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HUBUNGAN POLIMORFISME GEN CATECHOL-O-METHYLTRANSFERASE (COMT) VAL158MET DENGAN KEJADIAN MIOMA UTERI PADA ETNIS MELAYU DI SUMATERA SELATAN Precelia Fransiska; Ferry Yusrizal; Legiran Legiran
Jurnal Kedokteran Syiah Kuala Vol 18, No 3 (2018): Volume 18 Nomor 3 Desember 2018
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jks.v18i3.18014

Abstrak. Objektif : Untuk mengetahui distribusi karakteristik sosiodemografi, genotip dan alel polimorfisme gen Catechol-O-Methyltransferase (COMT) Val158Met dengan kejadian mioma uteri pada etnis Melayu di Sumatera Selatan. Desain Penelitian : Penelitian ini merupakan analitik observasional dengan desain kasus kontrol (case-control). Penelitian ini dilaksanakan pada bulan November 2018-Januari 2019 dilaboratorium bioteknologi fakultas kedokteran universitas sriwijaya. Sampel penelitian menggunakan sampel darah yang diambil pada 78 sampel yang terdiri dari 39 kasus dan 39 kontrol yang dilakukan dengan metode PCR RFLP. Hasil : Usia, usia saat menarche, riwayat keluarga dan merokok tidak terdapat hubungan yang bermakna sedangkan paritas dan menggunakan kontrasepsi hormonal memiliki hubungan yang bermakna. Genotip positif mioma terdapat 17 responden dan negatif mioma 1 responden dari 78 responden untuk alel guanin terdapat 33 responden dan alel adenin 3 responden. Kesimpulan : Tidak terdapat perbedaan hubungan antara gen Catechol-O-Methyltransferase (COMT) Val158Met dengan kejadian mioma uteri pada etnis Melayu di Sumatera Selatan dikarenakan hasil dari PCR dan RLFP hanya terdapat pemotongan sebanyak 18 responden dari 78 responden sehingga tidak dapat dianalisis menggunakan SPSS karena tidak memenuhi persyaratan uji statistik akan tetapi gen Catechol-O-Methyltransferase (COMT) Val158Met merupakan faktor risiko untuk terjadinya mioma uteri. Kata Kunci: Mioma uteri, Polimorfisme, gen Catechol-O-Methyltransferase (COMT) Val158met Abstract. Objective: to determine the characteristic distribution of sociodemography, genotypes and the polymorphism allele of the Catechol-O-Methyltransferase (COMT) Val158met gene with the incidence of uterine myoma in Malay ethnicity in South Sumatra. Intervention: This study is an observational analytic with case-control design (case-control). This research was conducted in November 2018-January 2019 in the laboratory of molecular biology at the Sriwijaya University medical school. The study sample used blood samples taken in 78 samples consisting of 39 cases and 39 controls carried out by the RFLP PCR method. Results: age, age at menarche, family history and smoking had no significant relationship while parity and hormonal contraception had a significant relationship. Positive myoma genotypes were 17 respondents and negative myoma 1 respondent from 78 respondents for the guanin allele there were 33 respondents and adenin alleles 3 respondents. Conclusion: there is no difference between the relationship between the Catechol-O-Methyltransferase (COMT) Val158met gene and the incidence of uterine myoma in Malay ethnicity in South Sumatra because the results of PCR and RLFP were only 18 respondents from 78 respondents so they could not be analyzed using SPSS because they did not meeting statistical test requirements but the Catechol-O-Methyltransferase (COMT) Val158met gene is a risk factor for the development of uterine myomas.Keywords: uterine myoma, Polymorphism, Catechol-O-Methyltransferase (COMT) Val158met

Polymorphism of CYP1A1 (Ile462Val) Gene Related to Uterine Myoma in Malays Ethnicity of South Sumatera Bella Ria Astuti; Ferry Yusrizal; Legiran Legiran
Mutiara Medika: Jurnal Kedokteran dan Kesehatan Vol 20, No 2 (2020): July
Publisher : Universitas Muhammadiyah Yogyakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18196/mm.200249

