Indonesian Journal of Perinatology

Retrograde Hysterectomy Approaches in Difficult Gynaecology Surgery

2025-08-23T12:28:30+00:00

Hysterectomy remains one of the most frequently performed gynecological surgeries worldwide. While extra-fascial hysterectomy is the standard abdominal approach, complex cases involving large fibroids, severe endometriosis, adhesions, or malignancy often require alternative techniques such as the Aldridge method or retrograde hysterectomy. These challenging situations are associated with distorted pelvic anatomy, fibrosis, and adhesions, increasing the risk of complications, including injury to adjacent organs. This article reviews strategies and operative steps in managing complex abdominal hysterectomies, with emphasis on retrograde hysterectomy as a valuable approach when the cervicovaginal junction cannot be clearly identified or when extensive adhesions are present. The surgical technique is described step by step, supported by imaging and intraoperative findings, and highlights methods such as hydrodissection and careful dissection around critical structures to minimize morbidity. Preoperative imaging, intraoperative decision-making, and technical modifications are emphasized as key factors for optimizing patient outcomes. Although this study provides a detailed description of techniques under challenging hysterectomies, its limitation lies in the reliance on schematic illustrations rather than comprehensive intraoperative photographic documentation.

Antioxidant administration on the incidence of preterm premature rupture of membranes: a literature review

2025-05-26T12:38:43+00:00

One of the obstetric issues that can lead to consequences for both the mother and the unborn child is premature rupture of membranes (PROM). In Indonesia, 35% of pregnancies ended in preterm rupture of the membranes in 2013. The incidence of preterm pregnancy is 2% of all pregnancies, while the incidence of term pregnancy ranges from 6 to 19%. At 37 weeks gestation, the phrase "premature rupture of membranes" is used. Preterm premature rupture of membranes (PPROM) is the term used to describe when the membranes burst before birth in women whose gestational age is less than 37 weeks. It is believed that the pathophysiology of premature membrane rupture involves reactive oxygen species (ROS). The result of premature membrane rupture is anticipated to be impacted by antioxidant supplementation.

Ethnopharmacological insights and clinical prospects of ten Indonesian medicinal plants for pregnancy, postpartum, and lactation: a systematic review

2025-07-15T04:50:17+00:00

Background: The perinatal period involves significant physiological and metabolic transitions, particularly concerning hypertensive disorders, preeclampsia, hemorrhage, lactation challenges, and oxidative stress. Although pharmacological therapies are available, their safety and accessibility remain inconsistent, especially in resource-limited settings. Indonesia’s extensive biodiversity and deep-rooted ethnomedicinal traditions offer promising yet underutilized botanical alternatives. This study aimed to review the efficacy of Indonesian medicinal plants used in pregnancy, postpartum, and lactation.

Methods: This systematic review investigates ten Indonesian medicinal plants traditionally used during pregnancy, postpartum recovery, and lactation: Sauropus androgynus, Curcuma longa, Moringa oleifera, Nigella sativa, Centella asiatica, Orthosiphon aristatus, Syzygium polyanthum, Andrographis paniculata, Solanum nigrum, and Zingiber officinale. Literature from 2000 to 2025 was reviewed using PRISMA guidelines across global and regional databases. Phytochemical composition, mechanisms of action, therapeutic effects (e.g., antihypertensive, antidiabetic, galactagogue, hemostatic, antioxidant), and clinical relevance were critically evaluated.

Results: All ten plants demonstrated pharmacological potential relevant to perinatal health challenges. Notably, Zingiber officinale offers antiemetic and anti-inflammatory benefits during early pregnancy, complementing the lactogenic, antihypertensive, and wound-healing properties of other species. However, gaps persist in human trials, dosage standardization, and regulatory oversight.

Conclusion: The review highlights the importance of integrating validated traditional botanicals into perinatal care through interdisciplinary research, targeted clinical trials, and culturally responsive health policies. Bridging ethnopharmacology with maternal health systems offers a scalable, sustainable pathway toward maternal wellness and equity in Indonesia and comparable global settings.

Metastatic breast cancer during pregnancy: a case report

2025-08-23T12:29:38+00:00

Introduction: Breast cancer is the most prevalent malignancy among women and a notable comorbidity during pregnancy. Pregnancy-associated breast cancer (PABC) presents unique challenges due to physiological breast changes that complicate early diagnosis. This case report aimed to present a 31-year-old female with a diagnosis of bilateral breast tumors, pleural effusion, and multiple thoracic soft tissue tumors during her second pregnancy, highlighting the complexities and treatment considerations involved.

Case presentation: A 31-year-old female patient, referred to Prof. Dr. I. G.N.G Ngoerah General Hospital, Denpasar, was in her second pregnancy at 20-21 weeks of gestation. She presented with bilateral breast lumps, worsening pain, and shortness of breath. Her obstetric history included a previous cesarean delivery and two abortions. Clinical examination revealed pleural effusion and multiple nodules suggestive of metastases. Biopsies confirmed tubular adenoma in the right breast and invasive breast carcinoma in the left breast. Ultrasound and chest x-ray findings indicated metastases to the liver and lungs. The patient was diagnosed with G4P1021 at 20 weeks of gestation with pregnancy-associated bilateral breast cancer and metastases.

Conclusion: PABC diagnosis and treatment are fraught with challenges due to the need to balance maternal and fetal health. Delays in diagnosis, limited antenatal care, and the aggressive nature of PABC contribute to poor outcomes. This case underscores the necessity of early detection, prompt multidisciplinary intervention, and tailored treatment strategies to improve PABC patients' prognoses.

Lavender aromatherapy reduces menstrual pain intensity in adolescents: a double-blind randomized clinical trial

2025-06-08T05:45:25+00:00

Introduction: Before, during, or after a period, dysmenorrhea may occur. Menstrual discomfort may persist for one to several days throughout the menstrual cycle. The uterine muscles contracting to release endometrial tissue is believed to be the cause of colic or chronic discomfort. Some predisposing factors that play a role in the pathophysiology of primary dysmenorrhea have not been explained to date, it is suspected that prostaglandin factors are the main cause of perceived pain. There are two methods for treating menstruation pain: pharmaceutical and non-pharmacological. A non-pharmacological treatment that can give good results is the use of lavender aromatherapy because the content of essential substances in it is suspected to reduce anxiety and pain sensations to reduce the intensity of dysmenorrhea.

Method: This study employs a double-blind, randomized pre- and post-test control design, thereby constituting a true experiment. This research was conducted in Susut Village, Bangli from January 2024 to March 2024. This study used a consecutive sampling technique followed by randomizing the grouping of treatment subjects who received the aroma of lavender therapy and the control subjects received a placebo for 15 minutes for 2 consecutive days. Pain intensity was measured using the NRS scale before and after the intervention.

Results: This study involved 60 subjects consisting of 30 cases and 30 controls. The administration of lavender aroma therapy significantly reduced the intensity of dysmenorrhea pain compared to placebo.

Conclusion: The administration of lavender aromatherapy lowers the intensity of dysmenorrhea pain.