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"Latar belakang: Salah satu aspek penting dalam upaya menurunkan angkakematian dan morbiditas Ibu adalah sistem rujukan yang efektif. PandemiCOVID-19 memberikan tantangan tersendiri dalam pelaksanaan sistem rujukan.Belum pernah dilakukan penilaian terhadap penerapan sistem rujukan obstetri diera pandemi COVID-19.Metode: Penelitian deskriptif-analitik berdesain potong lintang yangmembandingkan efektivitas rujukan sebelum (Juli-Desember 2019) dan saat di erapandemi COVID-19 (Maret-Agustus 2020) di Rumah Sakit Umum PusatNasional dr. Cipto Mangunkusumo. Efektivitas rujukan dinilai berdasarkan duakriteria, yakni kesesuaian diagnosis rujukan dan ketepatan prosedur yang meliputikomunikasi melalui sistem penanggulangan gawat darurat terpadu (SPGDT),pengantaran dengan ambulans, dan pelampiran surat rujukan.Hasil: Penelitian menemukan 198 kasus rujukan dari 464 kasus obstetri (42,67%)sebelum pandemi dan 231 kasus rujukan dari 486 kasus obstetri (47,53%) di erapandemi. Kesesuaian diagnosis dan ketepatan prosedur rujukan di era pandemiCOVID-19 secara signifikan lebih tinggi. Kesesuaian diagnosis meningkat dari57,58% sebelum pandemi menjadi 71,00% di era pandemi (p = 0,004). Ketepatanprosedur rujukan meningkat dari 28,28% sebelum pandemi menjadi 45,45% di erapandemi (p < 0,001). Berdasarkan kriteria tersebut, efektivitas rujukan di RumahSakit Umum Pusat Nasional dr. Cipto Mangunkusumo pada era pandemi COVID- 19 ditemukan lebih tinggi secara signifikan, yakni sebelum masa pandemi sebesar 21,72% dan di era pandemi sebesar 40,26% (p < 0,001).Kesimpulan: Terdapat peningkatan efektivitas rujukan ke Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo berdasarkan kesesuaian diagnosis danketepatan prosedur di era pandemi COVID-19 hingga 2x dibanding sebelum masa pandemi COVID-19."

"Latar Belakang: Gangguan berkemih dalam kehamilan dapat mempengarui kualitas dari hidup seorang ibu hamil. Akan tetapi, Sampai saat ini belum didapatkan data mengenai hubungan paritas dan trimester kehamilan dengan kejadian gangguan berkemih di Indonesia.Tujuan: Menganalisis faktor-faktor yang berhubungan dengan berbagai gangguan kejadian berkemih yang terjadi selama kehamilan.Metode: Penelitian ini merupakan penelitian analitik observasional dengan metode potong lintang. Subjek pada penelitian ini adalah ibu hamil yang berkunjung ke Puskesmas Cempaka Putih dan Puskesmas Johar Baru menggunakan metode consecutive sampling pada Juli 2019 sampai Desember 2019. Data yang dikumpulkan melalui wawancara, pengisian daftar harian berkemih, kuesioner Questionnaire for Urinary Incontinence Diagnosis (QUID) dan penilaian indeks sandvik.Hasil: Didapatkan sebanyak 279 ibu hamil yang memenuhi kriteria inklusi dan eksklusi. Didapatkan multiparitas berhubungan dengan terjadinya inkontinensa tekanan pada wanita hamil (P= 0,045, OR 2,59, CI 95% 1,002-6,73), tetapi tidak bermakna pada variabel yang lain (primipara dan nulipara dengan inkontinensia tekana; multipara, primipara dan nullipara dengan inkontinensia desakan, gangguan frekuensi dan nokturia; trimester kehamilan dengan inkontinensia tekanan, desakan, gangguan frekuensi dan nokturia) (P>0,05). Prevalensi inkontinensia tekanan yang terjadi pada kehamilan sebesar 11,1%, dimana pada trimester I,II,III yakni 12,7%, 12,4%, 10,9%. Prevalensi inkontinensia desakan yang terjadi pada kehamilan sebesar 5,0%, dimana trimester I,II,III yakni 4,6%, 2,8%, 8%. Prevalensi gangguan frekuensi yang terjadi pada kehamilan sebesar 75,6%, dimana trimester I,II,III yakni 67,3%, 74,7%, dan 79,1%. Prevalensi nokturia yang terjadi pada kehamilan 86% ,dimana pada trimester I,II,III, yakni 81,6%, 83,5%,dan 89,2%. Indeks keparahan inkontinensia urin terbanyak dalam kehamilan adalah pada tingkat ringan (93,3%) dan sedang (6,7%).Kesimpulan: Adanya hubungan yang bermakna antara multiparitas dengan terjadinya inkontinensia tekanan pada wanita hamil. Dilakukan penelitian selanjutnya untuk menilai faktor-faktor lainnya yang berpengaruh terhadap gangguan berkemih pada ibu hamil dengan cakupan dan subjek yang lebih luas.

