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Abstrak :
Tujuan : Mengetahui nilai ambang hitung badan lamelar pada usia kehamilan di atas 28 minggu dan perannya dalam memprediksi terjadinya RDS apabila dibandingkan dengan tes busa.

Metode : Sampel cairan ketuban diperoleh melalui amniotomi saat melakukan sectio sesarea pada wanita hamil dengan usia kehamilan di atas 28 minggu. Nilai hitung badan lamelar dihitung menggunakan mesin hematologi Advia 120. Tes busa juga dilakukan terhadap sampel cairan ketuban, sementara bayi diobservasi dan dinilai apakah mengalami RDS. Titik potong nilai hitung badan lamellar dalam memprediksi RDS dihitung menggunakan grafik Receiver Operating Characteristic.

Hasil : 59 sampel cairan ketuban diperoleh dari wanita dengan usia kehamilan 29-42 minggu. Angka kejadian RDS pada penelitian ini adalah 15,3 %. Didapatkan nilai Area Under the Curve 0,94 untuk pemeriksaan hitung badan lamelar. Pada titik potong 50.000 sel/μL, hitung badan lamelar memiliki nilai sensitivitas 89 % dan spesifisitas 92 %, sementara tes busa memiliki nilai sensitivitas 67 % dan spesifisitas 90 %. Nilai negative predictive value untuk hitung badan lamelar pada titik potong 50.000 sel/μL adalah 98 %, sedikit lebih tinggi dari tes busa yaitu 94 %.

Kesimpulan : Pemeriksaan tes busa dan nilai hitung badan lamelar merupakan alat yang dapat dipakai dalam memprediksi terjadinya RDS, namun nilai hitung badan lamelar memiliki nilai sensitivitas dan spesifisitas yang lebih tinggi dan memiliki beberapa kelebihan, yaitu lebih objektif, mudah dan cepat dikerjakan, serta hanya memerlukan sedikit sampel cairan ketuban.

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Purpose : The study was designed to compare lamellar body count and foam stability test in predicting the presence of Respiratory Distress Syndrome in pregnancy with gestational age above 28 weeks.

Method : Amniotic fluid specimens were collected by amniotomy during cesarean section from women with gestational age above 28 weeks. A haematology analyzer (Advia 120) was used to determine the lamellar body counts. We also performed foam stability test and observed the development of respiratory distress syndrome. Receiver operating characteristics curve was estimated to assess the threshold of lamellar bodies count that may predict the presence of Respiratory Distress Syndrome.

Result : 59 specimens were collected from woman with 29 - 42 weeks gestational age. The incidence of Respiratory Distress Syndrome was 15,3 %. Area under the curve for lamellar body count was 0,94. Lamellar body count, with the best cut off point of 50.000 cell/μL had sensitivity 89% and specifity 92% for predicting the presence of RDS, while the sensitivity of foam stability test was 67% and specifity was 90 %. The negative predictive value of the lamellar body count was 98% slightly better than the negative predictive value of the foam stability test 94 %.

Conclusion : Although both test are good predictor of RDS, lamellar body has higher sensitivity and specitivity. It also has more advantages as it only requires small amount of sample, fast, easy and more objective.

