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All Journal Majalah Kedokteran Sriwijaya Indonesian Journal of Obstetrics & Gynecology Science Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) Proceedings of the International Conference on Applied Science and Health Global Health Management Journal SRIWIJAYA JOURNAL OF MEDICINE Bioscientia Medicina : Journal of Biomedicine and Translational Research Indonesian Journal of Perinatology
Nuswil Bernolian
Biomedicine Doctoral Program, Faculty Of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia / Division Of Maternal Fetal Medicine, Department Of Obstetrics And Gynecology, Mohammad Hoesin General Hospital/Faculty Of Medicine, Unive
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Blood Cadmium and Preterm Birth: A Systems Toxicology Review of Molecular Mechanisms, Placental Disruption, and Translational Obstetric Implications Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Bachnas, Muhammad Adrianes; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Pribadi, Adhi; Sulistyowati, Sri; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Obstetrics & Gynecology Science Volume 8 Nomor 2 July 2025
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v8i2.949

Abstract

Objectives: Preterm birth (PTB) remains a leading global cause of neonatal morbidity and mortality, with multifactorial origins including inflammation, endocrine disruption, and placental dysfunction. Recent evidence identifies cadmium (Cd), a persistent environmental toxicant, as a modifiable contributor to PTB. This review aims to integrate the mechanistic, molecular, and clinical literature on maternal blood cadmium exposure and its role in the pathogenesis of PTB.Methods: A systematic and integrative review was conducted following PRISMA 2020 guidelines. Literature from 2000 to 2025 was retrieved using PubMed, Scopus, Embase, and Web of Science. Eligible studies included molecular toxicology, animal models, human epidemiological data, and placental mechanistic research addressing cadmium exposure and preterm birth. Inclusion criteria emphasized mechanistic clarity, gestational outcome relevance, and measurable cadmium biomarkers. Figures, tables, and mechanistic diagrams were used to illustrate toxicological convergence pathways.Results: Cadmium disrupts placental homeostasis via oxidative stress, endothelial dysfunction, impaired trophoblast invasion, progesterone suppression, and activation of inflammatory cascades such as the NLRP3 inflammasome. Consistent associations between maternal cadmium burden and PTB risk were found across animal, cellular, and human population studies. However, heterogeneity in exposure assessment, absence of unified risk thresholds, and confounding from co-exposures challenge causal inference. Literature remains fragmented, lacking integration between mechanistic insights and clinical risk models.Conclusions: Cadmium should be reclassified as a central agent in the pathophysiology of PTB. We propose a precision obstetrics framework that includes environmental cadmium screening in high-risk pregnancies, implementation of exposome-informed policies, and prospective multicenter studies with molecular endpoints. Obstetric care must evolve to include toxicological risk profiling as standard practice in the prevention of PTB.Kadmium dalam Darah dan Kelahiran Prematur: Tinjauan Toksikologi Sistemik terhadap Mekanisme Molekuler, Disrupsi Plasenta, dan Implikasi Obstetri TranslasiAbstrakTujuan: Kelahiran Prematur (preterm birth/PTB) tetap menjadi penyebab utama morbiditas dan mortalitas neonatal di seluruh dunia dengan etiologi multifaktorial yang mencakup inflamasi, gangguan endokrin, dan disfungsi plasenta. Bukti terbaru mengidentifikasi kadmium (Cd), suatu toksikan lingkungan persisten, sebagai faktor kontribusi yang dapat dimodifikasi terhadap PTB. Tinjauan ini bertujuan untuk mengintegrasikan literatur mekanistik, molekuler, dan klinis mengenai paparan kadmium dalam darah maternal dan perannya dalam patogenesis PTB.Metode: Tinjauan sistematis dan integratif dilakukan sesuai pedoman PRISMA 2020. Literatur dari tahun 2000 hingga 2025 dikumpulkan melalui database PubMed, Scopus, Embase, dan Web of Science. Studi yang memenuhi syarat mencakup toksikologi molekuler, model hewan, data epidemiologi manusia, dan penelitian mekanistik plasenta yang mengevaluasi hubungan antara paparan kadmium dan kelahiran prematur. Kriteria inklusi menekankan kejelasan mekanistik, relevansi terhadap hasil kehamilan, serta penggunaan biomarker kadmium yang terukur. Gambar, tabel, dan diagram mekanistik digunakan untuk mengilustrasikan jalur konvergensi toksikologis.Hasil: Kadmium mengganggu homeostasis plasenta melalui stres oksidatif, disfungsi endotel, gangguan invasi trofoblas, supresi progesteron, dan aktivasi jalur inflamasi seperti inflammasom NLRP3. Hubungan konsisten antara beban kadmium maternal dan risiko PTB ditemukan dalam studi hewan, seluler, dan populasi manusia. Namun, adanya heterogenitas dalam penilaian paparan, belum adanya ambang risiko yang seragam, serta pengaruh faktor pajanan lainnya menjadi tantangan dalam penarikan kesimpulan kausal. Literatur masih terfragmentasi dan belum mengintegrasikan temuan mekanistik dengan model risiko klinis secara menyeluruh.Kesimpulan: Kadmium seharusnya diklasifikasikan ulang sebagai agen sentral dalam patofisiologi PTB. Kami mengusulkan suatu kerangka kerja obstetri presisi yang mencakup skrining lingkungan terhadap kadmium pada kehamilan berisiko tinggi, menerapkan kebijakan berbasis exposome, serta studi prospektif multisentra dengan titik akhir molekuler. Pelayanan kebidanan harus berkembang dengan mengadopsi profil risiko toksikologis sebagai bagian dari praktik standar dalam pencegahan kelahiran prematur.Kata kunci: Disrupsi Plasenta; Interaksi Endokrin-Inflamasi; Kesehatan Reproduksi Lingkungan; Mekanisme Kelahiran Prematur; Toksisitas Kadmium,
Preterm Multigravida with Two Previous Cesarean Deliveries and a Fetus with Asymmetric IUGR and Cleft Lip and Palate: A Case Report Jhonatan, Senna Moca; Martadiansyah, Abarham; Bernolian, Nuswil; Mirani, Putri; Lestari, Peby Maulina; Agustria, Rizky; Arjanggi, Kiagus Irawan Satria
Sriwijaya Journal of Medicine Vol. 8 No. 2 (2025): Vol 8, No 2, 2025
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/sjm.v8i2.336

