Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Neonatal Outcome Associated With Birth Order and Chorionicity in Twin Pregnancy
Full text linkObjectives: The objective of this study is to examine the neonatal outcomes of twin pregnancies based on the difference of chorionicity and order of delivery.
Methods: An observational cross-sectional study was done among all women with >24 completed weeks gestation having twin pregnancies in the Department of Obstetrics and Gynaecology of Dr. Soetomo General Hospital and Universitas Airlangga Hospital, Surabaya, Indonesia in 2023.
Results: 49 twin from 1638 birth (2.99%) were recruited for the study. The MC groups had a higher prevalence of preterm birth <37 weeks (83.3 vs 53.8%), preterm birth <34 weeks (52.8 vs 15.4%), VLBW (25 vs 7.7%), ELBW (25 vs 15.4%), low Apgar scores at 5th minutes (50 vs 15.4%), admission to NICU (66.7 vs 15.4%), RDS (41.7 vs 7.7%), early neonatal death (33.3 vs 7.7%), and perinatal death (44.4 vs 15.4%) [p<0.05]. In relation to birth order, there were no significant difference in all neonatal outcomes, except the higher prevalence of lower Apgar scores in 1st (75 vs 50%) and 5th minutes (50 vs 19.4) in the second delivered MC twin (p=0.05). Out of the 98 twin babies, there were a total of 32 perinatal deaths (32.65%), consisting of eight stillbirths and twenty-four neonatal deaths.
Conclusions: Chorionicity and birth order were influenced by the neonatal outcomes of twin pregnancies. It is important to manage twin pregnancy in specialized or tertiary care center hospital
Comparison of Pulsatility Index and Notching of Uterine Artery Doppler on Normotensive Pregnancy and Established Pre-eclampsia
Full text linkObjective: The aim was to assess pulsatility index of uterine artery (Ut-A PI) of normotensive pregnancy and preeclampsia between 28-40 weeks of gestation.
Methods: This cross-sectional study was conducted at Dr. Sardjito Hospital and Harapan Kita Maternal Children Hospital as a tertiary referral hospital. The study included 220 women high risk pregnancies.
Result: There were 188 pregnant women normotensive pregnancy (85.5%) and 32 preeclampsia cases (14.5%). Weight, Body Mass Index, blood pressure, Mean Arterial Pressure, chronic hypertension, history of preeclampsia, and baby weight showed an significant association with preeclampsia. Pulsatility index of uterine artery had a sensitivity of 87.50% and a specificity of 98.94% whereas the notching had a sensitivity of 46.88% and a specificity of 87.23%.
Conclusion: The UtA PI is a complementary tool with good performance for the diagnosis of overall and severe preeclampsia with high sensitivity and specificity. UtA PI has better performance the notching.
Keywords: Pulsatility index, notching, normotensive, preeclampsi
Impact of Educational Intervention on HPV Vaccine Interest in Preclinical Medical Students
Full text linkObjectives: To assess the role of education on HPV vaccination interest among preclinical medical students at School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia.
Methods: This was a descriptive analytic study with cross-sectional method. The respondents of this study were 104 of preclinical medical students, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, based on proportional sampling method. Data were obtained in November 2023 using questionnaires tool. The collected data were then statistically analyzed with univariate and bivariate analysis.
Results: There was an increase that statistically significant in knowledge and HPV vaccination interest after educational intervention. And there was an association between education and HPV vaccination interest (p=0.000).
Conclusion: There is a role of education on HPV vaccination interest among preclinical medical students at School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia
Physical Activity Impact on Severity of Dysmenorrhea among Junior High School Students: A Cross Sectional Study
Full text linkObjective: This study aims to identify the prevalence of dysmenorrhea, the level of physical activity, the risk factors for dysmenorrhea and to determine the relationship between physical activity and the severity of dysmenorrhea among junior high school students.
Method: This is a cross-sectional, observational analytical study on the population of adolescence, junior high school students, conducted from July to December 2023 in Palembang. Primary data were obtained using Physical Activity Questionnaire for Older Children (PAQ-C) and working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) score.
Results: About 88.9% of students experienced primary dysmenorrhea, with 34.4% experiencing mild dysmenorrhea, 38.9% experiencing moderate dysmenorrhea, and 15.6% experiencing severe dysmenorrhea. The level of daily physical activity performed by the students was 43.3% low activity, 55.6% moderate activity, and 1.1% high activity. There was no significant relationship between physical activity and the degree of dysmenorrhea (p=0.459; PR=0.828; 95% CI: 0.558-1.230). Menarche age <12 years (PR=1.186), a family history of dysmenorrhea (PR=1.225), and irregular menstrual cycles (PR=1.283) are risk factors for higher degree of dysmenorrhea.
