Majalah Obstetri & Ginekologi

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 neonatal outcome following pregnancy termination was preterm birth, accompanied by low birth weight and respiratory distress.
Following pregnancy termination, laboratory parameters gradually demonstrated improvement over time.
Mississippi Protocol therapy was maintained for 4 days after pregnancy termination until both clinical status and laboratory values showed improvement.

ABSTRACT

Objective: To describe the implementation of the Mississippi Protocol (MP) in a case of superimposed pre-eclampsia complicated by class 2 HELLP syndrome.

Case Report: The patient initially received conservative treatment, including anticonvulsant prophylaxis, antihypertensive agents, and high-dose cortico-steroids, in accordance with the MP. However, during observation, placental abruption and fetal distress were noted. Consequently, an emergency (green code) Caesarean section was performed. Placental abruption is a known complication associated with pre-eclampsia. The neonatal outcome following pregnancy termination was premature birth, low birth weight, and respiratory distress. Following delivery, laboratory parameters gradually improved. MP therapy was continued for 4 days post-delivery until clinical and laboratory indicators normalized. The administration of high-dose corticosteroids in HELLP syndrome is based on its characteristic excessive inflammatory response, which represents the distinctive feature of this case. Corticosteroid therapy is intended to reduce maternal morbidity and mortality and to enhance neonatal outcomes.

Conclusion: Careful monitoring and comprehensive management are essential when applying the MP in such cases. The definitive treatment for both pre-eclampsia and HELLP syndrome remains the termination of pregnancy. Further research is required to assess the effectiveness of MP in emergency or complicated scenarios.

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.

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 limited healthcare access. The WHO’s BEmONC program in Indonesia aims to reduce MMR and IMR, but its effectiveness is suboptimal due to service-related issues. This study identified factors affecting essential obstetric and neonatal service implementation in primary healthcare facilities.

Materials and Methods: A literature review was conducted using a descriptive analysis approach, supported by Mendeley and Biblioshiny in R-Studio. Sixteen peer-reviewed articles were selected from four online databases, based on predefined inclusion criteria.

Results: The study identified three critical domains for improving and evaluating the performance of BEmONC teams. These domains include optimizing team efficacy through factors such as healthcare personnel, infrastructure, collaboration, and targeted training. Furthermore, effective BEmONC management is essential, encompassing policy formulation, communication strategies, operational improvements, and robust leadership. Lastly, evaluating the implementation of BEmONC requires consideration of factors such as self-efficacy, healthcare workforce capacity, and societal trust, confidence, and recognition. Key contributors to the success of BEmONC include efficient collaboration, streamlined administration, and focused evaluation. Enhancing maternal and newborn health service delivery can be achieved by addressing infrastructure deficiencies, improving healthcare worker performance, and fostering community trust.

Conclusion: Effective teamwork, robust management, and community confidence are pivotal in improving maternal and newborn health outcomes within 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: In 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, a prevalent gynecologic malignancy affecting women, poses a significant challenge due to the development of resistance to platinum-based therapy in its management.
PAX8 and CD117 have demonstrated potential as predictive biomarkers for platinum resistance in ovarian cancer; however, studies exploring their immunohistochemical expression in relation to platinum resistance in ovarian cancer patients remain limited.
This study aims to evaluate the immunohistochemical expression of CD117 and PAX8 in ovarian cancer tissues and investigate their association with the emergence of platinum resistance.

ABSTRACT

Objective: Ovarian cancer, a prevalent gynecologic malignancy, frequently presents challenges due to platinum therapy resistance. This study aims to investigate a monitoring approach for post-operative ovarian carcinoma and evaluate the immunohistochemical expression of PAX8 and CD117 in ovarian cancer tissues, assessing their association with platinum resistance development.

Materials and Methods: Employing a cross-sectional observational analytical design, this study utilized consecutive sampling of patients meeting predefined inclusion and exclusion criteria. Tissue samples, obtained from biopsy or surgical procedures and processed into representative paraffin blocks, underwent immunohistochemical analysis at the Anatomical Pathology Department of Saiful Anwar Hospital, Malang, Indonesia. Expressions of PAX8 and CD117 were evaluated using immunohistochemistry. Diagnostic performance was assessed through receiver operating characteristic (ROC) curves and Youden index calculations to determine sensitivity and specificity.

