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Wardhana MP, Kuntaman K, Utomo B, Aryananda RA, Rifdah SN, Wafa IA, Shahnaz AA, Ningrum D, Cininta NI, Ariani G, Van Lith JM, Dachlan EG. Evidence of Placental Villous Inflammation and Apoptosis in Third-Trimester Symptomatic SARS-CoV-2 Maternal Infection. Yonsei Med J 2024; 65:202-209. [PMID: 38515357 PMCID: PMC10973560 DOI: 10.3349/ymj.2023.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 03/23/2024] Open
Abstract
PURPOSE In view of conflicting reports on the ability of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to infect placental tissue, this study aimed to further evaluate the impact of inflammation and placental damage from symptomatic third-trimester maternal COVID-19 infection. MATERIALS AND METHODS This case-control study included 32 placenta samples each from symptomatic COVID-19 pregnancy and normal non-COVID-19 pregnancy. The villous placental area's inflammatory expression [angiotensin converting enzyme-2 (ACE-2), transmembrane protease serine-2 (TMPRSS2), interferon-γ (IFN-γ), interleukin-6 (IL-6), and SARS-CoV-2 spike protein] and apoptotic rate were examined using immunohistochemistry and Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) assay. Comparison and correlation analysis were used based on COVID-19 infection, placental SARS-CoV-2 spike protein evidence, and maternal severity status. RESULTS Higher expressions of TMPRSS2, IFN-γ, and trophoblast apoptotic rate were observed in the COVID-19 group (p<0.001), whereas ACE-2 and IL-6 expressions were not significantly different from the control group (p>0.05). Additionally, SARS-CoV-2 spike protein was detected in 8 (25%) placental samples of COVID-19 pregnancy. COVID-19 subgroup analysis revealed increased IFN-γ, trophoblast, and stromal apoptosis (p<0.01). Moreover, the results of the current study revealed no correlation between maternal COVID-19 severity and placental inflammation as well as the apoptotic process. CONCLUSION The presence of SARS-CoV-2 spike protein as well as altered inflammatory and apoptotic processes may indicate the presence of placental disturbance in third-trimester maternal COVID-19 infection. The lack of correlation between placental disruption and maternal severity status suggests the need for more research to understand the infection process and any potential long-term impacts on all offsprings born to COVID-19-infected pregnant women.
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Affiliation(s)
- Manggala Pasca Wardhana
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Kuntaman Kuntaman
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Budi Utomo
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Rozi Aditya Aryananda
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | | | - Ifan Ali Wafa
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Almira Aulia Shahnaz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Dahlia Ningrum
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Nareswari Imanadha Cininta
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Grace Ariani
- Anatomical Pathology Department, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Jan Mm Van Lith
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
- Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Erry Gumilar Dachlan
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia.
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Aryananda RA, Duvekot JJ, Van Beekhuizen HJ, Cininta NI, Ariani G, Dachlan EG. Transabdominal and transvaginal ultrasound findings help to guide the clinical management of placenta accreta spectrum cases. Acta Obstet Gynecol Scand 2024; 103:93-102. [PMID: 37968904 PMCID: PMC10755131 DOI: 10.1111/aogs.14715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/22/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION The clinical management of placenta accreta spectrum (PAS) depends on placental topography and vascular involvement. Our aim was to determine whether transabdominal and transvaginal ultrasound signs can predict PAS management. MATERIAL AND METHODS We conducted a retrospective cohort study of consecutive prenatally suspected PAS cases in a single tertiary-care PAS center between January 2021 and July 2022. When PAS was confirmed during surgery, abdominal and transvaginal ultrasound scans were analyzed in relation to PAS management. The preferred surgical approach of PAS was one-step conservative surgery (OSCS). Massive blood loss and PAS topography in the lower bladder trigone necessitated cesarean hysterectomy. Transvaginal ultrasound-diagnosed intracervical hypervascularity was split into three categories based on their quantity. Anatomically, the internal cervical os is located at the level of the bladder trigone and was used as landmark for upper and lower bladder trigone PAS. RESULTS Ninety-one women underwent OSCS and 35 women underwent cesarean hysterectomy (total 126 women with PAS). Abdominal and transvaginal ultrasound features differed significantly between women that underwent OSCS and cesarean hysterectomy: decreased myometrial thickness (<1 mm), 82.4% vs. 100%, p = 0.006; placental bulge, 51.6% vs. 94.3%, p < 0.001; bladder wall interruption, 62.6% vs. 97.1%, p < 0.001; abnormal placental lacunae, 75.8% vs. 100%, p < 0.001; hypervascularity (large lacunae feeding vessels, 57.8% vs. 94.6%, p < 0.001; parametrial hypervascularity, 15.4% vs. 60%, p < 0.001; the rail sign, 6.6% vs. 28.6%, p = 0.003; three-dimensional Doppler intra-placental hypervascularity, 81.3% vs. 100%, p < 0.001; intracervical hypervascularity 60.4% vs. 94.3%, p < 0.001); and cervical length 2.5 ± 0.94 vs. 2.2 ± 0.73, p = 0.038. Other ultrasound signs were not significantly different. The results of multivariable logistic regression showed placental bulge (odds ratio [OR] 9.3; 95% CI 1.9-44.3; p = 0.005), parametrial hypervascularity (OR 4.1; 95% CI 1.541-11.085; p = 0.005), and intracervical hypervascularity (OR 9.2; 95% CI 1.905-44.056; p = 0.006) were weak predictors of OSCS. Intracervical hypervascularity Grade 1 (vascularity <50% of cervical tissue) was more present in OSCS than higher gradings two and three (91% vs. 27.6% vs. 14.3%; p < 0.001). CONCLUSIONS Cesarean hysterectomy is associated with the PAS signs of placental bulge and Grade 2 and 3 intracervical hypervascularity. OSCS is associated with intracervical hypervascularity Grade 1 on transvaginal ultrasound. Prospective validation is required to formulate predictors for PAS management.
