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ANALGESIA MEDIS PADA PERSALINAN Ketut Surya Negara, I Gede Sastra Winata,
E-Journal Obstetric & Gynecology Udayana Vol 1, No 2 (2013)
Publisher : E-Journal Obstetric & Gynecology Udayana

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Nyeri persalinan merupakan suatu bentuk nyeri atau pengalaman sensorik dan emosional yang tidak menyenangkan dimana terkait dengan adanya kontraksi dari uterus selama menjalani proses persalinan. Secara umum terdapat dua faktor yang mempengaruhi intensitas nyeri bagi seorang ibu yang sedang memasuki fase persalinan yaitu faktor fisik dan psikologis. Nyeri pada proses persalinan merupakan hal yang paling ditakuti oleh sebagian besar ibu hamil. Sehingga ibu hamil tersebut cenderung lebih memilih untuk menghindari proses persalinan spontan dengan melakukan seksio sesarea atau seksio sesarean on request sebagai upaya untuk tidak merasakan sensasi nyeri yang diakibatkan oleh proses persalinan spontan tersebut. Meningkatnya angka seksio sesarea di seluruh penjuru dunia sebagian besar disebabkan oleh karena adanya permintaan ibu hamil dengan alasan takut akan nyeri persalinan ini. Namun di sisi lain, prosedur operasi seksio sesarea sendiri merupakan suatu prosedur intervensi obstetri yang memiliki risiko cukup besar. National Sentinel Cesarian Section berdasarkan audit tahun 2001 melaporkan bahwa kurang lebih 20% wanita di Inggris dinyatakan takut untuk menjalani nyeri selama proses persalinan dan 5% diantaranya ternyata memilih menjalani proses persalinan dengan cara seksio sesarean tanpa indikasi medis atau on request. Penelitian yang dilakukan oleh Jackson dan Irvine pada tahun 1998 melaporkan bahwa lebih dari 3% dari proses persalinan di sebuah Rumah Sakit di Inggris adalah seksio sesarean tanpa indikasi medis. Penelitian lainnya dilakukan oleh Marx et al pada tahun 2001, memperoleh bahwa telah terjadi peningkatan angka seksio sesarean on request di Inggris dan Wales, dimana sebesar 11.3% dari tahun 1989 sampai 1990, 15,5% dari tahun 1994 sampai 1995, 17% dari tahun 1997 sampai 1998 dan bahkan mencapai 21,5% pada tahun 2001. Berdasarkan hal tersebut maka mulai dikembangkan salah satu prinsip dasar obstetri modern yaitu mengurangi nyeri selama persalinan dengan menggunakan analgesia yang adekuat. Secara umum terdapat dua metode analgesia dalam persalinan yaitu farmakologis dan non farmakologis. Sehubungan dengan hal tersebut, maka melalui tulisan ini akan berusaha dipaparkan secara mendalam mengenai metode analgesia farmakologis atau medis dalam persalinan. Tulisan ini diharapkan dapat menjadi masukan atau tambahan pemikiran dalam rangka mengkaji pemanfaatan analgesia pada persalinan, hal ini terkait dengan intervensi yang dapat dilakukan dalam upaya-upaya pencegahan nyeri selama persalinan demi meningkatkan keberhasilan persalinan secara spontan pervaginam.

PERBEDAAN KADAR SERUM C-REACTIVE PROTEIN PADA PRETERM INPARTU DENGAN PRETERM TIDAK INPARTU Surya Negara, Ketut
E-Journal Obstetric & Gynecology Udayana Vol 2, No 2 (2014)
Publisher : E-Journal Obstetric & Gynecology Udayana