ABSTRACTASSOCIATION BETWEEN CYP1A1 (Ile462Val) GENE POLYMORPHISM AND OCCURANTE OF UTERINE MYOMA IN MALAYS POPULATION IN SOUTH SUMATERA.Bella Ria Astuti1, Ferry Yusrizal2 dan Legiran3Biomedical Science Program, Faculty of Medicine, University Sriwijaya Background : Uterine myoma is a tumor in the myometrium. Uterine myoma is a disease associated with interactions between genes, hormones, growth factors, cytokines, and the environment. Myoma has never been found before menarche, whereas after menopause only about 10% of myomas still grow. In general the incidence of uterine myoma is predicted to reach 20-30% in women over 35 years. In Indonesia myoma was found 2.39% - 11.7%. Uterine myomas can cause various symptoms including menometroragia, pelvic pain, spontaneous abortion and infertility. that the growth and development of uterine myomas depends on estrogen. Cytochrome CYP450 system is a group of enzymes involved in biosynthesis of steroid hormones and metabolic activation of carcinogens. CYP1A1 is one of three members of the CYP1 family that plays a role in the metabolism of large numbers of xenobiotics. The purpose of this study is to analyze the relationship of CYP1A1 (Ile462Val) gene polymorphism with the incidence of uterine myoma in ethnic Malays in South Sumatra. Methods : This study is an observational analytic study with a case control. This research was conducted in February 2019 in the laboratory of molecular Biology, Faculty of Medicine, Sriwijaya University. Test the statistics using the chi square test. The study sample used blood samples taken in 70 samples consisting of 35 case samples and 35 control cases. CYP1A1 (Ile462Val) gene polymorphism using the method PCR-RFLP. Results : There is a relationship between Polymorphism between genotypes and gene alleles CYP1A1 (Ile462Val) with the incidence of uterine myoma in ethnic Malays in South Sumatra. Key words : Polymorphism, Gene CYP1A1 (Ile462Val), Uterine leiomyoma.Citations : 63 (2001-2015)

Polymorphism of the Klotho G-395a Gene Promoter with the Incidence of Preeclampsia Desi Arlindia; Mgs. Irsan Saleh; Zen Hafyy; Legiran; Erial Bahar; Kms. Yusuf Effendi; Ferry Yusrizal
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 1 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i1.178

A B S T R A C TIntroduction. Preeclampsia is one of the leading causes of maternal and perinatalmorbidity and mortality and is still a disease of theory. Klotho is a new gene, inseveral biological processes in the pathophysiology of preeclampsia that play a rolein regulating endothelial nitric oxide production, angiogenesis, production ofantioxidant enzymes and protection against endothelial dysfunction. The Klotho G-395A genotype AA promoter polymorphism is the cause of hypertension. This studyaims to determine the relationship of the Klotho G-395A promoter polymorphism tothe incidence of preeclampsia. Methods. This study is an analytical study with acase-control design. The research was conducted at Pembina community healthcentre of Palembang and the public hospital of Prabumulih in February - July 2020and involving 50 case group and 50 control group. To determine the genotype andallotype of the Klotho G-395A gene promoter polymorphism, using polymerase chainreaction examination. Result. The results showed that the risk factors for maternalage and maternal gestational age had a significant relationship with the incidence ofpreeclampsia (p-value 0.015; p-value 0.000). There was a significant relationshipbetween the Klotho G-395A genotype GA + AA promoter polymorphism and theincidence of preeclampsia (p-value 0.024; OR = 2.571; 95% CI = 1.122-5.895), whileallotypes in the study sample also had a significant relationship with the incidenceof preeclampsia. preeclampsia (p-value 0.025; OR = 1.978; 95% CI = 1.087-3.599).Conclusion: There is a significant relationship between the Klotho G-395A genepromoter polymorphism and the incidence of preeclampsia.