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Affiliation(s)
- Rozi Aditya Aryananda
- Department of Obstetrics and Gynecology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
- Department of Obstetrics & GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Johannes J. Duvekot
- Department of Obstetrics & GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Heleen J. Van Beekhuizen
- Department of Obstetrics & GynecologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Gynecological Oncology, Erasmus MC Cancer CenterErasmus University Medical CenterRotterdamThe Netherlands
| | - Nareswari Imanadha Cininta
- Department of Obstetrics and Gynecology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Grace Ariani
- Department of Anatomical Pathology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Dr. Soetomo Academic General HospitalUniversitas AirlanggaSurabayaIndonesia
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Ernawati E, Aditiawarman A, Sulistyono A, Hasanah K, Ridfah SN, Akbar MIA, Dachlan EG. The Risk of Persistent Hypertension and Chronic Kidney Disease in Early- and Late-Onset Preeclampsia: A Report From Developing Country. Cureus 2023; 15:e50488. [PMID: 38222145 PMCID: PMC10787169 DOI: 10.7759/cureus.50488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Preeclampsia (PE) has been disproportionately prevalent in developing countries and constitutes a leading cause of maternal mortality, and also has long-term impacts, including renal consequences. This study aimed to explore the risk of persistent hypertension and kidney failure in early-onset PE (EOP) and late-onset PE (LOP) in the five years after delivery. METHODS This retrospective cohort study included women with a prior history of severe PE or normotensive pregnancy admitted to tertiary hospitals in Indonesia. The blood pressure, body mass index (BMI), urea, creatinine serum, and protein urine were analyzed, and the risk of chronic kidney disease (CKD) after five years was performed using the Kidney Disease Improvement Global Outcomes (KDIGO) classification. RESULTS Twenty-seven EOP, 35 LOP, and 30 normotensive cases were included. Mean blood pressure after five years was recorded as 115.6 ± 14.25 mmHg in the normotensive group, 131.82 ± 19.34 mmHg in the LOP group, and 154.96 ± 23.48 mmHg in the EOP group. According to the KDIGO classification, the normotensive group had an average 10% risk of CKD, but severe PE had a risk of CKD greater than 90%. In the severe PE group, the risk of CKD was 20.94 times higher compared to normotensive women (OR 20.94; 95% CI 2.67-163.72, p = 0.004). The risk of CKD in the EOP group was 6.75 times higher than in the LOP group (OR 6.75; 95% CI 2.19-20.76, p = 0.001), whereas persistent hypertension in the EOP group was 5.78 times higher than in the LOP group (OR 5.78; 95% CI 1.91-17.395, p = 0.002). CONCLUSIONS PE women have a higher risk of CKD than normotensive women. Women with a history of EOP are more likely to develop persistent hypertension and CKD than women with a prior LOP history.
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Affiliation(s)
| | | | - Agus Sulistyono
- Obstetrics and Gynaecology, Universitas Airlangga, Surabaya, IDN
| | - Kamalia Hasanah
- Obstetrics and Gynaecology, Universitas Airlangga, Surabaya, IDN
| | | | - M Ilham A Akbar
- Obstetrics and Gynaecology, Universitas Airlangga, Surabaya, IDN
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Alessandrini L, Aryananda R, Ariani G, Agustina B, Akbar MIA, Dachlan EG, Dekker G, Ernawati E. The correlation between serum levels and placental tissue expression of PLGF and sFLT-1 and the FIGO grading of the placenta accreta spectrum disorders. J Matern Fetal Neonatal Med 2023; 36:2183744. [PMID: 36859823 DOI: 10.1080/14767058.2023.2183744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE This study aims to further explore the role of angiogenic vs anti-angiogenic factors in placenta accreta spectrum (PAS). METHODS This cohort study included all patients with placenta previa and placenta accreta spectrum (PAS) disorders undergoing surgery at Dr. Soetomo Hospital (Academic Hospital of Universitas Airlangga, Surabaya, Indonesia) from May to September 2021. Venous blood samples for PLGF and sFlt-1 were drawn immediately prior to surgery. Placental tissue samples were taken during surgery. The FIGO grading was diagnosed intraoperatively by an experienced surgeon and confirmed by the pathologist and followed by immunohistochemistry (IHC) staining. The sFlt-1 and PLGF serum were performed by an independent laboratory technician. RESULTS Sixty women were included in this study (20 women with placenta previa; 10 women with FIGO PAS grade 1; 8 women with FIGO PAS grade 2; 22 women with FIGO PAS grade 3). The median with 95% Confidence interval of PLGF serum values in placenta previa, FIGO grade I, grade II, and grade III were 233.68 (0.00-2434.00), 124.39 (10.42-663.68), 236.89 (18.83-418.99) and 237.31 (2.26-3101.00) (p = .736); the median values with 95% CI of serum sFlt-1 levels in placenta previa, FIGO grade I, grade II, and grade III were 2816.50 (418.00-12925.00), 2506.00 (227.50-16104.00), 2494.50 (888.52-20812.00), and 1601.00 (662.16-9574.00) (p = .037). Placental PLGF expression in placenta previa, FIGO grade 1, grade II, and grade III showed median values (with 95% CI) of 4.00 (1.00-9.00), 4.00 (2.00-9.00), 4.00 (4.00-9.00), and 6.00 (2.00-9.00) (p = .001); sFlt-1 expression median values (with 95% CI) were 6.00 (2.00-9.00), 6.00 (2.00-9.00), 4.00 (1.00-9.00), and 4.00 (1.00-9.00) (p = .004). Serum PLGF and sFlt-1 levels did not correlate with placental tissue expression (p = .228; p = .586). CONCLUSION There are differences in PAS's angiogenic processes according to the severity of trophoblast cell invasion. But there is no overall correlation between serum levels and PLGF and sFlt-1 expression in the placenta, suggesting the imbalance between angiogenic and anti-angiogenic are local mechanisms in the placental and the uterine wall.
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Affiliation(s)
- Letizia Alessandrini
- Obstetrics and Gynecology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia
| | - Rozi Aryananda
- Obstetrics and Gynecology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia
| | - Grace Ariani
- Anatomical Pathology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia
| | - Betty Agustina
- Clinical Pathology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia
| | - Muhammad Ilham Aldika Akbar
- Obstetrics and Gynecology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Obstetrics and Gynecology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia
| | - Gustaff Dekker
- Obstetrics and Gynecology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia.,Women's and Children's Division, Northern Local Adelaide Local Health Network, Medical School North, University of Adelaide, Elizabeth Vale, Australia
| | - Ernawati Ernawati
- Obstetrics and Gynecology Department, Universitas Airlangga, Dr. Soetomo Academic Hospital, Surabaya, Indonesia
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Bachnas MA, Dekker GA, Mudigdo A, Purwanto B, Sulistyowati S, Dachlan EG, Akbar MIA, Chouw A, Sartika CR, Widjiati W. Mesenchymal stem cell secretome ameliorates over-expression of soluble fms-like tyrosine kinase-1 (sFlt-1) and fetal growth restriction (FGR) in animal SLE model. J Matern Fetal Neonatal Med 2023; 36:2279931. [PMID: 37953255 DOI: 10.1080/14767058.2023.2279931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION In the near future, stem cell research may lead to several major therapeutic innovations in medical practice. Secretome, a "by-product" of stem cell line cultures, has many advantages. Its easiness of storage, usage, and fast direct effect are some of those to consider. Fetal growth restriction (FGR) remains one of the significant challenges in maternal-fetal and neonatal medicine. Placentation failure is one of the most profound causal and is often related to increasing sFlt-1 in early pregnancy. This study aimed to investigate hUC-MSC secretome in ameliorating sFlt-1 and how to improve outcomes in preventing FGR in an animal model. MATERIALS AND METHODS Pristane-induced systemic lupus erythematosus (SLE) in a mouse model was used to represent placentation failure and its consequences. Twenty-one mice were randomized into three groups: (I) normal pregnancy, (II) SLE, and (III) SLE with secretome treatment. Pristane was administered in all Groups four weeks prior mating period. Secretome was derived from human umbilical cord mesenchymal stem cells (hUC-MSC) conditioned medium on the 3rd and 4th passage, around day-21 until day-28 from the start of culturing process. Mesenchymal stem cell was characterized using flow cytometry for CD105+, CD90+, and CD73+ surface antigen markers. Immunohistochemistry anlysis by using Remmele's Immunoreactive Score (IRS) was used to quantify the placental sFlt-1 expression in each group. Birth weight and length were analyzed as the secondary outcome. The number of fetuses obtained was also calculated for pregnancy loss comparison between Groups. RESULTS The administration of secretome of hUC-MSC was found to lower the expression of the placental sFlt-1 significantly in the pristane SLE animal model (10.30 ± 1.40 vs. 4.98 ± 2.57; p < 0.001) to a level seen in normal mouse pregnancies in Group I (3.88 ± 0.49; p = 0.159). Secretome also had a significant effect on preventing fetal growth restriction in the pristane SLE mouse model (birth weight: 354.29 ± 80.76 mg vs. 550 ± 64.03 mg; p < 0.001 and birth length: 14.43 ± 1.27 mm vs. 19.00 ± 1.41 mm), comparable to the birth weight and length of the normal pregnancy in Group I (540.29 ± 75.47 mg and 18.14 ± 1.34 mm, p = 0.808 and = 0.719). Secretome administration also showed a potential action to prevent high number of pregnancy loss as the number of fetuses obtained could be similar to those of mice in the normal pregnant Group (7.71 ± 1.11 vs. 7.86 ± 1.06; p = 0.794). CONCLUSIONS Administration of secretome lowers sFlt-1 expression in placenta, improves fetal growth, and prevents pregnancy loss in a mouse SLE model.
