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Patricia Wulandari
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Sriwijaya Journal of Obstetrics and Gynecology
Published by Phlox Institute: Indonesian Medical Research Organization
ISSN : 29869838     EISSN : 29869838     DOI : https://doi.org/10.59345/sjog
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Nursing Public Health
Focus Sriwijaya Journal of Obstetrics and Gynecology (SJOG) focused on the development of medical sciences especially obstetrics and gynecology for human well-being. Scope Sriwijaya Journal of Obstetrics and Gynecology (SJOG) publishes articles which encompass all aspects of basic research/clinical studies related to the field of obstetrics - gynecology and allied science fields, especially all type of original articles, case reports, review articles, narrative review, meta-analysis, systematic review, mini-reviews and book review.
Arjuna Subject : Kedokteran - Obstetrics and Gynaecology
Articles 35 Documents
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Exploring the Pathophysiology of Adenomy osis in Jakarta: Novel Insights into I nflammatory Pathways and Angiogenesis Suryani, Febria; Rodriguez, Maria
Sriwijaya Journal of Obstetrics and Gynecology Vol. 1 No. 1 (2023): Sriwijaya Journal of Obstetrics and Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v1i1.214

Abstract

Introduction: Adenomyosis, characterized by endometrial glands and stroma within the my ometrium, is a significant cause of morbidity (abnormal uterine bleeding (AUB), pain, infertility) among women globally. While its general pathophysiol ogy is increasingly understood, population-specific data, particularly f rom diverse Asian populations like that of Jakarta, Indonesia, remains limited. This study aimed to investigate the roles of specific inflammatory pathways and angiogenic factors in adenomyosis within a cohort of women in Jakarta, hypothesizing that common pathogenic mechanisms manifest in this population, potentially influenced by local factors. Methods: This prospective c ase-control study was conducted in three tertiary referral hospitals in Jakarta, Indonesia from January 2022 to December 2024. Fifty women undergoing hysterectomy, diagnosed with adenomyosis were recruited, alongside 50 cont rol women without adenomyosis undergoing hysterectomy for other benign conditions. Samples of eutopic endometrium, ectopic adenomyotic lesions, and associated myometrium were collected. Immunohistochemistry quantified inflamm atory cells (macrophages, mast cells, T-lymphocytes) and microvessel density (CD31). Expression of key inflammatory cytokines and angiogenic factors was assessed via qRT-PCR and ELISA. Results: Women with adenomyosis in th e Jakarta cohort exhibited significantly increased infiltration of M1-phenotype macrophages (p0.001) and mast cells (p0.001) in adenomyotic lesions and eutopic endometrium compared to controls. IL-6, TNF-α, and MCP-1 expression was markedly upregulated in adenomyotic foci (all p0.001). Microvessel density, VEGF-A, and VEGFR2 expression were significantly elevated in adenomyotic tissue (all p0.001). Strong positive correlations were observed between macrophage density, IL-6 levels, VEGF-A expression, and microvessel density within adenomyotic lesions, similar to findings in other populations. Conclusions: This study, conducted in Jakarta, provides strong evidence for a heightened pro-inflammatory and pro-angiogenic microenvironment in adenomyosis, consistent with general pathogenic theories. These findings i n an Indonesian population underscore the universal importance of th ese pathways and suggest that novel therapies targeting inflammation and angiogenesis could be relevant for women in this region. Further research should explore potential local modulatory factors.
The Overview of Menstrual Physiology: A Narr ative Literature Review Andini, Kusuma
Sriwijaya Journal of Obstetrics and Gynecology Vol. 1 No. 1 (2023): Sriwijaya Journal of Obstetrics and Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v1i1.215