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Background: Low urinary tract symptoms in pregnancy can affect the quality of life for a pregnant woman. However, until now there has been no data regarding the relationship between parity and trimester of pregnancy with the incidence of urinary disorders in Indonesia.

Objective: Analyzing the factors associated with various Low urinary tract symptoms has occur during pregnancy.

Methods: This research is an observational analytic study with cross sectional method. The subjects in this study were pregnant women who visited the Cempaka Putih Health Center and Johar Baru Health Center using the consecutive sampling method from July 2019 to December 2019. Data collected in the form of obstetric history through interviews, bladder dairy, Questionnaire for Urinary Incontinence Diagnosis (QUID) Indonesian version and index sandvik

Results:Obtained as many as 279 pregnant women who met the inclusion and exclusion criteria. Obtained multiparity associated with the occurrence of pressure incontinence in pregnant women (P = 0.045, OR 2.59, 95% CI 1.00-6.73), but not significant in other variables (primipara and nulipara with stress incontinence; multipara, primipara and nullipara with urge incontinence, frecuency and nocturia; trimester with stress incontinence, urge incontinence, frecuency and nocturia) (P> 0.05). The prevalence of stress incontinence that occurs in pregnancy is 11.1%, where in the I, II, III trimesters that is 12.7%, 12.4%, 10.9%. The prevalence of urge incontinence that occurs in pregnancy is 5.0%, where I, II, III trimesters are 4.6%, 2.8%, 8%. The prevalence of frequency that occur in pregnancy is 75.6%, where I, II, III trimesters are 67.3%, 74.7%, and 79.1%. The prevalence of nocturia that occurs in pregnancy is 86%, where in the I, II, III trimesters, ie 81.6%, 83.5%, and 89.2%. The highest severity index in urinary incontinence in pregnancy was mild (93.3%) and moderate (6.7%).

Conclusion: There is a significant relationship between multiparity with the occurrence of stress incontinence in pregnant women. It is recommended to have further research to study other factors that may influence low urinary tract symptoms on pregnant women with broader scope and subjects background"