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Affiliation(s)
- Muhammad Adrianes Bachnas
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Hospital, Solo, Indonesia
| | - Gustaaf Albert Dekker
- Obstetrics and Gynaecology Department, Lyell-McEwin Hospital, The University of Adelaide, Adelaide, Australia
| | - Ambar Mudigdo
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Hospital, Solo, Indonesia
| | - Bambang Purwanto
- Department of Internal Medicine, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Hospital, Solo, Indonesia
| | - Sri Sulistyowati
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Hospital, Solo, Indonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Muhammad Ilham Aldika Akbar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Faculty of Medicine, Universitas Airlangga/Airlangga University Hospital, Surabaya, Indonesia
| | - Angliana Chouw
- ProSTEM, Prodia StemCell Indonesia Laboratory, Jakarta, Indonesia
| | | | - Widjiati Widjiati
- Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
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Gumilar KE, Priangga B, Lu CH, Dachlan EG, Tan M. Iron metabolism and ferroptosis: A pathway for understanding preeclampsia. Biomed Pharmacother 2023; 167:115565. [PMID: 37751641 DOI: 10.1016/j.biopha.2023.115565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
Preeclampsia (PE) is a serious medical condition that poses a significant health risk to women and children worldwide, particularly in the middle- and low-income countries. It is a complex syndrome that occurs as a result of abnormal pregnancy. Hypertension is the most common symptom of PE, with proteinuria and specific organ systems as detrimental targets. PE's pathogenesis is diverse, and its symptoms can overlap with other diseases. In early pregnancy, when the placenta takes over control, oxidative stress may be closely associated with ferroptosis, a type of cell death caused by intracellular iron accumulation. Ferroptosis in the placenta is defined by redox-active iron availability, loss of antioxidant capacity and phospholipids containing polyunsaturated fatty acids (PUFA) oxidation. Recent studies suggest a compelling potential link between ferroptosis and PE. In this article, we comprehensively review the current understanding of PE and discuss one of its emerging underlying mechanisms, the ferroptosis pathway. We also provide perspective and analysis on the implications of this process in the diagnosis, prevention, and treatment of preeclampsia. We aim to bridge the gap between clinicians and basic scientists in understanding this harmful disease and challenge the research community to put more effort into this exciting new area.
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Affiliation(s)
- Khanisyah Erza Gumilar
- Graduate Institute of Biomedical Science, China Medical University, Taichung 406040, Taiwan, ROC; Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Bayu Priangga
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 40705, Taiwan, ROC
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Ming Tan
- Graduate Institute of Biomedical Science, China Medical University, Taichung 406040, Taiwan, ROC; Institute of Biochemistry & Molecular Biology, and Research Center for Cancer Biology, China Medical University, Taichung 406040, Taiwan, ROC.
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Al Fauzi A, Apriawan T, Ranuh IGMAR, Christi AY, Bajamal AH, Turchan A, Agus Subagio E, Suroto NS, Santoso B, Dachlan EG, Utomo B, Kasper EM. Traumatic brain injury in pregnancy: A systematic review of epidemiology, management, and outcome. J Clin Neurosci 2023; 107:106-117. [PMID: 36527810 DOI: 10.1016/j.jocn.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) during pregnancy is an extremely rare condition in our neurosurgical emergency practices. Studies on the epidemiology and management of TBI in pregnancy are limited to case reports or serial case reports. There is no specific guidelines of management of TBI in pregnancy yet. METHODS The authors performed a structured search of all published articles on TBI in pregnancy from 1990 to 2020. We restricted search for papers in English and Bahasa. RESULTS The literature search yielded 22 articles with total 43 patients. We distinguished C-section based on its timing according to the neurosurgical treatment into primary (simultaneous or prior to neurosurgery) and secondary group (delayed C-section). The mean GOS value in primary C-section is better compared to secondary C-section in severe TBI group (3.57 ± 1.47 vs 3.0 ± 1.27, respectively) consistently in the moderate TBI group (4.33 ± 1.11 vs 3.62 ± 1.47, respectively). The fetal death rate in primary C-section is lower compared to secondary C-section in severe TBI group (14.2 % vs 33.3 %, respectively), contrary, in moderate TBI group (16.7 % vs 12.5 %, respectively). CONCLUSIONS Care of pregnant patients with TBI often requires multidisciplinary approach to optimize treatment strategy on a case-by-case basis in light of prior experience across different center. We propose management guideline for head injury in pregnancy.
