The Anxiety Level and Premature Rupture of Membrane Incidence during COVID-19 Pandemic

Abstract Objective: To determine the association between anxiety level and premature rupture of membrane incidence during COVID-19 pandemic. Methods: This study was a case-control study. The subjects of this study were patients giving birth at RSUD Dr. Moewardi Surakarta Hospital and UNS Sukoharjo Hospital in June - October 2021. Sampling was done by the purposive sampling technique on 70 samples. Data were analyzed using the chi-square test and logistic regression test. Results: Characteristic data of the study samples found that most of the study samples was severe anxiety (40%). There was a significant association between the level of anxiety with PROM incident (p = 0.00), and pregnant women with severe anxiety had a risk of PROM of 3.761 times compared to pregnant women who were not anxious (OR=3.761). In multivariate analysis, it was found that the most influential variable on the incidence of premature rupture of membranes was the level of anxiety (p=0.001) compared to parity (p=0.155), employment status (0.193), and education level (0.576). Conclusion: There was a significant association between anxiety level and premature rupture of membranes incidence during the COVID-19 pandemic, and there was an increased risk of premature rupture of membranes in pregnant women with severe anxiety levels during the COVID-19 pandemic. Keywords: anxiety level; premature rupture of membrane; COVID-19 pandemic

CONDITIONED MEDIA OF MESENCHYMAL STEM CELLS RECOVERS PLACENTAL GROWTH FACTOR IN PRISTANE MICE MODEL

Objectives: A low level of placental growth factor (PlGF) expression in placenta is strongly correlated with pregnancy loss, prematurity, fetal growth restriction, and preeclampsia. Pristane-induced lupus in mice model has been widely used to present placental damage and poor pregnancy outcomes. Conditioned media (CM), which is medium for culturing mesenchymal stem cells (MSCs), have grown much attention recently. It has rich amount of growth factors, exosomes, microvesicles, and immunomodulatory molecules. These could become beneficial resources to recover poor placentation. Methods: CM taken from the 3rd to 4th passage of the culture were underdone by using explant method of human umbilical cord (hUC). Ninety BALB/c mice were randomly distributed into three groups: Normal, pristane, and pristane + CM group. Mice in normal group were injected with 0.5 ml normal saline and other groups with 0.5 ml pristane. Four weeks later, mice were mated and only pristane + CM group received therapy of CM-MSCs 0.5 ml single dose after pregnancy was confirmed. On day 16, pregnancy was terminated and the placenta was analyzed for PlGF expression using immunoreactive score and statistically tested with analysis of variance. Results: The average of PlGF expression in normal, pristane, and pristane + CM group was 9.528, 3.428, and 10.085, respectively. CM have significantly increase PlGF (p<0.01**) and equal to normal (p=0.301). Conclusion: CM of hUC-MSCs has shown its therapeutical effect among the low level of PlGF in damaged placenta, and potentially would prevent fetal growth restriction and preeclampsia arose from spiral artery remodeling failure

Perbandingan Faktor Risiko antara Pertumbuhan Janin Terhambat Onset Dini dan Lambat di RSUD Dr. Moewardi

Tujuan: Mengetahui perbandingan faktor risiko antara pertumbuhan janin terhambat onset dini dan lambat di RSUD Dr. Moewardi.Metode: Penelitian observasional analitik dengan pendekatan cross sectional menggunakan data sekunder rekam medis ibu dengan pertumbuhan janin terhambat di RSUD Dr. Moewardi mulai 1 Januari 2020–31 Desember 2021. Pengambilan data menggunakan teknik total sampling, Data diolah menggunakan SPSS dan dianalisis menggunakan uji univariat, kemudia bivariat yaitu uji Chi Square.Hasil: Hasil analisis bivariat menunjukkan bahwa tidak terdapat perbedaan bermakna pada variabel usia, paritas, Indeks Massa Tubuh (IMT), pekerjaan ibu, hipertensi, preeklamsi, diabetes melitus, anemia, asma antara pertumbuhan janin terhambat onset dini dan onset lambat (p>0,05).Kesimpulan: Tidak terdapat perbedaan yang bermakna pada usia ibu, paritas, Indeks Massa Tubuh (IMT), pekerjaan ibu, preeklamsi, hipertensi, diabetes melitus, anemia, asma antara kejadian pertumbuhan janin terhambat onset dini dan lambat di RSUD Dr. Moewardi.Comparison of Risk Factor For Early and Late Onset Intrauterine Growth Restriction in RSUD Dr. MoewardiAbstract Objective: To find out the comparison of risk factors between early-onset and late onset intrauterine growth restriction at RSUD Dr. Moewardi.Method: This research is an analytical observational with a cross sectional approach was done by using medical records of pregnant woman with intrauterine growth restriction at RSUD Dr. Moewardi from January 1, 2020– December 31, 2021. Data was collected using a total sampling technique. And processed by SPSS then analyzed using univariate test, and Chi Square test.Results: The results of bivariate analysis showed that there was no significant differences of age, maternal employment, parity, Body Mass Index (BMI), maternal employment, hypertension, preeclampsia, diabetes mellitus, anemia, asthma between early-onset and late-onset with intrauterine growth restriction (p>0,05).Conclusion: There were no significant differences of maternal age, parity, Body Mass Index (BMI), preeclampsia, maternal employment, hypertension, diabetes mellitus, anemia, asthma between early and late onset intrauterine growth restriction at RSUD Dr. Moewardi.Key words: Risk Factor, Intrauterine Growth Restriction, Early Onset, Late Onse

