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"ABSTRAKLatar Belakang: Robekan perineum derajat III dan IV pada persalinanpervaginam telah menarik perhatian yang cukup tinggi di kalangan praktisi medis.Faktor-faktor risiko yang dapat menyebabkan robekan tersebut perlu diketahuikarena dapat menyebabkan inkontinensia alvi di kemudian hari dan menimbulkankeluhan-keluhan pada ibuTujuan: Mengetahui insidensi terjadinya robekan perineum derajat III dan IVtahun 2013 di RSCM, titik potong berat lahir janin yang berisiko menyebabkanterjadinya robekan dan sistem skor untuk memprediksi terjadinya robekantersebut.Metode: Penelitian observasional dengan menggunakan metode potong lintangdilakukan di IGD Obstetri dan Ginekologi RSUPN Dr.Cipto Mangunkusumo padaJanuari–Desember 2013. Semua subyek bersalin per vaginam sesuai dengankriteria inklusi dan eksklusi dimasukkan dalam penelitian sampai jumlah subyekminimal terpenuhi. Dengan metode ROC AUC ditetapkan titik potong berat lahirjanin yang berisiko terjadinya OASIS. Semua faktor risiko dianalisis dengananalisis regresi logistik. Faktor-faktor yang berhubungan terhadap terjadinyaOASIS akan dinilai probabilitasnya dengan menggunakan rumus p= 1/(1+e-y).Hasil: Dari 466 sampel penelitian, Subjek yang mengalami OASIS adalah 43(9.2%) sampel. Dengan metode ROC AUC didapatkan titik potong berat lahirjanin yang berisiko yaitu 2910 gram. Setelah analisis regresi logistik didapatkan 4variabel sebagai faktor risiko robekan perineum derajat III-IV yaitu persalinanforcep (p<0.001;OR 0.043,IK 95% 0.015-0.123), persalinan vakum (p<0.001;OR0.131, IK 95% 0.054-0.317), berat lahir janin >2910 gram (p=0.014; OR 0.35; IK95% 0.157 -0.807) dan multiparitas (p<0.001;OR 6.388; IK 95% 2.57-15.84). Denganmenerapkan rumus probabilitas p= 1/(1+e-y) didapatkan persalinan dengan alatdan berat lahir janin >2910 gram meningkatkan probabilitas terjadinya OASIS.,sedangkan multiparitas bersifat sebaliknya.Kesimpulan: Insidensi OASIS perlu diketahui tiap tahunnya untuk menjadi tolakukur tata laksana yang telah dilakukan. Titik potong berat lahir janin >2910 gramdapat menjadi nilai ukur baru pada penelitian-penelitian selanjutnya karena lebihmewakili subjek orang Indonesia. Sistem skor probabilitas yang sederhana inidapat membantu klinisi dalam memprediksi terjadinya OASIS pada saat prosespersalinan sehingga diharapkan dapat mengurangi insidensinya di masamendatang.

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ABSTRACTBackground: Obstetrical Anal Sphincter Injuries (OASIS) during vaginal deliveries have been highly concerned in daily practices. Risk factors that lead to OASIS must be identified. OASIS may eventually cause faecal incontinence in the future that can cause complaints among patients.Objectives: To identify the incidence of OASIS at Cipto Mangunkusumo Hospital in 2013, to determine cut off point of fetal birth weight that may lead to OASIS and to acquire the probability scoring system for risk factors causing OASIS.Methods: We conducted cross sectional observational research in delivery suite Cipto Mangunkusumo Hospital from Januari to December 2013. After inclusion and exclusion criteria screening, all subjects who underwent deliveries vaginally took part in the research. Receiver Operating Characteristic, Area Under The Curve (ROC) method was performed to determine fetal birth weight cut off point that may cause OASIS. Logistic regresion analysis was performed to analyze all the risk factors. Risk factors that significantly lead to OASIS were calculated and analyzed by equational probability formula p= 1/(1+e-y).Result: Among 466 research samples, we identified there were 43 (9.2%) subjects suffered from OASIS. ROC AUC method were applied to determine fetal birth weight cut off point that may lead to cause OASIS which resulted >2910 gram. As logistic regresion analysis performed, there were four risk factors that may cause OASIS. There were forceps delivery (p<0.001;OR 0.043,CI 95% 0.015-0.123), vacuum delivery (p<0.001;OR 0.131, CI 95% 0.054-0.317), fetal birth weight >2910 gram (p=0.014; OR 0.35; CI 95% 0.157-0.807) and multiparit y (p<0.001;OR 6.388; CI 95% 2.57-15.84). The equation probability formula p= 1/(1+e-y) was conducted. It resulted that assisted vaginal delivery and fetal birth weight >2910 gram increase the probability of OASIS incidence, while multiparity resulted conversely.Conclusion: OASIS incidence is crucial to be identified each year so that we can evaluate the treatment that has been conducted. Fetal birth weight cut off point of >2910 gram can be applied in the next researches in the future because it respresents more proportionally for Indonesian people. This simple probability scoring system can help clinicians to predict OASIS during delivery process so it may reduce the incidence."

"Latar belakang: Belum ada usaha maupun penelitian yang mampu memadukan berbagai faktor risiko untuk memprediksi terjadinya kerusakan otot levator ani akibat persalinan pervaginam. Penelitian ini bertujuan untuk mengetahui indeks yang dapat digunakan untuk memprediksikan kerusakan levator ani pada persalinan pervaginam.Metode: Penelitian kohort prospektif di dua rumah sakit di Jakarta tahun 2010-2011. Kriteria subjek adalah wanita hamil nulipara tanpa kerusakan levator ani saat hamil dan melahirkan pervaginam. Kerusakan levator ani diukur dengan USG 4 dimensi saat hamil dan tiga bulan pasca melahirkan. Variabel yang diteliti adalah usia, indeks masa tubuh, cara persalinan pervaginam, berat badan bayi lahir, episiotomi, robekan perineum, dan lamanya kala 2. Model prediksi dianalisis dengan analisis regresi logistik.Hasil: Sebanyak 182 subjek direkrut dengan 124 subjek memenuhi kriteria dan 104 subjek dapat dianalisis. Insiden kerusakan levator ani pada tiga bulan adalah sebesar 15,4% (IK 95%: 8,6-23%). Diperoleh dua model prediksi. Model prediksi pertama terdiri dari berat bayi (OR= 5,36 IK 95%: 1,08-26,59), episiotomi (OR= 5,41 IK 95%: 0,94-31,18), dan lama kala dua (OR= 15,27 IK 95%: 3,15-73,96). Model prediksi kedua terdiri dari lama kala dua (OR= 9,51 IK 95%: 1,23-68,10) dan robekan perineum (OR= 142,70 IK 95%: 14,13-1440,78).Kesimpulan: Variabel yang dapat memprediksikan kerusakan levator ani adalah berat bayi, episiotomi, dan kala dua pada model 1 dan lama kala dua serta robekan perineum pada model 2.

