Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Impact of Freeze-Dried Amnion Membrane and Human Amnion Stem Cell Seeding on TGF-B and Collagen Type III in Vesicovaginal Fistula
Full text linkObjective: to analize how freeze-dried amniotic membrane and human amniotic stem cell seeding affect TGF B and type III collagen expression in suturing a New Zealand rabbit vesicovaginal fistula model.
Metode: This experimental study employed New Zealand rabbits and a vesicovaginal fistula model with a post-test only control group design. The rabbits were divided into 3 groups: vesicovaginal fistula suturing alone, suturing with freeze-dried amniotic membrane, and suturing with freeze-dried amnion-seeded stem cells. After 7 days of treatment, specimens near the repaired vesicovaginal fistula were collected for immunohistochemical analysis of TGF B and collagen type III expression.
Result: TGF B expression was significantly higher in the freeze-dried amniotic membrane with stem cell seeding group (p=0.001) compared to the freeze-dried amniotic membrane without stem cell seeding group (p=0.017) and the suturing-only group (p=0.049). Additionally, type III collagen expression was significantly elevated in the freeze-dried amnion membrane and stem cell seeding group (p=0.001) compared to the freeze-dried amnion group without stem cell seeding (p=0.09) and the suturing-only group (p=0.026).
Conclusion: The expression of TGF B and type III collagen was higher in rabbits with vesicovaginal fistulas treated using freeze-dried amnion and amniotic stem cell seeding compared to those without amniotic stem cell seeding and vesicovaginal fistula suturing alone.
Keywords: Vesicovaginal Fistula, Freeze-dried Amnion, Stem cel
Anemia in Pregnancy and Its Maternal Perinatal Outcome
Full text linkObjective: To investigate the relationship between anemia in pregnancy and maternal perinatal outcomes.
Methods: This was a retrospective cohort study. This research was held at Prof. Dr. R. D. Kandou General Hospital Manado. Data was taken from January 2021 to December 2022.
Results: There were 1953 deliveries which 1304 subjects (66.7%) with anemia 649 subjects with anemia (33.3%), 489 subjects with mild anemia, and 160 subjects with moderate-severe anemia. The median maternal age was 28 years for mild anemia. The majority of mothers have a high school education. A total of 326 study subjects were multigravidas with mild anemia. The results of severe preeclampsia with mild anemia were 30 subjects. Prolonged labor tends to be higher in the mild anemia group. The highest distribution was observed in the mild anemia group, with 12 cases of maternal mortality, 88 cases of premature birth, 78 cases of low birth weight (LBW), 75 cases of disorders leading to decreased scores, and 24 cases of fetal mortality. In research subjects, IUGR tends to be more common in groups with moderate-severe anemia with 14 subjects (8.8%). Hemoglobin levels showed a median of 11.6 g/dL with a distribution midway between 10.5 and 12.6 g/dL. The mean MCV value is 76.1 fL (SD 8 fL). The mean MCH value was 24.8 + 3.6 pg. The MCHC value is 32.5%. Conclusions: There are no significant relation in pregnant women with anemia with preeclampsia, prolonged labor, maternal mortality rate and IUGR, but there are significant relation between anemia in pregnancy with increase rate of caesarean section, premature delivery, low birth weight, low APGAR score and fetal death.
Keywords: anemia in pregnancy, maternal outcome, neonatal outcom
Evaluation of Therapy in Preeclampsia Patients in Several Public and Private Hospitals
Full text linkObjective: To determine the rationality and effectiveness of therapy in preeclampsia patients at the Inpatient Installation of several public and private hospital in Banyumas area from January-December 2021.
Methods: This study is retrospective, employing purposive sampling for data collection. The data were extracted from the medical records of patients diagnosed with pre-eclampsia at the Inpatient Installation. The sample consisted of 212 patients with a confirmed diagnosis of pre-eclampsia.
