Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Increment of placental Caspase 3 expression in preeclampsia and its effect on birth weight and blood pressure
Get PDFObjective: To determine the placental apoptosis process in preeclampsia.
Methods: This study was an observational analytical study using
cross sectional design. This study was performed at Dr. Hasan
Sadikin Hospital, during April to June 2008. Immunohistochemical
analysis was used to examine the placental expression of kaspase 3.
Results: Placental expression kaspase 3 was significantly higher
in preeclampsia group (21,9%) than in the normal pregnancies (0)
with p=0,006. There was significantly correlation between placental
kaspase 3 with birth weight in preeclampsia on the otherhand, there
was no significant difference of placental expression kaspase 3 with
birth weight in normal pregnancies. There was no significant difference
of placental expression kaspase 3 with mother’s blood pressure
in the two group.
Conclusion: there is a significant increase of placental expression
of kaspase 3 in preeclampsias.
[Indones J Obstet Gynecol 2010; 34-1:3-6]
Keywords: caspase 3, preeclampsia, apoptosis
Review of Preterm Labour Cases at Dr. Cipto Mangunkusumo Hospital January – December 2009
Get PDFObjective: To describe and to evaluate preterm labour cases and management at obstetric emergency room of Dr. Cipto Mangunkusumo Hospital (RSCM) from January until December 2009.
Method: This is a cross-sectional study with 202 secondary data samples from stratified random sampling performed to all preterm labour cases at obstetric emergency room of RSCM from January until December 2009. The data were processed for frequencies and
bivariate analysis, and then further analyzed with multivariate analysis.
Result: Most of the patient’s age were between 17 to 35 years old (82.7%). Most of them belonged to preterm group or gestational age between 32 weeks to less than 37 weeks (69.8%). Fifty three percent of the preterm labour was caused by premature rupture of the membrane. About 47% of the babies had perinatal morbidity and the most morbidity cases was respiratory distress with septic condition (47.7%). Perinatal mortality only happened to 5.9% babies. From bivariate analysis, low socioeconomic level (p = 0.032), gestational age (extreme preterm p = 0.000, very preterm p = 0.000),
APGAR Score minute 1 < 7 (p = 0.000), APGAR Score minute 5 < 7 (p = 0.000) and preterm baby status (Small for Gestational Age p = 0.048) were the variable which influenced the perinatal morbidity in our hospital. Perinatal mortality was influenced by low socioeconomic level (p = 0.048), gestational age (extreme preterm p = 0.000,
very preterm p = 0.063), APGAR Score minute 1 < 7 (p = 0.000), APGAR Score minute 5 < 7 (p = 0.000) and also morbidity of the preterm baby (p = 0.000). In this study, we found there was significant relation between cases of membrane rupture and perinatal sepsis (p = 0.000; RR 5.98; 95% CI 2.72 - 13.39) but there was no significant
relation between cases with or without membrane rupture
compared to active or expectant management to the perinatal morbidity and mortality. From multivariate analysis, APGAR score minute 5 < 7 had the greatest influence to the perinatal morbidity and preterm baby morbidity had the greatest influence to perinatal mortality.
Conclusion: Perinatal morbidity and mortality caused by preterm labour in Dr. Cipto Mangunkusumo Hospital were influenced by several factors which are socioeconomic status, APGAR score, preterm baby status and also morbidity of the baby. Therefore we need to do comprehensive prevention in biologic and socioeconomic
condition of the patients. Expectant management in preterm labour cases should be made on many consideration since expectant management was proven had no correlation with good perinatal morbidity and mortality outcome.
[Indones J Obstet Gynecol 2011; 35-2: 61-6]
Keywords: preterm labour, risk factor, perinatal morbidity, perinatal mortalit
Measurement of Glucose/Insulin Fasting Ratio (G:I Ratio) for Insulin Resistance Identification on Polycystic Ovary Syndrome Patients
Get PDFObjective: To identify insulin resistance on PCOs patients and to know characteristics and clinical differences between PCOs patients with and without insulin resistance in Gynecologic Outpatient Clinic of H. Adam Malik Hospital, Clinic of Prof. Delfi Lutan, Clinic of Prof. Thamrin Tanjung and Clinic of Halim Fertility Center in Medan.
