Abstract Objective: To evaluate the diagnostic accuracy of high-risk human papillomavirus (HPV) DNA detection using the Hybrid Capture II assay in self-collected samples compared with clinician-collected samples. Methods: This cross-sectional diagnostic accuracy study enrolled women with abnormal cervical cytology or positive visual inspection with acetic acid (VIA) results at Dr. Cipto Mangunkusumo General Hospital, Jakarta. Participants performed self sampling followed by clinician-collected sampling. High-risk HPV DNA was detected using the Hybrid Capture II assay. Clinician-collected samples served as the reference standard. Results: High-risk HPV prevalence was 44.9%. Self-sampling showed substantial agreement with clinician-collected sampling (κ = 0.76), with 88.41% accuracy, 80.65% sensitivity, 94.74% specificity, 92.59% PPV, and 85.71% NPV. Conclusion: Self-sampling demonstrated comparable diagnostic performance to clinician-collected sampling and may be a reliable alternative for improving cervical cancer screening coverage in Indonesia. Keywords: cervical cancer screening; clinician-collected sampling; high-risk human papillomavirus; Hybrid Capture II; self sampling
ABSTRACT Objective: To describe the challenges of diagnosing and managing Placenta Accreta Spectrum (PAS) in a rural setting, particularly when referral to a specialized center is not feasible. Methods: Case report. We report a case of PAS managed in a resource-limited rural hospital at Siloam Hospitals Labuan Bajo, West Manggarai, Indonesia. Results: A 34-year-old multigravida with no antenatal care was diagnosed at 34 weeks’ gestation with placenta previa accreta and a singleton pregnancy. She had a history of one previous cesarean section and was admitted with antepartum hemorrhage. A planned referral to a specialized PAS center in Surabaya was interrupted by recurrent bleeding leading to hemorrhagic shock. An emergency cesarean section followed by hysterectomy was performed by a coordinated multidisciplinary team involving obstetrics-gynecology, surgery, urology, and anesthesiology–intensive care. The estimated blood loss was approximately 2000 mL. Both maternal and neonatal outcomes were favorable, with postoperative stabilization and no immediate complications. Histopathological confirmation was not performed due to limited facilities. Conclusion: Management of PAS in rural areas remains challenging because of limited access to early diagnosis, specialized referral centers, multidisciplinary teams, and blood bank services. This case highlights the importance of early recognition and multidisciplinary readiness to achieve favorable outcomes in low-resource settings. Keywords: antepartum hemorrhage, case report, multidisciplinary management, placenta accreta spectrum, rural settings
BACKGROUND: This study aims to determine the proportion/incidence of asymptomatic bacteriuria in women with infertility and calculate the proportion of asymptomatic bacteriuria in infertile women. METHODS: The study was conducted at Dr. RSUP. Kariadi, Semarang, in April 2021 - July 2021 by taking data on infertile female patients at the Dr. Central General Hospital. Kariadi in 2018-2020 underwent routine urine examinations. The design of this research method uses descriptive-analytic research with a cross-sectional approach. RESULTS: There were 137 women with infertility, 88 women in the primary infertility group and 49 women in the secondary infertility group. 110 (80.3%) women with the lowest level of bacteriuria were 107/uL and the highest level was 13,768/uL. Of 88 women with primary infertility, 70 (79.55%) women had asymptomatic bacteriuria and of 49 women with secondary infertility, 40 (81.63%) women had asymptomatic bacteriuria. The proportion of asymptomatic bacteriuria between the primary and secondary infertility groups was different, but not significant (p=0.76). CONCLUSION: The incidence of bacteriuria in infertile women is high and there is no difference in the proportion of asymptomatic bacteriuria in women with primary and secondary infertility. Keywords: Infertility, asimptomatic bacteriuria
