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All Journal Community Medicine and Education Journal Jurnal Ilmu Kedokteran dan Kesehatan Indonesia
I Made Pasek Soma Gauthama
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Humanities Education Health Professions Languange, Linguistic, Communication & Media Public Health

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Prolaps Tali Pusat pada Skor Zatuchni-Andros Baik : Sebuah Laporan Kasus Tantangan Persalinan Sungsang I Gede Agus Rio Saputra; I Made Pasek Soma Gauthama
Jurnal Ilmu Kedokteran dan Kesehatan Indonesia Vol. 4 No. 3 (2024): November : Jurnal Ilmu Kedokteran dan Kesehatan Indonesia
Publisher : Pusat Riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/jikki.v4i3.8850

Abstract

Breech delivery remains an obstetric challenge due to its potential for intrapartum and neonatal complications. One rare yet potentially fatal complication is umbilical cord prolapse, particularly in footling presentations. This case report was developed based on clinical observation and medical documentation of a 29-year-old woman, gravida 2 para 1, at 39–40 weeks of gestation, who experienced cord prolapse during breech labor despite having a Zatuchni–Andros score of 5, indicating a favorable prognosis for vaginal delivery. The patient was planned for a vaginal delivery under close monitoring; however, during the active phase of the first stage of labor, spontaneous rupture of membranes occurred, immediately followed by umbilical cord prolapse with irregular fetal heart rate (82–90 beats per minute). Emergency management included manual cord reposition, Trendelenburg positioning, oxygen administration, and an urgent cesarean section. The male infant, weighing 2,995 grams, was delivered with no spontaneous cry and an Apgar score of 0–0, indicating severe asphyxia, while the mother remained stable postoperatively. This case highlights that although a favorable Zatuchni–Andros score suggests good prognosis, dynamic intrapartum factors such as membrane rupture and fetal position may precipitate sudden cord prolapse. The neonatal outcome is highly dependent on the decision-to-delivery interval, ideally within 30 minutes. Continuous fetal monitoring, intensive intrapartum supervision, and readiness for emergency cesarean section are essential to prevent perinatal morbidity and mortality.
Synergistic Undernutrition: The Metabolic Nexus Between Chronic Energy Deficiency and Anemia in Rural Balinese Pregnant Women I Putu Adigama; I Nyoman Sayang; Gusti Ngurah Nyoman Yuliastina; I Made Pasek Soma Gauthama
Community Medicine and Education Journal Vol. 6 No. 2 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i2.828

Abstract

Despite the widespread implementation of Iron-Folic Acid (IFA) supplementation programs, the prevalence of maternal anemia in Indonesia remains stagnant, suggesting a multifactorial etiology beyond simple micronutrient deficiency. In rural agrarian settings, macronutrient adequacy—specifically protein-energy balance—may play a critical, yet overlooked, role in hematopoiesis. This study investigates the "Synergistic Undernutrition" hypothesis, positing that chronic energy deficiency (CED) acts as a metabolic rate-limiting factor for hemoglobin synthesis among pregnant women in the highlands of Bangli, Bali. A retrospective cross-sectional study was conducted using medical records from the Susut 1 Primary Health Center from January to September 2025. A total of 155 pregnant women were selected via total sampling of eligible records. Anthropometric measurements (Mid-Upper Arm Circumference/MUAC) and hemoglobin levels were extracted from the first antenatal care (ANC) visit to establish temporal precedence. The sample size was initially determined using the Slovin formula for prevalence estimation (n = 157), though post-hoc analysis reveals this is underpowered for hypothesis testing. Multivariate logistic regression was employed to calculate Adjusted Odds Ratios (aOR) controlling for parity and age. The prevalence of CED (MUAC <23.5 cm) was 37.4%, and anemia (Hb <11 g/dL) was 41.9%. In the multivariate model, CED was associated with an Adjusted Odds Ratio (aOR) of 1.88 (95% CI: 0.97–3.67). While the p-value (0.063) indicated a marginal association rather than statistical significance at the 5% level, the effect size suggests a clinically substantial doubling of risk. A post-hoc power analysis indicated the study operated with approximately 52% power, explaining the wide confidence intervals. Multiparity also showed a similar marginal association (aOR 1.88; p=0.066). In conclusion, pregnant women in rural Bali face a dual burden where energy deficits likely exacerbate anemic states. Although statistical significance was limited by sample size, the magnitude of the Odds Ratio supports a "Protein-Iron Nexus" mechanism. Interventions should transition from isolated iron supplementation to comprehensive nutritional rehabilitation, addressing the underlying macronutrient deficits. Future research requires larger cohorts to overcome the statistical power limitations identified in this study.
Maternal Oxygen Transport Capacity and Nutritional Reserves: Anemia and Mid-Upper Arm Circumference (MUAC) as Independent Predictors of Low Birth Weight in the Indonesian Highlands I Putu Adigama; I Nyoman Sayang; Gusti Ngurah Nyoman Yuliastina; I Made Pasek Soma Gauthama
Community Medicine and Education Journal Vol. 7 No. 1 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v7i1.832

Abstract

Low birth weight (LBW) remains a critical determinant of neonatal mortality and long-term metabolic syndrome, particularly in agrarian transition zones. While demographic factors are often studied, the specific impact of maternal oxygen transport capacity (hemoglobin) and somatic nutritional reserves (Mid-Upper Arm Circumference/MUAC) remains under-characterized in highland populations where the paradox of food security versus nutritional insecurity exists. A retrospective case-control study was conducted in the highland region of Bangli, Indonesia, covering all deliveries in 2024. To maximize statistical power within the available clinical population, a total sampling technique was employed for the case group (n=20 mothers delivering infants <2,500g), matched 1:2 with randomly selected controls (n=40 mothers delivering infants ≥2,500g). Data were analyzed using independent t-tests and binary logistic regression. The multivariate model was restricted to biological predictors to maintain statistical stability given the sample size. The prevalence of anemia and Chronic Energy Deficiency (CED) was significantly higher in the case group (p<0.001). Bivariate analysis indicated profound risks associated with anemia (OR=9.00) and CED (OR=6.93). In the adjusted multivariate model, maternal anemia (aOR=11.45; 95% CI: 2.50–52.40) and CED (aOR=9.80; 95% CI: 2.15–44.60) remained dominant, independent predictors. The wide confidence intervals reflect the small sample size inherent to the facility-based dataset. ROC analysis demonstrated that MUAC <23.5 cm offers excellent diagnostic accuracy (AUC=0.845). In conclusion, clinical markers of oxygen transport and nutritional substrate availability are superior predictors of LBW compared to maternal age or parity in this cohort. The findings advocate for a biological-first approach to antenatal risk stratification.
Co-Authors Gusti Ngurah Nyoman Yuliastina I GEDE AGUS RIO SAPUTRA I Nyoman Sayang I Putu Adigama