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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: 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: 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."

"ABSTRAKTujuan: Mengetahui efektifitas dan keamanan dari AVM dibandingkan dengan kuret tajam pada penanganan abortus inkomplit di bawah usia kehamilan 12 minggu dengan melihat dari lama tindakan, proporsi tingkat kebersihan evakuasi sisa konsepsi 1 minggu pasca tindakan, proporsi gejala-gejala infeksi 1 minggu pasca tindakan dan proporsi komplikasi pada saat tindakan AVM dan kuret tajam.Metode: Penelitian ini merupakan penelitian kohort prospektif (observasional) dengan jumlahsampel 62 subjek yang berkunjung dengan abortus inkomplit ke UGD RSCM, RS Fatmawati dan RSUD Karawang terbagi dalam 31 subjek pada kelompok prosedur AVM dan 31 subjek pada kelompok prosedur kuret tajam. Data dikumpulkan melalui pencatatan waktu lama prosedur AVM dibandingkan kuret tajam, pemeriksaan klinis komplikasi selama prosedur berlangsung, pemeriksaan klinis kebersihan sisa konspesi 1 minggu pasca tindakan dan gejala-gejala infeksi 1 minggu pasca tindakan.Hasil: Sebanyak 62 subjek (masing-masing 31 subjek), dimana didapatkan rerata dan simpang baku prosedur AVM 17,65 ± 4,128 menit dan kuret tajam 22,26 ± 4,611 menit dengan p = 0,00 dan IK 95% -4,513(-6,837 s/d -2,389), bermakna secara statistik. Pada perbandingan proporsi tingkat kebersihan evakuasi sisa konsepsi 1 minggupasca tindakan didapatkan pada AVM 3,2% (n = 1) dan pada kuret tajam 6,5% (n = 2) terdapat sisa konsepsi dengan penilaian klinis, p = 0,554, RR = 1,034 dan IK95% 0,924-1,158 tidak memiliki perbedaan bermakna secara statistik. Pada perbandingan lainnya, tidak ditemukan gejala-gejala infeksi 1 minggu pasca prosedur dan komplikasi selama prosedur berlangsung pada prosedur AVM dan kuret tajam.Kesimpulan: AVM juga memiliki keunggulan dalam kebersihan sisa konsepsi namun tidak bermakna secara statitik dan memiliki keamanan yang setara dengan kuret tajam dari tingkat gejala infeksi dan komplikasi selama prosedur.

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ABSTRACTObjective: To acknowledge the effectiveness and safety of MVA compare with SC in management of incomplete abortion below 12 weeks of gestation which compare time to perform procedure, rates of evacuation and infection one week after procedure, and complication during MVA and SC procedureMethods: A prospective study with 62 subjects with complain incomplete abortion came to ER at RSCM, RS Fatmawati and RS Karawang, divided into 31 subjects on MVA group and 31 subjects on SC group. The data was documented on the time of MVA procedure compare to SC, clinical findings on complication during procedure, completed evacuation and infection symptoms one week after procedure.Results: Sixty two subjects (31 each group) with average time of procedure was 17,65 ± 4,128 minutes and SC was 22,26 ± 4,611 minutes with p = 0,00 and 95% CI; -4,513(-6,837 to -2,389 with significant statistically difference. The comparison of completed evacuation one week after procedure was 3,2% (n = 1) on MVA and 6,5% (n = 2) on SC with clinical findings, and p = 0,554, RR = 1,034 and 95% CI 0,924-1,158 with no statistically difference. On the other comparison, we didn't find any infection symptoms one week after procedure and complication during procedure on both of procedures.Conclusion: MVA has more effective than SC on the time of procedure in incomplete abortion with below 12 weeks of gestation. MVA has superiority from completed evacuation but no statistically difference and has equal safety to SC on clinical infection symptoms and complication during procedure."