Abstract

Cleft lip and palate and intrauterine growth restriction (IUGR) are common congenital conditions and may suggest subtle genetic abnormalities. When no chromosomal defects are detected through standard testing, this combination presents a diagnostic challenge in prenatal care. . This case report presents a 33-year-old multigravida woman at 34 weeks of gestation, referred for suspected fetal growth restriction and cleft palate. Serial ultrasound examinations confirmed asymmetric IUGR along with a complete cleft involving the lip, alveolus, and palate. Elective cesarean delivery of pregnancy was performed at 36 weeks of gestation via cesarean section, with the infant diagnosed with unilateral cleft lip and palate. This case underlines the importance of considering advanced genetic testing in non-syndromic cases of CLP with IUGR. This case highlighting a gap in standard prenatal diagnostics and emphasizing the need for a broader genetic approach in such cases. Clinicians should remain alert and pursue early, comprehensive evaluation and multidisciplinary planning to ensure accurate diagnosis, timely intervention, and better neonatal outcomes.
The evaluation of early initiation breastfeeding implementation in dr. Mohammad Hoesin Hospital of Palembang, Indonesia: Complaints and barriers Bernolian, Nuswil; Sjaaf, Amal C.
GHMJ (Global Health Management Journal) Vol. 1 No. 2 (2017)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Abstract

