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Pendidikan Kesehatan tentang Penatalaksanaan Non Farmakologi untuk Mengurangi Nyeri Persalinan Yunika, Regina Pricilia; Ulya, Yadul; Herlina, Siskha Maya
ADMA : Jurnal Pengabdian dan Pemberdayaan Masyarakat Vol 4 No 1 (2023): ADMA: Jurnal Pengabdian dan Pemberdayaan Masyarakat
Publisher : LPPM Universitas Bumigora

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30812/adma.v4i1.2794

Labor is the process of expulsion of the fetus that occurs in full-term pregnancies born spontaneously with a rear-head presentation without complications to the mother and fetus. During childbirth, the mother feels pain that can interfere with comfort during contractions. Labor pain appears during the first stage of the active phase. Methods to reduce pain due to labor can be done with pharmacological and non-pharmacological methods. Non-pharmacological will not give side effects to the mother. Non-pharmacological techniques are usually deep breathing relaxation techniques, warm/cold compresses, music therapy, aromatherapy, and massage. Objective: to increase the knowledge of pregnant women about non-pharmacological management to reduce labor pain. Methods: counseling, discussion, question, and answer, as well as pretest and posttest. Result: there is an increase in knowledge of pregnant women who have good knowledge by 29,1%, namely from 62,5% increased to 91,6%. Conclusion: there is an increase in the knowledge of pregnant women about non-pharmacological management to reduce labor pain after receiving health education.

Penyuluhan tentang Manfaat Kurma (Phoenix dactylifera L.) sebagai Upaya Memperlancar Persalinan Ulya, Yadul; Herlina, Siskha Maya; Yunika, Regina Pricilia
ADMA : Jurnal Pengabdian dan Pemberdayaan Masyarakat Vol 4 No 1 (2023): ADMA: Jurnal Pengabdian dan Pemberdayaan Masyarakat
Publisher : LPPM Universitas Bumigora

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30812/adma.v4i1.2799

Fluid and nutritional needs are physiological needs that must be properly met by the mother during the birth process. Dates are rich in carbohydrates as a source of energy, influencing the progress of labor, spontaneity in labor and reducing postpartum hemorrhage. Carbohydrates as amplifiers are sugars that are absorbed and used by the body's cells shortly after consumption. Dates also contain B vitamins, minerals, iron, calcium, magnesium, potassium, saturated fatty acids and unsaturated fatty acids. Fatty acids besides providing energy also help provide prostaglandins. Fatty acids can help store energy and strengthen the uterine muscles. Dates also contain hormones that can stretch the uterus when approaching the birth of a baby. Therefore it is necessary to do counseling about the benefits of dates (Phoenix dactylifera L.) as an effort to facilitate labor. The activity of providing counseling about the benefits of dates (Phoenix dactylifera L.) as an effort to facilitate childbirth was carried out in Jempong Baru Village, Sekarbela District, Mataram City and was attended by 20 pregnant women. The results of the pretest and posttest showed an increase in pregnant women's knowledge about the benefits of dates (Phoenix dactylifera L.) as an effort to facilitate labor.

Identification Of Perineal Rupture Characteristics Ulya, Yadul; Herlina, Siskha Maya; Yunika, Regina Pricilia
JKM (Jurnal Kebidanan Malahayati) Vol 10, No 11 (2024): Volume 10 No.11 November 2024
Publisher : Program Studi Kebidanan Fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkm.v10i11.18182

