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Passive Smoking as a Significant Risk Factor of Cervical Dysplasia: A Novel Findings in Single Center Study in Denpasar, Bali, Indonesia Pradnyana, I Wayan Agus Surya; Mirani Ulfa Yusrika; I Gusti Bagus Mulia Agung Pradnyaandara; I Gde Sastra Winata
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 11 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i11.1126

Background: Colposcopy is a diagnostic procedure evaluating the cervix following an abnormal screening test. It aims to identify and treat cervical cancer precursors. Risk stratification at the end of colposcopy helps differentiate those who can return to regular screening from those needing more frequent screening or surveillance. The study examined the characteristics and risk factors of patients undergoing colposcopy for cervical dysplasia in Denpasar, Bali, Indonesia. Methods: This was a cross-sectional study of women who underwent colposcopy at BaliMed Hospital, Denpasar, Bali, Indonesia, from January 2021-December 2022. Data were derived from medical records. The gynecology oncologist performed a colposcopy examination with a biopsy sample, which was later checked by the pathologist. Bivariate and multivariate analyses were used to identify the risk factors associated with cervical dysplasia. Results: 142 patients underwent colposcopy with a mean age of 37.28+10.1 years. Seventy-eight patients (54.9%) had a low-grade cervical lesion, and 9 (6.3%) had a high-grade cervical lesion. After adjusting the employment status and education level, factors associated with cervical dysplasia were age at first intercourse <20 years (aOR [adjusted odd ratio] 2.44, 95% CI [1.04-5.69]) and history of smoking, either actively or passively (aOR 8.91, 95% CI [3.52-22.54]). From the biopsy result, patients with abnormal cervical lesions were associated with evidence of CIN (aOR 9.03, 95% CI [2.49-32.77]). Conclusion: Early age first sexual intercourse and history of smoking have been identified as significant risk factors for cervical dysplasia. Additionally, passive smoking has been shown to increase the risk. This research provides a foundational reference for future studies in this area.

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

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.

A Meta-Analysis Comparing the Effectiveness of Uterine-Sparing Procedures versus Hysterectomy for Adenomyosis: Patient-Reported Outcomes and Fertility Preservation Pradnyana, I Wayan Agus Surya; Kadek Agus Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1189

Background: Adenomyosis is a benign gynecological condition that can cause significant morbidity, including dysmenorrhea, menorrhagia, and pelvic pain. Hysterectomy has been the traditional treatment for adenomyosis, but uterine-sparing procedures (USPs) are increasingly being considered, especially for women who desire fertility preservation. This meta-analysis compared the effectiveness of USPs versus hysterectomy for adenomyosis, focusing on patient-reported outcomes (PROs) and fertility preservation. Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024, comparing USPs (e.g., laparoscopic or hysteroscopic adenomyomectomy, uterine artery embolization) with hysterectomy for adenomyosis. Studies reporting PROs (dysmenorrhea, menorrhagia, pelvic pain, quality of life) and fertility outcomes (pregnancy rate, live birth rate) were included. Random-effects models were used to pool data and assess heterogeneity. Results: Six studies (n = 1248 patients) met the inclusion criteria. USPs were associated with significantly lower rates of major complications (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23-0.54, p<0.0001) and shorter hospital stays (mean difference -2.73 days, 95% CI -3.29 to -2.17, p<0.0001) compared to hysterectomy. PROs, including dysmenorrhea, menorrhagia, and pelvic pain, significantly improved in both groups, with no significant difference between USPs and hysterectomy. Fertility preservation was significantly higher in the USP group (OR 3.9, 95% CI 3.02-5.03, p<0.0001). Conclusion: USPs offer a safe and effective alternative to hysterectomy for adenomyosis, with comparable improvements in PROs and significantly higher rates of fertility preservation. This information can guide clinicians and patients in shared decision-making regarding the optimal treatment approach.

Beyond the Scar: A Case Report on the Clinical Presentation, Diagnostic Nuances, and Surgical Management of Type I Cesarean Scar Pregnancy Pradnyana, I Wayan Agus Surya; Anak Agung Ngurah Jaya Kusuma; Gde Bagus Rizky Kornia
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1341

Background: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where the gestational sac implants within the fibrous tissue of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates, posing significant risks of maternal morbidity, including uterine rupture and severe hemorrhage. Type I CSP, or endogenic CSP, involves implantation on a healed scar with growth primarily towards the uterine cavity. Early and accurate diagnosis, relying heavily on ultrasonographic nuances, is crucial for appropriate management and fertility preservation. Case presentation: We present the case of a 36-year-old woman, G7P3033, with a history of two prior cesarean sections, who presented at 6-7 weeks of gestation with vaginal discharge. Transabdominal ultrasonography revealed a gestational sac implanted on the anterior uterine wall within the cesarean scar area, with a thin myometrium between the sac and the bladder, consistent with a Type I (endogenic, COS-1, Grade II) Cesarean Scar Pregnancy. The patient also had Stage II hypertension. After thorough evaluation and counseling, the patient underwent a laparotomy with wedge resection of the CSP and scar revision, along with bilateral fimbriectomy as per her request for sterilization. Conclusion: This case highlights the importance of high clinical suspicion for CSP in pregnant women with previous cesarean sections presenting with early pregnancy symptoms. Detailed ultrasonography is paramount for accurate diagnosis, classification, and guiding management. Surgical management, specifically laparotomy with wedge resection and scar repair, proved to be an effective treatment for this Type I CSP, allowing for removal of the ectopic pregnancy and reinforcement of the uterine wall, while addressing the patient's desire for permanent contraception. Timely intervention is key to preventing life-threatening complications and preserving future reproductive options if desired.

