Jurnal Novianti Alfina PDF
Jurnal Novianti Alfina PDF
OLEH:
Novianti Alfina
2018-84-071
PEMBIMBING:
AMBON
2019
KATA PENGANTAR
Puji dan syukur penulis panjatkan ke hadirat Tuhan Yang Maha Esa karena atas
rahmat dan cinta kasih-Nya penulis dapat menyelesaikan jurnal guna penyelesaian tugas
kepaniteraan klinik pada bagian OBSTETRI DAN GINEKOLOGI dengan judul
“Diagnostic Value of Non Stress Test in Latent Phase of Labor and Maternal and Fetal
Outcomes”.
Dalam penyusunan jurnal ini, banyak pihak yang telah terlibat untuk penyelesaiannya.
Oleh karena itu, penulis ingin berterima kasih kepada:
1. dr. Zulaiha Maricar, Sp.OG selaku dokter spesialis pembimbing jurnal, yang
membimbing penulisan jurnal ini sampai selesai.
Penulis menyadari bahwa sesungguhnya jurnal ini masih jauh dari
kesempurnaan, oleh sebab itu penulis mengharapkan banyak masukan berupa kritik dan
saran yang bersifat membangun untuk perkembangan penulisan jurnal diwaktu yang
akan datang.
Akhir kata penulis mengucapkan terima kasih, semoga jurnal ini dapat
bermanfaat bagi semua pihak.
Penulis
Global Journal of Health Science; Vol. 7, No. 2; 2015
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
Received: January 22, 2014 Accepted: August 6, 2014 Online Published: October 28, 2014
doi:10.5539/gjhs.v7n2p177 URL: http://dx.doi.org/10.5539/gjhs.v7n2p177
Abstract
Purpose: The Non stress test (NST) is one of the significant diagnostic fetal wellbeing tests. The purpose of this
study is to assess diagnostic value of NST during latent phase of labor by considering maternal and neonatal
outcomes.
Subjects: This case control study was performed on 450 healthy pregnant women with gestational ages between
38-42 weeks in AL-Zahra teaching hospital in Tabriz, Iran. All participants underwent NST after being admitted
to labor during their latent phase of delivery. Participants were divided into two groups including the study group
which included 150 participants with non-reactive NST results whereas 300 subjects with reactive NST results
assigned in the control group. Subjects in both groups were hospitalized for pregnancy termination because of
the delivery time. In order to find out the importance of routine performance of NST during delivery, the
relationship between NST results and maternal and fetal outcomes was evaluated. Several criteria including type
of delivery, meconium defecation, descent arrest, bradycardia, Apgar score, and still birth were compared
between two groups.
Results: Findings of this study showed that descent arrest occurred in 2.7% of the subjects in the study group,
whereas it occurred in 4.7% of the participants in the control group (p=0.44). Bradycardia found in 28% of the
participants in study group and 3.3% of the control group (p<0.001). The low Apgar score was found in 2.7% of
case group however; no the low Apgar score detected in the control group. Meconium defecation observed in
11.3% of the subjects in the study group and 9.7% of the participants in control group (p=0.62).The amount of
stillbirth was 2.7% in the study group and no stillbirths were found in control group. There was a significant
difference between the results of both groups in terms of bradycardia, low Apgar score and cesarean section.
Conclusion: Results of this study revealed that participants in study group with nonreactive NST results had
more fetal complications than those with reactive NST results. NST was found to be a valuable diagnostic test
for diagnosis of fetal distress during delivery in the latent phase. These findings of this study suggest that NST
should be performed routinely as a valuable diagnostic test during the latent phase of delivery.
Keywords: neonatal outcomes, maternal outcomes, pregnant women, non-reactive NST, Reactive NST, non
stress test
1. Introduction
The maternal mortality rate has significantly reduced in developing countries. Thus, the focus has shifted toward
fetal health. The fetus is a second patient with a high risk of morbidity and mortality. Gestational ages between
37 and 42 weeks are defined as a term pregnancy. By using diagnostic tests, 56% of the stillbirths can be
preventable (Zuspan & Zuspan, 1994; Jams, Steer, Weiner, & Gonic, 2000). Non Stress test (NST) is one of the
177
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 7, No. 2; 2015
antepartum surveillance techniques that is used to evaluate the fetal wellbeing and to rule out fetal distress
(Hassanzadeh, 2004). The basis of NST is the increase of fetal heart rate in response to fetal movements. The rise
of at least 15 bpm lasting for 15 seconds or more, during a period of 20 minutes is the definition of fetal heart
rate increase (FHR). A sufficient number of fetal movements is one of the indicators of a healthy fetus
(Christopher, Harman, & Frank, 2000; Leng & Duff, 2001; Hasanpour et al., 2013). Normally, fetal movements
lead to an increase in FHR (Menihan & Kopel, 2007) and are directly related to the sympathetic and
parasympathetic autonomic nervous systems which do not exist before 26-27 weeks (Zuspan & Zuspan, 1994;
Jams et al., 2000). When FHR increases in response to fetal movements, the fetus is considered healthy (Gabbe,
Niebyl, & Simposn, 2000; Gilbert & Hamon, 2003). NST result is one of the determinant factors for health
providers to decide between waiting, performing further assessment or starting labor induction. Although NST is
known as a valuable diagnostic test and is used as a diagnostic test during third trimester of the pregnancy,
currently it is not performed routinely during labor. At that time both mother and the fetus need regular
assessments based on the different stages and their risk statuses. Although the midwife or the health care
provider has to take care of both mother and the baby, the fetus cannot be observed directly. General guidelines
for fetal assessments during labor include FHR and amniotic fluid assessments. Maternal assessments also are
related to the fetal wellbeing. General maternal assessments are vital signs, contractions, labor progression (using
vaginal examination), amount of intake and output and the mother’s response to labor. Although FHR response
to fetal movement is one of criteria of healthy fetus, assessment of FHR is not performed routinely during labor.
