Asuhan Kebidanan Continuity of Care (COC) pada Ny. F G2P1A0 Umur 32 Tahun dengan Plasenta Letak Rendah di Desa Candiroto

Abstract

Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) remain important indicators in assessing the level of public health in Indonesia. The main causes of maternal mortality include hemorrhage, hypertensive disorders in pregnancy, and infection, while infant mortality is commonly caused by prematurity, low birth weight (LBW), asphyxia, and neonatal infections. One of the pregnancy complications that may cause bleeding is low-lying placenta, which can lead to antepartum hemorrhage, preterm delivery, and complications in both mother and baby. Efforts to reduce MMR and IMR can be carried out through the implementation of Continuity of Care (CoC) midwifery services from pregnancy, childbirth, postpartum, newborn and neonatal care, to family planning services. The purpose of this case study was to implement comprehensive midwifery care for Mrs. F, a 32-year-old G2P1A0 woman with a low-lying placenta in the working area of Candiroto Public Health Center. The method used was a case study with a Continuity of Care approach. The subject of the study was one pregnant woman who was followed from the third trimester of pregnancy through childbirth, postpartum period, newborn/neonatal care, and family planning services. Data were collected through anamnesis, observation, physical examination, supporting examinations, maternal and child health book documentation, and SOAP documentation. The study was conducted from November 8, 2025 to March 19, 2026. The results showed that during pregnancy, the patient experienced complications of low-lying placenta accompanied by recurrent antepartum hemorrhage, requiring referral and collaboration with an obstetrician and gynecologist. Delivery was conducted at 34 weeks and 4 days of gestation due to low-lying placenta with recurrent antepartum hemorrhage. The baby was born prematurely with a birth weight of 2,200 grams and experienced mild asphyxia; however, the baby's condition improved after initial management and continuous monitoring. Postpartum care was carried out through four visits, with the mother remaining in good condition without complications. Newborn and neonatal care showed that the baby’s growth and adaptation progressed well. Family planning services were provided through the selection of contraceptive implants according to the mother’s condition and needs. In conclusion, the implementation of Continuity of Care was effective in supporting early detection of complications, continuous monitoring of maternal and neonatal conditions, and improving the quality of midwifery care through appropriate collaboration and referral. Furthermore, the implementation of comprehensive midwifery care in this case was in accordance with theory and midwifery care standards.

Abstrak

Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB) masih menjadi indikator penting dalam menilai derajat kesehatan masyarakat di Indonesia. Penyebab utama AKI meliputi perdarahan, hipertensi dalam kehamilan, dan infeksi, sedangkan AKB banyak disebabkan oleh prematuritas, Berat Badan Lahir Rendah (BBLR), asfiksia, dan infeksi neonatal. Salah satu komplikasi kehamilan yang berisiko menyebabkan perdarahan adalah plasenta letak rendah yang dapat menimbulkan perdarahan antepartum, persalinan prematur, hingga komplikasi pada ibu dan bayi. Upaya penurunan AKI dan AKB dapat dilakukan melalui penerapan asuhan kebidanan berkelanjutan atau Continuity of Care (CoC) mulai dari masa kehamilan, persalinan, nifas, bayi baru lahir, neonatus, hingga pelayanan keluarga berencana. Tujuan studi kasus ini adalah melaksanakan asuhan kebidanan komprehensif pada Ny. F usia 32 tahun G2P1A0 dengan plasenta letak rendah di wilayah kerja Puskesmas Candiroto. Metode yang digunakan adalah studi kasus dengan pendekatan Continuity of Care. Subjek penelitian adalah satu ibu hamil yang diikuti mulai masa kehamilan trimester III, persalinan, nifas, bayi baru lahir/neonatus, hingga pelayanan keluarga berencana. Pengumpulan data dilakukan melalui anamnesis, observasi, pemeriksaan fisik, pemeriksaan penunjang, studi dokumentasi buku KIA, dan pendokumentasian SOAP. Penelitian dilaksanakan pada tanggal 8 November 2025 sampai 19 Maret 2026. Hasil asuhan menunjukkan bahwa pada masa kehamilan ditemukan komplikasi plasenta letak rendah disertai perdarahan antepartum berulang sehingga dilakukan rujukan dan kolaborasi dengan dokter spesialis obstetri dan ginekologi. Persalinan dilakukan pada usia kehamilan 34 minggu 4 hari dengan indikasi plasenta letak rendah disertai perdarahan antepartum berulang. Bayi lahir prematur dengan berat badan lahir 2.200 gram dan mengalami asfiksia ringan, namun kondisi bayi membaik setelah dilakukan penanganan awal dan pemantauan berkelanjutan. Asuhan nifas dilakukan sebanyak 4 kali kunjungan dengan hasil kondisi ibu dalam keadaan baik tanpa komplikasi. Asuhan bayi baru lahir dan neonatus menunjukkan pertumbuhan dan adaptasi bayi berjalan baik. Pelayanan keluarga berencana dilakukan dengan pemilihan KB implan sesuai kondisi dan kebutuhan ibu. Kesimpulan dari studi kasus ini menunjukkan bahwa penerapan Continuity of Care efektif dalam membantu deteksi dini komplikasi, pemantauan kondisi ibu dan bayi secara berkelanjutan, serta meningkatkan kualitas pelayanan kebidanan melalui kolaborasi dan rujukan yang tepat. Selain itu, pelaksanaan asuhan kebidanan komprehensif pada kasus ini telah sesuai dengan teori dan standar pelayanan kebidanan.