U M I V E R S I T A S M U H A M M A D I Y A H N o , D A F T A R . 0^9/ ?e^-vti^/ooO-

HUBUNGAN ANEMIA DALAM KEHAMILAN DENGAN

ANGKA KEJADIAN BERAT BAYI LAHIR RENDAH DI

RUMAH SAKIT MOH. HOESIN PALEMBANG

TAHUN 2011

Salah Satu Syarat Memperoleh Gelar

Sarjana Kedokteran (S.Ked)

Oleh:

Fadhyl Zuhry Lubis

NIM:70 2008004

Skripsi

FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH PALEMBANG

2011

HALAMAN PENGESAHAN

HUBUNGAN ANEMIA DALAM KEHAMILAN DENGAN ANGKA KEJADIAN BERAT BAYI LAHIR RENDAH DI

RUMAH SAKIT MOH. HOESIN PALEMBANG TAHUN 2011

Dipersiapkan dan disusun oleh Fadhyl Zuhry Lubis NIM:70 2008 004

Sebagai salah satu syarat memperoleh gelar Sarjana Kedokteran (S Ked)

Pada tanggal: 2 Maret 2012

Mcnyetujui:

dr. H. Svahrul Niluhammad. MARS Pemhim^i Pertama

dr.H. Hibsah Ridwan. M.Sc Peipbimbing Kedua

Dekan Fakultas Kedokteran

i

P E R N Y A T A A N

D e n g a n i n i S a y a m e n e r a n g k a n b a h w a :

1 . K a r y a T u l i s S a y a , s k r i p s i i n i a d a l a h a s t i d a n b e i u m p e r n a h d i a j u k a n u n t u k

m e n d a p a t k a n g e l a r a k a d e m i k , b a i k d i U n i v e r s i t a s M u h a m m a d i y a h P a l e m b a n g ,

m a u p u n P e r g u r u a n T i n g g i l a i n n y a .

2 . K a r y a T u l i s i n i m u r n i g a g a s a n , r u m u s a n , d a n p e n e l i t i a n S a y a s e n d i r i , t a n p a

b a n t u a n p i h a k l a i n , k e c u a l i a r a h a n T i m P e m b i m b i n g .

3 . D a l a m K a r y a T u l i s i n i t i d a k t e r d a p a t k a r y a a t a u p e n d a p a t y a n g t e l a h d i t u l i s

a t a u d i p u b l i k a s i k a n o r a n g l a i n , k e c u a l i s e c a r a t e r t u l i s d e n g a n d i c a n t u m k a n

s e b a g a i a c u a n d a l a m n a s k a h d e n g a n d i s e b u t k a n n a m a p e n g a r a n g d a n

d i c a n t u m k a n d a l a m d a f t a r p u s t a k a .

4 . P e m y a t a a n i n i S a y a b u a t d e n g a n s e s u n g g u h n y a d a n a p a b i l a d i k e m u d i a n h a r i

t e r d a p a t p e n y i m p a n g a n d a n k e t i d a k b e n a r a n d a l a m p e m y a t a a n i n i , m a k a S a y a

b e r s e d i a m e n e r i m a s a n k s i a k a d e m i k a t a u s a n k i l a i n n y a s e s u a i d e n g a n n o r m a

y a n g b e r l a k u d i P e r g u r u a n T i n g g i i n i .

P a l e m b a n g , M a r e t 2 0 1 2

Y a n g m e m b u a t p e m y a t a a

F a d h y l Z u h r y L u b i s N I M . 7 0 2 0 0 8 0 0 4

i i

'fTXj ta jbftf? txAf darpada harta Itixj aUan menjasa GD^I^ dan en^l^aa aUan menpyi harta fnu ia adajah pon^vjUiin Qidi^) GGdm^an harta adajah gan^ tGrhaUam. Uapu harta fu berUuran^ apdbip dhelanjaUan, tetapi ifrxj aUan Pertantdi apabila dtGpnjaUan'

( A U biry A b i Z T h c x U b )

l\arya eaya persembat Kap l epada:

1. f cdua orap^ tua saya ya)§ s a p ^ saya sayap^i. /lyal? dap

/I\amaK yap^ selalu memberiKap l epada fadpii semap^

dap pasil at yap^ a Q ip^< terutama uptti(

/ yap tcrima l asip telap mcpjadi ayap, sapabat. dap temap

bcrfiKir.

2. I\epada adiK-adil(Ku mayap^ dap ama, yap^ rajip belajarpya.

abap^ s a p ^ e^yap^ d e p ^ K iap

3- 5P^i^' ^'^'^ mepdii^up^a yap^ selalu sayap^ sama al u, /lyyia f osalita

4- T«map-t«mapKu ju^a y ^ laip /ly. / Ipam Beap. /Ibap^

U/epdy. Dop [termap. dap Ipep^ F ayKa. jilDi^ *Wf 'I/*5

5. Jerima l^ip j u ^ iijtuK BOO / l ^ 5eeopd /llxm yap^

scrip^ bap^ip aKa vjualatfu) serip^ p^jaK bcraptem

iii

UNIVERSITAS MUHAMMADIYAH PALEMBANG F A K U L T A S K E D O K T E R A N

SKRIPSI, F E B R U A R I 2012 F A D H Y L ZUHRY LUBIS

Hubungan Anemia Dalam Kehamilan Dengan Kejadian Bayi Berat Lahir Rendah Di Rs. Muhammad Hoesin Palembang Tahun 2011

IX + 47 Halaman + 10 Tabel

ABSTRAK

A n e m i a d a l a m K e h a m i l a n m e r u p a k a n s a l a h s a t u f a k t o r r e s i k o t e r j a d i n y a B a y i B e r a t L a h i r R e n d a h a t a u B B L R ( < 2 5 0 0 g r ) . B B L R m e r u p a k a n s a l a h s a t u p e n y e b a b k e m a t i a n p e r i n a t a l d a n n e o n a t a l . S e l a i n i t u B B L R j u g a d a p a t m e n g a i a m i h a m b a t a n p e r k e m b a n g a n d a n k e m u n d u r a n p a d a f u n g s i i n t e l e k t u a l n y a .

P e n e l i t i a n i n i b e r t u j u a n m e n g i d e n t i f i k a s i k a n h u b u n g a n k a d a r H b i b u h a m i l d e n g a n B B L R d e n g a n m e n g g u n a k a n d e s a i n o b s e r v a s i o n a l a n a l i t i k d e n g a n p e n d e k a t a n case control y a n g d i l a k u k a n d i R S U P D r . M u h a m m a d H o e s i n P a l e m b a n g J u m l a h s a m p e l s e b a n y a k 6 0 p a s i e n y a n g t e r b a g i d a l a m 2 k e l o m p o k y a i t u 3 0 p a s i e n B a y i B e r a t L a h i r R e n d a h ( B B L R ) s e b a g a i k e l o m p o k k a s u s d a n 3 0 B a y i B e r a t L a h i r . P e n g a m b i l a n s a m p e l p e n e l i t i a n d i l a k u k a n s e c a r a consecutive sampling. I n s t r u m e n p e n e l i t i a n m e n g g u n a k a n r e k a m m e d i k R S U P D r . M u h a m m a d H o e s i n d a r i b u l a n J a n u a r i 2 0 1 1 - D e s e m b e r 2 0 1 1 , d a t a y a n g d i a m b i l m e l i p u t i i d e n t i t a s s u b j e k , k a d a r h e m o g l o b i n d a n b e r a t b a d a n b a y i l a h i r A n a l i s a d a t a p e n e l i t i a n m e n g g u n a k a n m e t o d e u j i chi square d e n g a n l e v e l s i g n i f i k a n s i s e b e s a r 5 % .

D a r i H a s i l p e n e l i t i a n d i d a p a t k a n b a h w a i b u h a m i l y a n g m e n d e r i t a a n e m i a ( H b < 1 1 g r / d l ) s e b e s a r 3 3 , 3 3 %, s e d a n g k a n b a y i d e n g a n B B L R s e b e s a r 5 0 % . M e l a l u i a n a l i s i s d a t a m e n g g u n a k a n chi square (X^), d i d a p a t k a n t e r d a p a t h u b u n g a n y a n g b e r m a k n a a n t a r a a n e m i a d a l a m k e h a m i l a n d e n g a n k e j a d i a n B B L R ( p = 0 , 0 0 1 ) , r e s i k o u n t u k m e l a h i r k a n B B L R m e n i n g k a t s e c a r a s i g n i f i k a n d e n g a n d e r a j a t k e p a r a h a n a n e m i a ( O R = 6 , 8 1 p a d a i b u h a m i l d e n g a n a n e m i a r i n g a n / s e d a n g d a n O R ~ 9 , 2 8 6 p a d a i b u h a m i l d e n g a n a n e m i a b e r a t ) d i b a n d i n g k a n d e n g a n y a n g i b u y a n g t i d a k m e n g a i a m i a n e m i a s e w a k t u k e h a m i l a n .

T e r d a p a t h u b u n g a n y a n g b e r m a k n a a n e m i a d a l a m k e h a m i l a n d e n g a n k e j a d i a n B B L R . D a n d i d a p a t j u g a b a h w a I b u y a n g h a m i l d e n g a n a n e m i a d a l a m k e h a m i l a n d a p a t m e n i n g k a t k a n r e s i k o m e l a h i r k a n B a y i B e r a t L a h i r d a r i i b u y a n g h a m i l n o r m a l .

Referensi: 41 ( 2000-2011) Kata Kunci: Anemia, BBLR, Kehamilan

i v

UNIVERSITY OF MUHAMMADIYAH PALEMBANG M E D I C A L F A C U L T Y

SKRIPSI , F E B R U A R I 2012 F A D H Y L ZUHRY LUBIS

Association Anemia in Pregnancy with Low birth Weight in Muhammad Hoesin Hospital 2011

I X + 47 Page+10 Table

ABSTRACT

A n e m i a i n Pregnancy is a risk factor for Low B i r t h Weight Babies or L B W ( < 2 5 0 0 g ) . L B W is one of the causes o f p e r i n a t a l and neonatal mortality and also effect on developmental disturbance and deterioration of i n t e l l e c t u a l f u n c t i o n .

This study aims to identify the relationships of H b levels on Pregnance with L B W by using the observational of analytic design with case control approach which taken i n the D r . M u h a m m a d Hoesin H o s p i t a l Palembang. The number of samples a r e 6 0 patients which divide into 2 groups, 3 0 patients of Low B i r t h Weight (LBW) and 3 0 patient of N o r m a l B i r t h Weight. The subjects were selected based on consecutive sampling. The research instrument used medical records on D r . M u h a m m a d Hoesin H o s p i t a l f r o m J a n u a r y 2 0 1 1 - December 2 0 1 1 , includes the identity of the subject, hemoglobin levels and b i r t h weight. Analysis of data using chi square test with a significance level of 5%.

The results obtainedfrom research that women who suffer a n e m i a (Hb < 1 J g / dl) 3 3 . 3 3 % , whereas infants with low b i r t h weight by 5 0 % . Based on statistical test by chi square (X ^), there was significant association between a n e m i a i n pregnancy with low b i r t h weight (p = 0 , 0 0 1 ) , the risk L B W delivery increased significantly with the severity of a n e m i a (OR = 6,810 for women with mild/moderate a n e m i a and O R = 9,286for women with severe a n e m i a ) compared with women with no a n e m i a .

There was significant association between a n e m i a i n pregnancy with low b i r t h weight. A n d we also can find that a n e m i a in pregnancy may increase the risk to have Low B i r t h Weight Babies.

References: 41 (2000-2011) Keywords: A n e m i a , L B W , pregnancy

V

KATA PENGANTAR

F u j i s y u k u T p e n e l i t i p a n j a t k a n k e p a d a A l l a h S W T a t a s s e g a l a r a h m a t d a n

k a r u n i a - N y a s e h i n g g a p e n e l i t i d a p a t m e n y e l e s a i k a n p e n e l i t i a n i n i y a n g b e r j u d u l

"Hubungan Anemia dalam Kehamilan terhadap Kejadian Berat Bayi Lahir

Rendah di Rumah Sakit Moh. Hoesin Tahun 201P* s e b a g a i s a l a h s a t u s y a r a t

u n t u k m e l a k u k a n p e n e l i t i a n d i F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h

P a l e m b a n g . S a l a w a t b e r i r i n g s a l a m s e l a l u t e r c u r a h k e p a d a j u n j u n g a n k i t a , n a b i

b e s a r M u h a m m a d S A W b e s e r t a p a r a k e l u a r g a , s a h a b a t , d a n p e n g i k u t - p e n g i k u t n y a

s a m p a i a k h i r z a m a n .

P e n e l i t i m e n y a d a r i b a h w a p e n e l i t i a n i n i j a u h d a r i s e m p u m a . O l e h k a r e n a i t u ,

p e n e l i t i m e n g h a r a p k a n k r i t i k d a n s a r a n y a n g b e r s i f a t m e m b a n g u n g u n a p e r b a i k a n

d i m a s a m e n d a t a n g .

D a l a m h a l p e n y e l e s a i a n p e n e l i t i a n i n i , p e n u l i s b a n y a k m e n d a p a t b a n t u a n ,

b i m b i n g a n d a n s a r a n . P a d a k e s e m p a t a n i n i , p e n u l i s i n g i n m e n y a m p a i k a n r a s a

h o r m a t d a n t e r i m a k a s i h k e p a d a :

1 . A l l a h S W T , y a n g t e l a h m e m b e r i k e h i d u p a n d e n g a n s e j u k n y a k e i m a n a n .

2 . K e d u a o r a n g t u a y a n g s e l a l u m e m b e r i d u k u n g a n m a t e r i l m a u p u n s p i r i t u a l .

3 . D e k a n d a n s t a f f F a k u l t a s K e d o k t e r a n U n i v e r s i t a s M u h a m m a d i y a h

P a l e m b a n g .

4 . S y a h r u l M u h a m m a d , d r . H . M A R S s e l a k u p e m b i m b i n g I .

5 . H i b s a h R i d w a n , d r . H . M , S c s e l a k u p e m b i m b i n g I I .

6 . L i z a C h a i r a n i , d r . S p , A s e l a k u p e n g u j i .

S e m o g a A l l a h S W T m e m b e r i k a n b a l a s a n p a h a l a a t a s s e g a l a a m a l y a n g

d i b e r i k a n k e p a d a s e m u a o r a n g y a n g t e l a h m e n d u k u n g p e n e l i t i d a n s e m o g a l a p o r a n

i n i b e r m a n f a a t b a g i k i t a d a n p e r k e m b a n g a n i l m u p e n g e t a h u a n k e d o k t e r a n .

S e m o g a k i t a s e l a l u d a l a m l i n d u n g a n A l l a h S W T . A m i n .

P a l e m b a n g , M a r e t 2 0 1 2

P e n e l i t i

vi

DAFTAR ISI

H a l a m a n P e n g e s a h a n t

H a l a m a n P e m y a t a a n i '

H a l a m a n P e r s e m b a h a n d a n M o t t o u i

A b s t r a k

K a t a P e n g a n t a r v i

D a f t a r I s i vii

D a f t a r T a b e l i x

B a b I P e n d a h u i u a n 1

1.1 L a t a r B e l a k a n g 1

1.2 R u m u s a n M a s a l a h 4

1.3 T u j u a n P e l a k s a n a a n 4

1.3.1 T u j u a n U m u m 4

1.3.2 T u j u a n K h u s u s 4

1.4 M a n f a a t P e n e l i t i a n 5

B a b n T i n j a u a n P u s t a k a 6

2.1 F i s i o l o g i K e h a m i l a n 6

2.1.1 P e r u b a h a n F i s i o l o g i s a a t K e h a m i l a n 6

2.1.2 P e r t u m b u h a n J a n i n N o r m a l 9

2.1.3 B e r a t B a y i L a h i r R e n d a h 10

A . D e f i n i s i B e r a t B a y i L a h i r 10

B . F a k t o r y a n g M e m p e n g a r u h i B e r a t B a y i L a h i r 12

C. K a r a k t e r i s t i k B a y i B B L R 21

D K o m p l i k a s i B B L R 21

2.1.4 A n e m i a D a l a m K e h a m i l a n 20

A . D e f i n i s i A n e m i a d a l a m K e h a m i l a n 20

B . P a t o f i s i o l o g i A n e m i a d a l a m K e h a m i l a n 22

C. E t i o l o g i A n e m i a d a l a m K e h a m i l a n 22

v i i

2 . 1 . 5 H u b u n g a n A n e m i a d a l a m K e h a m i l a n t e r h a d a p B B L R 2 6

2 . 2 K e r a n g k a T e o r i 2 7

2 . 3 H i p o t e s i s 2 8

B a b I I I M e t o d e P e n e l i t i a n 3 0

3 . 1 J e n i s P e n e l i t i a n 3 0

3 2 W a k t u d a n t e m p a t p e n e l i t i a n 3 0

3 . 3 P o p u l a s i d a n S u b j e k / S a m p e l P e n e l i t i a n 3 0

3 . 3 . 1 P o p u l a s i 3 0

3 . 3 . 2 S a m o e l 3 0

3 . 3 . 3 K r i t e r i a I n k l u s i d a n E k s k l u s i 3 1

3 . 3 . 4 B e s a r S a m p e l 3 1

3 . 4 V a r i a b e l P e n e l i t i a n 3 2

3 . 4 . 1 V a r i a b e l B e b a s 3 2

3 . 4 2 V a r i a b e l T e r i k a t 3 2

3 . 5 D e f i n i s i O p e r a s i o n a i 3 2

3 . 6 C a r a k e r j a / c a r a p e n g u m p u l a n d a t a 3 3

3 . 7 C a r a o e n g o l a h a n d a n A n a l i s i s d a t a 3 4

3 7 1 P e n g o l a h a n d a t a 3 4

3 . 7 . 2 A n a l i s i s d a t a 3 4

3 . 8 A l u r P e n e l i t i a n 3 5

3 . 9 R e n c a n a / J a d w a l K e g i a t a n 3 7

3 . 1 0 A n g g a r a n 3 7

B a b I V H a s i l d a n P e m b a h a s a n 3 8

4 . 1 H a s i l P e n e l i t i a n 3 8

4 . 2 P e m b a h a s a n ^

B a b V K e s i m p u l a n d a n S a r a n 3 8

4 . 1 H a s i l P e n e l i t i a n 3 8

4 . 2 P e m b a h a s a n ^

D A F T A R P U S T A K A

L A M P I R A N

V l l l

DAFTAR T A B E L

T a b e l 1.1 K e a s l i a n P e n e l i t i a n 6

T a b e l 3 . 1 R e n c a n a A l u r 3 6

T a b e l 3 . 2 R e n c a n a A n g g a r a n 3 7

T a b e l 4 1 K a r a k t e r i s t i k r e s p o n d e n b e r d a s a r k a n u m u r 4 0

T a b e l 4 2 K a r a k t e r i s t i k r e s p o n d e n b e r d a s a r k a n P a r i t a s 4 0

T a b e l 4 . 3 K a r a k t e r i s t i k H e m o g l o b i n I b u H a m i l 4 1

T a b e l 4 . 4 K a r a k t e r i s t i k d e r a j a t A n e m i a d a l a m k e h a m i l a n 4 1

T a b e l 4 . 5 K a r a k t e r i s t i k B e r a t B a y i L a h i r 4 2

T a b e l 4 . 6 P e r b a n d i n g a n A n e m i a d a l a m K e h a m i l a n d e n g a n K e i a d i a n B B L R 4 2

T a b e l 4 . 7 P e r b a n d i n g a n d e r a j a t A n e m i a d a l a m K e h a m i l a n d e n g a n

k e j a d i a n B B L R 4 3

i x

BAB I

Pendahuiuan

1.1 Latar Belakane

S a t u d i a n t a r a d e l a p a n t a r g e t / S a s a r a n P e m b a n g u n a n M i l l e n n i u m a t a u

M i l l e n i u m Development Goals ( M D G s ) y a n g s e d a n g i n g i n d i c a p a i o l e h d u n i a

a d a l a h M D G s 4 y a i t u m e n u r u n k a n k e m a t i a n a n a k . t a r g e t y a n g d i c a n a n g k a n m u t a i

d a r i t a h u n 1 9 9 1 s a m o a i d e n e a n t a h u n 2 0 1 5 a d a l a h m e n u r u n k a n a n e k a k e m a t i a n

a n a k h i n g g a d u a p e r l i g a d a r i k o n d i s i t a h u n 1 9 9 1 . I n d i k a t o m y a k e b e r h a s i l a n t a r g e t

i n i a d a l a h A n g k a K e m a t i a n b a y i ( A K B ) , A n g k a K e m a t i a n B a l i t a ( A K A B A ) , d a n

C a k u p a n i m u n i s a s i C a m p a k u n t u k a n a k u s i a h i n g g a 1 2 b u l a n d a n 1 2 - 2 3 b u l a n .

S e c a r a g l o b a l World H e a l t h O r g a n i z a t i o n ( W H O . 2 0 1 1 ) m e m D e r l i h a t k a n

b a h w a a n g k a k e m a t i a n b a y i s e b e s a r 4 2 p e r 1 0 0 0 k e l a h i r a n h i d u p . P r o p o r s i A n g k a

K e m a t i a n B a y i l e b i h t i n g g i p a d a d a e r a h y a n g s e d a n g b e r k e m b a n g , s e p e r t i

I n d o n e s i a .

B e r d a s a r k a n L a o o r a n S u r v e i D e m o g r a f i d a n K e s e h a t a n I n d o n e s i a ( 2 0 0 7 )

A n g k a k e m a t i a n b a y i d i I n d o n e s i a m e n u n j u k k a n p e n u r u n a n y a n g c u k u p s i g n i f i k a n

d a r i 6 8 p a d a t a h u n 1 9 9 1 m e n j a d i 3 4 p e r 1 . 0 0 0 k e l a h i r a n h i d u p p a d a t a h u n 2 0 0 7 ,

s e h i n g g a t a r g e t s e b e s a r 2 3 p e r 1 . 0 0 0 k e l a h i r a n h i d u p p a d a t a h u n 2 0 1 5

d i o e r k i r a k a n d a o a t t e r c a o a i . D e m i k i a n o u l a d e n g a n t a r g e t o e n u r u n a n k e m a t i a n

a n a k d i p e r k i r a k a n a k a n d a p a t t e r c a p a i . N a m u n d e m i k i a n , m a s i h t e r j a d i d i s p a r i t a s

r e g i o n a l p e n c a p a i a n t a r g e t , y a n g m e n c e r m i n k a n a d a n y a p e r b e d a a n a k s e s a t a s

p e l a y a n a n k e s e h a t a n , t e r u t a m a d i d a e r a h - d a e r a h m i s k i n d a n t e r p e n c i l P n o r i t a s k e

d e o a n a d a l a h m e m o e r k u a t s i s t e m k e s e h a t a n d a n m e n i n g k a t k a n a k s e s o a d a

p e l a y a n a n k e s e h a t a n t e r u t a m a b a g i m a s y a r a k a t m i s k i n d a n d a e r a h t e r p e n c i l .

