Majalah Obstetri & Ginekologi

Determinants of interprofessional collaboration in implementing Basic Emergency Obstetric and Neonatal Care (BEmONC) services

Yuninda Loviana Ersianti — 2025-04-09

HIGHLIGHTS

BEmONC has been proven to diminish both newborn and mother death rates and morbidity.
The study identified three main areas for improving and assessing the determinants of interprofessional collaboration (IPC) in the implementation of BEmONC services: team performance, management, and BEmONC evaluation.

ABSTRACT

Objective: Maternal and infant mortality is a global challenge due to inadequate access to high-quality healthcare services. The WHO has implemented the BEmONC program in Indonesia to reduce MMR and IMR. Although the program is widely recognized in the country, it has been deemed suboptimal due to various healthcare service-related issues. The purpose of this study is to identify the factors that affect the execution of essential emergency obstetric and neonatal services in primary healthcare facilities.

Materials and Methods: The literature review was conducted using a descriptive analysis approach with the aid of Mendeley and Biblioshiny in R-Studio. Sixteen reputable articles were selected from four online databases based on specific inclusion criteria.

Results: The study identified three key areas for enhancing and assessing the BEmONC team. These areas involve optimizing team performance through factors such as health workers, infrastructure, teamwork, and appropriate training. Additionally, the study emphasizes the importance of effective BEmONC management, which includes policy development, communication strategies, management enhancements, and strong leadership. Finally, when evaluating the implementation of BEmONC, it is important to consider factors such as self-efficacy, the health workforce, as well as societal admiration, confidence, and trust. The primary factors contributing to the success of BEmONC were efficient cooperation, administration, and targeted assessment. Enhancing the implement-ation of maternal and newborn health services can be achieved by addressing the lack of facilities, improving the effectiveness of health workers, and fostering community admiration.

Conclusion: Effective teamwork, management, and community trust are critical to advancing maternal and newborn health outcomes in BEmONC services.

The impact of micronutrient supplementation on the outcome of In Vitro Fertilization: A comprehensive systematic review of current studies

Muhammad Raoul Taufiq Abdullah — 2025-04-09

HIGHLIGHTS

Potential benefits of vitamin D3 supplementation >20 ng/ml, along with myo-inositol, folic acid, and melatonin, on implantation rates.
Subsequent studies revealed no substantial enhancement in pregnancy rates when specific supplements were used.
Further research is needed to provide more definitive conclusions.

ABSTRACT

Objective: In vitro fertilization is the most common form of assisted reproductive and fertility technology. However, it is important to note the success rates of IVF generally decrease as a person gets older. Identifying modifiable factors affecting human fertility, including diet, is significant for clinical and community wellness. This systematic review investigates the role of micronutrients supplementation in fertility and its potential impact on in vitro fertilization (IVF) outcomes.

Materials and Methods: A systematic search in multiple databases using specific keywords related to in vitro fertilization, micronutrient supplementation, and outcome measures.

Results: Out of 1462 retrieved studies, 8 were included in the systematic review. These studies covered a range of micronutrients and their effects on different IVF outcomes. Findings indicated potential benefits of vitamin D3 supplementation. Vitamin D3 supplementation was associated with a significant improvement in implantation rates (p < 0.05) in two studies, while no significant effect was observed in clinical pregnancy rates in other micronutrients. The systematic review highlights the diverse effects of various micronutrient supplements on IVF outcomes. While some supplements showed potential benefits, others did not significantly improve pregnancy rates. Further research with larger cohorts is necessary to establish conclusive evidence. Keywords: micronutrient supplements, IVF outcomes, pregnancy rates.

Conclusion: This systematic review sheds light on the impact of micronutrients on IVF outcomes. Some studies suggested potential benefits of vitamin D3 supplementation >20 ng/ml, further research is needed to provide more definitive conclusions. Understanding the function of micronutrients in fertility could have significant implications for IVF treatment and female infertility management.

The effectiveness of pregnancy exercises for a smooth childbirth process

Thoyibatul Islami — 2025-04-09

HIGHLIGHTS

Pregnant women are prone to experiencing labor jams and tears during childbirth.
Regular pregnancy exercises during the third trimester of pregnancy can help the delivery process run smoothly and reduce the occurrence of birth canal tears.

ABSTRACT

Objective: Childbirth is the process of delivering the fetus, placenta, and membranes from the uterus through the birth canal. It requires both physical and psychological preparation to ensure a safe and smooth delivery. This study examined the effectiveness of pregnancy exercises in facilitating a smoother labor process.

Materials and Methods: This study employed a systematic review method, utilizing databases such as PubMed, ScienceDirect, ProQuest, Wiley Online Library, and EBSCO. Article selection followed the PICO framework, using keywords like "Prenatal Exercise" OR "pregnant* exercise" AND ("Length of labor" OR "stage* of childbirth") to identify relevant research.

