Indonesian Journal of Obstetrics and Gynecology

Stem Cell Therapy in Urogynecology – Expanding Horizons in Regenerative Medicine

Budi I santoso — Tue, 29 Oct 2024 00:00:00 +0000

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

Dinda Desti Cahyani, Heru Priyanto, Alfun Dhiya An, Supriyatiningsih — Tue, 29 Oct 2024 00:00:00 +0000

Objective: 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, MEOWS

Epidemiology of Cervix Uteri Cancer in Saudi Arabia from 2004 to 2017

Ibrahim Alghamdi — Wed, 30 Oct 2024 00:00:00 +0000

Abstract:

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.

The Prevalence of Post-traumatic Stress Disorder (PTSD) Symptoms in Women Hospitalized Due to COVID-19 Infection during Pregnancy in Indonesia and Its Association with Employment Status and Delivery Method: A Single Center Study

Tue, 29 Oct 2024 00:00:00 +0000

Objective: To analyze the prevalence of post-traumatic stress disorder (PTSD) symptoms in pregnant women infected with COVID-19 in one of the Indonesian tertiary referral centers for COVID-19 cases and its association with maternal employment status and delivery method.

Method: Data from medical records and an online questionnaire were collected for a cross-sectional study. The study included pregnant women treated in the COVID-19 non-intensive isolation wards throughout 2021. The occurrence of PTSD symptoms was assessed using the PTSD Checklist for DSM-5 (PCL-5). Prevalence of PTSD symptoms was decribed and its correlation with employment status and delivery method were analyzed.

Results: The analysis involved data from 75 patients, with a mean PCL-5 total score of 17 ± 13.85. Among them, 16% met the PTSD symptoms criteria (PCL-5 total score more than 32). Of the total, 72% were women who had undergone caesarean section (CS), and the same percentage were unemployed. Comparisons revealed no significant difference in PTSD symptoms occurence based on employment status (19% in employed women vs. 14.8% in unemployed women, p=0.729, 95% CI) and delivery method (14.8% in CS vs. 16.7% in spontaneous delivery, p=1, 95% CI).

Conclusion: This study revealed a significant prevalence of PTSD among pregnant women during the COVID-19 pandemic. Despite there is no association found between the prevalence of PTSD symptoms and employment status or delivery method in this study, further research is needed to understand the psychological effects, clinical implications, and relevant factors impacting pregnant women in the acute-event settings.

Keywords: COVID-19, pandemics, pregnancy, post-traumatic stress disorders

Vitamin D Levels and Risk Factors in Early Onset Preeclampsia, Late Onset Preeclampsia and Normal Pregnancy

Tue, 29 Oct 2024 00:00:00 +0000

Abstract

Objective: To determine the frequency distribution and the relation of risk factors to vitamin D levels in women with early onset (EOSPE), late-onset severe preeclampsia (LOSPE), and normal pregnancy.

Methods: This study was cross-sectional with pregnant women diagnosed with EOSPE LOSPE at RSUP DR M Djamil Padang and normal pregnancy at the Pengambiran Health Center. The serum samples of the research subjects were examined for blood levels of Vitamin D using the ELISA kit.

Results: Frequency distribution of risk factors for EOSPE respondents aged 20-35 years 50%, mothers not working 85%, single pregnancy 95%, normal blood sugar 80%, and an increase in the number of leukocytes 90%. Frequency distribution of LOSPE respondents, maternal age 20-35 years 60%, mothers not working 95%, single pregnancy 95%, normal blood sugar 65%, and increasing leukocytes 75%. Based on the data analysis test EOSPE respondents with risk factors for preeclampsia history and body mass index had a significant relation with vitamin D levels with P Value 0.00 (P < 0.05). LOSPE mothers with gravid risk factors, history of preeclampsia, history of hypertension, and history of Diabetes Mellitus had a significant relation with Vitamin D levels P Value 0.00 (P < 0.05).

Conclusion: The results of statistical tests for LOSPE mothers had a significant relation with Vitamin D levels compared to the risk factors for EOSPE mothers. The incidence of preeclampsia is influenced by complex etiopathogenesis, one of which is influenced by vitamin D levels.

Keywords: EOSPE, LOSPE, Elisa-kit, Vitamin D, Etiopathogenesis

An internal iliac artery ligation technique for bleeding control in the placenta accreta spectrum disorder

Tue, 29 Oct 2024 00:00:00 +0000

Objective: To assess the contribution of internal iliac artery ligation to bleeding control during surgery.

Methods: This retrospective study used secondary data from medical records. All patients diagnosed with PASD from January 2019 – to December 2022 were included in this study. Participants were grouped based on operation technique, and the blood loss and operative duration were evaluated. The tests used were the Kruskal-Wallis and the Mann-Whitney U tests.

