The Impact of Antenatal Care and Pre-Referral Emergency Management on Eclampsia-Related Maternal Mortality in a Low-Resource Setting

Backgrounds: Maternal mortality due to eclampsia had a high case fatality rate. This is frequently due to a failure in detection and monitoring during the ANC, as well as inadequate emergency management of eclampsia. Objective: To determine the impact of ANC and pre-referral emergency management of eclampsia-related maternal death at Dr. Soetomo and Airlangga University Hospital, Surabaya, Indonesia Methods: Analytical study with a retrospective cohort design from 2022-2023, using medical records of eclampsia patients referred to Dr. Soetomo Hospital and Airlangga University Hospital to investigate the relationship between ANC, pre-referral emergency management of eclampsia-related maternal death. Bivariate analysis used the Chi-square test, while multivariate analysis used logistic regression. Results: A total of 59 out of 65 patients met the inclusion criteria. Statistical analysis showed that study subjects aged ≥ 35 years had an association with maternal mortality in eclampsia cases (p = 0.007). A significant relationship also occurred in subjects who were not screened for preeclampsia (p = 0.013) and subjects who did not receive inadequate management of eclampsia (p = 0.000). Conclusion: Pre-referral emergency management of eclampsia is associated with eclampsia-related maternal death, hence health facilities must increase their ability to address eclampsia emergencies before referral

THE IMPACT OF THE COVID-19 PANDEMIC ON MATERNAL MORTALITY ATTRIBUTES

Background: The COVID-19 pandemic is a challenge for mothers to access health services in Indonesia. Patient management, referral processes, and maternal screening protocols are the reasons for this issue. Aims: This study aimed to analyze maternal mortality trends in East Java Province before and during the COVID-19 pandemic. Methods: This study was conducted using retrospective observation with a cross-sectional design, and samples were selected using a total sampling technique. The number of maternal deaths in East Java was 520 in 2019 and  565 in 2020. The independent variable in this study is the number of maternal deaths, and the dependent variables include age, gravida, place of death, rescue relay, time of death, and maternal complications. The variables of age, place of death, rescue relay, and gravida were assessed using the Chi-square test. Results: Statistical tests showed a ρ value of 0.195 for age; 0.916 for place of death; 0.646 for rescue relay; and 0.048 for gravida. Conclusion: Maternal mortality showed different trends before and after the pandemic in East Java.  Significant differences in maternal mortality rate are influenced by gravida status

FACTORS INFLUENCING HEALTH CARE PROVIDER IN CODUNCTING PREECLAMPSIA SCREENING

Background: Preeclampsia is responsible for maternal health globally due to its high morbidity and maternal mortality rates, especially in low-income countries such as Indonesia. Primary care providers, including general practitioners, midwives, and nurses, have a crucial role to play in the early assessment of preeclampsia screening. It was noted that factors affecting mortality were the lack of preparedness of officers in managing and responding to pregnancy emergencies, delayed recognition of worsening clinical signs of preeclampsia, as well as inadequate assessment and treatment for preeclampsia. This study aims to analyze the driving factors that influence health care provider in conducting preeclampsia screening in Gresik District. Methods: This research was an observational analytical study with a cross-sectional approach. The population in this study consisted of all doctors and midwives at the primary health facilities in the Gresik Regency area. The sample was taken from 159 respondents who were service providers in 20 primary health facilities in Gresik using simple random sampling. The variables in this study were the knowledge and attitudes of healthcare workers toward implementing preeclampsia screening. Data collection in this study used an online questionnaire conducted after issuing the Ethical Approval Letter until October 2023, which was then analyzed using a chi-square test with a significance level of 0.05.  Results: Only 27% of respondents demonstrated a good level of knowledge about preeclampsia, which affected the effectiveness of preeclampsia screening (p-value 0.04). A total of 86.2% of respondents showed a high level of attitude toward preeclampsia screening. However, this study found no significant relationship between healthcare workers' attitudes and preeclampsia screening (p-value 0.171). Conclusion: There is a significant link between the knowledge of the healthcare provider and the optimization of preeclampsia screening so new methods of training are needed that are assessed as effective and accompanied by rigorous monitoring and evaluation to enhance healthcare provider knowledge, especially concerning preeclampsia screening

Deteksi Dini Risiko Ibu Hamil Dengan Kartu Skor Poedji Rochjati Dan Pencegahan Faktor Empat Terlambat

