scale. Data were processed using computer program. Paired and independent sample t-tests were used for statistical analysis .Results and Discussion: The anxiety scores before treatment was comparable between the two groups (p>0.05). This scores decreased significantly after treatment from 36.79 to 29.79 in the treated group, and from 36.85 to 32.03 in the control group (p<0.05). The post treatment score was significanly different between the treated and the control groups (29.79±4.14 vs. 32.03±4.01; p<0.05).Conclution: Health education with booklet was more effective to decrease anxiety in the primigravida in facing labor compared to health education only.Keywords: health education, booklet, anxiety, primigravida. ABSTRAKLatar Belakang: Selama proses persalinan dan melahirkan seorang ibu primigravida cenderung mengalami peningkatan ketakutan dan kecemasan, karena rasa sakit dan ketidaknyamanan. Ibu khawatir tentang keselamatan dirinya dan bayinya. Apabila hal ini tidak dikelola dengan baik dapat menyebabkan beberapa komplikasi seperti persalinan prematur, partus lama, dan kematian janin. Pendidikan kesehatan merupakan salah satu upaya yang dapat dilakukan oleh tenaga kesehatan untuk menurunkan kecemasan dan mempersiapkan ibu dalam menghadapi proses persalinan dan melahirkan.Tujuan: Untuk mengetahui pengaruh pendidikan kesehatan terhadap kecemasan primigravida dalam menghadapi persalinan.Metode: Penelitian ini adalah quasi experiment dengan pendekatan pretest-postest control group design. Subyek penelitian adalah semua primigravida di wilayah Puskesmas Peterongan kabupaten Jombang. Sebanyak 66 responden yang memenuhi kriteria inklusi dan eksklusi direkrut.Subyek penelitian dibagi menjadi dua kelompok, kelompok perlakuan yang mendapatkan pendidikan kesehatan dan booklet (n=33) dan kelompok kontrol yang mendapatkan pendidikan kesehatan (n=33). Tehnik sampling menggunakan consecutive sampling dan cluster randomized trial. Instrumen yang digunakan untuk mengukur kecemasan adalah Zung Self-Rating Anxiety Scale. Data diolah dengan menggunakan program komputer. Paired sample t-test dan independent sample t-test digunakan untuk analisis statistik.Hasil dan Pembahasan: Skor kecemasan sebelum perlakuan adalah sebanding antara kedua kelompok (p>0,05). Skor ini menurun secara signifikan setelah perlakuan dari 36,79-29,79 pada kelompok perlakuan, dan dari 36,85-32,03 pada kelompok kontrol (p<0,05). Skor setelah perlakuan terdapat perbedaan yang signifikan antara kelompok perlakuan dan kontrol (29,79±4,14 vs. 32,03±4,01, p<0,05).Kesimpulan: Pendidikan kesehatan dengan booklet lebih efektif untuk menurunkan kecemasan primigravida dalam menghadapi persalinan dibandingkan dengan pendidikan kesehatan saja.Kata Kunci: pendidikan kesehatan, booklet, kecemasan, primigravida. 1,2 Program Studi Magister Keperawatan, Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta3 Bagian Obstetri dan Ginekologi, Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta

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

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

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