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All Journal Medicina E-Jurnal Medika Udayana The Indonesian Biomedical Journal Indonesian Journal of Obstetrics & Gynecology Science ISM (Intisari Sains Medis) : Jurnal Kedokteran Indonesian Journal of Perinatology Journal Research of Social Science, Economics, and Management

Evert Solomon Pangkahila

Department Of Obstetrics And Gynecology, Division Of Maternal-Fetal Medicine,Udayana University Hospital-Bali

Author-ID : 4353325

Biochemistry, Genetics & Molecular Biology Environmental Science Health Professions Medicine & Pharmacology Nursing Public Health

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TIDAK TERDAPAT PERBEDAAN YANG BERMAKNA ANTARA NILAI ABSOLUT CLUSTER DIFFERENTIATION4 DAN PERSENTASE CLUSTER DIFFERENTIATION4 IBU HAMIL 162 TERINFEKSI HUMAN IMMUNODEFICIENCY VIRUS PADA TRIMESTER II DAN III Pangkahila, Evert Solomon; Suwiyoga, Ketut; Mahayasa, Putu Doster
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (153.71 KB)

Nilai absolut cluster differentiation 4 (CD4) diduga dipengaruhi oleh tingkat hemodilusi yang berbeda pada tiap trimester, sedangkan nilai persentase CD4 diduga tidak dipengaruhi oleh tingkat hemodilusi. Oleh karena itu penelitian mengenai perbandingan antara nilai aboslut CD4 dan persentase CD4 pada trimester yang berbeda pada kehamilan dengan HIV penting untuk dilakukan untuk melihat variasi nilai hitung CD4 (absolut dan persentase).Untuk membuktikan pengaruh kehamilan terhadap variasi nilai hitungabsolut CD4 dan persentase CD4 pada kehamilan dengan HIVtrimester II dan III,penelitian observasional dengan menggunakan rancangan studi kohort dilakukan untuk melihat bagaimana variasi nilai absolut CD4 dibandingkan persentase CD4 pada wanita hamil dengan HIV trimester II dan III. Penelitian dilaksanakan selama dua tahun dimulai dari Oktober 2011 sampai Oktober 2013. Dua puluh sampel penelitian dianalisis secara statistik. Hasil uji t menunjukkan nilai P>0.05 pada nilai absolut CD4 maupun persentase CD4. Hasil penelitian menunjukkan bahwa nilai absolut CD4 dan persentase CD4 tidak mengalami fluktuasi yang bermakna selama trimester II dan III pada kehamilan dengan HIV. Nilai absolut CD4 merupakan metode yang dapat dipercaya dalam menilai status imun ibu hamil dengan HIV, tanpa perlu melakukan pemeriksaan persentase CD4. Nilai persentase CD4 dapat dipertimbangkan dalam menilai status imun ibu hamil dengan HIV apabila terdapat faktor lain selain kehamilan yang dapat memengaruhi nilai absolut CD4. [MEDICINA 2015;46:162-5].Absolute cluster differentiation 4 (CD4) count is suspected to be influenced by the degree of hemodilution which is different in each trimester of pregnancy, while percentage of CD4 is thought not to be under significant influence of hemodilution. Thus, a study about the comparison between absolut CD4 and percentage of CD4 at different trimester (2nd and 3rd trimester) of pregnancy with HIV infection, are important to evaluate the variation of CD4 (absolute and percentage). To prove the influence of pregnancy to the variation of absolute CD4 count and percentage of CD4 in pregnancy with HIV infection at 2 nd and 3 trimester, an observational study using cohort design was conducted to evaluate the variation of absolute CD4 and percentage of CD4 in pregnant woman with HIV infection at 2 nd and 3 rd rd trimester. This study was held from October 2011 until October 2013.Twenty sample were statistically analyzed. T-paired test showed that the P value >0.05 in both CD4 count. It means that there was no significant difference in mean of CD4, either absolute or percentage in 2 trimester. The result showed that the absolute and percentage of CD4 did not fluctuate significantly during the 2 nd and 3 trimester of pregnancy. Absolute CD4 count is a valid method to asses the immune status of pregnant woman with HIV, and its not necesarry to count the percentage of CD4. Percentage of CD4 probably should be considered if there are any other factors beside the pregnancy itself that can interfere with the absolute CD4 count. [MEDICINA 2015;46:162-5].