"Latar belakang: Angka Kematian Ibu (AKI) merupakan salah satu indikator yangdigunakan untuk mengukur status kesehatan ibu pada suatu wilayah. Asuhan antenatalmerupakan salah satu pilar utama safe motherhood untuk menuju kesehatan ibu yangberkualitas. Melalui kerjasama Kemenkes perbaikan kualitas pelayanan asuhan antenataldi Indonesia melalui penyusunan Instrumen Umpan Balik Untuk Pengumpulan DataKualitas Pelayanan Kesehatan Ibu dan Bayi Baru Lahir.Tujuan: Diketahuinya data kualitas pelayanan asuhan antenatal di RSCM denganmenggunakan Instrumen Umpan Balik Pengumpulan Data Kualitas Pelayanan KesehatanIbu dan Bayi sehingga dapat dilakukan optimalitasi dan perbaikan terhadap komponenkomponenterkait.Metode: Rancangan penelitian ini menggunakan desain deskriptif kualitatif yangmenganalisis data kualitas pelayanan asuhan antenatal di RSCM. Penelitian ini akanberlangsung pada bulan September pada fasilitas pelayanan asuhan antenatal di RSCM.Sampel penelitian ini menggunakan total sampling. Rancangan penelitian inimenggunakan desain deskriptif kualitatif yang menganalisis data kualitas pelayananasuhan antenatal di RSCM. Penelitian ini akan berlangsung pada bulan September padafasilitas pelayanan asuhan antenatal di RSCM. Sampel penelitian ini menggunakan totalsampling.Hasil: Penelitian dilakukan selama 1 bulan dengan cara melakukan observasi fasilitaspelayanan, observasi dan wawancara petugas kesehatan, evaluasi rekam medik sertawawancara pada pasien pelayanan asuhan antenatal di RSCM dari sarana fisik dankelengkapan medis mencakup 45 dari 66 butir (72 %), obat-obatan dan bahan medis 68dari 71 butir (97%), Pemerikaan laboratorium 36 dari 36 butir (100%), kualitas pengisianbuku KIA serta rekam medis rata-rata 54 %, kualitas penerimaan informasi dan persepsipasien menyatakan puas terhadap pelayanan di RSCM.Kesimpulan: Kualitas pengisian buku KIA dan kelengkapan rekam medis di RSCMmenurut Instrumen Umpan Balik Untuk Pengumpulan Data Kualitas PelayananKesehatan Ibu dan Bayi Baru Lahir masih sangat kurang. Persepsi ibu hamil yangdiwawancara pada penelitian ini menunjukkan persepsi yang puas terhadap pelayanandan kualitas pelayanan asuhan antenatal di RSCM. Temuan yang tidak sesuai standarsebagian karena ketidak sesuaian standar instrumen tersebut dengan standar RSCMsebagai rumah sakit rujukan tipe A.

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Backgrounds : Maternal Mortality Rate (MMR) is one indicator used to measure

maternal health status in an area. Antenatal care is one of the main pillars of safe

motherhood to achieve quality maternal health. Through the collaboration of the Ministry

of Health to improve the quality of antenatal care services in Indonesia through the

preparation of a Feedback Instrument for Collecting Data on the Quality of Maternal and

Newborn Health Services.

Aim : Knowing the quality of antenatal care service data at the RSCM by using the

Feedback Instrument Quality Data Collection of Maternal and Infant Health Services so

that it can be optimized and improved on related components.

Method : The design of this study uses a qualitative descriptive design that analyzes data

on the quality of antenatal care services at RSCM. This study will take place in September

at the antenatal care facility at RSCM. This study sample uses total sampling.

Result : The study was conducted for 1 month by observing service facilities, observing

and interviewing health workers, evaluating medical records and interviewing patients

with antenatal care services at RSCM from physical facilities and medical equipment

including 45 out of 66 items (72%), medicines and medical materials 68 out of 71 items

(97%), laboratory examination 36 out of 36 items (100%), quality of KIA book filling

and medical records an average of 54%, the quality of information reception and patient

perceptions expressed satisfaction with the service at RSCM.

Conclusion: The quality of filling KIA books and the completeness of medical records

at RSCM according to the Feedback Instrument for Data Collection of Quality of Health

Services for Mothers and Newborns is still very poor. The perception of pregnant women

interviewed in this study shows a satisfying perception of the service and quality of

antenatal care services at RSCM. The findings that are not in accordance with the standard

are partly due to the incompatibility of the instrument standards with the RSCM standard

as a type A referral hospital."