Results: The study findings revealed that the area under the curve (AUC) for PAX8 and CD117 was 0.785 and 0.809, respectively. PAX8 expression exhibited a positive predictive value of 53.125%, negative predictive value of 87.50%, sensitivity of 18.75%, specificity of 51.85%, and accuracy of 60.0%. For CD117 expression, the corresponding values were 71.4%, 72.73%, 70%, 72.73%, and 70% for positive predictive value, negative predictive value, sensitivity, specificity, and accuracy, respectively.

Conclusion: The immunohistochemical expression of PAX8 and CD117 in ovarian cancer tissues may serve as prognostic biomarkers for platinum resistance. Despite these findings, the study acknowledges several limitations that warrant refinement 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 focused on Papua, which had the highest infant mortality rate, using a multivariate approach to analyze various factors. Data from the IDHS 2017 and robust statistical analysis were 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 critical global public health concern, with 2.4 million neonates dying within the first month of life in 2020. In Indonesia, the infant mortality rate stood at 16.85 per 1,000 live births in 2022, with Papua Province reporting the highest incidence. This study seeks to examine the determinants of infant mortality in Indonesia, with a focus on maternal age, antenatal care, immunization status, delivery conditions, parity, educational attainment, maternal employment, household income, and housing characteristics.

Materials and Methods: This study utilized a quantitative cross-sectional design, analyzing secondary data from the Indonesian Demographic and Health Survey (IDHS) 2017. The sample comprised 658 women aged 15–49 years who delivered infants aged 0–11 months between 2012 and 2017 in Papua Province. The analytical approach consisted of three phases: univariate analysis to assess frequency distributions, bivariate analysis employing logistic regression (p < 0.05) to examine associations, and multivariate analysis using multiple logistic regression for simultaneous variable assessment. Variables with p-values < 0.25 were retained, while those exceeding 0.05 were sequentially eliminated, with emphasis on Odds Ratio (OR) variations.

Results: The analysis identified maternal education level as the most significant predictor of infant mortality, demonstrating an Adjusted Odds Ratio (AOR) of 43.579 (p-value = 0.000, 95% CI = 5.549–342.235). Mothers with only basic education were 43.57 times more likely to experience infant mortality compared to those with advanced education.

Conclusions: Maternal socioeconomic factors exert a substantial influence on infant mortality in Papua Province, and these findings can guide targeted interventions to mitigate 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) involves abnormal placental adherence to the myometrium, causing severe obstetric hemorrhage and increased maternal morbidity and mortality (3,000–5,000 mL blood loss). Its global incidence has risen from 0.12% to 0.31%, linked to uterine trauma from cesarean sections or curettage. This study evaluates the association between curettage history and PAS.

Materials and Methods: This study employed an analytical observational design with a case-control approach. Purposive sampling was utilized, resulting in the inclusion of 134 participants who met the predefined criteria. The study population consisted of women who delivered and were referred to Dr. Moewardi General Hospital, Surakarta, Indonesia, between May 2022 and May 2024. Data were analyzed using IBM SPSS version 25. The Chi-square test was applied to assess the association between variables at a significance level of p < 0.05, while logistic regression analysis was conducted to identify the most influential variables.

Results: The study cohort comprised 67 patients diagnosed with PAS and 67 without PAS. A statistically significant association was observed between a history of curettage and PAS, as determined by the Chi-square test, with a p-value of 0.000. Logistic regression analysis further confirmed this association, yielding a p-value of 0.001 and an odds ratio (OR) of 5.769 (95% CI: 2.090–15.928) for a history of curettage.

Conclusion: A history of curettage is significantly associated with the development of PAS. Patients with a prior curettage procedure are 5.769 times more likely to develop PAS compared to those without such a history.

Front Matter Vol. 33 No. 1 April 2025

Majalah Obstetri & Ginekologi — 2025-04-09