A n g k a K e m a t i a n B a y i ( A K B ) P r o v i n s i S u m a t e r a S e l a t a n p a d a T a h u n 2 0 1 0

s e b e s a r 4 2 p e r 1 0 0 0 k e l a h i r a n h i d u p , m e l i b i h i A n g k a r a t a - r a t a K e m a t i a n B a y i

N a s i o n a l ( P r o f i l s u m s e L 2 0 1 0 ) .

P e n y e b a b K e m a t i a n B a y i s a n g a t l a h b e r a g a m . B e d a s a r k a n L a p o r a n D i n a s

K e s e h a t a n K o t a P a l e m b a n g ( 2 0 0 6 ) p r o p o r s i p e n y e b a b k e m a t i a n b a y i m e n u n j u k a n

b a h w a y a n g t e r t m g g i a d a l a h p r e m a t u r d a n B a y i B e r a t l a h i r r e n d a h / B B L R

1

2

( 4 2 . 8 6 % ) . k e m u d i n a s f i k s i a l a h i r ( 7 . 9 3 % ) . o e n v a k i t i n f e k s i ( 3 . 1 7 % ) d a n k e l a i n a n

k o g e n i t a l ( 1 2 , 7 0 % ) .

B e r d a s a r k a n l a p o r a n R i s e t K e s e h a t a n D a s a r ( 2 0 1 0 ) p r e s e n t a s e B B L R d i

I n d o n e s i a m e n c a p a i 1 1 5 %, d i S u m a t e r a S e l a t a n p r e s e n t a s e B B L R s e b e s a r 1 1 . 4

%. d a n d a l a m l a o o r a n D i n a s K e s e h a t a n K o t a P a l e m b a n e o a d a t a h u n ( 2 0 1 0 ) h a n v a

s e b e s a r 1 ,15 %, n a m u n m e n g a i a m i p e n i n g k a t a n d i b a n d i n g p a d a t a h u n 2 0 0 8 y a n g

p a d a w a k t u i t u p r e s e n t a s e B B L R h a n y a s e b e s a r 0 , 6 %.

K e j a d i a n B B L R i n i d i p e n g a r u h i o l e h f a k t o r i b u d a n f a k t o r j a n i n . H a l - h a l

v a n e m e m o e n e a r u h i B B L R d i l i h a t d a r i f a k t o r e i z i i b u m a k a B B L R d i o e n e a r u h i

o l e h A n e m i a d a n K u r a n g E n e r g i K r o n i k , p e n y a k i t y a n g b e r h u b u n g a n l a n g s u n g

d e n g a n k e h a m i l a n s e p e r t i m a l a r i a , a n e m i a , s i f i H s , d a n i n f e k s i T O R C H ,

k o m p l i k a s i y a n g t e j a d i p a d a k e h a m i l a n i b u a n t a r a y a n g a n t a r a l a i n p e r d a r a h a n

antepartum, o r e - e k l a m o s i a b e r a t . e k l a m o s i a . f a k t o r b i o m e d i s i b u d a n r i w a v a t

p e r s a l i n a n d i a n t a r a n y a u m u r i b u < 2 0 t a h u n d a n > 3 5 t a h u n , d a n p a r i t a s b e r e s i k o

p r i m i p a r a d a n g r a n d e m u l t i p a r a ( B e m a b e , 2 0 0 4 ) .

B e r d a s a r k a n m a s a l a h t e r s e b u t m a k a B B L R i n i m e r u p a k a n s a l a h s a t u

m a s a l a h v a n e o e r l u m e n d a o a t k a n o e r h a t i a n k a r e n a s a n e a t e r a t k a i t a n n v a d e n e a n

k e l a n g s u n g a n h i d u p b a y i d a n k e m a t i a n b a y i . M e n u r u t P r i y a d i , d k k ( 2 0 0 8 )

m e m p e r l i h a t k a n p r e s e n t a s e b a y i y a n g m e n i n g g a i p a d a u s i a n e o n a t a l d e n g a n b e r a t

l a h i r < 2 5 0 0 g r a m ( B B L R ) l e b i h b e s a r ( 4 1 , 4 8 % ) d a r i p a d a b a y i y a n g h i d u p

( 1 0 . 3 4 % ) . S e d a n e k a n b a v i v a n e l a h i r > 2 5 0 0 o r e s e n t a s e v a n e h i d u o l e b i h b e s a r

( 8 9 , 6 6 % ) d i b a n d i n g k a n y a n g m a t i ( 5 8 , 6 2 % ) .

B a y i y a n g b e r t a h a n h i d u p m e m i l i k i g a n g g u a n f u n g s i k e k e b a l a n t u b u h d a n

m e n i n g k a t k a n r i s i k o p e n y a k i t , m e r e k a a k a n t e t a p k u r a n g g i z i , d e n g a n k e k u a t a n

o t o t b e r k u r a n e s e l a m a h i d u o n v a . d a n m e n d e r i t a i n s i d e n u n t u k t e r i a d i n v a d i a b e t e s

d a n p e n y a k i t j a n t u n g l e b i h t i n g g i ( U N I C E F A V H O , 2 0 0 4 ) . A n a k y a n g l a h i r d e n g a n

b e r a t l a h i r r e n d a h j u g a c e n d e r u n g m e m i l i k i g a n g g u a n k o g n i t i f d a n I Q l e b i h

r e n d a h , y a n g m e m p e n g a r u h i k i n e r j a m e r e k a d i s e k o l a h d a n p e k e r j a a n m e r e k a

s e b a e a i o r a n a d e w a s a ( A l a m . 2 0 0 8 ) s e h i n a e a b a v i d e n a a n B e r a t l a h i r r e n d a h

d a p a t m e n g a k i b a t k a n b i a y a y a n g c u k u p b e s a r u n t u k s e k t o r k e s e h a t a n d a n

m e m b e b a n k a n b e b a n y a n g s i g n i f i k a n p a d a m a s y a r a k a t s e c a r a k e s e l u m h a n .

3

A n e m i a m e m o a k a n s a l a h s a t u m a s a l a h k e s e h a t a n d i i n d o n e s i a v a n e h a r u s

s e g e r a d i t a n g g u l a n g i s e c a r a l e b i h s e r i u s d a n k o m p r e h e n s i p d e n g a n m e l i b a t k a n

l i n t a s p r o g r a m d a n s e k t o r a l . H a l i n i d i k a r e n a k a n a n e m i a d a l a m k e h a m i l a n d a p a t

m e m b a w a a k i b a t b u r u k b a i k p a d a i b u a t a u p a d a j a n i n , W H O ( 2 0 0 5 ) m e n c a t a t

b a h w a a n e m i a m e r u o a k a n o e n v e b a b k e m a t i a n i b u n o m o r 2 d i a s i a v a i t u s e b e s a r

1 2 , 8 %. S e h i n g g a a n e m i a j u g a m e m p a k a n h a l y a n g s e l a l u d i b a h a s d a l a m b e r b a g a i

p r o g r a m s e p e r t i M a k i n g Preganancy safer a t a u Safe M o t h e r h o o d Intensive,

t e r u t a m a u n t u k n e g a r a y a n g s e d a n g b e r k e m b a n g . D i d a l a m S u r v e i K e s e h a t a n

R u m a h T a n e e a f S K R T . 2 0 0 1 ) d i I n d o n e s i a o r e v a l e n s i a n e m i a o a d a k e h a m i l a n

a d a l a h s e k i t a r 4 0 , 1 % , d a n m e n i n g k a t p a d a t a h u n 2 0 0 6 y a i t u s e b e s a r 4 4 , 3 %

( W H O , 2 0 0 8 ) .

A n e m i a d a l a m k e h a m i l a n d a p a t m e n g g a n g g u p e r t u m b u h a n j a n i n d a l a m

k a n d u n a a n . I b u h a m i l d e n a a n a n e m i a b i s a m e l a h i r k a n b a v i o r e m a t u r d a n b a v i

d e n g a n b a y i b e r a t l a h i r r e n d a h ( B B L R ) . S t u d i d i k u a l a l u m p u r m e m p e r l i h a t k a n

t e r j a d i n y a 2 0 % k e l a h i r a n p r e m a t u r b a g i i b u y a n g t i n g k a t k a d a r haemoglobinnya

d i b a w a h 6 , 5 g r V o ( A m i r u d d i n d a n W a h y u d d i n , 2 0 0 4 ) . M u s t i k a H i d a y a t i , d k k .

( 2 0 0 5 ) m e n v a t a k a n b a h w a k e l o m o o k B B L R v a n e i b u n v a t e r o a o a r a n e m i a

m e m p u n y a i k e c e n d e r u n g a n 3 , 7 k a l i l e b i h b e s a r m e l a h i r k a n b a y i d e n g a n B B L R

d i b a n d i n g k a n d e n g a n d e n g a n i b u y a n g t i d a k t e r p a p a r a n e m i a . A l i d k k ( 2 0 1 1 )

m e n y a t a k a n r e s i k o B B L R 2 , 5 k a l i l e b i h t i n g g i p a d a w a n i t a d e n g a n a n e m i a

r i n e a n / s e d a n e . d a n 8 k a l i l e b i h b e s a r o a d a w a n i t a d e n e a n a n e m i a b e r a t .

M e l i h a t b e g i t u b e s a r m a s a l a h k e s e h a t a n y a n g d i t i m b u l k a n p a d a B a y i B e r a t

L a h i r R e n d a h d a n p e n e l i t i a n t e n t a n g A n e m i a d a l a m k e h a m i l a n t e r h a d a p k e j a d i a n

B a y i B e r a t L a h i r r e n d a h b e l u m b a n y a k d i l a k u k a n . H a l t e r s e b u t m e m b u a t p e n e l i t i

t e r t a r i k u n t u k m e l a k u k a n o e n e l i t i a n m e n e e n a i h u b u n e a n A n e m i a d a l a m

k e h a m i l a n t e r h a d a p a n g k a k e j a d i a n B a y i B e r a t L a h i r R e n d a h d i R u m a h S a k i t

M o e h a m m a d H o e s i n P a l e m b a n g .

4

1.2 Rumusan Masalah

a. A p a k a h a d a h u b u n g a n A n e m i a d a l a m k e h a m i l a n t e r h a d a p k e j a d i a n B a y i

B e r a t L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n P a l e m b a n g t a h u n

2 0 1 1 ?

b . A o a k a h a d a H u b u n e a n d e r a i a t k e o a r a h a n A n e m i a d a l a m k e h a m i l a n t e r h a d a o

k e j a d i a n B a y i B e r a t L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n

P a l e m b a n g t a h u n 2 0 1 1 ?

c. A p a k a h a d a h u b u n g a n f a k t o r r e s i k o A n e m i a d a l a m K e h a m i l a n t e r h a d a p

K e i a d i a n B a v i B e r a t L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n

P a l e m b a n g t a h u n 2 0 1 1 ?

1.3 Tuiuan Penelitian

1.3.1 Tujuan Umum

T u j u a n p e n e l i t i a n i n i i a l a h u n t u k m e n g e t a h u i h u b u n g a n a n e m i a d a l a m k e h a m i l a n

t e r h a d a p k e j a d i a n B a y i B e r a t L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n

P a l e m b a n e .

1.3.2 Tujuan Khusus

a. M e n g e t a h u i j u m l a h a n g k a k e j a d i a n B a y i d e n g a n B e r a t L a h i r R e n d a h d i

R u m a h S a k i t M o e h a m m a d H o e s i n P a l e m b a n g .

b . M e n e e t a h u i h u b u n e a n d e r a i a t k e o a r a h a n a n e m i a d a l a m k e h a m i l a n t e r h a d a o

k e j a d i a n B e r a t B a y i L a h i r R e n d a h ,

1.4 Manfaat oenelitian

1. M a n f a a t t e o r i t i s

M e m b e r i k a n i n f o r m a s i i l m i a h m e n g e n a i h u b u n g a n a n e m i a d a i a m k e h a m i l a n

t e r h a d a p K e j a d i a n B B L R d i R u m a h S a k i t M o e h a m m a d H o e s i n P a l e m b a n g .

2 . M a n f a a t u n t u k i n s t i t u s i

H a s i l p e n e l i t i a n i n i d i h a r a p k a n d a p a t m e n j a d i b a h a n m a s u k a n b a g i s e g e n a p

p e n e n t u k e b i j a k a n d a n i n s t a n s i t e r k a i t u n t u k m e m p r i o r i t a s k a n p r o g r a m k e s e h a t a n

k h u s u s n y a d a l a m m e n c e g a h k e j a d i a n a n e m i a s e l a m a k e h a m i l a n u n t u k

m e n u r u n k a n a n & k a k e i a d i a n B B L R .

5

3 . M a n f a a t u n t u k s u b i e k / m a s v a r a k a t

D e n g a n m e n g e t a h u i i n f o r m a s i h u b u n g a n a n e m i a d a l a m k e h a m i l a n t e r h a d a p

B B L R m a s y a r a k a t d a p a t m e n g e t a h u i d a n m e n g u p a y a k a n s u a t u t i n d a k a n

p r e v e n t i f u n t u k m e n g a t a s i a n e m i a p a d a i b u h a m i l s e h i n g g a b i s a m e l a h i r k a n b a y i

v a n e s e h a t d e n e a n b e r a t b a d a n l a h i r n o r m a l .

4 . M a n f a a t u n t u k p e n e l i t i

U n t u k m e n g a p l i k a s i k a n i l m u p e n g e t a h u a n t e n t a n g m e t o d e l o g i p e n e l i t i a n , t e r u t a m a

p e n e l i t i a n t e n t a n g h u b u n g a n A n e m i a d a l a m k e h a m i l a n t e r h a d a p k e j a d i a n B a y i

B e r a t L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n P a l e m b a n e t a h u n 2 0 1 1

d a n u n t u k m e n a m b a h p e n g a l a m a n d a n w a w a s a n i l m i a h p e n u l i s d a l a m m e l a k u k a n

p e n e l i t i a n .

BAB I I

Tinjauan Pustaka 2.1 Fisiologi Kehamilan

2.1.1 Perubahan Fisiologi pada Saat kehamilan

K e h a m i l a n m e n y e b a b k a n t e r j a d i p e r u b a h a n u m u m , s e l u r u h s i s t e m

t u b u h w a n i t a h a m i i a k i b a t m e n i n g k a t n y a h o r m o n a l y a n g d i k e i u a r k a n o i e h

p l a s e n t a , d a p a t m e m i c u p e r u b a h a n h o r m o n a l y a n g m e n g e n d a l i k a n n y a

s e h i n g g a t e r j a d i k e s e i m b a n g a n b a r u d a n a d a p t a s i i b u ( M a n u a b a , 2 0 0 7 ) .

P l a s e n t a d a l a m p e r k e m b a n g a n n y a m e n g e l u a r k a n h o r m o n e

s o m a t o m a t r o p i n , e s t r o g e n , d a n p r o g e s t e r o n y a n g m e n y e b a b k a n p e r u b a h a n

p a d a :

a. U t e r u s

S e l a m a k e h a m i l a n u t e r u s a k a n b e r a d a p t a s i u n t u k m e n e r i m a d a n

m e l i n d u n g i h a s i l k o n s e p s i ( j a n i n , p l a s e n t a , a m n i o n ) s a m p a i p e r s a l i n a n .

U t e r u s m e m p u n y a i k e m a m p u a n y a n g l u a r b i a s a u n t u k b e r t a m b a h b e s a r

d e n g a n c e p a t s e l a m a k e h a m i l a n d a n p u l i h k e m b a l i s e p e r t i k e a d a a n s e m u l a

d a l a m b e b e r a p a m i n g g u s e t e l a h p e r s a l i n a n .

P a d a p e r e m p u a n t i d a k h a m i l u t e r u s m e m p u n y a i b e r a t 7 0 g r a m d a n

k a p a s i t a s 1 0 m l a t a u k u r a n g . S e l a m a k e h a m i l a n , u t e r u s a k a n b e r u b a h

m e n j a d i s u a t u o r g a n y a n g m a m p u m e n a m p u n g j a n i n , p l a s e n t a , d a n c a i r a n

a m n i o n r a t a - r a t a p a d a a k h i r k e h a m i l a n v o l u m e t o t a l n y a m e n c a p a i 5 l i t e r

b a h k a n d a p a t m e n c a p a i 2 0 l i t e r a t a u l e b i h d e n g a n b e r a t r a t a - r a t a 1 1 0 0

g r a m ( P r a w i r o h a r d j o , 2 0 0 8 ) .

b . O v a r i u m

P r o s e s o v u l a s i s e l a m a k e h a m i l a n a k a n t e r h e n t i d a n p e m a t a n g a n

f o l i k e l b a r u j u g a d i t u n d a . H a n y a s a t u k o r p u s l u t e u m y a n g d a p a t d i t e m u k a n

d i o v a r i u m . F o l i k e l i n i a k a n b e r f l i n g s i m a k s i m a l s e l a m a 6 - 7 m i n g g u a w a l

k e h a m i l a n d a n s e t e l a h i t u a k a n b e r p e r a n s e b a g a i p e n g h a s i ! p r o g e s t e r o n e

d a l a m j u m l a h y a n g r e l a t i v e m i n i m a l ( P r a w i r o h a r d j o , 2 0 0 8 ) .

6

7

c. V a g i n a

S e l a m a k e h a m i l a n p e n i n g k a t a n v a s k u l a r i s a s i d a n h y p e r e m i a t e r l i h a t

j e l a s p a d a k u l i t d a n o t o t - o t o t d i p e r i n e u m d a n v u l v a , s e h i n g g a p a d a v a g i n a

a k a n t e r l i h a t b e w a m a k e u n g u a n y a n g d i k e n a l d e n g a n t a n d a C h a d w i c k s .

P e r u b a h a n i n i m e l i p u t i p e n i p i s a n m u k o s a d a n h i l a n g n y a s e j u m l a h j a r i n g a n

i k a t d a n h i p e r t r o f i d a r i s e l - s e l o t o t p o l o s ( P r a w i r o h a r d j o , 2 0 0 8 ) .

d . P a y u d a r a

P a y u d a r a m e n g a i a m i p e r t u m b u h a n d a n p e r k e m b a n g a n s e b a g a i

p e r s i a p a n m e m b e r i k a n A S I p a d a saa t l a k t a s i . P e r k e m b a n g a n p a y u d a r a

t i d a k d a p a t d i l e p a s k a n d a r i p e n g a r u h o r m o n e s a a t k e h a m i l a n , y a i t u

e s t r o g e n , p r o g e s t e r o n e , d a n s o m a t r o m a t r o p i n ( P r a w i r o h a r d j o , 2 0 0 8 ) .

e. S i s t e m K a r d i o v a s k u l a r

P e r e d a r a n d a r a h i b u d i p e n g a r u h i o l e h b e b e r a p a f a k t o r , a n t a r a l a i n :

1 ) M e n i n g k a t n y a k e b u t u h a n s i r k u l a s i d a r a h s e h i n g g a d a p a t

m e m e n u h i k e b u t u h a n p e r k e m b a n g a n d a n p e r t u m b u h a n j a n i n

d a l a m r a h i m .

2 ) T e r j a d i h u b u n g a n l a n g s u n g a n t a r a a r t e r i d a n v e n a p a d a s i r k u l a s i

r e t r o - p l a s e n t e r .

3 ) P e n g a r u h h o r m o n e s t r o g e n d a n p r o g e s t e r o n s e m a k i n m e n i n g k a t .

A k i b a t d a r i f a k t o r t e r s e b u t d i j u m p a i b e b e r a p a p e r u b a h a n

p e r e d a r a n d a r a h , y a i t u :

a ) V o l u m e d a r a h

V o l u m e d a r a h s e m a k i n m e n i n g k a t d i m a n a j u m l a h s e r u m

d a r a h l e b i h b e s a r d a r i p e r t u m b u h a n s e l d a r a h , s e h i n g g a

t e r j a d i s e m a c a m p e n g e n c e r a n d a r a h ( h e m o d i l u s i ) , d e n g a n

p u n c a k n y a p a d a h a m i l 3 2 m i n g g u . S e r u m d a r a h ( v o l u m e

d a r a h ) b e r t a m b a h s e b e s a r 2 5 - 3 0 % s e d a n g k a n s e l d a r a h

b e r t a m b a h s e k i t a r 2 0 % . C u r a h j a n t u n g a k a n b e r t a m b a h

s e k i t a r 3 0 % . B e r t a m b a h n y a h e m o d i l u s i d a r a h m u l a i t a m p a k

s e k i t a r u m u r h a m i l 1 6 m i n g g u , s e h i n g g a p e n g i d a p p e n y a k i t

j a n t u n g h a r u s b e r h a t i - h a t i u n t u k h a m i l b e b e r a p a k a l i .