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AbstractBackground: There have been no attempts or studies to integrate various risk factors that can be utilized to predict levator ani injury caused by vaginal delivery. This study was aimed to establish an index measurement system by using various risk factors for predicting levator ani injury in vaginal delivery.Methods: A prospective cohort was conducted at two hospitals in Jakarta between 2010 and 2011. The subjects were nulipara pregnant women without levator ani injury during pregnancy and vaginal birth. Levator ani injury was evaluated using 4D USG during pregnancy and three months after delivery. The variables studied were age, body mass index, mode of delivery, fetal birth weight, episiotomy, perineum rupture and duration of second stage labor. Prediction model was analyzed using logistic regression analysis.Results: There were 182 recruited subjects of which 124 subjects were eligible and only 104 subjects could be analyzed. Incidence of levator ani injury at three months after delivery was 15.4% (95% CI: 8.6-23%). Two prediction models were obtained. The first consisted of fetal birth weight (OR= 5.36, 95% CI: 1.08-26.59), episiotomy (OR= 5.41, 95% CI: 0.94-31.18), and duration of second stage labor (OR= 15.27, 95% CI: 3.15-73.96). The second model consisted of duration of second stage labor (OR= 9.51, 95% CI: 1.23-68.10) and perineum rupture (OR= 142.70, 95% CI: 14.13-1440.78).Conclusion: Fetal birth weight, episiotomy and duration of second stage labor could predict levator ani injury for model 1; while the variables of prediction for model 2 were duration of second stage labor and perineum rupture."

"Latar Belakang:Prolaps Organ Panggul (POP) merupakan kondisi kompleks yang terjadi akibat defek pada struktur penyokong vagina. Kondisi ini dapat disebabkan oleh proses trauma pada otot penyokong levator ani yang menyebabkan melebarnya luas hiatus genital. Pelebaran hiatus genital ini disebut ballooning. Prevalensi POP berkisar antara 20-50%, dengan insidensi mencapai 1,5 – 1,8 per 1000 wanita per tahun dengan puncak usia 60 – 69 tahun. Kondisi POP memberi dampak terhadap kualitas hidup seorang wanita dan sering dikaitkan dengan gangguan berkemih, buang air besar hingga disfungsi seksual. Tatalaksana definitif dalam penanganan POP adalah tindakan pembedahan. Tindakan levatorplasty dapat dilakukan pada kasus penurunan kompartemen posterior, terutama pada pasien POP dengan hiatal ballooning. Tindakan ini bertujuan untuk mengurangi risiko prolaps berulang di masa mendatang. Pasien dengan rencana operasi POP di RS Cipto Mangunkusumo (RSCM) Jakarta yang disertai ballooning pada pemeriksaan USG pre-operatif dilakukan tambahan tindakan levatorplasty, namun belum ada penilaian pasca operasi mengenai perbaikan kondisi ballooning tersebut.Objektif:Penelitian ini bertujuan untuk mengetahui perbaikan ballooning sebelum dan setelah dilakukannya tindakan levatorplasty pada pasien dengan POP. Perbaikan yang dinilai berupa perbaikan luas dan panjang diameter anterioposterior hiatus levator, perbaikan panjang Gh + Pb, serta perubahan skor keluhan disfungsi dasar panggul sebelum dan sesudah tindakan. Penilaian dilakukan dengan menggunakan USG 3 dan 2 dimensi untuk hiatus levator, pemeriksaan klinis Pelvic Organ Prolapse Quantification System (POP-Q) untuk panjang Gh + Pb, serta kuisioner Pelvic Floor Distress Inventory-20 (PFDI-20) untuk penilaian keluhan klinis disfungsi dasar panggul.Metode:Studi analitik komparatif berpasangan dengan desain gabungan kohort retrospektif dan kohort prospektif yang dilakukan di Poliklinik Kebidanan dan Kandungan Divisi Uroginekologi dan Rekonstruksi Departemen Obstetri dan Ginekologi RSUPN dr. Cipto Mangunkusumo. Pengumpulan data retrospektif dilakukan dari Oktober 2021 hingga April 2022, dengan pengumpulan data prospektif untuk dilakukan tindakan levatorplasty dilakukan dari Oktober 2021 hingga Januari 2022. Sampel penelitian adalah wanita dengan POP dan ballooning yang dinilai dengan pemeriksaan USG Transperineal serta POP-Q, dan akan menjalani operasi levatorplasty.Hasil:Tingkat keberhasilan levatorplasty pada pasien POP dengan ballooning dilihat dari penurunan derajat ballooning berdasarkan kategori Lh max pada 28 pasien (87,5%), Ap hiatal pada 26 pasien (81,25%), dan panjang Gh + Pb pada 25 pasien (78,1%). Parameter PFDI yang diukur juga mengalami perbaikan dengan penurunan nilai median PFDI mencapai 31,2 (p = 0,009), serta penurunan pada nilai median sub-bagian POPDI-6 hingga 20,8 (p = 0,009), CRADI-6 hingga 6,2 (p = 0,096), dan UDI-6 hingga 10,4 (p = 0,360).Kesimpulan:Prosedur levatorplasty ditemukan dapat memperbaiki kondisi ballooning pada pasien POP yang dinilai dari perbaikan nilai luas dan panjang diameter anteroposterior hiatus levator, perbaikan klinis secara objektif (yang dinilai dengan pemeriksaan POP-Q) serta secara subjektif (yang dinilai dengan kuisioner PFDI-20). Hasil penelitian ini diharapkan mampu menjadi bukti untuk penerapan prosedur levatorplasty untuk dapat dilakukan pada pasien-pasien POP yang disertai dengan ballooning di tempat praktik klinis di semua penjuru Indonesia. ......Background:Pelvic Organ Prolapse (POP) is a complex condition resulting from defects in the supporting structures of the vagina. This condition can be caused by a traumatic process to the supporting muscles of the levator ani which causes the widening of the genital hiatus. This widening process is called ballooning. The prevalence of POP ranges from 20-50%, with an incidence reaching 1.5-1.8 per 1000 women each year with a peak age of 60-69 years. POP conditions may have an impact on a woman's quality of life and are often associated with urinary and defecation disorders, and also sexual dysfunction. The definitive treatment for POP is surgery. Levatorplasty can be performed in cases of posterior compartment descent, especially in POP patients with Hiatal ballooning. This action aims to reduce the risk of recurrent prolapse in the future. At Dr. Cipto Mangunkusumo Hospital (RSCM) Jakarta, patients with POP who are found with Hiatal ballooning during pre-operative ultrasound examination will be planned for an additional levatorplasty procedure. But there was no postoperative assessment regarding the improvement of the ballooning condition.Objective:This study aims to determine the improvement of ballooning after the levatorplasty procedure in patients with POP. The improvements assessed were the area and length of the anteroposterior diameter of the levator hiatus, the length of Gh + Pb, and complaints improvement for pelvic floor dysfunction. The assessment was done using 3- and 2-dimensional ultrasound for levator hiatus, clinical examination of the Pelvic Organ Prolapse Quantification System (POP-Q) for length Gh + Pb, and the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire to assess clinical complaints of pelvic floor dysfunction.Methods:A paired comparative analytic study with a combined retrospective and prospective cohort design was carried out at the Obstetrics and Gynecology Outpatient Unit, Division of Urogynecology and Reconstruction, Department of Obstetrics and Gynecology, dr. Cipto Mangunkusumo Central General Hospital Jakarta. Retrospective data was collected from October 2021 to April 2022, with prospective data for levatorplasty performed from October 2021 to January 2022. The study sample was women with POP and ballooning who were assessed by transperineal ultrasound examination and POP-Q examination and will undergo levatorplasty procedure.Result:The success rate of levatorplasty in POP patients with ballooning was seen from the decrease in the degree of ballooning by the measurement of Lh max in 28 patients (87.5%), Ap hiatal in 26 patients (81.25%), and the length of Gh + Pb in 25 patients (78, 1%). The measured PFDI parameters also improved with a decrease in the median value of PFDI reaching 31.2 (p = 0.009), as well as a decrease in the median value of the POPDI-6 subsection to 20.8 (p = 0.009), CRADI-6 to 6.2 (p = 0.096), and UDI-6 to 10.4 (p = 0.360).Conclusion:The levatorplasty procedure is proven to repair the ballooning conditions in POP patients as assessed by improvements in the area and length of the anteroposterior diameter of the levator hiatus, clinical improvement objectively (as assessed by the POP-Q examination), and subjectively (as assessed by the PFDI-20 questionnaire). The results of this study are expected to be evidence for the application of the levatorplasty procedure to be performed on POP patients accompanied by ballooning in many clinical practices throughout Indonesia. "