Latar Belakang: Ruptur perineum merupakan salah satu masalah besar yang berkaitan dengan morbiditas dan mortalitas setelah kelahiran. Salah satu komplikasi yang dapat terjadi akibat ruptur perineum yaitu infeksi dan perdarahan. Beberapa faktor penyebab terjadinya ruptur perineum yaitu faktor ibu, janin dan persalinan.Tujuan: Mengidentifikasi karakteristik ibu bersalin yang mengalami ruptur perineum.Metode: Metode penelitian ini yaitu penelitian deskriptif dan dilaksanakan di Puskesmas Kediri Kabupaten Lombok Barat. Sampel dalam penelitian ini adalah 80 ibu bersalin pada tahun 2023 yang mengalami ruptur perineum dengan teknik purposive sampling. Data yang di ambil dalam penelitian ini adalah data sekunder, diolah secara univariat, dan disajikan dalam bentuk tabel distribusi frekuensi.Hasil: Hasil penelitian ini didapatkan dari 80 responden yaitu sebagian besar usia responden 20-35 tahun sebanyak 64 (80,0%), sebagian besar paritas responden multipara sebanyak 59 (73,8%), sebagian besar jarak kahamilan responden > 2 tahun sebanyak 71 (88,7%), sebagian besar responden dengan robekan derajat 2 sebanyak 68 (85,0%), serta berat bayi baru lahir sebagian besar 2500-4000 gram sebanyak 75 (93,7%).Kesimpulan: Perlunya perhatian dan kesadaran bidan dan ibu hamil dengan kondisi usia < 20 tahun dan > 35 tahun, jarak kehamilan < 2 tahun, berat BBL > 4000 gram saat hamil terhadap kejadian ruptur perineum, sehingga dapat meminimalkan robekan perineum.Saran: Diharapkan bidan meningkatkan kualitas dan kuantitas pelayanan pemeriksaan kehamilan sehingga dapat mendeteksi kelainan pada ibu hamil sejak dini sebagai upaya preventif terjadinya ruptur perineum terutama pada persalinan normal. Kata Kunci: Karakteristik, Persalinan, Ruptur Perineum ABSTRACT Background: Perineal rupture is a major problem related to morbidity and mortality after birth. One of the complications that can occur due to perineal rupture is infection and bleeding. Several factors cause perineal rupture, namely maternal, fetal and childbirth factors.Puspose: Identifying the characteristics of mothers who experience perineal rupture.Method: This research method is descriptive research and was carried out at the Kediri Community Health Center, West Lombok Regency. The sample in this study was 80 mothers giving birth in 2023 who experienced perineal rupture using a purposive sampling technique. The data taken in this research is secondary data, processed univariately, and presented in the form of a frequency distribution table.Results: The results of this study were obtained from 80 respondents, namely the majority of respondents aged 20-35 years as many as 64 (80.0%), the majority of respondents were multiparous as many as 59 (73.8%), the majority of respondents' pregnancy interval was > 2 years as many as 71 ( 88.7%), the majority of respondents with grade 2 tears were 68 (85.0%), and most of the newborns weighed 2500-4000 grams, 75 (93.7%).Conclusion: There is a need for attention and awareness by midwives and pregnant women aged < 20 years and > 35 years, between pregnancies < 2 years, BBL weight > 4000 grams during pregnancy regarding the incidence of perineal rupture, so as to minimize perineal tears.Suggestion: It is hoped that midwives will improve the quality and quantity of pregnancy examination services so that they can detect abnormalities in pregnant women early as an effort to prevent perineal rupture, especially in normal deliveries. Keywords: Characteristics, Childbirth, Perineal Rupture

Identification Of The Mother's Metal And Physical Preparations Before Delivery Herlina, Siskha Maya; Ulya, Yadul; Yunika, Regina Pricilia
JKM (Jurnal Kebidanan Malahayati) Vol 10, No 10 (2024): Volume 10 No.10 Oktober 2024
Publisher : Program Studi Kebidanan Fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkm.v10i10.17798

