Constraints and Barriers in Handling Severe Preeclampsia
DOI:
https://doi.org/10.37287/ijghr.v8i4.2003Keywords:
constraints, management, obstacles, preeclampsia, severityAbstract
WHO 2020 data shows a Maternal Mortality Rate (MMR) of 223 per 100,000. The Indonesian Health Profile in 2023, MMR in Indonesia is 189 per 100,000 live births. The most common causes of death are hypertension in pregnancy (412 cases), obstetric hemorrhage (360 cases) and other obstetric complications (204 cases). Preeclampsia is the most common hypertension in pregnancy in Indonesia, 7-10% of all pregnancies. Preeclampsia causes >70,000 maternal deaths and 500,000 fetal deaths worldwide each year. This study aims to explore in depth the obstacles and constraints in the management of severe preeclampsia at Dr. M. Djamil Padang General Hospital in 2025. Qualitative research methods. Informants were selected purposively with the following criteria: medical and nursing service managers, obstetrician/gynecologist specialists, midwives and nurses (in the emergency room or delivery room, obstetrics polyclinic, obstetrics inpatient, operating room, intensive care unit, and NICU), working for at least 1 year, directly involved in the management of severe preeclampsia, patients or their families. The number of informants was determined based on the saturation principle. Data collection techniques were in-depth interviews, field observations, document analysis, and FGDs. Data collection instruments used interview guidelines, voice recorders (with permission), and field notes. The analysis used was thematic. Data validity was verified by triangulation. Research results: Main strengths: the system is standardized (SOP, financing, evaluation). Main weaknesses: human resources, facilities, communication, and logistics. Biggest opportunities: strengthening the referral system and increasing human resources capacity. The main threat of patient overload due to referrals and delays in PEB management is influenced by several factors, including input, process, and output aspects of the healthcare system. Input Aspects (Men, Money, Methods)
References
Aboshnin, Z. A., Razzaq, S. A., & Hashem, L. H. (2024). Preeclampsia management: Advancements, guidelines, and emerging perspectives. Academia Open. https://doi.org/10.21070/acopen.9.2024.8793
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia. Obstetrics & Gynecology, 135(6), e237–e260.
Ananth, C. V., Keyes, K. M., & Wapner, R. J. (2021).Pre-eclampsia rates in the United States, 1980–2019. American Journal of Obstetrics and Gynecology, 225(3), 286.e1–286.e13.
Benschop, L., Schalekamp-Timmermans, S., Schelling, S., et al. (2020). Lifestyle factors and preeclampsia risk. Hypertension, 75(5), 1336–1343.
Brown, M. A., Magee, L. A., Kenny, L. C., et al. (2021). Hypertensive disorders of pregnancy: ISSHP classification and management recommendations. Hypertension, 77(2), e1–e18.
Duley, L., Meher, S., & Abalos, E. (2020).Management of pre-eclampsia. BMJ, 371, m4215.
Fox, R., Kitt, J., Leeson, P., et al. (2021). Preeclampsia: Risk factors, diagnosis, and management. BMJ, 372, n722.
Gestational Hypertension and Preeclampsia Study Group. (2023). Global trends in hypertensive disorders of pregnancy. The Lancet Global Health, 11(8), e1200–e1210.
Ghulmiyyah, L., & Sibai, B. (2020). Maternal mortality from preeclampsia/eclampsia. Seminars in Perinatology, 44(4), 151–160.
Hauspurg, A., & Jeyabalan, A. (2021). Postpartum preeclampsia management. Clinical Obstetrics and Gynecology, 64(1), 157–166.
Kementerian Kesehatan RI. (2022). Profil kesehatan Indonesia 2021. Jakarta: Kemenkes RI.
Kementerian Kesehatan RI. (2023). Profil kesehatan Indonesia 2022. Jakarta: Kemenkes RI.
Khalil, A., Samara, A., O’Brien, P., et al. (2023). Global failure to tackle maternal mortality. The Lancet Global Health, 11(8), e1120–e1121.
Magee, L. A., Singer, J., Lee, T., et al. (2022).Management of hypertension in pregnancy. Hypertension, 79(6), 124–134.
Mol, B. W. J., Roberts, C. T., Thangaratinam, S., et al. (2021). Pre-eclampsia. The Lancet, 387(10022), 999–1011.
Muslichah, M., Prawitasari, S., & Rachman, I. T. (2021). Hubungan PEB dengan pertumbuhan janin. Jurnal Kesehatan Reproduksi, 12(2), 85–92.
Nugroho, T., & Utami, S. (2022). Faktor risiko preeklampsia pada ibu hamil. Jurnal Kebidanan Indonesia, 13(1), 45–52.
Poniedziałek-Czajkowska, E., Mierzyński, R., & Leszczyńska-Gorzelak, B. (2023). Obesity and preeclampsia. International Journal of Environmental Research and Public Health, 20(2), 1267.
Poon, L. C., Shennan, A., Hyett, J. A., et al. (2020). The International Federation of Gynecology and Obstetrics (FIGO) initiative. International Journal of Gynecology & Obstetrics, 150(3), 287–293.
Prayoga, R., & Sari, D. (2023). Analisis sistem rujukan maternal di Indonesia. Jurnal Kesehatan Masyarakat, 18(2), 101–110.
Rana, S., Lemoine, E., Granger, J. P., & Karumanchi, S. A. (2020). Preeclampsia pathophysiology. Circulation Research, 124(7), 1094–1112.
Say, L., Chou, D., Gemmill, A., et al. (2021). Global causes of maternal death. The Lancet Global Health, 9(7), e1080–e1090.
Sharma, D. D., Chandresh, N., Javed, A., et al. (2024). Management of preeclampsia: Review. Cureus, 16(1), e51512.
Sibai, B. M. (2020). Evaluation and management of severe preeclampsia. American Journal of Obstetrics and Gynecology, 223(2), 192–203.
Syairaji, M., Nurdiati, D. S., Wiratama, B. S., et al. (2024). Maternal mortality in Indonesia. BMC Pregnancy and Childbirth, 24, 515.
Syam, W. D. P., Nulanda, M., Haeriyanti, H., et al. (2022). Faktor risiko PEB. Jurnal Pendidikan Tambusai, 8(1), 1123–1130.
Tessema, G. A., Laurence, C. O., Melaku, Y. A., et al. (2021). Trends in maternal mortality. BMC Public Health, 21, 123.
Townsend, R., O’Brien, P., & Khalil, A. (2021). Current best practice in preeclampsia. BMJ, 372, n144.
Utami, R., & Dewi, S. (2022). Kualitas pelayanan maternal di RS. Jurnal Administrasi Rumah Sakit, 8(2), 89–98.
WHO. (2020). WHO recommendations on maternal health. Geneva: World Health Organization.
WHO. (2022). Recommendations for prevention and treatment of preeclampsia. Geneva: WHO.
WHO. (2023). Maternal mortality: Levels and trends 2000–2023. Geneva: WHO.
Wulandari, A., & Fitriani, Y. (2023). Beban kerja tenaga kesehatan. Jurnal Keperawatan Indonesia, 26(1), 55–63.
Yuliani, E., & Sari, M. (2021). Manajemen kegawatdaruratan obstetri. Jurnal Kebidanan, 10(2), 120–128.
Zhang, J., Meikle, S., & Trumble, A. (2020). Severe maternal morbidity associated with preeclampsia. Obstetrics & Gynecology, 135(5), 123–130.
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