Impact of COVID-19 Pandemic on Postpartum Contraceptives Method Choice (IUD vs Tubectomy) and Characteristic Aspects: A Retrospective Descriptive Study

Objective: This study aims to assess the impact of the COVID-19 pandemic on postpartum contraceptive methods. Methods: This retrospective descriptive study was conducted at a single secondary center, utilizing secondary data retrieved from medical records at the Inpatient Installation of Sebelas Maret University Hospital, Surakarta, covering the period from January 2020 to January 2022. Results: Among users of intra-uterine devices (IUDs), 85% were below 35 years old, 65% were primiparous, 67% had a history of previous injectable contraceptive use, 79% received routine antenatal care, and 51% had education below a college level. These individuals were educated about the importance of contraceptive programs during the COVID-19 pandemic. Sixty-six percent of IUD insertions were conducted via vaginal delivery, and 27% had health facilities within less than 1 km. In contrast, tubectomy contraceptive users comprised 106 patients, with the majority (54%) being aged 35 years or older, all being multiparous, and 25% tested positive for COVID-19. Among tubectomy users, 43% had a history of previous injectable contraceptive use, 85% received routine antenatal care, and 54% had education below a college level. Similar to the IUD group, they were educated about the significance of contraceptive programs during the COVID-19 pandemic. Eighty-four percent of tubectomies were performed via cesarean section, and 27% of patients lived within less than 1 km from health facilities. Conclusion: The usage rates of intra-uterine devices and tubectomy for contraceptives remained stable during the COVID-19 pandemic. However, there was a decrease in postpartum in-person visits and mobility, coupled with an increase in hospitalizations.Keywords: contraceptive; family planning; intrauterine device; tubectom

Carbetosine, a Long-acting Oxytocin Agonist, as a Uterotonic in the Prevention of the Occurrence of Postpartum Bleeding

Objective: To evaluate the comparative effect of carbetocin vs. other uterotonic agents in the prevention of the occurrence of postpartum bleeding. Methods: Medical search engines like Pubmed, Google Scholar, and Cochrane are used for literature searches. The year period covered by the literature is 2013–2023. “Carbetocin” or “long-acting oxytocin” and “uterotonic” are the essential words, together with “post-partum hemorrhage” or “post-partum bleeding.” Data analysis was performed using the RevMan 5.4 application. Results: This study involved 12 clinical trials with a total sample of 32,312 people. Based on forest plot analysis, it was found that patients receiving carbetocin therapy had a risk of developing postpartum bleeding of 0.42 times compared to those receiving other uterotonic agents (misoprostol and oxytocin) (OR: 0.42; 95% CI: 0.26-0.68; p<0.0004; with heterogeneity p<0.00001, I2 85%) Conclusion: With its effectiveness and efficacy, carbetocin can be considered one modality that can prevent postpartum hemorrhage. In addition, it can benefit women at risk of having a major obstetric hemorrhage. Keywords: carbetocin, uterotonic, meta-analysis, clinical tria

Knowledge, Attitude, Practice of Pregnant Women and Husband’s Support on the Implementation of Pregnancy Exercise

Objectives: This study aims to evaluate the knowledge and attitudes of pregnant women and assess the level of support from their partners regarding the adoption of pregnancy exercises in the Tangerang region. Methods: A quantitative analysis was employed for this study, utilizing a cross-sectional study design. Results: Data were collected from 49 respondents, revealing a statistically significant relationship (p=0.031) between the knowledge of pregnant women and the implementation of pregnancy exercises. Additionally, a highly significant association (p<0.001) was observed between the attitudes of pregnant women and their adoption of pregnancy exercises. However, no significant relationship was found between the level of support from husbands and the implementation of pregnancy exercises. Conclusion: This study concludes that there is a significant correlation between the knowledge and attitudes of pregnant women and the adoption of pregnancy exercises. Keywords: attitude, husband support, knowledge, pregnancy, pregnancy exercise, prenatal yog

Serum Vitamin D Levels, Visual Analog Scale Dysmenorrhea Score, and Endometriosis ASRM Classification: a Relationship Study

