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Tjahjadi D, Aviani JK, Tjandraprawira KD, Parwati I, Permadi W, Djuwantono T, Li TC. Pregnancy outcomes after all mode of conception in patients with genital tuberculosis: a systematic review and meta-analysis. Obstet Gynecol Sci 2025:ogs.24045. [PMID: 39748636 DOI: 10.5468/ogs.24045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 11/04/2024] [Indexed: 01/04/2025] Open
Abstract
This systematic review and meta-analysis aimed to summarize the pregnancy outcomes of women di-agnosed with genital tuberculosis (GTB) who spontaneously conceived or underwent intrauterine in-semination (IUI) or in vitro fertilization (IVF) after being treated with antitubercular therapy (ATT). Pub-lications from the PubMed, Medline, Embase, Ovid, Scopus, Web of Science, and Google Scholar data-bases were searched from December 20, 2021, to March 5, 2022. The outcomes are presented as pooled averages with 95% confidence intervals. The inconsistency index (I2) test was used to measure the heterogeneity between studies. The certainty of the evidence was assessed using GRADEPro (https://www.gradepro.org/). Of the numerous articles identified, 33 met the inclusion criteria and were included in this systematic review. Generally, there was a significant increase in pregnancy rates among patients who underwent IVF compared with those who underwent ATT (37.9% vs. 23.8%; P=0.02). Con-versely, there was no significant difference in pregnancy rates between patients who underwent IUI and those who conceived spontaneously (18.1% vs. 23.8%; P=0.65). In cases in which no abnormalities were found on hysterosalpingography or hysterolaparoscopy, pregnancy rates were comparable be-tween spontaneous and IVF conceptions (48.4% vs. 49.2%). There were no significant differences in pregnancy or live birth rates between patients with GTB and those with other infertility factors under-going IVF treatment (P>0.05). ATT, which is administered during the early stages of GTB is effective in achieving pregnancy outcomes comparable to IVF. However, in patients with advanced-stage disease, IVF is a superior treatment modality, resulting in increased pregnancy rates.
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Sutrisno S, Marlina D, Tjandraprawira KD, Adinda Adriansyah PN. The impact of pathogenic BRCA1/2 tumor mutation status on high grade serous epithelial ovarian cancer survival outcome: A multicenter study from Indonesia. SAGE Open Med 2024; 12:20503121241299849. [PMID: 39575313 PMCID: PMC11580090 DOI: 10.1177/20503121241299849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 10/22/2024] [Indexed: 11/24/2024] Open
Abstract
Introduction Ovarian cancer is still a major health problem in Indonesia. development of breast cancer gene-related personalized medicine to increase the survival outcome of epithelial ovarian cancer patients in Indonesia is expected to be achieved. This research aims to evaluate the impact of pathogenic breast cancer gene 1 and breast cancer gene 2 tumor mutation on high-grade serous epithelial ovarian cancer survival outcome. Methods This study is an observational analytic study, using a historical cohort study design. A total of 68 from 144 patients diagnosed with International Federation of Gynecology and Obstetrics 2014 stage IIB-IV high-grade serous epithelial ovarian cancer between January 1st, 2015 until March 31st, 2021, at three centers in Jakarta. Next-generation sequencing tumor breast cancer gene 1 and breast cancer gene 2 testing and were included in this cohort historical study. We compared patient's overall survival outcomes, according to pathogenic breast cancer gene 1 and breast cancer gene 2 tumor mutational status. Clinicopathological characteristic factors that might affect patient's survival outcomes were also investigated. Results In the group of individuals with pathogenic breast cancer gene 1 and breast cancer gene 2 tumour mutations, the risk of death was significantly lower by 86% (adjusted RR 0.149; 95% CI: 0.046-0.475; p-value = 0.001), and the median survival time was significantly better (median 46 months; 95% CI: 34.009-57.991; p-value = 0.001) compared to the group without pathogenic breast cancer gene 1 and breast cancer gene 2 tumor mutations (median 23 months; 95% CI: 15.657-30.343; p-value = 0.001). The multivariate analysis revealed that the presence of a pathogenic breast cancer gene 1 and breast cancer gene 2 tumor mutation is an independent and positive prognostic factor for survival outcome. The adjusted relative risk was 0.149, with a 95% CI of 0.046-0.475, p-value = 0.001. Conclusions In high-grade serous ovarian cancer patients, the pathogenic breast cancer gene 1 and breast cancer gene 2 tumor mutations group have a better prognosis with longer survival outcomes than those without pathogenic breast cancer gene 1 and breast cancer gene 2 tumor mutations.