Clinical Efficacy of the Use of Honey as Wound Treatment in Surgical Site Infection due to Hysterectomy Patient with Type 2 Diabetes Mellitus Hartati; Mufida Muzakkie; Yusuf Effendi; Ferry Yusrizal; Ramzi Amin; Cindy Kesty; Vicela Patricia Virgyna
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 8 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i8.343

Introduction: Honey is believed to be used in the topical treatment of wounds and burns due to its anti-bacterial and wound healing promotion activities. The sugar content in honey is high enough to inhibit microbial growth. This case report reports the clinical efficacy of using honey as a postoperative hysterectomy wound dressing with type 2 diabetes mellitus complications. Case Presentation: A woman, 40 years old, lived in Palembang, housewife, came with complaints of open surgical scars and smelling pus. The patient is a postoperative patient with cesarean section with indications of a prolonged latent phase and macrosomia. The patient also had a history of uncontrolled diabetes mellitus since 8 years ago. Intraoperatively, a wound dehiscence is obtained in the lower uterine segment and adhesions between the anterior uterine body and the omentum and transverse colon. The patient finally underwent a supracervical hysterectomy and the surgical secretions were examined for bacterial culture and antibiotic resistance. During wound care, the patient's surgical wound was treated using honey dressings. Patient experienced improvement after treatment for 12 days post-operation. Conclusion: Honey has antibacterial and tissue regeneration ability which is high enough to heal surgical wounds. Further studies are needed for the application of honey to postoperative wounds more widely

Maternal Death Cause by Antepartum Eclampsia, With HELPP Syndrome and AKI Stage III : A Preventable Recurrent Death Ferry Yusrizal; Fitria Koeshardani; Agustina H; Zulkhair Ali; Junaidi A
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 11 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i11.372

Background: Eclampsia and severe preeclampsia is of the most frequent cause of maternal death. We usually find the case like this in our daily practice. The case most likely could be prevented. Eclampsia defined as a generalized seizure following preeclampsia in pregnancy. Eclampsia/Preeclampsia (EPH-Gestosis) cause a multisystem dysfunction such as HELLP syndrome, microangiopathy hemolytic anemia, liver dysfunction, and thrombocytopenia. Eclampsia and HELLP syndrome lead to maternal mortality, which happened mostly during third trimester. Most of the patient came to the hospital in a bad condition where the multi organs failure were exist. EPH-Gestosis are due to maternal death in 43,75%. Even the case usually severe, it’s a preventable death. A proper strategy is needed to reduce or to avoid the maternal death.Objective: To analyse a maternal death with eclampsia and how to prevent this recurrent death.Case Report: A woman, 30 years old, G2P1A0 32 weeks pregnant not in labor with antepartum eclampsia was admitted to Mohammad Hoesin General Hospital (MHGH) Palembang, a referral case. Patient experienced generalized seizure six times before coming to MHGH which every seizure duration is less than five minutes and unconscious. On physical examination, patient was conscious, with blood pressure of 160/100 mmHg, pale, and cold extremities. By ultrasound examination, it showed 34 weeks pregnancy with single life fetus. Laboratory examination showed leukocytosis (25.000/mm3), thrombocytopenia (58.000/mm3), hyperbilirubinemia, elevated SGOT and SGPT (1691 and 861 U/L), elevated creatinine serum (2,46 mg/dl), and elevated LDH (3629 U/L). The patient was treated based on the protocol for stabilization with intramuscular injection of MgSO4 40%, nifedipin 10 mg per oral, intravenous injection of dexamethasone 12 mg, and plan to terminate the pregnancy by caesarean procedure. The male baby was born, 2000 g weight and APGAR score 4/6/8. After the cesarean the consciousness not so well. Collaborating therapy to handle the case, with the anesthesiologist, internist and neurologist. Maternal death occurred in 3 days hospitalized …caused by multi organ failure (MOF). Conclusion: The maternal death caused by antepartum eclampsia and the complication. The diagnosis of antepartum eclampsia and HELLP syndrome was decided based on history taking, physical examination, and supporting examination. Multiple organ failure exist in this case when the patient came to MHGH. Patient already treated and tried to overcome the complication but maternal death still occurred. This maternal death has a likely same story of previous death pattern. It is needed a strategy to prevent or to reduce the maternal death and how to make a good effort to cease the case become severe or worst.

