240 http://jurnal.fk.unand.ac.

id 

3A 
Research Article 
High Risk Pregnancy Detection of Integrated ANC Services at 
Bendo Health Center, Kediri 
Wahyu Nuraisya 
Abstract Abstract 
Efforts to reduce maternal mortality in Indonesia include 
integrated antenatal care given to pregnant women regularly during pregnancy. Health services 
for pregnant women cannot be separated from delivery services, postpartum services and health services for 
newborns 
. Every pregnancy has the risk of experiencing complications or complications. The purpose of this study was to 
detect the high risk of pregnancy in integrated Ante Natal Care (ANC) services. This type of research is across- 
prospectivesectional study of the population of pregnant women who have integrated ANC at Bendo Health Center. 
The study was conducted in August 2015. The subjects were all populations. Collection of observation data 
using the Puji Rochyati Score Card (KSPR) and documentation studies of ANC examination results, laboratories and 
general examinations. The results obtained 51 respondents consisting of the majority of respondents (63%) 
experiencing high-risk pregnancies (score 6-10) and a small percentage (37%) at low risk (scores 2-6), most 
(67%) experienced complications and a small percentage (33%) is normal. Most (80%) complications are found at the 
time ofANC 
integratedand a small proportion (20%) of cases are old. Findings of pregnancy problems in most (55%)cases 
obstetric, 25% medical cases and 20% including both. High risk detection is important in integrated ANC.detection 
High riskmust be carried out synergistically with a series of examinations to detect problems or diseases. 
Good intervention can help pregnant women in labor. 
Key words: high risk detection, integrated ANC 
Abstract 
There are many ways to decrease the Maternal Mortality Rate (MMR) in Indonesia. One of the efforts made 
antenatal care (ANC) integrated on a regular basis during pregnancy. The service quality affects the health of 
antenatal and fetal, maternal and newborn and postpartum mothers. Detection of high-risk 
pregnancy is at risk of experiencing complications. The objective of this study was to detect high-risk 
pregnancy in integrated ANC services. This was a cross sectional prospective study on 
Bendo Kediri Health Center regency on August, 2015. The research sample was taken by total sampling. The 
collection of data through observation with Puji Rochyati Score Card and the documentation study from results 
ANC examination, laboratory and medical. Data were analyzed with descriptive analysis. The results of the 51 
respondents obtained most (63%) had high-risk pregnancies (score 6-10) and a small portion (37%), low risk (score 
2- 
6), most (67%) encountered a problem and the small proportion (33%) is normal, a condition that troubles the 
majority 
(80%) of the newly discovered ANC and a small portion (20%) of cases, the findings of aproblem are 
pregnancylarge (55%) cases of obstetric, 25% of medical cases and 20% both. Importantdetection of high risks 
remain 
in integrated ANC. Detection of high risk is carried out synergy with a series of checks on mother as a 
detection problem or disease. The equal intervention will help women in labor. 
Keywords: high risk detection, integrated ANC 
Author affiliation: D3 Midwifery Study Program STIKES Husada Kediri Work Correspondence: 
w.nuraisya@gmail.com Tel: 081332849265 
Andalas Health Journal. 2018; 7 (2) 
 
