Budi I. Santoso
Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia

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Avulsion of the Levator Ani at First Pregnancy Santoso, Budi I.; Khusen, Denny
Indonesian Journal of Obstetrics and Gynecology Vol. 37. No. 1 January 2013
Publisher : Indonesian Journal of Obstetrics and Gynecology

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AbstractObjective: To investigate whether demographic and obstetric risk factors are associated with avulsion of the levator ani at first pregnancy.Methods: A series of case was undertaken on 4 pregnant nulliparous women seen with a gestational age of more than 37 weeks. We analyzed with 3D/4D translabial ultrasound and digital assessment data of 4 women seen in a tertiary Urogynecological clinic. The use of 3D/4D ultrasound as a means of detection of trauma to the levator ani.Result: We had 4 women who had levator ani avulsion. Diagnosis of levator trauma (avulsion) on tomographic ultrasound was correlated with predelivery demographic variables and ultrasound parameters.Conclusion: With a greater understanding on the function of pelvic floor muscles, risk factors for trauma and damage as a result of pregnancy and birth, healthcare professionals will have better ability to meet the needs of women in the childbearing year. This study utilized a scoring system that can be used to predict the occurrence of levator ani muscle damage. In the end, the decline in quality of life for women, especially after a birth, can be prevented.[Indones J Obstet Gynecol 2013; 37-1: 51-6]Keywords: 3D/4D translabial ultrasound, demographic, levator ani avulsion, obstetric risk factors
Looking Back: What We Have Done and What We Should Do Next Santoso, Budi I.
Indonesian Journal of Obstetrics and Gynecology Vol. 36. No 1. January 2012
Publisher : Indonesian Journal of Obstetrics and Gynecology

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Budi Iman Santoso Assessment (BISA): a model for predicting levator ani injury after vaginal delivery Santoso, Budi I.
Medical Journal of Indonesia Vol 21, No 2 (2012): May
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (468.613 KB) | DOI: 10.13181/mji.v21i2.487

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Background: There have been no attempts or studies to integrate various risk factors that can be utilized to predict levator ani injury caused by vaginal delivery. This study was aimed to establish an index measurement system by using various risk factors for predicting levator ani injury in vaginal delivery.Methods: A prospective cohort was conducted at two hospitals in Jakarta between 2010 and 2011. The subjects were nulipara pregnant women without levator ani injury during pregnancy and vaginal birth. Levator ani injury was evaluated using 4D USG during pregnancy and three months after delivery. The variables studied were age, body mass index, mode of delivery, fetal birth weight, episiotomy, perineum rupture and duration of second stage labor. Prediction model was analyzed using logistic regression analysis.Results: There were 182 recruited subjects of which 124 subjects were eligible and only 104 subjects could be analyzed. Incidence of levator ani injury at three months after delivery was 15.4% (95% CI: 8.6-23%). Two prediction models were obtained. The first consisted of fetal birth weight (OR= 5.36, 95% CI: 1.08-26.59), episiotomy (OR= 5.41, 95% CI: 0.94-31.18), and duration of second stage labor (OR= 15.27, 95% CI: 3.15-73.96). The second model consisted of duration of second stage labor (OR= 9.51, 95% CI: 1.23-68.10) and perineum rupture (OR= 142.70, 95% CI: 14.13-1440.78).Conclusion: Fetal birth weight, episiotomy and duration of second stage labor could predict levator ani injury for model 1; while the variables of prediction for model 2 were duration of second stage labor and perineum rupture. (Med J Indones. 2012;21:102-7)Keywords: Levator ani, prediction model
Urinary catheterization in gynecological surgery: When should it be removed? Fattah, Adly N.A.; Santoso, Budi I.
Medical Journal of Indonesia Vol 22, No 3 (2013): August
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (477.08 KB) | DOI: 10.13181/mji.v22i3.589

