Hubungan Striae Gravidarum dengan terjadinya Laserasi Perineum pada persalinan vaginal

DIANA, Sulis, Prof.dr. Mohammad Hakimi, SpOG(K),PhD

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kesehatan Ibu dan An

Latar belakang: Striae gravidarum terjadi pada wanita hamil lebih kurang 50% - 90%. Tanda striae pada perut yang dijumpai selama kehamilan mungkin merupakan indikasi elastisitas kulit yang kuiang baik. Efek laserasi meliputi: (1) sakit kronis pada perineum, (2) dispareunia, (3) inkontinensia urin, (4) inkontinensia alvi, (5) resiko tinggi untuk laserasi vagina terulang. Tujuan: Tujuan penelitian ini adalah mencari alat/ petunjuk bagi dokter/ bidan dalam memutuskan pasien yang rentan terjadi laserasi sehingga perlu diberi tindakan episiotomi sesuai dengan standar asuhan persalinan normal. Metode: Jenis penelitian ini adalah studi analitik observasional dengan rancangan cross sectional. Pemilihan sampel dengan simple random sampling. Subyek penelitian adalah ibu inpartu di Rumah Sakit kabupaten Jombang dan kabupaten Mojokerto, bidan praktek swasta. Data dikumpulkan dengan formulir observasi, kuesioner, pemeriksaan fisik. Variabel terikat adalah laserasi vagina sedang variabel kontrol: letak janin, berat janin, lokasi episiotomi, diameter kepala bayi, umur kehamilan, lama persalinan kala II, paritas, genetik. Hasil: Ibu inpartu yang mengalami laserasi perineum derajat 3-4 sebanyak 90 orang (23.4%). Pada uji bivariabel Striae gravidarum mempunyai hubungan yang bermakna (OR=8,23, 95% IK=5,38-12.58), sedang variabel kontrol yang bermakna antara lain: BB janin >4000 gram (OR=5,14, 95% IK=1,37-19,27), SB (OR=2,71, 95% IK=1,44-5,00), paritas (OR=4,62, 95% IK=3,13-6,83), Umur ibu (OR=6,62, 95% IK=2,91-15,07), lama persalinan (OR=3,12, 95% IK=1,26-7,69), lokasi episiotomi (OR=12,08, 95% IK=7,53- 19,37), Pada Uji multivariabel yang masih menunjukkan hubungan bermakna yaitu variabel striae gravidarum, lokasi episiotomi, paritas, BB janin dan umur ibu. Kesimpulan: striae gravidarum mempunyai hubungan yang bermakna dengan kejadian laserasi perineum dan beberapa variabel kontrol juga berpengaruh pada laserasi vagina.

Background: Striae Gravidarium occurs to pregnant women as much as 50% – 90%. Striae signs on abdomen found during pregnancy may be an indication of less elastic skin. Effects of laceration consist of: (1) chronic disease on perineum, (2) dyspareunia, (3) urine incontinensia, (4) fecal incontinensia, (5) high risk of repeated vaginal laceration. Objective: The objective of the study was to find out ways/guides for doctors/midwives in determining patients liable to having laceration so that they get episiotomy according to normal birth care standard. Method: This was an analytical observational study with cross sectional design. Samples were taken using simple random sampling technique. Subject of the study were mothers in labor at hospitals of Jombang and Mojokerto districts and midwives providing private service. Data collection used observation form, questionnaires and physical examination. Dependent variable was vaginal laceration whereas control variables were fetus position, fetus weight, location of episiotomy, diameter of fetus head, gestation period, length of phase II of labor, parity and genetics. Result: mothers in labor having perineum laceration of 3 - 4 degrees were as many as 90 mothers (23.4%). Bivariable test showed that striae gravidarum and perineum laseration had significant relationship (OR=39.78%, 95% CI=21.00 -75.37), whereas significant control variables were: birth weight > 4000 grams (OR=5.14, 95% CI=1.37 – 19.27), SB (OR=2.71, 95% CI=1.44 – 5.00), parity (OR=4.62, 95% CI=3.13 – 6.83), mothers' age (OR=6.62, 95% CI=1.26 – 7.69), location of episotomy (OR=12.08, 95% CI=7.53 – 19.37). Multivariable test which showed significant relationship were variables of striae gravidarum, location of episotomy, parity, birth weight and mothers' age. Conclusion: Striae gravidarum had significant relationship with occurence of perineum laceration but control variables also had strong effects.

Kata Kunci : Kesehatan Ibu,Asuhan Persalinan,Laserasi,Striae Gravidanum, striae gravidarum, laceration, vaginal birth