Majalah Obstetri & Ginekologi

Acute fatty liver of pregnancy: An atypical case report

Riska Subono, Nurul Hikmah — Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Acute Fatty Liver of Pregnancy (AFLP) is an uncommon condition but life-threatening obstetric emergency, that increases the risk of fetal death due to preterm birth.
AFLP can be challenging for primary health workers (especially for general practitioners (GP) and midwives) since it mimics preeclampsia, viral hepatitis, intrahepatic cholestasis of pregnancy, and HELLPS syndrome, so more concern is needed in this case.

ABSTRACT

Objective: To present an atypical case of acute fatty liver of pregnancy.

Case Report: A 33-year-old woman was referred to the Emergency department of Dr. Soedarso Tertiary Referral Hospital, Pontianak, Indonesia, previously from the district hospital over 580 KM with diagnosis of multigravida (gravida 3 para 2) at 31 weeks gestation, suspected acute fatty liver disease (AFLP), severe oligohydramnios, and intrauterine growth restriction (IUGR). The patient had a history of nausea, vomiting, epigastric pain, polydipsia and polyuria, and seizure for less than 5 minutes with loss of consciousness. The patient originally did not know she was pregnant and using a contraceptive implant. She missed her period in the last six months ago, which was the first onset of epigastric pain. Further clinical examination resulted in pitting oedema but jaundice as a cardinal sign was not present. Laboratory data showed leukocytosis, normal haemoglobin level, normal blood glucose, hyperuricemia, increased function liver test with high transaminase and bilirubin, normal coagulation profile. Urinalysis showed proteinuria. The viral hepatitis and HIV tests were negative. Transabdominal ultrasound demonstrated a single intrauterine pregnancy with no echogenic liver features. Cardiotocography (CTG) showed category 2. This patient was diagnosed with AFLP based on Swansea Criteria (7 out of 10) and terminated pregnancy two days after diagnosis. A baby boy was born with birth weight 1.100 gr, birth length 34 cm, apgar score (AS) 9 and 10 at 1 and 5 minutes. The mother had a good prognosis, while the baby died on day 23 of life.

Conclusion: Acute Fatty Liver during Pregnancy is an uncommon but life-threatening obstetric emergency. Early screening, diagnosis, timely handling delivery, and intensive supportive care are essential to decrease morbidity and mortality for both mother and fetus. Multidisciplinary opinion needed for the best management of this case.

Profile of postpartum patients with urinary retention at Koja Regional Hospital, Jakarta, Indonesia

Suskhan Djusad, Alfa Putri Meutia, Surahman Hakim — Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Maternal age and fetal birth weight are key risk factors for PPUR.
Among 300 subjects, 63.7% experienced PPUR, identified using the Suskhan score, with catheterization as a useful tool for prevention and management planning.

ABSTRACT

Objective: Postpartum urinary retention (PPUR) is a common voiding disorder, defined as the inability to void spontaneously within 6 hours after delivery with a residual bladder volume exceeding 200 mL. High rates of PPUR in Indonesia indicate a need for greater awareness and intervention. This study aims to assess the incidence and potential contributing factors of PPUR among postpartum patients at Koja Regional Hospital in Jakarta, Indonesia.

Materials and Methods: A descriptive case-control study was conducted, including women who experienced urinary retention following vaginal delivery at Koja Hospital between September and December 2022. Residual urine volume was measured by catheterization 6 hours after delivery. Data analysis, performed using SPSS version 22, included patient demographics and clinical factors such as maternal age, parity, gestational age, neonatal birth weight, and postvoid residual urine volume. These factors were analyzed to determine their association with PPUR.

Results: Out of 300 subjects selected through consecutive random sampling, 63.7% experienced PPUR, while 36.3% had normal urinary function. Patients with a mean age of 26.91 ± 5.02 years (p = 0.000), primiparous status (first-time mothers) (p < 0.001), and a mean neonatal birth weight of 2980.95 ± 450.52 grams (p = 0.000) showed a higher risk of developing PPUR compared to other postpartum patients.