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Background: The aim of this study was to determine the most appropriate time for urinary catheter removal following a gynecological surgery.Methods: Critical appraisal of clinical trial articles were conducted. It was aimed to answer our clinical question whether 24-hour postoperative urinary catheter removal is superior compared to other durations in avoiding postoperative urinary retention (PUR) and urinary tract infection (UTI). The search was conducted on the Cochrane Library® and PubMed® using keywords “postoperative urinary retention”, “postoperative catheterization” and “urinary retention AND catheterization”. Reference lists of relevant articles were searched for other possibly relevant trials.Results: Seven articles were available as full text, then appraisals of six prospective RCTs involving 846 women underwent hysterectomy and vaginal prolapse surgery were performed finding at the re-catheterization and UTI rate. Subjects in earlier-removal groups were 3 to 4 times more likely to have re-catheterization (OR = 3.10-4.0) compared to later-removal groups, while they who have it removed on 5th day were 14 times more likely to develop UTI compared with immediate group (OR = 14.786, 95% CI 3.187- 68.595).Conclusion: The 24-hour catheterization policy in hysterectomy and vaginal prolapse surgery remains most appropriate although associated with an increased risk of re-catheterization. The removal of catheter before 24 hour (6 or 12 hour) could be considered to be used as one of interventions in further RCT(s) to find out the best duration which would result in lowest incidence in both of UTI and  PUR. (Med J Indones. 2013;22:183-8. doi: 10.13181/mji.v22i3.589)Keywords: Catheter, hysterectomy, prolapse, urinary tract infection
Indonesian local fetal-weight standard: a better predictive ability for low Apgar score of SGA neonates Fattah, Adly N.A.; Pratiwi, Karina N.; Susilo, Sulaeman A.; Berguna, Jimmy S.N.; Irwinda, Rima; Wibowo, Noroyono; Santoso, Budi I.; Zhang, Jun
Medical Journal of Indonesia Vol 25, No 4 (2016): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (511.187 KB) | DOI: 10.13181/mji.v25i4.1301

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Background: Accurate assessment of fetal growth is one of crucial components of antenatal care. A generic reference for fetal-weight and birthweight percentiles that can be easily adapted to local populations have been developed by Mikolajczyk and colleagues. This study aimed to validate our own local percentile standard by evaluating the odds ratio (OR) of low 1st and 5th minute Apgar score for small-for-gestational age (SGA) versus those not SGA.Methods: We used the generic reference tools for fetal-weight and birthweight percentiles developed by Mikolajczyk and colleagues to create our own local standard and then defined the SGA neonates. For validation, we used the database of singleton live deliveries (2,139 birth) during January 1st to December 31st 2013 in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We compared our reference with that of Hadlock and colleagues. For every reference, the OR of Apgar score <7 at 1st and 5th minutes for infants who were SGA versus those not estimated with bivariate and multivariate analyses.Results: SGA found in 35% (748/2,139) and 13% (278/2,139) of neonates using the definition derived from Indonesian standard and Hadlock’s. OR of Apgar score <7 at 1st and 5th minutes were 3.45 (95% CI=2.56–4.65) and 3.05 (95% CI=1.92–4.83) for the Indonesian local fetal-weight standard compared with respectively 2.14 (95% CI=1.65–2.76) and 1.83 (95% CI=1.21–2.77) for Hadlock and collegues’ reference.Conclusion: Indonesian local fetal-weight standard has a better ability to predict low 1st and 5th minutes Apgar scores of SGA neonates than has the Hadlock and collegues’ reference.
Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women Fakhrizal, Edy; Priyatini, Tyas; Santoso, Budi I.; Junizaf, Junizaf; Moegni, Fernandi; Djusad, Suskhan; Hakim, Surahman; Maryuni, Sri W.
Medical Journal of Indonesia Vol 25, No 3 (2016): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (435.805 KB) | DOI: 10.13181/mji.v25i3.1407

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Background: Mode of delivery and some certain risk factors have a relationship to postpartum stress urinary incontinence (SUI). For that reason, the objective of this study was to assess the prevalence of postpartum stress urinary incontinence (SUI), the relationship between postpartum SUI and mode of delivery; and the association between SUI and other demographic and obstetric factors.Methods: In this prospective observational cohort study, all primiparous women who were under postpartum care in obstetric and gynecologic ward were recruited. Four hundreds primiparous women with no history of urinary incontinence (UI) who fulfilled the criteria and would like to participate in this study were followed up for three months after delivery. The analysis was done using Stata 12. Bivariate analysis using Chi-square test and multivariate analysis using logistic regression test were done to obtain associated risk factors to postpartum SUI.Results: The prevalence of postpartum SUI was 8.8%. The mode of delivery was significantly associated with postpartum SUI, there were more women who got vaginal delivery that had stress urinary incontinence (14.1%) compared to women caesarean section (7.1%) with OR=2.1 (95% CI=1.05-4.31), this risk increased when vaginal delivery was assisted with vacuum instrument (OR=9.1, 95% CI=3.9-21.6). There was no statistical difference of stress urinary incontinence incidences in patients with emergency or elective caesarean section with OR=0.84 (95% CI=0.28-2.57). Based on multivariate analysis BMI ≥30 kg/m2 at labor, vacuum assisted delivery, birth weight more than 3,360 g, and second stage labor more than 60 minutes appeared to be associated with an increased rate of postpartum SUI.Conclusion: Stress urinary incontinence increased in the early postpartum period of a primiparous woman. Although vaginal delivery increased the risk of postpartum SUI, elective nor emergency caesarean delivery without vaginal delivery id not appear to increase the risk of stress urinary incontinence.
High preterm birth at Cipto Mangunkusumo Hospital as a national referral hospital in Indonesia Sungkar, Ali; Fattah, Adly N.A.; Surya, Raymond; Santoso, Budi I.; Zalud, Ivica
Medical Journal of Indonesia Vol 26, No 3 (2017): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (383.934 KB) | DOI: 10.13181/mji.v26i3.1454

