Antenatal and Intrapartum Perineal Protection Strategies for Preventing Perineal Trauma: A Systematic Review of Global Evidence with Implications from Indonesian Data
Kata Kunci:
Pijat Perineum Antenatal, Episiotomi, Trauma Perineum, Pijat Perineum Prenatal, Kompres HangatAbstrak
Latar Belakang: Trauma perineum, termasuk robekan spontan dan episiotomi, merupakan komplikasi umum pada persalinan pervaginam dengan prevalensi global 50–85%, berdampak pada fungsi dasar panggul, kesehatan seksual, dan kualitas hidup ibu. Berbagai intervensi, seperti pijat perineum, kompres hangat, dan dukungan manual perineum, telah diusulkan untuk mengurangi risiko ini. Di Indonesia, prevalensi trauma perineum tetap tinggi, dengan praktik episiotomi sering melebihi rekomendasi WHO. Tujuan: Melakukan tinjauan sistematis terhadap bukti terbaru (2020–2025) mengenai efektivitas pijat perineum, kompres hangat, dan intervensi kombinasi dalam pencegahan trauma perineum, dengan fokus pada relevansinya untuk praktik kebidanan di Indonesia. Metode: Tinjauan sistematis dilakukan sesuai pedoman PRISMA 2020 melalui pencarian di PubMed, Cochrane, dan Google Scholar. Kriteria inklusi meliputi studi RCT, kuasi-eksperimental, dan observasional yang mengevaluasi teknik perlindungan perineum kala II persalinan, dengan luaran meliputi perineum utuh, angka episiotomi, derajat robekan, dan obstetric anal sphincter injury (OASIS). Data dianalisis secara meta-analisis bila memungkinkan, atau sintesis naratif bila heterogenitas tinggi. Hasil: Dari 234 artikel yang diidentifikasi, 8 studi memenuhi kriteria, mencakup berbagai negara termasuk Indonesia. Kompres hangat menurunkan angka episiotomi (RR 0,78; 95% CI 0,66–0,91) dan meningkatkan perineum utuh (10–18%). Pijat perineum antenatal meningkatkan peluang perineum utuh (RR 1,15; 95% CI 1,05–1,26) dan mengurangi episiotomi hingga 25%. Dukungan manual menurunkan risiko OASIS sebesar 30–40%. Pendekatan kombinasi menunjukkan hasil paling optimal, dengan angka episiotomi serendah 7% dan perineum utuh hingga 55%. Kesimpulan: Intervensi perlindungan perineum, khususnya kompres hangat dan pijat perineum, efektif dan layak diterapkan di fasilitas pelayanan primer hingga tersier di Indonesia. Integrasi intervensi ini ke dalam pedoman nasional dan pelatihan kebidanan berpotensi menurunkan angka trauma perineum dan meningkatkan luaran ibu.
Unduhan
Referensi
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