Preterm Labor Predictors: Maternal Characteristics, Ultrasound Findings, Biomarker, and Artificial Intelligence

The identification of risk factors for preterm labor is an important predictor. The risk factors for preterm labor can be maternal characteristics, namely maternal obstetric history, maternal body mass index and weight gain, multiple pregnancy, maternal infections, periodontal disease, maternal vitamin D deficiency, and lifestyle. Nowadays, various accurate diagnostic methods have been developed to diagnose preterm labor, namely ultrasound (cervical length, cervical consistency, uterocervical angle, and fetal adrenal gland) and biomarkers (IL-6 and IL-8 in cervicovaginal fluid, Placental Alpha Microglobulin-1 (PAMG-1), and Insulin-Like Growth Factor Binding Protein-1 (IGFBP-1), Vascular Endothelial Growth Factor (VEGF), Placental Growth Factor (PGF), Soluble VEGF Receptor-1 (sFlt-1), High Mobility Group Box-1 (HMGB1), and calponin. Artificial Intelligence was developed to predict preterm labor, namely in the form of ultrasound software which is capable of detecting cervical funneling processes ranging from resembling the T, Y, V, and U-shaped. This software is expected to be easily used by general practitioners and obstetricians and gynecologists, especially those who work in rural areas.

CURRENT UPDATE ON CONGENITAL HEART DISEASE SCREENING IN PREGNANCY

Congenital Heart Disease (CHD) affects 8 births per 1,000 live births; equivalent to 1.35 million children born with CHD each year. Based on global incidence rate, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), and Atrioventricular Septal Defect (AVSD) are found on 54.5% of CHD cases. Genetic factors are known to involve in CHD. Moreover, it can also be caused by environmental and infectious factors. Ultrasonography has been widely utilized to screen CHD at 18-22 weeks gestational age. Screening aims to measure heart rate, heart size, heart position, four chamber of the heart, pericardium, atrium, ventricles, atrioventricular junctions, and ventriculoatrial junctions. Doppler echocardiography becomes primary diagnostic tools in CHD patients because of its high sensitivity and specificity, safety, and noninvasiveness. Follow-up examination is indicated on a few conditions. Maternal indications include autoimmune antibody, family history of defects, in vitro fertilization, maternal metabolic disease, or teratogenic exposure. Fetal indications include abnormal screening result, family history of CHD, abnormal heart rhythm, chromosomal abnormalities, extracardiac abnormalities, hydrops, or monochorionic twin pregnancy. With increased rate of CHD, better screening and follow-up should be conducted to achieve acceptable detection rate

Primigravida Hamil 12 Minggu dengan Atrial Septal Defect Secundum dan Hipertensi Pulmonal Berat Janin Tunggal Hidup Intrauterin

