Maternal and Neonatal Factors That Influence Perinatal Death in Cilacap

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33 The proceedings of the 2nd Bakti Tunas Husada-Health Science International Conference (BTH-HSIC 2019) - Preface | Atlantis…
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Series: Advances in Health Sciences Research
The proceedings of the 2nd Bakti Tunas Husada-Health

Science International Conference (BTH-HSIC 2019)
PREFACE
The 2nd BTH BTH-Health Science International Conference (BTH-HSIC) is a

continuation of The 1st International Seminar of Health Sciences (ISHS) Bakti
Tunas Husada, which has been held since 2017 with purpose to promote and
develop science in the health field. BTH-HSIC is a forum for academia,
researches, lectures, educators, students, and profession. They share
exchange ideas and latest information in this event about health sciences
and its application i.e. pharmacy, nears, health analyst, optometry, and the
relevant health sciences. This conference is an opportunity for general
participants to upgrade their knowledge in the health field and expand their
professionalism at work.
In The 2nd BTH-HSIC, there are five parallel sessions and four invite speakers
from Malaysia, Philippine, and Indonesia. There are 109 papers presented in
this conference, 69 to be presented orally and 40 papers by posters.
All the committee expressed their gratitude to the chairman of Sekolah Tinggi
ilmu Kesehatan bakti Tunas Husada who supported this event from the
preparation, implementation, and closing. We would also like to thank the
authors who were willing to take part in this activity and submit articles for
publication in the Atlantis press proceedings (WoS indexed) Furthermore, our
deepest appreciation goes to all co-hosts (STFI, UBK, STIKes Al-Irsyad
Cilacap, and Akper Serulingmas Cilacap)) for their assistance in this
conference.
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Gatut Ari Wardani, M.Sc.

Chairperson of the 2nd BTH-HSIC 2019
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The proceedings of the 2nd Bakti Tunas Husada-Health Science International Conference (BTH-HSIC 2019) - Articles | Atlantis…
Eneng Daryanti
Breast cancer is one of the leading causes of death in the world and
Indonesia. The coverage of breast cancer detection in the City of Tasikmalaya
2018 was 6,542 people. in Karsamenak Sub-District in the working Area of
Kawalu’s Public Health Center, in Tasikmalaya 2019, which has the highest
number...
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Proceedings Article
Maternal and Neonatal Factors That Influence Perinatal Death

in Cilacap General Hospital 2017-2018
Dwi Maryanti, Dewi Prasetyani
Perinatal is an episode of life at 28 or more gestational ages coupled with a

baby less than 7 days old. During the perinatal period is very vulnerable to
morbidity and death. Perinatal Mortality Rate (PPA) is the number of fetal
deaths born at 28 weeks or older plus the number of infant deaths less...
Article details
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Proceedings Article
Differences in Characteristics of Type 2 Diabetes Mellitus

Patients Between Those Who Have Complications and Those
Who Do Not Have Complications
Dewi Prasetyani, Dwi Maryanti
Objectives: The purpose of this study was to determine differences in the

characteristics of type 2 Diabetes Mellitus (DM) patients between those who
have complications and those who do not have complications. Method:
Participants in this study were type 2 DM patients (n = 41). Member of
Prolanis South...
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Applications a Progressive Relaxation to Anxieties Geriatry in Tasikmalaya
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Self Adaption Toward Stress Effect Criminal Punishment to Prisoners in Tasikmalaya
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Kusmiati, Meti
The Examination of HDL Cholesterol on Risk of Dyslipidemia Respondents
Kusmiati, Meti
The Effect of Soymilk Consumption Toward Reduction Levels of Total Cholesterol and
LDL Cholesterol on Menopause Women
Ledianasari
Inhibitory Activity of Tyrosinase Enzyme on Lotion Contains Pear (Pyrus pyrifolia
(Burm.F) Nakai) Rind Extract
Lestari, Yogi Andhi

