Objective: This study aimed to examine the effect of vitrification on apoptosis and survival in human preantral follicles after thawing. Methods: This experimental study was conducted at an acute tertiary care hospital from March 2012 to April 2013. Ovaries were sliced into 5x5x1-mm pieces and divided into the following three groups: preantral follicle isolation, ovarian tissue vitrification-warming followed by follicle isolation, and immunohistochemistry of fresh ovarian tissue. For statistical analyses, the Student t-test, chi-square test, Kruskal-Wallis test, and Kaplan-Meier survival analysis were used. Results: A total of 161 preantral follicles (70% secondary) were collected from ovarian cortex tissue of six women between 30 and 37 years of age who underwent oophorectomy due to cervical cancer or breast cancer. There were no significant differences in the follicular morphology of fresh preantral follicles and vitrified follicles after thawing. The mean Fas ligand (FasL) mRNA expression level was 0.43 +/- 0.20 (relative to beta-actin) in fresh preantral follicles versus 0.51 +/- 0.20 in vitrified follicles (p=0.22). The mean caspase-3 mRNA expression level in fresh preantral follicles was 0.56 +/- 0.49 vs. 0.27 +/- 0.21 in vitrified follicles (p=0.233). One vitrified-thawed secondary follicle grew and developed to an antral follicle within 6 days of culture. Conclusion: Vitrification did not affect preantral follicle morphology or mRNA expression of the apoptosis markers FasL and caspase-3. Further studies are required to establish whether vitrification affects the outcomes of in vitro culture and the maturation of preantral follicles.

Objective: Every year approximately 13% (78,000) of maternal death caused by unsafe abortion. Indonesia Family Planning Association predicts 2.5 million abortions per year and 1.5 million of them committed by teenagers. Adolescent reproductive health problems are more alarming year by year. Sexual behavior tends to be permissive and bold with limited knowledge of reproductive health has increased the risk of abortion. This study is to assess the knowledge, attitudes, and behavior regarding abortion in young adults. Methods: This is a descriptive cross-sectional study. The subjects were young women aged 18–24 years old who were fulfilled by inclusion and exclusion criteria. The knowledge, attitudes, and behavior were assessed using questionnaire. The results were analyzed using statistical program. Results: The total subjects recruited in this study were 55 subjects. Twenty-eight (50.9%) of subjects has a good knowledge and 27 (49.1%) of subjects had a moderate knowledge. Twenty-nine (52.7%) subjects had moderate attitudes and 36.4% of subjects had good attitude. Thirty (54.5%) of subjects had a good behavior regarding abortion. Conclusion: Most of the subjects had good level of knowledge and moderate attitude toward abortion.

Latar belakang: Kontrasepsi hormonal injeksi masih banyak digunakan di berbagai negara berkembang, termasuk di Indonesia. Tujuan penelitian ini adalah untuk membandingkan efikasi dan keamanan kontrasepsi hormonal injeksi mengandung 150 mg/mL medroxyprogesterone acetate (DMPA) (obat A) yang akan digunakan untuk program Keluarga Berencana Nasional, dibandingkan dengan inovatornya (obat B). Metode: penelitian ini open-label, acak, multisenter, 2 kelompok, melibatkan 400 subjek usia produktif, yang diacak untuk mendapatkan obat A atau obat B. Injeksi diberikan sekali setiap 3 bulan, selama 1 tahun. Hasil: Setelah 4 kali injeksi kontrasepsi periode satu tahun, tidak didapatkan kehamilan pada kedua kelompok, nilai Pearl-Index masing-masing kelompok nol. Insidensi kejadian tidak diinginkan sebanding pada kedua kelompok dan dapat ditoleransi, dengan kejadian paling sering adalah amenore, spotting, sakit kepala dan menstruasi memanjang. Simpulan: Kontrasepsi hormonal injeksi yang akan digunakan untuk program KB nasional (obat A) memiliki efikasi dan keamanan yang sebanding dengan inovatornya (obat B). Backgroud: Injectable hormonal contraceptives remain in extensive use in many developing countries, including Indonesia. This study was intended to compare the efficacy and safety of injectable hormonal contraception contain 150 mg/mL DMPA injection (Drug A), that will be used for national Family Planning Program, versus the innovator product (Drug B). Methods: This study was an open-label, randomized, multicenter, 2-parallel group study, involving 400 women of childbearing age, who received Drug A or Drug B four times at 3-month intervals. Results: No pregnancies occur in both groups after 4 injections of Drug A or Drug B over a period of 12 months, the Pearl-Index value for each group was zero. The incidence of adverse events between groups were comparable and tolerable, the most common events were amenorrhea, spotting, headache, and prolonged menstruation. Conclusion: The efficacy and safety of injectable DMPA (Drug A) produced for National Family Planning program was comparable with the innovator DMPA drug (Drug B).

