Indonesian Journal of Obstetrics and Gynecology

Eliminating Cervical Cancer in Asia–Pacific: From HPV Policy to Real-World Oncology Practice

Hariyono Winarto — 2026-01-30

N/A

Maternal Immunization against Respiratory Syncytial Virus (RSV): Indonesian Consensus 2025

Muhammad Alamsyah Aziz — 2026-01-30

Risk factors of stunting in children aged 24-59 months Jambi City in 2025

Rosa Riya — 2026-01-14

Abstract

Objectives: research is to determine the factors related to the incidence of stunting at the Tanjung Pinang Health Center, Jambi 2024.

Methods: This research is a quantitative research with a cross sectional approach. population study all children affected by stunting at the Tanjung Pinang Community Health Center. The sampling technique used a total sampling technique with data analysis using the chi-square test.

Results: From the results of the chi-square statistical test, a p-value was obtained of 0.509 (p>0.05). The relationship between economic status and the incidence of stunting.The relationship between education level and the incidence of stunting p-value is 0.746 (p>0.05). The relationship between maternal attitudes and the incidence of stunting p-value is 0.170 (p>0.05). The relationship between the level of knowledge and the incidence of stunting p-value is 0.395 (p>0.05). The relationship between maternal age and the incidence of stunting p-value is 0.355 (p>0.05). The relationship between maternal age and the incidence of stunting is p-value 0.024, which is all results (p>0.05).

Conclusion: The mother's attitude, child's age, education level, economic status and level of knowledge are not related to the incidence of stunting, but for maternal age there is a relationship to the incidence of stunting

Keywords: Stunting, mother's age, education level, economic status, knowledge level, child's age and mother's attitude

Analysis of Causes, Maternal And Perinatal Outcomes In Third Trimester Pregnant Women With Normocytic Anemia

Suchi Avnalurini Sharief — 2026-01-14

Abstract

Objective : Analyzing the causes, maternal and perinatal outcomes in third trimester pregnant women.

Method :This research is a hybrid study which combines 2 research designs, namely descriptive analytical and observational with a cross sectional study approach to assess laboratory examinations of anemic pregnant women and a cohort to assess maternal & perinatal outcomes in third trimester pregnant women with normocytic anemia. Bivariate analysis was carried out using the chi square test to measure the strength of the relationship between variables. A complete blood count, ferritin, TIBC, serum Fe, reticulocyte and peripheral blood smear were carried out. This research was conducted on third trimester pregnant women with anemia.

Results :Of the 50 pregnant women who experienced normocytic anemia, there were (92,0%) mild anemia, (8,0%) moderate anemia and no severe anemia was found. Maternal and perinatal outcomes have a p value <0.05. Most pregnant women in the third trimester have low serum Fe < 37 µ/dL (52,2%) in mild anemia and normal serum Fe 37-148 µ/dL (75%) in moderate anemia, most have low ferritin < 13 ng/ dL in mild anemia (82,6%) and (100%) in moderate anemia, most high TIBC ? 389 µ/dL in mild anemia (87%) and (100%) in moderate anemia, all reticulocyte values ??are high (> 1,50%) in mild and moderate anemia.

Conclusion :Chronic diseases and infections were the biggest causes of normocytic anemia in third trimester pregnant women in this study, howeverNormocytic anemia in this study had a picture of serum ferritin and iron that almost resembled microcytic anemia, which was probably caused by iron deficiency, so it was necessary to examine C-Reactive Protein (CRP) as a biomarker/sign of infectious disease.The higher the degree of anemia, the greater the risk of birth problems, which will affect the birth process. Likewise with perinatal outcomes, the higher the degree of anemia, the greater the incidence of LBW and asphyxia in babies.

Keywords: Normocytic anemia, pregnancy, maternal and perinatal outcomes, serum Fe, ferritin, TIBC, reticulocytes

Inflammatory Marker and their Association with COVID-19 Severity in Pregnant Women

Yuyun Lisnawati — 2026-01-14

Abstract :

Objective: To analyze the correlation between blood markers; C-Reactive Protein (CRP), D-Dimer, Neutrophil-to-Lymphocyte Ratio (NLR) and the severity of COVID-19 in pregnant women during the 2020 pandemic at Persahabatan Hospital, Jakarta.

