POM Harry Satria

Syarat?Kapan?Bagaimana?Dimana?

Ada sperma & sel telur yang matang Sekitar ovulasi

Pertemuan dan persenyawaan ovum & sperma

Di ampula

Pembentukan Ruang Amnion & Kuning Telur

Decidua :

Str. CompactumStr. SpongiosumStr. Basale

Decidua :

basaliscapsularisvera

Perubahan Endometrium

Chorion Frondosum

Trofoblast

1. Lapisan Langhans

(cytotrophoblast)

mesoderm

2. Lapisan luar

(syncytium/syncytio trophoblast)

decidua

Khorion

Vili

chorion laeve

chorion frondosum

PERKEMBANGAN

TROFOBLAST

Chorion Frondosum (chorionic villi)

These twin boys are at 9 weeks gestational age in development. Each twin has an amnionic cavity.

The amnions will eventually fuse to form a diamnionic dividing membrane.

12.unknown

Berbentuk cakram

15-20 cm, tebal 2-3 cm

+ 500 gram

2 bagian (bagian ibu dan bagian anak)16 - 20 kotiledon2 arteri umbilikales

1 vena umbilikalis

Skematik aliran darah dalam plasenta manusia

13.unknown

The umbilical cord inserts into the fetal surface of the placenta.

Note the vessels radiating out from the cord over the fetal surface in this normal term placenta.

14.unknown

The maternal surface of a normal term placenta is seen here.

Note that the cotyledons that form the placenta are reddish brown and indistinct.

15.unknown

I. Pertukaran Zat

1. Pasif : filtrasi

difusi

diapedese

2. Aktif : enzim

pinositosis

II. Kelenjar Endokrin

1. Steroid Hormon

(Estrogen dan Progesteron)

2. Protein Hormon

(HCG, HPL, HCT, HCCT)

3. Releasing Hormon

(TSHRF, FSHRH, CHR)

4. Enzim : HSAPase

Oksitosinose

Pregnancy spesific Protein

III. Sebagai barier

mekanis

kimiawi

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 plasenta30-100 cm; 1-1,5 cmWhartons jellyinsersi

sentral / parasentral / lateral / marginalis

diliputi amnion2 arteri umbilicales

1 vena umbilicalis

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).

16.unknown

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.

17.unknown

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.

18.unknown

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.

19.unknown

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.

20.unknown

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.

21.unknown

Berisi cairan amnion Banyaknya ~ umur kehamilan

alkalis

lanugo

vernix caseosa

Oligohidramnion < 500 cc Polihidramnion > 2000 cc

1. Pergerakan anak

2. Barier fisik

3. Pertahanan suhu

4. Membuka serviks (persalinan)

Asalnya : kencing janin

transudat dari ibu

sekret epitel amnion

campuran

Lama hamil = 280 hari

266 hari dari ovulasi

Taksiran Persalinan = NAEGELE

(siklus 28 hari)

Haid terakhir : Hari +7

Bulan -3

Tahun +1

Abortus: < 500 gr

< 22 minggu

Partus Imaturus: 500 - 1000 gr

22 - 28 minggu

Partus Prematurus: 1000 - 2500 gr

28 - 37 minggu

Partus Maturus: > 2500 gr

37 - 42 minggu

Partus Serotinus: > 42 minggu

1 bulan=1 cm

2 bulan=4 cm = 1 gr

3 bulan=9 cm = 14,2 gr

4 bulan= 16 cm = 108 gr

5 bulan= 25 cm = 316 gr

6 bulan= 30 cm = 630 gr

7 bulan= 35 cm = 1045 gr

8 bulan= 40 cm = 1680 gr

9 bulan= 45 cm = 2478 gr

10 bulan= 50 cm = 3400 gr

Implantation is beginning. Trophoblast cells proliferate and begin to invade the uterine epithelium. Invasion is effected through digestion of the uterine cells by secretions of the trophoblast cells. Upon contact with the endometrium the cytotrophoblast forms the syncytiotrophoblast and HCG (human chorionic gonadotropin) production begins.

7th day

150u (0.15mm)

Syncytiotrophoblast cells further invade the Endometrium by secreting hydrolytic enzymes.

8th day

24.unknown

Implantation continues. The synctiotrophoblast nearly completely surrounds the cytotrophoblast cells of the blastocyst. The primary yolk sac is (probably) formed as the hypoblast cells move around the blastocyst cavity.

