Faktor-faktor prognostik yang mempengaruhi luaran janin pada ekstraksi vakum

TRISIYANI, Ratna, Prof.dr. HM. Sulchan Sofoewan, SpOG

2003 | Tesis | PPDS I Obstetri dan Ginekologi

Latar belakang: Pemakaian ekstraktor vakum terus meningkat, sementara terjadi penurunan persalinan dengan ekstraksi forseps. Ekstraksi vakum lebih disukai daripada ekstraksi forseps karena tekniknya lebih mudah dan lebih aman baik bagi ibu maupun bayi. Depresi neonatal pasca ekstraksi vakum berhubungan dengan derajat kesulitan tindakan. Mencari faktor-faktor prognostik dapat sebagai upaya untuk mencegah terjadinya luaran janin jelek pada ekstraksi vakum sehingga dapat sebagai pertimbangan pemilihan ekstraksi vakum sebagai pertolongan persalinan tindakan yang aman. Tujuan: Mengetahui faktor-faktor prognostik dan pengaruhnya terhadap luaran janin pada ekstraksi vakum di RS Sarjito. Metode Penelitian: Studi Kasus Kontrol. Bahan dan cara: Semua persalinan secara ekstraksi vakum di RS Sarjito yang memenuhi kriteria inklusi maupun eksklusi dalam kurun waktu empat tahun (1999–2002) dipakai sebagai subyek penelitian. Luaran janin jelek dimasukkan sebagai kelompok kasus, sedangkan kelompok kontrol adalah ekstraksi vakum dengan luaran janin baik. Luaran janin dianggap jelek bila terdapat asfiksia berat, hiperbilirubinemia, kejang, lama perawatan lebih dari 3 hari, perawatan di NICU atau adanya kematian neonatal. Faktor-faktor prognostik yang dipelajari meliputi: lama tindakan, jumlah tarikan, lepas tidaknya mangkuk, ada tidaknya malpresentasi/malposisi, turunnya kepala dan berat badan lahir. Data dianalisis dengan program komputer dan uji statistik yang digunakan chi square dengan odds ratio, 95% Confidence Interval (CI) serta regresi logistik untuk uji multivariatnya. Hasil: Selama kurun waktu empat tahun (1999–2002) terdapat 114 luaran janin jelek dari 299 persalinan ekstraksi vakum yang memenuhi kriteria inklusi dan eksklusi. Insidensi luaran janin jelek berfluktuasi setiap tahun dan mempunyai kecenderungan mengalami penurunan yaitu 54%, 38% dan 28% pada tahun 2000, 2001 dan 2002. Faktor-faktor prognostik yang bermakna secara klinis maupun statistik adalah: lepasnya mangkuk (OR 11,17 CI 95% 4,16–30,01), lama tindakan menit (OR 11,06 CI 95% 4,93–24,83), jumlah tarikan (OR 4,43 CI 95% 1,87–10,49), adanya malpresentasi/malposisi (OR 2,13 CI 95% 1,03–4,41) dan turunnya kepala (OR 1,84 CI 95% 1,03– 3,27). Berat badan lahir secara klinis bermakna tetapi secara statistik tidak bermakna (OR 1,92 CI 95% 0,68–5,44). Dalam analisis regresi logistik yang tetap bermakna sebagai faktor prognostik adalah: lama tindakan (OR 7,97 CI 95% 1,95–32,64) dan lepasnya mangkuk (OR 3,46 CI 95% 1,08–11,03 ). Simpulan: Penelitian ini menunjukkan bahwa faktor prognostik yang berpengaruh terhadap luaran janin adalah lama tindakan dan lepasnya mangkuk.

Background: There was a progressive increase in delivery by vacuum extraction and a decrease in forceps delivery. Recent reports have provided evidence that assisted vaginal delivery by vacuum extraction in preference to obstetric forceps, with greater simplicity and safety to both mother and fetus compared to forceps. The prudent use of sequential instruments at operative vaginal delivery did not engender higher rates of maternal or neonatal morbidity. Neonatzal depression after clinically indicated vacuum extraction has been found to be related to the degree of difficulty of the procedure. Investigate prognostic factors can be as effort to avoided the poor fetal outcome of vacuum extraction and considering to choice the vacuum extraction as a safe operative vaginal delivery. Objectives: To investigate the prognostic factors influencing the poor fetal outcome delivered by vacuum extraction at Sarjito hospital. Study design : Case – control study. Material and method: All cases of vacuum extraction at Sarjito hospital that fitted the inclusion and exclusion criteria during four years period (1999–2002) were used in the study. The poor fetal outcome as the case group of the study, and the control group was vacuum extraction with good fetal outcome. The poor fetal outcome included severe asphyxia, hyperbilirubinemia, seizure, infant length of stay >3 days, NICU nursery admission or neonatal mortality. The prognostic factors being studied included the duration of the procedure, the number of tractions, the cup ‘popoffs’, station of the head, malpresentation/malposition and infant body weight. Data were obtained from the medical record department and recorded in their respective forms. They were analyzed using computer program, and tested with chi square test (odds ratio, 95% confidence interval) and logistic regression for the multivariate analysis. Result: There were 114 cases of poor fetal outcome of 299 operative vaginal delivery by vacuum extraction. The incidence of poor fetal out come fluctuated, but it had been decreasing in the last three years i.e. 54%, 38% and 28% in 2000, 2001 and 2002 respectively. The prognostic factors that influenced significantly were duration of the procedure (OR 11,06 CI 95% 4,13–24,83), the number of tractions (OR 4,43 CI 95% 1,87–10,49), the cup ‘pop-offs’ (OR 11,17 CI 95% 4,16– 30,01), malpresentation/malposition (OR 2,13 CI 95% 1,03–4,41) and station of the head (OR 1,84 CI 95% 1,03–3,27). The infant body weight clinically increased risk 1,9 times but it was not statistically significant (OR 1,92 CI 95% 0,68–5,44). The logistic regression analysis showed that the duration of the procedure and the cup ‘pop-offs’ were the prognostic factors affecting the fetal outcome. Conclusion: This study showed that the prognostic factors influencing fetal outcome in vacuum extraction were the duration of the procedure and the cup ‘pop-offs’.

Kata Kunci : Persalinan, Ekstraksi Vakum, Luaran Janin, vacuum extraction, fetal outcome, prognostic factors.