Hamil skrip

8/13/2019 Hamil skrip

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Syarat ?

Kapan ?

Bagaimana ?

Dimana ?


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Ada sperma & sel telur yang matang

Sekitar ovulasi

Pertemuan dan persenyawaan ovum &

sperma

Di ampula


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Gametogenesis


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A. Two-cell stage

B. Three-cell stage

C. Four-cell stage

D. Five-cell stageE. Six-cell stage

F. Eight-cell stage


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5 hari setelah fertilisasi


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Pembentukan Ruang Amnion & Kuning Telur


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Zigot

Pembelahan

Morula (32 sel)

exocoelom

Blastokist

trofoblast

bintik benih

Nidasi


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Nodus embryonale : ruang amnion

ruang kuning telur

Ectodermkulit, rambut, kuku, gigi, saraf

Entodermusus, hati, saluran nafas, kandung kencing

Mesodermotot, tulang, jaringan ikat, jantung & pembuluh darah


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Drawing of section implanted blastocysts. A. 10 days. B. 12 days after fertilization.

The stage of development is characterized by the intercommunication of the lacunaefilled 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)


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Bintik Benih

Ectoderm

mesoderm

entoderm

Discusembryonale (D.e)

Janin

D.e menonjol ke Ruang AmnionHubungan D.e dengan Trofoblast

Tangkai penghubung (Tali Pusat)


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Decidua :Str. Compactum

Str. Spongiosum

Str. Basale

Decidua :

basalis

capsularis

vera

PerubahanEndometrium


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Chorion

Frondosum


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Trofoblast

1. Lapisan Langhans

(cytotrophoblast) mesoderm

2. Lapisan luar

(syncytium/syncytio trophoblast) decidua

Khorion

Vili

chorion laeve

chorion frondosum

PERKEMBANGANTROFOBLAST


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Chorion

Frondosum

(chorionic villi)


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Chorion frondosum pembuluh darah ibu

decidua (Haftzote)

Membran plasenta : AmnionKhorion

16 minggu :sel Langhans hilang

terbentuk lapisan Nitabuchl


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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.


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Berbentuk cakram 15-20 cm, tebal 2-3 cm

+ 500 gram

2 bagian (bagian ibu dan bagian anak)

16 - 20 kotiledon

2 arteri umbilikales

1 vena umbilikalis


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Skematik aliran darah dalam plasenta manusia


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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.


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The maternal surface of a normal term placenta is seen

here.Note that the cotyledons that form the placenta are

reddish brown and indistinct.

I Pertukaran Zat


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I. Pertukaran Zat

1. Pasif :filtrasi

difusi

diapedese

2. Aktif : enzimpinositosis

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 bariermekanis

kimiawi


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1 Pertumbuhan janin2 Amnioskopi / amniosentesis3 Estrogen / pregnandiol urin4 Oksitosinase serum5 HPL6 OCT7 USG8 Profil biofisik


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Antara pusat janin - permukaan fetal plasenta

30-100 cm; 1-1,5 cm

Whartons jelly

Insersi sentral / parasentral / lateral / marginalis

diliputi amnion 2 arteri umbilicales

1 vena umbilicalis


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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 intercellularground substance (Wharton's jelly).


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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.


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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 agreater chance for cord trauma with bleeding during delivery.

Dividing membranes are see at the left in this twin placenta.


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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 moreloops of umbilical cord are wrapped around the baby's neck.

The relationship of the placenta to


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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 amnioticcavity.

The amniotic fluid in this cavity

allows for fetal movement and

protects the baby.


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The fetus at the left is macerated from prolonged demise in

utero.

The cause of the demise in this case is the marked twisting, ortorsion, of the umbilical cord.

A macerated placenta is present at the right.


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Berisi cairan amnion

Banyaknya ~ umur kehamilan

alkalis

lanugo

vernix caseosa

Oligohidramnion < 500 cc

Polihidramnion > 2000 cc


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1. Pergerakan anak

2. Barier fisik

3. Pertahanan suhu

4. Membuka serviks (persalinan)

Asalnya :kencing janin

transudat dari ibu

sekret epitel amnion

campuran


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Lama hamil = 280 hari

266 hari dari ovulasi

Taksiran Persalinan = NAEGELE (siklus 28 hari)

Haid terakhir : Hari +7

Bulan -3

Tahun +1


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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


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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 gr6 bulan = 30 cm = 630 gr

7 bulan = 35 cm = 1045 gr

8 bulan = 40 cm = 1680 gr9 bulan = 45 cm = 2478 gr

10 bulan = 50 cm = 3400 gr


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Implantation is beginning Trophoblast7th day


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Implantation is beginning. Trophoblast

cells proliferate and begin to invade

the uterine epithelium. Invasion is

effected through digestion of theuterine cells by secretions of the

trophoblast cells. Upon contact with

the endometrium the cytotrophoblast

forms the syncytiotrophoblast andHCG (human chorionic gonadotropin)

production begins.

150u (0.15mm)

8th d


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Syncytiotrophoblast cells

further invade the

Endometrium by secreting

hydrolytic enzymes.

