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All Journal e-CliniC JURNAL BIOMEDIK Jurnal Kedokteran Klinik Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) Medical Scope Journal (MSJ) Health & Medical Sciences
Erna Suparman
Universitas Sam Ratulangi Manado
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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PERAN ESTROGEN DAN PROGESTERON TERHADAP KANKER PAYUDARA Suparman, Erna; Suparman, Eddy
JURNAL BIOMEDIK : JBM Vol 6, No 3 (2014): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.6.3.2014.6319

Abstract

Abstract: Sex steroid hormones estrogen and progesterone are the main compounds in hormone replacement therapy (HRT). Due to the Woman’s Health Initiative report 2002, the use of these compounds was controversial. It was reported that these hormones increased the risks of stroke, coronary heart disease, venous thromboembolism, and breast cancer, especially if they were used for a long period of time. The role of sex steroid hormones in inducing or promoting breast malignancy is still not clearly understood. Hypothetically, the polymorphism in receptors and steroidogenesis in breast tissues are involved in promoting the proliferation of breast cells that may trigger carcinogenesis. Although there is a significant benefit in administration of HRT for the menopausal women, there are also probable risks due to this therapy. After prolonged debates and controversies about HRT, it is accepted that there is a significant increase in breast cancers due to the use of combined HRT after 3-4 years. Due to the adverse outcome, the use of hormone therapy must start from the lowest dose and for the shortest period of time.Keywords: hormone replacement therapy, estrogen, progesterone, breast cancerAbstrak: Hormon seks steroid estrogen dan progesteron merupakan kandungan utama dari terapi sulih hormone (TSH). Penggunaan kedua hormon tersebut mendatangkan kontroversi setelah Woman’s Health Initiative pada tahun 2002 melaporkan peningkatan risiko stroke, penyakit jantung koroner, venous thromboembolism dan kanker payudara terutama pada penggunaan jangka panjang. Peran hormon steroid seks dalam meningkatkan keganasan payudara belum jelas dipahami. Secara hipotetik, polimorfisme pada reseptor dan kemampuan steroidogenesis dari jaringan payudara berperan dalam meningkatkan proliferasi sel-sel payudara dan memicu karsinogenesis. Meskipun terdapat keuntungan bermakna dari penggunaan TSH pada wanita menopause, namun terdapat juga kemungkinan risiko yang perlu dipertimbangkan. Setelah melalui berbagai perdebatan dan kontroversi mengenai TSH, disepakati bahwa terdapat peningkatan bermakna dari keganasan payudara setelah 3-4 tahun menggunakan TSH kombinasi. Oleh karena efek samping tersebut maka penggunaan TSH harus dimulai dengan dosis yang serendah mungkin dengan durasi pemakaian yang sesingkat-singkatnya.Kata kunci: terapi sulih hormon, estrogen, progesteron, kanker payudara
Amenorea Sekunder: Tinjauan dan Diagnosis Suparman, Erna; Suparman, Eddy
Jurnal Biomedik : JBM Vol 9, No 3 (2017): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.9.3.2017.17335

