Background: One of the reason of the cause of high maternal mortality rate is delayed of referring patients to hospital in postpartum hemmorhage cases.
Objective: to determined the relationship between delayed referral by midwife in postpartum hemmorhage cases and near-miss morbidity at Soeradji Tirtonegoro Klaten hospital from January 2009 until December 2010.
Methods: A cohort retrospective study was conducted in 191 women with postpartum hemmorhage. The population of this study are all of the postpartum hemorrhage cases referred by midwife to Soeradji Tirtonegoro Klaten hospital. Subjects in this study are those who met inclusion and exclusion criteria, consisting of a group of mothers with postpartum hemorrhage cases that were referred by midwife. Criteria for inclusion in this study were all cases of postpartum hemorrhage that was referred to Dr Soeradji Tirtonegoro Klaten hospital.
Results: There were significant relationship between status of midwife and midwife’s workplace with delayed of referring patient to hospital (p: 0,003 and p: 0,001; p< 0.05). The length of working period of midwife and the education of midwife have significantly influenced the occurrence of near miss (RR = 1.328 and 95%CI 1.027-1.717; RR=1.288 and 95%CI 1.047-1.585 ; RR =1.434 and 95%CI 1.155-1.782). We found that delayed of referring patients to hospital, status of midwife, the length working period of midwife and the education of midwife are the risk factors of near-miss morbidity in postpartum hemorrhage cases (OR > 1).
Conclusion: The incidence of morbidity nearmiss in cases of postpartum hemorrhage in the late group were referred by midwives is higher than the group that was not too late referenced
Keyword: referred by midwife, postpartum hemorrhage, near-miss morbidity

Background: In preparation for emergency cesarean section will involve many decisions and move the various personnel from various disciplines with specific time limits in order to save mothers and neonate. Lack of harmony among team members will result in the need for longer time intervals, so that morbidity and increased maternal and neonate mortality.
Objective: Todetermine the effect of “responsetime” of emergency cesarean section to the out come of pregnancy in the Sarjito hospital.
Methods: The study designis aretrospective cohort.
Results: There were 150 cases of emergency Caesarean sectionin dr. Sardjito hospital during January 1, 2011 through December 31, 2011. The data retrievalis doneby taking aretrospectivecohortdata frommedical records of patients who entere dthestudy subjects. There were 150 cases of emergency Caesarean sectionin 681 cases of Caesarean section during 2011. Fromtable 4it can be seenthat the distribution of execution Caesarean section based on worked hours, 64 cases(42.7%) founded at work and 86 cases(57.3%) in the off hours. Basedon gestational age≥37 weeks there were 116 cases (77.3%) and<37 weeks there were 34 cases(22.7%). As for the difference intime <60 minutes there were 22 cases (14.7%) andat ≥ 60 minutes the re were 128 cases(85.3%). Type ofanesthesiaused was 123 cases(82.6%) regional anesthesia (spinal/ epidural) and 27 cases (17.4%) GA. From all cases of emergency Caesarean section,90.5% operator is are sidentand the restby a specialist. There were nosignificant differences in bivariate and multivariate analyzesto morbidity and mortality to maternal and neonatal.
Conclusion: No significant difference was found morbidity and mortality out comes for maternal and neonatal carein the “responsetime” <60 minutes and≥60 minutes at SarjitoHospital.
Key words: emergency cesarean section, decision – delivery time interval, response time, delivery time

Abstract
Objective. To asses the effects on increasing in blood pressure after administration of methylergonovine maleat in patients with severe preeclampsia.
Place of study. This study was conducted in dr. Sardjito Hospital, Yogyakarta, Indonesia from January – April 2010.
Study design. This study used method of prospective cohort to subject who eligible the inclusion.
Methods. The subject in this study were pregnant women with severe preeclampsia. Fifty five participants were divided into two groups. The first group (n=33) was treated with injection of methyergonovine maleat intra muscular in third stage of labor (after delivery of placenta) and the second group (n=22) was control group which mean had no intervention with methylergonovine maleat.
Results. After statistical test analysis paired t-test and independent t-test were done, there was a significant (p0,05) mean systolic pressure before administration of metylergonovine (148.8 mmHg) and 60 minutes after injection(151.8 mmHg). Significant difference between control group and the group which treated with metylergonovine was clearly demonstrate with increased of systolic and diastolic pressure at 30 minutes and 60 minutes following metlergonovine administration (p Conclusion. Administration of methylergonovine maleat via intra muscular injection may trigger the event of increasing systolic and diastolic pressure although clinically was not significant. Thus, if any indication on using of methylergonovine in third stage of labor which complicated with severe preeclampsia, adequate observation of the patients was required. read more

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.