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Background: Preterm birth is the leading direct that causes neonatal death. Indonesia was listed as one of the countries with the greatest number of preterm birth in 2010. This study aims to identify the prevalence and the potential risk factors of preterm birth among women underwent delivery in Cipto Mangunkusumo Hospital, an Indonesian national reference hospital.Methods: This retrospective cohort study involved 2,612 women who delivered between January and December 2013. Any clinical data which related to the potential risk factors and outcomes were recorded. The data were managed using chi-square for bivariate analysis and t-test or Mann-Whitney for numerical data followed by multiple logistic regression for multivariate analysis in SPSS version 20.0.Results: Preterm birth affected 1,020 of 2,616 pregnancies (38.5%). Non-booked patients increased nearly twice risk for preterm delivery (OR 1.89, 95% CI 1.37–2.61). While women with singleton pregnancy (OR 0.17, 95% CI 0.12–0.25), head presentation (OR 0.75, 95% CI 0.63–0.89), and regular ANC (OR 0.67, 95% CI 0.54–0.84) had lower risk for preterm birth. Apgar score, birthweight, and mode of delivery were significantly different between the pre-term group and the full-term group.Conclusion: Prevalence of preterm birth in Cipto Mangunkusumo Hospital was approximately 2.5 times higher compared to the national number. Several factors reducing preterm birth rate include singleton pregnancy, head presentation, and regular ANC.
Use of 2D and multislice transperineal ultrasonography to describe the degree of perineal laceration following vaginal delivery Santoso, Budi I.; Djusad, Suskhan; Hakim, Surahman; Moegni, Fernandi; Meutia, Alfa P.; Priyantini, Tyas
Medical Journal of Indonesia Vol 27, No 2 (2018): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (387.855 KB) | DOI: 10.13181/mji.v27i2.1908

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Introduction: Perineal tear is the most common complication after vaginal delivery. Pill-rolling test is a widely used clinical evaluation method to determine the degree of perineal tear. However, the evaluation results of anal sphincter complex (ASC) differ between clinical examination and 2D/multislice transperineal ultrasonography (TPUS). This study aims to describe measurement variation between these modalities.Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2015 to May 2016. Subjects were primiparous women after vaginal delivery. Clinical examination using pill-rolling test was performed to determine the degree of perineal laceration. Suture was conducted accordingly. The subjects were subjected to 2D/multislice TPUS 72 hours after delivery to evaluate the integrity of internal and external anal sphincters. Data were collected and analyzed to determine compatibility between these examinations.Results: Among 70 prospective primiparous women, five were excluded due to unavailability to undergo 2D/multislice TPUS 72 hours after delivery. The mean duration to perform 2D/multislice TPUS was 4.5 minutes, and pain was tolerable during the examination. The compatibility values of clinical examination with 2D and multislice TPUS were 0.98 and 0.93, respectively, with Cohen’s kappa of 0.92 (95% CI 0.81–1.00) and 0.79 (95% CI 0.58–0.99), respectively.Conclusion: Clinical examination is compatible with 2D/multislice TPUS for determining the degree of perineal tear after vaginal delivery.
Old Perineal Rupture - From Diagnosis to Reparation: Ruptur Perineum Lama: Diagnosis sampai Perbaikan Santoso, Budi I.; Chan, Nadir; Leonardo, Leonardo
Indonesian Journal of Obstetrics and Gynecology Volume 7 No. 3 July 2019
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (62.549 KB) | DOI: 10.32771/inajog.v7i3.664

