Apa sih 4T itu?
Yang dimaksud dengan Hindari 4T adalah : Terlalu Muda, Terlalu Tua, Terlalu Dekat, Terlalu Banyak. Terlalu Muda misalnya Ibu hamil pertama usia kurang dari 21 Tahun secara fisik kondisi rahim dan panggul belum berkembang secara optimal. Terlalu Tua misalnya ibu hamil pertama pada usia kurang lebih 35 Tahun dapat menyebabkan kematian pada ibu dan bayinya.Terlalu Dekat yang dimaksud disini jarak antara kehamilan pertama dengan berikutnya kurang dari 2 Tahun yang menyebabkan dapat menghambat proses persalinan seperti gangguan kekuatan kontraksi, kelainan letak, dan posisi janin. Terlalu Banyak Anak misalnya ibu pernah hamil dan melahirkan lebih dari 2 kali yang menyebabkan dapat menghambat proses persalinan, seperti gangguan kontraksi, kelainan letak dan posisi janin, perdarahan pasca persalinan.
Ini Resiko 4T!
1. Terlalu Muda
Terlalu Muda (Primi Muda) adalah ibu hamil pertama pada usia kurang dari 20 tahun. Dimana kondisi panggul belum berkembang secara optimal dan kondisi mental yang belum siap menghadapi kehamilan dan menjalankan peran sebagai ibu.
Resiko yang dapat terjadi pada kehamilan terlalu muda (primi muda) adalah :
😰Bayi lahir belum cukup bulan
😰Perdarahan dapat terjadi sebelum bayi lahir
😰Perdarahan dapat terjadi setelah bayi lahir
Alasan yang perlu diketahui adalah :
Secara fisik kondisi rahim dan panggul belun berkembang secara optimal, mengakibatkan kesakitan dan kematian bagi ibu dan bayinya. Pertumbuhan dan perkembangan fisik ibu terhenti/terhambat. Secara mental tidak siap menghadapi perubahan yang akan terjadi pada saat kehamilan.
Terlalu muda (Hamil Usia <20 tahun). Kehamilan terlalu muda beresiko bagi ibu dan juga bagi janinnya. Resiko bagi ibu antara lain adalah perdarahan pada saat melahirkan antara lain disebabkan karena otot rahim yang terlalu lemah dalam proses involusi. Lebih mudah untuk mengalami abortus, kelahiran prematur, eklampsia/preeklamsia dan persalinan yang lama. Kemungkinan yang bisa dialami oleh janin yaitu lahir prematur, BBLR (Berat Badan Lahir Rendah) berat saat lahir < 2500 gram) dan cacat janin.
Dampak Kehamilan Resiko Tinggi pada Usia Muda.
Keguguran
Keguguran pada usia muda dapat terjadi secara tidak disengaja. misalnya : karena terkejut, cemas, stres. Tetapi ada juga keguguran yang sengaja dilakukan oleh tenaga non profesional sehingga dapat menimbulkan akibat efek samping yang serius seperti tingginya angka kematian dan infeksi alat reproduksi yang pada akhirnya dapat menimbulkan kemandulan.
Persalinan prematur
Berat badan lahir rendah (BBLR) dan kelainan bawaan. Prematuritas terjadi karena kurang matangnya alat reproduksi, terutama rahim yang belum siap dalam suatu proses kehamilan, berat badan lahir rendah (BBLR) juga dipengaruhi gizi saat hamil kurang dan juga umur ibu yang belum menginjak 20 tahun. Cacat bawaan dipengaruhi kurangnya pengetahuan ibu tentang kehamilan, pengetahuan akan asupan gizi rendah, pemeriksaan kehamilan kurang, keadaan psikologi ibu kurang stabil. Selain itu cacat bawaan juga di sebabkan karena keturunan (genetik) proses pengguguran sendiri yang gagal, seperti dengan minum obat-obatan (gynecosit sytotec) atau dengan loncat-loncat dan memijat perutnya sendiri.
