Determinants of Low Apgar Score Among Preeclamptic Deliveries in Cipto Mangunkusumo Hospital...

7/25/2019 Determinants of Low Apgar Score Among Preeclamptic Deliveries in Cipto Mangunkusumo Hospital (Jurnal)

1/14

1. Title : DETERMINANTS OF LOW APGAR SCORE AMONG

PREECLAMPTIC DELIVERIES IN CIPTO MANGUNKUSUMO

HOSPITAL

2. Author(s): 1. Sulaeman Andrianto Susilo

2. Karina Niken Pratiwi

3. Adly Nanda Al Fattah

. !ima "rwinda

#. Noroyono $i%owo

3. A&&iliation(s)(ea'h author) : Department of Obstetrics & Gynecology,

Faculty of Medicine Universitas Indonesia

. is'laimer (i& any) :

#. on&li't o& interest :

*. !unnin+ title :,. orres-ondin+ author:

Name : !ima "rwinda

Full address :

PhoneFa/ num%ers :

0mail address :

. Sour'e(s) o& su--ort (i& any) :

. Num%er o& &i+ures :

14. Num%er o& ta%les : #

11. Syno-sis : 5euko'ytosis6 early onset -ree'lam-sia6

-reterm %irth6 and throm%o'yto-enia6 se7erity o& -ree'lam-sia6 and 8055P

syndrome are inde-endent risks o& ha7in+ in&ant %orn with 1st minute low

AP9A!s'ore in -ree'lam-ti' deli7eries.


2/14

1. Title o& the arti'le : DETERMINANTS OF LOW APGAR SCORE

AMONG PREECLAMPTIC DELIVERIES IN CIPTO

MANGUNKUSUMO HOSPITAL

2. A%stra't

3. Backgr!"# $ Pree'lam-sia is one o& the 'ommon 'ondition o&

unknown etiolo+y whi'h in'rease the risk o& maternal and -erinatal mor%idity

and mortality. Pree'lam-sia has +reat im-li'ation on ad7erse neonatal

out'ome. AP9A! s'ore (at 1 minute or # minutes) is one o& the indi'ators o&

-hysiolo+i' maturity o& the in&ant. There&ore6 we aim to see the 'orrelation o&

AP9A!s'ore in -ree'lam-ti' deli7eries.

%. M&'(#) $ ata were 'olle'ted durin+ anuary to e'em%er 2413

with all -ree'lam-ti' women with sin+leton li7e -re+nan'ies who deli7ered

their %a%ies in i-to ;an+unkusumo 8os-ital. The -rimary out'ome was

AP9A!s'ore. A+e o& +estation6 maternal a+e6 "


3/14

1. Title o& the arti'le : DETERMINANTS OF LOW APGAR SCORE

AMONG PREECLAMPTIC DELIVERIES IN CIPTO

MANGUNKUSUMO HOSPITAL

2. A%stra't

3. La'ar B&+aka"g $ Preeklamsia adalah suatu kondisi yan+ umum dari

-enye%a% yan+ tidak diketahui yan+ men+aki%atkan -enin+katan risiko i%u

dan mor%iditas dan mortalitas %ayi. Preeklam-sia %erkim-likasi %esar -ada

luaran neonatus. Skor AP9A! (1 menit atau # menit) adalah salah satu

indikator kematan+an &isiolo+is anak. oleh karena itu6 kami %ertuuan untuk

men'ari hu%un+an skor AP9A! -ada -ersalinan den+an -reeklam-sia.

%. M&'#& $ ata dida-atkan -ada %ulan anuari sam-ai esem%er

tahun 2413 den+an seluruh wanita -reeklamsia lahir tun++al yan+ melahirkan

di !S i-to ;an+unkusumo. 8asil luaran %eru-a skor AP9A!6 usia +estasi6

usia i%u6 "inari lo+istik di+unakan dalam analisis multi7ariatuntuk men'ari korelasi antara &aktor inde-enden den+an skor AP9A! se%a+ai

luaran.

