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Abstrak :
Latar Belakang: Defisiensi vitamin D berhubungan dengan berbagai luaran kehamilan yang tidak baik seperti pre-eklamsia, diabetes melitus gestasional, bayi berat lahir rendah, dan kelahiran preterm. Vitamin D diduga berperan dalam patofisiologi terjadinya kelahiran preterm melalui mekanisme penekanan mediator inflamasi. 

Tujuan: Penelitian ini bertujuan membandingkan kadar 25 (OH) D serum ibu dan tali pusat pada kelahiran preterm dan cukup bulan. Selain itu juga dicarikorelasi antara kadar 25 (OH) D serum ibu dengan tali pusat. Metode: Pada penelitian ini digunakan desain potong-lintang. Penelitian dilakukan di RSUPN Cipto Mangunkusumo dan RS Budi Kemuliaan Jakarta, mulai dari Januari 2017 sampai dengan Februari 2018. Kadar 25 (OH) D ibu dan tali pusat dibandingkan antara kelompok cukup bulan dan preterm. Hasil: Didapatkan 81 subjek yang dapat dilakukan analisis, yaitu 36 subjek (44,4%) melahirkan cukup bulan dan 45 (55,6%) preterm. Median 25 (OH) D maternal pada kelompok preterm dan cukup bulan berturut-turut 15 ng/mL dan 13,95ng/mL, sedangkan tali pusat 13 ng/ml dan 11,85 ng/ml.Tidak terdapat perbedaan kadar 25 (OH) D serum maternal (p=0,96) dan tali pusat (p=0,80) antara kedua kelompok. Terdapat korelasi positif antara kadar 25(OH) ibu dengan tali pusat (r=0,59, p<0,001 untuk kelompok cukup bulan dan r=0,44, p<0,002 untuk kelompok preterm). Kesimpulan: Kadar 25 (OH) D serum ibu dan tali pusat tidak berbeda bermakna antara kelompok kelahiran preterm dancukup bulan. Terdapat korelasi antara kadar 25 (OH) D ibu dengan tali pusat.

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Background: Vitamin D deficiency is associated with poor outcomes of pregnancy such as pre-eclampsia, gestational diabetes mellitus, low birth weight infants, and preterm birth. Vitamin D is thought to play a role in the pathophysiology of preterm deliveries through the mechanism of inflammatory mediator suppression. Objective: To compare maternal and umbilical serum 25 (OH) D levels between preterm and aterm deliveries group. In addition, the correlation between maternal and umbilical cord serum of 25 (OH) D were analyzed. Method: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital and Budi Kemuliaan Hospital Jakarta from January 2017 to February 2018. Pre-delivery maternal venous blood and umbilical cord vitamin D serum levels were measured for both of term and preterm deliveries group. Result: Eighty one subjects were eligible for analysis, 36 subjects (44.4%) delivered term babies and 45 (55.6%) delivered preterm babies. Median level of maternal serum 25 (OH) D were resepectively 15 ng/mL and 13.95 ng/mL for preterm and term group. Umbilical cord serum 25 (OH) D levels were respectively 13 ng/ml and 11.85 ng/ml for preterm and term group. There was no statistically difference between pereterm and term group of both maternal and umbilical serum 25 (OH) D levels (respectively p = 0.96, p = 0.80). There was a positive correlation between the maternal and umbilical 25 (OH) D levels in both groups (r = 0.59, p <0.001 for term group and r = 0.44, p <0.002 for preterm group). Conclusions: Maternal and umbilical serum 25 (OH) D levels were not significantly different between term and preterm groups. There was a correlation between maternal and umbilical serum levels of 25 (OH) D.

Abstrak :
Status gizi pada ibu hamil mempengaruhi komposisi mikrobiota usus ibu yang secara tidak langsung akan mempengaruhi pembentukan mikrobiota usus anak. Penelitian ini adalah suatu studi potong lintang yang mencari korelasi peningkatan berat badan dan lingkar lengan atas dengan jumlah Bifidobacterium dan Lactobacillus pada 52 ibu hamil trimester ketiga. Penelitian dilaksanakan di 10 Puskesmas Kecamatan Jakarta Timur selama bulan Februari?April 2015. Uji korelasi peningkatan BB dengan jumlah Bifidobacterium (r = 0,119, p = 0,4) dan dengan jumlah Lactobacillus (r = -0,009, p = 0,951). Korelasi LLA dengan jumlah Bifidobacterium (r = -0,211, p = 0,134) dan dengan jumlah Lactobacillus (r = - 0,013, p = 0,926). Dengan demikian, penelitian ini belum dapat membuktikan bahwa terdapat adanya korelasi antara peningkatan BB dan LLA dengan jumlah Bifidobacterium dan Lactobacillus pada kehamilan trimester ketiga.

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Maternal nutritional status influences maternal gut microbiota composition, which in turn shapes the infant?s gut microbiota composition. Recent studies have shown that gut microbiota regulates obesity by increasing energy harvest from diet and by regulating peripheral metabolism. This cross-sectional study reports the correlation of maternal weight gain and mid-upper arm circumference with Bifidobacterium and Lactobacillus on 52 third-trimester pregnant women. The study was done on February?April 2015 in 10 Primary Health Care Centres in East Jakarta. Correlation of maternal weight gain with Bifidobacterium (r = 0.119, p = 0.4) and with Lactobacillus (r = -0.009, p = 0.951). The correlation of MUAC with Bifidobacterium (r = -0.211, p = 0.134) and Lactobacillus (r = -0.013, p = 0.926). Thus, this study has not proven any correlation between maternal weight gain and MUAC with Bifidobacterium and Lactobacillus count.