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Bayuaji H, Susilo AFP, Tjandraprawira KD. Comparison of Time to Pregnancy in In Vitro Fertilisation between Endometriosis and Nonendometriosis. Obstet Gynecol Int 2024; 2024:4139821. [PMID: 39280236 PMCID: PMC11398961 DOI: 10.1155/2024/4139821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 08/03/2024] [Accepted: 08/30/2024] [Indexed: 09/18/2024] Open
Abstract
Background This study is to compare the time to pregnancy (TTP) between patients with endometriosis and nonendometriosis undergoing in vitro fertilisation (IVF).Material and Methods.This is an observational retrospective cohort study. We included 291 patients (53 with endometriosis and 238 without endometriosis) achieving biochemical pregnancy, whether singleton or multifetal (serum beta-hCG >5 mIU/mL), between 1st January 2014 and 31st March 2020. We excluded patients with incomplete case notes and those declining participation. Time to pregnancy is the interval between the time when infertility was established to the date of confirmed biochemical pregnancy, expressed in months. Endometriosis diagnosis includes any form of endometriosis through surgical confirmation. A statistical analysis was done through the Mann-Whitney U test. Time to pregnancy was assessed through the Kaplan-Meier test. A p value <0.05 is considered statistically significant. Results Endometriosis patients had a shorter infertility duration (4 years vs. 5 years, p=0.024). Both groups had similar median age and body mass index at presentation. There was no significant difference in the TTP between endometriosis and nonendometriosis groups (57.7 vs. 70.9 months, p=0.060), further confirmed by a Cox regression test incorporating confounders (IVF protocol (OR: 1.482, 95% CI 0.667-3.292, and p=0.334) and type of the cycle (OR 1.071, 95% CI 0.803-1.430, and p=0.640)). The endometriosis group reached the maximum cumulative pregnancy rate at around 169 months postinfertility diagnosis, whilst the nonendometriosis group at around 255 months postinfertility diagnosis. Conclusion Time to pregnancy between endometriosis and nonendometriosis is not significantly different. However, infertility among patients with endometriosis tends to be shorter.
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Sasotya RMS, Rinaldi A, Achmad ED, Ma’soem AP, Praharsini K, Imantika E, Wulandari F, Nathania N, Tjandraprawira KD. Diagnostics and Management Challenges of Nonpuerperal Uterine Inversions - Case Series. Int J Womens Health 2024; 16:1425-1435. [PMID: 39221427 PMCID: PMC11365529 DOI: 10.2147/ijwh.s474778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Non-puerperal uterine inversion (NPUI) is a rare gynaecological entity with unknown actual incidence. It presents diagnostic and surgical challenges, due to its rarity and lack of clinical experience. Methods Case series of 5 NPUI cases. Case Description (1) A 44-year-old P3A0 presented with chronic profuse vaginal bleeding and a prolapsed pedunculated fibroid measuring 9x8x7 cm. In theatre, the pedunculated fibroid was extirpated. Haultain procedure was performed to reposition the uterus, followed by suturing the uterus. (2) A 65-year-old P4A0 presented with a solid vaginal mass, with brisk bleeding measuring 10x10x8 protruding from the introitus. In theatre, the mass was excised, followed by Kustner procedure and a subtotal hysterectomy. (3) A 46-year-old P1A1 presented with a large pedunculated fibroid, hypovolemic shock and loss of consciousness. Upon presentation, she was in shock and severely anaemic (Hb 1.4 gr/dL). In theatre, the fibroid was excised followed by uterine repositioning. A large left ovarian cyst (Ø 10 cm) was identified. A subtotal hysterectomy and left salpingo-oophorectomy were performed. (4) A 34-year-old P3A0 presented with an acute vaginal lump measuring 10x6x5 cm. She had delivered her infant 2 months prior. In theatre, a Huntington procedure was performed to reposition the uterus, followed by a total abdominal hysterectomy. (5) A 60-year-old P3A0 presented with vaginal mass measuring 10×10×8 cm and chronic profuse vaginal bleeding. In theatre, uterine inversion was diagnosed. A Haultain procedure was performed, followed by a total abdominal hysterectomy and bilateral salpingo-oophorectomy. All cases had presented with vaginal mass and bleeding to varying degrees. The degree of inversion required various procedures (eg, Kustner, Haultain, Huntington) and different forms of hysterectomy. Conclusion Non-puerperal uterine inversion is a difficult pathology. Management is always surgical with different types of hysterectomy performed. With conservative surgery, Kustner, Huntington and Haultain procedures are indicated according to the severity and uterine position.
