LAPORAN PENDAHULUAN ANTE NATAL CARE (ANC)

A. KONSEP DASAR PENYAKIT

I. Kehamilan
1. Pengertian
Kehamilan adalah masa yang di mulai dari konsepsi sampai lahirnya janin. Lamanya hamil normal adalah
280 hari (40 minggu atau 9 bulan 10 hari) di hitung dari hari pertama haid terakhir. (Depkes RI, 2005)
Kehamilan adalah seorang yang mengandung sel telur yang telah dibuahi oleh seperma. Proses kehamilan
merupakan satu mata rantai yang berkesinambungan yang dimulai dari ovulasi (pelepasan ovum), terjadi
migrasi spermatozoa dan ovum lalu terjadi konsepsi dan pertumbuhan zigot, setelah itu terjadi nidasi pada
uterus, pembentukan plasenta, pertumbuhan dan perkembangan hasil konsepsi sampai aterm. (Prawiroharjo,
Sarwono, 2005)

2. Fase Kehamilan
a. Menurut Varney, 2007
a. Trimester pertama berlangsung pada minggu pertama sampai minggu ke- 12 (12 minggu)

b. Trimester kedua berlangsung pada minggu ke-13 sampai minggu ke-27 (15 minggu)

c. Trimester ketiga berlangsung pada minggu ke-28 sampai minggu ke-40 (13 minggu)

b. Menurut Sarwono, 2002

a. Trimester pertama (antara 0-12 minggu)
b. Trimester kedua dari bulan keempat sampai 6 bulan
c. Trimester ketiga dari bulan ketujuh sampai 9 bulan
c. Menurut Hanifa, 2002
a. Triwulan pertama (antara 0-12 minggu)
b. Triwulan kedua (antara 12-28 minggu)
c. Triwulan ketiga (antara 28-40 minggu)
3. Tanda-tanda Kehamilan
1) Presumtif / Tanda-tanda dugaan hamil
a. Amenore ( terlambat datang bulan)
• Konsepsi dan nidasi menyebabkan tidak terjadi pembentukan folikel
degraaf dan ovulasi.
• Mengetahiu tanggal haid terakhir dengan perhitungan rumus naegle
dapat ditentukan perkiraan persalinan
b. Mual (nausea) dan muntah
• Pengaruh estrogen dan progesteron terjadi pengeluaran asam lambung
yang berlebihan.
• Menimbulkan mual muntah terutama pagi hari yang disebutkan
morning sickness.
• Dalam batas yang fisiologis keadaan ini dapat diatasi.
• Akibat mual dan muntah nafsu makan berkurang
c. Ngidam
• Wanita hamil sering menginginkan makanan tertentu, keinginan yang
demikian disebut ngidam.
d. Sinkope atau pingsan
• Terjadinya gangguan sirkulasi ke daerah kepala (sentral)
menyebabkan iskemia susunan syaraf pusat dan menimbulkan sinkope
atau pingsan.
• Keadaan ini menghilang setelah umur kehamilan 16 minggu.
e. Payudara tegang
• Pengaruh estrogen-progesteron dan somatomamotropin menimbulkan
deposit lemak air, dan garam pada payudara.
• Payudara membesar dan tegang
• Ujung syaraf tertekan menyebabkan rasa sakit terutama pada hamil
pertama.
f. Sering miksi
• Desakan rahim ke depan menyebabkan kandung kemih cepat terasa
penuh dan sering miksi.
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g. Konstipasi atau obstipasi

• Pengaruh progesteron dapat menghambat peristaltik usus
menyebabkan kesulitan untuk buang air besar.
h. Pingmentasi kulit
• Sekitar pipi : cloasma gravidarum
 Keluarnya melanophore stimulating hormone hipofisis anterior
menyebabkan pigmentasi kulit pada muka.
• Dinding perut

