Fisiologi cairan dan

Ginjal
Dr.dr. Susy Purnawati, M.K.K
HOMEOSTASIS

• Pemeliharaan lingkungan internal yang relatif stabil

• Homeo = sama; stasis = berdiam atau menetap
• Apabila ada faktor yang mulai menjauhkan
lingkungan internal dari kondisi
optimalnya→respons fisiologis kompensatorik
(u/ memperkecil perubahan)
Peran ginjal
dalam proses homeostasis

• Apa itu lingkungan internal tubuh/

milieu interior ?
Kompartemen cairan tubuh
 CAIRAN INTRASEL
• Ada kemiripan untuk semua sel

• Membentuk 2/3 cairan tubuh total

(40% BB, 28 liter)
 CAIRAN EKSTRASEL
• Membentuk 1/3 cairan
tubuh (20% BB, 14 liter)
• Membentuk plasma (3 L &
cairan interstisium
11 L)
• Kategori minor lainnya:
cairan limfe & cairan lintas
sel
 CAIRAN INTERSTISIUM (C.JARINGAN)

• 2/3 CES
• Merupakan cairan yang membasahi
sel-sel jaringan (merup.lingkungan
internal sejati)
Fungsi
cairan
tubuh
GINJAL MENGHEMAT
PENGELUARAN AIR,
DAN BERPERAN DALAM
HOMEOSTASIS SECARA UMUM
(TERMASUK PENGATURAN ELEKTROLIT
DAN KESEIMBANGAN ASAM BASA)
 SAWAR PEMISAH
KOMPARTEMEN CAIRAN TUBUH
• Dinding pembuluh darah, memisahkan plasma dan cairan
interstisium
• Dinding pembuluh darah (kapiler) berpori-pori shg air dan zat
terlarut kec protein plasma secara terus menerus dan bebas
dipertukarkan antara plasma dan cairan interstisium.

• Membran plasma sel, memisahkan CES dan CIS

• Membran plasma sangat selektif untuk bahan terlarut, tapi air
dapat bebas menembus (akibat efek osmotik)
Komposisi cairan tubuh
Prinsip pengenceran indikator (indicator dilution principle) untuk mengukur
volume plasma, volume darah, volume cairan ekstraseluler, dan cairan tubuh
total, dan mengidentifikasi senyawa-senyawa yang digunakan untuk pengukuran
masing-masing volume tersebut.
Jika tidak ada kebocoran massa zat dari kompartemen
(Volume B x Konsentrasi B) akan sama dengan massa total
zat yang diinjeksi (Volume A x Konsentrasi A). Dengan
menyederhanakan perhitungan, seseorang akan dapat
menghitung volume B yang tidak diketahui dengan rumus:

Volume A x Konsentrasi A
Volume B = ______________________

Konsentrasi B
 Lakukan perhitungan berikut:
• Memperkirakan perubahan-prubahan volume ekstraseluler, osmolalitas
ekstraseluer, volume intraseluer dan osmolalitas intraseluler disebabkan oleh
infus 3(tiga) liter NaCl 0,9% (300mOsm/L), larutan Ringer Laktat
(300mOsm/L), NaCl 0,45% (154mOsm/L), dan NaCl 7,5%
(1200mOsm/L).
Peran Ginjal dalam menjaga
KESEIMBANGAN CAIRAN TUBUH
 ASUPAN DAN KELUARAN CAIRAN HARIAN

•Asupan:
•cairan dari makanan : 2.100 ml/hr
•dari metabolisme : 200 ml/hr
•asupan total : 2. 300 ml/hr

•Keluaran:
•insensible kulit : 350 ml/hr
•insensible paru : 350 ml/hr
•keringat : 100 ml/hr
•feses : 100 ml/hr
•urine : 1.400 ml/hr
•keluaran total : 2.300 ml/hr
 Homeostasis Air…..lanj

• Gangguan homeostasis air:

• Hipo/hipervolumia:
(gangg.keseimb.air & zat terlarut)
• Over/dehidrasi:
(gangg. keseimb.air)
Gangguan water homeostasis
KONSEP KESEIMBANGAN (HOMEOSTASIS)

