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 )

= ( 1 , 9 6 V 2 . 0 . 5 5 . 0 , 4 5 + 0 . 8 4 2 7 ( 0 - 5 0 0 7 5 0 ) + 0 . 6 0 . 0 4 0 ) ' ( 0 . 6 0 - 0 . 5 0 ) -

= 3 8 8 s a m p e i

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 .

44

L a m p i r a n 1 . H a s i l P e n e l i t i a n

NO Paritas

Diagnosis NO Primipara Multipara Grandemultipara CODING

Diagnosis

1. G I POAO 1 Piasenta previa

2. G I POAO 1 Piasenta previa

3. G I POAO 1 Piasenta previa

4. G I POAO 1 Piasenta previa

5. G I POAO 1 Piasenta previa

6. G I POAO 1 Piasenta previa

7. G I POAO 1 Piasenta previa

8. GIPOAO 1 Piasenta previa

9. G I POAO 1 Piasenta previa

10. G4P3AO 1 Piasenta previa

11 . G3P2AO 1 Piasenta previa

12. G2P3AO 1 Piasenta previa

13. G2P3AO 1 Piasenta previa

14. G5P6AO 1 Piasenta previa

15. G5A6AO 1 Piasenta previa

16. G10P9AO 1 Piasenta previa

17. — ™—.