"Latar Belakang: BPJS Kesehatan merupakan badan hukum yang diciptakan guna melaksanakan program jaminan kesehatan. Metode pembayarannya adalah Kapitasi untuk fasilitas kesehatan primer dan INA-CBGs untuk pelayanan  tingkat lanjut. Pelaksanaan BPJS Kesehatan dimulai tanggal 1 Januari 2014. Kepuasan pasien diartikan sebagai bentuk perasaan atau evaluasi subjektif terhadap kesesuaian antara harapan dan kenyataan. Tolak ukur yang ditetapkan untuk mengukur keberhasilan layanan fasilitas kesehatan adalah mengukur tingkat kepuasan pasien. Salah satu cara pengukuran adalah dengan metode Servqual, yang menilai perbandingan dua faktor utama, yaitu persepsi pelanggan atas layanan yang mereka terima (perceived service) dengan layanan yang diharapkan (expected service). Upaya pemenuhan kepuasan harus menyeluruh untuk semua pasien, BPJS maupun non BPJS. Di unit layanan Obstetri dan Ginekologi tindakan terbanyak adalah pembedahan, seksio sesarea. Tujuan Penelitian: Untuk menilai pengaruh kualitas pelayanan terhadap kepuasan pasien seksio sesarea pada unit layanan Obstatri dan Ginekologi FKUI/RSCM pada periode diberlakukannya INA-CBGs. Menganalisis dimensi kualitas pelayanan dengan metode Servqual terhadap kepuasan pasien seksio sesarea. Metode: Penelitian ini merupakan penelitian potong lintang (cross sectional), dengan desain studi analitik dengan pendekatan kuantitatif, menggunakan kuisioner yang disebar kepada 130 sampel (pasien BPJS dan non BPJS) dengan kasus seksio sesarea di RSCM antara bulan Januari 2017 hingga Desember 2017. Hasil: Hasil perhitungan nilai gap/kesenjangan pada seluruh dimensi pelayanan, pada kedua kelompok pasien BPJS dan non BPJS didapatkan nilai negatif, artinya skor harapan lebih besar dari skor persepsi/kenyataan. Artinya pasien belum merasa puas pada seluruh dimensi kualitas pelayanan. Gap/kesenjangan terbesar di pasien BPJS dan non BPJS berada pada dimensi Assurance (Jaminan) yaitu 1.72 untuk pasien BPJS dan -1.71 untuk pasien non BPJS, dan dimensi Empathy (Empati) dengan angka -1.80 untuk pasien BPJS dan -1.64 untuk pasien non BPJS. Berdasarkan analisa menggunakan diagram kartesius, Dimensi Assurance (Jaminan) dan Empathy (Empati) berada di kuadran A, sementara Tangible (Bukti langsung), Reliability (Keandalan), Responsiveness (Daya tanggap), di kuadran B.  Berdasarkan hasil analisa uji Mann-Whitney, didapatkan p<0.005 pada dimensi Tangible (Bukti langsung), Empathy (Empati). Sementara dari dimensi Reliability (Keandalan), Assurance (Jaminan), Responsiveness (Daya tanggap), didapatkan p>0.005. Dari hal ini disimpulkan bahwa pada sampel penelitian ini, metode Servqual yang menggambarkan kualitas pelayanan berpengaruh terhadap kepuasan pelanggan, terutama dalam dimensi Tangible (Bukti langsung), dan Empathy (Empati). Berdasarkan  penilaian uji korelasi Spearman, dari penilaian antara dimensi Tangible dan kepuasan pasien, didapatkan nilai koefisien korelasi -0.09, artinya korelasi tidak searah, dengan nilai p=0.307 (p>0.05). Sementara penilaian antara dimensi Empathy dan kepuasan pasien, didapatkan nilai koefisien korelasi 0.212, korelasi searah namun sangat lemah, dengan nilai p=0.015 (p<0.05). Kesimpulan: Didapatkan tingkat kepuasan pasien pada kedua kelompok, pasien BPJS dan non BPJS mesing-masing sebesar 69%. Dari hasil pengujian menggunakan metode Servqual dan diagram kartesius, kedua kelompok pasien, BPJS dan non BPJS masih belum merasa puas pada seluruh dimensi kualitas pelayanan terutama dimensi Assurance (Jaminan) dan Empathy(Empati).

