Indonesian Journal of Obstetrics and Gynecology (INAJOG)
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Analysis of Antenatal Care Quality in Cases of Referred Pregnant Women in Emergency Rooms Based on MCH Book Records: Analisis Kualitas Asuhan Antenatal Berbasis Telaah Buku KIA pada Kasus Rujukan Ibu Hamil di Unit Gawat Darurat
Get PDFObjective: To determine the quality of antenatal care received by pregnant women, and perceptions of pregnant women and antenatal care providers regarding antenatal care.Method: A quantitative and qualitative study of cases of referred pregnant women in the Emergency Room (ER) of Dr. Cipto Mangunkusumo Hospital (RSCM) from 2017–2018 was conducted. Quantitative data was obtained by assessing the overall completeness of filling in the Maternal Child Health (MCH) book used to report the antenatal care received by the subjects. The completeness of antenatal care in the health facility was obtained using a checklist. Qualitative data was obtained by interviewing pregnant women and antenatal care providers in health facilities.Result: There were 1.442 cases of referred pregnant women in RSCM’s ER for the year 2017–2018, of whom 820 possessed and could show their MCH Book. Pregnancy in adolescence below 20 years (9.1%) and pregnancy after age 35 (19.5%) were reported. Most pregnant women were well educated (74.3%), referred from hospital or clinic (57.6%), received antenatal care in a public health center (38.7%), were in labor (32%), and were in the third trimester of pregnancy (92%). All subjects presented an incomplete MCH book. Almost half had inadequate antenatal frequency (46%). The completeness of antenatal care components in health care was 90–100%. Qualitatively, the perceptions of mothers and antenatal care providers regarding quality of antenatal care, was inadequate.Conclusion: The quality of antenatal care in the case of referred pregnant women at the RSCM’s ER based on MCH Book records did not meet the required standard.Keywords: antenatal care quality, MCH book
Abstrak
Tujuan: Menentukan kualitas asuhan antenatal pada kasus rujukan ibu hamil di IGD RSCM yang memiliki buku KIA, dan persepsi ibu hamil yang memiliki buku KIA dan tenaga kesehatan pemberi layanan kesehatan tentang asuhan antenatal. Metode: Dilakukan studi kuantitatif dan kualitatif pada kasus rujukan ibu hamil di IGD RSCM yang memiliki buku KIA tahun 2017-2018. Pengambilan data kuantitatif dilakukan dengan telaah kelengkapan pengisian buku KIA secara umum, Kelengkapan komponen asuhan antenatal di fasilitas layanan kesehatan (fasyankes) asal asuhan antenatal didapatkan dari survei menggunakan daftar tilik. Pengambilan data kualitatif dilakukan dengan wawancara mengenai persepsi ibu hamil dan tenaga kesehatan pemberi pelayanan asuhan antenatal di fasyankes asal asuhan antenatal Hasil: Terdapat 1.442 kasus rujukan ibu hamil di IGD RSCM selama tahun 2017- 2018, 820 di antaranya memiliki dan dapat menunjukkan buku KIA. Terdapat subjek dengan usia kehamilan remaja dibawah 20 tahun (9,1%) dan usia diatas 35 tahun (19,5%). Sebagian besar ibu hamil yang dirujuk cukup berpendidikan (74,3%), dirujuk oleh RS atau klinik (57,6%) dan mendapat asuhan antenatal di puskesmas (38.7%), dalam status persalinan inpartu (32%), dengan usia kehamilan trimester III (92%). Semua subjek (100%) dinyatakan tidak lengkap dalam pengisian halaman di buku KIA. Hampir setengah subjek mempunyai jumlah kunjungan antenatal yang tidak ideal (46%). Kelengkapan komponen asuhan antenatal di fasyankes asal asuhan antenatal berkisar 90-100%. Secara kualitatif, didapatkan persepsi ibu hamil dan tenaga kesehatan pemberi asuhan antenatal, terhadap kualitas asuhan antenatal masih kurang tepat.Kesimpulan: Kualitas asuhan antenatal pada kasus rujukan ibu hamil di IGD RSCM berdasar rekam Buku KIA belum memenuhi standar. Kata kunci: buku KIA , kualitas asuhan antenatal
Uterine Fibroid in Breast Cancer Patients receiving Tamoxifen Therapy: Mioma Uteri pada Penderita Kanker Payudara dengan Terapi Tamoksifen
