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Regulation Of The Minister Of Health The Number 97 By 2014

Original Language Title: Peraturan Menteri Kesehatan Nomor 97 Tahun 2014

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REPUBLIC OF INDONESIA NEWS

No. 135, 2015 FRANKKES. The Time Before It Was Pregnant. Pregnant. Give me a copy. Give birth. Contraception. Sexual Health. Medical Services.

REGULATION OF THE REPUBLIC OF INDONESIA HEALTH MINISTER

NUMBER 97 IN 2014

ABOUT

HEALTH CARE MINISTRY PRIOR TO PREGNANCY, MATERNITY, CHILDBIRTH, AND AFTER GIVING BIRTH, HOSTING SERVICES CONTRACEPTIVE, AS WELL AS SEXUAL HEALTH CARE

WITH THE GRACE OF GOD ALMIGHTY

THE HEALTH MINISTER OF THE REPUBLIC OF INDONESIA,

DRAW: that to implement the provisions of Article 18, Section 25, and Article 28 of the Government Regulation No. 61 Year 2014 on Health Reproduction, need to establish the Minister of Health ' s Regulation on Health Care of the Future of Hamil, the Time of Hamil, Childbirth, and After Childbirth, The Implementation Of Contraceptive Services, As Well As Sexual Health Services;

Given: 1. Law Number 29 Of 2004 On The Practice Of Medicine (sheet Of State Of The Republic Of Indonesia In 2004 Number 116, Additional Sheet Of The Republic Of Indonesia Indonesia Number 4431);

2. Law No. 36 Year 2009 on Health (State Sheet of the Republic of Indonesia Year 2009 Number 144, Additional Gazette of the Republic of Indonesia 5063);

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2015, No. 135 2

3. Law No. 23 Year 2014 on Local Government (sheet of State of the Republic of Indonesia 2014 No. 244, Additional Gazette Republic of Indonesia Number 5584);

4. Law Number 36 Year 2014 on Health Power (Indonesian Republic of Indonesia Year 2014 Number 298, Additional Gazette Republic of Indonesia Number 5607);

5. Government Regulation No. 38 of 2007 On the Division of Government Affairs between Government, Provincial Government, and District/City Government (State Gazette of 2007 Indonesia Number 82, Extra State Sheet) Republic of Indonesia No. 4737);

6. Government Regulation No. 33 Year 2012 on Giving Mother Milk Exclusive (sheet Of State Of The Republic Of Indonesia Indonesia Year 2012 Number 58, Additional Gazette Of The Republic Of Indonesia Number 5291);

7. Government Regulation No. 61 of 2014 on Reproductive Health (Sheet Country Indonesia Republic Indonesia Year 2014 Number 169, Additional Sheet Republic Of Indonesia Number 5559);

8. Ministry of Health Regulation Number 1144 /Menkes/Per/VIII/2010 on the Organization and the Working Services of the Ministry of Health (News of the Republic of Indonesia 2010 Number 585) as amended by the Regulation of the Minister of Health Number 35 Year 2013 (State News of the Republic of Indonesia 2013 No. 741);

9. Regulation of Health Minister Number 25 of 2014 on Child Health Efforts (Republic of the Republic of Indonesia News 2014 No. 825);

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2015, No. 1353

DECIDED:

SET: THE HEALTH MINISTER ' S REGULATION ON HEALTH CARE BEFORE PREGNANCY, MATERNITY, CHILDBIRTH, AND AFTER CHILDBIRTH, THE HOSTING OF CONTRACEPTIVE SERVICES, AS WELL AS SERVICE SEXUAL HEALTH.

BAB I

provisions of UMUM

Article 1

In Regulation of this Minister referred to:

1. Pre-Pregnant Health Services are any activities and/or a series of activities aimed at women from adoleschood up to the time before becoming pregnant in order to prepare women to become healthy.

2. Maternity Health Services are any activity and/or a series of activities performed since conception until childbirth.

3. Birth Health Service, which is subsequently called Percopy is any activity and/or series of activities aimed at the mother since the start of the delivery of up to 6 (six) hours after giving birth.

4. After the birth of childbirth is any activity and/or a series of activities performed on the mother during the time of nifas and the service that supports babies who are given birth until the age of 2 (two) years.

5. Sexual Health Services are any activity and/or a series of activities aimed at the health of sexuality.

6. Perinatal maternal audits are a series of search for death or maternal pain, perinatal and neonatal activities to prevent similar pain or death in the coming days.

7. The next Central Government is called the Government of the Republic of Indonesia which holds the power of government, the State of the Republic of Indonesia as referred to in the Basic Law of the Republic of Indonesia in 1945.

8. The Regional Government is the Governor, the Regent or the Mayor and the area's device as an element of the holding of the local government.

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9. The Minister is the Minister for Government Affairs in the field of health.

Article 2

Health Care Settings of the Time Before Hamil, Hamil, Percopy, and After Childbirth, The Hosting Of Contraceptive Services, and the Sexual Health Service aims to:

a. guarantee the health of the mother so that it is able to deliver a healthy and quality generation;

b. reduce the pain rates and mortality rates of newborn mothers and babies;

c. guarantees the achieved quality of life and the fulfillment of reproductive rights; and

d. maintain and improve the quality of maternal and newborn health care services that are quality, secure and beneficial in accordance with the development of science and technology.

Article 3

Government, provincial local government, and The local government/city government guarantees the availability of health resources, means, infrastructure, and the hosting of Health Services prior to the Hamil, Hamil, Percopy, and Childbirth, The Delivery Of Contraceptive Services, and Sexual Health Services.

Article 4

(1) Health Service Pre-Pregnant, Pregnant, Percopy, and Childbirth, Contraceptive Services, and Sexual Health Services are held with a promotional, preventive, curative, and rehabilitative approach to which it is performed. Comprehensive and continuous.

(2) The Health Services of the Time of Hamil, the Time of Hamil, Percopy, and the Childbirth, The Staging Of Contraceptive Services, as well as Sexual Health Services as referred to in paragraph (1) performed by default.

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BAB II

HEALTH SERVICE PRIOR TO PREGNANCY, PREGNANCY, CHILDBIRTH, AND AFTER GIVING BIRTH

Part Of The Kesatu

Future Health Service

Section 5

(1) Service Pre-pregnancy health is performed to prepare for women in pregnancy and healthy childbirth and have a healthy baby.

(2) The Health Service Prior to Hamil as contemplated in verse (1) done on:

a. teen;

b. bride candidate; and/or

c. pair of fertile age.

(3) The Future Health Service Activities Prior to Hamil as referred to in paragraph (1) include:

a. physical examination;

b. Support check;

c. Immunization;

d. nutrition supplementation;

e. health consultation; and

f. Other health services.

Section 6

(1) Physical examinations as referred to in Section 5 of the paragraph (3) the least include:

a. vital sign check; and

b. nutrition status check.

(2) The examination of nutritional status as referred to in paragraph (1) letter b should be done especially for:

a. Tackling a problem with less energy than Kronis (KEK); and

b. Anemic status check.

Article 7

Examination checks as referred to in Section 5 of the letter b are the health services performed based on medical indications, consisting of:

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a. Routine blood check;

b. Recommended blood check;

c. examination of sexually transmitted diseases;

d. routine urine check; and

e. other support checks.

Section 8

(1) The immunization as referred to in Article 5 of the paragraph (3) of the letter c is performed in the preventive and protection efforts against the Tetanus disease.

(2) Tetanus immunization Toxoid (TT) as referred to in verse (1) is performed to achieve the status of T5 results of basic and advanced immunization.

(3) The status of T5 as referred to in verse (2) is intended for women of fertile age to have full immunity.

(4) In terms of the immunization status not yet achieved the status of T5 while granting basic immunization and Advanced as it is in verse (2), the granting of tetanus toxoid immunization may be performed as the bride's candidate.

(5) The provisions of the granting of tetanus toxoid immunization as referred to in paragraph (2) performed in accordance with the provisions of the laws.

Article 9

(1) The supplementation of nutrition as referred to in Article 5 of the paragraph (3) the letter d aims for the prevention of nutritional anemia.

(2) The supplementation of nutrition supplementation for the prevention of nutritional anemia as referred to in paragraph (1) is executed in the form of balanced nutrition and blood-added tablets.

Article 10

(1) The health consultation as referred to in Article 5 of the paragraph (3) of the letter e of communication, information, and education.

(2) Communication, information, and education as referred to in paragraph (1) may be provided by health and non-health personnel.

(3) The nonhealth as referred to in verse (2) includes school health care teachers, guidance teachers and counseling, trained cadres, middle-aged counselors, and other trained officers.

(4) Communication, information, and education as referred to in paragraph (1) among others is given through a question of answer, group

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guided discussion, and interactive discussions using the means and media of communication, information, and education.

Section 11

(1) The information of information communication and education as contemplated in Article 10 of the paragraph (1) is performed according to the stage of mental development and needs.

(2) Communication, information, and education-giving materials for adolescents include:

a. Clean and Healthy Living Behavior (PHBS);

b. growing the fireworks of the School Age Children and the Teen;

c. reproductive health;

d. immunization;

e. soul health and NAPZA;

f. nutrition;

g. Infectious diseases include HIV and AIDS;

h. Healthy Life Skills Education (PKHS); and

i. Intelegensian health.

(3) Communication, information, and educational information for prospective brides and spouses of fertile age (preception) include:

a. Prenuptial information includes:

1. Reproductive health and life cycle approach;

2. reproductive rights;

3. preparations that need to be done in premarital preparation; and

4. other information required;

b. information on fairness and gender equality in marriage including male role in health.

(4) The prenuptial preparation is as referred to a verse (3) letter a number 3 among other physical preparation, nutritional preparation, immunization status Tetanus Toxoid, and maintaining the health of the reproductive organs.

Second Quarter

Hamil Health Service

Article 12

(1) The Hamil Health Service aims to meet the rights of every pregnant mother acquiring a service quality that is of quality so that it is able to undergo pregnancy healthy, maternity with Congratulations, and give birth to a healthy, quality baby.

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(2) The Hamil Health Service as referred to in paragraph (1) is carried out from the occurrence of conception until prior to the start of the labor process

(3) the Hamil Health Service in question on the paragraph (1) is mandatory through a unified antenatal service.

(4) The integrated antenatal service as referred to in paragraph (3) is a comprehensive and qualified health service that is performed through:

a. Health care and nutrition services include stimulation and nutrition for the pregnancy to be healthy and the fetus is born healthy and intelligent;

b. problem early detection of problems, disease and purification/pregnancy complications;

c. a clean and secure delivery of a copy;

d. Anticipating planning and preparation for conducting referrals in the event of an ulit/complication.

e. the case of the case and the immediate and timely referrals when required; and

f. involve pregnant mothers, husbands, and their families in maintaining the health and nutrition of expectored mothers, preparing childbirth and preparedness in the event of complications/complications.

Article 13

(1) The Hamil Health Service is performed at least 4 (four) times during the period of pregnancy performed:

a. 1 (One) times in the first trimester;

b. 1 (One) times in the second trimester; and

c. 2 (Two) times in the third trimester

(2) The Hamil Health Service as referred to in paragraph (1) is performed by a health force that has the competence and authority.

(3) The Hamil Health Service is referred to on the verse (1) must be done according to the standard and recorded in the KIA book.

(4) The provisions of KIA books are conducted in accordance with the provisions of the laws.

Third Section

Percopy

Article 14

(1) Percopy must be performed at a health care facility.

(2) Percopy as referred to in paragraph (1) is provided to the mother

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Maternity in form 5 (five) basic aspects include:

a. make the clinic decision;

b. the care of the mother and baby baby;

c. prevention of infection;

d. (Medical records) of the labor upbringing; and

e. reference to the case of complications of a newborn mother and newborn.

(3) Percopies as referred to in verse (2) are performed in accordance with the normal standard Percopy Upbringing (APN).

Fourth Quarter

The Future Health Service After Giving Birth

Article 15

(1) The Time Health Service After Giving Birth includes:

a. health care service for mothers; and

b. New baby health services are born.

(2) Health care for mothers as referred to in paragraph (1) the letter at least 3 (three) times during nifas.

(3) Health care for mothers as referred to in verse (2) performed with the terms of the examination time including:

a. 1 (One) times in period 6 (six) hours up to 3 (three) postcopy days;

b. 1 (One) times in period 4 (4) days up to 28 (twenty-eight) pascaperated days; and

c. 1 (One) times in period 29 (twenty-nine) days up to 42 (forty-two) postcopy day.

(4) The maternal health care activity as referred to in paragraph (1) of the letter includes:

a. Blood pressure check, pulse, respiration and temperature;

b. Uteri fundus high check;

c. checkpoint loanhia and bleeding;

d. road check was born;

e. Exclusive breastfeeding and breast-giving advice;

f. Vitamin A capsule is given;

g. pascapercopy contraceptive service;

h. counseling; and

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i. the high risk management and the complications of the nifas.

(5) Health services for newbores as referred to in paragraph (1) letter b are exercised in accordance with the provisions of the inviters.

Article 16

(1) Pascapercopy contraceptive services as referred to in Section 15 paragraph (4) of the letter g aims to maintain the next pregnancy distance or limit the number of children executed in the nifas

(2) Contraceptive services as referred to in verse (1) are carried out through the selection of contraceptive methods according to the choice of husband and wife couple, as indicated, and do not affect the production of Mother's Milk.

Article 17

Conditions more Go on about the Health Services of the Time of Hamil, the time of Hamil, Percopy, and the Afterlife. Giving birth as set forth in Appendix I which is an inseparable part of this Minister's Rule.

BAB III

HOSTING CONTRACEPTIVE SERVICES

section 18

(1) Contraception Ministry's Service is done in a way that is possible in terms of religion, cultural norms, ethics, and health.

(2) The contraceptive service as referred to in paragraph (1) includes:

a. Contraceptive movement movement;

b. granting or installation of contraception; and

c. handling of the side effects, complications, and contraceptive failure.

Article 19

(1) The contraceptive service movement as referred to in Article 18 of the paragraph (2) a letter is performed before service until a fertile age couple is ready to choose the contraceptive method.

(2) The contraceptive service movement as referred to in verse (1) is carried out continuously by health and nonhealth resources accordingly. with the provisions of the laws.

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Article 20

(1) The granting or installation of the contraceptive as referred to in Article 18 of the paragraph (2) letter b must be preceded by counselling and consent of the medics (Informed Consent).

(2) Counseling as referred to in paragraph (1) may be performed at a health care facility or other place of service.

(3) Counseling as referred to in paragraph (1) of communication, information, and education on methods contraceptive.

(4) The information as referred to a verse (3) must be done in complete and sufficient so that the patient can decide to choose the contraceptive method to be used (informed choise).

Article 21

(1) Handling of contraceptive effects, complications, and contraceptive failure as referred to in Article 18 of the paragraph (2) of the letter c performed by the health force may be counselling, service by default, and/or referral to an advanced health care facility.

(2) The side effect as referred to in verse (1) is an unintended effect due to the use of the contraceptive tool but does not cause serious consequences.

(3) Replicated The contraceptive as referred to in paragraph (1) is a mild health disorder until heavy for clients that occur as a result of the giving/installation of the contraceptive method.

(4) The contraceptive failure as referred to in paragraph (1) is the occurrence of a pregnancy on an active KB acceptor that at the time used the method contraceptive.

(5) In the event of a contraceptive failure as referred to in paragraph (4), health care must provide counseling to the mother and her partner to prevent the psychological impact of an unwanted pregnancy.

Article 22

(1) The choice of contraceptive methods performed by the husband ' s husband spouse must consider age, parity, number of children, health conditions, and religious norms.

(2) The choice of contraceptive methods as referred to a verse (1) follows the rational contraceptive method according to the phase that the spouse of the spouse is facing includes:

a. delay pregnancy on young couples or mothers who have not aged 20 (twenty) years;

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b. Pregnancy in a married couple is between 20 (twenty) to 35 (thirty-five) years; or

c. does not want a pregnancy on a married couple over 35 (thirty-five) years.

Article 23

(1) The contraceptive method as referred to in Article 22 may be:

a. short term contraceptive method; and

b. long-term contraceptive method

(2) Short-term contraceptive method as referred to in paragraph (2) letters a include syringe, pills, and condoms.

(3) The delivery of short-term contraceptive methods of pills and condoms as intended in paragraph (2) performed at a health care facility or other facility.

(4) the long-term contraceptive method as referred to in paragraph (1) letter b includes the Contraceptive Device In Utero (AKDR), The Contraceptive Device Bottom of Skin or implants, Male Operating Methods (MOP), and Women ' s Operating Methods (MOW) must exercised by standard in the health care facility.

(5) The delivery of short-term contraceptive method is referred to in verse (2) and the long-term contraceptive method as referred to in paragraph (4) must be done by a competent health force.

(6) In terms of the spouse of the husband ' s husband choosing a short-term contraceptive method of pills as referred to in verse (2), the granting of service for the first time must be done by the power health.

Article 24

(1) The emergency contraception is given to the mother not protected contraception or rape victims to prevent pregnancy.

(2) The emergency contraceptive service on the unprotected mother of contraception as referred to in paragraph (1) includes:

a. a leaking condom, loose or misusing it;

b. The diaphragm is broken, torn or removed too quickly;

c. The senggama failure is cut off (e.g.: ejaculation in the vagina or on externa genitalia)

d. Miscalculated good times;

e. IUDs expulsions;

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f. forget to drink KB pills more than 2 tablets;

g. late more than 1 week for the KB injectable each month; and

h. too late for more than 2 weeks for the three-monthly KB syringe

(3) Emergency contraceptive giving as specified in paragraph (1) must be done by the health care standard.

Article 25

Further provisions are about Implementation of the Contraceptive Service as set forth in Appendix II which is an inseparable part of the Regulation of this Minister.

BAB IV

SEXUAL HEALTH MINISTRY

Article 26

(1) Health Service Sexual is given that every woman leads a sexual life with a partner lawful to allow couples to enjoy healthy, safe, uncoerced and discriminatory sexual relations, free from violence, fear, shame and guilt.

(2) Sexual health as referred to in paragraph (1) includes a sexual life that is:

a. free from sexually transmitted infections;

b. free of dysfunction and sexual orientation disorder;

c. freed from physical and mental violence;

d. able to set up a pregnancy; and

e. in accordance with ethics and morality.

Article 27

(1) Sexual Health Service is conducted on first-level health care facilities and advanced health care facilities.

(2) Sexual Health Services as referred to in paragraph (1) may be integrated with the health care or other health promotion program,

(3) the Integrated Health Service of other health services as referred to in paragraph (1) priority on:

a. Teen health care ministry;

b. Reproductive health services and contraceptive services;

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c. antenatal services; and

d. health services on sexually transmitted infections.

(4) Sexual Health Services integrated on other health promotion programs as referred to in paragraph (1) among other public service ads, health promotion for teen and adult youth, and other health promotion programs.

(5) In terms of Sexual Health Services integrated with the promotion of health for adolescents and young adults as referred to in verse (4), expected youth and young adults understood about his sexual state so that it can protect himself from pregnancy that undesirable, unsafe abortions, IMS including HIV and AIDS and the possibility of suffering from infertility through responsible sexual behavior, including abstinent abstinent.

Article 28

(1) Sexual Health Care Service executed at first-level health care facilities done in the form:

a. social skills;

b. communications, information, and education;

c. Counseling;

d. treatment; and

e. treatment.

(2) Social skills as referred to a (1) letter a performed in the form of a healthy life skills education (life skill education)

(3) counselling as referred to in paragraph (1) letter c executed with information given about the behavior of sexual deviation or the breakdown of sexuality and its influence on health.

