Faktor Risiko Persalinan Tanpa Pertolongan Tenaga Kesehatan di Kabupaten Banjarnegara Tahun 2018

The risk factors of medically unassisted baby delivery in Banjarnegara DistrictPurpose: This study aims to identify risk factors of medically unassisted baby delivery in Banjarnegara Regency. Method: Mix method research design (case-control completed with in-depth interview). The sample size was 112 with a ratio of 1: 1 (56 cases and 56 controls), taken by simple random sampling based on secondary data PWS-KIA Banjarnegara District Health Office in 2018 including a qualitative sample of 5 people taken purposively. Data collection was carried out by means of interviews using questionnaires and interview guides. Analysis of bivariable data with McNemar test and multivariable with multiple logistic regression using the STATA 13.1 program. Results: Thirty-four (60.7%) respondents who gave birth without the help of health workers had a low educational level. The result of multivariable analysis showed a significant relationship between maternal education (aOR = 4.06; 95% CI = 1.32-12.45), history of ANC (aOR = 4.26; 95% CI = 1.24-14.64 ) and family support (aOR = 7.16; 95% CI = 1.73-29.51). Qualitative results show that prior delivery experience was the reason why women chose to give birth at home without the help of health workers. Conclusion: Childbirth without the help of health workers in Banjarnegara District was influenced by maternal education, ANC history, and family support. It is expected that families can be involved in providing Information and Education Communication (IEC) during ANC visits of pregnant women to increase awareness and knowledge related to safe pregnancy and childbirth.Latar Belakang: Angka Kematian Ibu (AKI) masih menjadi prioritas utama di negara berkembang termasuk Indonesia yang masih mencapai 305 per 100.000 kelahiran hidup pada tahun 2015. Banjarnegara menjadi salah satu kabupaten penyumbang kematian ibu tertinggi kelima di Provinsi Jawa Tengah sebanyak 21 kasus pada tahun 2017. Salah satu strategi untuk menurunkan angka kesakitan dan kematian ibu sesuai SDGs 2030 adalah persalinan ditolong oleh tenaga kesehatan di fasilitas kesehatan. Penelitian ini bertujuan untuk mengidentifikasi faktor risiko persalinan tanpa pertolongan tenaga kesehatan di Kabupaten Banjarnegara Metode: Desain penelitian mix method (case-control yang dilengkapi dengan in-depth interview). Besar sampel adalah 112 dengan perbandingan 1:1 (56 kasus dan 56 kontrol), diambil secara simple random sampling berdasarkan data sekunder PWS-KIA Dinas Kesehatan Kabupaten Banjarnegara tahun 2018 termasuk sampel Kualitatif berjumlah 5 orang yang diambil secara purposif. Pengumpuan data dilakukan dengan cara wawancara menggunakan kuesioner dan panduan wawancara. Analisis data bivaribel dengan uji McNemar test dan multivariabel dengan multiple logistic regression menggunakan program STATA 13.1 Hasil: Penelitian ini menghasilkan temuan sebanyak 34 (60,7%) responden yang bersalin tanpa pertolongan tenaga kesehatan memiliki tingkat pendidikan Tamat SD. Hasil analisis multivariabel menunjukan hubungan yang signifikan antara pendidikan ibu (aOR=4,06; 95%CI=1,32-12,45), riwayat ANC (aOR=4,26; 95%CI=1,24-14,64) dan dukungan keluarga (aOR=7,16; 95%CI=1,73-29,51). Hasil kualitatf menunjukan faktor pengalaman bersalin sebelumnya menjadi alasan ibu bersalin dirumah tanpa pertolongan tenaga kesehatanKesimpulan: Persalinan tanpa pertolongan tenaga kesehatan di Kabupaten Banjarnegara di pengaruhi oleh pendidikan ibu, riwayat ANC dan dukungan keluarga. Diharapkan keluarga dapat dilibatkan dalam pemberian Komunikasi Informasi dan Edukasi (KIE) saat kunjungan ANC ibu hamil untuk meningkatkan kesadaran  dan pengetahuan terkait kehamilan dan persalinan yang ama

Perbandingan Luaran Maternal dan Neonatal antara Seksio Cesarea Emergensi dan Seksio Cesarea Elektif pada Kehamilan dengan Janin Presentasi Bokong

