OBGYNIA - Indonesian Journal of Obstetrics & Gynecology Science
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The Role of Neuron Growth Factor and Interleukin-10 in The Development of Pain in Adenomyosis: A Narrative Review
No full textIntroduction: Adenomyosis, a benign uterine condition characterized by endometrial tissue within the myometrium, leads to uterine enlargement, infertility, dysmenorrhea, and heavy menstrual bleeding. While its precise etiology remains elusive, delayed pregnancy may contribute to its increasing incidence among infertile women. This condition, predominantly affecting parous women, is also associated with higher rates of early miscarriage. Although immune dysregulation in endometriosis is well-documented, comparable research in adenomyosis is limited.Objective: This review aims to explore the roles of Interleukin-10 (IL-10), an anti-inflammatory cytokine, and Neuronal Growth Factor (NGF), a neuroimmune factor, in adenomyosis.Discussion: Elevated IL-10 levels in ectopic endometrial tissue suggest a potential immunosuppressive mechanism that may exacerbate symptoms. NGF is also implicated in the pain and inflammation associated with adenomyosis. A deeper understanding of the interplay between IL-10 and NGF could offer critical insights into the inflammatory nature and pain mechanisms of this condition.Conclusion: This review proposes IL-10 as a potential inflammatory biomarker and NGF as a pain marker in adenomyosis, paving the way for future research into novel therapeutic targets. Elucidating these pathways could lead to treatments focused on mitigating inflammation and alleviating associated symptoms of adenomyosis.Keywords: adenomyosis; neuronal growth factor; interleukin-10; pelvic pain Peran Neuron Growth Factor (NGF) dan Interleukin-10 (IL-10) dalam pembentukan Nyeri pada Adenomyosis : Sebuah Review NaratifAbstrakPendahuluan: Adenomyosis, suatu kondisi rahim jinak yang ditandai dengan adanya jaringan endometrium di dalam miometrium, menyebabkan pembesaran rahim, infertilitas, dismenore, dan perdarahan menstruasi yang berat. Meskipun etiologi pastinya masih belum jelas, kehamilan yang tertunda kemungkinan berkontribusi pada peningkatan insidennya di kalangan wanita infertil. Kondisi ini, yang sebagian besar memengaruhi wanita multipara, juga dikaitkan dengan tingkat keguguran dini yang lebih tinggi. Meskipun disregulasi imun pada endometriosis telah didokumentasikan dengan baik, penelitian serupa pada adenomyosis masih terbatas.Tujuan: Tinjauan ini bertujuan untuk mengeksplorasi peran Interleukin-10 (IL-10), sitokin anti-inflamasi, Faktor Pertumbuhan Saraf (NGF) dan faktor neuroimun dalam adenomyosis.Diskusi: Peningkatan kadar IL-10 dalam jaringan endometrium ektopik menunjukkan mekanisme imunosupresif potensial yang dapat memperburuk gejala. NGF juga berperan dalam nyeri dan peradangan yang terkait dengan adenomyosis. Pemahaman yang lebih dalam tentang interaksi antara IL-10 dan NGF dapat memberikan wawasan penting mengenai sifat inflamasi dan mekanisme nyeri dari kondisi ini.Kesimpulan: Tinjauan ini mengusulkan IL-10 sebagai biomarker inflamasi potensial dan NGF sebagai penanda nyeri pada adenomyosis. Hal tersebut membuka jalan bagi penelitian lebih lanjut untuk target terapeutik baru. Menguraikan jalur-jalur ini dapat mengarah pada perawatan yang berfokus pada mitigasi peradangan dan mengurangi gejala adenomyosis.Kata kunci: adenomiosis; interleukin-10; neuronal growth factor; nyeri pelvis
Reframing Female Genital Cosmetic and Aesthetic Surgery: Ethics, Function, and Sexual Health Beyond Appearance
