HUBUNGAN PENGETAHUAN DAN USIA TERHADAP KEJADIAN BLIGHTED OVUM PREGNANCY DI PKU MUHAMMADIYAH GAMPING YOGYAKARTA

ABSTRAKLatar Belakang: Blighted ovum adalah suatu keadaan hasil konsepsi yang tidak mengandung janin. Diperkirakan di seluruh dunia Blighted ovum merupakan 60% dari penyebab kasus keguguran, di ASEAN (association of southeast asian nations) mencapai 51%, di Indonesia ditemukan 37% dari setiap 100 kehamilan, di Provinsi Yogyakarta mencapai 30% dari 100 kehamilan dan di Kabupaten Sleman sebanyak 43,39% (WHO, 2015). Tujuan: Mengidentifikasi faktor yang berhubungan dengan kejadian kehamilan blighted ovum. Metodologi Penelitian: Jenis penelitian ini observasional analitik dengan pendekatan cross-sectional. Waktu penelitian ini dari 27 Maret 2021-12 Agustus 2021. Lokasi penelitian di PKU Muhammadiyah Gamping dengan sampel ibu hamil di PKU Muhammadiyah Gamping sebesar 30 responden, teknik pengambilan sampel Total Sampling. Luaran Yang Ditargetkan : Luaran penelitian ini jurnal nasional terakreditasi sinta 1-6. Hasil Penelitian: Faktor yang berhubungan dengan kejadian blighted ovum pregnancy yaitu faktor usia yang ditunjukkan dengan nilai p-value 0,04 dimana nilai p-value lebih kecil dibandingkan nilai signifikansi dengan tingkat kesalahan 5 % (0.05). Hal ini menunjukkan bahwa terdapat hubungan antara variabel usia dengan kejadian blighted ovum pregnancy. Untuk variabel pengetahuan nilai p-value 0,077 dimana nilai p-value lebih besar dibandingkan nilai signifikansi dengan tingkat kesalahan 5 % (0.05). Hal ini menunjukan bahwa tidak terdapat hubungan antara variabel pengetahuan dengan kejadian blighted ovum pregnancy.Kata Kunci: Hamil, Blighted OvumTHE RELATIONSHIP BETWEEN KNOWLEDGE AND AGE ON THE INCIDENCE OF BLIGHTED OVUM PREGNANCY AT PKU MUHAMMADIYAH GAMPING YOGYAKARTAABSTRACTBackground: Blighted ovum is a state of product of conception that does not contain a fetus. It is estimated that worldwide Blighted ovum is 60% of the causes of miscarriage cases, in ASEAN (association of Southeast Asian Nations) it reaches 51%, in Indonesia it is found 37% of every 100 pregnancies, in Yogyakarta Province it reaches 30% of 100 pregnancies and in Sleman Regency. as much as 43.39% (WHO, 2015). Objective: To identify factors related to the incidence of blighted ovum pregnancy. Research Methodology: This type of research is analytic observational with a cross-sectional approach. The time of this research is from 27 March 2021-12 August 2021. The research location is at PKU Muhammadiyah Gamping with a sample of pregnant women at PKU Muhammadiyah Gamping with 30 respondents, the sampling technique is Total Sampling. Targeted Outcomes: The outputs of this research are national journals accredited by sinta 1-6. Research Results: Factors related to the incidence of blighted ovum pregnancy are age, which is indicated by a p-value of 0.04 where the p-value is smaller than the significance value with an error rate of 5% (0.05). This shows that there is a relationship between the age variable and the incidence of blighted ovum pregnancy. For the knowledge variable, the p-value is 0.077 where the p-value is greater than the significance value with an error rate of 5% (0.05). This shows that there is no relationship between the knowledge variable and the incidence of blighted ovum pregnancy.Keywords: Pregnant, Blighted Ovum

Cervical Hydatidiform Moles Pregnancy: Diagnosis and Treatment

Cervical partial hydatidiform mole is a rare condition and difficult to diagnose. A 39-year-old Balinese woman from Sanglah General Hospital, Bali, Indonesia complained vaginal bleeding with abdominal pain. The patient was diagnosed with a partial hydatidiform mole based on physical examination, ultrasound, beta HCG levels and pathology examinations. Mass evacuation surgery followed by arterial ligation to stop the bleeding and periodically examination of beta HCG levels was carried out until the 14th week after the procedure. Beta HCG decreased gradually to normal level and indicate no risk of trophoblastic malignancy. Establishing the early diagnosis significantly affects the outcome of patient. Keywords: partial cervical hydatidiform mole, blighted ovum, pregnancy, diagnosis, therapy.