 Strie lividae
 Strie nigra
 Linea alba makin hitam
i. Perubahan sekitar payudara
• Hiperpigmentasi areola mamae
• Puting susu makin menonjol
• Kelenjar montgomery menonjol
• Pembuluh darah menifes sekitar payudara
j. Epulis
• Hipertropi gusi disebut epulis bisa terjadi bila hamil
k. Varices atau penampakan pembuluh darah vena
• Karena pengaruh dari estrogen dan progesteron terjadi penampakan
pembuluh darah vena.
• Penampakan pembuluh darah itu terjadi di sekitar genetalia eksterna,
kaki dan betis, dan payudara.
• Penampakan pembuluh darah ini dapat menghilang setelah persalinan.
2) Probabilitas / Tanda tidak pasti kehamilan
a. Rahim membesar, sesuai dengan tuanya hamil.
b. Pada pemeriksaan dapat dijumpai :
• Tanda Hegar’s
Konsistensi rahim yang menjadi lunak, terutama daerah isthmus uteri
sedemikian lunaknya, hingga kalau kita letakkan 2 jari dalam forniks
posterior & tangan satunya pada dnding perut atas symphyse, maka
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• Tanda chadwicks (kebiruan pada vulva dan vagina)

Warna selaput lendir vulva & vagina menjadi ungu.
• Tanda piscaseck
Uterus membesar ke salah satu jurusan hingga menonjol jelas ke
jurusan pembesaran tersebut.
• Ballotement
Adanya lentingan janin dalam uterus saat palpasi
• Braxton hick’s
Pada saat palpasi atau waktu toucher, rahim yang lunak sekonyong-
konyong menjdi keras karena berkontraksi.
c. Pemeriksaan tes biologis kehamilan positif
• Sebagian kemungkinan positif palsu
3) Absolut / Tanda pasti kehamilan
a. Terdengar denyut jantung janin (DJJ)
b. Teraba bagian anak oleh pemeriksa
c. Terlihat hasil konsepsi dengan USG
d. Teraba gerakan janin oleh pemeriksa

4. Diagnosa Banding Kehamilan

Pembesaran perut wanita tidak selamanya menjadi tanda suatu kehamilan,
sehingga perlu dilakukan diagnosis banding diantaranya :
1) Hamil palsu (pseudocyesis) atau kehamilan spuria
Dijumpai tanda dugaan hamil, tetapi dengan pemeriksaan alat canggih dan
tes biologis menunjukkan kehamilan.
2) Tumor kandungan atau mioma uteri
• Terdapat pembesaran rahim, tetapi tidak disertai tanda hamil
• Bentuk pembesaran tidak merata
• Perdarahan banyak saat menstruasi
3) Kista ovarium
• Pembesaran perut, tetapi tidak disertai tanda hamil
• Datang bulan terus berlangsung
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4) Hematometa
• Terlambat datang bulan yang dapat melampaui umur hamil
• Perut terasa sakit setiap bulan
• Terjadi penumpukkan darah dalam rahim
• Tanda dan pemeriksaan hamil tidak menunjukkan hasil yang positif
• Sebab himen in perforata
5) Kandung kemih yang penuh
• Dengan melakukan kateterisasi, maka pembesaran perut akan
menghilang.

5. Perubahan Pada Kehamilan

1) Perubahan dan Adaptasi Fisiologis
a. Perubahan Pada Kulit
Pada kulit terjadi perubahan deposit pigmen dan hiperpigmentasi
karena pengaruh melanophore stimulating hormone lobus hipofisis
anterior dan pengaruh kelenjar suprarenalis. (Manuaba, 1998)
Melasma di wajah yang biasa di sebut cloasma atau topeng
kehamilan, adalah bercak pada kulit di derah tonjolan maksila dan dahi
khususnya pada wanita hamil berkulit hitam. (Bobak, dkk. 2005)
Linea nigra adalah garis pigmentasi dari daerah symfisis pubis
sampai bagian atas fundus di garis tengah tubuh dan stria gravidarum
atau tanda regangan akan terlihat di bagian bawah abdomen. (Bobak,
dkk. 2005)
b. Perubahan kelenjar
Perubahan kelenjar gondok membesar sehingga leher ibu berbentuk
seperti leher pria. Perubahan ini tidak selalu terjadi pada wanita hamil.
c. Perubahan payudara
Mamae akan membesar dan tegang akibat hormone
Somatomatropin, esterogen, dan progesterone, akan tetapi belum
mengeluarkan air susu. (Wiknjosastro, Hanifa. 2007)
Rasa penuh, peningkatan sensitivitas, rasa geli dan rasa berat di
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sebasea / lemak yang muncul di areola primer dan tdisebut Tuberkel

Montgomery. (Bobak, dkk. 2005)
d. Perubahan Uterus
Uterus akan membesar pada bulan – bulan pertama di bawah
pengaruh esterogen dan progesterone yang kadarnya meningkat.
Pembesaran ini pada
dasarnya disebabkan oleh hipertropi otot polos uterus.

