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(Ananas Comosus (L.) Merr.) Juice on Fundal Height in Primigravida Mothers During Postpartum Period

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(Ananas Comosus (L.) Merr.) Juice on Fundal Height in Primigravida Mothers During Postpartum Period Harianja WY, et al. Belitung Nursing Journal. 2017 April;3(2):134-141 Accepted: 28 February 2017 http://belitungraya.org/BRP/index.php/bnj/ © 2017 The Author(s) This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORIGINAL RESEARCH ISSN: 2477-4073 THE IMPACT OF PINEAPPLE (ANANAS COMOSUS (L.) MERR.) JUICE ON FUNDAL HEIGHT IN PRIMIGRAVIDA MOTHERS DURING POSTPARTUM PERIOD Winda Yunyaty Harianja1*, Onny Setiani2, Umaroh3, MeLyana NuruL Widyawati1, Imam Djamaludin Mashoedi1, Sri Endang Pujiastuti1 1Magister Applied Midwifery, Health Ministry Polytechnic Semarang, Semarang, Indonesia 2Fakultas Kedokteran, Universitas Diponegoro, Semarang, Indonesia 3Prodi DIII Kebidanan, Health Ministry Polytechnic Semarang, Semarang, Indonesia *Corresponding author: Winda Yunyaty Harianja, S.ST, M.Tr. Keb Magister Applied Midwifery, Health Ministry Polytechnic Semarang Jl. Tirto Agung, Pedalangan, Banyumanik, Kota Semarang, Jawa Tengah, Indonesia (50268) E-mail: [email protected] ABSTRACT Background: Failure in the process of uterine involution can result in bleeding if not treated immediately. Provision of pineapple (Ananas Commosus (L). Merr) juice can be administered as a medicinal plant therapy to prevent sub involution of the uterus and is considered to speed up the recovery process of the uterine involution. Objective: This study aims to examine the effect of pineapple (Ananas Commosus (L). Merr) juice to decrease fundal height in primigravida mothers during postpartum period. Design: This was a quasi-experimental study with non-equivalent control group, conducted in the working area of the Health Center (Puskesmas) of Jekulo Kudus Indonesia on 1-30 December 2016. There were 28 respondents selected using consecutive sampling technique, consisted of 14 respondents in the intervention group and 14 respondents in the control group. Data were analyzed using independent t-test and paired t-test. Results: Findings showed that there was a mean difference of the height of the uterine fundus after given pineapple juice in the intervention group with mean score 13.80 in pretest and 5.80 in posttest, while there was also a decrease in fundal height in the control group with mean score 13.35 in pretest and 7.01 in posttest. The mean of fundal height in the intervention group was 8.15 cm and in the control group was 6.09 cm in 7 days. There was significant difference of the average of the decrease of fundal height between both groups with p- value (0.000). Conclusions: Pineapple (Ananas comosus (L.) Merr) juice had a significant effect in the decrease of fundal height. It is suggested that pineapple juice can be used as herbal or medicinal plants, which can be used during postpartum period that is processed naturally without involving the use of chemical and incorporated into the procedure standard of midwives in postnatal care. Keywords: pineapple juice, fundal height, primigravida, postpartum Belitung Nursing Journal , Volume 3, Issue 2, March-April 2017 134 Editor’s Note: This article has been updated on 17 June 2020 in terms of minor changes in the reference format. The update is according to BNJ Policy on article correction. INTRODUCTION prolonged labor (5 cases), and pre- Maternal mortality in Central Java eclampsia (9 cases).7 Indonesia in 2014 was 126.55 per 100,000 On the other hand, inadequate live births, and deaths occur during uterine contractions during postpartum postpartum was equal to 57.93%.1 period may cause poor involution Postpartum maternal mortality in Kudus process.8 Uterine involution is the process in 2015 was 10 people caused by high by which the uterus return to its normal preeclampsia (4 people), bleeding (3 pre-pregnant state, preceded by strong people), eclampsia (1 person), heart uterine contractions.9 If the process is disease (1 person), and pulmonary interrupted, then it is called uterine sub embolism (1 person),2 while the coverage involution, which is one of the symptoms of postpartum mothers in 2015 amounted in the postnatal pathology that can cause to 97.27%.2 complications during postpartum. The Postpartum hemorrhage is one of occurrence of sub involution uterus is one the most important issues, which lead to symptom of the failures of the uterus to maternal death. Based on research results return to the non-pregnant state, of Bateman BT, et al at the hospital of the characterized by delays of uterine fundus United States showed that in 2004-2010, reduction, and accompanied by of 25,654 deliveries, there were 876,641 lengthening the period of expenditure cases of bleeding in the postpartum lokhea or heavy bleeding and irregular, period, which 79% of the causes were soft and bigger uterus than normal.10 main atonic or lack of uterine contractions Uterine sub involution is one of the during postpartum.3 According to Walfish causes of bleeding, according to a study