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Fisiologi kehamilan

Supriyatiningsih
Bagian Obstetri & Ginekologi FK UMY
Transport Spermatozoa
Perkembangan
embryo

Widad – Obgyn UGM


Implantasi
Pertumbuhan & perkembangan embryo &
struktur penunjangnya
Plasenta

Widad – Obgyn UGM


Fungsi plasenta
• Plasenta:
– Pertukaran gas
– Transport nutrisi
– Ekskresi zat-zat sampah
– Produksi hormon
– Proteksi
Anatomi/Fisiologi
• Tali pusat
– Penghubung plasenta-janin
– 2 arteri
– 1 vena
• Selaput amnion
– Membran yang melingkupi janin
– Cairan amnion berasal dari beberapa sumber
– 500 - 1000 cc (setelah 20 minggu)
– Pecah  KPD
Diagnosis kehamilan
• Anamnesis
• Pemeriksaan fisik
• Pemeriksaan laboratorium
• Pemeriksaan penunjang
Anamnesis -- Possible sign
• Amenorrhea
• Mual - muntah
• Mastodinia
• Quickening
• Frekuensi kencing
• Konstipasi
Pemeriksaan fisik -- Possible signs
• Suhu badan basal
• Penambahan berat badan
• Pigmentasi
• Perubahan payudara
• Pembesaran abdomen
• Perubahan genital
• Kontraksi uterus
• Ballotement
Linea nigra
Striae rubra

Widad – Obgyn UGM


Perubahan payudara
Hegar sign
Ballotement
Positive sign
• Palpasi
• Pemeriksaan laboratorium  test hCG
• Denyut jantung janin
– Stetoskop Laenec : 18 weeks
– Doppler : 12 weeks
– Ultrasound : 6- 7 weeks
• Rontgenography : 12-14 weeks  TERATOGENIK
Menentukan usia kehamilan
Rumus Naegele
HPM/HPHT harus teratur,  28 hari
HPL = (Tanggal + 7), (Bulan -3) (Tahun +1)
11-8-03  18-5-04
05-1-03  12-10-03
Durasi: 280 hari (40 minggu)
37 - 41 : kehamilan aterm
28 - 36 : kehamilan preterm
42 atau lebih : kehamilan postterm
Kurang dari 28 : Periode abortus
Widad – Obgyn UGM
Menentukan usia kehamilan
Tinggi Fundus uteri
Menentukan usia kehamilan

Quickening : 16-18 minggu pada multigravida


: 18-20 minggu pada primigravida
Test kehamilan positif: 5 minggu
Ultrasonografi:
– Gestational sac (GS)
– Crown-lump length (CRL)
– Biparietal diameter (BPD)
– Denyut jantung janin
Positive Signs
• Ultrasonografi:
– 5.5 minggu : Gestational sac
– 6 minggu : Embryonic pole
– 6-7 minggu : FHR
– 8 minggu : Gerakan janin
– 10 minggu : Plasenta
– 12 minggu : BPD
5,5 minggu
7 minggu
12 minggu, CRL 46.9 mm
6 weeks, dizygotic twin
Perubahan fisiologis
• TD menurun pada trimester-1
– sistolik  2-4 mmHg
– diastolik  5-15mmHg
• Denyut jantung  (hingga 10-15 x/menit)
• Volume darah  48-58%
• Cardiac output  40%
• Faktor pembekuan darah 
• Konsumsi O2  hingga 15%
• Motilitas usus 
• Produksi asam lambung 
Perubahan anatomi
•Diafragma naik 4 cm – rusuk terangkat
•Ukuran uterus 
•Kandung kencing bergeser naik
•Pergeseran usus
•Distraksi simfisis
•Dilatasi ureter
•Respons spinchter gastro-esophagus 
•supine hypotensive syndrome
•Aliran darah ke uterus  10x
•Tekanan venosa perifer 
Sistem Sirkulasi Janin
• Tekanan vaskuler kebalikan dari dewasa
– Venosa > arterial
• Konstriksi vaskuler pulmonal
– PaO2 rendah, paru-paru kolaps
• Resistensi rendah di plasenta
• Fetal shunts
Sistem Sirkulasi Janin

