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Maternal outcome in accreta cases. Conservative surgery and hysterectomy in Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from January 2017 to January 2018 Fita Maulina; Mohammad Adya Firmansha Dilmy; Yudianto Budi Saroyo; Yuditiya Purwosunu
Majalah Obstetri dan Ginekologi Vol. 29 No. 3 (2021): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V29I32021.129-135

Abstract

HIGHLIGHT1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed.3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital.ABSTRACTObjectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018.Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure.Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Prenatal diagnostic and management of megacystis microcolon intestinal hypoperistalsis syndrome: A report on a rare case in Cipto Mangunkusumo Hospital, Jakarta, Indonesia Fita Maulina; Yuditiya Purwosunu
Majalah Obstetri dan Ginekologi Vol. 28 No. 2 (2020): August
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V28I22020.93-98

Abstract

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare and the most severe form of functional intestinal obstruction in the newborn. The characteristic features of this congenital and fatal disease are abdominal distension, absent or decreased bowel peristalsis. Abdominal distension is a consequence of the distended, unobstructed urinary bladder with or without hydro nephrosis. Some previous reports have revealed that the typical antenatal sonographic findings are as follows: a greatly distended bladder, bilateral hydro nephrosis, and a normal amount of amniotic fluid; however, the antenatal diagnosis of this syndrome is occasionally difficult.
Vitamin D and T- regulator cells are not independent factors for RDS in premature neonates Putri Maharani Tristanita Marsubrin; Agus Firmansyah; Rinawati Rohsiswatmo; Yuditiya Purwosunu; Zakiudin Munasir; Tetty Yuniati
Paediatrica Indonesiana Vol 61 No 4 (2021): July 2021
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi61.4.2021.192-7

Abstract

Background The high morbidity and mortality of premature neonates remain significant problem in Indonesia with respiratory distress syndrome (RDS) as one of the most common problem. Vitamin D plays an important role in lung maturity. Vitamin D deficiency causes epithelial cell inflammation, leading to a higher risk of RDS. Previous studies suggest that T regulatory cells (Treg) in inflammatory diseases, such as RDS in neonates, are possibly linked to vitamin D deficiency. Objective To determine the role of vitamin D on RDS and Treg cells in very premature or very low birth weight neonates. Methods A prospective cohort study conducted on premature neonates in Neonatology Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Umbilical cord blood samples were collected to evaluate total vitamin D 25-OH levels and Treg cells. Subjects with RDS were evaluated until the end of the observation period. Results The mean umbilical cord vitamin D level was 15.79 (SD 6.9) ng/mL, and 53% of the subjects were found to be deficient. As much as 65.1% of neonates had RDS. The mean Treg level was 11.38 (SD 2.45)%. No significant correlation was observed between vitamin D level and the occurrence of RDS (RR 0.87; 95%CI 0.56 to 1.34; P=0.53); vitamin D level and the dysregulation of Treg cells (RR 1.30; 95%CI 0.76 to 2.21; P=0.31) as well as between Treg dysregulation and RDS (RR 1.11; 95%CI 0.70 to 1.75; P=0.64). However, we found that RDS group had a lower gestational age and higher presentation of dysregulation Treg. Conclusion In very premature or very low birth weight neonates, no association between occurence of RDS and vitamin D deficiency as well as Treg cell dysregulation.
Long-term Outcome of Severe Preeclampsia Cases: Cross – Sectional Study: Keluaran Jangka Panjang Kasus Preeklamsia Berat: Studi Potong Lintang Yuditiya Purwosunu; Nurida M. Siagian
Indonesian Journal of Obstetrics and Gynecology Volume 10 No. 1 January 2022
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v10i1.637