Conclusion: There is no relationship between physical activity and the degree of dysmenorrhea. Female students mostly experience moderate primary dysmenorrhea, with the dominant level of physical activity being moderate. Menarche age <12 years, a family history of dysmenorrhea, and irregular menstrual cycles are risk factors for the higher degree of dysmenorrhea.
Keywords: Adolescents, primary dysmenorrhea, physical activit
Preeclampsia with Acute Pulmonary Edema
Full text linkObjective: Describe the initial management for severe pre-eclampsia complicated with acute pulmonary edema.
Methods: A case report.
Case: 41 years old woman, G5P4A0, unknown gestational age, admitted with headache, dyspnea, and unconsciousness. The patient denied a history of past illness. Vital signs were checked, and crisis hypertension, tachypnea, tachycardia, and low oxygen saturation were obtained. Physical examination showed audible lung crackles and leg edema. Proteinuria +3 was detected. For initial management, the patient was given oxygen with Jackson-Rees bagging, Nicardipine drip, MgSO4 injection, and Furosemide injection. After the patient was fully conscious and stable in the ICU, the patient reported contractions with pelvic examination marked 8 cm dilatation. The patient underwent vaginal delivery and gave birth to a male, BW 2900gram, BL 47cm, APGAR 3/8.
Discussion: Increased plasma volume, cardiac output, vascular permeability, peripheral vascular resistance, and decreased oncotic pressure are the causes of pulmonary edema in preeclampsia. According to Wallace et al, lowering blood pressure, giving adequate oxygen, and fluid restriction are the main management of pulmonary edema in preeclampsia. The correct initial management in the ER gives a good output on this case report.
Conclusion: Initial management of acute pulmonary edema in pre-eclampsia patients should be done correctly, consequently decreasing maternal and fetal morbidity and mortality.
Keywords: pregnancy, severe pre-eclampsia, pulmonary edema
Sensitivity and Specificity of Modified Early Obstetric Warning Score (MEOWS) and Maternal Early Warning Criteria (MEWC) for Maternal Morbidity: A Retrospective Cohort Study in Pregnant Women with COVID-19
Full text linkObjective: To measure the comparative sensitivity, specificity, and predictive value of MEOWS and MEWC in predicting morbidity in pregnant patients infected with COVID-19. This research can be one of the screenings used to determine the level of care for pregnant patients with COVID-19.
Methods: The retrospective cohort technique was used to examine the 89 pregnant women with COVID-19 who were admitted to the Bantul Regional General Hospital between January and December 2021. Data analysis used the ROC curve to compare sensitivity, specificity, and predictive value.
Results: MEWC is better than MEOWS in predicting the morbidity of pregnant patients with COVID-19 infection. This is because MEWC has a better sensitivity (78,3%) and PPV value (78%) than MEOWS, even though it has a lower specificity value (81,8%) and NPV value (82%). The specificity value of MEWC (81.8%), when compared to MEOWS (97.1%), does have a lower specificity value. The results of MEOWS and MEWC data analysis using ROC produce an area under the curve for MEOWS of 74,9% while for MEWC of 80%.
Discussion: MEWC has a better sensitivity indicating that patients who do not trigger MEWC criteria will have a low risk of experiencing maternal morbidity. Screening tools will prioritize the sensitivity value compared to the specificity value of the instrument used. A screening tool will have a lower positive predictive value if the study population has a lower prevalence of morbidity. Based on the comparison of the predictive value, sensitivity, and specificity of the MEWC and MEOWS instruments, it can be concluded that MEWC is associated with maternal morbidity with a higher sensitivity than MEOWS, although it has a lower specificity. High sensitivity values will result in screening tools with consistent results. The ROC curve can also show that MEWC has a higher sensitivity value by looking at the Y-coordinate, which is higher than the Y-coordinate of MEOWS. MEWC has a better Receiver Operator Curve (ROC) intersection point than MEOWS, where the MEWC intersection point has the furthest point on the upper left of the ROC diagonal line.
Conclusion: MEWC has a higher sensitivity compared to MEOWS, even though it has a lower specificity. High sensitivity values will produce screening tools with consistent results.
