TUTORIAL

SKENARIO 3
KELOMPOK 5B
Tujuan Pembelajaran
1. Tanda-tanda kehamilan pasti dan tidak pasti
2. Pemeriksaan kehamilan ANC
3. Fisiologi kehamilan
4. Penegakan diagnosis
5. Konseling dan edukasi
TANDA PASTI
KEHAMILAN
 TANDA PASTI

Tanda pasti adalah tanda-tanda obyektif yang didapatkan oleh pemeriksa

yang dapat digunakan untuk menegakkan diagnosa pada kehamilan.

YANG TERMASUK TANDA

PASTI KEHAMILAN
 A.TERASA GERAKAN JANIN

 Gerakan janin :
 Primigravida: 18 minggu
 Multigravida : 16 minggu

Pada bulan ke IV dan V janin kecil jika dibandingkan dengan banyaknya air ketuban,
maka kalau rahim didorong atau digoyangkan, maka anak melenting. Ballottement dapat
ditentukan dengan pemeriksaan luar maupun dengan jari yang melakukan pemeriksaan
dalam.
 B. TERABA BAGIAN – BAGIAN JANIN

 Bagian-bagian janin secara objektif dapat diketahui oleh

pemeriksa dengan cara palpasi menurut Leopold pada akhir
trimester kedua.
 C. DENYUT JANTUNG JANIN

Denyut jantung janin secara objektif dapat diketahui oleh pemeriksa dengan
menggunakan :

1. Fetal Electrocardiograph pada kehamilan 12 minggu

2. Sistem dopller pada kehamilan 12 minggu
3. Stetoskop Laenec pada kehamilan 18-20 minggu
1 2

3
 D. PEMERIKSAAN SINAR RONTGEN & USG

 Sinar rontgen : kerangka janin

 USG : gambaran janin berupa ukuran kantong janin,panjangnya janin, dan diameter
bipariental hingga perkiraan tuanya kehamilan.
TANDA TIDAK
PASTI
KEHAMILAN
 TANDA-TANDA
Amenore Payudara menjadi
Mual dan muntah tegang dan besar
(morning sickness) Sering miksi
Mengidam Konstipasi atau
Pingsan obstipasi
Anoreksia Pigmentasi kulit
Fatigue Gusi berdarah
Varises
 AMENORE

Folikel menjadi Ovum dibuahi Korpus luteum

Ovulasi
korpus luteum spermatozoa hasilkan hCG

Tidak terjadi
Tidak terjadi
peluruhan Hamil
menstruasi
dinding Rahim
 AMENORE
 Selain kehamilan dapat  Gangguan hipofisis anterior
terjadi karena :  Sindrom sheehan
 Gangguan uterus  Amenorea galaktorea
 Sindrom asherman  Gangguan sistem saraf
 Gangguan ovarium pusat
 Tumor ovarium  Amenore hipotalamik
 Kegagalan ovarium dini  Anoreksia revosa &
 Sindrom resistensi bulimia
ovarium  Olahraga
 Sindrom ovarium
polikistik
MUAL DAN MUNTAH
hCG Progesteron Pencernaan
meningkat meningkat diperlambat &

Asam lambung Mual dan

meningkat muntah
MUAL DAN MUNTAH
 Terjadi pagi hari : morning sickness
 Karena semalaman tidur sehingga kadar asam lambung tinggi

 Berlebihan : hyperemesis gravidarum

 bisa berakibat dehidrasi

 Jika tidak terjadi hamil :

 Gangguan pencernaan
 Makanan yang tidak baik
 Stres
 dll
MENGIDAM
 Proses :
 Faktor psikologis
 Faktor kultural dan psikososial
 Karena butuh lebih banyak nutrisi
 Faktor hormonal (Peptida Opioid Endogen)
 PINGSAN

Kurangnya pasukan
oksigen atau
Iskemia SSP Pingsan
gangguan sirkulasi ke
kepala
ANOREKSIA (ANOREKSIA
NERVOSA)
 Merupakan gangguan makan yang ditandai dengan penolakan untuk mempertahankan BB
sehat dan rasa takut berlebihan terhadap peningkatan BB akibat pencitraan diri yang
menyimpang
 Gangguan psikologis
FATIGUE
Kebutuhan
Asupan nutrisi Energi
nutrisi
kurang berkurang
meningkat

