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How Long is the Safest InterDelivery Interval in Women with Previous History of Cesarean Delivery? Santoso, Budi I; Surya, Raymond; Firdaus, Karina K; Hakim, Surahman
Indonesian Journal of Obstetrics and Gynecology Volume 6. No. 2 April 2018
Publisher : Indonesian Socety of Obstetrics and Gynecology

  Objective: To investigate the association between interdelivery interval and uterine rupture in women with previous CD.   Methods: The formulation question was how long is the safest interdeliveryinterval to minimalize the risk of uterine rupture. Theauthors investigated in three databases including Pubmed,Cochrane, and Embase database. Inclusion criteria wereabstract answering the clinical question, written in Englishlanguage, and full-text paper availability.   Results: One systematic review, six cohort studies, and 1 casecontrolstudy were collected to compare the inter-pregnancyinterval to the risk of uterine rupture. The author retrievedseven articles suitable to the inclusion criteria after excluding tenarticles screened by the abstract and language. Then, the authoradded one article used in the systematic review. Hence, the criticalappraisal based on Validity, Importance, and Applicability (VIA)was performed for eight articles.   Conclusion: The inter-delivery interval 18 months is the safest time to avoid uterine rupture. Prostaglandin analogue induction should be avoided and for patients with a history of past cesarean using a single-layer closure to be educated about the increased risk. Keywords: cesarean delivery, inter-delivery interval, uterine rupture,vaginal birth after cesarean delivery

High preterm birth at Cipto Mangunkusumo Hospital as a national referral hospital in Indonesia Sungkar, Ali; Fattah, Adly N.A.; Surya, Raymond; Santoso, Budi I.; Zalud, Ivica
Medical Journal of Indonesia Vol 26, No 3 (2017): September
Publisher : Faculty of Medicine Universitas Indonesia

Background: Preterm birth is the leading direct that causes neonatal death. Indonesia was listed as one of the countries with the greatest number of preterm birth in 2010. This study aims to identify the prevalence and the potential risk factors of preterm birth among women underwent delivery in Cipto Mangunkusumo Hospital, an Indonesian national reference hospital.Methods: This retrospective cohort study involved 2,612 women who delivered between January and December 2013. Any clinical data which related to the potential risk factors and outcomes were recorded. The data were managed using chi-square for bivariate analysis and t-test or Mann-Whitney for numerical data followed by multiple logistic regression for multivariate analysis in SPSS version 20.0.Results: Preterm birth affected 1,020 of 2,616 pregnancies (38.5%). Non-booked patients increased nearly twice risk for preterm delivery (OR 1.89, 95% CI 1.37–2.61). While women with singleton pregnancy (OR 0.17, 95% CI 0.12–0.25), head presentation (OR 0.75, 95% CI 0.63–0.89), and regular ANC (OR 0.67, 95% CI 0.54–0.84) had lower risk for preterm birth. Apgar score, birthweight, and mode of delivery were significantly different between the pre-term group and the full-term group.Conclusion: Prevalence of preterm birth in Cipto Mangunkusumo Hospital was approximately 2.5 times higher compared to the national number. Several factors reducing preterm birth rate include singleton pregnancy, head presentation, and regular ANC.

Impact of pregnancy-induced hypertension on fetal growth Irwinda, Rima; Surya, Raymond; Nembo, Lidia F.
Medical Journal of Indonesia Vol 25, No 2 (2016): June
Publisher : Faculty of Medicine Universitas Indonesia

