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Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia)

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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.

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Articles 1,760 Documents

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The Psychopathology Changes in non-Obese PCOS Women Do Not Show any Influence on Neuropeptide Y Level Yustina, Mariza
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the Neuropeptide Y (NPY) levels in nonobese Polycystic Ovary Syndrome (PCOS) patients without insulin resistance and non-obese women without insulin resistance, in consideration of the psychopathologic conditions occurring in PCOS patients as well as the influence of these changes in affecting NPY levels. Methods: The subject was fourteen PCOS patients and 20 non-obese normal women, both without insulin resistance. The measurements of blood NPY levels using the ELISA method and a psychology assessment using Symptom Check List 90 (SCL-90) were carried out. Statistical analysis was performed using SPSS 17. Results: From 20 PCOS patients included in this study, 6 subjects (30%) were detected as having psychopathologic problems through completion of the SCL-90 questionnaire, with a cut-off score of >70 points. Measurement of NPY levels using ELISA found a mean NPY level of 8.02 ± 3.92 (95% CI 2.39 - 18.66) in the PCOS group compared to a mean of 7.78 ± 4.31 pg/ml (95% CI 0.74 - 15.47) in the control group. No significant difference was found in the mean levels of NPY between the two groups. Statistical assessment using the Spearman 2-variable correlation test also found no significant correlation between NPY levels and the SCL-90, scores in the PCOS group. Conclusion: There was no significant difference in NPY levels between the PCOS group and control group. Thirty percent of non-obese PCOS patients without insulin resistance were identified as having psychopathologic conditions. But in this group of patients, the psychopathologic changes had no influence on the levels of blood NPY. [Indones J Obstet Gynecol 2012; 36-3: 125-9] Keywords: neuropeptide Y, PCOS, psychopathologic conditions

Letrozole 2.5 mg Shows Higher Endometrial Thickness Compared to 5 mg Letrozole in Ovulation Induction Tobing, Anita
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the effects of ovulation induction with 2.5 mg letrozole to 5 mg letrozole by the number of mature follicles, endometrial morphology and endometrium thickness during the late follicular phase in infertility patient who successfully became pregnant. Method: This was a cross sectional study. We collected the data of infertility patient who successfully became pregnant after receiving ovulation induction regiment of 2.5 mg and 5 mg letrozole. Result: There mean number of follicles with diameter ≥ 18 mm was higher in group receiving 5 mg letrozole (1.64 SD ± 0.91) compared to group receiving 2.5 mg letrozole (1.37 SD ± 0.56) but statistically, there was no significant difference (p = 0.134). Endometrial thickness, which was measured by transvaginal ultrasound on the twelfth day of menstrual cycle, showed a significant difference (p = 0.023) between the groups. The endometrium was thicker in patients receiving 2.5 mg letrozole (7.83 mm SD ± 0.87) compared to patients receiving 5 mg letrozole (7.6 mm SD ± 1.10). The most common endometrium morphology found was triple line endometrium, both in group receiving 2.5 mg letrozole (65%) and in group receiving 5 mg letrozole (50%). Conclusion: There was a significant difference in endometrial thickness between the pregnant patients who had received 5 mg of letrozole and 2.5 mg of letrozole for ovulation induction and the most common endometrium morphology and description was triple line endometrium in both research groups. But there was no significant difference between the number of ≥ 18 mm follicles on 2.5 mg doses and 5 mg doses of letrozole. [Indones J Obstet Gynecol 2012; 36-3: 130-4] Keywords: endometrium morphology, endometrium thickness, infertility, letrozole, ovarium follicles

