Pemberian Makanan Tambahan pada Ibu Hamil KEK di Puskesmas Karya Wanita Pekanbaru

Chronic Energy Deficiency in pregnant women is a condition of pregnant women due to an imbalance in the intake of energy and protein nutrients, so that the substances the body needs are not fulfilled. Incident chronic energy deficiency in pregnant women have a risk of abortion, bleeding, prolonged labor, infection, low birth weight baby, birth defects, and causes of death indirectly. An attemt to resolve the incidence of malnutrition in pregnant women in chronic energy deficiency with supplementary food. Type of qualitative research. Research informants were pregnant women chronic energy deficiency, nutrition staff, midwives, health promotion officers, and cadres. Research results are the knowledge of pregnant women in chronic energy deficiency about supplementary feeding is stil lacking, the attitudes of pregnant women in chronic energy deficiency and their husband’s support about supplementary feeding are already good, compliance of pregnant women in chronic energy deficiency is still lacking, acceptance of pregnant women in chronic energy deficiency about supplementary feeding is stil lacking, delivery of information when counseling needs to be improved by using the contemporary method, distribution of supplementary feeding for Puskesmas officers in collaboration with cadres. Advice doing technical guidance to health workers about supplementary feeding, health workers increase again in providing information related to supplementary feeding, provide information using digital media such as video, made a special trick of setting an alarm as a reminder to consume supplementary feeding, make derivate technical guidelines from the ministry of helath according to conditions in the field.

LITERATURE REVIEW : EFEKTIFITAS PELVIC ROCKING EXERCISE MENGGUNAKAN BIRTHING BALL TERHADAP KEMAJUAN PERSALINAN PADA IBU PRIMIPARA

Indonesia's Health Profile in 2019 in general, there was a decrease in maternal mortality during the period 1991-2015 from 390 to 305 per 100,000 live births, if it is associated with the 2015 Millennium Development Goals (MDGs), namely reducing the maternal mortality rate (MMR) to 102/100,000 live births. the maternal mortality rate did not reach the MDGs target. Physiological efforts are made to prevent prolonged labor, such as pelvic rocking exercise using the birthing ball technique. This is also a method that really helps respond to pain in an active way and reduces the length of the first stage of labor in the active phase. This study aims to determine the effectiveness of the implementation of pelvic rocking with a birthing ball on the progress of labor in primiparous women in 2020. This study uses Systematic Literature Reviews (SLR), which is a synthesis of systematic, clear, comprehensive literature studies, by identifying, analyzing , evaluating through the collection of existing data with an explicit search method and involving a critical review process in the selection of studies. In 6 journals, all journals perform pelvic rocking exercise techniques using the birthing ball technique when the mother enters the first stage of the active phase. The conclusion in this study is that all journals reviewed by researchers can be ascertained that all of these journals get the same results, namely stating that using the Pelvic Rocking Exercise technique with the help of a birthing ball can make delivery times for mothers go faster

PERSALINAN PADA IBU DENGAN RIWAYAT KEKURANGAN ENERGI KRONIS

Ibu hamil yang mengalami KEK akan mengalami kekurangan gizi, tubuh mudah lelah, pucat, lemas, dan mengalami kesulitan salah satunya dalam proses persalinan. Pengaruh KEK terhadap proses persalinan dapat mengakibatkan persalinan sulit dan lama, persalinan sebelum waktunya (prematur), pendarahan setelah persalinan, serta persalinan dengan operasi. Puskesmas Sadananya data ibu hamil yang mengalami KEK sebanyak 70 orang (9,49%) dan berlanjut ke penyulit lainnya yaitu mengalami Abortus 5 0rang (3,5%), BBLR 9 bayi (6,3%). Jenis Penelitian ini merupakan penelitian deskriptif. Populasi dalam penelitian ini adalah seluruh ibu bersalin dengan riwayat KEK pada masa kehamilan di Wilayah Kerja Puskesmas Sadananya Kabupaten Ciamis Tahun 2019 sebanyak 70, Teknik pengambilan sempel mengunakan Simple Random Sampling. Analisa dalam penelitian ini adalah Univariat. Hasil penelitian menunjukan sebanyak 3 oang mengalami persalinan sebelum waktunya (4,3%), 1 orang mengalami perdarahan paska salin disebebkan atonia uteri (1,4%), dan 8 orang proses persalinan dengan Operasi (SC) (11,4%). Kesimpulan dari penelitian ini adalah Ibu hamil dengan riwayat KEK mengalami penyulit persalinan, meskipun secara jumlah tidak terlalu signifikan, namun hal ini tentunya tetap harus menjadi perhatian khususnya bagaimana bisa mencegah ibu hamil untuk tidak mengalami anemia, dan apabila sudah terjadi sebagai seorang bidan tentunya harus dapat mendeteksi penyulit yang akan terjadi denganmelakukan penapisan awal persalinanPregnant women who experience KEK will experience malnutrition, body easily tired, pale, weak, and experience difficulties, one of which is in the delivery process. The effect of KEK on the labor process can result in difficult and prolonged labor, preterm labor, bleeding after delivery, and delivery by surgery. Puskesmas Sadananya data on pregnant women who experience KEK as many as 70 people (9.49%) and continue to other complications, namely experiencing 5 0rang abortion (3.5%), LBW 9 babies (6.3%). This type of research is a descriptive study. The population in this study were all 70 women who gave birth with a history of KEK during pregnancy in the Work Area of the Sadananya Health Center, Ciamis Regency in 2019, the sampling technique used was Simple Random Sampling. The analysis in this research is Univariate.. The results showed as many as 3 people experienced premature labor (4.3%), 1 person experienced post-saline bleeding due to uterine atony (1.4%), and 8 people went into labor by surgery (11.4%). The conclusion of this study is that pregnant women with a history of KEK experience difficulty in childbirth, although the numbers are not too significant, this of course still has to be a concern, especially how to prevent pregnant women from experiencing anemia, and if it has occurred as a midwife, of course they must be able to detecting impending complications by performing an early screening of labor.

