Urinary Nephrin and Podocalyxin Levels as Predictors of Pre-eclampsia in High-Risk Pregnant Women

Introduction: Pre-eclampsia (PE) is characterized by new-onset hypertension and proteinuria. Damage of podocyte cells has been reported in pre-eclamptic women, thus podocyte specific proteins such as nephrin and podocalyxin could be useful biomarkers in PE. Aim: To investigate the role of urinary nephrin (u-nephrin) and urinary podocalyxin (u-PDX) levels in predicting PE in women with a high-risk pregnancy. Materials and methods: We included 101 pregnant women in this study and allocated them into three groups: group 1 included pregnant women at high risk of developing PE (n=41), group 2 - pregnant women with PE (n=30), and group 3 was the controls including healthy pregnant women (n=30). The inclusion criteria for women with PE were de novo hypertension >140/90 mm Hg, proteinuria >300 mg/24 hours, and presence of edema after 20 weeks of gestation, while the exclusion criteria were a history of renal diseases and pregnant women younger than 18. Inclusion criteria for the group of women with a high-risk pregnancy was gestational week >15, a history of PE in a previous pregnancy, pre-existing diabetes type 1 or 2, pre-existing hypertension, multiple gestations, prior placental abruption, obesity women, nulliparity, maternal age >35 years, and a family history of PE. The study was conducted from March 2016 to May 2017 in the Medical Faculty at the Institute of Medical and Experimental Biochemistry in Skopje. Urine samples were used to measure the nephrin and podocalyxin levels using immunoenzyme assay, creatinine and microalbumin. Blood samples were collected for biochemical analyses. Results: U-nephrin levels were elevated in 96.7% of women with PE, and 73% of women with a high-risk pregnancy. U-PDX levels were elevated in 63% of the women with PE and 100% of the women with a high-risk pregnancy. U-nephrin and u-PDX levels were significantly increased in women with a high-risk pregnancy and women with PE compared with a control group (p<0.001). A significant difference was found between the subgroups of pregnant women classified according to gestational age in their u-nephrin and u-PDX levels. There was a significant positive correlation between the levels of both markers and glomerular filtration rate, and significant negative correlation between the levels of both markers and gestational age. ROC analysis revealed that the cut-off value of 304.6 ng/ml of u-nephrin had a sensitivity (Se) of 96.7%, specificity (Sp) of 96.7% (for both Se and Sp 95% confidence interval (CI) 82.8-99.9), while the cut-off value of 59.5 ng/ml of u-PDX had a sensitivity of 100% and Sp of 93.3% (Se - 95% CI 88.4-100, Sp - 95% CI 77.9-99.2), in distinguishing women with PE and healthy pregnancies. Both markers showed excellent clinical utility (CUI&ge;0.81), for u-nephrin (CUI+ and CUI&minus; is 0.934), for u-PDX (CUI+ is 0.938; CUI&minus; is 0.933). Conclusions: U-nephrin and U-PDX levels could be useful as predictors of PE in women with a high-risk pregnancy.

Diabetes Mellitus Gestacional com ênfase nas Gestantes de Alto Risco / Gestational Diabetes Mellitus with an emphasis on High-Risk Pregnant Women