Abstract

Abstract: Secondary amenorrhea occurs when a woman in reproductive age who has experienced menstruation, at a sudden stops menstruating for at least three consecutive months. The basic principle underlying the physiology of menstrual function is composed of multiple organ systems with their appropriate compartments in which the menstrual cycle depends on, as follows: compartment I, disorders of the uterus; compartment II, disorders of the ovary; compartment III, disorders of the anterior pituitary; and compartment IV, disorders of the central nervous system (hypothalamus). Finding the cause of secondary amenorrhoea can be done by doing some tests or trials. Determination of the location of the specific anatomical defect is useful to obtain appropriate treatment according to the cause of amenorrhea.Keywords: secondary amenorrhoeaAbstrak: Dikatakan amenorea sekunder bila seorang wanita usia reproduktif yang pernah mengalami haid, tiba-tiba haidnya berhenti untuk sedikitnya 3 bulan berturut-turut. Prinsip dasar yang mendasari fisiologi dari fungsi menstruasi memungkinkan penyusunan beberapa sistem kompartemen yang tepat di mana siklus menstruasi bergantung, yaitu: kompartemen I gangguan pada uterus, kompartemen II gangguan pada ovarium, kompartemen III gangguan pada hipofisis anterior, dan kompartemen IV gangguan pada sistem saraf pusat (hipotalamus). Gangguan ini sering berhubungan dengan keadaan stres (wanita pengungsi, dipenjara, hidup dalam ketakutan), atlit wanita, atau anoreksia nervosa dan bulimia. Mencari penyebab amenorea dapat diperoleh dengan melakukan beberapa uji atau percobaan. Penentuan lokasi defek anatomis spesifik sangat bermanfaat untuk mendapatkan penanganan yang sesuai dengan penyebab amenore.Kata kunci: amenorea sekunder
GAMBARAN SINDROMA PREMENSTRUASI DENGAN OBESITAS MAHASISWI FAKULTAS KEDOKTERAN UNIVERSITAS SAM RATULANGI Rahim, Tiara Faradita; Tendean, Hermie M. M.; Suparman, Erna
e-CliniC Vol 4, No 1 (2016): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.4.1.2016.11031

Abstract

Abstract: Premenstrual syndrome is a set of symptoms associated with the menstrual cycle. Usually appear one to two weeks before the menstrual period and disappeared after the start of menstruation. One of the premenstrual syndrome’s risk factor is the body mass index. The prevalence of premenstrual syndrome in Virginia was 10,3%. Obese women (body mass index ≥30) had nearly a three fold increased risk for premenstrual syndrome than non-obese women. The purpose of this study was to know the description of premenstrual syndrome with obesity in female students of Medical Faculty Sam Ratulangi University. Method used a descriptive with cross sectional approach in 43 female students in Medical Faculty of Sam Ratulangi University that qualify. Based on the research in 43 female students of Medical Faculty Sam Ratulangi University, showed that the most distribution of respondents age was 20 – 22 years old (72,1%), the most of obesity category is obesity type I with BMI 30 – 34,9 kg/m2 (95,3%), and mostly respondents have a premenstrual syndrome with predominant types of symptom was affective symptom.Keyword: premenstrual syndrome, obesityAbstrak: Sindroma premenstruasi merupakan sekumpulan gejala yang muncul terkait dengan siklus menstruasi. Biasanya muncul satu sampai dua minggu sebelum periode menstruasi dan menghilang setelah mulainya menstruasi. Salah satu faktor risiko sindroma premenstruasi adalah indeks massa tubuh. Prevalensi sindroma premenstruasi di Virginia pada 10,3%. Perempuan obesitas (indeks massa tubuh ≥30) mempunyai risiko mengalami sindroma premenstruasi tiga kali lebih besar dibanding perempuan non obesitas. Tujuan penelitian ini untuk mengetahui gambaran sindroma premenstruasi dengan obesitas mahasiswi Fakultas Kedokteran Universitas Sam Ratulangi. Metode yang digunakan bersifat deskriptif dengan pendekatan cross sectional pada 43 mahasiswi Fakultas Kedokteran Universitas Sam Ratulangi yang memenuhi syarat. Berdasarkan penelitian yang dilakukan pada 43 mahasiswi Fakultas Kedokteran Universitas Sam Ratulangi, didapatkan distribusi usia responden terbanyak antara 20 – 22 tahun (72,1%), kategori obesitas terbanyak adalah obesitas I dengan IMT berkisar antara 30 – 34,9 kg/m2 (95,3%), dan sebagian besar responden mengalami sindroma premenstruasi (81,4%) dengan gejala yang paling dominan muncul adalah gejala afektif.Kata kunci: sindroma premenstruasi, obesitas
KARAKTERISTIK PERSALINAN LETAK SUNGSANG DI RSUP PROF. DR. R. D. KANDOU MANADO PERIODE 1 JANUARI 2014 – 31 DESEMBER 2014 Silinaung, Matricia Delaros G.; Kaeng, Juneke J.; Suparman, Erna
e-CliniC Vol 4, No 1 (2016): Jurnal e-CliniC (eCl)
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v4i1.10984

