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Obstroctuvie Sleep Apnea dalam Kehamilan Syifa Alkaf; Peby Maulina Lestari; Sofyan Effendi
Majalah Kedokteran Sriwijaya Vol 46, No 4 (2014): Majalah Kedokteran Sriwijaya
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36706/mks.v46i4.2724

Obstructive sleep apnea (OSA) adalah gangguan tidur yang banyak terjadi pada wanita hamil, dengan prevalensi sebesar 0,3 sampai 5% dari semua wanita hamil. OSA terjadi karena penutupan komplit ataupun inkomplit hidung dan faring secara intermiten, dengan obesitas sebagai fakor risiko mayor. Pasien OSA akan mengalami mengantuk, rasa lelah, serta sakit kepala di siang hari. OSA pada wanita hamil berhubungan dengan kejadian hipertensi dalam kehamilan termasuk preeklampsia, kelahiran preterm, dan tingginya kelahiran sesar akibat inertia uteri. Berkurangnya aliran darah plasenta ke janin pada penderita OSA berhubungan dengan luaran janin yang buruk antara lain pertumbuhan janin terhambat, bayi berat lahir rendah, dan penurunan nilai Apgar akibat hipoksia intra uterin. Penurunan berat badan, perbaikan pola hidup, dan perubahan posisi tidur dikatakan efektif memperbaiki gejala OSA pada wanita hamil. Penggunaan CPAP sampai pembedahan merupakan pilihan terapi pada penderita OSA derajat berat.

MATERNAL SERUM ENDOCAN AS A POTENTIAL PREECLAMPSIA MARKER Peby Maulina Lestari
Majalah Kedokteran Sriwijaya Vol 53, No 2 (2021): Majalah Kedokteran Sriwijaya
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/mks.v53i2.14468

Preeclampsia remains the leading cause of maternal and neonatal morbidity and mortality worldwide. The imbalance of interactions between the placenta, immunity and the maternal cardiovascular system also plays a role in preeclampsia. Early onset preeclampsia (POD) and advanced onset preeclampsia (POL) are thought to have different pathomechanisms, causing different clinical symptoms. One theory of preeclampsia is the occurrence of endothelial dysfunction. Endocan as a specific endothelial protein is also thought to have an effect. Various studies on the role of Endocan in cardiovascular disease have also been carried out, while its role in preeclampsia that occurs in pregnant women is still very minimal. This study aims to determine the role of Endocan as a specific endothelial protein in preeclampsia. The study design was cross-sectional. A total of 72 subjects (24 subjects each in the POD, POL and normotensive pregnancy groups) were selected by consecutive sampling. Enzym Linked Immunoabsorbant Assay (ELISA) was performed to assess the Endocan concentration. In general, there is no significant difference in the characteristics of research subjects. Endocan concentrations were found to be higher in the POD group, while in the POL and normotensive pregnancy groups there was no significant difference. Endocan can be considered as a potential marker of preeclampsia, especially early onset.

Cardiac Disease in Pregnancy: Maternal and Perinatal Outcomes in RSUP Dr. Mohammad Hoesin Palembang Ni Made Dyah Gayatri; Peby Maulina Lestari; Abarham Martadiansyah; Nuswil Bernolian; Hadrians Kesuma Putra; Rizky Agustria; Muwarni Emasrissa Latifah
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 2 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i2.448