10th day

25.unknown

Gastrulation begins when the primitive pit forms, though it can not be seen in this picture. Gastrulation is the process by which the third germ layer, the intraembryonic mesoderm, is formed. It involves ingression and migration of cells from the epiblast through the primitive pit and primitive streak. This results in a trilaminar embryo with the three basic germ layers; ectoderm, mesoderm, and endoderm.

2nd week

26.unknown

A very significant week for the embryo. It has changed from a flat trilaminar disc into a tubular embryo and has now acquired a three-dimensional form. The embryo and amnion have grown vigorously, but the yolk sac has not. The lateral edges fold under and become the ventral surface of the embryo. Neurulation is almost completed and the anterior (rostal) and posterior (caudal) neuropores are closing. Sometimes are still forming. Two pairs of branchial (pharyngeal) arches have formed (beginning about day 22).

Upper limb buds appear around day 25. The primordia of the eye and ear are present. The heart bulge is present.

4th week

27.unknown

The size of the embryo is now (approximately) 3.5 - 4.0 mm. Cranial and caudal neuropores have recently closed, and the buccal (oropharyngeal) membrane is opening. Upper (anterior) and lower (posterior) limb buds are present. Lower limb bud appears around day 28. Somite formation is ending at their final number of 38-44 pairs. The last half of the embryonic period (from 4 to 8 weeks) is the time when most of the organs are formed (organogenesis) and teratogens have their most damaging effects on the embryo.

5th week

28.unknown

The size of the embryo is now (approximately) 30mmCRL (Crown-Rump Length). The embryo trunk is elongating and the cervical region is straightening, raising the head. Genital ridges are ambisexual gonads.

7th week

30mmCRL

29.unknown

The size of the embryo is now (approximately) 35-40mmCRL (Crown-Rump Length). This marks the end of the Embryonic Period and the beginning of the Fetal Period. The first eight weeks is a time of embryogenesis, when major organ development begins. The beginnings of all essential structures are now present. The eyelids meet and close in this week. The head is large, most erect, and more rounded. External genitalia still not distinguishable as male or female. If male hormones are present, the ambisexual gonad will now begin to differentiate into a testis. The intestines are in the proximal part of the umbilical cord. The ears are still very lowset. Teratogens have their most damaging effects during the Embryonic Period.

8th week

35mmCRL

30.unknown

The head is now erect and the eyes face anteriorly. The ears are still lowset, but very close to their definitive position. The lower limbs are now well developed. Early toenail development.

15th week

130mmCRL

31.unknown

Head and body hair (lanugo) are visible. External ears stand out from the head. At this point the mother has felt movements of the fetus.

20th week

185mmCRL

32.unknown

The fetus has now been viable since 20-22 weeks, i.e., survival is possible in the outside world without extraordinary measures. Fingernails, toenails, and eyelashes are present. The fetus may now have a good head of hair. The body is filling out. Testes are descending. The eyelids have parted and the eyes are open.

30th week

275mmCRL

33.unknown

11 12 16 20 24 28 32 36 38

KEHAMILAN ATERM

Fetus : + 2 cm

Kehamilan

Enam Minggu

35.unknown

Fetus : + 7 cm

Kehamilan

Duabelas Minggu

36.unknown

Fetus : + 18-27 cm

Berat : + 300 grm

Kehamilan

Duapuluh Minggu

37.unknown

Fetus : + 25 - 38 cm

Berat : + 1000 grm

Kehamilan

Duapuluh Delapan

Minggu

38.unknown

Berat : + 3000 grm

Kehamilan

Aterm

> 37 minggu

39.unknown

PERUBAHAN ANATOMIS FISIOLOGIS PADA WANITA HAMIL

Kehamilan, terjadi perubahan pada :

Genitalia externaGenitalia internaPayudara

Uterus

Membesar pd bulan I estrogen dan progesteron

Hipertrofi otot polos uterus

Serabut kolagen higroskopik oleh karena estrogen meningkat

Uterus Normal Uterus hamil

Berat : 30 grUkuran : 7-7,5 cm x 5,2 cmx 2,5 cmBentuk: advokatBesar : telur ayamBerat : pd 40 minggu menjadi 1000grUkuran : 20 cm x 5,2 cm x 2,5 cm Bentuk : 4 bln => bulat akhir hamil => lonjong telur Besar : 8 minggu =>telur bebek.

12 minggu : telur angsa (FUT teraba diatas simfisiss)

tanda hegar : ismus panjang dan lebih lunak.

16 minggu : sebesar kepala bayi atau tinju orang dewasa

Tinggi (cm)Fundus uteri (TFU)

pusat SOP

dibawah pinggir pust

pinggir pusat atas

3 jari atas pusat

pusat proc. xiphoideus

1 jari dibawah proc. xiphoideus

3 jari dibawah proc. xiphoideus

16

20

24

28

32

36

40

Lingkaran retraksi fisiologis antara korpus yang padat dengan serviks

Patologis bila pusat dan simfisis ossis pubis.

