The Accuracy of Single Progesterone, Single β-hCG, and Their Combination Measurement in Predicting Early Miscarriage: A Prospective Study in Outpatient Setting

Introduction: Most of miscarriage events occurred during the first trimester of pregnancy. Recent studies found the beneficial effects of maternal serum markers to predict pregnancy outcomes. However, study in Indonesian setting was still limited, especially in outpatient setting. The aim of this study was to evaluate serum progesterone and β-hCG measurement  as a beneficial predictor of miscarriage.Materials & Methods: This was a prospective study recruiting outpatients pregnant women in Aceh who seek first medical attention for their pregnancy during January 2013 to January 2015. Serum progesterone and β-hCG level were measured beside routine obstetric procedure. The discrimination attained between miscarriage and non-miscarriage groups of pregnant women at the end of first trimester was evaluated using logistic regression and receiver operating curve analysis.Results: Among 70 pregnant recruited in this study, nineteen of them (27.1%) experienced miscarriage. Serum progesterone level of women in miscarriage group was lower than non-miscarriage group (17.85 (IQR 13.26-21.15) ng/dl vs 33.67 (IQR 21.83-44.14), p<0.001). Serum β-hCG level was also lower in miscarriage group (10 681 (IQR 5 787.5-26 577.5) mIU/ml vs 48 109 (IQR 17 137-93 915) mIU/ml, p=0.001). Single progesterone measurement gave a good predictor ability for miscarriage with 82.2% accuracy, 86.3% sensitivity and 73.7% specificity if 19.5 ng/dl was used as a cut-off point.Conclusion: Maternal serum progesterone level could be a good predictor for miscarriage during the first trimester of pregnancy. Single β-hCG serum in combination with progesterone serum measurement only had little added value for predicting miscarriage

THE EFFECTS OF CURCUMIN ADMINISTRATION ON EXPRESSION PATTERNS OF VEGF AND COX-2 IN FERTILE ENDOMETRIUM: A RANDOMISED CLINICAL TRIAL

Objective: Curcumin (diferuloylmethane) is a a compound isolated from turmeric with biological activities, including antifertility. Curcumin inhibits COX-2 expression in granulosa cells of ovarian follicles and disrupts vascular endothelial growth factor (VEGF) derived angiogenesis in the endometrium, reducing endometrial receptivity. The purpose of this study was to examine the effects of curcumin on COX-2 and VEGF expression in endometrium of fertile women. Methods: A prospective double-blind placebo-controlled clinical trial was conducted in a group of fertile women with regular menstrual cycles, aged between 20-30 y, married, and with children. Subjects were divided into a group receiving daily 800 mg encapsulated curcumin. Curcumin orally for ten days, starting on the third day of the first menstrual day, and a control group. Endometrial biopsy was performed using a microcuret and immunohistochemistry was used to assess VEGF and COX-2 expression. The results were analysed using an independent sample t-test. Results: In the curcumin-treated group, VEGF expression was significantly lower than the control group (p<0.05), and COX-2 expression was higher but not significantly so (p>0.05). Conclusion: The curcumin causes VEGF expression in endometrium is lower and negatively affects the growth of endometrial stromal cells

C-Reactive Protein and Matrix Metalloproteinase-7 in Preterm Premature Rupture of Membranes (PPROM) and Premature Rupture of Membranes (PROM): C-Reactive Protein dan Matrix Metalloproteinase-7 pada Ketuban Pecah Dini Kehamilan Preterm dan Aterm