Results: Out of 821 articles, 35 were identified as potentially relevant. Various study designs, including retrospective, observational, and experimental studies with control groups, indicated that prenatal exercise can not only facilitate a faster labor process but also accelerate postpartum involution and positively impact maternal and infant health. However, some cohort studies reported conflicting findings, showing no significant relationship between prenatal exercise and labor outcomes. These discrepancies may be attributed to factors such as maternal health status, prior childbirth experience, and the type and intensity of prenatal exercise performed.

Conclusion: The reviewed articles indicate that prenatal exercise significantly facilitates and optimizes the labor process. Therefore, it is essential to encourage pregnant women to engage in regular prenatal exercise starting in the third trimester, ensuring it is conducted safely and comfortably to maximize its benefits for both mother and baby.

The expression of immunohistochemical biomarkers PAX8 and CD117 in platinum resistant ovarian cancer at Saiful Anwar General Hospital, Malang, Indonesia

Robby Rinaldi Widodo — 2025-04-09

HIGHLIGHTS

Ovarian cancer is a gynecological disease commonly encountered by women, and resistance to platinum therapy is a significant challenge in its management
PAX8 and CD117 have shown potential as predictors of resistance in ovarian cancer. However, research on the expression of these biomarkers concerning platinum resistance in ovarian cancer patients.
The objective of this research is to assess the immunohistochemistry expression of CD117 and PAX8 in ovarian cancer and determine whether these expressions are linked to the development of platinum resistance.

ABSTRACT

Objective: Ovarian cancer is a gynecological disease commonly encountered by women, and resistance to platinum therapy is a significant challenge in its management. This study aims explore a monitoring method for post-operative ovarian carcinoma also evaluate the immunohistochemical expression of PAX8 and CD117 in ovarian cancer and identify their association with the occurrence of platinum resistance.

Materials and Methods: A cross-sectional approach to an observational analytical design, utilizing consecutive sampling which have met the inclusion and exclusion criteria. Tissue resulting from biopsy/surgical procedure which was made into a representative paraffin block was then subjected to immuno-histochemical examination in the Anatomical Pathology Department of Saiful Anwar Hospital Malang. PAX8 and CD117 expressions were analyzed using immunohistochemistry. The results of this study were assessed using ROC curves accompanied by Youden index calculation, determining sensitivity and specificity levels.

Results: In this research, the results were obtained that the area under the curve (AUC) for PAX8 and CD117 is 0.785 and 0.809, respectively. PAX8 expression demonstrates the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of 53.125%, 87.50%, 18.75%, 51.85%, and 60.0%, respectively. The expression of CD117 displays the following values: 71.4 percent, 72.73%, 70%, 72.73%, and 70% for the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy, respectively.

Conclusion: According to this study, PAX8 and CD117 immunohistochemistry expression in ovarian cancer may act as prognostic biomarkers for platinum resistance. In this study there are several limitations that can be revised in future research.

COVID-19 in pregnancy: Maternal and perinatal outcomes at Dr. Mohammad Hoesin Hospital, Palembang, Indonesia

Abarham Martadiansyah — 2025-04-09

HIGHLIGHTS

COVID-19 increases the likelihood of adverse maternal outcomes throughout pregnancy, including pneumonia, cesarean section, and ICU admission. Prompt diagnosis and treatment of COVID-19 may improve maternal outcomes.
COVID-19 does not increase the likelihood of adverse perinatal outcomes. Reassurance can be provided to expectant mothers.

ABSTRACT

Objective: The objective of this study was to analyze the maternal and perinatal outcomes of COVID-19 in pregnancy at Dr. Mohammad Hoesin Hospital, Palembang, Indonesia.

Materials and Methods: This retrospective cohort study was carried using medical records of pregnant mothers who delivered at Dr. Mohammad Hoesin Hospital Palembang from March 2020 to August 2021. The subjects were into two groups: pregnant women with and without COVID-19. Pearson Chi-Square test was used for bivariate analysis to determine the associations between COVID-19 and maternal as well as neonatal outcomes. The data were analysed using the Stata 15 statistical software. Multivariate analysis was done using the cox regression test to determine whether maternal characteristics affected those associations. P-value of < 0.05 were considered statistically significant.

Results: The study analyzed 220 subjects, including 62 COVID-19-positive (28.18%) and 158 COVID-19-negative (71.82%) patients. Among expectant mothers with COVID-19, caesarean sections were the most common maternal outcome (82.26%), while fetal distress was the most frequent perinatal outcome (12.13%). Significant associations were found between COVID-19 and maternal outcomes, including pneumonia (RR = 12.76), caesarean section (RR = 2.74), and ICU hospitalization (RR = 6.90). These associations remained significant after adjusting for maternal characteristics. However, no significant association was found between COVID-19 and perinatal outcomes.

