dr Adi Sukrisno, SpOG, FMAS

Syarat ?

Kapan ?

Bagaimana ?

Dimana ?

Ada sperma & sel telur yang matang
Sekitar ovulasi
Pertemuan dan persenyawaan ovum &
sperma
Di ampula
Gametogenesis
A. Two-cell stage
B. Three-cell stage
C. Four-cell stage
D. Five-cell stage
E. Six-cell stage
F. Eight-cell stage
5 hari setelah fertilisasi
Pembentukan Ruang Amnion & Kuning Telur
Zigot
Pembelahan
Morula (32 sel)
exocoelom
Blastokist
trofoblast
bintik benih
Nidasi
Nodus embryonale :
ruang amnion
ruang kuning telur
Ectoderm
kulit, rambut, kuku, gigi, saraf
Entoderm
usus, hati, saluran nafas, kandung kencing
Mesoderm
otot, tulang, jaringan ikat, jantung & pembuluh darah
Drawing of section implanted blastocysts. A. 10 days. B. 12 days after fertilization.
The stage of development is characterized by the intercommunication of the lacunae
filled 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)
Bintik Benih
Ectoderm
mesoderm
entoderm
Discus
embryonale (D.e)
Janin
D.e menonjol ke Ruang Amnion
Hubungan D.e dengan Trofoblast
Tangkai penghubung
(Tali Pusat)
Decidua :
Str. Compactum
Str. Spongiosum
Str. Basale
Decidua :
basalis
capsularis
vera
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)
Chorion frondosum
pembuluh darah ibu
decidua (Haftzote)
Membran plasenta : Amnion
Khorion
16 minggu : sel Langhans hilang
terbentuk lapisan Nitabuchl
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.
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
Skematik aliran darah dalam plasenta manusia
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.
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
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 plasenta
30-100 cm; 1-1,5 cm
Whartons jelly
insersi
sentral / parasentral / lateral / marginalis /
vilamentosa
diliputi amnion
2 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).
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.
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.
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.
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.
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.
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 - 40 minggu
Post matur > 40 mgg
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
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
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
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
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
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
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
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
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
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
11 12 16 20 24 28 32 36 38
KEHAMILAN ATERM
Fetus : + 2 cm
Kehamilan
Enam Minggu
Fetus : + 7 cm
Kehamilan
Duabelas Minggu
Fetus : + 18-27 cm
Berat : + 300 grm
Kehamilan
Duapuluh Minggu
Fetus : + 25 - 38 cm
Berat : + 1000 grm
Kehamilan
Duapuluh Delapan
Minggu
Berat : + 3000 grm
> 37 minggu
1. Faktor Ibu : tinggi badan
gizi
tempat tinggal
kehamilan ganda
kelainan uterus
2. Faktor Anak : jenis kelamin
kelainan genetis
infeksi intrauterin
kelainan congenital
3. Faktor Plasenta : insufisiensi plasenta
Berat plasenta/Berat Bayi menurun
sampai dengan 36 mg

28 mg = 0.25
38 mg = 0.15
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 :
Kepala Janin pada saat aterm
yang memperlihatkan
bermacam-macam ubun-
ubun, sutura, dan diameter
biparietal
Sutura : sagitalis
coronaria
lambdoidea
frontalis
Ubun-ubun besar :
Pertemuan 4 sutura : sagitalis
coronaria
frontalis
Ubun-ubun kecil :
Pertemuan 3 sutura : sagitalis
lambdoidea
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
3. Diameter oksipitofrontalis
4. Diameter oksipitomentalis
5. Diameter submentobregmatikus
Diameter Kepala Janin
pada cukup bulan
B. Ukuran melintang
1. D. Biparietalis ( 9 cm )
2. D. Bitemporalis ( 8 cm )
C. Ukuran lingkaran
1. C. Suboccipito - bregmatica : 32 cm
( lingkaran kecil )
2. C. Fronto - occipitalis : 34 cm
( lingkaran besar )
Diameter biparietalis dan
Diameter bitemporalis
Kepala dengan beberapa
sirkumferensia
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
Sirkulasi
Darah
Janin
Cardiovascular
system of fetus
HB janin Hb dewasa
Dibuat terutama di hepar
Transport O
2
lebih mudah
Menjadi Hb biasa 4 bulan
Peredaran darah lebih cepat
Kadar Hb lebih tinggi
eritrosit lebih banyak
O
2
darah janin lebih rendah
1. UTERUS
Uterus membesar
hiperplasi, hipertrofi otot
pertumbuhan aktif (estrogen)
pertumbuhan pasif : segmen bawah rahim
lingkaran retraksi
Tanda Piskacek
Kontraksi Braxton Hicks
Perubahan serviks
Pembentukan segmen bawah rahim dari isthmus uteri.
Pada dystocia lingkaran retraksi sangat tinggi
Pembentukan rahim dan perubahan sikap tubuh ibu
selama kehamilan
Minggu
6 12 16 20 24
Minggu
28 32 36 40
2. VAGINA
Elastisitas bertambah
Tanda Chadwick
Keasaman bertambah
3. OVARIUM
Corpus luteum graviditatum
4. DINDING PERUT
Striae gravidarum
lividae
albicans
O.K. hiperfungsi gl. suprarenalis
5. KULIT
hiperpigmentasi : linea nigra
chloasma
6. PAYUDARA
Membesar, nyeri
( hipertrofi alveoli )
Colostrum
Hiperpigmentasi
7. Berat Badan
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
8. DARAH
Volume darah bertambah
Eritrosit bertambah
Hydremi
Batas fisiologis : Hb : 11 gr%
Eri : 3,8 juta/mm
3

Leuco : 12000/mm
3
hemodilusi

9. Lain-lain
beban jantung bertambah
kerja paru-paru bertambah
sekresi HCl & gerakan lambung berkurang
kerja ginjal bertambah
ureter melebar
polakisuri
perubahan mental