Pelayanan Kesehatan Masa

Sebelum Hamil

dr Pandu H. Habibie, M.Ked.Klin., SpOG

Divisi Obginsos Dept Obgyn FK UNAIR
Materi presentasi ini beberapa saya ambil dari materi
dr. M. Hud Suhargono, SpOG, Subsp. Obginsos dan
dr. Nareswari ICM, SpOG
CUKUPKAH
?
Menurut Permenkes no 2 / th 2020 tentang standar pengukuran Antropomentri

1. Stunting (pendek menurut umur)

diukur melalui indeks tinggi/panjang badan menurut umur (TB/U atau PB/U). Status ini
menunjukkan indikasi masalah gizi kronis akibat kekurangan gizi maupun infeksi dalam
jangka waktu yang lama.

2. Wasting (kurus menurut tinggi badan)

diukur melalui indeks berat badan menurut tinggi/panjang badan (BB/TB atau BB/PB).
Status ini menunjukkan indikasi masalah gizi akut yang sensitif terhadap perubahan secara
cepat seperti wabah penyakit maupun kelaparan
3. Underweight (berat badan kurang menurut umur)
diukur melalui indeks berat badan menurut umur (BB/U). Status ini menunjukkan indikasi
masalah gizi secara umum. Pengukuran di posyandu setiap bulan biasanya menggunakan
indeks ini.
 Berdasarkan hasil SSGI 2021,
prevalensi stunting menunjukkan
penurunan dari 27,7% di tahun 2019
menjadi 24,4%. Namun, prevalensi
underweight mengalami peningkatan
dari 16,3% menjadi 17%. Apabila
ditinjau menurut standar WHO, hanya
Provinsi Bali yang mempunyai status
gizi berkategori baik dengan
prevalensi stunting di bawah 20%
(10,9%) dan wasting di bawah 5%
(3%).

Scaling Up Nutrion Indonesia , Februari 2022

Childhood Stunting: Challenges and Opportunities, WHO , 2014
9 BULAN yang berdampak pada kehidupan selanjutnya

October 4, 2010 | Vol. 176 No. 14

Uauy R, Kain J, Corvalan C (2011). How can the Developmental Origins of Health and Disease (DOHaD) hypothesis contribute to improving health in
developing countries. Am J Clin Nutr;90: 1-12
 ‘stunting syndrome’ in which
multiple pathological changes
marked by linear growth
retardation increase morbidity
1000 HDK
and mortality and reduce
physical, neuro- developmental
and economic capacity

Prendergast AJ, Humphrey JH. The

Stunting Syndrome in Developing
Countries. Paediatr Int Child
Health.2014.34:250-65

• Jalur hijau periode antara konsepsi dan 2 tahun (1000 HPK) ketika stunting dan mungkin semua patologi yang terkait paling responsif, atau dapat
dicegah oleh intervensi.
• Jalur kuning di antara usia 2 tahun dan masa anak dan masa remaja sampai puncak pertumbuhan mungkin terjadi, meskipun efek selama periode ini
pada komponen sindrom stunting lainnya (misalnya kognitif dan fungsi kekebalan tubuh) tidak ada hubungannya. Hal yang sama juga terjadi sebelum
bahwa intervensi gizi terhadap wanita kerdil selama periode pra-konsepsi memperbaiki hasil kelahiran.
• Jalur merah periode ketika sindrom stunting tampak tidak responsif terhadap intervensi
 RE S E ARC H ARTICLE

Role of m ate rn a l p rec o n ce p tio n n u tritio n o n

o ffsp rin g g ro w th an d risk of stu n tin g acro ss
th e first 1000 d ay s in V ietn am : A p ro sp e ctiv e
c o h o rt stu d y
Melissa F. Young 1 *, Phuong Hong Nguyen2,3, Ines Gonzalez Casanova1, O. Yaw Addo1 ,
Lan Mai Tran2, Son Nguyen2, Reynaldo Martorell1, Usha Ramakrishnan1
1 Hubert Departm ent of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,
United States of Am erica, 2 International Food Policy Research Institute, Washington, District of Columbia,
United States of Am erica, 3 Thai Nguyen University of Pharm acy and M edicine, Thai Nguyen, Vietnam

“ These findings underscore the importance of expanding the scope of current

policies and strategies to include the preconception period in order to
reduce child stunting”
PLOS ONE , August 30 , 2018
“ There is widespread agreement that to reduce maternal and
childhood mortality and morbidity , a continuum of care needs
to be provided through pregnancy, childbirth, the postnatal
period (addressing both mothers and infants), infancy,
childhood, adolescence and adulthood. There is also
widespread agreement that actions are needed at the
community, primary care and referral care level to deliver this
continuum of care “ ( WHO 2013 )
 Pentingnya Pelayanan Kesehatan Masa Sebelum Hamil
Dalam Mendukung Penurunan AKI, AKB, Stunting (1)

