bluuebunny/crossref_metadata_2025_split huggingface dataset:
Çadır Haritası Tabanlı Kaotik Optimizasyon Yöntemi
Authors: Tuncer Türker 
Published: December 2018

Gerçek hayatta bazı problemler matematiksel yöntemler kullanılarak
çözülememektedir Bu problemleri çözmek için
genellikle meta sezgisel optimizasyon yöntemleri kullanılmaktadır.
Meta-sezgisel optimizasyon yöntemlerinin başarımlarını arttırmak için kullanılan
çözümlerden biriside kaotik haritaların kullanılmasıdır. Kaos doğrusal olmayan
yöntemlerin fenomeni olarak literatürdeki yerini almaktadır. Bu makalede
sıklıkla kullanılan kaotik haritalardan biri olan çadır (tent) harita
kullanılarak yeni bir kaotik optimizasyon yöntemi önerilmiştir. Önerilen yöntem
parçacık tabanlı bir yöntemdir ve bu yöntem rastgele parçacık oluşturma, en iyi
değeri hesaplama, parçacık güncelleme ve en iyi değeri güncelleme aşamalarından
oluşmaktadır. Çadır harita parçacık güncelleme aşamasında kullanılmaktadır.
Önerilen yöntemim performansını test etmek için literatürde sıklıkla kullanılan
12 adet sayısal karşılaştırma fonksiyonu kullanılmıştır ve elde edilen sonuçlar
literatürde daha önce önerilmiş ve yaygın olarak kullanılan optimizasyon
yöntemleriyle karşılaştırılmıştır. Deneysel sonuçlar ve karşılaştırmalar,
önerilen yöntemin başarılı bir optimizasyon yöntemi olduğunu göstermektedir.
TİCARİ SOĞUTMA SİSTEMLERİNDE R22 AKIŞKANININ ALTERNATİFİ OLARAK R438A VE R417A AKIŞKANLARININ PERFORMANSININ İNCELENMESİ
Authors: Ergün Alper , Gürel Ali Etem , Ceylan İlhan 
Published: December 2018

Bu çalışmada, özellikle soğuk
depoculukta ve iklimlendirme sistemlerinde oldukça yaygın olarak kullanılan
R-22 soğutucu akışkanına alternatif olarak piyasaya sürülen ve ozon tabakasına
dost olan, iki soğutucu akışkan R-417A ve R-438A termodinamik açıdan
incelenmiştir. Yapılan çalışmada, R-22, R-417A ve R-438A soğutucu
akışkanlarının performansları karşılaştırılmıştır. Her 3 soğutucu akışkan da
değişken yük koşulları altında (-8°C, 0°C, -25°C ve -31°C) bilgisayar ortamında
bir simülasyon ile gerçekleştirilmiştir. Farklı evaporasyon sıcaklıkları için,
soğutucu akışkanların performansları termodinamiğin birinci ve ikinci kanunu
kullanılarak değerlendirilmiş ve sistemlere ait performans katsayıları (STK ve
ITK) hesaplanmıştır. Çalışmanın sonunda, R22 soğutucu akışkanına alternatif
olarak geliştirilen R417A ve R438A akışkanlarından, R438A akışkanının daha
yüksek STK ve ITK değerlerine sahip olduğu hesaplanmıştır. Ayrıca kondenser ve
kompresör yükleri incelendiğinde yine R438A akışkanının, R417A akışkanına göre
daha olumlu değerlerde olduğu gözlenmiştir.
Sonuç olarak incelen 3 akışkan için R22 akışkanına en iyi alternatifin R438A
olduğu tespit edilmiştir.
Genişletilmiş Karmaşık Kalman Filtresi Tabanlı Hız-Algılayıcısız Asenkron Motor Sürücüsünün Tasarımı
Authors: ZERDALİ Emrah 
Published: December 2018

