Sexual and Reproductive

Rights / Reducing Maternal

Mortality / Overview of
countrys maternal mortality
situation
 Sexual and reproductive health

Reproductive health is a state of complete physical, mental, and social well

being and not merely the absence of disease or infirmity, in all matters
related to the reproductive system and to its functions and processes.
adapted from FWCW Platform 94, 97; ICPD 7.2

Sexual health means having a responsible, satisfying, and safe sex life, that
is free from disease, injury, violence, disability, unnecessary pain, or risk of
death.
expanded upon FWCW Platform 94; ICPD 7.2
 Reproductive and sexual rights
Reproductive rights include the rights of couples and individuals to:
Make free and informed decisions about their reproductive
lives, including the number, timing, and spacing of their
children
Attain the highest standard of sexual and reproductive health
Sexual rights include the rights of all individuals to:
Make free and informed decisions on all matters relating to
their sexuality
Be free of discrimination, coercion, or violence in their sexual
lives and decisions
Expect and demand equality, full consent, mutual respect,
and shared responsibility in sexual relationships
adapted from the ICPD, ICPD+5 and FWCW documents
Gender, gender equality, and gender equity

Gender
socially defined roles and responsibilities of men and women, boys and girls

Gender equality
equal treatment of women and men

Gender equity
fairness and justice in the distribution of benefits and responsibilities between
women and men

Womens health is directly related to their status in society.

A rights-based approach to sexual and
reproductive health
The International Conference on Population and Development (ICPD)
affirmed that:

Women and men have the right to the highest standards of

sexual and reproductive health services and information,
free from discrimination, coercion, and violence.
The rights-based approach:

Places the health and well being of individuals at the

center of program policy design
Recognizes the importance of gender equity and equality
Builds on existing international human rights agreements
Essential health services to ensure
sexual and reproductive rights
Information and counseling
on human sexuality,
reproductive health, and
parenthood
Family planning
Prenatal/postnatal and
delivery care
Health care for infants
Safe abortion, where not
against the law
Management of abortion-
related complications
Prevention and treatment of
infertility
Prevention and treatment of
sexually transmitted
infections and reproductive
tract infections

If additional services such as diagnosis and treatment of reproductive system

cancers and HIV/AIDS are not offered, a system should be in place to
provide referrals to these services.
Client-centered, comprehensive care
Client-centered care:

Emphasizes free and informed consent

and respect for clients rights and needs
Involves clients in program design
and evaluation
Is provided by technically competent,
compassionate, and well-supervised staff
Integrates or links service components
Ensures privacy and confidentiality in counseling and treatment
for all clients, including adolescents

Comprehensive care addresses the full range of sexual and

reproductive health needs and provides referrals when appropriate.
How can governments protect and promote
sexual and reproductive health and rights?
Governments can:

Review all laws, policies, and practices, and change those that inhibit the full
exercise of reproductive and sexual rights

Enforce gender-sensitive laws and policies through active implementation and

monitoring mechanisms

Strengthen health infrastructures to make

comprehensive services more widely available, and give priority to financing for
sexual and reproductive health care

rights-based approach
(8)
 UU RI 1987 No. 7:
Penghapusan diskriminasi

Pasal 11

Hak atas perlindungan kesehatan dan keselamatan kerja, termasuk

usaha perlindungan terhadap fungsi reproduksi

Untuk mencegah diskriminasi terhadap wanita atas dasar

perkawinan atau kehamilan dan untuk menjamin hak efektif mereka
untuk bekerja, Negara-negara Peserta wajib membuat peraturan
yang tepat untuk melarang dengan dikenakan sanksi pemecatan
atas dasar kehamilan atau cuti hamil.
 UU RI 1987 No. 7:
Penghapusan diskriminasi

Pasal 12

Negara-negara peserta wajib melakukan langkah tindak yang tepat

untuk menghapus diskriminasi terhadap wanita di bidang
pemeliharaan kesehatan, dan untuk menjamin diperolehnya pelayanan
kesehatan termasuk pelayanan yang berhubungan dengan keluarga
berencana, atas dasar persamaan antara pria dan wanita.
kah kita mempersiapkan generasi?

o Pandawa:
Dari Panduke Parikesit

o Islam
Dari Ibrahim AS ke Muhammad SAW
 Give me good mother ,
I will give you good son

