HUBUNGAN PARITAS DENGAN KEJADIAN PLASENTA PREVIA DI RUMAH SAKIT MUHAMMADIYAH PALEMBANG PERIODE JANUARI- DESEMBER 2014 SKRIPSI Seba^i Salah Satu Syarat Memperoleh Gelar Sarjana Kedokteran (S.Ked) Oleh: SHINDINA FIRLI CLAUDIA NIM: 70 2012 061 FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH PALEMBANG 2017
72
Embed
HUBUNGAN PARITAS DENGAN KEJADIAN PLASENTA ...repository.um-palembang.ac.id/id/eprint/804/1/SKRIPSI624...HUBUNGAN PARITAS DENGAN KEJADIAN PLASENTA PREVIA DI RUMAH SAKIT MUHAMMADIYAH
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
HUBUNGAN PARITAS DENGAN KEJADIAN PLASENTA PREVIA DI RUMAH SAKIT
MUHAMMADIYAH PALEMBANG PERIODE JANUARI-
DESEMBER 2014
SKRIPSI Seba^i Salah Satu Syarat Memperoleh Gelar
Sarjana Kedokteran (S.Ked)
O l e h : SHINDINA F I R L I CLAUDIA
NIM: 70 2012 061
FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH PALEMBANG
2017
HALAMAN PENGESAHAN
HUBUNGAN PARITAS DENGAN KEJADIAN PLASENTA PREVIA DI RUMAH SAKIT MUHAMMADIYAH
PALEMBANG PERIODE JANUARI-DESEMBER 2014
Dipersiapkan dan disusun oleh : SHINDINA F I R L I GLAUDIA
NIM: 70 2012 061
Sebagai salah satu syarat memperoleh gelar Sarjana Kedokteran (S.Ked)
Pada tanggal 12 Febuari 2017
Meayetujui:
(m dr. Asmarani Ma*mun^ M . Kes Pembimbing Pertama
dr. Milla Fadilya Bustan Pembimbing Kedua
PERNYATAAN
D e n g a n i n i s a y a m e n e r a n g k a n b a h w a :
1 . K a r y a t u l i s s a y a , s k r i p s i i n i a d a l a h a s l i d a n b e l u m p e r n a h d i a j u k a n u n t u k
m e n d a p a t k a n g e l a r a k a d e m i k , b a i k d i U n i v e r s i t a s M u h a m m a d i y a h
P a l e m b a n g , m a u p u n p e r g u r u a n t i n g g i l a i n n y a .
2 . K a r y a t u l i s i n i m u m i g a g a s a n . r u m u s a n d a n p e n e l i t i a n d a r i P e n u l i s , t a n p a
b a n t u a n p i h a k l a i n , k e c u a l i a r a h a n t i m p e m b i m b i n g .
3 . D a l a m k a r y a t u l i s i n i t i d a k t e r d a p a t k a r y a a t a u p e n d a p a t y a n g t e l a h d i t u l i s
a t a u d i p u b l i k a s i k a n o r a n g l a i n , k e c u a l i s e c a r a t e r t u l i s d e n g a n d i c a n t u m k a n
s e b a g a i a c u a n d a l a m n a s k a h d e n g a n d i s e b u t k a n n a m a p e n g a r a n g d a n
d i c a n t u m k a n d a l a m d a f t a r p u s t a k a .
4 . P e m y a t a a n i n i s a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m u d i a n
h a r i t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e m y a t a a n i n i ,
m a k a s a y a b e r s e d i a m e n d a p a t k a n s a n k s i a k a d e m i k a t a u s a n k s i l a i n n y a
d e n g a n n o r m a y a n g b e r l a k u d i p e r g u r u a n t i n g g i a p a b i l a t e r d a p a t
p e l a n g g a r a n .
P a l e m b a n g , F e b u a r i 2 0 1 7
Y a n g m e m b u a t p e m y a t a a n . T E R A I > , n
N I M : 7 0 2 0 1 2 0 6 1
ii
D e n g a n r a s a b a n g g a d a n b a h a g i a s a y a k h u t u r k a n r a s a s y u k u r s a y a k e p a d a :
1 . A l l a h S W T , k a r e n a h a n y a a l a s i z i n d a n k a r u n i a n y a l a h m a k a s k r i p s i i n i d a p a t d i b u a t d a n s e l e s a i p a d a w a k t u n y a . F u j i s y u k u r y a n g t a k t e r h i n g g a p a d a A l l a h p e n g u a s a a l a m y a n g m e r i d h o i d a n m e n g a b u l k a n s e g a l a d o a .
2 . P a p a d a n M a m a s a y a y a n g t e r s a y a n g d a n t e r c i n t a , y a n g t e l a h m e m b e r i k a n d u k u n g a n m o r i l m a u p u n m a t e r i s c r t a d o a y a n g t i a d a h e n t i n y a u n t u k k e s u k s e s a n s a y a , k a r e n a t i a d a k a t a s e i n d a h l a n t u n a n d o a d a n t i a d a d o a y a n g p a l i n g k h u s u k s e l a i n d o a y a n g t e r u c a p d a r i o r a n g t u a .
3 . B a p a k ' i b u d o s c n , d r . A s m a r a n i M a * m u n , d r , M i l i a F a d i l y a B u s t a n d a n d r . I s k a n d a r y a n g s e l a m a i n i t e l a h t u l u s d a n n i k h l a s m e l u a n g k a n w a k t u n y a u n t u k m e m b e r i k a n b i m b i n g a n d a n p c l a j a r a n y a n g t i a d a t e m i l a i h a r g a n y a , a g a r s a y a m e n j a d i l e b i h b a i k . T e r i m a k a s i h b a n y a k B a p a k / I b u d o s e n , j a s a k a l i a n a k a n s e l a l u s a y a i n g a t .
4 . K e t i g a a d i k k u R a h m a t B u n t a r o R e n a l d i , B u n c e v i n R i v a n o R a h m a n , Q u i n s a A q i l a A i l i n a V i c e n t e r i m a k a s i h k a r e n a k a l i a n s e l a l u m e n d u k u n g d a n m e n d o a k a n , t e t a p b e r u s a h a m e n j a d i a p a y a n g b i s a m e m b u a t m a m a d a n p a p a b a n g g a .
5 . U n t u k S a h a b a t d a n k e l u a r g a k e 2 k u R a n i , T r i y a n t i , R u k m a n a , a r t i , t i y a , k a r a g i l s e r t a s a h a b a t g u n g g o n g , J a w a r a U j i a n . Y a n g s e l a l u m e m b e r i k a n s a y a s e m a n g a t , d a n m o t i v a s i y a n g p o s i t i f s e h i n g g a s a y a b i s a m e n g e r j a k a n s k r i p s i s a y a s a m a p a i s e l e s a i .
6 . U n t u k y a n g t e r k a s i h d a n t e r c i n t a H a n i S u p r a s t o w o t e r i m a k a s i h s u d a h b a n y a k m e m b e r i k a n s e m a n g a t , d a n s e l a l u s a b a r m e n g h a d a p i m o n s t e r s e p e r t i s a y a . L o v e y o u d e a r !!!
7 . U n t u k t e m a n - t e m a n s e p e r j u a n g a n D U O D E C I M s e m a n g a a a t u n t u k k i t a s e m u a !!!
M o t t o :
K e s u k s e s a n h a n y a d a p a t d i r a i h d e n g a n s e g a l a u p a y a d a n u s a h a y a n g d i s e r t a i d e n g a n d o a , k a r e n a s e s u n g g u n y a n a s i b m a n u s i a t i d a k a k a n b e r u b a h d e n g a n s e n d i r i n y a t a n p a b e r u s a h a .
i i i
U N I V E R S I T A S M U H A M M A D I Y A H P A L E M B A N G F A K U L T A S K E D O K T E R A N
S K R I P S I , J A N U A R I 2017 SHINDINA F I R L I G L A U D I A
H U B U N G A N P A R I T A S D E N G A N K E J A D I A N P L A S E N T A P R E V I A D I R U M A H S A K I T M U H A M M A D I Y A H P A L E M B A N G P E R I O D E J A N U A R I 2 0 I 4 - D E S E M B E R 2 0 1 4
xi + 72 halaman + 5 tabel
A B S T R A K
P i a s e n t a p r e v i a a d a l a h p i a s e n t a y a n g b e r i m p l a n t a s i t i d a k n o n r i a l s e h i n g g a m e n u t u p i s e l u r u h a t a u s e b a g i a n o s t i u m i n t e r n u m . F a k t o r y a n g m e m p e n g a r u h i t e r j a d i n y a p i a s e n t a p r e v i a s a l a h s a t u n y a a d a l a h s t a t u s p a r i t a s i b u . P e n e l i t i a n i n i b e r t u j u a n u n t u k m e n g e t a h u i h u b u n g a n p a r i t a s d e n g a n k e j a d i a n p i a s e n t a p r e v i a d i R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a n 2 0 1 4 - D e s e m b e r 2 0 1 4 . J e n i s p e n e l i t i a n ini m e r u p a k a n p e n e l i t i a n a n a l i t i k o b s e r v a s i o n a l d a n m e n g g u n a k a n r a n c a n g a n cross sectional mjerensial. B e s a r s a m p e i y a n g d i a m b i l 1 5 8 y a n g t e r d i r i d a r i 6 8 p e n d e r i t a p i a s e n t a p r e v i a d a n 9 0 b u k a n p e n d e r i t a p i a s e n t a p r e v i a . P e n g a m b i l a n s a m p e i d i i a k u k a n d e n g a n simpel random sampling P e n g a m b i l a n d a t a m e n g g u n a k a n i n s t r u m e n r e k a m m e d i k d e n g a n k r i t e r i a i n k l u s i d a n k r i t e r i a e k s k l u s i s e b a g a i mulching. K e m u d i a n d a t a d i a n a l i s a s e c a r a u n i v a r i a t d a n b i v a r i a t d e n g a n m e n g g u n a k a n chi- square. H a s i l p e n e l i t i a n m e n u n j u k a n b a h w a 4 2 . 4 % ( 6 8 i b u ) p e n d e r i t a p i a s e n t a p r e v i a . S e t e l a h d i i a k u k a n p e n g o l a h a n d a t a s e c a r a s t a t i s t i k d i d a p a t k a n h u b u n g a n p a r i t a s i b u d e n g a n p i a s e n t a p r e v i a ( p ^ 0 , 0 0 0 ; P R = 2 6 . 1 8 1 ) . B e r d a s a r k a n h a s i l p e n e l i t i a n i n i , m a k a d a p a t d i s i m p u l k a n b a h w a t e r d a p a t h u b u n g a n b e r m a k n a a n t a r a p a r i t a s i b u d e n g a n p i a s e n t a p r e v i a , s e r t a i b u d e n g a n p a r i t a s t i n g g i m e r u p a k a n f a k t o r r e s i k o 2 6 k a l i u n t u k t e r j a d i n y a p i a s e n t a p r e v i a .
K a t a k u n c i : P a r i t a s , P i a s e n t a P r e v i a , F a k t o r R e s i k o P i a s e n t a P r e v i a
i v
U N I V E R S I T Y O F M U H A M M A D I Y A H P A L E M B A N G M E D I C A L F A C U L T Y
E S S A Y, J A N U A R Y 2 0 1 7 S H I N D I N A F I R L I G L A U D I A
T h e Relationship of Parity with Placenta P r e v i a Incidence i n M u h a m m a d i y a h H o s p i t a l Palembang Period J a n u a r y 2014-December 2 0 1 4
x i + 72 pages + 5 tables
A B S T R A C T
Placenta previa is abnormal placental implantation so that it covers all or part ostium internum. On of the factors that injlunce the occurrence ofplacenta previa is the parity status of the mother. This research aims to determine the relationship of parity with the incidence of placenta previa m Muhammadiyah Hospital Palembang on the period January 2014- December 2014. This research was observational and analytical research using cross sectional inferential design. The number of sampei taken 158 consisting of 68 patient with placenta previa and 90 patients non sufferers. Sampling was done using simpel random sampling. Retrieving data using medical record instrument with inclusion and exclusion criteria as a matching. Then the data were analyzed using univariate and bivariate by using chi-square. The results showed that 17.2% (68 mothers) patients with placenta previa. After processing statistical data obtained maternal parity relationship with placenta previa (p 0.000; PR - 26.181). Based on these results, it can be concluded that there was a significant relationship between mother parity with placenta previa, as well as mothers with high parity is a risk factor 26 times for the occurrence of placenta previa.
Keyword: Parity, Placenta Previa, Risk Factor of Placenta Previa
V
KATA PENGANTAR
F u j i s y u k u r p e n e l i t i p a n j a t k a n k e p a d a A l l a h S W T a t a s s e g a l a r a h m a t d a n k a r u n i a - N y a s e h i n g g a p e n e l i t i d a p a t m e n y e l e s a i k a n p e n e l i t i a n i n i y a n g b e r j u d u l ^'Hubungan paritas dengan kejadian piasenta previa di Rumah Sakit Muhammadiyah Palembang periode Januari 2014- Desember 2014" s e b a g a i s a l a h s a t u s y a r a t u n t u k m e n d a p a t k a n g e l a r s a r j a n a k e d o k t e r a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g . S a l a w a t b e r i r i n g s a l a m s e l a l u t e r c u r a h k e p a d a j u n j u n g a n k i t a , N a b i b e s a r M u h a m m a d S A W b e s e r t a p a r a k e l u a r g a , s a h a b a t , d a n p e n g i k u t - p e n g i k u t n y a s a m p a i a k h i r z a m a n .
P e n e l i t i m e n y a d a r i b a h w a p e n e l i t i a n i n i J a u h d a r i s e m p u r n a . O l e h k a r e n a i t u , p e n e l i t i m e n g h a r a p k a n k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n g u n a p e r b a i k a n d i m a s a m e n d a t a n g .
D a l a m h a l p e n y e l e s a i a n p e n e l i t i a n i n i , p e n u l i s b a n y a k m e n d a p a t b a n t u a n , b i m b i n g a n d a n s a r a n . P a d a k e s e m p a t a n i n i , p e n u l i s i n g i n m e n y a m p a i k a n r a s a h o r m a t d a n t e r i m a k a s i h k e p a d a :
1 . A l l a h S W T y a n g t e l a h m e m b e r i k e h i d u p a n d e n g a n s e j u k n y a k e i m a n a n . 2 . R e k t o r d a n s t a f F a k u l t a s k e d o k t e r a n M u h a m m a d i y a h p a l e m b a n g 3 . D e k a n F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g . 4 . d r . A s m a r a n i M a ' m u n , M . K e s s e l a k u p e m b i m b i n g I 5 . d r . M i l l a F a d i l y a B u s t a n s e l a k u p e m b i m b i n g I I 6 . d r . H . I s k a n d a r Z . A , D T M & H , A P K , M . K e s , S P . P a r . K s e l a k u p e n g u j i 7 . K e p a l a R e k a m M e d i s R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g y a n g
t e l a h m e m b e r i k a n i z i n u n t u k m e l a k u k a n p e n e l i t i a n
S e m o g a A l l a h S W T m e m b e r i k a n b a l a s a n p a h a l a a t a s s e g a l a a m a l y a n g d i b e r i k a n k e p a d a s e m u a o r a n g y a n g t e l a h m e n d u k u n g p e n e l i t i d a n s e m o g a l a p o r a n i n i b e r m a n f a a t b a g i k i t a d a n p e r k e m b a n g a n i l m u p e n g e t a h u a n k e d o k t e r a n . S e m o g a k i t a s e l a l u d a l a m l i n d u n g a n A l l a h S W T .
