Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Mosaic Form of Turner Syndrome
Full text linkObjective: To report a case of breast growth disorder in a mosaic form of Turner Syndrome. Turner syndrome is a chromosomal condition characterized by small height and primary ovarian insufficiency that affects one in every 2500 female births. Mosaicism is likely to occur when monosomy X develops in only a few cells during development. The clinical presentation of Turner syndrome mosaicism is atypical, with symptom severity varying based on the number of affected cells. This case discusses issues with secondary sex development, including mild hyperandrogenism, and explores how combination hormonal treatment can aid in enhancing secondary sex development.
Method: Case Report.
Case: A 21-year-old woman presented with chief complaint of the lack of breast enlargement. She exhibited normal genitalia internally and externally and had a regular menstrual cycle. Karyotyping revealed a mosaic pattern of 45, X/46, XX (1 percent/99%) with normal estradiol levels and elevated testosterone levels (indicating mild hyperandrogenism). The patient underwent two cycles of hormone therapy using Ethinyl Estradiol and Drospirenone, resulting in breast growth progression from Tanner stage 1 to Tanner stage 2.
Conclusion: Mosaicism in Turner syndrome is plausible, and the severity of clinical symptoms correlates with the number of defective chromosomes. The presentation of Turner syndrome mosaicism varies, and therapy should be tailored to address specific symptoms. While breast development is observed in some girls with Turner Syndrome, instances of breast growth disorder may occur, involving estrogen activity and estrogen receptor sensitivity. Although the exact cause of impaired breast growth remains unknown, administering estrogen in such cases can improve secondary sexual characteristics.
Keywords: mild hyperandrogenism, mosaicism, turner syndrom
Acceptance and Satisfaction of Indonesian Women Undergoing Visual Inspection with Acetic Acid (VIA) Examination Using Digital Image and The Related Factors
Full text linkObjective: To determine the acceptance, satisfaction, and willingness to recommend of women undergoing VIA examination with and without digital image and their related factors.
Methods: This was an observational analytic study with cross sectional method. The subjects of this study were adult women undergoing VIA examination with or without digital image in Ulin Regional Hospital, Indonesia. Patients who did not fill the whole questionnaire were excluded from the study. Characteristics analyzed in the study were age, education, occupation, socioeconomic status, source of VIA information, and previous VIA experience. Outcomes analyzed in this study were acceptance, satisfaction, and willingness to recommend.
Results: There were 303 subjects who were included in the study (252 with digital image and 51 without digital image). There were no risk factors of lower acceptance, satisfaction, and willingness to recommend among women undergoing VIA examination. However, the cases of women with low acceptance and satisfaction are associated with lower information of the examination.
Conclusions: Digital IVA examination is a feasible alternative with acceptance, satisfaction, and recommendation rates that are the same as VIA examination without digital imaging.
Keywords: cervical cancer, digital image, Femicam®, visual inspection with acetic acid examinatio
Serum Vitamin D Levels, Visual Analog Scale Dysmenorrhea Score, and Endometriosis ASRM Classification: a Relationship Study
Full text linkObjective: To assess the correlation between vitamin D levels, dysmenorrhea intensity measured by the visual analogue scale (VAS), and the stage of endometriosis determined by the American Society of Reproductive Medicine (ASRM) grading score.
Methods: A cross-sectional study was conducted involving 37 women diagnosed with suspected endometriosis who met the inclusion and exclusion criteria. The aim was to determine the correlation between vitamin D levels, dysmenorrhea VAS scores, and the ASRM endometriosis stage at RSUP Dr. Mohammad Hoesin Palembang from November 2021 to April 2022. Bivariate analysis was employed to assess correlation, utilizing Pearson's correlation test and the Spearman Rank correlation test as an alternative method.
Results: There was a significant positive correlation between vitamin D levels and the VAS score for dysmenorrhea (r = 0.678; p = 0.000) and a very strong positive correlation between vitamin D levels and the degree of endometriosis (r = 0.774; p = 0.000) based on Spearman Rho's correlation test.
