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Maternal Outcomes with Twelve Hour versus Twenty Four Hour Maintenance Doses Of Magnesium Sulfate in Severe Postpartum Preeclampsia Dwi Putri, Ratu Astuti; Suhaimi, Donel; Hamidy, Yulis; Zulmaeta; Febriani; Yusuf, Muhammad
Indonesian Journal of Obstetrics and Gynecology Volume 13. No. 2 April 2025
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v13i2.2179

Introduction: Severe preeclampsia is a serious emergency that can complicate pregnancy and even lead to maternal death. It contributes to a significant increase in morbidity and mortality rates, affecting over 70,000 mothers. The cause of severe preeclampsia is still uncertain, but its management is continuously being developed to achieve the best possible outcomes for both the mother and baby. Magnesium sulfate (MgSO4) is the preferred treatment for preventing seizures in severe preeclampsia, as it has minimal side effects and is effective. However, there is a need for further research on reducing the duration of MgSO4 administration in Indonesia. Method: A clinical trial was carried out with 80 participants divided into two groups (control and trial), using randomized and double-blind methods. The study was conducted at multiple hospitals including Arifin Achmad Hospital, Tengku Rafian Hospital, Dumai City Hospital, Selasih Hospital, and Bengkalis Hospital from October 2022 to February 2023. The data collected was analyzed to evaluate maternal outcomes for both groups. The study was approved by Ethical Review Board for Medicine and Health and registered with the Thai Clinical Trials Registry (TCTR 20230811008) once the data was assessed. Results: This study examined pregnant women with severe preeclampsia, who were on average 30.98±6.04 years old, with 68.8% having had multiple pregnancies. Their gestational age was 33.37±2.88 weeks and the majority (72.5%) had a cesarean delivery. Their systolic blood pressure was 167.68±14.24mmHg and diastolic was 110.32±18.52mmHg. The study did not report on the incidence of eclampsia or maternal mortality, and there was no significant difference in serum magnesium sulfate levels between the two groups (p>0.005). Conclusions: Administering maintenance doses of MgSO4 for both 12 and 24 hours had similar effectiveness in preventing eclampsia, but the 12-hour group saw better outcomes for the mother. Keywords: Magnesium sulfate, Postpartum, Severe preeclampsia, 12 hours, 24 hours

Adjunctive Vaginal Probiotic Therapy for Preterm Premature Rupture of Membranes: A Systematic Review and Meta-Analysis of Latency Period, Maternal Infection, and Neonatal Morbidity Vani Ardiani; Donel S; Maya Savira; Zulmaeta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1484

Background: Preterm premature rupture of membranes (PPROM) significantly drives preterm birth rates and consequent neonatal morbidity and mortality. While standard antibiotic therapy aims to prolong pregnancy latency, it concurrently disrupts the protective vaginal microbiota. Adjunctive vaginal probiotics have been investigated as a means to restore beneficial flora, potentially mitigating ascending infection and improving perinatal outcomes. This study systematically synthesized the current randomized trial evidence regarding this adjunctive therapeutic strategy. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. PubMed, EMBASE, and CENTRAL databases were searched (2014–October 2025) for randomized controlled trials (RCTs) comparing adjunctive vaginal probiotics plus antibiotics versus antibiotics (alone or with placebo) in singleton pregnancies complicated by PPROM between 24+0 and 34+0 weeks’ gestation. Primary outcomes included the latency period (days) and maternal chorioamnionitis or infectious morbidity. Key secondary outcomes were neonatal intensive care unit (NICU) admission, neonatal sepsis, and neonatal mortality. Data were pooled using a random-effects model, calculating Mean Differences (MD) or Risk Ratios (RR) with 95% Confidence Intervals (CI). Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Three RCTs, encompassing 330 participants, met the inclusion criteria. Significant methodological limitations, including high risk of bias and critical baseline confounding by gestational age in the largest trial, were identified across the included studies. A sensitivity analysis addressing high heterogeneity (I²=98%) for latency (excluding one retrospective study; n=290) indicated a modest but statistically significant prolongation associated with probiotics (MD 2.98 days; 95% CI 1.80–4.16; p<0.0001; I²=0%). Probiotic use was linked to a significantly lower risk of maternal infection (RR 0.43; 95% CI 0.24–0.77; p=0.005; I²=0%; n=270). Statistically significant reductions were also observed for NICU admission (RR 0.59; 95% CI 0.46–0.75; p<0.0001; I²=55%; n=330) and neonatal mortality (RR 0.38; 95% CI 0.18–0.81; p=0.01; I²=0%; n=270), although these estimates are likely inflated due to baseline confounding. Conclusion: This meta-analysis suggests adjunctive vaginal probiotics may offer benefits in PPROM management by modestly prolonging latency and significantly reducing maternal infectious morbidity. While substantial reductions in NICU admission and neonatal mortality were observed, these findings must be interpreted with extreme caution due to the limited quantity and low quality of the primary evidence, particularly the high risk of bias and confounding. Definitive conclusions cannot be drawn, and routine clinical adoption is not supported by current evidence. High-quality, large-scale RCTs are imperative.

