The Role of Iron Adequacy for Maternal and Fetal Health

Nearly half of pregnant women in the world are reported to suffer anemia. And most of them are caused by iron deficiency, while the others by folate, vitamin B12 or vitamin A deficiency, chronic inflammation, parasite infections and hereditary disorders. Anemia in pregnant women is characterized when < 11 g / dL or any time during pregnancy. And when followed by low iron, it's called iron deficiency anemia. Iron plays an important role in many metabolic processes by transporting oxygen and allowing cells to generate energy. Low iron levels during pregnancy leading to anemia, related to an heightened risk of mother and fetus disease. Iron deficiency anemia can affect fetal development and persist long-term, while mild and serious pregnancy anemia can lead to premature birth, maternal and child mortality, bleeding, and infectious disease. The iron requirement during pregnancy exceeds 1000 mg for red cell expansion, 300 mg – 350 mg for developing fetus and placenta, and 250 mg for variable blood loss at delivery. Iron adequacy during pregnancy can be assured by proper nutrition, iron supplementation and fortification, and intravenous iron or blood transfusion. Iron supplementation is only enough to cover the prenatal iron requirements. Summary: Iron deficiency leading to anemia, rising risk of negative pregnancy outcomes. To meet increasing iron requirements during pregnancy including iron supplementation, fortification of staple iron foods, and intravenous iron or blood transfusion if required

Hubungan Antara Pemakaian Alat Kontrasepsi Dalam Rahim Dengan Kejadian Kandidiasis Vulvovaginalis Di Rsud Dr. Moewardi

Latar Belakang: Kandidiasis vulvovaginalis (KVV) adalah infeksi jamur pada saluran kelamin, vulva, dan vagina pada perempuan yang disebabkan oleh spesies Candida. Beberapa penelitian melaporkan bahwa AKDR dapat berperan penting dalam menyebabkan KVV. Tujuan: Penelitian ini bertujuan untuk mempelajari dan menganalisis hubungan antara pemakaian alat kontrasepsi dalam rahim dengan kejadian kandidiasis vulvovaginalis. Metode: Desain penelitian yang digunakan adalah metode observasional dengan rancangan penelitian cross sectional. Besar sampel 92 pasien. Sampel yang digunakan adalah pasien dengan umur 18-60 tahun yang menderita leukorea di RSUD Dr. Moewardi Surakarta. Pengambilan sampel menggunakan teknik purposive sampling. Hubungan antara pemakaian AKDR dengan kejadian kandidiasis vulvovaginalis ini dianalisis menggunakan Chi-Square dengan menggunakan program SPSS versi 21.0 for windows. Hasil: Terdapat hubungan yang signifikan secara statistik pasien yang menggunakan AKDR dan mengalami KVV berjumlah 43 orang (46,7%) dan yang tidak mengalami KVV berjumlah 12 orang (13,1%). Sedangkan pasien yang tidak menggunakan AKDR dan mengalami KVV berjumlah 21 orang (22,8%) dan yang tidak menderita KVV berjumlah 16 orang (17,4%). Hasil uji hipotesis Chi-square didapatkan significancy 0,029 dimana p < 0,05. Kesimpulan: Terdapat hubungan antara pemakaian alat kontrasepsi dalam rahim dengan kejadian kandidiasis vulovaginalis di RSUD Dr. Moewardi Surakarta yang signifikan secara statistik

Blood Transfusion in Obstetric Cases: Transfusi Darah pada Kasus Obstetri

Objective: To discuss about blood loss in an obstetric setting, the role of blood transfusion, and patient blood management.Methods: Literature review.Results: Severe anaemia with hemoglobin level less than 7 g/dL or late gestation (more than 34 weeks) and/ or significant symptoms of anaemia, the recommendation is giving only single unit transfusion followed by clinical reassessment for further transfusion. In postpartum hemorrhage (PPH), massive transfusion protocols are commonly used description as large volume of blood products over a brief period to a patient with uncontrolled or severe hemorrhage, transfusion more than 10 RBC units within 24 hours, transfusion more than 4 RBC units in 1 hour with anticipation of continued need for blood, replacement of more than 50% of total blood volume by blood products within 3 hours. All obstetric units have a clear-cut massive transfusion protocol for the initial management of life-threatening PPH, considering early transfusion therapy with RBCs and FFP.Conclusion: Patient blood management aims to maintain hemoglobin concentration, optimize haemostasis, and minimize blood loss in effort to improve patient outcomes. Massive transfusion protocol in management of life-threatening should depend on each obstetric unit.Keywords: blood transfusion, obstetric cases, patient blood management. &nbsp; Abstrak Tujuan: Untuk mendiskusikan tentang hilang darah dalam obstetric, peran transfusi darah, dan patient blood management.Metode: Kajian pustaka.Hasil: Anemia berat dengan nilai hemoglobin kurang dari 7 g/dL atau kehamilan lanjut (lebih dari 34 minggu) dan/ atau gejala nyata anemia, rekomendasi ialah memberikan satu unit transfusi diikuti dengan penilainan klinis untuk transfusi lebih lanjut. Pada perdarahan postpartum, protokol transfusi massif umum digambarkan sebagai volume darah yang dibutuhkan jumlah banyak dalam periode singkat, transfusi lebih dari 10 sel darah merah dalam 24 jam atau lebih dari 1 jam, penggantian lebih dari 50% total volume darah dalam 3 jam. Seluruh unit obstetric memiliki protokol transfusi massif yang jelas untuk taalaksana awal perdarahan postpartum dengan mempertimbangkan transfusi awal untuk komponen sel darah merah dan FFP.Kesimpulan: Patient blood management bertujuan untuk menjaga konsentrasi hemoglobin, optimalisasi hemostasis, dan minimalisasi hilang darah untuk meningkatkan luaran pasien. Protokol transfusi masfi dalam tatalaksana yang mengancam nyawa sangat bergantung pada setiap unit obstetrik.Kata kunci: kasus obstetri, patient blood management, transfusi darah &nbsp