Abstract

Objectives: To investigate the long term outcome of severe preeclampsia mother by clinically and laboratory, and the long term outcome of the baby that she delivered. Method: This is a cross sectional study was conducted at Obstetrics Outpatient Clinic Dr. Cipto Mangunkusumo General Hospital (Cipto Mangunkusumo NCGH) on January–June 2017, of patients with previous severe preeclampsia that gave birth in Cipto Mangunkusumo NCGHon January 2014 – December 2016, and was descriptively analyze using SPSS Statistics 24. Results: One hundred and twenty seven patients were studied, divided into 3 groups of post – delivery time which were 6 months, 12 months, and 24 months. The 6 months’ group, mean of blood pressure were 147/92 mmHg (SD 38/SD 39), BMI 29 kg/m2 (SD 6), CRP level 16.6 mg/l (0.3 – 42.60) and urine protein dipstick 1 (0 – 3). The 12 months’ group, mean of blood pressure were 112/88 mmHg (SD 12/SD 24), BMI 21s kg/m2 (SD 7), CRP level 12.7 mg/l (3.4 – 15.2) and urine protein dipstick 0 (0 – 3). The 24 months’ group, mean blood pressure 154/95 mmHg (SD 45/SD 62), BMI 28.83 kg/m2, CRP level 14,2 mg/l (SD 8.54) and urine protein dipstick 0 (0 – 3). Meanwhile, the long – term outcome of babies that 68% baby were born with preterm condition and mean birth weight were 1943 grams (SD 1245), the 5th minute Apgar score >7 were 63.78%, and only 44.88% baby had normal growth development. Conclusion: The long – term outcome patients with previous severe preeclampsia are blood pressure, BMI, and CRP level still high, and negative urine protein level until 2 years of post – delivery. The long – term outcome of the babies that delivered were on preterm condition and low birth weight, with less than 50% had normal growth and development. Keywords: c–reactive protein, growth and development, proteinuria, post–delivery, severe preeclampsia. Abstrak Tujuan: Untuk mengetahui keluaran jangka panjang pada pasien ibu PEB dari sudut klinis dan laboratoris, serta keluaran jangka panjang bayi yang dilahirkan. Metode: Penelitian ini menggunakan desain potong lintang terhadap pasien riwayat PEB yang pernah melahirkan di RSUPN Dr. Cipto Mangunkusumo pada bulan Januari 2014–Desember 2016. Subjek diminta datang ke Poli Obstetri RSUPN Dr. Cipto Mangunkusumo pada Januari–Juni 2017 untuk dilakukan pemeriksaan klinis dan laboratoris (CRP dan protein urin), serta dilakukan analisa deskriptif menggunakan SPSS Statistik 24. Hasil: Sebanyak 127 pasien yang diteliti terbagi dalam 3 kelompok yaitu pasien riwayat PEB pasca persalinan 6 bulan (kelompok I), 12 bulan (kelompok II), dan 24 bulan (kelompok III). Kelompok I didapatkan rerata tekanan darah (TD) 147/92 mmHg (SD 38/SD 39), IMT 29 kg/m2 (SD 6), kadar CRP 16,6 mg/l (0,3 – 42,60) dan protein urin 1 (0 – 3). Kelompok II didapatkan rerata tekanan darah (TD) 112/88 mmHg (SD 12/SD 24), IMT 21 kg/m2 (SD 7), kadar CRP 12,7 mg/l (3,4 – 15,2) dan protein urin 0 (0 – 3). Kelompok III rerata TD 154/95 mmHg (SD 45/SD 62), IMT 28,83 kg/m2, dengan rerata kadar CRP 14,2 mg/l (SD 8,54) dan protein urin 0 (0 – 3). Sedangkan keluaran jangka panjang bayi yang dilahirkan bahwa 68% lahir dengan kondisi preterm dengan rerata berat lahir 1.943 gram (SD 1.245), nilai Apgar menit ke-5 >7 63,78%, dan hanya 44,88% tumbuh – kembang bayi normal. Kesimpulan: Gambaran keluaran jangka panjang pasien riwayat PEB didapatkan tekanan darah, IMT dan kadar CRP masih tinggi, serta protein urin urin negatif setelah 2 tahun pascapersalinan. Keluaran jangka panjang bayi yang dilahirkan mayoritas kondisi preterm dan berat lahir rendah, dengan kurang dari 50% bayi tumbuh – kembang normal. Kata kunci: c– reactive protein, preeklamsia berat, proteinuria, pascapersalinan, tumbuh kembang bayi.
The Correlation between Gestational Age and Stress Level in Pregnant Women, in Ciracas Health Care Service, East Jakarta Anggia Widyasari; Elfikri Asril; Fahmi Rusnanta; Irene Sinta Febriana; Susie Susilawati; Yuditiya Purwosunu
JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol 1 No 2 (2012): JIMKI : Jurnal Ilmiah Mahasiswa Kedokteran Indonesia
Publisher : BAPIN-ISMKI (Badan Analisis Pengembangan Ilmiah Nasional - Ikatan Senat Mahasiswa Kedokteran Indonesia)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Abstrak Kehamilan merupakan masa yang rentan terjadi stres. American college of Obstetrician and Gynecologist (ACOG) mengeluarkan rekomendasi terkait skrining stres psikososial selama kehamilan. Tujuan studi ini untuk mengetahui hubungan antara usia gestasi dan tingkat stres pada ibu hamil. Studi ini menggunakan desain potong lintang dengan total sampel sebesar 100 subjek penelitian yang dipilih dengan teknik consecutive sampling. Data diambil dengan menggunakan metode kuesioner untuk menilai data demografik, riwayat obstetri, dan tingkat stres yang mengacu pada The Prenatal Psychosocial Profile Hassles Scale. Hasil studi menunjukkan terdapat korelasi bermakna antara usia gestasi dengan skor stres (p=0,022), Korelasi bersifat negatif yang berarti semakin bertambah usia gestasi maka skor stres akan berkurang, tetapi kekuatan korelasi yang dimiliki masih lemah (R=-0,230). Berdasarkan analisis regresi linier, setiap pertambahan usia gestasi sebesar satu minggu akan menurunkan skor stres sebanyak 0,053. Studi ini menyimpulkan bahwa semakin bertambah usia gestasi akan menurunkan tingkat stres. Oleh karena itu, skrining stres psikososial selama kehamilan sangat diperlukan, terutama pada trimester pertama
Feasibility Study For Birth Defect’s and Congenital Abnormalities’s Integrated Service In A Low-Middle Income Country Saroyo, Yudianto Budi; Firmansha Dilmy, Mohammad Adya; Salsabila Putri, Cut Tisya; Islamah, Rachelya Nurfirdausi; Budiman, Jenica Xaviera; Rumondang, Amanda; Purwosunu, Yuditiya; Irwinda, Rima; Rohsiswatmo, Rinawati
Indonesian Journal of Obstetrics and Gynecology Volume 13. No. 3 July 2025
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v13i3.2783

