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What are The Most Effective Management Strategies for Obstetric Emergencies in ICU Settings, and How do They Impact Maternal and Neonatal Mortality Rates? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 34 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/z43b0823

Background: Obstetric emergencies requiring intensive care unit (ICU) admission contribute significantly to maternal and neonatal mortality worldwide, yet optimal management strategies remain heterogenous across settings. Methods: This systematic review synthesized 80 studies (1990-2025) examining management strategies for obstetric emergencies in ICUs. Outcomes included maternal mortality, neonatal mortality, and effectiveness of interventions. Results: Hypertensive disorders (42.96% in Africa) and hemorrhage (24.15%) were the leading admission causes. Multidisciplinary team approaches, early intervention (<6 hours for hemorrhage), and protocolized care consistently improved outcomes. Whole blood transfusion reduced transfusion volumes versus component therapy (2,607 mL vs. 4,683 mL, p=0.03) with zero maternal deaths. The non-pneumatic antishock garment combined with balloon tamponade eliminated hemorrhage-related mortality (0% vs. 3 deaths). Continuous renal replacement therapy reduced sepsis mortality by 35%. Skills training for postpartum hemorrhage reduced maternal mortality from 75% to 0%. Maternal mortality ranged from 0%-41.2%, with African centers reporting 30.69% versus 3.03% in dedicated obstetric ICUs. Neonatal mortality ranged 4.2%-52%. Critical timing factors included ICU admission <24 hours from symptom onset and delivery before critical deterioration. Discussion: Effective management requires condition-specific, early, multidisciplinary approaches. Resource disparities explain much outcome variation, with unbooked status and delayed referral as key modifiable risk factors. Standardized protocols, early warning systems, and uterine-conserving techniques show strongest evidence. Conclusion: Early, protocol-driven, multidisciplinary ICU management significantly reduces maternal and neonatal mortality in obstetric emergencies. System strengthening and skills training are as crucial as technological interventions.

Is there a relationship between fasting blood glucose levels and the incidence of polyhydramnios in pregnant women with gestational diabetes? : A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/vehvp648

Introduction: Gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, including polyhydramnios. However, the direct relationship between fasting blood glucose levels and the incidence of polyhydramnios in GDM populations remains debated. This systematic review aimed to evaluate the association between fasting glucose levels and polyhydramnios occurrence in pregnant women with GDM. Methods: A systematic review of observational studies examining the relationship between glucose parameters and polyhydramnios in GDM pregnancies was conducted. Thirty-five studies published to 2026 were identified,. Data extraction focused on study characteristics, GDM populations, glucose measurements, polyhydramnios occurrence, and statistical associations. Results: Polyhydramnios rates among GDM women ranged from 8.3% to 56.8%. Direct evidence from Dashe et al. and Xu et al. demonstrated significant positive correlations between amniotic fluid glucose concentration and amniotic fluid index (AFI) in diabetic populations (r=0.32, p=0.04; r=0.330, p=0.002). Xu et al. further showed strong correlation between amniotic fluid glucose and maternal fasting glucose (r=0.589, p<0.01). Critically, well-controlled GDM demonstrated significantly lower AFI (13.9±4.2 cm) compared to uncontrolled GDM (16.4±4.4 cm, p<0.05). Bartha et al. showed early GDM screening reduced hydramnios rates from 12.7% to 2.1% (p<0.0001). Late-onset GDM was identified in 4.8-11.8% of women with third-trimester polyhydramnios and prior negative screening. Discussion: The evidence supports an osmotic mechanism whereby maternal hyperglycemia leads to elevated amniotic fluid glucose, increasing amniotic fluid volume. The glucose-polyhydramnios relationship is modifiable through glycemic control, explaining apparent contradictions between studies. Studies failing to detect associations typically examined narrow glycemic ranges in normoglycemic populations. Conclusion: Fasting blood glucose levels are positively associated with polyhydramnios in GDM, mediated through amniotic fluid glucose concentration. Early detection and strict glycemic control significantly reduce polyhydramnios incidence and severity.

Is a sedentary lifestyle associated with a decrease in semen quality in adult men aged 18-50 years? A Systematic Review Rizky Febriansyah; Bangar Parlinggoman Tua; Mutia Juliana; Aditya Rifandi Zaenudin
The Indonesian Journal of General Medicine Vol. 35 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/njxa1z45

Introduction: Global declines in semen quality over recent decades have raised concerns about the impact of modern lifestyles on male fertility. Sedentary behavior, increasingly prevalent in occupational and leisure settings, has been hypothesized as a potential contributing factor. This systematic review aims to evaluate whether a sedentary lifestyle is associated with decreased semen quality in healthy adult men aged 18-50 years. Methods: A systematic review was conducted following predefined screening criteria. Sixteen studies were included randomized controlled trial, etc. Studies were required to assess sedentary behavior (directly or indirectly), evaluate semen quality parameters (concentration, motility, morphology, volume, DNA fragmentation), and include healthy adult men aged 18-50 years. Data were extracted on study characteristics, sedentary behavior definitions, semen parameters, association findings, confounding factors, and limitations. Results: Direct evidence from two studies specifically measuring sedentary behavior showed inconsistent findings. Sterpi et al. (2024) reported mixed results across 13,509 men: three studies found declines in sperm concentration with high sedentary time, but most studies showed no significant associations with concentration, motility, or morphology. Eisenberg et al. (2015) found no association between occupational prolonged sitting and any semen parameter after adjustment for confounders. Indirect evidence from physical activity studies suggested that moderate physical activity benefits semen quality, while intense exercise may be detrimental (Montano et al., 2021; Nesello et al., 2020; Zańko et al., 2022). Obesity, strongly correlated with sedentary behavior, consistently predicted impaired semen quality (Magoutas et al., 2025; Venishetty et al., 2024; Бобков et al., 2020). Discussion: The available evidence does not demonstrate a robust independent association between sedentary behavior and decreased semen quality. Methodological limitations include heterogeneous definitions of sedentary behavior, reliance on self-report measures, inadequate adjustment for confounders (particularly BMI/obesity), and selection bias across study populations. The pathway linking sedentary behavior to semen quality appears mediated primarily through metabolic consequences (obesity, hormonal imbalances) rather than direct effects. Conclusion: Current evidence is insufficient to establish a causal relationship between sedentary lifestyle and decreased semen quality in healthy adult men aged 18-50 years. High-quality prospective studies using objective sedentary behavior measures (accelerometry) with adequate adjustment for adiposity and confounders are needed. Future research should distinguish between sedentary behavior's independent effects and those mediated through obesity.

