Sexual and reproductive health

Reproductive health is a state of complete physical, mental, and social well

being and not merely the absence of disease or infirmity, in all matters
related to the reproductive system and to its functions and processes.
adapted from FWCW Platform 94, 97; ICPD 7.2

Sexual health means having a responsible, satisfying, and safe sex life,
that is free from disease, injury, violence, disability, unnecessary pain, or risk
of death.
expanded upon FWCW Platform 94; ICPD 7.2
 Reproductive and sexual rights
Reproductive rights include the rights of couples and individuals to:
Make free and informed decisions about their reproductive
lives, including the number, timing, and spacing of their
children
Attain the highest standard of sexual and reproductive health
Sexual rights include the rights of all individuals to:
Make free and informed decisions on all matters relating to
their sexuality
Be free of discrimination, coercion, or violence in their sexual
lives and decisions
Expect and demand equality, full consent, mutual respect,
and shared responsibility in sexual relationships
adapted from the ICPD, ICPD+5 and FWCW documents
Gender, gender equality, and gender equity

Gender
socially defined roles and responsibilities of men and women, boys and girls

Gender equality
equal treatment of women and men

Gender equity
fairness and justice in the distribution of benefits and responsibilities between
women and men

Women’s health is directly related to their status in society.

The International Conference on Population and Development (ICPD)
affirmed that:

Women and men have the right to the highest standards of

sexual and reproductive health services and information,
free from discrimination, coercion, and violence.
The rights-based approach:

Places the health and well being of individuals at the

center of program policy design
Recognizes the importance of gender equity and equality
Builds on existing international human rights agreements
Essential health services to ensure
sexual and reproductive rights
Information and counseling
on human sexuality,
reproductive health, and
parenthood
Family planning
Prenatal/postnatal and
delivery care
Health care for infants
Safe abortion, where not
against the law
Management of abortion-
related complications
Prevention and treatment of
infertility
Prevention and treatment of
sexually transmitted
infections and reproductive
tract infections

If additional services such as diagnosis and treatment of reproductive system

cancers and HIV/AIDS are not offered, a system should be in place to
provide referrals to these services.
Client-centered, comprehensive care
Client-centered care:

Emphasizes free and informed consent

and respect for clients’ rights and needs
Involves clients in program design
and evaluation
Is provided by technically competent,
compassionate, and well-supervised staff
Integrates or links service components
Ensures privacy and confidentiality in counseling and treatment
for all clients, including adolescents

Comprehensive care addresses the full range of sexual and

reproductive health needs and provides referrals when appropriate.
How can governments protect and promote
sexual and reproductive health and rights?
Governments can:

Review all laws, policies, and practices, and change those that inhibit the full
exercise of reproductive and sexual rights

Enforce gender-sensitive laws and policies through active implementation and

monitoring mechanisms

Strengthen health infrastructures to make

comprehensive services more widely available, and give priority to financing for
sexual and reproductive health care

rights-based approach
(8)
 UU RI 1987 No. 7:
Penghapusan diskriminasi

Pasal 11

✓ Hak atas perlindungan kesehatan dan keselamatan kerja, termasuk

usaha perlindungan terhadap fungsi reproduksi

✓ Untuk mencegah diskriminasi terhadap wanita atas dasar

perkawinan atau kehamilan dan untuk menjamin hak efektif
mereka untuk bekerja, Negara-negara Peserta wajib membuat
peraturan yang tepat untuk melarang dengan dikenakan sanksi
pemecatan atas dasar kehamilan atau cuti hamil.
 UU RI 1987 No. 7:
Penghapusan diskriminasi

Pasal 12

Negara-negara peserta wajib melakukan langkah tindak yang tepat

untuk menghapus diskriminasi terhadap wanita di bidang
pemeliharaan kesehatan, dan untuk menjamin diperolehnya pelayanan
kesehatan termasuk pelayanan yang berhubungan dengan keluarga
berencana, atas dasar persamaan antara pria dan wanita.
Apakah kita mempersiapkan generasi?

o Pandawa:
Dari Panduke Parikesit

o Islam
Dari Ibrahim AS ke Muhammad SAW
“ Give me good mother ,
I will give you good son”

