Perbandingan Kadar Serum Seruloplasmin Pada Preeklamsia Berat Early Onset Dan Late Onset
PERBANDINGAN KADAR SERUM SERULOPLASMIN PADA PREEKLAMSIA BERAT EARLY ONSET DAN LATE ONSET
Makmur Sitepu, Muara P. Lubis, Jenius L. Tobing, Yostoto B. Kaban, M. Fauzie Sahil, M.Arief S. Departemen Obstetri dan Ginekologi
Fakultas Kedokteran – Universitas Sumatera Utara Medan, Indonesia, 2013
ABSTRAK Tujuan : Mengetahui perbandingan antara kadar serum seruloplasmin pada pasien preeklamsia berat early dan late onset. Metode : Penelitian ini menggunakan studi analitik komparatif dengan desain cross sectional. Subjek penelitian adalah semua ibu hamil yang memeriksakan kehamilannya di klinik kebidanan dan ruang gawat darurat Rumah Sakit H Adam Malik dan RS Jejaring FK USU serta memenuhi kriteria inklusi. Didapatkan 40 sampel, dengan 20 kasus wanita hamil dengan preeklamsia berat early onset dan 20 kasus wanita hamil dengan preeklamsia berat late onset. Hasil : Dari 40 subjek penelitian, didapatkan hasil kadar rata-rata serum seruloplasmin yang lebih tinggi pada penderita preeklamsia berat early onset (0,899 g/L) dibandingkan late onset (0,663 g/L) dengan p-value < 0,05. Dari uji korelasi pearson didapati adanya korelasi terbalik yang lemah (- 0,668) antara usia kehamilan ibu dengan preeklamsia berat early onset dengan kadar serum seruloplasmin (p-value 0,001) serta korelasi terbalik yang kuat (- 0,802) antara usia kehamilan ibu dengan preeklamsia berat late onset dengan kadar serum seruloplasmin. (p-value < 0,05). Kesimpulan : Kadar rata-rata serum seruloplasmin pada preeklamsia berat early onset lebih tinggi dibandingkan dengan late onset (p-value < 0,05). Terdapat korelasi terbalik yang kuat antara usia kehamilan dengan preeklamsia berat baik yang early onset maupun yang late onset dengan kadar serum seruloplasmin (p-value < 0,05). Dengan semakin meningkatnya usia kehamilan maka kadar seruloplasmin akan semakin rendah. Kata Kunci : Preeklampsia, early onset, late onset, seruloplasmin
Universitas Sumatera Utara
COMPARISON OF CERULOPLASMIN SERUM LEVEL IN EARLY ONSET AND LATE ONSET SEVERE PREECLAMPSIA
Makmur Sitepu, Muara P. Lubis, Jenius L. Tobing, Yostoto B. Kaban, M. Fauzie Sahil, M.Arief S.
Departement of Obstetric and Gynecology Medical Faculty – Universitas Sumatera Utara
Medan, Indonesia, 2013
ABSTRACT
Objective : To find the difference in ceruloplasmin serum level between patient with early and late onset severe preeclampsia. Method : this is a comparative analytic study with cross sectional design. Study subjects were pregnant women admitted to obstetric ward and emergency room of H. Adam Malik General Hospital and USU Medical Faculty satellite hospitals, who fulfilled the inclusion criteria. 40 subjects were obtained, with 20 cases of early onset severe preeclampsia and 20 cases of late onset severe preeclampsia. Result : From 40 subjects obtained, the average ceruloplasmin serum level was higher in subjects with early onset severe preeclampsia (0,899 g/L) compared to late onset severe preeclampsia (0,663 g/L) with p-value 0,05).
Universitas Sumatera Utara
Tabel 2. Perbandingan Kadar Serum Seruloplasmin antara Kehamilan dengan
Preeklamsia Berat Early Onset dan Kehamilan dengan Preeklamsia Berat Late Onset
DIAGNOSIS
MEAN
N Std. Deviation p-value
Seruloplasmin
(g/L)
Kadar Serum Early onset PEB 0,899
20 0,155
< 0,05
Seruloplasmin
Late onset PEB 0,663
20 0,137
< 0,05
Dari hasil penelitian ini didapati hasil
kadar rata-rata serum seruloplasmin pada
penderita preeklamsia berat early onset lebih
tinggi (0,899 g/L) dibandingkan dengan
preeklamsia berat late onset (0,663 g/L)
dengan p-value < 0,05.
