8 R SL Obstetric Patients Characteristics Labor in Dr. M. Djamil General Hospital Padang December 2019-February 2020 Period

Vol. 5, No.
2, Jul-Dec 2021
ANDALAS OBSTETRICS AND GYNECOLOGY JOURNAL
Alamat Korespondensi:
Ruang Redaksi Andalas Obstetrics and Gynecology Journal, Lantai 3 PPDS Obstetri dan Ginekologi Universitas
Andalas, RSUP DR. M. Djamil Padang, Jl. Perintis Kemerdekaan Padang, Sumatera Barat 25127
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http://jurnalobgin.fk.unand.ac.id/index.php/JOE
research
Obstetric Patients Characteristics Labor in Dr. M. Djamil

General Hospital Padang December 2019-February 2020
Period
Syntia Ambelina1, Desmiwarti2
Affiliasi penulis : 1. Resident of Obstetrics and Gynecology, Faculty of Medicine, Andalas
University, Dr. M. Djamil Central General Hospital Padang; 2. Sub Division of Social Obstetrics and
Gynecology, Obstetrics and Gynecology Department, Faculty of Medicine, Andalas University, Dr.
M. Djamil Central General Hospital Padang
Korespondensi: Syntia Ambelina, email: osynambelina@gmail.com, Hp: 082392042745
Abstract
Introduction : Maternal death in Indonesia was still high therefore efforts was needed to suppress
this maternal mortality rate.
Objective : To determine risk factors of maternal mortality and morbidity.
Methods : This was a descriptive study using cross sectional design with study sample including all
laboring mother in Obstetric Department of Dr. M. Djamil General Hospital Padang from December
2019 to February 2020 period. Sample were collected using total sampling technique with total of
119 samples included in this study. Data was collected from patients’ medical record, including age,
gestational age, gravidity, history of labor, diagnosis, method of delivery, maternal condition, and
neonates condition at birth.
Results : Mean of age was 30.6 ± 5.4 years, mean of maternal age was 36.1 ± 3.8 weeks, about 77
patients (64.7%) were multipara, 49 patients (41.2%) had history of spontaneous labor, most frequent
diagnosis were severe preeclampsia in 20 patients (16.8%), impending eclampsia in 9 patients
(7.6%), history of cesarean section 8 patients (6.7%), twin pregnancy 7 patients (5.9%), and
pregnancy with positive HBsAg in 7 patients (5,9%). Total 32 patients (26.9%) were referred patients
from various general hospital in West Sumatra. A total of 105 patients (88.2%) had cesarean section.
Mean birth weight of neonates was 2363.4 ± 964.7 gram, mean birth length was 44.1 ± 5.9 cm, mean
apgar score in the first 1 minutes was 5,9 ± 2,2, and mean apgar score in the first 5 minutes 7.4 ± 2.3.
During 3 months of study, total maternal deaths were found in 3 patients due to complicated
eclampsia, severe preeclampsia, and maternal congenital heart disease, while neonatal death was
found in 8 babies, where 6 (75%) had IUFD, and 2 (25%) had very low birth weight dying in the first
24 hours of life due to respiratory failure.
Conclusion : Most of labored mother were multiparas with history of spontaneous birth, and mostly
diagnosed as severe preeclampsia with method of delivery of cesarean section, and maternal and
neonatal death were still occurred.
Keywords: Death, Maternal, Neonatal
INTRODUCTION
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Correspondence: Syntia Ambelina, email: osynambelina@gmail.com
Vol. 5, No. 2, Jul-Dec 2021
Website:
eISSN : 2579-8324 pISSN : 2579-8323
Maternal death is one of indicators to assess the success of the effort to increase maternal
wellbeing and community health status1. Maternal mortality rate globally in 2015 was 216
per 100.000 births. This was far from target maternal mortality rate based on Millennium
Development Goals (MDG’s) 5 that is reduction of maternal mortality rate in 2015 as much
as 3⁄4 of maternal mortality in 1990.2,3 Maternal mortality rate in Indonesia at 1990 – 2015
tend to decrease from 390 to 305 per 100.000 live births. Yet this was still far from target to
be achieved in Indonesia in 2015, that is 102 per 100.000 live births. 2
Millennium Development Goals had ended in 2015 and World Health Organization
(WHO) had set new agenda for development goals from MDG’s to SDG’s. Target to be
achieved in an attempt to reduce maternal mortality rate was 70 per 100.000 live births in
2030. Based on maternal mortality rate in Indonesia in 2015 that was 305 per 100.000 live
births, Indonesia needs endeavour to achieve SDG’s.4,5
Delay in the decision making to refer pregnant mother to referral hospital due to lack
of awareness to warning sign was one contributing factor to maternal mortality rate. 6
Furthermore, post labor condition was the dominant cause of maternal mortality, such as
bleeding (28%), infection (11%), puerperal complication (8%), prolonged labor (5%),
abortion (5%), trauma (5%), emboli (5%), and others.6 Therefore, optimization of labor
management is important to be done.
METHODS
This was a descriptive study using cross sectional design with study sample including all
laboring mother in Obstetric Department of Dr. M. Djamil General Hospital Padang from
December 2019 to February 2020 period. Sample were collected using total sampling
technique with total of 119 samples included in this study. Data was collected from patients’
medical record, including age, gestational age, gravidity, history of labor, diagnosis, method
of delivery, maternal condition, and newborn condition at birth. Data analysis was done
using univariate analysis by computer software.
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RESULTS
Based on analysis result, labor mother characteristics in this study were as follows:
Table 1. Labor mother characteristics