Gampang
capek
 SERING MIKSI

Kandung
Uterus
kemih cepat Sering miksi
membesar
penuh
 KONSTIPASI/OBSTIPASI

Memperlambat
Progesteron meningkat Konstipasi/sembelit
gerakan usus
 PAYUDARA MENJADI TEGANG
DAN BESAR
Rangsang pertumbuhan
Estrogen meningkat system penyaluran ASI
dan jaringan payudara

Perkembangan
Progesteron
system alveoli Hipertrofi alveoli
meningkat
kelenjar susu

hCG dengan Disertai rasa

Pembesaran Pembesaran
estrogen penuh atau
payudara puting susu
progesterone tegang
PIGMENTASI KULIT
 Akibat estrogen dan progesterone meningkat
 Daerah terjadinya pigmentasi pada hamil :
 Puting susu dan areola (paling sering)
 Linea mediana abdomen, payudara, bokong, paha
 Area wajah (chloasma gravidarum) : dahi, hidung, pii, leher
GUSI BERDARAH

Pembuluh
Progesteron Gusi mudah
darah di gusi
meningkat berdarah
dilatasi
 VARISES

Varises di genital
Progesteron Pembuluh darah
eksterna, kaki,
meningkat dilatasi
betis, payudara
PEMERIKSAAN KEHAMILAN
Antenatal Care (ANC)
DEPKES & WHO
Menurut Depkes RI (2010), Antenatal care (ANC) adalah
pemeriksaan kehamilan yang diberikan oleh ahli medis
baik dari bidan maupun dokter kandungan selama masa
kehamilan, yang bertujuan dalam mengoptimalkan
kesehatan fisik dan psikis ibu hamil sehingga ibu dapat
melalui masa kehamilan dengan sehat

Kebijakan program pelayanan antenatal care

menetapkan frekuensi kunjungan antenatal care
sebaiknya minimal 4 (empat) kali selama kehamilam,
dengan ketentuan sebagai berikut : (Depkes, 2009).
 Minimal 2x pada Trimester
Minimal 1x pada Trimester
Minimal 1x pada Trimester ketiga (K3 & K4) 28-36
pertama (K1) usia kehamilan
kedua (K2) 14-28 minggu minggu dan 36 minggu
14 minggu
sampai akhir lahir
• Penapisan & pengobatan • Pengenalan komplikasi • Sama seperti kegiatan
anemia akibat kehamilan dan kunjungan ll & lll
• Perencaan persalinan pegobatannya • Mengenali adanya kelainan
• Pengenalan komplikasi • Penapisan preklamsia, letak dan presentasi
akibat kehamilan dan gemelli, infeksi alat • Memantapkan rencana
pengobatannya reproduksi dan saluran persalinan
perkemihan • Mengenali tanda-tanda
• Mengulang perencanaan persalinan
persalinan
Fisiologi Kehamilan
 Peleburan Pronukleus Laki-Laki dan
Perempuan
• Setelah sperma berhasil
menembus korona radiata dan
zona pleusida
• Ekor sperma akan terlepas dari
kepalanya
• Pronukleus laki-laki (sebagai
pembawa kromosom X/Y) akan
melebur dengan pronukleus
perempuan (sebagai pembawa
kromosom X)
• Kedua pronukleus tersebut
mengakibatkan kromoson zigot
berjumlah 46 buah/23 pasang
• Selanjutnya terjadi pembelahan
sel pada zigot
Pergerakan Zigot ke Uterus
Implantasi Blastokista
Perubahan Hormonal
Pengaruh Perubahan Hormonal

Sistem endokrin

Saluran cerna

Ginjal & sal. Kemih

Sistem
kardiovaskular
Perubahan Fisik/Anatomi
•
Besar uterus normal 30 gr, telur ayam

Awal-awal kehamilan  buah alpukat

8 minggu  telur bebek.
12 minggu  telur angsa, FU teraba
16 minggu  tinju dewasa
20 minggu  FU 1 jari bawah pusat
24 minggu  FU setinggi pusat
28 minggu  FU 3 jari diatas pusat
32 minggu  pertengahan pusat - Px
36 minggu  2-3jari dibawah Px
Nutrisi Awal Embrio
Perkembangan Janin
Perkembangan Janin
Ante Natal Care
7 T & 10 T
Pengertian ANC