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Rahman L, Anwar R, Zulvayanti Z, Tjandraprawira KD. Rupture Endometriomas Presenting as Acute Abdomen Infection in Hasty and Limited Resources Setting: A Pitfall Not to Miss - A Case Report. Int Med Case Rep J 2024; 17:635-641. [PMID: 38974882 PMCID: PMC11225996 DOI: 10.2147/imcrj.s472024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Abdominal pain is a diagnostic problem that requires immediate care and treatment for surgeons and gynecologists. The causes of abdominal pain in women of childbearing age range from benign and temporary to potentially life threatening. Rare etiologies such as spontaneous ruptured endometrioma are often not included in the radar of diagnosis due to their rarity and non-specific signs and symptoms in the patient. This case report aimed to show a resemblance between the clinical symptoms of acute abdomen in diffuse peritonitis due to hollow viscus perforation and spontaneous ruptured endometrioma. Case Description A 42-year-old woman presented to our hospital with abdominal pain. She had a history of fever for two weeks. She came from a tropical rural area where typhoid fever is common. She was advised to undergo emergency laparotomy because of the suspicion of diffuse peritonitis due to a hollow viscus perforation due to typhoid infection. Because of acute abdominal pain, a vertical incision was made to explore her abdominal cavity, and chocolate-like fluid and ovarian cysts were found during surgery. The diagnosis was changed to diffuse peritonitis due to spontaneous rupture of the endometrioma bilaterally. Conclusion This case suggests that the exact diagnosis and cause of abdominal pain varies. As the current gold standard for endometrioma is laparoscopy, surgeons must prepare a collaborative approach to the cause of the disease.
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Susilo AFP, Suryawan AZ, Tjandraprawira KD, Rachmawati A. Mayer-Rokitansky-Kuster-Hauser syndrome complicated with giant mucinous cystadenoma and inguinal herniation: case report. Oxf Med Case Reports 2024; 2024:omae036. [PMID: 38680771 PMCID: PMC11049569 DOI: 10.1093/omcr/omae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/26/2023] [Accepted: 02/24/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Coexistence of Mayer-Rokitansky-Kuster-Hauster syndrome (MRKH) with other conditions is rare, especially when MRKH was found in a young woman presenting with ovarian malignancy. This case report wishes to highlight MRKH complicated with giant mucinous cystadenoma and bilateral inguinal hernia. CASE REPORT A 22-year-old nulligravid woman was admitted with primary amenorrhea and abdominal mass. Abdominal examination revealed a cystic mass 25 × 25 × 20 cm in size and a vagina 1 cm in length. Pelvic magnetic resonance imaging (MRI) showed a giant multiloculated left ovarian mass amidst the absence of uterus. During the surgery, the giant multiloculated cystic mass was identified as mucinous cystadenoma on frozen section. Bilateral medial inguinal hernia was also identified. DISCUSSION MRKH coexisting with other disease is rare but considering other structures arising from paramesonephric duct (PMD) may exist, allows the possibility of other structural anomalies. CONCLUSIONS The present report illustrates a rare case of MRKH syndrome with giant ovarian cystadenoma and inguinal hernia.
