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All Journal International Journal of Public Health Science (IJPHS) MEDIA MEDIKA INDONESIANA Jurnal Kedokteran Diponegoro Journal of Biomedicine and Translational Research Indonesian Journal of Obstetrics & Gynecology Science Jurnal Kesehatan Reproduksi Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) Medica Hospitalia Diponegoro International Medical Journal (DIMJ) Indonesian Journal of Perinatology
Julian Dewantiningrum
Department Of Obstetrics And Gynecology, Faculty Of Medicine, Diponegoro University, Semarang, Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Medicine & Pharmacology Neuroscience Nursing Public Health

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Maternal hair lead and cytokine pro-inflammatory effects in preterm birth Qolby, Qonita Nur; Dewantiningrum, Julian; Pramono, Besari Adi; Maharani, Nani; Nugraha, Eka Djatnika; Muniroh, Muflihatul
International Journal of Public Health Science (IJPHS) Vol 13, No 4: December 2024
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v13i4.24146

Abstract

This case-control study analyzed the lead (Pb), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels in pregnant women with preterm birth (PTB) in Central Java, Indonesia. Hair samples from 72 pregnant women were collected non-invasively. The prenatal exposure to Pb was determined with the total reflection X-ray fluorescence (TXRF) method. Serum IL-6 and TNF-α were examined using enzyme-linked immunosorbent assays (ELISA). The Pb concentration in hair was slightly higher in women with PTB than those without PTB; however, this difference was not statistically significant. An elevated hair Pb level was not associated with increased PTB risk (OR 24.69, 95% CI 0.93–653.82, p>0.05). A serum TNF-α level ≥27 pg/ml, a serum IL-6 level ≥9 pg/ml, and the spouse’s smoking frequency were significantly associated with increased PTB risk (TNF-α OR 42.25, 95% CI 5.26–339.61; IL-6 OR 22.33, 95% CI 3.12–158.54; spouse’s smoking frequency OR 1.28, 95% CI 1.09–1.5), while the maternal hemoglobin concentration significantly decreased PTB risk (OR 0.43, 95% CI 0.2–0.927). This study demonstrates that maternal hair Pb concentration has no significant relationship with PTB. Serum TNF-α, IL-6, and the spouse’s smoking frequency potentially increased PTB risk, while the maternal hemoglobin level is a protective factor.
Effect of DLBS3233, Metformin, and Their Combination on the Expressions of VEGF and Endometriosis Implants in Endometriosis Mice (A Mouse Model in Endometriosis Study) Wardana, Setya Girindra; Trisetiyono, Yuli; Hadijono, Raden Soerjo; Mulyantoro, Inu; Cahyanti, Ratnasari Dwi; Dewantiningrum, Julian
Diponegoro International Medical Journal Vol 4, No 2 (2023): December 2023
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v4i2.18393

Abstract

Abstract Background: Endometriosis is a gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. The process of angiogenesis is regulated by VEGF which plays an important role in the development of endometriosis implants. Metformin is an insulin sensitizer that is known to have a beneficial effect in the treatment of endometriosis and DLBS3233 is a PPARγ agonist, it is hoped that it can reduce VEGF and reduce endometrial implants..Objective: To explore the effect of DLBS3233, metformin, and combination on VEGF expression and endometrial implant area of endometriosis-induced mice.Methods: This experimental study used 3-months old 28 BALB/c mice of endometriosis that were randomly and equally divided into four groups (K, P1, P2, and P3). On the 15th day, the K group was given a placebo, the P1 group was given DLBS3233 0.25 mg/day for 14 days, the P2 group was given metformin 4 mg/day for 14 days and the P3 group was given a combination. The immunohistochemistry of VEGF expression was performed from the abdominal cavity and pelvic peritoneal tissues of the mice and measured by the Remmele Scale Index, while the extracted mice's endometrial implants were analyzed with a computer tracing method. All data normality tests were calculated with the Shapiro-Wilk test. The mean difference test of all groups was analyzed using the one-way ANOVA test and the Kruskal-Wallis test.Results: There were significant differences in the expressions of VEGF (p=0.005) and endometrial implants (p=0.001). Expression of VEGF in the P3 group was significantly lower compared to others and endometrial implant area in the P2 group was significantly lower compared to others.Conclusion: DLBS3233 and Metformin may be a potentially effective drug treatments for endometriosis by decreasing VEGF expression and endometrial implants. Keywords: DLBS3233, Endometriosis, Metformin, VEGF
Factors Associated With Recurrence Of Epithelial Ovarian Cancer In RSUP Dr. Kariadi Semarang Kurube, Isabela Marsialina; Ambari, Ediwibowo; Iskandar, Teuku Mirza; Tjahjanto, Hary; Dewantiningrum, Julian; Mochtar, Arufiadi Anityo; Trisetiyono, Yuli
Diponegoro International Medical Journal Vol 3, No 2 (2022): December 2022
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v3i2.15448

