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Ayuandari, Sarrah
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Cumulative cyclophosphamide dose and serum anti-Mullerian hormone levels in adolescent cancer survivors in Indonesia Mulatsih, Sri; Ayuandari, Sarrah; Rahmawati, Naafi Rizqi; Oktasari, Rizki; Dewanto, Agung
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.376-82

Abstract

Background As both the prevalence and survival rates of cancer in children and adolescents has risen, longer-term effects of cancer treatment must be investigated. High-risk gonadotoxic chemotherapeutic agents such as cyclophosphamide may affect the ovarian reserve and impact female adolescent fertility. Anti-Mullerian hormone is a reliable marker to assess ovarian reserve. Objective To assess for a possible correlation between the cumulative dose of cyclophosphamide and serum anti-Mullerian hormone (AMH) levels among adolescent cancer patients. Methods This cross-sectional study included 12-18-year-old adolescent female cancer patients who had experienced menarche and received cyclophosphamide therapy. We recorded the patients’ full history, including menstrual history, computed the cumulative dose of cyclophosphamide received, and measured serum AMH levels. The correlation test was performed to evaluate for a possible correlation between the cumulative dose of cyclophosphamide and ovarian reserve as represented by AMH levels. Results Out of 12 female adolescent cancer patients, three complained of disturbances in their menstrual cycles. Low levels of AMH (<1.5 ng/mL) were noted in five patients. Median cumulative cyclophosphamide dose was 1,000 mg/m2 (range 1,000 to 5,250 mg/m2). Cumulative cyclophosphamide dose was negatively correlated with serum AMH levels, but this correlation was not statistically significant (r=-0.316, P=0.318). Conclusion This study has not been able to show a correlation between cumulative cyclophosphamide dose and serum AMH level. Regular evaluation of fertility and involvement of fertility team is recommended in adolescents receiving high-risk gonadotoxic chemotherapeutic agents.
Histeroskopi dalam Diagnosis dan Terapi Adhesi Alat Kontrasepsi Dalam Rahim pada Pasien Uterus Bikorporeal: Laporan Kasus Novita, Devie; Ayuandari, Sarrah; Attamimi, Ahsanudin; Widad, Shofwal
JURNAL KESEHATAN REPRODUKSI Vol 12, No 3 (2025)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.114776

Abstract

Latar Belakang: Pelepasan alat kontrasepsi dalam rahim (AKDR) pada uterus bikorporeal merupakan tantangan klinis akibat kompleksitas anatomi uterus. Kondisi patologis seperti adhesi AKDR dapat meningkatkan risiko kegagalan pelepasan secara konvensional. Tujuan: Untuk melaporkan peran histeroskopi sebagai modalitas diagnostik dan terapeutik dalam penatalaksanaan adhesi alat kontrasepsi dalam rahim (AKDR) pada pasien dengan uterus bikorporeal setelah kegagalan pelepasan secara konvensional.Metode: Seorang perempuan 33 tahun, multipara P2A0 dengan uterus bikorporeal, dirujuk ke Poliklinik Obstetri dan Ginekologi RSUP Dr. Sardjito Yogyakarta dengan dugaan adhesi AKDR setelah satu tahun pemasangan. Pasien mengeluhkan nyeri perut di luar siklus menstruasi disertai keputihan. Ultrasonografi transvaginal menunjukkan uterus bikorporeal dengan dua AKDR intrauterin.Hasil dan Pembahasan: Histeroskopi memungkinkan visualisasi langsung kavum uteri, konfirmasi adhesi AKDR, serta tindakan terapeutik secara simultan, sehingga menurunkan risiko komplikasi dan meningkatkan keberhasilan pelepasan.Kesimpulan: Histeroskopi merupakan modalitas minimal invasif yang efektif, aman, dan cost-effective dalam penatalaksanaan kegagalan pelepasan AKDR, terutama pada pasien dengan kelainan kongenital uterus.
Diagnostic Challenges in Uterine Smooth Muscle Tumors: Distinguishing Cellular Leiomyoma from STUMP in a Reproductive-Age Woman Hanum, Muhammad Rakha Nabil Abiyyu; Ayuandari, Sarrah; Sianturi, Rifan Morgan Dorema; Ariffianto, Adi; Widad, Shofwal
JURNAL KESEHATAN REPRODUKSI Vol 13, No 1 (2026)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.115968

