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ARTIKEL READING
Physical activity and urinary incontinence during pregnancy and postpartum:
A systematic review and meta-analysis

Disusun untuk Memenuhi Tugas Pengatar Praktik Kebidanan

Oleh:
ELISA KARUNIA SIHOMBING
NIM : P07524422055

PEMBIMBING

Dr. Samsider Sitorus, SST, M.Keb

PRODI SARJANA TERAPAN KEBIDANAN MEDAN

POLTEKKES KEMENKES MEDAN
TA.2022/2023
i
 KATA PENGANTAR

Puji dan Syukur penulis panjatkan kehadirat Tuhan Yang Maha Esa, karena atas
berkat rahmat dan karunia-Nya penulis dapat menyelesaikan Laporan Artikel reading
Physical activity and urinary incontinence during pregnancy and postpartum: A systematic
review and meta-analysis. Dalam kesempatan ini penulis menghanturkan rasa hormat dan
terima kasih yang sebesar – besarnya kepada dosen pengampu yang telah membimbing
selama ini.
Penulis juga mengakui bahwa dalam proses penulisan laporan ini, masih
jauh dari kesempurnaan baik materi maupun cara penulisannya. Namun demikian
penulis telah berupaya dengan segala kemampuan dan pengetahuan yang
dimiliki.
Dan oleh karenanya, penulis dengan rendah hati dan dengan tangan
terbuka menerima masukan kritik dan saran yang membangun guna perbaikan
dan penyempurnaan makalah ini dikemudian hari.
Akhirnya penulis berharap, makalah ini dapat bermanfaat bagi seluruh
pembaca. Dan dapat memberikan kontribusi yang positif serta bermakna dalam
proses perkuliahan Kebidanan.

Medan,13 November 2022

ELISA KARUNIA SIHOMBING

ii
 DAFTAR ISI
Halaman
Halaman Pengesahan ............................................................................................. i
Kata Pengantar ..................................................................................................... ii
Daftar Isi ..............................................................................................................iii
BAB I PENDAHULUAN
A. Judul ......................................................................................................... 1
B. abstrak ...................................................................................................... 1
C. latar belakang ...........................................................................................2
D. metode ...................................................................................................... 2
E. hasil dan pembahasan penelitian .............................................................. 2
F. kesimpulan ................................................................................................ 3
BAB II TELAAH JURNAL
A. Judul ......................................................................................................... 4
B. Abstrak ..................................................................................................... 4
C. Latar belakang .......................................................................................... 4
D. Metode ......................................................................................................5
E. Hasil dan pembahasan penelitian ............................................................. 5
F. Kesimpulan...............................................................................................5
BAB III TINJAUAN PUSTAKA
A. Definisi ................................................................................................... 6
B. Kajian Teori.......................................................................................... 10
BAB IV Penurup
A. Kesimpulan ............................................................................................ 16
B. Saran .......................................................................................................16

iii
 BAB I
PENDAHULUAN

A. Judul (Artikel yang dilaporkan)

1. Judul Artikel : Successful minimally invasive surgery for postpartum

retroperitoneal hematoma complicated by an infection: Two case reports
2. Edisi Terbit 2021
3. Pengarang Artikel :Nikolaus Veit-Rubin,Michel Boulvain,Jeanne Bertuit ,
Colin Simonson,David Desseauve
4.Penerbit : Von Aarburg
4. Kota Terbit : Europa
5. Nomot ISSN : e-ISSN: 1872 - 7654
6. Alamat situs : https://doi.org/10.1016/j.ejogrb.2021.11.005

5
 B. ABSTRACT

To assess the association of physical activity and urinary incontinence, or its recovery,
during pregnancy and postpartum.

A search of publications indexed in five major electronic databases (CENTRAL, PubMed,

EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the
30 March 2020 with a combination of keywords to identify studies of interest. Google
Scholar was used for non-indexed literature. All studies comparing physical activity with
standard care in pregnant and postpartum women were selected.

