Kejadian dan keberhasilan penanganan kasus perdarahan pada puskesmas pelayanan obstetri neonatal emergensi dasar (PONED) di Kabupaten Agam Sumatera Barat

ARIANI, Shinta, Prof. dr. M. Hakimi, Sp.OG(K), Ph.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Angka kematian ibu (AKI) tinggi disebabkan karena komplikasi obstetri secara langsung (90%) dengan kasus perdarahan (28%). Masalah perdarahan pascapersalinan menjadi penting bukan karena kasusnya banyak tetapi karena prosesnya cepat untuk menyebabkan kematian bagi ibu yang mengalaminya. Semua ibu dianjurkan untuk melahirkan dengan tenaga kesehatan dan memanfaatkan fasilitas Puskesmas Pelayanan Obstetri Neonatal Emergensi Dasar (PONED). Tujuan: Penelitian ini bertujuan untuk mengetahui keberhasilan penanganan kasus perdarahan pada Puskesmas PONED. Metode Penelitian: Penelitian observasional dengan desain studi potong lintang (cross sectional study). Lokasi penelitian pada Puskesmas PONED Dinas Kesehatan Kabupaten Agam Propinsi Sumatera Barat. Subjek penelitian adalah ibu yang mengalami perdarahan waktu hamil, persalinan dan pascapersalinan yang mendapatkan penanganan di Puskesmas PONED pada bulan Januari 2006 sampai April 2008 dengan besar sampel minimum sebanyak 50 orang dengan α=0,05 dan ß=20%. Data dianalisis dengan menggunakan beberapa cara yaitu analisis univariabel, bivariabel, dan multivariabel. Uji hipotesis dengan uji Chi-square (χ2) pada tingkat kemaknaan p=0,05, dan convidence interval=95%. Analisis multivariabel dengan menggunakan analisis regresi logistik. Hasil Penelitian: Hasil analisis menunjukan bahwa Puskesmas PONED kurang lengkap lebih besar kegagalan penanganan kasus perdarahan dibandingkan dengan Puskesmas PONED lengkap ditandai dengan (OR=8,4; 95% CI=3,49-20,58). Kesimpulan: Puskesmas PONED kurang lengkap mengalami kegagalan penanganan kasus perdarahan lebih tinggi dibandingkan dengan Puskesmas PONED lengkap. Variabel luar (umur ibu, jarak kelahiran anak, pengeluaran rumah tangga, dan jarak tempuh ke fasilitas kesehatan), tidak berhubungan dengan keberhasilan penanganan kasus perdarahan.

Background: High maternal mortality is caused by complications of direct obstetrics (90%) with bleeding cases (28%). Postpartum bleeding problems become important not because of the number of cases but because the process is relatively quick to cause death in mothers who encounter the problem. All mothers are recommended to give birth with the assistance of health staff and utilize health center facilities of basic emergency neonatal obstetric service. Objective: The study aimed to identify the performance of bleeding case management at basic emergency neonatal obstetric service of health center. Method: The study was observational and used cross sectional design. Location of the study was basic emergency neonatal obstetric service of health center at Agam District Health Office, Province of Sumatera Barat. Subject of the study were mothers that underwent bleeding during pregnancy, gave birth and parturated and got basic emergency neonatal obstetric service of health center from January 2006 to April 2008 with as many as 50 samples minimum with α=0.05 and β=20%. Data were analyzed using univariable, bivariable and multivariable methods. Hypothethic test used chi square at significance level p=0.05 and confidence interval 95%. Multivariable analysis used logistic regression. Result: The result of analysis showed that there was relationship between less capable basic emergency neonatal obstetric service of health center and the performance of bleeding case management with (OR=8,4;95% CI=3,49-20,58). Conclusion: Basic emergency neonatal obstetric service at health center which was less capable would have risk increase of failure in bleeding case management as many as times greater than those that were capable. External variables particularly mother’s ages, birth spacing, economic status, and distance to health facility were not significant.

Kata Kunci : Puskesmas PONED,Perdarahan,Persalinan,basic emergency neonatal obstetric service, bleeding case management.