Maternal characteristics Mean ± SD f (%)
Age (years) 30.6 ± 5.4
Gestational age (weeks) 36.1 ± 3.8
Gravidity
1. Primipara 32 (26.9)
2. Multiparas 77 (64.7)
3. Grande multiparas 10 (8.4)
History of labor
1. Present pregnancy 32 (26.9)
2. Spontaneous 49 (41.2)
3. Cesarean section 38 (31.9)
Diagnosis
1. Severe preeclampsia 20 (16.8)
2. Impending eclampsia 9 (7.6)
3. Placenta previa 8 (6.7)
4. Laboring 8 (6.7)
5. History of cesarean section 8 (6.7)
6. HbsAg 7 (5.9)
7. Twin pregnancy 7 (5.9)
8. PROM 6 (5)
9. Fetal distress 6 (5)
10. CPD 6 (5)
11. Hyperthyroid 6 (5)
12. Transverse malpresentation 4 (3.4)
13. Eclampsia 3 (2.5)
14. Oligohydramnios 2 (1.7)
15. Polyhydramnios 2 (1.7)
16. Placenta accreta 2 (1.7)
17. IUFD 1 (0.8)
18. Hydrops fetalis + IUFD 1 (0.8)
19. Triplets 1 (0.8)
20. Hydrocephalus 1 (0.8)
21. HIV 1 (0.8)
22. Hydrops fetalis 1 (0.8)
23. Prolonged 2nd stage of labor 1 (0.8)
24. Secondary uterine inertia 1 (0.8)
25. Congenital heart disease 1 (0.8)
26. Congestive heart failure 1 (0.8)
27. Metabolic encephalitis 1 (0.8)
28. Placental abruption 1 (0.8)
29. PVC Bigeminy 1 (0.8)
30. Breech presentation 1 (0.8)
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31. Macrosomia 1 (0.8)

Referral status
1. Voluntary 29 (24.4)
2. Primary health care 3 (2.5)
3. Outpatient clinic 26 (21.8)
4. General hospital 32 (26.9)
5. Private hospital in Padang 21 (17.6)
6. Regional private hospital 8 (6.7)
Method of delivery
1. Spontaneous 14 (11.8)
2. Cesarean section 105 (88.2)
Maternal outcome
1. Death 3 (2.5)
2. Alive 116 (97.5)
Based on Table 1, it was found that mean maternal age was 30.6 ± 5.4 years, mean
gestational age was 36.1 ± 3.8 weeks, total 77 (64.7%) patients were multiparas, 49 (41.2%)
patients had history of spontaneous labor, most frequent diagnosis was severe
preeclampsia in 20 (16.8%) patients, mostly referred from general hospital with total of 32
(26.9%) patients, frequent methods of delivery was cesarean section in 105 (88.2%)
patients, and maternal mortality were found in 3 (2.5%) patients.
Table 2. Neonates Characteristics

Neonates Characteristics Mean ± SD f (%)
Newborn outcome
a. Death 8 (6.3)
b. Alive 120 (93.7)
Birth weight (gram) 2363.4 ± 964.7
Birth length (cm) 44.1 ± 5.9
Apgar score at first 1 minute 5.9 ± 2.2
Apgar score at first 5 minutes 7.4 ± 2.3
Based on Table 2, neonatal death was found in 8 (6.3%) newborn, mean birth weight
was 2363.4 ± 964.7 gram, mean birth length was 44.1 ± 5.9 cm, mean apgar score in the first
1 minutes was 5.9 ± 2.2, while mean apgar score in the first 5 minutes 7.4 ± 2.3.
Table 3. Maternal Cause of Death

Maternal Cause of Death f (%)
Severe preeclampsia 1 (33.3)
Complicated eclampsia 1 (33.3)
Congenital heart disease 1 (33.3)
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Based on Table 3, cause of maternal death were severe preeclampsia, complicated

eclampsia and congenital heart disease with total of 1 (33.3%) case in each cause of death.
Tabel 4. Newborn Cause of Death