Beyond the Scar: A Case Report on the Clinical Presentation, Diagnostic Nuances, and Surgical Management of Type I Cesarean Scar Pregnancy Pradnyana, I Wayan Agus Surya; Anak Agung Ngurah Jaya Kusuma; Gde Bagus Rizky Kornia
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1341

Background: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where the gestational sac implants within the fibrous tissue of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates, posing significant risks of maternal morbidity, including uterine rupture and severe hemorrhage. Type I CSP, or endogenic CSP, involves implantation on a healed scar with growth primarily towards the uterine cavity. Early and accurate diagnosis, relying heavily on ultrasonographic nuances, is crucial for appropriate management and fertility preservation. Case presentation: We present the case of a 36-year-old woman, G7P3033, with a history of two prior cesarean sections, who presented at 6-7 weeks of gestation with vaginal discharge. Transabdominal ultrasonography revealed a gestational sac implanted on the anterior uterine wall within the cesarean scar area, with a thin myometrium between the sac and the bladder, consistent with a Type I (endogenic, COS-1, Grade II) Cesarean Scar Pregnancy. The patient also had Stage II hypertension. After thorough evaluation and counseling, the patient underwent a laparotomy with wedge resection of the CSP and scar revision, along with bilateral fimbriectomy as per her request for sterilization. Conclusion: This case highlights the importance of high clinical suspicion for CSP in pregnant women with previous cesarean sections presenting with early pregnancy symptoms. Detailed ultrasonography is paramount for accurate diagnosis, classification, and guiding management. Surgical management, specifically laparotomy with wedge resection and scar repair, proved to be an effective treatment for this Type I CSP, allowing for removal of the ectopic pregnancy and reinforcement of the uterine wall, while addressing the patient's desire for permanent contraception. Timely intervention is key to preventing life-threatening complications and preserving future reproductive options if desired.

Passive Smoking as a Significant Risk Factor of Cervical Dysplasia: A Novel Findings in Single Center Study in Denpasar, Bali, Indonesia Pradnyana, I Wayan Agus Surya; Mirani Ulfa Yusrika; I Gusti Bagus Mulia Agung Pradnyaandara; I Gde Sastra Winata
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 11 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i11.1126

Background: Colposcopy is a diagnostic procedure evaluating the cervix following an abnormal screening test. It aims to identify and treat cervical cancer precursors. Risk stratification at the end of colposcopy helps differentiate those who can return to regular screening from those needing more frequent screening or surveillance. The study examined the characteristics and risk factors of patients undergoing colposcopy for cervical dysplasia in Denpasar, Bali, Indonesia. Methods: This was a cross-sectional study of women who underwent colposcopy at BaliMed Hospital, Denpasar, Bali, Indonesia, from January 2021-December 2022. Data were derived from medical records. The gynecology oncologist performed a colposcopy examination with a biopsy sample, which was later checked by the pathologist. Bivariate and multivariate analyses were used to identify the risk factors associated with cervical dysplasia. Results: 142 patients underwent colposcopy with a mean age of 37.28+10.1 years. Seventy-eight patients (54.9%) had a low-grade cervical lesion, and 9 (6.3%) had a high-grade cervical lesion. After adjusting the employment status and education level, factors associated with cervical dysplasia were age at first intercourse <20 years (aOR [adjusted odd ratio] 2.44, 95% CI [1.04-5.69]) and history of smoking, either actively or passively (aOR 8.91, 95% CI [3.52-22.54]). From the biopsy result, patients with abnormal cervical lesions were associated with evidence of CIN (aOR 9.03, 95% CI [2.49-32.77]). Conclusion: Early age first sexual intercourse and history of smoking have been identified as significant risk factors for cervical dysplasia. Additionally, passive smoking has been shown to increase the risk. This research provides a foundational reference for future studies in this area.

A Meta-Analysis Comparing the Effectiveness of Uterine-Sparing Procedures versus Hysterectomy for Adenomyosis: Patient-Reported Outcomes and Fertility Preservation Pradnyana, I Wayan Agus Surya; Kadek Agus Wijaya
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i2.1189

Background: Adenomyosis is a benign gynecological condition that can cause significant morbidity, including dysmenorrhea, menorrhagia, and pelvic pain. Hysterectomy has been the traditional treatment for adenomyosis, but uterine-sparing procedures (USPs) are increasingly being considered, especially for women who desire fertility preservation. This meta-analysis compared the effectiveness of USPs versus hysterectomy for adenomyosis, focusing on patient-reported outcomes (PROs) and fertility preservation. Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024, comparing USPs (e.g., laparoscopic or hysteroscopic adenomyomectomy, uterine artery embolization) with hysterectomy for adenomyosis. Studies reporting PROs (dysmenorrhea, menorrhagia, pelvic pain, quality of life) and fertility outcomes (pregnancy rate, live birth rate) were included. Random-effects models were used to pool data and assess heterogeneity. Results: Six studies (n = 1248 patients) met the inclusion criteria. USPs were associated with significantly lower rates of major complications (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23-0.54, p<0.0001) and shorter hospital stays (mean difference -2.73 days, 95% CI -3.29 to -2.17, p<0.0001) compared to hysterectomy. PROs, including dysmenorrhea, menorrhagia, and pelvic pain, significantly improved in both groups, with no significant difference between USPs and hysterectomy. Fertility preservation was significantly higher in the USP group (OR 3.9, 95% CI 3.02-5.03, p<0.0001). Conclusion: USPs offer a safe and effective alternative to hysterectomy for adenomyosis, with comparable improvements in PROs and significantly higher rates of fertility preservation. This information can guide clinicians and patients in shared decision-making regarding the optimal treatment approach.

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