Introduction:The incidence of placenta accreta spectrum (PAS) has increased, but the optimal management and the optimal way to achieve vascular control are still controversial. This study aims to compare maternal outcomes between different methods of vascular control in surgical PAS management. Material and methods: A retrospective cohort study on consecutive cases diagnosed with PAS between 2013 and 2020 in single tertiary hospital. The final diagnosis of PAS was made following preoperative ultrasound and confirmation during surgery. Management of PAS using cesarean hysterectomy with internal iliac artery ligation (IIAL) was compared with two types of vascular control in uterine conservativeresective surgery (IIAL vs identification-ligation of the upper vesical, upper vaginal, and uterine arteries).Results: Over an 8-year period, 234 pregnant women were diagnosed with PAS meeting the inclusion criteria. Uterine conservative-resective surgery (200 cases) was associated with lower mean blood loss compared with cesarean hysterectomy with IIAL (34 cases) in all PAS cases (1379 ± 769 mL vs 3168 ± 1916 mL; p < 0.001). In subanalysis of the two uterine conservative-resective surgery subgroups, the group with identification-ligation of the upper vesical, upper vaginal, and uterine arteries had a significantly lower blood loss compared with uterine conservative-resective surgery with IIAL (1307 ± 743 mL vs 1701 ± 813 mL; p = 0.005). Women in the hysterectomy with IIAL group had more massive transfusion (35.3% vs 2.5%; p < 0.001; odds ratio[OR] 21.3, 95% confidence interval [CI] 6.9-66), major blood loss (>1500 mL) (70.6% vs 34%, p < 0.001; OR 4.7; 95% CI 2.1-10.3), catastrophic blood loss (>2500 mL)

Background: Insulin resistance is a frequent metabolic disorder in Polycystic Ovary Syndrome (PCOS). Moringa oleifera has been shown to increase insulin expres-sion and decrease the degree of insulin in diabetes mellitus, therefore it is expected that Moringa oleifera could decrease insulin levels and increase folliculogenesis in PCOS.Objective: To prove the effect of Moringa oleifera leaf extract in various doses might decrease the insulin levels and increase folliculogenesis in female PCOS-insulin resistant rats.Methods: The three month old white rat of Wistar strain (Rattus norvegicus) 100-130 grams were divided into five groups (n=8) including normal control, PCOS-insulin re-sistance, PCOS-insulin resistance given metformin and PCOS-resistance insulin were giv-en Moringa oleifera leaf extract in two doses. Then, the PCOS model-insulin resistance by injection of testosterone propionate for 28 days. After 14 days treatment, we analysed insulin levels and folliculogenesis.Results: The PCOS control group showed a significant increase in insulin levels compared to the normal control group. The insulin levels from group treatment with Moringa oleifera leaf extract of 250 mg/kgBW was significantly lower than the PCOS control group. Ovarian histology analysis found that the number and diameter of follicle of PCOS control group showed a significant decrease compared to normal control group. In addition, the treatment with metformin and leaf Moringa oleifera dose 250 mg/kgBW and 500 mg/kgBW showed significant increase of folliculogenesis compared to PCOS control group.Conclusions: Moringa oleifera could lowering the blood insulin levels, subsequently decreasing the androgen thus allowed the increasing of folliculogenesis in PCOS.

Introduction: Infants with low birth weight (LBW) was one of the main indicators of the cause of high infant mortality rates (IMR). The causes of IMR and maternal mortality rate (MMR) were determined by factors in maternal condition before and during pregnancy. In 2015, LBW in Surabaya reached 2.58%, namely a number of 1,261 of 48,783 born babies weighed. This study was performed by analyzing the effect of educational status as a risk factor affecting LBW in Dr. M. Soewandhie General Hospital Surabaya. Methods: This study used case control method with a retrospective approach using patient medical records as secondary data. The sample population were mothers who gave birth to infants with birth weight of 1,500 – 4,000 g in Dr. M. Soewandhie General Hospital Surabaya. The number of samples consisted of 80 patients with case and control ratio of 1:1. The sampling technique used was purposive sampling. Data collection techniques used variable data collection sheets taken from secondary data, namely medical records. Data analysis was performed by Chi-Square and Odds Ratio (OR) statistical tests. Results: Based on Chi-Square test, there was a relationship between educational status (p = 0.034) with the incidence of LBW. The results of this study indicated that the educational status of mothers that graduated from elementary school – senior high school was at risk of 9,750 times in delivering LBW. Conclusion: Educational status was the risk factor that had a correlation with LBW.

