ANTENATAL CARE

Eugenius Phyowai Ganap

Dr.dr. Eugenius Phyowai Ganap, SpOG(K)
 Tempat, Tanggal Lahir : Rangoon, 28 May 1981
 Agama: Islam
 Alamat: Jl. Suryodiningratan MJ 2/669 Yogyakarta
 Pekerjaan:
– Sekretaris Departemen OBGYN FK KMK UGM
– Kepala Divisi OBGYNSOS Departemen OBGYN FK KMK UGM
– Kepala Minat PPDS II OBGYNSOS Departemen OBGYN FK KMK UGM
– Tim UNIT JAMINAN MUTU FK KMK UGM
– Koordinator Pengabdian Masyarakat Departemen OBGYN FK KMK UGM /
RSUP Dr. Sardjito

 Pendidikan:
– 2013- 2015 : Program Pendidkan Sub Spesialis Obgynsos (Sp.OG Konsultan) FK
UGM
– 2012- 2017 : Program Pendidikan Doktor (S3) FK UGM
– 2007- 2011 : Program Pendidikan Dokter Spesialis Obsteri Ginekologi (Sp.OG)
FK UGM
– 2000- 2006 : Fakultas Kedokteran Umum FK UGM

 Penghargaan: “ TADJULUDIN AWARD 2012”

Outline Presentasi
PENDAHULUAN
Latar belakang
 ANGKA KEMATIAN IBU DI INDONESIA

Kematian ibu =18.000/ tahun

Kematian ibu = 1500/ bulan
Kematian ibu = 352/ minggu
307/100.000 kh (estimasi Bulin/th = 5 juta)

Seluruh Penumpang
Pesawat Boeing Jumbo Jet BUMIL ( ± 352 Jiwa )

Kematian ibu = 50/ hari

Hermawan LC, Depkes RI 2006 Kematian ibu = 2 / jam

PROSES PERSALINAN
Apakah kehamilan risiko tinggi dapat
dicegah ?

Ya

Deteksi dini Perbaikan

SOLUSI?
APA STRATEGI KITA DALAM
TURUNKAN AKI
 Lima Pilar Utama
dalam Strategi Penurunan AKI

1. Keluarga Berencana
2. ANC yang Berkualitas
3. Pertolongan Persalinan oleh Tenaga Terampil
4. Pelayanan Obstetri Emergensi
5. Pelayanan Nifas bagi Ibu dan Bayi
Antenatal Care Yang Baik
(BUTUH SDM AHLI)
 TUJUAN ANC
 Goal : Longitudinal care to achieve
healthy mother and baby
 Term:
– G3 P2 A0
Gravida : number of pregnancy
Paritas : viable baby
Abortus : non viable baby
– Nuligravida / Nulipara
– Primigravida / Primipara
– Multigravida / Multipara
 Reproductive history
 Diagnosis and treatment
– Uterine malformation
– Maternal autoimmune disease
– Genital infection
 Anatomi Uterus
TAMPILAN LEHER RAHIM

Normal

Normal Kanker Serviks

 Family history
 Carrier screening
– Tay-Sachs, Canavan’s disease, thalassemia,
Sickle cell anemia, Cystic fibrosis
 Genetic disease
– Muscular dystrophy, fragile X syndrome, Down
syndrome
 Other diseases: DM, Hypertension, CV
disease, etc
 Risk assessment
 Infectious disease screening
– Rubella, HBV, tuberculosis, CMV, Toxoplasm,
Parvovirus B19IgG, varicella, HIV, gonorhoe,
chlamydia, syphilis

 Exposure to medication
– Isotretinoin, Warfarin sodium, anticonvulsant
 Nutritional assessment
 BMI (weight/height2), anorexia, bulimia

 Eating habits
Fasting, pica, eating disorder, megavitamine

 Folic acid intake

 Social assessment
 Alcohol
 Tobacco
 Mood altering substances
 Domestic violence
 Financial difficulties
 Gestational age

Calculated from LMP

Gestational age: 280 days or 40 weeks

Naegel formula : LMP = 10-6-1999

EDD = 17-3-2000

Trimester : represent period of 3 months

 Gestational age
 Doppler ultrasound: FHR 11-12 weeks

 Fetoscope: 19-20 weeks

 Quickening: 17-19 weeks

 TFU up to umbilicus: 20 weeks

 First visit

As soon as the period is late:

Anamnesis
Physical examination
Obstetrics examination
Supporting examination (USG)
Lab. test
Objective: obtain base line data.
Kehamilan 7 minggu
Kehamilan 8,5 minggu,
panjang fetus 19 mm.
Kehamilan 13 minggu
Dizigotik twin
 Subsequent visits
 Every 4 weeks until 28 weeks of GA
 Every 2 weeks until 36 weeks of GA
 Every week until delivery

