Risk Factors Associated With the Case Fatality Rate of Pulmonary Tuberculosis in Pregnancy: A Five-Year Retrospective Study From a Developing Country.

Background Tuberculosis is a leading cause of maternal and fetal mortality in women of reproductive age. Tuberculosis is frequently misdiagnosed and treated inadequately during pregnancy. Although the global case fatality rate of tuberculosis is decreasing annually, the trend of tuberculosis mortality in Indonesia remains relatively high. Most tuberculosis reports do not include pregnancy status because most countries do not routinely screen for tuberculosis in pregnant women and do not report pregnancy status in female cases. In Southeast Asia, there is currently insufficient data regarding the risk factors associated with maternal mortality due to tuberculosis. This study aimed to identify the risk factors associated with tuberculosis-related mortality during pregnancy. Methodology This retrospective study was conducted at Dr. Soetomo General Hospital, Surabaya. Data were collected from patients' medical records. The samples were all pulmonary tuberculosis cases in pregnancy (suspected, bacteriological, and radiologically confirmed cases) from 2014 to 2018. Data on maternal characteristics, underlying risk factors, and maternal outcomes in pregnant women with tuberculosis were collected from medical records. A total of 77 cases of pulmonary tuberculosis in pregnancy were obtained and analyzed using the chi-square test for differences between pregnant women with tuberculosis who survived and those who did not. Results In total, 77 cases of pulmonary tuberculosis out of 7,242 deliveries were found during the past five years (incidence per year was 1.07), of whom 20.8% (16/77) died. Eight patients died before the gestational age reached 28 weeks. Most of the non-surviving women were aged <35 years (93.8%; 15/16). More than 30% (5/16) of the patients had human immunodeficiency virus co-infection, and the highest risk factors were pneumonia and miliary tuberculosis. Miliary tuberculosis was significantly associated with maternal mortality in pulmonary tuberculosis (p = 0.004) with a relative risk of 3.43. Conclusions According to the findings of this study, miliary tuberculosis is a significant risk factor for maternal mortality during pregnancy.

Parents'Knowledge of'Tarak'Breastfeeding Mothers in Indonesia.

Objectives: To analyse the relationship between the level of knowledge of parents about 'tarak' on eating patterns in breastfeeding mothers. Method: This study uses a descriptive correlational design with a cross-sectional approach. The sample in this study was determined by the krejcie and morgan sample size table as many as 99 pairs of breastfeeding mothers and mother in-laws were selected using a purposive sampling technique in East Java, Indonesia. The Spearman test was performed in the final test for knowledge of parents about 'tarak' (independent variable) and eating patterns in breastfeeding mothers (dependent variable). RESULTS: The results informed that there was no relationship between the level of parental knowledge about 'tarak' on eating patterns in nursing mothers, with p = 0.154. CONCLUSIONS: There was no relationship between knowledge of 'tarak' and the eating pattern of breastfeeding mothers. Although the mother's diet is not influenced by knowledge of 'tarak', it is still necessary to educate parents about 'tarak' and the proper diet for breastfeeding mothers to prevent misinformation. So that breastfeeding mothers can increase nutritional intake during breastfeeding.

The Risk of Persistent Hypertension and Chronic Kidney Disease in Early- and Late-Onset Preeclampsia: A Report From Developing Country.

BACKGROUND AND OBJECTIVE: Preeclampsia (PE) has been disproportionately prevalent in developing countries and constitutes a leading cause of maternal mortality, and also has long-term impacts, including renal consequences. This study aimed to explore the risk of persistent hypertension and kidney failure in early-onset PE (EOP) and late-onset PE (LOP) in the five years after delivery. METHODS: This retrospective cohort study included women with a prior history of severe PE or normotensive pregnancy admitted to tertiary hospitals in Indonesia. The blood pressure, body mass index (BMI), urea, creatinine serum, and protein urine were analyzed, and the risk of chronic kidney disease (CKD) after five years was performed using the Kidney Disease Improvement Global Outcomes (KDIGO) classification. RESULTS: Twenty-seven EOP, 35 LOP, and 30 normotensive cases were included. Mean blood pressure after five years was recorded as 115.6 ± 14.25 mmHg in the normotensive group, 131.82 ± 19.34 mmHg in the LOP group, and 154.96 ± 23.48 mmHg in the EOP group. According to the KDIGO classification, the normotensive group had an average 10% risk of CKD, but severe PE had a risk of CKD greater than 90%. In the severe PE group, the risk of CKD was 20.94 times higher compared to normotensive women (OR 20.94; 95% CI 2.67-163.72, p = 0.004). The risk of CKD in the EOP group was 6.75 times higher than in the LOP group (OR 6.75; 95% CI 2.19-20.76, p = 0.001), whereas persistent hypertension in the EOP group was 5.78 times higher than in the LOP group (OR 5.78; 95% CI 1.91-17.395, p = 0.002). CONCLUSIONS: PE women have a higher risk of CKD than normotensive women. Women with a history of EOP are more likely to develop persistent hypertension and CKD than women with a prior LOP history.