Pelayanan Ante Natal Care (ANC) adalah pelayanan

kesehatan oleh tenaga kesehatan terlatih untuk ibu
selama masa kehamilannya, dilaksanakan sesuai
dengan standar pelayanan antenatal yang ditetapkan
dalam standar pelayanan kebidanan (Kemenkes, 2010).
Tujuan ANC

• Memantau kemajuan kehamilan untuk memastikan kesehatan ibu dan tumbuh

kembang janin,
• Meningkatkan dan mempertahankan fisik dan mental ibu,
• Mengenali secara dini adanya ketidaknormalan atau komplikasi yang mungkin
terjadi selama kehamilan (termasuk riwayat penyakit secara umum, kebidanan
dan pembedahan),
• Mempersiapkan ibu agar masa nifas berjalan normal dan pemberian ASI eksklusif,
• Mempersiapkan peran ibu dan keluarga dalam menerima kelahiran janin agar
dapat tumbuh dan berkembang secara normal, serta mempersiapkan kesehatan
yang optimal bagi janin (Bartini, 2012).
7T
Timbang Tekanan
Tinggi FU
BB darah

Imunisasi Tablet Tes LAB

TT Besi sederhana

Temu
wicara
10 T

Timbang BB Tekanan darah Tinggi FU Imunisasi TT

Tentukan
Tes LAB
Tablet Besi Temu wicara presentasi
sederhana
janin dan DJJ

Tetapkan Tatalaksana
status gizi kasus
Antenatal Care
14 T & 21 T
Pengertian ANC
• Antenatal care adalah pemeriksaan kehamilan yang dilakukan untuk
memeriksakan keadaan ibu dan janin secara berkala yang diikuti
dengan upaya koreksi terhadap penyimpangan yang ditemukan pada
ibu hamil secara berkala untuk menjaga kesehatan ibu dan janinnya
(Depkes RI, 2003).
• Antenatal care (ANC) can be defined as the care provided by skilled
health-care professionals to pregnant women and adolescent girls in
order to ensure the best health conditions for both mother and baby
during pregnancy. The components of ANC include: risk identification;
prevention and management of pregnancy-related or concurrent
diseases; and health education and health promotion. (WHO, 2016)
ANC 14T (Kusmiyati, 2009)

Berat Tekanan Imunisasi

Tinggi FU Tablet Fe
Badan Darah TT

Perawatan Tingkat Persiapan

Hb VDRL
Payudara Kebugaran Rujukan

Protein Reduksi Kapsul Anti

Urine Urine Yodium Malaria
ANC Based on WHO’s 2016 Guideline
Recommendations on ANC
49 recommendations were grouped into five
topic areas:
A. Nutritional interventions (14)
B. Maternal and fetal assessment (13)
C. Preventive measures (7)
D. Interventions for common physiological symptoms
(6)
E. Health systems interventions to improve the
utilization and quality of ANC (9)
A. Nutritional interventions - 1
A.1.1: Counselling about healthy eating and keeping physically active Recommended
during pregnancy is recommended for pregnant women to stay
healthy and to prevent excessive weight gain during pregnancy.

A.1.2: In undernourished populations, nutrition education on Context-specific

increasing daily energy and protein intake is recommended for recommendation
pregnant women to reduce the risk of low-birth-weight neonates.

A.1.3: In undernourished populations, balanced energy and protein Context-specific

dietary supplementation is recommended for pregnant women to recommendation
reduce the risk of stillbirths and small-for-gestational-age neonates.

A.1.4: In undernourished populations, high-protein supplementation Not recommended

is not recommended for pregnant women to improve maternal and
perinatal outcomes.
A. Nutritional interventions -2
A.2.1: Daily oral iron and folic acid supplementation with 30 mg to Recommended
60 mg of elemental iron and 400 µg (0.4 mg) of folic acid is
recommended for pregnant women to prevent maternal anaemia,
puerperal sepsis, low birth weight, and preterm birth.
A.2.2: Intermittent oral iron and folic acid supplementation with 120 Context-specific
mg of elemental iron and 2800 µg (2.8 mg) of folic acid once weekly is recommendation
recommended for pregnant women to improve maternal and neonatal
outcomes if daily iron is not acceptable due to side-effects, and in
populations with an anaemia prevalence among pregnant women of
less than 20%.
A.3: In populations with low dietary calcium intake, daily calcium Context-specific
supplementation (1.5–2.0 g oral elemental calcium) is recommended recommendation
for pregnant women to reduce the risk of pre-eclampsia.
A.4: Vitamin A supplementation is only recommended for pregnant Context-specific
women in areas where vitamin A deficiency is a severe public health recommendation
problem, to prevent night blindness.
Nutritional interventions - 3
A.5: Zinc supplementation for pregnant women is only recommended Context-specific
in the context of rigorous research. recommendation
(research) 
A.6: Multiple micronutrient supplementation is not recommended for Not recommended
pregnant women to improve maternal and perinatal outcomes.

