Volume 3 Number 4 April 2024

E-ISSN: 2963-2900 | P-ISSN: 2964-9048

https://jmi.rivierapublishing.id/index.php/rp

The Relationship of Risk Factors with Preterm Labor at Ummi Bogor Hospital in
2022

Inna Noor Inayati1, Ade Ineu Martini2

Akademi Kebidanan Bandung Yayasan Ciara Putri1, Rumah Sakit Ummi Bogor2
Email: [email protected], [email protected]

Abstract
Preterm labor causes abnormalities in the baby and perinatal death. The exact cause of
preterm labor is not yet known, but maternal and pregnancy risk factors can cause it. This
study analyzes the relationship between risk factors and preterm labor at Ummi Bogor
Hospital Bogor in 2022. The research method uses an observational analytical design of
retrospective case-control design. The population is all mothers at Ummi Bogor Hospital
Bogor who gave birth prematurely in 2022, as many as 213 people. Bivariate analysis
technique using chi-square test. Respondent characteristics were 64.8% of mothers aged 20-
30 years, 60% multipara, 86.9% with singleton pregnancies, 82.2% with HAP, 71.4% with
KPD, 75.5% with PEB, and 97.7% with fetal distress. The results of bivariate analysis used
che square test of age p values (p = 0.846), p parity (p = 0.161), p game (0.118), p HAP (p =
0.354, p KPD (p = 0.861), p PEB (p = 0.404) and p Fetal distress (p = 0.252). In conclusion,
there is no relationship between age, parity, gameli, HAP, KPD, PEB, and fetal stress factors
for preterm labor at Ummi Bogor Hospital Bogor in 2022.

Keywords: Preterm Labor, Relationship, Risk Factors.

Corresponding Author; Inna Noor Inayati
E-mail: [email protected]

Introduction
Preterm labor, according to World Health Organization (WHO), is the birth of a baby
before 37 weeks of pregnancy and is one of the highest causes of infant mortality in the world.
As many as 75% of perinatal deaths are caused by prematurity, especially babies with a
gestational age of <32 weeks who cannot survive within the first year. Premature babies are
generally caused by pregnancy complications that make the mother's womb in womb weak so
that the fetus must be born immediately (Fikawati et al., 2015).
Preterm labor is too early labor, which occurs at more than 20 weeks gestation and before
37 weeks (Simhan, 2020). Globally, the rate of preterm births from 2000 to 2014 increased by
8.5%, amounting to 16% of under-five deaths caused by premature birth and causing newborn
deaths by 35% (Chawanpaiboon et al., 2019).
The cause of preterm labor is not known for sure. However, the incidence of early birth is
thought to come from the condition of the mother before pregnancy, such as merorok, often
exposed to exposure to cigarette smoke, excessive alcohol consumption, or complications
experienced by mothers during pregnancy. Factors that affect preterm labor are as follows:
Maternal factors are less than twenty years old or over 35 years, the distance between pregnancy
and childbirth is too close, chronic maternal diseases such as hypertension, heart, blood vessel
disorders (smokers), nutrition during pregnancy is lacking, work factors that are too heavy.
Pregnancy factors are premature rupture of membranes (KPD), pregnancy with hydramnios,

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multiple pregnancies (game), Haemoragic antepartum/antepartum hemorrhage (APH),