8

K e h a m i l a n s e l a l u m e m b e r a t k a n k e r j a j a n t u n g s e h i n g g a

w a n i t a h a m i l d e n g a n s a k i t j a n t u n g d a p a t j a t u h d a l a m

d e k o m p e n s a s i o k o r d i s . P a d a p o s t p a r t u m t e r j a d i

h e m o k o n s e n t r a s i d e n g a n p u n c a k h a r i k e t i g a s a m p a i k e l i m a .

b ) S e l d a r a h

S e l d a r a h m e r a h m a k i n m e n i n g k a t j u m l a h n y a u n t u k

d a p a t m e n g i m b a n g i p e r t u m b u h a n j a n i n d a l a m r a h i m , t e t a p i

p e r t a m b a h a n s e l d a r a h t i d a k s e i m b a n g d e n g a n p e n i n g k a t a n

v o l u m e d a r a h s e h i n g g a t e r j a d i h e m o d i l u s i y a n g d i s e r t a i

a n e m i a f i s i o l o g i s S e l d a r a h p u t i h m e n i n g k a t d e n g a n

m e n c a p a i j u m l a h s e b e s a r 1 0 . 0 0 0 / m l . D e n g a n h e m o d i l u s i d a n

a n e m i a m a k a l a j u e n d a p d a r a h s e m a k i n t i n g g i d a n d a p a t

m e n c a p i 4 k a l i d a r i a n g k a n o r m a l .

c ) S i s t e m r e s p i r a s i

P a d a k e h a m i l a n t e r j a d i j u g a p e r u b a h a n s i s t e m r e s p i r a s i

u n t u k d a p a t m e m n u h i k e b u t u h a n 0 2 . D i s a m p i n g i t u t e r j a d i

d e s a k a n d i a f r a g m a k a r e n a d o r o n g a n r a h i m y a n g m e m b e s a r

p a d a u m u r h a m i l 3 2 m i n g g u . S e b a g a i k o m p e n s a s i t e r j a d i n y a

d e s a k a n r a h i m d a n k e b u t u h a n 0 2 y a n g m e n i n g k a t , i b u h a m i l

a k a n b e r n a f a s l e b i h d a l a m s e k i t a r 2 0 - 2 5 % d a r i b i a s a n y a .

d ) S i s t e m p e n c e m a a n

T e r j a d i p e n i n g k a t a n a s a m l a m b u n g k a r e n a p e n g a r u h

e s t r o g e n .

e ) T r a k t u s u r i n a r i u s

P a d a b u l a n - b u l a n p e r t a m a k e h a m i l a n k a n d u n g k e m i h

a k a n t e r t e k a n o l e h u t e r u s y a n g m u l a i m e m b e s a r s e h i n g g a

m e n i m b u l k a n s e r i n g k e m i h . K e a d a a n i n i a k a n h i l a n g d e n g a n

m a k i n t u a n y a k e h a m i l a n b i l a u t e r u s k e t u a r d a r i r o n g g a

p a n g g u l . P a d a a k h i r k e h a m i l a n , j i k a k e p a l a j a n i n s u d a h m u l a i

t u r u n k e p i n t u p a n g g u l , k e l u h a n i t u a k a n t i m b u l k e m b a l i .

f ) P e r u b a h a n p a d a k u l i t

9

P a d a k u l i t d i n d i n g p e r u t a k a n t e r j a d i p e r u b a h a n w a m a

m e n j a d i k e m e r a h a n , k u s a m , d a n k a d a n g - k a d a n g j u g a a k a n

m e n g e n a i d a e r a h p a y u d a r a d a n p a h a . P e r u b a h a n i n i d i k e n a l

d e n g a n n a m a s t r i a e g r a v i d a r u m ,

g ) M e t a b o l i s m e

D e n g a n t e r j a d i n y a k e h a m i l a n , m e t a b o l i s m e t u b u h

m e n g a i a m i p e r u b a h a n y a n g m e n d a s a r , d i m a n a k e b u t u h a n

n u t r i s i m a k i n t i n g g i u n t u k p e r t u m b u h a n j a n i n d a n p e r s i a p a n

p e m b e r i a n A S I . D i p e r k i r a k a n s e l a m a k e h a m i l a n b e r a t b a d a n

a k a n b e r t a m b a h 1 2 , 5 k g . S e b g a i a n b e s a r p e n a m b a h a n b e r a t

b a d a n s e l a m a k e h a m i l a n b e r a s a l d a r i u t e r u s d a n i s i n y a .

K e m u d i a n p a y u d a r a , v o l u m e d a r a h , d a n c a i r a n e k s t r a s e l u l a r .

P a d a k e h a m i l a n n o r m a l a k a n t e r j a d i h i p o g l i k e m i a p u a s a y a n g

d i s e b a b k a n o l e h k e n a i k a n k a d a r i n s u l i n , h i p e r g l i k e m i a

p o s t p r a n d i a l d a n h i p e r i n s u l i n e m i a . Z i n c ( Z n ) s a n g a t p e n t i n g

u n t u k p e r t u m b u h a n d a n p e r k e m b a n g a n j a n i n . B e b e r a p a

p e n e l i a t i a n m e n u n j u k k a n k e k u r a n g a n z a t i n i d a p a t

m e n y e b a b k a n p e r t u m b u h a n j a n i n t e r h a m b a t . ( P r a w i r o h a r d j o ,

2 0 0 8 ) .

2.1.2 Pertumbuhan Janin Normal

P e r t u m b u h a n j a n i n m a n u s i a d i t a n d a i d e n g a n p o l a - p o l a s e k u e n s i a l

p e r t u m b u h a n , d i f e r e n s i a s i , d a n m a t u r a s i j a r i n g a n s e r a o r g a n y a n g

d i t e n t u k a n o l e h k e m a m p u a n s u b s t r a t o l e h i b u , t r a n s f e r s u b s t r a t m e l a l u i

p l a s e n t a , d a n p o t e n s i p e r t u m b u h a n j a n i n y a n g d i k e n d a l i n k a n o l e h g e n o m

( C u n i n g h a m d k k , 2 0 0 5 ) .

P e r t u m b u h a n j a n i n d i b a g i m e n j a d i t i g a f a s e p e r t u m b u h a n s e l y a n g

b e r u r u t a n ( L i n d a n F o r g a s , 1 9 9 8 ) . F a s e a w a l h i p e r p l a s i a t e r j a d i s e l a m a 1 6

m i n g g u p e r t a m a d a n d i t a n d a i o l e h p e n i n g k a t a n j u m l a h s e l s e c a r a c e p a t .

F a s e k e d u a , y a n g b e r l a n g s u n g s a m p a i m i n g g u k e - 3 2 , m e l i p u t i h i p e r p l a s i a

d a n h i p e r t r o p i s e l . S e t e l a h u s i a g e s t a s i 3 2 m i n g g u , p e r t u m b u h a n j a n i n

b e r l a n g s u n g m e l a l u i h i p e r t r o f i s e l d a n p a d a f a s e i n i l a h s e b a g i a n b e s a r

10

d e p o s i s i l e m a k d a n g l i k o g e n t e r j a d i . L a j u p e r t u m b u h a n j a n i n y a n g s e t a r a

s e l a m a t i g a f a s e p e r t u m b u h a n s e l i n i a d a l a h d a r i 5 g / h a r i p a d a u s i a 15

m i n g g u , 1 5 - 2 0 g / h a r i p a d a m i n g g u k e - 2 4 , d a n 3 0 - 3 5 g / h a r i p a d a u s i a

g e s t a s i 3 4 m i n g g u ( C u n i n g h a m d k k , 2 0 0 5 ) .

P e r t u m b u h a n j a n i n d i p e n g a r u h i b e b e r a p a f a k t o r y a i t u f a k t o r

l i n g k u n g a n i n t e r n a l ( y a i t u m e l i p u t i u m u r i b u , j a r a k k e l a h i r a n , p a r i t a s ,

k a d a r h e m o g l o b i n , s t a t u s g i z i i b u h a m i l , d a n p e n y a k i t p a d a s a a t

k e h a m i l a n ) , f a k t o r L i n g k u n g a n E k s t e m a l ( y a i t u m e l i p u t i k o n d i s i

l i n g k u n g a n , d a n t i n g k a t s o s i a l e k o n o m i i b u h a m i l ) , f a k t o r p e n g g u n a a n

s a r a n a k e s e h a t a n y a n g b e r h u b u n g a n f r e k u e n s i p e m e r i k s a a n k e h a m i l a n a t a u

a n t e n a t a l c a r e ( A N C ) .

M e s k i p u n t e l a h b a n y a k f a k t o r y a n g d i d u g a t e r l i h a t p a d a p r o s e s

p e r t u m b u h a n j a n i n , m e k a n i s m e s e l u l a r d a n m o l e k u l a r s e b e n a m y a u n t u k

p e r t u m b u h a n j a n i n y a n g a b n o r m a l t i d a k d i k e t a h u i d e n g a n j e l a s P a d a

k e h i d u p a n a w a l j a n i n p e n e n t u u t a m a p e r t u m b u h a n a d a l a h g e n o m j a n i n

t e r s e b u t , t e t a p i p a d a k e h a m i l a n l a n j u t , p e n g a r u h l i n g k u n g a n , g i z i , d a n

h o r m o n a l m e n j a d i s e m a k i n p e n t i n g .

2.1.3 Berat Bayi Lahir Rendah

A. Definisi Berat Bayi Lahir Rendah

M e n u r u t P r a w i r o h a r d j o ( 2 0 0 8 ) , B B L R a d a l a h n e o n a t u s d e n g a n

b e r a t b a d a n l a h i r p a d a s a a t k e l a h i r a n k u r a n g d a r i 2 5 0 0 g r a m ( s a m p a i

2 4 9 9 g r a m ) . D a h u l u b a y i i n i d i a k a t a k a n p r e m a t u r k e m u d i a n d i s e p a k a t i

d i s e b u t l o w b i r t h w e i g h t i n f a n t a t a u B e r a t B a y i L a h i r R e n d a h ( B B L R ) .

K a r e n a b a y i t e r s e b u t t i d a k s e l a m a n y a p r e m a t u r a t a u k u r a n g b u l a n

t e t a p i d a p a t c u k u p b u l a n m a u p u n l e b i h b u l a n . P e n e l i t i a n o l e h

g r u e n d w a l d , m e n u n j u k k a n b a h w a s e p e r t i g a b a y i b e r a t l a h i r r e n d a h

a d a l a h b a y i a t e r m .

K l a s i f i k a s i b a y i m e n u m t u m u r k e h a m i l a n d i b a g i d a l a m 3

k e l o m p o k y a i t u b a y i k u r a n g b u l a n a d a l a h b a y i d e n g a n m a s a k e h a m i l a n

k u r a n g d a r i 3 7 m i n g g u ( 2 5 9 h a r i ) , b a y i c u k u p b u l a n a d a l a h b a y i

11

d e n g a n m a s a k e h a m i l a n d a r i 3 7 m i n g g u s a m p a i d e n g a n 4 2 m i n g g u

( 2 5 9 - 2 9 3 h a r i ) , d a n b a y i l e b i h b u l a n a d a l a h b a y i d e n g a n m a s a

k e h a m i l a n m u l a i 4 2 m i n g g u ( 2 9 4 h a r i ) a t a u l e b i h ( B e m a b e , 2 0 0 4 ) .

D a r i p e n g e r t i a n d i a t a s m a k a b a y i d e n g a n B B L R d a p a t d i b a g i m e n j a d i

2 g o l o n g a n , y a i t u P r e m a t u r m u m i d a n D i s m a t u r i t a s .

a ) P r e m a t u r m u r n i a d a l a h n e o n a t u s d e n g a n u s i a k e h a m i l a n k u r a n g

d a r i 3 7 m i n g g u d a n m e m p u n y a i b e r a t b a d a n s e s u a i d e n g a n b e r a t

b a d a n u n t u k m a s a k e h a m i l a n , a t a u b i a s a d i s e b u t n e o n a t u s k u r a n g

b u l a n s e s u a i m a s a k e h a m i l a n . P e n y e b a b n y a b e r a s a l d a r i b e r b a g a i

f a c t o r i b u , f a k t o r j a n i n m a u p u n f a k t o r l i n g k u n g a n .

b ) D i s m a t u r i t a s a t a u K e c i l u n t u k m a s a k e h a m i l a n a d a l a h b a y i l a h i r

d e n g a n b e r a t b a d a n k u r a n g d a r i b e r a t b a d a n s e s u n g g u h n y a u n t u k

m a s a k e h a m i l a n . H a l i n i k a r e n a j a n i n m e n g a i a m i g a n g g u a n

p e r t u m b u h a n d a l a m k a n d u n g a n d a n m e m p a k a n b a y i y a n g k e c i l

u n t u k m a s a k e h a m i l a n ( K . M K ) .

B a y i b e r a t l a h i r r e n d a h m e r u p a k a n m a s a l a h p e n t i n g d a l a m

p e n g e l o l a a n n y a k a r e n a m e m p u n y a i k e c e n d e r u n g a n k e a r a h p e n i n g k a t a n

t e r j a d i n y a i n f e k s i , k e s u k a r a n m e n g a t u r n a f a s t u b u h s e h i n g g a m u d a h u n t u k

m e n d e r i t a h i p o t e r m i a . S e l a i n i t u b a y i d e n g a n B e r a t B a y i L a h i r R e n d a h

( B B L R ) m u d a h t e r s e r a n g k o m p l i k a s i t e r t e n t u s e p e r t i i k t e r u s , h i p o g l i k o m i a

y a n g d a p a t m e n y e b a b k a n k e m a t i a n . K e l o m p o k b a y i b e r a t l a h i r r e n d a h

y a n g d a p a t d i i s t i l a h k a n d e n g a n k e l o m p o k r e s i k o t i n g g i , k a r e n a p a d a b a y i

b e r a t l a h i r r e n d a h m e n u n j u k a n a n g k a k e m a t i a n d a n k e s e h a t a n y a n g l e b i h

t i n g g i d e n g a n b e r a t b a y i l a h i r c u k u p .

P r e v a l e n s i b a y i b e r a t l a h i r r e n d a h ( B B L R ) d i p e r k i r a k a n 1 5 % d a r i

s e l u m h k e l a h i r a n d i d u n i a d e n g a n b a t a s a n 3 , 3 % - 3 8 % d a n l e b i h s e r i n g

t e r j a d i d i n e g a r a - n e g a r a b e r k e m b a n g a t a u s o s i o - e k o n o m i r e n d a h ( W H O ,

2 0 0 4 ) . A n g k a k e j a d i a n d i I n d o n e s i a s a n g a t b e r v a r i a s i a n t a r a s a t u d a e r a h

d e n g a n d a e r a h l a i n . R i s k e d a s 2 0 1 0 , m e n d a t a b e r a t b a d a n b a y i b a r u l a h i r 1 2

b u l a n t e r a k h i r . T i d a k s e m u a b a y i d i k e t a h u i b e r a t b a d a n h a s i l p e n i m b a n g a n

12

w a k t u b a r u l a h i r . D a r i b a y i y a n g d i k e t a h u i b e r a t b a d a n h a s i l p e n i m b a n g a n

w a k t u b a r u l a h i r , 1 1 , 1 % l a h i r d e n g a n b e r a t b a d a n k u r a n g d a r i 2 5 0 0 g r a m

a t a u B B L R .

B. Faktor yang Mempengaruhi Berat Bayi Lahir

B e r a t b a d a n l a h i r m e r u p a k a n h a s i l i n t e r a k s i d a r i b e r b a g a i f a k t o r

m e l a l u i s u a t u p r o s e s y a n g b e r l a n g s u n g s e l a m a b e r a d a d a l a m

k a n d u n g a n . F a k t o r - f a k t o r y a n g d a p a t m e m p e n g a r u h i b e r a t b a y i l a h i r

a d a l a h s e b a g a i b e r i k u t ( M a n u a b a , 2 0 0 7 ) :

a ) F a k t o r L i n g k u n g a n I n t e r n a l , y a i t u m e l i p u t i u m u r i b u , j a r a k

k e l a h i r a n , p a r i t a s , k a d a r h e m o g l o b i n , s t a t u s g i z i i b u h a m i l , d a n

p e n y a k i t p a d a s a a t k e h a m i l a n .

b ) F a k t o r L i n g k u n g a n E k s t e m a l , y a i t u m e l i p u t i k o n d i s i l i n g k u n g a n ,

d a n t i n g k a t s o s i a l e k o n o m i i b u h a m i l .

c ) F a k t o r p e n g g u n a a n s a r a n a k e s e h a t a n y a n g b e r h u b u n g a n frekuensi

p e m e r i k s a a n k e h a m i l a n a t a u a n t e n a t a l c a r e ( A N C ) .

F a k t o r y a n g s e c a r a l a n g s u n g a t a u i n t e r n a l m e m p e n g a r u h i b e r a t b a y i

l a h i r a n t a r a t a i n s e b a g a i b e r i k u t :

1 ) U s i a I b u h a m i l

S e j u m l a h b e s a r p e n e l i t i a n e p i d e m i o l o g i t e l a h m e n c a t a t

b a h w a k e j a d i a n b e r a t b a y i l a h i r r e n d a h m e n i n g k a t e k s t r e m p a d a

k e h i d u p a n r e p r o d u k s i w a n i t a , y a i t u p a d a u s i a a n t a r a 15 d a n 1 9

t a h u n d a n a n t a r a u s i a 3 5 d a n 4 0 t a h u n . D a l a m m e n j e l a s k a n

f a k t a - f a k t a i n i , d a l a m k a s u s r e m a j a , s a n g a t p e n t i n g u n t u k

m e n a n y a k a n a p a k a h a d a f a k t o r - f a k t o r b i o l o g i s i n t r i n s i k y a n g

b e r t a n g g u n g j a w a b u n t u k k e j a d i a n i n i , a t a u j i k a k e h a m i l a n a t a u

k e h i d u p a n s e k a r a n g m e r u p a k a n k e m g i a n s o s i a l , y a n g m u n g k i n

m e n g h a s i l k a n p e r b e d a a n - p e r b e d a a n i n i t a n p a m e m a n d a n g u s i a .

B a h k a n , i t u a d a l a h t e r l i h a t b a h w a s e b a g i a n b e s a r i b u r e m a j a

a d a l a h o r a n g t u a t u n g g a l d e n g a n p e n d a p a t a n r e n d a h , p e r a w a t a n

s e b e l u m m e l a h i r k a n t i d a k m e m a d a i b e r a t b a d a n i b u y a n g

13

r e n d a h p a d a saa t h a m i l ( B e m a b e , 2 0 0 4 ) .

U m u r i b u e r a t k a i t a n n y a d e n g a n b e r a t b a y i l a h i r

d i k a r e n a k a n b e b e r a p a p e n y e b a b . M e n u r u t M a n u a b a ( 2 0 0 7 )

K e h a m i l a n d i b a w a h u m u r 2 0 t a h u n m e r u p a k a n k e h a m i l a n

b e r i s i k o t i n g g i , 2 - 4 k a l i l e b i h t i n g g i d i b a n d i n g k a n d e n g a n

k e h a m i l a n p a d a w a n i t a y a n g c u k u p u m u r . P a d a u m u r y a n g

m a s i h m u d a , p e r k e m b a n g a n o r g a n - o r g a n r e p r o d u k s i d a n f u n g s i

f i s i o l o g i n y a b e l u m o p t i m a l . S e l a i n i t u e m o s i d a n k e j i w a a n n y a

b e l u m c u k u p m a t a n g , s e h i n g g a p a d a s a a t k e h a m i l a n i b u

t e r s e b u t b e l u m d a p a t m e n a n g g a p i k e h a m i l a n n y a s e c a r a

s e m p u m a d a n s e r i n g t e r j a d i k o m p l i k a s i .

S e l a i n i t u s e m a k i n m u d a u s i a i b u h a m i l , m a k a a n a k y a n g

d i l a h i r k a n a k a n s e m a k i n r i n g a n . M e s k i k e h a m i l a n d i b a w a h

u m u r s a n g a t b e r i s i k o t e t a p i k e h a m i l a n d i a t a s u s i a 3 5 t a h u n j u g a

t i d a k d i a n j u r k a n , s a n g a t b e r b a h a y a . M e n g i n g a t m u l a i u s i a i n i

s e r i n g m u n c u l p e n y a k i t s e p e r t i h i p e r t e n s i , t u m o r j i n a k

p e r a n a k a n , a t a u p e n y a k i t d e g e n e r a t i f p a d a p e r s e n d i a n t u l a n g

b e l a k a n g d a n p a n g g u l .

K e s u l i t a n l a i n k e h a m i l a n d i a t a s u s i a 3 5 t a h u n i n i y a k n i b i l a

i b u t e m y a t a m e n g i d a p p e n y a k i t s e p e r t i d i a t a s y a n g d i t a k u t k a n

b a y i l a h i r d e n g a n m e m b a w a k e l a i n a n . D a l a m p r o s e s p e r s a l i n a n

s e n d i r i , k e h a m i l a n d i u s i a l e b i h i n i a k a n m e n g h a d a p i k e s u l i t a n

a k i b a t l e m a h n y a k o n t r a k s i r a h i m s e r t a s e r i n g t i m b u l k e l a i n a n

p a d a t u l a n g p a n g g u l t e n g a h .

M e n g i n g a t b a h w a f a k t o r u m u r m e m e g a n g p e r a n a n p e n t i n g

t e r h a d a p d e r a j a t k e s e h a t a n d a n k e s e j a h t e r a a n i b u h a m i l s e r t a

b a y i , m a k a s e b a i k n y a m e r e n c a n a k a n k e h a m i l a n p a d a u s i a

a n t a r a 2 0 - 3 0 t a h u n .

2 ) J a r a k K e h a m i l a n / K e l a h i r a n

I n t e r v a l p e n d e k a n t a r a k e l a h i r a n m e m p a k a n s a l a h v s a t u

u t a m a f a k t o r r i s i k o p r e m a t u r i t a s d a n b e r a t l a h i r r e n d a h . O j f c n v

14

h a l i n i d i t e m u k a n h u b u n g a n k u a t a n t a r a i n t e r v a l k e l a h i r a n

p e n d e k d a n k o v a r i a t l a i n n y a d a l a m k e h a m i l a n , s e p e r t i

p r e m a t u r i t a s , B B L R , d a n p e r s a l i n a n p a d a r e m a j a ( B e m a b e ,

2 0 0 4 ) .

M e n u r u t a n j u r a n y a n g d i k e i u a r k a n o l e h b a d a n k o o r d i n a s i

k e l u a r g a b e r e n c a n a ( B K K B N ) j a r a k k e l a h i r a n y a n g i d e a l a d a l a h

2 t a h u n a t a u l e b i h , k e r e n a j a r a k k e l a h i r a n y a n g p e n d e k a k a n

m e n y e b a b k a n s e o r a n g i b u b e l u m c u k u p u n t u k m e m u l i h k a n

k o n d i s i t u b u h n y a s e t e l a h m e l a h i r k a n s e b e l u m n y a . I n i

m e r u p a k a n s a l a h s a t u f a c t o r p e n y e b a b k e l e m a h a n d a n k e m a t i a n

i b u s e r t a b a y i y a n g d i l a h i r k a n . R e s i k o p r o s e s r e p r o d u k s i d a p a t

d i t e k a n a p a b i l a j a r a k m i n i m a l a n t a r a k e l a h i r a n 2 t a h u n

( M a n u a b a , 2 0 0 7 ) .

3 ) P a r i t a s

P a r i t a s s e c a r a l u a s m e n c a k u p g r a v i d a / j u m l a h k e h a m i l a n ,

p r e m a t u r / j u m l a h k e l a h i r a n , d a n a b o r t u s / j u m l a h k e g u g u r a n .

