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"ABSTRAKPenelitian ini bertujuan untuk mengetahui akurasi parameter pola gambaran ultrasonografi dan kadar CA 125 untuk membedakan endometrioma dengan kistadenoma musinosum yang merupakan penelitian uji diagnostik dengan desain penelitian cross-sectional yang dilakukan di Rumah Sakit Cipto Mangunkusumo dengan mengambil data retrospektif dari Januari 2015 hingga Desember 2017. Pasien poliklinik rawat jalan ginekologi dengan kecurigaan memiliki neoplasma ovarium kistik direkrut. Sebagai Gold standar adalah temuan histologi dari massa adneksa yang dioperasi. Pola gambaran ultrasonografi dan kadar CA 125 akan disusun menjadi model untuk mendiagnosis endometrioma, kistadenoma musinosum, tumor jinak lain, dan tumor ganas/ borderline. Analisis statistik dari prediksi model untuk mebedakan endometrioma dengan kistadenoma musinosum dihitung berdasarkan cross tabulation sehingga didapatkan nilai akurasi, sensitivitas, spesifisitas, nilai prediksi positif dan nilai prediksi negatif. Penelitian ini melibatkan 200 pasien, sebanyak 83 kasus (41,5%) adalah endometrioma, 50 kasus (25%) adalah kistadenoma musinosum, 35 kasus (17,5%) adalah tumor jinak lain, 32 kasus (16%) adalah tumor ganas/ borderline. Karakteristik endometrioma adalah median CA 125 158,25 IU/mL, dinding tipis (72,29%), unilokuler (78,31%), bilateral ( 56,60%), ekogenisitas ground glass (66,27%), adanya perlengketan (68,7%), tanpa komponen padat (80,7%), sementara itu karakteristik kistadenona musinosum adalah median CA 125 52,85 IU/mL, dinding tipis (58 %), multilokuler (76%), unilateral (98%), ekogenisitas campuran (52%), tanpa perlengketan (84%), dan tanpa komponen padat (66%). Akurasi dari model regresi multinomial untuk membedakan endometrioma dengan kistadenoma musinosum yaitu 86%, dengan nilai sensitivitas, spesifisitas, nilai prediksi positif, dan nilai prediksi negatif masing-masing 87%, 84%, 92%, dan 77%. Model ini akurat  secara statistik (p <0,05). Sebagai kesimpulan didapatkan parameter pola gambaran ultrasonografi dikombinasikan dengan kadar CA 125 memiliki kemampuan yang baik untuk membedakan endometrioma dengan kistadenoma musinosum.

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ABSTRACTThis study was aimed to assess the accuracy a set of parameter which are based on ultrasonography features and CA 125 level to discriminate endometrioma and mucinous cystadenoma. This was [i-[1] a diagnostic test research with cross-sectional study design conducted at Cipto Mangunkusumo Hospital with retrospective data from January 2015 through December 2017. Gynecological outpatients clinics with suspicion of having ovarian cyst neoplasms based on patient history, clinical examination and ultrasonography were recruited. The gold standard is the histological findings of discarded adnexal masses. We conducted models based on multinomial regression analysis using gray-scale ultrasound characteristics and CA 125 level variables to diagnose endometrioma, mucinous cystadenoma, other benign tumor, malignant/ borderline tumor. Statistical analysis were calculated using cross-tabulation, to get accuracy, sensitivity, specificity, positive predictive value, and negative predictive value to differentiate endometrioma and mucinous cystadenoma. This study involved 200 patients, as many as 83 cases (41.5%) were endometriomas, 50 cases (25%) were mucinous cystadenoma, 35 cases (17,5%) were other benign tumor, and 32 cases were (16%) malignant/ borderline tumor. The characteristic endometrioma patients were median CA 125 level 158,25 IU/mL, thin wall (72,29%), unilocular cysts (78,31%), bilateral ( 56,60%), ground glass echogenicity (66,27%), adhesion (68,7%), without solid component (80,7%), while the ovarian mucinous cystadenomas were median CA 125 52,85 IU/mL, thin wall (58 %), multilocular (76%), unilateral (98%), variable echogenicity (52%), without adhesion (84%), and without solid component (66%). The multinomial logistic models can discriminate endometrioma and mucinous cystadenoma with accuracy 86%, and sensitivity, specificity, positive predictive value, negative predictive value of 87%, 84%,  92%, and 77%, respectively. The models were significantly accurate (p<0,05). Inconclusion, a multinomial logistic model derived from ultrasonography features and CA 125 level can accurately to discriminate endometriomas and mucinous cystadenoma [i-[1]"

"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%."