Bu
çalışmada, stator akımlarının duran
eksen takımı bileşenlerini, rotor akısının duran eksen takımı bileşenlerini, rotor
mekanik hızını ve sürtünme terimini de içeren yük momenti kestirimlerini
gerçekleştiren genişletilmiş karmaşık Kalman filtresi (GKKF) tabanlı
hız-algılayıcısız vektör kontrollü asenkron motor sürücüsünün tasarımı
gerçekleştirilmiştir. Geleneksel genişletilmiş Kalman filtresi (GGKF) yerine,
karmaşık motor modelini kullanan GGKF algoritması kullanılarak GGKF
algoritmasındaki işlem yükünün düşürülmesi amaçlanmıştır. Önerilen sürücü
sisteminin başarımını doğrulamak amacıyla, sürücü sistemi hız terslemeleri ve
sıfır hızı da içeren geniş bir hız aralığında rampa ve basamak şeklindeki yük
momenti değişimleri altında test edilmiştir. Ayrıca, önerilen GKKF
algoritmasının işlem yükü aynı durumları ve parametreleri kestiren GGKF
algoritması ile karşılaştırılarak işlem yükünün azaltıldığı gösterilmiştir.
Estratégias para ensino de áreas de regiões planas irregulares na educação básica: uma proposta fundamentada no uso do software GeoGebra
Authors: Jesuz Danilo Augusto Ferreira de , Pereira Ana Lucia 
Published: December 2018

Desenvolver estratégias para o cálculo de áreas de regiões planas irregulares constitui-se em uma atividade didática interessante para capacitar o aluno a aplicar conhecimentos científicos aprendidos na escola em situações sociais, cotidianas e profissionais. Neste trabalho, apresentamos uma proposta para o cálculo aproximado da área de uma região plana irregular, valendo-nos de noções intuitivas da soma de Riemann. A proposta tem como fundamentação metodológica o uso de tecnologias digitais de informação e comunicação no processo de ensino e aprendizagem. Partimos de um problema que traz uma abordagem de contexto cotidiano e, por meio de diferentes estratégias de resolução, perpassamos por diversos e importantes conceitos relacionados ao conteúdo matemático em que estamos interessados. Utilizamos como aporte tecnológico o software GeoGebra, que é utilizado em diversos estágios da resolução do problema, desde a modelagem da problemática apresentada até a visualização de conceitos abstratos, proporcionando uma atividade interativa em que o aluno atua como protagonista no processo de construção de conhecimentos, cabendo ao professor o papel de mediador desse processo. Apresentamos discussões e reflexões visando corroborar a importância do uso dessa ferramenta tecnológica no desenvolvimento dos processos de ensino e de aprendizagem de matemática na educação básica.
Avaliação do Projeto Enxurrada de Bits
Authors: Monteiro Otaviano Martins , Souza Erlene Rosa dos Santos , Lopes Ramon Da Cunha , Dias Sandro Renato 
Published: December 2018

Este trabalho tem o objetivo de apresentar e avaliar o Enxurrada de Bits, que é um projeto de extensão pertencente ao CEFET-MG. O projeto visa divulgar a programação de softwares e a robótica através de oficinas de aprendizagem abertas ao público em geral. Também são ofertados cursos regulares e gratuitos destas áreas tecnológicas, destinados a estudantes de escolas públicas. O Enxurrada de Bits também organiza e sedia competições de programação e robótica e incentiva os alunos do CEFET-MG a participarem. A análise realizada neste trabalho considera a satisfação e o desenvolvimento pessoal dos alunos quanto aos cursos, além da mídia gerada pelo projeto e os resultados obtidos nas oficinas e competições.
KECEMASAN PADA IBU POST PARTUM PRIMIPARA DENGAN GANGGUAN PROSES LAKTASI
Authors: Agustin Ike Mardiati , Septiyana Septiyana 
Published: December 2018

ANXIETY IN PRIMIPHARA POSTPARTUM MOTHERS WITH LACTATION TROUBLE ON MATERNITY WARD ABSTRACTLabor or delivery is a normal physiological condition happens in life, especially to women. Changes in the role and process of newborn-baby care will lead to psychological problems. Anxiety is one of psychological problems that happens to primiphara mothers. Anxiety will affect the process of lactation (breastfeeding) for some primiphara mothers with psychological problems. This study is to provide an overview of a case study of nursing care for primiphara postpartum mothers who have problem with breastfeeding because of anxiety. This scientific paper is an analytical descriptive with a case study approach. The study was conducted on two primiphara mothers with anxiety in their breastfeeding. Data were obtained through interview, observation, and documentation. After having nursing care, there was a decrease in anxiety (patient 1: from 44.6% to be 30.3%, patient 2: from 32.1% to be 19.6 %). Besides, there is a difference in the increase of affective ability, with the highest increase patient 2 (60%) while patient 1 (40%). It is advisable for nurses to provide nursing care for primiphara postpartum mother with breastfeeding problem caused by anxiety. Keywords: Labor, primiphara, anxiety, lactation.
PENGARUH SIT STRETCHING TERHADAP PERUBAHAN SKALA NYERI PUNGGUNG BAWAH PADA KARYAWAN DI PT. RIFAN FINANCINDO BERJANGKA CABANG SEMARANG
Authors: Putra Gamalia Anggriya Dwi , Nuraeni Asti , Supriyono Mamat 
Published: December 2018

