2. SPECIFIC DATA Table 2 Distribution of the frequency of

COMPARISON OF NEW BORN MORBIDITY BETWEEN PERVAGINAM BREECH LABOR AND SECTIO CAESAREA WITH GLUTEAL PRESENTATION Morbidity Comparison Between The Newborn And Sectio Breech Deliveries Pervagina Caesarea Breech Linda Andri Mustofa Prodi D IV Bidan Pendidik STIKES Karya Husada Kediri E-mail: fardenmuktigmail.com ABSTRACT Labor with breech is a challenge in the management of obstetric and is associated with perinatal morbidity and mortality . This study aims to determine differences in maternal and perinatal morbidity between delivery and sectio caesarea pervagina with breech .The study design was observational comparative approach . The variable in this study is in labor pervagina infant morbidity and section caesarea breech . The research was conducted on August 8 to August 23, 2014 at Amelia Pare Hospital . 30 population breech babies born vaginally and 53 babies were born with a breech presentation section caesarea 2010 to 2014, with a total sample techniques . Data were analyzed using T test Test with a confidence level of 95 α = 0.05 . Results of the analysis showed that the vaginal delivery , 1 infant 3.3 had severe asphyxia , 12 infants 40 moderate and 17 infants 56.7 severe asphyxia . Conversely babies born with Sectio Caesarea , none suffered severe asphyxia , 10 infants 18.9 mild asphyxia and 43 infants 81.1 mild asphyxia . T test with a confidence level of 95 was obtained count value is smaller than alfa 0:02 , which means that there are differences in morbidity among infants born vaginally and sectiocaesarea breech . Labor with breech presentation at risk for both mother and baby , with the greatest risk to the fetus is hypoxia , caused by pinching the cord between the head and pelvis when the head enters the pelvic cavity . Keywords : neonatal morbidity , vaginal breech deliveries , sectiocaesarea . INTRODUCTION A breech deliveries WITH AN hearts management challenges associated WITH obstetrics and perinatal morbidity and mortality . There was a breech presentation Approximately 3 Up to 4 of all deliveries .Optimal method for having a baby with breech presentation into a very controversial issue and a major question in the field of midwifery . Breech delivery at term vaginal cause of perinatal mortality and morbidity rates between 1 and 2 . Perinatal morbidity and mortality in breech delivery reached nine times higher than spontaneous vertex delivery . Incidence of trauma and hypoxia damage is particularly high in small premature infants under 1.5 kg and the large baby over 3.5 kg Paul MF, Cawford, 2005: 184:312-3. The study acknowledges that there is a slightly greater risk of neonatal with 997 labor pervagina types of delivery options to be considered and chosen before birth , and should consider the health condition of the mother and the fetus and medical requirements that apply. Most of the pregnant women at the antenatal check the midwife , so the midwife should be able to help the mother to help pregnant women to plan and make choices labor. To be able to assist pregnant women with breech birth plan and choose the type of delivery , midwives should know the advantages and disadvantages and the fulfillment of requirements to deliver pervagina or SC to consider the risk of morbidity and maternal and perinatal mortality . LITERATURE REVIEW Breech presentation Diagnosis Breech is a longitudinal layout with the head of the fetus in the uterine fundus . The incidence is 3 to 4 , but had fetal morbidity and mortality rates are high. Diagnosi breech is generally not difficult . Titegakkan diagnosis by anamnesis, palpation, examination, X-ray examination, scanning and Ultra Sono Tomographic USG . Etiology Breech Presentation Location of the fetus in the uterus depends on the process of adaptation of the indoor fetus in the uterus . In pregnancy until approximately 32 weeks , the amount of water relative needs more , allowing the fetus to move freely . Thus the fetus can put yourself in a cephalic presentation , breech or transverse layout . In pregnancy the last quarter of the fetus is growing rapidly and the amount of water needs relatively reduced because the buttocks with both legs folded bigger than the head of the buttocks are forced to occupy a greater space in the fundus , while the head is in a smaller space in the lower uterine segment. In the months of pregnancy is not enough breech higher frequency while at term pregnancy the fetus is mostly found in the presentation of the head. Other factors that play a role in the breech of which is multparitas , twin pregnancy , hidramnion, hidrosepalus, plasenta previa and a narrow pelvis . Sometimes breech caused by abnormalities of the uterus and uterine deformities . Placenta is located in the cornu fundus can also cause breech because the placenta reduce the size of the rooms in the area of the fundus . Labor mechanism with Breech Presentation Buttocks into the pelvic cavity with a line transverse or oblique groin . After touching the pelvic floor occurs in the rotary axis so that at the bottom of the the second leg . After the pivot swivel breech birth occurs outside the fetal abdomen was in posterior shoulder through the door that allows the pelvis to the largest line of shoulder transverse or oblique . Axis rotation occurs in the shoulder , so that the shoulders are under simpisis front and rear shoulder passes perineum . At the time of the head into the pelvis with transverse or oblique sagittal suture . Occur in the pelvic cavity in the head rotation axis , so that the face memutas to posterior and occiput towards simpisis. By suboksiput as hipomoklion the chin , mouth , nose and the entire head was born in succession pass through the perineum . There is a real difference between the birth of the fetus in cephalic presentation and the fetus was born breech. At the presentation were born head first is part of the largest fetus so that the head has been born birth weight is not a member of difficulty. In contrast to the breech respectively - were born part of the increasingly great starts from the birth of the buttocks, shoulders, and then the head . Labor with Breech Presentation Case for section caesarea planned in breech presentation has been reviewed on a large scale by Brke and direkomondasikan on American college of Obstetricians and Gynecologists. TBT using designs randomissed control trial to compare the safety section caesarea breech deliveries pure planned pervagina . Two thousand women were recruited from 121 centers in 26 countries . The study concluded siding premature in 1999. Combined autcame peinatal and neonatal mortality and serious neonatal morbidity with exclude neonatal disorders were significantly lower in the planned sectiocaesarea than vaginal delivery group 1.6 versus 5.0 , mrelative risk [ RR ] 0.33 and statistically no difference in maternal mortality and serious morbidity pelvis line occupies thigh pelvic significantly between the two groups. Kind anteroposterior diameter and front trochanter is under simpisis. Then came the lateral flexion of the body of the fetus , so the trochanter back past the perineum and was born around the buttocks , followed by 998 of labor with breech presentation is one of the big questions in obstetrics that have been broken by the international community obstetric through randomized controlled trials to answer questions about what kind of delivery is best for fetuses with breech presentation Research shows that a planned cesarean delivery safer for labor with breech . Even based on the data monitoring committee , the results of this research for a while is because the final results of the study were able to answer questions that have been posed. But then the results are considered to be convincing has been controversial . Criticism of researchers to continue again . Some researchers even referred to has attracted rekomondasi . In an article written by Charlotte L Deans and Zoe Penn in The Obstetricians and Gynaecologist journal publish more data about labor rviw pervagina the breech . Large studies conducted by PREMODA study group was Trial , assessment of the fetal heart rate 100 in PREMODA and 33.4 on TBT and duration of the second stage more than 60 minutes 0 , 2 on PREMODA and 5.0 on TBT . They do not realize that these things affect the risk of neonatal slightly larger in vaginal deliveries . Other researchers have also published research showing ourcame comparable results in a smaller population . Irion and colleagues compared 385 with a vaginal delivery of breech presentation at birth section 320 caesarea planned and have fewer maternal complications in childbirth pervagina group and no neonatal morbidity corrected. Dublin alarab and colleagues published data on 641 deliveries . Caesarea planned delivery section 343 and 298 published in 2007. The study was deliveries pervaginal trial in which 146 conducted at a maternity unit at 800 women in France and Belgium with desaian prospective study , comparing breech deliveries pervagina with secsio caesarea planned. Researchers said the study conducted in France in 2001 until 2002. The vaginal delivery of breech presentation made in accordance with the standards and are routinely offered to women in accordance with rigorous criteria based on the guidelines set by the Collège National des Gynécologues et Obstétriciens Français CNGOF include the size of a normal pelvis , no hyperextension of the fetal head as determined by ultrasound , the estimated fetal weight between 2500 to 3800 grams , perfect breech presentation , examination electrically continuous fetal heart rate monitoring fetal wellbeing during labor informed consent pada ibu. Pada kelompok ibu yang direncanakan persalinan pervaginam 71 sukses dan skor apgar kurang dari 4, tidak ada perbedaan outcame yang berbeda diantara dua kelompok dan hanya satu neonatal yang meninggal, itupun pada kelompok section caesarea. Researchers commented on the difference between the critical management of their population with a study population Term Breech Trial TBT . For example the use of pelvimetry 82.4 in