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Hamil Diatas Usia 30

21 March 2013 96 Comments

Banyak wanita yang mempertanyakan mengapa hamil di usia 30-an atau 40-an dianggap memiliki resiko tinggi. Di atas usia 35 tahun, memang ada beberapa resiko yang meningkat baik untuk sang ibu (seperti tekanan darah tinggi dan pre-eklampsia) dan juga untuk sang bayi (seperti resiko Down Syndrome) meningkat tiap tahunnya. Tapi, tanpa mengabaikan resiko-resiko tersebut, wanita yang berusia di atas 35 tahun juga bisa kok menjalani kehamilan yang sehat dan melahirkan bayi yang sempurna.

Jika Anda seorang wanita berusia di atas 35 tahun dan sedang hamil, dokter Anda biasanya memperlakukan Anda dengan ekstra hati-hati. Anda akan diminta untuk check up kehamilan lebih sering, dan lebih diwajibkan untuk menjalani serangkaian tes, konseling genetik dan skrining kendala-kendala yang mungkin terjadi pada wanita hamil usia 30-an. Pilihan proses melahirkan juga biasanya lebih terbatas. Anda kemungkinan tidak akan disarankan untuk melahirkan di bidan atau rumah bersalin kecil, karena resiko melahirkan Anda lebih besar sehingga Anda akan diminta untuk melahirkan di rumah sakit besar atau rumah bersalin besar. Namun, dengan melakukan perawatan prenatal yang baik, Anda bisa mengurangi komplikasi yang berhubungan dengan usia persalinan secara signifikan.

Kabar baiknya adalah, kebanyakan wanita yang hamil di usia 40-an ternyata berhasil menjalani kehamilan yang sehat dan melahirkan bayi yang sehat pula. Dan wanita hamil pada usia 40-an biasanya lebih berhati-hati terhadap kehamilannya dibandingkan wanita yang lebih muda. Mereka akan lebih mencari dan menyerap informasi dengan baik tentang kondisi-kondisi dan resiko-resiko yang mungkin terjadi pada kehamilan mereka. Mereka biasanya lebih sering bertanya tentang perkembangan janin mereka. Mereka juga lebih mementingkan perawatan pre-natal dan biasanya mempersiapkan diri mereka lebih baik sebelum hamil, jika kehamilan tersebut memang direncanakan. Karena itu para ilmuwan sekarang mempercayai bahwa resiko ibu hamil di usia yang lebih tua tidak meningkat secara tajam hanya karena faktor usia saja.

Masalah-masalah utama

Ada beberapa masalah yang sering ditemukan dokter pada wanita hamil dengan usia di atas 35 tahun, seperti diabetes gestational (diabetes yang muncul pada saat kehamilan), tekanan darah tinggi dan juga masalah-masalah pada janin. Wanita hamil dengan usia yang lebih tua juga akan lebih sering mengalami masalah pada kandung kemih dibandingkan wanita hamil dengan usia yang lebih muda. Resiko-resiko lainnya adalah resiko keguguran lebih besar, lebih banyak yang melahirkan melalui operasi Caesar karena kondisi yang tidak memungkinkan untuk melahirkan secara normal, dan juga memiliki resiko lebih tinggi melahirkan bayi cacat.

Saat berusia akhir 30-an, wanita cenderung mengalami kondisi-kondisi medis berkaitan dengan sistem reproduksi, seperti fibroid uterine dan tumor otot. Fibroid uterine adalah pertumbuhan sel otot atau jaringan lain di dinding uterus, membentuk tumor. Fibroid uterine dan tumor otot bisa menimbulkan rasa nyeri atau perdarahan vagina saat kehamilan berkembang. Jika wanita tersebut hamil di atas usia 40 tahun, tingkat keparahannya bahkan lebih berat lagi. Problem-problem tadi bisa bertambah dengan adanya hemoroid (wasir), inkontinensi (kesulitan menahan keluarnya urin), varises, problem-problem pembuluh darah, nyeri otot, nyeri punggung, dan juga proses melahirkan yang lebih sulit dan lebih panjang.

Selain resiko melahirkan bayi dengan Sindroma Down, resiko keguguran dan melahirkan dengan operasi Caesar, wanita hamil berusia di atas 35 tahunan juga memiliki resiko bayi meninggal saat dalam rahim atau saat proses melahirkan. Walaupun resiko ini ada di setiap usia kehamilan, namun pada wanita dengan usia 35 tahun ke atas, resiko ini lebih besar, yaitu 7 dari 1000 kehamilan.

