PERUBAHAN LINGKUNGAN

INTRA EKSTRA UTERUS

TERHADAP FISIOLOGI
SISTEM TUBUH
Department of Physiology, Faculty of Medicine
University of Sumatera Utara, Medan
Indonesia

PROSES KELAHIRAN
(Perubahan Link. Intrauterine Link. Ekstrauterine)

at term

KONTRAKSI uterus
(Frekuensi-Durasi-Intensitas)

Sirkulasi (PO2/PCO2) terganggu

Asphyxia (PO2 & PCO2 )
Heart Rate :
140x/mnt 160-180x/mnt
bila O2 100-120x/mnt

Perubahan SIRKULASI segera setelah Lahir

Bayi
Bayi lahir
lahir(normal)
(normal)

Rangs.
Rangs. Dingin
Dinginpd
pdKulit
Kulit ++Asphyxia
Asphyxia

Bayi
BayiMenangis
Menangis

PO
PO22
70-80
70-80mmHg
mmHg
Saturasi
SaturasiHb-O
Hb-O22:: 80-90%
80-90%

at birth
potong

Umbilical cord (tali pusat)

Sirkulasi Plasenta (-)

Asphyxia (CO2 & O2 )

Tahanan peripher

Rangs. Dingin

Menangis Tarik Napas

Paru mengembang
Tahanan paru

TD.Aorta

TD. pulmonal

TD. Aorta >> TD. Art.Pulmonal

TD.
TD.Aorta
Aorta >>
>>TD.
TD.Art.Pulmonal
Art.Pulmonal

Aliran
Alirandarah
darahparu
paru

Aliran
AliranAtrium
AtriumKiri
Kiri
&&Aliran
AliranAtrium
AtriumKanan
Kanan

Tek.
Tek.Atrium
AtriumKiri
Kiri>>Tek.
>>Tek.Atrium
AtriumKanan
Kanan

Foramen
Foramen Ovale
OvaleTertutup
Tertutup

Bbrp. Jam postpartum

Aliran Atrium Kiri & Aliran Atrium Kanan
Aliran darah Aorta Arteri Pulmonalis

Konstriksi Duktus Arteriosus

(Penutupan Fungsional)
1 - 4 Bulan
Fibrosis Occluded
Sirkulasi Dewasa
7

Circulation in Fetus and Newborn

PERUBAHAN SIRKULASI
PLASENTA

PLASENTA

JARINGAN TUBUH

JARINGAN TUBUH

JARINGAN TUBUH
FO

FO
VENT Ki ATR Ki

VENT Ki ATR Ki

VENT Ki ATR Ki

PARU

PARU
PARU

PARU

DA

DA

DA
VENT Ka ATR Ka

VENT Ka ATR Ka

VENT Ka ATR Ka

FETUS

PERINATAL (0-1 Bln)

BAYI (1-4 Bln) Dewasa

FO : Foramen Ovale
DA : Ductus Arteriosus

MENARIK NAFAS PERTAMA (The First Breath)

Perubahan Respirasi Placenta Respirasi paru
Bayi
BayiLahir
Lahir
Rangsang
Rangsangsensorik
sensorik::Kulit
Kulit&&Otot
Otot

Asidosis
AsidosisRingan
Ringan

Pusat
PusatPernapasan
Pernapasan
Kontraksi
Kontraksiotot-otot
otot-ototPernapasan
Pernapasan
Vol.
Vol.Intra
IntraThoraks
Thoraks
&&Tek.
Tek.Intra
IntraThoraks
Thoraks

Udara
UdaraMasuk
Masukke
keParu
Paru
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REGULASI SUHU TUBUH

Bayi

Iklim intrauterine (tropis) Iklim Ekstrauterine

STRESS

Regulasi Suhu
BELUM STABIL

Suhu Tubuh
TDK STABIL

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Regulasi Suhu Blm. Stabil

Thermogenesis (Heat Gain)

Tak dpt menggigil (respon

dingin) Sistem syaraf blm.
Sempurna.
Respon dingin :
Metabolisme brown fat
Trigliserida
Free fatty acid

Thermolysis (Heat Loss)

Luas permukaan bayi >>
Dewasa
Kulit & Jar. Subcutan
tipis High
Conductance Panas
hilang >>
Cairan Tubuh

BB (5-10%) 2-3 Hr
pertama
12

FUNGSI LIVER
Bayi baru lahir

Sumber Energi

GLIKOGEN
GLIKOGEN
LIVER,
LIVER,OTOT,
OTOT,JANTUNG,
JANTUNG,dll
dll

Beberapa jam
postpartum

GLIKOGEN
GLIKOGEN

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REGULASIGLUKOSA
GLUKOSA
REGULASI
Segerasetelah
setelahlahir
lahir
KGD
KGD30-40mg/100mL
30-40mg/100mL
Segera
Bbrp.jam
jam
Bbrp.
Glikogen

