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Sety
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C
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ar
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d
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Pre
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Pre
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T
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CC B
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C
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p
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Sy
aif
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Dep
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tm
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Nu
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s
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Facu
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Hea
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Po
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Ma
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W
est Nu
s
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T
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ail:
s
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aif
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.
c
o
m
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
r
is
k
s
o
f
p
r
eg
n
a
n
cy
ar
e
d
y
n
am
ic
b
ec
a
u
s
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ea
lth
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p
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e
g
n
an
t
wo
m
en
ca
n
s
u
d
d
en
ly
ex
p
er
ien
ce
co
m
p
licatio
n
s
s
u
ch
as
p
r
ee
cla
m
p
s
ia
[
1
]
-
[
5
]
.
Pre
ec
lam
p
s
ia
is
a
d
an
g
er
o
u
s
d
is
o
r
d
er
th
at
c
o
m
m
o
n
l
y
m
an
if
ests
its
elf
af
ter
2
0
wee
k
s
o
f
p
r
eg
n
an
cy
[
6
]
.
I
t
is
ch
ar
ac
te
r
ized
b
y
h
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h
b
lo
o
d
p
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e
a
n
d
d
a
m
ag
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to
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t
h
er
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r
g
an
s
[
6
]
.
I
t
is
im
p
o
r
tan
t
f
o
r
p
r
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g
n
an
t
wo
m
en
t
o
atten
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r
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g
u
l
ar
p
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en
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ch
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k
-
u
p
s
to
m
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r
f
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s
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s
o
f
co
m
p
licatio
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s
s
u
ch
as
p
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clam
p
s
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B
o
th
th
e
m
o
th
er
an
d
t
h
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b
ab
y
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at
r
is
k
f
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d
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m
ajo
r
is
s
u
es
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r
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f
p
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wh
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ch
ca
n
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clu
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e
p
r
em
atu
r
e
b
ir
t
h
an
d
lo
w
b
ir
t
h
weig
h
t
[
7
]
.
E
ar
ly
d
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tio
n
an
d
m
an
ag
em
en
t
o
f
p
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clam
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ar
e
cr
u
cial
to
en
s
u
r
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s
af
e
p
r
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n
an
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an
d
d
eliv
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y
.
I
n
th
e
p
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s
en
ce
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f
p
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g
n
an
c
y
-
in
d
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p
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(
b
lo
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p
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th
at
is
eq
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to
o
r
g
r
ea
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th
an
1
4
0
/9
0
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m
Hg
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)
an
d
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tial
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(
g
r
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ter
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0
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/2
4
h
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r
s
)
,
p
r
ee
c
lam
p
s
ia
is
d
iag
n
o
s
ed
[
8
]
.
T
h
e
s
ev
er
ity
o
f
p
r
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clam
p
s
ia
ca
n
b
e
f
u
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th
e
r
class
if
ied
as
eith
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m
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r
s
ev
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e,
d
ep
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n
d
in
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o
n
th
e
class
if
icatio
n
s
ch
em
e
th
at
is
u
tili
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d
[
9
]
,
[
0
]
.
I
n
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d
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n
t
o
s
ev
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y
p
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(
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a
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p
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ater
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g
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[
1
1
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
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Th
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1331
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eg
n
a
n
cies
ar
e
c
o
m
p
licated
b
y
p
r
ee
clam
p
s
ia,
a
n
d
p
r
ee
cla
m
p
s
ia
an
d
ec
lam
p
s
ia
ar
e
r
elate
d
with
ten
to
f
if
teen
p
e
r
ce
n
t
o
f
all
m
ater
n
al
d
ea
th
s
th
at
o
cc
u
r
d
ir
ec
tly
.
I
t
is
esti
m
ated
th
at
r
o
u
g
h
ly
0
.
5
–
0
.
9
%
o
f
all
p
r
e
g
n
an
cies
ar
e
co
m
p
licated
b
y
s
ev
er
e
s
ig
n
s
o
f
p
r
ee
clam
p
s
ia,
wh
ich
in
clu
d
e
h
em
o
ly
s
is
,
in
cr
ea
s
ed
liv
e
r
en
zy
m
es,
an
d
lo
w
p
latelets.
A
d
d
itio
n
ally
,
a
p
p
r
o
x
im
ately
1
0
–
2
0
%
o
f
ca
s
es
o
f
s
ev
er
e
p
r
ee
clam
p
s
ia
ar
e
in
v
o
l
v
ed
in
co
m
p
licatio
n
s
.
W
h
en
co
m
p
ar
ed
to
t
h
e
d
ea
t
h
r
ate
at
3
7
wee
k
s
o
r
later
,
p
r
ee
clam
p
s
ia
at
a
g
estatio
n
al
ag
e
o
f
less
th
an
3
2
we
ek
s
wa
s
r
elate
d
with
a
twen
ty
f
o
ld
i
n
cr
ea
s
e
in
m
ater
n
al
m
o
r
tality
.
W
o
m
en
wh
o
h
ad
p
r
ee
clam
p
s
ia
h
ad
a
h
ig
h
er
o
v
er
a
ll m
o
r
tality
r
ate
m
an
y
y
ea
r
s
la
ter
[
1
2
]
,
wh
ich
was
also
g
r
ea
ter
th
an
th
e
g
e
n
er
a
l
m
o
r
tality
r
ate
am
o
n
g
w
o
m
en
.
Ad
d
itio
n
ally
,
p
r
ee
clam
p
s
ia
is
a
s
ig
n
if
ican
t
co
n
tr
ib
u
to
r
to
th
e
d
em
is
e
o
f
b
o
th
th
e
f
etu
s
an
d
th
e
n
ewb
o
r
n
.
Pre
ec
lam
p
s
ia
is
h
ig
h
ly
c
o
n
n
ec
ted
with
f
etal
g
r
o
wth
r
estrictio
n
,
lo
w
b
ir
th
weig
h
t,
p
r
em
atu
r
e
d
eliv
er
y
,
r
esp
ir
ato
r
y
d
is
tr
ess
s
y
n
d
r
o
m
e,
an
d
ad
m
is
s
io
n
to
n
eo
n
atal
in
ten
s
iv
e
ca
r
e
[
1
3
]
.
Hy
p
er
ten
s
io
n
a
n
d
/o
r
p
r
o
tein
u
r
ia
d
u
r
i
n
g
p
r
eg
n
a
n
cy
h
av
e
also
b
ee
n
lin
k
ed
to
s
till
b
ir
th
.
Fu
r
th
er
m
o
r
e,
p
r
ee
cla
m
p
s
ia
h
as b
ee
n
lin
k
e
d
to
s
till
b
ir
th
.
I
n
d
o
n
esian
Hea
lth
Pro
f
ile
Da
ta
2
0
1
9
,
h
y
p
er
ten
s
io
n
in
p
r
eg
n
an
cy
is
th
e
lead
in
g
ca
u
s
e
o
f
m
ater
n
al
d
ea
th
af
ter
b
leed
in
g
w
ith
a
t
o
tal
o
f
1
,
0
6
6
ca
s
es
[
1
4
]
.
As
f
o
r
d
ata
in
th
e
p
r
o
v
in
ce
o
f
W
est
Nu
s
a
T
en
g
g
ar
a
(
NT
B
)
,
th
e
n
u
m
b
e
r
o
f
m
o
th
er
s
wh
o
d
ied
d
u
e
t
o
p
r
ee
clam
p
s
ia
s
tar
tin
g
in
2
0
1
8
was
2
9
ca
s
es,
in
cr
ea
s
in
g
to
3
9
ca
s
es
in
2
0
1
9
,
t
h
en
d
ec
r
ea
s
in
g
b
y
3
1
ca
s
es
in
2
0
2
0
,
a
n
d
in
2
0
2
1
d
ec
r
ea
s
in
g
ag
ai
n
to
2
8
ca
s
es
[
1
5
]
.
Alth
o
u
g
h
th
er
e
is
a
r
ed
u
ctio
n
,
th
e
d
ea
th
r
ate
d
u
e
to
p
r
ee
clam
p
s
ia
s
till
n
ee
d
s
to
b
e
m
o
n
ito
r
e
d
an
d
co
n
s
id
er
ed
to
im
p
r
o
v
e
th
e
q
u
ality
o
f
m
ater
n
al
h
ea
lth
s
er
v
ices
in
NT
B
.
