The Beneficience of Family Social Support Toward Anticipatory Behaviour of Pregnancies Sign\u27s Alert in Primigravida

Introduction: Complication in pregnancy can be endangering both mother and fetus. Pregnant woman and her family must be able to recognize risk factors of the complication. Family support make pregnant woman feel more confident, happy and ready to face her pregnancy. The aimed of this study was to learn the influences of social family support toward anticipatory behavior of pregnancies sign\u27s alert in primigravida. Method: A quasy experimental purposive sampling design was used in this study. There were 20 respondents who met the inclusion criteria. They were divided into 2 groups, intervention and control groups, each comprising 10 respondents. The independent variable in this study was social family support and the dependent variable was the anticipatory behavior of pregnancies sign\u27s alert in primigravida. Data were collected by using questionnaire, observation and structured interview and then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that the social family support influencing the knowledge of pregnant woman with significant level p=0.011, social family support also influencing the attitude of pregnant woman with significant level p=0.008 and the action of pregnant woman p=0.017. There were difference knowledge, attitude and action between intervention and control groups after treatment with significant level p=0.000 for knowledge, p=0.015 for attitude and p=0.002 for action. Discussion: It can be concluded that social family support influence anticipatory behavior (knowledge, attitude and action) of pregnancies sign\u27s alert in primigravida. Further studies should be concern to the other factors that influencing the anticipatory behavior of pregnancies sign\u27s alert in primigravida, both of internal and external factors

Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence

BACKGROUND Prenatal ultrasound discrimination between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta is challenging both prenatally and intraoperatively, which often leads to overtreatment. In addition, accurate prenatal prediction of surgical difficulty and morbidity in placenta accreta spectrum is difficult, which precludes appropriate multidisciplinary planning. The advent of advanced 3-dimensional volume rendering and contrast enhancement techniques in modern ultrasound systems provides a comprehensive prenatal assessment, revealing details that are not discernible in traditional 2-dimensional imaging. OBJECTIVE This study aimed to evaluate the use of 3-dimensional volume rendering ultrasound techniques in determining the severity of placenta accreta spectrum and distinguishing between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta. STUDY DESIGN A prospective, cohort study was conducted between July 2022 and July 2023 in the fetal medicine unit of Dr Soetomo Academic General Hospital, Surabaya, Indonesia. All pregnant individuals with anterior low-lying placenta or placenta previa with a previous caesarean section who were referred with suspicion of placenta accreta spectrum were consented and screened using the standardised 2-dimensional and Doppler ultrasound imaging. Additional 3-dimensional volumes were obtained from the sagittal section of the uterus with a filled urinary bladder. These were analyzed by rotating the region of interest to be perpendicular to the uterovesical interface. The primary outcomes were the clinical and histologic severity in the cases of placenta accreta spectrum and correct diagnosis of dehiscence with nonadherent placenta underneath. The strength of association between ultrasound and clinical outcomes was determined. Multivariate logistic regression analyses and diagnostic testing of accuracy were used to analyze the data. RESULTS A total of 70 patients (56 with placenta accreta spectrum and 14 with scar dehiscence) were included in the analysis. Multivariate logistic regression of all 2-dimensional and 3-dimensional signs revealed the 3-dimensional loss of clear zone (P<.001) and the presence of bridging vessels on 2-dimensional Doppler ultrasound (P=.027) as excellent predictors in differentiating scar dehiscence and placenta accreta spectrum. The 3-dimensional loss of clear zone demonstrated a high diagnostic accuracy with an area under the curve of 0.911 (95% confidence interval, 0.819–1.002), with a sensitivity of 89.3% (95% confidence interval, 78.1–95.97%) and specificity of 92.9% (95% confidence interval, 66.1–99.8%). The presence of bridging vessels on 2-dimensional Doppler demonstrated an area under the curve of 0.848 (95% confidence interval, 0.714–0.982) with a sensitivity of 91.1% (95% confidence interval, 80.4–97.0%) and specificity of 78.6% (95% confidence interval, 49.2–95.3%). A subgroup analysis among the placenta accreta spectrum group revealed that the presence of a 3-dimensional disrupted bladder serosa with obliteration of the vesicouterine space was associated with vesicouterine adherence (P<.001)

Decidual killer immunoglobulin-like receptor (kir)2dl1 expression and the onset of preeclampsia, birth weight and placental weight in early and late onset preeclampsia

