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All Journal Majalah Obstetri dan Ginekologi Majalah Kedokteran Sriwijaya Indonesian Journal of Obstetrics & Gynecology Science Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) Proceedings of the International Conference on Applied Science and Health Global Health Management Journal SRIWIJAYA JOURNAL OF MEDICINE Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Indonesian Journal of Perinatology

Nuswil Bernolian

Biomedicine Doctoral Program, Faculty Of Medicine, Universitas Sriwijaya, Palembang, South Sumatera, Indonesia / Division Of Maternal Fetal Medicine, Department Of Obstetrics And Gynecology, Mohammad Hoesin General Hospital/Faculty Of Medicine, Unive

Author-ID : 242139

Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Comparison between Leukocyte Esterase Activity (LEA) and Histopathology Examination in Identifying Chorioamnionitis Cases: Uji Diagnostik Leukocyte Esterase Activity (LEA) terhadap Histopatologi pada Kasus korioamnionitis Putri H Novianesari; Nuswil Bernolian; Henni Maulani; Afifa Ramadanti; Theodorus Theodorus
Indonesian Journal of Obstetrics and Gynecology Volume 7, No. 1 January 2019
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To compare sensitivity and specificity of LEA to histopathology examination in diagnosing chorioamnionitis. Methods: We compared diagnostic tests in dr. Mohammad Hoesin hospital, Palembang, from September 2015 to April 2016. Ninety-one pregnant women were included. LEA and histopathology examination were carried out with neonatal sepsis as main outcome. Data were analysed by SPSS version 21.0 and Med-calc statistic. Results: Chorioamnionitis was detected in 54 (77.1%) patients with gestational period â‰¥37 weeks and in 16 (22.9%) patients with gestational period <37 weeks. Duration of membrane rupture was significantly associated with chorioamnionitis (p = 0.001 and p = 0.011). Neonatal sepsis was also significantly associated with chorioamnionitis in both groups (p = 0.014 and p = 0.036). LEA value with cut-off point >0.5 was able to significantly predict chorioamnionitis with 98.6% sensitivity and 95.2% specificity, providing better accuracy in diagnosing chorioamnionitis in preterm pregnancy group. Conclusion: LEA had a very good predictive value for chorioamnionitis with better accuracy in diagnosing chorioamnionitis in preterm pregnancy. Keywords: Chorioamnionitis, Histopathology, Leukocyte esterase activity, Neonatal sepsis, Salafia criteria Tujuan: Membandingkan sensitifitas dan spesifisitas diagnosis korioamnionitis antara pemeriksaan Leukocyte esterase activity (LEA) terhadap histopatologi. Metode: Penelitian uji diagnostik dilakukan di RSUP dr. Mohammad Hoesin Palembang selama periode September 2015 â€“ April 2016, 91 wanita hamil yang memenuhi kriteria inklusi selanjutnya dilakukan pemeriksaan LEA, Histopatologi dan luaran sepsis neonatorum. Data kemudian dianalisis dengan menggunakan software SPSS versi 21.0 dan Med-calc statistic. Hasil: Korioamnionitis terdeteksi pada 54 (77,1%) pasien dengan usia gestasi â‰¥37 minggu dan 16 (22,9%) pada usia gestasi <37 minggu. Durasi lamanya pecah ketuban akan berpengaruh secara signifikan terhadap kejadian korioamnionitis (p = 0,001 dan p = 0,011), Sepsis neonatorum juga secara signifikan berhubungan dengan kejadian korioamnionitis pada kedua kelompok (p = 0,014 dan p = 0,036). Kadar LEA dengan cut off point >0,5 secara signifikan mampu memprediksi kejadian korioamnionitis dengan sensitivitas 98,6%, spesifisitas 95,2% dan nilai akurasi yang lebih baik ditemukan dalam penegakan diagnosis korioamnionitis pada kelompok kehamilan preterm. Kesimpulan: Pemeriksaan LEA memiliki kekuatan prediksi yang sangat baik terhadap kejadian korioamnionitis dengan akurasi yang lebih baik dalam mendiagnosis korioamnionitis pada kehamilan preterm. Kata kunci: Korioamnionitis, Histopatologi, Leukocyte Esterase Activity,Sepsis Neonatorum, Kriteria Salafia

