ANTENATAL CARE

Presented by: DM Obsgyn FK UNSYIAH – RSUDZA March, 2013

Scope of Problem


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Maternal Health 180–200 million pregnancies per year 75 million unwanted pregnancies 50 million induced abortions 20 million unsafe abortions (same as above) 600,000 maternal deaths (1 per minute) 1 maternal death = 30 maternal morbidities

Neonatal Health • 3 million neonatal deaths (first week of life) • 3 million stillbirths

585.000 women die of pregnancy related complications – 99% in developing world – ~ 1% in developed countries EVERY MINUTE: • 380 women become pregnant • 190 women face unplanned or unwanted pregnancy • 110 women experience a pregnancy related complication • 40 women have an unsafe abortion • 1 woman dies from a pregnancyrelated complication .Maternal Mortality: A Global Tragedy • Annually.

9 6.Global Causes of Maternal Mortality Hemorrhage 24.9% Unsafe Abortion 12.9 .9% 12.8% 19.8% Infection 14.8 Eclampsia 12.9 14.9 Obstructed Labor 6.9% Other Direct Causes 7.9% Indirect Causes 19.9% 24.9 12.8 7.

islands. rivers — poor organization . personnel • Poorly trained personnel with punitive attitude • Finances • Mountains.But WHY Do These Women Die? THREE DELAYS MODEL Delay in decision to seek care Delay in reaching care • Lack of understanding of complications • Acceptance of maternal death • Low status of women • Socio-cultural barriers to seeking care Delay in receiving care • Supplies.

Australia. Scotland (1910–1915) New concept .screening healthy women for signs of disease By 1930‘s large number (1200) ANC clinics opened in UK No reduction in maternal mortality However.Interventions: Antenatal Care • • • • • ANC clinics started in US. widely used as a maternal mortality reduction strategy in 1980‘s and early 1990‘s Is ANC important? YES!! Early detection of problems and birth preparation .

dan akan diikuti oleh kunjungan pada 24 dan 28 minggu. "persyaratan pertama dari layanan bersalin adalah pengawasan efektif kesehatan wanita selama kehamilan . berasal dari model yang dikembangkan di Eropa pada dekade awal abad yang lalu (Oakley 1982). Konsep ini muncul dari keyakinan baru terhadap kemungkinan menghindari kematian ibu dan juga kematian janin dan bayi. Oakley (1982) .. Dr Janet Campbell menyatakan.ANTENATAL CARE • Program Antenatal care (prenatal)." • Departemen Kesehatan Inggris: ANC harus dimulai pada sekitar 16 minggu.. • Pada tahun 1929. kemudian dua minggu sampai 36 minggu dan setiap minggu..

observasi 2.ANTENATAL CARE Antenatal Care  program terencana oleh tenaga kesehatan 1. juga dikenal sebagai prenatal care. (WHO) . penanganan medik deteksi dini (kelainan obstetri) ANC. edukasi Ibu Hamil Kehamilan aman Persalinan aman 3. adalah serangkaian intervensi yang diterima seorang wanita hamil dari pelayanan kesehatan yang terorganisir.

Standar Pelayanan ANC • Pelayanan pada bumil min 4 kali • BB dan LILA dg teratur (BBLR) • BB rutin & TD (preeklampsi) • TFU • Palpasi abdominal • Imunisasi TT • • • • Pemeriksaan Hb Pemberian tablet zat besi Pemeriksaan urine Penyuluhan perawatan diri • Mendiskusikan rencana persalinan • Tersedianya alat-alat kehamilan .

Sasaran ANC Depkes RI (2001) Ibu Hamil Suami Keluarga Masyarakat .

Aims Of Antenatal Care To prevent. reassurance. education and support for the woman and her family To deal with the ‗minor ailments‘ of pregnancy To provide general health screening . detect and manage those factors that adversely affect the health of the baby To provide advice.

melahirkan dengan selamat. dan merawat anak secara fisik. termasuk riwayat penyakit secara umum. dan sosial ibu dan bayi. mental. psikologis dan sosial.• Memantau kemajuan kehamilan untuk memastikan kesehatan ibu dan tumbuh kembang bayi • Meningkatkan dan mempertahankan kesehatan fisik. • Membantu menyiapkan ibu menjalankan puerperium normal. ibu maupun bayinya dengan trauma seminimal mungkin • Mempersiapkan ibu agar masa nifas berjalan normal dan pemberian ASI eksklusif • Mempersiapkan peran ibu dan keluarga dalam menerima kelahiran bayi agar dapat tumbuh kembang secara normal. Tujuan ANC . kebidanan dan pembedahan • Mempersiapkan persalinan cukup bulan. • Mengenali secara dini adanya ketidaknormalan atau komplikasi yang mungkin terjadi selama hamil.

