Majalah Obstetri & Ginekologi

Benefits and safety of myomectomy during cesarean section

Anak Agung Ngurah Jaya Kusuma — 2024-04-01

Uterine myoma is a tumor in the uterus that is generally benign. There are many types of uterine myomas. These tumors can grow on the outer wall of the uterus, on the uterine muscle, or it can also be on the inner wall of the uterus. The most frequent kind of uterine tumor is myoma. Uterine myoma mostly occurs in women over thirty years of age. Its prevalence ranges from 5.4% to 77%, with uterine fibroids accounting for up to 5% of pregnancies. The myomectomy procedure is an option for women who still want children but are concerned about the possibility of subsequent surgical intervention. The myomectomy cesarean section is indicated if there were complications related to the myoma in a previous pregnancy. It also avoids the possibility of repeat laparotomy for fibroid removal in the future. Myomectomy surgery should be planned based on fibroids' location, size, and quantity, using suitable imaging. Myomectomy cesarean section can be an option compared to cesarean section without myomectomy, especially if it is performed by experienced surgeons with proper hemostatic techniques and performed in tertiary-level health facilities. This study will discuss the details of the benefits and safety of myomectomy during cesarean section so that it might be considered before performing this procedure.

Kartu Skor Poedji Rochyati in the Indonesian Maternal Referral System

Jojor Sihotang — 2024-04-01

Maternal Mortality Rate (MMR) represents fatalities during pregnancy, childbirth, and the postpartum period due to complications, not external factors. Timely detection is crucial for preventing maternal deaths, necessitating integrated planning. The "Kartu Skor Poedji Rochjati" (KSPR) emerges as a vital tool for identifying high-risk pregnancies, facilitating urgent referrals to mitigate complications and enhance healthcare. A literature review on maternal mortality, risk assessment tools, and KSPR effectiveness will be conducted to address the issues. The findings are expected to highlight KSPR's pivotal role in identifying at-risk pregnant women, enabling prompt referrals, and reducing maternal mortality rates. Case studies and data analysis will enrich our understanding of the tool's impact on maternal healthcare. The apex of public health involves embracing health-conscious lifestyles, reflected in indicators like mortality and morbidity. Proactively identifying high-risk pregnancies using KSPR is a strategic step in averting maternal mortality. Leveraging KSPR allows early intervention, reducing complications and contributing to enhanced maternal health, aligning with the goal of minimizing mortality risks.

Back Matter Vol. 32 No. 1 April 2024

Majalah Obstetri & Ginekologi — 2024-04-01

The impact of complementary therapies on dysmenorrhea in young women

Tammimin Ummah — 2024-04-01

HIGHLIGHTS

Complementary treatments have been shown to greatly reduce the intesity of dysminorrhea pain.
The use of medicinal plants, herbal concoctions, or compresses might reduce dysmenorrhea discomfort more effectively than taking medications like mefenamic acid, ibuprofen, piroxicam, etc.

ABSTRACT

Objective: The study's objective was to obtain latest data on alternative therapy for dysmenorrhea in adolescent females of reproductive age.

Materials and Methods: A scoping review was conducted using the PRISMA ScR protocol. A search was conducted on PubMed, Science Direct, and Wiley, yielding 848 studies. Ten literature studies were identified that satisfied the criteria for population, exposure, and outcome. The studies also incorporated inclusion criteria, focusing on women of reproductive age who had dysmenorrhea.

Results: Out of 848 articles, 32 were considered potentially relevant and met the inclusion criteria. The articles indicated that teenagers commonly used warm compresses and herbal drinks as supplementary therapies to alleviate dys-menorrhea due to their perceived effectiveness and comfort. Other complement-ary therapies for the condition included massage, relaxation, herbal products, self-care practices, acupuncture, and therapeutic methods.

Conclusion: Herbal and warm water compress are the most commonly applied alternative therapies for treating dysmenorrhea.

A case of vaginal varicosities without rupture after vaginal delivery

Eunike Jennifer Tandiono — 2024-04-01

HIGHLIGHTS

Vaginal varicosities are prone to happen in pregnant women with unspecific causes and multifactorial.
The mode of delivery in a pregnant woman with vaginal varicosities is still unknown, but it is not an indication of caesarean section.

