Indonesian Journal of Obstetrics & Gynecology Science
OBGYNIA (Indonesian Journal of Obstetrics & Gynecology Science) is a journal in the field of Obstetrics and Gynecology, and is officially issued by the Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Padjadjaran. OBGYNIA published research articles about the new scientific, clinical management of the patient, surgical techniques, new treatments and service evaluation, management and treatment services in obstetrics and gynecology covers areas: Fertility and Reproductive Endocrine Maternalfetal Medicine Oncology Reconstruction Urogynecology Obstetrics and Social Gynecology Obgynia also published case reports and article review on a limited basis This journal is expected to be a reliable source of information, quality and complete knowledge about medicine and health. Indonesian Journal of Obstetrics & Gynecology Science (Obgynia) is accredited (2022-2026) by National Journal Accreditation (ARJUNA) Managed by Ministry of Research, Technology, and Higher Education, Republic of Indonesia with Third Grade (Peringkat 3, Sinta 3), Nomor 79/E/KPT/2023.
Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran
Telomere & Early Senescence Trophoblast in Preeclampsia: Impact & Opportunity
In general, and with numerous studies, telomeres in trophoblast cells tend to be significantly shorter in preeclampsia compared to normal pregnancies. This telomere shortening occurs due to high oxidative stress and premature cellular senescence in the placenta. What are Telomeres? Telomeres are the final sections of chromosomes, consisting of repeating DNA strands. Telomeres function as protective "caps" that maintain the stability of DNA and chromosomes, preventing them from being easily damaged or broken apart during cell division. Each time a cell divides, the telomeres shorten slightly. If the telomeres become too short, the cell will no longer be able to divide and will decease. This is a key indicator of biological aging.
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The Accuracy of Systemic Inflammatory Indices as Preeclampsia Markers: A Retrospective Study
Objective: This study aimed to assess the association between systemic inflammatory indices, including the systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and pan immune inflammation value (PIV), and the development of preeclampsia. Methods: A retrospective study was performed at a tertiary healthcare facility from January to June 2025. This study employed a cross sectional design involving 100 samples, divided into two groups: the preeclampsia group (n=50) and the control group (n=50). Hematological parameters and inflammatory indices were compared, with a p-value < 0.05 indicating statistical significance. Results: Normality tests, receiver operating characteristic (ROC) curve analyses, and correlation tests were conducted to evaluate the systemic immune index (SII), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and pan immune inflammation value (PIV). Both the correlation test and ROC curve analyses showed no significant results for any variable (p > 0.05), with sensitivity and specificity ranging from 50 – 56% and 36 – 62%, respectively. Conclusion: The preeclampsia group tended to have higher inflammatory parameters, but the differences were not statistically significant. Future research could include additional inflammatory markers, such as CRP and fibrinogen, and consider confounding factors for more accurate results. Akurasi Indeks Inflamasi Sistemik Sebagai Penanda Preeklamsia: Sebuah Studi Retrospektif Abstrak Tujuan: Penelitian ini bertujuan untuk menilai hubungan antara indeks inflamasi sistemik yaitu systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), systemic inflammation response index (SIRI), dan pan immune inflammation value (PIV) dengan kejadian preeklampsia. Metode: Studi restropektif dilakukan di fasilitas kesehatan tersier periode Januari – Juni 2025. Metode penelitian yang digunakan dalam penelitian ini adalah cross-sectional. Studi ini meliputi 100 sampel, dibagi menjadi 2 kelompok: grup preeklamsia (n=50) dan kontrol (n=50). Parameter hematologi dan indeks inflamasi dibandingkan untuk dianalisis dengan nilai p< 0,05 dianggap signifikan secara statistik. Hasil: Uji normalitas, receiver operating characteristics (ROC) curve, dan uji korelasi dilakukan untuk menganalisis systemic immune index (SII), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), systemic inflammation response index (SIRI), dan pan-immune inflammation value (PIV). Hasil uji korelasi dan ROC curve tidak menunjukkan hasil bermakna pada seluruh variabel (p> 0,05) dengan rentang sensitivitas dan spesifisitas masing-masing sebesar 50 – 56% dan 36 – 62%. Kesimpulan: Kelompok preeklamsia cenderung mempunyai parameter inflamasi lebih tinggi, tetapi tidak berbeda signifikan. Studi berikutnya dapat mengggunakan parameter inflamasi lebih banyak seperti CRP dan fibrinogen, dan menganalisis faktor perancu supaya hasil studi lebih akurat.
Distribution and Clinical Characteristics of Endometriosis in a Tertiary Referral Hospital in Indonesia: A Cross-Sectional Study
Objective: The objective of this study is to describe the prevalence and distribution of demographic and reproductive characteristics among patients diagnosed with endometriosis at a tertiary referral hospital in Palembang, Indonesia. Methods: This is a descriptive cross-sectional study that was conducted on secondary medical record data of women with histopathologically-confirmed endometriosis between the period of July 2022 to December 2024 to achieve the objective mentioned previously by applying total sampling. Variables analyzed included age, age at menarche, menstrual cycle pattern, disease stage based on the revised American Society for Reproductive Medicine classification, marital status, parity, and body mass index. Data were then summarized using descriptive statistics. Results: A total of 507 patients were included. The highest number of cases occurred in 2024 (57.2%). Most patients were aged between 15 – 49 years (98.4%), had menarche at 8 – 15 years (98.8%), and regular menstrual cycles (98.0%). Stage IV was predominant (61.1%). Nearly half were nulliparous (49.5%), were married (94.1%), and had normal body mass index (38.5%). Conclusion: Most patients with endometriosis in this study were of reproductive age and were predominantly diagnosed at an advanced stage with nulliparity frequently observed. Distribusi dan Karakteristik Klinis Endometriosis di Rumah Sakit Rujukan Tersier di Indonesia: Studi Potong Lintang Abstrak Tujuan: Penelitian ini bertujuan untuk mendeskripsikan prevalensi dan distribusi karakteristik demografi serta reproduksi pasien endometriosis di rumah sakit rujukan tersier di Palembang, Indonesia. Metode: Metode yang digunakan dalam penelitian ini adalah metode deskriptif dengan desain potong lintang menggunakan data sekunder rekam medis pasien endometriosis yang terkonfirmasi secara histopatologi periode Juli 2022 hingga Desember 2024. Variabel yang dianalisis meliputi usia, usia menarche, pola siklus menstruasi, derajat berdasarkan klasifikasi Revised American Society for Reproductive Medicine, status pernikahan, paritas, dan indeks massa tubuh. Data dianalisis menggunakan statistik deskriptif. Hasil: Hasil penelitian menunjukkan bahwa sebanyak 507 pasien memenuhi kriteria. Kasus terbanyak ditemukan pada tahun 2024 (57,2%). Mayoritas pasien berusia 15 – 49 tahun (98,4%), usia menarche 8 – 15 tahun (98,8%), dan siklus menstruasi teratur (98,0%). Stadium IV mendominasi (61,1%). Sebanyak 49,5% pasien merupakan nulipara, 94,1% telah menikah, dan 38,5% memiliki indeks massa tubuh normal. Kesimpulan: Sebagian besar pasien endometriosis dalam penelitian ini merupakan wanita usia reproduktif dan terdiagnosis pada stadium lanjut dengan nuliparitas sebagai karakteristik yang sering ditemukan.