Abstrak :
Peningkatan berat badan selama hamil dan indeks massa tubuh (IMT) ibu laktasi yang berlebihan berhubungan dengan inflamasi kronis derajat rendah yang dapat menyebabkan dampak negatif bagi kesehatan ibu maupun bayi. Asupan nutrisi diketahui sebagai salah satu faktor utama yang mempengaruhi perubahan berat badan (BB), IMT, serta inflamasi pada ibu laktasi. Inflamasi kronis derajat rendah dapat diukur dengan high sensitivity C-Reactive Protein (hs-CRP), baik di serum maupun ASI. Selain dengan pemeriksaan laboratorium, status inflamasi juga dapat diprediksi oleh skor Dietary Inflammatory Index (DII), suatu alat yang dapat memprediksi potensi inflamasi diet individu. Penelitian ini bertujuan untuk mengetahui korelasi antara skor DII ibu laktasi dengan kadar hs-CRP serum dan ASI ibu 3-6 bulan post partum di Jakarta. Penelitian ini adalah studi potong lintang dengan menggunakan consecutive sampling yang melibatkan 71 subjek ibu laktasi 3-6 bulan post partum yang datang ke Puskesmas Cilincing dan Grogol Petamburan, Jakarta, pada bulan Februari-April 2019. Penilaian asupan nutrisi dilakukan dengan semi-kuantitatif Food Frequency Questionnaires, pemeriksaan antropometri meliputi BB prakehamilan, BB saat pengambilan data, dan tinggi badan, serta pengambilan sampel serum (dengan metode imunoturbidimetri) dan ASI (dengan metode ELISA) untuk pemeriksaan hs-CRP. Median CRP serum adalah 1,74 mg/L dan CRP ASI 6221,17 pg/mL, sementara rerata skor DII adalah 0,624. Ditemukan korelasi positif antara hs-CRP serum dan ASI (r = 0,269, p = 0,023), namun pada penelitian ini tidak didapati korelasi antara skor DII dengan kadar hs-CRP serum maupun ASI (r = -0,124, p = 0,301 dan r = 0,129, p = 0,283).

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Excessive gestational weight gain (GWG) and body mass index (BMI) in lactating mothers are associated with chronic low-grade inflammation which can cause negative effects to mother and baby. Nutrient intake has been known as important factor to affect inflammation, which can be measured by high sensitivity Creactive protein (hs-CRP). Beside laboratory assesment, level of inlammation can be determined by Dietary Inflammatory Index (DII) score, a tool developed to predict inflammation potential in diet consumed. This study aimed to examine the correlation between DII score with serum and breast milk hs-CRP in lactating mothers. A cross-sectional study was conducted by consecutively enrolling 71 lactating mothers, 3-6 months post-partum, age 20-35 years old, visiting Grogol Petamburan and Cilincing community health center on February-April 2019. Dietary assessment was conducted using semi-quantitative food frequency questionnaire. Anthropometric measurements included were pre-pregnancy weight, post-partum weight, and body height. Serum hs-CRP was measured by immunoturbidimetry method, and breast milk hs-CRP by ELISA method. Median of serum and breast milk CRP were 1,74 mg/L and 6221,17 pg/mL, respectively. Mean of DII score was 0,624. Positive correlation was found between serum and breast milk hs-CRP (r = 0,269, p = 0,023), but we can not find correlation between DII score with serum and breast milk hs-CRP (r = -0,124, p = 0,301 and r = 0,129, p = 0,283). There is no correlation between DII score with serum and breast milk hs-CRP.

Abstrak :
Air susu ibu adalah sumber nutrisi paling baik untuk pertumbuhan dan perkembangan bayi, yang mengandung banyak komponen penting salah satunya antioksidan enzimatik yaitu Superoksida Dismutase (SOD). Sebagai antioksidan lini pertama, SOD berfungsi mengkatalisis superoksida menjadi hidrogen peroksida dan selanjutnya hidrogen peroksida diubah menjadi air dan alkohol oleh katalase (CAT) dan Glutation Peroksidase (GPx). Vitamin E sebagai antioksidan eksogen dari luar tubuh akan membantu kerja SOD untuk mencegah keadaan stres oksidatif.  Fungsi vitamin E adalah mencegah terjadinya kerusakan lemak pada membran sel. Vitamin E akan bekerja secara sinergis dengan vitamin C yang akan mengubah kembali vitamin E menjadi bentuk non radikal. Asupan vitamin E dan vitamin C di Indonesia masih belum jelas terutama pada ibu laktasi sehingga perlu diteliti lebih lanjut. Penelitianini merupakan penelitianpotong lintang yang dilakukan di Puskesmas Grogol Petamburan dan Puskesmas Cilincing pada 60 orang ibu laktasi berusia 20-40 tahun yang menyusui bayi berumur 1-6 bulan. Penelitian ini berlangsung sejak bulan Maret hingga April 2019 yang bertujuanuntuk melihat korelasi antara asupan vitamin E dan vitamin C dengan aktivitas total SOD eritrosit dan ASI. Aktivitas total SOD eritrosit dan ASI dinilai menggunakanRansod kit 125 dengan metode spektrofotometri. Median aktivitas total SOD eritrosit sebesar 423,73 (242-858) U/ml, sedangkan median aktivitas total SOD ASI 58,34 U/ml(24,86-287,79) U/ml. Asupan vitamin E yang diperoleh pada penelitian ini adalah 91,7% subjek memiliki asupan vitamin E yang rendahsedangkan 70% subjek memiliki asupan vitamin C yang cukup. Pada penelitian ini tidak ditemukan adanya korelasi bermakna antara asupan vitamin E dan C dengan aktivitas total SOD eritrosit dan ASI (p>0,05).

