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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.

How Does Telemedicine-Based Postoperative Monitoring Affect Recovery Outcomes and Healthcare Costs for Women Undergoing Gynecological Procedures? : A Systematic Review Melati Ganeza; Yahya Nurlianto; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 39 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: 10.70070/75y50z88

Introduction: Postoperative care following gynecological surgery traditionally relies on in-person visits, which impose burdens on patients and healthcare systems. Telemedicine offers a potential alternative, but its impact on recovery outcomes and costs specifically for gynecological procedures requires systematic evaluation. Methods: This systematic review followed structured screening and data extraction procedures. We included randomized controlled trials, etc involving adult women (≥18 years) undergoing routine gynecological procedures. Studies examined telemedicine-based postoperative monitoring (remote technologies, virtual consultations, mobile apps, telehealth platforms) compared to standard care. Outcomes included recovery measures (complications, readmissions, patient satisfaction, quality of life, return to activities) and healthcare costs. Sixteen studies met inclusion criteria for final analysis. Results: Patient satisfaction was noninferior or superior to standard care across 10 studies (Lee et al., 2020; Wherley et al., 2025; Robin et al., 2025). Functional recovery improved significantly with comprehensive eHealth programs combining activity tracking and personalized advice, reducing return-to-normal-activities by 13 days (den Bakker et al., 2023). Simple telephone follow-up showed no benefit on quality of life or pain in enhanced recovery settings (Kassymova et al., 2020; Kassymova et al., 2022). Telemedicine was safe across all studies, with no increased complications or readmissions. Cost-effectiveness was demonstrated for internet-based programs (Bouwsma et al., 2018) and automated low-cost interventions (Sajnani et al., 2020; Robin et al., 2025), while nurse-led telephone models doubled costs without clinical benefit (Kassymova et al., 2025). Discussion: Intervention complexity predicts functional recovery benefits; personalized, interactive eHealth platforms outperform passive monitoring. Enhanced recovery after surgery (ERAS) contexts may attenuate marginal benefits of simple telephone follow-up. Satisfaction is universally preserved across all telemedicine modalities. Telemedicine does not increase low-acuity healthcare contacts and may reduce them through structured coaching. Cost-effectiveness depends on mechanism of savings—technology-mediated scalable interventions are superior to staffing-intensive models. Patient age, technological literacy, and psychological factors influence uptake and outcomes. Conclusion: Telemedicine-based postoperative monitoring for gynecological procedures is safe and achieves patient satisfaction equivalent or superior to standard care. Functional recovery benefits require comprehensive, personalized interventions with active patient engagement rather than simple follow-up. Cost-effectiveness favors automated or internet-based programs over labor-intensive telephone models. Future implementation should match intervention complexity to clinical context, target specific care gaps (activity guidance, expectation management), and consider patient digital literacy and psychological needs.

What are The Optimal Surgical Staging Procedures for Fallopian Tube Cancer in Terms of Diagnostic Accuracy, Morbidity, and Long-Term Patient Outcomes? : A Systematic Review Melati Ganeza; Yahya Nurlianto; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 39 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/nsxw3t27

Introduction: Primary fallopian tube cancer (PFTC) is a rare gynecologic malignancy that shares clinical and histological features with epithelial ovarian cancer. The optimal surgical staging procedures for PFTC and its precursor, serous tubal intraepithelial carcinoma (STIC), remain incompletely defined due to limited prospective data. Methods: This systematic review synthesized evidence from 16 studies, including RCT, etc. Data were extracted on diagnostic accuracy (upstaging rates), surgical morbidity, long-term outcomes (survival, recurrence), and comparative effectiveness of staging approaches (laparoscopy vs. laparotomy, complete vs. incomplete staging, extraperitoneal vs. transperitoneal lymphadenectomy). Results: For PFTC, comprehensive surgical staging (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy, peritoneal cytology/biopsies) improved 5-year survival from 33.3% to 65.4% (p=0.043) (Yu et al., 2007). Optimal cytoreduction significantly improved survival (68.4% vs. 41.7%, p=0.044) (Yu et al., 2007). Upstaging rates for apparent early-stage adnexal cancers were 23% (Brockbank et al., 2013). For STIC, upstaging varied from 0% in BRCA carriers undergoing risk-reducing surgery (Hoeven et al., 2018) to 43% in incidental STIC in low-risk women (Chay et al., 2015). Minimally invasive staging reduced blood loss, hospital stay, and lymphatic ascites (p<0.05) compared to laparotomy (Nezhat et al., 2010; Pérez-Medina et al., 2015; Kerbage et al., 2020). Extraperitoneal para-aortic lymphadenectomy had fewer intraoperative complications (OR 0.40, p=0.001) but more lymphoceles (OR 4.12) than transperitoneal approach (Li et al., 2021). Discussion: The evidence supports complete surgical staging and optimal cytoreduction for PFTC. For STIC, staging is most clearly indicated when incidentally found in non-BRCA patients. Minimally invasive approaches are preferred due to lower morbidity, provided tumor rupture is avoided. The independent prognostic value of lymphadenectomy remains debated, while omentectomy shows consistent survival benefit. Conclusion: Optimal surgical staging for fallopian tube cancer should include systematic lymphadenectomy, omentectomy, peritoneal biopsies, and cytology, aiming for no residual disease. Laparoscopic staging is safe and effective for early-stage and selected advanced cases. STIC management should be individualized based on BRCA status and clinical context.

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