Pravastatin for Prevention of Preterm Birth in High-Risk Pregnancies: A Pilot Randomized Controlled Trial
Objective: This research aims to evaluate the feasibility, safety, and preliminary efficacy of pravastatin for preventing preterm birth among high-risk pregnant women. Methods: This double-blind, randomized, placebo-controlled pilot trial was conducted at a tertiary referral center in Indonesia (August 2024–June 2025). Pregnant women at 14–28⁺⁶ weeks' gestation with ≥1 preterm birth risk factor were randomized 1:1 to oral pravastatin 20 mg twice daily or placebo until delivery. The primary outcome was preterm birth <37 weeks. All analyses were conducted on an intention-to-treat basis. Results: Thirty-five women were analyzed (pravastatin n=17; placebo n=18) with comparable baseline characteristics. Preterm birth <37 weeks was significantly lower in the pravastatin group (11.8% vs 72.2%; OR 0.051, 95% CI <0.01–0.31; p=0.001), with higher median gestational age at delivery (37 vs 34.5 weeks; p=0.005). Pravastatin was also associated with reduced preterm preeclampsia (11.8% vs 55.6%; p=0.006), higher neonatal birthweight (3227 ± 628 g vs 2446 ± 373 g; p<0.001), and lower rates of low birthweight (5.9% vs 77.8%; p<0.001). No significant differences in neonatal adverse outcomes were observed. Conclusion: In this small pilot trial (n=35), pravastatin was associated with a reduced incidence of preterm birth and improved gestational and neonatal outcomes among high-risk pregnancies. Given the small sample size, the very large observed effect sizes should be interpreted with caution and may reflect random variation. These preliminary findings support the feasibility and safety of pravastatin in this population and provide justification for larger, adequately powered randomized controlled trials. Pravastatin untuk Pencegahan Kelahiran Prematur pada Kehamilan Berisiko Tinggi: Uji Coba Terkontrol Acak Abstrak Tujuan: Penelitian ini bertujuan mengevaluasi kelayakan, keamanan, dan efikasi awal pravastatin dalam mencegah persalinan prematur pada ibu hamil berisiko tinggi. Metode: Uji klinis pilot tersamar ganda, acak, terkontrol plasebo ini dilakukan di pusat rujukan tersier di Indonesia (Agustus 2024 – Juni 2025). Ibu hamil dengan usia kehamilan 14 – 28⁺⁶ minggu yang memiliki ≥1 faktor risiko persalinan prematur diacak 1:1 untuk menerima pravastatin oral 20 mg dua kali sehari atau plasebo hingga persalinan. Luaran utama adalah persalinan prematur <37 minggu. Seluruh analisis dilakukan berdasarkan prinsip intention-to-treat. Hasil: Sebanyak 35 ibu hamil dianalisis (pravastatin n=17; plasebo n=18) dengan karakteristik dasar yang sebanding. Persalinan prematur <37 minggu secara bermakna lebih rendah pada kelompok pravastatin (11,8% vs 72,2%; OR 0,051; IK 95% <0,01 – 0,31; p=0,001), disertai median usia kehamilan saat persalinan yang lebih tinggi (37 vs 34,5 minggu; p=0,005). Pravastatin juga berhubungan dengan penurunan preeklamsia prematur (11,8% vs 55,6%; p=0,006), berat lahir neonatus yang lebih tinggi (3227 ± 628 g vs 2446 ± 373 g; p<0,001), serta penurunan angka berat lahir rendah (5,9% vs 77,8%; p<0,001). Tidak terdapat perbedaan bermakna pada luaran neonatal yang merugikan. Kesimpulan: Pada uji klinis pilot berskala kecil ini (n=35), pravastatin berhubungan dengan penurunan insiden persalinan prematur serta perbaikan luaran gestasional dan neonatal pada kehamilan berisiko tinggi. Mengingat jumlah sampel yang kecil, effect size yang sangat besar harus diinterpretasikan dengan hati-hati karena dapat mencerminkan variasi acak. Temuan awal ini mendukung kelayakan dan keamanan penggunaan pravastatin pada populasi tersebut, serta memberikan justifikasi untuk pelaksanaan uji klinis acak terkontrol berskala lebih besar dengan kekuatan statistik yang memadai.
Effect of Exercise, Metformin, and Their Combination on Ki-67 Expression and Endometriotic Implants in a Mouse Model of Endometriosis
Objective: To determine the effects of exercise, metformin, and their combination on Ki-67 expression and endometriotic implants in a mouse model of endometriosis. Methods: This experimental study used 28 three-month-old BALB/c mice with induced endometriosis, which were randomly and equally divided into four groups (K, P1, P2, and P3). On day 15, group P1 received a swimming protocol (10 minutes/day) for 14 days, group P2 received metformin (4 mg/day) for 14 days, and group P3 received a combination of both treatments, while group K served as the control and received no treatment. Immunohistochemical analysis of Ki-67 expression was performed on peritoneal tissues from the abdominal and pelvic cavities and measured using the Remmele Scale Index. Endometriotic implant areas were analyzed using a computer-based tracing method. Statistical analysis was performed using SPSS version 32, with significance set at p < 0.05. Results: There were significant differences in Ki-67 expression (p = 0.002) and endometriotic implant area (p < 0.001) among the groups. Ki-67 expression was significantly lower in the P1 group compared to the other groups, while the implant area was significantly lower in the P2 group compared to the other groups. Conclusion: Exercise and metformin may be effective potential treatments for endometriosis by reducing Ki-67 expression and endometriotic implant size. Pengaruh Olahraga, Metformin dan Kombinasi terhadap Ekspresi Ki-67 dan Implantasi Endometriosis pada Mencit Model Endometriosis Abstrak Tujuan: Penelitian ini bertujuan untuk menentukan pengaruh olahraga, metformin, dan kombinasinya terhadap ekspresi Ki-67 dan implan endometriotik pada model mencit endometriosis. Metode: Penelitian ini menggunakan metode penelitian eksperimental dengan menggunakan 28 ekor mencit BALB/c berumur tiga bulan dengan endometriosis yang diinduksi, yang dibagi secara acak dan merata menjadi empat kelompok (K, P1, P2, dan P3). Pada hari ke-15, kelompok P1 diberikan protokol renang (10 menit/hari) selama 14 hari, kelompok P2 diberikan metformin (4 mg/hari) selama 14 hari, dan kelompok P3 diberikan kombinasi kedua perlakuan, sedangkan kelompok K sebagai kontrol tidak diberikan perlakuan. Analisis imunohistokimia ekspresi Ki-67 dilakukan pada jaringan peritoneum rongga abdomen dan pelvis, serta diukur menggunakan Indeks Skala Remmele. Luas implan endometriotik dianalisis menggunakan metode penelusuran berbasis komputer. Analisis statistik dilakukan menggunakan SPSS versi 32 dengan tingkat signifikansi p < 0,05. Hasil: Hasil penelitin ini menunjukkan bahwa terdapat perbedaan bermakna pada ekspresi Ki-67 (p = 0,002) dan luas implan endometriotik (p < 0,001) antar kelompok. Ekspresi Ki-67 secara signifikan lebih rendah pada kelompok P1 dibandingkan kelompok lainnya, sedangkan luas implan secara signifikan lebih rendah pada kelompok P2 dibandingkan kelompok lainnya. Kesimpulan: Olahraga dan metformin berpotensi menjadi terapi yang efektif untuk endometriosis dengan menurunkan ekspresi Ki-67 dan ukuran implan endometriotik.
