INSIDENSI DAN FAKTOR RISIKO KEJADIAN INTRAUTERINE FETAL DEATH DI KABUPATEN NGADA: PENDEKATAN SECARA EPIDEMIOLOGI

MARIA KATHARINA EDA, dr. Shofwal Widad, SpOG(K).; dr. R. Detty Siti Nurdiati, MPH, PhD, SpOG(K)

2017 | Tesis-Spesialis | SP Ilmu Kebidanan dan Penyakit Kandungan

Latar belakang: Perinatal Mortality Rate (PMR) merupakan penyumbang terbesar tingginya angka kematian bayi di Indonesia. Menurut data WHO 2013 angka perinatal mortality rate dunia adalah 47/1000 kelahiran, sedangkan di Indonesia adalah 26 per 1000 kelahiran dimana Nusa Tenggara Timur (41/1000). Tujuan: mengetahui insidensi dan faktor risiko kejadian intrauterine fetal death di kabupaten Ngada. Metode: Penelitian ini menggunakan metode kohort retrospektif untuk mencari insidensi dan faktor risiko kejadian intrauterine fetal death di kabupaten Ngada dengan mengumpulkan data persalinan periode tahun 2014-2015. Hasil: Selama periode penelitian didapatkan 3275 persalinan dan 122 kejadian IUFD. Insidensi 3,7 per 1000 kelahiran. Didapatkan perbedaan bermakna antara kejadian IUFD dengan usia kehamilan (preterm: p=0,000; OR 17,7, IK 95% 10,3-30,4, early term: p=0,000; OR 3,5, IK 95% 1,9-6,2 dan postterm: p=0,000; OR 3,6, IK 95% 1,77,8), tempat persalinan (puskesmas PONED: p=0,000; OR 0,2, IK 95% 0,08-0,5, puskesmas/balai kesehatan: p=0,000; OR 0,09, IK 95% 0,030,2), penolong persalinan (bukan tenaga kesehatan: p=0,004; OR 4,2, IK 95% 0,4-12,4), kondisi geografis (rural: p=0,002; OR 2,6, IK 95% 1,4-4,9), jarak tempat tinggal ke fasilitas kesehatan (>5 km: p=0,005; OR 1,9, IK 95% 1,2-2,9) dan rujukan (dirujuk: p=0,000; OR 7,3, IK 95% 4,1-12,9). Faktor maternal yang bermakna dengan kejadian IUFD antara lain jenis persalinan (seksio sesarea: p=0,002; OR 2,2, IK 95% 1,3-3,7 dan persalinan dengan tindakan: p=0,000; OR 3,6, IK 95% 2,4-5,4) , kebiasaan pasien (diurut: p=0,000; OR 442,9, IK 95% 232,3-844,7) dan kondisi medis seperti kelahiran prematur (p=0,000; OR 10, IK 95% 5,8-19,6), preeklampsia (p=0,000; OR 12,8, IK 95% 6,6-24,7), kelainan letak (p=0,000; OR 9,7, IK 95% 4,7-19,7), ketuban pecah dini (p=0,000; OR 3,9, IK 95% 1,8-8,3), kelainan plasenta (p=0,000; OR 16,6, IK 95% 7,4-37,1), kehamilan kembar (p=0,000; OR 10,2, IK 95% 3,3-31,5), prolaps tali pusat (p=0,000; RR 343,7, IK 95% 38,6-3045,4), ruptur uteri iminen (p=0,000; OR 71,5, IK 95% 4,41178,0), infeksi (p=0,000; OR 35,7, IK 95% 3,1-408,2), dan gawat janin (p=0,001; OR 6,1, IK 95% 1,7-21,4). Faktor kondisi bayi yang didapatkan bermakna adalah berat badan bayi (BBLR: p=0,000; OR 8,8, IK 95% 6,1-12,9, berat berlebih: p=0,020; OR 3,3, IK 95% 1,1-9,2) dan kondisi medis bayi yaitu kelainan tali pusat (p=0,000; OR 3026,5, IK 95% 406,5-22525,2), prematur (p=0,000; OR 12,8, IK 95% 7,4-22,1), IUGR (p=0,001; OR 3,4, IK 95% 1,6-7,2), multifetal (p=0,000; OR 19,4, IK 95%, 7,9-47,5) dan makrosomia (p=0,027; OR 3,5, IK 95% 1,1-11,8). Kesimpulan: insidensi kejadian intrauterine fetal death adalah 37,2 per 1000 kelahiran. Faktor risiko yang didapatkan bermakna dengan kejadian IUFD antara lain usia kehamilan, tempat persalinan, penolong persalinan, kondisi geografis, jarak tempat tinggal ke fasilitas kesehatan dan rujukan. Selain itu didapatkan pula faktor maternal yang bermakna dengan kejadian IUFD antara lain jenis persalinan, kebiasaan pasien dan kondisi medis seperti partus prematur, preeklampsia, kelainan letak, ketuban pecah dini, kelainan plasenta, kehamilan kembar, prolaps tali pusat, ruptur uteri iminen, infeksi dan gawat janin. Sedangkan faktor kondisi bayi yang didapatkan bermakna adalah berat badan bayi dan kondisi medis bayi yaitu kelainan tali pusat, prematur, IUGR, multifetal dan makrosomia.