Background: Impaired maternal and uteroplacental perfusion can occur in pregnancy with cardiac disease leading to maternal and perinatal mortality and morbidity due to increased cardiac load and ventricular dysfunction. This research aims to determine maternal and perinatal outcomes of pregnancies with cardiac disease. Method: This research was a descriptive observational study conducted by total sampling method and cross-sectional design. This research used medical records of pregnant women with cardiac disease who gave birth in RSUP Dr. Mohammad Hoesin Palembang in January 2018-December 2020 as study samples. Result: Among 68 pregnancies with cardiac disease, there were 6 cases (0.87%) found in 2018, 38 cases (2.47%) found in 2019, and 24 cases (1.48%) found in 2020. The highest distribution of pregnancies with cardiac disease was found at 64.7% in the range of 20-35 years old age group; 57.4% in the multiparity group; 38.2% in the range of ≥34 – <37 weeks gestational age group; 86.8% in the high school educational level group; 66.2% in the high-risk cardiac functional status group; 54.4% in the peripartum cardiomyopathy group; and 36.8% with preeclampsia/eclampsia as a comorbid. In this study, maternal outcomes found were maternal mortality at 11.8%; cardiac failure at 70.6%; arrhythmia at 1.5%; and stroke at 1.5%, while perinatal outcomes found were prematurity at 60.3%; low birth weight at 64.4%; IUGR at 37.0%; IUFD at 1.4%; stillbirth at 6.8%; neonatal death at 9.6%; and perinatal asphyxia at 42.5%. Conclusion: The prevalence rate of pregnancies with cardiac disease in RSUP Dr. Mohammad Hoesin Palembang was 0.87% in 2018, 2.47% in 2019, and 1.48% in 2020. The most common maternal outcome in this study was cardiac failure, with most in the peripartum cardiomyopathy group, while the most common perinatal outcome was low birth weight, with most in the hypertensive heart disease group.

Kehamilan pada Skar Seksio Sesaria Nuswil Bernolian; Win T. Pangemanan; A. Kurdi Syamsuri; M. Hatta Ansyori; Putri Mirani; Peby Maulina Lestari; Abraham Martadiansyah; Cindy Kesty
Indonesian Journal of Obstetrics & Gynecology Science Volume 3 Nomor 2 September 2020
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia/v3n2.198

Tujuan: Memaparkan klasifikasi, faktor risiko, epidemiologi, cara diagnosis, tatalaksana, dan komplikasi kehamilan pada skar seksio sesareaMetode: Tinjauan pustakaKesimpulan: Kehamilan pada skar SC merupakan kehamilan yang kantung kehamilannya terdapat pada miometrium yang menipis akibat SC sebelumnya. Secara umum, kehamilan pada skar Caesarean Scar Pregnancy (CSP) dapat dibedakan menjadi 2 tipe, yaitu tipe 1 (endogenik) dan tipe 2 (eksogenik). Kejadiannya berkisar antara 1 per 8.000 dan 1 per 2.500 SC dengan risiko rekurensi 3,2-5,0% pada wanita dengan riwayat SC 1 kali yang ditatalaksana dengan dilatasi dan kuretase dengan atau tanpa embolisasi arteri uterina. Adapun faktor risiko CSP adalah tebal Segmen Bawah Rahim (SBR) <5 mm, kantong kehamilan menonjol ke plika vesikouterina, SC di rumah sakit umum daerah, dan riwayat perdarahan melalui vagina ireguler dan nyeri abdomen selama CSP sebelumnya. Pengobatan CSP dapat secara konservatif dengan metotreksat (MTX) maupun operatif termasuk eksisi jaringan kehamilan dengan laparoskopi, histerotomi, atau histerektomi. Pilihan pengobatan lain termasuk dilatasi dan kuretase, reseksi transervikal (TCR) dengan histeroskopi, embolisasi arteri uterina (UEA), kemoembolisasi arteri uterina, atau penempatan kateter balon ganda.Caesarean Scar PregnancyAbstractObjective: To explain about classification, risk factors, epidemiology, diagnostic methods, management, and complications of Caesarean Scar Pregnancy (CSP).Method: Literature review Conclusion: CSP is a pregnancy where the gestational sac is found in the thin myometrium due to previous CS. In general, Caesarean Scar Pregnancy (CSP) can be divided into 2 types, namely type 1 (endogenic) and type 2 (exogenic). Its incidence ranges from 1 per 8,000 and 1 per 2,500 SC with a recurrence risk of 3.2-5.0% in women with a history of 1 time CS who are treated with dilatation and curettage with or without uterine artery embolization. The risk factors for CSP are lower uterine segment thickness <5 mm, gestational sac pouches protruding into the vesicouterine fold, CS in regional public hospitals, and a history of irregular vaginal bleeding and abdominal pain during previous CSP. Caesarean scar pregnancy treatment can be conservative with methotrexate (MTX) or operatively including excision of pregnancy tissue with laparoscopy, hysterotomy, or hysterectomy. Other treatment options include dilatation and curettage, transcervical resection (TCR) with hysteroscopy, uterine artery embolization (UAE), chemoembolization of the uterine arteries, or placement of a double-balloon catheter.Key words: Caesarean scar pregnancy