Diagnostic Evaluation of Uterine Artery Doppler Imaging for the Prediction of Early Abnormal Pregnancy

Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy. Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when appropriate, was used to analyze the relationship between the variables. Results: there was a significant reduction of RI mean, PI mean, and S/D ratio among women with different types of abnormal pregnancy compared with the control group. RI and PI mean levels were significantly lower in women with hydatidiform mole and significantly higher in women with missed miscarriage. Lower left S/D mean level was significantly associated with hydatidiform mole and upper left S/D level was associated significantly with control women. For prediction of missed miscarriage; right and left uterine artery RI shows a sensitivity of 80%, 73.3%, a specificity of 68%, 71.1%, and the highest AUC was 0.78 for both.For prediction of molar pregnancy, right and left uterine artery RI showed a sensitivity of 63% for both, a specificity of 54.4%, 60%, and the highest AUC was 0.58, 0.61 respectively. Conclusions: Uterine artery Doppler ultrasonography at 6-12 weeks of gestation is predictive for early pregnancy complications such as missed abortion, hydatidiform mole, and blighted ovum.

Penggunaan Off-Label Misoprostol Pada Pasien Obstetri-Ginekologi Di Rumah Sakit Swasta Kab. Banyumas

Penggunaan obat off-label pada pasien obstetri-ginekologi memerlukan kewaspadaan karena berisiko tinggi bagi kehamilan. Meskipun masih terjadi perdebatan, data profil penggunaannya pada praktik klinik masih kurang. Penelitian ini bertujuan untuk mengobservasi penggunaan obat off-label pada pasien obstetri dan ginekologi di rumah sakit swasta, khususnya obat Misoprostol. Penelitian ini menggunakan pendekatan deskriptif observasional terhadap data rekam medis rumah sakit. Pengambilan data penelitian secara retrospektif di RSU Bunda (RS X) periode Juli 2017 – Desember 2017 dan RS Sinar Kasih (RS Y) periode Januari 2018 – Desember 2018. Jumlah sampel ditentukan menggunakan rumus Slovin, dengan teknik sampling systematic random sampling di RS X dan total sampling di RS Y. Jumlah keseluruhan sampel adalah 220 RM di RS X 130 dan RS Y 90. Penelitian dilakukan pada rentang waktu bulan Januari 2019 – Maret 2019. Hasil dianalisis secara univariat menggunakan beberapa referensi terkait. Hasil penelitian menunjukan adanya penggunaan obat off-label misoprostol sebanyak 26,92% di RS X dan sebanyak 4% di RS Y. Obat off-label yang ditemukan adalah Misoprostol yang tergolong ke dalam kategori off-label indikasi (Missed Abortion, Abortus Incomplete, Blighted Ovum, dan Induksi persalinan pada kasus Serotinus, KPD, dan IUFD), off-label dosis (50 µg, 100 µg dan 400 µg), dan off-label rute pemberian (sublingual dan vaginal).

COMPARISON OF MIFEPRISTONE (200mg) FOLLOWED BY MISOPROSTOL (800µg) 6 HRS LATER WITH 24 HRS LATER IN EARLY PREGNANCY FAILURE

INTRODUCTION: Early pregnancy failure (EPF) is an inclusive term that comprises incomplete, complete, or inevitable spontaneous abortion; anembryonic gestation (blighted ovum); and embryonic demise (missed abortion) at less than 14 weeks 1. It is one of the most common complications of pregnancy, accounting for approximately 15% to 20% of clinically recognized pregnancies 1,2. Many EPFs occur before pregnancies have been clinically recognized (that is, women mistake them for “late cycles”). AIMS & OBJECTIVES: To compare the efcacy between mifepristone 200mg orally followed by misoprostol 800µg vaginally 6 hrs later with mifepristone 200mg orally followed by misoprostol 800µg vaginally 24 hrs later in early pregnancy failure for termination up to 9 weeks of gestation. To reduce unusual blood loss. To reduce surgical intervention in case of early pregnancy failure. MATERIALS & METHODS: Hospital based Prospective randomiSe comparative single centre study. Department of Obstetrics and Gynecology Midnapore Medical College and Hospital. One year from January 2019 to February 2020 for data collection and six month for data analysis. Mother attended the Gynae OPD clinic and Obstetrics emergency with features of early pregnancy failure. The sample size was 50, with 25 patients in each group. RESULTS:We found that the table 4 shows the distribution according to gestational age. The main indication for which medical abortion was done in our study is early pregnancy failure (Blighted ovum) and missed abortion. Majority of patients were in the gestational age between 8-9 weeks with 48 % of women who underwent 6 hour interval regimen and 40% of women who underwent 24 hour interval regimen. P value documented is 0.849 which is not signicant. There was no signicant difference between two groups regarding gestational age (p value=0.849). SUMMARY AND CONCLUSION: Vaginal Misoprostol can be safely administered 6 hours following Mifepristone instead of waiting for 24 hours. Efcacy in achieving complete abortion rate is almost equal to 24 hours regimen and most acceptable from patient's side also. Additionally, women are less likely to experience side effects the earlier the misoprostol is used. Women can now have more exibility when using mifepristone and vaginal misoprostol for medical abortion