Pre
v
e
n
tio
n
ef
f
o
r
ts
an
d
ap
p
r
o
p
r
iate
tr
ea
tm
en
t
n
ee
d
to
b
e
co
n
tin
u
o
u
s
ly
im
p
r
o
v
ed
t
o
r
ed
u
ce
th
e
d
ea
th
r
ate
d
u
e
to
h
y
p
er
ten
s
io
n
in
p
r
e
g
n
an
c
y
in
th
e
ar
ea
.
W
ith
ad
v
an
ce
s
in
tech
n
o
lo
g
y
,
v
ar
io
u
s
m
et
h
o
d
s
h
av
e
em
er
g
e
d
to
d
etec
t
ea
r
ly
p
r
ee
clam
p
s
ia,
in
clu
d
i
n
g
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
m
eth
o
d
,
a
s
im
p
le
to
o
l
u
s
e
d
to
d
et
ec
t
th
e
r
is
k
o
f
p
r
ee
cla
m
p
s
ia
in
p
r
eg
n
a
n
t
wo
m
en
.
T
h
is
m
eth
o
d
is
s
o
s
i
m
p
le
th
at
ev
er
y
o
n
e
ca
n
u
s
e
it,
in
clu
d
in
g
f
a
m
ily
m
em
b
er
s
,
p
r
eg
n
an
t
wo
m
e
n
,
an
d
co
m
m
u
n
ity
h
ea
lth
wo
r
k
er
s
.
T
h
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
is
ca
p
ab
le
o
f
ea
r
ly
d
etec
tio
n
o
f
PE
with
an
ac
cu
r
ac
y
o
f
9
0
.
9
%
o
f
th
e
g
o
l
d
s
tan
d
ar
d
,
an
d
a
s
en
s
itiv
ity
o
f
9
6
.
8
%
an
d
a
s
p
ec
if
icity
o
f
7
9
.
7
%
[
1
6
]
.
T
h
is
m
eth
o
d
,
th
r
o
u
g
h
em
p
o
wer
m
e
n
t
an
d
co
llab
o
r
atio
n
with
h
ea
lt
h
ca
d
r
es,
h
as
n
o
t
y
et
b
ee
n
wid
ely
im
p
lem
en
ted
i
n
co
m
m
u
n
ities
.
T
h
er
e
f
o
r
e,
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
m
eth
o
d
is
u
s
ed
.
I
t
h
as
n
o
t
y
et
b
ee
n
o
p
tim
ally
u
s
ed
b
y
th
e
wid
er
c
o
m
m
u
n
ity
,
e
v
e
n
th
o
u
g
h
th
e
way
to
o
p
er
ate
th
is
m
eth
o
d
is
q
u
ite
s
im
p
le
a
n
d
ca
n
b
e
u
s
ed
b
y
f
am
ilies
an
d
th
e
wid
e
r
co
m
m
u
n
ity
to
d
etec
t
th
e
r
is
k
o
f
p
r
ee
clam
p
s
ia
ea
r
ly
s
o
t
h
at
th
e
in
cid
e
n
ce
o
f
p
r
e
ec
lam
p
s
ia
in
p
r
eg
n
an
t
wo
m
en
ca
n
b
e
r
ed
u
ce
d
to
a
m
in
i
m
u
m
.
T
h
e
m
ain
ch
allen
g
e
f
o
r
ca
d
r
es
is
to
e
n
s
u
r
e
p
r
o
p
er
tr
ai
n
in
g
an
d
ed
u
ca
tio
n
o
n
h
o
w
to
ef
f
ec
tiv
ely
u
s
e
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
m
eth
o
d
in
o
r
d
er
to
im
p
r
o
v
e
its
im
p
lem
en
tatio
n
a
n
d
im
p
ac
t
in
co
m
m
u
n
it
ies.
Ad
d
itio
n
ally
,
estab
lis
h
in
g
s
tr
o
n
g
p
ar
tn
e
r
s
h
ip
s
with
h
ea
lth
ca
r
e
p
r
o
v
i
d
er
s
an
d
l
o
c
al
au
th
o
r
ities
ca
n
h
elp
s
u
p
p
o
r
t
th
e
in
teg
r
atio
n
o
f
th
is
m
eth
o
d
i
n
to
e
x
is
tin
g
m
ater
n
al
h
ea
lth
p
r
o
g
r
am
s
.
T
h
i
s
p
r
o
b
lem
is
n
o
t
o
n
ly
f
o
r
ca
d
r
es
in
th
e
r
esear
ch
lo
ca
tio
n
b
u
t
als
o
f
o
r
all
h
ea
lth
ca
d
r
es
in
d
etec
tin
g
p
r
ee
clam
p
s
ia,
b
ec
au
s
e
p
r
o
p
e
r
tr
ain
in
g
a
n
d
ed
u
ca
tio
n
ar
e
ess
en
tial
f
o
r
th
e
im
p
lem
en
tatio
n
o
f
ef
f
ec
tiv
e
h
ea
lth
ca
r
e
m
eth
o
d
s
.
T
h
e
n
o
v
elty
o
f
t
h
is
s
tu
d
y
lies
in
its
f
o
cu
s
o
n
im
p
r
o
v
i
n
g
m
ater
n
al
h
ea
lth
o
u
tco
m
es
th
r
o
u
g
h
th
e
u
s
e
o
f
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
m
eth
o
d
.
B
y
em
p
h
asizin
g
th
e
im
p
o
r
tan
ce
o
f
tr
ain
in
g
an
d
ed
u
ca
tio
n
,
h
ea
lt
h
ca
r
e
p
r
o
v
id
er
s
ca
n
e
n
s
u
r
e
t
h
at
th
e
Dh
ian
a
Sety
o
r
i
n
i
Sco
r
e
C
ar
d
m
eth
o
d
is
im
p
lem
en
ted
co
r
r
ec
tly
an
d
e
f
f
ec
tiv
ely
.
T
h
is
r
esear
ch
h
as
t
h
e
p
o
ten
tial
to
n
o
t
o
n
ly
im
p
r
o
v
e
m
ater
n
al
h
ea
lth
o
u
tco
m
es
in
th
e
r
esear
ch
l
o
ca
tio
n
,
b
u
t
also
s
er
v
e
as
a
m
o
d
e
l
f
o
r
o
th
er
co
m
m
u
n
ities
lo
o
k
i
n
g
to
en
h
an
ce
t
h
eir
m
ater
n
al
h
ea
lth
p
r
o
g
r
am
m
es.
T
h
e
aim
o
f
th
is
s
tu
d
y
was
to
d
eter
m
in
e
th
e
ef
f
ec
t
o
f
th
e
ap
p
licatio
n
o
f
th
e
D
h
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
o
n
th
e
ea
r
ly
d
etec
tio
n
o
f
p
r
ee
clam
p
s
ia
r
is
k
.
W
e
h
o
p
e
t
h
at
th
is
r
esear
ch
will
p
r
o
v
id
e
u
s
ef
u
l
in
f
o
r
m
atio
n
f
o
r
th
e
d
e
v
elo
p
m
e
n
t
o
f
m
ater
n
al
an
d
ch
ild
h
ea
lth
p
r
o
g
r
am
m
es
in
th
e
co
m
m
u
n
ity
.
I
t
is
h
o
p
ed
th
at
th
e
r
esu
lts
o
f
th
is
r
esear
ch
will
in
cr
ea
s
e
p
u
b
lic
u
n
d
er
s
tan
d
in
g
o
f
th
e
i
m
p
o
r
tan
ce
o
f
ea
r
ly
d
etec
tio
n
o
f
p
r
ee
clam
p
s
ia
to
p
r
ev
en
t
m
o
r
e
s
er
io
u
s
c
o
m
p
lic
atio
n
s
.
I
n
ad
d
itio
n
,
we
h
o
p
e
t
h
at
th
is
r
esear
ch
will
p
r
o
v
id
e
r
ec
o
m
m
en
d
atio
n
s
to
r
elate
d
p
ar
ties
to
in
cr
ea
s
e
th
e
r
o
le
o
f
h
ea
lth
ca
d
r
es in
th
e
ea
r
l
y
d
e
tectio
n
o
f
p
r
ee
clam
p
s
ia.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
u
s
ed
a
q
u
asi
-
ex
p
er
im
en
tal
d
esig
n
,
with
a
two
-
g
r
o
u
p
ap
p
r
o
ac
h
(
in
ter
v
en
tio
n
an
d
co
n
tr
o
l)
.
