KEHAMILAN

Dr. FERDINAL FERRY, SpOG

1

Penghamilan

Syarat

Kapan

Bagaimana ?

Dimana

?
2

Ada sperma & sel telur yang matang

Sekitar ovulasi
Pertemuan dan persenyawaan ovum &
sperma
Di ampula

Penetrasi Sperma

truktur Sperma Manusia

Gametogenesi
s

Penentuan Sex

Perjalanan zigot sampai nidasi

Stadium dua sel Zygote

A. Two-cell stage
B. Three-cell
stage
C. Four-cell stage
D. Five-cell stage
E. Six-cell stage
F. Eight-cell stage

10

Blastocyst (107 sel)

5 hari setelah

11

Proses Implantasi

12

Pembentukan Ruang Amnion & Kuning

Telur

13

Pertumbuhan Telur
Zigo
t

Pembelaha
n

Morula (32
sel)
exocoelom
Blastokist

trofoblast
bintik benih

Nidasi
14

Pertumbuhan Telur
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
15

Bintik
Benih
Ectoderm
mesoder
m
entoderm

Discus
embryonale
(D.e)
Janin

D.e menonjol ke Ruang Amnion

Hubungan D.e dengan
Trofoblast
Tangkai
penghubung

16

Decidua & Chorion

17

Decidua :
Str. Compactum
Str. Spongiosum
Str. Basale

Perubahan
Endometriu
m

Decidua :
basalis
capsularis
vera
18

Chorion
Frondosum

19

Trofoblast

Khorion

PERKEMBANGA
N
TROFOBLAST

1. Lapisan Langhans
(cytotrophoblast)
mesoderm
2. Lapisan luar
(syncytium/syncytio
trophoblast)
decidua
Vili
chorion laeve
chorion frondosum

20

Chorion Frondosum
Chorion frondosum
pembuluh darah ibu
decidua (Haftzote)
Membran plasenta : Amnion
Khorion
16 minggu : sel Langhans hilang
terbentuk
lapisan Nitabuchl
21

Plasenta

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
22

Skematik aliran darah dalam plasenta

23
manusia

24

I. Pertukaran Zat
Faal Plasenta
1. Pasif :
filtrasi
difusi

diapedese
II. Kelenjar Endokrin
2. Aktif : enzim
1. Steroid Hormon

(Estrogen dan
pinositosis
Progesteron)
2. Protein Hormon
(HCG, HPL, HCT, HCCT)
3. Releasing Hormon
(TSHRF, FSHRH, CHR)
4. Enzim : HSAPase
III. Sebagai barier
Oksitosinose
mekanis
Pregnancy
kimiawi
spesific Protein
25

UJI FAAL PLASENTA

1. Pertumbuhan janin
2. Amnioskopi /
amniosentesis
3. Estrogen / pregnandiol
urin
4. Oksitosinase serum
5. HPL
6. OCT
7. USG
8. Profil biofisik

26

TALI PUSAT

Antara pusat janin - permukaan fetal

plasenta
30-100 cm; 1-1,5 cm

diliputi amnion

2 arteri umbilicales
1 vena umbilicalis

Whartons jelly
Insersi sentral / parasentral /
lateral /marginalis
27

This is a true knot of the umbilical cord.

28

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.
29
Dividing membranes are see at the left in this twin

The umbilical cord inserts centrally into the

placental disk.
30

A macerated placenta is present at the right.

31

Ruang Amnion

Berisi cairan amnion

Banyaknya ~ umur kehamilan
alkalis
lanugo
vernix caseosa

Oligohidramnion < 500

cc
Polihidramnion > 2000

32

Faal Air Ketuban

1.
2.
3.
4.

Pergerakan anak
Barier fisik
Pertahanan suhu
Membuka serviks
(persalinan)
Asalnya : kencing janin
transudat dari ibu
sekret epitel amnion
campuran
33

Kehamilan
Lama hamil = 280 hari
266 hari dari ovulasi
Taksiran Persalinan = NAEGELE
(siklus 28 hari)
Haid terakhir : Hari +7
Bulan -3
Tahun +1

34

Lama Kehamilan
Abortus

: < 500 gr
< 20 minggu

Partus Imaturus : 500 - 1000 gr

20 - 28 minggu
Partus Prematurus : 1000 - 2500 gr
28 - 37 minggu
Partus Maturus : > 2500 gr
37 - 42 minggu
Partus Serotinus/postmaturus/posterm
:
35
> 42 minggu

Pertumbuhan Janin
1 bulan
2 bulan
3 bulan
4 bulan
5 bulan
6 bulan
7 bulan
8 bulan
9 bulan
10 bulan

=
=
=
=
=
=
=
=
=
=

1 cm
4 cm
=
9 cm
=
16 cm
25 cm
30 cm
35 cm
40 cm
45 cm
50 cm

1
gr
14,2 gr
=
108 gr
=
316 gr
= 630 gr
= 1045 gr
= 1680 gr
= 2478 gr
= 3400 gr
36

Proses Pertumbuhan Janin

37

7th day
150u (0.15mm)

8th day

38

10th day

2nd week

39

4th 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
40
bulge is present.