Keywords: MEWC, maternal early warning system, maternal morbidity, MEOW
The Antibiotic Prescribing Practices of Gynecologists in Abdominal Hysterectomy
Full text linkObjective: To evaluate the pattern of antibiotics used for abdominal hysterectomy by gynecologists in infected and non-infected cases.
Methods: Data was collected through an online survey of gynecologists in Surabaya, Indonesia.
Results: A total of 200 gynecologists were involved in this study. All of them used prophylactic antibiotics in all cases of abdominal hysterectomy, and the most commonly used was cefazoline (70.5%), followed by ceftriaxone (15.5%) and cefotaxime (9%). Most gynecologists (68%) gave 2 grams of prophylactic antibiotic, and 79,5% of antibiotics were administered within 30 minutes before surgery. Additional antibiotics during surgery were given in prolonged surgery (79.01%) and intraoperative bleeding > 1500 mL (48.14%). The most common additional dosage used was 1 gram (72.9%), and most gynecologists (37.2%) continued antibiotics for one day ahead. The type of therapeutic antibiotics used for infected cases was varied, consisting of ceftriaxone (50.5%), metronidazole (42%), cefotaxime (17%), cefazoline (15.5%), gentamicin (12%), ampicillin-sulbactam (4%), and amoxicillin-clavulanic acid (3.5%). Most gynecologists (43.7%) gave these antibiotics for three days.
Conclusion: The majority of gynecologists in Surabaya already use prophylactic antibiotics for abdominal hysterectomy and therapeutic antibiotics for infected cases following the existing guidelines
 
Management of Vulvovaginal Candidiasis in Pregnancy
Full text linkPregnancy is a risk factor for vulvovaginal candidiasis (VVC). The most common cause of VVC in pregnancy is Candida albicans. During pregnancy, physiological changes occur, such as increased levels of estrogen, lower vaginal pH, increased production of vaginal mucosal glycogen and immunological changes so that Candida colonization in the vagina increases. Increased colonization can be symptomatic or asymptomatic. When symptoms and signs of vulvar pruritus, pain, swelling, redness, burning, dyspareunia, dysuria, vulvar edema, fissures, excoriation and vaginal discharge are found, it is necessary to perform microscopic examination and/or fungal culture to establish the diagnosis of VVC. Topical intravaginal antifungal therapy such as clotrimazole and nystatin, are the recommended treatment for VVC in pregnancy that has been shown its safety. Treatment with oral antifungal is not recommended because of the risk of causing congenital abnormalities in the fetus. Prophylactic administration in the last trimester of pregnancy in asymptomatic VVC cases provides good pregnancy and neonatal outcomes but is still being debated. In severe, prolonged or recurrent cases of VVC, other co-infections may be sought which may also need to be managed. Administration of probiotics for VVC therapy still requires further research
Epidemiology of Cervix Uteri Cancer in Saudi Arabia from 2004 to 2017
Full text linkAbstract:
Objectives: This study investigates the epidemiological pattern of Cervix Uteri cancer (CUC) throughout all administrative regions of Saudi Arabia. It examines the frequency number and percentage of diagnosed cases, the age-specific incidence rate (AIR), the crude incidence rate (CIR), and the age-standardized incidence rate (ASIR) stratified by age group, year of diagnosis, and regions.
Methods: A retrospective descriptive epidemiological investigation of all CUC cases documented in the Saudi Cancer Registry (SCR) between 2004 and 2017 was performed. Statistical Package for the Social Sciences, version 20.0, was utilized to analyse the data using descriptive statistics and the Kruskal-Wallis test (SPSS).
Results: In total, 1,451 UCU diagnosed cases were reported to the SCR between January 2004 and December 2017. Northern, Eastern, and Tabuk regions had the highest ASIR of CUC among Saudi women (2.2, 2.0, and 2.0 per 100,000 women). In contrast, among Saudi women, Jazan had the lowest overall ASIR of CUC (0.7 per 100,000 women, respectively).
Conclusion: The ASIRs of CUC in Saudi Arabia decreased slightly from 2004 to 2017. The Northern, Eastern, and Tabuk regions of Saudi Arabia had the highest ASIR of CUC among Saudi women, while women in Jazan, Saudi Arabia, were proven to be the least affected by CUC.
Keywords: Cancer epidemiology; Cervix Uteri cancer; Saudi Cancer Registry; oncology; Incidence rate