Yusrawati
Divisi Fetomaternal
Bagian Obstetri dan Ginekologi FK.Unand
Syarat ?
Kapan ?
Bagaimana ?
Dimana ?
Ada sperma & sel telur yang matang
Sekitar ovulasi
Pertemuan dan persenyawaan ovum &
sperma
Di ampula
Gametogenesis
A. Two-cell stage
B. Three-cell stage
C. Four-cell stage
D. Five-cell stage
E. Six-cell stage
F. Eight-cell stage
5 hari setelah fertilisasi
Pembentukan Ruang Amnion & Kuning Telur
Zigot
Pembelahan
Blastokist
trofoblast
bintik benih
Nidasi
Nodus embryonale :
ruang amnion
ruang kuning telur
Ectoderm
kulit, rambut, kuku, gigi, saraf
Entoderm
usus, hati, saluran nafas, kandung kencing
Mesoderm
otot, tulang, jaringan ikat, jantung & pembuluh darah
Drawing of section implanted blastocysts. A. 10 days. B. 12 days after fertilization.
The stage of development is characterized by the intercommunication of the lacunae
filled with maternal blood. Note in B that large cavities have appeared in the
extraembryonic endodermal cells have begun to form on the inside of the primary
yolk sac. (From Moore, 1988)
Bintik Benih
Ectoderm Discus
mesoderm embryonale (D.e)
entoderm
Janin
D.e menonjol ke Ruang Amnion
Hubungan D.e dengan Trofoblast
Tangkai penghubung
(Tali Pusat)
Perubahan
Decidua :
Endometrium
Str. Compactum
Str. Spongiosum
Str. Basale
Decidua :
basalis
capsularis
vera
Chorion
Frondosum
PERKEMBANGAN
Trofoblast Khorion TROFOBLAST
1. Lapisan Langhans
(cytotrophoblast)
mesoderm
2. Lapisan luar
(syncytium/syncytio trophoblast)
decidua
Vili
chorion laeve
chorion frondosum
Chorion
Frondosum
(chorionic villi)
Chorion frondosum
pembuluh darah ibu
decidua (Haftzote)
2. Aktif : enzim
pinositosis
II. Kelenjar Endokrin
1. Steroid Hormon
(Estrogen dan Progesteron)
2. Protein Hormon
(HCG, HPL, HCT, HCCT)
3. Releasing Hormon
III. Sebagai barier (TSHRF, FSHRH, CHR)
mekanis 4. Enzim : HSAPase
kimiawi Oksitosinose
“Pregnancy spesific Protein”
1. Pertumbuhan janin
2. Amnioskopi / amniosentesis
3. Estrogen / pregnandiol urin
4. Oksitosinase serum
5. HPL
6. OCT
7. USG
8. Profil biofisik
Antara pusat janin - permukaan fetal plasenta
30-100 cm; Ø 1-1,5 cm
diliputi amnion
2 arteri umbilicales
1 vena umbilicalis
Wharton’s jelly
insersi
sentral / parasentral / lateral / marginalis
Here is a normal three vessel umbilical cord. Note that there are
two arteries toward the right and a single vein at the left.
Most of the cord consists of a loose mesenchyme with intercellular
ground substance (Wharton's jelly).
This is a true knot of the umbilical cord. Such knots are
more likely with abnormally long umbilical cords that are
seen with increased fetal movement.
Such a knot could constrict the blood vessels and lead to
fetal demise.
Seen here is a "velamentous" insertion of the umbilical cord in which
the major umbilical vessels break up in the fetal membranes before
reaching the placental disk.
Such a condition is of no major consequence in utero, but could lead to
a greater chance for cord trauma with bleeding during delivery.
Dividing membranes are see at the left in this twin placenta.
The amniotic cavity has been opened here to reveal the normal fetal
surface of the placenta at the upper right.
The umbilical cord inserts centrally into the placental disk.
The abnormal finding here is a "nuchal cord" in which one or more
loops of umbilical cord are wrapped around the baby's neck.