pregnancy complications such as preeclampsia (PE) and eclampsia, history of abortion and
premature. Fetal factors are congenital disabilities and infections in the uterus.
The impact of preterm labor is not only on perinatal death but premature babies are often
accompanied by abnormalities, both short-term and long-term abnormalities. Short-term
abnormalities often occur in RDS (Respiratory Distress Syndrome), intra/periventricular
hemorrhage, NEC (Necrotizing Entero Colitis), broncho-pulmonary dysplasia, sepsis, and ductus
arteriosus patent. Long-term disorders are often cerebral palsy, retinopathy, mental retardation,
neurobehavioral dysfunction, and poor school performance. Another side that must be considered
in handling preterm babies, especially babies with deficient birth weight (< 1,500 grams), is very
expensive and requires much energy.
In 2021, 348 babies were born with low birth weight (BBLR) in Bogor City. The number
of BBLR babies in each sub-district is different; the most is found in North Bogor District, which
has 83 babies. Then followed by West Bogor District, with 77 babies; South Bogor, with 65
babies; Tanah Cereal, with 58 babies; Central Bogor, with 37 babies; and the least in East Bogor
District, with 28 babies. Problems, especially in premature birth, occur due to immaturity of the
organ system in the baby.
Based on data from the Obstetrics Register of Ummi Bogor Hospital (RS), the number of
deliveries in 2021 amounted to 2183, consisting of spontaneous labor and delivery with sectio
caesarea (SC). Of the 2183 deliveries, 197 preterm labors or preterm labor were found at Ummi
Bogor Hospital and the causes consisted of premature contractions as many as 66 cases (33.5%),
premature rupture of membranes (KPD) 46 cases (23%), PEB (Severe preeclampsia) 32 cases
(16.24%), gemeli 25 cases (12.6%), Antepartum Haemoragic (APH) 18 cases (9.13%), eclampsia
5 cases (2.53%), fetal distress 5 cases (2.53%). Based on the initial survey above, researchers are
interested in researching "The Relationship of Risk Factors with Preterm Labor at Ummi Bogor
Hospital in 2022".

Research Methods
This research uses a research design of an analytical survey. This research design is a case-
control with a retrospective approach to determine the relationship between risk factors and
preterm labor at Ummi Bogor Hospital Bogor in 2022. The population in this study was all
mothers with preterm labor, totaling 213 cases. The sample of this study used total sampling.
Total sampling is a technique where the number of samples equals a population of 213 cases. The
dependent variable is preterm labor. The independent variables were risk factors consisting of
age, parity, gamely, Haemoragic Antepartum (APH), Early Rupture of Membranes (KPD),
Preeclampsia (PE), and Fetal distress. The type of instrument used in data collection in this study
is an observation sheet of secondary data documentation. Data collection will be done using
secondary data obtained from medical record data through the therapeutic system. The type of
instrument used in data collection in this study is an observation sheet of secondary data
documentation. The analysis in this research uses the SPSS application. Data analysis was carried
out univariately to obtain the frequency distribution of risk factors, and bivariate analysis was
carried out using the Chi-Square test. The Chi Square test itself aims to test the relationship or
influence of two other variables. In this study, the chi square test was used to test the relationship
between risk factor variables and preterm labor. For example, the significance value is p<0.05. In
that case, H1 is accepted, and Ho is rejected, which means there is an association between risk

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Inna Noor Inayati, Ade Ineu Martini

factors and preterm labor. If p> 0.05, Ho is accepted, and H1 is rejected, meaning there is no
association between risk factors and preterm labor.

Results and Discussion

1. Univariate Analysis
This analysis was conducted to obtain the frequency distribution of risk factors: age, parity,
gameli, APH, KPD, PE, and fetal distress as the independent variable and preterm labor as the
dependent variable. After the study was carried out, the following frequency distribution data
were obtained:
a. Risk factors for maternal age in preterm labor at Ummi Bogor Hospital
Table 1. Risk Factors for Maternal Age in Preterm Labor at Ummi Bogor Hospital
Age Frequency Percentage
< 20
years
20 –
9 4,23%
35
138 64,79%
years
66 30,99%
> 35
years
old
Total 213 100,0%
Table 1 above shows that of the 213 respondents, 138 people aged 20-35 years
(64.79%), while those aged >35 years, as many as 66 people (30.99%).

b. Risk factors for parity in preterm labor at Ummi Bogor Hospital.

Table 2. Risk Factors for Parity in Preterm Labor at Ummi Bogor Hospital
Parity Frequency Percentage
Primi 61 28,6%
Multi 130 61,0%
Grande 22 10,3%
Total 213 100,0%
Table 2 above shows that of 213 respondents, multipara as many as 130 people (61.0%)
and primipara as many as 61 people (28.6%).

c. Risk factors for preterm labor at Ummi Bogor Hospital.

