Invasive Mole With Impending Uterine Rupture : A Case Report

Gestational  Trophoblastic  Disease  (GTD)  is an abnormal placenta, composed of a spectrum of premalignant to malignant disorders. In Indonesia, GTD incidence is particularly challenging to estimate, since not all cases will be reported or recognized. It classified into hydatidose mole and gestational trophoblastic neoplasia (GTN). One of those clinicopathological classification of GTN is malignant invasive mole. It is likely to be the cause of increased maternal mortality in Indonesia if the disease is not well diagnosed and treated. We reported the case, a 28 years old woman who had a invasive mole with impending uterine rupture. She had a pervaginam bleeding symptoms since 3 weeks after post curetase due to hydatidose mole indication. She also had multiple abortus history

Correlation of Tumor Vascularization Using Spectral Pulse Wave Doppler with Neoadjuvant Chemotherapy Response in IB2 and IIA2 stages of Cervical Cancer

Cervical cancer is an abnormal growth or cell changes in the cervical wall, which is the 4th rank in the most common cancer among female and the 2nd most common cancer in female aged fifteen until fourty four years old worldwide. Neovascularization becomes an important step in determining the onset and progressive cancer. Neoadjuvant chemotherapy has been evaluated as a treatment strategy in the stages IB2 and IIA2. The use of chemotherapy drug becomes more effective in adjacent and regular vascularization, and it allows the blood flow to the organs more quickly. This study aims to determine the correlation of tumor vascularization using Spectral Pulse Wave Doppler with neoadjuvant chemotherapy response in IB2 and IIA2 stages of cervical cancer. This research is a cohort analytic study which involves thirty six of patient in IB2 and IIA2 stages. The sampling is selected by using consecutive sampling technique. The data includes the result of ultrasound examination and were analyzed by using the Chi-square test. The results of the research on good and poor tumor vascularization had a good response to thirty of patient (83.3%) who were given neoadjuvant chemotherapy. There was no significant effect between tumor vascularization using Spectral Pulse Wave Doppler to the responses of neoadjuvant chemotherapy in IB2 and IIA2 stages of cervical cancer. Keywords: tumor vascularization using Spectral Pulse Wave Doppler, responses of neoadjuvant chemotherapy, IB2 and IIA2 stages of cervical cance

How far is Covid-19 Pandemic Situation Influence Surgical Treatment in Gynecology Cancer? : Comprehensive Review for Indonesian

Corona virus disease 2019 (COVID-19) was declared as global pandemic and caused devastating crisis in society. Despite of the growing pandemic, high quality medical services toward gynaecologic oncology patients must continue without overlooking the safety of medical staffs. Reducing risk is crucial and achieved by limiting high risk situations. The decision to perform or postpone surgery should be made based on the type and stage of the disease, medical condition of the patient, area census of COVID-19 cases, COVID-associated risks, and available logistic support including adjuvant treatment services. There are several recommendation for gynaecology cancer treatment published by several countries. However, those guidelines cannot be applied to every country across the globe because of the different situations of COVID-19 therefore we proposed guidelines for Indonesia. Surgical management for confiermed COVID-19 case should be postponed for at least 15 days for nonemergency cases. Surgery must be performed immediately for emergency cases such as Haemorrhage with unstable vital status refractory to transfusion, viscus perforation, signs of bowel obstruction refractory to conservative treatment, closed loop bowel or large bowel obstruction, hydatiform mole for live saving procedure.   Keywords: COVID-19, gynaecology cancer, surgical managemen

Primary Fallopian Tube Carcinoma : A Case Report

Objective: To report the case of primary fallopian tube carcinoma metastatic to cervix and omentum, but not infiltrate the ovarium Method: Case Report Case: A 40 years old woman presented with gradual onset pain and swelling of the abdomen. The patient was diagnosed with suspected ovarian carcinoma. After examination, the patient prepared for laparotomy; salpingo-oophorectomy, omentectomy, mass resection from pelvic and rectum  Result: The hystological examination result was high grade serous carcinoma from the fallopian tube metastasis to cavum douglas and omentum. This case is a rare case because the tubal carcinoma was metastasis to cavum douglas and omentum without infiltrate the ovarium. Discussion: Primary carcinoma of the fallopian tube is rare and accounts for about 0.14-1.8% of all gynecological malignancies. Clinically the diagnose of tubal carcinoma very similar to ovarian cancer, the diagnose can not distinguished pre operative. The new staging of FIGO may be reference for diagnostic and treatment of the desease. Thorough staging laparotomy is an important part of early management and systemic treatment. Keywords: tubal carcinoma, PFTC, metastasis, high grade serous carcinom

Migraine And Pregnancy: What Should We Know

Migraine is a common headache characterized by unilateral throbbing-like headache and pulsating in nature and sometimes associated with aura. Migraine is a disabling disorder that among adults is more prevalent among women than men. It is primary headache that is often found in pregnancy. Migraine is a common disorder in women of childbearing age, and usually requires pharmacological treatment. Migraine can be considered an important risk factor for hypertensive and vascular diseases during pregnancy. Migraine therapy in pregnancy is very challenging, it must taken into a consideration about the health of the mother and fetus.  Several effective antimigraine medications are reasonably safe for use by pregnant and breastfeeding women. Prophylactic theraphy should be given to patient with recurrent migraine attacks in pregnancy. Nonpharmacological strategies are always first-line treatment options for mild migraine, and should also be used complementarily whenever pharmacological treatment is required. Women with migraine should be offered periconceptional counselling to promote a safe and healthy pregnancy. Keywords: migraine; pregnancy; therap