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Human milk is the best nutrition for infant's growth and development. Human milk contains many components, one of them is superoxide dismutase (SOD). As a first line antioxidant, SOD plays a role to convert superoxide into hydrogen peroxide and furthermore will continue with catalase (CAT) and gluthathione peroxide (GPx) to change hydrogen peroxide into water and alcohol molecule. Vitamin E as an exogenous antioxidant will help SOD to prevent oxidative stress. Vitamin E inhibits lipid peroxidation in membrane cell. Vitamin C helps vitamin E back into non radical molecule. Vitamin E and vitamin C intake in Indonesia still unclear especially among lactating mothers. This cross sectional study conducted in Grogol Petamburan and Cilincing Health Centre in 60 lactating mothers aged 20-40 yo whose feeding 1-6 months infants. Study was held from march until April 2019 to assess correlation between vitamin E and C intake of lactating mothers with erythrocyte and brestmilk SOD total activity. Total SOD activity in erythrocyte and human milk were analyzed with Ransod kit 125with spectrophotometry method. Median SOD total activity in erythrocyte was 423,73 (242-858)U/ml, meanwhile SOD total activity in breastmilk has median value 58,34 U/ml (24,86-287,79) U/ml. Subjects with low vitamin C intake were 91,7% and 70% subjects had adequate vitamin C intake. There were no significant correlation between vitamin E and vitamin C intake in lactating mothers with erythrocyte and breastmilk SOD total activity (p>0,05).

Abstrak :
Latar Belakang: Spektrum Plasenta Akreta (SPA) merupakan salah satu komplikasi obstetri dengan tingkat morbiditas yang tinggi. 3D Power Doppler telah banyak digunakan untuk meningkatkan diagnosis SPA, seperti menggunakan Plasenta Akreta Indeks, tetapi hanya mengukur secara kualitatif. Oleh karena itu, penelitian ini bertujuan untuk memahami hubungan kuantitatif indeks vaskularisasi plasenta terhadap temuan makroskopik, grading histopatologi, dan perdarahan intraoperatif pada kasus SPA. Tujuan: Mengetahui hubungan indeks vaskular (vascular index / VI), indeks aliran (flow index / FI), dan indeks aliran vaskular (vascular flow Index / VFI) dengan diagnosis klinis, jumlah perdarahan dan temuan histopatologi SPA di Rumah Sakit Cipto Mangunkusumo. Metode: Sebuah studi cross-sectional dilakukan pada 34 wanita, yang secara klinis didiagnosis dengan SPA. Power Doppler 3D yang dikombinasikan dengan perangkat lunak VOCAL II digunakan untuk mengukur tingkat indeks vaskularisasi (VI), indeks aliran (FI), dan indeks aliran vaskularisasi (VFI). Gambaran gross anatomy dan hasil histopatologi yang dikategorikan sebagai akreta, inkreta, dan perkreta. Tingkat kehilangan darah intra-operatif diukur dan diklasifikasikan sebagai perdarahan masif diatas 1500 ml. Data kemudian dianalisis menggunakan Statistical Package for Social Sciences (SPSS) versi 25. Hasil: Median (min-max) untuk semua indeks vaskularisasi sebagai berikut: VI = 44,2 (23,7-74,9), FI = 35,4 (24,9-57), dan VFI = 15,3 (8,5-41,7). Nilai FI ditemukan signifikan dalam membandingkan tahap makroskopis (p =0,015) dan memiliki korelasi positif sedang dalam kaitannya dengan perdarahan (r =0,449). hasil analisa AUC of ROC VI, FI, dan VFI nilai batas terbukti sangat terkait dengan kehilangan darah 1500cc yaitu dengan hasil FI dengan nilai AUC of ROC 0.784, nilai cut off ≥38.9, OR: 10.00 (IK95% [1.58-63.09], p =0.014), VI dengan nilai AUC of ROC 0.712, nilai cut off ≥60.4, OR: 7.00 (IK95% [1.23-39.56], p =0.031), dan VFI dengan nilai AUC of ROC 0.779, nilai cut off ≥23.2, OR: 9.16 (IK95% [1.53-54.59], p =0.015). Kesimpulan. Indeks Vaskularisasi Plasenta (FI) yang diukur dengan Power Doppler 3 dimensi dapat menjadi pemeriksaan tambahan Diagnostik SPA yang berpotensi dapat memprediksi kedalaman invasi SPA secara intra-pembedahan, jumlah perdarahan dan kemungkinan akan didapatkannya perdarahan masif pada pembedahan SPA Kata Kunci. Plasenta akreta, 3D Power Doppler, indeks vaskular, indeks aliran, indeks aliran vaskular, perdarahan intraoperasi, histologi akreta ......Background: Placenta Accreta Spectrum (PAS) is an obstetrical complication with a high level of morbidity. The 3D Power Doppler method has been widely used to improve the PAS diagnosis, such as using Placenta Accreta Index, but it only measures qualitative features. Therefore, this study aims to understand the relationship of quantitative placental vascular indices towards macroscopic findings, histopathological grading, and intra-operative blood loss in cases of PAS disorder. Objectives: Knowing the relationship between vascular index (VI), flow index (FI), and vascular flow index (VFI) with clinical diagnosis, amount of bleeding and histopathological findings of SPA at Cipto Mangunkusumo Hospital. Methods: A cross-sectional study was conducted in 34 women, who were clinically diagnosed with PAS. The 3D Power Doppler in combination with VOCAL II software was used to measure the level of vascularization index (VI), flow index (FI), and vascularization flow index (VFI). Gross anatomical appearance and histopathology results were categorized as accreta, increta, and percreta. Intra-operative blood loss level was measured and classified as massive hemorrhage if it was≥1500 ml. Data were then analyzed using Statistical Package for Social Sciences (SPSS) version 25. Results: The median (min-max) for all vascularity indexes as follows: VI = 44.2 (23.7-74.9), FI = 35.4 (24.9-57), and VFI = 15.3 (8.5-41.7). FI value was found to be significant in comparing gross pathological stages (p=0.015) and had a moderate positive correlation in relation to blood loss (r= 0.449). the results of the AUC of ROC VI, FI, and VFI analysis above the cut-off values were shown to be strongly associated with blood loss ≥1500cc the results obtained: FI with AUC of ROC value of 0.784, cut off value 38.9, OR: 10.00 (IK95% [1.58-63.09], p = 0.014), VI with AUC of ROC value of 0.712, cut off value 60.4, OR: 7.00 (IK95% [1.23-39.56], p = 0.031), and VFI with AUC of ROC value of 0.779, cut off value 23.2, OR: 9.16 (CI95% [1.53-54.59], p = 0.015). Conclusion: Flow index (FI) value from 3D Power Doppler ultrasound may become a potential diagnostic marker to predict the depth of PAS invasion prior to surgery, along with the level of blood loss intra-operatively. Keywords: Placenta accreta spectrum (PAS), Ultrasound markers, Vascularization, Macroscopic, Histopathology, Blood loss, 3D Power Doppler Biopsy, Vascular Index, Flow Index, Vascular Flow Index

