The Role of Intrapartum Ultrasound to Predict Outcome of Delivery: Penggunaan Ultrasonografi Intrapartum untuk Memprediksi Luaran Persalinan

Objective: To predict outcome of delivery by using ultrasound measurements consisting  angle of progression, and head perineum distance.Methods: Sixtytwo parturients assigned in cohort prospective study. Ultrasound examination begin with identifying the cephalic position by placement of transducer on suprapubic region. The angle of progression is obtained trans-labially, head perineum distance and cervical dilation trans-perineally. Ultrasound findings of Nuchal cord, caput, moulding, occiput posterior position then compared with conventional findings. Labour is observed, outcomes are grouped into vaginal delivery and cesarean section.Results: Thirty-six women went for vaginal delivery, 26 underwent cesarean section. Independent T-test showed significant differences of the angle of progression (121.11o vs 88.85o) and head perineum distance (5.15 cm vs 7.26 cm) between the two groups. Linear regression test found a negative correlation on how the angle of progression affecting head perineum distance p-value <0.05 , R2 0.684, (r) – 0.827. Cervical dilation measurements both ultrasound and digital examination were assessed with the Bland-Altman reliability test with level of agreement (-1.0 cm) – (1.2 cm). Receiver Operating Characteristic curve showed cut-off value >101o angle of progression predicts vaginal delivery, area under curve 0.902 and positive likelihood ratio 4.4. Kappa reliability testing for nuchal cord, caput, moulding, and occiput posterior are 0.919, 0.938, 0.384, 0.681 respectively.Conclusion: Intrapartum ultrasound able to predict the outcome of delivery, digital examination of cervical dilation is the mainstay of measurement. Ultrasound able to rule out the presence of nuchal cord, caput, and occiput posterior.        Keywords: angle of progression, head perineum distance, intrapartum ultrasound.   Abstrak Tujuan: Mengetahui besar sudut penurunan kepala dan jarak kepala ke perineum dengan ultrasonografi intrapartum dalam memprediksi luaran persalinan. Metode: Enam puluh dua  ibu bersalin dilakukan pemeriksaan ultrasonografi intrapartum. Identifikasi posisi kepala dengan meletakan transduser di suprapubik, sudut penurunan kepala secara translabial, jarak kepala ke perineum dan nilai dilatasi serviks secara transperineal. Lilitan tali pusat, kaput, molase, dan oksiput posterior pada temuan ulstrasonografi dibandingkan dengan hasil pemeriksaan konvensional. Observasi persalinan dilakukan, di kelompokan untuk persalinan pervaginam dan seksio sesarea.Hasil: Didapatkan 36 persalinan pervaginam dan 26 seksio sesarea. Uji – t secara signifikan berbeda, nilai sudut penurunan kepala (121,11o vs 88,85o), jarak kepala ke perineum (5,15 cm vs 7,26 cm) pada kedua kelompok. Uji regresi linier sudut penurunan kepala dan pengaruhnya terhadap jarak kepala ke perineum berkorelasi negatif p <0.05, R2 0.684, (r) – 0.827. Batas kesepakatan nilai dilatasi serviks kedua metode diuji dengan uji reliabilitas Bland-Altman dengan batas kesepakatan sebesar (-1.0) cm – (1.2) cm. Sudut penurunan kepala memprediksi persalinan pervaginam sebesar  >101o, uji diagnostik dengan kurva Receiver Operating Characteristic didapatkan area dibawah kurva 0.902, rasio kemungkinan positif 4,4. Uji reliabilitas Kappa lilitan tali pusat, kaput ,molase, dan oksiput posterior berturut-turut (k) = 0.919, 0.938, 0.384, dan 0.681.    Kesimpulan: Penggunaan ultrasonografi intrapartum dapat memprediksi luaran persalinan, pemriksaan dalam tetap menjadi pemeriksaan utama dalam menilai dilatasi serviks, ultrasnografi mampu mendeteksi lilitan tali pusat, kaput, dan posisi oksiput posterior.Kata kunci: Jarak kepala ke perineum, sudut penurunan kepala, Ultrasonografi intrapartum

