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7/30/2019 Pengantar Maternitas II
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Pengantar maternitas II
Irma Nurbaeti
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RUANG LINGKUP FAKTOR-FAKTOR RESIKO
MATERNAL
Didunia AKI 430/100.000 kelahiran hdp
Di ngr berkembang 480/100.000lhr hdp
Negara maju : 27/100.000 lhr hdp
Eropa Utara : 0-11/100.000 lhr hdp
40% ibu mengalami msl obstetrik akut selamakehamilan, persalinan dan postpartum
15% ibu hamil mengalami komplikasi yang mengancamkehidupan
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PENYEBAB KEMATIAN IBU
secara umum
25 %
15%20%
8%
12%
13% 8%
Perdarahan hebat
Penyebab
Tidak
Langsung
Penyebab
Langsung
lainnya
Unsafe
abortionObstructed
labor
Infeksi
Eklampsia
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CATEGORIES OF HIGH-RISK PREGNANCY
MATERNAL AGE AD PARITY FACTORS
1. AGE 16 YEARS OR UNDER
2. NULLIPARA 35 YEARS OR OVER
3. MULTIPARA 40 YEARS OR OVER4. INTERVAL OF 8 YEARS OR MORE SINCE LAST
PREGNANCY
5. HIGH PARITY (5 OR MORE)6. PREGNANCY OCCURING 3 MONTHS OR LESSAFTER LAST BIRTH
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CATEGORIES OF HIGH-RISK PREGNANCY
PREGNANCY-INDUCED HYPERTENSION (PIH),
HYPERTENSION, KIDNEY DISEASE
1. Preeclampsia with hospitalization before labor
2. Eclampsia3. Kidney Disease-pyelonephritis, nephritis, nephrosis, etc
4. Chronic hypertension, severe (160/100mm Hg or over)
5. Blood pressure 140/90 mm Hg or above on 2 readings
30 minutes apart
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CATEGORIES OF HIGH-RISK PREGNANCY
ANEMIA AND HEMORRHAGE
1. Hematocrit 30% or below in pregnancy
2. Hemorrhage (previous pregnancy)- severe, requiringtransfusion
3. Hemorrhage (present pregnancy)
4. Anemia (hemoglobin below 11 g) for which treatmentother than oral iron preparation is required (hemolytic,macrocytic anemias, etc)
5. Sickle cell trait or disease
6. History of bleeding or clotting disorder at any time
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CATEGORIES OF HIGH-RISK PREGNANCY
FETAL FACTORS
1. Two or more previous preterm birth (twins=one birth)
2. Two or more consecutive spontaneous abortions (miscarriages)
3. One or more stillbirth at term gestation
4. One or more gross anomalies5. Rh incompatibilty or ABO isoimmunization problems
6. History of previous birth defect- cerebral palsy, brain damage,mental retardation, metabolic disorder such as phenylketonuria(PKU)
7. History of large infant (over 4032 gr)
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CATEGORIES OF HIGH-RISK PREGNANCY
DYSTOCIA (HISTORY OF OR ANTICIPATED)1. Contracted pelvis or cephalopelvic disproportion (CPD)
2. Multifetal pregnancy in current pregnancy
3. Two or more breech births
4. Previous operative births (e.g cesarean or midforceps birth)
5. History of prolonged labor (more than 18 hours for nullipara; morethan 12 hours for multipara)
6. Previously diagnosed genital tract anomalies (incompetent cervix,cervical or uterin malformation, solitary ovary or tube) or problem
(ovarian mass, endometriosis)
7. Short stature (1.5 m or less)
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CATEGORIES OF HIGH-RISK PREGNANCY
HISTORY OF OR CONCURRENT CONDITIONS
1. Diabetes ellitus, gestational diabetes
2. Hyperemesis gravidarum
3. Thyroid disease (hypothyroidism or hyperthyroidism)
4. Malnutrisi or extreme obesity (20% over weight for height; 15%under ideal weight for height)
5. Organic heart disease
6. Syphilis and TORCH infection, HIV positive, HPV
7. Tuberculosis or other serious pulmonary pathologic condition (e.g
emphysema, asthma)8. Malignant or premalignant tumors
9. Alcoholism, substance dependency
10. Psychiatric disease or epilepsy (documented)
11. Mental retardation
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CATEGORIES OF HIGH-RISK PREGNANCY
THOSE WITH PREVIOUS HISTORY OF
1. Late registration, or poor clinic attendance
2. Family violence including battery, rape,incest
3. Home situation making clinic attendance and
hospitalization difficult4. Mothers, including minors, without family
resources
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FAKTOR-FAKTOR RESIKO YG MEMPENGARUHI
HASIL KEHAMILANPosisi dlm
Struktur sosial
Infeksi dan Pengalaman
Resiko lingk. masa kanak2
Status genetik st. psikologis pola budaya motivasi
st. kes & health practices
fisiologis slm care seeking
kehamilan Nutrition practices
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FAKTOR RESIKO SOSIAL
SOSIODEMOGRAFI : Usia : remaja, tua
SOSIOEKONOMI
Pendapatan, pendidikan, etnik
PERILAKU Perokok, alkohol, drug abuse
KETEGANGAN Perceraian, penyakit, kematian
PHK, kekurangan
Emosi, sikap
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APA YANG BISA DILAKUKAN?
1. Akses maternal health service
Basic maternal care
Penolong persalinan terampil
Pencegahan dan treatmen komplikasiselama kehamilan, persalinan dan masanifas
Postpartum family planningBasic neonatal care
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APA YANG BISA DILAKUKAN?
2. Perbaikan ketimpangan gender, kemiskinan dan
diskriminasi wanita
Meningkatkan status wanita
Meningkatkan peran wnt pd masa reprod. Meningkatkan produktifitas
Merubah pandangan pandangan keluarga dan
masy. Wanita sbg penerima jasa prwt ttp dapat
menentukan/memutuskan