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.

Malignant mesenchymal vaginal tumor mimicking pedunculated submucous myoma: A case report.

INTRODUCTION: Vaginal mesenchymal cancer is one of the rarest cases, covering only 3% of all cases of vaginal malignancies. While risk factors are not heavily studied, genetic disorders and hereditary diseases have been stated to be responsible for the increasing incidence of vaginal mesenchymal carcinoma. The diagnosis of leiomyosarcoma could be done through anamnesis to find abnormal uterine discharge and pelvic pain and physical examination to find a protruding mass on the vagina, which then should be confirmed through a series of radiologic examinations and histopathological examinations. Due to its rarity, each case should be properly evaluated for its clinical manifestation, diagnostic results, and outcome of the treatment. CASE PRESENTATION: A 46-year-old woman came in with vaginal discharge and a protruding mass from the vagina without bleeding or urinary or defecation difficulties, which was suspected to be pedunculated submucous myoma. Based on pelvic USG and MRI, the mass was suspected to have originated from the vagina. Histopathology examinations from biopsy showed a possible mesenchymal malignant type. The patient then underwent total hysterectomy, bilateral salpingo-oophorectomy, and partial vaginectomy. Histopathological evaluation confirmed the diagnosis of leiomyosarcoma in the patient. DISCUSSION AND CONCLUSION: The patient was diagnosed with a vaginal malignant mesenchymal tumor stage II intraoperatively and underwent total hysterectomy and bilateral salpingo-oophorectomy. Leiomyosarcoma is not commonly diagnosed preoperatively, hence implying the importance of radiologic examination to do an early diagnosis prior to the histopathological analysis. Due to the rarity of vaginal mesenchymal malignancy, further studies are needed to increase understanding of this case.

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.

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.

Vesicouterine fistula presenting with cyclical haematuria mimicking bladder endometriosis: A case report.

Vesicouterine fistula (VUF) is an abnormal communication between the bladder and uterus, occurring 1-4% of all urogenital fistulas. Diagnosis is still a challenge because symptoms may appear late or fistula may be missed even after repeated examination. A 37-year old woman who has two children born through caesarean section complained of the absence of menstruation for the past three years. At the same time point, she experienced cyclic haematuria and amenorrhea. The diagnosis was made through ultrasonography, cystoscopy and hysteroscopy. She was then managed with laparoscopic bladder fistula repair continued with total laparoscopic hysterectomy. The VUF can present as an undesirable consequence of caesarean section.

Triglycerides, independent of Ferriman Gallwey Score, is a main determinant of free testosterone index in PCOS.

Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, affecting 5-20% of women worldwide. Hyperandrogenism, as the primary characteristic of PCOS, is not always present in every patient. The hyperandrogenic phenotype of PCOS patients is influenced by both hormonal and metabolic dysfunctions. Therefore, this study aims to determine the correlation between hormone profile, lipid profile, and clinical profile with free testosterone index in subjects with PCOS. Methods: This prospective cross-sectional study was conducted in the Dr. Cipto Mangunkusumo General Hospital between July 2014 and December 2016. The study involved 76 women with PCOS, who were classified into 2 subgroups: 39 subjects in the hyperandrogenism group and 37 subjects in the non-hyperandrogenism group. Each subject underwent physical examination, blood sample collection, and USG examination. Bivariate analysis was done using independent t-tests and Mann Whitney U-tests, while multivariate analysis was done using logistic regression. Results: Triglyceride and testosterone level showed weak (r = 0.232, p = 0.044) and moderate (r = 0.460, p ¡ 0.001) positive correlation with FTI, while SHBG level showed moderate negative correlation (r = -0.483, p ¡ 0.001). Triglyceride was also found to be determinant of hyperandrogenism condition in PCOS patient (OR 0.02, 95% CI 0.00-0.04, p = 0.013). However, there was no significant difference observed between FGS and hyperandrogenism (p = 0.43). Conclusions: Triglycerides, testosterone, and SHBG were associated with hyperandrogenism in PCOS patients, while FGS showed no such association.

Body fat percentage is a better marker than body mass index for determining inflammation status in polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is an endocrinopathic disorder most commonly experienced by women of reproductive age, and it is characterized by a low-grade chronic inflammatory condition. Excessive fat deposit has been long considered as an etiological factor in the pathogenesis of this inflammatory condition. Currently, body mass index (BMI) or percentage of body fat is used as a marker to assess the body fat composition of a person. OBJECTIVE: To determine whether BMI or body fat percentage (BFP) can be used as a better marker for measuring inflammation related to body fat accumulation in polycystic ovary syndrome patients. MATERIALS AND METHODS: This study took place at the Center for Reproductive Medicine, Yasmin Clinic, Cipto Mangunkusumo Hospital from January to December 2015. In this cross-sectional study, 32 reproductive age women with PCOS according to the Rotterdam criteria (2003) participated. Women with hyperandrogenism caused by non-classic congenital adrenal hyperplasia, pregnant and lactating women, etc., were excluded. Some variables such as BMI, clinical hyperandrogenism sign, BFP, and inflammatory markers were assessed and statistically analyzed. RESULTS: From a total of 32 subjects of the study, BFP had a significant positive correlation with procalcitonin levels (r=0.35; p=0.048), while BMI did not (r=0.27; p=0.131). CONCLUSION: BFP can be used as a better marker for measuring inflammation related to body fat accumulation in PCOS subjects.