Search

Background & Objective: The aim of this study is to evaluate the clinical risk factors associated with maternal death in pregnant women infected by COVID-19. Materials & Methods: This is a multicenter prospective study in Indonesia, included all pregnant women with confirmed COVID-19. Participants were divided into two groups based on the final outcomes: maternal death group and survived group. The main outcomes evaluated were: maternal background, clinical risk factors, comorbidities, clinical characteristics, and laboratory results. Results: There were 89 participants in the maternal death group and, 1673 in the survived group. The maternal death group have an older maternal age (32 vs 31 years old, P=0.03) and earlier gestational ages during admission (33 vs 37 weeks, P=0.000). The maternal death group have a significantly higher rate of cardiac disease (6.5% vs 1.2%, P=0.004), acute kidney injury (5.2% vs 0.3%, P=0.000), coinfections (29.9% vs 10.8%, P=0.000), and anemia (14.3% vs 6.7%, P=0.012). The maternal death group have a higher level of maternal blood leukocyte (13970 vs 10345), netrofil 75.7 vs 70), ALT (47 vs 23), AST (26 vs 19), CRP (37.4 vs 0.7), and procalcitonin (0.27 vs 0.06) (P<0.05). The risk factors that independently related to maternal death are fever (Exp(B): 12.847, 95% CI: 5.638-29.277; P=0.000), pneumonia from chest x-ray (Exp(B): 2.524, 95% CI: 1.163-5.479; P=0.019), and ICU admission (Exp(B): 49.430, 95% CI: 21.024-116.215; P=0.000). Conclusion: Our research indicates that the presence of fever, pneumonia, and ICU hospitalization are independently associated with maternal death in COVID-19-infected pregnant women. [ABSTRACT FROM AUTHOR]

Introduction The Indonesian INOVASIA study is an ongoing multicentre randomized, open controlled trial of pravastatin for the prevention of preeclampsia in patients deemed to be high risk. Here we evaluate the effects of pravastatin on circulating inflammatory and endothelial markers, i.e. Vascular Endothelial Growth Factor (VEGF), Interleukin-6 (IL-6), Endothelin-1 (ET-1), and Nitric Oxide (NO). Methods Pregnant women deemed to be at a high risk of developing preeclampsia women were recruited based on the Fetal Medicine Foundation preeclampsia screening test or a history of preterm preeclampsia, or clinical risk factors in combination with an abnormal uterine artery Doppler flow pattern at 11–20 week's gestation. This is a nested cohort study within the larger trial (INOVASIA); 38 patients were consecutively recruited and assigned to the pravastatin group and the control group. Participants in the pravastatin group received pravastatin (2 × 20 mg p.o) in addition to a standard regimen of aspirin (80 mg p.o) and calcium (1 g p.o), from 14 to 20 weeks until delivery. Blood samples to measure the various biomarkers were obtained in consecutive patients before starting the research medication and just before delivery (pre and post-test examination). Result The number of samples on the 2 time points for the various biomarkers was: VEGF: 38, IL-6: 30, ET-1: 38, and NO: 35. IL-6 levels decreased significantly in the pravastatin group (mean ± SD): (191.87 ± 82.99 vs. 151.85 + 48.46, p = .013), while levels in the control group did not change significantly (median (interquartile range)) (144.17 (53.91) vs. 140.82 (16.18), p = .177). ET-1 levels decreased significantly in the pravastatin group (3.64 ± 0.85 vs. 3.01 ± 0.74, p = .006) while the control group had more or less stable levels (3.57 ± 1.12 vs. 3.78 ± 0.73 p = .594). NO was the only serum marker that showed significant changes in both groups. NO levels increased in pravastatin group (11.30 (17.43) vs. 41.90 (53.18), p = .044) and decreased in control group (38.70 (34.80) vs. 10.03 (26.96), p = .002). VEGF levels appeared to follow opposite trends in the 2 groups (NS) (Pravastatin: 3.22 (0.62) vs. 3.28 (0.75), p = .402. Control: 3.38 (0.83) vs. 3.06 (0.74), p = .287). Conclusion Administration of 40 mg pravastatin resulted in an improvement in NO levels, and a decrease in IL-6 and endothelin (ET-1) levels. The direction of the effect of pravastatin on these biomarkers appears to underpin the potential for a beneficial effect of pravastatin in the prevention of preeclampsia. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia is a form of hypertension in pregnancy that leads to morbidity and mortality. Although the etiology remains unclear, there are some risk factors that are suspected to be associated with the development ofpreeclampsia. Objective: To find out the risk factors associated with the incidence of preeclampsia inAirlangga University Hospital. Method: This studyconducted an analytical-observational study with the hospitalized unmatchedbased case-control approach. 165 pregnant women were included. Data were analyzed in univariate, bivariate, and multivariate regression logistic and performed using statistical package for the social science (SPSS), p < 0.05 was considered statistically significant. Results: Pregnant women with preeclampsia were about 18 to 44 years old, with the average BMIis 31.19 kg/m2. There are significant relation between family history of hypertension (p = 0.000), maternal age (p = 0.004), BMI (p = 0.000), pregnancy interval (p = 0.009), and chronic hypertension (p = 0.007) with the incidence of preeclampsia. In the multivariate analysis using logistic regression, family history of hypertension was the most dominant factor with OR: 3.374 and 95% CI: 1.454 – 7.830 compared to other factors such as maternal age (OR: 2.885; 95% CI: 1.311 – 6.347; p: 0.008), and BMI (OR: 2.590; 95% CI: 1.525 – 4.400; p: 0.000). Conclusion: Family history of hypertension, maternal age, BMI, pregnancy interval, and chronic hypertension have a significant relationship with the incidence of preeclampsia. In multivariate analysis, family history of hypertension is the most dominant risk factor among others. [ABSTRACT FROM AUTHOR]

