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Ryan Saktika Mulyana
Departemen Obstetri Dan Ginekologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Dentistry Economics, Econometrics & Finance Environmental Science Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary

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Performance of Rapid Antibody Test and RT-PCR as Frontline Test for COVID-19 Diagnosis in Pregnancy: an Experience in Indonesia Evert S. Pangkahila; Ryan S. Mulyana; Hariyasa Sanjaya; Mulyantari K; Daniel H. Susanto
Journal Research of Social Science, Economics, and Management Vol. 1 No. 7 (2022): Journal Research of Social Science, Economics, and Management
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2051.354 KB) | DOI: 10.59141/jrssem.v1i7.106

Abstract

Ensuring an accurate diagnosis is critical for limiting the spread of SARS-CoV-2 and for the clinical management of COVID-19, especially in pregnant women. For now real-time reverse transcription polymerase chain reaction (RT-qPCR) is the currently recommended laboratory method for the diagnosis of acute SARS-CoV-2 infection. More recently, several easy-to-perform rapid antigen detection tests have been developed and are recommended as first-line screening test in several countries. The purpose of this study was to evaluate the comparative performance of a rapid antibody test and RT-PCR for the detection of SARS-CoV-2 infection, as a front-line test for the diagnosis of COVID-19 in pregnancy. This research method is a descriptive study to describe comparation of sensitivity and specificity between rapid SARS-CoV-2 antibody test to the gold standard nasopharyngeal RT-PCR swab test. Of the 271 samples, only 257 were eligible and fourteen cases were excluded from the study due to a lack of rapid antibody test and RT-PCR results. The results of this study showed that the rapid SARS-CoV-2 antibody test sensitivity was 80.95%, and the specificity was 90.68%, the NPV (negative predictive value) and the PPV (positive prognosis value) were 98.17% and 43.59%, respectively. Based only on the results of IgM and IgG, IgM and IgG sensitivity were 33.33% (7/21) and 71.43% (15/21), respectively, and the specificity was 91.1% (215/236, 21 false positive) and 91.53% (216/236, 20 false positive), respectively. The use of rapid antibody tests during pregnancy is a screening tool and is not currently applicable for diagnostic tool. To minimize false positives and negatives results, the use of rapid antibody tests should be combined with the RT-PCR test results.
Friedman Curve Positively Correlates with Cesarean Section and Oxytocin Augmentation in Active Phase Delivery as Compared to Partograph: Kurva Friedman Berkorelasi Positif dengan Seksio Sesarea dan Augmentasi Oksitosin pada Fase Aktif Persalinan dibandingkan Partograf Anak Agung Ngurah Anantasika; I Wayan Artana Putra; Ida Bagus Putra Adnyana; I Wayan Megadhana; Ryan Saktika Mulyana; Agustinus Darmawan Hariyanto
Indonesian Journal of Obstetrics and Gynecology Volume 11 No. 3 July 2023
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v11i3.1867