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Background: BPJS Kesehatan is a legal entity created to implement a health insurance program. The payment method is Capitation for primary health facilities and INA-CBGs for advanced services. The implementation of BPJS Kesehatan began on January 1, 2014. Patient satisfaction was interpreted as a form of feeling or subjective evaluation of conformity between expectations and reality. The benchmark set to measure the success of health facility services is measuring the level of patient satisfaction. One method of measurement is the Servqual method, which assesses the comparison of two main factors, namely customer perceptions of perceived service with the expected service. Efforts to fulfill satisfaction must be comprehensive for all patients, BPJS and non BPJS. In the Obstetrics and Gynecology service unit the most actions are surgery, cesarean section. Objective: To assess the effect of quality of service on the satisfaction of sectio caesarean patients in the Obstetrics and Gynecology service unit FKUI/RSCM in the period of enactment of INA-CBGs. Analyze the dimensions of service quality with the Servqual method on the satisfaction of seksio sesarea patients and find out the sociodemographic factors of patients with seksio sesarea at RSCM. Method: This study is a cross-sectional study, with analytic study design with a quantitative approach, using questionnaires distributed to 130 samples (BPJS and non BPJS patients) with cesarean section cases at the RSCM between January 2017 and December 2017. Result: The results of the calculation of the gap/gap in all dimensions of service, in both groups of BPJS and non BPJS patients obtained a negative value, meaning that the expectation score is greater than the perception/reality score. This means that patients are not satisfied with all dimensions of service quality. The biggest gap/gap in BPJS and non BPJS patients is in the dimension of Assurance (-1.72) for BPJS patients and -1.71 for non BPJS patients, and Empathy dimensions (Empathy) with -1.80 for BPJS patients and -1.64 for non patients BPJS. Based on the analysis using the Cartesian diagram, the Dimensions of Assurance (Employment) and Empathy (Empathy) are in quadrant A, while Tangible (direct evidence), Reliability (Reliability), Responsiveness (responsiveness), in quadrant B. Based on the results of the Mann-Whitney test, obtained p <0.005 on the dimensions of Tangible (direct evidence), Empathy (Empathy). While from the Reliability, Assurance, and Responsiveness dimensions, p> 0.005. From this it can be concluded that in the sample of this study, the Servqual method that describes service quality has an effect on customer satisfaction, especially in the dimensions of Tangible (direct evidence), and Empathy (Empathy). Based on the assessment of the Spearman correlation test, from the assessment between the dimensions of Tangible and patient satisfaction, the correlation coefficient value of -0.09 was obtained, meaning that the correlation was not in the same direction, with a value of p = 0.307 (p> 0.05). While the assessment between the Empathy dimension and patient satisfaction, the correlation coefficient value of 0.212 was obtained, the correlation was in the same direction but very weak, with a value of p = 0.015 (p <0.05). Conclusions: The level of satisfaction of patients in both groups was obtained, BPJS and non BPJS patients were 69% respectively. From the test results using the Servqual method and Cartesian diagram, the two groups of patients, BPJS and non BPJS are still not satisfied on all dimensions of service quality, especially the dimensions of Assurance and Empathy."

"Latar Belakang: Tindakan pembedahan atau operasi merupakan tindakan yang sangat berkaitan erat dengan bidang obstetri dan ginekologi. Masing-masing kasus akan bervariasi dan memiliki resiko dan jenis komplikasi tersendiri. Sistem pelayanan di RSCM saat ini telah mengalami perubahan pengaturan menjadi sistem Dokter Penanggung Jawab Pelayanan(DPJP) sejak tahun 2009. Belum ada penelitian di Indonesia yang menyimpulkan bagaimana pengaruh sistem DPJP terhadap angka komplikasi pembedahan. Tujuan: Penelitian ini bertujuan untuk mengetahui insidens kasus komplikasi dalam tindakan pembedahan obstetri dan ginekologi di RSCM pada masa sebelum dan sesudah DPJP. Metode: Penelitian dekriptif observasional ini dilakukan di RS Cipto Mangunkusumo sejak Desember 2017 hingga Februari 2018. Data sebelum sistem DPJP yaitu tahun 2007-2008 dan sistem DPJP yaitu tahun 2010-2011. Data tindakan pembedahan dijabarkan secara deskriptif dan insiden morbiditas diolah dengan analisis bivariat. Hasil: insidens terjadinya komplikasi pembedahan di RSCM pada masa sebelum versus sesudah DPJP adalah sebesar 2,7% versus 1,01%. Perubahan sistem menjadi DPJP di RSCM mempunyai resiko komplikasi yang lebih rendah yaitu sebanyak 22 dan pada sesudah DPJP menjadi 18 kasus bermakna secara statistik dengan nilai (p<0,05) dengan OR 0,41. Pada kasus ginekologi, sistem DPJP bermakna secara statistik (p<0,05) dengan nilai OR 0,23. Untuk onkologi tidak ada perbedaan bermakna, morbiditas pada kelompok pra DPJP sebesar 4,1% dan pada DPJP sebesar 2% dengan nilai p 0,07. Dari jenis pembedahan laparotomi, system DPJP bermakna secara statistik (p<0,05) dengan nilai OR 0,41. Kesimpulan: Perubahan sistem menjadi DPJP di RSCM mempunyai resiko komplikasi yang lebih rendah dibandingkan dengan sistem sebelum DPJP.

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Background: Background:Surgery is an action that is closely related to obstetrics and gynecology. Each case will have various risks and types of complications. The service system at RSCM has changed its settings to become a Service Responsible Doctor (DPJP) system since 2009. There has been no research in Indonesia about the correlation between the DPJP system with rate of surgical complications.

