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Articles 195 Documents
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Indications and Complications of Obstetrical Hysterectomy: Sardjito Hospital Experience Eda, Maria Katharina; Siswanti, Edi Patmini Setya; Widad, Shofwal
JURNAL KESEHATAN REPRODUKSI Vol 4, No 3 (2017)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (305.959 KB) | DOI: 10.22146/jkr.36480

Abstract

Latar Belakang: Histerektomi obstetri adalah operasi besar dan tetap merupakan salah satu bencana di bidang obstetri. Tindakan ini jarang dilakukan, namun merupakan operasi penyelamatan hidup dalam kasus perdarahan obstetrik yang sulit ditangani. Hal itu terkait dengan peningkatan morbiditas dan mortalitas ibu.Tujuan: Untuk menentukan indikasi dan komplikasi histerektomi obstetri di RSUP Dr. Sardjito. Metode: Penelitian ini menggunakan metode penelitian retrospektif kasus histerektomi obstetrik di RSUP Dr. Sardjito pada Januari 2012 hingga April 2015.Hasil dan Pembahasan: Selama masa studi, 30 histerektomi obstetri dilakukan. Delapan puluh persen kasus merupakan kasus rujukan. Rata-rata usia 32,47 tahun dengan standar deviasi 5,91. Atonia uteri merupakan indikasi yang paling umum (40%), diikuti oleh dehisensi uterus segmen bawah (33,3%), ruptur uteri (16,7%) dan plasenta akreta (10%). Tipe histerektomi yang dilakukan adalah histerektomi supra servikal sebesar 46,7%, histerektomi abdominal total 33,3%, dan histerektomi sesar 6%. Komorbiditas intraoperatif yang paling umum adalah kehilangan darah masif (93,3%). Disseminated Intravascular Coagulation (DIC) menyebabkan 30% dari komorbiditas pasca operasi. Kematian ibu mencapai 20%.Kesimpulan: Indikasi histerektomi obstetri ialah atonia uteri, dehisensi uterus segmen bawah, ruptur uterus, dan plasenta akreta. Komplikasi intraoperatif yang paling sering terjadi ialah kehilangan darah. DIC merupakan komplikasi paska operatif terbanyak dan penyebab utama kematian.Kata Kunci: Histerektomi obstetrik, atonia uteri, dehisensi uterus segmen bawah, ruptur uteri.
Pengalaman Ibu Bekerja dalam Pemberian AIS Eksklusif di Lingkungan Universitas Muhammadiyah Magelang Wijayanti, Kartika; Prawitasari, Shinta; Wenny, Wenny
JURNAL KESEHATAN REPRODUKSI Vol 3, No 1 (2016)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (251.337 KB) | DOI: 10.22146/jkr.13879

Abstract

Background: The percentage of breastfeeding within the last 24 hours is decreasing with increasing age of the baby with the percentage 6 month babies is only about 30.2%. The percentage Central Java reached 34.38%, the low, and became the 6th lowest at Indonesia. This is not met with the government’s target of 80% in 2010. In Magelang district, the number is decreased from 45.18% in 2011 and 25.6% in 2012. Total coverage of exclusive breastfeeding at Universitas Muhammadiyah Magelang is 13%.Objective: To identify employment mother’s experience for exclusive breastfeeding at Muhammadiyah Magelang University.Method: This is a qualitative study, transcendental phenomenological approach. The subjects of this study are employment mother at Muhammadiyah Magelang University who have babies 6-36 months. Data was collected with in-depth interviews, observation, and documentation. Sampling was carried out using purposive sampling technique. Data analysis using 6 stages Colaizzi data analysis. This study began in February 2014 - February 2015.Result and Discussion: This study resulted 6 categories: employment mother’s experiences for exclusive breastfeeding at work less fun, supporting factors of exclusive breastfeeding is complex, mother’s knowledge of exclusive breastfeeding is good, physical, technical, and pshycological preparation were necessary to give exclusive breastfeeding, and expectation of the workplace that support for exclusive breastfeeding.Conclusion: Employment mother’s experience for exclusive breastfeeding less fun. Mother’s effort to prepare for exclusive breastfeeding such as knowledge, physical, technical, and pshycological. Mother’s expectation is workplace that supports exclusive breastfeeding.Keywords: Experience, Employment mother, exclusive breastfeeding
Robekan Perineum pada Persalinan Vaginal di Bidan Praktik Swasta (BPS) Daerah Istimewa Yogyakarta Indonesia Tahun 2014-2016 Pangastuti, Nuring
JURNAL KESEHATAN REPRODUKSI Vol 3, No 3 (2016)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (236.262 KB) | DOI: 10.22146/jkr.36184