Tabel 3. Korelasi antara Kadar Serum Seruloplasmin dengan Usia Kehamilan Ibu dengan
Preeklamsia Berat Early Onset
Kadar
Usia Kehamilan
Seruloplasmin
(minggu)
(g/L)
Kadar Seruloplasmin (g/L) Pearson
1
-, 668
Correlation
P-value
,001
N 20 20
Usia Kehamilan (minggu) Pearson Correlation P-value N
-,668
,001 20
1 20
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Dari uji korelasi pearson didapati adanya korelasi terbalik yang lemah (- 0,668) antara usia kehamilan ibu dengan preeklamsia
berat early onset dengan kadar serum seruloplasmin. (p-value 0,001).
Tabel 4. Korelasi antara Kadar Serum Seruloplasmin dengan Usia Kehamilan Ibu dengan
Preeklamsia Berat Late Onset
Kadar Seruloplasmin Usia Kehamilan
(g/L)
(minggu)
Kadar Seruloplasmin (g/L) Pearson
1
-,802
Correlation
P-value
,000
N 20
20
Usia Kehamilan (minggu) Pearson
-,802
1
Correlation
P-value
,000
N 20
20
Dari uji korelasi pearson didapati adanya korelasi terbalik yang kuat (- 0,802) antara usia kehamilan ibu dengan preeklamsia berat late onset dengan kadar serum seruloplasmin. (p-value < 0,05). Dengan meningkatnya usia gestasi, maka kadar serum seruloplasmin akan semakin berkurang.
KESIMPULAN Kadar rata-rata serum seruloplasmin pada penderita preeklamsia berat early onset lebih
tinggi dibandingkan dengan preeklamsia
berat late onset. Terdapat korelasi terbalik
yang kuat antara usia kehamilan dengan
preeklamsia berat baik yang early onset
maupun yang late onset dengan kadar serum
seruloplasmin.
Dengan
semakin
meningkatnya usia kehamilan maka kadar
seruloplasmin akan semakin rendah.
SARAN Diperlukan penelitian lebih lanjut dengan jumlah sampel lebih besar untuk
Universitas Sumatera Utara
mendapatkan hasil yang lebih akurat sehingga kadar serum seruloplasmin dapat dijadikan suatu penanda yang spesifik untuk preeklamsia.Dengan penggunaan serum seruloplasmin sebagai alat prognostik untuk preeklamsia, diharapkan dapat menurunkan angka kematian ibu di Indonesia pada umumnya dan di Medan pada khususnya. DAFTAR PUSTAKA 1. W.T. Pangemanan. Diagnosis dini dan
prediksi hipertensi dalam kehamilan (HDK). Simposium hipertensi dalam kehamilan. PTP VII POGI, Surakarta 1991. 2. Samil R.S. Hipertensi dan kehamilan. Kumpulan naskah PIT POGI ke II, Malang, Juli 1983. 3. Adnan M.N., Lieberman E.S., Wilkins Haug I.E et al. The value of elevated second trimester β hCG in predicting development of preeclampsia. Am J obstet Gynecol 1997 ; 176(2) : 438-42 4. Roberts J.M., Pearson G, Cutler J, et al; NHLBI Working Group on Research on Hypertension During Pregnancy. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension 2003; 41:437– 45. 5. Sibai R.M., Ewell M, Levine R.J., et al. Risk factors associated with
preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997;177:1003–10. 6. Lie R.T., Rasmussen S, Brunborg H, et al. Fetal and maternal contributions to risk of pre-eclampsia: population based study. BMJ 1998;316:1343–7. 7. MacKay A.P., Berg C.J., Atrash H.K. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001;97:533–8. 8. Simanjuntak J.R. Evaluasi kematian maternal penderita preeklampsia berat di RSUD Dr. Pirngadi Medan tahun 1993—1997, Medan, Fakultas Kedokteran Universitas Sumatera Utara. Tesis. 1999. 9. Churchill D, Duley L. Interventionist versus expectant care for severe preeclampsia before term. Cochrane Database Syst Rev 2002(3): CD0033106. 10. Loombard H, Pattinson B. Interventionist versus expectant care for severe preeclampsia before term : RHL commentary, The WHO Reproductive Health Library; Geneva: World Health Organization, 2004. 11. Hubel C.A. Oxidative Stress in the pathogenesis of preeclampsia. Magee-