Abstract

Menstruation is a physiological or normal condition, namely events of the production of bl ood, mucus, and cell waste periodically originate from the uterine mucosa and occur relatively regularly from menarche until menopause, exc ept during pregnancy and lactation. Menstruation is the result of very n eat and standard cooperation from the hypothalamus-pituitary-ovarian endocrine axis. Hypothalamus spurs the pituitary gland by secreting gonad otropin-releasing hormone (GnRH), a deca-peptide secreted pulsatively by the hypothalamus. Menstruation is considered normal if it occurs between 22-35 days. Disturbance menstruation is most common at the beginning and end of the reproductive period, namely in those under 19 years of age and over 39 years of age. These disturbances may be related to the length of t he menstrual cycle or the number and duration of menstruation. One person Women can experience both disorders. This literature review aimed to describe the menstrual cycle physiologically and the disorders that accompany it.
The Relationship between Risk Factors for the Use of Oral Contraception and Sexual Activity with Cervical Cancer Incidence at Dr. M Djamil General Hospital, Padang, Indonesia Hidayat, Ahmad; Syifa
Sriwijaya Journal of Obstetrics and Gynecology Vol. 1 No. 1 (2023): Sriwijaya Journal of Obstetrics and Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v1i1.216

Abstract

Introduction: Cervical cancer is a malignancy of the cervix caused by the human papilloma virus (HPV). Cervical cancer often has no symptoms. Most patients are known to be positive for cervical cancer at an advanced stage. This study aim ed to determine the relationship between the use of oral contraceptives a nd sexual activity with the incidence of cervical cancer at Dr. M. Djamil General Hospital, Padang, Indonesia. Methods: This study was an analytic observational case-control study. A total of 37 subjects were researched as a case group and a total of 111 subjects as a control group. This study made observations of variable age, Education, work, use of oral contraceptives, and sexual activity for the first time. Data analysis was carried out using SPSS software univariate and bivariate. Results: Use of oral contracepti ves ≥ 5 years was not significantly associated with the incidence of cervical cancer, p> 0.05. Age at first sexual intercourse <18 years was signif icantly associated with the incidence of cervical cancer, p<0.05. Age at first pregnancy <18 years was significantly associated with the incidence of cervical cancer, p<0.05. Conclusion: Sexual activity is a risk factor that plays a role in the incidence of cervical cancer at Dr. M Djamil General Hospital, Padang, Indonesia.
An Overview and Management of Painful Menstrual Disorder (Dysmenorrhea): A Narrative Literature Review Juntu, Petrus; Ananta, Gede
Sriwijaya Journal of Obstetrics and Gynecology Vol. 1 No. 1 (2023): Sriwijaya Journal of Obstetrics and Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v1i1.217

Abstract

Primary dysmen orrhea is menstrual pain associated with the release of prostaglandins in the ovulatory cycle, but not with the pelvic disease. Approximately 9 0% of all women experience dysmenorrhea, 15% of whom are unable to last 1 to 3 days because of the severity of the pain. This literature review aimed to describe an overview and management of dysmenorrhea. Primary dysmenorrhea usually begins with the onset of ovulation cycles, with the highest prevalence in adolescence. In contrast, secondary dysme norrhea is associated with pelvic pathology (i.e., ovarian cysts, adenomyosis, endometriosis) that manifests in later reproductive years and can oc cur at any point in the menstrual cycle. Administration of nonsteroidal ant i-inflammatory drugs (NSAIDs) is the treatment of choice because these drugs reduce the activity of the cyclooxygenase (COX) enzyme and, thus, the p roduction of prostaglandins. NSAIDs work in the majority of women with primary dysmenorrhea and are most effective when started at the first sign of b leeding or cramping.
Overview of Risk Factors for Ectopic Pregnancy at Dr. M. Djamil General Hospital, Padang, Indonesia Rozali, Azwar; Asnawi, Zainuddin
Sriwijaya Journal of Obstetrics and Gynecology Vol. 1 No. 1 (2023): Sriwijaya Journal of Obstetrics and Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v1i1.218