Lower back pain is one of musculoskeletal disorder in the shape of pain in the back bone, to be exact is in the forth lumbar to the first sacrum. It is caused by the not appropriate posture (not ergonomic) while working or doing the activities, such as very long standing or sitting. This complaint can be reduced by sit stretching regularly. The aim of this study is to find out impact of sit stretching towards the changes of scale of lower back pain on employees at PT. Rifan Financindo Berjangka Branch Semarang. The method of research is quasy experiment designed in pre test and post test with compare group. Research subjects are 30 male and female employees. Sample taking uses total sampling. Statisitic test utilizes Mann Whitney with level of meaning (α=0,05). The result of pre test statisitc test is p-value = 0,467 (> 0,05), it means that there is no significant difference scale of lower back pain between intervention group and compare group before performing sit stretching to intervention group. The post test statisitic the result is p-value = 0,001 (> 0,05), it means there is a significant difference scale of lower back pain at intervention group with compare group after performing sit stretching on the intervention group. Based on result of p-value on post test can be concluded that there is an impact of sit stretching towards the changes in scale of lower back pain on the employees at PT. Rifan Financindo Berjangka Branch Semarang.
Potensi Paparan Pestisida Dan Dampak Pada Kesehatan Reproduksi Wanita Tani Studi Di Kabupaten Brebes
Authors: Widyawati Sigit Ambar , Siswanto Yuliaji , Pranowowati Puji 
Published: December 2018

Penggunaan pestisida dewasa ini semakin intensif untuk meningkatkan hasil pertanian. Selain bermanfaat, pestisida juga memiliki potensi yang membahayakan. Pada tahun 2008 pestisida dilaporkan menjadi bahan ke sembilan yang paling banyak menyebabkan keracunan. Pengguna pestisida bukan hanya petani pria, tetapi juga oleh wanita tani sehingga berpotensi mengganggu kesehatan reproduksinya. Penelitian ini bertujuan mengidentifikasi potensi paparan pestisida dan dampak pada kesehatan reproduksi wanita tani. Metode penelitian yang digunakan adalah metode deskriptif dengan lokasi penelitian dipilih secara purposive sampling di Kabupaten Brebes, yakni pada lokasi penanaman bawang merah yang intensif penggunaan pestisidanya. Hasil penelitian menunjukkan: 1) para wanita tani juga terlibat dalam berbagai kegitan pertanian, 2) ada potensi penggunaan pestisida yang cukup tinggi dengan dosis diatas dosis yang dianjurkan, 3) ada hubungan antara lama pajanan pestisida dengan kesehatan reproduksi wanita tani, berupa kejadian berat bayi lahir ringan BBLR dan abortus, 4) analisis metabolit DAP dari sampel urin 5 wanita tani menunjukkan 1 orang (20%) terbukti mengalami paparan pestisida. Disarankan penggunaan pestisida secara selektif, hati-hati dan sesuai dosis yang dianjurkan, dengan menggunkan alat pelindung diri (APD) yang lebih baik, sehingga tidak berdampak pada kesehatan reproduksi wanita tani.
Faktor Penyebab Penundaan Operasi Elektif di Rumah Sakit Pemerintah di Semarang
Authors: Amurwani Fitria Siswi , Rofi'i Muhamad 
Published: December 2018