Abstract

Background: Vaginal delivery is the most preffered mode of delivery by all women, and the birth attendants. The vaginal delivery assistance was conducted by various health professionals such as midwives, physicians, and obstetricians. Various complaints of pelvic floor dysfunction and complaints related to the perineum as a result of vaginal perineal laceration during childbirth can affect the quality of life of a woman.Objective: To identify and conduct an analysis of maternal factors (maternal age, parity, gestational age), fetal factor (birth weight), and the labor factor (duration of 2nd stage of labor), with the occurrence of perineal rupture in vaginal delivery at the 5 Midwife’s Private Clinic (MPC), Yogyakarta, Indonesia.Method: Retrospective medical record searching, from January 2014 until December 2016.Result and Discussion: There were 1595 obtained samples of data that met the criteria for inclusion and exclusion. Number of perineal laceration reached 1201 (75.3%), with 1.9% of them are grade 3. Perineal rupture occurred in 80.55% of vaginal deliveries at young age, 69.14% in more than 35 years old women, and 85.05% primiparas. There was significant negative correlation (0.186) between parity and perineal rupture (p=0.000). The less the parity, the higher the incidence of perineal rupture (p=0.002). There was significant correlation between baby’s weight less than 2500 gram and perineal rupture but not for the baby’s weight more than 4000grams (p=0.304). The correlation was positive which meant that the heavier the baby’s weight the higher the incidence of perineal rupture. There was significant positive correlation (p=0,018) for the duration of 2nd stage of labor between 30-60 minutes and perineal rupture(0.061). The correlation was positive as well (0.092) for the duration of 2nd stage of labor more than 60 minutes and perineal rupture( p=0.002). The longer the duration of the 2nd stage of labor the higher the incidence of perineal rupture.Conclusion: There was significant relationship between parity, and duration of the 2nd stage of labor and perineal rupture in vaginal delivery.Keywords: perineal rupture, vaginal delivery, parity, duration of the 2nd stage of labor
HUBUNGAN KADAR ANTI MULLERIAN HORMONE (AMH) DENGAN KEBERHASILAN STIMULASI OVARIUM PADA FERTILISASI IN VITRO METODE PROTOKOL PANJANG Permana, Ridho; Widad, Shofwal; Lutfi, M.
JURNAL KESEHATAN REPRODUKSI Vol 2, No 3 (2015)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (299.507 KB) | DOI: 10.22146/jkr.12649