Article 29

(1) Sexual services in the form of social skills, communication, information, and education, as well as Counseling as referred to in Section 28 of the paragraph (2) of the letter a, letter b, and the letter c is a basic sexual service that can be performed by a trained health workforce.

(2) Health services in the form of treatment and treatment as referred to in paragraph (2) d and letter e only performed by doctors trained.

(3) In case there is a heavy sexual health case, a trained doctor as referred to a paragraph (4) must do

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referrals in accordance with the provisions of the laws.

BAB V

MANAGEMENT SUPPORT

Section Kesatu

Pencatatan and Reporting

Section 30

(1) Any health care facility in order to improve the quality of maternal health services must perform the Seekers and Reporting in accordance with the applicable mechanism.

(2) The mother health care reporting and Reporting Act as referred to in paragraph (1) consists of:

a. account and reporting of maternal health care results; and

b. Note and reporting of mother pain

c. The records and reporting of mother's death (mother's death surveilans).

(3) Mother health care reporting and reporting as referred to in paragraph (2) is performed in a single level.

Second Part

Surveilans of Mother and Child Health

Section 31

(1) The Mother Health Surveilans and Child is a systematic and continuous observation of data and information about the incidence or health issues of mothers and children and conditions that affect the increased coverage or quality of maternal and child health services. to obtain and provide information to host a mother's health service and child is effectively and efficiently.

(2) The Health and Child Health Surveilans as referred to in paragraph (1) include

a. record and reporting;

b. local area monitoring; and

c. perinatal maternal audits;

d. The follow-up response

Section 32

The search and reporting as referred to in Section 31 of the paragraph (2) of the letter includes:

a. Mother and Child Health Services;

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b. baby birth;

c. The pain of mother and child; and

d. the death of mother and child.

Article 33

(1) The monitoring of the local region as referred to in Section 31 of the letter b is done through the activities of collecting, processing, analyzing and interpresing the data and dissemination information to program organizers and related parties for the follow-up.

(2) The monitoring of local territory as referred to in paragraph (1) includes collecting, processing, analyzing and interpresing data and dissemination of the data. information to program organizers and related agencies for follow-up.

Article 34

(1) the perinatal maternal Audit as referred to in Article 31 of the paragraph (2) of the letter c is performed against each case of the death and pain of the pregnant mother, childbirth, and the period after giving birth, and newboric baby.

(2) Perinatal maternal audits as referred to in paragraph (1) must be done through a deep qualitative investigation regarding maternal and perinatal death situations and perinatal situations.

(3) Perinatal Maternal Audit as referred to in paragraph (1) hosted by the team at the county/city and provincial level.

(4) Maternal Audit Perinatal as referred to in paragraph (1) is performed to improve and maintain the quality of maternal and child health services.

(5) The perinatal maternal audit results are the basis for the implementation of the intervention consisting of:

a. the improvement of antenatal services capable of detecting and handling a high risk case adequately;

b. a clean and secure delivery of labor by skilled health care, post-natal services and births;

c. The Basic Neonatal and Basic Neonatal Services (PONED) and Comprehensive Neonatal and Neonatal Comprehensive Services (PONEK) services are reachable; and/or

d. Effective referrals for high risk cases and complications occur.

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Section 35

The follow-up response as referred to in Section 31 of the paragraph (2) of the letter d is based on the results of the analysis and interpretation of local area monitoring and perinatal maternal audits through disseminate information to program and party organizers related to the follow-up.

Third Section

The Military Breeding

Section 36

(1) In the framework of coaching, quality assurance, and planning on Maternal health care, a supervision in the form of facilitative breeding.

(2) A facilitative breeding as referred to in verse (1) is performed in a continuous way by using the instrument of a list of ticlies in accordance with the specified standard.

(3) The list of the tilic as referred to in paragraph (2) contains the following: Standards of health care and health care facilities management standards in providing health care.

Fourth Quarter

Accelerating Planning Decline Mother Death Figures

Section 37

(1) In order The Acceleration of Mother's Death Numbers, the Fast Forward Planning. The decline in Mother's Death Figures is done in a unified way.

(2) The Accelerating Planning Decline of Mother's Death Figures as referred to in paragraph (1) is proof-based.

(3) Based on the evidence as referred to in paragraph (2) includes maternal and child health survelans results as well as data, health information and other scientific studies that are valid and current.

Fifth Section

Integrated reproductive Health Service

Article 38

(1) Health Service Integrated reproduction is a health care activity that integrates all health care in the scope of reproductive health covering maternal and child health, family planning, adolescent reproductive health, prevention and countermeasures of sexually transmitted infections including countermeasures of HIV and AIDS, and ministry health

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Other reproduction.

(2) The Integrated reproductive Health Service as referred to in paragraph (1) is implemented according to the need at each stage of the life cycle beginning from the conception stage, the baby and children, adolescents, fertile age and advanced age.

(3) The Integrated reproductive Health Service as referred to in paragraph (1) is exercised at first-level health care facilities.

(4) The Integrated reproductive Health Service as referred to in paragraph (1) is intended to increase access and quality Reproductive health services through promotional, preventive, curative, and rehabilative efforts.

Article 39

Further provisions regarding Pencatatan and reporting, Surveilans of maternal and Child Health, Fasilitative breeding, Planning The acceleration in the decline in Mother's Death rate, and the Integrated reproductive Health Service as referred to in Article 30 to Section 38 are governed by the Minister's Rule.

BAB VI

HEALTH RESOURCES

Part Of The Consciousness

Health Service Facility

Article 40

Every service facility Health authorities are required to provide Health Services prior to pregnancy, maternity, childbirth, and future childbirth, birth control, and sexual health services in accordance with standards.

Article 41

(1) Facility First-level health care is mandatory for promotional, preventive, stabilization of cases and referencing cases that require referrals.

(2) Referring a case that requires a referral as referred to a paragraph (1) must be in condition. stable and punctual.

(3) Persuasion as in paragraph (1) is performed in accordance with the provisions of the laws.

(4) Referring a case that requires a referral as referred to in paragraph (1) can be done via the PONED Puskesmas and/or directly to an advanced level service facility.

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Second Section

Human Resources

Article 42

(1) Human resources in the health care ministry prior to becoming pregnant, pregnant, childbirth, and after-giving birth, and staging. Contraceptive services, including health and non-health care.

(2) Human resources in sexual health care must be health care.

(3) The health force as referred to in verse (1) and verse (2) are A power that has the competence and authority to the provisions of the laws.

(4) In the event of an area no health force has the competence and authority as referred to in paragraph (3), the other trained health care may receive an assignment.

(5) The assignment as referred to in the verse (3) is performed by the head of the local health service after obtaining consideration of the related profession organization.

Article 43

(1) The nonhealth that provides the health care of the pre-pregnant, pregnant, childbirth, and After childbirth, and the establishment of contraceptive services, trained personnel.

(2) The health care of the time before pregnancy, maternity, childbirth, and future childbirth, and the hosting of contraceptive services, which is given by the nonhealth force as referred to the paragraph (1) only

(1) In addition to providing the Health Service prior to pregnancy, maternity, childbirth, and future childbirth, the hosting of contraceptive services, and sexual health services, health care as referred to in Article 42 must perform the handling Complications include complications:

a. obstetrics;

b. Infectious diseases and infectious diseases are not contagious; and

c. nutritional problems.

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(2) The handling of complications as referred to in paragraph (1) is performed according to standard.

The Third Section

Availability of health and health provisions

Article 45

(1) Government and government Areas guarantee availability, alignment, and affordability of medicine and health supplies in the course of health care before becoming pregnant, pregnant, childbirth, and after childbirth, the implementation of contraceptive services, and sexual health care.

(2) Drug and health supplies as referred to the paragraph (1) to meet the security, efficacy, and quality requirements.

(3) The health supply as referred to in paragraph (2) is all the necessary materials and medical equipment in the course of the health ministry of the prior health. Pregnant, pregnant, childbirth, and after giving birth, birth control, and sexual health services.

(4) The medik tool as referred to in verse (3) must be in the ready state and with care. safety and safety of patients (patient safety).

BAB VII

EMPOWERMENT OF SOCIETY

Article 46

(1) In order to help accelerate the attainment of maternal health degree the optimal role as well as society is both individual and organized.

(2) The role as well as the society as referred to in verse (1) can be:

a. Delivery of the Cloud Service is available for the following: the holding of a pregnant mother class;

c. a midwife partnership and quack; and

d. home-waiting house.

(3) The role as well as the society as referred to in verse (1) can be developed in other forms according to the local conditions and needs.

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Section 47

(1) Percopy planning program and the prevention of complications as referred to in Article 46 of the paragraph (2) letter a is an activity in order to improve the scope and quality of health care for mothers and newbores.

(2) The program planning and prevention of complications as referred to in paragraph (1) is carried out through the increased active role of husband, family and society in planning for a copy of which safe and preparation facing pregnancy complications, childbirth and nifas including planning the use of post-copy contraceptive tools.

(3) The activities of the percopy planning program and the prevention of complications as referred to in paragraph (1) are:

a. Expectate and mapping of the pregnant mother's goals;

b. Blood donor preparation;

c. The investigation of maternity savings (tabulin) and maternity care social funds (dasolin);

d. An ambulance (transport);

e. the introduction of pregnancy and Percopy hazards signs; and

f. signing of the mandate of Percopy.

Article 48

(1) The person of the maternity class is referred to in Article 46 of the paragraph (2) the letter b aims to increase maternal knowledge and skills regarding pregnancy, childbirth, care nifas, family planning, newborn baby care and pregnant gymnasts.

(2) The pregnant mother class as referred to in verse (1) is done through the provision of means to study groups for pregnant mothers, in the form of face-to-face, and The organizers must be conducted by the health care provider. (antenatal) and be followed by all pregnant mothers, spouses and or families.

(3) Sarana as referred to in verse (1) may be a health care facility, a posyandu, village hall and a resident home.

Article 49

(1) The partnership between midwife and shaman as referred to in Article 46 of the paragraph (2) of the letter c may be made to improve the scope of the aid of labor by the health care facility.

(2) The partnership between midwife and shaman. as referred to in paragraph

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(1) is only performed on certain areas by considering cultural social constraints.

(3) The partnership between midwife and shaman as referred to in paragraph (1) is poured in a deal in writing between the two parties and at least known to the local Chief Village/Lurah.

Article 50

(1) The birth wait house as referred to in Article 46 of the paragraph (2) of the letter d is a place or room that serves as a place Temporary residence for her pregnant mother and her escort before or after the period of labor.

(2) The birth-waiting house referred to in verse (1) was formed in order to lower the death of the mother due to delay in aid and improve the quality of the aid of labor by health care in areas difficult to access to. health care facility.

Article 51

Further provisions regarding the Percopy and Prevention of Complications Planning Program, the hosting of the Pregnant Mother Class, the Bidan and Dukun Partnership, as well as the Nativity Waiting House as referred to in Article 46 to Section 50 is governed by the Regulation of the Minister.

BAB VIII

FUNDING

Article 52

(1) Financing of health care prior to pregnancy, maternity, childbirth, and future childbirth, the hosting of contraceptive services, and sexual health services are derived from Government, Local Government, public, private and other sources.

(2) The government as referred to in paragraph (1) is obligated to allocate health care funding of prior health care, maternity, childbirth, and future. giving birth, hosting contraceptive services, and sexual health services through The State Shopping Revenue Budget (APBN).

(3) Local government as referred to in paragraph (1) is obligated to allocate health care funding prior to conceivability, maternity, childbirth, and future after giving birth, hosting contraceptive services, and services sexual health through the Regional Shopping Revenue Budget (APBD).

(4) Funding sourced from public as well as private and source

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others as referred to in paragraph (1) are executed in accordance with the provisions of the laws.

BAB IX

COACHING AND SUPERVISION

Article 53

(1) The Minister conducts coaching and oversight of the hosting of the health care program prior to becoming pregnant, pregnant, childbirth, and after giving birth, the implementation of the contraceptive service, and the sexual health service.

(2) Coaching and Oversight referred to the paragraph (1) of standardization, technical guidance, and monitoring and evaluation.

(3) Coaching and Oversight As it is in a verse (1) it is done at least two (two) times a year.

Article 54

(1) The provincial government conducts coaching and supervision of the hosting of Health services prior to becoming pregnant, pregnant, childbirth, and after-giving birth, the hosting of contraceptive services, and (2) Coaching and supervision as referred to by paragraph (1) is performed at least 2 (two) times a year.

Article 55

(1) The municipal/municipal government conducts coaching and supervision over Hosting Health Services prior to pregnancy, maternity, childbirth, and after-giving birth, birth control, and sexual health services in its area by conducting health and medical training. health care facility.

(2) Coaching and Oversight as referred to in paragraph (1) is performed at least 2 (two) times a year.

BAB X

CLOSING provisions

Section 56

The rules of the Minister are in effect on the date of the invitation.

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For everyone to know it, ordering the Minister of the Union Regulation with its placement in the Republic of Indonesia News.

Set in Jakarta

on 30 December 2014

REPUBLIC OF INDONESIA HEALTH MINISTER,

NILA FARID MOELOEK

UNDRASED in Jakarta

on 28 January 2015

MINISTER FOR LAW AND HUMAN RIGHTS

REPUBLIC OF INDONESIA,

YASONNA H. LAOLY

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2015, No. 13525

ATTACHMENT I

HEALTH MINISTER REGULATION

REPUBLIC OF INDONESIA

NUMBER 97 IN 2014

ABOUT

THE HEALTH CARE MINISTRY PRIOR TO PREGNANCY, PREGNANT, CHILDBIRTH, AND THE FOLLOWING GIVING BIRTH, HOSTING CONTRACEPTIVE SERVICES, AS WELL AS SEXUAL HEALTH SERVICES.

INTEGRATED ANTENATAL SERVICES

I. INTRODUCTION

A. BACKGROUND

Nationally, our community ' s access to maternal health care tends to get better. While the current trend of Death (AKI) in Indonesia has been successfully lowered from the 390/ 100,000 live births (SDKI data in 1990) to 359/100,000 live births (2012 SDKI data). Nevertheless, if compared to the Millennium Development Goals (MDG) 5 target in 2015 amounted to 102 per 100,000 live births, so Indonesia still needs efforts and hard work to achieve it.

The factors contributed against maternal mortality, broadly categorically classified as direct causes and indirect causes. The immediate cause of maternal death is a factor related to pregnancy complications, childbirth and nifas such as bleeding, preeclampsia/eclampsia, infection, permisation of traffic and abortus. The indirect cause of maternal death is factors that weigh pregnant mothers like FOUR TOO (too young, too old, too often giving birth and too near birth distance) according to the 2002 SDKI as much as 22.5%, as well as in the United States. It complicates the process of handling pregnancy, childbirth and nifas such as THREE LATE (Too late to recognize the danger sign and take a decision, it's too late to reach a health facility and late in the handling of the arousal It's an emergency. Other important factors include pregnant mothers suffering from infectious diseases such as malaria, HIV/AIDS, tuberculosis, syphilis, and non-infectious diseases such as hypertension, diabetes mellitus, heart, mental illness, or the experiencing

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nutritional deficiency.

In addition there are still problems in the use of contraception. According to the 2012 SDKI data, the unmet-needis 8.5%. This condition is one of the causes of undesirable pregnancy and unsafe abortions, which can ultimately lead to pain and maternal mortality.

Malaria in pregnancy often raises complications. It's dangerous for you, the fetus and the baby. According to the 2013 Riskesdas data that the proportion of pregnant mothers is malaria with a RDT examination of 1.9% of which 1.3% of the Plasmodium Falcifarum parasite species, 0.4% of Plasmodium Vivax, and 0.2% Mix (a mixture of Plasmodium Falcifarum and Vivax). Where it can potentially contribute to the death of a mother in Indonesia. To address this, the activities that have been done include granting insecticide nets, malaria screening using RDT/microscopic, and treatment as early as possible for the HIV-positive expectanate mother using the Kina/ ACT. Based on P2PL data in 2013, of the 26 provinces of endemist malaria red and yellow (except DKI Jakarta, Banten, West Java, Central Java, East Java, and Bali) that pregnant mothers were given an insecticide mosquito net of 81% (391,640 mothers). Pregnant), pregnant mother performed screening using RDT/ Microscopis by 74.64% (337,796 pregnant mothers), a malaria positive mother with 940 pregnant mothers and a cure of 744 pregnant mothers. This suggests there are still missed opportunities of pregnant mothers in the endemic areas of red and yellow malaria that have not obtained a unified antenatal service with malaria optimally.

The other problem is HIV on pregnant mothers, in addition to Mother-to-child transmission, threatening the safety of her mother, can also be contagious. According to the Ministry of Health data in 2013, of 100,296 pregnant mothers who underwent HIV testing, 3,135 (3.1%) of pregnant mothers were tested positive for HIV.

Sifilis is one of the sexually transmitted infections that also needs to get attention. Pregnant women suffering from syphilis potentially to give birth to a baby with congenital syphilis. Ministry of Health data, from January-June 2013, as many as 10,353 pregnant mothers in syphilis, as many as 264 (2.5%) of pregnant mothers were declared positive syphilis.

Another infectious disease that is still a major issue of public health It is tuberculosis (TB). In pregnant women, TB can aggravate maternal health and nutritional status, as well as affecting growing janinand risk of contracting at

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the baby.

Chronic diseases such as hypertension, diabetes mellitus, heart, severe asthma, and mental disorders strongly affect maternal health conditions, fetuses and newbores are born. The treatment of chronic diseases in pregnant women is still not as expected and the data is not well recorded.

The nutritional deficiency in pregnant mothers is also still a public health issue that needs to receive special attention. Less zatiron intake in women in particular may cause anemia that will increase the risk of bleeding and give birth to a low birth weight, the prevalence of anemia in pregnant mothers of about 37.1% (Riskesdas2013). In addition to the lack of iron intake, anemia can also be caused due to the malledness and malaria. Another nutritional problem is the less energy of the chronicle (KEK) and the consumption of low-yodium salt. Based on Riskesdas ' 2013 data that the prevalence of the risk of a pregnant mother is 24.2%.

In addition to the handling of pregnancy problems and accompanying complications, it is necessary to increase the quality of the baby to be born, through the activities of brain booster covering fetal brain stimulation and a balanced nutritional intake in pregnant mothers.

The issue of Violence against Women (KtP) is a global issue associated with health and human rights. Pregnant women who get physical and psychic violence both from the husband and their closest people can influence pregnancy and fetal development.

The indicator used to describe maternity access to the ministry Antenatal coverage is K1-first contact and K4-contact 4 times with a health care workforce, by default. Based on the Riskesdas data that the coverage of expecatal mothers acquiring antenatal services has increased from 92.7% in the 2010 to 95.2% in 2013. Health care coverage increased from 79.0% in 2010 to 86.9% in 2013.Nevertheless, there is still inter-provincial and inter-county disparity/city disparity which is large enough. In addition to the gap, it is also found that pregnant mothers who do not receive a service should be given at the time of contact with the health care(missed opportunity).

To address those issues above, antenatal services at both government and private health facilities and individual practices/groups need to be held in comprehensive

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and integrated, spanning promotional, preventive and rehabilitative and rehabilitative efforts, which include KIA, nutrition, infectious disease control (immunization, HIV/AIDS, TB, malaria, sexually transmitted diseases), Disease handling is not contagious as well as some other local and specific programs according to the needs of the program.

B. Objectives

A unified antenatal service is a comprehensive and qualified antenatal service given to all expectated mothers.

The common goal:

To meet the rights of every pregnant mother obtained an antenatal service that quality so capable of undergoing a healthy pregnancy, maternity safely and giving birth to a healthy and quality baby.