Latar Belakang: Atrial Septal Defect (ASD) apabila disertai hipertensi pulmonal berat harus dikonseling karena tingginya insiden morbiditas dan mortalitas ibu dan janin. Tujuan: Memaparkan sebuah kasus primigravida dengan ASD secundum dan hipertensi pulmonal berat sehingga dapat dilakukan tatalaksana dan pemilihan kontrasepsi yang sesuai.Metode: Laporan kasus seorang wanita berusia 30 tahun, hamil 12 minggu, mengeluh sesak nafas, batuk pada malam hari, dan jantung berdebar-debar. Hasil rontgen thoraks menunjukkan gambaran hipertensi pulmonal disertai peningkatan vaskularisasi paru. Kateterisasi jantung menunjukkan ASD secundum besar, hipertensi pulmonal berat, high flow, high resistance, dan reaktif dengan tes O2. Hasil ekokardiografi (2017) menunjukkan ASD secundum berat, regurgitasi trikuspid dan pulmonal moderat. Ultrasonografi abdomen menunjukkan kesan hamil 12 minggu janin tunggal hidup intrauterin, mioma uteri intramural dan subserosum, perdarahan subamnion dan subkorion. Pada pasien ini, dilakukan abortus provokatus medisinalis melalui pemberian Prostaglandin dilanjutkan dengan dilatasi dan kuretase.Kesimpulan: Kehamilan pada wanita dengan ASD umumnya ditoleransi dengan baik, dengan luaran ibu dan janin yang baik. Pasien dengan penyakit jantung berat sebaiknya tidak hamil dan bila hamil sebaiknya diterminasi. Preparat estrogen merupakan kontraindikasi pada pasien jantung. Pemilihan kontrasepsi harus mempertimbangkan keparahan, tipe anatomis kelainan jantung, dan keinginan ibu untuk mempertahankan fungsi reproduksinya.Kata Kunci: primigravida, ASD secundum, hipertensi pulmonal  AbstractBackground: Atrial Septal Defect (ASD) with severe pulmonary hypertension should be counseled because of the high incidence of maternal and fetal morbidity and mortality. Objective: Describing a case of primigravida with ASD secundum and severe pulmonary hypertension so that appropriate management and contraception can be selected.Method: A 30-year-old woman, 12 weeks pregnant, suffered from shortness of breath, coughing at night, and palpitations. Chest X-ray showed pulmonary hypertension with increased pulmonary vascularity. Cardiac catheterization showed a large ASD secundum, severe pulmonary hypertension, high flow, high resistance, and reactive O2 test. Echocardiography (2017) showed severe ASD secundum, moderate tricuspid, and pulmonary regurgitation. Abdominal ultrasonography showed 12 weeks gestational age single live fetus intrauterine, intramural and subserosal uterine myoma, and also subamniotic and subchorionic bleeding. We did provoked abortion using Prostaglandin continued with dilatation and curettage.Conclusion: Pregnancy in women with ASD is generally well tolerated, with good maternal and fetal outcomes. Patients suffered from severe heart disease should not be pregnant, and if necessary get pregnancy terminated. Estrogen preparations are contraindicated in these patients. The choice of contraception must consider the severity, the anatomy of heart abnormality, and mother's desire to maintain her reproductive function. Key words: primigravida, ASD secundum, pulmonary hypertension

Risk Factors of Postpartum Urinary Retention: Faktor Risiko Retensio Urine Pascasalin

Objective: To determine the correlation between risk factors and the incidence of postpartum urinary retention (PUR) at RSUP Dr. Mohammad Hoesin Palembang. Method: Analytical observational study with cross sectional design to find out the correlation between risk factors and incidence of PUR at emergency room, delivery room and ward at dr. Mohammad Hoesin General Hospital Palembang since October 2018 to April 2019. There were 82 samples that met inclusion criteria. The correlation between risk factors and the incidence of urinary retention was analyzed using Chi Square test/ Fisher Exact test, and the most important risk factor was determined using the Logistic Regression test. Data analysis used SPSS version 22.0. Result: In this study, it was found that there was a significant relationship between prolonged second stage of labor (PR=40.75, p=0.000), type of labor (PR=9.028 CI 95% 2.114–38.558; p=0.004 ) and perineal laceration (PR=12.938 CI95% 1.872–89.414; p=0.016) with PUR. However, there was no significant relationship between age, parity, neonatal birth weight, episiotomy, vulvar edema and urinary retention (p>0.05). It was concluded that instrumental delivery had a significant effect on the incidence of urinary retention (PR=13,541 CI95% 2.381–77.018, p value=0.003) by using logistic regression test.Conclusion: The most important risk factor of urinary retention was instrumental delivery.Keywords:   instrumental delivery, perineal laceration, postpartum urinary retention, type of labor   Abstrak Tujuan: Untuk mengetahui hubungan antara faktor risiko dan kejadian retensio urine pascasalin di RSUP Dr. Mohammad Hoesin Palembang.Metode: Penelitian observasional analitik dengan desain potong lintang untuk mengetahui hubungan antara faktor risiko dan kejadian retensio urine pascasalin di IGD, kamar bersalin dan bangsal perawatan RSUP Dr. Mohammad Hoesin Palembang sejak Oktober 2018 sampai April 2019. Didapatkan 82 sampel yang memenuhi kriteria inklusi. Hubungan antara faktor risiko dan kejadian retensio urine dianalisis menggunakan uji Chi Square/Fisher Exact, sedangkan untuk mengetahui faktor risiko yang paling berperan menggunakan uji regresi logistik. Analisis data menggunakan SPSS versi 22.0.Hasil: Pada penelitian ini, didapatkan hubungan yang signifikan antara lama kala II (PR=40,75, p=0,000), jenis persalinan (PR=9,028 IK95% 2,114–38,558; p=0,004), laserasi perineum (PR=12,938 CI95% 1,872–89,414; p=0,016), dan retensio urine pascasalin. Namun, didapatkan hubungan yang tidak signifikan antara usia, paritas, BBL bayi, episiotomi, edema vulva, dan kejadian retensio urin (p>0,05). Dengan uji regresi logistik, didapatkan kesimpulan bahwa jenis persalinan dengan instrumen berpengaruh secara signifikan terhadap kejadian retensio urine (PR = 13,541 IK95% 2,381–77,018, p value = 0,003).Kesimpulan: Faktor risiko yang paling berperan terhadap kejadian retensio urine pascasalin adalah persalinan dengan instrumen.Kata Kunci: jenis persalinan, instrumen, laserasi perineum, retensio urine pascasali