Berat uterus normal < 30 gram, pada akhir kehamilan (40 minggu)
berat uterus menjadi 1000 gram dengan panjang < 20 cm dan dinding ±
2,5 cm. (Wiknjosastro, Hanifa. 2007)
Selama minggu awal kehamilan, peningkatan aliran darah uterus
dan limfe mengakibatkan edema dan kongesti panggul. Akibatnya
uterus, servik dan istmus melunak secara progresif dan servik menjadi
agak kebiruan, yang disebut “Tanda Chadwick”. (Bobak, dkk. 200 5)
Pada sekitar minggu ke 7 dan ke 8, terlihat pola pelunakan uterus
sebagai berikut : istmus melunak dan dapat ditekan (Tanda Hegar), servik
melunak (Tanda Goodell), dan fundus pada serviks mulai fleksi (Tanda
McDonald). (Bobak, dkk. 2005)
e. Vagina dan vulva
Vagina dan vulva akibat hormone esterogen mengalami perubahan
pula. Adanya hipervaskularisasi mengakibatkan vagina dan vulva tampak
lebih merah, agak kebiruan (livide). Tanda ini disebut tanda Chadwick.
Warna porsio pun tampak livide. (Wiknjosastro, Hanifa. 2007)
Selama hamil, pH sekresi vagina menjadi lebih asam. Peningkatan
pH ini membuat wanita hamil lebih rentan terhadap infeksi vagina. Dan
peningkatan vaskularisasi vagina dan visera panggul menyebabkan
peningkatan sensitivitas yang menyolok, yang menyebabkan peningkatan
keinginan dan bangkitan seksual, terutama selama trimester kedua.
(Bobak, dkk. 2005)
f. Perubahan pada tungkai
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tekanan uterus yang membesar pada vena femoralis sebelah kanan atau
kiri.
g. Perubahan pada sikap tubuh
Sikap tubuh ibu menjadi lordosis karena perut yang membesar
h. Sistem sirkulasi darah
Perubahan sistem sirkulasi darah menurut Mochtar, Rustam (1998)
adalah:
• Volume darah
Volume darah total dan volume plasma darah meningkat pesat sejak
akhir trimester pertama. Volume darah akan bertambah banyak,
kira – kira 20 %, dengan puncaknya pada kehamilan 32 minggu,
diikuti curah jantung yang meningkat sebanyak ± 30 %.
• Protein darah
Jumlah protein, albumin dan gamaglobulin menurun dalam triwulan
pertama dan meningkat secara bertahap pada akhir kehamilan.
Beta – globulin dan fibrinogen terus meningkat.
• Hitung jenis dan haemoglobin (Hb)
Hematokrit cenderung menurun karena kenaikan relatif volume
plasma darah. Konsentrasi Hb menurun, ini disebabkan volume
plasma yang meningkat.
• Nadi dan Tekanan Darah
Tekanan darah arteri cenderung menurun terutama selama trimester
kedua, dan akan naik lagi seperti pra hamil. Nadi biasanya naik,
rata – rata 84 x / menit.
• Jantung
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j. Sistem pencernaan
Saliva meningkat, dan pada trimester pertama mengeluh mual dan
muntah. Tonus otot saluran pencernaan melemah, sehingga motilitas dan
makanan lebih lama berada dalam saluran makanan. Gejala muntah /
emesis gravidarum sering terjadi biasanya pada pagi hari, disebut sakit
pagi / morning sickness.(Mochtar, Rustam. 1998)
k. Traktus Urinarius
Karena pengaruh desakan hamil muda dan turunnya kepala bayi
pada hamil tua terjadi gangguan miksi dalam bentuk sering kencing.
Desakan tersebut menyebabkan kandung kemih cepat terasa penuh.
Filtrasi pada glomerulus bertambah sekitar 69 – 70%. (Manuaba, 1998)
l. Metabolisme
Menurut Manuaba (1998), perubahan metabolisme pada ibu hamil
yaitu sebagai berikut :
• Metabolisme basal naik sebesar 15 – 20% dari semula
• Keseimbangan asam basa mengalami penurunan 155 mEq/liter
menjadi 145 mEq/liter
• Kebutuhan protein wanita hamil makin tinggi. Dalam makanan
diperlukan protein tinggi sekitar ½ gr/kg BB atau sebutir telur ayam
tiap hari
• Kebutuhan kalori didapat dari karbohidrat, lemak dan protein
• BB ibu hamil bertambah
2) Perubahan dan Adaptasi Psikologis
a. Perubahan psikologis ibu
Trimester pertama Trimester pertama sering dianggap sebagai
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dirinya telah hamil dan mencari bukti kehamilan pada setiap jengkal
tubuhnya.
Hasrat seksual pada trimester pertama sangat bervariasi antara
wanita satu dengan wanita yang lain. Meski beberapa wanita mengalami
peningkatan hasrat seksual akan tetapi secara umum trimester pertama
merupakan waktu terjadinya penurunana libido dan hal ini memerlukan
komunikasi yang jujur dan terbuka terhadap pasangannya masing-
masing. Banyak wanita merasakan kebutuhan kasih saying yang besar
dan cinta kasih tanpa seks.
b. Trimester II
Trimester kedua sering di kenal sebagai periode kesehatan yang
baik, yakni periode ketika wanita merasa nyaman dan bebas dari segala
rasa ketidaknyamanan yang normal yang dialami oleh ibu hamil.
Trimester kedua dibagi menjadi dua fase yakni fase pra-queckning dan
pasca quickening. Quickening menunjukkan kenyataan adanya
kehidupan yang terpisah , yang menjadi dorongan bagi wanita dalam
melaksanakan tugas psikologis utamanya pada trimester ini yakni
mengembangkan identitas sebagai ibu bagi dirinya sendiri, yang berbeda
dari ibunya.
Sebagian besar wanita merasa lebih erotis selama trimester kedua,
kurang lebih 80% wanita mengalami kemajuan yang nyata dalam
hubungan seksual mereka dibandingkan dengan trimester I dan sebelum
hamil. Trimester kedua hamper terbebas dari segala ketidaknyamanan
fisik, dan ukuran perut wanita belum menjadi masalah besar, lubrikasi
vagina menjadi semakin banyak pada masa ini, kekemasan, kekhawatiran
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trimester ini merupakan waktu persiapan yang aktif menantikan kelahiran