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Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
| | - Tedy Apriawan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - I G M Aswin R Ranuh
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ayu Yoniko Christi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eko Agus Subagio
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Santoso
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Utomo
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ekkehard M Kasper
- Department of Neurosurgery, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
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Akbar MIA, Azis MA, Riu DS, Wawengkang E, Ernawati E, Bachnas MA, Sulistyowati S, Dachlan EG, Mose JC, Dekker G. INOVASIA Study: A Multicenter Randomized Clinical Trial of Pravastatin to Prevent Preeclampsia in High-Risk Patients. Am J Perinatol 2022. [PMID: 35292944 DOI: 10.1055/a-1798-1925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our objective was to determine if treatment with pravastatin prevents preeclampsia in pregnant patients at risk of preeclampsia. MATERIAL AND METHODS The study was performed in four major tertiary hospitals in Surabaya, Bandung, and Makassar between 2017 and 2021. Pregnant women at high risk of developing preeclampsia were recruited and randomized into an intervention group and control group. The control group received low-dose aspirin (80 mg) and calcium (1 g) daily, while the intervention group received additional pravastatin (20 mg twice daily) starting from 14 to 20 weeks' gestation until delivery. The pregnancy was followed until delivery, and the clinical data were collected. The primary outcome was the occurrence of preeclampsia. RESULT A total of 173 people participated in this study, including 86 in the control group and 87 in the pravastatin group. The pravastatin group had a significantly lower rate of preterm preeclampsia (13.8 vs. 26.7%; p = 0.034; odds ratio [OR] = 0.034, 95% confidence interval [CI] = 0.202-0.905) and preterm birth (16.1 vs. 36%; p = 0.003; OR = 0.340, 95% CI = 0.165-0.7), mostly indicated preterm birth. Preeclampsia occurred later in the pravastatin group than in the control group (36.39 + 2.32 vs. 34.89 + 3.38 weeks, p = 0.048). Overall, the pravastatin group showed better perinatal outcomes. Neonates with low Apgar scores (<7) at 1 minute (5.7 vs. 25.6%, p = 0.000) and 5 minutes (2.3 vs. 25.6%, p = 0.028) were significantly less common in the pravastatin group. Additionally, the rate of low birthweight babies (<2,500 g) was lower in the pravastatin group (27.6 vs. 40.7%; p = 0.069). CONCLUSION Pravastatin (20 mg bid) significantly reduces the risk of preterm preeclampsia and preterm birth in women at a high risk of developing preeclampsia. KEY POINTS · This is an open-label multicenter RCT to evaluate pravastatin effect to prevent preeclampsia.. · Pravastatin significantly reduces the risk of preterm preeclampsia (PE) and preterm birth in high risk PE women.. · Pravastatin had a beneficial effect on perinatal outcomes, including Apgar scores and birth weight..
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Affiliation(s)
- Muhammad Ilham Aldika Akbar
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Alamsyah Azis
- Faculty of Medicine Universitas Padjajaran, Department Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Deviana Soraya Riu
- Faculty of Medicine Universitas Hasanudin, Department Obstetrics and Gynecology, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Ellen Wawengkang
- Faculty of Medicine Universitas Hasanudin, Department Obstetrics and Gynecology, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Ernawati Ernawati
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Adrianes Bachnas
- Faculty of Medicine Universitas Sebelas Maret, Department Obstetrics and Gynecology, Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Sri Sulistyowati
- Faculty of Medicine Universitas Sebelas Maret, Department Obstetrics and Gynecology, Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Erry Gumilar Dachlan
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Johanes Cornelius Mose
- Faculty of Medicine Universitas Padjajaran, Department Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Gus Dekker
- Faculty of Medicine Universitas Airlangga, Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Lyell McEwin Hospital, The University of Adelaide, Adelaide, South Australia
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9
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Aryananda RA, Aditiawarman A, Gumilar KE, Wardhana MP, Akbar MIA, Cininta N, Ernawati E, Wicaksono B, Joewono HT, Dachlan EG, Bachtiar CA, Kurniawati D, Virdayanti DP, Ariani G, Dekker GA, Sulistyono A. Uterine conservative-resective surgery for selected placenta accreta spectrum cases: Surgical-vascular control methods. Acta Obstet Gynecol Scand 2022; 101:639-648. [PMID: 35301710 DOI: 10.1111/aogs.14348] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of placenta accreta spectrum (PAS) has increased, but the optimal management and the optimal way to achieve vascular control are still controversial. This study aims to compare maternal outcomes between different methods of vascular control in surgical PAS management. MATERIAL AND METHODS A retrospective cohort study on consecutive cases diagnosed with PAS between 2013 and 2020 in single tertiary hospital. The final diagnosis of PAS was made following preoperative ultrasound and confirmation during surgery. Management of PAS using cesarean hysterectomy with internal iliac artery ligation (IIAL) was compared with two types of vascular control in uterine conservative-resective surgery (IIAL vs identification-ligation of the upper vesical, upper vaginal, and uterine arteries). RESULTS Over an 8-year period, 234 pregnant women were diagnosed with PAS meeting the inclusion criteria. Uterine conservative-resective surgery (200 cases) was associated with lower mean blood loss compared with cesarean hysterectomy with IIAL (34 cases) in all PAS cases (1379 ± 769 mL vs 3168 ± 1916 mL; p < 0.001). In sub-analysis of the two uterine conservative-resective surgery subgroups, the group with identification-ligation of the upper vesical, upper vaginal, and uterine arteries had a significantly lower blood loss compared with uterine conservative-resective surgery with IIAL (1307 ± 743 mL vs 1701 ± 813 mL; p = 0.005). Women in the hysterectomy with IIAL group had more massive transfusion (35.3% vs 2.5%; p < 0.001; odds ratio [OR] 21.3, 95% confidence interval [CI] 6.9-66), major blood loss (>1500 mL) (70.6% vs 34%, p < 0.001; OR 4.7; 95% CI 2.1-10.3), catastrophic blood loss (>2500 mL) (64.7% vs 12.5%;p < 0.001; OR 12.8, 95% CI 5.7-29.1), other complications (32% vs 12.4%; p = 0.007; OR 3.4, 95% CI 1.5-7.7), and intensive care unit admission (32.4% vs 1.5%; p < 0.001; OR 31.4, 95% CI 8.2-120.7) compared with the uterine conservative-resective surgery groups. The identification-ligation of the upper vesical, upper vaginal and uterine arteries had a significant lower risk for major blood loss (30.5% vs 50%; p = 0.041; OR 0.44, 95% CI = 0.2-0.9) compared with IIAL for vascular control of uterine conservative-resective surgery. CONCLUSIONS Cesarean hysterectomy is not the default treatment for PAS, PAS with invasion above the vesical trigone are suitable for uterine conservative-resective surgery with upper vesical, upper vaginal and uterine artery vascular control.