Method :This cross-sectional study was conducted at Persahabatan Hospital, a National Respiratory Referral Center in Jakarta. A total of 525 pregnant women with confirmed COVID-19 who met the inclusion criteria were included in the study.
Laboratory markers, including CRP, D-Dimer, and NLR, were analyzed and categorized as normal or elevated. Data were analyzed using the Chi-square test, and correlations were evaluated using Spearman’s rank correlation coefficient.

Result :The results showed that elevated biomarkers were significantly correlated with increased disease severity. CRP (>10 mg/L), D-Dimer (>3333 mg/L), and NLR (?5.8) were all associated with moderate to severe disease. All biomarkers demonstrated a significant correlation with disease severity (p < 0.005).

Conclusion: Elevated CRP, D-Dimer, and NLR levels are associated with increased disease severity in pregnant women with COVID-19, suggesting their potential role as practical indicators for disease severity assessment.

Keywords : Covid 19, CRP, D-Dimer, NLR, Pregnant.

Pregnancy Outcomes in Women Aged 20–34 vs. ?35 Years: A Cross-Sectional Study in a Tertiary Referral Center

Farsyah Septrial Hendra Syahputra — 2026-01-14

Objective: This study aims to compare pregnancy outcomes between mothers under and over 35 years of age at Dr. Hasan Sadikin General Hospital.

Methods: An observational analytic approach with a cross-sectional design was used. Data from the medical records of 150 patients at Dr. Hasan Sadikin General Hospital in 2022 were analyzed. Patients were divided into two groups: ages 20-34 and greater than or equal to 35. Data analysis was performed using SPSS version 27.0.

Results: Advanced maternal age was significantly associated with mode of delivery [OR 2.16, 95% CI (1.08-4.28), p=0.048], hypertensive disorders of pregnancy [OR 3.99, 95% CI (1.86-8.38), p<0.001], and postpartum hemorrhage [OR 2.93, 95% CI (0.99-8.79), p=0.044].

Conclusion: This study affirmed that advanced maternal age is associated with adverse maternal outcomes, namely hypertensive disorders of pregnancy and postpartum hemorrhage. Moreover, compared to mothers aged 20-34, advanced maternal age is linked with higher rates of cesarean deliveries and forceps deliveries.

Keywords: Advanced maternal age pregnancy, Adverse maternal outcomes, Neonatal outcomes, Peak reproductive years, Complications of pregnancy

Risk Factors of Intrauterine Growth Restriction: A Case-Control Study

Putu Jeremia Dani Bramanta — 2026-01-14

Abstract

Objectives: To explore out whether age, rate of delivery, and hypertension are risk factors for IUGR in Bethesda Hospital Yogyakarta

Methods: A case control study was used by evaluating medical record of patient who diagnosed with IUGR in Bethesda Hospital Yogyakarta between January 2015 – December 2021.

Results: The sample size was 62 with a case number of 31 (IUGR) and in control patients without IUGR of 31. Based on bivariate analysis with chi square test, it was found the risk factor for IUGR was hypertension (P = 0,032; OR = 3,906). Risk factor age (P = 0,115) and rate of delivery (P = 0,446; OR = 1,681) were not found to be risk factor for IUGR.

Conclusion: Hypertension is a risk factor for IUGR, whereas age and rate of delivery are not risk factors for IUGR in Bethesda Hospital Yogyakarta.

Keywords: IUGR, age, rate of delivery, hypertension.

Placental Vitamin D, Oxidative Stress, and Senescence Markers in Spontaneous Preterm Birth: A Comparative Cross-Sectional Study

Yudianto Budi Saroyo — 2026-01-29

Abstract
Objective: To evaluate the associations between vitamin D metabolism markers and biomarkers of oxidative stress and placental senescence among women with spontaneous preterm labor compared with those with term labor.

Methods: We conducted a comparative cross-sectional study between 2017 and 2019 in two hospitals in Jakarta, Indonesia. Maternal serum and placental samples were collected from women with term labor and spontaneous preterm labor. Markers of the vitamin D pathway 25-hydroxyvitamin D (25[OH]D), 1,25-dihydroxyvitamin D? (1,25[OH]?D?), vitamin D receptor (VDR), and CYP27B1 along with oxidative stress (8-hydroxy-2--deoxyguanosine [8-OHdG]) and placental senescence markers (GLB1 and HMGB), were measured using ELISA, LC–MS/MS, and ICP–MS. Between-group comparisons were performed using parametric or nonparametric tests, as appropriate, and correlations were assessed using Pearson’s or Spearman’s correlation coefficients.

