The advent of non-invasive prenatal testing (NIPT) utilizing cell-free fetal DNA (cfDNA) has transformed the landscape of early chromosomal anomaly detection. When paired with high-resolution ultrasound imaging, it establishes a robust framework for prenatal diagnostics. This study explores the efficacy of merging NIPT findings with detailed ultrasound markers to enhance the identification of both chromosomal and structural fetal abnormalities. Data from 190 cases demonstrated a cfDNA efficacy rate of 91.58 % (cfDNA ≥4 %) and a detection rate of 4.74 % for aneuploidies. The investigation delves into key findings for trisomies, monosomies, and physical malformations, backed by state-of-the-art diagnostic benchmarks. Markers such as nuchal translucency (NT), craniofacial characteristics, and cardiac irregularities were analyzed alongside genetic results. This integrative strategy significantly refines diagnostic precision, paving the way for personalized prenatal care and management.

Objectives: Maternal mortality rate (MMR) in Indonesia was reported to be 305 per 100,000 live births. Preeclampsia is the first target to decrease because it is one of the preventable pregnancy complications. Currently, preeclampsia has patterns for treatment from early detection to delivery; therefore, reasonable chances of decreasing the MMR rapidly and significantly should be considered in Indonesia. Materials and Methods: The reasons for choosing preeclampsia for reducing MMR included an early detection method, availability of affordable medication for the prevention of preeclampsia, development of a national guideline for medical practice regarding preeclampsia, establishment of health institutions by government and the private sector in remote areas, and availability of sufficient health personnel. Results: Early detection of risk factors of preeclampsia is of great importance. Recommended preventive medication includes a combination of acetyl salicylic acid and calcium for 12 weeks for a high-risk group. National guidelines for the management of preeclampsia should be distributed to all hospitals including those covered by national health insurance. Conclusions: The goal of zero mother mortality preeclampsia program is to make policies for all health workers and the general public so that the prevention process can take place. Delivery of all cases with hypertension should be performed in the hospital without exception so no delivery should be performed at home without specialist supervision.

The Zero Mother Mortality Preeclampsia (ZOOM) program was adopted as an accelerated initiative to curb mortality related to hypertensive disorders in pregnancy, including preeclampsia. This single-center, retrospective study in Bandung, West Java, aims to evaluate the impact of the ZOOM program implemented from 2015 to 2022. We analyzed 19,176 childbirths and associated maternal deaths due to hypertension in pregnancy. Diagnoses were validated using blood pressure measures, lab tests including urine protein, liver function, blood profiles, platelets, X-ray, echocardiography, and COVID-19 testing. The case fatality rate (CFR) was assessed to evaluate the impact of the ZOOM program. Hypertension in pregnancy was identified in 25.1% of cases, with 9.8% and 1.4% attributed to preeclampsia and eclampsia, respectively. Maternal deaths associated with hypertension accounted for 36.6%, with the majority linked to eclampsia. Heart failure (45.5%) and Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome (22%) were the most common complications. The CFR decreased from 61% in 2018 to 10% in 2022. The overall CFR from 2015 to 2022 was 1.3%, with the highest fatality rate observed in eclampsia cases (9.4%). However, a declining trend was seen since 2018, reaching a low of 0.2% in 2021. The implementation of the ZOOM program, which includes preeclampsia re-education, early detection, prompt intervention, protocol adjustments, and a refined referral system, led to a marked reduction in maternal deaths from hypertensive pregnancy disorders.

Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian–Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = −1.63) (95% CI; −4.92,0.28, p = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = −1.55, [CI: −2.89, −0.21], p = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07–3.01), p = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (−1.08–−0.33), p = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease’s response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.

Introduction: Gestational trophoblastic neoplasia (GTN) is a highly curable malignancy, but cases arising after abortion are uncommon and often diagnosed late. We report a recurrent high-risk GTN following abortion that relapsed multiple times despite etoposide–methotrexate–actinomycin D/cyclophosphamide–vincristine (EMA/CO). Case Report: A 26-year-old woman achieved initial remission with six cycles of EMA/CO but experienced several recurrences from 2021 to 2023. She presented again with rising β-hCG (16,925.8 mIU/mL) and an intrauterine mass. Paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE) was given for six cycles plus two consolidation cycles, resulting in complete remission. β-hCG normalized by January 2024 and remained undetectable for 12 months. Conclusion: This case highlights diagnostic challenges of post-abortion GTN and shows that TP/TE is an effective and well-tolerated salvage option for recurrent or EMA/CO-resistant GTN. Long-term β-hCG surveillance is essential to ensure durable remission and assess fertility outcomes.

BACKGROUND Hypoplastic left heart syndrome (HLHS) is a complex left-sided obstructive congenital cardiac condition with several variants. This report is of 5 cases with varying morphology of HLHS diagnosed by fetal prenatal ultrasound at the 4-chamber view (4CV) level. CASE REPORT Five cases were referred by obstetrics and gynecology specialists with preliminary information on visible congenital abnormalities in the third trimester. Fetal echocardiography showed that several morphological variants of HLHS were found. The patient in the first case had the most frequently found variant; this variation is usually linked to mitral valve stenosis (MVS). The second case had the characteristic of mitral valve atresia (MVA), and as a consequence, blood flow was not visible in this variant and the left ventricle (LV) was not clear or not adequately visualized by ultrasound. In the third case, the patient suffered from severe MVS and perhaps a small aorta. Uni-atrial conditions were described in the third case. In the fourth case, the patient had a narrow LV, MVA, ventricular septal defect, nearly united atrium, and tricuspid regurgitation. The fifth case was a case of HLHS with congenital diaphragmatic hernia. Further, 4 out of 5 of the cases were associated with widening of the cisterna magna and Dandy Walker syndrome-associated posterior fossa disorder malformations. The overall maternal age was over 35 years old in 4 cases. Karyotyping examination was not performed in all cases. CONCLUSIONS The role of ultrasound is very important in determining the diagnosis and the degree of development of hypoplastic LV. However, visualization at the 4CV level can detect abnormalities found in the LV.