Muhammad Ilham Aldika Akbar

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.

Clinical characteristics of acute fatty liver of pregnancy in a tertiary Indonesian hospital

Abstract 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.

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.