INTRODUCTION 
Maternal Mortality Rate (MMR) is still 
a serious problem in Indonesia. AKI in Indonesia 
ranks highest in ASEAN, which is 307 per 
100,000 live births, meaning that more than 18,000 mothers 
each year or two mothers per hour die from causes 
related to pregnancy, childbirth, and 
childbirth. Efforts to reduce MMR focused on 
the direct causes of maternal mortality that occurred 90% 
at the time of delivery and immediately after labor, 
namely bleeding 28%, eclampsia 24%, infection 11%, 
complications of purperium 8%, congestion 5%, abortion 
5%, obstetric trauma 5 %, 3% emboli and others. 
1 
East Java ranks fifth in 
all provinces in Indonesia with the highest number 
of maternal deaths after West JavaJava 
, Central, NTT and Banten (IDHS, 2012). TheOffice 
Provincial Healthsaid that maternal deaths 
increased in number to 474 
cases from 450 cases in 2012. Kediri District was 
one of the contributors to AKI in East Java at 
17 in 2013. The recorded maternal deaths were 
pre-eclampsia and eclampsai 32.4%, 
bleeding 8.1%, 5.4% sepsis or infection,labor 
2.7% long duration ofand others 51.4%. 
2 The 
mortality and morbidity of pregnant andwomen is 
maternitystill a big andproblem 
growing. The first time in 1987 at the 
international level was a conference ondeaths 
maternalin Nairobu, Kenya. In 1994 anheld 
International Conference on Population And 
Development (ICPD) wasin Cairo Egypt, which stated 
that male andreproductive health needs 
femalewere vital for socialand the 
developmentdevelopment of Human Resources (HR). 
Health services are expressed as an 
integral part of basic services that will be affordable 
to the community. It includesservices 
maternal healththat strive so that every pregnant woman 
can go through pregnancy and childbirth 
safely. 
3 
The efforts of the Ministry of Health in an effort to 
accelerate the reduction of MMR basically 
refer to the strategic intervention of the "FourPillars 
Safe Motherhood. The Family Planning Program 
241 journals.fk.unand.ac.id 
as the first pillar has been considered successful, but 
to support efforts to accelerate the reduction of 
MMR, it is necessary to sharpen the target so that the incidence of "4 
too" and unwanted pregnancies can be 
reduced as low as possible . Access to antenatal services 
as the second pillar is quite good, namely 87% in 1997; 
but the quality still needs to be improved. 
Safe delivery in terms of the third pillar which is 
categorized as childbirth assistance by 
health workers. The coverage ofobstetric services 
essentialas the fourth pillar. 
4 
Pregnancy involves physical and 
emotional changes from the mother and social changes in the 
family. In general, pregnancy develops 
normally and results in the birth of ahealthy baby 
termthrough the birth canal but sometimes it is 
not as expected. It is difficult to know 
beforehand that pregnancy will be a problem. 
Antenatal care / care is an important way 
to monitor and support the health ofpregnant women 
normaland detect mothers withpregnancies 
normal. 
5 
Pregnancy is a physiological process, 
but a normal pregnancy can turn into 
pathological / abnormal. The risk of pregnancy is dynamic, 
because a normal pregnant woman suddenly can 
be at high risk. A high-risk pregnancy 
according to Poedji Rochjati is a pregnancy with 
one or more risk factors, both from the mother's side 
and the fetus that has an adverse effect on 
both the mother and the fetus, 
has a risk of emergency but not emergency. 
6 
Various efforts to reduce maternal 
mortality include among others the 
integrated antenatal services provided to pregnant women 
at regular intervals during pregnancy. Health 
services for pregnant women cannot be separated 
from delivery services, postpartumand 
serviceshealth services for newborns. The quality 
of integrated antenatal care provided will 
affect the health of pregnant women and their fetuses, 
maternity and newborns and postpartum mothers. 
7 
Integrated antenatal services guide 
health professionals to ensure that the pregnancy is 
normal, able to detect problems withearly 
the Andalas Health Journal. 2018; 7 (2) 
 
