Julian Dewantiningrum
Department Of Obstetrics And Gynecology, Faculty Of Medicine, Diponegoro University, Semarang, Indonesia

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ASSOCIATION OF THIRD TRIMESTER MATERNAL HEMOGLOBIN WITH MEASUREMENT OF NEWBORN’S ANTRHROPOMETRY Rahman, Farhan Aulia; Anantyo, Dimas Tri; Dewantiningrum, Julian; Haryana, Bambang
DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) Vol 9, No 1 (2020): DIPONEGORO MEDICAL JOURNAL ( Jurnal Kedokteran Diponegoro )
Publisher : Faculty of Medicine, Diponegoro University, Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (457.77 KB) | DOI: 10.14710/dmj.v9i1.26572

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Background: More than 20 million babies are born each year with a body weight of less than 2500 g, and 17% of all births in developing countries. Birth weight plays a role in mortality and morbidity, development and, future health of children. Low birth weight is a significant risk factor for infant death and other physical disorders. Anemia that occurs in maternal can increase the risk of mortality, perinatal morbidity and can affect the state of newborns. Anemia in maternal is related to low gestational age, low birth weight, and increased risk of small infants for gestational age. Research on the relationship of maternal’s hemoglobin levels in third trimester  to anthropometric measurement of newborns has never been carried out at Rumah Sakit Nasional Diponegoro (RSND). Objective: This study aims to determine relationship between maternal’s hemoglobin levels in third trimester with anthropometry of newborns.  Method: This research was a study with cross sectional design. Data is collected from medical records at RSND. Babies born viewed medical records to determine inclusion criteria in the study. Anthropometric data were collected for newborns and the third trimester hemoglobin level was recorded in pregnant women. Assosiation analytic was performed with chi square test. Results: There was a significant relationship between maternal’s hemoglobin levels in third trimester with measurements of newborn weight, body length, and head circumference. Conclusion: Maternal’s hemoglobin in third trimester affect the measurement of weight, body length, and head circumference neonates.Keywords: anemia, hemoglobin, anthropometry, maternal, newborn
Persalinan Pervaginam dan Menyusui sebagai Faktor Risiko Kejadian HIV pada Bayi Dewi Astri Purnaningtyas; Julian Dewantiningrum
MEDIA MEDIKA INDONESIANA 2011:MMI Volume 45 Issue 3 Year 2011
Publisher : MEDIA MEDIKA INDONESIANA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (69.861 KB)