Two reviewers independently selected studies, assessed quality and extracted data. Odds
ratios with 95% confidence intervals were calculated using fixed effects or random effects
models, for low and moderate heterogeneity between studies, respectively.

Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-
analyses; subgroup and sensitivity analyses were not possible. Physical activity, either
during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95%
CI: 0.69–1.18) and OR 1.31 (95% CI: 0.74–2.34), respectively. Due to a lack of available
data, urinary incontinence recovering could not be assessed.

The available low evidence does not show that physical activity during pregnancy or
postpartum is associated with urinary incontinence. Moderate physical activity should
therefore be encouraged for the evidence-based benefits on other obstetrical outcomes.

C. Methods
The Cochrane criteria for systematic reviews were applied .
Data sources
A systematic review of publications indexed in five major electronic databases was
performed: PubMed, EMBASE, Cochrane Central Register of Controlled Trials
(CENTRAL), CINAHL Complete in EBSCOhost and PEDro. In addition, Google Scholar
was used for grey literature search and contact with study authors was established to identify
additional studies. The databases were searched from their respective inception dates to the
30 March 2020. A complete description of the search strategy is provided in Appendix A.
The lists of references in the identified publications were manually searched. Only studies
in English and French without any temporal or regional restrictions were assessed.
6
Eligibility criteria
The inclusion criteria were defined as follow:
1) Types of study: Giving healthy pregnant or postpartum women (up to 6 months after
birthin accordance with the WHO definition)
2) Intervention: Any type of physical activity corresponding to the definition of the WHO
was considered. This includes some activities of daily living (i.e. walking, climbing stairs,
cycling for transportation), occupational (i.e. work), household chores and any sports or
leisure activities.
Main outcomes
1) Primary maternal outcomes measure: incidence of urinary incontinence during pregnancy
and incidence of urinary incontinence in the postpartum period;
2) Secondary maternal outcomes measures: the recovery time of postpartum urinary
incontinence symptoms . According to the International Continence Society (ICS) we
defined the urinary incontinence symptom as ‘‘the complaint of any involuntary loss of
urine” and its subtypes: Stress urinary incontinence (SUI): ‘‘Complaint of involuntary loss
of urine on effort or physical exertion including sporting activities, or on sneezing or
coughing.” Urgency urinary incontinence (UUI): ‘‘Complaint of involuntary loss of urine
associated with urgency.” Mixed urinary incontinence (MUI): ‘‘Complaints of both stress
and urgency urinary incontinence” .
Data extraction
Titles and abstracts of studies identified using the search strategy were screened
independently by two reviewers (NvA and NVR) to identify those that met the inclusion
criteria, then eligibility was verified reading the full text. Any disagreement over the
eligibility of particular studies was resolved by a third reviewer (CS). All the publications
meeting the criteria were selected for full text analysis. Two reviewers (NvA and NVR)
independently extracted data and discrepancies were resolved through discussion with a
third reviewer (CS). Data Management was performed using the data management tool
Zotero.
Assessment of risk of bias
Two reviewers (NvA and NVR) independently assessed the overall quality and the risk of
bias of the included studies. The studies’ quality was assessed with a tool adapted to the
design of each study (the STROBE statement and the CONSORT checklist). The
assessment of risk of bias was assessed with the Cochrane instrument. Disagreements

