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

Published : 17 Documents
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Anti Mullerian Hormone Serum Level Indicates Ovarian Response in Controlled Ovarian Hyperstimulation of IVF Cycles Wiweko, Budi; Hestiantoro, Andon; Sumapraja, Kanadi; Natadisastra, Muharam; Febia, Eva; Andriyana, Huthia; Pradipta, Bram; Susanto, Cynthia Agnes
Indonesian Journal of Obstetrics and Gynecology Vol.34. no.3. July 2010
Publisher : Indonesian Journal of Obstetrics and Gynecology

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Objective: To evaluate the clinical value of Anti Mullerian Hormone serum (AMH) level as one of ovarian response indicator in controlled ovarian hyperstimulation in IVF cycles. Method: This cohort-prospective study was conducted in Dr. Cipto Mangunkusumo General Hospital. The subjects of this study were infertile couples who underwent controlled ovarian hyperstimulation in IVF cycles. The measurement of FSH level, estradiol level, AMH level, and antral follicles count was done in the beginning of IVF cycles. The cycles were divided into two groups, good responder group and poor responder group. Good responder group had three or more mature oocytes, while the poor responder group had two or less mature oocytes. Statistical analysis was done using T-Test and Receiver Operator Characteristic area under curve (ROCAUC) to measure the predictive value of AMH, FSH, estradiol, age, and antral follicle count as ovarian response predictors. Results and Discussion: From 92 IVF cycles, there were 15 poor responder cycles (16.3%) and 77 good responder cycles. AMH serum level was 3.75 ± 2.77 μg/ml in good responder cycles and 1.04 ± 1.39 μg/ml in poor responder cycles (p < 0.0001). AMH serum level was more superior than other ovarian response predictors (AUC 0.846) with cut-off value of 1.40 μg/ml. AMH serum level ≥ 1.40 μg/ml had good predictive value as ovarian reserve or ovarian reserve parameter with 81% sensitivity and 87% specificity. Conclusion: AMH serum level was more superior ovarian reserve and ovarian response predictor compared to other parameters.[Indones J Obstet Gynecol 2010; 34-3: 114-8]Keywords: anti-Mullerian hormone, ovarian reserve, ovarian response Tujuan: Untuk mengevaluasi nilai klinis pengukuran kadar Anti Mullerian Hormone (AMH) sebagai parameter respons ovarium pada program Fertilisasi In Vitro (FIV). Metode: Penelitian dilakukan di RS Dr. Cipto Mangunkusumo dengan rancangan penelitian prospektif kohort. Pasien infertilitas yang menjalani hiperstimulasi ovarium terkendali pada program FIV dilakukan pengukuran kadar FSH, estradiol, AMH dan penghitungan folikel antral basal (FAB). Pasien tersebut dikategorikan menjadi dua kelompok, yaitu perespons baik dan perespons buruk. Kelompok perespons baik memiliki oosit matur ≥ 3 buah saat dilakukan petik oosit. Sedangkan kelompok perespons buruk memiliki oosit matur < 3 buah. Analisis statistik menggunakan uji T tidak berpasangan dan Receiver Operator Characteristic (ROC) untuk melihat apakah AMH lebih superior dibandingkan faktor penduga antara yang lain.Hasil dan Pembahasan: Dari 92 siklus, 15 siklus (16,3%) dikategorikan perespons buruk dan 77 perespons baik. Rerata kadar AMH pada perespons baik adalah 3,75 ± 2,77 μg/ml dan 1,04 ± 1,39 μg/ml pada perespons buruk (p < 0,0001). Berdasarkan ROCAUC, AMH merupakan faktor penduga respons ovarium yang baik (AUC 0,846) dibandingkan faktor penduga yang lain seperti usia, FSH, estradiol, dan FAB. Nilai titik potong AMH yang didapatkan adalah 1,40 μg/ml dengan nilai sensitivitas sebesar 81% dan spesifisitas sebesar 87%.Kesimpulan: AMH merupakan faktor penduga respons ovarium yang lebih baik dibandingkan usia, FSH, Estradiol, dan FAB.[Maj Obstet Ginekol Indones 2010; 34-3: 114-8]Kata kunci: hormon anti-Mullerian, cadangan ovarium, respons ovarium
Predictive Factors for Pregnancy in IVF: An Analysis of 348 Cycles Wiweko, Budi; Hestiantoro, Andon; Sumapraja, Kanadi; Muharam, R.; Andriyana, Huthia; Febia, Eva; Pradipta, Bram; Susanto, Cynthia Agnes
Indonesian Journal of Obstetrics and Gynecology Vol. 34. No. 4. October 2010
Publisher : Indonesian Journal of Obstetrics and Gynecology