Tujuan: menganalisis kasus kematian maternal di RSUD Dr. Soetomo tahun 2011 – 2013 dengan tiga penyebab terbanyak (perdarahan pasca salin, preeklampsia berat dan penyakit jantung) ditinjau dari skor KSPR dan faktor empat terlambat.Bahan dan Metode: Penelitian ini merupakan penelitian retrospektif observasional dengan desain studi deskriptif. Objek pada penelitian ini merupakan pasien yang meninggal sebagai kasus kematian maternal di RSUD Dr. Soetomo tahun 2011-2013, dengan jumlah 58 orang. Variabel penelitian ini adalah tingkat risiko kehamilan berdasarkan KSPR, faktor empat terlambat dan kematian maternal.Hasil: Pada penelitian ini didapatkan seluruh kasus kematian maternal mengandung unsur faktor risiko dalam KSPR dan faktor empat terlambat. KRST merupakan kelompok faktor risiko terbanyak (55,2%), diikuti oleh KRT 39,7% dan KRR 5,2%. Faktor terlambat mendeteksi tanda bahaya ditemukan sebanyak 82,8%, terlambat mengambil keputusan merujuk 56,9%, dan terlambat sampai di tempat rujukan 15,5%. Faktor terlambat mendapat pertolongan di tempat rujukan terakhir tidak ditemukan pada penelitian ini.Simpulan: KSPR masih relevan digunakan untuk deteksi dini faktor risiko ibu hamil. Pencegahan faktor empat terlambat penting untuk menurunkan angka kematian materna

INA-CBGs claim versus total hospital cost: A vaginal delivery investigation at Airlangga University Academic Hospital, Indonesia

Background: Inadequate funding for vaginal delivery can be one of the barriers to reducing the maternal mortality rate. It could be therefore critical to compare the vaginal delivery cost between total hospital cost and INA-CBGs cost in national health insurance. Methods: This was a retrospective cross-sectional study conducted from October to December 2019 in Universitas Airlangga Academic Hospital. It collected data on primary diagnosis, length of stay, total hospital cost, INA-CBGs cost, and counted disparity. The data analyzed statistically using t-test independent sample (or Mann-Whitney test).Results: A total of 149 vaginal delivery claims were found, with the majority having a level II severity (79.87%) and moderate preeclampsia as a primary diagnosis (20.1%). There was a significant disparity in higher total hospital costs compared with government INA-CBGs costs (Rp. 9,238,022.09±1,265,801.88 vs 1,881,521.48±12,830.15; p<0.001). There was also an increase of LOS (p<0.001), total hospital cost (p<0.001), and cost disparity (p<0.01) in a higher severity level of vaginal delivery.Conclusion: Vaginal delivery costs in INA-CBGs scheme are underneath the actuarial value. There was also an increase in total hospital costs and a more significant disparity in the higher severity levels of vaginal delivery

THE CORRELATION BEETWEEN MOTHER'S NUTRITIONAL STATUS AND PARITY WITH THE INCIDENT OF LOW BIRTH WEIGHT (LBW) AT A PUBLIC HEALTH CENTER SURABAYA

Background: One of the highest causative factors of neonatal death in Indonesia is low birth weight (LBW), around 7,150 (35.3%) cases. Even though the trend of LBW incidents in East Java is decreasing, in the city of Surabaya itself the death rate due to LBW has increased from 31 deaths to 51 deaths. Simomulyo Public Health Center was ranked first with the highest incidence of LBW in Surabaya with 45 cases in 2019. Even though there was a decrease in cases in 2020, the death rate actually increased from 1 death to 4 deaths. WHO (2017) defines LBW as babies born weighing ≤ 2500 gr. Nutritional status and parity are two of the many risk factors for LBW. Knowing the causal relationship with the occurrence of LBW is important to do at the public Health Center as a first step in preventing LBW in the future. Method: This research is quantitative with an analytical observational design using a cross-sectional approach. Samples were taken using probability sampling techniques, namely random sampling. The total samples taken were 96 samples. Result: The results of the research was found that there was a relationship between nutritional status and the incidence of LBW with a value of p=0.005 (p<0.05) and the relationship between parity and the incidence of LBW with a value of p=0.001 (p < 0.05). Conclusion: there is a correlation between nutritional status and parity and the incidence of LBW at the Simomulyo Public Health Center Surabaya