Correlation between Leukocyte Esterase and the Incidence of Preterm Birth and Maternal and Neonatal Outcomes
Objective: Leukocyte esterase (LE) is a diagnostic marker for urinary tract infections (UTIs), the management of which may mitigate the risk of preterm labor and neonatal complications. This study evaluates the correlation between positive LE, preterm labor, and subsequent infant outcomes. Methods: This retrospective cohort study at Hasan Sadikin General Hospital analyzed medical records of singleton pregnancies in 2024. Using total sampling and multivariable logistic regression, the study evaluated the correlation between maternal urinalysis with positive leukocyte esterase, the incidence of preterm birth, and 5-minute APGAR scores. Results: Of the 420 patients analyzed, preterm labor occurred in 60.5% of cases. Positive LE was identified in 42.1% of the cases. Multivariate analysis revealed that positive LE significantly increased the risk of preterm delivery (aOR = 1.57, p = 0.042). However, positive LE was not a significant determinant of neonatal asphyxia (OR = 0.97, p > 0.999), which demonstrated a stronger association with lower birth weight and infrequent antenatal care visits. Conclusion: Maternal leukocyte esterase positivity is associated with approximately a 1.5-fold increase in the likelihood of preterm labor. Conversely, no significant association was observed between LE levels and neonatal asphyxia or 5-minute APGAR scores. Hubungan antara Leukosit Esterase dengan Kejadian Persalinan Prematur dan Luaran Ibu dan Bayi Abstrak Tujuan: Leukosit esterase membantu mendiagnosis Infeksi Saluran Kemih (ISK), yang berpotensi mengurangi risiko persalinan prematur dan asfiksia kelahiran. Penelitian ini bertujuan menganalisis korelasi antara leukosit esterase, persalinan prematur, dan hasil bayi. Metode: Studi kohort retrospektif yang dilakukan di Rumah Sakit Hasan Sadikin melalui data rekam medik, dilakukan total sampling pasien dengan kehamilan tunggal pada tahun 2024. Data dianalisis dengan uji Chi square, dilanjutkan dengan regresi logistik multivariat untuk mengevaluasi hubungan antara hasil urin leukosit esterase positif dengan persalinan prematur, dan skor APGAR 5 menit. Hasil: Dari 420 pasien, persalinan prematur terjadi pada 60,5% kasus. Leukosit Esterase (LE) positif ditemukan pada 42,1% kasus persalinan prematur. Analisis multivariat menunjukkan bahwa LE positif secara signifikan meningkatkan risiko persalinan prematur (aOR = 1,57; p = 0,042). Namun, hal tersebut bukan merupakan penentu signifikan bagi asfiksia neonatal (OR = 0,97; p > 0,999), yang justru lebih kuat dikaitkan dengan berat badan lahir rendah dan kunjungan perawatan antenatal (antenatal care) yang lebih sedikit. Kesimpulan: Leukosit esterase positif meningkatkan risiko persalinan prematur sekitar 1,5 kali lipat, namun tidak menunjukkan hubungan signifikan dengan asfiksia neonatal atau skor APGAR 5 menit.
Characteristics of Ovarian Cancer Patients From 2017 – 2023
Objectives: Ovarian cancer is a malignancy originating in the ovaries and is the most lethal gynecological cancer. It is among the ten most common cancers affecting women in Indonesia. This study aimed to describe the characteristics of ovarian cancer patients treated at Dr. Hasan Sadikin General Hospital, Bandung, during 2017 – 2023. Methods: This retrospective descriptive study was conducted using medical records of ovarian cancer patients treated at Dr. Hasan Sadikin General Hospital, Bandung, from 2017 – 2023. Data collected included age, parity, body mass index (BMI), clinical stage, histopathological findings, and treatment performed. Results: A total of 475 patients were identified. The most common characteristics were age 40 – 60 years (59.58%), nulliparity (53.47%), high BMI (51.37%), and clinical stage IIIC (22.74%). The predominant histopathological type was epithelial (78.74%), and the most frequently performed treatment was optimal debulking (33.05%). Most patients were diagnosed at advanced stages, consistent with the nonspecific presentation of ovarian cancer. Conclusion: Ovarian cancer patients were predominantly middle-aged, nulliparous, overweight, diagnosed at advanced stages, and had epithelial histopathology. The high proportion of advanced-stage diagnoses underscores the importance of increasing awareness, promoting early detection, and optimizing healthcare services to improve prognosis. Karakteristik Pasien Kanker Ovarium Periode 2017 – 2023 Abstrak Tujuan: Kanker ovarium merupakan keganasan yang berasal dari ovarium dan merupakan kanker ginekologi paling mematikan. Kanker ini termasuk dalam sepuluh jenis kanker tersering pada perempuan di Indonesia. Penelitian ini bertujuan untuk menggambarkan karakteristik pasien kanker ovarium yang dirawat di RSUP dr. Hasan Sadikin Bandung selama periode 2017 – 2023. Metode: Penelitian deskriptif retrospektif ini dilakukan menggunakan data rekam medis pasien kanker ovarium yang dirawat di RSUP dr. Hasan Sadikin Bandung pada periode 2017 – 2023. Data yang dikumpulkan meliputi usia, paritas, indeks massa tubuh (IMT), stadium klinis, hasil histopatologi, serta tindakan yang dilakukan. Hasil: Sebanyak 475 pasien diidentifikasi selama periode penelitian. Karakteristik yang paling sering ditemukan adalah usia 40 – 60 tahun (59,58%), nuliparitas (53,47%), IMT tinggi (51,37%), dan stadium klinis IIIC (22,74%). Tipe histopatologi yang paling dominan adalah tipe epitel (78,74%), dan tindakan yang paling sering dilakukan adalah optimal debulking (33,05%). Sebagian besar pasien terdiagnosis pada stadium lanjut, sesuai dengan gejala kanker ovarium yang tidak spesifik. Kesimpulan: Pasien kanker ovarium didominasi oleh perempuan usia paruh baya, nulipara, dengan kelebihan berat badan, terdiagnosis pada stadium lanjut, dan memiliki histopatologi tipe epitel. Tingginya proporsi diagnosis pada stadium lanjut menegaskan pentingnya peningkatan kesadaran, deteksi dini, dan optimalisasi layanan kesehatan untuk memperbaiki prognosis pasien kanker ovarium.
Comparison of Insulin-Like Growth Factor-1 (IGF-1) and Transforming Growth Factor-β1 (TGF-β1) Protein Expression Between Patients with Pelvic Organ Prolapse With and Without Cervical Elongation
Objective: Pelvic organ prolapse (POP) is a condition caused by weakened pelvic support structures and is often associated with cervical elongation. The role of growth factors, particularly insulin-like growth factor-1 (IGF-1) and transforming growth factor-β1 (TGF-β1), in the pathogenesis of cervical elongation remains unclear. Methods: This study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, involving patients with pelvic organ prolapse with or without cervical elongation selected by consecutive sampling. Cervical IGF-1 and TGF-β1 expression was assessed by immunohistochemistry, and prolapse severity by POP-Q. Each group included 23 subjects. Data were analyzed using the Shapiro–Wilk and Mann–Whitney U tests. Results: Most participants were ≥ 50 years old, and the POP without cervical elongation group had a significantly higher proportion of postmenopausal women (95.7% vs. 65.2%; p = 0.02). IGF-1 expression did not differ significantly between the two groups (mean 6.39 vs. 7.01; p>0.05). In contrast, TGF-β1 expression was significantly lower in the POP with cervical elongation group than in the POP without cervical elongation group (2.62 ± 1.08 vs. 5.48 ± 2.41; p < 0.001). Conclusion: Decreased TGF-β1 expression may contribute to cervical elongation in POP through impaired extracellular matrix remodeling, while IGF-1 does not clearly distinguish this phenotype. These findings suggest cervical elongation as a distinct biological entity within the POP spectrum, with implications for its pathophysiology and surgical management. Perbandingan Ekspresi Protein Insulin-Like Growth Factor-1 (IGF-1) dan Transforming Growth Factor-β1 (TGF-β1) antara Pasien Prolaps Organ Panggul dan tanpa Elongasi Serviks Abstrak Tujuan: Prolaps organ panggul (POP) merupakan kondisi akibat kelemahan jaringan penunjang pelvis yang sering disertai elongasi serviks. Peran growth factor, khususnya insulin-like growth factor-1 (IGF-1) dan transforming growth factor-β1 (TGF-β) dalam patogenesis elongasi serviks belum sepenuhnya dipahami. Metode: Penelitian ini dilakukan di RSUP Dr. Hasan Sadikin Bandung dengan melibatkan pasien prolaps organ panggul dengan atau tanpa elongasi serviks yang dipilih secara consecutive sampling. Ekspresi IGF-1 dan TGF-β1 pada jaringan serviks dinilai menggunakan imunohistokimia, sedangkan derajat prolaps dinilai dengan sistem POP-Q. Masing-masing kelompok terdiri dari 23 subjek. Data dianalisis menggunakan uji Shapiro–Wilk dan Mann–Whitney U. Hasil: Sebagian besar subjek berusia ≥50 tahun, dengan proporsi menopause lebih tinggi pada kelompok POP tanpa elongasi serviks dibandingkan kelompok POP dengan elongasi serviks (95,7% vs. 65,2%; p=0,02). Tidak terdapat perbedaan bermakna pada ekspresi IGF-1 antara kedua kelompok (6,39 vs. 7,01; p>0,05). Sebaliknya, ekspresi TGF-β1 secara signifikan lebih rendah pada kelompok POP dengan elongasi serviks dibandingkan dengan kelompok POP tanpa elongasi serviks (2,62 ± 1,08 vs. 5,48 ± 2,41; p < 0,001). Kesimpulan: Penurunan ekspresi TGF-β1 dapat berkontribusi terhadap elongasi serviks pada POP melalui gangguan remodeling matriks ekstraseluler, sedangkan IGF-1 tidak secara jelas membedakan fenotipe ini. Temuan ini menunjukkan bahwa elongasi serviks merupakan entitas biologis tersendiri dalam spektrum POP, dengan implikasi terhadap patofisiologi dan tata laksana bedah.