Abstract

Objective: To investigate the correlation between cesareansection and oxytocin augmentation in childbirth monitoredwith the Friedman curve compared to the World HealthOrganization (WHO) partographs.Methods: An analytic cross-sectional study was conductedfrom March to May 2021, involving mothers giving birthwhose delivery process was monitored using either theFriedman curve or the WHO partograph (n=28 for eachgroup) at Wangaya Hospital in Denpasar City. The durationof the active phase until delivery, occurrence of cesareansection, and administration of oxytocin augmentationwere assessed using the Friedman curve and the WHOpartograph. The normality of the data was tested using theKolmogorov-Smirnov test, and the Spearman correlationtest was employed to measure the direction and strengthof the correlation.Results: There was no signifi cant difference between thegroups in terms of monitoring the active phase until deliveryusing the Friedman curve compared to the WHO partograph(p=1.000 > 0.05). Maternal monitoring with the Friedmancurve showed a positive correlation with the occurrenceof cesarean section compared to the WHO partograph(r=0.296, p=0.027). Additionally, monitoring childbirth withthe Friedman curve exhibited a positive correlation with theadministration of oxytocin augmentation compared to theWHO partograph (r=0.298, p=0.026).Conclusion: The fi ndings suggest a stronger positivecorrelation between the incidence of cesarean section andthe administration of oxytocin augmentation in childbirthmonitored with the Friedman curve compared to the WHOpartograph.Keywords: cesarean section, Friedman curve, oxytocinaugmentation, WHO partograph.AbstrakTujuan: Untuk menentukan korelasi antara operasi sesardan augmentasi oksitosin pada persalinan yang dipantaudengan kurva Friedman dibandingkan dengan partografOrganisasi Kesehatan Dunia (WHO).Metode: Desain penelitian analitik potong lintangdilakukan pada Maret-Mei 2021, dengan melibatkan ibubersalin yang proses persalinannya dipantau menggunakankurva Friedman atau Partograf WHO (n=28 untuk setiapkelompok) di ruang bersalin di Rumah Sakit Wangaya,Kota Denpasar. Waktu fase aktif hingga kelahiran bayi,persalinan seksio sesarea, dan augmentasi oksitosin dinilaidengan menggunakan kurva Friedman dan Partograf WHO.Uji normalitas dilakukan dengan uji Kolmogorov-Smirnov,dilanjutkan dengan uji korelasi Spearman untuk mengukurarah dan kekuatan korelasi.Hasil: Pemantauan ibu bersalin dengan kurva Friedmandibandingkan dengan Partograf WHO dalam hal faseaktif-persalinan bayi menunjukkan tidak ada perbedaanyang signifi kan di antara kedua kelompok (p = 0,000 >0,05). Pemantauan ibu dengan kurva Friedman berkorelasipositif dengan kejadian bedah sesar dibandingkandengan Partograf WHO (r = 0,296, p = 0,027). Selain itu,pemantauan persalinan dengan kurva Friedman berkorelasipositif dengan pemberian oksitosin dibandingkan denganpartograf WHO (r = 0,298, p = 0,026).Kesimpulan: Terdapat korelasi positif yang lebih tinggiantara kejadian bedah sesar dan pemberian augmentasioksitosin pada proses persalinan yang dipantau dengankurva Friedman dibandingkan dengan partograf WHO.Kata kunci: augmentasi oksitosin, kurva friedman, partografWHO, seksio sesarea
High Neutrophils to Lymphocytes Ratio in Maternal Blood Serum as Risk Factor for Preterm Premature Rupture of Membrane Nicholas Renata Lazarosony; I Wayan Artana Putra; Ryan Saktika Mulyana; I Made Darmayasa; Ida Bagus Gde Fajar Manuaba; I Gde Sastra Winata; I Nyoman Gede Budiana
International Journal of Social Service and Research Vol. 3 No. 9 (2023): International Journal of Social Service and Research (IJSSR)
Publisher : Ridwan Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46799/ijssr.v3i9.518

Abstract

Introduction: Neutrophil-to-lymphocyte ratio (NLR) has been extensively studied as a prognostic factor for various diseases based on systemic inflammation. Premature rupture of membranes (PROM) is an obstetric problem that does not only occur in term pregnancies but can also occur in preterm pregnancies. One of the main etiologies for premature rupture of membranes is inflammation. Knowing the difference in the NLR between preterm prematurerupture of membranes (PPROM) and without PPROM is important to increase understanding of the crucial role of NLR in predicting the incidence of PPROM. Method: This analytic case-control study compared NLR values ??in maternal blood serum between PPROM and without PPROM. This research was conducted in the emergencydelivery room and obstetrics and gynecology outpatient clinic at Prof. dr. I.G.N.G. Ngoerah Hospital Denpasar from February to June 2022. Results: A high NLR in maternal blood serum may be a risk factor for PPROM. Patients with a high NLR had a 4.5 times greater likelihood of experiencing PPROM than those with a low NLR (OR = 4.5; 95% CI = 1.4 – 13.83; p = 0.007). Conclusion: A high NLR in maternal blood serum is a marker of inflammation with an increased risk of 4.5 times for the occurrence of PPROM.
HIGH SERUM RATIO OF SOLUBLE FMS-LIKE TYROSINE KINASE 1 (sFlt-1) TO PLACENTAL GROWTH FACTOR (PIGF) AND HIGH LEVEL OF LOW-DENSITY LIPOPROTEIN (LDL) AS RISK FACTORS OF PREECLAMPSIA Kevin Agastya Duarsa; Jaya Kusuma; Endang Sri Widiyanti; I Wayan Megadhana; Putu Doster Mahayasa; Ryan Saktika Mulyana
Jurnal Health Sains Vol. 4 No. 7 (2023): Journal Health Sains
Publisher : Syntax Corporation Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46799/jhs.v4i7.1004

