Risanto Siswosudarmo Risanto Siswosudarmo
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Fetal outcome of operative delivery and its risk factors in Sardjito Hospital Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 22, No 04 (1990)
Publisher : Universitas Gadjah Mada

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Abstract

A study on operative delivery was carried out during the period of 1988 to find out the fetal outcome and some of the risk factors. A cohort study was used, consisting of the exposed group (operative delivery, 212 cases) and the control group (spontaneous delivery, 212 cases) selected randomly using a computer generated random number. Only singleton pregnancy, gestational age 28 weeks or more or birthweight 1000 g or more were included into the study. All babies were followed up during their neonatal period in the neonatal care unit. Neonatal morbidity was defined as asphyxia, birth traumata and diseases such as fever, vomiting etc. found during the early neonatal period. Data were processed with IBM personal computer using version 2.0 SPSS program. t-test, chi–square test and relative risk were statistical analyses used in this study.Result showed that the incidence ofoperative delivery during that period was 24.62%. The most common one was cesarean section (39.2%) and the least common was internal podalic version and laparotomy (1.9%). Age more than 30 years, parity more than two (gravidity more than three) and referral cases seemed to be the risk factors for termination of delivery by an operative procedure.The risk of deliveringasphyxic babies was much more common in the exposed group compared to the control. The rate of severely asphyxic babies was 50.5% compared to only 5.9% and the rate of slight asphyxia was 38% compared to 11.3% respectively for the exposed and control groups. Mean one minute Apgar score was 3.87 vs 7.29 and mean five minutes Apgar score was 6.89 vs 9.15. The number of babies suffering from one or more morbidities were 94.0% in the exposed group vs23.6% in the control group. There was a significant difference in term of perinatal mortality but not in neonatal mortality, although it seemed to be clinically important.The study concluded that although fetal outcome in the operative delivery was worse, but with careful maneuver and intensive neonatal care the risk of neonatal mortality could be minimized.Key Words: high-risk labor - operative delivery - perinatal morbidity and mortality - asphyxic babies Apgar score
Management of premature rupture of the membrane Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 23, No 01 (1991)
Publisher : Universitas Gadjah Mada

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Abstract

A literature study on the management of premature rupture of the membrane (PROM) is carried out to find out the best method and its impact on maternal and neonatal morbidity.PROM is defined as rupture of the fetal membrane before the onset of true labor. The incidence of PROM varies from 0,7 to 10%. Premature labor and its consequences to the newborn as well as maternal and neonatal infections are complications attributed to early rupture of the membrane.Conservative management for PROM before 37 weeks of gestation is a method used by most obstetricians. Patients should be staying in bed as long as the amniotic fluid is still coming out, no vaginal examination performed, and she should be closedly monitored for signs of infection and prophylac tic antibiotics given. Once the signs of i nfection develop, termination of pregnancy should be carried out and massive antibiotics should be given. Risk of infection becomes evident if rupture of the membrane goes beyond 12 to 24 hours so that prophylactic antibiotics should be given before 12 hours of rupture. Most of the cases will go to labor before 48 hours, although in some cases labor can be postponed for 19, 33, 39, 44, and 55 days. If labor can be postponed for more than 48 hours, the risk of suffering From respiratory distress syndrome (RDS) in neonates is getting lower.The management of premature rupture of the membrane after 37 weeks of gestation depends on the condition of the cervix. Patients with ripe cervix can be induced immediately, but patients with unripe cervix should be managed conservatively.Key Words: PROM - RDS - prophylactic antibiotics - perinatal mortality - maternal infection
Toksoplasmosis pada Wanita Hamil Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 21, No 03 (1989)
Publisher : Universitas Gadjah Mada