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Pusianawati D, Suryawan AZ, Tjandraprawira KD, Cool CJ. Dilemmas in pregnancies with pulmonary hypertension: Case report from a low-resource setting. SAGE Open Med Case Rep 2023; 11:2050313X231201737. [PMID: 37771651 PMCID: PMC10524062 DOI: 10.1177/2050313x231201737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
Little awareness persists of how pregnancy worsens cardiac diseases. We wish to highlight the challenges in managing pulmonary hypertension (PH) in pregnancy, within low socioeconomic environments. A 31-year-old G3P1A1 of 5 months gestation presented with worsening dyspnea and extremital edema. She had a history of heart disease with no cardiologist follow-up. She was diagnosed with type I/II PH at 4 months gestation. Her ultrasound revealed intrauterine fetal death (IUFD). She was referred for pregnancy termination. At presentation, she was tachypneic with SaO2 at 68%. After labor, she was transferred to a cardiac intensive care unit with SaO2 at 60%. Bedside echocardiography revealed a high probability of PH (pulmonary artery systolic pressure value: 109 mmHg). Unfortunately, she deteriorated and passed away a day later. Cardiac diseases in pregnancy contribute significantly to maternal mortality in Indonesia and other low socioeconomic countries. Traditional views on pregnancy and family and human rights advocate pregnancy as one of the rights, pregnancy complicated with cardiac diseases is detrimental and potentially lethal. Disparities in healthcare practices and low socioeconomic environments also contribute to such outcomes. Lack of awareness and improperly held beliefs on conception and family have led women to conceive amidst severe underlying cardiac diseases with dire outcomes.
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Nugrahani AD, Maulana S, Tjandraprawira KD, Santoso DPJ, Setiawan D, Pribadi A, Siddiq A, Pramatirta AY, Aziz MA, Irianti S. Analysis of Clinical Profiles and Echocardiographic Cardiac Outcomes in Peripartum Cardiomyopathy (PPCM) vs. PPCM with Co-Existing Hypertensive Pregnancy Disorder (HPD-PPCM) Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5303. [PMID: 37629345 PMCID: PMC10455411 DOI: 10.3390/jcm12165303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/15/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian-Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = -1.63) (95% CI; -4.92,0.28, p = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = -1.55, [CI: -2.89, -0.21], p = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07-3.01), p = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (-1.08--0.33), p = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease's response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.
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Sibarani CNR, Permata HD, Martiana EF, Tjandraprawira KD, Hadinata CV. A rare case of squamous cell carcinoma transformation in a mature cystic teratoma of the ovary. SAGE Open Med Case Rep 2023; 11:2050313X231193305. [PMID: 37581115 PMCID: PMC10423442 DOI: 10.1177/2050313x231193305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023] Open
Abstract
Mature cystic teratoma of the ovary is the most common ovarian neoplasm (10%-20%). These tumors are generally benign but may undergo malignant transformation, 80% of which is squamous cell carcinoma, in postmenopausal women (1%-2%). Due to nonspecific findings, the preoperative diagnosis is challenging; most patients are detected at an advanced stage and have poor outcomes. A 40-year-old female, P2A0, complained of worsening lower abdominal pain and palpable abdominal mass. She had not been having menstrual periods for almost 4 months. For the last 3 months, she had asthenia, anorexia, and lost 10 kg. Abdominal examination was notable for an immobile, well-defined cystic mass measuring 12 × 8 × 8 cm with an irregular surface in the lower abdomen. Its overlying skin appeared reddish. A bimanual examination confirmed the adnexal origin of the cystic mass. Laboratory examination was notable for leukocytosis, thrombocytosis, increased neutrophil-to-lymphocyte ratio, and reduced absolute lymphocyte count. There was an increase in her cancer antigen 125. An abdominal ultrasonography examination showed bilateral mature cystic teratoma. A bilateral salpingo-oophorectomy was performed. A postoperative diagnosis of bilateral dermoid ovarian cysts was then established. The patient histopathology examination concluded squamous cell carcinoma (malignant transformation from benign cystic teratoma) in bilateral ovaries. The patient was referred to a gynecology oncology center for further examination and management. However, she missed the appointment for an unknown reason. The patient passed away 4 months after surgery. Clinicians should be aware of the possibility of malignant transformation of teratoma if a tumor has been present for a long time, its diameter is greater than 10 cm, there is a thickening of the cyst wall with papillary growth, there is an increase in tumor markers, and the patient is postmenopause. Malignant transformation of mature cystic teratoma remains a diagnostic and therapeutic puzzle and the prognosis is poor despite extensive initial surgery and optimal debulking.