PREMODA and 9.8 in the Term Breech 999 successfully. Reusable stringent selection criteria that allow for a vaginal delivery . They reported only two neonates born vaginally with Apgar score of 7 to 5 minutes . Both have normal neurology at 6 weeks and no deaths perinata and no trauma or neurological disorder significantly in both groups. Deans CL, Penn Z. The case for and against vaginal breech delivery. The Obstetrician Gynaecologist 2008;10:139 –144. Prognosis delivery with breech delivery The infant mortality rate in the high lebith breech deliveries when dibandiangkan with the location of the head . Naidoo Hospital in Semarang , Medan Priyadi general Hospital and the Hospital Hasan Sadikin obtained perinatal mortality rate respectively 38.5 , 29.4 and 16.8 . Eastman Reporting perinatal mortality rates between 12 to 14 . The most important cause of perinatal mortality is prematurity and handling sempuarna with less labor due to hypoxia or bleeding inside the skull . While hypoxia caused by pinching the cord between the head and pelvis when the head enters the pelvic cavity and due to retraction of the uterus that can cause the release of the placenta before birth head . Birth head Janian longer than 8 minutes after birth umbilicus will cause fetal life . In addition bilajanin nose and mouth breathing before birth can be dangerous because inhaled mucus can clog the airways . The danger of fetal asphyxia caused by cord menumbung , it is often 4 5 6 7 8 Amount 1 1 10 13 4 30 3.3 3.3 33.3 43.3 13.3 100 found in breech perfect legs or buttocks legs are not perfect teeapi rare for breech presentation . Injury to the fetal head occurs because the head must pass through the pelvis in a shorter time than the delivery head presentation , sihingga no time for kepaa to adjust to the shape and size of the pelvis. The above table shows that the breech vaginal delivery , Apgar score of babies born have low Apgar score Apgar score of 3 and higher only 8. Most babies born in vaginal deliveries had Apgar score of 6 number of 10 infants 33.3 7 number 13 infants 43.3 . Compression and decompression head happen quickly intervening , so Easily cause injury to the head and bleeding in the 2. Frequency Distribution Apgar scores at five minutes breech vaginal delivery . skull . When Obtained disproportion cepalopelvic , Although light in a breech delivery is very dangerous. Compression and decompression head intervention occurs quickly , so easily cause head injury and bleeding in the skull. When Getting a disproportion cepalopelvic , Though light in a breech delivery is very dangerous. APGAR Skor 5 6 7 8 9 Amount Amount 2 9 11 8 30 Percentage 6.6 30.0 36.7 26.7 100 Multiparity with good obstetric history does not always guarantee delivery in breech would be smooth because the fetus is large can cause pelvic disproportion despite normal size . METHOD Research Design Research design is comparatif study with observasional approach. In contrast to babies born with vaginal delivery , breech babies are born with caesarea section has a first -minute Apgar score better , ie low Apgar score 5 higher than the lowest Apgar score of babies born vaginally . Apgar scores are also higher at highest 9 . Samples that meet the inclusion criteria were 30 infants with breech presentation who are born vaginally and 53 infants with breech presentation who are born with 3. Frequency Distribution APGAR Score First Minute on Labor Sectio Caesarea With Presentation Buttocks . section caesarea in Amelia Pare Hospital in 2010 until 2014 . APGAR Skor 5 Amount 2 Percentage 3.8 RESULTS AND DISCUSSION 1. Frequency Distribution First Minute APGAR scores at vaginal delivery Buttocks With Presentation 6 8 15.1 7 20 37.7 8 23 43.4 Amount 53 100 In the fifth minute Apgar score APGAR Skor 3 Amount 1 Percentage 3.3 increased with the presentation breech babies born vaginally . Proven in Table 4.3 can be seen that in the fifth minute Apgar score is a minimum of five and the number 1000 of babies who have Apgar score of 7 increased to 20 infants 37.7 and Apgar score of 8 to 23 infants 43.4 . contrast to babies born by section caesarea has Apgar scores 8 number of 11 infants 36.7 and Apgar score of 9 number 8 infants 26.7 . 4. Frequency Distribution minute Apgar score five on Labor Sectio Caesarea With Gluteal Presentation. The highest Apgar score was also higher APGAR scores are 9 while the highest babies born vaginally is 8. Most breech babies born vaginally had Apgar APGAR Skor 5 6 7 Amount 2 9 Percentage 30.0 score 7 some 13 babies 43.3 in contrast to babies born by section caesarea has Apgar scores 8 number of 11 infants 36.7 and Apgar score of 9 number 8 infants 26.7 8 9 Jumlah 11 8 30 36.7 26.7 100 6. Comparison of Five Minute APGAR Scores In Vaginal Delivery And Sectio Caesarea With Gluteal Presentation. In the fifth minute Apgar score Vaginal delivery Childbirth Sectio increased infant born with breech presentation dengna section caesarea . AS ∑ ∑ Caesarea Sig 2- Proven in Table 4.4 can be seen that in the tailed fifth minute Apgar score maximum 9 number 8 infants 26.7 5 6 2 8.7 0.00 5. Comparison Minute APGAR Score 7 9 30.0 3 5.7 Fist In Vaginal Delivery And Sectio Caesarea With Gluteal Presentation Vaginal delivery Childbirth Sectio Caesarea 8 9 11 8 30 36.7 26.7 100 16 34 53 30.2 64.2 100 AS ∑ ∑ Sig 2- tailed DISCUSSION 3 4 5 6 7 8 9 1 1 1 10 13 4 30 3.3 3.3 3.3 33.3 43.3 13.3 100 2 9 11 8 53 30.0 36.7 26.7 100 0.02 Based on statistical test obtained by value calculated on the difference in scores Apgar in the first minute 0:02 and in the fifth minute 0:00 smaller with alpha 0.005 , which means there are significant differences between the scores APGAR in babies born vaginally and sectiocaesarea and also means there are differences in morbidity where the vaginal delivery , morbidity is higher . From the results of statistical tests In contrast to babies born with vaginal delivery , breech babies are born with caesarea section has a first -minute Apgar score better , ie low Apgar score 5 higher than the lowest Apgar score of babies born vaginally who have low Apgar scores 3 . The highest Apgar score was also higher APGAR scores are 9 while the highest babies born vaginally is 8. Most breech babies born vaginally had Apgar score 7 some 13 babies 43.3 in 1001 proved that breech babies born vaginally had a higher mrbiditas compared with breech babies are born with section caesarea. Birth attendants entirely obstetrics and gynecology specialist doctors so aid delivery has been done well, as evidenced by vaginal delivery output, only 1 infant 3.3 who were born vaginally suffered severe asphyxia in the first minute of his birth, and none of the infants who died. However, there are still 12 infants 40 had moderate asphyxia and 17 babies have 56.67 and no one baby was born without asphyxia or normal. Lack of good labor output can be caused by many things one of which refers delay, delay decisions and may be due to predictions of proportionate size and fetal pelvis performed with simple measurements without using pelvimetry. The results showed similar results to the study conducted by the Term Breech Trial TBT is a large multicenter study International randomized controlled trial to determine whether the planned labor SC safer than childbirth pervagina planned in fetuses with breech. The study involved 2,088 women from 121 centers in 26 pervagina and costs epidural higher and the cost of neonatal intermediate and intensive care for mothers and infants in group deliveries pervagina planned Henderson J , Stavros P , 2010: 174 8 : 1118 to 1119 . In contrast to the results of research , in some countries abroad , based on the results of the study showed no difference in morbidity or asphyxia among infants born vaginally or sectiocaesarea . The success of breech vaginal delivery due to meticulous screening by using sophisticated equipment and careful preparation for labor , one of them with the readiness funds to support the smooth delivery is the delivery process . Studies on the population of Europe countries. Participants were randomly also concluded advantage for neonates in selected, both the SC labor groups planned or in groups pervagina planned deliveries. Data were obtained from 2083 women. Of the 1041 women included in the group SC planned, 941 90.4 correctly - it gave birth to the SC and from 1042 women were included in the group of labor pervagina, 591 56.7 gave birth pervagina Palencia R, Gafni A, Hannah ME, Ross S, Willan AR, Et all 2010: 38: 490-8. Study Term Breech Trial TBT which was published in 2000 reported that there is a combination autcame perinatal mortality or neonatal morbidity and neonatal serious to exclude abnormalities konginetal was significantly lower in the group SC planned than in the group of labor pervagina planned 17 1039 [1.6] v. 521039 [5.0], relative risk [RR] 0.33, 95 confidence interval [CI] 0:19 to 0:56, and statistically there was no significant difference in maternal morbidity and mortality are serious between SC group planned and labor groups pervagina planned 411041 [3.9] v. 331042 [3.2], relative risk [RR] 1:24, 95 confidence interval [CI] 0.79-1.95 Iddekinge BV 2007: 9: 171-6 TBT also provide economic evaluation showing that lower costs at planned SC group than in the group pervagina planned deliveries 7,165 versus 8,042 [ Canadian ] . These costs are primarily related to the cost of hospital and doctors fees for childbirth 1002 breech deliveries with SC . Selection of the population in the breech presentation has been done with great care to examine the results of the planned delivery pervagina compared to SC planned. A large study published in 2006 with a prospective study of 8000 women in the maternity unit in France and Belgium , comparing labor pervagina and SC , said that during the study period of 2001 to 2002 in France , labor pervagina with breech implemented in standard and offered routinely in women according to rigorous selection criteria in accordance with the guidelines required by the Collège National des Gynécologues et Obstétriciens Français CNGOF . In women with childbirth pervagina