Johanes C. Mose

Influence of antenatal magnesium sulfate application on cord blood levels of brain-derived neurotrophic factor in premature infants.

Abstract Aim: To investigate the influence of antenatal magnesium sulfate (MgSO4) application on cord blood brain-derived neurotrophic factor (BDNF) levels – the first-line neuroprotection for preventing cerebral palsy in prematurely born infants. Subjects and methods: A randomized controlled trial was conducted by observing 72 pregnant women who were divided into three groups: group I (preterm pregnancy with MgSO4), group II (preterm pregnancy without MgSO4), and group III (full-term pregnancy as control group). Groups I and II were selected by block permutation randomization on subjects. Inclusion criteria consisted of preterm pregnancy at 34 weeks of gestation or less who were in labor or having planned terminations and receiving antenatal corticosteroids. Exclusion criteria consisted of previous complications caused by MgSO4, previous history of antenatal MgSO4 application in the current pregnancy infant was born before 4 h administration of MgSO4 or unborn more than 72 h after maximum course of antenatal MgSO4 of 24 h, prolonged antenatal MgSO4 treatment (>24 h), refusal to participate, and emergent adverse events during the study. Group I was given intravenous MgSO4; initial dose was 4 g, which was maintained at 1 g/h up to maximum of 24 h. Meanwhile, groups II and III were not given any special treatment. BDNF was examined by ELISA by taking 5 mL cord blood sample shortly after birth. The result was statistically measured by ANOVA. Results: The cord blood BDNF levels in premature infants with antenatal MgSO4 was significantly higher than in premature infants without antenatal MgSO4 (11,568 vs. 5027 pg/mL, P=0.000). Moreover, the result was statistically comparable to full-term infants (11,568 vs. 13,300 pg/mL, P=0.085). Conclusion: The application of antenatal MgSO4 in preterm delivery increased cord blood BDNF levels, which could have a potential role on fetal neuroprotection. Further investigation is needed.

The role of maternal & fetal doppler in pre-eclampsia

Pre-eclampsia is associated with significant maternal and fetal morbidity and mortality worldwide. Pregnancy complicated by preeclampsia and/or by fetal growth restriction are reported to have inadequate maternal vascular responses to placentation. This defective vascular response was due to the failure of second wave of endovascular trophoblast migration leading to both a reduced amount and depth of trophoblast invasion of myometrium followed by the development of placental hypoxia and ischemia that can be measured biophysically by means of Doppler Ultrasound. The role of Doppler in the screening and management of preeclampsia would be reviewed in here focusing on uterine artery, umbilicalartery (UA), middle cerebral artery (MCA) and ductus venosus (DV) waveforms. The commonly used flow velocity waveform (FVW) spectrum is used namely resistance index (RI), systolic/diastolic ratio (S/D) or pulsatility index (Pl). The presence or persistence of an early diastolic notch of uterine artery over 24 weeks of pregnancy is predictive of subsequent preeclampsia and or IUGR later on. Umbilical artery Pl falls with gestational age, although mean Pl is relatively stable after 30 weeks gestation. While elevated indices are predictive of adverse outcome, absent or reversed end-diastolic velocities (AREDV) are of particular significance for growth restriction. Mean MCA Pl increases to approximately 28weeks gestation and then falls to term. Progressive hypoxemia results in a reduction in MCA Pl and therefore values 5th centile are regarded as abnormal. The ratio of UA/MCA Pl has been widely used as an index of cerebral redistribution. The 9 51h centile for pulsatility index for vein (PIV) of ductus venosus FVW falls from 0.9 at 20 weeks to 0.7 at term, with values above this being regarded as abnormal. The absence or reversal of atrial systolic forward flow of DV FVW are of particular clinical significance. By using Doppler in the early detection of preeclampsia and its fetal complication namely growth restriction we can arrange the management decisions and monitoring strategy for preeclampsia.

MCV-MCH Value and One Tube Osmotic Fragility Test (OTOFT) Method for Thalassemia Trait Detection in Pregnancies -

The purpose of this study was to evaluate the prevalence of carrier thalassemia on pregnant women population who visit to antenatal clinic Hasan Sadikin Hospital, Bandung, Indonesia. Design study was cross sectional that 219 blood samples have collected in tubes containing EDTA anticoagulant. Sample examined for routine blood analysis and OTOFT method. If OTOFT method result was positive that confirm with alkaline Hemoglobin electrophoresis. 17 (7.76%) suspected carrier thalassemia were positive OTOFT method. Samples with OTOFT method positive have average values of Hemoglobin, MCV, and MCH were 10.88±1.61 g/dL, 82.64±8.66 fL, and 26.42±3.99 pg, that less than negative OTOFT method group. Average concentration of HbA2 Alkaline electrophoresis was 5.4%, more than common normal value could be concluded suspected carrier β thalassemia. Population of suspected carrier thalassemia was 7.76%. Combination MCV, MCH value and OTOFT method can use as simple screening tool for detection thalassemia trait in primary level.