ABSTRACT

Objective: Vaginal varicose is a rare condition characterized by dilated veins in the labia majora, labia minora, and vagina. This case report reported a woman with vaginal varicose who experienced labor without any delivery complications.

Case Report: The patient, a 29-year-old woman, gravida 3, para 2, presented with discomfort and swelling in the vagina at 32 weeks of gestational age. Despite reaching 39 weeks of gestation, the vaginal varicosities remained stable and painless. She had no prior history of varicose veins, hypertension, blood abnormalities, malignancy, or contraception usage. Physical examination revealed mild varicosities in the labium and significantly swollen varicosities protruding toward the vaginal introitus. Interestingly, a small varicose vein was also noted on her right leg, previously unnoticed by the patient. At 39 weeks pregnant, she experienced spontaneous vaginal delivery without complications. During the third stage of labor, the vaginal varicosities decreased in size, and no rupture occurred. The newborn, a healthy baby boy weighing 2961 grams and measuring 48 cm, was delivered vaginally. Despite a second-degree perineal tear, blood loss was minimal, and no complications nor rupture arose from the varicose veins.

Conclusion: Vaginal varicosities are rare, primarily occurring in multigravida pregnant women between 12 and 26 weeks of gestation. This case highlights that cesarean section is not necessarily indicated in pregnant women with vaginal varicosities. The successful vaginal delivery in this instance resulted in no varicose vein rupture, controlled bleeding, and regression of vaginal varicosities postpartum.

Early diagnosis and appropriate management of vaginal leiomyoma in rural areas

Ihya Ridlo Nizomy — 2024-04-01

HIGHLIGHTS

Extrauterine leiomyoma, including vaginal leiomyoma, is an exceedingly rare condition with complex pathogenesis and management
Clinical evaluation and high-quality imaging are required to confirm the diagnosis of vaginal tumor. If there are insufficient facilities, referrals must be made.
Operative management using vaginal approach was described for treating vaginal leiomyoma.

ABSTRACT

Objective: To describe the challenges of early diagnosis and appropriate management of vaginal leiomyoma in rural areas.

Case Report: A 26-year-old woman, P1A0, was referred from a rural hospital and presented a chief complaint of vaginal mass. The patient was admitted to the tertiary hospital with suspected malignant vaginal tumor and underwent a biopsy, which revealed leiomyoma on pathological examination. Despite conservative treatment, the mass continued to grow, unaffected by the menstrual cycle, causing discomfort. Following a second hospital admission, the patient underwent surgical management of extirpation and vaginal reconstruction. The microscopic finding of the tumor showed myositis cell proliferation with hyperplastic growth, monotonous nuclei, and variable cell shapes, supporting the diagnosis of vaginal leiomyoma. During postoperative monitoring, there was no vaginal bleeding. Thereafter, on the day following surgery, it was found that the right labium major was swollen. This was treated with anticoagulants, topical NSAIDs, and a sitz bath. The patient was discharged from the hospital in good condition and had an uneventful postoperative recovery.

Conclusion: Although the incidence of vaginal leiomyoma is uncommon, precise early diagnosis and appropriate management might improve outcomes, particularly in rural areas.

Early diagnosis and management of inseparable conjoint twins. A low-middle-income country experience

Aditiawarman — 2024-04-01

HIGHLIGHTS

Conjoined twins have captivated mankind for centuries due to the rarity of this birth type; nonetheless, physicians have constantly encountered difficulties in dealing with conjoined twins.
Early diagnosis of conjoined twins during prenatal examination is critical for ascertaining the prognosis of the fetus, guiding parental counseling over appropriate courses of action, and potentially enabling the termination of the pregnancy.
First-trimester ultrasonography and MRI are complementary modalities in determining the diagnosis and prognosis of conjoined twins in early pregnancy.

ABSTRACT

Objectives: To discuss the crucial early diagnosis of conjoined twins to determine the type and prognosis.