Background: Pregnancy-induced hypertension (PIH) is still a major cause of maternal and infant morbidity and mortality worldwide. The aim of this study to investigate the impact of PIH on fetal growth.Methods: A longitudinal cross-sectional study was conducted by 2,076 obstetric patients registered in the book of delivery emergency room BLUD RSUD Ende/ Ende hospital from September 1st 2014 to August 31st 2015. Pregnancy-induced hypertension was classified into gestational hypertension, preeclampsia, and severe preeclampsia. Categorical comparative chi-square continued by logistic regression analysis were performed to examine the effect of PIH to infants’ growth outcome.Results: Women with preeclampsia had higher number of preterm delivery (26.7%). Infants born from preeclamptic women had lower birth weight (median 2,575 gram; p<0.001), birth length (median 49 cm; p<0.001), and also head circumference (median 32 cm; p<0.001). Severe preeclampsia contributed statistically significance to SGA (OR=1.90; 95% CI=1.20-3.01; adjusted OR=1.91; 95% CI=1.20-3.01) and LGA (OR=2.70; 95% CI=1.00-7.29; adjusted OR=2.92; 95% CI=1.07-8.00). Based on birth weight independent of gestational age, severe preeclampsia had an impact to VLBW (OR=11.45; 95% CI=2.77-47.38; adjusted OR=8.68; 95% CI=1.57-48.04) and LBW (OR=6.57; 95% CI=4.01-10.79; adjusted OR=5.71; 95% CI=3.33-9.78) where it showed statistical significance.Conclusion: PIH women who had SGA or VLBL or LBW infants were caused by the hypoperfusion model as the pathogenesis of preeclampsia. Meanwhile, LGA infants born by preeclamptic women were due to the compensation of the decrease from uteroplacental perfusion or other diseases such as obese mother or gestational.diabetes mellitus.

Risk of small for gestational age babies in preterm delivery due to pregnancy-induced hypertension Irwinda, Rima; Santoso, Budi Iman; Surya, Raymond; Nembo, Lidia Firmiaty
Medical Journal of Indonesia Vol 28, No 1 (2019): March
Publisher : Faculty of Medicine Universitas Indonesia

BACKGROUND Pregnancy-induced hypertension (PIH) causes high maternal morbidity and mortality worldwide. This study aims to assess the impact of PIH on fetal growth according to gestational age in preterm deliveries.METHODS A prospective cohort study using secondary data was undertaken in Ende District, East Nusa Tenggara, Indonesia from September 2014 to August 2015. The t-test was performed to compare mean birth weight based on gestational week between normotensive and PIH women, continued by linear regression. The chi-square or Fisher exact test was also conducted to determine the probability of birthing small for the gestational age (SGA) and large for gestational age (LGA) babies between normotensive and PIH women.RESULTS A total of 1,673 deliveries were recorded in Ende Hospital over the 1-year study period, among which 182 cases involved preterm births. The PIH group had lower birth weight than normotensive women at each gestational age starting from 32–35 weeks (p=0.004; 95% CI 150.84–771.36). Normotensive women at gestational ages of 32 (p=0.05; 95% CI 0.01–0.83), 34 (p=0.37; 95% CI 0.01–4.12), and 36 (p=0.31; 95% CI 0.02–2.95) weeks had a lower risk of birthing SGA babies than PIH women; LGA babies were recorded at gestational ages of 33 (p=1.00; 95% CI 0.07–37.73) and 35 (p=0.31; 95% CI 0.34–63.07) weeks.CONCLUSIONS Poor perfusion of the uteroplacental is one of the reasons behind intrauterine growth restriction, which results in SGA babies born to PIH women.

How Long is the Safest InterDelivery Interval in Women with Previous History of Cesarean Delivery? Santoso, Budi I; Surya, Raymond; Firdaus, Karina K; Hakim, Surahman
Indonesian Journal of Obstetrics and Gynecology Volume 6. No. 2 April 2018
Publisher : Indonesian Socety of Obstetrics and Gynecology

  Objective: To investigate the association between interdelivery interval and uterine rupture in women with previous CD.   Methods: The formulation question was how long is the safest interdeliveryinterval to minimalize the risk of uterine rupture. Theauthors investigated in three databases including Pubmed,Cochrane, and Embase database. Inclusion criteria wereabstract answering the clinical question, written in Englishlanguage, and full-text paper availability.   Results: One systematic review, six cohort studies, and 1 casecontrolstudy were collected to compare the inter-pregnancyinterval to the risk of uterine rupture. The author retrievedseven articles suitable to the inclusion criteria after excluding tenarticles screened by the abstract and language. Then, the authoradded one article used in the systematic review. Hence, the criticalappraisal based on Validity, Importance, and Applicability (VIA)was performed for eight articles.   Conclusion: The inter-delivery interval 18 months is the safest time to avoid uterine rupture. Prostaglandin analogue induction should be avoided and for patients with a history of past cesarean using a single-layer closure to be educated about the increased risk. Keywords: cesarean delivery, inter-delivery interval, uterine rupture,vaginal birth after cesarean delivery

Antenatal Care for High Risk Pregnancy Sungkar, Ali; Surya, Raymond
Cermin Dunia Kedokteran Vol 47, No 10 (2020): Optalmologi
Publisher : PT. Kalbe Farma Tbk.

