Abarham Martadiansyah

Introduction and importance: Ectopia cordis is a rare congenital anomaly characterized by the abnormal positioning of the heart outside the thoracic cavity, frequently associated with additional congenital defects such as those seen in Pentalogy of Cantrell. Due to the rarity and severity of these anomalies, timely diagnosis and appropriate management remain clinically challenging but critical for patient outcomes. Case presentation: We report two distinct cases of ectopia cordis managed at our institution. The first case presented with complete ectopia cordis and absence of the sternum, requiring initial management with a Bogota bag followed by placement of bovine pericardium; unfortunately, the patient succumbed to complications of sepsis and heart failure at 12 days of life. The second case involved partial ectopia cordis accompanied by features of Pentalogy of Cantrell, managed conservatively with a Bogota bag and spontaneous epithelialization, resulting in successful discharge with stable clinical status. Clinical discussion: Management of ectopia cordis, especially when complicated by associated anomalies, presents significant surgical and clinical challenges. Survival rates remain low due to complications such as sepsis, cardiac instability, and limited thoracic cavity space. Utilization of biomaterials like bovine pericardium has shown promise in providing necessary cardiac protection when primary closure is not feasible. Early multidisciplinary intervention, involving neonatologists, pediatric cardiologists, and surgeons, is crucial for optimizing outcomes. Conclusion: While prognosis for ectopia cordis remains poor, careful and individualized management strategies, including timely intervention and infection prevention, can lead to favorable outcomes as demonstrated in our second case. This underscores the importance of a multidisciplinary approach and early prenatal diagnosis in enhancing survival rates for this rare condition. Highlights:

BACKGROUND:Postpartum blood loss after cesarean section can be challenging to control, resulting in maternal morbidity and mortality. Tranexamic acid (TXA) is a synthetic reversible plasminogen inhibitor that is approved for the management of heavy menstrual bleeding, but off-label use has been described, including for the control of postpartum hemorrhage (PPH). This study aimed to compare postpartum blood loss after cesarean section in women treated with either tranexamic acid or placebo. MATERIAL AND METHODS:This single-center clinical study conducted in Indonesia enrolled 88 women undergoing cesarean section. Participants were randomized into 2 groups: the treatment group (n=44) received 1 g of TXA intravenously at the time of surgical incision, and the placebo group (n=44) received 10 ml of saline. Blood loss was measured using a calibrated surgical suction device and pictogram, with total blood loss calculated by subtracting amniotic and irrigation fluids. RESULTS:PPH occurred in 10.2% of all patients. Group A had significantly less blood loss than group B (mean=459.4 ml vs 686.3 ml; P<0.001). TXA was significantly protective, reducing the risk of PPH by 87.5% compared to group B (RR=0.125 [95% CI 0.016-0.958]; P=0.045). There were no significant differences in adverse effects between the 2 groups (P=0.101). CONCLUSIONS:Intraoperative TXA administration significantly reduces blood loss and the risk of PPH in women undergoing cesarean sections. These findings support the routine use of TXA in cesarean management protocols to improve maternal safety and outcomes.

HIGHLIGHTS ABSTRACT Objective: The objective of this study was to analyze the maternal and perinatal outcomes of COVID-19 in pregnancy at Dr. Mohammad Hoesin Hospital, Palembang, Indonesia. Materials and Methods: This retrospective cohort study was carried using medical records of pregnant mothers who delivered at Dr. Mohammad Hoesin Hospital Palembang from March 2020 to August 2021. The subjects were into two groups: pregnant women with and without COVID-19. Pearson Chi-Square test was used for bivariate analysis to determine the associations between COVID-19 and maternal as well as neonatal outcomes. The data were analysed using the Stata 15 statistical software. Multivariate analysis was done using the cox regression test to determine whether maternal characteristics affected those associations. P-value of < 0.05 were considered statistically significant. Results: The study analyzed 220 subjects, including 62 COVID-19-positive (28.18%) and 158 COVID-19-negative (71.82%) patients. Among expectant mothers with COVID-19, caesarean sections were the most common maternal outcome (82.26%), while fetal distress was the most frequent perinatal outcome (12.13%). Significant associations were found between COVID-19 and maternal outcomes, including pneumonia (RR = 12.76), caesarean section (RR = 2.74), and ICU hospitalization (RR = 6.90). These associations remained significant after adjusting for maternal characteristics. However, no significant association was found between COVID-19 and perinatal outcomes. Conclusion: COVID-19 increases the likelihood of adverse maternal outcomes throughout pregnancy.