S h i n d i n a F i r l i C l a u d i a
vi
DAFTAR ISl
H A L A M A N J I D U L H A L A M A N P E N G E S A H A N ' H A L A M A N P E R N Y A T A A N " H A L A M A N P E R S E M B A H A N DAN M O T T O i i i A B S T R A K . i v A B S T R A C T . v K A T A P E N G A N T A R v i D A F T A R I S l vii D A F T A R T A B E L D A F T A R L A M P I R A N x
B A B I . P E N D A H U L U A N 1 .1 L a t a r B e l a k a n g ^ 1 .2 R u m u s a n M a s a l a h 3 1 .3 T u j u a n P e n e l i t i a n 4
1 . 3 . 1 T u j u a n U m u m 4 1 . 3 . 2 T u j u a n K h u s u s 4
1 .4 M a n f a a t P e n e l i t i a n 4 1 . 4 . 1 M a n f a a t T e o r i t i s 4 1 . 4 . 2 M a n f a a t P r a k t i s 4
1.5 K e a s l i a n P e n e l i t i a n 5
B A B I I . T I N J A L A N P U S T A K A 2 . 1 L a n d a s a n T e o r i
2 . 1 . 1 P a r i t a s 8 2 . 1 . 2 P i a s e n t a P r e v i a H 2 . 1 . 3 H u b u n g a n P a r i t a s d e n g a n K e j a d i a n P i a s e n t a P r e v i a 2 5
2 . 2 K e r a n g k a T e o r i 2 6 2 . 3 H i p o t e s i s 2 7
B A B H I . M E T O D E P E N E L I T I A N 3 . 1 J e n i s P e n e l i t i a n 2 8 3 . 2 W a k t u d a n T e m p a t P e n e l i t i a n
3 . 2 . 1 W a k t u P e n e l i t i a n 2 8 3 . 2 . 2 T e m p a t P e n e l i t i a n 2 8
3 . 3 P o p u l a s i d a n S a m p e i P e n e l i t i a n 3 . 3 . 1 P o p u l a s i 2 8 3 . 3 . 2 S a m p c l , B e s a r S a m p e i d a n S a m p e ! m i n i m a l 2 8 3 . 3 . 3 K r i t e r i a I n k l u a s i d a n E k s k l u s i 3 0 3 . 3 . 4 C a r a P e n g a m b i l a n S a m p e i 3 0
3 . 4 V a r i a b e l P e n e l i t i a n 3 . 4 . 1 VmzbQ\BQb?is [Independent V a r i a b l e ) 3 0
v i i
3 . 4 . 2 V a r i a b e l T e r i k a t [Dependent Variable) 3 0 3 . 5 D e f i n i s i O p e r a s i o n a l 3 0 3 . 6 C a r a K e r j a / c a r a p e n g u m p u l a n d a t a 3 2 3 . 7 C a r a P e n g o l a h a n A n a l i s i s D a t a
3 . 7 . 1 T a h a p a n P e n g o l a h a n D a t a 3 2 3 . 7 . 2 A n a l i s i s D a t a 3 2
3 . 8 A l u r P e n e l i t i a n 3 4
B A B I V . H A S I L DAN P E M B A H A S A N 4 . 1 H a s i l P e n e l i t i a n
4 . 1 . 1 A n a l i s i s U n i v a r i a t 3 5 4 . 1 . 2 A n a l i s i s B i v a r i a t 3 7
4 . 2 P e m b a h a s a n 4 . 2 . 1 A n a l i s i s U n i v a r i a t 3 8 4 . 2 . 2 A n a l i s i s B i v a r i a t 3 8
B A B V . K E S I M P U L A N DAN S A R A N 5 . 1 K e s i m p u l a n 4 0 5 . 2 S a r a n 4 0
D A F T A R P U S T A K A 4 2 L A M P I R A N 4 4
Vlll
D A F T A R T A B E L
T a b e l H a l a m a n
1 .1 K e a s l i a n P e n e l i t i a n 5
4 . 1 J u m i a h K a s u s O b g y n d i R S . M u h a m m a d i y a h 3 4
4 . 2 D i s t r i b u s i S a m p e i K a s u s B e r d a s a r k a n K e l o m p o k P a r i t a s 3 5
4 . 3 D i s t r i b u s i S a m p e i K a s u s B e r d a s a r k a n K e l o m p o k P i a s e n t a p r e v i a 3 5
4 . 4 T a b e l 2 x 2 3 6
4 . 5 H u b u n g a n P a r i t a s d e n g a n K e j a d i a n P i a s e n t a P r e v i a 3 6
IX
D A F T A R L A M P I R A N
L a m p i r a n H a l a m a n
1. H a s i ! P e n e l i t i a n 4 3
2 . H a s i l A n a l i s i s D a t a 5 2
3 . S i x r a t - s u r a t P e n e l i t i a n 5 5
4. L e m b a r A k t v i t a s B i m b i n g a n S k r i p s i 5 6
5. B i o d a t a 5 7
X
BAB I
PENDAHULUAN
Latar Belakang
K e m a t i a n m a t e r n a l [maternal mortality) h i n g g a s a a t i n i m a s i h m e n j a d i
t o l a k u k u r u n t u k m e n i l a i b a i k d a n b u r u k n y a k e a d a a n p e l a y a n a n k e b i d a n a n
(maternity care) d a l a m s u a t u n e g a r a a t a u d a e r a h . M e n u r u t d e f i n i s i W H O
" k e m a t i a n m a t e r n a l a d a l a h k e m a t i a n s e o r a n g w a n i t a w a k t u h a m i l a t a u
d a l a m 4 2 h a r i s e s u d a h b e r a k h i m y a k e h a m i l a n d a n t i n d a k a n y a n g d i i a k u k a n
u n t u k m e n g a k h i r i k e h a m i l a n " . A n g k a k e m a t i a n i b u ( A K I ) a d a l a h j u m i a h
k e m a t i a n m a t e r n a l d i p e r h i t u n g a n t e r d a p a t 1 . 0 0 0 a t a u 1 0 . 0 0 0 k e l a h i r a n
h i d u p , k i n i d i b e b e r a p a N e g a r a m a l a h a n t e r h a d a p a n 1 0 0 . 0 0 0 k e l a h i r a n h i d u p
( P r a w i r o h a r d j o , 2 0 1 0 ) . A K I I n d o n e s i a p a d a t a h u n 1 9 9 1 d a r i 3 9 0 m e n j a d i
2 2 8 p e r 1 0 0 . 0 0 0 k e l a h i r a n h i d u p p a d a t a h u n 2 0 0 7 . A n g k a k e m a t i a n i b u
m e n u r u n , n a m u n p e r l u u p a y a d a n k e r j a k e r a s u n t u k m e n c a p a i t a r g e t M D G
s e b e s a r 1 0 2 p e r 1 0 0 . 0 0 0 k e l a h i r a n h i d u p p a d a t a h u n 2 0 1 5 . A K I K o t a
P a l e m b a n g a d a l a h 3 1 7 p e r 1 0 0 . 0 0 0 k e l a h i r a n , l e b i h r e n d a h d a r i A K I
p r o v i n s i s u m s e l s e b e s a r 4 6 7 p e r 1 0 0 . 0 0 0 k e l a h i r a n ( D i n k e s K o t a
P a l e m b a n g , 2 0 1 0 ) .
P e n y e b a b k e m a t i a n m a t e r n a l a d a l a h p e r d a r a h a n o b s t e t r i k ( 2 4 , 8 % ) ,
i n f e k s i ( 1 4 , 9 % ) , e k l a m p s i a ( 1 2 , 9 % ) , p a r t u s t i d a k m a j u / d i s t o s i a ( 6 , 9 % ) ,
a b o r t u s y a n g t i d a k a m a n ( 1 2 , 9 % ) d a n s e b a b - s e b a b l a n g s u n g l a i n ( 7 , 9 % )
( C h a l i k , 2 0 1 0 ) . P e r d a r a h a n s e b a g a i p e n y e b a b k e m a t i a n i b u t e r t i n g g i t e r d i r i
t e r d i r i a t a s p e r d a r a h a n a n t e p a r t u m d a n p e r d a r a h a n p o s t p a r t u m . P e r d a r a h a n
a n t e p a r t u m m e r u p a k a n k a s u s g a w a t d a r u r a t y a n g k e j a d i a i m y a b e r k i s a r 3 %
d a r i s e m u a p e r s a l i n a n , p e n y e b a b n y a a n t a r a l a i n P i a s e n t a P r e v i a , s o l u s i o
p i a s e n t a , d a n p e r d a r a h a n y a n g b e l u m j e l a s s u m b e m y a ( W a r d a n a d a n
K a r t a k a , 2 0 0 7 ) .
P i a s e n t a P r e v i a a d a l a h p i a s e n t a y a n g b e r i m p l a n t a s i p a d a s e g m e n
b a w a h r a h i m d e m i k i a n r u p a s e h i n g g a m e n u t u p i s e l u r u h a t a u s e b a g a i d a r i
o s t i u m u r t e r i i n t e r n u m ( C h a l i k , 2 0 1 0 ) . K a s u s i n i m e n a r i k u n t u k d i p e l a j a r i
1
2
t e r u t a m a d i N e g a r a b e r k e m b a n g t e r m a s u k I n d o n e s i a , k a r e n a f a k t o r r i s i k o
y a n g m a s i h s u l i t d i h i n d a r i , p r e v a l e n s i n y a m a s i h t i n g g i s e r t a p u n y a a n d i l
b e s a r d a l a m a n g k a k e m a t i a n m a t e r n a l d a n p e r i n a t a l y a n g m e r u p a k a n
p a r a m e t e r p e l a y a n a n k e s e h a t a n . P a d a b e b e r a p a R u m a h S a k i t U m u m
p e m e r i n t a h d i l a p o r k a n k e j a d i a n i n s i d e n b e r k i s a r 1 , 7 % s a m p a i d e n g a n 2 . 9 % .
s e d a n g k a n d i n e g a r a m a j u i n s i d e n s i n y a l e b i h r e n d a h y a i t u k u r a n g d a r i 1 %
y a n g m u n g k i n d i s e b a b k a n o l e h b e r k u r a n g n y a p e r e m p u a n h a m i l d e n g a n
p a r i t a s t i n g g i . K e j a d i a n P i a s e n t a P r e v i a t e r j a d i k i r a - k i r a 4 d a r i 1 . 0 0 0
p e r s a l i n a n D a n p a d a t r i m e s t e r k e d u a , k e j a d i a n p i a s e n t a p r e v i a d a p a t
d i t e m u k a n d a l a m 4 % - 6 % d a r i k e h a m i l a n ( F r a n c o i s d a n F o l e y , 2 0 0 7 ) .
M e n u r u t d a t a W H O p e r s e n t a s e k e m u n g k i n a n t e r j a d i n y a p i a s e n t a
p r e v i a c u k u p t i n g g i . P r e v a l e n s i p i a s e n t a p r e v i a d i d u n i a p a d a t a h u n 2 0 0 8 ,
s e k i t a r 4 5 8 d a r i 1 0 0 . 0 0 0 k e l a h i r a n s e t i a p t a h u n n y a , s e d a n g k a n p r e v a l e n s i
p i a s e n t a p r e v i a p a d a t a h u n 2 0 0 9 , s e k i t a r 3 2 0 d a r i 1 0 0 . 0 0 0 k e l a h i r a n
( C r e s s w e l l , 2 0 1 3 ) . P r e v a l e n s i p i a s e n t a p r e v i a t e r t i n g g i y a i t u t e r d a p a t p a d a
w i l a y a h A s i a s e b e s a r 0 . 6 3 % ( K i m d k k , 2 0 1 2 ) . W H O m e n y e b u t k a n b a h w a
k e j a d i a n p i a s e n t a p r e v i a d i A s i a T e n g g a r a m e n y u m b a n g h a m p i r s e p e r t i g a
j u m i a h k e j a d i a n p i a s e n t a p r e v i a s e c a r a g l o b a l ( T r i s n a n t o r o , 2 0 1 1 ) . D i
I n d o n e s i a , p a d a t a h u n 2 0 0 9 d i l a p o r k a n o l e h b e b e r a p a p e n e l i t i b e r k i s a r
a n t a r a 2 . 4 - 3 . 5 6 % d a r i s e l u r u h k e h a m i l a n s e k i t a r 5 d a r i 5 0 0 k e l a h i r a n
s e t i a p t a h u n n y a ( A l a m s y a h , 2 0 1 2 ) . S e d a n g k a n d i S u m a t e r a U t a r a m e n u r u t
D e p k e s R l ( 2 0 0 7 ) , p a d a t a h u n 2 0 0 8 p r e v a l e n s i p i a s e n t a p r e v i a t e r j a d i s e k i t a r
2 d a r i 2 5 0 k e l a h i r a n s e t i a p t a h u n . F r e k u e n s i p i a s e n t a p r e v i a t o t a l i s
d i p e r k i r a k a n s e k i t a r 3 7 % d a r i k e s e l u r u h a n t i p e p i a s e n t a p r e v i a , f r e k u e n s i i n i
m e n c a p a i n i l a i t e r t i n g g i d a n s e m u a j e n i s p i a s e n t a p r e v i a , y a i t u t i p e I
p i a s e n t a p r e v i a 7 % , t i p e I I p i a s e n t a p r e v i a 2 9 % , t i p e I I I p i a s e n t a p r e v i a 2 7 %
( N a s r e e n , 2 0 1 1 ) .
P e n y e b a b k e m a t i a n i b u d i I n d o n e s i a a d a l a h 2 5 % p e r d a r a h a n , 2 0 %
p e n y e b a b t i d a k l a n g s u n g , 1 5 % i n f e k s i , 1 3 % a b o r s i y a n g t i d a k a m a n , 1 2 %
e k i a m p s i , 8 % p e n y u l i t p e r s a l i n a n , d a n 7 % p e n y e b a b l a i n n y a ( A l a m s y a h ,
2 0 1 2 ) . S a l a h s a t u p e n y e b a b k e m a t i a n m a t e r n a l i a l a h d i s e b a b k a n p i a s e n t a
3
p r e v i a . P i a s e n t a p r e v i a m a r u p a k a n s a l a h s a t u p e n y e b a b p e r d a r a h a n y a n g
m e m b e r i k o n t r i b u s i s e k i t a r 3 , 5 % d a r i s e l u r u h k e j a d i a n p e r d a r a h a n p a d a
k e h a m i l a n t r i m e s t e r k e t i g a ( N a s r e e n , 2 0 1 1 ) .
P e n y e b a b t e r j a d i n y a p i a s e n t a p r e v i a b e l u m d i k e t a h u i d e n g a n p a s t i
( C h a l i k , 2 0 1 0 ) . N a m u n , p a r i t a s i b u m e m i l i k i p e n g a r u h y a n g b e s a r t e r h a d a p
t i n g g i n y a a n g k a k e j a d i a n p i a s e n t a p r e v i a . P i a s e n t a p r e v i a l e b i h b a n y a k p a d a
k e h a m i l a n d e n g a n p a r i t a s t i n g g i d a n p a d a w a n i t a m u l t i p a r a d i l a p o r k a n
m e m i l i k i r i s i k o 5 % u n t u k t e r j a d i n y a p i a s e n t a p r e v i a d i b a n d i n g k a n d e n g a n
w a n i t a n u l i p a r a y a i t u 0 . 2 % ( F r a n c o i s d a n F o l e y , 2 0 0 7 ) .
P e r i s t i w a y a n g p a l i n g k h a s p a d a p i a s e n t a p r e v i a a d a l a h p e r d a r a h a n
t a n p a n y e r i , y a n g b i a s a n y a t i d a k t e r j a d i h i n g g a m e n d e k a t i a k h i r t r i m e s t e r
k e d u a a t a u s e t e l a h n y a . P a d a b a n y a k k a s u s p i a s e n t a p r e v i a , p e r d a r a h a n
d i m u l a i t a n p a g e j a l a p e r i n g a t a n d a n t a n p a d i s e r t a i n y e r i p a d a p e r e m p u a n
y a n g s e b e l u m n y a m e n g a l a m i r i w a y a t p r e n a t a l n o r m a ! ( C u n n i n g h a m , 2 0 1 3 ) .
P e n a n g a n a n k a s u s p i a s e n t a p r e v i a h a r u s d i r u j u k k e r u m a h s a k i t y a n g
m e m p u n y a i f a s i l i t a s o p e r a s i d a n t r a n s f u s i d a r a h ( S o t i a n , 2 0 1 1 ) .
D i R S U D P a l e m b a n g B a r i , p e n e l i t i m e m p e r o l e h d a t a d a r i t a h u n 2 0 1 3
k e j a d i a n p i a s e n t a p r e v i a s e b a n y a k 2 2 o r a n g , t a h u n 2 0 1 4 s e b a n y a k 5 1 o r a n g
( S o f i a n , 2 0 1 1 )
T i n g g i n y a j u m i a h k a s u s p i a s e n t a p r e v i a p a d a p a r i t a s t e r t e n t u
m e n d o r o n g p e n u l i s u n t u k m e l a k u k a n p e n e l i t i a n m e n g e n a i h u b u n g a n p a r i t a s
i b u d e n g a n k e j a d i a n p i a s e n t a p r e v i a s e l a m a t a h u n J a n u a r i 2 0 1 4 - D e s e m b e r
2 0 1 4 y a n g a d a d i R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g ( R S M P ) .
1.2. Rumusan Masalah
A d a k a h h u b u n g a n p a r i t a s d e n g a n k e j a d i a n p i a s e n t a p r e v i a d i R u m a h
S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4 ?
4
1.3. Tujuan Penelitian
1.3.1.Tujuan Umum
P e n e l i t i a n i n i b e r t u j u a n u n t u k m e n g e t a h u i h u b u n g a n p a r i t a s d e n g a n k e j a d i a n p i a s e n t a p r e v i a d i R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4 .
1.3.2.Tujuan Khusus
T u j u a n k h u s u s d a l a m p e n e l i t i a n i n i a d a l a h ;
1 . M e n g e t a h u i g a m b a r a n p a r i t a s i b u y a n g b e r s a l i n d i R u m a h S a k i t
M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4 .