"ABSTRAKKeluhan paling umum yang sering dialami perempuan usia reproduksi datang ke dokter adalah keputihan. Keputihan juga merupakan salah satu prediktor akan adanya infeksi menular seksual (IMS). Deteksi dini dan terapi yang adekuat pada IMS ini merupakan hal yang penting. Keputihan yang tidak diterapi dengan tepat memiliki risiko komplikasi terhadap organ reproduksi terutama pada perempuan dengan usia reproduksi yang seksual aktif. Data mengenai temuan mikroorganisme pada keputihan serta prevalensinya di Indonesia masih terbatas, terutama pada perempuan usia reproduksi seksual aktif. Penelitian ini bermaksud untuk menjawab masalah diatas. Temuan dari hasil penelitian ini diharapkan dapat menjadi data epidemiologis tambahan untuk klinisi dalam mendiagnosis keputihan pada perempuan usia reproduksi seksual aktif di Indonesia, sehingga dapat mengurangi terjadinya terapi yang tidak tepat.Metode:Penelitian ini merupakan penelitian deskriptif observasional dengan konsekutif sampling. Populasi target adalah semua perempuan usia reproduksi 15-49 tahun dengan keluhan keputihan. Populasi terjangkau adalah semua perempuan usia reproduksi yang sudah seksual aktif dengan keluhan keputihan yang datang ke poliklinik Ginekologi RSCM, RS puskesmas mitra RSCM, pada bulan Mei 2012 sampai Juni 2013Hasil:Temuan mikroorganime pada 81 subjek perempuan usia reproduksi seksual aktif dengan keluhan keputihan pada yang setuju mengikuti penelitian ini, yakni Candida sp. 31 orang (38,3%), Grup B Streptococcus 22 orang (27.2%), Trichomonas vaginalis 17 orang (21,0%), Staphylocossus aureus 16 orang (19.8%), Bacterial vaginosis 15 orang (18,5%), Chlamydia trachomatis sebanyak 11 orang (13,6%), Staphylococcus epidedermidis 8 orang (9.9%), Streptococcus viridans 5 orang (6.2%), Grup A Streptococcus 4 orang (4.9%), Acinetobacter baumanii 3 orang (3,7%), Neissseria gonorrhoe 2 orang (2,5%), Eschericia coli 2 orang (2.5%), Klebsiella pneumionia 2 orang (2.5%), Enterobacter aerogens 1 orang (1.2%), dan temuan mikroorganisme negatif pada 20 orang (24.6%). Pada identifikasi Candida sp , hasil kultur menunjukkan adanya Candida albicans pada 20 subjek (24,7%), Candida glabrata 5 subjek (6.2%), Candida tropicalis 3 subjek (3.7%), Candida parapsiolosis 2 subjek (2.5%).Kesimpulan:Mikroorganisme yang ditemukan pada perempuan usia reproduksi yang seksual aktif dengan keluhan keputihan secara berurutan dari persentase yang tersering adalah Candida sp., Grup B Streptococcus, Trichomonas vaginalis, Staphylocossus aureus, Bacterial vaginosis, Chlamydia trachomatis, Staphylococcus epidedermidis, Streptococcus viridans, Grup A Streptococcus, Acinetobacter baumanii, Neissseria gonorrhoeae, Eschericia coli, Klebsiella pneumionia, Enterobacter aerogens. Pemeriksaan kultur menunjukkan spesies candida yang paling sering ditemukan secara berurutan adalah Candida albicans, Candida glabrata, Candida tropicalis, dan Candida parapsiolosis.;Background:

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ABSTRACT

The commonest complaint of reproductive age women visiting a doctor is because of vaginal discharge. Vaginal discharge is one of the predictor of a sexual transmitted disease. Early detection and adequate therapy of sexual transmitted disease is an important matter. Vaginal discharge which were given inadequate therapy, can risc having complication on reproductive organs, especially in sexually active reproductive age women. Study in Indonesia regarding microorganisme findings in sexually active reproductive age women is still limited. This study was meant to solve this problem.

Method:

This study was descriptive observational study with consecutive sampling. The target population in this study were all sexually active reproductive age women who had complaints of vaginal discharge. The population of this study was affordable to all sexually active reproductive women who were treated at the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital and PHC partner of Ciptomangunkusumo Hospital in the period of may 2012 until June 2013.

Results: Microorganism findings in 81 sexually active women 18-45 years old who participated in this study, are Candida sp. 31 subject (38,3%), Grup B Streptococcus 22 subject (27.2%), Trichomonas vaginalis 17 subject(21,0%), Staphylocossus aureus 16 subject(19.8%), Bacterial vaginosis 15 subject(18,5%), Chlamydia trachomatis 11 subject (13,6%), Staphylococcus epidedermidis 8 subjects (9.9%), Streptococcus viridans 5 subjects (6.2%), Grup A Streptococcus 4 subjects (4.9%), Acinetobacter baumanii 3 subjects (3,7%), Neissseria gonorrhoeae 2 subjects (2,5%), Eschericia coli 2 subjects (2.5%), Klebsiella pneumionia 2 subjects (2.5%), Enterobacter aerogens 1 subjects (1.2%), negative findings on 20 subjects(24.6%). In the Identification of Candida sp , Culture result showed Candida albicans on 20 subjects (24,7%), Candida glabrata 5 subjects (6.2%), Candida tropicalis 3 subjek (3.7%), Candida parapsiolosis 2 subjects (2.5%).

Summary:

Microorganism findings in sexually active reproductive age women from the highest percentage order, are Candida sp.,Grup B Streptococcus, Trichomonas vaginalis, Staphylocossus aureus, Bacterial vaginosis, Chlamydia trachomatis , Staphylococcus epidedermidis, Streptococcus viridians,Grup A Streptococcus , Acinetobacter baumanii 3, Neissseria gonorrhoeae, Eschericia coli, Klebsiella pneumionia, Enterobacter aerogens. In the Identification of Candida sp , culture result from the highest percentage order are, Candida albicans, Candida glabrata Candida tropicalis, and Candida parapsiolosis.;Background:

The commonest complaint of reproductive age women visiting a doctor is because of vaginal discharge. Vaginal discharge is one of the predictor of a sexual transmitted disease. Early detection and adequate therapy of sexual transmitted disease is an important matter. Vaginal discharge which were given inadequate therapy, can risc having complication on reproductive organs, especially in sexually active reproductive age women. Study in Indonesia regarding microorganisme findings in sexually active reproductive age women is still limited. This study was meant to solve this problem.

