The Relationship between Ferritin Levels and Uterine Inertia  in Labor Women

Astri Ayu Agus; Andi Mardiah Tahir; Nurbani Bangsawan; Maisuri T Chalid; Efendi Lukas; Lenny M. Lisal

doi:10.24198/obgynia.v6i2.494

The Relationship between Ferritin Levels and Uterine Inertia in Labor Women

Astri Ayu Agus, Andi Mardiah Tahir, Nurbani Bangsawan, Maisuri T Chalid, Efendi Lukas, Lenny M. Lisal

Abstract

Objective: To determine the relationship between ferritin levels and the incidence of uterine inertia in pregnant women.
Method: This study uses a prospective cohort design. The study was conducted on all pregnant women aged 20-40 years who had antenatal care and be in labor at the Teaching Hospital in the Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University. Data were analyzed with the chi-square test and the Mann-Whitney test.
Results: Obtained 76 pregnant women where 44.7% of them had uterine inertia. The average ferritin level in the uterine inertia group was significantly lower (3.80 ± 2.84 ng/mL) than without the uterine inertia group (12.99 ± 11.40 ng/mL) with a value p<0.001. The average ferritin level in the mild anemia group was significantly higher (9.83 ± 10.35 ng/mL) than in the moderate anemia group (3.82 ± 2.51 ng/mL) with a p-value <0.05. Pregnant women with moderate anemia were found to be 4.68 more susceptible uterine inertia than pregnant women with mild anemia.
Conclusion: There was a relationship between ferritin levels in pregnant women and the incidence of uterine inertia where low ferritin levels was risk factor of uterine inertia.

Hubungan Kadar Feritin dengan Kejadian Inersia Uteri pada Ibu Bersalin

Abstrak
Tujuan: Untuk mengetahui hubungan antara kadar feritin dan kejadian inersia uteri pada ibu bersalin.
Metode: Penelitian ini menggunakan rancangan kohort prospektif. Penelitian dilakukan pada semua wanita hamil usia 20-40 tahun yang melakukan antebatal care dan persalinan di Rumah Sakit Pendidikan di bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Hasanuddin. Data dianalsiis dengan uji chi square dan uji Mann Whitney.
Hasil: Diperoleh 76 ibu hamil, sebanyak 44,7% di antaranya mengalami inersia uteri. Rata-rata kadar feritin pada kelompok inersia uteri secara signifikan lebih rendah (3,80±2,84 ng/mL) dibandingkan rata-rata kadar feritin pada kelompok tidak inersia uteri (12,99±11,40 ng/mL) dengan nilai p<0,001. Rata-rata kadar feritin pada kelompok anemia ringan secara signifikan lebih tinggi (9,83±10,35 ng/mL) dibandingkan rata-rata kadar feritin pada kelompok anemia moderat (3,82±2,51 ng/mL) dengan nilai p<0,05. Ibu hamil dengan anemia moderat mempunyai risiko mengalami inersia uteri sebanyak 4,68 kali lebih besar dibandingkan ibu hamil dengan anemia ringan.
Kesimpulan: Ada hubungan antara kadar feritin ibu hamil dan kejadian inersia uteri. Rendahnya kadar feritin menjadi salah satu penyebab kejadian inersia uteri.

Kata kunci: Feritin, Ibu Bersalin, Inersia Uteri

Keywords

ferritin, maternal, uterine inertia

Full Text:

PDF

References

World Health Organization. UNICEF. United Nations Population Fund and The World Bank. Trends in Maternal Mortality: 2000 to 2017 WHO. Geneva; 2019.

Pritasari K. Arah kebijakan dan rencana aksi program kesehatan masyarakat tahun 2020 - 2024. Rapat Kerja Nas Kementeri Kesehat RI. 2020;1–31.

Gill P, Patel A, Hoo J. Uterine Atony. US StatPearls Publ LLC [Internet]. 2020; Available from: //www.ncbi.nlm.nih.gov/books/NBK493238/

Liu G. Prevention effect of hemabate on postpartum hemorrhage caused by uterine inertia. J Hainan Med Univ. 2016;22(6):6–9.

Chutia T, Talukdar D, Konwar B, Ahmed F, Lalrintluanga K, Das D. Management of Incomplete Uterine Inertia in a Labrador Bitch - A Case Report. Int J Livest Res. 2016;6(9).

Blitz M, Yukhayev A, Pachtman S, Reisner J, Moses D, Sison C, et al. Twin pregnancy and risk of postpartum hemorrhage. J Matern Fetal Neonatal Med. 2019;

Ryan GA, Nicholson SM, Crankshaw DJ, Morrison JJ. Maternal parity and functional contractility of human myometrium in vitro in the third trimester of pregnancy. J Perinatol [Internet]. 2019;39(3):439–44. Available from: http://dx.doi.org/10.1038/s41372-019-0312-2

Nair M, Choudhury MK, Choudhury SS, Kakoty SD, Sarma UC, Webster P, et al. Association between maternal anemia and pregnancy outcomes: A cohort study in Assam, India. BMJ Glob Heal. 2016;1(1):1–9.