bayinya. Hal ini membuat ia berjaga-jaga dan menunggu tanda dan gejala
persalinan.
Sejumlah ketakutan muncul dalam trimester ini yaitu merasa cemas
dengan kehidupan bayinya dan dirinya sendiri, seperti : apakah bayinya
nanti akan lahir abnormal, terkait dengan persalinan dan pelahiran (nyeri,
kehilangan kendali dan hal –hal lain yang tidak diketahui), apakah ia
akan menyadari bahwa ia akan bersalin, atau bayinya tidak mampu
keluar karena perutnya sudah luar biasa besar, atau apakah organ vitalnya
akan mengalami cedera akibat tendangan bayi.
Wanita akan kembali merasakan ketidaknyamanan fisik yang
semakin kuat menjelang akhir kehamilan. Ia akan merasa canggung,
jelek, berantakan dan memerlukan dukungan yang sangat besar dan
konsisten dari pasangannya. Hasrat untuk melakukan hubungan seksual
akan menghilang seiring dengan membesarnya abdomen yang menjadi
penghalang. Alternative possisi dalam berhubungan seksual dan metode
alternative untuk mencapai kepuasan dapat membantu atau dapat
menimbulkan perasaan bersalah jika ia merasa tidak nyaman dengan
cara- cara tersebut. Berbagi perasaan secara jujur dengan pasangan dan
konsultasi mereka dengan tenaga kesehatan menjadi sangat penting.

II. Ante Natal Care (ANC)

1. Pengertian
Ante natal care (ANC) adalah usaha yang dilakukan pada waktu hamil
dengan tujuan mempersiapkan ibu dalam masa hamil agar waktu melahirkan
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b. Mengenal dan menangani penyakit yang menyertai hamil, persalinan dan

nifas
c. Memberikan nasehat dan petunjuk yang berkaitan dengan kehamilan,
persalinan, nifas, laktasi dan aspek keluarga berencana.
d. Menurunkan angka kesakitan dan kematian ibu dan perinatal

3. Frekuensi Kunjungan ANC

Menurut Saifuddin, AB (2002), sedikitnya empat kali kunjungan selama
periode antenatal, yaitu :
1) 1 kali kunjungan selama trimester pertama (sebelum 14 minggu)
2) 1 kali kunjungan selama trimester kedua (antara minggu 14 - 28)
3) 2 kali kunjungan selama trimester ketiga (antara minggu 28 – 36 dan
sesudah minggu ke 36)

