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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

Show Abstract | Download Original | Original Source | Check in Google Scholar

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.

Impact of COVID-19 on the histopathological aspect of the placenta during pregnancy Anak Agung Ngurah Jaya Kusuma
Majalah Obstetri & Ginekologi Vol. 31 No. 2 (2023): August
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V31I22023.97-102

The coronavirus disease 2019 (COVID-19) is still classified as a world pandemic. This disease can affect numerous systems of the human body. Pregnant women are classified as a vulnerable group since COVID-19 can cause high morbidity and mortality. Angiotensin-converting enzyme-2 (ACE-2) acts as a COVID-19 receptor, and this receptor is also present in the placenta. The placenta plays a significant part in the fetus, especially protecting it from harmful conditions. Since only a few studies are available, COVID-19’s influence on the placenta in pregnancy needs to be discussed further. The SARS-CoV-2-infected pregnant woman’s placenta showed histopathological alterations. Viral particles were detected on syncytiotrophoblast and chorionic villi vascular endothelial cells. Some studies show inflammatory conditions are not prominent in SARS-CoV-2 positive infection. This, perhaps due to the placenta’s immunological reaction, plays a significant role. The SARS-CoV-2 disorder tends to cause abnormalities within the placental tissue. Fetal vascular malperfusion (FVM) and maternal vascular malperfusion (MVM) are the most frequent findings from the studies included.

Healthcare Professional’ Roles Educate Exclusive Breastfeeding: A Qualitative Exploratory Study of Strategies and Challenges Mertasari, Luh; Duarsa, Dyah Paramita; Ani, Luh Seri; Kusuma, Anak Agung Ngurah Jaya; Bakta, I Made
Public Health of Indonesia Vol. 10 No. 3 (2024): July - September
Publisher : YCAB Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36685/phi.v10i3.837

Background:The exclusive breastfeeding program has been in place for several years, but its implementation in various countries remains suboptimal. To reduce health risks for both mothers and children, exclusive breastfeeding education should begin as early as possible during pregnancy. Objective:This study aimed to explore models of exclusive breastfeeding education during pregnancy. Method:This study used a qualitative descriptive design with an exploratory approach. The sample included all parties involved in providing exclusive breastfeeding education within the Public Health Centers working areas of Buleleng I, Sukasada I, and II. The participants comprised 35 healthcare professionals, pregnant women, postpartum mothers, and hamlet heads. Data were collected through in-depth interviews using semi-structured interview guidelines until data saturation was reached. Interviews were conducted via video calls and private messages to confirm the transcription results. Results:Thematic analysis identified three main themes: Healthcare professionals’ roles, knowledge, attitudes, and support (including multiple roles, perceptions about exclusive breastfeeding education, and formal motivation and support); Education strategy and mechanisms (encompassing educational strategies, methods, preparation, location, schedule, time allocation, content, stages, media, and effectiveness evaluation); Challenges (such as lack of knowledge, maternal circumstances, and environmental conditions). Conclusion:Public health centers should provide structured education, with midwives playing a key role in promoting exclusive breastfeeding. The delivery of education should remain flexible to accommodate various conditions. Keywords:Breastfeeding; Child; Health knowledge; Midwifery; Postpartum period

Benefits and safety of myomectomy during cesarean section Kusuma, Anak Agung Ngurah Jaya
Majalah Obstetri & Ginekologi Vol. 32 No. 1 (2024): April
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I12024.39-43