"Latar Belakang: Kanker ovarium merupakan kanker kedelapan tersering, terhitung hampir 4% dari semua kanker pada perempuan di dunia. Kanker ovarium memiliki prognosis yang buruk dan angka kematian tertinggi. Setiap tahunnya terdapat 225.000 perempuan yang terdiagnosis kanker ovarium dan 140.000 perempuan meninggal disebabkan oleh penyakit ini. Berdasarkan jumlah tersebut, 90% kasus merupakan kanker ovarium epitelial. Bila berdasarkan stadium, lebih banyak pasien datang terdiagnosis dengan kanker ovarium stadium lanjut dibandingkan dengan stadium dini. Hal ini dikarenakan kanker ovarium bersifat asimtomatik, onset gejala yang terlambat dan belum adanya skrining yang terbukti efektif untuk kanker ovarium. Tujuan utama pengobatan kanker stadium lanjut adalah memperpanjang waktu untuk bertahan hidup dengan kualitas hidup yang baik dan tata laksana standarnya adalah operasi sitoreduksi. Di RSCM, evaluasi kesintasan dari pasien kanker ovarium epitelial stadium lanjut yang menjalani operasi sitoreduksi belum dianalisis.Tujuan: Mengetahui kesintasan pasien kanker ovarium stadium lanjut yang menjalani operasi sitoreduksi di RSCM dan juga mengetahui kesintasannya berdasarkan hasil histopatologi dan pemberian kemoterapi ajuvan.Metode: Penelitian ini merupakan penelitian kohort retrospektif dengan menggunakan data dari rekam medis. Pengambilan sampel dilakukan dengan cara consecutive sampling. Subjek penelitian adalah semua pasien kanker ovarium epitelial stadium lanjut yang menjalani operasi sitoreduksi pada bulan Januari 2013-Januari 2015 di RSCM.Hasil: Dari 48 subjek yang diteliti, didapatkan sebanyak 23 (48%) subjek menjalani operasi sitoreduksi optimal dan 25 (52%) subjek menjalani operasi sitoreduksi suboptimal. Didapatkan kesintasan 5 tahun pada pasien yang menjalani operasi sitoreduksi optimal sebesar 43,5%, sedangkan untuk sitoreduksi suboptimal sebesar 32%. Pada pasien yang menjalani operasi sitoreduksi optimal, yang diberikan kemoterapi ajuvan didapatkan kesintasan 5 tahun sebesar 40%, sedangkan pada pasien yang tidak diberikan sebesar 46,2%. Pada pasien yang menjalani operasi sitoreduksi suboptimal, yang diberikan kemoterapi ajuvan didapatkan kesintasan 5 tahun sebesar 40%, sedangkan pada pasien yang tidak diberikan sebesar 20%. Pada pasien dengan hasil histopatologi seromusinosum didapatkan kesintasan 5 tahun sebesar 100%, sedangkan untuk serosa, musinosa, endometrioid dan sel jernih berturut-turut sebesar 50%, 33,3%, 25%, dan 21,4%.Kesimpulan: Operasi sitoreduksi optimal memiliki kesintasan 5 tahun yang lebih baik dibandingkan dengan operasi sitoreduksi suboptimal. Operasi sitoreduksi suboptimal dan tidak dilanjutkan dengan pemberian kemoterapi ajuvan memiliki kesintasan yang buruk. Jenis histopatologi seromusinosum memiliki kesintasan yang lebih baik dibandingkan dengan jenis serosum, musinosum, endometrioid dan sel jernih.

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Background: Ovarian cancer is the eighth most common cancer, almost 4% of all cancers in women in the world. Ovarian cancer has a poor prognosis and the highest mortality rate. Every year 225,000 women are diagnosed with ovarian cancer and 140,000 women die from this disease. Based on this number, 90% of cases are epithelial ovarian cancer. Based on stadium, more patients diagnosed with advanced-stage ovarian cancer compared with early stage, because ovarian cancer is asymptomatic, delayed onset and there is no screening that has proven effective for ovarian cancer. The standard management for advanced stage ovarian cancer is debulking surgery. At RSCM, evaluation of survival of advanced stage epithelial ovarian cancer patients who were performed debulking surgery has not been analyzed.

Objective: Knowing the survival of patients with advanced-stage ovarian cancer who underwent debulking surgery at RSCM and also knowing their survival based on histopathological results and adjuvant chemotherapy.

Methods: This was a retrospective cohort study using data from medical records. Sampling was done by consecutive sampling. The subjects of this study were all patients with advanced-stage epithelial ovarian cancer patients who were performed debulking surgery in January 2013-January 2015 at RSCM.

Results: From the 48 subjects, 23 (48%) subjects were performed optimal debulking surgery and 25 (52%) subjects were performed suboptimal debulking surgery. Overall survival in patients undergoing optimal debulking surgery is 43.5% with a median survival rate of 39 months, while for suboptimal debulking surgery is 32% with a median survival rate of 29 months. In patients who underwent optimal cytoreduction surgery, those given adjuvant chemotherapy obtained a overall survival is 40%, whereas in patients who were not given is 46.2%. In patients who underwent suboptimal cytoreduction surgery, those who were given adjuvant chemotherapy found a overall survival rate of 40%, whereas in patients who were not given is 20%. In patients with histopathological results seromucinous obtained 5-year survival by 100%, while for serous, mucous, endometrioid and clear cells simultaneously were 50%, 33.3%, 25%, and 21.4%.