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Lestari, Yogi Andhi

The Influence of Age Factor on the Antepartum Haemorrhage Event in Cilacap
Hospital Period of 2016–2018
Lestari, Tresna
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l.) as an Indicator of the Quality on Freshness Meat
Liswanti, Yane
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Liswanti, Yane
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Medical Radiation Workers
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Lukman, Mamat
Potential of Family-Based Diet Management Programs to Behavior of Diet
Hypertension Patients in Four Areas of Community Health Centers Cibeureum
Working Areas in Tasikmalaya City, Indonesia
Lusiyanti, Yanti
Mahendra, Nur Alim

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l.) as an Indicator of the Quality on Freshness Meat
Maksum, Iman Permana

In Silico Study of Single Chain Fragment Variable Antibody and Indonesian Serotype-
2 NS1 Dengue Virus Antigen
Maryanti, Dwi
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Who Have Complications and Those Who Do Not Have Complications
Maryanti, Dwi
Maternal and Neonatal Factors That Influence Perinatal Death in Cilacap General
Hospital 2017-2018
Megantara, Sandra
Prasetyani, Dewi
Differences in Characteristics of Type 2 Diabetes Mellitus Patients Between Those
Who Have Complications and Those Who Do Not Have Complications
Prasetyani, Dewi
Maternal and Neonatal Factors That Influence Perinatal Death in Cilacap General
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Relationship of Self Awareness and Knowledge of Diabetes with Blood Glucose Level
on DM II
Pratita, Anindita Tri Kusuma

Potential of Autotrophic Microalgae (Spirulina plantensis) in Decreased Coliform
Bacteria
Pratiwi, Erinda Nur

Effect Health Education on Improvement Knowledge of Students Class III and IV
About Hand Washing
Priatna, Muharam
Analgesic Activity of Infusion of Beluntas Radix (Pluchea indica (L.)) on the Male Mice
Purnami, Sofiati
Puspitasari, Resna
Antioxidant Activity of Chitosan from the Waste of Green Mussels Shell (Perna Viridis
L)
Rachmaniar, Revika
Thermal and Crystallinity Properties of Tengkawang Seeds Fat (Shorea mecistopteryx
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Rachmaniar, Revika
Pharmaceutical Cocrystal of Ethyl p-Methoxycinnamate: Formulation and
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Rahajeng, Nastiti
Rahardjo, Tur
A Preliminary Study on DNA Damage in Peripheral Blood of Cancer Patients After
R di th ith C tA
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Dr. Amirah M. Ghazali
Tanendri Arrizqiyani, M.Si.
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Advances in Health Sciences Research, volume 26
2nd Bakti Tunas Husada-Health Science International Conference (BTH-HSIC 2019)
Maternal and Neonatal Factors That

