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Abstrak :
Metode : Penelitian ini merupakan penelitian uji diagnostik dengan menggunakan metode potong lintang. Pengambilan sampel dilakukan secara konsekutif. Penelitian dilakukan di Poliklinik Obstetri dan Ginekologi RSCM Jakarta pada 31 Januari 2015 hingga 31 Januari 2020. Sebanyak 183 pasien wanita dengan kecurigaan neoplasma ovarium padat diikutsertakan dalam penelitian. Pasien dengan penyakit sistemik lainnya atau mengalami kehamilan dieksklusi dari penetlitian. Dilakukan uji kesesuaian dengan menggunakan uji Kappa. Didapatkan sensitivitas dan spesifisitas dari masing-masing penanda tumor

Hasil : AFP memiliki sensitivitas 1,92% dan spesifisitas 77,1% sebagai penanda disgerminoma. LDH memiliki sensitivitas 55,67% dan spesifisitas 65,65% sebagai penanda disgerminoma.. AFP memiliki sensitivitas 30,43% dan spesifisitas 85% sebagai penanda teratoma. LDH memiliki sensitivitas 30,43% dan spesifisitas 58,13% sebagai penanda teratoma . AFP memiliki sensitivitas 100% dan spesifisitas 88,89% sebagai penanda Yolk sac tumor. LDH memiliki sensitivitas 41,67% dan spesifisitas 59,65% sebagai penanda Yolk sac tumor. Kombinasi AFP dan LDH memiliki sensitivitas 100% dan spesifisitas 50,29% sebagai penanda Yolk sac tumor. Kombinasi tumor marker AFP dan LDH memiliki nilai sensitivitas yang lebih tinggi namun tidak memiliki akurasi yang lebih baik dibandingkan pemeriksaan menggunakan AFP atau LDH saja.

Kesimpulan : AFP dan LDH merupakan penanda tumor yang dapat digunakan untuk deteksi dini maupun skrining pada kasus neoplasma padat ovarium. ......Background: Ovarian neoplasms are the most common malignancy experienced by women in Indonesia. Solid ovarian neoplasm is a form of ovarian neopalsma that has a low survival rate due to late diagnosis. Early detection using tumor markers is one of the focuses of researches on ovarian neoplasms, one of which includes AFP and LDH.

Objective : To determine the sensitivity and specificity of AFP, LDH, and the combination of the two tumor markers.

Method : This research is a diagnostic test using cross sectional method. Sampling is done consecutively. The study was conducted at the Obstetrics and Gynecology Clinic of RSCM Jakarta from 31 January 2015 to 31 January 2020. A total of 182 female patients with suspicion of solid ovarian neoplasms were included in the study. Patients with other systemic diseases or pregnant were excluded from research. Conformity test was performed using the Kappa test. Sensitivity and specificity of each tumor marker was obtained

Result : AFP has a sensitivity of 1.92% and specificity of 77.1% as a marker of dysgerminoma. LDH has a sensitivity of 55.67% and a specificity of 65.65% as a marker of dysgerminoma. AFP has a sensitivity of 30.43% and a specificity of 85% as a marker of teratoma. LDH has a sensitivity of 30.43% and specificity 58.13% as a marker of teratomas. AFP has 100% sensitivity and 88.89% specificity as a marker of Yolk sac tumor. LDH has a sensitivity of 41.67% and specificity 59.65% as a marker of Yolk sac tumor. The combination of AFP and LDH has a sensitivity of 100% and a specificity of 50.29% as a marker of Yolk sac tumor. The combination of AFP and LDH marker tumors has a higher sensitivity value but does not have better accuracy than examinations using AFP or LDH alone

