Maternal Cystatin C Serum is Higher in Women with Severe Preeclampsia

Objective: To determine the comparison between maternal cystatin C serum in severe preeclampsia and normal pregnancy. Method: This was an observational study with cross sectional analytic approach. The subjects are sixty women with severe preeclampsia and normal pregnancy who met inclusion criteria. The maternal serum level of cystatin C was automatically measured with Particle Enhanced Nephelometric Assay (PENIA). Result: Mean serum level of cystatin C in severe preeclampsia was 1.169 ± 0.311 mg/l. Mean serum level of cystatin C in normal pregnancy was 0.929 ± 0.166. There was a significant differences between maternal serum levels of cystatin C in women with severe preeclampsia compared with women with normal pregnancy. Conclusion: There was a significant differences between maternal serum levels of cystatin C in severe preeclampsia compared with normal pregnancy. Keywords: cystatin C, endotheliosis glomerulus, severe preeclam

Oral versus Vaginal Misoprostol for Labour Induction : A Comparative Study

Objective: To compare the efficacy and safety of hourly titrated oral misoprostol in solution (OMS) with vaginal misoprostol (PV) for labor induction. Methods: Randomized Controlled Trial (RCT), double blind-add on the study was conducted from January-November 2016 in delivery ward of Moh. Hoesin general hospital. Women 30 weeks of gestation with an unfavorable cervix (Bishop score ï‚£6) and an indication for labor induction were randomly assigned to receive titrated oral or vaginal misoprostol. The OMS group received a basal unit of 20 ml misoprostol solution (1 ï­g/ml) every 1 hour for four doses and then were titrated against individual uterine response. In the absence of regular uterine contractions, the dose was increased to 40 ml hourly for four doses and then 60 ml for four doses. The vaginal group received 25 ï­g every 4 hours until attaining a more favorable cervix for three doses. All the subjects received amylum placebo. In labor within 12 hours was the primary outcome. Results: A total of 30 women were enrolled in this study. One subject in the OMS group was dropped out due to eclamptic seizure. The average interval from induction until in labour in OMS group was 5.753.14 hour and 6.604.46 hour in PV group (p = 0.56). In labour stage was achieved within 12 hours in 14 women (100%) in OMS group and 14 women (93.3%) in PV group (p = 1.00). Vaginal delivery was achieved within 24 hours in 13 women (92.9%) in OMS group and 15 women (100%) in PV group. The incidence of uterine hyperstimulation/ tachysystolic was 7.1% in OMS group compared with 13.3% in PV group. Fetal distress was found only 1 case (7.1%) in OMS group. There was no difference in the maternal and neonatal outcome of labor in both the groups. Conclusion: Oral titrated in solution, and vaginal route of administration of misoprostol for induction of labour are equally effective and safe. [Indones J Obstet Gynecol 2018; 6-2: 89-97] Keywords: hourly titrated oral misoprostol in solution, oral misoprostol, randomized controlled trial, vaginal misoprosto

Update Manajemen Preeklamsia dengan Komplikasi Berat (Eklamsia, Edema Paru, Sindrom HELLP)

