Satisfactory Outcome of Various Novel Modified Laparoscopic Neovaginoplasty Using Autologous Peritoneal Graft.

Management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome patients is by creating functional neovagina through surgical or nonsurgical route. Surgical repair using minimally invasive technique is a favorable option in creating neovagina. In this study, the patients underwent neovaginoplasty. Clinical follow-ups were done at 3, 6, and 12 months postoperatively. The primary outcomes were anatomic and functional successes; anatomical success was defined as a ≥6 cm-long neovagina that allows for easy introduction of two fingers, and functional success was defined with Female Sexual Function Index FSFI-6 questionnaire score above 19. Modified neovaginoplasty using autologous peritoneal graft was performed on the patients (n = 6). Follow-up showed mean vaginal lengths of 8.16 cm, mean surgery time of 175 min, mean blood loss of 59.17 ml, and mean duration of hospital stay of 2 days, with an average FSFI-6 score of 25,2. Therefore, we concluded that laparoscopic approach using modified technique of autologous peritoneal graft provides satisfactory result.

Challenges and diagnosis in therapy of secondary amenorrhoea in caesarean section patient with postpartum haemorrhage B-lynch sutures: a case report.

Introduction and importance: International Federation of Gynecology and Obstetrics (FIGO) and WHO report the incidence of postpartum haemorrhage (PPH) reaches 1-10% and contributes to an increase in postpartum maternal mortality with uterine atony as the most common cause. B-Lynch method is a suturing technique to overcome PPH. Although this method has proven useful as an emergency life-saving measure, the post-procedure complications are still able to occur. Presentation of case: The patient was not menstruating for 14 months after giving birth through caesarean section with B-Lynch due to PPH. Before pregnancy, she had regular menstruation cycle and normal menstrual duration. Her general and gynaecological status were normal. Ultrasound showed the impression of uterine hypoplasia and endometrium that were difficult to assess while both ovaries were normal. Diagnostic hysteroscopy showed a severe degree of Asherman's syndrome. The results of FSH, LH and estradiol were normal. Discussion: B-lynch suture is performed as a method to stop PPH in uterine atony. Secondary amenorrhoea occurs as a complication of B-lynch. Compression action of B-lynch can cause progressive myometrium necrosis resulting in synechiae and blockade of uterine blood flow. This will interfere with the development of the uterus. Intrauterine adhesions and amenorrhoea with normal levels of FSH, LH, and estradiol support the diagnosis of Asherman's syndrome. Conclusion: This case shows that the B-Lynch procedure, which is the worldwide recommended method for treating postpartum haemorrhage due to its high success rate, can cause complications of Asherman's syndrome and cause secondary amenorrhoea.

Ten years of in vitro fertilization in Indonesia: Access to infertility care in a developing country.

OBJECTIVE: This research was conducted to assess access to assisted reproductive technologies (ART) and the current status of the in vitro fertilization (IVF) program that have been implemented in Indonesia over the last 10 years. METHODS: We established a retrospective cohort study and descriptive analysis of the current state of access to infertility care in Indonesia. The data were collected from all IVF centers, clinics, and hospitals in Indonesia from 2011 to 2020, including the number of IVF clinics, total ART cycles, retrieved fresh and frozen embryos, average age of IVF patients, IVF pregnancy rate, and causes of infertility. RESULTS: The number of reported fertility clinics in Indonesia has increased from 14 clinics in 2011 to 41 clinics by 2020. As many as 69 569 ART cycles were conducted over the past 10 years, of which 51 892 cycles used fresh embryos and 17 677 cycles used frozen embryos. The leading cause of consecutive infertility diagnosis was male infertility. Nearly half of the women who underwent IVF procedures (48.9%) were under 35 years old. The pregnancy rate outcome of women who underwent IVF ranged from 24.6% to 37.3%. CONCLUSION: Developments in ART in Indonesia have led to improvements in the ART cycles performed throughout the 10 year period. The identification of key areas that require improvement can provide an opportunity to enhance access to infertility care.

Determinants of prematurity in urban Indonesia: a meta-analysis.