Abstract

HUBUNGAN KADAR ANTI MULLERIAN HORMONE (AMH)DENGAN KEBERHASILAN STIMULASI OVARIUM PADAFERTILISASI IN VITRO METODE PROTOKOL PANJANGRidho Permana, Shofwal Widad, M. LutfiABSTRACTBackground: Patient with decline oocyte number and quality assumed has lower Anti Mullerian hormone(AMH). AMH concentration which expressed by the granulosa cells of preantral and small antral folliclesindirectly determine the ovarian reserve. Therefore, AMH may be used as a marker of ovarian ageing andassociated with ovarian response in in vitro fertilization (IVF).Objective: To determine the effect of Anti Mullerian Hormone (AMH) on ovarian response in IVF longprotocol method.Method: This research is a retrospective cohort study in Permata Hati Fertility Clinic, IVF program-Dr.Sardjito Hospital, Yogyakarta, Indonesia. Seventy one cycle enrolled in an IVF program conducted fromJanuary 2011 through December 2013 at the Permata Hati Fertility Clinic.Result and Discussion: ROC curve were used to determine cut-off AMH. With cut-off point 2.59 ng/ml,subject divided into two groups (high AMH level: ≥2.59 ng/ml and low AMH level: <2.59 ng/ml). Totaldose gonadotropin was significantly different in two groups (p=0.02). High AMH and low AMH levelwere significantly associated with ovarian response (RR 2,05; CI 95% 1,32 – 2,20 ; p< 0,01). BesideAMH, multivariate analysis shows basal LH level (p=0,04; OR 7,22; CI 95% 1,09 – 47,87) and peritonealendometriosis (p=0,03; OR 7,80; IK 95% 1,15–52,81) were significantly influenced ovarian response in IVF.Conclusion: high AMH level influence ovarian response in IVF. Total dose gonadotropin on low AMH levelswas greater than high AMH level. In addition to AMH, ovarian response were influenced by basal LH leveland peritoneal endometriosis.Keywords: Anti Mullerian hormone (AMH), ovarian response, long protocol stimulation, in vitro fertilization(IVF).ABSTRAKLatar belakang: Pasien dengan penurunan jumlah dan kualitas oosit diduga mempunyai kadar AntiMullerian Hormone (AMH) lebih rendah. Konsentrasi Anti Mullerian Hormone (AMH) yang dihasilkanfolikel ovarium secara tidak langsung menggambarkan cadangan ovarium yang tersisa. Karenanya kadarAnti Mullerian Hormone (AMH) dapat digunakan sebagai prediktor yang akurat dari cadangan ovarium danrespons stimulasi ovarium pada fertilisasi in vitro.Tujuan: Untuk mengetahui pengaruh kadar Anti Mullerian Hormone (AMH) terhadap keberhasilanstimulasi ovarium pada fertilisasi in vitro pada metode protokol panjang.Metode: Penelitian ini menggunakan rancangan kohort retrospektif observasional.Hasil dan Pembahasan: Sebanyak 71 siklus dari 71 pasangan yang menjalani fertilisasi in vitro disertakandalam penelitian sesuai dengan kriteria inklusi dan eksklusi. Dengan cut off point AMH ditetapkan 2,59 ng/ml, maka subyek ini dibagi menjadi 2 kelompok yaitu ≥2,59 ng/ml sebagai kelompok AMH tinggi dan <2,59 ng/ml sebagai kelompok AMH rendah. Perbedaan bermakna antara dua kelompok ditemukan pada dosistotal gonadotropin (p=0,02).Terdapat perbedaan bermakna respons stimulasi ovarium antara AMH tinggidan AMH rendah (RR 2,05; IK 95% 1,32 – 2,20 ; p< 0,01). Kadar LH basal (p=0,04; OR 7,22; IK 95% 1,09 –47,87) dan endometriosis peritoneal (p=0,03; OR 7,80; IK 95% 1,15–52,81) juga mempengaruhi respons terhadap stimulasi ovarium.Kesimpulan : AMH tinggi mempengaruhi respons terhadap stimulasi ovarium. Dosis total gonadotropinpada AMH rendah dibutuhkan lebih banyak dibandingkan dengan AMH tinggi. Selain AMH, responsterhadap stimulasi ovarium juga dipengaruhi oleh kadar LH basal, dan endometriosis peritoneal.Kata kunci : kadar Anti Mullerian hormone (AMH), stimulasi ovarium protokol panjang, fertilisasi in vitro.Bagian Obstetri Ginekologi, Fakultas Kedokteran, Universitas Gadjah Mada Yogyakarta
PERBANDINGAN ANTARA PEMBERIAN ANTIBIOTIKA PROFILAKSIS PADA SEKSIO SESAR SESUAI ALUR KLINIS RSUP DR SARDJITO DENGAN ANTIBIOTIKA DOSIS MULTIPEL TERHADAP KEJADIAN INFEKSI LUKA OPERASI Rahmansyah, Ardian; Hakimi, Mohammad; Siswishanto, Rukmono
JURNAL KESEHATAN REPRODUKSI Vol 3, No 2 (2016)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (260.342 KB) | DOI: 10.22146/jkr.35444

