{"id":2870,"date":"2024-08-18T01:22:49","date_gmt":"2024-08-18T01:22:49","guid":{"rendered":"https:\/\/ipasindone1stg.wpenginepowered.com\/comprehensive-post-miscarriage-care-training-in-ntt-to-support-the-initial-implementation-of-services-at-primary-healthcare-facilities\/"},"modified":"2026-01-09T10:24:07","modified_gmt":"2026-01-09T10:24:07","slug":"comprehensive-post-miscarriage-care-training-in-ntt-to-support-the-initial-implementation-of-services-at-primary-healthcare-facilities","status":"publish","type":"post","link":"https:\/\/ipasindonesia.org\/en\/comprehensive-post-miscarriage-care-training-in-ntt-to-support-the-initial-implementation-of-services-at-primary-healthcare-facilities\/","title":{"rendered":"Comprehensive Post-Miscarriage Care Training in NTT to Support the Initial Implementation of Services at Primary Healthcare Facilities"},"content":{"rendered":"

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The IPAS Indonesia Foundation supports the Ministry of Health (Kemenkes) of the Republic of Indonesia in conducting comprehensive Post-Abortion Care (PAC) training. This training was held at WZ Johannes Regional General Hospital (RSUD), Kupang, East Nusa Tenggara (NTT), from August 12-16, 2024. <\/p>\n

This activity aims to prepare and strengthen the competence of Human Resources (HR), particularly healthcare professionals, in providing comprehensive PAC services as an initial step towards implementing the expansion of comprehensive PAC services in Primary Healthcare Facilities (FKTP), especially Community Health Centers (Puskesmas).<\/p>\n

PAC comprises a series of actions to manage women who experience miscarriage. PAC is crucial for reducing the high Maternal Mortality Rate (MMR) in Indonesia. The 2020 census results indicate a maternal mortality ratio of 189 per 100,000 live births. Data from the Ministry of Health’s Health Research and Development Agency in 2012 showed that 4% of maternal deaths were caused by miscarriage. <\/p>\n

[\/et_pb_text][et_pb_image src=”https:\/\/ipasindonesiad.wpenginepowered.com\/wp-content\/uploads\/2024\/09\/image-5.jpeg” alt=”Particularly in NTT, the geographical conditions and uneven distribution of health services still ” title_text=”image” _builder_version=”4.27.4″ _module_preset=”default” width=”82%” global_colors_info=”{}”][\/et_pb_image][et_pb_text _builder_version=”4.27.4″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n

Particularly in NTT, geographical conditions and uneven distribution of healthcare services remain challenges in managing miscarriage cases. For instance, referral access from community health centers to hospitals is often obstructed by floods during the rainy season. Furthermore, several roads are damaged, and some bridges have collapsed. These obstacles can endanger patient safety. <\/p>\n

“To make a referral, first, there’s the cost, and in certain weather conditions, it’s impossible to cross,” said Midwife Saleha Novilla Pattimoa, A.Md.Keb. <\/p>\n

Furthermore, the number of medical personnel in regional hospitals, especially obstetrician-gynecologists, is very limited, coupled with a high workload. Meanwhile, so far, patients experiencing miscarriage are usually directly referred to hospitals by community health centers. <\/p>\n

“If we have only one hospital in a district, it serves about 13 Community Health Centers. We handle many cases; there are miscarriage cases every day. We have two obstetrician-gynecologists,” said Dr. Yustinus M. Ujan, SpOG(K). <\/p>\n

[\/et_pb_text][et_pb_image src=”https:\/\/ipasindonesiad.wpenginepowered.com\/wp-content\/uploads\/2024\/08\/image-4-1024×682-1.jpeg” alt=”Given these conditions, this training attempts to address the challenges” title_text=”image-4-1024×682″ _builder_version=”4.27.4″ _module_preset=”default” width=”84%” global_colors_info=”{}”][\/et_pb_image][et_pb_text _builder_version=”4.27.4″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n

Given these conditions, this training aims to address the challenges by strengthening the capacity of healthcare personnel to expand and bring APK access closer to women. This training was conducted using an accredited Comprehensive APK curriculum. <\/p>\n

Inter-professional collaborative approach<\/strong> <\/strong> <\/p>\n

In line with national guidelines, this training in NTT emphasizes an inter-professional collaborative approach involving obstetrician-gynecologists, general practitioners, and midwives. The goal is to foster solid cooperation by mutually understanding the roles and authorities of each profession in providing APK services. <\/p>\n