T
h
e
in
ter
v
en
tio
n
g
r
o
u
p
was
g
iv
en
in
cr
ea
s
ed
k
n
o
wled
g
e
an
d
ab
ilit
y
to
d
etec
t
p
r
ee
clam
p
s
ia
u
s
in
g
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
,
wh
ich
c
an
b
e
d
o
wn
lo
a
d
ed
o
n
th
e
Play
s
to
r
e
with
th
e
lin
k
h
ttp
s
://p
la
y
.
g
o
o
g
le
.
co
m
/s
to
r
e/
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
3
3
0
-
1
3
3
7
1332
ap
p
s
/d
etailsp
r
o
v
id
ed
o
m
.
ap
lik
a
s
i.k
s
d
s
.
T
h
e
d
eliv
er
y
o
f
th
e
u
s
e
o
f
t
h
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
was
ca
r
r
ied
o
u
t
b
y
a
ce
r
tifie
d
s
en
io
r
m
id
wif
e
an
d
ass
is
ted
b
y
r
esear
ch
er
s
.
T
h
e
in
ter
v
e
n
tio
n
g
r
o
u
p
w
as
g
iv
en
k
n
o
wled
g
e
o
n
h
o
w
to
u
s
e
th
e
Dh
i
a
n
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
an
d
r
ep
ea
te
d
3
tim
es
to
in
cr
ea
s
e
u
n
d
e
r
s
tan
d
in
g
.
W
h
ile
c
o
n
tr
o
l
o
n
ly
g
iv
en
co
u
n
s
elin
g
a
b
o
u
t
p
r
ee
clam
p
s
ia
o
n
ce
th
r
o
u
g
h
ac
tiv
ities
at
th
e
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
.
Sp
ec
if
ic
co
m
p
o
n
en
ts
o
f
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
ar
e
s
ta
tem
en
ts
r
e
g
ar
d
in
g
ea
r
l
y
d
ete
ctio
n
o
f
p
r
e
g
n
an
c
y
p
o
is
o
n
in
g
r
is
k
/
p
r
ee
clam
p
s
ia
,
co
n
s
is
tin
g
o
f
th
e
n
u
m
b
er
o
f
p
r
eg
n
a
n
cies,
p
r
eg
n
an
c
y
p
o
is
o
n
in
g
h
er
ed
ity
,
ag
e,
h
is
to
r
y
o
f
h
ig
h
b
l
o
o
d
p
r
ess
u
r
e,
o
v
er
weig
h
t,
h
is
to
r
y
o
f
p
r
e
g
n
an
cy
p
o
is
o
n
in
g
,
h
is
to
r
y
o
f
d
iab
etes
wh
ich
ar
e
th
en
s
c
o
r
ed
a
n
d
ca
te
g
o
r
ized
in
to
lo
w
an
d
h
ig
h
r
is
k
.
Pra
ctic
al
ap
p
licatio
n
o
f
th
e
Dh
ia
n
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
ca
n
b
e
d
o
n
e
b
y
m
id
wiv
es
at
h
ea
lth
ce
n
ter
s
f
o
r
ea
r
ly
d
etec
tio
n
o
f
p
r
ee
clam
p
s
ia
s
o
as
to
a
v
o
id
m
ater
n
al
d
ea
th
d
u
e
to
c
h
ild
b
ir
th
.
T
h
e
s
p
ec
if
i
c
v
er
s
io
n
o
f
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
t
h
at
we
u
s
e
is
th
e
in
itial
v
er
s
io
n
p
u
b
lis
h
ed
b
y
Dh
ian
a
Sety
o
r
i
n
i
in
co
llab
o
r
atio
n
with
th
e
Min
is
tr
y
o
f
Hea
lth
.
T
h
e
P
o
ltek
k
es
Kem
en
k
es
Ma
tar
am
awa
r
d
e
d
th
is
s
tu
d
y
with
th
e
n
u
m
b
er
L
B
.
0
1
.
0
3
/6
/2
1
7
/2
0
2
4
,
wh
ich
in
d
icate
s
th
at
it
was
a
p
p
r
o
v
ed
f
o
r
eth
ical
co
n
d
u
ct.
Po
r
p
o
s
iv
e
s
am
p
lin
g
was
u
s
ed
,
with
a
to
tal
s
am
p
le
o
f
1
0
0
h
ea
lth
ca
d
r
es
d
iv
id
ed
in
to
5
0
c
o
n
tr
o
l
an
d
5
0
tr
ea
tm
en
t
g
r
o
u
p
s
.
T
h
e
n
u
m
b
er
o
f
s
am
p
les
was
d
eter
m
in
ed
u
s
in
g
th
e
L
em
esh
o
w
eq
u
ati
o
n
.
T
h
e
r
an
d
o
m
ized
s
am
p
le
tech
n
iq
u
e
th
at
we
u
s
e
i
s
to
d
eter
m
in
e
th
e
p
o
p
u
latio
n
f
ir
s
t,
th
en
ch
o
o
s
e
th
e
s
am
p
le
s
ize
u
s
in
g
a
f
o
r
m
u
la
lem
esh
o
w
wh
ich
th
en
g
ets
th
e
n
u
m
b
e
r
1
0
0
.
T
h
en
it
is
d
i
v
id
ed
in
to
two
co
n
tr
o
l
an
d
in
ter
v
en
tio
n
g
r
o
u
p
s
,
ea
ch
o
f
wh
ich
is
g
iv
en
a
n
u
m
b
er
wh
er
e
o
d
d
n
u
m
b
er
s
b
ec
o
m
e
co
n
tr
o
ls
an
d
ev
en
n
u
m
b
er
s
b
ec
o
m
e
in
ter
v
en
tio
n
s
u
s
in
g
E
x
ce
l
.
T
h
e
r
esear
c
h
lo
c
atio
n
in
clu
d
es
f
o
u
r
co
m
m
u
n
it
y
h
ea
lth
ce
n
ter
s
in
ea
ch
s
u
b
-
d
is
tr
ict
o
f
B
im
a
C
ity
:
J
atib
ar
u
,
Asak
o
ta,
W
est
R
as
an
ae
,
an
d
E
ast
R
asan
ae
.
Hea
lth
ca
d
r
es
wer
e
s
elec
ted
o
n
th
e
b
asis
o
f
th
eir
av
ailab
ilit
y
an
d
willin
g
n
ess
to
p
ar
ticip
ate
in
th
e
s
tu
d
y
.
Data
wer
e
co
llected
t
h
r
o
u
g
h
in
ter
v
iews
an
d
o
b
s
er
v
atio
n
s
to
ass
ess
th
e
im
p
ac
t
o
f
a
s
p
ec
if
ic
in
ter
v
e
n
t
io
n
.
Fu
r
th
e
r
d
etails
ar
e
p
r
o
v
i
d
ed
in
th
e
co
n
s
o
r
t
d
iag
r
am
as sh
o
wn
i
n
Fig
u
r
e
1
.
Fig
u
r
e
1
.
C
o
n
s
o
r
t
d
iag
r
am
[
1
7
]
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
a
p
p
lica
tio
n
o
f th
e
D
h
ia
n
a
S
etyo
r
in
i S
co
r
e
C
a
r
d
in
ea
r
ly
d
etec
tio
n
o
f th
e
r
is
k
o
f
…
(
S
ya
ifu
l
)
1333
T
h
e
co
llected
d
ata
wer
e
ex
p
r
ess
ed
in
th
e
f
o
r
m
o
f
r
atio
s
.
T
h
e
to
o
l
u
s
ed
f
o
r
d
ata
an
al
y
s
is
is
S
PS
S
v
er
s
io
n
2
9
.
B
ef
o
r
e
an
aly
zin
g
th
e
d
ata,
a
n
o
r
m
ality
test
was
p
er
f
o
r
m
e
d
u
s
in
g
th
e
Sh
ap
ir
o
-
W
ilk
test
.
Mo
s
t
d
ata
wer
e
n
o
t
n
o
r
m
ally
d
is
tr
ib
u
ted
.