Abstrak :
Penggunaan oksitosin drip untuk menginduksi persalinan semakin meningkat sebanyak 18 %. Sampai saat ini belum ada kesepakatan atas regimen dosis baik dalam hal dosis awal, dosis titrasi maupun dosis maksimal. Dari beberapa penelitian diketahui bahwa tidak terdapat perbedaan kadar oksitosin pada setiap fase persalinan . apabila dengan tetesan yang tetap dapat memberikan hasil yang cukup efektif, maka peningkatan dosis setiap beberapa menit tidak perlu dilakukan, sehingga memberikan kemudahan dalam pemberiannya. Saat ini di Indonesia belum ada penelitian yang membandingkan dosis oksitosin titrasi dengan menetap untuk mengetahui efektifitas pemberian oksitosin pada induksi persalinan. Metode: Penelitian ini merupakan uji klinis acak tersamar tunggal dengan pembanding (Single Blind Randomized Clinical Trial), dimana subjek tidak mengetahui jenis perlakuan yang mereka dapatkan. Didapatkan 68 subyek penelitian yang diambil di kamar bersalin RS Fatmawati, RSUZA Banda Aceh, sejak bulan Februari 2015 sampai Juni 2015. Terdapat 24 subyek ( 20 subyek dengan skor pelvik < 6 dan 4 subyek dengan skor pelvik ≥ 6) dengan 6 mU/menit, 24 subyek (20 subyek dengan skor pelvik < 6 dan 4 subyek dengan skor pelvik ≥ 6) dengan 8 mU/menit, dan 20 subyek (14 subyek dengan skor pelvik < 6 dan 6 subyek dengan skor pelvik ≥ 6) dengan dosis titrasi (mulai 4 mU/menit dititrasi 2 mU/menit setiap 30 menit). Hasil: Uji analisis statistik menunjukkan tidak terdapat perbedaan yang bermakna keberhasilan mencapai his adekuat antara kelompok dosis menetap dan titrasi (p=0,06; RR=3,15) dengan skor pelvik < 6, seluruh subyek dengan skor pelvik ≥ 6 berhasil mencapai kontraksi adekuat. Terdapat perbedaan yang bermakna waktu tercapainya kontraksi adekuat (p=0,03) antara kelompok dosis menetap 8 mU/menit dan titrasi dengan skor pelvik < 6. Tidak terdapat perbedaan yang bermakna waktu tercapainya kontraksi adekuat (p=0,16) antara kelompok dosis menetap 6 mU/menit dan titrasi dengan skor pelvik < 6. Tidak terdapat perbedaan yang bermakna waktu tercapainya kontraksi adekuat antara ketiga kelompok dengan skor pelvik ≥ 6 (p=0,80).Tidak terdapat perbedaan yang bermakna pada waktu persalinan antara ketiga dengan skor pelvik < 6 (p=0,16),tidak terdapat perbedaan pada waktu persalinan diantara ketiga kelompok dengan skor pelvik ≥ 6. Pada nilai Apgar menit ke-1 tidak terdapat perbedaan diantara ketiga kelompok dengan skor pelvik ≥ 6, dan tidak terdapat perbedaan bermakna diantara ketiga kelompok dengan skor pelvik < 6 (p = 0,40). Tidak terdapat perbedaan pada nilai Apgar menit ke-5 diantara ketiga kelompok baik pada kelompok dengan skor pelvik < 6 ataupun ≥ 6. Tidak didapatkan perbedaan bermakna pada intensitas nyeri saat kontraksi adekuat dengan NRS diantara ketiga kelompok baik pada kelompok dengan skor pelvik < 6 (p=0,22) ataupun ≥ 6 (p = 0,19). Tidak didapatkan perbedaan bermakna pada kejadian stress janin diantara ketiga kelompok baik pada kelompok dengan skor pelvik < 6 (p=0,41) ataupun ≥ 6 (p = 0,51). Hiperstimulasi dan ruptur uteri tidak terjadi pada semua kelompok dengan skor pelvik < 6 ataupun ≥ 6. Kesimpulan: Pada waktu tercapainya kontraksi adekuat dengan skor pelvik < 6 antara dosis 8 mU/menit menetap dan titrasi secara statistik terdapat perbedaan bermakna dan tidak terdapat perbedaan bermakna antara dosis 6 mU/menit menetap dan titrasi sedangkan pada skor pelvik ≥ 6 secara statistik tidak terdapat perbedaan pada ketiga kelompok. Tidak terdapat perbedaan bermakna secara statistik pada waktu persalinan pada ketiga kelompok dengan skor pelvik < 6 dan ≥ 6.