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Pendekatan klinis tidak terbukti cukup sensitif dan spesifik dalam mencegah persalinan preterm. Diketahui bahwa peningkatan kadar serum maternal Interleukin-6 (IL-6) berkaitan inisisasi persalinan preterm. Interleukin-6Â berperan sebagai perangsang utama respon protein fase akut, salah satu diantaranya adalah C- reactive protein (CRP). Untuk mengetahui kadar serum CRP pada preterm inpartu dan preterm tidak inpartu, serta untuk mengetahui perbedaan kadar serum preterm inpartu konservatif dan preterm inpartu yang gagal konservatif. Penelitian ini merupakan desain cross sectional analitik. Dari 64 sampel, didapatkan 32 kasus preterm inpartu dan 32 kasus preterm tidak inpartu setelah memenuhi kriteria inklusi dan kriteria eksklusi. Selanjutnya dilakukan pemeriksaan kadar serum CRP di laboratorium patologi klinik RSUP Sanglah. Dari data yang terkumpul, dilakukan pengujian normalitas data dengan Kolmogorov-Smirnov (K-S), setelah itu dilakukan analisis data dengan uji t-independent. Dari hasil analisis didapatkan rerata kadar CRP kelompok preterm inpartu adalah 26,99Â±44,45 dan rerata kelompok preterm tidak inpartu adalah 3,41Â±1,85. Analisis kemaknaan dengan uji t-independent didapatkan bahwa nilai t = 2,99 dan nilai p = 0,004. Hal ini berarti bahwa rerata kadar CRP pada kedua kelompok berbeda secara bermakna. Kemudian rerata kadar CRP kelompok preterm inpartu konservatif adalah 31,67Â±48,08 dan rerata kelompok preterm inpartu lahir adalah 6,15Â±7,50. Analisis kemaknaan dengan uji t-independent menunjukkan bahwa nilai t = 1,28 dan nilai p = 0,210. Hal ini berarti bahwa rerata kadar CRP pada kedua kelompok tidak berbeda. Berdasarkan hasil penelitian didapatkan bahwa rerata kadar CRP kelompok preterm inpartu adalah 26,99Â±44,45 dan rerata kadar CRP kelompok preterm tidak inpartu adalah 3,41Â±1,85, di mana secara statistik berbeda bermakna. Dan tidak terdapat perbedaan bermakna antara preterm inpartu konservatif dengan preterm inpartu yang gagal konservatif.

Lower Serum Catalase Level is Associated with Preterm Labor among Pregnant Women at Sanglah Hospital Denpasar, Bali-Indonesia Negara, I Ketut Surya; Surya, IGP; Sanjaya, Hariyasa; Anantasika, AAN; Mahardika, I Made
BALI MEDICAL JOURNAL Vol 5 No 3 (2016)
Publisher : BALI MEDICAL JOURNAL

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Background: Preterm labor is still become a serious health problem in Obstetric and Perinatology with no sensitive biomarker currently approved. Several studies show that decrease antioxidant activity may play significant role in preterm labor. However, only few studies had been conducted to evaluate blood catalase level in preterm labor and assess its role in preterm labor. Objective: The aim this study was to identify the differences of maternal serum catalase level in preterm labor compared with preterm pregnancy. Methods: An observational analytic cross sectional study was conducted from February to December 2014 using pregnant women with 28-36 weeks’ gestational age. Blood catalase level was evaluated by colorimetric method and the data was analyzed by SPPS for Windows 17.0 program. Results: 12 subjects were enrolled and divided into preterm and control group. No significant differences between mean age, gestational age, and parity between preterm and control group. However, blood catalase level was significantly lower in preterm group compared with control group (81.82 ± 20.38 vs 159.38 ± 35.79; p=0.001). Conclusion: Serum maternal catalase level were significantly lower in preterm labor compared with preterm normal pregnancy.

Risk-Factor for COVID-19 Patients with Ventilator Status at Sanglah Hospital: Cross-Sectional Study Putu Sudarmika; I Nengah Wardana; I Ketut Surya Negara; Ni Luh Putu Nurhaeni; Ni Made Aries Minarti; I Wayan Santyasa
Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan Vol. 5 No. 1 (2021)
Publisher : Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan (Journal of Research and Development in Health Services)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22435/jpppk.v5i1.5626