2 . M e n g e t a h u i j u m i a h k a s u s p i a s e n t a p r e v i a d i R u m a h S a k i t
M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4
3 . M e n g a n a l i s i s h u b u n g a n p a r i t a s i b u d e n g a n k e j a d i a n p i a s e n t a p r e v i a
d i R u m a h S a k i t M u h a m m a d i y a h p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r
2 0 1 4 .
1.4. Manfaat Penelitian
1.4.1. Manfaat Teoritis
1 . M e m b e r i k a n I n f o r m a s i i l m i a h m e n g e n a i d a t a - d a t a y a n g d a p a t
d i g u n a k a n d a l a m u s a h a p e n g e m b a n g a n I l m u k e d o k t e r a n ,
k h u s u s n y a b a g i a n o b s t e t r i k .
2 . M e n y e d i a k a n d a t a u n t u k p e n e l i t i a n l a n j u t a n y a n g b e r h u b u n g a n
d e n g a n p i a s e n t a p r e v i a .
1.4.2. Manfaat Praktis
1 . H a s i l p e n e l i t i a n d a p a t d i g u n a k a n s e b a g a i a c u a n u n t u k m e l a k u k a n
d e t e k s i d i n i t e r h a d a p k e j a d i a n p i a s e n t a p r e v i a .
2 . H a s i l p e n e l i t i a n d a p a t m e n j a d i i n f o r m a s i b a g i m a s y a r a k a t
m e n g e n a i f a k t o r y a n g d a p a t m e n i n g k a t k a n k e j a d i a n p i a s e n t a p r e v i a
d a n b e r t i n d a k s e g e r a a g a r t i d a k t e r j a d i k e p a r a h a n a k i b a t p e n y a k i t .
5
1.5. Keaslian Penelitian
T a b e l 1 .1 P e n e l i t i a n S e b e l u m n y a t e n t a n g p i a s e n t a p r e v i a
J u d u l P e n e l i t i a n D e s a i n
P e n e l i t i a n
H a s i l
H a r t o n o F a k t o r R i s i k o C a s e C o n t r o l
w a h y u d i , d a n k e j a d i a n P i a s e n t a
T e d j o y o u o n o , p r e v i a p a d a i b u
( 2 0 1 1 ) H a m i l d i R S U d r .
S o e d a r s o
P o n t i a n a k t a h u n
2 0 0 9 - 2 0 1 1
U s i a m a t e r n a l > 3 5
t a h u n m e r u p a k a n
f a k t o r r i s i k o d e n g a n
k e j a d i a n p i a s e n t a
p r e v i a ( O R = 1 , 8 7 ) ,
p a r i t a s > 3
m e r u p a k a n f a k t o r
r i s i k o d e n g a n
k e j a d i a n p i a s e n t a
p r e v i a ( 0 R = 2 , 0 7 ) ,
r i w a y a t s e k s i o
s e s a r i a s e b e l u m n y a
m e r u p a k a n f a k t o r
r i s i k o d e n g a n
k e j a d i a n p i a s e n t a
p r e v i a ( 0 R = 1 , 3 5 ) ,
d a n r i w a y a t a b o r t u s
m e r u p a k a n f a k t o r
r i s i k o d e n g a n
k e j a d i a n p i a s e n t a
p r e v i a ( O R = 2 , 3 4 ) .
H e n d r i c k d a n H u b u n g a n a n t a r a C r o s s
M e u t i a u s i a i b u d a n s e c t i o n a l
( 2 0 1 3 ) p a r i t a s d e n g a n
k e j a d i a n p i a s e n t a
p r e v i a d i R u m a h
B e r d a s a r k a n n i l a i
OddsRatio O R =
5 , 1 8 2 , a r t i n y a i b u
y a n g m e l a h i r k a n d i
R S U C u t M e u t i a
6
o a K i t u m u m u i K d U U p a l C l i / A L C l l
I V l c U l l a K d U U p a i e i l litara t a h i i n 9 019 -
/AGvf l U l a l d . Ut l lUl l 901 T v a n p hprn*\ia 7*
9 0 1 9 . 9 0 1 T XO tahim m p T T u l i k i
risiko 5 k a l i l e b i h
b e s a r u n t u k
m e n g a l a m i p i a s e n t a
nrp V I a Hi ha nH i n pka n
i h i i v ane mplah i rkan
nada u s i a < 3 0 t a h u n
dan mpmni inva i
h u b u n e a n b e r m a k n a
ni la i n vJiliif* "
( 0 , 0 0 1 ) , h u b u n g a n
nanta' i dpnean
kpiadian nlaspnta
n r p \ / i a HirlnryatL'an U l C V i u iiiuiipditvciii
n i la i O R — 7 000 mid i W I S . / ,uuu. art inva ibii v ane 111 t i 1 1 y u 1 L /Li y u i i ^
mplah i rkan dpnean
narita*; > 3 mpmi l i k i
ri'sikn 7 k a l i l e b i h E 1 bj 1 IVVZ / E v v E E E E ^ XJ1 E E
besar u n t u k
m e n g a l a m i p i a s e n t a
p r e v i a d i b a n d i n g k a n
p a r i t a s < 3 ,
h u b u n g a n a n t a r a
p a r i t a s d e n g a n
k e j a d i a n p i a s e n t a
p r e v i a m e m p u n y a i
7
n i l a i p v a l u e =
( 0 , 0 0 1 ) a r t i n y a
t e r d a p a t h u b u n g a n
b e r m a k n a a n t a r a
p a r i t a s d e n g a n
k e j a d i a n p i a s e n t a
p r e v i a d i R S U C u t
M e u t i a k a b u p a t e n
A c e h u t a r a 2 0 1 2 -
2 0 1 3 .
B A B 11
T I N J A U A N P U S T A K A
2.1. Landasan Teori
2.1.1 Paritas
A . D e f i n i s i
P a r i t a s a d a l a h k e a d a a n m e l a h i r k a n a n a k b a i k h i d u p a t a u p u n m a t i ,
t e t a p i b u k a n a b o r s i , t a n p a m e l i h a t a n a k n y a . D e n g a n d e m i k i a n , k e l a h i r a n
k e m b a r h a n y a d i h i t u n g s e b a g a i s a t u k a l i p a r i t a s ( S t e d m a n , 2 0 0 3 ) . P a r i t a s
a d a l a h b a n y a k n y a k e l a h i r a n h i d u p y a n g d i p u n y a i o l e h p e r e m p u a n
( B K K B N , 2 0 0 6 ) .
J u m i a h p a r i t a s m e r u p a k a n s a l a h s a t u k o m p o n e n d a r i s t a t u s p a r i t a s
y a n g s e r i n g d i t u l i s k a n d e n g a n n o t a s i G - P - A b , d i m a n a G m e n y a t a k a n
j u m i a h k e h a m i l a n ( g e s t a s i ) , P m e n y a t a k a n j u m i a h p a r i t a s , d a n A b
m e n y a t a k a n j u m i a h a b o r t u s . S e b a g a i c o n t o h n y a , s e o r a n g p e r e m p u a n
t e r s e b u t t e l a h p e r n a h m e n g a n d u n g s e b a n y a k d u a k a l i , d e n g a n s a t u k a l i
p a r i t a s d a n s a t u k a l i a b o r t u s , d a n s a a t i n i t e n g a h m e n g a n d u n g u n t u k
y a n g k e t i g a k a l i n y a ( S t e d m a n , 2 0 0 3 ) .
B . K l a s i f i k a s i
B e r d a s a r k a n j u m l a h n y a , m a k a p a r i t a s s e s e o r a n g p e r e m p u a n d a p a t
d i b e d a k a n m e n j a d i :
1 . N u l l i p a r a
N u l i p a r a a d a l a h p e r e m p u a n y a n g b e l u m p e r n a h m e l a h i r k a n
a n a k s a m a s e k a l i ( M a n u a b a , 2 0 1 2 ) .
2 . P r i m i p a r a
P r i m i p a r a a d a l a h p e r e m p u a n y a n g t e l a h m e l a h i r k a n s e o r a n g
a n a k , y a n g c u k u p b e s a r u n t u k h i d u p d i d u n i a l u a r
( V e m e y , 2 0 0 6 ) .
P r i m i p a r a a d a l a h p e r e m p u a n y a n g t e l a h p e r n a h m e l a h i r k a n
s e b a n y a k s a t u k a l i ( M a n u a b a , 2 0 1 2 ) .
8
9
3 . M u l t i p a r a
M u l t i p a r a a d a l a h p e r e m p u a n y a n g t e l a h m e l a h i r k a n s e o r a n g
a n a k l e b i h d a r i s a t u k a l i ( P r a w i r o h a r d j o , 2 0 1 0 ) .
4 . G r a n d e m u l t i p a r a
G r a n d e m u l t i p a r a a d a l a h p e r e m p u a n y a n g t e l a h m e l a h i r k a n 5
o r a n g a n a k a t a u l e b i h d a n b i a s a n y a m e n g a l a m i p e n y u l i t d a l a n
k e h a m i l a n d a n p e r s a l i n a n ( M a n u a b a , 2 0 1 2 ) .
C . F a k t o r y a n g M e m p e n g a r u h i P a r i t a s M e n u r u t F r i e d m a n
a . P e n d i d i k a n
P e n d i d i k a n b e r a r t i b i m b i n g a n y a n g d i b e r i k a n o l e h s e s e o r a n g
t e r h a d a p p e r k e m b a n g a n o r a n g l a i n m e n u j u k e a r a h s u a t u c i t a -
c i t a t e r t e n t u . M a k i n t i n g g i p e n d i d i k a n s e s e o r a n g , m a k a
m a k i n m u d a h d a l a m m e m p e r o l e h m e n e r i m a i n f o r m a s i ,
s e h i n g g a k e m a m p u a n i b u d a l a m b e r p i k i r r a s i o n a l b a h w a
j u m i a h a n a k y a n g i d e a l a d a l a h 2 o r a n g ( F r i e d m a n , 2 0 0 5 ) .
b . P e k e r j a a n
P e k e r j a a n a d a l a h s e r a n g k a i a n t u g a s a t a u k e g i a t a n y a n g h a r u s
d i l a k s a n a k a n o l e h s e s e o r a n g s e s u a i d e n g a n J a b a t a n a t a u
p r o f e s i m a s i n g - m a s i n g . B e b e r a p a s e g i p o s i t i f a d a l a h
m e n d u k u n g e k o n o m i r u m a h t a n g g a . P e k e r j a a n j e m b a t a n
u n t u k m e m p e r o l e h u a n g d a l a m r a n g k a m e m e n u h i k e b u t u h a n
h i d u p u n t u k m e n d a p a t k a n k u a l i t a s h i u p y a n g l e b i h b a i k
u n t u k k e l u a r g a d a l a m h a l g i z i , p e n d i d i k a n , t e m p a t t i n g g a l ,
s a n d a n g , l i b u r a n , d a n h i b u r a n s e r a t f a s i l i t a s p e l a y a n a n
k e s e h a t a n y a n g d i i n g i n k a n . B a n y a k a n g g a p a n b a h w a s t a t u s
p e k e r j a a n s e s e o r a n g y a n g t i n g g i , m a k a b o l e h m e m p u n y a i
a n a k b a n y a k k a r e n a m a m p u d a l a m m e m e n u h i k e b u t u h a n
h i d u p s e h a r i - h a r i ( F r i e d m a n , 2 0 0 5 ) .
10
K e a d a a n E k o n o m i
K o n d i s i e k o n o m i k e l u a r g a y a n g t i n g g i m e n d o r o n g i b u u n t u k
m e m p u n y a i a n a k l e b i h k a r e n a m e r a s a m a m p u d a l a m
m e m e n u h i k e b u t u h a n h i d u p ( F r i e d m a n , 2 0 0 5 ) .
L a t a r B e l a k a n g B u d a y a
Cultur universal a d a l a h u n s u r - u n s u r k e b u d a y a a n y a n g
b e r s i f a t universal, s e u a k e b u d a y a a n d i d u n i a , s e p e r t i
p e n g e t a h u a n b a h a s a d a n k h a s a n a h d a s a r , c a r a p e r g a u l a n
s o s i a l , a d a t - i s t i a d a t , p e n i l a i a n u m u m . T a n p a d i s a d a r i ,
k e b u d a y a a n t e l a h m e n a n a m k a n g a r i s p e n g a r u h s i k a p
t e r h a d a p b e r b a g a i m a s a l a h ( F r i e d m a n , 2 0 0 5 ) .
K e b u d a y a a n t e l a h m e w a m a i s i k a p a n g g o t a
m a s y a r a k a t n y a , k a r e n a k e b u d a y a a n p u l a y a n g m e m b e r i
c o r a k p e n g a l a m a n i n d i v i d u y a n g m e n j a d i a n g g o t a k e l o m p o k
m a s y a r a k a t a s u h a n n y a . H a n y a k e p e r c a y a a n i n d i v i d u y a n g
t e l a h m a p a n d a n k u a t l a h y a n g d a p a t m e m u d a r k a n d o m i n a s i
k e b u d a y a a n d a l a m p e m b e n t u k a n s i k a p i n d i v i d u a l
( F r i e d m a n , 2 0 0 5 ) .
L a t a r b e l a k a n g b u d a y a y a n g m e m p e n g a r u h i p a r i t a s
a n t a r a l a i n a d a n y a a n g g a p a n b a h w a s e m a k i n b a n y a k j u m i a h
a n a k , m a k a s e m a k i n b a n y a k r e z e k i ( F r i e d m a n , 2 0 0 5 ) .
P e n g e t a h u a n
P e n g e t a h u a n m e r u p a k a n d o m a i n d a r i p e r i l a k u . S e m a k i n
t i n g g i p e n g e t a h u a n s e s e o r a n g , m a k a p e r i l a k u a k a n l e b i h b e r s i f a t
l a m a . D e n g a n k a t a l a i n i b u y a n g t a h u d a n p a h a m j u m i a h a n a k
y a n g i d e a l , m a k a i b u a k a n b e r p e r i l a k u s e s u a i d e n g a n a p a y a n g i a
k e t a h u i ( F r i e d m a n , 2 0 0 5 ) .
11
2.1.2. Piasenta Previa
A . D e f i n i s i
P i a s e n t a p r e v i a a d a l a h p i a s e n t a y a n g b e r i m p l a n t a s i p a d a s e g m e n
b a w a h r a h i m , s e h i n g g a m e n u t u p i s e b a g i a n a t a u s e l u r u h d a r i ostium
uteri internum y a n g d i t a n d a i d e n g a n p e r d a r a h a n u t e r u s t a n p a a d a n y a
r a s a n y e r i y a n g b i a s a n y a t e r j a d i m e n j e l a n g a k h i r t r i m e s t e r k e d u a a t a u
s e s u d a h n y a ( C u n n i n g h a m , 2 0 0 9 ) .
M e n u r u t C h a l i k ( 2 0 1 0 ) , p i a s e n t a p e v i a l e b i h b a n y a k t e r j a d i p a d a
k e h a m i l a n d e n g a n p a r i t a s t i n g g i d a n p a d a u s i a d i a t a s 3 0 t a h u n . J u g a
l e b i h s e r i n g t e r j a d i p a d a k e h a m i l a n d e n g a n p a r i t a s t i n g g i d a n p a d a
k e h a m i l a n t u n g g a l . U t e r u s y a n g c a c a t j u g a i k u t m e m p e r t i n g g i a n g k a
k e j a d i a n n y a . P a d a b e b e r a p a R u m a h S a k i t U m u m P e m e r i n t a h
d i l a p o r k a n i n s i d e n n y a b e r k i s a r 1 ,7 % s a m p a i d e n g a n 2 , 9 %. S e d a n g k a n
d i N e g a r a m a j u i n s i d e n n y a l e b i h r e n d a h y a i t u k u r a n g d a r i 1 % y a n g
m u n g k i n d i s e b a b k a n o l e h b e r k u r a n g n y a p e r e m p u a n h a m i l d e n g a n
p a r i t a s t i n g g i .
K e j a d i a n p i a s e n t a p r e v i a t e r j a d i s e k i t a r 4 d a r i 1 . 0 0 0 p e r s a l i n a n .
D a n p a d a t r i m e s t e r k e d u a , k e j a d i a n p i a s e n t a p r e v i a d a p a t d i t e m u k a n
d a l a m 4 % - 6 % d a r i k e h a m i l a n ( F r a n c o i s d a n F o l e y , 2 0 0 7 ) .
B . K l a s i f i k a s i
M e n u r u t C h a l i k ( 2 0 1 0 ) , p i a s e n t a p r e v i a d a p a t d i g o l o n g k a n
m e n j a d i e m p a t b a g i a n y a i t u :
1 . P i a s e n t a p r e v i a t o t a l i s a t a u k o m p l i t a d a l a h p i a s e n t a y a n g
m e n u t u p i s e l u r u h o s t i u m u t e r i i n t e r n u m .