Results: A total of 67 women were included (term labor, n = 34; spontaneous preterm labor, n = 33), and both groups were vitamin D deficient. Placental 1,25(OH)?D? levels were significantly lower in the preterm group than in the term group (4.58 ± 2.90 vs 5.57 ± 3.50 pg/ng, p = 0.037). Placental VDR levels also differed significantly between groups {21.70 (6.06–73.40) vs 16.48 (1.87–74.67), p = 0.041}. Across all participants, 8-OHdG and placental senescence markers were negatively correlated with placental 25(OH)D and 1,25(OH)?D? levels and positively correlated with placental CYP27B1 and VDR expression.

Conclusion: In this comparative cross-sectional cohort, placental vitamin D metabolites were associated with lower levels of oxidative stress and placental senescence biomarkers, whereas VDR and CYP27B1 showed positive associations with these biomarkers. These patterns may reflect compensatory regulatory mechanisms in the context of maternal vitamin D deficiency. These findings are hypothesis-generating and warrant confirmation in prospective studies and mechanistic investigations.

Keywords: oxidative stress, placental senescence, spontaneous preterm labor, vitamin D.

Maternal Risk Factors Associated with Neonatal Stunting: A Case–Control Study

Anita Rohhmah — 2026-01-30

Abstract
Objective: To identify maternal risk factors associated with neonatal stunting at Wonosari Hospital.

Methods: A case–control study was conducted involving mothers who gave birth at Wonosari Hospital in 2023. Maternal sociodemographic characteristics (age, education, and occupation), nutritional status (body mass index and mid-upper arm circumference), and pregnancy-related factors (gestational age, gestational status, hemoglobin levels, blood pressure, pregnancy complications, and mode of delivery), as well as newborn length at birth, were obtained from medical records. Neonatal stunting was defined as a length-for-age z-score < ?2 SD according to World Health Organization (WHO) standards. Statistical analysis was performed using chi-square tests and multiple logistic regression.

Results: A total of 154 participants were included, equally divided into case (stunted newborns) and control (non-stunted newborns) groups. Mothers with a lower educational level had significantly higher odds of delivering a stunted newborn (p= 0.010; aOR = 2.845; 95% CI = 1.286–6.293). Preterm birth was also associated with an increased risk of neonatal stunting (p= 0.033; aOR = 9.847; 95% CI = 1.210–80.152). In addition, pregnancy complications were significantly associated with higher odds of neonatal stunting (p = 0.020; aOR = 2.728; 95% CI = 1.171–6.352).

Conclusion: Maternal factors, including low educational level, preterm birth, and pregnancy complications, were significantly associated with neonatal stunting at Wonosari Hospital. These findings underscore the importance of maternal education in neonatal health outcomes. Furthermore, close monitoring of fetal growth and nutritional status, along with appropriate management of pregnancy complications, may help reduce the risk of neonatal stunting. However, larger-scale studies are needed to assess the population-level impact of these factors.

Keywords: neonatal, pregnancy complication, stunting.

Overview of Women's Reproductive Health Problems among Foreign Tourists in Health Services in Bali

Anak Agung Ngurah Surya Wira Mahotama Putra — 2026-01-14

Objectives: To understand the overview of women's reproductive health problems among foreign tourists in several health services in Bali in 2022-2023.

Methods: The research design used is descriptive research with a cross-sectional method. The study sample consists of 103 samples selected through purposive sampling. Data from the research results will be analyzed univariately and processed using SPSS version 27. The research locations to be used are two private hospital in Bali

Results: The research results on foreign tourists with women's reproductive health problems revealed that the age group was predominantly 20-35 years, with 31 (60.8%) in 2022 and 34 (65.4%) in 2023. Most foreign tourists who visited did not have insurance, amounting to 32 (62.7%) in 2022 and 36 (69.2%) in 2023. The most common diagnosis was prolonged labor, with 20 (39.2%) in 2022 and 11 (21.2%) in 2023. The most frequent complaint was abdominal pain, experienced by 30 (58.8%) in 2022 and 19 (36.5%) in 2023. For the treatment of foreign patients with reproductive health issues, non-pharmacological treatment was predominant, with 34 (66.7%) in 2022 and 31 (59.6%) in 2023.