Table 3. Risk Factors for Gemeli in Preterm Labor at Ummi Bogor Hospital
Gemeli Frequency Percentage
Yes 28 13,1%
Not 185 86,9%
Total 213 100,0%
Table 3 above shows that of the 213 respondents who experienced Gemeli pregnancy,
as many as 28 people (13.1%), while those who did not experience Gemeli pregnancy, as
many as 185 people (86.9%).

d. Risk Factors for APH in Preterm Labor at Ummi Bogor Hospital.

Table 4. Risk Factors for APH in Preterm Labor at Ummi Bogor Hospital
APH Frequency Percentage

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Yes 38 17,8%
Not 175 82,2%
Total 213 100,0%
Table 4 above shows that of the 213 respondents who experienced APH, as many as 38
people (17.8%), while those who did not experience APH, as many as 175 people (82.2%).

e. Risk factors for KPD in Preterm Labor at Ummi Bogor Hospital.

Table 5. Risk Factors for KPD in Preterm Labor at Ummi Bogor Hospital
KPD Frequency Percentage
Yes 61 28,6%
Not 152 71,4%
Total 213 100,0%
Based on table 5 above shows that of the 213 respondents who experienced KPD, 61
people (28.6%) and 152 people (71.4%) did not experience KPD.

f. Risk Factors for Preeclampsia in Preterm Labor at Ummi Bogor Hospital.

Table 6. Risk Factors for Preeclampsia (PE) in Preterm Labor at Ummi Bogor
Hospital
PE Frequency Percentage
Exist 52 24,4%
None 161 75,6%
Total 213 100,0%
Table 6 above shows that 213 respondents experienced preeclampsia, as many as
52 people (24.4%), while those who did not experience preeclampsia, as many as 161 people
(75.6%).
Table 7. Risk Factors for Fetal Distress in Preterm Labor at Ummi Bogor
Hospital
Fetal
Frequency Percentage
distress
Yes 5 2,3%
Not 208 97,7%
Total 213 100,0%
Based on table 7 above shows that of 213 respondents who experienced fetal distress,
as many as 5 people (2.3%), while those who did not experience fetal stress, as many as 208
people (97.7%).

2. Bivariate Analysis
Bivariate analysis was conducted to determine the relationship between risk factors for
age, parity, gamely, APH, KPD, Preeclampsia, and fetal distress as independent variables and
preterm labor as the dependent variable. After the analysis was carried out, the following results
were obtained:
a. The relationship between maternal age and preterm labor at Ummi Bogor Hospital
Table 8. The Relationship between Maternal Age and Preterm Labor at Ummi Bogor
Hospital
Fact P
or va
Not Yes Total
Ris lu
k e

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n %n % n %
0,
Age 84
6
<20 0, 4,
3.8
year 8 1 5 9 2
0%
s % %
20-
60. 4. 64
35 12 1 13
10 70 ,8
year 8 0 8
% % %
s
>35 1,
29, 31
year 62 4 9 66
1% %
s %
10
Su 19 93 1 7 21
0
m 8 % 5 % 3
%
Based on Table 8 above, statistical tests using chi-square on the age variable we obtained a
correlation coefficient value of 0.846 because of the significance value of p> 0.05, then Ho was
accepted, meaning there was no relationship between age and regulatory labor at Ummi Bogor
Hospital.

b. Parity relationship with preterm labor at Ummi Bogor Hospital

Table 9. Parity Relationship with Preterm Labor at Ummi Bogor Hospital
P
Fact va
or Not Yes Total
lu
Ris e
k
n % n % n %
0,
Pari
16
ty
1
Pri 5 25, 3,3 6 28,6
7
mi 4 4% % 1 %
1 1
Mul 57, 3,8
2 8 3 61%
ti 3% %
2 0
Gra 2 10, 0 2 10,3
0
nde 2 3% % 2 %
1 2
Su 93 1 7 100
9 1
m % 5 % %
8 3
Based on Table 9 above, statistical tests using chi-square on the parity variable we obtained
a correlation coefficient value of 0.161 because of the significance value of p> 0.05, then Ho was
accepted, meaning that there was no relationship between parity and regulatory delivery at Ummi
Bogor Hospital.