Method: This descriptive cross sectional study conducted from July 2008 - June 2009, diagnosis of PCOs based on Rotterdam’s criteria was drawn for 5 ml blood samples, from mediana cubiti vein, after 10 - 12 hours fasting for determination of fasting glucose, fasting insulin, LH, FSH, prolactin and testosterone. Insulin resistance was determined by glucose/insulin fasting ratio < 4.5.
Result: From sixty one patients were divided into PCOs without insulin resistance (50 patients; 82%) and PCOs with insulin resistance (11 patients; 18%) group. No significant differences in clinico-biochemical characteristics, fasting glucose mean level, menstrual pattern, ovary volume, follicle number and reproductive hormone profile of two groups, except in BMI value, fasting insulin level and G:I ratio (p < 0.05).
Conclusion: There was significant correlation between fasting insulin level and insulin resistance with mean of fasting insulin level of 24.882 μU/ml. Insulin resistance was frequent on overweight group study according to WHO criteria (BMI 25 - 29.9 kg/m2).
[Indones J Obstet Gynecol 2011; 35-2: 74-8]
Keywords: insulin resistance, polycystic ovary syndrome, G:I rati
Distribution of Regulatory T-Cell (Cd4+, Cd25+) in the Peritoneal Fluid of Endometriosis Patients
Get PDFObjectives: To observe the distribution of Regulatory T-cell
(CD4+, CD25+) in the peritoneal fluid of endometriosis patients, as
related to the local immune system of the peritoneum.
Method: A cross-sectional descriptive research Perioneal fluid
was taken from endometriosis patients and non-endometriosis patients
who underwent laparoscopic or laparotomy surgery at Raden
Saleh Reproductive Health Clinic and Central Operating Theatre between
June 2008 to March 2009. Total leukocyte and its differential
count was counted manually. Regulatory T-cell was labelled with
monoclonal antibodies for CD45 (PerCP-347464), CD4 (SIPC-
340133) dan CD25 (PE-341009) and counted by Flowcytometry
(Facscalibur) using cellquest pro software. Data were collected and
analyzed with SPSS ver 11 software.
Result: Thirty-three patients were participated in this study, 12
non-endometriosis and 21 endometriosis patients were analyzed. 10
endometriosis patients were classified as minimal-mild, while 11
others were in moderate-severe stage. Higher median level of Regulatory
T-cells were found in endometriosis patients (0.52%) compared
to non-endometriosis cases (0.12%), even it was not significantly
different (p 0.403). The median level of Regulatory T-cell in
minimal-mild endometriosis (0.46%) was not significantly different
with moderate severe endometriosis (0.52%) (p 0.981).
Conclusion: The percentage and total number of Regulatory Tcell
in the peritoneal fluid did not show significant difference between
endometriosis and non-endometriosis patients. Endometriosis
patients shows tendency of higher percentage and total number of
Regulatory T-cell than non-endometriosis group. The stage of endometriosis
apparently does not show any significant difference in
terms of Regulatory T-cell in peritoneal fluid.
[Indones J Obstet Gynecol 2010; 34-1:19-23]
Keywords: Regulatory T-cells, CD4 CD 25, peritoneal fluid, endometriosi
Not only embryo quality but also Endometrial Thickness Contributes to IVF outcome: a retrospective study of all IVF cycles in Yasmin Clinic, Jakarta, Indonesia
Get PDFObjective: To study the endometrial thickness and embryo quality
during In Vitro Fertilization (IVF) cycles in predicting IVF outcome.
Methods: This retrospective study involved 206 infertile patients
undergoing 218 IVF cycles in Yasmin Clinic, Dr. Cipto Mangunkusumo
National Referral Hospital, Jakarta, Indonesia. All IVF
cycles were performed from January 2005 until May 2009. The outcome of this study is the clinical pregnancy following IVF cycles.
The endometrial thickness was measured on the day of human
chorionic gonadotrophin (hCG) administration. The number of embryos that developed ≥ 8 cells on cleavage II represented as the embryo quality.
