Risiko rehospitalisasi pada persalinan seksio sesaria dan persalinan operative vaginal di RS khusus ibu dan anak RSUD Kota Bandung

YULINDA, Prof. dr. Djaswadi D., SpOG(K), MPH, Ph.D

2009 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Morbiditas atau kesakitan ibu yang serius setelah persalinan seksio sesarea, seperti perdarahan, infeksi dan thromboemboli, dapat membawa dampak terhadap kesehatan fisik dan mental ibu, bayi dan keluarganya. Selain itu morbiditas ibu meningkatkan pembiayaan, terputusnya peran parenthood dan meningkatkan beban keluarga. Rehospitalisasi merupakan indikator kesehatan maternal yang banyak tidak terlaporkan. Tujuan penelitian ini adalah untuk mengetahui perbedaan risiko rehospitalisasi pada persalinan seksio sesarea dan persalinan operative vaginal Metode: Penelitian ini dilakukan dengan menggunakan jenis penelitian observasional analitik, desain unmatched case control study dengan menggunakan pendekatan kuantitatif dan kualitatif. Penelitian ini berfokus pada ibu post partum yang mengalami rehospitalisasi kemudian diamati jenis persalinan seksio sesarea sebagai paparan. Analisis data yang dilakukan yaitu analisis univariabel, bivariabel menggunakan chi-square dan multivariabel menggunakan regresi logistik. Besar sampel dalam penelitian ini sebanyak 146 orang, terdiri dari 49 kasus dan 97 kontrol . Hasil : Kejadian rehospitalisasi tiga kali lebih besar terjadi pada kelompok persalinan seksio sesarea dibandingkan dengan persalinan operative vaginal. Persalinan seksio sesarea mempunyai hubungan yang signifikan dengan rehospitalisasi (OR=3,24; 95% CI=1,34-7,80). Faktor lain yang mempengaruhi rehospitalisasi adalah Obstetrical hemorrhage dan ketuban pecah dini. Ditemukan ibu post partum yang belum mampu melakukan self care pada masa post partum, kondisi ini dapat meningkatkan risiko rehospitalisasi. Didapatkan juga ibu post partum dengan indikasi rehospitalisasi namun karena alasan ekonomi tidak melakukan rehospitalisasi. Kesimpulan: Kejadian seksio sesarea adalah sebesar 19% sedangkan kejadian rehospitalisasi sebesar 3%. Metode persalinan seksio sesarea dapat meningkatkan risiko rehospitalisasi sebesar 3,3 kali lebih tinggi dibandingkan persalinan operative vaginal.

Background: Severe maternal morbidity after cesarean section such as hemorrhage, infection or thromboemboli can bring serious impacts toward physical and mental health of the mother, infant, and family. Besides, maternal morbidity also leads to other problems such as the increased cost, discontinued parenthood role, and family’s increased burdens. Rehospitalization is an indicator of maternal health that its many cases remain unreported. Objective: To study the rehospitalization risk difference between cesarean section delivery and operative vaginal delivery. Method: This was an observational-analytic study with an unmatched case control study design using quantitative and qualitative approaches. This study focused on post partum women experiencing rehospitalization and cesarean section delivery as the exposure was then observed. Data were analyzed with univariabel analysis, bivariabel analysis using chisquare, and multivariabel analysis using logistic regression. Sample size was 146 persons consisting of 46 women as case and 97 women as control. Results: Rehospitalization was three times greater on cesarean section delivery than in operative vaginal delivery. Cesarean section had a significant relationship with rehospitalization (OR=3.24; 95%CI=1.34-7.80). Other factors affecting rehospitalization were obstetrical hemorrhage and premature rupture of membrane. This study showed that some post partum women were still unable to perform self care that increased rehospitalization risk. Some women with an indication of rehospitalization were also found not to do rehospitalization due to economic reason. Conclusion: The prevalence of Cesarean section delivery was 19%. The prevalence of rehospitalization was 3%. Cesarean section delivery could increase maternal rehospitalization 3.3 times greater than operative vaginal delivery. Other factors that had roles in increasing the incidence of rehospitalization were obstetrical hemorrhage and premature rupture of the membrane.

Kata Kunci : Persalinan seksio sesarea,Rehospitalisasi ; Cesarean section delivery, Maternal rehospitalization