Latar Belakang: Kehamilan dengan janin presentasi bokong terjadi pada 3-4% dari semua kelahiran tunggal. Presentasi bokong merupakan ±17% indikasi utama dikerjakannya seksio cesarea elektif saat ini. Seksio cesarea dapat menjadi prosedur untuk menyelamatkan ibu dan bayi, tetapi juga dapat menyebabkan komplikasi untuk ibu dan bayi. Seksio cesarea elektif diyakini dapat menurunkan risiko terjadinya komplikasi maternal dan neonatal dibandingkan seksio cesarea emergensi.Tujuan: Penelitian ini bertujuan untuk menilai luaran maternal dan neonatal antara seksio cesarea emergensi dan elektif dengan mengambil sampel pada kehamilan dengan janin presentasi bokong.Metode: Penelitian dilakukan dengan desain kohort retrospektif. Pengambilan sampel dilakukan secara konsekutif pada subjek ibu hamil dengan janin presentasi bokong yang melahirkan secara seksio cesarea selama tahun 2014-2019. Dua kelompok yang dibandingkan yaitu seksio cesarea emergensi dan elektif. Luaran penelitian adalah luaran maternal berupa kejadian infeksi dan perdarahan, sedangkan luaran neonatal adalah asfiksia dan cedera neonatal. Data dianalisis dengan uji Chi Square atau Fisher Exact, dilanjutkan uji regresi logistik.Hasil dan Pembahasan: Terdapat 240 sampel, terdiri dari 105 sampel seksio cesarea emergensi dan 135 sampel seksio cesarea elektif. Dari hasil analisis bivariat, diperoleh bahwa seksio cesarea emergensi berhubungan dengan lebih tingginya kejadian nilai Apgar rendah pada menit pertama dan menit kelima dan cedera persalinan, meskipun tidak bermakna secara statistik. Analisis multivariat menunjukkan bahwa seksio cesarea emergensi berhubungan dengan terjadinya infeksi maternal (p= 0.002, OR 3.65, 95% CI 1.59– 8.40) dan perdarahan (p= 0.042, OR 2.27, 95% CI 1.06– 6.1).Kesimpulan: Seksio cesarea emergensi secara signifikan berhubungan dengan luaran buruk maternal, yaitu terjadinya komplikasi infeksi dan perdarahan, namun tidak memberikan luaran neonatal yang lebih buruk dibandingkan seksio cesarea elektif. Pemeriksaan antenatal dan pengambilan keputusan penatalaksanaan yang tepat diperlukan untuk menekan terjadinya komplikasi.Kata kunci:  kehamilan dengan presentasi bokong, seksio cesarea emergensi, seksio cesarea elektif, luaran maternal, luaran neonatal

Faktor-Faktor yang Mempengaruhi Cakupan Skrining Kanker Serviks dan Loss to Follow Up pada Wanita dengan IVA Positif yang Menjalani Krioterapi di Negara Berkembang: Scoping Review

Background: Cervical cancer is one of the main health problems in developing country and the second most common cancer in Indonesian women. For a better outcome, it is necessary to pay attention for discovery of the disease at an early stage. Single visit approach with visual inspection of acetic acid (VIA) followed by cryotherapy considered efficient and cost effective. However, low uptake of screening and loss to follow up after cryotherapy remain the biggest challenge.Objective: We aimed to identify factors affecting low uptake of cervical cancer screening and loss to follow up women with VIA positive undergone cryotherapy in developing countries.Method: This study is a literature review with scoping review design. Systematic search were conducted from databases PubMed, ScienceDirect, SAGE journals, Scopus and Google Scholar. Total 42 articles were selected for analysis, 35 articles discussed factors affecting cervical cancer screening uptake in developing countries and 7 articles discussed loss to follow-up women with VIA positive undergone cryotherapy.Results and Discussion: Factors identified affecting cervical cancer screening uptake and loss to follow up from demand side included lack of knowledge, perception and awareness, access constrain, fear or shame feeling and cost related problem. From supply side or healthcare system, these factors included lack of trained providers, lack of infrastructure, lack of information, coordination and communication, as well as ineffective administrative processes.Conclusion: Problems of cervical cancer screening uptake and loss to follow up after cryotherapy were identified from demand side and health service provider side. Recommendation of service improvement must consider influencing factors and limitations encountered on the field. Keywords: cervical cancer, screening, visual inspection of acetic acid, loss to follow-up, cryotherap

