Budi Iman Santoso

Randomized trial of one versus two transcervical insertions of quinacrine pellets for sterilization

OBJECTIVE To determine the relative effectiveness of single vs. two transcervical monthly insertions of 252 mg of quinacrine for female sterilization. DESIGN Controlled clinical study. SETTING Family planning clinics of 6 academic centers. PATIENT(S) Sexually active reproductive-age women requesting sterilization. INTERVENTION(S) At each of six centers 70 and 30 women were randomly assigned to receive either one or two, respectively, monthly transcervical insertions to the fundus of 252 mg of quinacrine and 75 mg of diclofenac as pellets and they were followed for 1 year. MAIN OUTCOME MEASURE(S) Complications, side effects, and pregnancy failures. RESULT(S) There were no serious complications and side effects were transient and easily treated. There were 31 (7.4%) pregnancy failures in the single insertions group and 2 (1.1%) in the two insertions group, but with marked center variation. CONCLUSION(S) Quinacrine sterilization using two monthly insertions of 252 mg of quinacrine appears safe and reasonably effective.

Indonesian primary care physician perception towards contraception usage: a review

Indonesian Health Profile (IHF) in 2015 showed that there was an increase of population growth between 3.34 and 3.70 million per year from 2010 to 2015. It contributed to the Indonesian population of 255.46 million people in 2015. Population pyramid in Indonesia pointed out that the highest distribution was on younger population. It can impact to the population explosion in the next several years. One method to control the population growth is through family planning (FP). Indonesia regulation number 87 in 2014 stated that family planning is the way to limit number of children, spacing, and ideal age for pregnancy also delivery through promotion, protection, and assistance in appropriate to reproductive right to form quality family.

Cesarean Section Tariff Analysis Based on Indonesian Case Base Groups in Cipto Mangunkusumo Hospital

Introduction: Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan as the National Health Insurance Corporation/Administration in Indonesia has two payment mechanisms through capitation for the primary health care and Indonesian Case Base Groups (INA-CBGs) for the secondary health service. Based on data from Indonesian Demographic Health Survey (IDHS) in 2012, the number of cesarean deliveries per year (95% CI) was 611,561 (570.165–655.962) and Cesarean delivery rate per 100 live births (95% CI) was 12.9 (12.0–13.8). Meanwhile, the study conducted in Dr. Cipto Mangunkusumo hospital (RSUPNCM) in 2012 revealed that 40% women delivered through Caesarean Section (CS). Therefore, we would like to analyse the CS tariff in Cipto Mangunkusumo Hospital (RSUPNCM) as the c ntre of referral compared to INA-CBG’s tariff. Methods: This cross-sectional study design was conducted in RSUPNCM from February to May 20 6 by involving all CS claim records from 2014 to 2016. We erformed the descriptive a alysis consi ting of diminishing risk of loss, CS tariff, and optimization of the tariff. Results: The average length of stay (ALOS) on CS cases in 2014 and 2015 was about 5 to 7 days. The difference between RSUPNCM revenue expectation and INA-CBG’s tariff was from 62.97% to 74.22%. By using unit cost, we could diminish the risk of loss between 58.9% for high risk CS in the third class and 75.7% for moderate risk CS in the first class. In assumption, the best efficiency potency was 50% reduction of RSUPNCM total claims combined with 40% increase of INA-CBG’s claim. Conclusion: Unit cost for Caesarean section on mild and moderate risk CS could be decrease to reduce the deficit potency. Medical service fee should be recalculated to reach the best efficiency.

IIIB-IV Degree Perineal Rupture Repair Using Overlapping and End-to-End Techniques with Pudendal Block Anesthesia

Method: An open clinical trial with randomization was carried out in July 2010-April 2012. The population consisted of the patients who underwent vaginal delivery in Dr. Sardjito Central General Hospital, Sleman District General Hospital, as well as Tegalrejo, Jetis and Mergangsan Community Health Centers who did no have complaints of fecal urgency, anal incontinence, and/or fecal incontinence, and suffered IIIb-IV degree perineal rupture repaired within less than 24 hours of rupture. The exclusion criteria included conditions in which patients could not undergo repair at the moment (shock, uncooperative patient). Fourty-eight research samples were divided into 2 groups, 24 samples for each of the treatment group (overlapping repair) and the control group (end-to-end repair). Local anesthesia was performed in a pudendal-block manner.

Delivery Outcome Among Pregnant Women With Hypertension

Background: Hypertension in pregnancy remains a major cause of maternal and perinatal morbidity and mortality worldwide. The purpose of this study was to compare maternal and neonatal outcomes among women with hypertension (chronic hypertension (CHT), superimposed preeclamsia (SuperPE), gestational hypertension (GHT), mild preeclamsia (MPE), severe preeclamsia (SeverePE),and HELLP syndrome (HELLPs)). Methods: This retrospective evaluation was performed during January to December 2013 at Cipto Mangunkusumo Hospital, Jakarta-Indonesia, a tertiary-care hospital. The data was obtained from singleton deliveries database including women with hypertension(CHT, SuperPE, GHT, MPE, SeverePE,HELLPs) and control group (normotension and without comorbidities). Univariate and multivariate logistic regression analysis were performed. Results: There were 2103 deliveries in RSCM, 510 (24.3%) had hypertension in pregnancy and 1593 (75.7%) were control subject. CHT, SuperPE, GHT, MPE, severePE, HELLPs, were respectively found in 0.3%, 0.8%, 2.9%, 2.1%, 16.3%, and 1.8% in our patients. After adjusting with age, parity and comorbidities, the risk of having premature neonates are increased in women with HELLPs (adjustedOR 7.72; 95% Confidence interval (CI) 2.75–21.70), and superPE (aOR 4.41; 95% CI 1.23–15.89). Low birth weight (LBW) are increased in women with SeverePE (aOR 1.69; 95% CI 1.05–2.72) and HELLPs (aOR 24.62; 95% CI 3.33–182.16). Risk of Apgar score 5th minute below 7 is highest in women with HELLPs (aOR 9.19; 95% CI 1.58–53.57). Conclusion: Women with HELLPshad highest risks for premature neonates, LBW and Apgar score 5th minute below 7 among other types of hypertension.