Is Multiple Gestation Associated with an Increased Risk of Placenta Previa ? : A Systematic Review Carina Rhamadhanis; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 45 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/6wg4jy65

Background: Placenta previa is a major cause of antepartum hemorrhage, preterm delivery, and maternal morbidity. Multiple gestation is frequently listed as a risk factor in clinical guidelines, yet direct comparative evidence remains sparse and inconsistent. This systematic review evaluates whether multiple gestation independently increases the risk of placenta previa after accounting for key confounders, particularly assisted reproductive technology (ART) and prior cesarean delivery. Methods: We systematically screened RCT, etc that compared multiple gestations (twins or higher-order) with singleton gestations and reported placenta previa as an outcome. Studies were required to provide sufficient data for calculating measures of association (OR, RR, or incidence proportions). Data extraction focused on study design, population characteristics, multiple gestation details, placenta previa definition, association results, confounder adjustment, and sample sizes. Only studies with statistically significant positive findings were emphasized for the primary analysis. Results: Among 80 identified studies, only four provided direct quantitative comparisons between multiple and singleton gestations for placenta previa. In a cohort of 14,583 cesarean deliveries (Guo et al., 2022), placenta previa incidence was significantly lower in multiple gestations (2.4%) than singletons (3.9%; p=0.012)—a counterintuitive finding. Among placenta accreta spectrum (PAS) cases, twins had significantly lower previa rates (38.1% vs. 71.9%; p<0.001) and fewer prior cesareans (median 0 vs. 2) (Shamshirsaz et al., 2020). ART-conceived dichorionic twins had a nearly threefold higher risk of placenta previa compared with naturally conceived twins (RR=2.99; 95% CI 1.51–5.92; p=0.002; I²=0%) (Qin et al., 2016). The ART-associated previa risk was significantly lower in twins (OR=1.50) than in singletons (OR=2.67) (Karami et al., 2018). After adjusting for multiple gestations, the crude ART–previa association attenuated from OR=4.6 to aOR=1.8 (Johnston et al., 2015). Discussion: The apparent clinical association between multiple gestation and placenta previa is largely explained by confounding. ART increases both twinning and previa risk, while prior cesarean—a dominant previa risk factor—is less common in multiples. The lower crude previa rate in multiples is explained by their lower burden of uterine scarring. Mechanistically, ART alters endometrial receptivity and trophoblast invasion independently of plurality. In PAS, multiples exhibit a distinct risk profile (higher ART, lower previa, fewer prior cesareans). Conclusion: Multiple gestation is not an independent risk factor for placenta previa. The observed association is driven by ART and obstetric history. Future population-based studies must adjust for mode of conception, prior cesarean details, parity, and chorionicity.

What are The Rates of Mortality, Major Morbidity, and Hospital Readmission Within 30 Days Following Elective Gynecological Procedures in Patients Over 80 Years? : A Systematic Review Melati Ganeza; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 48 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/gj4gt527

Introduction: The global population is aging, and more women over 80 years are considered for elective gynecological surgery. However, evidence on short-term postoperative outcomes in this specific age group remains scarce. Methods: We conducted a systematic review following PRISMA guidelines, searching multiple databases for studies reporting 30-day mortality, major morbidity, or hospital readmission after elective gynecological procedures in patients ≥80 years. Observational studies, RCTs, etc were included. Results: The pooled 30-day mortality was 0–1% (Friedman et al., 2006; Fitzgerald et al., 2008). Major morbidity was elevated in elderly patients, particularly medical complications (UTI, respiratory failure, sepsis) (Friedman et al., 2006; Bourgin et al., 2016). No study reported 30-day readmission rates specifically for patients over 80. Length of stay was consistently longer in older patients (Friedman et al., 2006; Gultekin et al., 2015). Minimally invasive and obliterative procedures (e.g., colpocleisis) were associated with better outcomes (Raffone et al., 2021; Sadeh et al., 2022). Discussion: There is a profound evidence gap regarding perioperative outcomes in women over 80 undergoing elective gynecological surgery. Available data suggest low mortality but increased morbidity compared to younger patients. Readmission remains unmeasured. Frailty, hypoalbuminemia, and open surgical approach are key risk factors. Conclusion: Elective gynecological surgery in selected patients over 80 is feasible with low mortality, but major morbidity is higher. No readmission data exist. Future research must include this age group, report geriatric-specific outcomes, and evaluate ERAS protocols.

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