Newborn Cause of Death f (%)
IUFD 6 (75)
Very low birth weight 2 (25)
Based on Table 4, most frequent cause of neonatal death was IUFD found in 6 (75%)
newborn.
DISCUSSION
This study result found that mean age of laboring mother were 30.6 ± 5.4 years, with mean
gestational age of 36.1 ± 3,8 weeks, more than half of respondents were multiparas, with
history of spontaneous birth, and most frequent diagnosis of severe preeclampsia, referral
origin mostly found from general hospital, frequent method of delivery was cesarean
section, and maternal death was found in 3 (2.5%) patients. Study result by Astuti et al
(2017) in Hasan Sadikin General Hospital found that risk factors of maternal death were due
to pregnancy complication, labor complication, puerperal complication, maternal age,
comorbidities, AND, and living area. While in this study, maternal cause of death were
severe preeclampsia, complicated preeclampsia, and congenital heart disease.7,18
Ramli et al (2018) studying 9 districts in Aceh found that maternal cause of death were
bleeding (59.7%), eclampsia (25.5%), and preeclampsia (6.3%).8 Study by Nair et al (2017)
described risk of maternal death in England was 9 times greater in women with
comorbidities and women with anemia during pregnancy had 3 times greater risk.
Inadequate ANC visits and history of complicated pregnancy is associated significantly with
increased maternal death risk.9
Bauserman et al (2015) described factors related to maternal death 6 weeks after
delivery were maternal level of education, gravidity, antenatal visit with highest risk was
found in mother without any ANC visit during pregnancy, bleeding, hypertension in
pregnancy, and mortality risk was higher in cesarean section.10 Study in India by Bathia et al
(2018) found that direct cause of maternal death were severe preeclampsia and eclampsia
(25.9%), sepsis (22.2%), and bleeding (20.4%). While indirect cause were anemia (79.6%),
heart disease in pregnancy (9.3%), and jaundice in pregnancy (9.3%). This study also found
that delayed care from referral hospital was also the most frequent cause of maternal
death.11
Study by Evance et al (2013) showed that obstetric risk factors of maternal death in
Tanzania were bleeding (28%), eclampsia (19%), and other unknown direct cause. While
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non-obstetric cause were AIDS (16%), malaria (12%), and other unknown cause. This
showed that HIV/AIDS had contributed considerably in maternal death.12
Previous study result in Brebes, Central Java in 2016 found that most frequent direct
cause of death were preeclampsia/eclampsia (33.3%), uterine atony (16.7%), and postnatal
infection (7.4%). While indirect cause of death was heart disease (12.9%). Most case of
maternal death was found in hospital. This study also found that maternal level of
education, maternal occupation, antenatal visits, birth attendant, and obstetric complication
contribute to maternal death.13
Mahmood et al (2018) said that factors of maternal death in Kutai District,
Kartanegara was frequently found in age group of 30-35 years (30%), level of education of
elementary school (53%), housewives (86%), received national health insurance (66.6%),
and house distance to health care was10-20 minutes (46%). Direct cause of death was
preeclampsia/eclampsia and also affected by other indirect factors.14
In this study, total neonatal death was 8 babies with causes of death of IUFD and very
low birth weight. Study by Halim et al (2017) found that neonatal cause of death were
asphyxia (43%), premature birth (22%), and sepsis (5.2%). Asphyxia was known as the most
frequent cause of neonatal death in the first 24 hours after delivery.15 Study by Listiani et al
(2018) concluded that direct cause of neonatal death were asphyxia, premature birth, and
infection. While indirect cause of neonatal death were low birth weight, family income
affecting birth weight, and maternal level of education.16,19
Policy maker should review main cause of neonatal death, where there were
differences compared to caused death in older children. Neonatal death is commonly
caused by premature birth, intrapartum complication, and infection (sepsis, meningitis, and
pneumonia). WHO and Maternal and Child Epidemiology Estimation Group predicted that
35% of all neonatal death in 2017 was related to premature birth complication, 24% related
to delivery, 14% related to sepsis or meningitis, and 11% related to congenital anomaly.17,20
CONCLUSION
Most of labor mother were multiparas with history of spontaneous birth, and mostly
diagnosed as severe preeclampsia with method of delivery of cesarean section, and
maternal and neonatal death were still occurred.
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8 R SL Obstetric Patients Characteristics Labor in Dr. M. Djamil General Hospital Padang December 2019-February 2020 Period

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Vol. 5, No.

Obstetric Patients Characteristics Labor in Dr. M. Djamil

Table 1. Labor mother characteristics

31. Macrosomia 1 (0.8)

Table 2. Neonates Characteristics

Table 3. Maternal Cause of Death

Based on Table 3, cause of maternal death were severe preeclampsia, complicated

Tabel 4. Newborn Cause of Death

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