The Effect of Giving Gabus Fish on the Healing Process of

Postoperative Sectio Caesarean

Tetty Junita Purba, Andayani Boang Manalu, Putri Ayu Yessy Ariescha, Mutiara Dwi Yanti,

Rostiodertina Girsang, Eka Sri Wahyuni

Midwifery Faculty, Health Institute of DELI HUSADA

Deli Tua

Keywords: Gabus fish; wound healing, postoperative cesarean section

Abstract: This study is based on the high incidence of postoperative sectio cesarean wound infections ranging from

30-50%. According to the local community, Gabus fish has the efficacy of speeding up the process of

healing post-operative caesarean wounds. The study aims to determine the effect of Gabus fish on the

healing process of sectio caesarean. This research used quasi experiment method, which were an

intervention group and a control group and a sample of 34 mothers. Data were analyzed by using the

Fisher's Exact Test with the Spearman's correlation test, the results obtained by the majority of the

intervention group experienced rapid wound healing by 14 people (82.4%) and the control group

experienced slow wound healing by 13 people (76.5%). Statistical test results show that p value = 0.002 <α

= 0.05, then H0 is rejected, which is the effect of Gabus fish on the healing process of postoperative

caesarean wounds. In conclusion, Gabus fish consumption can accelerate healing postoperative wounds of

caesarean section around 82.4%.

1 INTRODUCTION

Sectio caesaria is a surgery to give birth to children

through an incision in the abdominal wall and uterus

(Oxorn & Forte, 2018). According to the World

Health Organization (WHO) for 2010, the average

standard for performing sectio caesarea in a country

is around 5-15% per 1000 births in the world. The

labor increase with sectio caesarea in all countries

during 2008 - 2010 was 110.000 per birth in all of

Asia (Kounteya, 2012). According to the Basic

Health Research (2013), there were 45937 deliveries

rate in North Sumatra as many as 9253 sectio

Caesarea (20.1%) with infection rates of post-sectio

caesarean scar after birth ranged from 30-50%. From

the above data, it shows that the incidence of section

cesarean infection in North Sumatra is quite high.

The use of Gabus fish extract is based on the

nutritional content of fish which is rich in albumin.

Albumin is a protein content with the most volume

or amount in the blood. In the process of healing or

wound recovery, albumin is very important because

it is in the process cell metabolism, albumin plays a

role in the formation of new cell tissue. By

Therefore, albumin is suitable for stimulating the

formation of new cells damaged by surgery during

surgery. The use of Gabus fish extract has greatly

developed in medicine or postoperative care in

humans. This has proven effective in accelerating

the wound healing process

The wound healing process is much influenced

by nutrition, endurance and supplementation. This is

supported by the research result which is conducted

by Setyowati (2010), it is about the relationship

between Gabus fish consumption with post SC

suture wound healing at Private Medical Center

(PMC) of Mrs. Aida Hasnani Nuhu, AMd. Keb.

Beru Village, Dawar Blandong Sub district,

Mojokerto Regency, it is used a Post Test only

control group design with the value results of p =

0.006 <α = 0.05, which means there is a relationship

between Gabus fish consumption with post SC

suture wound healing at PMC of Ny. Aida Hasnani

Nuhu, AMd. Keb. Beru Village, Dawar Blandong

Sub District, Mojokerto Regency. Nutrition that is

needed for wound healing is to consume foods that

are high in protein. Protein is found in food, meat

and fish. All types of fish are excellent sources of

protein. Gabus fish are known as fish with more

nutritional and protein content than other types of

Purba, T., Manalu, A., Ariescha, P., Yanti, M., Girsang, R. and Wahyuni, E.

The Effect of Giving Gabus Fish on the Healing Process of Postoperative Sectio Caesarean.

DOI: 10.5220/0009463200430050

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 43-50

ISBN: 978-989-758-460-2

fish such as milkfish (Waryana, 2010, p.76). The

advantage of Gabus fish has a high protein, protein

content per 100 grams of Gabus fish.

According to the Basic Health Research (2013)

Maternal Mortality Rate (MMR) in Indonesia is 250

per 100,000 live births (KH). More than 500,000

Indonesian women die every year. 18,000 deaths

occurred during childbirth caused by bleeding, birth

canal infections, pregnancy poisoning and other

illnesses suffered by the mother. According to the

Basic Health Research (2013) delivery rates in North

Sumatra province were 45937 deliveries with sectio

caesarea delivery at 9253 (20.1%) with infection

rates after birth of sectio caesarea ranging between

3-5% (Mappaware, 2014).