Abstract

Background: Clinical pathway recommend the use of short-term prophylaxis antibiotics for cesarean section. Long-term antibiotics or multiple doses was found in clinical practice. There are differences in the mode of administration and the number of doses administered at sardjito hospital.Objective: To determine the effectiveness of short-term antibiotic prophylaxis in cesarean section appropriate to clinical pathway in the prevention of surgical site infection (ssi), the incidence of fever, dysuria events, length of stay.Method: The study used randomized clinical trial. The study subjects who underwent cesarean section and meet the inclusion and exclusion criteria in the period July 2013 to January 2014 divided into an intervention group (n = 52) who received ampicillin 2 gram pre and post-cesarean section, and a control group (n = 54) who received ampicillin 2 gram pre cesarean section and 1 gram every 8 hours for 6 times. Observed on days 3 and 10 post-cesarean section. The primary outcomes assessed were the incidence of surgical wound infection based on the criteria of surgical site infection from Centers for Disease Controland Prevention. Secondary outcomes assessed were the incidence of fever, dysuria events, length of stay. Homogeneity analysis were conducted on subject. Outcome analysis performed bivariate with t test and chi squared test.Results and Discussion : A total of 106 subjects can be analyzed. SSI events in the intervention group at day 3 was 3.8% (n = 52) and control group was 1.84% (n = 54) with p>0.05 RR 2.077 (95% CI 0.194 to 22.219). SSI on day 10 of 7.7% (n = 52) in the intervention group versus 9.3% (n = 54) in controls with p<0.05 RR 0.831 (CI 95%, 0.236 to 2.924). Fever events on day 3 by 5.8% in the intervention group versus 3.7% incontrols with p>0.05 RR 1.558 (95% CI 0.271 to 8.948) and on day 10 was 3.8% versus 3.7 % with p>0.05 RR 1.038 (95% CI 0.152 to 7.102). Dysuria not found on day 3 and but on 10 found 5.8% in the intervention group versus 11.1% with p>0.05 RR 0.519 (IK95% 0.137 to 1.968). Length of stay after cesarean section for 3.21 ± 0.412 days in the intervention group and 3.26 ± 0.442 days in the control group with p>0.05 (95% CI -0.213 - 0.117).Conclusion: There is no significant difference in the incidence of surgical wound infections, the incidence of fever, dysuria, length of stay between short-term prophylaxis antibiotics ampicillin appropriate to clinical pathway and long-term or multiple doses prophylaxis antibiotics. Short term antibiotics prophylaxis are more efficiently with the same effectiveness in preventing outcomes research.Keywords: prophylaxis antibiotics, ampicillin, short term regimen, long term regimen, cesarean section, surgical site infection. 
Incidence of Unintended Pregnancy after Laparoscopic Tubal Sterilization at Dr.Sardjito Hospital Widyasari, Anis; Wibowo, Prakoso Adhi; Rahman, M. Nurhadi; LUTFI, MUHAMMAD; Widad, SHOFWAL
JURNAL KESEHATAN REPRODUKSI Vol 4, No 2 (2017)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (179.045 KB) | DOI: 10.22146/jkr.35423

Abstract

Background:  Laparoscopic tubal ligation is one of the most commonly performed sterilization procedures and has many advantages such as high success rate and early return to normal activity. In Indonesia, the incidence of unintended pregancy in a study was 0,15 %. This rate is comparable with pregnancy rates for women using another contraceptive method.Objective: To assess the incidence of unintended pregnancy on women who underwent laparoscopic tubal sterilization at Dr. Sardjito Hospital.Method: A descriptive observational study with retrospective cross-sectional design was conducted. The data were acquired from medical record from January 2009 to April 2015. Reports of unintended pregnancy within two years after procedure were recorded.Result and Discussion: 55 women met the inclusion criterion and none were excluded. Method failures resulting on pregnancy occured in 3 cases (5.45 %), so the success rate of the procedure was 94.55 %. All of the reported pregnancies happened within two years after the procedures. There was no major complication occured in the procedure, but minor bleeding (<50 cc) did occur in some cases.Conclusion: The incidence of unintended pregnancy on women who underwent laparoscopic tubal sterilization at Dr. Sardjito Hospital was higher than the average incidence reported on another studies.Keyword: female sterilization, laparoscopic tubal sterilization, unintended pregnancy.
Hubungan Pemakaian Antibiotik dengan Kejadian Infeksi Sectio Caesarea pada Pasien di RSUD Abepura Jayapura Papua Emma, Nani; Emilia, Ova; Prawitasari, Shinta
JURNAL KESEHATAN REPRODUKSI Vol 1, No 1 (2014)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (329.207 KB) | DOI: 10.22146/jkr.36477