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Latar Belakang : Preeklampsia masih menjadi penyebab utama morbiditas dan mortalitas pada ibu hamil. Hingga saat ini masih belum ada program penapisan untuk memprediksi preeklampsia di Indonesia. Pada tahun 2018 di Jakarta, dilakukan penelitianmengenai faktor-faktor risiko maternal dan profil biofisik yang dinilai dapat meningkatkan kejadian preeklampsia. Namun, hasil penelitian tersebut masih perlu dilakukan validasi eksternal untuk mengonfirmasi bahwa hasilnya valid dan bisa diaplikasikan pada situasi, waktu, tempat yang berbeda. Tujuan: Melakukan validasi eksternal hasilpenelitian terdahulu Metode: Desain kohort prospektif. Semua ibu hamil yang melakukan pemeriksaan kehamilan di RSCM, RSUK JoharBaru, dan RSUK Tebet dari April-November 2018 diikuti hingga bersalin/terjadi preeklampsia pada Januari 2019. Hasil: Total subjek 467 orang. Insidens preeklampsia dari ketiga rumah sakit adalah 18,2%. Hasil penelitian dianalisis secara bivariat dilanjutkan multivariat. Hasil penelitian yang secara statistik signifikan adalah hipertensi kronik, riwayat preeklampsia, tekanan arteri rerata≥ 95 mmHg, dan indeks pulsatilitas a.uterina tinggi. AUC-ROC (kemampuan diskriminasi untuk memprediksi preeklampsia) 85%. Sehingga merupakan instrumen yang baik untuk uji diagnostik. Hasil ROC dari penelitian sebelumnya menunjukkan hasil yang serupa. Cut off dari penelitian ini 0,91 (sensitivitas 79% dan spesifisitas 84%). Hasil uji validitas eksternal dari penelitian sebelumnya diterapkan pada penelitian ini dan menunjukkan hasil yang valid dan memiliki akurasi yang baik. Kesimpulan: Faktor-faktor yang meningkatkan risiko preeklampsia, yaitu hipertensi kronik, riwayat preeklampsia, tekanan arteri rerata ≥95 mmHg, dan indeks pulsatilitas a.uterina tinggi. Hasil perbandingan uji diagnostik dan uji validitas eksternalbaik. ......Background: preeclampsia is still leading causes of morbidity and mortality in pregnant women. Until today, there is still no screening program to predict preeclampsia in Indonesia. In Jakarta 2018, conducted research on maternal risk factors and biophysical profile to predict preeclampsia. However, the results still needs to be performed external validation to confirm that the results of the study are valid and can be applied on different situations, populations, and times. Objective: to perform external validation of the previous studyMethods: A prospective cohort design. Participants are all pregnant women who perform antenatal care in RSCM, RSUK JoharBaru, and RSUK Tebet from April-November 2018. They will be followed until January 2019. Results: Total participants 467 subject. Incidence of preeclampsia from 3 hospitals was 18,2%. The results had been analyzed bivariate continuing multivariate. The results of this study which statistically significant werechronic hypertension, history ofpreeclampsia, mean arterial pressure≥ 95 mmHg, and high pulsatility index of uterine artery. AUC-ROC (discrimination ability to predict preeclampsia) was 85%. Therefore, it is a good instrument fordiagnostic test. The ROC result of previous study seen shows the similar result.Cut off of this study was 0,91 (79% sensitivity and 84% specificity). The result of external validity test from previous study which applied to this study was valid and showed a good accuracy.Conclusion: Several factors increase the risk of preeclampsia, such as chronic hypertension,history of preeclampsia, mean arterial pressure≥ 95 mmHg, and high pulsatility index of uterine artery. The results of diagnostic test and external validation test are good.

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ABSTRAK
Latar Belakang : Sejak dimulai penyelenggaraan sistem Jaminan Kesehatan Nasional, pemerintah menerapkan sistem rujukan berjenjang. Namun, RSUPN Dr. Cipto Mangunkusumo sebagai fasilitas kesehatan rujukan tingkat lanjutan mengalami peningkatan jumlah pasien, khususnya di Poliklinik Obstetri dan Ginekologi. Peneliti ingin mengetahui perbandingan pola kasus rujukan sebelum dan setelah era JKN di Poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo. Metode : Penelitian ini adalah observasional potong lintang dengan menggunakan data rekam medis pasien yang dirujuk ke Poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo selama tahun 2013 dan 2014. Analisis dilakukan dengan analisis bivariat dengan chi square untuk membedakan ketepatan diagnosis rujukan, ketepatan asal fasyankes perujuk, dan kesesuaian diagnosis rujukan sebelum dan setelah pelaksanaan JKN. Hasil : Terdapat peningkatan jumlah kunjungan Poliklinik Obstetri dan Ginekologi sejak dilaksanakannya program JKN pada tahun 2014, yaitu sebanyak 4.311 pasien. Jumlah subjek adalah sebanyak 222 subjek, terdiri dari 104 subjek pada tahun 2013 dan 118 subjek pada tahun 2014. Dari analisis data, didapatkan tingkat ketepatan diagnosis sebelum JKN adalah 81,7% dan setelah JKN 72,9% (p=0,118), tingkat ketepatan fasyankes perujuk sebelum JKN adalah 63,5% dan setelah JKN 71,2% (p=0,220), serta tingkat kesesuaian diagnosis sebelum JKN adalah 89,4% dan setelah JKN 84,7% (p=0,302). Kesimpulan : Tidak ada perbedaan yang bermakna secara statistik antara ketepatan diagnosis rujukan, ketepatan fasyankes perujuk, dan kesesuaian diagnosis fasyankes rujukan sebelum dan sesudah pelaksanaan JKN.