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ABSTRACTVaginal delivery and breastfeeding as risk factors of HIV in infantsBackground: HIV incidence is increasing among housewives, leading to increasing HIV in infants. The aim of this study was to identify risk factors of HIV in infants.Method: A case control study was carried out among women who visited VCT (voluntary counselling and testing) clinic RSUP Dr. Kariadi during 2003-2011 that fulfill the inclusion criteria of term delivery and babies infection confirmed by VCT or PCRDNA/RNA. Risk factors were assessed by interview about ARV consumption during pregnancy, mode of delivery, prophylactic ARV for neonates and breastfeeding. CD4 concentration before delivery was defined from medical report. All subject divided into two group based on HIV infected children status, HIV and non HIV. Analysis used bivariate analysis using Chi square and odd ratio.Result: From 28 women: 16 women in HIV group and 12 women in non HIV group. Breast feeding (OR 13.00; 95% CI 2.12-79.59, p=0.006) and vaginal delivery (OR 6.07; 95% CI 1.11-3.24, p=0.050) were the most important risk factors for HIV infection in infants. ARV consumption during pregnancy (OR 0.13; 95% CI 0.01-1.40), ARV prophylactic in neonates (OR 0.20; 95% CI 0.02- 2.23), CD4 >400 sel/mm3 before delivery (OR 0.33; 95% CI 0.03-4.019) were not risk factors. Conclusion: Vaginal delivery and breastfeeding were risk factor for the incidence of HIV-infected infants.Keywords: Vertical transmission HIV, CD4 concentration, mode of delivery, breastfeeding, ARVABSTRAKLatar belakang: Insiden penderita HIV meningkat pada ibu rumah tangga, yang akan mempengaruhi peningkatan insiden penderita HIV baru pada masa perinatal. Penelitian ini bertujuan ingin mengetahui berbagai faktor risiko yang berpengaruh terhadap kejadian HIV pada bayi.Metode: Desain penelitian adalah studi kasus kontrol. Subyek penelitian adalah ibu dengan HIV yang datang ke klinik VCT RSUP Dr. Kariadi tahun 2002-2011, dengan kriteria inklusi cukup bulan serta bayi telah dilakukan pemeriksaan PCR DNA/RNA. Data diperoleh lewat wawancara langsung maupun per telepon dengan kuesioner terbuka dan pemeriksaan CD4 menjelang persalinan. Wawancara untuk mencari faktor risiko pemberian ARV selama kehamilan meliputi cara persalinan, pemberian ARV profilaksispada bayi dan pemberian ASI. Data dianalisis dengan Chi square.Hasil: Sebanyak 28 subyek penelitian terbagi dalam kelompok HIV 16 subyek dan non HIV 12 subyek. Analisis berbagai faktor risiko menunjukkan bahwa pemberian ASI (OR 13,00, 95% CI 2,12-79,59) dan persalinan pervaginam (OR 6,07, 95% CI 1,11-3,24) merupakan faktor risiko yang berpengaruh terhadap kejadian HIV pada bayi. Nilai CD4 serum ibu >400 sel/mm3 menjelang persalinan (OR 0,33; 95% CI 0,03-4,019), pemberian ARV profilaksis neonatus (OR 0,20; 95% CI 0,02-2,23) dan pemberian ARVpada ibu hamil (OR 0,13, 95% CI 0,01-1,40), tidak merupakan determinan terhadap penularan HIV dari ibu ke janin.Kesimpulan: Persalinan pervaginam dan pemberian ASI merupakan faktor risiko kejadian HIV pada bayi.
MELASMA SHOW UP IN CONTRACEPTIVE PILLS ACCEPTORS Cahya Novenita Azzahra; Widyawati Widyawati; Liza Afriliana; Julian Dewantiningrum
JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL) Vol 10, No 1 (2021): JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL)
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dmj.v10i1.29436

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AbstractIntroduction : Melasma is one of the most common hyperpigmentation disorders among womans, the common hyperpigmentation patches which commonly found on face especially on sunlight exposured area. One of the factors causing melasma is the use of oral contraceptives which cause the buildup of the hormones estrogen and progesterone on the skin.Objectives : Thus, the aim of the study is to analyze the association between duration of contraceptive pills use and melasma.Methods : This study used a cross-sectional design. The research was conducted in May-July 2020. The subjects were 36 womans aged 30-55 years old and oral contraceptive acceptors that qualify inclussion criteria and not eligible exclussion criteria. The data was collected primarily using questionnaires. Physical examinations were done through observation with a photo of the respondents. Data analysis using the Chi Square test with a significance value p <0,05.Results : Based on the results of this study, the significance of 0.017 less than 0.05 which indicates a relationship between variables duration of contraceptive pills use and melasma. Conclusions : This study shows a association between duration of contraceptive pills use and melasmaKeywords : melasma, contraceptive pills.
The Effect of Radiotherapy on Blood Components of Cervical Cancer Patients Afina Yuliani Putri; Yan Wisnu Prajoko; Julian Dewantiningrum; Ch Nawangsih Prihharsanti
JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL) Vol 10, No 6 (2021): JURNAL KEDOKTERAN DIPONEGORO (DIPONEGORO MEDICAL JOURNAL)
Publisher : Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dmj.v10i6.30411