Conclusion: The study indicates a significant association between postpartum urinary retention and maternal factors, including younger age, primiparity, and higher neonatal birth weight. Identifying these high-risk factors can enhance PPUR management, allowing healthcare providers to implement targeted monitoring and preventive measures, potentially improving postpartum outcomes in this patient population. This underscores the importance of monitoring these risk factors to better manage and potentially mitigate the incidence of PPUR.

p16 expression in patient with Loop Electrosurgical Excision Procedure (LEEP)

Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Clinicopathologic characteristic of patient with LEEP procedures dominated by women above 35 years old, with total parity less than 3 and without history of contraceptive usage.
The p16 expression analyzed by immunohistochemistry technique. The positive and negative reactivity of p16 ratio was 3:5 on LEEP specimen which microscopically appear as chronic cervicitis, low-grade and high-grade squamous intraepithelial lesion.

ABSTRACT

Objective: The study aim was to reveal p16 expression with the clinicopathological characteristics of patients who underwent cervical biopsy using the Loop electrosurgical procedure (LEEP) at Udayana University Hospital for the period 2020 – 2023.

Materials and Methods: The research was conducted at Anatomic Pathology Laboratory of Udayana University Hospital, Denpasar, Bali, Indonesia. The samples were selected based on inclusion criteria such as the formalin fixed paraffin embedded (FFPE) sample from positive IVA patient and continue for LEEP procedure. Otherwise, the exclusion criteria were moldy FFPE sample and incomplete clinical data. Then, p16 immunostaining procedure was carried out manually. The interpretation of p16 results was analyzed using SPSS software, version 25 by International Business Machines (IBM) Corporation.

Results: The positive p16 expression was revealed in 12 samples (38.7%), in contrast the negative staining appeared in 19 samples (61.3%). Unfortunately, p16 expression was not significant statistically based on age, parity, and contraceptive history, with p-values of 1.00, 0.45, and 0.65, respectively. Meanwhile, a statistically significant association was found between p16 expression and histopathologic diagnostic (p = 0.02, 95% CI 1.4 – 38.3). In addition, 22.2% of the variation of p16 expression based on multivariate analysis demonstrating a significant correlation (p = 0.01).

Conclusion: p16 expression with histopathology diagnostic characteristic in patient who underwent Loop Electrosurgical Excision Procedure (LEEP) was found statistically significant. Moreover, clinical application of p16 in daily practice should be performed with consideration especially for pre-cancer lesion in LEEP biopsy specimen procedure and clinicopathological approach is essential.

Nutritional status, hemoglobin, and albumin levels in predicting platinum resistance in ovarian cancer at Dr. Saiful Anwar Hospital, Malang, Indonesia

Tatit Nurseta, Ayu Rizky Widowati — Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Nutrition status, hemoglobin, and albumin levels are not predictors for platinum resistance.
Hemoglobin and albumin levels increased in both platinum-sensitive or platinum-resistant.

ABSTRACT

Objective: This study aimed to determine whether nutritional status, hemoglobin, and albumin levels could serve as reliable predictors for predicting platinum resistance in patients with ovarian cancer.

Materials and Methods: Conducted as a cross-sectional analysis, this study included 80 ovarian cancer patients who had completed six cycles of platinum-based chemotherapy. Patients were divided into two categories: those with platinum-resistant cancer and those with platinum-sensitive cancer, based on recurrence status following chemotherapy. Nutritional status was assessed through body mass index (BMI), and both hemoglobin and albumin levels were measured pre- and post-chemotherapy to investigate potential differences between the groups.

Results: The analysis revealed no significant difference in BMI between the platinum-sensitive and platinum-resistant groups (p = 0.743), suggesting that nutritional status, as measured by BMI, did not correlate with platinum resistance. Hemoglobin levels were similarly non-significant before (p = 0.072) and after chemotherapy (p = 0.055), indicating no clear association between hemoglobin levels and platinum response. However, hemoglobin levels showed significant increases post-chemotherapy in both the platinum-sensitive (p = 0.002) and platinum-resistant (p = 0.025) groups, though without affecting resistance outcomes. Pre-chemotherapy albumin levels did not significantly differ between the two groups (p = 0.218); but a significant post-chemotherapy difference was observed (p = 0.027), with both groups experiencing substantial increases from pre- to post-chemotherapy (p = 0.000).