Full text linkIn recent years, the convergence of aesthetic medicine and urogynecology has reshaped the dialogue on women’s health. Procedures once confined to reconstructive domains—repairing pelvic floor disorders, perineal trauma, or postpartum laxity—now coexist with aesthetic motivations emphasizing appearance and self-confidence. This editorial reflects on how female genital cosmetic surgery (FGCS) and female genital aesthetic surgery (FGAS) overlap yet differ ethically, functionally, and philosophically.Defining FGCS and FGASAccording to the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG), FGCS comprises elective surgical procedures that modify the appearance of genitalia without clear medical indication. These interventions originate in the cosmetic surgery paradigm, focusing on visual symmetry and patient satisfaction. In contrast, FGAS has evolved within gynecology and minimally invasive aesthetic medicine, aiming not only at external appearance but also at comfort, tissue quality, and functional harmony. The distinction matters: while FGCS is largely appearance-driven, FGAS aspires toward holistic well-being and sexual confidence. Recognizing these nuances helps physicians maintain ethical boundaries and ensure that patient motivation is grounded in informed understanding rather than social pressure
Blood Cadmium and Preterm Birth: A Systems Toxicology Review of Molecular Mechanisms, Placental Disruption, and Translational Obstetric Implications
Full text linkObjectives: Preterm birth (PTB) remains a leading global cause of neonatal morbidity and mortality, with multifactorial origins including inflammation, endocrine disruption, and placental dysfunction. Recent evidence identifies cadmium (Cd), a persistent environmental toxicant, as a modifiable contributor to PTB. This review aims to integrate the mechanistic, molecular, and clinical literature on maternal blood cadmium exposure and its role in the pathogenesis of PTB.Methods: A systematic and integrative review was conducted following PRISMA 2020 guidelines. Literature from 2000 to 2025 was retrieved using PubMed, Scopus, Embase, and Web of Science. Eligible studies included molecular toxicology, animal models, human epidemiological data, and placental mechanistic research addressing cadmium exposure and preterm birth. Inclusion criteria emphasized mechanistic clarity, gestational outcome relevance, and measurable cadmium biomarkers. Figures, tables, and mechanistic diagrams were used to illustrate toxicological convergence pathways.Results: Cadmium disrupts placental homeostasis via oxidative stress, endothelial dysfunction, impaired trophoblast invasion, progesterone suppression, and activation of inflammatory cascades such as the NLRP3 inflammasome. Consistent associations between maternal cadmium burden and PTB risk were found across animal, cellular, and human population studies. However, heterogeneity in exposure assessment, absence of unified risk thresholds, and confounding from co-exposures challenge causal inference. Literature remains fragmented, lacking integration between mechanistic insights and clinical risk models.Conclusions: Cadmium should be reclassified as a central agent in the pathophysiology of PTB. We propose a precision obstetrics framework that includes environmental cadmium screening in high-risk pregnancies, implementation of exposome-informed policies, and prospective multicenter studies with molecular endpoints. Obstetric care must evolve to include toxicological risk profiling as standard practice in the prevention of PTB.Kadmium dalam Darah dan Kelahiran Prematur: Tinjauan Toksikologi Sistemik terhadap Mekanisme Molekuler, Disrupsi Plasenta, dan Implikasi Obstetri TranslasiAbstrakTujuan: Kelahiran Prematur (preterm birth/PTB) tetap menjadi penyebab utama morbiditas dan mortalitas neonatal di seluruh dunia dengan etiologi multifaktorial yang mencakup inflamasi, gangguan endokrin, dan disfungsi plasenta. Bukti terbaru mengidentifikasi kadmium (Cd), suatu toksikan lingkungan persisten, sebagai faktor kontribusi yang dapat dimodifikasi terhadap PTB. Tinjauan ini bertujuan untuk mengintegrasikan literatur mekanistik, molekuler, dan klinis mengenai paparan kadmium dalam darah maternal dan perannya dalam patogenesis PTB.Metode: Tinjauan sistematis dan integratif dilakukan sesuai pedoman PRISMA 2020. Literatur dari tahun 2000 hingga 2025 dikumpulkan melalui database PubMed, Scopus, Embase, dan Web of Science. Studi yang memenuhi syarat mencakup toksikologi molekuler, model hewan, data epidemiologi manusia, dan penelitian mekanistik plasenta yang mengevaluasi hubungan antara paparan kadmium dan kelahiran prematur. Kriteria inklusi menekankan kejelasan mekanistik, relevansi terhadap hasil kehamilan, serta penggunaan biomarker kadmium yang terukur. Gambar, tabel, dan diagram