S e d a n g d a l a m a r t i k h u s u s y a i t u j u m l a h a t a u b a n y a k n y a a n a k

y a n g d i l a h i r k a n . P a r i t a s d i k a t a k a n t i n g g i b i l a s e o r a n g

i b u / w a n i t a m e l a h i r k a n a n a k k e e m p a t a t a u l e b i h S e o r a n g w a n i t a

y a n g s u d a h m e m p u n y a i t i g a a n a k d a n t e r j a d i k e h a m i l a n l a g i

k e a d a a n k e s e h a t a n n y a a k a n m u l a i m e n u m n , s e r i n g m e n g a i a m i

k u r a n g d a r a h ( a n e m i a ) , t e r j a d i p e r d a r a h a n l e w a t j a l a n l a h i r d a n

l e t a k b a y i s u n g s a n g a t a u p u n m e l i n t a n g .

P r i m i p a r a t a m p a k n y a d i k a i t k a n d e n g a n j u m l a h y a n g l e b i h

b e s a r I n t r a u t e r i n e Grwoth Retardation ( l U G R ) , k e l a h i r a n

p r e m a t u r d a n B B L R H a l i n i j u g a d i k e t a h u i b a h w a a n a k k e d u a

d a n k e t i g a b e r b o b o t l e b i h d a r i y a n g p e r t a m a . U n t u k

m e n j e l a s k a n f a k t a i n i , s e h a r u s n y a d i i n g a t b a h w a k e h a m i l a n

p e r t a m a t u j u a n n y a a d a l a h s e j a t i n y a u n t u k p e m a t a n g a n s t r u k t u r

r a h i m , t e r u t a m a s t r u k t u r p e m b u l u h d a r a h , m e m b u a t m e r e k a

l e b i h s e n s i t i f t e r h a d a p s t i m u l i k e h a m i l a n . P a d a k e h a m i l a n

15

b e r i k u t n v a . i n i d i t i n e k a t k a n o l e h k o n d i s i r a h u m v a n e

m e m u n g k i n k a n p e r k e m b a n g a n p l a s e n t a l e b i h b e s a r d a n , n u t r i s i

j a n i n l e b i h d i p e r b a i k i ( B e m a b e 2 0 0 4 ) . P e r l u d i c a t a t j u g a b a h w a ,

m u l a i d e n g a n k e h a m i l a n k e e m p a t ( G r a n d e M u l t i p a r a ) ,

o e n i n e k a t a n b e r a t l a h i r t e r b a l i k . s e h i n a e a r i s i k o B B L R

m e n i n g k a t l a g i d e n g a n a n a k - a n a k k e e m p a t d a n b e r i k u t n y a

( C u n n i g n h a m , 2 0 0 5 ) .

4 ) K a d a r H e m o g l o b i n ( H b )

K a d a r h e m o e l o b i n ( H b ) i b u h a m i l s a n e a t m e m o e n e a r u h i

b e r a t b a y i y a n g d i l a h i r k a n . S e o r a n g i b u h a m i l d i k a t a k a n

m e n d e r i t a a n e m i a b i l a k a d a r h e m o g l o b i n n y a d i b a w a h 1 1 g r / d l

p a d a t r i m e s t e r p e r t a m a d a n k e t i g a d a n 1 0 , 5 g r / d l p a d a t n m e s t e r

k e d u a ( W H O ) . H a l i n i i e l a s m e n i m b u l k a n c a n e c u a n

p e r t u m b u h a n h a s i l k o n s e p s i , s e r i n g t e r j a d i i m m a t u r i t a s ,

p r e m a t u r i t a s , c a c a t b a w a a n , a t a u j a n i n l a h i r d e n g a n b e r a t b a d a n

y a n g r e n d a h ( D e p k e s R l , 2 0 0 8 ) . K e a d a a n i n i d i s e b a b k a n k a r e n a

k u r a n e n v a s u o l a i d a r a h n u t r i s i a k a n o k s i e e n o a d a o i a s e n t a v a n s

a k a n b e r p e n g a r u h p a d a f u n g s i p l e s e n t a t e r h a d a p j a n i n ( C e t i n ,

2 0 0 4 ) .

D a l a m k e h a m i l a n n o r m a l , i b u m e n g a i a m i p e n u r u n a n

h e m o e l o b i n d a l a m 2 0 m i n e e u o e r t a m a . t e t a o k o n s t a n s a m o a i

d e n g a n m i n g g u 3 0 , d a n k e m u d i a n m e n i n g k a t s e d i k i t , B e b e r a p a

p e n u l i s t e l a h m e n g a m a t i b a h w a h e m o g l o b i n k u r a n g d a r i 9 g / d l

s e l a m a k e h a m i l a n d i k a i t k a n d e n g a n p e n i n g k a t a n n s i k o B B L R

d a n o r e m a t u r i t a s ( V e r h o e f F . 2 0 0 1 ) . S t e e r m e n u n i u k k a n b a h w a

i n s i d e n s d a r i B B L R t e r l i h a t p a d a n i l a i - n i l a i h e m o g l o b i n a n t a r a

9 , 5 d a n 1 0 , 5 g / d l d a n , s e b a l i k n y a , h e m o g l o b i n m e n i n g k a t l e b i h

d a n 1 2 g / d t m e n i n g k a t k a n k e j a d i a n b a i k B B L R d a n

o r e m a t u r i t a s : r i s i k o i n i t e r b u k t i s e b a e a i f a k t o r r i s i k o v a n e

i n d e p e n d e n ( S t e e r , 2 0 0 0 ) . H a s i l m e t a a n a l t s i s o l e h A l l e n j u g a

m e n e k a n k a n b a h w a h u b u n g a n a n t a r a k o n s e n t r a s i h e m o g l o b i n

16

d a n b e r a t b a d a n l a h i r d a o a t d i a a m b a r k a n k u r v a b e r b e n t u k U

( A l l e n , 2 0 0 0 ) . C u n n i n g h a m j u g a m e n y a t a k a n b a h w a a n e m i a

p a d a i b u h a m i l d a p a t m e n i n g k a t k a n d u a k a l i l i p a t r e s i k o u n t u k

m e l a h i r k a n b a y i p r e m a t u r e d a n t i g a k a l i l i p a t m e l a h i r k a n b a y i

B B L R ( M i m s . 2 0 1 0 ) .

5 ) S t a t u s G i z i I b u H a m i l

S t a t u s g i z i i b u p a d a w a k t u p e m b u a h a n d a n s e l a m a h a m i l

d a p a t m e m p e n g a r u h i p e r t u m b u h a n j a n i n y a n g s e d a n g

d i k a n d u n a . S e l a i n i t u e i z i i b u h a m i l m e n e n t u k a n b e r a t b a v i

y a n g d i l a h i r k a n , m a k a p e m a n t a u a n g i z i i b u h a m i l s a n g a t l a h

p e n t i n g d i l a k u k a n . P e n g u k u r a n a n t r o p o m e t r i m e r u p a k a n s a l a h

s a t u c a r a u n t u k m e n i l a i s t a t u s g i z i i b u h a m i l U k u r a n

a n t r o D o m e t r i i b u h a m i l v a n e o a l i n e s e r i n e d i e u n a k a n a d a l a h

k e n a i k a n b e r a t b a d a n i b u h a m i l d a n u k u r a n l i n g k a r l e n g a n a t a s

( L L A ) s e l a m a k e h a m i l a n ( M a n u a b a , 2 0 0 7 ) .

S e b a g a i u k u r a n s e k a l i g u s p e n g a w a s a n b a g i k e c u k u p a n g i z i

i b u h a m i l b i s a d i l i h a t d a r i k e n a i k a n b e r a t b a d a n n v a . I b u v a n e

k u r u s d a n s e l a m a k e h a m i l a n d i s e r t a i p e n a m b a h a n b e r a t b a d a n

y a n g r e n d a h a t a u t u r u n s a m p a i 1 0 k g , m e m p u n y a i r e s i k o p a l i n g

t i n g g i u n t u k m e l a h i r k a n b a y i d e n g a n B B L R . S e h i n g g a i b u

h a m i l h a r u s m e n e a l a m i k e n a i k a n b e r a t b a d a n b e r k i s a r 1 1 - 1 2 . 5

K g a t a u 2 0 % d a r i b e r a t b a d a n s e b e l u m h a m i l .

S e d a n g L i n g k a r L e n g a n A t a s ( L L A ) a d a l a h a n t r o p o m e t r i

y a n g d a p a t m e n g g a m b a r k a n k e a d a a n s t a t u s g i z i i b u h a m i l d a n

u n t u k m e n e e t a h u i r e s i k o K e k u r a n e a n E n e r e i K a l o r i ( K E K ) a t a u

g i z i k u r a n g . I b u y a n g m e m i l i k i u k u r a n L i n g k a r L e n g a n A t a s

( L L A ) d i b a w a h 2 3 , 5 c m b e r i s i k o m e l a h i r k a n b a y i B B L R

( D e p k e s R I , 2 0 0 8 ) , P e n g u k u r a n L L A l e b i h p r a k t i s u n t u k

m e n e e t a h u i s t a t u s e i z i i b u h a m i l k a r e n a a l a t u k u m v a s e d e r h a n a

d a n m u d a h d i b a w a k e m a n a sa j a , d a n d a p a t d i p a k a i u n t u k i b u

d e n g a n k e n a i k a n b e r a t b a d a n y a n g e k s t r i m .

17

T e l a h l a m a d i k e t a h u i b a h w a m a l n u t r i s i i b u a d a l a h

p e n y e b a b p e n t i n g d a r i P e r k e m b a n g a n J a n i n T e r h a m b a t ( l U G R ) ,

m e s k i p u n e f e k n y a m o d e r a t . M e n u r u t r e k o m e n d a s i d a r i

N a t i o n a l Research council of the A m e r i c a n Academy of

Sciences, i b u m e m b u t u h k a n a s u o a n n u t r i s i t a m b a h a n u n t u k

m e n d a p a t k a n p e r t u m b u h a n j a n i n y a n g o p t i m a l ( B e m a d e , 2 0 0 4 ) .

A s u p a n t a m b a h a n a d a l a h 3 0 0 k k a l p e r h a r i l e b i h d a r i k e b u t u h a n

n o r m a l s e o r a n g w a n i t a t i d a k h a m i l , y a n g a d a l a h , a s u p a n

m i n i m a l 2 5 0 0 k k a l o e r h a r i ( C h a r l t o n . 2 0 0 0 ) . P a r a

k e l o m p o k y a n g p a l i n g t e r k e n a d a m p a k a d a l a h p e r e m p u a n y a n g

y a n g m e n g a i a m i k o n d i s i g i z i b u r u k k e t i k a m e r e k a m e n j a d i

m e r e k a ( m e r e k a a k a n m e l a h i r k a n b e r a t b a d a n b a y i 4 0 0 - 6 0 0 g

k u r a n e d a r i r a t a - r a t a ) . d a n m e r e k a v a n e m e n d e r i t a k e k u r a n e a n

k a l o r i p a d a t r i m e s t e r k e t i g a ( b e r a t l a h i r 2 5 0 g r a m k u r a n g d a r i

r a t a - r a t a ) . B e b e r a p a a r t i k e l k h u s u s m e n g k a j i p e r a n a s a m l e m a k

o m e g a 3 d a n o m e g a 6 , s u p l e m e n y a n g b e r p e n g a r u h d a l a m

m e n u r u n k a n k e i a d i a n k e l a h i r a n o r e m a t u r d a n B B L R ( C h a r l t o n .

2 0 0 0 ) .

6 ) P e m e r i k s a a n K e h a m i l a n

P e m e r i k s a a n k e h a m i l a n b e r t u j u a n u n t u k m e n g e n a i d a n

m e n e i d e n t i f i k a s i m a s a l a h v a n e t i m b u l s e l a m a k e h a m i l a n .

s e h i n g g a k e s e h a t a n s e l a m a i b u h a m i l d a p a t t e r p e l i h a r a d a n y a n g

t e r p e n t i n g i b u d a n b a y i d a l a m k a n d u n g a n a k a n b a i k d a n s e h a t

s a m p a i saa t p e r s a l i n a n . P e m e r i k s a a n k e h a m i l a n d i l a k u k a n a g a r

k i t a d a o a t s e e e r a m e n e e t a h u i a o a b i l a t e r i a d i c a n e e u a n /

k e l a i n a n p a d a i b u h a m i l d a n b a y i y a n g d i k a n d u n g , s e h i n g g a

d a p a t s e g e r a d i t o l o n g t e n a g a k e s e h a t a n ( D e p k e s R I , 2 0 0 8 ) .

7 ) P e n v a k i t S a a t K e h a m i l a n

P e n y a k i t p a d a s a a t k e h a m i l a n y a n g d a p a t m e m p e n g a r u h i

b e r a t b a y i l a h i r d i a n t a r a n y a a d a l a h D i a b e t e s m e l i t u s ( D M ) ,

18

c a c a r a i r d a n o e n v a k i t i n f e k s i T O R C H . P e n v a k i t D M a d a l a h

s u a t u p e n y a k i t d i m a n a b a d a n t i d a k s a n g g u p m e n g g u n a k a n g u l a

s e b a g a i m a n a m e s t i n y a , p e n y e b a b n y a a d a l a h p a n k r e a s t i d a k

c u k u p p r o d u k s i i n s u l i n / t i d a k d a p a t g u n a k a n i n s u l i n y a n g a d a

A k i b a t d a r i D M i n i b a n v a k m a c a m n v a d i a n t a r a n v a a d a l a h b a c i

i b u h a m i l b i a s m e n g a i a m i k e g u g u r a n , p e r s a l i n a n p r e m a t u r ,

k e m a t i a n d a l a m r a h i m , b a y i m a t i s e t e l a h l a h i r ( k e m a t i a n

p e r i n a t a l ) k a r e n a b a y i y a n g d i l a h i r k a n t e r l a l u b e s a r , m e n d e r i t a

e d e m d a n k e l a i n a n o a d a a l a t t u b u h b a v i ( M a n u a b a . 2 0 0 7 ) .

P e n y a k i t i n f e k s i T O R C H a d a l a h s u a t u i s t i l a h j e n i s p e n y a k i t

i n f e k s i y a i t u T o x o p l a s m a , R u b e l l a , C y t o m e g a l o v i r u s d a n

H e r p e s . K e e m p a t j e n i s p e n y a k i t i n i s a m a b a h a y a n y a b a g i i b u

h a m i l v a i t u d a o a t m e n e a n a e u i a n i n v a n e d i k a n d u n e n v a B a v i

y a n g d i k a n d u n g t e r s e b u t m u n g k i n a k a n t e r k e n a k a t a r a k m a t a ,

t u l i . H y p o p l a s i a ( g a n g g u a n p e r t u m b u h a n o r g a n t u b u h s e p e r t i

j a n t u n g , p a r u - p a r u , d a n i i m p a ) B i s a j u g a m e n g a k i b a t k a n b e r a t

b a v i t i d a k n o r m a l , k e t e r b e l a k a n c a n m e n t a l , h e o a t i t i s . r a d a n e

s e l a p u t o t a k , r a d a n g i r i s m a t a , d a n b e b e r a p a j e n i s p e n y a k i t

l a i n n y a ( M a n u a b a , 2 0 0 7 ) .

F a k t o r - f a k t o r y a n g m e m p e n g a r u h i b e r a t b a y i l a h i r s e c a r a

t i d a k l a n e s u n c / e k s t e m a l d a o a t d i i e l a s k a n s e b a e a i b e r i k u t :

1 ) F a k t o r l i n g k u n g a n

F a k t o r l i n g k u n g a n t e r s e b u t m e l i p u t i k e b e r s i h a n d a n

k e s e h a t a n l i n g k u n g a n s e r t a k e t i n g g i a n t e m p a t t i n g g a l

K o n t a m i n a s i a i r t a n a h o l e h o e r t a n i a n d a o a t m e w a k i l i r i s i k o

k e s e h a t a n m e l a l u i a i r m i n u m . D i a n t a r a risiko i n i , s u a t u

s t u d i e k o l o g i s d i s o r o t p a p a r a n a i r m i n u m y a n g

t e r k o n t a m i n a s i d e n g a n n i t r a t d a n h u b u n g a n n y a d e n g a n

P e r k e m b a n e a n J a n i n T e r h a m b a t ( B u k o w s k v . 2 0 0 1 ) .

P e n e l i t i a n l a i n t e r a k h i r m e m b e r i k a n h i p o t e s i s

t e n t a n g h u b u n g a n a n t a r a k o n t a m i n a s i l i n g k u n g a n d a n

19

B B L R . B a v i v a n e l a h i r d a l a m d a e r a h v a n e t e r k o n t a m i n a s i

m e m i l i k i b e r a t r a t a - r a t a l e b i h r e n d a h d i b a n d i n g k a n m e r e k a

y a n g l a h i r d i d a e r a h y a n g t i d a k t e r k o n t a m i n a s i . A s o s i a s i i n i

d i p e r t a h a n k a n s e t e l a h d i s e s u a i k a n u n t u k f a k t o r - f a k t o r l a i n

( B o b a k . 2 0 0 7 ) .

2 ) F a k t o r e k o n o m i d a n s o s i a l m e l i p u t i j e n i s p e k e r j a a n , t i n g k a t

p e n d i d i k a n d a n p e n g e t a h u a n i b u h a m i l .

C. Karakteristik Klinis B B L R

B a y i d e n g a n B B L R m e m i l i k i k a r a k t e r i s t i k b e r a t b a d a n k u r a n g d a r i

2 5 0 0 g r a m , p a n j a n g b a d a n k u r a n g a t a u s a m a d e n g a n 4 5 c m , l i n g k a r

d a d a k u r a n g d a n J O c m , l i n g k a r k e p a l a k u r a n g d a n 3 3 c m . M a s a

e e s t a s i k u r a n e d a r i 3 7 m i n e e u . K e o a l a r e l a t i f l e b i h b e s a r d a r i o a d a

b a d a n n y a . O s s i f i k a s i t e n g k o r a k s e d i k i t , u b u n - u b u n d a n s u t u r a l e b a r ,

g e n e t a l i a i m m a t u r . G e r a k a n l e m a h , o t o t m a s i h h i p o t o n i k , t a n g i s a n

l e m a h , p e m a p a s a n l e m a h d a n s e r i n g t e r d a p a t s e r a n g a n apnea. R e t l e k s

m e n e h i s a o d a n m e n e l a n b e l u m s e m o u m a . r e f l e k s m o r o d a o a t o o s i t i f .

r e f l e k b a t u k b e l u m s e m p u r n a . F r e k u e n s i p e r n a p a s a n b e r v a r i a s i p a d a

h a r i - h a r i p e r t a m a ( H a s s a n R , A l a t a s H , 2 0 0 7 ) .

D. Komolikasi oada B L R

A l a t t u b u h b a y i p r e m a t u r b e l u m b e r f l i n g s i s e p e r t i b a y i m a t u r . O l e h

s e b a b i t u i a m e n g a i a m i l e b i h b a n y a k k e s u l i t a n u n t u k h i d u p d i l u a r

u t e r u s i b u n y a . M a k i n p e n d e k m a s a k e h a m i l a n n y a m a k i n k u r a n g

s e m o u m a o e r t u m b u h a n a l a t - a l a t d a l a m t u b u h n v a . d e n a a n a k i b a t

m a k i n m u d a h n y a t e r j a d i k o m p l i k a s i d a n m a k i n t i n g g i n y a a n g k a

k e m a t i a n n y a . D a l a m h u b u n g a n i n i s e b a g i a n b e s a r k e m a t i a n p e r i n a t a l

t e r j a d i p a d a b a y i - b a y i p r e m a t u r ( W i k n j o s a s t r o , 2 0 0 6 ) .

K o m o l i k a s i l a n a s u n e v a n e d a o a t t e r i a d i o a d a b a v i b e r a t b a d a n

l a h i r r e n d a h m e n u r u t C u n n i n g h a m a d a l a h :

20

a. H i o o t e r m i a

b . H i p o g l i k e m i a

c. G a n g g u a n h e m a t o l o g i s

d . H i p e r b i l i r u b i n e m i a

e. S i n d r o m a c a w a t n a f a s

f . I n f e k s i

g . A n e m i a

M a s a l a h i a n e k a o a n i a n e v a n e m u n e k i n t i m b u l o a d a b a v i - b a v i

d e n g a n b e r a t b a d a n l a h i r r e n d a h ( B B L R ) J u g a m e n u r u t C u n n i n g h a m

a d a l a h :

a. G a n g g u a n p e r k e m b a n g a n

b . G a n c e u a n o e r t u m b u h a n

c. G a n g g u a n K e m a m p u a n B e l a j a r

d . G a n g g u a n p e n d e n g a r a n

e. P e n y a k i t p a r u k r o n i s

f . K e n a i k a n a n e k a k e s a k i t a n o a d a s a a t d e w a s a s e o e r t i o b e s i t a s .

H i p e r t e n s i , d a n D i a b e t e s t i p e I .

2.1.4 Anemia dalam Kehamilan

A. Definisi

S e s e o r a n g i b u h a m i l d i k a t a k a n m e n g a i a m i a n e m i a s e l a m a

k e h a m i l a n J i k a m e m i l i k i kaOar haemoglodm ( H b ) k u r a n g d a n 1 0

e r % ( W i k n i o s a s t r o - 2 0 0 6 ) . A n e m i a b e r a t 5 - 6 e r % . s e d a n e 7 - 8 eT%.

r i n g a n 9 - 1 0 g r % ( M a n u a b a , 2 0 0 7 ) , d a n C e n t e r s f o r D i s e a s e C o n t r o l

( 1 9 9 0 ) m e n d e f e n i s i k a n a n e m i a s e b a g a i k a d a r h e m o g l o b i n k u r a n g d a r i

11 g / d i p a d a t r i m e s t e r p e r t a m a d a n k e t i g a , d a n k u r a n g d a r i 1 0 , 5 g / d l

o a d a t r i m e s t e r k e d u a ( C u n n i n g h a m d k k . 2 0 0 5 ) .

A n e m i a l e b i h s e r i n g d i i u m o a i d a l a m k e h a m i l a n . H a l i n i k a r e n a

d a l a m k e h a m i l a n k e b u t u h a n a k a n z a t - z a t m a k a n a n b e r t a m b a h d a n

21

t e r i a d i o u l a o e r u b a h a n - o e r u b a h a n d a l a m d a r a h d a n s u m s u m t u l a n e

( W i k n j o s a s t r o , 2 0 0 6 ) .