Background: Early Initiation of Breastfeeding (EIB) is a worldwide health demand of both mother and child. EIB programme implementation is the duty and responsibility of all health care practitioners, ranging from executive staff and manager, which haven't runs well in dr. Mohammad Hoesin hospital.Aims: To identify opportunities and challenges of hospital management in running the EIB programme in Obstetric Department of dr. Mohammad Hoesin hospital.Methods: In this cross sectional study, all of birth mothers and health professionals were included. Samples were selected by purposive sampling. Data was obtained from the questionnaires which have been tested for validity and reliability.Results: Our study found disintegration of EIB implementation between the managerial and implementer staff. Most of EIB implementers (29 doctors and 14 midwives) stated that EIB was already done well but complained of low level of maternal EIB knowledge and lack of EIB practice support from hospital manager. While managerial staff (n = 12) blaming the EIB implementers worked attitude for this issue. Most patients (51,3%) performing EIB, while majority of no EIB group had abdominal delivery (p = 0,003) and complained that no EIB policy in operating room.Conclusion: At dr. Mohammad Hoesin hospital, EIB implementation faces challenges in managing the hospital, such no EIB policy in operating room, majority of patients are obstetric referral case with complication and unfit for EIB, managerial staff knowledge of EIB differ greatly, low socialization of EIB regulations and other elements of implementation, patient's level of knowledge, disintegration between the manager and executive staff causing ambiguity in the implementation of the EIB, and the lack of supervision of EIB implementation in the field. Keywords: Early initiation breastfeeding, Implementation, Evaluation, Hospital management, Complaints, Barrier Submitted: 17 April 2017, Accepted: 28 October 2017.
Acute Fatty Liver of Pregnancy: A Rare Case Further Complicated with Disseminated Intravascular Coagulation Junita, Nuria; Bernolian, Nuswil
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 3 November 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i3.687

Abstract

Introduction: An acute fatty liver of pregnancy is a rare and potentially deadly pregnancy complication. A case of acute fatty liver of pregnancy that is complicated with disseminated intravascular coagulation is hereby presented.Case Report: A 27-years old, 36 weeks pregnant female is presented with jaundice, elevated LDH and liver enzymes, and thrombocytopenia. An emergency obstetric ultrasonography examination found an unremarkable pregnancy without a placental abruption. The patient was managed conservatively and she delivered 6 days after the presentation. The neonate was treated in the neonatal intensive care unit due to a meconium aspiration. The patient suffered from a continued uterine bleeding and she was managed with the Sayeba’s technique. The laboratory work-up showed a disseminated intravascular coagulation with anemia and thrombocytopenia. The patient was treated with a packed red cell and fresh frozen plasma transfusion. The patient required an intensive care treatment. Discussion: An acute fatty liver of pregnancy is a potentially deadly complication of pregnancy and it requires a multidisciplinary, intensive support. The acute fatty liver of pregnancy symptoms are similar to those of a HELLP syndrome. An acute fatty liver of pregnancy requires a prompt delivery followed with a intensive support. Complications of an acute fatty liver of pregnancy include a hepatic failure and a disseminated intravascular coagulation which should be managed accordingly.Conclusion: An acute fatty liver of pregnancy requires a prompt diagnosis and treatment to achieve the best possible maternal outcome.Acute Fatty Liver of Pregnancy: Kasus Jarang Dengan Komplikasi Koagulasi Intravaskular DiseminataAbstrak Pendahuluan: Acute fatty liver of pregnancy adalah komplikasi kehamilan yang langka dan dapat mematikan. Laporan ini memaparkan sebuah kasus acute fatty liver of pregnancy dengan komplikasi koagulasi intravascular diseminata.Laporan Kasus: Seorang perempuan berusia 27 tahun, hamil 36 minggu datang dengan icterus, peningkatan kadar LDH dan enzim hati, serta trombositopenia. Pemeriksaan ultrasonografi obstetric di IGD menemukan kehamilan tanpa komplikasi dan tanpa solusio plasenta. Pasien ditatalaksana secara konservatif dan melahirkan 6 hari pasca-perawatan. Neonatus dirawat di ruang rawat intensif karena aspirasi meconium. Pasien mengalami perdarahan uterus dan ditatalaksana dengan kondom Sayeba. Pemeriksaan laboratorium menunjukkan adanya koagulasi intravaskular diseminata dengan anemia dan trombositopenia. Pasien ditatalaksana dengan transfuse packed red cell dan fresh frozen plasma. Pasien memerlukan perawatan intensif. Pembahasan: Acute fatty liver of pregnancy adalah komplikasi kehamilan yang dapat mematikan dan memerlukan tatalaksana intensif multidisipliner. Acute fatty liver of pregnancy memiliki gejala yang menyerupai sindrom HELLP. Acute fatty liver of pregnancy ditatalaksana dengan melakukan persalinan diikuti dengan terapi intensif. Komplikasi acute fatty liver of pregnancy meliputi gagal hepar dan koagulasi intravascular diseminata yang harus ditatalaksana dengan tepat.Kesimpulan: Acute fatty liver of pregnancy memerlukan diagnosis dan tatalaksana yang cepat untuk meningkatkan luaran maternal.Kata kunci: acute fatty liver of pregnancy, koagulasi intravascular diseminata, komplikasi kehamilan 
Multigravida at 31 Weeks with Imminent Preterm Labor, Type 2 Diabetes Mellitus, Maxillary Abscess, and Bad Obstetric History : A Case Report Sentani, Ray Suga Aulia; Bernolian, Nuswil; Muzakkie, Mufida; Kusnadi, Yulianto
Sriwijaya Journal of Medicine Vol. 8 No. 3 (2025): Vol 8, No 3, 2025
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/sjm.v8i3.351