The Association of Bladder Wall Thickness with Severity of Symptoms in Patients with Overactive Bladder

Objective: To investigate the association of bladder wall thickness (BWT) with severity of symptoms in overactive bladder patients in Obstetrics and Gynecology Department Dr. Mohammad Hoesin general hospital Palembang. Methods: An analytical observational study was conducted at Gynecology clinic Dr. Mohammad Hoesin General Hospital Palembang from November 2015 to August 2016. Data were analyzed with SPSS 16.0 for Windows. Bivariate analysis with the Chi square and association Rank-Spearman test was used to assess the association between BWT and visual analog scale (VAS). Results: Fourty subjects were included in the study. The mean BWT in the overactive bladder group was thicker compared to those without overactive bladder (5.8522 0.5783 vs 5.2176 0.67937). There was significant association between BWT and overactive bladder complaints. Abnormal group (5mm) had 12 times risk of overactive bladder compared to normal sample (5mm) (p = 0.029, RR = 12). Conclusion: Thus, the thickness of the urinary bladder wall measured with ultrasound examination (USG) can be used to assess the status and degree of urinary disorders in women with complaints of painful urinate and urinary disorders.  Keywords: bladder wall thickness, detrusor overactivity, overactive bladder, visual analog scal

The risk of sensorineural hearing impairment in preeclampsia: Risiko Gangguan Pendengaran Sensorineural pada Pasien Preeklamsia

