LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA

BULAN: JANUARI 2018

Jenis
Usia
Persalinan
Kehami Frek
Alamat Pendidikan Pekerjaan Tanggal Lahir Tanggal Anak (SptBKep, Penolong Penyebab Tempat
No. Nama Anak / Orang tua Umur L/P lan saat wensi BB / PB Tempat Melahirkan Komplikasi ibu Jam meninggal
(Puskesmas) Orang tua Orang tua Meninggal ke- Sc, Vacum, Persalinan Meninggal Anak Meninggal
Dilahirk ANC
Drip, Spt
an (mg)
Brach)
1 M. Padli/ Nurlaili Payung, (PKM Keruak) SD IRT 11/30/2017 12/30/2017 1 bln L 39 mg 9x 2 3000/50 SC RSUD Dokter HIV Diare Rumah 17.00 wita

2 Raisa Yonatanu/ Nurhayati Kp.Tengah, (PKM Keruak) TTS IRT 1/12/2018 1/19/2018 7 hr P 41 mg 8x 3 2200/48 Spt.B PKM Keruak Bidan - Atresia Ani RSUP NTB 16.30 wita

3 By. Rohyati Bt. Rimpang,(PKM Keruak) SD IRT 1/14/2018 1/14/2018 0 hr L 40 mg >4x 3 3600/50 Spt.B RSUD Bidan PEB IUFD RSUD 02.00 wita

4 By. Helmi Sungkar Kw. Datuk,(PKM Keruak) SMU IRT 1/10/2018 1/10/2018 0 hr P 39 mg 6x 2 2800/50 Spt.B PKM Keruak Bidan - IUFD PKM 02.30 wita

5 By firman Hamkim Bere Kedit (pkm jerowaru) SD IRT 11/12/2017 1/4/2018 2 bulan L 39 mgg 6x 3 4200/52 Spontan RSUD bidan Penumonia RSUD 09.00 wita

6 By Dwi Linda/Hamdani Jor (pkm Jerowaru) SMA IRT 1/8/2018 1/8/2018 0 hari P 24mgg 4x 1 800 Spontan RSUD Bidan IUFD RSUD 10.25 wita

7 By Nurhidayati/Abdul Azis Moyot (PKM Sakra) SMA Pedagang 1/12/2018 1/12/2018 0 hari P 42 mgg 5x 3 3500/49 SptBKep RSUD Bidan Post terem IUFD RSUD

8 By Isnia/isnia/nasrudin Sakra Selatan (Pkm Sakra) SMP IRT/Tani 1/19/2018 1/21/2018 3 hari L 26 mgg 3x 1 1500/39 SptBKep RSUD Bidan Preterem BBLR RSUD

9 Bayi Ny.Sri Wahyuni Bungtandang,Gn Rajak (pkm rensing) SD/SD IRT/TKI 1/1/2018 1/4/2018 3 hari P 40 mg 7x 4 3,1 / 50 SptBKep polindes gn. Rajak bidan tdk ada aspirasi air susu RSUD 00.30 wita

10 Bayi Ny.Hazpiratul Jannah Bowoh, Pengkelak Mas (pkm rnsing) SMA swasta 1/24/2018 1/24/2018 0 hari L 23 mg 4x 2 500 gr SptBKep RSUD bidan tdk ada IUFD RSUD

11 Bayi Ny.Muliasih Toyang,Borok Toyang(pkm rensing) SMP IRT 1/19/2018 1/19/2018 0 hari L 36 mg 6x 2 3,2 / 50 SC RSUD SPOG PEB,Solutio plaseIUFD RSUD

12 By Shofia Wardani/Abd.Kadir Z Surabaya Utara (pkm Lepak) SI/SI Swasta/tani 1/2/2018 1/2/2018 0 hari L 32mgg 4x 3 900 Spt.B RSUD Bidan IUFD RSUD

13 By Hj muslihan/Salasiah Kuwangwai (Pkm Lepak) SD/TS Tani/tani 1/10/2018 1/10/2018 0 hari L 42 mgg 4x 4 4500/50 SC RSUD Dokter IUFD RSUD

14 Talita Wihya Z/Yuni Hariani/wiranto Gb tengak Surabaya (pkm lepak) SMP/SMP IRT/Tani 1/1/2018 1/11/2018 10 hari P 36mgg 3x 1 2000/45 Spt.B PKM bidan ikterus neo RSUD

15 By Istiharoh/ahmad leming (pkm terara) SMA/S2 IRT/Notaris 1/14/2018 1/14/2018 0 hari L 39mgg 4x 1 3100/50 drip RS risa Dokter IUFD RS

16 By Rusniati/Faozan Grepek (Pkm Terara) SD/SD IRT/Swasta 1/2/2018 1/9/2018 7 hari L 29mgg 5x 2 1200 Spt.B Pkm sakra bidan BBLR Rumah

17 By Rulasmini Rentang (Pkm Sikur) SD/SD IRT 1/8/2018 1/8/2018 0 hari P 36mgg 5x 3 2500/46 P.SPT B RSUD bidan IUFD RSUD

18 By Rohini/ Ld.nangka (Pkm Ld.nangka) SMA Swasta 1/14/2018 1/20/2018 6 hari P 27mgg 4x 3 900 Spt. B kep RSUD bidan partus prematurusBBLR RSUD 01.00 wita

19 by Abdul Majid/siti fatimah Gn.Sepang (PKm Denggen) SMP Pedagang 12/25/2017 12/28/2017 3 hari L 35 mngg 7x 3 2000/45 SC RSUD Dokter gameli BBLR RSUD 23.30 Wita

20 By Siri Maryam/ fitriana Sawing Majidi (PKm Denggen) SMP Karyawan toko 1/28/2018 1/28/2018 0 hari P 24 mngg 4x 1 600 Spt.B kep RSUD bidan anemia ringan IUFD RSUD 16.00 wita

21 Yuda Alinta Utama/ Rida Lailul I/ EkKelayu Sel (Pkm Selong) SMA/SMA IRT/Swasta 2/9/2013 1/25/2018 5 tahun L 40 mgg 8 1 3000/50 Spontan BPS Bidan Kecelakaan RSUP NTB 07.00 wita

22 By Ririn Istiani montong meong, (pkm Lb.Haji) SMA IRT 1/3/2018 1/3/2018 0 hari L 40mgg 8x 1 2000/37 Spt.Bkep RSUD Bidan IUFD RSUD 21.00 wita

23 By Martini Beruk (pkm lb.haji) SMA IRT 1/13/2018 1/13/2018 0 Hari L 28mgg 6x 3 2000/38 Drip RSUD Bidan IUFD RSUD 10.00 wita

24 By Hidayatul Maryani Burne (pkm Lb.haji) SMA IRT 1/27/2018 1/27/2018 0 hari L 34 mgg 10x 3 2900/45 Drip RSUD Bidan IUFD RSUD 09.00 wita

25 By Ny H I Tirtandai (pkm korleko) SD/SD IRT/Tani 1/5/2018 1/5/2018 0 hari P 28mgg 5x 2 600/21 Spt B PKM Bidan gameli+prematur BBLR RSUD 23.30 wita

26 By Ny H II Tirtandai (pkm korleko) SD/SD IRT/Tani 1/5/2018 1/5/2018 0 hari P 28mgg 5x 2 700/23 Spt B PKM Bidan gameli+prematur BBLR RSUD 23.30 wita

27 By Rahmawati Rumbuk (pkm Batuyang) SMP IRT 1/16/2018 1/18/2018 2 hari L 39mgg 6x 2 2000/47 Spontan B BPM Bidan BBLR Rumah 12.00 Wita

28 BY Nurul Aini untas (pkm batuyang) SMP IRT 1/20/2018 1/20/2018 0 hari L 28mgg 4x 2 1700/38 Spontan B Rumah Dukun BBLR RSUD 09.00 wita

29 BY kiswari/nasromi Gbk Daya (pkm Batuyang) SMA IRT 1/18/2018 25/012018 7 hari P 36mgg 2x 1 2800/50 Spontan B PKM Bidan Kelainana BawaaRSUD 21.00 Wita

30 By suryani untas (pkm batuyang) SMK IRT 1/23/2018 1/23/2018 0 hari L 24mgg 4x 2 700/29 Spontan B RSUD Bidan IUFD RSUD

31 By Innayatussakdiah Gn.Malang (pkm Lb.Lombok) SMP Swasta 1/12/2018 1/12/2018 0 hari P 42 mgg 8x 1 4300/50 spontan PKM Bidan tidak ada Distosia bahu PKM 21.30 Wita

32 By sulinah/Kamar Suela (pkm Suela) SD Petani 1/2/2018 1/2/2018 0 hari P 37 mgg 9x 1 2000/47 SC RSUD Dokter IUFD RSUD

33 By Nurul Aini/Azmi Suela (pkm Suela) SD Petani 1/2/2018 1/2/2018 0 hari P 38mgg 9x 1 2200/47 Spt Belkep RSUD Bidan IUFD RSUD

34 By Sitijah/ Sitijah Aikprapa / (pkm Aikmel) SD IRT 12/31/2017 1/10/2018 9 HARI P 39 MGG 7X 4 2900/47 Spt.B.Kep BPM Bidan - Asfiksia Berat RSUD SELONG

35 M.Syarifudin/Husriah+Mas'ut Bagik Nyaka Utara/(pkm Aikmel) SMP DAGANG 12/10/2017 1/5/2018 26 HARI L 37 MGG 4X 3 2500/46 Spt.B.Kep PKM Bidan - Diare Akut RSUD SELONG 19.20 wita

36 By Hidaytul fitri Ds.Ree Kaltim (Pkm Kalijaga) SI/SI Guru 1/20/2018 1/20/2018 0 hari L 40mgg 1x 1 Spontan RSUD bidan Sup.CPD IUFD RSUD 09.00 wita

37 By Ambulin/Murni Padak (Pkm Sambelia) SD IRT 11/20/2017 12/12/2017 22 hari P 42mgg 7x 4 3700/49 p.Spt PKM Bidan Riwayat SC Ikterus+hipoglik RSUD

38 By Sumarni/Tinggi Kokok Nangka (pkm Belanting) TS/TS petani 1/2/2018 1/3/2018 1 hari L 30mgg 6x 4 1200/40 Spontan RSUD Bidan Persalinan prematprematur/BBLR RSUD

39 Haikal/Riandidni/muhdin Kokok Nangka (pkm Belanting) SMA/SMA Irt/petani 2/6/2017 1/16/2018 11 bulan L 38mgg 7x 1 spontan Pkm Belanting bidan - diare pkm belanting

40 By Mahyani jenggik (pkm rarang) SMA IRT 1/11/2018 1/11/2018 0 hari P 34mgg 8x 2 3000/50 Spt.Bkep polindes bidan - IUFD Polindes 02.00 Wita
 Alamat
No. Nama Anak / Orang tua
(Puskesmas)

1 By Mariana Lungkak, PKM Keruak

2 Nuri HasanahP/Nurhasanah Mt. Bt Bawi (pkm JEROWARU)
3 By Husnaini Mungkik (pkm Jerowaru)
4 By Isan Pemongkong (Pkm Jerowaru)
5 BY Bq. Sopianti Lingkok Laki (PKM Rensing)
6 Aisyah/ Silawati/ Tahire Tanak Beak, Gelanggang (pkm Lepak)
7 Devanu Febian Z/ Henik Trisnawati/M. Zaenudin Tenges, gereneng (pkm Lepak)
8 By Ny Mahyani/ M.Faizin Pesisok Santong (Pkm Terara)
9 By Ny Maenah Genjer, (pkm Terara)
By Maulina S/M.Fauzi Sikur (pkm Sikur)
By Jumarti/ Zaenal Sikur (pkm Sikur)
By Nurhayati/ Makbul Sikur (pkm Sikur)
10 By Siti Rauhul J Dsn Baru, Pr.jurang (pkm Mt.Betok)
11 By Quratul Aini Pr.jurang Selatan (Pkm Mt.Betok)
12 By Diana Hidayat/Kuknis Hidayat Paokmotong, (pkm Masbagik)
13 Aliya/Istiarini Ld Nangka utara (pkm ld.nangka)
14 By nurhasikin/nurhasikin Ld Nangka utara (pkm ld.nangka)
15 By nurhasikin/nurhasikin Ld Nangka utara (pkm ld.nangka)
16 By Nur Islamiah Dames (pkm Kerongkong)
17 By Siti Aisyah Dames (pkm Kerongkong)
18 Halimatuzzahro Anjani (Pkm Kerongkong)
19 Bayi Ny. Subuhiyah Dasan Lekong (pkm dsn.lekong)
20 By Kudusiah Rk.Hikmah (Pkm Pr.Sela)

21 By Haruna Timba Gerah (PKm Pr.Sela)

22 Bayi Ny. Rohmi Paok Pampang Timur (pkm dsn.lekong)

23 By Risna Wahyu Dayan Masjid Pancor (pkm Denggen)

24 By Suriatin/ M. Mulyadi Kr.Anyar, Kembang Sari (pkm Selong)

25 Diki Putra Pratama Dasan Baru (Pkm Lb.Haji)
26 By Ny Sahnim Repok (pkm Lb.Haji)
27 Naura/ Suhaemi/Satriadi Grese (korleko)
28 By Ahmad/Rohmi Gubuk lekok (pkm Batuyang)
29 By Nurena LB.Lombok (Pkm Lb.lombok)
30 M. Ega Febrianto/ Ilwan Suntalangu (PKM Suela)
31 M. Zildan Alfaqih/Hasbiratul Ketangga (pkm Suela)
32 By Sumiarti Suela (Pkm Suela)
33 By Fuji Sukmawati Perigi (PKM Suela)
34 Suryano Dusun Mujahidin,(pkm Lenek)
35 By Ainun Bagek Anjra (PKm Kalijaga)
36 By Supaiah Lendeng Belo (pkm Kalijaga)
37 Firda Oktafiani/indah Hawali Ladon (pkm Kalijaga)
38 Rikaaini/ Minzanwadi Sembalun (PKM Semablun)
39 By Sartini/ Dasan tinggi (pkm Sambelia)
40 By Hirjan/Abdurahman Karang Baru (pkm Karang Baru)

Lahir mati : 22
neo : 16
By :4.
Balita :1
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: FEBRUARI 2018

Usia
Pendidikan Pekerjaan Tanggal Kehamilan saat
Tanggal Lahir Umur L/P
Orang tua Orang tua Meninggal Dilahirkan
(mg)

SMP IRT 2/24/2018 2/24/2018 0 hari P 39 mgg

sma irt 1/9/2018 2/11/2018 1 bulan P 38 mgg
SMA IRT 24/023018 2/24/2018 0 Hari L 39 mgg
SD IRT 2/2/2018 2/2/2018 0 hari P 39 mgg
SMA IRT 1/27/2018 1/27/2018 0 Hari P 40 mgg
SMA/ TT SD IRT/Tani 2/9/2018 2/9/2018 0 Hari P 28 mgg
SI/SI IRT/Swasta 2/13/2018 2/13/2018 0 Hari L 38 mgg
SMP/SMA IRT/Swasta 2/25/2018 2/25/2018 0 hari L 39 mgg
SD IRT 2/18/2018 2/18/2018 0 Hari L 39 mgg
SMA/SMA IRT/Buruh 1/15/2018 1/15/2018 0 Hari P 24 mgg
SMP/SD IRT/Buruh 1/18/2018 1/18/2018 0 Hari P 28 mgg
SD/SMP IRT/tani 1/19/2018 1/19/2018 0 hari L 40 mgg
SMP/PT IRT/KUA 1/28/2018 1/28/2018 0 Hari P 39 mgg
PT/PT PNS/PNS 2/7/2018 2/7/2018 0 hari P 39 mgg
SI/SI Guru/Swasta 1/10/2018 1/10/2018 0 Hari L 38 mgg
D3 perawat 2/7/2018 2/9/2018 2hr P 28 mgg
SMP IRT 2/6/2018 2/6/2018 0 hr P 30 mgg
SMP IRT 2/6/2018 2/6/2018 0hr P 30 mgg
SI Guru 2/4/2018 2/5/2018 1 Hari L 39 mgg
SMA IRT 2/17/2018 17/02/1028 0 Hari P 39 mgg
SMA Swasta 2/8/2018 2/8/2018 0 Hari P 39 mgg
SD IRT 2/12/2018 2/12/2018 0 hari L 35 mgg
SMA IRT 2/16/2018 2/16/2018 0 Hari P 38 mgg

