PROSES KELAHIRAN

(Perubahan Link. Intrauterine
Link. Ekstrauterine)

PERUBAHAN LINGKUNGAN
INTRA – EKSTRA UTERUS KONTRAKSI uterus
“at term”
TERHADAP FISIOLOGI (Frekuensi-Durasi-Intensitas)

SISTEM TUBUH
Sirkulasi (PO22/PCO22) terganggu

Department of Physiology, Faculty of Medicine Asphyxia (PO22 

 & PCO22 
)
University of Sumatera Utara, Medan
Indonesia Heart Rate :
140x/mnt

160-180x/mnt
1

bila O22 



100-120x/mnt

at birth
Perubahan SIRKULASI segera setelah Lahir
potong Umbilical cord (tali pusat)

Bayi
Bayilahir
lahir (normal)
(normal)
Sirkulasi Plasenta (-)

Asphyxia (CO2  & O2 )

Rangs.
Rangs.Dingin
Dinginpd
pdKulit
Kulit++ Asphyxia
Asphyxia Menangis  Tarik Napas
Rangs. Dingin
Tahanan peripher 
Paru mengembang

Bayi
BayiMenangis
Menangis Tahanan paru 

TD.Aorta  TD. pulmonal 

PO
PO22


70-80
70-80 mmHg
mmHg
Saturasi TD. Aorta >> TD. Art.Pulmonal
SaturasiHb-O
Hb-O22::80-90%
80-90% 3
 Bbrp. Jam postpartum

Aliran Atrium Kiri  & Aliran Atrium Kanan 

Aliran darah Aorta
Arteri Pulmonalis

Konstriksi Duktus Arteriosus

(Penutupan Fungsional)

1 - 4 Bulan

Fibrosis
Occluded

Sirkulasi Dewasa
5 6

Circulation in Fetus and Newborn

TD.
TD.Aorta
Aorta >>
>>TD.
TD.Art.Pulmonal
Art.Pulmonal

Aliran
Alirandarah
darahparu
paru

Aliran
AliranAtrium
AtriumKiri
Kiri&&Aliran
AliranAtrium
AtriumKanan
Kanan

Tek.
Tek.Atrium
AtriumKiri
Kiri>>Tek.
>>Tek.Atrium
AtriumKanan
Kanan

Foramen Ovale Tertutup

7 8
 PERUBAHAN SIRKULASI MENARIK NAFAS PERTAMA (The First Breath)

PLASENTA PLASENTA Perubahan Respirasi Placenta
Respirasi paru

JARINGAN TUBUH JARINGAN TUBUH JARINGAN TUBUH Bayi

BayiLahir
Lahir
FO
FO
Rangsang
Rangsangsensorik
sensorik::Kulit
Kulit&&Otot
Otot Asidosis
AsidosisRingan
Ringan
VENT Ki  ATR Ki VENT Ki  ATR Ki VENT Ki  ATR Ki

PARU PARU
PARU PARU Pusat
PusatPernapasan
Pernapasan
DA DA DA

VENT Ka  ATR Ka VENT Ka  ATR Ka VENT Ka  ATR Ka Kontraksi

Kontraksiotot-otot
otot-ototPernapasan
Pernapasan

FETUS PERINATAL (0-1 Bln) BAYI (1-4 Bln)
Dewasa Vol.

Vol.Intra
IntraThoraks
Thoraks&&Tek.
Tek.Intra
IntraThoraks
Thoraks

FO : Foramen Ovale Udara

UdaraMasuk
Masukke
keParu
Paru
9 10
DA : Ductus Arteriosus

REGULASI SUHU TUBUH Regulasi Suhu Blm. Stabil

Thermogenesis (Heat Gain) Thermolysis (Heat Loss)

Bayi Iklim intrauterine (“
(“tropis”
tropis”)  Iklim Ekstrauterine

Tak dpt menggigil (respon Luas permukaan bayi >>

STRESS dingin)
Sistem syaraf blm. Dewasa
Sempurna. Kulit & Jar. Subcutan tipis
Regulasi Suhu Respon dingin :
High Conductance

BELUM STABIL Panas hilang >>

Metabolisme “brown fat”

Trigliserida
Cairan Tubuh 

Free fatty acid
Suhu Tubuh
TDK STABIL BB  (5-10%) 2-3 Hr
pertama
11 12
 REGULASIGLUKOSA
REGULASI GLUKOSA
FUNGSI LIVER
Segerasetelah
Segera setelahlahir
lahir
KGD30-40mg/100mL

KGD 30-40mg/100mL

Bayi baru lahir Bbrp.jam

Bbrp. jam
Sumber Energi
Glikogen
Glikogen 


GLIKOGEN
GLIKOGEN GLUKONEOGENESIS
GLUKONEOGENESIS
LIVER,
LIVER,OTOT,
OTOT,JANTUNG,
JANTUNG,dll
dll Gangguan/gagal
Gangguan/gagal