A.7: Vitamin B6 (pyridoxine) supplementation is not recommended Not recommended

for pregnant women to improve maternal and perinatal outcomes.

A.8: Vitamin E and C supplementation is not recommended for Not recommended

pregnant women to improve maternal and perinatal outcomes.

A.9: Vitamin D supplementation is not recommended for pregnant Not recommended

women to improve maternal and perinatal outcomes.

A.10: For pregnant women with high daily caffeine intake (more than Context-specific
300 mg per day), lowering daily caffeine intake during pregnancy is recommendation
recommended to reduce the risk of pregnancy loss and low-birth-  
weight neonates.
B.1. Maternal assessment - 1
B.1.1: Full blood count testing is the recommended method for Context-specific
diagnosing anaemia in pregnancy. In settings where full blood count recommendation
testing is not available, on-site haemoglobin testing with a
haemoglobinometer is recommended over the use of the haemoglobin
colour scale as the method for diagnosing anaemia in pregnancy.
B.1.2: Midstream urine culture is the recommended method for Context-specific
diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings recommendation
where urine culture is not available, on-site midstream urine Gram-
staining is recommended over the use of dipstick tests as the method
for diagnosing ASB in pregnancy.
B.1.3: Clinical enquiry about the possibility of intimate partner Context-specific
violence (IPV) should be strongly considered at antenatal care visits recommendation
when assessing conditions that may be caused or complicated by IPV in
order to improve clinical diagnosis and subsequent care, where there is
the capacity to provide a supportive response (including referral where
appropriate) and where the WHO minimum requirements are met.
B.1. Maternal assessment - 2
B.1.4: Hyperglycaemia first detected at any time during pregnancy should be Recommended
classified as either gestational diabetes mellitus (GDM) or diabetes mellitus in
pregnancy, according to WHO criteria.
B.1.5: Health-care providers should ask all pregnant women about their tobacco Recommended
use (past and present) and exposure to second-hand smoke as early as possible in
the pregnancy and at every antenatal care visit.
B.1.6: Health-care providers should ask all pregnant women about their use of Recommended
alcohol and other substances (past and present) as early as possible in the
pregnancy and at every antenatal care visit.
B.1.7: In high-prevalence settings, provider-initiated testing and counselling (PITC) Recommended
for HIV should be considered a routine component of the package of care for
pregnant women in all antenatal care settings. In low-prevalence settings, PITC can
be considered for pregnant women in antenatal care settings as a key component
of the effort to eliminate mother-to-child transmission of HIV, and to integrate HIV
testing with syphilis, viral or other key tests, as relevant to the setting, and to
strengthen the underlying maternal and child health systems.
B.1.8: In settings where the tuberculosis (TB) prevalence in the general population Context-specific
is 100/100 000 population or higher, systematic screening for active TB should be recommendation
considered for pregnant women as part of antenatal care.
B.2.Fetal assessment
B.2.1: Daily fetal movement counting, such as with “count-to-ten” kick Context-specific
charts, is only recommended in the context of rigorous research. recommendation
(research)

B.2.2: Replacing abdominal palpation with symphysis-fundal height (SFH) Context-specific

measurement for the assessment of fetal growth is not recommended to recommendation
improve perinatal outcomes. A change from what is usually practiced
(abdominal palpation or SFH measurement) in a particular setting is not
recommended.

B.2.3: Routine antenatal cardiotocography is not recommended for Not recommended

pregnant women to improve maternal and perinatal outcomes.

B.2.4: One ultrasound scan before 24 weeks of gestation (early Recommended

ultrasound) is recommended for pregnant women to estimate
gestational age, improve detection of fetal anomalies and multiple
pregnancies, reduce induction of labour for post-term pregnancy, and
improve a woman’s pregnancy experience.