The Serum Level of Vascular Endothelial Growth Factor (VEGF) is Declined after Paclitaxel-Carboplatin Combined Chemotherapy Treatment on Epithelial Ovarian Cancer Abdullah, Amelia
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To assess the effect of Paclitaxel-Carboplatin combination on epithelial ovarian cancer by studying the changes in VEGF serum levels after receiving 3 series of chemotherapy. Methods: This was a cohort study conducted at several teaching hospitals in Obstetrics and Gynecology Department of the Faculty of Medicine, Hasanuddin University from April 2011 to March 2012. The subjects were patients with ovarian cancer who met the inclusion criteria and had undergone surgery. The clinical staging was determined with 2009 FIGO criteria. They went through histopathology examination to determine the histological type and cell differentiation of the lesion. They also went through combined chemotherapy of Paclitaxel and Carboplatin. The data were analyzed with paired t-test. Results: The study reveals that out of 30 cases of ovarian cancer who received a combination chemotherapy, most were < 45 years of age (53.33%), nulliparous (46.7%), serosum type (53.3%), with moderate differentiation (36.7%), and in advanced stage (73.3%). The VEGF serum level after 3 series of chemotherapy was lower than before (the average value: 294.67 vs 572.77 ng/ml). There was a significant change in VEGF serum level after receiving chemotherapy (p=0.000). The VEGF serum level of advanced-stage and early stage epithelial ovarian cancer after chemotherapy decreases significantly (p=0.000 and p=0.011). The advanced-stage cases showed more responses to chemotherapy than the early-stage did. There was a tendency that adenocarcinoma serosum type was more responsive to the therapy than mucinosum type (p=0.000 vs 0.003). Conclusion: There is no difference in VEGF serum level based on cell differentiation but there is a tendency that well and moderate differentiated cells have a greater change than the poor differentiated cells (p=0.003, p=0.003 vs p=0.019). [Indones J Obstet Gynecol 2012; 36-3: 135-9] Keywords: carboplatin, epithelial ovarian cancer, paclitaxel, VEGF

Diabetes Mellitus and Hypertension are Risk Factor for Endometrial Cancer Wijaya, Chresni F.
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To find out whether diabetes mellitus and/or hypertension is associated with endometrial cancer and could increase the staging of the cancer. Method: This was an analytic retrospective descriptive study with cross sectional design. Data were taken from the medical record of patients diagnosed as having endometrial cancer in Obstetrics and Gynecology Department of Dr. Hasan Sadikin Hospital from 1st January 2007 - 31st December 2011 and analyzed descriptively. Result: There were 125 cases of endometrial cancer. Prevalence was 2.56 %. The incidence increased in age > 40 y/o (92 %) and had diabetes mellitus and/or hypertension (66.4 %). Conclusion: Diabetes mellitus and/or hypertension were associated with risk factors of endometrial cancer but not proven to increase the staging of the cancer. [Indones J Obstet Gynecol 2012; 36-3: 140-3] Keywords: diabetes mellitus, endometrial cancer, hypertension

Vascular Endothelial Growth Factor-C (VEGF-C) Expression Can Not Predict Pelvic Lymph Node Metastases and Response to Neo-adjuvant Chemotherapy in Bulky Cervical Cancer Hutapea, Johnson
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To assess whether VEGF-C expression can predict the response to neoadjuvant chemotherapy and pelvic lymphnode metastases in bulky cevical cancer. Methods: Seventeen cervical cancer stage IB2 and IIA2 cases during the period of July 2009 until June 2010 were collected consecutively and given neoadjuvant chemotherapy (NAC) PVB prior radical surgery. Response to treatment was evaluated based on the change of tumour size. VEGF-C expression was examined immunohistochemically at tumour biopsy before chemotherapy. The presence of lymphnode metastases histopathologically were obtained from pelvic lymphnode dissection. The difference and correlation of response and metastases on VEGF-C expression were analized statistically. The validity of the cut off percentage of immunopositive cells to VEGF-C to identify non responding and metastatic cases was calculated with the ROC. Multivariate analysis were done to determine the predictor of no response to chemotherapy. Results: Clinical response, using the RECIST version 1.1 criteria, was found in 41.18% cases and lymphnode metastases were found in 27.27% cases. VEGF-C was expressed in all cases. Statistically, there were no significant differences and correlation in response to treatment and pelvic lymphnode metastases on VEGF-C expression. At the cut off ≥ 76% immunopositivity to VEGF-C, the sensitivity to identify no response and the specificity to identify response to NAC are 70.00% and 71.43% respectively (LR+ 2.45 and LR- 0.42); whereas at the cut off ≥ 75% immunopositivity to VEGF-C, the sensitivity to identify lymphnode metastases and the specificity to identify no lymphnode metastases are 100.00% and 75.00% (LR+ 4.0 and LR- 0). With multivariate analysis using logistic regression, the cut off ≥ 76% immunopositive cells to VEGF-C were found to have positive coefficient, largest OR and statistic score, 1.93, 6.88 (96% CI OR 0.45; 104.34) and 41 respectively, to predict non responders in a prediction score model. Conclusion: VEGF-C expression on biopsy specimen bulky cervical cancers can not differentiate cases that respond to NAC and metastases to the pelvic lymphnode from that do not. The cut off ≥ 76% immunopositive cells to VEGF-C in a prediction model can be used as an alternative predictor to identify non responders. [Indones J Obstet Gynecol 2012; 36-3: 144-9] Keywords: bulky cervical cancer, neoadjuvant chemotherapy, response and metastases prediction, VEGF-C immunohistochemistry expression