c. The relationship between gambling and preterm labor at Ummi Bogor Hospital
Table 10. Gameli's Relationship with Preterm Labor at Ummi Bogor Hospital
Fact P
Not Yes Total
or va

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Ris lu
k e
n % n % n %
0,
Ge
11
meli
8
1 1
79, 1 7 86,
Not 7 8
8% 5 % 9%
0 5
2 13, 0 2 13,
Yes 0
8 1% % 8 1%
1 2
Su 93 1 7 100
9 1
m % 5 % %
8 3
Based on Table 10 above, statistical tests using chi-square on the Gemelli variable obtained
a correlation coefficient value of 0.118 because the significance value of p> 0.05, then Ho was
accepted, meaning there was no relationship between Gamely and preterm labor at Ummi Bogor
Hospital.

d. The relationship between HAP and preterm labor at Ummi Bogor Hospital
Table 11. APH Relationship with Preterm Labor at Ummi Bogor Hospital
P
Fact va
or Not Yes Total
lu
Ris e
k
n % n % n %
0,
HA
35
P
4
5,
16 77 1 17 82,
Not 2
4 % 1 5 2%
%
1,
16 17,
Yes 34 4 9 38
% 8%
%
Su 19 93 1 7 21 10
m 8 % 5 % 3 0%
Based on Table 11 above, the results of statistical tests using chi-square on the APH variable
obtained a correlation coefficient value of 0.354 because the significance value of p> 0.05, then
Ho was accepted, meaning that there was no relationship between APH and preterm labor at
Ummi Bogor Hospital.

e. The relationship between KPD and preterm labor at Ummi Bogor Hospital
Table 12. The Relationship between KPD and Preterm Labor at Ummi Bogor Hospital
Fa P
cto Not va
Yes Total
r lu
Ris e
k n % n % n %
0,
KP
86
D
1

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66 5,
No 14 1 15 71,
,2 2
t 1 1 2 4%
% %
26 1,
Ye 28,
57 ,8 4 9 61
s 6%
% %
Su 19 93 1 7 21 10
m 8 % 5 % 3 0%
Based on table 12. above, the results of statistical tests using chi-square on the KPD variable
obtained a correlation coefficient value of 0.861 because the significance value of p> 0.05, then
Ho was accepted, meaning there was no relationship between KPD and preterm labor at Ummi
Bogor Hospital.

f. The relationship between Preeclampsia (PE) and preterm labor at Ummi Bogor Hospital
Table 13. The Relationship between PE and Preterm Labor at Ummi Bogor Hospital
P
Factor Not Yes Total
value
Risk
n % n % n %

PE 0,404

None 151 70,9% 10 4,7% 161 75,6%

Yes 47 22,1% 5 2,3% 52 24,4%

Sum 198 93% 15 7% 213 100%
Based on Table 13 above, the results of the statistical tests used chi-square. In the
Preeclampsia variable, a correlation coefficient value of 0.404 was obtained because of the
significance value of p> 0.05, and then Ho was accepted, meaning that there was no relationship
between Preeclampsia and Preterm labor at Ummi Bogor Hospital.

g. The fetal relationship is stressed with premature labor at Ummi Bogor Hospital.
Table 14. Fetal Relationship Stressed with Preterm Labor at Ummi Bogor Hospital
Not Yes Total P
va
HIS
n % n % n % lu
e
Fet
0,
al
25
dist
2
ress
1 6, 97
91,1 1 20
Not 9 6 ,7
% 4 8
4 % %

0, 2,
1,9
Yes 4 1 5 5 3
%
% %
1 10
Su 1 7 21
9 93% 0
m 5 % 3
8 %

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Based on Table 14 above, the results of statistical tests using chi-square on the variable Fetal
stress obtained a correlation coefficient value of 0.252 because the significance value of p> 0.05,
then Ho was accepted, meaning that there was no relationship between Fetal stress and preterm
labor at Ummi Bogor Hospital.

