Nutrisi dan Perhatian

Klinis pada Kehamilan

Nutrition and Care Problem in Pregnancy

Symposium Sumpah Dokter 201

Sebelas Maret University
Fenti Endriyani

OVERVIEW
St
1 Session Best Western Premiere, Solo, Indonesia
19 November 2017
• Uterus
Myocyte Arrangement, Size, shape,
position, Uteroplacental Bloodflow
Perubahan
• Breast
Larger, visible vein, aerola
Fisiologi
pigmented, hipertropic glands Kehamilan
• Vagina and Perineum
Increased vascularity, Chadwick Sign
Physiologic
Change in
• Metabolic Change
Weight Gain, Protein, Carbohydrat, Fat, Pregnancy
Leptin, Ghrelin, Mineral, Water, Iron
• Hematological
Change
Blood Volume, Haemoglobin,
platelet
• Cardiovascular
System
Heart, Blood Pressure, Circulation

• Respiratory Tract
Pulmonary Function, Oxigen delivery

• Urinary System, etc

Cunningham et al. 2013
 Metabolic Change
 Weight Gain  Water metabolism  Protein metabolism
 Fat metabolism  Electrolyte & mineral metabolism  Leptin & Ghrelin

Tabel 1. Additional energy demand during normal pregnancy

↓ Insulin, Glucose
Synthesis

↑ Lipolysis

↑ Placental
Growth

↑ metabolic rate,
appetite, breats
development,
blood volume

↑ uterine blood
&blood flow
Lowensohn et al. 2016; Cunningham et al. 2013
 Metabolic Change
 Weight Gain  Water metabolism  Protein metabolism
 Fat metabolism  Electrolyte & mineral metabolism  Leptin & Ghrelin

Diagram of changes in osmolarlity in

Diurnal change in plasma glucose and insulin gestasional period
in normallate pregnancy
Cunningham et al. 2013
Recommended Daily Intake during Pregnancy and Dietary
Source of Macro and Micronutrein

Lowensohn et al. 2016

DEPLETION EXCCESSIVE

Small Gestation Age (SGA) macrosomia, ↑ ratio of

or Low Birth Weight caesarean sections & perinatal
(<2500) death of fetuses
Spontaneous birth ↑ the risk of
SGA is associated with an shoulder dystocia and brachial
increased risk of adult plexus injury
metabolic disease (ex:
anesthesiological complications
Type 2 Diabetes) difficulties in intubation, necessity of high
dosages of anesthetic medication administration,
problems with subarachnoideal and epidural
deficits in children’s anesthesia
development endometritis in puerperium,
thrombosis, vulvitis and
stunting of linear growth infections of urinary tract

causes 12% of child decreased percentage of breast-

feeding women
deaths
Black. 2013; Lowensohn et al. 2016; Agnieszka. 2007

Balance Nutrition Principal

 Ante Natal Care
1) Melengkapi Riwayat Medis

2) Pemeriksaan Fisik Umum

3) Pemeriksaan Fisik
Obstetri  60 mg zat besi elemental = 320
sulfasferosus (segera setelah tidak mual)
4) Pemeriksaan Penunjang
 400 μg asam folat 1x/hari
5) Pemberian Suplemen dan  Kalsium 1.5-2g/hari (area asupan
Pencegahan Penyakit rendah, cegah preeklamsi)

 75 mg Aspirin 1x/hari (Untuk risiko

6) Konseling, Informasi, & tinggi Preeklamsia)
Edukasi
 Vaksin Tetanus Toksoid

7) Identifikasi Komplikasi
dan Melakukan Rujukan
WHO dan Kemenkes RI.2013
 Developing countries contribute over 99% of
maternal deaths in the world
Maternal
Indonesia ranks 5th Problem,
In the largest number of maternal deaths
One of the highest Indonesia
Maternal Mortality Ratio (MMR) in Southeast Asia
Facing
Kematian Neonatal hingga
Preeklamsi Hemorrhage Infection Jaundice 12 per 1.000 KH dan
Angka Kematian Balita 25
25.0% bleeding per 1.000 KH
14.9% Prematurity
4.7% Fever Target Of
2.1% Convulsion During delivery Interventions SDG’S
49.1% Prolonged labor
21.1% Premature rupture of membrane AKI hingga di bawah 70
10.6% Bleeding infection per 100.000 KH
2.3% Convulsion
6.4% Other

Widyaningsih et al. 2017; Kemenkes RI.2015

Referrences
Line: Fentiendr
Email: fenendriyani@gmail.com