Objective: To provide a randomized comparison between Jadena® and Norplant® in terms of efficacy and acceptability among Indonesian women. Method: This study was a phase IV, open label, randomized, multicenter study throughout Indonesia. Subjects were Indonesian adult women who were randomized to receive Jadena® or Norplant® as their contraceptive method. The subjects were recruited from 6 large cities in Indonesia, such as Medan, Palembang, Jakarta, Semarang, Surabaya, and Makassar. Result: Of 600 subjects, 301 women getting to Jadena® and 299 women to Norplant® were enrolled between August 1998 and February 1999. The mean age was 29.8 (SD 5.3) years old, ranging from 18 to 40 years old. We did not find the pregnancy during the study. Non-pregnancy probability at the end of one year was similar between Jadena® (0.920 (SD 0.016)) and Norplant® users (0.916 (SD 0.084)). The continuation rates of Jadena® at one and three-year were 95.3% and 66.8%; whereas, the continuation rates of Norplant® was 94.3% at year-1 and 70.2% at year-3. Conclusion: The new two rod levonorgestrel subdermal system (Jadena®) showed similar efficacy with the old six capsule levonorgestrel subdermal system (Norplant®) in term of birth control. Both implant systems also have similar tolerability profile. Jadena® is easier to insert and remove than Norplant®. Keywords: birth control, efficacy, implant

Objective: To evaluate the acceptability, effectivity and side effects of Postplacental IUCD after vaginal delivery at Dr. Cipto Mangunkusumo Hospital (RSCM) after 6 month of insertion. Methods: A prospective study was conducted at RSCM Jakarta during the period of August to October 2012. Postplacental IUCD was inserted into the subjects’ uterus until it reached the fundus. Follow up was done at 40-42 days and 6 months after delivery. Results: A total of 234 women were recruited in this study, with 19.2% loss of follow up. No significant difference on subjects characteristics who came and loss of follow up in this study. Expulsion was experienced by 5.1% subjects (total expulsion 4.1% and partial 1%) at the first visit on 40-42 days and 7.5% subjects (total expulsion 0.6% and partial 6.9%) at the second visit, after 6 months. 9.3% subjects had the IUCD removed at the first and second visit. Among all of the subjects who had the IUCD removed by request or had the expulsion, 61% were willing to do reinsertion. The effectivity of IUCD was 100%, with 68.9% subjects was still breastfeeding. The side effects were vaginal discharge (23%), dysmenorrhea (4-21%), and spotting (2-10%). Conclusion: The acceptability and effectivity of postplacental IUCD after 6 months were 86.8% and 100%. Cummulative expulsion rate were 12.6%, and the most common side effects were vaginal discharge, dysmenorea, and spotting. Keywords: acceptability, effectivity, expulsion rate, IUD, postplacenta

Reproduction process is really not a dangerous activity because it has gender rights reflected in the supporting components, i.e. ability, success, and safety. In the social reality, however, it is found different, as the high mortality rates of mothers and children, the appearance of sexual intercourse disease, and the side effects of contraceptive use. Biran Affandi, in his writing, describes social realities of the reproduction health which tends to be in the high risky point especially for women. All of these are as the consequence of the individuals who do not adhere their reproduction right.

Objective: To know the relationship between obesity and gynecology cancer. Method: This study use case control study design for 250 gynecology patients (125 controls and 125 cases) in Prof. Dr. R. D. Kandou Manado Hospital from 1 July to 30 November 2015. The data was collected by measuring Body Mass Index (BMI) and filing out selfadministered questioners. Result: From the 250 subjects, the study group (125 subjects), 72 subjects have obesity (57.6%) and 97 subjects have multiple parities (77.6%) with 58 subjects diagnosed with cervical cancer (46.4%). In the control group (125 subjects), 71 subjects have normal weight (56.8%) and 67 subjects have multiple parities (53.6%) with 64 subjects diagnosed with ovarium cysts (51.2%). Using multivariate logistic regression, the overweight and obese subjects have 7 folds higher risk to develop gynecology cancer compared to those with normal or underweight subjects. Those with multiple parities and grande multipara subjects have 3 folds higher risk to develop gynecology cancer compared with those who are nullipara and primipara. Conclusion: A significant correlation is found between obesity and gynecology cancer using multivariate logistic regression analysis (p=0.000, OR=6.9 (95% CI = 3.62-13.13). [Indones J Obstet Gynecol 2016; 1: 23-30] Keywords: gynecology cancer, multiple parities, obesity

