Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain limited. This study aimed to describe the prevalence of prophylactic antibiotic use, factors associated with its use, and clinician adherence to guidelines. A retrospective review was conducted for all deliveries from 1 January 2016 to 31 December 2018 at a tertiary level hospital in Indonesia. The prevalence of prophylactic antibiotic use during delivery was 47.1%. Maternal education level, Ob/Gyn specialist-led delivery, a history of multiple abortions, C-section, premature membrane rupture, and antepartum hemorrhage were independently associated with prophylactic antibiotic use. Clinician adherence to the guidelines was 68.9%. Adherence to guidelines was the lowest in conditions where the patient had only one indication for prophylactic antibiotics (aOR 0.36, 95% CI 0.24–0.54). The findings showed that the prevalence of prophylactic antibiotic use during delivery was moderate to high. Adherence to local guidelines was moderate. Updating the local prescribing guidelines may improve clinician adherence.

Introduction and importance: Ectopia cordis is a rare congenital anomaly characterized by the abnormal positioning of the heart outside the thoracic cavity, frequently associated with additional congenital defects such as those seen in Pentalogy of Cantrell. Due to the rarity and severity of these anomalies, timely diagnosis and appropriate management remain clinically challenging but critical for patient outcomes. Case presentation: We report two distinct cases of ectopia cordis managed at our institution. The first case presented with complete ectopia cordis and absence of the sternum, requiring initial management with a Bogota bag followed by placement of bovine pericardium; unfortunately, the patient succumbed to complications of sepsis and heart failure at 12 days of life. The second case involved partial ectopia cordis accompanied by features of Pentalogy of Cantrell, managed conservatively with a Bogota bag and spontaneous epithelialization, resulting in successful discharge with stable clinical status. Clinical discussion: Management of ectopia cordis, especially when complicated by associated anomalies, presents significant surgical and clinical challenges. Survival rates remain low due to complications such as sepsis, cardiac instability, and limited thoracic cavity space. Utilization of biomaterials like bovine pericardium has shown promise in providing necessary cardiac protection when primary closure is not feasible. Early multidisciplinary intervention, involving neonatologists, pediatric cardiologists, and surgeons, is crucial for optimizing outcomes. Conclusion: While prognosis for ectopia cordis remains poor, careful and individualized management strategies, including timely intervention and infection prevention, can lead to favorable outcomes as demonstrated in our second case. This underscores the importance of a multidisciplinary approach and early prenatal diagnosis in enhancing survival rates for this rare condition. Highlights:

BACKGROUND:Postpartum blood loss after cesarean section can be challenging to control, resulting in maternal morbidity and mortality. Tranexamic acid (TXA) is a synthetic reversible plasminogen inhibitor that is approved for the management of heavy menstrual bleeding, but off-label use has been described, including for the control of postpartum hemorrhage (PPH). This study aimed to compare postpartum blood loss after cesarean section in women treated with either tranexamic acid or placebo. MATERIAL AND METHODS:This single-center clinical study conducted in Indonesia enrolled 88 women undergoing cesarean section. Participants were randomized into 2 groups: the treatment group (n=44) received 1 g of TXA intravenously at the time of surgical incision, and the placebo group (n=44) received 10 ml of saline. Blood loss was measured using a calibrated surgical suction device and pictogram, with total blood loss calculated by subtracting amniotic and irrigation fluids. RESULTS:PPH occurred in 10.2% of all patients. Group A had significantly less blood loss than group B (mean=459.4 ml vs 686.3 ml; P<0.001). TXA was significantly protective, reducing the risk of PPH by 87.5% compared to group B (RR=0.125 [95% CI 0.016-0.958]; P=0.045). There were no significant differences in adverse effects between the 2 groups (P=0.101). CONCLUSIONS:Intraoperative TXA administration significantly reduces blood loss and the risk of PPH in women undergoing cesarean sections. These findings support the routine use of TXA in cesarean management protocols to improve maternal safety and outcomes.