The relationship of the placenta to
the amniotic cavity and fetus is
shown here in the case of a term
infant whose mother died in an
accident.
The placental disk is at the left, with
the maternal surface that would be
attached to the uterus at the
decidual plate.
The baby is seen inside the amniotic
cavity.
The amniotic fluid in this cavity
allows for fetal movement and
protects the baby.
The fetus at the left is macerated from prolonged demise in
utero.
The cause of the demise in this case is the marked twisting, or
torsion, of the umbilical cord.
A macerated placenta is present at the right.
Berisi cairan amnion
Banyaknya ~ umur kehamilan
alkalis
lanugo
vernix caseosa
Syncytiotrophoblast cells
further invade the
Endometrium by secreting
hydrolytic enzymes.
10th day
28 mg = 0.25
38 mg = 0.15
Bagian terpenting dalam persalinan terdiri dari :
Ubun-ubun besar :
Pertemuan 4 sutura : sagitalis
coronaria
frontalis
Ubun-ubun kecil :
Pertemuan 3 sutura : sagitalis
lambdoidea
A. Muka Belakang
1. D. Suboccipito-bregmatica : 9,5 cm
foramen magnum - UUB
2. D. Suboccipto frontalis : 11 cm
foramen magnum - pangkal hidung
3. D. Fronto-occipitalis : 12 cm
pangkal hidung - belakang kepala
4. D. Mento-occipitalis : 13,5 cm
dagu - belakang kepala
5. D. Submento - bregmatica : 9,5 cm
bawah dagu - UUB
1. Diameter suboksipotobregmatikus
2. Diameter suboksipitofrontalis
3. Diameter oksipitofrontalis
4. Diameter oksipitomentalis
5. Diameter submentobregmatikus
C. Ukuran lingkaran
1. C. Suboccipito - bregmatica : 32 cm
( lingkaran kecil )
2. C. Fronto - occipitalis : 34 cm
( lingkaran besar )
Diameter biparietalis dan Kepala dengan beberapa
Diameter bitemporalis sirkumferensia
2 arteri
1 vena
“darah campuran”
isi vena cava inferior lebih bersih dari aorta
Setelah lahir :
Ductus Botali menutup lig. Arteriosum
Foramen ovale menutup
Duct. Venosus aranti lig teres hepatis
Aa umbilicales lig vesico umbilicale laterale
Sirkulasi
Darah
Janin
Cardiovascular
system of fetus
HB janin ‡ Hb dewasa
Dibuat terutama di hepar
Transport O2 lebih mudah
Menjadi Hb biasa 4 bulan
Tanda Piskacek
Kontraksi Braxton Hicks
Perubahan serviks
Pembentukan segmen bawah rahim dari isthmus uteri.
Pada dystocia lingkaran retraksi sangat tinggi
Minggu
6 12 16 20 24
Minggu
28 32 36 40
3. OVARIUM
Corpus luteum graviditatum
4. DINDING PERUT
Striae gravidarum
lividae
albicans O.K. hiperfungsi gl. suprarenalis
5. KULIT
hiperpigmentasi : linea nigra
chloasma
6. PAYUDARA
Membesar, nyeri
( hipertrofi alveoli )
Colostrum
Hiperpigmentasi
7. Berat Badan
Triwulan 1 : 1 kg
Triwulan 2 : 5 kg
Triwulan 3 : 5,5 kg
Janin : 3 kg
Plasenta : 0,5 kg
Air ketuban : 1 kg
Rahim : 1 kg
Lemak : 0,5 kg
Protein : 2 kg Kebutuhan Fe, Ca
Air : 1,5 kg dan P bertambah
8. DARAH
Volume darah bertambah
Eritrosit bertambah
Hydremi
Batas fisiologis : Hb : 11 gr%
Eri : 3,8 juta/mm3
Leuco : 12000/mm3
9. Lain-lain
beban jantung bertambah
kerja paru-paru bertambah
sekresi HCl & gerakan lambung berkurang
kerja ginjal bertambah
ureter melebar
polakisuri
perubahan mental