HUBUNGAN KADAR Beta-hCG 12 HARI PASCA TRANSFER EMBRYO DENGAN LUARAN KEHAMILAN

AGUNG KURNIAWAN, dr. Shofwal Widad, SpOG(K).; dr. Diah Rumekti Hadiati, M.Sc, SpOG(K)

2017 | Tesis-Spesialis | SP Ilmu Kebidanan dan Penyakit Kandungan

Latar belakang: Subfertilitas merupakan salah satu permasalahan yang sering ditemukan di era modern ini. Berbagai metode ditemukan dan digunakan untuk meningkatkan angka keberhasilan reproduksi pada perempuan. Teknologi reproduksi berbantu memiliki risiko terjadinya keguguran dan kehamilan ektopik. Kadar serum beta-hCG 12 hari pasca transfer embryo memiliki peranan penting dalam prediksi luaran kehamilan. Tujuan penelitian: Untuk memprediksi luaran kehamilan, sensitivitas, spesifisitas serta nilai ambang kadar beta-hCG 12 hari pasca transfer embryo. Metode penelitian: Penelitian menggunakan rancangan penelitian observasional kohort retrospektif di Klinik Permata Hati RSUP. Dr. Sardjito Yogyakarta tahun 2012-2015. Subyek penelitian 130 subyek yang terbagi menjadi 65 subyek dengan kadar beta-hCG <76 IU/l dan 65 subyek =76 IU/l. Luaran kehamilan diklasifikasikan sebagai viabel (janin hidup pada usia kehamilan = 22 minggu)dan non viabel ( kehamilan biokimia, ektopik, mola dan keguguran). Hasil: Median dan minimum kadar beta-hCG pada kehamilan viabel 167 IU/l dan 44 IU/l, dan 53 IU/l dan 16 IU/l pada kehamilan non viabel. Terdapat hubungan yang bermakna antara kadar serum beta-hCG 12 hari pasca transfer embryo dengan luaran kehamilan. Kadar beta-hCG =76 IU/l sebanyak 50 (76,9%) pada kehamilan viabel dan sebanyak 15 (23,1%) subyek pada kehamilan non viabel. Kadar betahCG <76 IU/l sebanyak 7 (10,8%)pada kehamilan viabel dan 58 (89,2%) pada kehamilan non viabel (p=0,000). Kadar beta-hCG terendah pada kehamilan ganda 300 IU/l. Kesimpulan: Kadar beta-hCG 12 hari pasca transfer embryo bermakna secara statistik dalam membantu memprediksi luaran kehamilan viabel dengan cut-off point 71,5 IU/l, sensitivitas 89,1 % dan spesifitas 79,5 %. Nilai positive predictive value (PPV) adalah 76,9 %, dan nilai negative predictive value (NPV) adalah 89,2%.

Background: Subfertility is one of the problems that are often found in this modern era. Assisted reproductive technologies have the risk of miscarriage, ectopic pregnancy and biochemical pregnancy. Various methods are found and used to improve the success rate of reproduction in women. Levels of serum betahCG 12 days after embryo transfer has an important role in the prediction of outcome of pregnancy. Objective: To predict the outcome of pregnancies with high levels of beta-hCG 12 days after embryo transfer and determine the sensitivity and specificity as well as the value of the threshold levels of beta-hCG 12 days after embryo transfer. Methods: This study design was a retrospective cohort observational study. Subjects were from Klinik Permata Hati RSUP Dr. Sardjito Hospital from 2012-2015 as many as 130 samples were divided into 65 subjects with beta-hCG levels < 76 IU/l and 65 subjects = 76 IU/l. Results: The median and minimum beta-hCG concentration was 167 IU/l and 44 IU/l in viable pregnancies and 53 IU/l and 16 IU/l in non viable pregnancies (p=0.000). There was a significant correlation between the levels of beta-hCG 12 days after embryo transfer with pregnancy outcome. The levels of beta-hCG =76 IU/l in viable pregnancy 50 (76.9%)subjects, in non viable pregnancy 15 (23.1%)subjects. The levels of beta-hCG <76 IU/l in viable pregnancy, 7 (10.8%)subjects, in non viable pregnancy 58 (89.2%)subjects. Conclusion: The beta-hCG 12 days after the embryo transfer was statistically significant in helping to predict the outcome of viable pregnancy with cut-off point 71.5 IU/l, sensitivity of 89.1 % and spesificity 79.5 %. The positive predictive value (PPV) was 76.9%, and the negative predictive value (NPV) was 89.2%.

Kata Kunci : Teknologi reproduksi berbantu, subfertilitas, kadar beta-hCG, transfer embryo, luaran kehamilan, Assisted reproductive technology, subfertility, levels of beta-hCG, embryo transfer, pregnancy outcome.