Latar Belakang: Angka kematian ibu merupakan salah satu target yang telah ditentukan dalam tujuan ke-3 Sustainable Development Goals (SDGs), target yang akan dicapai yaitu mengurangi angka kematian ibu secara global dari 218 menjadi kurang dari 70 per 100.000 kelahiran hidup hingga kurun waktu 2030 (WHO, 2018).Tingginya angka kematian ibu merupakan masalah kesehatan dunia terutama di negara berkembang. Di perkirakan 830 wanita meninggal diseluruh dunia setiap harinya dikarenakan komplikasi selama kehamilan atau persalinan. Dimana 99 % kematian terjadi di negara bepenghasilan menengah kebawah dan hampir dua pertiga terjadi di Afrika (WHO, 2018).Tujuan: mengidentifikasi persiapan mental dan fisik ibu hamil trimester III menjelang persalinanMetode: Jenis penelitian ini menggunakan jenis penelitian deskriptif. Sampel dalam penelitian ini adalah ibu hamil trimester yang berjumlah 40 orang.Hasil: persiapan fisik dan mental ibu menjelang persalinan terdapat 25 (62,5%), Hasil yang didapatkan sebanyak 15 (37,5%) ibu hamil. 25 ibu hamil yang lain belum dikatakan siap secara fisik karena komponen dari Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) belum terpenuhiKesimpulan: berdasarkan hasil penelitian yang sudah dilakukan. Ibu hamil sebagaian besar lebih banyak yanag mampu mempersiapkan persalinanya secara mental, sedangankan persiapan secara fisik masih belum banyak dilakukan karena beberapa komponen dari P4K belum terpenuhi.Saran: persiapan secara fisik dan metal harus dilakuakan oeh tenaga kesehatan kepada ibu hamail dalam mempersiapkan persalinananya, karena hal ini mampu mengurangi resiko terjadinya komplikasi pada ibu maupun bayinya. Kata Kunci: persiapan fisik, persiapan mental, ibu bersalin ABSTRACT Background: The maternal mortality rate is one of the targets that has been determined in the 3rd goal of the Sustainable Development Goals (SDGs), the target to be achieved is to reduce the global maternal mortality rate from 218 to less than 70 per 100,000 live births until 2030 (WHO, 2018). The high maternal mortality rate is a world health problem, especially in developing countries. An estimated 830 women die worldwide every day due to complications during pregnancy or childbirth. Where 99% of deaths occur in lower-middle-income countries and almost two-thirds occur in Africa (WHO, 2018).Objective: identifying the mental and physical preparation of pregnant women in the third trimester before deliveryMethod: This type of research uses a descriptive type of research. The sample in this study is 40 pregnant women in the trimester.Results: The physical and mental preparation of mothers before childbirth was 25 (62.5%), the results obtained were 15 (37.5%) pregnant women. The other 25 pregnant women have not been said to be physically ready because the components of the Childbirth Planning and Complications Prevention (P4K) Programme have not been fulfilledConclusion: Based on the results of the research that has been carried out. Most pregnant women are able to prepare for their labor mentally, while physical preparation is still not much done because some components of P4K have not been fulfilled.Suggestion: Physical and metal preparations must be made by health workers to Hamail's mother in preparing for her delivery, because this can reduce the risk of complications for the mother and her baby. Keywords: Physical preparation, mental preparation, maternity

Edukasi Tentang Ruptur Perineum Ulya, Yadul; Herlina, Siskha Maya; Yunika, Regina Pricilia
ABDIMASKU : JURNAL PENGABDIAN MASYARAKAT Vol 8, No 1 (2025): JANUARI 2025
Publisher : LPPM UNIVERSITAS DIAN NUSWANTORO

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62411/ja.v8i1.2741

Ruptur perineum merupakan robekan perineum atau perlukaan jalan lahir yang terjadi pada saat kelahiran bayi baik menggunakan alat maupun tidak. Dampak yang ditimbulkan karena ruptur perineum seperti perdarahan hebat yang dapat menjalar ke segmen bawah uterus dan perdarahan hebat. Mengingat besarnya masalah yang ditimbulkan, sebagai upaya promotif dan preventif perlu dilakukan edukasi tentang ruptur perineum. Kegiatan ini mempunyai dua tahapan yaitu tahap pertama merupakan perencanaan kegiatan dan tahap kedua pemberian edukasi dengan beberapa tahapan kegiatan yaitu pretest, pemberian materi, dan posttest. Kegiatan pengabdian masyarakat ini diikuti oleh 20 ibu hamil di Geguntur, Kelurahan Jempong Baru, Kecamatan Sekarbela, Kota Mataram.Hasil dari edukasi ini adalah terdapat peningkatan pengetahuan ibu hamil sebelum dan setelah diberikan edukasi tentang ruptur perineum sebagai upaya meminimalisir terjadinya robekan akibat laserasi atau episiotomi saat bersalin.

