Rhesus incompatibility in pregnancy: a case report

Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs due to the destruction of red blood cells, which the most common cause is rhesus incompatibility. This study aims to present a case of Rhesus incompatibility in pregnancy without a clinically significant effect on the baby. Case: A-38-years-old Indonesian woman with gravida 4 para 3 (G4P3A0), 32 weeks of gestational age came to the emergency department due to vaginal bleeding. On blood typing, she had an A-negative (A-) blood type. Her husband and all three of their children had O-positive (O+) blood type. The patient underwent a cesarean section due to recurrent antepartum hemorrhage following the total placenta previa. She gave birth to a baby girl, weighed 2,220 grams with an A-positive blood type. The hemoglobin level was 14.6 g/dL without any sign of neonatal jaundice during the first 24 hours of life. Conclusion: Our case illustrates a woman who did not show any sign of clinically Rhesus antigen alloimmunization. Low immunogenicity and dose-dependent response to a low fetal blood volume exposure might explain this phenomenon.

Management of polyhydramnios pregnancy without risk factors: a case report

Introduction: Polyhydramnios is a condition in which the amount of amniotic fluid increases more than 2 litres. The causes of polyhydramnios are multifactorial, and most are idiopathic. Here we report challenging management of polyhydramnios case without apparent risk factors. Case: A 30-year-old woman G2P1001, 27-28 weeks of gestational age referred due to our tertiary health care center due to polyhydramnios. The patient chief complaint was progressively enlarged abdomen since a month ago. Her previous pregnancy, medical history and family history were unremarkable. The obstetric examination reflects the size of uterus equivalent to 36 weeks of gestational age. The fetomaternal ultrasound reveals a life, single fetus with normal heart rate and fetal movement, estimated fetal weight about 1057 grams, placenta corpus posterior grade I, Maximum Vertical Pocket 22.83 cm, no major congenital abnormalities were visible and bladder appears filled. Laboratory tests revealed blood glucose levels 90 mg/dl, Hb-A1c 5.2%, Ureum 27.30 mg/dl, Creatinine 3.39 mg/dl, and numerous leukocytes on urine sediment. Amnioreduction and fetal pulmonary maturation were conducted by Dexamethason protocol. Amnioreduction yield 1500 ml of clear, yellowish amniotic fluid. Regarding abnormality in renal function, diagnosis of Acute on Chronic Kidney Disease (ACKD were established by Internal medicine department, and the patients were given a series of ceftriaxone injection. The patient was planned for indomethacin therapy; however, Indomethacin was not available in Bali. Conclusion: Careful search for causes both from the maternal factor and fetal abnormalities can help to determine the prognosis of pregnancy. Ideally, amnioreduction, coupled with indomethacin therapy, are needed to reduce amniotic fluid, and serial monitoring of the amniotic fluid volume is required to prevent preterm labor.

The effect of antibiotic therapy on Salivary Catalase kinetic parameters in neonatal at risk of Sepsis

Introduction: This study describes the effect of antibiotic therapy on salivary catalase kinetic parameters (CAT) at neonatal at risk of sepsis. Methods: Study is conducted from February – June 2015. Salivary samples are obtained from 20 neonates (5 normal-healthy neonates and 15 neonates at risk of sepsis) at Ulin General Hospital, Banjarmasin, Indonesia. The samples were placed in four different groups: P0 as control group (saliva + hydrogen peroxide/H2O2), P1 (saliva + 2 mg Ampicillin + H2O2), P2 (saliva + 0.2 mg Gentamicin + H2O2), P3 (saliva + 2 mg Ampicillin + 0.2 mg Gentamicin + H2O2). The solution is incubated at 37oC and 40oC before catalase (CAT) activity is measured. Catalase activity is measured by using a spectrophotometer at 240 nm. Kinetic parameters are measured at different concentrations of H2O2 and temperature. Kinetic parameters are represented by the Michaelis-Menten constant (Km) and the maximum reaction speed (Vmax) obtained through the Lineweaver-Burk curve plot. Results: The Km of Catalase on the saliva of neonates at risk of sepsis treated with antibiotics (4.37, 1.84, 0.12, and 0.23, 3.74, 1.5, for P1, P2, P3 respectively) was lower than the control group (17.61 and 12.54), both at 37ºC and 40ºC. Similarly, Vmax of the neonates at risk of sepsis treated with antibiotics (0.46, 0.34, 0.04 and 0.07, 0.20, 0.24) was lower than the control group (1.47 and 0.53) at 37ºC and 40ºC. Conclusion: The study shows that the Catalase activity at the saliva of newborns at risk of sepsis treated with antibiotic was lower than the control group.

Congenital vulvar teratoma: a case report

Introduction: Teratoma is an embryonal neoplasm consisted of 3 germinal layers. Teratoma usually arises along the line of embryonic cleft and sinus closure formed by the fusion of skin during the embryonic development. In this case report, we present a case of fetal Teratoma on the vulval region, a very rare variant of the disease. Case: A 28-year-old woman came for a routine check-up for her first pregnancy at her 26th weeks of gestational age. On ultrasound examination, a mass was found around the fetal vulva. There was no mass or malformations on other body parts. Placenta and the amount of amniotic fluid were normal. History of congenital anomaly in the family was denied. The patient then gave birth to a female baby at 38 weeks of gestational age without any complication. The baby was healthy, 2650 gram in weight, 50 cm in length, with good APGAR Score (8-10). On the baby left labia, there was a mass measured 5 cm x 4 cm x 3 cm, with slight discoloration. We recommend an early tumor excision to prevent unnecessary complication such as malignant transformation. Although at the time of writing, the patient still waiting for the schedule to remove the tumor due to a non-medical factor. Conclusion: Congenital Teratoma in the vulvar region was a very rare event. First-line therapy is early tumor excision and usually carries an excellent prognosis.

The role of circular Ribonucleic Acid in preeclampsia: a literature review

Circular RNAs (circRNAs) are non-coding RNAs with a covalently closed circular structure that present in a variety of organisms. The circRNAs are more stable and durable than linear RNAs due to incompatibility with the RNases. Recent studies have shown that circRNAs are expressed differently at the mother-fetal interface of women with preeclampsia compared to women with normal pregnancy. Although the evidence showed that circRNAs mediate various pathological processes in pregnancy, the mechanism of action is still unclear. In this paper, we provide a highlight of the current state of knowledge about circRNAs, its relation to preeclampsia, and the potential applications as preeclampsia biomarkers.