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Background: Radiotherapy exposure is known to have a lethal effect on blood cells because hematopoietic cells are very sensitive to radiation exposure even at low doses. Cervical cancer with radiotherapy can have the effect of reducing blood cells. Blood cells that may experience the effects of radiotherapy include haemoglobin, leukocytes and platelets.Objective: Knowing the effects of radiotherapy towards blood components of cervical cancer patients.Methods: This study was an observational study with the type of study before and after design. Data collected from medical records as secondary data in the Radiotherapy Unit of Dr. Kariadi Semarang in 2019-2020 with a total of 128 cervical cancer patients undergoing 3D radiotherapy. The statistical test used the Saphiro Wilk data normality test and the result data analysis used the Paired T Test and the Wilcoxon test.Results: Hypothesis testing for Hb levels using the Paired T Test showed an insignificant value of p=0.749 and p=0.141. Hypothesis test for the number of leukocytes and platelets using the Wilcoxon test. Leukocytes received a significant value of p=0.000 and insignificant p=0.957. Platelets received a significant value of p=0.000 and p=0.000. Hb value decreased by -0.44, leukocytes by -3.5, and platelets by -84.34.Conclusion: There was an insignificant decrease in haemoglobin levels yet significant decrease in leukocyte and platelet counts in cervical cancer patients undergoing radiotherapy where the platelets experienced the most decrease compared to haemoglobin and leukocytes.
Randomized Controlled Trial of Tranexamic Acid’s Effect on Bleeding Length: A Study on DMPA Users with Abnormal Uterine Bleeding Who Receive Low-Dose Oral Contraceptive Pill Rabiah Adawiyah; Inu Mulyantoro; Julian Dewantiningrum; Noor Pramono
Journal of Biomedicine and Translational Research Vol 6, No 1 (2020): April 2020
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jbtr.v6i1.4450

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ABSTRACTBackground: Contraceptive injection is the most common contraception used in Indonesia. Among the contraceptive injections, depomedroxy progesterone acetate (DMPA) is the most effective method with pregnancy rate of 0,3 pregnancy in 100 women annually. Abnormal uterine bleeding (AUB) is a common side effect occurred in DMPA users which leads to the discontinuation of contraception.Objective: To explore the effect of tranexamic acid on bleeding length for DMPA users with AUB who receive low dose Oral Contraceptive Pills (OCP).Methods: We performed double blind randomized control trial between  two groups to investigate the effect of tranexamic in managing AUB in DMPA users who receive low dose OCP. This study was performed in Dr. Kariadi Hospital Semarang, Indonesia. Forty-four subjects were divided into two groups, equally. Group 1 received 250 mg tranexamic acid four times a day for 5 days and OCP once a day for 28 days, while Group 2 received placebo four times a day for 5 days and OCP once a day for 28 days. Both groups were evaluated for bleeding length during treatment and were analyzed using Mann Whitney for post treatment with tranexamic acid.Results: The mean bleeding length was 5.2±3.62 days and 9.2±6.16 days in group 1 and 2 respectively. These bleeding lengths were significantly different between both groups (p=0.018). The precentage of subjects in whom bleeding was stopped during the first week after initial treatment was significantly higher in  group  1 than group 2 (77,3 % vs 45,5 %, p<0,030).Conclusion: Tranexamic acid significantly reduced the bleeding length in DMPA users who use OCP.
Level of hsCRP Maternal Serum During Puerperium of Severe Preeclampsia Julian Dewantiningrum; Zaki Hetami
Journal of Biomedicine and Translational Research Vol 4, No 1 (2018): July 2018
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (738.192 KB) | DOI: 10.14710/jbtr.v4i1.2501

