Neuroproteksi Otak Janin pada Persalinan Preterm dan Pertumbuhan Janin Terhambat

Adrianes Bachnas

doi:10.56951/medicinus.v33i2.45

Neuroproteksi Otak Janin pada Persalinan Preterm dan Pertumbuhan Janin Terhambat

Penulis

Adrianes Bachnas Divisi Fotematernal, Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sebelas Maret, RSUD Dr. Moewardi, Solo

DOI:

https://doi.org/10.56951/medicinus.v33i2.45

Kata Kunci:

neuroproteksi, persalinan preterm, pertumbuhan janin terhamba

Abstrak

Tujuan mulia dari suatu kehamilan adalah untuk melahirkan insan yang berkualitas, guna mengemban amanah sang Maha Pencipta dimuka bumi ini. Tidak hanya lahir selamat yang diharapkan, namun juga lahir sehat, kuat, dan cerdas. Cerdas baik secara intelektualitasnya, maupun mental, spiritual, dan sosial. Untuk itu, dibutuhkan otak yang baik dan sehat.

Otak adalah mikroprosesor sentral pada tubuh manusia. Otak berfungsi sebagai pusat penyimpanan dan analisis data. Otak berfungsi sebagai pusat pengendali seluruh proses fisiologis tubuh yang meliputi seluruh sistem organ, pusat informasi sensoris dan reaksi motorik, serta sebagai pusat seluruh bentuk intelegensi.

Segala bentuk kondisi yang berpotensi menimbulkan jejas pada otak merupakan ancaman serius yang harus diantisipasi dengan baik. Persalinan preterm dan pertumbuhan janin yang terhambat adalah kondisi patologis tersering yang berpotensi tinggi untuk menimbulkan jejas otak. Jejas otak yang terjadi dapat ringan hingga berat dan dapat bersifat permanen. Pada kondisi ringan kemungkinan hanya intelegensi saja yang terpengaruh, seperti kemampuan numerik, verbal, dan komunikasi sosial yang berkurang. Sementara pada kondisi berat seperti cerebral palsy, dapat berakibat seorang individu menjadi tidak dapat hidup tanpa bantuan orang lain di sepanjang kehidupannya.

Neuroproteksi otak janin antenatal menjadi langkah yang sangat penting dalam tata laksana problematika di atas. Belum adanya bentuk terapi dengan hasil yang memuaskan terhadap jejas otak yang sudah terlanjur terjadi, menggiring kita untuk dapat melakukan prediksi dan tindakan preventif terhadap segala bentuk kondisi patologis selama kehamilan dan persalinan yang berpotensi mencederai otak janin. Hal ini adalah konsep dasar dari neuroproteksi otak janin antenatal

Unduhan

Baca Selengkapnya

Referensi

Bachnas MA, Akbar MIA, Dachlan EG, Dekker G. The role of magnesium sulfate (MgSO 4 ) in fetal neuroprotection. J Matern Neonatal Med. 2019;0(0):1–13. DOI: https://doi.org/10.1080/14767058.2019.1619688

Sebire NJ, Sepulveda W. Correlation of placental pathology with prenatal ultrasound findings. J Clin Pathol. 2008;61(12):1276–84. DOI: https://doi.org/10.1136/jcp.2008.055251

Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. American Journal of Obstetrics and Gynecology 2012;206(4):300–8. DOI: https://doi.org/10.1016/j.ajog.2012.01.022

Kim MY, Buyon JP, Guerra MM, Rana S, Zhang D, Laskin CA, et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: Results of the PROMISSE study. Am J Obstet Gynecol. 2016;214(1):108.e1-14. DOI: https://doi.org/10.1016/j.ajog.2015.09.066

Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol. 2018;218(2):S745–61. DOI: https://doi.org/10.1016/j.ajog.2017.11.577

Giannubilo S, Tranquilli A. Anticoagulant Therapy During Pregnancy for Maternal and Fetal Acquired and Inherited Thrombophilia. Curr Med Chem. 2012;19(27):4562–71. DOI: https://doi.org/10.2174/092986712803306466