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Objective: Selective estrogen receptor modulators (SERMs) such as tamoxifen play a role in increasing the risk of developing uterine Fibroid.Methods: Case reportCase: Mrs. 47 years old, Para 6, presented with chief complaints of vaginal bleeding since a year ago. The patient was diagnosed with breast carcinoma 4 years ago and has had a right mastectomy followed by 6 cycles of chemotherapy which is then continued with tamoxifen treatment for 4 years, USG examination revealed uterine myoma to which we performed bilateral salphingoophorectomy hysterectomy, with anatomic pathology results of a uterine Fibroid and chronic endometritis.Conclusion: Selective estrogen receptor modulators (SERMs) such as tamoxifen exhibit antagonistic reactions in breast tissue which makes it appropriate to be used in the treatment of breast cancer. However, they can also be potentially agonistic on estrogen receptors in the uterus, which can cause the growth of uterine Fibroid. Nevertheless, the benefits of adjuvant tamoxifen for breast cancer outweighs its potential for developing uterine Fibroid and endometrial carcinoma, because metastatic breast cancer will always be fatal, whereas uterine myoma and endometrial cancer caused by the effects of tamoxifen can be prevented by regular evaluation and total hysterectomy.Keywords: breast cancer,tamoxifen, uterine fibroid,
Abstrak
Tujuan: Selektif estrogen reseptor modulator (SERMs) seperti tamoksifen berperan dalam meningkatkan risiko mengembangkan mioma uteri. Metode: Laporan KasusKasus: Ny 47 Thn Para 6, datang dengan keluhan perdarahan dari jalan lahir yang dirasakan ibu selama 1 tahun ini, pasien telah menderita kanker payudara 4 tahun yang lalu dan telah dilakukan mastektomi mammae dextra dilanjutkan kemoterapi 6 siklus kemudian dilanjutkan dengan pengobatan tamoksifen selama 4 tahun ini, dari pemeriksaan USG didapatkan adanya mioma uteri kemudian dilanjutkan dengan tindakan histerektomi salphingooforektomi bilateral, dengan hasil patologi anatomi suatu mioma uteri dan endometritis kronis.Kesimpulan: Selektif estrogen reseptor modulator (SERMs) seperti tamoksifen merupakan reaksi antagonis reseptor estrogen pada jaringan payudara yang digunakan dalam pengobatan kanker payudara, tetapi dapat berpotensi agonis pada reseptor estrogen pada uterus sehingga dapat menyebabkan pertumbuhan mioma uteri. Tetapi penggunaan tamoksifen ajuvan untuk kanker payudara lebih bermanfaat dibandingkan dengan potensinya untuk mengembangkan mioma uteri dan karsinoma endometrium, karena kanker payudara metastatik akan selalu berakibat fatal, sedangkan mioma uteri dan kanker endometrium yang ditimbulkan oleh efek tamoksifen dapat dicegah dengan evaluasi teratur dan dilakukan tindakan total histerektom.Kata kunci: kanker payudara, mioma uteri, tamoksife
The Role of Intrapartum Ultrasound to Predict Outcome of Delivery: Penggunaan Ultrasonografi Intrapartum untuk Memprediksi Luaran Persalinan
Get PDFObjective: To predict outcome of delivery by using ultrasound measurements consisting angle of progression, and head perineum distance.Methods: Sixtytwo parturients assigned in cohort prospective study. Ultrasound examination begin with identifying the cephalic position by placement of transducer on suprapubic region. The angle of progression is obtained trans-labially, head perineum distance and cervical dilation trans-perineally. Ultrasound findings of Nuchal cord, caput, moulding, occiput posterior position then compared with conventional findings. Labour is observed, outcomes are grouped into vaginal delivery and cesarean section.Results: Thirty-six women went for vaginal delivery, 26 underwent cesarean section. Independent T-test showed significant differences of the angle of progression (121.11o vs 88.85o) and head perineum distance (5.15 cm vs 7.26 cm) between the two groups. Linear regression test found a negative correlation on how the angle of progression affecting head perineum distance p-value <0.05 , R2 0.684, (r) – 0.827. Cervical dilation measurements both ultrasound and digital examination were assessed with the Bland-Altman reliability test with level of agreement (-1.0 cm) – (1.2 cm). Receiver Operating Characteristic curve showed cut-off value >101o angle of progression predicts vaginal delivery, area under curve 0.902 and positive likelihood ratio 4.4. Kappa reliability testing for nuchal cord, caput, moulding, and occiput posterior are 0.919, 0.938, 0.384, 0.681 respectively.Conclusion: Intrapartum ultrasound able to predict the outcome of delivery, digital examination of cervical dilation is the mainstay of measurement. Ultrasound able to rule out the presence of nuchal cord, caput, and occiput posterior. Keywords: angle of progression, head perineum distance, intrapartum ultrasound.
Abstrak
Tujuan: Mengetahui besar sudut penurunan kepala dan jarak kepala ke perineum dengan ultrasonografi intrapartum dalam memprediksi luaran persalinan. Metode: Enam puluh dua ibu bersalin dilakukan pemeriksaan ultrasonografi intrapartum. Identifikasi posisi kepala dengan meletakan transduser di suprapubik, sudut penurunan kepala secara translabial, jarak kepala ke perineum dan nilai dilatasi serviks secara transperineal. Lilitan tali pusat, kaput, molase, dan oksiput posterior pada temuan ulstrasonografi dibandingkan dengan hasil pemeriksaan konvensional. Observasi persalinan dilakukan, di kelompokan untuk persalinan pervaginam dan seksio sesarea.Hasil: Didapatkan 36 persalinan pervaginam dan 26 seksio sesarea. Uji – t secara signifikan berbeda, nilai sudut penurunan kepala (121,11o vs 88,85o), jarak kepala ke perineum (5,15 cm vs 7,26 cm) pada kedua kelompok. Uji regresi linier sudut penurunan kepala dan pengaruhnya terhadap jarak kepala ke perineum berkorelasi negatif p <0.05, R2 0.684, (r) – 0.827. Batas kesepakatan nilai dilatasi serviks kedua metode diuji dengan uji reliabilitas Bland-Altman dengan batas kesepakatan sebesar (-1.0) cm – (1.2) cm. Sudut penurunan kepala memprediksi persalinan pervaginam sebesar >101o, uji diagnostik dengan kurva Receiver Operating Characteristic didapatkan area dibawah kurva 0.902, rasio kemungkinan positif 4,4. Uji reliabilitas Kappa lilitan tali pusat, kaput ,molase, dan oksiput posterior berturut-turut (k) = 0.919, 0.938, 0.384, dan 0.681. Kesimpulan: Penggunaan ultrasonografi intrapartum dapat memprediksi luaran persalinan, pemriksaan dalam tetap menjadi pemeriksaan utama dalam menilai dilatasi serviks, ultrasnografi mampu mendeteksi lilitan tali pusat, kaput, dan posisi oksiput posterior.Kata kunci: Jarak kepala ke perineum, sudut penurunan kepala, Ultrasonografi intrapartum
Identification of Bacteria on Postcesarean Section Patient’s Wound Operation: Identifikasi Bakteri pada Luka Operasi Pasien Pascaseksio Sesarea
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Objective: To determine the type of bacteria in post-cesarean surgical patient wounds obtained through the patient's surgical wound swab in the Ward Obstetrics and Gynecology RSUD Ulin Banjarmasin in the period August-October 2019.Methods: This study was a descriptive study with a cross-sectional approach. A total of 36 samples were taken using a purposive sampling method, but only 32 bacterial isolates were obtained. Samples in the form of clean operating wound contaminated post-cesarean patients were planted on growth media and identified microscopically to be further classified based on responses to biochemical tests.Results: Descriptive analysis shows that there are three types of bacteria, namely Staphylococcus aureus as much as 59.3%, Staphylococcus epidermidis as much as 25.0%, and Escherichia coli as much as 15.6%.Conclusion: Obtained 3 types of bacteria in the results of surgical wound swab in post-cesarean section patients who were hospitalized in the Ward and Obstetrics Hospital of Ulin Hospital Banjarmasin, namely Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli.Keywords: cesarean section, contaminant bacteria, surgery wound swab.