SD IRT 1/14/2018 1/14/2018 0 Hari L 40 mgg

SMA IRT 1/30/2018 1/30/2018 0 Hari L 32 mgg

SMA IRT 2/3/2018 2/3/2018 0 Hari L 28 mgg

SMP Tukang 1/28/2018 1/29/2018 1 Hari L 38 mgg

SMP/Tdk TamatIRT/Nelayan 12/15/2017 2/5/2018 2 bulan L 40 mgg
SMP IRT 2/25/2018 2/25/2018 0 hari P 32 mgg
SMA/SD IRT/Buruh 2/6/3018 2/6/3018 0 hari P 41
D3/SMA Bidan 1/29/2018 2/1/2018 3 Hari L 38 mgg
Tidak Sekolah IRT 2/12/2018 2/12/2018 0 Hari P 34 mgg
SMP IRT 2/9/2018 2/10/2018 1 Hari L 38 mgg
SMA IRT 9/22/2016 2/24/2018 17 Bulan L 38 mgg
SD IRT 2/18/2018 2/18/2018 0 Hari P 33 mgg
SD IRT 2/15/2018 2/15/2018 0 Hari P 28 mgg
SD Petani 10/19/2017 2/8/2018 4 bulan L 39 mgg
SD IRT 1/29/2018 1/29/2018 0 Hari L 40 mgg
SMP IRT 2/13/2018 2/13/2018 0 Hari L 32 mgg
SMP IRT 10/15/2017 1/10/2018 3 Bulan P 40 mgg
SMP/SD IRT/Tani 2/9/2018 2/9/2018 0 hari L 40 mgg
SD IRT 2/18/2018 2/18/2018 0 Hari L 37 mgg
SMA/SMP IRT/Swasta 2/16/2018 2/16/2018 0 hari L 24 mgg
I & BALITA

Jenis Persalinan
Frekwens Anak (SptBKep, Sc, Tempat Penolong
BB / PB Komplikasi ibu
i ANC ke- Vacum, Drip, Spt Melahirkan Persalinan
Brach)

7x 3 1500/47 Spt. B Pkm Bidan Taa

6x 3 3200/50 normal BPS Bidan
4x 2 2100 Normal BPS Bidan Preterem
7x 2 2000 Sc RSUD Spog
6x 3 3500/49 Spt B kep Pkm Rensing Bidan Taa
2x 1 2500 Spt. B RSUD Selong Bidan
4x 1 2700 Spt.B BPS Bidan
4x 1 2800/48 Spt. B BPS Bidan
8x 1 2500/47 Spt.B RSUD Bidan
2 1000/36 Spontan RSUD Bidan
4x 1 700/30 Spontan RSUD Bidan
5x 2 3400/50 SC RSDU Dokter
8x 1 3200/47 Spontan BPS Prima Bidan Bps Prima
6x 3 3000/48 Spontan BPS Prima Bidan Bps Prima
7x 3 1200/45 Sc RSUD SPoG
4X 3 1900 SptBkep RSUDS bidan PRETERM
4X 4 1100 SptBkep RSUDS bidan Eklamsi
4X 5 1200 SptBkep RSUDS bidan Eklamsi
7x 3 2500/49 SC RS RISA Doter Plasenta Previa
6x 1 3300/50 Spt Brach Poskesdes Bidan
7x 1 3500/50 Drif RSUD Bidan KPD
Heamoragi
7x 2 3000/50 spontan RSUD Selong Bidan Antepartum dan
Febris
7x 1 3000/50 spontan BPS Bidan

8x 4 3000/50 SC RSU Dokter

Tali Pusat
7x 1 - SC RSUD Selong Dokter
Menumbung

7x 2 1200/40 Spt.B Kep RSUD Selong Bidan Taa

6x 3 2200/43 SC RSUD Selong Dokter APB

6x 1 3300/40 SptBkep BPS Bidan Tdk Ada
6x 3 1000/35 SPtBkep PKM Bidan Gangguan Psikologis
8x 2 3000/50 Spt. B RSUD bidan PEB
6x 1 3000/47 SC RSUD Dokter PEB
3x 3 3500/49 Drip RSUD Selong Bidan/Dokter Taa
6x 2 4000/45 Spt Belkep RSUD Bidan KPD
8x 1 3500/50 SC RSUD SPoG HDk
8x 4 1600/40 Spt Brach RSUD Bidan
7x 4 1200/46 Spt Beelkep RS RISa Bidan
8x 3 2900/48 Spt. B Kep Poskesdes Bidan Tidak Ada
5x 2 3000/50 Pspt.B RSUD Dokter taa
6x 3 1800/46 Pspt.B PKM Wanasaba Bidan Taa
6x 2 3200/50 Pspt.B Bps Bidan Taa
6 x 1 3800/49 Spt. B Kep PKM Bidan Taa
7x 2 4000/50 p.Spt.B PKM Bidan
3x 1 600 Drif RSUD Spog taa
 Penyebab Jam
Tempat Meninggal
Meninggal Anak meninggal

IUFD PKm 14.00 Wita

Kelainan Usus RS Kota Mataram
BBLR PKm Keruak 09.00 Wita
BBLR RSUD Selong 17.00 Wita
IUFD Pkm Rensing 00.30 Wita
Kelainan Jantung RSUD Selong
Asfiksia Berat RSUD Selong
Asfiksia Perjalanan
IUFD RSUD Selong
Asfiksia RSUD Selong
Asfiksia RSUD Selong
IUFD RSUD Selong
IUFD BPS Prima 02.30 Wita
IUFD BPS Prima 00.00 Wita
IUFD RSUD Selong
BBLR RSI RISA MTRAM 17.10 wta
IUFD RSUD SELONG
IUFD RSUD SELONG
Asfiksia RSUD Selong 10.00 wita
IUFD+lilitan Poskesdes
Asfiksia RSUD Selong 01.00 Wiita
IUFD RSUD Selong 18.00 WITA
IUFD BPS
kelainan
RSUD Selong
Konginetal

IUFD RSUD Selong 10.00 WITA

BBLR RSUD Selong 14.00 Wita

Asfiksia RSUD SELONG

Pneumonia Rumah 07.00 Wita
IUFD PKM 19.45 Wita
Asfiksia RSUD Selong 17:00
Asfiksia RSUD Selong 12.35 Wita
IUFD RSUD Selong
Asfiksia RSUD Selong 13.00 Wita
KDS RSI Namira 07.00 Wita
IUFD RSUD Selong 23.30 Wita
IUFD RS Risa 20.00 Wita
Aspirasi Rumah 12.00 Wita
IUFD RSUD Selong 14.00 Wita
IUFD PKm Wanasaba 19.00 Wita
Pneumonia Rumah 07.30 Wita
IUFD PKM
IUFD PKM
IUFD RSUD Selong 04.30 Wita
N
Nama Anak / Orang tua Alamat (Puskesmas)
o.

1 Sofiya Salsabila / hernawati mendana. (Keruak)

2 herman/ Ida royani kp. Baru (pkm Keruak)
3 By Aqila daeng manggis Serumbung (pkm Jerowaru)
4 By Fitrianingsih Jerowaru daye (PkmJerowaru)
5 By Nurfaizah/ Musniawan Sakra Selatan (PKm Sakra)
6 By Eti Diana/ Sahabudin Rumbuk Timur (pkm Sakra)
7 By Nurjannah Peteluan Timuk (PKM Rensing)
8 By Mardiana Gn.rajak (Pkm Rensing)
9 Amidatun/ Nurisah (Iq.Roja)-sudirman Mt, awas,greneng (Pkm Lepak)
10 m. Khalif Arkan/ Sumiati Gereneng (PKM Lepak)
11 By Mustini/Joni Iskandar DS gelanggang (pkm Lepak)
12 By Baiq erna Mt.betok (pkm Mt. Betok)
13 By Salemah Pengengat (pkm Mt. Betok)
14 By Sukiandi Lingkok Telu (pkm Mt. Betok)
15 By Sii Nurazizah Sikur (pkm Sikur)
16 By Husnul Khotimah Sikur (pkm Sikur)
17 M. Zaeni/Rohani Sikur (pkm Sikur)
18 Nadira/Ehsania Presak (Pkm Ld.Nangka)
19 Sirfa Marianan/ Muslihatun/ Masiun Timuk Jero (pkm Dsn.lekog)
20 M. Afiful Adian/ Maemunah kerongkong (pkm Kerongkong)
21 Zaenul Muttaqin/ Nurhayati kerongkong (pkm Kerongkong)
22 by Ny Sofa Dsn. Borok
23 Majidah/Subuhiyah/ Arifin Dasan tinggi (Pkm Dsn lekong)
24 Jamilah/ Subuhiyah/ Arifin Dasan tinggi (Pkm Dsn lekong)
25 By Yunita yulanda/ Hardiansyah Setanggor (pkm dsn.lekong)
26 By Fitriah Kebon tatar (pkm selong)
27 By Kuratul Hasanal DsnAmbengan (pkmLb.haji)
28 By Nurhidayah Lb. Haji (PKm Lb. Haji)
29 Bq. Siti hasnawati/ Nislahun/Zulkahpi gbk Pedaleman (pkm Korleko)
30 By Sumarni/Suhardi Ds gerung (pkm korleko)
31 By Yuliastuti/Saiful Bahri Bagek elen (pkm Korleko)
32 By Siti Maryam Bagek papan pkm Batuyang)
33 kamarudin/ Rihun Ketngga (pkm Suela)
34 Ida Royani/ Pajri Selaparang (pkm Suela)
35 Desta Abimayu / Iq ria ramaan Bela (pkm Lenek)
36 Atika Balqis Azizah Kp. Remaja (pkm Aikmel)
37 M. Yusuf Febian/ Hj. Aminah Cempaka Putih/ kembang kerang (PKM Aikmel)
38 by Ceria dika/ Ceria Gb/ lauk sambelia (pkm sambelia)
39 By fatmawati Lb. Pandan (pkm Sambelia)
40 By Sahnun/sahnun Rarang Sel (Pkm Rarang)
41 By Muliani Rarang Tengah (Pkm Rarang)
42 By Mariati/ mariati lando (pkm rarang)
43 Reni M/ Nurhayati Embung Kandong (pkm Rarang)
44 Dafa farid/ Linda karang baru (Pkm Kr. Baru)
45 By Desi Suryani karang baru (Pkm Kr. Baru)

iufd : 13
Neo : 19
Bayi : 12
Balita : 1
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: MARET 2018

Usia
Keham
ilan Frek
Pendidikan Pekerjaan Tanggal Lahir Tanggal
Umur L/P saat wensi
Orang tua Orang tua Meninggal
Dilahir ANC
kan
(mg)
SMA IRT 3/5/2018 3/19/2018 14 hari P 39 mgg 10 x
SMP IRT 3/4/2018 3/7/2018 3 hari L 39 mgg 5 x
D2 Guru 3/3/2018 3/3/2018 0 hari P 37 mgg 6 x
SMP IRT 3/23/2018 3/23/2018 0 Hari L 39 mgg 5 x
SMA/TS IRT/Buruh 3/28/2018 3/28/2018 0 hari L 36 mgg 6 x
SMP/SD IRT/ Buruh 3/21/2018 3/21/2018 2 jam P 39mgg 8 x
SMA IRT 3/12/2018 3/12/2018 0 Hari L 40 mgg 7 x
SD IRT 3/8/2018 3/11/2018 3 Hari L 28 mgg 6 x
TTSD/TTSD Tani/Tani 1/6/2018 1/12/2018 6Hari P 30 mgg 5 x
SMP IRT 3/26/2017 3/23/2018 11 Bulan L 39 mgg 4 x
SMp/SMP IRT/tani 3/19/2018 3/20/2018 1 hari L 24mgg 3 x
SMA Wiraswasta 3/6/2018 3/6/2018 0 hari P 32 mgg 5 x
SD IRT 2/16/2018 2/16/2018 0 hari L 38 mgg 3 x
SD IRT 3/19/2018 3/21/2018 2 hari P 26 mgg 3 x
SD IRT 3/24/2018 3/24/2018 0 Hari L 38 mgg 8 x
SD IRT 1/24/2018 3/12/2018 47hari P 40 mgg 8x
SD IRT 8/22/2017 3/25/2018 7 bulan L 39 mgg 6 x
SMP IRT 12/17/2017 3/13/2018 3 Bln P 39 mgg 7 x
SD/SD IRT/ buruh 1/24/2018 3/25/2018 2 bulan P 39 mgg 7 x
SMP IRT 1/30/2018 1 bulan 9 hari L 38 mgg 9 x
SD IRT 1/18/2018 3/16/2018 2 bulan L 39 mgg 8 x
SD Tani 2/17/2018 5/3/2018 16 Hari P 32 mgg 6 x
SI/SMA IRT/ buruh 3/20/2018 3/23/2018 3 Hari P 31 mgg 6 x
SI/SMA IRT/ buruh 3/20/2018 3/24/2018 4 Hari P 31 mgg 6 x
SMA/SMA IRT/Swasta 2/19/2018 2/19/2018 0 Hari L 28 mgg 5x
SD IRT 3/9/2018 3/9/2018 0 Hari P 38 mgg 6 x
SMP IRT 3/30/2018 3/30/2018 0 hari L 38 mgg 8 x
SD IRT 3/27/2018 3/27/2018 0 hari P 39mgg 8 x
SMA/DIV IRT/Swasta 3/12/2018 3/14/2018 2 hari P 37 mgg 8 x
SMA/SD IRT/tani 3/5/2018 3/12/2018 7 hari p 28 mgg 6 x
SMp/SMP Irt/Buruh 3/6/2018 P 27mgg 5x
SD IRT 3/12/2018 3/12/2018 0 hari L 40 mgg 6 x
SD IRT 8/25/2016 3/6/2018 18 bulan L 38 mgg 7 x
SMP IRT 1/24/2018 3/15/2018 50 Hari P 40mgg 7 x
SD IRT 12/24/2018 3/24/2018 3bulan L 38 mgg 4 x
SD IRT 11/22/2017 3/19/2018 4 Bulan P 26 mgg 6 x
SMP Swasta 2/24/2018 3/6/2018 10 hari L 39 mgg 8 x
SI Swasta 3/9/2018 3/24/2018 15 hari L 38 mgg 7 x
SMA Dagang 3/13/2018 3/13/2018 0 hari L 33 mgg 6x
SD/SD IRT/tani 3/20/2018 3/20/2018 0 Hari L 36 mgg 8 x
SD/SMP IRT/tani 2/28/2018 2/28/2018 0 hari L 38 mgg 8 x
SD/SD/ IRT/tani 3/8/2018 3/8/2018 0 hari L 34 mgg 5 x
SD/SD Irt/ Tani 5/15/2017 2/19/2018 9 bulan P 40 mgg 8 x
SMA IRT 1/27/2018 2/27/2018 1 bulan L 40 mgg 7 x
SMA IRT 3/1/2018 3/1/2018 0 hari L 43 mgg 8 x
FD, BAYI & BALITA
018