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ABSTRACT
Background : Since the start of National Health Coverage Program or in Indonesian Jaminan Kesehatan Nasional (JKN), the government has implemented vertical referral system. Even though Dr. Cipto Mangunkusumo General Hospital is the highest referral health facility, there is a growing number of patients, specifically in obstetric and gynacology outpatient clinic. Objective : To understand the pattern of referral cases (accuracy of referral diagnosis, accuracy of referral health facility and consistency of referral diagnosis) in obstetrics and gynecology outpatient clinic before and after the implementation of JKN. Methods : This is an observational cross sectional study using medical records of patients who were referred to obstetrics and gynecology outpatient clinic in Dr. Cipto Mangunkusumo General Hospital in 2013 and 2014. Data was analyzed with bivariate analysis with chi square, consisting the accuracy of referral cases, accuracy of referral health facility, and consistency of referral cases before and after implementation of JKN. Results: There is a growing number of patients in obstetrics and gynecology outpatient clinic after the implementation of JKN in 2014, which is 4.311 patients. Subjects were 222 cases, 104 cases from 2013 and 118 cases from 2014. From the analyzed data, the accuracy of referral diagnosis before JKN is 81,7% and after JKN 72,9%. (p=0,118), the accuracy of referral health facility before JKN is 63,7% and after JKN 72,9% (p=0,220), and the consistency of referral diagnosis before JKN is 89,4% and after JKN 84,7% (p=0,302). Conclusion : There is no statistically significant difference between the accuracy of referral diagnosis, accuracy of referral health facility, and consistency of referral diagnosis before and after the implementation of JKN.

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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%. ......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.

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Penelitian ini bertujuan untuk mengetahuikinerjaDokter Penanggung Jawab Pasien (DPJP) sebagai staf pengajar oleh peserta Program Pendidikan Dokter Spesialis (PPDS) di Departemen Obstetri dan Ginekologi Rumah Sakit Cipto Mangunkusumo pada bulan Januari hingga Juni 2013 dan faktor-faktor yang mempengaruhinya. Metode Desain penelitian ini adalah potong lintang menggunakan kuesioner yang sudah divalidasi, dengan responden peserta PPDS di ruang rawat, poliklinik, dan instalasi gawat darurat Departemen Obstetri dan Ginekologi RSCM pada bulan Januari - Juni 2013. Hasil Penelitian ini menghasilkan 131 kuesioner yang diisi oleh 40 peserta PPDS. Sebanyak 58.78% responden menyatakan kinerja DPJP sebagai pembimbing sudah baik, sementara 46.56% menyatakan fungsi DPJP sebagai pendidik sudah sangat baik. Terdapat hubungan antara lamanya DPJP menjadi konsultan dengan kinerja DPJP, bahwa DPJP yang menjadi konsultan kurang atau sama dengan 10 tahun dinilaimemilikikinerja lebih baik. Terdapat hubungan yang bermakna antara cara komunikasi langsungdan sering dengan kinerja DPJP yang sangat baik. Faktor lain yang dinilai pada penelitian ini, yaitu tahap PPDS, tempat penugasan DPJP, dan jabatan DPJP tidak menunjukkan hubungan yang bermakna. Kesimpulan Secara keseluruhan, dari ketiga fungsinya, kinerja DPJP dinyatakan baik. Hasil ini dinilai dari 2 sisi yaitu dari faktor DPJP maupun faktor PPDS, dan diketahui bahwa kinerja DPJP dipengaruhi oleh lamanya menjadi konsultan, dan juga intensitas dan cara diskusi dengan PPDS. ......Objective To assess the performance of Doctors-In-Charge of Patients (DICPs) as teaching staffby doctors enrolling in the Specialty Doctor Education Program (PPDS) in The Department of Obstetrics and Gynecology of Ciptomangunkusumo Hospital during the period of January to June 2013 as well as to explore the factors influencing their performance. Study design It is a cross-sectional study using a validated-questionnaire. Respondents of the study are doctors enrolling in the Specialty Doctor Education Program (PPDS) or generally referred to as residents in the inpatient rooms, outpatient clinic and emergency department of the Department of Obstetrics and Gynecology of Ciptomangunkusumo Hospital (RSCM) on January - June 2013. Results The study outcome was 131 questionnaires filled by 40 residents. The result showed that 58.78% of respondents stated that the performance of DICP as a counselor had been good, while 46.56% stated that DICP’s function had been very good. There was a relationship between the duration of DICP’s role as consultants with their performance, in which DICPs who had been consultants for 10 years or less were assessed to have better performances. There was also a significant relationship between the communication methodand frequency of DICPs and their performance. Other factors assessed are resident’s level of PPDS education, point of DICP’s assignment, and job position of DICPs did not show significant relationship. Conclusion Among its three functions, DICPs’ performance was considered as good. The result was assessed from two sides, including DICP factors and residents’ factors, and it was known that the performanceof DICP was influenced by the duration of their role as consultants; and their intensity of interaction and way of discussions with their residents.