Method:

This study was descriptive observational study with consecutive sampling. The target population in this study were all sexually active reproductive age women who had complaints of vaginal discharge. The population of this study was affordable to all sexually active reproductive women who were treated at the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital and PHC partner of Ciptomangunkusumo Hospital in the period of may 2012 until June 2013.

Results: Microorganism findings in 81 sexually active women 18-45 years old who participated in this study, are Candida sp. 31 subject (38,3%), Grup B Streptococcus 22 subject (27.2%), Trichomonas vaginalis 17 subject(21,0%), Staphylocossus aureus 16 subject(19.8%), Bacterial vaginosis 15 subject(18,5%), Chlamydia trachomatis 11 subject (13,6%), Staphylococcus epidedermidis 8 subjects (9.9%), Streptococcus viridans 5 subjects (6.2%), Grup A Streptococcus 4 subjects (4.9%), Acinetobacter baumanii 3 subjects (3,7%), Neissseria gonorrhoeae 2 subjects (2,5%), Eschericia coli 2 subjects (2.5%), Klebsiella pneumionia 2 subjects (2.5%), Enterobacter aerogens 1 subjects (1.2%), negative findings on 20 subjects(24.6%). In the Identification of Candida sp , Culture result showed Candida albicans on 20 subjects (24,7%), Candida glabrata 5 subjects (6.2%), Candida tropicalis 3 subjek (3.7%), Candida parapsiolosis 2 subjects (2.5%).

Summary:

Microorganism findings in sexually active reproductive age women from the highest percentage order, are Candida sp.,Grup B Streptococcus, Trichomonas vaginalis, Staphylocossus aureus, Bacterial vaginosis, Chlamydia trachomatis , Staphylococcus epidedermidis, Streptococcus viridians,Grup A Streptococcus , Acinetobacter baumanii 3, Neissseria gonorrhoeae, Eschericia coli, Klebsiella pneumionia, Enterobacter aerogens. In the Identification of Candida sp , culture result from the highest percentage order are, Candida albicans, Candida glabrata Candida tropicalis, and Candida parapsiolosis. ;Background:The commonest complaint of reproductive age women visiting a doctor is because of vaginal discharge. Vaginal discharge is one of the predictor of a sexual transmitted disease. Early detection and adequate therapy of sexual transmitted disease is an important matter. Vaginal discharge which were given inadequate therapy, can risc having complication on reproductive organs, especially in sexually active reproductive age women. Study in Indonesia regarding microorganisme findings in sexually active reproductive age women is still limited. This study was meant to solve this problem. Method:This study was descriptive observational study with consecutive sampling. The target population in this study were all sexually active reproductive age women who had complaints of vaginal discharge. The population of this study was affordable to all sexually active reproductive women who were treated at the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital and PHC partner of Ciptomangunkusumo Hospital in the period of may 2012 until June 2013. Results: Microorganism findings in 81 sexually active women 18-45 years old who participated in this study, are Candida sp. 31 subject (38,3%), Grup B Streptococcus 22 subject (27.2%), Trichomonas vaginalis 17 subject(21,0%), Staphylocossus aureus 16 subject(19.8%), Bacterial vaginosis 15 subject(18,5%), Chlamydia trachomatis 11 subject (13,6%), Staphylococcus epidedermidis 8 subjects (9.9%), Streptococcus viridans 5 subjects (6.2%), Grup A Streptococcus 4 subjects (4.9%), Acinetobacter baumanii 3 subjects (3,7%), Neissseria gonorrhoeae 2 subjects (2,5%), Eschericia coli 2 subjects (2.5%), Klebsiella pneumionia 2 subjects (2.5%), Enterobacter aerogens 1 subjects (1.2%), negative findings on 20 subjects(24.6%). In the Identification of Candida sp , Culture result showed Candida albicans on 20 subjects (24,7%), Candida glabrata 5 subjects (6.2%), Candida tropicalis 3 subjek (3.7%), Candida parapsiolosis 2 subjects (2.5%). Summary:Microorganism findings in sexually active reproductive age women from the highest percentage order, are Candida sp.,Grup B Streptococcus, Trichomonas vaginalis, Staphylocossus aureus, Bacterial vaginosis, Chlamydia trachomatis , Staphylococcus epidedermidis, Streptococcus viridians,Grup A Streptococcus , Acinetobacter baumanii 3, Neissseria gonorrhoeae, Eschericia coli, Klebsiella pneumionia, Enterobacter aerogens. In the Identification of Candida sp , culture result from the highest percentage order are, Candida albicans, Candida glabrata Candida tropicalis, and Candida parapsiolosis.;Background:The commonest complaint of reproductive age women visiting a doctor is because of vaginal discharge. Vaginal discharge is one of the predictor of a sexual transmitted disease. Early detection and adequate therapy of sexual transmitted disease is an important matter. Vaginal discharge which were given inadequate therapy, can risc having complication on reproductive organs, especially in sexually active reproductive age women. Study in Indonesia regarding microorganisme findings in sexually active reproductive age women is still limited. This study was meant to solve this problem. Method:This study was descriptive observational study with consecutive sampling. The target population in this study were all sexually active reproductive age women who had complaints of vaginal discharge. The population of this study was affordable to all sexually active reproductive women who were treated at the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital and PHC partner of Ciptomangunkusumo Hospital in the period of may 2012 until June 2013. Results: Microorganism findings in 81 sexually active women 18-45 years old who participated in this study, are Candida sp. 31 subject (38,3%), Grup B Streptococcus 22 subject (27.2%), Trichomonas vaginalis 17 subject(21,0%), Staphylocossus aureus 16 subject(19.8%), Bacterial vaginosis 15 subject(18,5%), Chlamydia trachomatis 11 subject (13,6%), Staphylococcus epidedermidis 8 subjects (9.9%), Streptococcus viridans 5 subjects (6.2%), Grup A Streptococcus 4 subjects (4.9%), Acinetobacter baumanii 3 subjects (3,7%), Neissseria gonorrhoeae 2 subjects (2,5%), Eschericia coli 2 subjects (2.5%), Klebsiella pneumionia 2 subjects (2.5%), Enterobacter aerogens 1 subjects (1.2%), negative findings on 20 subjects(24.6%). In the Identification of Candida sp , Culture result showed Candida albicans on 20 subjects (24,7%), Candida glabrata 5 subjects (6.2%), Candida tropicalis 3 subjek (3.7%), Candida parapsiolosis 2 subjects (2.5%). Summary:Microorganism findings in sexually active reproductive age women from the highest percentage order, are Candida sp.,Grup B Streptococcus, Trichomonas vaginalis, Staphylocossus aureus, Bacterial vaginosis, Chlamydia trachomatis , Staphylococcus epidedermidis, Streptococcus viridians,Grup A Streptococcus , Acinetobacter baumanii 3, Neissseria gonorrhoeae, Eschericia coli, Klebsiella pneumionia, Enterobacter aerogens. In the Identification of Candida sp , culture result from the highest percentage order are, Candida albicans, Candida glabrata Candida tropicalis, and Candida parapsiolosis.;Background:The commonest complaint of reproductive age women visiting a doctor is because of vaginal discharge. Vaginal discharge is one of the predictor of a sexual transmitted disease. Early detection and adequate therapy of sexual transmitted disease is an important matter. Vaginal discharge which were given inadequate therapy, can risc having complication on reproductive organs, especially in sexually active reproductive age women. Study in Indonesia regarding microorganisme findings in sexually active reproductive age women is still limited. This study was meant to solve this problem. Method:This study was descriptive observational study with consecutive sampling. The target population in this study were all sexually active reproductive age women who had complaints of vaginal discharge. The population of this study was affordable to all sexually active reproductive women who were treated at the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital and PHC partner of Ciptomangunkusumo Hospital in the period of may 2012 until June 2013. Results: Microorganism findings in 81 sexually active women 18-45 years old who participated in this study, are Candida sp. 31 subject (38,3%), Grup B Streptococcus 22 subject (27.2%), Trichomonas vaginalis 17 subject(21,0%), Staphylocossus aureus 16 subject(19.8%), Bacterial vaginosis 15 subject(18,5%), Chlamydia trachomatis 11 subject (13,6%), Staphylococcus epidedermidis 8 subjects (9.9%), Streptococcus viridans 5 subjects (6.2%), Grup A Streptococcus 4 subjects (4.9%), Acinetobacter baumanii 3 subjects (3,7%), Neissseria gonorrhoeae 2 subjects (2,5%), Eschericia coli 2 subjects (2.5%), Klebsiella pneumionia 2 subjects (2.5%), Enterobacter aerogens 1 subjects (1.2%), negative findings on 20 subjects(24.6%). In the Identification of Candida sp , Culture result showed Candida albicans on 20 subjects (24,7%), Candida glabrata 5 subjects (6.2%), Candida tropicalis 3 subjek (3.7%), Candida parapsiolosis 2 subjects (2.5%). Summary:Microorganism findings in sexually active reproductive age women from the highest percentage order, are Candida sp.,Grup B Streptococcus, Trichomonas vaginalis, Staphylocossus aureus, Bacterial vaginosis, Chlamydia trachomatis , Staphylococcus epidedermidis, Streptococcus viridians,Grup A Streptococcus , Acinetobacter baumanii 3, Neissseria gonorrhoeae, Eschericia coli, Klebsiella pneumionia, Enterobacter aerogens. In the Identification of Candida sp , culture result from the highest percentage order are, Candida albicans, Candida glabrata Candida tropicalis, and Candida parapsiolosis."

