Jusuf S. Effendi

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.

Heme Oxygenases1 (Hmox1) and Serum Ferritin Level between Preeclampsia and Normal Pregnancy

Objective: To determine the comparison of Hmox-1 to serum ferritin level between patients with preeclampsia and normal pregnancy. Methods: This study used analytic observational with cross sectional design. We included 30 subjects with preeclampsia and the other 30 people with normal pregnancy in accordance with inclusion and exclusion criteria. Examination of Hmox-1 and ferritin level was performed through ELISA method. The data consisted of physical and laboratory examination and they would be continued to the calculation in the statistical analysis. Results: The average of Hmox-1 level in normal pregnancy and preeclampsia was 1.2 (SD 1.6) ng/ml and 0.3 (SD 0.2) ng/ml (p 0.05). Conclusion: The level of Hmox-1 in preeclamptic group is lower than normal pregnancy; while, the ferritin level in women with preeclampsia is higher than normal pregnancy. There is no significant correlation between Hmox-1 and ferritin serum level. [Indones J Obstet Gynecol 2017; 5-1: 8-11] Keywords: ferritin, Hmox-1, 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.

The Role of Natural Progesterone Administration on the Levels of Progesterone-induced Blocking Factor, Interleukin-10 and the Prolongation of Gestational Length in Impending Preterm Delivery

Progesterone plays an important role in maintaining pregnancy. The success of pregnancy depends on the balance of immune response between the mother and the fetus. Progesterone regulates the immunological response through progesteroneinduced blocking factor (PIBF) which is synthesized by lymphocytes. Progesterone-induced blocking factor inhibits the production of arachidonic acid, reduced NK cell activity, and modulates the cytokine balance by increasing interleukin-10 (IL-10) level that is produced by Th2. This study aims to determine the roles of natural progesterone administration on PIBF and IL-10 levels and the increase in gestational length. This is an experimental research with preand post-test design. Subjects were pregnant women who met the criteria (n = 22). The treatment was done for 7 days. Progesteroneinduced blocking factor and IL-10 levels were measured before and after the administration of natural progesterone and the length of gestation were noted. The study was conducted at Dr Hasan Sadikin Hospital within July to December 2013. Results showed that after the administration of natural progesterone, there were increases on PIBF (p = 0.039) and IL-10 levels (p = 0.031). A positive correlation was noted between PIBF and IL-10 levels (r = 0.549; Spearman rank correlation test). There was also positive correlation between PIBF serum level (moderate strength correlation) and the length of gestation (r = 0.428; Point biserial correlation test). Progesterone-induced blocking factor serum level had more influence on the prolongation of the pregnancy compared to IL-10 level (OR: 1.016, 95% CI: 1.001 to 1.03; p = 0.033). Increased levels of PIBF and IL-10 after the administration of natural progesterone on the impending preterm delivery may prolong the gestation. Progesterone-induced blocking factor serum level have more dominant role in prolongation of gestation compared to IL-10.