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RASIO ESTRIOL/ ESTRADIOL TINGGI SEBAGAI PREDIKTOR KEBERHASILAN INDUKSI PERSALINAN PADA KEHAMILAN LEWAT WAKTU Muhammad Nur Adintyo Rahman1, Shinta Prawitasari2, Heru Pradjatmo3 ABSTRACT Background : Induction of labor is a common procedure performed at 15-20 % of pregnancies. The most common indication was prolonged pregnancy (70 %). The past decade labor induction rate was increased 2-fold as well as the risk of cesarean section. Difficulties to predict the success of induction made predictors of success of induction widely studied. Predictors can be physical or chemical markers. One of the chemical marker 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 labor in prolonged pregnancy. Method : The design of study are Prospective Cohort. Study two hospitals (Wonosobo District Hospital and 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 and estradiol the induction which end in vaginal delivery were noted as succesull induction Receiver Operating Characteristic (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 to determine the correlation between variables. Results and Discussion : This study obtained 76 samples, 69 with successful induction and 7 failed of induction. 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 showed that 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 group were higher (≥ 35) compared with induction failure group (<35). Keywords : prolonged pregnancy, labor induction , estriol/ estradiol ratio, predictors ABSTRAK Latar Belakang : Induksi persalinan adalah prosedur umum yang dilakukan pada 15-20% kehamilan. Indikasi tersering adalah kehamilan lewat waktu (70%). Satu dekade terakhir angka induksi persalinan telah 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 kimia adalah rasio kadar estriol terhadap estradiol. Tujuan : Mengetahui nilai rasio kadar estriol estradiol untuk memprediksi keberhasilan induksi pada kehamilan lewat waktu Metode : Kohort prospektif. Dua rumah sakit (RSUD Wonosobo dan RSUD Banjarnegara) dipakai dalam penelitian ini dari 10 September 2013 sampai 31 Desember 2013. Subyek yang memenuhi kriteria inklusi dan eksklusi diambil sampel darah sebanyak 5 ml sebelum Induksi untuk diperiksa kadar estriol dan estradiol kemudian dilihat keberhasilan induksinya. Analisis yang digunakan adalah metode Receiver Operating 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 mengetahui hubungan antar variabel. Hasil dan Pembahasan : Selama waktu penelitian didapatkan 76 sampel, 69 dengan induksi berhasil dan 7 gagal induksi. Dengan cut off point 35, nilai sensitivitasnya 71%, nilai Spesifitas 71%, nilai ramal positif 49%, nilai ramal negatif 55,6%. Nilai Area Under Curve sebesar 80.7%. Likelihood ratio positive 1,06 dan likelihood ratio negative 0,88. Hasil analisis multivariat menunjukkan bahwa Rasio estriol/ estradiol ≥ 35 berhubungan dengan keberhasilan induksi secara signifikan (RO 9.598; IK 95% 1.378-66.859) Skor Bishop juga 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 induksi Kata kunci : Kehamilan lewat waktu, induksi persalinan, rasio estriol/ estradiol, prediktor 1,2,3 Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Gadjah Mada Yogyakarta