Preeklamsia Pascasalin Nuswil Bernolian; Wim T. Pangemanan; A. Kurdi Syamsuri; M. Hatta Ansyori; Putri Mirani; Peby Maulina Lestari; Abarham Martadiansyah; Cindy Kesty
Indonesian Journal of Obstetrics & Gynecology Science Special Issue: Article Review
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia/v4n2s.196

AbstrakTujuan: Memaparkan etiologi dan faktor risiko, diagnosis banding, patofisiologi, pemantauan, terapi, komplikasi, rekurensi dan tindakan preventif pada kasus preeklamsia pascasalin.Metode: Tinjauan pustaka dengan berbagai referensi yang diakses melalui mesin pencarian seperti Pubmed dan Sci-Hub dengan menggunakan kata kunci preeclampsia, hypertension, postpartum, management. Sumber referensi yang digunakan yaitu guidelines, jurnal, dan buku teks yang diterbitkan dalam 15 tahun terakhir.Kesimpulan: Insiden preeklamsia di Indonesia yaitu 128.273/tahun atau sekitar 5,3%. Sebanyak 0,3 – 27,5% kasus yang dilaporkan mengalami preeklamsia atau hipertensi pascasalin. Gejala-gejala preeklamsia pascasalin muncul setelah melahirkan. Mayoritas kasus berkembang dalam 48 jam setelah persalinan, walaupun sindrom dapat muncul hingga 6 minggu setelah persalinan. Periode pascasalin merupakan waktu kritis bagi spesialis obstetri dan ginekologi untuk menjamin wanita dengan riwayat preeklamsia untuk dipantau dalam jangka waktu pendek dan panjang. Akan tetapi, pemantauan pascasalin sangatlah rendah, berkisar antara 20-60%. Pemilihan antihipertensi pasca salin yaitu berikatan kuat dengan protein dan solubilitas lipid yang rendah sehingga lebih sedikit yang masuk ke ASI. Selain itu, dipengaruhi juga oleh ionisasi, berat molekul dan konstituen ASI (kandungan lemak, protein, dan air). Agen lini pertama untuk preeklamsia pascasalin adalah labetalol dan hidralazin intravena serta nifedipin. Wanita dengan hipertensi gestasional ataupun preeklamsia biasanya dapat menghentikan antihipertensi dalam 6 minggu pasca salin.Postpartum PreeclampsiaAbstractObjective: To explain about etiologies and risk factors, differential diagnosis, pathophysiology, follow up, treatment, complications, recurrence, and prevention of preeclampsia post delivery discharged.Method: Literature review with several references accessed through search engines such as Pubmed and Sci-Hub by using keywords preeclampsia, hypertension, postpartum, management. Reference sources used are guidelines, journals, and textbooks published in the last 15 years.Conclusion: The incidence of preeclampsia in Indonesia is 128,273/year or around 5.3%. As many as 0.3-27.5% of cases reported postpartum preeclampsia or hypertension. Symptoms of postpartum preeclampsia appear after delivery. The majority of cases develop within 48 hours after delivery, although the syndrome can appear up to 6 weeks after delivery. The postpartum period is a critical time for obstetricians and gynecologists to ensure women with a history of preeclampsia are monitored in the short and long term. However, postpartum monitoring is very low, ranging from 20-60%. The choice of antihypertensive postpartum is that it is strongly bound to protein with low lipid solubility so that fewer enter breast milk. In addition, it is also influenced by ionization, molecular weight and constituents of breast milk (fat content, protein, and water). The first line agent for postpartum preeclampsia is intravenous labetolol and hydralazine and also nifedipine. Women with gestational hypertension or preeclampsia can usually stop antihypertension within 6 weeks postpartum.Key word: postpartum preeclampsia, antihypertension