mekanistik digunakan untuk mengilustrasikan jalur konvergensi toksikologis.Hasil: Kadmium mengganggu homeostasis plasenta melalui stres oksidatif, disfungsi endotel, gangguan invasi trofoblas, supresi progesteron, dan aktivasi jalur inflamasi seperti inflammasom NLRP3. Hubungan konsisten antara beban kadmium maternal dan risiko PTB ditemukan dalam studi hewan, seluler, dan populasi manusia. Namun, adanya heterogenitas dalam penilaian paparan, belum adanya ambang risiko yang seragam, serta pengaruh faktor pajanan lainnya menjadi tantangan dalam penarikan kesimpulan kausal. Literatur masih terfragmentasi dan belum mengintegrasikan temuan mekanistik dengan model risiko klinis secara menyeluruh.Kesimpulan: Kadmium seharusnya diklasifikasikan ulang sebagai agen sentral dalam patofisiologi PTB. Kami mengusulkan suatu kerangka kerja obstetri presisi yang mencakup skrining lingkungan terhadap kadmium pada kehamilan berisiko tinggi, menerapkan kebijakan berbasis exposome, serta studi prospektif multisentra dengan titik akhir molekuler. Pelayanan kebidanan harus berkembang dengan mengadopsi profil risiko toksikologis sebagai bagian dari praktik standar dalam pencegahan kelahiran prematur.Kata kunci: Disrupsi Plasenta; Interaksi Endokrin-Inflamasi; Kesehatan Reproduksi Lingkungan; Mekanisme Kelahiran Prematur; Toksisitas Kadmium
A Clinical Case of Thoracopagus Conjoined Twins
Full text linkIntroduction: Conjoined twins result from the incomplete division of a single fertilized egg, with an incidence of approximately 1 in 200,000 live births. This rare congenital anomaly presents significant anatomical and physiological challenges, necessitating a multidisciplinary approach for diagnosis, management, and ethical considerations. Case Presentation: A pair of thoracopagus conjoined twins was delivered at Arifin Achmad General Hospital following preterm labor complicated by premature rupture of membranes (PROM). Prenatal ultrasound identified shared thoracic and abdominal structures, including cardiac and vascular abnormalities. The twins exhibited severe congenital anomalies, such as cardiomegaly and ventriculomegaly. Despite immediate resuscitation efforts, both infants succumbed due to extensive anatomical complications.Conclusion: The prognosis of thoracopagus twins remains poor, particularly in cases with extensive organ fusion. Advances in prenatal imaging and fetal surgery may improve outcomes in select cases; however, a multidisciplinaryand compassionate approach remains essential for optimal perinatal care. Keywords: Conjoined twins, Thoracopagus, Prenatal diagnosis, Ethical challenges, Perinatal managementKasus Klinis Bayi Kembar Siam Tipe ThoracopagusAbstrakPendahuluan: Kembar siam terjadi akibat pembelahan zigot yang tidak sempurna, dengan insiden 1 dari 200.000 kelahiran hidup. Anomali kongenital langka ini menimbulkan tantangan kompleks dalam aspek anatomi, fisiologi,serta etika sehingga memerlukan pendekatan multidisiplin dalam diagnosis dan penatalaksanaan. Laporan Kasus: Sepasang kembar siam thoracopagus lahir prematur di RSUD Arifin Achmad akibat persalinan preterm yang disertai ketuban pecah dini (KPD). Pemeriksaan ultrasonografi prenatal mendeteksi fusi struktur torako-abdominal, termasuk keterlibatan organ jantung dan pembuluh darah utama. Bayi mengalami kelainan kongenital berat kardiomegali dan ventrikulomegali. Meskipun dilakukan resusitasi segera, keduanya tidak bertahan hidup akibat komplikasi anatomi yang luas. Kesimpulan: Prognosis kembar siam thoracopagus tetap buruk, terutama pada kasus dengan keterlibatan organ yang luas. Kemajuan dalam pencitraan prenatal dan pembedahan janin dapat meningkatkan harapan hidup dalam kondisi tertentu; namun, pendekatan multidisiplin yang komprehensif dan penuh empati tetap menjadi kuncidalam perawatan perinatal
Maternal and Neonatal Outcomes in Pregnancies with Systemic Lupus Erythematosus (SLE) from 2021 to 2023 at Hasan Sadikin Hospital, Bandung