Angka penundaan operasi elektif di Rumah Sakit Pemerintah Di Semarang masih tinggi dan kurang sesuai dengan indikator mutu klinis rumah sakit. Penundaan operasi elektif disebabkan karena faktor medis, faktor pasien, faktor logistik dan administrasi dan faktor lain-lain. Tujuan penelitian ini untuk mengetahui gambaran penyebab penundaan operasi elektif di Rumah Sakit Pemerintah di Semarang. Penelitian ini merupakan jenis penelitian deskripsi kuantitatif dengan metode survei. Pengumpulan data dilakukan dengan lembar observasi dan check list. Jumlah responden sebanyak 54 orang dengan teknik sampling jenuh. Data yang diperoleh diolah dengan menggunakan analisa univariat untuk mengetahui distribusi dan persentase masing-masing variabel. Karakteristik responden sebagian besar adalah laki-laki (53,7%), usia paling banyak 41-60 tahun (40,7%), tingkat pendidikan paling banyak SMA (25,9%), pekerjaan lain-lain berjumlah (53,7%), paling banyak dirawat di kelas III (66,7%) dengan fasilitas Jamkesmas (42,6%). Lama penundaan operasi elektif paling banyak >5 hari (38,9%). Penundaan operasi elektif di Rumah Sakit Pemerintah di Semarang disebabkan karena faktor medis (48,1%), faktor pasien (14,8%), faktor logistik dan administrasi (27,8%) dan faktor lain-lain (9,3%). Penundaan operasi elektif paling banyak disebabkan karena faktor medis dan sebagian besar disebabkan karena perubahan akut fungsi kardiovaskuler dan pernapasan, nilai laboratorium tidak normal dan pasien menolak operasi. Perawat diharapkan melakukan monitoring lebih intensive terhadap fungsi kardiovaskuler dan pernapasan, nilai laboratorium dan memberikan edukasi serta motivasi pasien pre-operasi.
Hubungan Sikap dan Pengalaman Pelaksanaan Manajemen Nyeri pada Perawat terhadap Pelaksanaan Manajemen Nyeri Pasien Paska Operasi
Authors: Dewi Bella Arinda Mashita , Ropyanto Chandra Bagus 
Published: December 2018

The Ameican Society of Anastheiologists (ASA) mendefiniskan nyeri pasca operasi sebagai nyeri yang timbul pada pasien karena prosedur bedah yang dilakukan. Nyeri pasca operasi yaang tidak ditangani dapat berefk secara fisiologis dan psikologis pada pasien. Manajemen nyeri penting untuk mengurangi nyeri dan memberikan kenyamanan pada pasien sehingga peningkatan manajemen nyeri merupakan kebutuhan mendesak. Faktor yang mempengaruhi perawat pada pelaksanaan manajemen nyeri yaitu sikap dan pengalaman perawat. Penelitian bertujuan mengidentifikasi hubungan sikap dan pengalaman terhadap pelaksanaa manajemen nyeri. Desain penelitian adalah kuantitatif korelasi dengan pendekatan cross sectional dengan sampel non probability sampling berupa tehnik total sampling dan jumlah responden 45 perawat di ruang perawatan bedah. Hasil penelitian didapatkan perawat dengan sikap positif sebnyak 62,2 % dengan pengalaman kurang sebanyak 55,6 %, dan manajemen nyeri kurang baik 51,1 %. Hasil uji statistik didapakan nilai p=0,003 sehingga didapatkan hubungan antara sikap terhadap pelaksanaan manajemen nyeri. Terdapat hubungan antara pengalaman terhadap manajemen nyeri dengan nilai p=0,025. Hasil penelitian dapat digunakan sebagai bahan kajian untuk pelaksanaan manajemen nyeri dengan menambah wawasan perawat, sementara sikap positif perawat harus dipertahankan dan menambajh pengalaman perawat dengan memberikan pelatihan serta seminar tentang manajemen nyeri.
Interprofesioanal Education (IPE) Sebagai Upaya Membangun Kemampuan Perawat Dalam Berkolaborasi Dengan Tenaga Kesehatan Lain
Authors: Kusumaningrum Puput Risti , Anggorowati Anggorowati 
Published: December 2018

