Background: The common location of Endometriosis is in genitalia organs, for instance, the ovary, uterus, fallopian tube, and sometimes even in the intestine, bladder, and in rare locations such as the navel, lungs, or brain. Umbilical Endometriosis is the most irregular form of Endometriosis and the most common cutaneous form of Endometriosis. Primary umbilical endometriosis diagnosis is often biased and delayed; the exact etiopathology remains unclear. Our case report discusses the diagnosis and management options for this rare disease. Case presentation: We reported a Primary Umbilical Endometriosis case, confirmed by a history of the nodule with pain, swelling, and bleeding at the umbilicus, which occurs during menstruation. The nodule was surgically removed, and histopathological analysis shows fibromycsoid tissue with multiple forms of subepithelial endometrial glands and surrounding stroma, confirmed as Endometriosis. Conclusion: The definitive treatment for umbilical Endometriosis is surgical excision with total removal of the umbilicus. The prognosis is good, and the recurrence rate is meager if complete excision is successfully performed.

Introduction: A trial of labor after a cesarean (TOLAC) section is a maternal choice with previous caesarian section. However, for those with 2 previous scars, there are pros and cons to allowing the patient for vaginal birth after caesarian section (VBAC) in view of increasing complications. The incidence of SC in Indonesia has been increasing over the year. In addition, several studies have shown an increased risk of problems in subsequent pregnancies in mothers with a history of cesarean section. Thus VBAC in 2 previous scars becomes a alternative choice for a certain patient. Case Illustration: We reported 3 cases of TOLAC; Three of the cases were planned for vaginal birth after caesarian section (VBAC) since prenatal periode Case 1: A 30-year-old woman, G3P2, 39 weeks with two times previous cesarean section. Cardiotocography was normal. The patient was closely monitoring the signs of uterine rupture during labor, and after 7 hours, she had a successful VBAC without complication. Born female baby with body weight 4000 with a good, mother and baby were in good condition. Case 2: A 38-year-old woman, G6P4A1, 41 weeks pregnant with two previous vaginal deliveries and had two previous CS before the current pregnancy. The patient was closely monitored of vital signs and signs of uterine rupture. Cardiotocography is normal. After 8 hours later, she had a successful VBAC without complication, born a male baby with a body weight of 3500gr, with good APGAR score. Case 3: A 35-year-old woman, G3P2A0, had two previous CS admitted at 39 in the latent phase of labor with a cervical dilatation of 2 cm. The labor progressed to second stage after 9 hours. After a hour attempted to conduct delivery, the fetus was still not delivered. Catheterization was performed and found haematuria and proceded with emergency CS due to suspect a uterine rupture. Intraoperatively, the uterine rupture was noted at lower anterior of uterine corpus size 2x1 cm and a repair was performed Conclusion: VBAC can be considered in patients with two previous c-sections with after proper selection, close monitoring and adequate counseling. Prenatal care is a concern for pregnant women to prevent complications and reduce maternal and fetal morbidity and mortality. The VBAC decision returned to personalization and adequate assessment and counseling are mandatory.

Physical changes during pregnancy cause stretching of the pubic symphysis. Pubic symphysis rupture occurs when the joint widening is more than 10 mm which is confirmed by radiologic. The conservative and surgical are required to management of rupture of the symphysis. 25-year-old women with a postpartum birth canal tear using a vacuum. The patient felt severe pain and a lump in the pubic area. On examination, the uterus was 2 fingers below the navel, swelling in symphysis area, and pressure pain, and there were the labia and urethra lacerated without active bleeding. in laboratory tests, hemoglobin 7.3 g/dL, leukocytes 15,300/mm3, and platelets 255,000/mm3. The results of the pelvic x-ray examination are symphisiolysis. The patient underwent surgery with open reduction internal fixation (ORIF) and suturing the lacerated urethra by the surgical department. During the treatment, light mobilization and education on self and baby care were carried out. The wound was cleaned in 3 days and the urinary catheter was maintained for up to 14 days. The patient was discharged and carried out control every month for 6 months. Pubic symphysis rupture is one of the rare complications of labor due to multiparity, macrosomia, use of forceps, difficult labor, malpresentation, and trauma. The diagnosis is made when the intrapubic distance is greater than 10 mm on pelvic radiography. An MRI examination is preferred to assess for tissue tears. Operative internal fixation is performed when conservative therapy fails, soft tissue damage, and intrapubic distance of more than 25 mm. Pubic symphysis rupture is a labor complication due to the stretching of the symphysis. Surgical treatment is performed when conservative therapy fails.