AbstrakPercobaan persalinan per vaginam dapat menjadi pilihan untuk wanita yang sebelumnya pernah mengalami seksio sesarea. Percobaan yang berhasil dinamakan sebagai vaginal birth after a cesarean (VBAC). Kegagalan VBAC sering kali disebabkan karena terjadinya inersia uteri hipotonik. Augmentasi oksitosin drip bukan merupakan kontraindikasi, pemberian augmentasi oksitosin drip merupakan upaya untuk meningkatkan angka keberhasilan VBAC akan tetapi harus diberikan dengan pemantauan kontinu. Penelitian ini bertujuan untuk menentukan perbedaan keberhasilan VBAC pada inersia uteri hipotonik dengan dan tanpa pemberian oksitosin drip. Penelitian ini merupakan penelitian eksperimental dengan rancangan uji klinik acak terkontrol (randomized clinical trial), terhadap 40 penderita dengan riwayat seksio sesarea di Rumah Sakit Dr. Hasan Sadikin, Rumah Sakit Umum Daerah Sumedang, dan Rumah Sakit Astana Anyar yang memenuhi kriteria inklusi periode Maret-Mei 2009; dilakukan perbandingan dua kelompok, yaitu kelompok dengan oksitosin drip dan tanpa oksitosin drip. Karakteristik penderita, keberhasilan VBAC, dan komplikasi ibu serta keluaran neonatus dicatat sebagai data. Uji kemaknaan perbedaan dua proporsi dengan menggunakan chi-kuadrat. Hasil penelitian menunjukkan bahwa keberhasilan VBAC secara statistik tidak memperlihatkan perbedaan bermakna antara kelompok oksitosin drip (80%) dan tanpa oksitosin drip (60%) dengan nilai p=0,168 (p>0,05), tetapi dengan interval kepercayaan 95% keberhasilan VBAC dengan oksitosin drip lebih besar 1,71 (0,72-4,06). Komplikasi pada ibu dan neonatus yang timbul pada kedua kelompok tidak berbeda bermakna. Simpulan, pemberian oksitosin drip pada kasus inersia uteri hipotonik meningkatkan keberhasilan VBAC. [MKB. 2012;44(2):114-20]. Kata kunci: Inersia uteri hipotonik, oksitosin drip, vaginal birth after a cesarean (VBAC) The Successful Comparison of Vaginal Birth After a Cesarean (VBAC) on Hypotonic Uterine Inertia with and without Oxytocin Infusion AbstractTrial of labor after cesarean section can be a choice on maternity with cesarean history. The successful trial of labor is then called vaginal birth after a cesarean (VBAC). The failure on VBAC is often caused by hypotonic uterine inertia. Oxytocin infusion augmentation is not a contraindication; it is a solution for increasing success on VBAC with requisite continuing observation. The aim of this research was to determine the successful differences of VBAC on hypotonic uterine inertia with and without oxytocin augmentation. This research was an experimental study on randomized clinical trial, using 40 patients with history of cesarean section at Dr. Hasan Sadikin Hospital and two satellite hospitals (Sumedang and Astana Anyar) during March-May 2009 which fulfilled inclusion criteria divided into two groups; the group using oxytocin infusion and the group without oxytocin infusion. The patients' characteristic, the success on VBAC and the maternal complication also neonatal condition were noted as encode. Chi-square test was used for statistical...

Introduction: Takayasu's arteritis (TA) is a rare systemic, chronic inflammatory, progressive, idiopathic disease of aorta and its main branches. Takayasu's arteritis causes narrowing, occlusion and aneurysm of arteries. The etiology of TA is still unknown. It may be autoimmune or genetic in origin or infective diseases. It is commonly found in Asia and oriental countries. Worldwide annual incidence is 1.2 -2.6 cases/million. Women are affected in 80% -90% of cases with age of onset below 40 years. TA does not worsen or improve with pregnancy but has adverse effect on pregnancy in the form of abortion, Intrauterine fetal death, superimposed preeclampsia, Intrauterine growth restriction, abruption and congestive heart failure. Because the disease is common in women of childbearing age, management of pregnancy in these patients becomes important; however optimal management for pregnant patients with this disease has not yet been established. Due to the manifold cardiovascular complications that can occur in the course of the disease, management of pregnancies in TA patients is a challenge for the clinician. An interdisciplinary collaboration of obstetrician, rheumatologist, cardiologist and anaesthetist is necessary to improve maternal and fetal prognosis. This was the first reported case of TA in pregnancy in Hasan Sadikin Hospital with superimposed preeclampsia and pulmonary hypertension. Materials and Methods: The patient, G1P0A0 was diagnosed as TA since one year ago, and when the patient was pregnant, the patient routinely came to obstetric and rheumatology clinics. Angiographic examination showed dilatation of aorta ascendant, narrowing of aorta descendent at 8 thoracal vertebrae, and arcus aorta, abdominal aorta and the branches were without abnormalities that lead to type IIb TA. On physical examination blood pressure was 200/100 mmHg How to cite this paper: Permadi, W.,

