Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Knowledge, Attitude, Practice of Pregnant Women and Husband’s Support on the Implementation of Pregnancy Exercise
Full text linkObjectives: This study aims to evaluate the knowledge and attitudes of pregnant women and assess the level of support from their partners regarding the adoption of pregnancy exercises in the Tangerang region.
Methods: A quantitative analysis was employed for this study, utilizing a cross-sectional study design.
Results: Data were collected from 49 respondents, revealing a statistically significant relationship (p=0.031) between the knowledge of pregnant women and the implementation of pregnancy exercises. Additionally, a highly significant association (p<0.001) was observed between the attitudes of pregnant women and their adoption of pregnancy exercises. However, no significant relationship was found between the level of support from husbands and the implementation of pregnancy exercises.
Conclusion: This study concludes that there is a significant correlation between the knowledge and attitudes of pregnant women and the adoption of pregnancy exercises.
Keywords: attitude, husband support, knowledge, pregnancy, pregnancy exercise, prenatal yog
Eliminating HPV DNA Positive Result with Large Loop Excision of the Transformation Zone (LLETZ)/Loop Electrosurgical Excision Procedure (LEEP) in Precancerous Cervical Lesions
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Objective: To determine the use of LLETZ/LEEP to eliminate HPV DNA positive result in patients with cervical precancerous lesions at General Hospital dr. Mohammad. Hoesin, Palembang.
Methods: A case series with cervical precancerous lesions was undertaken at the Oncology Polyclinic of dr.Mohammad Hoesin Hospital Palembang from January to October 2022. There were 24 samples with positive HPV DNA before LLETZ/LEEP. Samples then checked for HPV DNA after LLETZ/LEEP. The effectiveness of LLETZ/LEEP therapy was analyzed using the Mc Nemar test. Comparison of HPV DNA outcomes (positive or negative) based on procedure, HPV DNA type and histopathological type was analyzed using Fisher Exact and Pearson Chi Square tests. All data were analyzed using SPPS version 22.0.
Results: In this study, it was found that the average age of patients with cervical precancerous lesions was 40.25 ± 7.67 years (28 - 57 years). Based on the diagnosis, 8 samples were found with High-grade Squamous Intraepithelial Lesion (HGSIL) and 16 samples with Low-grade Squamous Intraepithelial Lesion (LGSIL). All samples in this study were housewives and the majority were multiparas (75.0%). History of abortion in the patients in this study was only found in 5 samples (20.8%). The results showed that there were significant differences in the HPV DNA before and after LLETZ/LEEP therapy (p = 0.000). In addition, the results showed that there was no difference in the outcome of HPV DNA based on the procedure (p = 1.000) and the type of HPV DNA (p = 0.643). After LLETZ/LEEP therapy was carried out, it was found that only 1 subject has positive HPV DNA result and the HPV DNA virus found was type 52 and (high risk) and 42 (low risk).
Conclusion: It can be concluded that LLETZ/LEEP therapy is effective in eliminating HPV DNA positive results in cervical precancerous lesions
Keywords: cervical cancer, HPV DNA, LLETZ/LEEP, precancerous lesions, RC
Clinicopathological of Pre-Operative Thrombocytosis in Epithelial Ovarian Cancer
Full text linkAbstract
Objective: To investigate the clinicopathological of preoperative thrombocytosis in patients with epithelial ovarian cancer at dr. Soedarso Regional General Hospital Pontianak.
Methods: A cross-sectional retrospective study was conducted over three months from January 2022 to March 2022, and bivariate analysis was performed using the Chi-Square test.
Results: A total of 28 subjects met the inclusion criteria, with 19 subjects had thrombocytosis (67.9%) and 9 subjects did not experience thrombocytosis (32.1%). Meanwhile, the results of the Chi Square Test showed a relationship between thrombocytosis and histopathological type in the subjects (p=0.036).