A good level of protein consumption is needed

for the wound healing process. In the end, with a

good consumption pattern and protein consumption

level, it is hoped that the wound healing process can

run perfectly, and avoid the problem of postnatal

infection due to post-cesarean wounds. One of them

is by consuming gabus fish (Purwaningsih, 2010).

Research conducted by Fitriyani (2016) with

titled "Gabus Fish Extract to Accelerate Post

Cesarean Wound Recovery." This research shows

that Gabus fish extract significantly influences the

speed of wound healing in all objects with

inflammatory symptoms and faster wound

conditions. According to Ulandari et al (2011)

Gabus fish has benefits such as increasing albumin

levels and endurance, accelerating the process of

healing internal and external wounds. Whereas one

of the factors in the process of accelerating wound

healing that it requires high protein found in Gabus

fish. The phenomenon that develops in the

community of North Sumatra Particularly in Deli

Serdang Regency today that there are still many

myths in the community that affect the health of

postpartum mothers, such as it does not allow to

consume food such as eggs, meat, shrimp because it

will aggravate stitches; though these foods are very

important for the wound healing process. Besides

that, the majority of Deli Serdang Regency people

have Gabus fish pond waters because of affordable

and easy to obtain reasons and the call of health

workers who advise post partum mothers to use

Gabus fish in healing post-operative wounds

because the Gabus fish content contains protein and

albumin which is very important for health

(Ghufran, 2010, p.93). Based on research on amino

acids in gabus fish triggers the production of

collagen which can increase the strength and

elasticity of the skin. Assisted by the presence of

glycine, arachidonic acid and fatty acids, gabus fish

has been proven to help accelerate wound healing.

By consuming gabus fish regularly and regularly can

also provide anti-pain effects. In one study it was

said that gabus fish had a content that could increase

the antinociceptive effect.

The effect is able to relieve the pain that occurs

due to injury.

Not only limited to that, anti-pain medication

combined with consumption of gabus fish also

provides a more maximum effect. The study said

that the administration of gabus fish extract can

reduce the intensity of pain felt by patients after

surgery.

Based on research that has been done revealed

that gabus fish has the highest albumin content

compared to sea fish and other freshwater fish like

catfish and carp. Albumin is one important types of

proteins needed by the human body every day even

in the process of healing wounds. Fish gabus has

strategic potential as well as its uses widespread in

the food and pharmaceutical industries. Albumin is a

blood plasma protein which is synthesized in the

heart and plays an important role in guarding plasma

osmotic pressure, transporting molecules small

plasma as well as extra fluid cells as well binding

drugs. In addition, albumin can be used to overcome

various diseases especially those due to the reduced

amount of blood protein, like burns, broken bones,

post surgery, and lung infections. Suprayitno

(2008a) stated gabus fish albumin have a much

better quality than egg albumin commonly used in

healing post-surgical patients. Gabus fish itself,

contains 6.2% albumin and 0.001741% Zn with

essential amino acids namely threonine,valine,

methionine, isoleucine, leucine, phenylalanine,

lysine, histidine, and arginine. As well as non-

essential amino acids including aspartic acid, serine,

glutamic acid, glycine, alanine, cysteine, thyroxine,

hydroxilisin, ammonia, hydroxyproline, and proline.

Related to the content of albumin contained there

gabus fish, obtained data that contains fish albumin

male gabus by 6.7% lower than fish female gabus

that has an albumin level of 8.2%. Albumin which

has such a big role, until now it is still imported in

the form of Human Serum Albumin (HSA) which is

very expensive. For get crude albumin, can be done

with steaming or vacuum extractor to obtain better

yield and quality. Gabus fish through his albumin as

a compiler of HSA can be used as an alternative

availability of nutrients in order to improve nutrition

Indonesian people without using big costs

(Moedjiharto, 2008). The study was conducted in the

treatment of patients using gabus fish that is steamed

for 60 minutes and filtered the water, then drink it in

the patientmpostoperatively for 8 days. The result

will be a patient's wound heal faster and without side

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

effects. This matter due to the high protein content

in fish gabus which functions in the formation of

new cells in the patient's body postoperatively. High

content gabus fish protein can be utilized for

overcome malnutrition. Malnutrition is characterized

by low levels of albumin, are below normal levels

3,5--5,5 g / dl (Suprayitno, 2008b). The phenomenon

that develops in the community at the moment there

are still many myths in the community that influence

health in puerperal mothers, like no allow

consuming food like, eggs, meat, shrimp because it

will aggravate stitches. Though kind these foods are

very important to wound healing process. other than

that the majority of the people of Deli Serdang

Regency are many has cork fishpond waters because

of affordable and easy to obtain reasons as well the

call of health workers who advocate for post partum

mothers to use deep cork fish extract wound healing

due to cork fish content containing protein and

albumin which is very important for health

(Ghufran, 2014).

