Objective To create a model for prediction of success of uterine‐preserving procedures in women with placenta accreta spectrum (PAS). Methods PAS‐ID is a multicenter study that included 11 centers from 9 countries. Women with PAS, who were managed between January 1, 2010 and December 31, 2019, were retrospectively included. Data were split into model development and validation cohorts, and a prediction model was created using logistic regression. Main outcome was success of uterine preservation. Results Out of 797 women with PAS, 587 were eligible. Uterus‐preserving procedures were successful in 469 patients (79.9%). Number of previous cesarean sections (CS) was inversely associated with management success (adjusted odds ratio [aOR] 0.02, 95% confidence interval [CI] 0.001–3.63 with five previous CS). Other variables were complete placental invasion (aOR 0.14, 95% CI 0.05–0.43), type of CS incision (aOR 0.04, 95% CI 0.01–0.25 for classical incision), compression sutures (aOR 2.48, 95% CI 1.00–6.16), accreta type (aOR 3.76, 95% CI 1.13–12.53), incising away from placenta (aOR 5.09, 95% CI 1.52–16.97), and uterine resection (aOR 102.57, 95% CI 3.97–2652.74). Conclusion The present study provides a prediction model for success of uterine preservation, which may assist preoperative and intraoperative decisions, and promote incorporation of uterine preservation procedures in comprehensive PAS protocols.

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The application of antenatal MgSO4 in preterm delivery increased cord blood BDNF levels, which could have a potential role on fetal neuroprotection. Further investigation is needed.

Masalah gizi yang paling umum dialami oleh ibu hamil adalah Kurang Energi Kronis (KEK). Program Pemberian Makanan Tambahan Pemulihan (PMT-P) diadakan untuk mengatasi masalah KEK, faktanya belum memberikan hasil sesuai harapan. Penelitian bertujuan mengetahui perbedaan asupan energi dan protein setelah program PMT-P terhadap keberhasilan perbaikan status gizi ibu hamil. Rancangan penelitian adalah mixed method dengan strategi triangulasi konkuren. Teknik pengambilan sampel penelitian kuantitatif adalah consecutive sampling, dengan responden 47 ibu hamil KEK. Partisipan penelitian kualitatif diambil secara purposive sampling. Analisis data kuantitatif diolah dengan uji Mann-Whitney. Hasil penelitian menunjukkan bahwa program PMT-P pada ibu hamil KEK hanya mampu memperbaiki status gizi menjadi normal sebesar 13%. Asupan energi dan protein ibu hamil KEK setelah program PMT-P mampu mengubah status gizi menjadi normal sebesar 20%. Tidak terdapat perbedaan asupan energi dan protein setelah program PMT-P terhadap status gizi ibu hamil KEK dan normal (p>0,05). Penyebab ibu hamil KEK tidak mengalami perubahan status gizi setelah program PMT-P adalah pola makan, konsumsi makanan, status ekonomi, status kesehatan dan faktor internal yang meliputi pekerjaan dan pengetahuan.Simpulan penelitian ini adalah program PMT-P belum memberikan hasil sesuai harapan, ditandai dengan sedikitnya jumlah ibu hamil KEK yang mengalami perubahan status gizi menjadi normal. Terdapat faktor-faktor lain yang mempengaruhi perbaikan status gizi ibu hamil KEK seperti pola makan, konsumsi makanan, status ekonomi, status kesehatan dan faktor internal yang meliputi pekerjaan dan pengetahuan. Hal yang dilakukan adalah dengan meningkatkan pengetahuan gizi seimbang ibu hamil melalui penyuluhan.

Preeclampsia is the major cause of both maternal and neonatal morbidity and mortality. Its insidence remains high and the management has not been established yet because its etiology and pathophysiological are still poorly understood. Theories regarding etiopathogenesis and management of preeclampsia have been postulated yet it remains controversial. Placental ischemic and angiogenic imbalance are suggested to be predisposing factors of preeclampsia. It is thereby targeted in prevention of preeclampsia. Unfortunately, both primary and secondary prevention using various supplements and drugs fails to exhibit good outcome. Overall, these efforts are considered useless. In recent years, researchers have been using statin derivative in management of preclampsia. It has been reported that statin provides protective effect in endothelial cells by inducing expression of Hmox-1 and inihibiting release of sFlt-1 as well as potent antioxidant properties.Thus, statin has been proposed as promising agent to significantly reduce anti-angiogenic in preeclamptic patients which is overviewed in this review based on recent studies.

