Aim: To determine whether term pregnant women with human immunodeficiency virus infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta. Methods: This cross-sectional analytical study was conducted at Sanglah General Hospital, Denpasar, and affiliated hospitals. Subjects were termed pregnant women with HIV (+) who received a minimum of six months of antiretroviral therapy as a risk group and pregnant women with HIV (-) as a non-risk group. Caspase-3 expression was assessed by immunohistochemical examination of placental tissue. The cut-off value for caspase-3 levels was determined by constructing a receiver operating characteristics (ROC) curve. The difference in proportion was assessed by the chi-square test, and the prevalence ratio (PR) was reported. The significance of this study was p<0.05. Results: Each 20 pregnant women were included in the risk and no-risk groups. There was no difference in age, gestational age, parity, and body mass index (BMI) between the two groups. The mean expression of caspase-3 was significantly higher HIV (+) group than in the HIV (-) group (162.62 vs. 105.83; p = 0.000). The selected cut-off value of Caspase-3 was 127.05, with a sensitivity of 75% and a specificity of 75%. After classification, a significantly higher proportion of Caspase-3 expression was found in the HIV (+) group than in the HIV (-) group (75% vs. 25%; p=0.002). Pregnant women with HIV (+) and receiving antiretroviral therapy for a minimum of six months had a three times higher chance of having a high Caspase-3 prevalence than pregnant women who were not (RP=3.0; 95% CI = 1.348 – 6.678). Conclusion: Pregnant women with HIV infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta.
Introduction: Polyhydramnios is a condition in which the amount of amniotic fluid increases more than 2 litres. The causes of polyhydramnios are multifactorial, and most are idiopathic. Here we report challenging management of polyhydramnios case without apparent risk factors. Case: A 30-year-old woman G2P1001, 27-28 weeks of gestational age referred due to our tertiary health care center due to polyhydramnios. The patient chief complaint was progressively enlarged abdomen since a month ago. Her previous pregnancy, medical history and family history were unremarkable. The obstetric examination reflects the size of uterus equivalent to 36 weeks of gestational age. The fetomaternal ultrasound reveals a life, single fetus with normal heart rate and fetal movement, estimated fetal weight about 1057 grams, placenta corpus posterior grade I, Maximum Vertical Pocket 22.83 cm, no major congenital abnormalities were visible and bladder appears filled. Laboratory tests revealed blood glucose levels 90 mg/dl, Hb-A1c 5.2%, Ureum 27.30 mg/dl, Creatinine 3.39 mg/dl, and numerous leukocytes on urine sediment. Amnioreduction and fetal pulmonary maturation were conducted by Dexamethason protocol. Amnioreduction yield 1500 ml of clear, yellowish amniotic fluid. Regarding abnormality in renal function, diagnosis of Acute on Chronic Kidney Disease (ACKD were established by Internal medicine department, and the patients were given a series of ceftriaxone injection. The patient was planned for indomethacin therapy; however, Indomethacin was not available in Bali. Conclusion: Careful search for causes both from the maternal factor and fetal abnormalities can help to determine the prognosis of pregnancy. Ideally, amnioreduction, coupled with indomethacin therapy, are needed to reduce amniotic fluid, and serial monitoring of the amniotic fluid volume is required to prevent preterm labor.
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