Maternal and Neonatal Outcomes of Severe Preeclampsia: Delivery at 34–36 Weeks versus Term: A Retrospective Study at a Tertiary Referral Hospital
Introduction: Severe preeclampsia (SPE) is a leading cause of maternal and perinatal morbidity and mortality in developing countries. The optimal timing of delivery remains debated, particularly whether termination at 34 – 36 weeks worsens outcomes compared with term delivery. This study compared maternal and neonatal outcomes of SPE delivered at 34 – 36 weeks versus at term. Methods: This retrospective observational study used medical records of women with SPE who delivered at Dr. Hasan Sadikin General Hospital, Bandung, during 2020 – 2023. Total sampling yielded 336 women (120 at 34 – 36 weeks; 216 at term). Outcomes were analysed using Chi-square, Fisher exact, and Mann-Whitney tests, with p≤0.05 considered significant. Results: Maternal mortality did not differ between the 34 – 36-week and term groups (5.0% vs 3.7%; p=0.569), nor did delivery mode, postpartum haemorrhage, or premature rupture of membranes. Among singletons, neonatal outcomes differed significantly for birth weight, one-minute APGAR, and five-minute APGAR (all p<0.05); ten-minute APGAR, NICU admission, respiratory distress, and neonatal mortality (6.5% vs 2.9%; p=0.200) did not differ. No outcome differed among twins. Conclusion: Delivery at 34 – 36 weeks for severe preeclampsia did not show a significant difference in maternal and neonatal mortality compared with term delivery, though neonates born earlier had lower birth weight and poorer early APGAR adaptation. Indicated delivery within this window may be considered according to maternal-fetal condition and neonatal readiness, with cautious interpretation given the retrospective design. Luaran Maternal dan Neonatal Preeklamsia Berat: Persalinan Usia 34 – 36 Minggu versus Aterm: Studi Retrospektif di Rumah Sakit Rujukan Tersier Abstrak Latar Belakang: Preeklamsia berat (PEB) merupakan penyebab utama morbiditas dan mortalitas maternal serta perinatal di negara berkembang. Waktu terminasi optimal masih diperdebatkan, terutama apakah persalinan pada usia 34 – 36 minggu memperburuk luaran maternal dan neonatal dibandingkan aterm. Penelitian ini membandingkan luaran maternal dan neonatal PEB yang dilahirkan pada usia 34 – 36 minggu dan aterm. Metode: Penelitian observasional retrospektif menggunakan rekam medis perempuan dengan PEB yang bersalin di RSUP Dr. Hasan Sadikin Bandung periode 2020 – 2023. Total sampling memperoleh 336 subjek (120 bersalin pada usia 34 – 36 minggu; 216 aterm). Data dianalisis dengan uji Chi-square, Exact Fisher, dan Mann-Whitney; p≤0,05 dianggap bermakna. Hasil: Mortalitas maternal tidak berbeda antara kelompok 34 – 36 minggu dan aterm (5,0% vs 3,7%; p=0,569), demikian pula jenis persalinan, perdarahan pascapersalinan, dan ketuban pecah dini. Pada kehamilan tunggal, luaran neonatal berbeda bermakna pada berat lahir, APGAR menit pertama, dan APGAR menit kelima (semua p<0,05); APGAR menit kesepuluh, perawatan NICU, gangguan napas, dan mortalitas neonatal (6,5% vs 2,9%; p=0,200) tidak berbeda. Tidak ditemukan perbedaan luaran pada kehamilan gemelli. Kesimpulan: Persalinan pada usia 34 – 36 minggu untuk preeklamsia berat tidak menunjukkan perbedaan bermakna dalam mortalitas maternal dan neonatal dibandingkan persalinan aterm, meskipun neonatus yang dilahirkan lebih awal menunjukkan berat lahir lebih rendah dan APGAR awal yang lebih buruk. Persalinan terindikasi pada usia ini dapat dipertimbangkan sesuai kondisi maternal-fetal dan kesiapan neonatal, dengan interpretasi hati-hati mengingat desain retrospektif.
Association Between Antepartum Hemorrhage and Preterm Delivery at Dr. Hasan Sadikin General Hospital in 2025
Objective: This study aimed to determine the association between antepartum hemorrhage and the risk of preterm birth at Dr. Hasan Sadikin General Hospital in Bandung in 2025. Methods: This analytical observational study used a retrospective cross-sectional design and secondary data from patients’ medical records. The study population comprised all pregnant women who received obstetric care at Dr. Hasan Sadikin General Hospital, Bandung. A total sampling technique was used, including all subjects who met the inclusion and exclusion criteria. Data were analyzed using logistic regression in SPSS version 27.0. Result: A total of 102 medical records were included in the analysis. Multivariate logistic regression revealed that women with antepartum hemorrhage had an eightfold higher risk of preterm birth compared with those without antepartum hemorrhage. Conclusion: Antepartum hemorrhage was significantly associated with an increased risk of preterm birth at Dr. Hasan Sadikin General Hospital in Bandung in 2025 (p < 0.05). Hubungan Perdarahan Antepartum dan Risiko Persalinan Preterm di RSUP Dr. Hasan Sadikin Tahun 2025 Abstrak Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara perdarahan antepartum dan risiko persalinan preterm di RSUP Dr. Hasan Sadikin Bandung pada tahun 2025. Metode: Penelitian observasional analitik ini menggunakan desain potong lintang retrospektif dengan memanfaatkan data sekunder yang diperoleh dari rekam medis pasien. Populasi penelitian mencakup seluruh ibu hamil yang mendapatkan pelayanan obstetri di RSUP Dr. Hasan Sadikin Bandung. Teknik total sampling digunakan dengan memasukkan seluruh subjek yang memenuhi kriteria inklusi dan eksklusi. Analisis data dilakukan menggunakan regresi logistik dengan perangkat lunak SPSS versi 27.0. Hasil: Sebanyak 102 rekam medis dianalisis dalam penelitian ini. Analisis regresi logistik multivariat menunjukkan bahwa ibu hamil dengan perdarahan antepartum memiliki risiko delapan kali lebih tinggi mengalami persalinan preterm dibandingkan dengan ibu hamil tanpa perdarahan antepartum. Kesimpulan: Perdarahan antepartum berhubungan secara signifikan dengan peningkatan risiko persalinan preterm di RSUP Dr. Hasan Sadikin Bandung pada tahun 2025 (p < 0,05).