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Aziz MA, Zahra F, Razianti ZB C, Kharismawati N, Sutjighassani T, Almira NL, Tjandraprawira KD. Challenges in prenatal diagnosis of foetal anorectal malformation and hydrocolpos - Case report. Ann Med Surg (Lond) 2022; 84:104949. [PMID: 36582906 PMCID: PMC9793165 DOI: 10.1016/j.amsu.2022.104949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/29/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance: Foetal hydrocolpos and anorectal malformation are difficult to diagnose prenatally due to abundance of differential diagnoses. This case report presents the challenges of diagnosing such disorders. Case presentation A G3P2A0 woman came at 32 weeks of pregnancy with a referral for foetal ovarian cyst. Ultrasound revealed a singleton breech pregnancy, estimated foetal weight 3528 g. A septate abdominal cyst measuring 11.31 × 7.17 cm and polyhydramnios were present. Elective caesarean section delivered a female baby weighing 2820 g and measuring 43 cm. Neonatal examination revealed a right lateral suprapubic mass and a rectovestibular fistula. A sinoscopy revealed a suspected hydrocolpos. An abdominal hydrocolpos drainage was performed; a patent urachus and normal bilateral adnexa were present. Clinical discussion Hydrocolpos is a rare congenital disorder due to distal obstruction of various etiologies. It may be mistaken with other pathologies, including fetal ovarian cysts. A genitourinary congenital abnormality may occur in conjunction with other abnormalities, including gastrointestinal tract anomalies. The presence of imperforate anus and/or fistula should alert the clinician of a possible association with VACTERL syndrome. Conclusion Hydrocolpos is a rare congenital genitourinary disorder with various differential diagnoses. Simultaneous presence of other abnormalities is likely, with possible association to other syndromes.
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Susilo AFP, Tjandraprawira KD, Rachmawati A. Isolated growth hormone deficiency and amenorrhea - Case report. Ann Med Surg (Lond) 2022; 84:104909. [PMID: 36582894 PMCID: PMC9793238 DOI: 10.1016/j.amsu.2022.104909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Growth hormone (GH) deficiency is the most common hypopituitarism disorder. We highlight the challenges to its diagnosis and management in the setting of a developing country. Case description A 14-year-old came with a chief complaint of inability to menstruate. Menarche was at 12-years old, lasted 7 days, soaking 2 pads/day which discontinued shortly after. Thelarche was at 12-years-old and her breast is at Tanner stage 3. Her axillary and pubic hair are at Tanner stage 1. Height was 120 cm, weight 34.8 kg, height for age z-score < -3. Her lab results were normal for estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin. Bone age was suitable for age. Magnetic resonance imaging revealed pituitary gland hypoplasia (5.3 mm). A hormonal panel 3 years prior showed abnormally low GH level but normal cortisol and thyroid hormone levels. She was diagnosed with isolated growth hormone deficiency (IGHD) with delayed puberty. She was treated with medroxyprogesterone tablets once daily, after which her menstruation restarted. However, due to her economic background, she declined genetic tests, discontinued her medication and amenorrhea recurred. Clinical discussion Amenorrhea present after a brief menarche should alert gynaecologists of a possible multi-hormone disorder with an underlying structural abnormality. IGHD may be due to a structural abnormality, such as pituitary gland hypoplasia. Unfortunately, economic reasons prevented the patient from receiving optimal treatment. Conclusion IGHD rarely presents with a gynaecological complaint. Hormonal and genetic tests along with imaging should be undertaken. Growth hormone supplementation is the treatment of choice.
