Majalah Obstetri & Ginekologi

Blood Pressure Variability as a predictor of maternal and neonatal outcomes in preeclampsia

Ryan Saktika Mulyana — 2025-11-26

HIGHLIGHTS

Increased blood pressure variability (BPV) in preeclampsia is associated with a higher risk of maternal complications, such as prolonged hospitalization and eclampsia, as well as neonatal complications, including low birth weight and the need for NICU admission.
Incorporating BPV monitoring into routine prenatal care may improve early detection of high-risk cases, allowing for timely interventions to reduce adverse maternal and neonatal outcomes.

ABSTRACT

Objective: Preeclampsia remains a major cause of maternal and perinatal morbidity and mortality worldwide. This study aimed to evaluate the impact of blood pressure variability (BPV) on maternal and neonatal outcomes in preeclamptic patients, emphasizing its potential role in clinical management.

Materials and Methods: A retrospective cohort study was conducted on 40 preeclamptic patients treated at Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, between January 2020 and December 2022. BPV was determined from serial systolic and diastolic blood pressure measurements during antenatal care. Maternal outcomes included length of hospitalization, preterm birth, premature rupture of membranes, eclampsia, postpartum hemorrhage, ICU admission, and composite adverse events. Neonatal outcomes included birth weight, Apgar scores, NICU admission, stillbirth, congenital anomalies, and neonatal death. Statistical analyses were performed using bivariate and multivariate logistic regression methods, with variables of p < 0.25 included in final models.

Results: High BPV was significantly associated with increased maternal adverse events (adjusted OR 13.66; 95% CI 2.26–82.43; p = 0.004) and neonatal adverse outcomes (p = 0.011). Specifically, it correlated with low birth weight (p < 0.001), shorter birth length (p = 0.003), preterm birth (p = 0.003), and higher NICU admission rates (p = 0.005). No significant association was observed with fetal distress, intrauterine growth restriction, or neonatal death. The study achieved a statistical power of 86.7%.

Conclusion:Increased BPV in preeclampsia is strongly linked to adverse maternal and neonatal outcomes. Routine BPV monitoring may serve as an important tool for early risk identification and improved obstetric management.

Comparative analysis of stromal inflammatory cell infiltration and HPV infection status in cervical dysplasia and squamous cell carcinoma using the Klintrup-Mäkinen Scoring method

Nicholas Adrian Fahendra — 2025-11-26

HIGHLIGHTS

KM score is a reliable method to help determine the diagnosis of cervical dysplasia and squamous cell carcinoma.
KM score cannot be used to differentiate infection status in cervical dysplasia and squamous cell carcinoma.

ABSTRACT

Objective: Cervical cancer is the second most common malignancy in women, with 604,127 new cases reported globally in 2020. Persistent high-risk human papillomavirus (HPV) infection is the primary cause. This study aimed to evaluate the relationship between stromal inflammatory cell infiltration using the Klintrup-Mäkinen (KM) score and HPV infection status in cervical dysplasia and squamous cell carcinoma (SCC).

Materials and Methods: A cross-sectional study was conducted using secondary data from formalin-fixed paraffin-embedded (FFPE) cervical tissue samples diagnosed as dysplasia or SCC at Atma Jaya Catholic University of Indonesia from 2014 to 2022. HPV status was determined using PCR-based assays, while stromal inflammatory cell infiltration was assessed microscopically at 100× magnification and graded according to the KM scoring system by two blinded observers. Statistical analyses, including Chi-square and Spearman’s correlation tests, were performed using STATA/IC 15, with p < 0.05 considered significant.

Results: A total of 38 samples were analyzed, comprising 20 (52.63%) cases of dysplasia and 18 (47.37%) cases of SCC. HPV positivity was identified in 70% of dysplasia and 94.44% of SCC cases. KM scores of 2/3, indicating moderate to severe inflammatory infiltration, were significantly more frequent in SCC (77.78%) compared to dysplasia (20%), showing a strong association with pathological diagnosis (p = 0.0019). However, no significant correlation was observed between KM score and HPV status in either lesion type.

Conclusion: The KM scoring method provides a reliable and cost-effective approach for assessing stromal inflammatory cell infiltration in cervical lesions, aiding histopathological diagnosis, although it does not predict HPV infection status.

