Objective: To determine the comparison between maternal cystatin C serum in severe preeclampsia and normal pregnancy. Method: This was an observational study with cross sectional analytic approach. The subjects are sixty women with severe preeclampsia and normal pregnancy who met inclusion criteria. The maternal serum level of cystatin C was automatically measured with Particle Enhanced Nephelometric Assay (PENIA). Result: Mean serum level of cystatin C in severe preeclampsia was 1.169 ± 0.311 mg/l. Mean serum level of cystatin C in normal pregnancy was 0.929 ± 0.166. There was a significant differences between maternal serum levels of cystatin C in women with severe preeclampsia compared with women with normal pregnancy. Conclusion: There was a significant differences between maternal serum levels of cystatin C in severe preeclampsia compared with normal pregnancy. Keywords: cystatin C, endotheliosis glomerulus, severe preeclamp

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.

Tujuan: Seiring dengan bertambahnya insidensi preeklamsia dengan komplikasi berat, manajemen yang adekuat diperlukan. Penulisan artikel ini bertujuan untuk memaparkan update manajemen preeklamsia dengan komplikasi berat (eklamsia, edema paru, dan sindrom HELLP). Metode: Tinjauan pustaka (literature review) dengan menggunakan 15 referensi antara tahun 2011–2020. Hasil: Manajemen preeklamsia dengan komplikasi berat membutuhkan pendekatan multidisiplin, medikamentosa (kalsium 1,5–2 gram/hari; aspirin dosis rendah 75–150 mg/hari; MgSO4 dengan dosis awal 4–6 gram IV dan pemeliharaan 1-2 gram/jam hingga 24 jam pascasalin; kortikosteroid; antihipertensi seperti labetalol, hidralazin, nifedipin, natrium nitroprusside, nitrogliserin), dan non-medikamentosa (olahraga, pembatasan cairan). Sementara itu, prinsip penanganan awal eklamsia, yaitu D (Dangers) – R (Response) – S (Send for Help) – A (Airway) – B (Breathing) – C (Compressions) – D (Defibrillation). Adapun manajemen obstetri pada kasus preeklamsia dengan gejala berat, yaitu manajemen ekspektatif dan persalinan (spontan ataupun seksio sesaria). Kesimpulan: Tatalaksana yang cepat dan tepat pada kasus preeklamsia dengan komplikasi berat sangat diperlukan untuk mengurangi morbiditas pada ibu dan janin. Manajemen kasus preeklamsia dengan gejala berat berupa manajemen ekspektatif dan persalinan (spontan ataupun seksio sesaria). Update on Management of Preeclampsia with Severe Features (Eclampsia, Pulmonary Edema, HELLP Syndrome) Abstract Objective: As the incidence of preeclampsia with severe features increases, adequate management is required. The purpose of this review is to present an update on the management of preeclampsia with severe features (eclampsia, pulmonary edema, and HELLP syndrome). Method: Literature review using 15 references between 2011–2020. Results: Management of preeclampsia with severe features requires a multidisciplinary, medical approach (calcium 1.5–2 g/day; low-dose aspirin 75–150 mg/day; magnesium sulfate at an initial dose of 4–6 g IV and maintenance 1-2 g/hour to 24 hours postpartum; corticosteroids; antihypertensives such as labetalol, hydralazine, nifedipine, sodium nitroprusside, nitroglycerin) and non-medical (exercise, fluid restriction). Meanwhile, the principles of early management of eclampsia, namely D (Dangers) – R (Response) – S (Send for Help) – A (Airway) – B (Breathing) – C (Compressions) – D (Defibrillation). The obstetric management in cases of preeclampsia with severe features is expectant management and delivery (spontaneous or cesarean section). Conclusion: Prompt and appropriate management of cases of preeclampsia with severe features is needed to reduce maternal and fetal morbidity. Management of preeclampsia cases with severe features is expectant management and delivery (spontaneous or cesarean section). Key words: preeclampsia, eclampsia, HELLP syndrome, severe.

Memaparkan klasifikasi, faktor risiko, epidemiologi, cara diagnosis, tatalaksana, dan komplikasi kehamilan pada skar seksio sesarea Metode: Tinjauan pustaka Kesimpulan: Kehamilan pada skar SC merupakan kehamilan yang kantung kehamilannya terdapat pada miometrium yang menipis akibat SC sebelumnya. Secara umum, kehamilan pada skar Caesarean Scar Pregnancy (CSP) dapat dibedakan menjadi 2 tipe, yaitu tipe 1 (endogenik) dan tipe 2 (eksogenik). Kejadiannya berkisar antara 1 per 8.000 dan 1 per 2.500 SC dengan risiko rekurensi 3,2-5,0% pada wanita dengan riwayat SC 1 kali yang ditatalaksana dengan dilatasi dan kuretase dengan atau tanpa embolisasi arteri uterina. Adapun faktor risiko CSP adalah tebal Segmen Bawah Rahim (SBR) <5 mm, kantong kehamilan menonjol ke plika vesikouterina, SC di rumah sakit umum daerah, dan riwayat perdarahan melalui vagina ireguler dan nyeri abdomen selama CSP sebelumnya. Pengobatan CSP dapat secara konservatif dengan metotreksat (MTX) maupun operatif termasuk eksisi jaringan kehamilan dengan laparoskopi, histerotomi, atau histerektomi. Pilihan pengobatan lain termasuk dilatasi dan kuretase, reseksi transervikal (TCR) dengan histeroskopi, embolisasi arteri uterina (UEA), kemoembolisasi arteri uterina, atau penempatan kateter balon ganda.

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.