*. R&)!+' $ ari #4 wanita den+an -reeklam-sia6 se%anyak *

memnuhi kriteria inklusi. Skor AP9A! 1 menit dan * menit se%anyak 1@

(**) dan#.@ (2*)dari neonatus. "ayi %aru lahir


4/14

1. I"'r#!c'-"

Pree'lam-sia is one o& the 'ommon 'onditions o& unknown etiolo+y whi'h

in'rease the risk o& maternal and -erinatal mor%idity and mortality. 1The e/a't

etiolo+y o& -ree'lam-sia remains unknown6 &a'tors that are 'urrently morea''e-ted in'lude a%normal tro-ho%last in7asion o& uterine %lood 7essels6 in'reased

7aso-ressor res-onse and 7asos-asm6 immunolo+i'al intoleran'e to the &etus and

+eneti' a%normalities.2 Pree'lam-sia a&&e'ts 3 E #@ o& -re+nan'ies6 it is an

im-ortant &a'tor in &etal +rowth restri'tion as it is 'ommonly asso'iated with

-la'ental insu&&i'ien'y.3Pree'lam-sia has +reat im-li'ation on ad7erse neonatal

out'ome. The 7arious 'om-li'ation seen are low AP9A! s'ore6 "ntra


5/14

2. M&'(#)

This retros-e'ti7e 'ohort study was -er&ormed %etween anuary to e'em%er

2413 with all -ree'lam-ti' women with sin+leton li7e -re+nan'ies who deli7ered

their %a%ies in i-to ;an+unkusumo 8os-ital. The study -o-ulation 'onsisted o&* -ree'lam-ti' women. Primary out'ome measure was mor%idity o& the in&ant

as in AP9A!s'ore at 1st and #th minute that esta%lished %y -erinatolo+y residents6

we di7ided +rou- o& low AP9A! s'ore I, and normal AP9A! s'ore J,. $e

o%tained data &rom the data%ase6 whi'h in'lude a+e o& +estation6 maternal a+e6

"inary lo+isti' was used as multi7ariate analysis to see the 'orrelation %etween

A+e o& +estation6 maternal a+e6 "


6/14

3. R&)!+')

There were 213 deli7eries re+istered in our data%ase &or o7er a year. #4 women

were dia+nosed as -ree'lam-sia and only * women met the in'lusion 'riteria

and ha7e 'om-lete data. The distri%ution o& 'hara'teristi's and the risk &a'tors o&

low AP9A!s'ore amon+ our su%e'ts shown in Ta%le 1.Var-a+&) N. 4N5 %%,6

Ma'&r"a+ ag& 4/r6

5ow !isk (I3#)

8i+h !isk (MJ3#)

Par-'/

Nulli-ara

;ulti-ara

WGA 40&&k)6

Aterm

Preterm

B-r'(0&-g(' 4gra)6S/)'+-c BP 4Hg6

D-a)'+-c BP 4Hg6

M&a" Ar'&r-a+ Pr&))!r& 4Hg6

P+a'&+&'c!"' 47189:L 6

H&g+-" +&;&+ 4g:#+6

L&!kc/'& +&;&+ 4C 143D5 6

H&a'cr-' 4


7/14

Ta%le 2. om-arison %etween 5ow AP9A!S'ore and Normal AP9A!S'ore at 1

minute +rou- %ased on o%stetri'al 'hra'ateristi's

hiVar-a+&) L0 APGAR

Scr& 4"5@,6

Nra+

APGAR

Scr&

4"53,86

P O## Ra'-

Ma'&r"a+ Ag&

Produ'ti7e

Non-rodu'ti7e

W&&k G&)'a'-"

Aterm

Preterm

P+a'&+&'

B1#4/145

I1#4/145A"&-a

No

es

H&a'cr/'&

B 3.#

I 3.#

L&!kc/'&

B 1# C 143D5

I 1# C 14

3

D5ANC

es

No

O")&'

0arlyonset

5ateonset

IUGR

es

No

MAP

I13#

B13#

S&;&r-'/

;ild -ree'lam-siaa

Se7ere -re

e'lam-sia%

Su-erim-osed'

8055P Syndrome

# (*.*@)

2, (31.@)

1, (1.@)

* (4.2@)

*# (,#.*@)

21 (2.@)

,4 (1.@)

1* (1.*@)

4 (*.#@)

* (#3.#@)

(#,@)

3, (3@)

* (,.1@)

1 (24.@)

## (*@)

31 (3*@)

12 (1@)

, (*@)

# (*.*@)

2, (31.@)