Introduction: Holoprosencephaly (HPE) is the most frequent malformation of the prosencephalon. It represents the absence or incomplete division of the prosencephalon during the 4 th and 8 th week of gestation. Its incidence is estimated to be 1 in 16,000 live births and 1 in 250 spontaneous abortions. According to the degree of cerebral involvements, it is classified into 3 types: alobar, semilobar, and lobar. Alobar is the most severe type. Duodenal atresia occurs in approximately 1:10,000 live births. It can be fatal unless diagnosed and surgically treated promptly. It is a less common cause of polyhydramnion. The diagnosis of duodenal obstruction may be suspected prior to the child's birth by prenatal ultrasonography. The outcome of congenital duodenal obstructions, in terms of mortality rate, has improved over the last decades, mainly attributable to the improvement in the quality of prenatal diagnosis and neonatal intensive care. Embryological basis for etiology of duodenal atresia is thought to be due to errors of recanalization. Duodenal atresia is associated with other congenital anomalies in spite with holoprosencephaly. This is the only case (HPE with duodenal atresia) which is reported in Hasan Sadikin Hospital in the last five years. Materials and Methods: A patient G 2 P 1 A 0 who had vaginal birth 6 years ago, without complication on mother and fetus was referred to Hasan Sadikin Hospital with abdominal discomfort as main complaint on her 33-34 weeks of pregnancy. Prenatal care was during the first and second trimester by midwife and sonography in satellite hospital. She had polyhydramnion and head abnormality and referred to Hasan Sadikin Hospital. Sonography examination showed alobar holoprosencephaly, abnormal facial (cleft lip and palate, absent nasal bone, hypotelorism), duodenal atresia and polyhydramnios (Amniotic Fluid Index 50 cm); other examinations were normal. Amnioreduction and karyotyping examination were done. After 3 weeks the amniotic fluid increased

OBJECTIVE:To evaluate the role of the middle cerebral artery (MCA) to the umbilical artery (UA) blood velocity waveform’s pulsatility index (PI) screening in proximity to delivery as a predictor of high-risk pregnancy and neonatal outcomes.METHODS:The study used a nested case–control method, consisting of 34 women with high-risk pregnancies and 34 pregnant women who were classified as normal. The MCA/UA PI ratio was evaluated within 14 days before delivery. All subjects’ newborns were evaluated for neonatal outcomes, which included fetal distress, abnormal cardiotocography or fetal heart rate patterns, neonatal mortality, Apgar score, duration of hospitalization, and neonatal intensive care unit (NICU) admission. A cutoff point for MCA/UA PI ratio was assessed using the receiver operating characteristic curve. The correlations between the MCA/UA PI ratio and high-risk pregnancy and neonatal outcomes were assessed with multivariable linear regression based on the cutoff point obtained.RESULTS:The MCA/UA PI ratio in high-risk pregnancy was significantly lower compared with normal pregnancy (p= .011). The MCA/UA PI ratio of ≤1.32 finding was 6.37 times higher in high-risk pregnancy (p= .017, AOR 6.37, 95% CI 1.40–28.97), 5.9 times higher in pregnancy with the neonate’s first-minute Apgar less than 7 (p= .031, AOR 5.90, 95% CI 1.18–29.61), and 18.62 times higher in neonates admitted to the NICU (p= .023, AOR 18.62, 95% CI 1.43–2702.94).CONCLUSIONS:Low MCA/UA PI is associated with high-risk pregnancies and adverse neonatal outcomes, such as low first-minute Apgar score and NICU treatment.

Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian–Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = −1.63) (95% CI; −4.92,0.28, p = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = −1.55, [CI: −2.89, −0.21], p = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07–3.01), p = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (−1.08–−0.33), p = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease’s response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.