Severe Complication of Uterine Perforation and Ileum Prolapse after Having Unsafe Abortion Pradana, Aryando
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: Discuss complication after unsafe abortion and management of uterine perforation after curettage. Methods: Case report. Conclusion: Uterine perforation and ileum prolapse in this patient was a complication from unsafe abortion from unregistered health practicioner, fortunately the outcome is good, although actually it could be prevent. [Indones J Obstet Gynecol 2012; 36-3:150-3] Keywords: hysteroraphy, ileum anastomose, ileum laceration, ileum prolapse, ileum resection, incomplete abortion, uterine perforation

Fertility Outcomes after Laparoscopic Reversal of Tubal Sterilization Hadisaputra, Wachyu
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To know pregnancy outcome in the tubal reversal of sterilized women. Method: Literature review. Results: Sterilization is considered the most common contraception methods in United States of America, approximately 39% women in reproductive age (15 - 44 years) used this method. However, approximately 15% of these patients deplored this decision due to the influence of their own environment and some factors, such as: young age, the death of a child, the disability of child, and change of partner/ remarried. Tubal reanastomosis or tubal reversal is a surgical procedure that attempts to restore the fallopian tube patency following sterilization. To date, the modern procedure is performed by doing an excision of the tubal segment and reanastomosis by transabdominal laparoscopy. Recently, the laparoscopic technology has developed and evolved rapidly as the robotic assisted laparoscopy was invented. There is alternative method for restoring the fertility in sterilized women who regretted the decision of being sterilized. Unlike the tubal reversal which is conducted in order to restore the tubal function, the IVF is performed to bypass the function of tubes in fertility. The major advantage for laparoscopic surgery is short postoperative stay duration with minimal tissue handling, less postoperative adhesions, and diminish morbidity rate. Despite of its major drawback, high-cost of robotic machine and machine maintenance; there are advantages of robotic laparoscopy compared to the conventional laparoscopy, such as improved dexterity, more precise and accurate articulation, reduced tremor, and better visualization of the operating field. In vitro fertilization (IVF) is the hallmark in the era of assisted reproductive technology and became an alternative option to regain the fertility in sterilized women. Conclusion: The pregnancy rate and live birth rate in laparoscopy, robotic and open surgery were relatively similar. Surgical reversal to women younger than 40 is recommended and laparoscopic reversal should be performed if the expertise is available. It is reasonable to counsel IVF to over 40 women. [Indones J Obstet Gynecol 2012; 36-3: 154-60] Keywords: gynecology, IVF, pregnancy outcomes, reanastomosis, robotic laparoscopy, tubal reversal