Abstract

Introduction: Ectopic pregnancy is an emergency condition that is the cause of maternal death during the first trimester of pregnancy. Most extrauterine implantations occur in the fallopian tubes. This study aimed to find an overview factor risk of ectopic pregnancy at Dr. M Djamil General Hospital, Padang, Indonesia. Methods: This study was a descriptive observational study and used secondary data from medical record data at the medical record installation of Dr. M Djamil General Hospital, Padang, Indonesia. A total of 100 research subjects participated in this study, and the research subjects met the inclusion criteria. The inclusion criteria in this study were patients with ectopic pregnancy disorders who were treated at Dr. M Djamil General Hospital, Padang, Indonesia, over 18 years of age and had complete medical record data. Data analysis was carried out using SPSS software version 25. Univariate analysis was performed to present the distribution frequency data for each variable test. Results: The majority of research subjects had an age range of 26-35 years (55%). The most common risk factors in this study were a history of abortion in a previous pregnancy (47%), parity 0 (46%), and abortion occurring in the first pregnancy (35%). Conclusion: Maternal age, history of abortion, parity, and gravidity are risk factors that play a role in the incidence of ectopic pregnancy at Dr. M Djamil General Hospital, Padang, Indonesia.
Peer-Led Nutritional Education Plus Iron-Folic Acid for Adolescent Iron-Deficiency Anemia: A Cluster Randomized Controlled Trial in Indonesia Indri Yani Septiana; Annisa Annisa
Sriwijaya Journal of Obstetrics and Gynecology Vol. 3 No. 2 (2025): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v3i2.279

Abstract

Introduction: Iron-deficiency anemia affects roughly one-third of adolescent girls and, by entering reproductive life with depleted iron stores, propagates intergenerational maternal risk. Standard weekly iron-folic acid (IFA) supplementation is undermined by poor adherence. We evaluated whether adding a peer-led nutritional-education program to IFA improves hematologic and psychosocial outcomes more than IFA alone. Methods: In a single-blind, parallel-group cluster randomized controlled trial in urban Palembang, Indonesia, 16 school clusters were randomized 1:1 to peer-led education plus weekly IFA (60 mg iron, 2.8 mg folic acid) or IFA alone. We enrolled 320 post-menarcheal girls aged 13–17 years with baseline hemoglobin 8.0–11.9 g/dL. Co-primary outcomes were hemoglobin and serum ferritin; the secondary outcome was the WHO-5 Well-Being Index, assessed at baseline, 3 and 6 months. Generalized linear mixed models with cluster random intercepts (intention-to-treat) were used. Results: At 6 months the intervention produced adjusted mean differences of +1.42 g/dL hemoglobin (95% CI 1.05–1.79; Cohen's d 2.11), +13.5 µg/L ferritin (10.2–16.8; d 2.75) and +23.4 WHO-5 points (19.8–27.0; d 3.14), all p<0.001. Anemia resolved in 89.3% versus 33.1% (RR 2.70, 95% CI 2.13–3.42; NNT 2). Adherence was higher with the intervention (92.5% vs 74.3%; OR 4.25). The multivariable model discriminated resolution well (AUC 0.89, 0.85–0.93). No severe adverse events occurred. Conclusion: A peer-led nutritional-education program markedly enhanced the efficacy of standard IFA, normalizing hemoglobin, replenishing iron stores and improving psychosocial well-being in anemic adolescent girls. This low-cost, scalable, school-based strategy is a promising preconception reproductive-health intervention for Indonesia and similar settings.
Efficacy of a Specialist Tele-Mentoring Triage System on Severe Maternal Morbidity and Mortality in High-Risk Pregnancies: A Stepped-Wedge Cluster Randomized Trial Muhammad Yoshandi; Rheina Weisch Fedre; Desiree Montesinos
Sriwijaya Journal of Obstetrics and Gynecology Vol. 3 No. 2 (2025): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v3i2.280