Results: From this study, it was found that antihypertensive medications given were methyldopa (52.8%), nifedipine (45.2%), and amlodipine (2%). It was found that the results of the five appropriate analyses were the suitable indication, right patient, proper medication, right dose, and correct route (100%). The antihypertensive medications used were effective in reducing the blood pressure of preeclampsia patients (100%), with an average decrease in systolic pressure by 37 mmHg, an average decrease in diastolic pressure by 22 mmHg, and an average decrease in MAP by 28 mmHg.
Conclusion: Antihypertensives given to preeclampsia patients in several public and private hospitals in Banyumas were rational and effective in reducing the patient's blood pressure.
Keywords: antihypertensives, effectiveness, preeclampsia, rationality
Effectiveness of the Telemedicine Approach on Maternal Health Practices among Pregnant Women in Rural Areas
Full text linkObjectives: To systematically evaluate the current evidence on the effectiveness of the telemedicine approach on maternal practices in rural communities. The author hopes that this study offers a breakthrough to draw a solid conclusion regarding the feasibility of implementing telemedicine to improve maternal health in rural areas of Indonesia.Methods: A systematic literature search was performed using international databases, such as Cochrane, PubMed, EBSCOhost, Science Direct, Scopus, and Google Scholar, published from 2012 to August 31, 2022. Risk of bias assessment was conducted using the Cochrane Risk of Bias tools 2.0 for randomized controlled trials and converted to the AHRQ standards.Results: This study included five randomized controlled trials from different countries, namely India, Ethiopia, and Kenya. Telehealth interventions, delivered using mobile applications, phone calls, or short text messaging, improved the number of ANC visits, safe childbirth in hospitals or by skilled staff, exclusive breastfeeding, and immunization compliance, with a significant difference compared to the control group that received no intervention (p<0.05). Nevertheless, considering the already widely used mobile phone technologies in rural settings, it is now clear that the telehealth approach should be scaled up and implemented in clinical settings.Conclusion: Telehealth-based intervention is a promising approach to promote better maternal health practices among pregnant mothers in rural and low-resources settings. This approach has been proved to successfully made a significant difference in terms of antenatal care visits and safe childbirth practice.Keywords: Maternal health practices, pregnant women, rural areas, systematic review, telemedicine
Vitamin D Levels and Risk Factors in Early Onset Preeclampsia, Late Onset Preeclampsia and Normal Pregnancy
Full text linkAbstract
Objective: To determine the frequency distribution and the relation of risk factors to vitamin D levels in women with early onset (EOSPE), late-onset severe preeclampsia (LOSPE), and normal pregnancy.
Methods: This study was cross-sectional with pregnant women diagnosed with EOSPE LOSPE at RSUP DR M Djamil Padang and normal pregnancy at the Pengambiran Health Center. The serum samples of the research subjects were examined for blood levels of Vitamin D using the ELISA kit.
Results: Frequency distribution of risk factors for EOSPE respondents aged 20-35 years 50%, mothers not working 85%, single pregnancy 95%, normal blood sugar 80%, and an increase in the number of leukocytes 90%. Frequency distribution of LOSPE respondents, maternal age 20-35 years 60%, mothers not working 95%, single pregnancy 95%, normal blood sugar 65%, and increasing leukocytes 75%. Based on the data analysis test EOSPE respondents with risk factors for preeclampsia history and body mass index had a significant relation with vitamin D levels with P Value 0.00 (P < 0.05). LOSPE mothers with gravid risk factors, history of preeclampsia, history of hypertension, and history of Diabetes Mellitus had a significant relation with Vitamin D levels P Value 0.00 (P < 0.05).
Conclusion: The results of statistical tests for LOSPE mothers had a significant relation with Vitamin D levels compared to the risk factors for EOSPE mothers. The incidence of preeclampsia is influenced by complex etiopathogenesis, one of which is influenced by vitamin D levels.