Objective: To determine the difference in qualitative serum CRP and MMP-7 levels between PROM and PPROM Methods: Research with a case-control design with premature rupture of membranes in term pregnancy as a control group and preterm pregnancy as a case group conducted in the delivery room of the Regional General Hospital dr. Zainoel Abidin Banda Aceh starting from January 2020. Total number of each group as many as 30 samples that met the inclusion and exclusion criteria by taking venous blood samples to check the levels of qualitative CRP serum and levels of the Metalloproteinase-7 Matrix (MMP-7). Statistical tests for categorical - numerical data groups were tested using independent sample t-test and categorical - categorical data groups were tested using Chi-Square test. Results: A total of 60 samples with 30 PPROM and 30 PROM mothers. There was no statistically significant difference in the qualitative CRP serum result in PROM patients with term and preterm pregnancies. On MMP-7 examination, the mean MMP-7 level of preterm PROM mothers was higher than at term PROM, which was 5.28 mg / L and there was a significant relationship between MMP-7 and qualitative CRP in PROM patients with term pregnancy (p <0.05). Conclusion: There is no significant difference in the value of qualitative CRP and MMP-7 between PPROM and PROM. However, there was a significant association between qualitative serum CRP and plasma MMP-7 in PROM. Keywords: c-reactive protein, matrix metalloproteinase-7,rupture of membranes.   Abstrak Tujuan: Untuk mengetahui perbedaan gambaran serum CRP kualitatif dan kadar MMP-7 antara kehamilan preterm dan aterm dengan ketuban pecah dini di RSUD  Dr. Zainoel Abidin Banda Aceh. Metode: Penelitian dengan desain kasus kontrol dengan ketuban pecah dini kehamilan aterm sebagai kelompok kontrol dan kehamilan preterm sebagai kelompok kasus. yang dilakukan di Kamar Bersalin Rumah Sakit Umum Daerah dr. Zainoel Abidin Banda Aceh pada Januari 2020. Dengan jumlah masing-masing kelompok sebanyak 30 sampel yang memenuhi kriteria inklusi dan eklusi dengan pengambilan sampel darah vena untuk dilakukan pemeriksaan kadar serum CRP kualitatif dan kadar Matrix Metalloproteinase-7 (MMP-7). Uji statistik untuk kelompok data yang bersifat kategorik - numerik diuji menggunakan uji T tidak berpasangan dan pasangan kelompok data yang bersifat kategorik - katergorik akan diuji menggunakan uji Chi-Square. Hasil: Sebanyak 60 penderita KPD dengan 30 Ibu KPD Preterm dan 30 KPD aterm. Tidak dijumpai perbedaan yang bermakna secara statistik gambaran serum CRP kualitatif pada penderita KPD dengan kehamilan aterm dan preterm. Pada pemeriksaan MMP-7 rerata kadar MMP-7 ibu KPD preterm lebih tinggi dibandingkan KPD  aterm yakni senilai 5,28 mg/L dan terdapat hubungan bermakna antara MMP-7 dan CRP kualitatif pada penderita KPD dengan kehamilan aterm (p < 0,05). Kesimpulan: Tidak terdapat perbedaan gambaran signifikan nilai CRP kualitatif dan MMP-7 antara KPD preterm dan aterm. Namun, terdapat hubungan yang signifikan antara serum CRP kualitatif dan MMP-7 plasma pada penderita ketuban pecah dini dengan kehamilan aterm. Kata kunci: c-reactive protein, matrix metalloproteinase-7, ketuban pecah dini

Penanganan Adenomiosis dengan Reseksi Laparotomik pada Perempuan Infertil (Pengalaman pada 32 kasus)

Tujuan: Untuk melihat hasil tatalaksana pengobatan adenomiosis dengan reseksi. Rancangan/rumusan data: Kajian retrospektif deskriptif. Tempat: Klinik Fertilitas dan Menoandropause SamMarie Jakarta. Bahan dan cara kerja: Dikumpulkan kasus adenomiosis pada perempuan infertil selama tiga tahun (Januari 1999 sampai Desember 2001) yang diagnosis ditegakkan dengan USG transvaginal. Kasus dilakukan reseksi secara laparotomi dan dilakukan pemeriksaan Patologi anatomi sebagai diagnosis pasti adenomiosis uteri. Dan pascareseksi dinilai perubahan gejala klinis, angka keberhasilan hamil dan laju kekambuhan. Hasil: Selama 3 tahun ditangani 1619 kasus infertilitas dan terdapat 66 (4,07%) kasus adenomiosis yang didiagnosis dengan USG trasvaginal. Sebanyak 32 kasus dilakukan tindakan operasi reseksi dengan hasil histopatologi menunjukkan 30 (93,75%) kasus adenomiosis dan 2 (6,25%) kasus mioma uteri. Yang berhasil hamil adalah 3 (9,4%) kasus yaitu dua kasus melahirkan hidup, satu kasus berakhir dengan abortus 6 minggu. Dan 25 (78,1%) kasus tidak hamil dan 4 (12,5%) kasus terjadi kekambuhan penyakit. Hilang gejala tapi tidak hamil 24 (75,35%) kasus. Kesimpulan: Pengobatan adenomiosis dengan reseksi dapat menyembuhkan lesi dan dapat terjadi kehamilan. Kekambuhan penyakit dapat terjadi setelah satu tahun pascareseksi. [Maj Obstet Ginekol Indones 2008; 32-1: 22-5] Kata kunci: adenomiosis, reseksi, inferti

