Maternal Referral at Kalabahi General Hospital : A Descriptive Study

Abstract

Maternal Referral at Kalabahi General Hospital : A Descriptive Study Rujukan Maternal di Rumah Sakit Daerah Kalabahi : Sebuah Studi Deskriptif Abstract Fuad Saddam, Putu A. A. Purbawa Departement of Obstetrics dan Gynecology Kalabahi Public Hospital, Alor Objective: To identify the characteristics of maternal referral to the Obstetrics Emergency Unit of Kalabahi General Hospital, Alor Regency, East Nusa Tenggara, Indonesia during the period of January 1, 2016 to December 31, 2017. Methods: This descriptive study was conducted to identify the characteristics of maternal referrals. Sampling method used in this study is a total sampling, in which data from register books and medical records of patients referred to Obstetrics Emergency Unit Kalabahi General Hospital from January 2016 to December 2017 were reviewed. Results: There were 724 referrals to the Obstetric Emergency Unit of Kalabahi General Hospital during the period of 20162017,

comprising 704 obstetrics cases (97.24%) and 20 gynecology cases (2.76%). Pregnancy risk assessment of these referral cases using Poedji Rochjati Score showed that 353 out of the total 565 cases (62.48%) were high risk pregnancy, and the most frequent cases are severe preeclampsia and eclampsia (46 cases/13.03%), term pregnancy with previous caesarean section (40 cases/11.33%), and breech position 39 cases (11.05%). There are 8 maternal mortality cases caused by delayed referral consisting 5 eclampsia cases and 3 antepartum bleeding cases. Analysis using cross tabulation shows that 97.20% of cases in which the women are aged above 35 were high risk pregnancies. Other cross tabulation shows that 91.55% of grand multiparity cases were high risk pregnancies. There were 452 cases of referral done when the women was in labor, in which 230 cases (50.88%) managed with a caesarean section. Out of those cases, 319 babies (68.02%) were born without asphyxia. Conclusions: Most of the referral in Obstetric Emergency Unit in Kalabahi General Hospital are labor of high risk pregnancies, where in the most of the cases, the risk factors are either the age of the mother or the parities, which is supported by the finding of maternal mortality case. Keywords: age, parity, risk pregnancy, the referral system Nusa Tenggara Timur Abstrak Tujuan: Mengetahui karakteristik rujukan maternal yang dirawat di IGD Kebidanan RSD Kalabahi Kabupaten Alor, Nusa Tenggara Timur, Indonesia selama periode 1 Januari 2016 – 31 Desember 2017. Metode: Penelitian ini merupakan survei dengan desain deskriptif untuk mengetahui karakteristik rujukan maternal dengan menggunakan total sampling. Dilakukan telaah menggunakan buku register rujukan, catatan / rekam medis, selama 2 tahun dari Januari 2016 – Desember 2017 di IGD Kebidanan RSD Kalabahi. Hasil: Dari total 724 rujukan, terdapat 704 (97,24%) kasus Obstetri dan 20 (2,76%) kasus Ginekologi. Berdasarkan risiko kehamilan Skor Poedji Rochdjati sebanyak 353 (62,48%) kasus yang berisiko dari 565 kasus, dimana risiko yang sering terjadi yakni; 46 (13,03%) kasus dengan PEB / Eklamsia, 40 (11,33%) kasus bekas SC sebelumnya, serta 39 (11,05%) kasus dengan letak sungsang. Terdapat 8 kasus dengan rujukan terlambat mengakibatkan kematian ibu dimana 5 kasus dengan eklamsia, dan 3 kasus dengan antepartum bleeding. Tabulasi silang risiko kehamilan dan usia ibu sebagian besar berusia ≥ 35 tahun 97,20% ibu hamil yang berisiko tinggi. Tabulasi silang antara kehamilan risiko tinggi dengan paritas menunjukkan bahwa 91,55% kehamilan Grandemultipara berisiko tinggi. Rujukan inpartu berjumlah 452 kasus persalinan dimana sebanyak 230 (50,88%) kasus dengan melahirkan secara operatif seksio sesaria. Luaran bayi didapatkan 319 (68,02%) dengan bayi bugar dari 469 bayi. Kesimpulan: Rujukan yang datang di IGD Kebidanan RSD Kalabahi sebagian besar rujukan obstetri inpartu dengan mayoritas kehamilan berisiko tinggi, usia ibu yang berisiko, dan jumlah paritas yang berisiko. Hal ini didukung dengan didapatkannya temuan kasus kematian ibu. Kata kunci: kehamilan berisiko , paritas, sistem rujukan, usia.