Influence Perinatal Death in Cilacap
General Hospital 2017-2018
Dwi Maryanti 1) , Dewi Prasetyani2)
1, 2 STIKES Al-Irsyad Al-Islamiyyah Cilacap
bidandwimaryanti@gmail.com
Abstract --- Perinatal is an episode of life at 28 identified that the numbers of perinatal death
or more gestational ages coupled with a baby less were 39 infants (Pratiwi, Dian Wahyu, 2012).
than 7 days old. During the perinatal period is very Other data showed that the incidence of perinatal
vulnerable to morbidity and death. Perinatal deaths in 2015 at . Dr. RD Kandou
Mortality Rate (PPA) is the number of fetal deaths
born at 28 weeks or older plus the number of infant
ManadoHospital as many as 85 babies from 1649
deaths less than 7 days recorded for 1 year per 1,000 live births (Simamora. Wellina R,
live births in the same year. Method: This type of Tendean.Hermie M. M, Mamengko. Linda ,
research is descriptive correlational research with a 2016). Furthermore, in RSIA Siti Fatimah,
cross-sectional approach. The number of samples in Makassar City in 2011 - 2012 the number of
this study was 180 events. With a total sampling perinatal deaths was 69 (1.5%) out of 4763 total
technique. The data collection tool uses a checklist deliveries. (Pongkapadang.MN, Ansar. J,
with logistic regression analysis. Results: The Wahidudin, 2014) and in Batang District in 2011
factors that influenced the incidence of perinatal there were 47 cases of perinatal
death were birth weight and asphyxiation with p
<0.05. That the birth weight has a chance of 10.799
deaths (Mahmudah. Ummul, Cahyati. Widya
and the incidence of asphyxia has a chance of 7.6 Hary, Wahyuningsih. Anik Setyo, 2011).
times for the occurrence of perinatal death. The number of perinatal deaths is determined
Conclusion: The factors that influence the incidence by the sum between the infant mortality rate and
of perinatal death are birth weight and the stillbirth rate. In 2015 the number of stillbirths
asphyxiation. was found to be 13 per 1000 live births and the
infant mortality rate in 2015 was known to be
Keywords: perinatal death, asphyxia, birth 22.23 per 1000 live births (UNICEF, 2015). It can
weight be concluded that in 2015 the number of perinatal
deaths was 35.23 per 1000 live births. Perinatal
I. INTRODUCTION mortality rates in Indonesia are not known for
certain because there is no comprehensive survey.
It is estimated in Indonesia at 460 per 100,000
Perinatal is an episode of life at 28 or more each year (Mahmudah. Ummul, Cahyati. Widya
gestational ages coupled with a baby less than 7 Hary, Wahyuningsih. Anik Setyo, 2011).
days old. During the perinatal period is very The cause of perinatal death, when viewed
vulnerable to morbidity and death. Perinatal from the cause of stillbirth death and infant death
Mortality Rate (PPA) is the number of fetal can be caused by known infant factors such as
deaths born at 28 weeks or older plus the number congenital abnormalities, pre-term births,
of infant deaths less than 7 days recorded for 1 asphyxia, LBW and sepsis. The results of Mutia's
year per 1,000 live births in the same year. study, Maya Sari (2018) found that congenital
The number of perinatal deaths in several abnormalities had a 6.4 times greater risk of
hospitals is as follows: Pirngadi Medan found the perinatal death and sepsis had a 7.8 times risk of
number of perinatal deaths as many as 30 babies, experiencing perinatal death and birth trauma at
the period March - April 2017(Mutia, Maya Sari, risk of 7.67 times to experience perinatal death.
2018), furthermore at Puskesmas Candi Referring to the research of Pongkapadang.MN,
Kabupaten Sidoarjo during 2010 – 2011 was Ansar. J, Wahidudin (2014) note that asphyxia
Copyright © 2020 The Authors. Published by Atlantis Press SARL.

This is an open access article distributed under the CC BY-NC 4.0 license -http://creativecommons.org/licenses/by-nc/4.0/. 332
neonaturum provides an opportunity of 3.72 times III. RESULTS

to experience perinatal death, as well as preterm
birth with a chance of 5.09 for perinatal death and A. Distribution of Maternal Factors of Age
LBW 4.33 times the chance of perinatal death. with Perinatal Death Events
When viewed from maternal factors known
to be caused by comorbidities from mothers when
pregnant women such as hypertension, obesity
and diabetes mellitus. Besides, infant deaths are
obtained from mothers giving birth at less than 20
years old, complications during labor, antepartum
bleeding and premature rupture of membranes p = 0,11
and parity. The results of research at RSUD Dr.
Pirngadi Medan is known, premature rupture of
membranes and antepartum hemorrhage 15 times
and 6 times for perinatal death, respectively. For
concomitant diseases such as diabetes,
preeclampsia and eclampsia, and anemia each has
a risk in cases of 16%, 10%, 3% (Mutia, Maya
Sari, 2018).
Results of research at Prof. RSUP Dr. RD Figure 1. Distribution of Maternal Age Factors
Kandou Manado shows that the majority of with Perinatal Death Events.
perinatal deaths occur from mothers with 28-34 Based on Figure 1 it is known that the
weeks gestation (51.7%), parity 2-4 (36.5%), age of mothers at risk, namely the age of
spontan delivery (74.1%) (Simamora. Wellina R, reproduction <20 years and> 35 years the
Tendean.Hermie M. M, Mamengko. Linda , majority (13.89%) experienced an incidence of
2016). It is also known that childbirth perinatal death. While mothers with no-risk age,
complications have a 3.54 times chance of namely the majority of reproductive age 20-35
perinatal death events and risk parity is 2,988 years (41.11%) in the control population. When
times the chance of perinatal death (Mahmudah. viewed from the results of the p value obtained
Ummul, Cahyati. Widya Hary, Wahyuningsih. 0.11, this means that there is no influence
Anik Setyo, 2011 dan Pongkapadang.MN, Ansar. between maternal age and the incidence of
J, Wahidudin, 2014) perinatal death.
Based on this description, the researcher is
interested in researching Perinatal Death and its B. Distribution of Maternal Parity Factors
Influence with Maternal and Neonatal Factors in with Perinatal Death Events
Cilacap District Hospital 2017 - 2018. Variables
from maternal factors consist of age, parity,
gestation period, type of labor, accompanying
diseases, complications of childbirth. For neonatal
factors consisting of LBW, asphyxia, congenital p = 0,23
abnormalities, sepsis, birth trauma.
II. MATERIAL AND METHOD
Research conducted was a descriptive

