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Abstrak :
Tesis ini membahas mengenai determinan pemilihan lokasi bersalin pada pasien obstetri di unit rawat jalan RSK Azzahra, yaitu faktor predisposisi, faktor pemungkin, faktor pendorong, dan faktor kebutuhan. Penelitian ini bersifat analitik kuantitatif dengan desain penelitian survei cross sectional. Dari hasil penelitian terlihat bahwa determinan yang terbukti signifikan secara statistic dengan pemilihan lokasi bersalin pada pasien obstetri RSK Azzahra adalah waktu tempuh dari rumah ke RSK Azzahra (p=0,011), sumber biaya perawatan (p=0,023), persepsi responden terhadap tarif bersalin RSK Azzahra (p=0,000), persepsi responden terhadap pelayanan dokter (p=0,026), persepsi responden terhadap pelayanan perawat (p=0,02l), serta rekomendasi dari dokter untuk bersalin di RSK Azzahra (p=0,0i 1). Faktor yang secara statistik terbukti paling dominan adalah faktor persepsi terhadap tarif bersalin. Diharapkan pada pihak manajerial RSK Azzahra memberlakukan fasilitas ambulance on-call untuk menangkap pasien yang bertempat tinggal jauh, peninjauan terhadap strategi penetapan tarif pemberian reward dan evaluasi kinerja untuk meningkatkan kinerja dokter dan perawat, membuat kebijakan terkait rekomendasi bersalin dari dokter, membuat penelitian lebih lanjut mengenai analisis tarif dari RS dan RSK sekitar RSK Azzahra dan penelitian mengenai pilihan bersalin pada pasien yang telah bersalin di Azzahra dapat dilakukan untuk menambah dan mempertajam dari hasil yang telah dilaksanakan. ......This thesis describes determinants of obstetric outpatient’s choice for delivery location in Azzahra Hospital, which is predisposing, enabling, reinforcing, and need factor. This study is an analytical quantitative study with cross sectional survey. Based on the result, there are 29,6% patients that choose not to give birth in Azzahra Hospital. Determinants which proven signiticant statistically affect the choice of delivery location are time needed to Azzahra Hospital (p=0,0ll), source of payment (p=0,023), perception to delivery tariff (p=0,000), perception to doctors service (p=0,026), perception to nurse service (p=0,021), and doctor’s recommendation (p=0,0l 1). Multivariate analysis result shows that the most influence factor is perception to delivery tariff It is recommended to Azzahra Hospital Management to initiate on-call ambulance service to serve farther patients, conducting evaluation on pricing strategy, applying reward system and performance evaluation to maintain and increase doctors and nurses performance, assembling hospital policy regarding doctors recommendation system, it is advised to later study to carry out pricing analysis and tirrther study regarding delivery location selection on inpatients to enhance, intensify, and to be compared with the result existed.

Abstrak :
ABSTRAK
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 berturutturut 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. ABSTRACT
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.;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.;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.

