MANAJEMEN PENANGANAN KEGAWATDARURATAN OBSTETRI PADA PUSKESMAS PONED DI KABUPATEN DOMPU PROVINSI NUSA TENGGARA BARAT

NURJAYANTI, dr. Lutfan Lazuardi, M.Kes., Ph.D.

2012 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Kegawatdaruratan dan komplikasi obstetri tidak selalu dapat diramalkan sebelumnya dan mungkin saja terjadi pada ibu hamil yang di indentifikasi normal, sehingga ibu hamil harus dapat sedekat mungkin dengan sarana kesehatan yaitu puskesmas. Pelayanan kegawatdaruratan diberikan di puskesmas disebut Pelayanan Obstetri Neonatal Emergenci Dasar (PONED). Menurut laporan tahunan Dinas Kesehatan Kabupaten Dompu PONED tahun 2010 terdapat kematian ibu sebanyak 4 orang dari jumlah kelahiran hidup sebanyak 5.327 orang dan dari jumlah komplikasi obstetri yang ditemukan di puskesmas dan polindes/poskesdes sebanyak 1.192 dan dirujuk ke RSUD sebanyak 493 kasus. Metode Penelitian: Metode kualitatif dengan rancangan studi kasus dan data dianalisa secara deskriptif untuk mengevaluasi proses pelaksanaan manajemen penanganan kegawatdaruratan obstetri dan pengelolaan rujukan kasus kegawatdaruratan obstetri pada puskesmas PONED di Kabupaten Dompu. Subyek penelitian adalah kepala dinas kesehatan, kepala bidang Binkesmas dan kepala bidang Yankesdas dan rujukan Dinas Kesehatan Kabupaten Dompu, tim PONED puskesmas, bidan desa dan dokter IGD Rumah Sakit Umum Dompu, serta ibu hamil dengan jumlah responden 20 orang. Hasil: Pelayanan dan manajemen kegawatdaruratan puskesmas PONED masih bersifat on call, ketersediaan dana sudah cukup namun masih ada komponen biaya yang belum dianggarkan, fasilitas dan peralatan sebagian besar sudah ada, namun ada beberapa yang belum tersedia. Tim PONED belum mengikuti pelatihan untuk pengembangan staf dan program evaluasi belum pernah dilakukan. Penanganan dan pengelolaan rujukan ibu hamil belum sepenuhnya memakai standar rujukan BAKSOKU. Sarana transportasi ambulan kondisi tidak layak untuk dipakai merujuk. Kesimpulan: Ibu hamil yang dirujuk dan ditangani tidak sesuai prinsip dasar penanganan kasus rujukan dapat meningkatkan risiko kematian ibu.

Background: Emergency and obstetric complications can not always be foreseen in advance and may occur in pregnant women in the identification of normal, so that pregnant women should be as close as possible to health facilities is a primary health care. Emergency services are provided at primary health care is called Neonatal Basic Obstetric Services Emergency(PONED). According to the annual report of the District Health Office Dompu PONED maternal mortality in 2010 there were as many as 4 people from the number of live births and as many as 5,327 people from the number of obstetric complications were found in primary health care and Polindes/ Poskesdes as many as in 1,192 and refer to RSUD as many as 493 cases. Method: Qualitative methods in the design case studies and data analyzed by descriptive process management to evaluate the implementation of emergency handling and management of obstetric emergency obstetric referral cases in primary health care PONED in Dompu District. The subject of this research is Head of Division Binkesmas and Head of Division Yankesdas and referral health department Dompu district, PONED Primary health care team, midwives and physician emergency General Hospital Dompu, as well as pregnant women by the number of respondents 20 people. Result: Service and emergency management PONED Primary health care is still on call, the availability of funds is sufficient but there are still components that are not budgeted, most of the facilities and equipment already exists, but there are some that are not yet available. PONED team has not attended training for staff development and program evaluation has not been done. Handling and management of referral of pregnant women has not been fully put BAKSOKU referral standard. Ambulance transportation means the condition is not feasible to be used to refer. Conclusion: The pregnant women who are referred to and addressed the basic principle is not appropriate for handling the case referral may increase the risk of maternal death.

Kata Kunci : Kegawatdaruratan, obstetri, puskesmas PONED, rujukan kasus