Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S16–S49
Contents lists available at ScienceDirect
Pregnancy Hypertension: An International Journal of
Women’s Cardiovascular Health
journal homepage: www.elsevier.com/locate/preghy
Abstracts for oral presentations
2018 ISSHP and ISOM World Congress
17. Aberrant corpus luteum number as a contributor to altered
maternal vascular health in early pregnancy and preeclampsia
risk after assisted reproduction
Frauke von Versen-Höynck a, Purnima Narasimhan b, Elif Seda
Selamet Tierney c, Nadine Martinez b, Kirk P. Conrad d, Valerie L.
Baker b, Virginia D. Winn b (a Stanford University Medical
Center – Hannover Medical School, Sunnyvale and Hannover,
United States, b Stanford University Medical Center, Stanford,
United States, c Lucile Packard Children’s Hospital Stanford, Palo
Alto, United States, d University of Florida College of Medicine,
Gainsville, United States)
Introduction: Pregnancies conceived after utilization of assisted
reproductive technologies (ART) are associated with an increased
risk for preeclampsia. The pathophysiologic reasons are mainly
unknown.
Objective: We sought to determine if a non-physiologic hormonal
milieu influenced by the number of corpora lutea (CL) and the mode
of conception affects maternal vascular health in early pregnancy.
Methods: Blood pressure, endothelial function, circulating endothe-
lial progenitor cell numbers (CPCs), lipid levels, and CL hormones were
compared in a prospective cohort of women at 11 to 14 weeks’ gesta-
tion by number of CL and mode of conception (N = 57): 0 CL (pro-
grammed frozen embryo transfer (FET), N = 18); 1 CL (spontaneous
pregnancy after infertility [N = 16] and modified natural cycle FET
[N = 12]); or >3 CL associated with in vitro fertilization [N = 11].
Results: Women with 0 or >3 CL lacked the drop in mean arterial
blood pressure compared to women with 1 CL (P = 0.05; P = 0.05).
Reactive Hyperemia Index (RHI) was impaired in patients lacking a
CL compared to women with 1 CL (P = 0.04). Baseline pulse wave
amplitude (BPWA) was higher in subjects with >3 CL compared to
1 CL (P = 0.01) or zero (P = 0.01). Suppression of CL development in
FET cycles was associated with a lower RHI compared with FETs in
a natural cycle (P = 0.03). The number of angiogenic and non-
angiogenic CPCs was lower in the absence of a CL in FETs (P = 0.02
and P = 0.04). Relaxin levels correlated with the number of angio-
genic CPCs (r = 0.31; P = 0.03).
Discussion: Maternal vascular health in early pregnancy is altered
in women with aberrant numbers of CL (0 or >3), and might repre-
sent insufficient cardiovascular adaption leading to an increased risk
of preeclampsia.
doi:10.1016/j.preghy.2018.08.050
28. The massive problem of preeclampsia in indonesia: In need of
a redesigned national health care system
Muhammad Ilham Aldika Akbar a, Muhammad Adrianes
Bachnas b, Johannes Cornelius Mose c, Erry Gumilar Dachlan a,
Ernawati Ernawati a, Gustaaf Albert Dekker d, Anne Catherine
Staff e, Sri Sulistyowati b, Julian Dewantiningrum f, Aan
Jayakusuma g, John Wantanai h, Makmur Sitepu i, Jusuf
Sulaeman Effendi c, Herman Kristanto f (a Airlangga University,
Surabaya, Indonesia, b Sebelas Maret University, Solo, Indonesia,
c
Padjadjaran University, Bandung, Indonesia, d University of
Adelaide, Adelaide, Australia, e Oslo University Hospital, Oslo,
Norway, f Diponegoro University, Semarang, Indonesia, g Udayana
University, Bali, Indonesia, h Sam Ratulangi University, Manado,
Indonesia, i University of North Sumatra, Medan, Indonesia)
Objectives: Preeclampsia is a global maternal health burden due to
its high maternal mortality and morbidity, especially in low income
countries like Indonesia. The present national multicenter study was
conducted to evaluate the characteristics and outcomes of
preeclampsia in Indonesia, that has never been published before.
Methods: This is a one year (2016) retrospective multicenter study
of all preeclampsia cases in seven tertiary referral centers in
Indonesia: Medan, Bandung, Semarang, Solo, Surabaya, Bali, and
Manado.
Results: Among the total 1232 preeclampsia (PE) cases registered,
late-onset preeclampsia (>34 weeks) was the most common PE phe-
notype; 54% compared with 48% early-onset PE. Many of the
preeclamptic women had known risk factors for preeclampsia,
including anemia (26%), obesity (10%), and chronic hypertension
(8%). Maternal mortality was quite high (2.2%). Maternal complica-
tions were dominated by HELLP syndrome (9.8%) and pulmonary
edema (6.5%). About 11.9% of the mother required ICU admission.
Most of our patients underwent cesarean Section (52.8%). Perinatal
mortality rate was 12%. The most frequent perinatal complication
was asphyxia (27%). 11% of these newborn needed NICU admission.
Discussion: In contrast to most Western countries, the rate of pre-
term PE and pulmonary edema in Indonesia seems much higher than
published. The new format of our national health coverage (BPJS)
does often not cover the real cost of hospital treatment. The true hos-
pital costs is in more than 93% of preeclampsia patients exceeding
the BPJS funding, and the excess costs must be borne solely by the
hospital. As such PE represents also a major financial problem for
the already struggling public hospitals in Indonesia.
Conclusion: Preeclampsia stands out as a massive health care prob-
lem in Indonesia. Improving quality and consistency of antenatal care
and a complete redesign of the national health care insurance system
will be the pivotal steps forward to reduce its terrible impact.
doi:10.1016/j.preghy.2018.08.051