JRSSEM 2022, Vol. 01, No. 9, 1345 – 1353

E-ISSN: 2807 - 6311, P-ISSN: 2807 - 6494

DOI : 10.36418/jrssem.v1i9.147 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

THE EFFECTIVENESS OF THE COMBINATION OF

SNAKEHEAD FISH EXTRACT AND ACUPRESURE ON

ALBUMIN CONDITIONS AND BLOOD PRESSURE OF

PREGNANT WOMEN WITH PREECLAMPSIA

Shandy Wigya Mahanani¹*

Mardiyono²

Imam Djamaluddin³

Handayani

1,2,4

Poltekkes Kemenkes Semarang,

Sultan Agung Islamic University Semarang, Indonesia

e-mail: shandywigyam@gmail.com

, muh.mardiyono@gmail.com

imam.djamaluddin@gmail.com

, handayaniketut123@gmail.com

*Correspondence: shandywigyam@gmail.com

Submitted: 23 March 2022, Revised: 05 April 2022, Accepted: 16 April 2022

Abstract. One of the causes of maternal death is preeclampsia. Preeclampsia and eclampsia are

caused by factors that decrease serum albumin (hypoalbuminemia) which causes a decrease in

intravascular hypovolemic pressure. This study aimed to evaluate the effectiveness of snakehead

fish extract and acupressure on albumin levels and blood pressure in pregnant women with

preeclampsia. The research method is a non-randomized pretest-posttest control group design

study and was conducted at a health center in Central Java, Indonesia. A sample of 30 subjects; 15

subjects in the experimental group, and 15 subjects in the control group. The experimental group

was given snakehead fish extract 2x 500 mg every day for 14 days and acupressure at points GV

20, Li 3, and Ki 3 6 times for 14 days. Systolic and diastolic blood pressure measurements were

performed on day 1 and day 14. Data analysis used paired parametric t test. The results showed

that snake head extract and acupressure for 14 days had a significant decrease in diastolic from 12

mmHg to 10.66 mmHg (p=0.000), while in the control group there was no decrease in systolic

blood pressure of 0.667 (p=0.670) and systolic blood pressure was 0.667 (p=0.670). pressure 0.667

(p=0.670). diastolic 2.66 p=0.041. In the experimental group there was an increase in albumin levels

of 1.12 (p = 0.000. In the control group, albumin levels were -0.14 before and after the

measurement did not affect albumin levels with a value of p = 0.082. Giving snakehead fish extract

and acupressure at the KI 3 point, LV3, and GV 20 were effective in increasing albumin levels and

lowering blood pressure in preeclamptic women.

Keywords: acupressure; albumin; blood pressure; preeclampsia; snakehead fish.

Shandy Wigya Mahanani, Mardiyono, Imam Djamaluddin, Handayani
 
                               | 1346 
DOI : 10.36418/jrssem.v1i9.147      https://jrssem.publikasiindonesia.id/index.php/jrssem/index 
INTRODUCTION 
 
