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"ABSTRAK Latar BelakangPerdarahan pascasalin adalah penyebab 25% kematian ibu diseluruh dunia,bahkan mencapai 60% pada beberapa negara. Sekitar 60-90% disebabkan olehatonia uteri. Berbagai alat ditemukan dan digunakan seperti tamponade balonuterus, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloon dan TheGlenveigh Medical Complete Tamponade System namun memiliki efektifitassekitar 65-87,5% dan potensi komplikasi. Oleh sebab itu diperkenalkanlah suatumetode baru untuk mengontrol perdarahan pascasalin. MetodeTujuan dari penelitian ini adalah untuk melihat keamanan, kemudahan danefektifitas alat InPress mengatasi perdarahan pascasalin karena atonia uteri. AlatInPress menggunakan mesin vakum bertekanan rendah untuk menurunkantekanan atmosfer dalam kavum uteri sehingga uterus menjadi kolaps danmembuat tamponade sehingga perdarahan berhenti. Selain itu secara fisiologis,dapat merangsang kontraksi uterus pascasalin yang normal dan retraksi uterus kebentuk dan ukuran semula. HasilDari sepuluh subyek penelitian menunjukkan bahwa mesin vakum dengan cepatmenciptakan tamponade yang efektif melalui balon pengunci yang berada diostium uteri eksterna. Jumlah perdarahan yang dievakuasi dari kavum uteri sekitar100-250 cc, tertampung dalam kanister. Uterus kolaps dan terjadi tamponadedalam waktu 1-2 menit sehingga perdarahan berhenti. Alat InPress dipasangselama minimal 1 jam dan maksimal 6,5 jam. Repair luka robekan perineum danvagina dapat dilakukan dengan mudah saat alat InPress terpasang di dalam uterus.Pada sepuluh subyek tidak ada tindakan lanjutan untuk mengatasi perdarahansetelah alat InPress dipasang. Tidak ditemukan adanya kelainan pada uterus,serviks dan vagina pada saat dan sesudah pemasangan alat InPress. KesimpulanTamponade uterus yang berasal dari tekanan negatif mesin vakum terbukti aman dan efektif untuk mengatasi perdarahan pascasalin karena atonia uteri.ABSTRACT Background the Treatment of Postpartum Hemorrhage Due To UterineAtonia Postpartum Hemorrhage (PPH) is responsible for +/- 25% of maternal mortalityworldwide, reaching as high as 60% in some countries. Approximately 60-90%caused by uterine atonia. Many devices were invented and applied such as uterineballoon tamponade, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloondan The Glenveigh Medical Complete Tamponade System but the effectivenessonly about 65-87,5% control hemorrhage and have potential complications.Therefor a new method to control PPH has been introduced. MethodThe purpose of this study was to demonstrate patient safety, device efficiency, andease of use, as an overall Proof of Concept with a new device, the InPress Device,for the treatment of primary postpartum hemorrhage (PPH) due to atony.The InPress device uses gentle vacuum force to lower the atmospheric pressurewithin the uterine cavity to collapse the uterus into and onto itself to stophemorrhage through tamponade. It also stimulates normal postpartum uterinecontractions, to effect hemostasis. In this hemostatic state the atonic uterusrecovers, physiologically, and retracts down to its? normal hemostatic postpartumsize. Results Results from our ten trial patients showed that: the vacuum created an immediateeffective tamponade confined to the uterus by our seal situated at the externalcervical ostium, 100-250 milliliters of residual blood were evacuated from theuterine cavity into the vacuum canister. The uterus collapsed and regained tonewithin 1-2 minutes, and hemorrhaging stopped, in all cases. The device stayed inplace while vaginal and perineal lacerations, which occurred during delivery, wereeasily repaired. The device was left in for one-hour minimum up to 6,5 hours. There were no further operative procedures required to stop hemorrhaging in anyof these cases. There was no abnormality of uterus, cervix and vagina while andafter InPress procedur performed. Conclusion Vacuum induced uterine tamponade using physiologic force, is a safe andeffective way to achieve rapid control of PPH due to atony.;Background the Treatment of Postpartum Hemorrhage Due To UterineAtonia Postpartum Hemorrhage (PPH) is responsible for +/- 25% of maternal mortalityworldwide, reaching as high as 60% in some countries. Approximately 60-90%caused by uterine atonia. Many devices were invented and applied such as uterineballoon tamponade, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloondan The Glenveigh Medical Complete Tamponade System but the effectivenessonly about 65-87,5% control hemorrhage and have potential complications.Therefor a new method to control PPH has been introduced. MethodThe purpose of this study was to demonstrate patient safety, device efficiency, andease of use, as an overall Proof of Concept with a new device, the InPress Device,for the treatment of primary postpartum hemorrhage (PPH) due to atony.The InPress device uses gentle vacuum force to lower the atmospheric pressurewithin the uterine cavity to collapse the uterus into and onto itself to stophemorrhage through tamponade. It also stimulates normal postpartum uterinecontractions, to effect hemostasis. In this hemostatic state the atonic uterusrecovers, physiologically, and retracts down to its? normal hemostatic postpartumsize. Results Results from our ten trial patients showed that: the vacuum created an immediateeffective tamponade confined to the uterus by our seal situated at the externalcervical ostium, 100-250 milliliters of residual blood were evacuated from theuterine cavity into the vacuum canister. The uterus collapsed and regained tonewithin 1-2 minutes, and hemorrhaging stopped, in all cases. The device stayed inplace while vaginal and perineal lacerations, which occurred during delivery, wereeasily repaired. The device was left in for one-hour minimum up to 6,5 hours. There were no further operative procedures required to stop hemorrhaging in anyof these cases. There was no abnormality of uterus, cervix and vagina while andafter InPress procedur performed. Conclusion Vacuum induced uterine tamponade using physiologic force, is a safe andeffective way to achieve rapid control of PPH due to atony.;Background the Treatment of Postpartum Hemorrhage Due To UterineAtonia Postpartum Hemorrhage (PPH) is responsible for +/- 25% of maternal mortalityworldwide, reaching as high as 60% in some countries. Approximately 60-90%caused by uterine atonia. Many devices were invented and applied such as uterineballoon tamponade, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloondan The Glenveigh Medical Complete Tamponade System but the effectivenessonly about 65-87,5% control hemorrhage and have potential complications.Therefor a new method to control PPH has been introduced. MethodThe purpose of this study was to demonstrate patient safety, device efficiency, andease of use, as an overall Proof of Concept with a new device, the InPress Device,for the treatment of primary postpartum hemorrhage (PPH) due to atony.The InPress device uses gentle vacuum force to lower the atmospheric pressurewithin the uterine cavity to collapse the uterus into and onto itself to stophemorrhage through tamponade. It also stimulates normal postpartum uterinecontractions, to effect hemostasis. In this hemostatic state the atonic uterusrecovers, physiologically, and retracts down to its? normal hemostatic postpartumsize. Results Results from our ten trial patients showed that: the vacuum created an immediateeffective tamponade confined to the uterus by our seal situated at the externalcervical ostium, 100-250 milliliters of residual blood were evacuated from theuterine cavity into the vacuum canister. The uterus collapsed and regained tonewithin 1-2 minutes, and hemorrhaging stopped, in all cases. The device stayed inplace while vaginal and perineal lacerations, which occurred during delivery, wereeasily repaired. The device was left in for one-hour minimum up to 6,5 hours. There were no further operative procedures required to stop hemorrhaging in anyof these cases. There was no abnormality of uterus, cervix and vagina while andafter InPress procedur performed. Conclusion Vacuum induced uterine tamponade using physiologic force, is a safe andeffective way to achieve rapid control of PPH due to atony."