Abstrak :
Kejadian Komplikasi Obstetri merupakan masalah kesehatan masyarakat, karena prevalensinya yang tinggi dan merupakan salah satu faktor utama penyebab kematian ibu. Secara holistik, kejadian komplikasi obstetri dapat disebabkan oleh faktor medis (kualitas program dan layanan kesehatan ibu) dan faktor-faktor lain yang ada dalam konteks kewilayahan (kebijakan desentralisasi, pertumbuhan ekonomi, faktor lingkungan). Oleh karena itu, diperlukan studi/analisa lebih lanjut untuk mengetahui determinan yang berpengaruh terhadap kejadian komplikasi obstetri baik dari aspek individu maupun aspek kontekstual. Penelitian ini bertujuan untuk mengetahui peranan dari faktor komposisional (level individu) serta determinan kontekstual (level kabupaten/kota) terhadap kejadian komplikasi obstetri di 20 Kabupaten. Penelitian ini menggunakan desain potong lintang dengan pendekatan analisis multilevel untuk mengestimasi efek kontekstual, sehingga dapat ditentukan prioritas intervensi program terhadap kejadian komplikasi obstetri. Penelitian dilakukan dengan memanfaatkan data sekunder Riskesdas 2013, Studi Kualitas Pelayanan Kesehatan Ibu di 100 Fasilitas Kesehatan tahun 2012 dan data BPS Tinjauan Regional berdasarkan PDRB Kabupaten/Kota tahun 2010-2013, dengan melibatkan 2066 orang Wanita Usia Subur berusia 15-49 tahun) yang memiliki riwayat kehamilan, persalinan dan nifas. Hasil penelitian menunjukkan bahwa prevalensi Kejadian Komplikasi Obstetri di 20 Kabupaten adalah 30,1%. Tampak adanya perbedaan peranan di level individu dan level kabupaten/kota. Pada level individu, variabel yang berperan cukup besar terhadap kejadian komplikasi obstetri di 20 Kabupaten adalah kunjungan ANC (aOR: 3,17, 95% CI 1,29-7,76). Pada level Kabupaten, variabel yang berperan adalah kualitas pelayanan antenatal di rumah sakit (IOR: 0,291-1,287), kualitas pelayanan pascasalin di rumah sakit (IOR: 0,610-2,776), dan pertumbuhan ekonomi (IOR: 0,759-3,916). Namun determinan kejadian komplikasi obstetri masih didominasi oleh peran faktor risiko di level individu. Intervensi program kesehatan ibu dilakukan dengan memfokuskan pada perubahan perilaku sehat di tingkat individu, namun sejalan dengan peningkatan kualitas pelayanan kesehatan ibu di tingkat Kabupaten sehingga secara otomatis menarik minat dan kesadaran masyarakat untuk datang ke fasilitas kesehatan dalam mencari pelayanan KIA yang bermutu. ...... Obstetric complications is a public health problem, because of its high prevalence and one of the main factors that caused maternal mortality. Holistically, obstetric complications caused by medical factors (quality programs and maternal health services) and other factors that exist within the territorial context (decentralization policy, economic growth, environmental factors). Therefore, a further analysis was needed to find the determinants that affects obstetric complications from the aspect of individual and contextual level. The aims of this study was to search the role of compositional factors (individual level) as well as contextual determinants (districts level) in determine obstetric complications in 20 districts. This study used a cross-sectional design with multilevel analysis approach to estimate the effects of contextual factors, so it can determined intervention programa of obstetric complications. The study was conducted by using secondary data of Riskesdas 2013, the Quality of Maternal Health Care Assessment in 100 health facilities in 2012, and Regional Review based on Districts GDP in 2010-2013, involving 2066 Woman at Reproductive Age (15-49) who already have their history on pregnancy, childbirth and post-partum. The results showed that the prevalence of Obstetric Complications in 20 districts is 30.1%. There was a different role from the individual level and the districts level that influence an obstetric complications. At the individual level, the variable that contribute greatly to the prevalence of obstetric complications in 20 districts is antenatal care (aOR: 3,17, 95% CI 1,29-7,76). At the district level, the variable that played role was the quality of antenatal care in hospitals (IOR: 0,291-1,287), the quality of postnatal care in hospitals (IOR: 0,610-2,776), and economic growth (IOR: 0,759-3,916). However, determinants of obstetric complications were still dominated by the role of individual level risk factors. Intervention on maternal health programmes must be carried out by focusing on healthy behavior changes at the individual level, but in line with the improvement of the quality of maternal health services at the district level so that automatically can attract the interest and awareness of the community to obtain the better quality of maternal health services in health facilities.

