KETEPATAN WAKTU PELAYANAN SECTIO CAESAREA DAN LAMA RAWAT INAP DI RSU SANTA MARIA PEMALANG

M.Sariyem, Prof.dr. Iwan Dwiprahasto,M.MedSc.,Ph.D.

2013 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Sectio Caesarea salah satu bentuk persalinan yang kejadiannya semakin meningkat di seluruh dunia. Dalam 15 tahun terakhir, proporsi kelahiran Sectio Caesarea telah meningkat terus, di Inggris sampai mencapai angka 24% dari semua kelahiran. Sectio Caesarea bisa mengakibatkan risiko permasalahan pada ibu dan bayi yang dilahirkan. ` Tujuan: Mengidentifikasi faktor-faktor indikasi, menganalisis ketepatan waktu pelayanan dan menilai dampak terhadap outcomes dan lama hari rawat pada pasien yang menjalani Sectio Caesarea di RSU Santa Maria Pemalang Metode: Penelitian Observasional Analitik dilakukan untuk menggali faktor-faktor yang mempengaruhi keputusan dilakukanya tindakan operasi kemudian melakukan analisis hubungan ketepatan waktu pelayanan Sectio Caesarea terhadap outcomes dan lama rawat inap di RSU Santa Maria Pemalang. Hasil: Faktor indikasi medis Sectio Caesarea di RSU Santa Maria Pemalang adalah persalinan macet (24,5%), Abnormal Presentation Janin (17%), gagal induksi (13,2%), ketuban pecah dini (13,2%),hipertensi & preeklamsia (13,2%),riwayat SC (3,8%), panggul sempit (3,8%),permasalahan plasenta (1,9%) dan perdarahan Antepartum (1,9%). Faktor indikasi non medis atas permintaan pasien (7,5%). Waktu tanggap pelayanan Sectio Caesarea di RSU Santa Maria Pemalang antara 3 menit – 1920 menit sehingga rata-rata waktu 424 menit, dengan waktu tanggap >15 menit berpengaruh terhadap outcome dan lama rawat inap: risiko apgar skor 4-6 (RR=3,85; 95%CI=0,66-22,40), risiko lama rawat bayi >4 hari (RR= 2,50;95%CI=0,42-14,76), risiko lama rawat ibu >4 hari (RR=2,19;95%CI=0,37-12,99). Waktu tunggu pelayanan Sectio Caesarea antara 7 menit – 500 menit sehingga rata-rata waktu tunggu 107 menit, dengan waktu tunggu >15 menit berpengaruh terhadap outcome dan lama hari rawat: risiko terjadinya apgar skor 4-6 (RR=6,58;95%CI=1,05-41,35), risiko outcome buruk pada ibu (RR=1,60;95%CI=0,23-10,96), risiko lama rawat bayi >4 hari ( RR=4,27; 95%CI=0,67-27,23), risiko lama rawat ibu >4 hari ( RR=3,77; 95%CI=0,58-23,98). Waktu tunda pelayanan Sectio Caesarea antara 0-214 menit sehingga rata-rata waktu tunda 30 menit berpengaruh terhadap outcome dan lama rawat inap: risiko apgar skor 4-6 (RR=1,78;95%CI=1,22-2,60), risiko outcome buruk pada ibu (RR=9,346;95%CI=1,27-68,68), risiko lama rawat bayi >4 hari (RR=24,92;95%CI=3,63-171,11), risiko lama rawat ibu >4 hari (RR=6,58;95%CI=2,207-19,60) Kesimpulan: Ada hubungan pengaruh yang bermakna antara ketepatan waktu pelayanan Sectio Caesarea dengan outcomes dan lama rawat inap di RSU Santa Maria Pemalang.

Background: Number of sectio-caesarian delivery is increasing worldwide. In the last 15 years, proportion of section-caesarian delivery in the UK is 24% of all type of delivery. Unfortunately, sectio caesarian delivery poses medical risks to the mother and neonates. Aims: To identify factors affecting decision making for sectio caesaria, to analyze respon time to sectio-caesaria treatment and its impact to the outcomes of mother and neonates, and to measure length of stay of patients receiving sectio-caesaria treatment in Santa Maria Hospital, Pemalang. Method: This is an observational analytic study conducted from December 2012 to February 2013 to all patients receiving sectio-caesaria treatment at Santa Maria Hospital, Pemalang. Result: Indications for sectio caesaria delivery are failure to progress (24,5%), abnormal presentation (17%), failure labour induction trial (13,2%), amniotic rupture (13,2%), increased blood pressure in the mother with hypertension and pre-eclampsia (13,2%), small pelvic diameter (3,8%), placenta preavia, placental abruptions (1,9%) and antepartum bleeding (1,9%). Non-medical indications for sectio-caesarian at the patient’s request (7,5%). The response time from admission to sectio-caesarian is between 3 minutes - 1920 minutes so that the average time of 424 minutes, the response time> 15 mins influence on outcome and length of stay: the risk of Apgar score of 4-6 (RR = 3.85 , 95% CI = 0.66 to 22.40), the risk of long hospitalization for> 4 days (RR = 2.50, 95% CI = 0.42 to 14.76), the risk of long hospitalization mom> 4 days (RR = 2.19, 95% CI = 0.37 to 12.99). The wait time service Sectio Caesarea between 7 minutes - 500 minutes so that the average waiting time 107 minutes, with a wait time> 15 minutes affect the outcome and long day care: risk of Apgar score of 4-6 (RR = 6.58, 95% CI = 1.05 to 41.35), the risk of outcome worse in women (RR = 1.60, 95% CI = 0.23 to 10.96), the risk of long hospitalization for> 4 days (RR = 4.27; 95% CI = 0.67 to 27.23), the risk of long hospitalization mom> 4 days (RR = 3.77, 95% CI = 0.58 to 23.98). Time delay service Sectio Caesarea between 0-214 minutes so that the average time delay 30 minutes affect the outcome and length of stay: the risk of Apgar score of 4-6 (RR = 1.78, 95% CI = 1.22 to 2.60 ), the risk outcome for mother (RR = 9.346, 95% CI = 1.27 to 68.68), the risk of long hospitalization for> 4 days (RR = 24.92, 95% CI = 3.63 to 171.11 ), the risk of long hospitalization mom> 4 days (RR = 6.58, 95% CI = 2.207 to 19.60) Conclusions: There is a significant relationship between response time of sectioncaesarian treatment with neonate’s outcomes and length of stay in the Hospital Santa Maria Pemalang

Kata Kunci : Sectio Caesarea, ketepatan waktu, outcome dan lama rawat inap.