Di Renzo GC, Gratacos E, Kurtser M, Malone F, Nambiar S, Sierra N, et al. Good clinical practice advice: Prediction of preterm labor and preterm premature rupture of membranes. Int J Gynecol Obstet. 2019;144(3):340–6. DOI: https://doi.org/10.1002/ijgo.12744

Bachnas MA, Mose JC, Effendi JS, Andonotopo W. Influence of antenatal magnesium sulfate application on cord blood levels of brain-derived neurotrophic factor in premature infants. J Perinat Med. 2014; 42(1):129–34. DOI: https://doi.org/10.1515/jpm-2013-0137

Nardozza LMM, Caetano ACR, Zamarian ACP, Mazzola JB, Silva CP, Marçal VMG, et al. Fetal growth restriction: current knowledge. Arch Gynecol Obstet. 2017;295(5):1061–77. DOI: https://doi.org/10.1007/s00404-017-4341-9

Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller A, et al. Born Too Soon: The global epidemiology of 15 million preterm births. Reprod Health. 2013;10(Suppl 1):1–14. DOI: https://doi.org/10.1186/1742-4755-10-S1-S2

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: A systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88(1):31–8. DOI: https://doi.org/10.2471/BLT.08.062554

Brookfield KF, Elkomy M, Su F, Drover DR, Carvalho B. Optimization of Maternal Magnesium Sulfate Administration for Fetal Neuroprotection: Application of a Prospectively Constructed Pharmacokinetic Model to the BEAM Cohort. J Clin Pharmacol. 2017;57(11):1419–24. DOI: https://doi.org/10.1002/jcph.941

Magpie Trial Follow-Up Study Collaborative Group MTF-USC. The Magpie Trial: a randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for children at 18 months. BJOG [Internet]. 2007;114(3):289–99. DOI: https://doi.org/10.1111/j.1471-0528.2006.01165.x

Crowther CA, Hiller JE, Doyle LW, Haslam RR, Australasian Collaborative Trial of Magnesium Sulphate (ACTOMg SO4) Collaborative Group. Effect of Magnesium Sulfate Given for Neuroprotection Before Preterm Birth. JAMA. 2003;290(20):2669. DOI: https://doi.org/10.1001/jama.290.20.2669

Peebles D, Kenyon AP. Magnesium Sulphate to Prevent Cerebral Palsy following Preterm Birth. RCOG Sci Impact Pap. 2014;29:7.

American College of Obstetricians and Gynecologists Committee on Obstetric Practice, Society for Maternal-Fetal Medicine. Committee Opinion No. 455: Magnesium Sulfate Before Anticipated Preterm Birth for Neuroprotection. Obstet Gynecol [Internet]. 2010;115(3):669–71. DOI: https://doi.org/10.1097/AOG.0b013e3181d4ffa5

South Australia Guidelines. Clinical Guideline: Magnesium sulphate for neuroprotection of the fetus in women at risk of preterm birth. 2019.

WHO. WHO recommendation on the use of magnesium sulfate for fetal protection from neurological complications. 2015;1–7.

Bain E, Middleton P, Yelland L, Ashwood P, Crowther C. Maternal adverse effects with different loading infusion rates of antenatal magnesium sulphate for preterm fetal neuroprotection: the IRIS randomised trial. BJOG An Int J Obstet Gynaecol. 2014;121(5):595–603 DOI: https://doi.org/10.1111/1471-0528.12535

Zeng X, Xue Y, Tian Q, Sun R, An R. Effects and Safety of Magnesium Sulfate on Neuroprotection. Medicine. 2016;95(1):e2451. DOI: https://doi.org/10.1097/MD.0000000000002451

García Alonso L, Pumarada Prieto M, González Colmenero E, Concheiro Guisán A, Suárez Albo M, Durán Fernández-Feijoo C, et al. Prenatal Therapy with Magnesium Sulfate and Its Correlation with Neonatal Serum Magnesium Concentration. Am J Perinatol. 2018;35(2):170–6. DOI: https://doi.org/10.1055/s-0037-1606358