Universitas Sumatera Utara
Women Research Institute and the Department of Obstetrics and Gynecology and Reproductive Sciences, University of Pittsburg, Pennsylvania, 1999. 12. Scholl T.O et al. Oxidative stress, diet, and the etiology of preeclampsia. American Society for Clinical Nutrition. Am J Clin Nutr 2005;81:1390-6. 13. Toescu V et al. Changes in plasma lipids and markers of oxidative stress in normal pregnancy and pregnancies complicated by diabetes. Clinical Science 2004: 106; 93 – 98. 14. Poston L, Raijmakers T.M. Trophoblast Oxidative Stress, Antioxidants and Pregnancy Outcome - A Review, Placenta 2004;18: S72 – S78. 15. Gupta S et al. Lipid peroxidation and antioxidant status in preeeclampsia: A Systematic Review. CME Review Article, volume 64, number 11, Obstetrical and Gynecological Survey, 2009: 750-8. 16. Shakour-Shahabi L, Abbasali-Zadeh S, Rashtchi-Zadeh N. Serum level and antioxidant activity of ceruloplasmin in preeclampsia. Pakistan Journal of Biological Sciences 13 (13): 621-627, 2010.
17. Sidabutar E. Perbandingan kadar enzim
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Fakultas Kedokteran Universitas
Sumatera Utara. 2005. Tesis.
18. Egerman R.S. Hypertensive Disorders
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23. Brooks M.D. Pregnancy, Preeclampsia,
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of Emergency Medicine, St Mary-
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25. Park M, Brewster U.C. Management of
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27. Deeker G.A. Risk Factor for
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31. Royal College of Obstetricians and Gynaecologists. 2010. Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. NICE Clinical Guideline. National Collaborating Centre for Women’s and Children’s Health.
32. Committee on Technical Bulletins of thee american College of Obstetricians and Gynecologists. Hypertension in Pregnancy. ACOG technical bulletin number 219-January 1996. Int J Gynaecol Obstet 1996; 53: 175-83.
33. Brandon J.B., Amy E.H., Nicholas C.L. Hypertensive disorders in pregnancy, in: The Johns Hopkins Manual of Gynecology and Obstetrics 22nd ed. Philadelpia: Lippincott Williams & Wilkins; 2002: 183-94.
34. Hauth J.C., Cunningham F.C. Preeclampsia-eclampsia, in: Lindheimer MD, Roberts JM, editors Chesley’s Hypertensive Disorders in Pregnancy (2nd ed) . Stamford CT: Appleton & Lange, 1999: 169-99.
35. Zhang, J., 2007. Partner Change, Birth Interval, and Risk of Preeclampsia: A Paradoxical Triangle. Paediatric and Perinatal Epidemiology, 21(Suppl. 1): 31-35.
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36. Working group on High Blood Pressure on Pregnancy, Report of the National High Blood Presssure Education Program. Am J Obstet Gynecol 2000; 183: S1-S21.
37. Cunningham F.G., Gant N et al. Willliams Obsstetrics 22nd. McGrawHill, Medical Publishing Division, 2005; 762-4.
38. Riedman C, Walker I. Preeclampsia The Fact. Oxford University Press, New York, 1992: 128-43.
39. Sibai B.M. Diagnosis, Prevention, and Management of Eclampsia, Obstetricss & Gynecology, 2005: 105: 405-10.
40. Hubel CA. Lipid peroxidation in pregnancy: New perspectives on preeclampsia, Am J Obstet Gyneecol, 1989; 161: 1025-34.