"Latar Belakang: Kanker ovarium menduduki peringkat ke-3 sebagai kanker tersering pada perempuan di Indonesia. Keganasan ovarium dianggap sebagai silent killer karena tidak memiliki gejala yang signifikan pada stadium awal sehingga hampir 50% pasien datang sudah pada stadium lanjut. Oleh karena itu, diperlukan alat skrining di pelayanan primer untuk mendeteksi keganasan ovarium dan salah satu modalitas pemeriksaan adalah ultrasonografi sederhana.Tujuan: Mengetahui nilai diagnostik pemeriksaan ultrasonografi sederhana dalam menilai keganasan tumor ovarium dibandingkan hasil histopatologi pascaoperasi.Metode: Penelitian ini merupakan studi potong lintang pada pasien tumor ovarium di polikinik Ginekologi RSCM Jakarta yang dilakukan operasi pada bulan Maret hingga Juli 2015. Sampel penelitian diambil dengan metode consecutive sampling. Analisis menggunakan uji Chi-square dan regresi logistik untuk mencari hubungan antara pola morfologi ultrasonografi dengan hasil histopatologi dimana terdapat hubungan bermakna apabila nilai p<0,05. Selain itu, dibuat model persamaan dari regresi logistik untuk menghitung probabilitasHasil: Terdapat 80 subjek penelitian dimana 58 subjek (72,5%) dengan tumor jinak dan 22 subjek (27,5%) dengan tumor ganas. Hasil ultrasonografi dengan pola morfologi ≥2 menunjukkan hasil ganas pada 53,8% subjek dengan nilai diagnostik sensitivitas 100%, spesifisitas 82,8%, nilai duga positif 68,8%, dan nilai duga negatif 100%. Pola morfologi yang paling berpengaruh terhadap keganasan tumor ovarium adalah permukaan dalam dinding kista ireguler, multilokular, terdapat penonjolan papiler, dan ada bagian padat dalam tumor. Probabilitas subjek mendapat tumor ganas apabila memiliki pola morfologi ≥3 adalah lebih dari 88,9%,Kesimpulan: Pemeriksaan ultrasonografi sederhana dapat digunakan untuk mendeteksi keganasan tumor ovarium.

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Background: Ovarian cancer ranked 3rd most common cancer in Indonesian women. Ovarian malignancy is considered as silent killer because there is no significant symptom in early stage therefore almost 50% patients came in late stage. Thus, screening tool is needed in primary health care to detect ovarian malignancy and one of recommended modality is simple ultrasound examination.

Aim: To know diagnostic values of simple ultrasound examination to detect ovarian malignancy compared with post operative histopathologic findings.

Method: This study used cross-sectional design in Cipto Mangunkusumo Hospital gynecologic outpatients with ovarian tumor undergone operation between March to July 2015. Samples were taken using consecutive sampling. Analysis was done using Chi-square test and logistic regression to find the relationship between ultrasound morphologic patterns with histopathologic findings where there is a significant relationship when p value < 0.05. Furthermore, a model derived from logistic regression was made to calculate the probability having ovarian malignancy.

Result: There were 80 subjects which 58 subjects (72.5%) have benign tumor and 22 subjects (27.5%) have malignant tumor. Ultrasound examination result using ≥2 morphologic patterns gave malignant result in 53.8% subjects with diagnostic values of sensitivity of 100%, specificity 82.8%, positive predictive value of 68.8%, and negative predictive value of 100%. The most important patterns were irreguler internal cyst wall, multilocular, presence of pappilary projection, and presence of solid component. The probability of subject having ovarian malignancy if there were ≥3 morphologic patterns was more than 88.9%.