Glikogen
GLUKONEOGENESIS
GLUKONEOGENESIS
Gangguan/gagal
Gangguan/gagal

Pemberian
Pemberian
Glukosa
Glukosa

KGD<20mg/100mL
<20mg/100mL
KGD
Ggn.Syaraf
Syaraf&&Koma
Koma
Ggn.
Apnoe++Cyanosis
Cyanosis
Apnoe
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METABOLISME PROTEIN & LEMAK

Fetus
Tak
TakMelawati
MelawatiBarrier
BarrierPlacenta
Placenta

Melawati
MelawatiBarrier
BarrierPlacenta
Placenta

--Plasma
PlasmaProtein
Protein

--Immunoglobulin
Immunoglobulin

--Lemak
Lemak

Sintesa
Sintesadi
diHati
Hati::
Albumin
Albumin&&Lemak
Lemak

Segera Setelah
Lahir

Aktivasi
AktivasiMet.
Met.As.Nukleat
As.Nukleat&&
sintesa
sintesaProtein
Protein
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BILIRUBIN & FUNGSI DETOXIFIKASI

Fungsi
FungsiEkskresi
EkskresiBilirubin
Bilirubin(Hati)
(Hati)&&
Detoxifikasi
DetoxifikasiObat-obatan
Obat-obatan
Blm.
Blm.Sempurna
Sempurna

Physiological
Physiological
Joundice
Joundice(3-7
(3-7
Hari)
Hari)

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TRACT. GASTROINTESTINALIS
Rute PLACENTA Rute INTESTINAL

MOTILITA
MOTILITA
SS

Gastric
GastricEmptying
EmptyingTime
Time::3-4
3-4jam
jam
Enzym
EnzymLambung
Lambung&&HCl,
HCl,pH
pH::<3
<3
(pencernaan
(pencernaanSusu)
Susu)

SEKRES
SEKRES
II

ABSORPSI
ABSORPSI

Enzym
EnzymIntestinal,
Intestinal,dan
danEmpedu
Empedu

CUKUP
CUKUP
Amilase
AmilasePankreas
Pankreas<<<
<<<
Zat
ZatNutrisi
Nutrisi
BAIK
BAIK
Kecuali
KecualiLEMAK
LEMAK
17

PENGATURAN
ENDOKRIN
PERTUMBUHAN

Foetus Growth dipengaruhi :

Maternal Nourishment
Estrogen & Progesteron

Fetus Growth
Tdk.dipengaruhi :
Growth Hormon Foetus
Thyroxine Foetus

18

Thyroid Gland

PERKEMBANGAN

AKTIF segera Stlh Lahir

(respon thd dingin)

IBU

Lahir Bayi

(HYPOTHYROIDISM)

(HYPOTHYROIDISM)

19

Adrenal Korteks
Padaurine
urine
Pada

Kortikosteroid (+)

Keadaanstress
stress
Keadaan

Respon kelenjar (+)

SaatLahir
Lahir
Saat
PO22

PO
ASPHYXIA
ASPHYXIA
Adrenal
Medula

Epinephrin/NE
Epinephrin/NE
VASOKONSTRIKSI
VASOKONSTRIKSI

Respon Metabolik
Thd DINGIN

Mempertahankan
Sirkulasi Darah Otak

20

SISTEM SYARAF
Sifat Refleks
Sist. Syaraf Pusat
Flexion Reflex,menangis wkt.
Lapar, memutar Kepala, dll.
Pertumbuhan :
- me pd Trimester II & III
(maks)

Buka mata (respon Cahaya &

Suara)
Tidur barbagai posisi

-Berat : berat Otak Dewasa

21

PERAN HORMON DALAM

PROSES TUMBUH DAN
KEMBANG

22

Multiple hormones, including growth hormone (GH),

insulin-like growth factors (IGF-I and -II), insulin,
thyroid hormones, glucocorticoids, androgens, and
estrogens contribute to the growth process in
humans.
Among these, GH and IGF-I have been implicated
as the major determinants of growth in normal
postuterine life. However, deficiencies (or excesses)
of each of the other hormones can seriously affect
the normal growth of the musculoskeletal system as
well as the growth and maturation of other tissues.

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Pancreas: Insulin
actions: hypoglycemic (lowers blood
glucose)
increases transport of glucose into muscle and fat
cells (NOTE: does not increase uptake by brain,
liver, or kidney)
inhibits breakdown of glycogen and formation of
glucose from amino acids or fatty acids (inhibits
glycogenolysis and gluconeogenesis)
promotes formation of glycogen (liver, skeletal
muscles), protein synthesis (muscle), and fat
synthesis and storage (adipose)
27

5. Pancreas: Insulin (Control)

stimulated by:
increased blood glucose
increased blood amino acid and
fatty acid levels
parasympathetic impulses
hyperglycemic hormones (GH,
glucagon, epinephrine,
thyroxine, glucocorticoids)
indirectly result in insulin
secretion by increasing blood
glucose levels

inhibited by:
low blood glucose and by
somatostatin
sympathetic impulses

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