Introduction Successful remodelling of spiral artery ensures adequate uteroplacental perfusion and sufficient nutrient supply to the fetus. HLA-C interaction with maternal KIR determines the outcome of spiral artery remodelling. Strong inhibitory KIR2DL1 lower the expression of cytokines and angiogenic factors affecting uteroplacental perfusion and nutrient supply. Material and methods We analysed the decidual expression of KIR2DL1 in early and late preeclampsia groups by quantitative immunohistochemistry using anti human-KIR2DL1/CD158a antibody and its correlation with preeclampsia onset, birth weight and placental weight. 35 patients, 14 patients with early onset preeclampsia (EO-PE) and 21 with late preeclampsia (LO-PE) were analysed. Result There was a significant difference between the expression of KIR2DL1 between the EO-PE and LO-PE group (p < 0,001) with a strong negative correlation between decidual expression of KIR2DL1 and preeclampsia onset (p < 0,001, r = −0,723), birth weight (p < 0,001, r = −0,770) and placental weight (p < 0,001, r = −0,770). Conclusion In patients with EO-PE, the higher placental of KIR2DL1 and inhibitory KIR2DL1 contributes to earlier onset of preeclampsia, lower birth weight of the baby and low placental weight. The strong negative correlation might be due to much lower expression of cytokines and angiogenic factors in higher KIR2DL1 expression samples. The different expression of KIR2DL1 between EO-PE and LO-PE is in line with current concepts on different pathophysiologic pathway leading to these different PE phenotypes

Decidual killer immunoglobulin-like receptor (kir)2dl1 expression and the onset of preeclampsia, birth weight and placental weight in early and late onset preeclampsia

Introduction Successful remodelling of spiral artery ensures adequate uteroplacental perfusion and sufficient nutrient supply to the fetus. HLA-C interaction with maternal KIR determines the outcome of spiral artery remodelling. Strong inhibitory KIR2DL1 lower the expression of cytokines and angiogenic factors affecting uteroplacental perfusion and nutrient supply. Material and methods We analysed the decidual expression of KIR2DL1 in early and late preeclampsia groups by quantitative immunohistochemistry using anti human-KIR2DL1/CD158a antibody and its correlation with preeclampsia onset, birth weight and placental weight. 35 patients, 14 patients with early onset preeclampsia (EO-PE) and 21 with late preeclampsia (LO-PE) were analysed. Result There was a significant difference between the expression of KIR2DL1 between the EO-PE and LO-PE group (p < 0,001) with a strong negative correlation between decidual expression of KIR2DL1 and preeclampsia onset (p < 0,001, r = −0,723), birth weight (p < 0,001, r = −0,770) and placental weight (p < 0,001, r = −0,770). Conclusion In patients with EO-PE, the higher placental of KIR2DL1 and inhibitory KIR2DL1 contributes to earlier onset of preeclampsia, lower birth weight of the baby and low placental weight. The strong negative correlation might be due to much lower expression of cytokines and angiogenic factors in higher KIR2DL1 expression samples. The different expression of KIR2DL1 between EO-PE and LO-PE is in line with current concepts on different pathophysiologic pathway leading to these different PE phenotypes

Serial case reports: Pregnancy with Lucio’s phenomenon of leprosy in dr. Soetomo hospital, Surabaya

Leprosy is a complex disease which will affect in many aspects of the patient. In dr. Soetomo hospital, there were two cases of pregnancy with leprosy and Lucio’s phenomenon from 2014 until 2018. Both had been receiving multidrug therapy (MDT) before pregnancy but stopped due to lack of compliance. First case was resulted with term. Second case was admitted with worse condition than the first case, fetal growth restriction and ended with preterm delivery probably because the severity of the case. Lucio’s phenomenon incidence is increased in pregnancy due to immunodeficient condition. This serial case report shows that the initial diagnosis and optimum treatment of leprosy is very important especially in women of child-bearing age

The Quality of Antenatal Care Based on Index Satisfaction of Pregnant Women

Background: Quality antenatal care in the MCH program is considered to be one of the effective efforts to reduce maternal and child morbidity and mortality. An indicator of the success of ANC services can be seen from the output produced, namely in the form of K4 coverage. According to Kotler there are 5 (five) determinants of service quality that can be used as a basis for assessing the level of customer satisfaction with the quality of service received including Tangibles, Reliability, Responsiveness, Assurance and Empathy. Method: This research method is quantitative descriptive with survey approach. The total sample of 149 pregnant women with total sampling techniques. The instrument used was a questionnaire. Data analysis uses univariate analysis. Results: The most valued statements both from each dimension namely; tangible: Midwife performance reliability: recording in the MCH handbook, responsiveness: responses to complaints, assurance: the nature of the Midwife, empathy of communication between midwives and patients. The most valued statements are enough from each dimension namely; tangible: examination room, reliability: service procedures, responsieness: midwife response to patients waiting for long queues, assurance: guarantee to service, empathy: suitability of waiting time and duration of service. Conclusion: The data shows that the majority of respondents considered the quality of antenatal services at the Tambakrejo Public Health Center to be good but still needed to be improved so that the assessment was sufficiently good

