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INDONESIA
Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia)
Published by Perkumpulan Obstetri dan Ginekologi Indonesia
ISSN : 23386401     EISSN : 23387335     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology Public Health
The Indonesian Journal of Obstetrics and Gynecology is an official publication of the Indonesian Society of Obstetrics and Gynekology. INAJOG is published quarterly.
Arjuna Subject : -
Articles 20 Documents
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Search results for , issue "Volume. 34, No. 3, July 2010" : 20 Documents clear
Distention Media in Hysteroscopy for Diagnostic and Operative Procedure Hadisaputra, Wachyu
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: Hysteroscopy is the "gold-standard" procedure used to describe the morphology of uterine cavity and the presence of intrauterine lesions and it is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Hysteroscopy requires uterine distention for the effective visualization of the uterine cavity and the clearing of blood and tissue debris. Options for uterine distention include insufflation with carbon dioxide (CO2) gas, and instillation with electrolytic and nonelectrolytic liquid distention media. In this review, we would like to review known available distending media and its characteristics for diagnostic and operative hysteroscopy. Method: Literature review. Conclusion: Carbon dioxide and normal saline are the most preferable distention media for diagnostic hysteroscopy. There is no significant difference between these medium in terms of visualization quality, but most practitioners prefer to use normal saline because of it’s availability and acceptability, quick performance, fewer additional procedures, more satisfaction rate, and good visualization. Low viscosity fluids are the most preferable media for operative hysteroscopy. Low viscous-electrolytic fluids, mostly normal saline is recommended in operative cases using mechanical, laser or bipolar energy that requires no electricity. Nonelectrolytic low-viscosity fluids are most preferable for extensive operative procedures using electrosurgery. Mannitol are chosen over glycine or sorbitol when using monopolar electrosurgery. [Indones J Obstet Gynecol 2010; 34-3: 150-4] Keywords: hysteroscopy, distention media, diagnostic procedure, operative procedure
Comparative of Pulsatile Index and Resistance Index of Vascularization Intratumoral in Operable and Non Operable Cervical Cancer (Cross Sectional Study) Gondo, Harry Kurniawan
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: A cross sectional study from 49 cases of cervical carcinoma, diagnosed by histopathology, early staged was done by Oncogynecologist at Gyneco-Oncology clinic of Sanglah Hospital. Doppler ultrasonography was used to compared the different Pulsatile Index (PI), Resistance Index (RI) from artery intratumoral with diameter mass of the tumor, including operable and non operable. Method: This research was cross sectional study, present 49 samples established diagnosis with cervical cancer using anatomical patology analyzes and evaluation the staging by the supervisor in the policlinic of Oncology in Sanglah Hospital. Examination of intratumoral vascular cervical cancer Doppler ultrasonography was done at policlinic of Obstetrics Graha Amerta in Sanglah Hospital using Medison instrument, type Sonoace 8000 live prime. The data was analyzed using Kolmogorov Smirnov test normality, then the selected data with Independent Samples Test. Result: Profile mean of age and parity between operable cervical cancer and non operable was not significant (p > 0.05). The mean Pulsatile Index (PI) in operable sample is 0.66 ± 0.9, non operable sample is 1.11 ± 0.84, p=0.089 (p > 0.05), RI for operable sample is 0.32 ± 0.36 and non operable sample is 0.49 ± 0.28 (p > 0.05). Conclusion: There were no significant difference of PI and Resistance Index (RI) between operable and non operable on cervical cancer, but they were different in velocity mean. [Indones J Obstet Gynecol 2010; 34-3: 143-9] Keywords: pulsatile index, resistance index, cervical cancer
Gonadotoxic Effect of Combined Chemotherapy on Anti Müllerian Hormone (AMH) Level in non-Gynecologic Cancer Patients in Reproductive Age Jasirwan, Shanty Olivia F.