Influence of Total Hysterectomy to Sexual Function: Pengaruh Histerektomi Total dengan Fungsi Seksual Andini Z. Dini; Ferry Yusrizal; Firmansyah Basir; Theodorus
Indonesian Journal of Obstetrics and Gynecology Volume 10 No. 1 January 2022
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v10i1.1524

Objective: To determine whether there are differences the impact of total hysterectomy on sexual function between each woman. Women who perform total hysterectomy often experience fear of the negative effects of hysterectomy on their sexual function.Methods: Randomized clinical trials have been conducted in outpatient clinic Obstetrics and Gynecological wards of Dr. Muhammad Hoesin General Hospital, Palembang from February to October 2020. There were 40 samples of women undergoing a total hysterectomy met the inclusion criteria. Sexual function before and after hysterectomy was analyzed with the Wilcoxon test. Data analysis using SPSS version 22.0.Results: This study showed decreased of desire, decreased stimuli, decreased orgasm, increased lubrication, increased sexual satisfaction, and increased dyspareunia samples after a total hysterectomy. However, with statistical analysis obtained results there were no meaningful changes in sexual function of desire (p = 0.849), stimuli (p = 0.716), lubrication (p = 0.261), orgasm (p = 0.839), sexual satisfaction (p = 0.613) and dyspareunia (p = 0.510) after total hysterectomy .Conclusion: It can be concluded that there is no significantly total hysterectomy effect on sexual function, based on FSFI (sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, and pain.Keywords: clinical trial, FSFI, hysterectomy, sexual function. Abstrak Tujuan: Mengetahui adakah perbedaan dampak histerektomi total pada fungsi seksual antara setiap perempuan. Perempuan yang melakukan histerektomi total sering mengalami ketakutan akan efek negatif histerektomi pada fungsi seksualnya. Metode: Telah dilakukan uji klinis secara acak di poliklinik rawat jalan bangsal Obstetri dan Ginekologi RSUP Dr. Muhammad Hoesin Palembang dari bulan Februari sampai Oktober 2020. Sebanyak 40 sampel perempuan yang menjalani histerektomi total memenuhi kriteria inklusi. Fungsi seksual sebelum dan sesudah histerektomi dianalisis dengan uji Wilcoxon. Analisi data menggunakan SPSS versi 22.0.Hasil: Penelitian ini menunjukkan penurunan hasrat, penurunan rangsangan, penurunan orgasme, peningkatan lubrikasi, peningkatan kepuasan seksual, dan peningkatan dispareunia setelah histerektomi total. Namun dengan analistik statistik didapatkan hasil tidak ada perubahan yang bermakna pada fungsi seksual yaitu hasrat (p=0,849), rangsangan (p=0,716), lubrikasi (p= 0,716), lubrikasi (p=0,261), orgasme (p=0,839), kepuasan seksual (p= 0,613), dan dispareunia (p= 0,510) setelah histerektomi total.Kesimpulan: Dapat disimpulkan bahwa tidak ada pengaruh histerektomi total yang signifikan terhadap fungsi seksual berdasarkan FSFI (hasrat, seksual, gairah seksual, lubrikasi, orgasme, kepuasan seksual, dan nyeri.Kata kunci: fungsi seksual, FSFI, histerektomi, uji klinis.