Abstrak
Tujuan: Mengetahui gambaran jenis bakteri pada luka operasi pasien pascaseksio sesarea yang didapat melalui swab luka operasi pasien di Bangsal Kandungan dan Kebidanan RSUD Ulin Banjarmasin dalam periode Agustus-Oktober 2019.Metode: Penelitian ini merupakan studi dekskriptif dengan pendekatan potong lintang. Sebanyak 36 sampel diambil menggunakan metode purposive sampling, tetapi hanya didapatkan 32 isolat bakteri. Sampel swab luka operasi bersih terkontaminasi pasien paska seksio sesarea ditanam pada media pertumbuhan dan diidentifikasi secara mikroskopis untuk selanjutnya diklasifikasikan berdasarkan respon terhadap uji biokimia.Hasil : Analisis secara deksriptif menunjukkan bahwa terdapat tiga jenis bakteri, yaitu Staphylococcus aureus sebanyak 59,3%, Staphylococcus epidermidis sebanyak 25,0%, dan Escherichia coli sebanyak 15,6%.Kesimpulan : Didapatkan 3 jenis bakteri pada hasil swab luka operasi pasien pascaseksio sesarea yang dirawat inap di Bangsal Kandungan dan Kebidanan RSUD Ulin Banjarmasin, yaitu Staphylococcus aureus, Staphylococcus epidermidis, dan Escherichia coli.Kata kunci: seksio sesarea, bakteri kontaminan, swab luka operasi
Anemia in Pregnancy as a Predisposing Factor of Severe Preeclampsia: Anemia dalam Kehamilan sebagai Salah Satu Faktor Predisposisi Preeklamsia Berat
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Objective: This case may partly explain that anaemia can be a predisposing factor for the development of many women with preeclampsia were have a low level of haemoglobin during their pregnancy.Methods: A case reportCase: We present a case 23-year-old pregnant woman who has had moderate anaemia with severe preeclampsia at 38-week pregnant. As the evidence, there were elevated blood pressure, decreasing haemoglobin obtained by routine blood analysis, and presence of urine protein by urinalysis examination.Conclusion: In terms of anaemia as one of a predisposing factor of preeclampsia it is important to care provider, pregnant women, and families to prevent anaemia in pregnancy through routine ANC.Keywords: anaemia, pregnancy, severe preeclampsia.
