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Pregnancy is a condition that often creates a sense of happiness for married couples, but if does not prepared properly, it can lead to circumstances that can threaten death to the mother and baby. So, presumably absolute for every pregnant mother with the support of her husband and family to do the tests during Pregnancy / Antenatal Care (ANC) on a regular basis as recommended by your midwife or doctor.

Service examinations during pregnancy (ANC) is the health services provided to the mother during her pregnancy in accordance with the standards of full service, includes many things, including anamnesis, physical examination of both general and midwifery, laboratory examination on the indication as well as basic and specific interventions in accordance with risk there. ANC performed at least 1 time in the first trimester (up to 3 months of gestation), 1 time a second trimester (gestational age 3-6 months) and 2 times in the third trimester (gestational age 6-9 months). In the operational implementation of known standard called the “10 T” on examination during pregnancy are:

1. (Weigh) and weight measurement (height)

Weigh weight is always done at any time of the ANC, in the way of weighing the weight (in kg) was without shoes and wearing clothes that lenient. Weighing less than 45 kg in the third trimester maternal underweight states have the possibility of having a baby with low birth weight. Normal weight gain during pregnancy of 0.5 kg per week starting the second trimester.

Measuring height can be done at the beginning of the ANC alone, how to measure the height (in meters) is standing in an upright position without the use of shoes and measurements. Height less than 1.5 meters can be the reason for the planned operation by the birth process. Pregnant woman with her husband so as to prepare early operating costs, and foster psychological readiness for surgery.

2. Measure (pressure) blood

Measurement of blood pressure / tension is done regularly every ANC, shouts expected to remain in the blood during pregnancy is normal (120/80 mmHg). Things to watch out for is if during pregnancy increased blood pressure (hypertension) are not controlled, because it feared could of preeclampsia or eclampsia (toxicity in pregnancy) and can lead to death threats for both mother and fetus / baby. It also should be of concern is low blood pressure (hypotension), often accompanied by complaints of dizziness and lack of rest.

3. (Specify) nutritional status

To determine the nutritional status of pregnant women, should do some measurements. Midwife / doctor during pregnancy examination will take measurements Upper Arm Circumference (MUAC). MUAC measurements performed on women of childbearing age (15-45 years) and mother hamiluntuk predicting the energy and protein deficiency is chronic or has happened in a long time.

MUAC measurements performed with MUAC tape wrapped round 33 cm, or a cloth tape measure to the nearest 1 decimal (0.1 cm). When measured, ibuhamil in a standing position and made ​​at the midpoint between the shoulder and the base of the tip of the left elbow, if the pregnant woman in question is not left-handed.

Conversely, if he is left-handed, measurements were made on the right arm. This is done to minimize the bias that occurs, due to the enlargement of the muscle due to the activity, not due to accumulation of fat. Similarly, if the left arm paralyzed, measurements were made on the right arm.

With MUAC measurements can be used to screen for early detection and risk of babies with low birth weight (LBW). After a special study for women in Indonesia, LILA acquired the following standards:

A. If MUAC less than 23.5 cm, mean less ibuhamil nutritional status, such as the possibility of having CED (Chronic Energy Deficiency) or chronic anemia, and a higher risk of low birth weight babies.

B. If MUAC equal or more than 23.5 cm, mean ibuhamil good nutritional status, and risk of delivering low birth weight infants is lower.

4. Measure (high) fundus

Simply put, a midwife or a doctor when implementing ANC on a pregnant woman to determine the gestational age examination abdominal / stomach carefully. Examination done by palpation (touch hands directly on the abdomen of pregnant women) and direct measurements to estimate gestational age, and if the gestational age increases.

This examination was also conducted to determine the position, the lowest part of the fetus and the fetal head entry into the pelvic cavity, to look for abnormalities as well as timely referral. The monitoring aims to look at the indicators of maternal and fetal well-being during pregnancy.

5. (Specify) position of the fetus and the fetal heart rate

In conducting a physical examination during pregnancy, midwife / doctor will perform an examination to determine fetal position, especially when the third trimester or before the time of delivery predictions. In addition, the examination will be carried out also in fetal heart rate (FHR) as a reference to determine the health of the mother and the developing fetus, especially the fetal heart rate in the womb. Normal fetal heart rate is as much as 120-160 times per minute. Examination of the fetal heart rate should be performed on pregnant women, and new fetal heartbeat can be heard at 16 weeks gestation / 4 months.

Tool that is often used in determining the position of the fetus and the fetal heart rate at this time is an ultrasound ( Ultra Sono Tomographic ) . Ultrasound is a tool in medicine that utilizes ultrasonic waves ( waves that have a high frequency of 250 kHz – 2,000 kHz ) which then results are displayed in the monitor screen . Ultrasound is safe for the fetus and the mother .