THE EVALUATION OF EARLY INITIATION BREASTFEEDING PRACTICE in Dr. mohammad hoesin hospital palembang Nuswil Bernolian; Amal C. Sjaaf
Proceedings of the International Conference on Applied Science and Health No. 1 (2017)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Background: Compared to other countries, the rate of EIB in Indonesia remains low (34,5%). During our practice, particulary in delivery room, we often find practices which delayed EIB. The recent finding that early initiation of breastfeeding (EIB) could substantially reduce neonatal mortality should result in more comprehensive efforts to increase the number of infants breast-fed within an hour of birth. Such efforts can only be effective if policies and guidelines are based on a solid knowledge of the barriers and facilitators for EIB. Aims: To evaluate EIB practice in Dr. Moh. Hoesin hospital. Methods: This was an analytic observational study, using cross sectional design. Our populations were all of afterbirth mothers (spontaneous or abdominal delivery), doctors, midwifes, as well as managerial policy holder. Samples were selected by purposive sampling. Data was obtained from the questionnaire which have been tested for validity and reliability. This study included 29 doctors and 14 midwifes as EIB implementers; also 12 managerial staffs. Results: During the periodNovember to December 2016, there were 19 (51.3%) patients with post spontaneous or abdominal deliverypracticed EIB and 18 (48.6%) patients did not practice EIB. Most of patients in “no EIB group” had abdominal delivery (p = 0,003). Most of patients complained that no EIB policy in operating room. Most of implementers stated that EIB already done well. The EIB implementers complained that there was lack of support about EIB practice from hospital manager and maternal level of knowledge was low. Our study found the disintegration between the managerial and executive staff, causing ambiguity in the practice of the EIB. Conclusion: The opportunitiy of EIB practice was affected by medical condition ofmother and fetus,method of delivery, hospital support, EIB policy socialization, and patient’s knowledge. There were so many challenges for our hospital to practice EIB, such as no EIB policy in operating room,the mother's condition wasnot possible to practice EIB, knowledge of the managerial about EIB differ greatly, low socialization about regulations and other elements of the EIB implementation. Thereis also disintegration between the managerand executive staff causing ambiguity in the practice ofEIBand the lack of supervision of EIB practice in the field.

Cardiac Disease in Pregnancy: Maternal and Perinatal Outcomes in RSUP Dr. Mohammad Hoesin Palembang Ni Made Dyah Gayatri; Peby Maulina Lestari; Abarham Martadiansyah; Nuswil Bernolian; Hadrians Kesuma Putra; Rizky Agustria; Muwarni Emasrissa Latifah
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 2 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i2.448

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 total sampling method and 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 6 cases (0.87%) found in 2018, 38 cases (2.47%) found in 2019, and 24 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.

Characteristics of pregnancy with Systemic Lupus Erythematosus (SLE) in Dr. Mohammad Hoesin Hospital, Palembang Nyimas Aliyah Faizatun Muthmainnah; Nuswil Bernolian; Eddy Roflin; Cindy Kesty
Indonesian Journal of Perinatology Vol. 2 No. 1 (2021): Available Online: 1 June 2021
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with complex pathogenesis with broad clinical manifestations, more common in women of reproductive age between 15-44 years, so there is an increased incidence in pregnancies. Methods: This study was a descriptive observational study with a cross-sectional design using medical records of patients in Dr. Mohammad Hoesin Hospital Palembang from January 2018-June 2020. Sampling was carried out by total sampling with the presentation of data in tables and narratives. Data processing was performed using SPSS 25. Results: There were 1,039 pregnancies in January 2018-June 2020 with 26 pregnancies with SLE and 8 patients (30.8%) of moderate degree SLE. The demographic characteristics were 26-30 age range (30.8%), high school education status (53.8%), the number of pregnancies 2-3 times (53.8%), the number of primiparous births (46.2%), and the number of miscarriages was never experienced (65.4%). Based on clinical signs and symptoms, malaise (15.4%), malar rash, photosensitivity spots and alopecia (15.4%), inflammatory arthritis (46.2%), lupus nephritis (11.5%), abdominal pain ( 34.6%), lymphadenopathy (3.8%), anemia or lymphopenia (15.4%), and cephalgia (7.7%). Meanwhile, the parameter of diagnosis was lymphopenia (15.4%), eGFR stage 1 (34.6%), proteinuria or proteinuria and cylindruria (11.5%), ANA test (+) (19.2%), anti-dsDNA test (+) (19.2%), and the complement test decreased (7.7%). Pregnancy outcomes were found to have intrauterine growth restriction (IUGR) (19.2%) and preeclampsia and IUGR (11.5%). Conclusion: From the 26 pregnant patients with SLE, most were found with a moderate degree. Most demographic characteristics were age range 26-30 years old, high school education status, number of pregnancies 2-3 times, primipara, and never miscarriage. Characteristics of clinical signs and symptoms most commonly found in patients were malaise, malar rash, photosensitivity spots and alopecia, inflammatory arthritis, and abdominal pain. The diagnosis parameters were lymphopenia, stage 1 eGFR, proteinuria or proteinuria and cylindruria, ANA test (+), and anti-dsDNA test (+). Most pregnancy outcome is intrauterine growth restriction (IUGR).

