Faktor-faktor risiko terjadinya vaginasis bakterial pada kehamilan
HANDAYANI, Dian Rini, dr. Ova Emilia,M.Med, SpOG, Ph.D
2008 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang: Bakterial vaginosis (BV) merupakan suatu keadaan abnormal pada ekosistem vagina. Prevelensi (BV) mencapai 70 persen pada kurun reproduksi. Kehamilan yang diiringi (BV) terbukti mengakibatkan kelahiran premature dan berat badan lahir rendah. Diketahui pula berisiko persalinan preterm 3-8 kali lebih tinggi dibandingkan wanita dengan flora normal. Risiko lebih tinggi pula terkena amnionitis, endrometritis post partum, dan ketuban pecah dini. Tujuan: Penelitian adalah untuk mendapatkan cara pemeriksaan sederhana, menapis (BV) dengan menggunakan inspection visual acetate acid (IVA) dan mengetahui faktor-faktor risiko yang mempengaruhi terjadinya (BV). Diharap hasil penelitian berguna sebagai dasar mengembangkan metode deteksi dini sekaligus mengetahui faktor risiko (BV) oleh ibu hamil sendiri, petugas kesehatan terdepan, khususnya bidan – bidan di desa. Metode: Penelitian ini merupakan penelitian studi diagnostic IVA, dilanjutkan studi case control. Bila hasil pewarnaan gram ditemukan clue cell (positif) ditetapkan sebagai kasus dan kontrolnya adalah hasil pewarnaan gram tidak ditemukan mikroorganisme pathogen. Secara prospektif diteliti factor-faktor risiko yang mempengaruhinya. Kriteria inklusi meliputi bumil dengan mukus vagina gatal dan atau tidak gatal, tampak discharge vagina, encer. Sampel sebanyak 304, sebagai kasus dan control masing-masing 152. Diseleksi secara acak, dengan memberi nomor urut yang melakukan pemeriksaan kehamilan di puskesmas, RSUP Dr. Sardjito dan RS Happy Land Medical Center Yogyakarta. Penelitian dilakukan mulai bulan Juli 2005 dengan menggunakan tiga tahap pelaksanaan. Tahap pertama ; penjaringan (BV) pada kehamilan, tahap kedua yaitu uji coba diagnosis albotyl 2.5 persen (IVA). Standar emasnya adalah pewarnaan Gram. Tahap terakhir menetapkan kasus kontrol. Analisa data dengan tabel 2x2, Chi-Square, Tes Kaffa dan Analisa Bivariat Multivariat (Logistik Regresi), dengan kepercayaan p<0.05. Hasil: IVA 2.5% sensitivitas 55.3%(C.I 95% : 5,712–19,300), spesifisitas 89.5 % (C.I 95% : 2,038 – 3,115), dengan NPP (84%) dan NPN (66.6%). Dan diketahuinya faktor-faktor yang mempengaruhi vaginosis bakterial: umur, riwayat kehamilan dan pemakai pantyliner. Kesimpulan: IVA 2.5% mendeteksi vaginosis bakterial mempunyai kesalahan 45.7%. Faktorfaktor risiko (BV) adalah umur, riwayat kehamilan, dan pantyliner.
Background: Bacterial vaginosis (BV) is an abnormal condition in vaginal ecosystem. Due to the fact that BV prevalence reaches 70% during pregnancy period, a pregnancy with BV can lead to premature childbirth (preterm childbirth can be 3 – 8 times as high as a pregnant woman with normal flora) and low birth weight. Objectives: This research aimed at gaining a simple examination way by BV personal screening with inspection visual acetate acid (IVA) for developing an early detection method and knowing risk factors triggering BV by pregnant women and health attendants especially midwives. Methods: This is an IVA diagnostic study followed by case control study. The case is determined if the result of Gram staining is positive (clue cell is found) and the control used is a gram staining result with no pathogen microorganism. Prospectively, influential risks factors are examined along with inclusive criteria covering pregnant women with itchy or not itchy vaginal mucus and thin vaginal discharge. From 304 randomly selected respondents checking their pregnancy starting July 2005 in Primary Health Center of Dr. Sardjito General Hospital and in Happyland Medical Center Yogyakarta, 152 respondents were as the case and the rest were selected as the control (each respondent was equipped with a sequence number). The three steps of the research were a) BV screenings on pregnancy; b) tests of 2.5% albotyl diagnosis (IVA) with a Gram staining gold standard; and c) determining case control. Data analyses were with table of 2x2, Chi-Square, Kappa Test, and Bivariable-Multivariable Analysis with trusting level of p<0.05. Results: IVA 2.5% sensitivity to detect BV Infection was 55.3% (C.I 95% : 5,712 – 19,300), while its specificity was 89.5% (C.I 95% : 2,038 – 3,115) with NPP (84%) and NPN 66.6%. Risk factors with statistically significant difference triggering BV Infection were as follows: age, pregnant women’s history, and pantyliner use. Conclusions: IVA 2.5% as an early detection was less sensitive to detect BV for around 45.7% was considered undetected (fake negative) and for the lower the acid level is the less sensitive the early detection is. Risk factors found triggering BV Infection were age, pregnant women’s history, and pantyliner use
Kata Kunci : Screening,Asam asetat,Vaginal bacterial,Risk faktor,Gram, cetate acid, Bacterial Vaginosis