"ABSTRAKLatar belakang: Keputihan merupakan sering dijumpai menjadi alasan wanita berobat ke dokter. Pengenalan faktor risiko dan gejala yang menyertainya serta kaitannya denganpenyebab mikrobiologi keluhan keputihan dapat berguna bagi klinisi dalam praktiksehari-hari. Penelitian ini mencari hubungan antara faktor risiko dan gejala yang dialamiterhadap temuan mikrobiologi penyebab keputihan pada wanita usia reproduksi. Metode: Penelitian ini merupakan penelitian potong lintang di Departemen Obstetri &Ginekologi RS Cipto Mangunkusumo, Jakarta. Wawancara dilakukan pada pasien dipoliklinik dengan keluhan keputihan untuk identifikasi faktor risiko dan gejala. Temuanmikrobiologi dikonfirmasi dengan pemeriksaan yang spesifik sebagai baku emas. Hasil: Sebanyak 81 subjek ikut serta dalam penelitian ini. Candida sp merupakanpenyebab infeksi tunggal terbanyak yang ditemukan (17 subjek, 12,3%). Hubunganseksual yang sering (≥3 times/week, p<0,001) dan keputihan meningkat setelahberhubungan seksual (p=0.04) bmerupakan faktor risiko dan gejala yang berhubungandengan Bacterial vaginosis, berturut-turut. Bau amis (p=0,09), nyeri vulva (p=0,026),dan peningkatan keputihan setelah hubungan seksual (p=0,002) merupakan gejala yangberhubungan dengan Trichomonas vaginalis. Gatal (p=0,028), keputihan sepertigumpalan susu (p<0,001), dan keputihan meningkat setelah hari ke-14 siklus menstruasi(p<0.001) berhubungan dengan Candida sp sementara penggunaan pil KB kombinasi(p=0,03) dan perdarahan setelah hubungan seksual (p=0,009) merupakan gejala yangberhubungan dengan Chlamydia trachomatis.Kesimpulan: Beberapa faktor risiko dan gejala berhubungan dengan temuanmikrobiologi spesifik sebagai penyebab keluhan keputihan pada populasi wanita usia reproduksi.;

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ABSTRACT

Background: Vaginal discharge is a common reason for women to seek medical

attention worldwide. Recognition risk factors and symptoms and their association to

specific microbiological causes of vaginal discharge can be benefical for clinician in

clinical practice. This study aimed to identify risk factors and symptoms and their

association to specific microbiological causes of vaginal discharge among reproductive

aged women.

Methods: This was a cross-sectional study conducted in Department of Obstetric &

Gynecology, Cipto Mangunkusumo Hospital, Jakarta. We interviewed outpatient

subjects with vaginal discharge for risk factors and symptoms. Microbiological causes

identification was performed using gold standard methods.

Results: A total of 81 subjects were included in this study. Candida sp was the

commonest single infection (17 subjects, 12.3%). Frequent (≥3 times/week) sexual

intercourse (p <0.001) and increased discharge after sex (p=0.04) were risk factor and

symptom associated with Bacterial vaginosis, respectively. Fishy odor (p=0.09), vulva

pain (p=0.026), and increased discharge after sex (p=0.002) were symptoms associated

with Trichomonas vaginalis. Itchy sensation (p=0.028), clumps of milk appearance

(p<0.001), and discharge increased after 14th day of cycle (p<0.001) were associated

with Candida sp while taking combination pill (p=0.03) and bloody discharge after sex

(p=0.009) were associated with Chlamydia trachomatis.

