Abstract
Introduction: preeclampsia/eclampsia contributed to 30% of maternal mortality in RSUP Dr. Kariadi. Pre-induction bishop score assessment is a standard for cervical maturity estimation. Other predictors currently being developed, including insulin-like growth factor binding protein-1 (IGFBP-1). However, there is no cut-off point for IGFBP-1 examination in full term pregnancy, especially with preeclampsia and its complications. Objective: to find IGFBP-1 levels and Bishop Score differences in preeclampsia women with induction labor.Methods: this prospective observational cohort study was conducted in preeclampsia women with gestational age ≥37 weeks planned labor induction at Obstetrics and Gynecology Ward RSUP Dr. Kariadi Semarang and networking hospital during study period (n=66). History taking, physical examination, proteinuria, cervical mucus IGFBP-1, and bishop score calculation was performed. Statistical analysis was performed with paired-t test, followed by ROC for cut-off value of successful induction prediction, and logistic regression to determine confounding variables effect on IGFBP-1 levels.Results: The average Bishop score of 66 subjects was 2.5±1.81 and 2.6±1.8 for women who deliver ≤24 labor and in labor for ≤12 hours, respectively. Although the bishop score was higher in the successful labor group, there was no significant difference between groups. Mean IGFBP-1 value was 8.29±5.033 mcg/L with median value of 10.8 mcg/L. Successful induction had significant higher IGFBP-1 levels with area-under-curve (AUC) 0.76 and 8.145 cutoff value (p=0.002, RR=5.1).Conclusion: IGFBP-1 level with cutoff point 8.145 can be used as predictor of successful labor induction in term pregnancy with preeclampsia.
Highlights
Nowadays, preeclampsia is still the top three cause of maternal and fetal morbidity and mortality, with 128,273 annual incidence of preeclampsia in Indonesia or about 5.3%, with no significant decrease in the last two decades (Wibowo et al, 2016)
Methods: this prospective observational cohort study was conducted in preeclampsia women with gestational age ≥37 weeks planned labor induction at Obstetrics and Gynecology Ward RSUP Dr Kariadi Semarang and networking hospital during study period (n=66)
insulin-like growth factor binding protein-1 (IGFBP-1) level with cutoff point 8.145 can be used as predictor of successful labor induction in term pregnancy with preeclampsia
Summary
Preeclampsia is still the top three cause of maternal and fetal morbidity and mortality, with 128,273 annual incidence of preeclampsia in Indonesia or about 5.3%, with no significant decrease in the last two decades (Wibowo et al, 2016). Active management is done by immediate delivery once pregnancy reaches aterm (Wibowo et al, 2016). In preeclampsia which not been in labor yet, induction of labor becomes an option for pregnancy termination (National Collaborating Centre for Women’s and Children’s Health, 2010; the American College of Obstetricians and Gynecologists, 2013). Bishop Score currently a standard to estimate cervical maturation. Several studies have shown that cervical maturity is a major predictor of successful labor induction compared to other factors assessed in the Bishop score. Bishop score is a simple and easy examination; it is a subjective scoring with high inter- and intra-observer variability with low predictive value to assess induction outcome (Benediktsdottir, Eggebø and Salvesen, 2015)
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