Evaluasi pelaksanaan manajemen aktif kala III persalinan di ruang bersalin Rumah Sakit Umum Daerah Sleman

OLFAH, Yustiana, Prof.dr. Mohammad Hakimi, Ph.D.,Sp.OG(K)

2007 | Tesis | S2 Ilmu Kedokteran Klinik (Maternal Perinatal)

Latar Belakang:Penyebab kematian maternal yang terpenting di Indonesia menurut laporan adalah perdarahan, infeksi dan toxemia gravidarum. Angka kematian maternal rata-rata 39 per 100.000 kelahiran dan perdarahan merupakan penyebab kematian utama tersebut. Manajemen aktif kala III terbukti mengurangi kejadian perdarahan pasca persalinan. Buku Acuan Nasional Pelayananan Kesehatan Maternal dan Neonatal sudah merekomendasikan manajemen aktif kala III untuk setiap persalinan sebagai usaha untuk mengurangi komplikasi. Di RSUD Sleman, protap manajemen aktif kala III sudah ada tetapi belum pernah dilakukan evaluasi terhadap pelaksanaannya. Tujuan:penelitian ini adalah untuk mendeskripsikan pelaksanaan manajemen aktif kala III pada ibu bersalin. Metode:Penelitian ini menggunakan metode kualitatif dengan pendekatan pengumpulan data triangulasi. Data diambil dari hasil observasi, wawancara mendalam dan diskusi kelompok terarah yang dimulai sejak minggu kedua Desember 2005 sampai minggu keempat Mei 2006 di Ruang Bersalin RSUD Sleman. Subyek penelitian ini adalah semua bidan yang bertugas menolong persalinan di ruang bersalin. Analisis utama yang dilakukan dalam penelitian ini adalah mendeskripsikan hasil observasi dan penuturan responden serta diskusi kelompok terarah. Secara umum langkah yang dilakukan menggunakan interactive model dari Miles dan Huberman. Hasil: Tindakan manajemen aktif kala III yang telah dilaksanakan sesuai standar baru pada pemberian oksitosin. Penjepitan dan pemotongan talipusat, peregangan tali pusat terkendali dan pemijatan fundus uteri tidak sepenuhnya dilaksanakan sesuai standar. Tindakan lain yang dilakukan di luar standar adalah pemberian methylergomerin sesudah plasenta lahir.

Background: Major causes of maternal mortality in Indonesia are bleeding, infection and toxemia gravidarum. Maternal mortality rate is 39 per 100,000 births and bleeding contributes the greatest percentage. Phase III active management has been proven effective in minimizing the occurence of post childbirth bleeding. The World Health Organization and national policy have recommended phase III active management for every childbirth as an effort to reduce complication. At RSUD Sleman there is operational procedure of phase III active management but its implementation has never been evaluated. Objective: To describe the implementation of phase III active management in childbirth process . Method: The study used qualitative method with triangular data collection approach. Data were obtained from observation, indepth interview and focus group discussion from the second week of December 2005 to the fourth week of May 2006 at delivery room of RSUD Sleman. The subject of the study were all midwives assisting childbirth at delivery room. Main analysis applied in this study was describing the result of observation and respondents' explanation as well as as focus group discussion. In general the process was conducted using interactive model of Miles and Huberman. Result: Action taken in every step of phase III active management was mainly supplying oxytocin. Clipping and cutting of umbilical cord, controlled umbilical cord stretching and fundus uteri massaging were not fully implemented according to the standard. Another action taken outside the standard was supplying methylergometrin after the birth of placenta. Conclusion: The implementation of phase III active management at RSUD Sleman has not been fully conducted according to the standard.Background: Major causes of maternal mortality in Indonesia are bleeding, infection and toxemia gravidarum. Maternal mortality rate is 39 per 100,000 births and bleeding contributes the greatest percentage. Phase III active management has been proven effective in minimizing the occurence of post childbirth bleeding. The World Health Organization and national policy have recommended phase III active management for every childbirth as an effort to reduce complication. At RSUD Sleman there is operational procedure of phase III active management but its implementation has never been evaluated. Objective: To describe the implementation of phase III active management in childbirth process . Method: The study used qualitative method with triangular data collection approach. Data were obtained from observation, indepth interview and focus group discussion from the second week of December 2005 to the fourth week of May 2006 at delivery room of RSUD Sleman. The subject of the study were all midwives assisting childbirth at delivery room. Main analysis applied in this study was describing the result of observation and respondents' explanation as well as as focus group discussion. In general the process was conducted using interactive model of Miles and Huberman. Result: Action taken in every step of phase III active management was mainly supplying oxytocin. Clipping and cutting of umbilical cord, controlled umbilical cord stretching and fundus uteri massaging were not fully implemented according to the standard. Another action taken outside the standard was supplying methylergometrin after the birth of placenta. Conclusion: The implementation of phase III active management at RSUD Sleman has not been fully conducted according to the standard.

Kata Kunci : Manajemen Aktif Kala III,Persalinan Kala III,active management, standard operation procedure