Conclusion: Based on the research conducted, the overview of women's reproductive health problems among foreign tourists in several health services in Bali in 2022-2023 is dominated by the age group 20-35 years, most of whom have health insurance. The most common diagnosis is prolonged labor, with the majority experiencing complaints of lower abdominal pain, and treatment predominantly involving non-pharmacological methods.

Assessing Contraceptive Service Training Using the Kirkpatrick Model to Improve Health Worker Competency

Shinta Prawitasari — 2026-01-14

Contraceptive use can significantly prevent maternal deaths by preventing unwanted and unplanned pregnancies, as well as preventing high-risk pregnancies. The contraceptive service training program for health workers, especially midwives and doctors who work in primary healthcare facilities, is an important factor in managing the program and providing contraceptive services to the community. This study aims to evaluate contraceptive service training using the Kirkpatrick evaluation model level 1-3. This study is a quasi-experimental study based on the Kirkpatrick model in which contraceptive service training was conducted in Nusa Tenggara Barat, Indonesia. Thirty health workers participated in the study after providing informed consent. The in-service training was evaluated using the Kirkpatrick model’s reaction, learning, and behavior levels. The subjects who participated in this study came from representatives of districts/cities in West Nusa Tenggara province. The participants’ reaction to the training proved effective, with 86.89% satisfaction. At the learning level, the average subject has a pre-test score of 56.33 and a post-test score of 95.73. There is an increase in the knowledge of contraceptive training participants. The increase in pre-test and post-test scores is also significant, with p = 0.000. The behavior level score showed a slight decrease in competency after one year of observation.

Determining Factors for Discontinuing Hormonal Contraceptive Use in Acceptors at The Kassi Kassi Community Health Center

Nia Karuniawati — 2026-01-14

Introduction : During the COVID-19 pandemic, several experts have reported the effects of pregnancy accompanied by COVID-19 on both the mother and infant, influenced by the symptoms and signs presented. This study aims to analyze the correlation between blood markers; C-Reactive Protein (CRP), D-Dimer, Neutrophil-to-Lymphocyte Ratio (NLR) and the severity of COVID-19 in pregnant women during the 2020 pandemic at Persahabatan Hospital, Jakarta.

Method : This cross-sectional study was conducted at Persahabatan Hospital, a National Respiratory Referral Center in Jakarta. A total of 525 pregnant women who met the inclusion criteria were evaluated. Laboratory markers, including CRP, D-Dimer, and NLR, were analyzed and categorized as normal or elevated. Data were analyzed using Chi-Square tests, and correlations were evaluated using Spearman’s rank correlation coefficient.

Result : The result of this study found that elevated biomarkers were significantly correlated with increased severity of disease. CRP (>10 mg/L), D-Dimer (>3333 mg/L), and NLR (>5.8) were all associated with moderate to severe disease. Statistical analysis showed significant correlations with p-values <0.005 and a 95% confidence interval.

Conclusion : Elevated CRP, D-Dimer, and NLR levels are associated with increased disease severity in pregnant women with COVID-19. These biomarkers can serve as useful predictors for the severity of the disease.

Keywords : Covid 19, CRP, D-Dimer, NLR , Pregnant

Detection of Uterine Cavity Pathology in Subfertile Women Prior to In Vitro Fertilization Using Transvaginal Sonography and Office Hysteroscopy

Nadya Lusiana — 2026-01-14

Objective: To compare transvaginal sonography (TVS) and office hysteroscopy in detecting uterine cavity pathology in subfertile women prior to in vitro fertilization (IVF).
Methods: This retrospective cross-sectional study included 104 subfertile women who underwent both TVS and office hysteroscopy at the Yasmin IVF Clinic, Dr. Cipto Mangunkusumo Kencana Hospital, Jakarta. Findings from TVS and hysteroscopy were compared with histopathological results for chronic endometritis, endometrial polyps, submucosal fibroids, and
endometrial hyperplasia. Findings of uterine septum and intrauterine synechiae on TVS were compared with hysteroscopy as the reference standard.

