1. kehamilan mu
DESCRIPTION
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POM Harry Satria
- 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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Pembentukan Ruang Amnion & Kuning Telur
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Decidua :
Str. CompactumStr. SpongiosumStr. BasaleDecidua :
basaliscapsularisveraPerubahan Endometrium
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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
PERKEMBANGAN
TROFOBLAST
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Chorion Frondosum (chorionic villi)
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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.
12.unknown - Berbentuk cakram
15-20 cm, tebal 2-3 cm
+ 500 gram
2 bagian (bagian ibu dan bagian anak)16 - 20 kotiledon2 arteri umbilikales1 vena umbilikalis
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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
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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 umbilicales1 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 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
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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 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
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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)
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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
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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
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Kehamilan, terjadi perubahan pada :
Genitalia externaGenitalia internaPayudaraUterus
Membesar pd bulan I estrogen dan progesteron
Hipertrofi otot polos uterus
Serabut kolagen higroskopik oleh karena estrogen meningkat
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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
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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)
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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.