Recurrent cervical hemorrhages and thromboses associated to pulmonary thrombembolism in a hereditary thrombophilia with heterozygous mutants of MTHFR and PAI-1. Case Report and Pathophysiology Hypotheses

A 30 years Caucazian nullipara, 1 blighted ovum, former Yasmin user (1 year), without antiphospholipid antibodies, prophylactic cervical cerclage at 19 weeks pregnancy, is readmitted in emergency at 21 weeks gestation for heavy pelvic pains, and abundant vaginal red blood loss, with cerclage suppression. Under tocolysis and vaginal progesterone, she presents 3 new episodes of intense pains and red, pulsatile blood loss from different cervical areas at 24- 36 hours after admittance, with mechanical hemostasis by nylon sutures at cervico- vaginal junction. The 4th episode is followed by severe anemia (Hb= 6.03mg/dL, Ht= 18.32%), haemodinamic instability, coagulation disorders- hematomas, generalized petaechia, and at 24 hours after last vaginal sutures she claims thoracic pains, dyspneea, cianosis. There are not registered fetal distress, placental abnormalities, cervical shortness below 2.5 cm (when cerclage), and maternal heart abnormalities at repeated ultrasound examinations. No thoracic computer tomography because maternal refuse. After a cardiologist consultation it is appreciated a mild/moderate pulmonary thrombembolism, without deep legs venous thrombosis, and it is started continuous intravenous anticoagulant therapy – heparine 25,000UI/day x 6 days, then fraxiparine in increased dosages continued to term, and 6 weeks postpartum. The laboratory test confirms intravascular disseminated coagulation with secondary fibrinolysis, and positivity for heterozygous mutants of MTHFR (methylene tetrahydrofolate reductase deficiency C677T and A1298C), and PAI (plasminogen activator inhibitor)-1 (4G). Cesarean delivery is performed at 37 weeks for fetal distress at labor onset, with extraction of a girl 3340g, Apgar=7/8, premature senescent placenta, thin umbilical cord. No maternal and neonate postpartum complications.

Trends in the incidence, rate and treatment of miscarriage—nationwide register-study in Finland, 1998–2016

STUDY QUESTION What changes have occurred in the incidence of miscarriage, its treatment options, and the profile of the women having miscarriages in Finland between 1998 and 2016? SUMMARY ANSWER The annual incidence of registry-identified miscarriage has declined significantly between 1998 and 2016, and non-surgical management has become the dominant treatment. WHAT IS KNOWN ALREADY Miscarriage occurs in 8–15% of clinically recognized pregnancies and in ~30% of all pregnancies. Increasing maternal age is associated with an increasing risk of miscarriage. The treatment of miscarriage has evolved significantly in recent years: previously, surgical evacuation of the uterus was the standard of care, but nowadays medical and expectant management are increasingly used. STUDY DESIGN, SIZE, DURATION We conducted a nationwide retrospective cohort study of 128 381 women that had experienced a miscarriage that was managed in public healthcare between 1998 and 2016 in Finland. PARTICIPANTS/MATERIALS, SETTING, METHODS We used the National Hospital Discharge Registry for the data. Women aged 15–49 years that had experienced their first miscarriage during the follow-up period and had miscarriage-related diagnoses during their admission to public hospital were included in the study. Miscarriages were defined by the 10th Revision of the International Statistical Classification of Diseases and related Medical Problems (ICD-10) diagnostic codes O02*, O03* and O08*. Women with ectopic, molar and continuing pregnancies and induced abortions were excluded. Treatment was divided into surgical and non-surgical treatment using the surgical procedure codes. MAIN RESULTS AND THE ROLE OF CHANCE The annual incidence of registry-identified miscarriage has declined from 6.8/1000 15–49-year-old women in 1998 to 5.0/1000 in 2016 (P < 0.001). Also, the incidence rate of registry-identified miscarriage (i.e. the proportion of miscarriages of registry-identified pregnancies [i.e. deliveries, induced abortions, and miscarriages]) has declined from 112/1000 15–49-year-old pregnant women in 1998 to 83/1000 in 2016 (P < 0.001). The largest decrease in this proportion occurred among women over 40 years of age, among whom 26.5% of registry-identified pregnancies in 1998 ended in miscarriage compared to that of 16.4% in 2016. The proportion of missed abortion has increased (30.3 to 38.8%, P < 0.001) whereas that of blighted ovum has decreased (25.4 to 12.8%, P < 0.001). The proportion of registry-identified miscarriages seen among nulliparous women has increased from 43.7 to 49.6% (P < 0.001). Mean age at the time of miscarriage remained at 31 years throughout the study. Altogether, 29% of all miscarriages were treated surgically and 71% underwent medical or expectant management. The proportion of surgical management has decreased from 38.0 to 1.6% for spontaneous abortion, from 60.7 to 9.4% for blighted ovum and 70.9 to 11.2% for missed abortion between 1998 and 2016. LIMITATIONS, REASONS FOR CAUTION This study includes only women with registry-identified pregnancies, i.e. women who were treated in public hospitals. However, the number of women treated elsewhere is presumed to be small. Neither can this study estimate the number of women having spontaneous miscarriage with no hospital contact. WIDER IMPLICATIONS OF THE FINDINGS Both the annual incidence and incidence rate of miscarriage of all registry-identified pregnancies has decreased, and non-surgical management has become the standard of care. These findings are of value when planning allocation of healthcare resources and at individual level considering fertility and miscarriage questions. We speculate that improving ultrasound diagnostics explains the increasing proportion of missed abortion relative to other types of miscarriage. More investigation is needed to examine potential risk factors, complications and morbidity associated with miscarriages. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the research funds of the Helsinki and Uusimaa hospital system, by a personal grant from Viipurin Tuberkuloosisäätiö to R.L. and by a personal grant from The Finnish Cultural Foundation to N.H. The authors have no conflicts of interest to declare.