The special purpose is:

1. Provides integrated, comprehensive and qualified antenatal services, including health and nutrition counseling of expectate mothers, birth control and breast counseling.

2. Dismissing "missed opportunity" on pregnant mothers in getting integrated, comprehensive, and quality antenatal services.

3. It detecationally detected the disorder/disorder that the pregnant mother suffered.

4. Intervening against abnormalities in pregnant mothers as early as possible.

5. Conducting a case referral to a health care facility in accordance with the existing referral system

C. TARGET SERVICE AND USER OF THE PLAYBOOK

1. Service objective:

All pregnant mothers are targeted for a unified antenatal service objective.

2. Guideline user

a. Health care that delivers maternal health care, newborn baby and family planning

b. Government and private health facilities that provide antenatal services

c. Cross-related programs at the central level, propinsi and

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county/city

d. Institutions of education and health care training (colleges, Poltekkes, STIKes, RS, Bapelkes, Training Center, and more).

e. Organization of related professions.

D. INDICATOR

1. First visit (K1)

K1 is the first contact of a pregnant mother with a health power that has competence, to obtain a unified and comprehensive service according to standard.

The first contact must be done as early as possible on The first trimester, preferably before week 8.

2. 4th visit (K4)

K4 is a pregnant mother with four or more contacts with a competency, in order to obtain a unified and comprehensive service to the standard (1-1-2).

Contact 4 times are done as follows: at least one time in the trimester I (0-12 weeks), at least one time in the 2nd trimester (> 12-24 weeks), and at least 2 times in the 3rd trimester (> 24 weeks to birth). Antenatal visits can be more than 4 times as needed and if there is a complaint, illness or pregnancy disorder.

3. Handling Complications (PK)

PK is the handling of obstetric complications, infectious and non-infectious diseases and nutritional problems that occur in the time of pregnancy, maternity and nifas. Services are provided by health care which has competence.

The frequent obstetrics, diseases and nutritional problems are: bleeding, preeclampsia/eclampsia, permissive copy, infection, abortus, malaria, HIV/AIDS, syphilis, TB, hypertension, diabetes meliitus, iron nutrition anemia (AGB) and less of chronic energy (KEK).

E. TARGET

In the Health Ministry Strategy Plan 2010-2014 has set a target for Antenatal Visit and Handling Complications as follows:

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THE NATIONAL TARGET YEAR

K1 K4 PK

2010 95 84 58.5

2011 96 88 63

2012 97 90 67

2013 98 93 71.5

2014 100 95 75

II. INTEGRATED ANTENATAL SERVICE

A. CONCEPT MINISTRY

Health services on expectable mothers cannot be separated by service of labor, the ministry of nifas and the health care of newbores. The quality of the antenatal services provided will affect the health of pregnant women and the fetus, maternity and newborn mothers as well as nifas mothers.

In the integrated antenatal service, health power must be able to ensure that pregnancy It is normal, able to detect the premature problems and illnesses that the pregnant mother experienced, to intervene in the future so that the pregnant mother is ready to undergo a normal copy.

Every pregnancy, in its development has a risk It's a purview or complication Therefore, antenatal services must be performed routinely, as per standard and integrated for qualified antenatal services.

The paddled antenatal service is a comprehensive and qualified health service that is performed. through:

a. Health care and nutrition services include nutrition and nutrition in order for pregnancy to be healthy and the fetus is born healthy and intelligent

b. problem early detection of problems, disease and purification/pregnancy complications

c. a clean and safe preparation of a copy;

d. Anticipating planning and preparation for conducting a referral if there is a complication/complication.

e. The case of the case and the immediate and timely referrals should be required.

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f. Involving pregnant women, her husband and family maintain the health and nutrition of a pregnant mother, preparing childbirth and preparedness in the event of an ulit/complication.

The comprehensive and integrated antenatal framework framework

In performing antenatal checks, the health care must provide a quality service as standard is made up of:

1. Weight gain and body weight gain

Weight weight gain at each time antenatal visit is performed to detect the presence of fetal growth disorder. Weight gain of less than 9 kilograms during pregnancy or less than 1 kilogram each month indicates the presence of fetal growth disorder.

High measurement of the body in the first time a visit is performed for the presence of the child. A risk factor in a pregnant mother. The height of the pregnant mother's body is less than 145 cm to increase the risk for the occurrence of CPD (Cephalo Pelvic Dislocated)

2. Measurement of blood pressure

The measurement of blood pressure at each time antenatal visit is performed to detect the presence of hypertension (blood pressure ≥ 140/90 mmHg) in pregnancy and preeclampsia (hypertension is accompanied

Mother is pregnant with soul disorder

The handling of disease handling is not contagious and its follow-up

Infectious disease handling and its follow-up

Handling of mental disorders and its follow-up,

pregnant Sehat

Pregnant mother with obstetrics complications

ANC

Pregnant mothers are at risk

Pregnant mothers with non-infectious diseases

Mother is pregnant with infectious disease

The nutrition handling and follow-up

planning for the delivery safe at the health facility

Handling of complications and referrals

Perslinan Aman and Bersih

BBL Treatment

Mother Hamil

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edema face and or lower limbs; and or proteinuria)

3. The status value of Gizi (Ukur circumference over /LiLA)

The LiLA measurement is only done on first contact by the health force in the trimester I for screening mother hamilrisk KEK. Lacking in chronic energy here means the pregnant mother who suffers from malnutrition and has been prolonged (some months/year) where LiLA is less than 23.5 cm. Mothers pregnant with KEK will be able to give birth to a low birth weight baby (BBLR).

4. High measurement fundus uteri

The height measurement of fundus at each time antenatal visit is performed to detect the growth of the fetus according to or not with the age of pregnancy. If the height of the fundus does not correspond to the age of pregnancy, there is a possibility of foetal growth The measurement standard uses a measuring tape after a 24-week pregnancy

5. Determine fetal presentation and fetal heart rate (DJJ)

Determining the fetal presentation is performed at the end of the trimester II and next each time antenatal visit. This examination is intended to know the location of the fetus. If, in the trimester III the lower part of the fetus is not head, or the head of the fetus has not yet entered the pelvis means there are abnormalities, narrow pelvis or other problems.

DJJ ' s assessment is done at the end of the trimester I and next each time Antenatal visit. DJJ is less than 120 times/minutes or DJJ is fast over 160 times/minutes indicating the presence of an emergency.

6. Screening of tetanus immunization status and giving the tetanus Toksoid (TT) immunization if necessary

To prevent the occurrence of the tetanus neonatorum, the pregnant mother must have TT immunization. At the time of the first contact, the pregnant mother was diskrining her THer immunization status. The TT immunization of her pregnant mother, was given the current status of immunisasiTibu. The pregnant mother minimized the immunization status of T2agar to obtain protection against tetanus infection. Pregnant mothers with immunization status of T5 (TTLong Life) do not need to be given TT immunizations anymore.

The TT immunization has no maximum interval, there is only minimal interval. The minimum interval of TT immunization and its long protection can be seen in the following table:

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Imunicization TT

Selang minimum grant

Old immunization Protection

TT1

Initial steps of immune formation against disease

tetanus

TT2 1 month after TT1 3 Years

TT3 6 months after TT2 5 Years

TT4 12 months after TT 3 10 Years

TT5 12 months after TT4 ≥25 Years

7. Give the tablet more blood (iron tablet)

To prevent iron nutrition anemia, any pregnant mother must get a blood-added tablet (an iron tablet) and Folat Acid of at least 90 tablets during pregnancy given since first contact.

8. Check the lab (regular and special)

A lab check done on pregnant mothers is a routine and special laboratory check. A routine laboratory examination is a laboratory examination that must be performed on every pregnant mother, blood type, blood hemoglobin, and a specific examination of the endemist area/epidemic (malaria, HIV, etc.). While a special laboratory examination is another laboratory examination conducted over indications on pregnant mothers who did antenatal visits.

A laboratory check was conducted at the time the antenatal included:

a. Blood-class examination

The blood-class examination of the mother is not only to know the type of mother's blood type but also to prepare for the potential for blood donor, which is necessary in the event of a situation. gawatdaruratan.

b. Screening of Blood Hemoglobin (Hb) levels

Examination of pregnant maternal hemoglobin levels is performed at least once in the first trimester and once in the third trimester. This check was intended to find out that the pregnant mother had anemia or not during her pregnancy due to the condition

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anemia can affect the process of growing fetal flowers in utero. The examination of the blood hemoglobin content of pregnant mothers in the second trimester is carried out over an indication.

c. Protein screening in urine

The examination of protein in the urine in pregnant mothers is carried out in the second and third trimesters over indications. This examination is intended to determine the presence of proteinuria in a pregnant mother. Proteinuria is one of the indicators of pre-eclampsia in pregnant mothers.

d. Blood sugar levels check.

Pregnant mothers suspected of suffering from diabetes mellitus should be carried out on blood sugar screening during pregnancy at least once in the first trimester, once in the second trimester, and once in the third trimester.

e. Malaria blood check

All pregnant mothers in the endemic area Malariadido examination of Malaria ' s blood in order of screening at first contact. Pregnant women in the non endemis Malaria area carried out Malaria blood checks if there were any indications.

f. Sifilis test screening

A syphilis test check was carried out in areas with high risk and a pregnant mother who allegedly suffered from syphilis. Syphilis should be done as early as possible in pregnancy.

g. HIV screening

In the area of widespread and concentrated HIV epidemics, health care in mandatory health care facilities offers an HIV-tested all mothers pregnant inclusive at other routine laboratory checks at a time antenatal check or ahead of childbirth.

In areas of low HIV epidemic, HIV test offers by health care are prioritiously prioritiously with IMS and TB inclusive at routine laboratory screening other during antenatal check or ahead of delivery

Engineering offering this is called the Provider Initiated Testing and Councelling (PITC) or the HIV Test of the Health Service Providing and Counseling Initiative (TIPK).

h. BTA check

A BTA check was performed on a pregnant mother suspected of suffering from tuberculosis as a precaution for infection

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The tuberculosis does not affect fetal health.

In addition to the salacy above, if required can be done in a referral facility.

Given the case of bleeding and preeclamsi/eclamsi is the main cause of maternal death, hence the use of risk detection by bidan including village midwives including routine laboratory examination tools (blood type, Hb), vetting tools special laboratory (gluko-protein urine), and a pregnant test.

9. In the case of antenatal examination and laboratory examination results, every abnormality found in a pregnant mother must be handled in accordance with the standards and the health authority. Cases that cannot be addressed are referenced in accordance with the referral system.

10. Meet wicara (counseling)

Temu wicara (counseling) is performed on each antenatal visit that includes:

a. Mother's health

Every pregnant mother is encouraged to check her pregnancy regularly to the health of the health and advocate for her pregnant mother to rest sufficient during her pregnancy (about 9-10 hours per day) and not working heavily.

b. Lifestyle clean and healthy

Every pregnant mother is encouraged to maintain body hygiene during pregnancy e.g. washing hands before eating, shower 2 times a day by using soap, brushing your teeth after breakfast and before bed And do a light sport.

c. The husband/family role in pregnancy and childbirth planning

Every pregnant mother needs to get support from the family especially the husband in her pregnancy. Husbands, families or communities need to prepare the cost of childbirth, the needs of the baby, the transport of referrals and potential blood donors. This is important in the case of pregnancy complications, childbirth, and nifas to be taken to a health facility.

d. Signs of danger on pregnancy, childbirth and nifas as well as readiness to face complications

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Every pregnant mother is introduced to know the signs of good danger during pregnancy, childbirth, and nifas such as bleeding on pregnant young or pregnant, out of the liquid smelling on the way of birth during nifas, etc. Knowing the signs of danger is important for the expectant mother to immediately seek help to the health care power.

e. A balanced nutritional intake

During pregnancy, mothers are encouraged to get enough food intake with a balanced nutritional pattern because it is important for the process of growing fetal flowers and maternal health degrees. For example, pregnant mothers are advised to drink more blood-plus tablets to prevent anemia from being pregnant.

f. The symptoms of an infectious disease and are not contagious.

Every pregnant mother should know about the symptoms of infectious disease and the disease is not contagious because it can affect the health of the mother and the fetus.

g. The offer to conduct HIV and Counseling in the Epidemic area extends and is concentrated or mothers pregnant with STIs and TB in low-epidemic areas.

Every pregnant mother is offered for HIV tests and is immediately given information about The risk of an HIV transmission from a mother to her fetus. If the pregnant woman is HIV positive then the treatment of the HIV transmission from Mother to Child (PPIA) counselling the HIV transmission from the Child. For pregnant women who are negative given an explanation for keeping HIV negative is given an explanation for keeping HIV negative during pregnancy, breastfeeding and so on.

h. Initiation of the Early Scare (IMD) and exclusive breastfeeding

Each pregnant mother is recommended to provide breast milk to her baby soon after the baby is born because breast milk contains an essential immune substance for baby health. Breast feeding is continued until the baby is 6 months old.

i. KB passports

The pregnant mother was given a briefing about the importance of taking birth after childbirth to foster a pregnancy and that the mother had time to care for her own health, children, and family.

j. Immunization

Every pregnant mother must have an immunization status (T) that still provides protection to prevent the mother and baby from having tetanus neonatorum.

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Every minimum pregnant mother has a T2 immunization status to be protected against a tetanus infection.

k. The improvement of intelegenic health in pregnancy (Brain booster)

To be able to improve the intelegensia of babies to be born, expectable mothers are encouraged to provide auditory stimulation and fulfillment of brain-packing nutrients (brain booster) simultaneously in the pregnancy period.

B. SERVICE TYPE

A unified antenatal service is provided by the competent health care physician, midwife and trained nurse, in accordance with the applicable provisions.

The integrated antenatal service consists of:

1. Anamnesa

In giving a unified antenatal service, there are some things that need to be noticed when performing anamnesa, that is:

a. Asking for a complaint or a problem felt by the mother of the moment.

b. Asked for important signs associated with pregnancy and disease problems that were likely to be suffered from pregnant mothers:

o excessive Muntah

The nausea and vomiting may appear in young pregnancies especially in the morning but the condition is It's usually gone after a three-month pregnancy. This situation is nothing to worry about, unless it is hard enough, until it is unable to eat and the weight decreases steadily.

o Pusing

Pusing commonly appears in young pregnancy. If dizziness is interrupted, it is necessary to be alert.

o headache

The great headaches that arise in pregnant mothers may harm maternal and fetal health.

o Bleeding

The bleeding time is pregnant, although little is already a sign of danger so that the expectable mother should be alert.

o Great abdominal pain

Great stomach pain can harm the mother ' s health

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and the fetus.

o Demam

The high fever is over 2 days or the issuance of excessive fluid from the uterus and sometimes odour is one of the signs of danger in pregnancy.

o Batuk lama

Batuk for longer than 2 weeks, there needs to be an advanced examination and can be suspected of pregnant mothers suffering from TB.

o Thumping-debar

The beating heart of a pregnant mother is one of the problems of pregnancy to be alert.

o Fast tired

In the first two or three months of pregnancy, it usually arises a tired, sleepy feeling excessive and dizziness, which usually happens in the afternoon. The chances of a mother suffering lack of blood.

o Sesak breath or hard breathing

By the end of the month to eight pregnant mothers often feel a little tightness when breathing because the baby presses the mother ' s lungs. However, if this is overstated, it is necessary to be alert.

o Kewhithan which smells

The whiteness of the odor is one of the hallmarks of the pregnant mother.

o the fetal movement

The baby movement is starting to feel mother on Fourth-month pregnancy. If the fetal movement does not appear at this age of pregnancy, the decreasing movement or absence of movement then the pregnant mother should be alert.

o Behavior changes during pregnancy, such as rowdy, appealing, speaking alone, not bathing, dsb.

During pregnancy, mothers could experience changes in behavior. This is due to hormonal changes. In a condition that interferes with the health of the mother and the fetus, it will be consulted to a psychiatrist.

o History of violence against women (KtP) during pregnancy

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The information about violence against women especially pregnant mothers is often difficult to dig up. Victims of violence do not always want to be frank on the first visit, which may be caused by fear or have not yet been able to express the problem to others, including the health care officer. In these circumstances, the health officer is expected to recognize the victim and provide support in order to open up.

c. Asked for the status of a visit (new or old), the present history of pregnancy, the history of pregnancy and previous childbirth and the history of the illness the mother suffered.

d. Asking for the immunization status of a pregnant mother Tetanus

e. Asked for the number of blood-plus tablets (the Fe tablets) consumed by the pregnant mother

f. Asked of medications that were consumed like: antihypertension, diuretics, antivomitus, antipyretics, antibiotics, TBs and so on.

g. In the region of endemis malaria, ask symptoms of malaria and a history of malaria drug use.

h. At the high risk area of STIs, ask the symptoms of STIs and the history of the disease on her This information is important for the step-step of the sexual communicable disease.

i. Asking for a mother's diet during pregnancy that includes the amount, frequency and quality of food intake is associated with the gyzinya content.

j. Asking for readiness to face childbirth and torture the possibility of complications in pregnancy, among others:

o Who will help the delivery?

Every pregnant mother has to copy in the health care power.

o Where will the maternity?

The pregnant mother can copy diPoskesdes, Puskesmas or in the hospital?

o Who's with the mother when you copy?

By the time of maternity, the mother should be accompanied by a husband or a nearby family. People/community organizations, cadres, shamans and midwife are involved in readiness and alertness in the face of medical and neonatal care and neonatal care

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o Who's going to be a blood donor when there's bleeding?

This husband, family and society are setting up a prospective blood donor who can at any time donate his blood to the safety of the mother.

o Transport what will it be used if we should be referred to?

The transport tools can come from the public according to the joint agreement that can be used to usher in maternity candidates to the delivery area including referral sites. The transportation tools can be cars, ojek, rickshaw, bicycles, stretchers, boats, etc.

o Is it prepared for the cost of the delivery?

The husband is expected to be able to prepare funds for the delivery of the future mother. The cost of the delivery may also be tabulin (maternity savings) or dasolin (maternity care social fund) which can be used to help with the financing of antenatal, childbirth and glinchins.

The anamnesa information could be obtained. from your own mother, husband, family, cadre or other reliable information source.

Every mother is pregnant, on the first visit needs to be informed that antenatal care during pregnancy is minimum 4 times and at least 1 time a visit delivered by husband.

2. Examination

Examination in a unified antenatal service, covering various types of checks including assessing the general state (physical) and psychological (psychiatric) expectable mothers.

Table 2. Types of Integrated Antenatal Care Checks.

No Type Of Examination

TrimesterI Trimester II Trimester III

1 Public State of the Density

2 The body temperature of the body was added

3 Blood Pressure was added

4 LiLA was able to be found

6 LiLA was the case

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No Kind of Examination

TrimesterI Trimester II Trimester III

7 TFU were in the way

8 Presentation Janin was involved

9 DJJ The following were

10 Examination of Hb Preliminary Preliminary

11 Blood Fables

12 urine proteins of the following

13 Sugar darah/reduction

s protein malfunction

14 Malaria Blood Miculted release

15 BTA STATES Notes

16 IMS/ Sifilis The release of the current

17 HIV Iculology Resulting of its kind.

18 ultrasounds of the right to be used in the event

Ket:

conducted a routine check

: special: special: conducted examination of the indication

Endemic to the area of endemis will be a routine check

The event of the event: in the area of the epidemic that extends and concentrated or pregnant mothers with STIs and TB will be a routine check

The examination of the laboratory/support is done in the table above. If at the facility is not available, then the health force must refer to a pregnant mother to a higher health care facility.