T
h
er
ef
o
r
e
,
n
o
n
-
p
ar
am
et
r
ic
d
a
ta
an
aly
s
is
was
u
s
ed
,
n
am
ely
th
e
Ma
n
n
–
W
h
itn
ey
test
(
b
etwe
en
-
g
r
o
u
p
test
)
[
1
8
]
.
T
h
e
Ma
n
n
-
W
h
itn
ey
U
test
is
a
n
o
n
-
p
ar
am
etr
ic
test
u
s
ed
to
co
m
p
ar
e
two
in
d
ep
en
d
en
t
g
r
o
u
p
s
wh
en
th
e
d
ata
ar
e
n
o
t
n
o
r
m
ally
d
is
tr
ib
u
t
ed
.
T
h
is
test
is
p
ar
ticu
lar
ly
u
s
ef
u
l
in
s
itu
atio
n
s
in
wh
ich
th
e
ass
u
m
p
tio
n
s
o
f
p
ar
a
m
etr
ic
test
s
ca
n
n
o
t b
e
m
et
[
1
9
]
.
T
h
e
Min
is
tr
y
o
f
Hea
lth
in
I
n
d
o
n
esia
(
Nu
m
b
e
r
:
DP.0
4
.
0
3
/X
XXI
V/1
1
8
0
/2
0
2
4
)
h
as
r
e
g
is
ter
ed
f
o
r
t
h
is
s
tu
d
y
,
an
d
th
e
n
ec
ess
ar
y
p
ar
ti
es
at
th
e
r
esear
ch
s
ite
h
av
e
also
g
iv
en
th
eir
a
p
p
r
o
v
al.
At
th
e
co
o
r
d
in
atio
n
s
tag
e,
f
o
u
r
h
ea
lth
ce
n
ter
s
th
at
s
er
v
ed
as
r
esear
ch
lo
ca
tio
n
s
f
o
r
ca
d
r
e
d
ev
elo
p
m
en
t
a
n
d
s
am
p
le
s
elec
tio
n
wer
e
s
elec
ted
.
C
o
o
r
d
in
atio
n
was
th
en
p
er
f
o
r
m
ed
o
n
th
e
ch
o
s
en
s
am
p
les.
T
h
e
h
ea
lth
ce
n
ter
s
we
r
e
ch
o
s
e
n
b
ased
o
n
th
eir
ca
p
ac
ity
to
s
u
p
p
o
r
t
th
e
s
tu
d
y
o
b
jectiv
es
an
d
ac
ce
s
s
ib
ilit
y
to
th
e
tar
g
et
p
o
p
u
latio
n
.
T
h
is
en
s
u
r
e
d
th
at
r
esear
ch
co
u
ld
b
e
co
n
d
u
cte
d
e
f
f
icien
tly
an
d
ef
f
ec
tiv
ely
with
i
n
th
e
co
m
m
u
n
ity
.
T
h
e
q
u
esti
o
n
n
air
e
d
is
s
em
in
ate
d
b
y
th
e
R
ep
u
b
lic
o
f
I
n
d
o
n
esi
a'
s
Min
is
tr
y
o
f
Hea
lth
s
er
v
ed
as
a
m
o
d
el
f
o
r
th
e
r
esear
ch
.
T
h
e
q
u
esti
o
n
n
air
e
co
n
s
is
ts
o
f
r
esp
o
n
d
en
t
ch
ar
ac
ter
is
tics
(
ag
e,
ed
u
ca
ti
o
n
,
g
e
n
d
er
,
m
ar
ital
s
tatu
s
,
wo
r
k
s
tatu
s
)
,
k
n
o
wled
g
e
,
a
n
d
a
b
ilit
y
lev
el.
Fo
r
t
h
e
p
u
r
p
o
s
e
o
f
d
eter
m
in
in
g
wh
eth
er
o
r
n
o
t
th
e
q
u
esti
o
n
n
air
e
was
v
alid
,
th
e
Pear
s
o
n
p
r
o
d
u
ct
-
m
o
m
e
n
t
a
n
aly
s
is
test
was
co
n
s
id
er
ed
.
Acc
o
r
d
in
g
to
t
h
e
r
esu
lts
o
f
th
e
test
,
ev
er
y
s
in
g
le
q
u
esti
o
n
th
at
was
s
u
b
m
itted
h
ad
a
v
alu
e
th
at
was
g
r
ea
ter
th
an
0
.
5
.
I
f
th
e
r
esu
lts
o
f
th
e
r
eliab
ilit
y
test
s
h
o
w
th
at
th
e
v
ar
iab
le
h
as
a
C
r
o
n
b
ac
h
'
s
a
lp
h
a
s
co
r
e
th
at
is
g
r
ea
ter
th
a
n
0
.
9
5
8
,
th
en
it
is
p
o
s
s
ib
le
to
ass
er
t
th
at
th
e
v
ar
iab
le
is
r
eliab
le
o
r
co
n
s
is
ten
t
in
ter
m
s
o
f
m
ea
s
u
r
em
en
t.
I
n
g
en
er
al,
th
e
s
tu
d
y
q
u
esti
o
n
n
air
e
th
at
was
co
n
s
tr
u
cted
b
ased
o
n
th
e
m
o
d
el
u
s
e
d
b
y
th
e
Min
is
tr
y
o
f
Hea
lth
p
r
o
v
ed
b
o
t
h
v
alid
ity
an
d
r
eliab
ilit
y
.
T
h
e
c
r
ed
ib
ilit
y
o
f
th
e
p
r
o
ce
d
u
r
es
u
s
ed
to
co
l
lect
d
ata
f
o
r
th
e
s
tu
d
y
is
im
p
r
o
v
ed
as
a
r
esu
lt
o
f
th
ese
f
in
d
in
g
s
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
a
b
l
e
1
s
h
o
w
s
t
h
a
t
r
e
s
p
o
n
d
en
t
s
i
n
t
h
e
i
n
t
e
r
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
g
r
o
u
p
s
w
e
r
e
h
o
m
o
g
e
n
e
o
u
s
i
n
a
l
l
c
a
t
e
g
o
r
i
e
s
,
w
it
h
e
a
c
h
p
-
v
a
l
u
e
>0
.
0
5
.
T
h
i
s
i
n
d
ic
a
t
es
t
h
at
t
h
e
r
es
p
o
n
d
e
n
t
s
i
n
t
h
e
i
n
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s
t
r
e
n
g
t
h
e
n
ed
b
y
t
h
e
s
i
m
il
a
r
i
t
y
i
n
t
h
e
r
e
s
p
o
n
d
e
n
t
c
h
a
r
a
c
t
e
r
is
ti
c
s
b
et
w
e
e
n
t
h
e
i
n
t
e
r
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
g
r
o
u
p
s
.
Kn
o
wled
g
e
in
th
e
in
ter
v
en
t
io
n
g
r
o
u
p
in
c
r
ea
s
ed
s
ig
n
if
ic
an
tly
in
b
o
t
h
k
n
o
wled
g
e
a
n
d
ab
ilit
y
ca
teg
o
r
ies.
Ho
wev
e
r
,
i
n
th
e
c
o
n
tr
o
l
g
r
o
u
p
,
k
n
o
wled
g
e
an
d
ab
ilit
ies
d
id
n
o
t
d
i
f
f
er
s
ig
n
if
ic
an
tly
b
etwe
en
p
r
e
-
an
d
p
o
s
t
-
test
s
.
T
h
is
s
h
o
ws
th
at
th
e
ap
p
licatio
n
o
f
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
was
b
etter
th
an
co
u
n
s
elin
g
c
o
n
d
u
cted
b
y
t
h
e
co
m
m
u
n
ity
h
e
alth
ce
n
ter
f
o
r
d
etec
tin
g
ea
r
ly
p
r
ee
clam
p
s
ia.
T
h
is
is
in
lin
e
with
r
esear
ch
co
n
d
u
cted
b
y
Dh
ia
n
a
Sety
o
r
in
i
w
h
ich
s
h
o
ws
th
at
th
e
u
s
e
o
f
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
is
m
o
r
e
ef
f
ec
tiv
e
in
d
etec
tin
g
ea
r
ly
p
r
ee
clam
p
s
i
a
[
1
6
]
.
T
h
u
s
,
it
ca
n
b
e
co
n
clu
d
ed
th
at
th
e
u
s
e
o
f
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
ca
n
s
ig
n
if
ican
tly
in
cr
ea
s
e
k
n
o
wled
g
e
a
n
d
a
b
ilit
y
to
d
etec
t
p
r
ee
clam
p
s
ia.