Labor includes three stages including: stage one or full cervical dilatation, stage two or infant delivery, and stage
three or passage of the placenta. Stage one consists of three phases of latent, active, and deceleration. The latent
phase is the initial phase of the labor during which contractions become regular and cervical dilatation reaches
3–4 cm. Many pregnant women arrive at hospitals during their first stage of labor. Midwives and nurse midwives
provide a fundamental role during labor while providing support during delivery processes, developing a
meaningful experience, rapid detection of the possible complications, and prevention of mortality and morbidity.
NST is one of the surveillance techniques that can avoid unnecessary interventions in childbirth and associated
complications for both mother and fetus. Guidelines for NST, ultrasound examination and Doppler examinations
are based on limited evidence (Tveit, Saastad, Stray-Pedersen, Børdahl, Flenady, Fretts, & Frøen, 2009; Olesen
& Svare, 2004; Frøen, Tveit, Saastad, Børdahl, Stray-Pedersen, & Heazell, 2008). Therefore, in order to show
the diagnostic value of NST during the latent phase of the labor and its role in diagnosis of fetal complications,
this study performed to test the association between NST results and maternal and neonatal outcomes in term
pregnant women referred to Alzahra hospital of Tabriz in 2013.
2. Materials and Methods
This descriptive study was performed from April to November 2013, in Al Zahra educational you said teaching
before hospital affiliated with Tabriz University of Medical Sciences. Data gathering tools included: A personal
and social demographic questionnaire, an obstetric checklist, and forms for NST reports. Information about the
study was given to the eligible participants and a written informed consent was obtained from each of them. The
study population included 450 pregnant women including 150 subjects in case group and 350 participants in
control group. The gestational ages of all of the subjects were between 38-42 weeks. All participants had been
referred to emergency department of Al Zahra educational hospital for termination of pregnancy due to natural
delivery timing. All participants underwent NST after being admitted to the labor department during their latent
phase of delivery. By considering ∝=5% and the power=80% and the Apgar score difference of 2 between two
groups, 150 subjects were estimated for each group. In order to increase the study accuracy, the control group
participants were doubled in size in comparison to the case group (300 subjects).
For this study, the following inclusion criteria for study group included; subjects who were willing to participate
in the study, singleton pregnancies, gestational ages between 38-42 weeks, normal FHR between 120 and 160
beats per minute, having no known systemic disease during or before pregnancy, not having pelvic diseases, non-
smoking and no alcohol consumption, having no history of previous Cesarean section, infant congenital anomaly
or stillbirth and having non-reactive results in NST (less than 2 increase in fetal heart rate during 20 min) and
being hospitalized because of natural delivery timing. Inclusion criteria for the control group only differed from
the study group in terms of reactive NST results.
The tools for data collection included a checklist which was devised based on the available information used in
previous research including: maternal demographic characteristics and midwifery specifications, NST results,
and maternal and fetal outcomes. The mothers’ personal and midwifery specifications in the checklist consisted
of age, education, income level, number of deceased and alive children, history of previous abortion, the first
date of last menstruation period (LMP), gestational age based on LMP, first trimester sonography, and NST
178
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 7, No. 2; 2015
reports.
Maternal and fetal outcomes which were evaluated in this study included: the Apgar score, neonatal
hospitalization status, duration of hospitalization in NICU, type of childbirth (Natural vaginal delivery or
Cesarean section), cause of Cesarean section (bradycardia, descent arrest, and/or meconium defecation).
The FHR monitoring device used in this research was manufactured by Japanese Toyota Company, model
MT325, which is one of the most prestigious companies producing medical equipment and as a result, has
scientific and practical validity and reliability. NST results and maternal and fetal outcomes were compared
between the study and control groups to determine the diagnostic value of the NST during latent phase of
delivery. Data were analyzed by SPSS 17 using Chi square test or Fisher’s exact test, Spearman’s correlation
coefficient, and Mann – Whitney U test. A logistic regression model was used in order to evaluate the predictor
variables with p-value equal to or less than 0.05 considered as statistically significant.