No full textObjective: To describe maternal and neonatal outcomes in pregnant women with SLE at Dr. Hasan Sadikin General Hospital, Bandung.Methods: This descriptive study reviewed secondary data of pregnant women with SLE at RSHS from January 2021 to December 2023.Results. A total of 41 pregnant women with SLE and 82 without SLE were included. SLE patients were younger (29.44±5.03 years) than non-SLE (33.76±7.31 years). Most SLE patients had normal (63.4%) or overweight (36.6%) nutritional status. Skin rash was the most common symptom (78%). Hypertension (14.6% vs 73.2%) and fetal death (4.9% vs 17.1%) were lower in the SLE group. Live birth rate was higher (95.1% vs 89.0%), but low birth weight incidence was higher (65.9% vs 53.7%) in SLE.Conclusion: Pregnant women with SLE tend to be younger and overweight. Hypertension and fetal death were lower, but low birth weight and growth restriction were more frequent in SLE pregnancies, despite quality ANC. The cause of fetal growth restriction in SLE remains unclear.Luaran Ibu dan Bayi pada kehamilan dengan Lupus Eritematosus Sistemik (LES) pada tahun 2021 - 2023 di Rumah Sakit Hasan Sadikin BandungAbstrakTujuan: Penelitian ini bertujuan untuk mendeskripsikan luaran maternal dan neonatus pada wanita hamil dengan LES di RSUP Dr. Hasan Sadikin Bandung.Metode: Penelitian ini menggunakan metode deskriptif untuk meninjau data sekunder ibu hamil dengan LES di RSHS dari Januari 2021 hingga Desember 2023.Hasil. Sebanyak 41 wanita hamil dengan LES dan 82 tanpa LES diikutsertakan. Pasien LES lebih muda (29,44±5,03 tahun) dibanding non-LES (33,76±7,31 tahun). Mayoritas pasien LES berstatus gizi normal (63,4%) atau overweight (36,6%). Ruam kulit paling umum (78%). Hipertensi (14,6% vs 73,2%) dan kematian janin (4,9% vs 17,1%) lebih rendah pada LES. Kelahiran hidup lebih tinggi (95,1% vs 89,0%), tapi berat lahir rendah lebih tinggi (65,9% vs 53,7%) pada LES.Kesimpulan: Wanita hamil dengan LES cenderung lebih muda dan overweight. Komplikasi hipertensi dan kematian janin lebih rendah, tetapi berat lahir rendah dan hambatan pertumbuhan janin lebih sering pada LES, meski mendapat ANC berkualitas. Penyebab hambatan pertumbuhan janin pada LES belum diketahui.Kata kunci: Kehamilan; Komplikasi; Luaran maternal; Luaran neonatus; Lupus Eritematosus Sistemi
Factors Affecting Breastfeeding Practice among Mothers with Hospitalized Neonates
Full text linkIntroduction: Breastfeeding is essential for premature infants, as it reduces morbidity while enhancing cognitive development, ultimately supporting a more productive adulthood. However, in the United States, where 10–12% of infants are born prematurely, hospitalization in the Neonatal Intensive Care Unit (NICU) presents significant challenges to breastfeeding practices as it introduces barriers such as maternal stress, mother-infant separation, limited visitation, and inadequate support, which hinder successful breastfeeding. Method: This review used several databases, namely Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library to search original and review articles in English about breasfeeding, internsive care unit, and risk factors in the last 10 years. Other reference sources used were guidelines and textbooks.Result: The findings reveal that breast milk’s bioactive components play a critical role in protecting against morbidity during NICU hospitalization, while also fostering cognitive development. Factors influencing breastfeeding practices include demographic (maternal age, education), biological (maternal and infant health), attitudinal (breastfeeding confidence), social (family support), and hospital regulations (NICU policies).Conclusion: Factors affecting breastfeeding practice among mothers with hospitalized neonates include planned pregnancy, medical interventions, and family support. NICU hospitalization can be a significant barrier to breastfeeding due to inadequate support, visitation time, mother-infant separation, maternal stress and anxiety, and clinical conditions.Faktor-Faktor yang Memengaruhi Praktik Menyusui pada Ibu dengan Neonatus Rawat InapAbstrakPendahuluan: Pemberian Air Susu Ibu (ASI) sangat penting bagi bayi prematur karena dapat mengurangi morbiditas sekaligus meningkatkan perkembangan kognitif, yang pada akhirnya mendukung kehidupan dewasa yang lebih produktif. Namun, di Amerika Serikat, di mana 10–12% bayi lahir prematur, rawat inap di Neonatal Intensive Care Unit (NICU) menghadirkan tantangan signifikan terhadap