THE DIAGNOSTIC METHODS OF PLACENTA ACCRETA SPECTRUM DISORDERS Alia Desmalia; Nuswil Bernolian; Abarham Martadiansyah; Theodorus Theodorus; Citra Dewi; Putri Mirani; Peby Maulina Lestari; Cindy Kesty
Majalah Kedokteran Sriwijaya Vol 54, No 3 (2022): Majalah Kedokteran Sriwijaya
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/mks.v54i3.19655

Placenta Accreta Spectrum Disorder (PASD) is abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall. Magnetic resonance imaging (MRI) examination is one of the tools that can help diagnosing PASD earlier, so that maternal morbidity and mortality can be reduced. This study aims to determine the prevalence, risk factors of PASD and the accuracy of Placenta Accreta Index Score (PAIS) and MRI, with histopathological examination in diagnosing PASD at dr. Mohammad Hoesin General Hospital (RSMH) Palembang during the 2018–2021. A descriptive study with a survey design on pregnant and intrapartum women with suspected PASD was performed at Department of Obstetrics and Gynecology at RSMH Palembang from 2018 until 2021. There were 72 study subjects who met the inclusion criteria. The relationship between the independent and dependent variables was analyzed using Chi Square and Fisher Exact. The cut-off point of the PAIS scores was analyzed using the Receiver Operating Curve (ROC). The comparison of the diagnostic value of PAIS and MRI scores used the Youden Index. Data was analyzed with SPPS version 22.0 From 72 subjects, 60 subjects (83.3%) were PASD and 12 subjects (16.7%) were not PASD. The risk factors of PASD in this study was surgical history more than once (PR = 4.600 (95% CI 1.261–16.781); p = 0.037). Youden Index values and PAIS accuracy were 0.782 and 0.953 while Youden Index values and MRI accuracy were 0.333 and 0.886. PAIS and MRI could be considered as diagnostic tools for PASD. However, overall, PAIS had a better diagnostic value than MRI.

Pulmonary hypertension in pregnancy Bernolian, Nuswil; Kesty, Cindy; Mirani, Putri; Lestari, Peby Maulina; Martadiansyah, Abarham; Agustria, Rizky
Indonesian Journal of Perinatology Vol. 5 No. 1 (2024): Available online: 1 June 2024
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v5i1.36

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.

Pencegahan Abortus pada Awal Kehamilan Bernolian, Nuswil; Pangemanan, Wim T.; Syamsuri, Ahmad Kurdi; Ansyori, M. Hatta; Mirani, Putri; Lestari, Peby Maulina; Martadiansyah, Abarham; Kesty, Cindy
Indonesian Journal of Obstetrics & Gynecology Science Volume 6 Nomor 3 November 2023
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v6i3.403