K e h a m i l a n m e m i c u p e r u b a h a n - p e r u b a h a n f i s i o l o g i s y a n g s e r i n g

m e n g a b u r k a n d i a g n o s i s s e j u m l a h k e l a i n a n h e m a t o l o g i s s e r t a

o e n e k a i i a n n v a . H a l i n i t e r u t a m a b e r l a k u o a d a a n e m i a . S a l a h s a t u

p e r u b a h a n y a n g p a l i n g b e r m a k n a a d a l a h e k s p a n s i v o l u m e d a r a h

d e n g a n p e n i n g k a t a n v o l u m e p l a s m a y a n g t i d a k s e p a d a n s e h i n g g a

h e m a t o k r i t b i a s a n y a m e n u r u ( C u n n i n g h a m d k k , 2 0 0 5 ) .

M e n u r u t M a n u a b a ( 2 0 0 7 ) . a n e m i a o a d a k e h a m i l a n a d a l a h a n e m i a

k a r e n a k e k u r a n g a n z a t b e s i , j e n i s a n e m i a y a n g p e n g o b a t a n n y a r e l a t i f

m u d a h , b a h k a n m u r a h . A n e m i a p a d a k e h a m i l a n m e r u p a k a n m a s a l a h

n a s i o n a l k a r e n a m e n c e r m i n k a n n i l a i k e s e j a h t e r a a n s o c i a l e k o n o m i

m a s v a r a k a t . d a n n e n e a r u h n v a s a n e a t b e s a r t e r h a d a o k u a l i t a s s u m b e r

d a y a m a n u s i a . A n e m i a i b u h a m i l d i s e b u t " p o t e n s i a l d a n g e r t o m o t h e r

a n d c h i l d " ( p o t e n s i a l m e m b a h a y a k a n i b u d a n a n a k ) , k a r e n a i t u l a h

a n e m i a m e m e r l u k a n p e r h a t i a n s e r i u s d a r i s e m u a p i h a k y a n g t e r k a i t

d a l a m o e l a v a n a n k e s e h a t a n o a d a l i n i k e d e o a n . D i o e r k i r a k a n r a t a - r a t a

p r e v a l e n s i a n e m i a p a d a w a n i t a h a m i l d i I n d o n e s i a s e k i t a r 4 4 , 3 %

( W H O , 2 0 0 8 ) .

K a d a r H e m o g l o b i n ( H b ) i b u s a n g a t m e m p e n g a r u h i b e r a t b a y i y a n g

a k a n d i l a h i r k a n . I b u h a m i l v a n e a n e m i a k a r e n a H b n v a r e n d a h b u k a n

h a n y a m e m b a h a y a k a n j i w a i b u t e t a p i j u g a m e n g g a n g g u p e r t u m b u h a n

d a n p e r k e m b a n g a n s e r t a m e m b a h a y a k a n j i w a j a n i n . H a l i n i

d i s e b a b k a n k a r e n a k u r a n g n y a s u p l a i n u t r i s i d a n o k s i g e n p a d a p l a s e n t a

v a n e a k a n b e r o e n e a r u h o a d a f u n e s i o l a c e n t a t e r h a d a o i a n i n . ( G r u s l i n .

2 0 0 7 ) .

A n e m i a p a d a i b u h a m i l a k a n m e n a m b a h risiko m e n d a p a t k a n B a y i

B e r a t L a h i r R e n d a h ( B B L R ) , risiko p e r d a r a h a n s e b e l u m d a n p a d a saa t

o e r s a l i n a n . b a h k a n d a o a t m e n v e b a b k a n k e m a t i a n i b u d a n b a v i n v a . i i k a

i b u h a m i l t e r s e b u t m e n d e r i t a a n e m i a b e r a t ( D e p k e s R I , 2 0 0 8 ) . U n t u k

m e n g e t a h u i a p a k a h s e s e o r a n g m e n g a i a m i a n e m i a a t a u t i d a k m a k a

23

d i t e m u k a n d i n e c a r a m a i u m a u o u n b e r k e m b a n e

( W i k n o j o s a s t r o , 2 0 0 6 ) H a l i n i d i k a r e n a k a n m a s i h b a n y a k

k e b u t u h a n n u t r i s i i b u h a m i l y a n g t i d a k b i s a t e r p e n u h i p a d a i b u

h a m i l d i n e g a r a - n e g a r a m a j u . T e r u t a m a r e s i k o n y a a k a n

m e n i n e k a t o a d a k e h a m i l a n d a n b e r k a i t a n d e n e a n a s u o a n b e s i

y a n g t i d a k a d e k u a t d i b a n d i n g k a n k e b u t u h a n j a n i n y a n g c e p a t .

A n e m i a d e f e s i e n s i b e s i m e r u p a k a n t a h a p d e f e s i e n s i y a n g

p a l i n g p a r a h , y a n g d i t a n d a i o l e h p e n u r u n a n c a d a n g a n b e s i ,

k o n s e n t r a s i b e s i s e r u m , d a n s a t u r a s i t r a n s f e r r i n v a n e r e n d a h . d a n

h e m o g l o b i n a t a u n i l a i h e m a t o c r i t y a n g m e n u r u n . P a d a

k e h a m i l a n , k e h i l a n g a n z a t b e s i t e r j a d i a k i b a t p e n g a l i h a n b e s i

m a t e r n a l k e j a n i n u n t k e r i t r o p o e s i s , k e h i l a n g a n d a r a h p a d a s a a t

o e r s a l i n a n . d a n l a k t a s i v a n e k e s e l u r u h a n n v a m e n c a o a i 9 0 0 m e

a t a u s e t a r a d e n g a n 2 l i t e r d a r a h . O l e h k a r e n a s e b a g i a n b e s a r

p e r e m p u a n m e n g a w a l i k e h a m i l a n d e n g a n c a d a n g a n b e s i y a n g

r e n d a h m a k a k e b u t u h a n t a m b a h a n i n i b e r a k i b a t p a d a a n e m i a

d e f e s i e n s i b e s i f W i k n o d i o s a s t r o . 2 0 0 9 ) .

G e j a l a y a n g k h a s p a d a a n e m i a j e n i s i n i a d a l a h k u k u

m e n j a d i r a p u h d a n m e n j a d i c e k u n g s e h i n g g a m i r i p s e p e r t i

s e n d o k , g e j a l a s e p e r t i i n i d i s e b u t k o i l o r i k a . S e l a i n i t u , a n e m i a

i e n i s i n i i u e a m e n c a k i b a t k a n o e r m u k a a n l i d a h m e n i a d i l i c i n .

a d a n y a p e r a d a n g a n p a d a s u d u t m u l u t d a n n y e r i p a d a s a a t

m e n e l a n . S e l a i n g e j a l a k h a s t e r s e b u t p a d a a n e m i a d e f i s i e n s i b e s i

j u g a t e r j a d i g e j a l a u m u m a n e m i a s e p e r t i l e s u , c e p a t l e l a h s e r t a

m a t a b e r k u n a n e - k u n a n c . ( B a k t a . 2 0 0 7 ) .

A n e m i a m e g a l o b l a s t i k ( 2 9 % )

A n e m i a m e g a l o b l a s t i k a d a l a h a n e m i a y a n g d i s e b a b k a n

d e f i s i e n s i v i t a m i n B 1 2 d a n a s a m t b l a t . A n e m i a j e n i s i n i d i t a n d a i

d e n e a n a d a n v a s e l m e e a l o b l a s t d a l a m s u m s u m t u l a n e b e l a k a n e .

S e l m e g a l o b l a s t a d a l a h s e l p r e k u r s o r e r i t r o s i t d e n g a n b e n t u k s e l

y a n g b e s a r . ( B a k t a , 2 0 0 7 ) .

24

T i m b u l n v a m e e a l o b l a s t a d a l a h a k i b a t e a n e e u a n m a t u r a s i

i n t i s e l k a r e n a t e r j a d i g a n g g u a n s i n t e s i s D N A s e l - s e l e r i t o b l a s t

a k i b a t d e f i e n s i a s a m f o l a t d a n v i t a m i n B 1 2 d i m a n a v i t a m i n B 1 2

d a n a s a m t b l a t b e r t u n g s i d a l a m p e m b e n t u k a n D N A i n t i s e l d a n

s e c a r a k h u s u s u n t u k v i t a m i n B 1 2 D e n t i n e d a l a m o e m b e n t u k a n

m y e l i n . A k i b a t g a n g g u a n s i n t e s i s D N A p a d a i n t i e r i t o b l a s t i n i

m a k a m a t u r a s i i n t i l e b i h l a m b a t , s e h i n g g a k r o m a t i n l e b i h l o n g g a r

d a n s e l m e n j a d i l e b i h b e s a r k a r e n a p e m b e l a h a n s e l y a n g l a m b a t .

S e l e r i t o b l a s t d e n e a n u k u r a n v a n e l e b i h b e s a r s e r t a s u s u n a n

k r o m a t i n y a n g l e b i h l o n g g a r d i s e b u t s e b a g a i s e i m e g a l o b l a s t S e l

m e g a l o b l a s t i n i f U n g s i n y a t i d a k n o r m a l , d i h a n c u r k a n s a a t m a s i h

d a l a m s u m s u m t u l a n g s e h i n g g a t e r j a d i e r i t r o p o e s i s i n e t e k t i f d a n

m a s a h i d u o e r i t r o s i t l e b i h o e n d e k v a n e b e r u i u n e o a d a t e r i a d i n v a

a n e m i a ( H a n d a y a n i , 2 0 0 8 ) .

K e k u r a n g a n a s a m f o l a t b e r k a i t a n d e n g a n b e r a t l a h i r

r e n d a h , a b l a s i o p l a s e n t a d a n N e u r a l T u b e D e f e c t ( N T D ) . N T D

v a n e t e r i a d i b i s a b e r u o a a n e n s e f a l i . s o i n a b i f i d a ( k e l a i n a n t u l a n e

b e l a k a n g y a n g t i d a k m e n u t u p ) , m e n i n g o - e n s e f a l o k e l ( t i d a k

m e n u t u p n y a t u l a n g k e p a l a ) . K e l a i n a n - k e l a i n a n t e r s e b u t

d i s e b a b k a n k a r e n a g a g a l n y a t a b u n g s a r a f t u l a n g b e l a k a n g u n t u k

t e r t u t u o ( A r i s m a n . 2 0 0 4 ) .

A n e m i a h e m o l i t i k ( 0 , 7 % )

A n e m i a h e m o l i t i k d i s e b a b k a n o l e h p r o s e s h e m o l i s i s .

H e m o l i s i s a d a l a h p e n g h a n c u r a n a t a u p e m e c a h a n se ! d a r a h m e r a h

s e b e l u m w a k t u n v a H e m o l i s i s b e r b e d a d e n e a n o r o s e s o e n u a a n

y a i t u p e m e c a h a n e r i t r o s i t k a r e n a m e m a n g s u d a h c u k u p u m u r n y a .

P a d a d a s a m y a a n e m i a h e m o l i t i k d a p a t d i b a g i m e n j a d i d u a

g o l o n g a n b e s a r y a i t u a n e m i a h e m o l i t i k k a r e n a f a k t o r d i d a l a m

e r i t r o s i t s e n d i r i ( i n t r a k o r o u s k u l a r ) v a n e s e b a e i a n b e s a r b e r s i f a t

h e r e d i t e r d a n a n e m i a h e m o l i t i k k a r e n a f a k t o r d i l u a r e r i t r o s i t

( e k s t r a k o r p u s k u l a r ) y a n g s e b a g i a n b e s a r b e r s i f a t P i 4 ? f i ^ t e q

25

s e o e r t i m a l a r i a d a n t r a n s f u s i d a r a h .

P r o s e s h e m o l i s i s a k a n m e n g a k i b a t k a n p e n u r u n a n k a d a r

h e m o g l o b i n y a n g a k a n m e n g a k i b a t k a n a n e m i a . H e m o l i s i s d a p a t

t e r j a d i p e r l a h a n - l a h a n , s e h i n g g a d a p a t d i a t a s i o l e h m e k a n i s m e

k o m o e n s a s i t u b u h t e t a o i d a o a t i u e a t e r i a d i t i b a - t i b a s e h i n a e a

s e g e r a m e n u r u n k a n k a d a r h e m o g l o b i n .

D. Pensanih Anemia dalam Kehamilan

M e n u r u t p e n e l i t i a n , t i n g g i n y a a n g k a k e m a t i a n i b u b e r k a i t a n e r a t

d e n g a n a n e m i a . A n e m i a j u g a m e n y e b a b k a n r e n d a h n y a k e m a m p u a n

j a s m a n i k a r e n a s e l - s e l t u b u h t i d a k c u k u p m e n d a p a t p a s o k a n

o k s i e e n . P a d a w a n i t a h a m i l . a n e m i a m e n i n e k a t k a n frekuensi

k o m p l i k a s i p a d a k e h a m i l a n d a n p e r s a l i n a n R i s i k o k e m a t i a n

m a t e r n a l , a n g k a p r e m a t u r i t a s , b e r a t b a d a n b a y i l a h i r r e n d a h , d a n

a n g k a k e m a t i a n p e r i n a t a l m e n i n g k a t . D i s a m p i n g i t u , p e r d a r a h a n

a n t e o a r t u m d a n o o s t o a r t u m l e b i h s e r i n e d i i u m o a i o a d a w a n i t a v a n e

a n e m i s d a n l e b i h s e r i n g b e r a k i b a t f a t a l , s e b a b w a n i t a y a n g a n e m i s

t i d a k d a p a t m e n t o l e r i r k e h i l a n g a n d a r a h . D a m p a k a n e m i a p a d a

k e h a m i l a n b e r v a r i a s i d a r i k e l u h a n y a n g s a n g a t ringan h i n g g a

t e r i a d i n v a e a n e e u a n k e l a n e s u n e a n k e h a m i l a n ( a b o r t u s , o a r t u s

i m a t u r / p r e m a t u r e ) , g a n g g u a n p r o s e s p e r s a l i n a n ( i n e r t i a u t e r i , a t o n i a

u t e r i , p a r t u s l a m a , p e r d a r a h a n a t o n i s ) , g a n g g u a n p a d a m a s a n i f a s

( s u b i n v o l u s i r a h i m , d a y a t a h a n t e r h a d a p i n f e k s i d a n s t r e s s k u r a n g ,

o r o d u k s i A S I r e n d a h ) . d a n e a n e e u a n o a d a i a n i n ( a b o r t u s ,

d i s m a t u r i t a s , m i k r o s o m i , B B L R , k e m a t i a n p e r i n a t a l , d a n l a i n - l a i n )

( A m i r u d d i n , W a h y u d i n , 2 0 0 7 ) . M e n u r u t W i k n o j o s a s t r o ( 2 0 0 6 ) d a n

G r u s l i n ( 2 0 0 7 ) a n e m i a j u g a m e n g a k i b a t k a n i n f e k s i ( i n t r a p a r t u m

m a u o u n o o s t o a r t u m ) .

26

.5 Hubungan Anemia dalam Kehamilan dengan B B L R

M e n u r u t p e n e l i t i a n , t i n g g i n y a a n g k a k e m a t i a n i b u b e r k a i t a n e r a t

d e n g a n a n e m i a . A n e m i a j u g a m e n y e b a b k a n r e n d a h n y a k e m a m p u a n

j a s m a n i k a r e n a s e l - s e l t u b u h t i d a k c u k u p m e n d a p a t p a s o k a n o k s i g e n . P a d a

w a n i t a h a m i l . a n e m i a m e n i n e k a t k a n frekuensi k o m o l i k a s i o a d a

k e h a m i l a n d a n p e r s a l i n a n . R i s i k o k e m a t i a n m a t e r n a l , a n g k a p r e m a t u r i t a s ,

b e r a t b a d a n b a y i l a h i r r e n d a h , d a n a n g k a k e m a t i a n p e r i n a t a l m e n i n g k a t .

D a m p a k a n e m i a p a d a k e h a m i l a n b e r v a r i a s i d a r i k e l u h a n y a n g s a n g a t

r i n e a n h i n e e a t e r i a d i n v a e a n e e u a n k e l a n e s u n e a n k e h a m i l a n ( a b o r t u s ,

p a r t u s i m a t u r / p r e m a t u r ) ( A m i r u d d i n , 2 0 0 4 ) .

D a l a m p r o s e s p e r t u m b u h a n n y a , j a n i n , a p a b i l a m e n g a i a m i

k e k u r a n g a n k a d a r s u b s t r a t , b a i k n u t r i e n m a u p u n o k s i g e n , a k a n m e n g u b a h

a k t i v i t a s m e t a b o l i k n v a a e a r d a o a t b e r t a h a n h i d u o . d e n e a n c a r a

m e n g a k t i f k a n h o r m o n e norephineprim y a n g b i s a d i s t i m u l a s i CRM d a n

Cortisol, y a n g k i t a t a b u p u n y a d a m p a k n e g a t i v e t e r h a d a p p e r t u m b u h a n

j a n i n . S e l a i n i t u p a d a k e k u r a n g a n n u t r i s i y a n g d a p a t d i s e b a b k a n o l e h

a n e m i a d a o a t m e n i n e k a t k a n Oxidative stress v a n e i u e a b e r o e n e a r u h

t e r h a d a p p e r t u m b u h a n f e t u s ( G r u s l i n , 2 0 0 7 ) . P e n g a r u h n y a t i d a k h a n y a

p a d a u k u r a n p a n j a n g , b e r a t , l i n g k a r k e p a l a , t a p i j u g a o r g a n - o r g a n d a l a m

t u b u h b a y i . ( W i k n o j o s a s t r o , 2 0 0 6 ) .

P e n e l i t i a n H i d a v a t i ( 2 0 0 5 ) i u e a m e n e m u k a n b a h w a i b u v a n e v a n e

m e n d e r i t a a n e m i a p a d a saa t k e h a m i l a n m e m p u n y a i f a k t o r r e s i k o 3 , 7 k a l i

l i p a t m e l a h i r k a n B a y i B e r a t L a h i r R e n d a h . P e n e l i t i a n l a i n m e n g e m u k a k a n

b a h w a i b u y a n g m e m i l i k i k a d a r H b 7 - 1 0 , 9 g r / d l a k a n m e m i l i k i f a c t o r

r e s i k o 2 . 5 k a l i l i o a t m e l a h i r k a n B B L R . s e d a n e k a n i b u v a n e m e m i l i k i H b <

7 g r / d l m e m p u n y a i f a c t o r r e s i k o 8 k a l i l i p a t m e l a h i r k a n B B L R ( A l i d d k ,

2 0 1 1 ) .

27

2.2 Kerangka Teori

F a k t o r I n t a i i a l ;

a ) U m u r I b u , b ) I n t e r v a l k e h a m i l a n , c ) p a r i t a s , d ) N u t i r i s i I b u , e ) K e h a m i l a n b e r e s i k o ( p r e e k l a m p s i a ,

K e h a m i l a n g a n d a , d l l )

0 Anemia*, - Ringan/Sedang = = 7-10,9 gr/dl - Berat = < 7 gr/dl

F a k t o r E k s t e m a l

a) P a p a r a n l i n g k u n g a n b ) S o s i o - e k o n o m i k c ) F r e k u e n s i d a r i A N C

1 . M e n u r u n n y a t r a n s f e r n u t i r e n & o k s i g e n k e f e t u s

2 . A k t i v i t a s N o r e p h i n e p h r i n e / K o r t i s o l

3 . M e n i n g k a t n y a O x i d a t v e s t r e s s 4 . M e n i n g k a t n y a I n f e k s i

I X P e r t u m b u h a n d a n p e r k e m b a n g a n

f e t u s ( l U G R ) Berat Bayi Lahir Rendah*

S u m b e r d a r i : M o d i f i k a s i P e n e l i t i a n G r u s l i n ( 2 0 0 7 ) , B r o d k s y d a n

C h r i s t o u ( 2 0 0 4 ) , s e r t a K i n z l e r ( 2 0 0 7 ) .

* = V a r i a b e l y a n g d i t e l i t i

— = V a r i a b e l y a n g t i d a k d i t e l i t i

28

2.3 Hiootesis

1. A d a h u b u n g a n A n e m i a d a l a m k e h a m i l a n d e n g a n k e j a d i a n B a y i B e r a t

L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n P a l e m b a n g t a h u n

2 0 1 1

2 . A d a H u b u n u a n f a k t o r r e s i k o A n e m i a d a l a m k e h a m i l a n d e n e a n k e i a d i a n

B a y i B e r a t L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n

P a l e m b a n g t a h u n 2 0 1 1 .

3 A d a h u b u n g a n d e r a j a t A n e m i a d a l a m k e h a m i l a n d e n g a n k e j a d i a n B a y i

B e r a t L a h i r R e n d a h d i R u m a h S a k i t M o e h a m m a d H o e s i n P a l e m b a n e

t a h u n 2 0 1 1 .

BAB I I I

Metode Penelitian

3.1 Jenis penelitian

P e n e l i t i a n i n i t e r m a s u k j e n i s p e n e l i t i a n o b s e r v a s i o n a l a n a l i t i k d e n g a n

p e n d e k a t a n k a s u s k o n t r o l u n t u k m e m p e l a j a r i h u b u n g a n a n t a r a a n e m i a d a l a m

k e h a m i l a n d e n g a n k e j a d i a n B a y i B e r a t L a h i r R e n d a h d i R u m a h S a k i t

M u h a m m a d H o e s i n P a l e m b a n g .

P e n e l i t i a n k a s u s k o n t r o l a d a l a h r a n c a n g a n s t u d i e p i d e m i o l o g i y a n g

m e m p e l a j a r i h u b u n g a n a n t a r a p a p a r a n ( f a k t o r p e n e l i t i a n ) d a n p e n y a k i t

d e n g a n c a r a m e m b a n d i n g k a n k e l o m p o k k a s u s d a n k e l o m p o k c o n t r o l

b e r d a s a r k a n s t a t u s p a p a r a n n y a ( K a s j o n o , 2 0 0 9 )

3.2 Waktu dan tempat penelitian

P e n e l i t i a n d i l a k u k a n d i R u m a h S a k i t M u h a m m a d H o e s i n P a l e m b a n g

p a d a k u r u n w a k t u b u l a n J a n u a r i s a m p a i d e n g a n D e s e m b e r 2 0 1 1 .

3.3 Populasi & sampel penelitian

33.1 Populasi

1. Populasi Terjangkau

P e n e l i t i a n i n i d i l a k u k a n t e r h a d a p s e l u r u h b a y i l a h i r b e s e r t a i b u n y a y a n g

m e l a h i r k a n d i R u m a h S a k i t M u h a m m a d H o e s i n P a l e m b a n g d a l a m k u r u n

w a k t u J a n u a r i s a m p a i d e n g a n D e s e m b e r 2 0 1 1 .

2. Populasi Target

B a y i d e n g a n B e r a t L a h i r R e n d a h B e s e r t a i b u n y a p a d a k u r u n w a k t u

J a n u a r i s a m p a i d e n g a n D e s e m b e r 2 0 1 1 .