Abstract Objective: To determine the risk of sensorineural hearing impairment in preeclampsia patients and to in Obstetric and Gynecology Department in Dr. Mohammad Hoesin Hospital Palembang. Method: An analytic observational case-control study was held in Dr. Mohammad Hoesin Hospital Palembang from January 1st to December 31st 2016. Subjects were obtained through consecutive sampling. Hypothetical tests used were unpaired t-test, Chi-square test and Fisher test for expected deviation standard <5, significance determined based on p-value if p<0.05. Data progressing and analysis were done using SPSS version 17.0 for windows.  Results: Characteristics distribution of the subjects were overall homogenous. With the Chi-square test, no significant difference was found in hearing function examination with OAE and tympanometry in both groups (p>0.05). From unpaired t-test, there was no significant difference between mean Air Conducting (AC) and Bone Conducting (BC) of the right ear in severe preeclampsia group and healthy pregnancy group (p=0.340), as well as mean AC and BC of the left ear in severe preeclampsia group and healthy pregnancy group (p=0.059). Based on the Fisher's Exact test, no significant relation was found between severe preeclampsia and sensorineural hearing impairment (p=0.999).  Conclusion:There was no significant relation between severe preeclampsia and sensorineural hearing impairment in Obstetric and Gynecology Department in Dr. Mohammad Hoesin Palembang. Keywords: otoacoustic emission, preeclampsia, sensorineural hearing impairment.   Abstrak Tujuan: Mengetahui risiko gangguan pendengaran sensorineural pada pasien dengan preeklamsia di Departemen Obstetri dan Ginekologi RSUP Mohammad Hoesin Palembang. Metode: Penelitian analitik observasional dengan disain kasus kontrol pada wanita hamil di RSMH sejak 1 Januari – 31 Desember 2016. Subjek dipilih secara consecutive sampling. Analisis dengan uji t tak berpasangan, Chi-square, dan uji Fisher untuk ekspektasi sd<5, kemaknaan ditentukan berdasarkan (p) jika p<0.05. Proses mengolah dan analisis data ini dilakukan menggunakan SPSS 17.0 for windows. Hasil: Distribusi karakteristik umum subjek secara keseluruhan adalah homogen. Berdasarkan uji Chi Square, tidak didapatkan perbedaan bermakna hasil pemeriksaan fungsi pendengaran dengan OAE dan Timpanometri pada kedua kelompok (p>0,05). Dengan uji T tidak berpasangan, tidak didapatkan perbedaan bermakna rerata Air Conducting (AC) dan Bone Conducting (BC) telinga kanan kelompok PEB dan kelompok hamil normal (p=0,340), begitu juga dengan rerata Air Conducting (AC) dan Bone Conducting (BC) telinga kiri kelompok PEB dan kelompok hamil normal (p=0,059). Berdasarkan uji statistik Fisher, tidak didapatkan hubungan bermakna antara preeklamsia berat dengan gangguan pendengaran sensorineural (p=0,999). Simpulan:Tidak terdapat hubungan yang bermakna antara preeklamsia berat dengan gangguan pendengaran sensorineural berdasarkan pemeriksaan audiometri di Departemen Obstetrik dan Ginekologi RSUP Dr. Mohammad Hoesin Palembang. Kata kunci: gangguan pendengaran sensorineural, otoacoustic emission, preeklamsi

Maternal Obesity Increases Risk for Adverse Maternal Outcome at RSUP Dr. Mohammad Hoesin Palembang