Abortus merupakan suatu kejadian terminasi kehamilan dengan usia kehamilan <20 minggu dan berat janin <500 g. Angka kejadian abortus disebutkan sekitar 15% dari seluruh kehamilan. Terdapat beberapa faktor risiko abortus yaitu faktor risiko yang dapat dimodifikasi dan tidak dapat dimodifikasi. Beberapa faktor risiko yang dapat dimodifikasi yaitu faktor nutrisi, konsumsi kafein, alkohol, kebiasaan merokok, infeksi, paparan radiasi, beban kerja, dan pengaruh obat-obatan. Beberapa faktor risiko yang tidak dapat dimodifikasi, yaitu genetik, kelainan kongenital, dan lain-lain. Dengan mengetahui faktor risiko tersebut, dokter dapat melakukan pencegahan dan intervensi yang sesuai dengan kondisi masing-masing pasien yang mengalami abortus. Metode yang digunakan adalah tinjauan pustaka dengan menggunakan beberapa database seperti Pubmed, Wiley Online Library, dan ScienceDirect dari 10 tahun terakhir.Prevention of Miscarriage in Early PregnancyAbstractMiscarriage is an event of termination of pregnancy with < 20 weeks of gestation and fetal weight < 500 grams. The incidence of miscarriage is around 15% of all pregnancies. There are several risk factors for miscarriage, namely modifiable and non-modifiable risk factors. Some modifiable risk factors are nutritional factors, consumption of caffeine, alcohol, smoking habit, infection, radiation exposure, workload, and the influence of drugs. Several risk factors that can not be modified, namely genetics, congenital abnormalities, and others. By knowing these risk factors, doctors can carry out prevention and intervention according to the conditions of each patient who undergoes miscarriage. The method used is a literature review using several databases such as Pubmed, Wiley Online Library, and ScienceDirect from the last 10 years.Key words: miscarriage, prevention, risk factors, pregnancy.

Multigravida 37 Weeks Pregnant Not in Labour with Carotid Cavernous Fistula Life Single Fetus Head Presentation: Case Report Puspitasari, Dwi Cahya; Bernolian, Nuswil; Pangemanan, Wim Theodorus; Syamsuri, Ahmad Kurdi; Ansyori, Muhammad Hatta; Mirani, Putri; Lestari, Peby Maulina; Martadiansyah, Abarham
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 1 Maret 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i1.611

Background: Carotid cavernous fistula (CCF) is an abnormal shunt from the carotid artery to the cavernous sinus. The management of pregnant patients with CCF is individualized. The aims of this case report are to document a rare presentation of a multigravida at 37 weeks of gestation with a carotid cavernous fistula, describe clinical symptoms and management, report outcomes, and contribute insights to the medical literature.Case Report: The referred patient, G2P1A0, who was 37 weeks pregnant with a live single fetus in cephalic presentation, presented with left eye swelling persisting since the first pregnancy at 6 months gestation, associated with headaches. The patient underwent neurosurgical intervention at Mohammad Hoesin Hospital, including digital subtraction angiography (DSA). Currently, experiencing preterm labor symptoms, the management includes inpatient care, blood transfusion (Hb > 10 g/dL), and termination via the perabdominal approach.Discussion: A multigravida at 37 weeks pregnant in labor with carotid cavernous fistula and a live single fetus in head presentation, as existing literature suggests, has no clear link between maternal carotid cavernous fistula history and fetal outcomes. Despite concerns about potential fetal abnormalities and cancer risk from endovascular embolization therapy during pregnancy, postpartum follow-up with advanced digital subtraction angiography (DSA) is planned.Conclusion: The complexity of managing a multigravida at 37 weeks pregnant in labor with carotid cavernous fistula and a live single fetus in head presentation emphasizes the importance of a multidisciplinary approach for optimal maternal and fetal outcomes.Multigravida Hamil 37 Minggu Belum Inpartu dengan Fistula Cavernosa Karotis Janin Tunggal Hidup Presentasi Kepala: Laporan KasusAbstrakLatar belakang: Fistula kavernosus karotis (CCF) adalah celah/ lubang abnormal dari arteri karotis ke sinus kavernosus. Penatalaksanaan pasien hamil dengan CCF bersifat individual. Tujuan dari laporan kasus ini adalah untuk mendokumentasikan presentasi langka seorang multigravida pada usia kehamilan 37 minggu dengan fistula kavernosus karotis, mendeskripsikan gejala klinis dan penatalaksanaannya, melaporkan hasil, dan menyumbangkan wawasan untuk literatur medis.Laporan Kasus: Pasien yang dirujuk, G2P1A0, pada usia kehamilan 37 minggu dengan janin tunggal hidup dengan presentasi kepala, datang dengan pembengkakan mata kiri yang berlangsung sejak kehamilan pertama pada usia kehamilan 6 bulan, yang berhubungan dengan sakit kepala. Pasien menjalani intervensi bedah saraf di Rumah Sakit Mohammad Hoesin, termasuk Digital Subtraction Angiography (DSA). Saat ini, mengalami gejala persalinan prematur, penatalaksanaan yang dilakukan meliputi rawat inap, transfusi darah (Hb > 10 g/dL), dan terminasi melalui pendekatan perabdominal.Diskusi: Seorang multigravida dengan usia kehamilan 37 minggu yang melahirkan dengan fistula kavernosa karotis dan janin tunggal hidup dengan presentasi kepala, merupakan kasus yang jarang terjadi, karena literatur yang ada menunjukkan tidak ada hubungan yang jelas antara riwayat fistula kavernosa karotis ibu dan hasil janin. Meskipun ada kekhawatiran mengenai potensi kelainan janin dan risiko kanker dari terapi embolisasi endovaskular selama kehamilan, tindak lanjut pascapersalinan dengan angiografi pengurangan digital (DSA) lanjutan direncanakan.Simpulan: Kompleksitas pengelolaan multigravida dengan usia kehamilan 37 minggu dalam persalinan dengan fistula kavernosa karotis dan janin tunggal hidup dengan presentasi kepala, menekankan pentingnya pendekatan multidisiplin untuk luaran ibu yang optimal. Perlunya pendektanan multidispilin keilmuan memeberiksan hasil yanga baik pada ibu dan bayinya.Kata kunci: Fistula Kavernosa Karotis, Angiografi Pengurangan Digital