Conclusion: COVID-19 increases the likelihood of adverse maternal outcomes throughout pregnancy.

Curcumin reduces inflammation process in mice model preeclampsia

Bambang Rahardjo — 2025-04-09

HIGHLIGHTS

Increased oxidative stress results in increased iNOS in pre-eclampsia.
COX-2 expression in the placenta of women suffering from preeclampsia increases and is associated with increased thromboxane production.

ABSTRACT

Objective: Preeclampsia is one of the most frequently documented pregnancy complications, with a prevalence of approximately 2 to 15% of all pregnancies. Preeclampsia is a leading cause of maternal mortality. According to research in Indonesia, preeclampsia accounts for 66.8% of all cases of hypertension during pregnancy. This research aims to evaluate the impact of curcumin on serum levels of COX-2 and iNOS in a mouse model of preeclampsia.

Materials and Methods: This study employed a true experimental design with a post-test-only controlled group approach using pregnant Rattus norvegicus as a preeclampsia model. Curcumin was administered orally via a feeding tube after dissolving powdered tablets. Dosages were 30 mg/day, 50 mg/day, or 100 mg/day, adjusted for the rats' weight. Serum COX-2 and iNOS levels were measured using ELISA kits from Bioassay Technology Laboratory, with concentrations reported in pg/ml. Analysis was performed using SPSS for Windows 19.0.

Results: Serum COX-2 levels showed significant differences (p < 0.05) across groups. L-NAME treatment increased COX-2 levels compared to the negative control. Curcumin (50 and 100 mg/kgBW) reduced COX-2 levels significantly compared to the positive control, with no notable differences between curcumin doses. For iNOS levels, significant differences were also found (p < 0.05). Curcumin at 100 mg/kgBW significantly lowered iNOS levels compared to the positive control, with no significant differences between other treatment groups.

Conclusion: Curcumin administration effectively reduces COX-2 and iNOS levels in the serum of Rattus norvegicus with a preeclampsia model.

The influence of maternal factors and residential building characteristics on infant mortality in Papua Province, Indonesia, based on secondary data analysis of the IDHS 2017

Septinda Ayu Prasninda Januar Putri — 2025-04-09

HIGHLIGHTS

This study focuses on Papua, which has the highest infant mortality rate, using a multivariate approach to analyze various factors. Data from the IDHS 2017 and robust statistical analysis are expected to aid in formulating effective health policies.
The uniqueness of this research lies in its broader scope of variables, including education and employment, while considering the social and cultural context of Papua, providing new insights into infant health issues.

ABSTRACT

Objective: Infant mortality remains a significant global health issue, with 2.4 million infants died before one month of age in 2020. In Indonesia, the infant mortality rate was 16.85 per 1,000 live births in 2022, with Papua Province reported the highest rate. This study aims to identify factors contributing to infant mortality in Indonesia, focusing on maternal age, antenatal care, immunization, delivery conditions, parity, education, maternal employment, income, and housing characteristics.

Materials and Methods: This study employed a quantitative cross-sectional design using secondary data from the Indonesian Demographic and Health Survey (IDHS) 2017. The sample included 658 women aged 15-49 who gave birth to infants aged 0-11 months between 2012 and 2017 in Papua Province. The analysis comprised three stages: univariate analysis for frequency distribution, bivariate analysis using logistic regression (p < 0.05) to test relationships, and multivariate analysis with multiple logistic regression for simultaneous evaluation. Variables with p values < 0.25 were included, while those > 0.05 were progressively removed, focusing on changes in Odds Ratio (OR).

Results: The analysis found that maternal education level is a dominant factor influencing infant mortality, with an Adjusted Odds Ratio (AOR) of 43.579 (p-value = 0.000, 95% CI = 5.549-342.235). Mothers with a basic education are 43.57 times more likely to experience infant mortality compared to those with higher education.

Conclusions: Maternal socioeconomic factors significantly impact infant mortality in Papua Province, and the findings can inform strategies to reduce mortality rates in the region.

Placenta Accreta Spectrum in delivered women is associated with history of curettage: A case-control study at Dr. Moewardi General Hospital, Surakarta, Indonesia

Helena Adelia Prabowo — 2025-04-09

HIGHLIGHTS

Placenta Accreta Spectrum cases rise in proportion to the high frequency of uterine wall damage.
A significant association was found between curettage history and Placenta Accreta Spectrum.

ABSTRACT

Objective: Placenta Accreta Spectrum (PAS) is a condition in which the placental villi directly adhere to the myometrium, a leading cause of serious obstetric bleeding. The situation has increased morbidity and mortality in pregnant women due to 3.000 – 5.000 mL blood loss. The incidence of PAS has risen globally from 0.12% to 0.31%, linked to frequent uterine damage from procedures like cesarean sections or curettage. This study aims to determine the association between history of curettage and PAS.