3. Results
In this study, the mean age for pregnant mothers was 26.47±5.55 years in the case group and 25.56±5.22 years in
the control group (p=0.09). The mean gestational age was 39.06±0.86 weeks in the case group and 38.90±1.14
weeks in the control group (p=0.093). In terms of the job, all participants were housewives. There was no
statistically significant difference between the two groups in terms of individual, social and midwifery
specifications.
From 150 participants in study group, 17 cases of meconium defecation were reported (11.3%) and 15 cases led
to Cesarean section. Out of 15 cesarean section deliveries, 4 infants were hospitalized in NICU. From 300
mothers in control group, there were 29 cases of meconium defecation (9.7%). 24 out of 29 cases with
meconium defecation underwent Cesarean section (p=0.62) from which 2 infants were transferred to the NICU.
There was no statistically significant difference between the two groups for meconium defecation. There was no
placenta abruption in the study group however 2 placenta abruption occurred in the control group (0.7%) and
both infants were treated in the NICU. There was no statistically significant difference between the two groups
for placenta abruption. There were 4 cases with descent arrest in the study group (2.7%) each of which led to
Cesarean section. There were 14 cases of descent arrest reported in the control group (4.7%) which ended with
Cesarean section (p=0.44).
Fetal bradycardia occurred in 42 subjects in the study group (28%) which led to Cesarean section in all of them
and from which 19 infants were hospitalized in NICU. Fetal bradycardia reported in 10 participants in the
control group (3.3%) which ended with Cesarean section in all of them and one infant was hospitalized in NICU.
There was a statistically significant difference for fetal bradycardia between two groups (p<0.001).
In the study group, 4 infants (2.7%) were born with low Apgar score (0-3 score), 2 (1.3%) infants with moderate
Apgar score (4-6 score), and 144 (96%) with high Apgar (7-10 score). There was no low Apgar score among
participants in the control group and only one infant was born with moderate Apgar score (0.3%) and the others
were born (99.7%) with high Apgar score. There was a statistically significant difference between two groups in
terms of the Apgar score. Overall, 24 infants (16%) were hospitalized in NICU in case group and 8 infants (2.7%)
were hospitalized in NICU in control group.
In terms of neonatal weight in case group, 100 infants were born with normal weight (66.7%), 49 infants with
moderate weight (32.7%), and one infant was born with low weight (0.7%). However; in the control group 265
infants were born with normal weight (88.3%), 34 infants with moderate weight (11.3%) and one infant was born
with low weight (0.3%). There was a statistically significant difference between two groups in terms of neonatal
weight.
In terms of mortality, 4 stillbirths occurred among subjects of the study group, whereas there was no stillbirth in
the participants of control group. Results of a logistic regression analysis showed that among the effective factors,
neonatal weight was just equally predictive in both groups. Table 1 depicts the distribution of fetal complications
among both groups. There were statistically significant differences between two groups for Bradycardia, first
minute Apgar score, delivery type and mortality rate. Table 2 shows the frequency distribution for types of
delivery between the study and the control groups. Cesarean section occurred in 42.7% of participants in study
group and in 17% of subjects in control group. In general, Cesarean section was performed in 25.6% of all
participants in both groups.
179
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 7, No. 2; 2015
Table 2. Frequency distribution for delivery types between the study and control groups
Types ofdelivery
Groups
NVD C/S Total
Study 86 (57.3%) 64 (42.7%) 150
Control 249 (83.0%) 51 (17.0%) 300
Total 335 (74.4%) 115 (25.6%) 450
4. Discussion
Healthcare providers apply screening strategies to diagnose high-risk situations in order to perform appropriate
interventions and obtain better outcomes. Although several techniques are used to monitor fetal well-being in
both low and high risk pregnancies such as NST, biophysical profile, etc., the most suitable time to apply these
techniques and their diagnostic value to detect fetal complications is controversial. Annually, 3.2 million
stillbirths occur. Early detection and timely management of maternal and fetal complications during pregnancy
and labor can reduce the rate of stillbirth and prevent maternal and fetal morbidity and mortality. During labor,
late detection of maternal and fetal complications such as placental dysfunction and its related hypoxia or poor
maternal and fetal tolerance of labor results in stillbirth, neonatal physical and developmental disabilities, and
maternal and neonatal mortality and morbidity (Haws, Yakoob, Soomro, Menezes, Darmstadt, & Bhutta, 2009).
Non stress test is one of the available non invasive screening techniques suggested for use in high risk
pregnancies during the prenatal period. In addition, NST is used as a screening tool for monitoring fetal
well-being via using the relationship between fetal movement and heart rate. Labor is the last stage of pregnancy
and it is important to assess feto-placental and utero placental efficient performance.