This collaborative training concept also aims to ensure the fulfillment of needs for the expansion of APK services to primary-level facilities, in line with the national APK guidelines published in 2020. <\/p>\n

[\/et_pb_text][et_pb_image src=”https:\/\/ipasindonesiad.wpenginepowered.com\/wp-content\/uploads\/2024\/08\/image-3-1024×682-1.jpeg” alt=”With this approach, it is hoped that not all miscarriage cases will be directly referred to a hospital” title_text=”image-3-1024×682″ _builder_version=”4.27.4″ _module_preset=”default” width=”81%” global_colors_info=”{}”][\/et_pb_image][et_pb_text _builder_version=”4.27.4″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n

With this approach, it is hoped that not all miscarriage cases will be directly referred to hospitals. Instead, services can be provided at community health centers in accordance with APK guidelines. In the national APK guidelines, Primary Healthcare Facilities (FKTP), especially Community Health Centers (Puskesmas) with difficult access to Advanced Referral Healthcare Facilities\/Hospitals or in emergency conditions, are authorized to comprehensively manage uncomplicated miscarriage cases with gestational age less than 13 weeks. <\/p>\n

Therefore, this training is expected to foster a solid, trusting, and mutually supportive team. Nevertheless, as a supervisor, the obstetrician-gynecologist plays a crucial role in ensuring the implementation of services by the community health center team. <\/p>\n

“In my opinion, this training is good, but for obstetrician-gynecologists, the duration is too long. My suggestion is to make it blended<\/g>, a combination of offline and online, where theory can be self-studied. For beginners<\/em> like midwives, then<\/em> five days would be appropriate,” said Dr. Edward Manurung SpOG(K). <\/p>\n

Use of WHO-recommended medical procedures<\/strong> <\/strong> <\/p>\n

Another objective of this training is to introduce Manual Vacuum Aspiration (MVA) tools for performing APK. MVA is a medical procedure used to remove tissue from the uterus using a vacuum device or aspirator. The use of MVA is highly recommended by the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) due to its safety. <\/p>\n

[\/et_pb_text][et_pb_image src=”https:\/\/ipasindonesiad.wpenginepowered.com\/wp-content\/uploads\/2024\/08\/image-2-1024×682-1.jpeg” alt=”With the introduction of AVM, it is hoped that participants will begin to shift from sharp curettage methods” title_text=”image-2-1024×682″ _builder_version=”4.27.4″ _module_preset=”default” width=”82%” global_colors_info=”{}”][\/et_pb_image][et_pb_text _builder_version=”4.27.4″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n

With the introduction of MVA, participants are expected to shift from sharp curettage to the use of MVA. Sharp curettage is a medical procedure to remove retained products of conception by scraping the uterine lining with a sharp, spoon-shaped instrument. <\/p>\n

The use of sharp curettage can increase the risk of complications in APK management, such as uterine perforation (uterus punctured by surgical instrument) and Asherman’s Syndrome (scar tissue within the uterine wall). These complications can make it more difficult for women to conceive and can damage the uterine lining. The impact of sharp curettage on women who become pregnant again can lead to placental adhesion during childbirth. <\/p>\n

“What I learned from this training is the use of MVA, because MVA has always been taught in courses, but we weren’t very familiar with it, and it turns out sharp curettage has been abandoned,” said Dr. Pujiastuti Wetang. <\/p>\n

Data from the Guttmacher Institute (2020) shows that only 67% of hospitals on Java Island have MVA equipment. Of these, only 7% of patients were managed using APK. In NTT, several training participants stated that miscarriage patients are still managed using sharp curettage. <\/p>\n

“We still use sharp curettage because MVA is unavailable; we’ve used sharp curettage for 10 years,” said Dr. Edward. <\/p>\n

So far, there are two methods recommended by WHO and FIGO for managing miscarriage. The first is operative management using MVA for gestational ages under 14 weeks, and dilation and evacuation for pregnancies \u2265 14 weeks. The second is medical management with the administration of misoprostol according to the dosage in the APK guidelines. <\/p>\n

From this training, the IPAS Indonesia Foundation provided MVA equipment to hospitals whose healthcare personnel participated. We also encourage the Ministry of Health to facilitate the procurement of this equipment because MVA is already included in the Ministry of Health’s catalog. This way, APK can be performed at Community Health Centers and hospitals. <\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

[et_pb_section fb_built=”1″ _builder_version=”4.16″ global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.27.4″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″] The IPAS Indonesia Foundation supports the Ministry of Health (Kemenkes) of the Republic of Indonesia in conducting comprehensive Post-Abortion Care (PAC) training. This training was held at WZ Johannes Regional General Hospital (RSUD), Kupang, […]<\/p>\n","protected":false},"author":4,"featured_media":2876,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"\r\n