planned , 71 success not only of the Apgar score in the first 5 minutes of less than 4 , there was no difference in individual autcome different in both groups. Only one non malformations and neonatal death occurs in the SC group . The author commented on the criticism of Management of the different between their population with a population of at BTM , as an example of the use pelvimetry 82.4 versus 9.8 in the Term Breech Trial , fetal heart rate monitoring 100 versus 33.4 and the period at 60 minutes of the second 0.2 versus 5.0 . The study acknowledges that there is a slightly greater risk of neonatal pervagina with labor , but not as it was concluded by the authors of TBT . At willing in France conducted a rigorous selection and management guidelines to minimize the risk . The author also published a study comparing autcome the smaller population . Irion and friends - friends in Switzerland compare pervagina planned 385 deliveries with the planned 320 SC maternal complications were smaller at birth pervagina smaller and there was no difference in neonatal morbidity . Iddekinge BV , 200 : 171-6 . In Dublin , Alaran and friends - friends publish data from 641 deliveries , deliveries SC 343 planned and 298 deliveries pervagina planned , where 146 of pervagina successful delivery . Conducted a rigorous selection on research pervagina delivery . Reported only two neonates born pervagina have 7 Apgar score at 5 minutes and no anomalies perinatal deaths or cases of trauma and neurological dysfunction significantly in both groups . In this study nulliparous women were significantly less in group deliveries pervagina than multiparous women Deans CL , Penn , 2008: 139-44 Autcome data available from long- term neonates born with birth pervagina is encouraging and BTM comes from the author , who has published a subgroup analysis in 2004. This suggests that the prevalence of death or abnormal neurodevelopment in two years did not differ between the groups and labor pervagina Caesarean section is supported by the publication of data from a population smaller than the more dominant BTM came from developing countries , where the ante- natal screening and counseling be applied CL Deans , Penn , 2008 : 139-44 . Another implication of the implementation of planning policy SC for all deliveries with breech , will have a negative impact , namely the reduction in the number of practitioners with the skills and experience to help pervagina with breech deliveries . Although he has made a policy , but undiagnosed breech will happen . Some of these women will choose breech deliveries pervagina and some women might bring them to the doctors due date to give birth to the SC. 1003 Drycott and friends - colleagues show that emergency obstetric training can reduce perinatal autcame on delivery to the location of the head. So training breech deliveries may be required as the ancient art . Improved SC in the future and vaginal birth after caesarea VBAC that can not be predicted , can be made a policy for the selection of antenatal safe to predict whether a pregnant woman can give birth to breech pervagina Deans CL , Penn , 2008: 139-44 Education and preparation for childbirth including potential complications and treatment is . anatenatal important part of the service . handling is HCWs should be professional to the patients choice to give birth pervagina or SC . The officer must explain the importance of the effect of birth SC planned against maternal and neonatal autcome , subsequent pregnancy outcomes and patient acceptance of choice SC. When counseling about labor SC, we must remember that childbirth SC at risk . Based on studies comparing SC repeats VBAC labor , we must anticipate the ultimate choice of women for childbirth SC which is planned to heighten the incidence of maternal morbidity , including bleeding , infection and venous thromboembolism . Maternal mortality which occurred in the State - developed countries , 2 to 3 times higher in SC planned labor than labor pervagina although no large studies of the risk of maternal mortality in childbirth SC planned. Lawrence M , Leeman MD . Plante LA 2006 : 265-8 , Murphy DJ , Pope C , Frost J , Liebling RE , 2003 : 1-5 .With ultrasound , the estimated fetal weight between 2500 to 3800 grams , perfect breech presentation , examination electrically continuous fetal heart rate monitoring fetal wellbeing during labor informed consent of the mother . In the group of women who planned vaginal delivery and a 71 success Apgar score of less than 4 , there is no difference outcame different between the two groups and only one neonatal death , and even then the group section caesarea . In Indonesia the problems that often arise in the selection of the type of delivery is the lack of readiness in planning delivery. Failing to detect abnormalities Jakarta: Badan Pusat Statistik; layout , ketidaktauan the public about the risks of labor with breech presentation , and economic problems causing people prefer to choose a vaginal delivery without considering the risks to mother and baby . Midwives should improve the ability to perform prenatal care and early referral of pregnant women planning on adengan abnormalities breech . Midwives should not be attending births with breech presentation , but the midwife as those closest to the public should be able to help mothers and their families to understand the condition of the mother and planning deliveries with communication , information and education . SUGGESTION The midwife must assist pregnant women to plan labor in accordance with the 2008. BKKBN. Indonesia. Buku panduan praktis pelayanan kontrasepsi. Edisi ke-2. Jakarta BKKBN; 2006 Chapman V, Ester M. Asuhan kebidanan persalinan dan kelahiran. Jakarta: EGC; 2006. Departemen kesehatan. Indonesia. Menuju persalinan yang aman dan selamat agar ibu sehat bayi sehat. Jakarta: Departemen kesehatan Indonesia; 2009. Departemen kesehatan. Indonesia. Pedoman program perencanaan persalinan dan pencegahan komplikasi dengan stiker. Jakarta: Departemen kesehatan Indonesia; 2009. Henderson J, Stavros P. The economic case for planned cesarean section for conditions of the mother and the risk factors breech presentation at term. so that labor can run smoothly and complications can be prevented with good planning . With a breech pregnancy is a pregnancy with a very high risk and should give birth in hospital There are 2 types of labor with breech that can be chosen by the mother , which pervagina labor and breech deliveries . Choice of type of delivery should be considered and chosen before birth , and should consider the health National perinatal epidemiology. [serial online]. 2006. [diunduh tanggal 19 Juli 2010];1748:1118- 1119. Tersedia dari URL: http:www.cmaj.cacgireprint174 81118 Deans CL, Penn Z. Review the case for and against vaginal breech delivery. Obstetgynaecol. [serial online]. 2008. [diunduh tanggal 19 Juli condition of the mother and the fetus and 2010];10:139-44. Tersedia dari medical requirements that apply Vaginal delivery with a breech presentation is done according to standard and routinely offered to women who fit the criteria are strictly based on the guidelines set by the Collège National des Gynécologues et Obstétriciens Français CNGOF includes the size of a normal pelvis , no hyperextension of the head of the fetus is determined by ultrasound , fetal weight estimates between 2500 to 3800 grams , perfect breech presentation , examination electrically continuous fetal heart rate monitoring fetal wellbeing during labor informed consent of the mother . URL: http:onlinetog.orgcgireprint103 139 Iddekinge BV. Risk management planned vaginal breech delivery :should this be the mode of choice?. Obstetgynaecol. [serial online]. 2007. [diunduh tanggal 19 Juli 2010];9:171-6. Tersedia dari URL http:onlinetog.orgcgireprint93 171 Lawrence M, Leeman MD. Plante LA. Patient-choice vaginal delivery?. Obstetginaecol. [serial online]. 2006. 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Jakarta : Salemba Medika Martaadisoebrata D, Sastrawinata RS, Saifuddin AB. Bunga rampai obstetri dan ginekologi sosial: Perkembangan obstetri dan ginekologi sosial. Jakarta: yayasan bina pustaka Sarwono Prawirohardjo; 2005. h. 20. Mc Donald. Obstetri Williams. Jakarta: EGC. 1997. Manuaba. Pengantar Kuliah Obstetri. Jakarta: EGC. 2007 Paul MF, Cawford. Use of external abdominal ice to complete external cephalic version in term breech pregnancy. Obstetgynecol. [serial online]. 2005. [diunduh tanggal 19 Juli 2010]:184:312-3. Tersedia dari URL: http:www.jabfm.orgcgireprint18 4312 Palencia R, Gafni A, Hannah ME, Ross S, Willan AR. Et all. The costs of planned cesarean versus planned vaginal birth in the term breech trial. [serial online]. 2006. [diunduh tanggal 19 Juli 2010];1748.[11 scrib]. Tersedia dari URL: http:www.cmaj.cacgireprint174 81109 Pasupathy D, Wood AM, Pell JP, Fleming M, Smith GCS. Time trend in the risk of delivery related perinatal and neonatal death associated with breech presentation at term. Epidemiology. [serial online]. 2008. [diunduh tanggal 19 Juli 2010];38:490-8. Tersedia dari URL: http:ije.oxfordjournals.org 1005 ABSTRACT RISK SCREENING OF PRE-ECLAMPSIA AND ECLAMPSIA IN PREGNANT WOMEN IN PUSKESMAS PLOSO KLATEN REGENCY KEDIRI Siti Asiyah Advance Midwifery Study Program STIKES Karya Husada Kediri Email: aninkamilagmail.com Pre-eclampsia in Indonesia was the second leading cause of maternal mortality, while in East Java was the first cause of death. From year to year pre-eclampsia cases continue to rise, these conditions require preventive measures in order to reduce morbidity and mortality due to pre-eclampsia. The research objective was to screen potential risk pregnant women to pre-eclampsia. This type of research descriptive with operational research approach, the entire population was pregnant women in Puskesmas Ploso Klaten number of 170 pregnant women, total sampling technique sampling which met the inclusion criteria a number of 117 respondents. Data collection tools such as interview guides, tension meter, measuring weight and height. The experiment was conducted in June and July 2015. The data analysis of frequency distribution percentages. From interviews obtained 45 pregnant women 38.46 there was a risk factor to develop pre-eclampsia, and 52.63 are factors that primigravida pregnancy status. From the results of the examination showed 57 48.7 positive 1, 20 17.1 positive 2 and 6 5.1 positive 3. Allegedly immunologic factors contribute to the onset of hypertension in pregnancy was proven by the fact primigravida have a greater risk of hypertension in pregnancy when compared multigravida. Whereas, of the value ROT, MAP and IMB means that 48.7 has the potential for pre-eclampsia occurs less than 50. 