en Risk Factors of Premature Rupture of Mem
en Risk Factors of Premature Rupture of Mem
en Risk Factors of Premature Rupture of Mem
Abstract
Maternal mortality rate in Indonesia based on 2012 Indonesia Demographic and Health Survey is 359 per 100,000 live births. Causes of the maternal mor-
tality are still dominated by bleeding, pre-eclampsia/eclampsia and infections. One of causes of infections is premature rupture of membrane. Premature rup-
ture of membrane may increase morbidity and mortality among mothers and children. Incidence of premature rupture of membrane amount to 10% of all child-
births. This study aimed to analyze risk factors of premature rupture of membrane incidence at Mother and Child Hospital of ANNISA Citeureup, Bogor District
in 2014. This study was analytical and used a case control design. The samples consisted of 114 mothers who suffered from premature rupture of membrane
and control, 228 mothers who did not suffer from premature rupture of membrane. Results of this study showed that risk factors of premature rupture of mem-
brane were age, parity and education. Based on multivariate analysis, education was the most dominant risk factor for premature rupture of membrane inci-
dence.
Keywords: Education, pregnancy, premature rupture of membrane
Abstrak
Angka kematian ibu di Indonesia berdasarkan Survei Demografi dan Kesehatan Indonesia tahun 2012 sebanyak 359 per 100.000 kelahiran hidup. Penyebab
kematian ibu tersebut masih didominasi oleh pendarahan, pre-eklampsia/eklampsia, dan infeksi. Salah satu penyebab infeksi adalah ketuban pecah dini.
Ketuban pecah dini dapat meningkatkan morbiditas dan mortalitas pada ibu dan anak. Insiden kejadian ketuban pecah dini sekitar 10% dari seluruh persali-
nan. Penelitian ini bertujuan untuk mengetahui faktor risiko kejadian ketuban pecah dini di Rumah Sakit Ibu dan Anak (RSIA) ANNISA Citeureup, Kabupaten
Bogor tahun 2014. Penelitian ini merupakan penelitian analitik dengan rancangan penelitian kasus kontrol. Sampel terdiri dari 114 orang kasus ibu yang men-
galami ketuban pecah dini dan kontrol sebanyak 228 ibu bersalin yang tidak mengalami ketuban pecah dini. Hasil penelitian menunjukkan faktor risiko ter-
hadap kejadian ketuban pecah dini yaitu usia, paritas dan pendidikan. Berdasarkan analisis multivariat, didapatkan faktor yang paling dominan berisiko ter-
hadap kejadian ketuban pecah dini yaitu pendidikan.
Kata kunci: Pendidikan, kehamilan, ketuban pecah dini
How to Cite: Maryuni, Kurniasih D. Risk factors of premature rupture of Correspondence: Maryuni, Midwifery Studies Binawan Institute of Health
membrane. Kesmas: National Public Health Journal. 2017; 11 (3): 133-137. Science, Kalibata Raya street No 25-30, Jakarta, Phone: +6221 8011777, e-mail:
(doi:10.21109/kesmas. v11i3.1153)
maryuni80@gmail.com
Received: August 9th 2016
Revised: November 11th 2016
Accepted: January 16rd 2017
Copyright @ 2017, Kesmas: National Public Health Journal, p-ISSN: 1907-7505, e-ISSN: 2460-0601, Accreditation Number: 56/DIKTI/Kep/2012, http://journal.fkm.ui.ac.id/kesmas
Kesmas: National Public Health Journal, 2017; 11 (3): 133-137
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Maryuni et al, Risk Factors of Premature Rupture of Membrane
Case Control
Variable Category p Value OR (95% CI)
n % n %
95% CI
Variable B S.E Sig Exp (B)
Lower Upper
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Kesmas: National Public Health Journal, 2017; 11 (3): 133-137
not attach to the place where it should be. Moreover, tis- incidence, so if there are multigravida mothers in preg-
sue of pelvic cavity and the muscles are weakening as in nancy check, health officers are expected to make plans,
line with the age getting older. This makes the pelvic ca- therefore premature rupture of membrane would not oc-
vity no longer easy to face and solve heavy complications cur or be handled without any complications.14
such as bleeding. In certain condition, its hormonal con- There was a significant relation between multiple
dition is not as optimum as the age before. That is why pregnancy and premature rupture of membrane inci-
the risk of miscarriage, amniotic fluid leak, fetal death dence as considered by p value = 0.000, OR = 2.676, CI
and other complications also increasing. Although the = 1.683 – 4.254, which concluded that mothers with
cause of premature rupture of membrane was not yet multiple pregnancy were 2.676 times more likely to get
known certainly, but the possible predisposing factors premature rupture of membrane incidence than mothers
were women’s age younger than 20 years and older than without multiple pregnancy. Results of this study are in