Abstract

Preeclampsia is an obstetric disease that is a health problem worldwide, including in Indonesia. Several studies have shown that changes in the maternal spiral arteries are thought to lead to preeclampsia. Preeclampsia in this decade has been associated with changes in angiogenesis regulatory proteins originating from the placenta and circulating in the mother's blood circulation, namely soluble FMS-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF). The author was interested in examining the ratio of sFlt-1/PIGF and low-density lipoprotein (LDL) to the incidence of preeclampsia in pregnant women. This study used a case control analytic observational design. The research sample was selected by consecutive sampling of 20 cases and 20 controls. Univariate analysis was used to describe patient characteristics descriptively, and bivariate analysis was used to determine the relationship between the 2 variables There is no significant difference in the characteristics of the research subjects. Low PIGF levels are a risk factor for preeclampsia (OR 4.33; p 0.0302) with a cut-off value of 24.5. High sFlt-1 levels are a risk factor for preeclampsia (OR 4.33; p 0.027) with a cut-off value of 869.5. A high sFlt-1/PIGF ratio is a risk factor for preeclampsia (OR 4.33 p 0.030) with a cut-off value of 38. High LDL levels are a risk factor for preeclampsia (OR 6.0; p 0.013) with a cut-off value of 150 ,2. Low placental growth factor (PIGF), high levels of soluble FMS-like tyrosine kinase 1 (sFlt-1), and high levels of LDL are risk factors of preeclampsia in pregnant women.
ANGKA KELANGSUNGAN HIDUP PASIEN KANKER SERVIKS DI RUMAH SAKIT UMUM PUSAT PROF. DR. I.G.N.G. NGOERAH Mahastya, I Wayan Cahya; Budiana, I Nyoman Gede; Mulyana, Ryan Saktika; Suwardewa, Tjokorda Gde Agung; Wijaya Surya, I Gede Ngurah Harry
E-Jurnal Medika Udayana Vol 13 No 8 (2024): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2024.V13.i08.P17

Abstract

ABSTRACT Cervical cancer is a type of cancer that develops in the cervix as a result of an infection with high-risk HPV. Cervical cancer patients have varying survival rates. This will be influenced by the patient's prognostic factors such as age, histopathological type, metastases, stage, tumor size, and treatment modalities. This research employs an analytical observational approach and utilizes a retrospective cohort research design. Survival rates will be measured using Kaplan Meier and log-rank based on prognostic factors. The research was carried out at RSUP Prof. Dr. I.G.N.G. Ngoerah, utilizing data from cervical cancer patients in the year 2021. The sample in this study was 245 samples. From 245 samples, 55 patients (22.4%) experienced events (died), 32 patients (13.1%) were uncensored (alive), and 158 patients (64.5%) were censored. The highest one-year survival rate based on prognostic factors was patients with age <40 years (78.8%), histopathological type of SCC (78.1%), no metastases (78.2%), patients with stage I (81%), tumor size < 2 cm (82.9%), and treatment modalities of chemotherapy, radiotherapy, and hysterectomy (90%). The results of the analysis based on the log rank test which reports only the incidence of metastasis factors show significant results on the one-year survival of cervical cancer patients. The overall one-year survival rate for cervical cancer patients is 77.6%. To determine the survival rate for cervical cancer patients over three and five years, further research is required. Keywords: Cervical cancer, HPV, Kaplan-Meier, Log rank, and Survival rate.
KARAKTERISTIK MENOPAUSE PADA PERAWAT DI RSUP SANGLAH DENPASAR TAHUN 2021 Kirana, Ni Wayan Kartika Candra; Surya, I Gede Ngurah Harry Wijaya; Manuaba, Ida Bagus Gede Fajar; Mulyana, Ryan Saktika
E-Jurnal Medika Udayana Vol 11 No 4 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i04.P16