Congenital vulvar teratoma: a case report I Nyoman Hariyasa Sanjaya; Ryan Saktika Mulyana; Evert Solomon Pangkahila; Hartanto Hartanto
Indonesian Journal of Perinatology Vol. 1 No. 1 (2020): Available Online: 1 December 2020
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Introduction: Teratoma is an embryonal neoplasm consisted of 3 germinal layers. Teratoma usually arises along the line of embryonic cleft and sinus closure formed by the fusion of skin during the embryonic development. In this case report, we present a case of fetal Teratoma on the vulval region, a very rare variant of the disease. Case: A 28-year-old woman came for a routine check-up for her first pregnancy at her 26th weeks of gestational age. On ultrasound examination, a mass was found around the fetal vulva. There was no mass or malformations on other body parts. Placenta and the amount of amniotic fluid were normal. History of congenital anomaly in the family was denied. The patient then gave birth to a female baby at 38 weeks of gestational age without any complication. The baby was healthy, 2650 gram in weight, 50 cm in length, with good APGAR Score (8-10). On the baby left labia, there was a mass measured 5 cm x 4 cm x 3 cm, with slight discoloration. We recommend an early tumor excision to prevent unnecessary complication such as malignant transformation. Although at the time of writing, the patient still waiting for the schedule to remove the tumor due to a non-medical factor. Conclusion: Congenital Teratoma in the vulvar region was a very rare event. First-line therapy is early tumor excision and usually carries an excellent prognosis.

Management of polyhydramnios pregnancy without risk factors: a case report I Nyoman Hariyasa Sanjaya; Ryan Saktika Mulyana; Evert Solomon Pangkahila; Denni Prasetyo
Indonesian Journal of Perinatology Vol. 1 No. 1 (2020): Available Online: 1 December 2020
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Introduction: Polyhydramnios is a condition in which the amount of amniotic fluid increases more than 2 litres. The causes of polyhydramnios are multifactorial, and most are idiopathic. Here we report challenging management of polyhydramnios case without apparent risk factors. Case: A 30-year-old woman G2P1001, 27-28 weeks of gestational age referred due to our tertiary health care center due to polyhydramnios. The patient chief complaint was progressively enlarged abdomen since a month ago. Her previous pregnancy, medical history and family history were unremarkable. The obstetric examination reflects the size of uterus equivalent to 36 weeks of gestational age. The fetomaternal ultrasound reveals a life, single fetus with normal heart rate and fetal movement, estimated fetal weight about 1057 grams, placenta corpus posterior grade I, Maximum Vertical Pocket 22.83 cm, no major congenital abnormalities were visible and bladder appears filled. Laboratory tests revealed blood glucose levels 90 mg/dl, Hb-A1c 5.2%, Ureum 27.30 mg/dl, Creatinine 3.39 mg/dl, and numerous leukocytes on urine sediment. Amnioreduction and fetal pulmonary maturation were conducted by Dexamethason protocol. Amnioreduction yield 1500 ml of clear, yellowish amniotic fluid. Regarding abnormality in renal function, diagnosis of Acute on Chronic Kidney Disease (ACKD were established by Internal medicine department, and the patients were given a series of ceftriaxone injection. The patient was planned for indomethacin therapy; however, Indomethacin was not available in Bali. Conclusion: Careful search for causes both from the maternal factor and fetal abnormalities can help to determine the prognosis of pregnancy. Ideally, amnioreduction, coupled with indomethacin therapy, are needed to reduce amniotic fluid, and serial monitoring of the amniotic fluid volume is required to prevent preterm labor.