Abstract

Introduction: Maternal deaths in low- and middle-income settings are driven largely by delays in recognising and treating obstetric emergencies at the primary-care frontline. Real-time specialist tele-mentoring may compress these delays, yet trial evidence on hard maternal and neonatal endpoints remains scarce in Indonesia. We evaluated whether a specialist tele-mentoring triage system reduces severe maternal morbidity and mortality in high-risk pregnancies. Methods: In a closed-cohort stepped-wedge cluster randomized trial, ten primary-to-referral facility clusters across two Indonesian metropolitan regions sequentially crossed from conventional referral to a 24/7 tele-mentoring triage system (audiovisual specialist consultation, portable cardiotocography/vital-sign telemetry, and a Maternal Early Warning Score [MEWS] algorithm) over six two-month periods. The primary outcome was a composite of maternal death and WHO-defined severe maternal morbidity. Intention-to-treat analysis used generalized linear mixed models adjusting for secular trend and cluster random effect. Results: Among 1,858 high-risk women, the composite outcome fell from 7.97% (95% CI 6.39–9.88) during control person-time to 4.41% (95% CI 3.27–5.93) during tele-mentoring (adjusted OR 0.51, 95% CI 0.36–0.73, p<0.001; absolute risk reduction 3.55%; number-needed-to-treat 28). Door-to-treatment time shortened by 85.6 minutes (Cohen's d 1.77, p<0.001). MEWS discriminated the composite outcome well (AUC 0.84, 95% CI 0.80–0.88). NICU admission (OR 0.66, NNT 19, p=0.003) and 5-minute Apgar <7 (OR 0.58, p=0.002) also improved. Conclusion: A specialist tele-mentoring triage system roughly halved the odds of severe maternal morbidity and mortality in high-risk pregnancies and improved neonatal outcomes. Scaling specialist-guided digital triage could meaningfully strengthen obstetric emergency referral in Indonesia.
Efficacy and Cost-Effectiveness of HPV-DNA Self-Sampling with Telemedicine-Supported Triage for Cervical Cancer Screening in Underserved Indonesian Populations: A Pragmatic Randomized Controlled Trial Rachmat Hidayat; Lisye Tiur Simanjuntak; Sarah Fernandez
Sriwijaya Journal of Obstetrics and Gynecology Vol. 3 No. 2 (2025): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v3i2.281

Abstract

Introduction: Cervical cancer screening coverage in Indonesia remains far below the WHO elimination target, because distance, lost wages, scarce female providers, and fragmented referral cause low participation and high triage attrition. We evaluated whether HPV-DNA self-sampling integrated with physician-led telemedicine triage improves screening completion and follow-up adherence and is cost-effective versus standard clinic-based screening. Methods: In a pragmatic, open-label, two-arm randomized controlled trial across two contrasting Indonesian regions—a dense metropolitan periphery (Region A) and a riverine/remote periphery (Region B)—1,032 under-screened women aged 30–50 years were randomized 1:1 to community-delivered HPV-DNA self-sampling with telemedicine triage of high-risk HPV (hrHPV)-positive results, or to standard referral for visual inspection with acetic acid or cytology. Primary outcomes were screening uptake within three months and the incremental cost-effectiveness ratio (ICER) per additional hrHPV case successfully triaged. Analysis followed intention-to-treat with multivariable logistic regression. Results: Screening uptake was 82.0% versus 48.1% (risk ratio 1.71, 95% CI 1.55–1.88; absolute difference 33.9%, number-needed-to-invite 3; adjusted odds ratio 4.94, 95% CI 3.72–6.56, p<0.001), consistent across regions (interaction p=0.42). Among hrHPV-positive women, follow-up adherence was 92.7% (38/41) versus 57.1% (12/21) (odds ratio 9.50, 95% CI 2.28–39.6, p=0.003), and CIN2+ was detected and treated in 11 versus 3 women. Cost per successful follow-up was US$315 versus US$516; the intervention was dominant in 96% of probabilistic simulations. Conclusion: Integrating HPV self-sampling with physician-led telemedicine triage substantially increased both screening and triage completion across diverse geographies while remaining cost-effective. National programs should embed telemedicine-supported triage to close the cervical-screening cascade.
Development and Validation of an Explainable Machine-Learning Model to Predict Cumulative Live Birth in PCOS-Associated Infertility Anies Fatmawati; Hesti Putri; Theresia Putri Sinaga
Sriwijaya Journal of Obstetrics and Gynecology Vol. 3 No. 2 (2025): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v3i2.282