Discussion
The relationship of maternal age risk factors with preterm labor
Healthy reproductive age for pregnancy ranges from 20-35 years. This is based on the
incidence of maternal mortality in pregnant women and childbirth at the age of under 20 years,
which is 2 to 5 times higher than maternal mortality at the age of 20 to 35 years, after the age of
35 years, maternal mortality rates increase
Age or age is the length of time lived or since birth. Age greatly determines a mother's
health and the mother is said to be at high risk if pregnant women are under 20 years old and over
35 years old. Age helps to anticipate the diagnosis of health problems and the actions taken
(Walyani, 2015). In this study, there were 138 respondents (64.79%) pregnant at a healthy
reproductive age, namely 20-35 years, 66 respondents (30.99%) pregnant at the age of 35 years,
and 9 respondents (4.23%) pregnant at the age of <20 years. Age factors that are prone to
pregnancy are ages that are more or less than healthy reproductive age, namely <20 years and >35
years. The age of the mother is <20 years, and the uterus and pelvis are often immature and have
not reached adult size, and organs are still in doubt, so pregnant women are at risk of premature
labor, and pregnant women aged >35 years have a greater risk than the age of mothers between
20-35 years because older pregnant women, the reproductive function begins to decline and
physical strength has also decreased so that it affects the development and growth of the fetus and
allows the occurrence of preterm labor.
Based on the theory and research above, researchers argue that the cause of premature
labor at the age of <20 years is because a woman's reproductive organs are not mature enough to
be fertilized and seen from the mindset of not understanding enough with pregnancy plus the lack
of antenatal care and attention from family and husband, causing mothers to know less about the
symptoms of danger in pregnancy. At the same time, the cause of premature labor at the age of
>35 years is because the female reproductive organs experience the aging process, which can
cause difficulties in labor and can cause death to the mother. Judging from the pattern of thinking,
mothers will tend to be lazy to check pregnancy because they feel they already have experience
in pregnancy and childbirth. In contrast, at the age of >35 years, mothers are advised to check
more pregnancies because there is a possibility that other diseases can arise during this pregnancy
or diseases that the mother has suffered can become increasingly threatening to the health of the
mother and fetus.
In theory, it is stated that pregnant women under the age of < 20 years have psychological
and physical conditions, and the fulfillment of nutrition and nutrition is still somewhat lacking.
At the age of >35 years often arise diseases such as hypertension or diabetes mellitus, which will
result in the inhibition of fetal food entering through the placenta.
The results of bivariate analysis in this study with statistical tests using Chi Square In the
age variable, the correlation coefficient value p = 0.846 was obtained because the significance
value of p > 0.05, then Ho was accepted, meaning that there was no relationship between age and
preterm labor at Ummi Bogor Hospital. The results of this study contradict the theory and research
conducted by Drastita et al. in 2022, which states that maternal age has a statistically significant
relationship with premature labor (Drastita et al., 2022). However, the results of this study are by

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Rahmawati et al. who show there is no relationship between age and preterm labor because
preterm labor is Multifactorial, Where each factor has an attachment of one factor to another
factor that causes premature labor. This is in line with the research of Mutiara et al., who stated
that the test results for the Contingency Coefficient Exhibited a moderate relationship between
age and preterm labor. The moderate relationship category indicates that other factors can lead to
preterm labor apart from the mother's age, including preeclampsia, malnutrition, anemia, and low
socioeconomic (Rahmawati et al., 2021).

