Indeks Pulsatilitas Dan Takik Diastolik Doppler Arteri Uterina Dalam Memprediksi Preeklamsia: Studi Kohort Prospektif

Muhammad Wahyu Utomo, dr.R.Detty Siti Nurdiati Z,MPH,Ph.D,SpOG.Subsp.K.Fm; dr. Irwan Taufiqurrahman, SpOG, Subsp. K.Fm

2024 | Tesis-Subspesialis | SUBSPESIALIS OBSTETRI DAN GINEKOLOGI

Latar belakang: Sitotrofoblas menginvasi arteri spiralis yang memperdarahi desidua. Invasi arteri spiralis yang seharusnya menembus jaringan elastis medial, muscular dan neural dan mengganti lapisan endomethelium hanya dapat menembus dangkal sampai lapisan superficial yang mengakibatkan pembuluh darah memiliki resistensi yang tinggi. Dengan mengukur Doppler velocimetri arteri uterina terbukti sangat berguna untuk memprediksi gangguan sirkulasi plasenta. Sehingga kita dapat memprediksi terjadinya preeclampsia.
Tujuan: Menganalisa dan memprediksi luaran kehamilan dengan menggunakan indeks pulsatilitas dibandingkan takik diastolik pada Doppler arteri uterina.
Metode: Studi ini merupakan studi kohort prospektif pada wanita hamil sehat, wanita hamil hipertensi dan wanita hamil preeklamsia sebanyak 183 orang. Saat kunjungan akan dilakukan pencatatatan karakteristik demografi, pengukuran tekanan darah, pemeriksaan indeks pulsatilitas dan takik diastolik Doppler ultrasonografi arteri uterina.
Hasil: Persentasi kejadian preeklamsia 16,9?ngan nilai ambang optimal indeks pulsatilitas Doppler arteri uterina dengan sensitifitas 83.87?n spesifisitas 95,39?ngan cut off 1,23. Sedangkan nilai ambang takik diastolik adalah sensitifitas 54,84?n spesifisitasnya 92,76%.
Kesimpulan: Indeks pulsatilitas Doppler arteri uterina lebih baik dalam memprediksi kejadian preeklamsia dibandingkan takik diastolik.

Background: The cytotrophoblasts invade the spiral artery which bleeds the basal decidua. The invasion of the spiral artery that is supposed to penetrate the medial, muscular, and neural elastic tissues and replace the endothelium layer can only penetrate superficially to the superficial layer resulting in high resistance of the blood vessels. So we can predict the occurrence of preeclampsia.
Objective: To analyze and predict pregnancy outcomes using the pulsatility index compared to notching in the Doppler of the arterial arteries.
Methods: This study is a prospective cohort study of 183 healthy pregnant women, hypertensive pregnant women and preeclampsia pregnant women. During the visit, demographic characteristics will be recorded, blood pressure measurement, pulsatility index, and notching of the uterine artery ultrasound Doppler will be carried out.
Results: The percentage of preeclampsia incidence was 16,9% with the optimal threshold value of the pulsatility index of the uterine artery Doppler index with a cut off 1,23 sensitivity of 83,87% and a specificity of 95,39%. Meanwhile, the threshold value of the notching is 54,84% sensitivity and 92,76% specificity.
Conclusion: The pulsatility index of the uterine artery Doppler is better in predicting incidence of preeclampsia than notching.

Kata Kunci : Indeks Pulsatilitas, Takik diastolik, Hipertensi, Preeklamsia, Pulsatility Index, Notching, Hypertension, Preeclampsia