Conclusion: Simple ultrasound examination can be used to detect ovarian malignancy."

"Kehamilan remaja merupakan salah satu masalah dalam Obstetri dan Ginekologi,di negara maju sekalipun dan terutama di negara berkembang. Kehamilan remajamembawa morbiditas dan mortalitas, tidak hanya maternal namun juga neonatal.Beragam faktor risiko ikut menentukan morbiditas dan mortalitas kehamilanremaja. Penelitian ini merupakan penelitian potong lintang dengan consecutivesampling dimana data penelitian ini diperoleh dari Rumah Sakit dr. ZainoelAbidin, Banda Aceh selama periode waktu Juni hingga November 2012.

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Teenage pregnancy is one of the problems in Obstetric and Gynecology, even in

this modern era of Obstetric, mainly in developed country such as Indonesia.

Teenage pregnancy can come out with morbidity and mortality, not merely for the

mothers but also for the neonates. Several factors may contribute to the morbidity

and mortality of teenage pregnancy. This study was using cross sectional design

with consecutive sampling data. The data obtained in dr. Zainoel Abidin Public

Hospital, Banda Aceh in period of June until November 2012.

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"Latar Belakang: Preeklamsia merupakan penyebab utama morbiditas dan mortalitas ibu dan bayi di seluruh dunia. Gejala preeklamsia disebabkan oleh disfungsi endotel maternal. Eritrosit maternal dapat berperan menyebabkan disfungsi endotel maternal melalui gangguan keseimbangan nitric oxide. Stres oksidatif dan trace elements pada eritrosit dicurigai berperan menyebabkan gangguan produksi nitric oxide. Stres oksidatif eritrosit juga dapat mempengaruhi morfologi eritrosit. Tujuan: Penelitian ini membandingkan aktifitas antioksidan superoxide dismutase eritrosit, kadar trace elements eritrosit dan indeks eritrosit pada kehamilan normal dan preeklamsia. Metode: Penelitian ini merupakan studi potong lintang dengan jumlah sampel 20 pasien preeklamsia dan 20 pasien hamil normal yang melakukan kunjungan pada RS Cipto Mangunkusumo, RSUD Kab. Tangerang dan RSUD Koja. Pemeriksaan antioksidan superoxide dismutase eritrosit dengan metode ELISA dan pemeriksaan trace elements eritrosit dengan metode ICP-MS. Data disajikan dalam tabel dan dianalisis dengan uji parametrik yakni uji-t tidak berpasangan bila sebaran normal atau uji Mann-Whitney U bila sebaran tidak normal. Penelitian ini sudah lolos kaji etik dan mendapatkan persetujuan pelaksanaan dari Komite Etik Penelitian Kesehatan FKUI-RSCM.Hasil: Didapatkan kadar eritrosit preeklamsia dibandingkan kontrol adalah (4,39 ± 0,55 vs 3,84 ± 0,44 juta/ml) (p=0,001), MCV (83,01 ± 8,48 vs 88,53 ± 5,6 fL) (p=0,020), MCH (26,9 ± 3,6 vs 29,6 ± 5,7 pg) (p=0,009) dan MCHC (32,4 ± 1,7 vs 33,4 ± 1,03 %) (p=0,023). Tidak terdapat perbedaan bermakna RDW-CV eritrosit preeklamsia dibandingan kontrol 14,3 (12,5-23,7) vs 14,1 (12-16,2) (p=0,448). Kadar aktifitas SOD eritrosit kelompok preeklamsia dibandingkan kelompok kontrol adalah 35,74 ± 7,97 vs 28,9 ± 6,28 U/ml (p=0,005); Aktifitas SOD/Hb eritrosit kelompok preeklamsia dibandingkan kelompok kontrol adalah 310,8 ± 83,4 vs 257,88 ± 63,1 U/g Hb (p=0,029). Untuk trace elements preeklamsia dibandingkan kontrol adalah : Ferrum (67 (23-82) vs 75 (24-92)) fg/RBC (p=0,033); Cobalt (0,15 (0,05-0,61) vs 0,08(0,02-0,34)) ag/RBC (p=0,027); Selenium (18,5 ± 4,6 vs 21,7 ± 2,8) ag/RBC (p=0,014); Cadmium (0,10 (0,02-0,22) vs 0,33 (0,01-0.14)) (p=0,006) dan Timbal (9,37 ± 4,67 vs 5,6 ± 2,06) ag/RBC (p=0,003). Trace elements eritrosit mangan, nikel, cuprum, seng, arsenik, merkuri dan thalium tidak terdapat perbedaan antara kehamilan preeklamsia dan kontrol.