Magnitude of Postpartum Hemorrhage and Its Associated Factors in Ethiopia: Systematic Review and Meta-analysis.

Background: Postpartum hemorrhage or postpartum bleeding (PPH) is often defined as loss of > 500 ml of blood after vaginal delivery or > 1,000 ml after cesarean delivery within 24 hrs. Postpartum hemorrhage is a leading direct cause of maternal morbidity and mortality in Ethiopia. Therefore, the main objective of this systematic review and meta-analysis was to estimate the pooled magnitude of postpartum hemorrhage and the pooled effect size of the associated factors in Ethiopia.Methods: Primary studies were searched in PubMed / MEDLINE online, Science Direct and Hinari Cochrane Library, CINAHL, African Journals Online databases, Google and Google Scholars. The search for studies was not limited by time and all articles up to October 10/2021 were included. The data extraction format was prepared in Microsoft Excel. The data extracted from the Microsoft Excel format was exported to Stata Version 16.0 statistical software for analysis. A random effect meta-analysis model was used. Statistical heterogeneity was evaluated by the I2 test and Egger's weighted regression test was used to assess publication bias.Result: A total of 165 records from the electronic databases were excluded, but 145 records were excluded for different reasons, and finally 20 studies were included in this final analysis. The pooled magnitude of postpartum hemorrhage in Ethiopia was 8.18% [(95% CI; 6.996 - 9.363]. Older age [OR= 5.038 (95% CI; 2.774 - 9.151)], prolonged labor [OR = 4.054 (95% CI; 1.484 - 11.074)], absence of ANC visit [OR = 13.84 (95% CI; 5.57 - 34.346)] grand-multiparty, [OR = 6.584 (95% CI; 1.902 - 22.795)], and history of postpartum hemorrhage [OR = 4.355 (95% CI; 2.347 - 8.079)] were identified as factors for the occurrence of postpartum hemorrhage.Conclusions: This study concludes that the magnitude of postpartum hemorrhage in Ethiopia was moderately high. The finding was strongly help different stakeholder working in maternal and child health to focus on the main contributors factors to reduce PPH. Health professionals attending delivery should emphasize high-risk groups of mothers. Encouraging ANC visit and prevent prolonged labor should be recommended to reduce the occurrence of postpartum hemorrhage.

The Assessment of Intrapartum Transperineal Ultrasonographic Parameters for their Effectiveness in Evaluation of Progress of Labor and Prediction of Mode of Delivery in Egyptian Women