Pregnancy outcomes in patients with multiple sclerosis treated with teriflunomide: Clinical study data and 5 years of post-marketing experience

Background: Teriflunomide is contraindicated in pregnancy. Some pregnancies have occurred despite guidance to use effective contraception. Objectives: To report outcomes of pregnancies occurring in teriflunomide clinical trials and the post-marketing setting. Methods: Outcomes are summarized for pregnancies in teriflunomide monotherapy clinical trials and the post-marketing setting (data cutoff: December 2017). Results: Of 437 confirmed teriflunomide-exposed pregnancies, 222 had known outcomes (70 from clinical trials; 152 from the post-marketing setting); 161 were reported prospectively and 61 retrospectively. There were 107 (48.2%) live births, 63 (28.4%) elective abortions, 47 (21.2%) spontaneous abortions, 3 (1.4%) ectopic pregnancies, 1 (0.5%) stillbirth, and 1 (0.5%) maternal death leading to fetal death. Four birth defects were reported among cases with known pregnancy outcome: ureteropyeloectasia (only defect considered major); congenital hydrocephalus; ventricular septal defect; and malformation of right foot valgus. A case of cystic hygroma was identified on antenatal ultrasound (pregnancy outcome unknown). One elective abortion followed prenatal diagnosis of fetal anomaly (blighted ovum). The risk of major birth defects in prospectively reported live birth/stillbirth outcomes was 3.6% (1/28) in clinical trials and 0.0% (0/51) in post-marketing reports. Conclusions: Outcomes were consistent with the general population. Current human data do not indicate a teratogenic signal in teriflunomide-exposed pregnancies.

Faktor-Faktor yang Mempengaruhi terjadinya Blighted Ovum (BO) pada Ibu Hamil di Rumah Sakit dr. Zainoel Abidin Kota Banda Aceh Tahun 2015

Blighted ovum adalah suatu keadaan hasil konsepsi yang tidak mengandung janin. Diperkirakan di seluruh dunia. Blighted ovum merupakan 60% dari penyebab kasus keguguran, di Indonesia ditemukan 37% dari setiap 100 kehamilan. Penelitian inibersifat analitik dengan pendekatan case control. Sampel adalah seluruh ibu hamil, sampel 36 orang ibu-ibu hamil yang mengalami blighted ovum dan 36 orang ibu-ibu hamil normal yaitu sebanyak 72 orang. Teknik pengambilan sampel menggunakan purposive sampling Pengumpulan data dilakukan dengan menggunakan cheklist. Dari 72 responden terdapat 12 orang ibu hamil dari kelompok usia yang beresiko terjadinya blighted ovum, sedangkan 60 orang lagi tidak beresiko terjadinya blighted ovum, nilai odds ratio 3.667, dan pada kelompok paritas terdapat 20 orang ibu hamil yang beresiko tinggi terjadinya blighted ovum dan 52 orang lagi tidak beresiko tinggi terjadinya bligted ovum, nilai Odds ratio 3.504.