Conclusion: The findings suggest that BMI, hemoglobin, and albumin levels are not reliable predictors of platinum resistance in ovarian cancer patients. Although both hemoglobin and albumin increased significantly after chemotherapy, these changes did not correspond with platinum resistance status.

Effects of autologous platelet-rich plasma in promoting endometrial thickness on patients with thin endometrium following IVF

Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

It was observed that autologous PRP substantially increased endometrial thickness in individuals experiencing infertility linked to a thin endometrium.
The elevated clinical pregnancy rate emphasizes the favorable effectiveness of autologous PRP in addressing issues related to a thin endometrium in IVF programs.

ABSTRACT

Objective: The objective of this research was to investigate the impact of autologous platelet-rich plasma (PRP) in enhancing endometrial thickness among individuals experiencing infertility associated with a thin endometrium.

Materials and Methods: Nine individuals with a thin endometrium who participated in an in vitro fertilization (IVF) program were enrolled in the study. This study occurred in Yasmin Clinic, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Patients underwent a hormone replacement protocol involving the preparation of the endometrium with estradiol valerate. Treatment with PRP was initiated when the endometrial thickness was less than 7 mm. Autologous PRP was infused into the uterine cavity between the 10th and 12th days after administering estradiol valerate, and the assessment of endometrial thickness was conducted using ultrasound 48 hours later. A second administration of PRP was provided in cases where the endometrial thickness was below 7 mm. Frozen-thawed embryo transfer (FET) will be performed if the endometrium reaches adequate thickness (minimum 7 mm).

Results: Seven of nine patients had adequate endometrial thickness followed by FET. Endometrial thickness was improved in 8 from 9 patients (88.8%). Five patients were improved at the first autologous PRP infusion (62.5%) and three patients (37.5%) at the second PRP infusion. The implantation rate was 33.3-100%, clinical pregnancy was 100%, and ongoing pregnancy rate was 83.3%.

Conclusion: The use of autologous platelet-rich plasma (PRP) successfully stimulates endometrial development in individuals with a thin endometrium during frozen-thawed embryo transfer.

The effect of docosahexaenoic acid (DHA) supplementation on total antioxidant capacity (TAC), superoxide dismutase (SOD), and interleukin-6 levels in underweight pregnant women

Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Underweight pregnant women, face an imbalance in energy and protein intake.
TAC, SOD, and IL6 with administration of DHA to pregnant women with chronic energy deficiency in the third trimester provide benefits.

ABSTRACT

Objective: Underweight pregnant women face oxidative stress and inflammation, increasing their risk of intrauterine growth restriction (IUGR) and preterm birth. This study investigates the effects of DHA supplementation on Total Antioxidant Capacity (TAC), Superoxide Dismutase (SOD), and Interleukin-6 (IL-6) in underweight pregnant women, along with the correlation between DHA and these markers.

Materials and Methods: This experimental pre-test/post-test study focused on underweight pregnant women in the Made District, Surabaya, Indonesia. Eligible participants were in their second or third trimester, had a BMI below 18.5, and were taking DHA regularly. Exclusion criteria included early pregnancy (gestational age < 14 weeks), BMI above 18.5, irregular DHA intake, and withdrawal from the study. The study ran from July to December 2023, using non-probability sampling to select participants. Blood samples were collected before and after two months of DHA supplementation.

Results: Following the intervention, TAC levels demonstrated a noteworthy increase (p < 0.05). SOD levels also exhibited a significant difference (p <0.05), and IL-6 levels showed a significant change (p < 0.05). A strong and positive correlation (r = 0.718) was observed between the increased TAC and SOD levels. DHA influenced both TAC and IL-6, with a significant relationship between TAC and IL-6 (p < 0.01). Furthermore, elevated SOD levels were associated with a decrease in IL-6 levels (p < 0.01). The correlation coefficient value of 0.718 between changes in SOD and TAC indicated a robust positive correlation.