Conclusion: Optimal debulking surgery has a better 5-year survival compared to suboptimal debulking surgery. Suboptimal cytoreduction surgery and not followed by adjuvant chemotherapy has poor survival. The histopathological type of seromucinous has better survival compared with the types of serous, mucinous, endometrioid and clear cells."

"ABSTRAK Latar Belakang: Satu pertiga kehamilan di negara berkembang merupakan kehamilan yang tidak diinginkan. Akibat upaya terminasi kehamilan baik dilakukan oleh tenaga medis maupun tenaga non medis dapat menyebabkan morbiditas dan mortalitas ibu. Metode efektif untuk menanggulanginya ialah Kontrasepsi Darurat Kondar . Namun belum ada penelitian yang mengevaluasi pengetahuan tenaga kesehatan, khususnya bidan sebagai lini terdepan terhadap kondar. Oleh karena itu, perlu diketahui tingkat pengetahuan, sikap, dan perilaku bidan terhadap kondar di IndonesiaTujuan: Penelitian ini bertujuan untuk mengetahui tingkat pengetahuan, sikap, dan perilaku bidan terhadap kondar. Metode: Penelitian ini menggunakan desain potong lintang. Dengan Consecutive sampling. peneliti mengambil semua subjek yaitu bidan yang bekerja di wilayah Kecamatan Cipondoh Kabupaten Tangerang sampai jumlah subjek minimal terpenuhi sebesar 97 orang. Pengambilan data dilakukan dengan menggunakan kuesioner tertulis yang dibuat oleh peneliti berdasarkan penelitian-penelitian terdahulu dengan tema serupa. Data yang diperoleh akan dilaporkan secara deskriptif untuk variabel kategorik. Hasil analisis disajikan dalam bentuk jumlah n dan persentase proporsi . Penyajian data deskriptif dibuat dalam bentuk tabel maupun grafik. Hasil: Dari 100 responden, 83 bidan mempunyai pengetahuan yang baik terhadap kondar. Sikap bidan yang baik terhadap kondar di puskesmas dan di praktek swasta adalah 84,62 dan 85,06 , berturut-turut. Sejalan dengan itu, perilaku yang baik ditunjukkan oleh bidan di puskesmas dan di praktek swasta adalah sebesar 100 dan 94,25 . Namun dari pertanyaan secara kualitatif tingkat pengetahuan , sikap dan prilaku bidan masih tergolong kurang. Kesimpulan: Tingkat pengetahuan, sikap dan perilaku bidan terhadap kontrasepsi darurat dikatakan masih kurang. Masih dibutuhkan pelatihan tentang kondar pada bidan agar penggunaannya efektif di masyarakat. Kata Kunci: Kontrasepsi darurat, bidan, kehamilan tidak diinginkan, Alat kontrasepsi dalam rahim ABSTRACT Background One third of pregnancies in developing countries is an unwanted pregnancy. Due to pregnancy termination efforts performed by both medical personnel and non medical personnel can cause maternal morbidity and mortality. The effective method for dealing with them is Emergency Contraception EC . However, there is no research that evaluates the knowledge of health workers, especially midwives as the leading line of condar. Therefore, it is necessary to know the level of knowledge, attitudes, and behavior of midwives to EC in IndonesiaAim This study aims to determine the level of knowledge, attitudes, and behavior of midwives to EC. Methods This study used cross sectional design. With Consecutive sampling. Researchers took all the subjects of the midwife who worked in the District Cipondoh Tangerang, Banten , Indonesia until the number of subjects is met at least 97 people. The data were collected by using written questionnaires made by researchers based on previous studies with similar themes. The data obtained will be reported descriptively for categorical variables. The analysis results are presented in the form of sum n and percentage proportion . The presentation of descriptive data is made in the form of tables and graphs. Result Of the 100 respondents who answered the questionnaire, 83 of the midwives had a good knowledge of the condition. Good midwife attitudes toward condar in puskesmas and in private practice were 84.62 and 85.06 , respectively. Accordingly, the good behavior shown by midwives in puskesmas and in private practice is 100 and 94.25 . But from the question qualitatively the level of knowledge, attitude and behavior of midwives is still classified as less. Conclusion The level of knowledge, attitudes and behavior of midwives towards emergency contraception is said to be lacking. Training on EC on midwives is still needed for effective use in the community. Keywords Emergency contraception, midwife, unwanted pregnancy, uterine contraception. "