Bram Pradipta
Faculty of Medicine University of Indonesia/ Dr. Cipto Mangunkusumo Hospital Jakarta

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CESAREAN MYOMECTOMY: A CASE REPORT IN ZAINOEL ABIDIN GENERAL HOSPITAL, BANDA ACEH, INDONESIA Pradipta, Bram; Andalas, Mohd.
Proceedings of The Annual International Conference, Syiah Kuala University - Life Sciences & Engineering Chapter Vol 1, No 1 (2011): Life Sciences
Publisher : Syiah Kuala University

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The objective of the present study was to improve skill and knowledge in making a Cesarean myomectomy decision, its complications and its post operative care. Uterine myomas are the most common pelvic tumors over the age of 30. The incident of myomas in pregnancy are 0.05-5%.Myomas are now more frequently seen as many women delaying childbearing which is the time for greatest  risk of myoma growth. Also the use of ultrasonography has improved the diagnostic capability of detecting small myomas and has increased our knowledge of myomas in pregnancy. Myomectomy during cesarean section has traditionally been discouraged because of the risk of uncontrollable hemorrhage.  There are approximately 7 choices to be made according cesarean myomectomy such to leave it be, to leave it with Uterine artery ligation, to remove pedunculated fibroids only, to remove pedunculated, anterior subserous or lower uterine segment fibroids, to remove all anterior uterine fibroids, to remove all fibroids and selective removal of fibroids. A 32- year-old, gravida 3 para 2, Indonesian women presented with postterm-pregnancy and 20 cm intra mural- uterine myoma. Cesarean myomectomy was done to her with little to none intraoperative hemorrhage. Post C-section we found complications shown by uterine atony, profuse bleeding seen at the drainage through the peritoneum and marked changes in hemoglobin value. It is then carefully evaluated and managed using extensive follow up, high dose oxytocyin and blood transfusion. Cesarean myomectomy is now considered by many not always as a hazardous procedure and can be performed  in experienced hands, in a well equipped tertiary institution, with the advent of better anesthesia, with  availability of blood, in selected patients and according to site and size of myomas. It is always important to have a good informed consent beforehand and post operative care of cesarean myomectomy
LATE POST PARTUM HEMORRHAGE - CAUSES AND DEFINING ASPECTS: CASE SERIES IN ZAINOEL ABIDIN GENERAL HOSPITAL, BANDA ACEH, INDONESIA Pradipta, Bram; Yeni, Cut Meurah
Proceedings of The Annual International Conference, Syiah Kuala University - Life Sciences & Engineering Chapter Vol 1, No 1 (2011): Life Sciences
Publisher : Syiah Kuala University

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Improving skill and knowledge in making a diagnosis and management of late post partum hemorrhage.Globally, more than half a million women die annually due to pregnancy and childbirth. Bleeding causes 28% of the direct causes of maternal deaths and remains the most common cause of maternal death. In developing countries, several countries have maternal mortality ratio over 1000 women per 100,000 live births, and WHO statistics illustrates that 25% of maternal deaths resulting from post partum hemorrhage, which counted more than 100,000 maternal deaths per year. Postpartum hemorrhage can be divided into 2 types: early postpartum hemorrhage, which occurs within 24 hours of delivery, and late postpartum hemorrhage, which occurs 24 hours to 6 weeks after delivery. Most cases of postpartum hemorrhage, greater than 99%, are early postpartum hemorrhage. Notably, most women are still under the care of their delivering provider during this time. But a few are considered late postpartum hemorrhage. Here we presented case series consisted of two cases with late postpartum hemorrhage. Both of them enrolled in Zainoel Abidin General Hospital OBGYN emergency ward as an outpatient post c-section patient. The first case was a 38 years old Indonesian women, Parity 4, post-cesarean section that comes with hypovolemic shock and post partum hemorrhage and foul smelling lochia. Six days after treatment the patient is discharged with good condition with abnormalities found in the form of disturbances of uterine contractions and uterine infection. The second case was a 19 years old, parity 1, post-Caesarean section 120 days ago for CPD indication that comes with recurrent bleeding after the operation. Curettage of the endometrium was then done to the patient in Bireun Hospital prior to the Zainoel Abidin General Hospital, but the bleeding persisted. Patients were then treated for 10 days and discharged with good condition with a diagnosis of abnormal uterine bleeding. With many women delivering outside of hospitals and early postpartum hospital discharge being a growing trend, postpartum hemorrhage that presents to the emergency department may be either early or late. Late post partum hemorrhage though a minority still poses great risk to maternal health. Key management of both early and late HPP are rapid assesment and diagnosis of conditions, restoration of blood volume and simultaneously search for the cause. HPP diagnosis is confirmed by observing the amount of bleeding and the patient's clinical symptoms. Management of HPP requires teamwork and a systematic yet comprehensive management
OVARIAN CRYOPRESERVATION AND TRANSPLANTATION: A PRESERVING FERTILITY PROCEDURE Pradipta, Bram; Rajuddin, .; Andalas, Mohd
Proceedings of The Annual International Conference, Syiah Kuala University - Life Sciences & Engineering Chapter Vol 2, No 1 (2012): Life Sciences
Publisher : Syiah Kuala University