Objective: To assess the correlation between vitamin D levels, dysmenorrhea intensity measured by the visual analogue scale (VAS), and the stage of endometriosis determined by the American Society of Reproductive Medicine (ASRM) grading score. Methods: A cross-sectional study was conducted involving 37 women diagnosed with suspected endometriosis who met the inclusion and exclusion criteria. The aim was to determine the correlation between vitamin D levels, dysmenorrhea VAS scores, and the ASRM endometriosis stage at RSUP Dr. Mohammad Hoesin Palembang from November 2021 to April 2022. Bivariate analysis was employed to assess correlation, utilizing Pearson's correlation test and the Spearman Rank correlation test as an alternative method. Results: There was a significant positive correlation between vitamin D levels and the VAS score for dysmenorrhea (r = 0.678; p = 0.000) and a very strong positive correlation between vitamin D levels and the degree of endometriosis (r = 0.774; p = 0.000) based on Spearman Rho's correlation test. Conclusion: There is a significant relationship between vitamin D levels with the VAS score of dysmenorrhea and the degree of endometriosis ASRM. Keywords: american society of reproductive medicine, endometriosis, visual analogue scale, vitamin

Mosaic Form of Turner Syndrome

Objective: To report a case of breast growth disorder in a mosaic form of Turner Syndrome. Turner syndrome is a chromosomal condition characterized by small height and primary ovarian insufficiency that affects one in every 2500 female births. Mosaicism is likely to occur when monosomy X develops in only a few cells during development. The clinical presentation of Turner syndrome mosaicism is atypical, with symptom severity varying based on the number of affected cells. This case discusses issues with secondary sex development, including mild hyperandrogenism, and explores how combination hormonal treatment can aid in enhancing secondary sex development. Method: Case Report. Case: A 21-year-old woman presented with chief complaint of the lack of breast enlargement. She exhibited normal genitalia internally and externally and had a regular menstrual cycle. Karyotyping revealed a mosaic pattern of 45, X/46, XX (1 percent/99%) with normal estradiol levels and elevated testosterone levels (indicating mild hyperandrogenism). The patient underwent two cycles of hormone therapy using Ethinyl Estradiol and Drospirenone, resulting in breast growth progression from Tanner stage 1 to Tanner stage 2. Conclusion: Mosaicism in Turner syndrome is plausible, and the severity of clinical symptoms correlates with the number of defective chromosomes. The presentation of Turner syndrome mosaicism varies, and therapy should be tailored to address specific symptoms. While breast development is observed in some girls with Turner Syndrome, instances of breast growth disorder may occur, involving estrogen activity and estrogen receptor sensitivity. Although the exact cause of impaired breast growth remains unknown, administering estrogen in such cases can improve secondary sexual characteristics. Keywords: mild hyperandrogenism, mosaicism, turner syndrom

Acceptance and Satisfaction of Indonesian Women Undergoing Visual Inspection with Acetic Acid (VIA) Examination Using Digital Image and The Related Factors

Objective: To determine the acceptance, satisfaction, and willingness to recommend of women undergoing VIA examination with and without digital image and their related factors. Methods: This was an observational analytic study with cross sectional method. The subjects of this study were adult women undergoing VIA examination with or without digital image in Ulin Regional Hospital, Indonesia. Patients who did not fill the whole questionnaire were excluded from the study. Characteristics analyzed in the study were age, education, occupation, socioeconomic status, source of VIA information, and previous VIA experience. Outcomes analyzed in this study were acceptance, satisfaction, and willingness to recommend. Results: There were 303 subjects who were included in the study (252 with digital image and 51 without digital image). There were no risk factors of lower acceptance, satisfaction, and willingness to recommend among women undergoing VIA examination. However, the cases of women with low acceptance and satisfaction are associated with lower information of the examination. Conclusions: Digital IVA examination is a feasible alternative with acceptance, satisfaction, and recommendation rates that are the same as VIA examination without digital imaging. Keywords: cervical cancer, digital image, Femicam®, visual inspection with acetic acid examinatio

Body Composition Parameters, Adiponectin, Leptin and Adiponectin/Leptin Ratio are Correlated with LH/FSH Ratio in Women with PCOS but not in Women without PCOS