~ Napoleon ~

“Good women
Good mothers
Good nation”

~ Muhammad SAW ~
Hak reproduksi = Hak azasi

✓ International Conference for

Population Development 1994
✓ ICPD +10
✓ Hak perempuan untuk menentukan
kapan hamil, berapa anak. Hak untuk
menikmati kehidupan seksual.
✓ AWAS Kekerasan dalam rumah
tangga
 Harapan Pasien

✓ Dihargai, bersahabat, ramah, rahasia terjaga

✓ Dokter memahami situasi dan kebutuhan perempuan
✓ Informasi jelas dan lengkap
✓ Dokter kompeten
✓ Mudah memperoleh pertolongan
✓ Jujur dan adil dalam hal informasi
 Harapan Dokter
✓ Peran dokter: menjaga
privasi, sikap positif, siap
menolong
✓ Demi kepentingan pasien
✓ Informasi jelas, pendek,
bahasa awam,jelaskan
efeksamping
✓ Bantu mengambil keputusan:
berikan gambaran
VS Harapan Pasien
✓ Pasien : mengharap
kesembuhan, layanan yang
ramah, perhatian
✓ Pasien harus banyak
bertanya
✓ Hak pasien untuk memilih
cara/metoda
✓ Mengetahui untung-rugi
 Interaksi Dokter - Pasien
✓ Salam – memperkenalkan diri – Greetings
✓ Tanya masalah – Ask
✓ Jelaskan penyakit - Tell
✓ Bantu membuat keputusan - Help
✓ Jelaskan yang terbaik - Explain
✓ Kapan kunjungan berikut - Return

GATHER
 EVALUASI
Gather (greets, ask, tell, help, explain, return) :
✓ Salam dan memperkenalkan diri
✓ Tanyakan kebutuhan perempuan tsb
✓ Jelaskan diagnosis/penyakit
✓ Diskusikan alternatif prosedur/cara- risiko dan efek samping
….ingat EBM
✓ Apakah tindakan sesuai standar
 Maternal Mortality (1994-2014)
400
390 334
350
307
Per 100.000 live births

300
228
250

200

150 110
100

50

0
1994 1997 2002 2007 2009 2010 2011 0012 2013 2014

2007 Target 2014

AKI 228/100.000 110/100.000
Pertambahan penduduk: 5 juta/tahun
Minimal kehamilan: 5 juta

Kematian Maternal: 230/100000

11500 total kematian/th
Penyebab kematian % Jumlah kasus
Perdarahan 30 3450
Estimasi Near Miss
Minimal 111500 kasus
preeklampsia 25 2875
Infeksi 12 1380
Jumlah kasus Keguguran 5 675
Perdarahan 34500 Partus lama 5 675
preeklampsia 28750 Komplikasimasanifas 8 920
Infeksi 13800 Emboli 3 345
Keguguran 6750 Lain - lain 12 1380
Partus lama 6750
Komplikasimasanifas 9200
Emboli 3450 10 X lipat Malaysia; 20 X lipat singapore !!
Lain - lain 13800
 Lain-lain
12%
Perdarahan
Kompl masa
30%
puerpureum
8%

Emboli obst
3%
P. lama/macet
5%

Abortus
5%

Infeksi
12%
Eklamsia
25%

Riskedas 2007
Sadarkah kita????
1 in … women die for maternal reasons

The number of women that

The number of women that
die of maternity cause is…
die from maternity related
Less than 1 in 1000 in 61
reasons average…
countries, about 41% of the
1 in 11,000 women in developed
world’s population more than 1
regions 1 in 842 women in
in 50 in 44 countries, about 12%
developing regions
of the world’s population

Notes:
Lifetime risk of maternal mortality is the probability that a 15-year old
female will die eventually from a maternal cause
Source:
WHO, UNICEF, UNFPA, World Bank (2007)
 Iron Supplements,
Malaria Intermittent
Oxytocin and treatment and
Manual Antiretroviral for HIV
Compression

Indirect causes
Severe bleeding
20%
24%

other Direct
Magnesium Causes
Sulfate Eclampsia 8%
12% Obstructed
Labor
Infection 8% Patogram
Family Planning and 15%
Unsafe Abortion
Postabortion Care 13% Antibiotics