Background: The use of levonorgestrel implants as a contraceptive method have undergone changes in the number of implants used, beginning from six rods in the early methods to two rods in the present method and have been proven effective. This study aims to evaluate the efficacy of single rod implant (Monoplant®) by measuring serum levonorgestrel concentration and cervical mucus quality.Methods: Thirty healthy women, aged 20-40 year old, and have been proven fertile, underwent single rod implant insertion. Levonorgestrel serum levels was measured every month and cervical mucus viscosity was examined every three month, until six months.Results: Levonorgestrel serum concentration was consistently above minimum effective level (200 pg/mL), from month 3 to 6 respectively 338.9 pg/mL, 424.8 pg/mL, 320.3 pg/mL, and 337.5 pg/mL. Almost all of the acceptors (96.7%) had good cervical mucus viscosity since three months following implant insertion. Conclusion: Levonorgestrel serum concentration in Monoplant® users was still above minimum contraceptive level until the sixth month. Viscosity of cervical mucus increased immediately following implant insertion. This indicates that single rod levonorgestrel implant is effective as a contraceptive method.Keywords: cervical mucus viscosity, implant monoplant®, serum levonorgestrel

Objective: This research was conducted to measure levonorgestrel serum concentration Monoplant® after six months of usage. Method: Thirty healthy women, 20 - 40 years old, and after been proven for fertility, had implants on their body. Levonorgestrel serum levels were measured monthly from the first month to the sixth month. Result: Levonorgestrel serum concentration was still above 200 pg/ml until the sixth month. First month and second month serum concentration was not recorded while data for the following months were 338.9 pg/ml, 424.8 pg/ml, 320.3 pg/ml, and 337.5 pg/ml. Conclusion: Levonorgestrel serum concentration in Monoplant® users was still above contraceptive level until six months. [Indones J Obstet Gynecol 2011; 35-3: 122-7] Keywords: single rod implant Monoplant®, levonorgestrel serum concentration

Norplant®, as a first-generation levonorgestrel implant and containing six capsules, has been shown to be effective as long-term contraception since more than 25 years ago. In the process, then the number of implants was reduced to two rods called Norplant-2®, which is then updated into Jadena® (in Indonesia) or Jadelle® (in America). As a country with the largest implant acceptors in the world, Indonesia has developed its own implant method consisting of two rods called Indoplant®. Currently being developed implant that consists of single rod called Monoplant®. Monoplant® is expected to be the best option because it only consists of a single rod implant that is easy to insertion and remove, effective and safe for at least three years.

Objective: To know the effectiveness of Insecticide Treated Nets (ITNs) and Intermitten Preventive Treatment in preventing malaria during pregnancy. Material and methods: Review of several literatures and journals about the effectiveness of ITNs and IPT in preventing malaria during pregnancy. Results: Review for 16 literatures about malaria during pregnancy and several studies about the use of ITNs and IPT in preventing malaria during pregnancy was performed. From all of the methods for preventing mosquitos bites, the use of ITNs were probably the most effective method. Previous studies indicate that among gravida 1 - 4, the use of ITNs lowered the paracitemia rate for 38% and severe anemia for 47%. During labor, mean hemoglobin level were 0.6 g/dl higher, and the placental and maternal malaria were lowered for 35%. For the newborns, ITNs help by lowering the incidence of low birth weight (low birth weight prevalence were lowered for 28% in gravida 1 - 4), lowering the risk of anemia in the newborns, lowering the risk of neonatal death, promoting the growth and development during the first weeks after birth. For IPT, studies also indicate that this strategy was effective in preventing malaria during pregnancy because it could lower the risk of severe anemia in primigravida living in malaria area. Even pregnant women who just got 1 dose due to the delay of antenatal care, they significantly got benefit from this intervention. Conclusion: Pregnant women is one of the high risk group for getting malaria infection. Due to the severe complication that could happen following malaria during pregnancy and lots of women could not get the access for effective intervention, preventing malaria during pregnancy is very important. Malaria during pregnancy could be prevented effectively by using ITNs and getting IPT. If malaria during pregnancy happens, very important to know whether it is with or without complication, because the one without complication is very easy to treat, but the one with complication requires specialystic care in the tertiary health care facility. Keywords: insecticide treated nets (ITNs), intermitten preventive treatment (IPT)