"Latar Belakang: Preeklampsia - eklampsia merupakan penyebab utama morbiditas dan mortalitas ibu dan bayi di dunia khususnya negara-negara sedang berkembang dengan insidensidi Indonesia berkisar 8,6%. Pemberian aspirin diharap dapat menjadi solusi pencegahan preeklampsia bagi ibu hamil dengan risiko tinggi untuk menurunkan terjadi persalinan prematur, berat badan bayi yang rendah, serta turut meningkatkan angka mortalitas dan morbiditas perinatal. Tujuan: Mengetahui keluaran penggunaan aspirin dosis rendah pada ibu hamil dengan risiko tinggi preeklampsia. Metode: Studi ini merupakan kohort retrospektif. Melibatkan 695 subjek ibu hamil dengan risiko tinggi preeklampsia yang dibagi menjadi dua kelompok dengan terapi aspirin dosis rendah dan tanpa terapi. Hasil: Angka kejadian preeklampsia pada kelompok aspirin lebih rendah (8.9%) secara bermakna (odds ratio 0.37; 95% confidence interval, 0.26 hingga 0.54; P = <0.001) dibandingkan kelompok kontrol (14.8%). Pada kelompok aspirin penurunan angka kejadian preeklampsia lebih rendah secara bermakna pada pasien luaran kehamilan kurang dari 34 minggu dibanding luaran kehamilan > 34 minggu (odds ratio 0.117; 95% confidence interval, 0.048 hingga 0.282; P = <0.001). Kesimpulan: Pada studi ini, pemberian aspirin dosis rendah pada ibu dengan risiko tinggi preeklampsia terjadi penurunan insiden preeklampsia secara bermakna dan penurunan luaran kehamilan kurang dari 34 minggu

