Ketepatan rujukan bidan pada kehamilan berisiko di Rumah Sakit Umum Daerah Dr. Soedarso Pontianak Kalimantan Barat

SARI, Utin Siti Candra, dr. Ova Emilia, SpOG, M.M.Ed, PhD

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Angka Kematian Ibu (AKI) di Indonesia menurut World Health Organization, menduduki urutan ke-3 setelah Banglades dan India, yaitu 230 per 100.000 kelahiran hidup. Diperkirakan 5 juta kelahiran setiap tahun atau 20.000 ibu meninggal akibat komplikasi kehamilan dan persalinan. Penyebab AKI, perdarahan (24%), eklamsi (12%), komplikasi aborsi yang tidak aman (13%), infeksi sepsisi, termasuk infeksi penyakit menular hubungan seks (15%), persalinan lama (8%), Penyebab AKI di Indonesis antara lain: antenatal, penolong persalinan, sistim rujukan, kurang memadainya pelayananan kesehatan oleh tenaga profesional dan etos kerja yang rendah. WHO, Depkes RI dan Making Pregnancy Safer memprioritaskan peningkatan mutu perawatan kehamilan/persalian, akses pelayanan yang terampil dan akses rujukan kasus komplikasi. Pelayanan kesehatan primer oleh bidan dapat menurunkan AKI (20%), di tunjang sistim rujukan efektif AKI dapat di tekan (80%). Tujuan Penelitian: Untuk mengetahui hubungan karakteristik bidan dengan ketepatan merujuk kehamilan berisiko di RSUD dr. Soedarso Pontianak. Metode Penelitian: Jenis penelitian observasional, rancangan crosssectional. Sampel seluruh ibu kehamilan berisiko yang di rujuk bidan ke RSUD dr. Soedarso, jumlah sampel 173 responden. Menggunakan data sekunder dan kuesioner. Analisis dengan uji statistik Chi Square dan Regresi Logistik untuk mengetahui pola hubungan antar variabel. Hasil: Bidan yang D-III Kebidanan, ada pelatihan dan pengalaman lama masa kerja lebih 10 tahun lebih tepat menegagkkan diagnosis dan lebih tepat dalam teknik merujuk kehamilan berisiko dibandingkan dengan bidan yang belum D-III,tidak pelatihan dan lama masa kerja yang kurang. Tidak ada hubungan yang signifikan antara karakteristik bidan dalam ketepatan menegakkan diagnosis kehamilan berisiko dan ketepatan dalam teknik merujuk kehamilan berisiko di RDUD dr. Soedarso Pontianak. Kesimpulan: Ada hubungan antara karakteristik bidan dengan ketepatan merujuk kehamilan berisiko di RSUD dr. Sodarso Pontianak, namun secara statistik tidak signifikan

Background: Maternal mortality in Indonesia according to the World Health Organization (WHO) is in the third rank after Bangladesh and India, i.e. 230 per 100,000 births alive. It is estimated that each year out of 5 million births, as many as 20,000 mothers die due to complication in pregnancy and births. The cause of maternal mortality are bleeding (24%), eclampsia (12%), complication of unsafe abortion (13%), sepsis due to infection of sexually transmitted diseases (15%), and prolonged labor (8%) due to hip-head disproportion. Other causes are lack of antenatal care, unskilled birth assistants, weak referral system, limited health service provided by health professionals and low work ethic. WHO and Indonesian Ministry of Health in the program of making pregnancy safer put priorities on improvement of pregnancy and child birth quality of care, access to health service provided by skilled health professional, and access to referral of complication cases. Objective: To identify the relationship between characteristics of midwives and accuracy of risk pregnancy referral at dr. Soedarso Hospital of Pontianak. Method: The study was observational with cross sectional design. Samples consisted of all pregnant mothers at risk referred by midwives to dr. Soedarso Hospital of Pontianak with as many as 173 respondents. Data were obtained from questionnaires and secondary data. Statistical data analysis used chi square and logistic regression to find out relationship among variables. Result: Inaccuracy in making diagnosis belonged to high for midwives who had not had DIII certificate (50%), who did not follow training (51,85%), and who worked for (symbol)10 years (51,72%). Inaccuracy in referral technique belonged to very high for midwives who had not had DIII certificate (91.43%), who did not have training (100%) and who worked for (symbol)10 years (96.55%). The result of statistical test was p>0.05 with OR=1.10 for midwives who did not have DIII certificate; OR=1,17 for those who did not have training and OR=1,16 for those who worked for (symbol)10 years. This meant that inaccuracy in diagnosis was higher 1.17 times in midwives without DIII certificate, 1.10 times in those without training and 1.16 times in those working for (symbol)10 years than in midwives having DIII certificate, training and working for >10 years. The result of statistical test of inaccuracy in referral was p>0.05 with OR=1.28 for midwives without DIII certificate, OR=0.88 for those without training and OR=3.50 for those who worked for less than 10 years. This meant that inaccuracy in referral technique was higher 1.28 times in midwives without DIII certificate, 0.88 times in those without training and 3.50 in those who worked for (symbol)10 years than in those having DIII certificate, training and working for >10 years. Conclusion: There was relationship between characteristics of midwives and accuracy in referring risk pregnancy at dr. Soedarso Hospital of Pontianak, however the relationship was statistically insignificant.

Kata Kunci : Ketepatan rujukan,Kehamilan berisiko,Bidan,accuracy, referral, midwives