Abstract Corona Virus Disease 19 is a contagious infectious disease that has a major impact on all aspects of life. This study explores the factors associated with the need for ventilators use in COVID-19 patients. This cross-sectional study uses secondary data from medical records, taken by total sampling technique, of patients treated at Sanglah Hospital from March 2020 to August 2020. Only complete and clear medical record of patients diagnosed with COVID-19 were analyzed using chi-square and stepwise logistic regression with SPSS for windows 25 software. This study had received ethical approval from the Udayana University independent ethics commission with the number 1839/UN 14.2.2.VII/LT/2020. Patients with aged ≥ 50 years (OR 2.8; 95% CI 1.45—5.54)), BMI > 25 kg/m2 (OR 4.5; 95% CI 1.57—13.03), alcohol consumption history (OR 3.8; 95% CI 1.35—10.81), hemoglobin level <10 g/dl (OR 3.8; 95% CI 1.74—9.15), or WBC ≥ 12.000 (OR 2.3; 95% CI 1.05—5.12), were at higher risk to use ventilator. Gender, smoking history, employment history, length of stay, having comorbidity had no significant difference in the need for a ventilator. The most dominant risk factor causing worsening outcomes of COVID-19 was BMI > 25 kg/m2. Keywords: risk factor, ventilator status, COVID-19, body mass index Abstrak Corona Virus Disease 19 merupakan penyakit menular yang berdampak besar pada semua aspek kehidupan. Studi ini mengeksplorasi faktor-faktor yang berhubungan dengan kebutuhan penggunaan ventilator pada pasien COVID-19. Penelitian ini merupakan studi potong lintang menggunakan data sekunder dari rekam medis. Pengumpulan data menggunakan teknik total sampling dengan melakukan eksplorasi rekam medis pasien yang dirawat mulai bulan Maret 2020 sampai Agustus 2020 di RSUP Sanglah. Kriteria rekam medis yang digunakan dalam penelitian adalah rekam medis yang lengkap dan jelas dari pasien terdiagnosis COVID-19. Analisis dilakukan secara deskriptif dan analitik menggunakan uji chi-square, dan regresi logistik bertahap dengan software SPSS dari windows versi 25. Penelitian ini telah mendapatkan persetujuan etik dari komisi etik independen Universitas Udayana nomor 1839/UN 14.2.2.VII/LT/2020. Total sebanyak 331 rekam medis yang dianalisis. Pasien berumur ≥ 50 tahun (OR 2,8; 95%CI 1.45-5.54), indeks massa tubuh > 25 kg/m2 (OR 4.5; 95% CI 1.57—13.03), riwayat konsumsi alkohol (OR 3.8; 95% CI 1.35—10.81), kadar hemoglobin <10 g/dl (OR 3.8; 95% CI 1.74—9.15), jumlah lekosit ≥ 12.000 (OR 2.3; 95% CI 1.05—5.12), mempunyai risiko lebih besar untuk menggunakan ventilator selama perawatan. Jenis kelamin, riwayat merokok, riwayat pekerja migran, lama perawatan di rumah sakit, dan komorbiditas tidak berhubungan bermakna dengan penggunaan ventilator. Indeks massa tubuh >25 kg/m2 merupakan faktor risiko paling dominan terhadap perburukan pasien COVID-19 yang dinilai dari penggunaan ventilator selama dirawat di rumah sakit Kata kunci: indeks massa tubuh, penggunaan ventilator, faktor risiko, COVID-19

Delphi Approach to explore ways to optimize case manager services in inpatient wards of Sanglah General Hospital Sayu Kade Alit Sagitariani; Pande Putu Januraga; I Ketut Surya Negara
Public Health and Preventive Medicine Archive Vol. 8 No. 2 (2020)
Publisher : Universitas Udayana

