Rini Kuswohadi Pramono
Department of Dermatology and Venereology, Phlox Institute, Palembang, Indonesia

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Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) in Jakarta, Indonesia: A Comprehensive Assessment of Clinical Features, Risk Factors, and Management Outcomes Rini Kuswohadi Pramono; Felicia Sari; Muhammad Yusuf; Nadia Khoirina
Sriwijaya Journal of Obstetrics and Gynecology Vol. 3 No. 1 (2025): Sriwijaya Journal of Obstetrics and Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v2i2.179

Abstract

Introduction: Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy (PEP), is a common, self-limiting dermatosis of pregnancy. However, its specific characteristics and management outcomes in Indonesia, a diverse and populous nation, remain understudied. This study aimed to comprehensively assess the clinical features, risk factors, and management outcomes of PUPPP in an Indonesian population. Methods: A retrospective cohort study was conducted at Private Hospital in Jakarta, Indonesia, between January 2019 and December 2023. Medical records of pregnant women diagnosed with PUPPP were reviewed. Data collected included demographics, gestational age at onset, clinical presentation (lesion morphology, distribution, pruritus severity), associated symptoms, parity, pre-pregnancy BMI, weight gain during pregnancy, smoking history, presence of comorbidities, treatment modalities, and treatment outcomes (symptom resolution time, recurrence). Statistical analysis was performed using SPSS version 28. Results: A total of 285 pregnant women were included in the study. The mean age was 29.5 years (SD ± 4.8). The majority (72.3%) were primigravida. Onset was most common in the third trimester (88.4%). The most frequent presenting symptom was severe pruritus (94.7%), followed by erythematous papules (98.2%) and urticarial plaques (91.6%). Lesions predominantly affected the abdomen (96.5%), particularly the striae distensae (89.1%), with frequent involvement of the thighs (75.4%) and buttocks (62.1%). Higher pre-pregnancy BMI (p=0.012) and excessive gestational weight gain (p=0.003) were significantly associated with PUPPP development. Topical corticosteroids (85.6%) were the most commonly used treatment, followed by oral antihistamines (68.4%). Symptom resolution occurred within a mean of 10.2 days (SD ± 3.5) after treatment initiation. Recurrence was observed in 8.4% of cases. Conclusion: PUPPP in Indonesian women predominantly affects primigravida in the third trimester, presenting with severe pruritus and characteristic lesions on the abdomen, thighs, and buttocks. Higher pre-pregnancy BMI and excessive gestational weight gain appear to be significant risk factors. Topical corticosteroids and oral antihistamines are effective in achieving symptom resolution. These findings highlight the need for increased awareness and appropriate management of PUPPP in Indonesia.
Admission interleukin-6 and carbapenemase carriage independently predict 30-day mortality in female Fournier's gangrene: a multicenter cohort Rini Kuswohadi Pramono; Tanvir Ahmed; Annisa
Sriwijaya Journal of Obstetrics and Gynecology Vol. 4 No. 1 (2026): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v4i1.304

Abstract

Background: Female Fournier's gangrene (FG) is an underrecognized obstetric and gynecologic infectious emergency that frequently arises from vulvar, Bartholin gland, and episiotomy-related sources and carries high mortality. Rising multidrug resistance threatens standard empirical antibiotic regimens, yet female-specific data integrating inflammatory biomarkers with the genomic resistome are scarce. Objective: To identify independent predictors of 30-day mortality and characterize the genomic resistome in women with FG to inform targeted broad-spectrum therapy. Methods: In this multicenter retrospective cohort at two tertiary referral hospitals in Palembang, Indonesia (January 2020–December 2025), 42 women with surgically confirmed FG were studied. Admission interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), procalcitonin (PCT), and C-reactive protein (CRP) were measured; deep-tissue isolates underwent culture, broth-microdilution MIC testing, and multiplex PCR/next-generation sequencing for resistance genes. Multivariable logistic regression, ROC analysis, and Kaplan-Meier/Cox modeling were performed. Results: Thirty-day mortality was 26.2% (95% CI 15.3–41.1), and infections were polymicrobial in 85.7%. Non-survivors had markedly higher admission IL-6 (485.2 vs 142.5 pg/mL; p<0.001; Cohen's d=2.58) and PCT (18.6 vs 4.2 ng/mL; p<0.001). IL-6 predicted mortality with an AUC of 0.93 (95% CI 0.83–0.99), outperforming LRINEC (AUC 0.69). Independent predictors were carbapenemase-producing isolates (adjusted OR 4.15, 95% CI 1.85–9.20; p=0.001) and admission IL-6 ≥300 pg/mL (adjusted OR 3.80, 95% CI 1.62–8.85; p=0.002). Resistome-concordant empirical therapy was associated with lower mortality (modeled NNT 3). Conclusion: Admission IL-6 and carbapenemase carriage independently predicted 30-day mortality in this female FG cohort. Rapid biomarker and resistome screening may support risk stratification and empirical coverage in high-resistance tertiary settings, but prospective external validation is required before practice adoption.