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Bicornis unicollis uterus as a risk factor of preterm birth: A case of young woman with multiple premature births Hasanuddin, Hasanuddin; Maharani, Cut R.; Nora, Hilwah; Roziana, Roziana; Aditya, Rizka; Dewi, Tgk. Puspa; Qadri, Sofyan
Narra J Vol. 3 No. 3 (2023): December 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i3.229

Bicornis unicollis uterus is a rare congenital uterine abnormality that occurs due to the failure of Mullerian duct fusion early in the development of the female internal genitalia system. In this case report, we present a woman with bicornis unicollis uterus who had preterm birth. A 30-year-old female patient with two caesarean sections history with premature babies was presented to the hospital with a complaint of regular contractions for twelve hours in her third preterm pregnancy. The patient has no particular symptoms besides acute abdominal pain. The ultrasonography examination indicated a uterus didelphys with breech presentation fetus. Due to the patient’s caesarean history and the fetal presentation, an emergency caesarean section was decided and performed. It was found that the gravid uterus was on the left and the baby was subsequently delivered with a complete placenta. Postoperative condition of the patient was shown to be stable while the baby underwent an intensive care at the neonatal intensive care unit. This case report highlights that early diagnosis in this rare case is critical since bicornis unicollis uterus are mostly asymptomatic. Caesarean section was chosen in the present case based on consideration of the fetal and maternal clinical conditions.

Dandy Walker Malformation Prenatal Diagnosis and Postnatal Outcome in Multigravida: A rare Case Mustaqin, Mustaqin; Utami, Niken Asri; Dewi, Tgk. Puspa; Fandika, Bayu Azizka Putra
Journal of Society Medicine Vol. 4 No. 6 (2025): June
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i6.214

Introduction: Dandy Walker malformation (DWM) is a rare congenital anomaly characterized by cerebellar vermis hypoplasia, posterior fossa expansion, and fourth ventricle enlargement, often associated with hydrocephalus and chromosomal abnormalities like Trisomy 18 (Edwards syndrome). This case report describes the prenatal diagnosis and postnatal outcome of DWM in a multigravida patient. Case: A 43-year-old multigravida woman at 29–30 weeks’ gestation presented to Dr. Zainoel Abidin General Hospital with suspected fetal anomalies. Obstetric examination revealed a transverse fundal height of 23 cm, estimated fetal weight of 1,500 grams, fetal heart rate of 140 beats/min, and maternal hypertension (160/90 mmHg). Ultrasound identified DWM (absent cerebellar vermis, enlarged fourth ventricle), bilateral hydronephrosis, and undescended testes. The patient had a history of poorly controlled hypertension and reported owning a cat for one year but denied alcohol or smoking. Following counseling, pregnancy termination was performed, resulting in the delivery of a 1,400-gram male infant (length: 36 cm, Apgar score: 4–5). Postnatal phenotypic examination revealed undescended testes, low-set ears, overlapping digits, respiratory distress, small stature, and hypotonia. Karyotyping confirmed Trisomy 18. Conclusion: This case underscores the importance of prenatal ultrasound in detecting DWM and associated anomalies, enabling informed decision-making. The coexistence of DWM and Trisomy 18 highlights the need for genetic testing in such cases. Despite termination, the poor postnatal outcome reflects the severe prognosis of Trisomy 18. This report contributes to the limited literature on DWM in multigravida patients.

Cortisol and pregnancy-related anxiety in relation to preeclampsia among third-trimester pregnant women: A case–control study from Aceh, Indonesia Hezron, Teuku M.; Dewi, Tgk. Puspa; Septivera, Yusra; Rajuddin, Rajuddin; Utami, Niken A.
Narra J Vol. 5 No. 3 (2025): December 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i3.2985