Background and purpose: Case manager services in inpatientrooms have gained popularity in many hospitals in Indonesia,however there are challenges in its implementation. This study aims to explore ways to optimize the characteristics of the case manager, case management practice and outcome of the case manager in cases in inpatient wards based on the Sanglah Hospital standards. Methods: The study utilized a two-stage Delphi study design,started with a qualitative data collection and followed by aquantitative survey. Data collection was done in May-June 2020 based on the concept of case manager characteristics, practice and outcomes. The qualitative data collection through in-depth interviews involved 9 key informants. It aimed to explore case manager services based on qualifications, competencies, ethical standards, workload, hierarchy and guidelines, implementation of case management and indicators of effectiveness of case management at Sanglah General Hospital. The results of the indepth interviews with thematic analysis informed the Delphi survey instrument development. The Delphi survey aimed to generate agreement on the characteristic of the case manager, case management practice and outcome of the case manager among 21 expert panelists (case managers) in the inpatient wards of Sanglah Hospital. This Delphi survey was conducted in 3 rounds, the results were analyzed based on the median value and quartile deviation (QD). Results: The three rounds of the Delphi survey showed that there was an agreement regarding the qualifications of the case manager, competency development, mechanism for appointment and placement of case managers, case manager guidelines, organizational structure, job descriptions and authorities, information of the presence and role of case managers, screening indicators according to characteristics of inpatient cases, case management target measurement tools, case manager service evaluation indicators as well as the activity feedback loop. Conclusion: Optimization of the case manager service should focus on aspects of human resources, developing guidelines and work systems as well as evaluation indicators and feedback mechanism.

The beta Human Chorionic Gonadotropin (hCG) levels in the vaginal washing fluid as a predictor of Premature Rupture of Membrane (PROM) Danny Aguswahyudi; Ketut Suwiyoga; I Ketut Surya Negara; I Wayan Megadhana; I Nyoman Bayu Mahendra; I Gusti Putu Mayun Mayura; Made Bagus Dwi Aryana
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Background: Several biomarkers have been investigated as predictors of Premature rupture of membrane (PROM), but these biomarkers have not been applied in clinical practice due to their high cost and complexity. Beta-HCG is thought to be an easy, cost-effective and promising predictor of PROM in clinical practice. This study aims to determine the relationship between beta-hCG level in vaginal washing fluid with the PROM and the cut-off value of beta-hCG level in vaginal washing fluid in predicting the incidence of PROM.Methods: This diagnostic study was conducted in the Sanglah General Hospital, Denpasar, from May to July 2020. The subjects involved in this study are all pregnant women with gestational age ?24 weeks who came with complaints of vaginal discharge and were treated in the delivery room of the Emergency Ward, Sanglah General Hospital. The beta-HCG level was evaluated using the immunoassay method and the ROC curve analysis was performed to determine the beta-hCG level in vaginal washing cut-off point that can predict the incidence of PROM. Data were analyzed using SPSS version 22 for Windows.Results: Thirty-five subjects who met the inclusion and exclusion criteria were involved in this study. The cut-off value of beta-hCG vaginal washing fluid to predict PROM obtained in this study was 118.1 mIU/ml with sensitivity of 95.83%, specificity of 81.81%, PPV of 92.00%, NPV of 90.00%, and accuracy of 91.43% (AUC: 0.947; 95%CI: 0.870-1.000; p<0.001).Conclusion: Beta-hCG level in the vagina washing fluid can be used as a fast and non-invasive predictor of PROM in pregnant women.