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: To assess the effect of combined chemotherapy on levels of Anti-Müllerian Hormone (AMH). Method: This is a prospective cohort study on 12 non-gynecologic cancer women aged 20 - 40 years who received combined chemotherapy treatment. AMH levels and menstrual pattern before and after three months of chemotherapy were examined. The relationships between age, chemotherapy regimens and the cumulative doses on the change of AMH were also analyzed. Result: The median age of subjects was 37 years (range 20 - 40 years). Pre chemotherapy AMH analysis revealed an inverse correlation between age and AMH levels (r = -0.715; p = 0.009). AMH levels after 3 months of combined chemotherapy drastically declined to 84.6% (p = 0.002). Multivariate analysis indicated that age and total cumulative dose were the main factors contributing to the AMH levels reduction (r = -0.679; p = 0.002 and r = 0.405; p = 0.027). Ten of 12 subjects (83.3%) experienced amenorrhea after 3 months of chemotherapy and had lower level of pre and postchemotherapy AMH compared to those who still maintained normal periods (p = 0.03 and 0.02). Conclusion: AMH levels in non-gynecological cancer women who received combined chemotherapy decreased dramatically after 3 months of chemotherapy. Main factors that contribute to this were the cumulative dose and age. Most of these subjects experienced amenorrhea after 3 months of chemotherapy. [Indones J Obstet Gynecol 2010; 34-3: 119-24] Keywords: ovarian reserve, chemotherapy, Anti Müllerian Hormone (AMH), ovarian function, gonadotoxic
Removing the uterus and both ovaries: pros and cons of hysterectomy and bilateral oophorectomy Baziad, Ali
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Removing the uterus and both ovaries, due to many reasons, are still performed at perimenopausal age and due to many reasons, uterus and ovaries removal are still performed at reproductive age. Hysterectomy with or without salphingooophorectomy is still the most common procedure performed not only in developing countries but also in developed countries. Among of all reasons the most frequent one is to improve the quality of life and prevent future malignancies if the uterus and both ovaries are not removed. Malignancies might probably occur although the incidence rate is very low. When both of the ovaries are removed, estrogen will decrease significantly, this will cause short and long term medical problems and decrease the quality of life. The incidence of coronary heart disease and fractures increases as estrogen decreases. A study performed by Parker et al with some of 10.000 women who underwent total hysterectomy and bilateral salphingooophorectomy at the age of 50 - 54 years old and did not receive HRT, shows that 838 died due to heart disease.1 Other studies reported cognitive disturbances among women who underwent bilateral salphingooophorectomy.2 Further more, the incidence of depression, anxiety and sexual disturbances is higher in women whose ovaries were removed compared to those who underwent natural menopausal state. If both ovaries were removed and then medical problems occured, the next question would be whether the clinician is willing to give HRT or whether the patient is willing to have HRT? In Indonesia, clinicians are afraid of giving HRT and patients are not willing to have HRT. Then what will happen to the patient? Symptomatic medication is then given. One of the reasons of removing both ovaries is to prevent the occurence malignancies of ovary and breast. HRT will increase the incidence of breast cancer. If it is so, then the patient is at the point of no return. If the uterus is removed, will medical problems happen? Yes, there are papillary thyroid cancer found in women whose uterus were removed.3 It shows that uterus also plays important role in controlling thyroid glands. Levi et al. reported an increased risk of epithelial thyroid cancer in women with artificial menopause (OR 6.3%, 95% CI: 1.7 - 23.2).4 Several studies in Europe and USA concluded that hysterectomy will increase the risk of thyroid cancer.5,6 Estrogen indirectly takes part in controlling the release of HRT, if there is no estrogen then HRT release will increase and trigger the growth of thyroid tumor.3 Myometrium and endometrium also have the ability to produce thyroid hormone. The level of iodothyronine deodinase enzyme is high in myometrium and endometrium, especially during pregnancy.7,8 There are 2 types of deodinase enzyme, type 2 and type 3. D2 enzyme transforms T4 to active T3, while D3 transforms T4 to inactive T3.7,8 If uterus is removed, the T3 will decrease and HRT release will be uncontrolled. Estrogen only (+ progesterone) will increase D2 enzyme activity while estrogen + progesterone will increase D3 activity.9 It shows that estrogen plays more important role in increasing D2 enzyme activity. If there is no uterus, then there is no D2 enzyme available. Uterus also has the ability to syntezise prostacycline. Prostacycline has vasodilatation effect, increasing the blood flow to the heart. Women without uterus will have an increased risk of heart disease. Removing the uterus has to be considered carefully. The incidence of malignancies as a consequence of conserving the uterus is lower compared to the adverse effect due to hysterectomy and bilateral salphingooophorectomy. Further study is needed in Indonesia to evaluate the consequences of hysterectomy and bilateral salphingooophorectomy towards thyroid cancer and quality of life in the future.