Cardiac Disease in Pregnancy: Maternal and Perinatal Outcomes in RSUP Dr. Mohammad Hoesin Palembang Ni Made Dyah Gayatri; Peby Maulina Lestari; Abarham Martadiansyah; Nuswil Bernolian; Hadrians Kesuma Putra; Rizky Agustria; Muwarni Emasrissa Latifah
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 2 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i2.448

Background: Impaired maternal and uteroplacental perfusion can occur in pregnancy with cardiac disease leading to maternal and perinatal mortality and morbidity due to increased cardiac load and ventricular dysfunction. This research aims to determine maternal and perinatal outcomes of pregnancies with cardiac disease. Method: This research was a descriptive observational study conducted by total sampling method and cross-sectional design. This research used medical records of pregnant women with cardiac disease who gave birth in RSUP Dr. Mohammad Hoesin Palembang in January 2018-December 2020 as study samples. Result: Among 68 pregnancies with cardiac disease, there were 6 cases (0.87%) found in 2018, 38 cases (2.47%) found in 2019, and 24 cases (1.48%) found in 2020. The highest distribution of pregnancies with cardiac disease was found at 64.7% in the range of 20-35 years old age group; 57.4% in the multiparity group; 38.2% in the range of ≥34 – <37 weeks gestational age group; 86.8% in the high school educational level group; 66.2% in the high-risk cardiac functional status group; 54.4% in the peripartum cardiomyopathy group; and 36.8% with preeclampsia/eclampsia as a comorbid. In this study, maternal outcomes found were maternal mortality at 11.8%; cardiac failure at 70.6%; arrhythmia at 1.5%; and stroke at 1.5%, while perinatal outcomes found were prematurity at 60.3%; low birth weight at 64.4%; IUGR at 37.0%; IUFD at 1.4%; stillbirth at 6.8%; neonatal death at 9.6%; and perinatal asphyxia at 42.5%. Conclusion: The prevalence rate of pregnancies with cardiac disease in RSUP Dr. Mohammad Hoesin Palembang was 0.87% in 2018, 2.47% in 2019, and 1.48% in 2020. The most common maternal outcome in this study was cardiac failure, with most in the peripartum cardiomyopathy group, while the most common perinatal outcome was low birth weight, with most in the hypertensive heart disease group.

THE DIAGNOSTIC METHODS OF PLACENTA ACCRETA SPECTRUM DISORDERS Alia Desmalia; Nuswil Bernolian; Abarham Martadiansyah; Theodorus Theodorus; Citra Dewi; Putri Mirani; Peby Maulina Lestari; Cindy Kesty
Majalah Kedokteran Sriwijaya Vol 54, No 3 (2022): Majalah Kedokteran Sriwijaya
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/mks.v54i3.19655