Pelatihan Detector Kebocoran Liquid Petroleum Gas (LPG) Sebagai Media Belajar Teknologi Hadi, Sirojul; Dewi, Puspita; Soraya, Siti; Yasa, I Nyoman Miyarta; Yunika, Regina Pricilia
Jurnal Ilmiah Pengabdian dan Inovasi Vol. 1 No. 1 (2022): Jurnal Ilmiah Pengabdian dan Inovasi (September)
Publisher : Insan Kreasi Media

Fires in homes can be caused by short circuits and leakage of Liquid Petroleum Gas (LPG). LPG gas leaks are very dangerous because apart from being able to cause fires, they can also cause explosions so LPG leaks need to be dealt with quickly so as not to cause greater damage. One way to overcome this is by training the community to make LPG gas detectors. The result of the PKM is that effective training can be carried out for junior high school children, senior high schools, and the general public.

Identification Of Labor Pain In Mothers In The Active Phase Of First Labor Yunika, Regina Pricilia; Ulya, Yadul; Herlina, Siskha Maya
JKM (Jurnal Kebidanan Malahayati) Vol 11, No 5 (2025): Volume 11 No 5 Mei 2025
Publisher : Program Studi Kebidanan Fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkm.v11i6.20453

Latar Belakang: Persalinan adalah proses alamiah yang akan dihadapi oleh setiap ibu hamil, di mana terjadi pengeluaran hasil konsepsi berupa bayi dan plasenta dari rahim ibu. Pada saat terjadi kontraksi, maka mulut rahim akan melebar sehingga mendorong bayi keluar. Tulang pubis menerima tekanan kuat dari rahim, yang menyebabkan nyeri pada persalinan. Banyak penyulit dan komplikasi yang menyebabkan kematian ibu dan bayi dapat dihindarkan jika persalinan dikelola dengan baik.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi nyeri persalinan pada ibu bersalin kala 1 fase aktif.Metode: Metode penelitian ini adalah desktiptif. Penelitian akan dilaksanakan di Puskesmas wilayah kerja Kabupaten Lombok Barat, Nusa Tenggara Barat. Sampel dalam penelitian ini sebanyak 20 ibu bersalin kala 1. Data dikumpulkan menggunakan kuesioner, diolah secara univariat, dan disajikan dalam bentuk tabel distribusi frekuensi.Hasil: Hasil menunjukkan sebagian besar usia pada kategori tidak beresiko yaitu 17 responden (85%) dan 3 responden (15%) pada usia beresiko, Sebagian besar paritas pada kategori primipara yaitu 14 responden (70%) dan 6 responden (30%) dengan multipara, serta sebagian besar ibu bersalin mengalami nyeri sedang pada persalinan kala I yaitu sebanyak 14 responden (70%), 4 responden (20%) dengan nyeri berat dan 2 responden (10%) dengan nyeri ringan.Kesimpulan: Hasil menunjukkan bahwa sebagian besar ibu mengalami nyeri dalam persalinan kala I dengan skala nyeri sedang.Saran: Tenaga kesehatan dapat memberikan pelayanan terbaik selama persalinan kala I, sehingga ibu dalam proses persalinannya lebih tenang, rileks dan tidak menimbulkan nyeri persalinan yang terlalu berlebihan. Kata Kunci : Kala I Fase Aktif, Nyeri, dan Persalinan ABSTRACT Background: Childbirth is a natural process that every pregnant woman will face, where the results of conception in the form of a baby and placenta are released from the mother's womb. When contractions occur, the cervix will widen, pushing the baby out. The pubic bone receives strong pressure from the uterus, which causes pain during labor. Many complications that cause maternal and infant death can be avoided if labor is managed properly.Objective: This study aims to identify labor pain in mothers giving birth in the first active phase.Method: This research method is descriptive. The research will be conducted at the Health Center in the working area ofWest Lombok Regency, West Nusa Tenggara. The sample in this study was 20 mothers in the first stage of labor. Data were collected using a questionnaire, processed univariately, and presented in the form of a frequency distribution table.Results: The results showed that most of the ages were in the non-risk category, namely 17 respondents (85%) and 3 respondents (15%) in the risk age, Most of the parity in the primipara category were 14 respondents (70%) and 6 respondents (30%) with multipara, and most of the mothers in labor experienced moderate pain in the first stage of labor, namely 14 respondents (70%), 4 respondents (20%) with severe pain and 2 respondents (10%) with mild pain.Conclusion: The results show that most mothers experience problems in the first stage of labor, namely problems with labor pain with moderate pain.Suggestion: Health workers can provide the best service during the first stage of labor, so that the mother is calmer, more relaxed during the labor process and does not experience excessive labor pain. Keywords: Stage I Active Phase, Pain, and Labor