Preeclampsia still remains an important topic in relation to the cardiovascular system in more than 300 million women worldwide, with both short and longterm mobidities. The purpose of this study was to compare maternal cardiovascular risk of early and lateonsets of preeclampsia 5 years after labor. It was a retrospective cohort study of preeclampsia patients within the period of January 2013 to January 2014, who delivered at Dr. Soetomo General Hospital. The maternal cardiovascular risk assessment include; body mass index (kg/m²), waist circumference (cm), blood pressure (mmHg), fasting blood sugar levels (mg/dL), HDL cholesterol levels (mg/dL), LDL cholesterol levels (mg/dL), blood triglyceride levels (mg/dL), total cholesterol levels (mg/dL) and ATP-III Framingham scores. There was a higher and significant cardiovascular risk factors in relations to hypertension and/or metabolic syndrome (p 0.031) in the early-onset of severe preeclampsia group, which also supported an increase of 1.47 folds of cardiovascular risks (RR 1..471; CI 95 [1.071-2.019]) compared with the late-onset group. The incidence of metabolic syndrome 5 years after preeclampsia was higher in the early-onset of preeclampsia group compared with the late-onset. Also, the cardiovascular risk factors related to hypertension and / or metabolic syndrome were higher in the early-onset group and supported an increase in cardiovascular risk factors of 1.47 times compared with the late-onset group. [ABSTRACT FROM AUTHOR]

Acute fatty liver of pregnancy (AFLP) is a rare, often autosomal recessive disorder with a major risk for maternal and perinatal mortality and morbidity. In order to achieve a more favorable outcome, awareness of its clinical signs and symptoms and early recognition are of pivotal importance. Over a 5-year period, 18 patients were diagnosed with AFLP (one twin, 19 babies). The most common sign and symptoms were jaundice, hypoglycemia, nausea and vomiting, encephalopathy, and hypertension. Abnormal laboratory test results included elevated total/conjugated (direct) bilirubin, AST, ALT, PT, APTT, creatinine, leukocyte count, and hypoalbuminemia. Maternal and fetal mortality rate was high: 66.7% resulted in a maternal death and 57.9% in an intrauterine fetal demise (IUFD). The number of complications was found to correlate with maternal death (p = .042). Surviving AFLP patients had ≤3 complications, while patients with >3 complications on presentation had a high risk of maternal death (OR = 5.0; 95% CI: 0.55-45.4). The presence of hypertension significantly increased the risk of maternal death (OR: 24.5; 95% CI: 1.1-542.8; p = .01). The risk of IUFD was primarily related to gestational age at delivery and birth weight. The high rate of jaundice as presenting symptom of AFLP suggests that Indonesian primary maternity care providers may often miss its important earlier signs and symptoms, in particular de novo onset of nausea and vomiting in late pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To compare the level of serum heme oxygenase 1 (HO-1), soluble FMS like tyrosine kinase (sFlt-1), and neonatal outcome in early onset preeclampsia (EO-PE), late onset preeclampsia (LO-PE), and normal pregnancy (NP).Methods: In this prospective observational case control study, HO-1 and sFlt-1 levels were measured in blood samples within 24 h of hospital admission. Preeclampsia cases were divided into two groups based on gestational age at delivery: EO-PE (<34 weeks) and LO-PE (≥34 weeks). A total of 45 patients were involved in this study.Result: Maternal serum level of sFlt-1 was higher in EO-PE than LO-PE and NP groups (mean ± SD; 14.50 ± 17.12 ng/ml vs 5.20 ± 6.69 ng/ml vs 2.72 ± 1.2 ng/ml [p = 0.020]. Maternal serum level of HO-1 was not different between EO-PE, LO-PE, and NP groups (p = 0.681). Birthweights were significantly lower in the EO-PE group compared with the LO-PE and NP groups (1580 ± 536 g vs 2635 ± 578 g vs 3010 ± 371 g [p = 0.000]). The rate of small for gestational age infant (26.7% vs 6.7% vs 0%; p = 0.046) and perinatal death (20% vs 0 vs 0; p = 0.037) was also significantly higher in EO-PE compared to LO-PE and NP. The maternal sFlt-1 level was negatively correlated with birthweight (p = 0.006; CC = -0.445).Conclusion: This study did not find a correlation between maternal HO-1 levels and sFlt-1 levels. Maternal serum sFLt-1 levels in preeclampsia were higher in EO-PE and were associated with a worse perinatal outcome. [ABSTRACT FROM AUTHOR]