Abstract

Background: The number of caesarean section (CS) operations in the world has increased sharply within the last 20 years. Increase of the need for CS operations also increases the problem related to surgical process. Infection happens about 2% to 16% after CS operation. The incidence of post CS is associated with some factors such as supplementation of prophylaxis antibiotics, duration of childbirth, width of membrane wound, duration of surgical nursing monitoring and number of CS. CS infection associated with antibiotic use occurs before or after CS operation. The incidence increases 3 times in patients that do not use antibiotics before CS operation. Use of prophylaxis antibiotics in CS operation significantly minimizes the incidence of infection.Objective: To identify antibiotic use according to standard operational procedure to the incidence of infection in CS mothers.Method: The study was analytical with cross sectional design, undertaken at Abepura Local Hospital. Population were all mothers who gave birth through CS at the hospital. Samples were taken using systematic random sampling technique as many as 44 samples. Data were obtained through questionnaire, interview and document studies  and analyzed using chi square and logistic regression test, risk prevalence at confidence interval (CI) 95% and significance p<0.05.Result: The majority of subject (56.82%) had no infection; 59.09% used antibiotics according to the procedure; 52.27% had good nutrition status; 54.55% had emergency operation; 50% had anemia. Average length of CS operation was 2.26 +1.38 hours. There was significant association between antibiotic use, nutrition status, Hb level, and types of operation and the incidence of CS infection (p<0.05). The result of multivariate analysis showed there was significant association between antibiotic use, nutrition status, types of operation and the incidence of infection. Use of antibiotic brought dominant risk for the incidence of CS infection (PR=2.36; 95% CI=1.45-3.38) whereby antibiotic use, nutrition status and types of operation could predict the incidence of CS infection as much as 10.7%.Conclusion: The majority of subject had no infection and used antibiotic according to the procedure. The probability for the incidence of CS infection was greater in antibiotic use irrelevant with the procedure. Factor most dominantly affecting the incidence of CS infection was antibiotic use irrelevant with the procedure. Keywords: antibiotic use, caesarean section, incidence of infection
PRESERVASI FERTILITAS PADA PENDERITA KANKER Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 2, No 3 (2015)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (255.114 KB) | DOI: 10.22146/jkr.12656

