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Ada sperma & sel telur yang matang
Sekitar ovulasi
Pertemuan dan persenyawaan ovum &
sperma
Di ampula
Pembentukan Ruang Amnion & Kuning
Telur
 Perubahan
Decidua : Endometrium
Str. Compactum
Str. Spongiosum
Str. Basale
Decidua :
basalis
capsularis
vera
Chorion
Frondosum
 PERKEMBANGA
Trofoblast Khorion N
TROFOBLAST
1. Lapisan Langhans
(cytotrophoblast)
mesoderm
2. Lapisan luar
(syncytium/syncytio
trophoblast)
decidua
Vili
chorion laeve
chorion frondosum
Chorion
Frondosum
(chorionic
villi)
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
III. Sebagai barier (TSHRF, FSHRH, CHR)
mekanis 4. Enzim : HSAPase
kimiawi Oksitosinose
Pregnancy spesific
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
diliputi amnion
2 arteri umbilicales
1 vena umbilicalis

Whartons jelly
insersi
sentral / parasentral / lateral /
marginalis
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
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 - 42 minggu
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
7th day
Implantation is beginning.
150u (0.15mm)
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.
8th day

Syncytiotrophoblast
cells further invade the
Endometrium by
secreting hydrolytic
enzymes.
10th 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.
2nd week 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
 A very significant week for the
4th week 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.
 The size of the embryo is now
5th week
(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
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.
8th The size of the embryo is now
(approximately) 35-40mmCRL
week (Crown-Rump Length). This marks
35mmC the end of the Embryonic Period
and the beginning of the Fetal
RL 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
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.
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.
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.
11 12 16 20 24 28 32 36 38
KEHAMILAN ATERM
Kehamila
n
Enam
Fetus :+2
Minggu
cm
 Kehamilan
Duabelas
Minggu
Fetus : + 7
cm
 Kehamilan
Duapuluh
Minggu
Fetus : + 18-27 cm
Berat : + 300 grm
 Kehamilan
Duapuluh
Delapan
Minggu
Fetus : + 25 - 38 cm
Berat : + 1000 grm
Kehamilan
Aterm
> 37 minggu

Berat : + 3000
grm
PERUBAHAN ANATOMIS FISIOLOGIS
PADA WANITA HAMIL
Kehamilan, terjadi perubahan pada :
Genitalia externa
Genitalia interna
Payudara

Uterus
Membesar pd bulan I estrogen dan progesteron
Hipertrofi otot polos uterus
Serabut kolagen higroskopik oleh karena estrogen meningkat
 Uterus Normal Uterus hamil

Berat : 30 gr Berat : pd 40 minggu

menjadi 1000gr
Ukuran : 7-7,5 cm x 5,2 cmx Ukuran : 20 cm x 5,2 cm x
2,5 cm 2,5 cm

Bentuk: advokat Bentuk : 4 bln => bulat akhir

hamil => lonjong telur
Besar : telur ayam 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)

16 pusat SOP
20 dibawah pinggir pust
24 pinggir pusat atas
28 3 jari atas pusat
32 pusat proc. xiphoideus
36 1 jari dibawah proc. xiphoideus
40 3 jari dibawah proc. xiphoideus
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)
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.
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.
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.
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.
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
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.
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.
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.

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 konsepsi
ibu sendiri.