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Abstract

Cancer is a major health problem in both developed and developing countries. In women, cancer incidence rates increased every year. Developments in treatment modalities and the ability to detect tumours in the early stages increased their survival rate but also raise fertility problems. Those problems are the fertility preservation for patient who have to endure gonadotoxic chemotherapy and or radiation even though they still need their fertility functions. Ovarian cryopreservation and autotransplantation were initially designed to protect and restore reproductive function in patients receiving sterilizing chemotherapy and/or radiotherapy. Other indications including patients undergoing haematopietic stem cell transplantation, autoimmune diseases and those undergoing oophorectomy for non-cancer conditions. Options in cryopreserved ovarian tissues include autotransplantation and xenotransplantation. An orthotopic site or a heterotopic site can be considered for autotransplantation. Xenotransplantation of human ovarian tissue into immunodeficient animals can prevent immunological rejection.  The theoretical advantage of orthotopic grafts is the restoration of normal reproductive function and natural conception after transplantation but application for cancer patients is problematic because of the potential risk of transmission of microscopic metastatic disease. With Xenotransplantantion, the possibility of cancer transmission and relapse can be eliminated because cancer cells cannot penetrate the zona pellucida, and some technical difficulties of in vitro growth and maturation of primordial follicles can be bypassed. But it is still unknown whether conditions for the growth and maturation of human oocytes in an animal host are comparable to those in situ and whether animal pathogens can be transmitted to human tissue with it. Ovarian tissue cryopreservation is the fertility preservation option for prepubertal girls and for women who face thehigh likelihood of diminished ovarian reserve requiring immediate treatment. Its procedure are still within improvement and also in the study of understanding its mechanism. In the future, studies and large clinical trials are still needed to develop better cryoprotectants and cryopreservation protocols and also standardization - optimization transplantation techniques
GLIOBLASTOMA IN PREGNANCY: A CASE REPORT Pradipta, Bram; Yeni, Cut M.
Proceedings of The Annual International Conference, Syiah Kuala University - Life Sciences & Engineering Chapter Vol 2, No 1 (2012): Life Sciences
Publisher : Syiah Kuala University

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Abstract

Incidence of primary intracranial tumour in pregnancy is very rare. This rare association  is becoming more common because women in developed societies defer childbearing to the third or fourth decade of life. We presented A case of a 33- year-old, gravida 2 para 1, Indonesian Acehnese women presented with pregnancy and recurrent Glioblastoma. Her chief complaint was headache that is worsening since 1 month ago. She is a patient of Neurosurgery Department since 7 months earlier with complaints of major headache, vomitting,  seizure and weakness of the left part of her body when she was 12 weeks pregnant. Patients was diagnosed with brain tumor on right temporoparietal region. Her CT scan result are midline shift to the left of falx cerebri with obliterated right ventricle and hypodens mass on right region size 5,04x 5,17 cm x 5,79 cm. Craniotomy was performed with no regards of the pregnancy but the patient refuse to terminate the pregnancy. Post craniotomy patient was supposed to undergo series of radiotherapy but decided not to since it may complicate her pregnancy. After 5 month went untreated, patient then had another CT scan due to her recurring complaint and the result was there?s an area of hypo and hyperdens in fronto parietal dextra and sinistra with brain edema. The patient was treated for a week when her condition was worsening with loss of consciousness. We then perfomed joint operation with Neurosurgery dept consist of Cesarean section that was continued with craniotomy where we delivered a heathy 1900 gram baby boy. The patient was then treated for 2 days in the intensive care unit and another 4 days in the ward then discharged home in good condition. Every brain tumours in pregnancy bring  dilemmas with no standard treatment in medicine.  Its diagnosis  is challenging because of the need to treat the mother and minimizing the effects of cancer treatment on the fetus. The treatment intention is  to minimise mortality and morbidity for both maternal and fetal which can be achieved by prolonging pregnancy while alleviating complications from the brain tumour. The management have to be individualised  from a multi-disciplinary team and the consideration of a multitude of factors, including nature and location of the tumour, associated signs and symptoms, fetal gestation and the patient?s wishes.
The Comparison of Clinical and Surgical Staging of Cervical Cancer: A Retrospective Study on Patients at Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia Pradipta, Bram
Indonesian Journal of Obstetrics and Gynecology Volume. 35, No. 1, January 2011
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Abstract