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Background: The use of intravenous oxytocin to induce labor has increased as much as 18%. Until now there has been no agreement on dosing regimen in terms of the initial dose, titration dose and maximum doses. From several studies concluded that there are no differences in the levels of oxytocin in every phase of labor. if giving fixed dose provide an effective results, then increase the dose every 30 minutes is not necessary, thus providing ease of administration. Currently in Indonesia there has been no study comparing oxytocin titration with fixed dose to determine the effectiveness of oxytocin in labor induction. Method: This study is a single-blind randomized clinical trial with a comparator (Single Blind Randomized Clinical Trial), where the subject does not know the type of treatment they get. Obtained 68 samples taken in the policlinic and delivery room at Fatmawati Hospital, Jakarta and Zaenoel Abidin Hospital, Banda Aceh, since February 2015 until June 2015. There were 24 samples (20 subjects with pelvic score <6 and 4 subjects with pelvic score ≥ 6) with 6 mU/minute fixed dose, 24 samples (20 subjects with pelvic score <6 and 4 subjects with pelvic score ≥ 6) with 8 mU/minute fixed dose, and 20 samples (14 subjects with pelvic score <6 and 6 subjects with pelvic score ≥ 6) with titrated dose (started from 4 mU / min titrated 2 mU / min every 30 minutes). Results: Statistical test analysis showed no significant difference the success of achieving adequate contraction between fixed and titration dose group (p = 0.06; RR = 3.15) with pelvic score <6, all subjects with pelvic score ≥ 6 made in to adequate contraction. There is a significant difference in time for achieve adequate contraction (p = 0.03) between fixed dose groups 8 mU / min and titrated group with pelvic score <6. There were no significant differences in the achievement of his time adequate (p = 0.16) between the dose groups settled 6 mU / min and titrate with pelvic score <6. There were no significant differences in in time for achieve adequate contraction among the three groups with the pelvic score ≥ 6 (p = 0.80). There was no significant difference in delivery time among the three groups with the pelvic score < 6 (p = 0.16), no difference in delivery time among the three groups with pelvic score ≥ 6. At Apgar score 1 minute there was no difference among the three groups with pelvic score ≥ 6, and there are no significant differences among the three groups with pelvic score <6 (p = 0.40). There were no differences in the Apgar score 5 minutes among the three groups both in the group with pelvic score <6 or ≥ 6. There were no significant differences in the intensity of pain during adequate contractions with NRS among the three groups both in the group with pelvic score <6 (p = 0.22) or ≥ 6 (p = 0.19). There were no significant differences in the incidence of fetal stress among the three groups both in the group with pelvic score < 6 (p = 0.41) or ≥ 6 (p = 0.51). Hyperstimulation and uterine rupture did not occur in all groups with a score of pelvic <6 or ≥ 6. Conclusion: From the statistical test analysis, for time to achieve adequate contraction with pelvic score < 6 between 8 mU / min fixed dose and titration dose significantly different and there is no significant difference between the 6 mU / min fixed dose and titration dose, while with the pelvic score ≥ 6 there were no differences in all three groups , but there were no significant differences in the time of delivery in the three groups both with pelvic score <6 and ≥ 6.

Abstrak :
Latar Belakang: Selama kehamilan terjadi perubahan fisiologis yang memengaruhi metabolisme nutrisi dan energi. Sehingga status nutrisi pra-kehamilan merupakan faktor penting bagi pertumbuhan janin dan kesehatan ibu Wanita dewasa dengan indeks massa tubuh (IMT) <18,5 digunakan sebagai indikator kekurangan energi kronis (KEK). Dan sebanyak 24,2% wanita hamil yang berumur 15-49 tahun memiliki risiko KEK berdasarkan indikator lingkar lengan atas (LILA). Berdasarkan Riskesdas 2013, prevalensi wanita hamil berisiko tinggi dengan tinggi badan <150 cm mencapai 31,3 %. Hingga saat ini, hanya beberapa penelitian yang mempelajari status nutrisi wanita hamil trimester I dengan mengukur IMT, LILA dan tinggi badan, serta hubungannya dengan luaran bayi dan plasenta Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan IMT, LILA dan tinggi badan ibu hamil trimester I sebagai prediksi status nutrisi prakonsepsi dengan ukuran plasenta dan luaran bayi. Metode: Desain penelitian adalah potong lintang pada 134 pasien yang sesuai kriteria. Data pasien mengambil riwayat kehamilan trimester pertama menggunakan catatan kehamilan untuk menilai kecukupan gizi ibu dan keadaan klinis bayi pada saat persalinan. Hasil: Pada uji korelasi bivariat antara IMT, LILA, dan tinggi badan ibu hamil dengan karakteristik bayi lahir (berat, panjang, lingkar kepala, lingkar perut, berat plasenta, volume plasenta), menunjukan hasil yang signifikan pada semua variabel kecuali pada korelasi antara tinggi badan dengan lingkar kepala, lingkar perut, berat plasenta, dan volume plasenta bayi. Analisis multivariat menunjukan adanya korelasi antara berat, panjang, lingkar kepala, lingkar perut, berat plasenta, dan volume plasenta bayi lahir dengan LILA. Kesimpulan: Terdapat korelasi positif antara berat, panjang,lingkar kepala, lingkar perut, berat plasenta, dan volume plasenta bayi lahir terhadap LILA kehamilan trimester pertama.