Kadar heat shock protein 70 cairan amnion yang tinggi sebagai faktor risiko terjadinya ketuban pecah dini pada kehamilan aterm Ines Kurniaty Hartono; Ketut Suwiyoga; I Ketut Surya Negara; I Gede Mega Putra; Made Bagus Dwi Aryana; I Gde Sastra Winata; I Wayan Megadhana
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Background: Premature rupture of membranes (PROM) is a condition that complicates labor with an unclear pathogenesis. HSP70 is thought to be involved in this pathogenesis process and the presence of HSP in the extracellular compartment reflects tissue damage and induces an immunologic response. Therefore, this study aimed to study the relationship between HSP70 levels in amniotic fluid and the incidence of PROM.Methods: This study used a case-control design in the ER delivery room and the laboratory of Sanglah Hospital, Denpasar. Samples were taken from mothers who gave full term delivery in the emergency room at Sanglah Hospital Denpasar with mothers who gave birth at term with KPD as cases and mothers who gave full term delivery without KPD as controls. Data was taken from medical records and measured levels of HSP70 at the Sanglah Hospital Denpasar Laboratory. Data analysis was performed using the Mann-Whitney test and ROC test.Results: A total of 28 cases and 28 controls were recruited. There were no significant differences in baseline characteristics between cases and controls. The MannWhitney test found significant differences in the mean levels of HSP70, 11.58 (±8.16) ng/mL in controls and 17.15 (±6.51) ng/mL in cases, respectively. ROC analysis found an AUC of 0.737 with an optimal cutoff value of 12.5 ng/mL. An amniotic fluid HSP70 level of more than 12.5 ng/mL was associated with PROM with an OR of 17.33 (95% CI 3.43 - 87.70).Conclusion: High amniotic fluid HSP 70 level is a risk factor for PROM in term pregnancy. Latar belakang: Ketuban pecah dini (KPD) merupakan suatu kondisi yang mempersulit persalinan dengan patogenesis yang belum jelas. HSP70 dianggap terlibat dalam proses patogenesis ini dan keberadaan HSP di kompartemen ekstraseluler mencerminkan kerusakan jaringan dan menginduksi respon imunologi. Oleh karena itu, penelitian ini bertujuan untuk mempelajari hubungan kadar HSP70 dalam cairan ketuban dengan kejadian KPD.Metode: Penelitian ini menggunakan desain kasus kontrol di ruang bersalin IGD dan Laboratorium RSUP Sanglah Denpasar. Sampel diambil dari ibu yang bersalin cukup bulan di ruang bersalin IGD RSUP Sanglah Denpasar dengan ibu yang melahirkan cukup bulan dengan KPD sebagai kasus dan ibu yang bersalin cukup bulan tanpa KPD sebagai kontrol. Data diambil dari rekam medis dan dilakukan pengukuran kadar HSP70 di Laboratorium RSUP Sanglah Denpasar. Analisis data dilakukan dengan menggunakan uji Mann-Whitney dan uji ROC.Hasil: Sebanyak 28 kasus dan 28 kontrol direkrut. Tidak ada perbedaan yang signifikan dalam karakteristik dasar antara kasus dan kontrol. Uji MannWhitney menemukan perbedaan yang signifikan dalam tingkat rata-rata HSP70, masing-masing 11,58 (± 8,16) ng/mL pada kontrol dan 17,15 (± 6,51) ng/mL dalam kasus. Analisis ROC menemukan AUC 0,737 dengan nilai cutoff optimal 12,5 ng/mL. Tingkat HSP70 cairan ketuban lebih dari 12,5 ng/mL dikaitkan dengan PROM dengan OR 17,33 (95% CI 3,43 - 87,70).Simpulan: kadar HSP 70 cairan amnion yang tinggi merupakan faktor risiko terjadinya KPD pada kehamilan aterm.

Kadar heat shock protein 70 (HSP 70) yang tinggi pada serum ibu sebagai faktor risiko persalinan preterm Tjokorda G. A. Suwardewa; Ketut Surya Negara; Anak Agung Ngurah Anantasika; I Wayan Artana Putra; I Gde Sastra Winata; Piere Emanuel Yoltuwu
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15562/ism.v13i1.1329