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Background : Preeclampsia is a major cause of maternal and infant morbidity and mortality worldwide. Symptoms of preeclampsia are caused by maternal endothelial dysfunction. Maternal erythrocytes can play a role in causing maternal endothelial dysfunction through impaired nitric oxide balance. Oxidative stress and micro-minerals in erythrocytes are suspected to play a role in causing impaired nitric oxide production. Oxidative stress of erythrocytes can also affect the morphology of erythrocytes. Objective : This study compared the anti-oxidant activity of erythrocyte superoxide dismutase, erythrocyte micro mineral content and erythrocyte index in normal pregnancy and preeclampsia. Methods: This study is a cross-sectional study with a sample of 20 patients with preeclampsia and 20 pregnant patients without preeclampsia who visited Cipto Mangunkusumo Hospital, Kab. Tangerang and hospitals. Koja. Examination of erythrocyte superoxide dismutase antioxidant by ELISA method and micro erythrocyte mineral examination by ICP-MS method. The data are presented in tables and analyzed by parametric test, unpaired t-test if the distribution is normal or the Mann-Whitney U test if the distribution is not normal. This research has passed the ethical review and received implementation approval from the Health Research Ethics Committee of the FKUI-RSCM.

Results: The preeclampsia erythrocyte levels compared to controls were (4.39 ± 0.55 vs 3.84 ± 0.44 million/ml) (p=0.001), MCV (83.01 ± 8.48 vs. 88.53 ± 5 .6 fL) (p=0.020), MCH (26.9 ± 3.6 vs 29.6 ± 5.7 pg) (p=0.009) and MCHC (32.4 ± 1.7 vs 33 ,4 ± 1.03%) (p=0.023). There was no significant difference in RDW-CV of preeclampsia erythrocytes compared to controls 14.3 (12.5-23.7) vs. 14.1 (12-16.2) (p=0.448). SOD activity levels of erythrocytes in the preeclampsia group compared to the control group were 35.74 ± 7.97 vs. 28.9 ± 6.28 U/ml (p=0.005);The erythrocyte SOD/Hb activity of the preeclampsia group compared to the control group was 310.8 ± 83.4 vs. 257.88 ± 63.1U/g Hb (p=0.029). For preeclampsia trace minerals compared to controls were: Ferrum (67 (23-82) vs 75 (24-92)) fg/RBC (p=0.033); Cobalt (0.15 (0.05-0.61) vs. 0.08(0.02-0.34)) ag/RBC (p=0.027); Selenium (18.5 ± 4.6 vs. 21.7 ± 2.8) ag/RBC (p=0.014); Cadmium (0.10 (0.02-0.22) vs. 0.33 (0.01-0.14)) (p=0.006) and Lead (9.37 ± 4.67 vs 5.6 ± 2.06) ag/RBC (p=0.003). The trace elements erythrocyte: manganese, nickel, cuprum, seng, arsenic, mercury and thallium showed no significant difference between the preeclampsia and control groups."