Objective: To evaluated the Placenta Accreta Index (PAI) score for its association with histopathological diagnosis, E-cadherin expression, and clinical outcomes in Placenta Accreta Spectrum (PAS) disorders. Methods: A retrospective cross-sectional analysis was conducted on 81 patients with PAS at a tertiary referral center. Data on PAI scores, histopathology, and maternal/neonatal outcomes were collected. Statistical analysis compared outcomes between patients with PAI scores ≥4 and <4. Results: A PAI score ≥4 was not significantly associated with the final histopathological diagnosis of PAS (p=1.000). E-cadherin expression was lower in PAS tissue, but not significantly correlated with PAI score. However, a PAI score ≥4 was significantly associated with increased intraoperative blood loss (1275 mL vs. 968 mL, p=0.005) and a higher likelihood of requiring blood transfusion (RR 1.56, 95% CI 1.126–2.150, p=0.007). No significant associations were found between PAI score and adverse neonatal outcomes. Conclusion: The PAI score is a practical tool for predicting surgical morbidity, specifically hemorrhage and transfusion risk, in pregnancies clinically suspected of PAS, supporting its use for preoperative planning in resource-limited settings. Its utility as a primary diagnostic marker for histopathological invasion appears limited in a high-risk referral population. Keywords: E-cadherin, maternal outcome, neonatal outcome, placenta accreta spectrum, PAI Score
Objective: To analyze the relationship between the expression levels of miRNA-191 and miRNA-548c-3p in embryo culture media and embryo chromosomal status. Methods: This cross-sectional study was conducted on 30 embryos from 12 patients aged 28–40 years who underwent an in vitro fertilization (IVF) program in three clinics. Embryos were cultured until the blastocyst stage. PGT-A was performed after blastocyst biopsy on day 5 or 6, and chromosomal analysis was carried out using the NGS method. The expression levels of miRNA-191 and miRNA-548c-3p were analyzed from embryo culture media samples using the qPCR method. The relationship between the expression levels of these miRNAs and embryo chromosomal status was then assessed. Results: There were no significant differences in subjects’ characteristics between the euploid and aneuploid embryo groups (p > 0.05). There was no significant difference in the expression level of miRNA-191 between euploid and aneuploid embryos (median quantification 7.260 vs 1.039, p = 0.497). Similarly, there was no significant difference in the expression level of miRNA-548c-3p between the two groups (median quantification 1.919 vs 4.311, p = 0.707). Conclusion: The expression levels of miRNA-191 and miRNA-548c-3p show no relationship with embryo chromosomal status. Their expression in embryo culture media does not appear to be a good biomarker candidate for predicting embryo chromosomal status. Keywords: Chromosomal status, IVF, miRNA-191, miRNA-548c-3p.
Abstract Objective: To investigate the relationship between serum zinc (Zn) and copper (Cu) levels and mental distress in postmenopausal women. Methods: This cross-sectional study included 87 postmenopausal women. Participants with a history of hysterectomy or estrogen therapy were excluded. Mental distress was assessed using the Self-Reporting Questionnaire-20 (SRQ-20). Serum Zn and Cu concentrations were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Data were analyzed using SPSS version 25, employing independent t-tests, Mann–Whitney tests, and Pearson correlation analysis. Results: The mean serum zinc levels in participants with and without mental distress were 67.93 ± 9.03 µg/dL and 71.07 ± 12.99 µg/dL, respectively (p = 0.390). The mean serum copper levels were 129.38 ± 12.31 µg/dL in participants with mental distress and 131.78 ± 18.22 µg/dL in those without (p = 0.638). No significant correlations were found between serum zinc or copper levels and mental distress (r = -0.03, p = 0.775; r = -0.002, p = 0.984, respectively). These findings suggest that zinc and copper may not serve as reliable biomarkers for screening mental distress in postmenopausal women. Conclusion: Serum zinc and copper levels were not significantly associated with mental distress in postmenopausal women. keywords: copper, mental distress, postmenopausal, zinc.
