Tesis

Keluaran Jangka Panjang Kasus Preeklampsia Berat: Studi Potong – Lintang = Long – term Outcome of Severe Preeclampsia Cases: Cross – Sectional Study .

LATAR BELAKANG: Preeklampsia Berat (PEB) merupakan komplikasi penyakit dalam kehamilan yang dapat menimbulkan morbiditas dan mortalitas maternal dan perinatal. Salah satu patofisiologi penyebab PEB adalah disfungsi endotel dan C – Reactive Protein (CRP) merupakan salah satu biomarker inflamasi sistemik akut yang diharapkan dapat menjadi faktor prediktif komplikasi PEB di kehamilan berikutnya. TUJUAN: Untuk mengetahui keluaran jangka panjang pada pasien ibu PEB dari sudut klinis dan laboratoris, serta keluaran jangka panjang bayi yang dilahirkan. METODE: Penelitian ini menggunakan desain potong – lintang terhadap pasien riwayat PEB yang pernah melahirkan di RSUPN Cipto Mangunkusumo pada bulan Januari 2014 – Desember 2016. Subjek diminta datang ke Poli Obstetri RSUPN Cipto Mangunkusumo pada Januari 2017 – Juni 2017 untuk dilakukan pemeriksaan klinis dan laboratoris (CRP dan protein urin). HASIL: Sebanyak 127 pasien yang diteliti, adalah pasien riwayat PEB pasca persalinan 6 bulan, 12 bulan, dan 24 bulan. Kelompok I didapatkan rerata tekanan darah (TD) 147/92 mmHg (SD 38/SD 39), IMT 29 kg/m 2 (SD 6), kadar CRP 16,6 mg/l (0,3 – 42,60) dan protein urin 1 (0 – 3). Kelompok II didapatkan rerata tekanan darah (TD) 112/88 mmHg (SD 12/SD 24), IMT 21 kg/m 2 (SD 7), kadar CRP 12,7 mg/l (3,4 – 15,2) dan protein urin 0 (0 – 3). Kelompok III rerata TD 154/95 mmHg (SD 45/SD 62), IMT 28,83 kg/m 2 , dengan rerata kadar CRP 14,2 mg/l (SD 8,54) dan protein urin 0 (0 – 3). Sedangkan keluaran jangka panjang bayi yang dilahirkan bahwa 68% lahir dengan kondisi preterm dengan rerata berat lahir 1.943 gram (SD 1.245), nilai Apgar menit ke-5 >7 63,78%, dan hanya 44,88% tumbuh – kembang bayi normal. KESIMPULAN: Gambaran keluaran jangka panjang pasien riwayat PEB didapatkan tekanan darah, IMT dan kadar CRP masih tinggi, serta protein urin urin negatif setelah 2 tahun pasca persalinan. Keluaran jangka panjang bayi yang dilahirkan mayoritas kondisi preterm dan berat lahir rendah, dengan kurang dari 50% bayi tumbuh – kembang normal.
KATA KUNCI: Preeklampsia Berat, c – reactive protein, proteinuria, pasca persalinan, tumbuh – kembang bayi


BACKGROUND: Severe preeclampsia is complicated disease in pregnancy that may cause maternal and perinatal morbidity and mortality. One of the pathophysiology is endothelial disfunction with C-reactive protein is one of the acute systemic inflammation biomarker that expected may be predictive factor of complication of severe preeclampsia in subsequent pregnancy. OBJECTIVES: This study was aimed to know the long – term outcome on severe preeclamptic mother by clinically and laboratory, and the long – term outcome of the baby that she delivered. METHODS: This is a cross – sectional study of patient with previous severe preeclamptic that gave birth in Cipto Mangunkusumo National Center General Hospital on January 2014 – December 2016. Subjects were called to come to Obstetrics Outpatient Clinic on Januari 2017 – June 2017 to be examined (physcial and laboratory CRP and urine dipstick). RESULTS: 127 patients were studied, divided into 3 groups of post – delivery time which were 6 months, 12 months, and 24 months. The 6 months group, mean of blood pressure were 147/92 mmHg (SD 38/SD 39), BMI 29 kg/m (SD 6), CRP level 16,6 mg/l (0,3 – 42,60) and urine protein dipstick 1 (0 – 3). The 12 months group, mean of blood pressure were 112/88 mmHg (SD 12/SD 24), BMI 21 kg/m (SD 7), CRP level 12,7 mg/l (3,4 – 15,2) and urine protein dipstick 0 (0 – 3). The 24 months group, mean blood pressure 154/95 mmHg (SD 45/SD 62), BMI 28,83 kg/m 2 , CRP level 14,2 mg/l (SD 8,54) and urine protein dipstick 0 (0 – 3). Meanwhile, the long – term outcome of babies that 68% baby were born with preterm condition and mean birth weight were 1943 grams (SD 1.245), the 5th minute Apgar score >7 were 63,78%, and only 44,88% baby had normal growth – development. CONCLUSION: The long – term outcome patients with previous severe preeclampsia are blood pressure, BMI, and CRP level still high, and negative urine protein level until 2 years of post – delivery. The long – term outcome of the babies that delivered were on preterm condition and low birth weight, with less than 50% had normal growth and development.
Keywords: severe preeclampsia, c – reactive protein, proteinuria, post – delivery, growth and development