Results: There were 51 among 218 cycles (23.4%) resulted in
pregnancy. The endometrial thickness on day of hCG administration
was significantly higher in pregnant group compared to non-pregnant
group (11.49±1.97 mm versus 10.13±1.93mm;
Efficacy of 600 μg Misoprostol compare to 400 μg Misoprostol orally for expulsion of conception mass on pregnancy failure under twenty two weeks of gestational age
Get PDFObjective: To evaluate the efficacy and adverse effect of misoprostol
in pregnancy termination under 22 weeks of gestation with
dosage 400 μg, in comparison to 600 μg.
Method: The research was performed in Obstetric and Gynecology
Division in Dr. Cipto Mangunkusumo General Hospital to 70
subjects which were chosen with consecutive sampling, divided into
two groups with block randomization and double blind. Group A received
400 μg of misoprostol every 6 hours while group B received
600 μg of misoprostol every 6 hours for a maximum of 2 days. Each
group was evaluated for the time it took to reach complete abortion
and for the adverse effects, consisting of abdominal cramping,
bleeding, vomiting, and diarrhea.
Result: Success rate for termination with misoprostol 400 μg
and 600 μg were 88.5% and 91.4%, with no statistical difference
found (p=1.000). There was no difference in the time for reaching
complete abortion between two dosages (p=0.701) with a mean of
22 ± 8 hours. Adverse effects were found more frequent and more
severe in the group consuming 600 μg of misoprostol compared to
the group receiving 400 μg of misoprostol.
Conclusion: Four hundred micrograms of misoprostol every six
hour is recommended for termination of pregnancy under 22 weeks
of gestational age, without statistical difference in efficacy, but with
lower adverse effects.
[Indones J Obstet Gynecol 2010; 34-2: 59-63]
Keywords: misoprostol, pregnancy failure, dosage, efficacy, adverse
effec
Characteristics of Patients with Hypertension in Pregnancy at Sanglah Hospital
Get PDFObjective: To report the profile of patients with Hypertension in Pregnancy (HIP) at Sanglah Hospital Denpasar from 2009 to 2010.
Method: A retrospective descriptive study from all HIP patients at Sanglah Hospital Denpasar, Bali during January 2009 to December 2010.
Result: The prevalence of HIP at Sanglah Hospital was 9.32%, which consisted of 1.82% gestational hypertension, 0.19% chronic hypertension, 1.36% mild preeclampsia, 4.70% severe preeclampsia, 0.43% superimposed preeclampsia, and 0.82% eclampsia. From
all of HIP cases, we found that the majority were nulliparous (47.23%), primipaternal (53.1%), and had hypertension at term (51.9%). Most of the cases were found at maternal age > 35 years (14.62%), followed by age < 20 years (13.47%). Most of them also had Ante Natal Care (ANC) frequency ≥ 4 times (69.09%), and had
their ANC done by a midwife (52.76%) and followed with an obstetrician (40.81%). The majority of the cases were referral cases (62.39%) mostly by midwives (22.45%). From all of the cases, we found that total preterm labor was 35.14%, perinatal mortality was 9.32% and maternal mortality was 1.16%.
Conclusion: The prevalence of HIP at Sanglah Hospital was
higher than previous years. Most of them had already had ANC done by health care providers, who were mostly midwives and obstetricians. Therefor, the quality of ANC seems to need an improvement by having an earlier referral system, so cases can be treated earlier.
[Indones J Obstet Gynecol 2011; 35-3: 97-9]
Keywords: hypertension in pregnancy, preeclampsia and
eclampsia, descriptiv
Anti Mullerian Hormone Serum Level Indicates Ovarian Response in Controlled Ovarian Hyperstimulation of IVF Cycles
Get PDFObjective: To evaluate the clinical value of Anti Mullerian Hormone
serum (AMH) level as one of ovarian response indicator in
controlled ovarian hyperstimulation in IVF cycles.
Method: This cohort-prospective study was conducted in Dr.