Conclusion: Preoperative thrombocytosis is associated with the histopathological type of epithelial ovarian cancer at dr. Soedarso Regional General Hospital Pontianak.
Keywords: epithelial ovarian cancer, histopathology, stage, thrombocytosi
Unusual Location: Omental Ectopic Pregnancy Killing Me Slowly
No full textObjective: Omentum pregnancy is an ectopic pregnancy in the abdominal cavity. The event has high morbidity and mortality. The purpose of this case is to present a rare case of abdominal ectopic pregnancy that occurred in a young woman.
Methods: Case report.
Results: A 22-year-old woman at 16 weeks gestation presented with abdominal pain and clinical shock. Examination results revealed pregnancy outside the womb, with an estimated fetal weight of 193 grams and positive heart activity. The patient underwent laparotomy surgery, revealing that the pregnancy had occurred in the omentum organ with placental attachment.
Conclusion: In this case, emergency management began with the patient's reception in the emergency department, followed by laparotomy exploration. After a meticulous surgery, the pregnancy's location was identified in the omentum, and the evacuation of pregnancy products was performed. The patient received treatment for several days until being discharged home. Early diagnosis and interprofessional management are crucial if similar conditions are suspected in the future to prevent morbidity.
Keywords: abdominal cavity, ectopic pregnancy, omental pregnanc
Actinomycin-D vs Methotrexate in Low-Risk Gestational Tropoblastic Neoplasia: Which is the better option?
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Background
Low-Risk Gestational Trophoblastic Neoplasia (LRGTN) is a malignant trophoblastic disease that can be cured with the proper management. Actinomycin-D (ACT) and Methotrexate (MTX) have been used as a single drug regimen for LRGTN. Therefore, this study aims to compare the efficacy and safety of ACT-based regimen and MTX-based regimen for LRGTN treatment.
Methods
Electronic databases were systematically searched for Randomized Controlled Trials (RCTs) and High-Quality Non-Randomized Controlled Trials (Non-RCTs) comparing ACT with MTX for patients with LRGTN. Studies were fully screened, extracted, and assessed. Studies without Complete Remission (CR) were excluded. The meta-analysis was carried out to quantify the efficacy and safety of each ACT and MTX regimens based on odds ratios (ORs) and 95% confidence intervals (95% CIs).
Results:
In total, 8 RCTs and 14 non-RCTs were included (2203 patients). Our study concludes that ACT has a higher CR than MTX (79.4% [716/902] vs 66.9%[871/1301]; OR 2.13; 95% CI 1.46-3.10, in the random-effects model). Furthermore, ACT is better in terms of efficacy compared to MTX in both the RCTs [81.2% (259/319) vs 66.1% (199/301); OR 2.17; 95% CI 1.49-3.16, in the fixed-effects model] and non-RCTs group [457/583 (78.4%) vs 672/1000(67.2%); OR 2.10; 95% CI 1.28-3.45, in the random-effects model]. Safety wise, the use of ACT has a higher incidence of alopecia (OR 3.52, 95% CI: 1.27-9.75, in the random-effects model) compared to MTX while MTX has a higher risk of developing liver toxicity (OR 0.54, 95% CI: 0.32-0.91, in the fixed-effects model) compared to ACT. Other side effects are not significantly different between the two groups.
Conclusion:
Our meta-analysis concluded that ACT has a better efficacy compared to MTX for LRGTN patients. In terms of safety, ACT-based regimens have a higher chance of suffering from
alopecia and a lower chance of suffering from liver toxicity. Future clinical studies on single-drug regimens for LRGTN should be conducted in order to produce higher-quality data.
Keywords:
Methotrexate, MTX, Dactinomycin, Actinomycin-D, ACT, Low-Risk Gestational Trophoblastic Neoplasia, LRGTN 
Successful management of an unruptured extrauterine pregnancy in a woman with a history of prior miscarriage in Indonesia: a case report
No full textObjective: To describe the prompt and successful treatment of an extrauterine pregnancy case in a tertiary-level hospital in Indonesia.