Aims: To determine the incidence of complications in obgyn surgery at the RSCM before and after the DPJP.

Methods: This observational descriptive study was conducted at Cipto Mangunkusumo Hospital from December 2017 to February 2018 before the DPJP (2007-2008) and after DPJP (2010-2011). Surgical action data are described descriptively and the incidence of morbidity is processed by descriptive bivariate analysis.

Result: the incidence of surgical complications at the RSCM before and after the DPJP was 2.7% versus 1.01%. The system change to DPJP at the RSCM has a lower risk of complications compared to the system before DPJP that is as much as 22 and after the DPJP to 18 cases statistically significant with the value (p <0.05) with OR 0.41. In gynecological cases DPJP system reduces the number of complications (p <0.05) with an OR value of 0.23. No significant differences in the oncology case, pre-DPJP group was 4.1% and the DPJP was 2% with a p value of 0.07. in Laparotomy technique the DPJP system was statistically significant (p <0.05) with an OR value of 0.41.

Conclusion: The new DPJP system in RSCM has alower risk of complications compared to the system before DPJP."

"ABSTRAKTujuan: Mengetahui pencapaian IPSG oleh tenaga kesehatan di departemen obstetri dan ginekologi Rumah Sakit Cipto Mangunkusumo (RSCM) dan faktor-faktor yang memengaruhinya.Metode: Penelitian ini menggunakan disain potong lintang di RSCM dengan menggunakan kuisioner. Responden yang memenuhi kriteria inklusi dicatat dan data yang diperoleh diolah secara statistik.Hasil: Dari data yang dikumpulkan sejak Mei hingga Agustus 2018 didapatkan pencapaian International Patient Safety Goals(IPSG) oleh tenaga kerja di departemen obstetri dan ginekologi di RSCM yaitu untuk IPSG 1 92,4%, IPSG 2 94,4%, IPSG 3 95,1%, IPSG 4 88,7%, IPSG 5 88,7% dan IPSG 6 84,9 %. Lama bekerja di unit yang bersangkutan, lama kerja sejak lulus, harapan gaji yang diterima, supervisi yang dirasakan oleh tenaga kesehatan dan tingkat pendidikan terakhir tenaga kesehatan memiliki hubungan yang bermakna terhadap pencapaian IPSG.Kesimpulan: Pencapaian IPSG oleh tenaga kesehatan di departemen obstetri dan ginekologi RSCM adalah cukup tinggi. Pencapaian yang cukup tinggi tersebut berhubungan dengan beberapa karakteristik, faktor psikologis dan faktor organisasi.

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ABSTRACTObjective: To know the IPSG achievement by medical staff at obstetry and gynecology department on Rumah Sakit Cipto Mangunkusumo (RSCM) and to know the other factors that influence the achievement.Method: This research used cross sectional design with randomized sampling. Data that fulfilled the inclusion criteria were collected and analyzed.Results: From the data that we collected since May until August 2018 conclude that the International Patient Safety Goals (IPSG) achievement by medical staff at obstetry and gynecology department on RSCM are 92,4% for IPSG 1, 94,4% for IPSG 2, 95,1% for IPSG 3, 88,7% for IPSG 4 and 84,9% for IPSG 5. There was a correlation between the length of time working in the same unit, length of time since graduation, the salary that the medical staff expected, supervise, and the last education of the medical staff with IPSG achievement.Conclusion: IPSG achievement by medical staff at obstetry and gynecology on RSCM is high. The achievement is correlate with some of the characteristics, psychological and organization."