Bil lingkaran masuk sampai pusat =>ruptura uteri.

Serviks Uteri

Jaringan ikat (>> kollagen) lebih banyak dari jar. otot yang hanya 10 %.

Estrogen meningkat, bertambah hipervaskularisasi => lunak

Fungsi tdk sbg sfingter => partus => membuka mengikuti tarikan korpus uteri keatas dan tekanan bagian bawah janin ke bawah.

Post partum => berlipat-lipat dan tidak menutup.

Kelenjar-kelenjar berfungsi lebih baik=> sekresi >> => cairan pervaginam >> (fisiologis)

Vagina dan vulva

Hipervaskularisasi => lebih merah, kebiru-biruan => livide => tanda Chadwick => warna portio => livide (+)

Ovarium

Sampai kehamilan 16 mg => korpus luteum graviditas (+) dg diameter 3 cm => estrogen & progesteron.

.>16 mg => plasenta terbentuk => korpus luteum mengecil.

Mamma

Membesar dan tegang o.k hormon somatoammotropin, estrogen dan progesterone.

estrogen : hipertrofi sistem saluran

progesterone: menambah sel-sel asinus pd mammae

Glandula Montgomery => jelas menonjol pd permukaan areola mammae.

Hamil 12 minggu ke atas dari putting susu dapat keluar cairan berwarna putih agak jernih, disebut kolustrum, setelah partus agak kental dan agak kuning.

Sirkulasi darah

Sirkulasi darah ibu bertambah secara fisiologik dg adanya pencairan darah yang disebut hidremia.

Eritropoiesis meningkat,penambahan volume plasma jauh lebih besar sehingga Hb jadi rendah.

Protein, albumin & gamma globulin menurun pd triwulan I dan meningkat pd akhir kehamilan. LED umumnya meningkat.

Sistem Respirasi

Rasa sesak nafas pd kehamilan 32 minggu krn usus-usus tertekan oleh uterus yang membesar kearah diafragma.

Kebutuhan O2 wanita hamil meningkat 20%

Traktus Digestivus

Rasa enek (nausea) karena estrogen yang meningkat.

Obstipasi karena penurunan tonus otot-otot tr. digestivus.

Sering dijumpai morning sickness, hiperemesis gravidarum dan salivasi.

Traktus Urinarius.

Trimester pertama sering kencing karena kandung kencing tertekan uterus.

Akhir kehamilan krn penekanan oleh kepala bayi.

Pembesaran ureter kiri dan kanan, tetapi kanan lebih membesar krn uterus lebih sering memutar ke kanan hidroureter dextra dan pielitis dextra lebih sering.

Poliuria karena peningkatan filtrasi glomerulus

Kulit

Kloasma gravidarum karena peningkatan MSH.

Linea alba menjadi hitam : linea grisea.

Hiperpigmentasi pada leher, areola mammae.

Pada kulit perut : striae livide => striae albikantes setelah partus.

Metabolisme dalam kehamilan

BMR meningkat 10 -15 %, sistem endokrin juga tinggi.

Na turun diikuti turunnya plasma bikarbonat.

Penurunan dalam fraksi albumin dan sedikit penurunan gamma globulin. Globulin alfa-1, alfa-2 dan beta dan fibrinogen meningkat.

Kadar kolesterol meningkat sampai 350 mg.

Janin butuh 30-40 gr kalsium. Kadar kalsium serum memang lebih rendah karena adanya hidremia tetapi masih cukup untuk menanggulangi adanya tetani.

Fosfor, magnesium dan tembaga banyak tertahan dalam masa hamil daripada tidak hamil.

Wanita hamil butuh tambahan besi sekitar 800 mg.

Sebaiknya diet wanita hamil diberikan 30-50 mg besi sehari, dpt diberikan sebagai sulfas ferrosus atau glukonas ferrosus sesudaah makan.

Kadar alkali-fosfatase meningkat 4x lipat dibanding wanita tdk hamil, mulai kehamilan 4 bulan.

Alkali fosfatase dapat dipakai untuk menilai fungsi plasenta.

Berat badan wanita hamil naik 6,5 16,5 kg, rata-rata 12,5 kg, terutama 20 minggu terakhir.

Kenaikan BB terlalu banyak pada pre-eklampsia

Kenaikan BB pada kehamilan disebabkan oleh

Hasil konsepsiibu sendiri.