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Background: Preeclampsia and eclampsia arestill major problemsin the world. Maternal mortality of severe preeclampsia at the puerperal period is likely to be greater because of the cardiovascular diseases (CVD). HsCRP (high sensitivity C-Reactive Protein) is a usefull prediction for CVD among non preeclamptic patients. Before using hsCRP as a marker for that prediction of cardiovascular event from preeclamptic patient, we should do research to know difference of hsCRP between preeclampsia and normal pregnancy.Objective: To determine the differences levels of hsCRP among severe preeclampsia and normal pregnancyMethod : A cross sectional study was conducted to severe preeclampsia. The inclusion criteria were subjects in puerperal period (2- 6 weeks) with a history of severe preeclampsia and normotensive.Exclusion criteria were puerperal infection, chronic hypertension, metabolic syndrome, caesarean section delivery and refuse to join this research. All subjects were examined the levels of hsCRP maternal serum when blood pressure £140 / 90.Result: Subjects were consist of 26 severe preeclampsia (53%) and 23 normal pregnancy (46.9%). Level of hsCRP in severe preeclampsia was 4.73 +3.57while in normotensive 2.42 +4.14 (p <0.05). Severe preeclampsia group will increase the risk of hsCRP rise as much as 2.5 times compared to the normotensive group.Conclusion:Level of hsCRP in patients with preeclampsia post partum were higher than patients with normal pregnancies. 
Neutrophil-Lymphocyte Ratio(NLR), Platelet-Lymphocyte Ratio (PLR) and D-Dimer to Length of Stay in ICU of Pregnancy with COVID-19 Complicating Severe Coagulopathy Mona Galatia Marpaung; Rizky Syahriar Syoufana; Radith Aulia; Julian Dewantiningrum
Indonesian Journal of Obstetrics & Gynecology Science Volume 5 Nomor 1 Maret 2022
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia/v5n1.350

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Objective: The aim of this study was to obtain data that D-Dimer levels, Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR) as a prognostic factors of length of stay in ICU. The longer length of stay in the Intensive Care Unit (ICU) as an indicator of severe coagulopathy.Methods :This study uses an analytic observational study with a cross sectional approach to analyze NLR , PLR ,and the D-Dimer levels and their relationship to length of stay in ICU of pregnant women with COVID-19 infection who were treated at RSUP Dr. Kariadi during March 2020 to October 2021. Medical records of patients with pregnancy confirmed COVID-19 who were diagnosed by PCR (polymerase chain reaction) and treated at Dr Kariadi Hospital between March 2020 and October 2021 were reviewed, p value <0.05 considered significant. Results:  The mean value of D-Dimer was 3746.6 ± 4852.33 (460-20) ug/L, NLR was 8.14 ± 6.35 (2.20-29.60), PLR was 27.66 ± 20.60 (6.80-96.66). 15 were treated in ICU with Length of stay 0.3 ± 0.46 (0-1) with the significancy was NLR p 0.008, PLR p 0.073 and D-dimer p 0.225. Conclusion : High NLR, PLR and D-dimer levels correlated with severe coagulopathy that effect the length of stay in ICU.Neutrophyl-Lymphocyte Ratio (NLR) , Platelet-Lymphocyte Ratio (PLR) dan D-dimer Terhadap Lama Rawat Inap di ICU pada Kehamilan dengan COVID-19 yang Mengalami Koagulopati Berat Abstrak Tujuan: Tujuan dari studi ini untuk menilai jumlah D-Dimer , Neutrophyl-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR) sebagai factor prognostic dari lama rawat inap di ICU. Metode: Studi ini menggunakan desain analitik observasional dengan pendekatan cross sectional  untuk menganalisa NLR, PLR dan jumlah D Dimer dan hubungannya dengan lama rawat inap di ICU dari Wanita hamil dengan infeksi COVID 19 yang dirawat di RSUP Dr Kariadi selama bulan Maret 2020 hingga Oktober 2021, nilai p <0.05 dianggap signifikan. Hasil: Rerata nilai D Dimer dari subjek ialah 3746,6 ± 4852.33 (460-20) ug/L, NLR  8.14 ± 6.35 (2.20-29.60), PLR  27.66 ± 20.60 (6.80-96.66). 15 pasien dirawat di  ICU dengan lama rawat inap 0.3 ± 0.46 (0-1) dengan nilai signifikansi dari NLR p 0.008, PLR p 0.073 dan D-dimer p 0.225. Kesimpulan: NLR dan D dimer yang tinggi berhubungan dengan keparahan koagulopati yang menyebabkan lama rawat inap di ICU.Kata kunci : Lama rawat inap ICU, koagulopati, kehamilan dengan COVID 19
High-Sensitivity Cardiac Troponin I Level and Left Ventricular Diastolic Dysfunction on Severe Preeclampsia: Kadar High Sensitivity Cardiac Troponin I dan Disfungsi Diastolik Ventrikel Kiri pada Preeklamsia Berat Rahmad R. B. Wicaksono; Julian Dewantiningrum; Herman Kristanto
Indonesian Journal of Obstetrics and Gynecology Volume 9 No. 1 January 2021
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v9i1.1429