"Latar Belakang: Mortalitas neonatus global terjadi pada 19/1000 kelahiran hidup dan 35% diakibatkan komplikasi prematuritas dan ketuban pecah dini (KPD) preterm terjadi pada 30-40% dari seluruh kasus. Manajemen KPD preterm memerlukan ketepatan diagnosis, rujukan, dan intervensi agar tidak terjadi morbiditas dan mortalitas ibu dan janin. Di RS Cipto Mangunkusumo terdapat 737 persalinan preterm dari 1524 total kelahiran tahun 2017.Tujuan: Mengetahui hubungan proses rujukan terhadap luaran neonatus pada kasus ketuban pecah dini pada kehamilan preterm.Metode: Kohort retrospektif di RS Cipto Mangunkusumo pada pasien rujukan KPD preterm bulan Januari 2016-September 2017. Analisis statistik dengan SPSS 20.0.

Hasil: Terdapat 214 kasus KPD preterm. Asal rujukan terutama dari rumah sakit dan 36 kasus dirujuk karena tidak ada NICU dan 66 kasus karena fasilitas yang ada tidak mencukupi. Pemeriksaan sesuai standar pada 91 kasus, pemberian antibiotika pada 161 kasus dan pemberian kortikosteroid di tempat rujukan 143 kasus. Terdapat 94 neonatus dengan komplikasi; korioamnionitis klinis(18.69%), APGAR skor menit 1<7(19.16%), APGAR skor menit 5<7 (9.8%), RDS(32.34%), sepsis(37.38%) dan mortalitas(9.8%). Dari analisis multivariat, hubungan didapatkan antara asal rujukan dengan APGAR skor menit 1, usia kehamilan dan kortikosteroid dengan RDS, usia kehamilan, lama rujukan, kortikosteroid dan korioamnionitis klinis dengan sepsis neonatus.Kesimpulan: Alur rujukan KPD preterm berlangsung sesuai alur rujukan berjenjang. Terdapat hubungan antara proses rujukan dengan luaran neonatus.

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Background:  Neonatal mortality rate is 19/1000 live birth worldwide with 35% mortality due to complication of prematurity. Preterm premature ruptured of membrane caused 30-40% preterm birth. In Cipto Mangunkusumo hospital, total of peterm birth in 2017 was 737 cases from 1524 total birth. To prevent neonatal and maternal morbidity and mortality, prompt diagnosis, referral process and obstetric intervention are needed.Purpose: To evaluate the correlation between referral process and neonatal ocutcome in preterm premature ruptured of membrane.Method: This research was conducted in Cipto Mangunkusumo hospital on January 2016 to September 2017 with retrospective cohort study. Referral data and neonatal outcomes who fulfilled the inclusion criteria were collected and analyzed.Result: From data collection from January 2016 to July 2017, 334 cases with preterm premature ruptured of membrane and 214 cases fulfilled the inclusion criteria. Patients most  reffered from hospital due to limited facility (35.29%) and due to NICU was full (64.71%). Administration of antibiotic was found in 75.23% cases and 66.82% cases with corticosteroid administration from the first referral provider. Newborn with complication was found in 43.93%; clinical chorioamnionitis (18.69%), APGAR score minute 1 <7 (19.16%), APGAR score minute 5 <7 (9.8%), RDS (32.34%), neonatal sepsis (37.38%) and early neonatal mortality (9.8%). From bivariate analysis, first care provider has correlation with APGAR score minute 1 < 7 (p=0.00 1), RDS (p=0.003), and neonatal sepsis (p=0.01). Administration of corticosteroid correlated significantly with APGAR score minute 1 < 7 (p=0.003, RR 0.4, CI95% 0.23-0.96), RDS (p=0.002, RR 0.46, CI95% 0.27-0.79) and neonatal sepsis (p=0.001, RR 0.46, CI95% 0.28-0.75). Time of referral correlated significantly with neonatal sepsis (p=0.014, RR 1.7, CI95% 1.2-1.26). After multivariate analysis, correlation found in: first care provider with APGAR score minute 1, gestational age and corticosteroid administration with RDS, gestational age, length of referral and corticosteroid administration with neonatal sepsis.Conclusion: There is correlation between referral process and neonatal outcome."