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