Abstract

The age of menopause varies in each woman, due to differences in the characteristics of certain factors that are thought to have an effect. This study aims to determine the age of menopause and the characteristics of education level, marital status, parity, age of menarche, age of first birth, history of hormonal contraceptive use, and Body Mass Index in postmenopausal nurses at Sanglah General Hospital Denpasar in 2021. This study is an observational descriptive study with a cross-sectional approach. The sample consisted of 60 respondents who were collected by total sampling method. Data were collected through interviews using a questionnaire. The results showed that 88,3% experienced menopause at the age of >45 years with the most distribution at the age of 50 years (30%). The characteristics of respondents were as follows, namely 100% in married, 88,3% completed D3/S1/S2/S3, 73,3% had given birth to 1-2 children, 88,3% gave birth to their first child at the age of 20-29 years, 58,3% menarche at age > 14 years, 61,7% never used hormonal contraception, 51,7% are obese I. The results of this study are expected to be used as a basis for further research to determine the association between the characteristics of a woman and menopausal age. Keywords : menopause, menopausal age, characteristics.
Relationship between total 25(OH)D and interleukin-2 contents in preterm conversion patients Sanjaya, I Nyoman Hariyasa; Mulyana, Ryan Saktika; Kamajaya, I Gusti Ngurah Agung Trisnu
Indonesian Journal of Perinatology Vol. 5 No. 1 (2024): Available online: 1 June 2024
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v5i1.37

Abstract

The most essential nutrient for pregnant women is vitamin D. A lack of vitamin D can cause preterm labor and other issues like low birth weight, preeclampsia, and issues with the baby's bones. According to some research, there is no safe top level and a 75–80 nmol/L range. According to additional studies, an ideal range is between 75 and 110 nmol/L and a daily dosage of 1800 to 4000 IU of vitamin D3. In both early and late pregnancies, women with sufficient vitamin D levels (at least 30 ng/mL) exhibited a significant decrease in the incidence of preeclampsia. It is also known that vitamin D modulates the immune system in several ways. T-cell proliferation can be suppressed, and pro-inflammatory cytokines, including IL-2, IFN-, and IL-17, can be produced less frequently when vitamin D is present. A lack of vitamin D may lead to a rise in cytokines that promote inflammation, such as IL-2. This paper will, therefore, examine the relationship between vitamin D, IL-2 levels, and the risk of premature labor.
Maternal-related factors associated with development and improvement of peripartum cardiomyopathy and therapeutic outcomes of bromocriptine Pradnyaandara, I Gusti Bagus Mulia Agung; Mulyana, Ryan Saktika; Sutedja, Jane Carissa; Jagannatha, Gusti Ngurah Prana; Wibawa, I Bagus Satriya; Deantri, Fanny; Pradnyana, I Wayan Agus Surya; de Liyis, Bryan Gervais
Majalah Obstetri & Ginekologi Vol. 32 No. 2 (2024): August
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I22024.112-127