Based on the above background, the formulation

of the study problem was "The Effect of Giving

Gabus Fish on the Healing Process of Postoperative

Sectio Caesarean in 2019".

2 METHOD

This research is a quantitative study with a Quasi

Experiment method with the treatment and

observation process carried out with a prospective

(time series) where the sample is as a control group

and then used as an intervention group (Nursalam,

2013). The location of this study was conducted at

Sembiring General Hospital. Samples were obtained

by researchers as many as 34 people with a purposive

sampling technique. Purposive sampling is a non-

random sampling technique in which researchers

observe the wound healing process starting on the 7th

day and the 14th day (second week).

This research was conducted by dividing 2

groups, namely the intervention group (given Cork

fish) consisting of 17 people and the control group

(without Cork fish) consisting of 17 people. The

processing of cork fish starts from cleaning cork fish

to cooking it. Cork fish that has been cooked either

fried or in soup was given to the intervention group

for 5 days of administration. Cork fish is given for 5

days post caesarean section operation with

administration @ 100 grams / day. On the 7th and

14th day postoperative wound healing began to be

observed using the wound healing assessment

observation sheet that researchers used containing 5

wound assessment items. Criteria for assessment of

wounds are assessed by 5 criteria, namely no signs of

infection in the wound, no bleeding, formation of

blood clots in fibrin, dry sores and abscesses. This is

measured by the Measurement Scale which is given a

value of 1 if the answer is Yes and given a value of 0

if the answer is No. Then the results of these

observations are grouped in the category of wound

healing which is categorized as Fast if the

respondent's answer is ≥75-100% while it is

categorized as Slow if the respondent's answer <75%.

The statistical formula used to analyze the effect

of giving Gabus fish on post cesarean wound healing

using the Fisher Exact Test with Spearman

Correlation Test significance value p value <0.05.

RESEARCH PROCEDURE STAGE

Figure 1: Research Procedure Stage

The Effect of Giving Gabus Fish on the Healing Process of Postoperative Sectio Caesarean

How to cook gabus fish that is, gabus fish cleaned

and weeded (tail, scales, gills, and entrails) then

washed using clean water 3 times (Sari, 2014) until

there is no blood and mucus, then drained and

weighed. Furthermore, steamed fish with a ratio of

notes between fish and steamed water is 1: 1/3

(Fatmawati, 2014). According to Sari (2014)

steaming for 30 minutes with a temperature of 85-

900C can be obtained the highest levels of albumin

by 24.25%. The purpose of this cooking is to

inactivate enzymes and kill spoilage microbes that

are pathogenic and do not form spores (Sari, 2014).

A good cooking process can affect the organoleptic

value of gabus fish, especially on texture. According

to Irawan (1997) in Fatmawati (2014). The purpose

of cooking both boiling and steaming is done to

maintain the quality of fish meat that is a dense

texture.

Figure 2: Research Flow (a) Gabus Fish, (b) Cooked, (c)

Gabus Fish is ready to be served, (d) Mother eats Gabus

Fish, (e) Surgery wound was observed, (f) Dry wound, (g)

Wound infection

Criteria for assessment of wounds assessed by 5

criteria, namely no signs of infection in the wound,

no bleeding, formation of blood clots in fibrin, dry

sores and non-festering wounds. It is measured by a

Measurement Scale that is rated 1 if Answer Yes and

given a value of 0 if the Answer No. Category in

wound healing is divided by 2 namely Fast: ≥75-

100% while Slow: <75%.

3 RESULTS AND DISCUSSION

3.1 Results of Cross Tabulation Effect

of Gabus Fish Giving against

Healing of Postoperative Caesarean

Sectio Wounds

Based on table 1. it is known that the majority of the

intervention group respondents with fast wound

healing were 14 respondents (82.4%) while the slow

wound healing was 3 respondents (17.6%).

Table 1: Frequency Distribution of Intervention

Groups of Postoperative Sectio Caesarean Mothers

Based on Wound Healing

No.

Recovery

The wound

1 Fast 14 82,4

2 Slow 3 17,6

Total 17 100

Based on table 2. it is known that the majority of the

control group respondents with fast wound healing

were 4 respondents (23.5%) while the slow wound

healing was 13 respondents (76.5%).