5th 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
41 their most
damaging effects on the

7th
week
30mmC
RL

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.

42

8th
week
35mmC
RL

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
43
still very lowset. Teratogens have

15th
week
130mmC
RL

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.

44

20th week
185mmCR
L

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.

45

30th week
275mmCR
L

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.
46

Pertumbuhan Janin

11 12 16

20

24

28
32
36
KEHAMILAN ATERM

47

38

Kehamila
n
Enam
Fetus
:+2
Minggu
cm

48

Kehamilan
Duabelas
Minggu

Fetus : + 7
cm

49

Kehamilan
Duapuluh
Minggu

Fetus : + 18-27 cm
Berat : + 300 grm

50

Kehamilan
Duapuluh
Delapan
Minggu

Fetus : + 25 - 38 cm
Berat : + 1000 grm

51

Kehamilan
Aterm
> 37 minggu
Berat : + 3000
grm

52

rtumbuhan janin dipengaruhi oleh :

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
53
plasenta

Index Plasenta

Berat plasenta/Berat Bayi

menurun sampai dengan 36
mg
28 mg = 0.25
38 mg = 0.15
54

Kepala Anak
Bagian terpenting dalam persalinan terdiri
dari :
a. Bagian muka : tulang hidung
tulang pipi
rahang atas
rahang bawah
b. Bagian tengkorak : tulang dahi
tulang ubun-ubun
tulang pelipis
tulang belakang kepala
55

Kepala Janin pada saat

aterm yang
memperlihatkan
bermacam-macam
ubun-ubun, sutura,
dan diameter
biparietal
56

Sutura : sagitalis
coronaria
lambdoidea
frontalis
Ubun-ubun besar :
Pertemuan 4 sutura :
sagitalis
coronaria
frontalis
Ubun-ubun kecil :
Pertemuan 3 sutura : sagitalis
lambdoidea
57

UKURAN KEPALA BAYI

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
58
bawah dagu - UUB

1. Diameter
suboksipotobregmatikus
2. Diameter suboksipitofrontalis
3. Diameter oksipitofrontalis
4. Diameter oksipitomentalis
5. Diameter
submentobregmatikus

Diameter Kepala
Janin pada cukup
bulan

59

UKURAN KEPALA BAYI

Lanjutan

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 )
60

Diameter
biparietalis dan
Diameter
bitemporalis

Kepala dengan
beberapa
sirkumferensia
61

Peredaran Darah Janin

2 arteri
1 vena
darah campuran
isi vena cava inferior lebih bersih dari
aorta
Setelah lahir :
Ductus Botali menutup lig. Arteriosum
Foramen ovale menutup
Duct. Venosus aranti lig teres hepatis
Aa umbilicales lig vesico umbilicale
62
laterale

Sirkulas
i Darah
Janin

63

Cardiovascula
r
system of
fetus

64

HB janin Hb dewasa
Dibuat terutama di hepar
Transport O2 lebih mudah
Menjadi Hb biasa 4 bulan
O2 darah janin lebih
rendah

Peredaran darah lebih

cepat
Kadar Hb lebih tinggi
eritrosit lebih banyak

65

Perubahan Badan Ibu

1. UTERUS

Uterus membesar
hiperplasi, hipertrofi otot
pertumbuhan aktif (estrogen)
pertumbuhan pasif : segmen bawah
rahim
lingkaran retraksi
Tanda Piskacek
Kontraksi Braxton Hicks
Perubahan serviks
66

Pembentukan segmen bawah rahim dari isthmus

uteri.
67
Pada dystocia lingkaran retraksi sangat
tinggi

Minggu
6

Minggu

12

28

16

32

20

36

24

40

Pembentukan rahim dan perubahan

68
sikap tubuh ibu selama kehamilan

Lanjutan

Perubahan Badan Ibu

2. VAGINA
Elastisitas bertambah
Tanda Chadwick
Keasaman bertambah

3. OVARIUM
Corpus luteum
graviditatum
69

Perubahan Badan Ibu

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
70
Hiperpigmentasi

Lanjutan

Lanjutan

Perubahan Badan Ibu

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
71

Lanjutan

Perubahan Badan Ibu

8. DARAH
Volume darah bertambah
Eritrosit bertambah
Hydremi
Batas fisiologis : Hb
: 11 gr%
Eri
: 3,8 juta/mm3
Leuco : 12000/mm3

72

Lanjutan

Perubahan Badan Ibu

9. Lain-lain
beban jantung bertambah
kerja paru-paru bertambah
sekresi HCl & gerakan lambung
berkurang
kerja ginjal bertambah
ureter melebar
polakisuri
perubahan mental
73

74