praktik menyusui akibat berbagai hambatan seperti stres maternal, pemisahan ibu dan bayi, waktu kunjungan yang terbatas, serta dukungan yang tidak memadai, yang menghalangi keberhasilan menyusui.Metode: Tinjauan pustaka ini menggunakan beberapa basis data, yaitu Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library, untuk mencari artikel asli dan ulasan dalam bahasa Inggris tentang menyusui, unit perawatan intensif, dan faktor risiko dalam 10 tahun terakhir. Sumber referensi lainnya yang digunakan adalah pedoman dan buku teks.Hasil: Kumpulan bukti yang ada di literatur saat ini menunjukkan bahwa komponen bioaktif dalam ASI memiliki peran penting dalam melindungi bayi dari morbiditas selama hospitalisasi di NICU, sekaligus mendukung perkembangan kognitif. Faktor-faktor yang memengaruhi praktik menyusui meliputi faktor demografis (usia ibu, pendidikan), biologis (kesehatan ibu dan bayi), sikap (kepercayaan diri dalam menyusui), sosial (dukungan keluarga), dan kebijakan rumah sakit (aturan di NICU).Kesimpulan: Faktor-faktor yang memengaruhi praktik menyusui pada ibu dengan bayi yang dirawat di NICU meliputi kehamilan yang direncanakan, intervensi medis, dan dukungan keluarga. Rawat inap di NICU dapat menjadi penghalang signifikan terhadap keberhasilan menyusui akibat kurangnya dukungan, waktu kunjungan yang terbatas, pemisahan ibu dan bayi, stres dan kecemasan maternal, serta kondisi klinis bayi.Kata Kunci: Air susu ibu, Faktor risiko, Ibu, Menyusui, NIC
Tubal Pathology in Infertility
Full text linkInfertility is a complex reproductive issue which requires thorough evaluation and targeted intervention. A key cause of female infertility is fallopian tube dysfunction, which plays role in egg transport and fertilization. Structural damage to the tubes, including blockages, adhesions, and deformities, significantly reduces fertility potential. One major cause of tubal disease is sexually transmitted infections, especially Chlamydia trachomatis and Neisseria gonorrhoeae, which can lead to pelvic inflammatory disease (PID). 1 In regions where Mycobacterium tuberculosis infection is still prevalent, genital tuberculosis is another contributor to tubal disease, causing inflammation and eventual obstruction. Chronic infection promotes scarring, narrowing, and complete obstruction of the fallopian tubes. Additionally, endometriosis can also exacerbate tubal dysfunction by creating adhesions and disrupting normal tube anatom
Recurrent Premature Rupture of Membranes in a Patient with Conservative Treatment Failure, Leading to Placental Abruption and Preterm Delivery: A Case Report.
No full textIntroduction: Preterm Premature Rupture of Membranes in premature labor refers to the rupture of the amniotic sac before 37 weeks of gestation. PPROM is one of the most common complications during pregnancy and can lead to more serious risks for both the mother and the fetus. While premature labor is the most prevalent complication associated with PROM, it is important to note that placental abruption, though rare, can also occur concurrently.Case: A 24-year-old woman with a gestational age of 30-31 weeks has been treated conservatively at 27-28 weeks of gestation and returned to the hospital with complaints of watery discharge and blood spots. Physical examination found abdominal tenderness and defans. From the internal examination, it was found that there was no amniotic fluid with a cervical opening of 3-4 cm, and the bleeding was blackish-red. The patient was diagnosed with G2P1A0 (second pregnancy, one live birth, and no abortions) at 30-31 weeks with placental abruption lasting more than 24 hours and failed conservative treatment. An emergency cesarean section was performed and the infant was placed under NICU care.Discussion: The infection and inflammatory process following conservative treatment can be a cause behind placental abruption in mothers. The primary management approach involves monitoring the vital signs of both the mother and the fetus. This assessment is crucial in determining the best next steps, and a cesarean section is often expected to ensure the safety of both the fetus and the mother.Conclusion: Placental abruption is a serious obstetric emergency that