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Background: Preeclampsia - eclampsia is the main cause of maternal and infant morbidity and mortality in the world, especially developing countries such as Indonesia with incident about 8.6%. We hoped that aspirin can be a solution to prevent preeclampsia for pregnant women with a high risk of preeclampsia to reducing preterm labor, low birth weight, and also increasing perinatal mortality and morbidity. Objective: To determine the output of using low-dose aspirin in pregnant women with a high risk of preeclampsia. Method: This study was a retrospective cohort. Involves 695 pregnant women with a high risk of preeclampsia and divided into two groups with low-dose aspirin therapy and without therapy. Results: The incidence of preeclampsia in the aspirin group was significantly lower (8.9%) (odds ratio 0.37; 95% confidence interval, 0.26 to 0.54; P = <0.001) compared to the control group (14.8%). In the aspirin group the decrease in the incidence of preeclampsia was significantly lower in patients with pregnancy outcomes less than 34 weeks compared with pregnancy outcomes more than 34 weeks (odds ratio 0.117; 95% confidence interval, 0.048 to 0.282; P = <0.001). Conclusion: In this study, administration of low-dose aspirin to women with a high risk of preeclampsia resulted in a significant decrease in the incidence of preeclampsia and a reduction in pregnancy outcomes of less than 34 weeks."

"Latar Belakang : Preeklampsia masih menjadi penyebab utama morbiditas dan mortalitas pada ibu hamil. Hingga saat ini masih belum ada program penapisan untuk memprediksi preeklampsia di Indonesia. Pada tahun 2018 di Jakarta, dilakukan penelitianmengenai faktor-faktor risiko maternal dan profil biofisik yang dinilai dapat meningkatkan kejadian preeklampsia. Namun, hasil penelitian tersebut masih perlu dilakukan validasi eksternal untuk mengonfirmasi bahwa hasilnya valid dan bisa diaplikasikan pada situasi, waktu, tempat yang berbeda. Tujuan: Melakukan validasi eksternal hasilpenelitian terdahulu Metode: Desain kohort prospektif. Semua ibu hamil yang melakukan pemeriksaan kehamilan di RSCM, RSUK JoharBaru, dan RSUK Tebet dari April-November 2018 diikuti hingga bersalin/terjadi preeklampsia pada Januari 2019. Hasil: Total subjek 467 orang. Insidens preeklampsia dari ketiga rumah sakit adalah 18,2%. Hasil penelitian dianalisis secara bivariat dilanjutkan multivariat. Hasil penelitian yang secara statistik signifikan adalah hipertensi kronik, riwayat preeklampsia, tekanan arteri rerata≥ 95 mmHg, dan indeks pulsatilitas a.uterina tinggi. AUC-ROC (kemampuan diskriminasi untuk memprediksi preeklampsia) 85%. Sehingga merupakan instrumen yang baik untuk uji diagnostik. Hasil ROC dari penelitian sebelumnya menunjukkan hasil yang serupa. Cut off dari penelitian ini 0,91 (sensitivitas 79% dan spesifisitas 84%). Hasil uji validitas eksternal dari penelitian sebelumnya diterapkan pada penelitian ini dan menunjukkan hasil yang valid dan memiliki akurasi yang baik. Kesimpulan: Faktor-faktor yang meningkatkan risiko preeklampsia, yaitu hipertensi kronik, riwayat preeklampsia, tekanan arteri rerata ≥95 mmHg, dan indeks pulsatilitas a.uterina tinggi. Hasil perbandingan uji diagnostik dan uji validitas eksternalbaik.