17.1 has the potential to occur pre-eclampsia by 50 and 6 5.1 had the potential to occur 75 of pre-eclampsia. Keywords: Screening, pregnant women, the risk of pre-eclampsia PRELIMINARY The cause of death of women giving birth in Indonesia is divided into two, namely the direct cause of death and cause of death indirectly. The first death is the largest cause of highest. Diagnosis Preeclampsia is set at least two symptoms of the triad of preeclampsia preeclampsia is the increase in overweight marked edema, bleeding 34, both preeclampsia and proteuria, high blood pressure, eclampsia was 18, an indirect cause of 18, 11 other direct causes, embolism 1, 10 abortion, sepsis 8. Sulistiono A, 2013. While the maternal mortality rate in East Java pre-eclampsia and eclampsia 34.88, bleeding 25.09, 26.98 other causes, heart 8.08, 4.98 infesi Maternal Mortality Report IFI and the District se Municipality of East Java in 2012. Based on these data we can conclude the maternal mortality rate due to pre eclampsia and eclampsia are still very high in Indonesia, especially in East Java causes of maternal mortality are 1011 because it is pregnant supervision is very important because the cause of death is quite high, especially in developing countries Manuaba, I; 2003. Based on observations of researchers has been applied in the field is limited to detecting the case, then in case of pre-eclampsia is done handling. Cases of preeclampsia may actually be predicted from the beginning before pregnant women develop preeclampsia and can diperkirakanan there is likely to occur with preeclampsia along with the amount of risk, namely with Mananyakan previous history and risk factors of pregnant women as well as perform a physical examination that sederhanan such as blood pressure and weight measurements. With predicted time of the research was not in place, or have been diagnosed with pre-eclampsia. In this study, the sampling techniques used in a way without random non-random from the beginning about the risk of sampling. Retrieval technique pre-eclampsia can be carried out preventive measures so as not to place pre-eclampsia. The positive impact kedepanya could lower the maternal mortality rate due to a case of pre-eclampsia. METHODS This type of research is descriptive or explanatory research ecplanatory research with the approach of operational research, being used is total sampling. Ie the sampling is done by taking the overall research subject who met the inclusion criteria.Sadangkan sample in this research were 117 pregnant women. Manual data collection tools such as interviews to multiply medical history and risk factors, as well as the tension meter airaksa to check blood pressure, weight scales that have because this research is to been re-calibrated and height implement the process of antenatal care in screening the risk of pre-eclampsia, to do an interview and blood pressure check and counting IMB pregnant women, resulting uotput pregnant women have a risk of pre-eclampsia terdeksi Hidayat A, 2010. The variable in this study is a single gauges. Data were collected in two ways interview and examination of blood pressure, weight and height. RESULTS Results interview Risk factors for pre-eclampsia Table 1 Distribution Frequency Pre-eclampsia risk variable, as it only aims to find the big picture case, without No. Risk factors preeclampsia for Frequency performing analytical tests. The variables in this study are the risk factors and clinical symptoms of pre-eclampsia risk. The population

1. 2.

No risk There are R isk amount 72 45 117 61.53 38.46 100 in this study were all pregnant women who are in the working area of Puskesmas Plosoklaten totaling 170 people from four villages namely distance 66, Village Klanderan 16 Kawedusan Village 43, Village Gondang 45 people. Inclusion criteria were common characteristics of research subjects in the target population and the population to be studied affordable. Nurasalam, 2010 criteria for inclusion in this study were pregnant women who were in the area, Willing respondents, more than 20 weeks gestational age. The exclusion criteria is to eliminate or exclude subjects who meet the inclusion criteria for various reasons. Nursalam 2010 The exclusion criteria in this study were At the 1012 From the table above shows the respondents obtained 45 of 117 pregnant women 38.46 there is a risk factor to develop pre-eclampsia. Table 2 Distribution of Frequency of types of risk Pre eclampsia No. Risk factors for Frequenc preeclampsia y 1. Primigravida 30 2. Age risky 14 3 A history of pre eclampsia 1 4 Illness 7  History of 4 hypertension 1  Diabetes Tooth ache amount 57 From the table above types of risk actors are 52.63 of the factors, namely pregnancy status or nulliparous pregnant the first time. P rosentase 52.63 24.56 1.75 12.3 7.01 1.75 100 3 shows that of the 117 respondents almost Factor F F 1 No 34 29.1 symptoms 2 Positive 56 47.9 1 0.9 1 P3 rosentase Positive 20 17.1 2 4 Positive 6 5.1 3 Amount 116 99.1 1 0.9 Based on the contingency table above shows that of the 117 respondents almost half of the respondents, 56 respondents 47.9 showed positive clinical symptoms 1 the case of preeclampsia in pregnant women in the family there is a history of preeclampsia. Frequency Table 9 Effect of pregnancy status nulliparous with clinical symptoms of pre-eclampsia risk. 20No. Clinical 17.1 Primigravida Total symptoms amount 117 100 Based on the above table shows that of the 117 respondents surveyed nearly half of the respondents, there were 83 respondents 70.9 positive for risk, and almost half, or 20 respondents positive 2. Table 7 Effect of maternal age with clinical symptoms of pre-eclampsia risk No. Clinical symptoms Age of mother Total No Factor There Factor Physical examination F F Table 3 Distribution assessment ROT Roll 1 No symptoms 29 24.8 5 Over Test 2 Positive 1 50 42.7 7 No. Value ROT Frequency P rosentase Positive 2 18 15.4 2 1. Positive 76 65 4 Positive 3 6 5.1 2. Negative 41 35 Amount 103 88.0 1 Based on the contingency table above amount 117 100 Based on the above table shows that of the 117 respondents surveyed most of the respondents, there were 76 respondents 65 had a positive ROT value. Table 4 Distribution of ratings MAP Mean Arterial Pressure half of the respondents, 50 respondents 42.7 showed positive clinical symptoms 1 occurs at the age of preeclampsia that there is no risk factors for preeclampsia. Table 8 Effect of families with a history of No. Value MAP Frequency P rosentase pre-eclampsia with clinical 1. 2. Positive Negative 28 89 23.9 76.1 symptoms of pre-eclampsia risk No Clinical Families with a history of Pre Total amount 117 100 . symptoms Eclampsia Based on the above table shows that of the 117 respondents surveyed almost all respondents, there were 28 respondents 23.9 had a positive MAP value. Table 5 Distribution of ratings BMI Body mass index No. Value IMB Frequency 1. Positive 12 10.3 2. Negative 105 89.7 amount 117 100 Based on the above table shows that of the 117 respondents surveyed almost all respondents, there were 12 respondents 10.3, body mass index is not a risk of pre-eclampsia. Table 6 Distribution scoring of clinical symptoms of pre-eclampsia risk of Value ROT, MAP and IMB No. The risk of pre-eclampsia P rosentase 1. No symptoms 34 29.1 2. Positive 1 57 48.7 3. Positive 2 4. Positive 3 6 5.1 1 No symptoms 24 20.6 10 8.5 34 29.1 2 Positive 1 46 39.3 11 9.4 57 48.7 3 Positive 2 13 11.1 7 6.0 20 17.1 4 Positive 3 4 3.4 2 1.7 6 5.1 amount 84 74.4 30 25.6 117 100 The relationship of risk factors with clinical symptoms 1013 No Factor There No Factor There Factor F F F Based on the contingency table above shows that of the 117 respondents almost half of the respondents, 46 respondents 39.3 showed positive clinical symptoms 1 the case of preeclampsia in pregnant women whose pregnancy status F 34 29.1 57 48.7 20 17.1 6 5.1 117100 is not at risk of preeclampsia. DISCUSSION From interviews obtained 45 pregnant women 38.46 there is a risk factor to develop pre-eclampsia, and 52.63 were of factors, namely pregnancy status primigravid or pregnant the first time. Many risk factors for pre-eclampsia occurs one of which is primigravida first pregnancy this can be explained on the theory of immunologic intolenransi mother and fetus. Allegedly immunologic factors contribute to the onset of hypertension in pregnancy is proven by the fact primigravid have a greater risk of hypertension in pregnancy when compared multigravida Angsar D, 2010. Normal maternal immune response does not reject the products of conception which is foreign. This is because the human leukocyte antigen protein G HLA-G, which plays a role in modulating the immune response, so she did not reject the products of conception placenta. HLA-G in the placenta protects the fetus from lysis by trafoblas Natural killer cells NK mother. Boutiler PL, Mallet V, 1977. HLA â € G facilitate trafoblas invasion into the maternal decidua tissue. In the placenta of hypertension in pregnancy HLA-G downhill and easy inflammatory reaction Yie Shang-mian, et al, 2004 At the beginning of the second trimester of pregnancy women have a tendency to occur with preeclampsia, turns out to have the proportion of helper cells is lower than the tension of normal Dikman A, John CM, 2010. From the results of who develop preeclampsia 26 will develop preeclampsia daughter, son-in-law while 8 had preeclampsia Riedman C, Walker I.1992 From the results of the examination of symptoms clinics, 76 respondents 65 had a positive ROT value. ROT value is the measurement by comparing two measurements of First Instance in the supine position and then second on his side if the difference between the two is more or equal to 9 mm Hg then tested positive for risk of pre-eclampsia Sulistiono A, 2014. ROT value but less accurate if used as a measure of the risk of pre-eclampsia compared to the value of MAP Gumilar E, 2013. MAP calculation of 28 respondents 23.9 had a positive MAP value. 