Perbandingan manajemen aktif kala III dan konvensional terhaap durasi kala III

LONGULO, Olkamien Jesdika, Prof. dr. Djaswadi Dasuki, MPH.,PhD,SpOG(K)

2010 | Tesis | S2 Ilmu Kedokteran Klinik

Kala III persalinan merupakan periode antara kelahiran bayi dan pengeluaran plasenta. Manajemen aktif kala III bertujuan untuk menghasilkan kontraksi uterus lebih efektif sehingga dapat mempersingkat durasi kala III. Manajemen aktif kala III durasi menjadi lebih pendek 5-15 menit dan menurunkan risiko perdarahan 60-70%. Tujuan penelitian ini adalah mengevaluasi perbedaan rerata durasi kala III pada subyek yang dilakukan manajemen aktif kala III dan manajemen konvensional, menganalisis faktor-faktor lain yang mempengaruhi rerata durasi kala III, mendeskripsikan faktor determinan pelaksanaan manajemen aktif kala III di Rumah Sakit Umum Sinar Kasih GKST Tentena Kabupaten Poso Sulawesi Tengah. Penelitian ini merupakan jenis penelitian uji klinik dengan rancangan randomized clinical trial dengan pendekatan kuanitatif dan kualitatif. Sampel penelitian ibu hamil dan melahirkan normal yang memenuhi kriteria inklusi periode Desember 2009-Maret 2010, jumlah sampel 128 dengan teknik consecutive sampling. Analisis univariat, bivariat dengan menggunakan uji statistik chi-square dan independent t-test, analisis multivariat menggunakan regresi logistik. Hasil analisis multivariabel dengan permodelan menunjukkan ada pengaruh yang bermakna antara manajemen aktif kala III dengan durasi kala III (OR: 6,07 IK 95%: 2,66-15,70) dengan mempertimbangkan variabel umur ibu dan paritas. Umur ibu 20-34 tahun mempunyai pengaruh yang bemakna terhadap durasi kala III (OR: 3,63 IK 95%: 1,51-8,70), demikian pula paritas (OR: 4,11 IK 95%: 1,78-9,43). Manajemen aktif kala III memberikan pengaruh sebesar 27% (R2=0,27) pada penurunan durasi kala III. Hasil analisis kualitiatif faktor determinan pelaksanaan manajemen aktif kala III adalah provider. Kesimpulan penelitian bahwa rerata durasi kala III lebih singkat dengan manajemen aktif kala III dibandingkan manajemen konvensional. Umur ibu dan paritas diprediksi menimbulkan efek terhadap penurunan durasi kala III. Umur kehamilan secara statistik tidak bermakna mempengaruhi rerata durasi kala III. Faktor provider yaitu pengetahuan dan keterampilan merupakan faktor utama yang menghambat pelaksanaan manajemen aktif kala III.

The third stage of labor is a period between delivery of a baby and complete expulsion of the placenta. The active management of labor aims at producing more effective uterus contraction so that it can shorten the duration of the third stage. The duration of active management of the third stage of labor become shorter by 5-15 minutes and this condition reduces the risk of bleeding up to 60-70%. This study aims to evaluate the mean difference of the duration of the third stage on the subject treated with the conventional management of the third stage of labor, to analyze other factors that effect mean duration of the third stage and to describe the determinant factors in the implementation of the active management of the third stage of labor in GKST Tentena public hospital in Poso District of Sulawesi Tengah. This was a clinical trial study with a randomized clinical trial design using qualitative and quantitative approaches. The sample were pregnant women with a method of normal delivery who met the inclusion criteria in the period of December 2009-March 2010, as many as 128 sample taken using consecutive sampling. The data were analyzed using univariate analysis, bivariate analysis with chi-square test and independent t-test, and multivariate analysis with binomial regression. The result of multivariable analysis with modeling showed that there was a significant relationship between the third stage active management of labor and the third stage duration (OR:6, 07 CI 95%: 2,66-15,70) after considering the variables of maternal age and parity. Age maternal 20-34 years has a significant influence to third stage duration (OR:3,63 CI 95%: 1,51-8,70) and also parity (OR:4,11 CI 95%: 1,78-9,43). The third stage active management give contribution reduce third stage duration until 27% (R2=0,27). The conclusion of this study is that the mean duration of the third stage using the active management was shorter than using the conventional management. Maternal age and parity were predicted to cause effects on the reduced duration of the third stage. Gestational age insignificantly effected the mean duration of the third stage statistically. The provider factor which was knowledge an skill was the determinant factor that became the barrier for the implementation of the active management of the third stage of labor.

Kata Kunci : Manajemen aktif kala III,Manajemen konvensional,Durasi kala III, active management of the third stage of labor, conventional management, the duration of the third stage