HIGHLIGHTS 1. Myomectomy during cesarean section is a recommended and safe procedure. 2. This procedure benefits the patient because it avoids a second operation and anesthesia complications and is cost-saving. ABSTRACT Uterine myoma is a tumor in the uterus that is generally benign. There are many types of uterine myomas. These tumors can grow on the outer wall of the uterus, on the uterine muscle, or it can also be on the inner wall of the uterus. The most frequent kind of uterine tumor is myoma. Uterine myoma mostly occurs in women over thirty years of age. Its prevalence ranges from 5.4% to 77%, with uterine fibroids accounting for up to 5% of pregnancies. The myomectomy procedure is an option for women who still want children but are concerned about the possibility of subsequent surgical intervention. The myomectomy cesarean section is indicated if there were complications related to the myoma in a previous pregnancy. It also avoids the possibility of repeat laparotomy for fibroid removal in the future. Myomectomy surgery should be planned based on fibroids' location, size, and quantity, using suitable imaging. Myomectomy cesarean section can be an option compared to cesarean section without myomectomy, especially if it is performed by experienced surgeons with proper hemostatic techniques and performed in tertiary-level health facilities. This article discusses the details of the benefits and safety of myomectomy during cesarean section so that it might be considered before performing this procedure.

Current preeclampsia prediction model and biomarker Kusuma, Anak Agung Ngurah Jaya
Majalah Obstetri & Ginekologi Vol. 32 No. 3 (2024): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V32I32024.214-222

HIGHLIGHTS Most studies report that FMF predictive models involving a combination of maternal factor screening and biomarkers have significantly better detection capacity than risk factor screening alone. All predictive models generally use maternal factors as the basis for calculations and algorithms. Several biomarkers that have been reported in studies to act as elements of prediction models include MAP, UtA-PI, and the ratio of sFlt-1/PlGF level. ABSTRACT Preeclampsia (PE) is a serious hypertensive disorder that occurs during pregnancy and is often accompanied by proteinuria (excessive protein in the urine), posing significant risks to both maternal and neonatal health worldwide. PE is a leading cause of maternal and neonatal morbidity and mortality and is notably challenging to predict due to its unpredictable nature and steadily rising incidence rates globally. As a result, substantial efforts have been directed toward developing predictive models and identifying biomarkers to assess the risk and progression of PE. However, existing models vary widely in their design, methodologies, and efficacy. Current prediction models recommended by notable organizations, including the National Institute for Health and Care Excellence (NICE), the American College of Obstetricians and Gynecologists (ACOG), the Fetal Medicine Foundation (FMF), and the World Health Organization (WHO), generally involve screening based on maternal characteristics and known risk factors. These include parameters such as maternal age, body mass index (BMI), number of pregnancies and births, blood pressure, and uterine arterial pulse index (UtA-PI). Additionally, biomarkers like mean arterial pressure (MAP), UtA-PI, and the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) are employed to improve predictive accuracy. Despite the diversity of predictive models and biomarkers, there is no consensus on the optimal model for PE prediction, largely due to the limitations in comparative studies and the challenges involved in cross-study comparisons. However, literature suggests that the FMF model demonstrates superior detection capacity compared to other predictive models.

The application of Mississippi Protocol in superimposed pre-eclampsia patients with class 2 hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome Kusuma, Anak Agung Ngurah Jaya
Majalah Obstetri & Ginekologi Vol. 33 No. 1 (2025): April
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mog.V33I12025.83-88

HIGHLIGHTS The neonatal outcome following pregnancy termination was preterm birth, accompanied by low birth weight and respiratory distress. Following pregnancy termination, laboratory parameters gradually demonstrated improvement over time. Mississippi Protocol therapy was maintained for 4 days after pregnancy termination until both clinical status and laboratory values showed improvement. ABSTRACT Objective: To describe the implementation of the Mississippi Protocol (MP) in a case of superimposed pre-eclampsia complicated by class 2 HELLP syndrome. Case Report: The patient initially received conservative treatment, including anticonvulsant prophylaxis, antihypertensive agents, and high-dose cortico-steroids, in accordance with the MP. However, during observation, placental abruption and fetal distress were noted. Consequently, an emergency (green code) Caesarean section was performed. Placental abruption is a known complication associated with pre-eclampsia. The neonatal outcome following pregnancy termination was premature birth, low birth weight, and respiratory distress. Following delivery, laboratory parameters gradually improved. MP therapy was continued for 4 days post-delivery until clinical and laboratory indicators normalized. The administration of high-dose corticosteroids in HELLP syndrome is based on its characteristic excessive inflammatory response, which represents the distinctive feature of this case. Corticosteroid therapy is intended to reduce maternal morbidity and mortality and to enhance neonatal outcomes. Conclusion: Careful monitoring and comprehensive management are essential when applying the MP in such cases. The definitive treatment for both pre-eclampsia and HELLP syndrome remains the termination of pregnancy. Further research is required to assess the effectiveness of MP in emergency or complicated scenarios.