Abstract

Imminent preterm labor (IPL) is defined by irregular uterine contractions, back pain, and vaginal discharge, with approximately 25-30% of cases progressing to preterm delivery. Preterm birth remains a major global issue, contributing to 35% of neonatal deaths, and often results in long-term health complications for the infant. This case report discusses a 35-year-old woman (G4P2A1) at 30 weeks of gestation, with a history of type 2 diabetes mellitus (T2DM), bad obstetric history (BOH), and a right maxillary abscess. She presented with swelling and pus discharge from the maxillary region, along with abdominal cramps, but no signs of imminent labor. The patient’s diabetes was managed with insulin, and her clinical condition was complicated by high blood glucose and an ongoing infection. The cervical length was measured via ultrasound, which indicated a risk for preterm delivery, and the patient was diagnosed with IPL. Initial management included fluid resuscitation, tocolytics to prevent labor, and antibiotics for the maxillary abscess. The patient was closely monitored, and insulin therapy was adjusted to stabilize glucose levels. Despite the complexity of managing IPL in diabetic patients, the patient's condition improved after debridement of the abscess and management of blood glucose levels. This case emphasizes the importance of multidisciplinary care in managing complicated pregnancies with comorbidities like T2DM.
Water Birth as Neuroendocrine Medicine: A Critical and Integrative Review of Hormonal and Psychophysiological Impacts on Maternal and Neonatal Outcomes Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Darmawan, Ernawati; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Perinatology Vol. 6 No. 2 (2025): Available online : 1 December 2025
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v6i2.79