• Kontrol keseimbangan cairan

tubuh
• merupakan integrasi beberapa sistem untuk
mempertahankan volume,
osmolaritas dan
keasaman
• Diskusikan !!!!
Waktu 10 menit
 Homeostasis Air…..lanj
• Peran ADH ????
 Homeostasis Air…..lanj
• Peran ADH:
• Dehidrasi: sel2 osmoreseptor di hipotalamus mengkerut, hipofise
posterior, sekresi ADH, tubulus distal & duktus kolektivus ginjal
menyerap >> air, urin berkurang dan lebih pekat
 Homeostasis Air…..lanj
• Peran mekanisme haus:

• Dehidrasi:
• rasa kering di mulut & tenggorokan,
impuls ke pusat haus dan osmoreseptor di hipotalamus;
• ↓ vol.darah, ↓ tek.darah

• merangs.pusat haus, timbul keinginan u/ minum

• merangs sekresi renin dan produksi angiotensin II,
 Homeostasis Air…..lanj
• Peran aldosteron:

hipovolumia, hipotensi: renin & angiotensin II, (atau jika hiperkalemia)

mengakibatkan sekresi aldosteron (korteks adrenal), reabsorbsi Na+ >> dan
air (jika ADH +),
(dan K+ yang tinggi di plasma diekskresikan lewat filtrat) di tubulus kolektivus
ginjal, volume & tek. darah meningkat.
 Homeostasis Air…..lanj
• Peran SS simpatis:

Hipovolumia, hipotensi: rangs. baroreseptor di lengkung aorta & art. karotis,

impuls ke medulla, impuls simpatis meningkat ke ginjal, arteriole afferen
konstriksi (& merangs sekresi renin), produksi urine berkurang
Peran Ginjal dalam menjaga KESEIMBANGAN VOLUME DAN TEKANAN DARAH
 Fisiologi Ginjal
Menguraikan secara berututan segmen tubulus yang dilalui aliran ultrafiltrat
yagn dibentuk pada Capsula Bowman sampai cairan tersebut masuk kedalam
pelvis renalis !
Anatomi

• Ginjal
• Ureter
• Vesika urinaria
• Urethra

4/25/2019 40
•Arteriola aferen dan eferen -
cabang arteri renalis
(cab. aorta
abdominalis)

•Penampang
eferen < aferen
Apa isi (cairan
yang lewat) di
pelvis renalis
menuju ke
ureter??
Komponen:
• vaskular (dialiri darah)
• tubulus (dialiri filtrat atau materi urin)

dari 8 nefron

4/25/2019 47
 NEFRON adalah UNIT
FUNGSIONAL DARI GINJAL
Terdiri dari:

-kapiler glomerulus
-kapsula Bowman
-tubulus
PROSES PEMBENTUKAN URINE DI
GINJAL

TIGA PROSES DI NEFRON

1. FILTRASI di GLOMERULUS
2. REABSORPSI di TUBULUS
3. SEKRESI di TUBULUS
49
FILTRASI, REABSORPSI & SEKRESI.

4/25/2019 50
 FILTRASI GLOMERULUS
• Saat filtrasi, sejumlah besar air dan zat terlarut dari darah melewati
membran filtrasi glomerulus ke capsula glomerulus

• Membran filtrasi dibentuk oleh 3 lapisan:

1. Fenestrated glomerular endothelium
2. Basement membrane
3. Filtration slit (celah filtrasi)

• Semua konstituen plasma lolos dalam filtrasi kecuali komponen

proteinnya
• Membran filtrasi dibentuk oleh 3
lapisan:
1. Fenestrated glomerular endothelium
2. Basement membrane
3. Filtration slit (celah filtrasi)
 Filtrasi Glomerulus
25 % dari COP menuju ginjal
pria BB 70 kg, vol. plasma cuma 3 liter

GFR: 125 ml/menit ( 115 ml wanita) atau

180 L/hari
jadi plasma di proses oleh ginjal
180 L/hr/3 liter = 60 kali/hari

Urine yang terbentuk hanya 1 – 1,5 L/hari

99% lebih filtrat di reabsorpsi kembali
 TEKANAN FILTRASI NETTO

4/25/2019 58
• GFR dikontrol oleh 2 mekanisme:
1. Otoregulasi GFR
• Dlm batas2 tertentu dpt mempertahankan
tekanan kapiler glomerulusnya konstan. Dgn cara:
vasokonstriksi dan vasodilatasi arteriola
aferent. Shg tdk cpt dipengaruhi perub tekanan
arteri.
• Myogenik mechanism
• Tubuloglomerular mechanism
2. Kontrol simpatis ekstrinsik
• Rangsangan saraf simpatis---arteriola aferent
berkontriksi untuk mencegah peningkatan
GFR
 Renal Clearance untuk menilai Fungsi Ginjal

