Tesis

Studi Perbandingan Pemasangan AKDR Pascaplasenta dengan Klem Ovarium Dibandingkan dengan Manual: Ekspulsi dan Penerimaan = Study of Expulsion and Acceptability of Postplacental IUD Using Ovarian Clamp and Manual Technique.

Latar belakang: Alat Kontrasepsi Dalam Rahim (AKDR) merupakan salah satu metode kontrasepsi paling efektif dan paling sering digunakan di dunia. Pemasangan pascaplasenta dinilai sebagai metode pemasangan yang paling efektif dalam meningkatkan penerimaan pasien. Pemasangan AKDR pascaplasenta dapat dilakukan menggunakan tangan maupun klem ovarium. Namun, belum terdapat penelitian yang membandingkan kedua metode tersebut di Indonesia. Tujuan: Membandingkan perbedaan tingkat ekspulsi dan penerimaan antara metode pemasangan AKDR manual dan pascaplasenta di Indonesia. Metode: Penelitian ini merupakan uji randomisasi terkontrol tersamar tunggal pada peserta AKDR pascaplasenta di rumahs akit tersier di Jakarta pada Oktober 2019 hingga Oktober 2020. Perempuan berusia 20-35 tahun yang melahirkan pervaginam dan berencana untuk dipasangkan AKDR diikutsertakan dalam peneelitian. Perempuan dengan anomali anatomi, perdarahan uterin abnormal baru, maupun pelvic inflammatory disease selama 3 bulan terakhir dieksklusi dari penelitian. Subjek dirandomisasi menjadi grup pemasangan manual dan klem ovarium. Dilakukan pemantauan pada minggu ke-1, ke-6, dan ke-12. Hasil: Didapatkan sebanyak 57 subjek AKDR dengan pemasangan manual dan 52 subjek AKDR dengan pemasangan klem ovarium. Tidak terdapat perbedaan ekspulsi maupun penerimaan selama masa pemantauan minggu ke-1 (p > 0,05), minggu ke-3 (p > 0,05), maupun minggu ke-6 (p > 0,05). Simpulan: Tidak terdapat perbedaan tingkat ekspulsi dan penerimaan antara akseptor AKDR pascaplasenta yang dilakukan pemasangan secara manual maupun menggunakan klem ovarium.
Kata kunci: Kontrasepsi, AKDR, klem ovarium, kontrasepsi pascaplasenta


Background: Intrauterine device (IUD) is one of the most used and effective contraceptives in the world. Postplacental insertion is considered to be the most effective method for increasing compliance. Postplacental IUD can be inserted using ovarian clamp, or manual technique. It is thought that IUD insertion method would affect its efficacy and adverse events. This study aims to investigate the difference of expulsion and acceptance of both method in Indonesia. Method: Single-blinded randomized controlled trial determined to compare the rate of expulsion and acceptance on postplacental IUD patients was done at tertiary hospitals in Jakarta on October 2019 to October 2020. Women aged 20-35 years undergoing vaginal birth were recruited. Women who had anatomical anomaly, recent abnormal uterine bleeding, or pelvic inflammatory disease over the last 3 months were excluded in this study. Subjects were randomized into manual and ovarian clamp groups using simple random sampling. All subjects were followed up for 3 months. Expulsion and acceptance were observed on the 1 st week, the 6 th week, and the 12 th week. Data was analyzed accordingly. Result: A total of 57 manual insertion and 53 clamp subjects were included in the study. There were no expulsion recorded on both study group during 1 week follow up. There was no significant difference of expulsion between groups during 6 weeks and 12 weeks follow up period (p > 0.05). There was no significant difference of acceptance between groups during the follow up period (p > 0.05). Conclusion: There was no significant difference of expulsion and acceptance rate between manual and ovarian clamp postplacental intrauterine device insertion
Keywords: Contraceptive, intrauterine device, ovarian clamp, postplacental contraceptive.