HUBUNGAN INDEKS MASSA TUBUH DENGAN KEJADIAN PREEKLAMSIA PADA IBU HAMIL DI RSUD TRIKORA SALAKAN

ABSTRAKAngka Kematian Ibu (AKI) yang tinggi merupakan permasalahan Kesehatan di Indonesia yang belum terselesaikan sampai saat ini. Di RSUD Trikora Salakan pada tahun 2019 terdapat 4 kasus kematian ibu dimana penyebab utamanya adalah hipertensi dalam kehamilan. Salah satu faktor yang berkaitan erat dengan terjadinya preeklamsia adalah obesitas. Salah satu cara untuk mengidentifikasi status gizi ibu hamil adalah dengan menggunakan rumus Indeks Massa Tubuh (IMT). Tujuan penelitian ini adalah untuk mengetahui hubungan indeks massa tubuh dengan kejadian preeklamsia pada ibu hamil di RSUD Trikora Salakan. Jenis penelitian ini adalah penelitian deskriptif analitik dengan desain penelitian menggunakan desain retrospektif. Populasi dalam penelitian ini adalah semua ibu hamil dengan preeklamsia yang memeriksakan diri di RSUD Trikora Salakan sejak bulan Januari 2020 – September 2020 yang berjumlah 41 orang. Teknik pengambilan sampel Total sampling. Analisa data menggunakan uji Rank Spearman. Hasil Penelitian menunjukkan bahwa responden dengan IMT underweight tidak ada yang mengalami preeklamsia ringan dan berat, responden dengan IMT normal yang mengalami preeklamsia ringan sebanyak 1 orang (2,4%) dan tidak ada yang mengalami preeklamsia berat, responden dengan IMT overweight yang mengalami preeklamsia ringan sebanyak 21 orang (51,2%) dan yang mengalami preeklamsia berat sebanyak 9 orang (22%), responden dengan IMT obese tidak ada yang mengalami preeklamsia ringan dan yang mengalami preeklamsia berat sebanyak 10 orang (24,3%). Hasil perhitungan statistik menggunakan uji Rank spearman diperoleh hasil bahwa p value sebesar 0,000< 0,05. Kesimpulan : Ada hubungan yang signifikan antara indeks massa tubuh (IMT) dengan kejadian preeklamsia pada ibu hamil di RSUD Trikora Salakan.Kata Kunci : Umur, Paritas, Indeks Massa Tubuh, PreeklamsiaRELATIONSHIP OF BODY MASS INDEX WITH PREECLAMSIA EVENTS IN PREGNANT WOMEN IN RSUD TRIKORA SALAKANABSTRACTBackground : High Maternal Mortality Rate (MMR) is a health problem in Indonesia that has not been resolved to date. At the Trikora Salakan Regional Hospital in 2019 there were 4 cases of maternal death where the main cause was hypertension in pregnancy. One of the factors that is closely related to the occurrence of preeclampsia is obesity. One way to identify the nutritional status of pregnant women is to use the Body Mass Index (BMI) formula. Research purposes: To determine the relationship between body mass index and the incidence of preeclampsia in pregnant women at Trikora Salakan General Hospital. Research method: This type of research is descriptive analytical research with research design using retrospective design. The population in this study is all pregnant women with preeclampsia who checked themselves in Trikora Salakan Hospital since January 2020 – September 2020 which amounted to 41 people. Total sampling technique. Analyze the data using Spearman's Rank test. Results: The results showed that respondents with underweight BMI no one experienced mild and severe preeclampsia, respondents with normal BMI who experienced mild preeclampsia as much as 1 person (2.4%) and no one experienced severe preeclampsia, respondents with overweight BMI who experienced mild preeclampsia as many as 21 people (51.2%) and who experienced severe preeclampsia as many as 9 people (22%), respondents with imt obese no one experienced mild preeclampsia and who experienced severe preeclampsia as many as 10 people (24.3%). Statistical calculation results using spearman Rank test obtained the result that p value of 0.000< 0.05. Conclusion: There is a significant relationship between body mass index (BMI) and preeclampsia incidence in pregnant women in Trikora Salakan Hospital.Keywords : Age, Parity, Body Mass Index, Preeclampsia

Serum Expression of ESM-1, HMWA, and AGEs and Its Relationship with Disease Severity in Patients with Gestational Hypertension

