Efektivitas posisi jongkok terhadap lama persalinan kala II pada Primipara

NAWANGSIH, Umu Hani Edy, Prof.dr. Djaswadi Dasuki, MPH.,Ph.D.,Sp.OG(K)

2006 | Tesis | S2 Ilmu Kedokteran Klinik

Latar Belakang : Sampai saat ini posisi berbaring, dorsal recumbent atau litotomi masih menjadi posisi dominan dalam praktek pertolongan persalinan. Akan tetapi posisi tegak (termasuk posisi jongkok) pada kala II persalinan secara anatomis sebenarnya memiliki keuntungan-keuntungan bagi wanita dalam proses persalinan. Tujuan dari penelitian ini adalah mengetahui apakah posisi persalinan jongkok dapat mempersingkat waktu kala II, menurunkan risiko kejadian ruptur dan episiotomi. Metode: Penelitian dengan rancangan Randomized Controlled Trial (RCT) dilakukan di beberapa tempat bidan praktek swasta (BPS) mitra peneliti di Yogyakarta periode September 2005 – April 2006. Didapatkan 109 subyek, dimana 55 subyek melakukan persalinan dengan posisi jongkok dan 54 subyek melakukan persalinan dengan posisi dorsal recumbent. Analisis yang digunakan meliputi uji statistik student t-test, chi-square test, perhitungan OR dengan confidence interval 95 %, dan analisis regresi. Hasil: Terdapat perbedaan rerata lama kala II yang signifikan antara posisi jongkok dan dorsal recumbent (34,3±15,9 vs 40,8±11,3; p=0,014). Posisi jongkok juga berhubungan dengan penurunan kejadian ruptur. Perempuan yang melahirkan dengan posisi jongkok secara signifikan memiliki prevalensi ruptur perineum yang lebih sedikit daripada posisi dorsal recumbent (39,1% vs 60,9%; p=0,003; OR=3,63; 95%CI: 1,581 – 8,335). Terdapat penurunan kejadian episiotomi pada posisi jongkok dibandingkan dorsal recumbent (14,5% vs 29,6%; p=0,057; OR=2,474; 95%CI; 0,956 – 6.398), tetapi secara statistik tidak signifikan. Kesimpulan: Posisi jongkok selama kala II persalinan sedikit mempersingkat lama kala II dan secara signifikan menurunkan prevalensi ruptur perineum.

Background : Up to recent times, dorsal recumbent and lithotomy still became a more frequently adopted positions in modern obstetrics. However, upright position, including squatting, during second stage of labor may have advantages for women delivering their babies. The aim of this study was to determine whether squatting position in second stage of labor influenced duration of second stage of labor, proportion of episiotomy, and perineal rupture. Method : A randomized controlled trial study was conducted in Yogyakarta from September 2005 – April 2006. The study was conducted on 109 primigravidae pregnant women who were randomly classified into 2 groups. The control group comprised of 54 mothers in dorsal recumbent position throughout labor and delivery. The squatting group consisted of 55 cases who squat during 2nd stage of labor. Third stage of labor conducted in supine position. Duration of second stage of labor, proportion of episiotomy, and perineal rupture then evaluated using chi square, student t test, and multivariate regression. Result : There was a significantly mean difference between the squatting and control groups (34.3±15.9 vs 40.8±11.3; p=0.014). Squatting also associated with lower incidence of perineal rupture. Women having birth in dorsal recumbent had significantly higher prevalence of perineal rupture (39.1% vs 60.9%; p=0.003; OR=3.63; 95%CI: 1.581 – 8.335). Lower incidence of episiotomy found in squatting compared to dorsal recumbent position (14.5%vs 29.6%; p=0.057; OR=2.474; 95%CI; 0.956 – 6.398), but statistically not significant. Conclusion : The squatting position during second stage of labor, slightly shortened second stage of labor, and significantly lowered the overall prevalence of rupture perineum.

Kata Kunci : Persalinan Kala II,Posisi Jongkok, labor position, squatting, dorsal recumbent, second stage of labor, primigravidae.