Assessing the Role of Acupressure Techniques to Overcome Hyperemesis Gravidarum, Made Tangkas Earns a Doctoral Degree

Located in the graduate courtroom lt. III, Denpasar Postgraduate Building, the Doctoral Promotion exam has taken place with promovendus candidate dr. Made Tangkas, Sp.OG, MPH., with the dissertation title "Application of Acupressure at PC 6 Point Reduces Serum Levels of Interleukin 1, Interleukin 6, Dopamine and Human Chorionic Gonadotrophin and Improves Clinical Outcomes and Urinary Ketones in Hyperemesis Gravidarum Patients." (15/5/2023)

 

Hyperemesis gravidarum (HEG) is a complication of young pregnancy which is characterized by excessive nausea and vomiting causing dehydration, electrolyte disturbances and metabolism. The etiopathogenesis of HEG is not yet clear, many factors are thought to play a role such as hormonal, inflammatory, neurotransmitter and other factors. Therefore, HEG treatment is still empirical and sub-optimal, primarily aimed at restoring fluids and electrolytes and reducing complaints of nausea and vomiting.

 

A pharmacological approach using antiemetic drugs is carried out but the side effects of these drugs cause discomfort to patients when using them. Besides that, teratogenic effects are still suspected to occur and the costs are quite expensive, causing the development towards a non-pharmacological approach using herbal preparations and acupressure techniques.

Acupressure technique is a traditional Chinese medical technique which is known to have positive benefits for improving human health as well as an effect on complaints of nausea and vomiting, especially acupressure at the PC6 point.

 

Many studies have been conducted on the effectiveness and efficacy of acupressure in improving complaints of nausea and vomiting, but no one has examined how the mechanism works to improve complaints of nausea and vomiting. This study aims to prove whether the action of acupressure at PC 6 has an effect on inflammatory and hormonal processes and how the mechanism can improve the clinical outcomes of nausea, vomiting and urine ketones in patients with hyperemesis gravidarum by examining Interleukin-1β, Interleukin-6, Dopamine and hCG levels. as well as urine ketones and interviews using the PUQE questionnaire.

 

This study involved 30 subjects of pregnant women with HEG who were divided into 2 groups, 3 of which were not analyzed due to dropouts. In the treatment group, acupressure was performed at the PC6 point, while in the control group, at the sham point for 48 hours using an acupressure bracelet. Serum samples were collected and interviewed in the first 24 hours and the second 24 hours. Serum IL-1β, IL-6, Dopamine, hCG levels were examined by ELISA technique, urine ketones by drum stick. Differences in pre-test values, 24 hour and 48 hour values were tested using the Wilcoxon comparative statistical test for non-homogeneous data and the Paired t test for homogeneous data. While the Path Analysis test was carried out to see the strength of the relationship between variables.

 

The decrease in IL-1β and IL-6 levels was significantly greater in the treatment group compared to the control group. Likewise, the reduction in urine hCG and ketone levels was significantly greater in the treatment group compared to the control group.

In dopamine levels, there was an increase in both groups but the increase in the treatment group was smaller than the control group.

 

Clinical improvement using the PUQE score reduction was significantly greater in the treatment group compared to the control group.

The Path test proved that acupressure at the PC 6 point improved the clinical outcome of nausea and vomiting in the first 24 hours through its effect on dopamine, whereas within 48 hours through its effect on IL-6, which was greater than the other variables.

 

The exam was led by the Dean of FK Unud, Dr. dr. Komang Januartha Putra Pinatih, M.Kes., with the testing team:

1. Dr. dr. I Made Jawi, M.Kes (Promoter)

2. Prof. Dr. dr. I Made Wiryana, Sp.An-KIC (Co-promoter I)

3.Dr. dr. I Nyoman Gede Budiana, Sp.OG, Subsp.Onk (Co-promoter II)

4. Dr. dr. I Wayan Putu Sutirta Yasa, M.Si

5. Prof. Dr. dr. Tjok Gde Agung Senapathi, Sp.An., KAR

6. dr. I Made Ady Wirawan, S.Ked, MPH., Ph.D

7.Dr. dr. I Made Sudarmaja, M. Kes

8.Dr. dr. Dyah Kanya Wati, Sp.A (K)

 

While academic invitations are:

1.Dr. dr. I Nyoman Hariyasa Sanjaya, Sp.OG(K), MARS

2.Dr. dr. I Wayan Artana Putra, SpOG, Subsp, K.Fm

3.Dr. dr. I Gusti Ayu Widianti, M. Biomed

4.Dr. dr. Ketut Suarjana, MPH

5.Dr. dr. I Putu Eka Widyadharma, M.Sc., Sp.S(K)

 

In this exam, Dr. dr. Made Tangkas, Sp.OG, MPH., was declared the 378th Doctor Graduate of the Doctoral Degree in Medical Sciences, Faculty of Medicine, University of Udayana with the Cum Laude predicate.