Abstrak
Tujuan: Kasus ini sebagian dapat menjelaskan bahwa anemia dapat menjadi faktor predisposisi bagi perkembangan banyak perempuan dengan preeklamsia yang memiliki kadar hemoglobin yang rendah selama masa kehamilan mereka.Metode: Laporan kasus.Kasus : Kami melaporan kasus ibu hamil berusia 23 tahun yang mengalami anemia sedang dengan preeklamsia berat di usia 38 minggu, dibuktikan dari peningkatan tekanan darah, penurunan hemoglobin, serta protein uria pada pemeriksaan urinalisis.Kesimpulan : Berkaitan antara anemia sebagai predisposisi preekalmsia, penting bagi petugas kesehatan dan ibu hamil serta keluarga untuk mencegah anemia dalam kehamilan melalui ANC yang rutin.Kata kunci : anemia, kehamilan, preeklamsia berat
Interaction of Physical Activity and Body Mass Index with Age at Menarche : Interaksi Aktivitas Fisik dan Indeks Massa Tubuh dengan Usia Menarche
Get PDFObjective: To investigate the interaction of physical activity and body mass index with age at menarche in Babun Najah Junior High School.Methods: This was a cross sectional study. The sampling technique in this study is non-probability sampling by a total sampling.Results: The results of the study were processed using the Chi-Square statistical test on 142 samples, obtained p-value = 0.748 (p>0.05) for the relationship between physical activity and age at menarche, p-value = 0.048 (p<0.05) for relationship between body mass index with age at menarche, and p-value > 0.05 for the interaction of physical activity and body mass index with age at menarche.Conclusions: There is no interaction of physical activity and body mass index with age at menarche in Babun Najah Junior High School.Keywords: body mass index, interaction, menarche age, physical activity.
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Tujuan: Mengetahui interaksi aktivitas fisik dan indeks massa tubuh dengan usia menarche di Madrasah Tsanawiyah Swasta Babun Najah.Metode: Jenis penelitian ini adalah observasional analitik dengan desain penelitian potong lintang. Teknik pengambilan sampel dalam penelitian ini adalah pengambilan sampel non probabilitas dengan metode total sampling.Hasil: Terdapat hubungan antara indeks massa tubuh dengan usia menarche (p-value = 0,048) , tidak terdapat hubungan antara aktivitas fisik dengan usia menarche (p-value = 0,784) serta tidak terdapat interaksi antara aktivitas fisik dan indeks massa tubuh dengan usia menarche (p-value > 0,05).Kesimpulan: Tidak terdapat interaksi aktivitas fisik dan indeks massa tubuh dengan usia menarche di Madrasah Tsanawiyah Swasta Babun Najah.Kata kunci: aktivitas fisik, indeks massa tubuh, , interaksi, usia menarch
Chlamydia Trachomatis Infection and Spontaneous Abortion: Infeksi Chlamydia Trachomatis dan Abortus Spontan
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Objective: To determine the correlation between spontaneous abortion and Chlamydia trachomatis infection.
Methods: A cross-sectional study was conducted in women who experienced spontaneous abortion. Normal pregnancies with gestational age more than equal to 37 weeks as control. Detection of C. trachomatis in the product of conception or placenta from curettage using the PCR method.
Results: Positive C. trachomatis was found 3 cases in the abortion group and 4 cases in control. In the abortion group, C. trachomatis found in 1 case with vaginal discharge history and 2 cases without this history. C. trachomatis also found in 3 cases without a history of abortion. This bacteria was not found in patients with an abortion history. In the control group, 2 cases of positive C. trachomatis were found in pregnant women with or without a history of vaginal discharge and abortion, respectively. There were no significant differences regarding the positive of C. trachomatis between the two study groups regarding history of vaginal discharge and abortion.
Conclusions: Spontaneous abortion does not correlate with C. trachomatis infection.
Keywords: chlamydia trachomatis, infection, spontaneous abortion.
Abstrak
Tujuan: Untuk mengetahui hubungan antara abortus spontan dan infeksi Chlamydia trachomatis.
Metode: Penelitian potong lintang dilakukan pada perempuan yang mengalami abortus spontan. Kehamilan normal dengan usia kehamilan lebih dari sama dengan 37 minggu sebagai kontrol. Deteksi C. trachomatis pada produk konsepsi atau plasenta dari kuretase menggunakan metode PCR.