Classification Of Antenatal Care Shared Care Hospital Maternity Team General Practitioner (GP) Community Midwives .

Advice. 5. 2. 9. 3. Reassurance & Education Reassurance & explanation on pregnancy symptoms: 1. Nausea Heartburn Constipation Shortness Of Breath Dizziness Swelling Back-ache Abdominal Discomfort Headaches . 7. 6. 8. 4.

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Dating Pregnancy • Confirms the pregnancy and accurately dates it. .Confirmation of the pregnancy Symptom of the pregnancy • Breast tenderness • Amenorrhea ● Nausea ● Urinary Frequency Pregnancy test • Positive urinary or serum pregnancy test are usually sufficient confirmation of a pregnancy.

Reduced incidence in induction of labor for ‗prolonged pregnancy‘ 3.Dating Pregnancy A. 2. Dating by ultrasound Benefits of a dating scan: 1. Early detection of multiple pregnancies 5. Menstrual EDD B. Accurate dating women with irregular menstrual cycles or poor recollection of LMP. Detection of otherwise asymptomatic failed intrauterine pregnancy . Maximizing the potential for serum screening to detect fetal abnormalities 4.

Past Medial History Past Obstetric History Booking History Previous Gynaecological History Family History Social History .

Booking Examination Cardiovascular Full Breast Examination Full Physical Examination Respiratory Systems Full Pelvic Examination Abdominal .

Examination for most healthy women: 1. Recognition of any abdominal scars indicative of previous surgery 4. 5. Accurate measurement of blood pressure 2. Urine examination . Abdominal examination to record the size of the uterus 3. Measurement of height and weight for calculation of the BMI.

Pattern Of Follow Up Visits 4 weekly appointments from 20 weeks until 32 weeks fortnightly visits 32 weeks to 36 weeks weekly visits The minimum number of ‗visits‘ recommended by the Royal College of Obstetricians and Gynaecologists is 5 Occurring at 12. 20. 28-32. . 36 and 40-41 weeks.

.  Enquiry regarding fetal movements (24 weeks).  Measurement of blood pressure (a screen for pregnancy-related hypertensive disorders). particularly for protein.  Urinalysis. preeclampsia and gestational diabetes.Content Of Follow Up Visits  General questions regarding maternal well-being. blood and glucose: this is used to help detect infection.

Oedema of the hands and face is somewhat more important as a warning feature of pre-eclampsia. .  Abdominal palpation for fundal height: If repeated symphysis–fundal height measurement are made throughout a pregnancy. the detection of fetal growth problems and abnormalities of liquor volume increased. Examination for oedema: Oedema is common in pregnancy and is mostly an insensitive marker of pre-eclempsia.

women at 28 weeks may be tested for gestational diabetes.  A full blood count and red cell antibody screen is repeated at 28 and 36 weeks. it provides considerable reassurance and will occasionally detect an otherwise unrecognized intrauterine fetal death. Auscultation of the fetal heart: There is no evidence that this practice is of any benefit in a woman confident in the movements of her baby. . however.  Depending on the screening policy of the particular unit.

transverse or oblique). It is often at this appointment that a decision is made regarding the mode of delivery (i. vaginal delivery or planned Caesarean section). From 36 weeks. the lie of the fetus (longitudinal. its presentation (cephalic or breech) and the degree of engagement of the presenting part should be assessed and recorded.e. .

a discussion regarding the merits of induction of labour for prolonged pregnancy should occur. . At 41 weeks’ gestation.  An association between prolonged pregnancy and increased perinatal morbidity and mortality means that women are usually advised that delivery of the baby should occur by 42 completed weeks‘ gestation.  This will usually mean organizing a date for induction of labour at approximately 12 days past the EDD.

” .What Is Safe Motherhood? “A woman’s ability to have a SAFE and healthy pregnancy and childbirth.

―Every Pregnancy Is at Risk‖ TERIMA KASIH .