Maternal Mortality Determinants in Refferal Hospital : Three Years Retrospective Study
Abstract
Background: Maternal mortality rate is one indicator used to assess overall women health status. According to the WHO, 99% of maternal deaths are delivery related and dominantly occur in developing countries. Objective: To determine the causes of maternal deaths at H. Adam Malik General Hospital Medan based on the following factors: remote determinants, the intermediate determinants, and outcome determinants as a risk factor of maternal deaths. Methods: This retrospective analytical study reviewed medical records of women who underwent delivery at H. Adam Malik General Hospital, Medan from January 1st 2010 until December 31th 2012. Data were statiscally analysed using a descriptive and inferential approach. Univariate, bivariate, and multivariate logistic regression analysis were used. Results: This study obtained as much as 681 complete medical records for 3 years, with 37 maternal deaths. Pre-eclampsia / eclampsia is the most common cause of death by 20 cases (54.1%). Maternal education degree, referral systems, facilities for delivery, history of systemic diseases, pregnancy and postpartum related complications were significantly correlated to the outcome of labor with OR of 1.97; 10.11; 41.36; 5.818; 3.49; and 685.7, respectively and p<0.05. Based on the multiple logistic regression test, maternal history of systemic diseases, pregnancy and postpartum related complications were the three factors that most significantly correlated to maternal mortality with p <0.05. Conclusion: Delivery outcomes were significantly associated with the followingfacrors: formal education, referral status, facilities for delivery, history of systemic diseases, mode of delivery, pregnancy and postpartum related complications. Maternal history of systemic diseases, pregnancy and postpartum related complicationswere the three factors that most significantly correlated to maternal mortality.
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References
WHO. Maternal care.Department of Reproductive Health and Research WHO, 2003
WHO, Depkes RI, FKM UI. Modul safe motherhood. Kerjasama WHO-Depkes- RI -FKM-UI, 1998
Departemen Kesehatan RI. Profil kesehatan. 2007.
Dinas Kesehatan SUMUT, Profil Kesehatan Provinsi Sumatera Utara 2011.
Survei Demografi dan Kesehatan Indonesia 2012; BKKBN;2013
Effendi IH. Prevalensi Kematian Maternal di RSUP Adam Malik Medan Tahun 2008 – 2010; Departemen Obstetri dan Ginekologi FK USU; 2012
Hanum NS. Karakteristik dan Faktor-Faktor Penyebab Kematian Maternal dan Perinatal di RSUP Adam Malik dan RSUD Dr Pirngadi Medan Januari 2003 – 2007; Departemen Obstetri dan Ginekologi FK USU; 2008.
Soemantri S dkk. Kajian Kematian Ibu dan Anak di Indonesia, Badan Litbangkes,Depkes, RI. 2004.
Depkes RI, Badan Litbangkes. Pelayanan Kesehatan ibu dan Anak. Dalam: Susenas, Status Kesehatan, Pelayanan Kesehatan, Perilaku Hidup Sehat, dan Kesehatan Lingkungan. Jakarta. 2004Hal. 52-53.
McCarty J,Maine D. A framework for analyzing the determinants of maternal mortality. Study family plan.1992.
Royston E, Amstrong S. Pencegahan morbiditas dan mortalitas ibu hamil. Alih bahasa : Maulany R.F. Jakarta. Binarupa aksara.2000.
Lutan D (ed). Sinopsis Obstetri : Obstetri Fisiologi & Obstetri Patologi. Jilid I ed 2. Jakarta : EGC. 1998.hal. 298-306.
Depkes RI,Dirjen Binkesmas. Prinsip Pengelolaan Program KIA. Dalam: Pedoman Pemantauan Wilayah Setempat Kesehatan Ibu dan Anak (PWS-KIA). 2004. Hal. 1-11.
Wiknjosastro, Ilmu Kebidanan, edisi ketiga, Yayasan Bina Pustaka Sarwono Prawirohardjo, Jakarta, 2008.
Cuningham FG, Gant NF,Lenovo KJ et all, Williams Obstetrics. 23rd Edition 2009.
Agus Suprapto, Julianto Pradono, Dwi Hapsari. Determinan Sosial Ekonomi pada Pertolongan Persalinan di Indonesia. Maj. Kes. Perkotaan 2002;11(2) : 18-29.