Objective: To know the correlation between quantitative Hepatitis B surface Antigen (HbsAg) and maternal Hepatitis B Envelope Antigen (HbeAg) with hepatitis B intrauterine transmission via placental infection. Hepatitis B in pregnancy causes a mother to child transmission (MTCT) via transplacental route started with placental infection. HBV DNA viral load and HBeAg are the independent risk factors for MTCT, but it rarely available in developing country. Materials and methods: A cross-sectional study in 33 pregnant women with HbsAg positive in 4 referral hospital in East Java, Indonesia. Quantitative HBS Ag and HBeAg) status were determined serologically from a peripheral venous blood sample. Placental Hepatitis B infection was detected by immunohistochemistry of HBsAg from placental tissues. The intrauterine transmission was diagnosed by positive HBsAg in cord blood sampling after deliveries. Results: Serum quantitative HBsAg level has a good sensitivity and spesificity to predict placental infection (90% and 83%), with a cut off value of 3.14 Log10 IU/mL (AUC 0.87; 95% CI: 0.74-0.99). Quantitative HBsAg level also has a good sensitivity and spesificity to predict HBV transmission in umbilical blood cord (81.8% and 95.5%) with a cut off value of 3.62 log 10 IU/ml (AUC: 0.925, 95% CI: 0.813-1; p = 0.000). Placental infection is significantly related with intrauterine transmission with OR 4.6 (95% CI 2.29-9.4; p = 0.002). Conclusion: The study reveals that maternal serum quantitative HBsAg level can be used as an alternative test to substitute HBeAg or HBV DNA as a marker to predict the placental infection and intrauterine transmission, especially in low-middle income countries., (Copyright © Tehran University of Medical Sciences.)

Objective: This study aims to analyze the effect of advanced maternal age (>35 years old) in maternal and perinatal outcomes of preeclampsia women. Materials and methods: This is a retrospective cross-sectional study involved all women who were diagnosed with preeclampsia at Universitas Airlangga Hospital (Surabaya, Indonesia) between January 2016 until May 2017. The participant was divided into two groups based on maternal ages: the first group was women older than 35 years old (advanced maternal age - AMA), and the other group was 20-34 years old (reproductive age - RA). The primary outcomes of this study were the maternal and perinatal outcome. Results: There were a total of 43 AMA preeclampsia women and 105 RA preeclampsia women. The AMA preeclampsia group had a higher proportion of poor maternal outcome (the occurence of any complication: pulmonary edema, HELLP syndrome, visual impairment, post partum hemorrhage, and eclampsia) compared to RA preeclampsia group (60,5% vs 33,3%, p = 0,002; OR 3,059, CI 1,469-6,371). There was no significant difference in the other maternal complications such as HELLP syndrome, pulmonary oedema, and eclampsia. The only difference was the occurrence of postpartum haemorrhage which was higher in the AMA group (16,3% vs 4,8%, p = 0,02; OR 3,889, CI 1,161-13,031). The prevalence of cesarean delivery was more common in AMA group (53,3% vs 28,6%, p = 0,004; OR 2.825, CI 1.380-5.988). The AMA preeclampsia women also had poorer perinatal outcomes compared to the RA group (81,4% vs 59%, p = 0,009; OR 3.034 CI 1.283-7.177). AMA women had a higher risk of perinatal complication such as prematurity (OR 3.266 CI 1.269-8.406), IUGR (OR 4.474 CI 1.019-19.634), asphyxia (OR 4.263 CI 2.004-9.069), and infection (OR 2.138 CI 1.040-4.393). Conclusion: Advanced maternal age increases the risk of poorer maternal and neonatal outcomes in preeclampsia patients. The addition of advanced maternal ages in preeclampsia should raise the awareness of the health provider, tighter monitoring, complete screening and early intervention if needed to minimize the risk of complications., (Copyright © Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences.)