"Latar belakang: Retensio urine pasca persalinan merupakan salah satu komplikasi tersering dalam persalinan. Salah satu jenis retensi urine yang sulit diketahui adalah tipe covert yang tidak bergejala. Akan tetapi, retensi urine tipe covert dapat menyebabkan retensi urine persisten yang dapat menurunkan kualitas hidup. Diperlukan suatu studi untuk meneliti faktor risiko terjadinya retensi urine tipe covert agar dapat dideteksi lebih dini. Tujuan: Mengetahui faktor risiko retensi urine pasca persalinan tipe covert. Metode: Penelitian ini merupakan penelitian analitik observasional dengan metode potong lintang (cross sectional). Subjek dari penelitian ini merupakan ibu yang melakukan persalinan pervaginam di RSUPN Cipto Mangunkusumo, RSUP Persahabatan, RSUD Koja, RSUD Kabupaten Tangerang, dan RSUD Karawang pada20 September 2019 hingga 27 Februari 2020. Pasien dengan riwayat retensi urine sebelumnya, penggunaan kateter menetap, atau memiliki nyeri VAS 5 meski sudah diberikan analgetik dieksklusi dari penelitian. Pasien yang tidak berkemih 6 jam pasca persalinan termasuk dalam drop out.Hasil: Didapatkan sebanyak 520 subjek yang memenuhi kriteria inklusi dan eksklusi. Tidak terdapat hubungan antara usia ibu dengan kejadian retensio urine pascapersalinan tipe covert (p > 0,05). Paritas primipara lebih berisiko mengalami kejadian retensio urine pascapersalinan tipe covert (p < 0,001, OR 3,8 IK95% 1,87-7,72). Durasi persalinan kala II ≥ 20 menit lebih berisiko mengalami kejadian retensio urine pascapersalian tipe covert (p < 0,001, OR 36,69 IK95% 14,9-90,20). Ruptur perineumberat (derajat 3 atau 4) lebih berisiko mengalami kejadian retensio urine pascapersalinan tipe covert (p = 0,050, OR 8,54 IK95% 1,00-73,66). Berat bayi saat lahir > 3.000 gramlebih berisiko mengalami kejadian retensio urine pascapersalinan tipe covert (p < 0,001, OR 8,54 IK95% 1,76-7,59). Persalinan pervaginam menggunakan alat lebih berisikomengalami kejadian retensio urine pascapersalinan tipe covert (p = 0,002, OR 4,79 IK95% 1,75-12,99). Tidak terdapat hubungan antara volume urine kala III dengan kejadian retensio urine pascapersalinan tipe covert (p > 0,05). Kesimpulan: Faktor risiko terjadinya retensi urine pasca persalinan tipe covert adalah paritas primipara, durasi persalinan kala II memanjang, ruptur perineum berat, beratbadan lahir bayi besar, dan persalinan pervaginam dengan bantuan alat.

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Background: Postpartum urine retention is one of the most common complications in labor. One type of urine retention that is difficult to know is the asymptomatic covert

type. However, covert type urine retention can cause persistent urine retention which could reduce quality of life. A study is needed to examine the risk factors for covert type urine retention so that they can be detected early. Objective: To determine the risk factors for the occurrence of covert urinary retention after delivery.

Method: This study was an observational analytic study with cross sectional. method. The subjects of this study were mothers delivering vaginal deliveries at Cipto Mangunkusumo General Hospital, Friendship Hospital, Koja Regional General

Hospital, Tangerang District General Hospital, and Karawang General Hospital from September 20th 2019 to February 27th 2020. Patients with a history of previous urinary retention, moderate catheter use, or moderate pain even though analgesics have been excluded from the study. Patients who did not urinate 6 hours after delivery were dropped out.

Result: There were 520 subjects who met the inclusion and exclusion criteria. There was no relationship between maternal age and the incidence of covert postpartum urine

retention (p> 0.05). Primiparous parity was more at risk of having covert postpartum urine retention (p <0.001, OR 3.8% 95.97-7.72). Duration of second stage of labor ≥ 20 minutes is more at risk of covert postpartum urine retention (p <0.001, OR 36.69 IK95% 14.9-90.20). Severe perineal rupture (grade 3 or 4) is more at risk of having covert postpartum urine retention (p = 0.050, OR 8.54 IK95% 1.00-73.66). The birth weight > 3,000 grams is more at risk of having covert postpartum urine retention (p<0.001, OR 8.54 IK95% 1.76-7.59). Vaginal delivery using a tool is more at risk of

having covert postpartum urine retention (p = 0.002, OR 4.79 IK95% 1.75-12.99). There is no relationship between the volume of urine stage III with the incidence covert

postpartum urine retention (p> 0.05). Conclusion: Risk factors of covert type urine retention are primiparous parity, prolonged duration of second stage of labor, severe perineal rupture, birth weight of large infants, and vaginal delivery with the aid of a tool."

"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."