Héman LM, Linden PJQ Van Der. Does magnesium sulfate increase the incidence of postpartum hemorrhage? A systematic review. Open J Obstet Gynecol. 2011;01(04):168–73. DOI: https://doi.org/10.4236/ojog.2011.14032

Schoots MH, Gordijn SJ, Scherjon SA, van Goor H, Hillebrands JL. Oxidative stress in placental pathology. Placenta. 2018;153–61 DOI: https://doi.org/10.1016/j.placenta.2018.03.003

Longtine MS, Nelson DM. Placental dysfunction and fetal programming: The importance of placental size, shape, histopathology, and molecular composition. Semin Reprod Med. 2011;29(3):187-96. DOI: https://doi.org/10.1055/s-0031-1275515

Barker DJP. Adult consequences of fetal growth restriction. Clin Obstet Gynecol. 2006 Jun;49(2):270–83. DOI: https://doi.org/10.1097/00003081-200606000-00009

Galan HL. Fetal Growth Restriction. In: Protocols for High-Risk Pregnancies: An Evidence-Based Approach: Sixth Edition. John Wiley and Sons Inc.; 2015.

Hecher K, Bilardo CM, Stigter RH, Ville Y, Hackelöer BJ, Kok HJ, et al. Monitoring of fetuses with intrauterine growth restriction: A longitudinal study. Ultrasound Obstet Gynecol. 2001;18(6):564-70. DOI: https://doi.org/10.1046/j.0960-7692.2001.00590.x

Luria O, Bar J, Kovo M, Malinger G, Golan A, Barnea O. The role of blood flow distribution in the regulation of cerebral oxygen availability in fetal growth restriction. Med Eng Phys. 2012 Apr;34(3):364–9. DOI: https://doi.org/10.1016/j.medengphy.2011.07.032

Figueras F, Gratacos E. An integrated approach to fetal growth restriction. Best Practice and Research: Clinical Obstetrics and Gynaecology. 2017;38:48-58. DOI: https://doi.org/10.1016/j.bpobgyn.2016.10.006

Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110–20. DOI: https://doi.org/10.1016/j.ajog.2016.09.076

Bloomfield FH, Spiroski AM, Harding JE. Fetal growth factors and fetal nutrition. Seminars in Fetal and Neonatal Medicine. 2013;18(3):118-23. DOI: https://doi.org/10.1016/j.siny.2013.03.003

Georgieff MK. Nutrition and the developing brain: Nutrient priorities and measurement. Am J Clin Nutr. 2007;85(2):614–20.

Khor GL. Micronutrient status and intervention programs in Malaysia. Food Nutr Bull. 2005;26(2):S281-5 DOI: https://doi.org/10.1177/15648265050262S220

Saraswati E, Sumarno I. Risiko Ibu Hamil Kurang Energi Kronis (KEK) dan Anemia untuk Melahirkan Bayi dengan Berat Badan Lahir Rendah (BBLR). Jurnal Penelitian Gizi dan Makanan. 1998.

Castrogiovanni P, Imbesi R. The role of malnutrition during pregnancy and its effects on brain and skeletal muscle postnatal development. Journal of Functional Morphology and Kinesiology. 2017;2:30. DOI: https://doi.org/10.3390/jfmk2030030

WHO. WHO | New guidelines on antenatal care for a positive pregnancy experience. WHO. 2016.

WHO. Good maternal Nutrition The best start in life. WHO. 2016.

Lowensohn RI, Stadler DD, Naze C. Current Concepts of Maternal Nutrition. Obstet Gynecol Surv. 2016;71(7):413-26. DOI: https://doi.org/10.1097/OGX.0000000000000329

Godfrey K, Robinson S, Barker DJP, Osmond C, Cox V. Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. Br Med J. 1996;312(7028): 410–4. DOI: https://doi.org/10.1136/bmj.312.7028.410

Szwajcer EM, Hiddink GJ, Koelen MA, van Woerkum CMJ. Nutrition awareness and pregnancy: Implications for the life course perspective. Eur J Obstet Gynecol Reprod Biol. 2007;135(1):58-64. DOI: https://doi.org/10.1016/j.ejogrb.2006.11.012