MATERNAL SERUM ENDOCAN AS A POTENTIAL PREECLAMPSIA MARKER

Preeclampsia remains the leading cause of maternal and neonatal morbidity and mortality worldwide. The imbalance of interactions between the placenta, immunity and the maternal cardiovascular system also plays a role in preeclampsia. Early onset preeclampsia (POD) and advanced onset preeclampsia (POL) are thought to have different pathomechanisms, causing different clinical symptoms. One theory of preeclampsia is the occurrence of endothelial dysfunction. Endocan as a specific endothelial protein is also thought to have an effect. Various studies on the role of Endocan in cardiovascular disease have also been carried out, while its role in preeclampsia that occurs in pregnant women is still very minimal. This study aims to determine the role of Endocan as a specific endothelial protein in preeclampsia. The study design was cross-sectional. A total of 72 subjects (24 subjects each in the POD, POL and normotensive pregnancy groups) were selected by consecutive sampling. Enzym Linked Immunoabsorbant Assay (ELISA) was performed to assess the Endocan concentration. In general, there is no significant difference in the characteristics of research subjects. Endocan concentrations were found to be higher in the POD group, while in the POL and normotensive pregnancy groups there was no significant difference. Endocan can be considered as a potential marker of preeclampsia, especially early onset

Obstroctuvie Sleep Apnea dalam Kehamilan

Obstructive sleep apnea (OSA) adalah gangguan tidur yang banyak terjadi pada wanita hamil, dengan prevalensi sebesar 0,3 sampai 5% dari semua wanita hamil. OSA terjadi karena penutupan komplit ataupun inkomplit hidung dan faring secara intermiten, dengan obesitas sebagai fakor risiko mayor. Pasien OSA akan mengalami mengantuk, rasa lelah, serta sakit kepala di siang hari. OSA pada wanita hamil berhubungan dengan kejadian hipertensi dalam kehamilan termasuk preeklampsia, kelahiran preterm, dan tingginya kelahiran sesar akibat inertia uteri. Berkurangnya aliran darah plasenta ke janin pada penderita OSA berhubungan dengan luaran janin yang buruk antara lain pertumbuhan janin terhambat, bayi berat lahir rendah, dan penurunan nilai Apgar akibat hipoksia intra uterin. Penurunan berat badan, perbaikan pola hidup, dan perubahan posisi tidur dikatakan efektif memperbaiki gejala OSA pada wanita hamil. Penggunaan CPAP sampai pembedahan merupakan pilihan terapi pada penderita OSA derajat berat

THE DIAGNOSTIC METHODS OF PLACENTA ACCRETA SPECTRUM DISORDERS

Placenta Accreta Spectrum Disorder (PASD) is abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall. Magnetic resonance imaging (MRI) examination is one of the tools that can help diagnosing PASD earlier, so that maternal morbidity and mortality can be reduced. This study aims to determine the prevalence, risk factors of PASD and the accuracy of Placenta Accreta Index Score (PAIS) and MRI, with histopathological examination in diagnosing PASD at dr. Mohammad Hoesin General Hospital (RSMH) Palembang during the 2018–2021. A descriptive study with a survey design on pregnant and intrapartum women with suspected PASD was performed at Department of Obstetrics and Gynecology at RSMH Palembang from 2018 until 2021. There were 72 study subjects who met the inclusion criteria. The relationship between the independent and dependent variables was analyzed using Chi Square and Fisher Exact. The cut-off point of the PAIS scores was analyzed using the Receiver Operating Curve (ROC). The comparison of the diagnostic value of PAIS and MRI scores used the Youden Index. Data was analyzed with SPPS version 22.0 From 72 subjects, 60 subjects (83.3%) were PASD and 12 subjects (16.7%) were not PASD. The risk factors of PASD in this study was surgical history more than once (PR = 4.600 (95% CI 1.261–16.781); p = 0.037). Youden Index values and PAIS accuracy were 0.782 and 0.953 while Youden Index values and MRI accuracy were 0.333 and 0.886. PAIS and MRI could be considered as diagnostic tools for PASD. However, overall, PAIS had a better diagnostic value than MRI