Despite extensive research, the interplay between hormonal stress markers and pregnancy-specific anxiety in the pathogenesis of preeclampsia remains insufficiently understood. This study aimed to analyze the simultaneous relationships between serum cortisol levels, pregnancy-related anxiety, and the occurrence of preeclampsia among third-trimester pregnant women. A case–control study was conducted at three hospitals in Banda Aceh, Indonesia, involving third-trimester pregnant women. Serum cortisol concentrations were measured using an immunoassay, and anxiety levels were assessed with the validated Pregnancy Related Anxiety Questionnaire (PRAQ). Preeclampsia diagnosis followed standard clinical and laboratory criteria. Associations between cortisol levels (categorized into high and normal) and PRAQ scores (classified as high and low–moderate) with preeclampsia were evaluated using the Chi-squared test, and crude odds ratios (OR) with 95% confidence intervals (95%CI). The Spearman’s correlation was used to determine the correlation between cortisol levels and PRAG scores. A total of 66 pregnant women were included in the final analysis (33 with preeclampsia and 33 with normal pregnancy). Women with high serum cortisol levels had a markedly greater likelihood of developing preeclampsia compared with those with normal cortisol levels (odds ratio (OR)=34.00; 95% confidence interval (95%CI): 4.93–234.46). Similarly, women with high pregnancy-related anxiety exhibited a significantly elevated risk of preeclampsia (OR=16.71; 95%CI: 4.95–56.39). No significant correlation was observed between cortisol levels and PRAQ scores in both groups (preeclampsia: r=-0.041, p=0.821; normal pregnancy: r=0.278, p=0.117). In conclusion, elevated serum cortisol and high pregnancy-related anxiety are independently associated with preeclampsia, although not directly correlated with each other. These findings highlight the potential of dual screening for cortisol and pregnancy-specific anxiety as an innovative approach for early identification of women at high risk of preeclampsia.

Relationship between serum CA125, prolactin and cortisol levels with disease stage and pain level in endometriosis patients Fasha, Teuku A.; Rajuddin, Rajuddin; Dewi, Tgk. Puspa; Rusnaidi, Rusnaidi; Munizar, Munizar
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.2988

Endometriosis affects approximately 10% of women of reproductive age and is characterized by the presence of endometrial tissue outside the uterine cavity. Diagnostic delays are common due to nonspecific symptoms and the absence of reliable biomarkers. Serum CA125, prolactin, and cortisol have been implicated in the pathophysiology of endometriosis through inflammatory, neuroendocrine, and stress-response mechanisms. However, their role as biomarkers in endometriosis remains poorly studied. This study aimed to investigate the relationships between serum CA125, prolactin, and cortisol levels with endometriosis staging and pain severity in endometriosis patients. A cross-sectional study was conducted at Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, involving women with laparoscopically confirmed endometriosis. Serum CA125, prolactin, and cortisol levels were measured using electrochemiluminescence immunoassay (ECLIA). Disease staging followed the American Society for Reproductive Medicine (ASRM) classification, and pain severity was assessed using the Numeric Rating Scale (NRS). Statistical analyses were performed using the Spearman correlation test. A total of 30 women with confirmed endometriosis were included in this study, with a mean age of 37.2 years. Endometriosis stages were distributed as stage II (20.0%), stage III (16.7%), and stage IV (63.3%), and the mean pain score was 5.60±1.48. Elevated serum biomarker levels were observed with CA125 of 72.65±55.39 U/mL, prolactin of 1456.77±1799.79 μIU/mL, and cortisol of 341.92±189.02 nmol/L. The serum CA125 level was positively correlated with endometriosis staging (r=0.580, p=0.001) but not with pain severity. Prolactin and cortisol had no significant correlations with disease stage or pain severity (all p>0.05). This study shows that serum CA125 levels are significantly correlated with endometriosis staging, supporting its potential as a biomarker of disease progression. Although prolactin and cortisol levels were elevated, their lack of association with clinical parameters suggests broader neuroendocrine dysregulation rather than direct markers of disease severity.