Conclusion: Several risk factors and symptoms found to be associated with microbiological causes of vaginal discharge in our population.;Background: Vaginal discharge is a common reason for women to seek medicalattention worldwide. Recognition risk factors and symptoms and their association tospecific microbiological causes of vaginal discharge can be benefical for clinician inclinical practice. This study aimed to identify risk factors and symptoms and theirassociation to specific microbiological causes of vaginal discharge among reproductiveaged women.Methods: This was a cross-sectional study conducted in Department of Obstetric &Gynecology, Cipto Mangunkusumo Hospital, Jakarta. We interviewed outpatientsubjects with vaginal discharge for risk factors and symptoms. Microbiological causesidentification was performed using gold standard methods.Results: A total of 81 subjects were included in this study. Candida sp was thecommonest single infection (17 subjects, 12.3%). Frequent (≥3 times/week) sexualintercourse (p <0.001) and increased discharge after sex (p=0.04) were risk factor andsymptom associated with Bacterial vaginosis, respectively. Fishy odor (p=0.09), vulvapain (p=0.026), and increased discharge after sex (p=0.002) were symptoms associatedwith Trichomonas vaginalis. Itchy sensation (p=0.028), clumps of milk appearance(p<0.001), and discharge increased after 14th day of cycle (p<0.001) were associatedwith Candida sp while taking combination pill (p=0.03) and bloody discharge after sex(p=0.009) were associated with Chlamydia trachomatis.Conclusion: Several risk factors and symptoms found to be associated with microbiological causes of vaginal discharge in our population.;Background: Vaginal discharge is a common reason for women to seek medicalattention worldwide. Recognition risk factors and symptoms and their association tospecific microbiological causes of vaginal discharge can be benefical for clinician inclinical practice. This study aimed to identify risk factors and symptoms and theirassociation to specific microbiological causes of vaginal discharge among reproductiveaged women.Methods: This was a cross-sectional study conducted in Department of Obstetric &Gynecology, Cipto Mangunkusumo Hospital, Jakarta. We interviewed outpatientsubjects with vaginal discharge for risk factors and symptoms. Microbiological causesidentification was performed using gold standard methods.Results: A total of 81 subjects were included in this study. Candida sp was thecommonest single infection (17 subjects, 12.3%). Frequent (≥3 times/week) sexualintercourse (p <0.001) and increased discharge after sex (p=0.04) were risk factor andsymptom associated with Bacterial vaginosis, respectively. Fishy odor (p=0.09), vulvapain (p=0.026), and increased discharge after sex (p=0.002) were symptoms associatedwith Trichomonas vaginalis. Itchy sensation (p=0.028), clumps of milk appearance(p<0.001), and discharge increased after 14th day of cycle (p<0.001) were associatedwith Candida sp while taking combination pill (p=0.03) and bloody discharge after sex(p=0.009) were associated with Chlamydia trachomatis.Conclusion: Several risk factors and symptoms found to be associated with microbiological causes of vaginal discharge in our population.;Background: Vaginal discharge is a common reason for women to seek medicalattention worldwide. Recognition risk factors and symptoms and their association tospecific microbiological causes of vaginal discharge can be benefical for clinician inclinical practice. This study aimed to identify risk factors and symptoms and theirassociation to specific microbiological causes of vaginal discharge among reproductiveaged women.Methods: This was a cross-sectional study conducted in Department of Obstetric &Gynecology, Cipto Mangunkusumo Hospital, Jakarta. We interviewed outpatientsubjects with vaginal discharge for risk factors and symptoms. Microbiological causesidentification was performed using gold standard methods.Results: A total of 81 subjects were included in this study. Candida sp was thecommonest single infection (17 subjects, 12.3%). Frequent (≥3 times/week) sexualintercourse (p <0.001) and increased discharge after sex (p=0.04) were risk factor andsymptom associated with Bacterial vaginosis, respectively. Fishy odor (p=0.09), vulvapain (p=0.026), and increased discharge after sex (p=0.002) were symptoms associatedwith Trichomonas vaginalis. Itchy sensation (p=0.028), clumps of milk appearance(p<0.001), and discharge increased after 14th day of cycle (p<0.001) were associatedwith Candida sp while taking combination pill (p=0.03) and bloody discharge after sex(p=0.009) were associated with Chlamydia trachomatis.Conclusion: Several risk factors and symptoms found to be associated with microbiological causes of vaginal discharge in our population.;Background: Vaginal discharge is a common reason for women to seek medicalattention worldwide. Recognition risk factors and symptoms and their association tospecific microbiological causes of vaginal discharge can be benefical for clinician inclinical practice. This study aimed to identify risk factors and symptoms and theirassociation to specific microbiological causes of vaginal discharge among reproductiveaged women.Methods: This was a cross-sectional study conducted in Department of Obstetric &Gynecology, Cipto Mangunkusumo Hospital, Jakarta. We interviewed outpatientsubjects with vaginal discharge for risk factors and symptoms. Microbiological causesidentification was performed using gold standard methods.Results: A total of 81 subjects were included in this study. Candida sp was thecommonest single infection (17 subjects, 12.3%). Frequent (≥3 times/week) sexualintercourse (p <0.001) and increased discharge after sex (p=0.04) were risk factor andsymptom associated with Bacterial vaginosis, respectively. Fishy odor (p=0.09), vulvapain (p=0.026), and increased discharge after sex (p=0.002) were symptoms associatedwith Trichomonas vaginalis. Itchy sensation (p=0.028), clumps of milk appearance(p<0.001), and discharge increased after 14th day of cycle (p<0.001) were associatedwith Candida sp while taking combination pill (p=0.03) and bloody discharge after sex(p=0.009) were associated with Chlamydia trachomatis.Conclusion: Several risk factors and symptoms found to be associated with microbiological causes of vaginal discharge in our population."