Analisis Faktor Risiko Cedera Buli Iatrogenik pada Operasi Obstetri

Background: Bladder is one of urinary tract that is anatomically close to gynecological organs. The risk of iatrogenic bladder injuries is an undesirable event. It can increase in obstetric and gynecological  procedures. We can identified  the risk factors for iatrogenic bladder injuries can be identified at the beginning of operations. One of which is related to distorted pelvic anatomy, including adhesions, history of surgery, endometriosis and obesity. The type of surgery also plays a role in increasing risk of iatrogenic bladder injuries. This study aims to determine the risk factors that can increase iatrogenic bladder injuries in obstetric and gynecological surgery at Dr. RSUP. Sardjito in 2015-2020.Objective: To determine the risk factors that increase iatrogenic bladder injury in obstetric and gynecological surgery at dr. Sardjito in 2015-2020Method: Case control study was conducted at Dr. RSUP. Sardjito, Yogyakarta from January 2021 to March 2022. There were 120 patient subjects who underwent obstetric and gynecological procedures at Dr. Sardjito Hospital from 2015 to 2020 who entered the inclusion criteria. The relationship between risk factors and the incidence of iatrogenic bladder injuries was analyzed using the Chi Square test. Multivariate analysis to determine the most important risk factors were analyzed using Logistic Regression test. Data analysis with SPPS version 22.0Results and Discussion: In this study, there was an association between adhesions and the incidence of iatrogenic bladder injuries (OR = 28,895 (95% CI 9111 – 91,641); p 0.05).Conclusion : Adhesions had 29 times risk for increasing iatrogenic bladder injuries in this study.Keywords: Adhesions, Distorted Pelvic Anatomy, Risk Factors, Iatrogenic Bladder Injuries, Obstetrics, Gynaecology

Hubungan Metode Persalinan dengan Penggunaan IUD Pascasalin di RSUD Panembahan Senopati Bantul

Latar Belakang: Periode pascasalin merupakan masa yang penting untuk memulai kontrasepsi, namun masih kurang dimanfaatkan, utamanya untuk penggunaan IUD pascasalin. Hal ini ditunjukkan oleh penggunaan IUD pascasalin hanya 14,06% dari keseluruhan metode kontrasepsi pascasalin. Angka seksio sesarea meningkat signifikan akhir-akhir ini, mencapai 29,6% di Indonesia. Peningkatan angka seksio caesarea (SC) tidak diikuti peningkatan penggunaan IUD pascasalin. Padahal peluang penggunaan IUD pascasalin pada persalinan abdominal/seksio sesarea lebih besar. Tujuan: Penelitian ini bertujuan untuk melihat hubungan antara metode persalinan dengan penggunaan IUD Pascasalin di RSUD Panembahan Senopati. Metode: Penelitian ini merupakan penelitian analitik dengan desain cross sectional atau potong lintang, sampel penelitian diambil dari pasien yang melahirkan di RSUD Panembahan Senopati, data dikumpulkan dengan metode wawancara. Uji Chi square dan prevalence ratio dipakai untuk analisis statistika. Hasil dan Pembahasan: Penelitian ini melibatkan 260 subyek, 161 (61,92%) persalinan vaginal dan 99 (38,08) SC. Total pengguna IUD pascasalin sebanyak 128 (49,23%). Persalinan SC memiliki hubungan bermakna dengan penggunaan IUD pascasalin (p 0,000; PR 1,49; CI 1,19-1,89).  Faktor lain yang mempengaruhi penggunaan IUD pascasalin secara bemakna adalah riwayat penggunaan metode kontrasepsi jangka panjang (MKJP) sebelumnya (p 0,002; PR 1,68; CI 1,38-2,06), adanya asuransi Jaminan Kesehatan Nasional (JKN) (p 0,038; PR 1,71; CI 1,04-2,80), dan konseling (p 0,000; PR 2,84; CI 1,85-4,35). Alasan terbanyak subyek menolak penggunaan IUD pascasalin adalah takut efek samping (35%). Kesimpulan: Penggunaan IUD pascasalin lebih tinggi secara bermakna pada seksio sesarea dibandingkan persalinan vaginal. Faktor lain yang mempengaruhi penggunaan IUD pascasalin secara bermakna adalah riwayat penggunaan MKJP, adanya asuransi JKN dan konseling. Kata Kunci: IUD pascasalin; metode persalinan; angka pemasangan; persalinan vaginal, SC 

Comparison of Serum Interleukin-6 (Il-6) Levels Between Patients With HELLP Syndrome Versus Normotensive Pregnant