• Definisi renal clearance: volume plasma yang dibersihkan secara

menyeluruh dari suatu zat oleh ginjal per satuan waktu
• Besar kecepatan zat “dibersihkan” dari plasma merupakan
parameter untuk mengetahui fungsi2 ginjal. Bisa menghitung
kecepatan aliran darah yang melalui ginjal
 Peran Ginjal dalam Produksi Erythropoetin

• Menunjukkan tempat produksi erythropoetin, rangsang yang adekuat untuk

pelepasan erythropoetin, dan jaringan target dari kerja erythropetin.
• Erythropoietin, the primary regulator of erythropoiesis, is produced by the
kidney and levels vary inversely with oxygen availability. Hypoxia-inducible
factor-1 (HIF-1), a major transcriptional regulator of several hypoxia-
sensitive genes, including erythropoietin, is functionally deactivated by
oxygen in a reaction catalyzed by prolyl hydroxylase. Erythropoietin acts by
binding to a specific trans-membrane dimeric receptor (Robert N. Foley,
2008)
 Regulation of RBC production
• Erythropoiesis is stimulated by erythropoietin
hormone produced by the kidney in response to
hypoxia (low oxygen in the blood)
• Hypoxia caused by:
• Low RBC count (Anaemia)
• Hemorrhage
• High altitude
• Prolong heart failure
• Lung disease
Dr Sitelbanat 80
Tissue oxygenation and RBC
formation

Dr Sitelbanat 81
 Erythropoietin
• Glycoprotein
• 90% from renal cortex 10% liver
• Stimulate the growth of early stem cells
• Does not affect maturation process
• Can be measured in plasma & urine
• High levels of erythropoietin
• anemia
• High altitude
• Heart failure
• Lung Disease

(Result in polycythemia) 82
 Renal cortical
endothelial cells
are the ones
releasing
Erythropoietin
(EPO)
Sebastian Bachmann et al finally
discovered it in 1993,
the fibroblasts located in the space
around the blood capillaries of the renal
cortex are the cells that synthesize EPO
 Role of the kidneys in RBC
formation

Dr Sitelbanat 84
QUIZ and Home work
 SEKRESI TUBULUS
• Meningkatkan eliminasi zat2 tertentu dari
tubuh
• Sekresi yang penting: H+, K+ dan ion-
ion organik (PO4=)
• Sekresi H+: mengatur keseimb as bs
• Sekresi K+: menjaga eksitabilitas membran
sel otot dan saraf
• Ion2 organik: eliminasi senyawa organik
asing
 REABSORPSI TUBULUS
• Mengembalikan
• bhn2 penting u/
tubuh

• Sangat selektif
• Air : 99%
• Natrium : 99,5%
• Glukosa : 100%
• H+ : 100%
• Urea (zat sisa): 50%
Di PCT (tubulus proksimal, proximal convoluted tubule) K+ melewati pompa sodium potassium yang membutuhkan
ATP (transport aktif transelular)
Selain itu K+ juga secara difusi melewati potassium channel
Reabsorpsi Glukosa
Kondisi Glukosa Darah Meningkat
Urea berdifusi sesuai perbedaan konsentrasi, mengikuti
proses reabsorpsi air
Pada segmen ini terdapat channel
Cotransport molecule
SISTEM COUNTERCURRENT (arus balik)