Correlation Between First-Trimester Anemia in Pregnancy and the Incidence of Preeclampsia: A Retrospective Cohort Study
Introduction: Preeclampsia affects 2 – 4% of pregnancies worldwide and is a leading cause of maternal and perinatal morbidity and mortality. Anemia in pregnancy—defined as hemoglobin <11 g/dL in the first or third trimester—remains prevalent, affecting 48.9% of Indonesian pregnant women (Riskesdas 2018). First-trimester anemia may contribute to preeclampsia through oxidative stress, endothelial dysfunction, and impaired placentation. Objective: To analyze the association between first-trimester anemia and preeclampsia at Prof. Dr. Margono Soekarjo Regional General Hospital (January – December 2023). Methods: This retrospective cohort study used total sampling of pregnant women treated at the hospital from January to December 2023. Variables included first-trimester hemoglobin and preeclampsia status. Logistic regression analysis was performed using SPSS 27.0. Results: The model showed good fit (Hosmer–Lemeshow = 2.491, p=0.778; Nagelkerke R²=0.367). First-trimester hemoglobin was significantly associated with preeclampsia (p<0.001; OR=0.884, 95% CI: 0.849–0.921). Each 1 g/dL increase in hemoglobin was associated with an 11.6% reduction in the odds of preeclampsia. Conclusion: First-trimester anemia was significantly associated with preeclampsia. Adequate early hemoglobin levels were associated with lower odds of preeclampsia, underscoring the importance of early hematologic monitoring and iron–folate supplementation in antenatal care. Korelasi antara Anemia Trimester-Pertama pada Kehamilan dan Kejadian Preeklampsia: Studi Kohort Retrospektif Abstrak Pendahuluan: Preeclampsia memengaruhi 2 – 4% kehamilan di seluruh dunia dan merupakan penyebab utama morbiditas serta mortalitas maternal dan perinatal. Anemia pada kehamilan—didefinisikan sebagai hemoglobin <11 g/dL pada trimester pertama atau ketiga—masih banyak terjadi, memengaruhi 48,9% ibu hamil Indonesia (Riskesdas 2018). Anemia trimester pertama dapat berkontribusi terhadap preeclampsia melalui oxidative stress, disfungsi endotel, dan gangguan plasentasi. Tujuan: Penelitian ini bertujuan menganalisis korelasi antara anemia trimester pertama dan preeclampsia di Rumah Sakit Umum Daerah Prof. Dr. Margono Soekarjo (Januari – Desember 2023). Metode: Penelitian ini merupakan studi retrospektif bersifat kohort dengan teknik total sampling terhadap ibu hamil yang dirawat di rumah sakit dari Januari hingga Desember 2023. Variabel yang diteliti meliputi hemoglobin trimester pertama dan status preeclampsia. Analisis logistic regression dilakukan menggunakan SPSS 27.0. Hasil: Model menunjukkan kecocokan yang baik (Hosmer–Lemeshow = 2.491, p=0.778; Nagelkerke R²=0.367). Hemoglobin trimester pertama berhubungan signifikan dengan preeclampsia (p<0.001; OR=0.884, 95% CI: 0.849–0.921). Kenaikan hemoglobin sebesar 1 g/dL berhubungan dengan penurunan peluang preeclampsia sebanyak 11,6%. Kesimpulan: Anemia trimester pertama berhubungan secara signifikan dengan preeclampsia. Kadar hemoglobin awal yang memadai berhubungan dengan penurunan peluang terjadinya preeclampsia, sehingga menekankan pentingnya pemantauan hematologi dini dan suplementasi zat besi–folat dalam pelayanan antenatal.
Clinical Characteristics and Maternal–Fetal Outcomes of Severe Preeclampsia Referral Cases at Waled General Hospital: A Retrospective Study
Objective: Severe preeclampsia remains a major contributor to maternal and perinatal morbidity and mortality, particularly in developing countries, where delayed referral and inadequate early detection are common. This study aimed to describe the clinical characteristics and maternal–fetal outcomes of severe preeclampsia cases referred to Waled General Hospital. Method: A retrospective descriptive study was conducted using secondary data from medical records and maternal health (KIA) books for pregnant women diagnosed with severe preeclampsia and referred to Waled General Hospital from January to December 2024. Collected data included maternal demographic characteristics, gestational age, laboratory findings, maternal risk factors, and maternal–fetal outcomes. Result: A total of 76 pregnant women with severe preeclampsia were included, with a mean maternal age of 33.3 years. Most participants were multiparous (75%), and 40.8% had extreme maternal age (<20 or >35 years). Proteinuria was present in 69.7% of cases, and fetal complications were more frequent than maternal complications, particularly prematurity (13.2%), followed by intrauterine growth restriction (6.6%) and intrauterine fetal death (2.6%). Conclusion: Severe preeclampsia referral cases at Waled General Hospital were marked by substantial maternal risk factors and adverse maternal–fetal outcomes, particularly prematurity. Strengthening early detection, clinical assessment, and timely referral may improve maternal and perinatal outcomes. Karakteristik Klinis dan Luaran Maternal–Fetal Kasus pada Rujukan Preeklamsia Berat di RSUD Waled Cirebon: Studi Retrospektif Abstrak Tujuan: Preeklamsia berat masih menjadi penyebab utama morbiditas dan mortalitas maternal serta perinatal, terutama di negara berkembang yang sering menghadapi keterlambatan deteksi dini dan rujukan. Penelitian ini bertujuan untuk mendeskripsikan karakteristik klinis dan luaran maternal–fetal pada kasus rujukan preeklamsia berat di RSUD Waled. Metode: Penelitian deskriptif retrospektif dilakukan menggunakan data sekunder berupa rekam medis dan buku Kesehatan Ibu dan Anak (KIA) pasien hamil dengan diagnosis preeklamsia berat yang dirujuk ke RSUD Waled pada periode Januari hingga Desember 2024. Data yang dikumpulkan meliputi karakteristik demografis maternal, usia kehamilan, temuan laboratorium, faktor risiko maternal, serta luaran maternal–fetal. Hasil: Sebanyak 76 ibu hamil dengan preeklamsia berat diikutsertakan dalam penelitian dengan rerata usia maternal 33,3 tahun. Mayoritas pasien merupakan multipara (75%), dengan hampir setengahnya (40,8%) berada pada kelompok usia maternal ekstrem, yaitu berusia <20 tahun atau >35 tahun. Proteinuria ditemukan pada 69,7% kasus, dan komplikasi fetal lebih sering ditemukan dibandingkan komplikasi maternal, terutama prematuritas (13,2%), restriksi pertumbuhan intrauterin (6,6%), dan kematian janin intrauterin (2,6%). Kesimpulan: Kasus rujukan preeklamsia berat di RSUD Waled ditandai oleh tingginya faktor risiko maternal serta luaran maternal–fetal yang merugikan, terutama prematuritas. Penguatan deteksi dini, penilaian klinis, dan rujukan yang tepat waktu berpotensi meningkatkan luaran maternal dan perinatal.