IN addition, NST is beneficial during the antenatal period, but it is not routinely used during labor or intrapartum
phases. During uterine contractions, the blood and oxygen flow decreases temporarily. Thus it is important to
assess fetal tolerance of this decrease. The reduction or loss of fetal movements is a warning sign for mothers
especially, when it is due to utero placental insufficiency. Several studies have been carried out in order to
evaluate maternal and neonatal outcomes related to fetal movement decrease (Kerner, Yogev, Belkin,
Ben-Haroush, Zeevi, & Hod, 2004; Malcus, 2004; Liston, Sawchuck, & Young, 2007). Non stress test (NST) is
one of the fundamental components of prenatal care. Studies have shown mothers with decreased fetal
movements (DFM) are at higher risk of stillbirth, fetal distress, preterm birth, and other related outcomes. Daily
fetal movement counting in the 9th month of pregnancy decreased perinatal mortality (Gurneesh & Ellora, 2009).
Similarly, in a study by Sidha and Singh (2008), in the absence of any other risk factors interfering in early
delivery, daily fetal movement counting was found to be useful in diagnosing at- risk fetuses in low risk
pregnancies (Sing & Sidhumk, 2008). This study showed that NST is a useful technique in recognizing high risk
fetuses during the latent phase of delivery. Although previous studies have shown the importance of performing
NST during prenatal period, the importance of NST during latent phase of labor has been neglected. Since there
is a high relationship between DFM and the fetal outcomes, proper and timely management should be planned
for any conditions associated with DFM (Frøen, Tveit, Saastad, Børdahl, Stray-Pedersen, Heazell, Flenady, Ruth,
& Fretts, 2008). It has been shown that improved DFM management along with uniform information to women
decrease stillbirths (Tveit, Saastad, Stray-Pedersen, Børdahl, Flenady, Fretts, & Frøen, 2009). Several case
control studies using daily count chart for fetal movements have shown significant differences between that first
minute Apgar score below 7, and mortality rate between case and control groups (Shanmugavel, Sodhi, Sandhu,
180
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 7, No. 2; 2015
Sidhu, Singh, Katariya, & Khandelwal, 2008). Similarly, in our study, significant differences were found
between two groups in terms of morality rate, and the first minute Apgar score below 7. In addition, this study
found a significant statistical differences for bradycardia, and delivery type between study and control groups
(p<0.001). According to results of this study, NST has a high diagnostic value in diagnosis of fetal distress. In
order to have an optimal management of labor, NST should be applied during latent phase of labor.
5. Conclusion
Results of this study revealed that participants in study group with non reactive NST results had more fetal
complications than those with reactive NST results in control group. Since results of current study revealed
significant differences between two groups in terms of the delivery type, descent arrest, bradycardia, first minute
Apgar score below 7, and mortality rate, this study suggests that NST as a valuable screening technique to be
used routinely as a diagnostic test during latent phase of labor. Further research is recommended to explore the
relationship between contraction stress test (CST) and fetal and maternal outcomes during the latent phase of
delivery. In addition, overall cesarean section rate was high and performed in 25.6% of all participants.
Acknowledgements
We gratefully acknowledge of the assistance Dr Carolyn S.Pierce; Associate Professor at Decker School of
Nursing Binghamton University for reviewing the article and also Dr Geraldine (Gerri), R.Britton; Assistant
Professor at Decker School of Nursing Binghamton University.
References
Christopher, R., Harman, S. M., & Frank, A. M. (2000). Assessing fetal health. In D. K. James, P. J. Steers, C. P.
Weinter, & B. Gonik, High Risk pregnancy (p. 253). Philadelphia: W.B Saunders Company.
Frøen, J. F., Tveit, J. V., Saastad, E., Børdahl, P., Stray-Pedersen, B., & Heazell, A. E. (2008). Management of
decreased fetal movements. Seminars in Perinatology, 32, 307-311.
http://dx.doi.org/10.1053/j.semperi.2008.04.015
Gabbe, G.S., Niebyl, R. J., & Simposn, J. (2000). Obstetrics normal and problem pregnancies (4th ed., pp.
33-324). Saunders.
Gilbert, E., & Hamon, J. (2003). Manual of high risk pregnancy and delivery (pp. 605-620). Saint Louis: Mosby.
Gurneesh, S., & Ellora, D. (2009). DFMC Chart: An inexpensive way of assessing fetal well being at home. J
Obstet Gynecol India, 59(3), 217-219.
Hasanpour, S., Raouf, S., Shamsalizadeh, N., Bani, S., Ghojazadeh, M., & Sheikhan, F. (2013). Evaluation of the
effects of acoustic stimulation and feeding mother stimulation on non-reactive non-stress test: A randomized
clinical trial. Arch Gynecol Obstet, 287(6), 1105-1110. http://dx.doi.org/10.1007/s00404-012-2695-6
Hassanzadeh, M. (2004). The survey of relationship between maternal position and non – stress test results in
pregnant mothers hospitalized in Alzahra health center of Tabriz (MSC thesis of midwifery, pp. 6-10).
Nursing and Faculty of Tabriz university of Medical Sciences.