G4P3AO 1 Piasenta previa

18. G3P2AO 1 Piasenta previa

19. G2P3AO 1 Piasenta previa

20. G2P3AO 1 Piasenta previa

21 . 6 5 P 6 A 0 1 Piasenta previa

22. G6A7AO 1 Piasenta previa

23. G10P9AO 1 Piasenta previa

24. G4P3AO 1 Piasenta previa

25. G4P3AO 1 Piasenta previa

26. G2P3AO 1 Piasenta previa

27. G2P3AO 1 Piasenta previa

28. G3P2AO Piasenta previa

29. G2P3AO Piasenta previa

30 G3P2AO Piasenta previa

3 1 G4P3AO Piasenta previa

32 G2P3AO Piasenta previa

33 G2P3AO Piasenta previa

34 G3P2AO Piasenta previa

35 G2P3AO Piasenta previa

36 64P3AO Piasenta previa

37 G4P3AO Piasenta previa

38 G2P3AO Piasenta previa

39 G2P3AO Piasenta previa

40 G3P2AO Piasenta previa

45

4 1 G2P3AO 1 Piasenta previa

42 G3P2AO Piasenta previa

43 G4P3AO Piasenta previa

44 G2P3AO Piasenta previa

45 G2P3AO Piasenta previa

46 G3P2AO I Piasenta previa

47 G2P3AO I Piasenta previa

48 G5P6AO Piasenta previa

49 G4P3AO Piasenta previa

50 G4P3AO Piasenta previa

51 G2P3AO Piasenta previa

52 G2P3AO Piasenta previa

53 G3P2AO Piasenta previa

54 G2P3AO Piasenta previa

55 G3P2AO Piasenta previa

56 G4P3AO Piasenta previa

57 G6P7AO Piasenta previa

58 G5P6AO Piasenta previa

59 G8A7AO Piasenta previa

60 P5A6AO Piasenta previa

6 1 P6A7AO 1 Piasenta previa

62 G4P3AO Piasenta previa

63. G2P3AO I Piasenta previa

64. G2P3AO Piasenta previa

65. G3P2AO Piasenta previa

66. G2P3AO Piasenta previa

67. G3P2AO Piasenta previa

68. G4P3AO Piasenta previa

69. G IPOAO 2 SECTIO CAESARIA

70. G IPOAO 2 SECTIO CAESARIA

71 . G I POAO 2 SECTIO CAESARIA

72. G I POAO 2 SECTIO CAESARIA

73. G I POAO 2 SECTIO CAESARIA

74. G I POAO 2 SECTIO CAESARIA

75. G I POAO 2 SECTIO CAESARIA

76. G IPOAO 2 SECTIO CAESARIA

77. G I POAO 2 SECTIO CAESARIA

78. G4P3AO 2 SECTIO CAESARIA

79. G2P3AO 2 SECTIO CAESARIA

80. G2P3AO 2 SECTIO CAESARIA

8 1 . G3P2AO 2 SECTIO CAESARIA

82. G2P3AO 2 SECTIO CAESARIA

83. G3P2AO 2 SECTIO CAESARIA

84. G4P3AO 2 SECTIO CAESARIA

85. G6P7AO 2 SECTIO CAESARIA

86. G5P6AO 2 SECTIO CAESARIA

46

87 68A7AO 2 SECTIO CAESARIA

88 P5A6AO 2 SECTIO CAESARIA

89 P6A7AO 2 SECTIO CAESARIA

90 G IPOAO 2 SECTIO CAESARIA

91 G IPOAO 2 SECTIO CAESARIA

92 G I POAO 2 SECTIO CAESARIA

93 G I POAO 2 SECTIO CAESARIA

94. G I POAO 2 SECTIO CAESARIA

95. G I POAO 2 SECTIO CAESARIA

96. G I POAO 2 SECTIO CAESARIA

97. G I POAO 2 SECTIO CAESARIA

98. G IPOAO ' 2 SECTIO CAESARIA

99. G5P6AO 2 SECTIO CAESARIA

ICQ. G6A7AO 2 SECTIO CAESARIA

101 . G10P9AO 2 SECTIO CAESARIA

102 G I POAO 2 SECTIO CAESARIA

103 G I POAO 2 SECTIO CAESARIA

104 A L/"T .

GIPOAO 2 SECTIO CAESARIA

105 G I POAO 2 SECTIO CAESARIA

106. G I POAO 2 SECTIO CAESARIA

107. G I POAO 1 2 SECTIO CAESARIA

108. G IPOAO 2 SECTIO CAESARIA

109. G IPOAO 3 CKB

110. G IPOAO 1 3 CKB

111 . G I POAO 3 CKB

112. G I POAO 3 CKB

113. G I POAO 3 CKB

114. G I POAO 3 CKB

115. G I POAO 3 CKB

116. G5P6AO 3 CKB

117. G6A7AO 3 CKB

118. G10P9AO 3 CKB

119. G I POAO 3 CKB

120. G I POAO 3 CKB

121 . G I POAO 3 CKB

122. G IPOAO 3 CKB

123. G IPOAO 3 CKB

124. G IPOAO 3 CKB

125. G IPOAO 3 CKB

126. G IPOAO 3 CKB

127. G IPOAO 3 CKB

128. G IPOAO 3 CKB

129. G IPOAO 3 CKB

130. G4P3AO 3 CKB