correlational study. The design used in this study
was cross sectional. The population of this study
was maternity mothers with the incidence of
perinatal death in Cilacap District Hospital in
2017-2018. In this study, a sample of cases,
namely mothers with 90 perinatal deaths and 90
controls, was normal mothers. To test the
hypothesis by determining the relationship
between independent and dependent variables, Figure 2. Distribution of Maternal Parity
through logistic regression tests. Factors with Perinatal Death Events.
333
The second maternal factor is the parity between comorbidities and the incidence of
factor. In Figure 2 below it can be seen that the perinatal death.
majority (26.11%) in the population of perinatal
death cases is known to occur in mothers with no-
risk parity, namely parity 2-4 and in the control
population known to the majority (28.33%) of
mothers with risk parity i.e. parity 1 and parity>
5. Obtained a p value of 0.23 which means there
is no influence between parity and perinatal
mortality events.
C. Distribution of Maternal Factors during the
Gestation Period with Perinatal Death
Events
The gestation period is the same as the term

gestational age. Figure 3 shows that the majority
(47.22%) of mothers with no-risk gestation were
mothers with a control population.
Whereas for mothers with risky gestation, the
majority (22.78%) is a case population. The result
of p is 0.00 which means there is an influence Figure 4. Distribusi Penyakit Penyerta Dengan
between gestation and perinatal death. Kematian Perinatal
E. Distribution of Maternal Factors in

Complications of Labor with Perinatal Death
p = 0,23 Events
From Figure 5, the risk of delivery

complications variable is dominated by the case
group (13.33%), while the risk of delivery
complications variable is not risk dominated by
the control group (40%). The result of p value is
0.29, which means there is no influence.
p = 0,29
Figure 3. Distribution Of Gestation Periods

With Perinatal Mortality
D. Distribution of Maternal Factors of

Concomitant Diseases with Perinatal
Death Events
The fourth factor is accompanying the

disease. Accompanying diseases are events that
occur during pregnancy until perinatal death.
Factors of comorbidities were experienced by the Figure 5. Distribution of Labor Complications
majority (16.67%) of mothers who experienced with Perinatal Death
perinatal death, while mothers who did not
experience co-morbidities (45%) were
experienced by mothers in the control group. The
results of the p value indicate a correlation
334
F. Distribusi Faktor Neonatal Berat Badan Asphyxia, when seen in Figure 7 the majority
Lahir Dengan Kejadian Kematian experienced by neonates from the case population
Perinatal (25.56%) and neonates who did not experience
asphyxia, the majority occurred in neonates in the
control group (47.78%). From the results of the p
p = 0,00 value is known to influence the incidence of
asphyxia and perinatal death
H. Distribution of Neonatal Factors in the

