Background: Uncontrolled population development can prompt an assortment of populace issues and can be one of the reasons for increasing maternal death rates. The utilization of contraceptives in Indonesia was progressively dominated by injectable contraceptives and pill contraceptives in 2015 (52.21% and 24.36%, respectively). However, the rate of termination of the use of short-acting contraceptives by family planning clients was higher than other methods, therefore the use of short-acting contraceptives is less efficient than long acting reversible contraceptives (LARCs)  for longer term spacing because it is easy to skip a treatment for economic or other reasons, which can result in unintended pregnancy. Therefore, the National Family Planning Program in Indonesia is encouraging the use of LARCs to control population growth. Pameungpeuk is a region which has the second largest population, with the highest total fertility rate in South-West Java. The proportion of active users of LARCs in Pameungpeuk is very low (10.66%). This study aimed to analyze factors associated with the utilization of LARCs among family planning clients at the Pameungpeuk Rural Hospital. Methods: This study design was cross-sectional with systematic random sampling. The sample group in this study was 84 family planning clients. We performed statistical analyses using chi-square test. Results: We found significant associations between the age of women (p=0.024), the cost of contraception (p=0.022), knowledge (p=0.042), beliefs (p=0.002), skill of health workers (p=0.008) and support from health workers (p=0.014). However, education (p=0.212), family income (p=0.087), attitude (p=0.593), exposure to information on LARCs (p=0.378), support from partners (p=0.094), support from friends (p=0.414) and the support of community leaders (p=0.367) had no significant association with the utilization of LARCs. Conclusions: These findings highlight a critical need for improved education among family planning clients at the Pameungpeuk rural hospital regarding the use of LARCs for both medical and elective reasons.

Acute subdural haematoma (ASDH) is rarely caused by an aneurysmal rupture. We report four cases of pure acute subdural haematomas caused by ruptured intracranial aneurysms. Aneurysms were localized in the posterior communicating artery in two cases, in the anterior communicating artery in one case and in the middle cerebral artery in one other case. Possible mechanisms for this type of aneurysmal bleeding are discussed. A good prognosis for these patients can be expected with rapid evacuation of the haematoma (in case of high intracranial pressure and midline structure shift), and treatment of the aneurysm (surgical clipping or endovascular treatment). Our report demonstrates the utility of angiography in the evaluation of nontraumatic acute subdural haematomas. Angiography has to be performed before haematoma evacuation or just after if the patient requires urgent surgery in case of intracranial hypertension. Aneurysms may require surgical clipping or endovascular treatment.

Background: Acquired uterine arteriovenous malformation (AVM) is a rare conditiondue to traumatic episodes in cesarean section. The patient can suffer from lifethreateninghemorrhage or recurrent vaginal bleeding. Establishing this diagnosis isdifficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolization (TAE) procedure is rarely performed in our center. All of thecases were found with history of massive bleeding and diagnosed lately after recurrentbleeding history. Even though promising, one of our cases failed to be managed withTAE. It is important to diagnose early symptoms of AVM in order to prevent the lifethreatening event.Case presentation: In these case series, four cases of AVMs after cesarean procedureswill be reviewed. One could be diagnosed in less than a month but the other three tookseveral months. The symptom of vaginal bleeding might occur a few weeks after theprocedure is done, and most patients need transfusion and hospitalization. Three out offour patients were initially sent to the hospital in order to recover from shock condition,and one patient was sent for a diagnostic procedure. AVMs diagnostic was establishedwith ultrasound with or without angiography. Three of our cases were succeeded byperforming TAE procedure without further severe vaginal bleeding. One case failed tobe treated with embolization and had to proceed with hysterectomy.Conclusion: AVM should be considered early-on in patient with abnormal uterinebleeding and history of cesarean section. Embolization is still the first-choice treatmentof AVMs, otherwise definitive treatment is hysterectomy in a patient without fertilityneed, or impossible to perform TAE.