22 (*3.@)

131 (3*.2@)

2#1 (*.,@)

14 (34.3@)

32 (#@)

1 (#@)

22 (,.3@)

, (21.,@)

111 (34.@)

2 (*.2@)

12# (3.,@)

23# (*#.3@)

23 (1.@)

*, (1.*@)

(12.2@)

31* (,.@)

1, (.,@)

33 (#.3@)

344 (3.3@)

*4 (1*.,@)

4.41

I4.441

I4.441

4.#32

4.44*

I4.441

4.*23

I4.441

4.442

4.442

I4.441

1.2 (4.,#

2.4#)

4.11 (4.4* E

4.1)

*.1 (3.14 E

12.1#)

1.21 (4.*, E

2.24)

1.# (1.24 E

3.1#)

4.4 (4.2# E

4.*#)

4.* (4. E

1.##)

12., (,.1 E

21.4)

3.2, (1.#4 E

,.1)

4. (4.2* E

4.,#)

2.44 (1.3 E

2.1)


8/14

S=uare6 a-I4.4#L a6 %6 ' are &used in analysis

Ta%le 2 shows the 'om-arison o& 5ow AP9A!S'ore and Normal S'ore in 1

minute with 'on&oundin+ &a'tors o& -ree'lam-sia. $e &ound that $9A6-latelet6

hemato'rit6 leuko'yte6 onset o& -ree'lam-sia6 "


9/14

Ta%le 3. om-arison o& %etween 5ow AP9A!S'ore and Normal AP9A!S'ore

at # minutes +rou- %ased on o%stetri'al 'hara'teristi's

hi

S=uare6 a-I4.4#

Var-a+&) L0

APGAR

Scr&4"52%6

Nra+

APGAR

Scr&4"5%226

P O##

Ra'-

Ma'&r"a+ Ag&

5ow !isk

8i+h !isk

W&&k G&)'a'-"

Aterm

Preterm

P+a'&+&'

B1#4/145

I1#4/145

A"&-a

No

es

H&a'cr-'

B 3.#

I 3.#

L&!kc/'&

B 1# C 143D5

I 1# C 143

D5ANC

es

No

O")&'

0arlyonset

5ateonset

IUGR

es

No

MAP

I13#

B13#

S&;&r-'/

;ild -ree'lam-siaa

Se7ere -ree'lam-sia%

Su-erim-osed'

8055P Syndrome

1* (**.,@)

(33.3@)

(1*.,@)

24 (3.3@)

1* (**.,@)

(33.3@)

24 (,@)

3 (13@)

14 (1.,@)

1 (#.3@)

13 (#.2@)

11 (#.@)

24 (3.3@)

(1*.,@)

1, (,4.@)

, (2.2@)

# (24.@)

1 (,.2@)

1 (,#@)

* (2#@)

2,3 (*.*@)

1 (3#.@)

2* (*2.*@)

1# (3,.@)

31 (2.,@)

31 (,.3@)

3, (*.3@)

## (13.,@)

11 (33.@)

21 (**.*@)

1*1 (3.2@)

2*1 (*1.@)

31 (4.@)

1 (1.2@)

2 (1.@)

34 (4.*@)

2 (#.,@)

3 (.3@)

31 (4.@)

1 (1.2@)

4.3,

I4.441

I4.441

4.31

4.4*

4.11

4.,#

I4.441

4.443

4.#

I4.441

1.14

(4.*

2.*2)

4.12 (4.4

E 4.3*)

*.31 (2.#4

E 1#.)

4.# (4.2,

E 3.2)

1.2 (4.*2

E 3.2)

4.#2 (4.23E 1.1)

1.1 (4.4

E 3.#,)

4.14 (4.4

E 4.2#)

.3* (1.#4

E 12.,4)

4.,1 (4.2,

E 1.#)

1.2* (1.4*

E 1.#1)


10/14

Ta%le 3 shows the 'om-arison o& 5ow AP9A!S'ore and Normal S'ore in # minutes

with 'on&oundin+ &a'tors o& -ree'lam-sia. $e &ound that $9A6 -latelet6 onset and

se7erity o& -ree'lam-sia6 or"