4. Informasi Saat Kunjungan ANC

1) Trimester I (Sebelum minggu ke 14)
• Membangun hubungan saling percaya antara petugas kesehatan dan ibu
hamil
• Mendeteksi masalah dan menanganinya
• Melakukan tindakan pencegahan, seperti tetanus neonatorum, anemia
kekurangan zat besi, penggunaan praktek tradisional yang merugikan
• Memulai persiapan kelahiran bayi dan persiapan menghadapi komplikasi
• Mendorong perilaku yang sehat (gizi, latihan, kebersihan dan istirahat)
2) Trimester II (Sebelum minggu ke 28)
Sama seperti di atas, ditambah kewaspadaan khusus mengenai pre eklamsia
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5. Nasehat Untuk Ibu Hamil

1) Diet
Pada dasarnya dianjurkan makanan empat sehat lima sempurna. Karena
kebutuhan akan protein dan bahan makanan tinggi, dianjurkan sebuah telur
sehari. Nilai gizi dapat ditentukan dengan bertambahnya BB sekitar 6,5 – 15
Kg selama hamil. BB yang bertambah terlalu besar atau kurang perlu
mendapat perhatian khusus karena kemungkinan terjadi penyulit kehamilan.
Kenaikan BB tidak boleh > ½ kg / minggu. (Manuaba, 1998)
2) Pekerjaan rumah
Pekerjaan rutin dapat dilaksanakan. Bekerjalah sesuai dengan
kemampuan, dan makin dikurangi dengan semakin tua kehamilan.
(Manuaba, 1998)
3) Wanita bekerja di luar rumah
Kehamilan bukan merupakan halangan untuk berkarya asalkan
dikerjakan dengan pengertian sedang hamil. Wanita karier yang sedang
hamil mendapatkan hak cuti hamil selama tiga bulan, yang dapat diambil
sebelum menjelang kelahiran dan dua bulan setelah persalinan.
(Manuaba,1998)
4) Pakaian hamil
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• Hentikan hubungan seksual pada mereka yang sering mengalami gugur

kandung, persalinan sebelum waktunya, mengalammi kematian dalam
kandungan, sekitar dua minggu sebelum persalinan
6) Perawatan payudara
Menurut Manuaba (1998), perawatan payudara sebelum lahir bertujuan
untuk memelihara hygiene payudara, melenturkan / menguatkan putinng
susu, dan mengelurakan putting susu yang datar. Tehnik perawatannya
adalah :
a. Kompres putting susu dan area sekitarnya dengan menempelkan kapas /
lap yang dibasahi minyak.
b. Bersihkan putting susu dan area sekitarnya dengan handuk kering yang
bersih.
c. Pegang kedua putting susu lalu tarik keluar bersama dan diputar ke dalam
20 kali, keluar 20 kali.
d. Pangkal payudara dipegang kedua tangan lalu payudara diurut dari
panngkal menuju putting susu sebanyak 30 kali.
e. Kemudian pijat daerah areola sehinga keluar cairan 1 – 2 tetes untuk
memastikan saluran susu tidak tersumbat.
f. Pakailah BH yang menyokong payudara.
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8) Persiapan persalinan dan laktasi

Salah satu tujuan persiapan persalinan adalah untuk meningkatkan
kesehatan optimal menjelang persalinan dan segera dapat memberikan
laktasi. Untuk dapat mencapai kesehatan optimal menjelang persalinan perlu
dilakukan dua langkah penting yaitu melakukan senam hamil dan
mempersiapkan keadaan puyudara untuk laktasi. (Manuaba, 1998)
9) Senam hamil
Senam hamil bertujuan untuk mempersiapkan dan melatih otot – otot
sehingga dapat dimanfaatkan untuk berfungsi secara optimal dalam
persalinan normal. Senam hamil ditujukan bagi ibu hamil tanpa kelainan
atau tidak terdapat penyakit yang menyertai kehamilan, yaitu penyakit
jantung, penyakit ginjal, penyulit kehamilan (hamil dengan perdarahan,
hamil dengan gestosis, hamil dengan kelainan letak), dan kehamilan disertai
anemia. Senam hamil dimulai pada umur kehamilan sekitar 24 – 28 minggu.