Haws, R. A., Yakoob, M. Y., Soomro, T., Menezes, E. V., Darmstadt, G. L., & Bhutta, Z. A. (2009). Reducing
stillbirths: screening and monitoring during pregnancy and labour. BMC Pregnancy Childbirth, 7(9), 1-3.
http://dx.doi.org/10.1186/1471-2393-9-S1-S5
Jams, D. K., Steer, P. J., Weiner, C. P., & Gonic, B. (2000). High risk pregnancy (pp. 11-12). Philadelphia: WB
Saunders Company.
Kerner, R., Yogev, Y., Belkin, A., Ben-Haroush, A., Zeevi, B., & Hod, M. (2004). Maternal self-administered
fetal heart rate monitoring and transmission from home in high-risk pregnancies. Int J Gynaecol Obstet,
84(1), 33-39. http://dx.doi.org/10.1016/S0020-7292(03)00331-X
Leng, F., & Duff, P. (2001). Obsterrics & Gynecology (pp. 9-46).
Liston, R., Sawchuck, D., Young, D., Society of Obstetrics and Gynaecologists of Canada., British Columbia
Perinatal Health Program. (2007). Fetal health surveillance: antepartum and intrapartum consensus
guideline. J Obstet Gynaecol Can, 29(9 Suppl 4), S3-56.
Malcus, P. (2004). Antenatal fetal surveillance. Curr Opin Obstet Gynecol, 16(2), 123-128.
http://dx.doi.org/10.1097/00001703-200404000-00005
Menihan, C. A., & Kopel, E. (2007). Electronic fetal monitoring: Concepts and applications (65-68).
Philadelphia: Lippincott Williams & Wilkins.
181
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 7, No. 2; 2015
Olesen, A. G., & Svare, J. A. (2004). Decreased fetal movements: Background, assessment, and clinical
management. Acta Obstet Gynecol Scand, 83, 818-826. http://dx.doi.org/10.1080/j.0001-6349.2004.00603.x
Shanmugavel, C., Sodhi, K. S., Sandhu, M. S., Sidhu, R., Singh, S., Katariya, S., & Khandelwal, N. (2008). Role
of power Doppler sonography in evaluation of therapeutic response of the knee in juvenile rheumatoid
arthritis. Rheumatol. 28(6), 573-578. http://dx.doi.org/10.1007/s00296-007-0482-7
Sing, G., SIDHUMK no capitals, L.T.S. (2008). Daily Fetal Movement Count Chart: Reducing Perinatal
Mortality in Low Risk Pregnancy. MJAFI. 64, 212-213.
Tveit, J. V. H., Saastad, E., Stray-Pedersen, B., Børdahl, P., Flenady, V., Fretts, R., & Frøen, J. F. (2009).
Reduction of late stillbirth with the introduction of fetal movement information and guidelines – a clinical
quality improvement. BMC Pregnancy & Childbirth, 9, 32. http://dx.doi.org/10.1186/1471-2393-9-32
Zuspan, F. P., & Zuspan, E. J. (1994). Current therapy in obstetrics and gynecology (p. 287). Philadelphia:
Saunders.
Copyrights
Copyright for this article is retained by the author(s), with first publication rights granted to the journal.
This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution
license (http://creativecommons.org/licenses/by/3.0/).
182
Nilai Diagnostik Non StressTest dalam Fase Laten Persalinan dan Hasilnya pada
Ibu dan Janin
Abstrak
Tujuan: Non Stres Test (NST) adalah salah satu tes diagnostik signifikan untuk
melihat kesejahteraan janin. Tujuan dari penelitian ini adalah untuk melihat nilai
diagnostik NST selama fase laten persalinan dengan mempertimbangkan hasil ibu
dan bayi baru lahir.
Subjek: Studi kontrol kasus ini dilakukan pada 450 wanita hamil sehat dengan
usia kehamilan antara 38-42 minggu di rumah sakit pendidikan AL-Zahra di
Tabriz, Iran. Semua peserta menjalani NST ketika dirawat di rumah sakit selama
fase laten pengiriman mereka. Peserta dibagi menjadi dua kelompok termasuk
kelompok studi yang termasuk 150 peserta dengan hasil NST non-reaktif
sedangkan 300 subyek dalam kelompok kontrol dengan hasil NST reaktif. Subjek
di kedua kelompok dirawat di rumah sakit untuk terminasi sesuai waktu
persalinan. Untuk mengetahui pentingnya kinerja rutin NST selama persalinan, Di
evaluasi hubungan antara hasil NST dan hasil ibu dan janin. Beberapa kriteria
termasuk jenis persalinan, hasil mekonium, kesulitan persalinan, bradikardia, skor
Apgar, dan kelahiran mati dibandingkan antara dua kelompok.
Hasil: Temuan dari penelitian ini menunjukkan bahwa kesulitan persalinan terjadi
pada 2,7% dari subyek dalam kelompok studi, sedangkan itu terjadi pada 4,7%
dari peserta dalam kelompok kontrol (p = 0,44). Bradikardia ditemukan pada 28%
dari peserta dalam kelompok studi dan 3,3% dari kelompok kontrol (p <0,001).