7
 between the reviewers over the risk of bias in particular studies were resolved by discussion,
with involvement of a third reviewer (CS) when necessary. Information on funding of the
included studies was sought.
Assessment of the quality of evidence
The Grading of Recommendations Assessments, Development and Evaluation (GRADE)
approach was used to assess the level of quality of the evidence (Table 1). Two reviewers
(NvA and NVR) working independently assessed the quality of the evidence and reached a
consensus on any downgrading decisions.
Statistical analysis
Primary outcome and secondary outcomes were defined as dichotomous outcomes and
summaries of intervention effects for each study were provided by calculating odds ratios
(OR) with 95% confidence intervals (CI). The clinical and methodological heterogeneity
among included studies were assessed qualitatively. Statistical heterogeneity was assessed
using I2 statistic. Metaanalyses were performed using a random effects analysis model. In
case of low heterogeneity (I2 < 25%), we pooled the estimates of the effects with a fixed
effects model. We report the overall effect as pooled odds ratios with their 95% confidence
intervals and the statistical significance was determined with a Z score and its P value. In
case it was not possible to include one study in a meta-analysis, a descriptive synthesis was
done. Statistical analysis was performed using RevMan 5
D. Results
General characteristics of the studies
The selection of studies was listed in the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) flow chart (Fig. 1) . A total of 2343 citations have
been identified by the database searches. After screening titles and abstracts, seven relevant
studies met inclusion criteria , with 12,479 participants. The details of the seven included
studies and the 66 excluded studies are presented in Appendix (Tables A.1 and A.2
respectively). Among the excluded studies, three ongoing studies were identified (detailed in
Table A.3 in Appendix). Among included studies, six were observational studies and one
was an experimental study . Three were cross-sectional studies , two were cohort studies
and one was a casecontrol study . Participants were assessed either during pregnancy (from
the 21st to 42nd week of gestation, when specified) , or during postpartum , or both
. Some participants were elite athletes or runners , some were classified as regular and non-
regular exercisers , or exercisers and nonexercisers , doing frequent or occasional exercise .
Some were classified as doing low-impact, high-impact or no activities
8
Introduction
Urinary incontinence (UI) is a common condition among women , which can
lead to substantial reduction in quality of life for affected individuals . Pregnancy and
childbirth are considered important risk factors for the development of UI . Prevalence
estimates for any type of UI during pregnancy and the first year postpartum are reported to
be 32–64% and 15–30% respectively. According to the World Health Organization (WHO)
, physical activity is an important and modifiable health factor for all age groups. In adults
aged between 18 and 64 years old, there is strong evidence that physical activity improves
cardiorespiratory and muscular fitness, and reduces the risk of depression. There is
moderate evidence it increases bone density in adults . Additionally, other publications
report that mild to moderate physical activity is associated with a reduction of the
prevalence of UI in women .
Previous systematic reviews have been carried out on physical activity and UI in
pregnant and postpartum women, but included studies which often assessed interventions
combining exercises for pelvic floor muscle training (PFMT) and another physical activity .
Although antenatal PFMT seems to be effective in preventing urinary incontinence (low-
quality evidence) in late pregnancy and (moderate-quality evidence) in the postnatal period.
In a population of continent women, its effectiveness to treat urinary incontinence is
uncertain. PFMT programs require the intervention of a physiotherapist for patient
education and its cost effectiveness is unknown. Therefore, its use in an unselected
population of pregnant women cannot be recommended .
Physical activity is recommended for pregnant and postpartum women given
numerous beneficial outcomes . The aim of this systematic review and meta-analysis is to
assess the association between UI, or its recovery postpartum, and physical activity without
PFMT in this population.(Von Aarburg et al., 2021)

9
 BAB II
TELAAH JURNAL
Judul
Dilihat Dari Segi Judul cukupmenarik masyarakat untuk membaca artikel tersebut,
karena penulis ingin mengetahui bagaimana Physical activity and urinary incontinence
during pregnancy andpostpartum.

Abstrak

Dilihat dari abstrak sudah padat, jelas dan jelas yang mana berisi tujuan
penelitian, metode penelitian, hasil penelitian dan kesimpulan dari penelitian. Yang
mana pada saat orang membaca abstrak sudah bisa menyimpulkan dari isi jurnal
tersebut.
Pendahuluan
Dilihat dari segi pemaparan pendahuluan daridiangkatnya masalah tersebut
sudah cukup padat dan jelas, yang mana dari pendahuluan sudah terdapat data yang
mendukung data Pada masalah yang diangkat. Dari segi pemaparan materi tentang
Physical activity and urinary incontinence during pregnancy and postpartum

Metodologi
Studi kasus ini menggunakan metode sistematik review dan meta-analisis
dengan menggunakan data sekunder.