Maternal mortality rate in Indonesia is still relatively high. The biggest cause of maternal mortality in Indonesia is bleeding. Most bleeding in the puerperium (75-80%) is uterine atony. Uterine atony is the most frequent cause of the occurrence of bleeding postpartum. This study aimed to analyze the risk factors for uterine atony in Cut Meutia General Hospital and Health Center PONED in North Aceh district. This study uses a case control design, as a case group, maternal postpartum hemorrhage with uterine atony and control group, maternal postpartum hemorrhage without uterine atony. The sample size for each selected group 69 (the number of cases during the period from 2015 to 2017) while the control selected at random with the same number as many as 69 cases. Data analysis using chi square and multiple logistic regression. The results of the research bivariable indicates a meaningful associated with uterine atony is preeclampsia with OR 10,30 (CI 95%: 2,91-36,41), twin pregnancy with OR 17,31 (CI 95%: 2,21-135,76), induction of labor with an OR 4,39 (CI 95%: 1,0-21,45), grande multipara with OR 4,52 (CI 95%: 1,61-12,73) compared with primipara. Multivariable those associated with uterine atony is the age of the mother with OR 2,98 (CI 95%: 0,56-15,82), preeclampsia with OR 20,27 (CI 95%: 4,66-88,20), induction of labor with an OR 6,69 (CI 95%: 1,12-39,95), twin pregnancy with OR 52,39 (CI 95%: 5,65-486,03), anemia with OR 3,06 (CI 95%: 1,07-8,69). This study concluded that parity, preeclampsia, twin pregnancy and labor induction were risk factors for the incidence of uterine atony with twin pregnancy as the most dominant factor in the incidence of uterine atony. Keywords : Risk factors; Uterine Atony.

BackgroundPreeclampsia is a major cause of morbidity and mortality, both maternal and perinatal. The etiology and pathophysiology of preeclampsia remain unknown. Research shows the implantation of the placenta in preeclampsia occurs due to incomplete angiogenic imbalance as one of the preeclampsia pathogenesis. PlGF is angiogenic protein which is synthesized in placenta by mRNA PlGF. When damage occurs, mRNA will be released from cell and form cell-free mRNA. This study aims to analyze the differences between the PlGF mRNA expression in severe preeclampsia and normal pregnancy as well as to measure the relationship between cell-free mRNA and levels of PlGF with the incidence of severe preeclampsia.MethodsThe method used in this study is an observational analytic study with cross-sectional design. Blood samples were obtained from patients with preeclampsia and normal pregnancies as the controlling factors in accordance with inclusion and exclusion criterias. Examination of the PlGF level was measured by ELISA method and mRNA PIGF expression was measured by RT-PCR. Physical and laboratory examinations of patients were recorded and collected as data. Calculations were done by statistical analysis.ResultsMean of the cell-free mRNA PlGF expression level in severe preeclampsia is 2.2983 ng/mL within the scale of 1.96–2.83 ng/mL and deviation standard of 0.1897. Using Pearson Analysis Test, the result shows that there is a positive correlation between cell-free mRNA expression and PlGF protein level in severe preeclampsia, with r = 0.640 dan p < 0.004.ConclusionThere is no difference between expression of cell-free mRNA PlGF in severe preeclampsia serum and normal pregnancy. There is a significant correlation between expression of cell-free mRNA and PlGF protein level in severe preeclampsia.

Background: The neonatal mortality rate is Banjarnegara district is high compared with a target of IMR in Central Java province. In 2012 the neonatal mortality rate in Banjarnegara reached 316 cases, whereas in 2013 there were 115 cases in all health centers working area. The high neonatal mortality rate in Banjarnegara influenced by the persistence of early marriage in woman, birth attendant by non skilled health worker (dukun bayi) and women’s parity more than 4.Objective: The purpose of this study is to analyze the correlation between maternal age, parity and birth attendants with the incidence of neonatal mortality and examine the most dominant factors influencing the incidence neonatal mortality in the Health Center working area in Banjarnegara.Method: This study is a case control study design with retrospective approach. The data consists of perinatal verbal autopsy and medical records as many as 136 respondents consisting of 68 mothers who gave birth to her child and neonatal death and 68 maternal and child alive. Subjects were mothers who gave birth a baby who died aged 0-28 days.Result and Discussion: Statistical analysis using Chi Square, Mann Whitney, and multiple logistic regression. The results showed maternal age and parity variables were not significantly corerelated with neonatal mortality (p> 0.05), the variables significantly corerelated with neonatal mortality was birth attendants with p = 0.001. The results of logistic regression showed the strength of the corerelation from the most dominant variable to the smallest variable were birth attendants with OR: 5.64 (95% CI: 1.81 to 17.4), maternal age OR 3.97 (CI 95%, from 1.54 to 10.22), and parity OR: 0.32 (CI 95% 0.12 to 0.87).Conclusion: In conclusion, there was no relationship between maternal age and parity with neonatal mortality but there was a relationship between birth attendants with neonatal mortality. Based on the results of the multivariable analysis, birth attendants’ effect on the incidence of neonatal deaths was 5 times greater than mother’s age and parity.Keywords: Neonatal mortality, maternal age, parity, birth attendants