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