Methods: We report a case of prompt and successful management of unruptured tubal pregnancy in the dr. Soetomo General Hospital Surabaya.
Results: Mrs. N (32 years old) presented with lower abdominal pain and vaginal bleeding several days before admission. She was sexually active, used no contraceptives, and had a history of miscarriage. On examination, she was hemodynamically stable. A bimanual exam revealed cervical motion tenderness and pain. A high human chorionic gonadotropin (hCG) level (1,725 IU/L) and a left-sided mass, highly suspected as an extrauterine gestational sac without sign of free fluid in the abdomen nor fetal heart rate on ultrasound, prompted diagnostic laparoscopy. We found a tubal pregnancy located on the ampullae of the left fallopian tube with minimal hemoperitoneum (50 ml). A chromopertubation test was done to ensure a patent right fallopian tube, so we did a salpingectomy. The patient recovered well and was discharged home on day 2 post-procedure.
Conclusion: Early diagnosis is vital and feasible to prevent morbidity and mortality in women with ectopic pregnancy. All sexually active women complaining about painful abdomen or bleeding through the vagina must be examined for an ectopic pregnancy to enable early diagnosis and prompt treatment. A laparoscopic surgery done by a trained individual provided a safe and minimally invasive intervention to this case.
Keywords: case report, ectopic pregnancy, laparoscopy, salpingectomy, tubal pregnanc
Body Composition Parameters, Adiponectin, Leptin and Adiponectin/Leptin Ratio are Correlated with LH/FSH Ratio in Women with PCOS but not in Women without PCOS
Full text linkObjective: To investigate the correlation between body composition parameters, adiponectin, leptin and the adiponectin/leptin ratio and the LH/FSH ratio in women with polycystic ovary syndrome (PCOS).
Methods: A cross-sectional study was conducted at Reproductive Cluster Yasmin, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, with sixty women with PCOS and sixty healthy women as controls (matched for age and BMI). Body composition parameters, including body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), percent body fat (PBF), visceral fat area (VFA), percent subcutaneous fat (PSF) and skeletal muscle mass (SMM), were measured; levels of fasting glucose, fasting insulin, testosterone, and sex hormone binding globulin (SHBG) were measured; and homeostatic model assessment for insulin resistance (HOMA-IR) values, anti-Mullerian hormone (AMH), free androgen index (FAI), Ferriman-Gallwey (FG) score, adiponectin levels, leptin levels, adiponectin/leptin ratio, LH, FSH and LH/FSH ratio were measured.
Results: Body composition parameters (body weight, BMI, WC, WHR, PBF, VFA, PSF, SMM) were not significantly different between women with PCOS and controls. Fasting insulin (P<0.05), HOMA-IR (P<0.05), AMH (P<0.01), FAI (P<0.01), FG score (P<0.01) and LH/FSH ratio (P<0.05) were higher in PCOS women. Adiponectin (P<0.01) was lower in PCOS women, while leptin and the adiponectin/leptin ratio were not significantly different between groups. Most of body composition parameters, adiponectin, leptin and adiponectin/leptin ratio were correlated with HOMA-IR in both groups.
SMM was positively correlated with the LH/FSH ratio, while body weight, BMI, WC, PBF, VFA, and PSF were inversely correlated with the LH/FSH ratio in PCOS patients but not in controls. WHR was not correlated in either group. Leptin (r=-0.278; P<0.05) was negatively correlated with the LH/FSH ratio only in the PCOS group. Adiponectin (r=0.394; P<0.01) and the adiponectin/leptin ratio (r=0.413; P<0.01) were also positively correlated with the LH/FSH ratio only in the PCOS group. AMH was correlated with the LH/FSH ratio, whereas testosterone level, FAI, FG score, fasting insulin level and HOMA-IR value were not correlated with the LH/FSH ratio in PCOS women.