Introduction: High fetal head station has been associated with prolonged labor and delivery outcomes. Although clinical assessment of fetal head station is both subjective and unreliable, women with prolonged labor are subjected to multiple digital vaginal examinations. The use of ultrasound has been proposed to aid in the management of labor since 1990s. Ultrasound examination is more accurate and reproducible than clinical examination in the diagnosis of fetal head station and in the prediction of arrest of labor. Ultrasound examination can, to some extent, distinguish those women destined for spontaneous vaginal delivery and those destined for operative delivery and may predict the outcome of instrumental vaginal delivery. Such a technique has the potential to reduce the frequency of intrusive internal examinations and associated infection and could be useful in allowing the assessment of women in whom digital VE is traumatic or contra-indicated. Intrapartum ultrasound not only provides objective and quantitative data in labor, but also helps to make more reliable clinical decisions aiming to improve obstetric outcomes of both the mother and fetus as a supplementary tool for active management. Aim of the work: This study aims at assessing the value of intrapartum transperineal ultrasonography as a quantitative and objective tool in the evaluation of progress of labor and prediction of mode of delivery. Subjects: This study was a prospective observational study conducted on 600 primiparous women in active first stage of labor admitted to Kasr Al Ainy maternity hospital from January 2017 to June 2018. The studied population was divided into two groups. Group A of 300 women with normal progress of labor and group B of 300 women with prolonged 1st stage of labor. Methods: Fetal head station(FHS) was assessed clinically by digital vaginal examination (dVE) and sonographically by transperineal ultrasound measurement of head perineal distance (HPD) and angle of progression (AOP). Intrapartum care of the patient continued as normal based only on digital vaginal examinations using the modified WHO partogram. (1). Statistical analysis was targeted towards assessing the potential of the intrapartum ultrasonography in the evaluation of progress of labor and prediction of mode of delivery. Results: All studied parameters for assessment of FHS (dVE, HPD, and AOP) significantly corelated with each other and with both progress of labor and mode of delivery with P value (<0.001). The highest sensitivity for prediction of progress of labor is observed using dVE (83%), the highest specificity is observed using AOP (78.3%). The highest sensitivity for prediction mode of delivery is for combined HPD & AOP (97.7%) while the highest specificity is for AOP (81%). When combining both HPD and AOP for prediction of mode of delivery, the assessment of both parameters was found to have a high sensitivity of 97.7% and a high positive predictive value of 86.63%. Conclusion: Intrapartum ultrasound examination is a valuable tool in the prediction of progress of labor and mode of delivery. The assessment of fetal head station by transperineal ultrasound measurement of HPD and AOP is much more informative of the progress of labor and the mode of delivery than digital assessment of fetal head station. Keywords: Labor, intrapartum ultrasound, Angle of progression, Head perineal distance, fetal head station, digital vaginal examination.

Penerapan Counter Pressure Untuk Mengurangi Nyeri Persalinan Kala I Di Klinik Rahayu Ungaran

Pain during labor increases maternal anxiety which can increase the risk of prolonged labor and high rates of secsio caesaria because this is the determining point of whether a mother can undergo a vaginal delivery or end with an action due to complications caused by severe pain.It is very important for the delivery helpers to meet the mother's need for their security and comfort.This study was conducted to find out the effectiveness of Counter Pressure Massage Against Decreased Labor Pain During I Active Phase at Rahayu Ungaran Clinic. This research uses preecperiment research method with the design of one group pretest posttest research. Samples were taken using accidental sampling techniques, namely as many as 20 maternity mothers. The instruments used in this study are SOP sheets (Standard Operating Procedures). The results of this study using Marginal Homogenity Test showed the value of Asymp value. Sig. (2-tailed) acquired 0.000. Based on statistical test criteria: If a Significant value > 0.05 then there is a difference or H0 is accepted. So 0.000 > 0.05 means in this case there is a difference before and when counter pressure technique or H0 is accepted. There is an effect of Counter Pressure Massage on the reduction of labor pain during the I active phase at Rahayu Ungaran Clinic. It is expected that future researchers will carry out a Counter Pressure Massage for mothers so that they can be used as a method of effective pain reduction. ABSTRAK Nyeri persalinan dapat menimbulkan stres yang dapat menyebabkan pelepasan hormon yang berlebihan seperti ketokolamin dan steroid. Nyeri dapat dikurangi dengan teknik farmakologi dan teknik nonfarmakologi. Teknik farmakologi dengan menggunakan obat analgesik, sedangkan teknik nonfarmakologik adalah pengendalian nyeri dengan menggunakan teknik counterpressure yang mengurangi sensasi nyeri dengan menghambat rasa sakit dari sumbernya. Penelitian ini dilakukan untuk mengetahui efektivitas Counter Pressure Massage Terhadap Penurunan Nyeri Persalinan Kala I Fase Aktif di Klinik Rahayu Ungaran. Penelitian ini menggunakan metode penelitian preeksperimen dengan rancangan penelitian one group pretest posttest. Sampel diambil menggunakan teknik accidental sampling, yaitu sebanyak 20 ibu bersalin. Instrumen yang digunakan dalam penelitian ini adalah lembar SOP (Standar Operasional Prosedur). Hasil penelitian ini menggunakan uji Marginal Homogenity Test menunjukkan nilai nilai Asymp. Sig. (2-tailed) diperoleh 0.000. Berdasarkan kriteria pengujian statistik: Jika nilai Signifikan > 0.05 maka terdapat perbedaan atau H0 diterima. Jadi 0.000 > 0.05 berarti dalam hal ini terdapat perbedaan sebelum dan saat dilakukan teknik counter pressure atau H0 diterima. Ada pengaruh Counter Pressure Massage terhadap penurunan nyeri persalinan kala I fase aktif di Klinik Rahayu Ungaran. Diharapkan ibu bersalin peneliti yang akan datang untuk melakukan Counter Pressure Massage sehingga dapat dijadikan metode pengurangan rasa nyeri yang efektif.