Results: Office hysteroscopy detected chronic endometritis in 16.3% of subjects, with a sensitivity of 33% and specificity of 68%, whereas TVS did not identify any cases. Submucosal fibroids were detected by both modalities with identical specificity (100%) and sensitivity (75%). Endometrial polyps were identified in 47.1% of cases by hysteroscopy and 15.4% by TVS. TVS
demonstrated higher specificity (88% vs. 35%), although both modalities showed low sensitivity (15% for TVS vs. 50% for hysteroscopy). Both methods accurately detected endometrial hyperplasia, showing high specificity (97%). Uterine septum and intrauterine synechiae were detected exclusively by hysteroscopy.

Conclusion: Both TVS and office hysteroscopy are effective in detecting submucosal fibroids and endometrial hyperplasia. However, only hysteroscopy can identify chronic endometritis, uterine septum, and intrauterine synechiae, while TVS demonstrates higher specificity for detecting endometrial polyps. Histopathology remains the gold standard, and office
hysteroscopy provides important complementary diagnostic value prior to IVF.

Keywords: in vitro fertilization, office hysteroscopy, sub-fertility, transvaginal sonography

Papaya Fruit (Carica papaya L.) and Its Effectiveness on Menstrual Patterns in Women Using Depo Medroxyprogesterone Acetate (DMPA): A Quasi-Experimental Study

Nurhayati Nurhayati — 2026-01-14

Objective: This study aims to determine the effectiveness of administering papaya ( Carica Papaya L) in Medroxy Depo Acceptor Progesterone Acetate (DMPA) on Menstrual Patterns in PMB Patmawati .

Method: Research was conducted at PMB Fatmawati. This research is a Quasy-Experiment research with a Posttest Only Control Group Design research design where this research was carried out by providing treatment (intervention) in the form of Papaya fruit ( Carica Papaya L) then observing the Menstrual Cycle Pattern. Next, the measurement results were compared with the measurement results in the control group who did not receive treatment (intervention) consuming papaya fruit ( Carica Papaya L).

Results: There was a significant effect between changes in menstrual patterns between groups that consumed papaya and those who did not consume papaya (p = 0.000) and thare was a significant difference before and after consuming papaya on changes in menstrual patterns (p=0.001).

Conclusion: Consuming papaya fruit regularly and consistently ( carica Papaya L) as an acceptor of Medroxy Depo Progesterone Acetate (DMPA) shows a good effect on changing menstrual patterns from previously irregular to regular

Keywords: DMPA, Papaya Fruit, Menstrual Cycle

Drospirenone–Ethinyl Estradiol and Cyproterone Acetate in Moderate Severe Acne with Hyperandrogenism: A Randomized Double-Blind Trial

Eka Rusdianto Gunardi — 2026-01-30

ABSTRACT

Background: Acne vulgaris is a health problem experienced by 85% of people in Indonesia. The highest prevalence is in women, who attempt to treat acne vulgaris. Unsuccessful acne vulgaris therapy is associated with hormonal influences, the stimulation of the sebaceous glands by androgen hormones. Hyperandrogenism is experienced by 10% of women in Indonesia. The main therapy for hyperandrogens is ciproterone acetate. Drospirenone combined with ethinyl estradiol, apart from sparing pregnancy, is also thought to be effective in treating clinical symptoms of hyperandrogenism. Currently, there is no study on drospirenone for acne and hyperandrogen therapy in Indonesia.

Objective: Determine the efficacy of treatment combination 3-mg drospirenone and 20-microgram ethinyl estradiol as management of choice for moderate-severe acne vulgaris and symptoms of hyperandrogenism (hirsutism, secondary amenorrhea, and oligomenorrhea) for 3 cycles.

Method: A randomized clinical trial with a double-blind study was done. Consecutive sampling is based on a random allocation table. A total of 42 subjects were diagnosed with moderate-severe acne vulgaris with hirsutism, secondary amenorrhea and/or oligomenorrhea at RSCM, divided into 2 groups, 21 subjects using drospirenone 3 mg combined with 0.030 mg ethinyl estradiol (DRSP/EE) and 21 subjects using 2 mg ciproterone acetate and 0.035 mg ethinyl estradiol (CRPN/EE), followed with examination of free testosterone check in laboratory. There was 1 subject who dropped out (Cyproterone group). The duration of therapy was 3 months then evaluation of acne lesions, Ferriman Gallwey score (FG score), and menstrual period.