Department of Obstetrics and Gynecology Meilisva Audila Anggraeni, Budi Wicaksono, Agus Sulistyono Department of Obstetrics and Gynecology Faculty of Medicine Universitas Airlangga Dr. Soetomo General Hospital Surabaya
Abstract Objective: To determine the relationship between the levels of knowledge and attitudes of midwives in the Rumbai sub district and the implementation of 10T antenatal care. Methods: This was a cross-sectional study with an analytic observational design involving 43 midwives in the Rumbai sub district. Data were collected using a questionnaire that had undergone validity and reliability testing using the SPSS program. The implementation of 10T antenatal care was assessed using a Likert scale. Data were analyzed using SPSS version 23.0. Results: The majority of respondents were aged 31–35 years (39.5%), had a diploma (D3) as their highest educational level (55.8%), had 1–5 years of work experience (46.5%), and worked in clinics (44.2%). There were significant relationships between educational level (p=0.031, C=0.294), knowledge level (p=0.029, C=0.211), years of service (p=0.026, C=0.094), and attitudes(p=0.048, OR=1.391) of midwives and the implementation of 10T antenatal care in the Rumbai sub-district. Conclusion: This study demonstrated a significant relationship between midwives’ attitudes and the implementation of 10T antenatal care in the Rumbai sub-district. Additionally, there were associations between educational level, knowledge level, and the implementation of 10T antenatal care. Among the respondents, 88.3% (20 out of 24) of midwives with a diploma (D3), 77.8% (14 out of 18) with a bachelor’s degree, and 0% (0 out of 1) with a master’s degree completed the 10T implementation. These findings indicate that midwives with a diploma (D3) demonstrated the highest level of implementation compared to those with higher educational levels. Therefore, efforts to improve the implementation of 10T antenatal care should be tailored according to the educational background of midwives. Keywords: antenatal care, attitude, level of knowledge, midwives
Abstract Objective: To evaluate the accuracy of office hysteroscopy in assessing tubal patency compared with hysterosalpingography. Methods: This cross-sectional study was conducted from January 2021 to May 2023 and involved 26 subjects who underwent office hysteroscopy as part of a subfertility work-up. Tubal patency was assessed using the bubble test (Parryscope test) and by measuring changes in the amount of fluid in the pouch of Douglas after the procedure. All subjects subsequently underwent hysterosalpingography as the standard method. Due to technical limitations, diagnostic laparoscopy the gold standardwas not performed. Agreement between office hysteroscopy and hysterosalpingography was evaluated using concordance rates and kappa values, along with sensitivity, specificity, positive predictive value, and negative predictive value. Pain scores during the procedure and post-procedural symptoms were also analyzed. Results: The concordance between the two modalities in assessing tubal patency was 67% (moderate agreement), with a kappa value of 0.28 (fair agreement). Office hysteroscopy resulted in lower pain scores and a reduced incidence of post procedural lower back pain and abdominal bloating. Conclusion: Office hysteroscopy demonstrates fair accuracy in assessing tubal patency compared with hysterosalpingography, with the advantages of minimal pain and no serious side effects. Keywords: HSG, office hysteroscopy, tubal patency.
Abstract Background: Fertility preservation has become an important aspect for women at risk of diminished ovarian reserve, including patients with ovarian disease. Ovarian cystectomy is known to adversely affect ovarian reserve, particularly after repeated procedures. Oocyte cryopreservation has emerged as an established strategy for preserving fertility potential in such cases. Objective: We report a 23-year-old nulligravid, unmarried, and not sexually active patient with a history of repeated ovarian surgery for managing ovarian cysts. Ovarian reserve testing revealed a markedly reduced anti-Müllerian hormone (0.8 ng/mL), consistent with diminished ovarian reserve. The patient underwent oocyte cryopreservation initiated with controlled ovarian stimulation. Oocyte retrieval yielded three mature oocytes, which were successfully cryopreserved without complication. Consistent with our case, previous studies have shown a 30–50% decline in AMH after cystectomy, with more pronounced effects in bilateral disease or repeated surgery. Although the number of retrieved oocytes was limited, oocyte cryopreservation provided the patient with the possibility of future reproductive options. Conclusion: This case highlights that repeated ovarian surgery can significantly impair ovarian reserve, threatening the future reproductive potential of young women. Although the number of mature oocytes retrieved in patients with diminished ovarian reserve may be limited, oocyte cryopreservation remains an effective strategy to preserve fertility. Keywords: anti-Müllerian hormone, fertility preservation, oocyte cryopreservation, ovarian cystectomy, ovarian reserve, young women.