Tetanus Toxoid Immunization

Clean Delivery

Adapted from: Maternal Health Around the World” World Health Organization,
*Other direct causes include: ectopic pregnancy, embolism, anesthesia-related Geneva, 1997
*indirect causes include: anemia, malaria, heart disease
Kontraktilitas sangat ditentukan oleh jumlahserabut
miometrium, dimana serabut ini bisa terdegradasi menjadi
jaringan ikat bila:

➢Riwayat kuretase berulang

➢Riwayat infeksi (panmetritis)
A. 12 B. 12
Wall Thickness (mm)

Wall Thickness (mm)

10 10
8 8
6 6
4 4
2 2
0 0
15 20 25 30 35 40 15 20 25 30 35 40

C
Week Gestation Week Gestation

C. 14 D. 12
Wall Thickness (mm)

Wall Thickness (mm)

12 10
10 8

D
B
8
6
6
4 4
2 2
0 0
16 21 26 31 36 15 20 25 30 35 40
Week Gestation Week Gestation

E
E. 12 F. 12
Wall Thickness (mm)

Wall Thickness (mm)

10 10
8 8
6 6
4 4
2 2
0 0
16 21 26 31 36 15 20 25 30 35 40
Week Gestation Week Gestation

Uterine wall thickness (in mm) during pregnancy. The continuous line represents the mean and the dashed linesrepresent the upper and lower
95% confidence intervals. A, Anterior lower segment; B, mid-anterior wall; C, fundal wall; D, posterior wall; E, right wall; F, left wall
J Ultrasound Med 1998;17:661–665,
• Karbohidrat, Trigliserida → ATP
• Ca, K, Phosphor → Pompa Na dan Ca
• Oksitosin
• Prostaglandin

Gap Junction
Sources: Nuts, bonding - intimacy

1.Psychoneuroendocrinology 1992;17:3–35 6.Horm Behav 2000; 37:145–155

2.Nat Genet 2000; 25:284–288 7.Endocrinology 1997; 138:2829–2834
3.PNAS 1979; 76:6661–6665 8.Neuroscience 2000; 95:567–575
4.Physiol Behav 1996; 60: 1209–1215 9.J Neuroscience 2004;24:2974–2982
5.Endocrinology 2003; 144:2291–2296Am 10.J Physiol Regul Integr Comp Physiol 2004; 287:R1494–R1594
Experience from the 1960s in Malaysia, Sri
Lanka and Thailand

7200 new midwives

registrations

18,314 new midwives

From 2,500 beds to 10,800 in

small community hospitals

32
Kualitas Bangsa

• Human Development Index

• Semakin tinggi HDI semakin aman, sejahtera dan adil suatu bangsa
Segala upaya bernegara dan berbangsa adalah untuk memberikan
kualitas kependudukan yang tertinggi
Lalu, apa hubungan HDI dengan Prenatal Care atau
Preconception Care?

• Fetal Programing
• 1000 hari pertama kehidupan
• Epigenetik
• Pregnancy is a stress test for life
Sadarkah kita ……………….
• Berkeluarga, Berbangsa, Bernegara
• Bahkan keselamatan bumi ini sangat bergantung kualitas manusia
penghuninya
• Dan ternyata kualitas manusia ini sudah ditentukan sejak awal
kehamilan
There is a mismatch between opportunity and investment

 Brain growth and Spending on Health,

maximum potential for Education, Income Support,

Intensity of Brain’s Development

change Social Services and Crime →

Public Expenditure
1 3 10 60 80
Conception Birth
Age

Public Spending on Services for Children 0-6 years

2,0%
% GDP

1,0%

0,0%
Denmark Sweden Finland France United Australia Canada
States

Dr. Jacques Vandergaag – University of Amsterdam – Calgary Presentation January 2004