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Abstract

A literature review of toxoplasmosis in pregnant women has been carried out. The airn..of this review is.to recognize the epidemiology, pathogenesis, mode of transmission, clinical manifestation, diagnosis and mariagernent. Toxoplasrnosis is a parasitic disease catiiedby ToxoplasinO gondii. Two groups of people being higly VuLnerable to the disease are the deieloping fetus and thoseWhO are inimtmodeficient. In humans, prevalence of positive serologic test titers increases with age. There are considerable differences in prevalence rate between, countries.. The prevalence rate of positive serologic test among pregnant women varies between 15% to 96% depending on the geographic area and age group, while the incidence of congenital toxoplasmosis varies from one to seven per 1000 live births.Toxoplasma invade every organ in the body; but the most vulnerable organ or tissue are those where access to circulating antibody is.impeded (e.g., brain and retina). The barrier to passive diffusiOn Of antibodies into brain and eye has been given as an explanatiOn of the continued proliferation of theparasite on theie sites at the same time that his disappearing from eirtraneural sites, giving rise to latent infection. The developing fetus is usually infected transplacentally. The risk of fetal infection is related to the time when maternal infection occurs. if Toxoplasma infection is acquired late in pregnancy, the protozoa are most frequently transmitted to the fetus but the infection is subclinical in the newborn. If, however, the mother is infected early in pregnancy (for example-during the third month) transmission to the fetus occurs less often but frequently results in severe disease to the new born. There is no clinical signs and symptoms pathognomonic for the disease in pregnant women. In the infant, there is usually a clinical triad — hydrocephalus, chorioretinitis and intracranial calcifications. However, definitive diagnosis of Toxoplasma infection is established by isolation of Toxoplasma gondii from blood or body fluid.,deniostration of cyst in the placenta or tissues or by serologic tests. Sulfonamides, pyrimethamine and spiramycine are drugs considered tole effective in killing the organism. Seronegative pregnant women is .the group of people in which avoidance of infectionKey Words: Toxoplasma gondii --pregnancy --congenital toxoplasmosis serologic test -- pyrimethamine
Drug use in pregnancy and labor Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 23, No 02 (1991)
Publisher : Universitas Gadjah Mada

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Drug use in pregnancy should consider two main things, the first is its indication to the mother and the second, the more important, is its potential side-effect to the fetus. The aim of this paper is to review the possibility of side-effects of drugs commonly used during pregnancy, labor and delivery.Side-effects of drugs to the fetus are classified into three catagories namely1. embryotoxic effect,2. teratogenic effect and 3. minor side-effect.Embryotoxic effect is the most severe side-effect causing CO the death of the conceptus which usually terminates in early abortion. Teratogenic effect is an effect that causes major congenital anomalies. This effect happens if certain drugs are taken during the phase of organogenesis, i. e. between the third and the eighth week after conception. The minor side-effect may occur if some potential drugs are taken during the fetal period, i. e. during the phase of cellular hypertrophia or after the second month of pregnancy.Based on the teratogenic property of drugs, they can be classified into three major divisions:1. known teratogens such as thalidomide, anticancer drugs, certain hormones, sodium valproate and isotretionine,2. probable teratogens such as anticonvulsant, tobacco, alcohol, lithium, warfarin, and3. possible teratogens such as barbiturate, sulphonamide, certain an timalarials, oral an ndiabetics, LSD, certain antibiotics and some vaccines.The severity of anomalies in the fetus depends on the type of drugs, dosage, phase of fetal development, and species sensitivity. The general rule is all potential teratogenic drugs should be avoided during pregnancy, especially during the first trimester. Drugswith certain teratogenic effect should absolutely not be used during pregnancy, in spite of its indication.Key Words: drugs - pregnancy - teratogens - embryo toxic effects - congenital malformation
Insertion of Norplant by midwives and physicians: A comparative cohort study Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 23, No 04 (1991)
Publisher : Universitas Gadjah Mada

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Abstract

A comparative cohort study on the insertion of Norplant by midwives and physicians had been carried out to compare its safety. A total of 500 acceptors participated in the study, 292 of which belonged to the midwive group and 202 to the physician group. They came from suburban areas surrounding the city of Yogyakarta. Although both groups were statistically differen tin terms of age and body weight, they were no t so clinically. Norplantwas delivered outside the hospital during the mass campaign (safari susuk), but standardized hospital asepsis was taken. Follow-up was done one week thereafter to detect the presence of complications or side-effects, such as pain, inflammation, abscess and sense of itching. t-test, chi-square test and relative risk were statistical analyses used in the study.Results showed that midwives inserted Norplant more rapidly compared to physicians (2.36 vs 3.45 minutes respectively), although it did not have clinical importance. 23.6% of cases among the in idwive group showed a variety of complications while that of the physician group was 19.7%, the relative risk being 1.20 (0.82-1.75). More detailed complications such as pain, inflammation, abscess and itching did not show significant difference. The risk of complication in all cases was influenced neither by the. duration of insertion nor by the level of education.The study concluded that midwives could insert Norplant as safe as physicians.Key Words: norplant-midwive-contraception-obstetrics-family planning
The influence of conservative management of premature rupture of the membrane On infant Morbidity and mortality Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 23, No 03 (1991)
Publisher : Universitas Gadjah Mada