6. Tanda Bahaya Kehamilan

• Berkaitan dengan ibu
Menurut Saifuddin (2002), tanda bahaya ibu hamil adalah :
a. Perdarahan peervaginam
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IV. Pathway

Kehamilan
(Konsepsi dan nidasi)

Perubahan hormonal
(peningkatan hormon estrogen progesteron)

Metabolisme
Meningkat Aktifitas kelenjar Pembesaran Penekakan pada Tonus otot saluran Perubahan
meningkat uterus vesika urinaria pencernaan menurun psikologis

Cardiak out
Produksi Hcl
put meningkat Diafragma Peran baru
lambung dan Frekuensi Motilitas usus
tertekan dalam keluarga
saliva meningkat miksi menurun
meningkat

Frekuensi nadi Keterbatasan

Rangsangan Pengembangan diafragma
meningkat Inhibisi refluks kognitif
terhadap medula tidak optimal
spingter menurun
vomiting center
meningkat
Intake nutrisi
Sisa pencernaan Cemas
berkurang
Ekspansi paru tertahan lama pada
Mual dan muntah menurun usus
Kelemahan Gangguan pola
fisik tidur dan
Aktifitas Kekurangan Pola napas
Konstipasi istirahat
intoleras volume cairan tidak efektif
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B. DAMPAK PENYAKIT TERHADAP KEBUTUHAN DASAR MANUSIA

1. Kebutuhan Oksigenasi
Untuk memenuhi kebutuhan oksigen dan akibat desakan pembesaran rahim
pada diafragma, mengakibatkan pergerakan diafragma pada saat respirasi tidak
optimal sehingga terjadi peningkatan respirasi yang fisiologis sekitar 20 -25%.
2. Kebutuhan Cairan dan Elektrolit
Akibat pengaruh peningkatan hormon estrogen dan progesteron terjadi
peningkatan secresi Hcl lambung, mengakibatkan terjadinya mual dan muntah
dalam batas yang fisiologis. Akibat maul dan muntah intake cairan akan berkurang.
3. Kebutuhan Sirkulasi
Tekanan darah agak lebih rendah dari pada normal (8 – 12 minggu), kembali
pada tingkat pra kehamilan selama setengah kehamilan teakhir. Denyut nadi
meningkat 10-15 %. Murmur sistolik pendek dapat terjadi sehubungan dengan
peningkatan volume, varises, sedikit edema ekstremitas bawah/tangan mungkin ada
(terutama pada trimester terakhir).
4. Kebutuhan Nutrisi
Terjadi peningkatan metabolisme basal 15-20%. Akibat pengaruh
peningkatan hormon estrogen dan progesteron terjadi peningkatan secresi Hcl
lambung, mengakibatkan terjadinya mual dan muntah dalam batas yang fisiologis.
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C. ASUHAN KEPERAWATAN
1) Pengkajian
1) Identitas

• Nama suami dan istri

Agar dalam melakukan komunikasi dengan pasien keluarga dapat terjalin
komunikasi dengan baik.
• Usia
Penyulit dalam kehamilan remaja lebih tinggi dibanding umur 20 sampai 30
tahun.
• Alamat
Ditanyakan untuk maksud mempermudah hubungan / informasi bila
diperlukan. Bila keadaan mendesak, dengan diketahuinya alamat tersebut
bidan dapat mengetahui tempat tinggal pasien/klien dan lingkungannya.
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• Riwayat keluhan utama

 P : Provokasi / palatif (penyebab)