B.2.5: Routine Doppler ultrasound examination is not recommended for Not recommended
pregnant women to improve maternal and perinatal outcomes.
C. Preventive measures - 1
C.1: A seven-day antibiotic regimen is recommended for all pregnant Recommended
women with asymptomatic bacteriuria (ASB) to prevent persistent
bacteriuria, preterm birth and low birth weight.

C.2: Antibiotic prophylaxis is only recommended to prevent recurrent Context-specific

urinary tract infections in pregnant women in the context of rigorous recommendation
research. (research)

C.3: Antenatal prophylaxis with anti-D immunoglobulin in non-sensitized Context-specific

Rh-negative pregnant women at 28 and 34 weeks of gestation to prevent recommendation
RhD alloimmunization is only recommended in the context of rigorous (research)
research.

C.4: In endemic areas, preventive anthelminthic treatment is Context-specific

recommended for pregnant women after the first trimester as part of recommendation
worm infection reduction programmes.

C.5: Tetanus toxoid vaccination is recommended for all pregnant women, Recommended
depending on previous tetanus vaccination exposure, to prevent
neonatal mortality from tetanus.
C. Preventive measures - 2
C.6: In malaria-endemic areas in Africa, intermittent preventive Context-specific
treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended recommendation
for all pregnant women. Dosing should start in the second trimester, and
doses should be given at least one month apart, with the objective of
ensuring that at least three doses are received.

C.7: Oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil Context-specific

fumarate (TDF) should be offered as an additional prevention choice for recommendation
pregnant women at substantial risk of HIV infection as part of
combination prevention approaches.
D. Common physiological symptoms
D.1: Ginger, chamomile, vitamin B6 and/or acupuncture are recommended for the relief Recommended
of nausea in early pregnancy, based on a woman’s preferences and available options.

D.2: Advice on diet and lifestyle is recommended to prevent and relieve heartburn in Recommended
pregnancy. Antacid preparations can be offered to women with troublesome symptoms
that are not relieved by lifestyle modification.
D.3: Magnesium, calcium or non-pharmacological treatment options can be used for the Recommended
relief of leg cramps in pregnancy, based on a woman’s preferences and available options.

D.4: Regular exercise throughout pregnancy is recommended to prevent low back and Recommended
pelvic pain. There are a number of different treatment options that can be used, such as
physiotherapy, support belts and acupuncture, based on a woman’s preferences and
available options.

D.5: Wheat bran or other fibre supplements can be used to relieve constipation in Recommended
pregnancy if the condition fails to respond to dietary modification, based on a woman’s
preferences and available options.
D.6: Non-pharmacological options, such as compression stockings, leg elevation and Recommended
water immersion, can be used for the management of varicose veins and oedema in
pregnancy, based on a woman’s preferences and available options.
E. Health systems interventions to improve
the utilization and quality of ANC – 1
E.1: It is recommended that each pregnant woman carries her own case Recommended
notes during pregnancy to improve continuity, quality of care and her
pregnancy experience.

E.2: Midwife-led continuity-of-care models, in which a known midwife or Context-specific

small group of known midwives supports a woman throughout the recommendation
antenatal, intrapartum and postnatal continuum, are recommended for
pregnant women in settings with well functioning midwifery programmes.

E.3: Group antenatal care provided by qualified health-care professionals Context-specific

may be offered as an alternative to individual antenatal care for pregnant recommendation
women in the context of rigorous research, depending on a woman’s (research)
preferences and provided that the infrastructure and resources for delivery
of group antenatal care are available.
E. Health systems interventions to improve
the utilization and quality of ANC – 2
E.4.1: The implementation of community mobilization through facilitated Context-specific
participatory learning and action (PLA) cycles with women’s groups is recommendation
recommended to improve maternal and newborn health, particularly in rural
settings with low access to health services. Participatory women’s groups
represent an opportunity for women to discuss their needs during pregnancy,
including barriers to reaching care, and to increase support to pregnant
women.

E.4.2: Packages of interventions that include household and community Context-specific

mobilization and antenatal home visits are recommended to improve recommendation
antenatal care utilization and perinatal health outcomes, particularly in rural
settings with low access to health services.
E. Health systems interventions to improve
the utilization and quality of ANC – 3
E.5.1: Task shifting the promotion of health-related behaviours for maternal Recommended
and newborn health to a broad range of cadres, including lay health workers,
auxiliary nurses, nurses, midwives and doctors is recommended.