Abstrak Tujuan: Memaparkan etiologi dan faktor risiko, diagnosis banding, patofisiologi, pemantauan, terapi, komplikasi, rekurensi dan tindakan preventif pada kasus preeklamsia pascasalin. Metode: Tinjauan pustaka dengan berbagai referensi yang diakses melalui mesin pencarian seperti Pubmed dan Sci-Hub dengan menggunakan kata kunci preeclampsia, hypertension, postpartum, management. Sumber referensi yang digunakan yaitu guidelines, jurnal, dan buku teks yang diterbitkan dalam 15 tahun terakhir. Kesimpulan: Insiden preeklamsia di Indonesia yaitu 128.273/tahun atau sekitar 5,3%. Sebanyak 0,3 – 27,5% kasus yang dilaporkan mengalami preeklamsia atau hipertensi pascasalin. Gejala-gejala preeklamsia pascasalin muncul setelah melahirkan. Mayoritas kasus berkembang dalam 48 jam setelah persalinan, walaupun sindrom dapat muncul hingga 6 minggu setelah persalinan. Periode pascasalin merupakan waktu kritis bagi spesialis obstetri dan ginekologi untuk menjamin wanita dengan riwayat preeklamsia untuk dipantau dalam jangka waktu pendek dan panjang. Akan tetapi, pemantauan pascasalin sangatlah rendah, berkisar antara 20-60%. Pemilihan antihipertensi pasca salin yaitu berikatan kuat dengan protein dan solubilitas lipid yang rendah sehingga lebih sedikit yang masuk ke ASI. Selain itu, dipengaruhi juga oleh ionisasi, berat molekul dan konstituen ASI (kandungan lemak, protein, dan air). Agen lini pertama untuk preeklamsia pascasalin adalah labetalol dan hidralazin intravena serta nifedipin. Wanita dengan hipertensi gestasional ataupun preeklamsia biasanya dapat menghentikan antihipertensi dalam 6 minggu pasca salin. Postpartum PreeclampsiaAbstract Objective: To explain about etiologies and risk factors, differential diagnosis, pathophysiology, follow up, treatment, complications, recurrence, and prevention of preeclampsia post delivery discharged. Method: Literature review with several references accessed through search engines such as Pubmed and Sci-Hub by using keywords preeclampsia, hypertension, postpartum, management. Reference sources used are guidelines, journals, and textbooks published in the last 15 years. Conclusion: The incidence of preeclampsia in Indonesia is 128,273/year or around 5.3%. As many as 0.3-27.5% of cases reported postpartum preeclampsia or hypertension. Symptoms of postpartum preeclampsia appear after delivery. The majority of cases develop within 48 hours after delivery, although the syndrome can appear up to 6 weeks after delivery. The postpartum period is a critical time for obstetricians and gynecologists to ensure women with a history of preeclampsia are monitored in the short and long term. However, postpartum monitoring is very low, ranging from 20-60%. The choice of antihypertensive postpartum is that it is strongly bound to protein with low lipid solubility so that fewer enter breast milk. In addition, it is also influenced by ionization, molecular weight and constituents of breast milk (fat content, protein, and water). The first line agent for postpartum preeclampsia is intravenous labetolol and hydralazine and also nifedipine. Women with gestational hypertension or preeclampsia can usually stop antihypertension within 6 weeks postpartum. Key word: postpartum preeclampsia, antihypertension

Update Manajemen Preeklamsia dengan Komplikasi Berat (Eklamsia, Edema Paru, Sindrom HELLP)

HIGHLIGHTS ABSTRACT Objective: The objective of this study was to analyze the maternal and perinatal outcomes of COVID-19 in pregnancy at Dr. Mohammad Hoesin Hospital, Palembang, Indonesia. Materials and Methods: This retrospective cohort study was carried using medical records of pregnant mothers who delivered at Dr. Mohammad Hoesin Hospital Palembang from March 2020 to August 2021. The subjects were into two groups: pregnant women with and without COVID-19. Pearson Chi-Square test was used for bivariate analysis to determine the associations between COVID-19 and maternal as well as neonatal outcomes. The data were analysed using the Stata 15 statistical software. Multivariate analysis was done using the cox regression test to determine whether maternal characteristics affected those associations. P-value of < 0.05 were considered statistically significant. Results: The study analyzed 220 subjects, including 62 COVID-19-positive (28.18%) and 158 COVID-19-negative (71.82%) patients. Among expectant mothers with COVID-19, caesarean sections were the most common maternal outcome (82.26%), while fetal distress was the most frequent perinatal outcome (12.13%). Significant associations were found between COVID-19 and maternal outcomes, including pneumonia (RR = 12.76), caesarean section (RR = 2.74), and ICU hospitalization (RR = 6.90). These associations remained significant after adjusting for maternal characteristics. However, no significant association was found between COVID-19 and perinatal outcomes. Conclusion: COVID-19 increases the likelihood of adverse maternal outcomes throughout pregnancy.