Erry Gumilar Dachlan

Placenta accreta spectrum results in significant morbidities. Implantation process is regulated by PGE2 among other factors. This review aimed to discuss the role of PGE2 in the placenta accreta spectrum. Review of literatures searched in PubMed, PubMedCentral, EuropePMC, Wiley, and Science Direct with relevant keywords. Articles found were screened by authors and voted for inclusion. PGE2 is synthesized from arachidonic acid by COX. Increased synthesis of PGE2 results in increased angiogenesis and placental invasion. PGE2 action mainly occurs through the EP1-EP4 as the main receptors of PGE2. Reduced PGE2 receptors expression may results in defective decidualization resulting in poor pregnancy outcomes. Inactivation of PGE2 occurs through HPGD enzyme. Upregulation of HPGD results in lower PGE2 tissue concentration leading to decreased PGE2 activity. Disorders of HPGD expression has been implicated in abnormal implantation in animals. PGE2 synthesis, signaling, and inactivation plays significant role in placental invasion. Defects in any of the processes may lead into placenta accreta spectrum.

Wardhana MP, et al. Yonsei Med J. 2024 Apr;65(4):202-209. https://doi.org/10.3349/ymj.2023.0309

BACKGROUND: This study analyzed pregnancy outcomes in postpartum women who were infected with COVID-19 during their pregnancy in resource-limited settings during the second wave of the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study included all pregnant women with COVID-19 at a tertiary referral hospital in Surabaya, Indonesia, from June to August 2021. Patients were classified according to clinical presentation into asymptomatic-mild, moderate, and severe-critical. Data regarding their basic maternal characteristics, clinical symptoms, delivery, and neonatal outcomes were collected and analyzed across these severity levels through ANOVA, Kruskal–Wallis, or Mann–Whitney U test by incorporating SPSS Statistics software version 29.0. RESULTS: During the second wave of COVID-19 in Indonesia, a total of 184 COVID-19 cases were reported, with high mortality rate (22%). Only 26.6% of these cases were asymptomatic-mild, and the remaining 73.4% had more severe conditions. The severe-critical group had significantly lower gestational age, slower onset of diseases/symptoms, and higher maternal death proportions than the other two groups (P < 0.001). Clinical symptoms, vital signs, and inflammatory markers (NLR, CRP, and procalcitonin) were also significantly worse in the severe-critical group than in the other groups (P < 0.05). Consequently, severe cases showed a higher cesarean section rate (P = 0.034), lower birth weight, lower Apgar score, higher incidence of perinatal deaths (P < 0.001), and higher incidence of neonatal support (P = 0.003). CONCLUSIONS: The study's findings specified the devastating consequences of second wave of COVID-19 in a resource-limited setting. Focus on improving the health system and health facilities' capacity is warranted to anticipate all possibilities of other pandemics in the future.

Background: Heart disease in pregnancy is one of the leading causes of maternal mortality and morbidity in developing countries. However, the characteristics of the disease vary between countries and regions. This study aimed to present the characteristics of pregnant women with heart disease in an economically advantageous region of a developing country. Design and methods: A cross-sectional study was conducted using data from the Weekly Report of Obstetrics and Gynaecology Department to assess pregnant women with heart disease characteristics and pregnancy outcomes. A total sample of 69 pregnant women with heart disease regarding theirgestational age was included in the study. Variables observed were maternal characteristics, heart disease's clinical parameter, and maternal and neonatal outcomes. Chi-square test was used to examine the different characteristics of congenital and acquired heart disease groups. Results: The prevalence of cardiac disease in pregnancy was 5.19%. Fifty-three point six percent of pregnant women with heart disease were suffered from congenital heart disease (CHD), while 46.4% were acquired heart disease (AHD). Most labor methods were Cesarean delivery, and 69.6% of women experienced cardiac complications. Maternal death was reported in 8.69% of cases. Four cases were CHD complicated by pulmonary hypertension, which leads to Eisenmenger syndrome. Two other cases were AHD complicated by Peripartum Cardiomyopathies. Although statistically insignificant, complications are more common in the AHD group than CHD. Conclusion: Cardiac disease prevalence in pregnancy is considered high, with CHD as the most common case, which significantly differs from other developing countries.

Background and Aim: Endometriosis affects the ovaries and causes a decrease in the oocyte quality during endometrial receptivity. During the development of ovarian follicles, paracrine communication occurs between granulosa cells and oocytes. This study was conducted to determine the effects of bone marrow mesenchymal stem cell transplantation on tumor necrosis factor-alpha (TNF-α) receptor 1 (TNFR1) expression, granulosa cell apoptosis, and folliculogenesis in endometriosis mouse models. Materials and Methods: This study involved 42 female mice, which were divided into three groups: Healthy mice (T0), endometriosis mice without transplantation (T1), and endometriosis mice with bone marrow mesenchymal stem cell transplantation (T2). The mice were injected intraperitoneally with endometrial fragments (200 μL) to become endometriosis models. On day 15, the endometriosis models received mesenchymal stem cells. Sample collection was performed on day 29. Granulosa cell apoptosis and TNFR1 expression were examined using immunohistochemical staining, and folliculogenesis was assessed using hematoxylin and eosin staining of ovary samples. The data obtained from both examinations were statistically analyzed using Statistical Package for the Social Sciences. Results: The results showed that TNFR1 expression is significantly decreased in T2 (p<0.004). The apoptosis of granulosa cells was lower in T2 (p<0.000). The primary, secondary, and graafian follicle counts in T2 were significantly increased. Conclusion: Bone marrow mesenchymal stem cell transplantation in endometriosis mouse models can reduce TNFR1 expression and granulosa cell apoptosis and improve folliculogenesis.