Objective. To determine: 1) Is CD56 + CD16 pNK cells higher in early idiopathic recurrent miscarriages compared to normal patients? 2) Are CD56 + CD16 + pNK cells lower in early idiopathic recurrent miscarriages compared to normal patients? 3) Are there any associations between CD56 + CD16 + pNK cells with early idiopathic recurrent miscarriage?Methods. This study was an observational analytic study with cross sectional design comparing CD56+ CD16+ CD3+ in patients with recurrent early idiopathic miscarriage (case group) with patients who had offspring (control group). This study was conducted at the Department of Obstetrics and Gynecology H. Adam Malik General Hospital Medan and several hospitals network. The study was conducted by taking blood samples in the luteal phase, and CD56 +, CD16 +, and were examined. Data analysis using SPSS computer program. This study was conducted on the approval of the patient and has been approved by the Ethics Committee of University of Sumatera Utara Medical Faculty.Results. The mean score of CD56 + CD16 +% lymph of the early idiopathic recurrent miscarriage group was lower than the control groups mean score, but the statistical test results with the Mann-Whitney test showed no significant difference in the CD56 + CD16 +% lymph score of the early idiopathic recurrent miscarriage group with the control group. The mean score of CD56 + CD16 + Abs Count of the recurrent idiopathic early recurrent miscarriage group was lower than the mean score of CD56 + CD16 + Abs Count of the control group, and the statistical test results with the Mann- Whitney test showed no significant difference in CD56 + CD16 + Abs Count values of recurrent idiopathic early recurrence with the control group. The ROC value of serum CD56 + CD16 +% lymph level was 0.63. Cut off point is 7.50 with sensitivity of 82% and specificity of 46%. The ROC value of serum CD16 + CD56 + Abs Count was 0.73. The cut off point was 197.50 with a sensitivity of 82% and a specificity of 64.Conclusion. The score of CD56 + CD16 + cell pNK values were lower in the group of patients with early idiopathic recurrent miscarriage than the control group. CD56 + CD16 + pNK cells have been shown to be associated with early idiopathic recurrent miscarriage.
Background. IUGR (Intrauterine Growth Restriction) increases the morbidity and mortality of fetuses and, in the future, it will lead to fetal programming such as hypertension, diabetes mellitus, stroke and kidney failure.Objective. To determine renal volume and function in Normal and Growth Restricted Fetuses at 36 weeks gestation.Methods. A cohort study was conducted for 28 up to 36 weeks gestation in 20 IUGR fetuses compared with normal fetuses by examining renal volume, the volume of the secretion of urine, amniotic fluid index. Examination of renal volume is conducted with 3D VOCAL technique with 30 degrees rotation, as well as upon the volume of the bladder.Results. The mean left kidney volumes of IUGR and normal fetuses were 6.47 ml, SD 1.85 ml and 11.09, SD 2.91 ml respectively. It was statistically and significantly different based on Mann-Whitney test at p 0.001. On the other side, the mean right kidney volumes of IUGR fetuses and the normal ones were also statistically and significantly different. They were 6.07 ml, SD 1.9 and 10.75 ml, SD 3.35 ml respectively.The mean of urine volume per hour of IUGR fetuses was 8.21 ml, SD 3.48 ml and the normal ones were 19.23 cc, SD 5.79 which was statistically different. Although it had not reached oligohydramnios but the amount of amniotic fluid of IUGR fetuses was less than that of the normal ones, it signified 6.57 ml, SD 2.28 ml compared to 11.85 SD 2.53 respectively. Such different figures were statistically and significantly different at p 0.001.Conclusion. Fetal renal volume with growth restriction is lower than that of the normal ones and so does the secretion of urine between the two groups of the fetuses. It is also discovered that the volume of amniotic fluid index of IUGR fetuses is lower too than that of the normal fetuses.