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ABSTRAK
Telah diketahuinya PMTCT sebagai cara menurunkan angka transmisi vertikal ibu hamil HIV ke anaknya. Sejauh mana langkah-langkah PMTCT yang dilakukan di RSCM adalah dengan melihat luarannya yaitu status Human Immunodeficiency Virus (HIV) pada anak. Oleh karena itu kami mencari adanya perbedaan transmisi vertikal pada anak dari ibu hamil HIV positif pada PMTCT tidak lengkap dengan lengkap serta faktor-faktor yang mempengaruhi. Ini merupakan penelitian Kohort retrospektif dengan mengambil data dari rekam medis dan/atau menghubungi ibu dengan HIV dan anaknya dari Januari 2010-Februari 2012, secara retrospektif diambil. Dikumpulkan karakteristik dari para subjek, program PMTCT yang didapat dan faktor-faktor risiko sesuai dengan literatur sebelumnya yang mempengaruhi transmisi vertikal. Terdapat 75 ibu hamil dengan HIV positif namun hanya 54 pasang ibu-anak (72%) dengan data yang lengkap. Pada 27 ibu hamil yang mendapat PMTCT lengkap tidak ditemukan transmisi vertikal, sedangkan pada 27 ibu hamil lainnya dengan PMTCT tidak lengkap ditemukan 7 anak positif HIV. Dengan regresi logistik didapatkan hanya ketuban pecah ≥ 4 jam yang menjadi faktor risiko terjadinya transmisi vertikal (p 0.001, RR 64.5, CI 95% 6.14-677.6, uji regresi logistik). Terdapat perbedaan bermakna antara PMTCT tidak lengkap dan lengkap dan dengan melakukan PMTCT lengkap dapat memberikan efek protektif terhadap terjadinya transmisi vertikal sebesar 25.9% (RR 0.741).

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ABSTRACT
PMTCT program has been known as a way to decrease the rate of vertical transmission of HIV pregnant women to their children. The extent to which the steps are performed in the RSCM was to look at the HIV status in their children. Therefore this study analyzed any differences on vertical transmission in group with incomplete program and group with complete program as well as the factors influencing completion. This was a retrospective cohort study performed by data collection from medical records and / or interviews with the HIV-infected women from January 2010-February 2012. Variables analyzed were characteristics of the subjects, applied PMTCT program and risk factors that affect transmission. Seventy-five pregnant women with HIV-positive were initially recruited, but 21 subjects were excluded due to incomplete medical record. In first group (n=27) who received complete PMTCT, the vertical transmission were not found, while the second group (n=27) with incomplete PMTCT, seven children were HIV- positive. Rupture of membrane lasted for more than 4 hours was the only significant risk factor for vertical transmission (p 0.001, RR 64.5, CI 95% 6.14-677.6, logistic regression test). There was a significant difference between complete and incomplete PMTCT program. Complete PMTCT program may provide protective effect against the occurrence of vertical transmission of 25.9% (p 0.010, RR 0.741, CI 95% 0.593-0.926, Fisher’s test).