3.3.2 Sampel

S a m p e l m e r u p a k a n b a g i a n ( s u b s e t ) d a r i p o p u l a s i y a n g d i p i l i h

d e n g a n c a r a t e r t e n t u h i n g g a d i a n g g a p d a p a t m e w a k i l i p o p u J a s i n y a

( S a s t r o a s m o r o , 2 0 0 7 ) . T e k n i k s a m p l i n g y a n g d i g u n a k a n d a l i

3 0

31

i n i y a i t u c o n s e c u t i v e s a m p l i n g . C o n s e c u t i v e s a m p l i n g i n i m e r u p a k a n j e n i s

n o n - p r o b a b i l i t y t e r b a i k , d a n s e r i n g k a l i m e r u p a k a n c a r a y a n g p a l i n g

m u d a h . C o n s e c u t i v e s a m p l i n g s e t i a p p a s i e n y a n g m e m e n u h i k r i t e r i a

p e n e l i t i a n d i m a s u k k a n d a l a m p e n e l i t i a n s a m p a i k u r u n w a k t u t e r t e n t u ,

s e h i n g g a j u m l a h p a s i e n y a n g d i p e r l u k a n t e r p e n u h i . ( S a s t r o a s m o r o , 2 0 0 7 )

3 3 3 Kriteria Restrtksi

1. Kriteria Inklusi:

a. B a y i d e n g a n B B L R b e s e r t a i b u n y a .

b . I b u h a m i l d e n g a n a n e m i a .

c . U m u r i b u 2 0 - 3 5 t a h u n .

2. Kriteria eksklusi

a . I b u m e l a h i r k a n d e n g a n riwayat p r e m a t u r s e b e l u m n y a .

b . I b u h a m i l d e n g a n p e n y a k i t j a n t u n g .

c . I b u h a m i l d e n g a n p r e - e k l a m p s i a ringan m a u p u n p r e - e k l a m p s i a

b e r a t .

d . I b u d e n g a n e k l a m p s i a .

e. I b u h a m i l d e n g a n i n f e k s i .

f . I b u h a m i l g e m e l l i .

g . B a y i m e n g a i a m i c a c a t b a w a a n .

33.4 Estimasi Besar Sampel

E s t i m a s i b e s a r s a m p e l u n t u k p e n e l i t i a n k a s u s k o n t r o l m e n u r u t

L a m e s h o w ( 1 9 9 7 ) a d a l a h :

n l = n 2 = n = r ( Z l - a / 2 V 2 P ( 1 - P ) ) + ( Z l - B V P I ( l - P l ) + P 2 ( 1 - P 2 ) ) f

( P l - P 2 ) ^

n : U k u r a n m a s i n g - m a s i n g s a m p e l d a r i k e d u a k e l o m p o k s a m p e l

P I : P e r k i r a a n P r o p o r s i s a k i t p a d a p o p u l a s i t e r p a p a r = 0 , 7 1

P 2 : P e r k i r a a n P r o p o r s i s a k i t p a d a p o p u l a s i t a k t e r p a p a r = 0 , 4

P : ( P l + P 2 ) / 2 = 0 , 5 5

Z l - a / 2 : 1 , 9 6

32

Z l - p : 0 , 8 4

O R : 3 , 7

S e t e l a h d i h i t u n g b e r d a s a r k a n m m u s , d i d a p a t k a n n = 2 7 , 5 5 m a k a

u k u r a n s a m p e l m i n i m a l y a n g d i g u n a k a n p e n e l i t i p a d a p e n e l i t i a n i n i a d a l a h

2 8 s u b j e k u n t u k m a s i n g - m a s i n g k e l o m p o k .

1. Kelompok Kasus

K e l o m p o k k a s u s a d a l a h b a y i d e n g a n B B L R b e s e r t a i b u n y a y a n g

m e l a h i r k a n d i R u m a h S a k i t M u h a m m a d H o e s i n P a l e m b a n g p a d a b u l a n

J a n u a r i s a m p a i d e n g a n D e s e m b e r 2 0 1 1 .

2. Kelompok kontrol

K e l o m p o k k o n t r o l a d a l a h b a y i tidak B B L R b e s e r t a i b u n y a y a n g

m e l a h i r k a n d i R u m a h S a k i t M u h a m m a d H o e s i n P a l e m b a n g p a d a b u l a n

J a n u a r i s a m p a i d e n g a n D e s e m b e r 2 0 1 1 .

3.4 Variabel penelitian

1. Variabel Bebas

A n e m i a s e l a m a m a s a K e h a m i l a n

2. Variabel Terikat

B a y i B e r a t L a h i r R e n d a h

3.5 Defenisi operasionai

1. Kehamilan Dengan Anemia

a . D e f i n i s i

- I b u h a m i l d e n g a n H b < 1 1 g r / d l p a d a k e h a m i l a n t r i m e s t e r

p e r t a m a d a n k e t i g a , d a n H b < 1 0 , 5 g r / d l p a d a k e h a m i l a n t r i m e s t e r

k e d u a ( C D C , 2 0 1 0 ) .

- A n e m i a r i n g a n / s e d a n g = 7 - 1 0 , 9 g r / d l . A n e m i a b e r a t = < 7 g r / d l

( W H O , 2 0 0 8 )

34

3.6 Cara Kerja/Cara pengumpulan data

P e n g u m p u l a n d a t a d i l a k u k a n m e l a l u i t e l a a h r e k a m m e d i k p e r s a l i n a n a n t a r a

b u l a n J a n u a r i s a m p a i d e n g a n b u l a n D e s e m b e r t a h u n 2 0 1 1 s e l a m a d u a m i n g g u ,

d i m u l a i d a r i b u l a n J a n u a r i . J e n i s d a t a y a n g d i k u m p u l k a n m e l i p u t i :

a . D a t a I d e n t i t a s I b u d a n B a y i , riwayat k e h a m i l a n d a n p e r s a l i n a n i b u , s t a t u s

H b , j a r a k k e l a h i r a n , p a r i t a s d a n d a t a p e r a w a t a n a n t e n a t a l .

b . D a t a b e r a t b a d a n b a y i s e t e l a h d i l a h i r k a n

3.7 Cara Pengolahan Data dan analisis data

3.7.1 Pengolahan data

D a t a y a n g t e l a h d i k u m p u l k a n m a k a p e n e l i t i a k a n m e l a k u k a n

a n a l i s a d a t a s e h i n g g a d a t a t e r s e b u t d a p a t d i t a r i k k e s i m p u l a n n y a .

A d a p u n d a t a d i a n a l i s i s d e n g a n m e n g g u n a k a n software statistik.

L a n g k a h a w a l a d a l a h m e l a k u k a n p e n y i m t i n g a n ( e d i t i n g ) t e r h a d a p

d a t a y a n g a d a . A p a b i l a t e m y a t a t i d a k a d a d a t a y a n g d i r a s a k a n k u r a n g

( d a t a l e n g k a p / s i a p ) , s e l a n j u t n y a d i l a k u k a n e n t r i k e d a l a m k o m p u t e r .

P e m b e r s i h a n d a t a ( C l e a n i n g ) t e r h a d a p d a t a - d a t a y a n g t i d a k w a j a r d a n

d i c e k k e b e n a r a n n y a p a d a r e k a p i t u l a s i d a t a y a n g t e l a h d i k u m p u l k a n .

3.7.2 Analisis data

A n a l i s i s d a t a d i l a k u k a n d e n g a n d u a t a h a p y a i t u a n a l i s i s u n i v a r i a t

d a n a n a l i s i s b i v a r i a t .

1. Analisis Univariat

A n a l i s i s u n i v a r i a t d i l a k u k a n u n t u k m e n d e s k r i p s i k a n v a r i a s i s e l u r u h

v a r i a b e l y a n g d i g u n a k a n d e n g a n c a r a m e m b u a t t a b e l d i s t r i b u s i

f r e k u e n s i m a u p u n m e m b u a t n i l a i r a t a - r a t a , m a u p u n n i l a i t e n g a h u n t u k

d a t a k o n t i n y u .

2. Analisis Bivariat

A n a l i s i s b i v a r i a t d i l a k u k a n u n t u k m e l i h a t h u b u n g a n a n t a r a v a r i a b e l

i n d e p e n d e n d e n g a n v a r i a b e l d e p e n d e n . A n a l i s i s b i v a r i a t y a n g

d i l a k u k a n p a d a p e n e l i t i a n i n i a d a 2 y a i t u : — - s ^ ^

35

a. A n a l i s i s H u b u n g a n a n e m i a s e l a m a m a s a k e h a m i l a n d e n g a n B B L R .

A n a l i s i s y a n g a k a n d i g u n a k a n p a d a m e n g u j i d u a v a r i a b e l y a n g

b e r s k a l a k a t e g o r i k a n a l i s i s a d a l a h d e n g a n u j i chi square, d e n g a n

m e l i h a t n i l a i fisher exact test b i l a d i j u m p a i n i l a i < 5 d a n m e l i h a t n i l a i

continue correction a p a b i l a t i d a k d i j u m p a i n i l a i h a r a p a n < 5 .

b . A n a l i s i s H u b u n g a n d e r a j a t k e p a r a h a n a n e m i a s e l a m a m a s a

k e h a m i l a n d e n g a n B B L R .

A n a l i s i s y a n g a k a n d i g u n a k a n a d a l a h u j i r e g r e s i l o g i s t i k s e d e r h a n a ,

n i l a i y a n g a k a n d i l i h a t a d a l a h n i l a i P y a n g d i t a m p i l k a n o l e h u j i

s t a t i s t i k u j i r e g r e s i l o g i s t i k s e d e r h a n a .

c . U n t u k m e l i h a t Odds R a t i o , s e b a g a i n i l a i u n t u k m e l i h a t s e b e r a p a

b e s a r a n e m i a d a p a t m e n j a d i f a k t o r r e s i k o t e r h a d a p k e j a d i a n B B L R .

3.8 Alur kerja/alur penelitian

3.8.1 Alur kerja/alur penelitian 1

B a y i b a n i l a h i r y a n g m e l a h i r k a n d i R S M P k u r u n w a k t u J a n u a r i s/d D e s e m b e r 2 0 1 1

B a y i d e n g a n B B L R y a n g m e l a h i r k a n d i R S M P k u r u n w a k t u J a n u a r i s/d D e s e m b e r

2 0 1 1

K r i t e r i a I n k l u s i K r i t e r i a E k s k l u s i K r i t e r i a I n k l u s i » 4

K r i t e r i a E k s k l u s i

B a y i B B L R ( + )

I b u H a m i i A n e m i a ( + )

I b u H a m i l A n e m i a ( - )

B a y i B B L R ( - )

I b u H a m i l A n e m i a ( + )

I b u H a m i l A n e m i a ( - )

36

3.8.2 Alur kerja/alur penelitian 2

B a y i b a r u l a h i r y a n g m e l a h i r k a n d i R S M P k u r u n w a k t u J a n u a r i s/d D c s c m b c r 2 0 1 1

B a y i d e n g a n B B L R R S M P k u r u n w a k t u J

2 0

y a n g m e l a h i r k a n d i a n u a r i s/d D e s e m b e r 11

K r i t e r i a I n k l u s i

B a y i B B L R ( + )

I b u H a m i l A n e m i a ringan/ s edang

I b u H a m i l A n e m i a

be ra t

1 I b u H a m i l

dengan t i d a k a n e m i a

K r i t e r i a E k s k l u s i

B a y i B B L R ( - )

I b u H a m i l A n e m i a r i n g a n / s edang

I b u H a m i l A n e m i a

be ra t

I b u H a m i l d e n g a n t i d a k

a n e m i a

3.7 Rencana alur kerja

Tabel 3.1 Rencana Alur Kerja

N o . K e g i a t a n

1 .

2 .

3 .

P e n g a j u a n j u d u l P e r s i a p a n p r o p o s a l s k r i p s i d a n s u r v e y p e n d a h u i u a n P e m b u a t a n p r o p o s a l d a n k o n s u l t a s i

37

p e m b i m b i n g A 4 .

S e m i n a r p r o p o s a l

5 . P e l a k s c i n a a n p i e n e l i t i a n

o. r c n g i u n p uioi i d a t a d a n a n a l i s i s p e n e l i t i a n

7 . P e n y u s u n a n l a p o r a n p e n e l i t i a n

8 . U j i a n s k r i p s i

3.8 Anggaran

Tabel 33 Rencana Anggaran

No. Harga 1 K e r t a s A 4 2 rim 7 0 g r a m @ 3 5 . 0 0 0 R p . 7 0 . 0 0 0 2 A l a t t u l i s d a n m a p R p . 3 0 . 0 0 0 3 F o t o k o p i a n d a n p e n j i l i d a n p r o p o s a l d a n s k r i p s i R p . 1 5 0 . 0 0 0 4 B i a y a p e n g a m b i l a n d a t a d i R u m a h S a k i t R p . 1 5 0 . 0 0 0 5 S o u v e n i r t e r i m a k a s i h R p . 3 0 0 . 0 0 0 6 T r a n s p o r t a s i R p . 1 0 0 . 0 0 0

Total R p . 8 0 0 . 0 0 0

BAB IV

Hasil dan Pembahasan

4.1 Hasil

4.1.1 Deskripsi Lokasi Penelitian

R S U P D r . M o h . H o e s i n P a l e m b a n g d i d i r i k a n p a d a t a h u n 1 9 5 3 a t a s

p r a k a r s a M e n t e r i K e s e h a t a n R I D r . M o h a m m a d A l i ( D r . L e e k i a t T e n g )

d e n g a n b i a y a p e m e r i n t a h p u s a t p a d a t a n g g a l 0 3 J a n u a r i 1 9 5 7 r u m a h s a k i t

i n i d i m u l a i o p e r a s i o n a i y a n g d a p a t m e l a y a n i m a s y a r a k a t s e - S u m b a g s e l d i

m a n a s a a t i t u m e l i p u t i p r o v i n s i s e - S u m a t e r a S e l a t a n , L a m p u n g , J a m b i ,

B e n g k u l u d a n B a n g k a B e l i t u n g .

T a h u n 1 9 9 3 - 1 9 9 4 R S U P P a l e m b a n g m e n g u b a h s t a t u s d a r i R S

V e r t i k a l ( R S P e n e r i m a N e g a r a B u k a n P a j a k ) m e n j a d i R S S w a d a n a s e s u a i

S K . M e n k e s R I N o . l 2 7 9 / M e n k e s / S K / X I / 1 9 9 7 R S U P P a l e m b a n g r e s m i

b e m a m a R S U P . D r . M o h a m m a d H o e s i n P a l e m b a n g .

T a h u n 2 0 0 0 d e n g a n P P N o 1 2 2 / 2 0 0 0 , R S U P . D r . M o h . H o e s i n

P a l e m b a n g d i t e t a p k a n m e n j a d i s a l a h s a t u d a r i 13 R u m a h S a k i t

P e m e r i n t a h m e n j a d i R u m a h S a k i t P e r u s a h a a n J a w a t a n d i I n d o n e s i a d a n

o p e r a s i o n a l n y a d i m u l a i t a n g g a l 0 1 J a n u a r i 2 0 0 2 , s e b a g a i R u m a h S a k i t

P e r j a n ( p e r u s a h a a n j a w a t a n ) s e c a r a o p e r a s i o n a i R S M H P a l e m b a n g m a s i h

t e t a p m e l a k s a n a k a n f u n g s i p e l a y a n a n s o s i a l n y a b a g i m a s y a r a k a t e k o n o m i

k u r a n g m a m p u m e l a l u i P r o g r a m A S K E S K I N .

K e m u d i a n t a h u n 2 0 0 5 b e r d a s a r k a n P P 2 3 / 2 0 0 5 t a n g g a l 13 J u n i 2 0 0 5

t e n t a n g P e n g e l o l a a n K e u a n g a n B a d a n L a y a n a n U m u n d e n g a n S K M e n k e s

R I N o : 1 2 4 3 / M e n k e s / S K y V I I I / 2 0 0 5 , t a n g g a l 1 1 A g u s t u s 2 0 0 5 t e n t a n g

P e n e t a p a n 1 3 e k s R u m a h S a k i t P e r j a n s t a t u s n y a m e n j a d i U n i t P e l a k s a n

T e k n i s D e p k e s R I d e n g a n m e n e r a p k a n p o l a p e n g e l o l a a n , K e u a n g a n B a d a n

L a y a n a n U m i m d i l a k s a n a k a n p a d a J a n u a r i 2 0 0 6 .

S e j a l a n d e n g a n p e r k e m b a n g a n R S M H t e l a h b a n y a k m e m b a n g u n

f a s i l i t a s m a u p u n r e n o v a s i b a n g u n a n t e r u t a m a f a s i l i t a s r u a n g r a w a t u n t u k

m a s y a r a k a t m e n e n g a h k e a t a s n a m i m t e t a p m e m p e r h a t i k a n u n t u k

3 8

3 9

m a s y a r a k a t y a n g k u r a n g b e r u n t u n g y a n g m e m p e r g u n a k a n J a m k e s m a s

( J a m i n a n K e s e h a t a n M a s y a r a k a t ) y a n g m e r u p a k a n p r o g r a m d a r i

D e p a r t e m e n K e s e h a t a n d a n J a m s o s k e s S u m s e l S e m e s t a ( J a m i n a n S o s i a l

S u m a t e r a S e l a t a n S e m e s t a ) y a n g m e r u p a k a n p r o g r a m d a r i P e m e r i n t a h

P r o v i n s i S u m a t e r a S e l a t a n , s e h i n g g a s a a t i n i k o m p o s i s i t e m p a t t i d u r u n t u k

m a s y a r a k a t k u r a n g m a m p u l e b i h d a r i 5 0 % d a r i j u m l a h a l o k a s i y a n g

t e r s e d i a .

U n t u k m e n i n g k a t k a n p e l a y a n a n k e p a d a m a s y a r a k a t R S U P

D r . M o h d . H o e s i n P a l e m b a n g t e l a h m e m b a n g u n b e b e r a p a g e d u n g a n t a r a

l a i n C O T d a n G e d u n g B r a i n & H e a r t C e n t r e , d i m a n a C O T i n i s e n d i r i

m e r u p a k a n s a i a h s a t u p e l a y a n a n d e n g a n s t a n d a r I n t e m a s i o n a l , s e d a n g k a n

p e l a y a n a n B r a i n & H e a r t C e n t r e m e r u p a k a n p e l a y a n a n p e r t a m a d i

I n d o n e s i a y a n g m e n g g a b u n g k a n a n t a r a P e l a y a n a n j a n t u n g d a n S t r o k e .

S e t e l a h m e l a l u i b e r b a g a i p e r s i a p a n d a n p e m b i n a a n s e r t a p e n i l a i a n d a r i t i m

s u r v e y k o m i s i g a b u n g a n A k r e d i t a s i R u m a h S a k i t , m a k a d e n g a n k e p u t u s a n

M e n t e r i K e s e h a t a n s e j a k t a n g g a l 1 2 S e p t e m b e r 2 0 0 9 R u m a h S a k i t D r .

M o h d . H o e s i n P a l e m b a n g t e l a h m e m p e r o l e h s t a t u s a k r e d i t a s i p e n u h y a i t u

m e m i l i k i 1 6 p e l a y a n a n y a i t u : a d m i n i s t r a s l m a n a j e m e n , p e l a y a n a n m e d i s ,

p e l a y a n a n g a w a t d a r u r a t , p e l a y a n a n k e p e r a w a t a n , rehabilitasi m e d i k ,

f a r m a s i , K e s e l a m a t a n K e c e l a k a a n K e r j a ( K 3 ) , r a d i o l o g i , l a b o r a t o r i u m ,

k a m a r o p e r a s i , p e n g e n d a l i a n I n f e k s i d i R S , p e r i n a t o l o g i r e s i k o t i n g g i ,

p e l a y a n a n r e h a b i l i t a s i m e d i k , p e l a y a n a n g i z i , p e l a y a n a n i n t e n s i f d a n

p e l a y a n a n d a r a h . D a n s a a t i n i R S U P D r . M o h d H o e s i n P a l e m b a n g m e n j a d i

R u m a h S a k i t k e l a s A .

L.2 Karakteristik Subjek

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n d a r i rekam m e d i k R S U P D r .

M o e h a m m a d H o e s i n d i p e r o l e h d a t a d a r i b u l a n J a n u a r i s a m p a i d e n g a n

D e s e m b e r 2 0 1 1 , d i d a p a t k a n p o p u l a s i p e n e l i t i a n s e b a n y a k 2 0 1 b a y i d a n

s u b j e k s e b a n y a k 6 0 b a y i . D a t a d i p e r o l e h d e n g a n m e l i h a t b e r a t b a d a n b a y i

m a s u k d a l a m k a t e g o r i B B L R a t a u t i d a k .

4 0

B e r d a s a r k a n d a t a - d a t a t e r s e b u t d a p a t d i b u a t k a r a k t e r i s t i k s u b j e k

p e n e l i t i a n s e b a g a i b e r i k u t :

Tabel 4.1 Karakteristik responden berdasarkan umnr (n=60)

Usia Jnmlah Persentase (%)

2 1 - 2 5 3 0 50

2 6 - 3 0 2 2 3 6 , 6 7

3 1 - 3 5 8 1 3 , 3 3

Total 60 100

B e r d a s a r k a n h a s i l p e n e l i t i a n t e r h a d a p 6 0 r e s p o n d e n , r a t a - r a t a u m u r

i b u h a m i l a d a l a h 2 6 , 3 t a h i m , u m u r i b u h a m i l t e r e n d a h a d a l a h 2 0 t a h i m d a n

u m u r i b u h a m i l t e r t i n g g i a d a l a h 3 5 t a h u n . H a l i n i d i m a k s u d k a n u n t u k

m e n g u r a n g i b i a s d a l a m p e n e l i t i a n . U m u r 2 0 - 3 5 t a h u n m e r u p a k a n u m u r

y a n g i d e a l d a n r e l a t i f a m a n u n t u k h a m i l d a n m e l a h i r k a n .

Tabel 4.2 Karakteristik responden berdasarkan Paritas (n==60)

Paritas Jnmlah Presentase (%)

2 2 6 4 3 , 3 3

3 23 3 8 , 3 3

4 11 1 8 , 3 3

Total 60 100

P a r i t a s b e r v a r i a s i d a r i p a r i t a s 2 s a m p a i 4 . I b u d e n g a n p a r i t a s k e - 2

s e b a n y a k 2 6 k a s u s , p a r i t a s k e - 3 s e b a n y a k 2 3 k a s u s , d a n p a r i t a s k e - 4

s e b a n y a k s e b a n y a k 1 1 o r a n g .

