RINGKASAN
STRATF:Gl PENliRliNAN KKJADlAN
PREEKIAMPSIA
(PF:) MELAUJI
PENDEKATAN STlJDI KASUS KELOLA DAN METODE
MULTIPLE
CRITERL4 UTILITY ASSESMENT
(MCUA)
DI
KOTA MEDAN
PE merupakan salah satu penyulit dalam kehamilan dan persalinan yang
dapat
menyebabkan
kematian
ibu
dan
janin.
Berbagai
faktor
dinyatakan
berhubungan dengan kejadian ini dan disebut juga sebagai
''Dissease of many
Theories"
Untuk mengetahui
determinan PE, berupa faktor internal (usia ibu ;
<
20 dan > 35
tahun, usia
menarche ;
<
12 dan 16 tahun, usia menikah ;
<
20 dan 35 tahun, usia
saat kehamilan pertama ;
<
20 dan> 35 tahun, usia kehamilan ;
<
20 dan> 35 tahun,
penyakit lain yang ihu derita selama hamil ; jantung, ginjal dan OM, dan riwayat PE
; tidak ada riwayat PE dan faktor eksternal (ANC ;
<
4 kali, pendidikan ; SLTA
kebawah, pekerjaan ; tidak bekerja) tclah dilakukan penelitian studi kasus kelola
terhadap ibu hamil dan bersalin di RSUP H Adam Malik Medan, RSUD Dr. Pirngadi
Medan, RS Sundari Medan dan klinik bersalin di kota Medan periode 1 Oktober - 28
Februari 2005 sebanyak 98 kasus yaitu ibu yang menderita PE dan 98 kontrol, ibu
yang melahirkan di tempat yang sama dengan kasus dengan tanpa preeklampsia
disetaraxan dcngan kasus tcrhadap paritas dan riwayat hipertensi sebelum hamil.
Sample dipilih tidak secan, random, pengumpulan data dengan wawancara langsung
menggunakan kuesioner.
Analisis data dengan analisis
univariat, bivariat, dan multivariat (multiple logistic
regression analysis) menggunakan perangkat lunak komputer.
Ditemukan
proporsi kasus dengan PE berat 69.4% dan PE ringan 30.6%. Ada
hubungan yang bermakna antara faktor risiko internal dan internal dengan kejadian
PE, kecuali usia kehamilan dan penyakit lain selama hamil. Bahwa terdapat
hubungan yang signifikan antara beberapa faktor risiko terhadap kejadian PE yaitu
faktor usia ibu (OR
=3.3; 95% CI 1.551-7.126; nilai p
=
0.001), usia
menarche (OR
=
3.3; 95% Cl 1.698-6.358; nilai p
=0.000), usia menikah (OR
=4.6; 95%CI
2.042-10.254; nilai p
ｾ0.000), usia pada kehamilan pertama (OR
=4.7; 95% CI
1.928-11.432 nilai
p=
0.000), riwayat PE (OR
=3.4; 95% Cl1.306-9.113; nilai p
=0.009),
ANC (OR
=
13.5; 95% C16.725-27.009; nilai p
=
0.000), pekerjaan (OR
=2.5; 95%
CI 1.298-4.937; nilai p
0=0.006), dan pendidikan (OR
=3.1; 95% CI 1.680-5.659;
nilai p
ｾ0.000).
Dati delapan faktor risiko yang dianalisis dengan multivariat temyata hanya tiga
variabel yang berhubungan secara bermakna dengan kcjadian PE yaitu usia
menarche tidak normal (adjusted OR
=
3.2 95% CI
=
1.455-7.229; nilai p
=
0.004),
usia menikah (adjusted OR
=
3.7 95% CI
=1.419-9.766; nilai p
=0.008), dan ANC
(adjusted OR = 10.795% CI = 5.202-22.093; nilai P = 0.000)
Untuk menentukan masalah mana yang harus diintervensi terlebih dahulu digunakan
metode
MCUA
dengan mempertimbangkan besamya masalah, keseriusan masalah,
kemampuan sumber daya manusia untuk mengatasi masalah, tehnologi yang
tersedia, dan kerawanan politik untuk mengatasi masalah tersebut, dan diperoleh
score
tertinggi pada variabel
ANC.
Maka strategi penurunan kejadian PE dilakukan
melalui peningkatan kualitas
ANC.
Kata Kunci : PE, Faktor Risiko, Strategi
11
ABSTRACT
THE STRATEGI of MINIMIZING PREECLAMPSIA (PE) INCIDENCE
by CASE CONTROL STUDY APPROACH AND MULTIPLE CRITERIA
I
UTILITY ASSESMENT (MCUA) METHOD
in
MEDAN
PE is worsening of pregnancy and giving birth that can cause maternal and fetal
mortality. Various factor have been stated to have relationship with this incident
which is called "deseases of many theories".
This study
was
aimed to learn the influence of the risk factors of internal factor
(including mother's age; < 20 and> 35
th ,age of menarche; < 12 and> 35
th,age
of marriage;
<
20 and > 35
th,mother's age during first pregnancy;
<
20 and> 35
th,age of pregnancy;
<
20 and > 35
th ,other diseases suffered by mother's during
pregnancy; hearth disease, kidney, Diabetes Mellitus and the history of PE; without
PE history) and external factor (ANC;
<
4 times, education; un employment, and
occupation;
<
high school) toward PE in Medan City. This was matohed case control
study using 98 PE cases and 98 comparisons matching in parity and hypertension
history before pregnancy from H. Adam Malik General Hospital, Dr. Pirngadi
Hospital, Sundari Hospital, maternity clinics in Medan visitors during October 1,
2004 to February 28, 2005.
Samples were drawn not rondomly and data were collected through direct interviews
by using questionnaires and analyzed applaying univariate, bivariate, and multivariate
(multiple logistic regressions analysis) using computer software.
The result shows that 69.4% of the cases was malignant PE and the rest (30.6%)
benign. There is a significant association between interval risk factors and PE with
the exception of both the age of pregnancy and the other diseases suffered during
pregnancy namely including mother's age (OR
=3.3; 95% Cl 1.551-7.126; P value
=0.001), age of menarche (OR
=
3.3; 95% Cl 1.698-6.358; P value
=0.000), age
of marriage (OR
=
4.6; 95%CI 2.042-10.254; p value
=
0.000), mother's age during
first pregnancy (OR
=
4.7; 95% CI 1.928-11.432 P value
=
0.000), the history of Pli
(OR
=
3.4; 95% CI 1.306-9.113; p value
=
0.009), ANC (OR
=13.5; 95% CI
6.725-27.009; p value
=0.000), education (OR
=3.1; 95% CI 1.680-5.659; p value
=0.000), occupation (OR
=2.5; 95% CI 1.298-4.937; P value
=0.006).
Multiple logistic regressions analysis shows only there out of eight variables
are significant association with PE namely, age of menarche (Adjusted OR
=
3.2;
95% CI 1.455-7.229; p value
=0.004), mother's age when getting married
111
(Adjusted OR
=
3.7; 95% CI 1.419-9.766; P value
=
0.008), and ANC (Adjusted OR
=
10.7; 95% CI 5.202-22.093; P value
=
0.000).
i
To determine the problem to be first intervened, the MCUA method was used by
considering the size of problem, the seriousnes of problem, the capability of available
human resources, available technologi, and existing political instability of solve the
problem, and the highest score of ANC variable. Therefore, the strategy of
minimizing the incident of PE is carried out through the improvement of ANC.
Key words: PE, risk factor, strategy
IV