Keywords: EOSPE, LOSPE, Elisa-kit, Vitamin D, Etiopathogenesi
Carbetosine, a Long-acting Oxytocin Agonist, as a Uterotonic in the Prevention of the Occurrence of Postpartum Bleeding
Full text linkObjective: To evaluate the comparative effect of carbetocin vs. other uterotonic agents in the prevention of the occurrence of postpartum bleeding.
Methods: Medical search engines like Pubmed, Google Scholar, and Cochrane are used for literature searches. The year period covered by the literature is 2013–2023. “Carbetocin” or “long-acting oxytocin” and “uterotonic” are the essential words, together with “post-partum hemorrhage” or “post-partum bleeding.” Data analysis was performed using the RevMan 5.4 application.
Results: This study involved 12 clinical trials with a total sample of 32,312 people. Based on forest plot analysis, it was found that patients receiving carbetocin therapy had a risk of developing postpartum bleeding of 0.42 times compared to those receiving other uterotonic agents (misoprostol and oxytocin) (OR: 0.42; 95% CI: 0.26-0.68; p<0.0004; with heterogeneity p<0.00001, I2 85%)
Conclusion: With its effectiveness and efficacy, carbetocin can be considered one modality that can prevent postpartum hemorrhage. In addition, it can benefit women at risk of having a major obstetric hemorrhage.
Keywords: carbetocin, uterotonic, meta-analysis, clinical tria
Multidisciplinary Approach of Placenta Accreta Spectrum Management to Reduce Blood Loss and Prevent Organ Injury in Referral Center
Full text linkObjective: To investigate the differences in blood loss and organ injury at our PAS referral center over the past six years.Methods: This retrospective analytical study included 150 subjects diagnosed with PAS based on histopathological findings from 2018 to 2023 at the PAS Center of Dr. Moewardi Regional Hospital, Surakarta, Indonesia. Subjects were divided into two groups: before 2020 and after 2021, based on multidisciplinary team appointments.Results: The highest number of Placenta Accreta Spectrum (PAS) cases occurred in 2020, with 36 patients. Hysterectomy was the most frequently performed procedure for managing PAS in all groups. However, differences in blood loss, organ injury, and length of hospital stay between the periods from 2018 to 2020 and 2021 to 2023 were statistically significant (p < 0.05).Conclusion: Multidisciplinary approaches involving various medical specialties and teams are essential to ensure maternal safety and effectively manage massive blood loss and organ damage during PAS surgery procedures.Keywords: Placenta accreta spectrum, Blood loss reduction, Organ injury prevention
Peripheral Serum AMH Level Reflects the Size of the Follicle Pool in a Mouse Model Study
No full textObjective: This is to compare peripheral and central serum levels of Anti-Mullerian hormone (AMH) in experimental animals for predicting ovarian reserve.
Methods: This is an experimental study involving 20 female Sprague-Dawley rats aged 8–10 weeks with normal estrus cycles as the young control group and 5 female rats aged 28–30 weeks as the old control group (n = 5/group): the young control group, the old control group, the 1x cisplatin group, the 2x cisplatin group, and the 3x cisplatin group. After treatment, tissue collection, histological staining, and blood collection through the retro-orbital bleeding (ROB) and heart were performed. Subsequently, measurements of ovarian weight, follicle counting, and levels of AMH and Follicle-stimulating hormone (FSH) were conducted.Results: The serum AMH levels from ROB in the young control, 1x cisplatin, 2x cisplatin, 3x cisplatin, and the old control groups were 1151, 1818, 2782.96, 1381.352, and 1544 ng/mL, respectively. Cisplatin 2x group was significantly (p<0.005) higher compared to the young control. The average concentrations of serum AMH in the ROB and heart were higher in the 2x cisplatin group compared to the other groups. Meanwhile, cisplatin 3x group decreased in level due to the burn out phenomenon.
Conclusion: AMH is a preferred marker compared to FSH. Blood collection through the ROB is considered a less invasive alternative technique in the treatment group, requiring serial observation.
Keywords: AMH, follicle pool, ovarian aging, RO