Faktor yang Berhubungan dengan Kejadian Persalinan Prematur di RSUD Dr Soetomo

Latar Belakang: Secara global, persalinan preterm menjadi penyebab utama kematian neonatus usia dini 0-7 hari pertama kehidupan dengan menimbulkan dampak morbiditas yang tinggi juga. Indonesia menempati urutan negara ke 5 estimasi persalinan preterm tertinggi di dunia. Beberapa faktor yang dapat berpengaruh terhadap persalinan preterm yaitu idiopatik, iatrogenik, sosio-demografi, maternal dan genetik. Penelitian ini bertujuan untuk melihat hubungan antara usia ibu, pendidikan ibu, pekerjaan ibu dan riwayat persalinan preterm terhadap kejadian persalinan prterm di RSUD Dr. Soetomo Surabaya. Metode: Metode penelitian ini adalah analitik observasional dengan rancang bangun case control. Jumlah populasi sebanyak 1311 orang pada periode 1 Januari - 31 Desember 2018. Sampel dibagi dalam dua kelompok yaitu kelompok kasus (ibu yang bersalin preterm) dan kelompok kontrol (ibu yang bersalin tidak preterm) sebanyak masing-masing kelompok 137 orang yang disesuaikan dengan kriteria inklusi dan eksklusi dan berdasarkan teknik pengambilan sampel yaitu simpel random sampling. Variabel independen terdiri dari usia ibu, pendidikan, pekerjaan dan riwayat persalinan preterm sedangkan variabel dependen adalah persalinan preterm. Analisis data bivariat menggunankan uji Chi-Square test dengan taraf signifikansi α = 0,05 (95% CI). Hasil: Hasil uji Chi-Square menunjukkan bahwa tidak ada hubungan bermakna antara usia ibu bersalin (nilai p = 0,259), pendidikan (nilai p = 1), pekerjaan (nilai p = 0,225) dan riwayat persalinan preterm (nilai p = 0,191) dengan kejadian persalinan preterm. Kesimpulan: Faktor risiko seperti usa ibu bersalin, pendidikan ibu, pekerjaan ibu dan riwayat persalinan preterm tidak memiliki hubungan terhadap kejadian persalinan preterm. Abtract Background : Globally, preterm labor is the main cause of neonatal mortality in the first 0-7 days of life with a high impact of morbidity. Indonesia ranks 5th in the highest estimate of preterm labor in the world. Several factors that can influence preterm labor are idiopathic, iatrogenic, socio-demographic, maternal and genetic. This study aims to look at the relationship between maternal age, maternal education, maternal occupation and a history of preterm labor against the incidence of prenatal labor in RSUD Dr. Soetomo Surabaya. Method : The method of this study is observational analytic with a case-control design. The total population is 1311 people in the period January 1 - December 31, 2018. Samples were divided into two groups, namely the case group (preterm maternity) and the control group (mothers who were not preterm) as many as 137 groups each according to the inclusion criteria and exclusion and based on sampling techniques, namely simple random sampling. Independent variables consisted of maternal age, education, occupation and a history of preterm labor while the dependent variable was preterm labor. Bivariate data analysis used the Chi-Square test with a significance level of α = 0.05 (95% CI). Results : The Chi-Square test results showed that there was no significant relationship between maternal age (p = 0.259), education (p = 1), employment (p = 0.225) and preterm labor history (p = 0.191) with the incidence of preterm labor. Conclusion: Risk factors such as maternal age, maternal education, maternal occupation and a history of preterm labor have no relationship to the incidence of preterm labor

Risk Factors Associated With the Case Fatality Rate of Pulmonary Tuberculosis in Pregnancy: A Five-Year Retrospective Study From a Developing Country

Abstract Background Tuberculosis is a leading cause of maternal and fetal mortality in women of reproductive age. Tuberculosis is frequently misdiagnosed and treated inadequately during pregnancy. Although the global case fatality rate of tuberculosis is decreasing annually, the trend of tuberculosis mortality in Indonesia remains relatively high. Most tuberculosis reports do not include pregnancy status because most countries do not routinely screen for tuberculosis in pregnant women and do not report pregnancy status in female cases. In Southeast Asia, there is currently insufficient data regarding the risk factors associated with maternal mortality due to tuberculosis. This study aimed to identify the risk factors associated with tuberculosis-related mortality during pregnancy. Methodology This retrospective study was conducted at Dr. Soetomo General Hospital, Surabaya. Data were collected from patients’ medical records. The samples were all pulmonary tuberculosis cases in pregnancy (suspected, bacteriological, and radiologically confirmed cases) from 2014 to 2018. Data on maternal characteristics, underlying risk factors, and maternal outcomes in pregnant women with tuberculosis were collected from medical records. A total of 77 cases of pulmonary tuberculosis in pregnancy were obtained and analyzed using the chi-square test for differences between pregnant women with tuberculosis who survived and those who did not. Results In total, 77 cases of pulmonary tuberculosis out of 7,242 deliveries were found during the past five years (incidence per year was 1.07), of whom 20.8% (16/77) died. Eight patients died before the gestational age reached 28 weeks. Most of the non-surviving women were aged <35 years (93.8%; 15/16). More than 30% (5/16) of the patients had human immunodeficiency virus co-infection, and the highest risk factors were pneumonia and miliary tuberculosis. Miliary tuberculosis was significantly associated with maternal mortality in pulmonary tuberculosis (p = 0.004) with a relative risk of 3.43. Conclusions According to the findings of this study, miliary tuberculosis is a significant risk factor for maternal mortality during pregnancy