HIGHLIGHT1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed.3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital.ABSTRACTObjectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018.Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure.Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

The well-known hypervolemia associated with normal pregnancy averages 40 to 45 percent above blood volume in non-pregnant women after 32 to 34 weeks. The case was on Mrs. FN, 40 years old, a patient reffered due to sinus bradycardia before the insertion of permanent pacemaker. After 6 month-use of the permanent pacemaker, she became pregnant with triplet pregnancy. This case report evaluated the patient's condition from her hypervolemic condition to her cardiac function.

Objectives: To report maternal and perinatal outcomes of hyperthyroidsm in pregnancy.Case Report: There were 3622 cases of delivering pregnant women during the period of the study. From this number, the prevalence of pregnant women with hyperthyroid was 0.2 %. We reported 9 cases of hyperthyroid in pregnancy. The number of pregnancy complication and outcome on pregnant women with hyperthyroidism were preterm labor (44%) and preeclampsia (22%), both were found in group of mother who did taking antihyperthyroid therapy. In those who did not take antihyperthyroid therapy 11% had spontaneous abortion and 11% had preterm delivery. Fetal complications were intrauterine growth restriction (11%) and intrauterine fetal death (23%), both of these complication were on the group who did not take antihyperthyroid. On the contrary, 44% babies were born with normal birthweight in group who took antihyperthyroid.Conclusion: There were differences noted between the group that took adequate treatment and the group that did not take antihyperthyroid. The incidence of intrauterine growth restriction and intrauterine fetal death were high in group that did not took antihyperthyroid therapy but the incidence of preterm delivery as the maternal complication was high in group that did take the antihyperthyroid therapy.

Endometriosis is the presence of endometrial tissue outside the Uterus. The true incidence of endometriosis is not really known, but it is believed that 10-15% of all women in their reproductive age will develop endometriosis and 25-35% of all women who are infertile have endometriosis. The true incidence of endometriosis in adolescents is difficult to quantify and estimates vary among different studies. Although in the past it was assumed that endometriosis presented only after many years of menstruation, studies have shown endometriosis to occur prior to menarche and between 1-6 months after the onset of menarche. A 66% of adult women with endometriosis report the onset of pelvic symptoms prior to age 20. Although etiology and pathophysiology of endometriosis is not well‐understood, but increased rate of retrograde menstruation in patients with heavier menses as with bleeding disorder, is a possible mechanism of disease. Here, we report an early adolescent admitted with dysmenorrhea with bleeding disorder, suspected Von Willebrand disease, presenting abnormal uterine bleeding.