can endanger both the mother and the fetus. The most prevalent cause of abruption is an infection inflammatory reaction in the uterus. While PPROM rarely triggers placental abruption, it did occur in this case.Rekurensi Ketuban Pecah Dini pada Pasien Gagal Perawatan Konservatif Yang Menyebabkan Solusio Plasenta dan Persalinan PrematurAbstrak Pendahuluan: Ketuban pecah dini pada persalinan prematur merupakan pecahnya lapisan ketuban sebelum usia 37 minggu. Ini merupakan kondisi komplikasi yang paling sering terjadi pada kehamilan dan dapat memunculkan komplikasi yang lebih serius pada ibu dan janin. Komplikasi ketuban pecah dini paling sering adalah pada persalinan prematur. Namun demikian, adanya solusio plasenta pada persalinan prematur masih jarang terjadi.Kasus: Wanita 24 tahun dengan usia kehamilan 30 - 31 minggu telah dirawat secara konservatif pada saat usia kehamilan 27 - 28 minggu datang kembali ke rumah sakit dengan keluhan keluar air dan bercak darah. Dari pemeriksaan fisik, diketahui adanya nyeri tekan pada perut dan defans. Saat pemeriksaan dalam, tidak ditemukan adanya ketuban, namun terdapat pembukaan pada serviks 3 - 4 cm dan adanya perdarahan berwarna merah kehitaman. Pasien didiagnosis dengan G2P1A0 30-31 minggu dengan solusio plasenta ketuban pecah dini durasi >24 jam dan gagal rawat konservatif. Dilakukan sectio cesarea emergensi dan perawatan NICU untuk bayi.Diskusi: Adanya proses infeksi-inflamasi post perawatan konservatif menjadi salah satu mekanisme terjadinya solusio plasenta pada ibu. Tatalaksana berupa pemantauan tanda vital ibu dan janin, ini menjadi prinsip utama dalam penentuan langkah berikutnya dan operasi sectio sesarea diharapkan dapat menyelamatkan janin dan ibu.Kesimpulan: Solusio plasenta merupakan salah satu kegawatdaruratan obstetri yang berpotensi membahayakan ibu dan janin. Ada banyak faktor pencetus solusio dan yang paling sering di antaranya adalah adanya reaksi infeksi-inflamasi dalam uterus. Ketuban pecah dini menjadi pencetus yang jarang ditemukan pada kasus solusio plasenta, namun ditemukan pada kasus ini.Kata kunci:Inflamasi, Infeksi, Ketuban Pecah Dini, Solusio Plasent
Hypomethylation of the Promoter Region of the Vascular Endothelial Growth Factor (VEGF) Gene and It’s Low Expression in Placenta as a Risk Factor for Preeclampsia
Full text linkObjective: This study aimed to determine the association between hypomethylation of VEGF gene promoter region and low VEGF expression in the placenta as a potential risk factor for preeclampsia.Methods: An observational case-control study was conducted involving pregnant women with preeclampsia and normotensive controls. Placental tissue samples were collected and analysed for DNA methylation status of the VEGF gene promoter using quantitative real-time PCR. VEGF expression levels in placental tissue were measured using ELISA. Results: Significant hypomethylation of the VEGF promoter region was observed in placenta samples from preeclamptic women compared to controls. This finding correlated with decreased VEGF expression. These results indicate that reduced VEGF expression due to promoter hypomethylation may impair placental vascularization, contributing to preeclampsia.Conclusions: Hypomethylation of the VEGF promoter and subsequent reduction in placental VEGF expression may serve as early biomarkers to predict preeclampsia. These results highlight the importance of epigenetic regulation in preeclampsia pathogenesis and suggest potential targets for early diagnosis and intervention.Hipometilasi Regio Promoter Gen Vascular Endothelial Growth Factor (VEGF) dan Ekspresi Vascular Endothelial Growth Factor (VEGF) yang Rendah pada Plasenta sebagai Faktor Risiko PreeklampsiaAbstrakTujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara hipometilasi pada daerah promoter gen VEGF dan rendahnya ekspresi VEGF di plasenta sebagai faktor risiko potensial terjadinya preeklampsia.Metode: Penelitian observasional dengan desain kasus-kontrol ini melibatkan ibu hamil dengan preeklampsia dan kontrol normotensif. Sampel jaringan plasenta dikumpulkan dan dianalisis untuk menentukan status metilasi DNA pada daerah promoter gen VEGF menggunakan quantitative real-time PCR. Tingkat ekspresi