Abstract

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare uterine neoplasms with histological features between benign leiomyomas and leiomyosarcomas. Their unpredictable biological behavior poses diagnostic and therapeutic challenges, particularly in reproductive-age women where hysterectomy—the conventional definitive treatment—is avoided to preserve fertility. A 35-year-old nulligravida woman presented with prolonged menstrual bleeding and severe dysmenorrhea (VAS 7) for two years. Previous hormonal therapy with dienogest and norethisterone provided partial relief. MRI revealed multiple subtypes 3, 5, and 6 myomas (55 cm3) and an endometriotic cyst. After six months of GnRH agonist therapy with persistent symptoms, laparoscopic myomectomy with adhesiolysis and excision of endometriotic nodules was performed. Five leiomyomas were excised using laparoscopic morcellation, followed by uterine reconstruction. Histopathology showed a cellular tumor composed of spindle to oval cells with mild pleomorphism and 4 mitoses per 10 HPF, without necrosis or hemorrhage—features consistent with cellular leiomyoma, with STUMP as a differential diagnosis. Immunohistochemistry revealed Ki-67 positivity in 3% of cells, supporting cellular leiomyoma. The postoperative course was uneventful, and regular follow-up was scheduled. Differentiating STUMP from cellular leiomyoma is challenging due to overlapping histopathological features. Low proliferative indices such as Ki-67 <5% favor benign behavior. Fertility-preserving management via laparoscopic myomectomy is feasible when performed with contained morcellation to minimize recurrence risk. Reported recurrence rates following conservative management range from 7–21%, with promising fertility outcomes yielding 38–41% pregnancy rates. Long-term surveillance is essential because recurrences and rare malignant transformations may occur several years postoperatively. This case highlights the diagnostic challenge of differentiating cellular leiomyoma from STUMP and underscores the value of combining histopathology and immunohistochemistry in management. Laparoscopic myomectomy offers a fertility-preserving option with a reported 13.2% recurrence rate and 38.8% pregnancy success rate after 24 or more follow-ups. Further case accumulation is essential to refine fertility-preserving protocols for this rare entity.
A Rare Cause of Secondary Postpartum Hemorrhage: Uterine Scar Dehiscence with Cervico-Isthmic Laceration After Repeat Cesarean Section Berns, Annike Ida; Ayuandari, Sarrah; Maliki, Fauzan Achmad; Prawitasari, Shinta; Ariffianto, Adi
JURNAL KESEHATAN REPRODUKSI Vol 13, No 1 (2026)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jkr.118397

Abstract

To describe a rare and atypical case of secondary postpartum hemorrhage (PPH) induced by uterine scar dehiscence in conjunction with an unexplained uterine laceration in the cervico-isthmic region. We report the case of a 29-year-old woman, gravida 2 para 2, who had significant vaginal bleeding and signs of hemorrhagic shock 10 days post-repeated cesarean section. The bleeding was not controlled despite initial resuscitation and medical care. Transabdominal ultrasonography revealed signs of pathology at the previous cesarean scar site. Due to persistent hemodynamic instability, an emergency laparotomy was conducted, exposing active hemorrhage from uterine scar dehiscence, as well as a laceration extending caudally into the cervico-isthmic area, without a clearly identifiable cause. Definitive management required total hysterectomy to achieve hemostasis. This case highlights the importance of consideration of structural causes when medical treatment fails, as early surgical intervention can be life-saving.
Co-Authors Ahsanudin Attamimi Ariffianto, Adi Berns, Annike Ida Dewanto, Agung Fauzan Achmad Maliki Hanum, Muhammad Rakha Nabil Abiyyu Naafi Rizqi Rahmawati, Naafi Rizqi Novita, Devie Oktasari, Rizki Shinta Prawitasari Shofwal Widad Sianturi, Rifan Morgan Dorema Sri Mulatsih