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Affiliation(s)
- Rozi Aditya Aryananda
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Aditiawarman Aditiawarman
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Khanisyah Erza Gumilar
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Manggala Pasca Wardhana
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - M Ilham Aldika Akbar
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Nareswari Cininta
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Ernawati Ernawati
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Budi Wicaksono
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Hermanto Tri Joewono
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Citra Aulia Bachtiar
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Devita Kurniawati
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Dian Puspita Virdayanti
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Grace Ariani
- Anatomical Pathology Department, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Gustaaf Albert Dekker
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia.,Women & Children's Division, Department of Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - Agus Sulistyono
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
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10
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Puspa Pitaloka C, Secka A, Ernawati E, Sulistyono A, Juwono HT, Gumilar Dachlan E, Aditiawarman A. Characteristics shifting of heart disease in pregnancy: A report from low middle-income country. J Public Health Res 2021; 10:2137. [PMID: 34278766 PMCID: PMC8764548 DOI: 10.4081/jphr.2021.2137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart disease in pregnancy is one of the leading causes of maternal mortality and morbidity in developing countries. However, the characteristics of the disease vary between countries and regions. This study aimed to present the characteristics of pregnant women with heart disease in an economically advantageous region of a developing country. DESIGN AND METHODS A cross-sectional study was conducted using data from the Weekly Report of Obstetrics and Gynaecology Department to assess pregnant women with heart disease characteristics and pregnancy outcomes. A total sample of 69 pregnant women with heart disease regarding their gestational age was included in the study. Variables observed were maternal characteristics, heart disease's clinical parameters, and maternal and neonatal outcomes. Chi-square test was used to examine the different characteristics of congenital and acquired heart disease groups. RESULTS The prevalence of cardiac disease in pregnancy was 5.19%. Fifty-three point six percent of pregnant women with heart disease were suffered from congenital heart disease (CHD), while 46.4% were acquired heart disease (AHD). Most labor methods were Cesarean delivery, and 69.6% of women experienced cardiac complications. Maternal death was reported in 8.69% of cases. Four cases were CHD complicated by pulmonary hypertension, which leads to Eisenmenger syndrome. Two other cases were AHD complicated by Peripartum Cardiomyopathies. Although statistically insignificant, complications are more common in the AHD group than CHD. CONCLUSION Cardiac disease prevalence in pregnancy is considered high, with CHD as the most common case, which significantly differs from other developing countries.
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Affiliation(s)
- Cyntia Puspa Pitaloka
- Master Program of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya.
| | - Absa Secka
- Master Program of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya.
| | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya / Dr. Soetomo General Hospital; Department of Obstetrics and Gynaecology, Airlangga University Academic Hospital, Surabaya.
| | - Agus Sulistyono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya / Dr. Soetomo General Hospital.
| | - Hermanto Tri Juwono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya / Dr. Soetomo General Hospital.
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya / Dr. Soetomo General Hospital.
| | - Aditiawarman Aditiawarman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya / Dr. Soetomo General Hospital.
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11
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Dwiningsih SR, Darmosoekarto S, Hendarto H, Dachlan EG, Rantam FA, Sunarjo S, Wiyasa IWA, Widjiati W. Effects of bone marrow mesenchymal stem cell transplantation on tumor necrosis factor-alpha receptor 1 expression, granulosa cell apoptosis, and folliculogenesis repair in endometriosis mouse models. Vet World 2021; 14:1788-1796. [PMID: 34475699 PMCID: PMC8404130 DOI: 10.14202/vetworld.2021.1788-1796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/14/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND AIM Endometriosis affects the ovaries and causes a decrease in the oocyte quality during endometrial receptivity. During the development of ovarian follicles, paracrine communication occurs between granulosa cells and oocytes. This study was conducted to determine the effects of bone marrow mesenchymal stem cell transplantation on tumor necrosis factor-alpha (TNF-α) receptor 1 (TNFR1) expression, granulosa cell apoptosis, and folliculogenesis in endometriosis mouse models. MATERIALS AND METHODS This study involved 42 female mice, which were divided into three groups: Healthy mice (T0), endometriosis mice without transplantation (T1), and endometriosis mice with bone marrow mesenchymal stem cell transplantation (T2). The mice were injected intraperitoneally with endometrial fragments (200 μL) to become endometriosis models. On day 15, the endometriosis models received mesenchymal stem cells. Sample collection was performed on day 29. Granulosa cell apoptosis and TNFR1 expression were examined using immunohistochemical staining, and folliculogenesis was assessed using hematoxylin and eosin staining of ovary samples. The data obtained from both examinations were statistically analyzed using Statistical Package for the Social Sciences. RESULTS The results showed that TNFR1 expression is significantly decreased in T2 (p<0.004). The apoptosis of granulosa cells was lower in T2 (p<0.000). The primary, secondary, and graafian follicle counts in T2 were significantly increased. CONCLUSION Bone marrow mesenchymal stem cell transplantation in endometriosis mouse models can reduce TNFR1 expression and granulosa cell apoptosis and improve folliculogenesis.
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Affiliation(s)
- Sri Ratna Dwiningsih
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Soehartono Darmosoekarto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Hendy Hendarto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Department of Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Sunarjo Sunarjo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - I. W. Arsana Wiyasa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Brawijaya Malang, Jl. Mayjen Prof. Dr. Moestopo No. 47, Surabaya 60132, Indonesia
| | - Widjiati Widjiati
- Department of Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
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12
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Akbar MIA, Yosediputra A, Pratama RE, Fadhilah NL, Sulistyowati S, Amani FZ, Dachlan EG, Dikman Angsar M, Dekker GA. Pravastatin suppresses inflammatory cytokines and endothelial activation in patients at risk of developing preeclampsia: INOVASIA study. J Matern Fetal Neonatal Med 2021; 35:5375-5382. [PMID: 33522342 DOI: 10.1080/14767058.2021.1879785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The Indonesian INOVASIA study is an ongoing multicentre randomized, open controlled trial of pravastatin for the prevention of preeclampsia in patients deemed to be high risk. Here we evaluate the effects of pravastatin on circulating inflammatory and endothelial markers, i.e. Vascular Endothelial Growth Factor (VEGF), Interleukin-6 (IL-6), Endothelin-1 (ET-1), and Nitric Oxide (NO). METHODS Pregnant women deemed to be at a high risk of developing preeclampsia women were recruited based on the Fetal Medicine Foundation preeclampsia screening test or a history of preterm preeclampsia, or clinical risk factors in combination with an abnormal uterine artery Doppler flow pattern at 11-20 week's gestation. This is a nested cohort study within the larger trial (INOVASIA); 38 patients were consecutively recruited and assigned to the pravastatin group and the control group. Participants in the pravastatin group received pravastatin (2 × 20 mg p.o) in addition to a standard regimen of aspirin (80 mg p.o) and calcium (1 g p.o), from 14 to 20 weeks until delivery. Blood samples to measure the various biomarkers were obtained in consecutive patients before starting the research medication and just before delivery (pre and post-test examination). RESULT The number of samples on the 2 time points for the various biomarkers was: VEGF: 38, IL-6: 30, ET-1: 38, and NO: 35. IL-6 levels decreased significantly in the pravastatin group (mean ± SD): (191.87 ± 82.99 vs. 151.85 + 48.46, p = .013), while levels in the control group did not change significantly (median (interquartile range)) (144.17 (53.91) vs. 140.82 (16.18), p = .177). ET-1 levels decreased significantly in the pravastatin group (3.64 ± 0.85 vs. 3.01 ± 0.74, p = .006) while the control group had more or less stable levels (3.57 ± 1.12 vs. 3.78 ± 0.73 p = .594). NO was the only serum marker that showed significant changes in both groups. NO levels increased in pravastatin group (11.30 (17.43) vs. 41.90 (53.18), p = .044) and decreased in control group (38.70 (34.80) vs. 10.03 (26.96), p = .002). VEGF levels appeared to follow opposite trends in the 2 groups (NS) (Pravastatin: 3.22 (0.62) vs. 3.28 (0.75), p = .402. Control: 3.38 (0.83) vs. 3.06 (0.74), p = .287). CONCLUSION Administration of 40 mg pravastatin resulted in an improvement in NO levels, and a decrease in IL-6 and endothelin (ET-1) levels. The direction of the effect of pravastatin on these biomarkers appears to underpin the potential for a beneficial effect of pravastatin in the prevention of preeclampsia.