Introduction: Preterm birth defined as parturition that occurs less than 37 completed weeks of gestation is still being a big problem in obstetrics, especially in perinatology. Preterm delivery is one of the most common causes of neonatal morbidity and mortality. This study examined serum HSP 70 levels as a risk factor for preterm delivery.Method: The research design was analytic with a case-control method at Sanglah Hospital from February to June 2021. The samples were divided into two groups which are in the case group was 30 samples and the control group was 30 samples. In both groups, HSP 70 levels were collected by taking 5cc of blood sample from cubital vein. Furthermore, the examination was carried out using the enzyme-link immunosorbent assay (ELISA) method at Biomedik Terpadu Laboratory service.Result: Based on the data on the characteristics of the subjects, respectively maternal age, gestational age, BMI, and parity there was no significant differences between two group. Serum HSP levels were significantly different between the two groups with OR 4.030 (95%CI: 1,372-11,84; p-value 0.01). The cut-off value for serum HSP 70 levels was 12.85 ng/ml, with a sensitivity of 70%, specificity of 63.3%, and an area under the curve (AUC) value of 0.807 (95% CI 0.697 – 0.916, p-value <0.001).Conclusion: This study revealed that high levels of HSP 70 in serum is a risk factor of preterm labor. High blood serum levels of HSP 70 could be a reference in determining high risk of preterm labor in pregnant women. Pendahuluan: Persalinan preterm didefinisikan kelahiran sebelum usia gestasi kurang dari 37 minggu masih menjadi masalah besar dalam bidang obstetri khususnya dibidang perinatologi. Persalinan preterm merupakan salah satu penyebab utama tingginya angka morbiditas dan mortalitas neonatus. Penelitian ini meneliti mengenai kadar HSP 70 pada serum ibu sebagai faktor risiko persalinan preterm.Metode: Rancangan penelitian yang digunakan adalah analitik dengan metode kasus-kontrol, dilakukan di RSUP Sanglah pada periode Februari 2021 sampai Juni 2021. Sampel dibagi menjadi 2 kelompok yakni kelompok kasus sebanyak 30 sampel dan kontrol 30 sampel. Pada kedua kelompok, pemeriksaan kadar HSP 70 dilakukan melalui pengambilan sampel darah 5 ml pada vena cubiti. Selanjutnya dilakukan pemeriksaan dengan metode enzyme-link immunosorbent assay (ELISA) di Unit Laboratorium Biomedik Terpadu.Hasil: Data karakteristik subyek yaitu usia ibu, usia kehamilan, IMT dan jumlah paritas, tidak ditemukan adanya perbedaan bermakna. Kadar serum HSP yang tinggi berbeda bermakna antara kedua kelompok dengan nilai OR 4.030 (IK 95%: 1,372-11,84; nilai p 0.01). Nilai cut off kadar serum HSP 70 sebesar 12.85 ng/ml, dengan sensitifitas sebesar 70%, spesifisitas 63,3%, dan nilai area under the curve (AUC) sebesar 0,807 (IK 95% 0,697 – 0,916, nilai p <0,001).Simpulan: Penelitian ini menunjukkan bahwa kadar HSP 70 yang tinggi pada serum ibu sebagai faktor risiko kejadian terjadinya persalinan preterm. Nilai kadar HSP 70 yang tinggi dapat menjadi suatu acuan dalam menentukan risiko tinggi kejadian persalinan preterm pada ibu hamil.

Hubungan antara kadar homosistein (Hcy) dengan kejadian ketuban pecah dini (KPD) pada kehamilan preterm Agrifa Eko Albert Sembiring; Tjokorda Gde Agung Suwardewa; Ketut Surya Negara; I Nyoman Gede Budiana; Ida Bagus Putra Adnyana; Evert Solomon Pangkahila
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Premature rupture of membranes (PROM) has been a problem in obstetrics since ancient times until now. The incidence of PROM in the world ranges from 5% - 15% of all pregnancies, while the incidence in developing countries, especially Indonesia ranges from 4.5% to 7.6% of all pregnancies. Preterm is one of the highest contributors to perinatal mortality and morbidity. The incidence of preterm pregnancy in the world is around 9.6% of all births, while in Southeast Asia is around 11.1% It has been shown to have a significant effect on vascular endothelial pathology. Methods: The study was conducted with an analytic cross-sectional design involving 70 respondents of pregnant women with gestational age of 20 - < 37 weeks with and without PPROM who came to the outpatient clinic and maternity ward of Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar from May 2021 – July 2021. Results: The results of the analysis of this study found a statistically significant relationship between homocysteine (Hcy) levels and the incidence of preterm premature rupture of membranes (p = 0.001). The prevalence ratio value of 2.2 means that high homocysteine levels is a risk factor for premature rupture of membranes in preterm pregnancy (RP = 2.2; 95% CI = 1.33-2.94; p = 0.001). Conclusion: High homocysteine level is a risk factor for premature rupture of membranes in preterm pregnancy. Latar Belakang: Ketuban pecah dini (KPD) preterm merupakan masalah di bidang obstetrik sejak dahulu sampai sekarang. Insiden KPD di dunia berkisar antara 5% - 15% dari seluruh kehamilan. Insiden KPD di negara berkembang khususnya Indonesia berkisar 4,5% - 7,6% dari seluruh kehamilan. Kehamilan preterm menjadi salah satu penyumbang tertinggi angka mortalitas dan morbiditas perinatal. Insiden kehamilan preterm di dunia sekitar 9.6% dari semua kelahiran, sedangkan di Asia tenggara terdapat sekitar 11,1%. Hcy telah terbukti signifikan berpengaruh pada patologi endotel pembuluh darah. Metode: Penelitian dilakukan dengan rancangan cross sectional analitik dengan melibatkan 70 responden wanita hamil dengan usia gestasi 20 - <70 minggu dengan atau tanpa KPD yang dating ke poliklinik dan ruang bersalin RSUP Prof. Dr. I.G.N.G. Ngoerah bulan Mei 2021 – Juli 2021. Hasil: Diperoleh hubungan bermaksana secara statistik antara kadar homocycteine dengan kejadian ketuban pecah dini pada kehamilan preterm (p = 0, 001), dan rasio prevalensi 2,2 berarti kadar homosisteine yang tinggi merupakan faktor risiko terjadinya ketuban pecah dini pada kehamilan preterm (RP = 2.2; 95% CI = 1.33-2.94; p = 0.001). Kesimpulan: Kadar homosistein yang tinggi merupakan faktor risiko terjadinya ketuban pecah dini pada kehamilan preterm.

