BACKGROUND: Abortion remains a problem in the obstetric care as it is one of the causes of maternal and fetal death. Bleeding or miscarriage threat in the first trimester comprises 20% to 25% of all pregnant women, and 50% of them will end as spontaneous abortion. The major cause of maternal death in abortion is hemorrhage. Some recent studies have indicated that MMP-9 is important in the process of embryo implantation into the endometrium and spontaneous abortion occurs when there is an overwhelming increase of MMP-9. This data indicate the importance of a further research to elucidate the role of MMP-9 in spontaneous abortion.METHODS: This was a cross sectional study, included 70 pregnant women with gestational age <20 weeks who came for examination and treatment at the Department of Obstetrics and Gynecology, Medical Faculty of Padjadjaran University/Hasan Sadikin Hospital, Bandung. RESULTS: There were differences in the MMP-9 levels in spontaneous abortion compared to normal pregnancy and MMP-9 had a cut-off point >1221.7 with the sensitivity of 48.6% specificity of 80%, and accuracy of 60.9%.SUMMARY: The MMP-9 level in spontaneous abortion was higher than in normal pregnancy.KEYWORDS: MMP-9, spontaneous abortion, normal pregnancy
Placental abruption is a common complication of preeclampsia. It is an obstetric emergency that occurs when the placenta partially or completely separates from the uterine wall. The diagnosis is usually made clinically or objectively. It is relatively rare but put a serious risk for both the fetus and the mother. We reported a case of a 32-year-old multigravid patient at 35-36 weeks gestation who presented with moderate vaginal bleeding and lower abdominal pain. Her obstetric history included one premature vaginal delivery. Her blood pressure started to rise in the second trimester of pregnancy. The examination revealed that her blood pressure was 190/120 mmHg, and she had pitting edema on her extremities and tender uterine fundus. The fetal heart rate was bradycardia at 100 beats per minute. Placental abruption and fetal distress were suspected. An emergency cesarean section was performed. Intraoperatively, the uterus showed intramural bleeding and was livid, with the beginning of Couvelaire-uterus. The uterus was left in situ. In conclusion, placental abruption interrupts the vital function of the placentae which leads to fetal hypoxia and even fetal death. It is an obstetric emergency that requires immediate intervention to save the fetus and reduce the risk of complications in the mother.
The pandemic of COVID-19 continues with new variants. More than 401 million people in the world infected by COVID-19 and approximately 5.7 million people lost their lives. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has respiratory system as a target. This virus uses a receptor binding domain of SARS-CoV-2 Spike (sRBD) protein to bind ACE-2 receptor and enter human respiratory cells. The antibody to sRBD protein will block the virus. Convalescent plasma from recovered COVID-19 patient contains neutralization antibody which can neutralize sRBD and eliminate the virus. Therefore, this study aims to assess the therapeutic effect of convalescent plasma to neutralization antibody and inflammatory parameter level in moderate COVID-19 patients. This is a one-group pretest-posttest study of nine moderate COVID-19 patients admitted in Unggul Karsa Medika Hospital, Bandung, Indonesia. The study was done from August 1, 2021 to January 1, 2022. The level of neutralization antibody and inflammatory parameter were assessed before and after convalescent plasma therapy in moderate COVID-19 patient. Data analysis performed by SPSS program with p < 0.05 and dependent t-test. Our study shows that convalescent plasma therapy can influence the increase of neutralization antibody (142. 5 AU/mL vs 13.432 AU/mL, p value = 0.011) and the decrease of Interleukin-6 (IL-6) (41.61 pg/mL vs 14.5 pg/mL, p value = 0.008) and C-reactive protein (CRP) level (84.2 mg/L vs 17.4 mg/L, p-value = 0.018) in moderate COVID-19 patient. The patients were also getting better clinically, with the use of oxygen decreasing gradually from non-rebreathing masks to nasal cannula and from nasal cannula to room air after given convalescent plasma therapy. Therefore, we conclude that convalescent plasma therapy has a positive role in increasing neutralization antibody and decreasing inflammatory parameters which are IL-6 and CRP, thus had potential usefulness in therapy for moderate COVID-19 patients.
Abdominal pregnancy is the rarest ectopic pregnancies, with an incidence of 1 per 10,000 live births, and life-threatening because the symptoms are not specific and diagnosis is made after abdominal pain, amenorrhea and vaginal bleeding occur. We present a rare case of abdominal pregnancy in a 31-year-old Indonesian woman with severe abdominal pain within 24 hours before hospital admission, accompanied by nausea, vomiting, dizziness and weakness. She felt the pain increasing since the last 2 weeks and limiting her movement. She has a history of a left tubal pregnancy 5 years ago. Ultrasonography examination revealed an ectopic pregnancy, and she was rushed to the operation room for emergency exploratory laparotomy. An abdominal pregnancy was found, located in the right adnexa with excessive fluid in cavum Douglass and a foetus in around 11–12 weeks of gestation accompanied by free fluid in the subdiaphragmatic, subhepatic and pelvic cavity. The surgery was a successful, four units of whole blood were transfused, and the patient was safely discharged from the hospital. The current concept on management of abdominal pregnancy supports immediate surgical intervention with pregnancy termination, as found in this case, because the patient’s condition is hemodynamically unstable indicating hemorrhagic shock correlated with massive hemoperitoneum. A prompt diagnosis and good teamwork in treatment plays an important role for such a life-threatening condition to avoid maternal morbidity and mortality in a case of abdominal pregnancy.
Background Twin-to-twin transfusion syndrome (TTTS) is a condition that can occur as a complication of a monochorionic twin pregnancy that may develop at any stage of pregnancy and most cases are diagnosed in the second trimester of pregnancy. The syndrome is a placental vascular anomaly that can affect the two fetoplacental circulations which can result in hypotony, hypovolemia, anemia, and oliguria being developed in the donor, whereas the recipient fetus is at risk of hypertrophy, hypertension, hypervolemia, polycythemia, and polyhydramnios. Case presentation A 32-year-old multigravida woman (Gravida 5 Para 4 Abortion 0) with a gestational age of 26 weeks came to the Obstetrics and Gynecology Clinic of Unggul Karsa Medika Hospital with the results of the first ultrasound at 24 weeks of gestation which revealed monochorionic diamniotic intrauterine twins and anterior placenta with grade I maturity. Twin A Maturity of 23 weeks 2 days with a fetal weight of 578 grams, oligohydramnios, fetal kidney, and bladder are not visible, whereas Twin B Maturity of 26 weeks 6 days with a fetal weight of 1205 grams, polyhydramnios with a single 12 cm deepest pocket and normal fetal kidney with bladder distention. The diagnosis of twin-to-twin transfusion syndrome was made with twin A as donor twins and twin B as recipient twins. Conclusion TTTS can be diagnosed with routine prenatal ultrasound and can be deferred into 4 stages based on ultrasound and doppler results. There are multiple options for management including expectant management, amnioreduction, intentional septostomy, fetoscopic laser photocoagulation, selective reduction, and voluntary pregnancy termination.
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