THE ROLE OF PREDICTOR PLACENTAL GROWTH FACTOR, SOLUBLE ENDOGLIN, SOLUBLE-FMS-LIKE-TYROSINE KINASE-1 AND PULSATIL UTERINA ARTERIAL INDEX TO PREDICT THE EARLY ONSET OF PREECLAMPSIA

Objective: In preeclampsia, there will be an increase in SFlt-1 and in and decrease in PlGF levels. This condition will cause disorders of vasculogenesis and angiogenesis in fetomaternal circulation, which will eventually lead to preeclampsia syndrome such as proteinuria, hypertension and endothelial dysfunction. Methods: An observational study design with nested case-control. The study was conducted at Bunda Thamrin Hospital, Tanjung Mulia Medika Hospital, Sundari Hospital and private practice, from March to November 2018, with a sample of 64 research subjects. Results: The results of this study indicate that there were significant values with p<0.05, namely the pulsatile value of the uterine artery index with a 1.228 cut-off point, Area Under Curve (AUC) of 78.2% (95% CI 59.3%-97%), sensitivity 80%, specificity 64.6%, PlGF level with 441 pg/ml cut-off point, Area Under Curve (AUC) of 82.5% (95% CI 61.5%-100%), sensitivity 80%, specificity 87.7%, sFlt-1 level with a cut-off point of 10087.5 pg/ml, Area Under Curve (AUC) of 81.2% (95% CI 63.6%-98.9%), sensitivity 80%, specificity 67.7% while sEng with p value>0.05 which means it is not significant. Conclusion: From this study, no significant differences were found in sEng, whereas differences were found in the pulsatile value of the uterine artery index, PlGF levels, and sFlt-1 levels in the incidence of early-onset preeclampsia. From the multivariate analysis, an examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia

COMPARISON IMMUNOHISTOCHEMISTRY EXPRESSION OF DESIDUAL NATURAL KILLER (dNK) IN SEVERE PREECLAMPSIAAND NORMAL PREGNANCY

Objective: Preeclampsia characterized systematically by extensive vascular endothelial dysfunction and microangiopathy on mother, dNK is very important for the success of placentation. They are the key mediator of maternal immune system interactions with fetal cells. dNK cells are also involved in the modulation of EVT and the remodeling of spiral arteries. Methods: Analytic research with cross-sectional study, with samples of pregnant women who suffer from severe PE and aterm pregnancy which came to H. Adam Malik Hospital and Networking Hospital, November 2015-April 2016. The samples are 46 women, who met the inclusion criteria. Results: Immunohistochemistry examination dNK cell in the severe PE case group and control group, statistically found p<0,05. dNK placenta expression in the severe preeclampsia case group gives an overview of expression with a mean of 2.55±2.31, while the control group of normal pregnancy had higher mean is 8.66±3.16. Conclusion: The examination of immunohistochemistry of dNK cells showed there is a significant difference in the expression of Immuno-histochemistry dNK cells between severe PE case group and non severe PE

CONSERVATIVE TECHNIQUE OF PLACENTA ACCRETA SPECTRUM DISORDER (PASD)

This article review was aimed to discuss about the choices of conservative technique of placenta accrete spectrum disorder. Placenta Accreta Spectrum Disorder (PASD) is an obstetric complication complexes which tend to cause high maternal morbidity. Maternal morbidity has been reported in 60% of cases and mortality reaches 7% in women with placenta accreta. Internationally, the incidence of abnormal placental invasion has increased in the last 30 y and is currently reported to occur in 2–90 per 10,000 deliveries. Main cause of PASD is uterine surgery in particular, scars from cesarean section, a 56-fold increase in risk after three times cesarean section. In cases without massive bleeding and coagulopathy, a conservative approach can be considere. Four main conservative management methods have been described in several international literature, namely extirpative techniques (manual removal of the placenta); leaving the placenta in situ or an observative approach; one-step conservative operation (removal of the location of the accreta; and Triple-P procedure (stitching around the accretion area after resection)

Quality of Life and Sexual Function of Placenta Accreta Spectrum Disorder Patients after Surgery