OBJECTIVES: Indonesia is the fifth country with the highest number of preterm births worldwide. More than a third of neonatal deaths in Indonesia were attributed to preterm birth. Residential areas affected the occurrence of preterm birth due to differing socioeconomic and environmental conditions. Many studies have investigated the determinants of prematurity in Indonesia, however, most of them were performed in rural areas. This study is the first meta-analysis describing the determinants of preterm birth in urban Indonesia, which aimed to become the foundation upon implementing the most suitable preventative measure and policy to reduce the rate of preterm birth. METHODS: We collected all published papers investigating the determinants of preterm birth in urban Indonesia from PubMed MEDLINE and EMBASE, using keywords developed from the following key concepts: "preterm birth", "determinants", "risk factors", "Indonesia" and the risk factors, such as "high-risk pregnancy", "anemia", "pre-eclampsia", and "infections". Exclusion criteria were multicenter studies that did not perform a specific analysis on the Indonesian population or did not separate urban and rural populations in their analysis, and articles not available in English or Indonesian. The Newcastle Ottawa Scale was used to assess the risk of bias. This systematic review was registered in PROSPERO. RESULTS: Sixteen articles were included in the analysis and classified into five categories: genetic factors, nutrition, smoking, pregnancy characteristics or complications, and disease-related characteristics. CONCLUSIONS: Our meta-analysis revealed adolescent pregnancy, smoking, eclampsia, bacterial vaginosis, LC-PUFA, placental vitamin D, and several minerals as the significant determinants of preterm birth in urban Indonesia.

Combined clinical and ultrasound criteria could accurately predict the Y chromosome in primary amenorrhea patient.

This study aimed to assess the combined clinical and ultrasound criteria as a diagnostic tool for screening the Y chromosome related to primary amenorrhea. This cross-sectional study involving 59 subjects was taken from medical records at the Reproductive Immunoendocrinology Polyclinic of Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. The medical records of subjects were then cross-checked with karyotyping analysis results. Sensitivity, specificity, and predictive values were analyzed to assess the criteria. Two subjects were presented with a Y chromosome, and one without a Y chromosome was misclassified into another group. After analysis, we found that combined clinical and ultrasound criteria could predict the Y chromosome related to primary amenorrhea with 95.9% accuracy, with sensitivity and specificity of 80% and 97.96%, respectively. Combined clinical and ultrasound criteria (introduced as Kanadi Sumapraja Criteria) could be used as a diagnostic tool for screening a Y chromosome related to primary amenorrhea.

Factors related to maternal mortality rate in covid-19 patients - a cross-sectional study from an Indonesian covid-19 referral hospital.

BACKGROUND: The covid-19 pandemic may cause severe clinical manifestations in a vulnerable population, such as pregnant women. Based on Indonesian Obstetrics and Gynecology Association (POGI), the number of maternal deaths due to covid-19 from April 2020 to April 2021 reached 3% and increased to 9% since the delta variant of covid-19 emerged. This research was expected to identify factors that are related to the mortality rate of pregnant women with covid-19. MATERIALS AND METHODS: This was a cross-sectional study using secondary data collected from June 2020 to August 2021. The study was conducted in Universitas Indonesia Hospital, a national covid-19 referral hospital. Patient characteristics, pregnancy profile, comorbidities, laboratory results, chest X-ray examination, treatment options, and the severity of symptoms were evaluated. In addition, bivariate data analysis was carried out using the SPSS device. RESULTS: Out of 114 research subjects, seven patients (6.1%) died, and 107 patients (93.9%) survived. The risk of mortality was significantly (P < 0.05) related to patients' age, duration of hospitalization, gestational age, severity rate of covid-19, the level of hemoglobin, leukocyte count, platelet count, lymphocytes, the levels of D-dimer, C-reactive protein, transaminase enzymes, urea, creatinine, eGFR, sodium, potassium, and procalcitonin. In addition, significant differences (P < 0.05) related to maternal mortality rate were also shown in the presence of comorbidities (type 2 diabetes, congestive heart failure, coronary artery disease/acute coronary syndrome, and urinary tract infection), and the use of steroids and tocilizumab. CONCLUSION: Various factors significantly related to the mortality rate of pregnant women with covid-19. This study may become the basis for a further study with a larger number of subjects, adjustment of assessment and management of covid-19 infected pregnant women, thus hopefully reducing the risk of mortality in pregnant women with covid-19.