Skor Apgar yang rendah ditemukan pada 2,7% dari kelompok kasus; tidak ada
skor Apgar rendah yang terdeteksi pada kelompok kontrol. Pengeluaran
mekonium diamati pada 11,3% dari subyek dalam kelompok studi dan 9,7% dari
peserta dalam kelompok kontrol (p = 0,62). Jumlah kelahiran mati adalah 2,7%
pada kelompok studi dan tidak ada kelahiran mati yang ditemukan pada kelompok
kontrol. Ada perbedaan yang signifikan antara hasil kedua kelompok dalam hal
bradikardia, skor Apgar rendah dan operasi caesar.
Kesimpulan: Hasil penelitian ini mengungkapkan bahwa peserta dalam kelompok
studi dengan hasil NST non-reaktif memiliki lebih banyak komplikasi janin dari
pada mereka yang hasil NST reaktif. NST ditemukan sebagai tes diagnostik yang
berharga untuk diagnosis gawat janin selama persalinan dalam fase laten. Temuan
penelitian ini menunjukkan bahwa NST harus dilakukan secara rutin sebagai tes
diagnostik yang berharga selama fase laten pengiriman.
Kata kunci: hasil neonatal, hasil ibu, wanita hamil, NST non-reaktif, NST reaktif,
tes non stres’
1. Pendahuluan
3. Hasil
Dalam penelitian ini, usia rata-rata untuk ibu hamil adalah 26,47 ± 5,55
tahun pada kelompok kasus dan 25,56 ± 5,22 tahun pada kelompok kontrol (p =
0,09). Usia kehamilan rata-rata adalah 39,06 ± 0,86 minggu pada kelompok kasus
dan 38,90 ± 1,14 minggu pada kelompok kontrol (p = 0,093). Dalam hal
pekerjaan, semua peserta adalah ibu rumah tangga. Tidak ada perbedaan yang
signifikan secara statistik antara kedua kelompok dalam hal spesifikasi individu,
sosial dan kebidanan.
Dari 150 peserta dalam kelompok studi, 17 kasus defekasi mekonium
dilaporkan (11,3%) dan 15 kasus mengarah ke operasi sesar. Dari 15 kelahiran
sesar, 4 bayi dirawat di rumah sakit di NICU. Dari 300 ibu dalam kelompok
kontrol, ada 29 kasus defekasi mekonium (9,7%). 24 dari 29 kasus dengan
defekasi mekonium menjalani operasi caesar (p = 0,62) dan 2 bayi dipindahkan ke
NICU. Tidak ada perbedaan yang signifikan secara statistik antara kedua
kelompok untuk defekasi mekonium. Tidak ada solusio plasenta pada kelompok
studi namun 2 solusio plasenta terjadi pada kelompok kontrol (0,7%) dan kedua
bayi dirawat di NICU. Tidak ada perbedaan yang signifikan secara statistik antara
kedua kelompok untuk solusio plasenta. Ada 4 kasus dengan kesulitan persalinan
pada kelompok studi (2,7%) yang masing-masing mengarah ke operasi sesar. Ada
14 kasus penyulit persalinan yang dilaporkan pada kelompok kontrol (4,7%) yang
berakhir dengan operasi sesar (p = 0,44).
Bradikardia janin terjadi pada 42 subjek dalam kelompok studi (28%)
yang menyebabkan seksio sesarea pada mereka semua dan 19 bayi dirawat di
NICU. Bradikardia janin dilaporkan pada 10 peserta dalam kelompok kontrol
(3,3%) yang berakhir dengan operasi sesar pada mereka semua dan satu bayi
dirawat di rumah sakit di NICU. Ada perbedaan yang signifikan secara statistik
untuk bradikardia janin antara dua kelompok (p <0,001). Dalam kelompok studi, 4
bayi (2,7%) dilahirkan dengan skor Apgar rendah (skor 0-3), 2 bayi (1,3%)
dengan skor Apgar sedang (skor 4-6), dan 144 (96%) dengan Apgar tinggi (Skor
7-10). Tidak ada skor Apgar yang rendah di antara peserta dalam kelompok
kontrol dan hanya satu bayi yang lahir dengan skor Apgar sedang (0,3%) dan
yang lainnya lahir (99,7%) dengan skor Apgar yang tinggi. Ada perbedaan yang
signifikan secara statistik antara dua kelompok dalam hal skor Apgar. Secara
keseluruhan, 24 bayi (16%) dirawat di rumah sakit di NICU dalam kelompok
kasus dan 8 bayi (2,7%) dirawat di rumah sakit di NICU dalam kelompok kontrol.
Dalam hal berat neonatal pada kelompok kasus, 100 bayi dilahirkan
dengan berat normal (66,7%), 49 bayi dengan berat sedang (32,7%), dan satu bayi
lahir dengan berat rendah (0,7%). Namun, pada kelompok kontrol 265 bayi
dilahirkan dengan berat badan normal (88,3%), 34 bayi dengan berat badan
sedang (11,3%) dan satu bayi lahir dengan berat badan rendah (0,3%). Ada
perbedaan yang signifikan secara statistik antara dua kelompok dalam hal berat
neonatal.