Preeclampsia  and  eclampsia  are  the 
largest  causes  of  mortality  and  morbidity 
for mother and baby in the world. Pregnant 
women  with  hypertension  are  at  risk  of 
experiencing  complications  2-3%  during 
pregnancy.  Handling  of  hypertension  in 
pregnant women has been done by giving 
anti-hypertensive  drugs  methyldopa  250 
mg  and  nifedipine  10  mg.  Giving 
antihypertensives  can  prolong  pregnancy, 
but  most  respondents  are  not  responsive 
to  antihypertensive  drugs.  There  are  side 
effects  of  pharmacological  therapy, 
including  dizziness,  hypotension,  fatigue, 
depression, hypoglycemia, and IUGR. 
Preeclampsia and eclampsia contribute 
a  large  number  of  maternal  and  infant 
mortality and morbidity in the world, where 
during preeclampsia and eclampsia there is 
a  decrease  in  serum  albumin 
(hypoalbuminemia)  so  that  intravascular 
hypovolemic pressure decreases (Liu et al., 
2014). The main cause of maternal death in 
cases of preeclampsia is pulmonary edema 
because  left  cord  decompensation  has 
excessed extravascular fluid and decreased 
pressure  on  plasma  colloids  due  to 
proteinuria and replacing large blood loss 
with  crystalloids  and  the  liver  has 
decreased albumin synthesis (Gunawan & 
Utama, 2020). 
 Hypertension in pregnancy can reduce 
blood  perfusion  in  the  kidneys  and 
decrease  the  rate  of  filtration  in  the 
glomerulus  as  in  glomerulopathy  so  that 
there is an increase in the permeability of 
plasma proteins such as albumin (Cornelis, 
Odutayo,  Keunen,  &  Hladunewich,  2011). 
Decreased renal glomerular filtration  
rate due to renal artery spasm results in 
decreased  protein  absorption  resulting  in 
proteinuria, and decreased serum albumin 
results  in  reduced  intravascular 
hypovolemic pressure (Solberg et al., 2021); 
(McNaughton,  Jacobson,  &  Kripalani, 
2014); (Jamshidnezhad, Kabootarizadeh, & 
Hoseini, 2019). Low albumin levels result in 
inadequate fetoplacental circulation, multi-
organ  hypoperfusion,  and  overall 
endothelial damage. Lack of oxygen in the 
placenta  stimulates  the  release  of 
vasoactive  substances  in  the  blood  which 
affect  the  heart.4  Normal  albumin  levels 
range from 3.4-5.4 g/dl.  
Low albumin levels result in inadequate 
fetoplacental  resulting  in  endothelial 
damage,  hypoalbuminemia  is  also  a 
triggering  factor  in  the  incidence  of 
preeclampsia  in  pregnant  women. 
Hypoalbuminemia  can  be  overcome  by 
consuming  foods  that  contain  lots  of 
protein. 
Snakehead  fish  (Channa  Striata)  has  a 
high  protein  content,  snakehead  fish 
extract  capsules  have  a  high  albumin 
content and are animal antioxidants. With 
high albumin content in snakehead fish, it 
is  expected  to  be  able  to  overcome  the 
problem  of  hypertension  in  pregnant 
women . 
The many impacts on pharmacological 
drugs  need  to  be  accompanied  by  non-
pharmacological  treatments  as  a 
complement  for  better  results  (Han,  Lee, 
Commodore-Mensah, & Kim, 2014). Non-
pharmacological  treatment  for  mild  cases 
of preeclampsia in pregnant women is by 
performing acupressure measures that aim 
to open and stimulate the circulation of chi 
by  activating  the  meridian  points  called 

1347 | The Effectiveness of the Combination of Snakehead Fish Extract and Acupresure on

Albumin Conditions and Blood Pressure of Pregnant Women with Preeclampsia

acupoint pressure points that are close to

the skin.6 Acupressure is a simple therapy

that has no side effects because it does not

require an invasive technique and is a

technique that is easy to do (Mehta,

Dhapte, Kadam, & Dhapte, 2017).

Acupressure is a derivative of acupuncture

which is a physiotherapy massage at certain

points on the surface of the body. In the

case of hypertension, acupressure at

certain points can stimulate nerve waves

that can accelerate blood circulation, relax

spasms, and stabilize blood pressure.8

Acupressure in this study used the LV 3, GV

20, and KI 3 points.

The purpose of this study was to

determine the effectiveness of the

combination of snakehead fish extract and

acupressure on albumin levels and blood

pressure in pregnant women with

preeclampsia.

METHODS

The study design was a Quasi

Experiment with a Pretest-Posttest with

Control Group design. This study identified

the effectiveness of a combination of

snakehead fish extract and acupressure on

albumin levels and blood pressure in

pregnant women with preeclampsia. This

study contained 2 treatment groups,

namely treatment group I was given a

combination of snakehead fish extract and

acupressure while treatment group II as

control was only given standard midwifery

care according to the service. The duration

of intervention for each respondent was 2

weeks. The independent variable in this

study was a combination of snakehead fish

extract and acupressure, while the

dependent variable in this study was

albumin levels and blood pressure. The

population in this study were pregnant

women with preeclampsia in the

Wonosobo district. The sample in this study

used Stratified Random Sampling. Taking

the subject in the study using a non-

probability sampling technique, purposive

random sampling type. The instrument in

this study used a tool to check albumin

levels in the blood using the Bromcresol

Green method, mercury

sphygmomanometer, snakehead fish

extract, and 3 ml of venous blood samples.

Data analysis used the Shapiro-Wilk test

and homogeneity test, the data were

normally distributed and homogeneous,

followed by the analysis of variance using

the paired T-Test parametric test. Has

passed the ethical clearance test at dr.

Moewardi Surakarta.

