Background Transverse Vaginal Septum (TVS) is a rare congenital abnormality, classified as the Mullerian duct anomaly development. 1,2 TVS incidence range from 1:2.000 to 1:72.000. Management of TVS may only requirement local excision with a simple end to end anastomosis of the vagina, and use of skin grafts, but this technique has been reported has common complications of secondary tissue contracture, which often lead to stenosis of the vagina. 3 In this case we managed TVS with simple flap technique to avoid such postoperative complications and maintain caliber of vagina. Case A 11 years old girl complained cyclical abdominal pain since a year ago without history of menstrual blood. Patient already had vaginal surgery for removing menstrual blood, but after vaginal surgery the menstrual blood cannot be removed, then referred to our hospital. Ultrasound examination revealed hematometra and hemocolpos. The septum location was 3,38 cm proximal distance from vaginal introitus with the thickness of 8.1 mm. We performed simple excision of the septum with formerly performed distal vaginal septum mucosa preparation creating lateral flaps, then approximating the flaps to the edge of the proximal vaginal mucosa with interrupted suture continued with hymenorraphy. The patient has no complaint 6 months after surgery with vaginal length 8 cm, and had regular menstrual cycle. Conclusion A simple flap surgery technique can be done in transverse vaginal septum, with no complication such as tissue contracture, vaginal stenosis, or insightly scarring. This is a simple technique and can be done with hymenorraphy to restore normal anatomy of hymen.
ABSTRACT Background : Abortion the ending of pregnancy due to removing an embryo or fetus before it can survive outside the uterus. Examination on placental tissue currently does not provide much information. Annexin V (ANX V), formerly known as placenta anticoagulant protein and alpha coagulant vascular, is found in the placenta and vascular endothelium and several other tissues. This ANX V is found at the top of the placenta syncytiotrophoblast, and it is also found that this protein content freely decreases with the antiphospholipid syndrome (APS). This study aimed to assess the relationship between the description of ANX V expression and histopathology of curettage tissue in patients with recurrent abortion. Methods : This study was conducted using curettage tissue samples of patients with recurrent abortion in the Obstetrics and Gynecology section of Abdul Manap Hospital and Baiturahim Hospital in February to August 2018. The collected samples were diagnosed with HE preparations, to determine histopathological features in each group, villi infarction. hydrophic villi, sincytial knots, fibrin stroma and inter villi thrombus with the highest total score were 15. Then immunohistochemical assessment with Annexin V (ANX V) results compared with positive controls and negative controls with cut-off points 10%. Results: We have found a recurrent abortion sample with positive Annexin V immunoexpression, which is the most common histopathological score of 11-15 on recurrent abortion (p = 0.001 and r = -0.784) Conclusion: There is a relationship between immunohistochemistry ANX V with histopathological features of recurrent abortion curettage. Keywords: Annexin V, Histopathology, Recurrent abortion ABSTRAK Latar Belakang: Abortus adalah keadaan pengeluaran hasil konsepsi sebelum janin dapat hidup di luar kandungan. Pemeriksaan pada jaringan plasenta saat ini tidak banyak memberikan informasi. Annexin V (ANX V), dulu dikenal dengan placental anticoagulant protein I dan vascular coagulant alfa, ditemukan di plasenta dan endotel vaskular dan beberapa jaringan yang lain. ANX V ini ditemukan di puncak permukaan sinsitiotrofoblas plasenta, dan ditemukan pula bahwa kadar protein ini secara bermakna menurun di villi plasenta penderita abortus dengan antiphospholipid syndrome (APS). Penelitian ini bertujuan melihat hubungan gambaran ekspresi ANX V dengan histopatologi jaringan kuretase pada penderita abortus berulang. Metode : Penelitian ini dilakukan dengan menggunakan sampel jaringan kuretase pasien abortus berulang di bagian Obstetri dan Ginekologi RS Abdul manap dan RS Baiturahim periode februari sampai agustus 2018. Sampel yang terkumpul dilakukan diagnosis terhadap sediaan HE, untuk menetukan gambaran histopatologis pada masing-masing kelompok yaitu infark villi, hidrofik villi, sincytial knots, fibrin stroma serta trombus inter villi dengan skor total tertinggi adalah 15. Kemudian dilakukan pemulasan dan penilaian imunohistokimia dengan Annexin V (ANX V) Hasil pulasan imunohistokimia Anti ANX V dibandingkan dengan kontrol positif dan kontrol negative dengan cut-off point 10%. Hasil: Didapatkan 30 sampel abortus berulang dengan imunoekspresi Annexin V positif, didapatkan paling banyak dengan skor histopatologi 11- 15 pada abortus berulang (p = 0.001 and r = -0.784). Kesimpulan: Terdapat hubungan antara imunohistokimia ANX V dengan gambaran histopatologi pada kuretase abortus berulang. Kata Kunci: Annexin V, Histopatologi, Abortus berulang
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