Introduction. Preeclampsia (PE) is a multisystem syndrome of the second half of pregnancy characterized by hypertension, proteinuria and maternal organ dysfunction. It affects 2-8% of all pregnancies worldwide and is a leading cause of both maternal and perinatal death. Moreover, PE is in high percentage associated with fetal prematurity.Material and methods. This study is a literature review of articles published from 2006 to 2017, held in the following databases: PUBMED, Scientific Electronic Library Online (SciELO), and online Knowledge Library (B-ON). For this research 51 articles responding to inclusion criteria and key words regarding preeclampsia screening and similar works were selected.Results. More than 50,000 maternal deaths per year worldwide are a consequence of PE. Among most serious complications Elevated Liver enzymes and Low Platelets (HELLP syndrome), eclampsia, stroke, disseminated intravascular coagulation (DIC) are considered. It is mandatory to screen pregnant women during first trimester according both maternal characteristics and parameters.Conclusion. Owing placental alteration linked with PP, an opportune screening of risk population and aspirin administration (150 mg per day from 11-14 weeks until 36 weeks' gestation) may reduce maternal and fetal complications, while for chronic hypertension the benefits of this treatment during pregnancy is controversial.
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia 2 Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia 3 Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia Corresponding author: Anditha Sitompul, e-mail: anditha.namira@gmail.com The role of placental growth factor, soluble-Fms-like tyrosine kinase-1 and diastolic notch uterine artery to predict the early onset of preeclampsia M.P. LUBIS1, H. HARIMAN2, S.N. LUMBANRAJA1, A. BACHTIAR3
Aim. Estimation of gestational age on basis of Last Menstrual period is reliable and universally followed. Ultrasound gives an objective evidence and dates pregnancy based on crown rump length, biparietal diameter, head circumference, abdominal circumference and femur length. Patients with uncertain dating in third trimester require a simple easy reproducible method when parameters are lagging behind and fetal kidney length can be used as an indicator for gestational age. Materials and methods. A total of 100 well dated normal pregnant patients were studied in third trimester using ultrasound and 3.5 mHz probe and purposive sampling technique. The fetal kidney size was measured and compared with other standard parameters used in pregnancy dating by Ultrasound. Statistical analysis was done using Karl Pearson coefficient and significance was found by student "t" test. Analysis was computed using statistical package SPSS version 11.5.P value is expressed in correlation coefficient. The third trimester was divided into two groups 28-34 weeks and 34-41 weeks. Results. The mean Kidney length was measured and was in the range of 28-38 mm in the first group A and 31-41 mm in second group B. Linear coefficient of individual parameters BPD, HC, AC, FL with gestational age showed strong correlation. Kidney length also showed strong correlation as compared to these parameters. Conclusion. Measurement of Kidney length is of value when other parameters do not accurately predict gestational age and is not affected by growth aberrations and artifacts associated with other standard parameters. What is new in this paper. This paper studies the possibility of using fetal kidney as a biometric indicator for fetal growth when BPD HC AC and FL are inconclusive due to any cause.
The Authors report a case of a perineal lesion in a 9-year-old girl hit by a SUV while she was running out of her stepfathers shop. This kind of injury was compatible with a sexual abuse, supported by the history of her stepfather, a man with criminal records for this kind of crime. At first the inquiries strongly pointed to the sexual abuse and showed that the road accident had occurred unexpectedly, while the child was trying to elude her stepfather. However on demand of the medical examiner new witness evidence had been admitted together with a survey of the SUV. Only after these further inquiries the forensic pathologist, together with the gynecologist, excluded any hypothesis of violence and declared that the perineal injury was due to the running over. In such events a multidisciplinary approach is fundamental, led by the experience of the physicians involved.
Introduction. Placenta influences foetal birth weight and it is thought that abnormalities in placental growth precede abnormalities in foetal growth. Methods. 225 antenatal women between 12 to 40 weeks of gestation with known LMP, which had been confirmed by first trimester ultrasound, had an ultrasound and BPD, HC, AC and FL were measured according to the standard protocols. Placental thickness in cm was measured. Gestational age was computed by the ultrasound machine based on Hadlock tables by using regression equations from combination of measurements (computation software package). The Correlation and regression analysis was carried out to quantify the relationship between the gestational age in weeks, growth parameters and Placental thickness in cm in all patients. results. Total number of subjects analyzed were 225. The range for thickness of placenta measured was 1.3 3.9 cm and the mean placental thickness was 2.748 cm. When the placental thickness of the entire study population was compared with the gestational age, a coefficient of correlation (r) = 0.972 was obtained which was statistically significant [p< 0.001]. Conclusion. Placental thickness correlated well with foetal biometric parameters routinely used in antenatal ultrasound.