Rising trends and indication of Caesarean section in Indonesia

The rate of Caesarean delivery is rising dramatically worldwide, and also nationally. The number of Caesarean births exceeds the WHO recommended rate. This study aims to provide an overview of current increasing trend of Caesarean section, including elective procedure, and its risk. A review was conducted using online database, surveillance reports, and national surveys to identify studies with topics of prevalence, trend, indications, and risks of Caesarean delivery. Overall, there is an increase of Caesarean section in global, Asia, and Indonesia setting. We found an increase of 8% from 2013 to 2018 based on population survey, and increase of elective Caesarean surgery, particularly in tertiary care. We listed the possible health risks in short term, long term among mothers and child. Advanced maternal age, higher socio-economic status, higher educational level, residing in urban area, and ownership of health insurance were found to be factors associated with maternal choice on Caesarean delivery. The information presented is important to raise awareness among policy makers aimed to develop a national strategy in reducing the rate of Caesarean delivery

Vitamin D Supplementation to Reduce the Risk of Preeclampsia: Is It True?

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Preterm Delivery and the Psychological Burden on Parents

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Zinc Deficiency Among Lactating Mothers in Jakarta : Associated Factors

Background and Objectives : Deficiency of zinc is prevalent worldwide mostly in developing countries. However, its prevalence among vulnerable group such as lactating mothers is still unknown in most populations. This study aimed to determine the prevalence of zinc deficiency among lactating mothers in Jakarta and factors that influence it.Methods :A cross sectional study was conducted in Puskesmas Kecamatan Grogol Petamburan, West Jakarta and Puskesmas Kecamatan Cilincing, North Jakarta between February and April 2019. A total of 75 lactating mothers at 3–6 months postpartum, aged 20–40 years old were recruited using consecutive sampling method. Subjects were interviewed for education levels, occupation, physical activity, types of breastfeeding (exclusive or not), and numbers of parity. Dietary assessment of zinc and protein was carried using semi quantitative food frequency questionnaire (FFQ). Weight and height were measured to assess the body mass index (BMI). Blood samples were taken to analyze serum zinc concentrations. Descriptive analysis, one way ANOVA, and unpaired t-test were used, p-values ≤0.05 were considered significant.Results :The mean of serum zinc was 62.33 ± 11.89 and zinc deficiency was found in 76% of the subjects. There were no significant differences of serum zinc related to education levels, occupation, types of breastfeeding, numbers of parity, zinc intakes, protein intakes, and categories of BMI. Significant difference of serum zinc was found between levels of daily physical activity (p = 0.008) – light, moderate, and vigorous.    Conclusion :Zinc deficiency was prevalent among lactating mothers in Jakarta. There was a significant difference of serum zinc between different levels of daily physical activity

IS SERUM ZINC LEVEL CORRELATED WITH INSULIN RESISTANCE AMONG LACTATING MOTHERS IN JAKARTA?