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility, yet predicting the cumulative live birth rate (CLBR) after in vitro fertilization (IVF) is difficult because of marked clinical heterogeneity. Conventional linear models discriminate modestly and most machine-learning (ML) tools remain uninterpretable. We aimed to develop and internally validate an explainable ML model for CLBR in women with PCOS. Methods: In a multicenter retrospective cohort at two tertiary reproductive-medicine centers in Indonesia (January 2018–December 2023), 1,245 women with PCOS (Rotterdam criteria) undergoing a first IVF/intracytoplasmic sperm injection cycle were analysed. Five algorithms (logistic regression, support vector machine, random forest, gradient boosting and eXtreme Gradient Boosting [XGBoost]) were trained (70%) and internally validated (30%) with 5-fold cross-validation. Discrimination used the area under the ROC curve (AUC) with DeLong confidence intervals (CI); SHapley Additive exPlanations (SHAP) quantified feature importance. Multivariable logistic regression, calibration and number-needed-to-treat (NNT) were also derived. Results: Overall CLBR was 54.6% (95% CI 51.8–57.4%). XGBoost performed best (AUC 0.82, 95% CI 0.79–0.85; accuracy 76.4%; sensitivity 78.2%; specificity 74.1%) and significantly exceeded logistic regression (AUC 0.72; ΔAUC 0.10, p<0.001). SHAP ranked top-quality embryo number, maternal age, anti-Müllerian hormone and oocyte yield as dominant predictors. Each additional top-quality embryo raised CLBR odds (adjusted OR 1.85, 95% CI 1.66–2.06, p<0.001); ≥3 versus <3 embryos yielded an NNT of 3.3. Conclusion: An explainable XGBoost model accurately predicts CLBR in PCOS-associated infertility and can support individualised counselling and cycle-management decisions. Prospective external validation is warranted before clinical deployment.
Mobile Health Intervention to Improve Uptake and 12-Month Continuation of Long-Acting Reversible Contraception Among Urban Female Adolescents: A Multicenter Randomized Controlled Trial Rizky Ayu; Sana Ullah; Immanuel Simbolon
Sriwijaya Journal of Obstetrics and Gynecology Vol. 3 No. 2 (2025): Sriwijaya Journal of Obstetrics & Gynecology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjog.v3i2.283

Abstract

Introduction: Adolescent pregnancy remains a major source of obstetric and psychosocial morbidity in densely populated Indonesian cities. Long-acting reversible contraception (LARC) offers first-line efficacy, yet adolescent uptake and continuation are constrained by misinformation and stigma. Mobile health (mHealth) may bridge this gap discreetly. We evaluated whether an interactive, encrypted mHealth platform improves LARC uptake and 12-month continuation versus standard care. Methods: We conducted a parallel, two-arm (1:1), open-label multicenter randomized controlled trial with blinded outcome assessment at two tertiary reproductive-health centers in Jakarta and Palembang, Indonesia. Sexually active women aged 15–21 years not desiring pregnancy within 12 months were block-randomized (stratified by center and parity). The platform delivered interactive education, private counselor chat, and automated reminders. Primary outcomes were LARC uptake at 1 month (intention-to-treat) and time-to-discontinuation over 12 months, analyzed with risk ratios (RR), Kaplan–Meier survival, Cox regression, and number needed to treat (NNT). Results: Of 390 adolescents screened, 364 were randomized (182 per arm). LARC uptake was 36.8% with mHealth versus 16.5% with standard care (RR 2.23, 95% CI 1.53–3.26; adjusted odds ratio 2.95, 95% CI 1.80–4.84; p<0.001). Absolute risk reduction was 20.3% (NNT 5). The 12-month continuation rate was 82.1% versus 56.7% (log-rank p=0.014), and Cox regression showed a 62% lower discontinuation hazard (adjusted hazard ratio 0.38, 95% CI 0.17–0.85; p=0.018). Conclusion: An encrypted, interactive mHealth intervention more than doubled LARC uptake and improved 12-month continuation among urban Indonesian adolescents, supporting integration of scalable, stigma-sensitive digital platforms into adolescent family-planning services.

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