~ Napoleon ~

Good women
Good mothers
Good nation

~ Muhammad SAW ~
Hak reproduksi = Hak azasi

International Conference for

Population Development 1994
ICPD +10
Hak perempuan untuk menentukan
kapan hamil, berapa anak. Hak untuk
menikmati kehidupan seksual.
AWAS Kekerasan dalam rumah
tangga
 Harapan Pasien
Dihargai, bersahabat, ramah, rahasia terjaga
Dokter memahami situasi dan kebutuhan perempuan
Informasi jelas dan lengkap
Dokter kompeten
Mudah memperoleh pertolongan
Jujur dan adil dalam hal informasi
Harapan Dokter
Peran dokter: menjaga
privasi, sikap positif, siap
menolong
Demi kepentingan pasien
Informasi jelas, pendek,
bahasa awam,jelaskan
efeksamping
Bantu mengambil keputusan:
berikan gambaran
VS Harapan Pasien
Pasien : mengharap
kesembuhan, layanan yang
ramah, perhatian
Pasien harus banyak bertanya
Hak pasien untuk memilih
cara/metoda
Mengetahui untung-rugi
 Interaksi Dokter - Pasien
Salam memperkenalkan diri Greetings
Tanya masalah Ask
Jelaskan penyakit - Tell
Bantu membuat keputusan - Help
Jelaskan yang terbaik - Explain
Kapan kunjungan berikut - Return

GATHER
 EVALUASI
Gather (greets, ask, tell, help, explain, return) :
Salam dan memperkenalkan diri
Tanyakan kebutuhan perempuan tsb
Jelaskan diagnosis/penyakit
Diskusikan alternatif prosedur/cara- risiko dan efek samping
.ingat EBM
Apakah tindakan sesuai standar
 Maternal Mortality (1994-2014)
400
390 334
350
307
Per 100.000 live births

300
228
250

200

150 110
100

50

0
1994 1997 2002 2007 2009 2010 2011 0012 2013 2014

2007 Target 2014

AKI 228/100.000 110/100.000
 Penyebab kematian % Jumlah kasus
Perdarahan 30 3450
preeklampsia 25 2875
Infeksi 12 1380
Jumlah kasus Keguguran 5 675
Perdarahan 34500 Partus lama 5 675
preeklampsia 28750 Komplikasimasanifas 8 920
Infeksi 13800 Emboli 3 345
Keguguran 6750 Lain - lain 12 1380
Partus lama 6750
Komplikasimasanifas 9200

!!
Emboli 3450
10 X lipat Malaysia; 20 X lipat singapore
Lain - lain 13800
Penyebab AKI

Lain-lain; 12%
Kompl masa puerpureum; 8%
Emboli obst; 3% Perdarahan; 29%
P. lama/macet; 5%
Abortus; 5%
Infeksi; 12%
Eklamsia; 25%

Riskedas 2007
 Sadarkah kita????

Tiap jam ada 540 kematian ibu

Hamil tidak lebih aman dr berpergian dengan pesawat,
bahkan perang Irak sekalipun
1 in women die for maternal reasons

The Lifetime Risk of Maternal Mortality Is

Higher than 1 in 100 Women in 59 Countries,
where more Than One Third of
The Worlds Population Lives. In Developing Regions,
Womens Risk of Dying from
Maternity Related Reasons is 13 times Higher
than In Developed Regions

1 dari 97 perempuan hamil meninggal

The number of women that

The number of women that
die of maternity cause is
die from maternity related
Less than 1 in 1000 in 61
reasons average countries, about 41% of the
1 in 11,000 women in developed
worlds population more than 1 in
regions 1 in 842 women in
50 in 44 countries, about 12% of
developing regions
the worlds population

Notes:
Notes:
Lifetime risk of maternal mortality is the probability that a 15-year old female
will die
Lifetime riskeventually from
of maternal a maternal
mortality is thecause
probability that a 15-year old female
will Source:
die eventually from a maternal cause
Source:
WHO, UNICEF, UNFPA, World Bank (2007)
WHO, UNICEF, UNFPA, World Bank (2007)
 Evidence-Based Interventions
for Major Causes of Maternal
Mortality Iron Supplements,
Malaria Intermittent
Oxytocin and treatment and
Manual Antiretroviral for HIV
Compression

Indirect causes; 20.00%

Severe bleeding; 24.00%

other Direct
Magnesium Causes; 8.00%
Sulfate
Eclampsia; 12.00% Obstructed
Unsafe Labor; 8.00%
Patogram
Family Planning and
Abortion;
Infection; 15.00%

Postabortion Care 13.00%

Antibiotics

Tetanus Toxoid Immunization

Clean Delivery

Sudah tepatkah intervensi yang di upayakan??

