Budi Wicaksono

OS018. Maternal mortality and its mainly possible causepre-eclampsia/eclampsia in developing country (Surabaya-Indonesia as themodel)

INTRODUCTION By slow decrease of Indonesias 2010 highly maternal mortality rate (MMR) as 228/100,000 births mostly estimated to be out reach toward 2014 MDG target achievement of 118/100,000 births, even maternal deaths are notoriously under reported, possibly at least by as much as quarter. The population of Indonesia according to the 2010 national census is 237.6 million, with 58% living on the island of Java, the worlds most populous island since it is only 6% of Indonesia total area. Despite risk approaching strategy and referral method in Indonesia national health system had already been formed but the application has not been optimal yet so that its achievement is still far from destination. OBJECTIVES To study the correlationship between maternal mortality rate and its mainly possible cause pre-eclampsia/eclampsia METHODS Retrospectively study was performed by using data Dr. Soetomo teaching hospital Surabaya and local government of East Java. RESULTS Before the year 2008 the maternal deaths on our hospital Dr. Soetomo Surabaya was depicted very high as approximate 713/100,000 births (range 5.05-10.24 per 100,000 births) or 105 maternal deaths among 14,712 births. Pre-eclampsia/eclampsia was the most possible cause rate of 50-65%. Although at present tend to be improved situation but the year 2008 classic data indicated bad referral system application of severe pre-eclampsia and eclampsia cases that they came lately into our teaching hospitals intensive care unit with approximately 12.6% major complications consist of 50% lung oedema and the remain with placental abruption and cerebral bleeding. In more detailed description of maternal deaths as 29% died on the day 1 of intensive care unit treatment that some cases were death on arrival, 35% on the day 1-3 and >day 3 showed 36% of deaths. Even 40% our preeclampsia/eclampsia dominated ventilator use in hospital ICU due to >60% lung oedema that almost those 70% persist until 3 days (72h) in respiratory machine use. Our Dr. Soetomo hospital Surabaya as the tertiary hospital and referral center as well we observed 210 cases of severely pre-eclampsia which divided into 40 cases of early onset and late onset type as 170 cases by the year 2010. Mainly the characteristic features in early onset type as follow 70% they were reproductive ages (20-35 years old), 60% was 24-32 gestational weeks, 12.5% got complication of Hellp syndrome, 25% with low albumin serum level (<3g%) and had renal failure as 40%. CONCLUSION Despite Indonesia MMR apparently declined over last two decades but it did not slump as expected even it failed to achieve the 2014 MDGs target.

New three-dimensional/four-dimensional volume rendering imaging software for detecting the abnormally invasive placenta

This study aimed to determine the role of three‐dimensional (3D)/four‐dimensional (4D) volume rendering ultrasound (VRU) in the diagnosis of abnormally invasive placenta (AIP).

Serum heme oxygenase 1 (HO-1), soluble FMS like tyrosine kinase (sFlt-1) level, and neonatal outcome in early onset, late onset preeclampsia, and normal pregnancy

ABSTRACT 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.

P26. Comparison serum inhibin A level, placenta inhibin A level and placenta inhibin A expression in severe preeclampsia/eclampsia and normal pregnant women

in the year 2010 where 15 severe pre-eclampsia/eclampsia and 15 normal pregnant blood samples as control were collected. ELISA method was use to make assesment of inhibin A maternal serum and placental levels, for the expression of placental inhibin A, immunohistochemistry method was done in this study as well as the use of statistical analysis. Results: Inhibin A serum levels in both maternal and placental appeared to be significantly increase comparing with normal pregnancy as control as well as its expression in placenta. In severe pre-eclampsia/eclampsia they were found as 17.3 ± 12.9 ng, 18.1 ± 13.5 ng, 20.4 ± 5.2 ng, respectively at the levels of maternal serum, placental and placental expression compared to normal pregnancy as 5.3 ± 1.8 ng (p < 0.05), 6.2 ± 1.6 ng (p < 0.05) and 4.9 ± 1.6 ng (p < 0.05). Conclusion: Inhibin A increase seem in severe preeclampsia/eclampsia.