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Pengaruh Model Asuhan Antenatal Cegah Prematur (AACP) Dalam Menurunkan Angka Persalinan Preterm: Peran Deteksi Dini dan Pengobatan Infeksi Vaginosis Bakteri = Effect of Antenatal Care Model Prevent Premature (AACP) In Reducing Preterm Delivery Rate: The Role of Early Detection and Treatment of Bacterial Vaginosis Infection.

Latar belakang: Angka mortalitas dan morbiditas akibat persalinan preterm masih cukup tinggi. Di Indonesia, persalinan preterm menyebabkan 36% kematian neonatus. Salah satu penyebab terkuat persalinan preterm yaitu infeksi vaginosis bakteri diperkirakan berperan dalam 30% kejadian persalinan preterm. Infeksi vaginosis bakteri dapat dicegah namun belum ada cara yang efektif dan praktis untuk mendiagnosis dan mengobati infeksi vaginosis bakteri secara dini. Tujuan: Penelitian ini dilakukan untuk melihat pengaruh penerapan Model Asuhan Antenatal Cegah Prematur (AACP) terhadap penurunan kejadian persalinan preterm. Penelitian ini menilai perubahan tingkat pengetahuan bidan dan perilaku bidan setelah mendapatkan pelatihan serta perubahan tingkat pengetahuan dan sikap ibu hamil setelah penyuluhan. Penelitian ini juga melihat perbandingan akurasi diagnostik kit pemeriksaan pH vagina dengan pemeriksaan baku emas pewarnaan Gram serta efektivitas pengobatan infeksi vaginosis bakteri lebih awal. Selain itu, akan dianalisis hubungan antara variabel–variabel yang dapat memprediksi persalinan preterm dengan kejadian persalinan preterm. Metode: Penelitian ini merupakan penelitian campuran kuantitatif dan kualitatif. Penelitian menggunakan non-randomized controlled trial yang dilakukan sejak bulan Februari 2010 sampai bulan Desember 2010, pada ibu hamil dengan usia kehamilan 14–18 minggu dengan kehamilan tunggal, yang datang ke pusat-pusat layanan kebidanan primer di 5 kecamatan di Jakarta. Kelompok perlakuan mendapat penerapan model AACP, yaitu kunjungan ke bidan minimal empat kali selama kehamilan. Pada kelompok perlakuan, bidan mendapatkan pelatihan mengenai persalinan preterm dan pencegahannya. Pengukuran perubahan tingkat pengetahuan bidan dan ibu hamil menggunakan kuesioner. Perubahan perilaku bidan dan ibu hamil dinilai melalui diskusi kelompok terfokus (focused group discussion). Luaran utama yang dinilai adalah angka kejadian persalinan preterm pada kedua kelompok. Selain itu, dilakukan analisis bivariat dan multivariat untuk menentukan faktor prediksi. Dari hasil analisis, disusun sistem skoring untuk memprediksi persalinan preterm. Hasil: Didapatkan 160 ibu hamil pada kelompok perlakuan dan 149 ibu hamil pada kelompok pembanding. Dari 160 ibu hamil, didapatkan 6 subjek dengan persalinan preterm pada kelompok perlakuan sedangkan pada kelompok pembanding ditemukan 8 subjek dari 149 ibu hamil (Tidak terdapat perbedaan yang bermakna). Didapatkan adanya perbedaan yang bermakna pada hasil uji pengetahuan bidan dan ibu hamil pada kedua kelompok. Pemeriksaan baku emas dengan pewarnaan Gram memiliki akurasi yang lebih baik dibandingkan dengan pemeriksaan pH vagina mandiri. Pengobatan infeksi vaginosis bakteri menurunkan kejadian persalinan preterm. Dengan analisis bivariat dan multivariat, ditemukan ibu hamil dengan riwayat preterm, riwayat merokok sebelumnya, riwayat keguguran, keluhan keputihan dengan warna lendir kuning dan keluhan nyeri gigi selama hamil merupakan variabel yang dapat memprediksi persalinan preterm. Simpulan: Persalinan preterm merupakan salah satu penyebab mortalitas dan morbiditas yang tinggi pada neonatus. Pada penelitian ini tidak ditemukan perbedaan yang bermakna tentang jumlah persalinan preterm antara kelompok perlakukan yang menerima model AACP dengan kelompok pembanding. Namun, terdapat perubahan pengetahuan dari bidan dan ibu hamil yang mendapat perlakuan. Selain itu, dari penelitian ini kami juga menemukan skor prediksi risiko persalinan preterm sebagai alat deteksi dini sebagai salah satu upaya pencegahan persalinan preterm.
Kata kunci: asuhan antenatal model, intervensi dini, infeksi vaginosis bakteri, pH vagina, pelatihan bidan, persalinan preterm



Background: The mortality rate and morbidity due to preterm delivery is still quite high. In Indonesia, the preterm delivery caused 36% mortality of the newborn. One of the strongest causes of preterm delivery is bacterial vaginosis infection that contributed approximately 30% incidence of preterm delivery. Bacterial vaginosis infection could be prevented but the effective and practical ways to diagnose and treat bacterial vaginosis in early infection are still questioned. Objective: This study aimed to see the effect the application of Prevent Premature Antenatal Care Model (AACP) to reducing preterm delivery. The study reviewed changes in the level of knowledge of midwives and midwife behavior after getting the training and changes in the level of knowledge and attitude of pregnant women after counseling. This study also looked at comparison diagnostic accuracy of pH vaginal examination kit with the gold standard examination of Gram staining and the effectiveness of early treatment of bacterial vaginosis infection. In addition, the relationship between preterm delivery occurrence and variables that can predict preterm birth will be analyzed. Methods: This was a mixed of quantitative and qualitative research. The study used a nonrandomized controlled trial conducted from February 2010 until December 2010, in pregnant women with gestational age 14-18 weeks with singleton pregnancies, who came to the centers of primary midwifery services in 5 districts in Jakarta. The treatment group received application of AACP model. Comparison group received standard antenatal care. In the treatment group, midwives received training on preterm birth and its prevention. Measurement of changes in the level of knowledge of midwives and pregnant women were measured using questionnaires. Changes in behavior of midwives and pregnant women were assessed through focus group discussions. The main outcomes assessed were the incidence of preterm birth in both groups. In addition, bivariate and multivariate analyses were done to determine predictive factors. From the analysis, a scoring system was developed to predict preterm birth. Results: There were 160 pregnant women in the treatment group and 149 pregnant women in the comparison group. Of 160 pregnant women, 6 subjects were found with preterm delivery in the treatment group, meanwhile in the comparison group eight pregnant women with preterm delivery were found of 149 pregnant women (which was no significant difference). There was a significant difference from the knowledge test results midwives and pregnant women in both group. Gold standard examination with Gram staining had better accuracy than the vaginal pH self-examination. Treatment of bacterial vaginosis infection could reduced the incidence of preterm delivery. After bivariate and multivariate analysis, pregnant women with a history of preterm, previous smoking history, history of miscarriage, vaginal discharge complaint with the color yellow mucus and tooth pain while pregnant was found to be variables that could predict preterm delivery. Conclusion: Preterm delivery is one of the causes of high mortality and morbidity in neonates. In this study, it was found that there was no significant difference between treatment groups that received AACP model compare to the comparison group. In term, at prevency preterm delivery. However, there were changes in knowledge of midwives and pregnant women who received the antenatal model. In this study, we also found a score predictive risk of preterm delivery for early detection of risk factors as one of prevention of preterm delivery.
Keywords: antenatal care model, bacterial vaginosis infection, early intervention, midwife training, preterm delivery