Faktor-faktor yang berhubungan dengan ibu nyaris mati dan kematian maternal (near miss maternal morbidity and maternal mortality) di RSUD Undata Provinsi Sulawesi Tengah

MANGUN, Mardiani, Prof. dr. Djaswadi Dasuki, MPH., Sp.OG(K), Ph.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Angka Kematian ibu di Indonesia menurut laporan SDKI 2003, masih tinggi yaitu 307/100.000 kelahiran hidup, dibanding dengan negara ASEAN lainnya. Satu peristiwa paling dekat dengan kematian adalah near miss maternal morbidity, yaitu suatu komplikasi obstetrik yang mengancam jiwa ibu hamil, melahirkan atau dalam waktu 6 minggu setelah melahirkan (nifas) tetapi hidup, karena faktor keberuntungan karena pelayanan & perawatan yang cepat & tepat di rumah sakit. Jumlah kasus near miss lebih banyak (211) dibanding kasus kematian (44). faktor risiko kematian ibu juga merupakan faktor risiko near miss. Near miss merupakan indikator baru untuk menilai mutu pelayanan kebidanan & untuk meningkatkan perawatan kesehatan maternal sehingga pasien yang berisiko tinggi/komplikasi obstetri berat tidak mengalami near miss bahkan kematian. Tujuan: Penelitian ini untuk mengetahui faktor–faktor yang berhubungan dengan kejadian near miss/maternal mortality dalam rangka memperbaiki mutu pelayanan kebidanan di RSUD Undata Provinsi Sulawesi Tengah. Metoda: Penelitian ini merupakan penelitian observasional berbasis rumah sakit (hospital based) dengan rancangan matched case-control study. Lokasi penelitian di RSUD Undata Prov. Sulawesi Tengah. Subjek penelitian adalah ibu (maternal) dengan menyetarakan gejala/diagnosis, yang terdiri dari 27 kasus: 81 kontrol (1:3). Faktor risiko yang diteliti: waktu tunggu (response time), penolong, transfusi darah dan perawatan di ICU, dengan confounding variable: umur, paritas dan kondisi saat masuk Rumah Sakit. Analisis data menggunakan “Conditional Logistic Regression”. Hasil: Analisis statistik menunjukkan bahwa faktor risiko yang berhubungan dengan maternal mortality adalah response time (OR=4,1; 95%CI=1,37- 12,27) dan kondisi saat masuk rumah sakit (OR=4,8 95%CI=1,11-20,72).Faktor risiko lain: penolong, transfusi darah dan perawatan di ICU, secara praktis mempunyai hubungan dengan maternal mortality. Simpulan: Ibu yang terlambat ditangani berpeluang lebih besar untuk mengalami kematian dibandingkan ibu near miss. Faktor lain yang berpengaruh adalah kondisi ibu jelek/buruk saat masuk rumah sakit.

Background: According to the 2003 Indonesia’s Health and Demographic Survey (IHDS), maternal mortality rate in Indonesia remains high (307 per 100.000 live births). Near miss maternal morbidity is an obstetric complication that threatens a mother’s life during pregnancy and delivery or within 6 weeks after delivery but she survives by chance or due to timely and appropriate hospital services and treatment. The number of near miss cases is greater than that of mortality cases (211 and 44, respectively). The incidence of near miss is close to death so that maternal death risk factor is considered as a near miss risk factor. Near miss becomes a new indicator to assess obstetric service quality to improve maternal health services with the hope that the high risk patients need to be treated in the Intensive Care Unit (ICU) in order that near miss and ultimately maternal mortality can be avoided. Objective: To study related factors of the incidence of near miss/maternal mortality to improve obstetric service quality at the Undata Provincial General Hospital, Central Sulawesi Province. Method: This was a hospital-based observational study with a case control study design by using retrospective. The study site was in Undata Provincial General Hospital in Central Sulawesi Province. The study subject was mothers with matching symptoms and diagnosis consisting of 27 cases and 81 controls (1:3). Risk factors observed were response time, birth attendants, blood transfusion and ICU service and the confounding variables were age, parity and the condition at hospital admission. The data analysis employed here was conditional logistic regression. Results: Statistical analysis showed that the risk factor related to maternal mortality was response time and the condition at hospital admission; OR=4.1 (95%CI=1.37-12.23) and OR=4.8 (95%CI=1.11-20.72) respectively. Practically, birth attendants, blood transfusion, and ICU service were correlated with maternal mortality. Conclusion: Mothers with delayed treatment had a greater chance to die compared to near miss. Another affecting factor was the mother’s condition at hospital admission.

Kata Kunci : Faktor risiko,Near miss,maternal mortality,risk factor