<![CDATA[RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTORKEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILANLEWAT WAKTUMuhammad Nur Adintyo Rahman1, Shinta Prawitasari2, Heru Pradjatmo3ABSTRACTBackground: Induction of labor is a common procedure performed at 15-20 % of pregnancies. The mostcommon indication was prolonged pregnancy (70 %). The past decade labor induction rate was increased2-fold as well as the risk of cesarean section. Difficulties to predict the success of induction made predictorsof success of induction widely studied. Predictors can be physical or chemical markers. One of the chemicalmarker is the ratio of estriol to estradiol levels.Objective: To determine the value of the ratio of estriol/ estradiol to predict success of induction of laborin prolonged pregnancy.Method: The design of study are Prospective Cohort. Study two hospitals (Wonosobo District Hospitaland Banjarnegara District Hospital) used in this study from September 10, 2013 until December 31,2013. Blood sampling was drown from the subject before induction to examin the levels of estriol andestradiol the induction which end in vaginal delivery were noted as succesull induction Receiver OperatingCharacteristic (ROC) method in order to determine the sensitivity, specificity, positive predictive value,negative predictive value and Area Under the Curve. Bivariate and multivariate analyzes also used todetermine the correlation between variables.Results and Discussion: This study obtained 76 samples, 69 with successful induction and 7 failed ofinduction. The research got a cut-off was point 35 the sensitivity was 71% value, specificity value of 71%,positive predictive value 49%, negative predictive value was 55.6%. Area Under the was value of 80,7%.Positive likelihood ratio 1,06 and negative likelihood ratio 0,88. Bivariate and multivariate analysis showedthat the ratio of estriol / estradiol ≥ 35 ng / mL significantly associated with successful induction (OR 9,598;95% CI 1,378-66,859) Bishop score was also associated with a significant induction success (OR 13,481;95% CI 1,955 -92,955)Conclusion: This study shows that the proportion ratio of estriol / estradiol in succeed induction groupwere higher (≥ 35) compared with induction failure group (<35).Keywords: prolonged pregnancy, labor induction , estriol/ estradiol ratio, predictorsABSTRAKLatar Belakang: Induksi persalinan adalah prosedur umum yang dilakukan pada 15-20% kehamilan.Indikasi tersering adalah kehamilan lewat waktu (70%). Satu dekade terakhir angka induksi persalinantelah meningkat 2 kali lipat begitu juga dengan risiko seksio sesarea. Keberhasilan induksi sulit diprediksi.Prediktor keberhasilan induksi banyak diteliti baik penanda fisik maupun kimia. Salah satu penanda kimiaadalah rasio kadar estriol terhadap estradiol.Tujuan: Mengetahui nilai rasio kadar estriol estradiol untuk memprediksi keberhasilan induksi padakehamilan lewat waktuMetode: Kohort prospektif. Dua rumah sakit (RSUD Wonosobo dan RSUD Banjarnegara) dipakai dalampenelitian ini dari 10 September 2013 sampai 31 Desember 2013. Subyek yang memenuhi kriteriainklusi dan eksklusi diambil sampel darah sebanyak 5 ml sebelum Induksi untuk diperiksa kadar estrioldan estradiol kemudian dilihat keberhasilan induksinya. Analisis yang digunakan adalah metode ReceiverOperating Characteristic (ROC) untuk dapat mengetahui nilai sensitivitas, spesifitas, nilai ramal positif,nilai ramal negatif dan Area Under Curve. Analisis X2 dan Regresi logistik digunakan untuk mengetahuihubungan antar variabel.Hasil dan Pembahasan: Selama waktu penelitian didapatkan 76 sampel, 69 dengan induksi berhasil dan7 gagal induksi. Dengan cut off point 35, nilai sensitivitasnya 71%, nilai Spesifitas 71%, nilai ramal positif49%, nilai ramal negatif 55,6%. Nilai Area Under Curve sebesar 80.7%. Likelihood ratio positive 1,06 danlikelihood ratio negative 0,88. Hasil analisis multivariat menunjukkan bahwa Rasio estriol/ estradiol ≥ 35berhubungan dengan keberhasilan induksi secara signifikan (RO 9.598; IK 95% 1.378-66.859) Skor Bishopjuga berhubungan dengan keberhasilan induksi secara signifikan (RO 13,481; IK 95% 1.955-92.955)Kesimpulan: Kelompok yang berhasil diinduksi memiliki proporsi rasio estriol/ estradiol yang lebih tinggi(≥ 35) dibandingkan dengan kelompok gagal induksiKata kunci: Kehamilan lewat waktu, induksi persalinan, rasio estriol/ estradiol, prediktor1,2,3 Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta]]>
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