Abstrak :

Latar Belakang: Perdarahan masif merupakan komplikasi paling banyak pada kasus spektrum plasenta akreta. Penyebab perdarahan terutama tergantung dari derajat keparahan spektrum plasenta akreta yang dapat diprediksi dari USG dan secara klinis dibuktikan pada saat operasi. Meskipun banyak faktor yang memengaruhi jumlah perdarahan saat operasi, namun memprediksi jumlah perdarahan melalui jumlah aliran darah yang masuk ke uterus adalah suatu patut diperhatikan. Oleh karena itu, penelitian ini bertujuan untuk memahami hubungan volume flow arteri uterina dan iliaka interna terhadap perdarahan, temuan intraoperasi dan histopatologi pada kasus SPA.

Tujuan: Mengetahui hubungan volume flow dan diameter arteri uterina dan iliaka  interna dengan perdarahan dan temuan intraoperasi serta histopatologi pada pasien spektrum plasenta akreta.

Metode: Sebuah studi cross-sectional dilakukan pada 31 wanita, yang secara klinis didiagnosis dengan SPA. Pengukuran volume flow dan diameter arteri uterina dan iliaka interna dilakukan dengan USG Doppler sebelum operasi dilakukan. Temuan intraoperasi dan hasil histopatologi dikategorikan sesuai kriteria klinis dan histopatologi FIGO. Jumlah perdarahan intraoperasi diukur dan dicatat. Data kemudian dianalisis menggunakan Statistical Package for Social Sciences (SPSS) versi 25.

Hasil: Dari 31 subjek penelitian didapatkan jumlah perdarahan intraoperasi sebanyak 1500 (1000-3000) mL. Sebagian besar tindakan yang dilakukan bersifat elektif (n=18^; 58,1%) dengan seksio sesarea diikuti oleh histerektomi sebanyak 19 kasus (61,3%). Temuan klinis intraoperasi yang paling sering ditemukan adalah kriteria klinis FIGO 1 sebanyak 15 kasus (48,4%). Hasil histopatologi terbanyak adalah kriteria histopatologi FIGO 2 sebanyak 19 kasus (61,3%).

Rerata volume flow Arteri Iliaka Interna (p=0,002) berkorelasi dengan jumlah perdarahan intraoperasi dengan koefisien korelasi sebesar 0,525, sedangkan rerata volume flow Arteri Uterina tidak berkorelasi dengan jumlah perdarahan intraoperasi. Rerata diameter arteri uterina (p=0,034) berkorelasi positif dengan jumlah perdarahan intraoperasi dengan koefisien korelasi sebesar 0,383. Hal ini menunjukkan semakin besar volume flow arteri Iliaka Interna, semakin besar jumlah perdarahan intraoperasi. Ditemukan bahwa rerata diameter arteri iliaka interna memiliki perbedaan secara statistik dengan temuan klinis intraoperatif (p=0,044). Tidak ditemukan hubungan antara rerata volume flow dan diameter arteri uterina dan arteri iliaka interna dengan hasil histopatologi.

Kesimpulan. Pengukuran volume flow arteri iliaka interna dan diameter arteri uterina dapat memberikan gambaran perkiraan jumlah perdarahan saat operasi kasus spektrum plasenta akreta. ......Background: Massive bleeding is the most common complication in cases of the placenta accreta spectrum (PAS). The cause of bleeding largely depends on the severity of the PAS, which can be predicted through ultrasound (USG) and clinically confirmed during surgery. Although many factors influence the amount of bleeding during surgery, predicting the amount of bleeding through the measurement of blood flow into the uterus is noteworthy. Therefore, this study aims to understand the relationship between the volume flow of the uterine and internal iliac arteries and bleeding, intraoperative findings, and histopathology in PAS cases.

Objective: To determine the Relationship between Volume Flow and Diameter of Uterine and Internal Iliac Arteries with Intraoperative Bleeding and Findings, as well as Histopathology in Patients with Placenta Accreta Spectrum.

