Tesis

AKDR CU T380A Pascaplasenta : Penerimaan, Efektifitas dan Efek Samping = Postplacenta IUCD Cu T380A : Acceptability, Effectivity and Side Effects

Latar belakang: Data demografi dan survey kesehatan dunia mengemukakan bahwa 92-98% perempuan tidak ingin hamil dalam 2 tahun pertama setelah persalinan, dan 66,5% ingin menggunakan kontrasepsi dengan unmet need 40%. Kontrasepsi pascasalin yang dapat diandalkan, efektif, dan jangka panjang seperti Alat Kontrasepsi Dalam Rahim (AKDR) sangat dibutuhkan. Tujuan: Mengevaluasi penerimaan, efektivitas dan efek samping AKDR pascaplasenta pada persalinan pervaginam di RSCM selama periode 6 bulan setelah pemakaian. Metode: Penelitian observasional dengan disain kohort prospektif. Semua subjek yang memenuhi kriteria penelitian, dilakukan pemasangan AKDR Cu T380A pascaplasenta dan dicatat hingga mencapai jumlah sampel yang dibutuhkan. Penelitian dilakukan di RS Cipto Mangunkusumo Jakarta periode Agustus – Oktober 2012. Penerimaan, efektivitas dan efek samping termasuk angka ekspulsi dinilai pada kunjungan 40-42 hari pascasalin dan 6 bulan kemudian. Hasil: Jumlah total subjek 234 orang, dengan 19,2% tidak datang pada kunjungan ulang pertama dan kedua. Tidak terdapat perbedaan bermakna pada karakteristik subjek yang datang maupun tidak datang pada kunjungan ulang. Pada kunjungan I, 5,1% subjek mengalami ekspulsi dan 4,5 % subjek melakukan pelepasan AKDR. Pada kunjungan II, didapatkan 7,5% ekspulsi dan 4,8% subjek melepas AKDR di luar RS. Dari keseluruhan tersebut terdapat 8,5% yang bersedia dipasang ulang. Efektivitas AKDR mencapai 100% dengan 68,9% subjek masih menyusui hingga 6 bulan. Ekspulsi total pada kunjungan I dan kunjungan II adalah 4,1% dan 0,6%, sedangkan ekspulsi parsial adalah 1% dan 6,9%. Efek samping tersering lainnya adalah keputihan (23%), nyeri haid (4-21%) dan perdarahan bercak (2-10%). Kesimpulan: Penerimaan dan efektivitas selama 6 bulan adalah 86,8% dan 100%. Efek samping ekspulsi secara kumulatif selama 6 bulan adalah 12,6%, dengan efek samping lain seperti keputihan, nyeri haid dan perdarahan bercak.
Kata kunci : AKDR Cu T380A, Pascaplasenta, Penerimaan, Efektivitas, Efek samping, Ekspulsi


Background: Current world demographics and health surveys show that 92-98% of women want to delay their future pregnancy for at least 2 years after giving birth. A majority (66,5%) of these mothers require contraception of which 40% are unmet (unmet needs).The Intra Uterine Contraceptive Device (IUCD) can be a reliable, effective long term option to fulfill these unmet needs Objectives: To evaluate the acceptability, effctivity and side effects of Postplacental IUCD after vaginal delivery at Cipto Mangunkusumo Hospital after 6 months period of insertion Methods: We conducted a prospective observational cohort study, Subjects were recruited in Cipto Mangunkusumo Hospital, Jakarta at August-October 2012. Postplacental IUCD was inserted intu the subjects’ uterus until it reached the fundus. The data for acceptibility, effectivty and side effects, including the expulsion rate was obtained at 40-42 days and 6 months after delivery. Result: A total of 234 women were included in this study, with 19,2% loss of follow up. There is no significant difference on subjects’ characteristics who came and loss of follow up in this study. At the first follow up, 5,1% subjects experienced IUCD expulsion, and 4,5% had the IUCD removed by request. On the second follow up, expulsion was found in 7,5% of the subjects and 4,8% had the IUCD removed by request or outside our hospital. Eight and a half percent of those subjects were willing to receive IUCD reinsertion. The IUCD effectivity in six months follow up was 100%, with 68,9% of the subjects were still breastfeeding at 6 months after delivery. Total expulsion rate on first follow up compared to 6 months follow up was 4,1% and 0,6%, and the partial expulsion was 1% and 6,9%. The most common side effects were vaginal discharge (23%), dysmenorea (4-21%), and spotting (2-10%). Conclusion: The acceptability and effectivity of postplacental IUCD after 6 months were 86,8% and 100%. Cummulative expulsion rate after 6 months were 12,6%, and the most common other side effects were vaginal discharge, dysmenorea, and spotting.
Keywords: IUD, IUCD, Cu T380A, postplacenta, acceptability, effectivity, side effect, expulsion rate