Conclusion: There is a significant relationship between vitamin D levels with the VAS score of dysmenorrhea and the degree of endometriosis ASRM.
Keywords: american society of reproductive medicine, endometriosis, visual analogue scale, vitamin
Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes
Full text linkObjective: To assess the maternal and perinatal outcome in pregnant women with HIV infection and the role of Antiretroviral therapy in reducing complications of pregnancy.
Methods: A retrospective analysis was conducted on data from HIV-positive mothers receiving antenatal care at a tertiary care center between February 2015 and January 2020. The study examined various adverse pregnancy outcomes in relation to antiretroviral treatment. Statistical analysis employed chi-square and Fisher’s exact tests to determine differences in distribution proportions of patients on ART versus those not on ART across various antenatal and neonatal complications, with significance attributed to p-values <0.05.
Results: A total of 155 patients were found to be HIV positive. Out of this 58 were diagnosed before pregnancy and 97 during pregnancy. Miscarriage was seen in one (0.6%) patient on ART and two (1.2%) not on treatment (p-value 0.6). Sixteen (10.3%) patients underwent medical termination of pregnancy (MTP); all were given HIV-positive status and they were all on ART (p-value <0.001). Anemia was seen in eighteen (11.6%) patients out of which 14(9%) were on ART (p-value 0.01). One (0.64%) woman had thrombocytopenia and she was on ART (p-value 1). Two (1.2%) patients on ART had diabetes mellitus (p-value 0.4). One (0.64%) patient who was on ART developed polyhydramnios (p-value 1). A total of 8 (5.16%) women had hypertensive disorders; out of which 4(2.58%) were on ART (p-value 1). 11(7.09%) patients who were on ART and 6(3.8%) not on ART had preterm labor (p-value 0.2). 12(7.74%) patients who were not on ART had intrauterine growth restriction (IUGR) and 2(1.29%) on ART had IUGR. A total of 6(3.87%) patients had Intrauterine fetal demise (IUFD), of which 3(1.93%) were on ART and 3(1.93%) were not (p-value 1). Pre-labour rupture of membranes (PROM) was observed in 2(1.29%) women on ART and 11(7.09%) patients not on ART (p-value 0.004). All women (100%) had CD4 counts more than 500. All (100%) babies delivered at our center received antiretroviral therapy either with oral Nevirepine. Almost half the women (51.6%) had vaginal delivery. Almost one-fourth, 41(26.4%) had a cesarean section. All caesareans were done given obstetric indications. There were no instrumental deliveries. Our study had a total of 122 live births. All 122(100%) babies were exclusively breastfed. None of the babies delivered in our center developed HIV on follow up which was done at 6 weeks and 6 months. Nine (5.8%) patients had infections. None of these women were on ART(p-value < 0.001).
Conclusion: HIV infection during pregnancy is associated with various adverse outcomes, but ART plays a crucial role in mitigating these risks and preventing mother-to-child HIV transmission. Initiating ART in all HIV-positive mothers and their infants is essential regardless of HIV status.
Keywords: anemia, ART, HIV, MTP, Perinatal outcome, PROM
The value of intrapartum ultrasound in predicting mode of delivery: A prospective cohort study
Full text linkAbstract
Objectives: Ultrasound contributes significantly to management of labor, delivery and prevention of adverse maternal and fetal outcomes. Among many suggested intra-partum ultrasound parameters, the use of transperineal ultrasound scan to assess the angle of progression (AoP) and levator hiatus anteroposterior diameter (APD) has been suggested to result in a more objective evaluation of labor progress. The aim of this study was to assess this claim.