11/14

The maor &indin+ in this study was to 'on'lude o& whi'h 'o7ariates in'reasin+

hi+h risk o& -ree'lam-sia. Sur-risin+ly6 mean arterial -ressure (;AP) was not

si+ni&i'ant &a'tor &or -ree'lam-ti' women ha7in+ %a%y with low AP9A! s'ore

a&ter adustin+ with other si+ni&i'ant &a'tors (Platelet B1#1/1456 early onset

-ree'lam-sia6 -reterm %irth6 leu'o'yte B 1# C 14

3

D5) whi'h was 'ontradi'ti7e toKumari et al study whom stated that hy-ertensi7e disorders o& -re+nan'y in'rease

the risk o& low AP9A!s'ore &or in&ant 'om-ared to 'ontrol.14Fre=uent antenatal

'are (isit J 3) was not also asso'iated at de'reasin+QQin'reasin+ risk &or

-ree'lam-ti' mothers ha7in+ %a%y with low AP9A! s'ore whi'h was

'ontradi'ti7e to kumari et al study whom stated that e/-ert o%stetri' mana+ement

'an -re7ent these -ro%lems in most o&&s-rin+s o& those women6 -ro7ided they

re'ei7e antenatal 'are and +i7e o%stetri'ians time to a't6 in our su%e'ts it was

=uite the o--osite6 this was -ro%a%ly due to la'k o& mana+ement on antenatal 'are

that was +i7en to mothers when they were -re+nant. Althou+h there was o&ten

+eneral 'on'ordan'e %etween our &indin+s and those o& others6 dis're-an'ies

mi+ht %e e/-lained %y &a'tors that were neither e7aluated nor 'ontrolled &or in our

study.

$eeks o& +estation is a stron+ risk &a'tor o& ad7erse res-iratory out'ome that was

-art o& s'orin+ in AP9A!6 it was o%7iously do'umented in se7eral studies

(ers-y'k6 et al) that 'on'luded -rematurity as an inde-endent risk &a'tor &or

-erinatal ad7erse out'omes (?dds ratio 3.L - M 4.441).13"n this study6 we &ound

that -reterm %irth asso'iated with in'reasin+ risk o& low AP9A!s'ore at 1 minute

%ut not in # minutes. 5euko'yte 'ounts and low AP9A!s'ore 'ould -ossi%ly %ee/-lained %y Fetal "n&lammatory !es-onse Syndrome (F"!S) %e'ause maternal

leuko'yte 'ount is one o& the indi'ators o& intrauterine in&e'tion and de7elo-ment

o& F"!S. 9i%%s6 et al &ound leu'o'yte le7el 1#.,#4mm as si+ni&i'ant mean le7el

'orrelated with intraamnioti' in&e'tion6 it was shown that the risk was 3 &old

hi+her &or ha7in+ in&ant %orn with low AP9A! s'ore.1* 8emato'rit le7el was

&ound statisti'ally si+ni&i'ant in in'reasin+ risk o& in&ant %orn with low AP9A!

s'ore6 %y usin+ multi7ariate analyses6 hemato'rit was not si+ni&i'ant 'om-ared to

other 'on&oundin+ &a'tors (PJ4.4#). "n this study6 low -latelet 'ounts was

si+ni&i'antly asso'iated with 1st minute low AP9A! s'ore in neonates. This

&indin+ o& worsenin+ throm%o'yto-enia may re-resent in&lammatory -ro'ess that

'ould -ossi%ly asso'iated in neonatal out'omes6 in this 'ase6 low AP9A!s'ore in

in&ant %orn. Sur-risin+ly6 a&ter usin+ multi7ariate analyses6 there is no si+ni&i'ant

&a'tors 'orrelated with 5ow AP9A! s'ore at # minutes o& in&ant %orn6 this may %e

'aused %y +ood resus'itation -er&ormed %y the residents who hel-ed sur7i7al o&

the in&ants.

?ur study o&&ers se7eral stren+thsL the hi+h num%er o& -ree'lam-ti' women

allowed us to study the asso'iation %etween o%stetri' -arameters with neonatal

out'ome6 in this study was low AP9A!s'ore in in&ant %orn. 8owe7er6 our studyhas also weakness due to its retros-e'ti7e desi+n %e'ause it has -otential o&


12/14

missin+ data. As we dire'tly re-ort the data a&ter deli7ery6 we attem-ted to

minimiGe %ias. "t was hel-ed %y welltrained o%stetri' residents on duty and

re'he'ked %y 'onsultant.


