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"Latar belakang: Alat Kontrasepsi Dalam Rahim (AKDR) merupakan salah satu metode kontrasepsi paling efektif dan paling sering digunakan di dunia. Pemasangan pascaplasenta dinilai sebagai metode pemasangan yang paling efektif dalam meningkatkan penerimaan pasien. Pemasangan AKDR pascaplasenta dapat dilakukan menggunakan tangan maupun klem ovarium. Namun, belum terdapat penelitian yang membandingkan kedua metode tersebut di Indonesia.Tujuan: Membandingkan perbedaan tingkat ekspulsi dan penerimaan antara metode pemasangan AKDR manual dan pascaplasenta di Indonesia.Metode: Penelitian ini merupakan uji randomisasi terkontrol tersamar tunggal pada peserta AKDR pascaplasenta di rumahs akit tersier di Jakarta pada Oktober 2019 hingga Oktober 2020. Perempuan berusia 20-35 tahun yang melahirkan pervaginam dan berencana untuk dipasangkan AKDR diikutsertakan dalam peneelitian. Perempuan dengan anomali anatomi, perdarahan uterin abnormal baru, maupun pelvic inflammatory disease selama 3 bulan terakhir dieksklusi dari penelitian. Subjek dirandomisasi menjadi grup pemasangan manual dan klem ovarium. Dilakukan pemantauan pada minggu ke-1, ke-6, dan ke-12.Hasil: Didapatkan sebanyak 57 subjek AKDR dengan pemasangan manual dan 52 subjek AKDR dengan pemasangan klem ovarium. Tidak terdapat perbedaan ekspulsi maupun penerimaan selama masa pemantauan minggu ke-1 (p > 0,05), minggu ke-3 (p > 0,05), maupun minggu ke-6 (p > 0,05).Simpulan: Tidak terdapat perbedaan tingkat ekspulsi dan penerimaan antara akseptor AKDR pascaplasenta yang dilakukan pemasangan secara manual maupun menggunakan klem ovarium.

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Background: Intrauterine device (IUD) is one of the most used and effective contraceptives in the world. Postplacental insertion is considered to be the most effective method for increasing compliance. Postplacental IUD can be inserted using ovarian clamp, or manual technique. It is thought that IUD insertion method would affect its efficacy and adverse events. This study aims to investigate the difference of expulsion and acceptance of both method in Indonesia.

Method: Single-blinded randomized controlled trial determined to compare the rate of expulsion and acceptance on postplacental IUD patients was done at tertiary hospitals in Jakarta on October 2019 to October 2020. Women aged 20-35 years undergoing vaginal birth were recruited. Women who had anatomical anomaly, recent abnormal uterine bleeding, or pelvic inflammatory disease over the last 3 months were excluded in this study. Subjects were randomized into manual and ovarian clamp groups using simple random sampling. All subjects were followed up for 3 months. Expulsion and acceptance were observed on the 1st week, the 6th week, and the 12th week. Data was analyzed accordingly.

Result: A total of 57 manual insertion and 53 clamp subjects were included in the study. There were no expulsion recorded on both study group during 1 week follow up. There was no significant difference of expulsion between groups during 6 weeks and 12 weeks follow up period (p > 0.05). There was no significant difference of acceptance between groups during the follow up period (p > 0.05).

Conclusion: There was no significant difference of expulsion and acceptance rate between manual and ovarian clamp postplacental intrauterine device insertion.

