Sensitivitas, Spesifisitas dan Akurasi Pengukuran Kontraksi Uterus Kala I Fase Aktif Ibu Bersalin Menggunakan Tokodinamometer

Abstract

Pada umumnya, pemeriksaan kontraksi uterus dilakukan dengan menekan fundus uteri, namun demikian cara tersebut menyebabkan ketidaknyamanan dan hanya dapat mengetahui frekuensi kontraksi sedangkan durasi dan intensitas kontraksi pengukurannya bersifat subjektif. Cara lain yang digunakan adalah menggunakan Kardiotokografi, namun harganya mahal danl lebih sulit untuk menginterpretasikan hasil. Tokodinamometer dapat digunakan untuk menilai kemajuan persalinan karena dapat dibaca langsung, sederhana, dan harga terjangkau, sehingga dapat digunakan di komunitas. Penelitian ini bertujuan untuk mengukur sensitivitas, spesifisitas dan akurasi Tokodinamometer dalam mengukur kontraksi uterus kala I fase aktif pada ibu bersalin. Rancangan penelitian merupakan studi observasional analitik dengan desain Cross sectional (potong silang). Sampel penelitian berjumlah 47 orang yang memenuhi kriteria inklusi di Rumah Sakit Khusus Ibu dan Anak Kota Bandung, dengan teknik concecutive sampling. Pengambilan data dengan mengukur kontraksi uterus  menggunakan Tokodinamometer dan Kardiotokografi (KTG) diukur secara bersamaan sebanyak 2 kali. Analisis menggunakan uji Wilcoxon’s, dan uji diagnostik. Hasil penelitian didapatkan, frekuensi dan intensitas kontraksi uterus tidak terdapat perbedaan (p>0,05), sedangkan durasi kontraksi terdapat perbedaan bermakna (p< 0,05) antara ibu bersalin kala I fase aktif yang diukur menggunakan Tokodinamometer dan KTG. Tokodinamometer memiliki nilai sensitivitas (90,47%), spesifisitas (78,26%) dan akurasi (87,21%). Tokodinamometer dapat digunakan untuk pemantauan kontraksi uterus di komunitas.

Kata kunci : Fase aktif, Kontraksi uterus, Tokodinamometer 

Sensitivity, Specificity, and Accuracy Measurement of Stage I Active Labor Uterus Contraction Using Tokodynamometer

Examination of uterine contractions is generally done by pressing the uterine fundus. This method can cause discomfort and can only reveal the frequency of contraction while the duration and intensity of contraction measurement is subjective, leading to inaccurate decision making in early phase of labor. Labor monitoring should be done by cardiotocography. However, this device is expensive and interpretation of results needs specific skills.  Since  contraction assessment is important to understand the progress of labor, a device that can be used at the community level is needed. This study aimed to analyze the sensitivity, specificity and accuracy of Tokodynamometer in measuring uterine contraction in the first stage of active phase of labor. This was a crossectional analytic observational study on 47 women who met the inclusion criteria in Bandung City Maternal and Child Hospital t RSKIA Bandung, with concecutive sampling technique. Tokodynamometer and Cardiotocography were used to measure uterine contractions simultaneously. Each measurement was done twice or according to mother condition. Data collected were analyzed using  Wilcoxon’s test and diagnostic test. The results showed that the frequency and intensity of uterine contractions did not differ (p>0.05), whereas the duration of contraction was significantly different with p=0.012 (p<0.05) between measurements taken using Tokodinamometer and CTG in active phase of labor. The Tokodynamometer has sensitivity specificity and accuracy values of 90.47 %, 78.26 %), and 87.21 %,, respectively. Tokodynamometer has almost similar sensitivity, specificity, and accuracy to Cardiotocography as the gold standard. Thus, Tokodynamometer can be used for monitoring uterine contractions in community setting.

Key words: Active phase, uterine contractions, Tokodynamometer