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All Journal Medfarm: Jurnal Farmasi dan Kesehatan Malahayati International Journal of Nursing and Health Science
Oktama, Nizan Dani
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Chemistry Health Professions Medicine & Pharmacology Nursing Public Health

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Silent threat in early pregnancy: A case of spontaneous heterotopic pregnancy with tubal rupture Oktama, Nizan Dani; Fakhrizal, Edy
Malahayati International Journal of Nursing and Health Science Vol. 8 No. 7 (2025): Volume 8 Number 7
Publisher : Program Studi Ilmu Keperawatan-fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/minh.v8i7.968

Abstract

Background: Heterotopic pregnancy (HP) is a rare but potentially life-threatening condition characterized by the coexistence of intrauterine and extrauterine pregnancies. While its incidence in natural conception is estimated at 1 in 30,000 cases, the risk increases considerably with the use of assisted reproductive technologies. Because its symptoms often mimic those of ectopic pregnancy, HP remains a diagnostic challenge, particularly in patients without recognized risk factors. Purpose: To highlight the silent yet serious threat of spontaneous heterotopic pregnancy in early gestation, illustrated by a case of tubal rupture in a natural conception. Method: A descriptive case report of a 43-year-old multigravida woman who presented at 7 weeks of gestation with sudden lower abdominal pain and clinical features of intra-abdominal hemorrhage. Diagnostic evaluation included ultrasonography and laboratory investigations, followed by an emergency laparotomy. Results: Ultrasound imaging revealed two intrauterine gestational sacs along with free fluid in the pouch of Douglas. Laboratory tests indicated anemia (hemoglobin 8.1 g/dL) and marked leukocytosis. Emergency laparotomy confirmed a ruptured right fallopian tube with massive intraperitoneal bleeding. The patient underwent right salpingectomy, left tubectomy, and intrauterine curettage at her request. Her postoperative recovery was uneventful, and she was discharged in good condition after two days. Conclusion: This case underscores the diagnostic difficulty of heterotopic pregnancy in spontaneous conceptions. The presence of an intrauterine pregnancy may create false reassurance, masking a concurrent ectopic gestation. Clinicians should consider HP in the differential diagnosis of any reproductive-aged woman with abdominal pain, regardless of conception method, to prevent life-threatening maternal complications.
The Relationship Between Pregnant Women’s Knowledge, Attitudes, and Behaviors Toward Tetanus Toxoid Immunization Andri, Sofyan; noviardi, Noviardi; Oktama, Nizan Dani
MEDFARM: Jurnal Farmasi dan Kesehatan Vol 14 No 2 (2025): Medfarm: Jurnal Farmasi dan Kesehatan
Publisher : LPPM Akafarma Sunan Giri Ponorogo

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.48191/medfarm.v14i2.613

Abstract

Tetanus Toxoid (TT) immunization remains a critical strategy in preventing maternal and neonatal deaths caused by tetanus. Despite its proven effectiveness, TT immunization coverage in Indonesia including in Pekanbaru City remains below target. Among the contributing factors are pregnant women's levels of knowledge, attitudes, and behaviors, which are believed to significantly influence immunization uptake. Objective: This study aimed to assess the relationship between pregnant women’s knowledge, attitudes, and behaviors and their participation in TT immunization programs across three health center areas in Pekanbaru: Simpang Tiga, Rejosari, and Okura. Methods: A descriptive analytic quantitative study with a cross-sectional design was conducted, involving 111 pregnant women who attended antenatal care (ANC) visits in May 2025. Data were analyzed using the Chi-Square test, Spearman Rank correlation, Cramer’s V, and logistic regression, with a significance level set at p < 0.05. Results: The study found statistically significant differences in knowledge, attitudes, and behaviors among the three health center areas (p < 0.05). Notably, good knowledge did not always correspond to positive attitudes—many well-informed respondents still exhibited negative attitudes. However, a strong correlation was observed between attitude and behavior (Cramer’s V = 0.552). Logistic regression revealed that knowledge (OR = 0.201; p = 0.005), attitude (OR = 2.068; p = 0.036), and behavior (OR = 5.660; p < 0.001) significantly influenced TT immunization uptake, with behavior emerging as the most dominant factor. Conclusion: Efforts to improve TT immunization coverage must go beyond knowledge-based education and focus on fostering positive attitudes and reinforcing supportive behaviors. Behavior-centered interventions and effective communication by health workers are essential to strengthen immunization outcomes.
Co-Authors Fakhrizal, Edy Noviardi Noviardi, Noviardi Sofyan Andri