Methods: A cross-sectional study was conducted on 31 women clinically diagnosed with PAS. Measurement of volume flow and diameter of the uterine and internal iliac arteries was performed using Doppler ultrasound before surgery. Intraoperative findings and histopathological results were categorized according to clinical and FIGO histopathological criteria. The amount of intraoperative bleeding was measured and recorded. The data were then analyzed using Statistical Package for Social Sciences (SPSS) version 25.

Results: From 31 study subjects, the amount of intraoperative bleeding was found to be 1500 (1000-3000) mL. Most procedures were elective (n=18; 58.1%), with cesarean section followed by hysterectomy in 19 cases (61.3%). The most common intraoperative clinical finding was FIGO clinical criteria 1 in 15 cases (48.4%). The majority of histopathological results were FIGO histopathological criteria 2 in 19 cases (61.3%). The mean volume flow of the Internal Iliac Artery (p=0.002) correlated with the amount of intraoperative bleeding with a correlation coefficient of 0.525, while the mean volume flow of the Uterine Artery did not correlate with the amount of intraoperative bleeding. The mean diameter of the uterine artery (p=0.034) positively correlated with the amount of intraoperative bleeding with a correlation coefficient of 0.383. This indicates that the larger the volume flow of the Internal Iliac Artery, the greater the amount of intraoperative bleeding. It was found that the mean diameter of the internal iliac artery differed statistically with intraoperative clinical findings (p=0.044). No relationship was found between the mean volume flow and diameter of the uterine and internal iliac arteries with histopathological results.

Conclusion: Measurement of the volume flow of the internal iliac artery and the diameter of the uterine artery can provide an estimate of the amount of bleeding during surgery in cases of the placenta accreta spectrum.

Abstrak :

Latar Belakang: Preeklamsia merupakan gangguan hipertensi dalam kehamilan yang disebabkan oleh plasentasi abnormal dengan penyebab pasti yang belum diketahui. Perubahan pola makan dan pola makanan berubah drastis selama dekade terakhir baik di negara maju maupun berkembang terutama peningkatan konsumsi gula tambahan diantaranya fruktosa. Fruktosa memegang peranan penting pertumbuhan janin pada trimester pertama. Namun, konsumsi berlebih fruktosa dapat menyebabkan disfungsi endotel yang dapat mengakibatkan hipoksia plasenta sehingga terjadi preeklamsia. PRPP sebagai metabolit antara pada metabolisme fruktosa diduga meningkat pada kondisi preeklamsia yang diakibatkan oleh konsumsi fruktosa berlebih. Penelitian ini bertujuan untuk mengetahui peningkatan kadar PRPP pada kondisi preeklamsia dan korelasinya dengan konsumsi fruktosa meternal serta jumlah leukosit.

Metode: Penelitian potong lintang pada 60 perempuan hamil yang dibagi menjadi dua kelompok. Kelompok preeklamsia dan hamil normal, masing-masing sebanyak 30 subjek yang dilakukan pemeriksaan kadar PRPP pada leukosit dan jumlah leukosit dari darah vena. Seluruh subjek dilakukan wawancara sFFQ (semiquantitative Food Frequent Questionnaire)konsumsi gula maternal.

Hasil: Kadar PRPP leukosit pasien preeklamsia lebih tinggi bermakna pada kelompok preeklamsia (7.015,67 vs 5.577,63, p=0,003). Jumlah leukosit pada kelompok preeklamsia lebih tinggi dibandingkan kelompok normal (15.905 (5.014,10) vs 8.078,33 (1.141,74) /mm³, p=0,000). Konsumsi fruktosa kelompok preeklamsia lebih tinggi dibandingkan kelompok normal namun tidak bermakna secara statistik (6,25 (0,6 – 10,54) vs 4,65(0,60 – 19,4) g/hari, p=0,32). Korelasi positif lemah kadar PRPP dengan jumlah leukosit (r=0,327, p=0,035). Tidak ada korelasi kadar PRPP dengan konsumsi fruktosa maternal (r=-0.013, p=0.923). Tidak ada korelasi jumlah leukosit dengan konsumsi fruktosa maternal (r=0.122, p=0.352).

Kesimpulan: Terdapat perbedaan bermakna kadar PRPP leukosit kelompok preeklamsia dibandingkan kelompok normal. Terdapat korelasi positif lemah kadar PRPP leukosit dengan jumlah leukosit. Tidak terdapat korelasi kadar PRPP leukosit dengan konsumsi fruktosa maternal dan jumlah leukosit dengan konsumsi fruktosa maternal. ...... Preeclampsia is a hypertensive disorder in pregnancy caused by abnormal placentation with an unknown exact cause. Changes in diet pattern and diet composition have changed dramatically over the past decade, in both developed and developing countries, especially the increase in consumption of added sugars including fructose. Fructose plays an important role in fetal growth in the first trimester. However, excessive consumption of fructose can cause endothelial dysfunction which can result in placental hypoxia resulting in preeclampsia. PRPP as an intermediate metabolite in fructose metabolism is thought to increase in preeclampsia conditions caused by excess fructose consumption. This study aims to determine the increase in PRPP levels in preeclampsia conditions and its correlation with meternal fructose consumption and leukocyte count.

Method: Cross-sectional observational study on 60 pregnant women divided into two groups. The preeclampsia and normal pregnancy groups, each as many as 30 subjects were examined for PRPP levels in leukocyte and leukocyte counts from venous blood. All subjects were interviewed with sFFQ (semiquantitative Food Frequent Questionnaire) on maternal sugar consumption.