3. Advanced handling and handling cases.

Based on the results of anamnesa, physical examination and other laboratory/support checks, doctors are enforcing a work diagnosis or an appeal diagnosis, while the midwife/nurse can recognize the normal state of the and troubled/abnormal circumstances in expectwomen.

Here is the handling and follow-up case in the integrated antenatal service.

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Table 3. Case & Advanced Case

No Results of Handling and Advanced Case

1 Pregnant Mother with antepartum bleeding

Emergencies, headers for bleeding handling as standard

2 Mother pregnant with fever o Tangani fever according to standard o If in 2 days the fever

or the general state worsens, immediately ruing

3 pregnant mothers with mild hypertension (blood pressure 140/90 mmHg) without proteinuria

o Tangani hypertension by default

o Check it back in 2 days, if blood pressure increases, promptly header.

o If there is a fetal disorder, immediately header.

o Counseling, diet food for hypertension in pregnancy

4 pregnant mothers with severe hypertension (diastole ≥ 110 mmHg) without proteinuria

Header for hypertension handling Standard by default.

5 pregnant mothers with pre eclampsia,

o Hipertension accompanied

o Edema face or bottom limb, and or

o Proteinuria (+)

The state of emergences, the header for pre-eclampsia handling is standard.

6 Pregnant Mother BB Less (BB rise < 1 Kg/month), or

Mother ' s pregnant risk KEK (LiLA < 23.5 cm)

Rujuk for maternity care handling of KEK risk according to standard.

7 Mom pregnant BB More (BB rise > 2Kg/month).

The header for further examination.

8 pregnant mothers with less tetanus immunization status

Rujuk to get TT vaccine injections in status

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No Results for Handling and Advanced Case

of T5 immunity

9 TFU did not match the age of pregnancy.

Rujuk for the handling of fetal growth disorder.

10 The fetal abnormalities of the trimester III.

Heading for pregnancy handling with fetal abnormalities.

11 Emergency Fetuses for emergency treatment

12 pregnant mothers with anaemia o Rujuk for anemia handling according to standard

o Counseling nutrition, diet food rich iron and protein

13 mothers pregnant with diabetes mellitus (DM).

o Rujuk for DM handling according to standard

o Counseling nutrition, diet food for pregnant mother DM

14 pregnant mothers with Malaria o Konselingsleep using insecticide mosquito nets

o Provide treatment as appropriate.

o Rujuk for further treatment in malariadengan complications.

15 pregnant mothers with tuberculosis (TB)

o Rujuk for TB handling according to standard

o Counseling nutrition, diet diet for pregnant TB TB

o Monitoring drinking TB drug

o TOffer HIV Test

16 pregnant mothers with IMS/ Sifilis

o Rujuk to IMS treatments include Sifilis in pregnant mothers and husbands according to standard

o TOffer HIV test

17 pregnant mothers with HIV o Counseling for childbirth plan

o Rujuk for HIV treatment according to standard

o Counseling nutrition, diet food

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No Handlers Handling and Tindak Case

for HIV expeccary mother

o Counseling feeding baby baby born from mother with HIV

17 pregnant mothers are likely to have a problem psychiatric

o Rujuk for mental health services.

o Pantau reciprocity referrals

o Cooperation with referral facility during pregnancy

18 pregnant mothers who experienced domestic violence

Rujuk to the hospital that has a Integrated Service Center facility (PPT) against victims of violence

18 pregnant mothers who experiencing domestic violence

Heading to the hospital that has Integrated Service Center (PPT) facilities against victims of violence

At any antenatal visit, all services include anamnesa, examination and The handling of the handling as well as the follow-up plan should be informed of the pregnant mother and her husband. Explain the signs of danger where pregnant mothers should come immediately to get help from health care.

If found abnormalities or abnormal circumstances on antenatal visits, inform the follow-up plan including the need reference to case handling, laboratory examination/support, ultrasound, consulting or treatment, as well as the next control schedule, if required to arrive sooner.

The pregnant mother who experienced domestic violence is the expectored mother Through all forms of violence that result, or perhaps. In effect, physically, sexually, sexually, mentally or suffering; including the threat of such acts, coercion or dissatisfaction of freedom, both in society and in private life.

Center The Integrated Service (PPT) of the victims of violence is the site of service to victims of violence both in public and private hospitals including police hospitals comprehensive by multidisciplinary bodies under one roof. (one stop services)

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4. Record of integrated antenatal check results.

The search results are part of a quality integrated antenatal service standard. Every time an examination, the health force is obliged to record the results on medical records, Mother Cards and KIA Books.

At this time record antenatal check results are still very weak, so the data could not be analyzed for improved antenatal service quality.

By applying the registrar as part of the standard of service, then the quality of the antenatal service can be improved.

5. Effective communication, information and education (KIE).

Effective KIE including counseling is part of a unified antenatal service given since the first contact to help expectate mothers in addressing the problem

Table 4. KIE materials are effective in integrated antenatal services

No Material KIE Fill messages

1 Preparatory and preparedness to face complications

o Signs of danger in pregnancy, childbirth and nifas.

o Tabulin

o Site of the copy

o Transport referral

o Penhelper labor

o Candidate blood donor

o Companion to copy

o Husband STANDBY (ready to take care)

2 Initiation of the exclusive breastfeeding and breast milk

o Skin to skin contact for IMD

o Kolostrum

o Rawat merge

o ASI alone 6 months

o Not given formula milk

o Desire to breastfeed

o Explanation of the importance of ASI

o Treatment of milk nipples

3 KB paska percopies o appropriate method in the time

nifas

4 nutritional problems o Iron tablet supplementation

o Consumption of iodine salt

o Consumption of solid calorie and iron-rich foods

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No Materials KIE Fill the message

o Extra food

5 Imunicization TT on expectable mother

o the importance of TT immunization in expectable mothers as a prevention and protection effort of mother and baby against tetanus

6 chronic disease and infectious diseases.

o precautionary efforts.

o Recognive the symptoms of the disease

o Applying PHBS

o Compliance drinking medicine.

7 Class moms o Each pregnant mother uses KIA book

o Exchange of experience between expectmom

o Senam pregnant

8 Brain booster o Communicating with fetuses

o Musik to stimulate fetuses

o Nutritions of nutrition balanced for expectable mothers.

9 HIV/AIDS information (PPIA/PMTCT) and IMS

o Definition of HIV, AIDS and IMS

o Penularan HIV and IMS

o The importance of HIV testing

10 KtP o INFORMATION VIOLENCE against women

o BenForms KtP

o Due to KtP

o Prevention and handling of KtP

III. INTEGRATED ANTENATAL SERVICES

To host a unified antenatal service is required a data-based management. The Ministry of Health establishes norms, standards, procedures and criteria (NSPK) for integrated antenatal services, including conducting advocacy, facilitation, co-ordination, coordination, monitoring and evaluation of the host and integrated antenatal services.

A. INPUT

The input required to host a unified antenatal service among others includes:

1. The existence of norms, standards, procedures and criteria (NSPK) of integrated antenatal services.

2. Center-level annual planning and budgeting,

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provincial and county/city for the holding of integrated antenatal services at the health care facility.

3. The existence of facilities and health facilities is standard in organizing a unified antenatal service.

4. The logistics needed to support a unified antenatal service.

5. The appropriate KIA program management power to manage integrated antenatal services at the levels of the province and the city/city.

6. The presence of healthcare is to provide a unified antenatal service to the standard.

7. System information and referral sites for each case in the implementation of a unified antenatal service.

8. The presence of information on the status of endemicity and high risk areas of the disease affecting pregnancy.

9. The program's implementation guidelines are associated with a unified antenatal service.

B. PROSES

1. The socialization of norms, standards, procedures and criteria (NSPK) of the integrated antenatal services are flees.

2. Planning and budgeting of the annual KIA program of central, provincial and county/city programs for the holding of integrated antenatal services at the health care facility.

3. Perform integrated antenatal services on the means and healthcare facilities.

4. Using logistics as needed in the holding of a unified antenatal service.

5. Standardization of the KIA program managers in the holding of integrated antenatal services at the levels of the province and the city/city.

6. The standard of health care in delivering a unified antenatal service.

7. Use the information, system and case reference sites in the implementation of a unified antenatal service.

8. Using information of endemicity and high risk areas of pregnancy-related illness in giving

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integrated antenatal service.

9. Use the related program implementation guidelines in hosting integrated antenatal services.

C. OUTPUT

1. The socialization of norms, standards, procedures and criteria (NSPK) integrated antenatal services.

2. The performance of an integrated antenatal service at a health care facility is based on annual budget-supported planning at the central, provincial and county/city levels.

3. The lactating of the integrated antenatal service is disarana and the health care facility has been standardized.

4. He used the necessary support logistics for the integrated antenatal service.

5. The KIA program management power is able to manage integrated antenatal services at the levels of the province and district/city.

6. Health care is capable of delivering an integrated antenatal service to the standard.

7. Use of system information and referral premises in the implementation of a unified antenatal service.

8. The integrated antenatal service is accomplished in accordance with the status of endemicity and high risk areas of the disease affecting pregnancy.

9. Information of endemicity and high risk areas of pregnancy related to pregnancy in delivering antenatal services

10. Use the associated program implementation guidelines in hosting a unified antenatal service.

IV. LOGGING AND REPORTING

A. NOTE:

A unified antenatal service seeker using an existing form is:

1. Mom ' s card or other medical records are stored at the health facility

2. Mother cohort: is a collection of data-data from the mother card.

3. The book KIA (held by mother).

4. Logging of the existing program (note from

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Imunicization, from malaria, nutrition, KB, TB, etc.)

The form must be fully filled every time complete gives the service. This document must be stored and maintained properly because it will be used on the next contact. Under certain circumstances the document is required for the medical audit activities.

B. REPORTING

Reporting integrated antenatal services using an already existing reporting form, which is

LB3 KIA

THE PWS KIA

case PWS Imunization

s Provisioning of the related program traffic, reporting follows the existing form on the program

The health power that provides antenatal services in the Puskesmas work area, reports the recapitulation of a unified antenatal service every beginning of the month to Puskesmas or to be adapted to their respective area policies.

Puskesmas set up a recapitulation report of the health workforce in its area of work and included it into the KIA Register for the purposes of processing and analyzing data as well as the creation of the PWS KIA report.

The data processing and analysis results are reported to the county/city health service every month. The PWS KIA graph is used by Puskesmas to monitor the achievement of the target and view the trend of implementation of integrated antenatal services as well as use for cross-sector meetings.

The county/city health department sets up the results the processing and analysis of data from all the Puskesmas in its territory for the purposes of processing and analyzing data and the creation of the PWS KIA level of county/city charts every month.

Results of data processing and analysis reported to the Health Service Province every month. The PWS KIA graph is used by the District Health Service/City to monitor the achievement of targets and view the trend of implementation of integrated antenatal services.

The Provincial Health Service sets up processing results and data analysis of the entire district/city on its territory to

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data processing and analysis requirements.

Data processing and analysis results are reported to the Data Center and Surveilens of the Ministry of Health with busan to Part PI Setditjen Bina Gizi and KIA every 3 months. The PWS KIA graph is used by the provincial health service to monitor the achievement of targets and view the trend of implementation of integrated antenatal services.

The Ministry of Health Information and Information Center along with the PI Setditjen Bina Gizi section And the KIA set up the processing and data analysis of the entire province per county. Meanwhile, through the Directorate General of Bina Gizi and KIA gave feedback to the Head of Provincial Health Service through the Governor.

Cross-program related to the integrated antenatal service was responsible for reporting the recapitulation of the results services to the program in charge of the respective programs (from Puskesmas to the Centre) and provide busan to the KIA program in charge of the program.

V. CLOSING

The Integrated antenatal Service is a comprehensive and qualified antenatal service that is given to all expectated mothers to fulfill the rights of every pregnant mother acquiring a qualified antenatal service so that it is capable of undergoing a Healthy pregnancy, maternity, and childbirth.

The integrated antenatal service includes a promotional, preventive, and a curative and rehabilitative service that includes KIA's ministry, nutrition, and the quality of the antenatal care. infectious disease control (immunization, HIV/AIDS, TB, malaria, disease Sexually transmitted, non-infectious (hypertension, diabetes mellitus), pregnant women who experienced violence during pregnancy as well as other specific programs according to the need.

Every health care facility in both government and private health facilities must be able to provide a comprehensive service to expectable mothers in order to ensure a normal pregnancy, detecting the early onset of the problem and the disease that the mother experiences and intervening in the future.

The service guidelines integrated antenatal, which is a dynamic guideline, so it can be adjusted with the development of the area ' s specific programs and needs.

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Attachment

The concept of a unified antenatal service groove in Puskesmas

Note:-Poli KIA only refers to the ANC routine laboratory check

-Poli KIA is only performing a pregnant mother's screening. based on complaints and clinical symptoms

-Alur services are tailored to their respective region conditions.

HEALTH MINISTER

REPUBLIC OF INDONESIA,

NILA FARID MOELOEK

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ANNEX II REGULATION OF THE HEALTH MINISTER OF THE REPUBLIC OF INDONESIA NUMBER 97 OF 2014 ABOUT THE HEALTH CARE OF THE PRIOR HEALTH CARE, MATERNITY, CHILDBIRTH, AND PERIOD AFTER BIRTH, THE IMPLEMENTATION OF CONTRACEPTIVE SERVICES, AND SEXUAL HEALTH SERVICES.

IMPLEMENTATION OF CONTRACEPTIVE SERVICES

A. Family Planning and Contraception Service

Everyone has the right to define the life of its production and be free of discrimination, coercion, and/or violence that respect the sublime values that do not denigrate the dignity according to the religion norm (Act Number 36 of 2009 on Health Article 72 verse (2))

Individual reproductive rights as part of an internationally recognized right-rights of human rights may be interpreted to mean that each person is good. Men and women, regardless of the difference in social class, tribe, age, religion, etc.) have the same rights to decide freely and responsively (to the person, family and society) concerning the number of children, the distance between children, and determining the birth time of the child and where it will give birth.

The Family Planning (KB) is an attempt to regulate the birth of the child, the distance and the ideal age of giving birth, regulating pregnancy, through promotion, protection, and assistance in accordance with reproductive rights to realize a qualified family.

Pregnancy settings are an attempt to help a married couple ' s husband to give birth at an ideal age, have child count, and set the ideal child-born distance by using the means, tools, and contraceptive drugs.

The contraceptive service is the giving or installation of contraception and other actions that are related to contraception to Prospective and Family Planning participants are conducted in the KB-service facility.

B. Important things in the delivery of contraceptive services

In performing contraceptive services, there are a few things to pay attention to:

1. Counseling and approval of medical action

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2. Family planning and client screening

3. Infection strangulation

4. Medical requirements in the use of contraception

5. Sexually transmitted infections in and contraception

6. Teens and contraception

7. Contraceptive for female over 35 years old

8. Post-copy birth control

9. Contraceptive post miscarriage

10. Emergency contraception

1. Counseling and approval of medical action

Counseling is a very important aspect in the service of KB and reproductive health. Good counseling can make clients feel satisfied, help clients in using their contracepts longer and increase birth control and influence the interaction between health and client's customers who can improve relationships and The trust that exists. Good counseling techniques and adequate information should be applied and discussed interactively throughout the client ' s visit in a manner that corresponds to the existing culture. With complete information and enough to give clients the ability to choose contraception, which will be used.

The health officer ' s attitude in good counseling especially for new KB client candidates

a. Treat a client well

b. The interaction between the officer and the client

c. Provides information that is good and true to the client

d. Avoiding excessive information from

e. Discussing the client ' s desired method

f. Helps clients to understand and remember

Steps in giving birth control.

It can be applied to six steps already known by a keyword ONE-TOWARD as follows:

s SA : SApa and SAlam to the client openly and politely

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S: T: Tasked a client of information about itself

contraceptive

BanTUis a client determining its options

s J: Jelaskan is complete how to use contraceptive options

THE S : The need for a Ulang

Place and Counseling Services

Not all health means can be reached by the client, therefore the counseling services there are 2 (two) types of counseling places, That is:

a. KB counseling on the field

Being lactated by: officer in the field (PPLKB, PLKB, PKB, PPKBD, Sub PPKBD, and Kader who is already getting standard counseling training

The information provided, includes:

1) Understanding the family planning benefits

2) The process of pregnancy/healthy reproduction

3) Information of various contraceptive properties that are correct and complete (the way it works, benefits, possible side effects, complications, failure, cons indication, where contraception can be obtained, referrals, as well as costs)

4) Information on various contraceptive methods

b. PPP counseling at the health facility

Condued by medical personnel and trained paramedics in health facilities, namely: Doctors, Bidan, Nursing as well as Bidan in the village. Performed at a health facility and attempted to be given an individual in a special room.

The information provided, including:

The study provides more detailed contraceptive information in accordance with the client needs

Ensuring that the client's choice contraception has been in accordance with her health condition

The person helps the client select other contraception if the chosen one turns out to be unsuitable for the conditions

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health

Refers referencing clients if selected contraceptive is not available at the health facility or if the client requires medical assistance from experts in case of health problems examination other

The user gives counselling on revisits to ensure that the client has no complaints in the use of contraceptive options.

Informed Choice and Informed Consent

Informed Choice is a condition of the participants/candidates of the KB participants who choose contraception based on the sufficient knowledge after receiving complete information through the Communication Inter Personal/Counseling (KIP/K).

In this case the health officer can use the Decision Retrieval (ABPK) Tool for KB. ABPK-KB helps officers in counselling by default and while inviting clients to be more participatory and helping clients to make decisions.

Informed Consent is the consent given by the client or her family on the basis of information and explanation of the medical actions to be performed against such clients.

The information provided must be fully delivered-in full, honest and true about the contraceptive method to be used by a candidate/client of KB. Any medical action that contains the risk must be with a written consent signed by the entitled grant of consent, i.e. the client concerned in a conscious and healthy mental state.

With the medical action it is performed including contraception, then its influence on the institution of marriage is large enough that the permit must be from both sides. This is in contrast to other medical actions that do not concern the reproductive organs of which the permit is primarily provided by the party that will undergo such action.

2. Family planning and client screening

In determining the contracepting method the client will use, need to do family planning and client screening. In the family planning there are some things that need to be noticed, namely:

A female can give birth after she gets the first haid

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The fertility rate of a female will continue until death haid

The best possible pregnancy and least risk is between

The first and second copies of the first and second copies are at least the lowest risk

The distance between two births should be 2

In the execution of the planning of the family there are three phases in the selection of rational contraceptive methods with the following sequence, y

The Electoral Contraceptive Method Selection

The client screening aims to determine whether there is a pregnancy or not, the state of which need special attention, and other diseases problems that require observation and further management of high blood pressure).

3. Prevention of infection

The prevention of infection will protect clients and the health care of an infected infection. Some are the way the standard vigilance is:

Pretend to each person dap

56

a 20-35 years

-4 years

aitu:

Figure 1

(e.g. Diabetes and

at Passing an infection.

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The hand of the Cuci is an important attempt to prevent cross contamination.

The use of a pair of gloves before touching anything wet like skin chipped, mucous membranes, blood or other body duh, as well as used tools and other contaminated materials, or before performing invasive actions.

The use of body armor (e.g., protective eyeglasses (goggles), masks and celemek) to antisipate the body ' s splashdown (seam or excretion), for example, when cleaning tools or materials, other.

The use of antiseptic materials to cleanse the skin or mucous membranes before conducting surgery, clearing the wound, or rubbing hands before surgery with antiseptic materials

The safe work culture is as safe as possible did not install a syrapping cap (recapping), stroking the sharp tools in a safe manner, if possible, use a blunt needle to stitch the wound.

