Indonesian Journal of Obstetrics and Gynecology

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ISSN / EISSN : 23386401 / 23387335
Total articles ≅ 270
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Yeva Rosana, Dwiana Ocviyanti, Rahmah Amran
Indonesian Journal of Obstetrics and Gynecology pp 208-212; doi:10.32771/inajog.v7i3.899

Abstract:Objectives:To investigate the role of microscopic examination of urine sample in supporting early diagnosis of asymptomatic urinary tract infection (UTI) in pregnant women. To compare correspondence between microscopic examination and urine culture result as a gold standard diagnostic modality to support the diagnosis of UTIs and as an evidence-based to start empirical therapy. Methods: Microscopic analysis was conducted in 74 centrifuged and non-centrifuged urine samples from 317 pregnant who came to six healthcare centres in Jakarta, which showed a positive result of nitrite examination. The results of the microscopic examination of bacteriuria and leukocyturia were compared with a urine culture. Results: Sensitivity of centrifuged bacteriuria was the highest among the other microscopic parameters, which was 74% with the p-value of 0.009. Combination of bacteriuria and leukocyturia≥3/HPF dan≥5/HPF have increased the specificity with the value of 91.5% and 93.6% in non-centrifuged urine. Conclusion: This result showed that the best method of microscopic examination for early diagnosis of asymptomatic urinary tract infection in pregnant women is the detection of bacteriuria in centrifuged urine. Combination of bacteriuriaandleukocyturiatest, as well as leukocyturia≥3/HPF and≥5/HPF, can be used to rule out the diagnosis of UTI at an early stage. Keywords: asymptomatic urinary tract infection, bacteriuria, leukocyturia,microscopic examination, urine culture. Abstrak Tujuan: Mengetahui peran pemeriksaan mikroskopis sampel urin dalam mendukung diagnosis dini infeksi saluran kemih asimptomatik (ISK) pada perempuan hamil. Membandingkan kesesuaian antara pemeriksaan mikroskopis dan hasil kultur urin sebagai modalitas diagnostik standar emas untuk mendukung diagnosis ISK dan sebagai dasar bukti untuk memulai terapi empiris. Metode: Penelitian uji mikroskopik dilakukan pada 74 sampel urin disentrifugasi dan tidak sentrifugasi, dari 317 sampel urin perempuan hamil yang berobat ke-enam puskesmas di Jakarta dengan uji nitritpositif. Hasil uji mikroskopik bakteri uria dan leukosit uria dibandingkan dengan hasil kultururin. Hasil: Sensitivitas bakteriuria yang disentrifugasi menunjukan hasil yang paling baik dibandingkan dengan parameter uji mikroskopik lain, yaitu 74% dengan nilai p yang bermakna sebesar 0,009. Kombinasi bakteri uria dan leukosituria ≥3/LPB dan ≥5/LPB dapat meningkatkan spesifisitas uji dengan nilai 91,5% dan 93,6% pada urin yang tidak disentrifugasi. Kesimpulan: Hasil menunjukkan bahwa bakteri uria pada urin yang disentrifugasi, merupakan metode yang paling baik untuk membantu diagnosis dini ISK tidak bergejala pada perempuan hamil. Uji kombinasi bakteri uria dan leukosituria, serta uji leukosituria ≥3/LPB dan ≥5/LPB dapat dimanfaatkan untuk membantu secara dini menyingkirkan orang yang tidak mengalami ISK. Kata kunci: bakteriuria, infeksi saluran kemih tidak bergejala, kultur urin,leukosituria, uji mikroskopik
Mariana Afiati, Azhari Azhari, Firmansyah Basir, Theodorus Theodorus
Indonesian Journal of Obstetrics and Gynecology pp 183-187; doi:10.32771/inajog.v7i3.606

Abstract:Objective: to assess the association between risk factors related to IUD acceptors' compliance at RSMH Palembang. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology Dr. Mohammad Hoesin Hospital/Faculty of Medicine Sriwijaya University Palembang since May - December 2017. Subjects were women who use IUD contraceptives in the Department of Obstetrics and Gynecology Dr.MohammadHoesin Hospital Palembang and meet our inclusion and exclusion criteria. Medical counselling, knowledge, and side effects were assessed using a questionnaire. Data were analyzed by Chi-square test using SPSS software version 17. Results: There was a significant relationship between side effects and compliance of IUD use. There was no significant correlation between knowledge and medical counselling with compliance of IUD. Conclusions: Side effects associated with compliance of IUD. Keywords:compliance, contraception, IUD Abstrak Tujuan: mengetahui hubungan faktor-faktor resiko yang bermakna dalam mempengaruhi kepatuhan peserta akseptor IUD di RSMH Palembang. Metode: Penelitian potong lintang ini dilakukan di Departemen Obstetri dan Ginekologi Rumah Sakit Dr. Mohammad Hoesin/Fakultas Kedokteran Universitas Sriwijaya Palembang sejak Mei – Desember 2017. Sampel penelitian ini adalah perempuan yang menggunakan kontrasepsi IUD di Departemen Obstetri dan Ginekologi Rumah Sakit Dr. Mohammad Hoesin/Fakultas Kedokteran Universitas Sriwijaya Palembang dan memenuhi kriteria inklusi dan eksklusi. Konseling medik, pengetahuan, dan efek samping dinilai dengan menggunakan kuesioner. Data dianalisis dengan uji Chi square menggunakan SPSS versi 17. Hasil: Ada hubungan bermakna antara efek samping IUD dengan kepatuhan pemakaian IUD. Tidak ditemukan hubungan bermakna antara tingkat pengetahuan dan konseling medic dengan kepatuhan akseptor IUD. Kesimpulan: Efek samping IUD mempengaruhi kepatuhan pemakaian IUD. Kata kunci: IUD, kontrasepsi, kepatuhan.
Eka R Gunardi, Leonanta Mahardika Ginting
Indonesian Journal of Obstetrics and Gynecology pp 188-192; doi:10.32771/inajog.v7i3.641

Abstract:Objective: To investigatethe level of knowledge, attitude, and behaviour of midwives to emergency contraception in Indonesia. Methods: This study used a cross-sectional design. Subjects were midwives who worked in the District CipondohTangerang, Banten, Indonesia until the number of subjects is met at least 100 people. The data were collected by using written questionnaires made by researchers based on previous studies with similar themes. The data obtained will be reported descriptively for categorical variables. The analysis results are presented in the form of sum (n) and percentage (%) (proportion). Results: Of the 100 respondents who answered the questionnaire, 83% of the midwives had a good knowledge of the condition. Good midwife attitude toward EC in public health care and private practices were 84.62% and 85.06%, respectively. Accordingly, the good behaviour shown by midwives in public health care and private practice is 100% and 94.25%. However, from the question qualitatively the level of knowledge, attitude and behaviour of midwives is still classified as less. Conclusion: The level of knowledge, attitude and behaviour of midwives towards emergency contraception is said to be lacking. Training on EC on midwives is still needed for practical use in the community. Keywords: emergency contraception, midwife, unwanted pregnancy, uterine contraception Abstrak Tujuan:Mengetahui tingkat pengetahuan, sikap, dan perilaku bidan terhadap kondar di Indonesia. Metode:Penelitian ini menggunakan desain potong lintang dengan pengambilan sampel berturut-turut. Peneliti mengambil semua subjek yaitu bidan yang bekerja di wilayah Kecamatan Cipondoh Kabupaten Tangerang sampai jumlah subjek minimal terpenuhi sebanyak 100orang. Pengambilan data dilakukan dengan menggunakan kuesioner tertulis yang dibuat oleh peneliti berdasarkan penelitian-penelitian terdahulu dengan tema serupa. Data yang diperoleh akan dilaporkan secara deskriptif untuk variable kategorik. Hasil analisis disajikan dalam bentuk jumlah (n) dan persentase (%) (proporsi). Hasil: Dari 100 responden, 83% bidan mempunyai pengetahuan yang baik terhadap kontraspsi darurat. Sikap bidan yang baik terhadap kondar di puskesmas dan di praktik swasta adalah 84,62% dan 85,06%, berturut-turut. Sejalan dengan itu, perilaku yang baik ditunjukkan oleh bidan di puskesmas dan di praktik swasta adalah sebesar 100% dan 94,25%. Namun dari pertanyaan secara kualitatif tingkat pengetahuan , sikap dan prilaku bidan masih tergolong kurang. Kesimpulan:Tingkat pengetahuan, sikap dan perilaku bidan terhadap kontrasepsi darurat dikatakan masih kurang. Masih dibutuhkan pelatihan tentang kondar pada bidan agar penggunaannya efektif di masyarakat. Kata kunci: alat kontrasepsi dalam rahim, bidan, kehamilan tidak diinginkan, kontrasepsi darurat.