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"Latar belakang: Alat Kontrasepsi Dalam Rahim (AKDR) merupakan Metode Kontrasepsi Jangka Panjang (MKJP) yang memiliki efektivitas tinggi. Pemasangan AKDR pascaplasenta akan meningkatkan cakupan penggunaan kontrasepsi dan menurunkan angka unmeet need. Metode pemasangan AKDR pascaplasenta bervariasi dengan menggunakan tangan, inserter, dan klem. Selain masalah pemasangan, permasalahan yang sering muncul pada penggunaan AKDR diantaranya adalah ekspulsi, infeksi, dan efek samping, yang mempengaruhi kenyamanan dan penerimaan klien. Tujuan: Tujuan penelitian ini adalah untuk mengetahui efektivitas, ekspulsi, penerimaan, dan efek samping pemasangan AKDR pascaplasenta dengan klem. Metode: Penelitian ini merupakan studi observasional longitudinal prospektif. Populasi terjangkau adalah akseptor AKDR pascaplasenta yang melahirkan di RSUPN Dr. Cipto Mangunkusumo pada periode April 2018 sampai dengan Maret 2019. Evaluasi dilakukan melalui wawancara pada minggu keenam, bulan ketiga, dan bulan keenam. Analisis data bersifat deskriptif dalam jumlah dan persentase. Hasil: Sebanyak 94 orang subjek diikutkan dalam penelitian. Sebanyak 4,2% tidak dapat dilakukan pendataan pada bulan ketiga dan 19,1% pada bulan keenam. Efektivitas AKDR mencapai 100%. Angka ekspulsi diperoleh 2,13% pada minggu keenam, 3,45% pada bulan ketiga, dan 0% pada bulan keenam. Angka penerimaan didapatkan pada bulan ketiga 93,3% dan bulan keenam 90,8%. Efek samping yang muncul adalah: perdarahan (3,45% pada bulan ketiga dan 1,45% pada bulan keenam) dan nyeri perut (3,45% pada bulan ketiga dan 4,35% pada bulan keenam). Kejadian perforasi dan infeksi tidak ditemukan. Keluhan tambahan yang didapatkan berupa dispareunia, keputihan, dan benang keluar. Sebanyak 91,1% subjek pada bulan ketiga dan 88,16% pada bulan keenam merasa puas terhadap pemasangan AKDR pascaplasenta dengan klem. Kesimpulan: Pemasangan AKDR pascaplasenta dengan klem memiliki efektivitas baik, dengan angka ekspulsi kumulatif 5,32% dan penerimaan kumulatif tiga bulan 93,3% dan enam bulan 90,8%.

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Bakcground: Intrauterine device (IUD) is a high effectivity of long term contraception method. Postplascenta IUD increase the number of contraception use and decrese the unmeet need of contraception. There are three methods of postplacental IUD: manually using hand, using inseter, and clamp. Instead of insertion problem, expulsion, infection, and side effects are problems that influence the comfortability and acceptability.

Objectives: To evaluate the effectivity, expulsion, acceptability, and side effects of postplacenta IUD insertion using clamp. Method: This is an observational longitudinal prospective study. The population are IUD acceptors who delivered at Dr. Cipto Mangunkusumo National General Hospital, Jakarta at April 2018-March 2019. The evaluation was done at 6 weeks, 3 months, and 6 months after delivery by interviewing the subjects. Data was analysed descriptively on number and precentage.

Result: A total of 94 women were included in this study, with 4,2% loss of follow up at 3 months and 19,1% at 6 months. The effectivity was 100%. The expulsion rate were 2,13%; 3,45%; and 0% at 6 weeks, 3 months, and 6 months respectively. The total acceptability rate at 6 weeks, 3 months, and 6 months were 96,81%; 93,3%; and 90,8% respectively. The post-placenta IUD acceptability rate at 6 weeks, 3 months, and 6 months were 95,74%; 88,89%; and 85,63%. The side effects were menorrhagia (3,45% at 3 months and 1,45% at 6 months) and abdominal pain (3,45% at 3 months and 4,35% at 6 months). We didn't find any perforation and infection. The additional side effects were dyspareunia, vaginal discharge, and coming out of threat. 91,1% and 88,16% subjects were satisfy to the IUD contraception at 3 months and 6 months.

Conclusion: Postplacenta IUD using clamp had good effectivity, with cumulative expulsion rate 5,32%. The acceptability were 93,3% and 90,8% at 3 months and 6 months respectively."