Dalam hal kematian, 4 kelahiran mati terjadi di antara subyek dari
kelompok studi, sedangkan tidak ada kelahiran mati pada peserta kelompok
kontrol. Hasil analisis regresi logistik menunjukkan bahwa di antara faktor-faktor
yang efektif, berat neonatal sama-sama prediktif pada kedua kelompok. Tabel 1
menggambarkan distribusi komplikasi janin di antara kedua kelompok. Ada
perbedaan yang signifikan secara statistik antara dua kelompok untuk Bradikardi,
skor Apgar menit pertama, jenis persalinan dan tingkat kematian. Tabel 2
menunjukkan distribusi frekuensi untuk jenis persalinan antara penelitian dan
kelompok kontrol. Seksio sesaria terjadi pada 42,7% partisipan dalam kelompok
studi dan 17% subyek pada kelompok kontrol. Secara umum, operasi sesar
dilakukan pada 25,6% dari semua peserta di kedua kelompok.
Tabel 2. Distribusi frekuensi untuk jenis persalianan antara kelompok studi dan
kelompok kontrol
Grup Tipe persalinan
NVD C/S Total
Studi 86 ( 57.3 %) 64 (42.7 %) 150
Control 249 (83.0 % 51 (17.0 %) 300
Total 335 (74.4 ) 115 (25.6 %) 450
4. Diskusi
Penyedia layanan kesehatan menerapkan strategi skrining untuk
mendiagnosis keadaan berisiko tinggi agar melakukan intervensi yang sesuai
sehingga memperoleh hasil yang lebih baik. Meskipun beberapa teknik digunakan
untuk memantau kesejahteraan janin baik kehamilan berisiko rendah dan tinggi
seperti NST, profil biofisik, dan lain-lain, waktu yang paling tepat untuk
menerapkannya serta teknik dan nilai diagnostiknya untuk mendeteksi komplikasi
janin masih kontroversial. Setiap tahun, 3,2 juta lahir mati terjadi. Deteksi dini
dan manajemen komplikasi ibu dan janin yang tepat waktu selama kehamilan dan
persalinan dapat mengurangi angka kelahiran mati dan mencegah morbiditas dan
mortalitas ibu dan janin. Selama persalinan, deteksi yang terlambat, komplikasi
ibu dan janin seperti disfungsi plasenta dan hipoksia terkait atau toleransi buruk
ibu dan janin terhadap persalinan menyebabkan lahir mati, cacat fisik dan
perkembangan neonatal, dan angka kematian dan kesakitan ibu dan bayi baru lahir
(Haws, Yakoob, Soomro, Menezes, Darmstadt, & Bhutta, 2009).
Tes non stres adalah salah satu teknik skrining non invasif yang tersedia
yang disarankan untuk digunakan dalam risiko tinggi kehamilan selama periode
prenatal. Selain itu, NST digunakan sebagai alat skrining untuk memantau
kesejahteraan janin dengan menilai hubungan antara gerakan janin dan detak
jantung. Persalinan adalah tahap terakhir kehamilan dan penting untuk menilai
kinerja efisien feto-plasenta dan uterus. Selain itu, NST bermanfaat selama
periode antenatal, tetapi tidak secara rutin digunakan selama persalinan atau fase
intrapartum. Selama kontraksi uterus, aliran darah dan oksigen menurun
sementara. Karena itu penting untuk nilai toleransi janin dari penurunan ini.
Pengurangan atau kehilangan gerakan janin adalah tanda peringatan bagi ibu
terutama, ketika itu disebabkan oleh insufisiensi utero plasenta. Beberapa
penelitian telah dilakukan untuk mengevaluasi hasil ibu dan bayi terkait dengan
penurunan gerakan janin (Kerner, Yogev, Belkin, Ben-Haroush, Zeevi, & Hod,
2004; Malcus, 2004; Liston, Sawchuck, & Young, 2007). Non stress test (NST)
adalah salah satu komponen dasar perawatan kehamilan. Penelitian telah
menunjukkan ibu dengan penurunan janin.
Gerakan janin menurun (DFM) berisiko lebih tinggi untuk lahir mati,
gawat janin, kelahiran prematur, dan hasil terkait lainnya. Harian penghitungan
pergerakan janin pada bulan ke-9 kehamilan menurunkan angka kematian
perinatal (Gurneesh & Ellora, 2009). Demikian pula, dalam sebuah studi oleh
Sidha dan Singh (2008), dengan tidak adanya faktor risiko lain yang mengganggu
di awal persalinan, penghitungan pergerakan janin harian ditemukan bermanfaat
dalam mendiagnosis janin berisiko yang berisiko rendah kehamilan (Sing &
Sidhumk, 2008). Studi ini menunjukkan bahwa NST adalah teknik yang berguna
dalam mengenali risiko tinggi janin selama fase laten persalinan. Meskipun
penelitian sebelumnya telah menunjukkan pentingnya melakukan NST selama
periode prenatal, pentingnya NST selama fase laten persalinan telah diabaikan.