and diseases experienced by pregnant women, 
intervening adequately so that pregnant women are ready 
to undergo normal labor. 
7 
Every pregnancy, in its development 
has the risk of experiencing complications or complications. 
Antenatal care must be done routinely, 
according to standards and integrated forantenatal care 
quality. Antenatal care is very 
necessary for every pregnant woman because the condition of pregnant women 
influences the continuity of pregnancy and 
fetal growth in the womb. To 
overcome the problems mentioned above, 
antenatal services in publichealth facilities 
and privateand individual / group practices 
need to be carried out comprehensively and integratedly. 
Promotive, preventive, as well as curative andefforts 
rehabilitative, which include MCH services, nutrition, 
control of infectious diseases (immunization, HIV / AIDS, 
TB, Malaria, sexually transmitted diseases), treatment 
of chronic diseases and several other local and 
specific programs according to the needs of the program . 
8 
Most of these deaths can be prevented 
through antenatal care that is able to detect 
and deal with high-risk cases adequately, 
clean and safe delivery assistance, and 
midwifery / perinatal referral services that are 
affordable when needed. 
9 
Complications are largely preventable, if the 
health of pregnant women is always maintained through 
regular antenatal examinations andassistance 
clean and safein Healthy Indonesia 2010 is 
targeted to decrease MMR and IMR. One 
way is to improve the quality and maintain 
continuity of maternal andhealth services 
perinatalat the basic service level andservices 
primary referral, can be done by 
developing the concept of Maternal-Perinatal Audit 
(AMP). 
10 
The importance of Ante Natal Care (ANC) is integrated 
in the examination of pregnant women are expected to 
do the appropriate minimum standard of antenatal care 
are carried out continuously and 
242 http://jurnal.fk.unand.ac.id 
thorough so as to detect and 
deal with high risk to the mother pregnant. 
Based on the above phenomenon, it is necessary to study 
"High Risk Pregnancy Detection ofServices 
Integrated ANCat Bendo Health Center in 
Kediri District" 
METHODS 
This study is a descriptive study that 
describes the detection of high risk pregnancies in 
integrated ANC services at Bendo 
Pare District, Kediri District. 
The target population of this study were all pregnant 
women who received integrated ANC services. 
Affordable population is all pregnant women who 
get integrated ANC services in the 
Bendo Community Health Center, Pare District, Kediri Regency 
in August 2015. 
Samples were taken by accidental 
sampling, namely pregnant women who met thecriteria 
inclusion; pregnant women who are willing to be studied andcriteria 
exclusion; incomplete medical record data 
The variables in this study consisted of avariable 
single, namely detection of high risk pregnancy in 
integrated ANC services. This research was conducted 
on 9 and 23 August 2015 atHealth Center, 
BendoPare District, Kediri Regency. 
Collecting observational data using 
the Score Card Puji Rochyati (KSPR) and study 
documentation of ANC examination results, laboratories 
and general examinations. 
RESULTS 
Table 1. Distribution of respondents based on maternal age 
Code Age Number Percentage 
1 ≤ 16 years 0 0 
2 17-34th 31 87% 
3 ≥35 years 14 13% 
51 
Age of mothers during pregnancy most (87%) ofage 
productivebut still found a small percentage 
who are at risk of ≥ 35 years old. 
Andalas Health Journal. 2018; 7 (2) 
 
Table 2. Distribution of respondents based on 
Gravida Gravida Code Number of Percentages 
1 Primigravida 23 43% 
2 Multigravida 28 57% 
51 100% 
Respondents in this study were mostly 
multigravida who showed 
experience in previous pregnancies 
Table 3. Distribution of respondents by age 
pregnancy 
Pregnancy Age Code Amount Percentage 
1 TM I 4 10% 
2 TM 2 20 33% 
3 TM 3 27 57% 
51 100% 
In Table 3 the gestational age of the respondents 
in this study was mostly in the third trimester of more 
than 28 weeks. 
Table 4. Distribution of respondents based on the results of the 
examination of 
the Results Code Number Percentage 
1 Normal 20 33% 
2 Problem 31 67% 
51 100% 
The results of examinations in pregnant women when ANC was 
integrated both pregnancy examinations, laboratories 
and doctors showed that most respondents 
found problems in pregnancy. 
Table 5. Distribution of respondents based on time of 
discovery 
Code Type of Findings Amount Percentage 
1 New 36 80% 
2 Duration 15 20% 
51 100% 
Problems in pregnancy found at the time 
of this integrated ANC showed that most of 
the cases were newly discovered. 
243 http://jurnal.fk.unand.ac.id 
Table 6. Distribution of respondents by type of 
findings 
Code Type of Findings Amount Percentage 
1 Obstetrics 22 55% 
2 Medical 15 25% 
3 Both of them 14 20% 
51 100% 
If viewed from the type of findings on the 
condition of pregnant women when the integrated ANC shows 
most of the conditions of the respondents arefindings 
obstetric. 
Table 7. Distribution of respondents based on scores Praise 
Rochyati 
Pregnancy Risk Code Total percentage 
1 low risk 22 37% 
2 high risk 29 63% 
3 very high risk 0 0% 
51 100% 
Screening conducted on pregnant women at 
integrated ANC at Bendo District Health Center 
Kediri from 51 respondents using the 
Puji Rochyati scorecard showed that most of them 
were in the high risk pregnancy category. 
DISCUSSION 
The results of research on high risk detection 
in pregnant women in pregnant women atANC 
integratedin Bendo Health Center, Kediri Regency from 
12 and 26 August 2015 to 30 
respondents using KSPR showed that 
most of them were in thepregnancy category 
high risk. This proves how important 
a pregnancy is to early detection of the risk of 
pregnancy. A pregnancy can always 
cause the possibility of a lowrisk 
or highthat will result in complications 
during labor and childbirth so the risk ofoccurs 
death. The existence of high risk early detection 
makes it easy to plan for 
pregnancy and childbirth according to the level of risk 
experienced. 
Andalas Health Journal. 2018; 7 (2) 
 