Abstract

PRESERVASI FERTILITAS PADA PENDERITA KANKER*Heru Pradjatmo1ABSTRACTBackground: Young women who survive from cancer as candidates to face reproductive problemsassociated with cytotoxic cancer therapy. Side effects that alter the quality of life becomes unacceptable.Advances in reproductive medicine enables previously infertile women can obtain offspring.Objective: To recognize the effort that can be done to prevent adverse effects on fertility patients due tocancer therapyMethod: Literature studyResult and Discussion: In general, women age 40 years or less with cancer who received chemotherapy tobe likely ovarian function will cease. Studies show that many technique performed before chemotherapyallows women to have babies would be greater. Women prior to treat chemotherapy should be consultedto physicians in the field of reproductive and endocrinology for fertility preservation methods to deal withoncologist who take care the patient. All methods that can be performed should be included in counselingand all counseling and treatment including possible complications should be documented and recorded.Keywords : infertility, chemotherapy, adverse effect, preservationABSTRAKLatar Belakang: Perempuan muda yang survive dari penyakit kanker menjadi kandidat menghadapimasalah reproduksi berkaitan dengan terapi kanker yang bersifat sitotoksik. Sehingga efek samping yangmerubah kualitas kehidupan menjadi tidak dapat diterima. Kemajuan dalam kedokteran reproduksimemungkinkan wanita yang sebelumnya infertil akibat prngobatan penyakit kanker sekarang dapatmemperoleh keturunan.Tujuan: Untuk memahami upaya yang dapat dilakukan untuk mencegah terjadinya efek samping terhadapfertilitas penderita akibat terapi kanker.Metode: Studi literaturHasil dan Pembahasan: Secara umum perempuan penderita kanker sampai umur 40 tahun yangmendapat kemoterapi kemungkinan dapat berhenti fungsi ovariumnya. Studi menunjukkan bahwabeberapa teknik yang dilakukan sebelum kemoterapi memungkinkan wanita memperoleh keturunan lebihbesar. Seharusnya sebelum terapi dikonsulkan ke dokter dibidang reproduksi untuk metode preservasifertilitas dengan kesepakatan ahli onkologi yang menangani. Semua metode yang dapat dilakukan harusdimasukkan dalam konseling. Semua konseling dan pengobatan termasuk komplikasi yang mungkin terjadiseharusnya di dokumentasikan dan dicatat.Kata Kunci: infertilitas, khemoterapi, efek samping, preservasi1 Bagian Obstretika & Ginekologi Fakultas Kedokteran UGM/RSUP Dr. Sardjito Yogyakarta* Dipresentasikan pada seminar in vitro maturation (IVM) in vitro fertilization andlaparoskopic surgery, Yogyakarta, 8-9 November 2013
Impact of Obstetrician/Gynecologist Hospitalists on Response Time of Obstetric Emergency Operation in Sardjito Hospital Yogyakarta Indonesia: A Retrospective Cohort Study Ganap, Eugenius Phyowai; Hakimi, Mohammad; Hadijono, Soerjo; Emilia, Ova
JURNAL KESEHATAN REPRODUKSI Vol 3, No 3 (2016)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (231.85 KB) | DOI: 10.22146/jkr.35955

Abstract

Background: The hospitalist model in obstetric care which was introduced over the last decades now has an important role in care delivery management with the potential positive impact on maternal and neonatal outcomes.Objective: The aim of this study was to evaluate the effect of hospitalist model towards surgical emergency response time.Method: This research design was cohort a retrospective study. Participants included were  the patient in the time before and after implementation of obstetrician/gynecologist full-hospitalist policy during October 2013 until September 2014. The outcome measured were mean response time and possible hospital factors which contribute to response time.Result and Discussion: We included a total of 71 patients (30 on-call obstetrician group and  41 full-time hospitalist group).  Univariate analysis indicated  mean response time was significantly differ in full-time hospitalist group when compared to the on-call obstetrician group (65.3 + 25.89 vs. 84 + 22.29 mins; p = 0.002). Multivariable analysis determined that hospital factors which contribute to response time are readiness of operating theatre.Conclusion: Implementation of full-time hospitalist model is associated with a significant improvement of response time in emergency obstetric care.Keywords: Maternal mortality, Obstetrician/Gynecology Hospitalist, C-section, Response Time
RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTOR KEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILAN LEWAT WAKTU Adintyo Rahman, Muhammad Nur; Prawitasari, Shinta; Pradjatmo, Heru
JURNAL KESEHATAN REPRODUKSI Vol 2, No 2 (2015)
Publisher : Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan UGM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1087.055 KB) | DOI: 10.22146/jkr.12642