Abstract

Background: Water birth, defined as labor and/or delivery conducted in warm water, has gained increasing recognition as a patient-centered and physiologically supportive birth practice. Beyond analgesia, growing evidence indicates that water immersion during labor modulates maternal neuroendocrine regulation, psychological well-being, and neonatal physiological adaptation. Nevertheless, these hormonal and psychophysiological mechanisms remain insufficiently integrated into conventional perinatal research and clinical frameworks. This review aims to synthesize current evidence on the neuroendocrine, psychophysiological, obstetric, and neonatal effects of water birth and to evaluate its clinical effectiveness and safety in low-risk pregnancies. Methods: An integrative review was conducted using a PRISMA-guided approach to identify peer-reviewed studies published between 2000 and 2025. Literature searches retrieved 3,287 records from major biomedical databases, of which 44 studies (12 randomized controlled trials, 19 cohort studies, 6 case–control studies, and 7 systematic reviews) met inclusion criteria. Data were synthesized thematically, focusing on maternal hormonal responses (oxytocin, β-endorphins, cortisol, prolactin), labor outcomes, breastfeeding, postpartum mood, neonatal adaptation, and safety considerations. Results: Across study designs, water immersion during labor was associated with increased endogenous oxytocin and β-endorphin activity and reduced stress-related hormonal responses. Clinically, first-stage labor was shortened by approximately 42–78 minutes, and epidural analgesia use was reduced by 30–50% compared with conventional land birth. Episiotomy rates were generally below 5%, and maternal satisfaction scores were consistently higher. Early breastfeeding initiation occurred in 86–92% of water birth cases, with exclusive breastfeeding rates at six weeks ranging from 66–77%. Neonatal outcomes, including 5-minute Apgar scores and NICU admission rates, were comparable to or slightly better than conventional birth in low-risk populations, with no consistent increase in infection or respiratory complications when standardized protocols were applied. Conclusion: Water birth supports a hormonally optimized and psychologically protective labor environment, with measurable benefits for labor efficiency, maternal experience, breastfeeding success, and neonatal physiological transition. When implemented under evidence-based guidelines, it represents a credible non-pharmacological option within contemporary, physiology-informed maternity care.
Co-Authors A. Kurdi Syamsuri Achmad Taufan Adhi Pribadi Adrian, Ronny Afifa Ramadanti Agustria, Rizky Al Farisi Sutrisno, Muhammad Alba G.E. Bahar Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Alia Desmalia Aloysius Suryawan Amal C. Sjaaf Amir Fauzi Amir Fauzi Anang Ansyori Andonotopo, Wiku Ansyori, Muhammad Hatta Ardesy Melizah Arjanggi, Kiagus Irawan Satria Bachnas, Muhammad Adrianes Bambang Rahardjo Bangun T. Purwaka, Bangun T. Benedictus Wicaksono Widodo Chairil Anwar Cindy Kesty Citra Dewi Cut Meurah Yeni Damar Prasmusinto Darmawan, Ernawati Eddy Roflin Eke P Mahacakri Evert Solomon Pangkahila Firmansyah Basir Firmansyah Basir Henni Maulani Herman Kristanto I Nyoman Hariyasa Sanjaya Jhonatan, Senna Moca Johanes C. Mose Julian Dewantiningrum Juneke J. Kaeng Junita, Nuria Kesty, Cindy Kgs Irawan Satria Arjanggi Kurjak, Asim M. Hatta Ansyori Made K. Karkata, Made K. Mahacakri, Eke P Maharsi, Rahma Maisuri T. Chalid, Maisuri T. Makmur Sitepu, Makmur Martadiansyah, Abarham Maulani, Henni Muhammad Irsan Saleh Mutiara Budi Azhar Muwarni Emasrissa Latifah Muzakkie, Mufida Ni Made Dyah Gayatri Nisfita, Rizania Raudhah Noroyono Wibowo Novianesari, Putri H Nurul Islamy Nurul Islamy Nyimas Aliyah Faizatun Muthmainnah Optima Fitra Ilhami Pangemanan, Wim T Pangemanan, Wim Theodorus Peby Maulina Lestari, Peby Maulina Pramono, Mochammad Besari Adi Puspitasari, Dwi Cahya Putra, Hadrians Kesuma Putri H Novianesari Putri Mirani Putri Mirani Putri Mirani Putri Mirani Putri, Asri Indriyani Rima Irwinda, Rima Rizky Agustria Ronny Adrian Rose Mafiana Ryan Saktika Mulyana Sangjaya, Arif Sentani, Ray Suga Aulia Sjaaf, Amal C. Sjaaf, Amal C. Sri Sulistyowati Stanojevic, Milan Syamsuri, Ahmad Kurdi Syifa Alkaf Theodorus Theodorus Theodorus Theodorus Theodorus Theodorus Theodorus Theodorus Theresia Monica Rahardjo Wim T Pangemanan Wim T. Pangemanan Wim T. Pangemanan Win T. Pangemanan Wiradnyana, Anak Agung Gede Putra Yulianto kusnadi Yusrawati Yusrawati Yusuf Efendi