Psychosexual Interventions for Childhood Sexual Abuse Survivors: A Narrative Review in Obstetric and Gynecological Care
Objective: To evaluate the effectiveness of psychosexual interventions in improving sexual function and related psychological outcomes among women with a history of childhood sexual abuse, and to explore their clinical relevance and applicability in obstetric and gynecological care settings. Methods: A narrative review of literature from PubMed and ScienceDirect, published through February 2026, was conducted. Included studies involved adult women with a history of childhood sexual abuse who received psychosexual interventions and reported sexual or psychological outcomes. Non-primary studies and those failing to meet inclusion criteria were excluded. Results: Eight studies discussing psychosexual interventions were included, mainly comprising of cognitive-behavioral approaches, mindfulness-based therapy, and expressive writing, demonstrated improvements in sexual function, particularly desire and arousal, and reductions in sexual distress. Trauma-focused therapies, including TF-CBT, EMDR, and CPT, primarily reduced PTSD and related psychological symptoms, resulting in indirect effects on sexual health. This review also summarizes main principles of psychosexual interventions relevant for clinical application. Conclusion: Childhood sexual abuse has long-term effects on sexual functioning across multiple domains. Integrating trauma-focused and psychosexual interventions is crucial for supporting recovery and optimizing sexual health outcomes. In clinical practice, this includes routine screening, tailored counseling that accommodates cognitive and emotional vulnerabilities, and the application of trauma-informed and human rights-based care. Future research is warranted to strengthen these clinical applications. Intervensi Psikoseksual pada Penyintas Kekerasan Seksual Anak: Tinjauan Naratif dalam Praktik Obstetri dan Ginekologi Abstrak Tujuan: Untuk mengevaluasi efektivitas intervensi psikoseksual dalam meningkatkan fungsi seksual dan luaran psikologis terkait pada perempuan dengan riwayat kekerasan seksual pada masa kanak-kanak, serta mengeksplorasi relevansi dan aplikasinya dalam praktik obstetri dan ginekologi. Metode: Tinjauan naratif dilakukan menggunakan PubMed dan ScienceDirect hingga Februari 2026. Studi yang melibatkan perempuan dewasa dengan riwayat kekerasan seksual pada masa kanak-kanak yang menerima intervensi psikoseksual dan melaporkan luaran seksual atau psikologis disertakan. Studi non-primer dan yang tidak memenuhi kriteria tidak diinklusikan Hasil: Sebanyak delapan studi yang membahas intervensi psikoseksual disertakan, terdiri dari terapi berbasis mindfulness, expressive writing, dan pendekatan kognitif-perilaku menunjukkan perbaikan fungsi seksual, terutama pada aspek hasrat, gairah, dan distres seksual. Terapi berfokus trauma seperti TF-CBT, EMDR, dan CPT terutama menurunkan gejala PTSD dan gangguan psikologis terkait, dengan efek tidak langsung terhadap kesehatan seksual. Tinjauan ini juga merangkum prinsip-prinsip utama psikoseksual yang relevan bagi praktik klinis. Kesimpulan: Kekerasan seksual pada masa kanak-kanak berdampak jangka panjang terhadap fungsi seksual di berbagai domain. Integrasi terapi berfokus trauma dan intervensi psikoseksual penting untuk mendukung pemulihan dan meningkatkan kesehatan seksual. Dalam praktik klinis, hal ini mencakup skrining rutin, konseling yang disesuaikan dengan keterbatasan kognitif dan emosional, serta penerapan pendekatan berbasis trauma dan hak asasi manusia. Penelitian berkualitas tinggi masih diperlukan untuk memperkuat aplikasi klinis.
Pain Management and Shared Decision-Making in Office-Based Gynecologic Procedures: Evidence-Based Strategies and Clinical Perspectives
Introduction: Pain during office-based gynecologic procedures is a frequent source of patient distress and may negatively affect satisfaction, adherence to care, and willingness to undergo future procedures. Optimizing pain management and integrating shared decision-making are therefore essential components of high-quality gynecologic practice. Evidence Acquisition: A narrative, non-systematic review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, and the Directory of Open Access Journals (DOAJ). Articles published between 2005 and 2025 were identified using keywords related to gynecologic procedures, pain management, analgesia, and shared decision-making. Randomized controlled trials, meta-analyses, observational studies, guidelines, and selected French-language publications were included. Evidence was qualitatively assessed based on methodological quality and clinical relevance. Results: Pain is commonly reported during office gynecologic procedures in the absence of targeted interventions. Systemic analgesics alone appear to provide limited intra-procedural pain relief, whereas local anesthetic techniques and procedural modifications are associated with reduced pain. Vaginoscopic hysteroscopy, small-diameter instruments, and saline distension media have been associated with improved tolerance. Shared decision-making has been associated with lower perceived pain, reduced anxiety, and higher patient satisfaction across procedures. Conclusions: Effective pain management in office gynecology requires a multimodal, patient-centered approach. Combining evidence-based analgesic strategies with procedural optimization and shared decision-making may improve patient experience and procedural acceptance. Keywords: Office gynecologic procedures; Pain management; Intrauterine device; Endometrial biopsy; Hysteroscopy; Shared decision-making
Comparing Various GnRH Protocols to Improve Fertility Outcomes in Patients with Adenomyosis: A Qualitative Systematic Review
Introduction: Adenomyosis impairs fertility through chronic inflammation and endometrial damage. While IVF with GnRH modulation is used to improve outcomes, no universal protocol exists. This study compares long versus short GnRH agonist protocols for improving fertility in adenomyosis patients. Methods: This qualitative systematic review [CRD420251272312] searched databases like PubMed and Semantic Scholar in November 2025. It included English-language observational studies or RCTs involving human samples, while excluding duplicates and incomplete manuscripts. Results: From 858 abstracts, three studies were analyzed. No method significantly altered oocyte count or myometrial thickness. Ultra-long and long GnRH agonist protocols showed higher pregnancy rates and lower miscarriage risks, whereas antagonist and short agonist protocols had poorer outcomes. Conclusions: Ultra-long and long GnRH agonist protocols are promising for adenomyosis, but these preliminary results from limited studies require validation through larger randomized controlled trials addressing confounding factors. Perbandingan Variasi Protokol GnRH untuk Meningkatkan Hasil Kesuburan pada Pasien dengan Adenomiosis: Sebuah Tinjauan Sistematis Kualitatif Abstrak Pendahuluan: Adenomiosis mengganggu kesuburan melalui peradangan kronis dan kerusakan endometrium. Meskipun IVF dengan modulasi GnRH digunakan untuk meningkatkan hasil, tidak ada protokol universal yang ada. Studi ini membandingkan protokol agonis GnRH panjang versus pendek untuk meningkatkan kesuburan pada pasien adenomiosis. Metode: Tinjauan sistematis kualitatif ini [CRD420251272312] mencari basis data seperti PubMed dan Semantic Scholar pada November 2025. Ini mencakup studi observasional atau RCT berbahasa Inggris yang melibatkan sampel manusia, sambil mengecualikan duplikat dan manuskrip yang tidak lengkap. Hasil: Dari 858 abstrak, tiga studi dianalisis. Tidak ada metode yang secara signifikan mengubah jumlah oosit atau ketebalan miometrium. Protokol agonis GnRH ultra-panjang dan panjang menunjukkan tingkat kehamilan yang lebih tinggi dan risiko keguguran yang lebih rendah, sementara protokol antagonis dan agonis pendek memiliki hasil yang lebih buruk. Kesimpulan: Protokol agonis GnRH ultra-panjang dan panjang menjanjikan untuk adenomiosis, tetapi hasil awal dari studi terbatas ini memerlukan validasi melalui uji coba terkontrol acak yang lebih besar yang membahas faktor-faktor perancu.
Effectiveness of Laser Therapy in Stress Urinary Incontinence Patients: A Systematic Review and Meta-Analysis
Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of laser therapy in improving urinary and sexual function in women with SUI. Methods: The literature was selected using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol. We did literature searches in several databases, including Science Direct, Pubmed, Google Scholar, Cochrane, ProQuest, and Scopus, from inception until January 2025. Quality assessment was performed using the Cochrane Risk of Bias Tool. Mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. Result: There were ten journals with 598 participants that met the criteria. The results of the pooled analysis showed a statistically significant improvement in post-laser therapy pad weight (MD = -0.49; 95% CI: -0.97 to -0.01; p = 0.0435). Despite the non-significant differences and heterogeneity found in the meta-analysis of sexual function outcome (MD = -0.49; 95% CI: -0.97 to -0.01; p = 0.0435), the individual studies stated that the sexual function was improved in women with SUI post-laser therapy. Discussion: Laser therapy, particularly CO₂ and Er:YAG modalities, appears effective in enhancing sexual function in women with SUI. Variability in protocols and outcome measures among studies may contribute towards heterogeneity. Most trials had small sample sizes and short follow-ups. Conclusion: Laser therapy shows promise for improving urinary and sexual function in women with SUI, warranting further robust research. Efektivitas Terapi Laser pada Pasien Inkontinensia Urin Stres: Tinjauan Sistematis dan Meta-Analisis Abstrak Tujuan: Tinjauan sistematis dan meta-analisis ini bertujuan untuk mengevaluasi efektivitas terapi laser dalam meningkatkan fungsi urinasi dan seksual pada wanita dengan SUI. Metode: Literatur diseleksi dengan protokol Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). Penelusuran literatur dilakukan pada beberapa basis data, termasuk Science Direct, Pubmed, Google Scholar, Cochrane, ProQuest, dan Scopus, sejak awal hingga Januari 2025. Penilaian kualitas dilakukan menggunakan Cochrane Risk of Bias Tool. Perbedaan mean (MD) dengan interval kepercayaan (CI) 95% dihitung menggunakan model efek acak. Hasil: Terdapat sepuluh jurnal dengan 598 partisipan yang memenuhi kriteria. Hasil penelitian dari analisis gabungan menunjukan bahwa terdapat peningkatan yang signifikan secara statistik pada pad weight pasca terapi laser (MD = -0,49; 95% CI: -0,97 hingga -0,01; p = 0,0435). Meskipun perbedaan dan heterogenitas yang tidak signifikan ditemukan dalam meta-analisis hasil fungsi seksual (MD = -0.49; 95% CI: -0.97 to -0.01; p = 0.0435), studi individual menyatakan bahwa fungsi seksual membaik pada wanita dengan SUI pasca-terapi laser. Diskusi: Terapi laser, khususnya modalitas CO₂ dan Er:YAG, tampak efektif dalam meningkatkan fungsi seksual pada wanita dengan SUI. Variabilitas dalam protokol dan ukuran hasil di antara studi dapat berpengaruh pada heterogenitas. Sebagian besar uji coba memiliki ukuran sampel kecil dan follow-up yang singkat. Kesimpulan: Terapi laser menunjukkan harapan untuk meningkatkan fungsi urin dan seksual pada wanita dengan SUI, yang menjamin penelitian lebih lanjut yang kuat.