Despite 38% gradual fall since 2000, there was still approximately 295,000 women died during and following pregnancy and childbirth in 2017. Factors that lead to high maternal mortality include inequality access to health service, severe bleeding (mostly postpartum hemorrhage), infection, high blood pressure during pregnancy, complication from delivery, and unsafe abortion. These deaths are correlated to delay in decision to seek care, delay in reaching care, delay in receiving adequate health care. Improvement of antenatal care was the solution to this problem. Indonesia has not updated to the newest model of WHO antenatal care in 2016. Defining high-risk and updating the model can help Indonesia provides excellent care for mothers and reduce maternal deaths.Meskipun terdapat penurunan angka kematian ibu (AKI) sebesar 38% sejak tahun 2000, 295.000 wanita meninggal peripartum pada tahun 2017. Faktor yang menyebabkan AKI di antaranya tidak meratanya akses pelayanan kesehatan, perdarahan berat, infeksi, tekanan darah tinggi selama kehamilan, komplikasi persalinan, dan aborsi tidak aman. Kematian ini terkait dengan keterlambatan keputusan untuk merujuk, keterlambatan untuk mencapai tempat rujukan, dan keterlambatan mendapatkan tatalaksana yang baik. Hingga saat ini, Indonesia belum mengikuti panduan kunjungan antenatal terbaru dari WHO tahun 2016. Mendefinisikan kehamilan risiko tinggi dan penyesuaian model kunjungan antenatal diharapkan dapat memberikan perawatan yang baik bagi ibu dan menurunkan kematian maternal.Â

Skoring Prognosis Tetanus Generalisata pada Pasien Dewasa Surya, Raymond
Cermin Dunia Kedokteran Vol 43, No 3 (2016): Kardiologi
Publisher : PT. Kalbe Farma Tbk.

Latar Belakang: Tetanus merupakan penyakit toksemia akut yang disebabkan oleh tetanospasmin bakteri Clostridium tetani. Luaran tetanus dinilai berdasarkan Phillips score ataupun Dakar score. Pada laporan kasus ini akan dilakukan perbandingan skoring prognosis yang lebih baru, yaitu Tetanus Severity Score (TTS), dengan yang telah diakui sebelumnya. Laporan kasus: Seorang laki-laki 65 tahun datang dengan keluhan mulut terasa kaku, tidak dapat dibuka, nyeri tenggorokan, sulit menelan, perut terasa tegang, nyeri punggung dan pinggang, sulit berjalan serta lemas sejak 2 hari sebelum masuk rumah sakit (RS). Pasien memiliki riwayat tertusuk kayu yang diobati secara tradisional. Tidak ada riwayat imunisasi tetanus dalam 10 tahun terakhir. Pada pemeriksaan fisik didapat luka berbentuk garis pada telapak kaki kiri. Didapatkan meningismus, risus sardonikus, trismus Â½ cm, rigiditas otot perut (perut papan), opistotonus, serta uji spatula positif. Pasien ditatalaksana dengan infus NaCl 0,9%, D5%, diazepam drip, imunoglobulin, ceftriaxone, metronidazole, serta rawat luka. Prognosis pasien berdasarkan Phillips score ialah 16 sesuai dengan severitas sedang, Dakar score 1 sesuai dengan severitas ringan (mortalitas 10%). Pada TSS didapatkan skor 2 dengan mortalitas risiko rendah (6,3%). Skoring prognosis TSS memberikan hasil serupa dengan dua skoring sebelumnya. Simpulan: Skoring prognosis TSS dapat diaplikasikan pada pusat layanan kesehatan dengan fasilitas terbatas.

Pengaruh Infeksi Malaria Vivax pada Kehamilan Surya, Raymond
Cermin Dunia Kedokteran Vol 43, No 12 (2016): Kardiovaskular
Publisher : PT. Kalbe Farma Tbk.