Resumo: Considerando o Diabetes Mellitus um problema de saúde pública e sendo um dos principais fatores de morbimortalidade no Brasil, torna-se relevante destacar o aumento de casos ocorridos do DMG em gestantes de alto risco. Esta pesquisa teve por objetivo: investigar o perfil clínico do diabetes mellitus gestacional (DMG) e como o mesmo pode levar a uma gravidez de alto risco, sua associação aos fatores de riscos e suas principais complicações. Quanto à metodologia é exclusivamente de caráter bibliográfico. Foi feita uma pesquisa de revisão bibliográfica, a qual utilizou fontes de internet, onde foram aplicados critérios de inclusão e exclusão, chegando a um total de 12 artigos selecionados. A partir desses artigos, a pesquisa verificou que os fatores de riscos associados ao DMG e suas complicações, fazem correlação com a gravidez de alto risco. Assim, se faz necessário o rastreamento e monitoramento, a prevenção, o diagnóstico e tratamento do DMG tanto para a mãe quanto para o feto. Logo é fundamental a atuação do farmacêutico na equipe multidisciplinar, pois contribui desde a gestão, aquisição até a dispensação eficiente dos medicamentos auxiliando de forma a reduzir os riscos, promovendo atenção, cuidado e uma saúde de qualidade às gestantes. Palavras Chave: Diabetes Mellitus. Diabetes Mellitus Gestacional. Gravidez de Alto Risco. Abstract: Considering Diabetes Mellitus a public health problem and one of the main morbidity and mortality factors in Brazil, it is relevant to highlight the increase in cases of GDM in high-risk pregnant women. This research aimed to: investigate the clinical profile of gestacional diabetes mellitus (GDM) and how it can lead to a high-risk pregnancy, its association with risk factors and its main complications. As for the methodology, it is exclusively bibliographic in nature. A bibliographic review research was carried out, using internet sources, where inclusion and exclusion criteria were applied, reaching a total of 12 selected articles. From these articles, the research found that the risk factors associated with GDM and its complications are correlated with high-risk pregnancy. Thus, it is necessary the tracking and monitoring, prevention, diagnosis and treatment of GDM for both mother and fetus. Therefore, the role of the pharmacist in the multidisciplinary team is essential, as he contributes from the management, acquisition to the efficient dispensing of medicines, helping to reduce risks, promoting attention, care and quality health for pregnant women. Keywords: Diabetes Mellitus. Gestational Diabetes Mellitus. High-risk Pregnancy.

HIGH RISK PREGNANCY DETECTION USING TELEHEALTH-BASED SCREENING

High-risk pregnancy is a pregnancy that is likely to cause harm or complications to the mother and fetus. Given the high rate of disease transmission, the use of telehealth technology can be an effective and efficient way to deal with the spread of the virus. Telehealth is one solution to overcome the problem of access to health, with telehealth it can perform screening to detect high-risk pregnancies early, so that pregnant women can get continuous monitoring. Telehealth can operate as a filter that is able to expand and facilitate access to services, especially in the examination and screening of risks in pregnancy and can apply high risk detection instruments in pregnancy in applications, so as to facilitate decision making. Telehealth can detect high-risk pregnancies early, so that pregnant women can get continuous monitoring. The purpose of this activity is to conduct and determine the effectiveness of telehealth-based high-risk detection in pregnant women. The method of activity is in the form of community service through webinars and screenings which are carried out within 6 months online. The result of the activity is an increase in the knowledge of webinar respondents with an average pre-test value of 120 and post-test 157 out of a total of 200. Based on the results of screening using the SIBIDAN application, from 25 pregnant women in trimesters 1,2, and 3 who became respondents, the results were 52%, low risk group, 32% high risk group, and 16% very high-risk group. Therefore, further assistance, monitoring, and referral are needed to minimize pregnancy complications.

HUBUNGAN TINGKAT PENGETAHUAN DENGAN PENERAPAN MODEL DETEKSI DINI KEHAMILAN RESIKO TINGGI OLEH KADER POSYANDU DI DESA JATEN, KARANGANYAR