Occurrence of Sepsis with Perinatal Death
Based on the results of the study in Figure 8

known in the case population, there are 4.44% of
patients with sepsis while the entire control
population did not experience sepsis. The results
of the p value indicate there is an influence
between the incidence of sepsis and perinatal
death.
Figure 6. Distribution of Birth Weight p = 0,00

Variables with Perinatal Death
Based on the picture above, it is known that

the incidence of low birth weight or referred to as
the majority risk category (26.11%) is
experienced by the case population and neonatal
with normal weight or not at risk by the majority
(48.33%) by the control population. The result of
p shows that there is an influence between
neonatal birth weight and the incidence of
perinatal death Figure 8. Distribution of Variable Occurrence
G. Distribution of Factors for Asphyxia and of Sepsis with Perinatal Death
Perinatal Death
I. Neonatal Factor Distribution of Congenital
Abnormalities with Perinatal Death
p= Congenital abnormalities are abnormalities of

0,00 both organs and functions experienced by
neonates. The results in Figure 3.9 show that none
of the entire control population experienced
congenital abnormalities while the congenital
abnormalities occurred in both the case and
control populations. The results of the p value
indicate that there is an influence between
congenital abnormalities and the incidence of
perinatal death.
Figure 7. Distribution of Variable Asphyxia

Events with Perinatal Death
335
variable birth weight and the incidence of

p = 0,00 asphyxia affects the incidence of perinatal death.
L. Criteria for Results with Negalgarke R

Square testing
Negalgarke R Square test obtained a

value of 0.576 which can be interpreted that as
much as 57.6% of maternal factors that
influence perinatal mortality, the rest is caused
by other factors.
M. Criteria Results with Classification plot
testing.
Figure 9. Distribution of Congenital Based on the classification plot value of

Abnormalities with Occurrence of Variable 82.2, then this shows that the logistic
Events regression model used is quite good, because
it can guess correctly 82.2% of the conditions
J. Distribution of Neonatal Trauma Factors that occur.
Born with Perinatal Death.
IV. DISCUSSION
The results showed that of the ten variables