Associations of VEGF and CA125 with disease stage and pain among women with endometriosis: A cross-sectional study in Indonesia Sujudi, Akmal; Rusnaidi, Rusnaidi; Dewi, Tgk. Puspa; Rajuddin, Rajuddin; Septivera, Yusra
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3013

Endometriosis is a chronic gynecological disease characterized by the presence of endometrial tissue outside the uterine cavity, affecting approximately 10% of women of reproductive age. Vascular endothelial growth factor (VEGF) and cancer antigen 125 (CA125) have been proposed as potential biomarkers in endometriosis; however, evidence regarding their association with disease stage and pain severity remains limited, particularly in the Indonesian population. The aim of this study was to evaluate the relationship between peritoneal fluid VEGF and serum CA125 levels with endometriosis stage and pain severity. A cross-sectional study was conducted involving patients with surgically and histopathologically confirmed endometriosis who underwent laparoscopy or laparotomy at Dr. Zainoel Abidin Hospital, Banda Aceh, between February and July 2025. Peritoneal fluid VEGF and serum CA125 levels were measured using enzyme-linked immunosorbent assay and chemiluminescence immunoassay, respectively. Endometriosis stage was classified according to the revised American Society for Reproductive Medicine (rASRM) criteria, and pain severity was assessed using the Numeric Rating Scale. Statistical analyses included Spearman’s correlation and receiver operating characteristic (ROC) curve analysis. Our data suggested no significant correlation between VEGF levels and endometriosis stage (r=0.042; p=0.813). Peritoneal fluid VEGF levels showed a moderate positive correlation with pain severity (r=0.505; p<0.05), and ROC analysis identified an optimal cut-off value of 39.45 pg/mL, with a sensitivity of 73.68% and specificity of 73.33% for distinguishing severe pain from mild-to-moderate pain. Serum CA125 levels demonstrated a significant positive correlation with endometriosis stage (r=0.422; p=0.013), and ROC analysis yielded an optimal cut-off value of 32.45 U/mL, with a sensitivity of 86.95% and a specificity of 63.64% for distinguishing stage IV endometriosis from lower stages. No significant correlation was observed between CA125 levels and pain severity (r=0.186; p=0.292). This study represents the first report from Indonesia to simultaneously evaluate peritoneal fluid VEGF and serum CA125 in relation to endometriosis stage and pain severity. This study highlights that CA125 is primarily associated with endometriosis stage, whereas VEGF is more closely related to pain severity, supporting their complementary roles in endometriosis assessment.

Comparison of interleukin-6 and serum creatinine levels in preeclampsia and normal pregnancy patients: A cross-sectional study in Indonesia Dewi, Syerli R.; Yeni, Cut M.; Munizar, Munizar; Dewi, Tgk. Puspa; Utami, Niken A.; Rusnaidi, Rusnaidi
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3016

Preeclampsia (PE) is a complication of pregnancy with high morbidity and mortality, characterized by endothelial dysfunction, systemic inflammation, and impaired renal function. Interleukin-6 (IL-6) and serum creatinine have potential as biomarkers for early detection of PE; however, data from Indonesia are limited. The aim of this study was to compare IL-6 and serum creatinine levels between pregnant women with PE and normotensive controls, as well as their diagnostic performance in identifying PE. A cross-sectional study involving pregnant women with PE and normotensive controls was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Serum IL-6 and creatinine levels were measured using the ECLIA method. Levels were compared using the Mann–Whitney test; diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression was used to evaluate combined diagnostic contribution. A total of 68 pregnant women were included, comprising 34 patients with PE and 34 normotensive controls. Median IL-6 levels were significantly higher in the PE group (16.05 pg/mL) than in the control group (3.71 pg/mL). Receiver operating characteristic analysis demonstrated excellent diagnostic performance of IL-6, with an are under the curve (AUC) of 0.831 (95%CI: 0.734–0.929). At an optimal cutoff value of 5.52 pg/mL, IL-6 achieved a sensitivity of 73.53%, specificity of 76.47%, and diagnostic accuracy of 86.76%. Median serum creatinine levels were also significantly elevated in the PE group (0.56 mg/dL) compared with controls (0.44 mg/dL; p<0.001). The AUC for serum creatinine was 0.806 (95%CI: 0.700–0.912), indicating good diagnostic performance. At a cutoff value of 0.475 mg/dL, serum creatinine demonstrated a sensitivity of 70.59%, specificity of 73.53%, and accuracy of 72.06%. Multivariable logistic regression confirmed that IL-6 (B=0.123; p=0.005) and serum creatinine (B=9.306; p=0.023) were independently associated with PE, explaining 57.5% of PE variability (Nagelkerke R²=0.575). These findings indicate that serum IL-6 and creatinine are significantly associated with PE, and their combined assessment shows potential as a predictive biomarker with good diagnostic performance.

