Pratiwi, Nanda Agnesia Jati and Dr. dr. Sutrisno and Dr. dr. Nanik Setijowati (2022) Pengaruh Faktor Risiko Kehamilan, Komplikasi Obstetric, Tempat Persalinan Dan Rujukan Terhadap Kejadian Kematian Maternal Akibat Post Partum Haemmorhage (Studi Kasus Di Kabupaten Jember Tahun 2017-2019). Magister thesis, Universitas Brawijaya.
Abstract
Kematian maternal merupakan kematian seorang Wanita atau ibu pada periode kehamilan sampai 42 hari pasca persalinan. Biasanya digunakan sebagai indikator dalam kesejahteraan suatu bangsa yang dinyatakan dalam Angka Kematian Ibu (AKI) / Maternal Mortality Rate (MMR) dengan jumlah kematian ibu / 100.000 kelahiran hidup. Kematian ibu diakibatkan oleh beberapa penyebab antara lain 3 penyebab terbesar yaitu perdarahan, preeklamsi eklamsia dan infeksi. Perdarahan dibagi dalam perdarahan antepartum dan postpartum. Perdarahan post partum penyumbang angka kematian ibu tertinggi di berbagai belahan dunia. Perdarahan post partum atau biasa dikenal dengan Post Partum Haemmorhage (PPH) yaitu perdarahan yang dialami Wanita pasca melahirkan ( 24 jam sampai 4 minggu pasca salin) yang ditandai dengan keluarnya darah dari jalan lahir > 500 mL persalinan pervaginam dan >1000 mL pada persalinan perabdominal. Mayoritas penyebab adalah 4T (Tone, Trauma, Tissue, Thrombin). Kematian yang disebabkan karena PPH biasnya disertai dengan adanya faktor lain diantaranya faktor tempat persalinan dan rujukan. Dalam penelitian ini bertujuan untuk menganalisa adakah pengaruh faktor risiko kehamilan, komplikasi Obstetric terhadap kejadian PPH dan faktor tempat persalinan dan rujukan terhadap kejadian kematian akibat PPH. Jenis penelitian ini adalah observasional analitik dengan desain case control study yang dilakukan pada bulan Maret 2022- April 2022 di Kabupaten Jember dengan sumber data berupa Otopsi Verbal Maternal, Rekam Medis dan Register Persalinan yang didapatkan dari Dinas Kesehatan Kabupaten Jember dan 25 Puskesmas yang tersebar di 31 kecamatan di Kabupaten Jember. Subyek penelitian adalah 43 ibu yang meninggal akibat PPH sebagai kelompok kasus dan 86 ibu dengan PPH yang hidup sebagai kelompok kontrol. Kedua kelompok dilakukan pengambilan data riwayat kehamilan yaitu usia, paritas dan status anemia ibu, komplikasi obstetric yaitu riwayat atonia uteri, retensio plasenta dan laserasi jalan lahir, serta riwayat tempat persalinan dan rujukan ibu meliputi jumlah estafet rujukan ibu dan lama ibu dirujuk. Kemudian dilakukan tabulasi dan pengujian bivariat dengan Chi-Square setelah itu dilanjutkan dengan pengujian multivariat dengan regresi logistic dengan menggunakan SPSS 25.0 dengan taraf kesalahan 0,05 dan dilakukan uji probabilitas untuk mengetahui besar pengaruh variabel penelitian. Pada uji bivariat didapatkan kategori usia >35 tahun (p-value = 0.001), paritas (p- value = 0.000), anemia (p-value = 0.006), atonia uteri (p-value = 0.000), retensio plasenta (p-value = 0.000), laserasi (p-value = 0.041) keseluruhan mempunyai pengaruh signifikan terhadap kejadian Post Partum Haemmorhage. Sedangkan pada tempat persalinan Rumah sakit didapatkan (p-value = 0.053), estafet rujukan 2 (p-value = 0.002) rujukan ≥ 3 (p-value = 0.000), perkiraan waktu rujukan (p-value = 0.064). Sehingg didapatkan hasil yang signifikan terhadap kejadian kematian maternal akibat Post Partum Haemmorhage. Pada analisis multivariat didapatkan hasil paritas (p-value = 0.022, OR = 1.331 95% CI 1.26-20.34), Anemia (p-value = 0.042, OR = 5.061 95% CI 1.07-31.87), Retensio plasenta (p-value = 0.037, OR = 0.074 95% CI 0.01-0.86), laserasi (p-value = 0.086, OR = 0.086 95% CI 0.01-0.97) sehingga didapatkan pengaruh terhadap kejadian PPH di Kabupaten Jember dengan nilai probabilitas 97%. Estafet rujukan (p-value = 0.000, OR = 3.166 95% CI 1.864-5.378), kecepatan rujukan (p-value = 0.073, OR = 4.394 95% CI 1.27-15.14) mempunyai pengaruh terhadap kejadian kematian maternal akibat PPH di Kabupaten Jember dengan nilai probabilitas 97%. Pada penelitian ini terbukti bahwa faktor risiko kehamilan, komplikasi obstetric berpengaruh terhadap kejadian Post Partum Haemmorhage dan tempat persalinan dan rujukan berpengaruh terhadap kejadian kematian akibat Post Partum Haemmorhage di Kabupaten Jember Tahun 2017-2019.
