comparison of malondialdehide (mda)

8/13/2019 Comparison of Malondialdehide (MDA)

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Comparison of Malondialdehide (MDA) Level in Pregnancy and Post Parturition of Severe

Preeclampsia PatientsPerbandingan Jumlah Malondialdehide terhadap Kehamilan dan Post Partum pada Pasien Preeclampsia

Sonny I. Santoso, Freddy W. Wagey, Maria Loho

Fetomaternal Division, Department of Obstetrics and Gynecology

Faculty of Medicine University of Sam Ratulangi / Prof.Dr. R.D. Kandou HospitalManado

Abstract

Objective: to recognized malondialdehida level (MDA) in pregnancies compared with post parturition in

severe preeclampsia patients.

Method: All the research subject who has fulfilled the inclusion criteria, we take blood sample 1, and measure

malondialdehida (MDA) level. Eight days post parturition, measure malondialdehida (MDA) level to be compared.Data was processed and analized statistically.

Result: The sample was taken from 32 research subject in pregnancy with severe preeclampsia and continued byresearch subject after 8 days post parturition. Average level of malondialdehida (MDA) in pregnancy with severe

preeclampsia was 0.883 nmol/ml, while 8 days post parturition is 0.284 nmol/ml.

Conclusion: Malondialdehida level (MDA) in pregnancy women with PEB looks higher, and there was decreased of

MDA level in eight days post parturition (p


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INTRODUCTION

Preeclampsia was 5-15 % of pregnancycomplication and one of the three most causedof highest morbidity and mortality rate in

maternal and perinatal beside hemorrhargic andinfection. Based on WHO (World Health

Organization) occurrence of preeclampsia was

0.5% for every pregnancies. This mean that70.000 cases every years and 43,000 deaths

occurs caused by preeclampsia. In R.D. Kandou

general hospital Manado in 2010 found that

preeclampsia incidence and eclampsia for 2.07%

and 0.3% from 2411 parturition, respectively.1-4In preeclampsia patients found a

situation called as oxidative stress where

disturb of oxidant balance and anti oxidant signby elevation of peroxide lipid level (oxidant/ free

radical) as well as decreased of anti oxidant

activities. Endotelial cell exposed with

peroxidase lipid causes endotelial cell become

defect that initially in membrane of endotel cell.This called as endotelial dysfunction. Peroxidelipid has three form that can be test by

laboratory examination To be used as indicators

peroxide lipid process.5-8,9

Products are dienes conjugated,

malondialdehyde (MDA), and chromolipidfluorescent. Beside peroxide lipid level would benormally after four months post parturition, so

level of peroxide lipid as marker stress

oxidative was the sensitive index that can be

measured in preeclampsia patients.10-13

METHODS

This analysis study with cross sectional with

analytic comparative design to evaluated

malondialdehida level (MDA) by materal

blood serum where blood taken for 5 cc while

severe preeclampsia pregnancy patient at 37weeks of gestation age admitted to hospital

and 5 cc in eights weeks post parturition thenanalyzed the relation between both. The study

was conducted in Obstetr ic and Gynaecology

Department of Faculty of Medicine / Prof. Dr.

R.D. Kandou General Hospital in Manado.Study cases taken from data of pregnant

women diagnose with severe preeclampsia,

on April 2012 and July 2012. The variables

consist of dependent variable: Malondialdehida

(MDA) and free variable: during pregnancy and

post parturition. The inclusion criteria are:

available to participate in study wtih informed

consent, gestation age 37 weeks, intra

uterine singleton fetal, women with severepreeclampsia, women post parturition withsevere preeclampsia.The exclusion criteria:

Diabetes Mellitus, Chronic hypertension. Themethod of sampling is size sample using rule

from Moliseau

The study started with subjectselection. On this stage, the subjects of

study were selected consecutively that

fulfill inclusion and exclusion criteria until

subjects acquired with severe preclampsia. All

the subjects signed the informed consent andfilled the study blank.The next stage was

examination of malondialdehida level (MDA)

by materal blood serum while patient at 37weeks of gestation age admitted to hospital

and in eights weeks post parturition,

sentrifuge and store in refrigerator in Prodia

laboratory in Manado and sent to Analitic

laboratory of Udayana Bali University toestimated malondialdehida level (MDA).

METHODS

Pregnant women is measured her blood

pressure in upper arm about 2-3 cm fromcubiti fossa and systolic pressure decidebased on korotkoff sound I while diastolic

pressure was korotkoff V sound, measuring of

blood pressure done twice time with interval

four hours. Proteinuria is a present protein inurine that check by qualitative. Examination

of malondialdehida level (MDA) by materalblood serum where blood taken for 5 cc while

patient at 37 weeks of gestation age

admitted to hospital and 5 cc in eights weeks

post parturition, sentrifuge and store in

refrigerator in Prodia laboratory in Manado

and sent to Analitic laboratory of Udaya BaliUniversity to estimated malondialdehida level

(MDA).

RESULTS

Evaluation of subject characteristic on theTable 1.


