PERBANDINGAN PENGARUH PEMBERIAN METILERGOMETRIN SECARA INTRAVENA DAN INTRAMIOMETRIAL PADA SEKSIO SESAREA

ANITA ROHMAH, Dr. H. Risanto Siswosudarmo, SpOG(K),

2013 | Tesis | S2 Ilmu Kebidanan dan Penyakit Kandungan

Latar belakang: Perdarahan pascasalin adalah penyebab utama meningkatnya morbiditas dan mortalitas maternal. Walaupun mempunyai efek samping, metilergometrin masih banyak digunakan sebagai second line drug dalam penanganan perdarahan pascasalin setelah oksitosin. RCOG merekomendasikan pemberian injeksi metilergometrin 0,5 mg secara intravena untuk pencegahan atoni uteri pada seksio sesarea, sedangkan World Health Organization (WHO) merekomendasikan pemberian 0,2 mg metilergometrin intravena atau intramuskuler, dan bila perlu dapat diulang setiap 15 menit sampai dosis maksimum 1 mg. Terdapat perbedaan cara pemberian pada seksio sesarea, yaitu secara intravena dan intramiometrial. Tujuan penelitian: Menganalisis perbandingan pengaruh pemberian metilergometrin secara intravena dan intramiometrial pada seksio sesarea terhadap lama pelepasan plasenta, jumlah perdarahan kala III dan kala IV serta efek samping yang berupa kenaikan tekanan darah dan kejadian mual/muntah. Metodologi: Menggunakan desain Randomized Controlled Trial (RCT). Subyek penelitian berjumlah 96 orang (48 orang intravena dan 48 orang intramiometrial) dengan indikasi seksio sesarea yang memenuhi kriteria inklusi dan ekslusi pada periode April 2012 sampai September 2012. Digunakan uji statistik independent t-test untuk data nominal dan chi-square untuk data untuk data dikotomi. Analisis data memakai komputer perangkat lunak paket statistik SPSS versi 15.0. Hasil: Tidak terdapat perbedaan yang bermakna dari jumlah perdarahan kala III dan kala IV pada metilergometrin intravena dibanding intramiometrial (95%CI: -115,32-33,94, p=0,99), demikian juga pada rerata penurunan kadar hemoglobin, pada perlakuan intravena 0,96±0,49 dan intramiometrial 0,95±0,35 (95%CI: -0,17-0,18, p=0,472), kadar hematokrit 2,77±1,37 dan 2,79±1,05(95% CI:-0,62-0,37). Lama pelepasan plasenta juga tidak didapatkan perbedaan bermakna 2,15±0,75 menit dan intramiometrial 2,32±0,90 menit (95%CI:-30,23-10,27) Kesimpulan: Tidak ada perbedaan bermakna pada jumlah perdarahan kala III dan kala IV, lama pelepasan plasenta dan penurunan kadar hemoglobin dan hematokrit antara pemberian metilergometrin secara intravena dan intramiometrial.

Background: Postpartum hemorrage is a major cause of increased morbidity and maternal mortality. Although it has side effects, methylergometrin still widely used as a second line drug in the treatment of postpartum hemorrhage after oxytocin. RCOG recommends giving methylergometrin injection of 0.5 mg intravenously for the prevention of uterine atonia in caesarean section, while the World Health Organization (WHO) recommends giving methylergometrin 0.2 mg intravenously or intramuscularly, and if necessary can be repeated every 15 minutes up to a maximum dose of 1 mg. There is a difference route of administration of methylergometrin in caesarean section, there is intravenous and intramyometrial administration. Objective: Comparing effects of intravenous and intramyometrial methylergometrin in the length of detachment of the placenta and the amount of bleeding in the stage III and stage IV. Methodology: Randomized Controlled Trial (RCT). The subject was 96 pregnant women. Subjects were grouped into intervention group (intravenous methylergometrin) and control group (intramyometrial methylergometrin) with indication caesarean section who qualified inclusion and exclusion criteria, from April 2012 to September 2012. Statistical tests used independent t-test for nominal data and chi-square for dicotomic data. Analysis of the data using computer software SPSS version 15.0. Results: There was no significant mean difference between the amount of bleeding the third stage and fourth stage (95% CI: -115,32-33,94, p= 0.99), there was no significant difference between the mean of decrease in hemoglobin levels, the intravenous group 0,96 ± 0.49 and 0.95±0.35 intramyometrial (95% CI: -0,17-0,18, p = 0.472). The length of detachment of the placenta is also not found significantly difference (95% CI:-30,23-10,27), p=0.06). Conclusion: There was no significant difference in the effect of intravenous and intramyometrial methylergometrine in the amount of bleeding the third and fourth stage, the mean of decrease of hemoglobin and hematokrit levels, and the length of detachment on cesarean section.

Kata Kunci : metilergometrin, intravena, intramiometrial