Abstract

HIGHLIGHTS Younger age, black race, normotension, and multiparity indicate a poorer prognosis for peripartum cardiomyopathy recovery, while bromocriptine therapy reduces adverse events.   ABSTRACT Objectives: This study aimed to fill the significant knowledge gap regarding peripartum cardiomyopathy (PPCM), a heart failure phenotype linked to pregnancy. The main objectives were to explore the factors influencing the development and progression of PPCM and to assess the outcomes of bromocriptine.Materials and Methods: Systematic search across PubMed, ScienceDirect, and Cochrane Library identified studies until December 2022. This study includes non-randomized prospective and retrospective studies, as well as relevant randomized controlled trials. Risk factors were compared between the recovered and non-recovered PPCM groups, and bromocriptine therapy outcomes were evaluated against standard heart failure treatment as the primary endpoint.Results: The analysis included 24 observational studies and 1 randomized controlled trial involving 1,651 PPCM patients; 9 studies evaluating the outcomes of bromocriptine therapy. The most prevalent factors were caesarean delivery (proportion=53%, 95%CI=41%-66%) and anemia (proportion=51%, 95%CI=38%-65%). Non-recovered patients were younger (MD=-1.04 years old, 95%CI=-1.82-(-0.27), p=0.008) and predominantly black (RR=1.82, 95%CI=1.43-2.31, p <0.001). Hypertensive disorders and primiparity were found less among non-recovered patients (RR=0.73, 95%CI=0.60-0.88, p=0.001; RR=0.81, 95%CI=0.66-0.99, p=0.04, respectively). Non-recovered patients also exhibited higher baseline serum creatinine levels, lower LVEF, larger left ventricular end-systolic diameter (LVESD), larger left ventricular end-diastolic diameter (LVEDD), and lower fractional shortening (all P-values<0.05). Furthermore, bromocriptine significantly reduced major adverse cardiac events (MACE), mortality, and increased LVEF (all P-values<0.05).Conclusion: Younger maternal age, black race, absence of hypertension, and multiparity are associated with poorer prognosis for PPCM recovery. Bromocriptine therapy demonstrates superior benefits in reducing adverse events in PPCM.
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,
Co-Authors A. A. Ngurah Laksamana Yudha A.A. Ngurah Laksamana Yudha Adhi Pribadi Agustinus Darmawan Hariyanto Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Alfonso Anggriawan Aloysius Suryawan Anak Agung Gede Putra Wiradnyana Anak Agung Ngurah Anantasika Andonotopo, Wiku Anom Suardika Bachnas, Muhammad Adrianes Bambang Rahardjo Cut Meurah Yeni Daniel H. Susanto de Liyis, Bryan Gervais Deantri, Fanny Denni Prasetyo Endang Sri Widiyanti Endang Sri Widiyanti Evert Solomon Pangkahila Hartanto Hartanto I Gde Sastra Winata I Made Darmayasa I Nyoman Gede Budiana I Nyoman Hariyasa Sanjaya I Wayan Artana Putra I Wayan Megadhana I Wayan Megadhana Ida Bagus Gde Fajar Manuaba Ida Bagus Putra Adnyana Jagannatha, Gusti Ngurah Prana Jaya Kusuma Julian Dewantiningrum Kamajaya, I Gusti Ngurah Agung Trisnu Kevin Agastya Duarsa Kirana, Ni Wayan Kartika Candra Kurjak, Asim Made Suyasa Jaya Mahastya, I Wayan Cahya Manuaba, Ida Bagus Gede Fajar Ni Kadek Mulyantari Ni Wayan Ariati Trisna Dewi Nicholas Renata Lazarosony Nuswil Bernolian Nyoman Bayu Mahendra Pradnyaandara, I Gusti Bagus Mulia Agung Pradnyana, I Wayan Agus Surya Pramono, Mochammad Besari Adi Putu Doster Mahayasa Rey Jauwerissa Sri Sulistyowati Stanojevic, Milan Surya, I Gede Ngurah Harry Wijaya Sutedja, Jane Carissa Theresia Monica Rahardjo Tjokorda Gde Agung Suwardewa Wibawa, I Bagus Satriya Wijaya Surya, I Gede Ngurah Harry William Alexander Setiawan Wiradnyana, Anak Agung Gede Putra