Abstract

Abstract: The cause of breech presentation is unknown, but there are some risk factors besides prematurity such as structural abnormality of the uterus, polyhydramnion, placenta previa, multiparity, uterine myoma, multiple pregnancy, fetal anomalies (anencephaly, hydrocephalus), and previous history of breech presentation. Before the age of 28 weeks, the incidence of breech presentation ranges from 25-30%, and most fetus will turn into a cephalic presentation after 34 weeks of gestation. This study aimed to determine the characteristics of breech delivery.This was a descriptive retrospective study using medical records of Prof. Dr. R. D. Kandou Hospital Manado period 1 January 2014 – 31 December 2014. This study obtained 214 cases of breech delivery out of the total of 3,347 deliveries. Breech delivery was most common in multigravida, at the age of 37-41 weeks The most common type of presentation was incomplete breech presentation and the management of labour was mostly per vaginam (spontaneous Bracht). Birthweights were more common in the range of 2500 - 3999 grams and the newborn babies were not asphyxiated. Complications were rarely found, however, there were 15 cases of infant death. Keywords: breech delivery, breech presentation Abstrak: Penyebab terjadinya presentasi bokong tidak diketahui, tetapi terdapat beberapa faktor risiko selain prematuritas, yaitu abnormalitas struktural uterus, polihidramnion, plasenta previa, multiparitas, mioma uteri, kehamilan multiple, anomali janin (anensefali, hidrosefalus), dan riwayat presentasi bokong sebelumnya.Sebelum umur kehamilan 28 minggu, kejadian presentasi bokong berkisar antara 25-30%, dan sebagian besar akan berubah menjadi presentasi kepala setelah umur kehamilan 34 minggu.Tujuan penelitian ini untuk mengetahui karakteristik dari persalinan letak sungsang. Penelitian ini menggunakan metode deskriptif retrospektif melalui rekam medik di RSUP Prof. dr. R. D. Kandou Manado periode 1 Januari 2014 – 31 Desember 2014. Dari penelitian ini diperoleh 214 kasus persalinan letak sungsang dari total persalinan 3.347 persalinan. Persalinan letak sungsang paling banyak ditemukan pada multigravida, kelompok usia kehamilan 37 – 41 minggu, jenis presentasi bokong kaki (incomplete breech) dengan penanganan paling banyak ialah persalinan pervaginam (spontaneus Bracht). Berat badan lahir bayi letak sungsang paling sering berkisar 2500 – 3999 gram, umumnya bayi tidak mengalami asfiksia. Walaupun jarang ditemukan komplikasi, mortalitas bayi letak sungsang terdapat sebanyak 15 kasus.Kata kunci: persalinan letak sungsang, presentasi letak sungsang
Peran GnRH agonis Suparman, Erna; Suparman, Eddy
Jurnal Biomedik : JBM Vol 8, No 1 (2016): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.8.1.2016.12329