Expression of p16INK4a Biomarker has a Diagnostic Value in Predicting the Progressivity of Precancerous Cervical Lesion Indarti, Junita
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: To evaluate clinical value of p16INK4a biomarker level, by doing p16INK4a immunocytochemistry staining, as a predictor of progressivity of precancerous cervical lesion. Method: Design of this research is case-control study which will be stratified. Research was conducted in Cytology Laboratorium, Gynecology Specialistic Division, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital from August 2007 to September 2008. Immunocytochemistry examination was conducted in Anatomic Pathology Department, Dr. Hasan Sadikin Hospital. We divided the sample into two categories; patients with and without cervical intraepithelial neoplasia (CIN). This research will evaluate HPV infection and p16INK4a biomarker by doing p16INK4a immunocytochemistry (ICC) staining. Results: We have done immunocytochemistry examination in 130 patients, 26 without CIN and 104 with CIN. Immunocytochemistry cut-off point level is 50, which means value < 50 means low (L) p16INK4a expression and in reverse, value ≥ 50 means high (H) p16INK4a expression. The bivariate analysis of our study were p16INK4a (H) expression has the risk of CIN 1 with OR 8.4, for CIN 2 with OR 13 and for CIN 3 with OR 21, greater than p16INK4a (L) with all p values are significant. ICC p16INK4a (H) expression, age, number of sexual partners, and education are contributory to the risk of progressivity in CIN. The multivariate analysis demonstrates, ICC expression of p16INK4a (H) has a risk (OR) of CIN 1 17.19 times greater than p16INK4a (L); p16INK4a (H) expression’s OR for CIN 2 is 25.56; and for OR CIN 3 is 37.32. The expression of p16INK4a has a significant p value and high OR, thus ICC expression of p16INK4a is suggested to be included in the algorithm of precancerous cervical lesion guidelines and scoring of probability of CIN as an alternative to HPV DNA considering less cost of the test. In this research, we found a scoring model to determine probability of progressivity in precancerous cervical lesion. Conclusion: The expression of p16INK4a has a diagnostic value in predicting the progressivity of precancerous cervical lesion. [Indones J Obstet Gynecol 2010; 34-3: 125-30] Keywords: p16INK4a expression, immunocytochemistry, predictor of progressivity, precancerous cervical lesion
Low Class Ib (HLA-G/Qa-2) MHC Protein Expression against Hsp-70 and VCAM-1 Profile on Preeclampsia. An observation on experimental animal Mus Musculus with Endothelial Dysfunction model Sulistyowati, Sri
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: To analyze the expression of MHC class Ib Qa-2 protein (homologue to HLA-G in human), Hsp-70, and VCAM-1 in trophoblast cells of preeclampsia and control using endothelial dysfunction model on Mus Musculus. Method: Design of study is experimental study. Pregnant mice was treated with anti-Qa-2. Hsp-70 and VCAM-1 expressions of trophoblast cells was assessed on week I, II, and III. Result: Negative Qa-2 expression was achieved after administration of 40ng anti Qa-2 on the fifth day of pregnancy. The Hsp-70 and VCAM-1 expressions in negative Qa-2 mice (preeclampsia) was higher compared with those of positive Qa-2 mice (normal pregnancy) on week I, II and III. Conclusion: Low Qa-2 and high of HSP-70 and VCAM-1 expression might be useful for prediction of preeclampsia or endothelial dysfunction. [Indones J Obstet Gynecol 2010; 34-3: 103-7] Keywords: preeclampsia, HLA-G/Qa-2, Hsp-70, VCAM-1, endothelial dysfunction
Report Risk of Malignancy Index of Ovarian Cancer Patients in Dr. Sardjito Hospital, Yogyakarta Rachmasari Putri, Henny Meitri Andrie
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: To analyse retrospectively the score of the risk of malignancy index (RMI) in determining malignancy in the patients with ovarian mass in Dr. Sardjito Hospital Yogyakarta. Method: Retrospective analysis. Results: Ninety patients with complete medical record and adnexal mass were enrolled in the study from January 2007 to March 2009. Subjects consisted of 70 patients (77.78%) diagnosed with malignant ovarian mass and 20 patients with benign mass (22.22%), More than half of the malignant ovarian mass were serous carcinomas and at advanced stages (51.43% and 51.43% subsequently). Univariate analysis presented significant difference for ultrasound score and serum Ca-125 level in identification of ovarian malignancy, but not with the age or the menopausal status. The performance of RMI (≥ 200 for malignancy) had a sensitivity of 70%, a specificity of 75%, a positive predictive value of 90.74%, and negative predictive value of 41.67%. The serum Ca-125 level had a sensitivity of 81.43%, a specificity of 60%, a positive predictive value of 87.69%, and a negative predictive value of 48%. The ultrasound score had a sensitivity of 65.71%, a specificity of 65%, a positive predictive value of 86.79%, and a negative predictive value of 35.14%. Conclusion: Due to the nature of retrospective study, RMI is reliable for identification of malignant and benign ovarian mass improve the management of ovarian mass including referral system and the decision regarding the approach used during surgery. [Indones J Obstet Gynecol 2010; 34-3: 131-5] Keywords: risk of malignancy index, RMI, ovarian cancer, ovarian malignancies, ovarian carcinomas