Jenis
Persalinan
Tempat
Anak ke- BB / PB (SptBKep, Sc, Penolong Persalinan
Melahirkan
Vacum, Drip,
Spt Brach)

2 3400/52 Spontan Pkm Keruak Bidan

2 3000/48 Spontan Rumah Dukun
2 Spontan RSUD Bidan
3 2800/49 SC RSUD SpOG
1 2500/47 SC RSUD SpOG & bidan
3 3000/48 Spt B RSUD SpOG& Bidan
4 3000 Spt B.Kep RSUD Bidan
4 2200 Spt B.Kep RSUD Bidan
3 1100 SC RSUD SpOG
2 3000 SPt.B Poskesdes Bidan
1 1000 Spt. B Poskesdes Bidan
3 1500/45 Drip RSUD Bidan
3 2300/50 SC RSUD SpoG
2 1000 Spontan RSUD SpoG
2 2900/28 Spontan PKM Bidan
2 3000/49 Spontan PKM Bidan
1 2500/48 SC RSUD SpOG
2 3100/51 SptBKep Polindes Bidan
3 3500/50 Spontan Poskesdes Bidan
5 3500/50 Spontan BPS Bidan
3 3300/49 Spontan BPS Bidan
2 1700/45 Spontan RSU Bidan
2 1200 Spt Brach Poskesdes Bidan
2 1100 Spt Brach Poskesdes Bidan
1 1200 Spontan RSI Namira Bidan
4 3000/48 Spontan RSI Namira Bidan
4 5200/50 Spontan BPS Bidan
2 2700/47 SC RS Dokter
1 1600/46 Spt B.Kep Pkm Bidan
1 1300/45 SPt B RSUD bidan
2 Dripoxy RSI Namira Dokter
6 2800/48 spontan Polindes bidan
2 3000/50 SC RSUD Dokter
2 3600/50 Spontan Polindes Bidan
4 4500/57 Spt. Bkep Polindes Bidan
2 900/32 Spt. B kep RSUD
3 2150/46 Spt. B kep Polindes Bidan
1 2700/46 SC RS Mataram SpoG
1 1300/37 Spontan Polindes Bidan
5 2600/48 Spt. Bkep RSUD Bidan
4 2200/45 SC RSUD SpOg
2 2000/40 SC RS Risa Dokter SpOg
2 2600/47 SptBrach PKm Bidan
1 3000/51 SC RSUD SpOg
1 3000/48 Spontan PKM bidan
 Penyebab Meninggal Tempat Jam
Komplikasi ibu
Anak Meninggal meninggal

taa Penumonia RSUD 14.30 wita

taa RDS RSUD 16.00 Wita
PEB IUFD RS
Petal distres kelianan jantung RSUD 12.00 Wita
iufd RSUD
Asfiksia RSUD
PEB IUFD RSUD 05.30 Wita
PPI BBLR RSUD 01.00WIta
Asfiksia RSUD
Pneumonia Berat RSUD
BBLR RSUD
PEB IUFD RSUD
Pos SC IUFD RSUD
BBLR RSUD
taa IUFD PKM 14.01 Wita
Taa Pneumonia RSUD 09.10 wita
Aspirasi Rumah 12.00 Wita
Tidak ada Pneumonia Berat RSUD 20.30 Wita
tdk Ada KIPI Rumah 19.00wita
Demam Rumah 17.00 Wita
Demam Rumah 18.30 wita
cacat Bawaan RSUD 10.40 Wita
Gameli BBLR RSUD 01.00 Wita
Gameli BBLR RSUD 01. 00 Wita
IUFD RSI Namira 18.00 wita
Tidak ada IUFD RSI Namira
DM ASfiksia BPS 10.00 Wita
Kista dan Peb Asfiksia RS 10.00 Wita
tdk Ada BBLR RSUD 05.00 Wita
Prematur BBLR RSUD 16.00 Wita
IUFD RSI Namira
asfiksia PKM 17.00 Wita
LetakLintang Penumonia PKM Suela 15.30wita
KDK Pkm Suela 10.30 wita
Tdk ada Sudden Death infan Rumah 21.30 Wita
Apb (Plasenta Previa) + Prematur Pneumonia RSUD 03.30 Wita
Sepsis+Aspirasi Rumah 11.00 Wita
Jantung Sesak RS
BBLR RS
PEB IUFD RSUD 20.00 Wita
PEB/ Oligo IUFD RSUD 22.00 Wita
Letak Lintang IUFD RS Risa
Letak Lintang PenumoniaBerat RSUD 11.20 Wita
KPD+cpd Kel/ jantung Rumah 06.00 Wita
Serotinus iufd pkm 06.15 wita
N
Nama Anak / Orang tua Alamat (Puskesmas)
o.

1 M. Fikri/Emi Salmiati Lungkak Keruak

2 By.L/Laili Inayati Pelebe Keruak
3 Raudatul janah/Jumisah/Sanun Baret Tengak/Sukaraja
4 Rista/Subali/Sukri Songak/PKM Sakra
5 By. Nurjanah/Nurjanah - M.Ridwan Rumbuk/ PKM Sakra
6 Siti Hadiatul Isnaini /Isnaini/Rizal Sakra Selatan/Sakra
7 By.Hafizah/Hafizah/Musniawan Sakra Selatan/Sakra
8 Ardian R/Halimatusakdiah/M.Amin Bagek Perie/PKM Lepak
9 By. Yuliana Semaya/PKM Sikur
10 Rahma Delani Presak/Montong Baan/PKM Sikur
11 By. Murni Lekong Pituk/Kotaraja
12 Supiani/Salihun Gubuk Lauk/PKM Pringgasela
13 By.Diah Ratna/Diah Ratna/ M. Ali HanGubuk Timuk /Sukamulia/Ds.Lekong
14 By. Pihan/Rusdin Dasan Tiga/Sukamila/Ds. Lekong
15 By Siti aisah Gapuk Lauk/ PKM Kerongkong
16 Faisal Sani/Desi Mayani Kampung Baru RT 05. Baru/Denggen
17 By. Risuni (Risuni/ Mustaan) Gubuk Baret/PKM Korleko
18 By. Hafiz Ramdhani (Sundari/MuhajiriGeres Lauk/ PKM Korleko
19 By. Mulfiani Benyer Daya/PKM Batuyang
20 By. Iq. Andri Bagek Gaet 1/ PKM Batuyang
21 By. Ny. Mahni Lb. Lombok/PKM Lombok
22 Siti Zaenab/Sahmin Suntalangu/PKM Suela
23 By. Sri Handayani Ketangga/ PKM Suela
24 By. Murihan Perigi/ PKM Suela
25 By. Inaq Johni Mekarsari/PKM Suela
26 By. Baiq Rihun Suela / PKM Suela
27 Asmaul Husnah/ Iq. Yani Kalibambang Lenek /PKM Lenek
28 Fizah/M. Ihsan Asmalang Selatan/PKM Kalijaga
29 By. Ny. Sarimatullah Sembalun
30 M. Topan/Halimah/Saat Gubuk Lauk Sembelia
31 By Hartani Ds bagek/PKM Sembelia
32 By. Ny Leny Rahmawati/M. Rizal PahlMenanga Reak Desa Dara Kunci/Belanting
33 Zainudin/ Nurul Yani/ Ibrahim Obel-Obel/PKM Belanting
34 By. Maryun/Maryun Batu Baye Rarang Tengak/Rarang
 Mengetahui
Kepala Bidang
Bina Kesehatan Masyarakat

Suardi, SKM,MPH.
NIP. 19721231 199503 1 007

NB:
Lahir mati : 10
Neo : 16
Bayi :6
Balita :2
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: APRIL 2018

Usia
Kehamila Frek
Pendidikan Pekerjaan Tanggal Tanggal
Umur L/P n saat wensi Anak ke-
Orang tua Orang tua Lahir Meninggal
Dilahirka ANC
n (mg)
SMP IRT 24-Feb-18 29-Mar-18 33 Hr L 40 Mg 8x 1
SMP IRT 13-Apr-18 17-Apr-18 4 Hr L 40 Mg 9x 1
SD Tani 21-Feb-18 3-Apr-18 42 Hr P 39 Mg 6x 4
SD IRT/Buruh 29-Dec-16 11-Apr-18 2 Th p Aterm > 5x 3
SMP/SMP IRT/Buruh 2-Apr-18 3-Apr-18 1 Hr P 34-35 Mg 6x 1
SMA/SMP Tani 29-Mar-18 29-Mar-18 0 Hr L 25-26 Mg 5x 1
SD/SD Tani 28-Mar-18 28-Mar-18 0 Hr L 40 Mg 5x 1
SD/SD IRT/Tani 7-Mar-18 27-Apr-18 30 Hr L 40 Mg > 4x 3
SD IRT 14-Apr-18 15-Apr-18 0 Hr L 32 Mg 5x 1
SD Buruh 14-Mar-18 25-Mar-18 11 Hr P 36 Mg 7x 4
SD IRT 21-Apr-18 21-Apr-18 0 Hr L 40 Mg 8x 3
SMP IRT 18-Apr-18 18-Apr-18 0 Hr L 41 Mg 8x 3
S1 Guru 6-Apr-18 6-Apr-18 0 Hr L 34-35 Mg 11x 1
SMP/SD IRT/Wirasw 13-Apr-18 13-Apr-18 0 Hr L 40 Mg 8x 4
SMA/SMA IRT/Wirasw 13-Apr-18 13-Apr-18 0 Hr L 38 mg 3x 3
SLTA IRT 14-Apr-18 14-Apr-18 5 Jam L 28 Mg 1x 2
SD/SMP IRT/TKI 30/3/2018 30/3/2018 0 Hr L 30 Mg 5x 2
SMA/SMA IRT/Buruh 22-Jun-17 5-Apr-18 9 Bln 14 HL 39 Mg 8x 2
SMP IRT 25-Mar-18 27-Mar-18 2 Hr L 30 Mg 4x 2
SMP IRT 1-Apr-18 11-Apr-18 10 Hr P 28 Mg 4x 3
S1 Guru 24-Apr-18 24-Apr-18 0 hr L 36 Mg 8x 2
SD Petani 25-Mar-18 19-Apr-18 24 Hr P 38 Mg 4x 4
SD IRT 22-Apr-18 25-Apr-18 4 Hr L 42 Mg 5x 5
SMP IRT 24-Apr-18 24-Apr-18 0 Hr P 40 Mg 4x 2
SD Petani 4-Apr-18 4-Apr-18 0 Hr L 38 Mg 6x 3
SD IRT 12-Apr-18 12-Apr-18 0 Hr P 40 Mg 6x 3
SD IRT 8-Mar-18 17-Apr-18 1 Bln P 39-40 Mg 8x 5
SMP/SD IRT/Tani 29-Jun-17 11-Apr-18 10 Bln P 39 Mg 6x 1
S1 IRT 16-Apr-18 17-Apr-18 1 Hr L 36 Mg 4x 1
SD Tani 10-Apr-18 12-Apr-18 2 Hr L 38 Mg 5x 4
SD IRT/Tani 30/3/18 30/3/18 0 hari P 32 mg 5x 2
S1 IRT/Karyaw 23-Apr-18 23-Apr-18 0 Hr L 40 Mg 9x 1
SMP/SD IRT/Buruh 19-Jan-17 28-Feb-18 13 Bln L 40 Mg 4x 2
SD/SD IRT/Tani 28-Mar-18 30-Mar-18 2 Hr L 36 Mg 8x 3
AYI & BALITA

Jenis
Persalinan
(SptBKep, Tempat
BB / PB Penolong Persalinan Komplikasi ibu
Sc, Vacum, Melahirkan
Drip, Spt
Brach)
3000/47 Spt.LBK Poskesdes Bidan Tidak ada
2900/47 Spt.LBK Poskesdes Bidan Tidak ada
3300/50 Normal BPS Bidan Tidak ada
2400/48 P Spt RSU Bidan Gameli
2200/45 P Spt Polindes Bidan Tidak ada
1500/45 P Spt RSU Bidan Let Su
3000/49 P Spt RSU Bidan Tidak ada
3300/50 Spt.B Poskesdes Bidan -
1200/40 Spt RSU Dokter/Bidan Tidak ada
1600/45 Spt RSU Bidan Hipertensi,SC,HBsA
2500 Sontan RSUD Dokter Gameli
2500/47 Normal Polindes Bidan Tidak ada
2900 SC RSUD Dokter SPOG Eklamsi
3000/49 Spt Brach Puskesmas Bidan Tidak ada
2800/49 SptBKep Poskesdes Bidan -
1200/46 SptBKep RSUD Bidan Tidak ada
2000/45 SC RSUD Dokter Eklamsi
3200/49 Spontan Polindes Bidan Tidak ada
1500/43 Spt.B RSUD SPOG Prematur, HBSaG
1600/46 Spt. B RSU Bidan -
2500/49 Spontan RSUD Bidan Tidak ada
2200/48 Spt.B Kep BPM Bidan Tidak ada
3300/50 Spt.B Kep PKM Bidan Post Date
3000/48 Spt.B Kep Polindes Bidan
3500/48 Spt.B Kep RSUD Bidan Peb
3800/50 Spt. B Kep PKM Bidan Dist bahu
4000/52 Spt. B Poskesdes Bidan Tidak ada
3000 Spt. B Kep Polindes Bidan -
1800/36 Spt B Kep Dokter PKM, Bidan Preterm
2800/47 Spt RSUD Selong Bidan PEB
1800/45 Spt PKM Bidan -
3100/55 Spontan BPS Bidan Tidak ada
2400/47 Spontan Rumah Dukun Tidak ada
2200/47 SC RSUD SPOG Peb
 Jam
Penyebab Meninggal Anak Tempat Meninggal meningga
l

Pneumonia Rumah 13.00

Kelainan Bawaan Rumah 14.00
Suddenly dead/ kematian mendadak 11.00
Pneumonia RSU
Atresia Ani RSU P
Gagal Napas RSU
IUFD RSU
Sepsis RSUD
IUFD RSU 12.00
Hipotermi Rumah
IUFD RSUD 12.30
Cacat Bawaan Rumah
IUFD RSUD 15.30
IUFD Puskesmas 01.00
Asfiksia Poskesdes 3.00
BBLR RSUD 21.00
IUFD RSUD
Febris RSUD
BBLR RSUD 09.00
IUFD RSUD
IUFD RSUD 21.30
Pnemonia PKM 03.30
Asfiksia RSUD 16.00
Asfiksia RSUD 16.00
Asfiksia RSUD 20.05
IUFD PKM 02.30
Sianosis ec PJB Rumah 17.30
Inf Usus RSUD
Prematur/ BBLR RSUD 13.00
Asfiksia RSUD Selong 1.00
IUFD PKM 21.00
Asfiksia Berat BPS 08.10
Demam(kejang) Rmh Ortu Ds Longken se 18.00
Kelainan Paru-paru, BBLR RSUD 17.00
 Selong, ..........................
Kepala Seksi
Kesehatan Keluarga

Hj. Rokhliana, SST,MM

NIP. 19730314 199203 2 007
No. Nama Anak / Orang tua Alamat (Puskesmas)

