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All Journal journal of internal medicine E-Journal Obstetric & Gynecology Udayana Majalah Obstetri dan Ginekologi Indonesian Journal of Obstetrics and Gynecology (Majalah Obstetri dan Ginekologi Indonesia) ISM (Intisari Sains Medis) : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal of Global Pharma Technology
Anak Agung Ngurah Jaya Kusuma
Departemen/KSM Obstetri Dan Ginekologi, Fakultas Kedokteran, Universitas Udayana-RSUP Sanglah, Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Journal : Journal of Global Pharma Technology

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Cesarean Hysterectomy in Cases of Placenta Adhesiva Involving Urinary Bladder: Serial Cases Report Anak Agung Ngurah Jaya Kusuma
Journal of Global Pharma Technology Volume 12 Issue 09 (2020) Sept. 2020
Publisher : Journal of Global Pharma Technology

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Abstract

Background: Placenta adhesiva is an obstetrics complication with potentially high maternal and neonatal morbidity and mortality. Its incidence is increasing, but the management remains controversial. Antenatal diagnosis and method of delivery are the main issues. Many clinicians now prefer a conservative approach. While cesarean hysterectomy remains the method of choice in most cases, it still exposes women to torrential bleeding risk, with reported mean blood loss of 3.000-10.000 ml. We present four cases of placenta adhesiva with suspected urinary bladder involvement during antenatal care, which is managed with cesarean hysterectomy. Case Presentation: A 34 years old multigravida (G3P2A0) at 32-33 weeks gestational age (GA) and a-39 year’s old multigravida (G4P3A0) came to the clinic complaining of painless vaginal bleeding. In another case, a 38 years old multigravida was also referred from a regional hospital diagnosed with G5P2A3 32-33 weeks GA + antepartum bleeding (total placenta praevia) suspected placenta adhesiva. And the last case was A 24 years old multigravida, with known low-lying placenta for 20 weeks of GA. Greyscale Ultrasonography (US) showed placental implantation at anterior uterine corpus covering entire internal uterine ostium (IUO), seen multiple lacunas crossing the vesicouterine serous border and placental protrusion into the urinary bladder. The cesarean hysterectomy was performed in all cases by placental identification, preoperative bleeding control, and careful tissue resection, as proposed in the triple-P procedure. The cases show a promising outcome following CS hysterectomy in cases of placenta adhesiva involving urinary bladder. Conclusion: We recommend a comprehensive team approach for decision making and management of patients suspected of placenta adhesiva with careful preparation to avoid complications. Keywords: Placenta Adhesiva, Caesarean Hysterectomy, Urinary Bladder.
High Expression F2-Isoprostan (F2-IsoP), High Sterol Regulatory Element Binding Protein-2 (SREBP-2) and Low 2-Methoxyestradiol (2-ME) On Placenta Tissue as a Risk Factor of Pre-Eclampsia Jaya Kusuma AAN; Suwiyoga K; Mantik AN; Sukrama DM
Journal of Global Pharma Technology Volume 09 Issue 09
Publisher : Journal of Global Pharma Technology

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To date, pre-eclampsia (PE) still a problem of Maternal Fetal Medicine related to high incidence, maternal and neonatal morbidity and mortality. Pre-eclampsia is caused by pregnancy; however, the mechanism has not been established so it is still a disease of theories. This relates to differences in treatment, resulting in different ways of prevention and output of PE itself. Recently, the role of F2-IsoP ,SREBP-2 and 2-ME was suspected to be very important in the mechanism of the PE. Meanwhile, the placenta acts as a source regulatory protein production, so that the material of this study was taken from placental tissue. The study objective was to prove the high F2I-soP, high SREBP-2 and low 2-ME expression in the placenta as risk factors for PE Case control study has been conducted in the department of obstetrics and gynecology Sanglah Hospital with 62 samples in 2015. The case group consisted of 31 mothers with PE and control groups consisted of 31 non-PE mother. The study material is a placental tissue. F2-IsoP and SREBP-2 expression study was performed using immunohistochemistry and 2-ME with ELISA techniques in Pathobiology Laboratory Faculty of Veterinary Medicine Udayana University. Data were analyzed with chi square test and discriminant using SPSS. The statistical test results are presented in tabular form and narrative. In this study, it was found that high expression of F2-IsoP increased the risk of PE  4 times higher (OR = 4.44; 95% CI = 1.53 to 12.94; p = 0.005) ; high expression of SREBP-2 increased the risk of PE 8 times higher  (OR = 8.19, CI95% = 2,311 to 29.073; p = 0.001) and low expression of 2-ME increased the risk of PE 5 times higher (OR = 5.23; CI95% = 1.75 to 15.55; p = 0.002). On the discriminant test, we obtained contributing risk factor for the occurrence of PE were SREBP-2, F2Isop and 2-ME (p = 0.002) respectively. Conclusion, high F2-IsoP expression, high SREBP-2 expression and low 2-ME expression in placenta were risk factors for PE. The most dominant risk factor of PE mechanism was SREBP-2.Keywords: Pre-eclampsia, F2-Isoprostane, Sterol Regulatory Element Binding Protein-2, 2-Methoxyestradiol.
Co-Authors Anom Suardika DARMAYASA, K. Gde Bagus Rizky Kornia GUNUNG, K. I Dewa Made Sukrama I Gede Mega Putra I Gusti Putu Mayun Mayura I Ketut Suwiyoga I Made Darmayasa I Wayan Artana Putra I Wayan Megadhana KARKATA, M. K. Leony Lim Mantik AN Mona Mariana Muhammad Freddy Candra Sitepu Pradnyana, I Wayan Agus Surya