131 . G2P3AO 3 CKB

132. G2P3AO 3 CKB

47

133. G3P2AO 3 CKB

134. G2P3AO 3 CKB

135. G3P2AO 3 CKB

136. G4P3AO 3 CKB

137. G4P3AO 3 CKB

138. G4P3AO 3 CKB

139. G2P3AO 3 CKB

140. G2P3AO 3 CKB

141 . G3P2AO 3 CKB

142. G2P3AO 3 CKB

143. G3P2AO 3 CKB

144. G4P3AO 3 CKB

145. G6P7AO 3 CKB

146. G5P6AO 3 CKB

147. G8A7AO 3 CKB

148. P5A6AO 3 CKB

149. P6A7AO 3 CKB

150. G6P7AO 3 CKB

151 . G5P6AO 3 CKB

152. G8A7AO 3 CKB

153. G I POAO 4 Partus prematurus

154. G IPOAO 4 Partus prematurus

155. G IPOAO 4 Partus prematurus

156. G IPOAO 4 Partus prematurus

157. G IPOAO 4 Partus prematurus

158. G IPOAO 1 4 Partus prematurus

159. G IPOAO 4 Partus prematurus

160. G I POAO 4 Partus prematurus

161 . G I POAO 4 Partus prematurus

162. G I POAO 4 Partus prematurus

163. G IPOAO 4 Partus prematurus

164. G I POAO ; 4 Partus prematurus

165. G I POAO 4 Partus prematurus

166. G I POAO 4 Partus prematurus

167. G I POAO 4 Partus prematurus

168. G I POAO 4 Partus prematurus

169. G IPOAO 4 Partus prematurus

170. G I POAO : 4 Partus prematurus

171 . G I POAO 4 Partus prematurus

172. G I POAO 4 Partus prematurus

173. G I POAO 4 Partus prematurus

174. G I POAO 4 Partus prematurus

175. P6A7AO 4 Partus prematurus

176. G6P7AO 4 Partus prematurus

177. G5P6AO 4 Partus prematurus

178. G8A7AO 4 Partus prematurus

48

179. G3P2AO 4 Partus prematurus

180. G2P3AO 4 Partus prematurus

181 . G3P2AO 4 Partus prematurus

182. G4P3AO 4 Partus prematurus

183. G4P3AO 4 Partus prematurus

184. G4P3AO 4 Partus prematurus

185. G2P3AO 4 Partus prematurus

186. G2P3AO 4 Partus prematurus

187. G3P2AO 4 Partus prematurus

188. G2P3AO 4 Partus prematurus

189. G3P2AO 4 Partus prematurus

190. G4P3AO 4 Partus prematurus

191 . P6A7AO 4 Partus prematurus

192. G6P7AO 4 Partus prematurus

193. G5P6AO 4 Partus prematurus

194. G I POAO 5 Pre- Eclampsia

195. G I POAO 5 Pre- Eclampsia

196. G IPOAO 5 Pre- Eclampsia

197. G IPOAO 5 Pre- Eclampsia

198. G IPOAO 5 Pre-Eclampsia

199. G I POAO 5 Pre- Eclampsia

200. G I POAO 5 Pre- Eclampsia

201 . G I POAO 5 Pre- Eclampsia

202. G I POAO 5 Pre- Eclampsia

203. G I POAO 5 Pre-Eclampsia

204. G I POAO 5 Pre- Eclampsia

205. G IPOAO 5 Pre- Eclampsia

206. G IPOAO 5 Pre- Eclampsia

207. G I POAO 5 Pre- Eclampsia

208. G I POAO 5 Pre-Eclampsia

209. G I POAO 5 Pre- Eclampsia

210. G IPOAO 5 Pre- Eclampsia

211 . G I POAO 5 Pre- Eclampsia

212. G IPOAO 5 Pre- Eclampsia

213. G IPOAO 5 Pre-Eclampsia

214. G I POAO 5 Pre- Eclampsia

215. G I POAO 5 Pre- Eclampsia

216. G3P2AO 5 Pre- Eclampsia

217. G2P3AO 5 Pre- Eclampsia

218. G3P2AO 5 Pre-Eclampsia

219. G4P3AO 5 Pre- Eclampsia

220. G4P3AO 5 Pre- Eclampsia

221 . G4P3AO 5 Pre- Eclampsia

222. G2P3AO 5 Pre- Eclampsia

223. G2P3AO 5 Pre-Eclampsia

224. G3P2AO 5 Pre- Eclampsia

49

225. G2P3AO 5 Pre- Eclampsia

226. G3P2AO 5 Pre- Eclampsia

227. G4P3AO 5 Pre- Eclampsia

228. P6A7AO 5 Pre-Eclampsia

229. G6P7AO 5 Pre- Eclampsia

230. G5P6AO 5 Pre- Eclampsia

231 . G8A7AO 5 Pre- Eclampsia

232. P6A7AO 5 Pre- Eclampsia

233. G6P7AO 5 Pre-Eclampsia

234. G5P6AO 5 Pre- Eclampsia

235. G8A7AO 5 Pre-Eclampsia

236. P6A7AO 5 Pre-Eclampsia

237. G I POAO 6 Vacum