 Human Development Index and its Components
Mean years of Expected years of Change in
HDI HDI Value, Life expectancy at GNI per capita
Country schooling (years), schooling (years), HDI Value, 2012 rank, 2012-
rank 2013 birth (years), 2013 (2011 PPP $), 2013
2012 2012 2013
Very high human development
1 Norway 0.944 81.5 12.6 17.6 63,909 0.943 0
2 Australia 0.933 82.5 12.8 19.9 41,524 0.931 0
4 Netherlands 0.915 81.0 11.9 17.9 42,397 0.915 0
7 New Zealand 0.910 81.1 12.5 19.4 32,569 0.908 0
9 Singapore 0.901 82.3 10.2 15.4 72,371 0.899 3
15 Hong Kong, China (SAR) 0.891 83.4 10.0 15.6 52,383 0.889 0
15 Korea (Republic of) 0.891 81.5 11.8 17.0 30,345 0.888 1
17 Japan 0.890 83.6 11.5 15.3 36,747 0.888 -1
30 Brunei Darussalam 0.852 78.5 8.7 14.5 70,883 0.852 0
High human development
57 Russian Federation 0.778 68.0 11.7 14.0 22,617 0.777 0
62 Malaysia 0.773 75.0 9.5 12.7 21,824 0.770 0
73 Sri Lanka 0.750 74.3 10.8 13.6 9,250 0.745 2
89 Thailand 0.722 74.4 7.3 13.1 13,364 0.720 0
91 China 0.719 75.3 7.5 12.9 11,477 0.715 2
Medium human development
107 Palestine, State of 0.686 73.2 8.9 13.2 5,168 0.683 0
108 Indonesia 0.684 70.8 7.5 12.7 8,970 0.681 0
117 Philippines 0.660 68.7 8.9 11.3 6,381 0.656 1
118 South Africa 0.658 56.9 9.9 13.1 11,788 0.654 1
118 Syrian Arab Republic 0.658 74.6 6.6 12.0 5,771 0.662 -4
120 Iraq 0.642 69.4 5.6 10.1 14,007 0.641 0
121 Viet Nam 0.638 75.9 5.5 11.9 4,892 0.635 0
http://hdr.undp.org/en/content/table-1-human-development-index-and-its-components
 Pregnancy: a stress test for life

• Pregnancy stresses maternal carbohydrate, lipid, inflammatory pathways,

vascular function
• Pregnancy a screen for later Cardio – Metabolic diseases

Curr Opin Obstet Gynecol. 2003; 15: 465–471

Ann Epidemiol. 2005; 15:726,
Circulation. 2001; 123:1243
Cardiovascular Research (2014) 101, 561–570
“Unless early child development is addressed effectively
........ Countries will locked into proverty”

Kualitas Janin Kualitas Anak Kualitas

Bangsa
When investment in life capabilities occur earlier, future prospects are better

Capabilities

✓ Lack of social protection

✓ Poor job quality ✓ Lack of care
✓ Lack of social protection ✓ Higher incidence of disabilities

✓ Lack of employment
oppurtunities
✓ Low school availabilit and quality
✓ Violence, conflicts
✓ Early neglect
✓ Poor nutrition and
lack of pre- and
post-natal care
✓ Poor child
stimulation
Prenatal and Youth Adulthood Old age
early childhood

Represent life capability at its full potential for individuals; this is the path of life capabilities that individuals could achieve if they were able
to succesfully manage the vulnerabilities they are like.
Shows that when individuals fail to overcome vulnerabilities at any sensitive period, their life capabilities are likely to end up on a lower
path.
Later interventions could help individuals recover – but usually only partially – and move to a higher path.

