Incidence and first trimester risk factors of stillbirth in Indonesia.

OBJECTIVES: To determine the incidence and the risk factors of stillbirth from maternal biophysical, ultrasound, and biochemical markers at 11-13 weeks of gestation in the Indonesian population. METHODS: This was a retrospective cohort study of pregnant women for first-trimester preeclampsia screening at 11-13 weeks of gestation in some clinics and hospital in Jakarta. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA-PI) ultrasound, maternal ophthalmic peak ratio (Oph-PR) Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified into placental dysfunction-related when it occurred with preeclampsia or birth weight <10th percentile and non-placental dysfunction-related. Bivariate and multivariate logistic regression analyses were employed to determine the risk factors associated with stillbirth. RESULTS: Of 1,643 eligible participants, 13 (0.79 %) stillbirth cases were reported. More than half of the stillbirths (7) were placental dysfunction-related. After adjusted with maternal age, body mass index (BMI), and parity status, chronic hypertension (aOR (adjusted odds ratio)) 24.41, 95 % CI {confidence interval} 5.93-100.43), previous pregnancy with preeclampsia (aOR 15.79, 95 % CI 4.42-56.41), MAP >101.85 (aOR 26.67, 95 % CI 8.26-86.06), UtA-PI >1.90 (aOR 10.68, 95 % CI 2.34-48.58, and PlGF <28.77 pg/mL (aOR 18.60, 95 % CI 5.59-61.92) were associated with stillbirth. CONCLUSIONS: The incidence of stillbirth in the population is comparable to studies conducted in developed countries. Most routine variables assessed at the 11-13 weeks combined screening for preeclampsia are associated with the risk of stillbirth.

Correlation between Knowledge, Attitude, and Partner Support Towards Visual Inspection with Acetic Acid Test among Women in Denpasar City, Indonesia.

BACKGROUND: Cervical cancer is the fourth most common cancer in women worldwide. Thus a high mortality rate is unavoidable. Visual Inspection with Acetic Acid (VIA) is a practical and inexpensive screening test for detecting cervical cancer. We aim to show the association between knowledge, attitude, and partner support towards VIA practice in women in Denpasar, Bali. METHODS: The study design was a cross-sectional and analytical observational study conducted at the Public Health Center Denpasar in July-August 2022. The respondents consisted of 90 child-bearing-age women who met the inclusion criteria. The questionnaire consisted of informed consent, demographic characteristics (26 questions), knowledge (20 questions), attitude (22 questions), partner support (11 questions), and practice of VIA (2 questions). The data analysis used the Chi-square test using SPSS ver26. RESULTS: The median age of all respondents was 33 (10) years. The majority of respondents were monogamous (93.03%), had no history of miscarriage (80%), used contraception (56.07%), and the mean age of first sexual intercourse was 20.6 years. Up to 69 women (76.7%) had the VIA Test in the past five years, and 42 women (46.7%) took the test regularly every three years. There is a correlation between knowledge (p=0.001, r =0.334), attitude (p<0.001, r=0.367), and partner supports (p=0.03, r=0.197) toward practicing VIA. CONCLUSION: The practice of VIA is influenced by the level of knowledge, attitudes, and partner support of the child-bearing-age women in Denpasar. All healthcare professionals and the environment should support and encourage women to perform VIA regularly.

Midwives as the Primary Care Providers: Knowledge, Attitude, Practice, and Skill of Early Detection of Cervical Cancer Using Visual Inspection with Acetic Acid.

BACKGROUND: Cervical cancer is the third most common malignancy in women globally. It is also the leading cause of death for women in Indonesia. When detected at an early precancerous stage, cervical cancer is largely preventable. Early detection with Visual Inspection with Acetic Acid (VIA) is an acceptable, affordable, and safe alternative method in developing countries. Midwives, as primary health care providers, can perform VIA at various health center levels. This study evaluated the knowledge, attitude, practice, and skill of cervical cancer screening with VIA among midwives in Denpasar. METHODS: A cross-sectional study was conducted among 70 midwives at Public Health Centers in Denpasar, Bali, Indonesia, from July-August 2022. The data were collected using a structured knowledge, attitude, and practice questionnaire. An obstetrician-gynecologist assessed the skills with a standardized checklist. Data were analyzed using univariate, bivariate, and multivariate analysis on SPSS version 26. A level of p<0.05 was considered significant with a prevalence ratio (PR) and 95% confidence interval (CI). RESULTS: Out of all midwives, 42 (60.0%) were knowledgeable, 42 (60.0%) had a favorable attitude, 36 (51.4%) had good practice of VIA, and 54 (77.1%) had competent skills. Knowledge (PR=5.00, 95%CI=1.76-14.16), attitude (PR=2.92, 95%CI=1.08-7.89), and skill (PR=11.90, 95%CI=2.44-57.84) were associated with the practice of VIA. Age group and work experience were strongly associated with the training and skill of VIA. CONCLUSION: Most midwives in Denpasar were knowledgeable, had a favorable attitude, good practice, and competent skills to perform cervical cancer screening using VIA.