English Abstract
Maternal death is a death of a woman or mother during the period of pregnancy until 42 days after delivery. Usually used as an indicator of the welfare of a nation expressed in the Maternal Mortality Rate (MMR) with the number of maternal deaths / 100,000 live births. Maternal mortality is caused by several causes, including the 3 biggest causes, namely bleeding, preeclampsia, eclampsia and infection. Bleeding is divided into antepartum and postpartum hemorrhage. Post partum haemorrhage is the highest contributor to maternal mortality in various parts of the world. Post partum bleeding or commonly known as Post Partum Haemmorhage (PPH) is bleeding experienced by women after childbirth (24 hours to 4 weeks postpartum) which is characterized by bleeding from the birth canal > 500 mL vaginal delivery and > 1000 mL in abdominal delivery. The majority of causes are 4T (Tone, Trauma, Tissue, Thrombin). Deaths caused by PPH are usually accompanied by other factors including the place of delivery and referral. This study aims to analyze the influence of pregnancy risk factors, obstetric complications on the incidence of PPH and factors of place of delivery and referral to the incidence of death due to PPH. This type of research is an analytic observational with a case control study design conducted in March 2022-April 2022 in Jember Regency with data sources in the form of Maternal Verbal Autopsies, Medical Records and Birth Registers obtained from the Jember District Health Office and 25 Puskesmas spread over 31 district in Jember Regency. The subjects of the study were 43 mothers who died from PPH as a case group and 86 mothers with PPH who lived as a control group. For both groups, pregnancy history data were collected, namely age, parity and maternal anemia status, obstetric complications, namely a history of uterine atony, retained plasenta and laceration of the birth canal, as well as a history of place of delivery and maternal referrals including the number of relays referred to the mother and the length of time the mother was referred. Then tabulation and bivariate testing with Chi-Square were carried out after that followed by multivariate testing with logistic regression using SPSS 25.0 with an error level of 0.05 and a probability test was carried out to determine the effect of the research variables. In the bivariate test, the categories of age >35 years (p-value = 0.001), parity (p- value = 0.000), anemia (p-value = 0.006), uterine atony (p-value = 0.000), retained plasenta (p-value = 0.000) value = 0.000), lacerations (p-value = 0.041) overall have a significant effect on the incidence of Post Partum Haemmorhage. While at the place of delivery at the hospital, it was obtained (p-value = 0.053), referral relay 2 (p-value = 0.002) referral 3 (p- value = 0.000), estimated time of referral (p-value = 0.064). So that the results obtained were significant on the incidence of maternal death due to Post Partum Haemmorhage. In multivariate analysis, the results obtained parity (p-value = 0.022, OR = 1.331 95% CI 1.26- 20.34), Anemia (p-value = 0.042, OR = 5.061 95% CI 1.07-31.87), retained plasenta (p- value = 0.037, OR = 0.074 95% CI 0.01-0.86), lacerations (p-value = 0.086, OR = 0.086 95% CI 0.01-0.97) so that the effect on the incidence of PPH in Jember Regency with a probability value of 97% is obtained. Referral relay (p-value = 0.000, OR = 3.166 95% CI 1.864-5.378), referral speed (p-value = 0.073, OR = 4.394 95% CI 1.27-15.14) have an influence on the incidence of maternal mortality due to PPH in Jember Regency . with a probability value of 97%. In this study, it was proven that pregnancy risk factors, obstetric complications affect the incidence of Post Partum Haemmorhage and the place of delivery and referrals affect the incidence of death due to Post Partum Haemmorhage in Jember Regency in 2017-2019.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060114 |
| 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: | 31 Jan 2023 07:33 |
| Last Modified: | 31 Jan 2023 07:33 |
| URI: | http://repository.ub.ac.id/id/eprint/197186 |
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