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Background: preeclampsia is still leading causes of morbidity and mortality in pregnant women. Until today, there is still no screening program to predict preeclampsia in Indonesia. In Jakarta 2018, conducted research on maternal risk factors and biophysical profile to predict preeclampsia. However, the results still needs to be performed external validation to confirm that the results of the study are valid and can be applied on different situations, populations, and times. Objective: to perform external validation of the previous studyMethods: A prospective cohort design. Participants are all pregnant women who perform antenatal care in RSCM, RSUK JoharBaru, and RSUK Tebet from April-November 2018. They will be followed until January 2019. Results: Total participants 467 subject. Incidence of preeclampsia from 3 hospitals was 18,2%. The results had been analyzed bivariate continuing multivariate. The results of this study which statistically significant werechronic hypertension, history ofpreeclampsia, mean arterial pressure≥ 95 mmHg, and high pulsatility index of uterine artery. AUC-ROC (discrimination ability to predict preeclampsia) was 85%. Therefore, it is a good instrument fordiagnostic test. The ROC result of previous study seen shows the similar result.Cut off of this study was 0,91 (79% sensitivity and 84% specificity). The result of external validity test from previous study which applied to this study was valid and showed a good accuracy.Conclusion: Several factors increase the risk of preeclampsia, such as chronic hypertension,history of preeclampsia, mean arterial pressure≥ 95 mmHg, and high pulsatility index of uterine artery. The results of diagnostic test and external validation test are good."

"Latar Belakang : Indonesia merupakan salah satu negara di Asia dengan angka kematian ibu yang tinggi yaitu berkisar 126 per100,000 kelahiran hidup, dan 14% dari angka ini adalah karena hipertensi dan preeklampsia. Hal ini menjadi dasar perlunya upaya pencegahan preeklampsia yang dapat dilakukan melalui program skrining kehamilan berisiko tinggi yang efektif pada saat kunjungan antenatal, antara lain dengan penilaian karakteristik ibu dan faktor biofisik.Tujuan : Memperoleh kalkulasi faktor risiko dari karakteristik dan biofisik ibu hamil sebagai prediktor preeklampsia dan aplikasi penggunaannya dalam suatu program berbasis android yang dapat digunakan oleh tenaga medis.Metode : Studi ini kohort prospektif, dengan consecutive sampling mengumpulkan 1150 subyek terdiri dari ibu hamil dengan janin tunggal hidup dan tak terdapat kelainan kongenital. Setiap faktor maternal dan biofisik akan dianalisis bivariat, kemudian hasil yang bermakna dilanjutkan dengan analisis multivariat. Variabel yang bermakna hingga analisis multivariat akan menghasilkan persamaan regresi logistik yang digunakan untuk menghitung a priori risk seorang perempuan mengalami preeklampsia.Hasil : Berdasarkan hasil analisis, faktor risiko yang bermakna untuk prediktor preeklampsia meliputi hipertensi kronis, nilai indeks massa tubuh lebih besar sama dengan 25 kg/m2, nilai tekanan arteri rerata lebih besar sama dengan 95 mmHg, dan indeks pulsatilitas arteri uterina tinggi. Model prediksi risiko preeklampsia yang didapatkan yaitu logit (preeklampsia=1) adalah -3,63 + 2,11 (hipertensi kronik) + 0,50 (IMT lebih besar sama dengan 25 kg/m2) + 1,61 (MAP lebih besar sama dengan 95 mmHg) + 1,74 (IP arteri uterina tinggi). Cut-off 0,08 dengan sensitivitas 81,06% dan spesifisitas 73,07%. Kemampuan diskriminasi memprediksi preeklampsia sebesar 84% (instrumen yang baik untuk skrining).Kesimpulan : Faktor maternal dan biofisik dapat digunakan untuk skrining preeklampsia. Akurasi skoring dan sensitivitas pada penelitian ini mempunyai nilai yang tinggi sehingga digunakan sebagai acuan pembuatan program aplikasi prediktor preeklampsia berbasis android sebagai alat skrining preeklampsia yang efektif.