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Objective: To determine predictive factors for pregnancy after IVF.Method: The subject of this study were three hundred and forty eight IVF cycles in 266 couples who underwent controlled ovarian hyperstimulation in IVF cycles between January 2005 and March 2010. Categorical variables were compared using Chi Square test and continuous variables were analyzed using Independent t-test, p < 0.05 was considered statistically significant. Multivariate logistic regression analysis was done to test correlations between clinical variables and the occurrence of pregnancy.Results: The women’s age significantly influenced pregnancy rate since women under 35 years old has the best chance for pregnancy (56.4%). Endometrial thickness on the day of hCG administration also significantly influenced pregnancy in IVF (p < 0.001) because 64.1% of pregnancy occurred if endometrial thickness ≥ 10.95 mm. Serum FSH on 3rd day of period that can predict ovarian reserve also has significance on pregnancy. On the other hand, 61.5% pregnancy occurred if more than 6 mature oocytes were retrieved (p < 0.001). Among 92 patients of 348 cycles we found strong correlation between AMH level with number of mature oocytes retrieved (p < 0.001; r 0.659). Logistic regression done revealed the couple with best chance of pregnancy can be described as follows: women with endometrial thickness ≥ 10.95 mm, number of mature oocytes > 6 and age under 35 years old.Conclusion: This study enabled the characterization of many prognostic factors for pregnancy.[Indones J Obstet Gynecol 2010; 34-4: 180-4]Keywords: in vitro fertilization, clinical pregnancy, age, mature oocytes, endometrial thickness Tujuan: Untuk menentukan faktor penduga terjadinya kehamilan pada FIV. Metode: Penelitian dilakukan terhadap 348 siklus FIV dari 266 pasangan yang menjalani hiperstimulasi ovarium terkendali antara Januari 2005 - Maret 2010. Variabel kategorik dibandingkan dengan uji kai kuadrat sedangkan variabel kontinyu dianalisis dengan uji t tidak berpasangan. Nilai p < 0,05 dianggap bermakna. Untuk menilai hubungan antara variabel digunakan analisis multivariat dengan regresi logistik.Hasil: Usia perempuan memiliki hubungan bermakna terhadap kehamilan di mana 56,4% kehamilan terjadi pada perempuan berusia < 35 tahun. Ketebalan endometrium pada hari penyuntikan hCG juga berpengaruh terhadap tingkat kehamilan (p < 0,001) karena 64,1% kehamilan terjadi bila ketebalan endometrium ≥ 10,95 mm. Kadar FSH basal yang digunakan untuk meramalkan cadangan ovarium, juga mempunyai hubungan yang bermakna dengan ting-kat kehamilan. Sedangkan 61,5% kehamilan terjadi bila > 6 oosit matur berhasil dipetik (p < 0,001). Terdapat korelasi kuat antara kadar AMH dengan jumlah oosit matur yang berhasil dipetik pada 92 dari 348 siklus (p < 0,001; r 0,659). Setelah dilakukan regresi logistik diketahui bahwa peluang terbesar untuk hamil pada FIV bila ketebalan endometrium ≥ 10,95 mm, jumlah oosit matur > 6 dan usia pasien kurang dari 35 tahun. Kesimpulan: Penelitian ini menunjukkan karakteristik beberapa faktor prognostik kehamilan pada FIV.[Maj Obstet Ginekol Indones 2010; 34-4: 180-4]Kata kunci: fertilisasi in vitro, kehamilan, usia, oosit matur, ketebalan endometrium
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; Catherine, Catherine; DAnggraeni, Tricia; Nuryanto, Kartiwa Hadi
Indonesian Journal of Obstetrics and Gynecology Vol. 35. No 1. January 2011
Publisher : Indonesian Journal of Obstetrics and Gynecology