Abstract

Introductions: Epithelial ovarian cancer accounts for 90% of all ovarian malignancies. More than 70% of patients will experience a relapse even after receiving operative therapy and chemotherapy. There are several prognostic factors that influence the recurrence of ovarian cancer. In Indonesia, especially at Dr. Kariadi Hospital, Semarang, the data as mentioned above is still very limited.objective: Knowing the disease-free survival rate, optimizing surgery and factors related to the incidence of recurrence in epithelial ovarian cancer patients at Dr. Kariadi Hospital SemarangMethods: This study is a retrospective cohort study with survival analysis. Data were collected through medical records, with the study population are patients with a diagnosis of epithelial ovarian cancer who were treated at Dr. Kariadi Hospital Semarang in period January 2018-December 2019. Furthermore, patients who had been remission were observed for signs of disease recurrence for 2 years period.Results: There were 361 patients with epithelial ovarian cancer who underwent primary treatment at Dr. Kariadi Hospital, Semarang in  2018-2019. Furthermore, there were observations of recurrence in 148 patients who achieved remission. Of these 76 patients (51.4%) experienced recurrence, while 72 patients not relapse. From 148 epithelial ovarian cancer patients who underwent cytoreduction surgery at Dr. Kariadi Hospital, Semarang, 113 patients (76.4%) achieved optimal operation with a residu less than 2 cm, while 35 patients (23.6%) were not optimal with a residu more than 2 cm. FIGO stage (HR 2.44) and tumor residu (HR 2.15) were shown to be significant factors associated with the recurrence of epithelial ovarian cancer.Conclusion: Overall disease-free survival in epithelial ovarian cancer at Dr. Kariadi Semarang were 74.8% (6 months), 57.1% (1 year), 42.5% (18 months), and 37.4% (2 years). Tumor residual factors and FIGO stage were shown to be significant prognostic factors influencing the recurrence of epithelial ovarian cancer. 
Perbandingan Karakteristik dan Luaran Maternal pada Unexpected Spektrum Placenta Akreta saat Pandemi Covid -19 Cahyanti, Ratnasari Dwi; Dewantiningrum, Julian; Pramono, Besari Adi; Larasati, Irene Astrid; Wiyati, Putri Sekar
JURNAL KESEHATAN REPRODUKSI Vol 10, No 2 (2023)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.87601

Abstract

Latar belakang: Pandemi COVID-19 mempengaruhi sistem pelayanan kesehatan di dunia. Kegawatan maternal yang diakibatkan oleh Spektrum Placenta Akreta (SPA) menjadi tantangan di bidang obstetri, khususnya dalam kinerja multidisplin tim dan dukungan sumber daya fasilitas kesehatan.Tujuan: Membandingkan karakteristik dan luaran dari pasien dengan unexpected dan expected SPA saat pandemi COVID-19.Metode: Desain penelitian secara cross-sectional. Pengambilan sampel kasus SPA secara consecutive sampling dari data rekam medis RSUP Dr. Kariadi, Semarang, pada periode 2020 – 2021.Hasil dan Pembahasan: Limapuluh tiga dari 154 kasus (34,42%) merupakan unexpected SPA. Tidak terdapat perbedaan karakteristik yang meliputi umur, indeks massa tubuh, jumlah riwayat sectio cesarea, jumlah riwayat placenta previa, cara persalinan dan kerjasama tim. Jumlah perdarahan dan kebutuhan transfusi darah yang diberikan tidak terdapat perbedaan pada kedua kelompok. Terdapat risiko untuk Cesarean histerektomi pada unexpected SPA (adjusted OR 4,13 (1,31-55,02)). Case Fatality Rate (CFR) pada unexpeted 5,67%, sedangkan pada expected 0,9%. Pada kasus unexpexted SPA didapatkan 3 kasus dengan terkonfirmasi COVID-19 dan meninggal.Kesimpulan: Tata kelola spektrum placenta akreta di RSUP Dr. Kariadi selama pandemi COVID-19 tidak terdapat perbedaan luaran maternal pada kasus unxpected dan expected dan didapatkan kualitas pelayanan optimal dengan CFR yang rendah.Kata kunci: Spektrum Placenta Akreta (SPA), unxpected dan expected, pandemi COVID-19, luaran maternal
In Utero Ultrasonography Parameters as a Children Growth Prediction at Age 2 – 3 : Parameter Ultrasonografi in Utero sebagai Prediksi Pertumbuhan Anak Usia 2-3 Tahun Mazaya, Radiva H.; Dewantiningrum, Julian; Rahmadi, Farid A.; Anantyo, Dimas T.
Indonesian Journal of Obstetrics and Gynecology Volume 11 No. 2 April 2023
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v11i2.1791