Source: Human Development Report Office calculations

 Prevalensi NCD menurut Riskesdas 2013
Stroke Gagal
Umur Kanker Hiper- Hiper- Jantung koroner Gagal Jantung Batu Penyakit Sendi
Asma PPOK DM (%) Ginjal
(Tahun) (%) thyroid tensi Ginjal
D D/G D D/G D D/G Kronis D D/G
<1 1,5 0,3
1-4 3,8 0,1
5 – 14 3,9 0,1
15 – 24 5,6 0,6 0,6 0,4 8,7 0,1 0,7 0,02 0,1 0,2 2,6 0,1 0,1 1,5 7,0
25 – 34 5,7 1,6 0,9 0,8 0,3 14,7 0,2 0,9 0,05 0,1 0,6 3,9 0,1 0,3 6,0 16,1
35 – 44 5,6 2,4 2,1 1,7 0,4 24,8 0,3 1,3 0,09 0,2 2,5 6,4 0,3 0,7 12,4 26,9
45 – 54 3,4 3,9 3,5 3,9 0,5 35,6 0,7 2,1 0,19 0,4 10,4 16,7 0,4 1,0 19,3 37,2
55 – 64 2,8 5,6 3,2 5,5 0,5 45,9 1,3 2,8 0,38 0,7 24,0 33,0 0,5 1,3 25,2 45,0
65 – 74 2,9 8,6 3,9 4,8 0,5 57,6 2,0 3,6 0,49 0,9 33,2 46,1 0,5 1,2 30,6 51,9
75+ 2,6 9,4 5,0 3,5 0,5 63,8 1,7 3,2 0,41 1,1 43,1 67,0 0,6 1,1 33,0 54,8
Jenis Kelamin
Laki – laki 4,4 4,2 0,6 0,2 0,2 22,8 0,4 1,3 0,1 0,3 7,1 12,0 0,3 0,8 10,3 21,8
Perempuan 4,6 3,3 2,2 0,6 0,6 28,8 0,5 1,6 0,2 0,3 6,8 12,1 0,2 0,4 13,4 27,5
Prevalensi gangguan jiwa berat di Indonesia 2013 : 1.7%
Gangguan mental emosional penduduk > 15 th berdasarkan Self reporting

questionnaire-20 di indonesia 2013: 6%

Riskesdas 2013
Data Statistik

• Crude Birth Rate (18.79 per 1000, 2013): 4.697.000

• Laju Pertumbuhan Penduduk (1.49%, 2013: 3.725.000

• Preeklampsia: 10 – 15%
• Preterm: 15 – 20%
• IUGR: ~ 10%
• GDM: ~ 5%
• Defisiensi Besi: ~ 40%
• Defisiensi Zinc: ~60%
• Defisiensi Vit D:~ 80%

Sadarkah kita akan besarnya ancaman ?

 Glycemia (mmol/L) Insulinemia (mcU/L)
16 120

14
100
12 IUGR
80
Control
10

8 60

6
40
4
20
2

0 0
0 10 20 20
30 40 50 60
40 70 80 9060 0 10 2020 30 40 50 90
60
Time (mins)

Hofman P, J Clin Endocrol Metab 1997

 15

10

IU/L
5
Control (n=24) SGA (n=25) Increased blood pressure

0
FSH LH
400 10
350 9
250 8
300
7

Pg/mL

ng/mL
250
Inhibin B (pg/mL)

6
200 5
150 4
3
200 100
p<0.0001 2
50 1
Vs. * 0
0
Inhibin B Testosterone
30
28
150 26
24
22
mL

20
18
100 16
14
12
Cicognani A et al., J Pediatr 2003 10
Testicular Volume
%
Mean AGA SGA
80 AGA n=24
SGA n=25
60 Birthweight (kg) 3.3 2.3

40
FSH (U/L) 4.0 6.7

20
Insulin (mU/L) 8.3 13.0

DHEAS (mcg/dL) 157 257

0 1 2 3 Ovulations

Ovulations detected over 3 months

Ibanez L et al., J Clin Endocrinol Metab 2002
Number of glomeruli 1,500,000 –
Ages 1-17 yrs
In Term Births:
1,000,000 –

500,000 –
Birth Weight
Predicts
0–
Nephron Number
2.0 2.5 3.0 3.5

Birth weight, kg
 230,000 nephrons
2,000,000 – per kg increase
1,500,000 –
All Ages
in birth weight
Number of glomeruli

1,000,000 –
 Hughson et al,
500,000 –
Kid Internat (2003) 63, 2113
0–

2.0 2.5 3.0 3.5 4.0 4.5 5.0 Also:

Merlet-Benichou et al, 1999
Birth weight, kg
Manalich et al, 2000
 Vitamin D, effects on brain development, adult brain function and the links between low
levels of vitamin D and neuropsychiatric disease

Alzheimers
Disease
Depression & Cognition
Studies describing
an association
with Low Vitamin D Schizophrenia
[220] [141]

[152] [163] [6]

[149] [17] [142]

Austism [156] [208] [135]