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Background: The maternal nutritional status is an important factor for fetal growth and maternal health. Adult women with BMI <18.5 were used as an indicator of chronic energy deficiency (CED). And as many as 24.2% pregnant women aged 15 to 49 years old have the risks of CED based on their UAC. According to Riskesdas 2013, the prevalence of high risk pregnant women with body height <150 cm reaches up to 31.3%. Until now, there are few studies have studied the nutritional status of first trimester pregnant women by measuring their BMI, UAC and body height, as well as their association with the outcomes from placenta and infants. Objective: This study aims to determine the correlation between BMI, UAC and body height of first trimester pregnant women as predicted pre-conception nutritional status with placental size and outcomes of the infants. Method: The design of this study is cross sectional 134 patients who matched the criteria. Patients' data were obtained during their first trimester of pregnancy at network hospitals and Budi Kemuliaan Hospital. Results: Bivariate correlation test between BMI, UAC and body height of pregnant women with the characteristics of infants (body weight, body length, head circumference, abdominal circumference, placental weight, placental volume), elicited significant result on all of the variables, except on the correlation between body height with head circumference, abdominal circumference, placental weight, and placental volume. Multivariate analysis showed a correlation between infant's body weight, infants' body length, head circumference, abdominal circumference, placental weight, and placental volume with UAC. Conclusion: Significant correlation between infants' body weight, body length, head circumference, abdominal circumference, placental weight, and placental volume with UAC of first trimester pregnant women was proven.

Abstrak :
Penyakit membran hialin (PMH) dan gangguan toleransi minum (GTM) merupakan masalah pada bayi prematur dengan morbiditas dan mortalitas cukup tinggi. Pemberian steroid antenatal telah menurunkan angka PMH dan enterokolitis nekrotikans (EKN) komplikasi lanjut dari GTM, tetapi masih belum optimal dan masih didapat luaran yang berbeda pada bayi dengan usia gestasi, berat lahir dan tata laksana antenatalyang sama. Mikronutrien vitamin A, D₃ dan seng diketahui memengaruhi organ tersebut. Penelitian ini ingin mengetahui manfaat pemberian vitamin A (beta-karoten), vitamin D₃ dan seng menyertai deksametason untuk menurunkan kejadian PMH dan GTM pada bayi prematur. Uji klinis acak dilakukan pada subjek ibu hamil 28-34 minggu dan bayinya. Ibu hamil dirawat di rumah sakit untuk persiapan kelahiran prematur atas indikasi janin atau ibu. Subjek dibagi dalam kelompok intervensi dan kontrol. Kedua kelompok mendapat deksametason 2 x 6 mg intravena (2 hari). Kelompok intervensi mendapat dosis tunggal beta-karoten 25.000 IU dan vitamin D₃ 50.000 IU per oral, serta seng 50 mg/hari peroral (3 hari), sedangkan kelompok kontrol tidak. Sampel darah ibu dan tali pusat diambil untuk pengukuran kadar serum retinol, 25(OH)D dan seng. Bayi dipantau selama 4 minggu. Angka kejadian PMH, GTM, PMH-GTM dan hubungan kadar serum retinol, 25(OH)D dan seng pada kedua kelompok dengan luaran PMH-GTM, dianalisis dengan uji Chi-Square atau Fisher, uji t tidak berpasangan atau uji Mann Whitney dan uji t berpasangan atau uji Wilcoxon. Jumlah subjek 116 pasangan ibu-bayi, terbagi sama di kelompok intervensi dan kontrol. Kejadian PMH dan GTM pada bayi kelompok intervensi 7 (12,1%) dan 9 (16,1%), lebih rendah dan bermakna dibandingkan kelompok kontrol, 16 (27,5%) dan 19 (34,5%). Bayi PMH-GTM kelompok kontrol mempunyai kadar retinol, 25(OH)D dan seng di serum ibu dan tali pusat yang lebih rendah dibandingkan kelompok intervensi. Perbedaan bermakna didapatkan pada kadar 25(OH)D. Simpulan: Angka kejadian PMH dan GTM pada kelompok intervensi secara bermakna lebih rendah dibandingkan kelompok kontrol. Kadar retinol, 25(OH)D dan seng di serum ibu dan tali pusat berhubungan dengan luaran PMH-GTM.

