Indikasi persalinan Sectio Cesaria (SC) di Rumah Sakit Pemerintah dan Rumah Sakit Swasta di Kota Medan

SITORUS, Samsidar, Prof.dr. Djaswadi Dasuki, MPH.,SpOG(K).,Ph.D

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kes. Ibu dan Anak-Ke

Latar belakang : Persalinan sectio caesarea merupakan masalah kesehatan masyarakat (public health). Persalinan sectio caesarea mengakibatkan angka kesakitan ibu dan biaya persalinan semakin tinggi, dibanding dengan persalinan normal. Peningkatan CSR (caesarean section rate) sangat pesat hampir di seluruh negara. Standar rata-rata menurut WHO di sebuah negara adalah 10-15%. (WHO,1985). Persentasi CSR terbanyak menurut propinsi adalah Bali 42,6 dan Sumatera Utara 37%. Menurut Dirjen Pelayanan Medik Dep. Kes. RI (2000) CSR di rumah sakit pendidikan <20% dan di rumah sakit non pendidikan <15% per tahun. Peningkatan CSR disebabkan Indikasi dimana adanya indikasi medis dan indikasi non medis seperti permintaan ibu paling mendominasi. Indikasi persalinan sectio caesarea dipengaruhi oleh umur ibu, paritas yang semakin sedikit, pendidikan ibu, penghasilan, sosial budaya dan tafsiran berat janin serta faktor yang lain. Tujuan : Mengetahui indikasi persalinan SC dan membandingkan indikasi medis dan non medis persalinan SC di rumah sakit pemerintah dan rumah sakit swasta di kota Medan. Metode : Jenis penelitian adalah observasional dengan rancangan crosssectional. Populasi seluruh ibu dengan persalinan sectio caesarea di Kota Medan. Lokasi penelitian RS pemerintah : RSU DR Pirngadi dan RS swasta: Sri Ratu, Elisabeth, Mitra Sejati, Vina Estetica, Siti Hajar dan Martha Friska dipilih secara purposif. Subyek diambil dengan teknik acak sederhana sebesar 324 orang. Teknik pengumpulan data dengan menggunakan daftar tilik (check-list). Analisis data yang digunakan univariabel, bivariabel, multivariabel mengunakan analisis chi-square dan multinomial logistic regression dengan tingkat signifikan p < 0.05 dan confidance interval (CI) 95%. Hasil : Indikasi medis persalinan sectio caesarea di rumah sakit pemerintah 69.3% dan indikasi non medis 29.1%. Indikasi medis di rumah sakit swasta 30.7% dan Indikasi non medis 70.9%. Hasil uji analisi univariabel dan multivariabel menunjukkan ada hubungan yang bermakna rumah sakit pemerintah dan rumah sakit swasta terhadap indikasi persalinan sectio caesarea OR 5.5. (CI3.41-9.11) p <0.001. Variabel bebas lain yang significant adalah umur p=0.05, paritas p= 0.003,sosial budaya p=0.001, pendidikan= p,<0.001, penghasilan <0.001. Hasil stratifikasi bahwa umur, paritas, dan penghasilan merupakan efek modifikasi. sedangkan pendidikan dan sosial budaya perancu. Kesimpulan : ada perbedaan Indikasi persalinan sectio caesarea di rumah sakit pemerintah dan di rumah sakit swasta di Kota Medan.

Background: Caesarean Section (CS) remains a major public health problem resulting in more maternal morbidity and higher cost than normal delivery. Caesarean Section Rate (CSR) is high in almost all countries with the average according to WHO reaching 10-15% (WHO, 1985). The highest percentage of CSR regarding to provinces is Bali and North Sumatera Provinces, that is, 42.6% and 37% respectively. According to Health Office of Indonesia (2000), CSR in education hospital is less than 20% and in non education hospital is less than 15% per year. Increase of CSR is due to both medical and non medical indications such as mother’s demand for CS that dominates. CS indications are influenced by mother’s age, parity, mother’s education, income, socio-culture, estimation of baby’s weight, and other factors. Objective: To investigate and to compare medical and non medical CS indications in public and private hospitals in Medan. Method: This was an observational study with cross sectional study design. Population was all mothers delivering by CS in Medan. Study took place in Pimgadi hospital (public) and in Sri Ratu, Elisabeth, Mitra Sejati, Vina Estetica, Siti Hajar and Martha Friska hospitals (private) selected purposively. Three hundred and twenty four subjects were selected randomly. Data collection was by check list and the analysis used univariable, bivariable, stratification, and multivariable logistic regression with p < 0.05 and CI 95%. Results: Medical and non medical indications for CS in public hospital were 69.3% and 29.1% while medical and non medical indications for SC in private hospitals were 30.7% and 70.9%. There was a significant association between public and private hospitals and CS indications, OR 5.5 (CI 3.41 -9.11) p <0.001. Other significant independent variables were age p=0.05, parity p= 0.003, socio-culture p=0.001, education p<0.001, and income <0.001. After being stratified, age, parity, and income were modification effects while education and socio-culture were confounding factors. Conclusion: There is an indication difference of SC in public and private hospitals in Medan.

Kata Kunci : Persalinan Sectio Cesaria,RS Swasta dan RS Pemerintah