Conclusion: The findings suggest that DHA supplementation in underweight pregnant women positively affects oxidative stress and inflammation markers, improving TAC, SOD, and IL-6 levels.

Collagen-1 and elastin expression in cervical tissue: A comparison across cervical elongation, pelvic organ prolapse, and combined conditions

Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Pathogenesis of cervical elongation is still limited, including the histological and molecular differences between a cervical elongation and a normal cervix.
The expression of collagen-1 level in the cervical elongation group was stronger compared to the cervical elongation with POP and control group.

ABSTRACT

Objective: This study aimed to assess differences in the expression of Collagen-1 and Elastin in cervical tissues among patients with Cervical Elongation (CE), Pelvic Organ Prolapse (POP), a combination of CE with POP, and those without either condition.

Materials and Methods: An analytical study with a cross-sectional design was conducted, using immunohistochemistry (IHC) to analyze cervical tissue samples preserved in paraffin blocks. Patient groups included those diagnosed with CE, POP, CE combined with POP, and a control group without CE or POP. All participants underwent surgery between January 2021 and April 2023. IHC was used to measure the expression levels of Collagen-1 and Elastin in each tissue sample. Observations were made under 400x magnification, focusing on five randomly selected visual-field areas in each sample to determine the area fraction. Two experienced pathologists conducted the analyses in a blinded manner to ensure objective evaluation.

Results: Statistical analysis using the Kruskal-Wallis test revealed significant differences in the expression of Collagen-1 across the four groups (CE, POP, CE with POP, and control). Patients with CE showed a higher expression of Collagen-1 than those with CE and POP combined, as well as the control group. However, no significant differences in Elastin expression were observed among the groups.

Conclusion: Collagen-1 expression differs significantly across patients with CE, POP, and CE combined with POP, suggesting a distinct role in cervical tissue remodeling in these conditions. Conversely, Elastin expression was consistent across all groups, indicating that it may not play a differentiating role in these pathologies. These findings highlight Collagen-1’s potential involvement in the structural changes associated with CE and POP.

Current preeclampsia prediction model and biomarker

Anak Agung Ngurah Jaya Kusuma — Mon, 18 Nov 2024 00:00:00 +0700

Preeclampsia (PE) is a serious hypertensive disorder that occurs during pregnancy and is often accompanied by proteinuria (excessive protein in the urine), posing significant risks to both maternal and neonatal health worldwide. PE is a leading cause of maternal and neonatal morbidity and mortality and is notably challenging to predict due to its unpredictable nature and steadily rising incidence rates globally. As a result, substantial efforts have been directed toward developing predictive models and identifying biomarkers to assess the risk and progression of PE. However, existing models vary widely in their design, methodologies, and efficacy. Current prediction models recommended by notable organizations, including the National Institute for Health and Care Excellence (NICE), the American College of Obstetricians and Gynecologists (ACOG), the Fetal Medicine Foundation (FMF), and the World Health Organization (WHO), generally involve screening based on maternal characteristics and known risk factors. These include parameters such as maternal age, body mass index (BMI), number of pregnancies and births, blood pressure, and uterine arterial pulse index (UtA-PI). Additionally, biomarkers like mean arterial pressure (MAP), UtA-PI, and the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) are employed to improve predictive accuracy. Despite the diversity of predictive models and biomarkers, there is no consensus on the optimal model for PE prediction, largely due to the limitations in comparative studies and the challenges involved in cross-study comparisons. However, literature suggests that the FMF model demonstrates superior detection capacity compared to other predictive models.

Back Matter Vol. 32 No. 3 December 2024

Majalah Obstetri & Ginekologi — Mon, 18 Nov 2024 00:00:00 +0700

Evaluation of anti-Mullerian hormone as parameter of ovarian function in patients with systemic lupus erythematosus: A systematic review and meta-analysis

Mukhammad Nooryanto, Wulandari Wulandari — Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Systemic Lupus Erythematosus (SLE) patients show a strong correlation between Anti-Mullerian Hormone (AMH) levels and ovarian function. Lower AMH levels indicate higher risk of impaired ovarian function and diminished reserve, as revealed by this meta-analysis.
The comprehensive synthesis of available data in this study has important clinical implications for the management and counseling of Systemic Lupus Erythematosus (SLE) patients.