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Tjahyadi D, Tjandraprawira KD. Poor in vitro fertilisation outcomes in genital tuberculosis – Case report. Ann Med Surg (Lond) 2022; 81:104438. [PMID: 36147182 PMCID: PMC9486627 DOI: 10.1016/j.amsu.2022.104438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Genital tuberculosis (TB) exerts significant damage in the reproductive organs, particularly the Fallopian tubes and endometrium. Infertility is one of the most common presenting causes, often subsequently requiring assisted reproductive technology (ART). However, we have not had many experiences with genital TB despite being a country endemic for TB. This case series highlights the challenges we face and the solutions we wish we had. Case presentation In this case series, we recruited 7 patients undergoing in vitro fertilisation (IVF) treatment previously diagnosed with TB between January 01, 2014 and June 30, 2021. Patients were recruited at the beginning of their IVF treatments. Of 7 patients, 2 patients (28.6%) achieved live birth. 5 patients (71.4%) failed to conceive. All patients had good and/or excellent quality embryos upon transfer but only 2/7 managed to conceive and delivered. Clinical discussion Genital TB is often silent and only encountered during workup for infertility. Genital TB often produces extensive damage on the linings of the endometrium and Fallopian tubes, accounting for the recurrent implantation failures associated with the disease. Whilst antitubercular treatment may improve the prognosis, many women still fail to conceive. Conclusion Genital tuberculosis remains a significant issue in infertility. Cases are often silent and management is often delayed. IVF is often required due to the longstanding damage caused beforehand yet prognosis may remain poor.
Genital tuberculosis is a significant yet underdiagnosed etiology of infertility. Its profound severity often requires in vitro fertilisation for conception. Poor prognosis may still be found despite IVF due to recurrent implantation failures.
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Tjahyadi D, Ropii B, Tjandraprawira KD, Achmad YM, Permadi W, Djuwantono T. The impact of COVID-19 on A fertility center in Indonesia: A brief report. Ann Med Surg (Lond) 2022; 78:103762. [PMID: 35578606 PMCID: PMC9095072 DOI: 10.1016/j.amsu.2022.103762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/08/2022] [Accepted: 05/08/2022] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) affected the delivery of care in the fertility center. The higher transmissibility feature of omricon variant increase the transmission possibility between patients, healthcare professionals, and staff. Herein, we report the impact of the COVID-19 pandemic to the fertility center in Indonesia during the third wave period of the pandemic. Seven in vitro fertilization (IVF) cases were cancelled because the patients were tested positive for COVID-19 during their IVF program. Six of the total seventeen medical staff in our center were also tested positive for COVID-19 and stayed at home for self isolation. The cancellation of the IVF program was due to the lack of data regarding safety of IVF procedure in COVID-19 patients, shortage of medical staff, and the lack of negative pressure room in our fertility center. Our priority is to protect the remaining healthy patients in our center as well as the medical staff. The COVID-19 disadvantage both patients, care provider in reproductive healthcare. Regular screening of COVID-19 in fertility setting is highly recommended.
