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Transcript of DAFTAR ISI - sinta.unud.ac.id · PDF file2.4.1.4 Perubahan fisiologis arteri spiralis pada...

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DAFTAR ISI

Halaman

Halaman Sampul .......................................................................................... ii

Lembar Persetujuan ..................................................................................... iii

Penetapan Panitian Penguji ......................................................................... iv

Surat Pernyataan Bebas Plagarisme ............................................................. v

Ucapan terimakasih ...................................................................................... vi

Abstrak ......................................................................................................... x

Abstract ....................................................................................................... xi

Daftar isi ....................................................................................................... xii

Daftar Tabel ................................................................................................. xvi

Daftar Gambar .............................................................................................. xvii

Daftar Singkatan ........................................................................................... xix

Daftar Lampiran .......................................................................................... xxiii

BAB I PENDAHULUAN ............................................................................ 1

1.1 Latar Belakang ..................................................................................... 1

1.2 Rumusan Masalah ................................................................................ 8

1.3 Tujuan Penelitian ................................................................................. 9

1.3.1 Tujuan umum ......................................................................... 9

1.3.2 Tujuan khusus ........................................................................... 9

1.4 Manfaat Penelitian ............................................................................... 9

1.4.1 Manfaat akademik ....................................................................... 9

1.4.2 Manfaat praktis ........................................................................... 10

BAB II TINJAUAN PUSTAKA ................................................................. 11

2.1 Pre-eklampsia ...................................................................................... 12

2.1.1 Terminologi dan klasifikasi......................................................... 12

2.2 Epidemiologi........................................................................................ 13

2.3 Faktor Risiko Preeklampsia ................................................................ 15

2.4 Patogenesis .......................................................................................... 16

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2.4.1 Plasenta . .................................................................................... 16

2.4.1.1 Anatomi Plasenta ............................................................... 17

2.4.1.2 Anatomi makroskopik plasenta .......................................... 19

2.4.1.3 Anatomi mikroskopik plasenta .......................................... 20

2.4.1.4 Perubahan fisiologis arteri spiralis pada kehamilan normal 22

2.4.2 Plasenta merupakan peran sentral dalam patogenesis pre-

eklampsia ..................................................................................... 24

2.5 Stres Oksidatif Pada Pre-eklampsia .................................................... 27

2.5.1 F2-Isoprostane sebagai petanda stres oksidatif .......................... 28

2.6 Peran Dislipidemia Pada Pre-eklampsia .............................................. 31

2.6.1 Jalur biosintesis lipid ................................................................. 36

2.6.2 Metabolisme kolesterol ............................................................. 37

2.6.2.1 Jalur metabolism eksogen ................................................ 37

2.6.2.2 Jalur metabolisme endogen............................................ 39

2.6.2.3 Jalur reverse cholesterol transport ................................ 40

2.6.3 Kadar lipid normal ..................................................................... 42

2.6.4 Metabolisme lipid selama kehamilan ....................................... 45

2.6.5 Peran homeostasis lipid oleh faktor transkripsi sterol

regulatory element binding protein (SREBP) ..................... ....... 48

2.6.5.1 Struktur molekul SREBP-2 .......................................... 52

2.7 Peran estrogen pada pre-eklampsia ................................................... 55

2.7.1 Biosintesis 2-Methoxyestradiol ................................................ 57

2.7.2 Peran 2- Methoxyestradiol pada pre-eklampsia ........................ 59

BAB III KERANGKA KONSEP DAN HIPOTESIS PENELITIAN ..... 62

3.1 Kerangka Berpikir ................................................................................ 62

3.2 Konsep Penelitian ................................................................................ 64

3.3 Hipotesis Penelitian .............................................................................. 65

BAB IV METODE PENELITIAN ............................................................. 66

4.1 Rancangan Penelitian............................................................................ 66

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4.2 Lokasi dan Waktu Penelitian ................................................................ 67

4.2.1 Lokasi penelitian ......................................................................... 67

4.2.2 Waktu penelitian .......................................................................... 67

4.3 Populasi, Sampel dan Besar Sampel ..................................................... 67

4.3.1 Populasi target ............................................................................ 67

4.3.2 Populasi terjangkau ..... ............................................................... 67

4.3.3 Sampel penelitian ....................................................................... 67

4.3.3.1 Kriteria inklusi dan eksklusi ............................................ 68

4.3.3.1.1 Kasus ....................................................................... 68

4.3.3.1.2 Kontrol ........................................................................ 68

4.3.4 Besar sampel .............................................................................. 69

4.3.5 Cara pemilihan sampel ............................................................... 70

4.4 Identifikasi Variable, Hubungan Antar Variable, dan Definisi

Operasional Variable ............................................................................ 70

4.4.1 Identifikasi Variabel .................................................................. 70

4.4.1.1Variabel bebas ............................................................... 70

4.4.1.2Variabel tergantung ........................................................ 70

4.4.1.3Variabel kendali ............................................................ 71

4.4.2 Hubungan antar variabel ............................................................. 71

4.4.3 Definisi operasional variabel ..................................................... 71

4.5 Bahan dan cara pengumpulan data ...................................................... 75

4.5.1 Bahan ......................................................................................... 75

4.5.2 Instrumen penelitian ................................................................... 75

4.5.3 Cara pengumpulan data ............................................................. 76

4.5.4 Alur Penelitian dan prosedur pengambilan sampel .................. 76

4.5.4 1 Persiapan penelitian ................................................... 76

4.5.4.2 Alur penelitian ........................................................... ... 76

4.5.5 Prosedur pemeriksaan imunohistokimia 77

4.5.5.1 Pemeriksaan F2-Isoprostan dan SREBP-2... 77

4.5.5.2 Pemeriksaan 2-Methoxyestradiol ........ 80

4.6 Analisis data 82

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BAB V HASIL PENELITIAN DAN PEMBAHASAN ............................ 83

5.1 Distribusi Karakteristik Umur Ibu,Paritas dan Usia Kehamilan .......... 84

5.1.1 Pembahasan karakteristik umur ibu ............................................ 84

5.1.2 Pembahasan karakteristik usia kehamilan .................................. 88

5.1.3 Pembahasan karakteristik paritas ................................................. 89

5.2 Risiko Pre-eklampsia pada Ekspresi F2-Isoprostan Tinggi ..........