The discard disinfectable the infected after it is safely used to the prevent injury or transmission of infection to the community.

The power is done decontamination of instruments, gloves, and lainby materials with chlorine solution of 0.5% and washed clean, then district or DTT, in a recommended manner.

4. Medical requirements in contraceptive use

In giving counselling, it is especially important because of the issue of quality of service and access that affects contraceptive giving. Such information is about:

a. The effectiveness of various contraceptive methods

b. Some medical conditions that would increase the risk if there was a pregnancy

c. The return of fertility is according to contraceptive method

d. Medical conditions that affect the choice of contraceptive methods

In addition, for methods that require surgical procedures, insertion or revocation of tools by trained personnel need to be equipped with sufficient facilities for which procedures can be

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is carried out according to standard, including infection prevention procedures.

a. Effectiveness

In the selection of contraceptive clients needs to be given information about:

The relative effectiveness and various contractual methods available

The negative effects of ayng pregnancy are not desirable on health and risk Potential health in pregnancy with certain medical conditions.

Table 1. Effectiveness Of Various Contraceptive Methods

Levels

Effectiveness Of Contractual Method

Pregnancy per 100

females in 12 months

first use

Diwear

in

ordinary

Diwear

right and

consistent

Very effective Implan

Vasketomy

Suntyping combination

Suntyping DMPA/NET-EN

Tubketomy

AKDR CuT-380A

Progesterone pills (lactation pills)

0.05

0.15

3

3

0.5

0.8

0.0

0.05

0.1

0.05

0.3

0.5

0.6

0.5

Effective in

ordinary use,

is highly effective if

is used appropriately

and consistently

Method Amenore Laktation

Combination pills combination

progesterone pills (not times

lactation)

2

8

-

0.5

0.3

0.5

Effective if worn

is precise and

consistent

male Kondom

Senggama disconnected

Diafrgama + spermisida

15

27

29

2

4

18

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Natural KB

Female Condom

Spermisida

25

21

29

1-9

5

18

18

Without KB 85 85

WHO, 2004. Key: 0-1: very effective; 2-9: Effective; > 9: less effective

b. Some medical conditions will increase the risk of pregnancy

There are health states in women who can increase in the risk of pregnancy such as hypertension (> 160/100 mmHg); diabetes with neuropath/neropati/retinopati; ischemic heart disease; stroke; valve heart disease with hypertension; breast carcinoma; endomterium/ovarium/carcinoma; hepatis cirrhosis; hepatoma; crescent spherical cell disease; malignant trophoblas disease; TBC; scistosomiasis with liver fibrosis so that in this state it needs to be chosen a more counter-asption method. Effective.

c. The return of fertility

Need to inform that all methods of contraception except the steady birth control method do not involve the unending fertility of women, fertility will return again soon after the use of the contraceptive method is terminated except for DMPA and NET-EN injections each 10 months and 6 months counts since the last contraception

5. Sexually transmitted and contraceptive infections

The infection of the Reproduction Channel (ISR) and Sexually Transmitted Infections (IMS) is a disease that gets important attention to public health. Many women who have experienced ISR/IMS do not get treatment and treatment precisely because of some such things:

The male and female suffering may not be unmoved

The pain of the suffering is a symptom of ISR/IMS often unaware that being infected and many women do not get information about the abnormal vaginal fluid.

The pain of the pain is embarrassment, the disease suffered was

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social stigma

For that, contraceptive services can at once provide services to ISR/IMS such as:

educational institutions about IMS prevention and recognition of symptoms and ISR/IMS signs as well as complications

Counseling counseling sexual behavior at risk, client's compliance and couples for drug-mediated

Skrining or ISR/IMS screening

Health officers need to be self-discarting with the skills to conduct investigations or Screening without an attitude that judgs and blines the client shy, angry, offended or do not want to be blunt

ISR/IMS treatment needs

Refers to a more complete facility

The person provides contraception with double protection such as condoms

It is important to remember that counseling, education and service The contraceptively contraception and treatment of IMS is an important part for prevention and reducing the IMS incident.

6. Adolescents and contraceptive

A majority of teens have already experienced reproductive organs maturing and could reproduce but socially, mentally and emotionally immature. The exact information about sexual and reproductive problems for adolescents is very lacking and that the access to child-friendly services is still limited.

The reproductive health and reproductive health care services are in time for the youth to be used. is given to protect teenagers from the transmission of STIs and HIV/AIDS and unwanted pregnancies. For that need to be noticed the following:

The study learned of teenage sexual behavior, how his sexual behavior history

Basic teen contraceptive giving is for pregnancy prevention and prevention of STIs

Contraceptive in adolescents is temporary with minimal side effects and is spared the difficulty of its fertility recovery

A special papsmear screening rate for teens who are sexually active more than a year or a frequent change

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sexual partner

7. Contraceptive for girls over 35 years old

Women over 35 years old need a safe and effective contraception. This is a contraceptive method for women of over 35 years of age:

a. Combination pills/combination injections should not be used by women > 35-year-old smokers. These pills can serve as therapy at perimenopause times

b. The progestin can be used in perimenopause times (ages 40-50 years) can be used by smokers women

c. AKDR can be used by women aged > 35 ahun who are not exposed by IMS

d. Condoms

e. Steady Contraception

8. Post-copy birth control

1) The return of female fertility in post-percopy state is unexpected and can sometimes occur before menstruation. On average mothers who are not breastfeeding, ovulation occurs in 45 days after delivery or early and 2 out of 3 non-breastfeeding mothers will experience ovulation before menstruation.

2) KB Pasca Percopy is the use of the method Birth control is up to 42 days after giving birth.

3) In general, almost all methods of birth control can be used as a post-copy method of birth control.

4) The purpose of service of KB Pasca Percopy is to set the distance birth, the distance of pregnancy, and avoiding unwanted pregnancies, so every family can plan a safe and healthy pregnancy. It is also supported by the results of the Health Technology Assesment (HTA) Indonesia, in 2009.

5) KB in the breastfeeding period with recommendations as follows:

-Women in the breastfeeding period are recommended to use birth control before ovulation is first about 155 ± 45 days.

-That Feeding Exclusive delay of ovulation.

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-progestin's contraceptive method does not interfere with the volume and nutritional content of the Mother's Milk Water.

-Contraceptive Pill (progestin-only minipills) can begin to be given within the first 6 weeks of post-childbirth. However, for women who have limited access to health care, the minipill can be immediately used in a few days (after 3 days) post-copy.

-Contraceptive Injection/Depo Medroxy Progesterone Acetat (DMPA) In the first week (7 days) or the sixth week (42 days) post-childbirth is shown to have no negative effect on breastfeeding or baby development.

-The use of long-term DMPA (> 2 years) is shown to decrease the mineral density A bone of 5-10% a year. However, the WHO recommends the absence of long-time restrictions on the use of DMPA for women ages 18-45 years.

-There is no link between the duration of the use of DMPA with increased risk of breast cancer.

-The contraceptive implant is The choice for breast-feeding and safe women is used during lactation, at a minimum of 4 weeks post-copy

-IUDs post placenta is safe and effective, but the rate of exposure is higher than those of the ≥ 4 weeks post-copy. Expulsions can be downgraded by insertion of the AKDR within 10 minutes after the placenta expulsions, ensuring the insertion reaches the fundus of the uterus, and is worked on by a trained and experienced medic and paramedic.

-If 48 hours post The delivery has been passed, the insertion of the AKDR is delayed until 4 weeks or more post-copy

-A 4-week post of post-copy is secure using the AKDR copper T, while non-copper types require a delay of up to 6 weeks post-copy.

-Use of oral combination contraceptive in 6 months post percopy can lower the volume of breast milk in breast feeding women.

-In countries with limited access to

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contraception, MAL can be recommended for use.

-Amenorea Lactation method (MAL) effectively prevents pregnancy in post-childbirth nursing women who meet the criteria as follows: amenorrhea, Exclusive breastfeeding, limited protection in the first six months. MAL may be considered for use in areas with limited access to contraception.

6) AKDR Pascaplacenta: from all contraceptive devices and medications that can be used in post-labor, the most potentially preventing. missed opportunity KB post-childbirth is an AKDR pascaplasenta: the installation of the Contraceptive Device In Utero (AKDR) within 10 minutes after the placenta was born (or before the addition of the uterus to the caesar operation).

7) Here is a comparison table of the expulsion rate on the installation of IUDs in the nifas.

Table 2.

Comparison of expulsion rates

on the installation of IUDs in nifas.

Time

Insertion IDR

Definition of Observation Rate Observation

Early insertion

pascaplasenta

Insertion in 10 minutes

after placenta release

9.5-12.5% Ideal:

expulsion rate

low

Insertion immediately

pascapercopy

More than 10 minutes s.d. 48

post-copy hours

25-37% Still safe

Insertion delay

pascapercopy

More than 48 hours s.d. 4

week post-copy

NO

RECOMMENDED

KAN

Increuces

risk of perforation

and expulsions

interval interval

pascapercopy

More than 4 weeks post

percopy

3-13% Aman

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A wide range of maternal powers about post-labor birth control such as breast milk production and have not yet obtained post-copy haid, can already be dited and explained by the health care provider at the time of service. antenatal according to the recommendation of the results of the Health Technology Assesment (HTA) Indonesia, in 2009, which stated that:

1) Women in the breastfeeding period are recommended to use birth control before ovulation. the first time around ± 45 days

2) Exclusive breastfeeding delayed the occurrence ovulation.

3) The progestin contraceptive method does not interfere with the volume and nutrient content of breast milk

4) The progestin pill contraceptive can begin to be given in the first 6 weeks of post-labor, but for women who experience the limitations of access against health care, the minipill can be immediately used in a few days (after 3 days) post-copy.

5) Contraceptive injection progestin/Depo Medroxy Progesterone Acetat (DMPA) in the first week (7 days) or the sixth week (42 days) post-childbirth proved to be no negative effect on breastfeeding nor Infant development.

6) The use of long-term DMPA (> 2 years) has been shown to decrease bone mineral density by 5-10% per year, but WHO recommends the absence of long-term restrictions on the use of DMPA for women ages 18-45 years.

7) There is no link between the duration of the use of DMPA with increased risk of breast cancer.

8) The implant birth control is a choice for nursing and safe women to be used during lactation, a minimum of 4 weeks post-time. percopy

9) AKDR pascaplasenta is safe and effective, but the extent of its expulsions is more Higher than the expulsions of 4 weeks post-copy. Expulsions can be lowered by insertion of the AKDR within 10 minutes of the placenta, ensuring the insertion reaches the fundus of the uterus, and is done by the medical and paramedic trained and experienced paramedics. If 48 hours after post-copy has passed, AKDR insertion is delayed

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until ≥ 4 weeks post-childbirth. AKDR 4 weeks post percopy is safe by using AKDR copper T, while non-copper types require delays of up to 6 weeks post-copy.

10) The use of oral combination contraceptive in 6 months post-copy may decrease volume of breastfeeding on lactating women.

11) In countries with limited access to contraceptive services, MAL can be recommended for use

9. Post-miscarriage contraceptive

The post-miscarriage of contraceptive services includes the following:

1) Counseling about contrial

2) The guarantee of the indentation

3) Access to advanced upbringing

4) Information about the protection of STIs

The post-miscarriage contraception needs to begin as soon as ovulation can occur 11 days after miscarriage therapy, when counseling is delivered:

1) The client can get pregnant again before the next haid coming

2) there is a safe birth control method: contraception for after miscarriage at The I was the same as the contractpesi of the interval; the contractpesi after the miscarriage of trisemester II was the same as recommended in the post-copy period

3) where and how the data obtained the service

10. Emergency contraception

a. Background:

1) Undesired pregnancy (KTD) many terminates with abortus

2) Abortion, both safe and unsafe impacts on increasing Mother Death Figures (AKI)

3) One of the strategies of Making Pregnancy Safer (MPS) to downgrade AKI is the prevention of KTD

4) The Emergency Contraception is one way to KTD

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5) Emergency contraception is better than not using the KB method at all, but it remains less effective compared to existing KB

b. Limitations:

1) Emergency contraception is a contraceptive that can prevent pregnancy when used immediately after intercourse (often called post-senggama contraceptive or "morning after pill" or "morning after treatment".

2) Emergency contraception should not be used as a regular or continuous birth control method

c. Indication:

1) errors in contraceptive use, such as:

-Condoms leak

-Diafragma ruptured, torn or lifted too quickly

-Senggama failure was severed

-Wrong time count

-AKDR expulsi

-Forget to take birth control pills more than 2 tablets or 2 days

-Late more than 1 week for injection KB

-Late more than 1 week for monthly KB syringe

-Too late for more than 2 weeks for birth control three monthly

2) Rape

3) Does not use contraception

d. Counter Indications: Pregnant

e. Side effects: Mual, vomiting, bleeding/rickshaw

f. Type, way and emergency contraceptive administration

Table 3

Emergency Contraceptive Allowance

Way Dose Time Dose

I. Mechanic

AKDR-Cu 1 x installation In time

< 7 days pascasenggama

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II. Medik

Pil Combination 2 x 2 tablets Within 3 days pascasenggama second dose 12 hours later

Within 3 days pascasenggama the second dose 12 hours later

Progestin 2 x 1 tablet Within 3 days pascasenggama second dose 12 hours later

Estrogen 2.5 mg/dose

10 mg/dose

10 mg/dose

Within 3 days pascasenggama 2x 1 dose for 5 days

Mifepriston 1 x 600 mg Within 3 days pascasenggama

Danazol 2 x 4 tablets Within 3 days post senggama a second dose 12 hours later

Note:

Postinor is a The special contraceptive is packed for the condar registration BPOM through the MUI review and has been available at the drugstore

g. Limitations:

1) Only effective if used in 72 hours

2) The combination pill may cause nausea, vomiting, or breast pain

3) AKDR is only effective if installed 7 days after the relationship

h. Sexual

Installation of AKDR Installation requires a trained force and should not be used to client exposure to STIs.

i.

1) Counseling

2) Assessment prior to service

3) Instructions for clients

4) advanced observations

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C. Contraceptive Method

The contraceptive service is given using the method

contraception both hormonal and non-hormonal. According to the term

The timing of the use of contraception is divided into the Contraceptive Method

Long term (MKJP) and Long-term Contraceptive Non-Method

(non-MKJP).

Table 4

Contraceptive Method Category

No Method

Kandungan Masa

protection

Traditional/Modern

Hormonal

Non

Hormo

nal

MKJP Non

MKJP Traditional Modern

1. Methods of Amenorea

Lactation (MAL)

2. Family Planning

Natural (KBA)

3. Broken sanggam

4. The barier method

5. Counterasption

Combination (hormones

Estrogen and

Progesterone);

1) Pills

2) Suntik

6. Contraceptive

Progestin:

1) The Pills

2) Syringe

3) A Contraceptive Device

Bottom Of The Skin (AKBK)

7. Contraceptive Tool

In Utero

(AKDR)

8 Contraceptive

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NO METHOD

Kandungan Masa

protection

Traditional/Modern

Hormonal

Non

Hormo

nal

MKJP Non

MKJP Traditional Modern

Mantap, Methods

Female Operations

(MOW) and Method

Male Operations (MOP)

1. The method of Amenorea Laktasi (MAL)

a. Profile:

1) MAL is a contraceptive that relies exclusively on breastfeeding, meaning only breast milk without any additional food or drink.

2) MAL can be used as a contraceptive if:

3) breastfeeding Full breast feeding, over 8 times a day, not haid, baby age is less than 6 months old.

4) Effective up to 6 months

5) Must continue with the use of other contraceptive methods

b. Way of Work: delay/suppression of ovulation

c. Advantages/Benefits:

The effectiveness of the high, effective immediately, does not interfere with the sanggama

d. Limitations:

Need to be prepared since pregnancy treatment, difficult to implement due to social conditions, effectiveness only until the return of the haid or up to 6 months

2. Natural Family Planning (KBA)

a. Profile:

Effective when used in an orderly manner, Mother must learn to know when her peak days are direct, the couple voluntarily avoid the sanggama in Mother ' s fertile period

b. Advantages/Benefits:

No systemic side effects and no charges

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c. Limitations:

The effectiveness depends on the pair ' s willpower and discipline, there needs to be training (need KBA training, not medical personnel), need to record every day

3. Broken sanggam

a. Profile:

The traditional method of birth control, in which men remove their genitates from the vagina before reaching ejaculation

b. Work:

The penis (penis) is issued before ejaculation so that the sperm does not get into the vagina so that no meeting between sperm and ovum and pregnancy can be prevented

c. Advantages/Benefits:

Effective when implemented correctly, it can be used as a supporter of other KB methods and can be used any time

d. Limitations:

The effectiveness depends heavily on the willingness of the pair to perform the cut off each performing, severing the enjoyment in sexual intercourse

4. The barier method

Kondom

a. Profile:

The case is a sheath/rubber sheath that can be made of various materials including latex (rubber), plastic (vinyl) or natural materials (animal production) mounted on the penis during sexual intercourse; made of synthetic rubber that Thin, cylindrial, with thick edges, which are either flat-shaped or or have a form of a milk putting. Various materials have been added to condoms either to increase their effectiveness (e.g., the addition of spermicide) as well as sexual activity accessories.

The condom type is made up of:

-ordinary Kondom

-Condoms are contoured (serrated)

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-Condoms scented

-Condoms are not scented

The Condoms for men are already well known but condoms for women even though they are, have not been popular with any inconvenience to the discomfort (noisy)

b. Work:

The case is blocked by meeting sperm and egg cells by packing sperm at the end of the rubber sheath attached to the penis so that the sperm do not fall into the female reproductive tract.

Special for condoms made from latex and vinyl can prevent the transmission of microorganisms (IMS including HBV and HIV/AIDS) from one pair to another.

c. Advantages/Benefits:

The Murah is generally bought and can be purchased in general, no need for a special health check, double protection (in addition to preventing pregnancy but also preventing STIs including HIV-AIDS)

d. Limitations:

The way usage greatly affects the success of contraception, somewhat interfering with sexual intercourse (reducing the direct touch), could cause difficulty to maintain an erection, shame buying it in a public place

5. Combination (Estrogen And Progesterone); Pills and Suntics

The Combination pill

a. Profile:

Monofasic view: 21 tablets contain active hormones estrogen/progestin in the same dosage and 7 tablets without hormones

Bifasic properties: 21 tablets contain active estrogen/progestin hormones in two different doses and 7 tablets without hormones

Trifasic ' s release: 21 tablets contain active estrogen/progestin hormones in three different doses and 7 unhormonal tablets

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b. Work:

Pressed ovulation; prevent implantation; enthuse cervical mucus so hard to pass by sperm; the tuba movement is disrupted so that the egg transport by itself will be disrupted

c. Start time:

At any time during the period; after 6 months of exclusive breastfeeding; after 3 months for the non-breastfeeding; immediately or in 7 days post miscarriage

d. Advantages/Benefits:

The menstrual cycle becomes regular, the amount of blood haid decreases (preventing anemia), no haid pain, easily stopped at any time, reversibly (fertility immediately back after the use of the pill is stopped)

e. Limitations:

Expensive, must be drunk every day, reducing breast milk in nursing women

The Combination of

a. Profile:

A 25 mg depo medroxyprogesterone acetesterone, estradiol sipionate (Cyclofem) injected IM in, once a month

A 50 mg noretindron anantat and 5 mg estradiol injected IM in, once a month

b. Work way:

Presrender ovulation; make cervical mucus to be viscous so that sperm penetration is impaired; endometrial atrophy so implantation is disturbed; inhibits the transport of gametes by tuba

c. Start time:

1) The first injection is given within 7 days of the haid cycle.