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Background: Congenital abnormalities are anatomical and physiological abnormalities that are present in babies from birth. One of the main causes of high infant mortality and neonatal mortality in Indonesia is congenital abnormalities in babies. This study describes the prevalence of congenital abnormalities in Dr. Cipto Mangunkusumo Hospital, as a tertiary referral hospital in Indonesia, which requires integrated healthcare service to be treated well. Methods: Data obtained from 323 patients at Dr. Cipto Mangunkusumo General Hospital are collected in a year, to be further analyzed in retrospective cohort study. Collected data includes the patients’ age, birth date, reproductive history, gestational age, and congenital abnormalities of the baby. Results: The data shows that patients with the age group of 30-39 years old dominated the cases of pregnancy with congenital abnormalities. Cases are also more dominant in the gestational age of 13 – 28 weeks (second-trimester). Most cases of abnormalities are from the central nervous system with 159 cases and followed by cardiovascular system with 130 cases. Overall prevalence of congenital abnormalities are detected within patients during prenatal screening in Dr. Cipto Mangunkusumo General Hospital. Conclusion: This study highlights the importance in managing congenital abnormalities and birth defects by developing an integrated service in the healthcare system to lower infant and neonatal mortality. Keywords: birth defect, congenital abnormalities, prenatal screening
Higher Trace Elements and Lower Fatty Acids Levels in Erythrocytes as Predictors of Preeclampsia Putri, Ruth Widhiati Raharjo; Prasmusinto, Damar; Wibowo, Noroyono; Irwinda, Rima; Purwosunu, Yuditiya; Saroyo, Yudianto Budi
The Indonesian Biomedical Journal Vol 16, No 6 (2024)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v16i6.3256

