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Evaluation and diagnostic approach in patient with Perrault Syndrome Nathania, Rachael Christin; Usman, Steven Yulius; Aryasatiani, Ekarini
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.V32I22024.143-147

HIGHLIGHTS 1. The rare hereditary condition Perrault Syndrome is characterized by sensorineural hearing loss (SNHL) and ovarian dysfunction2. Cyclic estrogens and progesterone may be given to adolescents with amenorrhea to induce withdrawal bleeding and mimic the menstrual cycle. ABSTRACT Objectives: A multidisciplinary team, which included a reproductive endocrinologist and an otolaryngologist, identified Perrault Syndrome in a patient with secondary amenorrhea and bilateral sensorineural hearing loss. Case Report: A 16-year-old female presented to the obstetrics and gynecology clinic at a type B hospital with primary amenorrhea for one year. Menarche occurred at age 13, followed by regular menstrual cycles for two years, after which menstruation gradually ceased. She denied dysmenorrhea, constipation, leukorrhea, genital pruritus, growth retardation, and weight loss. The patient expressed concern about potential future infertility. At age 9, she was diagnosed with a viral infection by an ENT specialist due to bilateral hearing loss, leading to emotional disturbances. There was no history of prior medication, family illness, or chronic infections. Born at term via spontaneous vaginal delivery, the patient weighed 3,000 grams. Laboratory tests revealed normal T3 (1.51 ng/dl), FT4 (1.16 ng/dl), prolactin (18.25 ng/ml), estrogen (11 pg/ml), and progesterone (0.1 pg/ml) levels, but elevated FSH (66.46 mIU/ml) and LH (29.97 mIU/ml) levels. Symptomatic treatment included bone conduction hearing aids and estrogen replacement therapy. Conclusion: Perrault Syndrome, a rare hereditary condition, manifests as sensorineural hearing loss (SNHL) and ovarian dysfunction, including primary ovarian insufficiency (POI) and gonadal dysgenesis, in individuals with a 46, XX karyotype. Molecular diagnosis remains challenging. Consultation with a pediatric endocrinologist can guide cyclic estrogen and progesterone therapy to induce withdrawal bleeding in adolescents with amenorrhea. Women at risk of ovarian failure should consider donor eggs or oocyte cryopreservation. Avoiding aminoglycosides and excessive noise is crucial for managing hearing loss.

A case of vaginal varicosities without rupture after vaginal delivery Tandiono, Eunike Jennifer; Aryasatiani, Ekarini; Santoso, Brigita Naomi
Majalah Obstetri & Ginekologi Vol. 32 No. 1 (2024): April
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I12024.54-59

HIGHLIGHTS Vaginal varicosities are prone to happen in pregnant women with unspecific causes and multifactorial. The mode of delivery in a pregnant woman with vaginal varicosities is still unknown, but it is not an indication of caesarean section. ABSTRACT Objective: Vaginal varicose is a rare condition characterized by dilated veins in the labia majora, labia minora, and vagina. This case report reported a woman with vaginal varicose who experienced labor without any delivery complications. Case Report: The patient, a 29-year-old woman, gravida 3, para 2, presented with discomfort and swelling in the vagina at 32 weeks of gestational age. Despite reaching 39 weeks of gestation, the vaginal varicosities remained stable and painless. She had no prior history of varicose veins, hypertension, blood abnormalities, malignancy, or contraception usage. Physical examination revealed mild varicosities in the labium and significantly swollen varicosities protruding toward the vaginal introitus. Interestingly, a small varicose vein was also noted on her right leg, previously unnoticed by the patient. At 39 weeks pregnant, she experienced spontaneous vaginal delivery without complications. During the third stage of labor, the vaginal varicosities decreased in size, and no rupture occurred. The newborn, a healthy baby boy weighing 2961 grams and measuring 48 cm, was delivered vaginally. Despite a second-degree perineal tear, blood loss was minimal, and no complications nor rupture arose from the varicose veins. Conclusion: Vaginal varicosities are rare, primarily occurring in multigravida pregnant women between 12 and 26 weeks of gestation. This case highlights that cesarean section is not necessarily indicated in pregnant women with vaginal varicosities. The successful vaginal delivery in this instance resulted in no varicose vein rupture, controlled bleeding, and regression of vaginal varicosities postpartum.