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Background : Indonesia is one of the Asia countries with high maternal mortality rate range 126/100,000 live births, and 14% of them is due to preeclampsia. This is the reason for the need to perform preeclampsia prevention. An effective high-risk pregnancy screening during antenatal visits, by assessing maternal characteristics and biophysical factors.

Aim : To obtain risk calculations from maternal and biophysical characteristics as preeclampsia predictors and their use in an android-based program for medical daily practice.

Methods : This is a prospective cohort design studies. Around 1150 subjects was collected by consecutive sampling for every pregnant woman with a single live fetus with out any congenital anomalies. Each maternal and biophysical factor will be analyzed bivariately, then significant results are followed by multivariate analysis. Variables that are significant until multivariate analysis will produce a logistic regression equation that can be used to calculate a priori risk of a woman experiencing preeclampsia.

Results : Based on the analysis, there are some risk factors that significant for predicting preeclampsia, included chronic hypertension, body mass index ​​the same as or more than 25kg/m2, mean arterial pressure ​​the same as or more than 95mmHg, and high uterine artery pulsatility index. The risk prediction model of preeclampsia obtained was logit (preeclampsia = 1) was -3.63 + 2.11 (chronic hypertension) + 0.50 (BMI the same as or more than 25 kg/m2) + 1.61 (MAP the same as or more than 95 mmHg) + 1 , 74 (high PI uterine artery). Cut-off was 0.08 with sensitivity of 81.06% and specificity of 73.07%. Discrimination ability to predict preeclampsia by 84% (a good instrument for screening).

Conclusion : A combination of maternal and biophysical factors can be used for preeclampsia screening. This study shows a high accuracy scoring and sensitivity that can be use as a reference for making an Android-based preeclampsia predictor application program as an effective preeclampsia screening tool."

"ABSTRAKLatar Belakang: Angka kematian ibu yang diakibatkan oleh kasus preeklampsia bervariasi antara 4-16 . Salah satu komplikasi yang diakibatkan oleh preeklampsia adalah Acute Kidney Injury AKI , berkaitan dengan peningkatan produksi thrombus yang berhubungan dengan peningkatan produksi D-dimer di urin. Pada studi 2013 menunjukkan bahwa D-dimer urin merupakan alat diagnostik yang baik untuk menilai adanya penumpukan fibrin pada endotel glomerulus pada pasien preklampsia dengan AKI.Tujuan: Penelitian ini bertujuan melihat perbandingan kadar D-dimer urin pada wanita hamil normotensif, preeklampsia berat disertai oligouria dan non oligouria sehingga dapat dijadikan pilihan pemeriksaan awal preventif lain terhadap komplikasi AKI. . Metode: Penelitian potong lintang dilakukan sejak September 2016 sampai Januari 2017 di Instalasi Gawat Darurat, Poliklinik, Instalasi Rawat Inap Departemen Obstetri dan Ginekologi, RSCM. Sebanyak 140 pasien hamil yang telah memenuhi syarat dan ditawarkan untuk ikut penelitian untuk diperiksa kadar D-dimer darah dan urinnya. Subyek penelitian diambil dengan metode consecutive sampling, kemudian dibagi menjadi 3 kelompok yaitu hamil dengan normotensi 45 subyek , pasien hamil dengan PEB tanpa oligouria 44 subyek , dan pasien hamil dengan oligouria 51 subjek . Kadar D-dimer diperiksa dengan menggunakan Abcam Human D-dimer ELISA. Penelitian ini telah disetuji oleh Komite Etik dan Penelitian di tahun 2016.Hasil: Terdapat perbedaan kadar D-dimer urin antara ketiga kelompok p 0,013 dan secara spesifik perbedaan terletak antara kelompok normotensi dibandingkan dengan PEB tanpa oligouria p 0,005 , tidak terdapat perbedaan bermakna antara PEB non oligouria dibandingkan PEB oligouria p 0,019 . Nilai diagnostik D-dimer urin dalam mendeteksi AKI pada PEB dengan sensitivitas 78 dan spesifisitas 55 memiliki nilai AU 0,407 40,7 dengan titik potong > 308,45 ng/dL. Hal ini menunjukkan bahwa meningkatnya kadar D-dimer urin tidak secara signifikan mendiagnosis AKI.Kesimpulan: Kadar D- dimer urin tidak berbeda bermakna pada kelompok pasien PEB dengan oligouria maupun tanpa oligouria.Kata Kunci: Preeklampsia Berat, Kadar D-dimer urin, Acute Kidney Injury.