Beyond the Scar: A Case Report on the Clinical Presentation, Diagnostic Nuances, and Surgical Management of Type I Cesarean Scar Pregnancy Pradnyana, I Wayan Agus Surya; Anak Agung Ngurah Jaya Kusuma; Gde Bagus Rizky Kornia
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1341

Background: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where the gestational sac implants within the fibrous tissue of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates, posing significant risks of maternal morbidity, including uterine rupture and severe hemorrhage. Type I CSP, or endogenic CSP, involves implantation on a healed scar with growth primarily towards the uterine cavity. Early and accurate diagnosis, relying heavily on ultrasonographic nuances, is crucial for appropriate management and fertility preservation. Case presentation: We present the case of a 36-year-old woman, G7P3033, with a history of two prior cesarean sections, who presented at 6-7 weeks of gestation with vaginal discharge. Transabdominal ultrasonography revealed a gestational sac implanted on the anterior uterine wall within the cesarean scar area, with a thin myometrium between the sac and the bladder, consistent with a Type I (endogenic, COS-1, Grade II) Cesarean Scar Pregnancy. The patient also had Stage II hypertension. After thorough evaluation and counseling, the patient underwent a laparotomy with wedge resection of the CSP and scar revision, along with bilateral fimbriectomy as per her request for sterilization. Conclusion: This case highlights the importance of high clinical suspicion for CSP in pregnant women with previous cesarean sections presenting with early pregnancy symptoms. Detailed ultrasonography is paramount for accurate diagnosis, classification, and guiding management. Surgical management, specifically laparotomy with wedge resection and scar repair, proved to be an effective treatment for this Type I CSP, allowing for removal of the ectopic pregnancy and reinforcement of the uterine wall, while addressing the patient's desire for permanent contraception. Timely intervention is key to preventing life-threatening complications and preserving future reproductive options if desired.

Beyond the Scar: A Case Report on the Clinical Presentation, Diagnostic Nuances, and Surgical Management of Type I Cesarean Scar Pregnancy Pradnyana, I Wayan Agus Surya; Anak Agung Ngurah Jaya Kusuma; Gde Bagus Rizky Kornia
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1341

Background: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where the gestational sac implants within the fibrous tissue of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates, posing significant risks of maternal morbidity, including uterine rupture and severe hemorrhage. Type I CSP, or endogenic CSP, involves implantation on a healed scar with growth primarily towards the uterine cavity. Early and accurate diagnosis, relying heavily on ultrasonographic nuances, is crucial for appropriate management and fertility preservation. Case presentation: We present the case of a 36-year-old woman, G7P3033, with a history of two prior cesarean sections, who presented at 6-7 weeks of gestation with vaginal discharge. Transabdominal ultrasonography revealed a gestational sac implanted on the anterior uterine wall within the cesarean scar area, with a thin myometrium between the sac and the bladder, consistent with a Type I (endogenic, COS-1, Grade II) Cesarean Scar Pregnancy. The patient also had Stage II hypertension. After thorough evaluation and counseling, the patient underwent a laparotomy with wedge resection of the CSP and scar revision, along with bilateral fimbriectomy as per her request for sterilization. Conclusion: This case highlights the importance of high clinical suspicion for CSP in pregnant women with previous cesarean sections presenting with early pregnancy symptoms. Detailed ultrasonography is paramount for accurate diagnosis, classification, and guiding management. Surgical management, specifically laparotomy with wedge resection and scar repair, proved to be an effective treatment for this Type I CSP, allowing for removal of the ectopic pregnancy and reinforcement of the uterine wall, while addressing the patient's desire for permanent contraception. Timely intervention is key to preventing life-threatening complications and preserving future reproductive options if desired.

