Kejadian Ballooning dan Avulsi Otot Levator Ani Pada Persalinan Spontan Primipara Non OASIS di Fasilitas Kesehatan Tingkat Pertama
Authors: Rahman Muhammad Nurhadi , Sukarsa Mochamad Rizkar Arev , Rinaldi Andi Rinaldi , Achmad Eppy Darmadi , Sasotya Raden Mas Sonny , Armawan3 Edwin 
Published: March 2024

Pendahuluan: Kerusakan otot levator ani, seperti Ballooning dan Avulsi, sering terjadi pada Obstetric Anal Sphincter Injuries (OASIS) saat persalinan, yang menyebabkan masalah jangka panjang seperti inkontinensia dan prolaps uteri. Namun, hubungan antara kerusakan ini dengan robekan perineum derajat ringan atau Non-OASIS masih kurang dipahami. Penelitian ini bertujuan untuk mengeksplorasi prevalensi Ballooning dan Avulsi pada persalinan spontan primipara Non-OASIS tanpa episiotomi di fasilitas kesehatan tingkat pertamaMetode: Studi cross-sectional dilakukan di Rumah Sakit Umum Pusat Dr. Sardjito Yogyakarta dan praktik mandiri bidan di Sleman, Yogyakarta, melibatkan 69 pasien. Penggunaan USG 3D melalui pendekatan translabial digunakan untuk mengidentifikasi Ballooning dan Avulsi.Hasil: Dari 69 pasien yang mengalami persalinan spontan primipara Non-OASIS tanpa episiotomi yang terlibat dalam penelitian ini, 66,67% pasien mengalami robekan perineum derajat ringan, sementara 33,3% memiliki perineum intak. Prevalensi Ballooning adalah 26,1% dan Avulsi adalah 17,4%. Ballooning lebih umum terjadi pada pasien dengan robekan perineum derajat ringan (32,6%) daripada yang memiliki perineum intak (13,0%). Avulsi juga lebih sering terjadi pada pasien dengan robekan perineum derajat ringan (21,7%) dibandingkan dengan yang memiliki perineum intak (8,7%).Kesimpulan: Avulsi terjadi pada satu dari empat persalinan spontan primipara Non-OASIS tanpa episiotomi, sementara Ballooning terjadi pada satu dari enam persalinan. Studi ini memberikan wawasan tentang karakteristik kerusakan otot levator ani dalam setting praktik kebidanan mandiri yang berjejaring dengan fasilitas kesehatan tingkat pertama.The occurance of Ballooning and Avulsion of The Levator Ani Muscles in First Spontaneous Vaginal Birth Non-OASIS without Episiotomy at Primary Health FacilitiesAbstract Introduction: Damage to the levator ani muscles, such as Ballooning and Avulsion, often occurs during Obstetric Anal Sphincter Injuries (OASIS) during childbirth, leading to long-term issues like incontinence and uterine prolapse. However, the relationship between this damage and mild perineal tears or Non-OASIS is not fully understood. This study aims to explore the prevalence of Ballooning and Avulsion in spontaneous primiparous deliveries without episiotomy in primary healthcare facilities.Method: A cross-sectional study was conducted at Dr. Sardjito General Hospital in Yogyakarta and midwifery practices in Sleman, Yogyakarta, involving 69 patients. 3D ultrasound via translabial approach was used to identify Ballooning and Avulsion.Results: Out of 69 patients undergoing spontaneous primiparous deliveries without episiotomy, 66.67% experienced mild perineal tears, while 33.3% had intact perineum. The prevalence of Ballooning was 26.1% and Avulsion was 17.4%. Ballooning was more common in patients with mild perineal tears (32.6%) compared to those with intact perineum (13.0%). Avulsion also occurred more frequently in patients with mild perineal tears (21.7%) compared to those with intact perineum (8.7%).Conclusion: Avulsion occurs in one out of four spontaneous primiparous deliveries without episiotomy, while Ballooning occurs in one out of six deliveries. This study provides insights into the characteristics of levator ani muscle damage in the setting of primary healthcare facilities connected to independent midwifery practices.Key words: levator ani muscle avulsion, levator ani muscle ballooning, primipara, mild perineal tear.