Results: Leukocyte’s PRPP levels in preeclampsia patients were significantly higher in the preeclampsia group (7,015.67 vs 5,577.63, p=0.003). The number of leukocyte in the preeclampsia group was higher than in the normal group (15,905 (5,014.10) vs 8,078.33 (1,141.74) /mm3, p=0.000). The fructose consumption of the preeclampsia group was higher than in the normal group but not statistically significant (6.25 (0.6 - 10.54) vs 4.65 (0.60 - 19.4) g / day, p=0.32). Weak positive correlation of PRPP levels with leukocyte count (r=0.327, p=0.035). There was no correlation between PRPP levels and maternal fructose consumption (r =-0.013, p=0.923). There was no correlation between leukocyte count and maternal fructose consumption (r=0.122, p=0.352).

Conclusion: There was a significant difference in PRPP leukocyte levels in the preeclampsia group compared to the normal group. There is a weak positive correlation of leukocyte PRPP levels with leukocyte count. There was no correlation between leukocyte PRPP levels with maternal fructose consumption and leukocyte counts with maternal fructose consumption.

Abstrak :
Latar Belakang: World Health Organization melaporkan sebanyak 11 kematian anak dibawah lima tahun terjadi karena komplikasi intapartum termasuk keadaan asfiksia intrapartum. Hipoksia/asidemia fetal intrapartum berpotensi menyebabkan berbagai morbiditas baik jangka pendek seperti hypoxic-ischemic ensephalopathy maupun jangka panjang seperti cerberal palsy. FIGO mengatakan bahwa pH dibawah 7,2 adalah keadaan asidemia. Onset kerusakan otak yang terjadi saat asidemia dapat berjalan dengan cepat sehingga dibutuhkan pemantauan dini. Pola denyut jantung fetus yang abnormal berkaitan dengan 2,86 kali risiko asidemia dibanding pola CTG yang normal. Tujuan: Mencari hubungan antara katagori CTG dan pola CTG dengan kejadian asidemia janin, sehingga dapat memprediksi keluaran janin dan tatalaksana kehamilan selanjutnya. Metode: Penelitian ini menggunakan desain cohort retrospektif, menggunakan data rekam medis pasien persalinan dengan diagnosis gawat janin di RSCM pada Januari 2016-Desember 2017, yang kemudian dibagi menjadi dua kelompok yaitu kelompok CTG mencurigakan dan patologis dengan kejadian asidemia janin atau tidak. Kemudian dilakukan analisis statistik untuk menilai hubungan antara gambaran kardiotokografi dengan kejadian asidemia. Hasil: Terdapat 32 (30,8%) subjek dari 104 subjek dengan CTG mencurigakan dan terdapat 40 (40%) subjek dari 100 subjek dengan CTG patologis mengalami asidemia. Tidak didapatkan hubungan bermakna secara statistik kejadian asidemia antara kelompok CTG dengan kejadian asidemia janin (p=0.168; 95% CI 0.529-1.119). Asidemia janin terjadi pada 36,8% pada kelompok dengan pola CTG reduced variability, 38,5% pada absent variability, 20% pada tachycardia, 25% pada late deceleration, 58,3% pada late deceleration and reduced variability, 30,8% pada variable deceleration, 50% pada variable deceleration and reduced variability dengan semua hamil uji statistic menunjukan nilai p>0,05. Tidak terdapat pola CTG yang berhubungan yang bermakna dengan kejadian asidemia janin. Nilai pH pada penelitian ini memiliki median 7.24 dan nilai median pH pada kasus asidemia adalah 7.082. Kesimpulan: Penelitian ini menunjukkan bahwa tidak terdapat hubungan antara katagori CTG dengan kejadian asidemia janin, namun didapatkan trend bahwa CTG patologis lebih sering mengalami asidemia. Tidak terdapat hubungan antara pola CTG dengan kejadian asidemia janin, namun pola CTG late deceleration and reduced variability cenderung lebih sering mengalami asidemia janin.

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Introduction: WHO stated that there were 11 of infant mortality rate due to intrapartum complication including asphyxia. Intrapartum fetal hypoxia or acidemia causes short and long-term morbidity such as hypoxic ischemic encephalopathy and cerebral palsy. FIGO concluded that pH level under 7.2 was academic condition. Onset of brain dysfunction occurred rapidly; early monitoring is needed. Abnormal fetal heart rate is related with 2.86 times of academic risk compared with normal CTG pattern. Aims: Determine the relation between CTG category and pattern to intrapartum fetal acidemia so that we can predict fetal outcome and further pregnancy treatment. Methods: This cohort retrospective study design conducted through medical records in RSCM from January 2016-December 2017. All delivery patients with fetal distress diagnosis consisted of two groups including suspicious and pathological CTG group corresponding to fetal academic. Statistical analysis determine the relationship between cardiotocography and acidemia incidence. Results: There were 32 subjects (30.8%) from 104 subjects with suspicious CTG, and 40 subjects (40%) from 100 subjects with pathological CTG having acidemia. There was no significant relationship statistically with acidemia incidence between CTG category and fetal acidemia (p=0.168; 95% CI 0.529-1.119). Fetal acidemia was 36.8%, 38.5%, 20%, 25%, 58.3%, 30.8%, 50% in reduced variability, absent variability, tachycardia, late deceleration, late deceleration and reduced variability, variable deceleration, and variable deceleration and reduced variability CTG group; respectively, with statistical test results all p value >0.05. There was no relationship between CTG pattern and fetal acidemia. The pH value in this study had 7.24 for median with median pH in this acidemia case was 7.082. Conclusion: There is no relationship between CTG category and fetal acidemia; however, pathological CTG was more often in acidemia cases. There was no relationship between CTG pattern and fetal acidemia incidence; however, late deceleration and reduced variability CTG pattern tends to more often in fetal acidemia.