2) In the unhaid mother, the first injection can be given any time the mother is assured not to be pregnant, but for 7 days after the suntukan should not be doing sexual intercourse.

3) In the mother of post 6 months, breastfeeding and not yet haid, the first injection can be given any moment of origin to be sure not to be pregnant.

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4) In the mother pascapercopy > 6 months, breastfeeding and already got haid, the first injection can be given in the haid cycle of day 1 to day 7.

5) On the mother post 3 weeks and not breastfeeding, The first injection can be immediately given.

6) On the mother of post-proof the injection may be immediately given or within 7 days.

d. Advantages:

No internal examination is required and do not need to store a syringe

e. Limitations:

Must return every 30 days to the health workforce, possibly the delay of fertility recovery after the termination of usage

6. Progestin Contraceptive: Pills, Suntics and Lower-skin Contraceptive Devices (AKBK)

Progestin Pills

a. Profile

The contraceptive method of contraception using progestin, which is a copy of progesterone

There are 2 types of progestin pill packaging, namely:

o Kemasan 28 pills containing 75 µ g norgestrel

o Kemasan 35 pills containing 300 µ g levonorgestrel or 350 µ g norethindrone.

b. Work way:

Preventing ovulation, enthusing cervical mucus thereby lowering sperm penetration capability, making webbed mucus thin and atrophy and inhibiting the transport of gametes by tuba.

c. Start time:

1) Days 1-5 cycles of haid.

2) If on the 5th day of day or not haid, it can be used at any time of origin to be sure not to be pregnant, but do not perform sexual intercourse or use any other contraception for 2 days.

3) On breastfeeding mothers 6 weeks to 6 months post childbirth, not haid, can start at any time.

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4) In nursing mothers 6 weeks to 6 months post childbirth, and already haid, can begin on the day 1-5 of the haid cycle.

5) In the postmiscarriage mother may be immediately given.

d. Advantages:

Does not affect breast milk production, the return of fertility immediately if usage is stopped, easy to use and comfortable and the client can stop its own use.

e. Limitations:

Must be used every day and at the same time, if missing one pill, failure becomes larger; the dropout number is high enough.

Suntik Progestin

a. Profile

The contraceptive method of contraceptive using progestin, which is a copy of progesterone:

The solution is available in two types of packaging, namely:

1) Depo medroxyprogesterone acetate contains 150 mg DMPA, given every 3 months with Intramuscular injections in the buttocks;

2) Depo noretisteron enantat contains 200 mg noretindron enantat, given every 2 months in an intramuscular injectable manner.

b. Start time:

1) The first injection is given within 7 days of the haid cycle

2) In the unhaid mother, the first injection may be given at any time of reason the mother is not pregnant, but for 7 days after the dismay is not allowed conducting sexual intercourse

3) On breastfeeding mothers: after 6 weeks of post-labor, while on not breastfeeding mothers may use immediately after childbirth.

c. Work way

prevents ovulation, enthuse cervical mucus so as to decrease sperm penetration capability, makes webbed mucus thin and atrophy and inhibits

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The transport of gametes by tuba.

d. Advantages

Not suppressing breast milk production, can be used by women ages > 35 years to perimenopause

e. Limitations:

The Client is highly dependent on where the health service means for reinjections, it cannot be stopped at any time, slow the return of fertility after termination of use, average 4 months

The contraceptive Tool Bottom Skin (AKBK)

a. Profile

A low-skin contraceptive device that contains progestin wrapped in a polydimetric silicon silastic capsule.

There are 3 types available:

1) Norplant, consisting of 6 soft-hollow syllabary rods with length 3.4 cm, 2.4 mm diameter filled with 36 mg levonorgestrel and long work 5 years;

2) Implanon, consisting of a single white rod with a length of approximately 40 mm, a 2mm diameter filled with 68 mg 3 keto desogestrel and old work 3 years;

3) Jadelle and Indoplant, consisting of two bars containing 75 mg of Levonorgestrel with He's three years old.

b. Starting time:

{\f1 \f1 \f1 \fs\fs6 \fs\f1 \fs\fs6 \fs\f1 \fs\fs6 \f1 \f1 \f1 \f1 \f1 \f1 \f1 Work:

The cervical Lendir becomes viscous, disrupting the formation process of the endometrium so it is difficult to implantation; reduce sperm transport; suppress ovulation

d. Profit:

Long-term protection (up to 5 years), a rapid return of fertility after revocation, does not require an inspection in, not

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interfering with ASI

e. Limitations:

Need minor surgical action for insertion and revocation, unable to stop themselves using contraceptive use, but instead must go to the faskes for the revocation action

7. The Contraceptive Device In The Womb (AKDR)

a. Profile:

A contraceptive device made of flexible plastic, mounted in the uterus by pining both channels that produce ovaries so that there is no conception.

b. Start time:

1) Any time in the haid cycle (the client is definitely not pregnant)

2) Pascaabortus: immediately or within 7 days

3) Pasca copies:

o Within 10 minutes after the placenta was born (pascaplasenta early insertion)

o Up to the first 48 hours after giving birth (insertion immediately post-copy)

o At 4 weeks after giving birth (extended post-copy interval)

o At the time of the operation sesarea (trans secarea)

4) Pascasanggama unprotected: 1-5 days (emergency contraception)

Related to the type of contraception This is included in the long-term birth control method (MKJP) and the soon-possible delivery time has been copied, then the selection of this method is very effective and efficient where the post-paternity mother returns home is protected. with contraception with Couple Years Protection (CYP) a long one.

c. Work:

Preventing fertilisation, where copper in AKDR causes sterile inflammatory reactions, toxic to sperm so as to be unable to fertilisation.

d. Advantages:

High effectiveness, effective immediately after installation, method

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long term, does not affect the quality and volume of breast milk, can be installed immediately after giving birth or after abortus (if an infection does not occur), it can be used until menopause (1 year or more after haid last)

e. Limitations:

Not well used in women with STIs or girls who are often changing pairs, required medical procedures including a pelvic examination, a client cannot remove the AKDR itself, possibly the AKDR coming out of the uterus without Known, the client must examine the position of the thread of the AKDR from time to time by insering a finger into the vagina (some women do not want to do this).

8. Steady Contraception

Female Operating Methods (MOW)

a. Profile:

Is a steady contraceptive method that is voluntary for a woman if she does not want to get pregnant again.

b. Way of work:

Exclusion to the falopii tuba (tying and cutting or installing the ring), so the sperm cannot meet the ovum.

c. Time using:

Can be done immediately after childbirth or after fault operation, while for non-operation faults, ideally performed within 48 hours post-copy with minilaparotomy (if not within 2 days of post percopy, adjourn to 4-6 weeks).

d. Advantages:

The effectiveness is high, it does not affect the breastfeeding process, it does not depend on the senggama factor

e. Limitations:

Must be considered the permanent nature of this contraception (cannot be restored, except with a recanalised operation), a sense of pain/discomfort in the short term after action, must be performed by a trained doctor, little side effects such as pain or discomfort in the short term after action

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Male Operating Methods (MOP)

a. Profile:

The case is a clinical procedure to stop the male reproductive capacity

there are two types of vasectomy:

1) Insides

2) Vasectomy Without Knives (VTP).

b. Work way:

Exclusion to vasa deference so that the sperm transport groove is stunted and the fertilisation process (the union with ovum) does not occur.

c. Given time:

Could be done at any time

d. Advantages:

The effectiveness of its high, highly secure, morbidity and mortality is rare, high levels of cost efficiency ratio and its length of contraceptive use.

e. Limitations:

is not effective immediately (WHO suggests additional contraception for 3 months after the procedure, approximately 20-times ejaculation), minor complications such as infection, bleeding, post-surgery pain. A non-knife technique is a choice of reducing bleeding and pain compared to inside techniques

D. Clinic Proceed

a. Preparation

b. Infection Prevention

c. Installation steps

d. Action after installation

1. Installation and Revocation of AKDR Copper T 380A

Installation of AKDR Copper T 380A

a. Preparation:

Materials and Appliances

- Bivalve speculum (small, medium, or large)

-Tenakulum

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-Sonde uterus

-Forsep/korspans

-Gunting

-Bowl for antiseptic solution

-Sarung hand (which has been in DTT or the new system of checks or mittens)

- Antiseptic fluid (e.g.: povidon iodine) to cleanse the cervix

-fabric gauze or cotton

-Enough light sources to illuminate the cervix (sufficient flashlight lamp), and

-Copper T 380A IUDs which are still undamaged and injured

b. Installation

Step 1.

-Explain to the client what to do and allow the client to ask the question

-Tell the client it will likely feel a bit sore at some point of installation time and time. Later will be notified when up to those steps.

-Make sure the client has emptied the bladder.

Step 2

-Check the genitalia of the exterior

-Do a speculum check

-Do Pelvic examination

Step 3

-Do microscopic examination when available and no indication.

Step 4

-Enter the AKDR copper T 380A arm in its stery packaging

Step 5

-Enter the speculum and the vaginal and cervix with an antiseptic solution

-Use the tenakulum to clamp The cervix.

Step 6

-Enter the uterus sonde

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Step 7

-Install AKDR Copper T 380A

Actions after installation

1) Discard the contaminated wear before removing the glove.

2) Clear the surface contaminated.

3) Do decontaminate the tools and gloves immediately after completion.

4) Ajarkan on the client how to check the AKDR thread (by using the model when available)

5) Ask the client to wait at the clinic for 15-30 minutes after the installation of AKDR

Measures Revocation AKDR Copper T 380A

-Explain to the client what to do and please client to ask.

-Installs the speculum to see the cervix and the AKDR thread.

-Mengusap cervical and vaginal with antiseptic solution 2 to 3 times.

-Says on the client that it will now be done revocation. Ask the client to calm down and take a deep breath. Telling may arise pain, but it ' s normal

-Install a new AKDR if the client wants and its conditions allow

Infection Prevention

Installation

To reduce the risk of post infection Installation that may occur in a client, the clinic attendant must attempt to keep

the environment free of infection by means of the following.

To reduce the risk of post-installation infection that may occur in the client, officer clinic must attempt to keep

an environment free of infection by means of as follows.

-Not performing the installation for clients with IMS

-Wash hands with soap and running water before and after action.

-When necessary, ask the client to clear the area

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its genitals before performing a pelvic examination.

-Use the instrument and wear a pair of gloves that have been in DTT (or districts), or can use a disposable, disposable glove. (DISPOSABLE).

-After inserting the speculum and checking the cervix, the application of an antiseptic solution is multiple times evenly on the cervix and the vagina before initiating the action

-Enter the AKDR in its sterorical packaging.

-Use the technique " without touch " at the time of the installation of AKDR to reduce the utheric yeast contamination.

-Remove contaminated ingredients (gauze, cotton, and disposable gloves (disposable) correctly.

-Immediately decontaminate the equipment and reuse materials in chlorine solution 0.5% after use.

Revocation

While rarely associated with pelvic infection, the repeal of the AKDR must be exercised with caution. To reduce the risk to health officials during the repeal, the following infection prevention measures need to be done.

-Cuci hands with soap and running water before and after action.

-When necessary, ask the client for cleaning up its genitals before performing a pelvic examination.

-Use the instrument and wear a pair of gloves that have been in DTT (or districts), or can use disposable, disposable (disposable) gloves.

-Apply antiseptic solution several times evenly on the cervix and vagina before initiating action.

-Immediately decontaminate the equipment and reuse materials in chlorine Larvings 0.5% after use.

2. Installation and Revocation of the implant (KB)

Instalment of the implant

a. Preparation

s Materials and Appliances

-Desk check to lay down a client.

-Arms buffer tool.

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-Bar implant in the bag.

-Fabrics of sterile cover (high disinfection) as well as mangkok for place to lay implants.

-A pair of free powder rubber gloves that are already district (or It's a high-level disinfection.

-Sabun to wash hands.

-Antiseptic solubility for skin disinfection (e.g., betadine solution or other type of iodine type), complete with anti-corrosive cawan/mangkok.

-The local anesthetic substance (concentration 1% without Epinephrine).

-Semprit (5-10 ml) and syringes (22G) sizes 2.5 to 4 cm (1-1.5 per inchi)

-Trokar 10 and mandrin.

-Skalpel 11 or 15

-Kasa tampons, band aid and plaster

-Kasa sterile and tampons

- Epinephrine for anaphylactic depravity (must be available for emergency purposes)

-Klem clamp or forsep masquito (extra)

-Bak an instrument (closed)

.

-General:

-General:

Capsules The implant was installed right under the skin in the elbow folding pad, in the medial area of the footwear arm. For capsule installation, select a rarely used client arm.

-Step 1

Please client wash the whole arm with the soap and the running water and rinse it. Make sure there is no rest of the soap (the rest of the soap decreases certain antiseptic effectiveness). This step is very important when the client lacks the hygiene of herself to maintain her health and prevent the transmission of the disease.

-Step 2

Close the client bed (and the arm brace or side table, if any) with the fabric clean.

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-Step 3

Please client lie down with a less used arm (for example: left arm) placed on a buffer arm or side table. The arm must be properly dislocated and can be moved straight or slightly bent according to the preferred clinician position to make it easier to install

-Step 4

Specify the optimal installation place, 8 cm above the elbow crease.

-Step 5

Prepare the place of the tools and open the sterile wrap without touching the tools in it.

-Step 6

Open with caution the sterile implant with the second pull of the wrapper layer and drop the whole Capsule in sterile bowl.

b. Installation

Before making an insides, touch the insides with a needle or skalpel (scalpel) to ensure an anesthetic drug has worked.

-Step 1

Hold the skalpel at a 45 ° angle, make the shallow insides only for Just through the skin. Do not create long or deep insides.

-Step 2

Remember the second usefulness of the mark on the trokar. The trokar must be held with a sharp end facing upward. There are 2 signs on the trokar, a sign (1) near the base indicating the trokar boundary is inserted into the bottom of the skin before inserting each capsule. The sign (2) near the end indicates the trokar limit that must remain below the skin after installing each capsule.

-Step 3

With a sharp end facing upward and thrusters inside it insert the edge of the trokar through the insides wound With a little angle. Start from left or right on a fan-like pattern, move the trophy to the front of the clan

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stops as the sharp tip is entirely below the skin (2-3 mm from the end of the sharp end). Inserting the trolled don't force it. If there is a prisoner, try from the other angle.

-Step 4

To put the capsule right under the skin, lift the trokar up, so the skin is lifted. Enter the trokar slowly and carefully towards the sign near the base. The trolled must be shallow enough that it can be grabbed from the outside with a finger. The trokar must always be seen lifting the skin during installation. The entry of the troller will be smooth if it is in the right field under the skin.

-Step 5

When the trokar enters until the booster pull off the troller.

-Step 6

Enter the first capsule into the troqs. Use your thumb and index or tweezers or the clamps to take the capsule and insert into the trokar. If the capsule is taken by hand, make sure the gloves are free from powder or other particles. Thrust the capsule into the whole entry into the troller and reenter the thrusters.

-Step 7

Use the thrusters to drive the capsule to the far end of the troller until it feels there is a prisoner, but do not push it by force. (It will feel a prisoner at the time about half the thrusters get into the trokar).

-Step 8

Hold the thrusters tightly in place with the sampe felt there are prisoners to stabilize. Pull the troller tube by using the thumb and index towards the insides wound until the sign appears on the edge of the insides and

The rank touches the thrusters grip. The important thing to this step is to keep the thrusters in place and not push the capsule into the network.

-Step 9

When the troller touches the driving grip, the sign must be seen being cut inside wounds and capsules when it

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out of the trokar right under the skin. Pat the end of the capsule with the finger to make sure the capsule is already out entirely from the trokar.

-Step 10

Without removing the entire trokar, turn the tip of the trolled into the right lateral direction and return it again to the original position for Ensure the first capsule is free Next slide the trokar is about 15-25 degrees.

-Step 11

On the next capsule installation, to reduce the risk of infection or expulsions, make sure that the nearest capsule tip is more 5 mm from the edge of the insides of the wound.

- Step 12

Before removing the trolled, raba capsules to ensure the capsule is all installed.

-Step 13

The tip of all the capsules must be not on the edge of the insides (about 5 mm) lesions. If a capsule comes out or too close to the Iuka insides, it must be revoked carefully and refitted in the right place.

-Step 14

Once the capsule is installed everything and the position of each capsule is already (checked, Get the trolled out slowly. Press the place of the insides with the finger using the gauze for 1 minute to stop the bleeding. Clear the installation place with antiseptic gauze.

Actions After Installation

Closing the insides injury

1) Find the second edge of the insides and use the aid band or patch with sterile gauze to close the Iuka insides. The inside wound does not need to be stitched because it can create a scar tissue.

2) Check out the presence of bleeding. Close the mounting area with the tampon for hemostasis and reduce the bruise (subcutaneal bleeding).

Client care

1) Create a note on the medik record of the capsule installation and your accident that may occur

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during installation.

2) The client dies of 15 to 20 minutes for possible bleeding from inside injuries or other effects prior to repatriating the client. Provide a hint for the inside injury treatment after installation, if it can be given in writing.

c. Revocation measures

-Step I

Specify an inside location that has the same distance from the bottom end of all the capsules (near the elbow), roughly 5 mm from the bottom end of the capsule. When the distance is the same, then the insides are created at the place of the installation time. Before determining the location, make sure there is no end of the capsule under the old insides (It is to prevent the dismembering of the capsule while performing insides).

-Step 2

At the already selected location, make a small transverse inside of more than 4 mm with a skalpel. Do not create a large insides.

-Step 3

Start by clawing the capsule easily scratched from the outside or the nearest insides.

-Step 4

Push the end of the capsule to the insides with the fingertips to the end The capsule appears on the insides wound. When the end of the capsule appears on the inside wound, insert the curved clamp (mosquito or Crile) with the snap arches leading up. Then pin the end of the capsule with the clamp

-Step 5

Clear and open the connecteds that surround the capsule by rubbing it with sterile gauze to expose the end of the capsule.

-Step 6

The capsules of the already exposed capsules by using the second clamp remove the first clamp and pull out the capsule slowly and carefully with the second clerics. The capsule will be easily revoked by due to a connecteless connecteage that surrounds it not attached to a silicon rubber If the capsule is difficult to remove, separate the rest of the connecteers attached to the capsule with

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using gauze or skalpel.

-Step 7

Select the next capsule that appears most easily revoked. Use the same technique to pull out the next capsule. Before ending the action, count to make sure all the capsules have been lifted. Show all those capsules to the client. It is very important to reassure clients.

d. The action after the revocation

Closing the Insided Luka

-If the client does not want to continue the use of the implant again, clear the place of the insides and surroundings by using antiseptic gauze. Use the clamp to hold both edges of the insides wound as late as 10 to 15 seconds to reduce the bleeding from the iuka insides, then proceed with the insides wound.

-Deattach the two edges of the Iuka insides then enough with the aid band (plaster for minor injuries) or sterile gauze and plaster. The inside wound does not need to be stitched, as it may be possible to create a scar tissue. Check the possibility of bleeding.

Infection of Infection

Installation and Revocation Of Rod (Rod) Implant. To minimize the risk of infection in clients following the installation or the removal of implants, clinic officials must herattempt to keep the environment free of infection. For that, the officer needs to do the following.

1) Ask the client to clean with the soap all over the arm that will be fitted with the implant and rinse it until there is no remaining soap left.

2) Cuci hands with soap and Heraqua flowing water. For the installation and removal of the bar, the hand-washing with regular soap for 10-15 seconds is then rinsed with enough clean water.

3) Wear both gloves that have been either district or DTT.