T
h
ese
r
esu
lts
h
ig
h
lig
h
t
th
e
im
p
o
r
tan
ce
o
f
im
p
lem
en
tin
g
ef
f
ec
tiv
e
m
eth
o
d
s
to
p
r
e
v
en
t
an
d
tr
ea
t
h
ea
lth
co
n
d
itio
n
s
s
u
ch
as
p
r
ee
clam
p
s
ia.
T
h
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
ca
n
b
e
a
u
s
ef
u
l
to
o
l
f
o
r
h
ea
lth
wo
r
k
er
s
to
im
p
r
o
v
e
th
e
ea
r
ly
d
etec
tio
n
o
f
p
r
ee
clam
p
s
ia
to
p
r
o
v
id
e
ap
p
r
o
p
r
iate
an
d
e
f
f
ec
tiv
e
tr
ea
tm
en
t.
T
h
u
s
,
in
cr
ea
s
in
g
k
n
o
wled
g
e
a
n
d
ab
ilit
y
to
d
ete
ct
p
r
ee
clam
p
s
ia
ca
n
h
elp
r
ed
u
ce
th
e
r
is
k
o
f
s
er
io
u
s
co
m
p
licatio
n
s
in
p
r
eg
n
an
t
wo
m
en
an
d
th
ei
r
f
etu
s
es
[
2
2
]
-
[
2
8
]
.
Pre
ec
lam
p
s
ia
is
d
a
n
g
er
o
u
s
in
p
r
eg
n
a
n
t
wo
m
e
n
b
ec
a
u
s
e
it
ca
n
ca
u
s
e
h
ig
h
b
lo
o
d
p
r
ess
u
r
e,
o
r
g
an
d
a
m
ag
e,
an
d
ev
en
d
ea
th
.
Pre
g
n
an
t
wo
m
en
s
h
o
u
ld
r
ec
eiv
e
ap
p
r
o
p
r
iate
an
d
r
eg
u
lar
m
ed
ical
ca
r
e
to
p
r
ev
en
t
s
er
io
u
s
co
m
p
l
icatio
n
s
.
T
h
is
m
ay
in
v
o
lv
e
clo
s
e
m
o
n
ito
r
in
g
o
f
b
lo
o
d
p
r
ess
u
r
e
an
d
p
r
o
tein
le
v
els
in
t
h
e
u
r
in
e
as
well
as
ad
ju
s
tm
en
ts
to
d
iet
an
d
p
h
y
s
ical
ac
tiv
ity
ac
co
r
d
in
g
to
th
e
d
o
cto
r
'
s
r
ec
o
m
m
en
d
atio
n
s
.
I
f
p
r
ee
cla
m
p
s
ia
is
n
o
t
tr
ea
ted
p
r
o
p
er
ly
,
th
e
r
is
k
o
f
co
m
p
licatio
n
s
f
o
r
t
h
e
m
o
t
h
er
an
d
f
etu
s
ca
n
in
cr
ea
s
e
s
ig
n
if
ican
tly
.
Pr
ee
clam
p
s
ia
is
v
er
y
co
m
m
o
n
in
p
r
eg
n
an
t
wo
m
en
,
esp
ec
ially
d
u
r
in
g
t
h
e
s
ec
o
n
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
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lic
Hea
lth
Sci
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N:
2252
-
8
8
0
6
Th
e
a
p
p
lica
tio
n
o
f th
e
D
h
ia
n
a
S
etyo
r
in
i S
co
r
e
C
a
r
d
in
ea
r
ly
d
etec
tio
n
o
f th
e
r
is
k
o
f
…
(
S
ya
ifu
l
)
1335
an
d
th
ir
d
tr
im
ester
s
o
f
p
r
eg
n
a
n
cy
[
2
9
]
,
[
3
0
]
.
T
h
e
f
in
d
i
n
g
s
o
f
p
r
e
v
io
u
s
s
tu
d
ies
d
e
m
o
n
s
tr
ate
d
th
at
p
r
ee
clam
p
s
ia
ca
n
r
esu
lt
in
p
r
e
m
atu
r
e
b
ir
th
as
well
as
a
lo
w
b
ir
th
weig
h
t
in
in
f
an
ts
[
3
1
]
.
T
h
e
s
y
m
p
to
m
s
o
f
p
r
ee
clam
p
s
ia,
wh
ich
in
clu
d
e
s
ev
e
r
e
h
ea
d
ac
h
es,
ch
an
g
es
in
v
is
io
n
,
an
d
s
wellin
g
,
s
h
o
u
ld
b
e
b
r
o
u
g
h
t
to
th
e
atten
tio
n
o
f
p
r
eg
n
a
n
t
wo
m
en
,
an
d
th
ey
s
h
o
u
ld
s
ee
k
m
ed
ical
ass
is
t
an
ce
if
th
e
y
en
co
u
n
ter
an
y
o
f
th
ese
war
n
in
g
s
ig
n
als [
3
2
]
.
Dela
y
s
in
d
etec
tin
g
p
r
ee
clam
p
s
ia
ca
n
af
f
ec
t
th
e
f
etu
s
an
d
th
e
b
ab
y
in
th
e
wo
m
b
,
an
d
ca
n
e
v
en
ca
u
s
e
p
r
em
atu
r
e
b
ir
th
o
r
f
etal
d
ea
th
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
d
em
o
n
s
tr
ated
th
at
th
e
ea
r
ly
d
etec
ti
o
n
an
d
a
p
p
r
o
p
r
iate
c
ar
e
o
f
p
r
ee
clam
p
s
ia
ca
n
co
n
s
id
er
ab
ly
lo
wer
th
e
r
is
k
o
f
p
r
o
b
lem
s
f
o
r
b
o
th
th
e
m
o
th
er
a
n
d
th
e
in
f
a
n
t
[
3
3
]
.
T
h
er
ef
o
r
e,
it
is
ess
en
tial
to
h
av
e
p
r
e
n
atal
ex
a
m
in
atio
n
s
o
n
a
r
e
g
u
lar
b
asis
an
d
to
p
ay
cl
o
s
e
atten
tio
n
to
th
e
s
ig
n
s
an
d
s
y
m
p
to
m
s
o
f
p
r
ee
clam
p
s
ia,
wh
ich
i
n
clu
d
e
s
ig
n
s
a
n
d
s
y
m
p
to
m
s
s
u
ch
as
p
r
o
tein
u
r
ia
an
d
h
i
g
h
b
lo
o
d
p
r
ess
u
r
e
[
3
4
]
.
T
h
e
p
r
o
c
e
s
s
o
f
p
r
e
e
c
l
a
m
p
s
ia
i
t
s
e
l
f
i
s
s
t
i
ll
n
o
t
f
u
l
l
y
u
n
d
e
r
s
t
o
o
d
,
b
u
t
r
i
s
k
f
a
c
t
o
r
s
s
u
c
h
a
s
o
b
e
s
i
t
y
,
a
p
r
e
v
i
o
u
s
h
i
s
t
o
r
y
o
f
p
r
e
e
c
l
a
m
p
s
i
a
,
a
n
d
m
u
l
t
i
p
le
p
r
e
g
n
a
n
c
i
e
s
c
a
n
i
n
c
r
e
a
s
e
t
h
e
li
k
e
l
i
h
o
o
d
o
f
i
t
s
o
c
c
u
r
r
e
n
c
e
[
3
5
]
-
[
3
9
]
.
I
t
i
s
c
r
u
c
i
a
l
f
o
r
h
e
a
l
t
h
c
a
r
e
p
r
o
v
i
d
e
r
s
t
o
b
e
v
i
g
i
l
a
n
t
i
n
m
o
n
i
t
o
r
i
n
g
p
r
e
g
n
a
n
t
i
n
d
i
v
i
d
u
a
l
s
f
o
r
s
i
g
n
s
o
f
p
r
e
e
c
l
a
m
p
s
ia
a
n
d
e
d
u
c
a
ti
n
g
p
a
t
i
e
n
ts
o
n
t
h
e
i
m
p
o
r
t
a
n
c
e
o
f
s
e
e
k
i
n
g
m
e
d
i
ca
l
at
t
e
n
ti
o
n
i
f
th
e
y
e
x
p
e
r
i
e
n
c
e
a
n
y
c
o
n
c
e
r
n
i
n
g
s
y
m
p
t
o
m
s
.