8th day

10th day


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Implantation continues. The

synctiotrophoblast nearlycompletely 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

2nd week


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Gastrulation begins when the primitive pit

forms, though it can not be seen in this

picture. Gastrulation is the process bywhich 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 atrilaminar embryo with the three basic

germ layers; ectoderm, mesoderm, and

endoderm.

2nd week

4th week


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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-dimensiona

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 stillforming. 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.

5th week


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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


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The size of the embryo is now (approximately) 35

8th week


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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 willnow 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.

35mmCRL

15th week

130 CRL


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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.

130mmCRL

20th week

185 CRL


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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.

185mmCRL

30th week

275 CRL


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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. Theeyelids have parted and the eyes are open.

275mmCRL


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11 12 16 20 24 28 32 36 38

KEHAMILAN ATERM


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Fetus : + 2 cm

Kehamilan 6 minggu


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Fetus : + 7 cm

Kehamilan 12 Minggu


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Fetus : + 18-27 cmBerat : + 300 gr

Kehamilan 2 Minggu


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Berat : + 3000 gr

Kehamilan Aterm> 37 minggu


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1. Faktor Ibu : tinggi badan

gizitempat tinggal

kehamilan ganda

kelainan uterus

2. Faktor Anak : jenis kelamin

kelainan genetis

infeksi intrauterin

kelainan congenital

3. Faktor Plasenta : insufisiensi plasenta


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Berat plasenta/Berat Bayi menurunsampai dengan 36 mg

28 mg = 0.25

38 mg = 0.15


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a. Bagian muka : tulang hidung

tulang pipi

rahang atas

rahang bawah

b. Bagian tengkorak : tulang dahi

tulang ubun-ubun

tulang pelipis tulang belakang kepala

Bagian terpenting dalam persalinan terdiri dari :


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Kepala Janin pada saat atermyang memperlihatkanbermacam-macam ubun-ubun, sutura, dan diameterbiparietal

Sutura : sagitalis

coronaria


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coronaria

lambdoidea

frontalis

Ubun-ubun besar :

Pertemuan 3 sutura : sagitalis

coronariafrontalis

Ubun-ubun kecil :

Pertemuan 2 sutura : sagitalislambdoidea


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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


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. a ete subo s p to o ta s

3. Diameter oksipitofrontalis

4. Diameter oksipitomentalis

5. Diameter submentobregmatikus

Diameter Kepala Janin

pada cukup bulan


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B. Ukuran melintang

1. D. Biparietalis ( 9 cm )

2. D. Bitemporalis ( 8 cm )

C. Ukuran lingkaran1. C. Suboccipito - bregmatica : 32 cm

( lingkaran kecil )

2. C. Fronto - occipitalis : 34 cm

( lingkaran besar )


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Diameter biparietalis dan

Diameter bitemporalis

Kepala dengan beberapa

sirkumferensia


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Setelah lahir :Ductus Botali menutup lig. Arteriosum

Foramen ovale menutup

Duct. Venosus aranti lig teres hepatis

Aa umbilicales lig vesico umbilicale laterale

2 arteri

1 vena darah campuran

isi vena cava inferior lebih bersih dari aorta


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Cardiovascularsystem of fetus


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system of fetus

HB janin Hb dewasa

Dibuat terutama di hepar


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Dibuat terutama di hepar

Transport O2lebih mudah

Menjadi Hb biasa 4 bulan

Peredaran darah lebih cepat

Kadar Hb lebih tinggi eritrosit lebih banyak

O2darah janin lebih rendah


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1. UTERUS

Uterus membesar hiperplasi, hipertrofi otot

pertumbuhan aktif (estrogen)

pertumbuhan pasif : segmen bawah rahim lingkaranretraksi

Tanda Piskacek

Kontraksi Braxton Hicks

Perubahan serviks


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Pembentukan segmen bawah rahim dari isthmus uteri.

Pada dystocia lingkaran retraksi sangat tinggi

Minggu

6 12 16 20 24


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Pembentukan rahim dan perubahan sikap tubuh ibuselama kehamilan

Minggu

28 32 36 40

2. VAGINA

Elastisitas bertambah


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Elastisitas bertambah

Tanda Chadwick

Keasaman bertambah

3. OVARIUM

Corpus luteum graviditatum

4. DINDING PERUT

Striae gravidarum


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g

lividae

albicans

O.K. hiperfungsi gl. suprarenalis

5. KULIT

hiperpigmentasi : linea nigrachloasma

6. PAYUDARA

Membesar, nyeri ( hipertrofi alveoli )

Colostrum Hiperpigmentasi

7. Berat Badan


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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

Air : 1,5 kg

Kebutuhan Fe, Ca dan P

bertambah


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8. DARAH Volume darah bertambah

Eritrosit bertambah

Hydremi

Batas fisiologis : Hb : 11 gr%Eri : 3,8 juta/mm3

Leuco : 12000/mm3


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9. Lain-lain

beban jantung bertambah

kerja paru-paru bertambah

sekresi HCl & gerakan lambung berkurang

kerja ginjal bertambah

ureter melebar

polakisuri

perubahan mental

Hamil skrip

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