Selecting the best surgical approach in various cases of prolapsed pedunculated submucosal fibroids: A case series.

INTRODUCTION: The pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty. PRESENTATION OF CASES: The first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure. DISCUSSION: Vaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances. CONCLUSION: Customised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.

Laparoscopic proximal neovaginoplasty using autologous peritoneal graft to correct short vagina.

INTRODUCTION AND IMPORTANCE: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare condition characterized by congenital aplasia of the uterus and upper two-third vagina with normal secondary characteristics. Treatment of this condition consists of non-surgical and surgical management. After nonsurgical Frank method, neovaginal canal may be formed but sometimes the vaginal length may not be adequate to facilitate normal sexual intercourse. PRESENTATION OF CASE: A 27-year-old woman, sexually active, complained about the difficulty of sexual intercouse. The patient was diagnosed with vaginal agenesis and uterine dysgenesis with normal secondary sexual characteristics and chromosome (46, XX). The patient has had nonsurgical treatment by Frank method for 6 years and as a result we found a 5 cm-vaginal indentation but she still complaint of pain and discomfort during intercourse. Laparoscopy proximal neovaginoplasty using autologous peritoneal graft was performed to add the proximal vaginal length. DISCUSSION: In our case, the patient may have a short vagina as the result from inadequate Frank method dilatation. This may cause dyspareunia and discomfort to her sexual partner. Therefore, laparoscopic proximal neovaginaplasty and uterine band excision were carried out to correct the anatomical restriction and improve her sexual function. CONCLUSION: Laparoscopic proximal neovaginoplasty is a surgical method to increase proximal vaginal length by using autologous peritoneal graft which shows excellent result. This procedure should be considered in MRKH syndrome patients with unsatisactory nonsurgical treatment result.

Introducing Modified Technique of Combined Vaginal and Laparoscopic Approach for Creation of Neovagina.

INTRODUCTION AND IMPORTANCE: There are many methods described in the literature for creating a functional neovagina. However, the best method has yet to be determined. In our urogynecology training center, neovaginoplasty was usually performed by vaginal approach using modified McIndoe technique with amnion graft and >7 days hospitalization was required. However, we tried to combine both vaginal and laparoscopic modified technique of neovaginoplasty to improve the functional and surgical outcome as well as shortened hospital stay. CASE PRESENTATION: A 27-year-old woman came to our center with a chief complaint of primary amenorrhea and she was diagnosed with vaginal agenesis as part of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. She underwent neovaginaplasty using a combined vaginal and laparoscopic approach with autologous peritoneal graft. Patient was discharged the next day. The follow up result (6-24 months) was excellent with total vaginal length was 8 cm and FSFI score 34.5. CLINICAL DISCUSSION: The use of peritoneal graft using a laparoscopic approach for vaginal reconstruction was chosen in this case after proper counseling with the type of vaginal mucosal lining as the primary consideration. We combined our routine vaginal approach technique with laparoscopic approach to provide an autologous peritoneal graft and considered modifying the technique by extending the peritoneal dissection laterally to facilitate mobilization of the peritoneum to cover the whole surface of neovagina. CONCLUSION: Combined vaginal and laparoscopic modified technique of neovagina creation may present as treatment option for MRKH patients with excellent anatomical and functional result, minimal surgical complication and shorter hospital stay.

Severe chronic pelvic pain due to cystic degeneration of subserosal uterine fibroid with type 2 diabetes and obesity: Serial case report.