Case Report: A 27-year-old woman was referred to the type A referral hospital with suspicion of congenital abnormalities at 17 weeks of pregnancy. Ultrasound results showed intrauterine monochorionic monoamniotic twins with babies fused on their heads to the urogenital part. The MRI showed a craniopagus, suspected meningomyelocele, and severe bilateral hydronephrosis in the second baby. Due to non-separable cases and a bad prognosis for the fetus, the pregnancy was terminated using misoprostol induction and inserting a balloon catheter. The fetus is born weighing 400 g and 20 cm in length. Conjoined twins obtained the rostral type: a fused head with two faces, a fused thorax until the lower abdomen with one umbilicus, and two pairs of hands and feet. The diagnosis of conjoint twins becomes a problem in early pregnancy, mostly in developing countries. Early diagnosis of conjoined twins during prenatal examination is critical for ascertaining the prognosis of the fetus, guiding parental counseling over appropriate courses of action, and potentially enabling the termination of the pregnancy to prevent maternal stress and complications.

Conclusion: Conjoined twins should be identified as soon as feasible to establish the best course of management for both mother and fetus. Ultrasonography and MRI are modalities for determining the diagnosis and prognosis of conjoined twins.

Jackfruit seeds milk administration increased hemoglobin levels in third trimester pregnant women at Bangetayu Health Center, Semarang, Indonesia

Arum Meiranny — 2024-04-01

HIGHLIGHTS

Pregnant women are prone to suffer from anemia.
Jackfruit seeds milk can be consumed as a non-pharmacological treatment to prevent and overcome anemia in pregnant women.

ABSTRACT

Objective: This study aimed to investigate the impact of administering jackfruit seeds milk on hemoglobin levels in third trimester pregnant women at Bangetayu Health Center in Semarang, Indonesia.

Materials and Methods: This study utilized a quasi-experimental approach with pre- and post-test control groups. The study included a sample of 35 out of 107 third trimester pregnant women from the Bangetayu Health Center in Semarang, Indonesia. The study was conducted between January and February 2022. The research sample comprised 35 respondents, divided into 17 control groups and 18 intervention groups. Purposive sampling was utilized as the sample technique. Data analysis involved both univariate and bivariate analysis techniques. The analysis involved utilizing chi-square test and independent t-test. This study utilized the SPSS software version 23 for data analysis.

Results: The intervention group had an average hemoglobin level of 10.2 g/dL before treatment and 10.7 g/dL after therapy. The average hemoglobin level in the control group increased from 12.1 g/dL before to 12.4 g/dL after. The results indicated a p-value of 0.000 and a Relative Risk (RR) of 1.2.

Conclusion: The consumption of jackfruit seed milk had an effect on the hemoglobin levels of third-trimester pregnant women at the health center in Bangetayu, Semarang, Indonesia. Failure to consume jackfruit seed milk results in 1.2 times decrease in the likelihood of boosting hemoglobin levels.

Nano-curcumin in the decrease of proteinuria in white rats (Rattus norvegicus) with preeclampsia

Subandi — 2024-04-01

HIGHLIGHTS

The size of curcumin was modified to nano scale in order to enhance its bioavailability and facilitate its absorption in the body.
As a herbal medicine, nano-curcumin has the ability to reduce proteinuria and serve as a preventive measure against preeclampsia.

ABSTRACT

Objective: Since preeclampsia is one of the most serious hypertensive disorders in pregnancy, as it occurs in 5-7% of all pregnancies, and causes around 70,000 maternal deaths and 500,000 fetal deaths worldwide each year, this study aimed to determine the effect of nano-curcumin on proteinuria in pregnant white rats (Rattus norvegicus) with preeclampsia.

Materials and Methods: In this study, 24 white rats (Rattus norvegicus) were randomly selected and divided into six groups. Inclusion criteria included healthy rats aged 8 weeks or older, with normal blood pressure and weight, while exclusion criteria included sick, deceased, or prematurely birthing rats, and those with high blood pressure. Treatment, administered over six days from gestational days 13-18, involved L-NAME and nano-curcumin injections. Groups included K- (no treatment) and K+, P1, P2, P3, and P4 (treated with L-NAME and varying nano-curcumin doses). Blood pressure and proteinuria were evaluated on gestation days 12, 15, and 19 to confirm the preeclampsia model and assess nano-curcumin's effect on proteinuria. Urine collected over 24 hours in metabolic cages preceded rat termination. Data analysis utilized IBM SPSS version 23, including the Shapiro-Wilk test, parametric independent sample t-tests, One-Way ANOVA tests, and LSD post-hoc tests to identify group differences.

