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Ante Natal Care (ANC)

ASUHAN ANTE NATAL


Perawatan selama kehamilan.
Nuligravida: wanita yang tidak sedang dan belum
pernah hamil.
Gravida: wanita yang sedang/ pernah hamil tanpa
memandang hasil kehamilan.
Primigravida: hamil pertama
Nulipara: wanita yang belum pernah melahirkan bayi
mampu hidup.
Primipara: sekali melahirkan bayi mampu hidup. Pada
kehamilan ganda, paritas dihitung 1.
Multipara: wanita yang telah melahirkan dua janin viable
atau lebih.

Tujuan ANC
Promote and maintain the physical, mental and social
heath of mother and baby by providing education on
nutrition, personal hygiene, and birth process.
Detect & manage complications during pregnancy,
whether medical, surgical or obstetrical.
Develop birth preparedness and complication readiness
plan.
Help prepare mother to breastfeed successfully,
experience normal puerperium, and take good care of
the child physically, psychologically, and socially

Kunjungan pertama
Harus seawal mungkin.
Anamnesis umur, paritas, HPM, riwayat haid
Pemeriksaan fisik TB, BB, T, dan pemeriksaan
kehamilan.
Pemeriksaan laboratorium Hb, Hmt, gol darah,
rhesus
Pemeriksaan tambahan lain untuk memperoleh data
(parameter) dasar

Support psikis agar ibu hamil memiliki emosi


stabil.

Sign of pregnancy
Positive sign

Palpation
Fetal heart beat
Stetoscope of Laennec /fetoscop 18 weeks
Doppler 12 weeks
Ultrasound 6-7 weeks (fetal pool), 7-8 weeks (pulse), 8-9
weeks (fetal movement), 9-10 weeks (placentae), 12 weeks
(BPD).
Rontgenology
hCG test.

Probable sign:
Amenorrhea, nausea and vomiting, mastodinia, quickening,
urinary frequency, constipation, weight gain, increased basal body
temperature, cloasma

Determining pregnancy age


Naegeles rule
EDC (estimated day of confinement)
=(LMP+7) (month-3) (Year +1)
example: LMP 26/4/2004 EDC 3/2/2005

Fundal height
Quickening:
16 weeks in multigavida,
18 weeks in primigravida

Johnsons estimate of fetal weight


(EFW)
EFW = (fundal height N) x155
N = 12, if the vertex is at or above the ischial
spine.
N = 11, if the vertex is below the spines.
Example:
G3P1A1, examination fundal heigh was 34
cm, the head is floating.
EFW = (34-12)x155 = 3410 g.

1. Assessment of maternal health


This include not only determining the pregnant
womans overall health status, but also
identifying factors which may adversely affect
pregnancy outcome.

Age younger than 17 or older than 40


Grand multipara
Short stature
Obstetric history of any previous complication,
including surgery.

It will not identify all of women with the risk, but it


is critically important to identify and manage
complications as they arise among all pregnant
women.

2. Detection and management of


complication
Special emphasis should be placed on
identifying the acute complications of unsafe
abortion and ante-partum haemorrhage.
Other complication, such as hypertensive
disease, anemia, diabetes, malaria, or an STD,
are less obvious and require more detailed
physical examination.
Treatment for existing health conditions should
be undertaken.

3. Observation and recording of clinical


data
Height blood pressure, search for
oedemas, proteinuria, and haemoglobin (if
indicated by clinical sign), uterine growth,
fetal heart rate and presentation should be
recorded.

4. Maintenance of maternal nutrition


Good maternal nutrition is a major determinant of
normal fetal growth and development.
The recommended minimum nutritional requirements for
a pregnant woman have been eat at 2300 kcal/ day of a
balanced and culturally acceptable diet.
Supplementary food may be require if the basic food
ration available or distributed is inadequate.
The offer of supplement food can be a good incentive to
get women to attend for antenatal care. Health care
providers should be alert to signs of iron deficiency
anemia and iodine deficiency disorders.

Calcium must be supplemented during


pregnancy to meet fetal needs and
preserve maternal calcium stores.
Supplemental iron is needed during
pregnancy for the fetus and to prevent
depletion of the maternal iron stores,
especially during the latter part of
pregnancy. Iron is the only mineral that
usually must be prescribed.