Adapted from: Maternal Health Around the World World Health Organization,
*Other direct causes include: ectopic pregnancy, embolism, anesthesia-related Geneva, 1997
*indirect causes include: anemia, malaria, heart disease
Mengapa Tone (kontraksi)
menjadi faktor utama pada
perdarahan post partum?
Agar terjadi hemostasis yg adekuat
dibutuhkan
Kontraksi yg adekuat
- hanya jika serabut otot cukup
- hanya jika nutrien kontraktan cukup
- hanya jika jaras kontraksi lancar
- hanya jika gap junction adekuat
Faktor pembekuan adekuat
Evakuasi jaringan konsepsi
Serabut Miometrium

Kontraktilitas sangat ditentukan oleh jumlahserabut

miometrium, dimana serabut ini bisa terdegradasi menjadi
jaringan ikat bila:

Riwayat kuretase berulang

Riwayat infeksi (panmetritis)
A. 12 B. 12
Wall Thickness (mm)

Wall Thickness (mm)

10 10
8 8
6 6
4 4
2 2
0 0
15 20 25 30 35 40 15 20 25 30 35 40

C
Week Gestation Week Gestation

C
C. 14 D. 12
Wall Thickness (mm)

Wall Thickness (mm)

12 10
10 8

D
B
8
6

D
B
6
4 4
2 2
0 0

A
16 21 26 31 36 15 20 25 30 35 40

A
Week Gestation Week Gestation

E.

E
12 F. 12

E
Wall Thickness (mm)

Wall Thickness (mm)

10 10
8 8
6 6
4 4
2 2
0 0
16 21 26 31 36 15 20 25 30 35 40
Week Gestation Week Gestation

F
F
Uterine wall thickness (in mm) during pregnancy. The continuous line represents the
mean and the dashed linesrepresent the upper and lower 95% confidence intervals. A,
Anterior lower segment; B, mid-anterior wall; C, fundal wall; D, posterior
J Ultrasound wall;
Med 1998;17:661665,
 Zat kontraktan
Karbohidrat, Trigliserida ATP
Ca, K, Phosphor Pompa Na dan Ca
Oksitosin
Prostaglandin

Gap Junction
 Oxytocin is

1. Proposed to foster social interaction 1, 2

2. Induce the onset of maternal behavior 3
3. Lessen anxiety 4, 5 and aggression6
4. Attenuate the neuroendocrine response to psychogenic stress 710
5. Preparation, initiation, maintenance and regulate uterus contractions

Sources: Nuts, bonding - intimacy

1.Psychoneuroendocrinology 1992;17:335 6.Horm Behav 2000; 37:145155

2.Nat Genet 2000; 25:284288 7.Endocrinology 1997; 138:28292834
3.PNAS 1979; 76:66616665 8.Neuroscience 2000; 95:567575
4.Physiol Behav 1996; 60: 12091215 9.J Neuroscience 2004;24:29742982
5.Endocrinology 2003; 144:22912296Am 10.J Physiol Regul Integr Comp Physiol 2004; 287:R1494R1594
Experience from the 1960s in Malaysia, Sri
Lanka and Thailand

7200 new midwives

registrations

18,314 new midwives

From 2,500 beds to 10,800 in

small community hospitals

32
Kualitas Bangsa

Human Development Index

Semakin tinggi HDI semakin aman, sejahtera dan adil suatu bangsa
Segala upaya bernegara dan berbangsa adalah untuk memberikan
kualitas kependudukan yang tertinggi
Lalu, apa hubungan HDI dengan
Prenatal Care atau Preconception
Care?
Fetal Programing
1000 hari pertama kehidupan
Epigenetik
Pregnancy is a stress test for life
Sadarkah kita .
Berkeluarga, Berbangsa, Bernegara
Bahkan keselamatan bumi ini sangat bergantung kualitas manusia
penghuninya
Dan ternyata kualitas manusia ini sudah ditentukan sejak awal kehamilan
There is a mismatch between opportunity and
investment
Brain growth and Spending on Health,
maximum potential for Education, Income Support,

