Tujuan: menganalisis kasus kematian maternal di RSUD Dr. Soetomo tahun 2011 – 2013 dengan tiga penyebab terbanyak (perdarahan pasca salin, preeklampsia berat dan penyakit jantung) ditinjau dari skor KSPR dan faktor empat terlambat.Bahan dan Metode: Penelitian ini merupakan penelitian retrospektif observasional dengan desain studi deskriptif. Objek pada penelitian ini merupakan pasien yang meninggal sebagai kasus kematian maternal di RSUD Dr. Soetomo tahun 2011-2013, dengan jumlah 58 orang. Variabel penelitian ini adalah tingkat risiko kehamilan berdasarkan KSPR, faktor empat terlambat dan kematian maternal.Hasil: Pada penelitian ini didapatkan seluruh kasus kematian maternal mengandung unsur faktor risiko dalam KSPR dan faktor empat terlambat. KRST merupakan kelompok faktor risiko terbanyak (55,2%), diikuti oleh KRT 39,7% dan KRR 5,2%. Faktor terlambat mendeteksi tanda bahaya ditemukan sebanyak 82,8%, terlambat mengambil keputusan merujuk 56,9%, dan terlambat sampai di tempat rujukan 15,5%. Faktor terlambat mendapat pertolongan di tempat rujukan terakhir tidak ditemukan pada penelitian ini.Simpulan: KSPR masih relevan digunakan untuk deteksi dini faktor risiko ibu hamil. Pencegahan faktor empat terlambat penting untuk menurunkan angka kematian maternal

Despite most Indonesian women now receiving antenatal care on the nationally recommended four occasions and being delivered by skilled birth attendants, the nation’s maternal mortality ratio (MMR) is estimated as 177 per 100,000 live births. Recent research in a rural district of Indonesia has indicated that poor service quality due to organizational and personnel factors is now a major determinant of this high MMR. The present research is an in-depth analysis of possible health service organizational and quality of care related causes of death among 30 women admitted to a peak referral hospital in a major Indonesian city. Despite their condition being complex or deteriorating, most of these women arrived at the hospital in a state where it was feasible to prevent death with good quality care. Poor application of protocols, poor information flow from frontline hospitals to the peak referral hospital, delays in emergency care, and delays in management of deteriorating patients were the main contributing factors to these deaths. Pyramidal referrals also contributed, as many women were initially referred to hospitals where their condition could not be effectively managed. While generic quality improvement measures, particularly training and monitoring for rigorous application of clinical protocols (including forward planning for deteriorating patients) will help improve the situation, the districts and hospitals need to develop capacity to assess their local situation. Unless local organisational factors, staff knowledge and skill, blood and blood product availability, and local reasons for delays in providing care are identified, it may not be possible to effectively reduce the adverse pregnancy outcomes.

Objectives Data on the clinical manifestations and pregnancy outcomes of pregnant women with COVID-19 are limited, particularly in developing countries. The aim of this study was to analyze the clinical manifestations and pregnancy outcomes in COVID-19 maternal cases in a large referral hospital in Indonesia.Methods This study used a prospective cohort design and included all pregnant women with suspected COVID-19. Subjects were divided into COVID-19 and non-COVID-19 groups based on the results of real-time polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2. Clinical characteristics, laboratory results, and pregnancy outcomes were compared between the two groups.Results Of the 141 suspected maternal cases, 62 cases were COVID-19-confirmed (43.9%), while 79 suspected cases were negative (56.1%). The clinical manifestations and laboratory findings between the two groups were not significantly different (P>0.05). However, the maternal mortality directly caused by COVID-19 was significantly higher than that in the non-COVID-19 group (8.3% vs. 1.3%; P=0.044; odd ratio, 6.91; 95% confidence interval, 0.79-60.81).Conclusion The clinical manifestations and laboratory results of suspected pregnant women with positive and negative RT-PCR COVID-19 results were similar. However, within the Indonesian setting, COVID-19 significantly increases the risk of maternal death through both direct and indirect factors.

Background: The COVID-19 pandemic is a challenge for mothers to access health services in Indonesia. Patient management, referral processes, and maternal screening protocols are the reasons for this issue. Aims: This study aimed to analyze maternal mortality trends in East Java Province before and during the COVID-19 pandemic. Methods: This study was conducted using retrospective observation with a cross-sectional design, and samples were selected using a total sampling technique. The number of maternal deaths in East Java was 520 in 2019 and  565 in 2020. The independent variable in this study is the number of maternal deaths, and the dependent variables include age, gravida, place of death, rescue relay, time of death, and maternal complications. The variables of age, place of death, rescue relay, and gravida were assessed using the Chi-square test. Results: Statistical tests showed a ρ value of 0.195 for age; 0.916 for place of death; 0.646 for rescue relay; and 0.048 for gravida. Conclusion: Maternal mortality showed different trends before and after the pandemic in East Java.  Significant differences in maternal mortality rate are influenced by gravida status.