Penagruh kualitas rujukan kedaruratan obstetri terhadap asfiksia dan kematian perinatal di Rumah Sakit Sardjito dan Rumah Sakit Afiliasi

WIBOWO, Nanang, Prof. dr. H.Moh.Hakimi, PhD.,SpOG(K)

2010 | Tesis |

penting terhadap hasil kehamilan dan persalinan. Kurang lebih 40% kasus di RS merupakan kasus rujukan. Kematian maternal di RS pendidikan 80–90% merupakan kasus rujukan. Kematian perinatal di RS pendidikan 60% berasal dari kelompok rujukan. Salah satu keberhasilan bidang obstetri khususnya kegawatan obstetri adalah manajemen yang tepat sesuai standar yang ditetapkan termasuk kualitas sistem rujukan. Tujuan: Untuk mengetahui pengaruh kualitas rujukan kedaruratan obstetri terhadap kejadian asfiksia dan kematian perinatal. Metode: Studi kohort prospektif, dimana kelompok rujukan tidak sesuai standar disebut kelompok exposed, dan kelompok sesuai standar rujukan disebut kelompok kontrol. Desain dan cara penelitian: Penelitian dilakukan di RS Sardjito dan RS afiliasi di Yogyakarta. Setiap kasus rujukan kedaruratan obstetri yang sesuai kriteria inklusi dan eksklusi diobservasi dan dicatat. Hasil yang diamati adalah kejadian asfiksia bayi dan kematian perinatal. Data diolah dengan program statistik komputer. Analisis uji statistik dilakukan dengan Chi square dan analisis regresi logistik. Hasil: Dari 1 januari - 31 Maret 2010 terdapat 160 kasus rujukan kedaruratan obstetri terdiri dari 55 kasus (34,4%) di RS Sardjito dan 105 kasus (66,6%) di RS Afiliasi. Sebagian besar kasus tidak didampingi tenaga terlatih 81 kasus (50,6%). Rujukan tanpa surat keterangan 10 kasus (6,3%). Kesulitan transportasi pada 14 kasus (8,7%). Proses stabilisasi penderita tidak dilakukan pada 86 kasus (53,8%). Pada penelitian ini ditemukan bahwa penderita yang dirujuk tanpa stabilisasi memiliki risiko 2,29 kali untuk terjadi asfiksia bayi baru lahir, RR=2,29 (95% CI :1,27 – 4,12). Simpulan: Pelayanan rujukan kedaruratan obstetri sebagian besar belum dilaksanakanoptimal sesuai prinsip dasar rujukan ditetapkan. Tidak adanya tindakan stabilisasi yang optimal terbukti meningkatkan kejadian asfiksia bayi sebesar 2,29 kali.

outcome of pregnancy and labor. More or less 40% of the cases in the hospital are referred cases. In the teaching hospital, 80-90% of maternal mortality is referral cases. Around 60% of perinatal mortality in the teaching hospital arises from the referred group. One of the factors that determine successful management in the obstetric field is the precise management in line with the standard. Objective: To recognize the effect of obstetric emergency referral quality to the occurrence of asphyxia and perinatal death. Methods: Prospective cohort study. The referral group that did not fulfill the basic principles of referral, was named the exposed group, while the group that fulfilled the standard was named control group. Study design: This study was carried out in Sardjito Hospital and 4 other affiliated hospitals in Yogyakarta. Every obstetric emergency referral case that met the inclusion criteria was observed and recorded. The outcome of interest was neonatal asphyxia and perinatal death. Chi square test and logistic regression were used as statistical analysis. Result: From January 1st 2010 to March 31th 2010 there were 160 cases of obstetric emergency referral cases, of which 55 cases (34.4%) were from Sardjito hospital and 105 cases (66.6%) were from affiliated hospitals. Most of the cases, 81 cases (50.6%) were not accompanied by trained professionals during referral. There were 10 cases (6.3%) without letter of reference. Transportation difficulties were not found in 14 of the cases (8,7%). The stabilization process was not done in 86 of the cases (53.8%). In this study, it was found that patients that were referred without stabilization increased the risk of neonatal asphyxia to 2.29 times (RR=2.29 CI (1.27-4.12)). Conclusion: Most of the obstetric emergency cases were not optimally managed according to the basic principles of referral. Lack of optimal maternal stabilization during referral had been proven to increase occurrence of neonatal asphyxia to 2.29 times.

Kata Kunci : Rujukan obstetri,Asfiksia bayi,Kematian perinatal