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Abstract Objective: To know the relationship between high-sensitivity cardiac Troponin I (hscTnI) level with left ventricular dysfunction on severe preeclampsia.Methods: An observational analytics study with a cross-sectional approach of ten pregnant women with severe preeclampsia who underwent delivery or termination pregnancy and then performed a transthoracic echocardiography examination and serum levels of hscTnI.Results: There is a significant relationship between hscTnI levels and left ventricular diastolic dysfunction (p <0.05)Conclusion: These findings of this study have significant implications that severe preeclampsia is associated with heart remodelling and significant change in cardiac function especially left ventricular dilatation and elevation of hscTnI. Early identification and intervention may ameliorate subsequent cardiovascular disease so this requires regular and close follow-up of this target group.Keywords: high-sensitivity cardiac Troponin I, left ventricular diastolic dysfunction, severe preeclampsia. Abstrak Tujuan: Untuk mengetahui hubungan antara kadar high-sensitivity cardiac Troponin I (hscTnI) dengan disfungsi ventrikel kiri pada preeklamsia berat.Metode: Studi observasional dengan pendekatan potong lintang terhadap sepuluh ibu hamil dengan preeklamsia berat yang menjalani persalinan atau terminasi kehamilan kemudian dilakukan pemeriksaan ekokardiografi dan kadar hscTnI serum.Hasil: Ada hubungan yang bermakna antara kadar hscTnI dengan disfungsi diastolik ventrikel kiri (p <0,05).Kesimpulan: Temuan penelitian awal ini memiliki implikasi yang signifikan bahwa preeklamsia berat berhubungan dengan remodeling jantung dan perubahan signifikan pada fungsi jantung terutama dilatasi ventrikel kiri disertai peningkatan kadar hscTnI. Identifikasi dan intervensi dini dapat memperbaiki perjalanan penyakit kardiovaskular sehingga diperlukan pengawasan lanjut pada kelompok pasien ini.Kata kunci: disfungsi diastolik ventrikel, high-sensitivity cardiac troponin I jantung sensitivitas tinggi, kiri, preeklamsia berat
Karsinoma Ovarii Serosa pada Kehamilan dengan Komplikasi IUGR : Laporan Kasus di RSUP Dr. Kariadi, Semarang Hapsari, Anggiyasti Vidya; Ambari, Ediwibowo; Dewantiningrum, Julian; Ushan, Ery Perdana
Medica Hospitalia : Journal of Clinical Medicine Vol. 7 No. 1 (2020): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (369.943 KB) | DOI: 10.36408/mhjcm.v7i1.436