Dwi Pratika Anjarwati, Yudhistya Ngudi Insan Ksyatria, Widardo Widardo
Indonesian Journal of Obstetrics and Gynecology pp 166-169; doi:10.32771/inajog.v7i3.556

Abstract:Objective: to investigate the accuracy of estimated fetal weight using Hadlock II formula in RSUD Dr Moewardi. Methods: This cross-sectional study was conducted at RSUD Dr Moewardi in June 2017. Subjects were women who gave birth at RSUD Dr Moewardi from August 2014 to March 2017. The method of collecting data by quoting the medical record as required. Data analysis was done by using linear regression statistic test. Result: By distribution, the number of samples that, according to the standard, is 81.67 %. With the value of R = 0.706 which means that the relationship between two research variables are strong and the value of R Square = 0.499 which means that estimated fetal weight using Hadlock II formula has contribution 49.9 % on fetal birth weight and 50.1 % others by other factors. Conclusion: Fetal weight estimation using Hadlock II formula in RSUD Dr Moewardi has low accuracy. Operator skills training is required to improve the accuracy of estimated fetal weight. Keywords: fetal birth weight, fetal weight estimation, Hadlock II abstrak Tujuan : Mengetahui keakuratan taksiran berat janin menggunakan rumus Hadlock II di RSUD Dr Moewardi. Metode : Penelitian ini adalah penelitian observasional analitik. Penelitian ini dilaksanakan di RSUD Dr Moewardi pada Juni 2017. Subjek penelitian ini adalah data rekam medis dari ibu hamil yang mengalami partus di RSUD Dr Moewardi pada Agustus 2014 – Maret 2017. Metode pengumpulan data dengan mengutip data rekam medis pasien sesuai ketentuan. Analisis data dilakukan dengan uji statistik regresi linier. Hasil : Secara distribusi, jumlah sampel yang memenuhi standar yaitu 81,67 %. Dengan nilai R = 0,706 yang artinya bahwa hubungan kedua variabel penelitian ada dalam kategori kuat dan nilai R Square = 0,499 yang berarti taksiran berat janin menggunakan rumus Hadlock II memiliki pengaruh kontribusi sebesar 49,9% terhadap berat bayi lahir sedangkan 50.1 % lainnya dipengaruhi oleh faktor lain. Kesimpulan : Taksiran berat janin menggunakan rumus Hadlock II di RSUD Dr Moewardi kurang akurat. Perlu dilakukan pelatihan ketrampilan operator sehingga diharapkan dapat meningkatkan keakuratan taksiran berat janin. Kata kunci: berat bayi lahir , Hadlock II, , taksiran berat janin
Achmad Taufan, Nuswil Bernolian, Yusuf Efendi, Alba G E Bahar
Indonesian Journal of Obstetrics and Gynecology pp 179-182; doi:10.32771/inajog.v7i3.585

Abstract:Objective: To determine the risk of sensorineural hearing impairment in preeclampsia patients and to in Obstetric and Gynecology Department in Dr. Mohammad Hoesin Hospital Palembang. Method: An analytic observational case-control study was held in Dr. Mohammad Hoesin Hospital Palembang from January 1st to December 31st 2016. Subjects were obtained through consecutive sampling. Hypothetical tests used were unpaired t-test, Chi-square test and Fisher test for expected deviation standard 0.05). From unpaired t-test, there was no significant difference between mean Air Conducting (AC) and Bone Conducting (BC) of the right ear in severe preeclampsia group and healthy pregnancy group (p=0.340), as well as mean AC and BC of the left ear in severe preeclampsia group and healthy pregnancy group (p=0.059). Based on the Fisher's Exact test, no significant relation was found between severe preeclampsia and sensorineural hearing impairment (p=0.999). Conclusion:There was