2 . P i a s e n t a p r e v i a a d a l a h p i a s e n t a y a n g m e n u t u p i s e b a g i a n o s t i u m
u t e r i i n t e r n u m .
3 . P i a s e n t a p r e v i a m a r g i n a l i s a d a l a h p i a s e n t a y a n g t e p i n y a b e r a d a
p a d a p i n g g i r o s t i u m u t e r i i n t e r n u m .
4 . P i a s e n t a l e t a k r e n d a h a d a l a h p i a s e n t a y a n g b e i m p l a n t a s i p a d a
s e g m e n b a w a h r a h i m y a n g d e m i k i a n r u p a s e h i n g g a t e p i
12
b a w a h n y a b e r a d a p a d a j a r a k l e b i h k u r a n g 2 c m d a r i o s t i u m u t e r i
i n t e r n u m . J a r a k y a n g l e b i h d a r i 2 c m d i a n g g a p p i a s e n t a l e t a k
n o r m a l .
M e n u r u t C h a l i k ( 2 0 1 0 ) k l a s i f i k a s i p i a s e n t a p r e v i a b e r d a s a r k a n
p e m b u k a a n 4- 5 c m y a i t u :
1 . P i a s e n t a P r e v i a S e n t r a l i s ( T o t a l i s ) , a p a b i l a p a d a p e m b u k a a n 4 -
5 c m t e r a b a p i a s e n t a m e n u t u p i s e l u r u h o s t i u m .
2 . P i a s e n t a P r e v i a L a t e r a l i s , b i l a p a d a p e m b u k a a n 4 , 5 c m d i b a g i
m e n j a d i d u a , y a i t u :
a . p i a s e n t a p r e v i a l a t e r a l i s p o s t e r i o r , b i l a s e b a g i a n m e n u t u p i
o s t i u m b a g i a n b e l a k a n g .
b. P i a s e n t a p r e v i a l a t e r a l i s a n t e r i o r , b i l a s e b a g i a n m e n u t u p i
o s t i u m b a g i a n d e p a n .
c . P i a s e n t a p r e v i a l a t e r a l i s m a r g i n a l i s , b i l a s e b a g i a n k e c i l
a t a u h a n y a p i n g g i r o s t i u m y a n g d i t u t u p i p i a s e n t a .
C . F a k t o r r i s i k o
P e n y e b a b p i a s e n t a p r e v i a b e l u m d i k e t a h u i s e c a r a p a s t i , n a m u n
a d a b e b e r a p a f a k t o r r i s i k o m e n i n g k a t k a n k e m u n g k i n a n t e r j a d i n y a
p i a s e n t a p r e v i a , a n t a r a l a i n :
1 . U m u r
2 . B a n y a k n y a j u m i a h k e h a m i l a n d a n p e r s a l i n a n ( p a r i t a s ) .
3 . H i p o p l a s i a e n d o m e t r i u m
4 . K o r p u s l u t e u m b e r e a k s i l a m b a t .
5 . T u m o r - t u m o r , s e p e r t i m i o m a u t e r i , p o l i p e n d o m e t r i u m .
6 . E n d o m e t r i u m c a c a t , s e k s i o c e s a r e a n , k u r e t a s e , d a n m a n u a l
p i a s e n t a
7 . K e h a m i l a n k e m b a r .
8 . R i w a y a t p i a s e n t a p r e v i a s e b e l u m n y a ( S o f i a n , 2 0 I I ) .
13
a . U m u r i b u
D a l a m k u r u n w a k t u r e p r o d u k s i s e h a t d i k e n a ! b a h w a u m u r a m a n
u n t u k k e h a m i l a n d a n p e r s a l i n a n a d a l a h 2 0 - 3 5 t a h u n . W a n i t a p a d a
u m u r k u r a n g d a r i 2 0 t a h u n m e m p u n y a i r i s i k o y a n g l e b i h t i n g g i
u n t u k m e n g a l a m i p i a s e n t a p r e v i a k a r e n a e n d o m e t r i u m m a s i h
b e l u m m a t a n g , d a n k e j a d i a n p i a s e n t a p r e v i a j u g a s e r i n g t e r j a d i
p a d a i b u y a n g b e r u m u r d i a t a s 3 5 t a h u n k a r e n a t u m b u h
e n d o m e t r i u m y a n g k u r a n g s u b u r ( P r a w i r o h a r d j o , 2 0 1 0 ) .
B e r d a s a r k a n p e n e i i t i a n n y a d i R S d r . H a s a n S a d i k i n B a n d u n g
d a l a m k u r u n w a k t u J a n u a r i 1 9 9 8 - d e s e m b e r 2 0 0 2 , m e n g a t a k a n
b a h w a s e m a k i n t u a u m u r i b u m a k a k e m u n g k i n a n u n t u k
m e n d a p a t k a n p i a s e n t a p r e v i a s e m a k i n b e s a r , p a d a i b u y a n g
m e l a h i r k a n d e n g a n u s i a d i a t a s 4 0 t a h u n b e r i s i k o 2 , 6 k a l i u n t u k
t e r j a d i n y a p i a s e n t a p r e v i a .
b . P a r i t a s
P a r i t a s m e r u p a k a n s e s e o r a n g w a n i t a y a n g p e r n a h m e l a h i r k a n b a y i
a t e r m . B e b e r a p a i s t i l a h y a n g b e r k a i t a n d e n g a n p a r i t a s y a i t u :
1 . P r i m i p a r a a d a l a h s e o r a n g w a n i t a y a n g p e r n a h m e l a h i r k a n b a y i
a t e r m s e b a n y a k s a t u k a l i .
2 . M u l t i p a r a a d a l a h w a n i t a y a n g p e r n a h m e l a h i r k a n b a y i h i d u p
b e b e r a p a k a l i , d i m a n a p e r s a l i n a n t e r s e b u t t i d a k l e b i h d a r i l i m a
k a l i .
3 . G r a n d e m u l t i p a r a a d a l a h w a n i t a y a n g p e r n a h m e l a h i r k a n b a y i
a t e r m l e b i h d a r i l i m a k a l i ( M a n u a b a , 2 0 1 2 ) .
D . E t i o l o g i
P e n y e b a b b l a s t o k i s t a b e r i m p l a n t a s i p a d a s e g m e n b a w a h r a h i m
b e l u m l a h d i k e t a h u i d e n g a n p a s t i . M u n g k i n s e c a r a k e b e t u l a n s a j a
b l a s t o k i s t a m e n i m p a d e s i d u a d i d a e r a h s e g m e n b a w a h r a h i m t a n p a l a t a r
b e l a k a n g l a i n y a n g m u n g k i n . T e o r i l a i n m e n g e m u k a k a n s e b a g a i s a l a h
s a t u p e n y e b a b n y a a d a l a h v a s k u l a r i s a s i d e s i d u a y a n g t i d a k m e m a d a i ,
m u n g k i n s e b a g a i a k i b a t d a r i p r o s e s r a d a n g a t a u a t r o f i , P a r i t a s t i n g g i ,
14
u s i a l a n j u t , c a c a t r a h i m m i s a l n y a b e k a s b e d a h c e s a r , k e r o k a n ,
m i o m e k t o m i , d a n s e b a g a i n y a b e r p e r a n d a l a m p r o s e s p e r a d a n g a n d a n
k e j a d i a n a t r o t l d i e n d o m e t r i u m y a n g s e m u a n y a d a p a t d i p a n d a n g
s e b a g a i f a k t o r r i s i k o b a g i t e r j a d i n y a p i a s e n t a p r e v i a . C a c a t b e k a s b e d a h
s e s a r b e r p e r a n d a l a m m e n a i k k a n i n s i d e n d u a s a m p a i t i g a k a l i . P a d a
p e r e m p u a n p e r o k o k d i j u m p a i i n s i d e n p i a s e n t a p r e v i a l e b i h t i n g g i 2 k a l i
l i p a t . H i p o k s e m i a a k i b a t k a r b o n m o n o - o k s i d a h a s i ! p e m b a k a r a n r o k o k
m e n y e b a b k a n p i a s e n t a m e n j a d i h i p e r t r o f i s e b a g a i u p a y a k o m p e n s a s i .
P i a s e n t a y a n g t e r l a l u b e s a r s e p e r t i p a d a k e h a m i l a n g a n d a d a n
e r i t r o b l a s t o s i s f e t a l i s b i s a m e n y e b a b k a n p e r t u m b u h a n p i a s e n t a m e l e b a r
k e s e g m e n b a w a h r a h i m s e h i n g g a m e n u t u p i s e b a g i a n a t a u s e l u r u h
o s t i u m u t e r i i n t e r n u m ( P r a w i r o h a r d j o , 2 0 1 0 ) .
E . P a t o t l s i o l o g i
P a d a u s i a k e h a m i l a n y a n g l a n j u t , u m u m n y a p a d a t r i m e s t e r
k e t i g a d a n m u n g k i n j u g a l e b i h a w a l , o l e h k a r e n a t e l a h m u l a i
t e r b e n t u k n y a s e g m e n b a w a h r a h i m , t a p a k p i a s e n t a a k a n
m e n g a l a m i p e l e p a s a n . S e b a g i a n d i k e t a h u i t a p a k p i a s e n t a
t e r b e n t u k d a r i j a r i n g a n m a t e r n a l y a i t u b a g i a n d e s i d u a b a s a l i s
y a n g b e r t u m b u h m e n j a d i b a g i a n d a r i u r i . D e n g a n m e l e b a m y a
i s t h m u s u t e r i m e n j a d i s e g m e n b a w a h r a h i m , m a k a p i a s e n t a y a n g
b e r i m p l a n t a s i d i s i t u s e d i k i t b a n y a k a k a n m e n g a l a m i l a s e r a s i
a k i b a t p e l e p a s a n p a d a d e s i d u a s e b a g a i t a p a k p i a s e n t a . D e m i k i a n
p u l a p a d a w a k t u s e r v i k s m e n d a t a r [dilatation] a d a b a g i a n t a p a k
p i a s e n t a y a n g t e r l e p a s . P a d a t e m p a k l a s e r a s i i t u a k a n t e r j a d i
p e r d a r a h a n y a n g b e r a s a l d a r i s i r k u l a s i m a t e r n a l y a i t u d a r i r u a n g a n
i n t e r v i l l u s d a r i p i a s e n t a . O l e h k a r e n a f e n o m e n a p e m b e n t u k a n
s e g m e n b a w a h r a h i m i t u p e r d a r a h a n p a d a p i a s e n t a p r e v i a b e t a p a
p u n p a s t i a k a n t e r j a d i [unavoidable bleeding). P e r d a r a h a n d i
t e m p a t i t u r e l a t i f d i p e r m u d a h d a n d i p e r b a n y a k o l e h k a r e n a
s e g m e n b a w a h r a h i m d a n s e r v i k s t i d a k m a m p u b e r k o n t r a k s i
15
d e n g a n k u a t k a r e n a e l e m e n o t o t y a n g d i m i l i k i n y a s a n g a t m i n i m a l ,
d e n g a n a k i b a t p e m b u i u h d a r a h p a d a t e m p a t i t u t i d a k a k a n t e r t u t u p
d e n g a n s e m p u r n a . P e r d a r a h a n a k a n l x ; r h e n t i k a r e n a t e r j a d i
p e m b e k u a n k e c u a l i j i k a a d a l a s e r a s i m e n g e n a i s i n u s y a n g b e s a r
d a r i p i a s e n t a p a d a m a s a p e r d a r a h a n a k a n b e r l a n g s u n g l e b i h
b a n y a k d a n l e b i h l a m a . O l e h k a r e n a p e m b e n t u k a n s e g m e n b a w a h
r a h i m i t u a k a n b e r l a n g s u n g p r o g r e s i f d a n b e r t a h a p , m a k a l a s e r a s i
b a r u a k a n m e n g u l a n g k e j a d i a n p e r d a r a h a n . D e m i k i a n l a h
p e r d a r a h a n a k a n m e n g u l a n g t a n p a s e s u a t u s e b a b l a i n (causeless).
D a r a h y a n g k e l u a r b e r w a m a m e r a h s e g a r t a n p a r a s a n y e r i
(painless). P a d a p i a s e n t a y a n g m e n u t u p i s e l u r u h o s t i u m u t e r i
i n t e r n u m p e r d a r a h a n t e r j a d i l e b i h a w a l d a l a m k e h a m i l a n o l e h
k a r e n a s e g m e n b a w a h r a h i m t e r b e n t u k l e b i h d a h u l u p a d a b a g i a n
t e r b a w a h y a i t u p a d a o s t i u m u t e r i i n t e r n u m . S e b a l i k n y a , p a d a
p i a s e n t a p r e v i a p a r s i a l i s a t a u l e t a k r e n d a h , p e r d a r a h a n b a r u t e r j a d i
p a d a w a k t u m e n d e k a t i a t a u m u l a i p e r s a l i n a n . P e r d a r a h a n p e r t a m a
b i a s a n y a s e d i k i t t e t a p i c e n d e r u n g l e b i h b a n y a k p a d a p e r d a r a h a n
b e r i k u t n y a . U n t u k b e r j a g a - j a g a m e n c e g a h s y o k h a l t e r s e b u t p e r l u
d i p c r t i m b a n g k a n . P e r d a r a h a n p e r t a m a s u d a h b i s a t e r j a d i p a d a
k e h a m i l a n d i b a w a h 3 0 m i n g g u t e t a p i l e b i h s e p a r u h k e j a d i a n n y a
( P r a w i r o h a r d j o , 2 0 1 0 )
P a d a u m u r k e h a m i l a n 3 4 m i n g g u k e a t a s . B e r h u b u n g t e m p a t
p e r d a r a h a n t e r l e t a k d e k a t d e n g a n o s t i u m u t e r i i n t e r n u m , m a k a
p e r d a r a h a n l e b i h m u d a h m e n g a l i r k e l u a r r a h i m d a n t i d a k
m e m b e n t u k h e m a t o m a r e t r o p l a s e n t a y a n g m a m p u m e r u s a k
j a r i n g a n l e b i h l u a s d a n m e l e p a s k a n t r o m b o p l a s t i n k e d a l a m
s i r k u l a s i m a t e r n a l . D e n g a n d e m i k i a n , s a n g a t j a r a n g t e r j a d i
k o a g u l o p a t i p a d a p i a s e n t a p r e v i a ( P r a w i r o h a r d j o , 2 0 1 0 ) .
H a l i n i y a n g p e r l u d i p e r h a t i k a n a d a l a h d i n d i n g s e g m e n
b a w a h r a h i m y a n g t i p i s m u d a h d i i n v a s i o l e h p e r t u m b u h a n v i l i
o l e h t r o f o b l a s , a k i b a t n y a p i a s e n t a m e i e k a t l e b i h k u a t p a d a
16
d i n d i n g u t e r u s . L e b i h s e r i n g t e r j a d i p i a s e n t a a k r e t a d a n p i a s e n t a
i n k r e t a , b a h k a n p i a s e n t a p e r k r e t a y a n g p e r t u m b u h a n v i l i n y a b i s a
s a m p a i m e n e m b u s k e b u i i - b u l i d a n k e r e k t u m b e r s a m a p i a s e n t a
p r e v i a . P i a s e n t a i n k r e t a d a n a k r e t a l e b i h s e r i n g t e r j a d i p a d a u t e r u s
y a n g s e b e l u m n y a p e r n a h b e d a h c e s a r . S e g m e n b a w a h r a h i m d a n
s e r v i k s y a n g r a p u h m u d a h r o b e k o l e h s e b a b k u r a n g n y a e l e m e n
o t o t y a n g t e r d a p a t d i s a n a . K e d u a k o n d i s i i n i b e r p o t e n s i
m e n i n g k a t k a n k e j a d i a n p e r d a r a h a n p a s c a p e r s a l i n a n p a d a p i a s e n t a
p r e v i a , m i s a l n y a d a l a m k a l a t i g a k a r e n a p i a s e n t a s u k a r m e l e p a s
d e n g a n s e m p u r n a {retencio placentae), a t a u s e t e l a h u r i l e p a s
k a r e n a s e g m e n b a w a h r a h i m t i d a k m a m p u b e r k o n t r a k s i d e n g a n
b a i k ( P r a w i r o h a r d j o , 2 0 1 0 ) .