Development
change Social Services and Crime

BrainsDevelopment

Expenditure
PublicExpenditure
ofBrains

Public
Intensityof
Intensity

1 3 10 60 80
Conception Birth
Age

Public Spending on Services for Children 0-6 years

2.0%
% GDP

1.5%
1.0%
0.5%
0.0%
Denmark Sweden Finland France United States Australia Canada

Dr. Jacques Vandergaag University of Amsterdam Calgary Presentation January 2004

 Human Development Index and its Components
HDI HDI Value, Life expectancy at Mean years of Expected years of GNI per capita Change in
rank Country 2013 birth (years), 2013 schooling (years), schooling (years), (2011 PPP $), 2013 HDI Value, 2012 rank, 2012-
2012 2012 2013
Very high human development
1 Norway 0.944 81.5 12.6 17.6 63,909 0.943 0
2 Australia 0.933 82.5 12.8 19.9 41,524 0.931 0
4 Netherlands 0.915 81.0 11.9 17.9 42,397 0.915 0
7 New Zealand 0.910 81.1 12.5 19.4 32,569 0.908 0
9 Singapore 0.901 82.3 10.2 15.4 72,371 0.899 3
15 Hong Kong, China (SAR) 0.891 83.4 10.0 15.6 52,383 0.889 0
15 Korea (Republic of) 0.891 81.5 11.8 17.0 30,345 0.888 1
17 Japan 0.890 83.6 11.5 15.3 36,747 0.888 -1
30 Brunei Darussalam 0.852 78.5 8.7 14.5 70,883 0.852 0
High human development
57 Russian Federation 0.778 68.0 11.7 14.0 22,617 0.777 0
62 Malaysia 0.773 75.0 9.5 12.7 21,824 0.770 0
73 Sri Lanka 0.750 74.3 10.8 13.6 9,250 0.745 2
89 Thailand 0.722 74.4 7.3 13.1 13,364 0.720 0
91 China 0.719 75.3 7.5 12.9 11,477 0.715 2
Medium human development
107 Palestine, State of 0.686 73.2 8.9 13.2 5,168 0.683 0
108 Indonesia 0.684 70.8 7.5 12.7 8,970 0.681 0
117 Philippines 0.660 68.7 8.9 11.3 6,381 0.656 1
118 South Africa 0.658 56.9 9.9 13.1 11,788 0.654 1
118 Syrian Arab Republic 0.658 74.6 6.6 12.0 5,771 0.662 -4
120 Iraq 0.642 69.4 5.6 10.1 14,007 0.641 0
121 Viet Nam 0.638 75.9 5.5 11.9 4,892 0.635 0

http://hdr.undp.org/en/content/table-1-human-development-index-and-its-components
 Pregnancy: a stress
test for life
Pregnancy stresses maternal carbohydrate, lipid, inflammatory pathways,
vascular function
Pregnancy a screen for later Cardio Metabolic diseases

Curr Opin Obstet Gynecol. 2003; 15: 465471

Ann Epidemiol. 2005; 15:726,
Circulation. 2001; 123:1243
Cardiovascular Research (2014) 101, 561570
Unless early child development is addressed effectively
........ Countries will locked into proverty

Kualitas Kualitas
Janin Anak Kualitas
Bangsa
When investment in life capabilities occur earlier, future prospects are better

Capabilities

Lack of social protection

Poor job quality Lack of care
Higher incidence of disabilities
Lack of social protection

Lack of employment oppurtunities

Low school availabilit and quality
Violence, conflicts

Early neglect
Poor nutrition and
lack of pre- and post-
natal care
Poor child
stimulation
Prenatal and Youth Adulthood Old age
early childhood

Represent life capability at its full potential for individuals; this is the path of life capabilities that individuals could achieve if they were able to
succesfully manage the vulnerabilities they are like.
Shows that when individuals fail to overcome vulnerabilities at any sensitive period, their life capabilities are likely to end up on a lower path.
Later interventions could help individuals recover but usually only partially and move to a higher path.