4) Prepare install or revocation area with an antiseptic amount of cotton: use forsep for

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apply the cotton to the installation/revocation area.

5) After the completion of the installation and the removal of the implant rods, and before removing the glove, decontamination the instrument in solution chlorine 0.5%. Before disposing or soaking the needle and the syringe, the contents first with a chlorine solution (After installation, separate the plinger from the trokar. Dry blood will make it difficult time to separate the plinger and trokar.

6) Rendam for 10 minutes; then rinse with clean water to avoid corrosion in metal-based tools.

7) The fabric of operation (drape) must be washed before reuse. Once used, put on a dry and closed container then taken to the laundry room.

8) By sticking with gloves, dispose of contaminated materials (gauze, cotton, etc.) into a sealed container of a meeting or plastic bag That's not leaking. The needle and the disposable injectable device must be thrown into a puncture-resistant container.

9) Enter both hands that still wear gloves into a 0.5-% chlorine solution. Remove the gloves from the inside out. If you want to throw the gloves off. Put it in a container or a proof-resistant plastic bag.

10) When to reuse, decontaminate both gloves by being immersed in a Morin solution of 0.5%, for 10 minutes.

11) After all steps are completed, wash hands with soap and clean water that is and dry it with clean and dry towels or salted.

3. Contraceptive Injectable

a. Preparation

-Materials and Appliances

-The drug to be injected (Depo Provera ®, Cyclofem ®).

-Semprit syringe and needles (once used).

-Alcohol 60-90% and cotton

Installation

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Client Preparation

-Because the skin is unlikely that the anticlisation, antiseptic is used to minimize the amount of microorganisms on the skin where the injection should be performed. This is absolute must be implemented to reduce the risk of infection at the syringe location.

-Check the syringe whether clean or dirty.

-If the upper arm or butt to be injected looks dirty, the client candidate is asked cleaned it with soap and water.

-Let the area dry.

Prepares Officer

-Step I

Cuci hands with soap and rinse with running water.

Dry with a towel or Expected.

-Step 2:

Open and remove the canned cans on the vial that covers the rubber. Remove the existing rubber at the top of the vial with cotton that has been moistened with a 60-90% alcohol. Let it dry (on Depo Provera ® /Cyclofem ®).

-Step 3:

If using a syringe and a syringe once used, immediately unlock the plastic. If using syringe and syringe-injected syringes with DTT, use the DTT to retrieve it.

-Step 4:

Install the needle at the syringe by inserting a needle in the mouth of the coupling spurts

-Step 5

The vial is vial with the mouth of the vial down. Insert the syringe in the splinter. Use the same needle to suck up the syringe contraceptive and inject it with the client.

b. Injection steps

Sune Area Preparation

-Step I

Clear the skin that would be injected with the ethyl /isopropyl alocohol 60-90% of ethyl /isopropyl alocohol.

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-Step 2

Let the skin dry sehelum can be injected.

The Sune technique

the bottle shuffle is well, hinting the occurrence of air bubbles (on the Provera/Cyclofem Depo). Remove the contents.

The Suninject is intractively intractable in the butt area (gluteal area). If the injection is too shallow, the contraceptive absorption of the injection will be slow and does not work immediately and effectively.

The Provera Depo (3ml/150mg or 3ml/150mg) is given every 3 months (12 weeks).

Cyclofem 25 mg Medroxy Progesterone Acetesterone and 5 mg Estrogen Sipionate is given each month.

c. Action after injection

-Do not massage syringes. Explain to the client that the drug will be too fast in the serap.

-Do n' t put it back on, and do n' t bend it or break it. Remove the needle and the splinter in a box/place of invisibility/translucent, e.g. a wooden box, a plastic bottle or a can which has a lid. A bottle of an infusion can be used but there is a possibility of translucent.

-Put the box on an easy to reach and easy to open without using a sharp object.

-Kubur/burn if the box has been 2/3 full.

4. Tubektomi

a. Preparation

-Client

-Client is encouraged to shower prior to action, or cleanse the lower abdomen area to the sex area with water and soap. The pubic hair is quite scisted and shaved as soon as it interferes with the operation of the operating area. Client is using the operating system.

-Materials and Appliances

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-Operations

b. Infection Prevention

before surgery

Operator and officer washing hands with antiseptic solution, then using surgical clothing and sterile gloves.

Use antiseptic solution to clean up Pussy and cervix. Apply an antiseptic solution to the operating area starting from the center then extends to the outer area with a detour movement.

The action during the surgery

Use the instrument, gloves and a sterile cover cloth. Work with high skills to reduce trauma/complications (bleeding)

After surgery

Still using gloves, the operator and the officer throw waste into the container. Perform decontamination actions on instruments or surgical instruments before laundered with a 0.5-% chlorine solution. Wash your hands off the glove.

c. Premedikation and Anastesi

The forwarding of premedictation may be avoided, if the client is anxious to find the cause first and do the counselling again. When required can be given 5-10 mg of diazepam orally 30-45 minutes prior to the operation act.

The local anesthesia that uses a lidocaine 1% is considered safer than the general anaesthesia or the conduction (spinal/epidural). compared to general anesthesia that may increase the complications of respiratory depersion.

Drug table to remove nyeri/pain

Drug regimen

Maximum dose of General Dosage

Unit/kg Client 40 -50Kg

Atropin 0.01 mg 0.4 mg 0.6 mg

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All the awarding of inravena should use the infusion set and liquids such as dextrose, agram physiologics or ringer lactate. The medicine should be given slowly-land. Always provide a drug antdotum before an operation action.

d. Resuscitation and emergency measures

Secan may be available:

Ambu Bag ' s tank

oxygen tangki with flow settings, oxygen hoses and masks

The slime-sucking machine, the air pipe for the nose (two size)

s air pipe for mouth (two sizes)

s Infus set and fluid infusion

The Appliance Service is for acute surgical action

e. Operation steps.

- Minilaparotomy interval

This method is a simplification of previous laparotomy, only a small incision (3cm) either lower abdominal blood (suprapubic) or subumbical. This action can be done many lien, low-cost realtive, safe and effective.

Counseling PraBedah

-Introducing yourself

Diazepam

Midazolam

0.1 Mg

0.05 mg

5 mg

2.5 mg

10 mg

3 mg

Meperidine

ketamine

1 Mg

0.5 mg

50 mg

25 mg

Lidokain 1%

s analygesic tuba

s local anastesi

Up 5

cc/tuba

Maks 300

mg/20cc

5 ml 1% lidocaine 1% for each tuba

5ml 0.5 bupivakain lidocaine gel 2%

(max 300 mg).

Bupivakain 0.5% 20 cc (max 125 mg)

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-Anamnesa obstetric history

-Telaah medik note

-Explain operation technique, anastesi and possible pain/bad taste

PraBedah Preparation

-Step 1: check Surgical tool

-Step 2: pairs of tension, pulse, breathing

-Step 3: pair wing needle

-Step 4: If necessary premedication, after oral dizepam, give pethidin 1mg/kgBB intrambishops

Aspecimen and Antiseptic

-Step 1: wear opersai room clothes, hats and masks

-Step 2: Wash and hand brush with antiseptic solution for 3 minutes

-Step 3: wear sterile gloves/DTT

Pelvik check and Uterus Fiksation

-Step 1: Usap geintalia eksterna and perineum with gauze antiseptic and do catheterization

-Step 2: perform a bimanually pelvic examination, position values and large uterus as well as pelvik abnormalities

-Step 3: Install the speculum and cervix values and vagna then perform the action asepside apda portio and vagina

-Step 4: Attach tenaculum at 12 o'clock and do sonde

-Step 5: install a uterus elevator

-Step 6: Embed the elevator handle on the gaagng tenakulum to maintain the position of the uterus

-Step 7: Take off the gloves, paakai dress operation and sterile gloves

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Preparatory Field Operations and Determination of Inside Place

-Step 1: Instructions to the nurse to inject diazepam 0.1 mg/Kg BB intravenous, after 3 minutes of intravenous injection of Ketamine 0.5 mg/KgBB wait 3 minutes

-Step 2: specify the inside place on the abdominal wall by moving the uterus elevator to the bottom so the uteri fundus touches the abdominal wall 2 -3 cm datas pubis

-Step 3: Do an act of asepsis on place of insides

Open the abdominal wall

-Step 1: injections infiltration 3-4 cc of local anastesi under the skin, after 2 minutes of anastesi effect value with pinset

-Step 2: do the transverse inside on the skin and subcutaneal tissue of 3 cm in the predetermined place

-Step 3: Separate the subcutaneously subcutaneously network until terlhat fasia

-Step 4: Needle Needle to fasia and do local anastesi infiltration 3 cc sambi lpulls needles

-Step 5: Fasia pin (with kocher) on 2 places in a vertical direction with 2 cm range, do insides in a horizontal direction, width to the left and and to the right

-Step 6: Separate muscle tissue is blunt at the center line with index finger and arterial clamps so tmapak peritonium and do local anesthetic infiltration 3 cc while pulling the needle.

-Step 7: Jepit peritonium with 2 klem, translumination for indentification, insert omentum and gut from

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peritonium with blunt side scissors

-Step 8: Gunting peritonium vertical direction 2 cm up and 1 cm down

-Step 9: Enter 2 bak items (retractor) on the insides The peritonium and the strain to show the uterus in the operating field

-Step 10: if the omentum or the intestine block the field of view, use the gauze, flip the tip of the screen with the clamp.

Reaching Tuba

-Step 1: Move elevator uterus until the fundus fundus appears on the operating field

-Step 2: Tamper with one of the uteri cornu and a rotundum ligament on an operating field by moving elevators and identification of a tuba

-Step 3: Jepit Tuba with pinset or Babcock clamps and pull slowly out through the insides of the hole up to look fimbria

Cutting Tuba (Cara Pomeroy)

-Step 1: Jepit tuba on 1/3 of the proximal with klem Babcock, lift up to the curved tuba, determine mesosalping deaerah without blood vessels

-Step 2: Insert a round needle with a catgut thread No. 0 at 2 cm from the top of the arch and tie one of the base of the tuba arch

-Step 3: Tie the two base arches of tuba secar together by using the same thread

-Step 4: Cut the tuba right above the thread

-Step 5: Check the bleeding on the tuba stump and check the tuba lumen to convince the tuba to be truncated

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-Step 6: Cut the catgut thread 1 cm from the tuba and enter the tuba chemo into the abdominal cavity

-Step 7: Do the same action on the other tuba side.

Closing the abdominal wall

-Step 1: Check out the abdominal cavity (possible bleeding or intestinal laceration) and emit gauze.

-Step 2: stitch fasia with stitching knot or number 8 using chromic thread catgut no 1

-Step 3: Jahit subcutis with stitching vertices using plain catgut thread number 0

-Step 4: Stitch the skin with the knot stitching using silk thread number 0

Post Surgery Act

-Step 1: Clear the inside wound and the abdominal wall surrounding it with alcohol or betadin, close the wound with sterile and plaster.

-Step 2: Clear the inside wound and surrounding abdominal wall with alcohol or betadin close wound with sterile and plaster fabric

-Step 3: Release of the tenaqulum and elevator uterus

-Step 4: Check the tension, pulse and breathing

-Step 5: Ask a client about the subjective saturation

-Step 6: Move the client to the recovery room and observe 1 hour

-Step 7: Instruction to the nurse for the observation, pulse, respiratory damage to surgery and vaginal injury

Decontamination

-Step 1: Clear the glove hand in

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chlorine solution 0.5%, release and let it submerged in a solution of 10 minutes

-Step 2: Take off the operas, cap and mask and place on available premises

-Step 3: Cuci hand with running water and soap

-Step 4: Check out the entire operating equipment used, remit in chlorine solution 0.5% for 10 minutes

-Step 5: Check the tube and syringe that has been worn, immersed in a chlorine solution 0.5% in a separate place from the equipment.

-Step 6: Check the gauze, the rest of the thread and others that have been contaminated with blood or body fluids have been included in closed plastic

Minilaparatomi post-percopy

Do counseling, pre-surgical preparation as well as sepsis action and antisepsis.

Open the Wall Abarees

-Step 1: Do an act of asepsis on the operation of an operation around the navel with betadin or jodium alcohol then close with a hollow sterile fabric in the middle

-Step 2: Inject infiltration 3-4 cc local anesthetic (lignofabric 1%) on the insides, layer by layer until fasia, wait 2 minutes and value the anesthetic effect by clawing skin using chirurgis pinset

-Step 3: Do inside melingtang at skin and subcutaneous tissue of 2-3 cm directly below the navel

-Step 4: Insides layer by layer until nearly discharged peritonium is clamped with 2 klem, translumination for

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identifies and scissors the finger selecable so that it can enter the index finger and a tampon tang.

Achieved Tuba

-Step 5: insert the retractor into the abdominal cavity, pull the retractor to the direction of the tuba to be achieved

-Step 6: Jepit tuba with pinset or klem babcock and pull slowly out through the insides of the insides until it looks fimbria

-Step 7: If the tuba is covered in omentum or intestine, insert it by using a round gauze that is clamped in the arteries and the position of the trendelenberg client

(the way pomeroy)

-Step 1: Jepit tuba on 1/3 of the proximal with the Babcock clamp, lift Reaching the curved tuba, determining mesosalping deaerah without blood vessels

-Step 2: Enter a round needle with a Catgut flag No. 0 at 2 cm from the top of the arch and tie one of the base of the tuba arch

-Step 3: Tie both of the base of tuba secar together using the same thread

-Step 4: Cut the tuba right above the thread

-Step 5: Check the bleeding on the tuba stump and check the tuba lumen to convince the tuba have been truncated

-Step 6: Cut the catgut thread 1 cm from the tuba and enter the tuba chemo into the abdominal cavity

-Step 7: Do the same action on the other tuba side.

Closing the abdominal wall

- Step 1: Check the abdominal cavity (possible bleeding or intestinal laceration) and

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emit gauze roll

-Step 2: sewing fasia with stitching knot or number 8 using thread chromic catgut no 1

-Step 3: Jahit subcutis with stitching vertices using plain catgut thread number 0

-Step 4: Jahit skin with stitching knot using silk thread number 0

Post Surgery action

-Step 1: Clear the inside wound and the abdominal wall surrounding it with alcohol or betadin, close the wound with sterile and plaster fabric

-Step 2: Clear the inside wound and surrounding abdominal wall with alcohol or betadin close wound with sterile and plaster fabric

-Step 3: Release of the tenaqulum and elevator uterus

-Step 4: Check the tension, pulse and breathing

- Step 5: Ask a client about the subjective complaint

-Step 6: Move the client to the recovery room and observe 1 hour

-Step 7: Instruction to the nurse for the observation of tension, pulse, respiratory damage to surgery and vaginal injuries

Decontamination

-Step 1: Clear the glove in a chlorine solution 0.5%, release it and let it be submerged in the solution for 10 minutes

-Step 2: Take off the operating dress, cap as well as mask and put it on the available

-Step 3: Cuci hand with running water and soap

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-Step 4: Check out the entire operating equipment used, soak in a chlorine solution 0.5% for 10 minutes

-Step 5: Check the tube and the syringe that has been used, marinated in solution chlorine 0.5% in a separate place from equipment.

-Step 6: Check the gauze, the rest of the thread and others that have been contaminated with blood or body fluids have been included in closed plastic

f. Action after operation

Counseling and Pascasurgical Instructions

-Remind the patient to keep the operating wound area dry

-Explain on the client to not be senggama for one week post-operation, to return if there is a complaint (pain or bleeding), recontrol one week of operation paska

-If it is stable, the client can be repatriate 4-6 hours post operation

3. Vasectomy

a. Preparation

-Client

Client should take a shower and use clean and loose clothing or clear the scrotum and inguinal regions before entering the action room. The client is also rolling out to carry special pants to buffer the scrotum. The pubic hair was quite short-scissors shortly before the surgery. Wash the operating area with soap and water then repeat the can again with an antiseptic solution.

-Operation

Because a vasectomy is a minor surgical act and sometimes requires a small inside/without insides so it is only including superfisial areas, then clients can use their own clothes as long as it is clean and officers do not have to use surgical hats, masks or operating shirts.

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b. Infection Prevention

Before action

Cuci and rub skrotum, penis, and pubic area with soap and rinse with clean water. And then the antiseptic fluid in the operating area. The operator washed hands with antiseptic solutions and rinsed it with clean water

s. During action

Use instruments that have been district/DTT including gloves and desserts. Perform an action with high skill to reduce the risk of complications.

The after action

Still uses the glove, the operator dumps the contaminated ingredients into a closed container. Perform decontamination action with a chlorine 0.5% solution on the instrument or device that is still used again. Perform decontamination also on the action table or any other object that may be contaminated during action. Wash your hands after removing the gloves.

c. Premedikation and Anastesi

The granting of premedictation may be avoided, if the client is anxious to find the cause first and then recounseling. When required can be given 5-10 mg of diazepam orally 30-45 minutes prior to the surgery action.

The local anesthetic anesthesia uses lidocaine without epinerfin compared to a general anesthetic that may increase the complications of respiratory depersion.

d. Operating steps

Standard Vasectomy techniques

-Step 1: Pants opened and tilted pasen in outstretched position

-Step 2: The area of the scrotum, the penis, supra pubis, and the inside of the left thigh and right thigh cleaned with non-rangeable fluids such as a solution of iodine (betadine) 0.75% or a solution of khlorhexydin 4%.

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-Step 3: Close the affected area with a perforated sterile fabric on the scrotum to exit

-Step 4: right in the medianan linea above the vas deferens, skrotum shell is given The local anesthesia then the needle passed in and in the distal area and the proximal vases deferens were deponderated again, respectively 0.5 ml.

-Step 5: The skin of the skrotum is sliced longitudinal 1-2 cm, right above the deferens vase which has been accentuated to the surface leather.

-Step 6: Once the skin is opened, the vas deferens are held with a clamp, the bleeding is carefully missed. It is best to add anesthetic to the fasia vases deferens, and then the fasia is a longitudinal (0.5 cm) long-loved fasia. Setlah fasia vas deferens are opened visible clear white and shiny deferens vases. Then release Vas Deferens and his fasies with fine scissors

-Step 7: Jepitlah vas deferens with klem no place is 1-2 cm long and tie With both ends. Once tied up, don't cut it. Pull up a thread that binds both ends of the vase and the check if there's bleeding. Clamp at the bleeding point is enough.

-Step 8: Stick between the two bonds of 1 cm. Use the silk thread no. 00 or 1 to tie the vase. Binding should not be too loose and not too hard.

-Step 9: To prevent spontaneous recanalization is recommended by standardizing the reposition of the fasia vase deferens, i.e. sewing back the open fasia in such a way. visual, vas deferens

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The distal part is located outside the fasia.

-Step 10: Do for the right and left deferens vases, after completion of the skin with 1-2 other stitches catgut No. 000 then outpatient surgery, close with Sterile gauze and plastered.

Vasectomy Without Knives

-Step 1: Pants are opened and lay aspient in a stretched position

-Step 2: The hair around the scrotum is shaved until clean

-Step 3: Penis plastered to the abdominal wall

-Step 4: The skin region of skrotum, penis, supra pubis and part in the base of the left and right thighs are cleaned with an unstimulating liquid such as an iodofor solution or chlorhexine

-Step 5: Close the area that has been removed by the Hollow sterile cloth in place of the scrotum to the point.

-Step 6: right in the median linea above the vas deferens, the skrotum shell is given a local anesthetic and the needle is passed in and in the distal region and the proximal vases deferens are deponderated again. each 0.5 ml.