F . G a m b a r a n K l i n i s
C i r i y a n g m e n o n j o l p a d a p i a s e n t a p r e v i a a d a l a h p e r d a r a h a n u t e r u s
k e l u a r m e l a l u i v a g i n a t a n p a r a s a n y e r i . P e r d a r a h a n b i a s a n y a b a r u t e r j a d i
p a d a a k h i r t r i m e s t e r k e d u a k e a t a s . P e r d a r a h a n p e r t a m a b e r l a n g s u n g
t i d a k b a n y a k d a n b e r h e n t i s e n d i r i . P e r d a r a h a n k e m b a l i t e r j a d i t a n p a
s e s u a t u s e b a b y a n g j e l a s s e t e l a h b e b e r a p a w a k t u k e m u d i a n , j a d i
b e r u l a n g . P a d a s e t i a p p e n g u l a n g a n t e r j a d i p e r d a r a h a n y a n g l e b i h
b a n y a k b a h k a n s e p e r t i m e n g a l i r . P a d a p i a s e n t a l e t a k r e n d a h p e r d a r a h a n
b a r u t e r j a d i p a d a w a k t u m u l a i p e r s a l i n a n ; p e r d a r a h a n b i s a s e d i k i t
s a m p a i b a n y a k m i r i p p a d a s o l u s i o p i a s e n t a . P e r d a r a h a n d i p e r h e b a t
b e r h u b u n g s e g m e n b a w a h r a h i m t i d a k m a m p u b e r k o n t r a k s i s e k u a t
s e g m e n a t a s r a h i m . D e n g a n d e m i k i a n , p e r d a r a h a n b i s a b e r l a n g s u n g
s a m p a i p a s c a p e r s a l i n a n . P e r d a r a h a n j u g a b i s a b e r t a m b a h d i s e b a b k a n
s e r v i k s d a n s e g m e n b a w a h r a h i m p a d a p i a s e n t a p r e v i a l e b i h r a p u h d a n
m u d a h m e n g a l a m i r o b e k a n . R o b e k a n l e b i h m u d a h t e r j a d i p a d a u p a y a
p e n g e l u a r a n p i a s e n t a d e n g a n t a n g a n m i s a l n y a p a d a r e t e n s i o p i a s e n t a
s e b a g a i k o m p l i k a s i p i a s e n t a a k r e t a ( P r a w i r o h a r d j o , 2 0 1 0 ) .
a . P e n g a r u h P i a s e n t a P r e v i a T e r h a d a p k e h a m i l a n
17
K a r e n a d i h a l a n g i o l e h p i a s e n t a m a k a b a g i a n t e r b a w a h j a n i n t i d a k
t e r f i k s i r k e d a l a m p i n t u a t a s p a n g g u l , s e h i n g g a t e r j a d i l a h k e s a l a h a n
l e t a k j a n i n : l e t a k k e p a l a m e n g a p u n g , l e t a k s u n g s a n g , l e t a k l i n t a n g .
S e r i n g t e r j a d i p a r t u s p r e m a t u r u s k a r e n a a d a n y a r a n g s a n g a n k o a g u l u m
d a r a h p a d a s e r v i k s . S e l a i n i t u j i k a b a n y a k p i a s e n t a y a n g l e p a s , k a d a r
p r o g e s t e r o n t u r u n d a n d a p a t t e r j a d i h i s , j u g a l e p a s n y a p i a s e n t a s e n d i r i
d a p a t m e r a n g s a n g h i s . D a p a t j u g a k a r e n a p e m e r i k s a a n d a l a m ( S o f i a n ,
2 0 1 1 ) .
b . P e n g a r u h P i a s e n t a P r e v i a T e r h a d a p P a r t u s
1 . L e t a k j a n i n y a n g t i d a k n o r m a l , m e n y e b a b k a n p a r t u s a k a n m e n j a d i
p a t o l o g i k .
2 . B i l a p a d a p i a s e n t a p r e v i a l a t e r a l i s , k e t u b a n p e c a h a t a u d i p e c a h k a n
d a p a t t e r j a d i p r o l a p s f u n i k u l i .
3 . S e r i n g d i j u m p a i i n e r s i a p r i m e r .
4 . P e r d a r a h a n ( S o f i a n , 2 0 1 1 ) .
G . D i a g n o s i s
P e r e m p u a n y a n g m e n g a l a m i p e r d a r a h a n l a n j u t d a l a m k e h a m i l a n
l a n j u t b i a s a n y a m e n d e r i t a p i a s e n t a p r e v i a a t a u s o l u s i o p i a s e n t a .
G a m b a r a n k l i n i k y a n g k l a s i k s a n g a t m e n o l o n g m e m b e d a k a n a n t a r a
k e d u a n y a , D a h u l u u n t u k k e p a s t i a n d i a g n o s i s p a d a k a s u s d e n g a n
p e r d a r a h a n b a n y a k , p a s i e n d i p e r s i a p k a n d i d a l a m k a m a r b e d a h
d e m i k i a n r u p a s e g a l a s e s u a t u n y a t e r m a s u k s t a f d a n p e r l e n g k a p a n
a n a s t e s i a s e m u a s i a p u n t u k t i n d a k a n b e d a h s e s a r . D e n g a n p a s i e n d a l a m
p o s i s i l i t o t o m i d i a l a s m e j a o p e r a s i d i i a k u k a n p e r i k s a d a l a m [vaginal
toucher) d a l a m l i n g k u n g a n d i s i n f e k s i t i n g k a t t i n g g i ( D T T ) s e c a r a
p e r l a h a n d e n g a n d u a j a r i t e r l u n j u k d a n j a r i t e n g a h m e r a b a f o r n i k s
p o s t e r i o r u n t u k m e n d a p a t k e s a n a d a a t a u t i d a k a d a b a n t a l a n a n t a r a j a r i
d e n g a n b a g i a n t e r b a w a h j a n i n . P e r l a h a n j a r i d i g e r a k k a n m e n g i k u t i
s e l u r u h p e m b u k a a n u n t u k m e n g e t a h u i d e r a j a t a t a s k l a s i f i k a s i p i a s e n t a .
18
J i k a p i a s e n t a l a t e r a l i s a t a u m a r g i n a l i s d i l a n j u t k a n d e n g a n a m n i o t o m i
d a n d i b e r i o k s i t o s i n d r i p u n t u k m e m p e r c e p a t p e r s a l i n a n j i k a t i d a k
t e r j a d i p e r d a r a h a n b a n y a k u n t u k k e m u d i a n p a s i e n d i k e m b a l i k a n k e
k a m a r b e r s a l i n . J i k a t e r j a d i p e r d a r a h a n b a n y a k a t a u t e m y a t a p i a s e n t a
p r e v i a t o t a l i s , l a n g s u n g d i l a n j u t k a n d e n g a n s e k s i o s e s a r i a . P e r s i a p a n
y a n g d e m i k i a n d i s e b u t d e n g a n double set-upexamination. P e r l u
d i k e t a h u i t i n d a k a n p e r i k s a d a l a m t i d a k b o l e h a t a u k o n t r a - i n d i k a s i
d i i a k u k a n d i l u a r p e r s i a p a n double set-up examination. P e r i k s a d a l a m
s e k a l i p u n y a n g d i i a k u k a n d e n g a n s a n g a t l e m b u t d a n p e r l a h a n t i d a k
m e n j a m i n t i d a k a k a n m e n y e b a b k a n p e r d a r a h a n y a n g b a n y a k . J i k a
t e r j a d i p e r d a r a h a n b a n y a k d i l u a r p e r s i a p a n a k a n b e r d a m p a k p a d a
p r o g n o s i s y a n g l e b i h b u r u k b a h k a n b i s a f a t a l { P r a w i r o h a r d j o , 2 0 1 0 ) .
D e w a s a i n i double set-up examination p a d a b a n y a k r u m a h s a k i t
s u d a h j a r a n g d i i a k u k a n b e r h u b u n g t e r s e d i a a l a t u l t r a s o n o g r a f i .
T r a n s a b d o m i n a l u l t r a s o n o g r a f i d a l a m k e a d a a n k a n d u n g k e m i h y a n g
d i k o s o n g k a n a k a n m e m b e r i k e p a s t i a n d i a g n o s i s p i a s e n t a p r e v i a d e n g a n
k e t e p a t a n t i n g g i s a m p a i 9 6 % - 9 8 %. W a l a u p u n l e b i h s u p e r i o r j a r a n g
d i p e r l u k a n t r a n s v a g i n a l u l t r a s o n o g r a f i u n t u k m e n d e t e k s i k e a d a a n
o s t i u m u t e r i i n t e r n u m . D i t a n g a n y a n g t i d a k a h l i p e m a k a i a n
t r a n s v a g i n a l u l t r a s o n o g r a f i b i s a m e m p r o v o k a s i p e r d a r a h a n l e b i h
b a n y a k . D i t a n g a n y a n g a h l i d e n g a n t r a n s v a g i n a l u l t r a s o n o g r a f i d a p a t
d i c a p a i 9 8 % positive predictive value d a n 1 0 0 % negative predictive
value p a d a u p a y a d i a g n o s i s p i a s e n t a p r e v i a . T r a n s p e r i n e a ! s o n o g r a f i
d a p a t m e n d e t e k s i o s t i u m u t e r i i n t e r n u m d a n s e g m e n b a w a h r a h i m , d a n
t e h n i k i n i d i l a p o r k a n 9 0 % positive predictive value d a n 1 0 0 % negative
predictive value d a l a m d i a g n o s i s p i a s e n t a p r e v i a . Magnetic Resonance
Imaging ( M R I ) j u g a d a p a t d i e p r g u n a k a n u n t u k m e n d e t e k s i k e l a i n a n
p a d a p i a s e n t a t e r m a s u k p i a s e n t a p r e v i a . M R I k a l a h p r a k t i s j i k a
d i b a n d i n g k a n d e n g a n U S G , t e r l e b i h d a l a m s u a s a n a y a n g m e n d e s a k
( P r a w i r o h a r d j o , 2 0 1 0 ) .
19
H . P e n a t a l a k s a n a a n
1 . P e n a n g a n a n P a s i f
a. P e r h a t i a n :
S e t i a p p e r d a r a h a n t r i w u l a n k e t i g a y a n g l e b i h d a r i s h o w
( p e r d a r a h a n i n i s i a l ) , h a r u s d i k i r i m k e r u m a h s a k i t t a n p a
d i i a k u k a n m a n i p u l a s i a p a p u n , b a i k r e k t a l m a u p u n v a g i n a l
( P r a w i r o h a r j o , 2 0 1 0 ) .
A p a b i l a p a d a p e n i l a i a n b a i k , p e r d a r a h a n s e d i k i t , j a n i n
m a s i h h i d u p , b e l u m i n p a r t u , k e h a m i l a n b e l u m c u k u p 3 7
m i n g g u , a t a u b e r a t b a d a n j a n i n d i b a w a h 2 5 0 0 g r , m a k a
k e h a m i l a n d a p a t d i p e r t a h a n k a n i s t i r a h a t d a n p e m b e r i a n
o b a t s e p e r t i s p a s m o l i t i k a , p r o g e s t i n a t a u p r o g e s t e r o n e .
O b s e r v a s i l a h d e n g a n t e l i t i .
b . S a m b i l m e n g a w a s i p e r i k s a l a h g o l o n g a n d a r a h , d a n s i a p k a n
d o n o r t r a n s f u s i d a r a h . B i l a m e m u n g k i n k a n k e h a m i l a n
d i p e r t a h a n k a n s e t u a m u n g k i n s u p a y a j a n i n t e r h i n d a r d a r i
p r e m a t u r i t a s .
c . H a r u s d i i n g a t b a h w a b i l a d i j u m p a i i b u h a m i l t e r s a n g k a
p i a s e n t a p r e v i a , r u j u k s e g e r a k e r u m a h s a k i t d i m a n a
t e r d a p a t f a s i l i t a s o p e r a s i d a n t r a n s f u s i d a r a h ,
d . B i l a k e k u r a n g a n d a r a h , b e r i k a n l a h t r a n s f u s i d a r a h d a n o b a t
p e n a m b a h d a r a h .
2 . M e m i l i h C a r a P e r s a l i n a n p a d a P i a s e n t a P r e v i a
F a k t o r y a n g m e n e n t u k a n s i k a p a t a u t i n d a k a n p e r s a l i n a n
m a n a y a n g a k a n d i p i l i h a d a l a h :
a . J e n i s p i a s e n t a p r e v i a .
b . P e r d a r a h a n : b a n y a k , a t a u s e d i k i t t e t a p i b e r u l a n g .
c . K e a d a a n i b u h a m i l .
d . K e a d a a n j a n i n : h i d u p , g a w a t , a t a u m e n i n g g a l .
e . P e m b u k a a n j a l a n l a h i r .
f . P a r i t a s a t a u j u m i a h a n a k h i d u p .
20
g . F a s i l i t a s p e n o l o n g d a n r u m a h s a k i t .
S e t e l a h m e m p e r h a t i k a n f a k t o r d i a t a s , a d a d u a p i l i h a n
p e r s a l i n a n , y a i t u :
1 . P e r s a l i n a n p e r v a g i n a m :
a . A m n i o t o m i
A m n i o t o m i a t a u p e m e c a h a n s e l a p u t k e t u b a n a d a l a h
c a r a y a n g t e r p i l i h u n t u k m e l a n c a r k a n p e r s a l i n a n p e r
v a g i n a m . I n d i k a s i a m n i o t o m i p a d a p i a s e n t a p r e v i a :
1 . P i a s e n t a p r e v i a l a t e r a l i s a t a u m a r g i n a l i s a t a u l e t a k
r e n d a h , b i l a t e l a h a d a p e m b u k a a n .
2 . P a d a p r i m i g r a v i d a d e n g a n p i a s e n t a p r e v i a l a t e r a l i s
a t a u m a r g i n a l i s d e n g a n p e m b u k a a n 4 c m a t a u l e b i h .
3 . P i a s e n t a p r e v i a l a t e r a l i s a t a u m a r g i n a l i s d e n g a n
j a n i n y a n g s u d a h m e n i n g g a l .
k e u n t u n g a n a m n i o t o m i a d a l a h b a g i a n t e r b a w a h
j a n i n y a n g b e r f u n g s i s e b a g a i t a m p o n a k a n m e n e k a n
p i a s e n t a y a n g b e r d a r a h d a n p e r d a r a h a n b e r k u r a n g a t a u
b e r h e n t i , p a r t u s a k a n b e r l a n g s u n g l e b i h c e p a t , d a n b a g i a n
p i a s e n t a y a n g b e r d a r a h d a p a t b e b a s m e n g i k u t i c i n c i n
g e r a k a n d a n r e g a n g a n s e g m e n b a w a h r a h i m , s e h i n g g a
t i d a k a d a l a g i p i a s e n t a y a n g l e p a s . S e t e l a h k e t u b a n
d i p e c a h k a n b e r i k a n o k s i t o s i n d r i p s 2 . 5 - 5 s a t u a n d a l a m
5 0 0 c c d e k s t r o s a 5 %. B i l a u p a y a d i a t a s b e l u m b e r h a s i l ,
a d a d u a c a r a l a g i y a n g d a p a t d i k e r j a k a n t e r u t a m a d i d a e r a h
p e r i f e r d i m a n a f a s i l i t a s o p e r a s i t i d a k a d a d a n p e n d e r i t a
t i d a k m a u d i r u j u k k e r u m a h s a k i t y a n g a d a f a s i l i t a s
o p e r a s i n y a .
b . M e m a s a n g c u n a m W i l l e t G a u s z
C a r a :
1 . K u l i t k e p a l a j a n i n d i k l e m d e n g a n c u n a m W i l l e t
G a u s z .
21
2 . C u n a m d i i k a t d e n g a n k a i n k a s a a t a u t a l i d a n
d i b e r i b e b a n k i r a - k i r a 5 0 - 1 0 0 g r a t a m s a t u
b a t u b a t a s e p r t i k a t r o l .
3 . D e n g a n j a l a n i n i d i h a r a p k a n p e r d a r a h a n b e r h e n t i
d a n p e r s a l i n a n d i a w a s i d e n g a n t e l i t i .
c . V e r s i B r a x t o n - H i c k s
V e r s i d i i a k u k a n p a d a j a n i n l e t a k k e p a l a , u n t u k
m e n c a r i k a k i s u p a y a d a p a t d i t a r i k k e l u a r . B i l a j a n i n
l e t a k s u n g s a n g a t a u l e t a k k a k i , m e n a r i k k a k i k e l u a r
a k a n l e b i h m u d a h . K a k i d i i k a t d e n g a n k a i n k a s a ,
k a t r o l , d a n d i b e n b e b a n s e b e r a t 5 0 - 1 0 0 g r ( s a t u b a t u
b a t a ) .
1 . M e n e m b u s p i a s e n t a d i i k u t i d e n g a n v e r s i B r a x t o n
- H i c k s a t a u W i l l e t G a u s z
H a l i n i s e k a r a n g t i d a k d i i a k u k a n l a g i k a r e n a
b a h a y a p e r d a r a h a n y a n g b a n y a k M e n e m b u s
p i a s e n t a d i i a k u k a n b i l a p i a s e n t a p r e v i a s e n t r a l i s .
2 . M e t r e u r y n t e r
Y a i t u m e m a s u k k a n k a n t o n g k a r e t y a n g d i i s i
u d a r a a t a u a i r s e b a g a i t a m p o n , c a r a i n i s e k a r a n g
t i d a k d i p a k a i l a g i .