Source: Human Development Report Office calculations

 Prevalensi NCD menurut Riskesdas 2013
Stroke
Jantung koroner Gagal Jantung Penyakit Sendi
(%) Gagal
Umur Kanker Hiper- Hiper- Batu
Asma PPOK DM Ginjal
(Tahun) (%) thyroid tensi Ginjal
D D/G D D/G D D/G Kronis D D/G

<1 1,5 0,3

1-4 3,8 0,1
5 14 3,9 0,1
15 24 5,6 0,6 0,6 0,4 8,7 0,1 0,7 0,02 0,1 0,2 2,6 0,1 0,1 1,5 7,0
25 34 5,7 1,6 0,9 0,8 0,3 14,7 0,2 0,9 0,05 0,1 0,6 3,9 0,1 0,3 6,0 16,1
35 44 5,6 2,4 2,1 1,7 0,4 24,8 0,3 1,3 0,09 0,2 2,5 6,4 0,3 0,7 12,4 26,9
45 54 3,4 3,9 3,5 3,9 0,5 35,6 0,7 2,1 0,19 0,4 10,4 16,7 0,4 1,0 19,3 37,2
55 64 2,8 5,6 3,2 5,5 0,5 45,9 1,3 2,8 0,38 0,7 24,0 33,0 0,5 1,3 25,2 45,0
65 74 2,9 8,6 3,9 4,8 0,5 57,6 2,0 3,6 0,49 0,9 33,2 46,1 0,5 1,2 30,6 51,9
75+ 2,6 9,4 5,0 3,5 0,5 63,8 1,7 3,2 0,41 1,1 43,1 67,0 0,6 1,1 33,0 54,8
Jenis Kelamin
Laki laki 4,4 4,2 0,6 0,2 0,2 22,8 0,4 1,3 0,1 0,3 7,1 12,0 0,3 0,8 10,3 21,8
Perempuan 4,6 3,3 2,2 0,6 0,6 28,8 0,5 1,6 0,2 0,3 6,8 12,1 0,2 0,4 13,4 27,5
Prevalensi gangguan jiwa berat di Indonesia 2013 : 1.7%
Gangguan mental emosional penduduk > 15 th berdasarkan Self reporting

questionnaire-20 di indonesia 2013: 6%

Riskesdas 2013
Data Statistik

Crude Birth Rate (18.79 per 1000, 2013): 4.697.000

Laju Pertumbuhan Penduduk (1.49%, 2013: 3.725.000

Preeklampsia: 10 15%
Preterm: 15 20%
IUGR: ~ 10%
GDM: ~ 5%
Defisiensi Besi: ~ 40%
Defisiensi Zinc: ~60%
Defisiensi Vit D:~ 80%

Sadarkah kita akan besarnya ancaman ?

 Insulin Resistance in IUGR
Glycemia (mmol/L) Insulinemia (mcU/L)
16 120

14
100
12 IUGR
Control
80
10

8 60

6
40
4
20
2

0 0
0 10 2020 30 40 50 40
60 70 80 90
60 0 10 20
20 30 40 50 90
60
Time (mins)

Hofman P, J Clin Endocrol Metab 1997

 Gonadal Function in Male 15

Born SGA 10
Age range: 15.2 20.8

IU/L
5
Control (n=24) SGA (n=25) Increased blood pressure

0
FSH LH
400 10
250 350 9
300 8
7

Pg/mL

ng/mL
250
Inhibin B (pg/mL)

6
200 5
150 4
200 100 3
p<0.0001 2
50 1
Vs. * 0 0
Inhibin B Testosterone
30
28
150 26
24
22
mL

20
18
16
100
14
12
Cicognani A et al., J Pediatr 2003 10
Testicular Volume
 Reduced Ovulation Rate in Adolescent Girls Born SGA
Mean age: 15.5 yr, >3 yr post-menarche

%
Mean AGA SGA
80 AGA n=24
SGA n=25
Birthweight (kg) 3.3 2.3
60

40 FSH (U/L) 4.0 6.7

20
Insulin (mU/L) 8.3 13.0

DHEAS (mcg/dL) 157 257

0 1 2 3 Ovulations

Ovulations detected over 3 months

Ibanez L et al., J Clin Endocrinol Metab 2002
Number of glomeruli 1,500,000
Ages 1-17 yrs
In Term Births:
1,000,000

500,000
Birth Weight
Predicts
0
Nephron Number
2.0 2.5 3.0 3.5

Birth weight, kg
230,000 nephrons
2,000,000 per kg increase
1,500,000
All Ages
in birth weight
Number of glomeruli

