Three-Delay Model on Maternal Mortality Cases in Tertiary Referral Hospital in Indonesia

Abstract

Maternal mortality remains a worldwide concern to this day. Three main causes of maternal mortality during 2010–2013 were hemorrhage, hypertension, and infection, which all of them are the direct causes. The high MMR is also due to the presence of 3 delay which is Delay in seeking assistance (type–1), delay in identifying and accessing medical center (type–2) and delay in having prompt treatment (type–3) . Therefore, this study aims to describe maternal mortality cases in tertiary hospital which is Cipto Mangunkusumo Hospital (CMH) so that the root of problems in maternal deaths can be discovered and improvements can be done in the future. This was a descriptive study conducted in the Department of Obstetrics and Gynecology at CMH, Jakarta. Data collection was taken from 2016 – 2018 where subjects were taken from secondary data on maternal mortality. Based on the data that has been collected in CMH total live births in Emergency Department CMH during 2016-2018 which was 4.226 cases. There was 22 maternal death cases (0.52%). Most deaths were occurred in 2017 (50% of all cases). Indirect causes of maternal mortality were the leading cause in this study, including septic shock, hypovolemic shock due to Dengue Shock Syndrome, cardiogenic shock, and acute respiratory failure. Three delay models were three main factors contributing to maternal mortality interrelated and influenced by other factors with delay in looking for assistance and treatment (31,8%) was the upmost factor of maternal mortality. More than half maternal deaths in CMH during 2016 – 2018 caused by indirect causes. Among three delay models, delay in looking for assistance and treatment was the upmost factor of maternal mortality. Keywords: maternal mortality, three-delay model.   Tiga Model Keterlambatan pada Kasus Kematian Ibu di Rumah Sakit Tersier di Indonesia Kematian ibu masih menjadi perhatian dunia hingga saat ini. Tiga penyebab utama angka kematian ibu (AKI) selama 2010-2013 adalah perdarahan, hipertensi, dan infeksi, yang semuanya merupakan penyebab langsung. Tingginya AKI juga disebabkan oleh adanya 3 keterlambatan yaitu keterlambatan dalam mencari pertolongan, keterlambatan dalam mengidentifikasi dan mengakses pusat kesehatan, dan keterlambatan dalam mendapatkan pengobatan yang tepat. Penelitian ini bertujuan untuk mendeskripsikan kasus kematian ibu di rumah sakit tersier yaitu Rumah Sakit Cipto Mangunkusumo (RSCM) sehingga akar permasalahan kematian ibu dapat ditemukan dan dapat dilakukan perbaikan di masa yang akan datang. Penelitian ini merupakan penelitian deskriptif yang dilakukan di Bagian Obstetri dan Ginekologi RSCM, Jakarta. Pengambilan data diambil dari tahun 2016 – 2018, subjek diambil dari data sekunder kematian ibu. Berdasarkan data yang terkumpul di RSCM jumlah kelahiran hidup di Instalasi Gawat Darurat RSCM selama tahun 2016-2018 sebanyak 4.226 kasus. Terdapat 22 kasus kematian ibu (0,52%). Kematian terbanyak terjadi pada tahun 2017 (50% dari seluruh kasus). Penyebab tidak langsung kematian ibu merupakan penyebab utama dalam penelitian ini, antara lain syok septik, syok hipovolemik akibat dengue shock syndrome, syok kardiogenik, dan gagal napas akut. Tiga model keterlambatan merupakan tiga faktor utama penyebab kematian ibu yang saling berkaitan dan dipengaruhi oleh faktor lain dengan keterlambatan mencari pertolongan dan pengobatan (31,8%) merupakan faktor penyebab kematian ibu yang paling tinggi. Lebih dari separuh kematian ibu di RSCM selama tahun 2016 – 2018 disebabkan oleh penyebab tidak langsung. Di antara tiga model keterlambatan, keterlambatan dalam mencari bantuan dan pengobatan merupakan faktor utama kematian ibu. Kata kunci: kematian maternal, model tiga terlambat.