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Abstract

Premature rupture of the membrane (PROM) still gives a great problem in obstetrics because of its high perinatal morbidity and mortality, and whether conservative or active management should be taken is still debatable. The aim of the present study is to evaluate a conservative management of PROM especially on infant morbidity and mortality. A total of 130 PROM cases with gestational age of 28 weeks or more and birth weight of 1000 grams or more were included into the study. Twin and major congenital anomalies were excluded. A total of 129 non-PROM cases during the same period were selected randomly serving as control. Data were processed with IBM compatible personal computer using version 2.0 SPSS program: t-test, chi-square test and relative risk (RR) were statistical analysis used in this study.Both groups were comparable, in terms of gestational age, birth weight, type of presentation, but not in parity. Results showed that the risk of getting neonatal infection was 1.82 (0.95-3.46). Although it was not statistically different, but i t was clinically important. Rupture of membrane more than 48 hours gave the highest risk of neonatal infection (RR 2.77; 95% CL 0.95-8.05). Neonatal asphyxia was more common in the PROM group compared to the non-PROM. One minute Apgar score indicated that the risk of severe asphyxia was 2.19 (L44-3.33) and the risk ofmoderate asphyxia was 1.84 (1.19-2.87). Evaluation after five minutes showed that such risk became 1.56 (0.12-19.19) and 3.13 (1.65-5.93) respectively. Perinatal death in both groups did not show significant difference, but neonatal death due to sepsis in the PROM group was about four-folds compared to the non-PROM. Death atrributed to respiratory distress syndrome did not show significant difference.The study concluded that conservative management resulted in a high infant morbidity, although the infant mortality was relatively the same. As neonatal asphyxia was more common in the PROM group, then adequate resuscitation should be prepared. Although prophylactic antibiotics had been given, neonatal death due to infection was still high.Key Words: PROM - neonatal infection - asphyxia - obstetrics - infant mortality
Insertion of Norplant ith and withoul prophylactic antibiotics: A randomized C011 ironed siudy Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 24, No 01 (1992)
Publisher : Universitas Gadjah Mada

