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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