41. Zeeman G.G., Dekker G.A. Pathogenesis of preeeclampsia a hypothesis, 1992; Clin Obstet Gynecol, 1992; 35: 317-37.
42. Negi R et al, Oxidative stress and preeclampsia, Advances in Life Sciences, 2011 ; 1(1): 20-23.
43. Cotter, A.M., Molloy, A.M., Scott, J.M., and Daly, S.F., 2001, Elevated plasma homocysteine in early pregnancy a risk factor for the development of severe
preeclampsia, American J of Obstetrics and Gynaecology, 185 (4), 781-785. 44. Aydin, S., Benian, A., Madazli, R., Uludag, S., Uzun, H., and Kaya, S., 2004, Plasma malondialdehyde, superoxide dis-mutase, selectin, fibronectin, endothelin-1 and nitric oxide levels in women with pre eclampsia, Eur J Obstet Gynecol Reprod Biol, 113, 2125. 45. Walsh, S.W., 1998, Maternal-placenta interactions of oxida-tive stress and antioxidant in pre-eclampsia, Semin Reprod Endicrinol, 16, 93-104. 46. Sharma, J.B., and Mittal, S., 2004, Oxidative stress and pre-eclampsia, Obstet Gynacol Today, 9, 551-554. 47. Burton G.J., Jauniaux E. Oxidative Stress. Best Pract Res Clin Obstet Gynaecol. 2011 June; 25(3): 287–299. 48. Belo L., Caslake M., Santos-Silva A. LDL size, total antioxidant status and oxidised LDL in normal human pregnancy: a longitudinal study. Atherosclerosis. 2004;177:391–399. 49. Redman C.W., Sargent I.L. Preeclampsia, the placenta and the maternal systemic inflammatory response–a review. Placenta. 2003;24(Suppl. A):S21–S27.
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50. Redman C.W., Sargent I.L. Placental
stress and pre-eclampsia: a revised view.
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51. Myatt L., Cui X. Oxidative stress in the
placenta. Histochem Cell Biol.
2004;122:369–382.
52. Dadelszen et al. Subclassification of
Preeclampsia. Hypertension In
Pregnancy Vol. 22, No. 2, pp. 143–148,
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53. Tranquilli A.L. et al. The definition of
severe and early-onset preeclampsia.
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Pregnancy (ISSHP). Pregnancy
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of Women’s Cardiovascular Health 3
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54. http://journals.iucr.org/d/issues/2007/02/
00/hv5074/hv5074fig2mag.jpg
55. Burton G.J., Yung H.W., Cindrova-
Davies T. Placental endoplasmic
reticulum stress and oxidative stress in
the pathophysiology of unexplained
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onset
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2009;30(Suppl. A):S43–S48.
56. Gerretsen G., Huisjes H.J., Elema J.D.
Morphological changes of the spiral
arteries in the placental bed in relation to
pre-eclampsia and fetal growth
retardation. Br J Obstet Gynaecol. 1981;88:876–881. 57. Khong T.Y., De Wolf F., Robertson W.B. Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol. 1986;93:1049–1059. 58. Meekins J.W., Pijnenborg R., Hanssens M. A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies. Br J Obstet Gynaecol. 1994;101:669–674. 59. Cindrova-Davies T., Yung H.W., Johns J. Oxidative stress, gene expression, and protein changes induced in the human placenta during labor. Am J Pathol. 2007;171:1168–1179. 60. Many A., Roberts J.M. Increased xanthine oxidase during labourimplications for oxidative stress. Placenta. 1997;18:725–726. 61. Ghaseminejad et al. Correlation of serum ceruloplasmin with preeclampsia.Tehran Univ Med J 2009, 66(10): 761-766. 62. Perveen et al. Effect of gestational age on cord blood plasma copper, zinc, magnesium and albumin. Early Human Development 69 (2002) 15–23