Iskandar B, Meiwita. Dampak Krisis Moneter dan Bencana Alam terhadap Kesehatan dan Gizi Wanita. Dalam Lokakarya Nasional Dampak Krisis Ekonomi terhadap Kesehatan Masyarakat Rentan. Pusat Komunikasi Kesehatan Berperspektif Jender dan Yayasan Lembaga Konsumen Indonesia dan Ford Foundation.1999. Hal.47 -48.
Depkes RI, Dirjen Yanmedik. Derajat Kesehatan. Dalam : Morbiditas dan Mortalitas. 2005.
Handayani, Lestari, dkk. Model Pelayanan Persalinan Dukun Bayi-Bidan, Tinjauan Aspek Sosiobudaya untuk Rancangan Intervensi. Pusat Penelitian Kependudukan Universitas Gadjahmada, Yogyakarta. 1994. hal. 59
Bazar A, Theodorus, Aziz Z, Azhari. Maternal Mortality and Contributing Factors. Indonesian Journal of Obstetric and Gynecology Vol 36 January 2012; page 8-13
De Cheney AH, Nathaan L. Current obstetric and gynecologic diagnosis and treatment , 10th edition. Mc. Graw – Hill, Inc. 2007.
UNFPA, SAFE Research study and impacts. Delivery into good hands. New York, UNFPA. 2004
Fibriana AI. Faktor-faktor risiko yang mempengaruhi kematian maternal (studi kasus dikabupaten Cilacap)Semarang; Program Studi Magister Epidemiologi Program Pasca Sarjana Universitas Diponegoro;2007.
Koblinsky M, Timyan J, Gay J. Akses Pelayanan Bukan Hanya Sekedar Jarak. Dalam Kesehatan Wanita Sebuah Prespektif Global. Gajah Mada University Press. Yogyakarta ; hal.331 Â 354.
Roeshadi RH, Upaya menurunkan angka kesakitan dan angka kematian ibu pada penderita preeclampsia dan eklampsia. Pidato pengukuhan jabatan guru besar tetap Universitas Sumatera Utara.Medan;2006.
WHO. Reduction of maternal mortality. A joint WHO/UNFPA/UNICEF/ World Bank Statement. Geneva,;1999
UNFPA. Maternal mortality update 2002, A focus emergency obstetric care, New York UNFPA; 2003
Depkes RI. Pedoman pemantauan wilayah setempat kesehatan ibu dan anak. Direktorat Jenderal Pembinaan Kesehatan Masyarakat. Jakarta;1994
Fenton PM et all. Caesarian section in Malawi: prospective study of early maternal and perinatal mortality. British Medical Journal Vol 327.2003
Saifuddin AB. Kematian Maternal. Dalam : Ilmu kebidanan, Edisi ketiga, Jakarta, Yayasan Bina Pustaka,1994 : 22-27
Saifuddin AB,dkk. Buku acuan nasional pelayanan kesehatan maternal dan neonatal, Yayasan Bina Pustaka Sarwono Prawirohardjo. Jakarta.2000
SetyowatiT, Wiryawan Y, Sulisttyowati N. Protap pencatatan/pelaporan kematian maternal di puskesmas. Jakarta. Badan Litbang, Depkes RI.2000
Brabin BJ et all. anemia and pregnancy related maternal mortality. American society for Nutritional Sciences.2001
Depkes RI. Penanganan kegawat-daruratan obstetric. Ditjen Binkesmas,Depkes RI.Jakarta:1996
Wibowo B, Wiknjosastro GH. Kelainan dalam lamanya kehamilan. Dalam : Ilmu kebidanan, edisi ketiga, Jakarta, Yayasan Bina Pustaka.1994 : 323-338
Badan Pusat Statistik – Statistic Indonesia (BPS) and ORC Macro.
Indonesia Demographic and Health Survey 2002-2003, Claverton, Maryland ,USA : BPS and ORC Macro, 2003
ICD 10 10th revision Chapter XV : Pregnancy, childbirth and the puerperium. WHO.
UNFPA. Maternal mortality update 2002, a focus on emergency obstetric care New York, UNFPA; 2003.
Martaadisoebrata D,Sastrawinata RS, Saifuddin AB, Bunga Rampai Obstetri dan Ginekologi Sosial, Yayasan Bina Pustaka, Jakarta,2005.
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