"ABSTRAK Latar belakang: Data demografi dan survey kesehatan dunia mengemukakan bahwa 92-98% perempuan tidak ingin hamil dalam 2 tahun pertama setelah persalinan, dan 66,5% ingin menggunakan kontrasepsi dengan unmet need 40%. Kontrasepsi pascasalin yang dapat diandalkan, efektif, dan jangka panjang seperti Alat Kontrasepsi Dalam Rahim (AKDR) sangat dibutuhkan.Tujuan: Mengevaluasi penerimaan, efektivitas dan efek samping AKDR pascaplasenta pada persalinan pervaginam di RSCM selama periode 6 bulansetelah pemakaian.Metode: Penelitian observasional dengan disain kohort prospektif. Semua subjek yang memenuhi kriteria penelitian, dilakukan pemasangan AKDR Cu T380A pascaplasenta dan dicatat hingga mencapai jumlah sampel yang dibutuhkan.Penelitian dilakukan di RS Cipto Mangunkusumo Jakarta periode Agustus – Oktober 2012. Penerimaan, efektivitas dan efek samping termasuk angka ekspulsi dinilai pada kunjungan 40-42 hari pascasalin dan 6 bulan kemudian.Hasil: Jumlah total subjek 234 orang, dengan 19,2% tidak datang pada kunjungan ulang pertama dan kedua. Tidak terdapat perbedaan bermakna pada karakteristik subjek yang datang maupun tidak datang pada kunjungan ulang. Pada kunjungan I, 5,1% subjek mengalami ekspulsi dan 4,5 % subjek melakukan pelepasan AKDR. Pada kunjungan II, didapatkan 7,5% ekspulsi dan 4,8% subjek melepasAKDR di luar RS. Dari keseluruhan tersebut terdapat 8,5% yang bersedia dipasang ulang. Efektivitas AKDR mencapai 100% dengan 68,9% subjek masih menyusui hingga 6 bulan. Ekspulsi total pada kunjungan I dan kunjungan II adalah 4,1% dan 0,6%, sedangkan ekspulsi parsial adalah 1% dan 6,9%. Efek samping tersering lainnya adalah keputihan (23%), nyeri haid (4-21%) danperdarahan bercak (2-10%).Kesimpulan: Penerimaan dan efektivitas selama 6 bulan adalah 86,8% dan 100%.Efek samping ekspulsi secara kumulatif selama 6 bulan adalah 12,6%, dengan efek samping lain seperti keputihan, nyeri haid dan perdarahan bercak

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ABSTRAK Background: Current world demographics and health surveys show that 92-98% of women want to delay their future pregnancy for at least 2 years after giving birth. A majority (66,5%) of these mothers require contraception of which 40% are unmet (unmet needs).The Intra Uterine Contraceptive Device (IUCD) can be a reliable, effective long term option to fulfill these unmet needsObjectives: To evaluate the acceptability, effctivity and side effects of Postplacental IUCD after vaginal delivery at Cipto Mangunkusumo Hospital after 6 months period of insertionMethods: We conducted a prospective observational cohort study, Subjects were recruited in Cipto Mangunkusumo Hospital, Jakarta at August-October 2012.Postplacental IUCD was inserted intu the subjects’ uterus until it reached the fundus. The data for acceptibility, effectivty and side effects, including the expulsion rate was obtained at 40-42 days and 6 months after delivery.Result: A total of 234 women were included in this study, with 19,2% loss of follow up. There is no significant difference on subjects’ characteristics who came and loss of follow up in this study. At the first follow up, 5,1% subjectsexperienced IUCD expulsion, and 4,5% had the IUCD removed by request. On the second follow up, expulsion was found in 7,5% of the subjects and 4,8% had the IUCD removed by request or outside our hospital. Eight and a half percent of those subjects were willing to receive IUCD reinsertion. The IUCD effectivity in six months follow up was 100%, with 68,9% of the subjects were still breastfeeding at 6 months after delivery. Total expulsion rate on first follow up compared to 6 months follow up was 4,1% and 0,6%, and the partial expulsion was 1% and 6,9%. The most common side effects were vaginal discharge (23%), dysmenorea (4-21%), and spotting (2-10%).Conclusion: The acceptability and effectivity of postplacental IUCD after 6 months were 86,8% and 100%. Cummulative expulsion rate after 6 months were 12,6%, and the most common other side effects were vaginal discharge, dysmenorea, and spotting"