Konseling Genetik

Wanita yang hamil dengan usia di atas 35 tahun biasanya juga akan diminta untuk melakukan konseling genetik, atau konseling ini bisa juga dilakukan oleh dokter kandungan. Ada 3 wilayah yang menjadi fokus pada saat melakukan konseling genetik, yaitu sejarah/riwayat reproduksi pasien, riwayat kesehatan keluarga, serta consanguinity, yaitu kondisi genetika yang disebabkan perkawinan antar-saudara.

Riwayat reproduksi meliputi apakah pasien pernah hamil, pernah mengalami keuguguran, atau pernah mengalami kematian janin di dalam rahim atau saat proses melahirkan. Selain itu penggunaan metode KB, lama waktu penggunaan KB, dan apakah pasien pernah terpapar zat-zat berbahaya misalnya karena lingkungan pekerjaan juga menjadi informasi yang penting dalam konseling.

Riwayat kesehatan keluarga pasien juga penting untuk menentukan apakah kehamilan yang sedang dijalani termasuk kehamilan ber-resiko tinggi atau tidak. Informasi ini mencakup tentang status kesehatan pasien dan pasangan, para saudara kandung pasien dan pasangan, jika ada yang sudah meninggal juga akan ditanyakan penyebab dan usia saat meninggal serta apakah ada yang meninggal sehubungan dengan proses kelahiran (saat melahirkan atau saat dilahirkan). Riwayat kesehatan keluarga akan membantu dokter mengidentifikasi abnormalitas yang telah muncul di keluarga pasien dan membantu memprediksi kemungkinannya untuk muncul pada pasien.

Jika pasien dan pasangan masih tergolong saudara, hal ini juga penting untuk diinfokan pada dokter/konselor, karena jika pasangan suami istri adalah sepupu langsung, mereka memiliki 1/16 gen yang sama. Artinya kemungkinan terjadi kelainan-kelainan genetika pada anak yang akan dilahirkan lebih tinggi dibanding jika mereka menikah dengan orang yang tidak dalam satu kerabat. Beberapa orang Afrika dan etnis Mediterania juga memiliki kecenderungan untuk menurunkan penyakit Anemia sickle cell pada turunannya.

Yang penting untuk diperhatikan adalah, konselor atau dokter tidak akan memberikan keputusan pada pasien dan pasangannya berkenaan dengan hasil konseling. Mereka hanya akan menyediakan informasi-informasi yang dibutuhkan sang pasien tentang kehamilan dan janinnya, dan keputusan bahwa apakah kehamilan tersebut akan diteruskan atau digugurkan (jika prediksi terhadap resiko-resiko yang mungkin dialami terlalu tinggi) diserahkan sepenuhnya pada calon orang tua.

Prenatal Testing

Prenatal Testing atau pengujian-pengujian pada saat kehamilan yang dilakukan pada kehamilan beresiko tinggi tidak dapat mendeteksi semua abnormalitas yang mungkin terjadi. Namun abnormalitas kromosom bisa dideteksi pada saat perkembangan janin melalui serangkaian tes seperti amniocentesis, ultrasound, sampling chorionic villus dan fetoscopy. Hasil dari serangkaian pengujian ini akan memberi pilihan bagi pasangan untuk melanjutkan kehamilan atau menggugurkan janin yang dikandung jika ternyata terdeteksi adanya kelainan. Hasil tes-tes ini juga akan menjadi panduan bagi dokter dan tenaga kesehatan untuk melakukan tindakan-tindakan yang dirasa perlu pada saat kehamilan, kelahiran, dan membantu sang orang tua untuk memberi saran-saran tentang tumbuh-kembang sang buah hati.

Kehamilan di usia di atas 35 tahun kedengarannya memang menyeramkan, tapi seperti yang telah disebutkan sebelumnya, kebanyakan wanita yang hamil di atas usia 35 tahun berhasil menjalankan kehamilan yang sehat dan melahirkan bayi yang sempurna. Memang benar bahwa resiko akan bertambah sejalan dengan meningkatnya usia calon ibu saat hamil, namun dengan persiapan yang lebih matang, informasi yang lebih lengkap, serta bantuan tenaga kesehatan yang lebih sigap dan informatif terhadap kondisi kehamilan beresiko tinggi akan membantu sang calon ibu untuk bisa tetap percaya diri, sehat, dan semangat saat menjalani kehamilannya.

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