Pregnancy with Hypothyroid Secondary to Treatment of Thyroid Carcinoma: A Case Report

Background: Thyroid malignancy is one of the most common malignancies in women of reproductive age. One of the normal physiological change in pregnancy is an increase in total maternal thyroid levels. According to 2015 DATIN information, the prevalence of hypothyroidism in women of reproductive age was 2.2%. Method of delivery in patients with thyroid disorders are mostly by cesarean section due to complications of the mother and/or fetus. Fetal outcome usually associated with low birth weight and poor APGAR Score.Objective : Reporting a case of pregnancy with hypothyroidism secondary to thyroid carcinoma treatmentCase: A 37-year-old woman Gravida 3 Parity 2 Abortion 0 with 18 weeks pregnancy after thyroid ablation treatment with a history of Papillary Thyroid Carcinoma – Follicular Variant, following a complete thyroidectomy in August 2016. The patient was given 6-dose ablation therapy, the last therapy was performed in April 2019. On clinical examination, the patient have no sign and symptoms suggesting hypothyroidism. On laboratory examination, the thyroid stimulating hormone (TSH) level was increased. Levothyroxine dosage was adjusted until the patient in euthyroid status in the early 3rd trimester of pregnancy until the delivery period. The fetal examination suggests that the Bio-Physical Profile was normal according to gestational age. The patient underwent vaginal delivery following 38 weeks of gestation with good maternal outcomes and low birth weight neonatal outcomes, no thyroid nodules, and slightly increased thyroid function.Conclusion : Management of counselling about preconception, contraception, and initial screening of patients with a history of thyroid carcinoma are the initial steps to help a better outcome in pregnancies with thyroid disorders.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN PROLAPSUS UTERI DI RSUP Dr. KARIADI SEMARANG

Background: Uterine prolapse is a form of pelvic organ prolapse and ranks the second most common after cystourethrocele. The prevalence of pelvic organ prolapse is 41-50% in women aged over 40 years old and will increase in line with life expectancy increase. Although uterine prolapse rarely cause mortality and severe morbidity, but it can affect women’s quality of life. Prolapse etiology has not known certainly, but there are several factors that are considered as the cause. Objective: To determine the incidence of uterine prolapse, uterine prolapse patient characteristics and factors related to the incidence of uterine prolapse in Dr. Kariadi Hospital Semarang. Methods: An analytic observational study with cross-sectional design used medical records of uterine prolapse patients in Dr. Kariadi Hospital, during the years 2013 to 2014. Sampling was done by consecutive sampling and 56 medical records of uterine prolapse patients who met the inclusion criteria were obtained. Descriptive analysis was shown in the form of frequency and percentage distribution table, while the analytic analysis used Chi-square test and logistic regression. Results: There were 56 cases of uterine prolapse during the years 2013 to 2014. Most uterine prolapse patients aged over 50 years old (80.4%), multiparous (82.1%), post-menopausal (83.9%) and BMI < 25 kg/m2 (51.8%). Based on Chi-square test, there was a significant association between parity, age and menopause with uterine prolapse incidence (p = 0.000) however there was no significant association between BMI with uterine prolapse incidence (p = 0.643). The final result using multivariate logistic regression analysis found that age was the most influential factor on the incidence of uterine prolapse (p = 0.000) and OR = 102.5 (10.3-1020.058, CI 95%). Conclusions: There was association between parity, age and menopause with uterine prolapse incidence and age was the factors most associated with uterine prolapse incidence. Key words: uterine prolapse, parity, age, menopause, BM

PERBANDINGAN PROFIL HEMATOLOGI PADA PREEKLAMPSIA/ EKLAMPSIA DENGAN KEHAMILAN NORMOTENSI DI RSUP DR. KARIADI SEMARANG

Background: Preeclampsia is hypertension accompanied by proteinuria and edema which was one of the major cause of maternal death in Indonesia. There are changes hematological profile in preeclampsia. Aim: To compare the hematological profile of preeclampsia and eclampsia with normotensive pregnancies at RSUP Dr. Kariadi Semarang. Methods: This was a cross-sectional with observational analysis. Data was taken from the medical records of pregnant and labor women in Hospital Dr. Kariadi 2014. The assessment of hematogical profile consisted of the number of erythrocytes, hemoglobin concentration, hematocrit levels, levels of MCV, MCH, MCHC, leukocyte count, and platelet count. The data were statistically analized using the comparative test of One Way ANOVA and Kruskal-Wallis as alternative test. Results: There were 13 patients with mild preeclampsia, 56 patients with severe preeclampsia, eclampsia 16 patients and 85 patients with normotensive. Hematocrit increased significantly in severe preeclampsia compared with mild preeclampsia and controls (p < 0.000). Leukocyte levels were significantly higher in severe preeclampsia compared with controls (p < 0.000). Hematocrit and leukocytes in mild preeclampsia and eclampsia showed no significant difference compared with normotensive pregnancies. There was a significant difference in the number of erythrocytes (p < 0.000) and hemoglobin (p < 0.001). There is no significant difference in MCH level (p < 0.870), MCV level (p < 0.770), MCHC level (p < 0.300), and platelets count (p < 0.425). Conclusion: Hematocrit in patients with severe preeclampsia was higher than mild preeclampsia and normotensive pregnancies. There was an increase in the number of leukocytes in patients with severe preeclampsia compared with normotensive pregnancies. There is no difference in hematocrit and leukocytes in mild preeclampsia and eclampsia than normotensive pregnancy. There were differences in the number of erythrocytes and hemoglobin. There was no differences in the levels of MCH, MCV, MCHC and platelets. Keywords: preeclampsia, eclampsia, hematological profil