2 . P e r s a l i n a n p a r a b d o m i n a l , d e n g a n s e k s i o s e s a r e a
I n d i k a s i s e k s i o s e s a r e a p a d a p i a s e n t a p r e v i a :
a . S e m u a p i a s e n t a p r e v i a s e n t r a l i s , j a n i n h i d u p s a t u a t a u
m e n i n g g a l ; s e m u a p i a s e n t a p r e v i a l a t e r a l i s , p o s t e r i o r ,
k a r e n a p e r d a r a h a n y a n g s u l i t d i k o n t r o l d e n g a n c a r a y a n g
a d a .
b . S e m u a p i a s e n t a p r e v i a l a t e r a l i s p o s t e r i o r , k a r e n a
p e r d a r a h a n y a n g s u l i t d i k o n t r o l d e n g a n c a r a y a n g a d a .
c . S e m u a p i a s e n t a p r e v i a d e n g a n p e r d a r a h a n y a n g b a n y a k
d a n t i d a k b e r h e n t i d e n g a n t i n d a k a n y a n g a d a .
22
d . P i a s e n t a p r e v i a d e n g a n p a n g g u l s e m p i t , l e t a k l i n t a n g .
P e r d a r a h a n p a d a b e k a s i n s e r s i p i a s e n t a {placental bed)
t e r k a d a n g b e r l e b i h a n d a n t i d a k d a p a t d i a t a s i d e n g a n c a r a
- c a r a y a n g a d a , j i k a h a l i n i d i j u m p a i t i n d a k a n n y a
a d a l a h ;
1 . B i l a a n a k b e l u m a d a , u n t u k m e n y e l a m a t k a n a l a t
r e p r o d u k t i f d i i a k u k a n l i g a s i a r t e r i a h i p o g a s t r i k a .
2 . B i l a a n a k s u d a h a d a d a n c u k u p , y a n g p a l i n g b a i k
a d a l a h h i s t e r e k t o m i .
3 . P e n a n g a n a n P i a s e n t a P r e v i a L a t e r a l i s d a n M a r g i n a l i s
L a k u k a n a m n i o t o m i
a . B e r i k a n o k s i t o s i n ( p i t u i t r i n , p i t o s i n , s i n t o s i n o n ) t i a p s e t e n g a h
j a m 2 . 5 s a t u a n a t a u p e r i n f i x s d r i p s .
b . B i l a d e n g a n a m n i o t o m i p e r d a r a h a n b e l u m b e r h e n t i ,
d i i a k u k a n c u n a m W i l l e t G a u s z a t a u v e r s i B r a x t o n - H i c k s .
c. B i l a s e m u a i n i b e l u m b e r h a s i l u n t u k m e n g h e n t i k a n
p e r d a r a h a n , b i l a j a n i n m a s i h h i d u p l a k u k a n s e k s i o s e s a r e a .
d . P a d a p i a s e n t a p r e v i a l a t e r a l i s p o s t e r i o r d a n p i a s e n t a p r e v i a
l a t e r a l i s y a n g b a g i a n b e s a m y a m e n u t u p i o s t i u m {grote lap),
s e r i n g l a n g s u n g d i i a k u k a n s e k s i o s e s a r e a , k a r e n a s e c a r a
a n a t o m i s d e n g a n c a r a d i a t a s p e r d a r a h a n a g a k s u k a r
d i k o n t r o l .
4 . P e n a n g a n a n P i a s e n t a P r e v i a S e n t r a l i s ( T o t a l i s )
1 . U n t u k m e n g h i n d a r i p e r d a r a h a n y a n g b a n y a k , m a k a p a d a
p i a s e n t a p r e v i a s e n t r a l i s d e n g a n j a n i n h i d u p a t a u m e n i n g g a l ,
t i n d a k a n y a n g p a l i n g b a i k a d a l a h s e k s i o s e s a r e a .
2 . W a l a u p u n t i d a k p e r n a h d i k e r j a k a n l a g i , n a m u n u n t u k
d i k e t a h u i , p a d a j a n i n m a t i d i d a e r a h p e d e s a a n d a p a t
d i i a k u k a n p e n e m b u s a n p i a s e n t a , k e m u d i a n d i i a k u k a n c u n a m
W i l l e t G a u s z a t a u v e r s i B r a x t o n - H i c k s u n t u k m e l a h i r k a n
j a n i n ( S o f i a n , 2 0 1 1 ) .
23
I . K o m p l i k a s i
A d a b e b e r a p a k o m p l i k a s i u t a m a y a n g b i s a t e r j a d i p a d a i b u h a m i l
y a n g m e n d e r i t a p i a s e n t a p r e v i a , d i a n t a r a n y a a d a y a n g b i s a
m e n i m b u l k a n p e r d a r a h a n y a n g c u k u p b a n y a k d a n f a t a l .
1 . O l e h k a r e n a p e m b e n t u k a n s e g m e n r a h i m t e r j a d i s e c a r a r i t m i k ,
m a k a p e l e p a s a n p i a s e n t a d a r i t e m p a t m e l e k a t n y a d i u t e r u s d a p a t
b e r u l a n g d a n s e m a k i n b a n y a k , d a n p e r d a r a h a n y a n g t e r j a d i i t u
t i d a k d a p a t d i c e g a h s e h i n g g a p e n d e r i t a m e n j a d i a n e m i a b a h k a n
s y o k .
2 . O l e h k a r e n a p i a s e n t a y a n g b e r i m p l a n t a s i p a d a s e g m e n b a w a h
r a h i m d a n s i f a t s e g m e n i n i y a n g t i p i s m u d a h l a h j a r i n g a n t r o f o b l a s
d e n g a n k e m a m p u a n i n v a s i n y a m e n e r o b o s k e d a l a m m i o m e t r i u m
b a h k a n s a m p a i k e p e r i m e t r i u m d a n m e n j a d i s e b a b d a r i k e j a d i a n
p i a s e n t a i n k r e t a d a n b a h k a n p i a s e n t a p e r k r e t a . P a l i n g r i n g a n
a d a l a h d a l a m m i o m e t r i u m . W a l a u p u n b i a s a n y a t i d a k s e l u r u h
p e r m u k a a n m a t e r n a l p i a s e n t a m e n g a l a m i a k r e t a a t a u i n k r e t a a k a n
t e t a p i d e n g a n d e m i k i a n t e r j a d i r e t e n s i o p i a s e n t a d a n p a d a b a g i a n
p i a s e n t a y a n g s u d a h t e r l e p a s t i m b u l l a h p e r d a r a h a n d a l a m k a l a
t i g a . K o m p l i k a s i i n i l e b i h s e r i n g t e r j a d i p a d a u t e r u s y a n g p e r n a h
s e k s i o s e s a r e a . D i l a p o r k a n p i a s e n t a a k r e t a t e r j a d i 1 0 % s a m p a i 3 5
% p a d a p a s i e n y a n g p e r n a h s e k s i o s e s a r e a s a t u k a l i , n i a k m e n j a d i
6 0 % s a m p a i 6 5 % b i l a t e l a h s e k s i o s e s a r e a 3 k a l i .
3 . S e r v i k s d a n s e g m e n b a w a h r a h i m y a n g r a p u h d a n k a y a p e m b u i u h
d a r a h s a n g a t p o t e n s i a l u n t u k r o b e k d i s e r t a i o l e h p e r d a r a h a n y a n g
b a n y a k . O l e h k a r e n a i t u , h a r u s s a n g a t d i p e r h a t i k a n p a d a s e m u a
t i n d a k a n m a n u a l d i t e m p a t i n i m i s a l n y a p a d a w a k t u
m e n g e l u a r k a n a n a k m e l a l u i i n s i s i p a d a s e g m e n b a w a h r a h i m
a t a u p u n w a k t u m e n g e l u a r k a n p i a s e n t a d e n g a n t a n g a n p a d a
r e t e n s i o p i a s e n t a . A p a b i l a o l e h s a l a h s a t u s e b a b t e r j a d i
p e r d a r a h a n b a n y a k y a n g t i d a k t e r k e n d a l i d e n g a n c a r a y a n g l e b i h
s e d e r h a n a s e p e r t i p e n j a h i t a n s e g m e n b a w a h r a h i m , l i g a s i a r t e r i a
24
u t e r i n e , l i g a s i a r t e r i a o v a r i k a , p e m a s a n g a n t a m p o n , a t a u l i g a s i
a r t e r i a h i p o g a s t r i k a , m a k a p a d a k e a d a a n y a n g s a n g a t g a w a t
s e p e r t i i n i j a l a n k e l u a m y a a d a l a h m e l a k u k a n h i s t e r e k t o m i t o t a l .
M o r b i d i t a s d a r i s e m u a t i n d a k a n i n i t e n t u m e r u p a k a n k o m p l i k a s i
t i d a k l a n g s u n g d a r i p i a s e n t a p r e v i a .
K e l a i n a n l e t a k j a n i n p a d a p i a s e n t a p r e v i a l e b i h s e r i n g t e r j a d i . H a l
i n i m e m a k s a l e b i h s e r i n g d i a m b i l t i n d a k a n o p e r a s i d e n g a n s e g a l a
k o n s e k u e n s i n y a .
K e l a h i r a n p r e m a t u r d a n g a w a t j a n i n s e r i n g t i d a k t e r h i n d a r k a n
s e b a g i a n o l e h k a r e n a t i n d a k a n t e r m i n a s i k e h a m i l a n y a n g t e r p a k s a
d i i a k u k a n d a l a m k e h a m i l a n b e l u m a t e r m . P a d a k e h a m i l a n < 3 7
m i n g g u d a p a t d i i a k u k a n a m n i o s e n t e s i s u n t u k m e n g e t a h u i
k e m a t a n g a n p a r u j a n i n d a n p e m b e r i a n k o r t i k o s t e r o i d u n t u k
m e m p e r c e p a t p e m a t a n g a n p a r u j a n i n s e b a g a i u p a y a a n t i s i p a s i .
K o m p l i k a s i l a i n d a r i p i a s e n t a p r e v i a y a n g d i l a p o r k a n d a l a m
k e p u s t a k a a n s e l a i n m a s a r a w a t a n y a n g l e b i h l a m a , a d a l a h b e r i s i k o
t i n g g i u n t u k s o l u s i o p i a s e n t a ( R i s i k o R e l a t i f 1 3 . 8 ) , s e k s i o s e s a r e a
( R R 3 . 9 ) , k e l a i n a n l e t a k j a n i n ( R R 2 . 8 ) , p e r d a r a h a n
p a s c a p e r s a l i n a n ( R R 1 . 7 ) , k e m a t i a n m a t e r n a l a k i b a t p e r d a r a h a n
( R R 5 0 % ) , dandissemmated intravascular coagulation ( D I C )
1 5 . 9 %. ( P r a w i r o h a r d j o , 2 0 1 0 ) .
25
2 . 1 . 3 . H u b u n g a n P a r i t a s d e n g a n K e j a d i a n P i a s e n t a P r e v i a
B e b e r a p a P e n e l i t i a n t e l a h m e n u n j u k k a n a d a n y a h u b u n g a n a n t a r a p a r i t a s
d e n g a n risiko t e r j a d i n y a p i a s e n t a p r e v i a . R i s i k o r e l a t i f p i a s e n t a p r e v i a p a d a w a n i t a
m u l t i p a r a d i b a n d i n g k a n p r i m i g r a v i d a ( H a r t o n o d a n T e d j o y o u o n o , 2 0 1 1 ) .
H a s i l P e n e l i t i a n t e r s e b u t j u g a s e p e n d a p a t d e n g a n P r a w i r o h a r d j o ( 2 0 1 0 ) , y a n g
m e n g a t a k a n b a h w a w a n i t a p a r i t a s t i n g g i m e m p u n y a i r i s i k o y a n g t i n g g i u n t u k
t e r j a d i n y a p i a s e n t a p r e v i a , s e d a n g k a n w a n i t a p r i m i p a r a m e m p u n y a i risiko l e b i h
r e n d a h u n t u k t e r j a d i n y a p i a s e n t a p r e v i a .
P i a s e n t a p r e v i a l e b i h s e r i n g d i t e m u k a n p a d a w a n i t a m u l t i p a r a , h a l i n i
b e r k a i t a n j u g a d e n g a n a d a n y a p r o s e s p e r a d a n g a n d a n k e j a d i a n a t r o f i d i
e n d o m e t r i u m ( P r a w i r o h a r d j o , 2 0 1 0 ) .
26
2.2.Kerangka Teori
Paritas tinggi Usia > 35
Usia < 20 tahun
Perubahan pada
pembuiuh darah
(sclerosis arteri kecil
dan arteriole
Riwavat sesar
Vaskularisasi
Di endometrium
Atrofi endometrium
Memperluas
permukaan piasenta
i Piasenta previa
Ketidak mampuan
serabut otot segmen
bawah uterus untuk
berkontraksi
Segmen uterus megalami
perubahan
Pelebaran segmen
pembukac
bawah uterus dan
>n serviks
Lepasnya plasen ta dari dasarnya
Sinus uterus robek
i Perdarahan merah segar dan tanpa nyeri
( S u m b e r : C h a l i k , 2 0 1 0 ; P r a w i r o h a r d j o , 2 0 1 0 ; M a n u a b a , 2 0 1 2 )
27
K e r a n g k a t e o r i d i a t a s b e r d a s a r k a n t e o r i d a r i C h a l i k , ( 2 0 1 0 ) , y a n g
m e n y a t a k a n f a k t o r r i s i k o p i a s e n t a p r e v i a t e r j a d i p a d a w a n i t a y a n g
b e r u s i a > 3 5 t a h u n . B e r d a s a r k a n t e o r i d a r i P r a w i r o h a r d j o ( 2 0 1 0 ) d a n
M a n u a b a ( 2 0 1 2 ) y a n g m e n g a t a k a n w a n i t a p a r i t a s t i n g g i m e m p u n y a i
r i s i k o y a n g t i n g g i u n t u k t e r j a d i n y a p i a s e n t a p r e v i a , s e d a n g k a n w a n i t a
p r i m i p a r a m e m p u n y a i r i s i k o l e b i h r e n d a h u n t u k t e r j a d i n y a p i a s e n t a
p r e v i a .
Hipotesis
H o T i d a k t e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a
p a r i t a s d e n g a n k e j a d i a n p i a s e n t a p r e v i a .
H a T e r d a p a t h u b u n g a n y a n g s i g n i f i k a n a n t a r a p a r i t a s
d e n g a n k e j a d i a n p i a s e n t a p r e v i a .
BAB III
METODE PENELITIAN
3.1. Jenis Penelitian
J e m s p e n e l i t i a n i n i m e r u p a k a n p e n e l i t i a n a n a l i t i k o b s e r v a s i o n a l d a n
m e n g g u n a k a n r a n c a n g a n cross sectional inferensial u n t u k m e n e t u k a n a d a
a t a u t i d a k h u b u n g a n p a r i t a s d e n g a n k e j a d i a n p i a s e n t a p r e v i a d i R S
M u h a m m a d i y a h P a l e m b a n g .
3.2. Waktu Tempat Penelitian
3 . 2 . 1 W a k t u P e n e l i t i a n
P e n e l i t i a n i n i d i l a k s a n a k a n p a d a b u l a n O k t o b e r - F e b u a r i 2 0 1 6 .
3 . 2 . 2 L o k a s i P e n e l i t i a n
P e n e l i t i a n d i i a k u k a n d i R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g .
3.3. Populasi dan Sampei Penelitian
3 . 3 . 1 . P o p u l a s i
D a l a m p e n e l i t i a n i n i , p o p u l a s i y a n g d i g u n a k a n a d a l a h s e l u r u h i b u
h a m i l d e n g a n p e r s a l i n a n y a n g t e r d a p a t P i a s e n t a P r e v i a d i b a g i a n o b g y n
R S . M u h a m m a d i y a h P a l e m b a n g d a n t e r c a t a t p a d a r e k a m m e d i k p e r i o d e
J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4 . J u m i a h s e l u r u h p o p u l a s i y a n g d i a m b i l
s e b a n y a k 3 9 5 .
3 . 3 . 2 . S a m p e i
S a m p e i p e n e l i t i a n i n i t e r d i r i d a r i s u b p o p u l a s i y a n g d a p a t d i
p e r g u n a k a n s e b a g a i s u b j e k p e n e l i t i a n a d a l a h s e l u r u h i b u h a m i l y a n g
b e r s a l i n d i b a g i a n o b g y n R S . M u h a m m a d i y a h p a l e m b a n g y a n g t e r c a t a t
p a d a r e k a m m e d i s p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4 .
a . B e s a r S a m p e i
D a l a m h a l p e n e l i t i a n a n a l i t i k m a k a j u m i a h s e l u r u h p o p u l a s i d i a m b i l
s e b a g a i s a m p e i y a i t u 1 5 8 p a d a p a r i t a s r e n d a h n l = 7 9 , p i a s e n t a p r e v i a
9 , p a r i t a s t i n g g i n 2 = 7 9 d e n g a n p i a s e n t a p r e v i a = 5 9 .