"Peningkatan BB selama kehamilan yang tidak optimal akan meningkatkan risiko komplikasi kehamilan, ibu dan anak melalui mekanisme peningkatan IL-6. Penelitian ini bertujuan untuk mengetahui korelasi kadar IL-6 serum perempuan hamil trimester 3 dengan peningkatan BB selama kehamilan. Penelitian dilakukan pada bulan Januari - Februari 2014 di Puskesmas Jatinegara, Jakarta. Metode penelitian yang digunakan adalah potong lintang, consecutive sampling, pada 64 subyek perempuan hamil trimester 3 ≥37 minggu. Didapatkan hasil penelitian yaitu 42,2% mempunyai IMT trimester 1 BB lebih, 40,6% mempunyai asupan energi total berlebih dan sesuai anjuran serta rerata peningkatan BB 12,1 (±3,8) kg dengan 40,6% mempunyai peningkatan BB selama kehamilan sesuai rekomendasi IOM. Kadar IL-6 serum perempuan hamil trimester 3 pada penelitian ini adalah 3,067 (0,608 ? 18,207) pg/ml dengan kadar IL-6 serum pada peningkatan BB kurang (3,441 (±1,819) pg/ml) dan lebih (3,017 (1,234?14,083) pg/ml) cenderung lebih tinggi dibandingkan dengan kelompok sesuai (2,707 (0,608?18,207) pg/ml). Didapatkan korelasi positif lemah tidak bermakna antara kadar IL-6 serum perempuan hamil trimester 3 dengan peningkatan BB selama kehamilan (r=0,144, p=0,257) dan analisis kadar IL-6 serum berdasarkan kelompok peningkatan BB selama kehamilan didapatkan hasil tidak berbeda bermakna (p=0,708). Kesimpulan hasil penelitian ini adalah kadar IL-6 serum berkorelasi lemah dengan peningkatan BB selama kehamilan.

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Gestational weight gain (GWG) that is not optimal will increase the risk of complications in pregnancy through increasing the IL-6 mechanism. This study aimes to determine the correlation of IL-6 serum levels on third trimester pregnancy with GWG. This is a cross-sectional study with consecutive sampling in 64 pregnant women ≥37 weeks. It was conducted in January-February 2014 at community health centers Jatinegara, Jakarta. The results are most subjects have overweight BMI at 1st trimester (42,2%), most of subjects have either sufficient or excessive total energy intake than the recommendation (40.6%), the majority of the subjects having sufficient GWG based on IOM guidelines (40.6%) with mean GWG is 12.1 (± 3.8) kg. Serum level of IL-6 is 3.067 (0.608-18.207) pg/ml with serum levels of IL-6 in insufficient GWG (3.441 (± 1.819) pg/ml)) and excessive GWG (3.017 (1.234-14.083) pg/ml)) tends to be higher compared with sufficient GWG (2.707 (0.608-18.207) pg/ml)). The correlation of IL-6 serum level on 3rd trimester with GWG is positive, weak and not significant (r = 0.144, p = 0.257). Analysis of IL-6 serum levels within GWG categories show no significant difference between groups (p = 0.708). In conclusion, there is weak correlation between IL-6 serum level on 3rd trimester of pregnancy with GWG."

"[ABSTRAKPenelitian ini bertujuan untuk mengetahui gambaran umum kanker ovarium di Rumah Sakit Ciptomangunkusumo (RSCM) 5 tahun terakhir beserta faktor-faktor yang berhubungan dengan kanker ovarium. Penelitan ini mengambil data pasien kanker ovarium selain tipe borderline yang terdapat di Cancer Registry divisi Ginekologi Onkologi dan masih memiliki rekam medis di RSCM pada periode Januari 2010 – Desember 2014, dilakukan follow up untuk mengetahui kesintasan hidup selama 4 tahun. Kami mendapatkan 98 subyek penelitian. Pada penelitian ini didapatkan insidensi kanker ovarium terbanyak pada usia 45-54 tahun (33,6%), insidensi kanker ovarium menurun dengan bertambahnya jumlah anak, sebagian besar kanker ovarium merupakan tipe epitelial (76,5%) dan sebagian besar pasien didiagnosa pada stadium lanjut (55.1%). Kesintasan hidup 4 pasien kanker ovarium tipe epitelial 77%; tipe germinal 83.3%; tipe stroma 100%. Kesintasan hidup 4 tahun dengan terapi pembedahan 84.1%; pembedahan disertai kemoterapi adjuvan 83.3%; kemoterapi neoadjuvan sebelum pembedahan 68.4%. Terdapat 63% respon komplit pada kelompok kemoterapi adjuvan; dan 41.2% pada kelompok kemoterapi neoadjuvan.