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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 bulan setelah 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 melepas AKDR 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%) dan perdarahan 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 needs Objectives: To evaluate the acceptability, effctivity and side effects of Postplacental IUCD after vaginal delivery at Cipto Mangunkusumo Hospital after 6 months period of insertion Methods: 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% subjects experienced 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

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Tesis ini bertujuan mengetahui kadar vitamin D dan zinc serum pasien preeklamsia berat dan hamil normal, mengetahui hubungan antara kadar vitamin D dan zinc dengan kejadian preklamsia berat, dan prevalensi preeklamsia berat di RSCM. Penelitian ini merupakan observasional potong lintang. Subyek penelitian adalah perempuan hamil yang menjalani persalinan di Kamar Bersalin RSCM pada Januari sampai dengan April 2014. Terdapat 22 subyek kelompok preeklamsia berat dan 22 subyek kelompok hamil dengan tekanan darah normal. Hasil penelitian didapatkan rerata kadar vitamin D dan median kadar zinc lebih rendah pada kelompok preeklamsia berat dibandingkan hamil normal, namun tidak berbeda bermakna. Kadar vitamin D dan zinc tidak berhubungan bermakna dengan kejadian preklamsia berat, dengan p=0,689 dan 0=0,517. Prevalensi hipertensi dalam kehamilan di RSCM adalah 31,07%, dengan rincian sebagai berikut: hipertensi kronik, hipertensi gestasional, preeklamsia ringan, preeklamsia berat, preeklamsia berat superimposed, sindrom HELLP, dan eklamsia gravidarum adalah 0,54%, 2,14%, 1,96%, 17,14%, 3,21%, 4,64%, dan 1,44%.

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The purpose of this investigation was to examine the maternal plasma level of vitamin D and zinc in cases of severe preeclampsia compare to normal pregnancy, to know association between level of vitamin D and zinc and severe preeclampsia, and to know prevalence of severe preeclampsia in Cipto Mangunkusumo. This is a cross sectional observational study. Subjects were pregnant women who gave birth in delivery room Cipto Mangunkusumo Hospital in between January and April 2014. There are 22 subjects in severe preeclampsia group and 22 subjects in normotensive pregnancy. Subject with severe preeclampsia were noted to have lower maternal vitamin D and zinc level to normotensive pregnancy with not significant statistically (p 0,689 and p 0,517). Prevalence of hypertension in Cipto Mangunkusumo hospital is 31,07% which is contain of: chronic hypertension 0,54%, gestational hypertension 2,14%, mild preeclampsia 1,96%, severe preeclampsia 17,14%, superimposed severe preeclampsia 3,21%, HELLP syndrome 4,64%, and eclampsia 1,44%.

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ABSTRAK
Pencegahan kematian maternal merupakan salah satu tujuan terpenting dari pelayanan maternal dan neonatal. Intervensi untuk menurunkan angka kematian ibu adalah kombinasi dari adanya tenaga terlatih, pelayanan obstetri emergensi dan tersedianya sistem rujukan. Saat ini usaha untuk menurunkan kematian maternal lebih mengarah pada penyediaan pelayanan obstetri dan neonatal emergensi dasar (PONED). Tingginya rujukan dari puskesmas dan angka kematian ibu di daerah kotamadya Jakarta Timur pada tahun 2012 menjadi perhatian peneliti sehingga kinerja puskesmas mampu PONED perlu dievaluasi. Jenis penelitian observasional dengan menggunakan pendekatan cross-sectional. Jumlah sampel yang diteliti adalah 8 puskesmas PONED yang berada di kotamadya Jakarta Timur.Pengumpulan data menggunakan kuosioner. Data dianalisa secara kuantitatif dengan menggunakan program statistik komputer stata 21. Penelitian inimengambil 8 sampel puskesmas PONED dan didapatkan faktor kinerja masukan yaitu struktur fisik ruangan, peralatan dan obat dan sumber daya manusia tidak memiliki hubungan yang bermakna dengan kelengkapan paket rujukan dan ketepatan waktu rujukan (0.196;0,196; 0,107; 0,107; 1,000; 0,143). Hubungan antara kinerja proses yaitu standard operating procedure (SOP), catatan medis dan tindakan PONED dengan kinerja keluaran pada puskesmas PONED di wilayah Jakarta Timur tidak dapat dianalisis secara statistik karena hasil sebaran data kinerja proses di puskesmas PONED wilayah Jakarta Timur seragam. Faktor lain yang mempengaruhi kinerja keluaran adalah keaktifan warga siaga, umpan balik rujukan dan adanya maklumat pelayanan yang belum ditelaah pada penelitian ini.