Tujuan: Seiring dengan bertambahnya insidensi preeklamsia dengan komplikasi berat, manajemen yang adekuat diperlukan. Penulisan artikel ini bertujuan untuk memaparkan update manajemen preeklamsia dengan komplikasi berat (eklamsia, edema paru, dan sindrom HELLP).Metode: Tinjauan pustaka (literature review) dengan menggunakan 15 referensi antara tahun 2011–2020.Hasil: Manajemen preeklamsia dengan komplikasi berat membutuhkan pendekatan multidisiplin, medikamentosa (kalsium 1,5–2 gram/hari; aspirin dosis rendah 75–150 mg/hari; MgSO4 dengan dosis awal 4–6 gram IV dan pemeliharaan 1-2 gram/jam hingga 24 jam pascasalin; kortikosteroid; antihipertensi seperti labetalol, hidralazin, nifedipin, natrium nitroprusside, nitrogliserin), dan non-medikamentosa (olahraga, pembatasan cairan). Sementara itu, prinsip penanganan awal eklamsia, yaitu D (Dangers) – R (Response) – S (Send for Help) – A (Airway) – B (Breathing) – C (Compressions) – D (Defibrillation). Adapun manajemen obstetri pada kasus preeklamsia dengan gejala berat, yaitu manajemen ekspektatif dan persalinan (spontan ataupun seksio sesaria).Kesimpulan: Tatalaksana yang cepat dan tepat pada kasus preeklamsia dengan komplikasi berat sangat diperlukan untuk mengurangi morbiditas pada ibu dan janin. Manajemen kasus preeklamsia dengan gejala berat berupa manajemen ekspektatif dan persalinan (spontan ataupun seksio sesaria).Update on Management of Preeclampsia with Severe Features (Eclampsia, Pulmonary Edema, HELLP Syndrome)AbstractObjective: As the incidence of preeclampsia with severe features increases, adequate management is required. The purpose of this review is to present an update on the management of preeclampsia with severe features (eclampsia, pulmonary edema, and HELLP syndrome).Method: Literature review using 15 references between 2011–2020.Results: Management of preeclampsia with severe features requires a multidisciplinary, medical approach (calcium 1.5–2 g/day; low-dose aspirin 75–150 mg/day; magnesium sulfate at an initial dose of 4–6 g IV and maintenance 1-2 g/hour to 24 hours postpartum; corticosteroids; antihypertensives such as labetalol, hydralazine, nifedipine, sodium nitroprusside, nitroglycerin) and non-medical (exercise, fluid restriction). Meanwhile, the principles of early management of eclampsia, namely D (Dangers) – R (Response) – S (Send for Help) – A (Airway) – B (Breathing) – C (Compressions) – D (Defibrillation). The obstetric management in cases of preeclampsia with severe features is expectant management and delivery (spontaneous or cesarean section).Conclusion: Prompt and appropriate management of cases of preeclampsia with severe features is needed to reduce maternal and fetal morbidity. Management of preeclampsia cases with severe features is expectant management and delivery (spontaneous or cesarean section).Key words: preeclampsia, eclampsia, HELLP syndrome, severe

Preeklamsia Pascasalin

AbstrakTujuan: Memaparkan etiologi dan faktor risiko, diagnosis banding, patofisiologi, pemantauan, terapi, komplikasi, rekurensi dan tindakan preventif pada kasus preeklamsia pascasalin.Metode: Tinjauan pustaka dengan berbagai referensi yang diakses melalui mesin pencarian seperti Pubmed dan Sci-Hub dengan menggunakan kata kunci preeclampsia, hypertension, postpartum, management. Sumber referensi yang digunakan yaitu guidelines, jurnal, dan buku teks yang diterbitkan dalam 15 tahun terakhir.Kesimpulan: Insiden preeklamsia di Indonesia yaitu 128.273/tahun atau sekitar 5,3%. Sebanyak 0,3 – 27,5% kasus yang dilaporkan mengalami preeklamsia atau hipertensi pascasalin. Gejala-gejala preeklamsia pascasalin muncul setelah melahirkan. Mayoritas kasus berkembang dalam 48 jam setelah persalinan, walaupun sindrom dapat muncul hingga 6 minggu setelah persalinan. Periode pascasalin merupakan waktu kritis bagi spesialis obstetri dan ginekologi untuk menjamin wanita dengan riwayat preeklamsia untuk dipantau dalam jangka waktu pendek dan panjang. Akan tetapi, pemantauan pascasalin sangatlah rendah, berkisar antara 20-60%. Pemilihan antihipertensi pasca salin yaitu berikatan kuat dengan protein dan solubilitas lipid yang rendah sehingga lebih sedikit yang masuk ke ASI. Selain itu, dipengaruhi juga oleh ionisasi, berat molekul dan konstituen ASI (kandungan lemak, protein, dan air). Agen lini pertama untuk preeklamsia pascasalin adalah labetalol dan hidralazin intravena serta nifedipin. Wanita dengan hipertensi gestasional ataupun preeklamsia biasanya dapat menghentikan antihipertensi dalam 6 minggu pasca salin.Postpartum PreeclampsiaAbstractObjective: To explain about etiologies and risk factors, differential diagnosis, pathophysiology, follow up, treatment, complications, recurrence, and prevention of preeclampsia post delivery discharged.Method: Literature review with several references accessed through search engines such as Pubmed and Sci-Hub by using keywords preeclampsia, hypertension, postpartum, management. Reference sources used are guidelines, journals, and textbooks published in the last 15 years.Conclusion: The incidence of preeclampsia in Indonesia is 128,273/year or around 5.3%. As many as 0.3-27.5% of cases reported postpartum preeclampsia or hypertension. Symptoms of postpartum preeclampsia appear after delivery. The majority of cases develop within 48 hours after delivery, although the syndrome can appear up to 6 weeks after delivery. The postpartum period is a critical time for obstetricians and gynecologists to ensure women with a history of preeclampsia are monitored in the short and long term. However, postpartum monitoring is very low, ranging from 20-60%. The choice of antihypertensive postpartum is that it is strongly bound to protein with low lipid solubility so that fewer enter breast milk. In addition, it is also influenced by ionization, molecular weight and constituents of breast milk (fat content, protein, and water). The first line agent for postpartum preeclampsia is intravenous labetolol and hydralazine and also nifedipine. Women with gestational hypertension or preeclampsia can usually stop antihypertension within 6 weeks postpartum.Key word: postpartum preeclampsia, antihypertensio