Hasil dan pembahasan penelitian

Hasil penelitian ini menunjukkan bahwa Tidak ada hubungan yang signifikan
secara statistik antara aktivitas fisik dan inkontinensia urin selama kehamilan (OR 0,90).
[p = 0,45), tanpa heterogenitas antara studi (I2 = 0%.Ada bukti kualitas 'rendah' dari tiga
studi observasional (n = 960) mengenai hubungan antara aktivitas fisik dan
inkontinensia urin selama kehamilan .Tidak ada hubungan yang signifikan secara
statistik antara aktivitas fisik dan inkontinensia urin selama periode postpartum (OR 1,31
[95% CI:0,74-2,34, p = 0,35]), dengan heterogenitas antara studi (I2 = 42%). Disana ada
bukti kualitas 'rendah' dari dua studi observasional [33,3 (n = 742) tentang hubungan
antara aktivitas fisik dan inkontinensiaurin selama periode postpartum
Kesimpulan
Pada jurnal yang di review berisi pembahasan yang sudah sesuai dengan teori
kemudian tujuan penelitian, hasil penelitian, dan dengan kualitas bukti yang rendah
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secara keseluruhan, ulasan ini tidak dapat untuk memberikan kesimpulan apa pun
mengenai efek aktivitas fisik saja di UI atau pemulihan pada wanita hamil dan
postpartum

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 BAB III

TINJAUAN PUSTAKA

A. Definisi

Inkontinensia urin merupakan kondisi yang berkaitan erat dengan kehamilan dan
memilki dampak yang besar terhadap kualitas hidup penderita. Inkontinensia urin adalah
suatu kondisi kehilangan urin secara tidak disengaja. Inkontinensia urin tipe tekanan sebagai
pengeluaran urin yang tidak disengaja saat aktivitas fisik, bersin ataupun batuk yang
mengakibatkan terjadinya peningkatan tekanan intraabdomen.(DHONI, 2017)(Yokoe et al.,
2021)

Masa nifas disebut juga post partum atau puerperium adalah masa atau waktu sejak
bayi dilahirkan dan plasenta keluar lepas dari Rahim sampai enam minggu berikutnya,
disertai dengan pulihnya kembali organ-organ yang berkaitan dengan kandungan yang
mengalami perlukaan dan lainsebagainya yang berkaitan saat melahirkan.(Kosanke, 2019)

B. Kajian Teori

a. Identitas klien

Meliputi nama, umur, pendidikan, suku bangsa, pekerjaan, agama, alamat, status
perkawinan, ruang rawat, nomor rekam medic, diagnosa medic, nama penanggung jawab,
alasan masuk, keadaan umum, tanda-tanda vital.

b. Data riwayat kesehatan

1) Riwayat kesehatan sekarang

Keluhan yang berhubungan dengan gangguan atau penyakit yang dirasakan klien saat ini.
Biasanya klien merasakan nyeri karena trauma akibat persalinan.

2) Riwayat kesehatan dahulu

Riwayat penyakit yang pernah diderita, yang ada hubungannya dengan penyakit klien
sekarang

3) Riwayat penyakit keluarga

Penyakit yang diderita klien dan apakah keluarga klien ada juga yang memiliki riwayat
persalinan yang sama.