Relationship Between Supporting Factors To Pregnancy Of Delivery Preparation Of Pregnant Women In The Thirty Trimester Herlina, Siskha Maya; Fatmawati, Nurul; Ulya, Yadul; Yunika, Regina Pricilia
JKM (Jurnal Kebidanan Malahayati) Vol 11, No 6 (2025): Volume 11 No 6 Juni 2025
Publisher : Program Studi Kebidanan Fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkm.v11i6.20888

Latar Belakang: Persiapan persalinan adalah rencana tindakan yang dibuat oleh ibu, anggota keluarga dan bidan. Ketidaksiapan ibu dalam menghadapi persalinan menjadi salah satu faktor penyebab tingginya Angka Kematian Ibu. Angka Kematian ibu (AKI) di kawasan ASEAN pada tahun 2020 AKI mencapai 235 per 100.000 kelahiran hidup Pengetahuan ibu mengenai persiapan persalinan merupakan faktor penting dalam menurunkan angka kematian ibu (AKI). Tujuan: untuk mengetahui faktor-faktor pendukung persiapan persalinan pada ibu hamil trimester III di Puskesmas Ampenan Metode: Penelitian ini adalah Pre - Eksperimen dengan menggunakan desain penelitian One group pretest-posttest design.. Teknik pengambilan sampel yaitu Purposive Sampling Hasil: Hasil penelitian ini sejumlah 19 responden (46.3%) yang lebih meningkat pengetahuannya setelah kelas ibu hamil, didapatkan ada 30 responden yang mengikuti kelas ibu hamil dengan nilai posttest lebih tinggi dari nilai pretest dengan jumlah ranking positif. sejumlah 38 responden (92.7%). Hal ini menunjukkan bahwa pengetahuan ibu hamil meningkat sesudah mengikuti kelas ibu. Kesimpulan: Berdasarkan hasil identifikasi, ditemukan bahwa ada hubungan pelaksanaan kelas ibu hamil terhadap pengetahuan ibu hamil tentang persiapan persalinan. Saran: Diharapkan program kelas ibu hamil tetap dilanjutkan di puskesmas sebagai wadah untuk meningkatkan pengetahuan ibu hamil khususnya mengenai persiapan persalinan. Kata Kunci: factor pendukung persiapan persalinan, persiapan persalinan, ibu hamil trimester III ABSTRACT Background: Childbirth preparation is an action plan made by the mother, family members and midwives. The mother's unpreparedness in facing childbirth is one of the factors causing the high Maternal Mortality Rate. The Maternal Mortality Rate (MMR) in the ASEAN region in 2020 MMR reached 235 per 100,000 live births. Mothers' knowledge about childbirth preparation is an important factor in reducing maternal mortality rates (MMR). Objective: to determine the supporting factors for childbirth preparation in pregnant women in the third trimester at the Ampenan Health Center Method: This study was a Pre-Experiment using a One group pretest-posttest design. The sampling technique was Purposive Sampling. Results: The results of this study were 19 respondents (46.3%) whose knowledge increased after the pregnant women's class, 30 respondents were found to have attended the pregnant women's class with a posttest score higher than the pretest score with a positive ranking. a total of 38 respondents (92.7%). This shows that the knowledge of pregnant women increased after attending the mother's class. Conclusion: Based on the results of the identification, it was found that there was a relationship between the implementation of the pregnant women's class and the knowledge of pregnant women about childbirth preparation. Suggestion: It is hoped that the pregnancy class program will continue in community health centers as a forum to increase the knowledge of pregnant women, especially regarding preparation for childbirth. Keywords : supporting factors for childbirth preparation, childbirth preparation, pregnant women in the third trimester