A Case Report of Primary Amenorrhea Due to Imperforate Hymen with Hematocolpos and Hematometra: Diagnosis and Management
Introduction: Imperforate hymen (IH) is a congenital anomaly of the female genital tract that causes obstruction of vaginal flow. This report aims to describe the clinical presentation of an imperforate hymen and the surgical approach used in the patient. Case Illustration: A 13-years-old girl presented to the obstetrics and gynecology clinic with the chief complaint of lower abdominal pain. Physical examination of the external genitalia revealed a bulging, bluish hymenal membrane. Pelvic ultrasonography showed findings consistent with hematocolpos and hematometra. A diagnosis of imperforate hymen was established. A hymenotomy was performed using a cruciate incision technique. Postoperative evaluation two weeks later demonstrated good wound healing without complications. Conclusion: Imperforate hymen should be identified and managed promptly to prevent complications. Hymenotomy using a cruciate incision technique is an effective therapeutic option with favorable clinical outcomes. Amenore Primer Akibat Himen Imperforata dengan Hematokolpos dan Hematometra: Diagnosis dan Tatalaksana Abstrak Pendahuluan: Himen imperforata (HI) merupakan anomali kongenital saluran genitalia wanita yang menyebabkan obstruksi saluran vagina. Laporan ini bertujuan untuk mendeskripsikan himen imperforata dan pendekatan pembedahan pada pasien. Ilustrasi Kasus: Seorang perempuan usia 13 tahun datang ke poliklinik dengan keluhan utama nyeri perut bawah. Inspeksi genitalia eksterna menunjukkan himen menonjol berwarna kebiruan, dan gambaran hematokolpos pada ultrasonografi pelvis. Diagnosis himen imperforata ditegakkan. Tindakan himenotomi dilakukan dengan teknik insisi menyilang. Evaluasi dua minggu pascaoperasi menunjukkan penyembuhan yang baik tanpa komplikasi. Kesimpulan: Himen imperforata perlu diidentifikasi dan ditangani segera untuk mencegah komplikasi. Himenotomi dengan teknik insisi menyilang merupakan pilihan terapi efektif dengan hasil klinis yang baik.
Dicephalic Parapagus Conjoined Twins in a 37 Week Dichorionic Twin Pregnancy: A Case Report
Introduction: Conjoined twins are a rare congenital anomaly resulting from incomplete embryonic division between days 13 and 15 post-fertilization. Dicephalic parapagus is exceptionally rare, characterized by two heads on a single trunk with variable degrees of organ sharing, and is associated with high perinatal morbidity and mortality. Case presentation: A 20-year-old gravida 3 para 2 woman at 37 weeks was referred with suspected conjoined twins. Ultrasound revealed key clinical findings consistent with dicephalic parapagus, including two heads, a single thorax containing one heart, and shared abdominal organs (one liver, one kidney, one urinary bladder, and two gallbladders). After multidisciplinary planning, an elective cesarean section was performed, delivering live conjoined twins with ambiguous genitalia. The neonates were admitted to the NICU for stabilization and further imaging. The mother had an uncomplicated postoperative recovery and remained hemodynamically stable. The primary diagnosis was dicephalic parapagus with shared vital thoracoabdominal structures. The presence of a single functional heart, identified prenatally and confirmed postnatally, is the most decisive prognostic factor and significantly limits the possibility of surgical separation. This case highlights the importance of early prenatal detection and the role of coordinated multidisciplinary management. Conclusions: As a rare and complex case, this report underscores the challenges of late diagnosis of severe congenital anomalies in resource-limited settings. It emphasizes the need for improved antenatal screening, comprehensive parental counseling, and ethical considerations when managing conjoined twins with non-separable anatomy. Kembar Siam Parapagus Dicephalus pada Kehamilan Kembar Dikorionik 37 Minggu: Laporan Kasus Abstrak Pendahuluan: Kembar siam merupakan anomali kongenital yang sangat jarang terjadi akibat kegagalan pembelahan diskus embrionik antara hari ke-13 hingga ke-15 pascafertilisasi. Parapagus disefalus merupakan kasus yang sangat langka, ditandai dengan dua kepala pada satu batang tubuh dengan derajat berbagi organ yang bervariasi, serta memiliki morbiditas dan mortalitas perinatal yang tinggi. Presentasi kasus: Seorang wanita berusia 20 tahun dengan gravida 3 para 2 pada usia kehamilan 37 minggu dirujuk dengan dugaan kehamilan kembar siam. Pemeriksaan ultrasonografi menunjukkan temuan klinis penting berupa parapagus disefalus, dengan dua kepala, satu toraks berisi satu jantung, serta organ abdomen yang berbagi, termasuk satu hati, dua kantong empedu, satu ginjal, dan satu kandung kemih. Setelah perencanaan multidisiplin, dilakukan seksio sesarea elektif dan berhasil melahirkan bayi kembar siam hidup dengan genitalia ambigu. Keduanya dirawat di NICU untuk stabilisasi dan pemeriksaan lanjutan, sementara ibu menjalani pemulihan pascaoperasi tanpa komplikasi. Diagnosis utama adalah parapagus disefalus dengan berbagai organ vital torakoabdominal yang digunakan bersama. Keberadaan satu jantung fungsional merupakan faktor prognostik paling kritis yang sangat membatasi kemungkinan dilakukan pemisahan bedah. Kasus ini menekankan pentingnya deteksi prenatal dini, konseling orang tua yang komprehensif, dan tata laksana perinatal yang terkoordinasi. Kesimpulan: Sebagai kasus yang sangat langka dan kompleks, laporan ini menunjukkan tantangan diagnosis terlambat pada anomali kongenital berat, terutama di fasilitas kesehatan dengan sumber daya terbatas. Kasus ini menegaskan perlunya peningkatan kualitas skrining antenatal, edukasi keluarga, serta pertimbangan etis dalam menangani kembar siam dengan anatomi yang tidak dapat dipisahkan.