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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 parametrialinvolvement 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.Keywords: staging, cervical cancer, preoperative, postoperative
The Use of Human Papilloma Virus Vaccine to Prevent Cervical Cancer Pradipta, Bram; Sungkar, Saleha
Journal of the Indonesian Medical Association Vol. 57 No. 11 November 2007
Publisher : Journal of the Indonesian Medical Association

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Cervical cancer is the second most frequent malignant tumor in female in the world and the most common type of cancer found in female of developing countries, including Indonesia. It has been predicted that the number of people contracted by this cancer will increase in the near future due to the changes in lifestyle such as free sexual intercourse, changing sexual partners and smoking habit. Another factor that will lead to this situation is the low standard of living which leads to unhygienic lifestyle. It is difficult to carry out periodic check up to detect this cancer early in the developing countries like Indonesia as there is limited access to health center that is well equipped to carry out diagnostic tests. Furthermore, the high cost of the Pap test and the need of frequent visit to the health centers often discouraged someone to take the test. A preventive measure, one of which is HPV vaccination can be used to prevent cervical cancer. Many studies have proven that the use of monovalent, recombinant bivalent, and recombinant quadrivalent vaccines were effective to prevent cervical cancer. However, some factors should be considered about the HPV vaccine such as, who has to be vaccinated, whether male should be vaccinated or not, the type of virus that is commonly found in a particular country, the side effects, how long will the antibody last and community acceptance.Keywords: Human Papilloma Virus vaccine, recombinant, cervical cancer.
Uterine Atony, Pulmonary Fibrosis and Post Partum Hypertension in Post Partum Systemic Sclerosis Diffuse Patient: A Case Report in Zainoel Abidin General Hospital Banda Aceh Pradipta, Bram; Munawar, Munawar; Kamarlis, Reno Keumalazia
Journal of the Indonesian Medical Association Vol. 62 No. 4 April 2012
Publisher : Journal of the Indonesian Medical Association

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Objective: Diffuse systemic sclerosis (SSc) is an autoimmune disease with progressive fibrosis of skin and visceral tissues and vasculopathy. Pregnancies with SSc rarely found in daily practice. We report a case of 36 years old Indonesian women, gravida 5 para 4 with previous c-section, presented with pregnancy and SSc. Her chief complaint was premature rupture of membranes 24 hours. She is a patient of Internal Medicine Department since 6 months earlier with complaints of hardened skin, increased rigidity and curved hand and fingers. Patient was diagnosed with SSc with increased Sci-70 IgG autoantibodies and histopathology of the skin in accordance with scleroderma. Post C-section we found complications such as uterine atony, pulmonary fibrosis and postpartum hypertension consistent with SSc progression.Conclusion: Problems that can be encountered in pregnancy with SSc is the increase and progression of skin involvement and organ function deterioration. Common postpartum complications in pregnancy with SSc are pulmonary hypertension and renal crisis. Both of these and other complications make post partum patient with SSc require special attention and evaluation. J Indon Med Assoc. 2012;62:149-52.Keywords: diffuse systemic sclerosis, pregnancy, labor
Uterine Atony, Pulmonary Fibrosis and Post Partum Hypertension in Post Partum Systemic Sclerosis Diffuse Patient: A Case Report in Zainoel Abidin General Hospital Banda Aceh Pradipta, Bram; *, Munawar; Kamarlis, Reno Keumalazia
JOURNAL OF THE INDONESIAN MEDICAL ASSOCIATION Majalah Kedokteran Indonesia Vol 62, No 4 (2012): Journal of the Indonesian Medical Association Majalah Kedokteran Indonesia
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA

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Objective: Diffuse systemic sclerosis (SSc) is an autoimmune disease with progressive fibrosis of skin and viscelar tissues and vasculopathy. Pregnancies with SSc reraly found in daily practice. We report a case of 36 years old Indonesian women, gravida 5 para 4 with previous c-section, presented with pregnancy and SSc. Her chief complaint was premature rupture of membranes 24 hours.
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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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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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.
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 patients clinical symptoms. Management of HPP requires teamwork and a systematic yet comprehensive management
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