Introduction: Sertoli-Leydig cell tumor (SLCT) is a rare ovarian sex cord-stromal tumor.High-grade SLCT is more aggressive and potentially metastasizes, generally through expansion to the peritoneum or lymphovascular metastasis. Metastases to the walls of vesica fellea are very rare. Case description: A 52-year-old woman with heartburn for one week, accompanied by icteric eyes, nausea, vomiting, watery pale diarrhea for five days, and dark brown urine. Laboratory of all liver function were elevated, CEA slightly increased CEA, and CA-125 normal. Ultrasound and MSCT of the abdomen examination exhibited a solid mass of ovaries. MRCP showed multiple stones in the vesica fellea accompanied by cholangitis and obstructive jaundice. The clinical diagnosis was suspected of ovarian cancer with cholelithiasis and cholecystitis, complicated by jaundice is established. The patient underwent TAH-BSO surgery and cholecystectomy. The histopathological examination of the left and right ovaries revealed poorly differentiated, diffuse, and partially tubule-looking Sertoli-Leydig cells in hypercellular and hypocellular ovarian tumors. Polymorphic tumor cells, pleomorphic nuclei, partially with mucin-containing cytoplasm, form a signet ring. Immunohistochemicals of calretinin and inhibin were positively expressed, while EMA and CK were negatively expressed. High-grade SLCT was established as a definitive diagnosis. Histopathological examination of the vesica fellea showed a concluding secondary tumor from the ovary. Conclusion: SLCT incidence is <0.5% of ovarian tumors. Grade and histopathology type determine its nature. High-grade tumor prognosis is inferior serous carcinoma, signet-ring stromal tumor, and gastrointestinal adenocarcinoma metastases were the differential diagnoses because of histopathological morphology similarity. This may be the first case of bilateral high-grade SLCT with metastases to the vesica fellea causing obstructive jaundice.
Objective: To identify risk factors associated with cervical cancer and determine the strongest predictors among young adults at Prof. Dr. R.D. Kandou General Hospital. Methods: This study employed an analytical case–control design. Sampling was performed using a total sampling method, including all cervical cancer patients aged <45 years treated at Prof. Dr. R.D. Kandou General Hospital from January 2022 to June 2023. The independent variables included educational level, occupation, nutritional status, age at first sexual intercourse, multiple sexual partners, type of contraception, and parity. Associations between variables were analyzed statistically. Results: A total of 210 participants were included, comprising 105 cases and 105 controls. The most common age group was 30–39 years (51%). The predominant histopathological type was squamous cell carcinoma (82%), and most cases were diagnosed at stage IIB–IIIC1r (73%). Educational level (p=0.318) and occupation (p=0.972) were not significantly associated with cervical cancer in young adults. In contrast, normal nutritional status (p<0.001), age at first sexual intercourse ≤18 years (p<0.001), multiple sexual partners (p<0.001), use of hormonal contraception (p<0.001), and multiparity (p<0.001) were significantly associated with cervical cancer in young adults. Conclusions: Early age at first sexual intercourse (≤18 years), multiple sexual partners, use of hormonal contraception, and multiparity are significant risk factors for cervical cancer in young adults. Keywords: cervical cancer, risk factor, young adult
Abstract Objectives: To investigate the association between circulating progesterone concentrations measured one day prior to Frozen Embryo Transfer (FET) in Hormone Replacement Therapy (HRT) cycles and clinical pregnancy outcomes, and to determine the optimal progesterone threshold for predicting clinical pregnancy. Methods: A prospective cohort study was conducted at Da Nang Women and Children's Hospital from January 2023 to October 2024. A total of 243 women undergoing HRT-FET cycles were enrolled. Eligible participants had a body mass index (BMI) ≤25 kg/m², were aged 18–45 years, had an endometrial thickness >7 mm, and underwent transfer of one or two high-quality blastocysts. Circulating progesterone concentrations were measured on the fourth day of progesterone supplementation, one day prior to embryo transfer, and categorized into quartiles. Clinical pregnancy was defined by ultrasound confirmation of fetal cardiac activity at 7 weeks of gestation. Statistical analyses included t-tests, chi-square tests, multivariate regression, and receiver operating characteristic (ROC) curve analysis. Results: Clinical pregnancy rates across increasing progesterone quartiles were 31.7% (<9.1 ng/mL), 49.2% (9.1–<11.0 ng/ mL), 50.8% (11.0–<13.5 ng/mL), and 57.4% (≥13.5 ng/mL). Women with progesterone concentrations <9.1 ng/mL had a significantly lower clinical pregnancy rate compared with those in higher quartiles (31.7% vs. 52.5%, p = 0.033). ROC analysis demonstrated moderate predictive performance (AUC 0.65; 95% CI: 0.58–0.72), with an optimal progesterone cut-off value of 10.35 ng/mL (sensitivity 80.9%, specificity 52.3%). Conclusions: Lower serum progesterone concentrations measured one day prior to embryo transfer are associated with reduced clinical pregnancy rates in HRT-FET cycles, supporting the clinical value of progesterone monitoring. However, given the single-centre design and moderate predictive performance, the proposed threshold should be interpreted with caution and validated in larger, more diverse populations. Keywords: clinical pregnancy, frozen embryo transfer, hormone replacement therapy, progesterone.