Latar Belakang: Malaria merupakan salah satu masalah kesehatan masyarakat yang menyebabkan kematian terutama pada kelompok risiko tinggi yaitu bayi, anak balita, ibu hamil. Malaria pada kehamilan meningkatkan risiko kematian janin karena restriksi pertumbuhan fetus, prematuritas, berat badan lahir rendah (BBLR), dan anemia maternal. Laporan kasus ini akan membahas kontribusi infeksi malaria vivax pada kehamilan terhadap luaran neonatus. Laporan kasus: Wanita 30 tahun, G2P0A1 usia kehamilan 39-40 minggu dengan keluhan keluar darah pervaginam, riwayat anemia sepanjang kehamilan. Pasien dua kali menderita malaria vivax dan mendapat dihidroartemisin-piperakuin. Lahir bayi perempuan, spontan, Apgar Score (AS) 8/9/10, dengan berat badan 2100 g, panjang badan 49 cm, lingkar kepala 31 cm, lingkar dada 30 cm. Simpulan: Berat badan lahir rendah (BBLR) dikaitkan dengan infeksi malaria vivax saat kehamilan yang diperparah oleh anemia. Profilaksis intermiten sulfadoksin pirimetamin pada kehamilan sebaiknya dianjurkan pada daerah endemis malaria.Background: Malaria is one of the public health problems which contributes to mortality especially in high risk groups. Malaria in pregnancy increases fetal death risk due to fetal growth restriction (FGR), prematurity, low birth weight, and maternal anemia. This report discusses the impact of P.vivax infection in pregnancy to neonates outcome. Case : A 30 year-old woman, G2P0A1 39-40 weeks of gestation, came with vaginal bleeding. During pregnancy, she had malaria vivax infection twice and got dihydroartemisinin-piperaquine regimen. She was anemic. She delivered spontaneously a female baby with birthweight 2100 g, length 49 cm, head circumference 31 cm, chest circumference 30 cm, and APGAR score 8/9/10. Conclusion: Factors contributed to low birth weight are malaria during pregnancy and maternal anemia. Intermittent preventive treatment with sulfadoxin-pirimetamine should be implemented for pregnant women in malaria-endemic areas.

Kontroversi Persalinan Spontan pada Miopia Tinggi Iskandar, Ferdy; Surya, Raymond; Sungkar, Ali; Debby Anggriany, Friska
Cermin Dunia Kedokteran Vol 47, No 12 (2020): Dermatologi
Publisher : PT. Kalbe Farma Tbk.

Gangguan refraksi khususnya miopia tinggi pada wanita hamil sering dikaitkan dengan kejadian ablasio retina pasca-persalinan, sehingga persalinan per abdominam atau bantuan instrumen cenderung direkomendasikan pada wanita hamil dengan miopia tinggi. Padahal, indikasi persalinan per abdominam pada miopia tinggi adalah adanya neovaskularisasi koroid dan subretinal (dengan bintik Fuchs). Hingga saat ini belum didapatkan bukti bahwa miopia tinggi dan riwayat operasi retina sebelumnya meningkatkan risiko ablasio retina saat persalinan per vaginam.Refractive disorders, especially high myopia in pregnant women are often associated with postpartum retinal detachment, thus there is a tendency to recommend cesarean section or instrument-assisted labor in pregnant women with high myopia. In fact, the indications for cesarean section in patients with high myopia are choroidal and subretinal neovascularization (with Fuchs spots). There is no evidence of increased risk of retinal detachment during vaginal delivery in high myopia and previous history of retinal surgery.

Obesity and Endometrial Cancer: Mechanism and How to Deal with? Dewi Anggraeni, Tricia; Surya, Raymond; Pratama Kurniawan, Andrew
Cermin Dunia Kedokteran Vol 48, No 6 (2021): Kardiologi
Publisher : PT. Kalbe Farma Tbk.

Obesity is strongly associated with development of endometrial cancer more than any other cancer type. The relationship between obesity and endometrial cancer risk is combination of inflammation, insulin resistance, and increased bioavailability of estrogen. Obesity can increase risk to develop endometrial cancer as exogenous estrogen has impact for tumorigenesis. The best method to reduce the risk of endometrial cancer in obese women is through progesterone medication and lifestyle intervention.Obesitas erat kaitannya dengan terjadinya kanker endometrium lebih dari jenis kanker lainnya. Hubungan antara obesitas dan risiko kanker endometrium adalah kombinasi antara inflamasi, resistensi insulin, dan peningkatan bioavailabilitas estrogen. Obesitas dapat meningkatkan risiko terjadinya kanker endometrium karena estrogen eksogen berdampak pada tumorigenesis. Metode terbaik untuk mengurangi risiko kanker endometrium pada wanita yang obese adalah melalui pengobatan progesteron dan intervensi gaya hidup. Tricia

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