no significant relation between severe preeclampsia and sensorineural hearing impairment in Obstetric and Gynecology Department in Dr. Mohammad Hoesin Palembang. Keywords: otoacoustic emission, preeclampsia, sensorineural hearing impairment. Abstrak Tujuan: Mengetahui risiko gangguan pendengaran sensorineural pada pasien dengan preeklamsia di Departemen Obstetri dan Ginekologi RSUP Mohammad Hoesin Palembang. Metode: Penelitian analitik observasional dengan disain kasus kontrol pada wanita hamil di RSMH sejak 1 Januari – 31 Desember 2016. Subjek dipilih secara consecutive sampling. Analisis dengan uji t tak berpasangan, Chi-square, dan uji Fisher untuk ekspektasi sd0,05). Dengan uji T tidak berpasangan, tidak didapatkan perbedaan bermakna rerata Air Conducting (AC) dan Bone Conducting (BC) telinga kanan kelompok PEB dan kelompok hamil normal (p=0,340), begitu juga dengan rerata Air Conducting (AC) dan Bone Conducting (BC) telinga kiri kelompok PEB dan kelompok hamil normal (p=0,059). Berdasarkan uji statistik Fisher, tidak didapatkan hubungan bermakna antara preeklamsia berat dengan gangguan pendengaran sensorineural (p=0,999). Simpulan:Tidak terdapat hubungan yang bermakna antara preeklamsia berat dengan gangguan pendengaran sensorineural berdasarkan pemeriksaan audiometri di Departemen Obstetrik dan Ginekologi RSUP Dr. Mohammad Hoesin Palembang. Kata kunci: gangguan pendengaran sensorineural, otoacoustic emission, preeklamsia
Wiwi Irawan, Syahrul Rauf, Nasrudin A. Mappaware, St. Maisuri T. Chalid
Indonesian Journal of Obstetrics and Gynecology pp 224-227; doi:10.32771/inajog.v7i3.991

Abstract:Objective: To analyse the predictive value of HE4 in ovarian cancer patients according to their resistance and menopausal status Methods: Thirteen premenopausal and twenty-five menopausal ovarian cancer patients were measured for HE4 levels measured using automated chemiluminescent microparticle immunoassay ARCHITECT HE4. Patients categorized into resistant and non-resistant after six cycles of chemotherapy in addition to their clinical symptoms and ultrasound image of cancer. Results: The mean HE4 levels were higher in the resistant group compared with a non-resistant group (274.97 pmol/l vs 128.83 pmol/l; p=0.015). Five menopausal resistant women with HE4 levels >140 pmol/l compared with two women in the non-resistant group. In the pre-menopause group, eight resistant women with HE level >70 pmol/l whereas four women in the non-resistant group. HE levels in menopausal and premenopausal for both ovarian cancers resistant and non-resistant were not significantly different (p>0.05). Conclusion: HE4 levels in resistant ovarian cancer patients are higher compared with non-resistant but do not predict ovarian cancer resistance based on patient menopausal status. Keywords: HE4, ovarian cancer, resistance. Abstak Tujuan: Untuk menganalisis nilai prediktif HE4 pada pasien kanker ovarium berdasarkan resistensi dan status menopausenya Metode: Dilakukan pengukuran kadar HE4 menggunakan metode microparticle immunoassay ARCHITECT HE4 terhadap pasien kanker ovarium terdiri dari 13 perempuan premenopausal dan 25 perempuan menopause. Pasien dikategorikan menjadi resisten dan tidak resisten setelah 6 siklus kemoterapi selain gejala klinis dan gambar USG. Hasil: Rerata kadar HE4 rata-rata lebih tinggi pada kelompok yang resisten dibandingkan dengan kelompok yang tidak resisten (274,97 pmol/l vs 128,83 pmol/l; p=0,015). Terdapat 5 perempuan menopause yang resisten kanker ovarium dan 2 perempuan dalam kelompok