• Fetal shunts
– Ductus arteriosus
– Foramen ovale
– Ductus venosus
SIRKULASI DEWASA Pulmonary
Vena cavae veins
Right
ATRIUM Lef t LUNGS
ATRIUM

Right
VENTRICLE
SYSTEMIC Left Pulmonary arteries
VENTRICLE
CAPILLARIES

Right ventricle pumps to the lungs


Septa/partitions separate heart into Aorta Left ventricle serves rest of body
left and right chambers

de-oxygenated blood semilunar valves


AV valves
Vena
JANTUNG
SIRKULASI Vena cava ATRIUM ATRIUM
Pulmonalis
PARU
MATERNAL kanan kiri

VENTRIKEL VENTRIKEL
KAPILER kanan kiri
Pulmonary
SISTEMIK arteries
ARTERI
UTERINA

Aorta
PLASENTA
ARTERI UTERINA

VENA
UTERINA

PLACENTA
Pembuluh darah janin
UTERUS
PLASENTA Pembuluh darah
TALI PUSAT

HUGE EXCHANGE SURFACE


from branching processes - chorionic villi Maternal blood
- containing fetal capillaries Disuplai oleh arteri uterina
Keluar melalui vena uterina
Jantung memompa darah ke SIRKULASI
seluruh tubuh
JANIN
Jantung menerima darah
‘bekas’ dari seluruh tubuh
Paru-paru
Heart
Restriksi aliran darah
aorta menuju dari dari paru-paru

Janin mendapatkan darah


yg kaya oksigen dari
plasenta
VENA
masuk ke janin melalui sistem
CAVA
vena & melalui jalan pintas di
jantung
FETAL CIRCULATION I
Pembuluh darah berasal dari plasenta masuk janin
melalui vena umbilicalis, tetapi membawa darah
kaya O2

Fetal capillaries TALI PUSAT dengan


in placental villi 2 ARTERI UMBILICALIS
1 VENA UMBILICALIS

UTERINE WALL
FETAL CIRCULATION
PLACENTA
Menggunakan ductus venosus utk masuk ke
vena cava inferior  jantung

UMBILICAL VEIN
HEART Pulmonary
veins
Vena cava Right
ATRIUM
OLef t LUNGS
ATRIUM
IVC
DUCTUS VENOSUS to Right
VENTRICLE
get past the liver SYSTEMIC Left Pulmonary
VENTRICLE arteries
CAPILLARIES

Aorta
FETAL CIRCULATION
PLACENTA

UMBILICAL VEIN
HEART Pulmonary
veins
Vena cava Right
ATRIUM
OLef t LUNGS
ATRIUM
IVC
DUCTUS Right
VENOSUS VENTRICLE
Left Pulmonary
SYSTEMIC VENTRICLE arteries
CAPILLARIES
Umbilical
arteries
Aorta
FETAL CIRCULATION IV
Since oxygenated blood is coming in where
PLACENTA normally systemic venous blood arrives, &
the lungs have no access to air, the flow
through the heart is special & the lungs are
bypassed

UMBILICAL VEIN Pulmonary


HEART
veins
Vena cava Right
ATRIUM
OLef t LUNGS
ATRIUM
IVC
DUCTUS VENOSUS to Right
VENTRICLE
get past the liver SYSTEMIC Left Pulmonary
VENTRICLE arteries
CAPILLARIES

Umbilical
arteries
Aorta
FETAL CIRCULATION V
Karena darah kaya O2 datang dari tempat
PLACENTA yg normalnya merupakan muara vena
sistemik, dan karena paru-paru tidak punya
akses thd udara, maka aliran menuju paru-
paru dilewatkan (bypasseed)
O
UMBILICAL VEIN
HEART Pulmonary
veins
Vena cava Right
ATRIUM
OLef t LUNGS
ATRIUM
IVC
DUCTUS VENOSUS to Right
get past the liver VENTRICLE
Left Pulmonary
SYSTEMIC
VENTRICLE arteries
CAPILLARIES