Role of C-Reactive Protein, Erythrocyte Sedimentation Rate, Progesterone and Estradiol Hormone Levels in First Trimester Threatened Abortion: Peran C-Reactive Protein, Laju Endap Darah, Progesteron dan Estradiol pada Abortus Imminens Trimester Pertama

Objective: To assess correlation of High sensitivity C-Reactive Protein (Hs-CRP), erythrocyte sedimentation rate (ESR), progesterone and estradiol levels in the first trimester threatened abortion incidence in Dr. Zainoel Abidin Hospital, Banda Aceh.Methods: Case control design used in this study divided threatened abortion into a case group and normal pregnancy into a control group with a total of 20 subjects for each group. This research was conducted in the Emergency Room and Obstetric Ward of Dr. Zainoel Abidin hospital Banda Aceh in 2019. Eta correlation test was conducted to find out the link between variables towards threatened abortion with 95% confidence level followed by the Receiver Operating Curve (ROC) analysis to find out the cut off points.Results: Progesterone levels (14.76 ng/mL), estradiol (427.61 pg/mL), Hs-CRP (2.57 mg/L) and ESR (28.75 mm/hour) case group were lower compared to the control group. Incidence of threatened abortion correlates to progesterone and estradiol with the correlation strength respectively -0.838 and -0.416.Conclusion: Progesterone and estradiol correlate negatively with first-trimester abortion incidence. Evaluation of these two hormones levels is useful for diagnostic purposes and screening of threatened abortion with a cut point of progesterone 23.03 ng/mL and estradiol 468.8 pg/mL.Keywords: C-Reactive Protein, erythrocyte sedimentation rate, estradiol, progesterone, threatened abortion   Abstrak Tujuan: Penelitian ini bertujuan untuk menilai korelasi antara kadar High sensitivity C-Reactive Protein (Hs-CRP), Laju Endap Darah (LED), progesteron dan estradiol terhadap kejadian abortus imminens pada trimester pertama di RSUD Dr. Zainoel Abidin Banda Aceh. Metode: Desain kasus kontrol digunakan dalam penelitian ini dimana kejadian abortus imminens menjadi kelompok kasus dan kehamilan normal menjadi kelompok kontrol dengan jumlah masing-masing kelompok sebanyak 20 sampel. Penelitian ini dilakukan di Instalasi Gawat Darurat dan ruang rawat Obstetri Rumah Sakit Umum Dr. Zainoel Abidin (RSUDZA) Banda Aceh pada tahun 2019. Uji korelasi Eta digunakan untuk mengetahui korelasi antar variabel terhadap abortus imminens dengan tingkat kepercayaan 95% dilanjutkan dengan analisis Receive Operating Curve (ROC) untuk menentukan titik potong. Hasil: Kadar progesteron (14,76 ng/mL), estradiol (427,61 pg/mL), Hs-CRP (2,57 mg/L) dan LED (28,75 mm/jam) kelompok kasus lebih rendah dibandingkan kelompok kontrol. Kejadian abortus imminens berkorelasi terhadap progesteron dan estradiol dengan kekuatan korelasi (R) secara berurutan -0,838 dan -0,416. Kesimpulan: Progesteron dan estradiol berkorelasi negatif terhadap kejadian abortus imminens pada trimester pertama kehamilan. Evaluasi kadar kedua hormon tersebut bermanfaat untuk kepentingan diagnostik dan penapisan abortus imminens dengan titik potong progesteron 23,03 ng/mL dan estradiol 468,8 pg/mL. Kata kunci: abortus imminent, C-Reactive Protein, estradiol, laju endap darah, progestero