-Step 7: The vase deferens with the skin of the scrotum that are confirmed are fixed in the circle of the fixation of the fixation on the middle line of the scrotum. The cleverness of the clamps is reeven down so that the vas deferens lead to the bottom of the skin.

-Step 8: Then stab the most prominent part of the vas deferens, right next to the distal of the clamp circle with the tip of the sexy glue with the angle of the corner. Forty-five degrees. While stabbing a deferent vase better get to the vas deferens, then the sexy clamps are hot

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withdrawn, close of the gklem test and in closed state the tip of the clamp is reincorporated in the tusukkan hole, the course of the vases deferens.

-Step 9: Regades the end of the slow-slow klem. All tissue layers of the samapi shell of the vas deferens walls will be separated in one movement. After that the naked wall of the vas deferens can be seen.

-Step 10: With the tip of the disexed clamp facing down, one of the clamps of the clamps into the vas deferens wall and the tip of the klem rotated according to the clockwise direction, So the tip of the clamp faces up The tip of the klem is slow-pelasn is compressed and holds the anterior wall of the vas deferens. Remove the fixation glue from the skin and move it to hold the deferens vase that has opened up. Hold and fixation of the deferens vases that have been naked with the fixation clamps then remove the sexy clamp.

-Step 11: On the curvy deferens vases, the surrounding tissue is separated slowly down to the bottom with the sexy clamps. If the hole is wide enough, then the sexy glue is inserted into the hole. Then open the tip of the clamp-slowly the pararels in the direction of the vas deferens raised. It takes a kira-kiran 2 cm free deferens vase. Vases deferens dichrush soft with disexed clamps, snot done ligation with 3-0 silk thread.

-Step 12: Among the du ligation approximately 1-1.5 cm the deferens vases are cut and lifted. The thread on the distal putung is temporarily uncut. Control of the bleeding and return the putung-putung vase

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deferens in the scrotum.

-Langkah13: drag slowly the thread on the distal advantage. Subtly hold the fasia of the vas deferens with the disexed clamps and cap the fastly lobang with a bind in such a way that the epididymis is closed and the distal butts are outside the fasia. If there is no bleeding on the state of the vase the deferes are not strained, then the final thread can be cut and the vas deferens are returned in the scrotum.

-Step 14: perform the above action for the vase deferens next to the other, through the wound Same line. If there is no bleeding, the skin lesions do not need to be stitched up only proximate with the aid band and tensoplas.

e. Action after operation

Pasca vasectomy is recommended in the following:

-Client lay down for 15 minutes

-Amati pain or bleeding

-Notice of advice:

The wound is not wet

immediate return to the hospital if bleeding, fever, intense pain, vomiting and asphyxiation

The stay is avoided working the weight/bike while

If the husband's husband relationship uses a condom up to 15 ejaculation/3 months post action. It was then suggested check spermatozoa to make sure there were no more sperm found in semen

-Anjuran control a week to 2 weeks after action, continued with a month, three months and a year later.

E. Keep Contraceptive Service Quality

1. Quality Family Service Quality

Access to quality KB services is a condition of reproductive needs and health rights

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as set forth in the action program of ICPD Cairo, 1994. It includes the greetings of everyone's right to obtain information and access to various methods of safe birth control, effective, affordable and accetable.

The role and responsibility of men in KB need to be improved in order to be supportive. Contraceptive needs for his wife, increasing the communication of the husband's husband, increasing the use of male contraceptive methods, increasing STIs prevention efforts, etc.

Quality KB services include things among others:

Service care tailored to client needs

Client's data is professionally served and meets Service standards

-maintain privacy and privacy

Short wait hours

The officer provides information on various available contraceptive methods

The Officer explains the health facility's ability to clients in the service of various contraceptive options

The services facility must meet the specified requirements

Service availability is available at a predetermined and convenient time for the client

The contraceptive and contraceptive tool available in sufficient amount

the figure has a dynamic superfation system in order help resolve

There is an effective feedback mechanism from the client

The successful program of the Program requires a trained officer who:

The person is able to provide the information to a client with patient, understanding and sensitive

Has knowledge, positive attitude, and technical skills to provide services in the field of reproductive health

The ability to meet a defined standard of service standards

the ability to recognize and solve the problem

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The ability to have a referral system

has the ability to conduct a good clinical assessment

The company has the ability member-advice for improvement of the program

The network has a monitoring system and periodic superfitions

Quality service quality requires:

a. Staff trained in counseling, information giving and technical skills

b. Complete and accurate information for clients so that they can choose the most appropriate contraceptive method

c. The environmental environment in health facilities is influential to the ability of the officer in delivering quality services, especially in technical ability and interpersonal interaction (officer dank lien)

d. Officers and clients have a similar vision of quality services

Table: Officer role in KB ministry at health facility

KB Officer Method

Doctor Bidan Nurse

Pills v v v

Progestin Pills v v v

Suninterpret Progestin v v K

A combination v v K

Implan v v K

Tubektomi v K K

Vasectomy v K K

Kondom v v K

Diafragma v v K

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Spermisida v v v

AKDR v v K

Calendar v v v

The method of Amenorea Laktation v v v

Abstinensia v v v

Table: The ability of health facilities to provide the service of KB

Facility KB Method

RS Puskesmas Posyandu

Pills v v v

Pills Progestin v v v

Suninterpret Progestin v v v

Suninterpret Combines v v v

Implan v v v

Tubektomi v K K

Vasectomy v v K

Kondom v v v

Diafragma v v v

Spermisida v v v

AKDR v v v

Calendar v v v

Method Amenorea Laktation v v v v.

Abstinensia v v v

V: provide service

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K: counseling and referencing

2. Referral System

Purpose

The purpose of the referral system here is to improve the quality, scope and efficiency of contraceptive services in a unified way. Special attention is intended to support a decrease in the incidence of adverse effects, complications and failure of contraceptive use.

Tata Laksana

The medic alignment can take place:

Internal attention (interofficer) at one Puskesmas

The following between the housekeeper and the puskesmas

between the community and the puskesmas

The space between one center and another heirloom

The space between the heirloom and the hospital, the laboratory, or the health care facility referral

Internal control (intersection/service unit) at a hospital

Interface hospitals, labs or other health facilities and hospitals, labs or other service facilities.

In carrying out the referral must be given:

Counseling about the client ' s condition that causes it to be referenced

Counseling about expected conditions acquired in the referral venue

Information about the health care facility where referral is located

The Introduction of the Introduction to the intended service facility on the current client condition and previous history and effort/actions that have been provided

provide client's stabilisation efforts during the trip

s. Due to client's condition, during the course of the referral location, the client is accompanied by a nurse

the person calling the referral health facility to be provided as soon as the client arrives.

The referral health care facility, after providing relief efforts and client conditions has improved, should

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promptly returned the client to its original service facility where it first provided:

Counseling about client conditions before and after being given a countermeasure

Need to be advised by the client to continue using the contraceptive use

The introduction of the written introduction to the service facility referencing the client condition and the countermeasures that have been provided and the subsequent service suggestions. that should be implemented, especially about the continuation of contraceptive use

3. Minimum requirement of a Service Facility

The contraceptive services facility is one of the chains of a unified KB medical care facility chain with the general health care facility health care facility.

The KB ministry hosted by professionals, namely specialist physicians, general doctors, midwife and health nurses, mainly static, but for areas that are difficult to reach and on certain situations can be mobile (mobile)

Grouping of KB (static) service facilities based on their ability and authority Divided up of 4 classes, namely:

Simple Simple Birth Service Facility

s Full KB Service Facility

s Perfect KB Service Facility

s Plenary Birth Control Facility

-Classification of KB Faskes Based on Scope Service

No Lingkup Service

Faskes

KB

Simple

Faskes

KB

Faskes

Faskes

KB

Perfect

Faskes

KB

PLENARY

1. Counseling

√ √ √ √

2. Condoms

√ + √ √

3. Birth control (PPS)

√ √ √ √

4. Injectable Service KB

√ √% √

5. IUD/Implan Service

-√ √ √

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No Lingkup Service

Faskes

KB

Simple

Faskes

KB

Complete

Faskes

KB

Perfect

Faskes

KB

PLENARY

6. Vasektomi/

MOP--/√ √ √

7. Service

Tubektomi/MOW--√ √

8.

Rekanalization and

countermeasures

Infertility

---√

9.

Effects Countermeasures

Aside (appropriate

capabilities) and

referral efforts

√ √ √

Based On Healthcare Minimal Requirements

Power Classification

Simple Doctor/Bidan/Health Nurse V

Administration V/0

Full Doctor/Bidan/Health Nurse V

Administration V/0

Perfect Doctor VV

Bidan VV

VV Health Nurse

VV Administration

Full- Doctor VV

Bidan VV

VV Health Nurse

VV Administration

V: May be filled with one or both

VV: Must be filled and not zero "0"

V/0: May be filled or may be zero "0"

CLASSIFICATION OF BIRTH CONTROL

BASED ON THE MINIMUM REQUIREMENTS OF THE KB ' S FASKES

Simple Complete Complete Plenary

Counseling Kit Counseling Kit Counseling Kit

Kit Counseling Kit

BP3K BP3K BP3K

Tensimeter Tensimeter Tensimeter

Scales

Weight

Weight Scales

Body

Scales

Weight

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Obgyn Bed Obgyn Bed Obgyn Bed

IUD KIT IUD KIT IUD KIT

Implant

Removal Kit

Implant Removal

Kit

Implant Kit

Removal Kit

VTP Kit VTP Kit VTP Kit

Minilaparotomy

Kit/Laparoscopy

Minilaparotomy

Kit/Laparoscopy

4. Contraceptive Tool Supply Management

a. Basic Guide/contraceptive Drugs Basic Guide.

A good tool/contraceptive storage event is an effort to keep the quality of the contraceptive/contraceptive always in good and safe conditions for use by birth control clients.

A contraceptive Basic Device/contraceptive Base Guide:

1) Clean and sacred the device storage/contraceptive drug on a regular basis

2) Save the contraceptive device in dry, undamp state, gets air vents the good, and not exposed to the sun langsubng

3) Make sure that the fire hazard safety device is in good condition, as well as ready and easy to take/used

4) Place the condom dus made of cardboard to be kept away from electric source/light source, to prevent fire hazard

5) Place the dus Contraceptive tool (which is in the warehouse): +-10 cm above the floor; +-30 cm from the wall, the height of the arrangement is no more than 2.5m

6) To be arranged a carton dus so that the identity card/label is given the deadline. expiry or time at the plant can be easily seen

7) Place the contraceptive device on a position that allows for distribution in the FEFO system it is an early alocon term for more early time. distributed/used by clients

8) Place each type of contraceptive tool/drug separate, and keep away from ingredients containing insecticides, chemicals, old archives/old archives,

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office equipment and other materials

9) Separate the tool and contraceptive drug up to the expiry deadline, in accordance with the terms of the government or the aid provider.

10) Make sure that Contraceptive tool storage is really in a safe position.

To ensure that contraceptive devices are not yet on the expiry limit on time is channeled to the client, then apply the FEFO (First Expired First Out) policy. must be informed to the entire officer ' s ranks.

The things that need to be noticed on FEFO:

1) The research of any contraceptive device that arrives at a warehouse or service facility, when expired

2) Put any alokon dus in accordance with the expiry order of time. The top of the above is the alocon dus whose term is the closest to which it is found. Make sure that the alocon is easy to see and easily taken by the officer

3) Announce to the other officer to use the alokon that his expiry term is closest to first, and pan be sure not to deploy the already passing alokon The date of the expiry date.

The observation of the quality of contraceptive devices visually can be done if physically visible signs of abnormalities. Signs of identifiable abnormalities (so do not be used) are as follows:

No type of drugs

contraception

Signs abnormalities

1 KB pill The pill is seen broken (chapped, rape/shred,

changed color)

The Aluinium wrapping is broken

s. On the package. There are missing pills

The pill is badly damaged/damaged (there are brown spots,

easily ruptured)

2 Kondom Condoms are seen damaged

The condom-led layer of condoms is broken/leaked

The seal of the packaging is not intact

3 AKDR The sterile asan is already a truste/eropen

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No types of drugs

contraceptive

Signs abnormalities

4 Suntik KB Customary and unmixed homogeny

despite already being shaken

5 Implants of the sterile Kemasan look broken

One capsule or more in that packaging

missing or changed color (not white)

One capsule or more in that packaging

bengkok/not straight

b. The contraceptive inventory guide

Guna knows whether the contraceptive device stored in a storage facility on the faskes is still in good quality and safe to be channeled to a client, needs to be made of quality observations. against the physical device/contraceptive medication periodically. Observations are made using the Tilik List:

1) Inventory Management

2) The storage conditions

The effectiveness and quality of the contraceptive tool/drug are well preserved if stored in good condition.

Quality protection and contraceptive/contraceptive storage conditions

No Type

Contraception Storage Condition

Expiration

expiry

1 KB pills Save in a cool and dry place and

keep away from the sun directly

5 years

2 Condoms Save in a cool and dry place, namely

temperature, 40C and keep out of the rays

direct sun, chemicals, and

flammable materials

3-5 years

3 AKDR Protect from humidity, sunshine

directly, 15-30 degree C

7 years

4 Norplan Save at temperatures 15-30

degree C, keep it from high temperature

3-5 years

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No Type

Contraception Storage Condition

Periods

Expiry

5 Injectable KB Save in place of cool and dry, temperature

< 30 degrees C

5 years

Save on space temperature 15-30

degree C, perpendicular vials position

facing up, keep it from the rays

direct sun

To ensure whether the contraceptive/contraceptive is in good condition, before it is distributed to the client, do the following:

1) Officers perform a physical condition of the contraceptive tool/drug which is accepted

2) If the contraceptive condition is good, then it will be stored more than 6 months, if the storage conditions are less favorable (too hot/kmoist), the officer needs to periodically perform the physical inspection (weekly)

3) Do the logging and the export of the existing findings to get a good solution

5. Facilitative Breeding

a. Understanding

The facilitative breeding is an approach to performance improvement through a glorification with a focus on systematic monitoring, mutual problem solving and two-way communication between the equiliers and the disseminated

b. Goal

Keeping the quality of the quality process going on a continuous way by bringing together client's expectations with the quality of the health care provided

c. The focus and way of doing

The focus of facilitative breeding is on the system and performance process by leveraging data/information to identify and analyze the problem as well as find the root cause of the problem. Then apply selected solutions to keep and repair

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quality of service, which includes eight quality dimensions:

1) Service managing technical competence

2) Client's access to service facilities

3) The effectiveness of service

4) Efficiency service

5) Interhuman relations (client and service pelaksna)

6) Continuity of service

7) Service security

8) Kenyamana nministry

d. Facilitative Tuning Role:

1) Do a deep observation by tracing the causes and factors that affect the problem of problem

2) Find performance strengths and weaknesses without judging the selia object and attempting to provide Appropriate advice. Use a deliverable tool that is a list of structured tyclics and fit the performance assessment topic.

3) Focus the supervise on the process and the system, not on the individual

4) Orientates on the upcoming guidelines and not see on the error that has occurred

5) Conduct a continuous breeding with the caea analysing the results of the past glorification and following up the recommendation or repair advice

e. Execution Time

1) Post-training

-Is a follow-up training for evaluation effectiveness evaluation and assessing post-training performance in the working environment of the training participants

-Done should be 3-4 months pascapeworkout

-Executing is the officer who has got standardised training in related clinical aspects and has competence as a deliverer

-Using an instrument of KB ministry tikey and card charging format KB participant status

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-Steps are performed:

1. Explains the purpose of the facilitative supervise to the leadership

2. Request permission

3. Direct observation of the competency and service quality

4. Review the status of the KB participant status

5. Interview with client

2) periodic routine

-periodic regular breeding targets on health care facilities

-Executable according to planned schedule

-Executable: team consisting of officers Who was trained by the standards of birth control, the service manager and the officer who knows about contraception. Preferably an oworker is an officer who has been following an internship or a facilitative supervise training that has understood the principle of quality control activities.

-Using the instrument:

1. List of default KB of service steps

2. KB service status card charging format

3. Birth control (KB)

4. Birth certificate (KB)

5. List of means/infrastructure and alocon of service KB

6. Summary of the deliverable report

-Measures that need to be performed:

1. Breeding of officer skills

2. Breeding of service management

3. Summary of the glorification report summary

4. Facilitating the facilitative breeding

6. Monitoring and Evaluation

a. Role and Responsibility

The purpose of monitoring and evaluation systems is to know the extent of the total effort that

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is impacted by the advancement of the KB program, including the contraceptive service that includes the availability of service, the reach of service, and the quality of the service of the service based on the applicable policy. These activities can be accomplished through a role performed by the Mutu Guard (cross-sector) team by using established service indicators.

b. Logging and Reporting Systems

Notes and reporting activities are a process for obtaining data and information that are subject matter in the information system and needed for the operational interest of the program. Such data and information are also decision making materials, planning, monitoring and assessment as well as program control. Therefore data and information are hasted to be accurate, timely and trustworthy. In an effort to meet expectations and information generated as quality data and information, it is always done with refinement steps in accordance with the development of the program with new program vision and mission as well as the progress of progress information technology.

The search and service reporting of the contraceptive Program is addressed to the activities and results of operational activities including:

1) The contraceptive service Activity

2) The results of the contraceptive activity

3) The state of contraceptive tools

Special to account and reporting of the results of the contraceptive activity, related to different needs, performed in two versions: 1) in accordance with the format of BKKBN, and 2) in accordance with the format of the Ministry of Health.

Mechanism and currents Contraceptive reporting and reporting of contraceptive services:

1) Each new KB participant and the transfer of the KB transfered the KB Card Card (K/I/KB/04), stored by the KB participants and brought to the faskes every time when the KB participants made a re-visit

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2) Each new KB participant and the transfer of KB are made up of the KB Card Status Card (K/IV/KB/04), stored on the pertinated faskes and reused during the return visit of the faskes. it

3) Any KB ministry performed by Puskesmas should be logged in Kohor Service KB and Register KB Clinic (R/I/KB/04), recapitulated at each end of the month, and is a data source for charging Monthly Report KB Clinic (F/II/KB/2004)

4) Each receipt and expenditure of the contraceptive tool/drug by faskes is recorded in the Register of Contraception Medicine Clinics KB (R/II/KB/2004), recapitulation at each end of the month, and is the source of data for charging the KB Financial Clinic Report (F/II/KB/2004)

5) The contraceptive service is conducted in Pustu, Poskesdes/Polindes and Bidan/Doctors of Mandiri Practice each day noted in Kohor KB, performed recapitulation at each end of the month, sent to the Puskesmas in charge of the work area concerned and is a source of data for charging Bulanan Puskesmas Report

6) The contraceptive service that conducted in Bidan/Doctor Practice Mandiri every day noted in the Contraceptive Service Handbook on Doctor/Bidan Private Practice (B/I/DBS/04), taken by PDPKB and is the source of the data for the charging of the Liaison Officer Monthly Report Doctors/Bidan Practices of Mandiri (F/I/PHDBS/04) which later became the source of data for the charging of the Monthly Report of the KB Clinic (F/II/KB/2004)

7) Each month the Puskesmas officer makes the contraceptive Service Results Report that exists throughout the region It works by recruiting the results of the contraceptive service that is being done by Puskesmas and contraceptive services sent from Pustu, Poskesdes/Polindes and Bidan/Doctor Practices Mandiri tang is in its work area.

8) The puskesmas report was reported to the County/City Health Service and were exhaled to SKPD KB

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9) District/City Health Service reported to the Provincial Health Service.

HEALTH MINISTER

REPUBLIC OF INDONESIA,

NILA FARID MOELOEK

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