The Role of Vitamin D and Vitamin D Receptor in Placenta Accreta Spectrum: A Literature Review

Objective: This study aims to review the role of vitamin D and vitamin D receptor in Placenta Accreta Spectrum Disorder (PASD)Method: This review used several databases, namely Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library to search original and review articles in English about placenta accreta spectrum, placenta accreta, vitamin D, and vitamin D receptor in the last 10 years. Other reference sources used were guidelines and textbooks.Results: A total of four articles were included in this review.Discussion: Placenta accreta spectrum disorder is becoming more common around the world, owing to the rise in cesarean deliveries. It is linked to several risk factors, including a lack of vitamin D. Vitamin D and its receptor stimulate endometrial decidualization, which aids implantation. Vitamin D receptors in human placental trophoblasts create and respond to 1,25(OH)2D3, which promotes the conversion of endometrial cells to decidual cells. Women with PASD are mostly suffering from vitamin D deficiency. Conclusion: Vitamin D levels may influence trophoblast invasion in PASD and can be a potential diagnostic marker.Peran Vitamin D dan Reseptor Vitamin D dalam Spektrum Plasenta Akreta: Suatu Tinjauan PustakaAbstrakTujuan: Penelitian ini bertujuan untuk meninjau peran vitamin D dan reseptor vitamin D dalam Spektrum Plasenta Akreta (SPA)Metode: Tinjauan pustaka ini menggunakan beberapa sumber data yaitu Google Scholar, Science Direct, Elsevier, Medline, PubMed, Proquest, dan Wiley Online Library untuk mencari artikel penelitian dan tinjauan pustaka dalam Bahasa Inggris mengenai plasenta akreta, vitamin D, dan reseptor vitamin D dalam 10 tahun terakhir. Sumber referensi lain yang digunakan adalah pedoman dan buku teks.Hasil: Sebanyak empat artikel dimasukkan dalam ulasan ini.Diskusi: Spektrum Plasenta Akreta terjadi lebih sering di seluruh dunia karena meningkatnya persalinan sesar. Plasenta akreta terkait dengan beberapa faktor risiko termasuk kekurangan vitamin D. Vitamin D dan reseptornya merangsang desidualisasi endometrium dan berperan dalam implantasi. Reseptor vitamin D pada trofoblas plasenta membuat dan merespons 1,25(OH)2D3 yang mendorong konversi sel endometrium menjadi sel desidua. Mayoritas wanita dengan SPA mengalami kekurangan vitamin D.Kesimpulan: Kadar vitamin D dapat mempengaruhi invasi trofoblas pada SPA dan berpotensi menjadi penanda diagnostik.Kata kunci: spektrum plasenta akreta, reseptor vitamin D, vitamin

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

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

Cardiac Disease in Pregnancy: Maternal and Perinatal Outcomes in RSUP Dr. Mohammad Hoesin Palembang

