Journal Reading

ELEVATED AMNIOTIC FLUID LACTATE PREDICTS LABOR

DISORDERS AND CESAREAN DELIVERY IN NULLIPAROUS
WOMWN AT TERM
Martina Murphy, BNS; Michelle Butler, PhD; Barbara Coughlan, PhD; Donal Brennan, PhD;
Colm OHerlihy, PhD; Michael Robson, MD

Ronald Oscar
1407101030284

BAGIAN/ SMF OBSTETRI DAN GINEKOLOGI FAKULTAS KEDOKTERAN

UNIVERSITAS SYIAH KUALA/ RSUD dr. ZAINOEL ABIDIN BANDA ACEH
2017
Introduction

Increase
Increase
Dystocia repeat
cesarean
cesarean
delivery
delivery

Dystocia

Inefficient Efficient
uterine action uterine action
(IUA) (EUA)
Introduction
Inefficient uterine
action (IUA)

Lack frequency,
dysfunctional duration, and
uterine incoordinate force of the
action uterine action uterine
contractions

Myometrial fatigue

Switch from aerobic to

anaerobic metabolism

Resulting in an accumulation
of intramuscularactic acid
Introduction
Objective

Primary Objective
The purpose of this study was to measure the AFL at
the diagnosis and at each assessment of progress in
the first stage of labor with last sample measured
prior to delivery in an adequately powered cohort
of spontaneously laboring single cephalic
nulliparous at term cases

Secondary Objective
to examine labor events and outcomes so as to
assess the relationship between AFL and both labor
disorders and CD.
Material and Methods
The study was conducted
over 9 months in 2011
through 2012

Inclusion criteria
The study was conducted over 9 months in 2011 through
2012
All participants signed an informed consent form.
Women were recruited to the study immediately following
the vaginal examination confirming the diagnosis of labor.

Demographic data and

clinical presentation,
outcome, and antibiotic
therapy
Management of labor

Labor
Labor was diagnosed when the cervix was fully effaced
and at least 1 cm dilated

Amniotomy
Amniotomy was performed at the diagnosis of labor if
spontaneous rupture of the membranes had not already
occurred

Vaginal examination
Vaginal examinations were carried out every 2 hours to
assess progress in labor

Labor arrest
Labor arrest were dilation of the cervix at <1 cm/h over 2
hours in the first stage of labor and in the second stage of
labor
Management of labor
Oxytocin
Oxytocin was administered with a dose of
5 mU/min increasing to a maximum dose
of 30 mU/min.
The oxytocin was increased or decreased
at 15-minute intervals and by 5 mU/min
according to uterine activity

Prolonged labor
Duration of the first stage of labor was
recorded for AFL groups. Prolonged labor
was defined as duration of labor lasting
>720 minutes.
Quantification of AFL levels

Amniotic fluid samples were collected at each

vaginal examination to assess labor progress, including
the last sample before delivery, in a clean clear tube
The samples were collected by catching the amniotic
fluid sample flowing onto a sterile glove.
We needed 1 mL of amniotic fluid to perform the test.
Flowchart recruitment process
Result
Result
Result
Result
Result
Result
- Bivariat analysis
Pearson correlations were performed to explore
if a relationship exists among birthweight, labor
disorder, and AFL at diagnosis of labor within
each AFL group.
There were no significant relationships found in
AFL 0-4.9 mmol/L group or the AFL 5.0-9.9
mmol/L group.
There was a significant relationship between
birthweight and CD (r= 0.227, n= 80) found in the
AFL 10.0 mmol/L.
Result
- Multivariat Analysis
Multivariable analysis demonstrated that AFL, when
measured as a continuous variable, was an
independent predictor of a labor disorder (OR, 1.08;
95% CI, 1.01e1.16)
Using the same multivariable model demonstrated
that with AFL >5.0-9.9 mmol/L (OR, 1.6; 95% CI,
1.06e2.39) and AFL 10.0 mmol/L (OR, 1.72; 95% CI,
1.01e2.93) were independent predictors of a labor
disorder (dystocia).
Predictive values of AFL 5.0-9.9 mmol/L to predict
dystocia showed (positive predictive value [PPV] 61
Predictive values of AFL 10.0 mmol/L (PPV 74, NPV
42, overall accuracy 45).
Conclusion

There is a clear relationship between AFL at the

diagnosis of labor with labor disorders and CD.
Women with an AFL of !10.0 mmol/L are almost 3
times more likely to have a CD compared to
those with AFL value of <10 mmol/L.
Measurement of AFL at the diagnosis of
spontaneous labor may be useful in the
intrapartum management of single cephalic
nulliparous at term (37 weeks gestation) cases.
19
TELAAH KRITIS JURNAL
Apakah alokasi
subyek penelitian ke Penelitian ini memiliki desain
kelompok terapi atau penelitian prospective cohort
control betul-betul study yang tidak dibagi dalam
secara acak kelompok case dan control. Total
(random) atau tidak? 905 dilakukan penelitian secara
acak. Keseluruhan subjek yang
masuk dalam criteria inklusi
Jawaban:
diobservasi.
-Iya

Apakah semua
keluaran (outcome) Semua outcome mulai dari data
demografik, analisis univariat, bivariat,
dilaporkan?
hingga multivariat. Penelitian ini juga
melaporkan pasien yang mengalami
Jawaban: komplikasi selama penelitian
-Iya
20
TELAAH KRITIS JURNAL
Penelitian ini dilakukan di rumah
Apakah lokasi studi sakit pemdidikan University
menyerupai lokasi College Dublin, Dublin, Ireland
anda bekerja atau yaitu National Maternity Hospital,
tidak? Dublin, Ireland. Hal ini sam
dengan kondisi RSUZA yang juga
Jawaban: merupakan RS pendidikan.
-Iya Semua jenis sarana pemeriksaan
kesehatan juga tersedia di RSUZA.

Apakah kemaknaan
statistic maupun klinis
dipertimbangkan Kemaknaan statistik ditampilkan
atau dilaporkan? dalam bentuk p value, nilai r, OR, dan
confident interval.
Jawaban:
-Iya
21
TELAAH KRITIS JURNAL
Apakah tindakan
terapi yang
dilakukan dapat Tindakan pemeriksaan AFL dapat
dilakukan ditempat dilakukan dan diperiksa oleh
anda bekerja atau laboratorium mikrobiologi RSUZA.
tidak? Namun selama ini belum ada SOP RS
mengenai hal tersebut
Jawaban:
-Iya

Apakah semua
subyek penelitian Penelitian ini awalnya merekrut 1764,
diperhitungkan setelah melalui proses penyaringan
dengan kriteria inklusi dan ekslusi, total
dalam kesimpulan? pasien yang mengikuti penelitian menjadi
905. Semua subjek dirangkum dalam
Jawaban: flowchat.
-Iya
Kesimpulan

Dari 6 pertanyaan untuk telaah kritis jurnal

mendapatkan jawaban iya pada semua item.
Sehingga jurnal ini sangat baik untuk diterapkan
di RSUZA.
Thank You