Sriwijaya Journal of Obstetrics and Gynecology

Mid-trimester sFlt-1/PlGF ratio and uterine artery Doppler for predicting preeclampsia in congenital uterine anomalies: a prospective cohort study

Felicia Sari — 2026-07-17

Background: Congenital uterine anomalies (CUA) may worsen defective placentation, but the predictive value of angiogenic biomarkers in this high-risk group is unclear.

Objective: To evaluate serum soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), the sFlt-1/PlGF ratio and uterine artery pulsatility index (UtA-PI) for predicting early- and late-onset preeclampsia (PE) in CUA pregnancies.

Methods: This prospective longitudinal cohort included 145 women with CUA and 290 age-, parity- and BMI-matched controls at two Indonesian tertiary hospitals. Participants were assessed at 11–14, 20–24 and 28–32 weeks. PE was defined using ISSHP criteria. Analyses included risk ratios, multivariable logistic regression and receiver-operating-characteristic curves.

Results: PE incidence was 19.3% in CUA versus 5.9% in controls (RR 3.29, 95% CI 1.87–5.82; p < 0.001); early-onset PE occurred in 8.3% versus 1.4% (RR 6.00; p < 0.001). At 20–24 weeks, the sFlt-1/PlGF ratio was higher in CUA pregnancies that developed PE (42.5 vs 14.2; p < 0.001) and independently predicted PE (adjusted OR 2.72 per SD, 95% CI 1.58–4.69). The ratio-plus-UtA-PI model predicted early-onset PE with an AUC of 0.89 (95% CI 0.84–0.93), sensitivity of 88.1% and NPV of 99.3%.

Conclusion: The mid-trimester sFlt-1/PlGF ratio combined with UtA-PI strongly predicted early-onset PE in CUA. Pending external validation, its high NPV may support targeted surveillance in this under-studied population.

Machine learning identification of psychosocial and sociodemographic determinants of repeat adolescent pregnancy: a retrospective cohort study in an Indonesian metropolitan setting

Rachmat Hidayat — 2026-07-20

Background: Repeat adolescent pregnancy compounds obstetric and socioeconomic risk, yet conventional models seldom capture the non-linear interplay of psychosocial and sociodemographic determinants, particularly in low- and middle-income registries where such variables are rarely recorded.

Objective: To develop and compare interpretable machine-learning models to identify determinants of repeat adolescent pregnancy in an Indonesian metropolitan cohort.

Methods: In this retrospective cohort study, electronic medical records (2018–2023) from a tertiary referral hospital and affiliated primary-care network in Palembang, Indonesia, were analysed for 1,245 adolescents (aged 10–19 years) with at least one prior pregnancy. The outcome was a second pregnancy before age 20. Five models (logistic regression, random forest, support vector machine, multilayer perceptron, and XGBoost) were trained with SMOTE and 5-fold cross-validation; discrimination was assessed by AUC-ROC and interpretability by SHAP. A multivariable logistic model provided adjusted odds ratios (aOR).

Results: Repeat pregnancy occurred in 312/1,245 adolescents (25.06%; 95% CI 22.7–27.5%). XGBoost achieved the highest discrimination (AUC 0.89, 95% CI 0.86–0.92; F1 0.84). Independent determinants were non-use of postpartum LARC (aOR 8.86, 95% CI 6.00–13.07; p<0.001), low family support (aOR 3.82; p<0.001), education at most junior high (aOR 3.76; p<0.001), elevated EPDS (aOR 2.92, 95% CI 1.95–4.37; p<0.001), and age under 16 at first pregnancy (aOR 2.85; p<0.001). Postpartum LARC was strongly preventive (NNT approximately 3).

Conclusion: Interpretable gradient boosting accurately stratified repeat adolescent pregnancy risk, and psychosocial determinants carried predictive weight comparable to contraceptive non-use. These findings support risk-stratified, bio-psycho-social postpartum care and targeted LARC counselling for adolescent mothers in Indonesia.

Myo-inositol versus metformin pre-treatment and the follicular-fluid metabolome in PCOS women undergoing IVF: a double-blind randomized trial

Syaifudin — 2026-07-21

Background: Polycystic ovary syndrome (PCOS) impairs oocyte quality and complicates in vitro fertilization (IVF). Metformin and myo-inositol are widely prescribed insulin sensitizers, yet their comparative effects on the human follicular-fluid (FF) metabolome and IVF outcomes have rarely been examined head-to-head.

Objective: To compare myo-inositol and metformin pre-treatment in terms of the FF metabolome and embryologic, clinical, and safety outcomes in women with PCOS undergoing IVF.

Methods: In a double-blind, block-randomized (1:1) trial at two tertiary IVF centers in Jakarta and Palembang, Indonesia, 150 women with PCOS (Rotterdam criteria; aged 20–35 years; BMI 18.5–29.9 kg/m²) received myo-inositol 4 g/day (n=75) or metformin 1500 mg/day (n=75) for 12 weeks before and during a GnRH-antagonist protocol. FF was analyzed by LC-MS/MS. Analyses were intention-to-treat and included multivariable logistic regression, ROC analysis, and number needed to treat (NNT).

