Tesis

Insidensi dan Audit Tatalaksana Robekan Perineum Tingkat III dan IV di RSUPN Cipto Mangunkusumo Tahun 2011-2014 = Incidence and Audit of Obstetrics Anal Sphincter AniInjuries (OASIS) at Cipto Mangunkusumo National Hospital during 2011- 2014.

Latar belakang : Robekan perineum tingkat III dan IV dapat menimbulkan berbagai morbiditias seperti disfungsi organ panggul, dispareni, nyeri kronik, dan masalah psikososial yang mengganggu kualitas hidup perempuan. Audit terhadap tatalaksana robekan perineum perlu dilakukan sebagai dasar perbaikan panduan pelayanan klinis dan pelayanan di rumah sakit. Tujuan : mengetahui insidensi dan mengaudit tatalaksana robekan perineum tingkat III dan IV di Rumah Sakit Cipto Mangunkusumo pada tahun 2011-2014 berdasakan panduan Royal College of Obstetricians and Gynecologist (RCOG) tahun 2015. Metode : Studi deskriptif dengan desain potong lintang dilakukan dengan menggunakan data persalinan di RSUPN Cipto Mangunkusumo dari tahun 2011 sampai dengan 2014. Kesesuaian tatalaksana robekan perineum tingkat III dan IV dinilai berdasarkan kehadiran konsulen, tempat memperbaiki, penggunaan anestesi, metode jahitan, bahan jahitan, antibiotik pasca operasi, kateter 1 kali 24 jam, penggunaan analgetik dan laksantia. Subjek yang memenuhi minimal 7 dari 9 kriteria, dianggap mendapatkan tatalaksana yang sesuai dengan panduan RCOG. Hasil : Dari tahun 2011 sampai dengan 2014, insidensi robekan perineum berturut-turut adalah sebesar 3,54; 4,34; 3,95; dan 1,77%. Tatalaksana robekan perineum tingkat III dan IV pada studi ini didapatkan sesuai pada 57,8% subjek. Ketidaksesuaian ditemukan pada komponen tempat operasi, operator oleh ahli, dan penggunaan kateter urin 1 kali 24 jam pasca tindakan Kesimpulan : Insidensi robekan perineum derajat 3 dan 4 didapatkan masih tinggi. Masih terdapat tatalaksana robekan perineum derajat III dan IV yang belum sesuai dengan standar RCOG. K
ata kunci :ruptur perineum, insidensi, audit, RCOG


Background : OASIS may lead to several morbidities i.e pelvic organ dysfunction, dysparenia, chronic pain, and psychosocial problems leading to impaired quality of life of women. Audit of OASIS management is needed to improve the clinical guideline and practice of OASIS management in a hospital. Objective : To determine the incidence of OASIS and assess the case management at Cipto Mangunkusumo National Hospital during 2011-2014 using the criteria stated in the Royal College of Obstetricians and Gynecologist (RCOG) guideline 2015. Methods : A cross-sectional descriptive study was conducted using the delivery database in Cipto Mangunkusumo Hospital, a tertiary referral university hosptal in Jakarta, Indonesia during 2011-2014. The OASIS management of each subjects were assessed based on 9 items listed at RCOG 2015 guideline of OASIS management (consultant presence during repair, place of repair, use of anesthesia, methods of suturing, suturing material, use of post-operative antibiotic, use of urinary catheter 24 hour after surgery, use of laxative agent. Result : During 2011-2014, the incidence of OASIS were respectively 3,54; 4,34; 3,95; and. 1,77%. As many as 57,8% subjects with OASIS were approproately managed according to RCOG guideline. Surgery performed at delivery suite, surgery performed by resident (not an expert), and not using postoperative foley catheter were the items that frequently missed in the management. Conclusion : We found a relatively high incidence of OASIS in our hospital. There was several items included in RCOG guideline that should improved in our hospital.
Keywords :OASIS, incidence, audit, RCOG