Left hemiparesis due to space-occupying lesion in pregnancy Luminto; Aryasatiani, Ekarini; Panuntun, Mahendro Aji; Hassan, Bobby Wirawan; Sananta, Tania; Neil, Arya Elbert
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.V32I22024.136-142

HIGHLIGHTS 1. Present a case report detailing the diagnosis and management of a space-occupying lesion identified late in pregnancy.2. Current studies consistently indicate that the optimal period for tumor removal during pregnancy is the second trimester, balancing maternal and fetal outcomes. This case report contributes to the existing literature by providing a practical reference for managing space-occupying lesions in accordance with the latest evidence. ABSTRACT Objectives: The objective of this study was to present the findings from cases of space-occupying lesions (SOL) that were diagnosed late in pregnancy. This case report aimed to highlight the importance of considering space-occupying lesions as a differential diagnosis in instances of hemiparesis during pregnancy, thereby raising clinical awareness and improving diagnostic accuracy. Case Report: A female patient aged 30 years 34 weeks pregnant came with complaints of slurred speech since 3 months before entering the hospital accompanied by weakness in the left limbs since 3 months before admission. The patient felt weak and fell in the bathroom 2 times, at the office and at home. The patient had a history of taking aspilet for 1.5 months due to a misdiagnosis as a stroke in a Type B hospital and stopped when she came to the obstetric emergency room at a Type A Hospital for the first time. Cardiothoracograph examination shows a picture of a silent baby. Computed Tomography (CT) Scan examination showed a picture of hydrocephalus. Conclusion: To date, it has not been proven that pregnancy triggers brain tumors. However, increased blood supply to the brain during pregnancy may lead to tumor growth. This is also evident in this case where there is an increase in maternal blood volume and subsequent cerebral blood flow, causing an increase in the size of the SOL. On the other hand, there is no evident that brain tumors directly harm the fetus, though fetal hypoxia may occur indirectly due to maternal respiratory failure.

Cervical cancer screening before hysterectomy in pelvic organ prolapse patients: Is it essential? A case series Aryasatiani, Ekarini; Surya, Raymond; Harjanti, Dyonesia Ary; Ilona, Florinda; Kartika, Chandra Dewi; Cantika, Catalya Christina; Tenka, Lisda
Majalah Obstetri & Ginekologi Vol. 33 No. 2 (2025): August
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V33I22025.173-179

HIGHLIGHTS More advanced cervical precancerous histopathological findings compared with cervical cytology are observed in POP patients undergoing vaginal hysterectomy. Routine use of preoperative biopsy or ultrasound in POP patients undergoing vaginal hysterectomy cannot be recommended. ABSTRACT Objective: Pelvic organ prolapse (POP) results from weakening of the pelvic floor musculature. The reported prevalence of unexpected premalignant and malignant pathologies following hysterectomy ranges from 0.2 to 0.8%. This study aims to present a case series of patients with POP who underwent vaginal hysterectomy (VH) after preoperative evaluation for abnormal cervical cytology, which subsequently demonstrated more advanced histopathological findings. Case Series: Case 1: A 55-year-old woman, P3A0, was diagnosed with third-degree uterine prolapse and cystocele. Pap smear revealed atypical glandular cells of undetermined significance (AGUS). Histopathological examination after VH demonstrated vaginitis and metaplastic chronic cervicitis with atypia progressing to mild dysplasia of endocervical epithelial cells/low-grade squamous intraepithelial lesion (LSIL). Case 2: A 62-year-old woman, P5A0, was diagnosed with third-degree uterine prolapse. Pap smear revealed atypical squamous cells of undetermined significance (ASCH). Histopathological evaluation after VH demonstrated high-grade squamous intraepithelial lesion (HSIL) up to carcinoma in situ with microinvasive glandular involvement and focal extension. Conclusion: Given that cervical cancer remains the second leading cause of mortality among women in Indonesia, preoperative screening for precancerous gynecological lesions and malignancy is strongly recommended.

Sleeve Hymen as a Penetrate Problem in a Newly Married Woman: A Rare Case Report Surya, Raymond; Aryasatiani, Ekarini
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 3 November 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i3.748