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Anwar R, Tjandraprawira KD, Irawan B. Concurrent gestational trophoblastic neoplasia and large uterine fibroid in a nullipara – Case report. Ann Med Surg (Lond) 2022; 77:103659. [PMID: 35638016 PMCID: PMC9142663 DOI: 10.1016/j.amsu.2022.103659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The management of a large uterine fibroid concurrent with gestational trophoblastic disease (GTD) in a nullipara is complicated, challenging yet should focus on conserving fertility. We would like to share our experience. Case description A 28-year-old G1P0A0 of 10–11 weeks’ gestation presented with a profuse vaginal bleeding with a history of passing swollen, grape-like tissues from the vagina. Since 7 months prior, a large uterine fibroid >10 cm had been diagnosed on ultrasound. Patient was diagnosed with GTD with β-human chorionic gonadotropin (hCG) levels exceeding 1,000,000 mIU/mL. No pulmonary metastases were detected. She underwent a vacuum curettage for her complete hydatidiform mole.Six days later, she underwent an elective myomectomy. Her nulliparity precluded hysterectomy. Post-discharge, her β-hCG levels plateaued and were consistently high over 3 consecutive measurements. A diagnosis of gestational trophoblastic neoplasia (GTN) was established. Patient is currently undergoing a methotrexate-folinic acid rescue chemotherapy regimen due to her having a low risk, stage 1 GTN. Discussion Uterine fibroid may reach exceptional sizes. There is so far no link between GTD and uterine fibroids but their concurrent presence is extremely rare. The definitive management for a large fibroid is hysterectomy but considering the patient's nulliparity, a myomectomy was appropriate. GTD's definitive management is vacuum curettage.Periodical β-hCG measurement should follow discharge. Plateauing β-hCG levels indicated GTN and due to her low-risk GTN, she required a single-agent methotrexate chemotherapy. Most patients with low-risk GTN make a complete recovery. Conclusion Fertility after myomectomy and GTN generally has an excellent prognosis.
Uterine fibroids and gestational trophoblastic disease are rarely encountered together. Managing fibroids and gestational trophoblastic disease in a nullipara should focus on conserving fertility. Fertility after myomectomy is generally excellent. Fertility after chemotherapy for gestational trophoblastic disease is generally excellent.
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Irianti S, Tjandraprawira KD, Sumawan H, Karwiky G. Total atrioventricular block in pregnancy -Case report. Ann Med Surg (Lond) 2022; 75:103441. [PMID: 35386776 PMCID: PMC8977913 DOI: 10.1016/j.amsu.2022.103441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Bradycardia in pregnancy due to total atrioventricular block (TAVB) is a rare occurrence, often asymptomatic and may arise from a congenital disorder. Pacemaker is often required. Cases are few and management is not yet standardised. Case presentation A 24-year-old G2P0A1 of 9 months gestation presented with labor pains. She had had history of bradycardia diagnosed since a year prior but had not undergone tests nor received treatments. Her heart rate was 55-60 x/minute, her cardiotocography was reassuring and electrocardiogram revealed a TAVB with ventricular escape rhythm. As she had not had a pacemaker, an urgent cardiologist consultation was arranged during which a temporary pacemaker was installed. She underwent a caesarean section with general anaesthesia after which she had an uneventful recovery.A 38-year-old G2P1A0 of 2 months of gestation presented with slow heart rhythm and a history of asthma to the outpatient clinic. She also had not undergone tests nor received medication. At presentation, her heart rate was 48 x/minute and her ECG revealed a TAVB with junctional escape rhythm. She had a pacemaker installed at 8 months of gestation and subsequently underwent an elective caesarean section at 37 weeks under regional anaesthesia. She had an uneventful recovery afterwards. Clinical discussion TAVB in pregnancy requires a concerted effort involving obstetricians, cardiologists, and intensivists. Pacemaker implantation is recommended. Whilst vaginal delivery remains first-choice, caesarean section is indicated under obstetric indications. Conclusion Screening, early recognition, risk stratification and thorough planning are required to successfully manage TAVB in pregnancy.
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Tjahyadi D, Ropii B, Tjandraprawira KD, Parwati I, Djuwantono T, Permadi W, Li T. Female urogenital chlamydia: Epidemiology, chlamydia on pregnancy, current diagnosis, and treatment. Ann Med Surg (Lond) 2022; 75:103448. [PMID: 35386801 PMCID: PMC8977933 DOI: 10.1016/j.amsu.2022.103448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Female urogenital chlamydia is a disease caused by Chlamydia trachomatis infection in the female urogenital tract. It is a common bacterial sexually transmitted disease. The bacteria is transmitted through sexual contact with an infected partner or from mother to newborn during vaginal delivery. The prevalence varies among studies and the number is possibly higher due to the lack of massive screening. Many patients were asymptomatic and still be able to transmit the disease. The undiagnosed and untreated disease could cause pelvic inflammatory disease, which leads to infertility, ectopic pregnancy, and chronic pelvic pain. The prevalence among pregnant women is similar to non-pregnant women, therefore chlamydia screening in pregnant women is highly recommended. The nucleic acid amplification test is the most reliable method for the diagnosis due to high sensitivity. The current treatment is given by prescribing antibiotics.