E
a
r
l
y
d
e
t
e
c
t
i
o
n
a
n
d
m
a
n
a
g
e
m
e
n
t
o
f
p
r
e
e
c
l
a
m
p
s
i
a
c
a
n
s
i
g
n
i
f
ic
a
n
t
l
y
i
m
p
r
o
v
e
t
h
e
o
u
t
c
o
m
e
s
f
o
r
b
o
t
h
t
h
e
m
o
t
h
e
r
an
d
t
h
e
b
a
b
y
.
T
h
er
e
was
a
s
ig
n
if
ican
t
d
if
f
e
r
en
ce
b
etwe
en
th
e
lev
el
o
f
k
n
o
wled
g
e
an
d
ab
ilit
y
in
th
e
i
n
ter
v
en
tio
n
g
r
o
u
p
(
p
-
v
alu
e<
0
.
0
0
5
f
o
r
b
o
t
h
)
.
I
n
th
e
co
n
t
r
o
l
g
r
o
u
p
,
th
er
e
wer
e
n
o
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
in
k
n
o
wled
g
e
q
u
ality
(
p
>0
.
0
0
5
)
.
T
h
is
in
d
ica
tes
th
at
th
e
in
ter
v
en
tio
n
h
a
d
a
p
o
s
itiv
e
im
p
ac
t
o
n
th
e
k
n
o
wle
d
g
e
an
d
a
b
ilit
ies
o
f
th
e
g
r
o
u
p
.
T
h
ese
r
esu
lts
ca
n
s
er
v
e
as th
e
b
asis
f
o
r
th
e
d
ev
elo
p
m
en
t o
f
m
o
r
e
e
f
f
ec
tiv
e
in
ter
v
en
tio
n
p
r
o
g
r
am
s
in
th
e
f
u
tu
r
e.
T
h
er
ef
o
r
e,
it
is
im
p
o
r
tan
t
t
o
d
ev
elo
p
ap
p
r
o
p
r
iate
in
ter
v
en
ti
o
n
s
tr
ateg
ies
to
in
cr
ea
s
e
co
m
m
u
n
ity
k
n
o
wled
g
e
an
d
ab
ilit
ies
[
4
0
]
.
B
y
u
n
d
er
s
tan
d
in
g
th
e
im
p
ac
t o
f
in
ter
v
en
tio
n
s
o
n
k
n
o
wled
g
e
an
d
ab
ilit
ies,
f
u
tu
r
e
p
r
o
g
r
a
m
s
ca
n
b
e
tailo
r
e
d
to
a
d
d
r
ess
s
p
ec
if
ic
n
ee
d
s
with
in
co
m
m
u
n
ities
ef
f
ec
tiv
el
y
.
I
t
is
cr
u
cial
to
co
n
tin
u
e
ev
alu
atin
g
an
d
r
ef
i
n
in
g
in
te
r
v
en
tio
n
s
tr
ateg
ies to
en
s
u
r
e
o
p
ti
m
al
o
u
tco
m
es f
o
r
p
a
r
ticip
an
ts
.
Ur
in
e
p
r
o
tein
in
cr
ea
s
es
th
e
r
is
k
o
f
p
r
ee
clam
p
s
ia
d
u
r
in
g
p
r
eg
n
an
c
y
.
T
h
er
e
f
o
r
e,
it
is
im
p
o
r
tan
t
to
m
o
n
ito
r
p
r
o
tein
lev
els
in
u
r
in
e
r
eg
u
l
ar
l
y
d
u
r
in
g
p
r
eg
n
a
n
c
y
to
d
etec
t
p
r
ee
clam
p
s
ia
ea
r
ly
[
8
]
.
Acc
o
r
d
in
g
to
p
r
ev
io
u
s
r
esear
ch
co
n
d
u
cte
d
,
ea
r
ly
d
etec
tio
n
o
f
p
r
ee
clam
p
s
ia
ca
n
h
elp
in
m
an
ag
in
g
th
e
co
n
d
itio
n
ef
f
ec
tiv
ely
an
d
r
e
d
u
cin
g
th
e
r
is
k
o
f
co
m
p
licatio
n
s
f
o
r
b
o
th
th
e
m
o
th
er
a
n
d
th
e
b
ab
y
.
I
t
is
r
ec
o
m
m
en
d
e
d
to
c
o
n
s
u
lt
with
a
h
ea
lth
ca
r
e
p
r
o
v
i
d
er
f
o
r
p
r
o
p
er
m
o
n
ito
r
in
g
an
d
m
an
a
g
em
en
t
o
f
u
r
in
e
p
r
o
tein
le
v
els
d
u
r
in
g
p
r
e
g
n
an
c
y
[
4
1
]
.
Diab
etes
also
in
cr
ea
s
es
t
h
e
r
is
k
o
f
p
r
e
-
ec
lam
p
s
ia.
T
h
e
r
ef
o
r
e,
it
is
im
p
o
r
tan
t
to
m
ain
tain
a
s
tab
le
b
l
o
o
d
g
lu
co
s
e
lev
el
d
u
r
i
n
g
p
r
eg
n
an
c
y
.
Pre
ec
lam
p
s
ia
ca
n
ca
u
s
e
s
er
io
u
s
co
m
p
licatio
n
s
in
b
o
th
t
h
e
m
o
th
er
an
d
f
etu
s
.
Ap
p
r
o
p
r
iate
tr
ea
tm
en
t
is
r
eq
u
ir
ed
to
p
r
ev
e
n
t
th
is
r
is
k
.
Pre
ec
lam
p
s
ia
o
cc
u
r
s
n
o
t
o
n
ly
b
ec
au
s
e
o
f
th
e
f
ac
to
r
s
m
en
tio
n
ed
ab
o
v
e
b
u
t
is
also
in
f
lu
en
ce
d
b
y
g
en
etic
an
d
lif
e
s
ty
le
f
ac
to
r
s
.
Alth
o
u
g
h
it
is
n
o
t
f
u
lly
u
n
d
e
r
s
to
o
d
wh
y
p
r
ee
clam
p
s
ia
o
c
cu
r
s
,
a
p
p
r
o
p
r
iate
p
r
ev
en
tio
n
a
n
d
m
an
ag
em
en
t
ef
f
o
r
ts
ca
n
h
elp
r
ed
u
ce
th
e
r
is
k
o
f
co
m
p
licatio
n
s
d
u
r
in
g
p
r
eg
n
a
n
cy
[
3
4
]
.
T
h
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
is
u
s
ef
u
l
f
o
r
d
etec
tin
g
p
r
e
ec
lam
p
s
ia
d
u
r
in
g
p
r
e
g
n
an
c
y
.
Usi
n
g
th
is
s
co
r
e
ca
r
d
,
m
id
wiv
es
ca
n
im
m
ed
iately
tak
e
n
ec
ess
ar
y
ac
tio
n
s
to
p
r
ev
en
t
s
er
io
u
s
co
m
p
licatio
n
s
in
p
r
eg
n
an
t
wo
m
en
an
d
f
etu
s
es.
A
s
co
r
e
ca
r
d
is
an
ef
f
ec
tiv
e
t
o
o
l
f
o
r
m
o
n
ito
r
in
g
th
e
h
ea
lth
o
f
p
r
e
g
n
an
t
wo
m
e
n
o
n
a
r
eg
u
lar
b
asis
,
m
ak
i
n
g
it
p
o
s
s
ib
le
to
in
ter
v
en
e
m
o
r
e
q
u
ick
l
y
if
n
ec
ess
ar
y
.
T
h
u
s
,
t
h
e
D
h
i
a
n
a
S
e
t
y
o
r
i
n
i
S
c
o
r
e
C
a
r
d
c
a
n
h
e
l
p
t
o
i
n
c
r
e
a
s
e
t
h
e
le
v
e
l
o
f
s
a
f
e
t
y
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
.