Anemia kehamilan
Penyebab anemia pada saat hamil di usia muda disebabkan kurang pengetahuan akan pentingnya gizi pada saat hamil di usia muda. Karena pada saat hamil mayoritas seorang ibu mengalami anemia. Tambahan zat besi dalam tubuh fungsinya untuk meningkatkan jumlah sel darah merah, membentuk sel darah merah janin dan plasenta. Lama kelamaan seorang yang kehilangan sel darah merah akan menjadi anemis.
Keracunan Kehamilan (Gestosis)
Kombinasi keadaan alat reproduksi yang belum siap hamil dan anemia makin meningkatkan terjadinya keracunan hamil dalam bentuk pre-eklampsia atau eklampsia. Pre-eklampsia dan eklampsia memerlukan perhatian serius karena dapat menyebabkan kematian.
Kematian ibu yang tinggi
Kematian ibu pada saat melahirkan banyak disebabkan karena perdarahan dan infeksi. Selain itu angka kematian ibu disebabkan karena pengguguran kandungan yang cukup tinggi kebanyakan hal ini dilakukan oleh tenaga non profesional (dukun).
2. Terlalu Tua
Terlalu Tua (Primi Tua) adalah ibu hamil pertama pada usia ≥ 35 tahun. Pada usia ini organ kandungan menua, jalan lahir tambah kaku, ada kemungkinan besar ibu hamil mendapat anak cacat, terjadi persalinan macet dan perdarahan.
Resiko yang dapat terjadi pada kehamilan terlalu tua(primi tua ≥ 35 tahun) adalah :
😮 Hipertensi/tekanan darah tinggi
😮 Pre-eklamspsia
😮 Ketuban pecah dini: yaitu ketuban pecah sebelum persalinan dimulai
😮 Persalinan macet: ibu yang mengejan lebih dari 1 jam, bayi tidak dapat lahir dengan tenaga ibu sendiri melalui jalan lahir biasa.
😮 Perdarahan setelah bayi lahir
😮 Bayi lahir dengan berat badan lahir rendah/BBLR < 2500gr
Meningkatnya komplikasi medis dan persalian
Terlalu Tua (Hamil Usia > 35 tahun) Umur ibu juga mempengaruhi kapasitas tropiknya, sehingga pada ibu dengan umur lebih tua cenderung mempunyai bayi yang berat badannya lebih rendah. Pada umur 35 tahun atau lebih, kesehatan ibu sudah menurun, akibatnya ibu hamil pada usia itu mempunyai kemungkinan lebih besar untuk mempunyai anak cacat, persalinan lama dan perdarahan. Selain itu, hal yang paling dikhawatirkan jika usia ibu diatas 35 tahun ialah kualitas sel telur yang dihasilkan juga tidak baik. Ibu yang hamil pada usia ini punya resiko 4 kali lipat dibanding sebelum usia 35 tahun
Dampak Kehamilan Resiko Tinggi Pada Usia Tua
Risiko kehamilan yang mungkin terjadi saat terjadi kehamilan usia ibu mencapai 40 tahun atau lebih. Terdapat risiko pada ibu dan risiko pada bayi. Sel telur itu kan sudah ada di dalam organ reproduksi sejak wanita dilahirkan. Namun, setiap bulan sel telur itu dilepaskan satu per satu karena sudah matang. Berarti, sel telur yang tersimpan selama hampir 40 tahun ini usianya juga sudah cukup tua. Karena, selama itu sel telur mungkin terkena paparan radiasi. Di usia ini, wanita akan lebih sulit mendapatkan keturunan karena tingkat kesuburan yang sudah menurun.