Abstrak :
ABSTRAK
Kematian Ibu dan Anga Kematian Neonatal di Indonesia masih tinggi. Indonesia tercatat sebagai negara yang belum berhasil mencapai target MDGs keempat dan kelima di tahun 2015 Puskesmas PONED didirikan dalam rangka untuk mencapai target keempat dan kelima MDGS tersebut. Namun sayang penelitian mengenai kinerja puskesmas tersebut masih sangat jarang dilakukan. Desain penelitian ini adalah potong lintang dengan pengambilan sampel menggunakan metode consecutive sampling. Sampel penelitian adalah seluruh puskesmas PONED yang telah aktif berjalan lebih dari 1 tahun di Kota Bekasi. Pada 9 sampel yang ada, didapatkan bahwa kinerja puskesmas tersebut masuk dalam kategori sedang. Penentuan kinerja ini berdasarkan skor Penilaian Kinerja Rumah Sakit dalam Pelayanan Maternal - Perinatal dari Supervisi Fasilitatif (OJT) JNPK-KR tahun 2009. Sebagian besar Puskesmas PONED di Kota Bekasi yang diteliti mendapatkan nilai kurang pada bagian penilaian proses, terutama mengenai pelayanan post natal, dimana pelayanan ini meliputi kemampuan dalam pelayanan bayi < 2000 gram, pelayanan rawat gabung 24 jam, ASI penuh dan resusitasi neonatus. Hal ini juga disebabkan oleh kurang lengkapnya prasarana pendukung pada Puskesmas PONED, seperti alat vakum, obat resusitasi, fasilitas penanganan bayi preterm

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ABSTRACT
Indonesia?s maternal mortality rate remains high that the country did not succeed to achieve the target of Millenium Development Goals 4 and 5 in 2015. Basic Emergency Obstetrik and Newborn Care service program at public health care (BEmONC PHC) was established in order to achieve the goals. Unfortunately, study on performance of public health care in executing the program is rarely performed. The design of this study was cross-sectional with consecutive sampling as the subject selection method. The subjects were BEmONC PHC that had run the program actively more than one year in Bekasi. Performance of nine BEmONC PHC was categorized as moderate by using Penilaian Kinerja Rumah Sakit dalam Pelayanan Maternal-Perinatal scoring from facilitative supervision (on the job training) JNPK-KR in 2009. Most of all BEmONC PHC in Bekasi were rated below average in ?process? as one of the appraisal parts, especially postnatal service which included capability in infants less than 2000 grams born management, 24 hour rooming-in service, breastfeeding, and neonatal resuscitation. The cause was lack of supporting infrastructures at BEmONC PHC i.e vacuum, resuscitation drugs, and preterm neonatal management facility.

Abstrak :
Tesis ini membahas rujukan kasus kegawatdaruratan Obstetri Neonatal oleh Bidan Desa ke Puskesmas mampu PONED di Kabupaten Bogor. Penelitian ini adalah penelitian kualitatif. Hasil Penelitian menyarankan bahwa setiap bidan desa harus tinggal di desa dan mendapatkan pelatihan APN dan PPGDON; puskesmas harus membuat sosialisasi dan pembinaan khusus untuk kegiatan PONED; Dinas Kesehatan harus memenuhi kebutuhan Sumber Daya Manusia (SDM) khusus untuk petugas PONED melalui mutasi dan promosi yang tepat; memenuhi kebutuhan sarana dan pembinaan terjadwal secara rutin; membuat penilaian kinerja Puskesmas mampu PONED sebagai tolak ukur keberhasilan kegiatan PONED di Kabupaten Bogor; memberikan bantuan biaya transportasi kepada masyarakat miskin yang akan dirujuk. ...... The focus of this study is the referral case of an obstetric and neonatal emergency by villagel midwives to the PONED preliminary health Center in Bogor District. This research is a qualitative study. This study results come up with some suggestions. Every midwife need to stay in the rural district and get the training PPGDON and training APN; PHC should make some socialization and coaching program related to PONED activities; Health Department in Bogor must fulfill the need of PONED human resources by some mutation and promotion; in addition, the supervision facility and observation need to be scheduled regulary; some indicator of success have to be developed in order to measure the PONED performance effectively; besides, the cost of transportation also should be allocated to protect the poor.