Congenital Diaphragmatic Hernia Anomaly in Multigravida at 36 Weeks Gestation with One Previous Cesarean Section, Single Live Fetus, Cephalic Presentation: Case Report Putri, Asri Indriyani; Martadiansyah, Abarham; Bernolian, Nuswil; Al Farisi Sutrisno, Muhammad; Nisfita, Rizania Raudhah; Maharsi, Rahma
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 2 Juli 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i2.613

Background: Case of a multigravida at 36 weeks of gestation with one previous cesarean section carrying a single fetus was diagnosed with diaphragmatic hernia. This case aims to address the challenges posed by this complex scenario of diaphragmatic hernia and the importance of specialized care to ensure optimal maternal and fetal outcomes.Case Report: Referred from Muhammadiyah Hospital Palembang, the patient at 36 weeks of gestation with G3P2A0 status present a single live fetus and was diagnosed with diaphragmatic hernia. Following prior midwife care where fetal heartbeats were not detected, the patient was referred to Dr. Mohammad Hoesin Central General Hospital Palembang. The management plan includes a one-week follow-up and folic acid, calcium carbonate, and iron supplementation.Discussion: Congenital diaphragmatic hernia (CDH) is a developmental defect causing diaphragmatic discontinuity, diagnosed prenatally with 40% to 90% accuracy via ultrasound. The treatment aims to minimize lung hypoplasia and reduce mortality, typically performed at 26-28 weeks for severe cases and 30-32 weeks for moderate ones. The optimal delivery timing for CDH remains controversial, with lung-to-head ratio as a widely used prognostic indicator.Conclusion: Congenital diaphragmatic hernia (CDH) exhibits lower survival rates on the right side (50% vs. 75%), with lung area to head circumference ratio (LHR) as a common prognostic parameter. Recent minimally invasive techniques like FETO aim to improve prognosis by reducing pulmonary hypoplasia and mortality.Laporan Kasus: Multigravida Hamil 36 Minggu Belum Inpartu Bekas Seksio Sesarea Satu Kali Janin Tunggal Hidup Presentasi Kepala Dengan Anomali Kongenital Hernia DiafragmatikAbstrakLatar Belakang: Kasus multigravida hamil 36 minggu dengan riwayat operasi caesar janin tunggal hidup yang didiagnosis hernia diafragma. Tujuan laporan kasus ini untuk mengatasi tantangan yang ditimbulkan oleh skenario kompleks hernia diafragma dan menunjukkan pentingnya perawatan khusus untuk memastikan hasil akhir ibu dan janin yang optimal.Laporan Kasus: Pasien usia kehamilan 36 minggu dengan status G3P2A0 janin hidup tunggal dengan diagnosis hernia diafragma dirujuk dari RS Muhammadiyah Palembang setelah sebelumnya diperiksa oleh bidan dan tidak terdeteksi detak jantung janinnya sehingga memerlukan rujukan ke RSUP Dr. Mohammad Hoesin Palembang. Rencana penatalaksanaannya mencakup tindak lanjut selama satu minggu, bersamaan dengan suplementasi asam folat, kalsium karbonat, dan zat besi.Diskusi: Hernia diafragma kongenital (CDH) merupakan kelainan perkembangan yang menyebabkan diskontinuitas diafragma dan didiagnosis sebelum lahir dengan akurasi 40% hingga 90% melalui ultrasonografi. Tatalaksana bertujuan untuk meminimalkan hipoplasia paru-paru dan mengurangi angka kematian, biasanya dilakukan pada minggu ke 26 sampai 28 untuk kasus yang parah dan 30 - 32 minggu untuk kasus yang sedang. Waktu persalinan yang optimal untuk CDH masih kontroversial, dengan rasio paru-paru sebagai indikator prognosis yang banyak digunakan.Kesimpulan: Hernia diafragmatika kongenital (CDH) menunjukkan tingkat kelangsungan hidup yang lebih rendah pada sisi kanan (50% vs. 75%), dengan rasio area paru terhadap lingkar kepala (LHR) sebagai parameter prognosis yang umum; teknik invasif minimal terkini bertujuan untuk meningkatkan prognosis dengan mengurangi hipoplasia paru dan kematian.Kata kunci: Hernia Diafragma Kongenital, Riwayat Operasi Caesar Sebelumnya, Multigravida