 Q : Quality / bagaimana gejala dirasakan

 R : Region / dimana gejala dirasakan

 S : Skala keadaan / seberapa parah yang dialami pasien

 T : Time / sejak kapan keluhan terjadi dan sampai kapan

2. Riwayat kesehatan sekarang

Yang perlu dikaji : sejak kapan ibu merasakan pergerakan anak, umur
kehamilan, ANC berapa kali, dimana imunisasi TT didapatkan, teraphie yang
didapatkan, penyuluhan yang didapatkan, bila mulai didapatkan gerakan
anak,kalau kehamilan masih muda adalah mual, muntah, sakit kepala,
perdarahan.kalau kehamilan tua adalah bengkak di kaki/muka, sakit kepala,
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3) Dada : bentuk buah dada, pigmentasi puting susu dan gelanggang susu,
keadaan puting susu, adakah kolostrum
4) Abdomen GIT : bentuk abdomen,warna, adakah luka bekas operasi
apendeksitis, terbagi 9 regio hipokondria kanan (pembesaran hepar),
epigastrik (gastritis), hipokondria kiri (pembesaran lien), lumbal kanan
dan kiri (ginjal), umbilikus, iliaka kanan (apendiksitis), hipokondria,
iliaka kiri (scibala).
5) Abdomen obstetrik : perut membesar ke depan atau ke samping, keadaan
pucat, pigmentasi linia alba, nampakkah gerakan anak atau kontraksi
uterus, adakah strie gravidarum atau bekas luka.
6) Vulva : keadaan perineum, carilah varises, tanda chadwick, condyloma
akuminata, flour albus..
7) Anggota bawah : cari varises, oedema, luka, cicatrix pada lipat paha,
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4) Menurut leopold
1) Leopold I

• Kaki penderita di bengkokan pada lutut dan lipatan paha

• Pemeriksa berdiri sebelah kakan penderita dan melihat ke arah
muka penderita.
• Rahim dibawa ke tengah
• Tingginya fundus uteri ditentukan dan bagian apa dari anak yang
terdapat dalam fundus
• Tujuan : untuk mengetahui usia kehamilan dan TFU dan bagian apa
yang di fundus.
2) Leopold II
• Keadaan tangan pindah ke samping
• Tentukan dimama punggung anak , punggung anak terdapat di
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• Jika kita rapatkan ke dua tangan pada permukaan dari bagian

terbawah dari kepala yang masih teraba diluar :

 Convergent → bagian kecil dari kepala turun ke rongga panggul

 Sejajar → separuh dari kepala masuk ke dalam rongga panggul

 Divergent → sebagian besar dari kepala masuk kedalam rongga

panggul
• Tujuan : menentukan apa yang menjadi bagian bawah dan berapa
masuknya bagian bawah kedalam rongga panggul.
c. Auskultasi
• Djj terdengar dimana,frekwensi, irama, dengan cara 5 detik berselang, 30
menit dikalikan 2/dihitung selama 1 menit penuh.

• Kalau bunyi jantung janin kurang dari 120/menit atau lebih dari 160/menit
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• Urine Reduksi
Untuk mengetahui kadar glukosa dalam urine, sehingga dapat mendeteksi
penyakit DM pada ibu hamil yang merupakan faktor risiko dalam
kehamilan maupun persalinan.

• Haemoglobin
Untuk mendeteksi adanya anemia, bila Hb kurang dari 10 gr%. (normalnya
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2. Diagnosa Keperawatan
1) Ansietas berhubungan dengan adanya factor-faktor resiko khusus, krisis situasi,
ancaman pada konsep diri, konflik disadari dan tidak disadari tentang nilai-nilai
esensial dan tujuan hidup, kurang informasi.
2) Nutrisi kurang dari kebutuhan tubuh berhubungan dengan perubahan napsu
makan, mual/muntah, tidak mengenal peningkatan kebutuhan metabolik.
3) Kekurangan volume cairan berhubungan dengan output berlebihan (muntah),
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b. Berikan informasi tentang penyimpangan genetic khusus, resiko yang dalam

reproduksi dan ketersediaan tindakan/pilihan diagnosa.
RASIONAL : dapat menghilangkan ansietas berkenaan dengan
ketidaktahuan dan membantu keluarga mengenai stress, membuat
keputusan, dan beradaptasi secara positif terhadap pilihan
c. Kembangkan sikap berbagi rasa secara terus menerus.
RASIONAL : kesempatan bagi klien/pasangan untuk memuji pemecahan
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d. Timbang BB klien. berikan informasi tentang penambahan prenatal yang

optimum.
RASIONAL : ketidakadekuatan penambahan berat badan prenatal dan atau
dibawah berat badan normal masa kehamilan, meningkatkan resiko retardasi
pertumbuhan intrauterine (IUGR) pada janin dengan BBLR.
e. Tinjau ulang frekuensi dan beratnya mual/muntah.
RASIONAL : mual/muntah trimester pertama dapat berdampak negative
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e. Anjurkan peningkatan masukan minuman berkarbonat, makan enam kali

sehari dengan jumlah yang sedikit dan makanan tinggi karbohidrat
(popcorn, roti kering sebelum bangun tidur.
RASIONAL : membantu dalam meminimalkan mual/muntah dengan
menurunkan keasaman lambung.
4) Resiko tinggi pola napas tidak efektif berhubungan dengan
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