Abstract Objective: The incidence of breast cancer in pregnant women is noted to be 1 in 3000 – 10000 women. This case report aims to examine the management of breast cancer in pregnant patients, taking into account holistic factors and the importance of teamwork among various professional disciplines. Methods: A Case Report Case Presentation : In this case report, a 37-year-old woman, G3P2, 23 weeks gestational ag with breast cancer during pregnancy. Biopsy results showed stage II invasive papillary carcinoma of the breast, which progressed to an advanced stage. The patient and her husband were convinced in a family meeting to continue the pregnancy with coordinated multidisciplinary team. After undergoing conservative management, a cesarean section was performed at 31 weeks of gestation . The patient gave birth to a baby boy weighing 1355 grams with an Apgar Score of 6/8. Currently, the patient is undergoing outpatient care in the hematology oncology department and the baby is undergoing outpatient care with the pediatrics department. Discussion:Clinical experience and patient values are essential considerations in making appropriate management decisions. The management dilemma in this case required a holistic approach, facilitated by a social obstetrics and gynecology consultant. Clinical assessment indicated that early termination of pregnancy would not necessarily improve maternal prognosis, supporting the decision to continue conservative management. The multidisciplinary team conducted counselling through family meetings, ensuring that both patient and family were actively involved in the decision-making process. Therefore, obstetricians and gynecologists, particularly those engaged in social obstetrics and gynecology, play a crucial role as facilitators to achieve mutual agreement that reflects the expectations of all parties. Conclusion: This case demonstrates the importance of understanding a holistic approach and multidisciplinary team collaboration in decision-making for patients with breast cancer during pregnancy. Keywords: Holistic, Breast Cancer, Pregnancy
ABSTRACT Objective: This study aimed to evaluate the effect of ethanol extract of H. longiflora leaves on apoptosis regulation through Bcl-2 and Caspase-3 expression in BaP-induced Wistar rats (Rattus norvegicus). Methods: An experimental study with a post-test only control group design was conducted. Twenty-five female Wistar rats were randomly allocated into five groups: healthy control, negative control (BaP only), and three groups receiving kitolod extract at 100, 200, or 300 mg/kg BW. BaP administration was followed, one hour later, by co-treatment with the extract for 30 consecutive days. Cervical tissues were analyzed immunohistochemically for Bcl-2 and Caspase-3 expression. Results: Kitolod extract significantly reduced Bcl-2 expression compared with the negative control (p < 0.05) and increased Caspase-3 expression, with the strongest effect observed at 300 mg/kg BW. The healthy control group exhibited the lowest expression levels, while the negative control group showed the highest, demonstrating a consistent dose-response relationship. Conclusion: Ethanol extract of H. longiflora leaves suppressed Bcl-2 and enhanced Caspase-3 expression, thereby promoting activation of the intrinsic apoptotic pathway. Keywords: Hippobroma longiflora, benzo[a]pyrene, Bcl-2, Caspase-3, apoptosis, cervical cancer
Abstract Objective: To examine the correlation between maternal serum vitamin D levels and amniotic membrane thickness in cases of premature rupture of membranes (PROM). Methods: This analytical cross-sectional study was conducted from July to November 2022 at Dr. Zainoel Abidin General Hospital, the Universitas Syiah Kuala Research Laboratory, and Prodia Banda Aceh Laboratory. A total of 30 women with term PROM who met the inclusion and exclusion criteria were enrolled. Serum vitamin D levels were measured using Electrochemiluminescence Immunoassay (ECLIA), while amniotic membrane thickness was assessed histologically using hematoxylin Eosin (HE) staining. Spearman’s correlation test was performed with a 95% confidence level. Results: Thirty mothers with PROM were included, with a mean age of 31.37 ± 6.8 years. Vaginal delivery was the predominant mode of delivery (53.3%). The mean serum vitamin D level was 20.25 ng/mL (range: 8.5–42.5 ng/mL), and the mean amniotic membrane thickness was 82.51 µm (range: 28.69–227.8 µm). No significant correlation was observed between serum vitamin D levels and amniotic membrane thickness (r = −0.029; p = 0.878). Conclusion: There was no significant correlation between maternal serum vitamin D levels and amniotic membrane thickness in cases of PROM. Keywords: amnion, pregnancy, premature rupture of membranes, thickness of the membranes, vitamin D.