"LATAR BELAKANG: Keputihan adalah keluhan kewanitaan yang paling sering dijumpai pada pelayanan kesehatan primer, dengan kunjungan berdasarkan data CDC di Amerika Serikat sebanyak 2,7-3,6 juta pasien dengan keluhan keputihan pada tahun 2008. Keputihan abnormal tersering yang disebabkan infeksi adalah Bacterial Vaginosis BV pada 22-50 wanita, Kandidosis VulvoVaginal KVV sebesar 17-39 dan Trikhomoniasis TV sebesar 4-35. Beberapa di antara komplikasi serius yang dapat terjadi pada Bacterial Vaginosis antara lain keguguran, peradangan rongga panggul, persalinan prematur, khorioamnionitis, endometritis postpartum, serta infeksi pascaoperasi ginekologis. Timbulnya keputihan abnormal erat kaitannya dengan perubahan derajat keasaman pH dari keadaan normalnya yaitu 3,5-4,7 yang disebabkan penurunan flora normal laktobasili dan peningkatan mikroba patologis yang menghasilkan keputihan. Diagnosis keputihan dapat ditegakkan berdasarkan pendekatan sindromik, empirik, maupun laboratoris. Probiotik sebagai mikroorganisme hidup yang dapat memberikan keuntungan kesehatan kepada inangnya, dalam hal ini Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 pada beberapa penelitian uji klinis acak tersamar ganda di luar negeri telah terbukti memberikan kesembuhan yang signifikan dibanding terapi standar, baik sebagai terapi utama maupun ajuvan. Penelitian serupa belum pernah dilakukan di Indonesia.TUJUAN: Diketahuinya efektivitas klinis dan dibuktikannya tingginya proporsi kesembuhan dan tingkat kepuasan pascaterapi pasien kombinasi antimikroba-probiotik oral Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 dibanding kombinasi antimikroba-placebo pada pengobatan pasien usia reproduksi dengan keputihan di poliklinik rawat jalan obstetrik dan ginekologi RSCM.METODE: Penelitian ini merupakan penelitian uji klinis acak tersamar ganda dengan jumlah sampel inisial 84 subjek, dan terealisasi 50 subjek dengan populasi target wanita usia reproduksi yang berkunjung dengan keluhan keputihan ke poliklinik rawat jalan RSCM dan RSUD Arifin Achmad Pekanbaru, Riau dan memenuhi kriteria inklusi dan eksklusi, terbagi dalam 25 subjek pada kelompok kontrol dan 25 subjek pada kelompok perlakuan. Data dikumpulkan melalui pemeriksaan klinis dengan pendekatan sindromik, pemberian probiotik yang mengandung masing-masing 2,5x109 CFU Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 sebagai ajuvan terapi antimikroba standar pada kelompok perlakuan dan terapi antimikroba standar ditambah plasebo pada kelompok kontrol, dicatat respon terapi 4 mingggu kemudian menggunakan instrumen formulir pelaporan kasus khusus penelitian dan formulir peniliaian tingkat kepuasan berdasarkan Treatment Satisfaction Questionnaire For Medication TSQM VERSI II . Nilai risiko relatif, dan Uji chi square dilakukan untuk menilai hubungan antar variabel. Analisis interim dengan penilaian conditional power dan uji futilitas dilakukan di tengah penelitian karena jumlah sampel insial tidak tercapai. Penelitan ini sudah lolos kaji etik dan mendapat persetujuan pelaksanaan dari Komite Etik Penelitian Kesehatan FKUI-RSCM pada bulan Maret 2016.HASIL: Sebanyak 50 subjek dapat terkumpul dan dianalisa, terdiri dari 25 subjek perlakuan dan 25 subjek kontrol, dimana sebanyak 14 subjek 56 dari kelompok perlakuan sembuh dan 11 subjek 44 tidak sembuh, serta sebanyak 15 subjek 60 dari kelompok kontrol sembuh dan 10 subjek 40 tidak sembuh, sehingga menghasilkan risiko relatif sebesar 1,1 untuk subjek yang tidak sembuh, dan uji Chi-Square didapatkan nilai p 0,77, IK 95 ; 0,57-2,11 . Pada tingkat kepuasan didapatkan bahwa proporsi tingkat kepuasan tinggi skor 67-100 justru lebih besar pada kelompok plasebo sebesar 52,6 10 subjek dibanding kelompok probiotik sebesar 47,4 9 subjek . Berdasarkan uji statistik didapatkan nilai p sebesar 0,65 ge;0,05 , sehingga tidak ada perbedaan tingkat kepuasan responden pada kelompok perlakuan probiotik maupun kelompok kontrol plasebo . Kekurangan jumlah sampel telah dianalisis dengan kurva conditional power dan uji futilitas untuk mengetahui kemungkinan signifikansi pada jumlah sampel total, dan didapatkan nilai Z = -0.2865, sesuai dengan conditional power antara 0,11-0,13 sehingga indeks futilitas 0,88-0,87, dengan interpretasi bahwa kemungkinan kecil penelitian akan bermakna bila dilanjutkan hingga tercapai sampel total.KESIMPULAN: Tidak ditemukan perbedaan proporsi yang bermakna secara klinis maupun statistik pada tingkat kesembuhan maupun tingkat kepuasan pada pasien usia reproduksi dengan keputihan pada pemberian kombinasi antimikroba-probiotik oral Lactobacillus rhamnosus GR-1 dan Lactobacillus reuteri RC-14 dibanding kombinasi antimikroba-plasebo setelah terapi selama 4 minggu, namun dalam penelitian ini hipotesis awal proporsi kesembuhan kelompok perlakuan probiotik yang lebih tinggi daripada kelompok kontrol plasebo belum bisa ditolak, karena jumlah sampel belum memadai.KATA KUNCI : Keputihan, Bacterial Vaginosis, Kandidosis VulvoVaginal, Trikhomoniasis, Lactobacillus rhamnosus GR-1, Lactobacillus reuteri RC-14, uji klinis acak randomisasi ganda.

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BACKGROUND Vaginal discharge is one of the most frequent complain encountered in primary health care, as much as 2,7 to 2,6 million visits per year according to data from the CDC in the United States in 2008. The most common abnormal vaginal discharge caused by infection is Bacterial Vaginosis BV in 22 50 of women, vulvovaginal candidosis KVV of 17 39 and Trikhomoniasis TV of 4 35 . Some of the serious complications that may be caused bacterial Vaginosis include miscarriage, pelvic inflammation, premature delivery, chorioamnionitis, postpartum endometritis, as well as gynecological postoperative infection. Abnormal vaginal discharge is closely related to changes in the degree of acidity pH from the normal state which is 3.5 to 4.7 caused a decrease in the normal flora lactobacilli and an increase in microbes that produce pathological vaginal discharge. Diagnosis of vaginal discharge may be established based on syndromic, empirical, and laboratory approach. Probiotics known as living microorganisms that can provide health benefits to the host, in this case Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14, in several randomized clinical trials, double blinded, have been proven to provide healing significantly compared to standard therapy, either as primary or adjuvant therapy. Such researchs have not been done in Indonesia.OBJECTIVES To acknowledge the clinical effectiveness and prove the high proportion of cure and satisfaction levels of post treatment patients with a combination of antimicrobial probiotic oral Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 compared to a combination of antimicrobial placebo in the treatment of patients of reproductive age with vaginal discharge in the clinic outpatient obstetrics and gynecology RSCM.METHODS This study is a randomized, double blind, clinical trial with initial total sample was 84 subjects, and only 50 subjects were able to be analyzed with target population of reproductive age women who visited with complain of vaginal discharge to outpatient clinic at RSCM and Arifin Achmad Pekanbaru, Riau and met the inclusion criteria and exclusion, divided into 25 subjects in the control group and 25 subjects in the treatment group. Data were collected through a clinical examination with syndromic approach, administration of probiotics containing each 2,5x109 CFU Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 as an adjuvant standard antimicrobial therapy in the treatment group and placebo plus standard antimicrobial therapy in the control group, therapeutic response was recorded 4 weeks after treatment using the trial spesific case report form and level of satisfaction using a form based on treatment satisfaction Questionnaire For Medication TSQM VERSION II . Relative risk values, and chi square test was performed to assess the relationship between variables. The interim analysis with conditional power assesment and futility testing in the middle of the study was performed due to insufficient sample size. Research has already qualified and approved by Ethics Commitee for Health Researches Faculty of Medicine University of Indonesia RSCM in March 2016.RESULTS A total of 50 subjects has participated and analyzed, consisting of 25 subjects treated and 25 control subjects, with 14 subjects 56 of the treatment group cured and 11 subjects 44 not cured, and as many as 15 subjects 60 cured of the control group and 10 subjects 40 not cured, resulting in a relative risk of 1.1 for subjects that is not cured, and the Chi square test p value 0.77, 95 CI 0.57 to 2 , 11 . On the treatment staisfaction level analysis, it was found that high level of satisfaction score ge 67 unexpectedly higher in the placebo group of 52,6 10 subjetcs compared to probiotic group, of 47,4 9 subjects . Based on statistical test, p value was 0,65 ge 0,05 , equals to no difference in the level of satisfaction of respondents in treatment group probiotic and control group placebo . Lacking number of samples collected 50 subjects have been analyzed with conditional power and futility test curve for possible significancy provided the total number of samples able to be collected, and obtained the value of Z 0.2865, corresponds to conditional power between 0.11 to 0.13 and futility index of 0.87 to 0.88, which may be interpreted as low possibility of reaching statistical significance even if the trial was continued to initially calculated minimum sample.CONCLUSION There was no clinical and statistical difference in the proportion of cure and the level of satisfaction in patients of reproductive age with vaginal discharge in the treatment with combination of antimicrobial oral probiotic Lactobacillus rhamnosus GR 1 and Lactobacillus reuteri RC 14 compared to combination of antimicrobial placebo after treatment for 4 weeks. However in this study, the initial hypothesis of higher proportion of cure at the treatment group probiotic compared to placebo still cannot be excluded, due to insufficient samples collected. KEYWORDS Vaginal discharge, Bacterial Vaginosis. Vulvovaginal candidiasis, Trikhomoniasis, Lactobacillus rhamnosus GR 1, Lactobacillus reuteri RC 14, randomized double blind controlled trial."