Table 2: Frequency Distribution of Control Groups

of Postoperative Sectio Caesarean Mothers Based on

Wound Healing

No.

Recovery

The wound

1 Fast 4 23,5

2 Slow 13 76,5

Total 17 100

Based on Table 3 the results obtained are

respondents who were given Gabus fish

(intervention) with Fast wound healing as many as

14 respondents (41.2%) and Slow wound healing as

many as 3 respondents (8.8%) while the results of

respondents who were not given Gabus fish (control)

with rapid wound healing by 4 respondents (11.8%)

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

and Slow wound healing by 13 respondents (38.2%).

After testing with the Fisher's Exact Test with the

Spearman Correlation test it can be seen that the

significant value of p-value = 0.002 is smaller than

the value of α = 0.05. So from these results it can be

said that there is an effect of giving Gabus fish to the

healing process of postoperative caesarean sores.

Research which is conducted by Indah Setyowati

(2013), in her research on the relationship between

consumption of Gabus fish (Ophiocephalus) with

wound healing of cesarean section stitches at PMC

of Ny. Aida Hasnani Nuhu, AMd.Keb Beru Village,

Dawar Blandong Sub district, Mojokerto Regency, it

is found that half of respondents who were given

Gabus fish (intervention group) as many as 17

respondents which is experienced wound healing in

postoperative sectio cesarean surgery (≤7 days) as

many as 12 respondents (70, 6%). In this case,

Gabus fish as an alternative therapy for wound

healing post sectio caesarean. According to Kelvin

(2014), 100 grams of Gabus fish can get 25.2 grams

of protein; it is higher than chicken (18.2 grams),

beef (18.8 grams) and eggs (12.8 grams), 25.5%

higher than the protein content of milkfish and

snapper (20%), carp (16%), or sardines (21.1%).

Gabus fish is a potential source of albumin and

protein which also contains complete amino acids

and micronutrients. From various case studies and

research it is known that extra Gabus fish can

significantly increase albumin levels in albuminemia

cases and accelerate the process of wound healing in

postoperative cases (Nugroho, 2013).

Table 3: Results of Cross Tabulation Effect of

Gabus Fish Giving Against Healing of Postoperative

Sectio Caesarean Wounds

No Gabus

Fish

Wound Healing Total α P

Val

Fast Slow

N % n % n %

1 Was

given

14 41,2 3 8,8 17 52,9 0,0

0,0

2 Not

given

4 11,8 13 38,

17 47,1

Total 34 100

Based on Table 4, it can be seen that the study is

conducted on 34 respondents, it was divided into 2

groups: the group that was given Gabus fish

(intervention group) was coded I as many as 17

respondents and the group that was not given Gabus

fish (control group) was given code K as many as 17

respondents were known that in the intervention

group with rapid wound healing as many as 14

respondents (82.4%) with slow wound healing only

3 respondents (17.6%). It is found that the control

group with fast wound healing as many as 4

respondents (23.5%) with slow wound healing as

many as 13 respondents (76.5%). Because Gabus

fish is one type of fish whose main content is protein

or albumin which is quite high. While one of the

factors in the process of accelerating the healing of

stitches in post-sectional caesarean stitches that it

requires high protein which is found in Gabus fish.

The Gabus fish protein content is also higher than

food which has been known as a source of protein

such as eggs, chicken meat, and beef. Because of

this content, Gabus fish has very high benefits or

uses to accelerate the healing of post sectio

caesarean wound sutures. This is because the main

content of it is the protein or albumin which is quite

high. So the administration of Gabus fish to healing

postoperative section cesarea is very effective.

Giving cork fish to the treatment group was intended

for accelerate post SC wound healing. Because cork

fish is one types of fish whose main content is its

protein or albumin high enough. While one factor

the process of accelerating wound healing post SC

stitches ie require high protein found in fish cork.

The cork fish protein content too higher than food

ingredients that are so far known as a source of

protein like eggs, chicken meat, or meat cow.

Because of this content, cork fish has the benefits or

uses very high to speed up post SC wound suture

healing. One of the cork fish consumption motivated

by the age of the respondent. Age is quite mature

cause respondents in the treatment group who get

cork fish able realize the importance of consuming

cork fish as an alternative treatment which

accelerates wound healing

the stitches he experienced. This matter also affects

his obedience in consume cork fish for research.

This is in accordance with research conducted by

Prof. DR.