The aim of this research was to determine differences in HE4 urine levels in women with ovariancyst and normalovary. This research is a comparative analytic,using case control design. This research was conducted in RSUPH. Adam Malik Medan, dr.Pirngadi Medan and the networking hospitals of the Department of Obstetries and Gynecology of Faculty of Medicine University of North Sumatera from September 2017 to February 2018. The sample is ovarian cyst patients which met the inclusion and exclusion criteria, compared to control group which are women with normal ovary. The mean rank of HE4 level of ovarian cyst patient is 56,35, with the median of 76,41, and min-max 42,40-92,80. Meanwhile in patient with normal ovary, the mean rank of urine HE4 is 24,64, with the median of 49,11, and min-max 30-69. With Mann-Whitney test, p value is 0,000 (p<0,05),showing a significant differences. The mean urine HE4 levels of ovarian cyst are significantly higher than that of in normal ovary.
The rationale for this study is in the lack of precise data on the role of urogenital opportunistic pathogenic infection in uterine cervix pathologies development. The purpose of the work is to make a clinical laboratory evaluation of the role of urogenital opportunistic pathogenic flora in etiology and pathogenesis of pathological uterine cervix conditions and to identify possible preventive measures to uterine cervix development. The main method used was clinical laboratory study of uterine cervix cells and tissue condition in 151 patients before and after the treatment, which allowed the Authors to prove the role of urogenital opportunistic pathogenic infection in uterine cervix pathologies development and cells homeostasis disorders. Before the treatment, different uterine cervix pathologies were not identified only in 17.2% of the patients, normal cytogram was observed in 12.6% of patients. After the treatment, uterine cervix pathologies were not identified in 72.9% of patients, normal cytogram was observed in 54.3% of patients, i.e. the number of cured patients increased by more than 4 times. Thus, the role of urogenital opportunistic pathogenic infection in uterine cervix disease development and cells homeostasis disorders was proved. The results of the present study confirmed the role of the urogenital opportunistic pathogenic infection in uterine cervix cells and tissues condition and cells homeostasis disorders, which identified primary preventive measure of cervix neoplasms development. The materials of the present study can be useful for dermatovenerologists and obstetricians that are involved in treatment of patients from the mentioned above category.
Community empowerment is defined as a process whereby individuals, organizations and communities gain control over their life. In relation to the definition of community empowerment, this study aims to determine the effect of empowerment of women of childbearing age on cervical cancer prevention behavior. This study is a quasi-experiment which was conducted on women of childbearing age in two areas: Perwiritan and Moria in Titirantai village, Medan Baru district, in the area of community healthcare center/Puskesmas Padang Bulan in Medan. Using purposive sampling technique, 60 women of childbearing age were examined as sample of this study. Data was analyzed through paired t-test and logistic regression analysis. Findings found that there is a significant difference of mean on knowledge, attitude and action of women of childbearing age before and after empowerment (p <0.05). The OR of knowledge after interacting with the confounding variable is at 0.162 and action at 4.875. Thus, this research suggests that empowerment is an effective way in improving behavior of women of childbearing age on early detection of cervical cancer. In addition, empowerment of women of childbearing age can also be used as one of the primary or secondary prevention programs on cervical cancer especially for housewives.