Multi-stakeholder perspectives on cervical cancer screening implementation in Indonesia: A qualitative study of cervical screening barriers in Banda Aceh Yolanda, Febrina; Dewi, Tgk. Puspa; Nainggolan, Sarah I.; Munawar, Munawar; Munizar, Munizar; Bulqini, Rijal; Suhanda, Rachmad; Rusnaidi, Rusnaidi
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3022

Indonesia is committed to the WHO's cervical cancer elimination strategy through the National Action Plan (RAN) 2023–2030, targeting 75% screening coverage by 2030. However, current rates remain critically low at 7.02%. This study explores multi-stakeholder perspectives to identify implementation barriers and facilitators for policy enhancement. A qualitative descriptive case study was conducted in Banda Aceh (July-August 2025) involving 25 stakeholders: City Health Office Head, 11 puskesmas heads, 11 VIA coordinators and 2 community organization representatives. Thematic analysis using NVivo v.16 identified key implementation factors. Five major themes emerged: (1) Knowledge gaps—screening perceived necessary only when symptomatic despite available information; (2) Access paradox—excellent geographic access and flexibility undermined by limited examination rooms, insufficient midwives, and psychosocial barriers (shame, fear, lack of spousal support); (3) Financial sustainability—free services threatened by complex BPJS claims and low reimbursement affecting logistics; (4) Service quality variation—dependent on cross-sector collaboration and staff competency, with uneven training and limited cryotherapy (only 2 centers); and (5) Communication challenges—inconsistent digital media use necessitates face-to-face counseling and cadres, though reach remains limited. Implementation faces psychological barriers, capacity limitations, and uneven digital adoption despite strong infrastructure. Priority policy recommendations include: (1) HPV DNA self-sampling to overcome privacy barriers; (2) simplified BPJS claims with adequate reimbursement; (3) systematic competency-building and cryotherapy expansion; and (4) culturally-adapted education integrating local language and religious leaders. These evidence-based enhancements could accelerate Indonesia's RAN 2030 elimination targets.

Determinants of intrauterine device use among reproductive-age women in a province implementing Islamic Sharia law in Indonesia: An application of the theory of planned behavior Purnama, Dean R.; Dewi, Tgk. Puspa; Rusnaidi, Rusnaidi; Utami, Niken A.; Aditya, Rizka; Suhanda, Rachmad
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3025

The utilization of the intrauterine device (IUD) in Indonesia remains low at 3.9%, despite its high effectiveness (99.4%) and designation as a national family planning priority, suggesting the presence of psychosocial barriers influencing contraceptive behavior among women of reproductive age. This study aimed to analyze psychosocial factors influencing IUD use behavior based on the theory of planned behavior, including attitudes, subjective norms, perceived behavioral control, actual behavioral control, and intention, in Banda Aceh—the only province in Indonesia implementing holistic Sharia law. A quantitative cross-sectional study was conducted among women of reproductive age from six urban public health centers using cluster random sampling. Data were collected through face-to-face interviews using a structured TPB-based questionnaire validated for reliability. Statistical analyses included linear regression and binary logistic regression with a significance level set at p<0.05. A total of 442 women were included in the final analysis. Attitude toward IUD use, subjective norms, and perceived behavioral control were all significantly associated with intention to use an IUD, all had p<0.001. Attitudes toward IUD use (B=0.410; p<0.001; R²=0.213), subjective norms (B=0.552; p<0.001; R²=0.413), perceived behavioral control (B=0.273; p<0.001; R²=0.255), and actual behavioral control (B=0.273; p<0.001; R²=0.255) were all significantly associated with IUD use behavior. Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.780; p<0.001; R²=0.566). Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.78; p<0.001; R²=0.56). This study highlights that all intention was shaped by positive attitudes, strong subjective norms, and a high level of behavioral control. Efforts to increase IUD use should therefore focus on educational interventions, strengthening partner and social support, and improving the accessibility and quality of long-acting contraceptive services.

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