Permasalahan Kesehatan Indonesia

1 dari 3 Wanita Usia Subur mengalami Kurang Energi Kematian Ibu
Masalah kronis**
1 dari 3 Remaja mengalami Anemia**
Gizi
1 dari 4 WUS mengalami Anemia (22,7%)*
1 dari 3 Wanita Dewasa mengalami Obesitas**
Kematian Bayi
Ibu Rumah Tangga menempati urutan ke 2 tertinggi
Penyakit penderita HIV/AIDS****
Menular 0,4% perempuan menderita Tuberkulosis**
0.39% perempuan menderita Hepatitis** Stunting
36,8% perempuan > 18 tahun mengalami Hipertensi**
Penyakit
Tidak 1,78% perempuan menderita Diabetes Millitus**
Menular 1,6% perempuan mengalami penyakit jantung** Gangguan pertumbuhan
~30% kasus Kehamilan 4 Terlalu (Terlalu Tua, Terlalu dan Perkembangan Anak
Muda, Terlalu Dekat, & Terlalu banyak)* ~1.500.000
Lainnya
7% kejadian Kehamilan Tidak Diinginkan*** ~350.000

Sumber: *Riskesdas 2013; **Riskesdas 2018; ***SDKI 2017; Laporan perkembangan HIV/AIDS Perceraian
2021

Skrining Layak Hamil , Dir Kes Usia Produktif dan Lansia, Kemenkes 2022
 Pentingnya Pelayanan Kesehatan Masa Sebelum Hamil
Dalam Mendukung Penurunan AKI, AKB, Stunting (2)

Banyaknya calon pengantin

dan PUS Perempuan dengan
masalah kesehatan yang
berisiko jika hamil Penting
melakukan
perencanaan
kehamilan
(skrining layak
hamil) sehingga
70% Catin akan hamil dalam dapat menjalani
1 tahun pertama setelah kehamilan dan
pernikahan persalinan yang
sehat dan selamat
serta memperoleh
bayi yang sehat

Masyarakat menganggap
kehamilan kedua dan
seterusnya lebih mudah dan
tidak berisiko daripada
kehamilan pertama
Skrining Layak Hamil , Dir Kes Usia Produktif dan Lansia, Kemenkes 2022
 Dengan Cara :
KESEHATAN PRANIKAH : Ibu sehat sebelum 1. Kehamilan yang direncanakan
menikah akan memperbaiki luaran kehamilan dan 2. Kondisi siap dan optimal untuk
hamil
bayi yang dilahirkan

HAMIL KALAU ADA PERLUNYA JANGAN

HAMIL KALAU TIDAK ADA KEPERLUANNYA
BACKGROUND Prematurity
Unplanned
UNPLANNED PREGNANCY 40% Infection
RESULTS IN POOR Planned Congenital anomaly
60%
MATERNAL & PERINATAL
OUTCOME

Maternal anemia &

undernutrition (20%)
49% vs 62%
 US, WHO (2014) RSDS (2019-2022)
Incidence: 3-4% Incidence: 19,69%

INTRODUCTION Perinatal deaths: 295.000/year Perinatal deaths: 67%

Hospitalization cost: USD 22.9 billionCost ???
MULTIPLE ORGAN
SINGLE ORGAN INVOLVED
Congenital anomaly US scan referral (n: 318) INVOLVED

Missing data (n: 47)

Normal ultrasound (n: 4) CARDI

GI HEAD, OVASC
HEAD
TRACT CNS ULAR
Congenital anomaly (n: 267) 46%
19% 68% SYSTE
M 16%
Single organ (n: 169) Multiorgan (n: 98)

15
INTRODUCTION: THE IMPORTANCE OF
OLD CONCEPT NEW CONCEPT
PRECONCEPTION HEALTH
PERICONCEPTION 6 MONTHS
POOR CARE (FACT: ONLY 3 MONTHS)

PRENATAL
CARE
ANTENATAL CARE 9 MONTHS

POOR
PERINATAL FAVOURABLE
OUTCOME PERINATAL
OUTCOME
 INTRODUCTION: THE IMPORTANCE OF
PRECONCEPTION
Primary prevention of HEALTH
maternal and infant mortality
and morbidity
World Health Organization (2013)
Centers for Disease Control and Prevention (2014)

