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PERUBAHAN ANATOMI &

FISIOLOGI IBU HAMIL

dr. ADNAN ABADI , SpOG , KFER

IT Obstetri : Obstetri Fisiologi


1.Perubahan

morfologi janin dan fisiologi

janin.
2.Perubahan anatomik dan Fisiologi ibu
hamil.

PERUBAHAN ANATOMI & FISIOLOGI


IBU HAMIL
Perubahan

pada traktus genitalia

Uterus
Serviks
Ovarium
Tuba

Fallofii
Vagina
Perineum

PERUBAHAN ANATOMI & FISIOLOGI


IBU HAMIL
Perubahan

pada kulit
Perubahan pada Payudara
Perubahan Metabolisme
Perubahan Hematologi
Perubahan Pada sistem Kardiovaskuler

PERUBAHAN ANATOMI & FISIOLOGI


IBU HAMIL
Perubahan

pada sistem Respirasi


Perubahan pada SistemTraktus
Gastrointestinal
Perubahan Sistem Endokrin
Perubahan Hematologi
Perubahan pada Sistem Muskuloskletal

MATERNAL ADAPTATION TO
PREGNANCY

Uterus
During

pregnancy, uterine enlargement


involves stretching and marked hypertrophy of
muscle cells

MATERNAL ADAPTATION TO
PREGNANCY
Cervix
softening

and cyanosis of the cervix


vascularity and edema of the entire
cervix
hypertrophy and hyperplasia of the
cervical glands.

MATERNAL ADAPTATION TO
PREGNANCY
Ovarium
Ovulation

ceases during pregnancy and the


maturation of new follicles is suspended
only a single corpus luteum of pregnancy can
be found
functions maximally during the first 6-7 wks of
pregnancy (4-5 wks postovulation)

MATERNAL ADAPTATIONS
Fallopian
The

tubes

musculature of the fallopian tubes little


hypertrophy
The epithelium of the tubal mucosa flattened
Decidual cells may develop in the stroma of the
endosalpinx, but a continuous decidual
membrane is not formed.

MATERNAL ADAPTATIONS
Vagina

& perineum

increased

vascularity and hyperemia develop in


the skin and muscles of the perineum and vulva
softening of the normally abundant connective
tissue of these structures
Increased vascularity prominently affects the
vagina

MATERNAL ADAPTATIONS
Vagina
The

& perineum

copious secretion and the characteristic


violet color of the vagina during pregnancy
(Chadwick sign)
hypertrophy of the smooth-muscle cells
The papillae of the vaginal mucosa
hypertrophy, creating a fine, hobnailed
appearance

SKIN CHANGES
In

the later months of pregnancy, reddish,


slightly depressed streaks develop in
the skin of the abdomen,the breasts and
thighs
the reddish striae of the present pregnancy,
glistening, silvery lines that represent the
cicatrices of previous striae

SKIN CHANGES
the

midline of the abdominal skin becomes


markedly pigmented, assuming a brownishblack color to form the linea nigra
irregular brownish patches of varying size
appear on the face and neck, giving rise to
chloasma or melasma gravidarum (mask of
pregnancy)
accentuation of pigment of the areolae and
genital skin

BREAST CHANGES
1st

month breast tenderness and


tingling
2nd month the breasts increase in size
the nipples larger, more deeply
pigmented, and more erectile

BREAST CHANGES
Then

a thick, yellowish fluid, colostrum,


can often be expressed from the nipples by
gentle massage
the areolae broader and more deeply
pigmented
Scattered through the areolae glands of
Montgomery, (hypertrophic sebaceous
glands)

METABOLIC CHANGES
Water
At

metabolism

term, the water content of the fetus,


placenta, and amnionic fluid amounts to
about 3.5 L.

METABOLIC CHANGES
Water

metabolism

Increased

water retention is a normal


physiological alteration of pregnancy.

This

is mediated by a fall in plasma osmolality


of approximately 10 mOsm/kg induced by a
resetting of osmotic thresholds for thirst and
vasopressin secretion

METABOLIC CHANGES
Water

metabolism

Another

3.0 L accumulates as a result of


increases in the maternal blood volume
and in the size of the uterus and the
breasts.
Thus, the minimum amount of extra water
that the average women retains during
normal pregnancy is about 6.5 L.

PROTEIN METABOLISM
At

term, the fetus + placenta 4 kg &


contain approximately 500 g of protein, or
about half of the total pregnancy increase .

The

remaining 500 g is added to the


uterus as contractile protein, to the breasts
primarily in the glands, and to the maternal
blood as hemoglobin and plasma proteins.

PROTEIN METABOLISM
Amino

acids used for energy are not


available for synthesis of maternal protein.

With

increasing intake of fat and


carbohydrates as energy sources, less
dietary protein is required to maintain
positive nitrogen balance.

CARBOHYDRATE METABOLISM
Normal

pregnancy is characterized by
mild fasting hypoglycemia, postprandial
hyperglycemia, and hyperinsulinemia
pregnancy-induced state of peripheral
resistance to insulin
1. Increased insulin response to glucose.
2. Reduced peripheral uptake of glucose.
3. Suppressed glucagon response.

FAT METABOLISM
The

concentrations of lipids, lipoproteins,


and apolipoproteins in plasma increase.

Low-density

lipoprotein cholesterol (LDLC) levels peak week 36 the hepatic


effects of estradiol and progesterone

FAT METABOLISM
High-density

lipoprotein cholesterol (HDLC) peaks at week 25, decreases until week


32, and remains constant for the remainder
of pregnancy.

High-density

lipoprotein-2 and -3
cholesterol levels peak at approximately 28
weeks and remain unchanged throughout
the remainder of pregnancy

HAEMATOLOGICAL CHANGES
the

blood volumes at or very near term


averaged about 40 to 45 percent above
their nonpregnant levels

hemoglobin

concentration and the


hematocrit decrease slightly during normal
pregnancy

HAEMATOLOGICAL CHANGES
The

total iron content of normal adult


women ranges from 2.0 to 2.5 g
The leukocyte ranges 5000 - 12,000/Ul
fibrinogen concentration increases about
50 percent to average about 450 mg/dL
late in pregnancy, with a range from 300 to
600

CARDIOVASCULAR SYSTEM
CHANGES
The

most important changes in cardiac


function the first 8 weeks of pregnancy
Cardiac output is increased the 5th
week of pregnancy
Between weeks 10 - 20, plasma volume
,preload

RESPIRATORY SYSTEM CHANGES

The

diaphragm rises + 4 cm during


pregnancy .
The subcostal angle widens transverse
diameter of the thoracic cage +2 cm
The thoracic circumference increases + 6
cm

RESPIRATORY SYSTEM CHANGES


The

amount of oxygen needs


The respiratory rate is little changed
during pregnancy
the tidal volume, minute ventilatory
volume, and minute oxygen uptake
increase appreciably as pregnancy
advances

GI TRACT CHANGES
Gastric

emptying and intestinal transit


times are delayed in pregnancy because
of hormonal or mechanical factors.
Pyrosis (heartburn) is common during
pregnancy and is most likely caused by
reflux of acidic secretions into the lower
esophagus

BAHAN / BUKU ACUAN


1.
2.
3.
4.
5.
6.

Buku Kebidanan YBP Sarwono Prawiroharjo


William Obstetric
Kebidanan Fisiologi dr. Supono
Kebidanan Fisiologi FK UNPAD
Bunga Rampai Kebidanan Rustam Mochtar
Dll.