Pratiwi, Dyah Krisnawati Satia and Dr. dr. I Wayan Agung Indrawan and Dr. dr. Sutrisno (2022) Pengaruh Akses Fasilitas Pelayanan Kesehatan Primer Kualitas Antenatalcare Dan Riwayat Persalinan Terhadap Kejadian Kematian Akibat Postpartum Hemorrhage Primer Di Kabupaten Jember Tahun 2017-2019. Magister thesis, Universitas Brawijaya.
Abstract
Postpartum Hemorrhage primer merupakan salah satu suatu keadaan dimana ibu mengeluarkan darah darah lebih dari 500 cc pada persalinan normal dan lebih dari 1000 cc pada persalinan seksio sesarea yang apabila tidak tertangani dapat meningkatkan morbiditas dan mortalitas ibu pasca salin. Terdapat banyak faktor risiko baik secara medis maupun non medis yang mempengaruhi kejadian kematian ibu akibat postpartum haemorrhage primer. Pada faktor non medis, akses menuju fasilitas pelayanan kesehatan primer menjadi salah satu faktor penting yang mempengaruhi keselamatan ibu yang mengalami postpartum haemorrhage primer. Faktor medis kejadian postpartum haemorrhage primer dapat dibagi pada masa kehamilan yakni kelengkapan pemeriksaan ANC ibu dan keteraturan ibu melakukan ANC dan pada masa persalinan diantaranya metode persalinan, durasi persalinan, penolong persalinan, tempat bersalin, dan komplikasi yang ibu alami selama persalinan. Kabupaten Jember merupakan salah satu kabupaten di Provinsi Jawa Timur yang memiliki Angka Kematian Ibu paling tinggi dengan salah satu penyebab utama adalah postpartum hemorrhage primer. Tujuan penelitian ini adalah untuk mengetahui dan menganalisis pengaruh akses ke fasilitas pelayanan kesehatan, kualitas ANC, dan riwayat persalinan terhadap kejadian kematian akibat postpartum hemorrhage primer di Kabupaten Jember pada tahun 2017– 2019. Penelitian ini dilakukan secara observasional analitik dengan desain case control, yang dilakukan pada bulan Maret – April 2022 di Kabupaten Jember. Subyek penelitian ibu nifas yang mengalami postpartum haemorrhage primer telah memenuhi krikteria penelitian sebanyak 120 orang yang dibagi kedalam dua kelompok yaitu 40 orang pada kelompok kasus (mortalitas akibat postpartum haemorrhage primer) dan 80 orang pada kelompok kontrol (morbiditas akibat postpartum haemorrhage primer). Data diperoleh dari format Otopsi verbal Maternal (OVM) dan buku register ibu yang alamat ibu, kelengkapan pemeriksaan ANC, jumlah kunjungan ANC, durasi persalinan, penolong persalinan, tindakan persalinan, penolong persalinan, tempat persalinan, dan komplikasi persalinan. Analisa yang digunakan Uji Chi- square yang dilanjutkan dengan analisis Regresi Logistik Biner dilakukan dengan menggunakan SPSS versi 25.0 dengan Alpha =0.05. Hasil analisis bivariat menunjukkan kelengkapan pemeriksaan ANC (p value = 0.009), metode persalinan (p value = 0.025), tempat persalinan (p value = 0.015), atonia uteri (p value = 0.009), dan retensio plasenta (p value = 0.001) memiliki hubungan yang signifikan terhadap kejadian kematian ibu akibat postpartum haemorrhage primer. Sementara waktu tempuh menuju fasyankes primer (p value = 0.243), jarak menuju fasyankes (p value = 1.000), kunjungan ANC (p value = 0.066), durasi persalinan (p value = 0.056), penolong persalinan (p value = 0.107), dan laserasi jalan lahir (p value = 0.333) tidak memiliki pengaruh signifikan terhadap kejadian kematian ibu akibat postpartum haemorrhage primer. Berdasarkan hasil penelitian ini membuktikan bahwa pemeriksaan ANC kejadian atonia uteri, tempat persalinan, waktu menuju ke fasilitas pelayanan kesehatan primer, dan jarak menuju fasilitas pelayanan primer.
English Abstract
Primary Postpartum Hemorrhage is a condition in which the mother bleeds more than 500 cc in normal delivery and more than 1000 cc in cesarean section delivery which, if left untreated, can increase maternal morbidity and mortality after delivery. There are many risk factors both medical and non-medical that affect the incidence of maternal death due to primary postpartum haemorrhage. In non-medical factors, access to primary health care facilities is one of the important factors affecting the safety of mothers who experience primary postpartum haemorrhage. The medical factors for primary postpartum haemorrhage can be divided during pregnancy, namely the completeness of the maternal ANC examination and the regularity of the mother doing ANC and during delivery including the method of delivery, duration of delivery, birth attendant, delivery site, and complications that the mother experienced during delivery. Jember Regency is one of the districts in East Java Province that has the highest maternal mortality rate with one of the main causes of primary postpartum hemorrhage. The purpose of this study was to determine and analyze the effect of access to health care facilities, quality of ANC, and delivery history on the incidence of death due to primary postpartum hemorrhage in Jember Regency in 2017–2019. This research was conducted by analytical observation with a case control design, which was conducted in March – April 2022 in Jember Regency. The research subjects postpartum mothers who experienced primary postpartum haemorrhage had met the research criteria as many as 120 people were divided into two groups, namely 40 people in the case group (mortality due to primary postpartum haemorrhage) and 80 people in the control group (morbidity due to primary postpartum haemorrhage). The data were obtained from the Maternal Verbal Autopsy (OVM) format and the mother's register book which included the mother's address, completeness of ANC examination, number of ANC visits, duration of labor, birth attendant, delivery action, birth attendant, place of delivery, and delivery complications. The analysis used Chi-square test followed by Binary Logistics Regression analysis performed using SPSS version 25.0 with Alpha = 0.05. The results of the bivariate analysis showed the completeness of the ANC examination (p value = 0.009), delivery method (p value = 0.025), place of delivery (p value = 0.015), uterine atony (p value = 0.009), and retained placenta (p value = 0.001). has a significant relationship to the incidence of maternal death due to primary postpartum haemorrhage. Meanwhile, travel time to primary health facilities (p value = 0.243), distance to health facilities (p value = 1,000), ANC visits (p value = 0.066), duration of labor (p value = 0.056), birth attendant (p value = 0.107), and laceration of the birth canal (p value = 0.333) did not have a significant effect on the incidence of maternal mortality due to primary postpartum haemorrhage. Based on the results, it was proven that the ANC examination of the incidence of uterine atony, the place of delivery, the time to the primary health care facility, and the distance to the primary care facility
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060096 |
| Subjects: | 600 Technology (Applied sciences) > 618 Gynecology, obstetrics, pediatrics, geriatrics > 618.2 Obstetrics |
| Divisions: | S2/S3 > Magister Kebidanan, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 25 Jan 2023 04:11 |
| Last Modified: | 25 Jan 2023 04:11 |
| URI: | http://repository.ub.ac.id/id/eprint/196925 |
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