Ethanol extract of Cyclea barbata Miers induces follicle development through 17ß-estradiol level and LHR expression

Noviyanti Noviyanti — 2025-11-26

HIGHLIGHTS

Docking analysis revealed that there are four novel compounds in barbata, including Zearalenone, Bis(2-ethylhexyl) phthalate, Benzanthrone, and Octytldecyl phthalate have stronger affinity -9.7; -9.6; -9,2; and -7.7 kcal/mol, respectively.
The extract of barbata leaves increased follicle development (75%) by elevating estrogen levels and LHR expression at all doses.

ABSTRACT

Objective: Infertility, often linked to anovulation from impaired follicular maturation, affects millions globally. Cyclea barbata Miers, a plant with estrogen-like properties, may enhance follicle development through hormonal modulation. This study evaluated the ethanol extract of C. barbata leaves for its ability to promote in vitro follicle development by increasing 17ß-estradiol levels and luteinizing hormone receptor (LHR) expression.

Materials and Methods: Molecular docking analysis identified four novel compounds in C. barbata—Zearalenone, Bis(2-ethylhexyl) phthalate, Benzanthrone, and Octyl decyl phthalate—with binding affinities of -9.7, -9.6, -9.2, and -7.7 kcal/mol to estrogen receptor alpha (ESRa). Secondary follicles (2-3 mm) from goat ovaries were cultured in vitro using TCM-199 medium supplemented with 10% FBS, PMSG, hCG, and C. barbata extract at 25, 50, or 100 ppm for six days. Follicle maturation was assessed via microscopy for size, cumulus-oocyte complex formation, and polar body extrusion. 17ß-estradiol levels and LHR expression were analyzed using one-way ANOVA and LSD tests.

Results: The 100 ppm dose achieved 75% follicle maturation, significantly higher than 25% at lower doses and controls. It increased 17ß-estradiol levels (36.83 ± 2.33 pg/mL, p < 0.000) and LHR expression (261.874 ± 54.606, p < 0.000), with dose-dependent effects confirmed by statistical analysis.

Conclusion: C. barbata extract at 100 ppm enhances follicular maturation by elevating 17ß-estradiol and LHR expression, likely due to its estrogenic compounds. Further in vivo and clinical studies are needed to confirm its therapeutic potential for ovulatory disorders.

Maternal profiles and outcome of Placenta Accreta Spectrum (PAS) in a retrospective cohort study in Dr. Saiful Anwar General Hospital, Malang, Indonesia

Bambang Rahardjo — 2025-11-26

HIGHLIGHTS

This study compares maternal characteristics and outcomes between PAS and non-PAS patients, including analysis using the Placenta Accreta Index.
PAS is associated with significantly higher intraoperative blood loss and postoperative ICU admission rates.
Findings underscore the importance of early identification and PAI-based risk stratification to optimize surgical planning and maternal outcomes.

ABSTRACT

Objective: This study aims to investigate maternal risk factors associated with PAS among patients at Dr. Saiful Anwar Regional General Hospital in Malang.

Materials and Methods: This retrospective cohort study was conducted at RSUD Dr. Saiful Anwar Malang, analyzing medical records of patients diagnosed with Placenta Accreta Spectrum (PAS) from January 2023 to August 2024. Patients were categorized into PAS and non-PAS groups, with further classification of PAS patients based on their Placenta Accreta Index (PAI) score (<5 and ≥5) to compare clinical outcomes. A total of 47 eligible patients were included based on gestational age ≥28 weeks, clinical suspicion of PAS, and histopathological confirmation. Demographic, clinical, intraoperative, and postoperative data were collected and analyzed. Data were analyzed using SPSS 27.0. Ethical approval was obtained from the RSUD Dr. Saiful Anwar Ethics Committee.

Results: Patients with PAI scores ≥5 had higher intraoperative blood loss (3467.50 ± 2520.35 mL) compared to those with PAI scores <5 (2212.50 ± 1055.32 mL, p=0.764). Hysterectomy was the primary surgical approach in both groups (PAI <5: 88.88%, PAI <5: 92.75%, p=0.667). Bladder trauma (AAST grade IV) occurred in 100% of patients with PAI <5, whereas bladder infiltration was observed only in the PAI ≥5 group (p=0.117). NICU admission was more frequent in the PAI ≥5 group (31.25% vs. 0%, p=0.061). ICU admission was required in all PAI <5 patients (100%) and 75% of PAI <5 patients (p=0.102). No statistically significant associations were found.