Objective. The research is to investigate the expression and the relationship between serum endothelial cell-specific molecular molecule-1 (ESM-1), high molecular weight adiponectin (HMWA), and late glycosylation terminal product (AGEs) in patients with gestational hypertension. Methods. 75 patients with pregnant hypertension who were treated in our hospital from June 2019 to June 2020 were selected as the case group, and 70 healthy pregnant women with pregnancy examination at the same period in our hospital were selected as the control group to analyze the changes in serum ESM-1, HMWA, and AGEs levels and the correlation with the degree of illness and their predictive value. Results. Serum ESM-1 and AGEs were significantly higher in the case group than in the control group. Serum HMWA was significantly lower than that in the control group ( P < 0.05 ). The gestational hypertensive serum ESM-1 and AGEs was significantly lower than in patients with mild preeclampsia and severe preeclampsia. Serum HMWA was significantly higher than in patients with mild preeclampsia and severe preeclampsia. Serum ESM-1 and AGEs of mild preeclampsia were significantly lower than in patients with severe preeclampsia. Serum HMWA was significantly higher than in patients with severe preeclampsia ( P < 0.05 ). The result of correlation analysis shows a positive correlation between serum ESM-1 and AGEs ( P < 0.05 ). A negative correlation was observed between HMWA and the degree of illness ( P < 0.05 ). Conclusion. Serum ESM-1, HMWA, and AGEs are abnormally expressed in gestational hypertension, are closely related to the degree of condition, and have important clinical significance for condition control.

Patterns of Maternal Neutrophil Gene Expression at 30 Weeks of Gestation, but Not DNA Methylation, Distinguish Mild from Severe Preeclampsia

Neutrophils are activated and extensively infiltrate blood vessels in preeclamptic women. To identify genes that contribute to neutrophil activation and infiltration, we analyzed the transcriptomes of circulating neutrophils from normal pregnant and preeclamptic women. Neutrophils were collected at 30 weeks’ gestation and RNA and DNA were isolated for RNA sequencing and 5-hydroxy-methylcytosine (5-hmC) sequencing as an index of dynamic changes in neutrophil DNA methylation. Women with normal pregnancy who went on to develop mild preeclampsia at term had the most uniquely expressed genes (697) with 325 gene ontology pathways upregulated, many related to neutrophil activation and function. Women with severe preeclampsia who delivered prematurely had few pathways up- or downregulated. Cluster analysis revealed that gene expression in women with severe preeclampsia was an inverse mirror image of gene expression in normal pregnancy, while gene expression in women who developed mild preeclampsia was remarkably different from both. DNA methylation marks, key regulators of gene expression, are removed by the action of ten-eleven translocation (TET) enzymes, which oxidize 5-methylcytosines (5mCs), resulting in locus-specific reversal of DNA methylation. DNA sequencing for 5-hmC revealed no differences among the three groups. Genome-wide DNA methylation revealed extremely low levels in circulating neutrophils suggesting they are de-methylated. Collectively, these data demonstrate that neutrophil gene expression profiles can distinguish different preeclampsia phenotypes, and in the case of mild preeclampsia, alterations in gene expression occur well before clinical symptoms emerge. These findings serve as a foundation for further evaluation of neutrophil transcriptomes as biomarkers of preeclampsia phenotypes. Changes in DNA methylation in circulating neutrophils do not appear to mediate differential patterns of gene expression in either mild or severe preeclampsia.

Serum Calcium Levels in Preeclampsia

Objectives: To determine the serum calcium levels in mild and severe preeclampsia and compare it with normal pregnancy. Methods: It was a comparative cross sectional study. Thirty five normotensive pregnant women, n=30 women with mild preeclampsia and n=70 with severe preeclampsia were recruited at Liaquat University of Medical and Health Sciences, Hospital. The serum calcium was measured and levels were compared among three groups. The data was analysed on SPSS v. 20. Results: The gestational age was more in the normal pregnancy compared to mild and severe preeclampsia (38.7±2.1 vs 36.7±3.6 and 36.2±2.8, p-value=0.0002). The calcium concentration was less in the both groups of preeclampsia i.e., 8.41± 0.96 mg/dl in mild and 8.02± 0.77 mg/dl in severe preeclampsia vs 9.2± 0.32 mg/dl in normal pregnant women, (p-value <0.001). Conclusion: We found lower levels of serum calcium in preeclampsia, suggesting its possible role in pathogenesis. Further studies to investigate the potential role of dietary supplementation of micronutrients during pregnancy are recommended.