RESULTS AND DISCUSSION

Table 1. The difference of albumin level in the intervention and control group

Albumin

Measurement

Group

Intervensi

Kontrol

mean±SD

Min-Max

Mean±SD

Min-Max

Before

3,467±0,241

3.1-4.0

4,093±0,421

3.6-4.9

After

4,587±0,388

4.0-5.2

3,953±0,387

3.6-5.0

P-value

0,000

0,082

Difference

1.12±0,323

-0,14±0,289

Shandy Wigya Mahanani, Mardiyono, Imam Djamaluddin, Handayani

| 1348

Based the Table 1, the albumin level

measurement before the intervention

group showed a mean of 3.46 gr/dl and in

the control group, the albumin level was

4.09 gr/dl. Measurement of albumin levels

after the intervention group increased by

an average of 4.58 gr/dl, while in the

control group the measurement of albumin

levels after decreased by an average of 3.95

gr/dl. The intervention group experienced

an increase of 1.12 gr/dl, in the control

group -0.14 gr/dl.

Changes in the mean albumin levels in

mild preeclampsia respondents who

carried out 2 blood sampling to measure

albumin levels before and after the

intervention with snakehead fish extract

and acupressure and changes in albumin

levels in the control group can be seen in

the following figure.

Figure 1. Description of albumin level in the intervention and control group

Based on Figure 1, shows that albumin

levels in the intervention group

respondents before and after giving

snakehead fish extract and acupressure

experienced a significant increase. In the

paired t-test measuring albumin levels

before and after in the intervention group,

statistically, there was an effect on albumin

levels after being given snakehead fish

extract and acupressure with a value of

p=0.000. In the control group, the albumin

level before and after the measurement did

not affect the albumin level with a value of

p=0.082.

The results of statistical tests that have

been carried out can be concluded that the

administration of snakehead fish extract

500 mg x 2 a day for 14 days and 6 times

acupressure in 14 days can increase the

albumin levels in the intervention group by

1.12 gr/dl and affect the albumin levels.

before after

albumin intervensi albumin kontrol

Variabel

Group

Intervensi

Kontrol

Albumin

Mean ± SD

Pre - pre

3,46 ±0,241

4,09±0,421

-4,997

0,000

Post - post

4,58 ±0,388

3.95 ± 0,38

4,471

0,000

Δ - Δ

1,12±0,323

-0,14±0,289

11,238

0,000

Shandy Wigya Mahanani, Mardiyono, Imam Djamaluddin, Handayani

| 1349

DOI : 10.36418/jrssem.v1i9.147 https://jrssem.publikasiindonesia.id/index.php/jrssem/index

Table 2. The difference of systolic pressure in the intervention group and control group

Blood pressure

measurement

Group

Intervention

Systole

mean ±

Min-

Max

mean ±

Min-Max

Before

139.3 ±

7.03

130-150

138.6 ±

5.16

130-150

After

127.3 ±

4.57

120-130

139.3 ±

5.93

130-150

0,000

Difference

-12

± 5.6

-10

± 2.5

*paired t-test

Variabel

Kelompok

Intervensi

Kontrol

Sistol

Mean ± SD

Pre - pre

139,3 ±7,037

138,6±5,164

0,296

0,770

Post - post

127,3 ±4,57

139,3 ± 5,936

-6,200

0,000

Δ - Δ

12,00±5,60

-0,667±5,936

6,008

0,000

*independent t-test

Table 3. The difference of diastolic pressure in the intervention group and control group

Blood pressure measurement

Group

Control

Diastole

diastole

Mean ± SD

Min-Max

Mean ± SD

Min-Max

Before

90.67 ± 2.58

90-100

91.33 ± 3.51

90-100

After

80.00 ± 0.00

80-80

88.67 ± 3.51

80-90

P-value

0.670

0.041

Difference

0.66

± 5.93

-2.66

± 4.57

* paired t-test

Variabel

Kelompok

value

Intervensi

Kontrol

Diastol

Mean ± SD

Pre -

pre

90,67±2,582

91,33±3,519

0,592

0,559

Post -

80,00±0,000

88,67

0,000

Shandy Wigya Mahanani, Mardiyono, Imam Djamaluddin, Handayani

| 1350

post

±3,519

9,539

Δ - Δ

10,66±2,581

2,66±4,577

5,896

0,000

*independent t-test

Based on the table above, the

measurement of systolic blood pressure

before the intervention group with a mean

of 139.3 mmHg and diastole 90.67 mmHg.

In the control group, the mean

measurement of systole was 138.6 mmHg

and diastole 91.3 mmHg. Measurement of

systole after the intervention group with a

mean of 127.3 mmHg and diastole 80

mmHg, while in the control group systole

before the mean was 139.3 mmHg and

diastole 88.67 mmHg.