Abstract

BACKGROUND: Preeclampsia is one of the common causes of maternal death in Indonesia. Many studies only focus on the diagnosis and pharmacological treatment of preeclampsia. However, predictors of preeclampsia need to be observed to add more focus on the etiology and prevention of preeclampsia. The imbalances of trace elements and fatty acids play an important role in preeclampsia. Therefore, this study was conducted to evaluate the status of trace elements and fatty acids in preeclampsia patients as predictors of preeclampsia.METHODS: A cross-sectional study was conducted in 3 hospitals, and involving 40 pregnant women classified into severe preeclampsia and normotensive groups. Trace elements and fatty acids were measured in serum and erythrocytes using Inductively Coupled Plasma and Gas Chromatography-Mass Spectrometry. Serum and erythrocytes fatty acid levels' cut-off value, sensitivity, and specificity were analyzed using Receiver Operating Characteristic (ROC) curve and Area Under the Curve (AUC) value.RESULTS: Serum selenium, manganese, and iron levels were significantly different in the preeclampsia group than in the controls (p<0.05). Of all the heavy metals, higher concentrations of cadmium, arsenic, lead, and mercury were found in preeclampsia groups compared to control. Linoleic acid showed the highest predictive value to increase severe preeclampsia with AUC of 0.8. The ratio of high omega-6/omega-3 increases the risk of preeclampsia.CONCLUSION: Selenium, manganese, iron, cadmium, arsenic, lead, and mercury levels are higher in the serum of preeclampsia patients. Almost all erythrocyte fatty acids were significantly higher in the control group compared to preeclampsia. Measurement of trace elements and fatty acids is needed as a predictor of preeclampsia. Erythrocyte fatty acids measurement is considered better than serum.KEYWORDS: trace elements, fatty acids, preeclampsia
Studi Ekspresi Glukosa Transporter pada Preeklampsia dan Hubungannya dengan Gangguan Metabolik pada Ibu Hamil Fairuz, Vycka Fikriyani; Saroyo, Yudianto Budi; Purwosunu, Yuditiya
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i2.55163

Abstract

Gangguan metabolik merupakan masalah kesehatan global yang ditandai dengan obesitas, resistensi insulin, hipertensi, dan hiperglikemia. Patogenesis sindrom metabolik bersifat multifaktorial, dipengaruhi oleh faktor nutrisi, genetik, dan lingkungan. Pada ibu hamil, gangguan metabolisme akibat obesitas dan hipertensi meningkatkan risiko diabetes melitus gestasional dan preeklamsia. Preeklamsia terjadi akibat gangguan plasenta yang disebabkan oleh defisiensi invasi trofoblas pada arteri spiral miometrium, mengakibatkan iskemia janin. Metabolisme karbohidrat, terutama glukosa, berperan penting dalam patofisiologi preeklamsia. Glukosa merupakan sumber utama energi yang dimetabolisme oleh sel trofoblas plasenta melalui ekspresi glukosa transporter (GLUT) pada jaringan fetomaternal. Tiga jenis GLUT utama yang berperan dalam transport glukosa antara ibu dan janin adalah GLUT1, GLUT3, dan GLUT4. Dalam kondisi preeklamsia, berkurangnya perfusi plasenta dan hipoksia menyebabkan gangguan ekspresi GLUT, sehingga transport glukosa ke janin menurun. Akibatnya, terjadi keterbatasan pertumbuhan janin serta peningkatan risiko komplikasi lainnya. Studi ini bertujuan untuk memahami hubungan antara ekspresi GLUT dan preeklamsia guna mengidentifikasi potensi intervensi terapeutik yang dapat meningkatkan transport glukosa ke janin. Hasil penelitian menunjukkan bahwa gangguan regulasi GLUT pada preeklamsia berkontribusi terhadap restriksi pertumbuhan janin. Kesimpulannya, pemahaman lebih lanjut mengenai ekspresi GLUT dalam preeklamsia dapat berkontribusi pada pengembangan strategi pengobatan yang lebih efektif untuk meningkatkan kesehatan ibu dan janin.
Lower Ferrum, Selenium, and Cadmium; Higher Chromium and Lead Levels in Preeclampsia Patients’ Erythrocyte: A Cross-Sectional Study Sandhy Prayudhana; Damar Prasmusinto; Noroyono Wibowo; Rima Irwinda; Yuditiya Purwosunu; Yudianto Budi Saroyo
The Indonesian Biomedical Journal Vol 17, No 1 (2025)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v17i1.3257