Results: 108 PAS patients were discovered. The most age group was between 20-35 years with parity of more than or equal to 4, history of Cesarean section once, gestational age at termination 34-36 weeks, and maternal death in 7 out of 101 cases. There were 49 resections, 13 resections with internal iliac artery ligation, 34 hysterectomies, and 12 hysterectomies with internal iliac artery ligation. There was no difference in bleeding and operative duration between resection vs. resection with internal iliac artery ligation (p: 0.113; p: 0.639), hysterectomy vs. a hysterectomy with internal iliac artery ligation ((p:0.052; P:0.723), and resection with ligation vs hystetectomy with the internal iliac artery ligation (p:0.052; p:0.723). Bleeding and operative duration differed significantly between resection vs. hysterectomy (p:0.002; p:0.013). All patients underwent tourniquet placement.

Conclusion An Internal iliac artery ligation was not shown to reduce bleeding in treating PASD.

Keywords: accreta, internal iliac artery, placenta .

The value of intrapartum ultrasound in predicting mode of delivery: A prospective cohort study

Gamal Omar, Marwa F Sharaf , Mohammad A. Taymour — Wed, 30 Oct 2024 00:00:00 +0000

Abstract

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

Aidrus Muthalib, Kanadi Sumapraja, Achmad Kemal Harzif, Mila Maidarti — Tue, 29 Oct 2024 00:00:00 +0000

Objectives: 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.

The SDGs Perspective of TeleDoVIA Reliability for Cervical Cancer Elimination in 2030: A Cross Sectional Study in Indonesia

Tue, 29 Oct 2024 00:00:00 +0000

Objective: 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.

Impact of Freeze-Dried Amnion Membrane and Human Amnion Stem Cell Seeding on TGF-B and Collagen Type III in Vesicovaginal Fistula

Jojor Sihotang, Eighty Mardiyan, Widjiati Widjiati, Amiruddin Hidayatullah — Wed, 30 Oct 2024 00:00:00 +0000

Objective: to analize how freeze-dried amniotic membrane and human amniotic stem cell seeding affect TGF B and type III collagen expression in suturing a New Zealand rabbit vesicovaginal fistula model.

Metode: This experimental study employed New Zealand rabbits and a vesicovaginal fistula model with a post-test only control group design. The rabbits were divided into 3 groups: vesicovaginal fistula suturing alone, suturing with freeze-dried amniotic membrane, and suturing with freeze-dried amnion-seeded stem cells. After 7 days of treatment, specimens near the repaired vesicovaginal fistula were collected for immunohistochemical analysis of TGF B and collagen type III expression.

Result: TGF B expression was significantly higher in the freeze-dried amniotic membrane with stem cell seeding group (p=0.001) compared to the freeze-dried amniotic membrane without stem cell seeding group (p=0.017) and the suturing-only group (p=0.049). Additionally, type III collagen expression was significantly elevated in the freeze-dried amnion membrane and stem cell seeding group (p=0.001) compared to the freeze-dried amnion group without stem cell seeding (p=0.09) and the suturing-only group (p=0.026).

Conclusion: The expression of TGF B and type III collagen was higher in rabbits with vesicovaginal fistulas treated using freeze-dried amnion and amniotic stem cell seeding compared to those without amniotic stem cell seeding and vesicovaginal fistula suturing alone.

Keywords: Vesicovaginal Fistula, Freeze-dried Amnion, Stem cell

Atypical Findings of Suspect Twin to Twin Transfusion Syndrome Quintero V: a Rare Case Report

Bahar Sangkur Gusasih, Setyorini Irianti, Muhammad Alamsyah Aziz, Andi Kurniadi — Wed, 30 Oct 2024 00:00:00 +0000

Introduction: Twin-to-twin transfusion syndrome (TTTS) is a serious complication in monochorionic multiple pregnancies.

Case Illustration: A-38 years old woman with G3P2AO felt 8 months pregnant and came for polyclinic control with the diagnosis of G3P2A0 gravida 34-35 weeks; Gemelli; Baby I Breech position; Baby I Polyhydramnios, IUFD; Suspected Twin Twin Transfusion Syndrome (TTTS Quintero V). However, atypical findings of TTTS are rarely found and should be taken as special notes such in this case. We will report a rare finding of TTTS in which the SDP level of the donor fetus was normal (not oligohydramnios). The suspected diagnosis of TTTS Quintero V in this case was made clinically based on the maternal-fetal ultrasound findings of a diamniotic monochorionic gemelli pregnancy with IUFD in the 2^nd fetus II. However, there were non-standard findings in this case where the SDP level of the donor fetus was normal (not oligohydramnios). No other sequele complications were found in this case based on other examinations.

Conclusions: Several therapies are available for TTTS including amnioreduction, laser ablation of the vascular placental anastomosis, selective feticide, and septostomy. Timing of delivery after management of singleton fetal death in the late second or early third trimester is debatable. Delivery method is determined based on obstetric indications.

Actinomycin-D vs Methotrexate in Low-Risk Gestational Tropoblastic Neoplasia: Which is the better option?

Heronimus Hansen Kaware, Kevin Wijaya Khoo, Balivia Andi Permata Hapsari — Wed, 30 Oct 2024 00:00:00 +0000

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

Anxiety in Pregnant Women During the Covid-19 Pandemic: A Systematic Review with Meta-Analysis

Cyntia Puspa Pitaloka, Brahmana Askandar Tjokroprawiro, Muji Sulistyowati — Wed, 30 Oct 2024 00:00:00 +0000

Objective : 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, pandemi