238. G I POAO 6 Vacum

239. G IPOAO 6 Vacum

240. G IPOAO 6 Vacum

241. G I POAO 6 vacum

242. G IPOAO 6 Vacum

243. G IPOAO 6 Vacum

244. G I POAO 6 Vacum

245. G I POAO 6 Vacum

246. G I POAO 6 Vacum

247. G I POAO 6 Vacum

248. P6A7AO 6 Vacum

249. G6P7AO 6 Vacum

250. G5P6AO 6 vacum

251 . G8A7AO 6 Vacum

252. P6A7AO 6 Vacum

253. G6P7AO 6 Vacum

254. G5P6AO 6 Vacum

255. G8A7AO 6 Vacum

256. P6A7AO 6 Vacum

257. G4P3AO 6 Vacum

258. G4P3AO 6 Vacum

259. G2P3AO 6 vacum

260. G2P3AO 6 Vacum

261 . G3P2AO 6 Vacum

262. G2P3AO 6 Vacum

263. G2P3AO 6 Vacum

264. G3P2AO 6 Vacum

265. G I POAO 6 Vacum

266. G IPOAO 6 Vacum

267. G I POAO 6 Vacum

268. G I POAO 6 vacum

269. G I POAO 6 Vacum

270. G IPOAO 6 Vacum

50

271 G I POAO 6 Vacum

272 G1POAO X J J.T\Jr\KJ

g Varum 273 G I POAO 6 Vacum

TJA GIPOAO 6 Vacum

275. G IPOAO 6 Vacum

276. G IPOAO 6 Vacum

1 1 1 . GIPOAO 6 vacum

278. G I POAO 6 Vacum

279. G I POAO 7 KET

280. G I POAO 7 KET

281 . G I POAO 7 KET

282. G IPOAO 7 KET

283. G IPOAO 7 KET

284 G IPOAO , 7 KET

285 G l POAO 7 KET l \ l * 1

286 £ . L J U -

GIPOAO 7 KET

287 G I POAO —, 7 KFT l i t . 1

288 G2P3AO X J ^ r i J r i X i J

7 KET

289 G3P2AO 7 KFT

290 G6P7AO 7 KFT

291 . 6 5 P 6 A 0 7 KET

292. G8A7AO 7 KET

293. P6A7AO 7 KET

294. 6 6 P 7 A 0 7 KET

295. G5P6AO 7 KET

296. G8A7AO 7 KET

297. P6A7AO 7 KET

298. G4P3AO 7 KET

299. G4P3AO 7 KET

300. G2P3AO 7 KET

301 . G2P3AO 7 KET

302. G3P2AO 7 KET

303. G2P3AO 7 KET

304. G2P3AO 7 KET

305. G3P2AO 7 KET

306. G6P7AO 7 KET

307. G5P6AO 7 KET

308. G8A7AO 7 KET

309. P6A7AO 7 KET

310. G6P7AO 7 KET

311 . G2P3AO 7 KET

312. G3P2AO 7 KET

313. G2P3AO 7 KET

314. G2P3AO 7 KET

315. G3P2AO 7 KET

316. G6P7AO 7 KET

5 1

317. G5P6AO 7 KET

318. G8A7AO 7 KET

319. G6P7AO 7 KET

320. G5P6AO 7 KET

321 . G8A7AO 7 KET

322. G2P3AO 7 KET

323. G2P3AO 7 KET

324. G4P3AO 8 Partus Spontan

325. G4P3AO 8 Partus spontan

326. G2P3AO 8 Partus spontan

327. G2P3AO 8 Partus spontan

328. G3P2AO 8 Partus spontan

329. G2P3AO 8 Partus spontan

330. G2P3AO 8 Partus spontan

331 . G3P2AO 8 Partus spontan

332. G6P7AO 8 Partus spontan

333. G5P6AO 8 Partus Spontan

334. G8A7AO 8 Partus spontan

335. G6P7AO 8 Partus spontan

336. 65P6AO 8 Partus spontan

337. G8A7AO 8 Partus spontan

338. G2P3AO 8 Partus spontan

339. G2P3AO 8 Partus spontan

340. G4P3AO 8 Partus spontan

3 4 1 . G4P3AO 8 Partus spontan

341 . G2P3AO 8 Partus Spontan

342. G2P3AO 8 Partus spontan

343. G3P2AO 8 Partus spontan

344. G2P3AO 8 Partus spontan

345. G4P3AO 8 Partus spontan

346. G2P3AO 8 Partus spontan

347. G2P3AO 8 Partus spontan

348. G3P2AO 8 Partus spontan

349. G2P3AO 8 Partus spontan

350. G4P3AO 8 Partus Spontan

351 . G4P3AO 8 Partus spontan

352. G2P3AO 8 Partus spontan

353. G2P3AO 8 Partus spontan

354. G3P2AO 8 Partus spontan

355. G2P3AO 8 Partus spontan

356. 62P3AO 8 Partus spontan

357. G3P2AO 8 Partus spontan

358. G4P3AO 8 Partus spontan

359. G4P3AO 8 Partus Spontan

360. G2P3AO 8 Partus spontan

361 . G2P3AO 8 Partus spontan

52

362. G3P2AO 8 Partus spontan

363. G2P3AO 8 Partus spontan

364. G2P3AO 8 Partus spontan

365. G3P2AO 8 Partus spontan

366. G6P7AO 8 Partus spontan