Aorta
FETAL CIRCULATION VI Lungs are bypassed 1

Oxygenated blood comes in Foramen ovale between atria


lets red blood pass into the left atrium for
where normally systemic venous
distribution, via left ventricle & aorta,
blood arrives
around the fetus
HEART Pulmonary
veins
Vena cava Right
ATRIUM
OLef t LUNGS
ATRIUM
DUCTUS IVC
Right
VENOSUS VENTRICLE
SYSTEMIC Left Pulmonary
VENTRICLE arteries
CAPILLARIES
Umbilical
arteries

Another bypass is the


Aorta Ductus arteriosus
Lungs are bypassed 2 allowing blood to pass from
pulmonary trunk to the aorta
FETAL CIRCULATION VII: Conversion to post-natal
Foramen ovale DUCTUS VENOSUS &
Critical steps are closure of
Umbilical arteries Ductus arteriosus

Foramen ovale
HEART Pulmonary
veins
Vena cava Right
ATRIUM
OLef t LUNGS
ATRIUM
DUCTUS IVC
Right
VENOSUS VENTRICLE
SYSTEMIC Left Pulmonary
VENTRICLE arteries
CAPILLARIES
Umbilical
arteries

Aorta Ductus arteriosus


FETAL CIRCULATION VIII: Conversion to post-natal
Closure of Foramen ovale
Forces venous blood (now all deoxygenated) into the
right ventricle for expulsion to the lungs

Closure of DUCTUS VENOSUS


Stops use of umbilical HEART Pulmonary
vessels, & converts all veins
vena cava blood to
Vena cava Right
ATRIUM
OLef t LUNGS
deoxygenated ATRIUM
IVC
Right
VENTRICLE
SYSTEMIC Left Pulmonary
VENTRICLE arteries
CAPILLARIES
Closure of
Umbilical
arteries
Stops use of Aorta Closure of
umbilical vessels Ductus arteriosus
means that blood expelled from the right
ventricle has to go to the lungs
FETAL CIRCULATION IX: Conversion to post-natal
Closure of Foramen ovale First inspirations of the lungs
cause lung vessels to greatly
Pressure-rise in left atrium resists the reduce their resistance. Blood
blood trying to come through the Foramen flows more freely through, so
ovale, and pushes its flap back onto the raising the pressure in the left
septum for later fusion atrium

Closure of DUCTUS Pulmonary


veins
VENOSUS Vena cava Right
ATRIUM
OLef t LUNGS
ATRIUM
Initial closure is by IVC
muscular contraction,
Right HEART
VENTRICLE
lumen is obliterated by SYSTEMIC Left Pulmonary
VENTRICLE
fibrosis only later CAPILLARIES arteries

Umbilical
arteries
Aorta Closure of
Ductus arteriosus
FETAL CIRCULATION Foramen ovale
Pulmonary FETAL CIRCULATION X:
HEART
Vena cava Right OLef t veins Conversion to post-natal
ATRIUM LUNGS
ATRIUM
DUCTUS IVC The foramen ovale can just seal
Right
VENOSUS VENTRICLE shut, but the ductus venosus &
SYSTEMIC Left Pulmonary
CAPILLARIES
VENTRICLE arteries d. arteriosus (&umbilical
Umbilical arteries) have to shrivel to
arteries
become just connective tissue
Ductus arteriosus ligaments
Aorta

Pulmonary
Vena cava HEART veins
Right
Ligamentum venosum ATRIUM Lef t LUNGS
ATRIUM
Note distinction between Right VENTRICLE
venous deoxygenated blood Left
SYSTEMIC Pulmonary
in Right chambers & VENTRICLE
arteries
CAPILLARIES
oxygenated blood from
lungs in Left chambers of
postnatal baby
Aorta POST-NATAL
Medial umbilical ligaments Widad – Obgyn UGM
Ligamentum arteriosum CIRCULATION