Detection of high risk of pregnancy as an effort to 
discover the high risk of pregnant women by 
considering the risk factors 
for prenatal care. High risk detection is 
carried out as an effort to prevent the 
possibility of morbidity or death through 
increasing the effectiveness and efficiency of 
more intensive services to the risk of pregnant women 
quickly and quickly, so that the condition of the mother and 
baby can be prevented. 
11 
Health services for pregnant womennot 
canbe separated from delivery, 
servicespostpartum services and health services for newborns 
. The quality of antenatal care affects the 
health of pregnant women and the fetus, maternity and newborns 
and postpartum mothers. Integrated ANC services are 
able to detect early problems and diseases 
experienced by pregnant women and intervene 
adequately so that pregnant women are ready to undergo 
normal labor. 
11 
Pregnancy checks on integrated ANC 
include various types of examinations including assessing 
the general (physical) and psychological (psychological) condition of 
pregnant women. Handling and follow-up cases 
based on the results of history, physical andexaminations and 
laboratorydoctor's diagnosis. Midwives can 
recognize normal conditions and problematic conditions 
in pregnant women by conducting early detection of the risk of 
pregnancy by using KSPR. 
12 The 
implementation of integrated ANC in this study 
showed that most (67%) found 
problems during pregnancy and the type ofproblems 
pregnancyfound showed that most 
(55%) were obstetric problems, anumber 
smallof medical problems (25%) and the rest were a 
combination of obstetric problems and medical. 
The discovery of pregnancy problems at the integrated ANC was 
mostly found (80%) at the time of the 
examination while the rest were problems 
that had been discovered during theANC examination 
previous. This shows that integrated ANC is 
the right step for pregnant women to 
detect problems during pregnancy in order to be able to 
prevent complications during labor. 
244 http://jurnal.fk.unand.ac.id 
Research shows the closeness of the relationship 
between pregnancy conditions and labor complications. 
A pregnancy that experiences complications 
has a risk of labor complications 
of 3.2 times. The risk of labor complications 
based on the place of residence of pregnant women shows that 
rural areas have a risk of 2 times. 
13 
The results of the Senewel and Sulistyowati study 
further strengthen the results of this study that 
early detection of the risk of pregnancy is anway 
effectiveto prevent complications during 
labor. Pregnancy is considered risky if there are 
medical conditions that can affect the health 
and life of the mother or fetus and both.ANC 
Integratedis very important givenhealth workers 
tofor pregnant women because it is not only able to 
detect early risks of pregnancy, but also 
detect problems experienced by pregnant women who 
can interfere with pregnancy socan be carried out 
that prompt and appropriate interventionsin an effort to 
minimize pregnancy complications and prevent 
labor complications. 
14 
integrated ANCs are important to be carried out to 
detect problems in the mother's pregnancy. 
The results of the research in Kudus District regarding the 
implementation of early detection of pregnancy comorbidities 
in antenatal services showed that early detection 
of comorbidities by midwives in village health centers 
(puskesdes) was not optimal because it was related toresources 
humanand laboratory examination facilities. 
This shows how important the implementation of 
integrated ANC for pregnant women is carried out by 
puskesmas that havehuman resources and 
more adequatelaboratory facilities so that they 
can detect problems in maternal pregnancy. 
15 
Every pregnant woman needs supervision during 
pregnancy considering that each pregnancy has a risk 
even though it shows acondition at the beginning of pregnancy 
normal. This shows that supervision during 
pregnancy and early detection is very important 
for health workers to plan follow- 
up to minimize risks to the mother or 
fetus. 
16 
Andalas Health Journal. 2018; 7 (2) 
 
CONCLUSION 
The results of the integrated ANC examination show 
most pregnancies with problems and 
a small proportion of normal pregnancies. Whileproblems 
pregnancyshow mostproblems 
obstetric, a small portion of medical problems and the rest are 
both. 
SUGGESTIONS The 
integrated ANC implementation will touch more on the 
target of pregnant women if done not only 
statically in Bendo Health Center as thehealth center 
main, but also on mobile to all 
village health posts (poskesdes) ormaternity 
villageposts (Polindes) Bendo Health Center work area 
due to consideration distance and time. 
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