2 8
29
b . S a m p e i m i n i m a l
P a d a p e n e l i t i a n i n i s a m p e i m i n i m a l b i s a d i t e n t u k a n d e n g a n
m e n g g u n a k a n r u m u s u j i h i p o t e s i s t e r h a d a p 2 p r o p o r s i :
R u m u s :
m = n 2 = ( Z a 7 2 P Q + z / ? 7 p l q l + p 2 q 2 f ( p i - p z )
K e t e r a n g a n :
Z a = 1 . 9 6 Z P = 0 . 8 4 2 Q l = 0 . 4 0
P 2 = 0 . 6 0 P 1 + P 2 = 0 . 5 5 Q 1 - 0 , 5 5 = 0 . 4 5
Q 2 = 0 . 4 0 P I = 0 . 5 0
P a d a p e r h i t u n g a n s a m p e i m i n i m a l d e n g a n m e n g g u n a k a n r u m u s
S a s t r o a s m o r o ( 1 9 9 5 ) d i d a p a t k a n ;
m = n 2 - ( Z a ^ Z P Q + z f ^ p l Q l + p 2 Q 2 f ( p i - p 2 )
K a r e n a h a s i l f i n i t e m a k a d i g u n a k a n r u m u s S l o v i n , 1 9 7 5 ; n l = n / ( l + ( ( n - ] / N ) ) n l = 3 8 8 / ( l + ( ( 3 8 8 - l / 3 9 5 ) ) n l = 7 9 n 2 = 7 9
P a d a p e n e l i t i a n i n i d a r i p o p u l a s i d i j a d i k a n s a m p e i s e b e s a r 1 5 8 ( S u d i g d o , 2 0 1 1 ) .
30
3.3.3. Kriteria Restriksi
1 . K r i t e r i a I n k l u s i
- K r i t e r i a I n k l u s i f a k t o r r i s i k o y a n g d i m a n a d i d a l a m n y a t e r d a p a t
f a k t o r r i s i k o P a r i t a s
- K r i t e r i a I n k l u s i f a k t o r e f e k a d a l a h d i m a n a d i d a l a m n y a t e r d a p a t
f a k t o r e f e k y a i t u P i a s e n t a P r e v i a
2 . K r i t e r i a E k s l u s i
- T i d a k d i s e r t a i p e n y a k i t l a i n , m i s a l n y a M i o m a a t a u p e n y a k i t
d i a b e t e s
3.3.4. C a r a Pengambilan Sampei
C a r a p e n g a m b i l a n s a m p e i y a n g a k a n d i i a k u k a n d a l a m p e n e l i t i a n i n i
a d a l a h m e n g g u n a k a n t e k n i k simple random sampling, y a i t u
p e n g a m b i l a n s a m p e i y a n g d i d a s a r k a n s e c a r a a c a k , d a n b e r d a s a r k a n
c i r i a t a u s i f a t - s i f a t p o p u l a s i y a n g s u d a h d i k e t a h u i .
Variabel Penelitian
3.4.1. Variabel Independent
V a r i a b e l b e b a s p a d a p e n e l i t i a n i n i a d a l a h P a r i t a s .
3.4.2. Variabel Dependent
V a r i a b e l t e r i k a t p a d a p e n e l i t i a n i n i a d a l a h P i a s e n t a P r e v i a
31
3.5. Definisi Operasional
No V a r i a b e l D e f i n i s i A l a t U k u r C a r a U k u r H a s i l U k u r S k a l a
U k u r
1 . P a r i t a s J u m i a h k e l a h i r a n R e k a m O b s e r v a s i H a s i l p e n g u k u r a n O r d i n a l
i b u p a d a s a a t m e d i k d a t a d i k a t e g o r i k a n
p e n e l i t i a n y a n g s e k u n d e r . m e n j a d i :
t e r t e r a d i r e k a m 1 . P a r i t a s r e n d a h
m e d i k . 2 . P a r i t a s t i n g g i
I n t e r p r e t a s i :
- U n t u k
p r i m i p a r a
d i s e b u t p a r i t a s
r e n d a h 1 k a l i
p a r t u s
- U n t u k
m u l t i p a r a d a n
g r a n d e
m u l t i p a r a
d i s e b u t p a r i t a s
t i n g g i > 2 k a l i
p a r t u s
2 . P i a s e n t a P a s i e n y a n g d i R e k a m O b s e r v a s i H a s i l p e n g u k u r a n N o m i n a !
P r e v i a d i a g n o s i s p i a s e n t a m e d i k . d a t a d i k a t e g o r i k a n
p r e v i a . s e k u n d e r m e n j a d i :
1 . P e n d e r i t a
P i a s e n t a
P r e v i a
2 . B u k a n
P i a s e n t a
P r e v i a .
32
3.6. C a r a kerja/cara pengumpulan data
D a t a d i k u m p u l k a n d a r i d a t a s e k u n d e r y a n g d i a m b i l d e n g a n c a r a m e l i h a t
r e k a m m e d i k d i R S M u h a m m a d i y a h P a l e m b a n g .
3.7. Cara Pengolahan dan Analisis Data
3.7.1. Pengolahan data
D a r i d a t a y a n g t e l a h d i k u m p u l k a n , m a k a p e n e l i t i a k a n
m e n g e l o l a h d a t a m e n g g u n a k a n software statistik s e h i n g g a d a t a
t e r s e b u t d a p a t d i t a r i k k e s i m p u l a n n y a . L a n g k a h a w a l a d a l a h
m e l a k u k a n p e n y u n t i n g a n {editing) t e r h a d a p d a t a y a n g a d a . A p a b i l a
t e m y a t a t i d a k a d a d a t a y a n g d i r a s a k a n k u r a n g ( d a t a l e n g k a p / s i a p ) ,
s e l a n j u t n y a d i i a k u k a n e n t r i k e d a l a m k o m p u t e r . P e m b e r s i h a n d a t a
{Cleaning) t e r h a d a p d a t a - d a t a y a n g t i d a k w a j a r d a n d i c e k
k e b e n a r a n n y a p a d a r e k a p i t u l a s i d a t a y a n g t e l a h d i k u m p u l k a n .
3.7.2. Analisis data
A n a l i s i s d a t a d i i a k u k a n d e n g a n d u a t a h a p y a i t u a n a l i s i s
u n i v a r i a t d a n a n a l i s i s b i v a r i a t .
1. Analisis Univariat
A n a l i s i s u n i v a r i a t d i i a k u k a n u n t u k m e n d e s k r i p s i k a n v a r i a s i
s e l u r u h v a r i a b e l y a n g d i g u n a k a n d e n g a n c a r a m e m b u a t t a b e l
d i s t r i b u s i f r e k u e n s i m a u p u n m e m b u a t n i l a i r a t a - r a t a .
2. Analisis Bivariat
A n a l i s i s b i v a r i a t d i i a k u k a n u n t u k m e l i h a t h u b u n g a n a n t a r a
v a r i a b e l i n d e p e n d e n d e n g a n v a r i a b e l d e p e n d e n . A n a l i s i s b i v a r i a t
y a n g d i i a k u k a n p a d a p e n e l i t i a n i n i a d a 2 y a i t u :
a . U n t u k m e n g e t a h u i h u b u n g a n p a r i t a s d e n g a n P i a s e n t a P r e v i a .
A n a l i s i s y a n g a k a n d i g u n a k a n p a d a u j i d u a v a r i a b e l y a n g
b e r s k a l a k a t e g o r i k a n a l i s i s a d a l a h d e n g a n u j i chi square
d e n g a n t a b e l 2 x 2 d a n j i k a t i d a k m e m e n u h i s y a r a t < 5 g u n a k a n
alternative Fisher.
33
b . U n t u k m e l i h a t Confidence interval d a n Ratio prevalensi,
s e b a g a i n i l a i u n t u k m e n e n t u k a n s e b e r a p a p a r i t a s d a p a t
m e n j a d i f a k t o r r i s i k o t e r h a d a p k e j a d i a n P i a s e n t a P r e v i a .
34
3.8. Alur Penelitian
P a s i e n O b g y n y a n g b e r s a l i n d a n t e r d i a g n o s i s d i r e k a m m e d i s R S M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4 .
I S a m p e i
P r i m i p a r a
P i a s e n t a p r e v i a ( + ) P i a s e n t a p r e v i a ( - )
M u l t i / g a r a n d e m u l t i p a r a
P i a s e n t a p r e v i a ( + ) P i a s e n t a p r e v i a ( - )
I A n a l i s i s u j i h i p o t e s i
BAB IV
HASIL DAN PEMBAHASAN
4.1. Hasil Penelitian
D a r i h a s i ! p e n e l i t i a n y a n g d i d a p a t d a r i p e r i o d e j a n u a r i 2 0 1 4 - d e s e m b e r 2 0 1 4
p a d a k a s u s o b g y n d i R S . M u h a m m a d i y a h p a l e m b a n g j u m i a h p o p u l a s i s e b e s a r 1 5 8
d e n g a n k e j a d i a n k a s u s p i a s e n t a p r e v i a 6 8 k a s u s .
P a d a T a b e l 4 . 1 d i s a j i k a n k a s u s p e r s a l i n a n y a n g t e r j a d i d i o b g y n
4.1.1. Analisis Univariat
A. Populasi
T a b e l 4 . 1 J u m i a h K a s u s O b g y n d i R S . M u h a m m a d i y a h p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4
Kasus Kelahiran Jumiah Persentase (%)
P i a s e n t a P r e v i a 6 8 1 7 . 2
S e c t i o C a e s a r i a 4 0 1 0 . 1
C e d e r a K e p a l a B e r a t 4 4 1 1 . 1
P a r t u s P r e m a t u r u s 4 1 1 0 . 4
P r e - E c l a m p s i a 4 3 1 0 . 9
V a c u m 4 2 1 0 . 6
K e h a m i l a n E k t o p i k 4 5 1 1 . 4
T e r g a n g g u
P a r t u s S p o n t a n 6 4 1 6 . 2
Cepalo Pelvic 8 2 . 0
Disoropoiion
Total 395 100
B e r d a s a r k a n T a b e l 4 . 1 t e m y a t a d i d a p a t k a n p i a s e n t a p r e v i a
1 7 . 2 ( 6 8 % ) , s e c t i o c a e s a r i a 1 0 . 1 ( 4 0 % ) , C K B 1 1 . 1 ( 4 4 % ) , p a r t u s
p r e m a t u r u s 1 0 . 4 ( 4 1 % ) , p r e - e c l a m p s i a 1 0 . 9 ( 4 3 % ) , v a c u m 1 0 . 6
( 4 2 % ) , K E T 1 1 . 4 ( 4 5 % ) , p a r t u s s p o n t a n 1 6 . 2 ( 6 4 % ) , d a n C P D 2 . 0
( 8 % ) .
3 5
36
B. P a r i t a s
T a b e l 4 . 2 . D i s t r i b u s i S a m p e i K a s u s B e r d a s a r k a n K e l o m p o k P a r i t a s
( n = 1 5 8 )
Paritas Jumiah Persentase (%)
P a n t a s r e n d a h * 7 9 5 0 . 0
P a r i t a s t i n g g i ** 7 9 5 0 . 0
T o t a l 1 5 8 1 0 0
* p r i m i p a r a
•* m u l t i / g r a n d e m u l t i p a r a
H a s i l p e n e l i t i a n m e n u n j u k k a n b a h w a d a r i 1 5 8 s a m p e i k a s u s
s e b e s a r 7 9 ( 5 0 . 0 % ) i b u d e n g a n p a r i t a s P r i m i p a r a s e d a n g k a n 7 9
( 5 0 . 0 % ) i b u d e n g a n p a n t a s m u l t i / g r a n d e m u l t i p a r a . U n t u k k e p e r l u a n
a n a l i s i s b i v a r i a t , m a k a k e l o m p o k p a r i t a s d i b a g i m e n j a d i d u a
k a t e g o r i y a n g b e r k e l o m p o k b e r i s i k o ( m u l t i / g r a n d e m u l t i p a r a ) d a n
k e l o m p o k t i d a k b e r i s i k o ( P r i m i p a r a ) .
C . P i a s e n t a P r e v i a
T a b e l 4 . 3 . D i s t r i b u s i P i a s e n t a P r e v i a B e r d a s a r k a n K e l o m p o k P a r i t a s
( n = 1 5 8 )
Paritas Jumiah Persentase ( V o )
P e n d e r i t a P i a s e n t a P r e v i a 6 8 4 2 . 4
B u k a n P i a s e n t a P r e v i a 9 0 5 7 . 6
T o t a l 1 5 8 1 0 0
D a r i T a b e l 4 . 3 d i a t a s d a r i 1 5 8 i b u d i p e r o l e h p e n d e r i t a p i a s e n t a
p r e v i a s e b a n y a k 6 8 ( 4 2 . 4 % ) , d a n b u k a n p i a s e n t a p r e v i a 9 0 ( 5 7 . 6 % ) .
37
4.1.2. A n a l i s i s B i v a r i a t
A n a l i s i s b i v a r i a t u n t u k m e l i h a t h u b u n g a n p a r i t a s d e n g a n p i a s e n t a
p r e v i a d i R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g p e r i o d e J a n u a r i 2 0 1 4 -
D e s e m b e r 2 0 1 4 , D a p a t d i l i h a t p a d a T a b e l 4 . 4 d a n 4 . 5
T a b e l 4 . 4 T a b e l 2 X 2
P a r i t a s P i a s e n t a P r e v i a P e r s e n t a s e ( % )
\ a T i d a k
P a r i t a s T i n g g i 5 9 20 7 9 ( 5 0 . 0 % )
P a r i t a s R e n d a h 9 70 7 9 ( 5 0 . 0 % )
T o t a l 6 8 9 0 1 5 8 ( 1 0 0 % )
T a b e l 4 . 5 H u b u n g a n P a r i t a s d e n g a n K e j a d i a n P i a s e n t a P r e v i a { n = 3 9 5 )
P a r i t a s K e j a d i a n P i a s e n t a
P r e v i a T o t a l % P R
Y a % T i d a k % P
p a r i t a s t i n g g i 5 9 7 4 . 7 2 0 2 5 . 3 7 9 1 0 0 6 4 . 7 8 6 2 6 . 1 8 1
P a r i t a s
r e n d a h 9 1 0 , 1 7 0 8 9 . 9 7 9 1 0 0 0 , 0 0 0
T o t a l 6 8 8 4 . 8 9 0 1 1 5 . 2 1 5 8 1 0 0
P a d a T a b e l 4 . 4 d i a t a s m e n u n j u k a n b a h w a y a n g m e n g a l a m i p i a s e n t a
p r e v i a , d e n g a n p a r i t a s t i n g g i y a i t u 5 9 i b u ( 7 4 . 7 % ) l e b i h b a n y a k d i b a n d i n g k a n
p a r i t a s r e n d a h y a i t u 9 i b u ( 1 0 . 1 % ) .
D a r i h a s i l a n a l i s i s h u b u n g a n p a r i t a s d e n g a n k e j a d i a n p i a s e n t a p r e v i a
d e n g a n u j i cht- squere d i p e r o l e h n i l a i u n t u k p v a l u e s e b e s a r 0 , 0 0 0 < a ( 0 . 0 5 ) .
s e c a r a s t a t i s t i k d a p a t d i k a t a k a n H " d a l a m p e n e l i t i a n i n i d i t o l a k , a r t i n y a a d a
h u b u n g a n b e r m a k n a a n t a r a p a r i t a s d e n g a n p i a s e n t a p r e v i a d i R u m a h S a k i t
M u h a m m a d i y a h P a l e m b a n g .
3 8
D a r i u j i Prevalens Rate ( P R ) a n t a r a p a r i t a s t i n g g i d a n p a r i t a s r e n d a h
s e b e s a r 2 6 . 1 8 1 d a p a t d i s i m p u l k a n i b u d e n g a n p a r i t a s t i n g g i m e r u p a k a n r i s i k o
u n t u k t e r j a d i n y a P i a s e n t a P r e v i a 2 6 k a l i l e b i h b e s a r d i b a n d i n g k a n i b u d e n g a n
P a r i t a s r e n d a h .
4.2. Pembahasan
4.2.1 Analisis Univariat
B e r d a s a r k a n h a s i l a n a l i s i s u n i v a r i a t , d i s t r i b u s i f r e k u e n s i k e j a d i a n p i a s e n t a
p r e v i a d a r i 1 5 8 s a m p e i k a s u s y a n g d i t e l i t i , d i p e r o l e h p r o p o r s i p a r i t a s i b u m e n e m p a t i
p r o p o r s i t e r b e s a r p a d a m u l t i / g r a n d e m u l t i p a r a ( 2 - 5 k a l i p a r t u s ) y a i t u 5 9 i b u
( 7 4 . 7 % ) , d i i k u t i p r o p o r s i p a r i t a s i b u P r i m i p a r a ( 1 k a l i p a r t u s ) y a i t u 9 i b u ( 1 0 . 1 % ) .
