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.

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.

Investigation into the mechanism underlying excessive trophoblast invasion yields further strategies and insights for the diagnosis and treatment of placenta accreta spectrum disorder (PASD). We conducted a comprehensive literature review to analyze the relationship between CXCR2 expression and PASD, as well as the possibility of CXCR2 being used as a therapeutic and diagnostic biomarker for PASD. Chemokines are well-known mediators in the immune system, particularly for cell recruitment, angiogenesis, and tumor infiltration. CXCR2 is an important component of the immune system, particularly in neutrophils. One of the CXCR2 ligands, IL-8, has also been found to be expressed in the decidua and trophoblasts of humans and to promote autocrine or paracrine trophoblast migration and invasion. The potential role of CXCR2 in trophoblast invasion in PASD provides researchers with a glimpse into the molecular pathogenesis of PASD.CXC Motif Chemokine Receptor 2: Sekilas tentang Patogenesis Molekuler Gangguan Spektrum Plasenta AkretaAbstrakInvestigasi mekanisme invasi berlebihan trofoblas pada gangguan Spektrum Plasenta Akreta (SPA) akan memberikan lebih banyak strategi dan ide untuk diagnosis dan pengobatan. Kami melakukan tinjauan literatur yang komprehensif untuk menganalisis hubungan antara ekspresi CXCR2 dan SPA serta potensi CXCR2 sebagai penanda terapeutik dan diagnostik untuk SPA. Kemokin berperan sebagai mediator dalam sistem imun karena perannya dalam perekrutan sel, angiogenesis, dan infiltrasi tumor. CXCR2 mempengaruhi sistem imun, terutama pada neutrofil. Salah satu ligan CXCR2, IL-8, juga telah ditemukan diekspresikan dalam desidua dan trofoblas manusia serta untuk mempromosikan migrasi dan invasi trofoblas autokrin atau parakrin. Peran CXCR2 dalam invasi trofoblas pada SPA memungkinkan para peneliti untuk melihat sekilas patogenesis molekuler SPA.Kata kunci: penanda; CXCR2; plasenta akreta

Fetus in fetu (FIF) is a rare congenital anomaly characterized by the presence of a parasitic monozygotic twin encased within the body of its host twin. Because FIF is asymptomatic throughout pregnancy, it is mainly diagnosed in children with an abdominal mass after birth. In the case reported here, at 38-39 weeks of gestation, a 33-year-old woman (gravida 4, para 3) was referred for routine obstetric ultrasonography. Fluid accumulation was identified along with calcification resembling two well-developed legs and trunk with undifferentiated organs inside. Slight spontaneous movement of the legs was observed. The fetus was delivered based on the presumed diagnosis of FIF. Postnatal sonography and computed tomography (CT) supported the diagnosis. The neonate underwent surgical excision of the tumor and was discharged on the eighth postoperative day. Ultrasound can be used to provide accurate prenatal diagnosis of FIF. Early diagnosis is important to improve outcomes.