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All Journal MEDICINUS JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia
Arya Ady Nugroho
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Fetus dengan Massa Lidah Besar, Prosedur EXIT pada Seksio Sesarea Darurat: Laporan Kasus Nugroho, Arya Ady; Damar Prasmusinto; Ummu Hani; Widyastuti
JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol 12 No 1 (2025): JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol. 12.1 (2025)
Publisher : BAPIN-ISMKI (Badan Analisis Pengembangan Ilmiah Nasional - Ikatan Senat Mahasiswa Kedokteran Indonesia)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53366/jimki.v12i1.904

Abstract

Pendahuluan: Prosedur Ex Utero Intrapartum Treatment (EXIT) adalah teknik penting untuk mendukung fungsi kardiopulmoner janin selama seksio sesarea dengan mempertahankan sirkulasi plasenta. EXIT digunakan dalam berbagai indikasi, seperti manajemen jalan napas (EXIT-to-airway), reseksi tumor (EXIT-to-resection), dan ECMO. Meskipun prosedur ini banyak dilaporkan untuk kasus-kasus tertentu, keberhasilan pada kasus massa lidah besar dengan ketuban pecah dini sangat jarang dilaporkan. Kasus ini bertujuan untuk menambah pemahaman tentang aplikasi EXIT dalam situasi darurat dan dampaknya pada hasil neonatal. Ilustrasi Kasus: Wanita hamil 25 tahun dengan usia kehamilan 38 minggu, didiagnosis dengan massa besar pada lidah janin. Dilakukan seksio sesarea darurat dengan prosedur EXIT untuk mengamankan jalan napas neonatus. Durasi EXIT adalah 3 menit 30 detik, dengan intubasi endotrakeal yang berhasil. Pasca-lahir, MRI mengonfirmasi massa lidah yang melibatkan otot dan vaskularisasi arteri lingual, dengan diagnosis tumor vaskular. Diskusi: Prosedur EXIT berhasil mengamankan jalan napas neonatus dan mempertahankan sirkulasi plasenta. Kasus ini menyoroti pentingnya pendekatan multidisiplin dalam menangani massa fetal besar dan ketuban pecah dini. Keberhasilan EXIT dalam kasus ini menambah wawasan terkait penerapan prosedur ini untuk situasi darurat yang tidak terduga. Simpulan: EXIT dapat digunakan untuk menangani massa lidah besar pada janin dengan ketuban pecah dini, memberikan hasil neonatal yang baik dengan tim multidisiplin yang terkoordinasi.
Diagnostic Dilemma in Massive Cellular Leiomyoma with Cystic Degeneration Arya Ady Nugroho; Riyan Hari Kurniawan; Aprilia Asthasari Siregar
MEDICINUS Vol. 38 No. 11 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/qkhd0b31

Abstract

Background: Uterine leiomyomas, commonly known as fibroids, are prevalent benign tumors in women of reproductive age. While often asymptomatic, they can become symptomatic when they enlarge or when degenerative changes occur. Cystic degeneration, which occurs in approximately 4% of leiomyomas, presents a diagnostic challenge, as it can mimic malignancy on imaging due to its solid-cystic appearance on imaging. This case report aims to highlight the diagnostic dilemma posed by large leiomyomas with cystic degeneration and to emphasize the importance of advanced imaging as well as histopathological examination in confirming benign diagnoses and excluding malignancy. Case Presentation: A 27-year-old woman presented with progressive abdominal distension and intermittent lower abdominal pain over thepast year. Imaging revealed a large, solid-cystic mass in the uterine fundus, raising suspicion of malignancy. Further diagnostic workup, including magnetic resonance imaging (MRI) and histopathological examination, confirmed the massas a benign leiomyoma with cystic degeneration. The patient underwent a laparotomy myomectomy, and intraoperative findings confirmed a well-circumscribed subserosal mass with cystic degeneration. Histopathology examination alsoconfirmed a benign leiomyoma, ruling out malignancy. Conclusion: This case underscores the diagnostic challenges of differentiating large leiomyomas with cystic degeneration from malignancies. Advanced imaging, particularly MRI, along with histopathological examination, plays a crucial role in establishing an accurate diagnosis and subsequently, guiding appropriate management.
NAUSICAA Compression Suture of The Lower Uterine Segment in Morbidly Adherent Placenta Previa Case Arya Ady Nugroho; Sri Pudyastuti; Tri Apriliawan Bendarto Rahardjo
MEDICINUS Vol. 38 No. 12 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/gna3c076

Abstract

Background: Placenta accreta spectrum or morbidly adherent placenta occurs mostly on a previous cesarean scar when placenta fails to detach due to abnormal invasion of placenta in to the uterine wall. The incidence of morbidly adherent placenta increased in the past decade from 0.8 per 1000 deliveries to 3 per 1000 deliveries.1 The increase in the incidence is attributed to increase in cesarean deliveries from 1 in about 2500 births to 1 in 500 births.2  A recent retrospective study reported that the rate of accreta for previous 1, 2, 3, 4, and 5 cesarean deliveries was found to be 26.7%, 43.5%, 65.5%, 55.6%, and 66.7%, respectively.3 Case presentation: In this study, We present a case of thirty-one year-old gravida III para II, 36 weeks of gestasional age, presented to the outpatient clinic and diagnosed with adhesive total placenta previa on US exam. Patient underwent c-section continued with nausicaa uterine compreesion suture, intraoperative bleeding was 1100 cc, there was no complication. Conclusion: Fertility-sparing surgery for women with morbidly adherent placenta could be one of the options to be considered. Nausicaa suture is a simple and feasible alternative to hysterectomy in patients suffering from major PPH.
Triple-Threat Pregnancy: Navigating PPCM, Preeclampsia, and Thalassemia Major – A Holistic Reproductive Risk Assessment Post-Cesarean Delivery Arya Ady Nugroho; Yudianto Budi Saroyo; Dwiana Ocviyanti
MEDICINUS Vol. 39 No. 1 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/qdxs3625

Abstract

Background: Pregnancies complicated by multiple severe maternal conditions such as peripartum cardiomyopathy (PPCM), preeclampsia, and β-thalassemia major, pose significant risks to both mother and fetus. This case explores the challenges of managing a high-risk pregnancy, involving these conditions and highlights the importance of a multidisciplinary approach in high-risk pregnancy management.Case presentation: A 33-year-old pregnant woman with β-thalassemia major presented at 32+4 weeks of gestation with acute dyspnea, severe preeclampsia, and signs of PPCM. She was carrying dichorionic diamniotic twins and required emergency cesarean section after stabilization. Echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of 35%. The patient underwent immediate postoperative management and received a trans-cesarean intrauterine device (IUD) insertion for long-term contraception. Both neonates were admitted to the neonatal intensive care unit (NICU) for prematurity care.Conclusion: This case underscores the critical need for a holistic, multidisciplinary approach in managing complex highrisk pregnancies, focusing on immediate maternal stabilization, neonatal care, and long-term reproductive planning.
Co-Authors Aprilia Asthasari Siregar Damar Prasmusinto Dwiana Ocviyanti Riyan Hari Kurniawan Sri Pudyastuti Tri Apriliawan Bendarto Rahardjo Ummu Hani WIDYASTUTI Yudianto Budi Saroyo