Lower Urinary Tract Obstruction (LUTO) pada fetus: laporan kasus Rey Jauwerissa; I Nyoman Hariyasa Sanjaya; Endang Sri Widiyanti; Ryan Saktika Mulyana; Evert Solomon Pangkahila
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Background: Lower fetal urinary tract obstruction (LUTO) is an abnormality observed during an ultrasound test in the antenatal period in the form of an enlarged fetal bladder. Oligohydramnios, renal cortex dilation, and pulmonary hypoplasia may be caused by obstruction of the lower urinary tract. In the management of LUTO, early diagnosis and assessment as early as possible are very important. The insertion of a shunt from the fetal bladder to the amniotic cavity is one of the therapies for fetal LUTO (vesicoamniotic shunt). This case study aims to determine the management of LUTO in fetuses at Sanglah Hospital, Bali, Indonesia. Case Presentation: A 39-year-old female G3P2002 was referred to the obstetrics and gynecology clinic of Sanglah Hospital with suspected fetal LUTO for 18-19 weeks. There were no complaints or risk factors for LUTO in the past. Physical examination and obstetric examinations were within normal limits. On ultrasound examination, there was a hypohyperechoic image measuring 4.3 x 5.3 cm with the impression of the enlarged bladder, key-hole appearance, oligohydramnios, and bilateral hydronephrosis. Double pigtail installation on the fetus, amnioinfusion, and amniosynthesis was performed for karyotyping. Ten weeks after double pigtail placement, the patient developed premature labor and subsequently gave birth to a baby boy, LBW 1,800 gram, with severe asphyxia, Potter facies, abdominal distension, and leg deformities. Unfortunately, the baby eventually died 1 hour postpartum.Conclusion: Overall, infants have a poor prognosis for fetal LUTO cases. In assessing the effectiveness of treatment, early diagnosis, assessment, and early intervention are very critical. Latar Belakang: Lower Urinary Tract Obstruction (LUTO) pada fetus merupakan suatu kelainan pada periode antenatal berupa pembesaran kandung kemih fetus yang ditemukan pada pemeriksaan USG. Sumbatan saluran kemih bagian bawah tersebut dapat menyebabkan oligohidramnios, pelebaran korteks ginjal, hingga hipoplasia paru. Diagnosis awal dan evaluasi sedini mungkin sangat penting dalam penanganan LUTO. Salah satu penanganan fetal LUTO adalah dengan pemasangan shunt dari vesika urinaria fetus ke rongga amnion (vesicoamniotic shunt). Laporan kasus ini bertujuan untuk mengevaluasi penanganan LUTO terhadap fetus di RSUP Sanglah, Bali, IndonesiaPresentasi Kasus: Seorang perempuan 39 tahun G3P2002 18-19 minggu dirujuk ke poliklinik kebidanan dan kandungan RS Sanglah dengan kecurigaan fetal LUTO. Pada anamnesis tidak didapatkan keluhan maupun faktor risiko LUTO. Pemeriksaan fisis dan pemeriksaan obstetri dalam batas normal. Pada pemeriksaan USG didapatkan gambaran hipohiperekoik berukuran 4,3 x 5,3 cm dengan kesan vesika urinaria membesar, key-hole appearance, oligohidramnios dan hidronefrosis bilateral. Dilakukan tindakan pemasangan double pigtail pada fetus, amnioinfusion serta amniosintesis untuk pemeriksaan karyotyping. Sepuluh minggu setelah pemasangan double pigtail, pasien mengalami partus prematurus imminens dan selanjutnya melahirkan bayi lelaki, BBL 1.800 gram, dengan asfiksia berat, Potter facies, distensi abdomen dan deformitas tungkai. Sayangnya, bayi akhirnya meninggal 1 jam pasca-persalinan.Kesimpulan: Secara keseluruhan kasus fetal LUTO memiliki prognosis yang kurang baik bagi bayi. Diagnosis awal, evaluasi dan intervensi sedini mungkin sangat penting dalam menentukan keberhasilan terapi.

