Akurasi Pemeriksaan Ultrasonografi oleh Residen Obstetri dan Ginekologi pada Kasus Seksio Sesarea Emergensi di RSPAD Gatot Soebroto April-Oktober 2016
| Main Authors: | Kapnosa Hasani, Rachmat Dediat, Arief Rahman, Ichnandy, Ardhana Iswari, Wulan, Uli Pardede, Tiarma, Darus, Febriansyah, Puspitasari, Bintari, Santana, Sanny, Abidin, Finekri, Endjun, Judi J |
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| Format: | Article info application/pdf eJournal |
| Bahasa: | eng |
| Terbitan: |
PT. Kalbe Farma Tbk
, 2017
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| Online Access: |
http://www.cdkjournal.com/index.php/CDK/article/view/734 http://www.cdkjournal.com/index.php/CDK/article/view/734/497 |
Daftar Isi:
- Pendahuluan: Pemeriksaan taksiran berat janin menggunakan ultrasonografi (USG) saat ini rutin pada keadaan emergensi untuk membantu keputusan managemen pasien di kamar bersalin. Pada penelitian ini dilakukan penilaian akurasi taksiran berat janin menggunakan ultrasonografi oleh residen obstetri dan ginekologi pada kasus seksio sesarea emergensi. Desain: Studi retrospektif terhadap 63 kasus kehamilan yang menjalani seksio sesarea emergensi di RSPAD Gatot Soebroto April-Oktober 2016. Taksiran berat janin (TBJ) dikalkulasi dan dibandingkan dengan berat lahir (BL) Dilakukan analisis ketepatan diagnosis makrosomia, berat lahir rendah dan faktor-faktor yang berperan dalam akurasi pemeriksaan USG.Hasil: Rerata selisih absolut antara TBJ dan BL 222 ± 198 g (172-272). Rerata persentase selisih absolut antara TBJ dan BL 8,0 ± 5,9 % (6,2-9,7%). Selisih absolut antara TBJ dan BL didapatkan < 10 % pada 71 % kasus. Pada uji korelasi didapatkan korelasi yang baik antara TBJ dan BL (r=0,91, p=0,001). Kemampuan memprediksi makrosomia memiliki sensitifitas 67 % dan spesifisitas 98 %. Kemampuan memprediksi berat lahir rendah memiliki sensitifitas 80 % dan spesifisitas 95 %. BMI ≥ 35 kg/m2 memiliki rerata kesalahan pengukuran lebih besar (359 g vs 208 g, p=0,001). Keadaan oligohidramnion dan inpartu tidak didapatkan mempengaruhi akurasi taksiran berat janin. Simpulan: Pemeriksaan taksiran berat janin oleh residen memiliki akurasi cukup baik. Diagnosis makrosmia memiliki sensitifitas rendah. BMI pasien ≥ 35 kg/m2 merupakan salah satu faktor yang mempengaruhi akurasi pemeriksaan USG oleh residen. Background: Ultrasonography-based estimated fetal weight is currently a routine workup for emergency cases in the delivery room. This study explores the accuracy of estimated fetal weight using ultrasonography conducted by obstetrics and gynecology residents during emergency caesarean sections. Design: This is a retrospective study conducted on 63 pregnancies terminated with emergency caesarean section in RSPAD Gatot Soebroto on April to October 2016. Estimated fetal weight (EFW) was calculated and compared to birth weight, analyzed for accuracy for diagnosis of macrosomia, low birth weight, and factors that influence the accuracy of an ultrasonography imaging. Results: Absolute means difference between EFW and BW was 222 ± 198 g (172-272). Absolute means difference percentage between EFW and BW was 8,0 ± 5,9 % (6,2-9,7%). Absolute difference between EFW and BW was found to be <10% in 71% of cases. Correlation tests showed a good correlation between EFW and BW (r=0,91, p=0,001). Sensitivity of macrosomia diagnosis was 67% with a specificity of 98%, while low birth weight predictions had 80% sensitivity and 95% specificity. EFW miscalculation is higher in women with BMI ≥ 35 kg/m2 (359 gr vs 208 gr, p=0,001); oligohydramnion and delivery were not found to influence EFW accuracy. Conclusion: Fetal weight estimation obstetrics and gynecology residents was found to have adequate accuracy. The diagnosis of macrosomia, however, was found to have low sensitivity, and maternal obesity (≥ 35 kg/m2) influenced the accuracy of ultrasonographic diagnosis.