Placenta Accreta Spectrum Disorder (PASD) is abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall. Magnetic resonance imaging (MRI) examination is one of the tools that can help diagnosing PASD earlier, so that maternal morbidity and mortality can be reduced. This study aims to determine the prevalence, risk factors of PASD and the accuracy of Placenta Accreta Index Score (PAIS) and MRI, with histopathological examination in diagnosing PASD at dr. Mohammad Hoesin General Hospital (RSMH) Palembang during the 2018–2021. A descriptive study with a survey design on pregnant and intrapartum women with suspected PASD was performed at Department of Obstetrics and Gynecology at RSMH Palembang from 2018 until 2021. There were 72 study subjects who met the inclusion criteria. The relationship between the independent and dependent variables was analyzed using Chi Square and Fisher Exact. The cut-off point of the PAIS scores was analyzed using the Receiver Operating Curve (ROC). The comparison of the diagnostic value of PAIS and MRI scores used the Youden Index. Data was analyzed with SPPS version 22.0 From 72 subjects, 60 subjects (83.3%) were PASD and 12 subjects (16.7%) were not PASD. The risk factors of PASD in this study was surgical history more than once (PR = 4.600 (95% CI 1.261–16.781); p = 0.037). Youden Index values and PAIS accuracy were 0.782 and 0.953 while Youden Index values and MRI accuracy were 0.333 and 0.886. PAIS and MRI could be considered as diagnostic tools for PASD. However, overall, PAIS had a better diagnostic value than MRI.

Hubungan Status Gizi dan Asupan Energi-Protein dengan Pertambahan Berat Badan Selama Hamil sebagai Risiko Maternal Kurniati, Ardesy Melizah; Partan, Radiyati Umi; Lestari, Peby Maulina; Liberty, Iche Andriyani
Bahasa Indonesia Vol 23 No 1 (2024): Damianus Journal of Medicine
Publisher : Atma Jaya Catholic University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25170/djm.v23i1.5409

Pendahuluan: Pertambahan berat badan selama kehamilan yang ideal diharapkan dapat mendukung persalinan yang aman. Status gizi ibu prakehamilan menjadi acuan dalam menentukan pertambahan berat badan yang ideal di setiap trimester kehamilan. Asupan gizi yang adekuat, terutama asupan energi dan protein, diharapkan dapat memenuhi kebutuhan ini. Status gizi prakehamilan dan asupan gizi yang tidak mencukupi merupakan risiko maternal yang harus dipantau. Penelitian ini memiliki tujuan utama untuk menganalisis hubungan antara status gizi ibu prakehamilan dan asupan energi-protein dengan pertambahan berat badan pada ibu hamil di Kecamatan Gandus. Metode: Penelitian ini memiliki desain cross-sectional menggunakan data primer. Ibu hamil trimester 2 dan 3 dengan kehamilan janin tunggal yang menghadiri kegiatan skrining kesehatan di Balai Kecamatan Gandus Palembang, memiliki data berat badan sebelum hamil, dan bersedia berpatisipasi direkrut sebagai responden penelitian. Responden menjalani pengukuran antropometri dan wawancara asupan energi-protein 1 bulan terakhir menggunakan formulir SQ-FFQ. Data dianalisis menggunakan Chi-Square (alternatif Fisher/Kolmogorov-Smirnov). Hasil: Sebanyak enam puluh ibu hamil berpartisipasi, sebagian besar berada pada rentang usia reproduktif, masa kehamilan trimester 3, dan beraktivitas sebagai ibu rumah tangga. Status gizi sebelum hamil sebagain besar berada pada berat badan lebih/obes dan tidak ditemukan status gizi kurang. Pertambahan berat badan ibu sebagian besar tidak memenuhi rekomendasi, demikian pula dengan asupan energi-protein. Terdapat hubungan bermakna antara status gizi prakehamilan dan pertambahan berat badan selama hamil (p=0,014). Tidak terdapat hubungan antara asupan energi maupun protein dengan pertambahan berat badan selama hamil. Simpulan: Status gizi prakehamilan berhubungan dengan pertambahan berat badan selama hamil, sebaliknya asupan energi-protein tidak berhubungan.

