HighlightsWe report a rare case of pelvic pain in adult.The pelvic pain was caused by Herlyn-Werner-Wunderlich Syndrome.The main diagnostic tool was MRI.The problem was overcame with excision of the septum.We report a complete investigation and management of Herlyn-Werner-Wunderlich Syndrome.

Background: Preeclampsia occurs in 3-7% of pregnancy and contributes to 18% maternal mortality. Unfortunately, proper diagnosis and prompt treatment for preeclampsia are limited in rural area due to limited facilities. Neutrophils, lymphocytes, and red distribution width, some of the inflammatory response, are considered as marker for preeclampsia. We evaluated the NTR and RDW as a reliable marker for preeclampsia in limited facilities health care.

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a global pandemic in March 2020 by the World Health Organization (WHO). By February 2022, the disease had infected more than 500 million people globally. COVID-19 frequently manifests as pneumonia and mortality is mainly caused by acute respiratory distress syndrome (ARDS). Previous studies have reported that pregnant women are at a higher risk of SARS-CoV-2 infection and complications can happen due to alterations in the immune response, respiratory physiology, hypercoagulable state, and placental pathology. Clinicians face the challenge of selecting the proper treatment for pregnant patients with different physiological characteristics compared with the non-pregnant population. Furthermore, drug safety for both the patient and the fetus should also be considered. Efforts to prevent COVID-19, including prioritizing vaccination for pregnant women, are essential to break the chain of COVID-19 transmission in the pregnant population. This review aims to summarize the current literature regarding the effect of COVID-19 in pregnant women, its clinical manifestations, treatment, complications, and prevention.

Background: Morbidly adherent placenta is a condition which placenta adheres and invades deeply into the myometrium and, in some cases, until uterine serosa, thus contribute to peri-partum hemorrhage and significant maternal mortality.Purpose: To identify prevalence, clinical characteristics and their odds ratio to increasing se-verity of morbidly adherent placenta case in RSUP Persahabatan from 2015 to 2018Methods: Cohort retrospective studyResults: From 2015 to 2018, prevalence of morbidly adherent placenta was around 0.8%. The risk factors which contribute to increasing severity of morbidly adherent placenta were: age above 35 years (OR 1.6, 95% CI 0.41-6.24) and history of Caesarean section more than 2 times (OR 1.63, 95% CI 0.41-6.46). The presence of increasing severity of morbidly adherent placenta were related to volume of blood loss more than 1000 ml during surgery (OR 2.13, 95% CI 0.52-8.76). Conclusion: The prevalence of morbidly adherent placenta at Persahabatan General Hospital in 2015-2018 was 0.8%. Age, history of Caesarean section more than 2 times, volume of blood loss, and duration of surgery were not statistically associated with adherent placenta case.