Polymorphism of the Klotho G-395a Gene Promoter with the Incidence of Preeclampsia Desi Arlindia; Mgs. Irsan Saleh; Zen Hafyy; Legiran; Erial Bahar; Kms. Yusuf Effendi; Ferry Yusrizal
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 1 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i1.178

A B S T R A C TIntroduction. Preeclampsia is one of the leading causes of maternal and perinatalmorbidity and mortality and is still a disease of theory. Klotho is a new gene, inseveral biological processes in the pathophysiology of preeclampsia that play a rolein regulating endothelial nitric oxide production, angiogenesis, production ofantioxidant enzymes and protection against endothelial dysfunction. The Klotho G-395A genotype AA promoter polymorphism is the cause of hypertension. This studyaims to determine the relationship of the Klotho G-395A promoter polymorphism tothe incidence of preeclampsia. Methods. This study is an analytical study with acase-control design. The research was conducted at Pembina community healthcentre of Palembang and the public hospital of Prabumulih in February - July 2020and involving 50 case group and 50 control group. To determine the genotype andallotype of the Klotho G-395A gene promoter polymorphism, using polymerase chainreaction examination. Result. The results showed that the risk factors for maternalage and maternal gestational age had a significant relationship with the incidence ofpreeclampsia (p-value 0.015; p-value 0.000). There was a significant relationshipbetween the Klotho G-395A genotype GA + AA promoter polymorphism and theincidence of preeclampsia (p-value 0.024; OR = 2.571; 95% CI = 1.122-5.895), whileallotypes in the study sample also had a significant relationship with the incidenceof preeclampsia. preeclampsia (p-value 0.025; OR = 1.978; 95% CI = 1.087-3.599).Conclusion: There is a significant relationship between the Klotho G-395A genepromoter polymorphism and the incidence of preeclampsia.

Clinical Efficacy of the Use of Honey as Wound Treatment in Surgical Site Infection due to Hysterectomy Patient with Type 2 Diabetes Mellitus Hartati; Mufida Muzakkie; Yusuf Effendi; Ferry Yusrizal; Ramzi Amin; Cindy Kesty; Vicela Patricia Virgyna
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 8 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i8.343

Introduction: Honey is believed to be used in the topical treatment of wounds and burns due to its anti-bacterial and wound healing promotion activities. The sugar content in honey is high enough to inhibit microbial growth. This case report reports the clinical efficacy of using honey as a postoperative hysterectomy wound dressing with type 2 diabetes mellitus complications. Case Presentation: A woman, 40 years old, lived in Palembang, housewife, came with complaints of open surgical scars and smelling pus. The patient is a postoperative patient with cesarean section with indications of a prolonged latent phase and macrosomia. The patient also had a history of uncontrolled diabetes mellitus since 8 years ago. Intraoperatively, a wound dehiscence is obtained in the lower uterine segment and adhesions between the anterior uterine body and the omentum and transverse colon. The patient finally underwent a supracervical hysterectomy and the surgical secretions were examined for bacterial culture and antibiotic resistance. During wound care, the patient's surgical wound was treated using honey dressings. Patient experienced improvement after treatment for 12 days post-operation. Conclusion: Honey has antibacterial and tissue regeneration ability which is high enough to heal surgical wounds. Further studies are needed for the application of honey to postoperative wounds more widely

Maternal Death Cause by Antepartum Eclampsia, With HELPP Syndrome and AKI Stage III : A Preventable Recurrent Death Ferry Yusrizal; Fitria Koeshardani; Agustina H; Zulkhair Ali; Junaidi A
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 5 No. 11 (2021): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/bsm.v5i11.372