Hubungan antara kadar homosistein (Hcy) dengan kejadian ketuban pecah dini (KPD) pada kehamilan preterm Agrifa Eko Albert Sembiring; Tjokorda Gde Agung Suwardewa; Ketut Surya Negara; I Nyoman Gede Budiana; Ida Bagus Putra Adnyana; Evert Solomon Pangkahila
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Premature rupture of membranes (PROM) has been a problem in obstetrics since ancient times until now. The incidence of PROM in the world ranges from 5% - 15% of all pregnancies, while the incidence in developing countries, especially Indonesia ranges from 4.5% to 7.6% of all pregnancies. Preterm is one of the highest contributors to perinatal mortality and morbidity. The incidence of preterm pregnancy in the world is around 9.6% of all births, while in Southeast Asia is around 11.1% It has been shown to have a significant effect on vascular endothelial pathology. Methods: The study was conducted with an analytic cross-sectional design involving 70 respondents of pregnant women with gestational age of 20 - < 37 weeks with and without PPROM who came to the outpatient clinic and maternity ward of Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar from May 2021 – July 2021. Results: The results of the analysis of this study found a statistically significant relationship between homocysteine (Hcy) levels and the incidence of preterm premature rupture of membranes (p = 0.001). The prevalence ratio value of 2.2 means that high homocysteine levels is a risk factor for premature rupture of membranes in preterm pregnancy (RP = 2.2; 95% CI = 1.33-2.94; p = 0.001). Conclusion: High homocysteine level is a risk factor for premature rupture of membranes in preterm pregnancy. Latar Belakang: Ketuban pecah dini (KPD) preterm merupakan masalah di bidang obstetrik sejak dahulu sampai sekarang. Insiden KPD di dunia berkisar antara 5% - 15% dari seluruh kehamilan. Insiden KPD di negara berkembang khususnya Indonesia berkisar 4,5% - 7,6% dari seluruh kehamilan. Kehamilan preterm menjadi salah satu penyumbang tertinggi angka mortalitas dan morbiditas perinatal. Insiden kehamilan preterm di dunia sekitar 9.6% dari semua kelahiran, sedangkan di Asia tenggara terdapat sekitar 11,1%. Hcy telah terbukti signifikan berpengaruh pada patologi endotel pembuluh darah. Metode: Penelitian dilakukan dengan rancangan cross sectional analitik dengan melibatkan 70 responden wanita hamil dengan usia gestasi 20 - <70 minggu dengan atau tanpa KPD yang dating ke poliklinik dan ruang bersalin RSUP Prof. Dr. I.G.N.G. Ngoerah bulan Mei 2021 – Juli 2021. Hasil: Diperoleh hubungan bermaksana secara statistik antara kadar homocycteine dengan kejadian ketuban pecah dini pada kehamilan preterm (p = 0, 001), dan rasio prevalensi 2,2 berarti kadar homosisteine yang tinggi merupakan faktor risiko terjadinya ketuban pecah dini pada kehamilan preterm (RP = 2.2; 95% CI = 1.33-2.94; p = 0.001). Kesimpulan: Kadar homosistein yang tinggi merupakan faktor risiko terjadinya ketuban pecah dini pada kehamilan preterm.

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

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.

Karakteristik Pasien Kanker Serviks Stadium IIB Pasca Kemoterapi Neoadjuvant di RSUP Sanglah Denpasar Tahun 2020-2021 Satriawan, Nyoman Gede Dikawijaya; Winata, I Gde Sastra; Pangkahila, Evert Solomon; Manuaba, Ida Bagus Gede Fajar
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.P18

Kanker serviks adalah keganasan pada leher rahim akibat human papilloma virus. Terapi pada kasus kanker serviks stadium IIB adalah kemoterapi neoadjuvant. Tujuan dari penelitian ini untuk mengetahui karakteristik berdasarkan usia, tipe histopatologi, riwayat keluarga, paritas, riwayat kontrasepsi, respon kemoterapi, dan status operabilitas pada kasus kanker serviks stadium IIB pasca kemoterapi neoadjuvant di RSUP Sanglah Denpasar. Penelitian ini merupakan penelitian deskriptif retrospektif yang bersumber dari rekam medis pasien dengan teknik total sampling. Populasi dan sampel penelitian ini adalah pasien kanker serviks stadium IIB pasca kemoterapi neoadjuvant di RSUP Sanglah Denpasar periode 2020-2021 sesuai kriteria inklusi. Hasil penelitian menunjukkan terdapat 40 pasien kanker serviks stadium IIB dengan jumlah kasus tertinggi usia 40-49 tahun (45%). Tipe histopatologi tersering squamous cell carcinoma (85%). Pasien tanpa riwayat keluarga menderita kanker serviks sejumlah 92,5%. Pasien dengan jumlah paritas >2 sebanyak 52,5%. Pasien dengan riwayat penggunaan kontrasepsi sebanyak 65%. Respon kemoterapi baik lebih banyak ditemukan sebesar 70%. Status pasien operabel sebesar 57,5%. Kata kunci : karakteristik, kanker serviks stadium IIB, kemoterapi neoadjuvant.

