Background and Objectives: The pathogenesis of placenta accreta spectrum disorder (PASD) is influenced by the inflammatory process. Therefore, the examination of biomarkers related to the inflammatory process, namely matrix metalloproteinase (MMP) and CXC motif chemokine receptor 2 (CXCR2), is expected to bring researchers to a bright spot regarding the pathogenesis of PASD. This study analyzes the role of CXCR2, MMP-2, and MMP-9 in the pathogenesis of PASD. Materials and Methods: An observational study with a case–control design was conducted to assess differences in the mean density of CXCR2, MMP-2, and MMP-9 immunostaining in placental and uterine tissue in 17 patients with PASD and 34 patients without PASD at the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin Hospital Palembang. The expression of CXCR2, MMP-2, and MMP-9 was measured by immunohistochemistry analysis. The data were analyzed using STATA version 15. Results: There were no significant differences in the mean levels of MMP-2 expression in patients with and without PASD. There were significant differences in the expression of placental CXCR2 (p = 0.003), uterine CXCR2 (p < 0.001), and uterine MMP-9 (p = 0.018) in patients with and without PASD. Conclusions: CXCR2 and MMP-9 may play a role in the pathogenesis of PASD.

The recent increase in placenta accreta spectrum has been correlated with a rise in the rate of cesarean sections. A recent study provides evidence that hampered wound healing results in cesarean scar defects that lead to a failure in the normal process of decidualization and deeper adherence of trophoblasts. Matrix metalloproteinase (MMP) is crucial in every step of wound healing as it alters the wound matrix, facilitating cell migration, as well as tissue remodeling. MMP-9 expression is higher in placental and decidual tissue in cases of placenta accreta. Based on these findings, assessment of MMP-9 expression can shed new light on the etiopathology of placenta accreta spectrum disorder and can be a potential diagnostic marker.

Pregnancy is a complex and vulnerable period that presents a number of challenges to women, including the development of postpartum psychiatric disorders. These disorders can include postpartum depression and anxiety, which are relatively common, and the rare but more severe postpartum psychosis. In addition, other postpartum psychiatric disorders can include obsessive-compulsive disorder, post-traumatic stress disorder and eating disorders. The etiology of postpartum psychiatric disorders is a complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors. The goals of treating postpartum mental illness are reducing maternal symptoms and supporting maternal-child and family functioning. Women and their families should receive psychoeducation about the illness, including evidence-based discussions about the risks and benefits of each treatment option. In this article, we would like to focus on postpartum depression (PPD). Identifying and treating this problem can reduce the alarming number of suicides among depressed perinatal women and the possible adverse effects of untreated maternal depression on their child’s cognitive and behavioral development. Developing effective strategies in global settings that allow the delivery of targeted therapies to women with different clinical phenotypes and severities of PPDs is essential. In this review, we discuss the latest developments in screening, treatment, and prevention methods.