Berfungsi bagi tubulus collectivus

untuk ekskresi urin pekat
Peran ADH pada
tubulus distal
Sodium (Na+)
Potasium (K+)
RESPON TERHADAP ALDOSTERON
ADH (ANTI DIURETIC HORMON) ATAU VASOPRESSIN
MENGATUR OSMOLARITAS URIN
KONSENTRASI URIN DITENTUKAN OLEH
LOOP HENLE DAN DUKTUS PENGUMPUL
 Fisiologi:
Kesehatan Pariwisata
Konsep homeostasis dan adaptasi kehamilan pada keadaan lingkungan
pariwisata:
• Pegunungan
• Perjalanan darat, laut dan udara
• Berenang dan penyelaman
• Pantai
 Respon Tubuh Ibu terhadap Kehamilan
• Yang paling nyata di antara banyak reaksi ibu terhadap fetus / hormone
kehamilan adalah retensi cairan / edema yg berperan thdp penambahan berat
badan sebesar 6 pon oleh cairan yg bertambah dalam darah dan cairan
ekstraselular
• Keinginan untuk makan juga meningkat. Tetapi membutuhkan tambahan
nutrisi yang sehat (calcium, fosfat, besi). Traveling berisiko kuliner sesuai
kenangan akan makanan kesukaan dan emosi si ibu
• Sebagai akibat peningkatan sekresi hormone selama kehamilan (hormone
tiroksin, korteks adrenal dan hormone kelamin) kecptn metab basal
meningkat sktr 15% (pada pertengahan akhir kehamilan), sehingga sering
mrs kepanasan
 Maternal Response to Pregnancy
Blood flow to placenta requires increased
cardiac output (40% higher). 625 ml/menit darah mengalir
melalui sirkulasi ibu dari plasenta (fase akhir kehamilan)

Blood volume increases by 30% - due to

aldosterone and estrogen – cause Na
and H2O retention
Increased aldosterone, renin, angiotensinogen
– may be stimulated by reduction in effective
circulating blood volume caused by large
placental blood pool

BP increases slightly

Increased Ca reabsorption, increased 25-OH-vit D

dan 1,25-(OH)2-vit D
Supine Hypotension Syndrome
Supine Hypotension in
Syndrome in
Pregnancy
Pregnancy
Supine position

IVC occlusion

Dec atrial filling pressure

Dec cardiac output

95% of women 5% of women

Inc vascular resistance ? Parasympathetic response

Normalize BP Hypotension
Morning Sickness
Occurrence – 70% of pregnancies
Onset 4-8 wks gestation; improvement before 14-16 wks

Mechanisms:
Relaxation of smooth muscle of stomach
? Inc hCG – serum levels don’t correlate well
Higher frequency of female fetus – 56%
Usually associated with more favorable outcome
 Pregnancy-induced Hypertension
– pre-eclampsia, eclampsia
– characterized by increased BP in 3rd trimester
(pada 4% ibu hamil), akibat hilangnya protein lewat urin
– high mortality and morbidity
- BP normalizes following delivery, faster with
Caesarean section and D/C
– Immunological component: primipara (1st pregnancy)
usually
Ibu membutuhkan/ memakai 20% oksigen
tambahan (krn penambahan besar tubuh dan
metab basal)
• Increased alveolar ventilation (50%)– due
to progesterone (efek hormone ini juga
meningkatkan sensitivitas pusat napas
thdp kadar CO2)
• Increased tidal volume (40%) – causes
decr. in maternal plasma CO2 – slight
alkalosis
• Kidney function increases: GFR by 50%
• Kemampuan reabsorpsi Na+ , Cl- dan air oleh tubulus meningkat 50%
(akibat hormone steroid placenta dan korteks adrenal
• Terjadi peningkatan pembentukan eritrosit di sum-sum tulang
 Pregnancy Travel
Pregnancy Travel: Road Trip (Louise Chang, 2008)
• Pregnancy travel by car has some of the same risks and rules as traveling by plane
• "The big problem is blood clots,"
• Blood clots in pregnant women tend to form in the deep veins of the legs or in the
pelvic area. This condition is known as deep vein thrombosis (DVT) (venous
thromboembolism). Pulmonary embolism (PE) is a life-threatening event that
occurs when a DVT breaks off and travels to the blood vessels of the lungs.
• Blood clots are also potentially dangerous to your baby. Blood clots can form inside
the placenta, cutting off blood flow and harming the baby.
• If in a car and driving long distances, get out and walk every few hours. If
have been diagnosed with a blood clotting disorder, need special stockings to
increase circulation and decrease blood clot risk.)
• Calf exercises can also help keep blood flowing. "Lift your foot up and twirl
or wiggle it around for exercise,"
• Be seatbelt savvy. There are nearly 170,000 car crashes involving pregnant
women every year.
 Pregnancy and Altitude