yang tidak resisten dengan kadar HE4 >140 pmol/l. Pada kelompok premenopause, 8 perempuan yang resisten dengan tingkat HE >70 pmol/l sedangkan 4 perempuan dalam kelompok tidak resisten. Kadar HE dalam menopause dan premenopause untuk kedua kanker ovarium resisten dan tidak resisten tidak berbeda secara signifikan (p>0,05). Kesimpulan: Kadar HE4 pada pasien kanker ovarium lebih tinggi daripada tidak resisten tetapi tidak memprediksi resistensi kanker ovarium berdasarkan status menopause pasien. Kata kunci : HE4, kanker ovarium, resistensi .
Laila Nuranna, Zakiah Tourik
Indonesian Journal of Obstetrics and Gynecology pp 233-237; doi:10.32771/inajog.v7i3.1021

Abstract:Objective:To determine the prevalence of malignant ovarian germ cell tumour in term of characteristics, management, and 3-year survival rate in Dr. Cipto Mangunkusumo Hospital Jakarta from 2011 to 2013. Methods: This is a cross-sectional study. Secondary data were collected from medical record as well as interviewing patients through phone call or home visit. Results: We collected data from 24 subjects. As many as 54.2% of subjects were between 20 to 40 year old, and 58.3% was single. Around 83.3% of the subjects came with chief complaint of abdominal enlargement. Histopathology finding confirmed dysgerminoma in 50% subjects, mixed ovarian germ cell tumour in 25%, endodermal sinus tumour or yolk sac tumour in 16.7%, and immature teratoma in 8.3%. Half of the cases were found in stage I. The primary therapy was conservative surgical staging and adjuvant chemotherapy.In 2 subjects with dysgerminoma, neoadjuvant chemotherapy (bleomycin, etoposide, cisplatin, and cyclophosphamide-cisplatin regimen) resulted in a good response. The 3-year survival rate was 83.3% in dysgerminoma, 100% in mixed ovarian germ cell tumour, and 50% in immature teratoma. Conclusion: In malignant ovarian germ cell tumour, conservative surgical staging followed by a complete course of chemotherapy is the treatment of choice with 3-year survival rate exceeding 70%. Keywords: dysgerminoma, non-epithelial ovarian tumour,ovarian germ cell tumour, survival Abstrak Tujuan : Mengetahui sebaran meliputi karateristik, penatalaksanaan dan kesintasan 3 tahun pasien tumor ganas sel germinal ovarium di RSCM tahun 2011 – 2013. Metode : Penelitian ini menggunakan studi potong lintang dengan mengambil data sekunder dari rekam medis dan mewawancarai pasien atau keluarga pasien via telepon atau kunjugan rumah. Hasil : Pada penelitian ini, dari 24 subjek penelitian, 54,2% ditemukan pada usia 20-40 tahun dan 58,3% subjek belum menikah. Sebanyak 83,3% datang dengan keluhan perut membesar. Secara histopatologi didapatkan jenis disgeminoma, tumor sel germinal campuran, sinus endodermal (yolk sac) dan teratoma imatur dengan proporsi masing-masing 50%, 25%, 16,7% dan 8,3%, sebagian besar kasus (50%) ditemukan pada stadium I. Conservative surgical staging dan kemoterapi adjuvan tatalaksana pilihan. Terdapat 2 subjek jenis disgerminoma yang diberikan dengan kemoterapi neoadjuvan (regimenbleomycin, etoposide, cisplatin dan cyclophosmide-cisplatin) memberikan respon yang baik. Kesintasan ≥ 3 tahun pada jenis disgerminoma mencapai 83,3%, pada tumor sel germinal campuran 100% dan pada teratoma imatur mencapai 50%. Kesimpulan : Pada tumor ganas sel germinal ovarium conservative surgical staging diikuti kemoterapi lengkap merupakan pilihan terapi dengan kesintasan ≥ 3 tahun mencapai > 70%. Kata kunci : disgerminoma,kesintasan, tumor ovarium non epithelial, tumor sel germinal ovarium.
