Hubungan Matrix Metalloproteinase-2 dengan Grading Placenta Accreta Spectrum Disorder (PASD) di RSUP H. Adam Malik Medan

Abstract

Background: In immunohistochemistry, MMP-2 is highly expressed in extravillous invasive trophoblast cells and vascular endothelium of the fourth week of pregnancy. MMP-2 acts as a key mediator in trophoblast penetration and neovascularization. Isaka et al. reported that extravillous trophoblast cells strongly expressed MMP-2 in placental tissue during the first trimester. It is argued that gelatinase activity, especially the MMP-2 enzyme, regulates the invasive capacity of trophoblast cells. Objective: Discover the relationship between MMP-2 and grading of Placenta Accreta Spectrum Disorder (PASD) at H. Adam Malik General Hospital Medan Methods: Observational analytical research with a case-control design was used in this research. Paraffin blocks were obtained from pregnant women suffering from PASD and pregnant women with normal placentas at term gestation. The data is then analyzed using the accuracy of reading MMP-2 expression, the kappa value from two observers will be calculated and declared valid if the value is >75%, while to analyze the difference between the relationship between MMP-2 and each PASD grading and the control group, a chi-square test will be carried out if the data normally distributed and if it is not normally distributed it will be tested with Fisher Exact. To assess the PASD grading which has the most significant impact on changes in MMP 2 expression, logistic regression will be used. Results: Using the correlation test in this study, the results of MMP-2 expression were significant in PASD compared to normal placenta. (p=0.025). There was no significant difference in the results of MMP-2 expression between each grading of Placenta Accreta Spectrum Disorder (Grade 1, Grade 2, and Grade 3) (p=0.527). Placenta Accreta Spectrum Disorder grading did not have a significant relationship with APGAR score (p = 0.392). Placenta Accreta Spectrum Disorder grading does not have a significant relationship with the baby's birth weight. (p=0.116). Placenta Accreta Spectrum Disorder Grading has a significant relationship with Histopathological Outcomes. (kappa score = 0,417). There are differences in the amount of bleeding based on PASD Grading. (p<0.001). There was no significant relationship between the severity of placenta accreta and ICU admission (p=0.798) Conclusion: There is a significant relationship between MMP-2 expression in PASD compared to normal placenta. No significant differences were found in the results of MMP-2 expression between each grading of Placenta Accreta Spectrum Disorder (Grade 1, Grade 2, and Grade 3), Placenta Grading Accreta Spectrum Disorder does not have a significant relationship with APGAR score and ICU admission, but Placenta Accreta Spectrum Disorder Grading has a significant relationship with Histopathological Outcomes and Bleeding