Conclusion: Higher PAI score may indicate a more complex clinical course, further research with larger sample sizes is necessary to validate its predictive value.

Gestational weight gain as a factor associated with urinary incontinence and quality of life

Rizka Aulia — 2025-11-26

HIGHLIGHTS

There is a correlation between maternal weight gain and urinary incontinence, an increase in weight during pregnancy may raise the risk of urinary incontinence.
Urinary incontinence correlates with poorer quality of life in pregnant women and has the potential to affect their well-being negatively.

ABSTRACT

Objective: Urinary incontinence (UI) frequently occurs in pregnancy, primarily caused by increased intra-abdominal pressure. If left unmanaged, UI can lead to both physical and psychological discomfort, potentially reducing a pregnant woman’s quality of life. This research aims to examine the relationship between gestational weight gain and the occurrence of urinary incontinence, along with its effects on quality of life.

Materials and Methods: A cross-sectional study was carried out among 50 pregnant women in their third trimester residing within the catchment area of Lebaksiu Primary Health Care, Tegal Regency, Central Java. Pre-pregnancy weight was extracted from the Handbook of Maternal and Child Health (MCH), while current weight was measured directly. measured using the validated Indonesian version of the ICIQ-UI SF questionnaire, while quality of life was assessed with the Indonesian version of the WHOQOL-BREF. Both instruments were administered through face-to-face interviews. Correlation was tested using Spearman’s rank correlation, with statistical significance set at p<0.05.

Results: The results showed a statistically significant positive correlation between maternal weight gain and the incidence of urinary incontinence (p=0.001; r=0.462), and a significant negative correlation between urinary incontinence and quality of life (p=0.000; r=-0.614). 70% of pregnant women experience urinary incontinence, and 46% report a decreased quality of life.

Conclusion: These findings suggest that greater maternal weight gain is associated with a higher risk of UI, and that UI negatively affects pregnant women’s quality of life. Integrating educational programs and policies that emphasize the importance of maintaining an ideal body weight during pregnancy may help prevent UI and improve the overall quality of life for pregnant women.

Reinterpreting potential biomarker in umbilical cord as a marker of chorioamnionitis and funisitis in prelabor ROM

Julian Dewantiningrum — 2025-11-26

HIGHLIGHTS

HsCRP and IL-6 levels in umbilical cord blood serve as reliable early biomarkers of chorioamnionitis and funisitis in prelabor ROM, enabling more accurate neonatal sepsis risk assessment and targeted clinical intervention.
Early identification of amnionitis and funisitis through hsCRP and IL-6 measurements guides timely clinical decisions, including prompt antibiotics or intensified monitoring, thereby reducing severe neonatal complications.

ABSTRACT

Objective: Prelabor rupture of membranes (ROM) occurs in approximately 1% of all pregnancies and 30% of all preterm births, and the etiology remains unclear. Prelabor ROM is associated with a high incidence of funisitis and chorioamnionitis leading to neonatal sepsis. This study aimed to assess whether hsCRP, procalcitonin, and IL-6 level in umbilical cord as indicators for identifying pregnancies at risk for these complications.

Materials and Methods: This research used cross sectional design conducted in dr.Kariadi hospital. Inclusion criteria were pregnant woman with 28-42 weeks of gestational age, singleton and prelabor ROM. Exclusion criteria included other comorbidities. The participants were divided into two groups: with and without funisitis-chorioamnionitis, which were detected using histopathologic examination. Statistical analysis was performed using the chi-square, t-test/Mann-Whitney between two group, wit statistically significant set at p<0.05.

Results: A total of 88 pregnant women were included in the study, consisting of 23 pregnant women with chorioamnionitis-funisitis and 65 pregnant women without funisitis-chorioamnionitis. Procalcitonin levels in the group with and without chorioamnionitis-funisitis were 0.88±0.6 vs 1.06±0.46 ug/mL (p=0.07). IL-6 levels in the chorioamnionitis-funisitis were 54.41(9.34-445.9) vs 2.83(0.09-454.82) pg/mL in without chorioamnionitis-funisitis (p<0.001). HsCRP levels in the funisitis-chorioamnionitis compared to those without chorioamnionitis-funisitis group were 1.39(0.07-10.5) vs 0.17(0.03-10.5) mg/L (p<0.001).