1,000,000
Hughson et al,
500,000
Kid Internat (2003) 63, 2113
0

2.0 2.5 3.0 3.5 4.0 4.5 5.0 Also:

Merlet-Benichou et al, 1999
Birth weight, kg
Manalich et al, 2000
 Vitamin D, effects on brain development, adult brain function and the links between low
levels of vitamin D and neuropsychiatric disease

Alzheimers
Disease
Depression & Cognition
Studies describing
an association
with Low Vitamin D Schizophrenia [220] [141]

[152] [163] [6]

[149] [17] [142]

Austism [156] [208] [135]

Cross sectional Spectrum
Disorders [90] [98] [24]
Prospective
[159] [182] [154]
Intervention
[167] [170] [221]

[70] [242] [54]

[55]

Studies describing
no association [199]
with Low Vitamin D

Studies that have not controlled for reverse causality i.e. low levels of vitamin D possibly being due to impaired mobility or sun-avoidance behavior
have been omitted. Numbers in square brackets represent study cited in text. Type of shading reflects whether a study is cross-sectional , (pale);
prospective i.e. does low vitamin D predict later disease onset

Frontiers in Neuroendocrinology. 2013; 34: 4764

Pelayanan antenatal diupayakan agar
memenuhi standar kualitas 7 T, yaitu
1. Penimbangan berat badan dan pengukuran tinggi badan;
2. Pengukuran tekanan darah;
3. Pengukuran tinggi puncak rahim (fundus uteri);
4. Penentuan status imunisasi tetanus dan pemberian imunisasi tetanus
toksoid sesuai status imunisasi;
5. Pemberian tablet tambah darah minimal 90 tablet selama kehamilan;
6. Pelaksanaan temu wicara (pemberian komunikasi interpersonal dan
konseling, termasuk keluarga berencana); serta
7. Pelayanan tes laboratorium sederhana, minimal tes hemoglobin darah
(Hb) dan pemeriksaan golongan darah (bila belum pernah dilakukan
sebelumnya

Kemenkes 2013
Objectives of prenatal care

For the pregnant woman:

1. To increase her well-being before, during, and after pregnancy and to improve her self-image and self-care.
2. To reduce maternal mortality and morbidity, fetal loss, and unnecessary pregnancy interventions.
3. To reduce the risks to her health prior to subsequent pregnancies and beyond child-bearing years.
4. To promote the development of parenting skills.

For the fetus and infant:

1. To increase well-being.
2. To reduce preterm birth, intrauterine growth restriction, congenital anomalies, and failure to thrive.
3. To promote healthy growth and development, immunization, and health supervision.
4. To reduce neurological, developmental, and other morbidities.
5. To reduce child abuse and neglect, injuries, preventable acute and chronic illness, and the need for extended
hospitalization after birth.

For the family:

1. To promote family development and positive parent-infant interaction.
2. To reduce unintended pregnancies.
3. To identify for treatment behavior disorders leading to child neglect and family violence.