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ABSTRACTIntroduction Maternal mortality rate MMR caused by preeclampsia was ranged between 4 and 16 . One of the complication of preeclampsia is acute kidney injury AKI which is related to increase of thrombus formation that correlates with the production of D dimer level in urine. This aim of study is to determine urine D dimer level in normotensive, severe preeclampsia with oliguria and non oliguric patients.Methods This was a cross sectional study from September 2016 to January 2017 to patients in Obstetric Emergency Unit, Policlinic, ward and ICU, Obstetrics and Gynecology Department Dr. Cipto Mangunkusumo Hospital. There were 140 subjects of pregnant women fulfilled the subject rsquo s criteria included in the study. They were divided into 3 groups including pregnant normotensive 45 subjects , severe features of preeclampsia with oliguria 44 subjects , and no oliguric 51 subjects . Research was approved by Ethics Committee for Health Researches in 2016.Results Urine D dimer levels were different between each group p 0.013 and specific difference were found between normotensive group and no oliguric severe preeclampsia p 0.005 . No difference were found between group of no oliguric and oliguric severe preeclampsia p 0.119 . Urine D dimer provided 78 of sensitivity and 55 of specificity to support the diagnosis of acute kidney injury in severe preeclampsia, with cut off level 308.45 ng dL however, AUC of urine D dimer was 0.407 40.7 . High level of urine D dimer could not specifically diagnose AKI.Conclusion Urine D dimer level cannot differ between severe features of preeclampsia patient with oliguria and no oliguria.Keywords Severe features preeclampsia, Urine D dimer, Acute Kidney Injury."

"Salah satu penyebab tingginya angka kematian ibu di Indonesia adalah adanya hipertensi pada kehamilan yang disebabkan oleh preeklampsia. Hingga saat ini, penyebab preeklampsia masih belum diketahui secara pasti, namun teori yang berkembang menyebutkan adanya iskemia plasenta. Iskemia plasenta disebabkan adanya kegagalan pada proses angiogenesis. Penelitian yang menggunakan desain potong lintang ini bertujuan untuk melihat perbedaan protein yang mempengaruhi proses angiogenesis pada plasenta normal dan preeklampsia serta melihat interaksinya. Sampel yang digunakan adalah 34 plasenta kehamilan normal dan 34 plasenta kehamilan preeklampsia. Kadar protein TGF- , TGF- Reseptor dan SMAD2 diperiksa menggunakan metode ELISA dan ekspresi relatif mRNA SMAD2 dan TSP-1 diperiksa menggunakan metode RT-qPCR.Kadar protein TGF- , TGF- Reseptor 1, TGF- Reseptor 2 dan protein SMAD2 meningkat pada preeklampsia p=0,0001, p=0,004, p=0,0001, p=0,0001 . Ekspresi mRNA SMAD2 dan TSP-1 pada preeklampsia juga mengalami peningkatan p=0,033, p=0,002 . Didapatkan korelasi positif kuat antara kadar protein TGF- Reseptor 1 dan TGF- Reseptor 2 pada plasenta normal p=0,0001 R=0,799 dan preeklampsia p=0,0001 R=0,783 . Korelasi positif sedang pada korelasi TGF- dan protein SMAD2 pada plasenta normal p=0,0001 R=0,672 dan korelasi positif ringan pada plasenta preeklampsia p=0,028 R=0,331 . Ada korelasi positif kuat antara TGF- Reseptor 1 dan protein SMAD2 0,0001 R=0,704 pada plasenta normal dan korelasi positif sedang pada plasenta preeklampsia p=0,0001 R=0,675 . Pada korelasi antara TGF- Reseptor 2 dengan protein SMAD2 plasenta normal diperoleh korelasi sedang p=0,0001 R=0,650 begitu juga pada plasenta preeklampsia 0,0001 R=0,675 . Kemudian pada uji korelasi antara protein TGF- dengan mRNA SMAD2 diperoleh korelasi positif ringan pada plasenta normal p=0,022 R=0,347 dan tidak ada korelasi pada plasenta preeklampsia. Pada uji korelasi antara protein TGF- Reseptor 1 dengan mRNA SMAD2 diperoleh korelasi positif ringan pada plasenta normal p=0,016 R=0,370 dan tidak ada korelasi pada plasenta preeklampsia. Tidak ditemukan korelasi antara TGF- Reseptor 2 dengan mRNA SMAD2 pada kedua kelompok. Kemudian tidak ditemukan korelasi protein SMAD2 dengan mRNA TSP-1 pada plasenta normal namun terdapat korelasi positif kuat pada plasenta preeklampsia p=0,0001 R=0,774 . Dari penelitian ini disimpulkan bahwa ada pengaruh peningkatan kadar TGF- , TGF- Reseptor, dan protein SMAD2 dengan ekspresi relatif TSP-1 pada proses angiogenesis.