12
4) Riwayat obstetrik

Yang perlu diketahui mengenai riwayat obstetrik pada klien meliputi :

a) Keadaan haid

Meliputi menarche, siklus haid, hari pertama haid terkhir, jumlah dan warna darah yang
keluar, encer, menggumpal, lamanya haid, nyeri atau tidak dan bau.

b) Riwayat kehamilan

Meliputi berapa kali melakukan ANC ( Ante Natal Care), Selama kehamilan periksa
dimana, apakah diukur tinggi badan dan berat badan selama masa kehamilan.

c) Riwayat persalinan

Meliputi riwayat persalinan yang baru terjadi, jenis persalinan spontan atau caesaria,
penyulit selama persalinan.

c. Pola kebiasaan sehari-hari menurut Virginia Henderson

1) Respirasi

Frekuensi pernafasan biasanya mengalami peningkatan.

2) Nutrisi

Biasanya klien tidak mengalami gangguan pada nafsu makan. Kebanyakan ibu mengalami
peningkatan nafsu makan hingga dua kali lipat dari jumlah yang biasanya dikonsumsi.

3) Eliminasi

Pada ibu post partum normal kadang-kadang mengalami kesulitan pada saat buang air
kecil karena spincer uretra mengalami tekanan oleh kepala janin dan spame oleh iritasi
musculus spincter ani selama persalinan. Buang air besar. Jika belum buang air besar
Selama 2-3 hari post partum dapat mengakibatkan obstipasi maka diberikan obat laksans
peroral atau perektal atau bila belum berhasil diberikan obat pencahar/laksatif.

4) Istirahat/tidur

Biasanya klien tidak mengalami gangguan pada istirahat/tidurnya. klien mengalami

gangguan pada suhu tubuhnya yang dapat mencapai lebih dari 37,5 ˚C.

5) Kebutuhan personal hygine

Biasanya klien dalam pemeliharaan kesehtan terutama personal hygine dibantu oleh
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keluarga.

6) Aktivitas

Biasanya klien post partum nomal mengalami gangguan pada aktivitas dan kegiatan
sehari-hari karena keadaannya yang lemah.

7) Gerak dan keseimbangan tubuh

Pada ibu post partum aktivitas sehari-hari berkurang, mengalami gangguan pada saat
berjalan karena nyeri akibat adanya trauma persalinan.

8) Kebutuhan berpakaian

Biasanya pada klien tidak mengalami gangguan dalam kebutuhan berpakaian.

9) Kebutuhan keamanan

Apakah klien merasa aman dan terlindungi oleh keluarganya. Klien mampu menghindari
bahaya dari lingkungan.

10) Sosialisasi

Bagaimana klien dapat berkomunikasi dengan orang lain dalam mengekspresikan emosi,
kebutuhan, kekhawatiran dan opini

11) Kebutuhan spriritual

Apakah klien menjalankan ajaran agamanya ataukah terhambat karena keadaan yang
dialaminya sekrang.

12) Kebutuhan bermain dan rekreasi

Biasanya pada klien dalam memenuhi kebutuhan bermain dan rekreasi tidak terpenuhi
karena kondisinya lemah.
13) Kebutuhan belajar
Biasanya klien berusaha untuk mencari tahu yang mengarah pada perkembangan yang
nomal,kesehatan dan penggunaan fasilitas kesehatan yang tersedia.
d. Pemeriksaan fisik
1) Keadaan umum
Keadaan umum klien lemah
2) Kesadaran
Kesadaran pada klien umumnya composmentis