T
h
e
r
e
s
u
l
t
s
a
ls
o
s
h
o
w
e
d
t
h
at
c
a
d
r
e
s
w
h
o
w
e
r
e
g
i
v
e
n
a
n
u
n
d
e
r
s
t
a
n
d
i
n
g
o
f
t
h
i
s
s
c
o
r
e
c
a
r
d
w
e
r
e
b
e
t
t
e
r
a
b
l
e
t
o
r
e
c
o
g
n
i
z
e
t
h
e
s
y
m
p
t
o
m
s
o
f
p
r
e
e
c
l
a
m
p
s
i
a
a
n
d
e
c
l
a
m
p
s
i
a
,
s
o
t
h
e
y
c
o
u
l
d
p
r
o
v
id
e
t
i
m
e
l
y
t
r
e
at
m
e
n
t
c
o
m
p
a
r
e
d
to
t
h
o
s
e
w
h
o
w
e
r
e
o
n
l
y
g
i
v
e
n
r
eg
u
l
a
r
c
o
u
n
s
e
l
i
n
g
.
4.
CO
NCLU
SI
O
N
T
h
e
ap
p
licatio
n
o
f
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
is
m
o
r
e
ef
f
ec
tiv
e
in
in
cr
ea
s
in
g
k
n
o
wl
ed
g
e
an
d
th
e
ab
ilit
y
to
d
etec
t
p
r
ee
clam
p
s
ia
ea
r
ly
th
an
th
e
co
u
n
s
elin
g
m
eth
o
d
co
n
d
u
cted
b
y
th
e
h
ea
lth
ce
n
ter
.
T
h
is
ca
n
lead
to
im
p
r
o
v
e
d
o
u
tco
m
es
f
o
r
b
o
th
m
o
t
h
er
s
an
d
b
ab
ies,
as
th
e
ea
r
ly
d
etec
tio
n
o
f
p
r
ee
cla
m
p
s
ia
ca
n
p
r
e
v
en
t
s
er
io
u
s
co
m
p
licatio
n
s
.
I
m
p
le
m
en
tin
g
th
e
Dh
ian
a
Sety
o
r
in
i
Sco
r
e
C
ar
d
m
a
y
b
e
a
co
s
t
-
ef
f
ec
tiv
e
an
d
ef
f
icien
t
way
o
f
im
p
r
o
v
in
g
m
ater
n
al
h
ea
lth
in
r
eso
u
r
ce
-
lim
ited
s
ettin
g
s
.
Su
g
g
esti
o
n
s
f
o
r
h
ea
lth
f
ac
ilit
ies
s
ee
k
in
g
to
im
p
r
o
v
e
m
ater
n
al
h
ea
lth
o
u
t
co
m
es
in
cl
u
d
e
in
co
r
p
o
r
ati
n
g
th
e
Dh
ia
n
a
Sety
o
r
i
n
i
Sco
r
e
C
ar
d
in
to
r
o
u
tin
e
p
r
en
atal
ca
r
e
p
r
ac
tices.
T
h
is
co
u
ld
p
o
ten
tially
lead
to
b
etter
h
ea
lth
o
u
tco
m
es
f
o
r
p
r
eg
n
an
t
wo
m
en
an
d
th
eir
b
ab
ies,
u
ltima
tely
r
ed
u
cin
g
th
e
b
u
r
d
e
n
o
f
p
r
ee
clam
p
s
ia
-
r
elate
d
co
m
p
licatio
n
s
in
t
h
e
h
ea
lth
ca
r
e
s
y
s
tem
.
RE
F
E
R
E
NC
E
S
[
1
]
K
.
C
h
a
u
,
M
.
W
e
l
sh
,
A
.
M
a
k
r
i
s,
a
n
d
A
.
H
e
n
n
e
ss
y
,
“
P
r
o
g
r
e
ss
i
n
p
r
e
e
c
l
a
mp
si
a
:
t
h
e
c
o
n
t
r
i
b
u
t
i
o
n
o
f
a
n
i
ma
l
m
o
d
e
l
s
,
”
J
o
u
rn
a
l
o
f
H
u
m
a
n
H
y
p
e
r
t
e
n
si
o
n
,
v
o
l
.
3
6
,
n
o
.
8
,
p
p
.
7
0
5
–
7
1
0
,
A
u
g
.
2
0
2
2
,
d
o
i
:
1
0
.
1
0
3
8
/
s4
1
3
7
1
-
021
-
0
0
6
3
7
-
x.
[
2
]
Z
.
N
.
P
a
sc
u
a
l
a
n
d
M
.
D
.
L
a
n
g
a
k
e
r
,
“
P
h
y
si
o
l
o
g
y
,
P
r
e
g
n
a
n
c
y
,”
S
t
a
t
P
e
a
r
l
s
2
0
2
2
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
w
w
w
.
n
c
b
i
.
n
l
m
.
n
i
h
.
g
o
v
/
b
o
o
k
s
/
N
B
K
5
5
9
3
0
4
/
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
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I
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3
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Sep
tem
b
er
20
25
:
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3
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1336
[
3
]
C
.
B
i
s
so
n
,
S
.
D
a
u
t
e
l
,
E.
P
a
t
e
l
,
S
.
S
u
r
e
sh
,
P
.
D
a
u
e
r
,
a
n
d
S
.
R
a
n
a
,
“
P
r
e
e
c
l
a
m
p
s
i
a
p
a
t
h
o
p
h
y
si
o
l
o
g
y
a
n
d
a
d
v
e
r
s
e
o
u
t
c
o
mes
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
a
n
d
p
o
s
t
p
a
r
t
u
m,”
Fr
o
n
t
i
e
rs
i
n
M
e
d
i
c
i
n
e
,
v
o
l
.
1
0
,
M
a
r
.
2
0
2
3
,
d
o
i
:
1
0
.
3
3
8
9
/
f
me
d
.
2
0
2
3
.
1
1
4
4
1
7
0
.
[
4
]
Y
.
Zh
o
u
,
H
.
Q
i
,
a
n
d
N
.
Y
i
n
,
“
A
d
a
p
t
a
t
i
o
n
s
a
n
d
a
l
t
e
r
a
t
i
o
n
s
o
f
mat
e
r
n
a
l
mi
c
r
o
b
i
o
t
a
:
F
r
o
m
p
h
y
s
i
o
l
o
g
y
t
o
p
a
t
h
o
l
o
g
y
,
”
Me
d
i
c
i
n
e
i
n
Mi
c
r
o
e
c
o
l
o
g
y
,
v
o
l
.
9
,
p
.
1
0
0
0
4
5
,
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e
p
.
2
0
2
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o
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6
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j
.
me
d
mi
c
.
2
0
2
1
.
1
0
0
0
4
5
.
[
5
]
T.
N
a
k
a
g
a
w
a
,
D
.
-
H
.
K
a
n
g
,
a
n
d
R
.
J
.
Jo
h
n
so
n
,
“
A
n
e
l
e
v
a
t
i
o
n
i
n
seru
m
u
r
i
c
a
c
i
d
p
r
e
c
e
d
e
s
t
h
e
d
e
v
e
l
o
p
me
n
t
o
f
p
r
e
e
c
l
a
mp
s
i
a
,
”
H
y
p
e
r
t
e
n
si
o
n
R
e
se
a
rc
h
,
v
o
l
.
4
6
,
n
o
.
3
,
p
p
.
8
0
9
–
8
1
1
,
M
a
r
.
2
0
2
3
,
d
o
i
:
1
0
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1
0
3
8
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s
4
1
4
4
0
-
0
2
3
-
0
1
1
8
1
-
6.
[
6
]
V
.
D
.
G
a
r
o
v
i
c
e
t
a
l
.
,
“
H
y
p
e
r
t
e
n
s
i
o
n
i
n
p
r
e
g
n
a
n
c
y
:
d
i
a
g
n
o
si
s
,
b
l
o
o
d
p
r
e
ss
u
r
e
g
o
a
l
s,
a
n
d
p
h
a
r
m
a
c
o
t
h
e
r
a
p
y
:
a
s
c
i
e
n
t
i
f
i
c
s
t
a
t
e
me
n
t
f
r
o
m t
h
e
a
m
e
r
i
c
a
n
h
e
a
r
t
a
ss
o
c
i
a
t
i
o
n
,
”
H
y
p
e
r
t
e
n
si
o
n
,
v
o
l
.
7
9
,
n
o
.
2
,
F
e
b
.
2
0
2
2
,
d
o
i
:
1
0
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1
1
6
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Y
P
.
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
8
.
[
7
]
N
a
w
sh
e
r
w
a
n
,
A
.
K
h
a
n
,
S
.
M
u
b
a
r
i
k
,
G
.
N
a
b
i
,
C
.