Background: Perinatal Mortality Rate (PMR) is the largest contributor to high infant mortality rate in Indonesia. According to WHO 2013 world perinatal mortality rate is 47/1000 births, Indonesia is 26 per 1000 births and Nusa Tenggara Timur (41/1000). Objective: To determine the incidence and risk factors of intrauterine fetal death in kabupaten Ngada. Methods: This study used a retrospective cohort to identifiy the incidence and risk factors of intrauterine fetal death in the kabupaten Ngada by collecting deliveries data period 2014-2015. Results: During this study period there were 3275 deliveries and 122 intrauterine fetal death. The incidence was 3,7 per 1000 deliveries. Among cases there was significant differences between the gestasional age (preterm: p=0.000; OR 17.7, 95% CI 10.3 to 30.4, early term: p=0.000; OR 3.5, 95% CI 1.9 to 6.2 and postterm: p=0.000; OR 3.6, 95% CI 1.7 to 7.8), the place of delivery (puskesmas PONED: p = 0.000; OR 0.2, 95% CI 0.08 to 0.5), birth attendants (not medical attendants: p = 0.004; OR 4.2, 95% CI 0.4 to 12.4), the geographical conditions (rural: p = 0.002; OR 2.6. 95% CI 1.4 to 4.9) , distance to health care facilities (> 5km: p=0.005; OR 1.9, 95% CI 1.2 to 2.9) and reference (p=0.000; OR 7.3, 95% CI 4.1 to 12.9 ). Significant factor related to maternal condition were types of delivery (cesarean section: p=0.002; OR 2.2, 95% CI 1.3 to 3.7. operative vaginal delivery: p=0.000; OR 3.6, 95% CI 2.4 to 5.4), patients habit (massage: p=0.000; OR 442.9, CI 95% from 232.3 to 844.7) and medical conditions such as preterm birth (p=0.000; OR 10. 95% CI 5.8 to 19.6), preeclampsia (p=0.000; OR 12.8. 95% CI 6.6 to 24.7). fetal lie abnormality (p=0.000; OR 9.7, 95% CI 4.7 to 19.7), premature rupture of membranes (p=0.000; OR 3.9, 95% CI 1.8 to 8.3), placental abnormalities (p=0.000; OR 16.6, 95% CI 7.4 to 37.1), twin pregnancy (p=0.000; OR 10.2, 95% CI 3.3 -31.5), cord prolapse (p=0.000; OR 343.7, 95% CI 38.6 to 3045.4), imminent uterine rupture (p=0.000; OR 71.5, 95% CI 4.4 -1178.0), infection (p=0.000; OR 35.7, 95% CI 3.1 to 408.2), and fetal distress (p=0.001; OR 6.1, 95% CI 1.7 to 21.4). Fetal condition such as the fetal weight (low birth weight: p=0.000; OR 8.8, 95% CI 6.1 to 12.9) and medical conditions such as umbilical cord abnormalities (p=0.000; OR 3026.5, CI 95% 406.5 to 22525.2), preterm baby (p = 0.000; OR 12.8, 95% CI 67.4 to 22.1), IUGR (p=0.001; OR 3.4, 95% CI 1.6 to 7.2), multifetal (p=0.000; OR 19.4, 95% CI. 7.9 to 47.5) and macrosomia (p=0.027; OR 3.5, 95% CI 1.1 to 11.8). Conclusion: The incidence of intrauterine fetal death was 37.2 per 1000 births. The risk factors were obtained significantly to the incidence of IUFD include gestational age, place of delivery, birth attendance, geography, distance shelter and referral to health facilities. Additionally found also maternal factors were significantly associated with the incidence of IUFD among other types of labor, habits of patients and medical conditions such as premature labor, preeclampsia, abnormal lie, and premature rupture of membranes, placental abnormalities, twin pregnancy, cord prolapse, imminent uterine rupture, infection and fetal distress. While the fetal condition factor obtained meaningful is the fetal weight and medical condition of the baby such as umbilical cord abnormalities, preterm, IUGR, multifetal and macrosomia.

Kata Kunci : intrauterine fetal death,insidensi, faktor risiko, perinatal mortality rate