ABSTRACT

Objective: The assessment of ovarian function in patients with systemic lupus erythematosus (SLE) holds paramount importance for both clinicians and patients. This systematic review and meta-analysis delves into the role of anti-Mullerian hormone (AMH) as a key marker in evaluating ovarian function among SLE patients. Our study aims to provide valuable insights for clinicians managing ovarian function assessments and to offer practical recommendations for differences in therapy for patient care.

Materials and Methods: Studies comparing serum AMH levels between patients with systemic lupus erythematosus and healthy controls, as well as serum AMH levels between SLE patients, are necessary. PRISMA guidelines were used for this systematic review. Databases like PubMed, SCOPUS, EuropePMC, ProQuest, and Cochrane Central were searched using specific terms ("Anti-Mullerian Hormone" or "Ovarian Function" and "Systemic Lupus Erythematosus") for publications between 2000 and 2023. After removing duplicates, authors screened remaining articles based on abstracts, then reviewed selected abstracts in full-text. Studies meeting criteria were included based on unanimous agreement among investigators, with any disagreements resolved through author consensus.

Results: Data There were 12 eligible studies. In this research, we identified a link between SLE and diminished levels of AMH. Furthermore, it was observed that SLE patients undergoing cyclophosphamide (CYC) treatment also exhibited lowered AMH levels

Conclusion: The systematic review underscores the heightened risk of reduced ovarian reserve in SLE patients. Importantly, CYC treatment emerged as a factor contributing to compromised ovarian reserve. For individuals with systemic lupus erythematosus, particularly women in their reproductive years, assessing serum AMH levels can serve as a pivotal tool to inform therapeutic decisions and preserve ovarian health. Our study contributes to enhanced clinical understanding and patient care within the realm of SLE and reproductive health.

MicroRNAs obtained from cervical swabs in predicting preterm birth

Rosalia Purbandari, Suheni Ninik Hariyati — Mon, 18 Nov 2024 00:00:00 +0700

HIGHLIGHTS

Increased expression of certain miRNAs in women experiencing preterm birth could be linked to various molecular pathways which contributes to preterm birth.
miRNAs obtained from cervical swabs exhibit statistically significant difference in expression between women with term births and preterm births.

ABSTRACT

Objective: Identifying the risk of preterm birth is crucial for early intervention. miRNAs, small noncoding RNAs that regulate gene expression, play a key role in development and tissue maintenance. Under stress conditions, their regulatory functions become significant, linking them to disease states. Using miRNAs from cervical swabs as potential biomarkers could revolutionize preterm birth risk assessment. This systematic review examines current research on the effectiveness of cervical swab miRNAs in predicting and estimating preterm birth risks, aiming to enhance early detection and management strategies for preterm births.

Materials and Methods: Using the PubMed database, 14 articles were obtained using the keywords “microRNA” and “preterm”. Reviews and unrelated studies were then excluded from both pooled articles, resulting in 4 articles included in the final review. Risk of bias were examined using the Newcastle Ottawa Scale. Sample characteristics, time of cervical swab collection, and results from each study were extracted for further analysis.

Results: A total of 4 articles were included in this review. Various miRNAs were examined in and were generally successful in predicting preterm birth. miRNA-145, miRNA-199, miRNA-30, miRNA-21, and miRNA-181 family were examined by multiple studies and produced significant results in predicting preterm birth. Based on enrichment analysis, various miRNAs were found to be involved in several biomolecular signaling pathways leading to preterm birth, such as inflammation, chemokine and cytokine signaling pathway, and toll-like receptor signaling.

Conclusion: miRNAs obtained from cervical swabs exhibit statistically significant difference in expression between women with term births and preterm births. Further studies are needed to improve the predicting power and accuracy of miRNAs in preterm births.

Front Matter Vol. 32 No. 3 December 2024

Majalah Obstetri & Ginekologi — Mon, 18 Nov 2024 00:00:00 +0700