1 By Sutriyanti Mt. Belae, (pkm keruak)

2 By Ami Linda S Mt. Belae, (pkm keruak)
3 by rehan senyiur (pkm Keruak)
4 By Nurhayati I Dsn Orang Panan (PKM Jerowaru)
By Nurhayati II Dsn Orang Panan (PKM Jerowaru)
4 by susanti/ny rohini/asturi sakra sel (pkm sakra)
5 by Citra/ Ny Eva / hasanudin moyot belek (pkm sakra)
6 by Fitriani borok, toyang (pkm Rensing)
7 by herlina jero gunung (pkm rensing)
8 muh. Ramdan/hasnawati/ahmad ripa'i Lepak (pkm lepak)
9 Nurhaliza/ sahmah/mustamin mt.mas (pkm lepak)
10 Muliani/Juliati/Mashur Repok Bembek (pkm lepak)
11 komen doli/sriani/sukran dasan tereng gelanggang (pkm lepak)
12 by rusnah/jumadil otak desa (pkm terara)
13 by Lidiawani/m. nasib Embung raja (pkm terara)
14 Rafi/ Sumarni/Mahyam Embung raja (pkm terara)
15 by Fitriani/ Agus irawan bulang santong (pkm terara)
16 by nuraini Lk.Lima (pkm Mt.betok)
17 by nadia oktavia gading (pkm mt.betok)
18 by Rahmi Delani P Presak Sire (pkm siur)
19 by maliki/Ramlah tibu pace (pkm sikur)
20 by iq jayadi Montong sube (pkm ld.nangka)
21 by iin setiawati timbak (pkm ld.nangka)
22 Nadia Napatun Nisa/ Mardiah paok lombok timur (pkm kerongkong)
23 Ny Nurjannah anjani (pkm kerongkong)
24 gusasiah dsn borok (pkmkerongkong)
by Fitriani/lilik ismawadi karang sukun (pkm selong)
25 by kartini/ gupran teros (pkm lb.haji)
26 by nurhasanah/hasanudin banjarsari (pkm lb/haji)
27 by devi kurniati/ashari gb.Luk (pkm korleko)
28 by nuraini/ sahirun dsn. Tirpas (pkm korleko)
29 by fatir rozaki Lembak Daya (PkmKorleko)
30 by nazila ar/corina gubuk lekok (pkm Batuyang)
31 BY hulfiah gb. Motong (pkm batuyng)
BY. AFIKA VALEN LB. LOMBOK
BY. HAJIATUN SAOPI LB. LOMBOK
BY. RUSMIATI LB. LOMBOK
BY. SUHAEMI KP. PELITA
 BY. TASYA LB. LOMBOK
BY, INTAN KOMALASARI SEIMBANG
BY. RAHMAN JEJANGKA LAUK
35 L.M Yusuf/ nurul aini/ L humaidi kembang kerang (pkm aikmel)
36 By eka Swarna kembang kerang (pkm aikmel)
37 by nurhijjah Aikprapa (pkm aikmel)
38 by abdul wahid/renawati kembang kerang (pkm aikmel)
39 by muslihani rahayu lauk (pkm kalijaga)
40 by raudatul jannah ds.tembeng (pkm kalijaga)
41 by buhaen ds.lendang (pkm kalijaga)
42 by sri purnama/herfan syah beak daya (pkm wanasaba)
43 by mediawati/ orong balu (pkm wanasaba)
44 BY herlika/ nigrasim obel-obel (pkm belanting)
45 by nurjannah tojang (pkm rarang)

Mengetahui,
Kepala Puskesmas ………………..

…………………………..
NIP:…………………………..
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: MEI 2018

Usia
Keha
milan Frek
Pendidikan Pekerjaan Tanggal Tanggal Anak
Umur L/P saat wensi
Orang tua Orang tua Lahir Meninggal ke-
Dilahi ANC
rkan
(mg)

SMP IRT 5/7/2018 5/7/2018 0hari L 33 mgg 2 x 3

SMA IRT 5/10/2018 5/11/2018 18 jam L 31 mgg 4 x 2
SD IRT 5/13/2018 5/13/2018 0 hari P 40 mgg 6 x 4
SMP IRT 11/5/2018 12/5/2018 1 hari P 28 mg 5x 2
SMP IRT 11/5/2018 13/5/2018 2 hari L 28 mg 5x 2
SD/SD IRT/Buruh 12/7/2017 5/3/2018 5 bulan P 38 mgg 6 x 2
SMA/SMP Irt/Swasta 5/3/3018 5/5/2018 2 hari P 40 mgg 5 x 1
SMP IRT 5/18/2018 5/18/2018 0 hari P 24 mgg 3 x 2
SMP IRT 5/24/2018 5/24/2018 0 hari P 40 mgg 2 x 1
SMA/SMA IRT/Tani 5/17/2018 5/17/2018 0 hari L 36 mgg 4 x 4
SD/SMP Irt/tani 5/22/2018 5/22/2018 0 hari P 37 mgg 4 x 4
SD/SD IRT/Nelayan 5/3/2018 5/3/2018 0 hari P 38 mgg 4
SMP/SD IRT/Petani 4/29/2018 4/29/2018 0 hari L 40 mgg 6 x 3
SD/SD IRT/Buruh Bat 5/3/2018 5/3/2018 0 hari P 38 mgg 6 x 1
SMP IRT 5/20/2018 5/20/2018 0 hari P 22 mgg 4 x 5
SMP IRT/TKI 3/10/2018 4/2/2018 23 hari L 40 mgg 4 x 1
SMP/SMP IRT buruh 5/22/2018 5/22/2018 0 hari L 40 mgg 1 x 1
SD IRT 5/3/2018 5/4/2018 1 hari L 28 mgg 5 x 2
SMP IRT 5/1/2018 5/1/2018 0 hari P 28 mgg 5 x 1
SD Buruh 4/14/2018 5/7/2018 25 hari P 36 mgg 7 x 4
SD tani 4/5/2014 5/17/2018 3 tahun L 40 mgg 7 x 1
SD Buruh 5/1/2018 5/2/2018 1 hari L 38 mgg 4 x 3
S1 IRT 5/24/2018 5/25/2018 1 hari P 31 mgg 3 x 3
smp petani 2/22/2018 5/18/2018 3 bln P 38 mg 6x 3
sd petani 5/10/2018 5/18/2018 0 hari P 32 mg 6x 4
smp wiraswasta 22/04/2018 2/5/2018 10hari P 39 mg 8x 1
SMA IRT 5/16/2018 5/16/2018 0 hari L 42 mgg 5 x 2
SMA IRT 5/22/2018 5/22/2018 0 hari L 38 mgg 5 x 1
SD IRT 5/12/2018 5/13/2018 1 hari P 38 mgg 5 x 2
SMA/SMA pedagang 4/21/2018 4/27/2018 5 hari L 37 mgg 8 x 3
SD/SD irt/tani 5/15/2018 5/15/2018 0 hari L 33 mgg 4 x 3
SD/SMA IRT/Tani 4/17/2018 5/5/2018 19 hari L 40 mgg 8 x 2
bidan 8/6/2016 5/12/2018 2 tahun P 40 mgg 8 x 2
Sma 5/8/2018 5/8/2018 0 hari L 32 mgg 3 x 4
SD IRT 13-3-2018 28-5-2018 2 bl 15 hr P 36 mg 8x 2
SMP PEDAGANG 1/5/2018 1/5/2018 0 hr L 28 mg 6x 2
SD IRT 7/5/2018 7/5/2018 0 hr L 41 mg 7x 2
SD PETANI 18-5-2018 18-5-2018 0 hr P 40 mg 6x 1
 SMA IRT 10/5/2018 24-5-2018 14 hr P 38 mg 4x 1
SMP IRT 24-5-2018 24-5-2018 0 hr P 38 mg 2x 3
SMP IRT 27-4-2018 27-4-2018 0 hr L 41 mg 6x 1
SMp/SD IRT/Swasta 1/31/2018 4/28/2018 3 bulan L 40 mgg 6 x 5
SMA IRT 5/5/2018 5/5/2018 0 hari L 34 mgg 4 x 3
SD IRT 5/5/2018 5/5/2018 0 hari P 30 mgg 5 x 3
SD IRT 1/19/2018 5/23/2018 4 bulan L 40 mgg 7 x 2
SMp IRT 5/22/2018 5/23/2018 1 hari L 32 mgg 3
Sma irt 5/21/2018 5/21/2018 0 hari P 39 mgg 8 x 1
smp irt 5/12/2018 5/12/2018 0 hari P 40 mgg 6 x 5
sma wiraswasta 5/30/2018 5/31/2018 1 hati L 39 mgg 4 x 1
sma mahasiswa 5/20/2018 5/20/2018 0 hari L 30 mgg 2 x 1
ttsd/ sd swasta /irt 5/29/2018 8/29/2018 0 hari L 40 mgg 7 x 2
SD/SD tani/irt 4/30/2018 4/30/2018 0 hari L 32mgg 5 x 2

…………..

……..
………..
YI & BALITA

Jenis
Persalinan
(SptBKep, Tempat
BB / PB Penolong Persalinan
Sc, Vacum, Melahirkan
Drip, Spt
Brach)

1600/40 Spt.BLK RSUD Selong bidan

1700/40 letsu RSUD Selong bidan
3900/50 Spt.BLK pol.gn rajak bidan
1800/40 Spt B BPM Bidan
800/35 Spt. B BPM Bidan
2500/49 P.Spt Pol Sak Sel Bidan
3500/50 SC RSUD Selong Dokter SpOg
700 Spontan RSUD Selong bidan
3000 Spontan RSUD Selong bidan
1600/41 Spt.B RSUD Selong bidan
2900/49 Spt.b RSUD Selong bidan
2000/40 SC RSUD Selong Dokter SpOg
3200/50 SC RSUD Selong Dokter SpOg
1500/30 Spt.B Pkm terara Bidan
450 Spt.B RSUD Selong Bidan
2200/40 Spt.B BPM bidan
3000/45 Spt.B BPM bidan
1200 Spt.Bkep RSI Namira bidan
1300 Spt.Bkep BPM BIdan
2000 Spt RSUD Selong bidan
3000 Spt polindes bidan
1400/43 Spt.b RSUD Selong bidan/dokter
900/35 Spt b RSUD Selong dokter
4500 gr/50 cm sptb rsud bidan
1000 gr/40cm sptb poskesdes bidan
200gram/48cm sptb BPS Maria bidan maria
2900/49 Spontan RSUD Selong bidan
2600/47 Spt B BPS Bidan
3300/49 SPt B BPS Bidan
2700/49 spontan RSUD Selong dokter
1700/40 spt.B rumah bidan
3500/50 spontan pkm bidan
3000/50 Spontan RISA Dokter
1500/35 sc RSUD Selong Dokter
2800 gr/ 49 cm Spt. B POLINDES BIDAN
1200 gr Spt. B RSUD BIDAN
3000 gr Spt. B RSUD BIDAN
4000 gr SC RSUD DOKTER
3400 gr Spt. B PKM BIDAN
3000 gr Spt. B RSUD DOKTER
2500 gr SC RSUD BIDAN
3600/50 Spontan polindes bidan
3200/49 Spontan RSUD Selong bidan
SC RSUP Dokter
3600/49 Spontan polindes bidan
1300 Spt RSUD Selong Bidan
4000 sc RSUD Selong dokter
3400 spt RSUD Selong dokter
2400/48 P.spt.b RISA bidan
2500/45 p.spt b RSUD Selong bidAN
2500/47 Spontan pkm be;anting bidan
SC RSUD Selong dokter
 Jam
Penyebab Meninggal Tempat
Komplikasi ibu meningga
Anak Meninggal
l

taa IUFD RSUD Selong 16:00

taa prematur/ BBLR RSUD Selong 12:00
PEB + distosia bahu Asfiksia pol. Gn rajak 4:05
UK Prematur BBLR RSUD Selong 0:00
UK Prematur BBLR RSUD Selong 0:00
Taa Pneumonia RSUD Selong
taa jantung bawaan RSUD Selong
PPI+tali pusat mennumbung IUFD RSUD Selong 9:30
Kala II lama Asfiksia RSUD Selong 14:00
IUFD RSUD Selong
IUFD RSUD Selong
iufd RSUD Selong
IUFD RSUD Selong
IUFD pkm terara
IUFD RSUD Selong
BBLR Rumah
IUFD BPS
BBLSR RSUD Selong
BBLSR RSUD Selong
Riwayat Hipertensi, SC, HBsAg + prematur rumah 16:00
taa kanker getah bening rumah 17:00
gameli BBLR RSUD Selong
partus prematurus BBLR RSUD Selong
tidak ada penemonia rsud selong 2
DM, Hipertensi IUFD poskesdes 17.40 wita
eklamsia BBLR rsud selong
Postdate IUFD RSUD Selong
IUFD BPS
hipotermia Rumah
plasenta previa hipotermia RSUD Selong 5:30
prematur iufd rumah 21:00
kelainan jantung RSUD Selong 13:00
penumoniA RSUD Selong 11:00
IUFD RSUD Selong
- Pnemoni Berat Rumah -
Riwayat SC IUFD RSUD -
Riwayat SC IUFD RSUD -
KPD + Febris IUFD RSUD -
- Pnemoni Berat RSUD 16:00 wita
- IUFD RSUD 10:00 wita
- IUFD RSUD 17:30 wita
Pneumonia berat RSUD Selong 23:00
Asfiksia berat RSUD Selong 6:00
Eklamsia IUFD RSUP
penumonia berat RSUD Selong 20:00
Gameli Pramatur/BBLR RSUD Selong
partus lama iufd RSUD Selong
tali pusat menumbung iufd RSUD Selong
kpd bblr rumah
IUFD RSUD Selong
taa iufd pkm belanting
iufd RSUD Selong 08.00 wita

………….., …………………………
Bidan Koordinator Puskesmas …………….

…………………………………..
NIP:……………………………………
 Alamat
No. Nama Anak / Orang tua
(Puskesmas)

1 By Maryuniati Ketangge (PKM Keruak)

2 By F Bg.Gupung (PKM Keruak)
3 By Ririn Marlina Lungkak, (Pkm Keruak)
4 By M.Zainal Ansori/ Husnul Hotimah-Jumahir Tanggak Menceh (Pkm Lepak)
5 By Rizki Alfarizki/ Sofianti-L.Zulhaji Kuangwai, Menceh (Pkm Lepak)
6 By Ilmiyantari/Hariyanti Terara sel (pkm terara)
7 By Ernawati/Mujahidin Pesume ssantong (pkm terara)
8 Ragil Ahmadian Rasyid Sikur Barat (pkm Sikur)
9 Ray Saputra Presak Sire (Pkm Sikur)
10 By Suryani Molek sikur (pkm Sikur)
11 By Novi Selimur (PKm Ld.Nangka)
12 By Nursaftuni Montong Agung (PkmLD.Nangka)
13 By Ismiwati/ L. Frengki Bg.bangket (Pkm dsn lekong)
14 By Rohani/ Murdiyono Setanggor sel (Pkm Dsn Lekong)
15 By Fitriani Pr.Sela (PKM Pr.Sela)
16 By Solehah/ indrawati Getap (pkm Kerongkonh)
17 By Hamdiah Ld.bagek (pkm Kerongkong)
18 By Siti Nurlaela/ Jamaludin Gunung siup (pkm Denggen)
19 By Murniwati/ Samsul Hadi Gn. Sepang (pkm denggen)
20 By Aedil/ Fatimatuzahra Batu Mulut (pkm denggen)
21 By Saputral/Fatimatuzahra Batu Mulut (pkm denggen)
22 By Ahmad Ramadani (Zultani/toriq Jakawali) Sandubaya (pkm Selong)
23 By Eri Alwani/Kamarudin Kelayu Jorong (pkm Selong)
24 Nasrullah/ Rumisah/ Holis Dsn Tirpas (Pkm Korleko)
25 By Hilmiati/Musinin gres Timuk (Pkm Korleko)
26 By Miftahul Uyun/Sulhadi Gres Bagek Elen (Pkm Korleko)
27 By Marniati Apitaik (PKM Batuyang)
28 By Rohni Pohgading (PKM Batuyang)
29 By Muliani Telagawau (Pkm Batunyng)
30 By Resiwati Sapit (pkm Suela)
31 By Arma yunita Sapit (pkm Suela)
32 By Nurhayati Ketangga (pkm Suela)
33 By Solihat Kp.Remaja (Pkm Aikmel)
34 Julia Sulistia Bagek Nyaka (Pkm Aikmel)
35 By Ernawati Dasan Beruk (Pkm Aikmel)
36 By Zuhratul Aeni/ Malan Hamdi A Dsn Dobol (Pkm Kalijaga)
37 By Haeriah Petakawan (Pkm Kalijaga)
38 Amriana Rosada Sukarema (PKM Kalijaga)
39 By Sumarini/ Marwan Orong rentek (Pkm Wanasaba)
40 By Martum Sambelia (PKM Sambelia)
iufd : 24
neo 11
bayi 3
balita 2
Mengetahui
Kepala Bidang
Bina Kesehatan Masyarakat