13/14

*. C"c+!)-"

5euko'ytosis6 early onset -ree'lam-sia6 -reterm %irth6 and throm%o'yto-enia6

se7erity o& -ree'lam-sia6 and 8055P syndrome are inde-endent risks o& ha7in+

in&ant %orn with 1st minute low AP9A!s'ore in -ree'lam-ti' deli7eries. These

&indin+s 'ould hel- &or -hysi'ian in redu'in+ ad7erse e&&e't o& -ree'lam-sia &or

neonatal out'omes %y -re7entin+ these &a'tors with +ood mana+ement in ad7an'e.

,. C"+-c' I"'&r&)'

. Ack"0+g&"'

@. R&&r&"c&)

1. 9awde A6 >hosale ran'h $6 >urkman !6 8a%erman S6 9re+ory K6 et al.

ontem-orary -atterns o& s-ontaneous la%or with normal neonatal out'omes.

?%stetri's 9yne'olo+y 2414L11*:121E,.

#. Krilo7a . han'es o& Ad7erse Neonatal ?ut'ome in 8i+h!isk and 5ow!isk

?%stetri'al Patients. 244L:1E12.

*. ;ont+omery KS. AP9A!S'ores: 0/aminin+ the 5on+term Si+ni&i'an'e.

ournal o& Perinatal 0du'ation 2444L:#E.

,. asey >;6 ;'"ntire 6 5e7eno K. The ontinuin+ alue o& the AP9A!

S'ore &or the Assessment o& New%orn "n&ants. ?%stetri' and 9yne'olo+i'

Sur7ey 2441L#*:4*E,.

. ensen 56 ;athiasen !6 ;lholm >6 9reisen 9. 5ow #min AP9A!s'ore inmoderately -reterm in&antsL asso'iation with su%se=uent death and 'ere%ral

-alsy: a re+ister %ased anish national study. A'ta Paediatri'a 2411L141:e4E2.

. AyaG A6 ;uhammad T6 8ussain SA. Neonatal out'ome in -ree'lam-ti'

-atients. Ayu% ;ed oll U 244L

14. Kumari S6 Sharma ;6 ada7 ;6 Sara& A. Trends in neonatal out'ome with low

AP9A!s'ores. The "ndian ournal o& U 13L

11. Ad7erse -erinatal out'omes and risk &a'tors &or -ree'lam-sia in women with

'hroni' hy-ertension: a -ros-e'ti7e study. 244L#1:1442E.

12. Thorn+renerne'k K. 5ow #minute A-+arAP9A!s'ore: a -o-ulation%ased


14/14

re+ister study o& 1 million term %irths. ?%stetri's 9yne'olo+y 2441L:*#E

,4.

13. ers-y'k 06 >isson 6 !oman 86 ;arret S. Ad7erse res-iratory out'ome a&ter

-remature ru-ture o& mem%ranes %e&ore 7ia%ility. A'ta Paediatri'a

241L143:2#*E*1.

1. han+ 6 ;u+lia 5. Asso'iation o& earlyonset -ree'lam-sia in &irst-re+nan'y with normotensi7e se'ond -re+nan'y out'omes: a -o-ulation%asedstudy. >?9: An "nternational U 2414L

1#. 7an der en A6 S'haa& ;6 7an ?s ;A6 de 9root ;6 8aak ;6 Pakrt 06 et

al. om-arison o& Perinatal ?ut'ome o& Preterm >irths Startin+ in Primary

are 7ersus Se'ondary are in Netherlands: A !etros-e'ti7e Analysis o&

Nationwide olle'ted ata. ?%stet 9yne'ol "nt 241L241:23#,#.

1*. 9i%%s !S6 >lan'o 6 lair PS6 astaneda S. Vuantitati7e %a'teriolo+y o&amnioti' &luid &rom women with 'lini'al intraamnioti' in&e'tion at term.

"n&e't is 11L1#:1E.

1.

Determinants of Low Apgar Score Among Preeclamptic Deliveries in Cipto Mangunkusumo Hospital...

Documents

Transcript of Determinants of Low Apgar Score Among Preeclamptic Deliveries in Cipto Mangunkusumo Hospital...