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Affiliation(s)
- Muhammad Ilham Aldika Akbar
- Department Obstetrics & Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department Obstetrics & Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.,Department Obstetrics & Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Angelina Yosediputra
- Department Obstetrics & Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Raditya Ery Pratama
- Department Obstetrics & Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nur Lailatul Fadhilah
- Department Obstetrics & Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | - Fariska Zata Amani
- Department Obstetrics & Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Department Obstetrics & Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department Obstetrics & Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.,Department Obstetrics & Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Muhammad Dikman Angsar
- Department Obstetrics & Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department Obstetrics & Gynecology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.,Department Obstetrics & Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Gustaaf Albert Dekker
- Department Obstetrics & Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department Obstetrics & Gynecology, Lyell McEwin Hospital, The University of Adelaide, Elizabeth Vale, Australia
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13
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Dachlan EG, Nugraheni C, Rahniayu A, Aldika Akbar MI. Quantitative HBsAg and Qualitative HBeAg Predicts Intrauterine Placental Infection and Umbilical Blood Cord in Pregnant Women. J Family Reprod Health 2020; 14:106-115. [PMID: 33603802 PMCID: PMC7865194 DOI: 10.18502/jfrh.v14i2.4353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: To know the correlation between quantitative Hepatitis B surface Antigen (HbsAg) and maternal Hepatitis B Envelope Antigen (HbeAg) with hepatitis B intrauterine transmission via placental infection. Hepatitis B in pregnancy causes a mother to child transmission (MTCT) via transplacental route started with placental infection. HBV DNA viral load and HBeAg are the independent risk factors for MTCT, but it rarely available in developing country. Materials and methods: A cross-sectional study in 33 pregnant women with HbsAg positive in 4 referral hospital in East Java, Indonesia. Quantitative HBS Ag and HBeAg) status were determined serologically from a peripheral venous blood sample. Placental Hepatitis B infection was detected by immunohistochemistry of HBsAg from placental tissues. The intrauterine transmission was diagnosed by positive HBsAg in cord blood sampling after deliveries. Results: Serum quantitative HBsAg level has a good sensitivity and spesificity to predict placental infection (90% and 83%), with a cut off value of 3.14 Log10 IU/mL (AUC 0.87; 95% CI: 0.74-0.99). Quantitative HBsAg level also has a good sensitivity and spesificity to predict HBV transmission in umbilical blood cord (81.8% and 95.5%) with a cut off value of 3.62 log10 IU/ml (AUC: 0.925, 95% CI: 0.813-1; p = 0.000). Placental infection is significantly related with intrauterine transmission with OR 4.6 (95% CI 2.29-9.4; p = 0.002). Conclusion: The study reveals that maternal serum quantitative HBsAg level can be used as an alternative test to substitute HBeAg or HBV DNA as a marker to predict the placental infection and intrauterine transmission, especially in low-middle income countries.
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Affiliation(s)
- Erry Gumilar Dachlan
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Cahyanti Nugraheni
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Alphania Rahniayu
- Department of Pathology Anatomy, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Ilham Aldika Akbar
- Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.,Department of Obstetrics and Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
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14
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Akbar MIA, Yoseph D, - A, Bachnas MA, Dachlan EG, Dekker GA, Ernawati. Magnesium intoxication in women with preeclampsia with severe features treated with magnesium sulfate. Hypertens Pregnancy 2020; 39:221-227. [DOI: 10.1080/10641955.2020.1754851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Muhammad Ilham Aldika Akbar
- Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics and Gynecology, DR. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Daniel Yoseph
- Department Obstetrics and Gynecology, DR. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Aditiawarman -
- Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics and Gynecology, DR. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Adrianes Bachnas
- Department Obstetrics and Gynecology, Dr. Moewardi General Hospital, Faculty of Medicine Universitas Sebelas Maret, Solo, Indonesia
| | - Erry Gumilar Dachlan
- Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics and Gynecology, DR. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
| | - Gustaaf Albert Dekker
- Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Lyell-McEwin Hospital, The University of Adelaide, Adelaide, Australia
| | - Ernawati
- Department Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics and Gynecology, DR. Soetomo General Academic Hospital, Surabaya, Indonesia
- Department Obstetrics and Gynecology, Universitas Airlangga Hospital, Surabaya, Indonesia
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15
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Abstract
Prevention of neurologic disability associated with preterm birth is one of the major challenges in current perinatal medicine. Magnesium sulfate (MgSO4), the focus of this review has been proposed as major step forward for that matter. MgSO4 is easily accessible, cheap, and has been proposed as a mandatory part of the management of inevitable preterm birth. The results of the various RCT's on the use of MgSO4 for neuroprotection has been the subject of many systematic reviews, other studies focused on dosing schedules, side effects and only a few focused on exploring magnesium's mechanism of action. Meanwhile, many guidelines worldwide have plugged MgSO4 as an essential ingredient of daily best practice when managing inevitable preterm birth because it has been shown to reduce the risk of severe neurologic deficit, in particular, cerebral palsy in appropriately selected patients. The more premature, the greater benefit associated with the use of antenatal MgSO4. The dose of 4 g given intravenously 15 min continued by 1 g/h until maximum 24 h and minimum for 4 h is the standard regiment proposed in most guidelines. It should be noted, however, that a recent study found that a total dose of 64 g was associated with the maximum protective effect. Only the protocol used by the largest RCT, the BEAM trial, with a loading dose of 6 g initially followed by a 2-g/h maintenance dose, if continued for 24 h would give a total dose over 50 g. Other studies report on an increased risk of neonatal death with these high doses. Several studies expressed concerns about the risk of serious side effects for both mother and neonate. The results from the systematic review showed that the most commonly used dosage, 4 g bolus continued by 1 g/h maintenance, did not increase neonatal mortality and other suspected neonatal complication such as neonatal asphyxia, spontaneous intestinal perforation, necrotizing enterocolitis, and feeding intolerance. Giving a single bolus injection of 4 g MgSO4 for stimulating BDNF production in highly "suspicious" preterm labor, and 4 g again when preterm birth become inevitable may be best from a safety perspective and also appears to have a stronger rationale.