Results: Myo-inositol yielded more MII oocytes (11.6 ± 3.4 vs 10.1 ± 3.6; p=0.010), higher fertilization (72.5% vs 66.8%; p=0.006), and more top-quality embryos (4.3 ± 1.8 vs 3.4 ± 1.7; p=0.002). Clinical pregnancy was 48.0% versus 33.3% (unadjusted p=0.069; adjusted OR 2.18, 95% CI 1.04–4.57; p=0.039; NNT 7). Moderate–severe OHSS (6.7% vs 18.7%; p=0.038; NNT 8) and gastrointestinal events (9.3% vs 34.7%; p<0.001; NNT 4) were lower with myo-inositol. FF myo-inositol, D-chiro-inositol, and antioxidant capacity were higher; FF myo-inositol predicted pregnancy (AUC 0.78).

Conclusion: Myo-inositol pre-treatment shifted the FF metabolome toward a pro-developmental antioxidant profile and improved embryologic outcomes and tolerability versus metformin. The clinical-pregnancy signal remains provisional because the trial was underpowered for this endpoint and the unadjusted comparison was not significant; adequately powered live-birth trials are needed.

Deep learning-assisted digital VIA via telemedicine and HPV self-sampling for CIN2+ detection in remote archipelago women: a prospective diagnostic accuracy study

Theresia Putri Sinaga — 2026-07-21

Background: Cervical cancer disproportionately burdens women in low- and middle-income countries, where archipelagic geography and colposcopist shortages obstruct screening. Human papillomavirus (HPV) self-sampling is highly sensitive but poorly specific, generating colposcopy referrals that exceed remote-area capacity.

Objective: To evaluate whether deep-learning (DL)-assisted digital visual inspection with acetic acid (VIA), delivered by telemedicine, can triage HPV-positive women and detect high-grade cervical intraepithelial neoplasia (CIN2+).

Methods: In a prospective, double-blind, STARD-compliant diagnostic accuracy study, 642 women aged 30–50 years at an urban tertiary referral hospital (Center A) and five remote community health centers (Region B) in an Indonesian archipelago province underwent HPV-DNA self-sampling and smartphone-captured digital VIA analyzed by a MobileNetV2 convolutional neural network. All participants received colposcopy-directed biopsy as the reference standard, eliminating verification bias. Metrics used Wilson 95% confidence intervals (CI); multivariable logistic regression and decision-analytic triage metrics were derived.

Results: CIN2+ prevalence was 13.1% (95% CI 10.7–15.9). DL-assisted VIA achieved sensitivity 91.7% (95% CI 83.8–95.9), specificity 88.4% (85.4–90.8), and AUC 0.93, exceeding human-read VIA (sensitivity 67.9%). HPV self-sampling was most sensitive (95.2%) but least specific (81.5%). A sequential HPV→DL-VIA pathway raised specificity to 95.7% and positive predictive value to 75.5%, reducing colposcopy referrals by 46.4% and unnecessary referrals by 76.7% (number-needed-to-screen 7.6). HPV positivity dominated the multivariable model (adjusted OR 91.5, 95% CI 32.7–256.2, p<0.001; Nagelkerke R² 0.50).

Conclusion: Telemedicine-delivered, DL-assisted VIA is an accurate triage for HPV-positive women that conserves scarce colposcopy capacity while preserving CIN2+ detection. This decentralized two-step pathway is a scalable strategy for advancing cervical-cancer elimination in geographically isolated populations.

Admission interleukin-6 and carbapenemase carriage independently predict 30-day mortality in female Fournier's gangrene: a multicenter cohort

Rini Kuswohadi Pramono — 2026-07-22

Background: Female Fournier's gangrene (FG) is an underrecognized obstetric and gynecologic infectious emergency that frequently arises from vulvar, Bartholin gland, and episiotomy-related sources and carries high mortality. Rising multidrug resistance threatens standard empirical antibiotic regimens, yet female-specific data integrating inflammatory biomarkers with the genomic resistome are scarce.

Objective: To identify independent predictors of 30-day mortality and characterize the genomic resistome in women with FG to inform targeted broad-spectrum therapy.

Methods: In this multicenter retrospective cohort at two tertiary referral hospitals in Palembang, Indonesia (January 2020–December 2025), 42 women with surgically confirmed FG were studied. Admission interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), procalcitonin (PCT), and C-reactive protein (CRP) were measured; deep-tissue isolates underwent culture, broth-microdilution MIC testing, and multiplex PCR/next-generation sequencing for resistance genes. Multivariable logistic regression, ROC analysis, and Kaplan-Meier/Cox modeling were performed.

Results: Thirty-day mortality was 26.2% (95% CI 15.3–41.1), and infections were polymicrobial in 85.7%. Non-survivors had markedly higher admission IL-6 (485.2 vs 142.5 pg/mL; p<0.001; Cohen's d=2.58) and PCT (18.6 vs 4.2 ng/mL; p<0.001). IL-6 predicted mortality with an AUC of 0.93 (95% CI 0.83–0.99), outperforming LRINEC (AUC 0.69). Independent predictors were carbapenemase-producing isolates (adjusted OR 4.15, 95% CI 1.85–9.20; p=0.001) and admission IL-6 ≥300 pg/mL (adjusted OR 3.80, 95% CI 1.62–8.85; p=0.002). Resistome-concordant empirical therapy was associated with lower mortality (modeled NNT 3).

Conclusion: Admission IL-6 and carbapenemase carriage independently predicted 30-day mortality in this female FG cohort. Rapid biomarker and resistome screening may support risk stratification and empirical coverage in high-resistance tertiary settings, but prospective external validation is required before practice adoption.