Abstrak :
Salah satu upaya percepatan penurunan AKI yaitu meningkatkan kualitas pelayanan persalinan oleh nakes di fasyankes. Pemanfaatan layanan persalinan di fasyankes dipengaruhi oleh pelayanan antenatal yang diterima oleh ibu hamil. Penelitian ini bertujuan mengetahui efek pelayanan antenatal terhadap pemanfaatan layanan persalinan di Indonesia. Penelitian ini menggunakan desain cross sectional dengan analisis regresi logistik multinomial menggunakan sampel penelitian 15.142 wanita usia subur yang melahirkan anak terakhir lima tahun sebelum survei dan terpilih dalam sampel SDKI 2012. Hasil penelitian menunjukkan bahwa pemanfaatan layanan persalinan di fasyankes 64,63%. Pemeriksaan fisik umum dan obstetri, risiko terjadinya persalinan di rumah baik dengan penolong persalinan nakes maupun dukun 3,64 kali lebih besar terhadap persalinan di fasyankes pada ibu yang hanya mendapat 1 pemeriksaan dibandingkan ibu yang mendapat 4 pemeriksaan. Pemeriksaan penunjang, risiko terjadinya persalinan di rumah dengan penolong persalinan nakes 1,39 kali lebih besar terhadap persalinan di fasyankes pada ibu yang tidak mendapat pemeriksaan dibandingkan ibu yang mendapat pemeriksaan darah dan urin, serta risiko terjadinya persalinan di rumah dengan dukun 1,25 kali lebih besar pada ibu yang hanya mendapat pemeriksaan darah atau urin dibandingkan dengan ibu yang mendapat kedua pemeriksaan. Komponen suplemen tablet zat besi dan imunisasi TT, risiko terjadinya persalinan di rumah dengan penolong persalinan nakes 1,92 kali lebih besar terhadap persalinan di fasyankes pada ibu yang tidak mendapat tablet zat besi dan imunisasi TT dibandingkan ibu yang mendapat kedua pemeriksaan. Sedangkan risiko terbesar terjadinya persalinan di rumah dengan penolong persalinan dukun 2,16 kali lebih besar pada ibu yang tidak mendapat tablet zat besi dan imunisasi TT dibandingkan ibu yang mendapat keduanya. Semakin sedikit pemeriksaan yang dilakukan, maka risiko menjadi lebih besar untuk terjadinya persalinan di rumah. Oleh karena itu, sangat perlu untuk memberikan penyuluhan tentang pentingnya pemeriksaan kehamilan agar ibu cenderung melakukan persalinan di fasilitas pelayanan kesehatan, sehingga menekan risiko kematian ibu dan bayi. ...... One of the efforts to accelerate reduction of MMR by improving the quality of delivery care by skilled birth attendant in health facility. Utilization of delivery care at health facilities is influenced by antenatal care received by the pregnant mother. This study aims to determine the effect of antenatal care on the utilization of delivery care in Indonesia. This study used a cross sectional design with multinomial logistic regression analysis, using 15,142 women aged 15-49 years with a delivery in five years prior to survey selected in the sample IDHS 2012. The results showed that the utilization of delivery care in health facilities 64.63%. General physical checkup and obstetrics, the risk of delivery in home both with skilled birth attendant and traditional birth attendant more than 3.64 times to deliver in health facility, mothers who only receive one checkup compared to mothers who received 4 checkup. Supporting chekup, the risk of delivery in home with skilled birth attendant were 1.39 times more likely to the delivery in health facility, mother who did not received checkup compared mother who did blood and urine test, as well as the risk of delivery in home with traditional birth attendant were 1.25 times more likely, mothers who only checkup blood or urine test compared with mothers who received 2 checks. For component of iron tablet supplement and TT immunization, the risk of delivery in home with skilled birth attendant were 1.92 times more likely to delivery in health facility, women who did not receive iron tableet and TT immunization compared to mothers who received both. While the greatest risk of birth at home with traditional birth attendant was 2.16 times more likely mothers who did not receive iron tablet and TT immunization than mothers who received both. Lack of checkup, the risk increase for delivery in home. Therefore, it is very important to promote about the importance of pregnancy checkup so that mothers tend to delivery in health facilities, thus reducing the risk of maternal and infant deaths.