SEKOLAH TINGGI ILMU KESEHATAN (STIKes) MITRA HUSADA MEDAN

PRODI KEBIDANAN PROGRAM SARJANA

STANDARD OPERASIONAL PROSEDUR

PEMERIKSAAN FISIK IBU HAMIL
No. Dokumen Halaman Tgl Berlaku Revisi
FM-PM-I.IV.Pd2-05/35-09-1 1 dari 4 18 Oktober 2017 00

Nama Mahasiswa : Hari/ Tanggal :

NPM : Tahun Ajaran :
Ujian : Diagnostik Test Angkatan :

Jawablah sesuai dengan Standar Operasional Prosedur.

1. Cara pemeriksaan fisik :...........................................................................................................................……..
2. Tujuan Pemeriksaan palpasi Leopold I – Leopold IV sesuai dengan Standart Asuhan Kebidanan :
....................................................................................................................................................................................................
....................................................................................................................................................................................................
....................................................................................................................................................................................................
3. Cara Menentukan DJJ:
...............................................................................................................................................................
...................................................................................................................................................................................................
4. Ukuran – ukuran normal panggul luar:
a..................................................................................... c. ....................................................................................
b.................................................................................... d. ...................................................................................
5. Indikasi dan kontraindikasi pemeriksaan fisik ibu hamil :
....................................................................................................................................................................................................
....................................................................................................................................................................................................
....................................................................................................................................................................................................
A. Persiapan Alat
1. ………………………………….. 8. ………………………………….. 15. …... .........................................
2. ………………………………….. 9. ………………………………….. 16. …………………………………
3. ………………………………….. 10. ………………………………….. 17. …………………………………
4. ………………………………….. 11. ………………………………….. 18. …………………………………
5. ………………………………….. 12. ………………………………….. 19. …………………………………
6. ………………………………….. 13. ………………………………….. 20. …………………………………
7. ………………………………….. 14. ………………………………….. 21. …………………………………
B. Persiapan Petugas
1. ............................................................................................................................................................................................
2. ............................................................................................................................................................................................
3. ............................................................................................................................................................................................
4. ............................................................................................................................................................................................
Anamnese
1. Riwayat kehamilan sekarang
- ............................................................................................................................................................................................
- ............................................................................................................................................................................................
2. Riwayat kehamilan yang lalu
_ . ...........................................................................................................................................................................................
- .............................................................................................................................................................................................
- .............................................................................................................................................................................................
- ............................................................................................................................................................................................
3. Riwayat kesehatan/penyakit yang sedang/ pernah diderita
- ............................................................................................................................................................................................

4. Keadaan sosial ekonomi

- ............................................................................................................................................................................
- ............................................................................................................................................................................
- ............................................................................................................................................................................
- ............................................................................................................................................................................
 SEKOLAH TINGGI ILMU KESEHATAN (STIKes) MITRA HUSADA MEDAN
PRODI KEBIDANAN PROGRAM SARJANA

STANDARD OPERASIONAL PROSEDUR

PEMERIKSAAN FISIK IBU HAMIL
No. Dokumen Halaman Tgl Berlaku Revisi
FM-PM-I.IV.Pd2-05/35-09-1 2 dari 4 18 Oktober 2017 00

- ............................................................................................................................................................................
Prosedur Pelaksanaan
A. Mengukur Tinggi Badan
1. ……………………………………………………………………………………………………………………
2. ……………………………………………………………………………………………………………………
3. ……………………………………………………………………………………………………………………
4. ……………………………………………………………………………………………………………………
5. ……………………………………………………………………………………………………………………
6. ……………………………………………………………………………………………………………………
B. Menimbang Berat Badan
1. ……………………………………………………………………………………………………………………
2. ……………………
3. ………………………………………………………………………………………………
4. ……………………………………………………………………………………………………………………
5. ……………………………………………………………………………………………………………………
6. ……………………………………………………………………………………………………………………
7. ……………………………………………………………………………………………………………………
C. Mengukur Vital Sign
1. Mengukur Tekanan Darah
a. ……………………………………………………………………………………………………………
b. …………………………………………………………………………………………………………..
c. …………………………………………………………………………………………………………..
d. …………………………………………………………………………………………………………..
e. …………………………………………………………………………………………………………..
f. …………………………………………………………………………………………………………..
2. Menghitung Nadi
a. …………………………………………………………………………………………………………..
b. …………………………………………………………………………………………………………..
c. …………………………………………………………………………………………………………..
3. Menghitung Jumlah Pernafasan
a. …………………………………………………………………………………………………………..
b. …………………………………………………………………………………………………………..
c. …………………………………………………………………………………………………………..
d. …………………………………………………………………………………………………………..
4. Mengukur Suhu Tubuh
a. …………………………………………………………………………………………………………..
b. …………………………………………………………………………………………………………..
c. …………………………………………………………………………………………………………..
d. …………………………………………………………………………………………………………..
e. …………………………………………………………………………………………………………..
f. …………………………………………………………………………………………………………..
g. …………………………………………………………………………………………………………..
h. …………………………………………………………………………………………………………..
i. …………………………………………………………………………………………………………..
j. …………………………………………………………………………………………………………..
k. …………………………………………………………………………………………………………..
D. Mengukur Lingkar Lengan Atas
1. ………………………………………………………………………………………………………………..
2. ………………………………………………………………………………………………………………..
3. ………………………………………………………………………………………………………………..
4. ………………………………………………………………………………………………………………..
 SEKOLAH TINGGI ILMU KESEHATAN (STIKes) MITRA HUSADA MEDAN
PRODI KEBIDANAN PROGRAM SARJANA