Methods: This was a prospective observational cohort study involving primparous term singleton vertex presentation pregnant patients >18 years old admitted in the first stage of labor between January 2021 and May 2023. All patients provided an informed written consent. This investigation utilized both transabdominal and transperineal ultrasonography for comprehensive fetal and pelvic floor assessment. Transabdominal ultrasound evaluated standard parameters including fetal occiput position, biometry number, viability, presentation, and estimated fetal weight. Intrapartum transperineal ultrasonography, specifically performed during the first stage of labor, focused on the Levator Hiatus, measuring its anteroposterior diameter (APD) at rest and during Valsalva maneuver, as well as the angle of progression (AOP).
Results: The study population comprised 609 participants with a mean age of 22.8 ± 4.3 years and a high prevalence of being overweight and obesity (38.8% and 57.8%, respectively). When comparing patients who had an intrapartum CS to those who had a normal vaginal delivery (NVD). However, on logistic regression, age, BMI, gestational age, posterior occiput presentation, head circumference (HC), AOP (V) and APD (V) as significant predictors for both ICS and 2nd stage CS (p<0.05).
Conclusion: This study demonstrated that maternal age, BMI, gestational age, occiput posterior position, Angle of progression at Valsalva and levator hiatus anteroposterior diameter at Valsalva were independent significant predictors for Intrapartum cesarean section in primiparous women at term When the ratio between HC/APD at rest, BPD/APD at Valsalva and HC/APD at Valsalva is high, while the APD at Valsalva, AoP Valsalva values are low, cesarean section was more likely to be the mode of delivery.
Keywords: Intrapartum ultrasound, angle of progression, anteroposterior diameter of levator hiatus, mode of delivery, intrapartum cesarean section
Evaluation of Estradiol and Pro-Inflammatory Marker Level with VAS Score After Progestin Therapy in Endometriosis Patients
Full text linkObjectives: To compare estradiol levels and proinflammatory biomarkers (IL-6, IL-1B, and COX-2) in endometriosis patients with pain and without pain after progestin therapy.
Methods: This observational cross-sectional study involved 47 endometriosis patients undergoing three months of progestin therapy at RSUPN Cipto Mangunkusumo from March to June 2024. Serum levels of COX-2, IL-6, IL-1B, and estradiol will be measured using ELISA and Microplate Enzyme Immunoassay, with pain status assessed to determine associations between biomarkers and pain presence.
Results: A significant difference in COX-2 levels between patients with pain and those without, with higher levels in the pain group [1.845 (1.24-10.26) vs 1.55 (0.32-3.07), p = 0.004]. A significant positive correlation was found between IL-1Beta and IL-6 (r = 0.471, p = 0.001). COX-2 levels also exhibited a weak but statistically significant positive correlation with VAS scores (r = 0.360, p = 0.013).
Conclusion: There is a difference in inflammatory markers IL-6, IL-1 Beta and COX-2 in endometriosis patients with progestin therapy who experience pain and painlessness.
Keywords: endometriosis, estradiol, proinflammation, progestin therapy. 
Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Length of Cervix as Predictors of Premature Delivery during the Covid-19 Pandemic at Cipto Mangunkusumo General Hospital
No full textAbstract
Objective: The percentage of neonatal death continues to increase on a yearly basis, in which prematurity is the main cause of mortality. This study determines the descriptive outcomes between neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLT), and cervical length as predictors of preterm birth.
Methods: A retrospective analytical study is conducted using medical records from Dr. Cipto Mangunkusumo National General Hospital. The subjects of this study includes pregnant women diagnosed with preterm delivery in Dr. Cipto Mangunkusumo National General Hospital from April 2020 to June 2021. Data on neutrophil-lymphocyte and platelet-lymphocyte ratios were obtained from a complete blood test during admission. Cervical length is measured using transvaginal ultrasound. The three variables are compared to the control group, which consists of pregnant women with full term delivery.
Results: This study conducted a study with a total of 81 subjects with preterm delivery and 92 subjects with full term delivery. There were no significant difference in neutrophil-lymphocyte and platelet-lymphocyte ratios between preterm and a-term delivery (p=0.795 and p=0.475). Cervical length was significantly longer in preterm compared to full term delivery (24,50 vs 3,15 mm; p = 0,031). The neck cervical length of several participants was not assessed. Cervical length in preterm delivery obtained only 21 patients and data from 10 subjects from the full term group.