Abstrak :
[ABSTRAK
Penelitian ini bertujuan untuk mengetahui hubungan asupan vitamin A dan kadar retinol dengan status anemia pada dua kelompok ibu hamil trimester tiga, yaitu kelompok anemia dan non anemia. Penelitian ini merupakan penelitian potong lintang yang dilaksanakan di sepuluh puskesmas kecamatan Jakarta Timur dan merupakan bagian dari penelitian besar Departemen Gizi Fakultas Kedokteran Universitas Indonesia yang berjudul “Peran Gizi, Faktor Maternal dan Pelayanan Kesehatan pada Ibu Hamil Trimester Ketiga terhadap Komposisi Mikrobiota Ibu dan Berat Lahir Bayi: Studi Kohort di Jakarta”. Pengambilan data dilakukan pada bulan April hingga Mei 2015. Sebanyak 113 subjek ibu hamil trimester tiga dengan usia kehamilan diatas 32 minggu ikut dalam penelitansetelah memenuhi kriteria penelitian dan dibagi dalam dua kelompok berdasarkan kadar hemoglobin yaitu anemia (Hb<11g/dL) dan non anemia (Hb≥11g/dL). Setelah itu dilakukan pengukuran antropometri, wawancara asupan, pemeriksaan hemoglobin, dan serum retinol. Data yang dikumpulkan meliputi karakteristik demografi, antropometri, asupan makanan (makronutrien dan mikronutrien), kadar hemoglobin, dankadar serum retinol. Rentang usia subjek dalam penelitian ini adalah 19-44 tahun. Sebagian besar subjek (59,6%) memiliki tingkat pendidikan menengah (lulus SMP atau SMA). Rerata usia kehamilan pada subjek penelitian ini adalah 34,32 ± 1,86 minggu pada kelompok anemia dan 35,18±1,73 minggu pada kelompok non anemia.Rerata asupan protein pada kedua kelompok ibu masih berada di bawah AKG yaitu <77g/hari. Rerata asupan lemak pada kelompok anemia lebih tinggi daripada kelompok non anemia (p=0,04). Asupan Fe kedua kelompok sudah sesuai dengan AKG yaitu 40mg/hari (p=0,82). Asupan folat pada kelompok anemia lebih rendahdan kurang dari AKG dibandingkan kelompok non anemia (p=0,16).Asupan vitamin B12, hampir tidak ada perbedaan rerata antara dua kelompok dan sudah sesuai dengan AKG. Median asupan vitamin A pada kelompok non anemia lebih tinggi dari kelompok anemia (p=0,52). Rerata kadar retinol pada kelompok anemia adalah 1,40±0,50 dan pada kelompok non anemia adalah 1,45±0,44. (p=0,55).Tidak didapatkan hasil yang bermakna setelah dilakukan analisis multivariat sebagai kontrol perancu.

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ABSTRACT
The aim of the study was to determine the relationship between vitamin A and retinol levels with anemia status in two groups of three trimester pregnant women, namely the anemic and non anemic. This was a cross-sectional study conducted in ten sub-district Government Health Centre in East Jakarta and which part of a large research department of Nutrition Faculty of Medicine, University of Indonesia, entitled "The Role of Nutrition, Maternal Factors and Maternal Health Services with the Composition of the Microbiota in Third Trimester Maternal and Infant Birth Weight : The study cohort in Jakarta". Data was collected from April untill May 2015. A total of 113 third trimester pregnant women with gestational age above 32 weeks (35.0 ± 1.8) were participated in research after met the study criterions. They were divided into two groups based on the levels of hemoglobin which were anemic (Hb<11g /dL) and non anemic(Hb≥ 11g / dL), and continue with anthropometric examination, interview and Hb measurement. The data collected included demographic characteristics, anthropometry, food intake (macronutrients and micronutrients), hemoglobin, and serum retinol. The age range of the subjects in this study was 19-44 years old. Most subjects (59.6%) had secondary education (graduated from high school or high school). The mean gestational age of the subjects was 34.32 ± 1.86 weeks in anemic group and 35.18 ± 1.73 weeks in non anemic. Mean of protein intake in both groups are still under RDA which < 77g/day. The mean of fat intake in anemic group was higher than non-anemic group (p=0.04). Iron intake in both groups are in accordance with the RDA which 40mg/day (p=0.82). Folate intake was lower in anemia group than non-anemic group (p=0.16). There was no difference between vitamin B12 intake in both group andwere in accordance with RDA. The median of vitamin A intake in non-anemic group was higher than non-anemic group (p = 0.52). The mean retinol serum levels in anemic group was 1.40 ± 0.50 and non-anemic group was 1.45 ± 0.44. (P = 0.55). No significant results obtained from multivariate analysis in order to control the confounders., The aim of the study was to determine the relationship between vitamin A and retinol levels with anemia status in two groups of three trimester pregnant women, namely the anemic and non anemic. This was a cross-sectional study conducted in ten sub-district Government Health Centre in East Jakarta and which part of a large research department of Nutrition Faculty of Medicine, University of Indonesia, entitled "The Role of Nutrition, Maternal Factors and Maternal Health Services with the Composition of the Microbiota in Third Trimester Maternal and Infant Birth Weight : The study cohort in Jakarta". Data was collected from April untill May 2015. A total of 113 third trimester pregnant women with gestational age above 32 weeks (35.0 ± 1.8) were participated in research after met the study criterions. They were divided into two groups based on the levels of hemoglobin which were anemic (Hb<11g /dL) and non anemic(Hb≥ 11g / dL), and continue with anthropometric examination, interview and Hb measurement. The data collected included demographic characteristics, anthropometry, food intake (macronutrients and micronutrients), hemoglobin, and serum retinol. The age range of the subjects in this study was 19-44 years old. Most subjects (59.6%) had secondary education (graduated from high school or high school). The mean gestational age of the subjects was 34.32 ± 1.86 weeks in anemic group and 35.18 ± 1.73 weeks in non anemic. Mean of protein intake in both groups are still under RDA which < 77g/day. The mean of fat intake in anemic group was higher than non-anemic group (p=0.04). Iron intake in both groups are in accordance with the RDA which 40mg/day (p=0.82). Folate intake was lower in anemia group than non-anemic group (p=0.16). There was no difference between vitamin B12 intake in both group andwere in accordance with RDA. The median of vitamin A intake in non-anemic group was higher than non-anemic group (p = 0.52). The mean retinol serum levels in anemic group was 1.40 ± 0.50 and non-anemic group was 1.45 ± 0.44. (P = 0.55). No significant results obtained from multivariate analysis in order to control the confounders.]