Objective: Increased levels of inflammatory factors in newborns are often associated with lower maternal vitamin D levels. This study aimed to find out the relationship between maternal and umbilical cord vitamin D serum levels on umbilical cord Interleukin-6 (IL-6) and serum C-Reactive Protein (CRP) levels in premature infants.Methods: The study was an observational analytic, cross-sectional design in mothers who underwent preterm birth at 28-34 weeks' gestation due to premature rupture of membranes (PROM) and their infants at Dr. Cipto Mangunkusumo General Hospital (RSCM), Jakarta and Persahabatan General Hospital, Jakarta, from January 2017 to August 2018. Levels of serum vitamin D of the maternal and umbilical cord, umbilical cord IL-6 and serum CRP in premature infants were recorded. Vitamin D level was divided into deficiency (<10 ng/mL), insufficiency (10–29 ng/mL), and normal (>30 ng/mL) groups. The relationship of vitamin D levels with IL-6 and CRP was carried out using Kruskal Wallis test.Results: A total of 70 subjects met the research criteria. Umbilical cord IL-6 and serum CRP levels in premature infants of vitamin D deficient mothers were higher (20.31 pg/mL and 0.50 mg/L) compared to insufficient (3.34 pg/mL and 0.45 mg/L) and  normal  mothers (3.29 pg/mL and 0.30 mg/L), although  not  statistically  significant (IL-6 p = 0.665, CRP p = 0.89). Referring to the umbilical cord blood vitamin D levels, the results were different and not as expected, in which the umbilical cord IL-6 and serum CRP levels of preterm infants in the deficiency (3.76 pg/mL and 0.35 mg/L) and insufficiency (3.37 pg/mL and 0.40 mg/L) groups were lower (IL-6) and not different (CRP) than the normal group (9.41 pg/mL and 0.40 mg/L).Conclusion: There were an increasing tendency for umbilical cord IL-6 and serum CRP levels in premature infants of vitamin D deficient mothers although these were not statistically significant. Based on the levels of vitamin D umbilical cord blood, the CRP levels in the serum of premature infants were not different, while the IL-6 levels in the deficiency and insufficiency group were lower than in the normal group.Keywords: CRP, IL-6, maternal vitamin D, umbilical cord vitamin D.   Abstrak Tujuan: Peningkatan kadar faktor inflamasi pada  bayi baru lahir sering dikaitkan dengan rendahnya kadar vitamin D ibu. Penelitian ini bertujuan untuk mengetahui hubungan kadar serum vitamin D ibu dan tali pusat, dengan kadar IL-6 tali pusat dan serum C-Reactive Protein (CRP) bayi prematur.Metode: Studi observasional analitik dengan desain potong lintang pada  subjek  ibu yang mengalami kelahiran prematur di usia 28–34 minggu kehamilan disebabkan ketuban pecah dan bayi yang dilahirkannya, di  Rumah   Sakit  Umum  Pusat  Nasional dr. Cipto Mangunkusumo (RSCM) dan Rumah Sakit Umum Pusat Persahabatan, Jakarta, pada bulan Januari 2017 sampai Agustus 2018.  Variabel data adalah kadar serum vitamin D ibu dan tali pusat, kadar serum IL-6 tali pusat dan  kadar  CRP  darah  bayi.  Kadar vitamin D (25(OH)D) dibagi menjadi defisiensi (<10 ng/mL), insufisiensi (10–29 ng/mL) dan normal (>30 ng/mL) dan dicari hubungannya dengan kadar IL-6 tali pusat dan serum CRP bayi prematur, menggunakan uji Kruskal Wallis. Hasil: Sebanyak  70  subjek  telah memenuhi kriteria penelitian.  Kadar IL-6 tali pusat dan serum CRP bayi prematur dari kelompok ibu defisiensi vitamin D (20,31 pg/ml dan 0,50 mg/L) lebih tinggi dibandingkan kelompok ibu insufisiensi vitamin D (3,34 pg/mL dan 0,45 mg/L) maupun kelompok ibu normal vitamin D (3,29 pg/mL dan 0,30 mg/L) tetapi perbedaan tersebut tidak bermakna (IL-6 p=0,665 dan CRP p = 0,899).   Mengacu pada kadar vitamin D darah tali pusat didapatkan hasil yang berbeda dan tidak sesuai harapan, dimana tali pusat IL-6 dan serum CRP bayi prematur mengalami defisiensi (3,76 pg / mL dan 0,35 mg / L) dan insufisiensi. (3,37 pg / mL dan 0,40 mg / L) kelompok lebih rendah (IL-6) dan tidak berbeda (CRP) dibandingkan kelompok normal (9,41 pg / mL dan 0,40 mg / L).Kesimpulan: Didapat kecenderungan peningkatan kadar IL-6 darah tali pusat dan serum CRP bayi prematur dari ibu dengan defisiensi kadar vitamin D walaupun secara statistik tidak signifikan. Berdasarkan kelompok vitamin D darah tali pusat, kadar CRP serum bayi prematur tidak berbeda, sedangkan kadar IL-6 pada kelompok defisiensi dan insufisiensi lebih rendah dibandingkan pada kelompok normal.Kata kunci: CRP, IL-6, vitamin D ibu, vitamin D tali pusat.