Case Report: Pregnancy with Fetal Hydrathorax

Background: Cases of fetal hydrothorax (FHT) are rare, with an occurrence probability of 1 in every 10,000-15,000 pregnancies. The condition may remain undiagnosed, and the fetus may be aborted, or death may occur soon after birth in outlying hospitals before transfer to a tertiary care center. The incidence rate of FHT is higher in males than females (2:1). One of the most effective methods of diagnosing fetal hydrothorax is sonography. Three forms of currently available treatments are: thoracentesis, thoracoamniotic shunting (TAS), and thoracomaternal cutaneous drainage. Fetal outcomes could be improved by performing the Extrauterine Intrapartum Treatment (EXIT) procedure.Case Presentation: We present two cases of first pregnancy primary FHT. In the first case, a 24-year-old woman was diagnosed with asymptomatic FHT in the 28th week of gestation without any prior history. In the second case, a 22-year-old woman with poor medical history was diagnosed in the 35th week of pregnancy and was experienced difficulty of breathing. Both pregnancies were delivered by cesarean section based on obstetric indications. Thoracentesis was performed on both neonates, and pathological examination of the pleural fluid was conducted. However, they died shortly after birth.Conclusion: The EXIT procedure is still a challenging method. A fetus with FHT is at significant risk of pulmonary hypoplasia and respiratory distress following delivery. Early diagnosis and intervention of FHT are vital to ensure a good prognosis. Approaching multidisciplinary groups, providing supportive diagnostic facilities and financial support is essential in improving fetal outcomes and preventing FHT in subsequent pregnancies

HUBUNGAN ANTARA KARAKTERISTIK MATERNAL DENGAN LUARAN MATERNAL PADA PERSALINAN PERDARAHAN POSTPARTUM DI RSUP dr. KARIADI SEMARANG TAHUN 2013-2015

Latar Belakang: Angka Kematian Ibu (AKI) salah satu indikator untuk menilai derajat kesehatan masyarakat. Perdarahan postpartum merupakan salah satu penyebab kematian maternal terbanyak. Perdarahan postpartum adalah kehilangan darah lebih dari 500 ml setelah janin lahir pervaginam atau 1000 ml setelah janin lahir perabdominal. Tujuan: Mendeskripsikan hubungan antara karakteristik dengan luaran maternal pada perdarahan postpartum di RSUP dr.Kariadi Semarang. Metode: Penelitian ini merupakan penelitian deskriptif dengan pendekatan belah lintang. Data diambil dari catatan medik di RSUP dr. Kariadi Semarang (n=83). Analisis menggunakan tes chi square serta analisis multivariat dengan uji regresi logistik. Hasil: Pada tahun 2013-2015, subjek dengan plasenta restan 31,8% (33 orang), retensio plasenta 20,4% (17 orang), atonia uteri 13,2% (11 orang), robekan jalan lahir 9,6% (8 orang), gangguan pembekuan daran 1,2% (1 orang) dan penyebab lain 15,66 (13 orang). Hasil analisis bivariat dari anemia, syok, cara persalinan, histerektomi dan transfusi darah memiliki hasil tidak bermakna. Kesimpulan: Perdarahan postpartum menyebabkan bermacam morbiditas luaran maternal, yaitu anemia, syok, histerektomi, bedah sesar dan transfusi darah. Namun morbiditas luaran maternal yang diteliti tidak memberikan hasil yang bermakna. Kata kunci: Perdarahan postpartum, faktor risiko perdarahan postpartu

The Level of Depression in Third Trimester Pregnancy, With and Without Anemia

Anemia is a health problem worldwide, especially in pregnancy, as it can cause depression. Antenatal depression can cause impaired fetal growth and development, bleeding and abortion, prematurity, low birth weight babies, and postpartum depression. This research aims to determine the difference in levels of depression between anemia and non-anemia in the third trimester of pregnancy. It is an observational study with a cross-sectional design. The samples were 75 last-trimester pregnant women who did antenatal care in Diponegoro National and Amino Gondohutomo Hospital, and also Halmahera and Ngesrep Health Center in Semarang and willling to be respondents selected using a purposive sampling method. Data collection used a validated Edinburgh Postnatal Depression Scale (EPDS) questionnaire with a Content Validity Index (CVI) of 1.00 and a reliability of 0.706. Mann Whitney and Kruskal Wallis were utilized to analyze data. There were 38 respondents with anemia and 37 respondents without anemia. The 12 respondents (31.6%) with anemia had a risk of depression, and 13 respondents (35.1%) without anemia had a risk of depression. There was no significant difference in the level of depression in the third trimester of pregnancy with and without anemia (P0,05).