41

4.1.3 Analisis Univariat

1. Hemoglobin Ibu hamil

Tabel 43 Karakteristik Hemoglobin Ibu Hamil (n=60)

Hb Ibu HamU Jumlah Persentase (%)

T i d a k A n e m i a 4 0 6 6 , 6 7

A n e m i a 2 0 3 3 , 3 3

Total 60 100

I b u h a m i l y a n g k a d a r H e m o g l o b i n n y a ( H b ) < 1 1 g r / d l d a n

d i k a t e g o r i k a n a n e m i a s e j u m l a h 2 0 o r a n g a t a u 3 3 , 3 3 % . S e d a n g k a n i b u

h a m i l y a n g m e m i l i k i k a d a r h e m o g l o b i n > 1 1 g r / d l d a n d i k a t e g o r i k a n

t i d a k m e n g a i a m i a n e m i a , b e r j u m l a h 4 1 o r a n g a t a u 6 6 , 6 7 % . H a s i l

p e n e l i t i a n j u g a m e u n j u k k a n r a t a - r a t a H e m o g l o b i n i b u h a m i l a d a l a h

1 1 , 4 4 0 g r / d l , d e n g a n k a d a r h e m o g l o b i n t e r e n d a h a d a l a h 6 , 4 g r / d l ,

s e d a n g k a n k a d a r h e m o g l o b i n t e r t i n g g i a d a l a h 1 5 g r / d l .

Tabel 4.4 Karakteristik derajat Anemia dalam kehamilan (n=20)

Hb Ibu HamU Jumlah Persentase (%)

A n e m i a R i n g a n / S e d a n g 1 4 70

A n e m i a B e r a t 6 30

Total 20 100

P a d a t a b e l 4 . 4 d a p a t d i l i h a t d a r i 2 0 i b u h a m i l d e n g a n a n e m i a , 1 4

( 7 0 % ) d i a n t a r a n y a m e n d e r i t a a n e m i a ringan/sedang d a n y a n g

m e n d e r i t a a n e m i a b e r a t s e b a n y a k 6 o r a n g ( 3 0 % ) .

2. Berat Bayi Lahir

H a s i l p e n e l i t i a n r a t a - r a t a b e r a t b a d a n b a y i b a r u l a h i r a d a l a h 2 5 5 6 , 7

g r . B e r a t b a d a n b a y i l a h i r t e r e n d a h a d a l a h 1 5 0 0 g r , s e d a n ^ c ^ ^ J i e r a t

b a d a n b a y i l a h i r t e r t i n g g i a d a l a h 4 0 0 0 g r .

42

D a r i 6 0 s u b j e k y a n g d i t e l i t i , s e j u m l a h 3 0 o r a n g b a y i ( 5 0 % ) y a n g

d i l a h i r k a n m e m i l i k i b e r a t l a h i r < 2 5 0 0 g r d a n d i k a t e g o r i k a n B a y i B e r a t

L a h i r R e n d a h ( B B L R ) . S e d a n g k a n s e j u m l a h 3 0 o r a n g b a y i ( 5 0 % % )

d i l a h i r k a n d e n g a n b e r a t > 2 5 0 0 g r . D a t a d a p a t d i l i h a t p a d a t a b l e 5 . 3

b e r i k u t :

Tabel 4.5 Karakteristik Berat Bayi Lahir (n=60)

Berat Bayi Lahir Jumlah Presentase (%)

T i d a k B B L R 3 0 5 0

B B L R 30 5 0

Total 60 100

4.1.4 Hasil Analisis Bivariat

A. Hubungan Anemia dalam Kehamilan dengan Kejadian B B L R

Tabel 4.6 Perbandingan Anemia dalam Kehamilan dengan Kejadian B B L R

Srarus Aurini.1 Dcr.ir Da>i L;iliir Total P OR

B B L R ( ) BBLR(-»

Au^mift (-) 1 6 4 20 33.33 C 6 0 1 - . 4 2 P

Aneinii (-) 1 4 4 6 C " : o 6 6 , 0 ' 40 6 6 . 6 ' '

Total 30 100 30 100 60 100

B e r d a s a r k a n t a b e l 4 . 5 M e n u n j u k k a n p r e s e n t a s e B B L R d a r i i b u

y a n g m e n g a i a m i a n e m i a l e b i h b e s a r ( 5 3 , 3 3 % ) d i a n d i n g k a n d e n g a n b a y i

y a n g t i d a k B B L R ( 1 3 , 3 3 % ) . S e d a n g k a n p a d a i b u d e n g a n t i d a k a n e m i a ,

b a y i y a n g t i d a k B B L R m e m i l i k i p e r s e n t a s e l e b i h b e s a r ( 8 6 , 6 7 % ) ,

d i b a n d i n g k a n d e n g a n y a n g B B L R ( 4 6 , 6 7 % )

H a s i l u j i chi square pada s o f t w a r e m e n u n j u k k a n t i n g k a t

s i g n i f i k a n s i ( p ) s e b e s a r 0 , 0 0 1 d i m a n a s i g n i f i k a n s i a < 0 , 0 5 . S e d a n g k a n

p a d a p e r h i t u n g a n n i l a i X 2 y a n g d i d a p a t s e b e s a r 1 0 , 8 l e b i h b e s a r d a r i X 2

t a b e l s e b e s a r 3 , 8 4 1 ( p > 0 , 0 5 ) p a d a t a r a f s i g n i f i k a n s i a = 0 , 0 5 d e n g a n d b = l .

43

D e n g a n d e m i k i a n m a k a ffl t e r l e t a k d i d a e r a h p e n o l a k a n s e h i n g g a t e r d a p a t

h u b u n g a n a n t a r a a n e m i a d a l a m k e h a m i l a n d e n g a n k e j a d i a n B a y i B e r a t

L a h i r R e n d a h d i R S U P d r . M o e h a m m a d H o e s i n P a l e m b a n g . H u b u n g a n

k e k u a t a n a n t a r v a r i a b e l d a l a m p e n e l i t i a n i n i d i n i l a i d e n g a n m e n g g u n a k a n

odds r a t i o . O R h a s i l p e r h i t u n g a n a d a l a h s e b e s a r 7 , 4 2 9 . K a r e n a O R ( 7 , 4 2 9 )

> 1 , h a l i n i b e r a r t i a d a a s o s i a s i p o s i t i f a n t a r a f a k t o r r i s i k o d e n g a n p e n y a k i t .

B. Hubungan Derajat keparahan Anemia dalam Kehamilan dengan

Kejadian B B L R

Tabel 4.7 Perbandingan derajat Anemia dengan kejadian B B L R

Status .-VBeniia Beiat Ba>1 Laliii Total Co P OR

BBLR (-1 oo BBLR(- )

Anemia Berat 5 1':." i . .3 4 10.0 0.052

Anemia Riugau Sedaug 11 36.6 3 10.0 16 23.3 O.OOP 6.S10

Tidak .4uemia 14 46 * 26 3 5." 40 66.*'

Total 30 100 30 Too 60 100

H u b u n g a n a n t a r a A n e m i a d a l a m k e h a m i l a n d e n g a n B B L R t e r l i h a t

b a h w a s e m a k i n b e r a t d e r a j a t a n e m i a d a l a m k e h a m i l a n a k a n s e m a k i n

b e s a r k e m u n g k i n a n u n t u k m e l a h i r k a n b a y i B B L R . P a d a t a b e l 4 . 7

m e n u n j u k k a n p r e s e n t a s e B B L R d a r i i b u y a n g m e n g a i a m i a n e m i a b e r a t

l e b i h b e s a r ( 1 6 , 7 % ) d i a n d i n g k a n d e n g a n b a y i y a n g t i d a k B B L R

( 3 , 3 % ) . P a d a i b u d e n g a n a n e m i a r i n g a n / s e d a n g , b a y i y a n g B B L R

m e m i l i k i p e r s e n t a s e l e b i h b e s a r ( 3 6 , 6 % ) , d i b a n d i n g k a n d e n g a n y a n g

B B L R ( 1 0 , 0 % ) . S e d a n g k a n p a d a i b u d e n g a n t i d a k a n e m i a , b a y i y a n g

t i d a k B B L R m e m i l i k i p e r s e n t a s e l e b i h b e s a r ( 8 6 , 6 7 % ) , d i b a n d i n g k a n

d e n g a n y a n g B B L R ( 4 6 , 6 7 % ) .

D a r i N i l a i O R d a p a t d i s i m p u l k a n b a h w a i b u y a n g m e n g a i a m i

a n e m i a m e n g a i a m i A n e m i a B e r a t m e m p i m y a i k e c e n d e r u n g a n u n t u k

m e l a h i r k a n b a y i B B L R s e b e s a r 9,286 k a l i l e b i h b e s a r d i b a n d i n g k a n

d e n g a n i b u y a n g t i d a k m e n g a i a m i a n e m i a ( p == 0 . 0 5 2 ) . S e d a n g k a n i b u

44

y a n g m e n g a i a m i A n e m i a R i n g a n / S e d a n g m e m p u n y a i k e c e n d e r u n g a n

u n t u k m e l a h i r k a n b a y i B B L R s e b e s a r 6,810 k a l i l e b i h b e s a r

d i b a n d i n g k a n d e n g a n i b u y a n g t i d a k m e n g a i a m i a n e m i a ( p v a l u e =

0 . 0 0 9 ) .

4.2 Pembahasan

D a r i p e n e l i t i a n y a n g t e l a h d i l a k u k a n p a d a r e k a m m e d i k R S U P d r .

M o e h a m m a d H o e s i n d i p e r o l e h d a t a B a y i B e r a t L a h i r R e n d a h d a r i b u l a n

J a n u a r i s a m p a i d e n g a n D e s e m b e r 2 0 1 1 s e b a n y a k 2 0 1 . M e n u r u t D e p k e s R I

( 2 0 0 8 ) S a l a h s a t u p e n y e b a b B a y i B e r a t L a h i r R e n d a h a d a l a h a n e m i a d a l a m

k e h a m i l a n , y a n g m e m p a k a n p r o s e s f i s i o l o g i s d a l a m k e h a m i l a n y a n g m e n j a d i

s e m a k i n n y a t a d e n g a n l a n j u t n y a u m u r k e h a m i l a n d a n k o n s u m s i m a k a n a n y a n g

b u r u k t e m t a m a m a k a n a n y a n g m e n g a n d u n g z a t b e s i .

H a s i l a n a l i s i s u j i s t a t i s t i k m e n g g u n a k a n u j i chi square m e n u n j u k k a n

s i g n i f i k a n s i ( p ) s e b e s a r 0 , 0 0 1 d i m a n a s i g n i f i k a n s i a < 0 , 0 5 . H a s i l p e r h i t u n g a n

odds r a t i o ( O R ) a d a l a h 7 , 4 2 9 . K a r e n a O R ( 7 , 4 2 9 ) > 1 , b e r a r t i a d a a s o s i a s i

p o s i t i f a n t a r a f a k t o r r e s i k o y a n g d i t e l i t i ( a n e m i a d a l a m k e h a m i l a n )

m e n i n g k a t k a n k e j a d i a n B B L R . D e n g a n k a t a l a i n , a n e m i a d a l a m k e h a m i l a n

m e m p a k a n f a k t o r r i s i k o . H a l i n i s e s u a i d e n g a n p e n e l i t i a n y a n g d i l a k u k a n o l e h

N e l l y ( 2 0 0 8 ) d i R u m a h S a k i t U m u m R a n t a u p r a p a t K a b u p a t e n L a b u h a n B a t u ,

d a n N o v i z a ( 2 0 1 1 ) d i R S U D r . P i m g a d i M e d a n .

H a s i l a n a l i s i s s t a t i s t i k j u g a m e n g u n g k a p k a n b a h w a i b u y a n g m e n g a i a m i

A n e m i a R i n g a n / S e d a n g m e m p u n y a i k e c e n d e r u n g a n u n t u k m e l a h i r k a n b a y i

B B L R s e b e s a r 6 , 8 1 0 k a l i l e b i h b e s a r d i b a n d i n g k a n d e n g a n i b u y a n g t i d a k

m e n g a i a m i a n e m i a ( p v a l u e = 0 . 0 0 9 ) , s e d a n g k a n i b u y a n g m e n g a i a m i a n e m i a

m e n g a i a m i A n e m i a B e r a t m e m p u n y a i k e c e n d e r u n g a n u n t u k m e l a h i r k a n b a y i

B B L R s e b e s a r 9 , 2 8 6 k a l i l e b i h b e s a r d i b a n d i n g k a n d e n g a n i b u y a n g t i d a k

m e n g a i a m i a n e m i a ( p = 0 . 0 5 2 ) . T e m u a n i n i s a m a d e n g a n h a s i l p e n e l i t i a n y a n g

d i l a k u k a n A l i ( 2 0 1 1 ) y a n g m e n g i m g k a p k a n j u g a b a h w a d i b a n d i n g k a n d e n g a n

i b u y a n g t i d a k m e n g a i a m i a n e m i a , r e s i k o m e l a h i r k a n B B L R 2 , 5 k a l i l e b i h

4 5

b e s a r p a d a i b u h a m i l d e n g a n A n e m i a R i n g a n / S e d a n g , d a n 8 , 0 k a l i l e b i h b e s a r

p a d a i b u h a m i l d e n g a n A n e m i a B e r a t .

B e r d a s a r k a n h a s i l a n a l i s a s t a t i s t i k k e d u a v a r i a b e l t e r s e b u t , d a p a t d i k e t a h u i

b a h w a a d a b e b e r a p a f a k t o r y a n g d a p a t m e m p e n g a r u h i b e r a t b a d a n b a y i l a h i r

y a i t u f a k t o r l i n g k u n g a n i n t e r n a l , f a k t o r l i n g k u n g a n e k s t e m a l , d a n f a k t o r

p e n g g u n a a n s a r a n a k e s e h a t a n y a n g b e r h u b u n g a n frekuensi p e m e r i k s a a n

k e h a m i l a n a t a u a n t e n a t a l c a r e ( A N C ) . K a d a r h e m o g l o b i n i b u h a m i l t e r m a s u k

k e d a l a m f a k t o r l i n g k u n g a n i n t e r n a l .

D a l a m f a k t o r l i n g k u n g a n i n t e n a l t i d a k h a n y a k a d a r h e m o g l o b i n i b u h a m i l

y a n g d a p a t m e m p e n g a r u h i b e r a t b a d a n b a y i b a m l a h i r t e t a p i j u g a d a p a t

d i p e n g a r u h i o l e h u m u r i b u , j a r a k k e l a h i r a n , p a r i t a s , s t a t u s g i z i i b u h a m i l ,

p e m e r i k s a a n k e h a m i l a n , d a n p e n y a k i t p a d a s a a t k e h a m i l a n ( B e m a b e , 2 0 0 4 ) .

P a d a w a n i t a h a m i l , a n e m i a m e n i n g k a t k a n frekuensi k o m p l i k a s i p a d a

k e h a m i l a n d a n p e r s a l i n a n . R i s i k o k e m a t i a n m a t e m a l , a n g k a p r e m a t u r i t a s ,

b e r a t b a d a n b a y i l a h i r r e n d a h , d a n a n g k a k e m a t i a n p e r i n a t a l m e n i n g k a t .

D a m p a k a n e m i a p a d a k e h a m i l a n b e r v a r i a s i d a r i k e l u h a n y a n g s a n g a t ringan

h i n g g a t e r j a d i n y a g a n g g u a n k e l a n g s u n g a n k e h a m i l a n ( a b o r t u s , p a r t u s

i m a t u r / p r e m a t u r ) ( A m i m d d i n & W a h y u d i n , 2 0 0 4 ) .

D a l a m p r o s e s p e r t u m b u h a n n y a , j a n i n , a p a b i l a m e n g a i a m i k e k u r a n g a n

k a d a r s u b s t r a t , b a i k n u t r i e n m a u p u n o k s i g e n , a k a n m e n g u b a h a k t i v i t a s

m e t a b o l i k n y a a g a r d a p a t b e r t a h a n h i d u p , d e n g a n c a r a m e n g a k t i f k a n h o r m o n

norephineprine y a n g b i s a d i s t i m u l a s i CRH d a n Cortisol, y a n g k i t a t a h u p u n y a

d a m p a k n e g a t i v e t e r h a d a p p e r t u m b u h a n j a n i n . S e l a i n i t u p a d a k e k u r a n g a n

n u t r i s i y a n g d a p a t d i s e b a b k a n o l e h a n e m i a d a p a t m e n i n g k a t k a n Oxidative

stress y a n g j u g a b e r p e n g a r u h t e r h a d a p p e r t u m b u h a n f e t u s ( G r u s l i n , 2 0 0 7 ) .

P e n u r u n a n t i n g k a t p e r t u m b u h a n i n i m e n g a k i b a t k a n b e r a t b a y i l a h i r l e b i h

r e n d a h d a r i n o r m a l . P e n g a r u h n y a t i d a k h a n y a p a d a u k u r a n p a n j a n g , b e r a t ,

l i n g k a r k e p a l a , t e t a p i j u g a o r g a n - o r g a n d a l a m t u b u h b a y i ( W i k n o j o s a s t r o ,

2 0 0 6 ) .

K e t e r b a t a s a n p e n e l i t i a n i n i a d a l a h p a d a p e n g a m b i l a n d a t a a n e m i a i b u

h a m i l , p e n e l i t i t i d a k d a p a t m e l a k u k a n p e n e l i t i a n p a d a b e r a p a l a m a d a n

46

p e n y e b a b i b u m e n g a i a m i a n e m i a . K e l e m a h a n p e n e l i t i a n i n i y a n g l a i n a d a l a h

p e n e l u s u r a n d a n p e n g a m a t a n e f e k t i d a k d i l a k u k a n s e c a r a p r o s p e k t i f d e n g a n

d e s a i n k o h o r t . H a l i n i k a r e n a r a n c a n g a n p e n e l i t i a n y a n g d i l a k u k a n a d a l a h

k a s u s k o n t r o l . K e l e m a h a n p a d a p e n e l i t i a n k a s u s k o n t r o l a d a l a h k a r e n a d a t a

y a n g d i p a k a i d a t a s e k u n d e r y a i t u c a t a t a n m e d i k , b i a s a n y a d a t a c a t a t a n m e d i k

r u t i n y a n g s e r i n g d i p a k a i s e b a g a i s u m b e r d a t a t i d a k b e g i t u a k u r a t . s e h i n g g a

R a w a n t e i j a d i b i a s s a n g a t m u n g k i n , t i d a k d i k e t a h u i n y a p e n g a r u h v a r i a b e l l u a r

y a n g t i d a k t e r k e n d a l i d e n g a n t e k n i k matching, s e l a i n i t u O l e h k a r e n a k a s u s

d a n k o n t r o l d i p i l i h s e n d i r i o l e h p e n e l i t i m a k a s u k a r u n t u k m e y a k i n k a n b a h w a

k e d u a k e l o m p o k s e b a n d i n g d a l a m b e r b a g a i f a k t o r d a n s u m b e r b i a s l a i n n y a .

B A B V

Kesimpulan dan Saran

5.1 Kesimpulan

D a r i h a s i l p e n e l i t i a n y a n g d i l a k u k a n d e n g a n s u b j e k p e n e l i t i a n B a y i

B e r a t L a h i r r e n d a h d i d a p a t k a n

a. J u m l a h B B L R y a n g d i l a h i r k a n d i R S U P D r M u h a m m a d H o e s i n

P a l e m b a n g d a r i b u l a n J a n u a r i - D e s e m b e r 2 0 1 1 s e b a n y a k 2 0 1 b a y i .

b . D a r i s i m p u i a n s e c a r a s t a t i s t i k t e r d a p a t h u b u n g a n y a n g b e r m a k n a

a n t a r a I b u y a n g m e n g a i a m i A n e m i a p a d a k e h a m i l a n d e n g a n k e j a d i a n

B e r a t B a y i L a h i r R e n d a h ( p = 0 , 0 0 1 ) .

c. S e r t a d i d a p a t k a n j u g a b a h w a I b u y a n g m e n g a i a m i a n e m i a ringan/sedang

m e n i n g k a t k a n r e s i k o 6 , 8 1 0 l e b i h b e s a r m e l a h i r k a n B B L R d a n 9 , 2 8 6 k a l i

l e b i h b e s a r p a d a a n e m i a b e r a t d i b a n d i n g k a n d e n g a n i b u y a n g t i d a k

m e n g a i a m i a n e m i a .

5.2 Saran

1 . B a g i p e t u g a s k e s e h a t a n

D i h a r a p k a n p e t u g a s k e s e h a t a n l e b i h m e n i n g k a t k a n p r o g r a m

p e n y u l u h a n g i z i i b u h a m i l , b e r s a l i n , d a n n i f a s , m e l a k s a n a k a n

p e n c e g a h a n a n e m i a , d a n p e n a t a l a k s a n a a n a n e m i a d a l a m k e h a m i l a n

k e p a d a i b u - i b u h a m i l d i m a s y a r a k a t .

2 . B a g i m a h a s i s w a

D i h a r a p k a n b a g i m a h a s i s w a y a n g a k a n m e l a k u k a n p e n e l i t i a n

s e r u p a a g a r d a p a t m e l a k u k a n p e n e l i t i a n y a n g l e b i h b a i k d e n g a n

s a m p e l y a n g l e b i h b a n y a k d a n c a k u p a n y a n g l e b i h l u a s .

3. B a g i m a s y a r a k a t

B a g i I b u H a m i l d i s a r a n k a n m e n g k o n s u m s i m a k a n a n y a n g b e r g i z i

s aa t h a m i l , t e r u t a m a m a k a n a n y a n g m e n g a n d u n g z a t b e s i u n t u k

m e n g h i n d a r i t e r j a d i n y a a n e m i a d a n m e n g h i n d a r i r e s i k o m e l a h i r k a n b a y i

B B L R .

4 7

Daftar pustaka

A i a m , A . 2 0 0 8 . P r e t e n n a n d l o w b i r t h w e i g h t as risk f a c t o r s f o r i n f a n t d e l a y e d d e v e l o p m e n t . P e d i a t r i c a I n d o n e s i a n a . 4 8 ( 1 )

A l i , A A . R a y i s , D A . A b d a l l a h , T M . E l b a s h r , M I . A d a m , I . 2 0 1 1 . S e v e r e A n e m i a A s s o c i a t e d w i t h a H i g h e r R i s k f o r P r e e c l a m p s i a a n d p o o r P e r i n a t a l o u t c o m e i n K a s s a l a H o s p i t a l , e a s t e m s u d a n . B M C R e s e a r c h N o t e s . 4 ( 1 - 5 ) .