The association of parity risk factors with preterm labor

Parity is a condition related to the number of children born to the mother. The safest parity
regarding health and maternal mortality rate is 2-3 children. Parity >3 has a higher maternal
mortality rate. Risks at parity 1 can be managed with good obstetric care. In contrast, family
planning can reduce risks at high parity or prevent risks. Most pregnancies at high parity are
unplanned (De Dwijasistawati, Ariyani, & Sulaksana, 2023).
In this study, there were 130 multipara respondents (61.0%), 61 primipara (28.6%), and
22 grande-multi people (10.2%). Based on the theory, researchers argue that the health risks of
the mother and child increase in the first, fourth, and so on. First, pregnancy and childbirth
increase health risks that arise because the mother has never experienced a pregnancy before,
where the new birth canal will be tried to pass by the fetus. Conversely, if you give birth too often,
the uterus will become weaker because of uterine scarring due to repeated pregnancies, causing
an inadequate blood supply to the placenta so that the placenta does not get enough blood flow to
channel nutrients to the fetus as a result of which fetal growth is disrupted. Therefore, the mother
should plan more pregnancies to avoid risks (Ulfah & Sari, 2019).
In mothers with parity > 3 with a low economic level, it will affect the provision of funds
for pregnancy checks because to save these expenses, sometimes mothers cannot check their
pregnancies regularly, so they do not get enough information about pregnancy, even though the
mother already has experience in childbirth, mothers should anticipate bad possibilities. Pregnant
women who do not undergo antenatal care or do little and who have previously experienced
preterm labor are at higher risk (Solama, 2019).
The results of bivariate analysis in this study with statistical tests using Chi Square In the
parity variable, a correlation coefficient value of 0.161 was obtained, because the significance
value of P> 0.05, then Ho was accepted, meaning that there was no relationship between parity
and regulatory delivery at Ummi Bogor Hospital.
This result is from research conducted by Dwijasistawati et al., which stated that there
was no relationship between parity and the incidence of preterm labor with a value of p = 0.474.
(De Dwijasistawati et al., 2023).
In the study, Hanifah stated there was no relationship between parity or the number of final
deliveries in mothers and preterm labor (Hanifah1 & Wahyuningsih, 2017).
This study's results differ from the research conducted by Rahmawati et al., who stated
that there was a meaningful relationship of parity to preterm labor with a value of p = 0.007.
Parity is the number of deliveries that a mother has experienced, both live and stillbirth.
Mothers with a parity of more than three have a high mortality rate due to endometrial disorders.
At first, parity is risky because the uterus is the first time it receives the results of conception, and
the flexibility of the uterine muscles is still limited for fetal growth.

The association of gamely risk factors with preterm labor

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Gemeli pregnancy triggers preterm labor because it causes overdistension, which results
in retraction due to earlier uterine muscle tension that triggers the Braxton Hicks process;
contractions are more frequent and become labor contractions. In gemel pregnancy, there is also
stretching of the uterine muscles, which induces the formation of Gap junction, increased
regulation of oxytocin receptors, and production of prostaglandins E2 and F2 that will cause
uterine contractions and cervical dilation that induce preterm labor.
In the results of this study, respondents with Gemelli as many as 28 people (13.1%) and
not Gemelli as many as 185 people (86.9%). The results of bivariate analysis in this study with
statistical tests using Chi Square In the Gemelli variable, a correlation coefficient value of 0.118
was obtained because the significance value of p> 0.05, then Ho was accepted, meaning that there
was no relationship between gameli and preterm labor at Ummi Bogor Hospital. This study's
results align with Dwijasistawati et al.'s research, which showed no relationship between twin
pregnancies and the incidence of preterm labor in UPT. Tembuku I Health Center for 2020-2021
with a value of p = 0.061. (De Dwijasistawati et al., 2023).
This study's results align with Kiran's research, which states that the incidence of preterm
labor between Gemelli pregnancy and single pregnancy in Kanpur, India (p = 0.142) has no
significant difference.
In addition, Amini's research states that there is no relationship between twin pregnancies
and preterm labor.
This study is different from research conducted by Hanifah, which states that game has a
significant relationship with the incidence of preterm labor p = 0.03 and 3.3 times more risk of
preterm delivery compared to mothers with single pregnancies (Hanifah1 &; Wahyuningsih,
2017)
Pregnancy with two or more intrauterine fetuses is called a twin pregnancy, this
pregnancy can cause a higher risk of complications, experience hyperemesis gravidarum,
hypertension in pregnancy, pregnancy with hydramnios, labor with fewer months, and stunted
fetal growth. Pregnancy with two or more intrauterine fetuses is called a twin pregnancy, this
pregnancy can cause a higher risk of complications such as hyperemesis gravidarum, hypertension
in pregnancy, pregnancy with hydramnios, labor with fewer months, and stunted fetal growth.
Mother and fetus must get close observation so as to prevent complications, and
pregnancy care and antepartum management are needed. Monitoring in gemeli pregnancy should
be routinely done, mothers with gemeli pregnancy are recommended to perform sonography
examination to assess fetal growth and amniotic fluid once every 4 weeks for monochorionic twin
pregnancies and once every 6 weeks in gameli pregnancy.