The urgency of the investigated issue is caused by the problem of female infertility, in which the leading cause is the tubal peritoneal factor (the frequency of which does not tend to decrease), as well as inflammatory diseases of the uterine appendages, which lead to the formation of peritubar adhesions and occlusions of the fallopian tubes. Therefore, at present the fallopian tube is considered as one of the important structures in the female reproductive system. The article is aimed at studying the issues of lymphoid structures anatomy in the walls of the fallopian tubes in postnatal ontogenesis.One of the approaches to investigating this problem is the immunohistological method which makes it possible to reveal the state of the fallopian tubes in women at different phases of the menstrual cycle. For the study, 2000 pairs of fallopian tubes obtained from the corpses of women who died from accidental causes and did not have pathology at the level of the reproductive and immune systems were used. The histological examination of the endometrium was performed. The microanatomical sections of the fallopian tubes were divided into three parts: the isthmus, the ampulla and the infundibulum. Histological sections were stained with standard methods. Variation-statistical processing of the results was carried out by conventional methods.In the fallopian tubes during the studied periods of postnatal ontogenesis, diffuse lymphoid tissue is constantly present, in which under the influence of hormonal changes there are variously directed changes in the factors of innate immunity. The structure possesses the following characteristic features: it is rich in lymphoid cells the ratio of which changes not only with age but under the influence of external factors.The hormonal activity causes changes in the lymphoid structures of the mucous membrane of the fallopian tubes, which leads to a decrease in the immune response and causes atrophic changes in the mucous membrane of the female genital organs.The materials of the article can be useful for the studies developing complex problematics of correlation changes in the fallopian tube in case of its pathology within the genital tract.
Vasomotor symptoms (hot flushes, sweats) are the most frequent problems in menopausal period. Pathophysiology of vasomotor symptoms is based on estrogen decrease, alteration of neurotransmitters levels (serotonin, noradrenalin) and on dysregulation of systemic arterial tree. Hormone Replacement Therapy is a first-line treatment in the management of climacteric syndrome. Other non-hormonal therapies include drugs with central action as Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Noradrenalin Reuptake Inhibitors (SNRIs). A purified pollen extract has demonstrated to improve vasomotor symptoms and quality of life in premenopausal and postmenopausal women in randomized placebo-controlled trials. Its mechanism of action is based on a SSRI-like activity, through the inhibition of serotonin reuptake.
Aim The uterine mioma is located within the hyperestrogenic environment. The determination of aromatase expression is incredibly important to determine the pathogenesis and management. Method The Research is analytic (cross-sectional) observation to 24 block pyrroffin with immunohistochemical (IHC) examination to know the difference between aromatase expression of uterine and surrounding uterine tissues. Result Statistically, its significantly found the correlation between the aromatase expression towards the distance, the further the distance of miometrium from uterine myoma the lower the expression of aromatase enzyme (r = -0.563; p = 0.00). Conclusion the Expression of aromatase in miometrium is around myoma is lower than uterine myoma, because uterine myomas can synthesize the estrogen and it has the localized aromatization in tissues that have cell growth promoting effect.
Background. Menopause is the cessation of menstruation at least 12 months, begins at the age of 45-50 years and is accompanied by the declined of estrogen and progesterone hormones, causing complaints such as the decline in cognitive function. Hormone replacement therapy such as estradiol valerate and norgestrel can reduce complaints and reduce the risk of dementia.Objective. To assessed the difference in cognitive function with the administration of estradiol valerate 2 mg and norgestrel 0.5 mg which assessed by IQCODE on menopausal paramedics.Methods. This study is an experimental quasi research with prepost design conducted in July-December 2017. The study subjects were 40 menopausal paramedics at H. Adam Malik General Hospital and selected by consecutive sampling. Study subjects were asked to fill out the IQCODE questionnaire and will be excluded if the result is improvement and no change. Study subjects were asked to consume estradiol valerate 2 mg and norgestrel 0.5 mg for 3 months then cognitive function will be revalued. Data were analyzed using T-paired test.Results. Out of the 40 study subjects, 2 had improvement and no change, while the other 2 subjects were excluded due to tachycardia and loss to follow-up. The most often encountered characteristics of study subjects were the 50-59 years group (72.2%), multiparous (91.7%), overweight (63.9%) with duration of menopause for 2 years (36.1%).The mean score of IQCODE before and after intervention was 3.59 +/- 0.26 and 3.18 +/- 0.29 and there was a relationship between administering estradiol valerate and norgestrel with cognitive function. Conclusion. There was a significant association between administering estradiol valerate 2 mg and norgestrel 0.5 mg with cognitive function (p < 0,05).