BACKGROUND: Assessment of labor progress via digital vaginal examination is subjective, while intrapartum transperineal ultrasonography is deemed more objective and effective. The angle of descent (AoD) is a reliable intrapartum transperineal ultrasound parameter with minimal inter-observer and intra-observer errors. This study compared intrapartum transperineal ultrasonography with digital vaginal examination in evaluating the angle of descent for vaginal delivery selection in 70 women. MATERIAL AND METHODS: This cross-sectional study was conducted at Dr. Mohammad Hoesin Hospital Palembang in Indonesia, using a consecutive sampling method to measure AoD of 70 patients at admission and every 2 h during labor progression. Patients were monitored until childbirth, and outcomes of successful vaginal or cesarean delivery were reported. A diagnostic test determined the optimal AoD for predicting successful vaginal delivery and its predictive value. RESULTS: The study included 70 patients with a mean age of 28.29 +/- 6.09 years and a body mass index of 30.59 +/- 3.49 kg/m(2). Among them, 29 (41%) had successful vaginal deliveries. Adequate contraction frequency at admission was strongly associated with successful vaginal delivery (P<0.001). The optimal AoD for predicting successful vaginal delivery was 94.5 degrees, with an area under the curve of 0.567 (95% CI 0.425-0.710), sensitivity of 84.2%, specificity of 45.7%, and accuracy of 54.3%. CONCLUSIONS: Intrapartum transperineal ultrasonography for measuring AoD can be a valuable adjunct in labor management. Further investigations are needed to validate the optimal AoD in Indonesian pregnant women.

Pulmonary hypertension (PH) is a persistent increase in mean pulmonary arterial pressure (mPAP) of at least 20–25 mm Hg during right cardiac catheterization. For every million patients, there were 97 PH cases. Women are more likely than men (1.7:1) to receive a diagnosis, with a mean age of 37 years. The classification, pathophysiology, mechanism, and management of postpartum hemorrhage (PH) are the main aims of this review study. Pulmonary artery hypertension (PAH), pulmonary hypertension (PH) associated with left heart disease, pulmonary hypoxia and/or lung illnesses, chronic thromboembolic PH, and PH with unknown multifactorial processes are the five categories into which PH is divided. Women, particularly those of reproductive age, make up about 80% of individuals with idiopathic PAH. Pregnancy-related PH is one of the long-standing heart conditions with a significant morbidity and mortality rate. Its estimated death rate ranges from 30.56%. Pregnancy is therefore not advised in PH patients. Treating people with PH requires early diagnosis and effective treatment. These patients have optimism because of the impending PH medications (phosphodiesterase type 5 inhibitors, nitric oxide, endothelin receptor antagonists, and calcium channel blockers) as well as the advancements in hemodynamic monitoring and intensive care in PH specialty facilities. Pregnant women with PH should be treated with a multidisciplinary approach, such as obstetricians, cardiologists, intensivists, and neonatologists.

Update Manajemen Preeklamsia dengan Komplikasi Berat (Eklamsia, Edema Paru, Sindrom HELLP)

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.

Background: Impaired maternal and uteroplacental perfusion can occur in pregnancy with cardiac disease leading to maternal and perinatal mortality and morbidity due to increased cardiac load and ventricular dysfunction. This research aims to determine maternal and perinatal outcomes of pregnancies with cardiac disease. Method: This research was a descriptive observational study conducted by a total sampling method and a cross-sectional design. This research used medical records of pregnant women with cardiac disease who gave birth in RSUP Dr. Mohammad Hoesin Palembang in January 2018-December 2020 as study samples. Result: Among 68 pregnancies with cardiac disease, there were 4 cases (0.87%) found in 2018, 37 cases (2.47%) found in 2019, and 27 cases (1.48%) found in 2020. The highest distribution of pregnancies with cardiac disease was found at 64.7% in the range of 20-35 years old age group; 57.4% in the multiparity group; 38.2% in the range of ≥34 – <37 weeks gestational age group; 86.8% in the high school educational level group; 66.2% in the high-risk cardiac functional status group; 54.4% in the peripartum cardiomyopathy group; and 36.8% with preeclampsia/eclampsia as a comorbid. In this study, maternal outcomes found were maternal mortality at 11.8%; cardiac failure at 70.6%; arrhythmia at 1.5%; and stroke at 1.5%, while perinatal outcomes found were prematurity at 60.3%; low birth weight at 64.4%; IUGR at 37.0%; IUFD at 1.4%; stillbirth at 6.8%; neonatal death at 9.6%; and perinatal asphyxia at 42.5%. Conclusion: The prevalence rate of pregnancies with cardiac disease in RSUP Dr. Mohammad Hoesin Palembang was 0.87% in 2018, 2.47% in 2019, and 1.48% in 2020. The most common maternal outcome in this study was cardiac failure, with most in the peripartum cardiomyopathy group, while the most common perinatal outcome was low birth weight, with most in the hypertensive heart disease group.

The early 2021 rise in COVID-19 cases, as well as the advent of novel types due to mutations, tightened social activities. To avoid transmission of the virus between pregnant women, health workers, and other visitors, service adjustments are required to assist pregnant women in doing prenatal checkups. Every day at home, efforts to maintain the maternal can be made, including normal physical activity and managing dietary intake. To boost pregnant women's understanding, community service activities such as counseling on antenatal care, physical exercise, and particular dietary intake are carried out. In total, 92 expectant mothers took part in webinars. Prior to the webinar, a pretest was used to measure initial knowledge; the average result was in the "Good" category. The activity went off without a hitch, and the attendees were eager to ask questions. The post-test score increased to the "Very Good" level, according to the evaluation data. This webinar activity will help pregnant women gain a better understanding of how to stay healthy during the COVID-19 pandemic.