Abstract

BACKGROUND: Oxidative stress and trace elements in erythrocytes are linked to impaired nitric oxide that can lead to endothelial dysfunction in preeclampsia patients. The morphology of erythrocytes could also be affected by oxidative stress and trace elements. While the relationships between erythrocyte index, superoxide dismutase (SOD) activity, and oxidative stress in preeclampsia have been well established, less attention has been given to the erythrocyte trace elements and their role in disease progression. This study was performed to examine the erythrocyte trace element profile in women with preeclampsia, comparing it with controls. Additionally, it will explore the correlations between erythrocyte trace element levels, the erythrocyte index, and SOD activity.METHODS: A cross-sectional study was conducted involving 40 pregnant women consisting of those with severe preeclampsia and normotensive. Erythrocytes was isolated from blood samples, and analysis of erythrocyte SOD activity and trace elements were performed using the enzyme linked immunosorbent assay (ELISA) and inductively coupled plasma mass spectrometry (ICP-MS), respectively.RESULTS: Among 15 examined erythrocyte trace elements, the levels of ferrum (Fe), selenium (Se), and cadmium (Cd) were significantly lower, meanwhile, the levels of chromium (Cr) and lead (Pb) were significantly higher in preeclampsia subjects. Additionally, preeclampsia subjects exhibited smaller erythrocyte sizes compared to the normotensive subjects. The erythrocyte SOD activity was significantly elevated in the preeclampsia subjects than the normotensive subjects.CONCLUSION: Erythrocyte trace element levels of Fe, Se, Cd, Cr, and Pb were significantly altered in preeclampsia compared to normotensive controls. These findings suggest that these trace elements may serve as potential predictors for preeclampsia.KEYWORDS: preeclampsia, trace elements, antioxidant, oxidative stress, superoxide dismutase, erythrocyte index
Effect of High-Dose Vitamin D on Angiogenesis Markers in High-Risk Pregnant Women Nunki Febriastuti; Rima Irwinda; Noroyono Wibowo; Damar Prasmusinto; Yudi B. Saroyo; Yuditiya Purwosunu
Majalah Kedokteran Bandung Vol 58, No 1 (2026)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v58.4544

Abstract

Preeclampsia is characterized by impaired trophoblast invasion and angiogenesis. Recent evidence suggests that vitamin D supplementation may reduce the risk of preeclampsia by optimizing angiogenesis. This study aimed to evaluate the effect of high-dose vitamin D on angiogenesis markers in the first trimester by evaluating serum maternal placental growth factor (PlGF) and uterine artery pulsality index (UtA-PI) in pregnant women with a high risk for preeclampsia. A single-blind, randomized controlled trial was conducted on 80 pregnant women from April 2021 to April 2022 at Dr. Cipto Mangunkusumo National General Hospital and Koja District Hospital. Pregnant women at 7–11 weeks of gestation were divided into low-risk and high-risk preeclampsia groups. Each group was then randomized into a control group (multi-micronutrient supplementation/MMS) and an intervention group (MMS + vitamin D at 5,000 IU/day). Maternal serum 25(OH)D levels and PlGF levels, as well as Doppler UtA-PI, were measured at baseline and after one month of intervention. All participants had vitamin D deficiency at baseline. After one month, the increase in 25(OH)D level was significantly higher in the low-risk group (12.3±6.3 ng/mL vs 10.5±5.1 ng/, p<0.001). Mean UtA-PI was significantly reduced in both low-risk (-1.1±0.3) and high-risk (-0.43±0.26) intervention groups. PlGF level increasedwas significantly in both intervention groups (low-risk 107.9±32.0 vs. high-risk 70.5±18.3, p<0.001). High-dose vitamin D supplementation (5,000 IU/day) improves angiogenesis in the first trimester, suggesting potential benefits for improving pregnancy outcomes in women at risk for preeclampsia.