STANDARD OPERASIONAL PROSEDUR

PEMERIKSAAN FISIK IBU HAMIL
No. Dokumen Halaman Tgl Berlaku Revisi
FM-PM-I.IV.Pd2-05/35-09-1 3 dari 4 18 Oktober 2017 00

5. ………………………………………………………………………………………………………………..
6. ………………………………………………………………………………………………………………..
E. Pemeriksaan Fisik
1. Melakukan pemeriksaan umum
a. …………………………………………………………………………………………………………..
b. …………………………………………………………………………………………………………..
c. …………………………………………………………………………………………………………..
d. …………………………………………………………………………………………………………..
2. Mencuci tangan
3. Melakukan pemeriksaan kelainan local dengan mengamati
a. …………………………………………………………………………………………………………..
b. …………………………………………………………………………………………………………..
c. …………………………………………………………………………………………………………..
d. …………………………………………………………………………………………………………..
e. …………………………………………………………………………………………………………..
f. …………………………………………………………………………………………………………..
g. …………………………………………………………………………………………………………..
h. Payudara
1) ……………………………………………………………………………………………………….
2) ……………………………………………………………………………………………………….
3) ……………………………………………………………………………………………………….
4) ……………………………………………………………………………………………………….
5) ……………………………………………………………………………………………………….
6) ……………………………………………………………………………………………………….
i. Abdomen
- ……………………………………………………………………………………………………….
- ……………………………………………………………………………………………………….
F. Pemeriksaan Khusus Kebidanan
 Memberitahu ibu bahwa pemeriksaan akan dimulai pada daerah abdomen
1. Pemeriksaan Leopold I
- …………………………………………………………………………………………………………
- …………………………………………………………………………………………………………
- …………………………………………………………………………………………………………
- …………………………………………………………………………………………………………
Bila Usia kehamilan > 22 minggu menentukan TFU dapat menggunakan pita cm, menurut teori:

- ………………………………………………………………………………………………………..
- ………………………………………………………………………………………………………..

- ………………………………………………………………………………………………………..
- ………………………………………………………………………………………………………..
2. Pemeriksaan Leopold II
- ………………………………………………………………………………………………………..
- ………………………………………………………………………………………………………..
- ………………………………………………………………………………………………………..
3. Pemeriksaan Leopold III
- ………………………………………………………………………………………………………..
- ………………………………………………………………………………………………………..
- ………………………………………………………………………………………………………..
4. Pemeriksaan Leopold IV
- ………………………………………………………………………………………………………..
 SEKOLAH TINGGI ILMU KESEHATAN (STIKes) MITRA HUSADA MEDAN
PRODI KEBIDANAN PROGRAM SARJANA

STANDARD OPERASIONAL PROSEDUR

PEMERIKSAAN FISIK IBU HAMIL
No. Dokumen Halaman Tgl Berlaku Revisi
FM-PM-I.IV.Pd2-05/35-09-1 4 dari 4 18 Oktober 2017 00

- ………………………………………………………………………………………………………..
- ………………………………………………………………………………………………………..
5. Pemeriksaan Dengan Auskultasi
- …………………………………………………………………………………………………………
- …………………………………………………………………………………………………………
- …………………………………………………………………………………………………………
- …………………………………………………………………………………………………………
6. Pengukuran Panggul Luar
a. ………………………………………………….. c. ……………………………………………..
b. ………………………………………………….. d. ………………………………………………
G. Pemeriksaan CVAT: …………………………………………………………………………………………..
H. Pemeriksaan Genitalia Eksterna : …………………………………………………………………………….
I. Pemeriksaan Ekstremitas
1. Oedema pada tangan/ kaki, varises, Kelainan lain
a. …………………………………………………………………………………………………………
b. …………………………………………………………………………………………………………
c. …………………………………………………………………………………………………………
2. Pemeriksaan reflex patella
a. …………………………………………………………………………………………………………
b. …………………………………………………………………………………………………………
c. …………………………………………………………………………………………………………
d. …………………………………………………………………………………………………………
J. Jenis Pemeriksaan Laboratorium
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….

Diketahui,
Ka. Prodi Kebidanan
Program Sarjana

Febriana Sari, SST, M.Keb