Analisis faktor yang mempengaruhi perdarahan postpartum dini di RS Sardjito Yogyakarta dari tahun 1988-2002

HERIANTO, Andi Budi, dr. H. Saribin Hasibuan, SpOG

2003 | Tesis | PPDS I Obstetri dan Ginekologi

Latar belakang: Angka kematian maternal di Indonesia masih tinggi. Menurut Survey Kesehatan Rumah Tangga (SKRT) selama 10 tahun hanya terjadi sedikit penurunan angka kematian maternal ini. Salah satu penyebab kematian maternal adalah perdarahan terutama perdarahan postpartum sekitar 67% dan lebih dari 70% kematian karena trias preeklamsia, perdarahan dan infeksi dapat dihindari. Untuk negara-negara Asia Tenggara tahun 2000 angka kematian maternal tertinggi adalah Indonesia 384 kemudian berturut-turut diikuti Birma 230, Filipina 170, Vietnam 160, Thailand 44, Malaysia 39 dan Singapura 6. Mencari faktor-faktor risiko dapat sebagai upaya untuk pertimbangan melakukan tindakan antisipasi/pencegahan terjadinya komplikasi kehamilan dan menghindari terjadinya kematian serta sebagai salah satu pertimbangan untuk pemberian terapi Tujuan: Untuk mengetahui faktor-faktor risiko dan pengaruh akumulasi faktor risiko kejadian perdarahan postpartum dini di RS Sardjito. Metode penelitian: studi kasus-kontrol (case control study) Bahan dan cara: Semua kasus perdarahan postpartum dini di RS Sardjito yang memenuhi kriteria inklusi ataupun eksklusi dalam kurun waktu lima tahun (1998 -2002) dipakai sebagai kasus penelitian. Setiap kasus dicarikan satu kontrol dengan matching pendidikan. Perdarahan postpartum ditegakkan berdasarkan diagnosis klinis. Faktor risiko yang dipelajari meliputi: paritas, ketuban pecah dini, preeklamsia/eklamsia, anemia, partus lama, induksi/stimulasi dan overdistensi uterus. Data diambil dari unit rekam medik, dicatat dalam formulir penelitian. Data dianalisis dengan program komputer dan uji statistik yang digunakan Chi Square dengan Odd ratio CI 95% serta regresi logistik untuk uji multivariatnya. Hasil: Selama kurun waktu 5 tahun (1998 – 2002) ada 55 kasus perdarahan dari 3640 persalinan pervaginam. Insidensi perdarahan postpartum tiap tahunnya berfluktuasi dan mempunyai kecenderungan mengalami peningkatan setiap 2 tahun (tahun 1998 1,3%, 1999 0,9%, 2000 1,5%, 2001 0,9% dan 2002 3,5%). Preeklamsia/eklamsia, induksi/stimulasi dan overdistensi uterus tidak bermakna sebagai faktor risiko tetapi multiparitas (paritas ≥ 3) OR 2,87 CI 95% 1,23 – 6,73 p 0,02, ketuban pecah dini OR 3,44 CI 95% 1,55 – 7,65 p 0,04 dan anemia OR 2,76 CI 95% 1,25 – 6,12 p 0,02 bermakna sebagai faktor risiko perdarahan postpartum dini. Partus lama secara klinis bermakna tetapi secara statistik tidak bermakna (OR 2,04 CI 95% 0,18 – 23,15 p 0,97). Dalam analisis regresi logistik ketiganya tetap bermakna sebagai faktor risiko. Adanya akumulasi faktor risiko (3 atau lebih) meningkatkan risiko terjadinya perdarahan postpartum dini.(OR 4,78 CI 95% 1,47 – 15,53 p 0,01) dibandingkan akumulasi faktor risiko 2 atau kurang (OR 2,20 CI 95% 1,10 – 5,31 p 0,04). Simpulan: Insiden perdarahan postpartum dini di RS Sardjito tiap tahunnya berfluktuasi dan mempunyai kecenderungan mengalami peningkatan setiap 2 tahun. Faktor risiko yang berpengaruh terhadap kejadian perdarahan postpartum dini adalah multiparitas (paritas ≥ 3), ketuban pecah dini dan anemia. Akumulasi faktor risiko (3 atau lebih) meningkatkan risiko hampir 5 kali dibandingkan dengan 2 faktor risiko

Background: Maternal mortality rate in Indonesia is still high. According to Survey Kesehatan Rumah Tangga (SKRT) in 10 years period there’s a little decreased of maternal mortality rate. One of the caused maternal mortality is haemorrhage that’s as a risk of pregnancies.. In a study 67% of maternal mortality caused by haemorhage especialy postpartum haemorrhage but more than 70% of maternal mortality caused by haemorrhage, preeclampsia and infection can be avoided. In other Southeast Asian countries (2000 th), the maternal mortality ratio or the annual number of deaths of women from pregnancy-related causes for every 100,000 live births is lower than Indonesia's. In Burma, this ratio is 230; Philippines, 170; Vietnam, 160; Thailand, 44; Malaysia, 39; and Singapore, six. Investigate risk factors can be as effort to avoided the complication of pregnacies and maternal mortality also could be as considered to make therapy decision. Objectives: The purpose of this study was to investigate the risk factor and cumulative risk factor effect of early postpartum haemorrhage at Sardjito County Hospital Study design: Case-control study. Material and method: All cases of early postpartum haemorrhage at Sardjito County Hospital that fitted the inclusion and exclusion criteria during the five-years period (1998 to 2002) were used in the study. Each of those cases was paired with a control based on educational level. The postpartum haemorrhage was based on the clinical diagnosis. The preeliminary risk were beeing studied included parity, premature rupture of the membrane, preclampsia/eclampsia, anemia (haemoglobin level at the admission), prolonged labour, induction or stimulation and overdistended uterine. Data were obtained from the medical record department and recorded in their respective forms. They were analyzed using computer program, and tested with chi square test (odds ratio 95% confidential interval) and logistic regresi for the multivariat analysis. Result: There were 55 cases of early postpartum haemorrhage out of 3640 vaginaly delivery for the study. The incidens of early post partum haemorrhage were fluctuation each year and had increased tends every 2 years ( 1998 was 1,3%. 1999 was 0,9%, 2000 was 1,5%, 2001 was 0,9% and 2002 was 1,5%). Preeclampsia/eclampsia, induction/stimulation and overdistended uterine were not significant as risk factor but multiparity (parity ≥ 3) with OR 2,87 CI 95% 1,23 – 6,73 p0,02 premature ruputure of the membrane OR 3,44 95% CI 1,55 – 7,65 p 0,04 and anemia OR 2,76 95% CI 1,25 – 6,12 p 0,02 were significant as risk factor of early post partum haemorrhage. Prolonged labour clinically increased risk 2 times but statisticly not significant (OR 2,04 CI 95% 0,18 – 23,15 p 0,97). Cumulative risk factor (3 or more) had OR 4,78 CI 95% 1,47 – 15,53 p 0,01 compared with 2 or less risk factor OR 2,20 95% CI 1,10 – 5,31 p 0,04. Conclusion: In Sardjito County Hospital the prevalensi of early postpartum haemorrhage were fluctuation and had increased tends every 2 years. The risk factors that influenced early postpartum haemorrhage were multiparity (Parity ≥ 3), premature ruputure of the membrane and anemia also the effect of cumulative risk (3 or more) factors increased almost 5 times compared with 2 or less risk factor.

Kata Kunci : Postpartum Dini,Perdarahan, early postpartum haemorrhage, risk factors and cumulative risk factors.