INTRODUCTION AND IMPORTANCE: Uterine fibroids, benign tumors of the myometrium, can cause pelvic pain. Obesity and diabetes mellitus can increase the risk of developing fibroid. We present two cases of uterine fibroid, diabetes mellitus, and obesity with moderate-to-severe chronic pain. CASE PRESENTATION: The first case is a 37-year-old woman with pelvic pain and a subserosal uterine fibroid, primary infertility, grade 2 obesity, and diabetes mellitus. Pathologic examination revealed smooth muscle cells with degeneration sites. The second case is a 35-year-old nulliparous woman with abdominal enlargement, lower abdominal pain, diabetes mellitus, and morbid obesity. Ultrasonography showed a large uterus with a hyperechoic mass and cystic degeneration. Histopathological examination revealed leiomyoma. CLINICAL DISCUSSION: Our patient's chronic pelvic pain may be caused by its large size. Excess adipose tissue in obesity may result in the formation of estrone, causing the proliferation of fibroids. A subserous fibroid is less likely to cause infertility; thus, a myomectomy was performed to relieve pain. Obesity and diabetes could interfere with patients' periods. Higher levels of insulin and fat tissue induce androgen production. Increased estrogen levels lead to alteration of gonadotropin production, menstrual abnormalities, and ovulatory dysfunction. CONCLUSION: Cystic degeneration of the subserous uterine fibroid could induce pain though it rarely affects fertility. A myomectomy was conducted to relieve pain. Comorbid diseases such as diabetes mellitus and obesity can lead to cystic degeneration of the uterine fibroid.

Influence of internet, mobile phone use, and sociodemographic factors on women's knowledge and attitude towards contraception in Indonesia.

OBJECTIVE: Rapid population growth has been a problem in Indonesia for several decades. One of the reasons for this phenomenon is limited knowledge of reproductive health and proper contraception. METHODS: . The use of mobile phones and the internet has made it easier to access health information. This study aimed to determine the influence of the internet, mobile phone use, and sociodemographic factors on Indonesian women's knowledge of and attitudes toward contraception. METHODS: The present study used secondary data from the 2017 Indonesian Health and Demographics Survey. Altogether, 49,627 women participated in this study. Descriptive statistics were performed, and bivariate analysis using the chisquared test was performed to measure the association between variables. RESULTS: Knowledge about the ovulation cycle and contraception was positively associated with mobile phone ownership, frequent internet use, higher wealth index, reading printed media, listening to the radio, watching the television, higher educational level, and older age. The use and intention of contraception were positively associated with lower wealth index, watching television at least once a week, primary-secondary educational level, rural residence, and older age. Thus, acquisition of knowledge does not necessarily translate into implementation of contraceptive. METHODS: , since there might be certain digital and social barriers. CONCLUSION: Access to the internet and mobile phones as well as certain sociodemographic factors have contributed to an increase in women's knowledge about contraception, but not necessarily in their knowledge regarding the use of contraception.

Social factors influence on anxiety, depression level and psychological trauma of obstetrics and gynecology residents during COVID-19 pandemic.

Background and aim: The novel coronavirus disease 2019 (COVID-19) has enforced obstetrics and gynecology (ObGyn) residency training process to undergo wide changes including lessons modifications, yet their mental health were not evaluated. Hence, this study aimed to evaluate the influence of social factors on anxiety, depression level, and psychological trauma of ObGyn residents during the COVID-19 pandemic as well as the impact of COVID-19 to residency training program. Methods: A cross-sectional study was conducted in three institutions in Indonesia: the University of Indonesia, the University of Lambung Mangkurat, and the University of Syiah Kuala. A total of 169 ObGyn residents agreed to participate and were enrolled in this study. Results: Total 169 residents were eligible with a mean age of 26-42 years. 76.9% of the residents were exposed to COVID-19 patients during clinical rotation. Approximately half of them (52.6%) thought COVID-19 has brought negative effects. Long-distance learning was considered of good quality by 40.2% of participants. The majority experienced enough resting periods, nearly half of them (45.5%) were concerned about the impact of being a less competent specialist. Conclusion: Overall, no significant statistical relationship were revealed between social factors and depression, anxiety and psychological trauma in ObGyn residents during COVID-19 pandemic.

Determining laboratory parameters in pregnant women with severe COVID-19.