Materials and Methods: The type of research used is analytic observational with a case-control approach. The sampling technique used in this study is purposive sampling, and 134 samples match the inclusion criteria. The samples used are delivered women referred to Dr. Moewardi General Hospital, Surakarta, Indonesia, from May 2022 until May 2024. Data analysis utilizing IBM SPSS 25. Chi-square test determines the association between two variables at a significance level of p < 0.05, while logistic regression is used to determine the most influential variables.

Results: The sample consisted of 67 patients with PAS and 67 without PAS. There was a significant association between the history of curettage and PAS, as determined by a Chi-square test, with a p-value of 0.000. Further analysis using logistic regression on the history of curettage obtained a value of p = 0.001 and OR = 5.769 (CI95% 2.090 – 15.928).

Conclusion: The history of curettage is significantly associated with PAS. Patients who have had curettage in the past are 5.769 times more likely to experience PAS than patients without a history of curettage.

Front Matter Vol. 33 No. 1 April 2025

Majalah Obstetri & Ginekologi — 2025-04-09

The application of Mississippi Protocol in superimposed pre-eclampsia patients with class 2 hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome

Anak Agung Ngurah Jaya Kusuma — 2025-04-09

HIGHLIGHTS

The baby's outcome after pregnancy termination is premature, with low birth weight and respiratory distress.
After the termination of the pregnancy, laboratory parameters begin to improve over time.
Mississippi protocol therapy was continued 4 days post-termination of pregnancy until clinical and laboratory conditions improved.

ABSTRACT

Objective: To report the application of Mississippi Protocol (MP) in superimposed pre-eclampsia with class 2 HELLP syndrome.

Case Report: The patient was initially treated conservatively with anticonvulsant prophylaxis, antihypertensives and high-dose corticosteroids, according to the MP. However, during observation, there was placental abruption and fetal distress. Thus a green code Sectio Cesarea (SC) was performed. This placental abruption is one of the complications that can occur in pre-eclampsia. The baby's outcome after pregnancy termination is premature, with low birth weight and respiratory distress. After the termination of the pregnancy, laboratory parameters begin to improve over time. MP therapy was continued 4 days post-termination of pregnancy until clinical and laboratory conditions improved. The rationale for giving high doses of corticosteroids in HELLP syndrome is that the syndrome has an excessive inflammatory response is the uniqueness of this case report. Corticosteroids are expected to prevent maternal morbidity and mortality and improve fetal outcomes.

Conclusion: Monitoring and adequate management are mandatory in applying MP in patients. The definitive management of both pre-eclampsia and HELLP syndrome is the termination of pregnancy. Further study is needed to evaluate the efficacy of MP application in an emergency or complicated cases.

Back Matter Vol. 33 No. 1 April 2025

Majalah Obstetri & Ginekologi — 2025-04-09

Breaking the cycle of infertility with clomiphene citrate and letrozole for successful ovulation induction for obese women with PCOS

IGN Wiranta Permadi — 2025-04-09

HIGHLIGHTS

Polycystic ovarian syndrome (PCOS) is a hyperandrogenous state with oligo-anovulation.
Letrozole is more efficient than CC in promoting ovulation and facilitating pregnancy in women with PCOS who are overweight or obese.

ABSTRACT

Objective: Indonesia has a higher prevalence of PCOS, a common endocrine disorder that affects 4% to 8% of women who are of reproductive age. Obesity, insulin resistance, and anovulatory infertility are all linked to PCOS. The ability of letrozole and clomiphene citrate (CC) to induce ovulation in overweight or obese PCOS patients was examined in this meta-analysis.

Materials and Methods: PRISMA criteria were followed when conducting a systematic literature search utilizing PubMed, Google Scholar, Cochrane Library, and ScienceDirect. Keywords included PCOS, obesity, clomiphene, and letrozole. Studies published between 2000 and 2024 in English, with full-text accessibility, were included. The search yielded 260 studies, of which nine were selected for quantitative synthesis.

Results: Letrozole showed a 12% increase in ovulation and a 33% increase in pregnancy rates compared to clomiphene citrate (CC). There was no discernible difference in the two groups' endometrial thickness. This meta-analysis finds that letrozole is more successful than CC in triggering ovulation and achieving conception in overweight or obese PCOS patients.

Conclusion: In women with PCOS who are overweight or obese, letrozole works better than clomiphene citrate (CC) to induce ovulation. Because it is accessible and reasonably priced, CC is still the first-line treatment, even if its efficacy is lesser. As a second-line therapy, letrozole is advised for women who are resistant to or do not react to CC.