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Affiliation(s)
- Muhammad Adrianes Bachnas
- Maternal Fetal Medicine Division, Obstetrics and Gynecology Department, Faculty of Medicine Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Muhammad Ilham Aldika Akbar
- Maternal Fetal Medicine Division, Obstetrics and Gynecology Department, Faculty of Medicine Universitas Airlangga, Dr.Soetomo Hospital, Universitas Airlangga Hospital, Surabaya, Surakarta, Indonesia
| | - Erry Gumilar Dachlan
- Maternal Fetal Medicine Division, Obstetrics and Gynecology Department, Faculty of Medicine Universitas Airlangga, Dr.Soetomo Hospital, Universitas Airlangga Hospital, Surabaya, Surakarta, Indonesia
| | - Gustaaf Dekker
- Obstetrics and Gynaecology Department, Lyell-McEwin Hospital, the University of Adelaide, Adelaide, Australia
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Aryananda RA, Akbar A, Wardhana MP, Gumilar KE, Wicaksono B, Ernawati E, Sulistyono A, Aditiawarman A, Joewono HT, Dachlan EG, Parange A, Dekker GA. New three-dimensional/four-dimensional volume rendering imaging software for detecting the abnormally invasive placenta. J Clin Ultrasound 2019; 47:9-13. [PMID: 30246313 DOI: 10.1002/jcu.22641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study aimed to determine the role of three-dimensional (3D)/four-dimensional (4D) volume rendering ultrasound (VRU) in the diagnosis of abnormally invasive placenta (AIP). MATERIALS AND METHODS Twelve consecutive patients strongly suspected of having AIP on the basis of conventional ultrasound (US) and clinical history performed between September 2016 and December 2016 in the main tertiary referral hospital in Surabaya, East Java were included in this prospective observational study. A Samsung WS 80A Elite US scanner with a 3D/4D "crystal vue" and "realistic vue" volume rendering mode was used to establish the diagnosis of AIP and evaluate the site, and depth of placental invasion. The VRU images were compared with the intraoperative findings. RESULTS Using this novel US technique, all cases of suspected AIP were subsequently confirmed during surgery. Importantly, the new US technique provided a correct diagnosis of the degree of invasion in 11 out of these 12 suspected AIP cases: 5/5 for placenta percreta, 3/3 for placenta increta, and 2/3 for placenta accreta; one patient was misdiagnosed in terms of the degree of placenta accreta, and one patient had normal implantation). CONCLUSION This new software of 3D/4D VRU represents a promising technique for the preoperative diagnosis and staging of AIP.
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Affiliation(s)
- Rozi Aditya Aryananda
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Aldika Akbar
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Manggala Pasca Wardhana
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Khanisyah Erza Gumilar
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Budi Wicaksono
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Ernawati Ernawati
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Agus Sulistyono
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Aditiawarman Aditiawarman
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Hermanto Tri Joewono
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Erry Gumilar Dachlan
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
| | - Anupam Parange
- Women & Childrens Division, Department of Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - Gustaaf Albert Dekker
- Maternal-Fetal Medicine, Department of Obstetric & Gynecology, Dr. Soetomo Hospital, Faculty of Medicine of Universitas Airlangga, Surabaya, Indonesia
- Women & Childrens Division, Department of Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
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Aldika Akbar MI, Herdiyantini M, Aryananda RA, CIninta N, Wardhana MP, Gumilar KE, Wicaksono B, Ernawati, Sulistyono A, Aditiawarman, Joewono HT, Nadir Abdullah, Dekker G, Dachlan EG, Dikman Angsar M. Serum heme oxygenase 1 (HO-1), soluble FMS like tyrosine kinase (sFlt-1) level, and neonatal outcome in early onset, late onset preeclampsia, and normal pregnancy. Hypertens Pregnancy 2018; 37:175-181. [DOI: 10.1080/10641955.2018.1494187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Muhammad Ilham Aldika Akbar
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Mita Herdiyantini
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Rozi Aditya Aryananda
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Nareswari CIninta
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Manggala Pasca Wardhana
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Khanisyah Erza Gumilar
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Budi Wicaksono
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Ernawati
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Agus Sulistyono
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Aditiawarman
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Hermanto Tri Joewono
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Nadir Abdullah
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Gustaaf Dekker
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
- Department Obstetrics & Gynecology, Lyell Mc Ewin Hospital, The University of Adelaide, Adelaide, Australia
| | - Erry Gumilar Dachlan
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Dikman Angsar
- Department Obstetrics & Gynecology, DR. Soetomo – UNAIR Hospital, Universitas Airlangga, Surabaya, Indonesia
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Rauf KA, Dekker GA, Sulistyono A, Aditiawarman A, Harsono A, Gumilar KE, Ernawati E, Dachlan EG. 22. Decidual killer immunoglobulin-like receptor (kir)2dl1 expression and the onset of preeclampsia, birth weight and placental weight in early and late onset preeclampsia. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ilham Aldika Akbar M, Mayang Sari I, Aditiawarman, Gumilar Dachlan E, Dekker G. Clinical characteristics of acute fatty liver of pregnancy in a tertiary Indonesian hospital. J Matern Fetal Neonatal Med 2017; 32:1-191. [PMID: 29034746 DOI: 10.1080/14767058.2017.1393067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 01/16/2023]
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare, often autosomal recessive disorder with a major risk for maternal and perinatal mortality and morbidity. In order to achieve a more favorable outcome, awareness of its clinical signs and symptoms and early recognition are of pivotal importance. Over a 5-year period 18 patients were diagnosed with AFLP (one twin, 19 babies). The most common sign and symptoms were jaundice, hypoglycemia, nausea and vomiting, encephalopathy, and hypertension. Abnormal laboratory test results included: elevated total/ conjugated (direct) bilirubin, AST, ALT, PT, APTT, creatinine, leukocyte count, and hypoalbuminemia. Maternal and fetal mortality rate was high: 66.7% resulted in a maternal death and 57.9% in an intrauterine fetal demise (IUFD). The number of complications was found to correlate with maternal death (p = 0.042). Surviving AFLP patients had ≤ 3 complications, while patients with > 3 complications on presentation had a high risk of maternal death (OR = 5.0; 95% CI: 0.55-45.4). The presence of hypertension significantly increased the risk of maternal death (OR: 24.5; 95% CI: 1.1-542.8; p = 0.01). The risk of IUFD was primarily related to gestational age at delivery and birth weight. The high rate of jaundice as presenting symptom of AFLP suggests that Indonesian primary maternity care providers may often miss its important earlier signs and symptoms, in particular de-novo onset of nausea and vomiting in late pregnancy.