Abstract

ltrasound parameters during pregnancy and the growth of children aged 2 – 3 years.Methods: This was an analytic observational study with a longitudinal approach using data from the first 1,000 days of life. Study conducted at the Faculty of Medicine, Diponegoro University. The research subjects were children aged 2 – 3 years old with good nutritional status and democratic parenting from 14 City Health Centers in Semarang. The ultrasound parameters obtained were Biparietal Diameter (BPD), Abdomen Circumference (AC), Head Circumference (HC), Femur Length (FL) at 20 – 24 weeks of gestation. Data were obtained during the second trimester. Data on the growth of children at the age of 2 years obtained are height, weight, and HC. Statistical test using Pearson correlation test, with p<0.1 is considered significant.Results: The level of confidence used in this study was 90% and obtained 45 research subjects with a female gender of 26 children (57.8%) and 19 male children (42.2%). The Pearson test showed that there was no significant relationship between BPD and height (p=0.18; r=-0.20), AC and height (p=0.12; r=-0.23), and FL and height (p=0.17; r=-0.20). There was a significant relationship between HC and height (p=0.04; r=-0.29), BPD and weight (p=0.06; r=-0.28), HC and weight (p=0.01; r=-0,.5), AC and weight (p=0.08; r=-0.26), FL and weight (p=0.05; r=-0.29) and prenatal HC and postnatal HC (p=0.03; r=-0.32).Conclusion: There is a significant relationship between ultrasound parameters during pregnancy and the growth of children aged 2 – 3 years.Keywords: abdominal circumference, biparietal diameter, child growth, femur length, head circumference, pregnancy.AbstrakTujuan: Untuk mengetahui hubungan antara parameter ultrasonografi saat kehamilan dengan pertumbuhan anak usia 2-3 tahun.Metode: Penelitian ini merupakan penelitian observasional analitik dengan pendekatan longitudinal menggunakan data penelitian 1.000 hari pertama kehidupan yang dilakukan di Fakultas Kedokteran Universitas Diponegoro. Subjek penelitian adalah anak usia 2 – 3 tahun dengan gizi baik dan pola asuh demokratis dari 14 Puskesmas Kota Semarang. Parameter USG yang diperoleh adalah diameter biparietal (BPD), lingkar abdomen (AC), lingkar kepala (HC), dan panjang femur (FL) pada usia kehamilan 20 – 24 minggu. Data diperoleh selama trimester kedua. Data tumbuh kembang anak usia 2 tahun yang diperoleh adalah tinggi badan, berat badan, dan lingkar kepala. Uji statistik menggunakan uji korelasi Pearson, dengan p<0,1 dianggap signifikan.Hasil: Tingkat kepercayaan yang digunakan dalam penelitian ini adalah 90% dan diperoleh 45 subjek penelitian dengan jenis kelamin perempuan 26 anak (57,8%) dan 19 anak laki-laki (42,2%). Uji Pearson menunjukkan bahwa tidak ada hubungan yang signifikan antara BPD dengan tinggi badan (p=0,18; r=-0,20), AC dan tinggi badan (p=0,12; r=-0,23), dan FL dan tinggi (p=0,17; r=-0,20). Terdapat hubungan yang signifikan antara HC dengan tinggi badan (p=0,04; r=-0,29), BPD dan berat badan (p=0,06; r=-0,28), HC dengan berat badan (p=0, 01; r=-0,35), AC dan berat badan (p=0,08; r=-0,26), FL dan berat badan (p=0,05; r=-0,29) dan HC prenatal dan postnatal HC (p=0,03; r=-0,32).Kesimpulan: Terdapat hubungan yang signifikan antara parameter ultrasonografi saat kehamilan dan pertumbuhan anak usia 2 – 3 tahun.Kata kunci: diameter biparietal, kehamilan, lingkar abdomen, lingkar kepala, panjang femur, pertumbuhan anak.
Ethnopharmacological insights and clinical prospects of ten Indonesian medicinal plants for pregnancy, postpartum, and lactation: a systematic review 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; Rahardjo, Theresia Monica; Suryawan, Aloysius; Rahardjo, Bambang; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Sulistyowati, Sri; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Perinatology Vol. 6 No. 1 (2025): (Available online: 1 June 2025)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v6i1.77