Latar Belakang : Pelayanan kesehatan yang bermutu menjadi tuntutan bagi pemberi pelayanan kesehatan di era global. Pelayanan kesehatan yang bermutu dapat dicapai dengan praktek kolaborasi. Pendidikan terintegrasi yang dicetuskan sebagai media kolaborasi menurut WHO adalah Interprofesional Education (IPE). IPE merupakan proses dimana sekelompok peserta didik atau tenaga kesehatan dengan latar belakang berbeda belajar bersama dalam jangka waktu tertentu pada masa pendidikan, dengan interaksi sebagai tujuan utamanya, untuk kolaborasi dalam menyediakan pelayanan preventif, promotif, rehabilitataif, dan pelayanan kesehatan lainnya (WHO, 2010). Konsep pembelajaran IPE dapat diterapkan dalam 3 kegiatan yaitu pada pembelajaran di Rumah Sakit, akademik, dan komunitas. Pembelajaran IPE di Rumah Sakit yang berjalan baik diharapkan dapat menghasilkan profesional di bidang kesehatan yang mampu berkolaborasi dengan profesi kesehatan lain, sehingga dapat berperan serta dalam pembangunan kesehatan di Indonesia. Tujuan : Literature review ini untuk mengetahui apakah IPE dapat membangun kemampuan perawat dalam berkolaborasi dengan tim kesehatan lainMetode : Literature review ini dilakukan dengan melakukan penelusuran artikel publikasi pada EBSCO, Googlesearch, PubMed, Sciencedirect.com dengan kata kunci yang dipilih yaitu interprofessional education (IPE), collaboration, interprofessional collaboration (IPC). Penelusuran dilakukan dengan membatasi terbitan dari tahun 2010-2015. Hasil : Dari hasil penelusuran literatur bahwa IPE secara efektif dapat membangun kemampuan perawat dalam berkolaborasi dengan tenaga kesehatan lain. Diharapkan pelaksanaan IPE dapat dilaksanakan secara berkelanjutan dengan persiapan yang lebih maksimal lagi, mengingat institusi kesehatan merupakan penyedia utama calon tenaga kesehatan professional.
Komunikasi Interprofesional Sebagai Upaya Pengembangan Kolaborasi Interprofesi Di Rumah Sakit: Systematic Review
Authors: Purba Yunis Veronika , Anggorowati Anggorowati 
Published: December 2018

Komunikasi Interprofessional menjadi sangat penting dalam pelayanan kesehatan saat ini, di mana dapat memperluas populasi pelayanan kesehatan khususnya dalam memberikan perawatan dalam layanan kesehatan. Komunikasi interprofessional efektif adalah keterampilan penting yang dapat meningkatkan fungsi tim yang berkualitas tinggi, dalam perawatan pasien dengan melibatkan beberapa disiplin ilmu seperti dokter, perawat dan tim kesehatan lainnya (kolaborasi interprofesi). Tujuan sistematik review untuk mengetahui apakah komunikasi interprofesional dapat mengembangkan upaya kolaborasi interprofesi di Rumah Sakit. Metode yang digunakan adalah sistematik review. Artikel di cari melalui Google scholar, Proquest, Science direct, di lakukan menggunakan advanced searh dengan kata kunci Interprofesional, Communication, Collaboration,. Di dapatkan 3 artikel di mana masing-masing artikel menghasilkan bahwa komunikasi interprofesional dapat mengembangkan kolaborasi interprofesi di rumah sakit, dengan adanya komunikasi interprofesional yang efektif maka perawat, dokter, maupun tim kesehatan lainnya dapat saling menghargai dan dapat memiliki visi dan misi yang sama dalam memberikan layanan kepada klien guna meningkatkan mutu pelayanan dan kepuasan bagi klien sendiri.
GAMBARAN TINGKAT STRES PASIEN DIABETES MELLITUS
Authors: PH Livana , Sari Indah Permata , Hermanto Hermanto 
Published: December 2018

AbstrakDiabetes Mellitus merupakan kelainan metabolik yang ditandai dengan kenaikan kadar gula darah, akibat adanya kelainan sekresi insulin, kerja insulin atau keduanya. Pasien Diabetes Mellitus harus melakukan terapi pengelolaan sepanjang hidupnya baik secara farmakologis maupun non farmakologis untuk mencegah terjadinya komplikasi dan mengontrol kestabilan kadar gula darahnya. Terapi tersebut dapat menimbulkan suatu dampak tertentu, baik secara fisik maupun secara psikologis. Salah satu dampak psikologis yang dapat dirasakan oleh pasien Diabetes Mellitus adalah stres. Penelitian ini bertujuan untuk mengetahui gambaran tingkat stres pada pasien Diabetes Mellitus di wilayah dokter keluarga Djazariyah Kabupaten Kendal. Metode deskriptif kuantitatif. Alat ukur yang digunakan berupa kuesioner Depression Anxiety Stres Scale yang terdiri dari 42 pertanyaan. Sampel berjumlah 37 responden. Sebagian besar pasien Diabetes Mellitus mengalami stres ringan. Peneliti memberikan saran bagi peneliti selanjutnya untuk menggunakan kuesioner Depression Anxiety Stres Scale yang telah dimodifikasi disetiap pertanyaannya, agar mempermudah responden dalam menjawab. Kata kunci: Stres pada pasien Diabetes Mellitus. AbstractThe description of stress levels in Diabetes Mellitus patients. Diabetes Mellitus is a metabolic abnormality characterized by elevated blood sugar levels, due to an abnormality of insulin secretion, insulin work or both. Diabetes Mellitus patients should take life-long management therapy both pharmacologically and nonpharmacologically to prevent complications and control the stability of their blood sugar levels. The therapy can have a certain impact, both physically and psychologically. One of the psychological effects that can be felt by Diabetes Mellitus patients is stress. This study aims to determine the description of stress levels in Diabetes Mellitus patients in the area of Djazariyah family doctor Kendal District. Quantitative descriptive method. The measuring tool used is a questionnaire of Depression Anxiety Stress Scale consisting of 42 questions. The sample was 37 respondents. Most Diabetes Mellitus patients experience mild stress. Researchers provide suggestions for further researchers to use the questionnaire of Depression Anxiety Stress Scale that has been modified in each question, in order to facilitate respondents in answering. Keywords: Stress in Diabetes Mellitus clients
Contraception for Women with Diabetes Mellitus
Authors: Hadisaputra Wachyu 
Published: December 2018