Hasil: C. trachomatis positif ditemukan 3 kasus pada kelompok aborsi dan 4 kasus dalam kontrol. Pada kelompok abortus spontan, C. trachomatis ditemukan pada 1 kasus dengan riwayat keputihan dan 2 kasus tanpa riwayat keputihan. C. trachomatis juga ditemukan pada 3 kasus tanpa riwayat abortus. Bakteri ini tidak ditemukan pada pasien dengan riwayat abortus. Pada kelompok kontrol, 2 kasus positif C. trachomatis masing-masing ditemukan pada perempuan hamil dengan atau tanpa riwayat keputihan dan abortus. Tidak ada perbedaan signifikan C. trachomatis positif antara kedua kelompok penelitian berdasarkan riwayat keputihan dan abortus.
Kesimpulan: Abortus spontan tidak berkorelasi dengan infeksi C. trachomatis.
Kata kunci: abortus spontan, chlamydia trachomatis, infeksi
Quality of Life and Sexual Function of Placenta Accreta Spectrum Disorder Patients after Surgery
Get PDFObjective: To evaluate sexual function and quality of life features using two validated Female Sexual Function Index (FSFI) questionnaires, and the Short-Form Health Survey (SF-36) in patients with sexually active on Placenta Accreta Spectrum (PAS) Disorder patient.Method: This research is a cross sectional analytic observational study which was conducted in Haji Adam Malik General Hospital from January 2017 - December 2019. Thirty-five study patients who have been diagnosed with PAS disorder and have been treated for at least 3 months were divided into hysterectomy and conservative groups. This study data consisted of primary data from interviews and secondary data from medical records. Independent T test is used if it is normally distributed and Mann-Whitney is used if it is not normally distributed, and it is declared significant if the P value is <0.05.
Result: From 8 assessment variables in the SF-36 questionnaire by comparing the questionnaire scores of PASD patients in the hysterectomy and conservative groups by showing significant results on social function (P value 0.021). Whereas in the FSFI questionnaire, there were 6 variables to assess the sexual function of patients with pain variable showing significant results (P value 0.007).Conclusion: There were differences in quality of life (social function) and sexual function (pain) in PASD patients in the hysterectomy and conservative groups.Keywords: Female Sexual Functional Index, Placenta Accreta Spectrum, Quality of Life, Short-Form Health Survey.
Abstrak
Tujuan: Untuk mengevaluasi fungsi seksual dan fitur kualitas hidup dengan menggunakan dua kuesioner tervalidasi Female Sexual Function Index (FSFI), dan Short-Form Health Survey (SF-36) pada pasien dengan placenta accrete spectrum (PAS) disorder yang aktif secara seksual setelah tindakan operasi.Metode: Penelitian ini merupakan penelitian analitik observasional dengan metode potong lintang yang dilaksanakan di Rumah Sakit Umum Haji Adam Malik dari January 2017-December 2019. Tiga puluh lima pasien yang didiagnosis dengan plasenta akreta spectrum dan telah ditatalaksana minimal 3 bulan dibagi menjadi kelompok histerektomi and konservatif. Data penelitian ini terdiri atas data primer dari wawancara dan data sekunder dari rekam medis. Uji T independen digunakan jika berdistribusi normal dan Mann-Whitney digunakan jika tidak berdistribusi normal, serta dinyatakan signifikan jika nilai P <0.05.Hasil: Dari 8 variabel penilaian dalam kuesioner SF-36 dengan membandingkan skor kuesioner pasien PASD pada kelompok histerektomi dan konservatif dengan menunjukkan hasil yang signifikan pada fungsi sosial (nilai P = 0,021). Sedangkan dalam kuesioner FSFI terdapat 6 variabel untuk menilai fungsi seksual pasien dengan variabel nyeri yang menunjukkan hasil yang signifikan (nilai P = 0,007).Kesimpulan: Terdapat perbedaan dalam kualitas hidup (fungsi sosial) dan fungsi seksual (nyeri) pada pasien PASD di kelompok histerektomi dan konservatif. Kata Kunci: female sexual functional index, placenta accreta spectrum, quality of life, short-form health survey