Prenatal Diagnosis and Management of Advanced Abdominal Pregnancy in Dr. Moewardi Hospital Surakarta: A Case Series

Background: The abdominal pregnancy is a pregnancy anywhere in the abdominal cavity other than the tube, ovary, and broad ligament. Abdominal pregnancy has 7.7 times greater risk than tubal pregnancy and 90 times greater than intrauterine pregnancy. This study aims to reveal the diagnosis and treatment of abdominal pregnancy in Dr. Moewardi Hospital Surakarta.Subjects and Method: This was a case series study conducted at Dr. Moewardi Hospital Surakarta. This study report three cases of advanced abdominal pregnancy at Dr Moewardi Hospital (2019 – 2020), that consisted of two cases of advanced abdominal pregnancy to term, and one advanced abdominal pregnancy with acute abdomen.Case presentation: Case 1 (it was found abdominal pregnancy at 30 weeks), the condition of the mother and the fetus was good, the pregnancy was continued until the gestational age was term. The patient was given corticosteroids for lung maturation and magnesium sulfate for neuro­protection. Case 2 (an abdominal pregnancy was found at term), it was decided to immediately terminate it with good preoperative preparation. Both patients in case 1 and case 2 had good result in both the mother and the fetus. The placenta was left in situ in both cases to prevent massive bleeding and injury to the gastrointestinal organs. Case 3 (advanced abdominal pregnancy with acute abdominal symptoms) decided to undergo an emergency laparotomy and removal of the placenta.Conclusion: Abdominal pregnancy must be diagnosed and managed properly to reduce maternal mortality and morbidity. In advanced abdominal pregnancy, it could be considered to continue the pregnancy until the term. The placenta management of in situ without methotrexate might be considered in cases of abdominal pregnancy.Keywords: abdominal pregnancy, prenatal diagnosis, treatmentCorrespondence: Uchti Akbar. Departement of Obstetrics & Gynaecology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta, Jl. Kolonel Sutarto, Surakarta 57126, Central Java. Email : [email protected]. Mobile: 081397167176.Journal of Maternal and Child Health (2021), 06(04): 516-522https://doi.org/10.26911/thejmch.2021.06.05.01

Placental damage comparison between preeclampsia with COVID-19, COVID-19, and preeclampsia: analysis of caspase-3, caspase-1, and tumor necrosis factor-alpha expressionAJOG Global Reports at a Glance

BACKGROUND: Some studies have reported that preeclampsia with COVID-19 significantly increases the risk of adverse perinatal outcomes to nearly 3-fold in normal pregnancy. In theory, the pathophysiology of preeclampsia increases perinatal mortality and morbidity starting from placental injury, which is also believed to share a common pathway with COVID-19. Moreover, major placental injuries could be apoptotic, necrotic, or pyroptotic. OBJECTIVE: This study aimed to compare the placental damage between Preeclampsia with COVID-19, COVID-19, and preeclampsia in apoptotic, necrotic, or pyroptotic injuries. STUDY DESIGN: This was an observational analytical study with a cross-sectional setting. A total of 72 pregnant women were admitted to the hospital with diagnoses of preeclampsia with COVID-19, preeclampsia, and COVID-19. The diagnosis for preeclampsia was following the International Federation of Gynecology and Obstetrics criteria with at least 1 of the severe features. Patients with COVID-19 were eligible if they had a confirmatory polymerase chain reaction test with moderate to severe clinical degree. The placentas were taken after delivery, and the parameters were quantified with immunohistochemistry tests for caspase-3, caspase-1, and tumor necrosis factor-alpha representing apoptotic, pyroptotic, and necrotic pathways, respectively. RESULTS: Pregnancies complicated by both COVID-19 and preeclampsia, preeclampsia, and COVID-19 significantly had the highest placental damage on apoptotic, pyroptotic, and necrotic pathways shown from caspase-3, caspase-1, and tumor necrosis factor-alpha expressions in the placenta (P<.05). Moderate to severe degree of COVID-19 resulted in higher placental damage than preeclampsia in all 3 forms (P<.05). The apoptotic process was the most prominent among the pathways. CONCLUSION: Preeclampsia with COVID-19 showed significant placental damage, with major changes related to apoptosis, inflammation, and necrosis. Our data support poor perinatal outcomes of pregnancies complicated by both preeclampsia and COVID-19