Introduction: Insulin resistance is a condition that underlies the development of diabetes mellitus. The prevalence of diabetes mellitus keeps rising, including in Indonesia. A higher proportion of diabetes was found in women. Physiological changes during pregnancy can cause insulin resistance that may persist until postpartum period. Lactation and nutrient like zinc may improve insulin resistance. This study aimed to measure the correlation between zinc serum level and insulin resistance of lactating mothers in Jakarta.Methods: This study used cross-sectional design, was conducted in Puskesmas Kecamatan Grogol Petamburan, West Jakarta and Puskesmas Kecamatan Cilincing, North Jakarta from February to April 2019. A total of 75 lactating mothers at 3–6 months postpartum were selected using consecutive sampling method. Zinc serum was analyzed using atomic absorption spectrophotometry (AAS) method. Insulin resistance was assessed using the homeostasis model assessment-insulin resistance (HOMA-IR).Results: Approximately 76% (n = 57) subjects had low serum zinc level. Spearman correlation test between serum zinc level and HOMA-IR was done (r = 0.003, p = 0.977). Also, correlation test between BMI and HOMA-IR (r = 0.563, p &lt;0.001).Conclusion: No correlation was found between serum zinc level and HOMA-IR however, there was a significant moderate positive correlation between BMI and HOMA-IR.Keywords: Lactation, zinc, insulin resistance, HOMA-IR, BM

Penerokaan Terhadap Pendekatan Ibn Qayyim Al-Jauziyah Bagi Pesakit Kecelaruan Stres Pasca-Trauma Dalam Mencapai Kebahagiaan [An Exploration Of Ibn Qayyim Al-Jauziyah's Approach For Post-Traumatic Stress Disorder Patients In Achieving Happiness]

Dewasa kini, dapat kita lihat berlakunya peningkatan masalah kesihatan mental dalam kalangan rakyat Malaysia. Terdapat pelbagai faktor yang menyumbang kepada peningkatan masalah ini. Ia termasuklah kesan pandemik COVID-19 dan situasi bencana alam yang luar bisa dan berlaku dengan lebih kerap kebelakangan ini. Situasi yang berlaku ini semestinya mengundang trauma kepada yang mengalaminya. Justeru, kajian ini dijalankan untuk meneroka pendekatan Ibn Qayyim al-Jauziyah bagi pesakit kecelaruan stres pasca-trauma dalam mencapai kebahagiaan. Kajian ini merupakan kajian kualitatif&nbsp; menggunakan kaedah kajian kepustakaan. Data yang diperolehi telah dianalisis melalui kaedah analisis kandungan. Berdasarkan pendekatan Ibn Qayyim al-Jauziyah, terdapat lima kaedah yang boleh diaplikasikan oleh pesakit kecelaruan stres pasca-trauma dalam mencapai kebahagiaan iaitu pembersihan hati dan jiwa, kekuatan iman dan kematangan ilmu, bersyukur ketika diberi nikmat, bersabar ketika ditimpa musibah dan memohon keampunan ketika telah terjerumus dalam dosa. Konklusinya, dapatan kajian ini dipercayai dapat menyumbang kepada peningkatan tahap kesedaran badan-badan bertanggungjawab dalam mengaplikasikan elemen-elemen kebahagian melalui pendekatan Ibn Qayyim Al-Jauziyah ini dalam membantu mengurangkan statistik masalah kesihatan mental di Malaysia. Nowadays, there is an increase in mental health problems among Malaysians. There are various factors that contribute to the increased number of this health problem. It includes the effects of the COVID-19 pandemic and the extraordinary natural disaster situations that have occurred more frequent recently. These situations invite trauma to those who experience it. Thus, this study was conducted to explore Ibn Qayyim al-Jauziyah's approach for post-traumatic stress disorder patients in achieving happiness. This is a qualitative study using the library research method. The data obtained was analyzed through the content analysis. Based on Ibn Qayyim al-Jauziyah's approach, there are five method that can be applied by post-traumatic stress disorder patient&nbsp; to achieve happiness, which are the purification of the heart and soul, the strength of faith and the maturity of knowledge, gratitude when given blessings, patience when misfortune strikes and asking for forgiveness when one has fallen into sin. In conclusion, the findings of this study contributes to the awareness enhancement of responsible bodies in applying the elements of happiness through Ibn Qayyim Al-Jauziyah's approach in helping community to reduce the statistics of mental health problems in Malaysia

Can we predict birth asphyxia of neonates born from PPROM women?

Background: To develop a simple and accurate method of predicting birth asphyxia of neonates born from preterm premature rupture of membranes (PPROM) women utilizing clinical parameters that are generally available before delivery in the practical setting.Methods: A retrospective cohort was conducted at single tertiary hospital in Jakarta between January and December 2013. Subjects were PPROM women with singleton live pregnancy who had their delivery on 24 to 34 weeks of gestational age (GA). Primary outcome was birth asphyxia defined by 5th minutes APGAR score 12,450/mm3 (OR=3.6, 95%CI 1.11-11.63), (Final AUC=0.82 (95%CI 0.74-0.89). Clinical chorioamnitis, severe preeclampsia, mode of delivery, PPROM-admission duration was not associated with birth asphyxia.Conclusions: A prediction model to predict BA among PPROM women at 24-34 weeks GA was developed consisted of GA at PPROM and maternal leukocyte counts at patient’s admission