Yayasan IPAS Indonesia mendukung Kementerian Kesehatan (Kemenkes) Republik Indonesia untuk mengadakan pelatihan Asuhan Pasca Keguguran (APK) yang komprehensif. Pelatihan ini dilakukan di RSUD WZ Johannes, Kupang, Nusa Tenggara Timur (NTT), pada 12-16 Agustus 2024.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Kegiatan ini bertujuan untuk menyiapkan dan menguatkan kompetensi Sumber Daya Manusia (SDM) khususnya tenaga kesehatan dalam memberikan pelayanan APK yang komprehensif sebagai langkah awal untuk implementasi perluasan layanan APK komprehensif di Fasilitas Kesehatan Tingkat Pertama (FKTP), khususnya Puskesmas.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

APK merupakan serangkaian tindakan untuk menangani perempuan yang mengalami keguguran. APK sangat krusial untuk menurunkan tingginya Angka Kematian Ibu (AKI) di Indonesia. Hasil sensus tahun 2020 menunjukkan rasio kematian ibu adalah 189 per 100.000 kelahiran bayi yang hidup. Data dari Badan Penelitian dan Pengembangan Kesehatan Kemenkes pada 2012 menunjukkan 4% kasus kematian ibu disebabkan karena keguguran.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

Khususnya di NTT, kondisi geografi dan kurang meratanya pelayanan kesehatan masih menjadi tantangan dalam menangani kasus keguguran. Sebagai contoh, akses rujukan dari puskesmas ke rumah sakit kerap terhalang banjir saat musim hujan. Selain itu, sejumlah jalan kondisinya rusak dan beberapa jembatan roboh. Hambatan ini bisa membahayakan keselamatan pasien.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\u201c[Untuk merujuk], pertama butuh biaya, untuk keadaan cuaca tertentu, tidak bisa menyeberang,\u201d ujar Bidan Saleha Novilla Pattimoa, A.Md.Keb.\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Selain itu, jumlah tenaga medis yang ada di rumah sakit daerah, khususnya dokter spesialis kandungan sangat terbatas, ditambah beban kerjanya tinggi. Sementara itu, sejauh ini, pasien dengan keguguran biasanya langsung dirujuk ke rumah sakit dari pihak puskesmas.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\u201cKalau kami satu kabupaten hanya ada satu rumah sakit, melayani sekitar 13 Puskesmas. Kami banyak kasus yang kita tangani, setiap hari ada kasus keguguran. Kami ada dua orang dokter spesialis kandungannya,\u201d kata dr. Yustinus M. Ujan, SpOG(K).\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

Dari kondisi tersebut, pelatihan ini mencoba untuk menjawab tantangan melalui penguatan kapasitas tenaga kesehatan agar dapat memperluas dan mendekatkan akses APK kepada perempuan. Pelatihan ini dilaksanakan dengan menggunakan kurikulum APK Komprehensif yang sudah terakreditasi.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Pendekatan kolaborasi inter-profesi<\/strong>\u202f<\/strong>\u00a0<\/p>\r\n\r\n\r\n\r\n

Sejalan dengan pedoman nasional, pelatihan di NTT ini mengedepankan pendekatan kolaborasi inter-profesi yang melibatkan dokter spesialis kandungan, dokter umum, dan bidan. Tujuannya adalah untuk membentuk kerja sama yang solid dengan saling memahami peran dan kewenangan masing-masing profesi dalam memberikan layanan APK.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Konsep pelatihan kolaboratif ini juga bertujuan untuk memastikan pemenuhan kebutuhan untuk perluasan layanan APK hingga fasilitas tingkat pertama yang sejalan pedoman APK nasional yang diterbitkan pada tahun 2020.\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

Dari pendekatan ini, diharapkan tidak semua kasus keguguran langsung dirujuk ke rumah sakit. Akan tetapi, layanan dapat dilakukan di puskesmas sesuai dengan pedoman APK. Dalam panduan APK nasional, FKTP khususnya Puskesmas dengan akses ke Fasilitas Kesehatan Rujukan Tingkat Lanjut\/ Rumah sakit yang sulit atau kondisi gawatdarurat, berwenang untuk menangani kasus keguguran tanpa komplikasi dengan usia kehamilan kurang dari 13 minggu secara komprehensif.\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Oleh sebab itu, pelatihan ini diharapkan dalam membentuk tim yang solid, saling percaya, dan saling mendukung. Meski begitu, sebagai supervisor, dokter spesialis kandungan, memiliki peran yang sangat penting untuk memastikan pelaksanaan layanan oleh tim puskesmas.\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\u201cMenurut saya pelatihan ini bagus akan tetapi untuk spesialis kandungan durasinya terlalu panjang. Saran saya dibuat blended<\/em> kombinasi offline dan online, teori bisa dibaca sendiri. Buat beginner <\/em>seperti bidan, nah<\/em> itu bisa lima hari,\u201d ujar dr. Edward Manurung SpOG(K).\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Penggunaan prosedur medis yang direkomendasikan WHO\u202f<\/strong>\u202f<\/strong>\u00a0<\/p>\r\n\r\n\r\n\r\n