Sejak disana adalah hubungan yang tinggi antara DFM dan hasil janin,
manajemen yang cepat dan tepat waktu harus direncanakan untuk setiap kondisi
yang terkait dengan DFM (Froen, Tveit, Saastad, Bordahl, Stray-Pedersen,
Heazell, Flenady, Ruth, & Fretts, 2008). Telah terbukti bahwa manajemen DFM
ditingkatkan bersama dengan informasi serupa, untuk wanita mengurangi
kelahiran mati (Tveit, Saastad, Stray-Pedersen, Børdahl, Flenady, Fretts, & Frøen,
2009). Beberapa kasus studi kontrol menggunakan grafik jumlah harian untuk
pergerakan janin telah menunjukkan perbedaan yang signifikan antara yang
pertama skor Apgar menit pertama di bawah 7, dan tingkat kematian antara
kelompok kasus dan kelompok kontrol (Shanmugavel, Sodhi, Sandhu, Sidhu,
Singh, Katariya, & Khandelwal, 2008). Demikian pula, dalam penelitian kami,
perbedaan signifikan ditemukan antara dua kelompok dalam hal tingkat moralitas,
dan skor Apgar menit pertama di bawah 7. Selain itu, penelitian ini menemukan
perbedaan statistik yang signifikan untuk bradikardia, dan jenis persalinan antara
studi dan kelompok control (p <0,001). Menurut hasil penelitian ini, NST
memiliki nilai diagnostik yang tinggi dalam diagnosis gawat janin. Agar memiliki
manajemen persalinan yang optimal, NST harus diterapkan selama fase laten
persalinan.
5. Kesimpulan
Hasil penelitian ini mengungkapkan bahwa peserta dalam kelompok
studi dengan hasil NST non reaktif memiliki lebih banyak komplikasi pada janin
dari pada mereka yang hasil NST reaktif pada kelompok kontrol. Karena hasil
penelitian saat ini terungkap perbedaan yang signifikan antara dua kelompok
dalam hal persalinan, penyulit persalinan, bradikardi, menit pertama Skor Apgar
di bawah 7, dan tingkat kematian, penelitian ini menunjukkan bahwa NST sebagai
teknik skrining yang berharga yang digunakan secara rutin sebagai tes diagnostik
selama fase laten persalinan. Penelitian lebih lanjut direkomendasikan untuk
mengeksplorasi hubungan antara uji kontraksi stres (CST) dan hasil janin dan ibu
selama fase laten pengiriman. Selain itu, tingkat operasi sesar secara keseluruhan
tinggi dan dilakukan pada 25,6% dari semua peserta.
Journal Reading
Nilai Diagnostik Non StressTest dalam Fase Laten Persalinan dan Hasilnya pada Ibu dan Janin
September 2019
Novianti Alfina
2018-84-071
Pembimbing:
dr. Zulaiha Maricar, Sp. OG
Hassanzadeh, 2004).
• Tes Non Stres (NST) adalah salah satu teknik pengawasan antepartum yang
digunakan untuk mengevaluasi kesejahteraan janin dan untuk mengantisipasi
gawat janin
Rumah sakit
pendidikan Al 38-42 minggu
Zahra
Kuesioner demografi
pribadi dan sosial,
daftar pemeriksaan,
dan formulir untuk
laporan NST
Kriteria inklusi
Kelompok studi Kelompok kontrol
subyek yang bersedia berpartisipasi dalam Kriteria inklusi untuk kelompok kontrol hanya
penelitian kehamilan tunggal berbeda dari kelompok studi dalam hal hasil
usia kehamilan antara 38-42 minggu NST reaktif.
FHR normal antara 120 dan 160 denyut
per menit
tidak memiliki penyakit sistemik yang
diketahui selama atau sebelum kehamilan
tidak memiliki penyakit panggul
tidak merokok dan tidak ada konsumsi
alkohol
tidak memiliki riwayat operasi sesar
sebelumnya
anomali kongenital bayi atau lahir mati dan
memiliki hasil non-reaktif pada NST (kurang
dari 2 peningkatan denyut jantung janin
selama 20 menit) dan dirawat di rumah
sakit karena waktu persalinan.
Karakteristik demografi ibu dan spesifikasi kebidanan, hasil NST, dan hasil
ibu dan janin
Perangkat pemantauan FHR yang digunakan dalam penelitian ini
diproduksi oleh Perusahaan Toyota Jepang, model MT325
Data dianalisis dengan SPSS 17 menggunakan uji Chi square atau uji
Fisher, koefisien korelasi Spearman, dan uji Mann-Whitney U
Nilai p yang sama dengan atau kurang dari 0,05 dianggap signifikan
secara statistik.
HASIL