Suardi, SKM,MPH.
NIP. 19721231 199503 1 007
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: JUNI 2018 DINAS KESEHATAN KABUPATEN LOMBOK TIMUR

Usia
Kehamil Frekwe
Pendidikan Pekerjaan Orang Tanggal Tanggal
Umur L/P an saat nsi
Orang tua tua Lahir Meninggal
Dilahirk ANC
an (mg)
SD Petani 5/27/2018 5/27/2018 0 Hari L 42 mgg 5x
SMA Wiraswasta 6/1/2018 0106/2018 0 hari L 32 mgg 5x
SMA IRT 6/2/2018 6/2/2018 0 hari L 29 mgg 4x
D3/S1 Guru/Guru 6/1/2018 6/3/2018 2 Hari L 40 mgg 8x
SMP/SMP Tani/Tani 6/4/2018 6/4/2018 0 hari L 28 mgg 3x
SMA/SMA Pedagang 6/20/2018 6/20/2018 0 Hari L 32 mgg 6x
D1/S1 Pedagang/guru 6/13/2018 6/13/2018 0 hari L 41 mgg 6x
SMA IRT 12/12/2017 5/27/2018 5 bln L 38 mgg 8x
SD buruh 08/31/2014 5/31/2018 3,8 th L 39 mgg 7x
SD IRT 6/27/2018 6/27/2018 0 hari P 41 mgg 5x
SMP IRT 6/4/2018 6/4/2018 0 Hari L 24 mgg 2x
SD IRT 6/16/2018 6/16/2018 0 hari L 43 mgg 8x
SD/SD IRT/Buruh 6/11/2018 6/11/2018 0 hari P 38 mgg 6x
SMP/SMA IRT/Swasta 6/21/2018 6/21/2018 0 hari P 36 mgg 5x
SMP Buruh 6/19/2018 6/19/2018 0 Hari L 39 mgg 5x
SMP Petani 6/4/2018 6/4/2018 0 hari L 38 mgg 3x
IRT Petani 6/28/2018 6/28/2018 0 hari P 38 mgg 5x
S1/S1 Guru 6/17/2018 6/17/2018 0 hari P 38 gg 5x
SMP IRT 6/1/2018 01/16/2018 0 hari P 40 mgg 5x
SMA IRT 6/28/2018 6/29/2018 1 hari L 27 mgg 5x
SMA IRT 6/28/2018 6/29/2018 1 hari L 27 mgg 5x
IRT/Karyawan
SMP/SMP 6/11/2018 6/13/2018 2 hari L 40 mgg 8x
Swasta
SMA/SD IRT/Buruh 6/7/2018 6/7/2018 0 hari L 39 mgg 5x
SD/SD IRT/Tani 2/27/2017 5/28/2018 18 bln L 39 mgg 7x
SMp/SD IRT/Buruh 6/17/2018 5/17/2018 0 hari L 27 mgg 6
SMA/SMP Wiraswasta 6/22/2018 6/22/2018 0 hari P 25 mgg 5
SD IRT 6/4/2018 6/4/2018 0 Hari P 32 mgg 4x
SD IRT 6/24/2018 6/24/2018 0 Hari L 36 mgg 7x
SMP IRT 6/24/2018 6/24/2018 0 Hari P 38 mgg 5x
SMP IRT 6/14/2018 6/15/2018 1 hari L 24 mgg 3x
SMP IRT 6/23/2018 6/26/2018 4 hari P 39 mgg 8x
SD IRT 6/22/2018 6/22/2018 0 hari L 37 mgg 8x
SD IRT 5/26/2018 5/29/2018 4 hari P 36 mgg 6x
SMP Swasta 3/7/2018 5/29/2018 2 bln P 38 mgg 6x
SD IRT 6/14/2018 6/14/2018 0 hari P 28 mgg 4x
SMA IRT 6/5/2018 6/5/2018 0 hari P 38 mgg 6x
SD IRT 6/2/2018 6/2/2018 0 hari L 32 mgg 6x
SD IRT 8/9/2018 6/21/2018 10 bln P 38 mgg 6x
SD/SD Tani/IRT 6/24/2018 6/24/2018 0 hari P 40 mgg 9x
SD Petani 6/3/2018 6/3/2018 0 hari P 40 mgg 6x
BAYI & BALITA
ATEN LOMBOK TIMUR

Jenis
Persalinan
Anak (SptBKep,
BB / PB Tempat Melahirkan Penolong Persalinan Komplikasi ibu
ke- Sc, Vacum,
Drip, Spt
Brach)
3 3200/49 SPT.B PKM Keruak Bidan HBSAg +
5 2300/46 SC RS Risa Dokter
1 1300/27 Spt.B RSUD Bidan
3 3100/50 Spt.B Polindes Menceh Bidan
1 1100/36 Spt.B RSUD Dokter
3 2000/35 SC RSUD Dokter
4 3000/40 Spt.B RSUD Dokter
2 2700/46 Spontan Polindes bidan tdk ada
1 3000/50 spontan Pkm Sikur Bidan tdk ada
3 3000/50 Spontan Pkm Sikur Bidan HDK
Partus
8 800/35 Sungsang RSUD Bidan
Prematurus
2 3500/50 SPT.B kep RSUD Bidan Serotinus
2 3000 Spontan BPM Bidan
4 3800/ Spontan RSUD Dokter SpOg BSC
1 3300 Spontan Polindes Bidan
3 3500/50 Sptb RSUD Bidan Asma
3 2500/47 Sptb PKM Bidan tdk ada
1 2500/49 Sptb Kep RSUD Bidan Riwayat Sesak
1 4000/51 SptBkep Pkm Denggen Bidan Taa
2 800/35 SPt Brach RSUD Bidan Gameli
2 800/35 SPt Brach RSUD Bidan Gameli
2 3000/48 Spt.Bkep PKM Selong Bidan Taa
2 1600 Spt.Bkep RSUD Bidan Triplet
6 3500/50 Spt.B Rumah Bidan Tdk ada
2 SPt.B RSUD Bidan Prematur
1 SPT.B RISA SpOg Prematur
4 2000/40 Spt.B Bps Bidan
2 2300/48 SPt.B PKM Bidan
1 2200/48 SPT.B RSUD Bidan
1 1200/44 Spt.Bkep Rumah Bidan
2 1200/45 Spt.Bkep Polindes Bidan
3 4000/48 Spt.Bkep RSUD Bidan
2 3000/43 Spt.B RSUD Bidan KPD
3 2800/48 Sungsang PKM aikmel Bidan
1 600 Spt.B RSI Namira Bidan Preterm
5 2800 Spt.B PKM Bidan
4 2200/45 SC RISA SPOG Post SC
3 3500 Spt.B PKM Bidan
2 3200/47 Spontan Klinik Hamzar Bidan Ekalamsi
6 3100/50 P.Spt PKM Bidan Darah Tinggi
 Selong, ..........................
Kepala Seksi
Kesehatan Keluarga

Hj. Rokhliana, SST,MM

NIP. 19730314 199203 2 007
 Penyebab Meninggal Tempat Jam
Anak Meninggal meninggal

IUFD PKM Keruak

IUFD RS risa
BBLR RSUD
Kelainan Paru RSUD
IUFD RSUD
IUFD RSUD
IUFD RSUD
Sesak Rumah 9:00
Perut Bengkak Rumah 10:00
IUFD PKM 10:15
BBLR RSUD 17:30
IUFD RSUD 15:00
IUFD BPM 9:30
IUFD RSUD 5:00
Kelainan Bawaan RSUD 21:30
IUFD RSUD 21:00
IUFD PKM 11:00
IUFD RSUD 9:00
IUFD Pkm Denggen 14:00
BBLR RSUD 7:00
BBLR RSUD 8:00
Suspek Anemia, paha
RSUD 22:30
bengkak
IUFD RSUD 16:00
Tetanus RSUD 20:00
IUFD RSUD 10:00
IUFD RISA 20:00
IUFD
IUFD
IUFD
BBLR Rumah
BBLR Rumah 10:00
IUDF RSUD 22:00
Kel.Konginetal RSUP 10:00
Pnumonia RSUD 4:00
IUFD RSI Namira
IUFD PKM
IUFD RISA
Pneumonia RSUD 4:30
IUFD Klinik Hamzar 9:30
Aspirasi RSUD
 ………….., …………………………

tan Keluarga

…………………………………..
14 199203 2 007
 Alamat Pendidikan Pekerjaan
No. Nama Anak / Orang tua
(Puskesmas) Orang tua Orang tua

1 By Diana hariati Cerangan (Pkm Keruak) SMP IRT

2 By Khaerani/ Sahrip Mt. Wasi (Pkm Jerowaru) SD IRT
3 By Jamiatun jelok Busa (Pkm Jerowaru) SMA Petani
4 By Novi Slam Gn. Rajak (Pkm Rensing) SMA IRT
5 Nujuatul Solehah/Sahnim Pejaring (Pkm Rensing) SD IRT
6 Abdullah/ Amirah- Awaludin Lepak (Pkm Lepak) SD/SD Dagang/Tani
7 Siti Aisyah/ Sumiah-Ketah Pelopok, (Pkm Lepak) TTSD/SD Buruh Tani
8 Fathurrahman/ Zohrahil Patonah Repok Tanggak (pkm lepak) SD/SMP Tani
9 Muttaqin/ Nurul Hidayati-rusli Batu Nyala (Pkm Lepak) S1/S1 Honorer
10 By Idayani/Huriandi Sukadana (pkm Terara) SMP/SMp IRT/yani
11 By Yunisa Mt. Kanggo (Pkm Mt.Betok) SMP IRT
12 By Uswatun aulia Pkm Sikur SD TKI/IRT
13 By Hendri Wati Pkm Sikur Smp/Smp Buruh/IRT
14 Irsyat Pkm Masbagik SD/SMP IRT/Swasta
15 Arsyat Pkm Masbagik SD/SMP IRT/Swasta
16 By Fathuljannah Kesik (Pkm Ld. Nangka) SMP IRT
17 By Suharni Kesik (Pkm Ld. Nangka) SMP IRT
18 By Muslihatun Gua Punik (Pkm Ld.Nangka SD IRT
19 Zainul Muttaqin/ Nur Hayati Kerongkong (pkm Kerongkong) SD IRT
20 By Siti Maswah/ Husnul Hilwn Bagek Endep (Pkm Dsn. Lekong) SD/SMP IRT/Swasta
21 By Rohmatul islami Muhajirin (Pkm Denggen) SMA Karyawan Toko
22 By Kuni Sapingah Seruni (Pkm Selong) SMA IRT
23 M julian / Suryati/Suherman Kokok Lauk II (Pkm Selong) SD Buruh
24 By Septiana Dsn Montong (Pkm Lb.haji) SD Wiraswasta
25 Nurul Azwani/Subuhiah/Nirwandi Gbk Pedalman (Pkm Korleko ) SD/SD IRT/Tani
26 By Suhartini Ijo Makmur (Pkm Korleko) SD/SD Buruh/tani
27 By Sulhiah 1 Lembak Lauk (Pkm Korleko) SD/SD IRT/Tani
28 By Sulhiah 2 Lembak Lauk (Pkm Korleko) SD/SD IRT/Tani
29 By Purwnawati Dsn. Bagek Lauk (Pkm Batuyang ) SMP IRT
30 By Purnawati Dsn. Bagek Lauk (Pkm Batuyang ) SMP IRT
31 Sopiah Gbk. Tangak (Pkm Batuyang) SMA IRT
32 Gibran/Ruslinda bagek papan (Pkm Batuyang) SMA IRT
33 Sulhan Dsn. Tapen Daya (Pkm Batuyng) SMP IRT
34 By. Ny. Nurhasanah Dasan Gerung SD IRT
35 By Musri Sapit (Pkm Suela) SD IRT
36 By Muliadah Ketangga (Pkm Suela) SMA IRT
37 By Hilmiati Ketangga (Pkm Suela) SMP IRT
38 By Rianep P.Jeringo (Pkm Suela) SD Petani
39 M. Yuzan Perigi (Pkm Suela) SMP Petani
40 By Mahnep Kekalian (pkm Lenek) SD IRT
41 A Faris Munanda Peneda (Pkm Aikmel) SMP IRT
42 M. Andika/ Yuliani Keroya (Pkm Aikmel) SMA IRT
43 By Nurhasanah Pkm Sembalun SMP IRT
44 By Nurhidayah Embung Ganang (Pkm Belanting) SD/SD IRT/Tani
45 By Fitriati Lepak Loang (Pkm Belanting) SD/SD IRT/Tani
46 Irsad Mustapid/ fitriatul Aini Bebak (Pkm Rarang) SMA IRT
47 Bq. Sri Intan/ Abd. Muis Kbn. Depak SMA Wiraswasta

iufd : 19
neo 21
bayi 7

Mengetahui,
Kepala Puskesmas ………………..

…………………………..
NIP:…………………………..
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: …………………………………………..