Pulmonary hypertension in pregnancy Bernolian, Nuswil; Kesty, Cindy; Mirani, Putri; Lestari, Peby Maulina; Martadiansyah, Abarham; Agustria, Rizky
Indonesian Journal of Perinatology Vol. 5 No. 1 (2024): Available online: 1 June 2024
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v5i1.36

Pulmonary hypertension (PH) is a persistent increase in mean pulmonary arterial pressure (mPAP) of at least 20–25 mm Hg during right cardiac catheterization. For every million patients, there were 97 PH cases. Women are more likely than men (1.7:1) to receive a diagnosis, with a mean age of 37 years. The classification, pathophysiology, mechanism, and management of postpartum hemorrhage (PH) are the main aims of this review study. Pulmonary artery hypertension (PAH), pulmonary hypertension (PH) associated with left heart disease, pulmonary hypoxia and/or lung illnesses, chronic thromboembolic PH, and PH with unknown multifactorial processes are the five categories into which PH is divided. Women, particularly those of reproductive age, make up about 80% of individuals with idiopathic PAH. Pregnancy-related PH is one of the long-standing heart conditions with a significant morbidity and mortality rate. Its estimated death rate ranges from 30.56%. Pregnancy is therefore not advised in PH patients. Treating people with PH requires early diagnosis and effective treatment. These patients have optimism because of the impending PH medications (phosphodiesterase type 5 inhibitors, nitric oxide, endothelin receptor antagonists, and calcium channel blockers) as well as the advancements in hemodynamic monitoring and intensive care in PH specialty facilities. Pregnant women with PH should be treated with a multidisciplinary approach, such as obstetricians, cardiologists, intensivists, and neonatologists.

CXC Motif Chemokine Receptor 2: Glimpses into the Molecular Pathogenesis of Placenta Accreta Spectrum Disorder Mirani, Putri; Lestari, Peby Maulina; Murti, Krisna; Liberty, Iche Andriyani; Kesty, Cindy; Andrina, Hana; Stevanny, Bella
Indonesian Journal of Obstetrics & Gynecology Science Volume 7 Nomor 1 Maret 2024
Publisher : Dep/SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/obgynia.v7i1.481

Investigation into the mechanism underlying excessive trophoblast invasion yields further strategies and insights for the diagnosis and treatment of placenta accreta spectrum disorder (PASD). We conducted a comprehensive literature review to analyze the relationship between CXCR2 expression and PASD, as well as the possibility of CXCR2 being used as a therapeutic and diagnostic biomarker for PASD. Chemokines are well-known mediators in the immune system, particularly for cell recruitment, angiogenesis, and tumor infiltration. CXCR2 is an important component of the immune system, particularly in neutrophils. One of the CXCR2 ligands, IL-8, has also been found to be expressed in the decidua and trophoblasts of humans and to promote autocrine or paracrine trophoblast migration and invasion. The potential role of CXCR2 in trophoblast invasion in PASD provides researchers with a glimpse into the molecular pathogenesis of PASD.CXC Motif Chemokine Receptor 2: Sekilas tentang Patogenesis Molekuler Gangguan Spektrum Plasenta AkretaAbstrakInvestigasi mekanisme invasi berlebihan trofoblas pada gangguan Spektrum Plasenta Akreta (SPA) akan memberikan lebih banyak strategi dan ide untuk diagnosis dan pengobatan. Kami melakukan tinjauan literatur yang komprehensif untuk menganalisis hubungan antara ekspresi CXCR2 dan SPA serta potensi CXCR2 sebagai penanda terapeutik dan diagnostik untuk SPA. Kemokin berperan sebagai mediator dalam sistem imun karena perannya dalam perekrutan sel, angiogenesis, dan infiltrasi tumor. CXCR2 mempengaruhi sistem imun, terutama pada neutrofil. Salah satu ligan CXCR2, IL-8, juga telah ditemukan diekspresikan dalam desidua dan trofoblas manusia serta untuk mempromosikan migrasi dan invasi trofoblas autokrin atau parakrin. Peran CXCR2 dalam invasi trofoblas pada SPA memungkinkan para peneliti untuk melihat sekilas patogenesis molekuler SPA.Kata kunci: penanda; CXCR2; plasenta akreta

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