Metastatic breast cancer during pregnancy: a case report Widi, Made Yudha Ganesa Wikantyas; Putra, Wayan Artana; Kusuma, Anak Agung Ngurah Jaya; Wiradnyana, Anak Agung Putra; Sanjaya, I Nyoman Hariyasa; Budiana, I Nyoman Gede; Mahayasa, Putu Doster; Marta, Kadek Fajar
Indonesian Journal of Perinatology Vol. 6 No. 1 (2025): (Available online: 1 June 2025)
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v6i1.73

Introduction: Breast cancer is the most prevalent malignancy among women and a notable comorbidity during pregnancy. Pregnancy-associated breast cancer (PABC) presents unique challenges due to physiological breast changes that complicate early diagnosis. This case report aimed to present a 31-year-old female with a diagnosis of bilateral breast tumors, pleural effusion, and multiple thoracic soft tissue tumors during her second pregnancy, highlighting the complexities and treatment considerations involved. Case presentation: A 31-year-old female patient, referred to Prof. Dr. I. G.N.G Ngoerah General Hospital, Denpasar, was in her second pregnancy at 20-21 weeks of gestation. She presented with bilateral breast lumps, worsening pain, and shortness of breath. Her obstetric history included a previous cesarean delivery and two abortions. Clinical examination revealed pleural effusion and multiple nodules suggestive of metastases. Biopsies confirmed tubular adenoma in the right breast and invasive breast carcinoma in the left breast. Ultrasound and chest x-ray findings indicated metastases to the liver and lungs. The patient was diagnosed with G4P1021 at 20 weeks of gestation with pregnancy-associated bilateral breast cancer and metastases. Conclusion: PABC diagnosis and treatment are fraught with challenges due to the need to balance maternal and fetal health. Delays in diagnosis, limited antenatal care, and the aggressive nature of PABC contribute to poor outcomes. This case underscores the necessity of early detection, prompt multidisciplinary intervention, and tailored treatment strategies to improve PABC patients' prognoses.

Molecular mechanisms and biomarkers of autophagy in early onset preeclampsia: Key genes, pathways, and potential diagnostic/therapeutic targets Kusuma, Anak Agung Ngurah Jaya
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.V33I32025.262-270

HIGHLIGHTS Dysregulated autophagy in trophoblasts contributes to abnormal placentation and impaired spiral artery remodeling in early-onset preeclampsia. Oxidative stress and excessive mitochondrial ROS disrupt the autophagic balance, leading to cellular dysfunction and placental ischemia. Key autophagy-related genes (e.g., BECN1, LC3, ATG5, mTOR, TFEB) may serve as diagnostic or therapeutic targets in early-onset PE. Understanding the autophagy–oxidative stress interaction could inform biomarker development and novel interventions. ABSTRACT The pathogenesis of preeclampsia (PE) remains incompletely understood, with multiple mechanisms proposed. Among these, dysregulation of autophagy has emerged as a critical factor. Autophagy is essential for implantation, placental development, and pregnancy maintenance. Extravillous trophoblasts (EVTs) invade the decidua and proximal myometrium under hypoxic conditions, and autophagy supports this invasive process. In PE, impaired placentation has been associated with abnormal autophagic activity in trophoblastic cells. Furthermore, oxidative stress and excessive mitochondrial reactive oxygen species (ROS) production contribute to the pathophysiology of PE, potentially driving both insufficient and maladaptive upregulation of autophagy depending on the cellular microenvironment. Thus, PE is characterized not by a uniform increase or inhibition, but rather by disrupted autophagic balance. This review aims to clarify the role of autophagy dysregulation in the pathogenesis of PE.

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