ABSTRACT
Background: Placenta is a central and important focus on the pathogenesis of preeclampsia. Failure of trophoblast cell to the spiral arteries remodeling process due to excessive apoptosis causes uteroplacenter ischaemia and damage of endothelial cells that give rise to clinical manifestations of preeclampsia. Excessive throphoblast apoptosis in preeclampsia mainly occurs through the intrinsic pathway in which expression of Bax protein increases mitocondrial membranes permeability of cytochrom C which further activate the caspase cascade and become involved in the process of cell death. Objective: To compare the expression of Bax protein and throphoblastic apoptosis process between severe preeclampsia/eclampsia and the normotensive pregnancy. Methods: Cross sectional study which consist of 43 severe preeclampsia/eclampsia pregnancies and 38 third trimester normotensive pregnancies, recruited between October 2011 – March 2012. Trophoblastic Bax protein expression is measured by imunohistochemical staining technique and trophoblast apoptosis process is examined by the Tunel assay. Statistical analysis using the independent t test (p<0.05). Results: Bax protein expression was significantly higher in trophoblast cell of severe preeclampsia/eclampsia compared to normotensive pregnancy (1.7 vs 1.4, p=0.00). Bax expression positively correlated (r=0.01) with mean arterial pressure which is increasing of the mean arterial pressure will increase the expression of the Bax protein. There was no significant difference in trophoblastic apoptosis index between severe preeclampsia/eclampsia pregnancy and normotensive pregnancy (23.8 vs 35.5, p= 0.10). Conclusions: Bax protein expression was significantly higher in severe preeclampsia/eclampsia than normotensive pregnancy. There was no significantly difference in trophoblast apoptosis index between severe preeclampsia/eclampsia and normotensive pregnancy. Keywords: trophoblast, severe preeclampsia/eclampsia, Bax protein, apoptosis.

Abstract
Background: Early postpartum haemorrhage is still a leading cause of maternal mortality in Indonesia and in the district of East Lampung. Therefore it is necessary to investigate the risk factors associated with early postpartum haemorrhage in Sukadana hospital, East Lampung. At the end we hope that the incidence of bleeding can be identified and anticipated.
Objectives: To determine the risk factors associated with early post partum haemorrhage in Sukadana Hospital, District of East Lampung.
Design:  This was a case control study.
Method: The subject of this research was every vaginal delivery at East Lampung district  which suitable with the inclusion criteria. This research was conducted from October 2010 until March 2011, with 54 cases and 54 controls which have been matched by the education level. Bivariate and multivariate logistic regression were used for data analysis with α: 0,05 and 95% of confidence interval.
Results:  Proportion of elementary education and not school level was high (70,4%). Uterine atoni was the most prevalence cause for post partum haemorrhage (30 cases, 55,6%). Multivariate result for risk factor that significance for early postpartum haemorrhage was parity ≥3 with OR 3,32 (CI 95%; 1,15-9,6; p: 0,03). While preeclamsia and eclamsia, anemia, induction and stimulation Oxytocin 5 IU, premature rupture of membranes  were not significance statistically and clinically.
Conclusion:  Parity ≥ 3 are most dominant risk factor contribute to early        postpartum hemorrhage.
Keywords:  Early postpartum haemorrhage, risk factors, anemia.

Abstract
Background: For the treatment of advanced carcinoma of the cervix uteri chemoradiation protocol performed weekly or three weekly. To determine the therapeutic response comparison of both protocols, need to check the tumor marker SCC antigen before and after chemotherapy.
Objective: To determine the ratio of SCC antigen changes before and after the third on the protocol of chemotherapy weekly and three weekly protocol at an advanced carcinoma of the cervix uteri.
Methods: The study was performed in RS Sardjito, study subjects were patients with advanced carcinoma of cervix uteri who received chemotherapy protocol weekly or three weekly. Examination of SCC antigen levels before and after the third chemotherapy.
Results: There were 30 cases, each of the 15 cases who received weekly protocol and the protocol of three weekly 15 cases. Most 46-55 years old (60.0%) in the weekly protocol and also 60.0% at three weekly protocol. Parity 3 or more, 73.3% and 66.7%. Elementary education level (33.3% and 73.3%). Class III of ward (73.3% and 66.7%). Histopathology of epidermoid carcinoma (40.0%) and squamous cell carcinoma (40.0%). Stage IIB (73.3%) and IIIA (40.0%). At the weekly protocol, the average (mean) SCC antigen levels before treatment (SCC Pre Ag) 8.080 ± 13.151 mg / L and SCC antigen after the weekly protocol (SCC Post Ag) 3.067 ± 3.465 mg / L, with changes (decreased levels) amounting to 5.013 ± 12.000 mg / L. While the protocol three weekly average SCC Pre Ag 17.610 ± 21.575 ug / L and Post SCC Ag is 8.074 ± 14.760 mg / L, with changes (decreased levels) for 9.536 ± 14.873 mg / L. With a paired t test individually on a weekly and three weekly protocol obtained: First, there is no change in a significant SCC antigen levels before and after the third on the protocol of chemotherapy weekly. Second, there is a change in a significant SCC antigen levels before and after the third chemotherapy on three weekly protocol. Test done together with the independent t test acquired conclusions: there is no change in a significant SCC antigen levels before and after the third chemotherapy between the weekly protocol and three weekly protocols.
Conclusion: there is no change in a significant SCC antigen levels before and after the third chemotherapy between the weekly protocol and three weekly protocols on advanced carcinoma of the cervix uteri.

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