Universitas Sumatera Utara
Universitas Sumatera Utara
Makmur Sitepu, Muara P. Lubis, Jenius L. Tobing, Yostoto B. Kaban, M. Fauzie Sahil, M.Arief S. Departemen Obstetri dan Ginekologi
Fakultas Kedokteran – Universitas Sumatera Utara Medan, Indonesia, 2013
ABSTRAK Tujuan : Mengetahui perbandingan antara kadar serum seruloplasmin pada pasien preeklamsia berat early dan late onset. Metode : Penelitian ini menggunakan studi analitik komparatif dengan desain cross sectional. Subjek penelitian adalah semua ibu hamil yang memeriksakan kehamilannya di klinik kebidanan dan ruang gawat darurat Rumah Sakit H Adam Malik dan RS Jejaring FK USU serta memenuhi kriteria inklusi. Didapatkan 40 sampel, dengan 20 kasus wanita hamil dengan preeklamsia berat early onset dan 20 kasus wanita hamil dengan preeklamsia berat late onset. Hasil : Dari 40 subjek penelitian, didapatkan hasil kadar rata-rata serum seruloplasmin yang lebih tinggi pada penderita preeklamsia berat early onset (0,899 g/L) dibandingkan late onset (0,663 g/L) dengan p-value < 0,05. Dari uji korelasi pearson didapati adanya korelasi terbalik yang lemah (- 0,668) antara usia kehamilan ibu dengan preeklamsia berat early onset dengan kadar serum seruloplasmin (p-value 0,001) serta korelasi terbalik yang kuat (- 0,802) antara usia kehamilan ibu dengan preeklamsia berat late onset dengan kadar serum seruloplasmin. (p-value < 0,05). Kesimpulan : Kadar rata-rata serum seruloplasmin pada preeklamsia berat early onset lebih tinggi dibandingkan dengan late onset (p-value < 0,05). Terdapat korelasi terbalik yang kuat antara usia kehamilan dengan preeklamsia berat baik yang early onset maupun yang late onset dengan kadar serum seruloplasmin (p-value < 0,05). Dengan semakin meningkatnya usia kehamilan maka kadar seruloplasmin akan semakin rendah. Kata Kunci : Preeklampsia, early onset, late onset, seruloplasmin
Universitas Sumatera Utara
COMPARISON OF CERULOPLASMIN SERUM LEVEL IN EARLY ONSET AND LATE ONSET SEVERE PREECLAMPSIA
Makmur Sitepu, Muara P. Lubis, Jenius L. Tobing, Yostoto B. Kaban, M. Fauzie Sahil, M.Arief S.
Departement of Obstetric and Gynecology Medical Faculty – Universitas Sumatera Utara
Medan, Indonesia, 2013
ABSTRACT
Objective : To find the difference in ceruloplasmin serum level between patient with early and late onset severe preeclampsia. Method : this is a comparative analytic study with cross sectional design. Study subjects were pregnant women admitted to obstetric ward and emergency room of H. Adam Malik General Hospital and USU Medical Faculty satellite hospitals, who fulfilled the inclusion criteria. 40 subjects were obtained, with 20 cases of early onset severe preeclampsia and 20 cases of late onset severe preeclampsia. Result : From 40 subjects obtained, the average ceruloplasmin serum level was higher in subjects with early onset severe preeclampsia (0,899 g/L) compared to late onset severe preeclampsia (0,663 g/L) with p-value 0,05).
Universitas Sumatera Utara
Tabel 2. Perbandingan Kadar Serum Seruloplasmin antara Kehamilan dengan
Preeklamsia Berat Early Onset dan Kehamilan dengan Preeklamsia Berat Late Onset
DIAGNOSIS
MEAN
N Std. Deviation p-value
Seruloplasmin
(g/L)
Kadar Serum Early onset PEB 0,899
20 0,155
< 0,05
Seruloplasmin
Late onset PEB 0,663
20 0,137
< 0,05
Dari hasil penelitian ini didapati hasil
kadar rata-rata serum seruloplasmin pada
penderita preeklamsia berat early onset lebih
tinggi (0,899 g/L) dibandingkan dengan
preeklamsia berat late onset (0,663 g/L)
dengan p-value < 0,05.
