Anamnesis

Pelayanan antenatal terpada bagi ibu hamil

Evaluasi Kesehatan ibu hamil

1. Kondisi umum dan keluhan yang dirasakan selama kehamilan (masalah pada kehamilan ,
seperti mual muntah, demam , sesak napas, nyeri kepala, keputihan dan lainnya)
2. Riwayat Kesehatan ibu saat ini, seperti status imunisasi
3. Perencanaan persalinan yang meliputi tempat persalinan, transportasi, pembiayaan
persalinan, pendamping persalinan dan lainnya yang akan berhubungan dengan proses
persalinan ibu.
4. Rencana pemakaian kontrasepsi dan pilihan kontrasepsi

Pemeriksaan fisik umum :

1. Keadaan umum secara keseluruhan
2. Status gizi ibu, yang meliputi berat badan dan tinggi badan, LILA
3. Tanda tanda vital : tekanan darah , nadi ,suhu tubuh , frekuensi dan saturasi oksigen
dalam tubuh.

Pemeriksaan kehamilan : leopold, djj

Pemeriksaan penunjang :
1. Pemeriksaan labolatorium yang dibutuhkan sesuai indikasi
2. Pemeriksaan USG
■ Prenatal Surveillance
At each return visit, the well-being of mother and fetus are assessed (see
Table 10-1). Fetal heart rate, growth, and activity are evaluated. Maternal
blood pressure and weight and their extent of change are assessed. Symptoms
such as abdominal pain, nausea and vomiting, bleeding, vaginal fluid
leakage, headache, altered vision, and dysuria are sought. After 20 weeks’
gestation, uterine examination measures size from the symphysis to the
fundus with a traditional tape measure. In late pregnancy, vaginal
examination often provides valuable information. This may include
confirmation of the presenting part and its station, clinical estimation of
pelvic capacity and configuration, fetal ballottement as a reflection of
sufficient amnionic fluid volume, and cervical consistency, effacement, and
dilation (Chap. 22, p. 426).

Fundal Height
Between 20 and 34 weeks’ gestation, the height of the uterine fundus
measured in centimeters correlates closely with gestational age in weeks.
This measurement is used to monitor fetal growth and amnionic fluid
volume. It is measured along the abdominal wall from the top of the
symphysis pubis to the top of the fundus. Importantly, the bladder must be
emptied before fundal measurement. Obesity or the presence of uterine
masses such as leiomyomas also may limit fundal height measurement
accuracy. Moreover, using fundal height alone, fetal-growth restriction may
be undiagnosed in up to a third of cases (American College of Obstetricians
and Gynecologists, 2021b; Haragan, 2015).

Fetal Heart Sounds

Instruments incorporating Doppler ultrasound are usually used to easily
detect fetal heart action, and in the absence of maternal obesity, heart sounds
are almost always detectable by 10 weeks with such instruments (Chap. 24, p.
447). The fetal heart rate ranges from 110 to 160 beats per minute and is
typically heard as a double sound. Using a standard nonamplified
stethoscope, the fetal heart is audible by 20 weeks in 80 percent of women,
and by 22 weeks, heart sounds are expected to be heard in all (Herbert, 1987).
Because the fetus moves freely in amnionic fluid, the site on the maternal
abdomen where fetal heart sounds can be heard best will vary.

Additionally, with ultrasonic auscultation, one may hear the funic souffle,
which is a sharp, whistling sound that is synchronous with the fetal pulse. It
is caused by the rush of blood through the umbilical arteries and may not be
heard consistently. In contrast, the uterine souffle is a soft, blowing sound
that is synchronous with the maternal pulse. It is produced by the passage of
blood through the dilated uterine vessels and is heard most distinctly near the
lower portion of the uterus.

Sonography
Ultrasound imaging provides invaluable information regarding fetal anatomy,
growth, and well-being. As such, it is recommended that all pregnant women
be offered at least one prenatal sonographic examination (American College
of Obstetricians and Gynecologists, 2018l). Continuing trends suggest that
the number of these examinations performed per pregnancy is increasing.
Data from commercial insurance plans indicate that even low-risk
pregnancies receive an average of 4 to 5 ultrasound examinations (O’Keeffe,
2013). Sonography should be performed only for valid medical indications.
Additionally, needed information is obtained using the lowest possible
ultrasound exposure settings, which is the as low as reasonably achievable
(ALARA) principle (American Institute of Ultrasound in Medicine, 2016).

■ Subsequent Laboratory Tests

If initial results were normal, most tests need not be repeated. Hematocrit or
hemoglobin determination, along with serology for syphilis if it is prevalent
in the population, is repeated at 28 to 32 weeks (Hollier, 2003; Kiss, 2004).