1) Resiko Pada Bayi
Kehamilan di atas usia 40 itu berisiko melahirkan bayi yang cacat. Kecacatan yang paling umum adalah down syndrome (kelemahan motorik, IQ rendah) atau bisa juga cacat fisik. Adanya kelainan kromosom dipercaya sebagai risiko kehamilan di usia 40 tahun. Pertambahan usia dapat menyebabkan terjadinya kelainan terutama pada pembelahan kromosom. Pembelahan kromosom abnormal menyebabkan adanya peristiwa gagal berpisah yang menimbulkan kelainan pada individu yang dilahirkan. Terjadinya kelahiran anak dengan sindroma down, kembar siam, autism sering disangkut pautkan dengan masalah kelainan kromosom yang diakibatkan oleh usia ibu yang sudah terlalu tua untuk hamil. Akan tetapi hal inipun masih berada di dalam penelitian lanjut mengenai kebenarannya.
2) Risiko pada ibu.
Memasuki usia 35, wanita sudah harus berhati-hati ketika hamil karena kesehatan reproduksi wanita pada usia ini menurun. Kondisi ini akan makin menurun ketika memasuki usia 40 tahun. Risiko makin bertambah karena pada usia 40 tahun, penyakit-penyakit degeneratif (seperti tekanan darah tinggi, diabetes) mulai muncul. Selain bisa menyebabkan kematian pada ibu, bayi yang dilahirkan juga bisa cacat. Kehamilan di usia ini sangat rentan terhadap kemungkinan komplikasi seperti placenta previa, pre-eklampsia, dan diabetes. Risiko keguguran juga akan meningkat hingga 50 persen saat wanita menginjak usia 42 tahun. Terjadi perdarahan dan penyulit kelahiran. Elastisitas jaringan akan berkurang seiring dengan bertambahnya usia. Di usia semakin lanjut, maka sering terjadi penipisan dinding pembuluh darah meskipun kasus tidak terlalu banyak dijumpai, namun masalah pada kualitas dinding pembuluh darah khususnya yang terdapat di dinding rahim, dengan adanya pembesaran ruang rahim akibat adanya pertumbuhan janin dapat menyebabkan perdarahan
3. Terlalu Dekat Jarak Kehamilan
Terlalu Dekat Jarak Kehamilan adalah jarak antara kehamilan satu dengan berikutnya kurang dari 2 tahun (24 bulan). Kondisi rahim ibu belum pulih, waktu ibu untuk menyusui dan merawat bayi kurang. Resiko yang mungkin terjadi pada kehamilan jarak dekat adalah Keguguran, Anemia, Bayi lahir belum waktunya, Berat badan lahir rendah (BBLR), Cacat bawaan, Tidak optimalnya tumbuh kembang balita, Alasan yang perlu diketahui adalah, Kondisi rahim ibu belum pulih, Dapat mengakibatkan terjadinya penyulit dalam kehamilan, Waktu ibu untuk menyusui dan merawat bayi kurang.
Menjaga jarak antara kehamilan memiliki beberapa tujuan, di antaranya adalah:
Memberikan waktu istirahat untuk mengembalikan otot-otot tubuhnya seperti semula. Untuk memulihkan organ kewanitaan wanita setelah melahirkan. Rahim wanita setelah melahirkan, beratnya menjadi 2 kali lipat dari sebelum hamil. Untuk mengembalikannya ke berat semula membutuhkan waktu sedikitnya 3 bulan, itu pun dengan kelahiran normal. Untuk kelahiran dengan cara caecar membutuhkan waktu lebih lama lagi.
Menyiapkan kondisi psikologis ibu yang mengalami trauma pasca melahirkan karena rasa sakit saat melahirkan atau saat dijahit. Ini membutuhkan waktu yang cukup lama untuk membuat wanita siap lagi untuk hamil dan melahirkan.
Bagi wanita dengan riwayat melahirkan secara caecar, bayi lahir cacat, pre eklamsia, dianjurkan untuk memberi jarak antar kehamilan yang cukup. Karena mereka memiliki resiko lebih besar dari pada wanita dengan riwayat kelahiran normal dan supaya bayi yang sudah lahir mendapatkan ASI eksklusif dari ibunya.