Conclusion: The ratio of neutrophil-lymphocyte and platelet-lymphocyte cannot be used as predictors of preterm birth in all pregnant women. To reduce bias in this research, studies with prospective study design with a specified subject criteria are needed.
Keywords: cervical length, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, premature deliver
Prevalence of Gestational Diabetes and its Related Risk Factors among Rural Pregnant Women
Full text linkAbstract
Objectives: To estimate the prevalence of gestational diabetes among rural pregnant women and to assess the related risk factors among gestational diabetes mothers in rural areas.
Methods: A community-based cross-sectional study was conducted among antenatal mothers between 24 to 28 weeks of gestation in rural areas of Kancheepuram district, Tamil Nadu, for a period of one year from January 2017 to December 2017. Data were collected using a semi-structured questionnaire through face-to-face interviews with antenatal mothers regarding their demographic profile, obstetric history, nutrition, and lifestyle. The level of stress was assessed using the Perceived Stress Scale. Oral glucose tolerance tests (OGTT) were performed after an overnight fast of at least 12 hours, with a 75 g glucose load administered, and venous samples were drawn after 2 hours. GDM was diagnosed using specific criteria.
Results: Out of 244 antenatal mothers, 36 (14.8%) were found to have gestational diabetes. The majority of gestational diabetes mothers were housewives (p=0.02). In the current study, most of the GDM mothers were from lower-middle-class families (p=0.04). GDM mothers with a family history of chronic diseases like diabetes, hypertension, and heart disease (p=0.009), as well as those with an increased number of pregnancies, had a higher risk of gestational diabetes (47.6%), which was statistically significant (p=0.001). Patients with hypertension and thyroid disorders were also at an increased risk of developing diabetes during pregnancy (p=0.04). Past history of surgery (p=0.03), low calorie intake, and nutritional deficiencies in their diet (p=0.02) were other identified risk factors.
Conclusion: This study suggests that the prevalence of gestational diabetes is high among rural antenatal mothers. Therefore, these risk factors should be identified and managed through a risk-based approach to minimize the complications of GDM in both the mother and fetus.
Keywords: diabetes, pregnancy, stress
Impact of COVID-19 Pandemic on Postpartum Contraceptives Method Choice (IUD vs Tubectomy) and Characteristic Aspects: A Retrospective Descriptive Study
Full text linkObjective: This study aims to assess the impact of the COVID-19 pandemic on postpartum contraceptive methods.
Methods: This retrospective descriptive study was conducted at a single secondary center, utilizing secondary data retrieved from medical records at the Inpatient Installation of Sebelas Maret University Hospital, Surakarta, covering the period from January 2020 to January 2022.
Results: Among users of intra-uterine devices (IUDs), 85% were below 35 years old, 65% were primiparous, 67% had a history of previous injectable contraceptive use, 79% received routine antenatal care, and 51% had education below a college level. These individuals were educated about the importance of contraceptive programs during the COVID-19 pandemic. Sixty-six percent of IUD insertions were conducted via vaginal delivery, and 27% had health facilities within less than 1 km. In contrast, tubectomy contraceptive users comprised 106 patients, with the majority (54%) being aged 35 years or older, all being multiparous, and 25% tested positive for COVID-19. Among tubectomy users, 43% had a history of previous injectable contraceptive use, 85% received routine antenatal care, and 54% had education below a college level. Similar to the IUD group, they were educated about the significance of contraceptive programs during the COVID-19 pandemic. Eighty-four percent of tubectomies were performed via cesarean section, and 27% of patients lived within less than 1 km from health facilities.
Conclusion: The usage rates of intra-uterine devices and tubectomy for contraceptives remained stable during the COVID-19 pandemic. However, there was a decrease in postpartum in-person visits and mobility, coupled with an increase in hospitalizations.Keywords: contraceptive; family planning; intrauterine device; tubectom