Abstrak :
Latar Belakang : Korioamnionitis  telah dihubungkan dengan kejadian ketuban pecah dini preterm (PPROM),  persalinan preterm dan luaran kehamilan yang buruk salah satunya adalah kejadian sepsis neonatus awitan dini (SNAD). Infeksi ditengarai mempunyai peran penting terhadap kejadian korioamnionitis. Hingga saat ini pemeriksaan histopatologi merupakan standar baku emas untuk menegakkan diagnosis korioamnionitis. C-Reactive Protein (CRP), Neutrophil to Lymphocyte Ratio (NLR) dan Platelet to Lymphocyte Ratio (PLR) adalah marker inflamasi dari serum darah maternal, dan menggambarkan keadaan infeksi dan inflamasi. Tujuan penelitian ini adalah untuk mengetahui asosiasi antara kadar CRP, NLR dan PLR serum maternal serta kultur kuman membran amnion dengan kejadian korioamnionitis dan SNAD.Metode: Penelitian potong lintang terhadap 61 orang ibu dengan PPROM usia kehamilan £32 minggu. Kadar NLR dan PLR merupakan rasio neutrofil absolut dan platelet dengan limfosit absolut. Korioamnionitis ditegakkan dengan pemeriksaan histopatologi korioamnion. Dan jenis kuman diketahui dari kultur membran amnion. Hasil: Kejadian korioamnionitis pada pasien PPROM adalah 27,8%. Pada sampel dengan korioamnionitis Median NLR 8,59 (4,20–22,67) ; p = 0,03 , sedangkan PLR dan CRP berturut-turut adalah 166,10 (84,89–396,27) dan 5,80 (0,03–88);  p>0,05. Terdapat 25% sampel dengan korioamnionitis yang luarannya menderita SNAD. Kadar NLR, PLR dan CRP sampel dengan luaran SNAD berturut-turut adalah 7,13(3,03–16,15); 154,30(45,2-444,08); dan 12,40 (2,4 –67,53), semuanya mempunyai nilai p>0,05. Jenis bakteri yang terbanyak berasal dari ordo Enterobacteriales (68%) dan E. Coli (23,4%) merupakan spesies terbanyak. Namun tidak terdapat asosiasi antara jenis bakteri dengan kejadian korioamnionitis dan SNAD (p<0,05) Kesimpulan: Terdapat asosiasi NLR dengan kejadian Korioamnionitis. Namun tidak terdapat marker inflamasi maternal yang berasosiasi dengan kejadian SNAD. Pada penelitian ini tidak terdapat hubungan antara jenis bakteri dengan kejadian korioamnionitis maupun SNAD. ......Background: Chorioamnionitis has been associated with the incidence of preterm premature rupture of membranes (PPROM), preterm labor and poor pregnancy outcomes, one of which is the incidence of early onset neonatal sepsis (EONS). Infection is suspected to have an important role in the occurrence of chorioamnionitis. Until now, histopathological examination is the gold standard for diagnosing chorioamnionitis. C-Reactive Protein (CRP), Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) are inflammatory markers from maternal serum, and can describe the state of infection and inflammation. The purpose of this study was to determine the association between levels of CRP, NLR and PLR in maternal serum and amniotic membrane culture with the incidence of chorioamnionitis and EONS. Methods: A cross-sectional study of 61 mothers with PPROM at ≤32 weeks' gestation. NLR and PLR levels are the ratio of absolute neutrophils and platelets to absolute lymphocytes. Chorioamnionitis is confirmed by histopathological examination of the chorioamnion. And the type of germ is known from amniotic membrane culture. Results:The incidence of chorioamnionitis in PPROM patients was 27.8%. In samples with chorioamnionitis Median NLR 8.59 (4.20–22.67) ; p = 0.03 , while the PLR​​and CRP were 166.10 (84.89–396.27) and 5.80 (0.03–88) respectively; p>0.05. There are 25% of samples with chorioamnionitis whose outcome with EONS. The NLR, PLR and CRP levels of the samples with EONS were 7.13(3.03–16.15); 154.30(45.2-444.08); and 12.40 (2.4 –67.53), all of which have a value of p>0.05. The most types of bacteria come from the order Enterobacteriales (68%) and E. Coli (23.4%) are the most species. However, there was no association between the type of bacteria and the incidence of chorioamnionitis and SNAD (p<0.05). Conclusion: There is an association of NLR with chorioamnionitis. However, there were no maternal inflammatory markers associated with EONS. In this study, there was no relationship between the type of bacteria and the incidence of chorioamnionitis or EONS.