367. G5P6AO 8 Partus spontan

368. G8A7AO 8 Partus Spontan

369. P6A7AO 8 Partus spontan

370. G6P7AO 8 Partus spontan

371 . G4P3AO 8 Partus spontan

372. G4P3AO 8 Partus spontan

373. G2P3AO 8 Partus spontan

374. G2P3AO 8 Partus spontan

375. G3P2AO 8 Partus spontan

376. G2P3AO 8 Partus spontan

377. P6A7AO 8 Partus Spontan

378. G6P7AO 8 Partus spontan

379. G5P6AO 8 Partus spontan

380. G8A7AO 8 Partus spontan

381 . P6A7AO 8 Partus spontan

382. G6P7AO 8 Partus spontan

383. G5P6AO 8 Partus spontas

384. G8A7AO 8 Partus spontan

385. P6A7AO 8 Partus spontan

386. G2P3AO 8 Partus spontan

387. G5P6AO 8 Partus spontan

388 G3P2AO 9 CPD

389 G4P3AO 9 CPD

390 G4P3AO 9 CPD

391 G2P3AO 9 CPD

392 G2P3AO 9 CPD

393 G3P2AO 9 CPD

394 G2P3AO 9 CPD

395 G2P3AO 9 CPD

53

Lampiran 2. Hasil Analisis Data

1. Hasil Analisis Univariat

A. Distribusi Status Paritas

Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

status paritas *

Diagnosis 158 86.3% 25 13,7% 183 100.0%

status paritas

Frequency Percent Valid Percent Cumulative Percent

Valid multigrandemultipara 79 43.2 50.0 50.0

primipara 79 43.2 50.0 100.0

Total 158 86.3 100.0

Missi System Missi System 25 13.7

ng

Total 183 100.0

B. Distribusi Piasenta previa

Diagnosis

Frequency Percent Valid Percent Cumulative Percent

Valid Piasenta Previa 68 37.2 43.0 43.0

bukan Piasenta Previa 90 49.2 57.0 100.0

Total 158 86.3 100.0

Missing System 25 13.7

Total 183 100.0

54

2. Hasil Analisis Bivariat

A. Hubungan antara Paritas dan Piasenta previa

status paritas ' Diagnosis Crosstabulation

Diagnosis

Total Piasenta Previa

bukan Piasenta

Previa Total

status paritas multigrandem ulti par Count

^ % within status paritas

59

74.7%

20

25,3%

79

100.0%

primipara Count

% within status pantas

9

10.1%

70

89,9%

79

100.0%

Total Count

% within status paritas

68

42.4%

90

57.6%

158

100.0%

Chi-Square Tests

Value df

Asymp. Big. (2-

sided)

Exact Big. (2-

sided)

Exact Big. (1-

sided)

Pearson Chi-Square 67.403^ 1 .000

Continuity Correction'' 64.786 1 .000

Likelihood Ratio 74 180 1 000

Fisher's Exact Test .000 .000

Linear-by-Linear Association 66977 1 000

N of Valid Cases" 158

a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 33,50.

b. Computed only for a 2x2 table

55

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for status paritas

(multigrandemultipara / primipara) 26.181 10.755 63.732

For cohort Diagnosis = Piasenta

Previa 7.375 3.776 14.403

For cohort Diagnosis = bukan

Piasenta Previa .282 .192 .414

N of Valid Cases 158

55

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for status paritas

(multigrandemultipara / primipara) 10.755 63.732

For cohort Diagnosis = Piasenta

Previa 7.375 3.776 14.403

For cohort Diagnosis = bukan

Piasenta Previa .282 .192 ,414

N of Valid Cases 158

55

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for status paritas

(multigrandemultipara / primipara) 26.181 10.755 63.732

For cohort Diagnosis = Piasenta

Previa 7.375 3.776 14.403

For cohort Diagnosis = bukan

Piasenta Previa .282 .192 .414

N of Valid Cases 158

SURAT KETERANGAN N o : - ^ K E T / D - S / R S M P / l I / S O l ?

