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All Journal Narra J The Journal of Society Medicine (JSOCMED)
Indirayani, Ima
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Herlyn-Werner-Wunderlich syndrome: Challenges in diagnosis and management Roziana, Roziana; Nora, Hilwah; Maharani, Cut R.; Yeni, Cut M.; Dewi, Tengku P.; Rusnaidi, Rusnaidi; Indirayani, Ima; Aditya, Rizka; Al-shather, Zain; Haryani, Siti D.
Narra J Vol. 3 No. 2 (2023): August 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i2.223

Abstract

Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation characterized by a triad including uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. In this case report, we present a case of HWWS along with the challenges in diagnosis and multi-step treatment processes. A 25-year-old woman presented to Dr. Zainoel Abidin Hospital in Banda Aceh, Indonesia with a chief complaint of lower back pain for the past six months (two months after the marriage). The patient also complained of late menstruation, followed by thick yellow vaginal discharge resembling malodorous pus occurring after menstruation. Additionally, a history of fever and pain during intercourse was reported. Vaginal examination revealed purulent fluid emerging from a pinpoint hole on the right vaginal wall. Vaginal palpation revealed a two-branched uterus, along with a palpable cystic mass on the right vaginal wall. Ultrasound examination indicated the presence of the right and left hemi-uteri, measuring 4.7x1.35 cm and 5.7x1.26 cm in size, respectively with both ovaries appearing normal. Fluid accumulation was observed in the right hemivagina, while the left kidney exhibited normal features, and the right kidney showed signs of hypoplasia. The patient was diagnosed with uterus didelphys, fluid accumulation in the hemivagina, and right kidney hypoplasia. Magnetic resonance imaging (MRI) confirmed uterus didelphys and revealed narrowing of the right hemivagina, suggestive of HWWS. Hysteroscopy was performed to resect the vaginal septum with laparoscopic guidance, along with drainage of hematocolpos, pyocolpos and placement of an intracervical mold. Despite HWWs having conservative gradual management, it was opted to perform vaginal septum resection, hematocolpos and pyocolpos drainage and placement of an intracervical mould in this case, in order to relieve symptoms and restore the reproductive and sexual functions.
Esophageal Varices in Pregnancy Secondary to Hepatic Cirrhosis: A Case Report Royda D, Syerli; Indirayani, Ima; Roziana, Roziana
Journal of Society Medicine Vol. 4 No. 8 (2025): August
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i8.218

Abstract

Introduction: Pregnancy complicated by liver disease is a rare but clinically challenging condition. Portal hypertension is one such liver disease that may occur in pregnant women, primarily caused by cirrhosis. Esophageal varices, a manifestation of portal hypertension, carry significant maternal and fetal mortality risks. Case Description: We present the case of a 22-year-old woman referred from the Internal Medicine-Gastroenterology Department with a diagnosis of grade IV esophageal varices and grade IV gastric fundal varices. At the initial referral to the Obstetrics and Gynecology clinic, her pregnancy was estimated at 5–6 weeks gestation. Despite the high morbidity and rarity of this case, the patient maintained the pregnancy until 34–35 weeks of gestation. She had a two-year history of esophageal varices, with previous hospitalizations for melena and hematemesis. Fetomaternal ultrasound revealed a singleton fetus in cephalic presentation, consistent with 34–35 weeks of gestation, with suspected intrauterine growth restriction (IUGR). Abdominal ultrasound suggested hepatic cirrhosis, and endoscopic evaluation confirmed grade IV esophageal and gastric fundal varices. Termination of pregnancy was performed via abdominal delivery. Conclusion: Preventing pregnancy complications, accurate diagnosis, and meticulous management that balances maternal and fetal risks are crucial in such cases to improve outcomes.
Co-Authors Aditya, Rizka Al-shather, Zain Cut M. Yeni Dewi, Tengku P. Haryani, Siti D. Hilwah Nora Maharani, Cut R. Royda D, Syerli Roziana Roziana, Roziana Rusnaidi