Background: Interleukin-6 (IL-6) has been known associated with oxidative stress and endothelial dysfunction, and also has important roles in pathogenesis of preeclampsia. Several studies have demonstrated that there was a significant increase of serum IL-6 levels in preeclamptic compared to normotensive pregnant women. However, study to evaluate serum IL-6 level in pregnant women with HELLP (hemolysis, elevated liver enzyme, and low platelet) syndrome is not well documented yet. This study aims to evaluate serum IL-6 levels between women with HELLP syndrome compared to normotensive pregnant.Methods: The research design was observational cross-sectional study. Samples were recruited consecutively using inclusion and exclusion criteria from emergency department and inpatient wards at Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Serum IL-6 were collected from venous blood sample and measured by enzyme-linked immunoassay (ELISA) method. Independent-samples t-test or Mann-Whitney test was used to compare serum IL-6 values between women with HELLP syndrome and normotensive pregrnancy. A statistical measurement conducted using SPSS IBM Statistics 19® and considered significance when p<0,05.Results: There were 46 subjects, consisted of 23 women with HELLP syndrome and 23 women with normotensive pregnancy. Serum IL-6 level was a mean of 0,11±0,08 pg/mL and 0,15±0,20 pg/mL in women with HELLP syndrome compared to normotensive pregnancy respectively. There was no significant statistical difference between both groups (p=0,17).Conclusion:.The result of this study has shown that no significant difference of serum IL-6 level in HELLP syndrome women compared to normotensive pregnant women.

Pengaruh Kualitas Sperma terhadap Kualitas Embrio pada Pasangan yang Menjalani IVF di RSUP Dr. Sardjito

Latar belakang: Kualitas sperma pria pada beberapa dekade terakhir berdasarkan studi mengalami penurunan. Penurunan kualitas sperma merupakan penyebab infertilitas pada laki-laki. Kualitas sperma yang menurun mempengaruhi kualitas embrio yang akan didapakan pada program IVF. Kualitas sperma dapat menjadi faktor prediktor kualitas embrio yang akan didapatkan pada program IVF. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan kualitas sperma dengan kualitas embrio pada pasangan yang menjalani IVF di RSUP Dr. Sardjito. Metode: Penelitian ini menggunakan metode kohort retrospektif. Pengambilan sampel menggunakan consecutive sampling. Subjek penelitian dibagi menjadi 3, yaitu kualitas sperma normal, perubahan ringan sperma dan perubahan berat sperma pada pasangan suami istri yang menjalani program bayi tabung (IVF/ICSI) di klinik infertilitas Permata Hati, RSUP Dr. Sardjito, antara 1 Januari 2019-31 Desember 2020. Hasil: Sampel yang memenuhi kriteria inklusi dan eksklusi sebanyak 319. Sampel tersebut terbagi menjadi 93 pada sperma normal, 144 pada perubahan sperma ringan, 82 pada perubahan sperma berat. Hasil penelitian ini terdapat hubungan yang bermakna antara kualitas sperma dengan  kualitas embrio (p<0,001). Perubahan sperma berat secara statistik memiliki hubungan yang bermakna dengan embrio kualitas buruk (p<0,001). Pada perubahan sperma berat memiliki risiko 2,7 kali terhadap embrio kualitas buruk dibandingkan dengan sperma normal (OR=2,706; CI 95% 1,677-4,365). Kesimpulan: Kualitas sperma secara statistik memiliki hubungan yang bermakna dengan kualitas embrio pada pasangan yang menjalani IVF. Perubahan sperma berat memiliki risiko 2,7 kali terhadap embrio kualitas buruk dibandingkan dengan sperma yang norma