Chairun Nisa, David Lotisna, Deviana Soraya Riu, St. Maisuri T Chalid
Indonesian Journal of Obstetrics and Gynecology pp 193-195; doi:10.32771/inajog.v7i3.992

Abstract:Objective: To determine the correlation between the perineal body length and the pelvic organ prolapse (POP) in menopausal women. Methods: The total vaginal length (TVL), genital hiatus (GH), and perineal body (PB) length as the POP-Q component were measured at 60 menopausal women enrolled in a cross-sectional study. Results: Menopausal women with POP have the shorter perineal body (63.3%;
Ridwan A Putra, Iskandar Zulqarnain, Zaimursyaf Azis, Jusuf S Effendi, Wiryawan Permadi, Ria Bandiara
Indonesian Journal of Obstetrics and Gynecology pp 170-178; doi:10.32771/inajog.v7i3.1026

Abstract:Objective : To compare the effectiveness of oxytocin dose of 10 IU and 20 IU for preventing uterine atony in women undergoing cesarean section. Methods : This was a double-blind, randomized clinical trial with good matching selection with randomization block of patients who had risk factors for the occurrence of uterine atony such as preeclampsia, patients were receiving MgSO4, oxytocin intrapartum and chorioamnionitis who performed stratified randomization prospectively with two kinds of oxytocin doses which are 10 IU and 20 IU as a prophylaxis for uterine atony in women who performed emergency cesarean section with transverse incision and were using a general anesthesia. Results : This study found no any significant differences between the use of 10 IU and 20 IU as prophylaxis for uterine atony during cesarean section either in its action at the time or while in recovery room, especially on the cases without chorioamnionitis thus using oxytocin 10 IU regimen can be considered, besides the effectiveness did no differ, it will cost cheaper than oxytocin 20 IU regimen which frequently used. Conclusions : There were no significant differences in the incidence of blood loss during the cesarean section between the treatment of oxytocin 10 IU group and oxytocin 20 IU group. The additional uterotonic was using during the action of the cesarean section between the treatment of oxytocin 10 IU group, and oxytocin 20 IU group gave no significant differences. The side effects in this study at least form of chills and vomiting found no significant differences between both of groups despite the side effects that arise in oxytocin 20 IU group was higher at 23.08% than oxytocin 10 IU group at 15.19%. Chorioamnionitis would be a risk factor for the occurrence of uterine atony during the action of the cesarean section if it associated with the use of additional uterotonic in oxytocin 10 IU group if compared with oxytocin 20 IU group. Keywords : cesarean section, oxytocin, uterine atony. Abstrak Tujuan : Untuk membandingkan efektifitas penggunaan dosis 10 IU dan 20 IU sebagai profilaksis atonia uteri pada saat seksio sesarea. Metode : Penelitian ini menggunakan uji klinis acak ganda dengan seleksi yang sesuai dengan blok acak pada pasien-pasien yang memiliki faktor risiko terjadinya atonia uteri seperti preeklamsia, pasien yang diberikana MgSO4 dan oxytocin intrapartum sebelumnya serta chorioamnionitis yang dilakukan pengacakan secara prosfektif bertingkat yang diberikan dua jenis dosis oksitosin yaitu 10 IU dan 20 IU sebagai profilaksis atonia uteri pada perempuan yang dilakukan seksio sesarea darurat dengan insisi transversal dan menggunakan anestesi umum. Hasil : Penelitian ini menemukan tidak adanya perbedaan yang bermakna antara penggunaan dosis oksitosin 10 IU dan 20 IU sebagai profilaksis atonia uteri pada seksio sesarea baik saat tindakan operasi maupun saat berada di ruang pemulihan, terutama pada kasus-kasus tanpa khorioamnionitis dimana memerlukan...