E.5.2: Task shifting the distribution of recommended nutritional Recommended

supplements and intermittent preventative treatment in pregnancy (IPTp)
for malaria prevention to a broad range of cadres, including auxiliary nurses,
nurses, midwives and doctors is recommended.

E.6: Policy-makers should consider educational, regulatory, financial, and Context-specific

personal and professional support interventions to recruit and retain recommendation
qualified health workers in rural and remote areas.
E. Health systems interventions to improve
the utilization and quality of ANC – 4
E.7: Antenatal care models with a minimum of eight contacts are Recommended
recommended to reduce perinatal mortality and improve women’s
experience of care.
 PENEGAKAN DIAGNOSA

ANAMNESIS DAN PEMERIKSAAN FISIK

Anamnesis
1. RPS :
• HPHT
• Taksiran Persalinan → Rumus Naegelle
• Riwayat pemeriksaan penunjang sebelumnya
(USG, pem.lab)
• Keluhan mules-mules/kontraksi, keluar air dari
jalan lahir, keluar lendir darah
• Riwayat imunisasi TT
2. Riwayat penyakit dahulu : 3. Riwayat penyakit keluarga
• Diabetes melitus 4. Riwayat menstruasi :
• Hipertensi • Apakah setiap bulan ada haid?
• Tuberkulosis Haid lebih dari 1 kali dalam
• Hepatitis sebulan?
• Lamanya haid ?
• Berapa kali ganti pembalut dalam
sehari
• Dishmenorea ?
5. Riwayat Persalinan sebelumnya :
• Usia anak persalinan sebelumnya
• BBL
• Metode persalinan
• Penolong persalinan
• Riwayat keguguran ?
Pemeriksaan Fisik
1. TTV
2. Pemeriksaan obstetrik :
• Pemeriksaan Leopold I-IV
• Pengukuran Tinggi Fundus Uteri (TFU) untuk menentukan
Taksiran Berat Janin (TBJ)
• Auskultasi (Laennec)
• Pelvimetri Klinis
 Pemeriksaan Leopold I-IV
• Leopold I
Menentukan bagian teratas janin.
Contoh : teraba bagian atas janin
lunak, bulat, tidak melenting, kesan
bokong
• Leopold II
Menentukan posisi punggung janin
• Leopold III
Menentukan bagian terbawah janin
 Auskultasi
• Dilakukan untuk perhitungan detak jantung janin (DJJ)
• Dilakukan saat sudah mengetahui posisi punggung janin
menggunakan stetoskop Lannec.
• N : 120-160 detak per menit.
 Pelvimetri Klinis
1. Pemeriksaan Pintu
Atas Panggul (PAP) :
• Menilai Linea Terminalis
• Meraba promontorium
• Konjugata diagonalis ?
• Konjugata vera
2. Pemeriksaan Pintu Tengah
Panggul :
• Konkavitas os.sacrum
• Menilai arah dan sudut dinding
samping panggul
• Derajat penonjolan spina
ischiadica
3. Pemeriksaan Pintu Bawah
Panggul (PBP) :
• Besar sudut os.pubis → > 90 ͦ
atau < 90 ͦ
• Menilai mobilisasi os.coxygeus
PEMERIKSAAN PENUNJANG
 • Pemeriksaan Hb, pemeriksaan ini untuk menentukan kadar
hemoglobin, dan derajat anemia (bila ada)
• Pemeriksaan urin. Pemeriksaan ini untuk mengetahui adanya
protein dan glukosa dalam urin.
• USG
• Dopller
• UJI TROCH( Toksoplasma Rubella Cyctomegalovirus
Harpesimpleks) Dilakukan untuk mengetahui ada tidaknya infeksi
parasite seperti TORCH di dalam ibu hamil.
Edukasi dan Konseling Pada
Ibu Hamil
TENTANG NUTRISI
YANG MEMADAI

• KALORI
• PROTEIN
• KALSIUM
• ZAT BESI
• ASAM FOLAT
 • Jumlah kalori yang diperlukan bagi ibu hamil untuk setiap
harinya adalah 2500 kalori , pertambahan berat badan
Kalori sebaiknya tidak melebihi 10-12 kg selamahamil