Dr. Nurpudji A. Taslim from the University

Hasanuddin, Makassar which shows patient albumin

levels at Wahidin Hospital Sudiro Husodo Makasar,

South Sulawesi, increased sharply after several times

consuming cork fish. Research A similar action was

also carried out in part General Hospital Dr. Saiful

Anwar Poor. The results of the trial indicate albumin

of a yang level low (1.8 g / dl) becomes normal.

Research conducted at the University Hasanudin

also showed giving Cork fish extract for 10-14 days

can increase blood albumin levels 0.6-0.8 g / dl.

Albumin is a protein the most contained in cork fish

plasma, about 60% of the total plasma, or 3.5 to 5.5

g / dl

(www.sariikankutuk.com/2007).

The Effect of Giving Gabus Fish on the Healing Process of Postoperative Sectio Caesarean

Table 4: Observation Results of Post Partum Wound Heal Observation Based on Visit I (4 days), Visit II (7 Days) and

Visit III (14 Days)

No.

Code

VISITING

Percentage

I II III

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

1 I 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 13 86,7

2 I 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 10 66,7

3 K 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 13 86,7

4 I 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 14 93,3

5 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 100,0

6 K 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 9 60,0

7 K 0 0 0 0 1 0 1 1 1 1 1 1 1 1 1 10 66,7

8 K 1 0 0 0 1 1 1 0 0 1 1 1 1 1 1 10 66,7

9 I 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 14 93,3

10 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 100,0

11 K 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 13 86,7

12 K 0 1 0 0 1 1 1 1 0 1 1 1 1 1 1 11 73,3

13 K 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 10 66,7

14 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 100,0

15 I 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 14 93,3

16 K 0 0 0 0 1 0 1 1 0 1 1 1 1 1 1 9 60,0

17 I 1 0 0 0 1 1 1 0 0 1 1 1 1 1 1 10 66,7

18 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 100,0

19 K 0 0 0 0 1 0 0 1 0 1 1 1 1 1 1 8 53,3

20 K 1 0 0 0 1 1 1 1 0 1 1 1 1 1 1 11 73,3

21 K 0 1 0 0 1 1 1 1 0 1 1 1 1 1 1 11 73,3

22 K 0 0 0 0 1 0 1 1 0 1 1 1 1 1 1 9 60,0

23 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 100,0

24 I 0 0 1 0 1 1 1 1 1 1 1 1 1 1 1 12 80,0

25 I 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 14 93,3

26 K 1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 13 86,7

27 K 1 0 0 0 1 1 1 1 0 1 1 1 1 1 1 11 73,3

28 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 100,0

29 I 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 14 93,3

30 K 0 0 0 0 1 0 0 1 0 1 1 1 1 1 1 8 53,3

31 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 100,0

32 I 1 1 0 0 1 1 1 0 0 1 1 1 1 1 1 11 73,3

33 K 1 0 0 0 1 1 1 1 0 1 1 1 1 1 1 11 73,3

34 K 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 14 93,3

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

4 CONCLUSION

The conclusion of this study is that of 34

respondents who were divided into 2 groups namely

group 1 was the intervention group and group 2 was

the control group. In the control group consisting of

17 respondents it was found that 4 people

experienced rapid wound healing and 13 people

experienced old wound healing while in the

intervention group it was found that from 17

respondents, 14 people experienced rapid wound

healing and 3 people experienced slow wound

healing. And from the Fisher Exact Test results with

the Spearman Correlation test p value = 0.002 <α =

0.05. So it can be concluded that by consuming cork

fish can accelerate wound healing after caesarean

section around 82.4%.

5 SUGGESTION

For education : The results of this study for the Deli

Husada Deli Tua Health Institute can be used as

literature material in the library or data sources,

information sources that can be used as scientific

documentation for further research that requires

input in the form of data or research development

with the same topic

For Hospitals and Patients : The results of this study

for Sembiring Deli Tua General Hospital can take

advantage of the results of this study as a reference

for determining policies in terms of improving the

quality of nursing services in accelerating the

healing of patients with sectio caesarea. Whereas

patients are expected to pay more attention to

nutritious food intake for the next healing process,

especially those that have high protein content, so

that it can more quickly repair body cells that have

been injured due to incorrect operations one with

more regular gabus fish consumption.

For further research, it is expected that the results of

this study can be used as inspiration for further

research and researchers can also further refine the

method used, so that the results are more accurate

and can be used as an alternative therapy for post-

sectional caesarean patients.

ACKNOWLEDGEMENTS

This research was supported by Health Institute of

Deli Husada, Health Institute of Medistra Lubuk

Pakam, Sembiring General Hospital Foundation, and

Medistra Foundation, Indonesia.

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