 At least 4 ANC visits at various

trimester
2016 WHO ANC model
 Monitor
 Mother: weight gain, blood pressure,
anemia, fundal height, subjective complains
 Fetus: EFW (estimated fetal weight), lie,
presentation, single/ twin, movement, FHR
(fetal heart rate)
 Lab: Hb, urine, TORCH etc
 At week 36th (primigravida): bimanual
examination
LEOPOLD MANEUVER
Measure Fundal Height
 The uterus may be higher than expected :
1. large fetus, multiple pregnancy
2. polyhydrammnios
3. mistaken date of last menstrual period

 The uterus may be lower than expected :

1. small fetus, intrauterine growth restriction
2. oligohydramnios
3. mistaken date of last menstrual period.
Ultrasound
Weight gain during pregnancy

Range between 7-13 kg, i.e:

Fetus 3,5 kg
Plasenta 0,5 kg
Amniotic fluid 1,0 kg
Uterus 1,0 kg
Blood 2,0 kg
Breast 1,0 kg
 Nutrition during pregnancy
1. Calori : Non pregnant 2000 cal
Pregnant 2300 cal
Lactation 2800 cal
2. Protein : Non pregnant 0,9 g/kg bw/day
Pregnant 1,5 g/kg bw/day
3. Mineral : Iron 17 mg/day
Calsium 1 gram/day
4. Vitamin: food or supplement
Danger signs of pregnancy
Vaginal bleeding including spotting.
Persistent abdominal pain.
Sever & persistent vomiting.
Sudden gush of fluid from vagina.
Absence or decrease fetal movement.
Sever headache.
Edema of hands, face, legs & feet.
Fever above 100 F( greater than 37.7C).
Dizziness, blurred vision, double vision & spots before
eyes.
Painful urination.
IBU HAMIL PERLU TAHU APA TANDA
KEGAWATDARURATAN TERKAIT
KEHAMILAN
 Exercise
 Non-weight bearing exercise
 Regular exercise, 3x/wks
 No supine position
 Ensure adequate diet
 Ensure hydration
 Contraindication: PiH, preterm rupture of
membranes, preterm labor, incompetent
cervix, bleeding, IUGR
 Cigarette (nicotine)
 Increase the incidence of abortus,
premature labor, low birth weight,
abruptio placentae, placenta previa,
sudden infant death syndrome.
 Congenital anomaly: congenital
heart disease such as tetralogi Fallot
and patent ductus arteriosus.
 Smoking cessation
 Alcohol (chronic)
 Microsephal, palatoschisis
 Cardiovascular disorder
 Intra uterine growth retardation
 Mental retardation
 Working and travel
 No special requirement
 Avoid prolonged sitting
 Drive max 6 hours/day, stop every 2 hours
and walk for 10 minutes
 Support stockings, belly belt
Sleep:
 The pregnant woman should lie down to relax
or sleep for 1 or 2 hours during the afternoon.
 At least 8 hours sleep should be obtained every
night & increased towards term, because the
highest level of growth hormone secretion
occurs at sleep.
 Advise woman to use natural sedatives such as:
warm bath & glass of worm milk.
 Genetic counseling
 Older maternal age
 Fetal anomalies
 Abnormal triple screen or alpha fetoprotein
 Exposure to teratogens (drugs, radiation,
infection)
 Family history
 Reproductive failure
 Vaccine
 Vaccination in trimester I, increase
the abortus risk
 Tetanus vaccine for baby and mother
 Covid Vaccine
 Drugs during pregnancy
Basic principles: drugs are toxin, should be used
with caution (teratogenic).
Only prescribed by appropriate indication, and
consider contraindication or side effect.
Teratogenic features depend on:
1. Type and dosage
2. Developmental period
3. Plasental barrier
4. Type of the organism
 Highly Teratogenic
 Talidomide
 Anti tumor drugs
 Hormones (corticosteroid, androgen,
progestogen)
 Valproat (anticonvulsan)
 Isotretionin
 Sexual activity
 As needed
 Abstinence when:

1. History of habitual abortion

2. Vaginal bleeding
3. Partus prematurus imminens
4. Rupture of the membrane
5. Dilatation of cervix
BASIC  CINTA KASIH
 THANK YOU
FOR YOUR KIND ATTENTION

DR_PHYO_SPOG
 Case
N is a 22 year-old female, gravida 0 who has
recently married and is interested in
beginning a family. She is a healthy woman
except for her blood sugars. She was
diagnosed DM 4 years ago (?), but at present
her blood sugars are maintained normal. Her
husband has no medical problems. Their
families do not have any dominant diseases.
The couple visit the doctor to understand
what potential risks N may have in becoming
pregnant.
 Case
N is briefed on the potential impact of
diabetes on pregnancy. Tight control
during the preconception period and early
in conception is important to reduce the
incidence of diabetes-related birth defects.
Good control over pregnancy will reduce
macrosomia. N is told to have plan for
controlling her blood sugar with
endocrinologist if she desires to conceive.
 Case
N return to her physician’s office in six
months, reporting that seven weeks
have passed since her last menstrual
period. She took a home pregnancy test
two weeks ago that gave a positive
result. She has noted some breast
tenderness but only minimal nausea.
She denies any abdominal pain or
cramping.