For women at increased risk for HIV acquisition during pregnancy, repeat
testing is recommended in the third trimester, preferably before 36 weeks
(American College of Obstetricians and Gynecologists, 2018j). Similarly,
women who engage in behaviors that place them at high risk for hepatitis B
virus infection are retested at the time of delivery. Women who are D (Rh)
negative and are unsensitized should have an antibody screening test repeated
at 28 to 29 weeks. Anti-D immunoglobulin is given if they remain
unsensitized (Chap. 18, p. 354).

Group B Streptococcal Infection

The CDC (2010b) recommends that vaginal and rectal group B streptococcal
(GBS) cultures be obtained in all women between 35 and 37 weeks’
gestation, and the American College of Obstetricians and Gynecologists
(2020f) endorses this recommendation. Intrapartum antimicrobial prophylaxis
is provided to those whose culture results are positive. Women with GBS
bacteriuria, preterm labor, or a previous infant with invasive disease are given
empirical intrapartum prophylaxis. Trials are in progress to test an
investigational vaccine (Madhi, 2016). These infections are described further
in Chapter 67 (p. 1194).

Gestational Diabetes
All pregnant women are screened for gestational diabetes mellitus, whether
by history, clinical factors, or routine laboratory testing. Although laboratory
testing between 24 and 28 weeks’ gestation is the most sensitive approach,
there may be women at low risk who are less likely to benefit from testing
(American College of Obstetricians and Gynecologists, 2019d). Gestational
diabetes is discussed in Chapter 60 (p. 1079).

Genetic Screening
Serum screening for fetal aneuploidy is routinely offered to all pregnant
women—in the first trimester at 10 to 14 weeks, in the second trimester at 15
to 20 weeks, or as cell-free DNA screening at any point after 10 weeks
(American College of Obstetricians and Gynecologists, 2020d). Additionally,
the College recommends that both cystic fibrosis carrier screening and
screening for spinal muscular atrophy should be offered to all women
considering pregnancy or who are currently pregnant, provided that

carrier or disease status is not already known (American College of

Obstetricians and Gynecologist, 2017b).

Historically, carrier screening for selected genetic abnormalities was offered

only to women at increased risk based on ethnic or racial background. One
example is screening for Tay-Sachs disease in those of Ashkenazi Jewish
descent. However, given our increasingly diverse, multiethnic society,
previous assumptions about carrier risk may no longer apply. Although
ethnicity-specific carrier screening remains an option, providers should also
consider panethnic and expanded carrier screening strategies (American
College of Obstetricians and Gynecologists, 2017c). These are discussed
further in Chapter 17 (p. 342). All genetic screening is optional, and ideally,
genetic carrier screening and counseling should be performed before
pregnancy.

Neural-Tube Defects
Traditionally, screening for neural-tube defects has been performed as part of
second-trimester aneuploidy screening. An elevation of maternal serum
alpha-fetoprotein (MSAFP) levels then prompted additional evaluation with
ultrasound and/or amniocentesis. With the advent of other screening
modalities for aneuploidy, second-trimester MSAFP testing is less frequently
obtained. For example, the expansion of second-trimester fetal anatomical
surveillance has been used to screen and identify neural-tube defects
(American College of Obstetricians and Gynecologists, 2017f).

■ Immunization
Current recommendations for immunization during pregnancy are summarized in Table 10-7.
Well-publicized concerns regarding a causal link between childhood exposure to the thimerosal
preservative in some vaccines and neuropsychological disorders have led some parents to
vaccine prohibition. Although controversy continues, these associations have been proven
groundless. Thus, many vaccines may be used in pregnancy (Munoz, 2019). The American
College of Obstetricians and Gynecologists (2020c) stresses the importance of integrating an
effective vaccine strategy into the care of both obstetrical and gynecological patients. The
College further emphasizes that information on the safety of vaccines given during pregnancy is
subject to change, and recommendations can be found on the CDC website at
www.cdc.gov/vaccines.
Table--------
Influenza and tetanus–diphtheria–acellular pertussis (Tdap) vaccinations are recommended
routinely for all pregnant women (Munoz, 2019; Sperling, 2018b). Others are recommended for
specific indications (see Table 10-7). Women who are susceptible to rubella should receive
measles, mumps, and rubella (MMR) vaccination postpartum. This vaccine is contraindicated
during pregnancy.

•  Second trimester: at 18–20 weeks to confirm dates, assess fetal morphology and exclude
multiple pregnancies; to assess complications of pregnancy, including antepartum
haemorrhage, threatened premature labour and preterm prelabour rupture of membranes.
•  

Third trimester: fundal height small or large for gestation, previous intrauterine growth
restriction, multiple pregnancies, antepartum haemorrhage, malpresentation, maternal medical
conditions such as diabetes, renal disease, preeclampsia. Late pregnancy tests of fetalwellbeing
for assessment of the fetoplacental function may be appropriate.