Asfiksia perinatal berhubungan dengan luaran buruk neonatus, seperti buruknya skor Apgar; kebutuhan resusitasi dan ventilasi bertekanan positif, perdarahan intraventrikuler, hypoxic ischemic encephalopathy, hingga terjadinya kematian dini neonatus. Pemantauan kesejahteraan janin melalui berbagai modalitas indirek dilakukan untuk mendeteksi dini faktor risiko asfiksia perinatal, meskipun pemeriksaan gas darah tali pusat diakui sebagai metode baku penetapan status asam basa dan penegakkan keadaan asfiksia yang objektif. Asidosis metabolik janin menurut ACOG dan AAP ditegakkan jika dijumpai pH arteri tali pusat ≤ 7 dan defisit basa ≥ 12 mmol/L, tetapi masih belum diketahui nilai pH dan BD yang dapat digunakan untuk memprediksi kejadian luaran buruk neonatus. Penelitian ini dilakukan di RSUPNCM selama bulan Mei – Agustus 2020 terhadap persalinan dengan usia kehamilan di atas 27 minggu, baik secara spontan maupun operasi. Desain penelitian adalah kohort prospektif dengan masa pemantauan bayi baru lahir selama 7 hari. Sejumlah 135 subjek yang memenuhi kriteria diikutsertakan dalam penelitian ini. Nilai pH < 7,2015 dapat diterapkan pada sampel arteri maupun vena tali pusat karena menunjukkan akurasi baik dan prediktif terhadap kejadian luaran buruk neonatus jangka pendek, dengan nilai RR masing-masing 4,05 dan 5,9. Nilai BD arteri tali pusat tidak menunjukkan kemaknaan dalam memprediksi luaran buruk neonatus jangka pendek.
Perinatal asphyxia is associated with adverse neonatal outcomes, such as poor Apgar score, the need for positive pressure ventilation and resuscitation, intraventricular hemorrhage, hypoxic ischemic encephalopathy, and the occurrence of early neonatal death. Monitoring of fetal well-being through various indirect modalities is performed to detect the risk of developing perinatal asphyxia, although cord blood gas testing is recognized as the reference method of determining neonatal acid-base status and diagnosing perinatal asphyxia. According to ACOG and AAP, fetal metabolic acidosis is confirmed if either umbilical cord artery pH ≤ 7, or a base deficit ≥ 12 mmol / L is found, but it is still unknown whether pH and BD values could be used to predict the incidence of adverse neonatal outcomes. This research was conducted at the dr. Cipto Mangunkusumo General Hospital during May - August 2020 on spontaneous or caesarean deliveries with a gestational age of more than 27 weeks. The study design was a prospective cohort with 7 days monitoring period of newborns. A total of 135 subjects who met inclusion criteria were included in this study. The pH value of < 7.2015 showed good accuracy and predictive of short-term adverse outcome for both arterial and venous umbilical cord, with RR of 4.05 and 5.90 respectively. Umbilical cord BD was insignificant as short-term neonatal adverse outcomes predictor. |
SP-Ricky Tjahjadi.pdf :: Unduh