Usia
Jenis Persalinan
Kehamilan Frekw
Tanggal L/ Anak (SptBKep, Sc,
Tanggal Lahir Umur saat ensi BB / PB
Meninggal P ke- Vacum, Drip, Spt
Dilahirkan ANC
Brach)
(mg)

29/06/2018 29/06/2018 0 Hari L 32 mgg 4x 2 1000/37 Spt.B

7/4/2018 7/4/2018 0 Hari L 38 mgg 5x 2 4200/51 Vacum
7/9/2018 7/11/2018 2 hari P 29 mgg 5x 3 2000 Spontan
20/06/2018 20/06/2018 0 Hari P 32 mgg 6x 2 2000/48 Spontan Drip
23/06/2018 23/07/2018 1 Bulan P 40 mgg 6x 5 3500/ SptBkep
27/06/2018 1/7/2018 4 Hari L 39 mgg 7x 4 3500/50 Spontan
25/07/2018 25/07/2018 0 Hari P 40 mgg 7x 6 3000/50 Spontan
11/7/2018 11/7/2018 0 hari L 41 mgg 9x 2 2800/48 Spontan
27/06/2018 27/06/2018 0 Hari L 36 mgg 6x 2 2500/46 Spotan
21/07/2018 21/07/2018 0 Hari L 28 mgg 4x 2 1500/40 Sungsang perva
10/7/2018 11/7/2018 1 hari P 30 mgg 5x 1 1500/40 SptBkep
7/3/2018 07/03/20118 1 jam P 37 mgg 6x 1 2500/46 Spontan
22/07/2018 27/07/2018 5 hari L 36 mgg 7x 2 2800/48 Spontan
9/7/2018 9/7/2018 0 hari L 28 mgg 5x 2 Spontan
10/7/2018 11/7/2018 1 Hari L 29 mgg 5x 2 Drip
14/07/2018 7/10/1905 0 hari L 35 mgg 5x 2 1000 SptBkep
23/07/2018 23/07/2018 0 hari L 40 mgg 7x 3 2400 SptBkep
15/07/2018 15/07/2018 0 Hari L 42 mgg 8x 5 2500/48 SptBkep
01/01/2018 16/03/2018 2 bulan L 39 Mgg 8 kali 3 3300/ 49 Normal
14/07/2018 14/07/2018 0 hari L 43 mgg 9x 1 3000/50 Spontan
1/7/2018 1/7/2018 0 hari P 38 mgg 7x 2 2400/40 SptBkep
7/7/2018 7/7/2018 0 Hari L 28 mgg 3x 4 1000/39 Spontn
13/07/2018 13/07/2018 0 hari L 37 mgg 9x 4 3100/50 Spontan
29/06/2018 29/06/2018 0 Hari L 33 mgg 4x 3 1800/43 P.Spt.B
20/06/2018 27/06/2018 7 hari L 37 mgg 7x 2 2200/48 Spt.B
19/07/2018 19/07/2018 0 hari P 35 mgg 7x 3 1700 Drip C
24/07/2018 24/07/2018 0 hari L 24 mgg 4x 3 500 Spt.b
24/07/2018 24/07/2018 1 Hari L 24 mgg 4x 3 600 Spt.b
7/23/2018 7/23/2018 1 Hari P 28 mgg 7x 3 1100/40 SPT.B
7/23/2018 7/24/2018 1 hari L 28 mgg 7x 3 1200/39 SPT.B
7/7/2018 7/7/2018 1 hari L 26 mgg 4x 3 800/40 SPT.B
6/19/2018 7/19/2018 30 Hari L 40 mgg 8x 1 3000/40 SPT.B
7/21/2018 7/22/2018 2 hari P 26 mgg 3x 2 1000/38 SPT.B
8/7/2018 8/7/2018 0 hr P 40 mgg 5x 1 2800/47 spontan
18/07/2018 20/07/2018 3 hari L 27 mgg 6x 2 1000/43 SC
1/7/2018 1/8/2018 0 hari P 38 mgg 8x 2 2700/48 SptBkep
11/7/2018 11/7/2018 0 hari L 28 mgg 6x 3 2100/45 SptBkep
9/7/2018 9/7/2018 0 hari L 28 mgg 5x 3 1500/43 SptBkep
6/3/2018 7/7/2018 4 Bulan L 40 mgg 10 x 2 2800/48 SptBkep
22/07/2018 24/07/2018 2 hari P 40 mgg 9x 5 2700/49 P.Spt.B
4/16/2018 7/22/2018 3 Bulan L 39 mgg 4x 3 2900/46 Spt.B
4/29/2018 7/30/2018 3 Bulan L 40 mgg 6x 1 2600/49 Spt.B
6/26/2018 6/26/2018 0 Hari L 40 mgg 5x 3 3000/49 Normal
7/4/2018 7/4/2018 0 Hari L 36 mgg 7x 2 2000/47 Spontan
7/11/2018 7/11/2018 0 Hari L 28 Mgg 4x 7 1500/27 Spontan
4/18/2018 6/26/2018 2 Bulan L 34 Mgg 6x 1 2100/46 Normal
7/20/2018 7/20/2018 0 Hari L 28 mgg 5x 2 985/35 Normal
A

Penolong Penyebab Meninggal

Tempat Melahirkan Komplikasi ibu
Persalinan Anak

RSUD Bidan BBLR

RSUD Dokter KPD Asfiksia
Polindes Pemongkong Bidan Polihidramnion BBLR
RSUD Bidan IUFD
Polindes Bidan Hipoglikemi
PKM Bidan Ikterus
PKM Bidan IUFD
RSUD Bidan IUFD
RSUD Bidan IUFD
Pkm terara Bidan IUFD
BPS Rita Bidan Gameli BBLR
Polindes Sikur Bidan Polihidramnion Aspirasi
Pkm sikur Bidan Kelainan Jantung
Polindes Bidan BBLR
RSUD Bidan/Dokter BBLR
RSUD Bidan TBC IUFD
RSUD Bidan Gameli IUFD
RSUD Bidan Serotinus IUFD
BPS Bidan - Demam
RSUD Bidan Postdate IUFD
RS Bidan KPD IUFD
RSUD Bidan IUFD
Poskel Kelayu Sel Bidan IUFD
BPM Wijri Bidan Preterem IUFD
RSUD Bidan Letsu BBLR
RSUD Dokter PEB IUFD
RSUD Dokter Gameli IUFD
RSUD Dokter Gameli BBLR
RSUD Bidan Gameli BBLR
RSUD Bidan Gameli BBLR
PKM Bidan Prematur BBLR
BPS Bidan Tdk mau menyusu
POLINDES Bidan Prematur BBLR
RSU Bidan KPD Asfiksia
RSUD SPoG Eklamsia BBLR
RS Risa Bidan IUFD
RSUD Bidan IUFD
Rumah Dukun Anemia BBLR
Poskesdes Bidan Pneumonia
RSUD Bidan PEB+ Fetal Distres Asfiksia
Polindes Toya Bidan Diare Akut
Pkm Aikmel Bidan Sesak
Pkm Bidan Tali Pusat Menumbung
Pkm Bidan Asfiksia Berat
RSUD Bidan IUFD
BPS Bidan Susp. VKDB+ Anemia
RS Risa Dokter IUFD

………….., …………………………
Bidan Koordinator Puskesmas …………….

…………………………………..
NIP:……………………………………
 Tempat Meninggal Jam meninggal

RSUD 04.00 Wita

RSUD 12.00 Wita
RSUD
RSUD
RSUD
RSUD
PKM
RSUD
RSUD
Pkm Terara
Rumah 11.30 Wita
Pkm Sikur 19.10 Wita
RSUD 04.00 Wita
RSUD 15.30 Wita
RSUD 14.00 Wita
RSUD 09.00 Wita
RSUD 15.00 wita
RSUD 12.00 Wita
Rumah 05.00 Wita
RSUD 07.00 Wita
RSUD 10.30 wita
RSUD 20.10 Wita
Poskel Kelayu Sel 07.50 Wita
BPM Wijri 06.00 Wita
RSUD 12.30 Wita
RSUD 16.00 Wita
RSUD 01.00 Wita
RSUD 13.00 Wita
RSUD 20.00 Wita
RSUD 11.00 Wita
RSUD 09.00 Wita
Rumah 04.00 Wita
RSUD 17.00 Wita
RSU 05.00 wita
RSUD
RS Risa 10.00 Wita
RSUD 22.00 Wita
Rumah
PKM 09.00 Wita
 RSUD 04.00 Wita
RSUP 15.30 Wita
RSUD 11.00 Wita
Pkm 15.40 Wita
Perjalanan ke RSUD 10.30 Wita
RSUD 16.00 Wita
RSUD 02.57 Wita
RS Risa

…………………………
…………….

………………………..
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: …………………………………………..

Usia
Kehami Jenis Persalinan
Frekw
Alamat Pendidikan Pekerjaan Tanggal Tanggal lan saat (SptBKep, Sc, Tempat Penyebab Meninggal Tempat Jam
No. Nama Anak / Orang tua Umur L/P ensi Anak ke- BB / PB Penolong Persalinan Komplikasi ibu
(Puskesmas) Orang tua Orang tua Lahir Meninggal Dilahir Vacum, Drip, Spt Melahirkan Anak Meninggal meninggal
ANC
kan Brach)
(mg)
1 By Hamidatun Hamidah Gunung Rajak (Pkm Rensing) SD/SMP IRT/TKI 8/6/2018 8/6/2018 0 Hari L 28 mgg 3x 3 900 Spt.BKep RSUD Bidan Riwayat SC IUFD RSUD 22.00 Wita
2 By Nurhidayati Mt.Betok (Pkm Mt. betok ) SD IRT 8/23/2018 8/23/2018 0 Hari P 26 mgg 4x 6 1000 P.Spt.B RSUD Dokter, Bidan HPP BBLR RSUD 09.00 Wita
3 M.Ridoan/Nuraini Kesik (Pkm Ld.Nangka) SD IRT 8/14/2018 8/16/2018 3 Hari L 38 mgg 4x 4 3000 SC RSUD SpoG PEB Kelaianan Bawaan RSUD 17.00 Wita
4 By Nurlaela/ Sapiudin Dsn.Lekong (Pkm Dsn Lekong) SMA/SMA IRT/Swasta 7/30/2018 7/30/2018 0 Hari L 26 mgg 5x 2 900 Spotan RSUD Bidan, Dokter PEB BBLR RSUD
5 By Hida Royani Sekar Anyar (PKm Denggen) SMA IRT 8/6/2018 8/6/2018 0 Hari P 40 mgg 8x 1 3000/48 Spt.Brach PKM Denggen Bidan Letsu IUFD Pkm Denggen 02.00 Wita
6 Abdul Majid/ Niswatul Majidi (Pkm Denggen) SI IRT 8/8/2018 8/8/2018 0 Hari L 33 mgg 6x 3 900/35 Spt.Kep Klinik Kuncup B Dokter, Bidan Oligohidramnion IUFD+ Kelaianan BawaaKlinik Kuncup B 12.00 Wita
7 Arsyila Farzana /Marwah Anjani (Pkm Kerongkong) SMA Swasta 8/2/2018 8/2/2018 0 Hari P 35 mgg 6x 1 2000/42 Drip Oxy Risa dokter Taa IUFD Risa 06.00 Wita
8 M. Zaki Agustian/Sumiati/Parhan Azmi Presak Barat (Pkm Selong) SD/SMA IRT/Buruh 8/12/2018 8/16/2018 4 Hari L 37 mgg 3x 2 1900/46 SPT.Brach RSI Namira Dokter, Bidan Gameli BBLR RSUD 14.00 Wita
9 Ispan/Miptah Kubur Belo (Pkm Selong) SD/SD IRT/Buruh 8/25/2018 8/25/2018 0 Hari P 26 mgg 3x 3 400/ Spt. Brach Rumah Bidan IUFD IUFD Rumah 03.00 Wita
10 M. Zidan Abqori Kp. Seruni (Pkm Selong) SMA/SI IRT/Swasta 8/7/2018 8/12/2018 5 Hari L 34 mgg 9x 1 2300 SC RSUD SpoG Prematur TOP/BBLR RSUD 22.30 Wita
11 Abil Agustian (Muslihatun/Suraini) Gres Bagek Elen (Pkm Korleko) SI/SI Guru/Guru 1/8/2018 8/14/2018 4 Hari L 33 mgg 6x 2 2400/47 SPT.B Polindes Bidan Prematur BBLR+Hipotermi RSUD 15.00 Wita
12 By Nirmala Dasan Lendang (Pkm Batuyang) SMA IRT 8/11/2018 8/11/2018 0 Hari L 41 mgg 8x 4 3000/50 Spt.B RSUD Bidan PEB IUFD RSUD
13 By Muliana Bagek Gaet (Pkm Batuyang) SMA IRT 8/12/2018 1208/2018 0 Hari L 36 mgg 7x 1 200/46 Spt.B RSUD Bidan IUFD RSUD
14 By Hadijah Suntalangu (Pkm Suela) SMP Petani 8/23/2018 8/23/2018 0 Hari P 39 mgg 8x 4 3900/52 Spt.Bkep RSUD Bidan Post trauma IUFD RSUD 14.00 Wita
15 M. Dayyan Diris/ Wiwin Noviana Kr,Bila (Pkm Lenek) SMP IRT 7/28/2018 8/13/2018 16 Hari L 39 mgg 6x 1 3000/50 Vacum RSUD SpoG PEB+LHM Apneu+Hipotermia RSUD 19.00 Wita
16 BY Iq Yogi Koloh Petung Timuk (Pkm Lenek) TS IRT 8/17/2018 8/17/2018 0 Hari P 26 mgg 3x 7 800/35 P.Spt.B Pkm Lenek Bidan Sesak IUFD Pkm Lenek 03.00 Wita
17 BY Iq Rusnan Kb.Kerang daya (Pkm Aikmel) SD Tani 8/19/2018 8/19/2018 0 Hari P 40 mgg 6x 5 3300/48 Spt.B Pkm Aikmel Bidan Kel.Konginetal+IUFD PKM Aikmel 22.30 Wita
18 By Erni Supianti/ Dsn Beruk (Pkm Aikmel) SMP Dagang 10/7/2018 10/7/2018 0 Hari L 28 mgg 4x 2 900 Spt.B Kuncup Bunga Dokter IUFD Kuncup Bunga
19 By Marsahan Petakawan (Pkm Kalijaga) TS IRT 8/24/2018 8/24/2018 0 Hari L 26 mgg 3x 5 600 Spt.Bkep Rumah Bidan IUFD Rumah
20 Zoya Alaika Yumna/ Indrawati Mamben daya (Pkm Wansaba) SMP IRT 8/12/2018 8/18/2018 6 Hari P 39 mgg 3x 2 P.Spt.B Pkm Wanasaba Bidan Ikterus RSUD
21 By Anti Susilawati/Marwan Mekar Sari , Medayin (Pkm Belanting) SD/SD IRT/Tani 8/5/2018 8/5/2018 0 Hari L 26 mgg 3x 2 900/35 Spotan RSUD Bidan Taa Prematur/BBLR RSUD 08.00 Wita
22 By Rosalina/Salihun Obel-obel (Pkm Belanting) SD/SD IRT/Tani 8/5/2018 8/8/2018 3 Hari P 40 mgg 8x 1 2800/48 Spontan RSUD Bidan Taa Kejang Demam Rumah 16.00 Wita
iufd 12
neo 10

Mengetahui, ………….., …………………………

Kepala Puskesmas ……………….. Bidan Koordinator Puskesmas …………….

………………………….. …………………………………..
NIP:………………………….. NIP:……………………………………

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Mengetahui : Selong, September 2014

Kepala Bidang Kesga Kepala Seksi KIA

SUARDI, SKM, MPH Hj ROKHLIANA, SST, MM

NIP 19721231 199503 1 007 NIP 19730314 199203 2 007
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: …………………………………………..