5. Health education
Educational activity related to antenatal care:
Choosing the safest place for delivery
Clean delivery
The major simptoms of complications (bleeding,
severe abdominal pain, headache)
Where and when to seek care for complication
Exclusive breast feeding
Maternal nutrition
STD/HIV/AIDS prevention
Immunisation
Family planning

6. Prevention of major diseases


Iron folate prophylaxis anemia occurs in 60%
of pregnant women in developing countris
Tetanus toxoid immunisation
Vitamin A supplement
Antimalarials according to country policies
Antihelminthics (hookworm) in endemic areas
Iodized oil/salt may be given in areas of
moderate or severe IDD and following national
protocols

General information
Record the patients correct name,
address, birth date, phone number, choice
of whom to call in emergency, and special
personal preferences.

General examination
Record the vital sign blood pressure, pulse,
and respiration.
Note weight, height, body build, and state of
nutrition.
Assess general condition (skin, hair, neck,
breast, abdomen, extremities)
Pelvic examination vulvar and vaginal
varicosities; cervical consistency, position,
effecement, and dilatation; pelvic masses, pelvic
measurement.

Diagnosis, prognosis, plan & treatment


Diagnosis record the duration of
pregnancy and any anticipated
complications.
Prognosis record an initial prediction of
EDC and outcome of her pregnancy
(vaginal or CS). The prognosis must be
altered if obstetric problems develop.
Plan & treatment project the care
necessary for this gravida and pregnancy.

Laboratory tests
Obviously, laboratory tests must be
individualized for each patient. They
should be done as early as possible.

Exercise
A patient, G3P1A1, 35 years old comes to
you for prenatal care. She is 9 weeks of
gestation. How will you manage this
patient?
history taking

management

Linea nigra

Nutrisi dalam kehamilan


Kebutuhan kalori
wanita tidak hamil 2000 Kkal
wanita hamil 2300 Kkal
wanita menyusui
2800 Kkal
Protein untuk pertumbuhan janin, uterus,
plasenta, payudara, dan kenaikan sirkulasi ibu
(protein plasma, Hb)
wanita tidak hamil 0,9 g/kg BB/hari
hamil
+ 30 g/hari
Dianjurkan protein hewani komposisi asam
amino lengkap.

Mineral
semua mineral kecuali besi dapat
terpenuhi dengan makanan sehari-hari
yang adekuat.

Aktivitas selama hamil


Boleh mengerjakan pekerjaan sehari-hari
selama tidak memberikan gangguan.
Aktivitas dibatasi bila didapatkan penyulit
partus prematurus imminens, ketuban pecah,
menderita kelainan jantung.
Coitus tidak dibolehkan bila:

Ada perdarahan vaginal


Riwayat abortus berulang
Abortus/partus prematurus imminens
Ketuban pecah
Serviks telah membuka

Pakaian selama hamil


Stoking yang terlalu ketat mengganggu
aliran darah balik
Sepatu hak tinggi menambah lordosis
sehingga sakit pinggang >>

Defekasi
Defekasi menjadi tidak teratur karena:
Pengaruh relaksasi otot polos oleh estrogen
Tekanan uterus yang membesar
Pada kehamilan lanjut karena pengaruh
tekanan kepala yang telah masuk panggul.

Konstipasi dicegah dengan:


Cukup banyak minum
Olah raga
Pemberian laksatif ringan jus buah-buahan

Obat-obat selama hamil


Tahap paling kritis dalam perkembangan
janin minggu ke-2 hingga ke-8 pasca
konsepsi (periode organogenesis)
Sifat teratogenik obat ditentukan oleh:
Cara kerja obat
Kemampuan obat menembus barrier plasenta
Periode kritis perkembangan janin
Kepekaan spesiesnya

Exercise
Measure:
HPM: 9th July, 2006 EDC ..
HPM: 28th November, 2005 EDC ..
HPM: 1st October, 2004 EDC ..
TFU 32 cm, the head is engaged EFW ..
TFU 28 cm, vertex is below the spine
EFW ..
TFU 34 cm, vertex is above the spine EFW
..

1. Leveno KJ, Cunningham FG, Gant NF,


Alexander JM, Bloom SL, Casey BM,
Dashe JS, Sheffield JS, Yost NP.
Williams, Manual pf Obstetric. Mc GrowHill companies. 2003.
2. Siswosudarmo R. Obstetri Fisiologi. UPF
Kebidanan dan Penyakit Kandungan FK
UGM. 1992.