Abstract

Abstract: Gonadotropin Releasing Hormone (GnRH) agonists have a higher biological potential than endogenous GnRH. Administration of a GnRH agonist triggers FSH and LH secretion from the pituitary (flare-up effect), however, after several days pituitary sensitivity continues to decrease which causes decreases of LH, FSH, estrogen, and progesterone (down-regulation). Preoperative administration of GnRH agonists is recommended in uterine fibroid with severe anemia to reduce blood loss before, during, and after surgery. Due to shrinking of fibroid, laparoscopy or laparotomy with Pfannenstiel incision can be performed. Moreover, myomectomy will not require extensive incision, damaged myometrium and adhesion are minimum, therefore, those conditions will increase the success of fertility; facilitate the removal of submucosal fibroid with histeroscopy; and enable the vaginal hysterectomy more easily. In patients with polycystic ovarial syndrome, GnRH agonists will suppress the high levels of LH and testosterone. GnRH agonists halt the growth and reduce the size of an endometriosis, therefore, they can be used in patients with precocious puberty and premenstrual syndrome. The combination of exogenous gonadotropin plus a GnRH agonist used in vitro fertilization is associated with increased pregnancy rate as compared with the use of gonadotropins without a GnRH agonist. The administration of GnRH agonists trigger hypoestrogen that causes osteoporosis and other complaints such as hot flushes, vaginal dryness, headache, and sleep disturbance. GnRH agonists can be combined with low-dose estrogen and progestin (add-back therapy) to reduce these side effects. Addback provision of therapy is started 12 weeks after administration of GnRH agonists.Keywords: GnRH agonist, exogenous gonadotropinAbstrak: GnRH (Gonadotropin Releasing Hormone) agonis memiliki potensi biologis yang lebih tinggi daripada GnRH endogen. Permulaan pemberian GnRH agonis memicu pengeluaran FSH dan LH dari hipofisis (flare-up effect). Setelah beberapa hari sensitivitas hipofisis terhadap rangsangan GnRH agonis terus berkurang yang menyebabkan penurunan LH, FSH, estrogen, dan progesteron (down regulation). Pemberian GnRH agonis preoperatif dianjurkan pada mioma uteri dengan anemia berat untuk mengurangi kehilangan darah sebelum, selama dan setelah operasi. Dengan mengecilnya mioma maka dapat dilakukan tindakan laparoskopi atau laparatomi dengan insisi Pfannenstiel, juga saat miomektomi tidak diperlukan insisi luas, kerusakan miometrium dan perlekatan menjadi minimal sehingga akan meningkatkan keberhasilan fertilitas; mempermudah pengangkatan mioma submukosum dengan histeroskopi; dan mempermudah melakukan vaginal histerektomi. GnRH agonis pada pasien sindroma ovarium polikistik akan menekan tingginya kadar LH dan produksi testosteron. GnRH agonis menghentikan pertumbuhan dan mengurangi ukuran endometriosis, selain itu GnRH agonis dapat digunakan pada pasien dengan pubertas prekok dan sindroma premenstrual. Pada fertilisasi in vitro penggunaan kombinasi gonadotropin eksogen ditambah GnRH agonis berhubungan dengan peningkatan keberhasilan kehamilan dibandingkan dengan penggunaan gonadotropin tanpa GnRH agonis. Pemberian GnRH agonis memicu keadaan hipoestrogen yang menyebabkan osteoporosis dan keluhan lain seperti hot flushes, vagina yang kering, sakit kepala, dan gangguan tidur. GnRH agonis dapat dikombinasi dengan estrogen dosis rendah dan progestin (add-back therapy) untuk mengurangi efek samping tersebut. Pemberian addback therapy ini dimulai 12 minggu setelah pemberian GnRH agonis.Kata kunci: GnRH agonis, gonadotropin eksogen
Hipertiroid dalam Kehamilan Suparman, Erna
e-CliniC Vol 9, No 2 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v9i2.34907