Profile of Pregnant Women who Underwent Cesarean Section and their Perinatal Outcome at a Tertiary Referral Hospital: Profil Ibu Hamil dengan Indikasi Operasi Caesar dan Luaran Perinatal di Rumah Sakit Rujukan Tersier
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Objective: To investigate the effectiveness of referral system, in regard to pregnant women with indication of C-section, and to learn the patients’ profile and their baby’s perinatal outcome.Methods: The research uses a retrospective descriptive method utilizing patient medical records with history of C-section at RSCM from January 2016 to December 2019. The target population is all pregnant women who were referred and performed cesarean section to at the hospital.Results: The most indications of C-section were premature membrane ruptures (16.1%), fetal distress (14.5%) and previous C-section (14.1%). There were 1585 cases (41.9%) coming without referral, 779 cases (20.6%) were bookcase, and 806 (21.3%) non-bookcase without referral. The main reasons for referral were absence of NICU facilities (27.31%), premature membranes rupture (20.81%), and eclampsia/preeclampsia/HELLP syndrome (15.40%). Most babies are born with normal weight (2500-3999 grams) as many as 45.1% and 54.9% are groups of babies with abnormal weight. Most babies have an APGAR score 5 minute of 7-10 (83.6%). As many as 47.8% rooming in and infants requiring perinatological care in both SCN and NICU are 52.1%.Conclusion: The study found that the effectiveness of RSCM tiered referral system still has much room for improvements. The study also found gap between number of referred cases and the cases eventually underwent for C-section with the same indication. The screening can be done better for an indication of the origin of the reference whether it is appropriate to do the reference or not.Keywords: caesarean section, perinatal outcome, pregnant women, referral system.
Abstrak
Tujuan: Untuk mengetahui efektivitas sistem rujukan pada ibu hamil dengan indikasi seksio sesarea, serta mengetahui profil pasien dan hasil perinatal bayinya.Metode: Studi ini menggunakan metode deskriptif retrospektif dengan memanfaatkan rekam medis pasien riwayat seksio sesarea di RSCM dari Januari 2016 sampai Desember 2019. Populasi sasaran adalah semua ibu hamil yang dirujuk dan dilakukan seksio sesarea di RSCM.Hasil: Indikasi seksio sesarea terbanyak adalah ketuban pecah dini (16,1%), gawat janin (14,5%), dan riwayat seksio sesarea sebelumnya (14,1%). Ada 1.585 kasus (41,9%) yang datang tanpa rujukan, 779 (20,6%) bookcase, dan 806 (21,3%) non-bookcase tanpa rujukan. Alasan utama rujukan adalah tidak adanya fasilitas NICU (27,31%), ketuban pecah dini (20,81%), dan eklampsia/preeklamsia/sindrom HELLP (15,40%). Sebagian besar bayi lahir dengan berat badan normal (2500-3999 gram) sebanyak 45,1% dan 54,9% merupakan kelompok bayi dengan berat badan tidak normal. Sebagian besar bayi memiliki skor APGAR 5 menit 7-10 (83,6%). Sebanyak 47,8% rawat inap dan bayi yang membutuhkan perawatan perinatologi baik di SCN maupun NICU sebanyak 52,1%. Kesimpulan: Studi ini menemukan bahwa efektivitas sistem rujukan berjenjang RSCM masih memiliki banyak ruang untuk perbaikan. Studi ini juga menemukan kesenjangan antara jumlah kasus yang dirujuk dan kasus yang akhirnya menjalani seksio sesarea dengan indikasi yang sama. Penapisan dapat dilakukan lebih baik untuk indikasi asal rujukan apakah layak dilakukan rujukan atau tidak.Kata kunci: ibu hamil, luaran perinatal, seksio sesarea, sistem rujuka