Tujuan lain dari pelatihan ini adalah untuk mengenalkan alat Aspirasi Vakum Manual (AVM) dalam melakukan APK. AVM merupakan prosedur medis yang digunakan untuk mengeluarkan jaringan dari dalam rahim menggunakan alat vakum atau penyedot. Penggunaan AVM ini sangat direkomendasikan oleh Badan Kesehatan Dunia (WHO) dan Perkumpulan Obstetri Dan Ginekologi Dunia (FIGO) karena keamanannya.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\"\"<\/figure>\r\n\r\n\r\n\r\n

Dengan pengenalan AVM, diharapkan peserta mulai beralih dari metode kuretase tajam ke penggunaan AVM. Kuretase tajam adalah tindakan medis untuk membersihkan sisa hasil konsepsi dengan mengerok lapisan rahim dengan menggunakan alat yang mirip dengan bentuk sendok dan tajam.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Penggunaan kuretase tajam bisa meningkatkan risiko komplikasi dalam penanganan APK seperti, perforasi rahim (rahim tertusuk alat bedah) dan Asherman Syndrom (luka parut dalam dinding rahim). Komplikasi tersebut dapat menyebabkan kemampuan memiliki anak pada perempuan menjadi lebih susah serta merusak lapisan rahim. Dampak kuret tajam pada perempuan yang hamik kembali, dapat menyebabkan perlengketan plasenta saat proses persalinan.\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\u201cYang saya pelajari dari pelatihan ini adalah penggunaan AVM, karena dari dulu AVM diajarkan di mata kuliah tapi kayak kita belum terlalu familiar, dan ternyata kuretase tajam sudah ditinggalkan,\u201d kata Dokter Pujiastuti Wetang.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Data dari Guttmacher Institute (2020) menunjukkan baru 67% rumah sakit di Pulau Jawa yang memiliki peralatan AVM. Dari jumlah tersebut, hanya 7% pasien yang ditangani menggunakan APK. Untuk di NTT, sejumlah peserta pelatihan mengatakan, penanganan pasien keguguran masih menggunakan kuretase tajam.\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

\u201cKami masih menggunakan kuretase tajam, karena AVM tidak ada, 10 tahun pakai kuretase tajam,\u201d ujar Dokter Edward.\u202f\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Sejauh ini, ada dua cara yang direkomendasikan WHO dan FIGO untuk menangani keguguran. Yang pertama adalah tindakan operatif dengan menggunakan AVM untuk usia kehamilan di bawah 14 minggu serta dilatasi dan evakuasi untuk kehamilan \u2265 14 minggu. Yang kedua adalah tindakan medikamentosa dengan pemberian obat misoprostol sesuai dosis dalam panduan APK.\u202f\u00a0<\/p>\r\n\r\n\r\n\r\n

Dari pelatihan ini Yayasan IPAS Indonesia memberikan alat AVM kepada rumah sakit yang tenaga kesehatannya menjadi peserta. Kami juga mendorong Kemenkes untuk memfasilitasi pengadaan alat tersebut karena AVM telah masuk dalam katalog Kemenkes. Dengan begitu, APK ini bisa dilakukan di Puskesmas dan juga rumah sakit.\u202f\u202f\u00a0<\/p>\r\n","_et_gb_content_width":"","footnotes":""},"categories":[155],"tags":[15,48,174,156,49,175],"topic":[],"class_list":{"0":"post-2870","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","6":"hentry","7":"category-news","8":"tag-apk","9":"tag-ntt","11":"tag-post-miscarriage-care","12":"tag-takenusa"},"_links":{"self":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/posts\/2870","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/comments?post=2870"}],"version-history":[{"count":0,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/posts\/2870\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/media\/2876"}],"wp:attachment":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/media?parent=2870"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/categories?post=2870"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/tags?post=2870"},{"taxonomy":"topic","embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/topic?post=2870"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}