Jenis
Usia
Persalinan
Kehamilan
Alamat Pendidikan Pekerjaan Tanggal Tanggal Frekwensi Anak (SptBKep, Tempat Penolong Penyebab
No. Nama Anak / Orang tua Umur L/P saat BB / PB Komplikasi ibu Tempat Meninggal Jam meninggal
(Puskesmas) Orang tua Orang tua Lahir Meninggal ANC ke- Sc, Vacum, Melahirkan Persalinan Meninggal Anak
Dilahirkan
Drip, Spt
(mg)
Brach)
1 By Nurhazalbaeti/ Mujiburrahman Srewe (Pkm Jerowaru) SD/SD Nalayan 9/4/2018 9/4/2018 0 Hari P 38 mgg 4x 1 2200/40 Spontan RSUD Selong Bidan Polihidramnion Ancepalus RSUD 06.00 Wita
2 By Karya Istanti/ Hafiz ibrahim Kuang Baru (Pkm Sakra) SMA/SI IRT/Sopir 9/4/2018 9/4/2018 0 Hari L 34 mgg 4x 3 2000/42 SPT.B PKM Sakra Bidan Asfiksia/Prematur PKM Sakra
3 By Assaratul Hidayah/Sahni-L.Zainuduin Mengkuru (PKm Rensing) SMP Wiraswasta 7/13/2018 9/24/2018 2 bulan P 40 mgg 6x 4 3300 Spt,Bkep RSUD Selong Bidan Polihidramnion Peumonia PKM 00.30 Wita
4 Azril/ Sulkiah/ Irwan Ngelok, Greneng (Pkm Lepak) SD/SD IRT/TKI 8/29/2018 8/29/2018 0 Hari L 39 mgg 0x 2 2900 SC RSUD Selong Dokter Asfiksia Berat RSUD
5 Ahd. Lutfi/ Anilawati-Hendri p Bongkem Lepak (PKm Lepak) SMP/SMA IRT/Tani 9/1/2018 9/1/2018 0 Hari L 40 mgg 7x 1 1900 SC RSUD Selong Dokter IUFD RSUD
6 By Suriani/ Kajol Jawa (pkm Mt.Betok) S1/SMA IRT/Tani 9/6/2018 9/8/2018 3 Hari L 32 mgg 5x 1 1000/36 SC RSUD Selong Dokter PEB BBLR RSUD
7 M. Imam Sirajudin/ Salmah Keluncing (Pkm Mt. Betok) SMP/SMA IRT/Tani 7/24/2018 9/18/2018 58 Hari L 38 mgg 5x 2 3500/50 Spt.Bekep Polindes Bidan Kejang RSUD
8 (PKM Sikur) IUFD
9 By Sumiati Presak (Pkm Ld.nangka) SD/SD Pedagang 9/3/2018 9/11/2018 8 Hari L 34 mgg 5x 3 2900/45 Spt.B BPS Bidan DM Kelainan Bawaan RSUD 16.00 Wita
10 By Tika Pini Trisna/ M. Salehudin Kebon Montong (Pkm dsn.lekong) SMA IRT 9/12/2018 9/12/2018 0 Hari L 38 mgg 7x 1 3300/50 SC RSUP SPOG IUFD RSUP
11 By Elda/ Gelumpang (Pkm kerongkong) SMA iRT 9/2/2018 9/3/2018 1 Hari L 36 mgg 5x 1 2600/46 SPT.B Pkm Bidan taa Cacat bawaan RSUD Mataram 12.30 Wita
12 Sani/ Citra Kirana gerung Barat (Pkm Kerongkong) SMA Wiraswasta 9/5/2018 9/7/2018 3 Hari P 28 mgg 4x 2 2500/45 Drip RSUD Selong Bidan Taa Asfiksia RSUD 04.00 Wita
13 By Dian Febriani Sekaranyar/ denggen (Pkm Denggen) SMA IRT 9/12/2018 9/12/2018 0 Hari L 26 mgg 6x 1 700/21 Spt. Brach RSUD Selong Bidan Kelainan letak IUFD RSUD 23.09 Wita
14 By Hilmi/ Fathurrohman Gbk.tengak (Kelayu Utara), Pkm Selong SMP/SMP IRT/Tukang 9/28/2018 9/28/2018 0 Hari P 39 mgg 6x 2 2600/47 SC RSUD Selong SPOG KPD IUFD RSUD
15 Farisa Pathiatul Zulaika Nyelek, kel Jorong (Pkm Selong) SD/SD IRT/Buruh 5/18/2018 9/2/2018 3 Bulan P 39 MGG 5X 1 2200 Spontan Polindes Bidan Prematur Pneumonia RSUD 20.00 Wita
16 Elisa Julianti Teros (Pkm Lb. Haji) SD/SD IRT/Nelayan 7/5/2018 9/7/2018 64 Hari P 40 mgg 6x 3 3300/50 Spontan Poskesdes bidan Aspirasi perjalnan Merujuk Ke RSUD 03.30 Wita
17 Rohyani Bagek Kedok (Pkm Bt.Yang) SMA IRT 9/5/2018 9/5/2018 0 Hari P 40 mgg 7x 2 4500/50 SC RSUD Selong Dokter PEB IUFD RSUD 22.30 Wita
18 By H Mudung Timur, (Pkm Batuyang) SD IRT 06/092018 06/092018 0 Hari L 36 mgg 6x 1 3500/50 Spontan RSUD Selong Dokter IUFD RSUD 08.15 Wita
19 By Husniah Bagek gaet (PKM Batuyang) SMA IRT 9/14/2018 9/14/2018 0 Hari L 40 mgg 7x 2 2600/48 Spontan POlindes Bidan Anen Chepal RSUD 21.00 Wita
20 Yanik/ Januar Pohgading (Pkm Batuyang) SMA IRT 9/10/2018 9/10/2018 0 Hari L 28 Mgg 4x 1 1300/43 Spontan RSUD Selong Dokter IUFD RSUD 19.00 Wita
Pkm Lb. Lombok IUFD
21 Azkiatunnisa/ Arma Sapit (PKm Suela) SMP Petani 6/23/2018 9/9/2018 2,5 Bulan P 38 mgg 8x 1 2000/46 SPt. Bekep Poskesdes Bidan Pneumonia RSUD 23.15 Wita
22 M/. Ilham Sapit (PKm Suela) SMP Petani 8/3/2018 9/14/2018 1,5 Bulan L 38 mgg 8x 2 2500/48 Spt,Bkep Poskesdes Bidan Pneumonia RSUD 11:00
23 Ridwan Kamil/ Maemunah Sulela (PKM Sulea) SD Petani 9/9/2018 9/11/2018 2 Hari L 39 mgg 7x 2 3000/48 SPt. Bkep BPM Bidan Hipotrmia Rumah 05.00 Wita
24 Nurma pajriah/ pandu karisma Gbk Bagek (Pkm Lenek) SMA IRT 9/2/2018 9/6/2019 4 hari L 28 mgg 6x 2 1100/40 Spt. Bkep PKm Lenek Bidan BBLR RSUD 23.00 wita
25 Nurma pajriah/ pandu karisma Gbk Bagek (Pkm Lenek) SMA IRT 9/2/2018 9/6/2019 4 hari L 28 mgg 6x 2 1100/40 Spt. Bkep Puskel Bidan BBLR RSUD 23. 15 Wita
26 Widai azizia dsn. Baru (pkm lenek) SD IRT 7/12/2018 9/10/2018 2 Bulan P 39 mgg 6x 1 3300/49 Polindes Bidan pnemonia RSUD 01.30 Wita
27 By Iq Sahri Ramban Bela (PKm Lenek) SD IRT 9/22/2018 9/22/2018 0 Hari L 39 mgg 5x 5 3200/50 sc RSUD Selong SPOg Polihidramnion Ananchepaly RSUD 17.00 Wita
28 By Aetun Toya (Pkm Aikmel) SD IRT 9/6/2018 9/6/2018 0 Hari L 41 mgg 7x 4 2500/47 SPT.B Polindes Bidan Afiksia RSUD 14.00 Wita
29 By Nurhidayati/ Ahmad Sairi Erot lauk (Pkm Kalijaga) SAM/SD Buruh 9/20/2018 9/21/2018 1 Hari P 29 mgg 3x 3 900/25 Spontan RSUD Selong Bidan BBLR RSUD
30 Naufal Abiyan/ Farhah Praubanyar (PKM Kalijag) SMP Wiraswasta 3/30/2018 8/27/2018 4 bulan28 H L 29 mgg 7x 3 3400/49 SPt Kep Pol. Suralaga Bidan RSUD
31 M. gibran/ Zohratul Aini DS. Tembeng (Pkm Kalijag) SMA IRT 8/3/2019 8/27/2018 6 Bulan L 40 mgg 8x 1 3800/50 SC RSUD Selong DOkter KPD Susp. Encephalitis RS RISA
32 Rapaza/ Herpina Banjar Getas (PKM Wanasaba) SD IRT 5/23/2018 9/10/2018 4 Bulan L 38 mgg 4x 1 3500/49 SC RSUD Selong SPOG CPD Pneumonia RSUD
33 By Riniwati Tembeng Putik (PKm Wanasaba) S1/SMA Guru 9/24/2018 9/24/2018 0 Hari L 36 mgg 8x 1 2200/40 SC RSI Namira SPOG Kelainan Bawaan RSI Namira
34 By Okmiati Timburan (PKm Sambelia) SMA IRT/Tani 9/23/2018 9/23/2018 0 Hari P 29 mgg 5x 1 2000/15 SPt RS Bidan Panas IUFD RS 09.00 Wita
35 Siti Mirana/ Mujahid Marhun Melempo (PKm Belanting) TTSD/SMP Tani/IRT 9/14/2018 9/14/2018 0 Hari P 32 mgg 4x 2 2300/46 SPt Brach RSUD Selong Bidan IUFD RSUD 10.00 Wita
36 by Supariun Ds. Reban (Pkm Karang baru) SD/SD IRT/TKI 8/27/2018 8/27/2018 0 Hari P 35 mgg 5x 4 2000 Drip RS Namira SPOG IUFD RS namira 00.05 Wita
37 By Ny Paeni Otak Lendang (Pkm Masbagik baru) SMP IRT 9/9/2018 9/9/2018 0 Hari L 37 mgg 3x 2 2700/50 Normal PKm Masbar Bidn KPD Asfiksia Pkm Masbar 00.30 Wita

iufd 12

neo 16
bayi 10

Mengetahui, ………….., …………………………

Kepala Puskesmas ……………….. Bidan Koordinator Puskesmas …………….

………………………….. …………………………………..
NIP:………………………….. NIP:……………………………………
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: OKTOBER 2018

Jenis
Usia
Persalinan
Kehamilan
Pendidikan Pekerjaan Tanggal Tanggal Frekwensi (SptBKep, Tempat Penolong
No. Nama Anak / Orang tua Alamat (Puskesmas) Umur L/P saat Anak ke- BB / PB Komplikasi ibu Penyebab Meninggal Anak Tempat Meninggal Jam meninggal
Orang tua Orang tua Lahir Meninggal ANC Sc, Vacum, Melahirkan Persalinan
Dilahirkan
Drip, Spt
(mg)
Brach)
1 By Resti S/ Jakarja Maringkik (Pkm Keruak) SD IRT 2/10/2018 2/10/2018 0 Hari P 30 mgg 6x 2 2000/47 Spontan RS Namira Dokter Bidan IUFD RS Nammira 22.45 Wita
2 By Sarniati/ Sarniati Rengah, Desa Pandan Wangi (Pkm jerowaru) SD Tani 10/27/2018 10/27/2018 0 Hari L 28 mgg 4x 4 Spt B PKM Bidan Preterm IUFD PKM
3 By Patmah/ L. Apipudin Gunung Rajak (Pkm Rensing) SD IRT 10/15/2018 10/22/2018 7 Hari L 37 Mgg 7x 1 1500/40 SPT Bkep Polindes Gn. RaBidan Antresia Ani RSUD Kota 12.30 Wita
4 By sarah/ l. Taufikurrahman Gn. Rajak (Pkm Resning) SD IRT 10/15/2018 10/15/2018 0 Haei L 38 mgg 6x 2 3500/50 SPT Bekp Pkm Remsing Bidan BHsAg + IUFD PKm rensing 23.55 Wita
5 By Syahdan/ Nurul Wahida/ M. nahar Greneng Timur (Pkm Lepak) SMP/SD IRT/TKI 10/14/2018 10/14/2018 0 Hari L 34 mgg 5x 2 1700 Spontan RSUD Bidan IUFD RSUD
6 By Fitriati/ L. M. Ridwan Batumora (Pkm Sikur) SMMP/SMP IRT/Swasta 10/6/2018 10/9/2018 3Hari L 26 mgg 3x 2 1400/35 Spt Bkep RSUD Dokter BBLR RSUD 09.00 Wita
7 By Nurfaizah/ Zaitun Cengok (Pkm Sikur) SD/SMP IRT/ Swasta 10/15/2018 10/15/2018 0 Hari L 42 mgg 6x 3 3300/49 SPt Bekp PKM Bidan IUFD PKM 08.10 Wita
8 Dinda Ayu/ Haeroni Repok Raden(PKM Ld. Nangka) SMA IRT 10/13/2018 10/13/2018 2 Jam P 26 Mgg 5x 3 900 Spt RSUD Bidan PEB+Polidihramnion BBLR RSUD 17. 30 Wita
9 By Rohmi Hidayat Sekaranyar (Pkm Denggen) SMA Buruh 10/25/2018 10/29/2018 5 Hari L 36 Mgg 7x 2 2500/48 Spt.Bkep BPS Bidan harianah KPD Asfiksia Berat RSUD 05.00 Wita
10 By indiawati kepah (pkm kerongkong) SMA IRT 10/26/2018 10/26/2018 0 hari L 24 mgg 4x 3 700 SPT RSU BIDAN BBLR RSU SELONG 05.00 wita
11 By Siti Maesaroh BGbk Lekok2 Apitaik (Pkm Btuyang) SMA IRT 9/23/2018 9/27/2018 4 Hari P 28 mgg 4x 2 1100/40 Spontan RSUD Bidan Prematur BBLR RSUD
12 By Siti Maesaroh BGbk Lekok2 Apitaik (Pkm Btuyang) SMA IRT 9/23/2018 9/27/2018 4 Hari P 28 mgg 4x 2 1100/40 Spontan RSUD Bidan Prematur BBLR RSUD
13 By Sohinun bagek Gaet (Pkm batuyang) SMA IRT 10/24/2018 10/24/2018 0 Hari L 24 mgg 4x 1 600/30 Spontan PKM Bidan IUFD RSUD
14 By Sohinun bagek Gaet (Pkm batuyang) SMA IRT 10/24/2018 10/24/2018 0 Hari L 24 mgg 4x 1 600/30 Spontan PKM Bidan IUFD RSUD
15 By Nila Wati Gbk Daya, Pohg timur (PKm Batuyang) SMP IRT 10/3/2018 10/3/2018 0 Hari L 28 mgg 5x 1 600/30 Spontan RSUD Bidan IUFD RSUD
16 By canggal Lestari gubuk Bagek (Pkm Lenek) S1 IRT 10/22/2018 10/28/2018 6 Hari P 27 mgg 4x 2 800/36 Spt.Bekep RSUD Bidan Prterem BBLR RSUD 15.00 Wita
17 By Iq Masrul Aikprapa (PKM Aikmel) SD IRT 9/20/2018 9/20/2018 0 Hari P 27 mgg 3x 4 900 SPt RSUD Bidan Preterem IUFD+Ansepal
18 By Siti Riah Toya (Pkm Aikmel) SMP IRT 10/16/2018 10/16/2018 0 Hari L 38 mgg 4x 3 2300/40 SC RSUD Dokter Plasenta previa totalis IUFD RSUD
19 By Purnawati Dsn Lian Lauk (PKM Aikmel) SMA IRT 10/18/2018 10/18/2018 0 Hari L 38 mgg 6x 3 3500/49 SPT Polindes AikmelBidan IUFD + Kelainan KonginetaPolindes
20 By Suhartini Kembang Kerang Daya (PKM aikmel) SD IRT 10/17/2018 10/17/2018 0 Hari L 36 mgg 4x 9 3900/52 SPt RSUD DOkter Infeksi Torch IUFD RSUD
21 By Iq Pahri Pungkasan Kembang kerang (Pkm Aikmel) SD IRT 10/18/2018 10/18/2018 0 Hari P 40 mgg 4x 9 3900/52 SPt RSUD Dokter Riwayat SC IUFD RSUD
22 By Nurhasanah Montong pace, (PKm Aikmel) SD Tani 10/11/2018 10/11/2018 0 Hari L 34 mgg 4x 2 1500/37 SPt RSUD Bidan Gameli+Pretemr IUFD RSUD
23 By Uswatun Keroya (PKm Aikmel) SMP IRT 10/16/2018 10/16/2018 0 Hari L 28 mgg 2x 1 1000 Spt BPM Bidan IUFD BPM
24 By Aisah Bagik Nyaka (PKM Aikmel) SMP IRT 10/15/2018 10/15/2018 0 Hari L 32 mgg 4x 3 2600/46 SPT RSUD Bidan IUFD RSUD
25 M. Khaerul Sahreza Sukamandi (PKm Kalijaga) SMP/SMA IRT/Tani 7/5/2018 10/14/2018 3 Bulan L 39 mgg 5x 1 2600/49 SPT Polindes Bidan Pn Berat RSUD
26 By Nurimal/ Suriadi Dan Dobol )Pkm Kalijga) SD/SD IRT/TKI 25/20/2018 10/25/2018 0 Hari L 40 mgg 7x 1 3000 SPtBekp Kuncup Bunga Dokter IUFD Kuncup Bunga
27 By Usnisalawati/bambang Sugian (PKm Sambelia) SMA/SD IRT/Buruh 10/4/2018 10/4/2018 0 Hari P 24 mgg 4x 2 1000/35 Spt PKM Bidan BBLR RSUD 24.00 Wita
28 By Usnisalawati/bambang Sugian (PKm Sambelia) SMA/SD IRT/Buruh 10/4/2018 10/5/2018 1 Hari P 24 mgg 4x 2 1200/36 Spt PKM Bidan BBLR RSUD 05.00 Wita
29 By Siti Handayani/Sahlun Karang Baru (pkm Kr.baru) SMP/SD Dagang/Sopir 10/1/2018 10/2/2018 2 Hari P 41 Mgg 9x 3 3300/50 SC RS Risa Spog Serotinus Asfiksia Berat RSUD 17.00 wita
30 By Rauhun/ Iq Sriani Kr. Baru (Pkm Kr.Baru) SMA/SD IRT/Tani 10/27/2018 10/27/2018 0 Haari L 41 mgg 6x 3 2600/47 OD RSUD Spog Serotinus IUFD RSUD 22.00 Wita
iufd 18
neo 11
bayi 1

Mengetahui Selong, ..........................

