Post on 13-Dec-2015
08/03/2008
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Dapatkah Preeklampsia dicegah?
Noroyono WibowoDivisi Fetomaternal
Departemen Obstetri dan GinekologiFKUI RSCM Jakarta
08/03/2008
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• Women with previous pre-eclampsia are at increased risk of cardiovascular diseases
• Women with pre-eclampsia have unfavourablemetabolic profiles in pregnancy
• Cardiovascular risk factors that are present years before pregnancy are associated with a risk of pre-eclampsia
BMJ 2007;335;978-82
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80 – 90% dapat di cegah
Hamil harus dipersiapkan
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HamilHamil Membangun janin - Manusia
InflamasiInflamasi
ROSROS
ResistensiResistensi InsulinInsulin DIS
FUN
GSI
EN
DO
TEL
DIS
FUN
GSI
EN
DO
TEL
PREEKLAMPSIA
Status Nutrisi & Life style
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Trimester 1
1. PF: Gigi + Vagina + Serviks2. DPL + Ferritin + Fibrinogen3. Serum Protein Elektroforesis4. Profil Lipid5. TTGO 75 g Insulin 0/2 jam6. SOD7. Progesteron8. Hs CRP9. Ur/Cr, Cystatin C
Periodontitis Is Associated With Preeclampsia in Pregnant Women
• A total of 83 out of 130 preeclamptic women (63.8%) and 89 out of 243 controls (36.6%) had
chronic periodontitis (OR: 3.0; 95% confidence interval (CI): 1.91 to 4.87; P <0.001).
• Clinical attachment loss increased in the case group (4.0 ± 0.10 mm) compared to the control
group (3.0 ± 0.08 mm) (P <0.001).
• The average newborn birth weight from preeclamptic mothers was 2.453 g, whereas in
controls was 2.981 g (P <0.001).
• Two red complex microorganisms, Porphyromonas gingivalis and Tannerella forsythensis, and
the green complex microorganism Eikenella corrodens were more prevalent in the
preeclamptic group than in controls (P <0.01).
Journal of Periodontology. 2006, Vol. 77, No. 2;182-188
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Association Between Maternal Infections and Preeclampsia: A Systematic Review of Epidemiologic Studies
any infection (bacterial or viral) was associated with a
two-fold higher risk of preeclampsia. This association may provide a potential explanation for preeclampsia-related inflammation.
Maternal and Child Health Journal. 2008;12; 1092-7875
Association between serum ferritin and the insulin resistance syndrome in a representative population
European Journal of Endocrinology,2006; 154;333-340
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Age-adjusted ORs (95% CI) for the 6-year incidence of the IDF-defined metabolic syndrome according to high ferritin and transferrin levels (both above the upper tertiles) (A), lower ferritin and high transferrin levels (B), high ferritin and lower transferrin levels (C), and lower ferritin and lower transferrin levels (D).
Ferritin and Transferrin Are Associated With Metabolic Syndrome Abnormalities and Their Change Over Time in a General Population
Diabetes Care, 2007; 30:1795-1801
Characteristics of Some Plasma ProteinsProtein Fraction Concentration (mg/dL) Molecular Weight (D) Properties
Transthyretin Prealbumin 15-35 55,000 Retinol transport, binds T4
Albumin Albumin 4000-5000 66,000 Colloid osmotic pressure, binding protein
Retinol-binding protein
α1 3-6 21,000 Retinol transport
α1-Antiprotease α1 85-185 54,000 Protease inhibitor
Thyroxine-binding globulin
α1 1-3.5 58,000 Major binding protein for T3 and T4
Transcortin α1 3-3.5 52,000 Binds glucocorticoids
α-Fetoprotein α1 0.002 (adults) Elevated in adults with hepatoma
200-400 (fetus)
Ceruloplasmin α2 20-40 132,000 Contains copper
α2-Macroglobulin α2 150-400 725,000 Protease inhibitor
Haptoglobin α2 100-300 85,000* Binds hemoglobin
Transferrin β 200-400 89,000 Binds iron
Hemopexin β 50-120 60,000 Binds heme
Fibrinogen β 200-400 340,000 Clot formation
C-reactive protein γ 1.0 110,000 Acute phase reactant
Immunoglobulins γ 700-1500 150,000-950,000 Very heterogeneous
* One genetic variant forms higher molecular weight polymers (>200,000 D).T3, triiodothyronine; T4, thyroxine.
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Electrophoretic separation of plasma proteins on cellulose acetatemembrane at pH 8.6, densitometric scan. The electrophoretic patterndepends somewhat on the separation conditions, including supportmedium, pH, and ionic strength. ALB, albumin.
Plasma Contains A Complex Mixture of Proteins
Elsevier Meisenberg & Simmons: Principles of Medical Biochemistry 2e-www.studentconsult.com
Scale
10 nm
Albumin 69.00
Hemoglobin 64.500
1-Globulin 90.000
1-Globulin 156.000
1-lipoprotein 200.000 1-lipoprotein
1.300.000
Fibrinogen 340.000
Figure 50-1. Relative dimensions and approximate molecular masses of protein molecules in the blood (Oncley)
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© 2005 Elsevier
Plasma protein electrophoresis in various disease states. A, Normal. ALB, albumin. B, Immediate response pattern. C, Delayed response pattern. D, Liver cirrhosis. E, Protein-losing conditions (nephrotic syndrome, protein-losing enteropathy). F, Monoclonal gammopathy ("paraprotein").
• 160kDa, a2-globulin• Each molecule of ceruloplasmin binds six atoms of copper.
• carries 90% of the copper present in plasma• Copper is a cofactor for certain enzymes
• Amine oxidase, copper dependent superoxide dismutase, cytochrome oxidase, tyrosinase
Ceruloplasmin Binds Copper
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Theodore A. Kotchen
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63
72
81
90
3,5
4
4,5
5
Gestation (Weeks)
10 20 30 38 10-12
Plas
ma
gluc
ose
(mm
ol/L
)
Plas
ma
gluc
ose
(mm
ol/L
)
Postpartum