Disertasi

Resistensi Arteri Uterina, Annexin-V, Soluble Tumor Necrosing Factor-Receptor 2, dan Soluble FMS-Like Tyrosin Kinase-1 sebagai Prediktor Preeklamsia/Eklamsia dan Pertumbuhan Janin Terhambat. = Uterine Artery Resistance, Annexin-V, soluble Tumor Necrosing Factor-Receptor 2, and soluble FMS-Like Tyrosine Kinase-1 as Predictors of Preeclampsia / Eclampsia and Fetal Growth Restriction.

Adverse pregnancy outcome (APO) adalah kondisi patologis kehamilan yang berperan dalam morbiditas dan mortalitas maternal dan perinatal, antara lain preeklamsia (PE)/ eklamsia, keguguran berulang, kematian janin dalam kandungan, dan pertumbuhan janin terhambat (PJT). Penelitian ini bertujuan mengetahui peran resistensi arteri uterina, kadar Annexin-V, sTNF-R2, dan sFlt-1 pada serum wanita hamil trimester II sebagai prediktor PE dan PJT. Penelitian ini dilakukan menggunakan desain potong lintang, kohort dan nested case control di RS.Fatmawati dan Puskesmas Kecamatan Cilandak, Jakarta Selatan. Subjek penelitian adalah ibu hamil 22–24 minggu yang datang ke poliklinik antenatal care. Dilakukan pemeriksaan doppler velosimetri arteri uterina. Bila tinggi/takik dikategorikan sebagai kasus dan bila normal sebagai kontrol. Pada seluruh subjek penelitian dilakukan pemeriksaan Annexin-V, sTNF-R2 dan sFlt-1. Seluruh subjek diikuti secara prospektif sampai dengan timbul gejala PE atau PJT. Dari 96 subjek, 47 kasus dan 49 kontrol, lima subjek (5,2 %) dengan manifestasi APO, terdiri dari 3 subjek mengalami Preeklamsia (PE) dan Pertumbuhan Janin Terhambat (PJT), 2 subjek hanya mengalami Pertumbuhan Janin Terhambat (PJT). Seluruhnya terjadi pada kelompok kasus (10,6 %), dengan risiko relatif kejadian APO 11,46 (95 % IK: 0,65–201,66). Nilai titik potong kadar Annexin-V serum pada APO ≤ 0,84 ng/mL dengan nilai sensitivitas 80% dan spesifisitas 61,50%. Nilai titik potong kadar sTNF-R2 serum pada APO ≤ 236,93 ng/mL dengan nilai sensitivitas 60,00% dan spesifisitas 53,80%. Titik potong kadar sFlt-1 serum pada APO ≥ 1331,66 pg/mL dengan nilai sensitivitas 40,00% dan spesifisitas 75,80 %. Di buat model prediksi, menggunakan variabel paritas, usia maternal dan kadar annexinV < 0,84 ng/mL. Resistensi arteri uterina yang tinggi di usia kehamilan 22–24 minggu meningkatkan peluang terjadinya APO 11,46 kali.
Kata kunci: Adverse pregnancy outcome, Annexin-V, Model Prediksi Preeklamsia, Pertumbuhan Janin Terhambat.



Adverse pregnancy outcomes (APO) is a group of pathological conditions of pregnancy which play a role in morbidity and/or mortality maternal/perinatal. Included in this complications are preeclampsia (PE)/eclampsia, recurrent miscarriage, fetal death in utero, and Fetal Growth Restriction (FGR). The objective of this study was to determine the role of resistance of the uterine artery by doppler velocymetry examination, the serum levels of annexin-V, sTNF-R2, and sFlt-1 in the 22–24 weeks of pregnancy as a predictor of PE and FGR.

This study was conducted at Fatmawati Hospital and Cilandak Subdistrict Health Center, South of Jakarta. Subjects of the study was a 22–24 weeks pregnant women who came to the antenatal care clinic. Doppler velocymetry examination of uterine artery was conducted, subjects with high resistance categorized as cases, while when normal, categorized as a control. To all of the subjects, measurement of serum Annexin-V, sTNF-R2 and sFlt-1 was carry out.
Out of 96 subjects, 47 were cases and 49 were controls. Five (5.2 % ) subjects with APO, consisting of three subjects had PE and FGR, two subjects experienced only FGR. All of APO found in the case group (10.6%), with relative risk was 11.46 (95% CI: 0.65–201.66), with p = 0.096. If the notch was seen, the relative risk of APO was 6.44 (95% CI: 0.78–53.20), with p = 0.04.
The cut-off point of serum Annexin V in subject with APO was ≤ 0.84 ng / mL with a sensitivity of 80% and specificity of 61.50%. The cut-off point serum levels of TNF-R2 in subject with APO was ≤ 236.93 ng/mL, with a 60.00% sensitivity and specificity of 53.80%. The cut-off point serum levels of sFlt-1 in subject with APO was ≥1331.66 pg/mL with a 40.00% sensitivity and specificity of 75.80%.
Prediction model has been made, using variabel maternal age, parity and the serum level of Annexin V. High uterine artery resistance at 22–24 weeks gestational age increases the chances of APO 11.46 times.
Keywords: Adverse pregnancy outcome, Annexin-V, Fetal Growth Restriction, Prediction model, Preeclampsia.