F
a
n
,
a
n
d
S
.
W
a
n
g
,
“
Ef
f
e
c
t
o
f
p
r
e
e
c
l
a
mp
s
i
a
a
n
d
p
r
e
ma
t
u
r
e
r
u
p
t
u
r
e
o
f
mem
b
r
a
n
e
o
n
n
e
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[
3
8
]
T.
A
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m
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n
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A
.
M
.
P
.
R
o
m
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n
i
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“
Th
e
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o
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m
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:
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s f
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mp
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s1
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.
[
3
9
]
C
.
W
.
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v
e
s,
R
.
S
i
n
k
e
y
,
I
.
R
a
j
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p
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r
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A
.
T.
N
.
T
i
t
a
,
a
n
d
S
.
O
p
a
r
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l
,
“
P
r
e
e
c
l
a
mp
s
i
a
—
p
a
t
h
o
p
h
y
s
i
o
l
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g
y
a
n
d
c
l
i
n
i
c
a
l
p
r
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se
n
t
a
t
i
o
n
s
,
”
J
o
u
rn
a
l
o
f
t
h
e
Am
e
ri
c
a
n
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mb
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n
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a
n
d
C
.
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c
G
r
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t
h
,
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f
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l
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a
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d
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2.
[
41]
K
.
W
i
l
e
s
e
t
a
l
.
,
“
C
l
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n
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c
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C
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2.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
S
y
a
if
u
l
is
a
se
n
io
r
lec
tu
re
r
at
th
e
De
p
a
rtme
n
t
o
f
N
u
rsin
g
,
F
a
c
u
lt
y
o
f
He
a
lt
h
S
c
ien
c
e
,
P
o
lt
e
k
k
e
s
Ke
m
e
n
k
e
s
M
a
tara
m
,
Cit
y
o
f
M
a
tara
m
,
P
ro
v
i
n
c
e
o
f
NTB,
In
d
o
n
e
sia
.
He
h
o
l
d
s
a
M
a
ste
r'
s
d
e
g
re
e
in
Nu
rsi
n
g
a
n
d
h
a
s
o
v
e
r
1
0
y
e
a
rs
o
f
e
x
p
e
rien
c
e
in
t
h
e
field
.
He
is
p
a
ss
io
n
a
te
a
b
o
u
t
e
d
u
c
a
ti
n
g
f
u
t
u
re
n
u
rse
s
a
n
d
c
o
n
tri
b
u
ti
n
g
t
o
th
e
a
d
v
a
n
c
e
m
e
n
t
o
f
h
e
a
lt
h
c
a
re
in
In
d
o
n
e
sia
.
I
n
a
d
d
it
i
o
n
to
h
is
te
a
c
h
in
g
re
sp
o
n
sib
il
it
ies
,
he
is
a
c
ti
v
e
ly
in
v
o
l
v
e
d
in
re
se
a
rc
h
p
ro
jec
ts
f
o
c
u
se
d
o
n
imp
r
o
v
in
g
p
a
ti
e
n
t
c
a
re
a
n
d
n
u
rsi
n
g
e
d
u
c
a
ti
o
n
.
He
is
d
e
d
ica
ted
to
m
e
n
to
rin
g
st
u
d
e
n
ts
a
n
d
h
e
l
p
in
g
t
h
e
m
d
e
v
e
l
o
p
th
e
sk
i
ll
s
n
e
e
d
e
d
t
o
s
u
c
c
e
e
d
in
t
h
e
h
e
a
lt
h
c
a
re
in
d
u
stry
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
sy
a
ifu
lsa
ifu
l@
y
a
h
o
o
.
c
o
m
.
Nurw
a
h
id
a
h
is
a
lec
tu
re
r
a
t
th
e
De
p
a
rtme
n
t
o
f
Nu
rsi
n
g
,
F
a
c
u
lt
y
o
f
He
a
lt
h
S
c
ien
c
e
,
P
o
lt
e
k
k
e
s
Ke
m
e
n
k
e
s
M
a
tara
m
,
Cit
y
o
f
M
a
tara
m
,
P
ro
v
in
c
e
o
f
NTB,
In
d
o
n
e
sia
.
S
h
e
h
o
l
d
s
a
M
a
ste
r'
s
d
e
g
re
e
in
Nu
rsi
n
g
a
n
d
h
a
s
e
x
ten
siv
e
e
x
p
e
rien
c
e
in
c
li
n
ica
l
p
ra
c
ti
c
e
.
S
h
e
is
p
a
ss
io
n
a
te
a
b
o
u
t
e
d
u
c
a
ti
n
g
f
u
t
u
re
n
u
rse
s
a
n
d
c
o
n
tri
b
u
ti
n
g
t
o
th
e
a
d
v
a
n
c
e
m
e
n
t
o
f
h
e
a
lt
h
c
a
re
in
h
e
r
c
o
m
m
u
n
it
y
.
In
a
d
d
it
io
n
t
o
h
e
r
tea
c
h
in
g
re
sp
o
n
sib
il
it
ies
,
sh
e
is
a
c
ti
v
e
ly
i
n
v
o
l
v
e
d
i
n
re
se
a
rc
h
p
ro
jec
ts
a
ime
d
a
t
imp
r
o
v
i
n
g
p
a
ti
e
n
t
c
a
re
a
n
d
n
u
rsi
n
g
e
d
u
c
a
ti
o
n
.
S
h
e
is
d
e
d
ica
ted
t
o
fo
ste
ri
n
g
a
su
p
p
o
rti
v
e
lea
rn
in
g
e
n
v
iro
n
m
e
n
t
fo
r
h
e
r
st
u
d
e
n
ts
a
n
d
p
ro
m
o
ti
n
g
e
v
id
e
n
c
e
-
b
a
se
d
p
ra
c
ti
c
e
in
th
e
field
o
f
n
u
rsin
g
.
Sh
e
c
a
n
b
e
c
o
n
ta
c
ted
a
t
e
m
a
il
:
n
u
rwa
h
i
d
a
h
m
a
sk
u
r
3
4
@g
m
a
il
.
c
o
m
.
S
u
la
i
m
a
n
La
l
u
is
a
se
n
io
r
lec
tu
re
r
a
t
th
e
De
p
a
rtme
n
t
o
f
N
u
rsin
g
,
F
a
c
u
lt
y
o
f
He
a
lt
h
S
c
ien
c
e
,
Un
i
v
e
rsity
o
f
Qa
m
a
ru
l
Hu
d
a
Ba
d
a
ru
d
d
in
,
Cit
y
o
f
M
a
tara
m
,
P
ro
v
in
c
e
o
f
NTB,
In
d
o
n
e
sia
.
He
h
o
ld
s
a
P
h
.
D
.
in
H
e
a
lt
h
S
c
ien
c
e
a
n
d
h
a
s
p
u
b
li
sh
e
d
n
u
m
e
ro
u
s
re
se
a
rc
h
a
rti
c
les
in
re
p
u
tab
le
j
o
u
r
n
a
ls.
He
is
a
lso
a
c
ti
v
e
ly
i
n
v
o
lv
e
d
in
c
o
m
m
u
n
it
y
h
e
a
lt
h
p
r
o
jec
ts
a
n
d
se
rv
e
s
a
s
a
m
e
n
to
r
fo
r
a
sp
iri
n
g
n
u
rse
s in
t
h
e
r
e
g
io
n
.
His p
a
ss
io
n
fo
r
n
u
rsin
g
e
d
u
c
a
ti
o
n
a
n
d
re
se
a
rc
h
h
a
s le
d
h
im
t
o
c
o
ll
a
b
o
ra
te
wit
h
i
n
tern
a
ti
o
n
a
l
o
r
g
a
n
iza
ti
o
n
s
t
o
imp
ro
v
e
h
e
a
lt
h
c
a
re
p
ra
c
ti
c
e
s
in
u
n
d
e
rse
rv
e
d
c
o
m
m
u
n
it
ies
.
His
d
e
d
ica
ti
o
n
t
o
a
d
v
a
n
c
in
g
t
h
e
field
o
f
n
u
rsin
g
h
a
s
e
a
rn
e
d
h
im
re
c
o
g
n
it
i
o
n
a
s
a
lea
d
in
g
e
x
p
e
rt
i
n
th
e
re
g
io
n
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
su
laim
a
n
lalu
@g
m
a
il
.
c
o
m
.
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