Hubungan Posisi Persalinan Upright dengan Luaran Ibu dan Bayi Baru Lahir: Studi Kasus-Kontrol Retrospektif
DOI:
https://doi.org/10.63004/hrji.v4i5.1325Kata Kunci:
case-control retrospektif, episiotomi, luaran maternal, luaran neonatal, posisi bersalin, posisi upright, rekam medisAbstrak
Latar Belakang: Posisi persalinan merupakan faktor yang dapat dimodifikasi bidan dan berpengaruh terhadap luaran ibu bersalin dan neonatus. Di TPMB wilayah kerja Puskesmas Sukaraja Nuban, Kabupaten Lampung Timur, posisi litotomi masih mendominasi praktik persalinan dan angka episiotomi tercatat masih tinggi berdasarkan rekam medis tahun 2025. Tujuan: Menganalisis hubungan posisi persalinan upright (non-supine) dibandingkan posisi supine/litotomi dengan kejadian episiotomi dan luaran maternal-neonatal berdasarkan rekam medis persalinan di TPMB wilayah kerja Puskesmas Sukaraja Nuban tahun 2025. Metode: Studi case-control retrospektif murni berbasis rekam medis periode Januari–Desember 2025. Kasus adalah ibu bersalin yang mengalami episiotomi; kontrol adalah ibu bersalin tanpa episiotomi, di-matching 1:1 berdasarkan paritas dan kelompok usia. Besar sampel dihitung menggunakan rumus Schlesselman dengan α=0,05, power 80%, estimasi OR=3,0 dan proporsi paparan kontrol 35%, diperoleh minimal 44 per kelompok (total 88 rekam medis). Analisis data dilakukan pada tahun 2026 menggunakan uji Chi-Square, Odds Ratio (OR) dengan 95%CI, dan regresi logistik multivariat. Hasil: Diperoleh 44 kasus dan 44 kontrol yang memenuhi kriteria. Posisi supine/litotomi ditemukan pada 31 kasus (70,5%) dan 16 kontrol (36,4%), dengan perbedaan bermakna (p<0,001). Posisi supine secara bermakna berhubungan dengan peningkatan risiko episiotomi (OR=4,17; 95%CI: 1,76–9,87; p=0,001) dan durasi kala II memanjang (OR=3,12; 95%CI: 1,21–8,07; p=0,019). Tidak terdapat perbedaan bermakna pada luaran neonatal (p>0,05). Setelah dikontrol variabel confounding, posisi supine tetap sebagai faktor risiko independen episiotomi (AOR=3,89; 95%CI: 1,58–9,57; p=0,003). Kesimpulan: Posisi supine/litotomi berhubungan bermakna dengan peningkatan risiko episiotomi pada persalinan di TPMB wilayah kerja Puskesmas Sukaraja Nuban. Optimalisasi fasilitasi posisi upright oleh bidan diperlukan sebagai bagian dari asuhan persalinan berbasis bukti.
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Referensi
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