KARAKTERISTIK FAKTOR RISIKO ANEMIA DEFISIENSI BESI DALAM KEHAMILAN

The prevalence of maternal anemia during pregnancy in Indonesia keeps rising thus causing issues and complications on pregnancy. Several risk factors have been associated with anemia in pregnancy. This research aims to identify the risks associated with anemia occurrence during pregnancy. This study is cohort retrospective design performed on pregnant women (n=56) who are eligible based on the inclusion criteria. Study samples are recruited at South Manggarai Primary Public Health Facility during the period of January 2018-March 2019. Samples consisting of healthy pregnant women (n=28) and those who are anemic (n=28). Several risk factors then analyzed and associated with maternal anemia, these are maternal age, pre-pregnancy BMI (Body Mass Index), the timing of iron supplementation, parity, level of education, and gestational age when anemia first had been detected. Pregnant women whose BMI are underweight (RR 2.3 95% CI, p< 0.002), multiparous women (RR 1.3 95% CI, p<0.007), and third trimester pregnancy (RR 1.6 95% CI, p<0.03) increased in risk of developing anemia in pregnancy. Starting iron supplementation from the first trimester reduces the risk of developing anemia (RR 0.4 95% CI, p< 0.006) and statistic significance is shown (p-value <0.05). Although considered as not statistic significant, low-level education (RR 2,1 95% CI), and minimal gestational weight gain (RR 1.4 95% CI) show to increase risk of developing anemia in pregnancy. Pre-pregnancy BMI, timing of iron supplementation, parity, and gestational age are associated with iron deficiency anemia in pregnancy

Fertilization and Embryogenesis Success Rates in Morula IVF on Normo-Responder Group

A couple with infertility is a couple who fails to achieve pregnancy after 12 months or more after regular sexual intercourse without using contraception. Infertility can be caused by a male factor or a female factor. In-vitro fertilization (IVF) is one of the assisted reproductive technology (ART) for a couple with infertility. IVF has a high rate for a woman to achieve a pregnancy. Its procedure is the fertilization of sperm and oocyte by intracytoplasmic sperm injection (ICSI), or conventional IVF.this study aims to determine the success rate of fertilization and embryogenesis based on sperm characteristics in IVF patients in Morula IVF Jakarta period January – December 2018. The results of this study were analyzed bivariate based on sperm morphology, motility, and concentration. Based on the analysis that has been carried out, it was found that there was no significant relationship between the success rate of fertilization and sperm characteristics, with a p-value <0.050. Keywords: Infertility; in vitro fertilization; fertilization rate; embryo quality

Relationship between Antenatal Care Compliance and Low Birth Weight in Indonesia

The incidence of low birth weight in Indonesia from 2005-2010 was 7%3, reflecting the country's socioeconomic development. This study aims to determine if there is a relationship between ANC visit compliance with LBW events. This is descriptive research with a cross-sectional design. The study population was all individuals in the 2013 Riskesdas sample of pregnant women who had data on giving birth to low birth weight babies. Data collected included the frequency of ANC visits with the questionnaire code RKD13.IND IC11 and birth weight of infants less than 2500g in the IC29 block. There was a significant and positive relationship between compliance with ANC visits of pregnant women and LBW events in Indonesia from RISKESDAS data 2013, which was analyzed with chi-square P = 0.036 <a (0.5). Low birth weight babies with mothers fulfilled ANC compliance which is equal to (5.7%) and ANC compliance that is not fulfilled leaves a more significant percentage of LBW birth outcomes by (6.7%) Keywords: Pregnant women, Antenatal visits, Low birth weigh

The outcome of gynecologic cancer patients with Covid-19 infection: A systematic review and meta-analysis

Background: Cancer is a comorbidity that leads to progressive worsening of coronavirus disease 2019 (Covid-19) with increased mortality. This is a systematic review and meta-analysis to yield evidence of adverse outcomes of Covid-19 in gynecologic cancer. Methods: Searches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021–19 February 2022). The Newcastle-Ottawa Scale tool was used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI) and random-effects model were presented. Results: We accepted 51 studies (a total of 1991 gynecologic cancer patients with Covid-19). Covid-19 infection cases were lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56-0.90, p 0.005). Severe Covid-19 infection and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16-0.80, p 0.01), (OR 0.52, CI 0.44-0.62, p <0.0001), (OR 0.26, CI 0.10-0.67 p 0.005), (OR 0.63, CI 0.47-0.83, p 0.001) respectively. Increased Covid death was seen in gynecologic cancer vs population with breast cancer, non- Covid cancer, and non-cancer Covid (OR 1.50, CI 1.20-1.88, p 0.0004), (OR 11.83, CI 8.20-17.07, p <0.0001), (OR 2.98, CI 2.23-3.98, p <0.0001) respectively. Conclusion: Gynecologic cancer has higher Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer has fewer Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. These findings may aid health policies and services during the ongoing global pandemic. PROSPERO Registration: CRD42021256557 (22/05/21) Keywords COVID-19, Critical care outcome, Female genital neoplasms, Hospitalization, Morbidity, Mortalit