Adenomiosis Berdampak Buruk terhadap Keberhasilan in Vitro Fertilization

Departemen Obstetri dan Ginekologi RSUP Sanglah/ Fakultas Kedokteran Universitas Udayana, William Alexander Setiawan
In: Indonesian Journal of Obstetrics & Gynecology Science · 2021 · vol. 4(2s) , pp. 1–14 · doi:10.24198/obgynia.v4n2s.175 · W4233591623
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A systematic review found that adenomyosis significantly lowers IVF success rates, including implantation and live birth, and that GnRH agonist therapy improves clinical pregnancy rates.

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Paper ini adalah tinjauan pustaka yang bertujuan memaparkan etiologi, faktor risiko, diagnosis banding, patofisiologi, pemantauan, terapi, komplikasi, rekurensi, dan pencegahan preeklamsia pascasalin, dengan mengandalkan panduan, jurnal, dan buku teks yang terbit dalam 15 tahun terakhir serta pencarian melalui PubMed dan Sci-Hub memakai kata kunci terkait. Penulis menyajikan bahwa insiden preeklamsia di Indonesia sekitar 128.273/tahun (±5,3%) dengan 0,3–27,5% kasus melaporkan preeklamsia atau hipertensi pascasalin; gejala umumnya muncul dalam 48 jam tetapi dapat hingga 6 minggu, sementara pemantauan pascasalin dilaporkan rendah (20–60%). Tinjauan juga merangkum bahwa pilihan antihipertensi pascasalin dipengaruhi afinitas pengikatan protein dan kelarutan lipid rendah (sehingga lebih sedikit masuk ke ASI), serta dipengaruhi ionisasi, berat molekul, dan komponen ASI; lini pertama yang disebut adalah labetalol dan hidralazin intravena serta nifedipin. Keterbatasan yang tersurat adalah desainnya sebagai review literatur, tanpa data primer/analisis baru terhadap outcome spesifik selain sintesis referensi yang dipilih. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Abstrak Tujuan untuk meninjau secara sistematis dan menentukan pengaruh adenomiosis pada fertilitas dan keberhasilan In Vitro Fertilization (IVF). Metode dilakukan pencarian terstruktur di sumber data PubMed. Kata kunci yang dipakai dalam pencarian adalah “Adenomyosis”, “In Vitro Fertilization” dan “Infertility”. Referensi yang dicantumkan termasuk semua artikel dan ulasan terkait juga metaanalisis. Hasil didapatkan 10 penelitian yang mengevaluasi keberhasilan IVF pada wanita dengan dan tanpa adenomiosis. Angka implantasi, kehamilan per siklus, kehamilan per transfer embrio dan kelahiran hidup pada wanita dengan adenomiosis secara signifikan lebih rendah dibandingkan wanita tanpa adenomiosis. Angka keguguran pada wanita dengan adenomiosis lebih tinggi dibandingkan dengan wanita tanpa adenomiosis. Dilakukan juga evaluasi pada 4 penelitian yang membandingkan hasil fertilisasi pada kelompok wanita dengan adenomiosis yang tidak mendapat pengobatan dan yang mendapat pengobatan berupa pembedahan atau terapi medis gonadotropin releasing hormon (GnRH) agonis. Terapi bedah atau terapi medis dengan GnRH agonis terbukti meningkatkan angka kehamilan klinis pada wanita dengan adenomiosis. Kesimpulan adenomiosis memiliki efek yang merugikan pada luaran wanita yang menjalani program IVF. Penggunaan terapi GnRH agonis jangka panjang menunjukkan manfaat yang signifikan. Kata kunci: Adenomiosis, GnRH agonis, in vitro fertilization
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Abstract

Abstrak Tujuan: Memaparkan etiologi dan faktor risiko, diagnosis banding, patofisiologi, pemantauan, terapi, komplikasi, rekurensi dan tindakan preventif pada kasus preeklamsia pascasalin. Metode: Tinjauan pustaka dengan berbagai referensi yang diakses melalui mesin pencarian seperti Pubmed dan Sci-Hub dengan menggunakan kata kunci preeclampsia, hypertension, postpartum, management. Sumber referensi yang digunakan yaitu guidelines, jurnal, dan buku teks yang diterbitkan dalam 15 tahun terakhir. Kesimpulan: Insiden preeklamsia di Indonesia yaitu 128.273/tahun atau sekitar 5,3%. Sebanyak 0,3 – 27,5% kasus yang dilaporkan mengalami preeklamsia atau hipertensi pascasalin. Gejala-gejala preeklamsia pascasalin muncul setelah melahirkan. Mayoritas kasus berkembang dalam 48 jam setelah persalinan, walaupun sindrom dapat muncul hingga 6 minggu setelah persalinan. Periode pascasalin merupakan waktu kritis bagi spesialis obstetri dan ginekologi untuk menjamin wanita dengan riwayat preeklamsia untuk dipantau dalam jangka waktu pendek dan panjang. Akan tetapi, pemantauan pascasalin sangatlah rendah, berkisar antara 20-60%. Pemilihan antihipertensi pasca salin yaitu berikatan kuat dengan protein dan solubilitas lipid yang rendah sehingga lebih sedikit yang masuk ke ASI. Selain itu, dipengaruhi juga oleh ionisasi, berat molekul dan konstituen ASI (kandungan lemak, protein, dan air). Agen lini pertama untuk preeklamsia pascasalin adalah labetalol dan hidralazin intravena serta nifedipin. Wanita dengan hipertensi gestasional ataupun preeklamsia biasanya dapat menghentikan antihipertensi dalam 6 minggu pasca salin. Postpartum Preeclampsia

Abstract

Objective: To explain about etiologies and risk factors, differential diagnosis, pathophysiology, follow up, treatment, complications, recurrence, and prevention of preeclampsia post delivery discharged.

Method

Literature review with several references accessed through search engines such as Pubmed and Sci-Hub by using keywords preeclampsia, hypertension, postpartum, management. Reference sources used are guidelines, journals, and textbooks published in the last 15 years.

Conclusion

The incidence of preeclampsia in Indonesia is 128,273/year or around 5.3%. As many as 0.3-27.5% of cases reported postpartum preeclampsia or hypertension. Symptoms of postpartum preeclampsia appear after delivery. The majority of cases develop within 48 hours after delivery, although the syndrome can appear up to 6 weeks after delivery. The postpartum period is a critical time for obstetricians and gynecologists to ensure women with a history of preeclampsia are monitored in the short and long term. However, postpartum monitoring is very low, ranging from 20-60%. The choice of antihypertensive postpartum is that it is strongly bound to protein with low lipid solubility so that fewer enter breast milk. In addition, it is also influenced by ionization, molecular weight and constituents of breast milk (fat content, protein, and water). The first line agent for postpartum preeclampsia is intravenous labetolol and hydralazine and also nifedipine. Women with gestational hypertension or preeclampsia can usually stop antihypertension within 6 weeks postpartum. Key word: postpartum preeclampsia, antihypertension

Keywords

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Condition tags

adenomyosisinfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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