Kepala Bidang Kepala Seksi
Bina Kesehatan Masyarakat Kesehatan Keluarga

H. Suardi, SKM,MPH. Hj. Rokhliana, SST,MM

NIP. 19721231 199503 1 007 NIP. 19730314 199203 2 007
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: …………………………………………..
Usia
Persalinan
Kehamilan
Alamat Pendidikan Tanggal Anak (SptBKep, Tempat Penyebab Meninggal
No. Nama Anak / Orang tua Pekerjaan Orang tua Tanggal Lahir Umur L/P saat Frekwensi ANC BB / PB Penolong Persalinan Komplikasi ibu Tempat Meninggal
(Puskesmas) Orang tua Meninggal ke- Sc, Vacum, Melahirkan Anak
Dilahirkan
Drip, Spt
11/25/2018 (mg)
1 By Maya Mt Blae (PKM Keruak) SMA IRT 11/25/2018 O Hari P 39 mgg 5x 1 Spt Drip RSUD Bidan IUFD RSUD
2 By Ayuni/ Aeniah Mendane (PKm Keruak) SI Guru 12/11/2018 12/11/2018 0 Ghari P 29 mgg 4x 2 1500 Spt Drip RISA Bidan IUFD Risa
By Khaerul Hafiz Pene (Pkm Sukaraja) SMP Tani 11/18/2018 11/18/2018 0 Hari L 35 mgg 5x 2 2000 Spontan RSUD Bidan KPD BBLR PKM
4 By iq Nurhasanah Pene (Pkm Sukaraja) SMP TAni 11/24/2018 11/24/2018 0 Hari L 40 mgg 8x 3 3000 Spontan RSUD Bidan Jatuh IUFD RSUD
5 Aqifa Muazzara/yarisuni/usman Mt.beter (Pkm Rensing) SMA IRT 6/28/2014 11/2/2018 4 tahun P 40 mgg 7x 3 14 kg Spotan RSUD BIdan KPD Epilepsi RSUD
6 By Halimah Mt.Baan (PKM SIKUR) SD Tani 11/28/2018 11/28/2018 0 Hari P 36 mgg 7x 3 700/48 SPt Biasa RSUD Dokter Taa IUFD RSUD
7 By iq joni Kemong (PKm Sikur) SD tani 11/5/2018 11/5/2018 0 Hari P 32mgg 6x 3 700 SPontan RSud Bidan IUFD RSUD
8 Haerani/ismail Jurit Sel (Pkm Prnnggasela) SD Buruh 11/20/2018 20/22/2018 0 Hari L 30 mgg 3x 3 700 Spontan BPS Bidan IUFD BPS
9 By Yani Andrian Peresak( pkm Dsn.Lekong) SD Irt 27/10//2018 10/29/2018 2 Hari P 27 mgg 5x 2 800 SC RSUD Spog Preterem BBLR RSUD
10 Molida/ Satriawan/ Asnawat Keogkong )PKm Kerongkong) SMA Petani 11/14/2018 11/14/2018 0 Hari L 23 mgg 3x 2 700/24 SPt Bkep RSUD Bidan IUFD RSUD
11 Siti Isna ningsih/L. Sulael Kerongkong (PKM kerongkong) SI Guru 11/28/2018 11/28/2018 0 Hari L 32 mgg 6x 1 2000/45 SPt bekp RSUD Dokter IUFD RSUD
12 By Uswatun Hasanah Pamcor sanggeng (Pkm Denggen) SI Guru Honor 11/15/2018 11/15/2018 0 Hari L 36 mgg 2x 2 3000/48 SC RSUD Dokter Solusio Plasenta IUFD RSUD
13 Halpini Yuni P.Gandor (Pkm Lb.Haji) SMP IRT 11/14/2018 11/14/2018 0 Hari L 32 mgg 6x 2 4000/50 SC RSUD Dokter KPD IUFD RSUD
14 By Ny L 1 Ijobalit (PKm Korleko) SD Buruh 11/19/2018 11/19/2018 0 Hari P 24mgg 3 5 500 SPt b RSUD Bidan Prematur IUFD RSUD
15 By Ny L 2 Ijobalit (PKm Korleko) SD Buruh 11/19/2018 11/19/2018 0 Hari P 24mgg 3 5 700 SPt b RSUD Bidan Prematur BBLR RSUD
16 Sri Rohana Pohgading (Pkm Batuyang) SMP IRT 11/20/2018 11/20/2018 0 Hari L 41mgg 8x 2 200/48 Spontan RSUD Bidan IUFD RSUD
17 By Fitriani Bagek Gaet (Pkm Batuyang) SMP IRT 11/17/2018 11/19/2018 2 Hari L 28 mgg 4x 2 1600/39 Spontan RSUD Bidan BBLR RSUD
18 Rihun/Salman Batu belek (PKm Batuyang) SD Petabi 11/30/2018 11/30/2018 0 Hari L 41 mgg 6x 3 3400/50 Forcep RSUD SpOg IUFD RSUD
19 sahnim Gn.Malng (Pkm Lb.lombok SD IRT 11/5/2018 11/5/2018 0 Hari L 40 mgg 7x 2 4000 P Spt B RSUD Bidan Asfiksia RSUD
20 Siti Maryam Lb/Lombok SMp IRT 11/17/2018 11/17/2018 0 Hari L 40 mgg 7x 2 3200/ P Spt B PKM Bidan Asfiksia RSUD
21 Mariun Lb/Lombok SD IRT 11/23/2018 11/23/2018 0 Hari L 38 mgg 3x 3 4000 SC RS Dokter IUFD RSUD
22 by Siti Aida/ Aikprapa (Pkm Aimel) SD IRT 11/14/2018 11/14/2018 0 Hari P 30 mgg 5x 4 2100 Spt PKM Bidan IUFD PKM
23 by Maesarah Ketrang daya (PKM aikmel) SI GURU 11/21/2018 11/21/2018 0 Hari L 40 mgg 4x 1 2800/46 Od RSUD Bidan Partuus lama IUFD RSUD
24 By linasari Dsan bAgek (PKM aikmel) SMA IRT 10/29/2018 10/29/2018 0 Hari L 33 mgg 5x 1 1400/38 SPt RSUD Bidan gameli IUFD RSUD
25 By Uni wardani Toya (PKm Aikmel) SMP IRT 10/27/2018 10/27/2018 0 Hari L 40 mgg 8x 1 3300/50 SPT PKM Dokter dan bidan IUFD PKM
26 By Sulfaeni Toya (PKm Aikmel) SMP IRT 11/1/2018 11/1/2018 0 Hari P 41 mgg 7x 3 3100 Spt PKm Bidan IUFD PKM
27 Lutfiana Ulfa/ Murniah Bgaik Nyaka (PKM Aikmel) SD IRT 9/30/2018 11/16/2018 1,5 Bulan P 32 mgg 4x 4 1900/47 Spt Rumah Preterm Pneumonia RSUD
28 M. Zaenal/Khairiah/Sihabudin Praubanyar (Pkm Kalijga) SD Tani 11/12/2018 11/13/2018 1 Hari L 29 mggg 4x 5 200/45 Spt Bkp BPM Bidan RDS Rumah
29 Haurani/ Hasnawati Mamben Lauk (PKM wanasab) SMA Kader 11/2/2018 11/2/2018 0 Hari L 40 mgg 4x 4 3600/50 SPT B RSUD Bidan Asfiksia Berat RSUD
30 Yolanda Sari Obel 2 (Pkm Ba;nting) TTSD sopir 10/23/2017 11/11/2018 1 tahun 19 bln P 39 mgg 5x 3 3500/50 Spt Bekp Perjlanan bidan Pneumonia rumah
31 By Ria Febrianingsih/Zamwir Holik Dara Kunci PKm Belanting SI/SMA Guru/ swasta 11/19/2018 11/19/2018 0 Hari P 26 mgg 3x 1 800/22 Spt Bkp Pkm Bidan IUFD PKm
32 By Ria Febrianingsih/Zamwir Holik Dara Kunci PKm Belanting SI/SMA Guru/ swasta 11/19/2018 11/19/2018 0 Hari P 26 mgg 3x 1 830/22 Spt Bkp Pkm Bidan IUFD PKm
33 By Nova Nisviani/Hilmi Lepak Leong (pkm belanting) SMP Tani 11/28/2018 11/28/2018 0 Hari P 28 mgg 4x 2 1500/28 Spt bekp PKM Bidan BBLR RSUD
34 By Inaq Hamdani karang bAts / Pkm Rarang SD Tani 10/30/2018 10/30/2018 0 Hari P 36 MGG 5x 6 2000/40 Drip Rsi Yatopa Bidan IUFD RSI

iufd 21 22
neo 6 9
Mengetahui, bayi 1 1 ………….., …………………………
Kepala Puskesmas ……………….. balita 2 2 Bidan Koordinator Puskesmas …………….
34

………………………….. …………………………………..
NIP:………………………….. NIP:……………………………………
 Jam
meninggal

4:00
9:00
23:00

18:00
9:30
16:00
5:00
10:00

4:00
5:00

14:00

12:30
0:00
0:30
8:12
8:15
7:00

………………
 LAPORAN ANALISA KEMATIAN IUFD, BAYI & BALITA
BULAN: …………………………………………..

Usia
Jenis Persalinan
Kehamil Penyebab
Alamat Pendidikan Pekerjaan Orang Tanggal Frekwensi Anak (SptBKep, Sc, Tempat Jam
No. Nama Anak / Orang tua Tanggal Lahir Umur L/P an saat BB / PB Penolong Persalinan Komplikasi ibu Meninggal Tempat Meninggal
(Puskesmas) Orang tua tua Meninggal ANC ke- Vacum, Drip, Melahirkan meninggal
Dilahirk Anak
Spt Brach)
an (mg)

1 By Ratih Purwasih/ Ruba'i Pengekelak Emaas (Pkm Rensing) SMA IRT/Swasta 12/10/2018 12/12/2018 2 Hari L 31 mgg 6x 3 1700/40 SptBkep Pkm rensing Bidan Hamil Preterem BBLR RSUD 04.00 Wita
2 By Suhaimi Batu Ngoek rensing (Pkm Rensing) SMA IRT/Swasta 12/13/2018 12/15/2018 3 Hari L 44 mgg 7x 1 2500/48 SptBkep Pkm rensing Bidan Postdate asfiksia RSUD 18.00 Wita
3 By Kamariah Muntut, Desa Rensing (PKm Rensing) SMA IRT/TKI 12/12/2018 12/12/2018 0 Hari P 30 mgg 5x 2 2300 Drip RSUD Bidan Hamiil Preterm, Le IUFD RSUD 19.00 Wita
4 By Inaq toni Leming (Pkm terara) SD/SD IRT/Tani 12/18/2018 12/18/2018 0 Hari P 24 mgg 1x 3 1100 SPt Brach Bps Loteng Bidan taa BBLR RSUD
5 Lailatul rohmi Loyong (Pkm Kotaraj) SMA IRT 12/21/2018 12/1/2018 1 Jam P 30 mgg 4 2 1000 Spontan RSUD Bidan Gameli BBLR RSUD 16.00 Wita
6 By Zulfiana Hali Jorong (Pkm Selong) S1/S1 Guru/Guru 12/5/2018 12/5/2018 0 Hari L 32 mgg 5x 3 1200 Spontan Rumah bidan Gamerli IUFD Rumah 09.30 Wita
7 Nurhayatul/ Ridwan Toron Kertasari (Pkm Lb.haji) SD/SD IRT/buruh 12/7/2018 12/7/2018 0 Hari P 38 mgg 3x 2 2900/48 normal PKM Bidan taa IUFD Pkm 05.00 Wita
8 Niala Oktavia/Nurul Hidayah Dsn Leko (Pkm Korleko) SMP/SMP Buruh/Tani 10/15/2018 11/30/2018 45 Hari P 37 mgg 7x 1 3000/48 Spt B PKM Bidan Tdk ada Susp PenumRumah 16.00 Wita
9 huzaitul Yuliana Untas pohgading (Pkm Batuyang) D3 IRT 11/29/2018 12/2/2018 4 Hari L 36 mgg 6x 4 2500/48 Spontan RSUD Dokter Kel Bawaan RSUD 18.00 Wita
10 Rohaniatun/ M.haenudin Lb. Lombok (Pkm Lb.Lombok) SMP/SD Irt/Nelayan 12/21/2018 12/21/2018 0 Hari P 28 mgg 4x 3 1900/35 SPt B RSUD Bidan Taa IUFD RSUD 05.30 Wita
11 Mulyani Lb. Lombok (Pkm Lb.Lombok) SMA/SMA IRT/Oedagang 12/17/2018 12/17/2018 0 Hari L 28 mgg 3x 2 1800/32 SPt B RSUD Bidan Taa IUFD RSUD
12 Rohmi/ Salman Alfan Permatan (Pkm Lb.Lombok) Smp/Sd Irt/Tani 12/23/2018 12/23/2018 0 Hari P 28 mgg 4x 2 1800/34 Spt B RSUD Bidan taa IUFD RSUD
13 By Idayati Kr.Bila (Pkm Lenek) S1 IRT 8/12/2018 12/08/201 0 Hari P 39 mgg 7x 3 2800/50 P.Spt.B BPM Wijri Bidan taa IUFD Bpm Wijrii 17.30 wita
14 Azahartul laili/ Emi mAriana Kembag kerang lauk (Pkm Aikmel) SMA/S1 TKI 11/12/2017 12/27/2018 1 Tahun P 40 mgg 6x 3 4100/50 Spt.B polindes Bidan Kejang Pkm 14.00 Wita
15 Supni Bagek Rebak Kb. Kerang (Pkm Aikmel) TS/Ts Irt/Tani 12/26/2018 12/26/2018 0 Hari P 24 mgg 5x 3 1000/30 SPt B RSUD Bidan Preterem Asfiksia RSUD
16 Hapsah Dsn Bagiik Timur (Pkm Akmel) SD/SD Irt/Tani 12/20/2018 12/21/2018 1 Hari L 38 mgg 5x 1 2500/48 Spt drip RSUD Bidan KPD >12 jam Kejang RSUD 11.00 Wita
17 Sopiah Baret Lekok (Pkm Wanasaba) SMP/SMP Pedagang 12/9/2018 12/14/2018 6 hari L 40 mgg 6x 2 2400/48 SPt Bekp BPS Bidan Tdk ada Kelianan Ja RSUD 18.00 Wita

iufd 7
balita 1
bayi 1
neo 8

Mengetahui, ………….., …………………………

Kepala Puskesmas ……………….. Bidan Koordinator Puskesmas …………….

………………………….. …………………………………..
NIP:………………………….. NIP:……………………………………