Indonesian Journal of Obstetrics and Gynecology

Obstetrics and Gynecology Intensive Care

M. Fidel Ganis Siregar — Mon, 20 May 2024 00:00:00 +0000

Human Immunodeficiency Virus in Pregnancy a Retrospective Study on Maternal and Perinatal Outcomes

Mon, 20 May 2024 00:00:00 +0000

Objective: 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.

Prevalence of Gestational Diabetes and its Related Risk Factors among Rural Pregnant Women

Pragadeesh Raja Veerappan, Dharani Lenin, Sahaya Sona Thresa — Mon, 20 May 2024 00:00:00 +0000

Abstract

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.

Clinicopathological of Pre-Operative Thrombocytosis in Epithelial Ovarian Cancer

Catherine Sugandi, Widya Maulida, Manuel Hutapea — Mon, 20 May 2024 00:00:00 +0000

Abstract

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, thrombocytosis

Higher HIF-1alpha Level in Cervical Cancer Worsen the Outcome of Radiotherapy in Stage IIIB Squamous Cell Carcinoma of the Cervix

Mon, 20 May 2024 00:00:00 +0000

Eliminating HPV DNA Positive Result with Large Loop Excision of the Transformation Zone (LLETZ)/Loop Electrosurgical Excision Procedure (LEEP) in Precancerous Cervical Lesions

Mon, 20 May 2024 00:00:00 +0000

Abstract

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, RCT

CA-125 Examination as a Predictor the Resectability of Advanced Stage of Ovarian Cancer

Syamel Muhammad, Muhammad Rudy Setiawan — Mon, 20 May 2024 00:00:00 +0000

Objective: 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: A 32-years-old woman presented with lower abdominal pain and vaginal bleeding one days before admission. She was sexually active, used no contraceptives, and had a history of one 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 confirming a 6 week, 1 days age of pregnancy 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 painful abdomen or vaginal bleeding 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 pregnancy

Concordance and Acceptability of HPV DNA Genotyping Test by Patient’s Self-Sampling Against Clinician Sampling

Junita Indarti, Danny Maesadatu Syaharutsa, Ilham Utama Surya, Kristian Alda — Tue, 21 May 2024 00:00:00 +0000

Objectives: To determine the effectiveness of this alternative method, especially during the COVID-19 pandemic and considering Indonesia’s cultural context.

Methods: This study utilized a cross-sectional design, and involved patients at the Gynecology and Colposcopy Clinic of Dr. Cipto Mangunkusumo General Hospital. The estimated sample size was 48, determined using a diagnostic test formula. The sample population consisted of female patients with positive VIA or abnormal Pap smear results. Each patient underwent HPV DNA self-sampling and clinician sampling tests using the GenoFlow HPV Array technique and continued with colposcopy. All patients were also administered a questionnaire consisting of eight questions about their perspective on the self-sampling HPV DNA test. The data analysis employed a 2 × 2 table using SPSS version 20, and Cohen’s kappa coefficient was calculated to measure the agreement between the sampling results of patients’ and Clinicians’.

Results: Among the examinations conducted by clinicians, there were 33 patients with positive HPV results, whereas through self-sampling, there were 28 patients with positive HPV (p=0.00). High risk HPV was the most commonly observed, with HPV type 16 appearing the most (15%). Based on these data, the self-sampling sensitivity, specificity, positive predictive value, and negative predictive value were 85%, 100%, 100%, and 75%, respectively, with a concordance rate of 89.6%. The Cohen’s Kappa coefficient between samples taken by the clinician and self-sampling resulted in K=0.778, which is considered a good agreement (K=0.61-0.80). All patients concluded that the procedure was easy (100%), and the majority (60.5%) expressed a preference for the self-sampling method.

Conclusion: There is a good agreement between the results of self-sampling and clinician sampling for detecting HPV DNA, with patients positively accepting the self-sampling method, indicating its potential as an effective cervical cancer screening method.

Keywords: Cervical Cancer Screening, Clinician Sampling, Human Papillomavirus, Self-Sampling.

Successful management of an unruptured extrauterine pregnancy in a woman with a history of prior miscarriage in Indonesia: a case report

Achmad Fahrur Rozi Mukti, Arif Tunjungseto — Tue, 21 May 2024 00:00:00 +0000

Objective: 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 pregnancy

Management of Vulvovaginal Candidiasis in Pregnancy

Jessica Levina, Dwiana Ocviyanti, Robiatul Adawiyah — Mon, 20 May 2024 00:00:00 +0000

Pregnancy 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.