Uterine conservative-resective surgery for selected placenta accreta spectrum cases: Surgical-vascular control methods.

INTRODUCTION: The incidence of placenta accreta spectrum (PAS) has increased, but the optimal management and the optimal way to achieve vascular control are still controversial. This study aims to compare maternal outcomes between different methods of vascular control in surgical PAS management. MATERIAL AND METHODS: A retrospective cohort study on consecutive cases diagnosed with PAS between 2013 and 2020 in single tertiary hospital. The final diagnosis of PAS was made following preoperative ultrasound and confirmation during surgery. Management of PAS using cesarean hysterectomy with internal iliac artery ligation (IIAL) was compared with two types of vascular control in uterine conservative-resective surgery (IIAL vs identification-ligation of the upper vesical, upper vaginal, and uterine arteries). RESULTS: Over an 8-year period, 234 pregnant women were diagnosed with PAS meeting the inclusion criteria. Uterine conservative-resective surgery (200 cases) was associated with lower mean blood loss compared with cesarean hysterectomy with IIAL (34 cases) in all PAS cases (1379 ± 769 mL vs 3168 ± 1916 mL; p < 0.001). In sub-analysis of the two uterine conservative-resective surgery subgroups, the group with identification-ligation of the upper vesical, upper vaginal, and uterine arteries had a significantly lower blood loss compared with uterine conservative-resective surgery with IIAL (1307 ± 743 mL vs 1701 ± 813 mL; p = 0.005). Women in the hysterectomy with IIAL group had more massive transfusion (35.3% vs 2.5%; p < 0.001; odds ratio [OR] 21.3, 95% confidence interval [CI] 6.9-66), major blood loss (>1500 mL) (70.6% vs 34%, p < 0.001; OR 4.7; 95% CI 2.1-10.3), catastrophic blood loss (>2500 mL) (64.7% vs 12.5%;p < 0.001; OR 12.8, 95% CI 5.7-29.1), other complications (32% vs 12.4%; p = 0.007; OR 3.4, 95% CI 1.5-7.7), and intensive care unit admission (32.4% vs 1.5%; p < 0.001; OR 31.4, 95% CI 8.2-120.7) compared with the uterine conservative-resective surgery groups. The identification-ligation of the upper vesical, upper vaginal and uterine arteries had a significant lower risk for major blood loss (30.5% vs 50%; p = 0.041; OR 0.44, 95% CI = 0.2-0.9) compared with IIAL for vascular control of uterine conservative-resective surgery. CONCLUSIONS: Cesarean hysterectomy is not the default treatment for PAS, PAS with invasion above the vesical trigone are suitable for uterine conservative-resective surgery with upper vesical, upper vaginal and uterine artery vascular control.

Characteristics shifting of heart disease in pregnancy: A report from low middle-income country.

BACKGROUND: Heart disease in pregnancy is one of the leading causes of maternal mortality and morbidity in developing countries. However, the characteristics of the disease vary between countries and regions. This study aimed to present the characteristics of pregnant women with heart disease in an economically advantageous region of a developing country. DESIGN AND METHODS: A cross-sectional study was conducted using data from the Weekly Report of Obstetrics and Gynaecology Department to assess pregnant women with heart disease characteristics and pregnancy outcomes. A total sample of 69 pregnant women with heart disease regarding their gestational age was included in the study. Variables observed were maternal characteristics, heart disease's clinical parameters, and maternal and neonatal outcomes. Chi-square test was used to examine the different characteristics of congenital and acquired heart disease groups. RESULTS: The prevalence of cardiac disease in pregnancy was 5.19%. Fifty-three point six percent of pregnant women with heart disease were suffered from congenital heart disease (CHD), while 46.4% were acquired heart disease (AHD). Most labor methods were Cesarean delivery, and 69.6% of women experienced cardiac complications. Maternal death was reported in 8.69% of cases. Four cases were CHD complicated by pulmonary hypertension, which leads to Eisenmenger syndrome. Two other cases were AHD complicated by Peripartum Cardiomyopathies. Although statistically insignificant, complications are more common in the AHD group than CHD. CONCLUSION: Cardiac disease prevalence in pregnancy is considered high, with CHD as the most common case, which significantly differs from other developing countries.