use in women with diabetes mellitus.
Method: Literature review.
Result: Women in the reproductive age who are affected by a wide
range of chronic medical conditions, one of which is diabetes mellitus
(DM), may experience adverse health effects pre-conception and
in pregnancy. This condition will influence outcome of pregnancy
and contraceptive choice after delivery. Planning the use of contraception for women with DM who would experience high-risk pregnancy is a necessity, and counseling must consider the safety of different types of contraception that in comparison to the risk of pregnancy.
WHO has provided a guideline on choosing contraception, which is available from the UK Medical Eligibility Criteria for Contraceptive
Use (UKMEC), as the basis for contraception selection for women with DM. For DM patients without complication any type of contraception can be used in consideration for the advantages and disadvantages of each type of contraception. For diabetics with complications
or multiple risk factors, in the selection of contraceptive,
hormonal contraception (especially for combined hormonal contraception (CHC) pill and injection method) requires proper consideration and consultation with health care providers.
[Indones J Obstet Gynecol 2014; 4: 226-231]
Keywords: complications, contraception, diabetes mellitus, hormonal,
pregnancy
Effect of Delay in Postpartum Hemorrhage Management on the Rate of Near-Miss and Maternal Death Cases
Authors: Siswosudarmo Risanto 
Published: December 2018

Objective: To recognize the effect of delay in the management of postpartum bleeding to the occurrence of near-miss and maternal death cases. Method: Prospective cohort. The study population was patients with postpartum hemorrhage. All PPH cases from thirteen hospitals (Sardjito and 12 affiliated hospitals) were recorded. The study was carried out from January 1st to June 30th 2009. The study group was those who experienced delay and the control group was those withoutdelay. The outcome was measured as the number of near-miss and death cases. Near-miss was defined as those who experienced severe shock, demonstrated by systolic blood pressure 90 mmHg or less. Chi square test, t-test and logistic regressions were used to analyze our data.Result: From January 1st to June 30th 2009 we identified 139 cases of PPH from 8,924 deliveries (1.6%). From the 80 referred cases, as much as 22 cases (27.5%) were delayed, and 12 from 139 (8.6%) experienced delay in the hospital. A total of 30 cases among 139 (21.6%) experienced delay both outside and in the hospital. There were 74 near-miss cases, 9 of which ended in death of the patient. This means the real occurrence of near-miss cases is 65 from 139 cases or 46.8% while the occurrence of maternal death was 9 out of 139, or 6.47%. Case fatality rate was 9 from 139 or 6.47%; maternal near-miss ratio was 6.22; mortality index was 13.84% and maternal mortality ratio is estimated as 103/100.000 live births. Multivariate analysis showed delay in referral increased the risk of near-miss cases as much as 8.37 folds, while bleeding >1500 ml increased risk of near-miss by 12.12 folds. Delay in both referral and management in the hospital increased the risk of maternal death rate as much as 25.34 folds, hemoglobin <6 g/dl and unavailability of blood increase maternal death by 31.58 folds and 13.39 folds, respectively.Conclusion: Delay in referral and delay of in-hospital management ncreased the occurrence of near-miss and maternal mortality cases significantly. Multivariate analysis showed that the amount of bleeding, hemoglobin level and lack of blood availability influenced the occurrence of near-miss and maternal death more than the delay itself.Keywords: delay, maternal death, maternal near-miss, PPH