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Hyaline membrane disease (HMD) and feeding intolerance (FI)are still problems of premature neonatal morbidity and mortality. Antenatal steroid administration has been recognized to reduce HMDand FImortality rates, but it is still not optimal and there are still different outcomes in neonates with similar gestational age, birth weight and treatment. Micronutrients of vitamin A, D₃ and zinc are known to play a roleon the lung and intestines of the fetusand neonates. This study aimed to find out the benefits of administration of vitamin A (beta carotene), vitamin D₃ and zinc accompanying antenatal steroids for lung maturation, in order to reduce the incidenceof HMD and FI. A randomized clinical trial was conducted on pregnant women 28-34 weeks of gestational age who were hospitalized for the preparation of preterm delivery on the indication of the mother or fetus. Both groups received dexamethasone for lung maturation. The intervention group received oral micronutrients, i.e., beta carotene 25,000 IU single dose, vitamin D₃ 50,000 IU single dose and 50 mg zinc per day for 3 days. The incidence of HMD, FI, HMD-FI and the relationship of serum retinol, 25(OH)D, zinc concentrationsin maternal and umbilical cord with HMD-FI were analyzed by Chi-Square or Fisher test, unpaired t or Mann Whitney test and paired t or Wilcoxon test between the intervention and control groups. The total subjects were 116 pairs of pregnant mothers and neonates (58 interventions and 58 controls). The incidence of HMDand FIin neonates in the intervention group were 7 (12.1%) and 9 (16.1%),which weresignificantly lower thanthe control group, 16 (27.5%) and 19 (34.5%). The HMD-FI neonates in the control group had lower serum retinol and 25(OH)D concentrations in maternal and umbilical cord than in the intervention group. Significant differences were only found at 25 (OH) D concentration. Conclusion: The incidence HMD and FI in the neonates intervention group were significantly lower than the control group. There was a relationship betweenserum retinol, 25(OH)D and zinc concentrations with HMD-FI outcome.