A l l e n L H , 2 0 0 0 . A n e m i a a n d I r o n D e f e c i e n c y : E f f e c t o n P r e g a n c y O u t c o m e . T h e A m e r i c a n J o u r n a l o f C l i n i c a l N u t r i t i o n . 7 1 ( 1 2 8 0 S - 1 2 8 4 S ) .

A m i r u d d i n , R . W a h y u d i n . 2 0 0 4 . S t u d i K a s u s K o n t r o l A k t o r B i o m e d i s T e r h a d a p K e j a d i a n A n e m i a I b u H a m i l D i P u s k e s m a s B a n t i m u r u n g .

B a d a n P e n e l i t i a n D a n P e n g e m b a n g a n K e s e h a t a n K e m e n t e r i a n K e s e h a t a n R e p u b l i k I n d o n e s i a . 2 0 1 0 . L a p o r a n R i s e t K e s e h a t a n D a s a r 2 0 1 0 . ( h t t p : / / w w w . r i s k e s d a s . l i t b a n g . d e p k e s . g o . i d / d o w n l o a d y T a b e l R i s k e s d a s 2 0 1 0 . p d f , d i a k s e s 1 7 N o v e m b e r 2 0 1 1 )

B e n o i s t , D B . M c l e a n , E . E g l i , 1 . C o g s w e l l , M . 2 0 0 8 . W o r l d w i d e p r e v a l e n c e o f a n a e m i a 1 9 9 3 - 2 0 0 5 : W H O g l o b a l d a t a b a s e o n a n a e m i a .

B e m a b e , J V . S o r i a n o , T . A l b a l a d e j o , R . J u a r r a n z , M . C a l l e , M E . M a r t i n e z , D . R o j a s , V D . 2 0 0 4 . R i s k F a c t o r F o r L o w B i r t h W e i g h t : A R e v i e w . E u r o p e a n J o u m a l o f O b s t e t r i c s & G y n e c o l o g y a n d R e p r o d u c t i v e B i o l o g y . 1 1 6 ( 3 - 1 5 )

B o b a k , M . 2 0 0 1 . A i r P o l u t i o n A n d B i r t h W e i g h t I n B r i t a i n . J o u m a l E p i d i m i o l o g y . 1 2 ( 3 )

B r o d s k y , D . C h r i s t o u , H . 2 0 0 4 . C u r r e n t C o n c e p t i n I n t r a u t e r i n e G r o w t h R e s t r i c t i o n . J o u m a l I n t e n s i v e C a r e M e d i c i n e . 1 9 ( 3 0 7 - 3 1 5 ) .

B u k o w s k y , J . 2 0 0 1 . A g r i c u l t u r a l C o n t a m i n a t i o n o f G r o u n d w a t e r a s a P o s s i b l e risk f a k t o r f o r G r o w t h R e s t r i c t i o n . J o u m a l O c c u p E n v i r o n m e n t M e d i c i n e . 4 3 ( 4 )

C e t i n , I . F o i d a r t , J M . M i o z z o , M . R a u n , T . J a n n s o n , T . T s a t r i s , V . R e i k , W . C r o s s , J . M u z o n i , S H . l i l s l e y , N . H u p p e r t z , B . K i n g d o m , J . 2 0 0 4 . F e t a l G r o w t h R e s t r i c t i o n : W o r k s h o p R e p o r t . J o u m a l o f P l a c e n t a . 2 5 ( 7 5 3 - 7 5 7 )

C h a r l t o n , V . 2 ( X ) 0 . C r e e i m i e n t o F e t a l : P a r a m e t r o s N u t r i c i o n a l e s . I n T r a t a d o d e N e o n a t a l o g i a d e A v e r y . ( 4 4 - 4 5 )

C u n n i n g h a m . G F . G o m e l l a . T L . G a l . F G . 2 0 0 9 . N e o n a t a l o g v . ( h a l 2 3 2 - 2 3 5 ) E d : 6 . M c G r a w h i l l .

C u n n i n g h a m , G F . , 2 0 0 5 . G a n g g u a n P e r t u m b u h a n J a n i n . O b s t e t r i W i l l i a m s V o l ( h a l 8 2 5 - 8 4 5 ) . E G C . J a k a r t a . /

C u n n i n g h a m , G F . , 2 0 0 5 . P e r t u m b u h a n d a n P e r k e m b a n g a n J a n i n . O b s t e t r i W i l l i a m s V o l . 1 . ( H a l 1 3 8 - 1 7 5 ) . E G C . J a k a r t a

D e p a r t e m e n K e s e h a t a n R e p u b l i k I n d o n e s i a . 2 0 0 1 . L a p o r a n S t u d i K e s e h a t a n R u m a h T a n g g a 2 0 0 1 : S t u d i T i n d a k L a n j u t K e s e h a t a n A n a k .

D e o a r t e m e n K e s e h a t a n R e n u b l i k I n d o n e s i a . 2 0 0 8 . P r o f i l K e s e h a t a n I n d o n e s i a T a h u n 2 0 0 8 .

D i n a s K e s e h a t a n K o t a P a l e m b a n g . 2 0 0 6 . P r o f i l K e s e h a t a n k o t a P a l e m b a n g 2 0 0 6 . ( h t t p : / / w w w . d e p k e s . g o . i d / d o w n l o a d s / p r o f i l / k o t a % 2 0 p a l e m b a n g % 2 0 2 0 0 6 . p d f d i a k s e s 15 N o v e m b e r 2 0 1 1 )

D i n a s K e s e h a t a n K o t a P a l e m b a n g . 2 0 0 7 . P r o f i l K e s e h a t a n k o t a P a l e m b a n g 2 0 0 7 . ( h t t p : / / w w w . d i n k e s . p a l e m b a n g . g o . i d / t a m p u n g / d o k u m e n / d o k u m e n - 2 2 - 1 3 . p d f d i a k s e s 15 N o v e m b e r 2 0 1 1 )

D i n a s K e s e h a t a n K o t a P a l e m b a n g . 2 0 0 8 . P r o f i l K e s e h a t a n k o t a P a l e m b a n g 2 0 0 8 . ( h t t p : / / w w w . d i n k e s . p a l e m b a n g . g o . i d / t a m p u n g / d o k u m e n / d o k u m e n - 2 3 - 2 1 . p d f d i a k s e s 1 5 N o v e m b e r 2 0 1 1 )

D i n a s K e s e h a t a n K o t a P a l e m b a n g . 2 0 0 9 . P r o f i t K e s e h a t a n k o t a P a l e m b a n g 2 0 0 9 . ( h t t p : / / w w w . d i n k e s . p a l e m b a n g . g o . i t i / t a m p u n g / d o k u m e n / d o k u m e n - 3 5 - 3 7 . p d f , d i a k s e s 1 5 N o v e m b e r 2 0 1 1 )

D i n a s K e s e h a t a n K o t a P a l e m b a n g . 2 0 1 0 . P r o f i l K e s e h a t a n k o t a P a l e m b a n g 2 0 1 0 . ( h t t p : / / w w w . d i n k e s . p a l e m b a n g . g o . i d / t a m p u n g / d o k u m e n / d o k u m e n - 5 6 - 5 7 . p d f . d i a k s e s 15 N o v e m b e r 2 0 1 1 )

D i n a s K e s e h a t a n S u m a t e r a S e l a t a n . 2 0 1 0 , P r o f i l K e s e h a t a n S u m a t e r a S e l a t a n 2 0 1 0 ,

D j a j a , S a r i m a w a r . 2 0 0 1 . P e n y a k i t p e n y e b a b k e m a t i a n B a y i B a r u L a h i r ( N e o n a t a l ) d a n s i s t e m p e l a y a n a n k e s a h a t a n y a n g b e r k a i t a n d i I n d o n e s i a . ( h t t p : / / d i g i l i b . l i t b a n g . d e p k e s . g o . i d / g o . p h p ? i d = i k p k b p p k - g d l - r e s - 2 0 0 3 -s a r i m a w a r - 8 8 1 - n e o n a t a l , d i a k s e s 1 7 N o v e m b e r 2 0 1 1 )

G r u s l i n , A . N i m r o d , C A . 2 0 0 7 . B i o l o g y o f N o r m a l a n d D e v i a n t F e t a l G r o w t h . C l i n i c a l O b s t e t r i c s t h e f e t u s & M o t h e r . C h a p t e r 1 4 ( 2 0 3 - 2 1 3 ) .

H i d a y a t i , M . H a d i , H . S u s i l o , J . 2 0 0 5 . K u r a n g E n e r g i K r o n i s D a n A n e m i a I b u H a m i l S e b a g a i F a k t o r R e s i k o K e j a d i a n B a y i B e r a t L a h i r R e n d a h D i K o t a M a t a r a m P r o p i n s i N u s a T e n g g a r a B a r a t . S a i n s K e s e h a t a n . 1 8 ( 4 8 3 - 4 9 1 ) .

K a s j o n o , S . 2 0 0 9 . T e k n i k S a m p l i n g P e n e l i t i a n K e d o k t e r a n . G r a h a I l m u . Y o g y a k a r t a .

K h a n . K S . D k k . 2 0 0 6 . W H O a n a l y s i s o f c a u s e s o f m a t e m a l d e a t h : a s y s t e m a t i c r e v i e w . L a n c e t . 3 6 7 : 1 0 6 6 - 1 0 7 4 ( h t t p : / / w w w , w h o , i n t / e n t i t y / r e p r o d u c t i v e h e a l t h / t o p i c s / m a t e m a l p e r i n a t a l / c a u s e s m a t e m a l d e a t h flyer.pdf, d i a k s e s 1 7 N o v e m b e r 2 0 1 1 ) .

K i n z l e r , W L . K a m i n s k y , L . 2 0 0 7 . F e t a l G r o w t h R e s t r i c t i o n a n d S u b s q u e n t P r e g n a n c y R i s k s . S e m i n a r i n P e r i n a t o l o g y . 3 1 ( 1 2 6 - 1 3 4 ) .

L i n , C . F o r g a s , J . 1 9 9 8 . C u r r e n t C o n c e p t o f F e t a l G r o w t h R e s t r i c t i o n . C a u s e , C l a s s i f i c a t i o n , a n d P a t h o p h i s i o l o g y . J o u r n a l O b s t e t r i c a n d G i n e c o l o g y . 9 2 ( 6 )

M a n u a b a . G B I . M a n u a b a . C A I . M a n u a b a . F G B I . 2 0 0 7 . P e n e a n t a r K u l i a h O b s t e t r i . E G C . J a k a r t a .

M i m s . M D . P r c h a l . J T . H e m a t o l o e v E J u r i n e P r e g n a n c y . W i l l i a m s H e m a t o l o g v . E d : 8 . 2 0 1 0

M i n i s t r y o f H e a l t h I n d o n e s i a 2 0 0 8 . I n d o n e s i a D e m o g r a p h i c a n d H e a l t h S u r v e y 2 0 0 7 ( w w w . m o t o r c v c l e o u t r e a c h . o r g / F R 2 1 8 A p r i l 0 9 2 0 0 9 . p d f . d i a k s e s 1 7 N o v e m b e r 2 0 1 1 )

P r a b u m u r t i , N S , P u m a m i , T C . W i d a g d o , L . S e t y o n o . S . 2 0 0 8 . A n a l i s i s F a k t o r R e s i k o S t a t u s K e m a t i a n N e o n a t a l . J u m a l P r o m o s i K e s e h a t a n I n d o n e s i a . 3 ( 1 ) : 1 -9

P r a w o r i h a d j o , S . 2 0 0 8 . P e m b a h a n A n a t o m i d a n F i s i o l o g i p a d a P e r e m p u a n H a m i l . D a l a m : S a i f u d d i n , B , A . I l m u K e b i d a n a n . B i n a P u s t a k a S a r w o n o P r a w o r i h a r d j o . J a k a r t a .

P r i y a d i , N , 2 0 0 8 . A n a l i s i s F a k t o r R e s i k o S t a t u s K e m a t i a n N e o n a t a l . S t u d i K a s u s K o n t r o l d i K e c a m a t a n L o s a r i K a b u p a t e n B r e b e s . J u m a l P r o m o s i K e s e h a t a n I n d o n e s i a ,

S a s t r o a s m o r o , S . I s m a e l , S . 2 0 0 7 . D a s a r - d a s a r M e t o d o l o g i P e n e l i t i a n K l i n i s . S a g u n g S e t o . J a k a r t a .

S t a l k e r , P . 2 0 0 8 . K i t a S u a r a k a n M D G s D e m i P e n c a p a i a n n y a d i I n d o n e s i a .

S t e e r , P J . 2 0 0 0 . M a t e m a l h e m o g l o b i n c o n c e n t r a t i o n a n d b i r t h w e i g h t . T h e A m e r i c a n J o u m a l o f C l i n i c a l N u t r i t i o n . 7 1 ( 1 2 8 5 S - 1 2 8 7 S ) .

V e r h o e f F , F H . B r a h i m , T J . C h i m a s u k u , 1. d k k . 2 0 0 1 . A n A n a l y s i s o f I n t r a - U t e r i n e G r o w t h R e t a r d a t i o n i n r u r a l M a l a w i . E u r o p e a n J o u m a l o f C l i n i c a l N u t r i t i o n . 5 5 ( 6 8 2 - 6 8 9 ) .

W o r l d H e a l t h O r g a n i z a t i o n . 2 0 0 5 . M a t e m a l a m d o e r i n a t a l h e a l t h . C a u s e ^ f m a t e m a l d e a t h . J/y A . ?

W o r l d H e a l t h O r g a n i z a t i o n . 2 0 0 8 . W o r l d w i d e p r e v a l e n c e o f a n a e m i a 1 9 9 3 - 2 0 0 5 .

W o r l d H e a l t h O r g a n i z a t i o n . 2 0 1 1 . W o r l d H e a l t h S t a t i s t i c : G l o b a l H e a l t h I n d i c a t o r , ( h t t p : / / w w w . w h o . i n t / e n t i t v / w h o s i s / w h o s t a t / E N W H S 2 0 U F u l l . p d f , d i a k s e s 1 7 N o v e m b e r 2 0 1 1 )

Lampiran

Status Anemia B B L R

Total % Status Anemia B B L R (+) % B B L R (-) %

Total %

Anemia (+) 1 6 5 3 . 3 3 4 1 3 . 3 3 20 33.33

Anemia (-) 1 4 4 6 . 6 7 2 6 8 6 . 6 7 40 66.67

Total 30 100 30 100 60 100

x =

x* =

x =

x =

n ( A D - B C ) ^ ( A + B ) ( C + D ) ( A + C ) ( B + C )

6 0 ( 1 6 . 2 6 - 4 . 1 4 ) 2 ( 1 6 + 4 ) ( 1 4 + 2 6 ) ( 1 6 + 1 4 ) ( 4 + 2 6 )

6 0 ( 1 6 . 2 6 - 4 . 1 4 ) 2 _ ( 1 6 + 4 ) ( 1 4 + 2 6 ) ( 1 6 + 1 4 ) ( 4 + 2 6 )

7 7 7 6 0 0 0

1 0 , 8

7 2 0 0 0 0

X 2 t a b e l ( d . f = l , p = 0 , 0 5 ) 3 , 8 4 1

O R =

O R =

ad b e

1 6 . 2 6 4 . 1 4

O R = 7 , 4 9 2

statistics

HBIBU BBBAYI HBKATEGORI KADARHB PARITAS UMUR

IBU Umur

Kategori N Valid 60 60 60 60 60 60 60

Missing 0 0 0 0 0 0 0 Mean ,33 2556.67 1,57 11.440 2,75 26,30 2,58 Median .00 2450.00 2,00 12.000 3.00 25,50 2,50 Mode 0 2000(3) 2 12,0 2 23(a) 2 Minimum 0 1500 0 6,4 2 20 1 Maximum 1 4000 2 15,0 4 35 4

a Multiple modes exist. The smallest value is shown

HBIBU

Frequency Percent Valid Percent Cumulative

Percent Valid Tidak Anemia 40 66,7 66,7 66.7

Anemia 20 33.3 33,3 100,0 Total 60 100.0 100.0

HBKATEGORI

Frequericv Percent Valid Percent Cumulative

Percent Valid Anemia Berat 6 10,0 10,0 10.0

Anemia Ringan/Sedang 14 23,3 23.3 33,3 Tidak Anemia 40 66,7 66,7 100,0 Total 60 100,0 100,0

PARITAS

Cumulative Frequency Percent Valid Percent Percent

Valid 2 26 43.3 43,3 43.3 3 23 38,3 38,3 81,7 4 11 18,3 18,3 100,0 Total 60 100,0 100.0

UmurKategori

Cumulative Frequency Pel cent Valid Percent Percent

Valid 15-20 3 5,0 5,0 5,0 21-25 27 45.0 45,0 50,0 26-30 22 36,7 36,7 86,7 31-35 8 13.3 13,3 100,0 Total 60 100.0 100.0

B B L R ' HBIBU Crosstabulation

HBIBU T n t a l

Tidak Anemia Anemia T n t a l

BBLR Tidak BBLR Count 26 4 30 % within HBIBU 65,0% 20,0% 50,0%

BBLR Count 14 16 30 % within HBIBU 35.0% 80.0% 50,0%

Total Count 40 20 60 % within HBIBU 100.0% 100,0% 100.0%

Chi-Square Tests

Value df Asymp. Sig.

(2-sided) Exact Sig. (2-slded)

Exact Sig. (1-sided)

Pearson Chi-Square 10.a00(b) 1 ,001 Continuity Correction(a) 9,075 1 .003 Likelihood Ratio 11,366 1 .001 Fisher's Exact Test ,002 ,001 Linear-by-Linear

10,620 ,001 Association 10,620 1 ,001

N of Valid Cases 60 a Computed only for a 2x2 table b 0 cells (,0%) have expected count less than 5. The minimum expected count Is 10,00.

Risk Estimate

Value 95% Confidence Interval

Lower Upper Lower Odds Ratio for BBLR (Tidak BBLR / BBLR) 7,429 2 , 0 7 8 26,S53

For cohort HBIBU = Tidak Anemia 1.857 1,236 2.791

For cohort HBIBU = Anemia .250 .095 ,661

N of Valid Cases 60

BBLR * HBKATEGORI Crosstabulation

HBKATEGORI Total Total Anemia

Anemia Berat Ringan/Sedang Tidak Anemia BBLR Tidak BBLR Count 1 3 26 30

% within HBKATEGORI 16.7% 21,4% 65.0% 50.0% BBLR Count 5 11 14 30

% within HBKATEGORI 83.3% 78.6% 35.0% 50,0% Total Count 6 14 40 60

% within HBKATEGORI 100.0% 100.0% 100,0% 100,0%

Variables In the Equation

B df Sig. Exp(B) 95,0% C.I. for EXP(B) Lower Upper Lower Upper Lower Upper

Step 1(a)

HBKATEGORI 2 .009 HBKATEGORI(I) 2,228 1 .05? 9.286 .985 87,502 HBKATEG0RI(2) 1.918 1 .009 6,810 1,626 28,524 Constant ,619 1 ,062 ,538

a Variable(s) entered on step 1: HBKATEGORI.

KEMENTERIAN KESEHATAN DIREKTORAT JENDERAL BINA UPAYA KESEHATAN

RSUP. Dr. MOHAMMAD HOESIN PALEMBANG f^^Ml• .lalan .Underal Sudirman Kilonulfr 3,5 Palembang 3(H2h

Telepon (0711) 354-088 Kaksimile : (0711) 351-318 Surat KIcklronik : rsmhplg fl yahoo.coni

2 2 F e b r u a r i 2 0 1 2

S U R A T K E T E R A N G A N N o m o r ; L B . 0 2 0 3 / 1 1 1 .3 /o^r - / 2 0 1 2

Y a n g b e r t a n d a t a n g a n d i b a w a h i n i , K e p a l a B a g i a n P e n d i d i k a n d a n P e n e l i t i a n R u m a h S a k i t U m u m P u s a t D r . M o h a m m a d H o e s i n P a l e m b a n g m e n e r a n g k a n b a h w a :

Nama NIM Institusi

Fadyl Zuhry Lubis 70 2008 004 FK Universitas Muhammadiyah Palembang

T e l a h m e n y e l e s a i k a n p e n e l i t i a n d a l a m r a n g k a p e n y u s u n a n S k n p s i d e n g a n j u d u l "Hubungan Anemia Dalam Kehamilan Dengan Angka Kejadian Berat Bayi Lahir Rendah di Rumah Sakit Mohammad Hoesin Palembang" d a r i t a n g g a l 0 6 F e b r u a r i s . d 1 3 F e b r u a r i 2 0 1 2 d e n g a n BAIK

be m l k i a n l a h S u r a t K e t e r a n g a n i n i a g a r d a p a t d i p e r g u n a k a n s e b a g a t m a n a m e s t i n y a .

K a B a g . P e n d i d i k a n & P e n e l i t i a n , K a S u b B a g i a n P e n e l i t i a n

T a L f f i ^ S ^ s . , M K e s N I P 1 9 6 1 0 1 2 1 1 9 8 6 0 3 1 0 0 5

1

BIODATA

N a m a

T e m p a t / T g l . L a h i r

A l a m a l

T e l p / H p

E m a i l

F a d h y l Z u h r y L u b i s

G e n t i n g S a g a , 0 2 M e i 1 9 9 0

J l . P e r i n d u s t r i a n 1. B l o k C . N o . 1 2 , S u k a r a m e , P a l e m b a n g .

0 8 1 9 9 4 9 0 3 5 9 0

f a d h i l _ l u b i s @ y a h o o -CO . i d

N a m a O r a n g T u a

A y a h : R u s d a n Z a i n i L u b i s S . H , M . H

I b u : B a y u T r i s n a w a t i

J i u n l a h S a u d a r a

A n a k K e

R i w a y a t P e n d i d i k a n

2

1

S D N e g e r i N o . 1 K e b u n J e r u k , J a k a r t a t a h u n 1 9 9 6 - 2 0 0 2

S M P N e g e r i 5 E n t r o p , J a y a p u r a t a h u n 2 0 0 2 - 2 0 0 5

S M A N e g e r i 1 0 P a l e m b a n g t a h u n 2 0 0 5 - 2 0 0 8

P e n d i d i k a n D o k t e r U m u m U M P t a h u n 2 0 0 8 -

J -

P a l e m b a n g , 2 M a r e t 2 0 1 2

( F a d h y l Z u h r y L u b i s )