New three-dimensional/four-dimensional volume rendering imaging software for detecting the abnormally invasive placenta.

OBJECTIVE: This study aimed to determine the role of three-dimensional (3D)/four-dimensional (4D) volume rendering ultrasound (VRU) in the diagnosis of abnormally invasive placenta (AIP). MATERIALS AND METHODS: Twelve consecutive patients strongly suspected of having AIP on the basis of conventional ultrasound (US) and clinical history performed between September 2016 and December 2016 in the main tertiary referral hospital in Surabaya, East Java were included in this prospective observational study. A Samsung WS 80A Elite US scanner with a 3D/4D "crystal vue" and "realistic vue" volume rendering mode was used to establish the diagnosis of AIP and evaluate the site, and depth of placental invasion. The VRU images were compared with the intraoperative findings. RESULTS: Using this novel US technique, all cases of suspected AIP were subsequently confirmed during surgery. Importantly, the new US technique provided a correct diagnosis of the degree of invasion in 11 out of these 12 suspected AIP cases: 5/5 for placenta percreta, 3/3 for placenta increta, and 2/3 for placenta accreta; one patient was misdiagnosed in terms of the degree of placenta accreta, and one patient had normal implantation). CONCLUSION: This new software of 3D/4D VRU represents a promising technique for the preoperative diagnosis and staging of AIP.

Serum heme oxygenase 1 (HO-1), soluble FMS like tyrosine kinase (sFlt-1) level, and neonatal outcome in early onset, late onset preeclampsia, and normal pregnancy.

OBJECTIVE: To compare the level of serum heme oxygenase 1 (HO-1), soluble FMS like tyrosine kinase (sFlt-1), and neonatal outcome in early onset preeclampsia (EO-PE), late onset preeclampsia (LO-PE), and normal pregnancy (NP). METHODS: In this prospective observational case control study, HO-1 and sFlt-1 levels were measured in blood samples within 24 h of hospital admission. Preeclampsia cases were divided into two groups based on gestational age at delivery: EO-PE (<34 weeks) and LO-PE (≥34 weeks). A total of 45 patients were involved in this study. RESULT: Maternal serum level of sFlt-1 was higher in EO-PE than LO-PE and NP groups (mean ± SD; 14.50 ± 17.12 ng/ml vs 5.20 ± 6.69 ng/ml vs 2.72 ± 1.2 ng/ml [p = 0.020]. Maternal serum level of HO-1 was not different between EO-PE, LO-PE, and NP groups (p = 0.681). Birthweights were significantly lower in the EO-PE group compared with the LO-PE and NP groups (1580 ± 536 g vs 2635 ± 578 g vs 3010 ± 371 g [p = 0.000]). The rate of small for gestational age infant (26.7% vs 6.7% vs 0%; p = 0.046) and perinatal death (20% vs 0 vs 0; p = 0.037) was also significantly higher in EO-PE compared to LO-PE and NP. The maternal sFlt-1 level was negatively correlated with birthweight (p = 0.006; CC = -0.445). CONCLUSION: This study did not find a correlation between maternal HO-1 levels and sFlt-1 levels. Maternal serum sFLt-1 levels in preeclampsia were higher in EO-PE and were associated with a worse perinatal outcome.

Adherence to iron supplementation amongst pregnant mothers in Surabaya, Indonesia: Perceived benefits, barriers and family support.

BACKGROUND: Anaemia during pregnancy is a major nutritional problem that can cause preterm delivery and low birth weight. Adherence to iron supplementation can prevent anaemia during pregnancy. However, adherence to iron supplementation remains a problem in many countries. OBJECTIVE: This study aimed to identify the correlations of the perceived benefits and perceived barriers of and family support for iron supplementation with adherence to this practice amongst pregnant woman in Surabaya, Indonesia. METHODS: A cross-sectional study was carried out on 102 pregnant women who attended check-ups at the Puskesmas and received iron supplementation. Data were collected using questionnaires. RESULTS: Perceived benefits (r = 0.334, P = 0.001), perceived barriers (r = -0.294, P = 0.003) and family support (r = 0.263, P = 0.008) were noted to be correlated with adherence to iron supplementation amongst pregnant woman in Surabaya, Indonesia. CONCLUSION: Perceived benefits, perceived barriers and family support are related to adherence to iron supplementation; thus, developing good perceptions and family support should be properly promoted.