Abstract

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.
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,
Efficacy and Tolerability of Short-Term Hormonal Therapy Following Conservative Surgery for Endometriosis: Efficay and Clinical Tolerability of Short-Term Hormonal Treatment for Endometriosis Pain Trisetiyono, Yuli; Sarastry, Razmaeda; Dewantiningrum, Julian; Anityo Mochtar, Arufiadi; Kristanto, Herman; Thaufik Hidayat, Syarief
Indonesian Journal of Obstetrics and Gynecology Volume 13. No. 4 October2025
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v13i4.2588

Abstract

AbstractObjective: To compare the efficacy and tolerability of four short-term hormonal therapies; Dienogest (DNG), Depot Medroxyprogesterone Acetate (DMPA), continuous Combined Oral Contraceptive (COC), and Leuprolide Acetate (LA); administered for 12 weeks after conservative endometriosis surgery. Methods: This randomized, prospective, open-label study enrolled reproductive-aged women with surgically confirmed endometriosis. Participants were randomly assigned to receive DNG 2 mg daily, DMPA 150 mg intramuscularly every 12 weeks, continuous COC (ethinyl estradiol 0.03 mg and levonogestrel 0.15 mg) daily, or LA 3.75 mg intramuscularly every 4 weeks. Primary outcomes were changes in pain intensity (visual analog scale, VAS), hormonal markers (estradiol, E2), inflammatory markers (TNF-?), and the Menopause Rating Scale (MRS) as an indicator of tolerability. Data were analyzed using ANOVA with a significance level of p < 0.05. Results: All four regimens resulted in significant reductions in dysmenorrhea, dyspareunia, and chronic pelvic pain after 12 weeks (p < 0.001). E2 and TNF-? levels decreased significantly in all groups, with the greatest decline observed in the LA arm. No significant differences were found among regimens in pain reduction or biomarker changes (p > 0.05). MRS scores increased transiently at week 8, particularly in the LA group, reflecting hypoestrogenic effects, but decreased by week 12 in all groups. Conclusion: Short-term postoperative hormonal therapy with DNG, DMPA, COC, or LA effectively reduces pain and inflammatory markers following endometriosis surgery. Progestin-based therapies achieve comparable clinical efficacy to GnRH agonists with superior tolerability. Individualized selection based on symptom profile, side effects, and accessibility is recommended in accordance with ESHRE guidelines. Keywords: endometriosis-associated pain, Menopause Rating Scale, short-term hormonal therapy.
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.
Correlation between referral type (emergency vs scheduled) and maternal perinatal outcome in suspected placenta accreta spectrum : a retrospective cohort study in Dr.Kariadi hospital Semarang 2020-2023 Umami, Hayyina Maslikhatul; Cahyanti , Ratnasari Dwi; Tjahjanto, Hary; Hadijono, Soerjo; Dewantiningrum, Julian; Putra, Very Great Eka
Medica Hospitalia : Journal of Clinical Medicine Vol. 13 No. 1 (2026): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v13i1.1366