Association of Antepartum Distribution (APH) risk factors with preterm labor

Based on the research results by Rosenberg et al., APH during pregnancy has a risk of
2.86 times the chance of low birth weight (BBLR). Maternity mothers with APH tend to cause
babies to be born with low birth weight (BBLR).
In the results of this study, respondents who experienced APH 38 people (17.8%) and did
not experience APH 175 people (82.2%). The results of bivariate analysis in this study with
statistical tests using Chi Square In the APH variable, a correlation coefficient value of 0.354 was
obtained because the significance value of p> 0.05, then Ho was accepted, meaning that there was
no relationship between APH and preterm labor at Ummi Bogor Hospital.

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This study is in line with the research of Olusanya et al., who, after a multivariate analysis
of logistic regression, stated that antepartum hemorrhage did not influence the incidence of low
weight.
The results of this study are not in line with the research (Oğlak et al., 2022), which states that
bleeding during pregnancy increases twice the occurrence of babies with low birth weight (BBLR)
(Oğlak et al., 2022).
APH increases the risk of preterm labor, this is due to heavy bleeding in the mother so
that the mother and fetus need quick treatment so that the mother does not experience anemia and
the fetus does not experience hypoxia. Efforts for this treatment are to give birth to a fetus even
though the gestational age is still premature. APH often occurs due to placenta previa totalis,
which causes hefty bleeding and treatment by giving birth to a fetus even though the age is still
premature (Dewi et al., 2019).

Association of KPD risk factors with preterm labor

Early rupture of membranes (KPD) is the rupture of membranes before signs of labor,
waiting one hour before the start of labor signs. Factors that cause rupture of amniotic membranes
are the presence of uterine hypermotility that has long occurred before the membranes rupture,
amniotic abnormalities, namely amniotic membranes are too thin, predisposing factors such as
multipara, malposition, disproportion, cervical incompetence and artificially premature rupture of
membranes. The cause of the lack of connective tissue and vascularization in the amniotic
membrane is very weak and easily ruptures by removing amniotic fluid (Sari, n.d.).
In the results of this study, respondents who experienced KPD were 61 people (28.6%)
and did not experience KPD as many as 152 people (71.4%). The results of bivariate analysis in
this study with statistical tests using Chi Square In the KPD variable, a correlation coefficient
value of 0.861 was obtained, because the significance value of p > 0.05, then Ho was accepted,
meaning that there was no relationship between KPD and preterm labor at Ummi Bogor Hospital.
These results are based on Amini's research, which states that the occurrence of preterm
labor is not associated with KPD.
The results of this study are not in line with Hanifah's research, which states that there is
a relationship between KPD and the incidence of preterm labor (Hanifah1 & Wahyuningsih,
2017).
And research by Drastita et al that KPD has a statistically significant relationship with
the occurrence of preterm labor (Drastita et al., 2022).
The difference in research can be caused by the level of regularity of pregnancy checks
in pregnant women, where pregnancy checks provide predictions of essential health problems,
including disease prevention, screening, and promotion of good health to prevent preterm labor
(Akhtar et al., &; Afzal, 2018).