12 respondents 10.3, body mass index, a risk of pre-eclampsia. Of the value ROT, MAP and IMB are combined and create a score for risk of pre-eclampsia. Ie if positive 2 the mother is potentially the case of pre-eclampsia 50, and if positive 3 potential of 75 will occur pre-eclampsia Gumilar E, 2013 From the results, the results of 57 48.7 positive 1 , 20 17.1 positive 2 and 6 5.1 Positive 3. This means that 48.7 has the potential for pre-eclampsia occurs less than 50, while the positive 2 a 17.1 has the potential to occur pre-eclampsia by 50 and 6 5.1 had the potential to occur pre eclampsia 75. If the positive results obtained 2 and positive 3 then the mother must be referred to a doctor for preventive drug therapy of hypertension so as not to occur pre-eclampsia Sulistiono cross-tabulations contingency tables A, 2014. Such screening is very easy and between primigravida with clinical symptoms obtained 20 positive pregnant women at risk of pre-eclampsia consists of 11 9.4 positive 1, 7 6.0 positive 2 and 2 1.7 positive 3. Bardasar this data it is very important to pay attention to possible cases of inexpensive. Easy as can be done by medical personnel as well as the primary medical provider midwives spearhead pelanyanan antenatal care at the level of basic services such as health centers or villages.Membutukan cheap because only simple equipment. But although simply pre-eclampsia in pregnant women remains to be done with the correct primigravida. Besides other risk factors such as maternal age and a history of pre-eclampsia, hypertension history in keluanga also need to be aware of. The existence of heredity with a single gene. methods and with standard tools. From the study results mutkhir mentioned variations between operators large enough that could affect the diagnosis of high blood pressure in pregnancy Duggan, and Mileen 1998; More maternal genes in determining Brown and Simpson, 1992, Derry; hypertension when compared with genotype janin.Telah proven that women 1014 Wilkinson et al, 1991. For this reason it is suggested that the mother lying in the same position every blood pressure checks. Checks should be made guidelines for blood pressure in pregnancy are strictly Shoop. DIV Midwives Stikes Karya Husada. Kediri December 21 2014 defined, checks the blood pressure of Yie Shang-play, Liang-hong Li, Yue pregnant women with a sitting or lying Li-mei, Librach C. HLA-G protein position with the back left ditingikan with pillows, sebaikya the left arm IBI Center, 2006. concentration in placental tissue preeclamsia, Am J maternal serum and are Decreased in Obstet Gynecal, 2004; 191: 525-9 BIBLIOGRAPHY Angsar D, Mose JC, Hypertension In Pregnancy, Obstetrics Sarwono Prawiroharjo.BP-SP. Jakarta.2010, 534-35 Boutiller PL, V. Mallet HLA-G in Pragnancy, Review of Reproduction, 1997; 2: 7-13 Brown MA, Jm Simpson, 1992, Diversity of Blood pressure recording during Pregnancy: implications for the hypotensive disorders.Med March 2 J Aust 1992; 156 5: 306-308 Duggan, and Mileen 1998. Blood Pressure Measurements in Pregnancy: The US in a survey of methods used in theaching hospitals in south Australia. Aus NZ J Obstet Gynaecol 1998. Deeker GD.Risk Factor for preeclamsia. Clinical Obstrtris and Gynecology. 1999.42: 422-35 Gumilar ED, Akbar A I.2013.Deteksi Early preeclampsia. Division Feto maternal Dpt SMF Obstretri Gynekology.RS Dr.Soetomo. Airlangga University School of Medicine. Surabaya. IBI Indonesian Midwives Association. Services 2006.Standar kebidanan.IBI.Jakarta Maternal Mortality report Sekabupaten and City in East Java, 2012 Manuaba I BG, Manuaba C AI, Manuaba F IBG.2007. Introductory Lectures Obstretri, Chapter 6 Komplokasi In Pregnancy, Hypertension in Pregnancy. EGC. Jakarta Riedman C, Walker I. preeclamsia The Fact.Oxford University Press, New York, 1992: 130-3 Sulistiono A.Deteksi early preeclampsia and management of pre-referral. Work 1015 CONTINGENCY TRAINING ROLE OF EARLY IN THE COMMUNITY TO IMPROVE PREPAREDNESS OF TSUNAMI HAZARD ON SIDEM BEACH TULUNGAGUNG 2015 Siti Nurhasanah STIKes Hutama Abdi Husada Tulungagung stikeshahtayahoo.co.id Abstract Indonesia is a country which in Ring of Fire region, its makes Indonesia have some kind of the potensial disaster, one of them is Tsunami. Preparedness is very important to the community, so we need training early contingencies. In this study Pre-experimental design was used to form one group pretest and post test, as a pretest given questionnaires and as treatment given lectures and leaflets ended with giving the same questionnaire again with a pre-test questionnaire, the number of respondents are 20 people. The results based on the statistical test with Wilcoxon Signed Rank test obtained significant value of 0.000 which is smaller than the value of α 0.05. This suggests that the hypothesis is accepted which means that there are differences in the tsunami hazard preparedness in Sidem Beach Tulungagung before and after the training is conducted. So counseling or training is essential once performed on people who are not equipped to improve preparedness against tsunami hazard. Keywords: contingencies, preparedness and tsunami PRELIMINARY Disaster had often heard all the good people in the media such as television, RESEARCH METHODS The design in this research is using the pre-experimental easily done even if newspapers, radio and other media. there is a weakness in terms of internal Catastrophic events is something bad happens to a person or group of people, such as tsunami, floods, earthquakes, volcanoes and therefore make peoples lost property, objects and even lives. Tsunami is a terrible disaster. Our country is prone to disasters, both natural and man-made. Early contingency training to improve the preparedness of the community is very important to do by everyone, especially those located around the coast. Training is planned any attempt to influence, increase knowledge and change the behavior of other individuals, groups or communities that contingency training early heading towards the positive must be implemented by all the people, especially the early contingency training on the handling of the tsunami disaster. 1060 validity and external validity. The population in this study are all coastal communities that fit the criteria in Sidem who do not get early counseling about training of contingentcy, there are 20 people. The sample in this study is equal to the total sample or study population. The sampling technique used by researchers is total sampling, which means the determination of the sample by selecting all of the samples that match the criteria. Independent variables: contingency early training. Variable dependent : tsunami hazard preparedness. RESEARCH RESULT respondents. Recapitulation of research respondents If it compared the greatest frequency before based on results of a questionnaire and after training there is an increase, from distributed before and after training on an early contingent on the community to improve preparedness against tsunami hazard on the Sidem beach Tulungagung can be presented in frequency distribution table as follows: enough category to good category. Nevertheless, it should be further analyzed whether there are statistically significant increase. DISCUSSION Respondents from Sidem beach 1. Against Tsunami Hazard Preparedness Before Training Descriptive analysis of tsunami hazard preparedness against the respondent before the training given. Tulungagung selected as many as 20 people and were given a questionnaire before training. The result was 14 70.0 of respondents have sufficient preparedness in the category preparedness against tsunami hazard, 4 20.0 of respondents have preparedness in the poor category in the The frequency distribution of tsunami hazard preparedness and only 2 respondents by Tsunami Hazard 10.0 of respondents have preparedness Preparedness Against Before Training. in the category lacking in preparedness Preparedness Less Enough Good Total Total 4 14 2 20 20,0 70,0 10,0 100,0 against tsunami hazard. Some respondents don‟t understand about knowing the causes of tsunamis and how to save themselves if tsunami occur. Results of the questionnaire showed that respondents only know that when there is a Based on the data in the table was preparedness respondent before given training, the most are in the category enough, as many as 14 70.0 of respondents. 2. Against Tsunami Hazard Preparedness Training After Descriptive analysis of tsunami hazard preparedness respondents were given after the training. The frequency distribution of respondents by Tsunami Hazard Preparedness Against After Training Preparedness Total danger sign should immediately save themselves. They don‟t know how to save themselves from tsunami correctly. After training, respondents given and the result is no respondents who have less preparedness against tsunami, 2 10.0 of respondents have sufficient preparedness in the category in tsunami hazard preparedness and almost all respondents have preparedness in both categories in preparedness against the dangers of tsunamis, which is 18 90 of respondents. Results of statistical test to Wilcoxon Signed Rank test obtained significant value of 0.000 which is smaller than the value of α 0.05. This suggests that the hypothesis Less Enough Good Total 2 18 20 0,0 10,0 90,0 100,0 is accepted which means that there are differences in the tsunami hazard preparedness Sidem Beach Tulungagung before and after training. Changes in tsunami hazard Based on the table above, it turns preparedness is evident in the age group out after the responder preparedness 30 years - 60 years with significant value training given, that most are in the category of good, as many as 18 90.0 of 1061 0.005. These results indicate that young age is easier to understand the contingency training than those aged 60 years. While based education is a significant value of 0.031 with higher education more easily to understand the contingency training than respondents with elementary school. Based on the work of no significance to the changing understanding of contingency training, where the results of a statistical test 0.05, which is 0.773 which means that education has no effect in changing understanding of contingency training. While at work as fishermen have a good improvement, because fishermen will better know signs of a tsunami than the other jobs of the respondents. Carter. 