Objective: To find the relationship between level of obesity and adverse maternal outcomes in pregnant women Method: An observational analytic study with a cross sectional design with secondary data from medical record. Subjects were pregnant women who gave birth at RSUP Dr. Mohammad Hoesin Palembang in January 2015-December 2017. Samples were taken by purposive sampling technique. BMIs  were divided into 5 categories based on WHO criteria, normoweight, overweight, obese level I, II, and III. Underweight was excluded from the study.Result: Of 252 research subjects, 94 (37.3%) were subjects with normal BMI, 102 (40.5%) were overweight, 44 (17.5%) were obese level I, 6 (2.4%) were level II, and 6 (2.4%) were level III. The maternal outcome consisted of 135 cases (53.6%) of preeclampsia, 6 cases of gestational diabetes mellitus (2.4%), 41 cases of uterine inertia (16.3%), 56 cases of preterm labor (22.2%), assisted delivery 111 cases (44%), and healthcare associated infections (HAIs) 6 cases (2.4%). Further analysis showed that increased level of maternal obesity is related significantly with preeclampsia, gestational diabetes mellitus, uterine inertia, and assisted delivery.Conclusion: There are statistically significant association between obesity level and the incidence of preeclamsia, gestational diabetes, uterine inertia and assisted delivery.Obesitas Pada Wanita Hamil Meningkatkan Morbiditas Maternal Di RSUP Dr. Mohammad Hoesin PalembangAbstrakTujuan: Untuk menemukan hubungan antara tingkat obesitas dengan luaran maternal pada wanita hamil. Metode: Studi analitik observasional dengan desain potong lintang menggunakan data sekunder rekam medis. Subjek adalah wanita hamil yang melahirkan di RSUP Dr.Mohammad Hoesin Palembang pada Januari 2015 - Desember 2017. Sampel diambil secara purposive sampling. Indeks massa tubuh (IMT) dibagi menjadi 5 sesuai kriteria WHO, yaitu normal, berat badan lebih, obesitas level I, II, dan III. Berat badan kurang diekslusi dari penelitian. Hasil: Subjek penelitian dari 252 orang, 94 (37.3%) subjek dengan IMT normal, 102 (40.5%) subjek berat badan berlebih,  44 (17.5%) obesitas level I,  6 (2.4%) obesitas level II, dan 6 (2.4%) obesitas level III. Luaran  maternal terdiri dari 135 kasus (53.6%) of preeklampsia, 6 kasus diabetes mellitus gestasional,  41 kasus inertia uteri  (16.3%), 56 kasus persalinan preterm (22.2%), 111 kasus (44%) persalinan pervaginam berbantu, dan infeksi luka 6 kasus (2.4%).  Analisis menunjukkan adanya tingkatan obesitas maternal berkaitan secara signifikan dengan kejadian preeklampsia, diabetes mellitus gestasional, inertia uteri, dan persalinan pervaginam berbantu. Kesimpulan: Terdapat hubungan antara tingkat obesitas pada ibu hamil dengan preeklampsia, diabetes mellitus gestasional, dan persalinan pervaginam berbantu. Kata kunci: Indeks Massa Tubuh, Obesitas, Luaran Maternal, Morbiditas

Different Doses of Intraumbilical Oxytocin on the Third Stage of Labor: Berbagai Dosis Oksitosin Intraumbilikal pada Manajemen Aktif Kala III

  Objective: To compare the dose of oxytocin injected intraumbilicalltowards the duration of the third stage, blood loss volume, hemoglobinand hematocrit.   Methods: This study is a prospective randomised study with acontrol. The control group was given an intramuscular injection of10 IU oxytocin. The intervention of the three groups intraumbilicaloxytocin treatment dose of 10 IU, 20 IU and 30 IU diluted in 50 ml ofnormal saline solution and administered intraumbilically. Thesample selection by purposive sampling and the distribution groupbased on systematic random sampling (10 samples each). Data weretaken from the period April 2016-January 2017 with the inclusionand exclusion criteria. Data were analysed using Chi-square, T-test,ANOVA and Post hoc tests.   Results: Characteristics study for variables of age, occupation,parity, education, episiotomy and neonates weight showed homogeneouscharacteristics. The mean duration of the third stage forall groups was between 366.7  159.0 seconds and 440.1  244.99seconds. While the average number of postpartum haemorrhage forall group 61.894  226.3ml and 309.5  110.26 ml. There were nodifferences in the dose of oxytocin on the duration of the thirdstage (p> 0.05) and the amount of bleeding (p> 0.005). There was adifference of haemoglobin between intervention group of oxytocindose of 10 IU and 30 IU intraumbilical (p = 0.031). There was nodifference between the mean hematocrit levels between the groups(p> 0.005).   Conclusion: There were no differences in the dose of oxytocinintraumbilical towards the duration of the third stage, the amountof bleeding and hematocrit levels. The decrease of haemoglobingreater in 30 IU intraumbilical significantly. Keywords: duration of the third stage, haemoglobin and hematocrit,oxytocin intraumbilical, the amount of bleedin

