Indonesian Journal of Perinatology

Characteristics of cervical cancer screening using visual inspection with acetic acid and pap smear in the outpatient clinic at Prof. Dr I.G.N.G. Ngoerah Hospital Denpasar from January to December 2023

2024-12-21T03:07:28+00:00

Introduction: According to GLOBOCAN 2022, cervical cancer is the fourth leading cause of cancer-related morbidity and mortality among women worldwide, with 662,044 new cases and 348,709 deaths. In Southeast Asia, it ranks third in incidence and fourth in mortality. Indonesia contributes more than 50% of new cases (36,964) and deaths (20,708) in the region. Cervical cancer is largely preventable through early detection methods such as visual inspection with acetic acid (VIA) and Pap smear. However, differences in diagnostic accuracy between these screening methods highlight the need to identify patient characteristics appropriate for each modality. This study aimed to compare the characteristics of patients undergoing VIA and Pap smear screening at the outpatient clinic of Prof. Dr I.G.N.G. Ngoerah Hospital, Denpasar, from January to December 2023.

Methods: This observational analytical study used secondary data obtained from outpatient clinic registers and medical records of female patients who underwent VIA or Pap smear screening during the study period. Data were analysed using univariate analysis.

Results: Among 122 participants undergoing VIA, 24 (19.6%) had positive results. Pap smear examinations in 125 participants showed CIN I in 10 (8.0%), CIN II in 4 (3.2%), and CIN III in 5 (4.0%) participants. Vaginal discharge was reported in 7 VIA participants (5.7%) and 15 Pap smear participants (12.0%), while postcoital bleeding was reported in 2 participants (1.6%) in each group. Among VIA-positive cases, lesions were most commonly found in all four quadrants (45%).

Conclusion: Patient characteristics in VIA and Pap smear screening at Prof. Dr I.G.N.G. Ngoerah Hospital varied considerably, with a higher proportion of positive results observed in VIA compared to Pap smear screening.

Characteristics of preeclampsia cases based on early-onset and late-onset preeclampsia at Batuyang Primary Health Center in 2022–2024

2025-12-21T07:07:18+00:00

Introduction: Preeclampsia remains one of the leading causes of maternal and neonatal morbidity and mortality in Indonesia, with a significant incidence during pregnancy. It is classified into early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE) based on the gestational age at the time of diagnosis, each characterized by distinct clinical presentations and etiological mechanisms. This study aims to compare demographic and clinical characteristics between early-onset pre-eclampsia (EOPE) and late-onset pre-eclampsia (LOPE) at PKM Batuyang during the period 2022–2024.

Methods: This study employed a retrospective cross-sectional design with non-probability sampling. Data were obtained from the medical records of preeclamptic patients treated at Batuyang Primary Health Center between 2022 and 2024. The analyzed variables included maternal age, gestational age, parity, body mass index (BMI), history of abortion, hypertension, diabetes mellitus, and multiple pregnancies.

Results: Among the 162 preeclampsia cases reviewed, LOPE was more prevalent (84.6%) compared to EOPE (15.4%). Most cases occurred in women aged ≥35 years and those with multiparity. The majority of patients had a BMI below 30 kg/m². A small proportion of patients had a history of chronic hypertension, diabetes mellitus, or multiple gestation.

Conclusion: Late-onset preeclampsia was more frequently observed than early-onset cases at Batuyang Primary Health Center. Classification based on onset time is essential to guide optimal clinical management strategies. Further research is needed to identify risk factors to improve early detection and management of pre-eclampsia, thereby potentially reducing maternal and infant morbidity and mortality rates.

A predictive model for in vitro fertilization success: a retrospective cohort study from a tertiary clinic in Indonesia

2025-12-26T05:48:02+00:00

Background: In vitro fertilization (IVF) remains one of the most effective assisted reproductive technologies for the management of infertility; however, its success rate varies widely across populations and clinical settings. In Indonesia, data-driven evaluations of IVF success predictors remain limited, and locally validated prognostic tools to support individualized counseling and treatment planning are scarce. This study aimed to identify factors associated with successful pregnancy outcomes among couples undergoing IVF at the WIN Infertility Clinic, Puri Bunda Hospital, Denpasar.

Methods: A retrospective cohort study with a case–control approach was conducted using secondary data from medical records of 243 infertile couples who underwent IVF cycles between January 2023 and December 2024. Clinical pregnancy confirmed by laboratory and ultrasound findings was classified as the success group (n = 100), while unsuccessful cycles constituted the control group (n = 143). Variables evaluated included female age, basal hormonal profile, ovulation induction protocol, number of embryos transferred, body mass index (BMI), infertility duration, and infertility status. Univariate and multivariate logistic regression analyses were performed to identify independent predictors, followed by the development of a predictive scoring model.