1998. Konsep Resiko Analisa Bencana Direktorat Jendral Bina Kesehatan. 2006. Pedoman Penanganan Bencana Secara Umum . Departemen Kesehatan RI. Notoatmodjo, Soekidjo. 2002. Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta. Nursalam dan Pariani, Siti. 2001. Pendekatan Praktis Metodologi Riset Keperawatan . Jakarta : CV Sagung Seto. Panduan pembuatan tesis, Universitas Airlangga Surabaya, 2014 Prof.Dr.M.Zainudin, 2011 .Metodologi Penelitian Farmasi dan CONCLUSION Before training contingent, there Kesehatan,Airlangga university press. were 14 70.0 of respondents have Riwidikdo, Handoko. 2012. Statistik sufficient preparedness in the category, 4 20.0 of respondents have preparedness Kesehatan : Belajar Mudah Teknik Analisis Data dalam in the poor category and only 2 10.0 of Penelitian Kesehatan. Cetakan respondents have preparedness in the poor category. Keempat. Yogyakarta : Mitra Cendikia Press. After training contingency no Sukardi. E Maramis WF.1986. Evaluasi respondents who have preparedness in the PelatihanPembelajaran : poor category, 2 10.0 of respondents have sufficient preparedness in the category Penilaian Keberhasilan Pembelajaran. Applied and nearly all respondents have Approoach. preparedness in either category, namely 18 90 of respondents. BIBLIOGRAPHY Anderson. 1998. Konsep Bencana Bakornas. 2005. Pengantar Perencanaan Kontijensi : Manajeman Kedaruratan dan Perencanaan Kontijensi . Painan. INEE. 2012. Standar Minimum untuk Pendidikan : Kesiapsiagaan, Respons, Pemulihan. Jakarta : INEE World Conference on Disaster Reduction, 18-22 January 2005, Kobe, Hyogo, Japan, International Strategy for Disaster Reduction WHO. 2005. Hyogo Framework for ; Action 2005-2015 : Buliding the BNPB. 2011. Panduan Perencanaan Resilience of Nations and Kontijensi Menghadapi Bencana. Edisi Kedua. Jakarta : BNPB. BNPB. 2008. Peraturan Kepala Badan Nasional Penanggulangan Bencana Nomor ; 4 Tahun 2008 tentang Pedoman Penyusunan Rencana Penanggulangan Bencana. Jakarta : BNPB. Budiarjo L Irawati.P.Prasasti T. 1994. Mengajar Di Perguruan Tinggi : Direktorat Jendral Pendidikan Tinggi 1062 Communities to Disasters. Kobe : WHO 1063 STUDY OF KNOWLEDGE IN CHILDREN OF DISEASES DIPHTHERIA POSYANDU 8 BAGO VILLAGES IN DISTRICT TULUNGAGUNG 2015 Yeni Setyo Prastiwi 1 Azmi Bagus Prayogo 2 STIKes Hutama Abdi Husada Tulungagung Email: mecino06.mail.com Abstract Diphtheria is a disease caused by Corynebacterium diphtheria. The purpose of this study was to identify the knowledge of mothers about diphtheria. Design used in this research is descriptive using the techniques in making Total Sampling with a population of 35 people and a sample of 35 respondents.Data dikumpulks using a questionnaire measuring instrument. with the data collection technique the researchers came to the Posyandu then perform the informed concent then gave questionnaires to respondents.The data obtained and dioalah through the steps: Editing, Coding, Sorting, Scoring, Tabulating, then presented in tabular form of distribution, frequency and narrative and presented to be analyzed descriptively using the formula: P= SpSm x 100. From the research, it was found that knowledge of mothers of diphtheria in IHC 8 Village Bago Tulungagung gained 6 respondents 17.1 were included in either category, 22 respondents 62.9 in the category of pretty, 7 respondents 20 fall into the category of less. Results showed an average of all 35 respondents found the knowledge level of 66.8 and are included in the category enough.So the need for additional insight on diphtheria that better knowledge of the respondent. Keyword: Knowledge, mother, children under five, diphtheria. PRELIMINARY Diphtheria is an acute infectious disease that is highly contagious that occur locally on mucosal respiratory tract or skin, produced by bacillus gram- positive Corynebacterium diphtheria, is characterized by the formation of exudate shaped membrane at the site of infection, followed by general symptoms caused by an exotoxin produced by this bacillus. SudoyoAru, especially in East Java, in 2011 occurred 665 cases, in 2012 there were 954 cases and in 2013 then occurs 333. http:dinkes.jatimprov.go.id, whereas in Tulungagung itself occurred 9 cases in 2011 and then in 2012 increased to 16 cases and in 2013 the Department of Health Tulungagung noted there were 22 cases of diphtheria with most events in the village of Bago with 4 cases, one incident is in RT 02 RW 03 who entered the village Bago IHC 8. Previous et al 2009. environment in the village of Bago Number of diphtheria cases and deaths continue to increase, if no action never occurred case diphtheria especially the last 3 years there were no is more intensive expected to be cases of diphtheria there. increased drastically. http:www.smallcrab.com. In Indonesia in 2011 occurred 806 cases, in 2012 there were 1,192 cases in 2013 and 778 cases last occurred. Has been an outbreak of diphtheria cases, 1067 http:www.dinkes.tulungagung.go.id According Notoatmojo 2007, human behavior is the result of knowledge, if knowledge is less then the urge to behave lakupun less. Mothers who lack knowledge about the disease diphtheria, an effect on behavior, percentage of sentences that are namely the lack of maternal sensitivity to the signs and symptoms of diphtheria. In addition to mothers lack of knowledge about the disease diphtheria are also due to the lack of information from the health service. Notoatmojo 2007 Lack of knowledge of mothers of diphtheria at risk of increased transmission of the disease, because the signs and symptoms of diphtheria is almost the same as influenza, so many mothers who thought that the boy was only suffering from the flu, but in fact are experiencing the early phase of the disease diphtheria. Diphtheria disease itself is a disease common in the throat, and common problems that occur on the sufferer is pain that cause children to swallow hard to eat, and when this happens continuously will result in nutritional deficiencies children. SudoyoAru, et al 2009. To anticipate the spread of diphtheria required a knowledge that will form a behavior and consciousness. To increase knowledge about the disease diphtheria mother needed an education about the disease and how to prevent diphtheria the start of which provide immunity in children by: DPT immunization for Toddlers. Immunizations given 3 times that at the age of 2 months, 3 months and 4 months, avoid direct contact with patients. Maintaining personal hygiene, qualitative Arikunto, 2006. The population in this study are all mothers in the village of Bago IHC 8 Tulungagung. Total population in this study as many as 35 people. The sample in this study are all mothers in IHC 8 Village Bago Tulungagung numbering as many as 35 people. In this study, using total sampling technique in which the entire population is used as a research subject. The variable in this study is a single variable, namely Mrs. Knowledge Village Toddlers in Posyandu 8 Bago Tulungagung 2015. After the questionnaires distributed, data collection, after the data obtained do data processing Editing, Coding, Sorting, Scoring, Tabulating, then the data were analyzed result is a percentage using the formula P = Sp Sm x 100. Description: P is the percentage obtained, Sp is the score obtained, SM is the highest score is expected. The processing of the data is interpreted in the sentence qualitative criteria: good = 76-100, quite = 56- 75, and less = 56 Nursalam, 2013. RESEARCH RESULT Mother Knowledge About Disease Diphtheria Toddlers Table 1 : Distribution of frequency of knowledge of mothers of diphtheria in IHC 8 Village Bago Tulungagung 2015. to maintain stamina by eating nutritious foods and exercising wash hands before eating, perform regular health checks. From the description above, the authors are interested to investigate N o 1 2 3 Knowledg e Good Just Less than Frequenc y 6 22 7 Percen t 17,1 62,9 20 further the knowledge of mothers of diphtheria in Posyandu 8 Village Bago Tulungagung RESEARCH METHODS In this research using descriptive research design, ie when the fixed data collected, summed compared with the amount 35 100 Average Just 66,3 Source: Questionnaire Research 2015 Based on Table 1 above shows that the majority of mothers knowledge of diphtheria in IHC 8 village Bago, from expected number and percentage obtained. From then interpreted by the 1068 35 respondents there were 22 respondents 62.9 with enough found in educated respondents College knowledge. DISCUSSION Based on Table 1 above shows that most of the mothers knowledge of diphtheria in IHC 8 Village Bago in 2015 from 35 respondents obtained 22 respondents 62.9 knowledgeable enough, with the average of the whole is as much as 66.3. According to the theory of as many as 6 people 17 which is considered as a high level of education, so it feels natural that mothers knowledge of diphtheria in the category enough. CONCLUSIONS AND SUGGESTIONS A. CONCLUSION Knowledge mothers of diphtheria in IHC 8 Village Bago Tulungagung using Notoadmodjo 2003 knowledge is a questionnaire sheet obtained results influenced by two factors: internal and external factors, wherein the internal from 35 respondents obtained an average of the whole is as much as factors include age, intelligence, 66.3 are in the category enough. attitude, personality, whereas the external factors include the