Sooner than later: a little effort may avert postpartum haemorrhage in patients with acute hepatitis E

Background: The incidence of postpartum hemorrhage (PPH) in pregnancies with hepatitis E varies from 14-42%. Management of labor and PPH in these women with acute liver injury makes it a real obstetric challenge due to associated coagulopathies and contraindication for many drugs. Prophylactic insertion of condom balloon tamponade along with active management of the third stage of labour (AMTSL) prevent primary PPH in these women. Simultaneous use of injection tranexemic acid further gives reliable results. The present study was conducted to study the effectiveness of condom balloon tamponade in preventing PPH in pregnant women with acute hepatitis E in labor.Methods: The present study was conducted in the Department of Obstetrics and Gynecology, Pt. Jawaharlal Nehru Medical (JNM) College and associated Dr. Bhim Rao Ambedkar Memorial (BRAM) Hospital, Raipur, Chhattisgarh over period of two year from September 2018 to September 2020.Results: During the study period 32 women presented with hepatitis E in labor. Condom balloon tamponade was inserted prophylactically in all hepatitis E virus (HEV) positive cases immediately after delivery of placenta along with vaginal packing, irrespective of amount of bleeding. Inspite of so many odds in the form of unscanned pregnancies, multiparity, multifetal gestation, abruption, intrauterine fetal death (IUFD), prolonged labor, deranged liver and coagulation profiles, anemia and thrombocytopenia, our study showed high effectiveness of prophylactic condom balloon tamponade by encountering only one case of PPH.Conclusions: Prophylactic condom balloon tamponade insertion just after the removal of placenta is promising in averting PPH.

“I Felt Something Coming Down Below”: A Case of POP

Pelvic floor disorders, which includes pelvic organ prolapse (POP), have shown an increasing prevalence among women worldwide. (Wu 2014) It is perceived as embarrassment and affect the women’s quality of life. A 68-year-old housewife, Para 3, complained of a 50-cent coin size lump coming down from her vagina since 2019, which could be reduced back manually inside the vagina. The symptom exacerbated by straining and carrying heavy objects. Ignoring the symptom, causing the lump to increase in size and protruded out from her vagina for the past 2 months. She had 3 SVD with maximum birth weight of 3.75kg and a prolonged second stage of labour in her second pregnancy. She was not aware and never practiced pelvic floor exercise nor taken any HRT. There were no urinary symptoms nor constipation. Her BMI is 25.2kg/m2. Abdominal examination was unremarkable. On speculum examination, vagina was atrophic and third degree uterine prolapse was evident. She was arranged to have Vaginal hysterectomy, anterior colporrhaphy and sacrospinous fixation done. The positive risk factors in this case are multiparity, menopausal status, a history of prolonged labor and frequent heavy lifting. The delay in presentation is due to lack of awareness. It was also found in a study that feeling of embarrassment and social stigma could be the reason. (Abhyankar 2019) Pelvic Floor exercise and avoidance of heavy lifting may be beneficial at onset of symptom. For conclusion, POP awareness is crucial to empower women to prevent POP and seek treatment as soon as they are symptomatic.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S24

Prevalence and Factors Affecting the Labor Experience: A Systematic Review

Introduction: Labor experiences have potential short and long term physical and psychological effects on women’s lives. Many factors influenced role in a mother’s experience of childbirth, both positively and negatively. This study aimed to determine the prevalence and factors that influence the delivery experience.Methods: This study searched for articles in the databases, namely Pub Med, Scopus, ProQuest, ScienceDirect, and Sage. The keyword used is labor experience. A total of 3654 articles were found, after selecting studies using PRISMA found 18 corresponding articles.Results: In this study, 18 studies were included in this systematic review, eight studies examined the prevalence of labor experiences. The prevalence of labor experience was 6.8-44%. Factors related to childbirth experiences included: individuals, such as age, parity, fear, self-efficacy, participation, control, expectations, preparation, and interpersonal, such as husband support, caregiver support, unwanted medical problems, such as prolonged labor, stimulation, and induction, forceps delivery, emergency cesarean section, and use of analgesics in mothers, low APGAR scores and transfer to the NICU.Conclusion: This review showed the various factors associated with the childbirth experience. This finding suggests conducting further research into the reason these factors influence the experience of labor.