Pencegahan Abortus pada Awal Kehamilan

Abortus merupakan suatu kejadian terminasi kehamilan dengan usia kehamilan <20 minggu dan berat janin <500 g. Angka kejadian abortus disebutkan sekitar 15% dari seluruh kehamilan. Terdapat beberapa faktor risiko abortus yaitu faktor risiko yang dapat dimodifikasi dan tidak dapat dimodifikasi. Beberapa faktor risiko yang dapat dimodifikasi yaitu faktor nutrisi, konsumsi kafein, alkohol, kebiasaan merokok, infeksi, paparan radiasi, beban kerja, dan pengaruh obat-obatan. Beberapa faktor risiko yang tidak dapat dimodifikasi, yaitu genetik, kelainan kongenital, dan lain-lain. Dengan mengetahui faktor risiko tersebut, dokter dapat melakukan pencegahan dan intervensi yang sesuai dengan kondisi masing-masing pasien yang mengalami abortus. Metode yang digunakan adalah tinjauan pustaka dengan menggunakan beberapa database seperti Pubmed, Wiley Online Library, dan ScienceDirect dari 10 tahun terakhir.Prevention of Miscarriage in Early PregnancyAbstractMiscarriage is an event of termination of pregnancy with < 20 weeks of gestation and fetal weight < 500 grams. The incidence of miscarriage is around 15% of all pregnancies. There are several risk factors for miscarriage, namely modifiable and non-modifiable risk factors. Some modifiable risk factors are nutritional factors, consumption of caffeine, alcohol, smoking habit, infection, radiation exposure, workload, and the influence of drugs. Several risk factors that can not be modified, namely genetics, congenital abnormalities, and others. By knowing these risk factors, doctors can carry out prevention and intervention according to the conditions of each patient who undergoes miscarriage. The method used is a literature review using several databases such as Pubmed, Wiley Online Library, and ScienceDirect from the last 10 years.Key words: miscarriage, prevention, risk factors, pregnancy.Abortus merupakan suatu kejadian terminasi kehamilan dengan usia kehamilan <20 minggu dan berat janin <500 g. Angka kejadian abortus disebutkan sekitar 15% dari seluruh kehamilan. Terdapat beberapa faktor risiko abortus yaitu faktor risiko yang dapat dimodifikasi dan tidak dapat dimodifikasi. Beberapa faktor risiko yang dapat dimodifikasi yaitu faktor nutrisi, konsumsi kafein, alkohol, kebiasaan merokok, infeksi, paparan radiasi, beban kerja, dan pengaruh obat-obatan. Beberapa faktor risiko yang tidak dapat dimodifikasi, yaitu genetik, kelainan kongenital, dan lain-lain. Dengan mengetahui faktor risiko tersebut, dokter dapat melakukan pencegahan dan intervensi yang sesuai dengan kondisi masing-masing pasien yang mengalami abortus. Metode yang digunakan adalah tinjauan pustaka dengan menggunakan beberapa database seperti Pubmed, Wiley Online Library, dan ScienceDirect dari 10 tahun terakhir.Prevention of Miscarriage in Early PregnancyAbstractMiscarriage is an event of termination of pregnancy with <20 weeks of gestation and fetal weight <500 grams. The incidence of miscarriage is around 15% of all pregnancies. There are several risk factors for miscarriage, namely modifiable and non-modifiable risk factors. Some modifiable risk factors are nutritional factors, consumption of caffeine, alcohol, smoking habit, infection, radiation exposure, workload, and the influence of drugs. Several risk factors that can not be modified, namely genetics, congenital abnormalities, and others. By knowing these risk factors, doctors can carry out prevention and intervention according to the conditions of each patient who undergoes miscarriage. The method used is a literature review using several databases such as Pubmed, Wiley Online Library, and ScienceDirect from the last 10 years.Key words: miscarriage, prevention, risk factors, pregnancy