CORRELATION KNOWLEDGE LEVEL WITH ATTITUDE READINESS TO DO VACCINATION HUMAN PAPILLOMAVIRUS AT SENIOR HIGH SCHOOL STUDENTS 3 CITY OF BIMA Ahmad, Nurmi; Budiana, I Nyoman Gede; Surya, I Gede Ngurah Harry Wijaya; Pangkahila, Evert Solomon
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.P13

ABSTRAK Pendahuluan: Kanker serviks merupakan jenis tumor ganas yang bisa mengenai lapisan permukaan serviks. HPV memiliki pengaruh besar terhadap kejadian kanker serviks, vaksinasi HPV merupakan pilihan ideal untuk program pencegahan kanker serviks, namun untuk melakukan vaksinasi HPV tentunya dipengaruhi oleh pengetahuan dan sikap. Tujuan dari penelitian ini untuk mengetahui hubungan antara tingkat pengetahuan tentang kanker serviks dengan sikap kesediaan melakukan vaksinasi human papillomavirus pada siswi Sekolah Menengah Atas Negeri 3 Kota Bima. Metode : Penelitian deskriptif analitik ini menggunakan data primer yang di analisis dengan desain cross-sectional terhadap populasi siswa Sekolah Menengah Atas Negeri 3 Kota Bima sebanyak 193 sampel dengan melakukan pengambilan data menggunakan kuesioner. Hasil : Siswi yang memiliki tingkat pengetahuan baik 63,7%, siswi yang memiliki tingkat pengetahuan kurang 36,3%. Siswi yang memberikan sikap mendukung melakukan vaksinasi HPV 66,3%, siswi yang memberikan sikap tidak mendukung melakukan vaksinasi HPV 33,7%. Hubungan pengetahuan dengan sikap kesediaan melakukan vaksinasi HPV dari hasil analisis chi square memiliki hubungan signifikan dengan sikap kesediaan melakukan vaksinasi human papillomavirus (HPV) dengan p = 0,037 (p-value <0,05). Simpulan: Dapat disimpulkan bahwa terdapat hubungan antara tingkat pengetahuan dengan sikap kesediaan melakukan vaksinasi human papillomavirus. Perlu dilakukan penelitian lebih lanjut mengenai faktor lain yang mempengaruhi sikap mendukung terhadap kesediaan melakukan vaksinasi human papillomavirus. Kata kunci : kanker serviks, vaksin HPV, pengetahuan, sikap.

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

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

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 Adhi Pribadi Agrifa Eko Albert Sembiring Ahmad, Nurmi Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Aloysius Suryawan Andonotopo, Wiku Anom Suardika Bachnas, Muhammad Adrianes Bambang Rahardjo Cut Meurah Yeni Daniel H. Susanto Denni Prasetyo Duarsa, Vidya Saraswati Putri Endang Sri Widiyanti Hartanto Hartanto I Gede Mega Putra I Ketut Surya Negara I Ketut Suwiyoga I Made Darmayasa I Nyoman Gede Budiana I Nyoman Hariyasa Sanjaya Ida Bagus Putra Adnyana Julian Dewantiningrum Kurjak, Asim Kusuma, Anak Agung Ngurah Jaya Manuaba, Ida Bagus Gede Fajar Ni Kadek Mulyantari Nuswil Bernolian Pramono, Mochammad Besari Adi Putu Doster Mahayasa Rey Jauwerissa Ryan S. Mulyana Ryan Saktika Mulyana Satriawan, Nyoman Gede Dikawijaya Sri Sulistyowati Stanojevic, Milan Surya, I Gede Ngurah Harry Wijaya Theresia Monica Rahardjo Tjokorda Gde Agung Suwardewa William Alexander Setiawan Wiradnyana, Anak Agung Gede Putra

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