Objective: Coronavirus disease causes a wide spectrum of clinical picture in pregnant women. There are still a few studies concerning laboratory parameters to differentiate the severity of coronavirus disease-19 in pregnant patients. This article aims to identify the cut-off on laboratory parameters between pregnant women with asymptomatic/mild/moderate and severe/critical coronavirus disease-19 illness. Methods: All coronavirus disease-19 pregnant women coming to Dr. Cipto Mangunkusumo hospital between January and August 2021 were recruited into this cross-sectional study. All data extracted from medical records were classified into demographic characteristics and laboratory parameters. We defined demographic characteristics as age, parity, systolic, and diastolic blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation. Laboratory parameters measured in this study consisted of complete blood count, renal function test including urea, creatinine, liver function test including aspartate transferase, alanine transferase, infection marker test including procalcitonin, C-reactive protein, interleukin-6, cycle threshold values, ferritin, coagulation test including d-dimer, fibrinogen, random blood glucose, albumin, electrolytes. Data analysis was performed using SPSS statistics. Results: There were 159 cases assessed in this study consisting of 130 (81.8%) patients with asymptomatic/mild/moderate illness and 29 (18.2%) patients with severe/critical illness of coronavirus disease-19. Of 28 laboratory parameters, 12 of them were significant statistically; thus, it resulted to make a cut-off using receiver operating characteristic curve and show relative risk, and 95% confidence interval. In multivariate analysis that aspartate transferase, D-dimer, and albumin were laboratory parameters impacted to the severity of coronavirus disease-19 in pregnant women. The area under receiver operating characteristic curve was 0.834 (95% CI 0.736-0.932). Conclusion: Of all laboratory parameters, urea, aspartate transferase, alanine transferase, procalcitonin, C-reactive protein, lactate dehydrogenase (LDH), ferritin, D-dimer, random blood glucose, cycle threshold values, albumin, and chloride differs between asymptomatic/mild/moderate, and severe/critical illness coronavirus disease-19 in pregnant women; aspartate transferase, D-dimer, and albumin were laboratory parameters impacted the most to the severity of coronavirus disease-19 in pregnant women.

Rare case of pelvic schwannoma mimicking intra-ligamenter uterine fibroid: A case report.

INTRODUCTION AND IMPORTANCE: Schwannomas are benign tumors originating from Schwann cells of nerve fibers. Pelvic schwannomas are extremely rare. Here, we present a case of a 48-year-old woman with a pelvic schwannoma imitating degenerating cystic leiomyoma. CASE PRESENTATION: A 48-year-old woman presented with brown-yellowish bloody vaginal discharge, fever, abdominal enlargement, and pain. Abdominal ultrasound showed a homogeneous solid mass with a clear border separated from the uterus and left ovary. Computed tomography (CT) scan revealed a multilocular cystic mass with thick septa and solid enhancing component. Histopathological examination showed a mesenchymal tumor composed of cells with fine chromatin. The nuclei were oval or round, and some cells exhibited spindle and cigar-shaped nuclei. Tumor cells had an abundant amount of eosinophilic cytoplasm. Immunohistochemical examination demonstrated positive expression for S100 as specific staining for schwannomas. Mitosis was not found, and hyalinized blood vessels were observed. CLINICAL DISCUSSION: Compression by the tumor into the surrounding organs, such as the bladder and intestines, could cause difficulty with defecation and urination in patients. The absence of specific signs and symptoms can lead to a misdiagnosis of pelvic schwannoma. Surgery is the treatment of choice. It is difficult to establish a definitive diagnosis before surgery. Laparotomy approach was taken and a histopathological examination was completed to confirm the diagnosis. CONCLUSION: Unspecified pelvic pain with abdominal mass may suggest a rare tumor such as schwannoma. Transvaginal ultrasonography is incapable of reliably distinguishing between schwannoma and other tumors.

Ovarian cortex freezing as a method of fertility preservation in endometriosis: A case report.

BACKGROUND: Endometriosis affects women in many ways from infertility until reducing ovarian reserve. In women who do not want to immediately conceive, ovarium cortex cryopreservation may be an option for preserving fertility. CASE PRESENTATION: Two patients with chief complaints dysmenorrhea and abdominal enlargement, then checked Anti-Mullerian Hormone (AMH) level and Ca-125 level. Patient underwent transrectal ultrasonography, with the result of endometriosis cyst (sized 12 × 9x3 cm and 7 × 10 × 11 cm for first patient, while second patient had 18 × 10 × 14 cm). Then patients underwent cystectomy and ovarian cryopreservation. Histopathology results revealed endometriosis cyst, with different results of follicle density on the healthy cortex. Patient have an AMH level of 1.82 ng/mL before surgery and may decline after surgery. From the AMH normogram, the patient is below the 25th percentile and almost below the 10th percentile, and her biological age is 34. Normal histopathology result of the ovarian cortex suggested that 1.8 to 166 follicles per mm3 cortical tissue. DISCUSSION: We can see from the histopathology examination the density of the follicle was less than normal in this patient. Patients that suffer from endometriosis may have a low ovarian reserve even before surgery. A thorough consultation, followed by ovarian reserve evaluation, disease progression and recurrence of disease are needed to be monitored closely. CONCLUSION: From all the methods of fertility preservation, we concluded that this patient is most suitable for ovarian cortex freezing.

