PERUBAHAN

MORFOLOGI DAN
FISIOLOGI JANIN
Adenan Abadi
Fakultas Kedokteran Universitas Sriwijaya

PERTUMBUHAN dan PERKEMBANGAN

Selama 8 minggu pertama, terminologi embrio
digunakan terhadap perkembangan organisme oleh
karena pada masa ini semua organ besar sedang
dibentuk
Setelah 8 minggu, terminologi janin digunakan oleh
karena sebagian besar organ sudah dibentuk dan
telah masuk kedalam tahap pertumbuhan dan
perkembangan lanjut.
Janin dengan berat 500 1000 gram (22-23
minggu) disebut imature. Dari minggu 28 36
disebut preterm dan janin aterm adalah bila usia
kehamilan lebih dari 37 minggu.

Kehamilan 8 minggu
Panjang 2.1 2.5 cm
Berat 1 gram
Bagian kepala lebih dari setengah
tubuh janin
Dapat dikenali lobus hepar
Ginjal mulai terbentuk
Sel darah merah terdapat pada yolc
sac dan hepar

Kehamilan 12 minggu

Panjang 7 9 cm
Berat 12 15 gram
Jari-jari memiliki kuku
Genitalia eksterna sudah dapat
dibedakan antara laki dan
perempuan
Volume cairan amnion 30 ml
Peristaltik usus sudah terjadi dan
memilki kemampuan menyerap
glukosa

Kehamilan 16 minggu

Panjang 14 17 cm
Berat 100 gram
Terdapat HbF
Pembentukan HbA mulai terjadi

Kehamilan 20 minggu
Berat 300 gram
Detik jantung dapat terdengar
dengan menggunakan stetoskop
DeLee
Terasa gerakan janin
Tinggi fundus uteri sekitar umbilikus

Kehamilan 24 minggu
Berat 600 gram
Timbunan lemak mulai terjadi
Viabilitas mungkin dapat tercapai
meski amat jarang terjadi

Kehamilan 28 minggu
Berat 1050 gram ; panjang 37 cm
Gerakan pernafasan mulai terlihat ;
surfactan paru masih sangat rendah

Kehamilan 32 minggu
Berat 1700 gram dan panjang 42 cm
Persalinan pada periode ini 5 dan 6
neonatus dapat bertahan hidup

Kehamilan 36 minggu
Berat 2500 gram dan panjang 47 cm
Gambaran kulit keriput lenyap
Kemungkinan hidup besar

Kehamilan 40 minggu
Berat 3200 3500 gram ; panjang
50cm
Diameter biparietal 9.5 cm

Growth and Functional Development

of Fetus
Initial development of placenta and fetal
membranes occurs far more rapidly than
development of fetus
2-3 weeks after implantation of blastocyst,
the fetus remains almost microscopic in size
But thereafter the length of fetus increases
in proportion to age:
- At 12 weeks : 10 cm
- At 20 weeks : 25 cm
- At 40 weeks (at term) : 53 cm

Development of Organ Systems

Gross characteristics of different organs:
- Within 1 month after fertilization begun to develop
- During the next 2-3 months, most of details are
established
- Beyond the 4th month: mainly the same as those of the
neonate

Cellular development in each organ is usually far

from complete:
- Requires the full remaining 5 months for complete
development
- Even at birth certain structures (nervous system,
kidneys, and liver) lack full development

Circulatory System
Heart:
Begins beating during the 4th week after
fertilization 65 bpm and increases to 140
bpm before birth

Blood cells:
- During the midportion of fetal life:
Extra marrow areas are the major sources of blood
cells

- During the latter 3 months of fetal life:

Bone marrow gradually take over, while other areas
lose their ability, except for lymphocytes and plasma
cells produce in lymphoid tissue

Respiratory System
Respiration cannot occur during fetal life
At the end of 1st trimester of pregnancy: respiratory
movements caused by tactile stimuli or fetal asphyxia
During the latter 3-4 months of pregnancy for
unclearly reasons:
- Respiratory movements are inhibited
- Lungs remain almost completely deflated
- It prevents filling of lungs with debris from
meconium
- Fluid is secreted into the lungs by alveolar
epithelium up until birth keeping only clean fluid
in the lungs

Nervous System
Most of skin reflexes are present by
3rd 4th month of pregnancy
However, functions of central
nervous system that involve cerebral
cortex are still mainly undeveloped,
even at birth
Myelinization of some major tracts of
central nervous system becomes
complete only after 1 year of

Gastrointestinal Tract
By midpregnancy: fetus ingests and absorbs
large quantities of amniotic fluid
During the last 2-3 months: gastrointestinal
function approaches that of normal neonate
Small quantities of meconium are continually
formed in gastrointestinal tract and excreted
from bowel into amniotic fluid
Meconium is composed of:
- Residue from amniotic fluid
- Excretory products from gastrointestinal mucosa
and glands

The Kidneys
Fetal kidneys are capable of excreting urine
during at least the latter half of pregnancy
and urination occurs normally in utero
However, renal control systems for
regulating:
- Extracellular fluid electrolytes balances
- Acid-base balance
are almost nonexistent until after midfetal
life and do not reach full development until
a few months after birth

Fetal Metabolism
Fetal uses mainly glucose for energy
Fetal has a high rate of storage of fat and protein
Most of fat being synthesized from glucose,
rather than being absorbed from mothers blood
Some special problems of fetal metabolism in
relation to:
- Calcium and phosphate
- Iron
- Some vitamins

Metabolism of Calcium and

Phosphate

22.5 gr of calcium and 13.5 gr of phosphorus are

accumulated during gestation:
of it accumulates during the last 4 weeks of
gestation which is coincident with the period of rapid
ossification of fetal bones as well as rapid weight gain
During the earlier part of fetal life, fetal bones are
relatively unossified and have mainly cartilagous
matrix until 4th month of pregnancy
Total amount of calcium and phosphate needed during
gestation represent only 1/50 quantities of these
substances in mothers bone minimal drain from
mother
A much greater drain occurs after birth during lactation

Metabolism of Iron
Iron accumulates in fetus more rapidly than
calcium and phosphates
Most of iron is in the form of Hb, which begin to be
formed at 3rd week after fertilization
Small amounts of iron are concentrated in mothers
uterine progestational endometrium even before
implantation, which then ingested into embryo by
trophoblastic cells for early formation of RBC
1/3 of iron in a fully developed fetus is stored in
liver that can be used for several months after birth

Metabolism of Vitamins
Fetus needs vitamins equally as much as adult and in
some instances to a far greater extent
Vitamins function the same in fetus as in adult:
- Vit B: especially B12 and folic acid for formation of RBC
and nervous tissue as well as for overall growth
- Vit C: for appropriate formation of intercellular
substances, especially bone matrix and fibers of
connective tissue
- Vit D: probably for normal bone growth in fetus
But more important for adequate absorption of calcium
from mothers gastrointestinal tract large quantities
will be stored by fetal liver to be used for several months
after birth

..Metabolism of
Vitamins

- Vit E: necessary for normal development of early

embryo
although the mechanisms are not clear
In its absence in laboratory animals: spontaneous
abortion usually occurs at an early age
- Vit K: for formation of Factor VII, pro-thrombin, and
several other blood coagulation factors
When vit K is insufficient in mother: Factor VII and prothrombin become deficient in fetus as well as in mother
Because most vit K is formed by bacterial action in
colon, neonate has no adequate source of vit K
prenatal storage in fetal liver derived from mother is
helpful in preventing hemorrhage, particularly when
head is traumatized by squeezing through birth canal