35 years, previous preterm birth and premature rupture accordance with a theory stating that cause of premature
of membrane records.7 The similar result was also found rupture of membrane could be due to excessive tension of
in study conducted by Purwanti et al.,11 that found rela- uterus, such as multiple pregnancy, hydramnion, fetal
tion between age of mothers and premature rupture of malposition like breech. Then it could be due to infec-
membrane incidence, birth-giving mothers aged > 35 tions that might raise biomechanical process on amniotic
years end to have declining health and uterine condition, membrane, so premature rupture of membrane easy to
also the weak pelvic cavity and its muscles in line with occur.7 Multiple preganancy may raise excessive tension
the age getting older. of uterus and at the end, it may raise contraction. If con-
Different perspective was stated by study of Dars et traction is excessive while labor signs such as cervix
al.,4 which showed that premature rupture of membrane opening is not yet maximum, thus premature rupture of
incidence mostly occurred among patients aged 20 – 30 membrane incidence may arise.15 The similar result of
years, but no significant relation was found between age study was showed by Susilawati that there was relation
and premature rupture of membrane incidence because between number of fetus and premature rupture of mem-
premature rupture of membrane incidence in this study brane incidence, the more number of fetus like in multi-
was influenced more by infection factor, the low socio- ple pregnancy, it would make stomach in tense exces-
economy and quality of antenatal care (ANC). sively, so premature rupture of membrane easy to oc-
Results of statistical test analyzing relation between cur.16
parity and premature rupture of membrane incidence Chi square test on malposition or breech showed a
found p value = 0.003, OR 1.992, CI = 12.260 - 3.149 significant relation between malposition and premature
which means that there was a significant relation be- rupture of membrane incidence with p value = 0.000 (OR
tween parity and premature rupture of membrane inci- = 2.960). Result of this study was in line with theory that
dence. Based on results of multivariate logistic regres- there was relation between malposition and premature
sion, variable parity had significant relation with prema- rupture of membrane incidence. In malposition, the low-
ture rupture of membrane incidence. This is line with est position of fetus does not cover the birth canal, so
theory stating that women who experience pregnancy there is no resistance on amniotic membrane that causes
more than twice need to be more careful of because get- the easy leak of amniotic membrane.13 According to
ting pregnant too often results the weak uterine condition causes of premature rupture of membrane, malpositions
as it is often in tense due to pregnancy.12 namely breech and latitude position are possible because
Multiparity is one of predisposing factors of prema- the lowest position of fetus does not cover the birth canal
ture rupture of membrane incidence because among mul- in maximum, so no resistance is found on amniotic mem-
tiparous women, incompetent cervix is often found, so brane. 11 Based on study conducted by Leihitu and
there is no resistance on amniotic membrane. Parity Ruhyana,17 there was a relation between fetal malposi-
(multi/grande multiparity) is the general cause of pre- tion and premature rupture of membrane incidence.
mature rupture of membrane incidence.13 Parity is one of In education, there was OR = 2.379 which means that
factors causing premature rupture of membrane because mothers with high level of education (> junior high
the increase of parity which enables cervix damage du- school) were 2.379 times more likely to get premature
ring delivery before. The too many number of child is rupture of membrane than mothers with low level of edu-
medical factor that becomes a background of maternal cation (< junior high school) and it was proven by chi
and perinatal mortality. The more number of born child square test analysis that maternal education and prema-
is, it may decrease reproductive health with risks inclu- ture rupture of membrane incidence with p = 0.000
ding abortus, preeclampsia, premature rupture of mem- showed a significant relation between maternal educa-
brane and low birthweight. Multigravida mothers have tion and premature rupture of membrane incidence.
risk of suffering from premature rupture of membrane Based on multivariate logistic regression, there were
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Maryuni et al, Risk Factors of Premature Rupture of Membrane
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