• Jumlah protein yang diperlukan bagi ibu hamil 85 gram

per hari. Defisiensi proteindapat menyebabkan kelahiran
protein prematur, anemia, dan edema

• Jumlah kalsium yang diperlukan bagi ibu hamil 1,5 gram

per hari , Defisiensi kalsium dapat menyebabkan riketsia
kalsium pada bayi, osteomalasia dan kram pada ibu
 • Jumlah zat besi yang diperlukan bagi ibu hamil
30 mg/hari, terutama setelah trimester kedua.
Zat Besi Defisiensi = anemia

• Jumlah asam folat yang diperlukan bagi ibu

hamil 400 mikrogram per hari. Defisiensi=
Asam Folat anemia
 TENTANG PERAWATAN PAYUDARA

Payudara perlu dipersiapkan sejak sebelum bayi lahir sehingga dapat segera berfungsi
denganbaik pada saat diperlukan. Pengurutan payudara untuk mengeluarkan sekresi
dan membukaduktus dan sinus laktiferus, sebaiknya dilakukan secara hati-hati dan
benar, karenapengurutan yang salah dapat menimbulkan kontraksi pada rahim
 TENTANG PERAWATAN GIGI
 
Paling tidak dibutuhkan
dua kali pemeriksaan gigi
selama kehamilan, yaitu
pada trimesterpertama
dan ketiga
Dianjurkan untuk selalu
menyikat gigi
setelahmakan karena ibu
hamil sangat rentan
terhadap terjadinya
carriesdan gingivitis
[karenakeasaman mulut
meningkat
TENTANG KEBERSIHAN TUBUH DAN
PAKAIAN
 
• Kebersihan tubuh harus
terjaga selama kehamilan ,
• Gunakanpakaian yang longgar,
bersih dan nyaman, dan
hindarkan sepatu tinggi dan
alas kaki yangkeras (tidak
elastis) serta korset penahan
perut.
• Lakukan gerak tubuh ringan,
misalnyaberjalan kaki,
terutama pada pagi hari
• jangan melakukan pekerjaan
rumah tangga yang beratdan
hindarkan kerja fisik yang
dapat menimbulkan kelelahan
yang berlebihan.
• Ibu tidak dianjurkan
untuk melakukan kebiasaan
merokok selama hamil
MEMBERIKAN KONSELING
TERHADAP IBU HAMIL

pemberian informasi
tengtang perubahan yang
terjadi pada perubahan
janin sesuai dengan usia
kehamilan, serta
perubahan yang terjadi
pada ibu sendiri
Perubahan Perubahan
FISIK Psikologi

Perubahan
emosi
Daftar Pustaka
• Universitas Muhammadiyah Semarang. Kehamilan. Diakses tanggal 9 Januari 2019.
http://digilib.unimus.ac.id/files/disk1/109/jtptunimus-gdl-rikadewi-5413-3-babii.pdf
• http://eprints.undip.ac.id/43162/2/15._BAB_II.pdf
• Universitas Diponegoro. Kehamilan. Diakses tanggal 9 Januari 2019.
http://eprints.undip.ac.id/43162/2/15._BAB_II.pdf
• Universitas Sumatera Utara. Kehamilan. Diakses tanggal 9 Januari 2019.
http://repository.usu.ac.id/bitstream/handle/123456789/31620/Chapter%20II.pdf?sequence=4&isAllowed=y
• Prawirohardjo, Sarwono. Ilmu Kebidanan. PT BP-SP. 2016
• WHO. ANC Guideline 2016 diakses tanggal 10 Januari 2019
http://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf;jsessionid=FF2F4679C6115A2
11B4161AF91665E7B?sequence=1
• Sulistiyanti, Sunarti. KAJIAN PELAKSANAAN PELAYANAN ANTENATAL CARE OLEH BIDAN DI WILAYAH KERJA
PUSKESMAS MASARAN SRAGEN. INFOKES, VOL. 5 NO. 2 September 2015
• Orloff, NC & Hormes JM. Food Cravings in Pregnancy : Hypotheses, Preliminary Evidence, and Directions for Future
Research. 2014. diakses tanggal 10 Januari 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172095/#B55
• Mercer, ME & Holder MD. Food Cravings, Endogenous Opioid Peptides, and Food Intake : A Review. 1997. diakses
tanggal 10 Januari 2019. https://www.sciencedirect.com/science/article/pii/S0195666397901008?via%3Dihub