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Abstract Objective: To describe and discuss the technique to diagnose, preparing the reparation and postoperative management in old perineal rupture case.Methods: A 28-year-old primipara woman was referred to YPK Mandiri Hospital after having incontinence to flatus, to urinate and passive soiling. Three months before admission, she had her first child through vaginal delivery.Discussion: She was diagnosed with a third-degree obstetric anal sphincter injury (OASIS). Rectal examination with digital palpation (pill-rolling motion) and ultrasound examination, revealed a distinct gap anteriorly (10 â?? 2 o'clock). End to end technique was preferred to repair the defect.Conclusion: A good understanding of perineal and anal sphincter anatomy is essential to diagnose OASIS. The aim of reconstructive surgery is to restore the continuity of both the external and internal anal sphincters. Ideally, the repair should be performed as soon as possible after the injury.Keywords:obstetric anal sphincter injuries, OASIS, third-degree tear, perineum, perineal trauma.   Abstrak Tujuan:Untuk mendeskripsikan dan diskusi tentang tehnik dalam mendiagnosa, mempersiapkan operasi reparasi dan manajemen pasca operasi pada kasus rupture perineum lama.Metode:Sebuah laporan kasus yang diambil dari pasien perrempuan 28 tahun primipara yang dirujuk ke RS YPK Mandiri setelah mengeluhkan inkontinensia flatus, urin, dan keluarnya feses tanpa disadari. Tiga bulan sebelumnya, pasien melahirkan anak pertama melalui persalinan pervaginam.Diskusi: Diagnosa pasien adalah cedera sfingter ani obstetrik derajat tiga. Pemeriksaan rektal dengan palpasi digital (gerakan pill-rolling) dan pemeriksaan ultrasonografi, memperlihatkan adanya penipisan di daerah anterior (arah jam 10 â?? 2). Teknik end to end dipilih untuk memperbaiki defek.Kesimpulan:Pengetahuan yang baik mengenai anatomi perineum dan sfingter ani penting untuk mendiagnosis OASIS. Tujuan utama dari operasi rekonstruksi adalah untuk memperbaiki kontinuitas dari sfingter ani eksternal dan internal. Idealnya, reparasi dilakukan secepat mungkin setelah terjadinya cedera. Kata kunci: cedera sfingter ani obstetrik, OASIS,  perineum, trauma perineum, robekan derajat tiga
Postoperative Catheterization after Total Vaginal Hysterectomy: Six versus Twenty Four Hours. A Randomized Controlled Trial: Kateterisasi Pascaoperasi Total Vaginal Histerektomi: Enam Jam versus Dua Puluh Empat Jam. Sebuah Penelitian Randomisasi Terkontrol Djusad, Suskhan; Maukar, Abraham A.L.; Hakim, Surahman; Priyatini, Tyas; Santoso, Budi I.; Leonardo, Leonardo
Indonesian Journal of Obstetrics and Gynecology Volume 7 No. 4 October 2019
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (51.599 KB) | DOI: 10.32771/inajog.v7i4.677

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Abstracts Objective: To find out whether urinary bladder catheterization after total vaginal hysterectomy is more advantageous.Methods: Forty-six subjects were included. Subjects were divided into two groups. In one group (n = 24), a transurethral catheter was removed after six hours post-surgery. In the other group (n = 24), the catheter was removed after twenty-four hours. A few hours after removal of the catheter, patients were asked to urinate. Then residual volumes were measured by measuring cylinder, using 12F catheter. Pain was measured using visual analogue scale (VAS) score. Patientsâ?? length of stay was also compared. Data were analyzed using Student T-test if distributed normally or Mann-Whitney Rank if data was abnormal.Results: Mean age for each group was 63,21 ± 8,73 and 62,38 ± 7,52 (6 hours, 24 hours respectively). Median score for 6 hours group was 50,00 (range 5 - 80) and for 24 hours was 100 (range 30 - 250) (P = 0,000). Pain perception and hospital stay were not statistically different in both group (P = 0,134 and P = 0,377)Conclusion:In this study, difference in postoperative catheterization time is associated with residual volume. Keywords: bladder catheterization, postoperative catheterization, residual volume, total vaginal hysterectomy.   Abstrak Tujuan: Untuk membandingkan lama waktu pemasangan kateter paskaoperasi total vaginal histerektomi yang lebih menguntungkan.Metode: Empat puluh enam pasien ikut serta dalam penelitian. Secara acak dibagi menjadi 2 kelompok. Pada grup I (n = 24), pelepasan kateter dilakukan setelah enam jam pascaoperasi. Pada grup II (n = 24), kateter dilepas setelah dua puluh empat jam. Beberapa jam setelah pelepasan kateter, pasien diminta untuk buang air kecil. Lalu residu urin diukur setelahnya menggunakan gelas ukur, memakai kateter no. 12 F. Skor nyeri menggunakan skor Visual Analogue Scale (VAS). Lama rawat inap juga dibandingkan. Analisis data menggunakan student's T-test. Jika terdistribusi tidak normal, analisis memakai Mann-Whitney Rank.Hasil: Rerata usia untuk tiap grup adalah 63,21 ± 8,73 dan 62,38 ± 7,52 (6 jam, 24 jam, secara berurutan). Skor median untuk grup 6 jam adalah 50,00 (range 5 â?? 80) dan grup 24 jam adalah 100 (range 30 â?? 250) (P = 0,000). Tidak ada perbedaan signifikan secara statistic pada rasa skor nyeri dan lama rawat inap (P = 0,134 dan P = 0,377).Kesimpulan: Pada penelitian ini, perbedaan waktu pemasangan kateter pascaoperasi memiliki hubungan dengan volume sisa urine.Kata kunci: kateterisasi urine, kateterisasi pascaoperasi, volume sisa urine, total vaginal histerektomi.