Objective. To know the pattern of resistance of micro-organisms causing leucorrhea in post-menopausal women.Methods. A descriptive cross sectional study, conducted in Department of Obstetrics and Gynecology H. Adam Malik General Hospital Medan as Universitas Sumatera Utara's Teaching Hospital and other its networking hospitals. When the study began in January 2016 until December 2017, the sampling was done by consecutive sampling, with samples count were 126 post-menopausal women. Vaginal secretions were taken from the posterior fornix or lateral vaginal wall, sent to the Microbiology Department of Faculty of Medicine Universitas Sumatera Utara, to be cultured into the media: Sabaroud Dextrose Agar (SDA), Blood Agar, Mac Conkey (MC) and then tested the resistance.Results. From 126 post-menopausal women, most of respondents was 40-50 years old (57.1%) with mean ages of 50.6 years old and mean menopause time of 4.5 years, most of respondents 39 people (31 %) in high education, most of them (120 people) is still in couple (95.2%).Candida albicans was the most common cause of vaginal discharge (52.4%), Staphylococcus aureus (26.2%), and Escherichia coli (16.7%). While Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis and none of the parasites Trichomonas sp were not found. From the resistance test there are 18 (87.7%) Escherichia coli which is sensitive to Ciprofloxacin, there are 18 (54.55%) sample of Staphylococcus aureus which is sensitive to Vancomycin and all sample with Candida albicans (100%) sensitive to Fluconazole.Conclusion. The most common micro-organisms causing leucorrhea in post-menopausal is Candida albicans and all of them are sensitive to Fluconazole.
Aim. To assess the efficacy of Evandol, a novel food supplement containing Boswellia (BosLiq (R)), myrrh (MyrLiq (R)), pineapple and seed oil from Buglossoides arvensis, in reducing the pain score during and post intrauterine device (IUD) insertion in nulliparous women.Method. Patients that were to undergo IUD insertion were assigned to the treatment group and patients with the same baseline characteristics were assigned to the control group retrospectively. Patients in the treatment group took Evandol four days prior to IUD insertion and continued for three days post insertion. The control group patients did not receive Evandol therapy. Pain scores were recorded based on the Numerical Rating Scale (NRS) immediately after insertion and three days post insertion from both groups.Results. There were significant differences between the control and the treatment group in terms of pain scores at the time of IUD insertion and at three days after insertion. The Evandol treated patients were primed four days before the insertion, leading to significant reduction of pain at the time of insertion. Evandol maintained its pain relief capacity even after three days as evidenced by significantly different pain scores for the control group.Conclusions. Evandol, a unique herbal preparation, could help women overcome fear of pain during IUD insertion as evidenced by reduction in the pain score during insertion. Evandol seems to eliminate pain more efficiently compared to the control group after three days of post insertion. Further studies are needed to explore the temporal dynamics of pain relief in the days after insertion.What is new in this paper? This study reports for the first time the beneficial effect of the novel herbal preparation Evandol as a possible acute pain relief solution for nulliparous women undergoing IUD insertion. Evandol could be administered in day clinics as an alternative to pharmacological preparations to overcome fear of pain without side effects.
Aim. The purpose of the study was to assess the obstetric outcomes in users of the Trento family planning centre who obtained voluntary termination certification between 01/01/2003 and 31/12/2017, by comparing the social and demographic characteristics of women who chose to have a termination with those of women who decide to continue their pregnancy.Methods. The data concerning the users of Trento family planning centre who obtained termination certification are entered in a dedicated database. For each case, we collected a series of variables, most of which are the same as those recorded with the D12 template, the tool the Italian Institute of Statistics uses to monitor terminations. For each case relating to a woman residing in the province of Trento we assessed the obstetric outcomes in the 9 months following the issuance of the termination certificate, using the appropriate Trento health authority archives: births register, miscarriage register and the Accident & Emergency Dept. records. A multiple logistic regression model was used to evaluate the differences in the social and demographic characteristics of women who opted for a termination and those who decided to continue their pregnancy.Results. Of the 3563 female residents to whom Trento family planning centre issued a termination certificate in the period 2003-2017, it was observed that, with the exception of 46 cases that could not be confirmed, 82.6% actually had a termination, 6.0% had a miscarriage after having planned a termination, 0.6% decided to continue their pregnancy and subsequently had a miscarriage and 9.6% decided to continue the pregnancy and actually gave birth. The trend over time for cases of termination is not statistically significant and the social and demographic factors associated with the likelihood of continuing the pregnancy are: age between 30 and 34 years rather than minors, being married/cohabiting rather than single, being of a non-EU nationality, being nulliparous or primiparous rather than pluriparous, not having had a termination in the past.Conclusion. Issuance of a termination certificate does not automatically entail the performance of a termination procedure. By Italian law, women must be allowed adequate time to decide. The woman's social and demographic characteristics weigh heavily on the final decision. Family planning centres can provide great support to women's health when they interact correctly with the other health services. Interaction with local epidemiological services can afford a more accurate assessment of its work.What is new in this paper. The issuance of a termination certificate does not necessarily lead to the performance of a termination procedure. 8 out of 10 cases actually have a termination. Women's social and demographic characteristics weigh heavily on their final decision. Interaction with local epidemiological services can afford family planning centres a more accurate assessment of their work.
