Fisiologi kehamilanTri Agung Wahyu C

Transport Spermatozoa

Perkembangan embryo

Implantasi

Pertumbuhan & perkembangan embryo & struktur penunjangnya

Plasenta

Fungsi plasentaPlasenta:Pertukaran gasTransport nutrisiEkskresi zat-zat sampahProduksi hormonProteksi

Anatomi/FisiologiTali pusatPenghubung plasenta-janin2 arteri1 venaSelaput amnionMembran yang melingkupi janinCairan amnion berasal dari beberapa sumber500 - 1000 cc (setelah 20 minggu)Pecah KPD

Diagnosis kehamilanAnamnesisPemeriksaan fisikPemeriksaan laboratoriumPemeriksaan penunjang

Anamnesis -- Possible sign AmenorrheaMual - muntahMastodiniaQuickeningFrekuensi kencingKonstipasi

Pemeriksaan fisik -- Possible signs Suhu badan basalPenambahan berat badanPigmentasiPerubahan payudaraPembesaran abdomenPerubahan genitalKontraksi uterusBallotement

Linea nigra

Striae rubra

Perubahan payudara

Hegar sign

Ballotement

Positive signPalpasiPemeriksaan laboratorium test hCGDenyut jantung janinStetoskop Laenec: 18 weeksDoppler : 12 weeksUltrasound : 6- 7 weeksRontgenography : 12-14 weeks TERATOGENIK

Menentukan usia kehamilanRumus NaegeleHPM/HPHT harus teratur, 28 hari HPL = (Tanggal + 7), (Bulan -3) (Tahun +1)11-8-0318-5-0405-1-0312-10-03Durasi: 280 hari (40 minggu)37 - 41: kehamilan aterm28 - 37: kehamilan preterm42 atau lebih: kehamilan posttermKurang dari 28: Periode abortus

Menentukan usia kehamilan Tinggi Fundus uteri

Menentukan usia kehamilanQuickening: 16-18 minggu pada multigravida: 18-20 minggu pada primigravidaTest kehamilan positif: 5 mingguUltrasonografi: Gestational sac (GS)Crown-lump length (CRL)Biparietal diameter (BPD)Denyut jantung janin

Positive SignsUltrasonografi:5.5 minggu : Gestational sac6 minggu : Embryonic pole6-7 minggu : FHR8 minggu : Gerakan janin10 minggu: Plasenta12 minggu: BPD

5,5 minggu

7 minggu

12 minggu, CRL 46.9 mm

6 weeks, dizygotic twin

Perubahan fisiologisTD menurun pada trimester-1 sistolik 2-4 mmHgdiastolik 5-15mmHgDenyut 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 terangkatUkuran uterus Kandung kencing bergeser naikPergeseran ususDistraksi simfisisDilatasi ureterRespons spinchter gastro-esophagus supine hypotensive syndromeAliran darah ke uterus 10xTekanan venosa perifer

Sistem Sirkulasi JaninTekanan vaskuler kebalikan dari dewasaVenosa > arterialKonstriksi vaskuler pulmonalPaO2 rendah, paru-paru kolapsResistensi rendah di plasentaFetal shunts

Fetal shuntsDuctus arteriosusForamen ovaleDuctus venosusSistem Sirkulasi Janin

SIRKULASI DEWASAsemilunar valvesAV valves Vena cavaeRight ATRIUMPulmonary veinsPulmonary arteries Right VENTRICLELef t ATRIUM Left VENTRICLEAortaLUNGS SYSTEMIC CAPILLARIESde-oxygenated bloodRight ventricle pumps to the lungs Left ventricle serves rest of bodySepta/partitions separate heart into left and right chambers

SIRKULASI MATERNALVena PulmonalisPLASENTAARTERI UTERINAUTERUSPembuluh darah janin Vena cavaATRIUMkananPulmonary arteriesVENTRIKELkananATRIUMkiriVENTRIKEL kiriAortaPARUKAPILER SISTEMIKJANTUNGARTERI UTERINAPLACENTAVENA UTERINA

Pembuluh darah TALI PUSATMaternal bloodHUGE EXCHANGE SURFACEfrom branching processes - chorionic villi - containing fetal capillariesPLASENTADisuplai oleh arteri uterinaKeluar melalui vena uterina

SIRKULASI JANINParu-paruaortaHeartVENA CAVAJantung memompa darah ke seluruh tubuhJantung menerima darah bekas dari seluruh tubuhRestriksi aliran darah menuju dari dari paru-paruJanin mendapatkan darah yg kaya oksigen dari plasentamasuk ke janin melalui sistem vena & melalui jalan pintas di jantung