Cross sectional Spectrum
Disorders
[90] [98] [24]
Prospective
[159] [182] [154]
Intervention
[167] [170] [221]

[70] [242] [54]

[55]
Studies describing
no association [199]
with Low Vitamin D

Studies that have not controlled for reverse causality i.e. low levels of vitamin D possibly being due to impaired mobility or sun-avoidance behavior
have been omitted. Numbers in square brackets represent study cited in text. Type of shading reflects whether a study is cross-sectional , (pale);
prospective i.e. does low vitamin D predict later disease onset

Frontiers in Neuroendocrinology. 2013; 34: 47–64

Pelayanan antenatal diupayakan agar
memenuhi standar kualitas 7 T, yaitu

1. Penimbangan berat badan dan pengukuran tinggi badan;

2. Pengukuran tekanan darah;
3. Pengukuran tinggi puncak rahim (fundus uteri);
4. Penentuan status imunisasi tetanus dan pemberian imunisasi tetanus
toksoid sesuai status imunisasi;
5. Pemberian tablet tambah darah minimal 90 tablet selama kehamilan;
6. Pelaksanaan temu wicara (pemberian komunikasi interpersonal dan
konseling, termasuk keluarga berencana); serta
7. Pelayanan tes laboratorium sederhana, minimal tes hemoglobin darah
(Hb) dan pemeriksaan golongan darah (bila belum pernah dilakukan
sebelumnya

Kemenkes 2013
Objectives of prenatal care

For the pregnant woman:

1. To increase her well-being before, during, and after pregnancy and to improve her self-image and self-care.
2. To reduce maternal mortality and morbidity, fetal loss, and unnecessary pregnancy interventions.
3. To reduce the risks to her health prior to subsequent pregnancies and beyond child-bearing years.
4. To promote the development of parenting skills.

For the fetus and infant:

1. To increase well-being.
2. To reduce preterm birth, intrauterine growth restriction, congenital anomalies, and failure to thrive.
3. To promote healthy growth and development, immunization, and health supervision.
4. To reduce neurological, developmental, and other morbidities.
5. To reduce child abuse and neglect, injuries, preventable acute and chronic illness, and the need for extended
hospitalization after birth.

For the family:

1. To promote family development and positive parent-infant interaction.
2. To reduce unintended pregnancies.
3. To identify for treatment behavior disorders leading to child neglect and family violence.