Conclusion: Elevated levels of hsCRP and IL-6 in the umbilical cord were found to be significant biomarkers for chorioamnionitis and funisitis in prelabor rupture of membranes. These biomarkers could be useful in identifying pregnant women at high risk for these complications, enabling better clinical management.

Molecular mechanisms and biomarkers of autophagy in early onset preeclampsia: Key genes, pathways, and potential diagnostic/therapeutic targets

Anak Agung Ngurah Jaya Kusuma — 2025-11-26

HIGHLIGHTS

Dysregulated autophagy in trophoblasts contributes to abnormal placentation and impaired spiral artery remodeling in early-onset preeclampsia.
Oxidative stress and excessive mitochondrial ROS disrupt the autophagic balance, leading to cellular dysfunction and placental ischemia.
Key autophagy-related genes (e.g., BECN1, LC3, ATG5, mTOR, TFEB) may serve as diagnostic or therapeutic targets in early-onset PE.
Understanding the autophagy–oxidative stress interaction could inform biomarker development and novel interventions.

ABSTRACT

The pathogenesis of preeclampsia (PE) remains incompletely understood, with multiple mechanisms proposed. Among these, dysregulation of autophagy has emerged as a critical factor. Autophagy is essential for implantation, placental development, and pregnancy maintenance. Extravillous trophoblasts (EVTs) invade the decidua and proximal myometrium under hypoxic conditions, and autophagy supports this invasive process. In PE, impaired placentation has been associated with abnormal autophagic activity in trophoblastic cells. Furthermore, oxidative stress and excessive mitochondrial reactive oxygen species (ROS) production contribute to the pathophysiology of PE, potentially driving both insufficient and maladaptive upregulation of autophagy depending on the cellular microenvironment. Thus, PE is characterized not by a uniform increase or inhibition, but rather by disrupted autophagic balance. This review aims to clarify the role of autophagy dysregulation in the pathogenesis of PE.

Back Matter Vol. 33 No. 3 December 2025

Majalah Obstetri & Ginekologi — 2025-11-26

Vesicovaginal fistula with surgical interventions at Dr. Ramelan Naval Hospital, Surabaya, Indonesia

Sahika Nisandi Ayudelvi — 2025-11-26

HIGHLIGHTS

Vesicovaginal fistula (VVF) cases were primarily caused by hysterectomy, post-caesarean section surgery, and radiation therapy for cervical cancer. Symptoms experienced by patients included urine leakage from the vagina, foul odor, and pain during urination.
The success rate of fistula repair using cystography and fistula repair procedures was very high. Patients were able to urinate normally without pain or vaginal leakage.

ABSTRACT

Objective: Evaluating the risk factors and outcoumes of surgical interventions in patients with vesicovaginal fistula at Dr. Ramelan Naval Hospital Surabaya, from January 2019 to December 2023.

Case Series: There were 6 cases of vesicovaginal fistula that underwent surgical interventions at Dr. Ramelan Naval Hospital Surabaya from 2019 to 2023 that met the inclusion criteria. The majority of vesicovaginal fistula cases occurred as a result of hysterectomy, accounting for 4 cases (67%), followed by caesarean section surgery (16%) and radiation therapy for cervical cancer (17%). Symptoms experienced by the patients included urine leakage from the vagina, foul odor, and pain during urination. The vesicovaginal fistulas that underwent surgical interventions were typically 0.5 to 3 cm in size. Most of the cases involved simple-type fistulas. A total of 5 cases (83%) were successfully repaired. These patients were able to urinate normally, without pain or vaginal leakage. However, 1 case (17%) experienced recurrent fistula with an increase in the number of fistulas and continued to experience pain during urination and leakage from the vagina, particularly during strenuous activities.

Conclusion: The vesicovaginal fistula cases at Dr. Ramelan Naval Hospital Surabaya from 2019 to 2023 showed a high therapeutic success rate. Among 6 patients that we studied, the majority of cases were caused by hysterectomy, characterized as simple-type fistulas, with 83% of the cases successfully repaired.