Factors Related To First Antenatal Visits In Pregnant Women

Abstract Background: Pregnancy is a physiological event but in its developmen it has risks. In Nagekeo district in 2018 and 2019 there were 6 cases of maternal death and 121 cases of infant mortality with 52 deaths occurring antepartum. There were 10 infant deaths at the Boawae Health Center in 2019 with 5 cases of death occurring antepartum. In addition, there is a gap in achieving the first antenatal visit target of 19% and 14.8% in 2018 and 2019 where not all pregnant women have had their first pregnancy examination in the first trimester. Several factors can influence the behavior of pregnant women in conducting the first antenatal visit such as education level and cost. The importance of carrying out a pregnancy check in the first trimester allows for early detection of disease, administration of folic acid, communication and health information as well as management of problems found. This study aims to analyze the factors associated with the first antenatal visit in pregnant women. Methods: This type of research is observational analytic with a cross sectional design. The sample in this study were all pregnant women in the 2nd and 3rd trimesters who were in the working area of the Boawae Health Center. Data collected through questionnaires were then processed and analyzed by frequency distribution and cross distribution as well as Multiple Logistics Regression analysis with a significance level of 5% (p = 0.05). The research sample size is 86 respondents. The sampling technique is non-probability sampling with consecutive sampling. Bivariate data analysis using chi square and multivariate test using multiple logistic regression. Results: The results showed that the factors associated with the first antenatal visit were maternal health status with a p-value of 0.001 (p < 0.005), husband's education with a p-value of 0.000 (p < 0.005), pregnancy complications with a p-value of 0.001 (p < 0.005), costs with a p-value of 0.002 (p < 0.005) and the presence of a companion with a p-value of 0.000 (p < 0.005). Multivariate analysis showed that the most dominant factor influencing was the cost and presence of a companion, so it can be concluded that pregnant women who have KIS and are supported by a companion are more likely to have their first visit in the first trimester of pregnancy. Conclusion: There is a relationship between health status, husband's education, costs, presence of companions, pregnancy complications with the first antenatal visit

Situation Report: Maternal Health Management during COVID-19 Pandemic at Soetomo General Hospital and Universitas Airlangga Academic Hospital, Surabaya Indonesia

The case of COVID-19 in Indonesia has shown a significantly increasing curve. This condition affected the regulation of maternal health services in Indonesia, especially in East Java Province. The health services structure was a challenge in itself, where hospitals must be adaptive during the COVID-19 pandemic. This situation also caused changes in several components of maternal health services. The report focused on maternal services in two hospitals at East Java, Indonesia (Soetomo General Hospital and Universitas Airlangga Academic Hospital) that described five main components, including patient screening, hospital visit policies, intrapartum management, postpartum management, protection and safety for health workers, and funding issues

Health system and quality of care factors contributing to maternal deaths in East Java, Indonesia

Abstract Despite most Indonesian women now receiving antenatal care on the nationally recommended four occasions and being delivered by skilled birth attendants, the nation’s maternal mortality ratio (MMR) is estimated as 177 per 100,000 live births. Recent research in a rural district of Indonesia has indicated that poor service quality due to organizational and personnel factors is now a major determinant of this high MMR. The present research is an in-depth analysis of possible health service organizational and quality of care related causes of death among 30 women admitted to a peak referral hospital in a major Indonesian city. Despite their condition being complex or deteriorating, most of these women arrived at the hospital in a state where it was feasible to prevent death with good quality care. Poor application of protocols, poor information flow from frontline hospitals to the peak referral hospital, delays in emergency care, and delays in management of deteriorating patients were the main contributing factors to these deaths. Pyramidal referrals also contributed, as many women were initially referred to hospitals where their condition could not be effectively managed. While generic quality improvement measures, particularly training and monitoring for rigorous application of clinical protocols (including forward planning for deteriorating patients) will help improve the situation, the districts and hospitals need to develop capacity to assess their local situation. Unless local organisational factors, staff knowledge and skill, blood and blood product availability, and local reasons for delays in providing care are identified, it may not be possible to effectively reduce the adverse pregnancy outcomes

Analisis faktor-faktor risiko anemia pada ibu hamil di kabupaten Gresik tahun 2021

Latar belakang : Anemia pada kehamilan berkontribusi terhadap tingginya angka kesakitan dan kesakitan dan kematian ibu dan bayi serta meningkatkan risiko Bayi Berat Lahir Rendah (BBLR). Tujuan penelitian : mengetahui faktor-faktor yang berhubungan dengan anemia pada ibu hamil di Kabupaten Gresik. Metode :Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional study. Populasi seluruh ibu hamil trimester I-III di puskesmas Kabupaten Gresik pada bulan AgustusSeptember 2021. Jumlah sampel 282 ibu hamil yang diambil secara total sampling. Data yang digunakan adalah data sekunder. Instrumen menggunakan rekam medis kohort ibu hamil. Data dianalisis dengan uji Chisquare dengan p>0.05 dan regresi logistik. Hasil : Prevelensi anemia pada ibu hamil yang ditemukan pada penelitian ini sebesar 41,5%. Hasil uji statistik menunjukkan nilai p pada variabel usia ibu, usia kehamilan, paritas, gravida, tingkat pendidikan, dan status bekerja ibu adalah 0,742; 0,000; 0,860; 0,894; 0,002; 0,011. Analisis regresi logistik menunjukkan bahwa usia kehamilan (OR=7,814; 95%CI 4,121 – 12,400; p = 0,000) adalah variabel yang dominan. Kesimpulan : ada hubungan yang bermakna antara usia kehamilan, tingkat pendidikan, dan status bekerja terhadap kejadian anemia pada kehamilan