Female urogenital chlamydia is caused by Chlamydia trachomatis. Urogenital chlamydia affects young and sexually active women. Female urogenital chlamydia is diagnosed through indirect methods (serology-based tests) and direct methods (culture). Treatment of chlamydia consists of antibiotics with doxycycline being the first-line choice.
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Tjandraprawira KD, Kusumah AY, Kamilah AY, Putri DI, Ananta MR, Sari SP, Djuwantono T, Petrie A. Management and perinatal outcomes of hypertensive disorders of pregnancy in a low-resource setting in Indonesia. SAGE Open Med 2021; 9:20503121211060194. [PMID: 34888051 PMCID: PMC8649090 DOI: 10.1177/20503121211060194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: To provide up-to-date data concerning hypertensive disorders of pregnancy on maternal and neonatal profiles in Indonesia. Methods: Retrospective clinical audit on all pregnancy-associated hypertensive women between 1 January 2020 and 31 March 2020 at Cianjur General District Hospital. Results: Preeclampsia accounts for 66.8% (235/352) of hypertensive disorders of pregnancy, gestational hypertension 29% (102/352) and chronic hypertension 4.3% (15/352). Compared to other pregnant women, those with preeclampsia, on average, had higher systolic and diastolic blood pressures and poorer kidney (ureum and creatinine) and liver function (aspartate transaminase enzyme and alanine transaminase enzyme) profiles (p < 0.001, < 0.001, < 0.001, 0.003, 0.033 and 0.002, respectively), and required more intensive care admission. Neonates from women with severe forms of preeclampsia (eclampsia and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets)) had, on average, lower birthweight (p = 0.015 and 0.048, respectively) and birth length (p = 0.021, 0.017). Neonates from eclamptic mothers had poorer APGAR (appearance, pulse, grimace, activity and respiration) scores (p = 0.006 and 0.005, respectively). Conclusion: Hypertensive disorders of pregnancy exerts adverse maternal and neonatal outcomes, particularly among eclampsia and HELLP-syndrome neonates. Various challenges remain for optimal management.
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Permadi W, Bayuaji H, Tjandraprawira KD, Tjahyadi D, Harlianto H, Achmad YM, Astarto NW, Djuwantono T. Frozen vs. fresh cycles IVF outcomes: retrospective study from an Indonesian IVF centre. BMC Res Notes 2021; 14:177. [PMID: 33971946 PMCID: PMC8111934 DOI: 10.1186/s13104-021-05585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the live birth rates (LBR) and neonatal outcomes of frozen cycle in vitro fertilization (IVF) with fresh cycle IVF in the Indonesian population. Results This was retrospective study using secondary data of IVF patients at a private fertility centre. Study recruitment was between 3/8/2018 and 31/12/2019. Total sampling included all patients undergoing oocyte retrieval and embryo transfer within recruitment period. Patients undergoing fresh IVF cycles and frozen IVF cycles were compared. 351 patients were recruited: 68.1% (239/351) underwent fresh cycles and 31.9% (112/351) frozen cycles. AMH was significantly higher in frozen cycle group (p = 0.04). Ovulatory disorder was significantly higher in frozen cycle group (p = 0.001). Among patients aged ≤ 30, fresh cycle group had significantly higher LBR (p = 0.02). Among those with ovulatory disorder, LBR was significantly higher with frozen cycle. No significant LBR difference was noted with other infertility causes. When stratified according to pregnancy order, frozen cycle patients had significantly higher birth lengths (p = 0.03) but not length of gestation nor neonatal birthweights. There was no significant difference in the proportion of biochemical pregnancy resulting in LBR (p = 0.08). To conclude, frozen cycle provided higher LBR among patients with ovulatory disorder but fresh cycle was beneficial among patients aged ≤ 30.
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