Direktur Rumah Sakit Muhammadiyah Palembang dengan ini menerangkan bahwa :

Nama : Shindina Firli Claudia

NIM : 702012061

Jurusan : Ilmu Kedokteran

Institusi : Universitas Muhammadiyah Palembang

Adalah benar telah melakukan penelitian di Rumah Sakit Muhammadiyah Palembang

tangga! 23 - 2 6 November 2015 dengan judul penelitian "Hubungan Paritas Dengan

Kejadian Piasenta Previa di Rumah Sakit Muhammadiyah Palembang Periode Januari

2014-Desember 2014."

Demikianlah surat keterangan ini dibuat untuk dipergunakan sebagaimana mestinya

Palembang, 13 Jumadil Awwal 1438H 10 Februari 2017M

rsmuh_plg@ynhofXCO.id Palembang i02b^

F A K U L T A S K E D O K T E R A N UNIVERSITAS MUHAMMADIYAH PALEMBANG

SK. D IRJEN DIKTI NO, 2130 / D / T / 2008 T G L 11 JULI 2008 : IZIN P E N Y E L E N G G A R A P R O G R A M STUD! P E N D I D I K A N D O K T E R ̂

Kampus B : Jl. KH. Bhatql / Talang Banten 13 Ulu Telp. 0711 - 520045 Fax : 0711 516899 Palembang ( 30263 )

Nomor

Lampiran: -

Perihat

• idOj /I-13/FK-UMPAI/2015

: Mohon izin Penelitian

Palembang, 24 Nopember 2015.

Kepada :Yth. Sdr. Direktur

Rumah Sakit Muhammadiyah

Palembang

Di

Palembang.

Assalamu'alaikum. Wr. Wb.

Ba'da salam, semoga kita semua mendapatkan rahmat dan hidayah dari Allah SWT, Amin Ya Robbal

Alamin.

Sehubungan dengan rencana petaksanaan penelitian dan penyusunan skripsi mahasiswa Fakultas

Kedokteran Universitas Muhammadiyah Palembang, atas nama :

Nama

NIM

Jurusan

Judul Skripsi

Shindina Firli Glaudia

702012061

Ilmu Kedokteran

Hubungan Paritas dengan Kejadian Piasenta Previa di Rumah Sakit

Muhammadiyah Palembang Periode Tahun Januari 2014 - 31 Desember

2014.

Maka dengan Ini kami mohon kepada Saudara agar kiranya berkenan memberikan ijin penelitian yang

dibutuhkan dalam penyusunan skripsi kepada nama tersebut diatas di Rumah Sakit Muhammadiyah

Palembang.

Demikian, atas perhatian dan kerjasamanya diucapkan terima kasih.

Billahittaufig Walhidayah.

Wassalamu'alaikum. Wr. Wb.

Tembusan: 1. Yth. Wakil Dekan I, II, III, IV FK UMP. 2. Yth. Ka. UPK FK UMP, 3. Arsip.

•'A ' ! 13 (Dr.HM. All Muchtar, M.Sc. NBM/NIDN. 1062484/0020084707

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BIODATA

N a m a S h i n d i n a F i r l i G l a u d i a

T e m p a t T a n g g a l L a h i r

A l a m a t

T e l p / H p

F . m a i l

A g a m a

N a m a O r a n g T u a

A y a h

I b u

J u m i a h S a u d a r a

A n a k k e

R i w a y a t P e n d i d i k a n

L u b u k L i n g g a u , 1 6 O k t o b e r 1 9 9 4

J l . S u k a r e l a N o . 6 4 R t . 0 8 T a b a p i n g i n L u b u k L i n g g a u

0 8 1 3 7 3 5 8 5 4 0 4

s h i n d i n a f i r l i g ( r ^ y a h o o . c o m

I s l a m

B u n a r d i M a n s y u r

E r f i a n a Y u l i e t a , S . K m

3 ( D u a )

1 ( S a t u )

1 . T K B h a y a n g k a r i L u b u k L i n g g a u ( 1 9 9 9 - 2 0 0 0 )

2 . S D N 1 6 L u b u k L i n g g a u ( 2 0 0 0 - 2 0 0 6 )

3 . S M P N 1 L u b u k L i n g g a u ( 2 0 0 6 - 2 0 0 9 )

4 . S M A N 2 L u b u k L i n g g a u ( 2 0 0 9 - 2 0 1 2 )

5 . 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 ( 2 0 1 2 - S e k a r a n g )

( S h i n d i n a F i r l i G l a u d i a )