Abstract

Abstract: Hyperthyroidism in pregnancy could be a hyperthyroid condition that occurred before the pregnancy or acquired during the pregnancy. Hyperthyroidism in pregnancy is associated with adverse conditions for the fetus, mother, and also products of conception. The incidence for hyperthyroidism in pregnancy varies, ranging from 2-17 in 1000 births and accounts for 1-3% for all hyperthyroid cases. Clinical symptoms of hyperthyroidism in pregnancy also varies. Hyperthyroidism in pregnancy sometimes is hard to diagnose because it overlaps with normal pregnancy signs and symptoms. Clinical symptoms that might be found are tachycardia, thyromegaly, exophthalmos, and difficulty to gain weight with adequate food intake. Untreated hyperthyroidism could lead to preeclampsia and congestive heart failure for the mother, and miscarriage, placental abruption, and preterm birth. Therefore, maintaining euthyroidism on a patient is very important. Proper management of hyperthyroidism in pregnancy is very important for both mother and the fetus. Untreated hyperthyroidism could lead to pregnancy-related complications, such as premature birth, growth restriction, and even fetal death.Keywords: hyperthyroidism; pregnancy  Abstrak: Hipertiroid dalam kehamilan dapat merupakan kondisi hipertiroid yang telah ada sebelum terjadi kehamilan, atau kondisi yang didapatkan selama masa kehamilan.Hipertiroid dalam kehamilan dikaitkan dengan kondisi yang merugikan janin, ibu, dan hasil kandungan. Insidensi hipertiroid dalam kehamilan bervariasi, yaitu sekitar 2-17 dalam 1000 kelahiran serta merupakan 1%-3% dari jumlah kasus hipertiroid.Gejala klinis hipertiroid dalam kehamilan bervariasi. Pada kondisi hipertiroid dalam kehamilan, mungkin akan terdapat kesulitan dalam diagnosis, mengingat gejala-gejala dan tanda-tanda yang muncul saat terjadi kehamilan normal.2 Gejala klinis yang mungkin ditemukan ialah takikardia, tiromegali, eksoftalmos, dan tidak bertambahnya berat badan dengan asupan makanan yang memadai. Hipertiroid dalam kehamilan yang tidak ditangani dapat memicu preeklampsia dan gagal jantung kongestif pada ibu, serta meningkatkan risiko keguguran, solusio plasenta dan kelahiran prematur. Oleh karena itu mempertahankan eutiroidisme pada pasien sangatlah penting. Penatalaksanaan hipertiroid yang tepat selama kehamilan sangat penting bagi ibu dan janinnya. Hipertiroid yang tidak diobati dapat menyebabkan komplikasi terkait kehamilan seperti kelahiran prematur, hambatan pertumbuhan, dan bahkan kematian janin.Kata kunci: hipertiroid; kehamilan
Kontrasepsi Darurat dan Permasalahannya Suparman, Erna
Medical Scope Journal Vol 3, No 1 (2021): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.3.1.2021.34908

Abstract

Abstract: Emergency contraception is a contraceptive method that can prevent pregnancy if used immediately following unprotected sex. The use of emergency contraception could reduce the rate of unwanted pregnancy by up to 50%. There are two emergency contraceptive methods, including the emergency contraceptive pill and copper intrauterine device (IUD). Emergency contraceptive pills should be taken immediately following unprotected sex and are most effective when taken within 24 hours. IUD as an emergency contraceptive can be applied five days after unprotected sex, and it does not cause abortion. There is no absolute contraindication for emergency contraception except for known pregnancy, and simply because it is ineffective. The efficacy of emergency contraception can be defined by the proportion of women who become pregnant after using this method and the total pregnancy observed after using the method divided by the estimated number of pregnancies that would occur without using the method.Keywords: emergency contraception; sexual intercourse; pregnancy  Abstrak: Kontrasepsi darurat dapat mencegah kehamilan bila digunakan segera setelah senggama. Penggunaan kontrasepsi darurat dapat menurunkan angka kehamilan yang tidak diinginkan hingga 50%. Terdapat dua metode kontrasepsi darurat, yaitu pil kontrasepsi darurat dan alat kontrasepsi dalam rahim (AKDR) yang menggunakan tembaga. Pil kontrasepsi darurat harus diberikan sesegera mungkin setelah senggama tidak terlindungi, dan paling efektif bila diberikan dalam waktu 24 jam. AKDR sebagai kontrasepsi darurat dapat dipasang hingga lima hari pasca senggama tidak terlindungi. Kontrasepsi darurat terutama bekerja dengan mencegah fertilisasi, dan tidak menggugurkan kehamilan. Tidak ada kontraindikasi absolut untuk penggunaan kontrasepsi darurat kecuali kehamilan yang diketahui, dan ini hanya karena tidak efektif. Efektivitas kontrasepsi darurat dapat didefinisikan dari proporsi wanita menjadi hamil setelah menggunakan metode ini, dan jumlah kehamilan yang diamati setelah penggunaan dibagi dengan perkiraan jumlah kehamilan yang akan terjadi tanpa penggunaan.Kata kunci: kontrasepsi darurat; senggama; kehamilan
Lupus Eritematosus Sistemik (LES) pada Kehamilan Suparman, Erna
e-CliniC Vol 9, No 2 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v9i2.35375