Abstract

RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTORKEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILANLEWAT WAKTUMuhammad Nur Adintyo Rahman1, Shinta Prawitasari2, Heru Pradjatmo3ABSTRACTBackground: Induction of labor is a common procedure performed at 15-20 % of pregnancies. The mostcommon indication was prolonged pregnancy (70 %). The past decade labor induction rate was increased2-fold as well as the risk of cesarean section. Difficulties to predict the success of induction made predictorsof success of induction widely studied. Predictors can be physical or chemical markers. One of the chemicalmarker is the ratio of estriol to estradiol levels.Objective: To determine the value of the ratio of estriol/ estradiol to predict success of induction of laborin prolonged pregnancy.Method: The design of study are Prospective Cohort. Study two hospitals (Wonosobo District Hospitaland Banjarnegara District Hospital) used in this study from September 10, 2013 until December 31,2013. Blood sampling was drown from the subject before induction to examin the levels of estriol andestradiol the induction which end in vaginal delivery were noted as succesull induction Receiver OperatingCharacteristic (ROC) method in order to determine the sensitivity, specificity, positive predictive value,negative predictive value and Area Under the Curve. Bivariate and multivariate analyzes also used todetermine the correlation between variables.Results and Discussion: This study obtained 76 samples, 69 with successful induction and 7 failed ofinduction. The research got a cut-off was point 35 the sensitivity was 71% value, specificity value of 71%,positive predictive value 49%, negative predictive value was 55.6%. Area Under the was value of 80,7%.Positive likelihood ratio 1,06 and negative likelihood ratio 0,88. Bivariate and multivariate analysis showedthat the ratio of estriol / estradiol ≥ 35 ng / mL significantly associated with successful induction (OR 9,598;95% CI 1,378-66,859) Bishop score was also associated with a significant induction success (OR 13,481;95% CI 1,955 -92,955)Conclusion: This study shows that the proportion ratio of estriol / estradiol in succeed induction groupwere higher (≥ 35) compared with induction failure group (<35).Keywords: prolonged pregnancy, labor induction , estriol/ estradiol ratio, predictorsABSTRAKLatar Belakang: Induksi persalinan adalah prosedur umum yang dilakukan pada 15-20% kehamilan.Indikasi tersering adalah kehamilan lewat waktu (70%). Satu dekade terakhir angka induksi persalinantelah meningkat 2 kali lipat begitu juga dengan risiko seksio sesarea. Keberhasilan induksi sulit diprediksi.Prediktor keberhasilan induksi banyak diteliti baik penanda fisik maupun kimia. Salah satu penanda kimiaadalah rasio kadar estriol terhadap estradiol.Tujuan: Mengetahui nilai rasio kadar estriol estradiol untuk memprediksi keberhasilan induksi padakehamilan lewat waktuMetode: Kohort prospektif. Dua rumah sakit (RSUD Wonosobo dan RSUD Banjarnegara) dipakai dalampenelitian ini dari 10 September 2013 sampai 31 Desember 2013. Subyek yang memenuhi kriteriainklusi dan eksklusi diambil sampel darah sebanyak 5 ml sebelum Induksi untuk diperiksa kadar estrioldan estradiol kemudian dilihat keberhasilan induksinya. Analisis yang digunakan adalah metode ReceiverOperating Characteristic (ROC) untuk dapat mengetahui nilai sensitivitas, spesifitas, nilai ramal positif,nilai ramal negatif dan Area Under Curve. Analisis X2 dan Regresi logistik digunakan untuk mengetahuihubungan antar variabel.Hasil dan Pembahasan: Selama waktu penelitian didapatkan 76 sampel, 69 dengan induksi berhasil dan7 gagal induksi. Dengan cut off point 35, nilai sensitivitasnya 71%, nilai Spesifitas 71%, nilai ramal positif49%, nilai ramal negatif 55,6%. Nilai Area Under Curve sebesar 80.7%. Likelihood ratio positive 1,06 danlikelihood ratio negative 0,88. Hasil analisis multivariat menunjukkan bahwa Rasio estriol/ estradiol ≥ 35berhubungan dengan keberhasilan induksi secara signifikan (RO 9.598; IK 95% 1.378-66.859) Skor Bishopjuga berhubungan dengan keberhasilan induksi secara signifikan (RO 13,481; IK 95% 1.955-92.955)Kesimpulan: Kelompok yang berhasil diinduksi memiliki proporsi rasio estriol/ estradiol yang lebih tinggi(≥ 35) dibandingkan dengan kelompok gagal induksiKata kunci: Kehamilan lewat waktu, induksi persalinan, rasio estriol/ estradiol, prediktor1,2,3 Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta

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