Front Matter Vol. 33 No. 3 December 2025

Majalah Obstetri & Ginekologi — 2025-11-26

Perinatal exposure to ultraprocessed foods and its impact on maternal gut dysbiosis, placental inflammation, and neonatal immune programming: A systematic review

I Nyoman Hariyasa Sanjaya — 2025-11-26

HIGHLIGHTS

Perinatal ultraprocessed food (UPF) exposure disrupts maternal gut microbiota composition, increasing pro‑inflammatory taxa and systemic endotoxemia.
Placental immune activation and oxidative stress represent key mediators linking maternal diet to fetal immune and metabolic programming.
Neonatal outcomes include altered regulatory T‑cell development, Th2 immune skewing, allergic sensitization, and early metabolic risk.
Integrated dietary counseling, microbiota‑targeted interventions, and public health policies are urgently needed to mitigate transgenerational immune health risks.

ABSTRACT

Objective: To synthesize and critically evaluate evidence linking perinatal exposure to ultraprocessed foods (UPFs) with maternal gut dysbiosis, placental inflammation, and neonatal immune programming, and to identify translational implications for perinatal care.

Materials and Methods: A systematic narrative review was conducted following PRISMA 2020 guidelines, without PROSPERO registration. Literature searches of major databases (2000–March 2025) identified 1,845 records. After screening and eligibility assessment, 20 studies were included. Study quality was appraised using validated tools, and data were synthesized thematically into evidence domains covering maternal microbiota, inflammatory pathways, placental changes, and neonatal immune outcomes.

Results: Maternal UPF consumption was associated with gut dysbiosis characterized by reduced microbial diversity, increased pro-inflammatory taxa, and systemic endotoxemia. Elevated inflammatory biomarkers including lipopolysaccharide, interleukin‑6, tumor necrosis factor‑a, and C‑reactive protein were frequently reported. Limited placental studies revealed increased innate immune activation and oxidative stress. Neonatal immune alterations included regulatory T cell suppression, T helper 2 skewing, increased allergic sensitization, and metabolic programming changes. Evidence strength was highest for maternal gut dysbiosis and immune programming but limited for direct placental mechanisms. Translational opportunities include dietary counseling, microbiota-targeted interventions, and public health strategies aimed at improving maternal diet quality.

Conclusion: Perinatal exposure to UPFs adversely impacts the maternal gut–placenta–fetal immune axis. Integrated dietary interventions and population-level nutrition policies are urgently needed to mitigate downstream transgenerational immune risk.

Exploring the role of healthcare providers in supporting women after pregnancy loss: A scoping review

Rafhani Rosyidah — 2025-11-26

HIGHLIGHTS

The study examines healthcare providers’ roles in delivering holistic physical, emotional, and psychosocial support to women after pregnancy loss.
The findings identify major provider barriers—limited training, institutional constraints, and emotional burden—and recommend improved training, clearer guidelines, and stronger support systems.

ABSTRACT

Objective: Pregnancy loss is a complex emotional experience with a significant impact on women's physical and psychosocial health. This study aimed to explore the role of health workers in supporting women after pregnancy loss, focusing on their physical, emotional, and psychosocial needs, as well as the barriers faced by health workers.

Materials and Methods: A systematic search was conducted on six electronic databases, namely PubMed, Science Direct, Springer, ProQuest, Sage Journals, and EBSCOhost, using keywords related to pregnancy support, pregnancy loss, and challenges faced by health workers. Articles published within the last 10 years (2014-2024) were selected for this review. The selection process followed PRISMA guidelines, starting with the identification of 383 articles, followed by the removal of duplicates and screening of titles and abstracts. After the eligibility assessment stage, five articles were selected that met the inclusion criteria. Data extraction and synthesis: Data were systematically extracted using tables that included study purpose, design, participants, type of pregnancy loss, and key findings. The results of the analysis mapped the physical, emotional, and psychosocial support provided by health workers and the barriers affecting the quality of that support.

Results: Integrating physical, emotional, and psychosocial care is crucial to improve outcomes for women experiencing pregnancy loss. Addressing challenges faced by healthcare providers will enhance service quality and patient support.

Conclusions: Holistic support that includes physical, emotional and psychosocial aspects is essential in helping women to cope with pregnancy loss. However, barriers such as lack of training and institutional support affect the effectiveness of care. This review recommends strengthening formal training, developing structured guidelines, and improving support systems for health workers to enhance the quality of care and professional well-being.