The association of antenatal D-dimer and fibrinogen with postpartum hemorrhage and intrauterine growth restriction in preeclampsia

Background D-dimer and fibrinogen were verified to be altered in preeclampsia. This study was to evaluate the associations of D-dimer and fibrinogen plasma levels with postpartum hemorrhage or intrauterine growth restriction in preeclamptic women. Methods This was a retrospective study that recruited 278 preeclamptic women with singleton pregnancy from January 2016 to December 2019. Patients were allocated into five groups: mild preeclampsia (mPE) (n=68), mild preeclampsia with postpartum hemorrhage (mPE+PPH) (n=13), severe preeclampsia (sPE) (n=112), severe preeclampsia with postpartum hemorrhage (sPE+PPH) (n=17) and severe preeclampsia with intrauterine growth restriction (sPE+IUGR) (n=68). The antenatal D-dimer and fibrinogen plasma levels were analyzed among the groups. Logistic regression was used to determine the correlation between serum indexes and PPH or IUGR in preeclampsia. Results The antenatal D-dimer plasma levels were significantly higher in the sPE+PPH group than that in the sPE group (2.02 μg/ml versus 1.37 μg/ml, P = 0.001), but there was no difference in fibrinogen. Elevated D-dimer was associated with PPH among severe preeclamptic women (adjusted odds ratio (aOR) [95% CI]: 3.093 [1.527-6.264], P = 0.002). No differences in D-dimer and fibrinogen were found between the mPE and mPE+PPH groups or between the sPE and sPE+IUGR groups. Conclusions Elevated antenatal plasma D-dimer level may be associated with postpartum hemorrhage in severe preeclampsia, but not with intrauterine growth restriction. Future prospective clinical trials are needed to investigate the predictive value of D-dimer in postpartum hemorrhage in severe preeclampsia.

Pregnancy outcome after double renal transplant in a secondary level hospital

A 28-year-old recent migrant with no pre-conception care booked at 18 weeks of pregnancy with history of double renal transplant on left side wherein the kidney being placed in left iliac fossa. She was on cyclosporine, azathioprine, methylprednisolone the later was tapered in the first 2 months of pregnancy and was started on low dose aspirin, she had uneventful antenatal period until after 36 weeks when she developed mild preeclampsia and rising creatinine, which was managed by reducing immunosuppressant’s dose and was restarted on prednisolone by discussion over telephone with nephrologist from neighbouring Regional Hospital. She had an elective LSCS at 38 weeks as requested and had a healthy male baby after steroid cover. Her intraoperative and postoperative period was uneventful as well.

Reduced angiovasculogenic and increased inflammatory profiles of cord blood cells in severe but not mild preeclampsia

Preeclampsia (PE) is a prevalent pregnancy disorder that leads to high maternal and fetal morbidity and mortality. While defective vascular development and angiogenesis in placenta are known as crucial pathological findings, its pathophysiological mechanism remains elusive. To better understand the effects of PE on angio-vasculogenesis and inflammatory networks in the fetus and to identify their biological signatures, we investigated the quantitative and functional characteristics of cord blood-derived mononuclear cells (CB-MNCs) and CD31-positive MNCs. Flow cytometry analysis demonstrated that the CB-MNCs from the severe PE group had significantly decreased number of cells expressing CD3, CD11b, CD14, CD19, KDR, and CD31 compared with the normal group. Quantitative real time PCR (qRT-PCR) shows down-regulation of the major angiogenic factor VEGFA in MNCs and CD31+ MNCs in severe PE. The major inflammatory cytokines IL1 was highly upregulated in CD31+ CB-MNCs in the severe PE patients. Mild PE patients, however, did not display any significant difference in expression of all measured angiogenic genes and most inflammatory genes. These findings show distinct angiogenic and inflammatory signatures from severe PE, and they may play a significant role in the pathogenesis of vascular defects in placenta of severe PE.

A PROSPECTIVE STUDY OF MATERNALAND FETAL OUTCOME IN PREECLAMPSIAAND ECLAMPSIA

Introduction- Pre eclampsia and eclampsia is one of the leading cause of maternal and fetal morbidity and mortality. This study was undertaken to correlate coagulation prole in patients with pre-eclampsia and eclampsia with maternal and fetal outcome. Materials And Methods- A prospective study was conducted on 164 cases and 70 controls over a period of 2 years. The coagulation prole was carried out on the semiautomated TRINITY coagulometer. The haematological parameters were assessed on fully automated 3 part haematological analyser- TRIVITRON Model-CELLENIUM-19. The patients were classied into mild preeclamptic, severe preeclamptic and eclamptic based on the clinical and haematological parameters. Observations- The maternal and the foetal outcomes were studied and correlated with the coagulation prole. All the cases of mild preeclampsia had favourable maternal and fetal outcome. Out of total 102 cases of severe preeclampsia and eclampsia, 78 had normal coagulation prole and 24 had deranged prole. Thus out of 24 patients with deranged coagulation prole, 21 (87.5%) women had adverse maternal outcome and 24 (100%) had unfavourable fetal outcome. Conclusion- Deranged coagulation prole in preeclampsia and eclampsia is signicantly associated with adverse maternal and fetal outcome. Thus suspecting a deranged coagulation status early in the course of the disease will guide us in management before the patient goes into complications.