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ABSTRAK
Prevention of maternal mortality is one of the most important goals of maternal and neonatal care. Interventions to reduce maternal mortality rate involve several aspects, including presence of trained personnel, obstetric emergency care and availability of referral system. Current efforts to reduce maternal mortality rate are focused on the provision of Basic Emergency Obstetric and Newborn Care (BEmONC). However, the number of referral from community health centers and maternal mortality rate in East Jakarta in 2012 are still high. Thus, it’s important to evaluate the performance of community health centers which provide BEmONC. This study used cross-sectional design and involved 8 community health centers which provide BEmONC in East Jakarta. The collected data were analyzed quantitatively by using statistical program Stata 21. We found that the performance indexes in input sector, including physical structures of the building, equipment, drugs and human resources, have no significant relationship with the completeness of referral documents and time of referral (p= 0196; 0.196; 0.107; 0.107; 1.000; 0.143). Performance in process sector, including standard operating procedure (SOP), medical records and BEmONC care, at community health centers in East Jakarta were couldn’t analyzed due to similarity of data. We also identified several factors affecting performance in output sectors which have not been explored in this study. They are activity of warga siaga (community program involving husbands to support his pregnant wife), referral feedback, and availability of notice service

Abstrak :
[ABSTRAK
Latar Belakang : Inkontinensia urin sampai saat ini masih menjadi masalah bagi masyarakat dunia. Telah ada tiga penelitian yang membandingkan penurunan leher kandung kemih pada kelompok inkontinensia urin jenis stres dan kontinensia. Namun penelitian mengenai perbandingan tersebut belum ada di Indonesia sementara hasil penelitian yang telah ada belum dapat digeneralisir pada populasi di Indonesia. Berdasarkan hal tersebut peneliti ingin mengetahui apakah terdapat perbedaan rerata penurunan leher kandung kemih kelompok inkontinensia urin jenis stres dan kontinensia di Indonesia dengan perbedaan pada tiga buah aspek, yaitu aspek penegakan diagnosis, kelompok pembanding, dan pengukuran. Tujuan : Menganalisis perbedaan rerata mobilitas leher kandung kemih pada inkontinensia urin jenis stres dan kontinensia. Metode : Penelitian ini merupakan penelitian observasional. Untuk menjawab pertanyaan penelitian utama dan tambahan digunakan desain deskriptif potong lintang. Populasi target dalam penelitian ini adalah semua perempuan yang mengalami inkontinensia urin jenis stres dan kontinensia di Indonesia. Populasi terjangkau penelitian ini adalah semua perempuan yang mengalami inkontinensia urin jenis stres dan kontinensia masing-masing 37 orang yang berobat ke Unit Rawat Jalan Poliklinik Ginekologi RSCM periode Februari 2014 sampai Januari 2015. Hasil : Rerata jarak leher kandung kemih ke simfisis pubis saat istirahat, saat valsava dan mobilitas leher kandung kemih pada inkontinensia urin jenis stres berturut-turut adalah 26,9 ( SB 3,2) mm, 5 ( -29 - 22) mm dan 24,3 (SB 7,9) mm. Rerata jarak leher kandung kemih ke simfisis pubis saat istirahat, saat valsava dan mobilitas leher kandung kemih pada kontinensia berturut-turut adalah 26,9 (SB 3,2) mm, 17,6 (SB 5,3) mm dan 10 (SD 4,1) mm. Rerata jarak leher kandung kemih ke simfisis pubis saat valsava pada inkontinensia urin jenis stres lebih kecil dibandingkan kontinensia 6,3 (SB 7,1) mm VS 16,3 (SB 5,2) mm, p=0,0001. Rerata mobilitas leher kandung kemih pada inkontinensia urin jenis stres lebih besar dibandingkan kontinensia 20,8 ( SB 7,0) mm VS 10,0 (SD 4,8) mm, p=0,0001. Kesimpulan : Rerata jarak leher kandung kemih ke simfisis pubis saat valsava pada inkontinensia urin jenis stres lebih kecil dibandingkan kontinensia. Rerata mobilitas leher kandung kemih pada inkontinensia urin jenis stres lebih besar dibandingkan kontinensia.