Objective: To evaluate the accuracy of clinical examination in determining the stage of operable cervical cancer and the extent of the disease. Method: The study involved 58 subjects from outpatient, emergency unit, and ward of Department of Obstetrics and Gynecology Dr. Cipto Mangunkusumo Hospital, from January 2008 to December 2010 with a diagnosis of cervical cancer. Patients who were diagnosed with cervical cancer up to stage IIA were included and patients lost to follow-up, receiving preoperative neo-adjuvant chemotherapy, and died before getting treatment were excluded. The outcomes evaluation were postoperative clinical staging, including the presence of enlarged lymph nodes, parametrial involvement, and tumor size. Lymph nodes, parametrial, and the tumor size were assessed from the surgery and pathological anatomy results. Result: The age distribution of 58 subjects ranged from 25 to 70 years (mean 48.39 years, SD 8.82). Squamous cell carcinoma was the most frequent type (44.9%), followed by adenocarcinoma (24.1%). Errors in preoperative clinical staging compared with postoperative was 40% in stage IA1, 9.52% in stage IB1, 17.65% in stage IB2, and 7.14% in stage IIA. Sensitivity, specificity, positive predictive value, and negative predictive value for preoperative clinical examination of lymph nodes were 11.1%, 100%, 100%, and 85.96%. Sensitivity, specificity, positive predictive value, and negative predictive value for preoperative clinical examination of parametrial involvement were 37.5%, 100%, 100%, and 90.90%. Sensitivity, specificity, positive predictive value, and negative predictive value for preoperative clinical examination of the tumor size were 91.84%, 88.89%, 97.83% and 66.67%. Conclusion: Clinical examination has limitation, especially in determining lymph nodes and parametrial involvement. Other diagnostic modalities in determining the extent of the disease is necessary. Enforcement of the right diagnosis in patients with cervical cancer is needed to determine the appropriate treatment. [Indones J Obstet Gynecol 2011; 35-1: 25-9] Keywords: staging, cervical cancer, preoperative, postoperative
Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment Pradipta, Bram
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 3, July 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (213.341 KB) | DOI: 10.32771/inajog.v2i3.400

Abstract

Objective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole. Method: Case report. Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment. Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential. [Indones J Obstet Gynecol 2014; 3: 162-165] Keywords: EMACO, invasive mole, perforation
Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment Pradipta, Bram
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 3, July 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (213.341 KB) | DOI: 10.32771/inajog.v2i3.400

Abstract

Objective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole. Method: Case report. Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment. Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential. [Indones J Obstet Gynecol 2014; 3: 162-165] Keywords: EMACO, invasive mole, perforation
Effect of Smoking on Advanced Stage Cervical Cancer Patient Survival Pradipta, Bram; Andrijono, Andrijono; Fuady, Ahmad
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (144.045 KB) | DOI: 10.32771/inajog.v3i3.49