Introduction: Imperforate hymen (IH), an uncommon congenital anomaly, is a failure to completely canalize the hymen. This report aims to describe a sleeve hymen in a newly married woman and the surgical approach to the patient.Case Illustration: A 24-year-old newly married woman came to the gynecology polyclinic complaining of difficulty in sexual intercourse in the last 6 months. She felt painful and hard penile penetration since the first time of sexual intercourse. Inspection of external genitalia showed there was a hymen covering all vaginal introitus without an erythematous surface. The diagnosis indicated that the patient had a sleeve hymen. The patient underwent a U-shaped incision far away from the urethra as a hymenectomy.Discussion: Most of the IH patients are asymptomatic until menarche. Excess of estrogen status can cause the thickening of the hymen, called the sleeve hymen or “redundant” hymen. Meanwhile, epithelial cells’ failure in the center of the hymen to degenerate or excess cell proliferation may cause a microperforate hymen. There are several choices of treatment for IH, including hymenectomy (cruciate incision or hymen excision), hymen-preserving surgeries (simple vertical incision and annular hymenotomy), carbon dioxide laser, or insertion of a Foley catheter.Conclusion: Good anamnesis and physical examination can lead to the correct diagnosis of sleeve hymen. Hymenectomy is one of the alternative treatments for married women who have less concern about hymen-preserving surgery.Penebalan Himen sebagai Gangguan Penetrasi pada Wanita Baru Menikah: Sebuah Laporan KasusAbstrakPendahuluan: Himen imperforata (HI) merupakan kelainan kongenital yang tidak lazim didefinisikan sebagai kegagalan dalam kanalisasi himen. Laporan ini bertujuan untuk menggambarkan penebalan himen pada wanita yang baru menikah dan pendekatan pembedahan kepada pasien.Ilustrasi Kasus: Seorang wanita baru menikah berusia 24 tahun datang ke poliklinik ginekologi mengeluh gangguan hubungan seksual sejak 6 bulan lalu. Dia merasa sulit untuk penetrasi dan nyeri sejak pertama kali berhubungan seksual. Inspeksi pada genitalia eksterna memperlihatkan terdapat himen yang menutupi seluruh introitus vagina tanpa permukaan eritema. Diagnosis pada pasien ialah penebalan himen. Wanita tersebut dilakukan insisi bentuk U menjauhi uretra sebagai himenektomi. Diskusi: Kebanyakan pasien HI asimptomatik sampai menars. Kelebihan estrogen dapat menyebabkan penebalan himen yang dikenal sebagai himen “tidak berguna”. Sementara itu, kegagalan sel epitel di tengah himen untuk degenerasi atau kelebihan proliferasi sel dapat menyebabkan himen mikroperforata. Beberapa pilihan tatalaksana pada HI, yaitu himenektomi (insisi krusiata atau eksisi himen), pembedahan dengan konservasi himen (insisi vertikal simple dan himenotomi anular), laser CO2, atau insersi kateter Foley.Kesimpulan: Anamnesis dan pemeriksaan fisik yang baik dapat membantu mendiaganosis penebalan himen dengan tepat. Himenektomi merupakan salah satu tatatalaksana alternatif untuk wanita yang sudah menikah.Kata kunci: himen imperforate; himenektomi; microperforate hymen; penebalan himen,

Persalinan En Caul pada Kehamilan Kembar Surya, Raymond; Aryasatiani, Ekarini
Cermin Dunia Kedokteran Vol 50 No 7 (2023): Kardiovaskular
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v50i7.955

Pendahuluan: Persalinan en caul merupakan persalinan dengan bayi dilahirkan di dalam cairan amnion yang utuh. Kasus: Seorang wanita berusia 34 tahun dengan gravida 4 para 3 hamil 37 minggu datang ke IGD dengan keluhan keluar air-air sejak 3 jam sebelum masuk RS. Pemeriksaan menunjukkan kehamilan kembar presentasi lintang-lintang. Pasien diputuskan dilahirkan secara operasi seksio sesarea atas indikasi ketuban pecah dan posisi bayi lintang. Bayi pertama yang dilahirkan adalah laki-laki dengan berat 2.600 gram skor Apgar (Apgar score/AS) 7/9. Bayi kedua dilahirkan secara en caul dengan jenis kelamin laki-laki dengan berat 2.400 gram AS 7/9. Simpulan: Persalinan en caul lebih menguntungkan pada persalinan prematur, dan dapat juga dilakukan pada persalinan cukup bulan tanpa efek negatif pada bayi. Introduction: En caul birth is a delivery with an intact amniotic membrane covering a newborn’s body. Case: A 34-year-old gravida 4 para 3, 37 weeks of gestation presented to the Emergency Department due to membrane rupture 3 hours before admission. The examination revealed a twin pregnancy with a transverse-transverse presentation. A cesarean section was performed because of transverse presentation and membrane rupture. The first baby boy was born with 2,600 grams bodyweight and Apgar score (AS) of 7/9. The second baby boy was born en caul with 2,400 grams bodyweight and AS of 7/9. Conclusion: En caul birth is possible in preterm delivery, can also be performed in full-term labor without negative effects on the baby.

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