14
3) Pemeriksaan tanda-tanda vital
a) Suhu : Meningkat diatas 37,5˚C.
b) Nadi : Meningkat ( > 90 x/menit ).
c) Pernafasan : Meningkat ( > 20 x/menit ).
d) Tekanan darah : Normal 120/80 mmHg.
e. Pemeriksaan fisik head to toe
1) Kepala dan rambut
Meliputi bentuk kepala, kulit kepala apakah kotor atau berketombe, rambut apakah telihat
lusush ataukusut, apakah ada luka atau laserasi.
2) Wajah
Meliputi warna kulit apakah pucat atau tidak, bentuk wajah.
3) Mata
Meliputi bentuk bola mata , gerakan mata apakah ada atau tidak, konjungtiva anemis atau
tidak, bentuk mata simetri atau tidak.
4) Hidung
Meliputi kebersihan, ada apakah tdak sputum, dan polip.
5) Telinga
Meliputi apakah ada tidaknya kelainan anatomi dan fungsi pendengaran, bagaimana
kebersihan telinga.
6) Mulut, bibir dan faring
Meliputi bentuk bibir apakah simetris atau tidak, kelembaban, kebersihan mulut, ada
tidaknyapembesaran tonsil, ada tidaknya kelainan bicara.
7) Gigi
Meliputi jumlah gigi lengkap atau tidak, kebersihan gigi, ada tidaknya peradangan pada
gusi, karang gigi.
8) Leher
Meliputi ada tidaknya pembesaran kelnjar tiroid dan vena jugularis.
9) Integument
Meliputi warna kulit apakah pucat atau tidak, kebersihan, turgor, tekstur kulit.
10) Thorax
Meliputi ada tidaknya suara ronchi, ada tidaknya kolostrum, apakah putting susu masuk
atau tidak, apakah tampak kotor atau tidak.
11) Payudara
Meliputi pembesaran payudara, areola mammae warnaya lebih gelap, papilla menonjol,
keluar ASI.
15
12) Abdomen
Meliputi ada tidaknya distensi aabdomen, tinggi fundus uteri masih setinggi pusat, bagimana
denganbising usus, apakah ada nyeri tekan.
13) Genetalia
Meliputi bagaimana pengeluaran lochea, warnanya, banyaknya, baunya, dan apakah ada
edema pada vulva.
14) Ektremitas atas
Meliputi kesimetrisan, ujung-ujung jari sianosis atau tidak ada tidaknya edema.
15) Ekstremitas atas
Meliputi kesimetrisan, ada tidaknya edema, sianosis, bagaimana pergeraknya,reflex
patella.(Nurmasari et al., 2018)

16
 BAB IV
PENUTUP
A. Kesimpulan

Penelitian ini sudah cukup bagus ditambah lagi dengan dukungan penelitian
–penelitian yang lain yang menambah referensi pada penelitian ini
B. Saran
Untuk penelitian selanjutnya agar lebih menyempurnakan dalam pembuatan
jurnal dan juga sebagai masukan dalam membuat jurnal yang baik dan bena

17
 Daftar Pustaka
Arrias, J. C., Alvarado, D., & Calderón, M. (2019). No 主観的健康感を中心とした在宅
高齢者における健康関連指標に関する共分散構造分析Title. 5–10.
DHONI. (2017). Tinjauan Pustaka Tinjauan Pustaka. Convention Center Di Kota Tegal,
5(1), 6–37.
Kosanke, R. M. (2019). 済無No Title No Title No Title. 11–44.
Makalah Nifas & Laktasi Kel 1_2a . (n.d.).
Nurmasari, D., Fikri, M. EL, & Ritonga, H. M. (2018). Inkontinensia Urin. Journal of
Chemical Information and Modeling, 53(9), 1689–1699.
Von Aarburg, N., Veit-Rubin, N., Boulvain, M., Bertuit, J., Simonson, C., & Desseauve, D.
(2021). Physical activity and urinary incontinence during pregnancy and postpartum:
A systematic review and meta-analysis. European Journal of Obstetrics and
Gynecology and Reproductive Biology, 267, 262–268.
https://doi.org/10.1016/j.ejogrb.2021.11.005
Yokoe, T., Kita, M., Fukuda, H., Butsuhara, Y., Sumi, G., & Okada, H. (2021). Successful
minimally invasive surgery for postpartum retroperitoneal hematoma complicated by
an infection: Two case reports. Annals of Medicine and Surgery, 71, 103025.
https://doi.org/10.1016/j.amsu.2021.103025
(Arrias et al., 2019)(Makalah Nifas & Laktasi Kel 1_2a , n.d.)

18