Abstract

Objective: The researchers aim to investigate the relationship between smoking habit and other factors as prognostic factors of cervical cancer. Method: We performed a retrospective and prospective cohort study with subjects that are stage IIB-IVB cervical cancer patients in Dr. Cipto Mangunkusumo Hospital followed up from August 2009 to April 2014. The subjects’medical records were reviewed, and patients were interviewed about their current condition by telephone. Questions asked include smoking habit, spouse’s smoking habit, and mortality status. Patients that could not be contacted by phone were excluded from the study. Statistical analysis was done using Stata 10. Result: Out of 390 cervical cancer patients stage IIB-IVB in 2009, there were 270 patients (69.2%) that were included in the inclusion criteria. Most of the patients are 40-59 years old (82.2%) and are nonsmokers (91.8%). The most frequent clinicopathological characteristic is IIIB (63.3%) and squamous cell carcinoma (71.9%). The 5- year survival rate is 22.6%. There is no statistical significance between advanced stage cervical cancer survival with the patients’ or patients’ husbands’ smoking habit. Conclusion: In our study, smoking habits do not aggravate survival rate of advanced stage cervical cancer patients but further research must be done with more sample. Stage, and tumor size both by physical examination and ultrasound can be used as the prognostic factor. [Indones J Obstet Gynecol 2015; 3: 170-176] Keywords: Brigmann Index, cervical cancer, smoking, survival
Effect of Smoking on Advanced Stage Cervical Cancer Patient Survival Pradipta, Bram; Andrijono, Andrijono; Fuady, Ahmad
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (144.045 KB) | DOI: 10.32771/inajog.v3i3.49

Abstract

Objective: The researchers aim to investigate the relationship between smoking habit and other factors as prognostic factors of cervical cancer. Method: We performed a retrospective and prospective cohort study with subjects that are stage IIB-IVB cervical cancer patients in Dr. Cipto Mangunkusumo Hospital followed up from August 2009 to April 2014. The subjects’medical records were reviewed, and patients were interviewed about their current condition by telephone. Questions asked include smoking habit, spouse’s smoking habit, and mortality status. Patients that could not be contacted by phone were excluded from the study. Statistical analysis was done using Stata 10. Result: Out of 390 cervical cancer patients stage IIB-IVB in 2009, there were 270 patients (69.2%) that were included in the inclusion criteria. Most of the patients are 40-59 years old (82.2%) and are nonsmokers (91.8%). The most frequent clinicopathological characteristic is IIIB (63.3%) and squamous cell carcinoma (71.9%). The 5- year survival rate is 22.6%. There is no statistical significance between advanced stage cervical cancer survival with the patients’ or patients’ husbands’ smoking habit. Conclusion: In our study, smoking habits do not aggravate survival rate of advanced stage cervical cancer patients but further research must be done with more sample. Stage, and tumor size both by physical examination and ultrasound can be used as the prognostic factor. [Indones J Obstet Gynecol 2015; 3: 170-176] Keywords: Brigmann Index, cervical cancer, smoking, survival
Effect of Smoking on Advanced Stage Cervical Cancer Patient Survival Pradipta, Bram; Andrijono, Andrijono; Fuady, Ahmad
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (144.045 KB) | DOI: 10.32771/inajog.v3i3.49

Abstract

Objective: The researchers aim to investigate the relationship between smoking habit and other factors as prognostic factors of cervical cancer. Method: We performed a retrospective and prospective cohort study with subjects that are stage IIB-IVB cervical cancer patients in Dr. Cipto Mangunkusumo Hospital followed up from August 2009 to April 2014. The subjectsâ??medical records were reviewed, and patients were interviewed about their current condition by telephone. Questions asked include smoking habit, spouseâ??s smoking habit, and mortality status. Patients that could not be contacted by phone were excluded from the study. Statistical analysis was done using Stata 10. Result: Out of 390 cervical cancer patients stage IIB-IVB in 2009, there were 270 patients (69.2%) that were included in the inclusion criteria. Most of the patients are 40-59 years old (82.2%) and are nonsmokers (91.8%). The most frequent clinicopathological characteristic is IIIB (63.3%) and squamous cell carcinoma (71.9%). The 5- year survival rate is 22.6%. There is no statistical significance between advanced stage cervical cancer survival with the patientsâ?? or patientsâ?? husbandsâ?? smoking habit. Conclusion: In our study, smoking habits do not aggravate survival rate of advanced stage cervical cancer patients but further research must be done with more sample. Stage, and tumor size both by physical examination and ultrasound can be used as the prognostic factor. [Indones J Obstet Gynecol 2015; 3: 170-176] Keywords: Brigmann Index, cervical cancer, smoking, survival