Prognostic Value of Baseline Echocardiographic Parameters in Heart Failure With Improved vs Nonrecovered Ejection Fraction.

Background: Ejection fraction (EF) is often used as a prognostic indicator and for classifying heart failure (HF) patients. This study evaluates the association of echocardiographic parameters with HF with improved EF (HFimpEF). Methods: This single-centre study retrospectively included patients with HF with reduced EF (HFrEF) from a cohort of admitted patients over 2018-2020, who were then followed up prospectively until 2023. The control group was categorized as patients with non-recovered HFrEF, and the population group was categorized as patients with HFimpEF. Results: A total of 176 patients with HFrEF were included in the study. Non-ischemic etiology was found to be the most prevalent cause of HFimpEF. The baseline echocardiography examination revealed that the HFimpEF group exhibited significantly higher values for tricuspid annular plane systolic excursion (TAPSE; P < 0.001) and inferior vena cava diameter (P < 0.001). The non-recovered HFrEF group demonstrated higher baseline left atrial volume index (LAVi) values (P < 0.001). In multivariate analysis, a higher value of TAPSE (odds ratio 3.071; P = 0.008) and a lower value of LAVi (odds ratio 2.034; P = 0.008) were independent echocardiography variables associated with HFimpEF. After a mean follow-up duration of 32.5 ± 9.1 months, the HFimpEF group had higher survival from rehospitalization due to worsening HF and lower all-cause mortality (log rank P < 0.001 and P = 0.005, respectively). Conclusions: Higher TAPSE and lower LAVi in baseline were associated with the transition from HFrEF to HFimpEF. The HFimpEF group had better survival compared to those with non-recovered HFrEF.

Contexte: La fraction d'éjection est souvent utilisée comme indicateur pronostique et comme élément de classification des patients atteints d'insuffisance cardiaque. La présente étude visait à évaluer l'association entre les paramètres échocardiographiques et l'insuffisance cardiaque avec fraction d'éjection améliorée (ICFEA). Méthodologie: Cette étude monocentrique a été menée de façon rétrospective auprès d'une cohorte de patients atteints d'insuffisance cardiaque avec fraction d'éjection réduite (ICFER) traités entre 2018 et 2020, et cette cohorte a été suivie de façon prospective jusqu'en 2023. Les patients du groupe témoin ont été classés comme ayant une ICFER ne s'étant pas résorbée, et les patients de la population étudiée ont été classés comme ayant une ICFEA. Résultats: Au total, 176 patients présentant une ICFER ont été inclus dans l'étude. La cause la plus fréquente d'ICFER était une étiologie non ischémique. Lors de l'évaluation échocardiographique initiale, les patients du groupe ayant progressé vers l'ICFEA présentaient des valeurs significativement plus élevées en ce qui concerne l'excursion systolique du plan de l'anneau tricuspide (TAPSE pour tricuspid annular plane systolic excursion) (p < 0,001) et le diamètre de la veine cave inférieure (VCI) (p < 0,001). D'autre part, les patients du groupe dont l'ICFER ne s'est pas résorbée présentaient des valeurs initiales plus élevées à l'indice de volume auriculaire gauche (IVAG) (p < 0,001). Lors d'une analyse multivariée, des valeurs de TAPSE plus élevées (rapport de cotes [RC] de 3,071; p = 0,008) et des valeurs plus faibles d'IVAG (RC de 2,034; p = 0,008) étaient deux variables échocardiographiques indépendantes associées avec la progression vers l'ICFEA. Après un suivi d'une durée moyenne de 32,5 ± 9,1 mois, le groupe présentant une ICFEA présentait un taux plus élevé de survie sans réhospitalisation due à une aggravation de l'IC et un taux plus faible de mortalités toutes causes confondues que le groupe dont l'ICFER ne s'était pas résorbée (p selon le test logarithmique par rangs < 0,001 et p = 0,005, respectivement). Conclusions: Une valeur de TAPSE élevée et un IVAG faible à l'évaluation initiale étaient associés à un passage de l'ICFER à l'ICFEA. La survie de patients présentant une ICFEA était supérieure à celle des patients présentant une ICFER non résorbée.