One Point Technique of Intracutaneous Sterile Water Injection is as Effective as Four Points Technique in the Management of Labor Pain Ismail, Taufik
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 3, July 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare the score of VAS (visual analog scale), length of labor, and APGAR score in intracutaneous sterile water injection between one point technique and four points technique at Michaelis Rhomboid area in management of labor pain. Method: This is an experimental study, subjects were included by blinded controlled randomized study on 50 women with term pregnancy stage I active phase and were planned for spontaneous delivery. Subjects were divided into 2 groups randomly, 25 women with 0.5 ml sterile water intracutaneous injection on 4 points and 25 women with that on 1 point injection at one site at the painful area. Result: Reduction of labor pain on 1-point technique could decrease VAS score the most, 85.4 (4.3) into 48.4 (8.5) on minute 10. Length of labor was 11.2 (1.15) on 1 point injection group compared to 11.4 (1.2) on those with 4 point injection. On the other hand, APGAR score of the baby on group having 1-point injection was 7.86 (0.5) on min 1 and 9.68 (0.5) on min 5, compared to that on 4-points injection group, 7.52 (0.7) and 9.56 (0.5), respectively. In addition, 60% felt uncomfortable with 1-point injection whereas 80% of patients felt uncomfortable in 4-points injection. Conclusion: There is no significant difference on reduction of VAS score, duration of labor, and APGAR score of the baby between the group having 1 point injection and 4-point injection. However, injection on 1 point is more comfortable. [Indones J Obstet Gynecol 2012; 36-4: 167-70] Keywords: APGAR , intracutaneous sterile water injection, length of labor, VAS

The Level of Zinc is Increasing, while the Serum Folat Level is Decreasing, after Multi-Micronutrient Supplementation in Pregnant Woman Wibowo, Noroyono
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 4, October 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To measure the changes of serum iron, folic acid, zinc and selenium level on pregnant woman after multi-micronutrient supplementation. Method: First trimester pregnant woman whom attended Maternal- Fetal Policlinic at Dr. Cipto Mangunkusumo Hospital from July 2011 till October 2011 was considered into the study. The intervention was consumption of multi-micronutrient tablet once a day for three months period. The outcomes were the measurements of serum level of iron, folic acid, zinc and selenium before and after supplementation. We used paired T Test and Wilcoxon test for statistical analysis. Results: Twenty-eight pregnant women in their first trimester participated in the study. The micronutrient serum level was measured before and after supplementation during the time period. Before supplementation, serum iron and zinc level were below normal. Serum selenium level was normal with higher than normal serum folic acid level. After supplementation, serum zinc level was found to be below normal. Both level of serum iron and selenium increased to normal. Serum folic level was higher than normal. We found a decrease in serum zinc level with an increase in serum folic acid level that was statistically significant (p 0.009; p 0.003 respectively). We also found a slight decrease of serum iron level and an increase of serum selenium level that were not statistically significant (p 0.295; p 0.333). Conclusion: There is a decreased level of serum zinc with an increase in serum folic acid level after multi-micronutrient supplementation. [Indones J Obstet Gynecol 2012; 36-4: 171-5] Keywords: multi-micronutrient, supplementation

Lamellar Body Count has Higher Sensitivity and Specificity in the Prediction of Neonatal Respiratory Distress Syndrome Pradana, Aryando
Indonesian Journal of Obstetrics and Gynecology Volume. 36, No. 4, October 2012
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: The study was designed to acquire the cut-off value for lamellar body count and its role in predicting the presence of Respiratory Distress Syndrome (RDS) in pregnancy with gestational age above 28 weeks. Method: Amniotic fluid specimens were collected by amniotomy during cesarean section from women with gestational age above 28 weeks. A haematology analyzer (Advia 120) was used to determine the lamellar body counts. We also performed foam stability test and observed the development of respiratory distress syndrome. Receiver operating characteristics curve was estimated to assess the threshold of lamellar bodies count that may predict the presence of Respiratory Distress Syndrome. Result: Fifty nine specimens were collected from woman with 29 - 42 weeks gestational age. The incidence of Respiratory Distress Syndrome was 15.3%. Area under the curve for lamellar body count was 0.94. Lamellar body count, with the best cut-off point of 50,000 cell/μl had sensitivity 89% and specifity 92% for predicting the presence of RDS, while the sensitivity of foam stability test was 67% and specificity was 90%. The negative predictive value of the lamellar body count was 98% slightly better than the negative predictive value of the foam stability test 94 %. Conclusion: Although both test are good predictor of RDS, lamellar body count has higher sensitivity and specificity. It also has more advantages as it only requires small amount of sample, fast, easy and more objective. [Indones J Obstet Gynecol 2012; 36-4: 176-80] Keywords: foam stability test, lamellar body, respiratory distress syndrome

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eko subaktiansyah

Contact Email
eko.subaktiansyah@gmail.com

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