Complex Obstetric Case Report: Multigravida at 36 Weeks with Imminent Premature Delivery, Hansen's disease, and Prior Cesarean Section Sangjaya, Arif; Bernolian, Nuswil; Mafiana, Rose
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 1 Maret 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i1.614

Hansen’s disease, or leprosy, is a chronic granulomatous infection caused by the obligate intracellular bacterium Mycobacterium leprae. Pregnancy triggers leprosy in 10–25% of women because of immune disturbances, which affect the disease’s course. This study reports the case of a 26-year-old pregnant woman who presented with the chief complaint of abdominal cramps with a contraction every 10 min. The patient admitted to experience vaginal discharge since the onset of pregnancy, without itching or odor. She also revealed a history of leprosy since 2020, which manifested as lumps around the ears, face, and legs, along with numbness at the extremities. She started treatment in 2021 with multi-drug therapy (MDT) but self-discontinued at 14 weeks of pregnancy because of nausea and weakness. The management plan includes dexamethasone ( 12 mg ) intramuscularly to enhance fetal lung maturity, nifedipine ( 10 mg ) every 6 h to suppress preterm contractions, and dermatovenereological assessment to address the patient’s history of Hansen’s disease. A joint conference is planned to discuss and coordinate the management approach. This study underscores the importance of proper management with WHO-recommended multidrug therapy (MDT) comprising rifampicin, dapsone, and clofazimine. Overall, effective management strategies are crucial to prevent permanent nerve, skin, limb, and eye damage in mothers and infants affected by leprosy.Laporan Kasus: Multigravida Hamil 36 Minggu dengan Partus Prematurus Imminens, Morbus Hansen, dan Bekas Sectio CessariaAbstrakPenyakit Hansen, atau lepra, adalah infeksi granulomatosis kronis yang disebabkan oleh bakteri intraselular obligat Mycobacterium leprae. Kehamilan memicu kusta pada 10–25% wanita karena adanya gangguan imunitas yang memengaruhi perkembangan penyakit. Studi ini melaporkan kasus seorang wanita hamil berusia 26 tahun yang datang dengan keluhan utama nyeri perut dengan kontraksi setiap 10 menit. Pasien mengakui mengalami keluarnya cairan vagina yang tidak bau maupun disertai gatal sejak awal kehamilan. Pasien memilliki riwayat penyakit Hansen sejak 2020, yang ditandai dengan benjolan di sekitar telinga, wajah, dan kaki, bersama dengan mati rasa di ujung anggota tubuh. Pasien memulai pengobatan pada 2021 dengan multidrug therapy (MDT) tetapi menghentikannya sendiri pada usia kehamilan 14 minggu karena mual dan rasa lemah yang dirasakan. Rencana tatalaksana mencakup pemberian Deksametason 12 mg intramuskular untuk meningkatkan kematangan paru-paru janin, Nifedipin 10 mg setiap 6 jam untuk menekan kontraksi prematur, dan evaluasi dermatovenereologi untuk mengatasi riwayat penyakit Hansen pada pasien. Konferensi bersama direncanakan untuk membahas dan mengkoordinasikan pendekatan pengelolaan. Studi ini menekankan pentingnya pengelolaan yang tepat, dengan MDT yang direkomendasikan oleh WHO yang terdiri dari rifampisin, dapsone, dan clofazimin. Secara keseluruhan, strategi pengelolaan yang efektif sangat penting untuk mencegah kerusakan saraf, kulit, mata, dan anggota tubuh permanen baik pada ibu maupun bayi yang terkena penyakit ini.Kata kunci: Penyakit Hansen, persalinan prematur, diagnosis.