Results: The overall clinical pregnancy rate was 41.2%. Multivariate analysis demonstrated that four variables were independently associated with IVF success: female age (adjusted OR [aOR] 0.91; 95% CI 0.85–0.98; p = 0.012), number of embryos transferred (aOR 1.68; 95% CI 1.22–2.33; p = 0.001), normal BMI (aOR 2.00; 95% CI 1.12–3.59; p = 0.019), and duration of infertility (aOR 0.92; 95% CI 0.86–0.99; p = 0.041). A predictive scoring system derived from these factors demonstrated moderate discriminatory performance (AUC = 0.724).

Conclusion: Female age, number of embryos transferred, BMI, and infertility duration are significant independent predictors of IVF success at this center. The proposed scoring model may serve as a practical tool to support individualized patient counseling and optimize treatment planning in IVF programs.

Water Birth as Neuroendocrine Medicine: A Critical and Integrative Review of Hormonal and Psychophysiological Impacts on Maternal and Neonatal Outcomes

2025-12-29T02:12:35+00:00

Background: Water birth, defined as labor and/or delivery conducted in warm water, has gained increasing recognition as a patient-centered and physiologically supportive birth practice. Beyond analgesia, growing evidence indicates that water immersion during labor modulates maternal neuroendocrine regulation, psychological well-being, and neonatal physiological adaptation. Nevertheless, these hormonal and psychophysiological mechanisms remain insufficiently integrated into conventional perinatal research and clinical frameworks. This review aims to synthesize current evidence on the neuroendocrine, psychophysiological, obstetric, and neonatal effects of water birth and to evaluate its clinical effectiveness and safety in low-risk pregnancies.

Methods: An integrative review was conducted using a PRISMA-guided approach to identify peer-reviewed studies published between 2000 and 2025. Literature searches retrieved 3,287 records from major biomedical databases, of which 44 studies (12 randomized controlled trials, 19 cohort studies, 6 case–control studies, and 7 systematic reviews) met inclusion criteria. Data were synthesized thematically, focusing on maternal hormonal responses (oxytocin, β-endorphins, cortisol, prolactin), labor outcomes, breastfeeding, postpartum mood, neonatal adaptation, and safety considerations.

Results: Across study designs, water immersion during labor was associated with increased endogenous oxytocin and β-endorphin activity and reduced stress-related hormonal responses. Clinically, first-stage labor was shortened by approximately 42–78 minutes, and epidural analgesia use was reduced by 30–50% compared with conventional land birth. Episiotomy rates were generally below 5%, and maternal satisfaction scores were consistently higher. Early breastfeeding initiation occurred in 86–92% of water birth cases, with exclusive breastfeeding rates at six weeks ranging from 66–77%. Neonatal outcomes, including 5-minute Apgar scores and NICU admission rates, were comparable to or slightly better than conventional birth in low-risk populations, with no consistent increase in infection or respiratory complications when standardized protocols were applied.

Conclusion: Water birth supports a hormonally optimized and psychologically protective labor environment, with measurable benefits for labor efficiency, maternal experience, breastfeeding success, and neonatal physiological transition. When implemented under evidence-based guidelines, it represents a credible non-pharmacological option within contemporary, physiology-informed maternity care.

Challenges and strategies in implementing kangaroo mother care across Indonesia: a literature review

2025-12-17T09:44:52+00:00

Kangaroo Mother Care (KMC) is a simple and low-cost intervention proven effective in reducing morbidity and mortality among low birth weight (LBW) infants through skin-to-skin contact, exclusive breastfeeding, and post-discharge monitoring. KMC plays an essential role in maintaining the infant’s body temperature, enhancing physiological stability, improving the sucking reflex, accelerating weight gain, and strengthening the emotional bond between mother and baby. In Indonesia, KMC has been integrated into national health policy since 2009 through the “Mother and Baby Friendly Hospital Program,” yet its implementation still faces several challenges, including limited facilities, inadequate health worker training, and insufficient family support. Studies conducted at the hospital and primary care levels have demonstrated positive outcomes in terms of growth, physiological stability, and breastfeeding success among LBW infants who received KMC. The main barriers of KMC implementation in Indonesia are found at the maternal and family level, the healthcare provider and facility level, and also the social-cultural and economic level. Multistage efforts, such as developing legal frameworks, training, teamwork, utilizing the available resources, communication, supervision, documentation, and evaluation, may overcome the barriers and increase the KMC implementation in Indonesia.