Abstract

Abstract: Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that can affect women of childbearing age. Pregnancy causes alterations of the immune and neuroendocrine systems. Moreover, SLE in pregnancy is associated with prematurity and preeclampsia. Confirmation of the SLE diagnosis based on anamnesis, physical examination, and laboratory results is essential to differ the similar symptoms of normal pregnancy from pregnancy with SLE, such as preeclampsia, to lupus nephritis due to differences in treatment. The management of SLE in pregnancy has begun to be well understood; therefore, immunosuppressive drugs can be administered according to the indications and fetal safety. It is essential to educate women with SLE to not get pregnant before the 6-months remission period and explain the relative contraindications to pregnancy.Keywords: systemic lupus erythematosus; pregnancy; immunosuppressive  Abstrak: Lupus eritematosus sistemik (LES) merupakan suatu penyakit autoimun multi-organ yang dapat menyerang wanita usia reproduktif. Kehamilan menyebabkan perubahan pada sistem imun dan neuroendokrin. LES pada wanita hamil dihubungkan dengan kejadian kelahiran prematuritas dan preeklamsia. Penentuan diagnosis berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang penting untuk membedakan gejala-gejala yang mirip pada kehamilan normal dengan kehamilan yang disertai LES seperti preeklamsia dengan lupus nefritis karena tatalaksana yang diberikan berbeda. Tatalaksana LES pada kehamilan telah mulai dipahami sehingga pemberian obat-obatan imunosupresif dapat diberikan sesuai dengan indikasi dan keamanan pada janin. Penting untuk mengedukasi wanita dengan LES untuk tidak hamil sebelum melewati masa remisi enam bulan dan menjelaskan kontraindikasi relatif pada kehamilan.Kata kunci: lupus eritematous sistemik; kehamilan; imunosupresif
PENATALAKSANAAN ENDOMETRIOSIS Suparman, Erna
Jurnal Biomedik : JBM Vol 4, No 2 (2012): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.4.2.2012.754