Background: Eclampsia and severe preeclampsia is of the most frequent cause of maternal death. We usually find the case like this in our daily practice. The case most likely could be prevented. Eclampsia defined as a generalized seizure following preeclampsia in pregnancy. Eclampsia/Preeclampsia (EPH-Gestosis) cause a multisystem dysfunction such as HELLP syndrome, microangiopathy hemolytic anemia, liver dysfunction, and thrombocytopenia. Eclampsia and HELLP syndrome lead to maternal mortality, which happened mostly during third trimester. Most of the patient came to the hospital in a bad condition where the multi organs failure were exist. EPH-Gestosis are due to maternal death in 43,75%. Even the case usually severe, it’s a preventable death. A proper strategy is needed to reduce or to avoid the maternal death.Objective: To analyse a maternal death with eclampsia and how to prevent this recurrent death.Case Report: A woman, 30 years old, G2P1A0 32 weeks pregnant not in labor with antepartum eclampsia was admitted to Mohammad Hoesin General Hospital (MHGH) Palembang, a referral case. Patient experienced generalized seizure six times before coming to MHGH which every seizure duration is less than five minutes and unconscious. On physical examination, patient was conscious, with blood pressure of 160/100 mmHg, pale, and cold extremities. By ultrasound examination, it showed 34 weeks pregnancy with single life fetus. Laboratory examination showed leukocytosis (25.000/mm3), thrombocytopenia (58.000/mm3), hyperbilirubinemia, elevated SGOT and SGPT (1691 and 861 U/L), elevated creatinine serum (2,46 mg/dl), and elevated LDH (3629 U/L). The patient was treated based on the protocol for stabilization with intramuscular injection of MgSO4 40%, nifedipin 10 mg per oral, intravenous injection of dexamethasone 12 mg, and plan to terminate the pregnancy by caesarean procedure. The male baby was born, 2000 g weight and APGAR score 4/6/8. After the cesarean the consciousness not so well. Collaborating therapy to handle the case, with the anesthesiologist, internist and neurologist. Maternal death occurred in 3 days hospitalized …caused by multi organ failure (MOF). Conclusion: The maternal death caused by antepartum eclampsia and the complication. The diagnosis of antepartum eclampsia and HELLP syndrome was decided based on history taking, physical examination, and supporting examination. Multiple organ failure exist in this case when the patient came to MHGH. Patient already treated and tried to overcome the complication but maternal death still occurred. This maternal death has a likely same story of previous death pattern. It is needed a strategy to prevent or to reduce the maternal death and how to make a good effort to cease the case become severe or worst.

Hubungan Kadar Serum Klotho dengan Kejadian Preeklamsia (Association of Serum Klotho Levels With The Incidence of Preeclampsia) Martinova, Vera; Legiran, Legiran; Yusrizal, Ferry
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : CV. Ridwan Publisher

Preeklamsia merupakan penyakit multifaktorial yang memiliki berbagai faktor risiko, diantaranya usia ibu, jumlah anak (paritas) dan riwayat preeklamsia pada kehamilan sebelumnya. α-Klotho (KL) larut lebih tinggi pada wanita hamil dibandingkan dengan wanita tidak hamil. Namun, Preeklamsia bersama dengan bayi kecil untuk usia kehamilan dikaitkan dengan tingkat yang lebih rendah dari normal. Tujuan dari penelitian ini adalah untuk mengetahui hubungan kadar serum Klotho dengan kejadian preeklamsia. Penelitian ini merupakan penelitian case control yang bertujuan untuk melihat hubungan kejadian preeklamsia dengan kadar serum KL pada ibu hamil dengan preeklamsia yang dibandingkan dengan kehamilan normal. Sebanyak 62 responden, pengumpulan sampel dilakukan pada bulan April-Juli 2020, dengan jumlah sampel masing-masing sebanyak 31 sampel pada kasus dan kontrol yang telah memenuhi kriteria inklusi. Hasil penelitian ini didapatkan rerata kadar serum KL pada ibu hamil preeklamsia lebih rendah dibandingkan rerata kadar serum KL pada control, dari hasil tersebut ditemukan bahwa kadar serum KL menurun pada ibu dengan preeklamsia jika dibandingkan dengan ibu hamil normal. Kesimpulan dari penelitian ini yaitu terdapat hubungan yang signifikan antara kadar serum KL dengan kejadian preeklamsia dengan nilai p = 0,024

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