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Affiliation(s)
| | - Indah Mayang Sari
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
| | - Aditiawarman
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
| | - Erry Gumilar Dachlan
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
| | - Gustaaf Dekker
- a Department Obstetrics & Gynaecology , Universitas Airlangga , RSUD dr. Soetomo , Surabaya , Indonesia
- b Department Obstetrics & Gynaecology , Lyell Mc Ewin Hospital , the University of Adelaide , Adelaide , Australia
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Abstract
OBJECTIVE To analyze risk factors, obstetric outcome and the need for mechanical ventilation in preeclampsia complicated by pulmonary edema. MATERIALS AND METHODS Case-control study using medical record on preeclampsia complicated by pulmonary edema patients in East Java tertiary referral hospital over 2 years. A simple scoring system was developed to predict the need for mechanical ventilation, using logistic regression. RESULTS 1106 cases of preeclampsia were admitted, with 62 cases (5.6%) had pulmonary edema. Postpartum (p < .001) and cesarean delivery (p = .001) proportions were higher in the preeclampsia with pulmonary edema group. Of the 62 cases with pulmonary edema, 81% required intensive care admission and 60% needed mechanical ventilation support. Mechanical ventilation used was associated with eclampsia (p = .04), hypertensive crisis (p = .02), lower serum albumin (p = .05) and higher creatinine (p = .01). A simple scoring model developed could predict a 46%-99% probability of need for mechanical ventilation (AUC (ROC): 0.856, 95%CI 0.763-0.95). CONCLUSIONS Pulmonary edema is a common complication of preeclampsia in Indonesian referral hospitals. This severe complication increased maternal and perinatal morbidity and mortality. The developed scoring model in this study can be used as a triage tool to predict the probability of mechanical ventilation use due to this complication.
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Affiliation(s)
- Manggala Pasca Wardhana
- a Maternal Fetal Medicine Division, Department of Obstetrics & Gynecology , Fakultas Kedokteran Universitas Airlangga , Surabaya , Indonesia
| | - Erry Gumilar Dachlan
- a Maternal Fetal Medicine Division, Department of Obstetrics & Gynecology , Fakultas Kedokteran Universitas Airlangga , Surabaya , Indonesia
| | - Gustaaf Dekker
- a Maternal Fetal Medicine Division, Department of Obstetrics & Gynecology , Fakultas Kedokteran Universitas Airlangga , Surabaya , Indonesia.,b Department of Obstetrics & Gynaecology , University of Adelaide , Elizabeth Vale , SA , Australia
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Sulistyowati S, Bachnas MA, Anggraini ND, Yuliantara EE, Prabowo W, Anggraini NWP, Pramono MBA, Dachlan EG, Andonotopo W. Recombinant vascular endothelial growth factor 121 injection for the prevention of fetal growth restriction in a preeclampsia mouse model. J Perinat Med 2017; 45:245-251. [PMID: 27996960 DOI: 10.1515/jpm-2016-0149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022]
Abstract
AIM To discover the potential role of recombinant VEGF121 (rVEGF121) injection for the prevention of fetal growth restriction in a preeclampsia (PE) mouse model (Mus musculus). SUBJECTS AND METHODS This is an experimental study of 30 pregnant mice that were randomly divided into three groups: normal, PE, and PE with rVEGF121 injection. The PE mouse model was created by injecting anti Qa-2 10 ng iv, which is deleterious to Qa-2 expression (homologous to HLA-G), from the first to the fourth day of gestation. PE was validated by measuring serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor(PIGF) and also by kidney histopathology. Recombinant VEGF121 was given on the ninth day until the 11th day of pregnancy; mice were terminated on the 16th day. Fetal weights were acquired with a Denver analytical balance. Serum levels of sFlt-1 and PlGF were measured using enzyme-linked immunosorbent assay (ELISA). The data were statistically analyzed via analysis of variance (ANOVA). RESULTS On average, fetal birth weight was 0.7150 g in the normal group, 0.4936 g in the PE group, and 0.6768 g in the PE with rVEGF121 injection group. ANOVA showed significant growth restriction in the PE group (P=0.006), confirming the use of anti Qa-2 as a suitable PE model. Kidney histopathology results, sFlt-1 levels, and PlGF levels also demonstrated that anti Qa-2 consistently conferred hallmarks of PE in mice. Vascular endothelial growth factor (VEGF) injection prevented fetal growth restriction; comparable fetal weights were observed between the PE model with VEGF treatment and the normal group (P=0.610) but differed from the untreated PE group (P=0.021). CONCLUSIONS Injection of rVEGF121 has the potential to prevent fetal growth restriction in a newly proposed PE mouse model.
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Andriya R, Ernawati E, Wicaksono B, Sulistyono A, Aditiawarman A, Joewono HT, Dachlan EG. [224-POS]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Akbar A, Ariningtyas ND, Krismariono A, Dachlan EG. OS002. Comparison TNF-α level and pathogen periodontal microorganismbetween normal pregnant women, periodontitis pregnant women, and lateonset severe preeclampsia women. Pregnancy Hypertens 2012; 2:175-6. [PMID: 26105217 DOI: 10.1016/j.preghy.2012.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Preeclampsia Morbidity and Mortality is still high because of unknown etiology and pathogenesis. One of the theory about pathogenesis of preeclampsia in developing country is infections. Periodontitis is found in 10-60% preeclampsia cases in our center. So we held this research to evaluate the association between preeclampsia, periodontal pathogen, and TNF-α level. OBJECTIVES To compare and analyse the TNF-α level and pathogen periodontal microorganism between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia women. Furthermore the research want to find any relationship between periodontitis and late onset severe preeclampsia. METHODS Analytic observational research with cross sectional study design at Soetomo Hospital from November 2010 until February 2011. Thirty patients divided into 3 groups, normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia women group. All patients were evaluated whether any periodontitis. Periodontal swab were performed and blood samples were taken from all of the patients. TNF-α level and pathogen periodontal microorganism were evaluated and analysed. RESULTS There is a significant difference TNF-α level between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia p=0.000 (p<0.05). The highest TNF-α level is late onset preeclampsia, and the lowest is normal pregnant women. There is a significant difference pathogen periodontal microorganism between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia p=0.001 (p<0.05). Porpyromonas ginggivalis is the most pathogen periodontal microorganism found at the samples. There is a significant difference TNF-α level between the samples with positive and negative pathogen periodontal microorganism p=0.04 (p<0.05). CONCLUSION There is a significant difference about the TNF-α level and pathogen periodontal microorganism between normal pregnant women, periodontitis pregnant women, and late onset severe preeclampsia. Furthermore the TNF-α level between the samples with positive and negative pathogen periodontal microorganism is significantly difference. Maybe periodontitis has association with late onset severe preeclampsia.
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Affiliation(s)
- A Akbar
- Obstetrics Gynaecologic (Fetomaternal Division)
| | | | - A Krismariono
- Dentistry Division of Periodontal, Soetomo Hospital University of Airlangga, Surabaya, Indonesia
| | - E G Dachlan
- Obstetrics Gynaecologic (Fetomaternal Division)
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