M et al, postpartum hemorrhage was the conducted by Gita & Saced on normal state of blood loss > 500 ml at 24 hours pattern of uterine involution with after birth.4 Based of the study of Sher Symphysis Method- Fundus Distance (S- Zaman, Bushra et al indicated that the FD) in primiparous women in Fatemieh causes of primary postpartum hemorrhage Hospital, Hamedan, Iran, found that 21 were retained placenta which amounted to women from a total of 180 respondents (53.7%), followed by the birth canal experienced uterine sub involution due to laceration (29.3%), atonic (14.6%), and lack of adequate uterine contractions.11 uterine inversion of (2.4%).5 According to Therefore, efforts should be made to Ujah IAO et al found that the main cause accelerate the process of uterine of primary postpartum hemorrhage was involution to increase its contraction. atonic (47.9%) and retained placenta Postpartum care is one of the efforts (71.05%).6 that aims to expedite the recovery process, Based on the data of preliminary accelerate the process of involution with study obtained from the Health Center the aim of preventing the occurrence of (Puskesmas) of Jekulo Kudus in 2015, complications during childbirth. In indicated that there were 854 postpartum addition, medical treatment now has mothers (98.2%).7 There were two of developed a technique of treatment using postpartum maternal deaths due to medicinal plants. One of herbal / bleeding caused by uterine atony and pre- medicinal plants that are considered to eclampsia.7 Based on the report of this facilitate healing or recovery process is health center, of 854 deliveries, 34 consuming pineapple.12 Thus, mothers were reported making the referral nonpharmacologic efforts to improve to the hospital caused by uterine atony (11 uterine contractions during postpartum is cases), retained placenta (9 cases), to eat pineapple, which contains Belitung Nursing Journal , Volume 3, Issue 2, March-April 2017 135 bromelain enzyme. Bromelain is a reduction of fundal height in primigravida proteolytic enzyme or protease that is mothers during postpartum period in the found only in the pineapple plant (Ananas health center of Jekulo Kudus, Indonesia. Comosus (L.) Merr).13 The content of bromelain in pineapple (Ananas Comosus METHODS (L.) Merr) is most abundant in stems and Design fruits, while other parts such as seeds, This was a quasi-experimental study with bark, leaves, roots and its crown contains non-equivalent control group. only small amount of bromelain.13 Bromelain has a function as antiedema, Setting fibrinolytic, anti-cancer, anti-inflamma- This research was conducted in the tory, antibiotics, anticoagulants and anti- working area of the Health Center thrombotic and used as a medicine to cure (Puskesmas) of Jekulo Kudus on 1 – 30 or treatment. 13,14 December 2016. In this regard, bromelain enzyme increases the hydrolytic activity of the Population and sample connective tissue, especially on collagen. The target population in this study was 13 Collagen is a constituent component primigravida mothers in the postpartum walls of arteries, veins and capillaries of periods. There were 28 respondents the body which provides the strength, recruited in this study using consecutive structure and flexibility of blood vessels sampling technique. The formula of in order to transport blood throughout the Lemeshow17 was used to recruit the body effectively.15 Extract of pineapple or sample that consisted of 14 respondents in pieces of pineapple juice given repeatedly the intervention group and 14 respondents lead to the high concentration of the in the control group. The inclusion criteria enzyme bromelain in the blood. Collagen of the sample were postpartum primipara, is hydrolyzed by the enzyme bromelain had normal deliveries, had early initiation make the uterus becomes very pliable. of breastfeeding, no food restriction, Hydrolysis of collagen by bromelain, normal BMI, no complications, did early especially type III collagen can cause mobilization, could communicate uterine smooth muscle becomes elastic, cooperatively, able to eat orally in the thus the involution process will be form of soft or regular, and willing to better.15 become respondents by signing the According to the research of informed consent. Muzzamman who conducted laboratory tests on the effects of the extra pineapple Intervention on uterine contractions of female The intervention was given to the marmots, it showed that there was respondents in the intervention group was statistically a significant relationship the ripe pineapple juice with dose 250 between giving extra pineapple with the grams. The juice was made using a juicer activity of uterine contractions in female with a concentration level of 100% to marmots;16 thus, based on the results of make 200 cc of a pure juice without added these studies, it is assumed that water and sugar, given 1x daily for 7 days. consumption of pineapple fruit will also The juice was provided by the affect uterine contractions during investigators and taken directly by the pregnancy and non-pregnancy.
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