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Abstract

A randomized controlled study on the insertion of Norplant without prophylactic antibiotics had been carried out. The aim of the study was to compare the risk of complication happening shortly after insertion. A total of 500 acceptors completed their follow-up, 244 belonged to the antibiotic group (tetracycline), while 256 belonged to the control group. They come from suburban areas stuTounding the city of Yogyakarta.Insertion was carried out outside the hospital during the Safari Mass Campaign, with hospital standard asepsis. Follow-up was carried out one week after insertion to detect the presence of such complication or side effects as pain, inflammation, abscess and sense of itching. Data were processed with version 2.0 SPSS program using Nikon PC Computer. t-test, chi-square test and relative risk were statistical analysis used in the study.Results showed that both groups were comparable in. terms of age, body weight, parity, duration of insertion and level of education. The overall incidence of complication in the non-an tibiotic group was 19,9% compared to 24.2% in the antibiotic group (RRO.82, 95% CL 0.57– L19) . More detailed complications such as pain, inflammation, abscess and sense of itching show neither clinical nor statistical significant differences. The risk of complication in all, cases was influenced neither by duration of insertion nor by acceptors level of education.The study concluded that the insertion of Norplant without prophylactic antibiotics was as safe as with antibiotics.Key Words: Norplant - contraceptive mass campaign - antibiotics - obstetrics - contraceptive complication
Cytogenetic examination Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 13, No 02 (1981)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Cytogenetic examination on six normal persons, four men and two women, was carried out using a technique proposed by Dutrillaux with slight modification. Five drops of blood were taken from a peripheral vessel and was incubated on a PHA (phytohemarglutinine)-containing medium at 37°C for about 72 hours. Cell division was blocked by adding colchicine solution, an antimitotic agent, into this medium. A mixture of distilled water, magnesium chloride, hyaluronidase, and goat serum was used as hypotonic shock solution. Two out of these six examinations showed good results. The possibility of using this technique to examine some clinical syndromes, such as Down, Turner, and Klinefelter syndromes, as well as 13 and 18 trisomies, has also been discussed.Key Words: cytogenetics - chromosome - blood culture - colchicine - hypotonic shock solution
Pengaruh Persalinan Abnormal Terhadap Morbiditas dan Mortalitas Janin dan Usaha Menurunkan Kematian Perinatal Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 21, No 02 (1989)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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A discussion of the impact -of abnormal labor on the neonatal morbidity and mortality with special reference to birth trauma and perinatal mortality has been carried out. This report is a literature review of cases found in Sardjito Hospital and an illustration of obstetric cases during the first semester of 1987. The aim of this paper is to find out how far the negative impact of abhor.. LI labor on birth trauma and perinatal mortality is, as well as preventive measures to be taken.It is obvious that abnormal vaginal deliveries give rise to an increase incidence of birth trauma compared to spontaneous deliveries. The higher the birth weight, the higher the incidence of birth trauma. Caput succedaneum is the most frequent type of birth trauma. whereas broken bone is the least frequent.Transverse position is the most unfavorable position of the fetus, giving the perinatal mortality rate (PMR) 775/1000 deliveries. The second one is breech presentation, having the PMR 129/1000 deliveries. The very unfavorable obstetric operatives are vacuum and forcipal extraction and internal podalic version which altogether bring about the PMR 210.5/1000 deliveries. Prolonged labor gives rise to the PMR 21/2 times higher compared to non-prolonged labor. Although the Cesarean rate is quite high (12.5%), its PMR is still higher. This signifies that Cesarean section has not been adequately accomplished.Some efforts to reduce the PMR in this hospital are (1) expecting the high risk pregnant women especially during labor to be referred as soon as possible, (2) fast and appropriate management of such cases with sophisticated instruments provided, and (3) providing an intensive neonatal care.Key Words: high risk pregnancy -- abnormal labor and delivery birth trauma -- perinatal mortality rate -- neonatal care
Drug use in pregnancy and labor Risanto Siswosudarmo, Risanto Siswosudarmo
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 23, No 02 (1991)
Publisher : Journal of the Medical Sciences (Berkala ilmu Kedokteran)

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Abstract

Drug use in pregnancy should consider two main things, the first is its indication to the mother and the second, the more important, is its potential side-effect to the fetus. The aim of this paper is to review the possibility of side-effects of drugs commonly used during pregnancy, labor and delivery.Side-effects of drugs to the fetus are classified into three catagories namely1. embryotoxic effect,2. teratogenic effect and 3. minor side-effect.Embryotoxic effect is the most severe side-effect causing CO the death of the conceptus which usually terminates in early abortion. Teratogenic effect is an effect that causes major congenital anomalies. This effect happens if certain drugs are taken during the phase of organogenesis, i. e. between the third and the eighth week after conception. The minor side-effect may occur if some potential drugs are taken during the fetal period, i. e. during the phase of cellular hypertrophia or after the second month of pregnancy.Based on the teratogenic property of drugs, they can be classified into three major divisions:1. known teratogens such as thalidomide, anticancer drugs, certain hormones, sodium valproate and isotretionine,2. probable teratogens such as anticonvulsant, tobacco, alcohol, lithium, warfarin, and3. possible teratogens such as barbiturate, sulphonamide, certain an timalarials, oral an ndiabetics, LSD, certain antibiotics and some vaccines.The severity of anomalies in the fetus depends on the type of drugs, dosage, phase of fetal development, and species sensitivity. The general rule is all potential teratogenic drugs should be avoided during pregnancy, especially during the first trimester. Drugswith certain teratogenic effect should absolutely not be used during pregnancy, in spite of its indication.Key Words: drugs - pregnancy - teratogens - embryo toxic effects - congenital malformation