Snakehead or ChannaStriata is a

freshwater fish species that has high

nutrition of the amino acid glycine and lipid

arachidonic acid. Snakehead fish contains

high protein as much as 70%, 21% albumin,

zinc, amino acids, iron, and selenium.9500

mg of snakehead fish extract has a protein

content of 70.5% which includes 21%

albumin, Mg 0.3200 mg, Fe 0.0115 mg, Ca

0.7300 mg, copper 0.0025 mg, Zn 0.0175

mg, Mn 0.0025 mg, Mi 0.0023 mg, Co

0.0015 mg, Se 0.0031 mg. Albumin

contained in snakehead fish is 60% of the

protein in blood plasma.10 The results of

Veronika's research on 133 respondents

showed the incidence of maternal

morbidity was 33.8% and maternal

mortality was 3.8% of patients experienced

hypoalbuminemia in cases of severe

preeclampsia and eclampsia (Guest, 2013);

(Sivgin et al., 2013).

According to research results from

Wahyuni by giving 2gr of snakehead fish

extract for 7-10 can increase albumin levels

in the blood by 0.6-08gr/dl (p=0.001). In

patients with low albumin levels after 8

days of intervention, albumin levels have

Increased (Chen & Wang, 2014). In the

study, Syuma concluded that high albumin

snakehead fish extract can increase

albumin and MDA levels (Ayuda-Durán et

al., 2019).

In the Ogawa study, with 139 patients,

33 respondents had gestational

hypertension and 106 preeclamptic

patients, there was a significant

relationship between AT III and Albumin

activity in gestational hypertension

(p=0.003) and preeclampsia (p=0.003).13

Snakehead fish extract has the potential to

increase albumin levels in the blood serum

of preeclamptic patients.

Acupressure to treat hypertension has

been conducted in many studies, one of

which is by Haryani by providing

acupressure in reducing the pain scale of

hypertensive patients with a significant

magnitude of 0.5 which means moderate

(Bulut, Alemdar, Bulut, & Şalcı, 2020).

Whereas in Lestari's study using other

methods, namely Effleurage massage and

music therapy to reduce blood pressure in

maternal preeclampsia gave 0.2 which

means very weak (Kesumawati, Mardiyono,

& Latifah, 2020).

Previous research, conducted by

Kesumawati, used acupressure and

acumoxa at the HT 7 and LI11 meridians

and moxibustion at the GV 20 and KI 3

points to reduce blood pressure for

pregnant women with gestational

hypertension. The results obtained were

1351 | The Effectiveness of the Combination of Snakehead Fish Extract and Acupresure on 
Albumin Conditions and Blood Pressure of Pregnant Women with Preeclampsia 
 
1.494 which means very strong.16 
Based  on  the  results  of  previous 
research, it was shown that snakehead fish 
extract was effective for increasing albumin 
levels.  In  previous  studies,  the  use  of 
acupressure  and  moxibustion  at  the  HT7, 
LI11, GV 20, and KI3 points was effective in 
reducing  blood  pressure  in  pregnant 
women  with  hypertension.  So  the 
researchers  chose  to  research  a 
combination intervention of snakehead fish 
extract and acupressure at points KI 3, LV3, 
and GV 20, to increase albumin levels and 
reduce blood pressure for pregnant women 
with mild preeclampsia. 
The results of measuring albumin levels 
in the  intervention group and the control 
group obtained  a  significance level of  1.6 
which  means  very  strong.  In  the 
measurement  results  of  systolic  blood 
pressure  in  this  study,  it  was  found  a 
significance level of 2.26 which means very 
strong,  and  the  diastolic  blood  pressure 
value  of  2  (Ogawa  et  al.,  2014).  which 
means very strong. 
 
CONCLUSIONS 
 
Giving snakehead fish extract 500 mg x 
2 every day for 14 days and acupressure at 
points KI 3,  LV3 and GV 20 as  much as 6 
times for 14 days is effective in increasing 
albumin  levels  and  decreasing  blood 
pressure in preeclamptic mothers.  
The  administration  of  snakehead  fish 
extract  and  acupressure  was  effective 
against the increase in albumin levels with 
a value of P=0.000 
The  administration  of  snakehead  fish 
extract  and  acupressure  was  effective  in 
reducing  systolic  blood  pressure  with  a 
value of P=0.000 and diastole with a value 
of P=0.000. 
 
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