Association of risk factors for Preeclampsia (PE) with preterm labor

Hypertension in pregnancy is the cause of maternal and fetal death. Hypertension
accompanied by increased urine protein can cause preeclampsia/eclampsia. Preeclampsia-
eclampsia can cause the mother to experience more severe complications, this happens because
preeclampsia affects the arteries that carry blood to the placenta. Suppose the placenta does not
get enough blood. In that case, the fetus will experience a lack of oxygen and nutrients, such as
placental abruption, brain hemorrhage, and acute brain failure. Fetuses from mothers who
experience preeclampsia increase the risk of premature birth, inhibition of fetal growth in utero

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 Indonesian Multidisciplinary Journal

(IUGR), and hypoxia. So, most pregnancies with Preeclampsia and Eclampsia are handled by
giving birth to a fetus even though the age is still premature before further complications occur.
In the results of this study respondents with Preeclampsia 52 people (24.4%), and those
without Preeclampsia 161 people (75.6%). The results of bivariate analysis in this study with
statistical tests using Chi Square In the Preeclampsia variable, a correlation coefficient value of
0.404 was obtained because the significance value of p> 0.05, then Ho was accepted, meaning
that there was no relationship between Preeclampsia and Preterm labor at Ummi Bogor Hospital.
This result is by Amini's research, which suggests that) The results of the study value p = 0.647
mean that there is significantly no relationship between preeclampsia and preterm labor.
This is in line with Asih's research, which states that no relationship exists between
hypertension and the incidence of preterm labor (Asih & Sagita, 2020).
The results of this study are not in line with the research of Carolin et al., which states
that there is a significant relationship between preeclampsia and preterm labor (Carolin &
Widiastuti, 2019).
According to (Imran, Prawiroharjo, &; Mawi, 2016), In mild preeclampsia, it is better to
wait until the fetus is almost term, for example, 37 weeks. Conversely, if preeclampsia is severe,
according to experts, the chances of life for the fetus are better outside the womb than inside.
High blood pressure causes decreased blood flow to the placenta, resulting in impaired function
of the placenta, so helpers tend to terminate the pregnancy. This causes the prevalence of preterm
labor to increase.

Association of risk factors for fetal distress with preterm labor

Fetal distress refers to conditions when fetal development in the womb is not smooth.
This condition, which is also referred to as fetal distress, is often a sign that the supply of oxygen
to the baby's brain is inadequate. Suppose the underlying problem that triggers this condition is
not treated immediately. In that case, severe brain injury can occur, causing other problems, such
as developmental delays or cerebral palsy (Trisetiyaningsih et al., 2018).
In this study, respondents with Fetal distress 5 people (2.3%) and did not experience
Fetal distress 208 people (97.7%).
The results of the bivariate analysis in this study with statistical tests using Chi-Square
on variables of Fetal distress obtained a correlation coefficient value of 0.252; because the
significance value of p is 0.05, then Ho is accepted, meaning that there is no relationship between
Fetal distress against preterm labor at Ummi Bogor Hospital.
The results of this study are not in line with Hasritawati's research, which states that there
is a relationship between gestational age factors and the occurrence of Fetal distress (Study
Program III & Kebayakan, 2017).
According to the theory of pregnancy over time, premature pregnancy is one of the most
risky pregnancies. A premature fetus will undoubtedly be smaller, and the poster may be more
significant. The gestational age has reached 42 weeks, complete or more, calculated from the first
day of the last menstruation. This can cause more significant harm and complications both to the
mother and to the fetus she conceived during pregnancy, childbirth, or puerperium. Moreover, in
late labor, the mortality and morbidity rates are very high when compared to normal pregnancies.

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The Relationship of Risk Factors with Preterm Labor at Ummi Bogor Hospital in 2022
Inna Noor Inayati, Ade Ineu Martini

Conclusion
Based on the results of the research described above, it can be concluded that maternal age,
parity, gameli pregnancy, KPD, APH, Preeclampsia, and Fetal distress do not have a significant
relationship in the incidence of preterm labor.
Advice for midwives and health workers to always detect problems and emergencies in
pregnancy care early by paying attention to risk factors for preterm labor as a form of anticipation
and preventive action in reducing the incidence of preterm labor.
Advice to be expected to check her pregnancy regularly and regularly to midwives or other
health workers so that mothers who have a high risk of preterm labor can be known as early as
possible and get education related to factors that can cause preterm labor so that prevention can
be done appropriately and quickly.

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