Chronic Pelvic Pain in Women with Endometriosis is Associated with Psychiatric Disorder and Quality of Life Deterioration.

BACKGROUND: Endometriosis is a condition associated with pelvic pain, infertility, and possibly with decreased quality of life as well as psychiatric disorder. The purpose of our study was to evaluate the association between pain characteristic, psychiatric disorder, and quality of life in women with endometriosis. METHODS: A cross-sectional study was done involving 160 women with medical diagnosis of endometriosis. Pain intensity was evaluated using Visual Analog Scale (VAS), Quality of Life with Endometriosis Health Profile (EHP-30), and psychologic condition with Mini International Neuropsychiatric Interview International Classification of Diseases (Mini-ICD). RESULTS: VAS and psychiatric disorder were associated with higher EHP-30 score (ß = 9.3 (95% CI: 7.15-11.45; p < 0.001 and ß = 28.51 (95% CI: 20.06-36.05; p < 0.001), respectively) and hence, lower quality of life. The strongest correlation between VAS and EHP-30 was in pain (r=0.586; p<0.001) and 'control and powerlessness' (r = 0.583; p < 0.001). VAS was also higher in subjects with depression (49.5 (25.4-77.8) vs 34.4 (6.1-74.6); p < 0.001). CONCLUSION: We conclude that severe endometriosis-related pain and the presence of psychiatric disorder were associated with lower quality of life. Comprehensive management of endometriosis is crucial to improve patients' quality of life.

Factors affecting knowledge regarding unmet need on fertile aged women in Indonesia: evaluation of 2012 and 2017 IDHS.

BACKGROUND: The Family Planning (FP) Program is a national method of controlling population growth rates while improving maternal and child health. Indonesia, as one of the largest countries, has abysmally low contraceptive coverage. One of its main issues is unmet contraceptive needs. This study aims to determine the factors that influence women's unmet need of childbearing age (WCA) in Indonesia. METHODS: We performed an unpaired comparative analytic study with a cross-sectional method was conducted on secondary data obtained from 2012 to 2017 Indonesia Demographic and Health Survey (IDHS). The subjects in this study were all women of childbearing age (15-49 years). Subjects with incomplete data were excluded from the study. Unmet need was defined as WCA who did not use contraception but decline to have more children or wanted to delay their pregnancies. Chi-square analysis was performed on categorical data and Mann-Whitney U analysis on numerical data. RESULT: A total of 45,607 WCA in the 2012 IDHS data and 29,627 WCA in the 2017 IDHS data were included in the study. In the 2012 IDHS data, factors influencing unmet needs were age (p = 0.023) and parity (p < 0.0001). In the 2017 IDHS data, factors influencing unmet needs were the residential area (p = 0.003), level of education (p = 0.008), level of spouse's education (p < 0.0001), employment status (p = 0.03), possession of electricity (p = 0.001), and possession of television (p = 0.01). CONCLUSION: Factors affecting unmet needs are age, parity, residential area, level of education, level of spouse's education, employment status, possession of television, and possession of electricity. There were no recurring factors on 2012 and 2017 IDHS data.