Results: Characteristics of study subjects with the majority of subjects aged 25-35 years, 51,3%. The education level of most subjects about 57,1%, was a bachelor's degree. Testosterone levels at the start of the study were 1,41±0,64 for the DRSP/EE group and 1,32±0,48 for the CRPN/EE group. For the degree of acne, 85.7% of subjects using DRPS/EE and 85% of subjects using CPRN/EE had reduced acne lesions with a P value of 0.645. For hirsutism by calculating the FG score, 61.9% of the subjects using DRSP/EE and 50% of the subjects consumed CPRN/EE had a decreased FG score with a value of P value 0.443, and their menstrual period became regular for 85.7% of the subjects using DRSP/EE and 90% of the subjects using CPRN/EE with P value 0.645.

Conclusion: Drospirenone and ethinyl estradiol are as effective as cyproterone acetate combined with ethyl estradiol as treatment of moderate to severe acne vulgaris, hirsutism, secondary amenorrhea, and oligomenorrhea.

Keywords: acne vulgaris, cyproterone acetate, drospirenone, hirsutism, secondary amenorrhea

Age at Sexual Debut as a Determinant of HPV Infection in Women with Clinically Normal Cervix in Indonesia

Tofan Widya Utami — 2026-01-30

Objectives: This study examined the association between sexual debut and HPV infection in Indonesian women with a clinically normal cervix, contextualized within the Sustainable Development Goals (SDGs).

Methods: This prospective cohort study utilized primary data from structured interviews and gynecological exams conducted by the Female Cancer Program (FCP) team across public and private health providers in Jakarta (January 2012–July 2018). Cervical cancer risk factors, including early sexual debut, were analyzed using odds ratios (ORs).

Results: A total of 1,390 women with a clinically normal cervix were enrolled in this study, with 52 (3.7%) testing positive for HPV-DNA. Statistical analysis indicated an odds ratio (OR) of 1.176 (95% CI: 0.598–2.316, p = 0.601) for early sexual debut.

Conclusion: This study showed that there was an insignificant association between sexual debut and HPV infection in clinically normal cervix. According to the SDGs, early sexual debut and cervical cancer are highly associated. In order to meet the SDGs by 2030, more research is required to validate this finding and assess additional co-factors connected to cervical cancer.

A Spontaneous Uterine Rupture in Placenta Accreta Spectrum: a case series

isharyah sunarno — 2026-01-30

Objectives: Diagnosing uterine rupture in placenta accreta spectrum (PAS) can be challenging, often confirmed only during surgery after the rupture has occurred. This poses significant risks of morbidity and mortality for both the mother and neonates. Therefore, it is crucial for obstetricians to understand the clinical signs of uterine rupture in PAS cases. We aim to present four cases of grade 3a PAS and their associated maternal and neonatal outcomes related to spontaneous uterine rupture.

Case management: Four cases of spontaneous uterine rupture attributed to FIGO grading 3A PAS occurred at Wahidin Sudirohusodo Hospital, a tertiary healthcare center in Makassar, South Sulawesi, Indonesia. All patients were multigravida with prior cesarean sections, presented at preterm gestational ages, and had histologically confirmed PAS. They were referred from secondary healthcare facilities. In two cases, spontaneous uterine rupture was identified prior to surgery, with the patients presenting in hypovolemic shock and intrauterine fetal demise. In the other two cases, the rupture occurred during laparotomy before any uterine procedure, and the neonates were delivered alive. During the emergency laparotomy, uterine ruptures were identified at the sites of placental attachment. In one case, an additional rupture was observed on the posterior uterine wall. Management included emergency classical cesarean section followed by supracervical hysterectomy, postoperative ICU admission, and massive blood transfusion. All mothers were discharged in stable condition.

Conclusion: Spontaneous uterine rupture in PAS cases is associated with increased maternal morbidity as well as neonatal mortality and morbidity.

Keywords: caesarean section, placenta accreta spectrum, spontaneous uterine rupture, classical cesarean section, supracervical hysterectomy