"ABSTRAKRemaja merupakan salah satu kelompok yang paling berisiko terhadap masalah kesehatan. Salah satu masalah kesehatan remaja, khususnya pada remaja wanita, adalah masalah kesehatan reproduksi: keputihan. Keputihan pada remaja dapat berdampak infeksi dan infertilitas. Oleh karena itu, penanganan keputihan remaja sangat perlu untuk dilakukan. Tujuan penulisan karya ilmiah ini adalah untuk menggambarkan pelaksanaan asuhan keperawatan keluarga dengan intervensi catatan harian kesehatan untuk meningkatkan perilaku kebersihan organ reproduksi remaja wanita dengan masalah keputihan. Hasil intervensi keperawatan keluarga menggunakan catatan harian kesehatan menunjukkan peningkatan perilaku perawatan kebersihan organ kewanitaan dan penurunan frekuensi keputihan. Oleh karena itu, pemanfaatan catatan harian kesehatan dapat diterapkan petugas pelayanan kesehatan untuk meningkatkan perilaku perawatan kebersihan remaja dalam mengatasi masalah keputihan.

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ABSTRACTAdolescents are one of the most at risk group to health problem. One of problem in adolescents, especially in female adolescents, is reproductive health problem vaginal discharge. Vaginal discharge in adolescents can affect to infection and infertility. Therefore, management of vaginal discharge in adolescents is very important to be done. The purpose of this scientific project is to know about the description of family nursing care using health diary as an intervention in adolescents with vaginal discharge. The result of nursing intervention using health diary shows that vaginal hygiene behavior was increased and vaginal discharge frequent was decreased. Therefore, health diary can be used by health care workers to increase vaginal hygiene behavior in adolescents in order to solve vaginal discharge problem. "

"Latar Belakang: Gejala vagina dan berkemih berdampak buruk pada kesehatan seksual dan kualitas hidup wanita usia premenopause atau menopause/sindrom genitourinari menopause (SGM). Terapi laser vagina menawarkan pemulihan dan regenerasi jaringan dan organ berupa mengencangkan dan menebalkan jaringan mukosa vagina. Laser vagina diharapkan dapat memperbaiki gejala vagina, berkemih wanita, serta menguatkan kontraksi otot dasar panggul.Objektif: Mengetahui perbaikan gejala vagina dan berkemih serta kekuatan kontraksi otot dasar panggul pasca terapi laser di RS YPK Mandiri, tahun 2017 – 2021.Metode : Penelitian ini menggunakan studi kuasi eksperimental dengan mengambil data sekunder dari rekam medis.Hasil: Total didapatkan 54 subjek penelitian dengan rerata usia 45,5 (SD = 11,67) tahun. Sebanyak 70,4 % wanita belum menopause, dan 29,6 % tergolong SGM. Gejala vagina kering didapatkan mengalami perbaikan pasca terapi laser dengan presentase 95 % (p = 0,006), sedangkan presentase perbaikan gejala beser, inkontinensia urin tipe tekanan dan vagina longgar berurutan sebesar 78,2 %, 84,0 %, dan 60,0 %. Kekuatan kontraksi otot dasar panggul meningkat 3 bulan pasca terapi laser dari 25,00 (interquartile range (IQR) = 15,0) cmH2O menjadi 39,33 (IQR = 11,1) cmH2O (p = < 0,001). Demikian, kekuatan kontraksi otot dasar panggul berdasarkan skor Modified Oxford Scale (MOS) didapatkan 79,6 % (43 subjek) mengalami peningkatan 1 derajat MOS.Kesimpulan: Terapi laser vagina dapat menjadi terapi alternatif untuk melembabkan lubrikasi vagina, dan meningkatkan kekuatan kontraksi otot dasar panggul. ......Background: Vaginal and urinary symptoms often have adverse impact on the sexual health and quality of life of pre-menopausal or post-menopausal age women known as genitourinary syndrome of menopause (GSM). Vaginal laser offers tissue and organ restoration and regeneration by tightening and thickening vaginal mucosal tissue. Vaginal laser expected to improve vaginal symptoms, urination symptoms, and strengthen levator ani muscle.Objective: To know the improvement of vaginal and urinary symptoms and levator ani muscle contraction after laser therapy at YPK Mandiri Hospital, 2017-2021.Method: Quasi-experimental study by taking secondary data form medical records.Result: Total sample 54 subjects were obtained with mean age of 45,5 (SD = 11,67) years. 70,4 % of women are pre-menopausal, and 29,6 % are classified GSM. Dry vaginal symptoms were found to have improved after laser therapy with a percentage of 95 % (0,006), while the percentage of improvement in incontinence symptoms, stress urinary incontinence, and vaginal laxity respectively were 78,2 %, 84,0 %, and 60,0 %. The strength of levator ani muscle contraction increased 3 months after laser therapy from 25,00 (interquartile range (IQR) – 15,0) cmH2O to 39,33 (IQR = 11,1) cmH2O (p < 0,001). Thus, the strength of levator ani muscle contraction based on the Modified Oxford Scale (MOS) score was found to be 79,6 % (43 subjects) experiencing an increase of 1 - degree MOS.Conclusion: Vaginal laser therapy can be an alternative therapy to moisturize vaginal lubrication, and increase the strength of levator ani muscle contraction."

"ABSTRAKPenelitian ini bertujuan untuk memberikan gambaran evaluasi anatomis serta fungsional pasien pasca neovagina dengan graft membran amnion. Penelitian ini dilakukan dengan desain potong lintang deskriptif. Didapatkan 11 subyek dengan nilai minimum dan maksimum panjang vagina yaitu 7 dan 8 cm. Nilai minimum dan maksimum diameter vagina yaitu 3.5 dan 4.0 cm. Seluruh subyek mempunyai epitelisasi lengkap dan hasil histopatologi sesuai dengan epitel vagina serta tidak didapatkannya komplikasi. Total skor FSFI menunjukkan nilai minimum dan maksimum skor 27.2 dan 31.7, menunjukkan tidak didapatkan disfungsi seksual.

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ABSTRACTThis study aims to provide an overview of anatomical and functional evaluation of patients post neovagina with amniotic membrane graft. This study was conducted with a descriptive cross-sectional design. Obtained 11 subjects with a minimum and maximum length of the vagina are 7 and 8 cm. The minimum and maximum diameter of the vagina are 3.5 and 4 cm. All subject had complete epithelialization, vaginal epithelium as histopathological result and no complications. Total FSFI score showed the minimum and a maximum score of 27.2 and 31.7, shows no sexual dysfunction."