Monochorionic Triplet Pregnancy with an Acardiac Twin: A Poor Prognostic Case
Introduction: Twin Reversed Arterial Perfusion (TRAP) sequence, or acardiac twin, is a rare complication in monochorionic pregnancies due to abnormal placental anastomoses, leading to reversed perfusion and increased risk of heart failure, polyhydramnions, prematurity, and high mortality until 75% if untreated. Case report: A 29-year-old multigravida with a monozygotic triamniotic triplet pregnancy at 20–21 weeks presented with vaginal bleeding. Ultrasound revealed two non-viable fetuses and one suspected intrauterine demise. Vaginal delivery produced two stillbirth females neonatus (295 g and 275 g) and one malformed acardiac fetus (160 g). The placenta was monochorionic with two umbilical cords. Final diagnoses: complete abortion, monozygotic triamniotic triplet pregnancy, and acardiac twin (TRAP). Conclusion: TRAP in monochorionic triplet pregnancy carries poor prognosis. Early detection and referral to tertiary centers with fetal therapy are vital to improve outcomes. Kehamilan Triplet Monokorionik dengan Janin Akardiakus: Kasus dengan Prognosis Buruk Abstrak Pendahuluan: Twin Reversed Arterial Perfusion (TRAP) sequence atau janin akardiakus merupakan komplikasi langka pada kehamilan monokorionik yang terjadi akibat adanya anastomosis plasenta abnormal. Kondisi ini menyebabkan aliran perfusi terbalik sehingga meningkatkan risiko gagal jantung pada janin donor (pump twin), polihidramnion, prematuritas, serta mortalitas tinggi hingga mencapai 75% bila tidak ditatalaksana. Laporan Kasus: Seorang wanita berusia 29 tahun, multigravida, dengan kehamilan triplet monozigot triamniotik pada usia kehamilan 20 – 21 minggu datang dengan keluhan perdarahan pervaginam. Pemeriksaan ultrasonografi menunjukkan dua janin tidak hidup dan satu janin diduga mengalami kematian intrauterin. Persalinan pervaginam menghasilkan dua neonatus perempuan lahir mati (berat 295 g dan 275 g) serta satu janin akardiakus dengan malformasi (berat 160 g). Plasenta monokorionik dengan dua tali pusat. Diagnosis akhir: abortus komplit, kehamilan triplet monozigot triamniotik, dan janin akardiakus (TRAP sequence). Kesimpulan: TRAP pada kehamilan triplet monokorionik memiliki prognosis yang buruk. Deteksi dini dan rujukan ke pusat pelayanan tersier dengan fasilitas terapi fetal sangat diperlukan untuk memperbaiki luaran kehamilan.
Diagnostic Challenges of Antiphospholipid Syndrome in Recurrent Pregnancy Loss: A Case Report
Introduction: Recurrent pregnancy loss is a complex condition that affects a small number of women, with antiphospholipid syndrome being a well-recognized cause. Antiphospholipid syndrome is an autoimmune disorder associated with vascular thrombosis and pregnancy complications. Case report: We present a 23-year-old woman with four consecutive pregnancy losses and cerebral venous sinus thrombosis. Despite an initial inability to fully confirm APS using the Sydney criteria due to resource limitations that hindered repeated laboratory testing, consultation with the rheumatology department led to a diagnosis based on the European Alliance of Associations for Rheumatology and American College of Rheumatology (ACR/EULAR) 2023 criteria. This case highlights the diagnostic challenges of antiphospholipid syndrome, especially in low-resource settings where repeat laboratory testing is often not feasible, underscoring the importance of alternative classification systems for confirming antiphospholipid syndrome when standard criteria cannot be met. Further research is necessary to validate the ACR/EULAR 2023 classification criteria and evaluate their impact on pregnancy outcomes in patients. Conclusion: To optimize limited resources, improved diagnosis and pregnancy planning for patients with antiphospholipid syndrome and cerebral venous sinus thrombosis are achieved by applying current classification criteria along with multidisciplinary management, including anticoagulation and obstetric care. Tantangan Diagnosis Sindrom Antifosfolipid pada Keguguran Berulang: Sebuah Laporan Kasus Abstrak Pendahuluan: Keguguran berulang adalah kondisi multifaktorial yang memengaruhi sebagian kecil wanita, dengan sindrom antifosfolipid sebagai salah satu penyebab yang dikenal. Sindrom antifosfolipid adalah gangguan autoimun yang berhubungan dengan trombosis vaskular dan komplikasi kehamilan. Laporan kasus: Kami melaporkan seorang wanita berusia 23 tahun yang mengalami empat kali keguguran berturut-turut dan didiagnosis dengan trombosis sinus vena serebri. Meskipun pada awalnya konfirmasi penuh sindrom antifosfolipid, menurut kriteria Sydney tidak memungkinkan karena keterbatasan sumber daya yang menghambat pengulangan pemeriksaan laboratorium, konsultasi dengan bagian reumatologi menghasilkan diagnosis berdasarkan kriteria 2023 dari European Alliance of Associations for Rheumatology dan American College of Rheumatology (ACR/EULAR). Kasus ini menyoroti tantangan diagnostik sindrom antifosfolipid, terutama di lingkungan dengan sumber daya terbatas dengan pemeriksaan laboratorium berulang tidak selalu dapat dilakukan, serta pentingnya penggunaan sistem klasifikasi alternatif untuk menegakkan diagnosis ketika kriteria standar tidak dapat dipenuhi. Diperlukan penelitian lebih lanjut untuk memvalidasi kriteria klasifikasi ACR/EULAR 2023 dan menilai dampaknya terhadap hasil kehamilan pada pasien. Kesimpulan: Untuk mengoptimalkan sumber daya yang terbatas, penggunaan kriteria klasifikasi saat ini bersama perawatan antikoagulasi dan obstetri secara multidisipliner memungkinkan diagnosis dan perencanaan kehamilan yang lebih baik bagi pasien dengan sindrom antifosfolipid dan trombosis sinus vena serebral.
Adolescent’s Reproductive Health Issues in Remote Areas with Suspected Sexual Violence: A Case Series
Introduction: Sexual violence against adolescents is a major public health concern in Indonesia with significant medicolegal and psychosocial consequences. UNICEF estimates that more than 370 million girls in Asia have experienced sexual assault in childhood, while Indonesia’s 2021 National Survey reported a 6.9% lifetime prevalence among youth. Adolescents are particularly vulnerable due to stigma and limited access to adolescent-friendly services. Clinical descriptions of medicolegal genital findings in Indonesian adolescents remain limited. Case Presentation: This case series describes three female adolescents aged 16–18 years who underwent medicolegal genital examination following alleged sexual assault. Two patients had fresh hymenal lacerations consistent with acute penetrative trauma, while one had healed hymenal lacerations. All presented with emotional distress and received clinical assessment, reproductive health counseling, and recommendations for psychological support, sexually transmitted infection evaluation, and follow-up care. Examinations were conducted according to national forensic protocols. Conclusion: Normal or healed genital findings do not exclude sexual violence. Obstetricians and gynecologists play an important role in trauma-informed care. Multisectoral collaboration is needed to ensure comprehensive management and long-term support for adolescent survivors. Temuan Genital Medikolegal pada Remaja dengan Dugaan Kekerasan Seksual di Daerah Terpencil: Seri Kasus Abstrak Pendahuluan: Kekerasan seksual pada remaja merupakan masalah kesehatan masyarakat di Indonesia dengan konsekuensi medikolegal dan psikososial yang bermakna. UNICEF memperkirakan lebih dari 370 juta anak perempuan di Asia pernah mengalami kekerasan seksual pada masa kanak-kanak, sedangkan Survei Nasional Indonesia tahun 2021 melaporkan prevalensi seumur hidup sebesar 6,9% pada kelompok usia muda. Remaja rentan akibat stigma dan keterbatasan akses terhadap layanan yang ramah remaja. Deskripsi temuan genital medikolegal pada remaja Indonesia masih terbatas. Laporan Kasus: Seri kasus ini melaporkan tiga remaja perempuan usia 16–18 tahun yang menjalani pemeriksaan genital medikolegal setelah dugaan kekerasan seksual. Dua pasien menunjukkan laserasi himen baru yang konsisten dengan trauma penetratif akut, sedangkan satu pasien memiliki laserasi himen yang telah sembuh. Seluruh pasien mengalami distres emosional dan mendapatkan asesmen klinis, konseling kesehatan reproduksi, serta anjuran dukungan psikologis, evaluasi infeksi menular seksual, dan tindak lanjut. Kesimpulan: Temuan genital yang normal atau telah sembuh tidak menyingkirkan kemungkinan kekerasan seksual. Dokter spesialis obstetri dan ginekologi berperan penting dalam pelayanan berbasis trauma, dengan kolaborasi multisektoral untuk menjamin penanganan komprehensif dan dukungan jangka panjang bagi penyintas remaja.