Perbandingan daya guna oksitosin saat kepala Crowning dengan oksitosin segera setelah bayi lahir pada manajemen kala III

BRAHMANA, Ivanna Beru, dr. H. Zain Alkaff, SpOG(K)

2005 | Tesis | PPDS I Obstetri dan Ginekologi

Latar belakang: Dalam manajemen aktif kala III, oksitosin diberikan segera setelah bayi lahir sebagai upaya pencegahan terjadinya perdarahan postpartum. Pemberian oksitosin pada saat kepala crowning memungkinkan oksitosin bekerja lebih cepat sehingga memberi efek yang lebih baik. Tujuan Penelitian: Membandingkan keefektifan pemberian oksitosin saat kepala crowning dengan oksitosin segera setelah bayi lahir. Rancangan Penelitian: Uji klinis secara random (randomized clinical trial). Bahan dan Cara: Penelitian dilakukan di RS Dr. Sardjito Jogjakarta dan 8 rumah sakit afiliasi. Dari 1312 pasien yang memenuhi kriteria inklusi dan eksklusi dilakukan randomisasi menjadi 2 kelompok, 656 termasuk kelompok perlakuan dan 656 kelompok kontrol. Kelompok perlakuan mendapatkan oksitosin 10 IU intramuskuler pada saat kepala crowning, dan kelompok kontrol diberikan segera setelah bayi lahir. Luaran yang dinilai meliputi jumlah perdarahan, lama kala III, kejadian retensi plasenta, atoni uteri, dan kebutuhan uterotonika tambahan. Hasil: Kedua kelompok sebanding dalam hal paritas, umur kehamilan, kadar hemoglobin, umur ibu, dan lama persalinan. Terdapat perbedaan bermakna pada jumlah perdarahan (152,93±50,99 ml vs. 174,05±161,25 ml; p=0,001), dan lama kala III (7,69±3,27 menit vs. 8,25±3,58 menit; p= 0,003). Tidak didapatkan kejadian retensi plasenta dan atoni uteri pada kelompok perlakuan, sedang pada kelompok kontrol didapatkan 2 (0,3%) kasus retensi plasenta dan 9 (1,4%) kasus atoni uteri. Dari 9 kasus atoni uteri terdapat 1 (11,11%) orang meninggal dunia. Kebutuhan uterotonika tambahan pada kelompok kontrol 25 kali lebih banyak daripada kelompok perlakuan (0,2% vs. 3,8%; RR 25; 95% Cl 6,26-99,85). Simpulan: Pemberian oksitosin saat kepala crowning mengurangi jumlah perdarahan, memperpendek lama kala III, mengurangi kejadian retensi plasenta, atoni uteri, dan kebutuhan uterotonika tambahan dibandingkan kelompok oksitosin segera setelah bayi lahir.

Background: During active management of the third stage, oxytocin was given after delivery of the fetus to prevent postpartum hemorrhage. Oxytocin administration during the fetal head is crowning, however, stimulates uterine contraction faster and more effective bleeding control is expected. Objectives: To compare effectiveness of oxytocin administration in the active management of the third stage between when the head is crowning vs. soon after delivery of the fetus. Study design: Randomized clinical trial. Materials and methods: The study was conducted in Sardjito Hospital Jogjakarta and 8 affiliation hospitals. A total of 1312 patients meeting the inclusion and exclusion criteria were randomized into two groups, 656 belonged to the treatment (crowning) and 656 the control (after delivery of the fetus) groups. Outcomes measured were amount of bleeding, duration of the third stage, occurrence of retained placenta, uterine atony, and the use of additional oxytocics. Results: Both groups were comparable in terms of parity, gestational age, hemoglobin level, age, and duration of labor. There were significant differences in the amount of bleeding between treated and control group i.e. 152.93±50.99 ml vs. 174.05±161.25 ml (p= 0,001) and the duration of the third stage of labor i.e. 7.69±3.27 vs. 8.25±3.58 minutes (p= 0,003). There was no retained placenta and uterine atony in the treatment group, but there were 2 (0.3%) cases of retained placenta and 9 (1.4%) cases of uterine atony in the control group. One out of 9 cases (11,11%) of uterine atony died due to massive postpartum hemorrhage. The use of oxytocics in the control group was 3.8% compared to only 0.2% in the treatment, giving the relative risk 25 times higher (95%CI 6.26-99.85). Conclusions: The administration of oxytocin during the fetal head is crowning reduced the amount of postpartum bleeding and duration of the third stage of labor significantly. Neither retained placenta nor uterine atony was encountered, and the use of oxytocics was fewer than the treatment group.

Kata Kunci : Perdarahan Postpartum,Oksitosin, oxytocin, active management of the third stage, postpartum hemorrhage, additional oxytocics.