Maternal Referral Quality Analysis According to Phyo Referral Score and Its Association on Maternal and Neonatal Outcomes in RSUD Datu Sanggul Tapin

Putri Hasana Handayati, Dr. dr. Eugenius Phyowai Ganap, Sp.OG, Subsp. Obginsos ; Dr. dr. Shinta Prawitasari, M.Kes., Sp.OG, Subsp. Obginsos

2026 | Skripsi | PENDIDIKAN DOKTER

INTISARI

Latar Belakang: Angka kematian merupakan salah satu indikator utama kinerja kesehatan masyarakat. Di Tapin, angka kematian ibu masih tinggi, yaitu 303 per 100.000 kelahiran hidup pada tahun 2022, jauh dari target SDGs sebesar <70>
Tujuan: Penelitian ini bertujuan untuk menganalisis kualitas rujukan maternal di RSUD Datu Sanggul Tapin dan dampaknya terhadap luaran maternal dan neonatal.

Metode: Penelitian ini menggunakan desain kohort retrospektif dengan menganalisis rekam medis ibu hamil yang dirujuk dan luaran neonatal dari Januari 2021 hingga Desember 2023. Kualitas rujukan maternal dinilai menggunakan Phyo Referral Score dan dikategorikan menjadi kualitas baik dan buruk. Luaran maternal meliputi kebutuhan transfusi, perawatan di ICU, dan status kelangsungan hidup ibu, sedangkan luaran neonatal meliputi asfiksia, perawatan di NICU, dan status kelangsungan hidup neonatal. Data dianalisis menggunakan univariat dengan frekuensi dan persentase, analisis bivariat dengan uji chi-square, dan analisis multivariat menggunakan regresi logistik.

Hasil: Dari 517 kasus maternal yang dirujuk, sebagian besar rujukan memiliki kualitas baik (79,3%). Pada analisis bivariat, kualitas rujukan tidak menunjukkan hubungan signifikan dengan luaran maternal: kebutuhan transfusi, perawatan ICU, dan kelangsungan hidup ibu. Pada luaran neonatal, kualitas rujukan berhubungan dengan asfiksia neonatal (RR = 1,514 ; 95% CI = 1,067–2,147; p = 0,033) dan perawatan NICU (RR = 1,093; 95% CI = 1,038–1,151; p = 0,021), meskipun tidak berhubungan dengan kelangsungan hidup neonatal. Setelah disesuaikan dengan variabel lain dalam analisis multivariat, kualitas rujukan tetap signifikan hanya terkait dengan perawatan NICU (RR = 0,028; 95% CI = 0,074–0,709; p = 0,011). Asfiksia neonatal secara signifikan terkait dengan usia kehamilan <37 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed>
Kesimpulan: Sebagian besar rujukan dalam penelitian ini diklasifikasikan memiliki kualitas baik berdasarkan Phyo Referral Score. Kualitas rujukan tidak menunjukkan hubungan dengan luaran maternal, yang tampaknya lebih dipengaruhi oleh kondisi klinis ibu saat tiba. Namun, kualitas rujukan berhubungan dengan luaran neonatal, khususnya asfiksia dan perawatan NICU. Faktor lain seperti usia kehamilan <37>
Kata kunci:rujukan maternal, kualitas rujukan, Phyo Referral Score, luaran maternal, luaran neonatal, studi kohort retrospektif.

ABSTRACT

Background: Mortality rate is one of the key indicators of public health performance. In Tapin, maternal mortality remains high at 303 per 100,000 live births in 2022, which is far from the SDG target of <70>

Objective: This study aimed to analyze the quality of the maternal referral in RSUD Datu Sanggul Tapin and its impact on maternal and neonatal outcomes.

Method: This study used a retrospective cohort design analyzing medical records of referred pregnant women and neonatal outcomes from January 2021 to December 2023. Maternal referral quality was assessed using the Phyo Referral Score and categorized into good and poor quality. Maternal outcomes included transfusion demand, ICU admission, and survival status, while neonatal outcomes included asphyxia, NICU admission, and survival status. Data were analyzed using univariate by frequencies and percentages, bivariate analysis with chi-square test, and multivariate methods using logistic regression.

Results: Out of 517 referred maternal cases analyzed, most referrals had good quality (79.3%). In bivariate analysis, referral quality showed no significant association with maternal outcomes: transfusion demand, ICU admission, and maternal survival. In neonatal outcomes, referral quality was associated with neonatal asphyxia (RR = 1.514; 95%CI = 1.067 – 2.147; p = 0.033) and NICU admission (RR = 1.093; 95%CI = 1.038 – 1.151; p = 0.021), although not with neonatal survival. After adjusting with other variables in multivariate analysis, referral quality remained significantly associated only with NICU admission (RR = 0.028; 95%CI = 0.074 – 0.709; p = 0.011). Neonatal asphyxia was significantly associated with gestational age <37 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed>

Conclusion: Most referrals in this study were classified as good quality based on the Phyo Referral Score. Referral quality did not show a relationship with maternal outcomes, which seemed more affected by the mother’s clinical condition at the time of arrival. However, referral quality did relate to neonatal outcomes, particularly asphyxia and NICU admission. Other factors such as gestational age <37>

Keywords: maternal referral, referral quality, Phyo Referral Score, maternal outcomes, neonatal outcomes, retrospective cohort study.

Kata Kunci : maternal referral, referral quality, Phyo Referral Score, maternal outcomes, neonatal outcomes, retrospective cohort study