Background: Impaired maternal and uteroplacental perfusion can occur in pregnancy with cardiac disease leading to maternal and perinatal mortality and morbidity due to increased cardiac load and ventricular dysfunction. This research aims to determine maternal and perinatal outcomes of pregnancies with cardiac disease. Method: This research was a descriptive observational study conducted by total sampling method and cross-sectional design. This research used medical records of pregnant women with cardiac disease who gave birth in RSUP Dr. Mohammad Hoesin Palembang in January 2018-December 2020 as study samples. Result: Among 68 pregnancies with cardiac disease, there were 6 cases (0.87%) found in 2018, 38 cases (2.47%) found in 2019, and 24 cases (1.48%) found in 2020. The highest distribution of pregnancies with cardiac disease was found at 64.7% in the range of 20-35 years old age group; 57.4% in the multiparity group; 38.2% in the range of ≥34 – &lt;37 weeks gestational age group; 86.8% in the high school educational level group; 66.2% in the high-risk cardiac functional status group; 54.4% in the peripartum cardiomyopathy group; and 36.8% with preeclampsia/eclampsia as a comorbid. In this study, maternal outcomes found were maternal mortality at 11.8%; cardiac failure at 70.6%; arrhythmia at 1.5%; and stroke at 1.5%, while perinatal outcomes found were prematurity at 60.3%; low birth weight at 64.4%; IUGR at 37.0%; IUFD at 1.4%; stillbirth at 6.8%; neonatal death at 9.6%; and perinatal asphyxia at 42.5%. Conclusion: The prevalence rate of pregnancies with cardiac disease in RSUP Dr. Mohammad Hoesin Palembang was 0.87% in 2018, 2.47% in 2019, and 1.48% in 2020. The most common maternal outcome in this study was cardiac failure, with most in the peripartum cardiomyopathy group, while the most common perinatal outcome was low birth weight, with most in the hypertensive heart disease group

Kehamilan pada Skar Seksio Sesaria

Tujuan: Memaparkan klasifikasi, faktor risiko, epidemiologi, cara diagnosis, tatalaksana, dan komplikasi kehamilan pada skar seksio sesareaMetode: Tinjauan pustakaKesimpulan: Kehamilan pada skar SC merupakan kehamilan yang kantung kehamilannya terdapat pada miometrium yang menipis akibat SC sebelumnya. Secara umum, kehamilan pada skar Caesarean Scar Pregnancy (CSP) dapat dibedakan menjadi 2 tipe, yaitu tipe 1 (endogenik) dan tipe 2 (eksogenik). Kejadiannya berkisar antara 1 per 8.000 dan 1 per 2.500 SC dengan risiko rekurensi 3,2-5,0% pada wanita dengan riwayat SC 1 kali yang ditatalaksana dengan dilatasi dan kuretase dengan atau tanpa embolisasi arteri uterina. Adapun faktor risiko CSP adalah tebal Segmen Bawah Rahim (SBR) <5 mm, kantong kehamilan menonjol ke plika vesikouterina, SC di rumah sakit umum daerah, dan riwayat perdarahan melalui vagina ireguler dan nyeri abdomen selama CSP sebelumnya. Pengobatan CSP dapat secara konservatif dengan metotreksat (MTX) maupun operatif termasuk eksisi jaringan kehamilan dengan laparoskopi, histerotomi, atau histerektomi. Pilihan pengobatan lain termasuk dilatasi dan kuretase, reseksi transervikal (TCR) dengan histeroskopi, embolisasi arteri uterina (UEA), kemoembolisasi arteri uterina, atau penempatan kateter balon ganda.Caesarean Scar PregnancyAbstractObjective: To explain about classification, risk factors, epidemiology, diagnostic methods, management, and complications of Caesarean Scar Pregnancy (CSP).Method: Literature review Conclusion: CSP is a pregnancy where the gestational sac is found in the thin myometrium due to previous CS. In general, Caesarean Scar Pregnancy (CSP) can be divided into 2 types, namely type 1 (endogenic) and type 2 (exogenic). Its incidence ranges from 1 per 8,000 and 1 per 2,500 SC with a recurrence risk of 3.2-5.0% in women with a history of 1 time CS who are treated with dilatation and curettage with or without uterine artery embolization. The risk factors for CSP are lower uterine segment thickness <5 mm, gestational sac pouches protruding into the vesicouterine fold, CS in regional public hospitals, and a history of irregular vaginal bleeding and abdominal pain during previous CSP. Caesarean scar pregnancy treatment can be conservative with methotrexate (MTX) or operatively including excision of pregnancy tissue with laparoscopy, hysterotomy, or hysterectomy. Other treatment options include dilatation and curettage, transcervical resection (TCR) with hysteroscopy, uterine artery embolization (UAE), chemoembolization of the uterine arteries, or placement of a double-balloon catheter.Key words: Caesarean scar pregnanc

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