VEGF dalam jaringan plasenta diukur menggunakan metode ELISA.Hasil: Didapatkan hipometilasi yang signifikan pada daerah promoter gen VEGF pada jaringan plasenta ibu dengan preeklampsia dibandingkan kelompok kontrol. Temuan ini berkorelasi dengan penurunan ekspresi VEGF. Hasil tersebut menunjukkan bahwa penurunan ekspresi VEGF akibat hipometilasi promoter dapat mengganggu vaskularisasi plasenta, sehingga berperan dalam patogenesis preeklampsia.Kesimpulan: Hipometilasi pada daerah promoter gen VEGF dan penurunan ekspresi VEGF di plasenta dapat berfungsi sebagai biomarker awal untuk memprediksi terjadinya preeklampsia. Hasil ini menyoroti pentingnya regulasi epigenetik dalam patogenesis preeklampsia serta membuka peluang untuk diagnosis dini dan intervensi yang lebih tepat.Kata kunci: Preeklampsia, VEGF, Hipometilasi, Plasenta, Epigeneti
Case Report: Recurrent Surgical Wound Dehiscence in a Patient With Surgical Site Infection, Type 2 Diabetes, and Obesity
Full text linkIntroduction: Surgical site infection (SSI) is the most likely complication following a Cesarean section (CS). SSI is considered a contributing factor to the occurrence of surgical wound dehiscence (SWD). This condition is often associated with various risk factors, such as type 2 diabetes mellitus (T2DM) and obesity. Understanding the risk factors and management of SWD in high-risk populations is essential for improving clinical outcomes.Case Report: A 27-year-old woman, G2P2A0, was referred due to SWD. The patient underwent a CS at a secondary-level hospital due to oxytocin drip failure 20 days prior to referral. She was diagnosed with SSI six days post-surgery, and had received antibiotics and undergone re-hecting 11 days after the CS. The surgical wound reopened two days after the re-hecting procedure, prompting referral. The patient had uncontrolled T2DM and morbid obesity as comorbidities. Physical examination revealed an open CS wound measuring 15x5x3 cm with exposed fascia and discharge of pus and blood. Wound care was performed using gauze coated with antibiotics changed every 12 hours. Antibiotic administration was based on culture, sensitivity, and resistance testing before another re-hecting procedure was performed.Conclusion: Obesity and diabetes mellitus were risk factors for SWD in this case. The use of antibiotics guided by culture sensitivity and resistance testing, effective SSI management, and early detection and management of comorbid conditions are necessary to prevent and treat SWD complications.Laporan Kasus: Recurrent Surgical Wound Dehiscence pada Pasien Infeksi Daerah Operasi yang Memiliki Komorbid Diabetes Tipe 2 dan ObesitasAbstrakLatar belakang: Infeksi Daerah Operasi (IDO) merupakan komplikasi yang paling mungkin terjadi setelah operasi Caesar (SC). IDO dianggap sebagai faktor terjadinya Surgical Wound Dehiscence (SWD). Kondisi ini sering dikaitkan dengan berbagai faktor risiko seperti diabetes melitus tipe 2 (DMT2) dan obesitas. Pemahaman mengenai faktor risiko dan penanganan SWD pada populasi berisiko tinggi menjadi penting untuk meningkatkan luaran klinis.Laporan Kasus: Wanita 27 tahun, P2A0, dirujuk karena SWD. Pasien menjalani SC di RS PPK tingkat II karena gagal drip oksitosin 20 hari sebelum dirujuk. Pasien didiagnosis IDO 6 hari setelah operasi dan telah mendapatkan antibiotik dan dilakukan re-hecting 11 hari setelah SC. Luka operasi terbuka kembali dua hari setelah re-hecting, sehingga pasien dirujuk. Pasien memiliki komorbid DMT2 tidak terkontrol dan obesitas morbid. Pemeriksaan fisik menunjukkan tampak luka bekas SC terbuka berukuran 15x5x3 cm dengan dasar fasia dengan nanah dan darah. Perawatan luka dilakukan dengan kasa dilapisi antibiotik dan diganti setiap 12 jam. Antibiotik diberikan berdasarkan hasil tes kultur, sensitivitas, dan resistensi, sebelum dilakukan re-hecting kembali. Kesimpulan: Obesitas dan diabetes melitus menjadi faktor risiko terjadinya SWD pada kasus ini. Penggunaan antibiotik sesuai hasil kultur sensitivitas dan resistensi, perawatan IDO, serta deteksi dan manajemen faktor komorbid diperlukan untuk mencegah dan mengobati komplikasi SWD.Kata kunci: Diabetes mellitus tipe 2, infeksi daerah operasi, luka operasi terbuka, rekurensi