Adam I, Kheiri S, Sharif ME, Ahmed ABA, Rayis DA. Anaemia is associated with an increased risk for caesarean delivery. Int J Gynecol Obstet. 2019;147(2):202–5.

Kavle JA, Stoltzfus RJ, Witter F, Tielsch JM, Khalfan SS, Caulfield LE. Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania. J Heal Popul Nutr. 2008;26(2):232–40.

Escobar MF, Hincapie MA, Barona JS. Immunological Role of the Maternal Uterine Microbiota in Postpartum Hemorrhage. Front Immunol. 2020;11(March):1–5.

Andrikopoulou M, DÁlton M. Postpartum hemorrhage: early identification challenges. Semin Perinatol [Internet]. 2019;43:11–7. Available from: doi: 10.1053/j.semperi.2018.11.003

Farhana M, Tamura N, Mukai M, Ikuma K, Koumura Y, Furuta N, et al. Histological characteristics of the myometrium in the postpartum hemorrhage of unknown etiology: a possible involvement of local immune reactions. J Reprod Immunol [Internet]. 2015;110:74–80. Available from: doi: 10.1016/j.jri.2015.04.004

Jain D, Oda T, Tamura N, Itoh H, Kanayama N. 842: Role of inflammation in uterine isthmus leading to uterine atony: pathophysiology of Amniotic Fluid Embolism. Am J Obstet Gynecol [Internet]. 2019;220(1):S549–50. Available from: https://doi.org/10.1016/j.ajog.2018.11.865

Singh N, Herbert B, Sooranna GR, Orsi NM, Edey L, Dasgupta T, et al. Accepted Preprint first posted on 23 August 2017 as Manuscript JME-17-0080. Soc Endocrinol. 2017;(August):1–28.

Dignass A, Farrag K, Stein J. Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions. Int J Chronic Dis. 2018;2018(Table 1):1–11.

Goodarzi M, Bashardoost N. The study of the relationship of serrum ferritin and uterine contractions in pregnant women refer to medical centers of Isfahan. IJNMR. 2009;14(4):12–8.

Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017;29(9):401–9.

Nkwabong E, Mouafo CK, Njamen TN. Risk factors for uterine atony in two semi-urban hospitals. Int J Pregnancy Child Birth. 2020;6(2):45–9.

Soltan MH, Ibrahim EM, Tawfek M, Hassan H, Farag F. Raised nitric oxide levels may cause atonic postpartum hemorrhage in women with anemia during pregnancy. Int J Gynecol Obstet [Internet]. 2012;116(2):143–7. Available from: http://dx.doi.org/10.1016/j.ijgo.2011.09.017

Jahedbozorgan T, Yaghmaei M, Naserieh M. Comparison of serum ferritin levels in pregnant women with preterm and term deliveries. Immunopathol Persa. 2020;6(2).

Chiou B, Connor JR. Emerging and Dynamic Biomedical Uses of Ferritin. 2018;

Asrizal. Relationship Between Serum Ferritin Levels and Patient Characteristics in Pregnant Women. Int J Res Appl Sci Eng Technol. 2022;10(9):1370–4.

Hoesel B, Schmid JA. The complexity of NF-_B signaling in inflammation and cancer. Mol Cancer. 2013;12(86).

Ueda N, Takasawa K. Impact of inflammation on ferritin, hepcidin and the management of iron deficiency anemia in chronic kidney disease. Nutrients. 2018;10(9).

Premalahta H., Krishnegowda R. Prospective study of association of uterine atonicity and serum calcium levels. Int J Reprod Contraception, Obstet Gynecol. 2016;5(7):2221–3.

Savitri DA, Hadisubroto Y, Wulandari P, Studi P, Dokter P, Kedokteran F, et al. Perbedaan Kejadian Inersia Uteri Antara Persalinan Disertai dan Tanpa Disertai Anemia di RSD dr. Soebandi Jember. J Agromedicine Med Sci. 2019;5(3):172–6.

Frass KA. Postpartum hemorrhage is related to the hemoglobin levels at labor: Observational study. Alexandria J Med [Internet]. 2015;51(4):333–7. Available from: http://dx.doi.org/10.1016/j.ajme.2014.12.002

Garzon S, Cacciato PM, Certelli C, Salvaggio C, Magliarditi M, Rizzo G. Iron deficiency anemia in pregnancy: Novel approaches for an old problem. Oman Med J. 2020;35(5):1–9.

Julizar M, Effendi JS, Sukandar H. Analisis Faktor Risiko Atonia Uteri. Care J Ilm Ilmu Kesehat. 2019;7(3):108.

Omotayo MO, Abioye AI, Kuyebi M, Eke AC. Prenatal anemia and postpartum hemorrhage risk: A systematic review and meta-analysis. J Obstet Gynaecol Res. 2021;47(8):2565–76.

Al-Hijji J, Andolf E, Laurini R, Batra S. Nitric oxide synthase activity in human trophoblast, term placenta and pregnant myometrium. Reprod Biol Endocrinol. 2003;1(July).

DOI: http://dx.doi.org/10.24198/obgynia.v6i2.494