Objective: To get data about female teenage behavior in their sexual changes, unwanted teenage pregnancy and their negative consequences, contraception, and the relation between factors which are related to female teenage behavior. Method: Cross-sectional study at five Government Junior High Schools and five Government Senior High Schools in five regions in Jakarta. Two hundred female teenage respondents, aged between 11-17 years old, came from five Government Junior High Schools and five Government Senior High Schools in Jakarta who were picked by cluster random sampling, 20 students from each grade of school. The respondents were given questionnaires which have been validated before, and then we did scoring and statistical measurement with SPSS 13th version. Result: The respondents’ knowledge about their sexual organ changes and sexual behavior is moderate (46%), unwanted teenage pregnancy and their consequences is poor (79.5%), contraception is poor (62%) and scoring result of knowledge is poor (71%). Knowledge scoring among respondents aged between 11-14 years old is poor (85.9%), and also in age group 15-17 years old (60%). Respondents’ attitude about their sexual organ changes and sexual behavior is good (40.5%), unwanted teenage pregnancy and their consequences is good (42.5%), while contraception is poor (73.5%), and scoring result of attitude is poor (56.5%). Attitude scoring in age group 11-14 years old is poor (68.2%), and in group 15-17 years old is also poor (47.8%). Respondents’ behavior about their sexual organ changes and sexual behavior is poor (51%), unwanted teenage pregnancy and their consequences is good (66%), contraception is moderate (49%), and scoring result of behavior is moderate (49%). Attitude scoring age between 11-14 years old is moderate (55.3%), between 15-17 years old is moderate and poor (each 44.3%). The relation between behavior and the greatest impression of information source which is significant is from teacher/school (p=0.001). The relation between behavior and knowledge is only significant in age group 15-17 years old (p=0.014). There is significant relationship between behavior and attitude in age group 11-14 years old (p=0.013) and 15-17 years old (p=0.000). Determinant factor contributing to this behavior level is the information taken from their teacher/school (p=0.010). Conclusion: Respondents’ behavior about their sexual organ changes and sexual behavior is poor (51%), about unwanted teenage pregnancy and their consequences is good (66%), about contraception is moderate (49%) and scoring result of behavior is moderate (49%). Attitude scoring in age group 11- 14 years old is slightly better than in group 15-17 years old. [Indones J Obstet Gynecol 2010; 34-2: 51-8] Keywords: teenage pregnancy, unwanted pregnancy, sexual behavior, contraception Tujuan: Diperolehnya data mengenai sebaran perilaku remaja putri mengenai perubahan perilaku seksual yang terjadi pada dirinya, sebaran perilaku remaja putri mengenai kehamilan remaja yang tidak diinginkan dan dampaknya, sebaran perilaku remaja putri mengenai alat kontrasepsi dan hubungan antara faktor-faktor yang berhubungan dengan perilaku remaja putri. Metode: Studi bersifat deskriptif analitik yang dilakukan pada lima Sekolah Menengah Pertama dan lima Sekolah Menengah Atas di lima wilayah DKI Jakarta. Studi ini melibatkan dua ratus responden remaja putri berusia 11-17 tahun yang berasal dari lima SMP Negeri dan lima SMA Negeri di Jakarta yang dipilih secara cluster random sampling, masing-masing 20 responden diambil dari murid kelas I - kelas III. Responden diberi kuesioner yang telah dilakukan uji validasi sebelumnya, setelah terkumpul dilakukan skoring dan penghitungan statistik dengan SPSS versi 13. Hasil: Pengetahuan responden mengenai perubahan organ seksual dan perilaku seksual adalah sedang (46%), kehamilan yang tidak diinginkan dan dampaknya kurang (79,5%), alat kontrasepsi kurang (62%) dengan hasil skoring pengetahuan adalah kurang (71%). Sedangkan skoring pengetahuan bila dibagi berdasarkan usia 11-14 tahun, kurang (85,9%) dan 15-17 tahun juga kurang (60%). Sikap responden mengenai perubahan organ seksual dan perilaku seksual adalah baik (40,5%), kehamilan yang tidak diinginkan dan dampaknya baik (42,5%), alat kontrasepsi kurang (73,5%) dengan hasil skoring sikap adalah kurang (56,5%). Sedangkan skoring sikap bila dibagi berdasarkan usia 11-14 tahun adalah kurang (68,2%) dan 15-17 tahun juga kurang (47,8%). Perilaku responden mengenai perubahan organ seksual dan perilaku seksual adalah kurang (51%), kehamilan yang tidak diinginkan dan dampaknya baik (66%), alat kontrasepsi sedang (68,5%) dengan hasil skoring perilaku adalah sedang (49%). Sedangkan skoring perilaku bila dibagi berdasarkan usia 11-14 tahun adalah sedang (55,3%) dan 15-17 tahun sedang dan kurang (masing-masing 44,3%). Hubungan antara perilaku dan sumber informasi yang paling berkesan yang bermakna adalah berasal dari guru/sekolah (p=0,001). Hubungan perilaku responden dengan pengetahuan responden barulah bermakna pada usia 15-17 tahun (p=0,014). Terdapat hubungan yang bermakna antara perilaku dengan sikap responden pada usia 11-14 tahun (p=0,013) dan pada usia 15-17 tahun (p=0,000). Analisis bivariat dan multivariat menunjukkan bahwa faktor sumber informasi dari guru menjadi determinan utama perilaku responden. Kesimpulan: Perilaku responden mengenai perubahan organ seksual dan perilaku seksual adalah kurang (51%), mengenai kehamilan yang tidak diinginkan dan dampaknya baik (66%), mengenai alat kontrasepsi sedang (68,5%). Penilaian perilaku pada kelompok usia 11-14 tahun sedikit lebih baik dibandingkan dengan kelompok 15-17 tahun. [Maj Obstet Ginekol Indones 2010; 34-2: 51-8] Kata kunci: kehamilan remaja, kehamilan yang tidak diinginkan, perilaku seksual, alat kontrasepsi