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Table 1 . Characteristic of pregnant women with severe

preeclampsia in Prof. Dr. R. Kandou General Hospital in

Manado

Variabel Severe preeclampsia(n=38)

N %

Age

- 20 Years old- 20 - 24 Years old

- 25 - 29 Years old

- 30 - 34 years old- 35 Years old

Pregnancy

- Primary

- Multy

Education backgroud

- Elemetery

- junior high school

- senior high school

98

8

58

30

8

12

15

11

23,721

21

13,321

78,9

21,1

31,6

39,5

28,9

In table 1 showed that characteristic distribution

in pregnant women with severe preeclampsia,

the large number was 20 years old group for 9

cases (23.7%), primigravida for 30 cases (78.9%),

and based on educational background was juniorhigh school for 15 cases (39.5%).

Table 2. level of peroxide lipid (MDA) in patient with severe

preeclampsia and 8 days post parturition.

Severe

preeclampsia

Avarage Level of

Peroxide Lipid

(MDA) (nmol/ml)

Pairs t test

Pregnancy

8 days postparturition

0,883

0,284

82,241

(p < 0,01)

In table 2 showed that decreased ofmalondialdehida level (MDA) in post parturition

compare with pregnancy with severe

preeclampsia. Average level of malondialdehida(MDA) in pregnancy with severe preeclampsia

was 0.883 nmol/ml, while 8 days post parturition

is 0.284 nmol/ml. In table 2 showed that analyzepairs t test for 82,241 with p < 0.001, this resultshowed that decreasing of MDA level

significantly in eight days post parturition

patient.

DISCUSSION

In table 1 showed that pregnant women withsevere preeclampsia in 20 years old age group

for 9 cases (23.7%), this accordance with

literature said that one of risk factors for

preeclampsia is age for too young or too old

becoming pregnant (< 18 years old or > 35 yearsold).6-8,10. Based on literature said thatprimigravida was another factor for

preeclampsia, this according from data in studythat showed women with severe preeclampsia

the most was primigravida for 30 cases (78.9%).

This can be explained by etioloy of preeclampsiaon immunologic factor between maternal and

fetus. In normal pregnancy immune respon not

reject conception result that act as foreign body,

this because of human leucocyte antigen protein

G (HLA-G) that act as modulation immunerespon so mother not to reject conception

(placental). HLA-G in placental protect fetus

trophoblast from lysis by natural cell killer (NK)from mother. Except, HLA-G is a precondition for

trophoblast invasion in decidual tissues of

mother, except for facing natular cell killer. In

preeclampsia there is decreasing expression of

HLA-G and this would results to inhibition ofinvasion of trophoblat into decidual. As we knowthat trophoblast invasion was important thing so

decidual tissues becoming soft and loose so

easier for dilatation of spiralis arterial, if this

situation occur would decreased blood

circulation of uteroplacental, ischemic ofplacenta and preeclampsia would occur.14In this study showed that maternal education

background for the most was junior high school

for 30 cases (39.5%). Based on literature one of

the caused higher maternal mortality rates waspregnancy complicating, parturition, and post

parturition generally caused by to reason, that isless of knowledge about etiology and

management of complications that so important

in pregnancy, parturition and periode post

parturition, as well as less understanding and less

education about reproduction health.7

In table 2 showed that result from study that hasbeen analyze by statistic, level malondialdehida

(MDA) in pregnancy women with severepreeclampsia and post parturition found that

signifantly different. Level of Malondialdehida

(MDA) in pregnant women with severe

preeclampsia higher, and there is decrease ofMDA level in eight days post parturition.15-17

In this study found that average level of

malondialdehida (MDA) in pregnant women with

severe preeclampsia was 0.883 nmol/ml, and this

would seattle to decrease in eigth days post

parturition for 0.284 nmol/ml. this study


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accoradance with study was done by Wu et al

that study about malondialdehida level (MDA)

plasma would decreased 3 days post parturitionin severe preeclampsia patient and Chamy et aldone study about level MDA plasma would

decreased in 30 and 120 days post parturition inwomen with severe preeclampsia.18-19

Many study has evidence that there is correlation

between level of malondialdehida (MDA) withsevere preeclampsia and bad outcome perinatal

and maternal. Higher of level malondialdehida

(MDA), perinatal mortality was high. Another

researcher conclude that elevating of

malondialdehida level (MDA) can be asmeasurement of degree of preeclampsia.15-17

CONCLUSIONIn this study found that decreased of

malondialdehida (MDA) level significantly

decreased in eight days post parturition in

pregnant women with severe preeclampsia.

Malondialdehida levels (MDA) in pregnancy withsevere preeclampsia. Level MDA in pregnancywith severe preeclampsia higher compared with

post parturition.

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Hypertensive Disorders in Pregnancy. In Williams

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15. Hubel CA, McLaughlin MKA, Evans RWA, HauthBAA, Sims CJA, Roberts JMA. Fasting sertumtriglycerides, free fatty acids, and

malondialdehyde are increase in preeclampsia,are positively correlated, and decreased within 48

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Pijnenborg R, Vercruysse L, Hanssens M, VanAssche FA. Trophoblast invasion In Pre-eclampsia

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Closely Related To Clinical Severity Of

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http://download.journals.elsevierhealth.com/pdfs/journals/1726-4901/PIIS1726490108700340.pdfhttp://download.journals.elsevierhealth.com/pdfs/journals/1726-4901/PIIS1726490108700340.pdfhttp://download.journals.elsevierhealth.com/pdfs/journals/1726-4901/PIIS1726490108700340.pdfhttp://download.journals.elsevierhealth.com/pdfs/journals/1726-4901/PIIS1726490108700340.pdf

comparison of malondialdehide (mda)

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