Conclusion: Most of the body composition parameters, leptin, adiponectin and the adiponectin/leptin ratio were significantly correlated with HOMA-IR in both groups. However, correlations of those parameters with LH/FSH ratio were found only in PCOS but not in women without PCOS. Adiponectin and leptin may play a significant role in the mechanism of neuroendocrine disorders in PCOS, which is characterized by an increased LH/FSH ratio.
Keywords: adiponectin, adiponectin/leptin ratio, body composition, HOMA-IR, leptin, LH/FSH ratio, PCO
Expression of Yap Signaling Hippo Pathway in Cervical Pre-cancerous Lesions and Cervical Cancer
Full text linkAbstract Objective: To determine the expression of YAP in cervical pre-cancerous and cervical cancer lesions.Methods: Researchers systematically searched five databases using the checklist for Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline and Newcastle-Ottawa Scale (NOS).. Inclusion criteria were the original study of YAP expression in cervical pre-cancerous lesions and cervical cancer, observational and experimental study, and using immunohistochemical techniques. The study protocol was registered in the PROSPERO database of systematic review (IDCRD42023407469). Results: The data search in this study followed the PRISMA Guideline, which includes phases of identification, screening, and inclusion of studies. Initially, 245 articles were identified across five databases: Pubmed (105), ScienceDirect (8), Scopus (29), Web of Science (26), and ProQuest (77). After removing duplicates, 157 studies remained. During the initial screening, 142 studies were excluded, leaving 15 studies for further evaluation. These were assessed based on the use of immunohistochemistry staining for YAP expression and staining result. Subsequently, ten studies were excluded for either not using immunohistochsmistry or lacking staining result, resulting in five studdies selected for qualitative analysis. These five studies were evaluated using the New Ottawa Scale, as detailed in Table 1, and their YAP Expression characteristics are summarized in Table 2. Conclusion: This systematic review showed that YAP expression at all levels ranging from normal tissue, cervical intraepithelial neoplasia, squamous cell carcinoma, and adenocarcinoma had increased expression in the cytoplasm or cell nucleus following the development of cervical cancer and tumorigenesis influenced by intra-tumor heterogeneity for YAP expression. YAP is expressed in the cytoplasm and nucleus, with different functions. YAP expression in these two sites Excessive YAP expression will trigger epithelial changes into mesenchyme which also plays a role in cancer development. This YAP expression also correlates with HPV, in which YAP levels will be maintained and increased.Keywords: cervical cancer, cervical pre-cancerous lesions, YAP expression
The SDGs Perspective of TeleDoVIA Reliability for Cervical Cancer Elimination in 2030: A Cross Sectional Study in Indonesia
Full text linkObjective: To describe the prevalence of HPV infection in women with negative Visual Inspection with Acetic Acid (VIA) and introduce Teleconsultation of Documented VIA (TeleDoVIA) as an objective test and provide a rationalization for recommending TeleDoVIA as a “high-performance” test for cervical cancer screening in lower resource settings, from SDGs perspective, to accelerate the achievement of second pillar elimination and the third SDGs target in 2030.
Methods: This is a 7-year cross-sectional study. Subjects were recruited consecutively from several public and private health providers in Jakarta. VIA test was documented and consulted to the experts panel (TeleDoVIA). Negative VIA women underwent HPV-DNA testing using SPF10-DEIA-LiPA25 for PCR and electrophoresis.
Results: A total of 1,397 negative VIA subjects were collected, consist of 52 HPV-DNA positive. False-negative of VIA was 3.7% (95% CI 0.027–0.047).
Conclusion: VIA is a reliable screening method with a low false-negative rate. TeleDoVIA could be recommended as a reliable cervical cancer screening method in low resource settings such as Indonesia, which is in line with the third SDG: good health and well-being.