Oral versus Vaginal Misoprostol for Labour Induction : A Comparative Study

Objective: To compare the efficacy and safety of hourly titrated oral misoprostol in solution (OMS) with vaginal misoprostol (PV) for labor induction. Methods: Randomized Controlled Trial (RCT), double blind-add on the study was conducted from January-November 2016 in delivery ward of Moh. Hoesin general hospital. Women 30 weeks of gestation with an unfavorable cervix (Bishop score ï‚£6) and an indication for labor induction were randomly assigned to receive titrated oral or vaginal misoprostol. The OMS group received a basal unit of 20 ml misoprostol solution (1 ï­g/ml) every 1 hour for four doses and then were titrated against individual uterine response. In the absence of regular uterine contractions, the dose was increased to 40 ml hourly for four doses and then 60 ml for four doses. The vaginal group received 25 ï­g every 4 hours until attaining a more favorable cervix for three doses. All the subjects received amylum placebo. In labor within 12 hours was the primary outcome. Results: A total of 30 women were enrolled in this study. One subject in the OMS group was dropped out due to eclamptic seizure. The average interval from induction until in labour in OMS group was 5.753.14 hour and 6.604.46 hour in PV group (p = 0.56). In labour stage was achieved within 12 hours in 14 women (100%) in OMS group and 14 women (93.3%) in PV group (p = 1.00). Vaginal delivery was achieved within 24 hours in 13 women (92.9%) in OMS group and 15 women (100%) in PV group. The incidence of uterine hyperstimulation/ tachysystolic was 7.1% in OMS group compared with 13.3% in PV group. Fetal distress was found only 1 case (7.1%) in OMS group. There was no difference in the maternal and neonatal outcome of labor in both the groups. Conclusion: Oral titrated in solution, and vaginal route of administration of misoprostol for induction of labour are equally effective and safe. [Indones J Obstet Gynecol 2018; 6-2: 89-97] Keywords: hourly titrated oral misoprostol in solution, oral misoprostol, randomized controlled trial, vaginal misoprosto

THE EVALUATION OF EARLY INITIATION BREASTFEEDING PRACTICE in Dr. mohammad hoesin hospital palembang

Background: Compared to other countries, the rate of EIB in Indonesia remains low (34,5%). During our practice, particulary in delivery room, we often find practices which delayed EIB. The recent finding that early initiation of breastfeeding (EIB) could substantially reduce neonatal mortality should result in more comprehensive efforts to increase the number of infants breast-fed within an hour of birth. Such efforts can only be effective if policies and guidelines are based on a solid knowledge of the barriers and facilitators for EIB. Aims: To evaluate EIB practice in Dr. Moh. Hoesin hospital. Methods: This was an analytic observational study, using cross sectional design. Our populations were all of afterbirth mothers (spontaneous or abdominal delivery), doctors, midwifes, as well as managerial policy holder. Samples were selected by purposive sampling. Data was obtained from the questionnaire which have been tested for validity and reliability. This study included 29 doctors and 14 midwifes as EIB implementers; also 12 managerial staffs. Results: During the periodNovember to December 2016, there were 19 (51.3%) patients with post spontaneous or abdominal deliverypracticed EIB and 18 (48.6%) patients did not practice EIB. Most of patients in “no EIB group” had abdominal delivery (p = 0,003). Most of patients complained that no EIB policy in operating room. Most of implementers stated that EIB already done well. The EIB implementers complained that there was lack of support about EIB practice from hospital manager and maternal level of knowledge was low. Our study found the disintegration between the managerial and executive staff, causing ambiguity in the practice of the EIB. Conclusion: The opportunitiy of EIB practice was affected by medical condition ofmother and fetus,method of delivery, hospital support, EIB policy socialization, and patient’s knowledge. There were so many challenges for our hospital to practice EIB, such as no EIB policy in operating room,the mother's condition wasnot possible to practice EIB, knowledge of the managerial about EIBdiffer greatly, low socialization about regulations and other elements of the EIB implementation. Thereis also disintegration between the managerand executive staff causing ambiguity in the practice ofEIBand the lack of supervision of EIB practice in the field