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ABSTRACT
Background : Stress urinary incontinence still be the world problem. Various studies compared decreasing bladder neck on stress urinary incontinence and continence have been done. Research with the same purpose has not been done in Indonesia. Based on that, need to study how the comparison decreasing of bladder neck between stress urinary incontinence and continence groups in Indonesia with a difference in three aspects, such as diagnostic criteria, comparised group, and the observer. Aim : To analize difference bladder neck mobility on stress urinry incontinence and continence. Methods : This study was an observational study. Main and additional research questions using a cross-sectional design . The target population in this study were all women who undergo stress urinary incontinence and continence in Indonesia . The population of this study was affordable to all women who undergo stress urinary incontinence and continence were treated to the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital in the period Februari 2014 to January 2015. Results : Mean of distance of bladder neck to the symphysis pubic at rest, valsava and bladder neck mobility on stress urinary incontinence were 26,9 (SD 3,2) mm, 5 (-29 - 22) mm and 24,3 (SD 7,9) mm. Mean of distance of bladder neck to the symphysis pubic at rest, at valsalva and bladder neck mobility on continence were 26,9 (SD 3,2) mm, 17,6 (SD 5,3) mm and 10,0 (SD 4,1) mm. There was no differences between the distance of bladder neck to the symphysis pubic at rest on stress urinary incontinence and continence 27,1 (SD 3,3) mm VS 26,3 (SD 3,5) mm, p=0,523. Mean of distance of bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence 6,3 (SD 7,1) mm VS 16,3 (SD 5,2) mm, p=0,0001. Mean of bladder neck mobility on stress urinary incontinence was greater than continence 20,8 ( SD 7,0) mm VS 10,0 (SD 4,8) mm, p=0,0001. Conclusion : Mean of distance of the bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence. Mean of bladder neck mobility on stress urinary incontinence was greater than continence, Background : Stress urinary incontinence still be the world problem. Various studies compared decreasing bladder neck on stress urinary incontinence and continence have been done. Research with the same purpose has not been done in Indonesia. Based on that, need to study how the comparison decreasing of bladder neck between stress urinary incontinence and continence groups in Indonesia with a difference in three aspects, such as diagnostic criteria, comparised group, and the observer. Aim : To analize difference bladder neck mobility on stress urinry incontinence and continence. Methods : This study was an observational study. Main and additional research questions using a cross-sectional design . The target population in this study were all women who undergo stress urinary incontinence and continence in Indonesia . The population of this study was affordable to all women who undergo stress urinary incontinence and continence were treated to the Outpatient Clinic of Gynecology Unit of Ciptomangunkusumo Hospital in the period Februari 2014 to January 2015. Results : Mean of distance of bladder neck to the symphysis pubic at rest, valsava and bladder neck mobility on stress urinary incontinence were 26,9 (SD 3,2) mm, 5 (-29 - 22) mm and 24,3 (SD 7,9) mm. Mean of distance of bladder neck to the symphysis pubic at rest, at valsalva and bladder neck mobility on continence were 26,9 (SD 3,2) mm, 17,6 (SD 5,3) mm and 10,0 (SD 4,1) mm. There was no differences between the distance of bladder neck to the symphysis pubic at rest on stress urinary incontinence and continence 27,1 (SD 3,3) mm VS 26,3 (SD 3,5) mm, p=0,523. Mean of distance of bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence 6,3 (SD 7,1) mm VS 16,3 (SD 5,2) mm, p=0,0001. Mean of bladder neck mobility on stress urinary incontinence was greater than continence 20,8 ( SD 7,0) mm VS 10,0 (SD 4,8) mm, p=0,0001. Conclusion : Mean of distance of the bladder neck to the symphysis pubic at valsava on stress urinary incontinenc was lower than continence. Mean of bladder neck mobility on stress urinary incontinence was greater than continence]