Background. Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality. Lactate dehydrogenase levels are usually elevated in this condition and hence measuring LDH levels will help in identification of preeclampsia.Objectives. To study the correlation of Lactate dehydrogenase levels with maternal and perinatal outcome in preeclampsia and to assess the severity of disease in association with LDH levels.Study Design. Prospective comparative study.Material and methods. Pregnant women diagnosed with preeclampsia were enrolled in the study conducted at hospitals attached to Kasturba Medical College, Mangalore from September 2015 to March 2017 after approval from the institutional ethical committee. Serum LDH levels were measured and the women were categorized based on its levels and they were monitored till delivery. Maternal and perinatal outcomes and severity of disease were analyzed according to the levels of serum LDH.Results. A total of 90 patients with preeclampsia was studied. Mean LDH levels were found to be 646.95 IU/l. In mild preeclamptic women, LDH levels were < 600IU/L. In severe preeclampsia, 20 (44.25%) had LDH levels 800 IU/l. Higher LDH suggested increase in severity of disease which was found to be statistically significant. LDH was more than 600IU/L in 32(71%) of women with Systolic BP>160 mmHg and 14(31%) of women with Diastolic BP >110 mmHg. There was a significant association between serum LDH levels and fetal growth restriction, intra uterine fetal demise, low birth weight and low APGAR scores in neonates. Abruption placentae, Eclampsia and disseminated intravascular coagulation were associated with LDH >800IU/L.Conclusion. Preeclampsia is one of the most common causes for maternal and perinatal morbidity and mortality. Lactate Dehydrogenase (LDH) is a good indicator in assessing the severity in preeclampsia and also can help in early diagnosis and treatment and reducing the complications in mother and fetus.What is new in this Paper? Preeclampsia is a condition which is difficult to diagnose. Serum markers like Lactate dehydrogenase levels are usually elevated in preeclamptic women. In our study, we found that higher levels of LDH are associated with complications like abruption, eclampsia and DIC and perinatal morbidity.
Background. Uterine fibroid is a gynecological problem that frequently occurs to women in reproductive age. Based on World Health Organization (WHO), in 2010, uterine fibroid was estimated occurred in approximately 20-25% women worldwide, while in Indonesia, the incidence was 2.39-11.7%. Estrogen is one of the things that takes a role in uterine fibroid development. 17 beta-hydroxysteroid dehydrogenase type 1 (17 beta-HSD1) is a type of 17 beta-HSD enzyme that most often is associated in estrogen metabolism.Objective. To determine the difference in expression of 17 beta-HSD1 enzyme in uterine fibroid and normal myometrium.Methods. This study is a case control study that was conducted in each 20 tissues of uterine fibroid and normal myometrium of the same uterine that were randomly taken from September to November 2017 in Adam Malik General Hospital. The data were subsequently analyzed using Wilcoxon Signed Rank test.Results. It was found that patients with obese body mass index, multiparity, and submucous uterine fibroid type were the largest groups in this study. Strongly positive expression was found highest in uterine fibroid group (75%). There is a difference in expression of 17 beta-HSD1 in uterine fibroid and normal myometrium with p<0.05.Conclusion. The results of this study demonstrate a statistically significant difference between uterine fibroid and normal myometrium.