A. ADVICE

environment, education, employment, resources, religion, socio-economic, and cultural. From the results it can be seen that there is conformity between facts and theories, where the work can affect a persons knowledge, where most respondents worked as IRT as many as 15 people 43. Based on the theory Notoadmodjo 2003, someone who is busy with the day-to-day work or activities will have a little free time in obtaining the information. But even so the results of the study showed that knowledge of mothers of diphtheria in fair category. It is also due precisely to the preoccupations of respondents often interact with others, so it is more often gets information, therefore it is considered reasonable if the knowledge of mothers of diphtheria in the category enough. In addition to occupation, age may also affect the level of knowledge. Where most of the respondents aged 31- 40 years as many as 14 people 40. At this age of the respondents have a lot of experience so it can easily receive information. Education is also very influential in the level of knowledge, which the majority of respondents had high school as many as 15 people 43 to say the category of education level is quite high, but the good knowledge are mostly 1069 1. Theoretical Suggestions Theoretically, the results of this study are expected to be an addition to the information and can add knowledge to the mothers of diphtheria. 2. Practical Advice a. For the Respondents Society in particular mothers should increase knowledge about diphtheria, for example by seeking the necessary information from the print or electronic media, and following the extension of health. b. For Researchers Places As input information and knowledge, as well as education media about diphtheria. c. For Educational Institutions Expected educational institutions can use the results of this study as additional material information for learning in the educational process, so that the student and the student can contribute for example, counseling and motivation directly to the public. d. For Further Research Results of this study can be used as a reference for research on what factors are likely to influence the level of knowledge of mothers about diphtheria. ACKNOWLEDGEMENT REFERENCE Arikunto, S. 2006. Research Procedure A Practice Approach. Jakarta: PT. Rineka Reserved. Alimul, Aziz. 2007. Nursing Research and Scientific Writing Techniques. Jakarta: Salemba Medika. Hidayat, Aziz Alimul, 2008. Methods Data Analysis Techniques. Jakarta: Salemba Medika. Gunarso, S, 2010. Concepts and Health Education, Jakarta: PT. Gramedia Pustaka Utama. Koencoroningrat, 2013. Book Introduction to Anthropology. Mubarak, Iqbal, Zahid, 2007. Book Health Promotion. Jakarta: Graha Science Notoadmojo S. 2007. Health Education and Behavior. Jakarta: Rineka Reserved. Nursalam. 2013. Practical Approach Nursing Research Methodology. Jakarta: Salemba Medika. Nurul, Effendy. 2011. Science Communication Theory and Practice. Bandung: PT. Teens Rosdakarya. Sudoyo Aru, et al. 2009. Textbook of Medicine. Jakarta: Salemba Medika. Setiadi. 2007. The concept and writing of Nursing Research. Surabaya: Cipta Graha. http:www.smallcrab.com Accessed October 27 2014 Time: 16:54 pm Jakarta: Salemba Medika. http:dinkes.jatimprov.go.id Accessed Muaris, H, 2006. Textbook of Pediatrics, Volume 2. Jakarta: PT. Gramedia Pustaka Utama 1070 October 27, 2014 Time: 17:03 pm 1071 The Effect of Health Education About Circumcision Against Anxiety in Children who will do Circumcision Actions in Campurdarat, Tulungagung Hadi Santoso STIKes Hutama Abdi Husada Tulungagung Email: Hadisantoso.stikesgmail Abstract Anxiety is a condition in which individuals or groups to experience feelings that are difficult or scared and nervous activity decreased in responding to the threat of non- specific uncertainty. Anxiety often appear in children who will be taken circumcision. Most of them feel anxious because of a lack of knowledge. One way to improve knowledge in these children is to provide health education among them is the provision of leaflets. Of the problem researchers aimed to determine the effect of the provision of leaflets about the circumcision procedure on the level of anxiety in children that will be taken circumcision. The study design used was quasi experiment with methods of pre-test post test.Using incidental sampling technique with the subjects children will be taken circumcision in the district Campurdarat Tulungagung by the number of 20 respondents fit the inclusion criteria. Data collection techniques used quisioner HARS scale to determine the anxiety level of each respondent according to the criteria. so that unknown percentage of respondents according to their level. Furthermore, the data tekumpul processed using SPSS statistical test Statistical Product and Service Solution windows version 13 by the Wilcoxon Signed Rank test analysis with the results of Test p 0.05, where H0 is rejected, which means no influence. From the results obtained Wilcoxon statistical test where p = 0.002 p 0.05, so H0 is rejected and H1 accepted which means there is a leaflet giving the effect of circumcision procedure on the level of anxiety in children that will be taken circumcision. Thus needs to be given leaflets about the circumcision procedure to the child that will be taken circumcision to reduce anxiety. Keywords: Emergency, Grant Leaflet, and Circumsicion INTRODUCTION procedures and anasthesia. One form of One of the circumsicion‟s respon is anxiety. Anxiety is a condition in which individual or groups feel difficult or scared and nervous activity decreased in responding to the threat of non- specific uncertainty Carpenito, 1995, 132. Surgery is difficult experience for more patients. Many bad things can happen too, and it will danger for patients. So patients and families often show their attitude which unusually with their anxiety that they feel. Usually, treatment efforts that can be done to minimize or reduce anxiety in children is through health education. Health education is all the effort planned to influence other people, groups, or communities so that they do what would be expected by educational actors. Prof. Dr. Soekidjo, Notoatmodjo. 1996. As a media of helath education, namely leaflets. Leaflet is a form of information delivery or health education through the sheets are folded. The their anxiety correlates with all information content can be in the form procedures which must doing by patients and also threaten safety life for the impact of many surgical operation 1074 of words or images or a combination. Prof.Dr.Soekidjo, Notoatmodjo. 1996 From the children who lack In this study, there is only the primary health education about treatment group were given a leaflet circumcision, it can cause anxiety. From some incidents of phenomena in society, when it will circumcision done, almost of the children feel anxious at times. Beside that, researcher also had same experience, it was high anxiety when it about the treatment of anxiety in children to be performed circumcision. Observations carried out before and after treatment was given to the respondent. Population in this study are the children to be performed circumcision in will be taken circumcision Campurdarat, Tulungagung. circumcision. From the results of the The sample of this research is the children known to be doing circumcision preliminary study that researchers do in in Campurdarat and include in the Campurdarat, October 2011, 9 Tulungagung in respondents who inclusion criteria. In this study, sampling technique interviewed, 8 of them said anxious at a that means incidental sampling time will be taken circumcision, one of them said no problem. The impacts of anxiety can make them fear, tense and restless when it will be taken circumcision. They also have difficulty sleeping as well as diseases such as headaches, increased blood and so on. All of it due to the mental technique sampling is done by chance encountered by researchers Latipun, 2008, while independent variable in this study is the provision of leaflets about the circumcision procedure. In this study, researchers collected data by observing the childs anxiety level will be taken circumcision using HARS pressure will be taken when the before being given treatment for the circumcision. Of the impact of these concerns, it need support systems such as family or the closest person who will provision of leaflets about the circumcision procedure. Then the child is treated by administration of leaflets listen and give advice. Emotional about the circumcision procedure, after support will be very useful for someone who is getting anxiety. The role of health workers is needed to provide health education about circumcision procedures in the implementation of measures that circumcision can decrease anxiety in children and the children feel calm and ready to do circumcision. Based from description above, the researchers interested in conducting research with title The Effect of health education about circumcision to anxiety in children to be performed circumcision in Campurdarat Tulungagung.. the treatment is given to children who will be circumcision researchers observed another childs anxiety levels to be performed the circumcision. After the data collected from the observation level of anxiety children to be performed circumcision before and after treatment of the data will be processed by the editing, coding, sorting, tabulating and scoring. Then the data were analyzed using Wilcoxon Signed Rank test that will show the influence of whether or not the provision of leaflets anxiety about the procedure of circumcision against children will be taken RESEARCH METHODOLOGY sircumcision. Wilcoxon signed rank test This study uses Quasi was used to test the hypothesis of experiments with pre test - post test. This design does not use a control group. This draft seeks to strengthen the causal relationship to the group by comparing the results of the pretest and significance comparatif two samples are correlated when the data in ordinal tiered .To determine whether the effect of health education about circumcision procedure with leaflets against the post-test but without making a childs anxiety will circumcision in comparison with the influence imposed on other groups. Nursalam, 2001. 