4. Terlalu Banyak Anak
Terlalu Banyak Anak (Grande Multi) adalah ibu pernah hamil atau melahirkan lebih dari 4 kali atau lebih. Kemungkinan akan di temui kesehatan yang terganggu, kekendoran pada dinding perut, tampak pada ibu dengan perut yang menggantung.
Resiko yang dapat terjadi pada kehamilan terlalu banyak anak (4 kali melahirkan) adalah
🙅 Kelainan letak, persalinan letak lintang
🙅 Robekan rahim pada kelainan letak lintang
🙅 Persalinan lama
🙅 Perdarahan pasca persalinan
Dampak Terlalu Sering Dan Terlalu banyak Melahirkan
Memiliki banyak anak kini kurang diminati para orangtua dengan alasan biaya hidup dan pendidikan yang semakin mahal. Di luar masalah finansial sebenarnya melahirkan terlalu sering beresiko buruk bagi kesehatan ibu dan bayi. “Makin sering hamil, makin buruk dampaknya bagi kesehatan karena meningkatkan risiko kematian ibu”. Menurut Darney, wanita yang melahirkan anak lima orang atau lebih memiliki risiko kehamilan bermasalah. Salah satu komplikasi yang mungkin dialami adalah perdarahan saat persalinan.
Di Indonesia sendiri, saat ini perdarahan masih menjadi penyebab utama kematian ibu saat melahirkan. Rahim, organ tempat janin berkembang, terdiri dari jaringan otot. Kehamilan yang terlalu rapat akan mengendurkan otot-otot tersebut sehingga setelah persalinan rahim menjadi sulit berkontraksi untuk kembali ke ukurannya yang semula dan terjadilah perdarahan. Obat-obatan biasanya kurang berhasil mengatasinya. Risiko placenta previa dan plasenta akreta meningkat. Placenta previa adalah kelainan letak plasenta yang seharusnya di atas rahim malah di bawah, sehingga menutupi jalan lahir. Meningkatnya intervensi dalam persalinan seperti pemasangan infus atau induksi (rangsangan) agar tanda persalinan muncul. Induksi bisa dilakukan dengan pemberian obat-obatan atau memecahkan kantung ketuban. Usia ibu yang terlalu tua juga menyebabkan risiko kecacatan janin, komplikasi pada ibu (preeklampsia atau diabetes gestasional). Risiko bayi dilahirkan prematur akibat jaringan parut dari kehamilan sebelumnya bisa menyebabkan masalah pada plasenta bayi.
Slogan “Banyak Anak Banyak Rejeki” saat ini sudah mulai ditinggalkan oleh keluarga modern. Alasan utama tentu adalah semakin meningkatnya biaya hidup dan pendidikan. Namun apabila dikaji menurut ilmu kesehatan, para ilmuwan menyebutkan bahwa ternyata banyak anak juga bisa memperpendek usia khususnya pada wanita.
Mencegah dan penanganan 4 Terlalu
👌 Pelayanan KB berkualitas pasca persalinan, pasca keguguran,pelayanan KB berkualitas pasca persalinan, pasca keguguran.
👌 Meningkatkan partisifasi aktif dan pemanfaatan kerjasama lintas program dan sektor antara lain dengan jalan menjalin kemitraan dengan pemda, organisasi profesi.
👌 Sosialisasi dan advokasi melalui penyusunan hasil informasi cakupan program dan data informasi tentang masalah yang dihadapi.
Manfaat yang akan diperoleh dalam menghindari 4 Terlalu
👍 Bagi kehamilan yang akan terjadi adalah kehamilan yang diinginkan, maka proses kehamilan dan persalinan dapat dilalui dengan aman dan sehat.
👍 Ibu akan mempunyai kesehatan reproduksi yang prima dan memiliki waktu yang cukup untuk merawat diri dan keluarga.
👍 Anak akan tumbuh dan berkembang dengan optimal, sehat, cerdas, dan mempunyai peluang mendapatkan pendidikan yang lebih baik.
👍 Keluarga mempunyai peluang untuk meningkatkan kemandirian dalam mengembangkan kesejahteraan.
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