Successful Autologous Blood Patch Pleurodesis: A Safe and Useful Treatment for Persistent Pneumothorax in Former Pulmonary Tuberculosis and Aspergillosis in Pregnant Women Purnama, Nori; Simatupang, Elvando Tunggul Mauliate; Fauzi, Zarfiardy Aksa; Indriani, Sri; Yovi, Indra; Hatta, Hariadi; Zulmaeta
Malang Respiratory Journal Vol. 6 No. 1 (2024): March 2024 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2024.006.01.04

Background: Autologous Blood Patch Pleurodesis (ABPP) is one of the treatment options for persistent pleural air leaks especially in patients who are not suitable for surgical intervention. Persistence pneumothorax is defined as pneumothorax of more than five days duration. It is associated with increased morbidity and cost of care. The most widely accepted treatment for it is pleurodesis. Several types of pleurodesis have been proposed, including surgical approaches and the instillation of different chemicals in the intrapleural space. ABPP has proven to be a simple, inexpensive, efficacious and safe method. We present the case of the first patient with Persistent Pneumothorax we have treated Successfully with ABPP. ABPP is currently rarely and uncommonly used, but it provides benefits especially in special conditions with easier, cheaper, and quite effective procedures. Case: A female 35-year-old pregnant women patients with Former Tuberculosis (FTB) come to our hospital with complaints breathlessness and chest pain worsening since 3 days before admitted to our hospital. Chest radiography showed spontaneous pneumothorax with GeneXpert (GE) sputum Mtb Not Detected but there is Aspergillosis from Fungal Culture. Water Sealed Drainage (WSD) was inserted in right pleural for almost 1 month and this patient discharge with pneumostat. One month after that she come again with Persistence Pneumothotax, so that we do the pleurodesis with Blood Patch and get the improvement from clinical status. Antifungals are continued for an initial 4-6 weeks while an outpatient evaluation is conducted. Conclusion: ABPP is a safe, inexpensive and efficacious treatment for persistent pleural air leak. Autologous Blood Patch administration may be considered for patients with Persistent Pneumothorax.

Adjunctive Vaginal Probiotic Therapy for Preterm Premature Rupture of Membranes: A Systematic Review and Meta-Analysis of Latency Period, Maternal Infection, and Neonatal Morbidity Vani Ardiani; Donel S; Maya Savira; Zulmaeta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1484

Background: Preterm premature rupture of membranes (PPROM) significantly drives preterm birth rates and consequent neonatal morbidity and mortality. While standard antibiotic therapy aims to prolong pregnancy latency, it concurrently disrupts the protective vaginal microbiota. Adjunctive vaginal probiotics have been investigated as a means to restore beneficial flora, potentially mitigating ascending infection and improving perinatal outcomes. This study systematically synthesized the current randomized trial evidence regarding this adjunctive therapeutic strategy. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. PubMed, EMBASE, and CENTRAL databases were searched (2014–October 2025) for randomized controlled trials (RCTs) comparing adjunctive vaginal probiotics plus antibiotics versus antibiotics (alone or with placebo) in singleton pregnancies complicated by PPROM between 24+0 and 34+0 weeks’ gestation. Primary outcomes included the latency period (days) and maternal chorioamnionitis or infectious morbidity. Key secondary outcomes were neonatal intensive care unit (NICU) admission, neonatal sepsis, and neonatal mortality. Data were pooled using a random-effects model, calculating Mean Differences (MD) or Risk Ratios (RR) with 95% Confidence Intervals (CI). Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Three RCTs, encompassing 330 participants, met the inclusion criteria. Significant methodological limitations, including high risk of bias and critical baseline confounding by gestational age in the largest trial, were identified across the included studies. A sensitivity analysis addressing high heterogeneity (I²=98%) for latency (excluding one retrospective study; n=290) indicated a modest but statistically significant prolongation associated with probiotics (MD 2.98 days; 95% CI 1.80–4.16; p<0.0001; I²=0%). Probiotic use was linked to a significantly lower risk of maternal infection (RR 0.43; 95% CI 0.24–0.77; p=0.005; I²=0%; n=270). Statistically significant reductions were also observed for NICU admission (RR 0.59; 95% CI 0.46–0.75; p<0.0001; I²=55%; n=330) and neonatal mortality (RR 0.38; 95% CI 0.18–0.81; p=0.01; I²=0%; n=270), although these estimates are likely inflated due to baseline confounding. Conclusion: This meta-analysis suggests adjunctive vaginal probiotics may offer benefits in PPROM management by modestly prolonging latency and significantly reducing maternal infectious morbidity. While substantial reductions in NICU admission and neonatal mortality were observed, these findings must be interpreted with extreme caution due to the limited quantity and low quality of the primary evidence, particularly the high risk of bias and confounding. Definitive conclusions cannot be drawn, and routine clinical adoption is not supported by current evidence. High-quality, large-scale RCTs are imperative.

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