Results: The results of this study showed that nano-curcumin had the effect of reducing proteinuria in white rats with preeclampsia. The significant results of the One-Way Anova test was p=0.001 <0.05 and the LSD post-hoc test revealed that an effective dose was 25 mg/ml. It was found that higher nano-curcumin dose had a higher average of proteinuria.

Conclusion: Nano-curcumin can affect proteinuria in preeclampsia. The most effective dose is 25 mg/ml.

Moringa oleifera extract affects the diameter of the Graafian follicles in female Mus musculus

Amiruddin — 2024-04-01

HIGHLIGHTS

This study unveils a dose-dependent relationship between Moringa leaf extract and increased Graafian follicle size in female mice.
The significant positive effect of Moringa leaf extract on Graafian follicles suggests promising implications for fertility interventions, offering hope for individuals seeking natural treatment to address infertility challenges.

ABSTRACT

Objective: This study aimed to determine the effect of Moringa leaf extract (Moringa oleifera Lam.) on the diameter of Graafian follicles in female mice (Mus musculus).

Materials and Methods: This study used experimental design, employing a cohort of 24 female mice of 20-25 grams in weight, aged between 2-3 months, and in good health. These subjects were divided into three treatment groups and subjected to oral doses of Moringa leaf extract at 300 mg/kg BW, 400 mg/kg BW, and 500 mg/kg BW over a 14-day period. The study procedures involved the preparation of the experimental animals, preparation of Moringa leaf extract, treatments administration, and the preparation of histological specimens. Subsequently, the diameters of Graafian follicles within each treatment group were measured. Data analysis were performed using the ANOVA test (p <0.05) followed with the Least Significance Difference (LSD) test utilizing the IBM SPSS software.

Results: There were variations in Graafian follicle diameters across the experimental groups. The average diameters were 180.944 µm in the control group, 239.942 µm in treatment group 1, 315.006 µm in treatment group 2, and 396.650 µm in treatment group 3. This indicated that dose administration starting from 300 mg/kg, 400 mg/kg, and 500 mg/kg had an effect on the size of the follicle and antrum diameter. The number of granulosa cells was found to increase, as well as the size of the ovum.

Conclusion: Moringa leaf extract in different doses has a significant positive effect on increasing the diameter of the Graafian follicles in female mice.

Level of knowledge on preeclampsia following health education through a WhatsApp group

Anggi Wilis Prihazty — 2024-04-01

HIGHLIGHTS

WhatsApp groups can effectively overcome the constraints of antenatal care in delivering health education to pregnant women.
The scope of health information about pregnancy should be expanded as this study has shown that it enhances their level of knowledge.

ABSTRACT

Objective: Hypertension in pregnancy, including preeclampsia, is the third most common cause of maternal mortality in Indonesia; one of the problems is low preeclampsia knowledge in the community. WhatsApp, as a social media platform, could facilitate spearheading promotive and preventive efforts, especially for high-risk mothers in the community. This study aimed to analyze the difference in levels of knowledge after receiving education through WhatsApp groups.

Materials and Methods: This was a pre-experimental study using one group pre-test and one post-test design. The sample size was 58 high-risk pregnant women in one of the Public Health Centers in Surabaya. Respondents completed a preeclampsia knowledge questionnaire before and after receiving health education via WhatsApp group for 12 days. The results were analyzed using the Wilcoxon signed rank test, Mann-Whitney U-Test, and Kruskal Wallis test.

Results: Most respondents had good knowledge about preeclampsia before and improved after intervention. All respondents had a difference in knowledge before and after the intervention (p <0.001). The only factor that showed a difference in the initial knowledge level about preeclampsia was previous exposure to preeclampsia information (p=0.014).

Conclusion: Health education through WhatsApp groups can be considered to be provided as it has been proven effective in increasing the knowledge among high-risk pregnant women about preeclampsia. as it has been proven effective in increasing the knowledge among high-risk pregnant women about preeclampsia.

Front Matter Vol. 31 No. 1 April 2024

Majalah Obstetri & Ginekologi — 2024-04-01