Research article

Comparison of Malondialdehide (MDA) Level in Pregnancy and Post Parturition of Severe Preeclampsia Patients
Perbandingan 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 Hospital Manado

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 by research 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<0,01) Key words: malondialdehida level (MDA), pregnancy with severe preeclampsia, 8 days post parturition.

Abstrak Tujuan : mengetahui kadar malonaldehida pada kehamilan dibandingkan dengan post partum pada pasien preeclamsia berat. Metode: subjek penelitian yang memenuhi criteria inklusi, diambil sampel darahnya dan di ukur kadar malonaldehida(MDA) untuk dibandingkan dengan post partum. Data diproses dan dianalisa secara statistik. Hasil: Penelitian dilakukan pada 32 orang ibu hamil denga preeklamsia berat kemudian dilanjutkan dengan pengukuran sampel darah pada 8 hari post partum. Kadar rata-rata malonaldehida(MDA) pada preeklamsia berat adalah 0,883 nmol/ml, sementara 8 hari post partum adalah 0,284 nmol/ml. Kesimpulan: Kadar malonaldehida pada kehamilan dengan preeclampsia berat meningkat dan jumlahnya akan menurun dalam delapan hari post partum (p<0,01) Kata Kunci: kadar malonaldehida (MDA), kehamilan dengan preeclampsia berat, 8 hari post partum .

Correspondence: Sonny I. Santoso. Department of Obstetrics and Gynecology. Faculty of Medicine University of Sam Ratulangi/Prof.R.D. Kandou Hospital, Manado. HP 081356336888 Fax: 0431-859177. Email: sonnyiwan@yahoo.com

INTRODUCTION Preeclampsia was 5-15 % of pregnancy complication and one of the three most caused of highest morbidity and mortality rate in maternal and perinatal beside hemorrhargic and infection. Based on WHO (World Health Organization) occurrence of preeclampsia was 0.5% for every pregnancies. This mean that 70.000 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.1-4 In preeclampsia patients found a situation called as oxidative stress where disturb of oxidant balance and anti oxidant sign by 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. Peroxide lipid 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 chromolipid fluorescent. Beside peroxide lipid level would be normally 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 37 weeks of gestation age admitted to hospital and 5 cc in eights weeks post parturition then analyzed the relation between both. The study was conducted in Obstetric 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 severe preeclampsia, women post parturition with severe preeclampsia.The exclusion criteria: Diabetes Mellitus, Chronic hypertension. The method of sampling is size sample using rule from Moliseau The study started with subject selection. 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 and filled the study blank.The next stage was examination of malondialdehida level (MDA) by materal blood serum while patient at 37 weeks 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 to estimated malondialdehida level (MDA). METHODS Pregnant women is measured her blood pressure in upper arm about 2-3 cm from cubiti fossa and systolic pressure decide based 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 in urine that check by qualitative. Examination of malondialdehida level (MDA) by materal blood 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 Bali University to estimated malondialdehida level (MDA). RESULTS Evaluation of subject characteristic on the Table 1.

Table 1 . Characteristic of pregnant women with severe preeclampsia in Prof. Dr. R. Kandou General Hospital in Manado Variabel Severe preeclampsia (n=38) N % 9 8 8 5 8 30 8 12 15 11 23,7 21 21 13,3 21 78,9 21,1 31,6 39,5 28,9

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

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 junior high 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 Pregnancy 8 days post parturition Avarage Level of Peroxide Lipid (MDA) (nmol/ml) 0,883 0,284 Pairs t test

82,241 (p < 0,01)

In table 2 showed that decreased of malondialdehida 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 analyze pairs t test for 82,241 with p < 0.001, this result showed that decreasing of MDA level significantly in eight days post parturition patient. DISCUSSION In table 1 showed that pregnant women with severe 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 years old).6-8,10. Based on literature said that primigravida was another factor for preeclampsia, this according from data in study that showed women with severe preeclampsia the most was primigravida for 30 cases (78.9%). This can be explained by etioloy of preeclampsia on 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 immune respon 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 of invasion of trophoblat into decidual. As we know that 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 of placenta and preeclampsia would occur. 14 In 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 was pregnancy complicating, parturition, and post parturition generally caused by to reason, that is less 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 has been analyze by statistic, level malondialdehida (MDA) in pregnancy women with severe preeclampsia and post parturition found that signifantly different. Level of Malondialdehida (MDA) in pregnant women with severe preeclampsia higher, and there is decrease of MDA 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

accoradance with study was done by Wu et al that study about malondialdehida level (MDA) plasma would decreased 3 days post parturition in severe preeclampsia patient and Chamy et al done study about level MDA plasma would decreased in 30 and 120 days post parturition in women with severe preeclampsia.18-19 Many study has evidence that there is correlation between level of malondialdehida (MDA) with severe 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 as measurement of degree of preeclampsia.15-17 CONCLUSION In 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 with severe preeclampsia. Level MDA in pregnancy with severe preeclampsia higher compared with post parturition. REFERENCES
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