Objective: To investigate the correlation between body composition parameters, adiponectin, leptin and the adiponectin/leptin ratio and the LH/FSH ratio in women with polycystic ovary syndrome (PCOS). Methods: A cross-sectional study was conducted at Reproductive Cluster Yasmin, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, with sixty women with PCOS and sixty healthy women as controls (matched for age and BMI). Body composition parameters, including body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), percent body fat (PBF), visceral fat area (VFA), percent subcutaneous fat (PSF) and skeletal muscle mass (SMM), were measured; levels of fasting glucose, fasting insulin, testosterone, and sex hormone binding globulin (SHBG) were measured; and homeostatic model assessment for insulin resistance (HOMA-IR) values, anti-Mullerian hormone (AMH), free androgen index (FAI), Ferriman-Gallwey (FG) score, adiponectin levels, leptin levels, adiponectin/leptin ratio, LH, FSH and LH/FSH ratio were measured. Results: Body composition parameters (body weight, BMI, WC, WHR, PBF, VFA, PSF, SMM) were not significantly different between women with PCOS and controls. Fasting insulin (P<0.05), HOMA-IR (P<0.05), AMH (P<0.01), FAI (P<0.01), FG score (P<0.01) and LH/FSH ratio (P<0.05) were higher in PCOS women. Adiponectin (P<0.01) was lower in PCOS women, while leptin and the adiponectin/leptin ratio were not significantly different between groups. Most of body composition parameters, adiponectin, leptin and adiponectin/leptin ratio were correlated with HOMA-IR in both groups. SMM was positively correlated with the LH/FSH ratio, while body weight, BMI, WC, PBF, VFA, and PSF were inversely correlated with the LH/FSH ratio in PCOS patients but not in controls. WHR was not correlated in either group. Leptin (r=-0.278; P<0.05) was negatively correlated with the LH/FSH ratio only in the PCOS group. Adiponectin (r=0.394; P<0.01) and the adiponectin/leptin ratio (r=0.413; P<0.01) were also positively correlated with the LH/FSH ratio only in the PCOS group. AMH was correlated with the LH/FSH ratio, whereas testosterone level, FAI, FG score, fasting insulin level and HOMA-IR value were not correlated with the LH/FSH ratio in PCOS women. Conclusion: Most of the body composition parameters, leptin, adiponectin and the adiponectin/leptin ratio were significantly correlated with HOMA-IR in both groups. However, correlations of those parameters with LH/FSH ratio were found only in PCOS but not in women without PCOS. Adiponectin and leptin may play a significant role in the mechanism of neuroendocrine disorders in PCOS, which is characterized by an increased LH/FSH ratio. Keywords: adiponectin, adiponectin/leptin ratio, body composition, HOMA-IR, leptin, LH/FSH ratio, PCO

Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Length of Cervix as Predictors of Premature Delivery during the Covid-19 Pandemic at Cipto Mangunkusumo General Hospital

Abstract Objective: The percentage of neonatal death continues to increase on a yearly basis, in which prematurity is the main cause of mortality. This study determines the descriptive outcomes between neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLT), and cervical length as predictors of preterm birth. Methods: A retrospective analytical study is conducted using medical records from Dr. Cipto Mangunkusumo National General Hospital. The subjects of this study includes pregnant women diagnosed with preterm delivery in Dr. Cipto Mangunkusumo National General Hospital from April 2020 to June 2021. Data on neutrophil-lymphocyte and platelet-lymphocyte ratios were obtained from a complete blood test during admission. Cervical length is measured using transvaginal ultrasound. The three variables are compared to the control group, which consists of pregnant women with full term delivery. Results: This study conducted a study with a total of 81 subjects with preterm delivery and 92 subjects with full term delivery. There were no significant difference in neutrophil-lymphocyte and platelet-lymphocyte ratios between preterm and a-term delivery (p=0.795 and p=0.475). Cervical length was significantly longer in preterm compared to full term delivery (24,50 vs 3,15 mm; p = 0,031). The neck cervical length of several participants was not assessed. Cervical length in preterm delivery obtained only 21 patients and data from 10 subjects from the full term group. Conclusion: The ratio of neutrophil-lymphocyte and platelet-lymphocyte cannot be used as predictors of preterm birth in all pregnant women. To reduce bias in this research, studies with prospective study design with a specified subject criteria are needed. Keywords: cervical length, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, premature deliver

Unusual Location: Omental Ectopic Pregnancy Killing Me Slowly

Objective: Omentum pregnancy is an ectopic pregnancy in the abdominal cavity. The event has high morbidity and mortality. The purpose of this case is to present a rare case of abdominal ectopic pregnancy that occurred in a young woman. Methods: Case report. Results: A 22-year-old woman at 16 weeks gestation presented with abdominal pain and clinical shock. Examination results revealed pregnancy outside the womb, with an estimated fetal weight of 193 grams and positive heart activity. The patient underwent laparotomy surgery, revealing that the pregnancy had occurred in the omentum organ with placental attachment. Conclusion: In this case, emergency management began with the patient's reception in the emergency department, followed by laparotomy exploration. After a meticulous surgery, the pregnancy's location was identified in the omentum, and the evacuation of pregnancy products was performed. The patient received treatment for several days until being discharged home. Early diagnosis and interprofessional management are crucial if similar conditions are suspected in the future to prevent morbidity. Keywords: abdominal cavity, ectopic pregnancy, omental pregnanc