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One of the causes of high maternal mortality in Indonesia is the presence of hypertension in pregnancy caused by preeclampsia. Until now, the cause of preeclampsia is still not known, but the theory suggests the presence of placental ischemia. Placental ischemia is caused by failure of angiogenesis. This cross sectional study aims to examine the differences in proteins that affect angiogenesis in normal placenta and preeclampsia and see their interactions. The sample used was 34 placentas of normal pregnancy and 34 placental preeclampsia pregnancy. TGF protein levels, TGF receptors and SMAD2 were examined using the ELISA method and the relative expression of SMAD2 and TSP 1 mRNA was examined using the RT qPCR method.Levels of TGF protein, TGF Receptor 1, TGF Receptor 2 and protein SMAD2 increased in preeclampsia p 0.0001, p 0.004, p 0.0001, p 0.0001 . SMAD2 and TSP 1 mRNA expression in preeclampsia also increased p 0.033, p 0.002 . There was a strong positive correlation between protein content of TGF receptor 1 and TGF receptor 2 in normal placenta p 0.0001 R 0,799 and preeclampsia p 0.0001 R 0,783 . Moderate positive correlations in TGF and SMAD2 protein correla tion on normal placenta p 0.0001 R 0.672 and mild positive correlation of placenta preeclampsia p 0.028 R 0.331 . There was a strong positive correlation between TGF receptor 1 and the SMAD2 protein 0.0001 R 0.704 in normal placenta and moderately positive correlation in the preeclampsia placenta p 0.0001 R 0.675 . In the correlation between TGF Receptor 2 with normal placental SMAD2 protein obtained moderate correlation p 0.0001 R 0.650 as well as on preeclampsia placenta 0.0001 R 0.675 . Then the correlation test between TGF protein and SMAD2 mRNA obtained a mild positive correlation on normal placenta p 0,022 R 0,347 and no correlation on placenta preeclampsia. In the correlation test between TGF protein Receptor 1 and SMAD2 mRNA obtained a mild positive correlation on normal placenta p 0.016 R 0.370 and no correlation in placenta preeclampsia. No correlation was found between TGF receptor 2 and SMAD2 mRNA in both groups. Then there was no correlation of SMAD2 protein with TSP 1 mRNA in normal placenta but there was a strong positive correlation in placenta preeclampsia p 0.0001 R 0.774 . From this study it was concluded that there was an effect of increased levels of TGF , TGF receptor, and SMAD2 protein with relative expression of TSP 1 in angiogenesis process."

"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. "

"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), danVFI 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 SPAKata Kunci. Plasenta akreta, 3D Power Doppler, indeks vaskular, indeks aliran, indeks aliran vaskular, perdarahan intraoperasi, histologi akreta

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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"

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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.

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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."

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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.

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 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.

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