CAN PREVENT

UNWANTED PREGNANCY
INFERTILITY STILLBIRTHS
PREGNANCIES COMPLICATIONS

VERTICAL
TRANSMISSION
LOW BIRTH UNDERWEIGHT
BIRTH DEFECTS OF SEXUALLY
WEIGHT AND STUNTING
TRANSMITTED
INFECTIONS

LOWER RISK OF FOAD: TYPE 2

SOME FORMS OF DIABETES AND
CHILDHOOD CARDIOVASCUL
CANCER, AND AR DISEASE
 GOALS
PRECONCEPTION
HEALTH
HEALTHY
PREGNANCY
HEALTHY CHILD

• MATERNAL • ABSENT/MINIMUM • GOOD BIRTH

• PATERNAL FETAL WEIGHT
COMPLICATION • NO PERINATAL
• ABSENT/MINIMUM ASPHYXIA
MATERNAL • NO INFECTION,
COMPLICATION MALNUTRTION
RELATED
COMPLICATION

EASILY BE ACCESSIBLE
GENERALIZED INDIVIDUAL PRECONCEPTION HEALTH CARE
 Consider temporary
contraception
FIRST PITSTOP
(PRIMARY HEALTH
CARE)
Risk Factors Screening

REFER Multidisciplinary care

SECOND PITSTOP
(SECONDARY/TERTIARY
HEALTH CARE)

Effect of several condition

Evaluation and correction of
risk factors to the pregnancy
 Who? When? How?

• PCC should be provided • Any visit to a doctor in • Screening for high risk
to all reproductive age the reproductive years factors
individuals • Annual health check up • Nutrition &
• Postpartum check up supplementation
• A visit for a pregnancy • Weight management
test (underweight & obese
• Emergency visit women)
• Visit for infertility • Preventive health
treatment (vaccination)
• Premarital Counselling • Screening & treatment for
infection
• Individual (chronic
disease,medication,
addiction, etc)
 STEPS ON PRECONCEPTIONAL
CARE
SCREENING FOR HIGH ANAMNESIS – PHYSICAL DIAGNOSTIC:
RISK FACTORS • MEDICAL & SURGICAL HISTORY
• PREVIOUS OBSTETRIC HISTORY
• FAMILY HEALTH HISTORY
NUTRITION & • GENETIC CONDITION INVESTIGATION
• HABIT SCREENING (DRUGS, ALCOHOL, TOBACCO USE)
SUPPLEMENTATION
LABORATORY SCREENING:
WEIGHT • SCREEN FOR ANEMIA, DIABETES

MANAGEMENT
INFECTION
SCREENING &
VACCINATION
 STEPS ON PRECONCEPTIONAL
CARE
SCREENING FOR HIGH ANAMNESIS – PHYSICAL DIAGNOSTIC:
• NUTRITIONAL STATUS (BMI)
RISK FACTORS • MANAGE WITH NUTRTIONIST
SUPPLEMENTATION:
• IRON SUPPLEMENTATION
NUTRITION & • FOLIC ACID SUPPLEMENTATION:
SUPPLEMENTATION • 400 mcg per day for low risk
• 1000-4000 mcg for high risk (recurrent NTD, pregnancy loss, on anti-
epileptic drug, obesity)
• Folate supplementation reduces recurrence until 72% (Medical Research
WEIGHT Council Vitamin Study Research Group)
MANAGEMENT • IODINIZED SALT

INFECTION
SCREENING &
VACCINATION
 STEPS ON PRECONCEPTIONAL
CARE
SCREENING FOR HIGH OPTIMIZING WEIGHT IN OVERWEIGHT &
RISK FACTORS OBESE WOMEN
• Work with nutritionist
• Especially if there is DM, hypertension or history of NTD
NUTRITION & • Pregestational weight gain or obesity and excessive gestational weight
SUPPLEMENTATION gain are now well-established independent risk factors for maternal-
fetal complications and long-term risks in adult life for the child
• odds ratio (OR) is 2.04 (95% confdence interval [CI], 1.41-2.95) for
WEIGHT cesarean delivery
MANAGEMENT
INFECTION
SCREENING &
VACCINATION
 STEPS ON PRECONCEPTIONAL
CARE
SCREENING FOR HIGH INFECTION SCREENING
RISK FACTORS • Toxoplasmosis screen. If (+), treat
• Check for rubella, varicella, hepatitis B immunization status
NUTRITION &
SUPPLEMENTATION VACCINATION
• If the client is screened (-) for vaccination, consider to
WEIGHT complete all vaccination before conception
MANAGEMENT CONTRACEPTION
INFECTION • Consider contraception during vaccination course.
SCREENING & • Allow conception 1 month after vaccination
VACCINATION
Terima Kasih