The Family Planning (FP) Program is a national method of controlling population growth rates while improving maternal and child health. Indonesia, as one of the largest countries, has abysmally low contraceptive coverage. One of its main issues is unmet contraceptive needs. This study aims to determine the factors that influence women's unmet need of childbearing age (WCA) in Indonesia.An unpaired comparative analytic study with a cross-sectional method was conducted on secondary data obtained from 2012 and 2017 Indonesia Demographic and Health Survey (IDHS). The subjects in this study were all women of childbearing age (15­49 years). Subjects with incomplete data were excluded from the study. Unmet need was defined as WCA who did not use contraception but decline to have more children or wanted to delay their pregnancies. Chi-square analysis was performed on categorical data and Mann­Whitney U analysis on numerical data. A total of 45,607 WCA in the 2012 IDHS data and 29,627 WCA in the 2017 IDHS data were included in the study. In the 2012 IDHS data, factors influencing unmet needs were age and parity. In the 2017 IDHS data, factors influencing unmet needs were the residential area, level of education, level of spouse's education, employment status, possession of electricity, and possession of television.In conclusion, factors affecting unmet needs are age, parity, residential area, level of education, level of spouse's education, employment status, possession of television, and possession of electricity. There were no recurring factors on 2012 and 2017 IDHS data.

Hysteroscopy Role for Female Genital Tuberculosis.

Female genital tuberculosis affects the quality of women's lives. One of the symptoms is amenorrhea. In our country, it is still underdiagnosed due to limited resources. Hysteroscopy is known as one of the diagnostic tools for this condition. We performed hysteroscopy and endometrial biopsy in four cases. Hysteroscopy findings show various signs. Histopathological examination showed typical features of tuberculosis in some cases. We also learned that hysteroscopy could evaluate the condition of the endometrium when ongoing and after treatment is accomplished. It is useful for further explanation to the client. Hysteroscopy can be utilized as a diagnostic tool for endometrial sampling, evaluate intracavity condition after treatment, and prognostic tool for future reproductive function.

Cesarean scar pregnancy management: Different approach for different situation; A case series.

The incidence of caesaean scar pregnancy (CSP) increases since the cesarean delivery rate had increased as well. Diagnosing of CSP was also a challenge to identify the type of CSP which important things for choosing the right management. The CSP could be classified into two types, which are endogenous and exogenous. While the management was dependent into the types, such as suction curettage, resection, and also hysterectomy. This paper showed cases of cesarean scar pregnancy in Cipto Mangunkusumo General Hospital, in one year.

Secondary pyosalpinx after reconstructive surgery of vaginal agenesis patient with bilateral hematosalpinx: A case report.

INTRODUCTION AND IMPORTANCE: Congenital or hypoplasia vaginal agenesis is a very rare condition caused by the failure of developmental Mullerian ducts. The prevalence is 0.001%-0.025% populations. This condition often misdiagnosed because the symptom does not appear. Acute symptoms such as abdominal pain may occur due to the obstruction of retrograde menstrual flow. In this case, we presented a case complex management of vaginal atresia with pyosalpinx, hematometra and bilateral hematosalpinx. PRESENTATION OF CASE: A 12 years old teenager, non-sexually active, complained cyclic abdominal pain that worsening in seven months before admission. Patient never had menstrual blood flow during her life. Patient was diagnosed with hematometra, hematocolpos, bilateral hematosalpinx and distal vaginal agenesis. Amnion graft neovagina was performed. Five days after surgery, patient started to have fever. On the seventh days after surgery, amnion graft was removed. The next two days patient still had fever. Because of continuous fever, patient was test of COVID 19. The result was positive. On the eleventh days after the first surgery, patient complained abdominal pain VAS 3-4. Patient was diagnosed with pyosalpinx by ultrasound examination. Laparotomy was done performing adhesiolysis, bilateral salpingectomy, and omentectomy. DISCUSSION: In our case vaginal reconstruction surgery from vaginal approach has been done without management of the bilateral hematosalpinx because the consideration of small caliber of bilateral hematosalpinx. But then complications were developed when vaginal canal was opened, bilateral hematosalpinx were transformed into bilateral pyosalpinx and continue to developed into bilateral tubal abscess. We assume during this process, the bacteria from vagina could fastly infecting the blood and transformed it into pus and grew until tubal abscess. CONCLUSION: The surgical intervention in vaginal agenesis must be considered as a treatment and not only focus on the reconstruction. Laparoscopy or laparotomy may offered as options for combination treatment with vaginal approach reconstructive surgery for vaginal agenesis with obstruction complications such as hematometra and hematosalpinx to prevent the worst condition like ascending infection or misdiagnosed other severe conditions.