United States Public Health Service Expert Panel on the Content of Prenatal
Care. Caring for Our Future: the content of prenatal care. Washington, DC:
United States Department of Health and Human Services, 1989
 Preconseption Visit 1 3 Visit 2 Visit 3 Visit 4
Event 1
Visit 2 6-8 weeks ** 10-12 weeks 16-18 weeks 22 weeks
Screening Risk profiles 4 Risk profiles 4 Weight 5 Weight 5 Weight 5
Maneuvers Height and weight/BMI 5 GC/Chlamydia 4 Blood pressure 6 Blood pressure 6 Blood pressure 6
Blood pressure 6 Height and weight/BMI 5 Fetal aneuploidy Depression 11 Fetal heart tones 28
History and physical 7 Blood pressure 6 screening 24 Fetal aneuploidy Fundal height 30
Cervical cancer screening 2 History and physical 7 Fetal heart tones 28 screening 24 Cervical assessment 31
Rubella/rubeola 8 Rubella 8 Fetal heart tones 28
Varicella 9 Varicella 9 OB Ultrasound (optional) 29
Domestic violence 10 Domestic violence 10 Fundal height 30
Depression 11 Depression 11 Cervical assessment 31
CBC 16
ABO/Rh/Ab 17
Syphillis 18
Urine culture 19
HIV 20
[Blood lead screening 21]
Viral hepatitis 26
Counseling Preterm labor 12 Preterm labor 12 Preterm labor education 12 Preterm labor education 12 Preterm labor education 12
Education Substance use 2
[VBAC ]22
Prenatal and lifestyle Prenatal and lifestyle Prenatal and lifestyle
Intervention Nutrition and weight 2 Prenatal and lifestyle education 23 education 23 education 23
Domestic violence 10 education 23 Fetal growth Follow-up of modifiable Follow-up of modifiable
List of medications, herbal Physical activity Review labs from visit 1 risk factors risk factors
supplements, vitamins 13 Nutrition Breastfeeding Physiology of pregnancy Classes
Accurate recording of Follow-up of modifiable Nausea and vomiting Second-trimester growth Family issues
menstrual dates 14 risk factors Physiology of Quickening Length of stay
Nausea and vomiting pregnancy Preterm labor prevention 31 Gestational diabetes
Warning signs Follow-up of modifiable mellitus 32 (GDM)
Course of care risk factors Preterm labor prevention 31
Physiology of pregnancy
Discuss fetal aneuploidy
screening 24
Immunization Tetanus booster 27 Tetanus booster 27 [Progesterone 31] [RhoGam 17]
& Rubella/MMR 8 Nutritional supplements 25
Chemoprophylaxis [Varicella/VZIG 9] Influenza 27
Hepatitis B vaccine 26 [Varicella/VZIG 9]
Folic acid supplement 15 Pertussis 27
 Visit 5
Event 1
28 weeks
Screening Preterm labor risk 4
Maneuvers Weight 5
Blood pressure 6
Depression 11
Fetal heart tones 28
Fundal height 30
Gestational diabetes
mellitus (GDM) 32
Domestic violence 10
[Rh antibody status 17]
[Hepatitis B Ag 26]
[GC/Chlamydia 4]
Counseling Psychosocial risk factors 4
Education Preterm labor
Intervention education 12
Prenatal and lifestyle
education 23
Follow-up of modifiable
risk factors
Work
Physiology of pregnancy
Preregistration
Fetal growth Labor and delivery issues
Preterm labor prevention 31
Awareness of fetal
movement 33
Immunization [ABO/Rh/Ab 17]
& [RhoGam 17]
Chemoprophylaxis [Hepatitis B Ag 26]
Visit 5 Visit 7 Visit 8-11 Visit Post-Partum
32 weeks 36 weeks 38-41 weeks 4-6 weeks
Weight 5 Weight 5 Weight 5 Cervical cancer screening 2
Blood pressure 6 Blood pressure 6 Blood pressure 6 [GC/Chlamydia 4]
Fetal heart tones 28 Fetal heart tones 28 Fetal heart tones 28 Height and weight/BMI 5
Fundal height 30 Fundal height 30 Fundal height 30 Blood pressure 6
Cervix exam as indicated 34 Cervix exam as indicated 34 History and physical 7
Confirm fetal position 35 Domestic violence 10
Culture for group B Depression 11
streptococcus 36 Gestational diabetes
mellitus (GDM) 32
Preterm labor education 12 Prenatal and lifestyle Prenatal and lifestyle Contraception
Prenatal and lifestyle education 23 education 23 Discussion of postpartum
education 23
Follow-up of modifiable Follow-up of modifiable depression
Follow-up of modifiable risk factors risk factors Breastfeeding concerns
risk factors Postpartum care Postpartum and support
Travel Management of late vaccinations
Contraception pregnancy symptoms Infant CPR
Sexuality Contraception Post-term management
Pediatric care When to call provider Labor and delivery update
Episiotomy Discussion of Breastfeeding
postpartum depression
Warning signs/pregnancy
induced hypertension
[VBAC 22]
Preterm labor prevention 31
Tetanus/pertussis 27
 Aspek historis Bani Adam (Q.S.
penciptaannya Al-Araaf: 31)

Aspek Basyar (Q.S. Al-

biologisnya Mukminun :33)

Konsep Aspek Insan (Q.S. Ar-

Manusia kecerdasannya Rahman: 3-4)

Aspek Annas (Q.S. Al-

sosiologisnya Baqarah: 21)

Abdun (hamba)
Aspek
Khalifah Allah (An
posisinya Jin (72) 19