H a s i l p e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n T r i a n i n g s i h , M a r d h i y a h , d a n
D u a r s a ( 2 0 1 5 ) d i R S U D D r . H A b d u l M o e l o e k P r o v i n s i L a m p u n g t a h u n 2 0 1 0 - 2 0 1 2
y a n g m e n y a t a k a n k e l o m p o k i b u d e n g a n p a r i t a s b e r i s i k o ( m u l t i p a r a d a n g r a n d e
m u l t i p a r a ) l e b i h b a n y a k m e n g a l a m i p i a s e n t a p r e v i a y a i t u 1 3 1 i b u d e n g a n ( 8 5 . 6 % )
d i b a n d i n g k a n d e n g a n k e l o m p o k i b u d e n g a n p a r i t a s t i d a k b e r i s i k o ( p r i m i p a r a ) y a i t u
s e b a n y a k 2 2 i b u ( 1 4 . 4 % ) .
S e r t a p e n e l i t i a n L e s t a r i d a n M i s b a h ( 2 0 1 4 ) d i R S U D D r . A d j i d a r m o
R a n g k a s b i t u n g t a h u n 2 0 1 1 y a n g m e n y a t a k a n b a h w a p r o p o r s i k e j a d i a n p i a s e n t a
p r e v i a l e b i h b a n y a k t e r j a d i p a d a k e l o m p o k i b u d e n g a n p a r i t a s m u l t i p a r a d a n g r a n d e
m u l t i p a r a y a i t u s e b a n y a k 2 2 i b u ( 2 9 . 7 % )
4.2.2 Anilisis Bivariat
B e r d a s a r k a n h a s i l a n a l i s i s b i v a r i a t m e n u n j u k k a n b a h w a t e r d a p a t h u b u n g a n
b e r m a k n a a n t a r a p a r i t a s i b u d e n g a n k e j a d i a n p i a s e n t a p r e v i a d i R u m a h S a k i t
M u h a m m a d i y a h P a l e m b a n g .
H a s i l p e n e l i t i a n i n i s e j a l a n d e n g a n p e n e l i t i a n H a r t o n o d a n T e d j o y o u o n o ,
( 2 0 1 1 ) , y a n g m e n y a t a k a n t e r d a p a t h u b u n g a n b e r m a k n a a n t a r a p a r i t a s i b u d e n g a n
k e j a d i a n p i a s e n t a p r e v i a d e n g a n n i l a i p = 0 , 0 0 1 .
H a s i l p e n e l i t i a n t e r s e b u t j u g a s e j a l a n d e n g a n P r a w i r o h a r j o ( 2 0 1 4 ) , y a n g
m e n g a t a k a n b a h w a w a n i t a p a r i t a s t i n g g i m e m p u n y a i r i s i k o y a n g t i n g g i u n t u k
39
t e r j a d i n y a p i a s e n t a p r e v i a , s e d a n g k a n w a n i t a p r i m i p a r a m e m p u n y a i r i s i k o l e b i h
r e n d a h u n t u k t e r j a d i n y a p i a s e n t a p r e v i a . P a d a i b u d e n g a n p a r i t a s m u l t i p a r a b e r p e r a n
d a l a m a t r o f i e n d o m e t r i u m , a t a u k e a d a a n e n d o m e t r i u m m a k i n k u r a n g b a i k ,
d i k a r e n a k a n k e h a m i l a n y a n g b e r u l a n g d a p a t m e n y e b a b k a n v a s k u l a r i s a s i y a n g
b e r k u r a n g p a d a p e r s a l i n a n m a s a l a m p a u s e r t a t e r b e n t u k n y a j a r i n g a n p a r u t . J a n n g a n
p a r u t i n i m e n y e b a b k a n t i d a k a d e k u a t n y a p e r s e d i a a n d a r a h k e p i a s e n t a s e h i n g g a
p i a s e n t a m e n j a d i l e b i h t i p i s d a n m e n c a k u p d a e r a h u t e r u s y a n g l e b i h l u a s d a n
b e r i s i k o m e n u t u p i o s t i u m u t e r i i n t e r n u m g u n a m e m e n u h i k e b u t u h a n n u t r i s i j a n i n
( F e b r i n a , N u r t j a h y o , T h a i b , 2 0 1 3 ; L e s t a r i d a n M i s b a h , 2 0 1 3 ; O x o r n , 2 0 0 3 ) .
BAB V
KESIMPULAN DAN SARAN 5.1. Kesimpulan
D a r i h a s i l p e n e l i t i a n y a n g d i i a k u k a n p a d a R u m a h S a k i t M u h a m m a d i y a h
P a l e m b a n g m e n g e n a i H u b u n g a n P a r i t a s d e n g a n K e j a d i a n P i a s e n t a P r e v i a D i
R S M P p e r i o d e J a n u a r i 2 0 1 4 - D e s e m b e r 2 0 1 4 , m a k a d i s i m p u l k a n b a h w a i b u
y a n g m e l a h i r k a n d e n g a n p a r i t a s t i n g g i m e m i l i k i h u b u n g a n y a n g b e r m a k n a
a n t a r a p a r i t a s t i n g g i d e n g a n k e j a d i a n P i a s e n t a P r e v i a d a n P a r i t a s m e r u p a k a n
f a k t o r r i s i k o u n t u k t e r j a d i n y a P i a s e n t a P r e v i a .
5.2. Saran
S a r a n y a n g d a p a t p e n e l i t i b e r i k a n a d a l a h s e b a g a i b e r i k u t :
A . B a g i M a s y a r a k a t
1 A g a r m a s y a r a k a t I n d o n e s i a k h u s u s n y a m e l a k u k a n p e m e r i k s a a n A N C
u n t u k d e k t e k s i p i a s e n t a p r e v i a p a d a u s i a l e b i h d a r i 2 8 m i n g g u p a d a
k e h a m i l a n y a n g b e r i s i k o .
B . B a g i p e n e l i t i
1 . P a d a p e n e l i t i a n i n i t e m y a t a d a r i d a t a r e k a m m e d i k y a n g s a y a d a p a t k a n
m a s i h b a n y a k k e k u r a n g a n , s e h i n g g a s a y a s a r a n k a n r e k a m m e d i k h a m s
l e b i h l e n g k a p d a l a m m e n c a t a t d a n m e m a s u k a n d a t a k e r e k a m m e d i k
t e r s e b u t s e h i n g g a p e n e l i t i b i s a b e k e i j a l e b i h b a i k l a g i , c o n t o h n y a d a t a
p a r i t a s t i d a k l e n g k a p , t u l i s a n d i a g n o s i s y a n g t i d a k j e t a s .
C . B a g ] R u m a h S a k i t M u h a m m a d i y a h P a l e m b a n g
1 . H e n d a k n y a p i h a k R u m a h S a k i t d a p a t m e m i n t a p u s k e s m a s w i l a y a h k e r j a
r u m a h s a k i t t e r s e b u t u n t u k d a p a t m e l a k u k a n p r o m o s i k e s e h a t a n b e m p a
p e n y u l u h a n t e n t a n g p e n y a k i t p i a s e n t a p r e v i a m u l a i d a r i p e n g e r t i a n ,
p e n y e b a b , f a k t o r risiko, g e j a l a s e r t a p e n c e g a h a n d e n g a n m e l a k u k a n
d e t e k s i d i n i m e l a l u i p e m e n k s a a n A N C k e p a d a m a s y a r a k a t a g a r d a p a t
m e n u r u n k a n a n g k a k e j a d i a n p i a s e n t a p r e v i a .
4 0
41
2 . B a g i a n r e k a m m e d i s R u m a h S a k i t M u h a m m a d i y a h p a l e m b a n g
d i h a r a p k a n a g a r d a p a t l e b i h m e n i n g k a t k a n k e l e n g k a p a n d a r i d a t a r e k a m
m e d i k p a s i e n d a n l e b i h m e l e n g k a p i p e n g i s i a n d a r i d a t a r e k a m m e d i k .
42
D A F T A R P U S T A K A
A l a m s y a h . 2 0 1 2 . P e r d a r a h a n Antepartum, ( h l t p : / / e p r i n t s . u m s . a c . i d / 2 5 8 1 2 / 3 / B A B _ I . p d f , d i a k s e s t a n g g a l 5 S e p t e m b e r 2 0 1 5 ) .
A z u r a h , A G . , Z a i n o l , Z W Z . , L i m , P S . , S h a f i e e , M N . 2 0 1 4 . F a c t o r s A s s o c i a t e d w i t h P l a c e n t a p r e v i a i n P r i m i g r a v i d a I t s P r e g n a n c y O u t c o m e . T h e S c i e n t i f i c W o r l d J o u r n a l . 1 0 ( 1 ) : 6 .
B K K B N . 2 0 0 6 . D e t e k s i D i n i K o m p l i k a s i P e r s a l i n a n . J a k a r t a : B K K B N .
C h a l i k T M A . 2 0 1 0 . P e r d a r a h a n P a d a K e h a m i l a n L a n j u t d a n P e r s a l i n a n : P i a s e n t a P r e v i a . D a l a m : S a i f u d d i n A B , R a c h i m h a d i T , W i n k n j o s a s t r o G H ( E d i t o r ) , I l m u K a n d u n g a n . B d i s i 4 . J a k a r t a : P T B i n a P u s t a k a S a r w o n o P r a w i r o h a r d j o , h a l . 4 9 2 - 5 2 1 .
C r e s s w e l l , J h o n W . 2 0 1 3 . Research Design: P e n d e k a t a n Kualitaiif, Kuantitatif dan Mixed E d i s i k e t i g a . Y o g y a k a r t a : P u s t a k a p e l a j a r .
C u n n i n g h a m , F , G . 2 0 1 3 . O b s t e t r i W i l l i a m s . E d k e - 2 3 V o l k e - 2 . E G C , J a k a r t a , I n d o n e s i a . H a l . 8 0 8 - 8 1 2 .
D e p a r t e m e n K e s e h a t a n . 2 0 0 7 . P r o f i l K e s e h a t a n R l t a h u n 2 0 0 5 t e n t a n g k e s e h a t a n R I , J a k a r t a , I n d o n e s i a . H a l . 5 .
D i n a s K o t a P a l e m b a n g . 2 0 1 0 . P r o f i l K e s e h a t a n K o t a P a l e m b a n g T a h u n . 2 0 1 0 , P a l e m b a n g . H a l . 1 7
F r a n c o i s K E , F o l e y M R . 2 0 0 7 Antepartum Hemorrhage:Piasenta Previa. D a l a m : G a b b e S G , N i e b y l J R , S i m p s o n J ( e d i t o r ) . Obstetric Normal and Problem Pregnancies. P h i l a d e l p h i a . H a l . 4 5 8 - 4 6 5 .
F r i e d m a n , M a r i l y n M . 2 0 0 5 . B u k u A j a r K e p e r a w a t a n K e l u a r g a : R i s e t , T e o r i , d a n P r a k t e k . J a k a r t a : E G C
H a r t o n o , F . , W a h y u d i , T . , T e d j u y u w o n o , A . A . T . 2 0 1 1 . F a k t o r R i s i k o K e j a d i a n P i a s e n t a P r e v i a p a d a i b u h a m i l d i R S U d r . S o e d a r s o P o n t i a n a k T a h u n 2 0 0 9 -2 0 1 I . H a l 3 .
H e n d r i c k K . , M e u t i a M . 2 0 1 5 . H u b u n g a n a n t a r a u s i a i b u d a n p a r i t a s d e n g a n k e j a d i a n p i a s e n t a p r e v i a d i R u m a h S a k i t U m u m C u t M e u t i a K a b u p a t e n A c e h U t a r a T a h u n 2 0 1 2 - 2 0 1 3 . J u m a l L e n t e r a V o l . 1 5 . N o . l 3 . J u l i
K i m , L H . , C a u g h e y , A B . , L a g u a r d i a , J C d a n E s c o b a r , G J . 2 0 1 2 . R a c i a l a n d E t h n i c Differences In The Prevalence of Placenta Previa. Journal of Perinatology. 3 2 : 2 6 0 - 2 6 4 .
43
K u m i a w a t i , N . , T r i y a w a t i , L . 2 0 1 3 . P e n g a r u h U s i a d a n P a r i t a s T e r h a d a p K e j a d i a n P i a s e n t a P r e v i a P a d a I b u H a m i l T r i m e s t e r 111 d i R S U D D r . W a h i d i n S u d i r o H u s o d o M o j o k e r t o . H a l . 2 9 - 4 0 .
M a n u a b a , I . A . , F . M a n u a b a . , B . G . M a n u a b a . 2 0 1 2 . I l m u k e b i d a n a n . - 'Penyakit Kandungan. dan KB. E G C . J a k a r t a , I n d o n e s i a . H a l . 1 1 5 - 1 3 0 .
N a s r e e n . F . 2 0 1 1 . Incidence, Causes and Outcome of Placenta Previa. JPMI. 17 (I): 101.
N o t o a t m o d j o , S . 2 0 1 0 . M e t o d o l o g i P e n e l i t i a n K e s e h a t a n : " Metode Pengambilan Sampei". R i n e k a C i p t a , J a k a r t a , I n d o n e s i a . H a l . 8 9 1 - 8 9 3 .
O x o m , H . 2 0 1 3 . I l m u k e b i d a n a n p a t o l o g i d a n F i s i o l o g i p e r s a l i n a n . Y a y a s a n E s s e n t i a M e d i k a , J a k a r t a , I n d o n e s i a . H a l . 9 0 .
P r a w i r o h a r d j o , S . 2 0 1 0 . P e r d a r a h a n P a d a K e h a m i l a n L a n j u l D a n P e r s a l i n a n . E d k e - 4 . V o l k e - 2 . P . T . B i n a P u s t a k a S a r w o n o P r a w i r o h a r d j o , J a k a r t a , I n d o n e s i a . H a l . 4 9 5 - 5 0 2 .
S a s t r o a s m o r o , S . 2 0 1 1 . D a s a r - d a s a r M e t o d e i o g i P e n e l i t i a n K l i n i s : " p e m i l i h a n s u b y e k p e n e l i t i a n " . E d i s i k e - 4 . S a n g u n g s a t u . J a k a r t a , I n d o n e s i a . H a l . 8 8 -1 0 1 .
S o f i a n , A m r u , d r . S p . O G ( K ) . O n k . M W A L S . 2 0 1 1 . R u s t a m M o c h t a r S i n o p s i s O b s t e t r i : "Obstetri bisiologi, Obstetri Patologi". E G C . J a k a r t a , I n d o n e s i a .
S o p y u d i n , M . 2 0 1 0 . Besar Sampei dan Cara Pengambilan Sampei dalam Penelitian Kedokteran dan Kesehatan. E d k e - 3 . S a l e m b a M e d i k a , J a k a r t a , I n d o n e s i a . H a l . 6 9
S t e d m a n . 2 0 0 3 . K a m u s R i n g k a s a n Kedokteran STEDMAN untuk profesi kesehatan. J a k a r t a : E C G
S u w a n t i , W i b o w o , E . P . , H e r l i a n a , B R . 2 0 1 4 . Hubungan Umur, Jarak Persalinan dan Riwayat Abortus Dengan Kejadian Piasenta Previa di RS Provinsi NTB Tahun 2012. M e d i a B i n a I l m i a h . 8 ( 1 ) : 2
T r i s n a n t o , L . 2 0 1 1 . P e n y e b a b A n g k a k e m a t i a n I b u , ( h t t p : / / d i g i l i b . u n i m u s . a c . i d / f i l e s / d i s k l / 1 5 0 / j t p t u n i m u s - g d l - f u j i f a t m a w - 7 4 8 5 -1 - b a b i . p d f , d i a k s e s t a n g g a l 5 S e p t e m b e r 2 0 1 5 ) .
T r i a n i n i n g s i h , I . , M a r d h i y a h , D . , D u a r s a , A B S . 2 0 1 5 . F a k t o r - f a k t o r y a n g B e r p a n g a r u h p a d a T i m b u l n y a K e j a d i a n y a P i a s e n t a P r e v i a . J u m a l K e d o k t e r a n Y a r s i . 2 3 ( 2 ) : 1 0 3 - 1 1 3 .
V a m e y , H . 2 0 0 6 . B u k u A j a r A s u h a n K e b i d a n a n E d i s i 4 . J a k a r t a . E G C .
W a r d a n a G A , K a r t a n a M K . 2 0 0 7 . F a k t o r R i s i k o P i a s e n t a P r e v i a . C e r m i n D u n i a k e d o k t e r a n . ( 3 4 ) : 2 2 9 - 2 3 2 .