Abstrak

PREDIKSI RETENSIO PLASENTA

PADA PERSALINAN PERVAGINAM
DENGAN MENGGUNAKAN NOMOGRAM
DI RSUP DR. M. HOESIN PALEMBANG

Terry Mutia1, Abarham Martadiansyah1, Ferry Yusrizal1, Legiran2

1
Bagian/KSM Obstetri dan Ginekologi Fakultas Kedokteran Universitas Sriwijaya/
RSUP Dr. Mohammad Hoesin Palembang, Indonesia
2
Bagian Biomedik Fakultas Kedokteran Universitas Sriwijaya, Palembang

Latar Belakang : Berdasarkan data World Health Organization (WHO), perdarahan

pascasalin merupakan 25% penyebab kematian ibu. Sekitar 15-20% perdarahan pascasalin
disebabkan karena retensio plasenta (RP). Penelitian oleh Favilli dkk. tahun 2007-2017
mengenai nomogram sebagai metode penilaian baru mempunyai angka prediktif yang tinggi
dalam memprediksi RP. Penelitian ini bertujuan untuk menilai apakah nomogram dapat
digunakan untuk memprediksi RP pada persalinan pervaginam.
Metode : Penelitian observasi analitik menggunakan desain case control. Penelitian ini
terdiri dari kelompok kasus 36 wanita pascasalin dengan RP dan kelompok kontrol 69 wanita
pascasalin tanpa RP di KSM Obstetri dan Ginekologi RSUP Dr. Mohammad Hoesin
Palembang pada April 2019 hingga Februari 2021. Kriteria penelitian yaitu persalinan
pervaginam, kehamilan tunggal, presentasi kepala tanpa kelainan kongenital mayor dan tidak
terdapat plasenta akreta secara histopatologi. Nomogram digunakan untuk memprediksi
risiko RP.
Hasil : Semua subjek kasus merupakan rujukan dengan penolong persalinan bidan dan dukun. RP
memiliki hubungan bermakna dengan riwayat estrogen/progesteron (OR 3,308, 95% CI 1,418-7,715,
p=0,009) dan berat badan bayi lahir (OR 7,333, 95% CI 1,843-29,185, p=0,003). Usia ibu >35 tahun
berisiko mengalami RP, namun tidak bermakna secara statistik (OR 2,685, 95% CI 1,068-6,750,
p=0,058). Nomogram pada penelitian ini memiliki sensitivitas 44,44%, spesifisitas 50,72%, dan
akurasi 48,75%.
Simpulan : Nomogram tidak dapat digunakan untuk memprediksi RP pada persalinan
pervaginam di RSUP Dr. Mohammad Hoesin Palembang.
Kata Kunci : nomogram, retensio plasenta, persalinan pervaginam

Pembimbing Koordinator Program Studi

Pendidikan Spesialis Obstetri dan
Ginekologi Universitas Sriwijaya

dr. Abarham Martadiansyah, Sp.OG(K)-KFM dr. A. Abadi, Sp.OG(K)-FER

NIP. 19820314 201504 1002 NIP. 19630619 198903 1002
Abstract

PREDICTION OF RETAINED PLACENTA AFTER VAGINAL DELIVERY

USING NOMOGRAM IN DR. M. HOESIN GENERAL HOSPITAL
PALEMBANG

Terry Mutia1, Abarham Martadiansyah1, Ferry Yusrizal1, Legiran2

1
Department of Obstetrics and Gynecology, Faculty of Medicine Sriwijaya University/
Dr. Mohammad Hoesin General Hospital Palembang, Indonesia
2
Department of Biomedical Science, Faculty of Medicine Sriwijaya University, Palembang

Background: Based on data from the World Health Organization (WHO), post-partum
hemorrhage is a 25% cause of maternal death. About 15-20% of post-partum hemorrhage is
due to retained placenta (RP). Favilli et al. conducted a study between 2007-2017 reporting
that a nomogram as a new scoring system has a high predictive value to predict RP. This
study aimed to assess the nomogram as a new method to predict RP after vaginal delivery.
Method: This was an analytical observational study using case-control design. This study
consisted of 36 post-partum women with RP as a case group and 69 post-partum women
without RP as a control group in Department of Obstetrics and Gynecology Dr. Mohammad
Hoesin General Hospital, Palembang between April 2019 and February 2021. The study
criteria were limited to vaginal delivery, singleton pregnancy, vertex presentation with no
major fetal anomaly and no histological diagnosis of placenta accreta. A nomogram was
used to predict the risk of RP.
Results: All case group subjects were the referral case from midwives and traditional birth
attendants. The RP had a significant association with previous estro-progestins therapy (OR
3,308, 95% CI 1,418-7,715, p=0,009) and birth weight (OR 7,333, 95% CI 1,843-29,185,
p=0,003). The risk of RP was higher in maternal age >35 years but not statistically
significant association (OR 2,685, 95% CI 1,068-6,750, p=0,058). The nomogram in this
study had a sensitivity of 44.44%, a specificity of 50.72%, and an accuracy of 48.75%.
Conclusion: The nomogram cannot be used to predict RP after vaginal delivery in Dr.
Mohammad Hoesin General Hospital, Palembang.
Keywords: nomogram, retained placenta, vaginal delivery

Pembimbing Koordinator Program Studi

Pendidikan Spesialis Obstetri dan
Ginekologi Universitas Sriwijaya

dr. Abarham Martadiansyah, Sp.OG(K)-KFM dr. A. Abadi, Sp.OG(K)-FER

NIP. 19820314 201504 1002 NIP. 19630619 198903 1002