1075 Campurdarat, Tulungagung, using a computer with a technique SPSS Statistical Product and Service Solution Version 13 of Windows. To determine Wilcoxon Signed Rank Test p value = 0.02, with p 0,05 so that H0 rejected the level of significance between and H1 accepted which means that there variables in a meaningful measurement of the effect of the level of significance was p 0.05 that means H0 rejected H1 accepted, there is influence between the is significant influence between the provision of leaflets about the circumcision procedure against the childs anxiety level that will act variables measured. circumcision. Health education administration leaflet is the RESEARCH RESULT From 20 respondents before being educational activities undertaken by spreading the message, instill confidence given health education about so that people are not only conscious, circumcision, most of as many as 11 respondents experiencing moderate anxiety level with the percentage of 55 and then after a given health education about circumcision most of which were 9 respondents experiencing mild anxiety level with a percentage of 45. While, Wilcoxon Signed Rank Test that know, and understand, but is also willing and able to carry out the suggestion that has to do with health. Anwar, 1993. Information will be an impact on a persons knowledge. Wied Hary A. 1998 Accurate information can help eliminate fear and reduce anxiety Depkes RI, 1998. Referring to theory researchers do p value = 0.02, with p above and associated with cross 0,05 so that H0 rejected and H1 accepted, that means there is significant influence between the provision of tabulation shows that anxiety most happen at children aged 11-15 years with previous secondary school leaflets about the circumcision education is as much as 6 children with procedure against the childs anxiety the percentage of 46.15 with anxiety level that will act circumcision. being, then after the treatment given to as many as 5 percent of children with 38 DISCUSSION Based on the results of the study showed changes in levels of anxiety before and after health education leaflets about circumcision is found that before being given health education leaflets about circumcision of 20 respondents will be taken circumcision as many as 11 respondents experienced anxiety level was the percentage of 55, while 6 respondents experienced anxiety level light with a percentage of 30, and 3 respondents experienced a degree of severe anxiety with a percentage of 15 and after given health education leaflets about circumcision of 20 respondents will be taken circumcision most of as many as nine respondents experienced anxiety level light with a percentage of 45, while 6 respondents had moderate anxiety level with the percentage of 30, 4 respondents no worries with the percentage of 20, and 1 respondent suffered severe anxiety level with the percentage of 5. As well as the 1076 , 46 to mild anxiety, it shows the effect of the provision of health education leaflets about circumcision. Anxiety levels of children will be taken before the circumcision is given health education leaflets and after given health education leaflets showed a decrease in anxiety levels. This proves that the information obtained through health education leaflets accompanied by counseling about circumcision can reduce the level of anxiety children. Information obtained through the provision of health education leaflets are quite clear and easy to read so it‟s easy to understand and be understood by children. How the good extension anyway so the majority of respondents who experienced high levels of anxiety with numbers later after being given health education leaflets and counseling about circumcision can reduce the level of anxiety. That means, giving health education leaflets showed an influence on the childs level of anxiety. Hidayat, A. 2003. Riset Keperawatan dan Teknik Penulisan Ilmiah . Jakarta: Salemba Medika. CONCLUSIONS AND SUGGESTIONS Mansjoer, A. 2000. Kapita Selekta CONCLUSION From Wilcoxon Signed Rank test that researchers do p value = 0.02, with Kedokteran . Aesculapius Jakarta: Media p 0,05 so that H0 rejected and H1 accepted that means there is significant influence between the provision of leaflets about the circumcision procedure against the childs anxiety Nursalam. 2003. Konsep dan penerapan Metodologi Penelitian Ilmu Keperawatan . Jakarta: Salemba Media. level that will take circumcision. Nursalam. 2005.. Asuhan Keperawatan Bayi dan Anak . Jakarta: Salemba SUGGESTION Expected to health workers are associated with these results, nurses can use leaflet to minimize the childs Medika. Pusat pendidikan Tenaga Kesehatan Departemen Kesehatan RI, anxiety which will be taken 2009.. Asuhan Keperawatan circumcision and should have to apply the knowledge and application of knowledge learned during the lecture by providing health education using a variety of media that exist today. The results could be used as a reference future studies, mainly related to anxiety levels of children will be taken circumcision and further research to look for a more complete supporting Dalam Kontek Keluarga. Jakarta Setiadi. 2007. Konsep dan Penelitian Riset Keperawatan .Surabaya: Graha Ilmu Wrana, P. 1939. Historical review: Circumcision. Archives of Pediatrics

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quoted in: Zoske, Joseph data about the respondents among Winter 1998. Male others, additional data on the information obtained. Circumcision: A Gender BIBLIOGRAPHY Perspective. Journal of Studies

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Men‟s Arikunto, S. 2006. Prosedur Penelitian Suatu Pendekatan Praktek . Jakarta: Rinek Cipta Yupi, S. 2004. Buku Ajar: Konsep Dasar Keperawatan anak . Jakarta: EGC Asih,Y. 1999. Dasar-Dasar Riset Keperawatan . Jakarta: EGC Danim, S. 2003. Riset Keperawatan Sejarah Metodologi . Jakarta: EGC Gollaher, D. February 2000. Circumcision: a history of the world‟s most controversial surgery . New York, NY: Basic Books. hlm. 53 –72. 1077 THE CORELATION OF BODY MASS INDEX BMI WITH CARDIORESPIRATORY RESISTANCE ON NURSING PROGRAM STUDENTS Oka Ludianita 1, Ita Novita Dewi 2 STIKes Hutama Abdi Husada Tulungagung Email: zahyardia_odiayahoo.com Abstract Someone who has full of weight body, will suffer Cardiovaskuler. So it assumed that someone who has big body having cardiorespiratory endurance lower than normal people. The goal of the research is to know the correlation between BMI and cardiorespiratory endurance.This research design used correlation design by using sectional cross approaching. The populations of the research are the students of sarjana degree of grade III. The samples of the research are 52 people by using sampling total technique. BMI data is taken by using Antropometri measurement and using Balke test for cardiorespiratory endurance.The result of the research had been found that 52 student have normal BMI and having cardiorespiratory endurance. There were 16 people 47 from the statistic test of Spearman Rho is gotten score ρ= 0,002 α= 0,05 so H rejected and H 1 accepted. There is a correlation between BMI and Cardiorespiratory endurance on the students of nurse program on grade III at STIKes Hutama Abdi Husada Tulungagung.From the result above showed that good cardiorespiratory immune system existing by having routine exercires and enough nutrient, so BMI will be normal from that reason. The researcher hopes that the student must pay attention to BMI and cardiorespiratory endurance in order incrate the health of body and reaching healthy life. Keyword : Body Mess Index, Cardiorepiratory Endurance, Student INTRODUCTION Lifestyle of the people who tend to not have as much physical activity is something to watch out, because these habits can affect ones health. Various kinds of organ function decline in this community can be prevented through exercise Samihardja J., 2005. Sport is any systematic physical activity to encourage, foster and develop the potential of physical, spiritual, and social. Sports activities that can be done in everyday life sometimes requires great body energy, due perhaps in the sport activity there are movements that are quite complex or complicated. Because any movement in the sport activity definitely requires energy from the body. Activities regular exercise can help maintain physical fitness infallible, 2007. One form of capital is human resource development of healthy, that is healthy physically, mentally and socially. Teenagers who are healthy and have good endurance to be able to excel in learning and work so that productivity is increased. According to the WHO, adolescent is an individual both women and men who are in a period or age between children and adults. Limitation of teenagers in this case is the age of 10-24 years. Someone 1081 who has a prime cardiorespiratory endurance can perform daily activities with optimal and not get tired, and still have the energy reserves to do other activities Bastian, 2009. Cardiorespiratory endurance is the ability to receive, convey and to extract oxygen for physical work. It is the ability to survive in the physical work at a certain intensity. Cardiorespiratory endurance will improve with regular participation in aerobic activity, such as brisk walking, jogging, cycling, and swimming. Term aerobic means with oxygen, but when applied to exercise, refers to activities in which the oxygen requirement can be given continuously during the performance Anspaugh, 2006. Cardiorespiratory endurance is determined by the strength of Maximum Oxygen Volume VO2max, which is defined as the highest average oxygen that can be generated during exercise and is shown in the number of milliliters of oxygen consumed per kilogram of body weight per minute Nieman, 2008. According to Lloyd, et. al 2004 stated that the results of research on cardiorespiratory endurance conducted at the Nursing Academy student Serang Banten