Introduction: Breastfeeding is essential for premature infants, as it reduces morbidity while enhancing cognitive development, ultimately supporting a more productive adulthood. However, in the United States, where 10–12% of infants are born prematurely, hospitalization in the Neonatal Intensive Care Unit (NICU) presents significant challenges to breastfeeding practices as it introduces barriers such as maternal stress, mother-infant separation, limited visitation, and inadequate support, which hinder successful breastfeeding. Method: This review used several databases, namely Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library to search original and review articles in English about breasfeeding, internsive care unit, and risk factors in the last 10 years. Other reference sources used were guidelines and textbooks.Result: The findings reveal that breast milk’s bioactive components play a critical role in protecting against morbidity during NICU hospitalization, while also fostering cognitive development. Factors influencing breastfeeding practices include demographic (maternal age, education), biological (maternal and infant health), attitudinal (breastfeeding confidence), social (family support), and hospital regulations (NICU policies).Conclusion: Factors affecting breastfeeding practice among mothers with hospitalized neonates include planned pregnancy, medical interventions, and family support. NICU hospitalization can be a significant barrier to breastfeeding due to inadequate support, visitation time, mother-infant separation, maternal stress and anxiety, and clinical conditions.Faktor-Faktor yang Memengaruhi Praktik Menyusui pada Ibu dengan Neonatus Rawat InapAbstrakPendahuluan: Pemberian Air Susu Ibu (ASI) sangat penting bagi bayi prematur karena dapat mengurangi morbiditas sekaligus meningkatkan perkembangan kognitif, yang pada akhirnya mendukung kehidupan dewasa yang lebih produktif. Namun, di Amerika Serikat, di mana 10–12% bayi lahir prematur, rawat inap di Neonatal Intensive Care Unit (NICU) menghadirkan tantangan signifikan terhadap praktik menyusui akibat berbagai hambatan seperti stres maternal, pemisahan ibu dan bayi, waktu kunjungan yang terbatas, serta dukungan yang tidak memadai, yang menghalangi keberhasilan menyusui.Metode: Tinjauan pustaka ini menggunakan beberapa basis data, yaitu Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library, untuk mencari artikel asli dan ulasan dalam bahasa Inggris tentang menyusui, unit perawatan intensif, dan faktor risiko dalam 10 tahun terakhir. Sumber referensi lainnya yang digunakan adalah pedoman dan buku teks.Hasil: Kumpulan bukti yang ada di literatur saat ini menunjukkan bahwa komponen bioaktif dalam ASI memiliki peran penting dalam melindungi bayi dari morbiditas selama hospitalisasi di NICU, sekaligus mendukung perkembangan kognitif. Faktor-faktor yang memengaruhi praktik menyusui meliputi faktor demografis (usia ibu, pendidikan), biologis (kesehatan ibu dan bayi), sikap (kepercayaan diri dalam menyusui), sosial (dukungan keluarga), dan kebijakan rumah sakit (aturan di NICU).Kesimpulan: Faktor-faktor yang memengaruhi praktik menyusui pada ibu dengan bayi yang dirawat di NICU meliputi kehamilan yang direncanakan, intervensi medis, dan dukungan keluarga. Rawat inap di NICU dapat menjadi penghalang signifikan terhadap keberhasilan menyusui akibat kurangnya dukungan, waktu kunjungan yang terbatas, pemisahan ibu dan bayi, stres dan kecemasan maternal, serta kondisi klinis bayi.Kata Kunci: Air susu ibu, Faktor risiko, Ibu, Menyusui, NICU

Maternal death is still a problem among pregnant women. One of the most prevalent causes of maternal death is preeclampsia. Preeclampsia contributes not only to maternal death, but also increases fetal morbidity. Early screening for preeclampsia is a key factor to managing the condition. The Fetal Medicine Foundation (FMF) has developed an algorithm to predict preeclampsia during the first trimester of pregnancy. However, there has been lack of studies done in Indonesia its usage. Therefore, this study aims to examine the accuracy of the FMF algorithm as a screening tool to identify preeclampsia in women in the first trimester of pregnancy. //Prospective cohort study done in Obstetrics and Gynecology Department of Mohammad Hoesin Hospital Palembang in January-December 2023. Sixty subjects that met the inclusion criteria were followed from 11 to 13+6 weeks to birth. All subjects undergo history taking for maternal and obstetrics history, physical examination, in particular mean arterial pressure (MAP) measurement, ultrasonography examination to evaluate mean uterine artery pulsatility index (UtA-PI), crown-rump length (CRL), and laboratory testing for pregnancy-associated plasma protein-A [PAPP-A] and placental growth factor [PlGF]. The outcome of this study is the incidence of preeclampsia as well as the detection rate (accuracy rate), false positive rate, positive predictive value (PPV), and negative predictive value (NPV) of the FMF algorithm. Data were analyzed using SPSS version 25.0 with a significance level of p <0.05 and a 95% CI. Kolmogorov Smirnov test was used for data homogeneity, Chi-square or Fisher test for categorical data, One way anova and Kruskal wallis test for numerical data. Sixty subjects were enrolled. Among these, 30 subjects subsequently developed preeclampsia, with 18 (30%) experiencing early-onset preeclampsia, 12 (20%) experiencing late-onset preeclampsia, and 30 (50%) not developing preeclampsia (normotension). There was no significant difference in maternal characteristics and obstetric history among the three groups. MAP is found to be significantly different, with the highest found in the early onset preeclampsia group (p=0.021). Uterine artery pulsatility index (UtA-PI) was significantly higher in early-onset and late-onset preeclampsia subjects (p=0.019). There was no significant difference among the three groups in CRL. Serum PIGF was significantly lower in early onset and late-onset preeclampsia subjects (p-0.0001). Serum PAPP-A is also significantly lower in the early-onset preeclampsia subjects (p=0.0002). The combination of FMF/MAP, UtA-PI, yields the highest accuracy in predicting preeclampsia with 100% values for sensitivity, specificity, PPV, and NPV (p=0,000). The other combinations show lower accuracy, but quite good values of specificity and sensitivity. The FMF algorithm is an accurate screening tool to identify preeclampsia in the first trimester of pregnancy.