Vaginal Birth After Cesarean Characteristics with Maternal and Perinatal Out Come in Sanglah Hospital, Bali, 1st January 2015 to 31st December 2016 Period:A Descriptive Study I Ketut Surya Negara; Gede Agus Hendra Sujana
Journal of Global Pharma Technology Volume 09 Issue 03
Publisher : Journal of Global Pharma Technology

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Cesarean section delivery is a common choice for some women because it is often considered faster and safer. Over the past few decades, the cesarean section continues to be performed more frequently. As a result, there is also an increase in the number of women with a history of cesarean section and become a problem for pregnancy and subsequent types of labor. Method This is a retrospective descriptive study obtained using medical records in Sanglah Hospital Bali, 1st January 2015 to 31st December 2016 Period. Results Within 2 years since January 1, 2015 - December 31, 2016, the number of births in Single Deposer hospital as many as 2502 cases, consisting of 1753 (70.06%) vaginal delivery and 749 (29.94%) with cesarean section. Of all deliveries, the total number of deliveries with uterine scarring were 247 cases, consisting of 190 (76.92%) of direct cases of cesarean section, and 57 (23.08%) cases were decided by TOLAC. Of 57 TOLAC cases, 49 cases were successful VBAC (85.96%), while 8 cases were unsuccessful VBAC (14.04%).The incidence of VBAC was most frequently found in the age group of 20-35 years old (82.46%), body mass index (BMI) of ≤30 kg/m2 (91.23%), and gestational age of ≤40 weeks (84.2%). Based on the number of previous vaginal deliveries after cesarean, women with a history of vaginal delivery was most common with 29 cases. Based on previous cesarean section indications, fetal distress had the highest number of cases (35.09%). Women with cervix dilatation of ≥4 cm are more likely to have successful VBAC (85.96%). Almost all VBAC was spontaneous vaginal delivery (97.96%), except one. Almost all newborn have a birth weight of less than 4 kg (98.25%). Anemia and hysterectomy are among maternal morbidities found in our study. Based on perinatal morbidity, asphyxia, neonatal dengue, ARDS, and jaundice, were found in our study and only four newborns needed to be treated in the neonatal intensive care unit (NICU). Conclusion The success rate of VBAC in this study was high, the indications of previous cesarean section most due to fetal distress. Moderate asphyxia was the most common perinatal morbidity, followed by ARDS, severe asphyxia, neonatal dengue and jaundice. However, in most cases there is no perinatal morbidity. Keyword: Vbac, Tolac, Maternal Perinatal Outcome.

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