Objective This study aimed to determine the role of three‐dimensional (3D)/four‐dimensional (4D) volume rendering ultrasound (VRU) in the diagnosis of abnormally invasive placenta (AIP). Materials and Methods Twelve consecutive patients strongly suspected of having AIP on the basis of conventional ultrasound (US) and clinical history performed between September 2016 and December 2016 in the main tertiary referral hospital in Surabaya, East Java were included in this prospective observational study. A Samsung WS 80A Elite US scanner with a 3D/4D “crystal vue” and “realistic vue” volume rendering mode was used to establish the diagnosis of AIP and evaluate the site, and depth of placental invasion. The VRU images were compared with the intraoperative findings. Results Using this novel US technique, all cases of suspected AIP were subsequently confirmed during surgery. Importantly, the new US technique provided a correct diagnosis of the degree of invasion in 11 out of these 12 suspected AIP cases: 5/5 for placenta percreta, 3/3 for placenta increta, and 2/3 for placenta accreta; one patient was misdiagnosed in terms of the degree of placenta accreta, and one patient had normal implantation). Conclusion This new software of 3D/4D VRU represents a promising technique for the preoperative diagnosis and staging of AIP.

Tujuan: Mengidentifikasi kuman penyebab infeksi saluran kemih sebagai faktor risiko terjadinya ancaman persalinan preterm.Bahan dan Metode: Penelitian ini adalah penelitian analitik observasional cross sectional, dilakukan di Kamar Bersalin dan Poli Hamil RSUD Dr. Soetomo serta di Bagian Mikrobiologi Kedokteran Fakultas Kedokteran Universitas Airlangga Surabaya, pada bulan Januari-April 2015. Penghitungan jumlah koloni dan identifikasi kuman dilakukan melalui pemeriksaan kultur urine porsi tengah dan dilanjutkan dengan tes kepekaan antibiotika. Analisa statistik menggunakan uji Chi square untuk jumlah koloni kuman dan bakteriuria, dan uji Fischer exact untuk jenis kuman, menggunakan perangkat lunak SPSS 20. 0.Hasil: Sampel terdiri dari 20 wanita hamil dengan ancaman persalinan preterm/partus prematurus iminens (PPI) dan 20 wanita hamil normal tunggal dengan usia kehamilan 28-36 minggu. Perbandingan antara jumlah koloni kuman kedua kelompok secara statistik tidak signifikan, dengan nilai p=0,063 (p>0,05), perbedaan jenis kuman yang ditemukan antara kedua kelompok secara statistik tidak signifikan, dengan nilai p=0,058 (p>0,05).Simpulan: Pada kehamilan dengan ancaman persalinan preterm 80% didapatkan pertumbuhan kuman Staphylococcus epidermidis (30%) dan Escherichia coli (15%). Jumlah koloni kuman aerob urine pada kehamilan dengan ancaman persalinan preterm lebih banyak dibandingkan dengan kehamilan tanpa ancaman persalinan preterm, tetapi secara statistik tidak berbeda bermakna. Risiko terjadinya PPI pada wanita hamil dengan jumlah koloni kuman urine >105 cfu/mL 3 kali lebih besar dibanding wanita hamil dengan jumlah koloni <105 cfu/mL. Jenis kuman aeroburine pada kehamilan dengan dan tanpa ancaman persalinan preterm hampir sama.