6 . Immunization ( Tetanus Toxoid ) complete TT

One of the government policies that aim to reduce infant mortality or neonatal tetanus caused by the disease , it was TT immunization activities .

Benefits of TT immunization of pregnant women include :

Protect newborns from neonatal tetanus . Neonatal Tetanus Tetanus is a disease that occurs in neonates ( babies less than 1 month old ) caused by Clostridium tetani , the bacteria that secrete toxins ( poisons ) and attack the central nervous system .
Protect mothers against tetanus possible if injured .
Both of these benefits is the way to achieve one of the goals of the national immunization program is the elimination of maternal tetanus ( in pregnant women ) and neonatal tetanus ( infants aged less than 1 month ) .

TT immunization to pregnant women given 2 times , at a dose of 0.5 cc injected intramuscularly / subcutaneously ( under the muscle or under the skin ) . TT immunization should be given before pregnancy 8 months to get the full TT immunization . TT1 can be given since in the know positive pregnant which is usually given at the first visit pregnant women to health facilities . Granting distance ( interval ) with TT1 TT2 immunization is at least 4 weeks .

7 . Do ( test ) laboratotium

Simple laboratory tests conducted during prenatal care is Hb examination to assess anemic status in pregnant women . The Hb examination should be done since the first trimester , so that if found to be anemic conditions can be readily treated with the right .

If the risk of other diseases acquired during pregnancy such as high blood pressure / hypertension and diabetes / diabetes mellitus , it can be done other laboratory tests such as tests of kidney function , levels of protein ( albumin and globulin ) , blood and urine sugar levels complete .

Laboratory tests conducted in accordance with the requirements and conditions of pregnant women during antenatal care and aims to address the risk of other diseases during pregnancy . So that when the time of birth can take place safely and healthy .

8 . Provision ( iron tablets )

Pregnant women are prone to anemia ( low blood hemoglobin levels ) in the last 3 months of pregnancy , because at that time the fetus hoard iron reserves for itself the first month after birth supplies . Anemia in pregnancy can be caused by increased iron requirement for fetal growth , inadequate intake of iron in food consumed by pregnant mothers , mothers eating patterns disrupted due to nausea during pregnancy , and the tendency of the low reserves of iron ( Fe ) in women due to childbirth before and menstruation .

Lack of iron can lead to inhibition of cell growth in both fetal body and brain cells , fetal death , miscarriage , birth defects , LBW ( Low Birth Weight ) , anemia in infants who are born , premature birth , bleeding , infection prone . Iron deficiency is not the only cause of anemia , but if the high prevalence of anemia , iron deficiency is usually regarded as the most dominant cause . Consideration was made ​​of iron folate supplementation tablet is considered as one of the ways that are beneficial in overcoming the problem of anemia . Anemia can be overcome by taking iron tablets or Tablet Add Blood ( TTD ) . Commonly given to pregnant women by one tablet every day for 90 consecutive days during pregnancy . TTD ferrosulfat containing 200 mg , equivalent to 60 milligrams of elemental iron and 12:25 mg of folic acid .

9 . ( Test ) against sexually transmitted diseases ( STDs )

Pregnant women at high risk for STDs , which could interfere with urinary and reproductive tract . Efforts pregnancy diagnosis with an STD in the community is making a diagnosis of symptoms approach , providing therapy and counseling for the referral . It aims to monitor the presence of PMS that lasted normal fetal development .

10 . ( Gathering ) speech in preparation for the referral .

Provide consultation or cooperation handling
actions to be performed by a midwife or doctor in a colloquium , among others :

a.Merujuk to the doctor for a consultation , to help mothers make the right choice .

b.Melampirkan maternal health card with a referral

c.Meminta mother to come back after a letter of the results of the consultation and referral

d . Continue the monitoring of the condition of the mother and baby during pregnancy

e . Provide Antenatal care ( during pregnancy )

f . Early planning birth at home if it is not safe

g . Agreeing among decision makers in the family about the birth plan

h . Preparation and delivery fees

Hopefully , with antenatal care regularly and correctly , which is practiced labor will go smoothly , safe and healthy for the mother and baby . So as to reduce maternal and infant mortality during childbirth is still high in Indonesia. Where based on the IDHS 2012 was recorded that the maternal mortality rate stood at 102 per 100 thousand live births and the infant mortality rate of 23 per thousand live births .

# From a variety of sources

(dr. Yahmin Setiawan, MARS – Dirut Rumah Sehat Terpadu Dompet Dhuafa)

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