• “large, rhythmic, and repetitive movements using more than 50% of the body’s
muscle mass in a sustained manner … improve delivery of nutrients and oxygen,
improve stamina, and are associated with positive birth outcomes,”
• Recommendations include walking, hiking, jogging, aerobics, stair or hill climbing,
cycling, and swimming.
• The American College of Obstetricians and Gynecologists (ACOG) published in
1985 and revised in 1994: The guidelines that are most hotly contested by athletic,
fit women are: 1) exercise levels should not cause the heart rate to exceed 140 beats
per minute;
Pregnancy and Altitude
 Pregnancy and Altitude

• In general, past the first trimester (when risk of ectopic pregnancy or miscarriage is
highest) and before the 3rd trimester; if the pregnant woman is feeling good, short
stays at altitude should not have significant impact on the fetus or on the woman’s
health.
• According to both the Center for Disease Control and David Shlim (1997) , “there
are no reported cases of high altitude exerting a negative outcome on pregnancy in
a trekker or climber. Oxygen saturation is fairly well maintained up to an altitude of
10,000-12,000 feet…Because of the rapid drop-off in oxygenation above 12,000
feet (3,658 m) or so, we generally recommend that pregnant women avoid exposures
above that height.
• Climbing can continue just as before during the first trimester, if the mom-to-be is
comfortable doing so through bouts of morning sickness. After the first trimester
when the abdomen starts to protrude, there is increased risk of trauma to the fetus
in terms of 1) harness pressure, 2) rock (or object) fall, or 3) leader fall.
• The easiest solutions: 1) wear a full-body or specially designed harness that will ride
lower across the abdomen rather than directly across the belly button; 2) climb in
areas with solid rock and avoid more questionable crags or alpine routes that are
notorious for rock fall; 3) follow rather than lead; 4) climb familiar routes; or 6)
remain safe but still have fun.
• Besides external factors, there are internal factors to think about when
climbing. As you gain weight, you may be more susceptible to finger and
elbow tendon injuries or strains if you continue to push as hard as you have
before. Just as you would train when you are not pregnant, be well aware of
joints and tendons.
• Furthermore, as you gain weight, you’ll notice that your center of gravity
shifts upwards and forward; be sure to stretch muscles that get shortened
during pregnancy (lower back, chest, and hip flexors) and strengthen muscles
that get overstretched (hamstrings, gluteus, abdominals and upper back).
• “Long term exposure to altitude while pregnant has been shown to retard fetal
growth and it has been acknowledged that women tend to give birth to small babies
if they spend much of their pregnancy at altitude. Small babies have their own set
of problems at birth such as hypothermia, low blood sugar and a higher rate of
breathing problems and a need for intervention.
• This is more a problem of longer-term exposure to altitude and it is difficult to
predict the effect of a short visit to altitude when pregnant. It seems probable that a
two-week visit to moderate altitude (less than 3,000 meters) is unlikely to affect the
final birth weight of a baby.”
• If you do decide to stay somewhere at higher altitude, make sure your ascent is slow
and that you acclimatize well.
• It’s likely to be fairly easy to confuse the nausea associated with “morning sickness”
with the nausea you might experience with early signs of AMS. Be sure to build in
plenty of rest days, watch your footing carefully to avoid falling, keep well hydrated,
and descend if you feel worse.
(Kulpa, Patty, MD. “Exercise During Pregnancy and Post Partum”, in Medical and
Orthopedic Issues of Active and Athletic Women, Agostini, Rosemary, MD (1994)
Hanley & Belfus, Inc: Philadelphia.
 Long airplane travel
• The additional effects of long airplane travel, travel in remote areas, and
travel-related illnesses such as diarrhea (which contributes to dehydration, a
potentially dangerous condition for a pregnant woman) or malaria. (the
CIWEC Clinic Travel Medicine Center)
• "In general, air travel is OK during the entire pregnancy," says Kenneth Johnson,
DO, an associate professor of obstetrics and gynecology at Nova Southeastern
University. "But common sense dictates that women with complicated pregnancies
involving severe nausea, placenta previa, preterm labor, and other pregnancy-related