Conservative Surgical Management of Postpartum Hemorrhage (PPH) Using ’Surabaya Method’ (Modified B-Lynch Compression Suture) Sulistyono, Agus
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: To evaluate the efficacy of PPH management by conservative surgical management using B-Lynch Method and Surabaya method (Modified B-Lynch compression suture) as an alternative to hysterectomy in PPH due to uterine atony. Method: Eighty-four cases of PPH from 2786 deliveries were recruited in period of July 1, 2007 - August 31, 2008. The study was perfomed in Ob/Gyn Dept. Dr. Soetomo Hospital Surabaya, Indonesia. Its management consisted of 72 cases succeed with medical (uterotonics) and mechanical technique (tamponade technique) and the remain of 12 failed cases was done by conservative surgical technique that preserving uterus. The surgically therapy on these 12 cases were proceeded by B-Lynch technique on 4 cases and another 8 cases with Surabaya Method in which the technique was done by performing brace suturing way with 3 longitudinally stitches using chromic catgut no 2 and round needle. Result: From 12 cases showed that all 8 cases with Surabaya Method technique were success to stop bleeding, but 2 cases were failed from B-Lynch Method and hysterectomy were done. Two out of 8 cases Surabaya Method and 1 B-Lynch technique case were ended with death which possible causes were HELLP syndrome, DIC and multiple organ failure complication in severe preeclampsia, although actually the bleeding had already been stopped. Conclusion: The present study showed that Surabaya Method was effective to stop bleeding in PPH conservative surgical management with uterus preserving. Beside simple, effective and easy to implement, the advantage of Surabaya Method was quick. [Indones J Obstet Gynecol 2010; 34-3: 108-13] Keywords: PPH conservative management, Surabaya Method, B-Lynch technique
The Correlation of Decreased E-Cadherin and β1-Integrin Expression with the Depth of Myometrial Invasion and Pelvic Lymph Node Metastasis in Resectable Endometrial Cancer Hasanuddin, Hasanuddin
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: The purpose of this study was to determine the correlation between decreased E-Cadherin and β1-integrin expression in resectable endometrial cancer with the depth of myometrial invasion and pelvic lymph node metastasis. Method: This was a cross sectional study, we used immunohistochemistry examination on E-Cadherin and β1-integrin expression in resectable endometrial cancer patients who had surgery in 1997 to 2006 in Dr. Cipto Mangunkusumo Hospital and searched the correlation with the depth of myometrial invasion and pelvic lymph node metastasis. Result: The prevalence of endometrial cancer from 1997 to 2006 in Dr. Cipto Mangunkusumo Hospital was 7.0 in a year. Out of 64 patients with endometrial cancer only 36 paraffin block could be found and immunostaining on E-Cadherin and β1-integrin was done in 30 samples. Decreased E-Cadherin and β1-integrin expression was associated with the depth of myometrial invasion, pelvic lymph node metastasis, lymph ovascular space involvement and degree of differentiation in resectable endometrial cancer patients. Conclusion: Decreased E-Cadherin and β1-integrin expression was associated with the depth of myometrial invasion and pelvic lymph nodes metastasis. [Indones J Obstet Gynecol 2010; 34-3: 136-42] Keywords: E-Cadherin, β1-integrin, the depth of myometrial invasion, pelvic lymph node metastasis
Anti Mullerian Hormone Serum Level Indicates Ovarian Response in Controlled Ovarian Hyperstimulation of IVF Cycles Wiweko, Budi
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 3, July 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: To evaluate the clinical value of Anti Mullerian Hormone serum (AMH) level as one of ovarian response indicator in controlled ovarian hyperstimulation in IVF cycles. Method: This cohort-prospective study was conducted in Dr. Cipto Mangunkusumo General Hospital. The subjects of this study were infertile couples who underwent controlled ovarian hyperstimulation in IVF cycles. The measurement of FSH level, estradiol level, AMH level, and antral follicles count was done in the beginning of IVF cycles. The cycles were divided into two groups, good responder group and poor responder group. Good responder group had three or more mature oocytes, while the poor responder group had two or less mature oocytes. Statistical analysis was done using T-Test and Receiver Operator Characteristic area under curve (ROCAUC) to measure the predictive value of AMH, FSH, estradiol, age, and antral follicle count as ovarian response predictors. Results and Discussion: From 92 IVF cycles, there were 15 poor responder cycles (16.3%) and 77 good responder cycles. AMH serum level was 3.75 ± 2.77 μg/ml in good responder cycles and 1.04 ± 1.39 μg/ml in poor responder cycles (p < 0.0001). AMH serum level was more superior than other ovarian response predictors (AUC 0.846) with cut-off value of 1.40 μg/ml. AMH serum level ≥ 1.40 μg/ml had good predictive value as ovarian reserve or ovarian reserve parameter with 81% sensitivity and 87% specificity. Conclusion: AMH serum level was more superior ovarian reserve and ovarian response predictor compared to other parameters. [Indones J Obstet Gynecol 2010; 34-3: 114-8] Keywords: anti-Mullerian hormone, ovarian reserve, ovarian response

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