Tabel 3. Korelasi antara Kadar Serum Seruloplasmin dengan Usia Kehamilan Ibu dengan
Preeklamsia Berat Early Onset
Kadar
Usia Kehamilan
Seruloplasmin
(minggu)
(g/L)
Kadar Seruloplasmin (g/L) Pearson
1
-, 668
Correlation
P-value
,001
N 20 20
Usia Kehamilan (minggu) Pearson Correlation P-value N
-,668
,001 20
1 20
Universitas Sumatera Utara
Dari uji korelasi pearson didapati adanya korelasi terbalik yang lemah (- 0,668) antara usia kehamilan ibu dengan preeklamsia
berat early onset dengan kadar serum seruloplasmin. (p-value 0,001).
Tabel 4. Korelasi antara Kadar Serum Seruloplasmin dengan Usia Kehamilan Ibu dengan
Preeklamsia Berat Late Onset
Kadar Seruloplasmin Usia Kehamilan
(g/L)
(minggu)
Kadar Seruloplasmin (g/L) Pearson
1
-,802
Correlation
P-value
,000
N 20
20
Usia Kehamilan (minggu) Pearson
-,802
1
Correlation
P-value
,000
N 20
20
Dari uji korelasi pearson didapati adanya korelasi terbalik yang kuat (- 0,802) antara usia kehamilan ibu dengan preeklamsia berat late onset dengan kadar serum seruloplasmin. (p-value < 0,05). Dengan meningkatnya usia gestasi, maka kadar serum seruloplasmin akan semakin berkurang.
KESIMPULAN Kadar rata-rata serum seruloplasmin pada penderita preeklamsia berat early onset lebih
tinggi dibandingkan dengan preeklamsia
berat late onset. Terdapat korelasi terbalik
yang kuat antara usia kehamilan dengan
preeklamsia berat baik yang early onset
maupun yang late onset dengan kadar serum
seruloplasmin.
Dengan
semakin
meningkatnya usia kehamilan maka kadar
seruloplasmin akan semakin rendah.
SARAN Diperlukan penelitian lebih lanjut dengan jumlah sampel lebih besar untuk
Universitas Sumatera Utara
mendapatkan hasil yang lebih akurat sehingga kadar serum seruloplasmin dapat dijadikan suatu penanda yang spesifik untuk preeklamsia.Dengan penggunaan serum seruloplasmin sebagai alat prognostik untuk preeklamsia, diharapkan dapat menurunkan angka kematian ibu di Indonesia pada umumnya dan di Medan pada khususnya. DAFTAR PUSTAKA 1. W.T. Pangemanan. Diagnosis dini dan
prediksi hipertensi dalam kehamilan (HDK). Simposium hipertensi dalam kehamilan. PTP VII POGI, Surakarta 1991. 2. Samil R.S. Hipertensi dan kehamilan. Kumpulan naskah PIT POGI ke II, Malang, Juli 1983. 3. Adnan M.N., Lieberman E.S., Wilkins Haug I.E et al. The value of elevated second trimester β hCG in predicting development of preeclampsia. Am J obstet Gynecol 1997 ; 176(2) : 438-42 4. Roberts J.M., Pearson G, Cutler J, et al; NHLBI Working Group on Research on Hypertension During Pregnancy. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension 2003; 41:437– 45. 5. Sibai R.M., Ewell M, Levine R.J., et al. Risk factors associated with
preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997;177:1003–10. 6. Lie R.T., Rasmussen S, Brunborg H, et al. Fetal and maternal contributions to risk of pre-eclampsia: population based study. BMJ 1998;316:1343–7. 7. MacKay A.P., Berg C.J., Atrash H.K. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001;97:533–8. 8. Simanjuntak J.R. Evaluasi kematian maternal penderita preeklampsia berat di RSUD Dr. Pirngadi Medan tahun 1993—1997, Medan, Fakultas Kedokteran Universitas Sumatera Utara. Tesis. 1999. 9. Churchill D, Duley L. Interventionist versus expectant care for severe preeclampsia before term. Cochrane Database Syst Rev 2002(3): CD0033106. 10. Loombard H, Pattinson B. Interventionist versus expectant care for severe preeclampsia before term : RHL commentary, The WHO Reproductive Health Library; Geneva: World Health Organization, 2004. 11. Hubel C.A. Oxidative Stress in the pathogenesis of preeclampsia. Magee-
Universitas Sumatera Utara
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