Objective: Measuring Clinical risk management status in Obstetric Emergency Department of Cipto Mangunkusumo Hospital regarding to severe pre eclampsia treatment. Material and methods: Qualitative research was chosen as a study design. We interviewed 15 patients with severe pre eclampsia. We also interviewed Director of Medical Service, Consultant Doctor and Chief of Obstetric Emergency Department as part of Hospital Management. Results: As an output measurement, maternal mortality rate is 0.14 %; length of stay in emergency department is only 1 day; Patient satisfaction reported as much as 53.3%. On risk identification reported that Cipto Mangunkusumo Hospital did not have Standard of Operational and Procedure in Severe Pre Eclampsia treatment. There are registration and report procedure on clinical cases but there are not specific form used instead of medical records. Nurse quality reported not satisfied with no formal risk management system. Risk analysis procedure is already implemented. There are many adjustment in reducing risk such as staff training, upgrade facilities, supervise and communication forum. Priority system is needed to be improved. Risk funding is allocated for medical staff insurance regarding to law process against medical practice (if any) and for adjustment facilities of poor patients. Risk evaluation management is also already implemented. Conclusion: Risk Management on Severe Pre Eclampsia in Cipto Mangunkusumo Hospital is sufficient although some aspects has not optimally implemented. This achievement can be marked from output measurement such as maternal mortality rate, length of stay, and patient satisfaction on August 2008. Factors influence output are skill personnel including doctor, excellent facilities, and good quality of structure monitoring. Keywords: severe pre eclampsia, eclampsia, risk management, obstetric emergency department, Cipto Mangunkusumo Hospital

Objective: To know profile of pregnant women with tuberculosis at PPTI Baladewa polyclinic Jakarta, to evaluate impacts of tuberculosis medicinal treatment on pregnancy and to know the obstacles of pregnant women to look for tuberculosis treatment. Methods: Subjects were all pregnant women with tuberculosis and received tuberculosis treatment at polyclinic of PPTI Baladewa from January 2006 - December 2007. We reviewed medical record and did home visitation to fill questioners. Results: All subjects were in reproductive age and most of all were low socio-economic group. Pulmonary tuberculosis was found in 88.2% cases and Extrapulmonary tuberculosis in 11.8% cases. We found 29.4% relapse cases and 11.8% multi-drug resistance. Sputum examination with a smear positive for acid fast-bacillus was found in 52.9% cases. There was abnormality for all chest x-rays. The third most frequently symptoms were cough more than two weeks (88.2%), weight loss (88.2%) and anorexia (82.4%). Average time for the patients to look for treatment was 50.71 ± 31.2 days. The patients need more time because most of the symptoms are also present in pregnancy, the patients know absolutely nothing about TB and healthcare provider didn’t examine carefully. Treatment for the patients was given immediately without considering the gestational age. Conclusion: No harmful effect was observed for neonates even if the drugs were given in the first trimester of pregnancy. Keywords: profile, pregnancy, tuberculosis