CA-125 Examination as a Predictor the Resectability of Advanced Stage of Ovarian Cancer

Objective: To describe the prompt and successful treatment of an extrauterine pregnancy case in a tertiary-level hospital in Indonesia. Methods: We report a case of prompt and successful management of unruptured tubal pregnancy in the dr. Soetomo General Hospital Surabaya. Results: A 32-years-old woman presented with lower abdominal pain and vaginal bleeding one days before admission. She was sexually active, used no contraceptives, and had a history of one miscarriage. On examination, she was hemodynamically stable. A bimanual exam revealed cervical motion tenderness and pain. A high human chorionic gonadotropin (hCG) level (1,725 IU/L) and a left-sided mass, highly suspected as an extrauterine gestational sac confirming a 6 week, 1 days age of pregnancy without sign of free fluid in the abdomen nor fetal heart rate on ultrasound, prompted diagnostic laparoscopy. We found a tubal pregnancy located on the ampullae of the left fallopian tube with minimal hemoperitoneum (50 ml). A chromopertubation test was done to ensure a patent right fallopian tube, so we did a salpingectomy. The patient recovered well and was discharged home on day 2 post-procedure. Conclusion: Early diagnosis is vital and feasible to prevent morbidity and mortality in women with ectopic pregnancy. All sexually active women complaining painful abdomen or vaginal bleeding must be examined for an ectopic pregnancy to enable early diagnosis and prompt treatment. A laparoscopic surgery done by a trained individual provided a safe and minimally invasive intervention to this case. Keywords: case report, ectopic pregnancy, laparoscopy, salpingectomy, tubal pregnanc

Ovarian fibrosarcoma : A Case Report

This case report aims to report and discuss cases of ovarian fibrosarcoma. Ovarian fibrosarcoma is a rare case that generally occurs in women who have menopause. In the case of ovarian fibrosarcoma, the patient was 43 years old, had two children, and had no complaints during menstruation. The patient has lost weight in the last six months. The patient has performed debulking surgery optimally. On the PA results, it looks macroscopic, a piece of brownish-white tissue, densely rubbery, with a size of 15x12x5 cm, a solid white part is visible, and there is a yellowish-white part and anger, there is a 0.5-1.5 cm cavity filled with a yellowish liquid. On microscopic examination of the tumor, the tissue section appears to consist of a diffuse proliferation of tumor cells with hypercellular and hypocellular areas. Based on the results of macroscopic and microscopic examination of the tumor tissue, a skewed sarcoma is established in fibrosarcoma. The patient underwent chemotherapy after tumor surgery. Although there is no clear consensus on the administration of fibrosarcoma chemotherapy, several published case reports have demonstrated a lower probability of recurrence and a better prognosis in patients undergoing chemotherapy

Menstrual Migraine : How Hormones Impact Migraine

Menstrual Migraine is divided into 2 subtypes: Menstrually Related Migraine (MRM) and Pure Menstrual Migraines (PMM). In PMM symptoms do not occur outside the menstrual cycle while MRM, symptoms can occur at other times apart from the menstrual cycle. The occurrence of menstrual migraines is related to the female hormones cycle in the form of the decrease in estrogen levels which usually occurs a week before the onset of menstruation. The mechanism is unclear, but it is thought that a decrease in estrogen levels can trigger decrease in serotonin levels, causing cranial vasodilation and sensitization of the trigeminal nerve.   Keywords: menstrual migraine, hormone

The First Pelvic Exenteration in West Sumatera : A Case Report

Introduction: Pelvic exenteration (PE) is an ultra-radical surgical procedure introduced by Alexander Brunschwig in 1948, which a way for symptomatic palliative care in subjects with advanced gynecological malignancies that do not respond to radiation therapy, who experience subsequent complications including fistula, infection, or pain. Objective: The aim of this case report is to share our first experience of pelvic exenteration in patient with recurrent cervical cancer in West Sumatera. Case Report: We report the case of a 42-year-old woman, who was diagnosed with a progressive recurrent cervical cancer that had been treated with a radiotheraphy for cervical cancer stage IIIB and adjuvant chemotherapy. The patient was planned for pelvic exenteration. Prior to surgery, patient had done several preparations such as ultrasound, CT scan, laboratory tests, urologist and colorectal surgeon consult. The patient had undergone a supralevator pelvic exenteration by gynecologic oncologist, urologist and colorectal surgeon. The supralevator exenteration pelvic included total hysterectomy, bilateral salpingo-oophorectomy, cystectomy, and Miles procedure. The reconstruction process included ileal conduit and colostomy. Conclusions: Pelvic exenteration can be done with good teamwork between gynecologic oncologist, urologist, colorectal surgeon with postoperative complications (hypoalbuminemia and low intake) can be tolerated. Keywords: supralevator pelvic exenteration, cervical cance