complications should not fly." Most airlines do allow pregnant women to fly until
about a month before their due dates.
• As long as there are no known complications to pregnancy, traveling on an airplane
is reasonable. But it's important for pregnant women to get up and walk around
every hour during flight.
• "This is really a good idea for every flier, but in pregnancy it can be even
more important to keep your circulation flowing," Chervenak says. Here's
why: Pregnancy can cause circulation problems, and flying increases the
chance of developing a potentially fatal blood clot. Moving around keeps
the blood moving, which helps to prevent the formation of blood clots.
• Choose an aisle seat so you can get up and down without climbing over your
neighbor. This will also help mother get to the bathroom in a hurry.
(pregnant women have to use the bathroom a lot)
• Heavy lifting may cause problems during pregnancy, so schlepping bags from
gate to gate is not advisable for women who are traveling while pregnant.
"Use porters or suitcases with wheels to try to make pregnancy travel as
physically easy as possible,"
• Johnson adds that it's important to drink nonalcoholic, noncaffeinated
beverages before, during, and after air travel while pregnant. "Women who
do fly should drink extra fluids because air travel tends to be dehydrating," he
says. "Extra fluids will also help eliminate Braxton-Hicks 'false labor'
pains."
• Many airlines no longer supply meals, so it's important for pregnant women
to pack their own healthy meals. "Eat frequent small meals to
avoid hypoglycemia and nausea
 Kehamilan dan Lingkungan Laut dan
Penyelaman
• Hamil berenang (kolam)
• Hamil menyelam
 Pregnant and Swimming
• The zero impact nature of swimming means there is no impact on your most load
baring joints like the hips and knees.
• It is vitally important to remain hydrated, especially during exercise and that goes for
swimming while pregnant too. The water that enters your body keeps your unborn
baby cool. Our bodies keep cool by sweating but our baby is not able to sweat to
keep cool, hence it needs a constant circulation of water.
• If you enter the pool when you are pregnant, swim with a bottle of water on the
poolside and drink regularly during your swimming session
• Going swimming to relax be more beneficial than swimming to be
active.
• The first trimester (first 3 months) is the time you must be the most
cautious and not over do things.
 Pregnant and Diving Activity
• Bila manusia turun ke dalam laut, tekanan dari sekelilingnya akan meningkat
hebat. Untuk menjaga agar paru tidak kolaps maka harus diberi udara
bertekanan tinggi (hiperbarik)
• Bila seseorang ada dlm kedalaman 33 kaki (33x30 cm) di bawah permukaan
air laut akan terpapar tekanan 2 atm
• Gejala pertama narcosis gas nitrogen timbul pada kedalaman 120 kaki (gejala:
rasa riang dan kurang hati2); pada 150 kaki timbul rasa ngantuk. (Akibat gas
nitrogen larut bebas dalam lemak tubuh –membrane saraf-)
• Scuba diving biasanya penyelaman di kedalaman 200 kaki selama beberapa
menit.
• Penyelam yang diam lama pada kedalaman 200 kaki gas nitrogen larut dalam
cairan tubuh sebesar 7 liter. Atau jaringan jenuh oleh nitrogen. Jika menyelam
bbrp menit dikatakan tidak banyak nitrogen yg larut dalam jaringan.
• (perbandingan: 1/2 liter pada ketinggian permukaan laut, 2 liter pada
kedalaman 33 kaki, dan 4 liter pada kedalaman 100 kaki).
• Ketika menghirup oksigen bertekanan tinggi, berakibat P O2 jaringan juga
tinggi, yang merugikan jar tubuh terutama otak. Jika terpapar O2 dgn tek 4
atm (P O2 3040 mmHg) akan mengalami kejang-kejang kemudian diikuti
koma stlh 30 menit.
• (P O2 jaringan bersifat normal dengan nilai 40 mmHg). Bila P O2 berada di
atas titik kritis, yaitu di atas sekitar 2 atm P O2, maka P O2 jaringan bisa
sampai ribuan mmHg, maka akan terjadi kerusakan system metab sel
(terutama gangguan fungsi otak).
 Pregnant and Diving Activity:
Some Evidence Based
• Many female divers who become pregnant wonder about the implications of continuing to dive.
• The primary concern is the theoretical risk of decompression illness (DCI) to the fetus.
Since fetal blood circulation bypasses the lungs, any inert gas bubbles that have formed during scuba
cannot be filtered out. And the increase in deposited fat during pregnancy and use of constricting dive gear
on an expanding midsection and swollen hands and feet can adversely affect inert gas intake and elimination,
suggesting an increased risk of DCI for the pregnant diver.

