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 postnatal life

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