Objective: To evaluate sexual function and quality of life features using two validated Female Sexual Function Index (FSFI) questionnaires, and the Short-Form Health Survey (SF-36) in patients with sexually active on Placenta Accreta Spectrum (PAS) Disorder patient.Method: This research is a cross sectional analytic observational study which was conducted in Haji Adam Malik General Hospital from January 2017 - December 2019. Thirty-five study patients who have been diagnosed with PAS disorder and have been treated for at least 3 months were divided into hysterectomy and conservative groups. This study data consisted of primary data from interviews and secondary data from medical records. Independent T test is used if it is normally distributed and Mann-Whitney is used if it is not normally distributed, and it is declared significant if the P value is <0.05. Result: From 8 assessment variables in the SF-36 questionnaire by comparing the questionnaire scores of PASD patients in the hysterectomy and conservative groups by showing significant results on social function (P value 0.021). Whereas in the FSFI questionnaire, there were 6 variables to assess the sexual function of patients with pain variable showing significant results (P value 0.007).Conclusion: There were differences in quality of life (social function) and sexual function (pain) in PASD patients in the hysterectomy and conservative groups.Keywords: Female Sexual Functional Index, Placenta Accreta Spectrum, Quality of Life, Short-Form Health Survey. Abstrak Tujuan: Untuk mengevaluasi fungsi seksual dan fitur kualitas hidup dengan menggunakan dua kuesioner tervalidasi Female Sexual Function Index (FSFI), dan Short-Form Health Survey (SF-36) pada pasien dengan placenta accrete spectrum (PAS) disorder yang aktif secara seksual setelah tindakan operasi.Metode: Penelitian ini merupakan penelitian analitik observasional dengan metode potong lintang yang dilaksanakan di Rumah Sakit Umum Haji Adam Malik dari January 2017-December 2019. Tiga puluh lima pasien yang didiagnosis dengan plasenta akreta spectrum dan telah ditatalaksana minimal 3 bulan dibagi menjadi kelompok histerektomi and konservatif. Data penelitian ini terdiri atas data primer dari wawancara dan data sekunder dari rekam medis. Uji T independen digunakan jika berdistribusi normal dan Mann-Whitney digunakan jika tidak berdistribusi normal, serta dinyatakan signifikan jika nilai P <0.05.Hasil: Dari 8 variabel penilaian dalam kuesioner SF-36 dengan membandingkan skor kuesioner pasien PASD pada kelompok histerektomi dan konservatif dengan menunjukkan hasil yang signifikan pada fungsi sosial (nilai P = 0,021). Sedangkan dalam kuesioner FSFI terdapat 6 variabel untuk menilai fungsi seksual pasien dengan variabel nyeri yang menunjukkan hasil yang signifikan (nilai P = 0,007).Kesimpulan: Terdapat perbedaan dalam kualitas hidup (fungsi sosial) dan fungsi seksual (nyeri) pada pasien PASD di kelompok histerektomi dan konservatif. Kata Kunci: female sexual functional index, placenta accreta spectrum, quality of life, short-form health survey

The Role of Placental Growth Factor, Soluble Endoglin, and Uterine Artery Diastolic Notch to Predict the Early Onset of Preeclampsia

BACKGROUND: Reducing maternal mortality is one of the targets in the Millennium Development Goals (MDGs). In a systematic review, 4.6 per cent (95% CI 2.7-8.2) of pregnancies were complicated by preeclampsia worldwide. Preeclampsia occurs in around 10% of pregnancies in the world whereas developing countries contribute more than developed countries. In developing countries, there are 13 cases of preeclampsia in every 1,000 births, whereas in developed countries only 2-3 cases of preeclampsia are found in every 10,000 deliveries. Variations in prevalence among countries reflect, at least in part, differences in the distribution of maternal age and the proportion of nulliparous pregnant women in the population. AIM: We aimed to investigate the role of placental growth factor, soluble endoglin, and uterine artery diastolic notch to predict the early onset of preeclampsia. METHODS: This study used an analytical study with a nested case-control design. The study was conducted at Bunda Thamrin Hospital, Tanjung Mulia Mitra Medika Hospital, Sundari Hospital and a private clinic, from March to November 2018 with a total sample of 70 research subjects. RESULTS: Uterine artery diastolic notch was not found in 50% of subjects. A total of 27 subjects (38.6%) had a unilateral diastolic notch, and 8 subjects (11.4%) had a bilateral diastolic notch. Cut-off point PIGF levels was 441 pg/ml, and Area Under Curve (AUC) 82.5% (95% CI 61.5%-100%), with sensitivity 80% and specificity 87.7%. The levels sEng in this study could not predict the incidence of early-onset preeclampsia (p = 0.113). Combined PlGF and pulsatile index of uterine arteries may predict early onset preeclampsia with sensitivity 40% and specificity 90.77%. From these results, pregnant women o 22-24 weeks of pregnancy, the levels of PlGF and the uterine artery pulsatility index can be a predictor of early-onset preeclampsia. Examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia. CONCLUSION: From these results, it can be concluded that in pregnant women of 22-24 weeks, the diastolic notches in uterine arteries cannot predict the incidence of early-onset preeclampsia. PlGF levels and pulsatile index of uterine arteries can be used as predictors of early-onset preeclampsia although examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia

DIFFERENCES OF MAGNESIUM SERUM LEVELS BEFORE AND AFTER THE ADMISSION OF MgSO4 IN PREECLAMPSIA PATIENTS

Objective: The definitive treatment of preeclampsia until the fetus and placenta are delivered with magnesium sulfate (MgSO4) is a modality for the prevention and treatment of eclampsia. This study aims to determine the differences in serum magnesium (Mg) levels between before and after administration of MgSO4 in preeclampsia patients. Methods: This research was an analytical study with experimental design with one group pre and post-test control group design in 4 hospitals in Medan City, North Sumatera, Indonesia from July to November 2019, the preeclampsia group and as a control group is the normal pregnant women. Statistical analysis was performed to determine differences in initial serum Mg levels in the two groups, and differences in serum Mg levels before and after administration of MgSO4 in the preeclampsia group. Results: The study was conducted on 50 samples, divided into 2 groups with a total of 25 samples each. The mean Mg of serum in the preeclampsia group was 1,39 mEq/l (SD±0,28) lower than the control group, which was 1,53 mEq/l (SD±0,17) (p = 0.004). The average Mg level in preeclampsia patients before administration of MgSO4 was 1,39 mEq/l (SD±0,28), after MgSO4 administration, the average Mg level became 4,90 mEq/l (SD±0,37) (p<0,001). Conclusion: MgSO4 administration provides a significant increase in serum Mg levels in preeclampsia women. Serum Mg levels in preeclampsia patients are significantly lower than in women with normal pregnancies

Predictive biomarkers of preeclampsia severity in a low resource setting: Role of red blood cell indices, NLR, and albumin-to-creatinine ratio

Preeclampsia (PE), a serious medical condition with substantial maternal and perinatal implications, poses a significant challenge, particularly in high-incidence countries like Indonesia. Red blood cell (RBC) indices, neutrophil-to-lymphocyte ratio (NLR), and microalbuminuria (albumin-to-creatinine ratio (ACR)) may signal systemic inflammation and endothelial dysfunction, recently recognized as potential indicators for diagnosing and predicting disease severity. The aim of this study was to analyze RBC indices, NLR, and ACR changes in women with PE and their potential for predicting disease severity. A cross-sectional study was conducted at multi-center hospitals across Medan, Indonesia, from June 2022 to June 2023. The patients were grouped into PE cases with and without severe features. Demographic characteristics and complications were recorded while blood and urine were tested. The Chi-squared test, Fisher's exact test and Mann-Whitney test were used to determine biomarkers associated with severe PE. A total of 208 PE patients were included in the study (104 patients for each PE with and without severe features). Our data indicated that PE patients with severe features had higher red cell distribution width (18.5% vs 13.7%; p<0.001), NLR (5.66% vs 4.1%; p<0.001), and ACR (755.97 mg/dL vs 468.63 mg/dL; p<0.001) compared to those without severe features. In contrast, the platelet count was lower in severe features than those without (21.9 × 106/µL vs 27.0 × 106/µL; p=0.002). This study highlighted that PE patients with severe features predominantly had higher levels of RDW, NLR, and ACR and lower platelet counts compared to those without severe features. Therefore, basic tests such as complete blood count and urinalysis, which are inexpensive and feasible in primary care settings with limited resources, offer hope as valuable diagnostic biomarkers for pregnant women diagnosed with PE in a low resource setting