United States Public Health Service Expert Panel on the Content of Prenatal
Care. Caring for Our Future: the content of prenatal care. Washington, DC:
United States Department of Health and Human Services, 1989
 1 Preconseption Visit 1 3
Event
Visit 2 6-8 weeks **
Screening Risk profiles 4 Risk profiles 4
Maneuvers Height and weight/BMI 5 GC/Chlamydia 4
Blood pressure 6 Height and weight/BMI 5
History and physical 7 Blood pressure 6
Cervical cancer screening 2 History and physical 7
Rubella/rubeola 8 Rubella 8
Varicella 9 Varicella 9
Domestic violence 10 Domestic violence 10
Depression 11 Depression 11
CBC 16
ABO/Rh/Ab 17
Syphillis 18
Urine culture 19
HIV 20
[Blood lead screening 21]
Viral hepatitis 26
Counseling Preterm labor 12 Preterm labor 12
Education Substance use 2 [VBAC 22]
Intervention Nutrition and weight 2 Prenatal and lifestyle
Domestic violence 10 education 23
List of medications, herbal ✓ Physical activity
supplements, vitamins 13 ✓ Nutrition
Accurate recording of ✓ Follow-up of modifiable
menstrual dates 14 risk factors
✓ Nausea and vomiting
✓ Warning signs
✓ Course of care
✓ Physiology of pregnancy
Discuss fetal aneuploidy
screening 24
Immunization Tetanus booster 27 Tetanus booster 27
& Rubella/MMR 8 Nutritional supplements 25
Chemoprophylaxis [Varicella/VZIG 9] Influenza 27
Hepatitis B vaccine 26 [Varicella/VZIG 9]
Folic acid supplement 15 Pertussis 27
Visit 2 Visit 3 Visit 4
10-12 weeks 16-18 weeks 22 weeks
Weight 5 Weight 5 Weight 5
Blood pressure 6 Blood pressure 6 Blood pressure 6
Fetal aneuploidy Depression 11 Fetal heart tones 28
screening 24 Fetal aneuploidy Fundal height 30
Fetal heart tones 28 screening 24 Cervical assessment 31
Fetal heart tones 28
OB Ultrasound (optional) 29
Fundal height 30
Cervical assessment 31
Preterm labor education 12 Preterm labor education 12 Preterm labor education 12
Prenatal and lifestyle Prenatal and lifestyle Prenatal and lifestyle
education 23 education 23 education 23
✓ Fetal growth ✓ Follow-up of modifiable ✓ Follow-up of modifiable
✓ Review labs from visit 1 risk factors risk factors
✓ Breastfeeding ✓ Physiology of pregnancy ✓ Classes
✓ Nausea and vomiting ✓ Second-trimester growth ✓ Family issues
✓ Physiology of ✓ Quickening ✓ Length of stay
pregnancy Preterm labor prevention 31 ✓ Gestational diabetes
✓ Follow-up of modifiable mellitus 32 (GDM)
risk factors Preterm labor prevention 31
[Progesterone 31] [RhoGam 17]
 Visit 5 Visit 5 Visit 7 Visit 8-11 Visit Post-Partum
Event 1
28 weeks 32 weeks 36 weeks 38-41 weeks 4-6 weeks
Screening Preterm labor risk 4 Weight 5 Weight 5 Weight 5 Cervical cancer screening 2
Maneuvers Weight 5 Blood pressure 6 Blood pressure 6 Blood pressure 6 [GC/Chlamydia 4]
Blood pressure 6 Fetal heart tones 28 Fetal heart tones 28 Fetal heart tones 28 Height and weight/BMI 5
Depression 11 Fundal height 30 Fundal height 30 Fundal height 30 Blood pressure 6
Fetal heart tones 28 Cervix exam as indicated 34 Cervix exam as indicated 34 History and physical 7
Fundal height 30 Confirm fetal position 35 Domestic violence 10
Gestational diabetes Culture for group B Depression 11
mellitus (GDM) 32 streptococcus 36 Gestational diabetes
Domestic violence 10 mellitus (GDM) 32
[Rh antibody status 17]
[Hepatitis B Ag 26]
[GC/Chlamydia 4]
Counseling Psychosocial risk factors 4 Preterm labor education 12 Prenatal and lifestyle Prenatal and lifestyle Contraception
Education Preterm labor Prenatal and lifestyle education 23 education 23 Discussion of postpartum
Intervention education 12 education 23 ✓ Follow-up of modifiable ✓ Follow-up of modifiable depression
Prenatal and lifestyle ✓ Follow-up of modifiable risk factors risk factors Breastfeeding concerns
education 23 risk factors ✓ Postpartum care ✓ Postpartum and support
✓ Follow-up of modifiable ✓ Travel ✓ Management of late vaccinations
risk factors ✓ Contraception pregnancy symptoms ✓ Infant CPR
✓ Work ✓ Sexuality ✓ Contraception ✓ Post-term management
✓ Physiology of pregnancy ✓ Pediatric care ✓ When to call provider Labor and delivery update
✓ Preregistration ✓ Episiotomy ✓ Discussion of Breastfeeding
✓ Fetal growth Labor and delivery issues postpartum depression
Preterm labor prevention 31 Warning signs/pregnancy
Awareness of fetal induced hypertension
movement 33 [VBAC 22]
Preterm labor prevention 31
Immunization [ABO/Rh/Ab 17] Tetanus/pertussis 27
& [RhoGam 17]
Chemoprophylaxis [Hepatitis B Ag 26]
 Aspek historis Bani Adam (Q.S. Al-
penciptaannya ‟Araaf: 31)

Aspek Basyar (Q.S. Al-

biologisnya Mukminun :33)

Konsep Aspek Insan (Q.S. Ar-

Manusia kecerdasannya Rahman: 3-4)

Aspek Annas (Q.S. Al-

sosiologisnya Baqarah: 21)

Abdun (hamba)
Aspek
Khalifah Allah (An
posisinya Jin (72) 19