Abstrak :
Menarche dini merupakan salah satu faktor risiko kanker payudara yang berhubungan dengan lama pajanan estrogen. Penelitian mengenai faktor-faktor risiko menarche dini belum banyak dilakukan. Penelitian ini bertujuan untuk mengetahui hubungan antara asupan gizi, antropometri dan komposisi tubuh, serta aktivitas fisik dengan kadar estradiol dan menarche dini. Desain penelitian ini adalah potong lintang dengan subjek remaja putri 13-15 tahun di Jakarta, sejak Januari 2014 sampai Januari 2015. Analisis asupan gizi dilakukan dengan metode 24-hour recall dan Food Frequency Questionnaires (FFQ) semikuantitatif. Variabel antropometrik dan komposisi tubuh meliputi berat badan, tinggi badan, indeks massa tubuh (IMT), dan persentase lemak tubuh. Namun ditambahkan pengukuran lingkar lengan atas (LLA) dan lingkar pinggang (LP). Aktivitas fisik dinilai dengan Physical Activity Questionnaire (PAQ). Kadar estradiol serum diukur pada fase folikuler. Menarche dini adalah usia saat menstruasi pertama kali kurang dari 12 tahun. Terdapat 189 remaja putri usia13-15 tahun yang dilibatkan dari 8 SMP di Jakarta. Asupan gizi remaja putri berdasarkan PUGS cukup karbohidrat, kurang protein, tinggi lemak, dan rendah serat. Berdasarkan kriteria z-score IMT/U dari WHO, ditemukan sebanyak 3,2% gizi kurang, 73,5% normal, 18% mengalami overweight dan 5,3% mengalami obese. Lebih dari 90% subjek penelitian memiliki aktivitas fisik rendah. Proporsi menarche dini pada penelitian ini 22,8%. Kadar estradiol berkorelasi positif dengan asupan energi, protein, dan lemak. Berdasarkan kategori asupan, median estradiol berhubungan dengan asupan karbohidrat dan lemak. Terdapat korelasi negatif antara kadar estradiol dan LLA, LP serta z-score IMT/U. Terdapat hubungan antara menarche dini dan variabel-variabel antropometrik LLA dan LP serta z-score IMT/U. Tidak terdapat hubungan antara menarche dini, asupan gizi, aktivitas fisik, dan kadar estradiol. Faktor determinan kadar estradiol adalah asupan energi, protein, lemak dan zscore IMT/U, sedangkan faktor determinan menarche dini adalah LP. Dari hasil penelitian disimpulkan bahwa untuk menurunkan faktor risiko kanker payudara, perlu memperhatikan faktor-faktor yang terkait kadar estradiol dan menarch. ......Early menarche has been known as a risk factor of breast cancer because its association with the length of exposure time to estrogen. There are not much studies has been done on risk factors of early menarche. The aim of this study was to know the association among nutritional intake, anthropometry and body composition, physical activity, estradiol level and early menarche. This was a cross-sectional study involving adolescent girls aged 13-15 years in Jakarta, between January 2014 and January 2015. Interview on nutritional intakes were done by using the 24-hour recall and semiquantitative Food Frequency Questionnaires (FFQ). The anthropometric and body composition variables included body weight, body height, body mass index (BMI) and body fat percentage; however, additional variables were also measured, i.e. mid-upper arm circumference (MUAC) and waist circumference (WC). Physical activity was assessed by using the Physical Activity Questionnaires (PAQ). Serum estradiol levels was measured during follicular phase. Early menarche was defined if the first menstruation occurred before the age of 12 years. There were 189 adolescent girls enrolled in this study from 8 junior high schools in Jakarta. Based on guidelines of balanced nutrition, nutritiotional intake of adolescent girls were adequate carbohydrate intake, low protein intake, high fat intake, and low fiber intake. based on the WHO z-scores of BMI per age, there was 3,2% underweight, 73,5% normal, 18% overweight and 5,3% obese subjects. More than 90% of the study subjects had mild physical activity. The proportion of early menarche was 22.8%. Estradiol level was positive correlated with the intakes of energy, protein, and fat. Based on the diet intake category, median estradiol level was associate with the intakes of carbohydrate and fat. There was a negative correlation between estradiol level and MUAC, WC, and z-scores BMI per age. There was an association between early menarche and antrophometric measures (MUAC and WC) and z-scores BMI per age. No association was found between early menarche and nutritional intake, physical activity, or estradiol level. Determinant factors of estradiol level were the intakes of energy, protein, fat, and z-score BMI per age; while determinant factor of early menarche was waist circumference. To conclude, in order to reduce breast cancer risk, we should paid attention on factors associated with increased estradiol level and early menarche i.e. fat intake, physical acitivity and normal body weight.

Abstrak :
ABSTRAK
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 annexin-V < 0,84 ng/mL. Resistensi arteri uterina yang tinggi di usia kehamilan 22?24 minggu meningkatkan peluang terjadinya APO 11,46 kali

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ABSTRACT
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