PERBEDAAN DIAMETER ANTEROPOSTERIOR DAN AREA LEVATOR HIATAL PADA SAAT ISTIRAHAT, VALSAVA, DAN KONTRAKSI SELAMA KEHAMILAN DAN PASCA PERSALINAN VAGINAL DI RSUP DR. SARDJITO YOGYAKARTA
MUHAMMAD REZQA KALIFA, dr. Ahsanudin Attamimi, Sp.O.G, Subsp.K.Fm., M.Med.Ed ; Dr. dr. Muhammad Nurhadi Rahman, Sp.O.G., Subsp.Urogin-RE
2024 | Tesis-Spesialis | S2 Ilmu Kebidanan dan Penyakit Kandungan
Latar belakang: Dasar panggul merupakan keseluruhan struktur yang berada di
dalam rongga panggul mulai dari sisi lateral kanan hingga kiri dinding panggul, dari
tulang simfisis hingga koksigius. Disfungsi dasar panggul yang terjadi akibat
kelemahan otot dasar panggul dapat menyebabkan prolaps organ panggul dan
inkontinensia urin sehingga dapat terjadi penurunan kualitas hidup. Persalinan
vaginal merupakan faktor risiko terbesar disfungsi dasar panggul sehingga penting
untuk mengenal secara dini berbagai aspek yang dapat berkontribusi terhadap
disfungsi dasar panggul termasuk perubahan diameter anteroposterior dan area
hiatus levator.
Tujuan: Penelitian ini bertujuan untuk mengetahui perubahan diameter
anteroposterior dan area hiatus levator pada kehamilan dan pasca persalinan
vaginal.
Metode penelitian : Penelitian ini merupakan studi kohort prospektif yang
dilakukan di RSUP Dr. Sardjito pada bulan Januari – Desember 2023 dengan
pengambilan sampel secara consecutive sampling yang melibatkan pasien hamil
cukup bulan yang menjalani persalinan vaginal di RSUP Dr. Sardjito. Data yang
diperoleh ditabulasi dan diuji normalitas menggunakan uji Shapiro-Wilk. Uji T
berpasangan digunakan untuk menilai perbedaan area hiatus levator dan diamter
anteroposterior levator hiatus pra dan pascasalin bila data terdistribusi normal dan
uji Wilcoxon digunakan bila data tidak terdistribusi normal.
Hasil: Terdapat 40 subjek primigravida pada periode Januari – Desember 2023, 27
subjek menjalani operasi Seksio Caesaria, 3 subjek loss to follow up, dan 10 subjek
dengan data pra dan pascasalin lengkap. Rerata area levator hiatus prasalin ialah
13,55 + 6,91 dan pascasalin 13,83 + 0,68, p=0,722. Median diameter
anteroposterior levator hiatus prasalin ialah 5,16 (3,40-5,71) dan pascasalin 5,27
(3,82-5,60); p=0,611.
Kesimpulan: Tidak terdapat perbedaan diameter anteroposterior dan area hiatus
levator ani pada saat istirahat, valsava, dan kontraksi sebelum dan setelah persalinan
vaginal.
Kata Kunci. Persalinan vaginal, diameter anteroposterior, area hiatus levator,
prasalin, pascasalin
Background: The pelvic floor encompasses the entire structure within the pelvic cavity, extending
from the right lateral side to the left side of the pelvic wall, and from the symphysis bone to the
coccigius. Pelvic floor dysfunction resulting from pelvic floor muscle weakening can lead to pelvic
organ prolapse and urine incontinence, resulting in a diminished quality of life. Vaginal birth is
the primary determinant for pelvic floor dysfunction, making it crucial to promptly identify the
several factors that can contribute to this condition, such as alterations in the anteroposterior
diameter and levator hiatus area.
Objective: This study aims to determine the changes in anteroposterior diameter and levator hiatus
during pregnancy and after vaginal delivery.
Research method: This study is a prospective cohort study conducted at Dr. Sardjito Hospital
from January to December 2023. The study included full-term pregnant patients who went through
vaginal delivery at the same hospital. The sample method used was consecutive sampling. The
acquired data was organized into a table and subjected to the Shapiro-Wilk test to assess its
normalcy. The paired T test was employed to evaluate the disparity in the size of the levator hiatus
and the anteroposterior diameter of the pre- and postpartum levator hiatus, given that the data
exhibited a normal distribution. Conversely, the Wilcoxon test was utilized when the data did not
conform to a normal distribution.
Results: There were 40 primigravida subjects in the period January – December 2023, 27 subjects
underwent Caesarean section, 3 subjects lost to follow-up, and 10 subjects with complete pre- and
postpartum data. The average levator area of prenatal hiatus was 13.55 + 6.91 and postpartum
13.83 + 0.68, p=0.722. The median anteroposterior diameter of the levator of prenatal hiatus is
5.16 (3.40-5.71) and postpartum 5.27 (3.82-5.60); p=0.611.
Conclusions: There was no difference in the diameter of the anteroposterior and the levator ani
hiatus area at rest, valsava, and contractions before and after vaginal delivery.
Keywords. Vaginal delivery, anteroposterior diameter, levator hiatus area, prenatal, postpartum
Kata Kunci : Persalinan vaginal, diameter anteroposterior, area hiatus levator, prasalin, pascasalin