Introduction : During the COVID-19 pandemic, several experts have reported the effects of pregnancy accompanied by COVID-19 on both the mother and infant, influenced by the symptoms and signs presented. This study aims to analyze the correlation between blood markers; C-Reactive Protein (CRP), D-Dimer, Neutrophil-to-Lymphocyte Ratio (NLR) and the severity of COVID-19 in pregnant women during the 2020 pandemic at Persahabatan Hospital, Jakarta. Method : This cross-sectional study was conducted at Persahabatan Hospital, a National Respiratory Referral Center in Jakarta. A total of 525 pregnant women who met the inclusion criteria were evaluated. Laboratory markers, including CRP, D-Dimer, and NLR, were analyzed and categorized as normal or elevated. Data were analyzed using Chi-Square tests, and correlations were evaluated using Spearman’s rank correlation coefficient. Result : The result of this study found that elevated biomarkers were significantly correlated with increased severity of disease. CRP (>10 mg/L), D-Dimer (>3333 mg/L), and NLR (>5.8) were all associated with moderate to severe disease. Statistical analysis showed significant correlations with p-values <0.005 and a 95% confidence interval. Conclusion : Elevated CRP, D-Dimer, and NLR levels are associated with increased disease severity in pregnant women with COVID-19. These biomarkers can serve as useful predictors for the severity of the disease. Keywords : Covid 19, CRP, D-Dimer, NLR , Pregnant
Objectives: Diagnosing uterine rupture in placenta accreta spectrum (PAS) can be challenging, often confirmed only during surgery after the rupture has occurred. This poses significant risks of morbidity and mortality for both the mother and neonates. Therefore, it is crucial for obstetricians to understand the clinical signs of uterine rupture in PAS cases. We aim to present four cases of grade 3a PAS and their associated maternal and neonatal outcomes related to spontaneous uterine rupture. Case management: Four cases of spontaneous uterine rupture attributed to FIGO grading 3A PAS occurred at Wahidin Sudirohusodo Hospital, a tertiary healthcare center in Makassar, South Sulawesi, Indonesia. All patients were multigravida with prior cesarean sections, presented at preterm gestational ages, and had histologically confirmed PAS. They were referred from secondary healthcare facilities. In two cases, spontaneous uterine rupture was identified prior to surgery, with the patients presenting in hypovolemic shock and intrauterine fetal demise. In the other two cases, the rupture occurred during laparotomy before any uterine procedure, and the neonates were delivered alive. During the emergency laparotomy, uterine ruptures were identified at the sites of placental attachment. In one case, an additional rupture was observed on the posterior uterine wall. Management included emergency classical cesarean section followed by supracervical hysterectomy, postoperative ICU admission, and massive blood transfusion. All mothers were discharged in stable condition. Conclusion: Spontaneous uterine rupture in PAS cases is associated with increased maternal morbidity as well as neonatal mortality and morbidity. Keywords: caesarean section, placenta accreta spectrum, spontaneous uterine rupture, classical cesarean section, supracervical hysterectomy