• No human studies on the effects on the fetus of diving have been published since 1989.
• Divers Alert Network (DAN), the American College of Obstetricians and
The recommendation put forth by
Gynecologists, and all U.S. dive-training organizations is that the prudent course of action is for pregnant women to defer scuba until
after the child is born.
 Pregnant and Diving Activity:
Some Evidence Based
Leger Dowse, A. Gunby, R. Moncad, C. Fife & P. Bryson,
2006
• No human data, investigating the effects on the fetus of diving, have been published since 1989. We investigated any
potential link between diving while pregnant and fetal abnormalities by evaluating field data from retrospective study No.1
(1990/2) and prospective study No.2 (1996/2000). Some 129 women reported 157 pregnancies over 1,465 dives. Latest
gestational age reported while diving was 35 weeks. One respondent reported 92 dives during a single pregnancy, with two
dives to 65 m in the 1st trimester. In study No.2 >90% of women ceased diving in the 1st trimester, compared with 65% in
the earlier study. Overall, the women did not conduct enough dives per pregnancy, therefore no significant correlation
between diving and fetal abnormalities could be established. These data indicate women are increasingly observing the
diving industry recommendation and refraining from diving while pregnant. Field studies are not likely to be useful, or the
way forward, for future diving and pregnancy research. Differences in placental circulation between humans and other
animals limit the applicability of animal research for pregnancy and diving studies.
• Fetal blood circulation bypasses
the lungs
Fetal blood circulation bypasses
the lungs
 Pregnant and Diving Activity: Evidance based

Powell MR, Smith MT, 1985.

Animal study

Research on First trimester of pregnant who done diving

• has concentrated on the teratogenic, or birth-defect-causing, effects of hyperbaric oxygen (HBO).

Research on third trimester

• has examined the effects of decompression sickness (DCS or diver’s paralysis) on the fetus (akibat bernapas
di tekanan udara yg tinggi, jaringan jenuh oleh nitrogen yg tidak bisa dimetab)
• A range of developmental abnormalities have been associated with hyperbaric exposure, these include
• low birth weights,
• fetal abortion,
• bubbles in the amniotic fluid,
• premature delivery,
• abnormal skull development,
• malformed limbs,
• abnormal development of the heart,
• changes in the fetal circulation;
• limb weakness associated with decompression sickness, and blindness
Decompression stress
• Fetal sheep whose mothers underwent decompression dives sometimes formed bubbles even when the mothers
showed no signs of DCS.
• Researchers reported being able to tell that a fetus had bubbles by detecting early cardiac arrhythmias. For the
fetus, these abnormal heartbeats could be life threatening. Fetus limb weakness and spinal defects associated
with DCS, even when the mother had remained symptom-free.

• Fully functional lungs are extremely effective in filtering bubbles from

the circulation. In the fetus, however, most blood bypasses the lungs
(via the foramen ovale and ductus arteriosus shunts), and gas
exchange occurs through the placenta. Thus, pulmonary filtration of
bubbles does not occur within the fetus. This may increase the risk of
arterial gas embolism (AGE).
Bolton ME, 1980
• A survey of female divers who had recently given birth included 69 women who
had not dived during their pregnancies and 109 women who had. The nondiving
women reported no birth defects, while the diving women reported an incidence
of 5.5 percent.
• A safe limit for the partial pressure of oxygen (PO2) is frequently accepted as 1.4
to 1.6 atmospheres.
• In addition to possible risk to the fetus,
• changes in a woman’s body during pregnancy
might make diving more problematic. Nausea
may increase discomfort
• A woman’s growing abdomen could pose a
problem in fitting suits, weight belts and other
equipment. In addition to the hazards inherent in
poorly fitted gear, diving simply may not be
enjoyable
• The overall picture of the literature indicates that, while the effect may
be small, diving during pregnancy does increase the risk to the fetus,
and the consequences.
• Snorkeling along the water surface is safer than deep sea scuba diving
for pregnant mother
TERIMA KASIH

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