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All Journal Majalah Obstetri dan Ginekologi
Pradnyaandara, I Gusti Bagus Mulia Agung
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Health Professions Medicine & Pharmacology

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Maternal-related factors associated with development and improvement of peripartum cardiomyopathy and therapeutic outcomes of bromocriptine Pradnyaandara, I Gusti Bagus Mulia Agung; Mulyana, Ryan Saktika; Sutedja, Jane Carissa; Jagannatha, Gusti Ngurah Prana; Wibawa, I Bagus Satriya; Deantri, Fanny; Pradnyana, I Wayan Agus Surya; de Liyis, Bryan Gervais
Majalah Obstetri & Ginekologi Vol. 32 No. 2 (2024): August
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I22024.112-127

Abstract

HIGHLIGHTS Younger age, black race, normotension, and multiparity indicate a poorer prognosis for peripartum cardiomyopathy recovery, while bromocriptine therapy reduces adverse events.   ABSTRACT Objectives: This study aimed to fill the significant knowledge gap regarding peripartum cardiomyopathy (PPCM), a heart failure phenotype linked to pregnancy. The main objectives were to explore the factors influencing the development and progression of PPCM and to assess the outcomes of bromocriptine.Materials and Methods: Systematic search across PubMed, ScienceDirect, and Cochrane Library identified studies until December 2022. This study includes non-randomized prospective and retrospective studies, as well as relevant randomized controlled trials. Risk factors were compared between the recovered and non-recovered PPCM groups, and bromocriptine therapy outcomes were evaluated against standard heart failure treatment as the primary endpoint.Results: The analysis included 24 observational studies and 1 randomized controlled trial involving 1,651 PPCM patients; 9 studies evaluating the outcomes of bromocriptine therapy. The most prevalent factors were caesarean delivery (proportion=53%, 95%CI=41%-66%) and anemia (proportion=51%, 95%CI=38%-65%). Non-recovered patients were younger (MD=-1.04 years old, 95%CI=-1.82-(-0.27), p=0.008) and predominantly black (RR=1.82, 95%CI=1.43-2.31, p <0.001). Hypertensive disorders and primiparity were found less among non-recovered patients (RR=0.73, 95%CI=0.60-0.88, p=0.001; RR=0.81, 95%CI=0.66-0.99, p=0.04, respectively). Non-recovered patients also exhibited higher baseline serum creatinine levels, lower LVEF, larger left ventricular end-systolic diameter (LVESD), larger left ventricular end-diastolic diameter (LVEDD), and lower fractional shortening (all P-values<0.05). Furthermore, bromocriptine significantly reduced major adverse cardiac events (MACE), mortality, and increased LVEF (all P-values<0.05).Conclusion: Younger maternal age, black race, absence of hypertension, and multiparity are associated with poorer prognosis for PPCM recovery. Bromocriptine therapy demonstrates superior benefits in reducing adverse events in PPCM.
Blood Pressure Variability as a predictor of maternal and neonatal outcomes in preeclampsia Mulyana, Ryan Saktika; Pemayun, Tjokorda Gede Astawa; Narayani, Ida Ayu; Adikarya, I Putu Gede Danika; Pradnyaandara, I Gusti Bagus Mulia Agung; Paramyta, I Gusti Ayu Cintya
Majalah Obstetri & Ginekologi Vol. 33 No. 3 (2025): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V33I32025.180-187

Abstract

HIGHLIGHTS Increased blood pressure variability (BPV) in preeclampsia is associated with a higher risk of maternal complications, such as prolonged hospitalization and eclampsia, as well as neonatal complications, including low birth weight and the need for NICU admission. Incorporating BPV monitoring into routine prenatal care may improve early detection of high-risk cases, allowing for timely interventions to reduce adverse maternal and neonatal outcomes.   ABSTRACT Objective: Preeclampsia remains a major cause of maternal and perinatal morbidity and mortality worldwide. This study aimed to evaluate the impact of blood pressure variability (BPV) on maternal and neonatal outcomes in preeclamptic patients, emphasizing its potential role in clinical management. Materials and Methods: A retrospective cohort study was conducted on 40 preeclamptic patients treated at Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, between January 2020 and December 2022. BPV was determined from serial systolic and diastolic blood pressure measurements during antenatal care. Maternal outcomes included length of hospitalization, preterm birth, premature rupture of membranes, eclampsia, postpartum hemorrhage, ICU admission, and composite adverse events. Neonatal outcomes included birth weight, Apgar scores, NICU admission, stillbirth, congenital anomalies, and neonatal death. Statistical analyses were performed using bivariate and multivariate logistic regression methods, with variables of p < 0.25 included in final models. Results: High BPV was significantly associated with increased maternal adverse events (adjusted OR 13.66; 95% CI 2.26–82.43; p = 0.004) and neonatal adverse outcomes (p = 0.011). Specifically, it correlated with low birth weight (p < 0.001), shorter birth length (p = 0.003), preterm birth (p = 0.003), and higher NICU admission rates (p = 0.005). No significant association was observed with fetal distress, intrauterine growth restriction, or neonatal death. The study achieved a statistical power of 86.7%. Conclusion:Increased BPV in preeclampsia is strongly linked to adverse maternal and neonatal outcomes. Routine BPV monitoring may serve as an important tool for early risk identification and improved obstetric management.
Co-Authors Adikarya, I Putu Gede Danika de Liyis, Bryan Gervais Deantri, Fanny Jagannatha, Gusti Ngurah Prana Narayani, Ida Ayu Paramyta, I Gusti Ayu Cintya Pemayun, Tjokorda Gede Astawa Pradnyana, I Wayan Agus Surya Ryan Saktika Mulyana Sutedja, Jane Carissa Wibawa, I Bagus Satriya