KGD<20mg/100mL
KGD <20mg/100mL
Pemberian
Pemberian
Beberapa jam Glukosa
Glukosa
postpartum GLIKOGEN
GLIKOGEN
 Ggn.Syaraf
Ggn. Syaraf&&Koma
Koma
Apnoe + Cyanosis
Apnoe + Cyanosis
13 14

METABOLISME PROTEIN & LEMAK

BILIRUBIN & FUNGSI DETOXIFIKASI
Fetus
Fungsi
FungsiEkskresi
EkskresiBilirubin
Bilirubin(Hati)
(Hati)&&
Tak
TakMelawati
Melawati“Barrier
“Barrier Melawati
Melawati“Barrier
“BarrierPlacenta”
Placenta” Detoxifikasi
DetoxifikasiObat-obatan
Obat-obatan
Placenta”
Placenta” --Immunoglobulin
Immunoglobulin
--Plasma
PlasmaProtein
Protein Blm.
Blm.Sempurna
Sempurna
--Lemak
Lemak

Sintesa
Sintesadi
diHati
Hati::
Albumin
Albumin&&Lemak
Lemak Physiological
Physiological
Joundice
Joundice(3-7
(3-7Hari)
Hari)

Segera Setelah Aktivasi

AktivasiMet.
Met.As.Nukleat
As.Nukleat&&
Lahir sintesa
sintesaProtein
Protein

15 16
TRACT. GASTROINTESTINALIS
PENGATURAN ENDOKRIN
“Rute PLACENTA”
“Rute INTESTINAL”
PERTUMBUHAN

MOTILITAS Gastric
GastricEmptying
EmptyingTime
Time::3-4
3-4jam
jam
MOTILITAS
Enzym
EnzymLambung
Lambung&&HCl,
HCl,pH
pH::<3
<3
(pencernaan
(pencernaanSusu)
Susu) Foetus Growth dipengaruhi :
Enzym
EnzymIntestinal,
Intestinal,dan
danEmpedu
Empedu


“Maternal Nourishment”
Nourishment” Fetus Growth Tdk.dipengaruhi :
SEKRESI
SEKRESI CUKUP
CUKUP Estrogen & Progesteron Growth Hormon Foetus
Amilase
AmilasePankreas
Pankreas<<<
<<< Thyroxine Foetus

Zat
ZatNutrisi
BAIK
Nutrisi
BAIK
ABSORPSI
ABSORPSI Kecuali LEMAK
Kecuali LEMAK 18
17

Adrenal Korteks
Padaurine
Pada urine Kortikosteroid (+)

Thyroid Gland
Keadaanstress
Keadaan stress Respon kelenjar (+)

AKTIF segera Stlh Lahir

PERKEMBANGAN SaatLahir
Lahir
(respon thd dingin) Saat

PO22
PO

ASPHYXIA
ASPHYXIA

Adrenal Epinephrin/NE
Epinephrin/NE
IBU Lahir Bayi Medula
VASOKONSTRIKSI
VASOKONSTRIKSI
(HYPOTHYROIDISM) (HYPOTHYROIDISM)

Respon Metabolik Mempertahankan

19
Thd DINGIN Sirkulasi Darah Otak
20
 SISTEM SYARAF

Sifat Refleks

PERAN HORMON DALAM

Sist. Syaraf Pusat
Flexion Reflex,menangis wkt. PROSES TUMBUH DAN
Lapar, memutar Kepala, dll.
Buka mata (respon Cahaya &
KEMBANG
Pertumbuhan :
Suara)
- me
 pd Trimester II & III (maks)
Tidur barbagai posisi
-Berat : ¼ berat Otak Dewasa

21 22

Multiple hormones, including growth hormone (GH),

insulin-like growth factors (IGF-I and -II), insulin, thyroid
hormones, glucocorticoids, androgens, and estrogens
contribute to the growth process in humans.
Among these, GH and IGF-I have been implicated as the
major determinants of growth in normal postuterine life.
However, deficiencies (or excesses) of each of the other
hormones can seriously affect the normal growth of the
musculoskeletal system as well as the growth and
maturation of other tissues.

23 24
 25 26

Pancreas: Insulin 5. Pancreas: Insulin (Control)

• actions: hypoglycemic (lowers blood • stimulated by:
glucose) – increased blood glucose
– increases transport of glucose into muscle and fat – increased blood amino acid
and fatty acid levels
cells (NOTE: does not increase uptake by brain,
– parasympathetic impulses
liver, or kidney) – hyperglycemic hormones
– inhibits breakdown of glycogen and formation of (GH, glucagon, epinephrine,
thyroxine, glucocorticoids)
glucose from amino acids or fatty acids (inhibits indirectly result in insulin
glycogenolysis and gluconeogenesis) secretion by increasing blood
glucose levels
– promotes formation of glycogen (liver, skeletal
muscles), protein synthesis (muscle), and fat • inhibited by:
– low blood glucose and by
synthesis and storage (adipose) somatostatin
27 28
– sympathetic impulses
29 30

31