Abstract

Abstract: Endometriosis is characterized by the occurence of endometrial cells outside the uterine cavity. Endometrial tissue in the pelvic cavity increases the activity of macrophages to phagocyte endometrial tissue debris and influences intrauterine implantation. Bleeding, arising from endometriosis lesions, will lead to adhesions with surrounding tissues, resulting in changes of tubal motility, pain, and infertility. Laparoscopy examination is necessary for confirming the diagnosis. While transvaginal ultrasound is famous for its accuracy, it provides just a little help for finding cystic masses in the parametrium. Nowadays, the treatment of endometriosis with estrogen is begining to be abandoned because it may cause endometrial hyperplasia that can develop into endometrial cancer. Albeit, danazol treatment succeeds due to its hormonal and immunologic effects. The first-line of therapy given for reducing pelvic pain is NSAIDs or oral contraceptives. If this fails, a GnRH agonist is given in combination with estrogen and progestin as an add-back therapy, otherwise an operative laparoscopy has to be done. Concerning the degree of severe and extensive endometriosis, atraumatic surgery is the main option. The induction of ovulation shows a satisfactory result. Randomized trials using the GnRH agonist administration associated with the hormones (FSH and LH), clomiphene citrate, and intrauterine insemination, showed an increased incidence of pregnancy compared to those without therapy.Key words: endometriosis, hormones, pain, infertilityAbstrak: Endometriosis ditandai adanya sel-sel endometrium di luar kavum uteri. Jaringan endometrium di dalam rongga pelvis akan meningkatkan aktifitas makrofag untuk memfagositosis debris jaringan endometriosis serta mempengaruhi nidasi intrauterin. Perdarahan yang timbul dari lesi endometriosis akan menyebabkan perlekatan dengan jaringan sekitarnya, yang berakibat perubahan motilitas tuba, nyeri, dan infertilitas. Laparoskopi sangat diperlukan untuk diagnosis endometriosis. USG transvaginal yang tersohor karena akurasinya hanya sedikit membantu menemukan lesi di daerah parametrium. Dewasa ini, pengobatan endometriosis dengan estrogen mulai ditinggalkan karena mengakibatkan hiperplasia endometrium yang dapat berkembang menjadi kanker endometrium. Keberhasilan pengobatan dengan danazol disebabkan karena efek hormonal dan imunologiknya. Terapi lini pertama pada nyeri pelvis ialah NSAID atau kontrasepsi oral. Bila gagal, diberikan agonis GnRH dikombinasi dengan estrogen dan progestin add-back therapy, atau laparoskopi operatif. Pada endometriosis derajat berat dan luas, pembedahan atraumatik merupakan pilihan utama. Induksi ovulasi memberikan hasil yang cukup memuaskan. Randomized trials pada pemberian GnRH agonis dengan hormon FSH dan LH, clomifen sitrat, serta inseminasi intrauterin, memperlihatkan peningkatan angka kehamilan dibandingkan pada yang tanpa terapi.Kata kunci: endometriosis, hormon, nyeri, infertilitas
Bicornuate Uterus with Previous C-Section: A Case Report Suparman, Erna
Jurnal Biomedik : JBM Vol 13, No 3 (2021): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.v13i3.36695

Abstract

Abstract: Bicornuate uterus is a type of Mullerian duct malformation caused by incomplete fusion of fundal uterine cornu that leads to two connected uterine cavities and one cervix. The incidence of bicornuate uterus is estimated to be 0.1-0.6% and it is believed to account for 10% of all uterine anomalies. We reported a case of bicornuate uterus with previous cesarean sections in an expecting mother presented in labor during her 38-39 weeks of pregnancy. She had a history of two previous cesarean sections. Based on physical examination and transabdominal USG, the fetus was found in breech presentation. She was managed with another cesarean section. During the operation it was found that she had a bicornuate uterus. The main problems for this case were pregnancy with bad obstetric history, previous cesarean sections, breech presentation, and complications that could occur in future pregnancy. The patient was presented already in labor, so she was managed with emergency cesarean section to reduce the risk of uterine rupture. During the operation, she was found to have a bicornuate uterus. This proved that the cause of repeated breech presentation was one of the complications that could occur in pregnancy with bicornuate uterus. The most ideal management for this patient was elective cesarean section. In conclusion, uterine abnormalities are accompanied with uneventful outcomes such as preterm labour, fetal malpresentations, and even perinatal mortality. However, these anomalies may not be suspected before the occurrence of abortion or its complications. A high index of suspicion is needed to diagnose uterine abnormalities before the occurence of its complicationsKeywords: bicornuate uterus; breech presentation; pregnancy; Mullerian duct anomalies
Co-Authors Ar-Rakhimi, Lintang Eddy Suparman Edwin Lasut Frank M. M. Wagey, Frank M. M. Freddy W. Wagey Hermie M. M. Tendean John J. E. Wantania, John J. E. Juneke J. Kaeng Kaeng, Juneke J Laihad, Joel Bismarck Larumpaa, Florensia S. Matricia Delaros G. Silinaung, Matricia Delaros G. Max Rarung Maya Mewengkang Palinoan, Meynita Patricia C. Warouw, Patricia C. Pawa, Alif F. Potes, Velisitas Ana Maria Prasetyo, Ananto Rudy Lengkong Tiara Faradita Rahim, Tiara Faradita Wantania, John J E Wongkaren, Brenda