Cipto Mangunkusumo General Hospital. The subjects of this study
were infertile couples who underwent controlled ovarian hyperstimulation in IVF cycles. The measurement of FSH level, estradiol level, AMH level, and antral follicles count was done in the beginning of IVF cycles. The cycles were divided into two groups, good
responder group and poor responder group. Good responder group
had three or more mature oocytes, while the poor responder group
had two or less mature oocytes. Statistical analysis was done using
T-Test and Receiver Operator Characteristic area under curve
(ROCAUC) to measure the predictive value of AMH, FSH, estradiol,
age, and antral follicle count as ovarian response predictors.
Results and Discussion: From 92 IVF cycles, there were 15
poor responder cycles (16.3%) and 77 good responder cycles. AMH
serum level was 3.75 ± 2.77 μg/ml in good responder cycles and
1.04 ± 1.39 μg/ml in poor responder cycles (p < 0.0001). AMH serum
level was more superior than other ovarian response predictors
(AUC 0.846) with cut-off value of 1.40 μg/ml. AMH serum level ≥
1.40 μg/ml had good predictive value as ovarian reserve or ovarian
reserve parameter with 81% sensitivity and 87% specificity.
Conclusion: AMH serum level was more superior ovarian reserve
and ovarian response predictor compared to other parameters.
[Indones J Obstet Gynecol 2010; 34-3: 114-8]
Keywords: anti-Mullerian hormone, ovarian reserve, ovarian
respons
Relation between C-Reactive Protein Level and Intrauterine Infection in Pregnant Women with Premature Rupture of Membrane (PROM)
Get PDFObjective: To know the relationship between C-Reactive protein level in the blood of pregnant women with premature rupture of membrane (PROM) less than 12 hours and the incidence of intrauterine.
Method: This study was case series in 55 pregnant women with PROM less than 12 hours at Department of Obstetrics and Gynecology Medical Faculty, University of Sriwijaya Dr. Mohammad Hoesin Hospital, Palembang from July 1, 2009 until January 1, 2010. Data analysis was performed using Pearson Correlation test.
Result: The mean levels of C-reactive protein in pregnant women with PROM less than 12 hours was 27.12±15.58 mg/dl, in which 16.4% women had C-reactive protein level ≤ 10 mg/dl and 83.6% women had C-reactive protein level > 10 mg/dl. The mean rectal temperature of women was 37.41 ± 19°C, in which 85.5% women had rectal temperature < 38°C. The mean of leucocyte count in women was 10586 ± 2835/mm3, in which 69.1% women had leucocyte count < 15000/mm3. The correlation value between C-reactive protein level with rectal temperature was R=0.218 with p=0.110 and the correlation value between C-reactive protein level with leucocyte count was R=0.236 with p=0.082.
Conclusion: C-reactive protein can not be used as a single predictor of intrauterine infection.
[Indones J Obstet Gynecol 2011; 35-4:176-8]
Keywords: C-reactive protein, intrauterine infection, premature rupture of membrane (PROM
Ovarian Reserve Tests: The Use in Daily Clinical Practice
Get PDFObjective: To evaluate the significance of conducting ovarian reserve testing and decide when to order this testing in the clinical setting. And also to give individualized counseling to patients regarding the prognosis of infertility treatment based on their ovarian
reserve tests, such as: basal antral follicle count, basal ovarian volume, ovarian stromal blood flow, ovarian biopsy, basal serum Follicle Stimulating Hormone (FSH), basal serum estradiol, basal serum inhibin B, basal anti-Mullerian hormone serum. Clomphine Citrate
Challenge Test (CCCT), GnRH Agonist Stimulation Test (GA
ST), and Exogenous FSH Ovarian Reserve Test (EFORT).
Method: Literature study on published studies about the methods of ovarian reserve testing.
Conclusion: Ovarian reserve is an important key in initial assessment of the infertile patients and as a predictor of the success of infertility treatment. Currently, there is no single test which is highly reliable for assessing ovarian reserve. AMH serum may be a future hope and suggested as the best biomarker.
[Indones J Obstet Gynecol 2011; 35-4:235-40]
Keywords: ovarian reserve tes