Abstract

BACKGROUND : Maternal Mortality Rate (MMR) in Indonesia at 2023 was 189 over 100.000 live births. The most popular reason for maternal death was obstetrics hemorrhage. Obstetric hemorrhage can be caused by abnormal placentation. Abdominal delivery by cesarean section has increased recently in Indonesia. Cesarean section will increase the risk for placenta accreta spectrum, which raises maternal morbidity and mortality. AIM : To analyze the correlation of emergency and scheduled referral with maternal and perinatal outcomes of suspected placenta accreta spectrum patients in Dr.Kariadi Hospital Semarang 2020 – 2023.METHODS : A cohort retrospective study performed in May 2024, involved 153 women with suspected placenta accreta spectrum were referred to Dr.Kariadi Hospital Semarang in 2020 – 2023, divided by emergency referral and scheduled referral groups. We use Placenta Accreta Index (PAI) Score and all patients who fulfilled the criteria of the placenta accreta spectrum based on FIGO to predict suspicious placenta accreta spectrum. Descriptive analysis included the base characteristics of the patients. Correlation analysis with maternal and perinatal outcomes using Chi Square analyze of SPSS 25.00 version.RESULTS : A total of 69 patients with emergency referrals and 84 patients with scheduled referrals. Mean age was 32.97, median 32(24-44), median of gestation was 3(1-6) and 3(1-9), median of gestational age was 35(22-41) and 36(32-39). The emergency referral had a higher risk for cesarean hysterectomy with OR (95%CI) 2.92 (1.51–5.67), for maternal hemorrhage with OR (95%CI) 2.34 (1.22–4.49), for blood transfusion with OR (95%CI) 6.02 (2.46–14.76), for intensive care admission with OR (95%CI) 4.39 (1.5–12.79), for prematurity with OR (95%CI) 2.56(1.32–4.92), for asphyxia with OR (95%CI) 3.41(1.56–7.47). There were significant differences between emergency and scheduled referrals for vaginal delivery (p=0.03), and perinatal mortality (p=0.04). Estimated blood loss was 1453.7± 1253.6 ml in emergency referral and 878.3 ± 823.7 ml in scheduled referral.CONCLUSION : Emergency referrals had worse maternal and perinatal outcomes than scheduled referrals for suspicious placenta accreta spectrum patients.
Co-Authors Adhi Pribadi Afina Yuliani Putri Agoes Oerip Poerwoko Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Aloysius Suryawan Anantyo, Dimas T. Anantyo, Dimas Tri Andonotopo, Wiku Anityo Mochtar, Arufiadi Annastasia Ediati Bachnas, Muhammad Adrianes Bambang Rahardjo Besari Adi Pramono Besari Adi Pramono Cahya Novenita Azzahra Cahyanti , Ratnasari Dwi Ch Nawangsih Prihharsanti Cut Meurah Yeni Darmawan, Ernawati Dewi Astri Purnaningtyas Dik Puspasari Dwi Pudjonarko Ediwibowo Ambari Evert Solomon Pangkahila Hadijono, Raden Soerjo Hapsari, Anggiyasti Vidya Hary Tjahjanto Haryana, Bambang Herman Kristanto Hermawan Hermawan I Nyoman Hariyasa Sanjaya Inu Mulyantoro Kurjak, Asim Kurube, Isabela Marsialina Larasati, Irene Astrid Liza Afriliana Maria Mexitalia Martina Wibowo Mazaya, Radiva H. Mochtar, Arufiadi Anityo Mona Galatia Marpaung Mulyantoro, Inu Muniroh, Muflihatul Nani Maharani Noor Pramono Nugraha, Eka Djatnika Nuswil Bernolian Pramono, Mochammad Besari Adi Putra, Very Great Eka Putri Sekar Wiyati Qolby, Qonita Nur Rabiah Adawiyah Raden Soerjo Hadijono Radith Aulia Rahmad R. B. Wicaksono Rahmadi, Farid A. Rahman, Farhan Aulia Ratnasari Dwi Cahyanti Ratnasari Dwi Cahyanti, Ratnasari Dwi Rizky Syahriar Syoufana Ryan Saktika Mulyana Sarastry, Razmaeda Soejoenoes, Ariawan Soerjo Hadijono Sri Sulistyowati Stanojevic, Milan Suharyo Hadisaputro Teuku Mirza Iskandar, Teuku Mirza Thaufik Hidayat, Syarief Theresia Monica Rahardjo Umami, Hayyina Maslikhatul Ushan, Ery Perdana Wardana, Setya Girindra Widyawati Widyawati Wiradnyana, Anak Agung Gede Putra Yan Wisnu Prajoko Yuli Trisetiyono, Yuli Zaki Hetami