Omo Abdul Madjid, Arietta R.D. Pusponegoro, Immanuel S Margatan
Indonesian Journal of Obstetrics and Gynecology pp 159-165; doi:10.32771/inajog.v7i3.1037

Abstract:Objective: To investigate the circumstances of the obstetric referral case at the emergency department of the Dr.Cipto Mangunkusumo Hospital as well as the accuracy of the referral implementation. Method: We used cross-sectional study. Medical records of obstetric patients at Emergency department in RSCM in January 2013-July 2014 were obtained, then information about patients and their characteristic were collected. The accuracy of referral cases is based on emergency obstetric criteria by BPJS rules. Results: Primary Health Care became the leading referrer. Inappropriate diagnostic referral cases amounted to 21.2%when JKN first began to be implemented in 2014. Cases with improper diagnoses were more referred when JKN was implemented which amounted to 16.8% and non-emergency referral cases of 6.9% in 2014. Conclusion: Referral implementation has not been efficient and effective, the number of obstetric referral cases to emergency department of RSCM that can actually be handled in the secondary advanced health services after the application of JKN is still high. Monitoring and evaluation is needed by the Local Health Office to improve the quality of the referral system that applied in the newly JKN era. Keywords:accuracy of referrals,BPJS, JKN, obstetric emergencies, referral system. Abstrak Tujuan: Mengetahui gambaran kasus rujukan obstetri di IGD RSCM dan ketepatan pelaksanaan rujukan. Metode: Deskriptif desain studi potong lintang. Data diambil dari rekam medis pasien obstetri di IGD RSCMpada bulan Januari 2013 hingga Desember 2014, kemudian informasi mengenai data dan karakteristik pasien dikumpulkan. Ketepatan pelaksanaan rujukan kasus gaat daraurat obstetri berdasarkan Krietria gawatdarurat bagian kebidanan menurut ketentuan BPJS Kesehatan. Hasil: Perujuk terbanyak adalah Puskesmas (FKTP). Kasus rujukan dengan ketidaksesuaian diagnosa lebih banyakjumlahnya pada saat JKN mulai diterapkan pada tahun 2014 sebesar 21.2%. Kasus dengan diagnosa yang tidak tepat rujuk lebih banyak pada saat JKN di laksanakan yaitu sebesar 16.8% dan kasus rujukan yang bukan gawatdarurat sebesar 6.9% pada tahun 2014. Kesimpulan: Pelaksanaan rujukan belum efisien dan efektif, jumlah rujukan obstetri ke IGD RSCM yangsebenarnya dapat ditangani di fasilitas kesehatan tingkat lanjutan sekunder setelah penerapan JKN masih tinggi. Dibutuhkan monitoring dan evaluasi oleh Dinas Kesehatan setempat untuk meningkatkan kualitas sistem rujukan yang berlaku di era JKN yang baru diterapkan. Kata kunci : BPJS, gawat darurat obstetri, JKN, ketepatan rujukan, sistem rujukan.