studied as independent variables, it was found that
there were two variables that affected perinatal
mortality, namely weight and asphyxia. The
results of the study are in line with research by
Pongkapadang.MN, Ansar. J, Wahidudin (2014)
that the variable asphyxia neonatorum shows the
risk percentage of neonatal asphyxia in the case
group (43.7%) is greater than the control group
(17.2%).
This shows that the incidence of neonatal
asphyxia is more common in the case group. Odds
Ratio test results at 95% confident interval values
Figure 10. Distribution of Variables in obtained lower limit value (LL) = 1.85 and upper
Traumatic Birth Events with Perinatal Death limit (UL) = 7.49 which means the lower limit
and upper limit values do not exceed 1, the OR is
In this last factor, birth trauma, it is known in obtained at 3.72 . Because the lower limit and
Figure 10 that all populations, both control and upper limit values do not exceed 1, the results are
case populations, did not experience birth trauma. said to be significant, Ho is rejected, so the OR =
3.72 is significant. Thus the incidence of neonatal
K. Partial Influence Test of Mother Factors asphyxia is 3.72 times the risk of perinatal death
Asphyxia is a condition where at birth the
Tests for the influence of maternal factors baby does not cry right away. Based on the
partially can be seen based on the value of the explanation from Achadi, EL (2019) found that as
variable in the equation, it is found that a many as 7000 newborns die worldwide every day.
significant value is obtained at the weight variable As many as ¾ out of 7000 neonatal deaths occur
0.001 and the incidence of asphyxia 0.001 and the in the first week and 40% die within 24 hours.
odds ratio value on the birthweight variable has a The results of Azizah I and Handayani, OK
chance of 10.799 and asphyxia has a chance of (2017) showed a significant risk of neonatal death
7.6 times for occurrence of perinatal death. by asphyxia with a p value of 0.001 (Azizahm I
So it can be interpreted with a 95% dan Handayai, OK, 2017). When a neonate is
confidence level it can be concluded that the born and experiences no crying, it is an
emergency condition in which relief must be done
336
immediately within the first ninety seconds. If the = 4.33 is significant. Thus the incidence of LBW
first aid in the first 90 seconds successfully causes is 4.33 times the risk of perinatal mortality.
the baby to cry, the neonatal condition is saved. If Neonates with low birth weight need more
in the first 90 seconds it has not been successful glucose to maintain body warmth. Meanwhile,
then it can be continued up to a maximum of 10 neonatal metabolic abilities are not as perfect as
minutes and the risk is high for disability if the babies. When neonates with low birth weight
neonate is alive and can be at risk of death. need to increase the metabolism of which fuel is
Factors affecting asphyxia include: maternal oxygen and glucose, then the ability to breathe
age, maternal parity, meconium amniotic fluid, must also be increased where the respiratory
poor obstetric history, premature rupture of organs in neonates are not functioning optimally
membranes, birth weight, birth body with overall and are still running anaerobically. Likewise, the
p value <0.05 (Yuliana, U dan Anugrah, BE, fulfillment of glucose intake is not met in full
2018; Rahmawati, L dan Ningsih, MP, 2016; through breast milk, due to the limited ability to
Fajarriyanti, IN, 2017). eat and gastric capacity so that the dominant
The linkage of studies on asphyxia with the administration through the infusion. Limitations
current author's research is that there are several of the ability of respiratory and digestive
variables that although they do not affect perinatal functions of the neonate if not resolved at great
mortality, there are links to asphyxia events. The risk of death.
variable in the current author's research is labor Other neonatal factors that do not affect
complications, it is known that 23.3% of perinatal mortality are the incidence of sepsis,
respondents give birth with complications. The congenital abnormalities, and birth trauma. In a
complications of labor were found in the form of bivariate analysis for sepsis variables and
premature rupture of membranes wherein the congenital abnormalities, there is a relationship.
study of cited asphyxia affected asphyxia. This happens due to the incidence of sepsis and
Another variable, maternal age, based on congenital abnormalities in the case population.
multivariate analysis did not influence the Reality found in the field, the majority of
incidence of perinatal death, although as many as congenital abnormalities are multiple congenital
22.8% of all respondents were at risk of age <20 disorders. While the incidence of birth trauma
and> 35 years. The parity variable also did not was not found in all respondents.
effect on perinatal mortality, although 52.2% of
respondents with risk parity were known as parity
1 and parity> 4. Age at risk and reproductive risk V. CONCLUSION
parity do indeed need to be vigilant about Based on the results of the research above, it
pregnancy preparedness and physical preparation can be concluded that the factors that influence
for childbirth. the incidence of perinatal death are birth weight
The birth weight variable in this study is a and asphyxiation with p <0.05. That the birth
variable that influences perinatal mortality which weight has a chance of 10.799 and the incidence
has an opportunity of 10.799 times with a range of asphyxia has a chance of 7.6 times for the
of 2.70 to 43.11 times to experience perinatal occurrence of perinatal death.
death. The results of this study are in line with the A suggestion that can be given is the need for
research of Pongkapadang, MN, Ansar, J, special attention during pregnancy examination to
Wahidudin (2014) which shows that the calculate the estimated fetal weight in anticipation
percentage of risk of LBW occurrence in the of the possibility of intrauterine growth hormone
perinatal death group (60.9%) is greater than the so that if an estimated fetal weight is less than it
control group (26.4%). The riskiest study samples should be, there is a great risk for perinatal death.
(<2500 grams) occurred in the case group of 53
people (60.9%). This shows that LBW events are ACKNOWLEDGMENT
more common in the case group. Odds Ratio test
results at 95% confident interval values obtained This research was supported by STIKES Al
lower limit value (LL) = 2.28 and upper limit Irsyad Al Islamiyyah Cilacap. We would also like
(UL) = 8.24 which means the lower limit and to show our gratitude to the committee Health
upper limit values do not exceed 1, then the OR is Science International Conference and we thanks
4.33 . Because the lower limit and upper limit to "anonymous" reviewers for their so-called
values do not exceed 1, the results are said to be insights.
significant so that Ho is rejected, so the value OR
337
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