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Karsinoma ovarium merupakan keganasan ginekologi terbanyak kedua yang terjadi pada kehamilan. Dilaporkan terjadi 1:10.000 sampai 1:25.000 kehamilan. Histopatologi karsinoma ovarium jenis epitelial lebih jarang terjadi dibandingkan germ cell tumor1,2. Kehamilan tidak mempengaruhi prognosis karsinoma ovarium, akan tetapi komplikasi yang mungkin terjadi adalah torsi tumor, ruptur dan meningkatkan kemungkinan terjadinya persalinan prematur16. Tulisan ini melaporkan seorang wanita, 31 tahun, primigravida, hamil 34 minggu, dengan pembesaran abdomen melebihi usia kehamilan, peningkatan kadar Ca-125 darah dan massa solid ovarium sinistra disertai ascites pada pemeriksaan ultrasonografi. Pemeriksaan histopatologi jaringan tumor ovarium, uterus dan omentum menunjukkan diagnosis low grade serous carcinoma ovarii bilateral dengan infiltrasi hingga tuba dan omentum. Pemeriksaan rutin kehamilan dengan ultrasonografi penting dilakukan untuk skrining adanya neoplasma ovarium yang menyertai kehamilan. Penatalaksanaan hamil dengan tumor padat ovarium tergantung dari usia kehamilan. Menurut algoritme dilakukan operasi pengangkatan massa dan dilakukan frozen section (FS) untuk mengetahui sifat tumor jinak atau ganas pada usia kehamilan 18-22 minggu dan dilanjutkan dengan operasi lanjutan setelah kelahiran bayi16. Pada kasus ini dengan mempertimbangkan kehamilan ini merupakan kehamilan pertama dengan tidak adanya keluhan dan secara prinsip tidak adanya perubahan anatomi untuk dapat dilakukan operasi complete surgical staging saat bayi dilahirkan pada usia kehamilan 34 minggu, maka dari hasil rapat medis diambil keputusan untuk dilakukan operasi complete surgical staging bersamaan setelah sectio caesaria. Prosedur operasi ini tidak mudah dilakukan dan banyak dihindari, tetapi dengan kehati-hatian dan identifikasi struktur anatomi yang baik, maka operasi berjalan lancar.
Fetal Growth Cut-Off Point To Predict Neonatal Outcome In Pregnancy With Normal And Deficient Vitamin D Levels: Intergrowth-21, World Health Organization Fetal Growth Curve, And Hadlock’s Estimated Fetal Weight Dewantiningrum, Julian; Kristanto, Herman; Pudjonarko, Dwi; Mexitalia, Maria; Ediati, Annastasia; Soejoenoes, Ariawan; Hadisaputro, Suharyo
Medica Hospitalia : Journal of Clinical Medicine Vol. 10 No. 2 (2023): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v10i2.877

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Purpose : Analyze the cut-off point of fetal growth based on the Intergrowth-21, World Health Organization (WHO), and Hadlock’s estimated fetal weight (EFW) in pregnant women with normal or deficient vitamin D levels to predict neonatal outcomes. Method: This cross sectional study to develop a diagnostic test, included 120 of pregnant women who completed follow up until children aged 2 years, divided into normal and deficient vitamin D group. Ultrasound and maternal vitamin D level examined during the second trimester of pregnancy. EFW was calculated using Hadlock’s formula and plotted on the Intergrowth-21 and WHO curves. The reference standards were the neonatal outcome, LBW, stunting, and neurocognitive impairment. Significant odds ratio (OR) value and area under the curve (AUC) of 0.6 are used to determine the cut-off point to be used. Result: Fetal growth curve was based on the WHO at the 5th percentile to predict LBW to have an AUC of 0.6 and OR of 6, 95% confidence interval (CI) of 1.36–26.45. The AUC for predicting LBW based on Intergrowth and Hadlock were 0.45 and OR not significant. As well as the AUC estimated stunting based on Hadlock, the Intergrowth-21 and the WHO fetal growth curves is <0.6 with OR not statistically significant. The AUC predicted neurocognitive impairment based on WHO’s chart was 0.6 but OR not statistically significant. Conclusion: The WHO fetal growth curve can be used to predict LBW. The cut-off point of the fetal growth curve and which percentile is determined by the neonatal outcome.