Keywords: Southeast Asia < Asia; public health
Anxiety in Pregnant Women During the Covid-19 Pandemic: A Systematic Review with Meta-Analysis
No full textObjective : This study systematically reviewed and meta-analysis the prevalence and factors associated with anxiety in pregnant women during the pandemic.
Methods : We searched PubMed MEDLINE, Web of Science, Scopus, ProQuest, EBSCO, Science Direct, and Garuda journal databases in July 2021 and updated them in October 2021. All English and Bahasa journal articles from December 2019 were included in the search. We included studies that investigate factors affecting anxiety exclusively in pregnant women. The primary outcome was the prevalence ratio. The secondary outcome was the risk and protective factors as the independent variable. Joanna Briggs Institute Critical Appraisal Tools and RevMan 5.4 were used to do the analysis.
Results: After screening 2082 articles, we included 21 studies with 42.177 pregnant women. The pooled prevalence of anxiety was estimated at 28% (95% CI, 23-33.3). We found that 12 of the 21 studies contributed to 8 risks and 1 protective factor significantly in the meta-analysis. Not married/divorced/widowed, monthly income < 780 USD, screen time > 3 hours/day, history of exposure to COVID-19, complications in the current pregnancy, sleep less than 7 hours per day, subjective poor sleep quality, and high perception of vulnerability were risk factors. Meanwhile, the protective factor was trust in the government's official media.
Conclusion : There is a significant increase in the prevalence of maternal anxiety during the pandemic. Mental health screening during the antenatal visit must be carried out, and interventions to lower the anxiety level must be planned to prevent further harm.
Keywords: pregnancy, anxiety, mental health, COVID-19, pandemics
Tujuan: Penelitian ini meninjau secara sistematis dan meta-analisis prevalensi dan faktor yang berhubungan dengan kecemasan pada ibu hamil selama pandemi.
Metode: Pencarian dilakukan pada database jurnal PubMed MEDLINE, Web of Science, Scopus, ProQuest, EBSCO, Science Direct, dan Garuda pada Juli 2021 dan memperbaruinya pada Oktober 2021. Semua artikel jurnal berbahasa Inggris dan Indonesia dari Desember 2019 dimasukkan dalam pencarian. Kami menyertakan penelitian yang menyelidiki faktor-faktor yang mempengaruhi kecemasan secara eksklusif pada wanita hamil. Hasil utama adalah prevalensi. Hasil sekunder adalah faktor risiko dan protektif sebagai variabel independen. Joanna Briggs Institute (JBI) critical appraisal guideline digunakan untuk menilai kualitas penelitian yang disertakan. RevMan 5.4 dan Jamovi 2.0 digunakan untuk melakukan analisis kuantitatif
Hasil : Setelah menyaring 2082 artikel, kami menyertakan 21 penelitian dengan 42.177 wanita hamil. Prevalensi kecemasan yang terkumpul diperkirakan sebesar 28% (95% CI, 23-33,3). Kami menemukan bahwa 12 dari 21 studi berkontribusi terhadap 8 risiko dan 1 faktor pelindung secara signifikan dalam meta-analisis. Faktor risiko yaitu kondisi tidak menikah/bercerai/janda, pendapatan bulanan < 780 USD, waktu layar > 3 jam/hari, riwayat paparan COVID-19, komplikasi pada kehamilan saat ini, tidur kurang dari 7 jam per hari, kualitas tidur subyektif buruk, dan tingginya persepsi kerentanan. Sedangkan faktor protektif adalah kepercayaan terhadap media resmi pemerintah.
Kesimpulan : Terdapat peningkatan prevalensi kecemasan ibu yang signifikan selama pandemi. Skrining kesehatan mental selama kunjungan antenatal harus dilakukan, dan intervensi untuk menurunkan tingkat kecemasan harus direncanakan untuk mencegah bahaya lebih lanjut.
Kata kunci: kehamilan, kecemasan, kesehatan mental, COVID-19, pandem