Hubungan Onset Preeklamsia dengan Luaran Neonatus di RSUP Dr.Sardjito Yogyakarta

Background: Preeclampsia is one of the leading causes of death for both mother and fetus. Preeclampsia is divided into two categories of onset, for preeclampsia that begins at gestational age below 34 weeks is called early onset preeclampsia and late onset preeclampsia begins after gestational age above 34 weeks. In early-onset preeclampsia, there is an imperfect remodeling of the maternal spiral arteries, resulting in abnormal uteroplacental perfusion, causing hypoxia and acidosis in neonates which can increase incidence of IUGR, incidence of neonatal sepsis, neonatal mortality, low APGAR scores and longer hospital length of stay.Objectives: To determine the relationship between maternal and neonatal outcomes with early-onset preeclampsia and late-onset preeclampsia.Methods: This study was a retrospective cohort design and the sampling method used consecutive sampling. The research subjects were divided into two groups, the early-onset preeclampsia group and the late-onset preeclampsia group who were treated and gave birth at the RSUP. Dr. Sardjito Yogyakarta in 2019-2020.Results and Discussion: This study had a total sample of 235 subjects consisting of 146 subjects in the EO-PE group and 89 subjects in the LO-PE group. The two groups had a significant difference in the incidence of neonatal death, the incidence of neonatal sepsis and length of stay (p<0.05), but there was no significant difference in the incidence of IUGR (p=0.527) and the incidence of low Apgar score (p=0.771).Conclusion: There was no difference in the incidence of IUGR and low Apgar score between mothers with EO-PE and mothers with LO-PE. The incidence of neonatal sepsis and the incidence of neonatal death in mothers with EO-PE is higher than in mothers with LO-PE which was influenced by gestational age and history of preeclampsia. The length of neonatal hospital stay in mothers with EO-PE is longer than that of mothers with LO-PE, it was influenced by the onset of preeclampsia and gestational age. Keywords: Early onset preeclampsia; late onset preeclampsia; neonatal outcome; neonatal sepsis; IUGR.

Ogilvie’s Syndrome Post Elective Caesarean Section

Background: Ogilvie's syndrome is an acute abdominal condition characterized by massive colonic distension without any evidence of mechanical obstruction. In female patients this syndrome was associated with caesarean section and the use of spinal anaesthetics.Case: We report a case of Ogilvie's syndrome that occurred after elective caesarean section. On the first day postoperative care the patient complained of lower abdominal pain accompanied by abdominal bloating. Physical examination reveals a distended abdomen without clinical evidence of peritonitis. Vital signs were normal and laboratory results showed an increase in leukocytes. An abdomen radiology was taken and shows gas distention in the large intestine which did not decrease even after given muscle relaxants. The patient then underwent emergency surgery by digestive surgeon followed by decompression measures for intestinal distention. The patient got a good postoperative care and continued control through the outpatient clinic.Discussion: The exact mechanism that causes colonic dilatation in Ogilvie's syndrome is not known clearly, but many of these cases are associated with trauma, spinal anaesthesia, and pharmacological agents in which the autonomic nervous system (ANS) function is impaired. Diagnosis can be made by abdominal imaging which will show dilation of the large intestine. The main goal of treatment is to decompress the colon and thereby minimize the risk of colonic ischemia, perforation, and death. Pharmacological therapy should be considered in patients who fail conservative management within 24-48 hours, with the last resort being colonic decompression up to laparotomy with or without stoma creation.Conclusion: Although it has a rare incidence, Ogilvie's syndrome has a high morbidity and mortality rate. Proper management of Ogilvie's Syndrome is carried out according to an algorithm starting from conservative management, pharmacology, to surgical management in resistant cases.Key words: Ogilvie syndrome; acute abdomen; caesarean section complication

The Impact of Obstetrician/Gynecologist Hospitalists on Neonatal Quality of Care in Sardjito General Hospital Yogyakarta, Indonesia: A Retrospective Cohort Study

ABSTRACT Background : The hospitalist model in obstetric care which was introduced over the last decades now has an important role in care delivery management with the potential positive impact on neonatal outcomes.Methods : This research design was retrospective cohort. Participants included is the patient in the time before and after implementation of obstetrician/gynecologist full-hospitalist policy during October 2013 until September 2014. The outcome measured were mean response time, APGAR score at 5 minutes, , NICU admission. Univariate and multivariable analyses was conducted to evaluate and determine the factor which significantly contribute to neonatal outcomes.Results and Discussion: We included total 71 patients (37 on-call obstetrician group and  34 full-time hospitalist group).  Univariate analysis indicated  mean response time was significantly differ in full-time hospitalist group when compared to the on-call obstetrician group (65,3 + 25,89 vs. 84 + 22,29 mins; p = 0,002). Implementation of full-time hospitalist did not impact the  NICU admission and APGAR score at 5 minutes. Conclusion : Implementation of full-time hospitalist model is  not affecting neonatal outcomes.Keywords :  Infant and Maternal Mortality, Obtericians / Gynecologist Hospitalist, Labor and Delivery, Maternal and Neonatal Care, ICU Response Time.