Endometrial bleeding problems can be the major reason for discontinuing progestin-only contraception. In this study the endometrial angiogenic response in Norplant users was found to be lower than in women with normal menstrual cycles. These disturbances in angiogenic response may be caused by oxidant-antioxidant imbalance in the endometrium. The aims of this study were to investigate the effect of progestinonly contraceptives on blood concentrations of Iipid peroxide and vitamin E, and the effect of vitamin E supplementation on endometrial angiogenic response in vitro. The subjects for this study were Norplant users, depo-medroxyprogesterone acetate (DMPA) users, and controls. Circulating Iipid peroxide and vitamin E concentration was measured by routine methodology. Endometrial angiogenic response was assayed using an endothelial cell migration assay. The results showed that the blood concentrations of Iipid peroxide from Norplant users with bleeding problems were significantly higher than normal menstrual controls (P < 0.05) and supplementation of vitamin E (in vitro) increased the endometrial angiogenic score. Blood concentrations of Iipid peroxide were significantly increased (P < 0.05), and the blood concentrations of vitamin E were significantly decreased (P < 0.05) after 3 months exposure to Norplant or DMPA. The endometrial angiogenic scores in Norplant and DMPA users were significantly lower than in controls (P < 0.02). It is concluded that in progestin-only contraceptive users, higher Iipid peroxide and lower vitamin E concentration may cause endometrial cell damage and decrease the endometrial angiogenic response. It is suggested that vitamin E supplementation may counteract these unwanted side-effects.
Abstract Objective: To investigate the circumstances of the obstetric referral case at the emergency department of the Dr.Cipto Mangunkusumo Hospital as well as the accuracy of the referral implementation. Method: We used cross-sectional study. Medical records of obstetric patients at Emergency department in RSCM in January 2013-July 2014 were obtained, then information about patients and their characteristic were collected. The accuracy of referral cases is based on emergency obstetric criteria by BPJS rules. Results: Primary Health Care became the leading referrer. Inappropriate diagnostic referral cases amounted to 21.2%when JKN first began to be implemented in 2014. Cases with improper diagnoses were more referred when JKN was implemented which amounted to 16.8% and non-emergency referral cases of 6.9% in 2014. Conclusion: Referral implementation has not been efficient and effective, the number of obstetric referral cases to emergency department of RSCM that can actually be handled in the secondary advanced health services after the application of JKN is still high. Monitoring and evaluation is needed by the Local Health Office to improve the quality of the referral system that applied in the newly JKN era. Keywords:accuracy of referrals,BPJS, JKN, obstetric emergencies, referral system. Abstrak Tujuan: Mengetahui gambaran kasus rujukan obstetri di IGD RSCM dan ketepatan pelaksanaan rujukan. Metode: Deskriptif desain studi potong lintang. Data diambil dari rekam medis pasien obstetri di IGD RSCMpada bulan Januari 2013 hingga Desember 2014, kemudian informasi mengenai data dan karakteristik pasien dikumpulkan. Ketepatan pelaksanaan rujukan kasus gaat daraurat obstetri berdasarkan Krietria gawatdarurat bagian kebidanan menurut ketentuan BPJS Kesehatan. Hasil: Perujuk terbanyak adalah Puskesmas (FKTP). Kasus rujukan dengan ketidaksesuaian diagnosa lebih banyakjumlahnya pada saat JKN mulai diterapkan pada tahun 2014 sebesar 21.2%. Kasus dengan diagnosa yang tidak tepat rujuk lebih banyak pada saat JKN di laksanakan yaitu sebesar 16.8% dan kasus rujukan yang bukan gawatdarurat sebesar 6.9% pada tahun 2014. Kesimpulan: Pelaksanaan rujukan belum efisien dan efektif, jumlah rujukan obstetri ke IGD RSCM yangsebenarnya dapat ditangani di fasilitas kesehatan tingkat lanjutan sekunder setelah penerapan JKN masih tinggi. Dibutuhkan monitoring dan evaluasi oleh Dinas Kesehatan setempat untuk meningkatkan kualitas sistem rujukan yang berlaku di era JKN yang baru diterapkan. Kata kunci : BPJS, gawat darurat obstetri, JKN, ketepatan rujukan, sistem rujukan.
Seorang perempuan berusia 38 tahun dengan G5P1A3 (AH1) dan riwayat abortus habitualis, memiliki riwayat tumor jinak payudara 12 tahun lalu dan sudah dilakukan eksisi dengan hasil patologi dinyatakan jinak. Saat ingin menggunakan kontrasepsi hormonal, tenaga kesehatan menolak karena pasien memiliki riwayat tumor jinak payudara. Evidence based case report ini bertujuan untuk menelaah pengaruh kontrasepsi hormonal berbasis progestin pada perempuan dengan riwayat tumor payudara. Dilakukan pencarian melalui Pubmed®, Cochrane Library®, dan Google Scholar® menggunakan kata kunci atau Medical Subject Headings (MeSH). Didapatkan 3 buah artikel ulasan sistematik dan meta analisis berdasarkan penilaian validity, importance, and applicability (VIA). Sebuah ulasan sistematik dan meta analisis memperlihatkan tidak ada hubungan antara penggunaan progestin dengan risiko kanker payudara. Hanya ada satu ulasan sistematik yang memperlihatkan hubungan penggunaan progestin dengan risiko kanker payudara, namun studi tersebut memiliki heterogenitas tinggi. Kontrasepsi hormonal berbasis progestin tidak memiliki pengaruh terhadap peningkatan kejadian kanker payudara dan tidak berhubungan dengan kejadian tumor jinak payudara. Kata kunci: kontrasepsi berbasis progestin, tumor jinak payudara, kanker payudara. Influence of Progestin Contraception in Women with Breast Tumor History Abstract A 38-year-old women with G5P1A3 and recurrent pregnancy loss coming with history of benign breast tumor 12 years ago and it had been excised with the result of benign. When patient would like to apply hormonal contraception, health care provider refused due to history of benign breast tumor. Searching was conducted through Pubmed®, Cochrane Library®, and Google Scholar® with keyword or medical subject headings (MeSH). There were three systematic review and meta-analysis articles reviewed based on validity, importance, and applicability (VIA). A systematic review and meta-analysis showed that there was no relationship between progestin use and breast cancer risk. Only a systematic review stated the relationship between both of them; however, it showed high heterogeneity. Progestin based contraception does not have an effect to the incidence of breast cancer and there is no relationship with benign breast tumor. Keywords: progestin based contraception, benign breast tumor, breast cancer.
Objective: To evaluate related factors, which contribute to complication of teenage pregnancy. Method: A cross-sectional research by consecutive sampling method was held upon teenager who was having her first pregnancy or had just been having her first child. This research took place at dr. Zainoel Abidin Public Hospital, Banda Aceh, in period of June until November 2012. Result: By demographic characteristic, we obtained that the majority of complication of teenage pregnancy occur in the age range of 17-19 years old and most are within Sex maturation Rate grade 5. The most common complications are caesarean section, premature rupture of membranes and cephalo-pelvic disproportion. There is a significant relation between antenatal visit conducted in accordance with WHO criteria and economic level with the incidence of complication. Conclusion: We found significant relation between antenatal visit conducted in accordance with WHO criteria and economic level with the incidence of complication. Keywords: complications, teenage pregnancy.
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