Maternal Factors Related To Perineal Rupture Incidents Ulya, Yadul; Herlina, Siskha Maya; Yunika, Regina Pricilia
JKM (Jurnal Kebidanan Malahayati) Vol 11, No 7 (2025): Volume 11, Nomor 7 Juli 2025
Publisher : Program Studi Kebidanan Fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkm.v11i7.21325

Latar Belakang: Ruptur perineum merupakan salah satu masalah besar yang berkaitan dengan morbiditas dan mortalitas setelah kelahiran. Salah satu komplikasi yang dapat terjadi akibat ruptur perineum yaitu infeksi dan perdarahan. Beberapa faktor maternal penyebab terjadinya ruptur perineum yaitu umur, paritas, dan jarak kelahiran.Tujuan: Mengetahui faktor maternal yang berhubungan dengan kejadian ruptur perineum.Metode: Metode penelitian ini yaitu penelitian cross sectional dan dilaksanakan di Puskesmas Gunung Sari Kabupaten Lombok Barat. Sampel dalam penelitian ini adalah semua ibu bersalin normal di Puskesmas Gunung Sari Kabupaten Lombok Barat pada tahun 2024 sejumlah 240 orang, pengambilan sample dengan teknik total sampling. Data yang di ambil dalam penelitian ini adalah data sekunder, diolah secara univariat yang disajikan dalam bentuk tabel distribusi frekuensi, dan secara bivariat menggunakan uji chi square.Hasil: Hasil analisa bivariat diketahui bahwa dari 210 responden dengan reproduksi sehat terdapat 155 (64,6%) responden mengalami ruptur perineum, dari 158 responden yang multipara terdapat 110 (45,8%) responden mengalami ruptur perineum, dan dari 141 responden dengan jarak kelahiran < 2 tahun terdapat 111 (46,3%) responden mengalami ruptur perineum.Kesimpulan: Tidak terdapat hubungan bermakna antara umur dan paritas dengan ruptur perineum dengan p-value 0,325 dan 0,217. Terdapat hubungan bermakna antara jarak kelahiran dengan ruptur perineum dengan p-value 0,015.Saran: Diharapkan bidan meningkatkan kualitas dan kuantitas pelayanan pemeriksaan kehamilan sehingga dapat mendeteksi kelainan pada ibu hamil sejak dini sebagai upaya preventif terjadinya ruptur perineum pada persalinan normal. Kata Kunci: Maternal, Persalinan, Ruptur Perineum ABSTRACT Background: Perineal rupture is one of the major problems related to morbidity and mortality after childbirth. One of the complications that can occur due to perineal rupture is infection and bleeding. Several maternal factors that cause perineal rupture are age, parity, and birth spacing.Puspose: To determine maternal factors associated with the occurrence of perineal rupture.Method: This research method is cross-sectional research and was conducted at Gunung Sari Health Center, West Lombok Regency. The sample in this study were all mothers who gave birth normally at Gunung Sari Health Center, West Lombok Regency in 2024, totaling 240 people, sampling using total sampling technique. The data taken in this study are secondary data, processed univariately which is presented in the form of a frequency distribution table, and bivariately using the chi square test.Results: The results of the bivariate analysis showed that out of 210 respondents with healthy reproduction, 155 (64.6%) respondents experienced perineal rupture, out of 158 multiparous respondents, 110 (45.8%) respondents experienced perineal rupture, and out of 141 respondents with a birth interval of <2 years, 111 (46.3%) respondents experienced perineal rupture.Conclusion: There was no significant relationship between age and parity and perineal rupture with a p-value of 0.325 and 0.217. There is a significant relationship between birth interval and perineal rupture with a p-value of 0.015.Suggestion: It is hoped that midwives will improve the quality and quantity of pregnancy examination services so that they can detect abnormalities in pregnant women early on as a preventive measure against perineal rupture during normal delivery. Keywords: Childbirth, Maternal, Perineal Rupture

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