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ABSTRACTThe aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy.;The aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy.;The aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy., The aim of this research is to describe the incidence of ovarian cancer and its characteristic in Ciptomangunkusumo Hospital in the last 5 year. The data was collected from Gynecology Oncology Division’s Cancer Registry and RSCM’s medical record from Januari 2010 – December 2014, follow up was performed to know the survival. There was 98 subject in this research. The result was : majority incidence of ovarian cancer was in the age 45-54 years old (33,6%); ovarian cancer incidence decrease in parity’s group; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4 year survival rate for epithelial was 77%; germinal was 83,3%; and stromal was 100%. Based on therapy the 4 year survival rate was 84.1%; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvan chemotherapy. In the group of adjuvant chemotherapy there was 63% complete respon and 41.2% in neoadjuvan chemotherapy.]"

"Latar belakang: Prolaps organ panggul (POP) merupakan suatu permasalahan utama kesehatan dengan risiko seumur hidup pada perempuan yang menjalani paling sedikitnya satu kali intervensi pembedahan prolaps. Retensio urin pasca operasi rekonstruksi prolaps organ panggul disebabkan oleh beberapa faktor mulai dari pemeriksaan hingga penanganan pasca operasi yang berkontribusi terhadap terjadinya retensio urin. Penelitian di RSCM tentang penggunaan kateter 24 jam pada pasien pasca operasi prolapse organ panggul terhadap insiden retensio urin adalah sebesar 29,5%. Penelitian ini akan melakukan perbandingan penggunaan kateter 24 jam yang dibandingkan kateter 48 jam terhadap insiden retensio urin yang nantinya akan menjadi standar baku terbaru di RSCM dan RSUD Arifin Achmad Pekanbaru. Tujuan: Untuk mengetahui mana di antara kateter 24 jam dan 48 jam yang lebih baik untuk mengurangi angka kejadian retensio urin pascaoperasi prolaps organ panggul. Metode: Penelitian diagnosa, uji klinis acak, pengambilan sampel berturut-turut. Perbandingan antara kateter 24 jam dan 48 jam setelah operasi prolaps organ panggul Hasil: Total 54 subjek dalam penelitian ini, 3 subjek (11,1%) di antara 27 subjek dengan kateter 24 jam mengalami retensio urin. 1 subjek (3,7%) di antara 27 subjek dengan kateter 48 jam mengalami retensio urin. Kesimpulan: Penggunaan kateter 48 jam pascaoperasi prolaps organ panggul lebih baik daripada kateter 24 jam dalam mengurangi angka kejadian retensio urin.

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Background: Pelvic organ prolapse (POP) is a major health problem with a lifetime risk in women who undergo at least one prolapse surgical intervention. Postoperative retention of urine pelvic organ prolapse reconstruction is caused by a number of factors ranging from examinations to postoperative clients that

contribute to the occurrence of urinary retention. Research at the RSCM about 24- hour catheter use in postoperative pelvic organ prolapse patients for the incidence of urinary retention was 29.5%. This study will compare the use of a 24-hour catheter compared to a 48-hour catheter against the incidence of urinary retention which will later become the latest standard in RSCM and RSUD Arifin Achmad Pekanbaru. Objective: To know which one among 24-hour and 48-hour catheter is better to decrease incidence of urinary retention after pelvic organ prolapse surgery. Methode: Diagnosis research, randomized clinical trial, consecutive sampling. Comparison between 24-hour and 48-hour catheter after pelvic organ prolapse surgery Result: Total 54 subjects in this research, 3 subjects (11.1%) among 27 subjects with 24-hour catheter experienced urinary retention. 1 subject (3.7%) among 27 subjects with 48-hour catheter experienced urinary retention. Conclussion: The application of 48-hour catheter after pelvic organ prolapse surgery is beter than 24-hour catheter to decrease the incidence of urinary retention."