ABSTRAKSasaran pembangunan kesehatan yang akan dicapai pada tahun 2025 adalah meningkatnya derajat kesehatan masyarakat yang salah satunya ditunjukkan oleh menurunnya Angka Kematian Ibu dengan mengenalkan resiko tinggi pada ibu hamil dilakukan dengan skrining/deteksi dini berbagai faktor resiko secara pro aktif terhadap semua ibu hamil. Kader kesehatan memiliki peran yang besar dalam hal deteksi dini risiko tinggi kehamilan dan persalinan yang memerlukan pengetahuan dan penerapan model deteksi. Tujuan penelitian ini adalah Untuk mengetahui Hubungan Tingkat Pengetahuan Dengan Penerapan Model Deteksi Dini Kehamilan Resiko Tinggi Oleh Kader Posyandu Di Desa Jaten, Karanganyar. Metode penelitian observasional analitik dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah 192 orang kader posyandu di desa Jaten, tehnik sampling yang digunakan adalah “Accidental Sampling” dimana yang mengisi kuesioner melalui goegle form sejumlah 54 orang. Hasil penelitian Tingkat Pengetahuan Responden Sebagian besar mempunyai Tingkat Pengetahuan Baik yaitu 42 responden (77,8%), penerapan model deteksi dini kehamilan resiko tinggi oleh kader posyandu sebagian besar responden mempunyai penerapan model deteksi dini yang baik yaitu 41 responden (75,8%), hasil analisis cros tabulasi dengan uji Fisher's Exact Test di dapatkan hasil nya nilai p = 0,001. Kesimpulan : ada hubungan antara tingkat pengetahuan dengan penerapan model deteksi dini kehamilan resiko tinggi oleh kader posyandu desa Jaten, Karanganyar. Kata Kunci : kader, model deteksi, kehamilan resiko tinggiTHE RELATIONSHIP OF KNOWLEDGE LEVEL WITH THE APPLICATION OF HIGH RISK PREGNANCY EARLY DETECTION MODELS BY POSYANDU CADRES IN JATEN VILLAGE, KARANGANYARABSTRACTThe health development target to be achieved in 2025 is to increase the degree of public health, one of which is indicated by a decrease in the Maternal Mortality Rate by introducing high risk to pregnant women through screening/early detection of various risk factors proactively for all pregnant women. Health cadres have a big role in terms of early detection of high risk pregnancy and childbirth which requires knowledge and application of detection models. The purpose of this study was to determine the relationship between the level of knowledge and the application of the early detection model of high risk pregnancy by Posyandu cadres in Jaten Village, Karanganyar. Analytical observational research method with a cross sectional approach. The population in this study were all posyandu cadres in the village of Jaten, the sampling technique used was "Accidental Sampling" as many as 54 people. The results of the study on the Knowledge Level of Respondents Most of the respondents had a good knowledge level, namely 42 respondents (77.8%), the application of the high risk pregnancy early detection model by posyandu cadres, most of the respondents had a good early detection model application, namely 41 respondents (75.8%) , the results of the cross tabulation analysis with the Fisher's Exact Test, the result is the p value = 0.000. Conclusion; there is a relationship between the level of knowledge and the application of the high-risk pregnancy early detection model by posyandu cadres in Jaten village, Karanganyar. Keywords: Cadre, Detection Model, High Risk Pregnant

An audit of MTP in women with high-risk pregnancy

Background: The women who have been pregnant more than four times are fewer than 18or over 35-years-old, or have at least one medical issue before or during pregnancy, the pregnancy is considered high-risk. Increased maternal and foetal mortality and morbidity are linked to these risk factors. MTP in itself is a blind and risky procedure and performing it in High Risk Pregnancy (HRP) is a challenge for obstetrics and gynecology personnel. When performed with all pre, intra and post-op precautions, results are good and patient-friendly. Aims and Objectives: Aims of the study were to calculate the number, high-risk factors, method used, and its outcome of MTP in HRP. Materials and Methods: The present study was a retrospective observational study done at QMH, KGMU, Lucknow performed on subjects admitted for MTP from January 2018 to December 2018. Total admitted patients seeking MTP were 450 out of which 93 belonged to High-Risk Group who underwent surgical and medical abortion accordingly. All precautions and norms defined by Govt. of India were taken care of. Cases were evaluated on the basis of high-risk factors- Age, parity, obstetrical and medical illnesses, and interval since last delivery. Results: Out of 93 high-risk cases, 88 cases were of 1st trimester and 5 were of 2nd trimester abortion. Six cases required suction evacuation while seven cases were managed medically using medical abortion kit. Contraception was given to all subjects according to their needs. Seventy-one women were of more than 35 yrs, while two were teenagers. 21 women were grand multipara. Women of obstetrical risk were 17 while the rest were having medical illnesses. Conclusion: This study concludes that there are a large number of high-risk groups for MTP again showing unmet need and lack of specialized counseling of HR patients according to their mental and physical condition. Early recognition of pregnancy and timely intervention can be lifesaving in these women and proper contraceptive counseling is required to prevent future pregnancies.