FETAL CIRCULATION ITALI PUSAT dengan Fetal capillaries2 ARTERI UMBILICALISUTERINE WALLin placental villi1 VENA UMBILICALISPembuluh darah berasal dari plasenta masuk janin melalui vena umbilicalis, tetapi membawa darah kaya O2

FETAL CIRCULATIONPLACENTAUMBILICAL VEINDUCTUS VENOSUS to get past the liverMenggunakan ductus venosus utk masuk ke vena cava inferior jantung

FETAL CIRCULATIONPLACENTAUMBILICAL VEINDUCTUS VENOSUSPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTIVCOLef t ATRIUM

FETAL CIRCULATION IVPLACENTASince oxygenated blood is coming in where normally systemic venous blood arrives, & the lungs have no access to air, the flow through the heart is special & the lungs are bypassedUMBILICAL VEINDUCTUS VENOSUS to get past the liverPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTIVCOLef t ATRIUMUmbilical arteries

FETAL CIRCULATION VPLACENTAKarena darah kaya O2 datang dari tempat yg normalnya merupakan muara vena sistemik, dan karena paru-paru tidak punya akses thd udara, maka aliran menuju paru-paru dilewatkan (bypasseed)UMBILICAL VEINDUCTUS VENOSUS to get past the liverPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTIVCOLef t ATRIUMO

FETAL CIRCULATION VIOxygenated blood comes in where normally systemic venous blood arrivesLungs are bypassed 1Foramen ovale between atrialets red blood pass into the left atrium for distribution, via left ventricle & aorta, around the fetusDUCTUS VENOSUSPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTLungs are bypassed 2Another bypass is the Ductus arteriosusIVCOLef t ATRIUMallowing blood to pass from pulmonary trunk to the aorta

FETAL CIRCULATION VII: Conversion to post-natalCritical steps are closure ofForamen ovaleDUCTUS VENOSUS &Ductus arteriosusForamen ovaleDUCTUS VENOSUSUmbilical arteriesPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTDuctus arteriosusIVCOLef t ATRIUMUmbilical arteries

FETAL CIRCULATION VIII: Conversion to post-natalPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTUmbilical arteriesDuctus arteriosusIVCOLef t ATRIUMClosure ofForamen ovaleDUCTUS VENOSUSmeans that blood expelled from the right ventricle has to go to the lungsClosure ofClosure ofStops use of umbilical vessels, & converts all vena cava blood to deoxygenatedForces venous blood (now all deoxygenated) into the right ventricle for expulsion to the lungsClosure ofStops use of umbilical vessels

FETAL CIRCULATION IX: Conversion to post-natalClosure ofForamen ovalePulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGS SYSTEMIC CAPILLARIESDuctus arteriosusIVCOLef t ATRIUMDUCTUS VENOSUSClosure ofClosure ofInitial closure is by muscular contraction, lumen is obliterated by fibrosis only laterFirst inspirations of the lungs cause lung vessels to greatly reduce their resistance. Blood flows more freely through, so raising the pressure in the left atriumHEARTPressure-rise in left atrium resists the blood trying to come through the Foramen ovale, and pushes its flap back onto the septum for later fusion Umbilical arteries

Foramen ovaleDUCTUS VENOSUSUmbilical arteriesPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTDuctus arteriosusIVCOLef t ATRIUMPulmonary veins Vena cavaRight ATRIUMPulmonary arteriesRight VENTRICLELef t ATRIUMLeft VENTRICLEAortaLUNGSSYSTEMIC CAPILLARIESHEARTPOST-NATAL CIRCULATIONFETAL CIRCULATION X: Conversion to post-natalFETAL CIRCULATIONNote distinction between venous deoxygenated blood in Right chambers & oxygenated blood from lungs in Left chambers of postnatal babyThe foramen ovale can just seal shut, but the ductus venosus & d. arteriosus (&umbilical arteries) have to shrivel to become just connective tissue ligamentsLigamentum arteriosumLigamentum venosumMedial umbilical ligaments

The Uterine CycleSeries of cyclic phases of the endometriumPhases coordinate with the ovarian cycleEndometrial phases directed by FSH and LHPhases of uterine cycleMenstrual phase days 1-5 Stratum functionalis is shedProliferative phase days 6-14 Secretory phase days 15-28

Cycle Overviewhypothalamusanterior pituitaryFSHLHFSHLHLHestrogensestrogensFOLLICULAR PHASE LUTEAL PHASE menstruationovulationGnRHFSHLHestrogensprogesteroneGnRH secretion affects LH and FSH secretion by pituitaryLH and FSH affect follicle maturationEstrogen and progesterone from ovary affect uterus

The Menstrual Cycle

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