Co-Authors A. Kurdi Syamsuri Achmad Taufan Adhi Pribadi Adrian, Ronny Afifa Ramadanti Agustria, Rizky Al Farisi Sutrisno, Muhammad Alba G.E. Bahar Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Alia Desmalia Aloysius Suryawan Amal C. Sjaaf Amir Fauzi Amir Fauzi Anang Ansyori Andanaputra, Waskita Ekamaheswara Kasumba Andonotopo, Wiku Anita Deborah Anwar Ansyori, Muhammad Hatta Ardesy Melizah Arjanggi, Kiagus Irawan Satria Bachnas, Muhammad Adrianes Bambang Rahardjo Bangun T. Purwaka, Bangun T. Benedictus Wicaksono Widodo Chairil Anwar Cindy Kesty Citra Dewi Cut Meurah Yeni Damar Prasmusinto Darmawan, Ernawati Dharma, Wibisana Andika Krista Djanas, Dovy Eddy Roflin Efendi Lukas Eke P Mahacakri Eric Edwin Yuliantara Evert Solomon Pangkahila Firmansyah Basir Firmansyah Basir Harry Kurniawan Gondo Henni Maulani Herman Kristanto I Nyoman Hariyasa Sanjaya Jhonatan, Senna Moca Johanes C. Mose Julian Dewantiningrum Juneke J. Kaeng Junita, Nuria Kesty, Cindy Kgs Irawan Satria Arjanggi Khanisyah Erza Gumilar Kurjak, Asim Kusuma, Anak Agung Ngurah Jaya M. Hatta Ansyori Made K. Karkata, Made K. Mahacakri, Eke P Maharsi, Rahma Maisuri T. Chalid, Maisuri T. Makmur Sitepu, Makmur Martadiansyah, Abarham Maulani, Henni Muhammad Irsan Saleh Mutiara Budi Azhar Muwarni Emasrissa Latifah Muzakkie, Mufida Ni Made Dyah Gayatri Nisfita, Rizania Raudhah Noroyono Wibowo Novianesari, Putri H Nugraha, Laksmana Adi Krista Nurul Islamy Nurul Islamy Nyimas Aliyah Faizatun Muthmainnah Optima Fitra Ilhami Pangemanan, Wim T Pangemanan, Wim Theodorus Peby Maulina Lestari, Peby Maulina Pramono, Mochammad Besari Adi Puspitasari, Dwi Cahya Putra, Hadrians Kesuma Putra, Ridwan Abdullah Putri H Novianesari Putri Mirani Putri Mirani Putri Mirani Putri Mirani Putri, Asri Indriyani Rima Irwinda, Rima Rizky Agustria Ronny Adrian Rose Mafiana Ryan Saktika Mulyana Sangjaya, Arif Sentani, Ray Suga Aulia Sjaaf, Amal C. Sjaaf, Amal C. Sri Sulistyowati Stanojevic, Milan Syamsuri, Ahmad Kurdi Syifa Alkaf Theodorus Theodorus Theodorus Theodorus Theodorus Theodorus Theodorus Theodorus Theresia Monica Rahardjo Wim T Pangemanan Wim T. Pangemanan Wim T. Pangemanan Win T. Pangemanan Wiradnyana, Anak Agung Gede Putra WISNU PRABOWO Yulianto kusnadi Yusrawati Yusrawati Yusuf Efendi

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