Disertasi

Kombinasi Faktor Risiko, Gejala dan Tanda Klinis Sebagai Model Prediktor Diagnosis Retensio Urin Pascapersalinan PerVaginam = Combined Risk Factors, Clinical Signs and Symptoms as a Predictive Model for Diagnosis of Post-Partum Urinary Retention after Vaginal Delivery.

Tujuan : Mengetahui kombinasi faktor risiko, gejala, dan tanda klinis sebagai model prediktor diagnosis retensio urin pascapersalinan per vaginam sehingga didapatkan metode yang praktis untuk memprediksi retensio urin pascapersalinan. Metode : Penelitian ini merupakan studi potong lintang (cross sectional) terhadap kombinasi faktor risiko (persalinan primigravida, partus kala II lama, robekan jalan lahir yang luas, selta persalinan dengan menggunakan alat seperti forsep atau vakum), gejala (buang air kecil sedikit ataupun tidak bisa buang air kecil) dan tanda klinis (volume urin yang diukur dengan female catheter pada persalinan kala Ill) sebagai model prediktor diagnosis retensio urin pasca­ persalinan per vaginam. Penelitian ini merupakan sebuah riset diagnostik dengan observasi yang menjadi alat diagnostik dan prediktif terhadap kejadian retensio urin pascapersalinan per vaginam yang menganalisis lebih dalam mengenai kombinasi faktor risiko, gejala, dan tanda klinis Retensio Urin Pascapersalinan (RUPP). Subjek penelitian diambil secara konsekutif dan sesuai kriteria inklusi serta eksklusi. Didapatkan 500 subjek yang kemudian dianalisis dengan uji bivariat yang sekaligus menjadi dasar untuk analisis multivariat secara backward sehingga diperoleh model awal faktor prediktor terjadinya retensio urin dihitung dengan regresi logistik sampai didapatkan model akhir faktor prediktor terjadinya retensio urin yang meliputi lima variabel yaitu usia, paritas, lama kala II , ruptur perineum (robekan jalan lahir) dan pengukuran volume urin pada kala III. Penilaian diskriminasi dengan menggunakan area under the curve. HasH: Penelitian ini mencakup 500 subjek, dengan hasil analisis variabel yang memiliki hubungan bermakna yaitu usia dengan OR 2,58 (95% CI 1,48-4,54), paritas OR 3, 13 (95% CI 1,77-5,66), lama kala II dengan nilai OR 2,01 (95% CI 1, 16-3,48), ruptur perineum (robekan jalan lahir) OR 3, 19 (95% Cl 1,05-8,70), episotomi OR 1,84 (95 % CI 1,06-3 , 18), kapasitas kandung kemih enam jam pascapersalinan OR 14,26 (95% CI 7,36-28,87). Didapatkan nilai skoring yang memiliki kemungkinan untuk teljadi retensio urin sebesar 28 atau lebih (::: 28), dengan nilai sensitivitas 69.12% dan spesifisitas 61.34%. Nilai Area Under the Curve (AUC) dari skor retensio urin sebesar 0,6916 digenapkan menjadi 0,70 (95% CI 0,62 - 0,76). Simpulan : Variabel yang dapat memprediksi kemungkinan terjadi retensio urin yaitu usia, paritas, lama kala H, ruptur perineum (robekan jalan lahir), volume urin kala III dengan persamaan skor retensio urin ; 14U+20P+ 15LK2+ 13RP+ 1 OVU, dengan titik potong 28 atau lebih ( ::: 28).
Kata Kunci : Lama kala 11, paritas, retensio urin, ruptur perineum (robekan jalan lahir), usia, volume urin kala III.


Aim: To identify combined risk factors, clinical signs and symptoms as a predictive model for diagnosis of post-partum urinary retention after vaginal delivery and therefore, a practical model can be obtained to predict the occurrence of urinary retention after birth. Method: The study was a cross-sectional study on a combination of risk factors (primigravida delivery, prolonged second stage of labor, extensive laceration of the bil1h canal and instrumental delivery using forceps or vacuum), clini cal symptoms (less voided volume or inability to pass urine) and clinical signs (urine volume measured by female catheter in the third stage of labor) as a predictive model for diagnosis of post-partum urinary retention after vaginal delivery. This study was a diagnostic observational research that may become a diagnostic and predictive tool for the occurrence of post-partum urinary retention after vaginal bil1h that provides deeper analysis on the combined risk factors, clinical signs and symptoms of Post­ Pal1um Urinary Retention (PPUR). The study subjects were obtained consecutively accordin g to inclusion and exclusion criteria. There were 500 subjects, who were subsequently analyzed using bivariate analysis, which in turn became the baseline data for multivariate backward analysis resulting in an early model of predictive facto rs for the development of urinary retention. It was calculated using logistic regression until a final model was obtained for the predictive factors on the development of urin ary retenti on that included five vari ables, namely the age, parity, the length of second stage of labor, perineal rupture (laceration of the birth canal) as well as measurement of urine volume in the third stage of labor. The discriminative assessment was conducted using the area under the curve. Results: The study involved 500 subj ects and the results of variables analysis demonstrated that the variables which had significant correlation are age (OR 2.58;95% CI 1.48-4.54), parity (OR 3.13 ; 95% CI 1.77-5 .66), the length of second stage of labor (OR 2.0 1;9S% . CI 1.16-3.48), perineal rupture or laceration of the bil1h canal (OR 3. 19;95% CI 1.05-8.70), episotomy (OR 1.84; 95% CI 1.06-3.18), bladder capacity in 6 hours after birth (OR 14.26;95% CI 7.36-28.87). We found that a scoring valu e of 28 or more (2: 28) was likely to cause urinary retenti on, with 69.12% sensitivity and 61.34% of specificity. The Area Under the Curve (AUC) of urinary retention score was 0.6916, which was rounded into 0.70 (95% CT 0.62 - 0.76). Conclusion: Variables that can predict the probability of developing urinary retention are age, parity, the length of second stage of labor, perineal rupture ( laceration of the bil1h canal), urine volume in the third stage of labor with the following formulation of urinary retention score: 14U+20P+ ISLK2+ 13 RP+ 1 OVU, and a cut-off point of28 or more (2: 28).
Keywords: age, parity, perineal rupture (laceration of the bil1h canal), the length of second stage of labor, urinary retention, urinary volume in the third stage of labor.