PERUBAHAN LINGKUNGAN

INTRA EKSTRA UTERUS

TERHADAP FISIOLOGI
SISTEM TUBUH

Department of Physiology, Faculty of Medicine

University of Sumatera Utara, Medan
Indonesia

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 PROSES KELAHIRAN
(Perubahan Link. Intrauterine Link. Ekstrauterine)

KONTRAKSI uterus
at term
(Frekuensi-Durasi-Intensitas)

Sirkulasi (PO2/PCO2) terganggu

Asphyxia (PO2 & PCO2 )

Heart Rate :
140x/mnt 160-180x/mnt
bila O2 100-120x/mnt
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Perubahan SIRKULASI segera setelah Lahir

Bayi lahir (normal)

Rangs. Dingin pd Kulit + Asphyxia

Bayi Menangis

PO2 70-80 mmHg

Saturasi Hb-O2 : 80-90%
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at birth

potong Umbilical cord (tali pusat)

Sirkulasi Plasenta (-)

Asphyxia (CO2 & O2 )

Rangs. Dingin Menangis Tarik Napas

Tahanan peripher
Paru mengembang

Tahanan paru

TD.Aorta TD. pulmonal

TD. Aorta >> TD. Art.Pulmonal

 TD. Aorta >> TD. Art.Pulmonal

Aliran darah paru

Aliran Atrium Kiri & Aliran Atrium Kanan

Tek. Atrium Kiri >>Tek. Atrium Kanan

Foramen Ovale Tertutup

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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
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Circulation in Fetus and Newborn

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 PERUBAHAN SIRKULASI

PLASENTA PLASENTA

JARINGAN TUBUH JARINGAN TUBUH JARINGAN TUBUH

FO
FO

VENT Ki ATR Ki VENT Ki ATR Ki VENT Ki ATR Ki

PARU PARU
PARU PARU
DA DA DA

VENT Ka ATR Ka VENT Ka ATR Ka VENT Ka ATR Ka

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

FO : Foramen Ovale

DA : Ductus Arteriosus 9
 MENARIK NAFAS PERTAMA (The First Breath)

Perubahan Respirasi Placenta Respirasi paru

Bayi Lahir

Rangsang sensorik : Kulit & Otot Asidosis Ringan

Pusat Pernapasan

Kontraksi otot-otot Pernapasan

Vol. Intra Thoraks & Tek. Intra Thoraks

Udara Masuk ke Paru

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 REGULASI SUHU TUBUH

Bayi Iklim intrauterine (tropis) Iklim Ekstrauterine

STRESS

Regulasi Suhu
BELUM STABIL

Suhu Tubuh
TDK STABIL

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 Regulasi Suhu Blm. Stabil

Thermogenesis (Heat Gain) Thermolysis (Heat Loss)

Tak dpt menggigil (respon Luas permukaan bayi >>

dingin) Sistem syaraf blm. Dewasa
Sempurna. Kulit & Jar. Subcutan tipis
Respon dingin : High Conductance
Panas hilang >>
Metabolisme brown fat
Trigliserida
Cairan Tubuh
Free fatty acid

BB (5-10%) 2-3 Hr
pertama
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 FUNGSI LIVER

Bayi baru lahir

Sumber Energi

GLIKOGEN
LIVER, OTOT, JANTUNG,
dll

Beberapa jam
postpartum GLIKOGEN

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 REGULASI GLUKOSA

Segera setelah lahir KGD 30-40mg/100mL

Bbrp. jam

Glikogen

GLUKONEOGENESIS

Gangguan/gagal

KGD <20mg/100mL
Pemberian
Glukosa
Ggn. Syaraf & Koma
Apnoe + Cyanosis

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METABOLISME PROTEIN & LEMAK

Fetus

Tak Melawati Barrier Placenta Melawati Barrier Placenta

- Plasma Protein - Immunoglobulin
- Lemak

Sintesa di Hati :
Albumin & Lemak

Segera Aktivasi Met. As.Nukleat &

Setelah Lahir sintesa Protein

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BILIRUBIN & FUNGSI DETOXIFIKASI

Fungsi Ekskresi Bilirubin (Hati) &

Detoxifikasi Obat-obatan

Blm. Sempurna

Physiological
Joundice (3-7 Hari)

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TRACT. GASTROINTESTINALIS

Rute PLACENTA Rute INTESTINAL

Gastric Emptying Time : 3-4 jam

MOTILITA
S
Enzym Lambung & HCl, pH : <3
(pencernaan Susu)
Enzym Intestinal, dan Empedu
SEKRES CUKUP
I
Amilase Pankreas <<<

Zat Nutrisi BAIK

ABSORPSI
Kecuali LEMAK
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 PENGATURAN ENDOKRIN

PERTUMBUHAN

Foetus Growth dipengaruhi :

Maternal Nourishment Fetus Growth Tdk.dipengaruhi :

Estrogen & Progesteron Growth Hormon Foetus

Thyroxine Foetus

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 Thyroid Gland

AKTIF segera Stlh Lahir

PERKEMBANGAN
(respon thd dingin)

IBU Lahir Bayi

(HYPOTHYROIDISM) (HYPOTHYROIDISM)

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Adrenal Korteks
Pada urine Kortikosteroid (+)

Keadaan stress Respon kelenjar (+)

Saat Lahir

PO2

ASPHYXIA

Adrenal Epinephrin/NE
Medula
VASOKONSTRIKSI

Respon Metabolik Mempertahankan

Thd DINGIN Sirkulasi Darah Otak
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 SISTEM SYARAF

Sifat Refleks

Sist. Syaraf Pusat

Flexion Reflex,menangis wkt.
Lapar, memutar Kepala, dll.

Pertumbuhan : Buka mata (respon Cahaya &

Suara)
- me pd Trimester II & III (maks)
Tidur barbagai posisi
-Berat : berat Otak Dewasa

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PERAN HORMON DALAM
PROSES TUMBUH DAN
KEMBANG

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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.

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