Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain limited. This study aimed to describe the prevalence of prophylactic antibiotic use, factors associated with its use, and clinician adherence to guidelines. A retrospective review was conducted for all deliveries from 1 January 2016 to 31 December 2018 at a tertiary level hospital in Indonesia. The prevalence of prophylactic antibiotic use during delivery was 47.1%. Maternal education level, Ob/Gyn specialist-led delivery, a history of multiple abortions, C-section, premature membrane rupture, and antepartum hemorrhage were independently associated with prophylactic antibiotic use. Clinician adherence to the guidelines was 68.9%. Adherence to guidelines was the lowest in conditions where the patient had only one indication for prophylactic antibiotics (aOR 0.36, 95% CI 0.24–0.54). The findings showed that the prevalence of prophylactic antibiotic use during delivery was moderate to high. Adherence to local guidelines was moderate. Updating the local prescribing guidelines may improve clinician adherence.

Background. Preeclampsia is defined as gestational hypertension and proteinuria which can be measured by the elevation of liver transaminases to twice normal concentration, and the symptoms of increased intracranial pressure such as dizziness, blurred vision, and seizures. Zinc is an essential mineral for many biological functions and one of the trace elements that is directly involved in the oxidative/antioxidant balance, a pathogenesis process in preeclampsia that is highly dependent on dietary habits and supplements. This study was aimed to assess the association between serum zinc level with preeclampsia (PE). Methods: This observational, case-control study was performed on 90 women with singleton pregnancies at 28 to 42 weeks of gestation which were referred to the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital, Palembang, between August 2020 to November 2020. 30 pregnant women with PE were selected as cases and 60 healthy pregnant women were selected as controls. Maternal serum zinc samples were collected. The collected data were entered into the master table. Tabulation, coding, and statistical data analysis were performed using SPSS version 20.0 for Windows. Results: The mean serum zinc levels in the case group and control group were 43,90 ± 15,79 µg/dL (ranged from 15 to 86 µg/dL) and 48,77 ± 10,54 µg/dL (ranged from 22 to 83 µg/dL), respectively. A value of serum zinc levels with the best sensitivity and specificity was 45,5 µg/dL. Conclusion: There was a significant association between maternal serum zinc level with PE. The risk of PE was 3,2 times higher in pregnant women with serum zinc levels of ≤45,5 mcg/dL compared to pregnant women with serum zinc levels of >45,5 mcg/dL. In this case it is necessary to supplement zinc earlier in pregnancy to reduce the risk of preeclampsia.

Placenta accreta spectrum (PAS) is characterized by abnormal invasion of placental tissue into the underlying uterine muscles and has an incidence of 1/533–1/251. The incidence of complications includes uterine rupture (14–29%), PAS (6–10%), and retained placenta or incomplete placenta removal (4%). Here, we described a rare case of PAS and angular pregnancy, including how to diagnose and manage it preoperatively. A 32-year-old primigravida diagnosed at 24 weeks of gestation with a right angular pregnancy was admitted due to preterm premature rupture of membrane (PPROM) with a singleton fetus. We decided to perform hysterotomy because of the PPROM and intrauterine infection. Intraoperatively, we found PAS in the right angular pregnancy; therefore, we performed uterine conservative management with wedge resection on the right uterine fundus. Intraoperative bleeding was 1,600 cc. Histopathological examination revealed placenta increta. The maternal prognosis was good, while the fetus was poor, with an APGAR score of 1/1/0.

Background: Body stalk anomaly was a rare, sporadic defect in the abdominal wall with the expulsion of the contents of the thoracoabdominal organs. Body stalk anomaly was reported in about one in 7,500 births within 10-14 weeks of gestation. Body stalk anomaly was a rare malformation with a prevalence of about 0.12 cases per 10,000 births (both live and stillbirth). Aim: To compare the antenatal and postnatal findings of body stalk anomaly. Case description: A 29-year-old multigravid patient was referred to our hospital due to a congenital anomaly. There were several findings on ultrasonography and magnetic resonance imaging (MRI), namely low-set ears, banana sign, neural tube defects, severe scoliosis, short umbilical cord, fetus attached to the placenta, abdominoschisis, thoracoschisis with some organs out, and defects in both legs. Hysterotomy was performed at 24 weeks of gestation. A male baby weighing 650 gm with a body length of 33 cm and head circumference of 24 cm was born. His Apgar score was 1/1/1 and survived for 30 minutes after birth. The postnatal examination of the baby, performed postmortem, confirmed the antenatal diagnosis. Synopsis: A case about a comparison between ultrasound and MRI prenatal screening with postoperative findings in the diagnosis of body stalk anomaly. Conclusion: Antenatal ultrasonography provided an accurate diagnosis of body stalk anomaly, and the results could be a consideration for detection of the defect earlier. Furthermore, it could help in patient counseling about poor outcomes in neonates and termination planning earlier to avoid other additional risks or even complications of delivery.

Introduction: Preeclampsia has become the most common glomerular-based kidney disease affecting up to 8% of normal pregnancies. [1][2][3] Thus, a worsening condition of preeclampsia will be related to an increasing risk of renal disease, particularly acute kidney injury (AKI). 1,2 Acute kidney injury has become the common renal disease complication due to severe preeclampsia with the incidence up to 5%. 4 This complication is mainly caused by thrombotic microangiopathy involving renal arteries, which can be observed with an increasing urine D-dimer level. This study aims to determine the urine D-dimer level in severe preeclampsia-complicated AKI. Materials and methods: A cross-sectional study was conducted in Obstetric Emergency Unit and Obstetric Ward Unit, Cipto Mangunkusumo General Hospital, from January to April, 2013. Subjects were divided into two groups: severe preeclampsia-complicated AKI and normotensive pregnancy. The main outcome of this study was that urine D-dimer level was based on the cutoff point from receiver operating characteristic (ROC). The secondary outcomes were its sensitivity and specificity. Statistical analysis was performed using Mann-Whitney and Spearman correlation tests. Data were analyzed using SPSS 20.0. Results: There were 65 subjects collected during the study and divided into two groups: 35 patients with severe preeclampsia-complicated AKI and 30 patients with normotensive pregnancy. There was a significant increase in the urine D-dimer level in patients with severe preeclampsiacomplicated AKI compared with patients with normotensive pregnancy (2503 ng/mL vs 236.2 ng/mL; p = 0.001). Based on the ROC, the cutoff point for the urine D-dimer level was >818 ng/dL with area under the ROC curve was 0.819 (81.9%), sensitivity 80%, and specificity 73%. Conclusion:The urine D-dimer level significantly increased in severe preeclampsia-complicated AKI with a cutoff point of >818 ng/dL, sensitivity 80%, and specificity 73%.